AC 4413(1) RICH26 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1957 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1957 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 9 Births 9 Deaths 10 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 16 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 26 Shops Act 1950 27 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 41 Admission to Infectious Diseases Hospitals 41 Food Poisoning 41 Diphtheria Immunisation 41 Whooping Cough Immunisation 43 Vaccination Against Smallpox 43 Tuberculosis 43 1 Public Health Department, Parkshot, Richmond. July 1958. 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 1957 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is in accordance with instructions of the Minister of Health and special reference is made to certain subjects at the Minister's request. It is with the deepest regret that I have to refer to the untimely death of Mr. Bernard Aisthorpe who had been on your Public Health Department Staff since 1928 and your Chief Public Health Inspector since 1945. Mr. Aisthorpe became ill and underwent a major operation in February 1957. He returned to duty in June and remained at his post until a few weeks before his death in January of this year. During the whole of that period he was obviously ill, but his sense of duty was very strong. He was a loyal, hardworking, and efficient colleague, and in his death the department suffered a serious loss. Owing to illness and staff shortage the year under review has been a difficult one, but I think that the Report shows that a considerable volume of valuable work has been undertaken, and that the health and sanitary circumstances of the district have remained at a high level. I am indebted to Mr. Herbert, Chief Public Health Inspector, who has compiled the report on the Sanitary circumstances of the district and to Mrs. Smith, Chief Clerk, who has dealt with the vital statistics and has prepared the report for the printers. Finally, I wish to express my thanks to my Chairman and all members of the Council for their continued support, and my gratitude to every member of the Staff of the Health Department for their loyalty and co-operation, I am, Ladies and Gentlemen, Your obedient servant, ERIC PEREIRA, Medical Officer of Health. 2 LIST OF STAFF. Medical Officer of Health : ERIC PEREIRA, M.B., B.S., D.P.H. Chief 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.S.H.. DAVID MEIRON HUGHES, M.R.S.H. (From 1st April, 1957). Chief Clerk : MRS. F. G. SMITH. Clerks : MRS. M. SUMPTER. MISS J. TRANTER (Left 16.8.57). MISS PAMELA EVANS (Commenced 19.8 57). 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 1957. PREFACE. Staff. The vacancy for a District Public Health Inspector which had existed since August, 1956 was finally filled in April, 1957 by the appointment of Mr. D. M. Hughes. Repeated advertisements had failed to produce any suitable applicants. This was a serious matter particularly in view of the prolonged illnesses of other members of the staff, and the problem was finally solved by upgrading the post. Mr. C. S. Smeaton, who has held the post of District Public Health Inspector since 1939, became seriously ill in April. Happily, he made steady progress and was able to return to duty towards the end of July. Mrs. M. M. Sumpter became seriously ill in July and was still off duty at the end of the year. I am pleased to report that she is now making good progress towards recovery. Mr. Aisthorpe's tragic illness, already mentioned in my letter, together with the unusually high sickness rate amongst other members of the staff, have caused great difficulties. All urgent matters have been attended to but some of the routine work could not be covered and this is reflected in the report of the Chief Public Health Inspector. Population. The Registrar General's estimate of the population in 1957 was 42,450 which can be compared with the 1951 Census population of 41,944 and the population for 1956 which was estimated to be 42,420. Births. During the year 583 births were recorded (305 males and 278 females). This figure may be compared with 556 in 1956 and 851 in 1947. The proportion of births taking place in dwelling houses increased lightly to 24.6% compared with 23.6% 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. 4 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 45 premature live births and of these 41 survived. Of the four infants who failed to survive, all weighed less than 3 lbs. 4oz. 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 10 deaths of infants under 1 year of age, 4 were due to this cause. Deaths. The total number of deaths occurring amongst residents was 566 (293 males and 273 females) compared with 549 in 1956. The death rate, when corrected to allow for the high proportion of elderly residents, is 9.8 per thousand population which compares favourably with other towns in the country. NOTIFIABLE DISEASES. The table in Section F sets out the number of cases of infectious diseases notified during 1957. Measles. Following on the low incidence of measles in 1956 there was the expected epidemic in the Spring of 1957. Out of a total of more than a thousand cases only twelve required admission to hospital. Admission was generally due to more severe respiratory symptoms and all children made good recoveries. Whooping Cough. Rather more cases occurred than in the previous year but most were quite mild and there were no deaths. Poliomyelitis. I am pleased to report that there was not a single case of poliomyelitis in the district during 1957. Dysentery. Only 5 cases of dysentery were notified and of