borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1958 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1958 J. H. BROAD & Co , Ltd., Printers, 8, King Street, Richmond. Surrey. CONTENTS. Page. List of Staff 2 Preface 3,4,5,6,7,8 SECTION A — STATISTICS AND SOCIAL CONDITIONS. Social Conditions 9 Births 9 Deaths 9, 10, 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 16 Nursing Homes 17 Services provided by the Surrey Executive Council 17 Services provided by Richmond Borough Council 17 Laundry Service for Incontinent Patients 17 SECTION C —SANITARY CIRCUMSTANCES. Water Supply 18 Public Health Inspections 19 Public Health Contraventions and Defects 20,21 Notices to Remedy Contraventions and Abate Nuisances 22 Complaints 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 28 Diseases of Animals Act, 1950 28 Petroleum Acts 29 SECTION D —HOUSING. Housing. (Action under Housing and Public Health Acts) 30,31 Council's Housing Programme 32 Housing Repairs and Rents Act 1954 33, 34 SECTION E —INSPECTION AND SUPERVISION OF FOOD. Food Inspection 35 Sampling of Food and Drugs 36, 37,38 Classification of Food Premises 39 Improvements in Food Premises 39 Byelaws 40 Sale and Storage of Ice Cream 40 Milk-Licencing and Sampling 41,42 SECTION F — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Diseases 43 Admission to Infectious Diseases Hospitals 43 Food Poisoning 43 Diphtheria Immunisation 43,44 Vaccination Against Smallpox 44 Immunization against Tetanus 44 Tuberculosis 45,46 1 Public Health Department, Parkshot, Richmond. July 1959. 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 1958 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 would like to thank all members of my Staff for their loyalty and hard work during the year, and my colleagues in other depart' ments for their ready co-operation. Finally, I wish to express my appreciation of the support received from my Chairman and the Chairman and Members of all Committees with which I have been concerned. I am, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 2 LIST OF STAFF. Medical Officer of Health : ERIC PEREIRA, M.B., B.S., D.P.H. Chief Public Health Inspector : EDWARD S. HERBERT, M.A.P.H.I. Senior Additional Public Health Inspector : HENRY DOUGLAS WILLIAMS. Additional Public Health Inspectors : CHARLES S. SMEATON, M.R.S.H. DAVID MEIRION HUGHES, M.R.S.H. Chief Clerk : MRS. FLORENCE G. SMITH. Clerks : MRS. MARGARET M. SUMPTER. MISS PAMELA A. EVANS. 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 1958. PREFACE. Staff. Mr. E. S. Herbert was appointed Chief Public Health Inspector in January 1958 and Mr. H. D. Williams commenced duty as Deputy Chief Public Health Inspector at the end of June. Mrs. Sumpter, Clerk, who had been off duty seriously ill since July 1957 rejoined the staff at the end of September 1958. Miss Joyce Turner joined the department as temporary clerk for the period 24.4.58 to 24.10.58. Population. The Registrar General's estimate of the population in 1958 was 42,330 which can be compared with the 1951 Census population of 41,944 and the population for 1957 which was estimated to be 42,450. Births. During the year 591 births were recorded (320 males and 271 females). This figure may be compared with 583 in 1957 and 851 in 1947. The proportion of births taking place in dwelling houses fell slightly to 23.4% compared with 24.6% in the previous year. The proportion has remained at about this level since 1945, and there is no indication that improved housing conditions are affecting the situation. 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 37 premature live births and of these 28 survived. Of the 9 infants who failed to survive, 5 weighed less than 3lbs. 4ozs. at birth, 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 11 deaths of infants under 1 year of age, 7 were due to this cause. Deaths. The total number of deaths occurring amongst residents was 589 (290 males and 299 females) compared with 566 in 1957. 4 The death rate, when corrected to allow for the high proportion of elderly residents, is 10.7 per thousand population which compares favourably with other towns in the country. In Section A deaths are set out under their various causes. Reference to the Tables shows that 19.02% of deaths were caused by cancer compared with 18.37% in the previous year. The raised percentage is almost entirely due to the increased number of cases of cancer of the lung which occurred in men. NOTIFIABLE DISEASES. The Table in Section F sets out the number of cases of infectious diseases notified during 1958. Measles. Following the epidemic of measles which occurred in the Spring of 1957 the incidence in 1958 was very moderate and no case required admission to hospital. Whooping Cough. Only 20 cases were notified and these were quite mild. There is no doubt that immunization against this disease is playing a valuable part. Poliomyelitis. Only one case was notified and confirmed as a definite case. This occurred very late in the year, and the patient was the mother of a young child. About 3 weeks before the patient became ill, the child had an indefinite febrile illness which was not diagnosed. He had not been vaccinated against poliomyelitis and it is possible that he contracted the non-paralytic form of the disease and