??? ??? BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1954 J. H. BROAD & Co. Ltd., Printers, 8, King Street, Richmond, Surrey. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1954 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 Illegitimate Infants 12 Comparative Statistics 13 SECTION B—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Clinics and Treatment Centres 14 Health Visitors 14 District Nurses and Midwifery Services 14 Moral Welfare 14 Home and Domestic Help Services 14 Ambulance Facilities 14 Day Nurseries 14 Hospitals 15 Laboratory Facilities 15 Mortuary 15 Nursing Homes 15 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 17 Sanitary Inspection 18 Sanitary Defects 19 Notices Served 20 Prosecutions 21 Complaints 21 Petroleum Acts 22 Disinfection and Disinfestation 23 Prevention of Damage by Pests Act, 1949 23 Smoke Abatement 24 Rag, Flock and Other Filling Materials Act, 1951 24 Pet Animals Act, 1951 25 Diseases of Animals Act, 1950 25 Drainage and Sewerage Systems Tested 26 Factories Act 1937 26 Shops Act 1950 SECTION D—HOUSING. Housing 28 Council's Housing Programme 30 Moveable Dwellings 31 Closing Orders 31 Slum Clearance 31 Housing Repairs and Rents Act 1954 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Food Inspection Sampling of Food and Drugs Classification of Food Premises 36 Inspection of Food Premises 36 Byelaws37 Richmond Clean Food Traders' Guild 38 Sale and Storage of Ice Cream 38 Milk—Licencing and Sampling SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Diseases 41 Admission to Infectious Diseases Hospitals 41 Food Poisoning 41 Diphtheria Immunisation 41 Whooping Cough Immunisation 42 Vaccination Against Smallpox 43 Verminous Conditions—Scabies and Head Lice 44 Tuberculosis 44 1 Public Health Department, Parkshot, Richmond. July, 1955. 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 1954 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is similar to that for 1953 and is in accordance with Ministry of Health Circular 28/54. I think that the report shows that the health of the residents has been good during the year, that the Department has made every effort to eliminate any unsatisfactory circumstances, and that progress has been made. I would like to thank all members of my Staff for their loyalty and hard work during the year, and my colleagues in other depart' ments for their helpful co-operation. Finally I wish to express my appreciation of the support received from my Chairman and the Chairmen and members of all Committees with which I have been concerned. 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: EDWARD S. HERBERT, M.S.I.A. Additional Sanitary Inspectors: CHARLES S. SMEATON, M.R.San.I. NOLAN VICTOR SAUNDERS, M.R.San.I. Clerks: MRS. F. G. SMITH (Senior Clerk). MISS M. WILTSHIRE. MISS J. TRANTER. Rodent Officer: THOMAS R. SMITH Rodent Operator: RONALD EVANS. Drain Tester, Disinfector and Driver : JAMES DAVIS. 3 BOROUGH OF RICHMOND. Report of the Medical Officer of Health for the year 1954. PREFACE. Staff. Early in May, Mr. K. H. Halstead left the staff of Sanitary Inspectors to take up a similar position with another Authority. The vacancy was advertised on a number of occasions but there were no ipplicants. Thus for eight months of the year the department was short-staffed and a good deal of the routine work had to be left undone. The establishment, (a Chief Sanitary Inspector, a Senior Inspector and two District Inspectors) is exactly right for this area, but where prolonged vacancies exist the work must suffer. The Senior Clerk, Miss J. Black, resigned to take up a secretarial position in industry. She had held this appointment since 1946, and throughout this period she served the Authority faithfully and competently. The post was filled by the promotion of Mrs. F. G. Smith who had been on the Staff for the same length of time, and who was familiar with all aspects of the work. The vacancy caused by the promotion ot Mrs. Smith was filled by the appointment of Miss J. Tranter as junior clerk-typist. Population. The Registrar General's estimate of the population was 42,480 which is an increase of over 500 on the Census, population of 1951. As Richmond contains rather a high proportion of elderly persons the crude birth and death rates must be corrected to make them Properly comparable with rates for the remainder of the country. The Registrar General supplies factors for this purpose. Births. During the year 632 births were recorded (319 males and 313 females). This figure may be compared with 585 in 1953 and 851 in 1947, The number of illegitimate births was 35 which is one more than in 1953. This compares favourably with figures for the postwar years and is steady at the pre-war level. 4 The proportion of births taking place in dwelling houses remains at the low level of 23%. The proportion is much higher in Ham where housing conditions of young families are generally better, and it seems most unlikely that the figure will increase throughout the borough until substantial progress has been made in alleviating overcrowded and unsatisfactory housing conditions. There were 48 premature live births, of whom, 40 survived. 01 the 8 infants who failed to survive 5 weighed less than 4lbs. 6ozs. and because of the degree of prematurity, would be difficult to rear. Health Visitors are notified early of premature births and all possible assistance is given to the mothers. In addition, an enquiry is made into each case in an effort to discover the causes of prematurity. Loss of life through premature births is very considerable and should, in many cases, be preventable. Research into the subject is to commence shortly and the Local Health Authority will take part. There is no doubt that bad housing and the need for mothers to go to work play an important part. Deaths. The total number of deaths occurring amongst residents was 519 (254 males and 265 females). The death rate, when corrected to allow for the high proportion of elderly persons, is 9.84 per thousand, which compares favourably with other towns in the country. The table of comparative statistics shows that the death rate for certain important diseases is considerably lower in Richmond than elsewhere except in the case of pneumonia. The apparent high incidence of pneumonia in Richmond is due to the high proportion of elderly residents who, after living to a good age, finally die from pneumonia. It is pleasing to be able to report that during the year there was not a single death due to diphtheria, whooping cough, measles or poliomyelitis. Unfortunately, there was one infant death due to diarrhoea. This was a Nigerian boy, aged 8 months, who was staying with his parents in a local hotel. The infant contracted a virulent form of enteritis, and his condition deteriorated so rapidly, that he died before treat ment in hospital could be given. His brother and sister were mildly affected, but searching investigations failed to identify the causal organism. 