MAL 37 THE MALDENS & COOMBE URBAN DISTRICT COUNCIL REPORT For the Year ending December 31st, 1908, MEDICAL OFFICER OF HEALTH, Including the REPORT OP THE SANITARY INSPECTOR. Edward Miller, Printer, II The Pavement, New Maiden. The Urban District of the Maidens and Coombe. Health Committee, 1908-9. Chairman—C. H. Davis. A. T. E. Mursell, J. P., Chairman. G. C. Parnaby, J.P., Vice-Chairman. G. H. Holloway. Dunbar Kelly. F. T. Medhurst. T. W. Milward. H. C. Mitchell. H. G. Palmer. A. Woollacott. Staff of Public Health Department. Sanitary Inspector—Harry Hunter, Assoc. Royal Sanitary Institute. Veterinary Surgeon—J. E. Lloyd Still, M.R.C.V.S. Lond. Medical Officer of Health—Rashell Davison, M.D., M.R.C.S., Fellow Society Med. Officers of Health. Summary of Annual Health Report, 1908. Area—3,220 Acres. Situation—Ten miles south from Charing Cross, in the County of Surrey, the greater part of the district lying between the Hogg's Mill Stream and the Beverley Brook. Population Census, 1901—6,232. Estimated Population, 1908—11,085. Estimated Inhabited Houses, 1908—2,385. Rateable Value—£106,414; Assessable, £86,144. General District Rate—1s. 8d. Poor Rate, including Education Rate—is. 6d. For current half year. 2 New Malden, Surrey, January, 1909. Mr. Chairman and Gentlemen, I have the pleasure in presenting my Twelfth Annual Report on the Health and Sanitary Condition of the Urban District of the Maidens and Coombe under your care, for the year ending December 31st, 1908, together with a detailed report of the Sanitary Inspector. The growth of the district has necessitated several changes in the officials and their duties. In 1897, when I took over the work, the only assistance available was from the Surveyor "when he was not otherwise engaged." In 1901 the Surveyor was relieved of sanitary work, the dual office of Building and Sanitary Inspector being created. Early in this year, when the official work was being re-organised, it was found that the sanitary work had so greatly increased and could not be systematically followed, owing to a joint officer who was of necessity most of his time engaged as Building Inspector, that a new department was necessary in the interests of Public Health. The Health Department is now constituted of the Medical Officer of Health and a qualified Sanitary Inspector, who carry out the full duties of the office as prescribed by the Orders of the Local Government Board. The work undertaken by the Department is of a varied and multifarious character as required by modern sanitary legislation, as follows:— The duties under the General Orders of the Local Government Board. The Public Health Act, 1875, and the Amendment Acts, 1890 and 1907. The Rivers Pollution Prevention Acts, 1876 and 1893. The Epidemic and Other Diseases Prevention Act, 1883, with the Infectious Diseases (Notification) Act and Infectious Diseases (Prevention) Acts, 1889 to 1899. The Housing of the Working Classes Acts, 1885 to 1903. The Contagious Diseases (Animals) Act, 1886. 3 Dairies, Cowsheds, and Milkshops Orders and the regulations made thereunder. Sale of Horseflesh, &c., Regulations, 1889. Factory and Workshops Acts, 1891 to 1907. Food and Drugs Acts, with all the various bye-laws made under the above Acts. The Department also supervises the carrying out of all drainage work other than new building, the supervision of the Food Supply, and the collection and disposal of house and trade refuse, with a general supervision of everything pertaining to the health of the district. VITAL STATISTICS, 1908. Birth Rate per 1000 living:—23 per 1000. England and Wales 26 per 1000. Death Rate per 1000 living:—7'8 per 1000. England and Wales 15.4 per 1000. Infantile Mortality per 1000 Births :—70.6. Isolation Hospital, Tolworth—Fever and Diphtheria. Small Pox County Combined Hospital, Clandon. Water Supply from Thames—Metropolitan Water Board. BIRTHS. During the year there were 255 births, of which 130 were boys and 125 girls. The birth rate equalled 23 per 1,000 inhabitants, as compared with 26 for England and Wales. Of the total births, 3 or 1.2 per cent. were illegitimate. The births were distributed as follows:— Coombe 16 Old Maiden 11 New Maiden 228 Total 255 DEATHS. During the year 88 deaths were registered; two of these were non-residents, and are not calculated in the death rate. The deaths in each ward were as follows:— Coombe 7 Old Maiden 5 New Maiden 74 Total 86 4 The greatest age registered was in Old Maiden, a female aged 91. Ten deaths occurred in the Workhouse Infirmary, Kingston, five of whom averaged 81 years. Two hundred and twenty houses have been built and one hundred and ninety-three occupied. The new Workhouse Buildings, Norbiton Common, house 230 inmates. The Scattered Homes for Children, Kingston Road, house 69 children and 13 officers. Population estimated to be 11,085. Amongst the causes of death were the following diseases:— 1908. 1907. Phithisis 5 (2 visitors) 2 Cancer 8 8 Bronchitis 6 4 Pneumonia 4 4 Heart Disease 4 9 Senile Decay 11 8 Influenza 8 2 Infantile Mortality is measured by the proportion of deaths under one year to 1,000 births, and amounted to .18. During the last ten years the mortality has been:— 1899 16 1900 11 1901 18 1902 18 1903 5 1904 27 1905 15 1906 14 1907 24 1908 18 16.6 Average number for 10 years, 16.6. Infantile Mortality per 1,000 births for 1908, 70.6. 5 The figures for the various wards were:— Coombe 1 Old Maiden - New Maiden 17 Total 18 Premature Birth 5 Congenital Defects 2 Diphtheria 1 Tubercular Meningitis 1 Bronchitis 1 Influenza 2 Diarrhoea 1 Marasmus 4 Inanition (3 days) 1 It is satisfactory to note that although the population has doubled in the last ten years, the deaths under one year have not increased. Three illegitimate children were born, and one died during the year. All deaths in the district were certified by the Medical Attendant or H.M. Coroner. Dr. M. H. Taylor, H.M. Coroner for the division of Surrey, held inquests on seven cases:— Coombe 0 Old Maiden 0 New Maiden 7 The verdicts returned were as follows Natural Causes 3 Accidental Death—Scratch by scissors, producing septicoemia 1 Convulsions due to Tubercular Meningitis, accellerated by a fall 1 Suicides while temporarily insane 2 7 All post-mortems were held at the mortuary provided by the Council adjacent to the Council Buildings. 