infected his mother. The patient had quite extensive paralysis but fortunately she made a very good recovery. Dysentery. Fifty cases were notified and 2 were admitted to hospital. This unusually large number was due mainly to an outbreak of dysentery due to Shigella Sonnei at Parkshot Day Nursery and to a similar outbreak at Rivermead School, Kingston, which occurred at about the same time and which affected a number of the residents of Ham. Investigations revealed that 10 nursery children were infected with Shigella Sonnei and that in a number of cases their home contacts 5 were also infected. Six children living in Ham and attending Rivermead School were infected. In addition 89 suspected patients were referred by private doctors and of these 26 were proved to be true cases. The illness caused was mild, but a great nuisance to those concerned. Sometimes symptoms recurred after apparent cure, and in a number of cases the patients continued to carry the organism for several weeks. This necessitated exclusion from the Nursery or School until it was reasonably certain that the child was no longer infective. The remaining cases notified were individual cases of dysentery due to the same organism and which occurred at various times of the year and in various parts of the Borough. Food Poisoning. Eleven cases were notified. A mother, father, and a child all had symptoms of food poisoning. The suspected food was not available for examination and it was not possible to isolate a food poisoning organism from the patients. It is probable that this short, sharp, outbreak was due to faulty storage of a veal and ham pie, and that the symptoms were caused by toxims produced in the food before consumption. The remainder were single cases; three being caused by Salmonnella typhimurium, one by Staphylococcus Aureus and in four cases the agent was not identified. Scarlet Fever. I here were 24 cases. All were mild and of short duration. Two were admitted to hospital but in each case this was done because of poor home conditions and not because the patients were seriously ill. Pneumonia. Five cases were notified and all were adults. 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. Prevention of Diphtheria. The scheme for immunizing infants and children against diphtheria was continued as before, and a high state of immunity was maintained. 6 The policy of using combined antigens only during the 4th and 1st quarter of the year was continued, since this is considered to be the most practical way of reducing the slight risk of provoking cases of poliomyelitis. Prevention of Whooping Cough. Nearly every infant is protected against whooping cough as well as diphtheria. Efforts are made to commence inoculations by the third month as the disease is most dangerous in the first year of life. The vaccine does not give complete protection but when the disease does occur in an inoculated child, it is a mild illness. Prevention of Smallpox. The percentage of babies vaccinated in 1958 was 55.9% which is lower than in the previous year (66.9%). Prevention of Tetanus. Active immunization is available for those who desire it. 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 70% of the parents of eligible children take advantage of this scheme. Prevention of Poliomyelitis. The scheme is administered on a Divisional basis and figures quoted apply to the boroughs of Richmond and Barnes. During the closing months of 1957 supplies of vaccine were very limited and it was only possible to vaccinate 283 persons during October, November, and December. On the 1st January, 1958, 4,183 applicants were awaiting vaccination and a further 263 had only received one dose. Supplies of vaccine continued to be scanty during the first quarter of 1958 until May, when the import of American and Canadian Salk vaccine recommenced and the situation was greatly improved. Arrangements were made for five sessions to be held each week at the various clinics. Usually more than 120 appointments were made for each session and in the vast majority of cases the scheme worked smoothly and patients were kept waiting only a very few minutes. 7 Thereafter the position improved rapidly, and by the end of August only 461 registered applicants were waiting. In September the Minister of Health announced that third or boosting doses were to be given to all those vaccinated since the beginning of the scheme, and that the scheme would now include all young persons up to the age of 25 years. This meant that third injections were required by more than 9,000 children in addition to three injections for each of the new registrations. By the end of December over 4,000 third injections had been given and first or second injections had been given to a further 1,500. At this time it was apparent that young people aged 15-25 years were very slow at coming forward and that some 30% of school children had not yet been registered. It was obvious that, if supplies of vaccine remained adequate, a drive would have to be made early in the following year to include as many as possible of these two groups. 