RICH 24 AC 4413(1) RICHMOND BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1955 J. H. BROAD & Co. Ltd., Printers, 8, King Street, Richmond, Surrey. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1955 CONTENTS. Page. List of Staff 2 Preface 3 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 10 Births 10 Deaths 11 Maternal Mortality 11 Infant Mortality 12 Premature Infants 13 Illegitimate Infants 13 Comparative Statistics 14 SECTION B— GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Clinics and Treatment Centres 16 Health Visitors 16 District Nurses and Midwifery Services 16 Moral Welfare 16 Home and Domestic Help Services 16 Ambulance Facilities 16 Day Nurseries 16 Hospitals 17 Laboratory Facilities 17 Mortuary 17 Nursing Homes 17 SECTION C— SANITARY CIRCUMSTANCES. Water Supply 19 Sanitary Inspection 20 Factories Act 1937 22 Shops Act 1950 23 Sanitary Defects 23 Notices Served 25 Prosecutions 25 Complaints 26 Petroleum Acts 26 Disinfection and Disinfestation 27 Prevention of Damage by Pests Act, 1949 27 Smoke Abatement 28 Rag, Flock and Other Filling Materials Act, 1951 28 Pet Animals Act, 1951 29 Diseases of Animals Act, 1950 29 SECTION D— HOUSING. Housing. (Action under Housing and Public Health Acts) 31 Council's Housing Programme 32 Moveable Dwellings 33 Housing Repairs and Rents Act 1954 33 SECTION E— INSPECTION AND SUPERVISION OF FOOD. Food Inspection 34 Sampling of Food and Drugs 35 Classification of Food Premises 38 Improvements in Food Premises 38 Byelaws 39 Richmond Clean Food Traders' Guild 39 Sale and Storage of Ice Cream 39 Milk—Licencing and Sampling 40 SECTION F— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Diseases 42 Admission to Infectious Diseases Hospitals 42 Food Poisoning 42 Diphtheria Immunisation 42 Whooping Cough Immunisation 43 Vaccination Against Smallpox 43 Verminous Conditions—Scabies and Head Lice 44 Tuberculosis 45 1 Public Health Department, Parkshot, Richmond. July, 1956. 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 1955 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is similar to that for 1954 and is in accordance with Ministry of Health Circular 17/55. The report shows that the health of the residents has been good during the year ; that there has been no undue incidence of communicable disease and that good progress has been made in eliminating any unsatisfactory circumstances. I wish to record my appreciation of the loyalty and enthusiasm of all members of my staff throughout the year, and to thank my colleagues in other departments for their ready co'operation. Finally, I wish to refer to the support and consideration always given by my Chairman and all Members of the Council with whom 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 (SURREY). Report of the Medical Officer of Health for the year 1955. preface. Staff. The vacancy for a district Sanitary Inspector which occurred in May 1954 was not filled until April 1955 when Mr. N. V. Saunders was appointed to the staff. I am pleased to report that since that date there have been no vacancies or changes in the department. Population. The Registrar General's estimate of the population in 1955 was 42,240, which is an increase of 300 in the Census population of 1951 but about 200 less than the estimate for 1954. Births. During the year 623 births were recorded (318 males and 305 females). This figure may be compared with 632 in 1954 and 851 in 1947- The number of illegitimate births was 32 compared with 35 in the previous year. This figure seems likely to remain steady and is much the same as it was before the war. The proportion of births taking place in dwelling houses has once more fallen to the low level of 21%. In spite of the provision of an efficient domiciliary midwifery service there is a slow but sure tendancy for more and more mothers to be confined in hospital. This is general throughout the country and there is much to be said both for and against it. If the trend continues, and particularly if there is an official encouragement, this might be the beginning of the end of domiciliary midwifery. In my view this would be a great pity. Where housing conditions are satisfactory there is much to be said for home confinement, particularly for subsequent pregnancies where the first baby has been delivered without any complications. There were 42 premature live births, of whom 38 survived. Of the 4 infants who failed to survive 3 weighed less than 3 lbs. 4ozs. and so would be extremely difficult to rear. 4 Careful enquiries are made into every case of prematurity when parents are co-operative. The facts connected with each case are tabulated and then sent for expert examination. It is hoped that research into the cause of prematurity may enable preventative measures to be taken to reduce this loss of life. Of 8 deaths of infants under the age of 1 year, no less than 4 were due to prematurity. Deaths. The total number of deaths occurring amongst residents was 564 (275 males and 289 females) compared with 526 in 1954. Of this total the cause of death was cancer in 126 cases, compared with 92 cases in the previous year. The death rate, when corrected to allow for the high proportion of elderly persons, is 10.64 per thousand, which compares favourably with other towns in the country. Reference to the tables of Comparative Statistics shows that death rates for certain important diseases (including tuberculosis) is considerably lower in Richmond than elsewhere, whereas the rates for influenza, pneumonia and cancer are very unfavourable. This is due to the high proportion of elderly people in the population of this district. It is pleasing to report that during the year there was not a single death due to diphtheria, whooping cough, measles, or poliomyelitis. It should be noted that there were only 8 infant deaths and that no child under 2 years died from enteritis. The infant mortality rate at 13 per thousand live births is, in fact, the lowest ever recorded. NOTIFIABLE DISEASES. The table in Section F sets out the number of cases of infectious diseases notified by General Practitioners during 1955. There was the expected high incidence of measles, but apart from this the number of cases of other diseases was low. Whooping Cough. Once again the incidence of this disease was low and the cases which did occur were generally fairly mild. Under the scheme for immunizing children against whooping cough, a total of 1,887 children had been given the full course of protective inoculating by 31st December, 1955. 