AC4413(1) RicHMonD RICH 19 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1950 richmond : j. m. broad and co., LTD., printers, 8, king street. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1950 CONTENTS. Page. Introductory Letter List of Staff 3 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 4 Births 4 Deaths 4 Premature Infants 6 Comparative Statistics Table Births and Deaths 8 National Assistance Act, 1948 9 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 11 Sanitary Inspection 14 Sanitary Defects 17 Notices Served 20 Complaints Received 21 Food Inspection 23 Petroleum Acts 26 Disinfection and Disinfestation 26 Destruction of Insect Pests 26 Diseases of Animals Acts Rats and Mice Destruction Act 27 SECTION D—HOUSING. Housing 30 Council's Housing Programme 32 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Sale of Food and Drugs Acts 35 The Food and Drugs (Milk and Dairies) Act, 1944 36 Ice Cream 37 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Disease Admissions to Infectious Diseases Hospitals 39 Food Poisoning Diphtheria Immunisation Whooping Cough Immunisation Verminous Conditions—Scabies and Head-lice Tuberculosis 43 INDEX 46 1 Public Health Department, Parkshot, Richmond. August, 1951. 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 1950, upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is in accordance with the requirements of the Ministry of Health and special reference is made to certain subjects at the Minister's request. In other respects the report retains its usual form; additional information and explanatory notes being inserted after the statistical tables. The vital statistics show that there was no serious prevalence of infectious or controllable disease during the year. The incidence of measles was high but generally the course of the disease was mild. Whooping Cough again caused considerable distress but the number of cases was less than during the preceding year. There were six cases of poliomyelitis of which two were mild, two moderate and two severe. Although the death rate of tuberculosis has not fallen to the same extent as in most other towns the actual number of notifications of new cases was considerably less than in 1949. The Birth Rate has fallen to 15.1 per thousand of the population. After reaching a peak in 1947 there has been a tendency for the birth rate to decline. It is satisfactory to note that the Infant Mortality rate has also declined and has fallen to the lowest level ever recorded. I am indebted to Mr. B. Aisthorpe, Chief Sanitary Inspector, for his report on the Sanitary Inspection of the area. The full establishment of Inspectors was maintained throughout the year, and the figures show that an immense amount of work has been carried out. A rodent officer was newly appointed to the staff. The report shows that the local organisation worked smoothly and that considerable progress was made in destroying rats and mice in properties and sewers throughout the Borough. 1 I wish to record my sincere appreciation of the loyal and efficient service of every member of my staff, and of the ready co-operation of all officials of the Corporation. Finally, I desire to express my thanks to the Chairmen and Members of all Committees with which I have been concerned for their help and encouragement throughout the year. I am, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 3 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 : GEORGE C. SMITH, M.S.IA., A.R.San.I. Additional Sanitary Inspectors: CHARLES S. SMEATON, M.R.San.I. KENNETH H. HALSTEAD, M.S.I.A., A.R.San.I. Clerks: MISS J. BLACK (Senior Clerk). MRS. F. G. SMITH. MISS M. WILTSHIRE. Rodent Officer: THOMAS R. SMITH (from 12/4/50). Drain Tester and Disinfector: J. DAVIS. 4 SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1950) 42,410 Number of inhabited houses (estimated) 11,170 Rateable value £625,654 Sum represented by a Penny Rate £2,500 BIRTHS. Birth-Rate per 1,000 of estimated resident population 15.1 Total number of births (live and still) 641 Analysis:— M. F. Total. Live Births: Legitimate 294 293 587 Illegitimate 24 19 43 Still Births: Legitimate 8 3 11 Illegitimate — — — Still'Birth Rate per 1,000 total births 17.1 Environment of Births:— Proportion Taking place in the Borough 32% Proportion taking place outside the Borough 68% Proportion taking place in Institutions 75% Proportion taking place in dwelling houses 25% Proportion notified by midwives alone 61% Proportion notified by doctors or parents 39% DEATHS. Death-Rate per 1,000 of estimated resident population 11.8 (Corrected) 9.68 Total number of deaths from all causes 501 Analysis:— M. F. Total All causes 245 256 501 Cancer 47 46 93 Diphtheria — — — Measles 1 — 1 Whooping Cough 1 1 2 Diarrhoea (under two years) 1 4 5 5 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 19.0 Rate for legitimate infants per 1,000 legitimate live births 17.0 Rate for illegitimate infants per 1,000 illegitimate live births 46.5 Total number of infant deaths in the Borough 12 Analysis:— M. F. Total. Legitimate 2 8 10 Illegitimate 2 — 2 Environment of Infant Deaths:— Number occurring in the Borough 1 Number occurring outside the Borough 11 Number occurring in Institutions 11 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 1 ... 2 2. Congenital Debility and Malformation including Premature Birth 6 ... ... ... 6 1 1 ... ... 8 3. Enteritis ... ... ... ... ... 2 ... ... ... 2 4. Other defined diseases ... ... ... ... ... ... ... ... ... ... 5. Asphyxia (Accidental Death) ... ... ... ... ... ... ... ... ... ... 6. Accidental Death ... ... ... ... ... ... ... ... ... ... 6 ... ... ... 6 3 2 1 ... 12 6 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 14 14 1 — — 13 (b) In Nursing Homes 1 1 — — — 1 (c) In Hospitals — — — — — — Richmond Children born outside the Borough: (a) In Nursing Homes — — — — — — (b) In Hospitals 23 23 3 2 — 18 Children born in Richmond, mother normally residing elsewhere: (a) In Nursing Homes 1 1 — — — 1 (b) In Hospitals — — — — — — ILLEGITIMATE BIRTHS 1944 1945 1946 1947 1948 1949 1950 No. of illegitimate live births 62 62 51 54 38 40 43 No. of illegitimate deaths under 1 year 3 4 5 2 0 1 2 Illegitimate death rate 48 65 98 37 0 25 46 7 COMPARATIVE STATISTICS—1950. 