6 DISTRICTS. Acres. Estimated Population. Estimated Houses Occupied. Births. Deaths. Birth Rate. Death Rate. Coombe 1337 1383 163 16 7 11.6 5 Old Maiden 842 590 108 11 4 18.7 6.8 New Maiden 1041 9112 21 14 228 75 25 8.2 Totals 3220 11085 2335 255 86 23 7.8 OCCUPATION OF INHABITANTS. There are eight factories in the district, the majority being laundries. Most of the residents find work in London as professional or business men, clerks, mechanics, shop assistants, &c.; the balance is made up of labouring classes. Their several occupations, however, do not influence public health. HOUSE ACCOMMODATION. The houses, as a whole, have been well built, drained, and defended from damp by concrete foundations and a sufficient damp course, and are detached and semi-detached, roomy and pleasing residences. The smaller houses are occupied by clerks and mechanics. The cottage accommodation for the labourer is poor, the high rents demanded by the speculating landlord tend to compel two families living in one house, producing overcrowding and undesirable contact, especially in the case of disease. WATER SUPPLY. The water to the whole district is from the Thames, supplied by Metropolitan Water Works (Lambeth Division), and is so safe guarded that it has been free from pollution for some years. The only pollution takes place in the cistern of the householder who forgets to safeguard his own household by regularly cleaning the cistern. RECREATION AND SPORTS. Maiden Hill Recreation Ground.—It is pleasing to note that the Open Spaces Committee have made a good advance in regard to developing a practical scheme for the systematic laying out of the Maiden Hill Recreation Ground, which will provide a glorious breathing space of 20 acres for the benefit of public health. 7 Malden Green.—A striking advance has been made by the Open Spaces Committee in securing by Act of Parliament in 1908 a scheme for regulating and controlling Maiden Green as a place for exercise and recreation, and to be for all time maintained by the Council as a Common under the Metropolitan Commons Acts, 1866 to 1898. Byelaws are being framed, and will be in operation within a short period. Old Maiden can look upon the use of the greens as a permanent means of securing recreation, and the work of the Committee has been eminently successful. SANITARY POWERS OBTAINED BY THE COUNCIL. The Council has secured by its adoption of the Public Health Acts Amendment Act, 1907, one of the most powerful levers to operate sanitary improvements in the district. It cannot be denied that the Council are well to the front in securing reforms, but the powers conferred by the Local Government Board and Secretary of State will considerably assist the Public Health Officers. The Council are well in advance of many districts, and it is anticipated that good work will follow. EXCREMENT DISPOSAL. The system in vogue is the wet or water carriage method of removing sewage from the dwelling. In the old houses the soil, pipe, and drain leading to the junction with the sewer were six inches in diameter ; this was a serious defect, as the flush tank did not contain enough water to flush more than half the diameter of the pipe, allowing the unflushed portion to get foul and unhealthy. Every opportunity is taken to reconstruct their old drainage system. A few of these drains are still in existence; the majority have been relaid with four-inch pipes. All known cesspools have been abolished, and the whole of the district is sewered. SCAVENGING AND CLEANSING. Collection and disposal of all refuse is now carried out by the Health Department, viz., the collection, removal, and destruction of house and trade refuse. The effective disposal of dry refuse, paper, rags, and other more or less combustible material constitutes one of the greatest difficulties which every sanitary authority has to face. Some 2,671 loads are collected yearly. Much of this might be obviated and expense to the ratepayers reduced if individual householders would burn in their own grates such material as paper, rags, potato peelings, cabbage leaves, and similar substances; few do so, with the result that the average dustbin contains an objectionable amount of readily decomposing material. 8 This is especially objectionable during hot weather, when the dustbin becomes the rendezvous and breeding spot for flies, which have been proved to be the vehicle for spreading the following diseases:— Diarrhœa, Whooping Cough, Typhoid Fever, Tuberculosis, Scarlet Fever, Erysipelas, Smallpox, Ringworm, Measles, and other infectious or bacterial diseases. The flies mostly concerned were the bluebottle and common house fly; their feet end in pads furnished with innumerable hairs, each hair being provided with a sucker; kept moist by exudation, each fly can carry 100,000 bacteria, and as the number of eggs a fly can produce in a season is from two to five hundred million, the spread of infection by this means can easily be understood. The difficulty of extirpating such insects is almost insurmountable. Mistaken sentiment and failure to recognise or comprehend the vast amount of mischief and injury this apparently harmless insect is able to do to man, must be my excuse for asking the householders in the district to assist the sanitary authority to eradicate this nuisance. It is only by preventing the development and multiplication of these winged pests that there is any hope for