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 previous Annual Reports. Co-operation between the various authorities and officers concerned continues to improve. The Home Help Service plays a very large part in assisting these elderly people, thereby enabling them to remain at home in reasonable comfort. Other than in times of epidemic the waiting period for admission to a hospital or a home is not unduly long, and a desperate case is invariably admitted without delay. In many cases the old people create their own problems by refusing to leave their homes. A great deal is done to assist the aged by the local voluntary services. The "Meals on Wheels" Scheme organized by the W.V.S. provides a good meal twice weekly for those who want it, and the numerous Clubs provided by the Old Peoples Welfare Committee bring new interests into the lives of many elderly people who are not confined to their homes. I think that the chief need at present is the establishment of some form of "Day Hospital" or "Day Club" to which people who are house-bound through infirmity or physical defect can be transported and where they would be cared for, entertained, and given remedial treatment during the course of the day. 8 Such places have proved most successful in other districts, and are greatly appreciated by those who otherwise would never go out. 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. 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. 9 APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1958) 42,330 Number of inhabited houses (estimated) 12,012 Rateable value at 1.4.59 £953,300 Sum represented by a Penny Rate, 1959/60 (estimated) £3,955 Births. Birth Rate per 1,000 of estimated resident population . (Corrected) 13.9 12.9 Total number of births (live and still) 591 Analysis:— m f Total Live Births Legitimate 291 248 539 Illegitimate 22 18 40 Still Births Legitimate 5 5 10 Illegitimate 2 — 2 Still Birth Rate per 1,000 total births 16.9 Environment of Births Proportion taking place in Institutions 76.6 Proportion taking place in dwelling houses 23.4 Deaths. Total number of deaths from all causes 589 Death rate per thousand estimated resident population . (Corrected) . 13.9 10.7 10 The principal causes of deaths: — Malignant Neoplasms 113 Heart disease 175 Vascular lesions of Nervous System 84 287 Other circulatory diseases 28 Pneumonia 29 Bronchitis 30 62 Other respiratory diseases 3 Malignant Neoplasms were responsible for 113 deaths or 19.02% of total deaths. Diseases of the Heart and Circulation caused 287 deaths or 48.7% of total deaths. Diseases of the Respiratory System caused 62 deaths or 10.5% of total deaths. Deaths due to Violence. The table given below sets out the manner in which Richmond residents met their deaths from violence:— Falls 7 Drowning 3 Burns 1 Coal Gas Poisoning 2 Aircraft Crash 1 11 ANALYSIS OF DEATHS RELATING TO RICHMOND FOR THE YEAR 1958. Causes of Deaths. Male. Female. Total. Tuberculosis, respiratory 3 4 7 Tuberculosis, other — 1 1 Syphilitic Disease 3 1 4 Other Infective and parasitic diseases — 1 1 Malignant neoplasm, stomach 7 4 11 Malignant neoplasm, lung bronchus 33 1 34 Malignant neoplasm, breast — 12 12 Malignant neoplasm, uterus 3 3 Other malignant and lymphatic neoplasms 27 26 53 Leukaemia, Aleukaemia 2 1 3 Diabetas — 1 1 Vascular lesions of nervous system 32 52 84 Coronary disease, angina 51 30 81 Hypertension with heart disease 6 7 13 Other heart disease 34 47 81 Other circulatory diseases 14 14 28 Influenza 1 1 2 Pneumonia 10 19 29 Bronchitis 19 11 30 Other diseases of respiratory system 1 2 3 Ulcer of stomach and duodenum 3 2 5 Gastritis, enteritis and diarrhoea 1 1 2 Nephritis and nephrosis 1 — 1 Hyperplasia of prostate 6 — 6 Congenital malformations 2 3 5 Other defined and ill defined diseases 22 45 67 Motor vehicle accidents 1 1 2 All other accidents 6 6 12 Suicide 5 3 8 Homicide and operations of war — — — 290 299 589 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 263 0.35 Due to abortion 63 0.08 Total maternal mortalitiy 326 0.43 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 18.9 Rate for legitimate infants per 1,000 legitimate live births 20.4 Rate for illegitimate infants per 1,000 illegitimate live births 00.0 Total number of infant deaths in the Borough 11 Analysis:— M F Total Legitimate 3 8 11 Illegitimate — Environment of Infant Deaths:— Number occurring in the Borough 1 Number occurring outside the Borough 10 Number occurring in Institutions 10 Causes of Death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3-4 weeks over 4 weeks Total 1. Asphyxia (accidental) ... ... ... ... 1 1 2. Prematurity 7 ... ... ... ... 7 3. Congenital Abnormality 1 1 ... ... 1 3 8 1 ... ... 2 11 PREMATURE LIVE BIRTHS. PREMATURE 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 0 5 1 — — — — — 1 1 — Over 31b. 4oz to 4lb. 6oz 1 — 1 — — — — — 1 — Over 41b. 6oz. to 41b 15oz. 6 — 1 5 — — — — — — — Over 41b. 15oz. to 51b. 8oz. 15 1 1 13 9 — 9 — — 1 TOTALS 28 6 3 19 9 — 9 1 2 1 Note : No cases in following categories : (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. ILLEGITIMATE BIRTHS 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 No. of illegitimate live births 40 43 43 25 34 33 31 40 30 40 No. of illegitimate deaths under 1 year 1 2 0 3 1 2 0 3 1 0 Illegitimate death rate 25 46 0 120 29 60 0 75 33 0 COMPARATIVE STATISTICS — 1958. 