these, 3 were admitted to hospital. All cases were due to Shigella Sonnei. This organism is found widespread throughout the country and causes a form of dysentery which is usually mild. 5 Food Poisoning. There were two small outbreaks with a total of ten cases of whom two were admitted to hospital. As regards the outbreaks, the first consisted of a family of seven of whom six suffered from diarrhoea and sickness within a few hours of one another. Bacteriological examination of faecal specimens and remnants of food which had been consumed, did not reveal any specific food poisoning organism. The second outbreak consisted of two persons in the same household, who had similar symptoms to those described above. Again, bacterio' logical investigation failed to establish the nature of the causal organism. The other two were isolated cases of food poisoning caused by an organism known as Salmonella Typhimurium. One patient was an adult the other a child attending a Day Nursery. The source of infection could not be traced. Fortunately, there was no 6pread of the disease and both made good recoveries. Typhoid Fever. One case occurred. The patient was an Air Stewardess and she contracted the infection abroad — probably in Athens. She was nursed for one week by two relatives when the nature of the illness was unsuspected. These contacts were investigated and kept under surveillance but fortunately neither was infected. Paratyphoid Fever. There were two cases. The first was a toy aged seven who was admitted to a general hospital for investigation and was found to be infected with Salmonella paratyphi B. Faecal specimens from other members of the family were sent for examination, and it was found that his sister aged four and a half years was also infected. The source of infection could not be established. Both children made uneventful recoveries. IMMUNIZATION. The district Medical Officer of Health is responsible for this form of preventive medicine, but for the sake of convenience the work is carried out at Surrey County Council Clinics, and the schemes are administered from the Divisional Health Office, Sheen Road. 6 Prevention of Diphtheria. During the year a report by the Medical Research Council provided statistical evidence that prophylactic materials containing alum and combined prophylactics had a greater effect in provoking paralytic poliomyelitis than other antigens. The number of cases of poliomyelitis actually thought to have been provoked in this way was extremely small, compared with the numbers of children immunized, but nevertheless the Ministry of Health advised great caution in future policy. This was most unfortunate, since the alum containing prophylactics had given valuable immunity to diphtheria in the past, and the use of combined antigens reduced the number of injections required for protection against two or more diseases. In addition with their use babies could be protected at an earlier age, and in this district the target of immunizing 75% of babies under one year had been attained. Under the circumstances it was decided to discontinue altogether the use of alum containing prophylactics and to use combined antigens only in the 4th and 1st quarters of the year when poliomyelitis is unlikely to be prevalent. This had the effect of reducing the percentage of children under 5 years immunized but the level is still high and every effort will be made to improve the situation in future years. Prevention of Whooping Cough. In practically every case a child brought for immunization against diphtheria also receives protection against Whooping Cough. The vaccine does not give complete protection to all who receive it, but when Whooping Cough does occur in an inoculated child, it is a mild illness. Early protection is of great importance since the disease is more fatal to infants than to older children. Prevention of Smallpox. The percentage of babies vaccinated in 1957 was 66.9% which is the highest figure yet reached, and is higher than in most parts of the country. Prevention of Tetanus. Active immunization against tetanus is available for those who desire it. Just over 100 children were protected during the year. 7 Prevention of Tuberculosis. Active immunization against tuberculosis with B.C.G. is offered each year to children aged 13 years. The object is to give added protection against the disease during the adolescent period when they are particularly susceptible. Subsequently they develop the natural immunity which results from the normal activities of adult life. About 80% of parents of eligible children take advantage of this scheme. Prevention of Poliomyelitis. Unfortunately 1957 was again a year of very limited supplies of vaccine. Additional age groups were allowed to register but sufficient doses were not available for all of these when the year ended. At the present time the scheme is being operated by the staff of the County Council on a Divisional Basis and figures for Richmond alone are not available. I look forward to the time when supplies are unlimited and a campaign can be commenced to bring in all those who have not yet registered. CARE OF THE AGED AND THE CHRONIC SICK. There is little change to report in the local scheme for the care of the aged and chronic sick which was set out in the Annual Report for 1955. Health Visitors continue to supervise those who have become frail in health and to help them to obtain 'any assistance which is available from the Statutory or Voluntary organizations. Co-operation between the Hospital, General Practitioner, and Local Health Authority Services, continues to improve. When the domicilliary services are insufficient