us for permanent protection from them. The only remedy for the evil is extermination. So long as there is material as a nidus for flies to lay their eggs in, they will increase and multiply; the material consists of organic dirt, found especially in the following places:—Refuse heaps, stables and manure heaps, dairies, cowsheds, and middens, slaughter houses and butcher shops, fried fish shops, confectioneries and groceries, farmyards and kitchens, and any accumulation of decomposable refuse. By all means destroy the fly in any way available, but assist the sanitary authority by burning in your own grates as much vegetable waste material as possible, and so, by lessening the amount of refuse, assist the quick removal of these breeding places; free use of disinfectant should be practised; fly proof covering should be furnished for all food exposed for sale or awaiting cooking in the house. Flies mean filth; filth plus flies is more than a nuisance; it is a danger to health, and must be abated. 9 CASKS NOTIFIED UNDER THE INFECTIOUS DISEASES ACT. Old Maiden. New Maiden. Coombe. Total. Scarlet Fever 1 15 5 21 Diphtheria — 9 — 9 Measles — 468 — 468 Phthisis — 7 — 7 Erysipelas 2 7 — 9 Typhoid Fever — 3 — 3 3 509 5 517 Cases Treated at Tolworth Hospital. Coombe Old Maiden. New Maiden. Scarlet Fever 3 1 11 Diphtheria 0 0 7 Typhoid Fever 0 0 1 Not classed 1 0 1 4 1 20 Two cases were sent in and returned as not classed. One, as the diagnosis was doubtful, was sent in for observation. The other was an error in diagnosis. Scarlet Fever. Twenty-one cases were notified, one in Old Maiden, contracted in London, five in Coombe, and fifteen in New Maiden; at no period of the year did it become epidemic. At Coombe, three of the five cases occurred in adults; one case attended the elementary schools; of the fifteen in New Maiden, there was one in January and February and two in March; the district was then free till August 8th, when a child of two years old was notified, and on August 30th a child attending Burlington Road Schools, and living a long way from the former case, was notified. On October 4th, another child attending the schools was notified, but had contracted the disease outside the district; on the 11th, a child attending a private school was notified, and on the 12th a child at the Burlington Road Schools was discovered peeling. He was promptly sent to the isolation hospital, but five days after his return had a decided scarlet fever rash, was again sent to hospital and again peeled. 10 On December 15th, a case was discovered in a peeling condition at Lime Grove Schools. Dec. 27th, a case was infected by a "return case." Dec. 31st, a second case was reported in a house where another child was being treated. The appended leaflet is left at the house in any case not removed to the Isolation Hospital. Home Case. Children from this house must not attend day or Sunday School until permission is given by the Medical Attendant. All cases of "sore throat," "lumps in the neck," or of "peeling skin" occurring in the household are probably scarlatinal, and should be immediately reported to your Medical Attendant. Suspicion should also be roused by any sudden attack of illness, especially if beginning with vomiting. Public Library Books must be taken to the Health Department, Council Offices, New Maiden, and no books borrowed until the house has been disinfected. The patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. No children should be allowed to visit the infected house. A patient suffering from this disease is generally dangerous to others for six to eight weeks, and must not be allowed to mix with other people until the Medical Attendant certifies that there is no danger. There is a risk of infection while there is any discharge from the ear or nose, or while the throat remains sore or unhealthy. 11 Disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant and then washed. 2.—Special cups, saucers, and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose, or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4.—When the patient is free from infection, the Council undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free, to home cases once a week on application to the Sanitary Inspector, Health Department, Council Offices, New Maiden, between the hours of 9 a.m. and 10 a.m. RASHELL DAVISON, M.D., M.R.C.S., Medical Officer of Health. A penalty of £5 is attached to the exposure of infected persons and things. Diphtheria. Nine cases were notified, all in New Maiden, seven treated at the Isolation Hospital, one, an adult, at home, and one died. In five cases the drains were defective, and four cases attended a private school in Kingston Road, which was closed for 14 days. One child of 11 months old died suddenly late at night, and was removed to the mortuary. At the Infant School, Lime Grove, I discovered several children suffering from sore throat; two, although not suffering themselves, undoubtedly had the diphtheria bacillus present in their throats, and as carriers of this disease could infect others; they were excluded with a satisfactory result. Early Treatment of Diphtheria. It is a well-established fact that patients treated on the first or second day of the disease are almost invariably cured. It is, therefore, of the greatest importance to secure treatment at the earliest possible moment, and to effect this medical aid should be summoned as soon as the slightest speck of membrane appears on 12 the child's throat or a croupy cough develops; prompt treatment is not only essential to the patient, but would be economical from a financial standpoint: not only does a missed case of diphtheria frequently infect others, but delay in treatment involves a large dose of antitoxin. In the next place medical men should not wait for a definite bacteriological diagnosis before sending a patient