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) Nennatal Mortality (Under 4 weeks) (Live Births). England & Wales 16.4 21.6 11.7 22.5 16.2 Richmond 12.9 (Corrected) 16.9 10.7 (Corrected) 18.9 15.5 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 manage ment of the Home Help Supervisor who is based at the Divisional Health Office. An Ambulance Service is provided from the station in Kings Road, Richmond which operates under the control station in Maiden. The service is supported by the ambulance of the local division of the St. John Ambulance Brigade. A Day Nursery for the care of children up to the age of five years is located in Parkshot, Richmond. 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 Tol worth 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.1 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 Home is registered by the Surrey County Council:— Tyneham House Nursing Home, 108, Church Road. (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 under taken 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 1958 twenty new patients availed themselves of the service. Of these, 8 have since died, 3 have been removed to hospital, 6 discontinued the service, and 1 removed from the district. At present only two ladies of some 70 odd years are being assisted. During the year, 1,951 sheets were washed. 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.219 samples Treated water 335 samples For chemical analysis 27 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 766 Samples examined chemically (full analysis) 51 Samples of water are collected at all stages of the purification process at least five times each week and analysed at the laboratories of the Metropolitan Water Board. 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. Fiftytwo samples of river water were bacteriologically examined during the year. 19 The following figures show the daily average consumption from the three sources : — 1957 1958 All Richmond Wells 785,362 galls. 836,038 galls. Metropolitan Water Board 929,265 galls. 879,030 galls. Raw River Water ... 273,891 galls. 209,548 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) 22 Houses inspected (Public Health Acts) 556 Revisits to houses and other premises 712 Houses visited for Certificates of Disrepair 161 Visits paid in connection with:— Permitted number for dwellings 11 Vermin 28 Collection of Specimens (I.D.) 505 Enquiries into Infectious Diseases 143 Routine inspections in connection with:— Factories (mechanical) 20 Factories (non-mechanical) 14 Outworkers 29 Bakehouses 26 Butchers' Shops 59 Confectioners (Flour) 16 Confectioners (Sugar) 25 Dairies and Milk Shops 35 Fishmongers and Poulterers 15 Fried Fish Shops 10 Greengrocers and Fruiterers 44 Grocers 107 Ice-cream premises 89 20 Public Houses 36 Restaurants and Tea Shops 139 Food and Drugs Act Sampling 122 Milk Sampling (Designated Milk) 71 ice-cream Sampling 63 Unsound Food 158 Clean Air Act—Inspection and Observations... 118 Drainage 239 Interviews 629 Heating Appliances (Fireguard) Act 74 Massage Establishments — Merchandise Marks Act 11 Pet Animals Act, 1951 11 Petroleum Act, 1928 160 Piggeries 6 Public Conveniences — Rag Flock Act 22 Rats and Mice (Visits to Properties) 3881 Rats and Mice (Visits re sewer treatments) 902 Schools—Elementary and Secondary 1 Shops Act, 1950 71 Theatres and Cinemas — Water Supply 239 Miscellaneous Visits 805 10,385 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 33 Chimney stacks defective 10 Clothing accommodation in food premises inadequate 2 Coppers broken or otherwise defective 2 Damp-proof courses required or defective 7 Doors defective 20 21 Drainage systems obstructed 40 Drainage systems leaking or defective 15 Firegrates and flues defective 16 First'aid equipment in food premises inadequate — Floors broken or otherwise defective 55 Floor drainage inadequate — Food preparation equipment unsatisfactory 26 Food rooms requiring reconstruction 1 Food storage unsatisfactory 2 Gutters leaking or defective 49 Hot water supply provided 2 Lighting inadequate — Paving inadequate or defective 5 R.W.Ps. ventilating drainage systems — R.W.Ps. broken or otherwise defective 18 Refuse accumulations 1 Refuse receptacles defective 11 Roofs leaking or defective 81 Rooms requiring cleansing 8 Sanitary accommodation insufficient — Sanitary accommodation not separate for sexes — Sinks insanitary or defective 11 Sites requiring concrete — Soilpipes leaking or defective 4 Staircases defective 9 Ventilation of rooms inadequate — Walls: plaster defective 136 Walls: brickwork defective 48 Washing facilities in food premises inadequate 2 Wastepipes leaking or defective 12 Water fittings defective 4 Water supply inadequate 4 W.C.'s leaking or defective 26 Windows defective 95 Miscellaneous defects 77 807 In order to see that the defects were being properly remedied 711 visits were paid to the various premises. 