RICH 25 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health \ 1956 J. H. BROAD & Co. Ltd., Printers, 8, King Street, Richmond, Surrey. 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 14 Comparative Statistics 14 SECTION B — GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Clinics and Treatment Centres 15 Health Visitors 15 District Nurses and Midwifery Services 15 Moral Welfare 15 Home and Domestic Help Services 15 Ambulance Facilities 15 Day Nurseries 15 Hospitals 16 Psychiactric Services 16 Laboratory Facilities 16 Mortuary 17 Nursing Homes 17 SECTION C —SANITARY CIRCUMSTANCES. Water Supply 18 Public Health Inspections 19 Public Health Contraventions and Defects 20 Complaints 22 Notices to Remedy Contraventions and Abate Nuisances 22 Disinfection and Disinfestation 23 Factories Act 1937 24 Atmospheric Polution 25 Prevention of Damage by Pests Act, 1949 25 Shops Act 1950 26 Rag, Flock and Other Filling Materials Act, 1951 27 Pet Animals Act, 1951 27 Diseases of Animals Act, 1950 28 Petroleum Acts 28 SECTION D —HOUSING. Housing. (Action under Housing and Public Health Acts) 29 Council's Housing Programme 31 Housing Repairs and Rents Act 1954 32 SECTION E —INSPECTION AND SUPERVISION OF FOOD. Food Inspection 34 Sampling of Food and Drugs 35 Classification of Food Premises 37 Improvements in Food Premises 37 Byelaws 38 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 44 1 Public Health Department, Parkshot, Richmond. August, 1957. 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 1956 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is in accordance with the instructions of the Minister of Health and special reference is made to certain subjects at the Minister's request. I wish to express my thanks to all members of the Council for their continued support throughout the year, and to record my gratitude to every member of the Staff of the Public Health Department for their loyalty, hard work and co-operation. I am, Ladies and Gentlemen, Your obedient servant, ERIC PEREIRA, Medical Officcr of Health. 2 LIST OF STAFF. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H Chief Public Health Inspector: BERNARD AISTHORPE, M.R.S.H. Senior Additional Public Health Inspector: EDWARD S. HERBERT, M.A.P.H.I. Additional Public Health Inspectors: CHARLES S. SMEATON, M.R.San I. NOLAN VICTOR SAUNDERS, M.R.San.I. (Until August) Senior Clerk: MRS. F. G. SMITH. Clerks: MRS. M. SUMPTER. 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 1956. PREFACE. Staff. The year commenced with a full staff but in August Mr. Saunders resigned to take up an appointment with a neighbouring Authority. The vacancy was advertised repeatedly but no appointment had been made at the end of the year. Population. The Registrar General's estimate of the population in 1956 was 42,420 which can be compared with the 1951 Census popluation of 41,944 and the population for 1955 which was estimated to be 42,240. Births. During the year 556 births were recorded (292 males and 264 females). This figure may be compared with 623 in 1955 and 851 in 1947. The proportion of births taking place in dwelling houses increased slightly to 23.6% compared with 21% in the previous year. I am hopeful that this level may be maintained and that any future improvement in the housing situation may gradually lead to an increase in the number of babies born at home. There is an efficient domicilliary Midwifery Service provided by the County Council and it is to the advantage of all concerned if full use can be made of it. There were 35 premature live births and of these, 24 survived. Of the eleven infants who failed to survive, 6 weighed less than 3lbs. 4ozs. and so would be extremely difficult to rear. The cause of prematurity is receiving much attention at present and it is hoped that this waste of life will be reduced. Of 14 deaths of infants under 1 year of age, no less than 9 were due to this cause. Deaths. The total number of deaths occurring amongst residents was 549 (256 males and 293 females) compared with 564 in 1955. 4 The death rate, when corrected to allow for the high proportion of elderly residents, is 9.9 per thousand population which compares favourably with other towns in the country. Once again the death rates due to cancer are unfavourable in Richmond. There is no doubt that this is due to the high proportion of elderly residents. NOTIFIABLE DISEASES. The table in Section F sets out the number of cases of infectious diseases notified by General Practitioners during 195.6. Following the high incidence of measles in the previous year there was the expected reduction in numbers during the year under review. The incidence of all other infectious diseases was also very low. Whooping Cough. Only 26 eases were notified and most of these were quite mild. Poliomyelitis. Two cases only occurred —one in January and the other in August. The first was a married man aged 33 who became ill during the last days of December 1955. On the 2nd January serious symptoms had developed including paralysis of the limbs and he was removed to hospital. Unfortunately he became progressively worse and died two days later. This was an example of the worst form of the disease which can be rapidly fatal and which is more often seen in adults than in children. The other case was an eleven year old boy who in August had an illness associated with pain in the legs. He was not confined to bed and it was not until the latter part of September that he was taken to hospital, suffering from weakness of the muscles of the left leg. This was a mild form of paralytic poliomyelitis which was undiagnosed while the patient was in the infective state. There were seven close household contacts but no further cases occurred. Meningitis. In October a boy aged 13 was admitted to hospital with all the signs of meningitis and he was strongly suspected of being a case of poliomyelitis. Accordingly full preventive action was taken as regards close contacts. 