Ac 4413(1) RICHMOND Rich 21 BOROUGH OF RICHMOND (surrey) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1952 s J. H. BROAD St Co., Ltd., Printert, 8, King Street, Richmond, Surrey. BOROUGH OF RICHMOND (surrey) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1952 CONTENTS. Page. List of Staff 2 Preface 3 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 10 Births 10 Deaths 10 Maternal Mortality 11 Infant Mortality 11 Premature Infants 12 Comparative Statistics 13 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 14 Sanitary Inspection 16 Sanitary Defects 19 Notices Served 21 Complaints Received 23 Food Inspection 24 Food Premises 24 Byelaws 25 Richmond Clean Food Traders' Guild 25 Petroleum Acts 26 Disinfection and Disinfestation 26 Rodent Control 27 Smoke Abatement Rag, Flock and Other Filling Materials Act, 1951 28 SECTION D—HOUSING. Housing 30 Council's Housing Programme 32 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Sale of Food and Drugs 34 The Food and Drugs (Milk 6? Dairies) Act, 1944 35 Ice Cream 36 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Diseases 37 Admission to Infectious Diseases Hospitals 37 Laboratory Facilities 37 Food Poisoning 38 Diphtheria Immunisation 38 Whooping Cough Immunisation 39 Vaccination Against Smallpox 39 Verminous Conditions—Scabies and Head Lice _ Tuberculosis 1 Public Health Department, Parkshot, Richmond. July, 1953. 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 1952 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is in accordance with the instructions of the Minister of Health and special reference is made to certain subjects at the Minister's request. I wish to express my thanks to all members of the Council for their continued support throughout the year, and to record my gratitude to every member of the Staff of the Public Health Department for their loyalty, hard work and co-operation. 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: GEORGE C. SMITH, M.S.I A., M.R.San.I. (Resigned 31.8.52) Additional Sanitary Inspectors: CHARLES S. SMEATON, M.R.San.I. KENNETH H. HALSTEAD, M.S.I.A. Clerks: MISS J. BLACK (Senior Clerk). MRS. F. G. SMITH. MISS M. WILTSHIRE. Rodent Officer: THOMAS R. SMITH. Rodent Operator: RONALD EVANS. Drain Tester and Disinfector: JAMES DAVIS. 3 BOROUGH OF RICHMOND. Report of the Medical Officer of Health for the year 1952. PREFACE. Staff. Mr. G. C. Smith, Senior Additional Sanitary Inspector, obtained a Senior position on the staff of Kingston Borough Council in August. As deputy to the Chief Sanitary Inspector, Mr. Smith served this Authority most efficiently for nearly three years. His resignation was a loss to the Department but he deserved promotion. It was not possible to fill the vacancy caused by this resignation until January, 1953, so that there was a shortage of Inspecting Staff for the last four months of the year. There were no other changes in staff. Population. The Registrar General's estimate of the population was 42,130 which is an increase of nearly 200 on the Census population of 1951. Births. During the year 614 births were recorded—(311 males and 303 females). This figure may be compared with 648 in 1951 and-851 in 1947. The number of illegitimate births was 28 including 3 infants found dead in the Borough. This is the smallest number of such births recorded since the war years and is, in fact, back to pre-war level. The proportion of births taking place in hospitals or Nursing homes has risen to 80%. Everything possible is done to endeavour to persuade mothers to have their babies at home when conditions are satisfactory, but in spite of this, the proportion seeking admission to hospital rises slightly each year. There were 29 premature births belonging to this district, 25 of these survived for over 28 days. The three infants who failed to survive were born and nursed in hospitals where they were receiving every attention. Health Visitors are notified early of premature births and all possible assistance is given to the mothers. Each premature birth is investigated with a view to ascertaining the cause and so preventing a similar occurence in future. 4 Deaths. The total number of deaths occurring amongst residents were 588 (259 males and 329 females). When considering this figure it should be remembered that all deaths occurring in Kingsmead and other "long'Stay" Institutions are now assigned to this district. Because of this and the high proportion of elderly persons resident in Richmond the Registrar General supplies a factor by which the death rate is corrected and made comparable with the rest of the country. The corrected death rate is 11.1 per thousand population which compares favourably with the rate for England and Wales. In the majority of cases the death rates for various diseases compare satisfactorily with other towns. The exceptions are the tuberculosis, the influenza, and the pneumonia death rates. As regard tuberculosis, reference to the table in Section F shows that half the deaths occurred in persons over the age of 55. Such cases are of long standing and many of the patients have moved in from other districts. The high rates recorded for influenza and pneumonia are undoubtedly due to the abnormally high proportion of elderly residents. It should be noted that there were only 11 deaths of infants under 1 year of age and that no child under 2 years died from enteritis. The rates in these cases compared particularly favourably with other towns. Unfortunately, there was one maternal death—the patient developing an unusual form of pneumonia shortly after childbirth. Because of poor health she had been in hospital for several weeks before the confinement and she had every care. In view of the small population concerned this one death brings the maternal death rate for Richmond to a level well above that for England and Wales. Infectious Diseases—Notifications. Generally there was no serious outbreak of infectious or other notifiable disease during the year under review. The incidence of scarlet fever and measles in Richmond was considerably higher than elsewhere. This is difficult to explain particularly when one recalls that there was an epedemic of measles in 1951 and the incidence of scarlet fever was higher in that year than elsewhere. 