to the Hospital, as success in treatment depends upon antitoxin being administered at the outset of the disease, and it is important there should be no delay in the use of this remedy. Antitoxin has been for some years supplied free to medical men, and can always be obtained at the Health Department in the Council Building. The following leaflet is left at the house in any case not removed to the Isolation Hospital. Home Case. Children from this house must not attend day or Sunday School until permission is given by the Medical Attendant. All cases of "sore throat" or "lumps in the neck" occurring in the household are probably diphtheric, and should be immediately reported to your Medical Attendant. Public Library Books must be taken to the Health Department, Council Offices, New Maiden, and no books borrowed until the house has been disinfected. If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally dangerous to others for a period of at least three weeks, and must not be allowed to mix with other people during that period, or while there is any sore throat, or any discharge from ear or nose, or while diphtheria germs can be detected in the throat. 13 Disinfection. I.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.—Special cups, saucers, and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose, or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4.—When the patient is free from infection, the Council undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on application to the Sanitary Inspector, Council Offices, New Maiden, between the hours of 9 a.m. and 10 a.m. RASHELL DAVISON, M.D., M.R.C.S., Medical Officer of Health. A penalty of £5 is attached to the exposure of infected persons and things. Measles. Four hundred and sixty-eight cases were reported, all in New Maiden. During March, April, May, June, measles attacked children in both public and private schools. Of the 468 cases reported, 280 occurred in the Public Elementary Schools. 31 in Private Schools. 17 Adults. 188 in children not of school age. The schools were disinfected on several occasions, but the disease was so mild, parents did not always think it necessary to report cases, and so many more must have had the disease than were reported. Only six deaths were recorded as due to Measles. 14 Pneumonia. Four deaths were due to Pneumonia: One each at two months, one year and ten months, one year and six months, and one year and seven months. One aged six years from Laryngitis. Tuberculosis. Tuberculosis of all forms was the assigned cause of death in seven instances. Phthisis (consumption) was alone responsible for five deaths. Voluntary notification has been in force since the beginning of 1907. Seven cases have been notified during the year. Each case, when notified, is visited, a card of rules (details of which were given in my report for 1907) is left, disinfectants supplied, and the house disinfected when necessary. It should be noted that two of the five cases of Pthisis were visitors who had contracted the disease abroad. Deaths occurred at the following ages, in five cases;—25, 25, 60 (of only two months' duration) 30 and 37. Typhoid Fever Three cases were reported in New Maiden. The first case occurred in Kingston Road; the drainage at this locality had never been satisfactory; two cases occurred in this house in 1897. The drainage was inspected, and in places relaid. The drains have again been examined and found very defective, necessitating the complete relaying of the whole of the drainage to all the houses. This will, it is hoped, remedy the evil. A case occurred in George Road; here again the drains have been a source of trouble; the suspected cause, however, was from fried fish, of which the patient had eaten. The other case occurred in Grafton Road, is now in St. Bartholomew's Hospital, although no positive cause could be discovered, the child had been ailing for some weeks, and had been treated in St. Thomas' Hospital for appendicitis; the insanitary, dilapidated condition of the house, the defective and primitive sanitary arrangements were so bad that the usual notice has been served on the owner to forthwith repair and make habitable, in default an application will be applied to condemn the building as unfit for human habitation. 15 ELEMENTARY SCHOOLS. The children attending the Schools in the district number 1,407, as against 1,315 last year, an increase of 92. Coombe (Kingston Vale) 66 Old Maiden 131 New Maiden—Elm Road 237 „ Lime Grove 392 „ Burlington Road 581 1407 I have paid thirty-seven visits to the Schools, and found it necessary to visit five children in their homes, and have examined 30 cases for school attendance purposes. The record of infectious diseases for the year:— Scarlet Fever 10 Diphtheria 3 Measles 280 Total 293 Two cases of Scarlet Fever were discovered in a peeling condition, one in Burlington Road School, the other at Lime Grove. Two cases of Diphtheria were connected with two children I discovered to be carriers of the bacillus, although not presenting symptons themselves. This fortunate discovery prevented a further outbreak. The drains at the Old Maiden Schools have been relaid, and two new w.c.'s and urinal for boys erected. They are now in a very satisfactory condition. The Lime Grove School have also had the drains partly relaid, and automatic flushing tanks attached to the w.c.'s, and sufficient accommodation supplied for the teachers. The cloak room has not yet been supplied, the coats and hats are hung in the entrance, necessitating the children brushing through them when going in and out of school; they are hanging so close together, that no cleansing or disinfection can possibly prevent the spread of undesirable insects and possibly disease. 