5 There were 13 deaths of infants under 1 year which compares with 6 in 1953 the lowest number ever recorded. Of these, 8 were due to prematurity, 2 to pneumonia, 1 to enteritis, 1 to drowning, and 1 to congenital abnormality. In only the last case can the death really be considered to have been unavoidable. NOTIFIABLE DISEASES. The table in Section F sets out the numbers of cases of infectious diseases notified by General Practioners during 1954. There was no particularly high incidence of any diseases and generally the situation was more favourable than in the previous year. Measles. The comparatively small number of cases of measles was to be expected as this disease tends to be epidemic in alternate years. Generally the symptoms were moderate and in only two cases was admission to hospital required. Whooping Cough. The incidence was much lower than in 1953 when the abnormally high figure of 261 cases was reported. The scheme for immunizing children against whooping cough commenced in October 1952 and by 31st December, 1954, a total of 1406 children had been protected. It is therefore reasonable to hope that the scheme is beginning to have its effect and this dangerous disease is being reduced in incidence and severity. Poliomyelitis. Only one case was notified. This was a little girl aged 4-| years who was under investigation in hospital for difficulty in walking. There was some weakness of her muscles of the left leg otherwise all investigations were negative. The diagnosis was thus doubtful hut poliomyelitis seemed the most likely cause. Typhoid Fever. It is unusual to have to report two cases of this disease. The patients were husband and wife. The wife was the first to be taken '11 and after a few days treatment at home she was admitted to hospital where the diagnosis of typhoid fever was made. About 2 weeks later the husband also became ill and investigation in hospital proved that he was similarly infected. 6 Search was made for the source of infection without any satisfactory result. It was found that two relatives of the wife had suffered several years earlier from this disease but it was not possible to establish that either of them was a carrier. Paratyphoid Fever. In December a lady resident was taken ill, removed to hospital and was found to be suffering from paratyphoid B of an unusual phage type. A few cases of the same type had occurred in other districts and each case had eaten products of a bakehouse which had used a certain batch of frozen Chinese egg. Enquiries revealed that this patient's father lived in the same house and worked in a bakery which had used the same batch of egg. There was thus a possibility of a carrier amongst the Staff and danger that further cases might arise from this source. With the willing assistance of the Management specimens for investigation were obtained from every member of the Staff. No carrier was discovered and it did not appear that anyone on the staff had been infected. Food Poisoning. There was no outbreak in 1954. One child had the symptoms of acute food poisoning. At first no casual organism could be discovered but eventually, Staphylococcus Aureus was isolated. This may have been the cause. The source could not be discovered and there were no other cases associated. Another child was admitted to hospital with symptoms of food poisoning and was found to be infected with Salmonella typhimunurn. It was not possible to ascertain the source of infection. There were no other cases. Dysentery. Of the 27 cases notified all were due to an organism known as Shigella Sonnei. This form of dysentery is generally mild and it occurs widespread throughout the country. There was an outbreak at Kew in June when 20 cases occurred. A number of infected children attended Queens School and some spread of the infection occurred here. Spread was greater, however, in households particularly where overcrowded conditions existed. 7 Exclusion of cases and contacts from school, together with treatment controlled by bacteriological examination of specimens brought the outbreak to an end by the end of July. The remaining cases occurred singly or in pairs in various parts of the borough and were quite unrelated to one another. Immunization. The schemes for immunizing children against diphtheria and whooping cough were continued as in former years. In 1954 there was no interruption since there was no undue prevalence of poliomyelitis and the response of parents was very good. At the end of the year the percentage of pre-school and school children immunized was higher than ever before and, indeed, higher than in most parts of the country. Late in the year it was decided to recommend that immunization against diphtheria and whooping cough (combined) should commence at 3 months and be followed by vaccination against smallpox at 6 months. This is proving popular and the result should be that a higher proportion of infants under 1 year will be protected and the vaccination rate will rise . B.C.G. A start was made with the scheme to offer vaccination against tuberculosis with B.C.G. to all school children who are in their 13th year. Response was good and the organization worked smoothly with little interruption to school routine. Such inoculation should give useful protection during the subsequent four or five years after which natural development of resistance should supersede. This, together with improved facilities for the diagnosis, treatment and isolation of cases, should help to eradicate this crippling disease from the country in the forseeable future. The population is becoming more conscious of the importance of good health and their willingness to make use of services offered is an important factor in the progress of any scheme. Care of the Chronic Sick. This continues to be one of the most difficult problems. Richmond is situated within a hospital area which contains a very large number of cr y Pe°ple. A good deal is done for them but only too often it is ouri that when they become ill the available services are inadequate. 8 When an elderly sick person is living alone and admission to hospital is essential, I have the active co-operation of the Physician Superintendent of Kingston Hospital who controls the hospital beds for such patients. The less urgent cases, however, cannot be admitted and often the domiciliary services fall short of the required standard. With the help of District Nurses, Home Helps, and the activities of various voluntary organizations these cases are cared for fairly well by day— the chief difficulty comes at night when the burden is often too great for even the most willing relative. The whole problem has been under urgent and careful consideration by the Regional Hospital Board and the Surrey County Council and progress is being made. A special Geriatric Unit is being established in Kingston Hospital with a specially appointed Medical Officer in charge. This doctor has the services of a special Health Visitor and has the responsibility of assessing the urgency of all patients whose admission to hospital has been requested by the General Practitioners. Where immediate admission to hospital is impossible arrangements are made to provide any domicilary services which may be helpful. By making suitable treatment available at the Geriatric Unit it is hoped that a proportion of the patients will be so improved that they can return to their homes instead of entering permanently a hospital or Old Peoples Home. In addition, old people who have asked for assistance such as Home Help, will be more closely supervised by Health Visitors. It is hoped that in this way, any other services required will be provided earlier, thereby maintaining health and delaying or eliminating the need for admission to hospital. A lot remains to be done and time will be required, but attention has been focussed on the problem and it is heartening to feel that a start has been made. There is no doubt that the future will see continuing improvements. 