5 However, he made good progress in hospital and after full investigation it was decided that he was a case of lymphocytic meningitis and not a case of poliomyelitis. Meningococcal Meningitis. This was a case of a girl aged 13 years who was suddenly taken ill with symptoms of Meningitis. As soon as a diagnosis of Meningococcal meningitis was made appropriate modern treatment was commenced and she made an uneventful and complete recovery. This is a desease which occurs mostly under overcrowded living conditions and there was cause for concern since the patient came from very overcrowded accommodation situated over a restaurant. Very close contacts consisted of 3 adults and six children. Appropriate preventive action was taken and the contacts were kept under surveillance. Fortunately, no further cases occurred. Dysentery. Only five cases of dysentery were known to have occurred and all of these were due to an organism known as Shigella Sonnei. This organism is found widespread throughout the country and it causes a mild form of dysentery which is usually readily amenable to treatment. I have no doubt that in fact there were many more cases which responded to simple remedies and which were never diagnosed as dysentery. Food Poisoning. There was a short, sharp, outbreak of food poisoning amongst a family of two adults and three children. Within a period of two days all suffered from severe diarrhoea and all made rapid recoveries. No causative organism could be isolated. It is probable that this outbreak was due to toxins produced by organisms in food which had been kept too long or at a temperature which was high enough to encourage the multiplication of bacteria. I think that this very small number of cases speaks highly for the care generally taken by the housewives and the good standard of food production in the local hotels, restaurants, cafes, etc. 6 IMMUNIZATION. As the incidence of poliomyelitis was low there was no interruption of any scheme and good progress was made. As your Medical Officer of Health I am responsible for this aspect of preventive medicine but for the sake of convenience the work is mainly carried out at Clinics administered by the County Council. Prevention of Diphtheria. At the request of the Chief Medical Officer, Ministry of Health, great efforts have been made during recent years to get as many as 75% of infants under 1 year immunized against diphtheria. This objective has now been achieved and I think that this district is amongst the first to do so. If the diphtheria prophylactic is used cobined with Whooping Cough vaccine it is effective against both diseases when commenced as early as 3 months of age. The combined prophylactic is popular with parents as the numbers of injections is thereby reduced and early protection is made possible. Prevention of Whooping Cough. The proportion of infants protected against Whooping Cough is now as high as for diphtheria. The vaccine does not give complete protection to all those who receive it, but when Whooping Cough does occur in an inoculated child it is a mild illness. Early protection is most important as the disease is much more fatal to infants than to older children. Prevention of Smallpox. The policy of vaccinating against small pox after immunization against diphtheria (and Whooping Cough) has been continued with great success. Infants suffer so little inconvenience from the first course of injections that mothers present them for Smallpox vaccina' tion with increasing regularity. The proportion of babies vaccinated fell to a low level when the National Health Service Act was introduced but in Richmond it has been rising steadily and reached 64.7% in 1956. 7 Prevention of Tetanus. Active immunization against tetanus is now available to those who desire it. It is particularly popular with parents who have lived in America, or Canada. Prevention of Tuberculosis. Active immunization against tuberculosis with B.C.G. is offered to all children aged 13 years. The object is to give them added protection against this disease during the adolescent years when they are especially susceptible. Subsequently they develop the natural immunity which results from the normal activities of adult life. Of the children inoculated during the year there were no complications of any importance. Prevention of Poliomyelitis. A vaccine prepared by the Glaxo Laboratories became available in limited quantities for use for the first time in this country. Parents with children in certain age groups were invited to register them for inoculation. A small quantity of vaccine was provided in May and June and this was administered to registered children without any resulting reactions or harmful effects. The scheme was then suspended until December when a few more doses were supplied and were administered to those children who had received only one out of the two doses required for protection. The public demand for this vaccine has been growing steadily throughout the year and it is hoped that supplies will be more adequate next year. Figures relating to these various immunization schemes are set out in Section F. CARE OF THE AGED AND THE CHRONIC SICK. The local scheme for the care of the aged and the chronic sick which was outlined in the Annual Report for 1955 has worked smoothly. There is improved co-operation between the Hospital Services, the Welfare Services, the General Practitioner Services and the Medical Officer of Health. 8 The appointment of a Geriatrician jointly by the Surrey County Council and the Kingston Hospital Group has been a successful move and has done much to improve the general situation. Proper priority is given to cases for admission to hospital and really urgent cases are invariably admitted with a minimum of delay. There is a greater awareness of residents who are beginning to need assistance and available facilities are brought into action earlier than formerly. The establishment early in 1957 of a service for laundering sheets for incontinent patients has done much to reduce the difficulties of those being nursed at home. Attention has been focusscd on this difficult problem and I am pleased to report that there is a gradual but continuing improvement in the situation. NATIONAL ASSISTANCE ACT 1948. SECTION 47. Under this Section of the above Act the Council is able to apply to a Court of Summary Jurisdiction for an Order for the compulsory removal to suitable accommodation of a person who is living in insanitary circumstances, or who is suffering from grave chronic disease and who is unable to get