16 Ringworm is still very prevalent, and prevents many children from attending school. Ringworm of the scalp is especially difficult to treat by drugs, as the mothers have not the time or inclination to apply the application regularly to stamp it out. X-ray treatment is necessary, but this is only to be got at Hospitals where the Sanitary Authority are unable to supply the necessary apparatus, I cannot help thinking that the purchase of a portable installation which could visit the school at stated intervals would not be expensive, and by curing the disease quickly would enable a large number of children to attend school which they would not otherwise be able to do. Last year and this year, owing to the parents being out of work, a large number of children were underfed; a few largehearted gentlemen, ably assisted by ladies, started a soup kitchen for necessitious children only, which has greatly benefitted those in need. Last year 3,995 meals were supplied; this year it is continuing its good work, and will, I hope, become a permanent institution in the district. SCHOOL CLOSING FOR EPIDEMIC DISEASE. The latest code of regulations issued by the Board of Education, and which came into operation on August 1st last, contains important alterations of procedure connected with the closing of public elementary schools upon medical advice; compulsory closing is regulated in the same manner as by former codes. The sanitary authority, or any two members of the sanitary authority, can close a school, but only on the advice of the Medical Officer of Health, who cannot himself do more than give advice. In previous codes, if managers of schools considered that the requirement to close was unreasonable, they could, after closing, appeal to the Board of Education, but in the current code this power of appeal has been abolished. Formerly the Board were satisfied if the managers, by reason of the absence of a large number of children from school, obtained the sanction of or was acting under the advice of any registered medical practictioner, and not necessarily the Medical Officer of Health for the district. But now only the School Medical Officer can certify that the exclusion of certain children is desirable on the ground that such exclusion would prevent the spread of disease, the same officer is empowered to exclude children from school attendance on the ground that their unclean or verminary condition is detrimental to other scholars, and also on the ground that, owing to their state of health or their physical or mental defects, they are incapable of receiving proper benefit from the instruction of the school. 17 DAIRIES AND COWSHFDS. To further safeguard the district from contaminated milk, Mr. Still, M.R.C.V.S., has been appointed Veterinary Surgeon to examine and report on all milch cows in the district. The Council, acting as Sanitary Authority, have now taken every precaution that can legally be taken to safeguard the district against contaminated milk. All the cows are systematically inspected. The sheds are airy, healthy, and carry out all conditions required by the Act. Samples of milk are taken at the railway stations, from carts in the street, and all the dairies, and examined for Tuberculosis and diet contamination. All Dairies and Milkshops are frequently inspected, and great stress has been laid on the recent application of the London County Council, who, failing promised parliamentary legislation, have acquired the legal right to : Take samples of milk. Inspect cows in any dairy within or without the county of London. Power for their duly authorised officers to enter any dairy outside London from which milk is being sold for use within the county. Where they have reason to suspect that any cow is affected with Tuberculosis of the Udder, they may take samples of the milk of such cows. These conditions have been obtained and acted on in this district since 1906. The power in addition to these which the London County have obtained and we have not, is one that I advocated so long ago as 1905, viz., that the sanitary authority at the place of reception should, on proof of disease or contamination, have power to prohibit the sale of that milk in their district. When the new regulations are made, there are favourable signs that they will contain a clause to carry out these restrictions. FACTORY AND WORKSHOPS ACTS. All Workshops in the district have been periodically inspected. The number of registered Workshops has been greatly increased during the past year. 18 The Bakehouses and Eating Houses in the district are frequently inspected, and the desired standard of cleanliness in these places well maintained. SEWAGE WORKS AND TREATMENT. The disposal of sewage is a matter of which certainty has not yet reached finality; new processes and modifications of existing ones are likely to occur. The Royal Commission's Fifth Report (1908) for their general conclusions laid down this maxim, viz.:— "It is practicable to purify the sewage of towns to any degree required, either by land treatment or by artificial filters, and there is no essential difference between the two processes, for in each case, so far as it is not mechanical, it is chiefly affected by micro organism. The two main questions, therefore, to be considered in adopting a system of sewage purification are, first, the degree of purification required in the circumstances of each town and of the river or stream into which its liquid refuse is to be discharged, and second, how the degree of purification required can, in each particular, be most economically obtained." Their report necessarily deals with systems already in vogue, and they have, by personal and skilled examination, tabulated exactly of what these systems are capable. In the septic tank system they have clearly proved that it has not solved the sludge difficulty; that practically only 38 per cent. of the solids were digested. That it did not destroy pathogenic organism, they found as a result of a