9 Housing. During the year 17 permanent flats were added to the Council's estate bringing the total of properties owned up to 1834. The future programme is limited by shortage of building space and there is no easy solution to the problem of giving up requisitioned properties, dearing unfit dwellings, and attempting to re-house families who, for long, have been living under most unsatisfactory conditions. There are some 137 dwellings in the borough which are unfit and which should be demolished. These should be dealt with as soon as possible as with each passing year they deteriorate even further. In addition, there are properties which are in poor condition and which are not receiving the maintenance they require. These continue to deteriorate and in time will become unfit for habitation and thus come into the category of properties suitable only for demolition. Thus, if the Council is to solve its slum problem there is need for action in the near future—delay will only lead to even greater difficulties at a later date. Sanitary Circumstances. The report of the Chief Sanitary Inspector is included in Sections C, D and E, and reference to these shows the large and varied amount of work undertaken by the team of Inspectors and the Rodent Control Staff. Richmond Borough Council became a Food and Drugs Authority during the year and the Health Department took over these duties from the Surrey County Council as from the 1st April. These duties have been undertaken by the Inspectors without any increase in Staff. There were considerable difficulties at first because of the shortage of one Inspector but these have been overcome. There is no doubt that assumption of these duties was a very good 'tiove on the part of the Council. Not only is there a considerable financial saving, but it is obviously more effective for food sampling to be carried out by local officers who have an intimate knowledge of the district and know the tradesmen, rather than by officers of the County Council who cannot have his knowledge. On the whole it has been found that the nature and quality of foodstuffs sold are of a satisfactory standard. 10 APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1953) 42,480 Number of inhabited houses (estimated) 11,570 Rateable value £643,256 Sum represented by a Penny Rate £2,556 BIRTHS. Birth Rate per 1,000 of estimated resident population 14.8 (Corrected) 13.8 Total number of births (live and still) 632 Still birth rate per 1,000 total births ... ••• 17.4 Environment of births:— Proportion taking place in the Borough 23% Proportion taking place outside the Borough 77% Proportion taking place in Institutions 77% Proportion taking place in dwelling houses 23% Proportion notified by midwives alone 23% Proportion notified by doctors or parents 77% DEATHS. Death Rate per 1,000 estimated resident population 12.3 (corrected) 9.84 Total number of deaths from all causes 526 Analysis:— Live Births Legitimate Illegitimate Stillbirths Legitimate Illegitimate M 292 19 7 1 F 296 14 2 1 Total 588 33 9 2 Analysis:— All causes Cancer Diphtheria Measles Whooping Cough Diarrhoea (under two years) M 259 50 – – – 1 F 267 42 – – – Total 526 92 – – – 1 ii MATERNAL MORTALITY. The provisional numbers of deaths and death rates per 1,000 total live and still births are : — England and Wales. Number Rate Maternal causes, excluding abortion 402 0.58 Due to abortion 76 0.11 Total maternal mortalitiy 478 0.69 Richmond. Maternal causes, excluding abortion Nil Nil Due to abortion Nil Nil Total maternal mortality Nil Nil Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 20.9 Rate for legitimate infants per 1,000 legitimate live b'rths 18.7 Rate for illegitimate infants per 1,000 illegitimate live births 60.6 Total number of infant deaths in the Borough ... 13 Analysis:— Legitimate Illegitimate M 5 1 F 6 1 Total 11 2 Environment of Infant Deaths:— Number occurring in the Borough Number occurring outside the Borough Number occurring in Institutions 2 11 12 Causes of Death under 1 year of age. Cause of Death Under I week 1—2 week* 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 vear 1. Pneumonia ... ... ... ... ... 1 ... ... l 2 2. Acute Suppurative Bronchitis ... ... ... ... ... ... ... ... ... ... 3. Whooping Cough ... ... ... ... ... ... ... ... ... ... 4. Enteritis ... ... ... ... ... ... ... 1 ... 1 5 Prematurity 8 ... ... ... 8 ... ... ... ... ... 6 Congenital Abnormality ... ... ... ... ... 1 ... ... ... 1 7 Asphyxia ... ... ... ... ... ... ... ... ... ... 8 drowning 1 ... ... ... 1 ... ... ... ... ... 9 ... ... ... 9 2 ... 1 1 4 PREMATURE PREMATURE LIVE BIRTHS. STILLBIRTHS. Born in Hospital Born and Nursed at Home Born at Home and Transferred to Hospital Born and Nursed in Nursing Home Born in Hospital Born at Home Born in Nurs'g Home Weight Total Died within 24 hours of Birth Survived 28 days Total Died within 24 hours of Birth Survived 28 days Total Died within 24 hours of Birth Survived 28 days Total Died within 24 hours of Birth Survived 28 days 31b. 4oz. or less 7 3 3 – – – – – – – – – 2 – – Over 3lb. 4oz to 41b. 6oz 10 1 9 — — — 1 1 — — — — 1 – — Over 41b. 6oz. to 41b. 15oz. 7 — 7 1 — 1 — — — — — — — — Over 41b. 15oz. to 51b. 8oz 16 1 14 3 — 3 — — — 3 — 3 1 1 — TOTALS 40 5 33 4 — 4 1 1 — 3 – 3 4 1 — ILLEGITIMATE BIRTHS 1945 1946 1947 1948 1949 1900 1951 1952 1953 1954 No. of illegitimate live births 62 51 54 38 40 43 43 25 34 33 No. of illegitimate deaths under 1 year 4 5 2 0 1 2 0 3 1 2 Illegitimate death rate 65 1 98 30 0 25 46 0 120 29 60 COMPARATIVE STATISTICS—1954. Rate per 1,000 Population LIVE BIRTHS Rate per 1,000 (Total Live & Still) STILLBIRTHS Rate per 1,UU0 Population DEATHS (AH Causes) Rate per 1,000 Related Live Births DEATHS (Under One Year) Death Rate Per Million Population Rale p*r 1 000 (Live Birihs) Fnteritis & Diarr. (Under 2 vrs. of age) Who. C. Dipth. Infl. Acute Polio. Pneum. England & Wales 15.2 23.3 11.3 25.5 2.75 .25 46.75 2.75 481.75 0.80 Great Towns 10.8 25.6 12.0 29.2 3.5 .27 41.25 3.25 502.25 0.87 Smaller Towns 15.4 22.3 11.3 23.7 3.0 .175 46.0 4.5 493.25 0.50 Richmond 13.8 17.4 9.84 20.9 0.0 0.0 23.54 0.0 612.05 0.02 13 