44134) Richmond BOROUGH OF RICHMOND (SURREY) Rich 18 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1949. RICHMOND : J. H, BROAD AND CO., LTD., PRINTERS, 8, KINO STREET. k BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1949. CONTENTS. Page. Introductory Letter 1 List of Staff 2 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 3 Births 3 Deaths 3 Premature Infants 5 Comparative Statistics Table 6 Illegitimate Births and Deaths 7 National Assistance Act, 1948 8 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 9 Sanitary Inspection 12 Sanitary Defects 15 Notices Served 17 Complaints Received 18 Food Inspection 20 Petroleum Acts 23 Disinfection and Disinfestation 23 Destruction of Insect Pests 23 Diseases of Animals Acts 24 Rats and Mice Destruction Act 24 SECTION D—HOUSING. Housing 26 Council's Housing Programme 26 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Sale of Food and Drugs Acts 30 Milk (Special Designations) Regulations, 1936/48 31 The Food and Drugs (Milk and Dairies) Act, 1944 31 Ice Cream 33 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Disease 34 Smallpox 35 Admissions to Infectious Diseases Hospitals 37 Laboratory Work 37 Food Poisoning 38 Diphtheria Immunisation 38 Whooping Cough Immunisation 39 Verminous Conditions—Scabies and Head-lice 40 Tuberculosis 41 INDEX 43 1 Public Health Department, Parkshot, Richmond. July, 1950. To the Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1949 upon the Sanitary Circumstances, Sanitary Adminstration and Vital Statistics of the Borough. In my report for the year 1948 I dealt with Services relating to the care of Mothers and Young Children as these had only been transferred to Surrey County Council on the 5th July. On this occasion all reference to these services has been omitted and no mention is made of the Health Visiting and Clerical Staff who were similarly transferred. In other ways the report retains its usual form. Additional information and explanatory notes being inserted after the statistical tables in the hope that this makes it more interesting and readable. Once again I am indebted to Mr. B. Aisthorpe, Chief Sanitary Inspector for his report on the Sanitary Inspection of the area. In particular I wish to draw your attention to his statement on the progress made in relation to the Council's Clean Food Campaign. Considerable progress has been made; and it has been done despite a shortage of Sanitary Inspecting staff during the last quarter of the year. I wish to record my gratitude to all members of the staff of the Public Health Department for their support and co-operation. In particular I am indebted to Miss J. Black, Senior Clerk to the Department, who has carefully compiled all the statistical information. Finally, I desire to express my thanks to all members of the Council for the help and encouragement during a full year. I am, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 2 LIST OF STAFF. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. Chief Sanitary Inspector: BERNARD AISTHORPE, M.R.San.I. Senior Additional Sanitary Inspector: THOMAS S. ELLIS, Cert.S.I.B., M.S.I A. (resigned 11/9/49). Additional Sanitary Inspectors: CHARLES S. SMEATON, M.R.San.I. DUNCAN A. PATERSON, M.S.I.A., A.R.San.I. (resigned 10/12/49). Clerks: MISS J. BLACK (Senior Clerk). MRS. F. G. SMITH. MISS E. BRUNT (resigned 30/4/49). MISS M. WILTSHIRE (from 20/6/49). Drain Tester and Disinfector: J. DAVIS. 3 section a—summary of statistics and social conditions. Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1949) 42,060 Total population (including non civilians) 42,090 Number of inhabited houses (estimated) 11,087 Rateable value £618,934 Sum represented by a Penny Rate £2,403 births. Birth-Rate per 1,000 of estimated resident population 17.1 Total number of births (live and still) 719 Analysis:— M. F. Total. Live Births: Legitimate 342 328 670 Illegitimate 22 18 40 Still Births: Legitimate 6 1 7 Illegitimate 1 1 2 Still-Birth Rate per 1,000 total births 12.5 Environment of Births:— Proportion Taking place in the Borough 42% Proportion taking place outside the Borough 58% Proportion taking place in Institutions 76% Proportion taking place in dwelling houses 24% Proportion notified by midwives alone 99% Proportion notified by doctors or parents 1% deaths. Death-Rate per 1,000 of estimated resident population 12.03 (Corrected) 9.86 Total number of deaths from all causes 508 Analysis:— M. F. Total. All causes 245 263 508 Cancer 48 45 93 Diphtheria -— — — Measles — — — Whooping Cough — — — Diarrhoea (under two years) — — — 4 Maternal Mortality Rate per 1,000 total births 0.00 Total number of maternal deaths 0 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 21.1 Rate for legitimate infants per 1,000 legitimate live births 20.8 Rate for illegitimate infants per 1,000 illegitimate live births 25.0 Total number of infant deaths in the Borough 15 Analysis:— M. F. Total. Legitimate 9 5 14 Illegitimate 1 — 1 Environment of Infant Deaths:— Number occurring in the Borough 4 Number occurring outside the Borough 11 Number occurring in Institutions 14 Number occurring in dwelling houses 1 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 l ... ... 2 ... ... 1 ... 3 2. Congenital Debility and Malformation including Premature Birth 6 ... ... ... 6 1 ... 1 ... 8 3. Enteritis ... ... ... ... ... ... ... ... ... ... 4. Other defined diseases 2 ... ... ... 2 ... 1 ... 1 4 5. Asphyxia (Accidental Death) ... ... ... ... ... ... ... ... ... ... 6. Accidental Death ... ... ... ... ... ... ... ... ... ... 9 1 ... ... 10 1 1 2 1 15 5 PREMATURE INFANTS Number born Number nursed Number born alive but dying within Number surviving for over 28 days 24 hours 7 days 28 days Richmond Children born in the Borough: (a) At Home 6 5 - - - 6 (b) In Nursing Homes - - - - - — (c) In Hospitals 4 5 — 2 — 2 Richmond Children born outside the Borough: (a) In Nursing Homes 1 1 - - - 1 (b) In Hospitals 14 14 — 2 — 12 Children born in Richmond, mother normally residing elsewhere. (a) In Nursing Homes 2 2 - - - 2 (b) In Hospitals 1 1 — — — 1 ILLEGITIMATE BIRTHS 1944 1945 1946 1947 1948 1949 No. of illegitimate live births 62 62 51 54 38 40 No. of illegitimate deaths under 1 year 3 4 5 2 0 1 Illegitimate death rate 48 65 98 37 0 25 6 COMPARATIVE STATISTICS—1949. England and Wales 126 County Boroughs and Great Towns including London 148 smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census London Administrative County Richmond *Rates per 1,000 Civilian Population. Births— Live Births 16.7 (a) 18.7 18.0 18.5 16.9 Still Births 0.39 (a) 0.47 0.40 0.37 0.2 Deaths— All Causes 11.7 (a) 12.5 11.6 12.2 12.0 corrected 9.86 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Whooping Cough 0.01 0.02 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.45 0.52 0.42 0.52 0.49 Influenza 0.16 0.15 0.14 0.11 - Smallpox 0.00 0.00 - - - Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 0.02 Pneumonia 0.51 0.56 0.49 0.59 0.52 Notifications (corrected) Tpyhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.02 0.01 0.01 — Cerebro-spinal Fever 0.02 0.03 0.02 0.02 0.04 Scarlet Fever 1.63 1.72 1.83 1.46 0.42 Whooping Cough 2.39 2.44 2.39 1.70 2.5 Diphtheria 0.04 0.05 0.04 0.07 — Eyriseplas 0.19 0.20 0.19 0.17 0.07 Smallpox 0.00 0.00 0.00 0.00 0 02 Measles 8.95 8.91 9.18 8.54 10.9 Pneumonia 0.80 0.91 0.65 0.55 0.11 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.21 Acute Polioencephalitis 0.01 0.01 0.02 0.01 0.04 Food Poisoning 0.14 0.16 0.14 0.19 — Rates per 1,000 Live Births. Deaths— All causes under 1 year of age 32 (b) 37 30 29 21.1 Enteritis and Diarrhoea under 2 years of age 3.0 3 8 2.4 1.7 - Rates per 1,000 Total (Live and Still) Births. Notifications (corrected)— Puerperal Fever and Pyrexia 6.31 8.14 5.30 6.82 4.17 Maternal Mortality— Abortion with sepsis 0.11 — Abortion without sepsis 0.05 not available — Puerperal Infections 0.11 — Other maternal causes 0.71 - (a) Rates per 1,000 total population. (b) per 1,000 related live births. 