5 Poliomyelitis. During the year there were 12 cases of poliomyelitis and of these, 8 had paralytic symptoms and 4 were of the non-paralytic type. The two most seriously ill patients were both adult males aged 52 and 26 years respectively. They made satisfactory progress after lengthy treatment. The first case occurred on the 10th July and between that date and the 7th August, 7 of the cases had occurred and of these, 5 were paralytic and quite seriously ill. This number of cases so early in the season was rather alarming and suggested the possibility of a serious outbreak in the district. Accordingly, certain preventive measures were taken, such as cancelling temporarily immunization against diphtheria and whooping cough, and deferring non-urgent operations on the nose and throat. It so happened that only 5 more cases occurred, the onset of the last of these being the 28th October. Efforts were made to trace the source of infection in each of these cases but with no success. Two children who developed the disease early lived in the same street but the families were not known to one and other. Otherwise, cases were scattered throughout the Borough and there was not more than one case from any one school. One child was diagnosed as suffering from acute poliomyelitis when under observation in a childrens' ward at a General Hospital. She was immediately transferred to an isolation hospital, but of course, all other children in the ward were close contacts. Admissions to the ward were stopped and the other children were returned home as soon as possible. They were all kept under observation but fortunately, there were no further cases amongst them. There seems little doubt that when cases of poliomyelitis occur in a district there is an increased "healthy carrier" rate amongst the population. At these times, parents would do well if they saw that their children had plenty of fresh air by day and by night, and avoided excessive fatigue. As far as possible they should be kept out of crowded stuffy atmospheres and should not be taken into cinemas, large stores, etc. 6 Dysentery. Ten cases were notified during the year. Of these, 6 were due to an organism known as Shigella Sonnei, which is found widespread throughout the country. Four were isolated cases, the remaining two were sisters. There were two cases caused by an organism known as Shigella Flexner. The first case was the father who was an Air Steward and contracted the infection in Colombo. He infected his 5 year old daughter. Both patients responded well to treatment. The last two cases were children who had definite symptoms of dysentery but from whom no pathogenic organism could be isolated. Food Poisoning. Twelve cases were notified. In the main these were single isolated cases but in two instances there was some spread of the infection. In one household there were three cases due to Salmonella Typhimurium and in another there were two cases due to Staphylococcus Aureus. Two patients were infected at their place of work which, in each case, was outside Richmond. Considering the very large number of meals sold daily in the district and vast numbers of week-end visitors I consider that the small number of cases of food poisoning and dysentery reflects great credit on those concerned with the preparation, sale, and storage of food. Paratyphoid Fever. One isolated case was reported. This was a young woman who contracted the infection while on holiday in Italy. She made an uneventful recovery and there were no secondary cases. Encephalitis. This was the case of a child aged 5 years who was admitted to hospital with symptoms of meningitis. He was very seriously ill but finally made a complete recovery without a definite diagnosis having been made. It is quite possible that he was actually an unusual case of polio' myelitis and that he should have been included under that heading. 7 IMMUNIZATION. Because of the prevalence of poliomyelitis the schemes for immunizing children against diphtheria and whooping cough were suspended for nearly three months. At the end of this time every effort was made to catch up with arrears. The result was a very small decline in the percentage of children under 5 years of age who had been protected by the end of the year. The figure of 70.7% for this age group compares favourably with most parts of the country but it should be higher, and there seems to be some danger that suspension of immunization in the presence of poliomyelitis may do more harm than good. Combined immunization against diphtheria and whooping cough is popular with parents and as far as possible it is commenced at age 3 months ; immunization against diphtheria, whooping cough and tetanus can be carried out in exactly the same way and there is some evidence to show that the antigens when combined in this way are even more effective than when given separately. There is already a small demand for this "triple antigen" which will be made available during 1956. The policy of offering vaccination against smallpox after completing immunization has proved a success. It allows for earlier immunization and the percentage of infants vaccinated has slightly increased. The figure of nearly 50% of infants vaccinated is not good enough but again it is better than in most areas. The scheme for offering vaccination against tuberculosis with B.C.G. to all school children aged 13 years proceeded smoothly. 468 children were successfully inoculated and there were no complications worthy of note. Such vaccination should confer some protection in adolescents during the dangerous years when they are first beginning to come into contact with the infection in the outside world. CARE OF THE CHRONIC SICK. The care of the aged, infirm, and the chronic sick, continues as an outstanding problem. The appointment of a Geriatrician to the Kingston Hospital Group has done much to improve the situation. There has been a more rapid turn over of cases in the available beds and supervision of domicilliary cases has been more complete. 