DEATHS—RICHMOND (Rates per 1,000 Population). Actual Numbers. Rate. All Causes 526 12.3 Whooping Cough — 0.0 Diphtheria — 0.0 Tuberculosis 4 0.09 Influenza 1 0.02 Acute Poliomyelitis (including Polioencephalitis) — 0.00 Pneumonia 26 0.61 14 SECTION B—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. These are mainly provided by the Surrey County Council, the South West Metropolitan Regional Hospital Board, and the Executive Council for the County GmJiilll. In order to make the report complete these are briefly described below. (a) Services Provided by the Surrey County Council. These are organized on a Divisional basis, the Northern Division comprising the Boroughs of Richmond and Barnes. The Medical Officer of Health for Richmond is also the Divisional Medical Officer and this arrangement provides close co-ordination of the personal health services and environmental health. Administrative, Infant Welfare, and School Medical functions are carried out from the following Centres: — Divisional Health Offices and Welfare Centre, Kings Road, Richmond. Welfare Centre, Windham Road, Richmond. Welfare Centre, Back Lane, Ham. Health Visitors are employed and, according to the District in which they work they are based on one or other of the above centres. District Nurses and Midwives are provided and in Richmond their centre is the Nurses Home, 19, Larkfield Road. They work under the direct supervision of the general practitioners. Moral Welfare or the care of unmarried mothers and illegitimate children is undertaken by an officer based at the Divisional Health Office. A Home Help Service provides for domestic help in the home in cases of home confinement or illness. The service is under the manage' ment of the Home Help Supervisor who is based at the Divisional Health Office. An Ambulance Service is provided from the station in Kings Road, Richmond which operates under the control station in Maiden. The service is supported by the ambulance of the local division of the St. John Ambulance Brigade. A Day Nursery for the care of children up to the age of five years is located in Parkshot, Richmond. 15 (b) Services Provided by the Regional Hospital Board. Hospitals. The Royal Hospital and Kingston Hospital provide general treatment both for in-patients and out-patients. In addition, hospitals in London and Middlesex are frequently used by Richmond residents. Patients suffering from infectious diseases are admitted to the South Middlesex Hospital, Mogden Lane, except in the few instances when no beds are available. In these cases, patients are admitted to Tolworth Isolation Hospital or to a hospital in the London area. Laboratory Facilities. The laboratory of the Royal Hospital is available for the examination of specimens sent in by general practitioners. The Ministry of Health, Public Health Laboratory, Epsom, is available for the examination of samples of milk, ice-cream, and water and of any pathological specimens. In addition, the staff is always available to assist the Medical Officer of Health in field investigations in the case of epidemics or outbreaks of food poisoning. The Central Public Health Laboratory, Colindale, N.W.9, is available for advice, special immunising agents and special investigations. The Counties Public Health Laboratories, Victoria Street, S.W.I are used for the examination of water samples and for advice in the control of purity of the water supply. Mortuary. This is provided and maintained by Richmond Borough Council on a site close to the Petty Sessions Court. It is well equipped with two post-mortem examination tables. All such examinations required within the boroughs of Richmond and Barnes are carried out here and Barnes Borough Council make an annual payment for this service. Nursing Homes. The following private Nursing Homes are registered by the Surrey County Council: — The Misses E. Town and D. Smith, 9, Townshend Road. Tyneham House Nursing Home, 108, Church Road. Tuqvor House Nursing Home, 18, Mortlake Road, Kew. 16 (c) Services Provided by the Surrey Executive Council. Under Part IV of the National Health Service Act 1946, the Surrey Executive Council has the responsibility of providing General Medical and Dental Services, Pharmaceutical Services, and Supplementary Ophthalmic Services. Twenty-two doctors living within the Borough have undertaken to provide General Medical Services. Many of these have also undertaken to provide Maternity Medical Services. A list of doctors taking part is available at the Main Post Office, Public Library and Public Health Department. The offices of the Council are situated at 187, Ewell Road, SurHton. 17 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 162 samples Treated water 395 samples For chemical analysis 17 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 963 Samples examined chemically 225 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, allot' nents 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. Fifty-two samples of river water were bacteriologically examined during the year. 18 The following figures show the daily average consumption from the three sources : — 1953 1954 All Richmond Wells 771,049 galls. 756,186 galls. Metropolitan Water Board 946,937 galls. 877,564 galls. Raw River Water 228,411 galls. 192,534 galls. The use of the Terrace Gardens deep well was discontinued in November 1953 to allow for extensive overhaul. Work continued for twelve months and it was not until November 1954 that pumping from this source could be resumed. The effect of this was to reduce the annual yield of water from Richmond Wells and to increase the hardness of the supply. The water from the deep well is comparatively soft and has a most useful effect in reducing the hardness of water from our shallow wells. 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. 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 1954. Houses visited and particulars recorded (Housing Act) 67 Houses visited (Public Health Acts) 797 Revisits to houses and other premises 1499 Houses visited for Certificates of Disrepair 18 Visits paid in connection with:— Overcrowding 20 Vermin Disinfection 120 Enquiries into Infectious Diseases 144 Routine inspections in connection with:— 70 Factories (mechanical) Factories (non-mechanical) 22 Outworkers 20 19 Bakehouses 20 Butchers' Shops 63 Dairies and Milk Shops 13 Fishmongers and Poulterers 8 Fried Fish Shops 11 Ice-cream premises 74 Greengrocers' and Fruiterers 32 Other food stores 99 Public Houses 18 Restaurants and Tea Shops 122 Food and Drugs Act Sampling 71 Milk Sampling (Designated Milk) 114 Unsound Food 1^5 Drainage 783 Interviews 761 Massage Establishments 1 Pet Animals Act 5 Petroleum Acts 60 Piggeries 1 Rats and Mice (Visits to Properties) 4192 Rats and Mice (Visits re sewer treatments) 1483 Schools—Elementary and Secondary Shops Acts 5 Smoke Nuisances—Inspection and Observations 28 Theatres and Cinemas 4 Water Supply 264 Miscellaneous Visits 1373 12,684 Drainage and Sewerage Systems Tested. Hydraulic tests 32 Smoke tests 16 