the assistance required. Old or chronically sick patients are often very difficult to deal with because they refuse to enter a Home or a Hospital. Available domiciliary services may also be refused, but even if accepted they may not meet the real needs. Generally persuasion leads ultimately to a solution of the problem and compulsory action is rarely necessary; however, in 1956 action was taken in two cases which I report briefly below:— Case No. 1. A woman aged 80 occupied a ground floor room and she and her accommodation became seriously neglected. The room was infested with bugs. The old woman was deaf and was suffering from mild senile dementia with occasional delusions; she did her own cooking and was slowly starving herself. Despite great efforts by the Health Visitor and the District Nurse, she was becoming more and more neglected in her person. Persuasion was of no avail; she resolutely refused to consider admission to a Home. 9 An Order was applied for and obtained and she was transported (unwillingly) to an Old Peoples Home. Within a few days of her arrival there her general condition had considerably improved and she announced that she was happy to stay. She was well liked by the staff and the other residents and there is no doubt that the use of compulsory powers in this case was completely successful. Case No. 2. This was a man aged 70 who was suffering from chronic heart disease so serious that he was unable to care properly for himself. There seemed also to be some mental disturbance because he stubbornly refused every type of help and insisted that as there was nothing wrong with him there was no need for official interference. He managed, and lived in, a clock and jewellery shop. The premises were in a chaotic state of untidiness and filth. The patient remained in the shop all night, either sitting in front of an open fire into which he was liable to fall or lying behind the counter on an assortment of rags. After all other efforts had failed a Court Order was obtained and this unhappy man was admitted to a hospital bed. After 3 months his physical condition had improved and he was transferred by Order of the Court to an Old Peoples Home. The Order was extended from time to time on application by the Council and appeals by the patient were resisted, since his health was such that it was impossible to allow him to return to the original conditions. He was most unhappy in both Hospital and Home, and he died on the 25th January, 1957 shortly after his last appeal had been rejected. While this case had not the happy ending of the first one, there can be no doubt that compulsory action was correctly taken. He not only created insanitary conditions but owing to his liability to "heart attacks" there was a real danger of fire. He was thus a danger to himself and to the tenants of the flat above him. Provision of Health Services in the Area. Section B outlines the Health Services provided by the Authorities concerned. They are well developed, actively used, and generally cover the requirements of the residents. The chief need is for an adequately sized permanent clinic at Ham. The Surrey County Council have agreed in principal to the provision 10 of a Clinic, and the Borough Council have ear-marked a site at Ham Close. Housing development will soon commence in this area and it is hoped that the necessary approval for the erection of a Clinic will not be too long delayed. HOUSING. With the development of the Peldon Avenue and Ham Close sites there is every reason to hope that the programme for Slum Clearance will be started in the not too distant future. In addition to ridding the borough of worn out, unhealthy dwellings, this should also provide a site for useful re-development. SANITARY CIRCUMSTANCES. The report of the Chief Public Health Inspector is included in Section 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 Health Department. Unfortunately, there was a vacancy for a District Inspector in August and it had not been possible to fill this by the end of the year. This meant that some of the routine duties had to be curtailed so that the more urgent work could always be covered. APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1956) 42,420 Number of inhabited houses (estimated) 11,833 Rateable value £992,894 Sum represented by a Penny Rate £3,967 BIRTHS. Birth Rate per 1,000 of estimated resident population 13.1 (Corrected) 12.0 Total number of births (live and still) 556 Analysis:— M F Total Live Births Legitimate 268 236 504 Illegitimate 17 23 40 Still Births Legitimate 7 4 11 Illegitimate — 1 1 Still Birth Rate per 1,000 total births 21.6 11 Environment of Births:— Proportion taking place in Institutions 76.4 Proportion taking place in dwelling houses 23.6 DEATHS. Death Rate per 1,000 estimated resident population 12.9 (corrected) 9.9 Total number of deaths from all causes 549 Analysis:— M F Total Rate All causes 256 293 549 12.9 Cancer 44 49 93 2.2 Diphtheria — — — Nil Measles — — — Nil Whooping Cough — — — Nil Diarrhoea (under two years) — — — Nil Tuberculosis 4 2 6 0.14 Influenza — 1 1 0.02 Acute Poliomyelitis (including Polioencephalitis) 1 — 1 0.02 Pneumonia 6 7 13 0.30 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 330 0.46 Due to abortion 71 0.10 Total maternal mortalitiy 401 0.56 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 25.7 Rate for legitimate infants per 1,000 legitimate live births 21.8 Rate for illegitimate infants per 1,000 illegitimate live births 75,0 Total number of infant deaths in the Borough 14 Analysis:— M F Total Legitimate 4 7 11 Illegitimate — 3 3 Environment of Infant Deaths:— Number occurring in the Borough 2 Number occurring outside the Borough 12 Number occurring in Institutions 12 Causes of Death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... ... ... ... ... ... ... ... ... 2. Acute Suppurative Bronchitis ... ... ... ... ... ... ... ... ... ... 3. Whooping Cough ... ... ... ... ... ... ... ... ... ... 4. Atelectasis 1 ... ... ... 1 ... ... ... ... ... 5. Prematurity 8 ... ... ... 8 ... ... ... ... ... 6. Congenital Abnormality 2 ... ... ... 2 ... ... ... ... ... 7. Asphyxia (Accidental) 2 ... ... ... 2 ... ... ... ... 8. Middle Ear Disease ... ... 1 ... 1 ... ... ... ... ... 13 ... 1 ... 