5 It may be that the large crowds of people who visit Richmond especially at week-ends play their part in disseminating the organisms of these diseases or possibly the local private practitioners are more concientious in notifying the occurrence of cases. There were 13 cases of food poisoning including two small family outbreaks of 4 and 5 cases respectively. Both outbreaks were due to unsatisfactory storage of cooked meat in a warm atmosphere. No specific organisms were found in these cases, but the growth of non-specific organisms on the improperly stored meat was so excessive that the two families suffered quite distressing illnesses. The remaining four cases were isolated and unconnected and the source of infection was never traced. In one case the causal organism was Staphylococcus pyogenes and in the other three Salmonella typhimurium was isolated from the patients. One of the patients infected with Salmonella typhimurium was so severely ill that he died ten days after the onset. There were 10 cases of dysentry. The organism concerned was Shigella Sonnei which is found fairly widespread throughout the country. Four of the patients were little girls attending a local Infants school and a fifth case was a young brother of one of these. Although the orignal source of infection was not discovered there is no doubt that these children infected one another while at school. The remaining patients were quite unconnected and it was not possible to discover the source of infection. Advice and help in preventing the spread of infection was given and no further cases resulted. During the year there were five cases of poliomyelitis which occurred at fairly widely spaced intervals and apparently were unconnected. The age range was 6 months to 7 years—three being school children. Two of the children attended different classes at the same school but a period of more than two months separated the onset of disease in the two cases. Two of the cases were of the non-paralytic type and they made complete and uneventful recoveries. 6 The remaining three children suffered from the paralytic form. One, a baby, is left with noticeable weakness of the right arm. Another, a boy aged 5, has residual weakness of the back, abdominal and leg muscles. The third case was that of a boy who was quite severely affected and is still in hospital with considerable weakness of the back, abdominal and leg muscles. There is no evidence at all to suggest that any of these cases was in any way related to swimming, paddling, surgical operations or immunization. As in the case of other infectious diseases it may be that the large number of visitors to this Borough play their part in spreading the infection. When the disease is prevalent in a district, parents should see that their children do not suffer undue exertion or fatigue and keep away from crowds or stuffy atmospheres. The increased number of notifications of pulmonary tuberculosis is due to more careful searching for cases by the medical profession and to greater consciousness of the disease in the general public. Reference to the table in Section F which sets out the age groups of the notified cases, shows the usual distribution with the difference that no less than 11 cases were diagnosed in children of school age or under—formerly such cases were not often notified. Improved facilities for the examination of family contacts by X-Rays and skin tests are leading to the discovery of numerous early cases which are amenable to treatment. In addition, Mass Radiology is playing its part by the discovery of unsuspected cases and by awakening in the public a realization of the importance of having a periodical check-up. I think that the increased number of notifications should be considered as an indication of the increased activity of the tuberculosis services and that it should not be viewed with concern. When cases are diagnosed early they are readily amenable to treatment and their early removal from contact with others is an important factor in reducing the number of secondary cases. Early diagnosis, treatment, and careful search for contacts are the means by which this disease will finally be brought under control. Improved methods of treatment are assisting in many ways but the first essential must always remain early diagnosis. 7 Immunization. The diphtheria immunization campaign has been continued as in former years. The method of compiling statistics has been carefully scrutinized and the figures submitted in Section F are considered to be realistic and as accurate as it is possible for them to be. The fact that 69.9% of children under 5 years of age are immunized is satisfactory when it is remembered that half the number of infants born during the year do not become old enough for immunization until the following year. In addition a small number of parents refuse to have their children treated. Under the circumstances I doubt whether the level of immunization can be raised much in this age group, though every effort will be made to do so. With 91.5% of school children immunized there is very good protection indeed. The figure is almost certainly higher than this, as there is always a number who attend private schools who are immunized but for whom there are no records. Immunization against whooping cough was commenced in October for children under 5 years of age . It has been well received and is becoming more and more popular. Not only is the vaccine now in use much more effective than formerly but local and general reactions are much less marked. Vaccination against Smallpox is carried out at the local clinics and by private doctors. Compared with other parts of the country the recording of 68% Richmond babies protected in this way is very satisfactory. Water Supplies. Drinking water is from local wells and from the Metropolitan Water Board. Action taken to ensure the purity of these supplies is set out in the Appendix. Water fit for human consumption is made available by piped supply to every dwelling house in the Borough. 