7 Population. At the Census of 1931 the population of the Borough was 37,791 while the Registrar General's estimate in the middle of 1949 was 42,060. Since 1943 there has been an excess of births over deaths each year until 1949 when 719 births are recorded compared with 508 deaths. Births. There were 719 births during the year (371 males and 348 females) which is 23 more than in 1948 but still considerably less than in 1947 when the record total of 852 was reached. The number of illegitimate births was 42 compared with 38 in the previous year. 76% of births took place in hospitals or nursing homes, showing that residents are reasonably provided for in this respect. Deaths. The total number of deaths occurring amongst residents was 508 (245 males and 263 females) compared with 471 in the previous year. This gives a crude death rate of 12.03 per thousand of the population compared with 11.7 for England and Wales. This is a crude Death Rate which is not strictly comparable with other districts since the ages of populations vary. When corrected the rate is 9.8 per thousand which compares favourably with the rate for the whole country. The Infant Mortality Rate (deaths under one year of age) has again fallen from 26.1 to 21.1 per thousand live births. Each of the 15 infant deaths was carefully investigated with a view to ascertaining what preventive measures could help to reduce the incidence in future. From the table it will be seen that 8 of the deaths were due to congenital debility or malformation. The prevention of death in such cases is most difficult. It is satisfactory to note that no deaths were due to enteritis and there were no cases of accidental death or asphyxia. Fourteen of the deaths occurred in Institutions and only one in a Dwelling House. 8 There were twenty-five premature births, belonging to this district. Twenty-one of these survived for over 28 days and four died within 7 days of birth. The four deaths occurred in hospital. The Comparative Statistics are interesting in that the rates in Richmond can be compared with the rest of the country. That not a single case of typhoid or paratyphoid fever or diphtheria occurred is most satisfactory. On the other hand Richmond had rather a heavy share of cases of poliomyelitis. Apart from this the statistics show that the health of the people compares very favourably with other districts. NATIONAL ASSISTANCE ACT, 1948. Section 47—Removal to suitable premises of persons in need of care and attention. No action was taken by the Council under this Section of the Act, although at the end of the year it became apparent that action might be required early in the New Year. This was the case of an old lady living alone who was admitted to hospital suffering from burns. She had set fire to her bedroom, and it was felt that it would be quite unsafe to allow her to return home. After having notice served upon her she agreed to go voluntarily into Kingsmead, Old People's Home. After some weeks she settled down happily and eventually relinquished the tenancy of her home. There is a considerable number of old people living alone, improperly cared for, in the district. They form a most disturbing and difficult problem. A great deal is done for them by the Divisional Welfare Officer and every possible help is given through the domiciliary services. Most of these old people have a very strong sense of independence and object strongly to any suggestion that they should enter a Home. Apart from this there is a considerable shortage of suitable accommodation. For these reasons the policy generally is to help these old people as much as possible in their own homes and only when there is danger to the life or health of the individual or those living in the same house to take action under Section 47. In a number of cases these conditions were present but, after some persuasion, the old people agreed to go voluntarily into suitable residential accommodation. 9 SECTION C—SANITARY CIRCUMSTANCES. Water Supply. Richmond has two separate sources of drinking water:— (a) From local wells. (b) From the Metropolitan Water Board. (a) Richmond Borough Council owns seven wells. One of them, known as the Terrace Gardens well is 320 feet deep and reaches two miles of adits in the chalk. From this is obtained a pure and wholesome water which is softer in character than the supply obtained from the remainder. These are shallow wells which draw their water from the ballast covering the London clay. The water is not filtered but is chlorinated before being passed into public supply. Early in 1948 it was found that the two Ham Wells were not maintaining a wholesome supply and their use was discontinued. Water from these wells could not be kept under close supervision by passing it through the Petersham reservoir without laying new mains and thus incurring heavy expenditure. The local supply now comes from the deep well, from two shallow wells in the Old Deer Park and from two shallow wells in Petersham. Water from all these wells is pumped to the low level reservoir at Petersham where it undergoes controlled chlorination. It takes two to four hours to pass through the reservoir and is then pumped to the high level reservoir in Richmond Park where it remains for 24 hours before passing into public supply. Estimations of the amount of free chlorine in the water issuing from the low level reservoir are carried out every two hours by day and night by the staff of Petersham Pumping Station. In addition the free chlorine is continuously recorded by mechanical means at the Petersham Pumping Station and at the Old Works, Water Lane. It has been found that, to ensure a safe and wholesome supply dosage with chlorine must be maintained so as to provide between 0.4 and 0.5 parts per million free chlorine in the water issuing from the low level reservoir. After 24 hours contact in Richmond Park reservoir the free chlorine content is reduced to 0.15 p.p.m. and, by the time is reaches the consumer the free chlorine content is about 0.1 p.p.m. 10 In addition to these precautions camples of both the unchlorinated well waters and the chlorinated water passing into public supply are taken at regular intervals for bacteriological, physical and chemical examination. During the year no less than 624 such samples were taken and examined. Of these, 245 were samples of chlorinated water passing into public supply; everyone of these was free from coliform organisms and of a very high standard of purity. Chemical examinations of the water from individual wells now in use, showed that the organic quality remained entirely satisfactory throughout the year. 32 such samples were taken. Bacteriological examinations of the untreated water showed that, under normal