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 15.8 17.6 16.7 17.8 14.8 Still Births 0.37 0.45 0.38 0.36 0.26 Deaths— All Causes 11.6 12.3 11.6 11.8 11.8 corrected 9.68 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.01 0 01 0.01 0.01 0.05 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.36 0.42 0.33 0.39 0.47 Influenza 0.10 0.09 0.10 0.07 0.07 Acute Poliomyelitis (including Polioencephalitis) 0.02 0.02 0.02 0.01 0.05 Smallpox — — — — — Pneumonia 0.46 0.49 0.45 0.48 0.54 Notification & (corrected) Typhoid Fever 0.00 0.00 0.00 0.00 Paratyphoid Fever 0 01 0.01 0.01 0.01 — Meningicoccal Infection 0.03 0.03 0.02 003 — Scarlet Fever 1.50 1.56 1.61 1.23 0.82 Whooping Cough 3.60 3.97 3.15 3.21 1.7 Diphtheria 0.02 0 03 0.02 0.03 — Erysipelas 0.17 0.19 0.16 0.17 0.02 Smallpox 0.00 0.00 — — — Measles 8.39 8.76 8.36 6.57 9.3 Pneumonia 0.70 0.77 0.61 0.50 0.23 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0 13 0.12 0.11 0.08 0.08 Non Paralytic 0.05 0.05 0.06 0 05 0.04 Food Poisoning 0.17 0.16 0.14 0.25 0.23 Rates per 1,000 Live Births. Deaths— All causes under 1 year of age 29.8 (a) 33.8 29.4 26.3 19.0 Enteritis and Diarrhoea under 2 years of age 1.9 2 2 1.6 1.0 0.11 Rates per 1,000 Total (Live and Still) Births. Notifications (corrected) — Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 — Maternal Mortality— Abortion with sepsis 0.09 Other abortion 0.05 Complication of pregnancy and Delivery 0.54 not available Sepsis of childbirth and puerperium 0.03 Other complications of puerperinm 0.15 (a) Rates per 1,000 total population, 8 Population. At the Census of 1931 the population of the Borough was 37,791 while the Registrar General's estimate in the middle of 1950 was 42,410. Since 1943 there has been an excess of births over deaths each year until 1950 when 641 births are recorded compared with 501 deaths. Births. During the year 641 births were recorded—(326 males and 315 females). Figures for the past years are as follows:— 1946 772 births 1947 852 „ 1948 696 „ 1949 719 „ 1950 641 „ After the end of the war the birth rate rose to a peak in 1947 —since then there has been a tendency for it to fall, but it remains well above the pre-war level of under 400 births per annum. The number of illegitimate births was 43 compared with 40 in the previous year. 75% of births took place in hospitals or nursing homes and only 25% in dwelling houses. There were 38 premature births belonging to this district. Thirty two of these survived for over 28 days and six died within seven days of birth. Health visitors are notified early of the occurrence of a premature birth and every possible form of assistance is given to the mother. Deaths. The total number of deaths occurring amongst residents was 501 (245 males and 256 females) compared with 508 in the previous year. This gives a crude death rate of 11.8 per thousand of the population compared with 11.6 for England and Wales. This is a crude death rate which is not strictly comparable with other 9 districts since the ages of populations vary. When corrected the rate is 9.68 per thousand which compares favourably with the rate for the whole country. The Infant Mortality Rate is the lowest ever recorded and appreciably lower than that for the administrative County of London. Each of the 12 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. Of the 4 remaining deaths two were twin babies who contracted gastro-enteritis, another suffered from whooping cough complicated by broncho-pneumonia and the fourth was a premature baby who suffered from pneumonia. 11 of the deaths occurred in institutions and only one in a dwelling house. The death rate from tuberculosis is 0.47 per thousand compared with 0.49 in the previous year. The reduction, however, has not kept pace with that for London or the country as a whole. The reason for this is not clear but the Register is undergoing close scrutiny at the present time with a view to ensuring that no names remain on it which should have been removed. Later in the report, under Section F, it will be seen that the actual number of new cases of tuberculosis notified was considerably less than in 1949. This is perhaps a better indication of the progress of the disease than the number of deaths. Whooping Cough and poliomyelitis each caused two deaths hut the actual incidence of these diseases compares favourably with other parts of the country. It is satisfactory to note that there was not a single case of typhoid or paratyphoid fever or diphtheria and that there was no case of puerperal fever and no maternal death. NATIONAL ASSISTANCE ACT, 1948. Section 47—Removal to suitable premises of persons in need of care and attention. In one case action was commenced by the Council under this Section of the Act. 10 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. The comparatively large number of old people who live alone in the district forms a distressing problem. Action under the National Assistance Act was contemplated on more than one occasion but in each case the problem was finally solved in other ways. A great deal is done for these old people by the Divisional Welfare Officer and every possible help is given through the domicilliary services which are available. The policy generally is to help them as much as possible in their own homes and only to resort to action under Section 47 when every other means has failed and there is danger to the life or health of the individual or those living in the same house. 11 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) The local supply comes from the deep well in the Terrace Gardens, 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 it reaches the consumer the free chlorine content is about 0.1 p.p.m. In addition to these precautions samples of both the unchlorin' ated 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 581 such samples were taken and examined. Of these 296 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. 23 such samples were taken. 