8 NATIONAL ASSISTANCE ACTS, 1948 and 1951. Removal to suitable premises of persons in need of care and attention. No action was taken under the above Acts during the year 1952. A considerable number of cases were referred to the Health Department for assistance and the problems were invariably solved in other ways. There are two factors which cause difficulties in these cases. Firstly, there is a real shortage of hospital beds for the chronic sick and a similar shortage of accommodation in Homes for the Aged. The shortage is such that only the most urgent cases can be admitted; the less urgent cases must be assisted as far as possible in their own homes by the domiciliary services. Secondly, even when suitable accommodation can be obtained the old people often refuse to be moved from their homes even though they may be living in the utmost discomfort. These are the ones who might be compulsorily removed to suitable accommodation under the National Assistance Acts, except that if they are not living in insanitary conditions or not suffering from grave chronic disease no action can be taken. In really bad cases where suitable accommodation is urgently required I have invariably had the complete co-operation of the Physician Superintendent of Kingston Hospital who controls the beds for the chronic sick, and of the Divisional Welfare Officer who is concerned with the admittance of old persons to Part III accommodation. Housing. During the year 46 houses and 30 flats were added to the Council s estate, bringing the total of properties owned up to 1642. The future programme is limited since there is very little more land available for building purposes. In the meantime there remains a Waiting List of over 1,500 families, many of whom, are living in overcrowded and unsatisfactory conditions. This is a most serious problem which is undoubtedly causing ill-health and, in particular, mental ill-health, to a greater extent than is generally appreciated. It leads to the breaking up of families, to neglect of children, and is a potent cause of delinquency. It is a national problem which 9 can only be solved by the building of new houses and which must, therefore, remain with us for several years to come. Much is done by the Social Services—both statutory and voluntary —to assist with the many problems caused by bad housing, but it is an uphill task and much harm will have been done before the problem is solved. Sanitary Circumstances. The report of the Chief Sanitary Inspector is included in the Appendix to this Report. Reference to this shows that a very considerable volume of work has been carried out by the team of Inspectors and by the Rodent Control Staff. Much of the work done is connected with complaints made by members of the public and with inspections of properties made under the Housing, Public Health, and Factories Acts. In fact the Sanitary Inspectors are concerned with anything which may affect the public health and for this reason their duties are varied and often of a technical nature. In addition to the work outlined in the Appendix they play a considerable part in the prevention and spread of infectious disease and in maintaining the purity of the water supply. The policy is to obtain improved conditions in houses and business premises by persuasion and co-operation rather than by resorting to legal powers. Throughout the year only 42 Statutory Notices were served and it was only necessary to take legal proceedings in 4 instances. As far as possible (having regard to the staff available) all food premises are regularly inspected and advice is given as to desirable improvements which can be made. In this way numerous improvements were effected during the year and in two cases there were major re-constructions of the premises. During the year not a single case of food poisoning was traced to food or meals sold by the traders in Richmond. Some of the premises may be old and inconvenient but with good management a high standard of hygiene is maintained. It is satisfactory to be able to report that conditions generally in our food premises continue to improve and that they compare favourably with those of any town in the country. 10 APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,945 Population (Estimated 1952) 42,130 Number of inhabited houses (estimated) 11,385 Rateable value £634,814 Sum represented by a Penny Rate £2,508 BIRTHS. Birth Rate per 1,000 of estimated resident population 14.6 (corrected) 14.1 Total number of births (live and still) 614 Analysis:— M F Total Live Births Legitimate 283 287 570 Illegitimate 14 11 25 Stillbirths Legitimate 14 2 16 Illegitimate — 3 3 Still birth rate per 1,000 total births 30.9 Environment of births:— Proportion taking place in the Borough 22% Proportion taking place outside the Borough 78% Proportion taking place in Institutions 80% Proportion taking place in dwelling houses 20% Proportion notified by midwives alone 27% Proportion notified by doctors or parents 73% DEATHS. Death Rate per 1,000 estimated resident population 13.7 (corrected) 11.1 Total number of deaths from all causes 588 Analysis:— M F Total All causes 259 329 588 Cancer 48 43 91 Diphtheria — — — Measles — — — Whooping Cough — — — Diarrhoea (under two years) — — — 11 Maternity Mortality Rate per 1,000 total births 1.63 Total number of maternal deaths 1 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 18.5 Rate for legitimate infants per 1,000 legitimate live births 14.0 Rate for illegitimate infants per 1,000 illegitimate live births 120 Total number of infant deaths in the Borough 11 Analysis:— M F Total Legitimate 4 4 8 Illegitimate 2 1 3 Environment of Infant Deaths:— Number occurring in the Borough 4 Number occurring outside the Borough 7 Number occurring in Institutions 8 Number found dead 3 Causes of Death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... ... ... ... ... ... ... ... ... 2. Congenital Debility and Malformation including Premature Birth 3 ... 1 ... 4 ... ... ... ... 4 3. Enteritis ... ... ... ... ... ... ... ... ... ... 4.Birth Injury 1 ... ... 1 2 ... ... ... ... 2 5. Other defined diseases 1 ... ... ... 1 ... ... ... 