conditions, the wells produce a water of remarkable purity. Only at times of serious flooding by the river Thames is a temporary deterioration sometimes observed. Under the present arrangements this can readily be dealt with by shutting down the wells concerned for a few days. There have been complaints that the water tastes of chlorine. Every effort is made to reduce this to a minimum but this nuisance cannot be entirely eliminated unless new and very expensive apparatus is installed. Fortunately the proportion of residents who are unduly sensitive to the taste is not large and I am able to say, with confidence, that the small quantity of chlorine is quite harmless and that the water supply is wholesome in every respect. Richmond water contains 30 parts per 100.000 of hardness and is not plumbo-solvent. (b) The supply of the Metropolitan Water Board is received in bulk through six connections off the 30 inch M.W.B. main. The source of the water is the River Thames abstracted at Wraysbury, Laleham and Walton intakes and stored in the Thames Valley reservoirs. After storage the water is treated at the filtration works at Hampton and Surbiton. All the water is chlorinated before it leaves the works and adequate contact to ensure complete action has been provided at Hampton by the building of a contact tank which first came into operation in July, 1948. Since the 19th October the filtered water 11 has been treated by the method of controlled super-chlorination in place of the ammonia-chlorine process. Free chlorine is a much more powerful disinfectant than chloramine and there is. in addition, a considerable saving in the cost of chemicals. Treatment is controlled by hourly testing of the final water at the works and by an instrument continuously recording the amount of residual chlorine in the water after a specified period of contact. Samples of the water are collected at all stages of purification at least five times each week and analysed at the labaratories of the Metropolitan Water Board. Chemical examination was carried out on 250 samples and 980 samples were examined bacteriologically. The results of these examinations indicated that a very high standard of chemical and bacteriological purity was maintained throughout the year. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are tested to establish that its quality is up to that normally supplied. None of the samples was plumbo solvent. There is also a supply of raw river water delivered to allotments, Kew Gardens, and a proportion of the residences in Richmond. After sedimentation it is pumped to a special reservoir and is delivered from there by gravity. This water is not fit for drinking; it is used for gardens and for periodic flushing of sewers. The following figures show the daily average consumption from the three sources:— Daily Average 1948/49 Consumption. 1949/50 All Richmond Wells 655,765 galls. 697,118 galls. Metropolitan Water Board 878,400 galls. 985,507 galls. Raw River Water 191,602 galls. 275,318 galls. Two cottages connected with Teddington Lock obtain their water from a private well. Apart from this, water fit for human consumption is made available by piped supply to every dwelling house in the Borough. 12 SANITARY INSPECTION. For the following particulars I am indebted to the Chief Sanitary Inspector, who submitted his Report in accordance with the Sanitary Officers (Outside London) Regulations, 1935. Inspections during 1949. Houses visited and particulars recorded (Housing Act) 66 Houses visited (Public Health Acts) 1263 Revisits to houses and other premises 1500 Visits paid in connection with:— Overcrowding 13 Vermin 195 Disinfestation 20 Enquiries into Infectious Diseases 246 Corporation Dwellings 45 Routine inspections in connection with:— Factories (mechanical) 7 Factories (non-mechanical) 12 Work-places 2 Bakehouses 25 Butchers' Shops 27 Fishmongers' and Poulterers 9 Other registered food stores Cowsheds 5 Dairies and Milk Shops 40 Ice-cream premises 120 Restaurants and Tea Shops 272 Fried Fish Shops 6 Stables 10 Piggeries 3 Public Sanitary Conveniences 68 Shops Acts 174 Greengrocers' and Fruiterers 8 Tents, Vans, and Sheds 2 Rats and Mice 294 Smoke Observations 13 Schools—Elementary and Secondary 3 13 Water Supply 267 Drainage 280 Milk Sampling (Pasteurised) 35 Food Sampling 102 Unsound Food 105 Petroleum Acts 158 Rent Restrictions Acts 14 Interviews 626 Miscellaneous Visits 1358 Celluloid and Cinematograph Film Act 2 7472 Drains and Sewerage Systems Tested. Hydraulic test 40 Smoke tests 19 Chemical tests 19 Examinations 20 Factories Act, 1937. At the end of the year there were 187 factories on the register (126 mechanical and 61 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreathes, etc 1 — Bakeries 11 1 Boat Repairs 1 1 Boot-making and Repairing 10 4 Box-making 1 1 Building 5 8 Butchers 2 — Carpentry 1 4 Carpet-repairing — 1 Clothing 4 — Dressmaking — 7 Electrical Instruments 3 — Engineering 8 - 14 Furniture and Upholstery 4 6 Furriers — 1 Gas Storage 1 - Glue-making 1 — Jewellery Repairs — 1 Joiners 2 1 Laundering and Cleaning 3 1 Millinery — 2 Milk Pasteurising 1 — Motor Vehicle repairing 25 2 Photography (Printing and Developing) 2 — Printing 6 1 Sausage-making 3 — Saw Mills 2 — Stationers 2 — Surgical Instruments 1 — Tailoring 1 13 Undertaking 1 — Welding 1 — Wheelwright and Coach Building 3 — Wig-making — 1 Wireless Repairs 1 1 Miscellaneous Trades 19 4 126 61 Nineteen visits were made to the above premises during the year and as a result of action taken by the department, the following defective conditions have been remedied:— Ineffective drainage of floors 3 Want of cleanliness 1 Unsuitable sanitary conveniences 1 Other nuisances and defects remedied 4 9 Shop Acts, 1934. Shops on the Register 787 Visits made 174 15 SANITARY DEFECTS REPORTED. Water Supply: Defective or foul storage tanks 8 Defective fittings (notified to Water Engineer) 1 Defective covers 4 Unsuitable positions of tanks 1 W.C.'s and Urinals: Defective pans 45 Foul pans 2 Defective woodwork around pans 5 Defective seats 7 Absence of water supply 9 Defective flushing apparatus 10 Defective flush-pipe connections 11 Defective walls, floors or roofs 29 Defective doors and windows 22 Want of light and ventilation 3 Insufficient closet accommodation 3 Defective walls and channels of urinals 1 Insanitary urinals cleansed 1 Defective brickwork (repaired or re-built) 4 Closets not separate for sexes 2 Soil-Pipes: Defective or insufficient soil-pipes and vent shafts 17 Want of, or defective ventilation shafts 5 Rainwater pipe acting as ventilation shafts 11 Defective Fresh air inlets 5 Drains: Defective drains 24 Defective sewers 8 Want of additional house drains 1 Choked or foul drains or gullies 14 Defective or insufficient gullies 7 Defective grating, dishing or curbing 2 Absence of, or defective, interceptor 1 16 Defective manholes 6 Defective manhole covers and frames 3 Sub-soil drains required 1 Dustbins: Defective receptacles 25 Defective dust shutes 2 Paving: Defective paving of yards, forecourts, etc. 17 Sinks: Defective or insanitary sink 24 Want of sink 2 Insanitary wall-surface around sink 1 Waste-Pipes: Insanitary W.P.'s or shafts 38 Defective waste-pipes 5 Untrapped or unventilated waste-pipes 3 Waste-pipes directly connected to drain 1 Dampness: Defective roofs 162 Defective gutters or spouting 85 Want of