12 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 mininium 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 the Wraysbury, Walton and Laleham intakes and stored in the Thames Valley reservoirs at Staines, Littleton and Walton. After storage the water is treated at the filtration works at Hampton. The water is filtered by means of primary or rapid filtration followed by secondary or slow sand filtration. All the water is finally chlorinated before it leaves the works. In order to provide adequate contact to ensure complete action by the chlorine a contact tank is provided at the works which first came into operation in July, 1948. The water is treated by a method of controlled superchlorination by maintaining a fixed residual of free chlorine after a given period of contact. Samples of water are collected at all stages of the purification process at least five times each week and analysed at the laboratories of the Metropolitan Water Board. Chemical examination was carried out on 244 samples and 817 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. 13 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 Consumption. 1949/50 1950/51 All Richmond Wells 697,118 galls. 752,307 galls. Metropolitan Water Board 985,507 galls. 912,529 galls. Raw River Water 275,318 galls. 182,548 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. 14 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 1950. Houses visited and particulars recorded (Housing Act) 33 Houses visited (Public Health Acts) 1169 Revisits to houses and other premises 2049 Visits paid in connection with:— Overcrowding 55 Vermin 174 Disinfestation 18 Enquiries into Infectious Diseases 154 Corporation Dwellings 12 Routine inspections in connection with:— Factories (mechanical) 52 Factories (non-mechanical) 3 Work-places 2 Bakehouses 65 Butchers' Shops 95 Fishmongers'and Poulterers 39 Other registered food stores 152 Cowsheds 5 Dairies and Milk Shops 88 Ice-cream premises 128 Restaurants and Tea Shops 350 Fried Fish Shops 21 Stables 4 Rag and Bone, Dealers 6 Piggeries Public Sanitary Conveniences ) Shops Acts 42 Theatres, Cinemas 5 Greengrocers' and Fruiterers 39 Rats and Mice 3682 Smoke Observations 21 15 Schools—Elementary and Secondary 13 Water Supply 242 Drainage 771 Milk Sampling (Pasteurised) 55 Food Sampling 32 Unsound Food 163 Petroleum Acts 107 Rent Restrictions Acts 1 Street Vendors and Hawkers' Carts 1 Interviews 409 Miscellaneous Visits 1304 Celluloid and Cinematograph Film Act 1 Massage Establishments 2 11,566 Drains and Sewerage Systems Tested. During this year surveys were commenced in respect of "end of lease" provisions of parts of Queen's Road, Chisholm Road, Cambrian Road, and Wellington Road, which are properties in the Freehold Interest of the Richmond Borough Council. The Department inspected and smoke tested the drainage systems of 54 of these properties and submitted reports and recommendations for incorporation in the schedules of dilapidation. The number of drainage systems reported upon were:— Cambrian Road 19 Dwellings Chisholm Road 23 Queen's Road 9 Wellington Road 3 In addition the usual routine inspections and testings of new or old drainage systems was carried out and the following table shows the number and kinds of tests applied:— Hydraulic tests 12 Smoke tests 92 Chemical tests 18 Examinations of exposed drains 28 16 Factories Act, 1937. At the end of the year there were 200 factories on the register (146 mechanical and 54 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreathes, etc 1 — Bakeries 10 — Boat Repairs 1 1 Boot-making and Repairing 11 4 Box-making 1 1 Building 11 8 Butchers 1 — Carpet-repairing — 1 Clothing 4 — Dressmaking 4 8 Electrical Instruments 4 — Engineering 14 2 Furniture and Upholstery 3 7 Furriers — 2 Gas Storage 1 — Glue-making 1 — Jewellery Repairs ... 1 2 Joiners 6 1 Laundering and Cleaning 4 1 Millinery — 1 Milk Pasteurising 1 — Motor Vehicle repairing 26 — Photography (Printing and Developing) 3 — Printing 5 1 Sausage-making 3 — Saw Mills 2 — Tailoring 2 8 Undertaking 1 — Welding 2 — Wheelwright and Coach Building 6 — 17 Wig-making — 1 Wireless Repairs — 1 Miscellaneous Trades 16 4 146 54 221 visits of inspection were made to the premises outlined above during the year and the following defective conditions were remidied:— Want of cleanliness to Factory walls, etc. 4 Inadequate ventilation of Factories 1 Ineffective drainage of Factory floors 1 Insufficient Sanitary Accommodation 3 Unsuitable or defective conditions in Sanitary accommodation 2 Miscellaneous items 19 30 In the main the Factories visited were found to be in good condition, the defects found being mainly minor in character. Shops Acts, 1950. Shops on the Register 793 Visits made 42 Inspections with regard to the Shops Acts have of necessity been cut this year. The above figure does not include the number of visits paid to food shops which, when visited, are covered for all provisions of the various Acts. SANITARY DEFECTS REPORTED. Water Supply: Defective or foul storage tanks 2 Defective fittings (notified to Water Engineer) — Defective covers 1 Unsuitable positions of tanks — 18 W.C.'s and Urinals: Defective pans 50 Foul pans — Defective woodwork around pans 2 Defective seats 9 Absence of water supply 14 Defective flushing apparatus 17 Defective flush-pipe connections 21 Defective walls, floors or roofs 70 Defective doors and windows 26 Want of light and ventilation 7 Insufficient closet accommodation 6 Defective walls and channels of urinals 3 Insanitary urinals cleansed 3 Defective brickwork (repaired or re-built) 8 Closets not separate for sexes 2 Unsuitable or defective urinals 1 Soil-Pipes: Defective or insufficient soil-pipes and vent shafts 18 Want of, or defective ventilation shafts 4 Rainwater pipe acting as ventilation shafts 27 Defective Fresh air inlets 8 Drains: Defective drains 55 Defective sewers 8 Want of additional house drains 1 Choked or foul drains or gullies 31 Defective or insufficient gullies 9 Defective grating, dishing or curbing 7 Absence of, or defective, interceptor 14 Defective manholes 8 Defective manhole covers and frames 2 Sub-soil drains required 1 Want of additional manholes 1 Dustbins: Defective receptacles 103 Defective dust shutes 1 19 Paving: Defective paving of yards, forecourts, etc. 18 Sinks: Defective or insanitary sink 33 Want of sink 4 Insanitary wall-surface around sink 7 Waste-Pipes: Insanitary W.P.'s or shafts 33 Defective waste-pipes 5 Untrapped or unventilated waste-pipes 1 Dampness: Defective roofs 139 Defective gutters or spouting 78 Want of damp-proof course 10 Defective external brickwork 48 Defective pointing of door and window reveals 15 Damp and insanitary site under floor 4 Floor cavity unventilated 3 Defective wall or floor ventilators 10 General Defects: Verminous rooms 14 Verminous bedding — Dirty floors, woodwork, etc. 1 Accumulations of offensive matter 33 Nuisances from fowls, or other animals — Defective plastering (No. of rooms) 334 Dirty walls and ceilings (No. of rooms) 259 Dirty walls and ceilings of staircases and passages 48 Defective floors 73 Defective doors and windows 43 Defective doors and window fastenings 37 Defective furnace or brickwork of copper 5 Permitted No. not in rent book — Defective sashcords 95 Defective window sills 65 20 Windows not made to open 27 Inadequate lighting and ventilation 10 Defective firegrates and kitchen tanges 59 Defective chimney pots, etc. 23 Smoke nuisances 8 Defective coppers 2 Defective staircases 2 Contraventions of Byelaws 1 Dilapidated Outbuildings — Miscellaneous defects 313 Defective Larders 4 2,404 At the end of the year 1598 of the defects discovered had been abated, the work of remedying 343 was in hand and the balance of 463 were still outstanding. In order to see that these defects were being properly remedied 2,049 visits were paid to the various premises. NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 474 Interviews 409 Statutory Action. Act and Section. Notices Authorised. Notices Served. Public Health Act, 1936. Section 24 (Drainage) — — Section 39 (Drainage) 8 8 Section 45 (Defective Closets) 2 2 Section 75 (Dustbins) 7 7 Section 92/93 (Nuisances) 17 17 Housing Act, 1936. Section 9 (Insanitary Dwelling) 2 2 21 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 work in their default. The details in respect of the 3 cases are as follows:— Address of Premises. Act and Section. Cost of Repairs. 61, 63 and 65, Mount Ararat Road. Public Health Act, 1936. Sections 24 and 39. £128 0 0 PROSECUTIONS. No legal proceedings were taken during the year. On the 4th April, 1950, the owner of a property appealed against a notice served upon him under the provisions of Section 75 of the Public Health Act, 1936 to provide a new dustbin. The appeal was heard by the Magistrates and upheld. Notice was then served upon the occupier of the dwelling who provided the new dustbin. COMPLAINTS. The number of complaints received from the 1st January to 31st December, 1950 was 1,113, which is an increase over the same period in 1949 of 103. The complaints received have been classified as follows:— Defective firegrates 13 Defective sinks 10 Defective drains and gullies 56 Leaking pipes 13 Defective windows 2 Defective Walls and ceilings... 36 Defective storage tanks 3 Defective floor boards 5 Offensive manholes 8 Lack of water supply 8 Defective W.C's. 53 Defective roofs and gutters 52 Dampness 30 Dry rot 4 Defective stoves 4 22 Defective stairs and steps 6 Accumulation of rubbish 7 Defective dustbins 17 Unsound food 86 Nuisance from rats and mice 447 Nuisance from animals 6 Nuisance from smoke 7 Nuisance from vermin, ants, etc. 77 General Defects 137 Wasps Nests 15 Overcrowding 11 1,113 Prompt investigation was made and suitable action was taken to remedy the complaints. 23 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. Baby Food 1 2 Mildew Cereals 3 38 0 Unsound Cakes 7 0 Mouldy Cheese 4 3 Decomposed Chicken 4 4 Unsound Coffee 2 74½ . Unsound Dried Fruit 1 100 14 Out of Condition Fats 22 0 Rancid Fish (Tinned) 1 6 3½ Tins blown or pierced Fish (Wet) 3 103 0 Decomposed Flour 39 8 Moisture spoiled Fruit 3 3 5 Decomposed Fruit Pulp 50 0 Unsound Fruit Juice 41 1½ Tins blown or pierced Golden Syrup 2 0 Tins blown Ham 54 0 Unsound Jam, etc. 2 97 0 Unsound Meat (Tinned) 4 36 134 Tins blown or pierced Meat 1 42 0 Decomposed Milk (Tinned) 2 38 114 Tins blown or pierced Mincemeat 10 14 Fermented Mustard 8 Mouldy Ovaltine 1 0 Musty Paste (Fish and Meat) 1 6 Sour Pastry Mix 2 0 Out of Condition Pepper 1 0 Pickles 104 13 Fermented Poultry 94 0 Decomposed Puddings 60 13½ Mouldy Rabbits 92 0 Decomposed Salad Cream 10 11 Mildew Salt 3 0 Mouldy Sausage Rolls 15 1 Out of Condition Soup 1 43 14½ Tins blown or pierced Spaghetti 8 0 Unsound Sauces 2 0 Fermented Sweets 3 6 Unsound Vegetables 6 107 13 Tins blown or pierced Vita Cream 2 Sour 24 INSPECTIONS OF FOOD PREMISES. Steady progress in the inspection and improvement of the various food premises in the Borough has been maintained. During the year, a total of 1,145 inspection or reinspection visits were made by the Sanitary Inspectors and as a result of action taken by them the following improvements were carried out:— General cleansing and redecoration of Food premises 57 premises. Provision of Additional Sanitary accommodation 9 ,, Improvement and cleansing of existing Sanitary accommodation 15 „ Constant hot water supply installed 46 ,, Staff washing facilities provided or improved 33 ,, Ventilation of Food preparing rooms, etc., improved 8 Major improvement and alteration to Food preparing rooms 13 ,, Food Stores or cold rooms reconstructed or improved 14 ,, Drainage improved or repaired 12 „ Installation of new milk pasteurising plants 2 „ Co-operation by the proprietors of Food premises has been excellent. They have generally been eager to improve their premises and obtain a better standard for the preparation and handling of Foodstuffs. The total number of Food premises within the Borough is 380 and these premises carry on a total of 494 trades made up as follows:— Bakehouses Butchers Confectioners Wet Fishmongers Fried Fishmongers Grocers Greengrocers Ice Cream Manufacturers and Retailers 25 Public Houses 61 Restaurants: Cafes and Snack Bars 127 Dairies 22 School Meals Kitchcns 2 Cooked Meat Shops 494 RICHMOND CLEAN FOOD TRADERS' GUILD. The Richmond Food Traders' Advisory Committee which was formed in the Autumn of 1949 held several meetings throughout the year. All food traders