to meet the needs of the case they are referred to the Welfare Office for admission to a Home or to the Geriatrician for admission to Hospital. Responsibility for the supervision of patients awaiting admission to hospital is assumed by the Geriatrician who has a Health Visitor occupied full time on this work. In the winter months, and particularly when influenza is prevalent, the demand in hospital beds is liable to become critical. However, apart from these crisis, the needs of the people are being met and a bed is invariably found for a really desperate case. 8 During the warmer months, when the bed situation is a little easier, old people are admitted for two weeks in order to give the hard pressed relatives a short period of rest. This scheme has been much appreciated and in some cases it has been extended so that an elderly chronic sick patient has been admitted and re-admitted several times so that the burden is lightened for the relatives, and a bed is not permanently occupied in the hospital. Laundry Service for Incontinent Patients. The service was commenced in 1956 and has continued to work very smoothly. It is confined exclusively to patients who are incontinent and articles laundered are limited to sheets and draw sheets. Although the number of patients served at any one time is small, and the scope of the service is limited, the benefits have been enormous. Sheets are loaned to the patient in sufficient number; twice weekly the soiled sheets are collected and an equal number of laundered sheet? is handed in; a charge of sixpence per sheet is made. This service very considerably reduces the burden on the relatives, and makes it possible for them to nurse at home in comfort a patient who would otherwise have to be admitted to hospital. The small charge covers the actual cost of laundering, and is never a hardship to the patient since a special allowance is available from the National Assistance Board. Figures relating to the work done under this scheme are included in Section "B". 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. No action was taken under the section during this year. A number of cases caused concern, and action was contemplated, but in each instance a satisfactory solution was arrived at without resort to compulsion. The problem of dealing with the aged and chronic sick will always be a difficult one. Not only do we have to contend with a shortage of beds in Homes and in Hospitals, but in addition there are often difficulties caused by the patient's refusal to co-operate. A sense of 9 independence will often make them refuse to consider entering a Home or Hospital. They can often be quite well cared for by the domicilliary services by day, but because of infirmity they cannot be safely left by themselves at night. However, in each case, every effort is made to meet the needs of the situation and compulsory powers are only used as a last resort. SANITARY CIRCUMSTANCES. The report of the Chief Public Health 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 Health Department. APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1957) 42,450 Number of inhabited houses (estimated) 11,925 Rateable value at 1.4.58 £944,326 Sum represented by a Penny Rate, 1958/9 (estimated) £3,776 births. Birth Rate per 1,000 of estimated resident population . 13.7 (Corrected) 12.7 Total number of births (live and still) 583 Analysis:— M F Total Live Births Legitimate 287 259 546 Illegitimate 13 17 30 Still Births Legitimate 5 2 7 Illegitimate — — — Still Birth Rate per 1,000 total births 12.0 10 Environment of Births:— Proportion taking place in Institutions 75.4 Proportion taking place in dwelling houses 24.6 DEATHS. Total number of deaths from all causes 566 Death rate per thousand estimated resident population 13.3 (Corrected) 9.8 The principal causes of deaths:— Malignant Neoplasms 104 288 Heart disease 183 Vascular lesions of Nervous System. 82 Other circulatory diseases 23 Pneumonia 25 50 Bronchitis ... 23 Other respiratory diseases 2 Malignant Neoplasms were responsible for 104 deaths or 18.37% of total deaths. Diseases of the Heart and Circulation caused 288 deaths or 50.8% of total deaths. Diseases of the Respiratory System caused 50 deaths or 8.8% of total deaths. Deaths due to Violence. The table given below sets out the manner in which Richmond residents met their deaths from violence:— Road Traffic Deaths. 5 Falls 5 Drowning 3 Suicide 8 Old War Injuries 1 11 ANALYSIS OF DEATHS RELATING TO RICHMOND FOR THE YEAR 1957. Causes of Deaths. Male. Female. Total. Tuberculosis, respiratory 5 1 6 Syphilitic Disease 3 — 3 Other Infective and parasitic diseases — 1 1 Malignant neoplasm, stomach 6 4 10 Malignant neoplasm, lung bronchus 22 4 26 Malignant neoplasm, breast — 14 14 Malignant neoplasm, uterus — 2 2 Other malignant and lymphatic neoplasms 20 32 52 Leukaemaia, Aleukaemia 2 1 3 Diabetas 2 3 5 Vascular lesions of nervous system 24 58 82 Coronary disease, angina 53 35 88 Hypertension with heart disease 4 6 10 Other heart disease 46 39 85 Other circulatory diseases 13 10 23 Influenza 1 4 5 Pneumonia 15 10 25 Bronchitis 16 7 23 Other diseases of respiratory system 1 1 2 Ulcer of stomach and duodenum 4 -— 4 Gastritis, enteritis and diarrhoea 3 4 7 Nephritis and nephrosis 3 2 5 Hyperplasia of prostate 1 — 1 Congenital malformations — 7 7 Other defined and ill defined diseases 36 19 55 Motor vehicle accidents 1 4 5 All other accidents 6 2 8 Suicide 5 3 8 Homicide and operations of war 1 — 1 293 273 566 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 288 0.39 Due to abortion 61 0.08 Total maternal mortalitiy 349 0.47 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 17.4 Rate for legitimate infants per 1,000 legitimate live births 16.5 Rate for illegitimate infants per 1,000 illegitimate live births 33.3 Total number of infant deaths in the Borough 10 Analysis:— M F Total Legitimate 4 5 9 Illegitimate — 11 Environment of Infant Deaths:— Number occurring in the Borough Nil. Number occurring outside the Borough 10 Number occurring in Institutions 9 Causes of Death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2-3 weeks 3—1 weeks Tolal under 4 weeks 1. Asphyxia Neonatorum 2 ... ... ... 