8 Cases on the Waiting List for admission to hospital are closely supervised by the Health Visitor specially appointed for this purpose. She is able to report to the Geriatrician any deterioration in the patients' condition and by close association with the Divisional Health Office and Voluntary bodies to arrange for domicilliary services which may be required. Other frail old people who need assistance but not hospital admission are on the lists of the Health Visitors and District Nurses who are in a position, to provide the various local health authority and voluntary services which may be available. In this way an effort is being made to ensure that various officers are better informed concerning the frail elderly people in this area ; they are in a position to arrange rapidly for assistance to be provided and the patients themselves are being made aware of the way in which they can get assistance should they need it. This problem is complicated by the personalities of the patients themselves and for this reason there can be no easy solution. There are those who won't accept the domicilliary services and many who resolutely refuse to lose their independance and enter a Home. Under certain circumstances such patients can be forced to enter suitable accommodation under powers conferred on the Council by Section 47 of the National Assistance Act 1948. Use was not made of these powers during the year under review. SANITARY CIRCUMSTANCES. The report of the Chief Sanitary Inspector is included in Sections C, D and E, and reference to these indicates the large volume and varied nature of the work carried out by the Staff of the Public Health Department. A full establishment of Inspectors throughout the year has allowed all routine work to be covered in addition to a careful check on food establishments and an adequate food sampling programme. Since Richmond Borough Council became a Food and Drugs Authority in 1954 this work has been undertaken by the Sanitary Inspectors. Reference to the table in Section E shows that 123 samples were taken for examination and that of these, 10 were irregular. The irregularities were all dealt with by agreement with the vendors an 9 no prosecutions resulted during the year. The results indicate that on the whole the nature and quality of foodstuffs sold are of a satisfactory standard. In the same Section i would draw your attention to the large number of visits paid to food premises and the very substantial number of improvements which resulted therefrom. Provision of Health Services in the Area. Section B outlines the health services provided by the Authorities concerned. On the whole they are well organized and cover the needs of the residents. The services are augmented by a great deal of work undertaken by various voluntary organizations which continue to play a most active part in the life of the Borough. Owing to the Council's building and re-housing policy of recent years the population of Ham and Petersham has increased with a very marked increase in the number of children of all ages. The hutted Clinic erected in 1947 by the Council has served a most useful purpose but is now becoming too small to provide an adequate service and this deficiency will become more marked as time passes. I am very hopeful that if the Housing Committee will set aside a well placed and suitable site the County Council may provide a permanent adequately sized Clinic within the next few years. housing. For that part of Section D which deals with the Council's Housing Estate and future programme I am indebted to the Housing Manager. While reading this it is essential to bear in mind the great difficulties under which the Housing Committee are working by reason of the shortage of building sites. During the year only 14 families were re-housed and it was not possible to add any houses or flats to the estate. The future programme is more heartening, indicating as it does, that sites containing pre-fabricated bungalows are to be re-developed in such a way that they will house a larger number of families under better conditions. This form of re-development will continue during the next few years and through it there is hope that families living 10 in unfit houses and the worst cases on the waiting list will be found suitable accommodation. Mental ill-health, delinquency, broken marriages and problem families are some of the serious consequences of bad housing conditions. In addition, it is impossible for the child to develop into a normal healthy being under conditions of over-crowding, muddle, and resulting disharmony in the house. Unfortunately, there is no easy or rapid solution to this problem—in fact the eventual solution presumably depends on housing becoming easier throughout the country. Meantime, in the interests of health, re-development should proceed with a minimum of delay and every available site should be put to the best possible use. APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1955) 42,240 Number of inhabited houses (estimated) 11,675 Rateable value £648,454 Sum represented by a Penny Rate £2,587 BIRTHS. Birth Rate per 1,000 of estimated resident population 14.7 (Corrected) 13.7 Total number of births (live and still) 623 Analysis:— M F Total Live Births Legitimate 303 281 584 Illegitimate 12 19 31 Still Births Legitimate 3 4 7 Illegitimate — 1 1 Still Birth Rate per 1,000 total births ,,, ,, 12.8 11 Environment of Births :— Proportion taking place in the Borough 21% Proportion taking place outside the Borough 79% Proportion taking place in Institutions 79% Proportion taking place in dwelling houses 21% Proportion notified by midwives alone 21% Proportion notified by doctors or parents 79% DEATHS. Death Rate per 1,000 estimated resident population 13.3 (corrected) 10.64 Total number of deaths from all causes 564 Analysis:— M F Total All causes 275 289 564 Cancer 60 66 126 Diphtheria — — — Measles — — — Whooping Cough — — — Diarrhoea (under two years) — — — 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 369 0.54 Due to abortion 68 0.10 Total maternal mortalitiy 437 0.64 Richmond. Maternal causes, excluding abortion Nil Nil Due to abortion Nil Nil Total maternal mortality Nil Nil 12 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 13.0 Rate for legitimate infants per 1,000 legitimate live births 13.7 Rate for illegitimate infants per 1,000 illegitimate live births 0.0 Total number of infant deaths in the Borough 8 Analysis:— M F Total Legitimate 6 2 8 Illegitimate - - - Environment of Infant Deaths:— Number occurring in the Borough 1 Number occurring outside the Borough 7 Number occurring in Institutions 7 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 und«r 1 year 1. Pneumonia ... ... ... ... ... ... ... ... ... ... 