22 NOTICES TO REMEDY CONTRAVENTIONS AND ABATE NUISANCES. Informal Action. Preliminary intimations 288 Verbal intimations 126 Statutory Action. Act and Section. Notices Authorised. Notices Served Housing Act, 1957 Section 9 (Repairs) Public Health Act, 1936. Section 24 (Drainage) 10 10 Section 39 (Drainage) 5 5 Section 45 (Defective Closets) 1 1 Section 46 (Insufficient Closets) — — Section 75 (Dustbins) 2 2 Section 92/93 (Nuisances) 10 10 In the main the requirements of statutory notices were complied with, but 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 718, which is an increase of 26 compared with 1957. The complaints received have been classified as follows: — Disrepair of premises : — Dampness 39 Drainage 100 General Defects 175 Nuisance from Animals 6 Nuisance from Refuse 36 Nuisance from Smoke, fumes 19 Nuisance from Vermin 38 Rodent infestations 248 Unsound food 31 Miscellaneous Nuisances 26 718 Prompt investigation was made and suitable action taken to remedy the complaints. 23 DISINFECTION AND DISINFESTATION OF PREMISES. Reason. Houses. Rooms. Bedding, etc Infectious Fevers 4 4 31 Tuberculosis 4 5 17 Vermin 13 25 28 Other Diseases 7 5 596 Costs recovered throughout the year : £14 4s. 8d. 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. 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 171 factories on the register (150 mechanical and 21 non-mechanical) carrying on the following trades: — Mechanical. NonMechanical Bakeries 7 — Boilermakers 2 — Boot-making and Repairing 9 — Building 2 1 Butchers 2 — Clothing 5 1 Coach Building 4 — Dressmaking 8 5 Electrical Instruments, etc. 10 — Engineering 24 — Furniture and Upholstery 8 6 Joiners 9 2 Laundering and Cleaning 4 1 Motor Vehicle repairing 24 — Packing Goods 3 — Printing 9 — Tailoring 1 2 Watches and Jewellery 4 1 Miscellaneous Trades 15 2 150 21 In addition, 10 premises were recorded for the purpose of Section 7 of the Act (suitability of sanitary accommodation) being Institutions or sites of building operations. 25 Thirty-four 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 2 Insufficient Sanitary accommodation 1 Unsuitable or defective conditions in Sanitary accommodation — Other matters requiring attention 11 14 ATMOSPHERIC POLLUTION. The Clean Air Act, 1956 gives to local authorities the power to make Smoke Control Areas in any part of their district, and on the 21st October, 1958, the Council decided, in principle, that the whole of the Borough should be covered by successive Smoke Control Orders within the next 10 years. Richmond is not an industrial area, but it lies in that part of the Thames Valley which was referred to as a "black area" in the Beaver Report on Atmospheric Pollution. "Black Areas" are described in the Report as urban areas which are liable both to smoke pollution and to natural fog, and in Richmond it may be assumed that domestic chimneys are the principal cause of smoke pollution. When Smoke Control Areas are established, only smokeless fuels will be permitted to be used, and these fuels comprise electricity, gas, coke, anthracite, low volatile steam coal and carbonised coals ; in addition oil-fired installations will be acceptable if designed and properly maintained for oil fuels. After a Smoke Control Order becomes operative, it will be necessary for many heating and cooking appliances to be adapted or changed to enable them to be used with smokeless fuels, and in the case of private dwellings (but not new dwellings constructed after the 5th July, 1956) the greater part of the cost of conversion will be borne by the local authority. The cost will be divided on the basis of : — 30% paid by the owner or occupier 50% paid by the local authority 70% grant to the 40% paid by Exchequer grant j owner or occupier. 26 In making its decision, the Council expressed the hope that other local authorities in the London area would be no less vigorous in conducting a campaign to reduce atmospheric pollution, and there is promise that in the next ten years considerable progress will be made to this end. The survey of Richmond's first Smoke Control Area will be started in April 1959. During 1958, nineteen complaints were received concerning smoke emissions from chimneys. There is growing evidence that oil-fired furnaces may give trouble by the emission of carbon smuts which settle in the area adjacent to the chimney. This problem has caused concern not only to local authorities and factory management, but also to the manufacturers of oil-firing equipment and to the fuel suppliers. During the year, one factory chimney in Richmond was persistently emitting carbon smuts despite the owners' efforts to ensure that the oil-burners were properly installed and maintained. After a great deal of investigation and with the co-operation of all parties, the answer to the problem was found when the chimney stack was insulated, thus raising the flue gas outlet temperature and preventing the formation of smuts in the chimney. The Clean Air Act, 1956 provides that new furnace installations (exceeding 55,000 B.T.Us. per hour) must be capable of operating without emitting smoke, and in accordance with Section 3 of the Act, the Council approved 10 new installations during the year. In 3 other cases the Council received notification of proposals to install new furnaces. In addition, the Council approved plans for the erection of 4 new industrial chimneys in accordance with Section 10 of the Clean Air Act, 1956, being satisfied that the height of the chimneys would be sufficient to prevent nuisance. 