were circularized concerning conditions of Membership of the Guild and the scheme was publicized by meetings and through the press. By the end of the year there was a Membership of 33 food traders whose premises satisfied the requirements in all respects. The response by the traders has been rather disappointingly slow. There are many excellent establishments in the borough which would undoubtedly be admitted to the Guild instantly if they were to apply for Membership. There are several who do not apply for fear that they would thereby be required to spend money on the premises which they can ill afford. They do not seem to realise that any such improvements will, in any case, be required under the Food and Drugs Act, 1938, and the recently adopted Byelaws. The success of the scheme may ultimately depend on the Housewife. If she can be persuaded to expect any well-managed food store to exhibit a badge of the Guild it may, in time, become difficult for a trader to remain aloof. The object of the scheme is to encourage all Food Traders to maintain a high standard of hygiene and to gain their full cooperation, particularly, as regards the training and supervision of Food Handlers. 26 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 107 visits was paid to such premises. 49 premises are licenced to store a total of 69,500 gallons of Petroleum Spirit and 9 premises are licenced to store a total of 595 gallons of Cellulose Solutions, or Petroleum Mixtures. 1 new licence to store Petroleum Spirit or Cellulose Solutions was 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 only minor contraventions of the Act or Regulations. The licence fees collected throughout the year amounted to £15 15s. Od. Storage of Petroleum Spirit was discontinued at three premises and the storage tanks either removed, or filled with water and rendered safe. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding. Infectious Fevers 19 21 114 Tuberculosis 20 27 56 Vermin 38 63 4 Other Diseases 28 34 68 The total costs recovered from the disinfection and disinfestation of rooms during the year amount to £33 9s. 3d. DESTRUCTION OF INSECT PESTS IN THE HOME. Bugs: During the year 38 houses involving 63 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. 27 Respraying, particularly after redecoration of the rooms is still found to be effective in preventing a recurrence. 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. In addition to the above, 34 complaints were received of infestation by ants or other household pests. Inspections were made and the occupiers were advised and assisted. Towards the end of the year it is usual for quite a number of complaints to be received of nuisance by wasps. Such complaints are sent to the Surrey County Pests Officer at Guildford, who gives prompt attention to them by destroying the wasps and removing the nests. When there is any difficulty in identifying insects, information and advice can be obtained from the Natural History Section of the British Museum. CONTAGIOUS DISEASES OF ANIMALS ACTS. Several outbreaks of Foot and Mouth Disease occurred in England and Wales during the year but Richmond was not involved in Infected Area Restrictions. Under the provisions of the Tuberculosis Order, 1928, two cows in the herd of one of the Cowkeepers in the Borough were slaughtered and found to be affected with tuberculosis. Notification of these cases was received from the Ministry of Agriculture and Fisheries and the cleansing and disinfection of the infected parts of the cowsheds and the destruction of infected straw bedding was supervised. PREVENTION OF DAMAGE BY PESTS ACT, 1949. INSPECTION AND TREATMENT OF PREMISES INFECTED BY RATS AND MICE. Prior to this Act coming into force, the system in operation vvas the inspection of premises by the Sanitary Inspectors; the treatment for eradication being undertaken by the Rodent Branch of the Surrey County Council who were under contract with the Richmond Borough Council for the disinfestation of dwelling houses. 28 Business premises made contracts direct with the County representative. The Act which came into operation on the 31st March, 1950, resulted in the County Authorities discontinuing their Rodent Service as the responsibilities for the full administration of the Act fell directly upon the Local Authority. It was then necessary to set up a local organization to deal fully with the inspection and treatment of rat or mice infested properties. Accordingly, a Rodent Officer was appointed by the Richmond Borough Council and took up his duties on the 12th April, 1950. During the year 447 complaints of rat or mice infestation of premises were received, this figure being an increase of 158 over the previous year. 3,682 visits for inspection, sewer baiting, pre-baiting and poisoning were made by the Rodent Officer and Sanitary Inspectors and from the number of complaints received and investigated definite infestations were isolated on 184 premises (Rats) and 33 premises (Mice) these being immediately treated. By the end of the year 162 of these premises had been completely cleared of either Rats or Mice and the balance of 55 premises were well advanced towards complete eradication. No charges are made to the occupiers of dwellings and I believe that this has helped considerably in encouraging the public to report more readily the presence of rats or mice in or around their homes. Business premises are subjected to charges and during the year treatment has been carried out at 20 such premises for infestation by rats and 7 for mice. The charges recovered to the end of the year from these properties amounting to £142 14s. 9d. In addition to the foregoing, treatments of the foul sewers for the destruction of rats were carried out on two occasions, 15-5-50 to the 15-6-50 and 13-10-50 to the 23-11-50. In the first treatment 400 manholes were inspected, pre-baited and poison laid down and re-examination of manholes after the poisoning day showed that there had been good takes in the 162 manholes found to be infested. 