damp-proof course 11 Defective external brickwork 41 Defective pointing of door and window reveals 19 Damp and insanitary site under floor 10 Floor cavity unventilated 4 Defective wall or floor ventilators 6 General Defects: Verminous rooms 74 Verminous bedding 53 Dirty floors, woodwork, etc. 2 Accumulations of offensive matter 9 Nuisances from fowls, or other animals 2 Defective plastering (No. of rooms) 365 Dirty walls and ceilings (No. of rooms) 499 17 Dirty walls and ceilings of staircases and passages 22 Defective floors 63 Defective doors and windows 98 Defective doors and window fastenings 168 Defective furnace or brickwork of copper 9 Permitted No. not in rent book 1 Defective sashcords 111 Defective window sills 91 Windows not made to open 58 Inadequate lighting and ventilation 25 Defective firegrates and kitchen ranges 75 Defective chimney pots, etc. 18 Smoke nuisances 13 Defective coppers 6 Defective staircases 2 Premises infested with rats and mice 219 Contraventions of Byelaws 1 Dilapidated Outbuildings 1 Miscellaneous defects 254 2,968 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 321 Interviews 626 Statutory Action. Act and Section. Notices Authorised. Notices Served. Public Health Act, 1936. Section 24 (Drainage) 1 1 Section 39 (Drainage) 22 20 Section 45 (Defective Closets) 14 13 Section 75 (Dustbins) 4 4 Section 92/93 (Nuisances) 82 72 18 Rats and Mice (Destruction) Act, 1919 (Sec. 5) 1 1 Housing Act, 1936. Section 9 (Insanitary Dwelling) 19 15 In the main the work called for on Statutory notices was done by the owners but in 3 cases they failed to do so and it became necessary for the Local Authority to carry out the necessary work in their default. in their default. The details in respect of the 3 cases are as follows : - Address of Premises. Act and Section. Cost of Repairs. 22, Clarence Road, Kew Gardens. Housing Act, 1936. Section 9. £23 6 10 11a, Park Hill. Housing Act, 1936. Section 9. £36 12 6 40, Lawn Crescent, Kew Gardens. Housing Act, 1936. Section 9. £89 0 0 PROSECUTIONS. No legal proceedings were taken during the year. In two cases it was found necessary to apply for summonses but, in each case the owners carried out the work before the date of the Court hearing. COMPLAINTS. The number of complaints received by the Department from the 1st January to 31st December, 1949 was 1,010 which is an increase over the same period in 1948 of 164. The complaints received have been classified as follows:— Defective firegrates 8 Defective sinks 5 Defective drains and gullies 55 Leaking pipek 27 Defective windows 8 Defective Walls and ceilings 37 Defective storage tanks 7 Defective floor boards 8 19 Offensive manholes 9 Lack of water supply 1 Defective W.C s. 39 Defective roofs and gutters 69 Dampness 35 Dry rot 10 Defective stoves 7 Defective stairs and steps 2 Accumulation of rubbish 14 Defective dustbins 21 Unsound food 77 Nuisance from rats and mice 289 Nuisance from animals 7 Nuisance from smoke 10 Nuisance from vermin, ants, etc. 68 General Defects 197 1,010 20 FOOD INSPECTION. The following foodstuffs, found to be unfit for human consumption, were surrendered by the owners and either salvaged for animal food or destroyed. Commodity. Amount condemned Reason for condemnation. Cwt. lbs. ozs. Bacon 35 10 Decomposed Baked Beans 24 13 Tins blown Biscuits 37 0 Mouldy Cereals 57 8 Unsound Cakes, etc. 16 7 Mouldy Cheese 1 12 9 Decomposed Chocolate Spread 1 0 Mildewed Cocoa 4 Mouldy Coffee 14 Unsound Dried Egg 2 13 Out of Condition Fats 11 0 Rancid Fish (Tinned) 82 8½ Tins blown or pierced Fish (Wet) 44 41 0 Decomposed Fish Cakes 38 1 Decomposed Flour 72 0 Moisture spoiled Fruit 2 3 7 Decomposed Fruit Juice 48 7 Tins blown or pierced Jam, eto. 1 15 2½ „ „ „ „ Meat (Tinned) 2 13 9 „ „ „ „ Meat 5 46 15 Decomposed Milk (Tinned) 13 42 8 Tins blown or pierced Minoemeat 1 13 Fermented Mustard 5 12 Mouldy Paste (Fish and Meat) 19 6¼ Decomposed Pickles 14 0 Fermented Poultry 1 38 4 Decomposed Puddings 12 13 Mouldy Babbits 4 74 0 Decomposed Bennet 1 4 Out of Condition Byvita Bread 7 Mouldy Salad Cream 20 11 Mildew Sausage Bolls 9 12 Mouldy Soup 50 13½ Tins blown or pierced Spaghetti 3 0 Unsound Suet 26 0 Rancid Sauces 15 9½ Fermented Vegetables 10 3 7½ Tins blown or pierced Other Foodstuffs 30 12½ Out of Condition 21 Survey of Food Premises. On the 22nd March, 1949 a report was submitted to the Health Committee of the final survey of food premises the report covering : — 20 Bakehouses. 3 Cooked Meat Stores. 60 Grocers' Premises. 50 Public Houses. These premises were sub-divided into following Categories; — Category A. Premises which complied in all respects with the Food and Drugs Act Standard 77 Category B. Premises falling short of the Food and Drugs Act Standard but requiring only minor repair to bring them up to the necessary standard 50 Category C. Premises far below the Food and Drugs Act Standard and requiring major work or alterations to bring them to the desired standard 6 Proprietors of premises in either Class 'B' or 'C' were approached by the Department and in most cases a ready response was made to suggestions for improvement. Since the 1st January, 1949 the following works have been carried out by the proprietors:— 49 premises. General repairs, cleansing and redecoration completed. 14 premises. Improvement and cleansing of Sanitary accommodation carried out. 40 premises. Constant hot water supply and washing facilities provided. 9 premises. Additional Sanitary accommodation provided. 9 premises. Improvements to ventilation carried out. 20 premises. Major improvements and alterations to Food preparing rooms carried out. 22 At the beginning of 1950, work was due to commence on a further 25 premises. The Health Special Sub-Committee re Food and Drink cleanliness held meetings in April and June, when the desirability of Codes of Practice in respect of each of the various Food Trades, formation of a Food Traders1 Guild, and Education of Food Handlers, were the points under discussion. In October, 1949, a joint meeting of the Health Special SubCommittee and representatives of the Richmond Chamber of Commerce was held and arising from this meeting it was decided to set up the Richmond (Surrey) Food Traders Advisory Committee which should be composed of 5 members of the Richmond (Surrey) Borough Council and 13 members from the Food Traders in the Town, the objects of this Committee to be : — (a) To raise the Standards of Hygiene and cleanliness in the Manufacture, Distribution, and Handling of food and drink in the Borough. (b) In particular to encourage the observance of all Statutory standards of Hygiene and the Codes of Practice to be approved by the Richmond (Surrey) Borough Council and the Richmond (Surrey) Food Traders' Advisory Committee. The Richmond Food Traders Advisory Committee therefore came into being and held its first meeting on the 22nd November, 1949, when His Worship The Mayor of Richmond (Councillor F. G. Gaines) was appointed Chairman. Consideration at this meeting was given to: — (a) The Formation of a Richmond (Surrey) Clean Food Traders Guild. (b) Methods of publicising the scheme. (c) The issue of Emblems to those shops who complied in all respects with the Codes of Practice. (d) Membership of the ordinary food handler. Arising from this meeting it was decided the 1st day of May, 1950, should be fixed as the commencing date for the Food Traders Guild. Further meetings of this Committee are to be held early in 1950 when Codes of Practice in respect of the various Food Trades and publicity arrangements will be considered. 