1 2 6. Asphyxia (Accidental Death) ... ... ... ... ... ... ... ... ... ... 7. Accidental Death ... ... ... ... ... ... ... ... ... ... 8. Found Dead 3 ... ... 3 ... ... ... ... 3 8 ... 1 1 10 ... ... ... 1 11 12 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 4 4 — — - 4 (b) In Nursing Homes — — - — - - (o) In Hospitals — — — — — — Richmond Children born outside the Borough: (a) In Nursing Homes 1 1 - - - - (b) In Hospitals 24 24 1 1 1 21 Children born in Richmond, mother normally residing elsewhere: (a) In Nursing Homes — — — — — (b) In Hospitals — — — — ILLEGITIMATE BIRTHS 1944 1945 1946 1947 1948 1949 1950 1951 1952 No. of illegitimate live births 62 62 51 54 38 40 43 43 25 No. of illegitimate deaths under 1 year 3 4 5 2 0 1 2 0 3 Illegitimate death rate 48 65 98 30 0 25 46 0 120 13 COMPARATIVE STATISTICS—1952. England and Wales I 60 County Boroughs and Great Towns including London. 60 Smaller Towns (Resident populations 25,000— 50,000 at 1951 Census London Administrative County- Richmond Richmond Actual Nos. Births— Rates per 1,000 Home Population. Live Births 15.3 16.9 15.5 17.6 14.1 595 Still Births 0.35 0.43 0.36 0.34 0.45 19 22.6 (a) 24.6 (a) 23.0 (a) 19.2(a) 30.9 (a) Deaths— All Causes 11.3 12.1 11.2 12.6 13.7 588 correct ed 11.1 Typhoid and Paratyphoid 0.00 0.00 0.00 - - 0 Whooping Cough 0.00 0.00 0.00 0.00 - 0 Diphtheria 0.00 0.00 0.00 0.00 - 0 Tuberculosis 0.24 0.28 0.22 0.31 0.35 15 Influenza 0.04 0.04 0.04 0.05 0.07 3 Smallpox 0.00 - - - - 0 Aoute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.00 0.01 - 0 Pneumonia 0.47 0.52 0.43 0.58 0.57 24 Notifications (corrected) Typhoid Fever 0.00 0.00 0.00 0.00 - 0 Paratyphoid Fever 0.02 0.02 0.03 0.01 - 0 Meningicoccal Infection 0.03 0.03 0.03 0.02 - 0 Scarlet Fever 1.53 1.75 1.58 1.56 2.25 95 Whooping Cough 2.61 2.74 2.57 1.66 0.92 39 Diphtheria 0.01 001 0.03 0.01 - 0 Erysipelas 0.14 0.15 0.12 0.14 0.11 5 Smallpox 0.00 0.00 0.00 - - 0 Measles 8.86 10.11 8.49 9.23 12.72 536 Pneumonia 0.72 0.80 0.62 0.57 0.09 4 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.07 3 Non Paralytic 0.03 0.03 0.02 0.03 0.04 2 Food Poisoning 0.13 0.16 0.11 0.18 0.31 13 Rates per 1,000 Live Births. Deaths— All causes under 1 year of age 27.6 31.2 25.8 23.8 18.5 11 Enteritis and Diarrhœa under 2 years of age 1.1 1.3 0.5 0.7 — 0 Rates per 1,000 Total (Live and Still) Births. Notification (corrected)— Puerperal Fever and Pyrexia 17.87 23.94 10.22 30.77 1.6 1 MATERNAL MORTALITY England and Wales Richmond Number of Deaths Rates per 1,000 Total (Live and Still) Births Number of Deaths Rates per 1,000 Total (Live and Still) Birth Other complications of pregnancy, childbirth and puerperium 138 0.20 1 1.63 (a) Per 1,000 Total (Live and Still) Births 14 # SECTION C—SANITARY CIRCUMSTANCES. Water Supply. Richmond has two separate sources of drinking water:— (a) From local wells. (b) From the Metropolitan Water Board. The origin and method of treatment of these supplies have been fully reported in previous years and remain unchanged. Both supplies are treated by chlorination: and very close observation of the purity of the water is maintained by frequent examinations of the water samples. During the year the following samples were taken for examination:— (a) Richmond Water Supply. Untreated water 141 samples Treated water 408 samples For chemical analysis 15 samples Every sample of treated water passing into public supply was of the highest standard of bacterial purity. Chemical analysis of samples showed that the organic quality of the water maintained a high and satisfactory standard. (b) Metropolitan Water Board Supply. Samples examined bacteriologically 776 Samples examined chemically 246 The results of these examinations indicated that a very high standard of chemical and bacteriological purity was maintained throughout the year. In addition to these two supplies of drinking water there is a supply of raw river water which is delivered to Kew Gardens, allotments and to the gardens of a proportion of the residences in Richmond. The water is chlorinated as a precautionary measure but is not fit for drinking. 15 The following figures show the daily average consumption from the three sources:— 1951 1952 All Richmond Wells 841,881 galls. 796,533 galls. Metropolitan Water Board 832,973 galls. 837,997 galls. Raw River Water 205,161 galls. 258,397 galls. The drinking water supplies in the district are not plumbosolvent. Water fit for human consumption is made available by piped supply to every dwelling house in the Borough. 16 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 1952. Houses visited and particulars recorded (Housing Act) 4 Houses visited (Public Health Acts) 936 Revisits to houses and other premises 1625 Visits paid in connection with:— Overcrowding 39 Vermin 125 Disinfection 189 Enquiries into Infectious Diseases 165 Corporation Dwellings 3 Routine inspections in connection with:— Factories (mechanical) 50 Factories (non-mechanical) 2 Work'places 54 Bakehouses 29 Butchers' Shops 53 Fishmongers and Poulterers 16 Other registered food stores 68 Dairies and Milk Shops 82 ice-cream premises 113 Restaurants and Tea Shops 149 Fried Fish Shops 7 Stables 1 Rag and Bone Dealers 1 Piggeries 11 Public Houses 42 Shops Acts 333 Theatres, Cinemas 19 Greengrocers' and Fruiterers 33 Rats and Mice (Visits to Properties) 3492 Rats and Mice (Visits re sewer treatments) 1619 17 Smoke Observations 9 Schools—Elementary and Secondary 19 Tents, Vans and Sheds 2 Water Supply 217 Drainage 790 Milk Sampling (Pasteurised) 108 Unsound Food 163 Petroleum Acts 179 Rent Restriction Acts 1 Interviews 515 Rag Flock Act 12 Pet Animals Act 11 Miscellaneous Visits 1250 12,536 Drains and Sewerage Systems Tested. Hydraulic tests 18 Smoke tests 4 Chemical tests 20 Examinations 13 Factories Act, 1937. At the end of the year there were 157 factories on the register (139 mechanical and 18 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreaths, etc 1 1 Bakeries 9 2 Boat Repairs 3 1 Boot-making and Repairing 8 — Building 3 2 Butchers 2 — Clothing 3 1 Dressmaking 7 2 Electrical Instruments 5 — 18 Engineering 14 — Furniture and Upholstery 8 5 Gas Storage 1 — Glue-making 1 — Jewellery Repairs 1 1 Joiners 5 — Laundering and Cleaning 5 — Milk Pasteurising 2 — Motor Vehicle repairing 23 1 Photography (Printing & Developing) 1 — Printing 6 — Sausage-making 3 — Saw Mills 1 — Tailoring 1 2 Undertaking 1 — Welding 1 — Wheelwright and Coach Building 7 — Miscellaneous Trades 17 — 139 18 137 visits of inspection were made to the premises outlined above and the following defective conditions were remedied:— Want of cleanliness to Factory walls, etc. 4 Inadequate ventilation of Factories 1 Ineffective drainage of Factory floors Insufficient Sanitary accommodation 2 Unsuitable or defective conditions in Sanitary accommodation 4 11 In the main the Factories visited were found to be in good condition, the defects found being mainly minor in character. 