2. Acute Suppurative Bronchitis ... ... ... ... ... ... ... ... ... ... 3. Whooping Cough ... ... ... ... ... ... ... ... ... ... 4. Atelectasis 1 ... ... ... 1 ... ... ... ... ... 5. Prematurity 4 ... ... ... 4 ... ... ... ... ... 6. Congenital Abnormality ... ... ... ... ... ... ... ... ... ... 7. Asphyxia (Accidental) ... ... ... ... ... 1 ... ... ... 1 8. Disproportion, etc. 2 ... ... ... 2 ... ... ... ... ... 7 ... ... ... 7 1 ... ... ... 1 13 PREMATURE PREMATURE LIVE BIRTHS. STILLBIRTHS. Born in Hospital Born and Nursed at Home Born in Hospital Born at Home Born in Nursing Home Weight Total Died within 24 hours of Birth Died 2nd-28th day Survived 28 days Total Died within 24 hours of Birth Died 2nd-?8th day Survived 28 days 31b. 4oz. or less 6 3 — 3 — — — — 1 1 — Over 3lb. 4oz to 41b. 6oz. 8 — 1 7 1 — 1 — Over 41b. 6oz. to 4lb 15oz. 7 — — 7 — Over 41b. 15oz. to 51b. 8oz. 18 — — 18 2 — — 2 1 — — TOTALS 39 3 1 35 3 — — 3 2 1 — ILLEGITIMATE BIRTHS 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 No. of illegitimate live births 51 54 38 40 43 43 25 34 33 31 No. of illegitimate deaths under 1 year 5 2 0 1 2 0 3 1 2 0 Illegitimate death rate 98 30 0 25 46 0 120 29 60 0 14 COMPARATIVE STATISTICS—1954. Rate per 1,000 Population LIVE BIRTHS Rate per 1,000 (Total Live & Still) STILLBIRTHS Rate per l,O(J0 Population DEATHS (All Causes) Rate per 1,000 Related Live Births DEATHS (Under One Year) Death Rate Per Million Population Rate per 1.000 (Live Births) Enteritis & Diarr. (4 weeks-2 years). Neonatal Mortality (Under 4 weeks) Rate per 1,000 (Live Births). Who. C. Dipth. Infl. Acute Polio. Pneum. England & Wales 15.0 23 2 11.7 24.9 1.98 .29 67.12 5.42 472.4 0.75 17.3 Richmond 14.7 12.8 10.64 13.0 0.0 0.0 236.7 0.0 568.2 0.0 11.3 DEATHS—RICHMOND (Rates per 1,000 Population). Actual Numbers. Rate. All Causes 564 13.3 Whooping Cough — 0.0 Diphtheria — 0.0 Tuberculosis 4 0.09 Influenza 10 0.237 Acute Poliomyelitis (including Polioencephalitis) — 0.0 Pneumonia 24 0.568 15 NUMBER OF DEATHS AND DEATH RATES FROM TUBERCULOSIS AND CANCER 1955. The provisional numbers of deaths and death rates per million population during the year 1955 are as follows :— Number Rate England and Wales. Males Females Persons Males Females Persons Respiratory Tuberculosis 4,174 1,664 5,838 195 72 131 Other Tuberculosis 361 294 655 17 13 15 Richmond. Respiratory Tuberculosis 1 1 23 23 Other Tuberculosis 3 — 3 71 — 71 England and Wales. Cancer of Lungs and Bronchus 14,820 2.45! 17,271 693 106 389 Other Cancer 33,339 40,727 74,066 1,559 1,767 1,667 Richmond. Cancer of Lungs and Bronchus 17 6 23 402 142 544 Other Cancer 43 60 103 1,017 1,420 2,438 16 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. 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 management 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, 17 (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. 18 (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, Surbiton 19 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 examin ation : — (a) Richmond Water Supply. Untreated water 204 samples Treated water 378 samples For chemical analysis 28 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 913 Samples examined chemically 232 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. Fifty-two samples of river water were bacteriologically examined during the year. 20 The following figures show the daily average consumption from the three sources :— 1954 1955 All Richmond Wells 756,186 galls. 757,972 galls. Metropolitan Water Board 877,564 galls. 932,320 galls. Raw River Water 192,534 galls. 251,896 galls. The Terrace garden deep well has been in continuous use throughout the year. When pumping first re-started after an interval of 12 months for repairs the water was not of its original high standard of bacterial purity. However, with continued pumping, this has righted itself and it is most satisfactory to have again this supply of water which does something to soften the very hard 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 1955. Houses visited and particulars recorded (Housing Act) 3 Houses visited (Public Health Acts) 839 Revisits to houses and other premises 1158 Houses visited for Certificates of Disrepair 99 Visits paid in connection with:— Overcrowding 2 Vermin 124 Disinfection 166 Enquiries into Infectious Diseases 101 Routine inspections in connection with:— Factories (mechanical) 101 Factories (non-mechanical) 92 Outworkers 5 Bakehouses 64 21 Butchers' Shops 102 Dairies and Milk Shops 79 Fishmongers and Poulterers 81 Fried Fish Shops 15 ice-cream premises 192 Greengrocers' and Fruiterers 85 Other food stores 163 Public Houses 96 Restaurants and Tea Shops 278 Food and Drugs Act Sampling 193 Milk Sampling (Designated Milk) 126 Unsound Food 185 Drainage 480 Interviews 520 Massage Establishments 6 Pet Animals Act 9 Petroleum Acts 245 Piggeries 9 Public Conveniences 31 Rats and Mice (Visits to Properties) 4755 Rats and Mice (Visits re sewer treatments) 1468 Schools—Elementary and Secondary 42 Shop Act 271 Smoke Nuisances—Inspection and Observations 61 Stables 4 Theatres and Cinemas 32 Water Supply 299 Miscellaneous Visits 1076 13,657 Drainage and Sewerage Systems Tested. Hydraulic tests 22 Smoke tests 7 Chemical tests 20 Examinations 18 67 22 Factories Act, 1937. At the end of the year there were 162 factories on the register (143 mechanical and 19 non-mechanical) carrying on the following trades :—- Mechanical. NonMechanical. Artificial wreaths, etc 2 — Bakeries 9 — Boat Repairs — 1 Boilermakers 2 — Boot-making and Repairing 9 — Building 2 2 Butchers 3 — Clothing 2 — Coach Building 5 — Cycle Repairs 1 1 Dressmaking 10 4 Electrical Instruments, etc. 7 — Engineering 19 — Furniture and Upholstery 10 5 Joiners 7 2 Laundering and Cleaning 4 — Milk Pasteurising 2 — Motor Vehicle repairing 22 — Packing Goods 2 — Printing 6 — Saw Mills 2 — Tailoring 2 3 Toys 3 — Wallpaper manufacture 1 — Watch repairs 1 1 Miscellaneous Trades 10 — 143 19 In addition, 10 premises were recorded for the purpose of Section 7 of the Act (suitability of sanitary accommodation) being Institutions or sites of Building Operations. 