23 PETROLEUM (CONSOLIDATION) ACT 1928. Premises licenced to store Petroleum Spirit or Cellulose Solutions in accordance with the provisions of the above act were kept under regular supervision during the year and a total of 158 visits was paid to such premises. 49 premises are licenced to store a total of 72,000 gallons of Petroleum Spirit and 9 premises are licenced to store a total of 613 gallons of Cellulose Solutions, or Petroleum Mixtures. 3 new licences to store Petroleum Spirit or Cellulose Solutions were issued during the year and 46 applications for renewal of licences were granted. No application for a licence was refused and there were no applications for transfer of licence. One Petroleum Installation is under Government control and is not subject to licence by the Local Authority. In general the installations were found to be kept in good condition and there were no contraventions of the Act or Regulations. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding. Infectious Fevers 15 17 85 Tuberculosis 15 30 42 Vermin 43 74 53 Other Diseases 21 24 79 The total costs recovered from the disinfection and disinfestation of rooms during the year amount to £23 15s. 8d. DESTRUCTION OF INSECT PESTS IN THE HOME. Bugs: During the year 43 houses involving 74 rooms were treated by the Department for the destruction of bed bugs. The treatment consisted of spraying the walls, furniture and bedsteads with a 5% solution of D.D.T. in Kerosene. Respraying, particularly after redecoration of the rooms has been tound to be effective in preventing a recurrence. 24 Cockroaches: 5% and 10% D.D.T. Powder has a marked effect in eradicating these pests from properties. The product "Gammaxane" a lethal powder is giving excellent results. DISEASES OF ANIMAL ACTS. On the 24th August, 1949, an outbreak of Foot and Mouth Disease occurred at Foots Cray, Sidcup Kent. Richmond was not included in the resulting infected area but it was necessary during the infective period for two movement licences to be countersigned to enable cattle grazing in Richmond Park to be moved into the infected area for essential purposes. Rats and Mice (Destruction) Act 1919. During the year 289 Complaints were received from occupiers of dwelling houses or business premises as to the suspected presence of rats. To investigate these complaints 294 visits were made to the various properties and infestations were eventually isolated and dealt with at 219 premises. AJote. The number of visits quoted does not include visits made to carry out treatment which was done by the Surrey County Council Rodent Department and for which figures are not available. The free treatment of rat or mouse infested dwellings which was approved by the Richmond Borough Council on the 8th June, 1948, was in operation during the whole of 1949 and under this scheme 194 dwellings were freed from either rats or mice. Sewer Baiting. From the 11th to the 26th April inclusive 330 manholes in various sections of the Borough were subjected to treatment for the destruction of rats. The treatment consisted of prebaiting on two consecutive days with an unpoisoned bait (sausage rusk) and poisoning on the third day (Zinc Phosphide) and of the total number of manholes baited positive results were obtained in 126. 25 It was intended to bait a further section of the sewers in November, 1949 but owing to depletions of the Rodent staff of the Surrey County Council it was not found possible for the second treatment to be carried out. SMOKE ABATEMENT. Richmond being a residential district contains no very large works or factories. The smaller factories give little trouble by smoke nuisance. Thirteen complaints of a minor character were received during the year and all were overcome by inspection of the boiler plant, advice to stokers and interviews with managers. 13 observations for excess smoke were made on various chimneys from business premises throughout the area, but no contraventions were recorded. 26 SECTION D—HOUSING. Housing Statistics for the Year 1949. 1. Number of dwellings owned by the Local Authority:-— Number of houses 1177 Number of Flats 240 Total 1417 2. Unfit Houses. (I) Inspection of Dwelling Houses during the Year:— (i) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1329 (b) Number of inspections made for the purpose 2829 (ii) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 66 (b) Number of re-inspections made under the Regulations 35 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (iv) Number of dwelling houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 558 (II) 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 (including cases outstanding from the previous year) 432 27 (III). Action under Statutory Powers during the Year: — A. Proceedings under sections 9, 10, and 16 of the Housing Act, 1936;— (i) Number of dwelling houses in respect of which notices were served requiring repairs 1.5 (ii) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 12 (b) By Local Authority in default of owners 3 B. Proceedings under the Public Health Acts:— (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied Ill (ii) Number of dwelling houses in which defects were remedied after service of formal notices:—- (a) By owners Ill (b) By Local Authority in default of owners Nil. C. Proceedings under sections 11 and 13 of the Hous- ing Act, 1936:— (i) Number of dwelling houses in respect of which Demolition Orders were made Nil. (ii) Number of dwelling houses demolished in suance of Demolition Orders Nil. D. Proceedings under section 12 of the Housing Act. 1936:— - (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (ii)' Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 28 3. Overcrowding. Overcrowding is still very considerable throughout the BoroughProgress is made by the Housing Department but it is unable to keep pace with the heavy demands. 4. Council Houses. Total number of houses erected post-war to 31st December, 1949 Total number included in above erected in 1949 Total number of premises requisitioned up to 31st December, 1949 Total number of families rehou Total number of families still December, 1949 Temporary Bungalows 179 Permanent Houses 194 Permanent Flats 78 Permanent Houses 54 Permanent Flats Nil 123 (providing 241 family units) ed in 1949 111 on Waiting List at 31st 1695 Future Programme. At the present time there are 155 permanent dwellings under construction and the Council have acquired land which will permit the erection of a further 274 dwellings. Moveable Dwellings. A licence is held by an owner of land in the Borough permitting him to allow two caravans to stand on his land. This licence is renewable each year. Satisfactory provision is made for the disposal of household refuse, use of sanitary conveniences and main water supply and frequent inspections of the site are made to see these arrangements are being properly observed, 29 Withdrawal of Closing Orders. Closing orders or undertakings preventing the use of Underground Rooms for human habitation were made in respect of No. 33, Onslow Road on the 15th December, 1939 and No. 42, Montague Road on the 11th October, 1938. The principal defects which rendered the rooms unfit for habitation were dampness and contraventions of the "Regulations as to Underground Rooms," i.e., absence of site concrete, lack of dampproof courses, lack of open areas and insufficient areas of windows. The owners carried out work to make the basement fit for habitation and to comply with the "Regulations as to Underground Rooms ' and the Closing Orders were withdrawn on the following dates : — No. 33, Onslow Road. (8/3/49). No. 42, Montague Road. (21/6/49). 