very large number of observations that the liquor issuing from the septic tank is, bacteriologically, almost as impure as the sewage entering the tanks. On the third claim—which is much the most important—that the sewage which passed through the septic tank was more easily oxidized than sewage from which the solids had been allowed to settle, either with or without the aid of chemicals in tanks which were frequently cleared of sludge. The evidence received was conflicting, and they say as it is a great importance in the purification of sewage, they thought it most desirable to investigate "most exactly." Dorking was selected as a suitable domestic sewage (which is almost identical with our own.) Three identical percolating filters were constructed—one was fed with settled sewage, one with sewage that had been subjected to chemical precipitation, and one with septic tank liquor. The experiment was carried out by the Commission's own resident chemist, Mr. Eric Richards, and was carried on for over a year, 19 conclusively proving that in the case of an ordinary domestic sewage, septic tank liquor was not more easily oxidized on its passage through filters than other liquids. These experiments have borne out most conclusively that I was right in recommending the adoption of the Dibdin Slate Bed System. These beds had not been in work long enough for the Commission to take cognizance of their result. They mention the fact that "Mr. Dibdin has lately advocated the use of a large slab of slate in primary contact beds"; they say further that as a result of our inspection of the beds at Devizes, we came to the tentative conclusion that primary beds containing these slate slabs must be regarded more as preliminary settling tanks than as a contact bed; but we have proved much more than this in the two large slate tanks we have had working for the last two years—first, that they are aerobic and digestive, and their action is exactly the reverse of the septic tank, which is anaerobic producing much sludge, sulphurated hydrogen, sulphides, and smell, its effluent liquor clogs the succeeding filter beds, and when delivered into a stream the chemical contents are broken up and redeposited, forming black stinking mud. From two years' experience of our slate beds, I have been struck by the fact that nearly all our visitors go away with the erroneous idea that the "black humus" that adheres to the slates and bottom of the slate tanks is ordinary sludge, but this is not so; this is a deposit on the slates from the aerobic action of the organisms found in the sewerage: really "living earth," the portion I have now before me which I retained and which was scraped off the slates on October 8th, 1908, and have had in an ordinaryenvelope in my consulting room during the whole time, was at first soft but inodorous, containing living worms and organisms, but has never emitted any smell, becoming dry, clean, not soiling the fingers when handled and inodorous. In properly constructed slate tanks it has been proved that no sludge remains; you may have, after some years, an accumulation of a black jelly-like inodorous deposit, which is known as humus, is easily pulverised by exposure to air, but in no case can you accumulate the large quantity of stinking sludge produced by chemical and septic tank treatment. It has proved at Devizes and New Maiden most satisfactory and economical, carrying out the maxims laid down by the Royal Commission in their report. I have little doubt that the next Royal Commission, after careful examination, will recommend this system as efficacious and economical. We are at present laying down extra filter beds; when finished, the system will, I hope, be completed as a whole with Dibdin's slate bed method. In the Journal of the Royal Medical Corps, 20 Major Stamners, in his article of Dibdin's slate beds at Devizes, says the whole process from start to finish is aerobic, the anaerobic treatment in septic tanks being entirely done away with, and adds, as a result of his visit, that the installation has been in continuous use for over three years; during that time it caused no trouble and has worked efficiently. In installations, when septic tanks are employed, you always get trouble and expense with sludge, and not infrequently passing on to the filter and contact beds, causing clogging and inefficient action. In the primary beds at Devizes, after three years' use, there was only a deposit of an average of two inches at the bottom of humus; this formed a few months after commencing work, and has not increased. At Devizes it is calculated that under this system the annual expenses have decreased from £700 per annum (which was the cost of the chemical and sludge pressing process) to £200 per annum, so that any extra capital charge which may be necessary at its installation will soon be met by saving on working expenses. Lieut.Col. Firth, Professor of Hygiene in the Royal Army Medical College in Notters Hygiene, 1908, at page 514, says: "Dibdin's suggestion advocating the use of slate debris supported on suitable slate blocks for furnishing a matrix, appears to offer a reasonable hope of minimising the sludge problem "as the extra spaces available doubles the working capacity of the bed," and at any time the accumulation of silt may be flushed from the slates and the bed restored to its original condition as new. A detritus washed off the slate slabs is found to dry inoffensively when exposed to the atmosphere and to assume a condition resembling ordinary mould. An installation of this kind at Devizes has dealt with the whole of the "unscreened and unsettled" sewage of that town satisfactorily, and by continuing in one slate-filled tank, the double effect of the earlier digestive tanks and contact beds, marks a distinct step toward simplification." I hear on good authority that the War Office have made a decided move in adopting the slate bed method in two of their largest camps, a step which, I feel sure, will bring its merits before all public bodies. Since writing the above, I have had the opportunity of reading further experiments by Mr. Dibdin, explaining that the action of the "living earth" or deposit on the slates is not due to purely physical and chemical causes, but is the result of digestion. He also demonstrates the rate of destruction of the varied food stuffs placed upon the deposit, as these experiments have been carried out on "deposit" removed from slates at our own works, the result is of special interest to this Council. I have, therefore, with Mr. Dibdin's permission, attached a full report from the January 7th, 1909, issue of the Sanitary Record. 