14 ... ... ... ... 13 PREMATURE LIVE BIRTHS. PREMATURE STILLBIRTHS. Born in Hospital Born and Nursed at Home Born at Home and Transferred to Hospital 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-28th day Survived 28 day9 Total Died within 24 hours of birth Died 2nd-28th day Survived 28 days 3lb. 4oz. or less 5 5 — — — — — — 1 — 1 — 2 1 — Over 3lb. 4oz to 4lb. 6oz. 8 2 1 5 — — — — — — — — 1 — — Over 4lb. 6oz. to 4lb. 15oz. 6 — — 6 1 — — 1 1 — — 1 — — — Over 4lb. 15oz. to 5lb. 8oz. 8 — 1 7 5 1 — 4 — — — — 1 — — TOTALS 27 7 2 18 6 1 — 5 2 — 1 1 4 1 — Note: No cases in following catergories: 1. Born in Nursing Homes and nursed entirely there. 2. Born in Nursing Home and transferred to hospital on or before 28th day. 14 ILLEGITIMATE BIRTHS 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 No. of illegitimate live births 54 38 40 43 43 25 34 33 31 40 No. of illegitimate deaths under 1 year 2 0 1 2 0 3 1 2 0 3 Illegitimate death rate 36 0 25 46 0 120 29 60 0 75 COMPARATIVE STATISTICS —1956. Rate per 1,000 Population LIVE BIRTHS Rate per 1,000 (Total Live & Still) STILLBIRTHS Rate per 1,000 Population DEATHS (All Causes) Rate per 1,000 Related Live Births DEATHS (Under One Year) Neonatal Mortality (Under 4 weeks) (Live Births). England & Wales 15.6 22.9 11.7 23.8 16.9 Richmond 12.0 (Corrected) 21.6 9.9 (Corrected) 25.7 25.7 15 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. 16 (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. Psychiatric Services. The Medical Staff of Banstead Hospital hold an Out-patient Clinic every Tuesday afternoon at the Royal Hospital for patients living in Richmond and Barnes. During the year there were 125 new cases with a total of 564 attendances at the Clinic. Admissions to hospital numbered 78 females and 49 male patients and of these, over 90% entered as voluntary patients. In addition to the Clinic and Hospital facilities, local General Practitioners can readily arrange for domicilliary visits by Specialist psychiatrists. 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. 17 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. (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 18 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 229 samples Treated water 383 samples For chemical analysis 18 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 985 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, 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. Forty-nine samples of river water were bacteriologically examined during the year. 19 The following figures show the daily average consumption from the three sources:— 1955 1956 All Richmond Wells 757,972 galls. 728,134 galls. Metropolitan Water Board 932,320 galls. 926,140 galls. Raw River Water 251,896 galls. 247,945 galls. The drinking water supplies in the district are not plumbosolvent. Water fit for human consumption is made available by piped supply to every dwelling house in the Borough. PUBLIC HEALTH INSPECTIONS. For the following particulars I am indebted to the Chief Public Health Inspector, who submitted his Report in accordance with the Sanitary Officers (Outside Condon) Regulations, 1935. Inspections during 1956. Houses inspected and particulars recorded (Housing Act) 68 Houses inspected (Public Health Acts) 824 Revisits to houses and other premises 1245 Houses visited for Certificates of Disrepair 44 Visits paid in connection with:— Permitted number for dwellings 28 Vermin 69 Disinfection 86 Enquiries into Infectious Diseases 78 Routine inspections in connection with:— Factories (mechanical) 28 Factories (non-mechanical) 10 Outworkers 3 Bakehouses 60 Butchers' Shops 113 Dairies and Milk Shops 57 Fishmongers and Poulterers 52 Fried Fish Shops 17 Ice-cream premises 92 Greengrocers and Fruiterers 85 Grocers 117 Public Houses 51 20 Restaurants and Tea Shops 198 Food and Drugs Act Sampling 157 Milk Sampling (Designated Milk) 152 Ice-cream Sampling 50 Unsound Food 154 Drainage 541 Interviews 441 Massage Establishments 4 Pet Animals Act, 1951 21 Petroleum Act, 1928 158 Piggeries 9 Public Conveniences 11 Rag Flock Act 24 Rats and Mice (Visits to Properties) 4805 Rats and Mice (Visits re sewer treatments) 1293 Schools—Elementary and Secondary 31 Shops Act, 1950 316 Smoke Nuisances—Inspection and Observations 28 Theatres and Cinemas 6 Water Supply 214 Miscellaneous Visits 1005 12,745 PUBLIC HEALTH CONTRAVENTIONS AND DEFECTS. The visits and inspections made during the year, which covered all classes of premises, resulted in the following matters being reported for attention:— Animal nuisances 1 Basement areas inadequate 2 Ceilings broken or otherwise defective 83 Chimney stacks defective 19 Clothing accommodation in food premises inadequate 8 Coppers broken or otherwise defective 3 Damp-proof courses required or defective 4 Doors defective 27 Drainage systems obstructed 63 21 Drainage systems leaking or defective 69 Firegrates and flues defective 27 First-aid equipment in food premises inadequate 28 Floors broken or otherwise defective 61 Floor drainage inadequate 6 Food preparation equipment unsatisfactory 55 Food rooms requiring reconstruction 11 Food storage unsatisfactory 18 Gutters leaking or defective 71 Hot water supply provided 6 Lighting inadequate 4 Paving inadequate or defective 8 R.W.Ps. ventilating drainage systems 2 R.W.Ps. broken or otherwise defective 22 Refuse accumulations 49 Refuse receptacles defective 92 Roofs leaking or defective 131 Rooms requiring cleansing 100 Sanitary accommodation insufficient 2 Sanitary accommodation not separate for sexes — Sinks insanitary or defective 32 Sites requiring concrete 3 Soilpipes leaking or defective 19 Staircases defective 26 Ventilation of rooms inadequate 8 Verminous premises 3 Walls: plaster defective 186 Walls: brickwork defective 29 Washing facilities in food premises inadequate 23 Wastepipes leaking or defective 24 Water fittings defective 63 Water supply inadequate 24 W.C.'s leaking or defective 66 Windows defective 190 Miscellaneous defects 89 1,757 22 At the end of the year, 1,182 of the defects discovered had been abated, the work of remedying 141 was in hand, and the balance of 434 was still outstanding. In order to see that the defects were being properly remedied 1,245 visits were paid to the