30 SECTION E—INSPECTION AND SUPERVISION OF FOOD. SALE OF FOOD AND DRUGS. Particulars of samples taken in the Borough of Richmond by Surrey County Council during the year ended 31st December, 1949. Articles. Analysed Adulterated or Irregular Prosecutions Convictions Formal Informal Total Formal Informal Total FOOD : Milk 41 7 48 1 1 Apple Tart 1 1 Barley Meal 1 1 Cake 1 1 Fruit Drink Tablets... 1 1 Gelatine 1 1 Honey lee Cream 1 6 1 6 Jam 1 1 2 Meat Cooked and Prepared 2 2 Meat Pie 1 1 Milk Pndding full cream 1 1 I 1 Olive Oil 1 1 Salad Cream 2 2 Soft Drinks 2 2 Spirits 2 2 DRUGS : Iodised Blood Mixture 1 1 Tonic Phosphates 1 1 Vitamin Tonic 1 1 Totals 42 34 76 1 I 2 31 Milk (Special Designations) Order 1936. The above regulations remained in operation until 30th September, 1949, and under them the following samples were taken and licences granted: — No. of samples of milk taken for analysis during the year 40 No. of samples found to be satisfactory 36 Applications granted for the renewal of licences to sell Special Designated Milk:— Pasteurised Milk 18 Tuberculin Tested Milk 13 Applications granted for the renewal of Pasteurised Licences 1 Supplementary Licences granted 3 Milk and Dairies Regulations 1949. Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations 1949. Milk (Special Designations) (Raw Milk) Regulations 1949. The Food and Drugs (Milk and Dairies) Act, 1944 which amends the Food and Drugs Act, 1938 in relation to milk and dairies came into operation on the 1st October, 1949. The above regulations were made under this Act and came into operation on the same date. They revoke the Milk and Dairies Regulations 1926/43 and the Milk (Special Designations) Regulations 1936/48. The general effect was that all dairy farms and dairy farmers tie., farms, cowsheds or other premises on which milk is produced from cows) became from the 1st October the complete responsibility of the Ministry of Agriculture and Fisheries. The district Medical Officer of Health however retains the power to take appropriate action to prevent the spread of disease by infected milk. The Pasteurised and Sterilised Milk Regulations provide for the licencing of such premises by the Food and Drug Authority, which in the case of Richmond is the Surrey County Council. 32 In all other cases Dairies or Dealers in Special Designations will be under the control of Richmond Council both in respect of licence's and inspection and control of Dairies. The Surrey County Council has requested, pending consider,! tion of stalling arrangements in relation to the exercising of their new functions, the Corporation to permit their Sanitary Inspectors to carry out, as agents to the County Medical Officer, inspection and sampling of such pasteurising and sterilizing establishments as may exist in their district. Richmond Council agreed to this request. In so far as the Borough of Richmond is concerned arrangements are now as follows : — Dairy Farms. The responsibility for the two dairy farms (one at Petersham and one at Ham) passes directly to the Ministry of Agriculture and Fisheries. Pasteurising Establishments. At present there is one only located in Richmond. Responsibility for licencing and control passes to the County Council; though the Local Authority retains powers of inspection in so far as the Dairy is concerned. Dairies—Milkshops—Dealers in Designated Milk. The Corporation is the Authority for the issue of licences and general inspection of these premises. The Local Authority is not prevented from taking samples of milk from any dealer but unsatisfactory samples would have to be reported to the appropriate authority. Under these Regulations the following samples were taken during the period 1/10/49 to 31/12/49: — No. of samples taken... ... 16 No. found to be satisfactory ... 16 No. of licences granted authorising Dealers to store and sell Designated milk: — Pasteurised, sterilised and tuberculin tested 12 Pasteurised and sterilised only 4 Sterilised only Nil 33 Supplementary licences were granted authorising dealers to retail milk in the Borough from premises situated outside as follows: — Pasteurised, sterilised and tuberculin tested 1 Pasteurised and sterilised only Nil. Sterilised only 6 All premises in the district were inspected after receipt of the application for a licence and principal licences were verified with the appropriate Local Authorities. No licences were refused. ICE CREAM. Premises manufacturing or storing or selling Ice Cream have been kept under supervision throughout the year; the total number of visits paid in this respect being 120. A total of 92 samples were submitted to the Bacteriologist for examination and of this number 64 fell within Grades I and II and were considered satisfactory and 28 fell within Grades III and IV and were considered to be unsatisfactory. It must be remembered that the greater number of samples are taken from premises which have been found to produce unsatisfactory samples in the past; whereas those dealers who invariably produce good results are only sampled occasionally. The figures given therefore do not give a true picture of conditions throughout the Borough. Generally the standard is high and in all cases the Ice Cream (Heat Treatment) Regulations, 1947 are complied with in every respect. In all cases of unsatisfactory samples the premises were carefully inspected and methods of manufacture were investigated. The Manufacturers and retailers were found to be very co-operative in their efforts to improve conditions and were always willing to accept help and advice. 34 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). Disease. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Scarlet Fever ... 18 14 ... Puerperal Pyrexia 3 2 ... Pneumonia 5 2 22 Erysipelas 3 3 ... Measles 458 7 ... Whooping Cough 107 1 ... Poliomyelitis 9 9 ... Polioencephalitis 2 1 1 Cerebro Spinal Meningitis 2 2 ... Smallpox 1 1 ... Other Diseases ... ... 15 ... Total ... 