19 Shops Acts, 1950. Shops on the Register 793 Visits made 333 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 4 Defective fittings (notified to Water Engineer) 2 W.C.'s and Urinals: Defective pans 30 Foul pans 2 Defective woodwork around pans 1 Defective seats 5 Absence of water supply 9 Defective flushing apparatus 11 Defective flush-pipe connections 11 Defective walls, floors or roofs 25 Defective doors and windows 11 Want of light and ventilation 5 Insufficient closet accommodation 7 Insanitary urinals cleansed ... 2 Defective brickwork (repaired or re-built) 4 Closets not separate for sexes 1 Unsuitable or defective urinals 1 Soil-Pipes: Defective or insufficient soil-pipes and vent shafts 10 Want of, or defective ventilation shafts 4 Rainwater pipe acting as ventilation shafts 19 Defective Fresh air inlets 3 Drains: Defective drains 27 Defective sewers 4 Want of additional house drains 5 20 Choked or foul drains or gullies 20 Defective or insufficient gullies 11 Defective grating, dishing or curbing 7 Absence of, or defective, interceptor 18 Defective manholes 13 Defective manhole covers and frames 4 Sub-soil drains required 3 Dustbins: Defective receptacles 25 Paving: Defective paving of yards, forecourts, etc. 13 Sinks: Defective or insanitary sink 8 Want of sink 3 Insanitary wall-surface around sink 3 Waste-Pipes: Insanitary W.P.'s or shafts 2 Defective waste-pipes 23 Untrapped or unventilated waste-pipes 4 Dampness: Defective roofs 86 Defective gutters or spouting 42 Want of damp-proof course 8 Defective external brickwork 34 Defective pointing of door and window reveals 11 Damp and insanitary site under floor 3 Floor cavity unventilated 4 Defective wall or floor ventilators 4 General Defects: Verminous rooms 5 Verminous bedding 3 21 Dirty floors, woodwork, etc. 1 Accumulations of offensive matter 14 Defective plastering (No. of rooms) 174 Dirty walls and ceilings (No. of rooms) 126 Dirty walls and ceilings of staircases and passages 50 Defective floors 58 Defective doors and windows 38 Defective doors and window fastenings 34 Defective sashcords 62 Defective window sills 48 Windows not made to open 17 Inadequate lighting and ventilation 13 Defective firegrates and kitchen ranges 30 Defective chimney pots, etc. 21 Smoke nuisances 8 Defective coppers 1 Defective staircases 14 Miscellaneous defects 197 1466 At the end of the year, 1157 of the defects discovered had been abated, the work of remedying 51 was in hand, and the balance of 258 were still outstanding. In order to see that these defects were being properly remedied 1625 visits were paid to the various premises. notices served to remedy defects and abate nuisances. Informal Action. Preliminary intimations 317 Verbal intimations 21 Interviews 515 22 Statutory Action. Act and Section. Notices Authorised. Notices Served. Public Health Act, 1936. Section 24 (Drainage) 13 10 Section 39 (Drainage) 12 9 Section 40 (Soil Pipe) 1 1 Section 45 (Defective Closets) 4 2 Section 75 (Dustbins) 2 2 Section 92/93 (Nuisances 27 16 Housing Act, 1936. Section 9 (Insanitary Dwelling) 2 2 In the main the work called for by Statutory notices was carried out by the owners but in one case it became necessary for the Local Authority to carry out work in default under Section 9 of the Housing Act, 1936 at a cost of £74/5/6. PROSECUTIONS. It became necessary to take proceedings against an owner of premises who failed to comply with an abatement notice served under sections 92/93, Public Health Act, 1936. At the Petty Sessions Court, on the 21st April, 1952, a Nuisance Order was made requiring the owner to carry out works of repair within 56 days. Failure to comply with the Nuisance Order resulted in a further hearing at the Petty Sessions Court on the 4th September, 1952, when the owner was fined £5, with three guineas costs, with a continuing fine of 10s. per day until the date of commencement of repairs at the property. Proceedings in respect of four other premises were taken against the owner, following the service of statutory notices under the Provisions of the Public Health Act, 1936. At the Petty Sessions Court on the 21st April, 1952, the owner was fined £2 10s. Od. in respect of five summonses, and the Court granted Nuisance Orders for the work required. 23 COMPLAINTS. The number of complaints received from the 1st January to 31st December, 1952 was 597 which is a decrease over the same period in 1951. The complaints received have been classified as follows: — Defective firegrates 6 Defective sinks 6 Defective drains and gullies 62 Leaking pipes ... 16 Defective windows 6 Defective walls and ceilings 18 Offensive manholes 5 Lack of water supply 9 Defective W.C.'s 14 Defective roofs and gutters 41 Dampness 20 Dry rot 5 Defective stairs and steps 7 Accumulation of rubbish 8 Defective dustbins 8 Unsound food 5 Nuisance from rats and mice 221 Nuisance from animals 3 Nuisance from smoke 5 Nuisance from vermin, ants, etc. 36 General Defects 91 Overcrowding 2 Noise Nuisance 3 597 Prompt investigation was made and suitable action was taken to remedy the complaints. 