various premises. NOTICES TO REMEDY CONTRAVENTIONS AND ABATE NUISANCES. Informal Action. Preliminary intimations 448 Verbal intimations 40 Statutory Action. Act and Section. Notices Authorised. Notices Served. Housing Act, 1936 Section 9 (Repairs) — — Public Health Act, 1936. Section 24 (Drainage) 12 5 Section 39 (Drainage) 24 16 Section 45 (Defective Closets) 13 7 Section 46 (Insufficient Closets) — — Section 75 (Dustbins) 13 13 Section 92/93 (Nuisances) 50 39 In the main the requirements of statutory notices were complied with, but in respect of two properties urgent drain repairs were carried out by the Council in default of the owners, following the service of notices 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 respect of one property under Section 94, Public Health Act, 1936, when on the 16th April, 1956, a nuisance order was made against the owner to carry out works of repair within six weeks. COMPLAINTS. The number of complaints received was 842, which is an increase of 38 compared with 1955. 23 The complaints received have been classified as follows:— Disrepair or unsatisfactory conditions of premises:— Dampness 30 Drainage 89 General Defects 320 Nuisance from Animals 6 Nuisance from Refuse 13 Nuisance from Smoke, fumes 25 Nuisance from Vermin 39 Rodent infestations 275 Unsound food 31 Miscellaneous Nuisances 14 842 Prompt investigation was made and suitable action taken to remedy the complaints. DISINFECTION AND DISINFESTATION OF PREMISES. Reason. Houses. Rooms. Bedding, etc Infectious Fevers 22 22 68 Tuberculosis 9 9 48 Vermin 11 24 19 Other Diseases 5 6 429 Costs recovered throughout the year: £14 6s. 0d. Evidence of bed-bug infestation in dwelling houses continues to diminish; spraying with a 5% D.D.T. solution in Kerosene remains the most economic and effective treatment, and no instance has been recorded in Richmond of Cimex Lectularius being resistant to D.D.T. An alternative treatment employing a 5% B.H.C. spray is also available in cases where D.D.T. is considered undesirable. The policy of spraying School Kitchens, operating under the School Meals Service, has been continued and involves one treatment annually of 5% D.D.T. solution which leaves a residual film of insecticide on the walls as a deterrent to flies. The quantity of clothing fumigated before being sent abroad has increased in recent years; this service is carried out on behalf of members of the public to satisfy Post Office regulations, and a small charge is made for the treatment. 24 Factories Act, 1937. At the end of the year there were 159 factories on the register (138 mechanical and 21 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreaths, etc 2 — Bakeries 8 — Boat Repairs — 1 Boilermakers 2 — Boot-making and Repairing 9 — Building 2 2 Butchers 2 — Clothing 5 — Coach Building 4 — Cycle Repairs 1 1 Dressmaking 7 5 Electrical Instruments, etc. 6 — Engineering 20 — Furniture and Upholstery 8 6 Joiners 6 2 Laundering and Cleaning 4 1 Milk Pasteurising 2 — Motor Vehicle repairing 24 — Packing Goods 3 — Printing 6 — Saw Mills 2 — Tailoring 1 2 Toys 1 — Wallpaper manufacture 1 — Watches and Jewellery 4 1 Miscellaneous Trades 8 — 138 21 In addition, 6 premises were recorded for the purpose of Section 7 of the Act (suitability of sanitary accommodation) being Institutions or sites of building operations. 25 Thirty'eight visits of inspection were made to the premises out' lined above and the following defective conditions were remedied: — Want of cleanliness to Factory walls, etc. 10 Inadequate ventilation of Factories — Ineffective drainage of Factory floors — Insufficient Sanitary accommodation — Unsuitable or defective conditions in Sanitary accommodation 2 Other matters requiring attention 9 21 ATMOSPHERIC POLLUTION. Richmond, being a residential town, has few large works or factories, but the number of complaints concerning smoke emission continues at a comparatively high level, and their investigation remains an important duty of the Inspectors. Twenty-five complaints were received during the year and twentyeight observations for excessive smoke were made. Generally, interviews, with managers and advice to stokers resulted in improved conditions and no grounds were found to justify statutory action. Many of the complaints related to factory chimneys which are set among residential properties, and powers under the Public Health Act byelaws limit action by the local authority to those instances only where black smoke is being emitted. Despite this inadequate statutory standard there has been a happy record of co-operation with factory managements in reducing smoke emission to a minimum. The Clean Air Act was passed by Parliament during the year but had not come into operation by the 31st December. The Act will strengthen the control which local authorities can exercise in reducing atmospheric pollution, and it is likely that emphasis will need to be given to this field of environmental hygiene as soon as the Act becomes effective. 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. 26 A total of 4,805 visits was made to dwellings and business premises througout the year. Complaints of infestation by rats or mice numbered 275 and inspection and investigation revealed rat infestation at 148 premises and mice infestation at 113 premises. By the end of the year infestation had been cleared at 244 of these premises. Treatment of the foul sewers was carried out on two occasions, a total of 1,293 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all, 383 manholes were dealt with and of this number 144 were found to be infestated and were poison baited. An interesting departure was made from the accepted baiting routine when the second treatment of foul sewers was carried out in November. In co-operation with the Ministry of Agriculture, Food and Fisheries, a new technique was practised whereby a mould-inhibitor (paranitrophenol) was added to the baits, thus providing a longer period for the rats to establish a feeding habit in the sewer manholes. A comparison between the baiting time-tables of the old and new methods clearly shows this advantage. Old Method. New Method. 1st day: Prebaiting with damp sausage rusk. 1st day: Prebaiting with damp sausage rusk + paranitrophenol. 