608 57 23 The rather excessive number of cases of measles was expected and was in accordance with the prevalence throughout the country. Comparable figures are found in reports for 1947 and 1945. Generally the course of the illness was mild; only seven cases being serious enough to require admission to hospital. There were no deaths. Whooping Cough fell to its usual level and only one case required admission to hospital. I am pleased to be able to report that no deaths occurred as a result of this dangerous and distressing illness. Nine cases of poliomyelitis and two cases of polioencephalitis occurred; there was one death. The two cases of polioencephalitis were very acute in onset and both were adults. One, a man aged 36, died within twenty hours of first calling in his private doctor. The other, a woman aged 35, became extremely seriously ill and almost completely paralysed within a few hours of the onset. She was removed to hospital where she remained in much the same condition until her death in April, 1950. A feature about these two cases was that they lived close to one another. Other than this no actual contact could be discovered between the two families. Close contacts were kept under observation and there were no further developments, 35 Of nine cases of poliomyelitis, eight were children of school age and one was a baby girl aged 10 months. Six of these cases—5 girls and 1 boy- were the meningeal type of poliomyelitis with no paralysis. All made complete and uneventful recoveries. A girl, aged 6 was more seriously affected with some paralysis of the muscles of the back and thighs. There was a rapid improvement, however, and finally complete recovery. A boy, aged 7 was very seriously affected indeed with extensive paralysis involving the muscles of respiration. He has been treated in an "iron lung" and his condition is still serious. The baby aged 10 months, developed some paralysis of the back muscles and the muscles of the left leg. She was later transferred to an orthopaedic hospital when she improved considerably but there is some residual weakness of the left leg. All of these cases occurred during the months of September and October. Apart from the two cases of polioencephalitis, the other cases were widespread throughout the district. Two girls had been attending the same school but there was no close contact between them. In no case was it probable that infection had been contracted by swimming in the river or public swimming pools and overcrowded housing conditions did not seem to play any part. In time of prevalence of this disease prevention is therefore very difficult. One can only advise that young people should avoid crowds and excessive fatigue and that the importance of general hygiene and the value of fresh air should be remembered at all times. The two cases of cerebro-spinal meningitis occurred in babies aged 7 and 9 months respectively. Both made good recoveries. SMALLPOX. It is so unusual to report the occurrence of a case of smallpox in the Borough that I feel that a fairly full description is desirable. On the 5th April, 1949, I was informed by the Port of London Authority that eight passengers from S.S. Mooltan had returned to their residences in Richmond after having been vaccinated on the 2nd April, and disembarked on the 3rd April 36 A case of virulent smallpox had occurred during the voyage and had died at sea on the 1st April. On receipt of this information arrangements were made for the eight contacts to be visited daily until after the elapse of incubation period. One of the contacts was a lady aged 65. She had been suffering from pneumonia during the last two weeks of the voyage and was admitted for one night to hospital before proceeding, by ambulance, to her sister's flat in Richmond. Her general condition improved until the 13 th April when a few skin lesions appeared. On the following day she was transferred to Clandon Hospital suffering from smallpox. The diagnosis was later confirmed bacteriologically. The question of disinfection of the premises then arose. All floor coverings, curtains, bedding and any articles with which the patient had been in close contact were immediately sent to the Isolation hospital to be subjected to steam under pressure. As was feared, these articles were severely damaged and the Council later paid a claim from the owners for £115. Otherwise the room was sealed up and subjected to heavy concentrations of formalin vapour. The real problem was a wardrobe in the patient's room which contained clothing valued at £1500. Steam disinfection would undoubtedly have destroyed the whole lot. The patient had been removed to hospital at a very early stage. She had been confined to bed and I established that she had had no contact with the gowns and furs in the cupboard. On the 30th April, the room, which was still sealed up, was twice subjected to an intense concentration of formalin gas by the special Bacterol process. After this it was considered that disinfection was complete. The contents of the wardrobe were not harmed in any way by this process. Had the case been more severe or in a more advanced stage, steam disinfection would have been essential and the Council would have been faced with a heavy claim for damages. The occupants of the flat had now become close contacts. They were four in number. All were immediately vaccinated and kept under daily observation until all danger had passed. All other occupants of the block of flats were informed. There was some alarm 37 and a considerable number of them were vaccinated at the Health Centre, Windham Road on the following day. Others were vaccinated by their private doctors. In addition, a number of residents asked for vaccination at this time. I am pleased to report that the patient made a good recovery and that no futher cases occurred in the district. INFECTIOUS DISEASES—ADMISSIONS TO HOSPITAL I am pleased to report that under the new hospital administration Richmond residents have continued to be admitted to the South Mid' dlesex Fever Hospital. This excellent hospital now admits cases from a larger area than formerly with the result that all beds might easily become filled in time of epidemic. Under these circumstances patients from Richmond would be admitted to Tolworth Isolation Hospital or perhaps to a bed in a hospital situated in the L.C.C. area of the South West Metropolitan Regional Hospital Board. In fact, this only happened on 13 occasions during the year. Generally patients were promptly admitted, and I would like to record my appreciation of the helpful attitude of the Medical Superintendent of the South Middlesex Fever Hospital. His detailed reports on patients discharged from hospital are most valuable. LABORATORY WORK General practitioners send specimens for examination to the laboratory of the Royal Hospital, Richmond. The following table gives particulars of the specimens examined: Disease Suspected. Nature of Specimen. Result. Total. Positive. Negativ. Diphtheria Swabs from Throat and Nose Nil 114 114 Tuberculosis Sputa 5 74 79 Haemolytic Streptococcus Swabs from Throat and Nose 11 103 114 Total 16 291 307 38 In addition the following laboratory facilities are available to the Public Health Department: — CENTRAL PUBLIC HEALTH LABORATORY, COLIN- DALE AVENUE, N.W.9. For advice, special immunising agents and special investigations. MINISTRY OF HEALTH, PUBLIC HEALTH LABORATORY, EPSOM. For examination of samples of milk, ice cream and water and for advice and field investigations in cases of epidemics. THE COUNTIES PUBLIC HEALTH LABORATORIES, 66, VICTORIA STREET, S.W.I. For examination of water samples and advice on the control of water supply. FOOD POISONING OUTBREAKS. During the year no cases of food poisoning were notified by the local practitioners and no outbreak of disease required investigation as suspected food poisoning. DIPHTHERIA IMMUNISATION CLINIC. Number of children immunised for the first time during the year 1949 : — (a) Pre-school children (under 5 years) ... 588 (b) Between 5 and 15 years Total ... 