Chemical tests 13 Examinations 30 91 20 Factories Act, 1937. At the end of the year there were 160 factories on the register (146 mechanical and 14 non-mechanical) carrying on the following trades: — Mechanical. NonMechanical. Artificial wreaths, etc 2 — Bakeries 10 — Boat Repairs 1 1 Boilermakers 2 — Boot-making and Repairing 9 — Building 1 3 Butchers 3 — Clothing 2 — Coach Building 7 — Dressmaking 10 3 Electrical Instruments, etc. 8 — Engineering 21 — Furniture and Upholstery 8 3 Joiners 4 — Laundering and Cleaning 4 — Milk Pasteurising 2 — Motor Vehicle repairing 24 — Printing 7 — Saw Mills 2 Tailoring 2 2 Wallpaper manufacture 2 - Miscellaneous Trades 15 2 146 14 101 visits of inspection were made to the premises outlined above and the following defective conditions were remedied: — Want of cleanliness to Factory walls, etc – Inadequate ventilation of Factories – Ineffective drainage of Factory floors – 21 Insufficient Sanitary accommodation 3 Unsuitable or defective conditions in Sanitary accommodation 4 Other matters requiring attention 2 9 Shops Acts, 1950. 793 Shops on the Register Visits made 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. Animal nuisances Basement areas inadequate Ceilings broken or otherwise defective Chimney stacks defective Coppers broken or otherwise defective Damp-proof courses required or defective 1 Doors defective 21 Drainage systems obstructed 48 Drainage systems leaking or defective 47 Firegrates and flues defective 29 Floors broken or otherwise defective 38 Floor drainage inadequate – Food preparation equipment unsatisfactory 27 Food rooms requiring reconstruction 3 Food storage unsatisfactory 12 Gutters leaking or defective 34 Lighting inadequate 5 Paving inadequate or defective 4 R W.Ps. ventilating drainage systems 1 R-W.Ps. broken or otherwise defective 9 Refuse accumulations 6 22 Refuse receptacles defective 25 Roofs leaking or defective 60 Rooms requiring cleansing 102 Sanitary accommodation insufficient 4 Sanitary accommodation not separate for sexes — Sinks insanitary or defective 13 Sites requiring concrete 1 Soilpipes leaking or defective 15 Staircases defective 8 Ventilation of rooms inadequate 3 Verminous premises 3 Walls: plaster defective 135 Walls: brickwork defective 13 Washing facilities in food premises inadequate 5 Wastepipes leaking or defective 27 Water fittings defective 46 Water supply cut off 22 Water supply inadequate 1 W.C.'s leaking or defective 34 Windows defective 64 Miscellaneous defects 44 985 At the end of the year, 755 of the defects discovered had been abated, the work of remedying 90 was in hand, and the balance of 140 was still outstanding. In order to see that the defects were being properly remedied 1499 visits were paid to the various premises. NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 264 Verbal intimations 72 Interviews 761 23 Statutory Action. Act and Section. Notices Authorised. Notices Served. Public Health Act, 1936. Section 24 (Drainage) 8 5 Section 39 (Drainage) 23 7 Section 40 (Drain Ventilation) 1 — Section 45 (Defective Closets) 1 — Section 75 (Dustbins) 7 6 Section 92/93 (Nuisances) 45 32 Section 101 (Smoke Nuisance) 1 — Prevention of Damage by Pests Act, 1949 Section 4 (Treatment of Land) 2 Shops Act, 1950. Section 38 (Insufficient Closets) 1 — 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 39 of the Public Health Act, 1936, at a cost of £14 15s. 0d. PROSECUTIONS. It became necessary to take proceedings in two cases against owners of properties for non-compliance with notices served under sections 92/93, Public Health Act, 1936. At the Petty Sessions Court, on the 4th March, 1954, a Nuisance Order was made requiring the owner to carry out works to abate the nuisance within 28 days, and a fine of £1 was imposed. In the second case, on the 16th December, 1954, a Nuisance Order was also made for work to be carried out within 28 days, and a fine of £1 was imposed. COMPLAINTS. The number of complaints received from the 1st January to 31st December, 1954 was 830 which is a decrease of 56 over the same period in 1953. 24 The complaints received have been classified as follows:— Disrepair or unsatisfactory conditions of premises:— Dampness 45 Drainage 108 General Defects 296 Nuisance from Animals 9 Nuisance from Noise 4 Nuisance from Overcrowding 5 Nuisance from Refuse 18 Nuisance from Smoke, fumes 26 Nuisance from Vermin 30 Rodent infestations 261 Unsound food 28 830 Prompt investigation was made and suitable action taken to remedy the complaints. PETROLEUM (CONSOLIDATION) ACT 1928 AND REGULATIONS MADE THEREUNDER. Fifty-two premises within the Borough are licensed to store a total of 65,275 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 60 visits were made to the various installations. One new licence was approved and the total licence fees amounted to £35 0s. 0d. Only minor infringements of the Regulations were found. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding, etc. Infectious Fevers 23 26 166 Tuberculosis 15 18 121 Vermin 30 83 121 Other Diseases 8 13 887 25 Costs recovered throughout the year: £41 3s. 7d. 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 control 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 4,192 visits were made to Dwellings and Business premises throughout the year. 261 Complaints of infestation by rats or mice were received from occupiers of premises, and inspection and investigation revealed rat infestation at 135 premises and mice infestation at 61 premises. By the end of the year infestations had been cleared at 184 of these premises. Treatment of the foul sewers was carried out on two occasions, a total of 1,483 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all 466 manholes were dealt with and of this number 129 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, but an increasing number of complaints has been received alleging nuisance from smoke emission. 26 Twenty-eight complaints were received during the year, and 27 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. At the end of the year, the investigations of one complaint involving a boilerhouse chimney was still continuing. 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, and no infringement of the provisions of the Act was 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 the Act, "animals" is defined as including any description of vertebrate and as such includes goldfish and cage birds, which arc the principal sales in the shops licensed in the Borough. 27 Four 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 with 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. DISEASES OF ANIMALS ACT 1950. The number of outbreaks of Foot and Mouth Disease reported throughout England and Wales was not unduly serious in 1954. Richmond was not directly involved in any of these outbreaks but came under Infected Area Restrictions on one occasion. These restrictions controlled the movement of animals except for special purposes and in connection with this control two licences were issued or countersigned. One occupational licence issued to allow movement of animals from farm buildings to grazing grounds and one licence countersigned to allow movement of calves to a slaughterhouse for immediate slaughter. 