29 In the second treatment 333 manholes were dealt with and reexamination showed that there had been good takes in the 114 manholes found to be infested. The results obtained from both these treatments are considered to be very satisfactory particularly in view of the fact that the County Council had been unable to carry out the treatment in the Autumn of 1949. SMOKE ABATEMENT. Richmond being a residential district contains no very large works or factories. The smaller factories give little trouble by smoke nuisance. Seven 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. Twenty-one observations for excess smoke were made on various chimneys from business premises throughout the area, but no contraventions were recorded. 30 SECTION D—HOUSING. Housing Statistics for the year 1950. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1225 Number of Flats 260 Total 1485 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) 1202 (b) Number of inspections made for the purpose 3251 (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 33 (b) Number of re-inspections made under the Regulations 64 (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 502 (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) 499 31 (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 2 (ii) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 2 (b) By Local Authority in default of owners — B. Proceedings under the Public Health Acts:— (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 34 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 31 (b) By Local Authority in default of owners 3 C. Proceedings under sections 11 and 13 of the 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 5 32 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, 1950 Temporary Bungalows 179 Permanent Houses 242 Permanent Flats 98 Total number included in above erected in 1950 Permanent Houses 48 Permanent Flats 20 Total number of premises requisitioned up to 31st December, 1950 122 (providing 241 family units) Total number of families rehoused in 1950 111 Total number of families still on Waiting list at 31st December, 1950 1772 At the present time the Cedar Nurseries site is being developed which comprises 12 maisonettes, 5Q houses and 36 flats. In addition, a block of 21 flats is being erected at Broomfield Road. At the Sandy Lane site work has commenced on the roadways and sewers. In this situation there will be 193 dwellings, including 12 flats for elderly persons. 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 such arrangements are being properly observed. 33 Withdrawal of Closing Orders. Closing orders preventing the use of Underground rooms for human habitation were made by the Richmond Borough Council on the premises mentioned below:— No. 45, Church Road Date of Closing Order. 19/7/39. No. 60, Sheen Road „ „ ,, 4/5/39. No. 47, Sheen Road „ ,, „ 7/5/36. No. 10, Montague Road ,, ,, „ 23/9/38, No. 11, Montague Road „ „ ,, 7/12/37. The principal defects rendering these premises unfit for human habitation were:—Dampness and lack of damp-proof courses: pervious condition of sub-soil: lack of open area : insufficiency in window areas and inadequate lighting. During this year the owners of the properties mentioned carried out extensive work of reconditioning to the basement rooms which brought them to the standards required by the "Regulations as to Underground Rooms" and enabled the Closing Orders to be withdrawn. The orders were withdrawal by the Council on the following dates:— No. 45, Church Road 4/4/50. No. 60, Sheen Road 6/6/50. No. 47 Sheen Road 31/10/50. Nos. 10/11, Montague Road 31/10/50. The carrying out of the necessary works and the withdrawal of the Closing Orders therefore made available five useful flats. Individual Unfit Houses. No. 22, Kew Foot Road. This cottage in addition to having almost reached the end of its useful life was damaged by fire from Incendiary bombs in late 1940 and was completely uninhabitable. Following a resoultion by the Council on the 29th May, 1941 the owner was informed that the cottage was uninhabitable and should not be again let until it was made fit. 34 During late 1949 and early 1950 the new owner decided to reconstruct the premises for his own use and carried out extensive alterations and repairs which had the effect of once more rendering the cottage fit for human habitation. A report was made to the Health Committee as to the extent of the work done and that the cottage was now entirely suitable for re-occupation and the resolution of the Council dated the 29th May, 1941 was accordingly withdrawn on the 2nd May, 1950. Nos. 1 & 2, Cedar Lodge. These two cottages were also at the end of their useful life and following a survey in 1949 it was felt the only way of dealing with them was by their total demolition. This area was later acquired by the Council for rehousing purposes and in April of this year the tenants were rehoused and the houses demolished. Rent & Mortgage (Interest Restrictions) Act, 1920-1939. An application was made by the tenant of a self-contained flat for a Certificate under the provisions of the above Act to enable him to suspend payment of the increase of rent on the grounds that the premises were not in a reasonable state of repair. An inspection of the premises was made and the application found to be justified and the Council accordingly agreed to the issue of the necessary Certificate. The work was later carried out by the owner. 