24 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. . Articles Tons Cwts. Qrs. lbs. Chicken - - - 20 Fish (Wet and Dried) - 3 2 3 Fruit (Dried) — 3 — 10 Meat — 1 - 6 Sausages ... — — — 24 Tinned Goods (all classes) 2 — 2 6 2 8 2 13 INSPECTIONS OF FOOD PREMISES. Inspection of Food Premises has been steadily maintained throughout the year, a total of 592 visits being made. As a result of such visits the following improvements have been carried out:— Cleansing, repair and redecoration 10 premises Additional Sanitary accommodation 2 „ Improvement of existing Sanitary accommodation 4 „ Hot Water supply installed 2 „ Washing (staff) facilities improved 2 „ Drainage improvements 4 „ In no case was it necessary to serve Statutory Notice under the provisions of Section 13 of the Food and Drugs Act, 1938 for improvement of the premises. PROSECUTIONS. Two complaints were made by residents to the Department of (a) the finding of a nail in a brown loaf of bread, (b) finding of quantities of a black substance in a white loaf of bread. Investigations of these complaints were made and details submitted to the Health Committee who recommended the Council to take proceedings under the provisions of Section 3 of the Food and Drugs Act, 1938 (Sale of an article to the prejudice of the purchaser and not of the nature, substance or quality demanded). 25 Proceedings were instituted against the manufacturers of the bread and the cases were heard at the Petty Sessions Court, Richmond on the 18th September, 1952. The defendants were convicted on each of two summonses and fined £5 with an additional £5/5/0 costs in each case. BYELAWS AS TO THE HANDLING, WRAPPING AND DELIVERY OF FOOD AND SALE OF FOOD IN THE OPEN AIR. Byelaws for this purpose came into force on the 24th July, 1950 since when they have been very much in the minds of Inspectors when visiting food premises. Attention of proprietors has been drawn to infringements of the byelaws and advice and suggestions for improvement of methods given in many cases in an endeavour to help management and staff to achieve the byelaws standards. Experience has shown that the Byelaws do not provide an answer to some of the problems arising in the administration of the Food and Drugs Act, 1938. It still seems doubtful whether the provision of a constant hot water supply for handwashing, is legally enforceable. There appears to be no legal provision for dealing with food premises subject to cockroach infestation, and no provision to deal with the storage of refuse after it has been removed from the food room. Despite these shortcomings the standard in many food premises has been improved and during the year under review, in addition to the improvements set out in the preceding table, major reconstruction of food premises took place at two premises. RICHMOND CLEAN FOOD TRADERS' GUILD. During the year premises of all members of the Guild received inspection, and apart from the necessity to call upon some proprietors to carry out minor works of repair or decoration, the premises were found to be well maintained and well up to the standards set by the Guild. 26 Members have been constantly encouraged to further the interests of the Guild by prominent display of the Food Guild emblem on their premises. By the end of 1952 membership had increased by two to a total of 55 which represents a percentage of 14.51 of the total number of Food premises in the Borough, a somewhat discouraging figure. The Advisory Committee met on two occasions during the year, the Annual General Meeting being one, but apart from these meetings, there has been very little business for the Advisory Committee to discuss. There are still many premises within the Borough where the standard would admit immediate Guild membership but it is difficult to persuade the proprietors to apply. PETROLEUM (CONSOLIDATION) ACT 1928 AND REGULATIONS MADE THEREUNDER. Fifty premises within the Borough are licensed to store a total of 67,585 gallons of Petrol, Petroleum Mixtures and Cellulose solutions. They have received regular inspection to ensure that the various regulations have been observed. In all a total of 179 visits were made to the various installations. Two new licenses were approved and the licence fees amounted to £34 15s. 0d. Only minor infringements of the Regulations were found. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding, etc. Infectious Fevers 79 80 273 Tuberculosis 15 15 89 Vermin 22 181 65 Other Diseases 29 19 165 Costs recovered throughout the year £24 19s. 6d. 27 Solutions of D.D.T. in Kerosene are used for dealing with infestations by bedbugs and are usually applied in spray form to the walls, ceilings and woodwork of the infested rooms. It is becoming a rare occurence to give more than one course of treatment to eradicate bedbugs. D.D.T. powders prove very effective in dealing with ants and cockroaches and much practical help and advice has been extended to householders who have found their premises infested with these pests. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The rodent section of the staff have done much useful work during the year in eradicating rats and mice from premises and foul sewers. A total of 3492 visits were made to Dwellings and Business premises throughout the year. 221 complaints of infestation by rats or mice were received from occupiers of premises, and inspection and investigation revealed rat infestation at 189 premises, and mice infestation at 63 premises. By the end of the year infestations had been cleared at 244 of these premises. Treatment of the foul sewers was carried out on two occasions a total of 1619 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all 1473 manholes were dealt with and of this number 118 were found to be infested and were baited and poisoned. The takes of poison baits in the infested manholes were good and the results obtained at both sewer treatments were very satisfactory. SMOKE ABATEMENT. Richmond, being residential in character, has few large works or Factories and has little trouble with smoke nuisances from industrial chimneys. Five complaints of a minor character, were received during the year and 9 observations for excess smoke were made. Interviews with managers and advice to stokers, in those cases where the complaints were justified, resulted in improved conditions. 