23 193 visits of inspection were made to the premises outlined above and the following defective conditions were remedied : — Want of cleanliness to Factory walls, etc. 19 Inadequate ventilation of Factories 1 Ineffective drainage of Factory floors Insufficient Sanitary accommodation — Unsuitable or defective conditions in Sanitary modation 3 Other matters requiring attention 21 44 Shops Acts, 1950 Shops on the Register 793 Shops inspected 271 Towards the end of the year a survey was commenced of shops in the Borough. It was found necessary to draw the attention of occupiers of premises to the following contraventions of the Act :— (1) Failure to exhibit necessary forms 83 (2) Lack of satisfactory ventilation 1 (3) Lack of satisfactory heating 3 (4) Lack of satisfactory lighting 2 (5) Lack of suitable handwashing facilities 12 (6) Lack of suitable sanitary accommodation 7 SANITARY DEFECTS REPORTED. Animal nuisances 4 Basement areas inadequate 5 Ceilings broken or otherwise defective 92 Chimney stacks defective 12 Coppers broken or otherwise defective 1 Damp-proof courses required or defective 2 Doors defective 27 Drainage systems obstructed 38 Drainage systems leaking or defective 48 Firegrates and flues defective 42 Floors broken or otherwise defective 64 24 Floor drainage inadequate 3 Food preparation equipment unsatisfactory 58 Food rooms requiring reconstruction 17 Food storage unsatisfactory 22 Gutters leaking or defective 35 Hot water supply provided 6 Lighting inadequate 10 Paving inadequate or defective 6 R.W.Ps. ventilating drainage systems 2 R.W.Ps. broken or otherwise defective 33 Refuse accumulations 40 Refuse receptacles defective 37 Roofs leaking or defective 91 Rooms requiring cleansing 210 Sanitary accommodation insufficient. Sanitary accommodation not separate for sexes 1 Sinks insanitary or defective 19 Sites requiring concrete Soilpipes leaking or defective 19 Staircases defective 21 Ventilation of rooms inadequate 11 Verminous premises Walls: plaster defective. 193 Walls: brickwork defective 28 Washing facilities in food premises inadequate 29 Wastepipes leaking or defective 29 Water fittings defective 36 Water supply inadequate W.C.'s leaking or defective 178 Windows defective 126 Miscellaneous defects 1,690 At the end of the year, 1,322 of the defects discovered had been abated, the work of remedying 85 was in hand, and the balance of 283 was still outstanding. In order to see that the defects were being properly remedied 1158 visits were paid to the various premises. 25 NOTICES TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 437 Verbal intimations 80 Interviews 520 Statutory Action. Act and Section. Housing Act, 1936 Notices Authorised. Notices Served. Section 9 (Repairs) 1 — Public Health Act, 1936. Section 24 (Drainage) 6 3 Section 39 (Drainage) 33 23 Section 45 (Defective Closets) 9 — Section 46 (Insufficient Closets) 1 1 Section 75 (Dustbins) 11 11 Section 92/93 (Nuisances) 80 53 Prevention of Damage by Pests Act, 1949 Section 4 (Treatment of Land) 3 1 In the main the work called for by Statutory Notices was carried out by the owners, but work in default was done by the Local Authority in the following cases :— (1) Under the Prevention of Damage by Pests Act 1949, art area of land was cleared of rubbish and treated for rat infestation, of a total cost of £59 7s. 3d. on the owner's failure to comply with a notice served under Section 4 of the Act. (2) An urgent drain repair was carried out at a cost of £4 5s. 6d. after agreement with the owner concerned in order to avoid the delay of serving statutory notice under the Public Health Act 1936. In all cases where the Local Authority do work in default, the cost is recovered from the persons responsible in law. Legal proceedings were taken in the following cases :— (1) Three cases under Section 94, Public Health Act, 1936, on 3lst March, 1955, 18th April, 1955 and 21st July, 1955, when, in 26 each instance, a nuisance order was made for the work to be carried out within 28 days, and 3 guineas costs granted. (2) Under Section 95, Public Health Act 1936, on the 27th June, 1955, for failure to comply with a Nuisance Order, when the owner was fined £2 with a daily penalty of 10 shillings if the work remained outstanding after ten days. (3) On the 20th January, 1955, an appeal was dismissed in the Petty Sessions Court, where notice to provide a dustbin, under Section 75, Public Health Act, 1936, had been served on the tenant of the property. COMPLAINTS. The number of complaints received was 804, which is a decrease of 26 compared with 1954. The complaints received have been classified as follows: — Disrepair or unsatisfactory conditions of premises: — Dampness 51 Drainage 64 General Defects 259 Nuisance from Animals 5 Nuisance from Noise 7 Nuisance from Overcrowding 1 Nuisance from Refuse 12 Nuisance from Smoke, fumes 27 Nuisance from Vermin 48 Rodent infestations 289 Unsound food 24 Miscellaneous Nuisances 17 804 Prompt investigation was made and suitable action taken to remedy the complaints. PETROLEUM (CONSOLIDATION) ACT 1928 AND REGULATIONS MADE THEREUNDER. Fifty-four premises within the Borough are licensed to store a total of 66,000 gallons of Petrol, Petroleum Mixtures and Cellulose solutions. 27 They have received regular inspection to ensure that the various regulations have been observed. In all a total of 245 visits were made to the various installations. Four new licences were approved, two licences were not renewed, and the total licence fees amounted to £36 15s. Od. Only minor infringements of the Regulations were found. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding, etc Infectious Fevers 33 36 215 Tuberculosis 9 14 54 Vermin 30 65 48 Other Diseases 5 5 279 Costs recovered throughout the year : £25 17s. l^d. Solutions of D.D.T. in Kerosene are used for dealing with infestations by bedbugs and arc 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 4,755 visits were made to Dwellings and Business premises throughout the year. Complaints of infestation by rats or mice numbered 289 and inspection and investigation revealed rat infestation a.t 139 premises and mice infestation at 81 premises. By the end of the year infestations had been cleared at 199 of these premises. Treatment of the foul sewers was carried out on two occasions, a total of 1,468 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results, 28 In all 459 manholes were dealt with and of this number 132 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 the investigation of complaints alleging nuisance from smoke emission remains an important duty of the