2nd day: Renew baits. 4th day: Renew baits. 3rd day: Poison baiting (zinc phosphide). 8th day: Poison baiting (zinc phosphide). 5th day: Inspection. 11th day: Inspection. The degree of added efficiency which is claimed for the new method can only be assessed when the treated areas are baited again in 1957, but preliminary inspections indicate that there is now a greater prospect of reducing sewer infestations. SHOPS ACT, 1950. There are 793 shops on the Department's Register and 316 inspections were made during the year. This work continued the survey of 27 shop premises which was started at the end of 1955, and the attention of occupiers was drawn to the following contraventions of the Act:— (1) Failure to exhibit necessary forms 26 (2) Lack of satisfactory ventilation — (3) Lack of satisfactory heating 4 (4) Lack of satisfactory lighting — (5) Lack of suitable handwashing facilities 1 (6) Lack of suitable sanitary accommodation — Advice is given, from time to time, on the employment of young assistants, hours of closing, and other welfare provisions of the Act, and in no instance was it necessary to resort to legal proceedings to enforce these statutory requirements. 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 one 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. 28 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. Five 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 1956. Richmond was not directly involved in any outbreak and. was not affected by Infected Area Restrictions on any occasion. These restrictions control the movement of animals except for special purposes and in this connection no licences were issued or countersigned. PETROLEUM (CONSOLIDATION) ACT 1928 AND REGULATIONS MADE THEREUNDER. Fifty-seven premises within the Borough are licensed to store a total of 65,043 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 158 visits was made to the various installations. Six new licences were approved, three licences were not renewed, and the total licence fees amounted to £35 17S. 6d. Only minor infringements of the Regulations were found, 29 SECTION D—HOUSING. Housing Statistics for the Year 1956. 1. Number of dwellings owned by the Local Authority:- Number of Houses 1440 Number of Flats 400 1840 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) 892 (b) Number of inspections made for the purpose 2181 (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 68 (b) Number of re-inspections made under the Regulations 154 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (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 318 (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) 294 30 (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 47 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 55 (b) By Local Authority in default of owners 2 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 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:— (i) Number of representations made to the Local Authority with a view to the making of Closing Orders Nil 31 (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, 1956 Temporary bungalows 179 Permanent houses 485 Permanent flats 232 717 896 During 1956, 22 Temporary Bungalows in Peldon Avenue were demolished 22 874 Total number included in above, erected in 1956 Permanent houses Nil Permanent flats 28 Total number of Emergency houses up to 31st December, 195,6 4 comprising 13 units Total number of requisitioned premises up to December 31st., 195,6 60 (comprising 134 units) Total number of families rehoused in 1956 13 Total number of families still on Waiting List at December 31st, 1956 907 32 Future Programme. The erection of 8 one-bedroom flats and 2 two-bedroom flats in Stuart Road and Raleigh Road respectively, are nearing completion. Following the demolition of the 22 prefabricated bungalows in Peldon Avenue, the redevelopment of this site to provide 100 units of accommodation has commenced. As to the future, the temporary bungalows occupying the Ham Close site are to be demolished in stages ultimately giving a redevelopment of 229 units of accommodation. Planning permission has also been granted for the erection of 14 maisonettes on land adjoining Argyll House in Ham Street, and 6 flats at the northern end of King's Farm Avenue. 5. Housing Act, 1936: Unfit Houses. During the year a group of 8 almshouses was inspected and represented for action under Section 25, Housing Act, 1936. A Clearance Order in respect of these properties was made by the Council in February, and was confirmed by the Minister in October. The demolition of these houses had not been started by the end of the year. Two individual unfit houses were inspected during the year. In one instance the owner voluntarily demolished the property and cleared the site without recourse to statutory action, and in the other instance the owners voluntarily undertook not to allow the property to be used for human habitation. 6. 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. 33 The following tables show the action taken since the Act came into force:— 1954 1955 1956 Certificates of Disrepair: Applications received 17 29 8 Applications refused Nil 3 1 Certificates granted 17 26 7 Revocation Certificates (granted on completion of necessary repairs): Applications received Nil 25 5 Applications refused Nil Nil Nil Certificates granted Nil 25 5 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 - 2 2 24 Flour and Flour Confectionery — 1 2 8 Fruit and Vegetables — — 2 — Meat and Moat Products - 7 1 18 Milk and Milk Products - - 2 - Sugar and Sugar Confectionery — — — 13 Tinned Goods (all classes) — 16 2 5 1 9 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. Thirty-one 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 fifteen cases reports were made to the Health Committee. Warning letters were sent to offenders in twelve instances, and legal proceedings were taken in two cases under Section 2, Food and Drugs Act 1955. Both cases related to the same firm, and were heard on the 23rd July, 1956, when in respect of a jam sandwich containing a metal screw and a meringue containing a wire nail, the defendants were fined £20 and a total of 5 guineas costs. 