2 2. Prematurity 3 1 ... ... 4 3. Congenital Abnormality 3 ... 1 ... 4 8 1 1 ... 10 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-28th day Survived 28 days 31b. 4oz. or less 5 2 2 1 — — — — 1 — — Over 31b. 4oz to 41b. 6oz. 9 9 1 — 1 Over 41b. 6oz. to 41b. 15oz. 5 — — 5 2 — 2 1 Over 41b. 15oz. to 51b. 8oz. 21 — — 21 2 — — 2 — — — TOTALS 40 2 2 36 6 — — 5 2 — — Note: No cases in following catergories: (1) Born at home and transferred to Hospital on or before 28th day. (2) Born in Nursing Home and nursed entirely there. (3) Born in Nursing Home and transferred to hospital on or before 28th day. 13 ILLEGITIMATE BIRTHS 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 No. of illegitimate live births 38 40 43 43 25 34 33 31 40 30 No. of illegitimate deaths under 1 year 0 1 2 0 3 1 2 0 3 1 Illegitimate death rate 0 25 46 0 120 29 60 0 75 33 COMPARATIVE STATISTICS—1957. Rate per 1,000 Population LIVE BIRTHS Rate per 1,000 (Total Live & Still) STILLBIRTHS Rate per I.OUO Population DEATHS (All Causes) Rate per 1,000 Related Live Births DEATHS (Under One Year) Neonatal Mortality (Under 4 weeks) (Live Births). England & Wales 16.1 22.5 11.5 23.1 ] 6.5 Kichmond 12.7 (Corrected) 12.0 9.8 (Corrected) 17.4 17 4 14 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 assists 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. 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. 17 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. More than Twenty 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 (d) Services provided by Richmond Borough Council. These are dealt with generally in the body of this report. The undermentioned service is used in close association with the domiciliary services provided by other authorities, and so it is mentioned under this section. Laundry Service for Incontinent Patients. During 1957 twenty-five patients availed themselves of the service. Of these 14 have since died, 9 have been removed to hospital. One recovered and 1 discontinued the service. At present only 1 old lady of 92 years of age is being assisted. During the year 2,162 sheets were washed. * This Nursing Home closed down in September, 1957. 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 249 samples Treated water 347 samples For chemical analysis 30 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 801 Samples examined chemically 236 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. 19 The following figures show the daily average consumption from the three sources:— 1956 1957 All Richmond Wells 728,134 galls. 785,362 galls. Metropolitan Water Board 926,140 galls. 929,265 galls. Raw River Water 247,945 galls. 273,891 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 London) Regulations, 1935. Inspections during 1957. Houses inspected and particulars recorded (Housing Act) 7 Houses inspected (Public Health Acts) 605 Revisits to houses and other premises 783 Houses visited for Certificates of Disrepair 143 Visits paid in connection with:— Permitted number for dwellings 28 Vermin 28 Disinfection 98 Enquiries into Infectious Diseases 61 Routine inspections in connection with:— Factories (mechanical) 65 Factories (non-mechanical) 10 Outworkers 5 Bakehouses 24 Butchers' Shops 57 Confectioners (Flour) 12 Confectioners (Sugar) 33 Dairies and Milk Shops 23 Fishmongers and Poulterers 12 Fried Fish Shops 1 Greengrocers and Fruiterers 39 Grocers 86 Ice-cream premises 64 20 Public Houses 42 Restaurants and Tea Shops 223 Food and Drugs Act Sampling 129 Milk Sampling (Designated Milk) 159 Ice-cream Sampling 60 Unsound Food 140 Clean Air Act—Inspection and Observations 75 Drainage 361 Interviews 581 Heating Appliances (Fireguard) Act 9 Massage Establishments - Pet Animals Act, 1951 16 Petroleum Act, 1928 163 Piggeries 1 Public Conveniences 2 Rag Flock Act 6 Rats and Mice (Visits to Properties) 3574 Rats and Mice (Visits re sewer treatments) 1096 Schools—Elementary and Secondary 39 Shops Act, 1950 90 Theatres and Cinemas 8 Water Supply 286 Miscellaneous Visits 988 10,232 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 — Ceilings broken or otherwise defective 28 Chimney stacks defective 14 Clothing accommodation in food premises inadequate 11 Coppers broken or otherwise defective – Damp-proof courses required or defective 1 Doors defective 6 Drainage systems obstructed 58 21 Drainage systems leaking or defective 45 Firegrates and flues defective 8 First-aid equipment in food premises inadequate 15 Floors broken or otherwise defective 29 Floor drainage inadequate — Food preparation equipment unsatisfactory 26 Food rooms requiring reconstruction 20 Food storage unsatisfactory 16 Gutters leaking or defective 22 Hot water supply provided 15 Lighting inadequate 3 Paving inadequate or defective 3 R.W.Ps. ventilating drainage systems — R.W.Ps. broken or otherwise defective 15 Refuse accumulations 17 Refuse receptacles defective 16 Roofs leaking or defective 73 Rooms requiring cleansing 25 Sanitary accommodation insufficient 12 Sanitary accommodation not separate for sexes 3 Sinks insanitary or defective 14 Sites requiring concrete — Soilpipes