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 3,820 visits was made to dwellings and business premises throughout the year. Complaints of infestation by rats or mice numbered 213 and inspection and investigation revealed rat infestation at 144 premises 27 and mice infestation at 61 premises. By the end of the year infestation had been cleared at 190 of these premises. Treatment of the foul sewers was carried out on two occasions, a total of 902 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all, 250 manholes were dealt with and of this number 125 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. In May poison-baiting was carried out with zinc phosphide, and in November an anti-coagulant, Warfarin, was used. The second sewer treatment was concentrated upon specific areas in the Borough known to have been persistently infested with rats. During the year contracts were renewed with the Surrey County Council for regular visits to be made to schools and institutions, and other contracts were renewed with business premises in the Borough. These agreements are of value in that periodical visits by trained staff ensure that any evidence of rodent infestation is quickly noted and treatment applied. Such prompt action prevents an infestation becoming extensive, and indirectly lessens the risk of damage to goods and stock carried in the premises. SHOPS ACT, 1950. There are 793 shops on the Department's Register and 71 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 <ts 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 28 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. 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 1958. 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. 29 petroleum (consolidation) act 1928 and regulations made thereunder. Fifty-seven premises within the Borough are licensed to store a total of 60,430 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 160 visits was made to the various installations and only minor infringements of the Regulations were found. The total licence fees amounted to £36 5s. Od. During the year the attention of licensees was drawn to the condition of the licence which requires the testing of petrol storage tanks which have been installed for more than 20 years. Forty-eight tanks were tested and all were found to be satisfactory. 30 SECTION D—HOUSING. Housing Statistics for the Year 1958. 1. Number of dwellings owned by the Local Authority:— Number of Houses 1407 Number of Flats 416 1823 2. Unfit Houses. (I) Inspection of Dwelling Houses during the Year:-— (l) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) ... ... 578 (b) Number of inspections made for the purpose 1451 (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 22 (b) Number of re-inspections made under the Regulations 71 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 22 (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 203 (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)... ... 209 31 (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 13 (ii) Number of dwelling houses in which defects were remedied after service of formal notices : — (a) By owners 13 (b) By Local Authority in default of owners Nil 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 Nil (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 (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 32 (ii) Number of undertakings in respect of part of a building accepted under Section 18 Nil (iii) Number of Closing Orders made in respect of a part of a building Nil (iv) Number of Closing Orders determined Nil (v) Number of undertakings cancelled, the part of the building or underground rooms having been rendered fit 1 E. Proceedings under Sections 42—54, Housing Act, 1957: — (i) Number of Clearance Areas represented to Council under Section 42 Nil (ii) Number of houses included in Clearance Areas in (i) above Nil (iii) Number of Clearance Orders made under Section 43 Nil (iv) Number of properties demolished following ance Orders made 8 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, 1958 Temporary bungalows 179 Permanent houses 485 Permanent flats 248 733 912 During 1957 and 1958, 55 Temporary Bungalows in Peldon Avenue were demolished " 857 Total number included in above, erected in 1958 Permanent houses Nil Permanent flats 33 Total number of Emergency houses up to 31st December, 1958 2 comprising 8 units. Total number of Requisitioned premises up to December 31st, 1958 29 (comprising 68 units). Total number of families rehoused in 1958 10 Total number of families still on Waiting List at December 31st, 1958 513 Current Building Programme. By the end of August, 1959, the Peldon Avenue development consisting of 100 units will be completed as well as a further 14 in Sutherland House, Ham. Housing <yf Older Persons. The Council have purchased 10, King's Road, for conversion into old persons1 flatlets, and, in conjunction with the British Red Cross Society, it is expected to house 22 persons in 1959. In addition plans are very advanced for the erection of 42 older persons' flats on the North Road Site. Future Programme. Plans have been passed and a tender accepted for the erection of 64 flats on the Lower Mortlake Road site and these should be completed during 1960. The redevelopment of the Ham Close site has been modified and the erection of approximately 125 small units is contemplated. 5. 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. 