28 SECTION D—HOUSING. Housing Statistics for the Year 1954. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1468 Number of Flats 366 1834 2. Unfit Houses. (1) Inspection of Dwelling Houses during the Year: — (i) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 864 (b) Number of inspections made for the purpose 2381 (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 67 (b) Number of re-inspections made under the Regulations 300 (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 243 (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) 227 29 (III). Action under Statutory Powers during the Year: — A. Proceedings under sections 9, 10, and 16 of the Housing Act, 1936:— (i) Number of representations made to the Local Authority with a view to the serving of Notices requiring the execution of works Nil (ii) Number of dwelling houses in respect of which notices were served requiring repairs Nil (iii) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil B. Proceedings under the Public Health Acts:— (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 29 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 20 (b) By Local Authority in default of owners Nil. C. Proceedings under sections 11 and 13 of the Housing Act, 1936:— (i) Number of representations made to the Local Authority with a view to the making of Demolition Orders Nil (ii) Number of dwelling houses in respect of which Demolition Orders were made Nil (iii) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (iv) Number of houses in respect of which an undertaking was accepted under sub-section (3) of Section 11 of the Housing Act, 1936 Nil D. Proceedings under section 12 of the Housing Act, 1936:— (i) Number of representations made to the Local Authority with a view to the making of Closing Orders Nil 30 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (iii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 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, 1954 Temporary bungalows 179 Permanent houses 485 689 Permanent flats 204 Total number included in above, erected in 1954 Permanent houses Nil Permanent flats 17 Total number of Emergency houses up to 31st December, 1954 5 Comprising 32 units Total number of requisitioned premises up to December 31st., 1954 99 (providing 211 family units) Total number of families rehoused in 1954 57 Total number of families still on Waiting List at December 31st, 1954 1144 At the present time 24 flats on the factory site Townshend Terrace-Grena Road have been commenced. As to the future, it is proposed to erect 8 one-bedroom flats at Stuart Road and 4 one-bedroom flats at Chaucer Avenue, and 2 onebedroom flats at Raleigh Road, 31 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. Withdrawal of Closing Order. A Closing Order was made on the 13th February, 1940, on the basement premises of 23, Park Road. The works necessary to render the basement fit for habitation was carried out during the year and the Closing Order has been determined. Housing Act, 1936. Section 25. (Power to declare an Area to be a Clearance Area). During 1954, the six properties included in the Richmond (Surrey) (California Cottages) and (Berridges Cottages) Clearance Orders, 1953, were demolished. On the 30th August, 1954, the Housing Repairs and Rents Act 1954, came into operation, and local authorities are required, under the provisions of Part I of the Act, to submit to the Minister within one year, proposals for dealing with houses which should be included in Clearance Areas. A preliminary survey of houses unfit for human habitation was carried out during the year, and a report was made to the Council showing the number of properties recommended for action under the provisions of the principal Act. Housing Repairs and Rents Act, 1954. Part II of the Housing Repairs and Rents Act 1954, allows a "repair increase" of the rents of controlled houses, given certain conditions, and under Section 26, power is given to the local authority to grant certificates of disrepair if a house is not in good repair or is unsuitable for occupation having regard to the standard laid down in the Act. The granting of a certificate of disrepair by the local authority must be preceded by an application from the tenant after the landlord has claimed a repairs increase in rent. To the end of the year 17 applications had been received and in each case a certificate of disrepair was granted. 31 Section e.—inspection and supervision of food. Food Inspection. The following foodstuffs, found to be unfit for human con sumption, were surrendered by the owners and either salvaged foi animal food or destroyed. Articles Tons Cwts. Qrs. lbs. Butter and Cheese - 1 - 17 Fish — 2 12 Flour and Flour Confectionery - 2 6 Fruit and Vegetables — 1 2 — Meat and Meat Products — 6 2 21 Sugar — 1 — 12 Tinned Goods (all classes) — 19 1 1 1 12 1 12 Whenever possible condemned food is salvaged to be used for animal feeding, but in all other cases, the food is destroyed by burning at the Refuse destructor. Twenty-eight complaints, alleging that food had been sold in a condition unfit for human consumption, were received during the year and received full investigation, and in nine cases reports were made to the Health Committee. Warning letters were sent to offenders in seven instances, and legal proceedings were taken in one case under Section 3, Food and Drugs Act, 1954, when on the 18th November, 1954, the defendants were fined £5, and £3 3s. costs for selling bread containing glass fragments. Legal proceedings were pending, in two cases, at the end of the year. 34 Food & Drugs Act, 1938 (Sampling of Food and Drugs). The Richmond Borough Council became a Food and Drugs Authority on the 1st April, 1954, and the following table of sampling in the Borough during 1954 includes samples taken by the Surrey County Council in the quarter ending 31st March, 1954. Articles. Analysed Adulterated or Irregular Formal Informal Total Formal In formal Total Apricots, dried _ 1 1 Bark tablets — 1 1 Butter — 1 ] Fruit Cocktail — 1 1 Jam — 1 1 Lard — 1 1 Lemonade crystals — 1 1 Marzipan — 1 1 Meat tenderizer. — 1 1 Milk 41 46 2 2 Orange drink — 1 1 1 Pepper — 1 1 Saccharin tablets — 1 1 Sausages 22 22 3 Sweets 1 1 2 1 Vegetables, mixed - 1 1 Totals 64 19 83 6 3 — 34 ADULTERATED OR IRREGULAR SAMPLES. Sample No. 12: Pork Sausage Meat. A sample of Pork Sausage Meat, purchased on the 5th August, 1954, was found to contain 170 p.p.m. Sulphur Dioxide, and a preservative label was not displayed at the time of sale as required by the Public Health (Preservatives in Food) Regulations 1925-1953. The attention of the Vendors was drawn to this contravention and they took immediate action to comply with the Regulations, and to ensure that no future irregularity occurred. No further action was taken in this case. Sample