leaking or defective 16 Staircases defective 2 Ventilation of rooms inadequate 2 Walls: plaster defective 40 Walls: brickwork defective 7 Washing facilities in food premises inadequate 47 Wastepipes leaking or defective 17 Water fittings defective 11 Water supply inadequate 6 W.C.'s leaking or defective 43 Windows defective 53 Miscellaneous defects 42 782 22 At the end of the year, 658 of the defects discovered had been abated, the work of remedying 82 was in hand, and the balance of 42 was still outstanding. In order to see that the defects were being properly remedied 783 visits were paid to the various premises. NOTICES TO REMEDY CONTRAVENTIONS AND ABATE NUISANCES. Informal Action. Preliminary intimations 225 Verbal intimations 80 Statutory Action. Act and Section. Notices Authorised. Notices Served Housing Act, 1957 Section 9 (Repairs) — Public Health Act, 1936. Section 24 (Drainage) 4 2 Section 39 (Drainage) 7 7 Section 45 (Defective Closets) 4 3 Section 46 (Insufficient Closets) — — Section 75 (Dustbins) 2 1 Section 92/93 (Nuisances) 28 23 In the main the requirements of statutory notices were complied with, but in respect of one property repairs were carried out by the Council on behalf 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 person responsible in law. COMPLAINTS. The number of complaints received was 692, which is a decrease of 150 compared with 1956. 23 The complaints received have been classified as follows:— Disrepair of premises : — Dampness 39 Drainage 115 General Defects 168 Nuisance from Animals 11 Nuisance from Refuse 16 Nuisance from Smoke, fumes ... 29 Nuisance from Vermin 36 Rodent infestations 221 Unsound food 25 Miscellaneous Nuisances 32 692 Prompt investigation was made and suitable action taken to remedy the complaints. DISINFECTION AND DISINFESTATION OF PREMISES. Reason. Houses. Rooms. Bedding, etc Infectious Fevers 12 14 74 Tuberculosis 7 10 41 Vermin 14 47 40 Other Diseases 6 6 520 Costs recovered throughout the year : £21 13 s. 11d. Evidence of bed-bug infestation in dwellinghouses 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 164 factories on the register (144 mechanical and 20 non-mechanical) carrying on the following trades: — Mechanical. NonMechanical Bakeries 8 — Boilermakers 2 — Boot-making and Repairing 9 — Building 2 1 Butchers 2 — Clothing 5 — Coach Building 4 — Dressmaking 8 5 Electrical Instruments, etc. 8 — Engineering 22 — Furniture and Upholstery 8 6 Joiners 9 2 Laundering and Cleaning 5 1 Motor Vehicle repairing 22 — Packing Goods 3 — Printing 9 — Tailoring 1 2 Watches and Jewellery 4 1 Miscellaneous Trades 13 2 144 20 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 Seventy-five visits of inspection were made to the premises outlined above and the following defective conditions were remedied: — Want of cleanliness to Factory walls, etc ... — Inadequate ventilation of Factories — Ineffective drainage of Factory floors — Insufficient Sanitary accommodation 2 Unsuitable or defective conditions in Sanitary modation 2 Other matters requiring attention 1 5 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-nine complaints were received during the year and 75 visits and 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. Parts of the Clean Air Act, 1956, which came into effect at the beginning of the year, may be briefly summarised as follows: — (1) new furnace installations must be capable of operating without emitting smoke, and notification must be given to the Council when new furnaces are to be installed: 26 (2) the Council has power to regulate the height of new chimneys serving industrial premises. (3) subject to Ministry approval, the Council may declare the whole, or any part of the Borough to be a smoke control area : only smokeless fuels may be used in such an area: (4) the Council, through the operation of its Building Byelaws may now require new dwellings to have heating and cooking facilities which do not produce smoke : The remainder of the Clean Air Act which gives local authorities power to deal with smoke and grit from industrial and commercial premises is expected to come into force during 1958. 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 3,574 visits was made to dwellings and business premises throughout the year. Complaints of infestation by rats or mice numbered 221 and inspection and investigation revealed rat infestation at 118 premises and mice infestation at 67 premises. By the end of the year infest' ation had been cleared at 173 of these premises. Treatment of the foul sewers was carried out on two occasions, a total of 1,096 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all, 311 manholes were dealt with and of this number 163 were found to be infestated and were poison baited. The method of extended pre-baiting, using a mould-inhibitor (paranitrophenol), was continued for sewer treatments, allowing a longer period for 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. A comparison between the baiting time-tables of the old and new methods clearly shows this advantage. 27 Old Method. 1st day: Prebaiting with damp sausage rusk. 2nd day : Renew baits. 3rd day: Poison baiting (zinc phosphide). 5th day: Inspection. New Method. 1st day: Prebaiting with damp sausage rusk + paranitrophenol. 4th day: Renew baits. 8th day: Poison baiting (zinc phosphide). 11th day: Inspection. This method was first practised in Richmond during the sewer treatment in November 1956, and experience during the last twelve months indicates that the service is more efficient and that infestations are being limited to certain well-defined sections of the sewerage system. SHOPS ACT, 1950. There are 793 shops on the Department's Register and 90 inspections were made during the year. This work completed the survey of shop premises which was started at the end of 1955. 