Inspectors. Twenty-seven complaints were received during the year, and 50 observations for excess smoke were made. Generally, interviews with managers and advice to stokers resulted in improved conditions, and no grounds were found to justify statutory action. Revised legislation for combating atmospheric pollution had not been passed by Parliament by the end of the year, although it was known that a Clean Air Bill was under consideration. The major difficulties facing factory managements who wish to co-operate with the Local Authority in preventing smoke emission from coal-burning plants, are the varying quality of the coal received and, in winter months, the uncertainty of supplies. For these reasons, an increasing number of Companies are considering the relative advantages and costs of installing oil-fired plants. From the public health view-point, such changes would lessen the risk of air pollution, for the conditions under which oil is fired remain constant over long periods, and given regular plant maintenance, no serious smoke emission should arise. It must be emphasised, however, that continued improvement can only be sustained if efficient servicing is available for oil-firing plants. It is likely, therefore, that the next few years will mark a gradual change from coal to oil fuels in the larger factories. 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. 29 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 are the principal sales in the shops licensed in the Borough. 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 1955. Richmond was not directly involved in any outbreak and was not affected by Infected Area Restrictions on any occasion. These restrictions controlled the movement of animals except for special purposes and in this connection no licences were issued or countersigned. 30 SECTION D—HOUSING. Housing Statistics for the Year 1955. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1462 Number of Flats 372 1834 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) 842 (b) Number of inspections made for the purpose 2099 (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 3 (b) Number of re-inspections made under the Regulations 34 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 277 (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) 239 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 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 52 (ii) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 37 (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 1 (ii) Number of dwelling houses in respect of which Demolition Orders were made Nil (iii) Number of dwelling houses demolished in pur- suance of Demolition Orders Nil (iv) Number of houses in respect of which an taking 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: — (0 Number of representations made to the Local Authority with a view to the making of Closing Orders 1 32 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (iii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. 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, 1955 Temporary bungalows 179 Permanent houses 485 689 Permanent flats 204 Total number included in above, erected in 1955 ... Permanent houses Nil Permanent flats Nil. Total number of Emergency houses up to 31st December, 1955 5 comprising 24 units Total number of requisitioned premises up to December 31st., 1955 89 (comprising 193 family units) Total number of families rehoused in 1955 14 Total number of families still on Waiting List at December 31st, 1955 894 Future Programme. The erection of 24 flats on the Townshend Terrace and Grena Road site is nearing completion. Following the demolition of the prefabricated bungalows, the site of Peldon Avenue will be develop ed by the erection of 100 flats. 33 As to the future, work has commenced on the erection of 8 onebedroomed flats at Stuart Road, 4 one-bedroomed flats at Chaucer Avenue and 2 one-bedroomed flats at Raleigh Road. Moveable Dwellings. An owner of land within the Borough, holds a licence, renewable annually, permitting him to stand one caravan on the land. Satisfactory provision is made for the disposal of household refuse, use of sanitary conveniences and main water supply. Housing Act 1936 : Unfit Houses. No properties were represented during the year for inclusion in Clearance Areas, but the return to the Ministry of Housing and Local Government required under Part I of the Housing Repairs and Rents Act 1954 was submitted showing the Local Authority's proposal to deal with 137 houses which are unfit for human habitation. Of this total it is proposed that 126 will be included in Clearance Areas while the remainder will be subject to individual Demolition Orders. 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. The following tables show the action taken under this part of the Act during the year :— Certificates of Disrepair. Applications received 29 Applications refused 3 Certificates granted 26 Revocation Certificates (granted on completion of necessary repairs). Applications received 25 Applications refused Nil. Certificates granted 25 34 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. 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. Fish 3 1 Flour and Flour Confeotionery — 3 26 Fruit and Vegetables — 3 — 3 Meat and Meat Products 11 2 Milk and Milk Products 4 24 Sugar and Sugar Confectionery — — 1 — Tinned Goods (all classes) 1 — — 18 2 1 3 17 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-four 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 twelve cases reports were made to the Health Committee. Warning letters were sent to offenders in nine instances, and legal proceedings were taken in two cases under Section 3, Food and Drugs Act 1938. In the first, on 6th January, 1955, defendants were fined £20 and three guineas costs for selling milk containing glass fragments. In the second, on 2nd June, 1955, defendants were fined £10 and two guineas costs for selling a scone containing a piece of wire. 35 Food 8i Drugs Act, 1938 (Sampling of Food and Drugs). The following table shows the results of examinations made of samples procured for analysis during the year. Articles. Number Analysed Adulterated or Irregular Formal Informal Total Formal Informal Total Beef, minced 2 - 2 Biscuits 1 1 Brawn ... 