810 Grand Total of Children in the Borough who have received immunising treatment by the end of the year: — (a) Under 5 years 2202 (b) Between 5 and 15 years Number of Children given boosting doses during 1949 : Under 5 years 535 (b) Between 5 and 15 years 39 At the 31st December the percentages of children who had been immunised were as follows:— (a) Under 5 years 69.8% (b) Between 5 and 15 years 94% From these figures it will be seen that the Diphtheria Immunisation Scheme has been actively conducted during the year. The number of children immunised for the first time was 810 compared with 944 in 1948. The reduction in numbers is due to the smaller number of births in 1949 and to the temporary suspension of the scheme in the autumn on account of the epidemic of poliomyelitis. In addition the policy of giving single-reinforcing doses at appropriate intervals during a child's school life has been continued. The materials used are, for children under 10, Alum Precepitated Toxoid and for children over 10 Toxoid Anti-Toxin Floccules. Immunisation Against Whooping Cough. Immunisation against Whooping Cough was commenced in 1948, when 248 children received the full course of injections. The Scheme was continued in 1949 until suspended in October on account of the epidemic of poliomyelitis. By this time 381 children had received the full course of injections and the demand from the public was growing. At about this time it had become apparent that a number of cases of poliomyelitis were occurring rather shortly after receiving a prophylactic inoculation. The greater number of such cases seemed to follow the combined Diphtheria-Whooping Cough vaccine Whereas inoculation against Diphtheria is of undisputed value the value of inoculation against Whooping Cough is still inconclusive. Under the circumstances I felt that it was unjustifiable to inject into children a prophylatic which was of doubtful value and which might precipitate a case of poliomyelitis. For these reasons the scheme of immunisation against Whooping Couph has been indefinitely suspended. It is not intended to re-commence until a prophylactic is produced which is of proved value and is recommended by the Ministry of Health. 40 It is my earnest hope that such a prophylactic will be produced reasonably soon. Of the common infectious diseases, Whooping Cough is perhaps the most distressing of all, both for the patient and the parent; nearly one thousand children die in England from this disease each year and the general health of thousands of others is seriously affected. VERMINOUS CONDITIONS. YEAR 1941 1942 1943 1944 1945 1946 1947 1948 1949 Scabies 34 218 241 431 274 377 66 12 11 Head Lice — 204 205 181 188 308 239 78 141 Figures in the above table include children and adults treated for verminous conditions at the Health Centre, Windham Road. Scabies, in particular, increases rapidly in time of war; most of the fresh cases being traceable to members of the Armed Forces returning home on leave or after demobilisation. This trend is clearly seen in the table and it is very satisfactory to note that a very low level has been maintained in 1949. Infestation by head lice is not affected in quite the same way as it is not so contagious as scabies. The incidence is influenced by overcrowded housing, and by personal cleanliness. Whereas scabies, if neglected, becomes so distressing that treatment is demanded, infestation by head lice, inefficiently controlled, can be tolerated for months or years. A high proportion of the cases reported fall into this category. Inspections in the schools are frequent, and materials used for treatment are efficient. Unfortunately, time and again, cleansed children become re-infested in their houses; education in this respect is a slow process. 41 TUBERCULOSIS. The position in Richmond for the year 1949 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Sixty-seven cases of respiratory tuberculosis were notified, viz.: — 40 males and 27 females. The corresponding figure for 1948 was 53. Non-Respiratory Tuberculosis. Seven new cases of non-respiratory tuberculosis were notified during the year and there was one death from this cause. Seven such cases had been notified during 1948. TUBERCULOSIS REGISTER. After all additions and deletions had been taken into account, the number of cases of tuberculosis remaining upon the Register at the close of the year was as under:— Pulmonary. NonPulmonary. Males 184 20 Females 129 26 Total 313 46 Corresponding figures for 1948 299 53 PREVENTION OF TUBERCULOSIS- Under the Public Health (Prevention of Tuberculosis) Regulations 1925, powers are given to prohibit any person suffering from respiratory tuberculosis from entering upon employment involving the handling of milk. Under the Public Health Act 1936 (Section 172) powers are given to cause the removal and detention of any tubercular patient where proper precautions are not being taken and the circumstances are such as could constitute a danger to others. During the year 1949 it was not found necessary to take action under either of the above enactments. 42 TUBERCULOSIS. Age Periods. New Cases. Deaths. Respiratory NonRespiratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... 2 ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... 5 . ... 1 ... ... ... ... ... 15 13 6 1 ... 1 1 ... ... 25 10 11 2 ... 6 3 1 ... 35 7 2 ... ... 1 ... ... ... 45 2 3 ... ... 2 ... ... ... 55 6 3 ... ... 3 1 ... ... 65 and upwards ... ... ... ... 1 ... ... ... Totals 40 27 4 3 14 6 1 ... AFTER CARE. The Barnes and Richmond Tuberculosis Care Committee continued to play a most important part in the Surrey County Council Scheme for the "care and aftercare" of tuberculous patients. This voluntary Committee spent about <£450 on this work during the year, although financial help from the County Council amounted to only £50. The aim of the Committee is to supplement official help for the patient and his family, according to his individual needs, and so lessen the anxieties which hinder recovery. In addition to many families who have been referred to other agencies for help, some fifty families in Richmond have received help in cash or kind during the year from the Committee. 43 INDEX. Area of Borough Birth-Rate Births, Analysis of Cancer, Deaths from Chief Sanitary Inspector, Report of D.D.T. Death-Rate Deaths, Analysis of Deaths, Maternal Deaths, Neo-Natal Diarrhoea Enteritis (under 2 years) Diphtheria Diphtheria Immunisation Diseases of Animal Acts Disinfection Disinfestation Drains Factories Act Food and Drugs Act Food, Survey Food Poisoning ... Food, Unsound Head-Lice ... ... ... Health of the Borough Housing Illegitimacy Ice Cream Infant Mortality Infectious Diseases, Notifiable Inhabited Houses Laboratory Work Malformation, Congenital Maternal Mortality Measles Milk Milk (Special Designations) Regulations 1936/48 National Assistance Act, 1948 Notices, Sanitary Overcrowding Petroleum Acts Pneumonia ... ... ... ... Page 3 3 3, 7 3 12 23 3 3, 7 4 4 3 6, 37 38 24 23 23 13, 15 13 30 21 38 20 40 7 26 4 33 4 6, 34 3 37 4 4 6, 34 30, 31 31 8 17 28 23 4, 6, 34 44 Population Poliomyelitis Polioencephalitis Premature Infants Prosecutions Puerperal Pyrexia Rateable Value Rats and Mice Destruction Act, 1919 Sanitary Inspection and Complaints Scabies Scarlet Fever Sewers Sewers, Baiting of Shops Acts Smallpox Smoke Abatement South Middlesex Fever Hospital Staff, List of Statistics Stillbirths Streptococcal Infections Tuberculosis Verminous Conditions Water Supply Whooping-Cough Page 3, 7 6, 34 6, 34 5, 8 18 3, 6 3 24 12, 15, 18 40 6 24 24 14 35 25 37 2 6 3, 6 37 37, 41, 42 40 9 6, 34, 39