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; Woollen felt; 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 28 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. Six 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. Fiftyseven premises within the Borough are licensed to store a total of 62,370 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 163 visits was made to the various installations. Four new licences were approved, three licences were not renewed, and the total licence fees amounted to £37 5s. Od. Only minor infringements of the Regulations were found. 29 SECTION D—HOUSING. Housing Statistics for the Year 1957. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1411 Number of Flats 410 1821 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) 608 (b) Number of inspections made for the purpose 1534 (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 7 (b) Number of re-inspections made under the Regulations 97 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 199 (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) 216 30 (III). Action under Statutory Powers during the Year: — A. Proceedings under sections 9 and 10 of the Housing Act, 1957: — (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 ... 22 (ii) Number of dwelling houses in which defects were remedied after service of formal notices : — (a) By owners 23 (b) By Local Authority in default of owners 1 C. Proceedings under sections 16 and 23 of the Housing Act, 1957: — (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 1 (iii) Number of dwelling houses demolished in pur suance of Demolition Orders Nil (iv) Number of houses in respect of which an undertaking was accepted under sub-section (4) of Section 16 of the Housing Act, 1957 Nil D. Proceedings under section 18 of the Housing Act, 1957: — (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 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, 1957 Temporary bungalows 179 Permanent houses 485 727 Permanent flats 242 906 During 1957, 51 Temporary Bungalows in Peldon Avenue were demolished 51 Total number included in above, erected in 1957 855 Permanent houses Nil Permanent flats 10 Total number of Emergency houses up to 31st December, 1957 2 comprising 10 units Total number of requisitioned premises up to December 31st., 1957 50 (comprising 108 units) Total number of families rehoused in 1957 4 Total number of families still on Waiting List at December 31st, 1957 495 32 Future Programme. 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 has commenced. The redevelopment of the Peldon Avenue site is now in progress and 100 units of accommodation including two 9'Storey blocks of flats are being erected on this estate. As to the future, tenders are to be invited for 64 flats on the Lower Mortlake Road Site, and it is anticipated that tenders for the 42 flats on the North Road Site might be invited at the beginning of 1959. Due to the Government's restrictions on capital expenditure, the redevolpment of Ham Close has been deferred. 5. Housing Act, 1957 : Unfit Houses. No clearance area work was carried out during the year. One individual unfit house was represented and a Demolition Order was made by the Council on this property. 6. Rent Act, 1957. The Rent Act, 1957, came into operation on the 6th July, 1957, and repealed the Housing Repairs and Rent Act, 1954. The 1957 Act permits the rents of controlled houses to be increased within specified limits, and lays down a proceedure to enable the tenant and landlord to reach agreement on works of repair which should be carried out to the property. Should agreement not be possible, the tenant may apply to the local authority for a Certificate of Disrepair which, if granted, stops the rent increase. The landlord has the opportunity, however, of giving an undertaking to carry out the repairs within 6 months, and if such an undertaking is accepted by the local authority, the rent increase continues to be payable. The following tables show the action taken during the year: — PART 1—Applications for Certificates of Disrepair. Number of applications 59 Number of decisions not to issue certificates Nil. 33 Number of decisions to issue certificates : — (a) in respect of some but not all defects 37 (b) in respect of all defects 20 Number of undertakings given by landlords 47 Number of undertakings refused by Local Authority Nil. Number of certificates issued 10 PART 2—Applications for Cancellation of Certificates. Applications by landlords to local Authority for cancellation of certificates 4 Objections by tenants to cancellation of certificates 1 Decisions by Local Authority to cancel in spite of tenants objection 1 Certificates cancelled by Local Authority 4 34 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Food Inspection. The following foodstuffs, found to be unfit for human con sumption, were surrendered by the owners and either salvaged for animal food or destroyed. Articles Tons Cwts. Qrs. lbs. Fish 1 3 18 Flour and Flour Confectionery — — 1 13 Fruit and Vegetables — 1 2 25 Meat and Meat Products — 4 — 7 Milk and Milk Products — — 2 6 Tinned Goods (all classes) — 16 24 1 4 3 9 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-five 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 seventeen cases reports were made to the Health Committee. Letters were sent to offenders in eleven instances and legal proceedings were taken in two cases. In the first, under Section 2, Food and Drugs Act 1955, the defendants were fined £15 with two guineas costs for selling a loaf of bread containing a metal bolt. In the second case, under the Milk and Dairies Regulations, the defendants were conditionally discharged for using a dirty milk bottle. 