1 1 Bread and Butter 3 1 4 Cakes 1 4 5 Chicken, chopped 1 1 Chicklettes 1 1 Christmas Pudding 3 3 Cough Mixture 4 4 1 1 Crab Paste 1 1 Cream 2 2 Fish Cakes 1 1 2 Fruit, dried 5 5 Fruit milk drink 1 1 Fruit, tinned 5 5 Golden elixer ... 1 1 1 1 Ice-cream 3 2 5 Jam 2 2 Jelly 2 2 Lemonade powder 1 1 Margarine I 2 Marzipan 1 1 Meringue mixtures o o Milk 23 23 ] 1 Nerve Sedative 1 1 Orange drink . 1 ] Sausages 19 2 21 2 2 Soup 1 1 1 1 Sweets 5 15 20 3 1 4 Vitamin capsules 2 2 Totals 58 65 123 6 4 10 Sample No, 79 : Pork Sausages. A sample of Pork Sausages, purchased on the 7th February, 955, was found to contain 75 p.p.m. Sulphur Dioxide, and a preservative label was not displayed at the time of sale as required by 36 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. 80 : Cough and Influenza Mixture. An informal sample of Cough and Influenza Mixture, purchased on the 17th February, 1955, was found to have one ingredient not in the proportion shown in the formula on the label. The Public Analyst stated that the ingredient (acetylsalicylic acid) had decomposed and that it was necessary for this formula to be dispensed only a short time before sale. The Vendors, on notification of the report, immediately withdrew all stocks of the mixture and undertook to discontinue dispensing this product. Sample No. 95 : Tomato Soup. An informal sample of tinned Tomato Soup, purchased on the 14t,h April, 1955, was found to contain 440 p.p.m. Iron and to be discoloured in appearance ; the Public Analysa judged the soup to be unfit for human consumption. No other tins of soup from the same consignment were held by the Vendors, and the Public Health Committee authorised the Town Clerk to send a warning letter in this case. Samples Nos. 100 and 167 : Whipped Cream Bon-Bons. A sample of Whipped Cream Bon-Bons, purchased on the 14th April, 1955, was found to contain only 2% milk fat and in the opinion of the Public Analyst the ingredients did not conform to a printed statement on the carton that the sweets were "made from full cream condensed milk and dairy butter." This report was taken up with the Vendors, the Manufacturers and their solicitors between April and October 1955 ; arrangements were made for stocks of the sweets to be withdrawn from sale, and at a later date they were distributed as Whipped Bon-Bons. Eventually the manufacturers improved the recipe used in the making of the sweets so that they contained not less than 4% milk-fat, sufficient to permit the use of designation Whipped Cream Bon-Bons. 37 Sample No. 131 : Golden Elixir. An informal sample of Golden Elixir, purchased on the 18th July, 1955, was found not to have been dispensed in accordance with the formula printed on the label, one ingredient being absent. The Vendor stated that the missing ingredient had been used when the mixture was first dispensed, and had formed an unattractive sediment ; the use was discontinued but the labels had not been altered. The Vendor immediately amended the labels, and no further action was taken in this case. Sample No. 138 : Pork Sausages. A sample of Pork Sausages purchased on the 19th July, 1955, was found to contain 90 p.p.m. Sulphur Dioxide, and a preservative label was not displayed at the time of sale as required by the Public Health (Preservative in Food) Regulations 1925-1953. The Vendors stated that the preservative notice had been temporarily mislaid and they have taken steps to ensure compliance with the Regulations in the future. Sample No. 139 : Milk. A sample of Milk purchased from a cafe on the 19th July, 1955, was found to be deficient in milk-fat to the extent of 19%. The Owner stated that the Sampling Officer had been served from part of a bottle of milk and that the assistant had failed to shake the bottle to distribute the fat when it was first used. The Owner undertook to renew urgent instructions to his staff to ensure that the mistake did not recur. Sample No. 163 : Whipped Cream Bon-Bons. A sample of Whipped Cream Bon-Bons, purchased on the 20tn September, 1955, was found to contain only 1.3% milk-fat, and the Public Analyst stated that a milk-fat content of not less than 4% would be required to justify the description used. The sweets were imported from Holland, and following a meeting with the importing distributors the Company agreed that all future consignments would be sold as Whipped Bon-Bons, and immediate instructions were given for display cards, labels and price tickets to be amended. 38 Sample No. 184 : Hot Sweets. A sample of Hot Sweets, purchased on the 24th November, 1955, was found to be impregnated with a pepper extract which, in the opinion of the Public Analyst, was liable to cause irritation and blistering of the mouth. No further stocks were held by the Vandors, and a report from the Manufacturers stated that they had used a new supply of pepper extract which had unfortunately proved too pungent. They had since carefully controlled the manufacture of the sweets, and a later sample proved satisfactory on examination. CLASSIFICATION AND INSPECTION OF FOOD PREMISES. The following table classifies food premises in the Borough according to the principal business carried on, and sets out the visits made to each class of trade :— BUSINESS No. of Premises No. of Visits Bakehouses 11 64 Butchers (includes 28 premises registered for the manufacture of preserved food) 34 102 Confectioners (Flour) 17 17 Confectioners (Sugar) 44 44 Dairies (premises registered under Milk and Dairies Regulations) 6 79 Fishmongers 16 96 Greengrocers 39 85 Grocers 79 102 Ice-Cream Premises (Registered for Manufacture) ... 2 192 Ice-Cream Premises (Registered for Sale and Storage) 100 Licensed Premises 77 96 Restaurants, Cafes, etc.... 91 278 416 1,155 IMPROVEMENTS IN FOOD PREMISES. As the result of such inspections the following improvements have been carried out: — Food rooms repairs, cleansed or redecorated 154 premises Existing Sanitary accommodation improved 23 „ Constant hot water supply installed 5 „ Staff washing facilities improved 21 „ 39 New sinks provided 4 premises Ventilation and lighting of food rooms improved 5 „ Drainage improved, repaired or altered 22 „ Food rooms reconstructed 10 „ Food storage improved 21 „ Food preparation equipment renewed 57 „ Refuse accumulations removed 19 ,, Refuse receptacles provided 20 „ Other improvements or repairs carried out 115 „ Generally, improvements to food premises were effected without recourse to legal action, but in one instance the Council authorised proceedings against a cafe proprietor under Section 13, Food and Drugs Act 1938. Four summons were heard and the proprietor was fined a total of £35 with two guineas costs. 