21 Many otherwise experienced authorities on sewage disposal have expressed a difficulty in grasping the principle of the action which takes place on "Plate Beds," commonly known as slate beds, in consequence of that material forming the most convenient and economical form of plate. It is, therefore, with a view to making the process clear to those who have not followed biology in relation to the life processes at work in river water, tidal mudbanks, &c., that the following detailed account of some experiments which I have made is set out as clearly and succinctly as possible:— The idea which some apparently have that the destruction of waste organic matters must be due to purely direct physical and chemical causes seems to be the main stumbling block. As a matter of fact the work accomplished is purely the result of digestion. On looking at a mass of the deposit on a slate which has been employed for some time in a bed, the casual observer would notice nothing but a collection of debris, which is forthwith dubbed "sludge" and, offhand, relegated to that category, therebydenoting the foul accumulation of matters obtained in a sedimentation tank of the ordinary pattern. On smelling the mass, however, it is at once realised that it differs from ordinary sludge in that it is inoffensive. On allowing a portion to dry, it does so rapidly and without the production of offensive emanations given off by "sludge." These two facts point to a difference, and invite closer examination. This may be conveniently made as follows:— Place a portion of the deposit on a small piece of slate about 3 in. or 4 in. square for convenience, or other suitable support, and warm it very gently by applying heat to the under surface. A considerable movement will soon be seen to take place on the immediate surface, and gradually a heaving mass of minute worms will struggle to escape from the heated underlayer. These are clearly arobic organisms whose power of digestion is considerable, and it is to a great extent their casts which form the inoffensive humus which escapes from the slate layers with the effluent, thereby preventing the accumulation which is the cause of the choking of the old coarse contact beds. Next, take a fragment from the surface of the deposit by touching it with the point of a wire and place it on a microscope glass slide with a droplet of water, covering the whole with a thin glass cover in the usual manner. Now examine this with a ¼in. or higher power. It will be at once seen to be largely made up of innumerable living organisms of great complexity and variety, other than the worms. From these simple examinations it will be evident that instead of an inert mass of matter we have a hive of active and voracious living organisms, from the lowest type of bacteria up to the highly Experiments on the Rate of Destruction of Solid Matters in Slate Beds, Prepared with Deposit taken from the Slates in the Beds at Maiden, Surrey. Substance. First day, after 20 hours' rest. Second day. Third day. Fourth day. Fifth day. Bread Zooglea masses, starch cells, spiral vessels, motile bacteria, leptothrix, green confervæ, &c. Bread undergoing disintegration. Numerous bacteria, starch cells very attenuated and losing form. Bread completely disintegrated, abunddance of leptothrix, oscillaria, monadina, Clostridium, quantity of round granular matter, query worm casts. - - Butter Mass of fat cells Fat cells with brown granular matter (? worm casts). Brown granular matter with spirilla, leptothrix, fat cells. Irregular cellular membrane with colonies of micrococci and bacilli, &c. Butter reduced to a thin wafer. Cheese Masses of various bacteria, i.e., bacilli, micrococci, streptococci, &c. Swarming with colonies of motile bacilli. Bundles of stellate crystals interspersed with numerous bacteria, motile and nonmotile. Fat cells crowded with bacilli & diplococci. The cheese reduced to a thin pasty layer. Lettuce Chlorophyll attacked, bacilli, diplococci, zooglea, leptothrix, &c. Peaty matter, various bacteria. Granular matter, leptothrix, various bacteria, monadina, amoeba, infusoria, &c. Indefinite debris (? worm casts); lettuce decomposed to granular condition almost free from bacteria (? action of worms). Last trace of lettuce disappeared. Lean pork (cooked) Mud black underneath, deep chocolate on surface*, various bacteria, leptothrix, and encysted infusoria. *? worm casts. Meat in fibrous state, muscular fibres embedded in zooglea masses of bacteria, large numbers of spirilla and motile bacilli, anguillulæ and worms. Muscular fibre extremely attenuated, numerous spirilla, motile bacilli, and monadina, zooglea, oscillaria, &c.; the whole swarming with micrococci. Muscular fibre entirely destroyed, the residue being alive with motile bacilli, spirilla, monadina, oscillaria, anguillulæ, worms, &c. Pork reduced to a thin greyish scum of various organisms. Tendon from roast pork; very hard and tough Abundant organisms, various bacteria single and in zooglea form. Enormous numbers of micrococci and monadina. Swarming with micrococci, spirilla, monadina, granular