35 Food & Drugs Act, 1955 (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 Beefburger — 1 1 Biscuits — 3 3 Blancmange Powder — 1 1 Brawn — 1 1 Butter — 1 1 Cake — 4 4 Caviar — 1 1 — 1 1 Cheese — 11 11 — 1 1 Chicken Products — 3 3 Christmas Pudding — 2 2 Cough Mixture — 1 1 — 1 i Cream — 2 2 Dried Fruit — 8 8 Fish Cakes — 2 2 Flavouring — 1 1 Friars Balsam B.P. — 1 1 Fruit Salad — 3 3 Fruit Wafer — 2 2 Galantine — 1 1 Ham and Beef Roll — 1 1 Hamburger — 1 1 Jellies — 1 1 Margarine — 1 1 Meat Pies and Puddings — 4 4 Meat Products — 8 8 Mushrooms, Creamed — 1 1 Mustard — 1 1 Nerve Tonic — 2 2 — 1 1 Orange Squash — 1 1 Pepper — 2 2 Salmon Spread — 2 2 Sauce — 2 2 Sausages Sleeping Tablets — 9 2 9 2 — 2 2 Slimming Tablets — 3 3 Soup — 1 1 Steakettes — 1 1 sweets — 11 11 Vitamin Tablets — 2 2 Totals — 106 105 — 6 6 36 Sample No. 292 : Process Cheese. An informal sample of Process Cheese with Celery was reported by the Public Analyst to contain moisture exceeding 45%. The Wholesalers, who had no further stocks in hand of this consignment, drew the Public Analyst's report to the attention of the Danish dairy which manufactured the product, and arranged for any future imports to be examined. Samples Nos. 296 and 297 : Sausages. Informal samples of Pork Chipolatas and of Pork Sausages, purchased from the same manufacturer, were reported by the Public Analyst to be deficient in meat content. The manufacturers stated that the recipes used provided for a meat content exceeding 65%, and previous samples in fact showed that this standard had been maintained. No further action was taken in this case and later samples from the same manufacturer proved satisfactory. Sample No. 355 : Nerve and Strength Tonic. An informal sample of Children's Nerve and Strength Tonic was reported by the Public Analyst to be incorrectly labelled as the formula did not disclose a syrup sugar content. The Suppliers had not been aware that the Tonic contained syrup sugar, but they agreed at once to amend the formula label. Sample No. 366 : Cough and Bronchitis Mixture. An informal sample of Cough and Bronchitis Mixture was reported by the Public Analyst to be incorrectly labelled in that the mixture had been compounded to a very different formula from that given on the label. The Chemist at once withdrew this article from sale and checked all other labels at the same time amending the label for the Cough and Bronchitis Mixture. Sample No. 368 : German Caviar. An informal sample of German Caviar was reported by the Public Analyst not to have been prepared from the roe of sturgeon but from the lumpfish. The stock was immediately withdrawn from sale at the time when the retail shop changed ownership, and the new proprietors discontinued the sale of this article. 37 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 10 24 Butchers (includes 28 premises registered for the manufacture of preserved food) 34 57 Confectioners (Flour) 17 12 Confectioners (Sugar) 46 33 Dairies (premises registered under Milk and Dairies Regulations) 5 23 Fishmongers 15 12 Greengrocers 35 39 Grocers 75 86 Ice-Cream Premises (Registered for Manufacture) ... 2 Ice-Cream Premises (Registered for Sale and Storage) 108 64 Licensed Premises 78 42 Restaurants, Cafes, etc. 77 223 502 615 IMPROVEMENTS IN FOOD PREMISES. The standard of hygiene required in food premises is now set out in the Food Hygiene Regulations 1955. 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. 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. 38 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 20 premises 2. Food rooms repaired, cleansed or redecorated 25 „ 3. Food storage improved 16 „ 4. Food preparation equipment renewed 25 „ 5. Ventilation and lighting of food rooms improved 3 „ 6. Staff washing facilities improved 47 „ 7. Staff clothing accommodation provided 11 „ 8. First Aid Boxes provided 15 „ 9. Constant hot water supply installed 15 „ 10. New sinks provided 3 „ 11. Existing Sanitary accommodation improved 20 „ 12. Drainage improved, repaired or altered 4 „ 13. Refuse accumulations removed 8 „ 14. Refuse receptacles provided 9 „ 15. Other improvements or repairs carried out 45 „ 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. 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. 39 Ice-Cream. Premises manufacturing, storing or selling Ice-Cream have been regularly supervised, a total of 64 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. Fifty samples were submitted to the Public Health Laboratory for examination, and 39 were satisfactory (Grades I and II) and the remaining 11 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. These samples were obtained from six retailers who sold loose ice-cream ; on five premises the method of sterilizing servers was unsatisfactory, and in the sixth, the ice-cream storage temperature was found to be at fault. In carrying out these investigations, 7 samples of server water were examined bacteriologically of which 5 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 Treatment) 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. Fifteen samples were taken of cake filler, shrimps, bacon, ice and iced water, and iced lollies. The results were satisfactory in all cases except one of flaked ice, which had been taken from a restaurant. The proprietor was advised on storing the product without risk of contamination. 