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 requirement. In many cases attention has been drawn to infringements, and advice has been given in an endeavour to help management and staff to reach a higher hygienic standard. Richmond Clean Food Traders' Guild. By the end of 1955 membership of the Guild remained at a total of fifty-seven which represents a percentage of 13.7 of the totai number of food traders within the Borough. 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 changes in food legislation expected in 1956 may mean changes in Guild standards. Ice Cream. Premises manufacturing, storing or selling Ice Cream have been regularly supervised, a total of 192 visits being made. 40 Two premises are registered for the manufacture of ice cream, and 100 premises are registered for sale and storage ; in no case is the alternative heat'treatment method approved by the Ice Cream (Heat Treatment) Regulations, 1952, in use. A total of 128 samples were submitted to the Bacteriologist for examination and of this number 99 were within Grades I and II and considered to be satisfactory, but 29 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 and manufacture, and help and advice was given as to the best means of effecting improvement of the unsatisfactory samples, 8 related to a local manufacturing business where investigation showed that the sterilisation of the mixing vat had been inadequate. The remaining 22 unsatisfactory samples came from six dealers' premises and were due to unsatisfactory methods in sterilizing servers. In carrying out these investigations, 41 samples of server water and 2 samples of flavouring were submitted for bacteriliogical examination. 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. 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. 41 There have been two dairy farms within the Borough under the control of the Ministry, but towards the end of the year under review one of the dairy farms closed down. There are two pasteurising premises licensed by the 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 Milk 9 Tuberculin Tested Milk 9 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. Under the regulations the Local Authority continued to take samples from dealers and during the yeaf under review the following were taken: — Pasteurised Milk 102 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 2 „ Number found unsatisfactory Nil Raw Milk examined biologically for the presence of Tubercle bacilli 7 ,, 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. 42 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 32 13 - Pueperal Pyrexia — Pneumonia 24 4 24 Erysipelas Measles 6 482 4 8 — Whooping Cough Poliomyelitis Paralytic 50 8 8 — Poliomyelitis Non Paralytic 4 4 — Dysentery 10 5 — Ophthalmia Neonatorum 1 — Food Poisoning 12 2 — Typhoid — — — Paratyphoid 1 1 — Encephalitis 1 1 — Total 631 50 24 FOOD POISONING. Total number of outbreaks Nil Number of cases notified 12 Number of deaths Nil DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1955 :— (a) Pre-School children (under 5 years) ... 484 (b) Between 5 and 15 years ... ... 35 519 Grand Total of Children in the Borough who have received immunising treatment by the end of the year : — (a) Under 5 years 2013 (b) Between 5 and 15 years 4875 Number of children given re-inforcing doses during 1955 951 43 The following table shows the percentages of children immunised as recorded in the Annual Reports since 1948 :— 1948 1949 1950 1951 1952 1953 1954 1955 Under 5 years... 69.8 69.8 69 67.6 69.9 65.1 71.1 70.7 5 to 15 years ... 95.3 94 91.4 95.2 91 .5 95.8 95.9 96.0 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 1955. Diphtheria and Whooping Cough Combined Whooping Cough only Windham Road, Richmond 469 8 Back Lane, Ham 229 6 Sheen Road, Richmond 458 3 Private Doctors. In addition 111 children were immunised with the combined prophylactic by private doctors and 7 against whooping cough alone. By the end of December, 1887 children had been given the full course of protective inoculations. VACCINATION AGAINST SMALLPOX. 1•Welfare Centres. Number of attendances for vaccination at Welfare Centres in The Borough during 1955 was as follows ;— 44 Children Adults Windham Road, Richmond 98 4 Back Lane, Ham 53 Sheen Road, Richmond 125 10 Totals 276 14 Grand Total 290 VERMINOUS CONDITIONS. YEAR 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 Scabies . 241 431 274 377 66 12 11 7 2 Nil. 4 Nil. Nil. Head Lice 205 181 188 308 239 78 141 129 98 40 54 42 62 Figures in the above table are children attending schools in the Borough found to be verminous at routine inspections in school by Health Visitors. 2. Private Doctors. Number of Richmond residents who were vaccinated by private doctors was as follows: — Children Adults 132 211 Grand Total 343 3. Analysis of vaccinations at Welfare Centres and Private Doctors' Surgeries. Children. Adults Primary Vaccination 339 19 Re-vaccination 35 206 Totals 374 225 Grand Total 599 4. Figures showing the percentage of children under 1 year vaccinated during 1955. N°- Vaccinated Estimated mid-year Population % Vaccinated under 1 year. 298 600 49.7 45 Scabies is no longer a problem in the district. The 62 cases of 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. The position in Richmond for the year 1955 may be summarised as follows: — notifications: Respiratory Tuberculosis. Twenty-eight cases of respiratory tuberculosis were notified during the year, viz :—19 males and 9 females. The corresponding figure for 1954 was 27. Non-Respiratory Tuberculosis. Five new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Eight such cases have been notified during 1954. tuberculosis register. louse infestation are school children who are well known to the School TUBERCULOSIS. 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 Non Pulmonary Males 174 19 Females 107 17 281 36 Corresponding figures for 1954 294 39 46  New Cases Deaths Age Periods Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under5 1 — — — — — — — 5 1 — — — — — — — 15—24 4 4 2 — — — — 25—44 3 2 2 1 — — — 45—64 9 1 1 — — — 2 — 65 and upwards 1 2 — — — — 1 — Totals 19 9 3 2 1 — 3 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. 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.