28 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. This Act came into force on the 1st November, 1951 and briefly its provisions call for the registration of all premises in which Rag Flock or other filling materials, as defined in Section 33 of the Act (i.e. : Kapok; Woollenfelt; Cotton flock, etc.) are used, in the manufacture of bedding, toys, babycarriages and other articles of upholstery. The Act also calls for the licensing of premises where Rag Flock is (a) Manufactured; (b) Stored for distribution to registered premises but no premises coming within this definition are situated within the Borough. Only 1 Factory in the Borough has been registered, regular supervision of the premises has been maintained during the year. No infringements of the provisions of the Act were observed. PET ANIMALS ACT 1951. This Act came into force on the 1st April, 1952 and is designed to secure for Pet Animals kept in shops, for sale to the Public, suitable accommodation as regards size, temperature, lighting, ventilation and cleanliness; adequate supplies of food and drinking water; prevention of sale at too early an age; precautions to prevent the spread of infectious diseases amongst the animals and precautions to be taken in case of fire or other emergency. No person may now keep a pet shop unless he obtains a licence from the Local Authority, and it is an offence to sell animals as pets in any part of a street or public place, except at a stall or barrow in a market, or to sell pets to children under 12 years of age. In this Act, "animal" is defined as including any description of vertebrate and as such includes goldfish and cage birds, which are the principal sales in the shops licensed in the Borough. A Survey of all shops thought to come within the provisions of the Act was made and arising from this Survey, 4 premises hold licences from the Richmond Borough Council to carry on this business. Regular inspection of the premises is carried out, and a close liaison maintained wth the Local representative of the Royal Society for the Prevention of Cruelty to Animals. Licences are renewable annually and an inspection is made before renewals are brought before the Council. 29 DISEASES OF ANIMALS ACT 1950. The latter months of 1951 and the early months of 1952 were notable for the large number of outbreaks of Foot and Mouth Disease reported throughout England and Wales. Richmond was not directly involved in any of these outbreaks but came under Controlled Area Restrictions on four occasions during 1952. These restrictions controlled the movement of animals except for special purposes and in connection with this control the following licences were issued countersigned. Three occupational licences issued to allow movement of animals from farm buildings to grazing grounds; 8 licences countersigned to allow movement of calves, pigs and sheep to slaughterhouses for immediate slaughter, and 1 licence countersigned to allow the movement of calves from a farm in the Borough to an address in Surrey. 30 SECTION D—HOUSING. Housing Statistics for the year 1951. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1315 Number of Flats 327 Total 1642 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) 940 (b) Number of inspections made for the purpose 2565 (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 4 (b) Number of re-inspections made under the Regulations 49 (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 291 (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) 248 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 1 (b) By Local Authority in default of owners 1 B. Proceedings under the Public Health Acts: — (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 40 (ii) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 38 (b) By Local Authority in default of owners — C. Proceedings under sections 11 and 13 of the Housing 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 considerable throughout the Borough. The points scheme of House allocation usually covers the worst of these cases and their overcrowded conditions are relieved as and when houses are available. 4. Council Houses. Total number of houses erected post-war to 31st December, 1952 Temporary bungalows 179 Permanent houses 332 Permanent flats 165 497 Total number included in above, erected in 1952 Permanent Houses 46 Permanent Flats 30 Total number of requisitioned premises up to December 31st., 1952 113 (providing 227 family units) Total number of families rehoused in 1952 102 Total number of families still on Waiting List at December 31st, 1952 1510 At the present time there are 16 one-bedroomed flats on the Sandy Lane Estate and 9 one-roomed flatlets in Eton Street nearing completion. As to the future, it is proposed to erect, on two separate sites, a total of 8 one-bedroomed flats for aged persons. Moveable Dwellings. An owner of land within the Borough, holds a licence, renewable annually, permitting him to stand two caravans on the land. Satisfactory provision is made for the disposal of household refuse, use of sanitary conveniences and main water supply. Two inspections of this site were made during the year. 33 Withdrawal of Closing Orders. Closing Orders made under Section 12, Housing Act, 1936, by the Richmond Borough Council in respect of four basement premises were determined during the year following the completion of works of repair which rendered the premises fit for human habitation In the case of one other property, an undertaking was given by the owner on the 18th November, 1938, that the premises should not be let for human habitation. The undertaking was withdrawn on completion of a schedule of repairs which rendered the premises fit for habitation. Rent & Mortgage (Interest Restrictions) Act, 1920-1939. One application for a certificate to enable the tenant of a dwelling house to suspend payment of the increase of rent on the grounds of the premises being not in a reasonable state of repair, was made On inspection, the application was found to be justified and the Council agreed to the isuue of the necessary certificate. 