40 Milk—Licencing and Sampling. Under the provisions of the Food and Drugs Act, 1955, and Regulations made thereunder, Dairy Farms have become the direct responsibility of the Ministry of Agriculture and Fisheries: the premises on which milk is pasteurised or sterilised are licensed 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 is one pasteurising plant 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 18 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. Under the regulations the Local Authority continued to take samples from dealers and during the year under review the following were taken : — Pasteurised Milk 90 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 8 „ 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- 41 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). Diseases. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Scarlet Fever 12 5 — Pneumonia 18 6 — Erysipelas 4 2 — Measles 1141 12 — Whooping Cough 77 3 — Dysentery 5 3 — Food Poisoning 10 2 — Tvphoid 1 1 — Paratyphoid 2 2 — Total 1270 36 Nil FOOD POISONING. Total number of outbreaks 2 Number of cases notified 10 Number of deaths Nil DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1957 : — (a) Pre-School children (under 5 years) 450 (b) Between 5 and 15 years 32 482 Grand Total of Children in the Borough who have received immunising treatment by the end of the year: — (a) Under 5 years 1799 (b) Between 5 and 15 years 4882 Number of children given reinforcing doses during 1957 697 42 STATE OF IMMUNITY. The following table shows the percentages of children immunized in various age groups for the past three years. Age Group. 1955 1956 1957 Under 1 year 66.3 77.2 72.0 1—4 82.1 82.9 73.2 5 — 15 96.0 96.1 96.3 It is unfortunate that there has been a fall in the percentage of children immunized in the lower age groups. This is due to a number of causes, including the policy of avoiding combined antigens during the months when poliomyelitis is likely to be prevalent. Every effort will be made to regain lost ground in future years. The state of immunity of alt children is indicated by the "Immunity Index" which is the number of children immunised (primary or booster) during the last five years expressed as a percentage of the total estimated mid-year child population. The following table shows the trend during the last three years. 1955 1956 1957 Immunity Index for children 0 — 15 76.0 76.6 77.1 WHOOPING COUGH IMMUNISATION. With very few exceptions, children who are protected against diphtheria are also immunized against whooping cough. This is a very satisfactory state of affairs, and there is no doubt that use of the combined diphtheria-pertussis antigen has done much to encourage it. The new policy of using only single antigens in the 2nd and 3rd quarters of the year means that, at these times, no less than 5 injections at monthly intervals are required to give protection to both diseases. Bearing in mind that vaccination against smallpox is also of great importance, and that early inoculation against poliomyelitis has now become possible, there seems to be some danger that parents may object to the numerous injections and that one or more of the schemes may suffer in consequence. 43 During the year 470 children under the age of 5 years completed primary courses of inoculations against Whooping Cough. In addition 55 older children received reinforcing doses, but these have since been discontinued as being inadvisable. VACCINATION AGAINST SMALLPOX. 1. Analysis of vaccinations at Welfare Centres and Private Doctors' Surgeries. Children. Adults Primary Vaccination 466 30 Re-vaccination 68 280 Totals 534 310 Grand Total 844 2. Figures showing the percentage of children under 1 year vaccinated during 1957. No. Vaccinated Estimated mid-year Population under 1 year. % Vaccinated 378 565 66.9 IMMUNIZATION AGAINST TETANUS. During the year 41 children were giver courses of inoculations against Tetanus at the parents' request. TUBERCULOSIS. Vaccination Against Tuberculosis. Each year children who have reached their 13 th year are offered vaccination against tuberculosis with B.C.G. (Bacille Calmette- Guerin). The inoculation is preceded by a Mantoux skin test which indicates whether or not the child has already been infected with tuberculosis. Those who have already been infected are not given the inoculation but they are investigated by X-Rays and by enquiries regarding home contacts. The object of the scheme is to provide resistance to tuberculosis during the adolescent period when children are most susceptible to the infection. 44 About 70% of parents of eligible children take advantage of this scheme each year. During 1957 a total of 507 boys and girls were inoculated with B.C.G. in the Northern Division (Richmond and Barnes). The position in Richmond for the year 1957 may be summarised as follows: — NOTIFICATIONS: Respiratory Tuberculosis. Twenty-six cases of respiratory tuberculosis were notified during the year, viz:—16 males and 10 females. The corresponding figure for 1956 was 20. Non-Respiratory Tuberculosis. One new case of non-respiratory tuberculosis was notified during the year and there were no deaths from this cause. Two such cases were notified during 1956. 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 148 10 Females 100 14 248 24 Corresponding figures for 1956 273 29 45 Analysis of Cases and Deaths for 1957. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory Under 5 M F M F M F M F 1 1 — — — — — — 5 1 — — — — — — — 15—24 3 4 — 1 — — — — 25—44 2 2 — — — — — — 45—64 7 2 — — 2 — — — 65 and upwards 2 1 — — 3 1 — — Totals 16 10 — 1 5 1 — — 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.