No. 48: Pork Sausages. A sample of Pork Sausages purchased on the 13th October, 1954, was found, on examination by the Public Analyst, to contain only 42% meat. Legal proceedings were taken under Section 3, Food and Drugs Act 1936, against the vendor on the 16th December, 1954, and the Magistrates set a standard, in this case, that the Pork Sausages should have contained 65% meat. A fine of £2 with two guineas costs was imposed. Sample No. 49 Pork Chipolata Sausages. A sample of Pork Chipolata Sausages purchased on the 13th October, 1954, was found, on examination by the Public Analyst, to contain only 50% meat and, in addition, 250 p.p.m. Sulphur Dioxide. At the time of sale a preservative notice was not displayed as required by the Public Health (Preservatives in Food) Regulations 1925-1953. Legal proceedings were taken under Section 3, Food and Drugs Act, 1936, against the Vendor on the 16th December, 1954, and the Magistrates set a standard, in this case, that the Pork Chipolata Sausages should have contained 65% meat. The defendant was also found guilty of an offence under the Public Health (Preservatives in Food) Regulations 1925-1953, and fines totalling £6 with two guineas costs were imposed. 35 Samples No. 58, 59, 63 and 64: Milk. An institution in the Borough receives daily, under contract, a consignment of milk which is delivered in a number of churns. On the 16th December, 1954, informal samples were taken from two churns, after the consignment had been unsealed and partly used. Both samples (Nos. 58 and 59) were found to be below the presumtive standard laid down in the Sale of Milk Regulations 1939. On the 30th December, 1954, six samples were taken from the six churns of milk delivered on that day, and in two (Samples Nos. 63 and 64) the Public Analyst found a deficiency in non-fatty solids, but having regard to the consignment as a whole, the Public Analyst reported that an average for the six samples was right on the limit for genuine milk. No further action was taken in respect of this consignment of milk. Sample No. 62: Milk Drops. A sample of sweets, labelled Milk Drops, purchased on the 30th December, 1954, was reported by the Public Analyst to contain sugar, vegetable fat and dried skimmed milk, and that in his opinion the description "milk", unqualified was not applicable to articles prepared with skimmed milk. This opinion was drawn to the attention of the manufacturers who agreed, immediately, to alter the description of the sweets to White Drops, and to prepare and issue new display cards for that product. Sample No. 63: Fresh Orange Drink. An informal sample of Fresh Orange Drink was purchased on the 30th December, 1954, and was found to conform with the Soft Drinks Order 1953. The Public Analyst expressed a doubt that the article might be confused with Fresh Orange Juice concentrate, but after further consultation, and having regard to the standard set out in the Order of 1953, it was agreed that the description was not misleading. No further action was therefore taken in this case. 36 Classification of Food Premises. The number of food premises within the Borough is shown in the following table and has been classified, according to the principal business carried on:— Bakehouses 12 Butchers 33 Confectioners (flour) 15 Confectioners (sugar) 41 Dairies (registered) 36 Fishmongers 17 Greengrocers 38 Grocers 77 Ice Cream Manufacturing premises 3 Licensed premises 67 Restaurants, Cafes, etc. 100 409 Premises registered under the provisions of Section 62 of the Richmond (Surrey) Corporation Act, 1937 are as follows:— Premises registered for the manufacture of preserved food 28 Premises registered for the manufacture, storage, and sale of Ice Cream 102 The number of premises which are registered as Dairies under the Milk and Dairies Regulations of 1949 is 10. Inspection of Food Premises. The inspection of food premises has been steadily maintained throughout the year, a total of 460 visits being made. Of this number visits were made as follows to registered premises:— Butchers 63 Dairies13 Ice Cream Premises 74 37 As the result of such inspections the following improvements have been carried out: — Food rooms repaired, cleansed or redecorated 71 premises Existing Sanitary accommodation improved 4 ,, Constant hot water supply installed 1 ,, Staff washing facilities improved 3 ,, New sinks provided 1 ,, Ventilation and lighting of food rooms improved 2 ,, Drainage improved, repaired or altered 16 ,, Food rooms reconstructed 3 ,, Food storage improved 12 ,, Food preparation equipment renewed 26 ,, Refuse accumulations removed 1 ,, Refuse receptacles provided 5 ,, Other improvements or repairs carried out 64 ,, Statutory notices under Section 13 Food and Drugs Act, 1938, were served in respect of 8 premises on the owners or occupiers. The work required by these notices was carried out satisfactorily and no legal proceedings were necessary for contraventions of this section of the Act. Byelaws as to the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air. The above byelaws, which came into force on the 24th July, 1950, have received special attention by Sanitary Inspectors when visiting and inspecting food premises and it is pleasing to note that proprietors and staff of food establishments are in general observing the requirements. Attention has been drawn to infringements and advice, together with suggestions for improvements has been given in many cases in an endeavour to help management and staff to reach a higher hygienic standard. On the whole, the byelaws were well received and cooperation by food traders has been good. 38 Richmond Clean Food Traders' Guild. By the end of 1954 membership of the Guild remained at a total of fifty-seven which represents a percentage of 15.04 of the total number of food traders within the Borough and, while such a low figure is discouraging, it compares favourably with membership of similar Guilds operating in adjoining Boroughs. There are many non-members of the Guild whose premises are in good condition and would qualify for immediate membership, but it is still very difficult to get them to make application. The inspection of food premises generally has been curtailed owing to staff shortage, and it is difficult to assess the extent to which such premises may have fallen below the standards required by the Guild and statutory Regulations. In the main the badge of membership has been prominently displayed to public view. There has again been very little business for the Advisory Committee to discuss but the prospect of changes in food legislation during 1955 may mean changes in Guild Policy. Ice Cream. Premises manufacturing, storing or selling Ice Cream have been regularly supervised, a total of 74 visits being made. Three premises are registered for the manufacture of ice cream, but in no case is the additional heat-treatment method approved by the Ice Cream (Heat Treatment) Regulations, 1952, in use. A total of 62 samples were submitted to the Bacteriologist for examination and of this number 57 were within Grades I and II and considered to be satisfactory, but 5 which came within Grades III and IV were considered to be unsatisfactory. In the case of the unsatisfactory samples careful inspection was made of the premises, equipment and methods of storage or manufacture and help and advice given as to the best means of effecting improvement. The policy with sampling is to take the greater number of samples from premises which have produced unsatisfactory samples in the past and to sample only occasionally those dealers who invariably produce good results. 