35 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, 1950. Articles. Analysed Adulterated or Irregular Prosecutions Convic tions Formal Informal Total Formal Informal Total FOOD : Milk 32 17 49 2 1 3 Cake 1 1 Coffee Essence 1 1 Coffee and Chicory Essence 1 1 Coffee and Chicory Extract 1 1 Ice Cream 4 4 Lemonade Crystals 1 1 Meat Paste 1 1 Meat Pie 2 2 Non-Brewed Condiment 1 1 1* 1 Sausages 9 9 Soft Drinks X 2 3 Spirits 4 4 Vinegar 1 1 DRUGS : Epsom Salts 1 1 Liquid Paraffin 2 2 Nerve Tonio 1 1 * Labelling Offence Totals 46 37 83 2 2 4 36 THE FOOD AND DRUGS (MILK AND DAIRIES) ACT, 1944. The above Act which amends the Food and Drugs Act, 1938 in relation to milk and dairies, came into operation on the 1st October, 1949. Various regulations were made under the Act and came into operation on the same date. The general effect was that all dairy farms became the direct responsibility of the Ministry of Agriculture and Fisheries. Premises in which milk is pasteurised or sterilised must be licenced by the Food and Drugs Authority, which in the case of Richmond is the Surrey County Council. In all other cases, Dairies or Dealers in Designated Milk are under the control of Richmond Council in respect of licencing, inspection and control. No. of licences granted authorising dealers to store and sell Designated Milk:— Pasteurised Milk 18 Tuberculin Tested Milk 15 Sterilised Milk 19 Supplementary licences were granted authorising dealers to retail milk in the Borough from premises situated outside as follows: — Pasteurised Milk Tuberculin Tested Milk Sterilised Milk 8 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. Under the Regulations the Local Authority may continue to take samples from any dealer:— No. of samples of pasteurised milk taken 92 No. found to be satisfactory No. of samples of raw milk examined biologically for the presence of tubercle bacilli No. of samples found satisfactory The District Medical Officer of Health retains the power to take appropriate action to prevent the spread of disease by infected milk. 37 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 128. A total of 79 samples were submitted to the Bacteriologist for examination and of this number 56 fell within Grades I and II and were considered satisfactory and 23 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. 38 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 35 26 ... Puerperal Pyrexia ... ... ... Pneumonia 10 6 23 Erysipelas 1 1 ... Measles 397 6 1 Whooping Cough 71 3 2 Poliomyelitis Paralytic 1 4 1 Poliomyelitis Non Paralytic 2 2 ... Polioencephalitis ... ... 1 Cerebro Spinal Meningitis ... ... ... Smallpox ... ... ... Dysentery 1 1 ... Total ... 521 47 28 The number of cases of measles was higher than was expected in view of the high incidence during the previous year. The course of the illness was mild; only 6 cases being serious enough to require admission to hospital. Whooping Cough maintained a reasonably low level. Unfort' unately there were two deaths caused by this disease complicated by pneumonia. Six cases of poliomyelitis occurred during the year. Two were nonparalytic cases who made uneventful recoveries. Two were moderately severe cases and two were dangerously ill. Of the two severe cases one was a boy aged 8 years who had undergone an operation for the removal of tonsils 12 days before paralytic symp' toms commenced. When in hospital he was a contact of a nurse who developed acute poliomyelitis and died in another district. The boy became dangerously ill but has since made an almost complete recovery. The other severe case was a woman who suffered extensive paralysis and is still very considerably handicapped. The two deaths recorded do not belong to this series of cases. They relate to patients who contracted the disease during the previous year. Housing conditions in each case were quite satisfactory. The 39 children all went to different schools and the patients did not live particularly close to one another. In two instances contact with another case was established. In two cases undue exertion may have played a part in establishing the disease and in one case tonsillectomy seems to have been the cause. There is no evidence that swimming baths, ponds or the river played any part in the spread of the infection. I regret to have to report that a Richmond child who suffered a severe attack of acute poliomyelitis in October, 1949, is still in the South Middlesex Fever Hospital. During the whole of the period he has been treated in an Iron Lung. Recovery of the muscles has been slow and, at the present time, he is able to remain out of the Iron Lung for about 3 hours each day. INFECTIOUS DISEASES—ADMISSIONS TO HOSPITAL Formerly all cases of infectious disease requiring admission to hospital were sent to the South Middlesex Fever Hospital. Under the recent re-organisation this hospital draws patients from a larger area with the result that it quite often happens that no bed is available. Under these circumstances patients are admitted to Tolworth Isolation Hospital or perhaps to another hospital in Surrey or in the L.C.C. area of the South West Metropolitan Regional Hospital Board. During the year out of the total of 75 cases 43 patients were admitted to the South Middlesex Fever Hospital. Although these arrangements seem to have worked smoothly I regret that the change has been necessary. The old arrangement was more convenient for all concerned and personal contact between the Medical Officer of Health and the Medical Superintendent was of great value. LABORATORY WORK General practitioners send specimens for examination to the laboratory of the Royal Hospital, Richmond. In addition the following laboratory facilities are available to the Public Health Department: — CENTRAL PUBLIC HEALTH LABORATORY, COLINDALE AVENUE, N.W.9. For advice, special immunising agents and special investigations. 40 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. In the summer a sharp outbreak of food poisoning occurred which, on investigation, proved to be due to "cream" cakes which had been infected by Salmonella Typhimurium. The cakes were made in a small and poorly ventilated bakery. The artificial cream was received twice weekly from a reputable firm. In the bakehouse this was thickened with sugar in an electric mixer and was then fed into the cakes, either from a spoon or through an icing bag. Cream mixture which remained was stored for use the next day. Investigations showed that one of the food handlers had suffered from an abdominal upset five days before the outbreak. Subsequently blood examinations indicated that this illness had been due to an infection with salmonella typhimurium. Bacteriological investigations showed that organisms identical to those infecting the patients were being carried by one of the food handlers in the bakery and were present in washings taken from the icing bag. Fifteen patients suffered quite severely and were ill for a week or more. There were many who had only mild symptoms and did not seek medical advice. This outbreak demonstrates