35 Food & 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 Forma! Informal Total Almonds, ground - 1 1 Apple Jelly — 1 1 Bicarbonate of Soda - 1 1 Biscuits - 1 1 Butter 1 1 2 Cakes - 3 3 Cake Mixes 6 - 6 4 - 4 Castor Oil - 1 1 Cheese 1 1 2 - 1 1 Christmas Pudding — 1 1 Colouring Powder — 2 2 Cooked Meat 1 - 1 Cough Mixture - 4 4 Cream - 1 1 Cream of Tartar - 1 1 Friars Balsam B.P. - 4 4 - 1 1 Glycerine of Thymol — 1 1 Halibut Liver Oil — 1 1 Ice-cream 6 1 7 Lemon Cheese - 1 1 Liver Sausage 1 — 1 Macaroni 1 — 1 Manconnaise, Salmon - 1 1 Milk 16 3 19 1 — 1 Muscatels — 1 1 Oil of Eucalyptus — 2 2 Onions, pickled — 1 1 Oranges — 1 1 Prunes — 1 1 Rice, creamed - 1 1 Roll and butter - 1 1 Salt, tenderising — 1 1 Sandwich spread — 1 1 Sausages 2 1 2 Shrimps, potted — 1 1 Slimming Tablets - 1 1 Soup — 1 1 Steak and Kidney Pie — 1 1 Sweets 2 9 11 1 1 2 Trout, Smoked, pate — 1 1 Totals 36 56 91 6 3 9 36 Samples Nos. 215, 217, 218 and 220: Cake Mixes. Four formal samples of Cake Mixes were purchased on the 20th March, 1956, and in. respect of each sample the Public Analyst reported that the ingredients did not include icing or filling, but that the carton bore a large picture of an iced and filled cake. The Public Analyst stated that in his opinion it should have been made clear on the carton that the contents did not include ingredients for icing and filling. Correspondence with the four manufacturers showed that in two cases the product sampled was no longer being made. Representations were made by the other two manufacturers that the packaging and labelling of their products were not misleading, and no further action was taken on these samples. Samples Nos. 222 and 252: Rum Fudge. Samples of rum fudge purchased on the 9th April and 14th June, 1956 were examined by the Public Analyst and found not to contain genuine rum. Correspondence with the wholesaler and retailers showed that in each case the retailer had chosen to sell the sweets as "Rum Fudge", whereas the wholesaler described them as "Fudge with Rum Flavour". Undertakings were given by the retailers that the correct designation would be adhered to in the future. Sample No. 265: Channel Islands Milk. A formal sample of Channel Islands milk purchased on the 13th July, 1956 was examined by the Public Analyst and found to contain only 3.38% milk fat, whereas the statutory standard is 4%. In this case a warning letter was sent to the dairyman concerned. Sample No. 269: Friars Balsam. An informal sample of Friars Balsam B P. was purchased on the 13th July, 1956 and the Public Analyst reported the product to be deficient in total solids and in total balsamic acids. Correspondence with the retailers showed that the stock had been immediately withdrawn from sale, and the manufacturers stated that they had taken action to comply with the standards referred to by the Public Analyst. A subsequent sample of the product was found to be genuine. 37 Sample No. 273: Cottage Cheese. An informal sample of Cottage Cheese purchased on the 6th December, 1956 was found by the Public Analyst to be deficient in milk-fat. The manufacturers stated that their product was based on an American recipe, but that they had immediately revised the ingredients to ensure a satisfactory standard. A subsequent sample of the product was found to be genuine. 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 60 Butchers (includes 28 premises registered for the manufacture of preserved food) 34 113 Confectioners (Flour) 17 10 Confectioners (Sugar) 44 24 Dairies (premises registered under Milk and Dairies Regulations) 6 57 Fishmongers 16 69 Greengrocers 3d 85 Grocers 78 83 Ice-Cream Premises (Registered for Manufacture) 2 92 Ice-Cream Premises (Registered for Sale and Storage) 108 Licensed Premises 77 51 Restaurants, Cafes, etc. 92 198 524 842 IMPROVEMENTS IN FOOD PREMISES. The standard of hygiene required in food premises is now set out in the Food Hygiene Regulations 1955, which became operative during the year under review. The old standard was contained in Section 13 of the Food and Drugs Act, 1938, and many of its provisions had been found, in practice, to be ambiguous and to contain loop-holes which resulted in a lack of uniformity when applying the section. 38 The new Regulations are not perfect, but they contain many improvements which are welcomed. A constant supply of hot water for sinks and wash-hand basins, first-aid equipment, clothing lockers, and the temperature control of certain foods, are among the new provisions which make the Regulations workable and in line with the demand of public opinion for cleaner food. Throughout the post-war years, considerable attention has been focused, in Richmond, on attaining higher standards in food premises, and successive annual reports give evidence of the ready co-operation extended by proprietors and managements in achieving this end. It is therefore pleasing to record that during the year the work of implementing the new Regulations was effected with the same degree of harmony and without recourse to statutory action. As the result of the inspections made the following improvements have been carried out:— 1. Food Rooms reconstructed 10 premises 2. Food rooms repaired, cleansed or redecorated 73 „ 3. Food storage improved 17 „ 4. Food preparation equipment renewed 54 „ 5. Ventilation and lighting of food rooms improved 1 „ 6. Staff washing facilities improved 20 „ 7. Staff clothing accommodation provided 4 „ 8. First Aid Boxes provided 27 „ 9. Constant hot water supply installed 5 „ 10. New sinks provided 10 „ 11. Existing Sanitary accommodation improved 10 „ 12. Drainage improved, repaired or altered 9 „ 13. Refuse accumulations removed 11 „ 14. Refuse receptacles provided 33 „ 15. Other improvements or repairs carried out 77 „ 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 Public Health Inspectors visiting and inspecting food premises and it is pleasing to note that proprietors and staff of food establishments are in general observing the requirement: 39 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. Ice-Cream. Premises manufacturing, storing or selling Ice-Cream have been regularly supervised, a total of 92 visits being made. Two premises are registered for the manufacture of ice-cream, and 108 premises are registered for sale and storage; both manufacturers carry