39 The standard of ice cream production and sale is generally high and in all cases the Ice Cream (Heat Treatment) Regulations, 1947/52 have been complied with in every respect. Milk—Licencing and Sampling. Under the provisions of the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, and Regulations made thereunder, Dairy Farms have become the direct responsibilty of the Ministry of Agriculture and Fisheries : the premises on which milk is pasteurised or sterilised are licenced by the Food and Drugs Authority and in all other cases, Dairies or Dealers in Designated milk come under the complete control of the Local Authority in respect of licencing, inspection and control. There are two dairy farms within the Borough under the control of the Ministry, and in addition two pasteurising premises are licensed by the Richmond Borough Council as the Food and Drugs Authority. The following licences have been granted by the Council authorising dealers to store and sell Designated milks:— Pasteurised Milk 18 Tuberculin Tested Milk 19 Sterilised Milk 22 Supplementary licences were also granted, authorising dealers to retail milk in the Borough from premises situated outside, as follows: — Pasteurised Milk8 Tuberculin Tested Milk 8 Sterilised Milk 8 All premises are inspected before licences are granted, and principal licences are verified with the appropriate local authorities before licences are issued. No licences were refused. 40 Under the regulations the Local Authority continued to take samples from dealers and during the year under review the following were taken:— Pasteurised Milk 98 samples Number found unsatisfactory 4 „ Tuberculin Tested (Pasteurised) Milk 7 „ Number found unsatisfactory Nil Sterilized Milk 3 ,, Number found unsatisfactory Nil Raw Milk examined biologically for the presence of Tubercle bacilli 8 „ Number found unsatisfactory Nil The District Medical Officer of Health retains the power to take appropriate action to prevent the spread of disease by infected milk. 41 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 41 23 - Pueperal Pyrexia — — — Pneumonia 19 — 26 Erysipelas 2 2 — Measles 98 2 — Whooping Cough 56 1 — Poliomyelitis Paralytic 1 1 — Poliomyelitis Non Paralytic — — — Dysentery 27 8 — Ophthalmia Neonatorum 1 — — Food Poisoning 2 2 — Typhoid 2 2 — Paratyphoid 1 1 - Total 250 42 26 FOOD POISONING. Total number of outbreaks Nil Number of cases notified 2 Number of deaths Nil DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1954:— (a) Pre-School children (under 5 years) 691 (b) Between 5 and 15 years 38 729 Grand Total of Children in the Borough who have received immunising treatment by the end of the year:- (a) Under 5 years 2029 (b) Between 5 and 15 years 4783 Number of children given re-inforcing doses during 1954 804 42 The following table shows the percentages of children immunisec as recorded in the Annual Reports since 1947:— 1947 1948 1949 1950 1951 1952 1953 1954 Under 5 years 59 69.8 69.8 69 67.6 69.9 65.1 71.1 5 to 15 years 88 95.3 94 91.4 95.2 91.5 95.8 95.9 In addition the policy of giving single reinforcing doses at appropriate intervals during a child's school life has been continued. WHOOPING COUGH IMMUNISATION. 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 during 1954. Diphtheria and Whooping Cough Combined Whooping Cough only Windham Road, Richmond 611 28 Back Lane, Ham 446 22 Sheen Road, Richmond 619 31 Private Doctors. In addition 151 children were immunised with the combined prophylactic by private doctors and 5 against whooping cough alone. By the end of December, 1406 children had been given the full course of protective inoculations. 43 VACCINATION AGAINST SMALLPOX. 1. Welfare Centres. Number of persons vaccinated at Welfare Centres in the Borough during 1954 was as follows:— No Vaccinated Children Adults Windham Road, Richmond 78 6 Back Lane, Ham 30 — Sheen Road, Richmond 79 9 Totals 187 15 Grand Total 202 2. Private Doctors. Number of Richmond residents who were vaccinated by private doctors was as follows:— Children Adults 133 165 Grand Total 298 3. Analysis of vaccinations at Welfare Centres and Private Doctors' Surgeries. Children. Adults. Primary Vaccination 304 18 Re-vaccination 16 162 Totals 320 180 Grand Total 500 4. Figures showing the percentage of children under 1 year vaccinated during 1954. No. Vaccinated Estimated mid-year Population under 1 year. % Vaccina ted 272 572 47.6 44 VERMINOUS CONDITIONS. YEAR 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 Scabies 128 241 431 274 377 66 12 11 7 2 Nil. 4 Nil. Head Lice 204 205 181 188 308 239 78 141 129 98 40 54 42 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 42 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. TUBERCULOSIS. The position in Richmond for the year 1954 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Twenty-seven cases of respiratory tuberculosis were notified during the year viz:— 18 males and 9 females. The corresponding figure for 1953 was 74. Non-Respiratory Tuberculosis. Eight new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. 8 such cases have been notified during 1953. 45 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 173 21 Females 121 18 294 39 Corresponding figures for 1953 300 34 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M M F M F M F 0 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 5 2 1 ... ... ... ... ... ... 15 1 2 1 ... ... ... ... ... 25 6 6 3 2 ... ... 1 ... 35 3 ... 1 ... ... l ... ... 45 2 ... ... ... ... ... ... ... 55 1 ... ... ... ... ... ... ... 65 and upwards 3 ... 1 ... 1 l ... ... Totals 18 9 6 2 1 2 l ... 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. 46 AFTER CARE. The Barnes and Richmond Tuberculosis Care Committee continued their 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. NUMBER OF DEATHS AND DEATH RATES FROM TUBERCULOSIS AND CANCER—1954. The provisional numbers of deaths and death rates per million population during the year 1954 are as follows:— NUMBER RATE England & Wales. Males Females Persons Males F emales Persons Respiratory Tuberculosis 4,948 2,121 7,069 232 92 160 Other Tuberculosis 447 383 830 21 17 19 Richmond. Respiratory Tuberculosis 1 2 3 23 47 70 Other Tuberculosis 1 — 1 23 — 23 England & Wales. Cancer of Lungs & Bronchus 13,995 2,335 16,330 657 102 369 Other Cancer 33,324 40,445 73,769 1,565 1,760 1,660 Richmond. Cancer of Lungs 6? Bronchus ... 24 3 27 564 70 635 Other Cancer 26 39 65 612 917 1,530