the danger of certain foodstuffs when handled under unsatisfactory conditions. In this case if the food handler who was originally infected had remained off duty for a few days—or indeed if he had invariably washed his hands before handling the food—he would not have infected the bakery. If the organisation of the bakery and storage arrangements for the cream 41 had been adequate the organisms infecting the cream would not have been able to multiply to such an extent as to cause food poisoning. All conditions required for an outbreak were present—the infected food handler; the type of food so favourable to the growth of organisms; the warm temperature and the lack of good storage facilities. It is indeed fortunate that the infecting organism was not of a more virulent type when the results might have been far more distressing than they were. DIPHTHERIA IMMUNISATION CLINIC. Number of children immunised for the first time during the year 1950:— (a) Pre-school children (under 5 years) 574 (b) Between 5 and 15 years 227 Total 801 Grand Total of Children in the Borough who have received immunising treatment by the end of the year: — (a) Under 5 years 2326 (b) Between 5 and 15 years 3857 Number of Children given re-inforcing doses during 1950 676 At the 31st December the percentages of children who had been immunised were as follows:— (a) Under 5 years 69% (b) Between 5 and 15 years 91.4% 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 801 compared with 810 in 1949. 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. T.A.F. is used for all reinforcing doses and is given subcutaneously. 42 Immunisation Against Whooping Cough. Immunisation against Whooping Cough was suspended in October, 1949, and has not been re-commenced. The reason for this is that a vaccine has not yet been produced which is sufficiently reliable to merit the backing of the Ministry of Health. In addition during epidemics of poliomyelitis it was found that a number of cases were occurring shortly after a prophylactic inoculation. Controlled tests on a large scale have recently been completed and they prove that certain vaccines have in fact considerable effect in preventing the disease or in reducing its severity. When it becomes possible to obtain supplies of the most reliable of these vaccines the scheme will be re-commenced. Nearly one thousand children die in England and Wales each year from this dangerous and distressing complaint: and the health of thousands of others is adversely affected. The production of a really effective preventive vaccine will be of tremendous value to the community. VERMINOUS CONDITIONS. YEAR 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 Scabies 34 128 241 431 274 377 66 12 11 7 Head Lice — 204 205 181 188 308 239 78 141 129 Figures in the above table include children and adults treated for verminous conditions at the Welfare Centre, Windham Road, Richmond. The incidence of scabies is now at a very low level, and is no longer a serious problem in the district. The majority of the 129 cases of louse infestation are school children who are well known to the School Nurses. They are cleansed under supervision and 43 parents are given full instructions on how to prevent a recurrence. However, this advice is frequently disregarded and the children are found re-infested, particularly after the school holidays. Inspections in the schools are regularly carried out and materials used for the treatment are efficient. In spite of this I fear that it will be a long time before the incidence falls much below the present level, 44 TUBERCULOSIS. The position in Richmond for the year 1950 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Forty-two cases of respiratory tuberculosis were notified, viz:—21 males and 21 females. The corresponding figure for 1949 was 67. Non-Respiratory Tuberculosis. Seven new cases of non-respiratory tuberculosis were notified during the year and there were three deaths from this cause. Seven such cases had been notified during 1949. 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:— Non- Pulmonary. Pulmonary. Males 182 21 Females 123 24 Total 305 45 Corresponding figures for 1949 313 46 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 45 where proper precautions are not being taken and the circumstances are such as could constitute a danger to others. During the year 1950 it was not found necessary to take action under either of the above enactments. TUBERCULOSIS. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... — 5 2 1 1 1 ... ... ... ... 15 6 6 1 ... 1 1 ... ... 25 6 1 ... 2 1 ... ... ... 35 1 4 1 ... 3 3 ... 1 45 4 3 1 ... 2 .. 1 ... 55 1 3 ... ... 1 4 ... ... 65 and upwards ... 1 ... ... ... 1 ... 1 Totals... 21 21 4 3 8 9 1 2 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 after-care" of tuberculous patients. 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. ft INDEX. Page Area of Borough 4 Birth-Rate 4 Births, Analysis of 4, 8 Cancer, Deaths from 4 Chief Sanitary Inspector, Report of 14 D.D.T. 26 Death-Rate 4 Deaths, Analysis of 4 Deaths, Maternal 3 Deaths, Neo-Natal 5 Diarrhoea & Enteritis (under 2 years) 4, 5 Diphtheria 4, 9 Diphtheria Immunisation 41 Diseases of Animal Acts Disinfection 26 Disinfestation 26 Drains 15, 18 Factories Act Food and Drugs Act 35 Food and Drugs (Milk and Dairies) Act 1944 36 Food, Survey Food Poisoning 40 Food, Unsound Head-Lice 4 Health of the Borough Housing Illegitimacy 4, 6 Ice Cream Infant Mortality 5 Infectious Diseases, Notifiable 7, 38 Inhabited Houses Laboratory Work Malformation, Congenital Maternal Mortality Measles 4, 7, 38 Milk 36 National Assistance Act, 1948 70 Notices, Sanitary Overcrowding Petroleum Acts Pneumonia 47 Pagd Population 4, 8 Poliomyelitis 7, 9, 38 Polioencephalitis 7, 9, 38 Premature Infants 6 Prosecutions 21 Puerperal Pyrexia 7, 38 Rateable Value 4 Rats and Mice Destruction Act, 1919 27 Sanitary Inspection and Complaints 14 Scabies 42 Scarlet Fever 7, 38 Sewers 18 Sewers, Baiting of 28 Shops Acts 17 Smoke Abatement 29 South Middlesex Fever Hospital 38 Staff, List of 3 Statistics 4 Stillbirths 4, 7 Tuberculosis 9, 44 Verminous Conditions 42 Water Supply 11 Whooping-Cough 4, 7, 38