34 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, 1952. Articles. Analysed Adulterated or Irregular Prosecutions Convictions Formal Informal Total Formal Informal Total FOOD: Milk 29 11 40 Beer 2 2 4 Coffee 1 1 Confectionery 1 1 2 1 1 2 Fish Paste 2 2 Flour 1 1 Honey 1 1 Ice Cream 1 2 3 Jelly 1 1 Pepper 1 1 Sausages 5 5 Sausage meat 1 1 Whisky 2 2 Wine 1 1 DRUGS : Aspirin Tablets 1 1 Totals 25 06 1 1 2 35 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 19 Sterilised Milk 22 Supplementary licences were granted authorising dealers to retail milk in the Borough from premises situated outside as follows:— Pasteurised Milk 7 Tuberculin Tested Milk 7 Sterilised Milk 7 All premises in the district were inspected after receipt of the application of 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 121 No. found to be satisfactory 116 No. of samples of raw milk examined biologically for the presence of tubercle bacilli 6 No. of samples found satisfactory 6 The District Medical Officer of Health retains the power to take appropriate action to prevent the spread of disease by infected milk. 36 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 113. A total of 113 samples were submitted to the Bacteriologist for examination and of this number 96 fell within Grades 1 and II and were considered satisfactory and 17 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. 37 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). Diseases. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Scarlet Fever 95 42 - Puerperal Pyrexia 1 - - Pneumonia 4 - 24 Erysipelas 5 2 - Measles 536 5 - Whooping Cough 39 - - Poliomyelitis Paralytic 3 3 - Poliomyelitis Non Paralytic Dysentery 2 11 2 — Ophthalmia Neonatorum 3 - - Food Poisoning 13 4 1 Total 712 58 25 During the year 117 cases of suspected infectious disease were admitted to hospital. Of these 82 were accommodated in the South Middlesex Fever Hospital. The remaining 35 cases for whom beds were not available in the South Middlesex Hospital were admitted to Tolworth Isolation Hospital or to Isolation Hospitals in the L.C.C. area. 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, 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. 38 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. Total number of outbreaks 2 Number of cases notified 13 Number of deaths 1 DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1952:— (a) Pre-school children (under 5 years) 489 (b) Between 5 and 15 years 58 Total 547 Grand Total of Children in the Borough who have received immunising treatment by the end of the year:— (a) Under 5 years 2160 (b) Between 5 and 15 years 4285 Number of Children given re-inforcing doses during 1952 773 The following table shows the percentages of children immunised as recorded in the Annual Reports since 1946:— 1946 1947 1948 1949 1950 1951 1952 Under 5 years 69.9 59 69.8 69.8 69 67.6 69.9 5 to 15 years 86.2 88 95.3 94 91.4 95.2 91.5 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 Precipitated Toxoid and for children over 10 Toxoid Anti-Toxin Floccules. l.A.F. is used for all reinforcing doses and is given subcutaneously. 39 WHOOPING COUGH IMMUNISATION. Immunisation against Whooping Cough was recommenced in October, 1952. A combined prophylactic giving protection against Diphtheria and Whooping Cough is used, or in cases where Diphtheria Immunisation has already been completed, protection against Whooping Cough is given separately. Attendances at Clinics, October—December, 1952. Diphtheria and Whooping Cough Combined Whooping Cough only Windham Road, Richmond 199 200 Back Lane, Ham 38 36 Private Doctors. In addition 63 children were immunised with the combined prophylactic by private doctors and 5 against whooping cough alone. VACCINATION AGAINST SMALLPOX. 1. Welfare Centres. Number of persons vaccinated at Welfare Centres in the Borough during 1952 was as follows:— No. Vaccinated Children Adults Windham Road, Richmond 243 18 Back Lane, Ham 43 — Totals 286 18 Grand total 304 2. Private Doctors. Number of Richmond residents who were vaccinated by private doctors was as follows:— Children Adults 208 185 Grand Total 393 40 3. Analysis of vaccinations at Welfare Centres and Private Doctors' Surgeries. Children. Adults. Primary Vaccination 452 37 Re-vaccination 42 166 Totals 494 203 Grand Total 697 4. Figures showing the percentage of children under 1 year vaccinated during 1952. No. Vaccinated Net Births 1951 % Vaccinated. 411 604 68.0 VERMINOUS CONDITIONS. YEAR 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 Scabies 34 128 241 431 274 377 66 12 11 7 2 Nil. Head Lice - 204 205 181 188 308 239 78 141 129 98 40 Figures in the above table are children attending schools in the Borough found to be verminous at routine inspections in school by Health Visitors. Scabies is no longer a problem in the district. The 40 cases of louse infestation are school children who are well known to the School Nurses. They are given materials for cleansing and parents are given full instructions. Bad cases are cleansed at the school clinics by the Health Visitors. 41 TUBERCULOSIS. The position in Richmond for the year 1952 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Eighty-four cases of respiratory tuberculosis were notified viz:— 50 males and 34 females. The corresponding figure for 1951 was 61. Non-Respiratory Tuberculosis. Four new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Seven such cases have been notified during 1951. 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 196 23 Females 140 21 336 44 Corresponding figures for 1951 290 43 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 1 3 1 ... ... ... ... ... 5 3 4 ... 1 ... ... ... ... 15 5 7 ... ... 1 ... ... ... 25 11 10 ... ... 1 1 ... ... 35 6 5 ... 1 1 2 ... ... 45 12 2 1 ... 2 1 ... ... 55 7 1 ... ... 2 ... ... ... 65 and upwards 5 2 ... ... 5 2 ... ... Totals 50 34 2 2 12 6 ... ... Three of the above deaths were due to other conditions but affecting persons suffering from tuberculosis. This accounts for the discrepancy between these figures and those of the Registrar General. 42 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 1952 it was not found necessary to take action under either of the above enactments. 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.