34 The following tables show the action taken during the year: — PART 1—Applications for Certificates of Disrepair. Number of applications 37 Number of decisions not to issue certificates 4 Number of decisions to issue certificates : — (a) in respect of some but not all defects 29 (b) in respect of all defects 6 Number of undertakings given by landlords 24 Number of undertakings refused by Local Authority 1 Number of certificates issued 12 PART 2—Applications for Cancellation of Certificates. Applications by landlords to local Authority for cancellation of certificates 8 Objections by tenants to cancellation of certificates 2 Decisions by Local Authority to cancel in spite of tenants objection 1 Certificates cancelled by Local Authority 35 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Food Inspection. The following foodstuffs, found to be unfit for human consumption, were surrendered by the owners. Articles Tons Cwts. Qrs. lbs. Fish — — 3 Floor and Flour Confectionery — — 3 25 Fruit and Vegetables — 3 2 10 Meat and Meat Products — 2 — 12 Milk and Milk Products 18 Tinned Goods (all classes) — 19 3 26 1 7 2 7 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 seventeen cases reports were made to the Health Committee. Letters were sent to vendors in three instances and no legal proceedings were taken. 36 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 Butter — 1 1 Cake and Biscuits — 5 6 — 1 1 Cheese and Cheese Spread — 8 8 — 1 1 Chicken — 6 6 Cod Liver Oil — 1 1 Coffee — 1 1 Cough Mixtures — 8 8 — 1 1 Curry Powder — 1 1 Eucalyptus Oil ... — 1 1 Fish and Fish Paste — 7 7 2 2 Flavourings — 7 7 Friars Balsam B.P. — 2 2 Fruit — 6 6 1 1 Glycerine B.P. — I 1 Icing — 1 1 Marmalade — 1 1 1 1 Meat Cooked — 6 6 1 1 Meat Pies — 4 4 Milk 11 11 Nerve Tonics and Tablets — 5 5 — 1 1 Nutmeg — 1 1 Pepper — 1 1 Rice Pudding — 1 ) Sausage Rolls Sausages — 1 9 1 9 Sweets — 5 5 Vegetables — 3 3 Vitamin Tablets — 3 3 Wheat Germ — 1 1 Totals 11 97 108 — 9 9 37 Sample No. 417 : Smoked Saithe. An informal sample of Smoked Saithe was reported by the Public Analyst to contain benzoic acid (850 p.p.m.) contrary to the Public Health (Preservatives etc. in Food) Regulations 1925-1953. The article was withdrawn from sale and the attention of the German supplier was drawn to the irregularity. Sample No. 436 : Lemon, Glycerine and Honey Linctus. The Public Analyst reported that the description of this syrup was misleading. Correspondence with the manufacturing company showed that the question was being considered by the Association of the British Pharmaceutical Industry and further action on the sample was deferred for a recommendation by the Association. Sample No. 445 : Compound Syrup of Hypophosphites B.P.C. The sample was reported by the Public Analyst not to conform to the standard of the British Pharmaceutical Codex, and the matter was taken up informally with the manufacturing chemists. Sample No. 452 : Marmalade. The sample proved to be deficient in soluble solids and was a home-made product. On receipt of the Public Analyst's report, the sale was stopped and the supply discontinued. Sample No. 473 : Cheese and Ham Spread. An informal sample of an imported German cheese and ham spread proved to be deficient in butterfat, and to contain excess moisture having regard to the recommendation of the Food Standards Committee. The sample was also found to be incorrectly labelled. Correspondence with the importers and the German supplier brought about a decision to market the product under a description which brought the food outside the definition of Cheese Spread. Sample No. 474 : Sugar Sweet Cooked Shoulder. The sample was reported by the Public Analyst to be without any sugar content, and subsequent correspondence with the suppliers resulted in the product being sold under another description. 38 Sample No. 476 : Blueberries. The sample proved to be blueberries in syrup but incorrectly labelled under the labelling of Food Order, 1953. The suppliers agreed immediately to amend the labelling of their product. Sample No. 481 : White Meat Tunny. The Public Analyst reported a labelling irregularity in that the sample showed a salt ingredient which was not disclosed. The importers made arrangements for the contents to be correctly declared on the label in unsold consignments of the product. Sample No. 482 : Bruder Sticks. The sample was reported to be labelled so as to make a vitamin claim for the product without complying with the Labelling of Food Order, 1953. Correspondence with the suppliers and the German manufacturers eventually produced agreement to label the Bruder Sticks so as to comply with the Order. Merchandise Marks Act, 1926. Orders in Council have been made under Section 2 of the Act which require certain imported foods to bear an indication of their origin when exposed for retail sale. Eleven visits were made during the year for the purpose of advising retailers on these Orders, particularly in regard to the sale of imported apples, tomatoes and meat. Attention was also drawn, in three cases, to the need to indicate the origin of certain prepacked foods in accordance with Section 1 of the Act. 39 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 8 26 Butchers (includes 28 premises registered for the manufacture of preserved food) 34 59 Confectioners (Flour) 16 16 Confectioners (Sugar) 47 25 Dairies (premises registered under Milk and Dairies Regulations) 5 35 Fishmongers 16 15 Greengrocers 35 44 Grocers 75 107 Ice-Cream Premises (Registered for Manufacture) 2 80 Ice-Cream Premises (Registered for Sale and Storage) 114 Licensed Premises 78 36 Bestaurants, Cafes, etc. 78 130 508 501 IMPROVEMENTS IN FOOD PREMISES. The standard of hygiene required in food premises is set out in the Food Hygiene Regulations 1955. 