out the heat-treatment of ice-cream by raising the product to a temperature of not less than 160°F. for 10 minutes, and the high-temperature-shorttime method of heating to 175°F. for 15 seconds, permitted by the Ice-Cream (Heat Treatment) Regulations, 1952, is not in use. Eighty-six samples were submitted to the Public Health Laboratory for examination, and 65 were satisfactory (Grades I and II) and the remaining 21 were considered to be unsatisfactory (Grades III and IV). The unsatisfactory samples were followed up by careful inspection of the premises, equipment and methods of manufacture and storage. Fourteen of these samples came from eight retailers' premises and were due to unsatisfactory methods in sterilizing the servers. Four of the samples were taken from a restaurant where investigation showed that the main water supply was being contaminated in an old uncovered storage tank; a chain of contamination followed from the server water to the servers and then to the ice-cream. The remaining three samples were taken from a local manufacturer, and in this instance, it was found that the cooling process was being delayed. In carrying out these investigations, 43 samples of server water were examined bacteriologically of which 13 were found to be unsatisfactory. In all cases the necessary improvements were advised and carried out to eliminate unsatisfactory results. The policy in sampling is to concentrate upon premises which have produced unsatisfactory samples in the past, and to sample only occasionally those dealers who produce good results. The standard of ice-cream production, storage and sale is generally high and complies with the Ice-Cream (Heat Treatement) Regulations, 1947/52. Sampling for Bacteriological Examination. A wide range of food was sampled during the year, attention being concentrated on those foods which provide a good medium for bacterial contamination. 40 Twenty-two samples were taken of synthetic cream, egg albumen, ice and iced water, mussels, cockles, meat patties, flavoured drinks and salad cream. The results were satisfactory in all cases except one of synthetic cream, which had been taken from a restaurant kitchen. The proprietor was advised on the importance of storing the opened tin in the refrigerator when it was not in use. 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 is one dairy farm within the Borough under the control of the Ministry, and 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 21 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. 41 Under the regulations the Local Authority continued to take samples from dealers and during the year under review the following were taken : — Pasteurised Milk 110 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 24 „ Number found unsatisfactory Nil Raw Milk examined biologically for the presence of Tubercle bacilli 3 „ 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 25 15 - Pueperal Pyrexia - - - Pneumonia 13 - 1 Erysipelas 8 5 - Measles 85 - - Whooping Cough 26 1 - Poliomyelitis Paralytic 2 2 1 Poliomyelitis Non Paralytic - - - Dysentery 3 - - Ophthalmia Neonatorum 3 - - Food Poisoning 5 - - Typhoid - - - Paratyphoid - - - Encephalitis - - - Meningoccocal Infection 1 1 — Total 171 24 2 FOOD POISONING. Total number of outbreaks 1 Number of cases notified 5 Number of deaths Nil DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1956:— (a) Pre-School children (under 5 years) 555 (b) Between 5 and 15 years 38 593 Grand Total of Children in the Borough who have received immunising treatment by the end of the year:— (a) Under 5 years 2020 (b) Between 5 and 15 years 4867 Number of children given re-inforcing doses during 1956 800 43 The following table shows the percentages of children immunised as recorded in the Annual Reports since 1949:— 1949 1950 1951 1952 1953 1954 1955 1956 Under 1 year — — — — — — 66.3 77.2 Under 5 years 69.8 69.0 67.6 69.9 65.1 71.1 70.7 72.7 5 to 15 years 94.0 91.4 95.2 91.5 95.8 95.9 96.0 96.1 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. During the year 55.0 children completed a primary course of inoculation against Whooping Cough. In addition 75. older children received reinforcing doses. At the end of the year, 2,437 children had been given the full course of protective inoculations since the scheme commenced in October 1952. VACCINATION AGAINST SMALLPOX. 1. Analysis of vaccinations at Welfare Centres and Private Doctors Surgeries. Children. Adults. Primary Vaccination 429 24 Re-vaccination 39 220 Totals 468 244 Grand Total 712 2. Figures showing the percentage of children under 1 year vaccinated during 1956. No.Vaccinated Estimated mid-year Population under 1 year. % Vaccinated 369 570 64.7 44 Immunization against Tetanus. In August 1956 the Ministry of Health approved the use in County Clinics of Anti-tetanus Antigen, either in the form of the triple Antigen (with diphtheria and whooping cough) or separately. It is available on request by the parent. At the end of 1956, 29 children had been given full courses of the inoculations. VERMINOUS CONDITIONS. YEAR 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Scabies . 431 274 377 66 12 11 7 2 Nil. 4 Nil. Nil. Nil. Head Lice 181 188 308 239 78 141 129 98 40 54 42 62 57 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 57 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 1956 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Twenty cases of respiratory tuberculosis were notified during the year, viz:— 14 males and 6 females. The corresponding figure for 1955 was 28. Non-Respiratory Tuberculosis. Two new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Five such cases have been notified during 1955. 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 Non- Pulmonary Males 164 13 Females 109 16 273 29 Corresponding figures for 1955 281 36 Age Periods New Cases Deaths Respiratory Non- Respiratory Respiratory NonRespiratory M F M F M F M F Under 5 - - - - - - - - 5 - - - - - - - - 15—24 1 2 - - - - - - 25—44 7 1 1 - - - - - 45—61 4 2 — 1 1 1 — — 65 and upwards 2 1 - - 3 1 - - Totals 14 6 1 1 4 2 - — PREVENTION OF TUBERCULOSIS. During the year 514 children aged 13 were inoculated with B.C.G. (Bacille Calmette-Guerin). 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.