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 Regulations was effected with the same degree of harmony and without recourse to statutory action. 40 As the result of the inspections made the following improvements have been carried out: — 1. Food rooms reconstructed 32 premises 2. Food rooms repaired, cleansed or redecorated 145 „ 3. Food storage improved 43 „ 4. Food preparation equipment renewed 140 „ 5. Ventilation and lighting of food rooms improved 21 „ 6. Staff washing facilities improved 70 „ 7. Staff clothing accommodation provided 33 „ 8. First aid boxes provided 38 „ 9. Constant hot water supply installed 16 „ 10. New sinks provided 15 „ 11. Existing sanitary accommodation improved 27 „ 12. Drainage improved, repaired or altered 14 „ 13. Refuse accumulations removed 4 ,, 14. Refuse receptacles provided 9 „ 15. Other improvements or repairs carried out 381 „ 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. Ice-Cream. Premises manufacturing, storing or selling Ice-Cream have been regularly supervised, a total of 89 visits being made. Two premises are registered for the manufacture of ice-cream, and 114 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-one samples were submitted to the Public Health Laboratory for examination, and all were satisfactory (Grades I and II)- 41 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 icecream production, storage and sale is generally high and complies with the Ice-Cream (Heat Treatment) Regulations, 1947/52. 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 19 Tuberculin Tested Milk 19 Sterilised Milk 22 Supplementary licences were also granted, authorising dealers to retail milk in the Borough from premises situated outside, as follows: — Pasteurised Milk 8 Tuberculin Tested Milk 8 Sterilised Milk 8 All premises are inspected before licences are granted, and pnncipal licences are verified with the appropriate local authorities before licences are issued. No licences were refused. 42 Under the regulations the Local Authority continued to take samples from dealers and during the year under review the following were taken : — Pasteurised Milk 32 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 37 „ 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. 43 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 24 2 Pneumonia 6 1 1 Measles 50 Whooping Cough 20 — — Dysentery 50 2 — Food Poisoning... 11 — — Poliomyelitis (Para) 1 1 Total ... 161 6 1 FOOD POISONING. Total number of outbreaks 1 Number of cases notified 11 Number of deaths Nil diphtheria immunisation. Number of children immunised for the first time during the year 1958 : — (a) Pre-School children (under 5 years) 511 (b) Between 5 and 15 years 25 536 Grand Total of Children in the Borough who have received immunising treatment by the end of the year : — (a) Under 5 years 1800 (b) Between 5 and 15 years 5050 Number of children given re-inforcing doses during 1958 791 44 STATE OF IMMUNITY. The following table shows the percentages of children immunized in various age groups for the past three years. Age Group. 1956 1957 1958 Under 1 year 77.2 72.0 80.4 1—4 82.9 73.2 73.1 5—15 96.1 96.3 96.6 The state of immunity of all 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. 1956 1957 1958 Immunity Index for children 0—15 76.6 77.1 77.1 vaccination against smallpox. 1. Analysis of vaccinations at Welfare Centres and Private Doctors' Surgeries. Children. Primary Vaccination 365 Re-vaccination 32 Total 397 2. Figures showing the percentage of children under 1 year vaccinated during 1958. No. Vaccinated Estimated mid-year Population % Vaccinated under 1 year. 320 572 55.9 IMMUNIZATION AGAINST TETANUS. During the year 31 children were given courses of inoculations against Tetanus at the parents' request. 45 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. During 1958 a total of 528 boys and girls were inoculated with B.C.G. in the Northern Division (Richmond and Barnes). NOTIFICATIONS: Respiratory Tuberculosis. wenty-nine cases of respiratory tuberculosis were notified during the year, viz:—23 males and 6 females. The corresponding figure for 1957 was 26. Non-Respiratory Tuberculosis. I hree new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. One such case was notified during 1957. TUBERCULOSIS REGISTER. After all additions and deletions had been taken into account the number of cases of tuberculosis remaining upon the Register at the close of the year was as under: — Pulmonary NonPulmonary Males 136 10 Females 77 12 213 22 Corresponding figures for 1957... 248 24 46 Analysis o'f Cases and Deaths for 1958. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 5—14 1 1 — — — — — — 15—24 3 2 1 — 25—44 9 2 — 2 — — — – 45—64 8 1 — — 1 2 — 1 65 and upwards 2 — — — 2 2 — — Totals 23 6 — 3 3 4 — 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.