celular matter (? worm casts), fungoid mycelium. Quantity of brown granular matter (? worm casts), anguillulae, worms, monadina, many bacteria, zooglea masses, oscillaria, &c. Tendon reduced to a soft grey mass. Fat of ham Leptothrix, streptococci, and numerous zooglea masses. Fat cells interspersed with various bacteria Fat cells, brown granular matter (? worm casts), bacteria, &c. Fat cells with zooglea masses, spirilla, &c., various infusoria, opalina, oscillaria, &c. Fat largely reduced to a soft pasty mass. Brewery refuse in sewage Yeast cells practically destroyed, leptothrix, zooglea masses various infusoria. All odour of brewery refuse disappeared, grey surface deposit. - - - 24 organised worms, larvae, &c., which, like a collection of animals in a zoological gardens, feed upon the daily supply of food given to them, and so long as this supply is steadily and regularly maintained, so long will they perform their life functions, and in so doing destroy the waste organic matters which, in their collective form, we call sludge; the process involved being merely that of digestion—the waste products of one group being but food for a lower. The process may very conveniently be watched from day to day by placing the previously mentioned small piece of slate in an ordinary plate or saucer, and putting on the "living earth" on the slate small fragments of meat, bread, &c., and flooding the plate with water gently so as to completely cover the whole. After an hour or two gently decant the water from the plate so as to thoroughly drain the plate and deposit thereon. Leave it freely exposed to the air, preferably in a moderately warm atmosphere. On watching from time to time it will be seen that the piece of red meat has become coated with a grey deposit, this being often complete in four or five hours. Now touch the grey matter with the point of a wire, and transfer the minute quantity thus taken up to a microscope slide as before, and examine under a high power, when it will be seen that this grey matter is nothing but an enormous number of bacteria, many in a state of restless activity where they are not crowded in zooglea masses which prevent their rapid movements. Continue these observations from dav to day, each day flooding with water and draining after two hours or so. In a few days the solid particles of meat, &c., will become invisible and merged in the mass of black humus into which it is finally resolved. It is evident that this is precisely what takes place in a slate bed. When the bed is first filled with sewage, and allowed to stand full in a quiescent state for a couple of hours, the solid matters settle on the slates. Until the "living earth" is fully developed, the destructive action is slow, but in warm weather especially the organisms rapidly develop and attack the food thus provided for them, exactly as the organisms in a river mud attack the matter deposited thereon from a tidal water receiving sewage matters, and if the ratio of organisms, food and air supply are properly regulated, the action proceeds indefinitely without the evolution of nauseous odours. The account given in the Tables of a series of experiments made to ascertain the rate of destruction of various food stuffs when placed on the mud on the slates will be of interest. 25 Experiments with Deposit Collectad from Slates in Bed treating the Sewage at a Private House. A preliminary microscopical examination showed that the deposit was swarming with minute red worms, anguillulæ, infusoria, and various bacteria. Substance. First day. Second day. Third day. Fourth day. Lean of raw beef In four hours the red colour had turned to grey. The beef had sunk into the mud, grey in colour, and swarming with bacilli, spirilla, monadina, &c. Beef scarcely visible, being now one mass of various organisms. Meat entirely disappeared. Cheese In four hours the cheese was light grey in colour. Cheese had sunk into humus, swarming with bacilli of various kinds. Cheese reduced to a thin layer. Entirely reduced to a pasty condition. On November 2nd, 1908, 7 grammes of raw liver were placed on a layer of the above deposit, laid on the bottom of a 4 in. Petri dish, the area being 12 in. approximately. The quantity of liver thus treated was equal to the treatment of a sewage 100 times normal strength. First day (after 24 hours). Second day. Third day. Fourth day. Eighth day. Fifteenth day. Liver had lost colour, odour unpleasant. Odour offensive Very offensive. Odour decidedly reduced. Odour had entirely disappeared. Liver reduced to a very few resistant pieces, which were covered with whitish grey spots consisting of bacillus megatherium. Later, a growth of of the mould, mucor caninus, developed. Note.— This experiment was very drastic. The liver was laid very thickly, with scarcely any room between the pieces, none of which was smaller than one sixteenth in. diameter, whilst many approached ½ in. On November 6th another dish was similarly charged with I gramme of beef steak raw, I gramme of beef fat, and I gramme of cheese. On the sixth day the cheese had entirely disappeared, the beef steak was reduced to a greyish soft mass, and the fat was disintegrated. 26 In conclusion, I especially draw your attention to the valuable and efficient work of Mr. Hunter, the Sanitary Inspector. He has assisted me with great ability and unceasing energy to reorganise the multifarious duties of this department. His exhaustive report cannot but be received with satisfaction, and 1 am pleased to add that whenever he has been compelled to enforce regulations, somewhat objectionable to the householder, his great tact and courtesy have enabled him to carry out his duties with the least possible friction and with success. I am, Mr. Chairman and Gentlemen, Yours faithfully, RASHELL DAVISON, m.d., m.r.c.s., Medical Officer of Health. February 22nd, 1909. 27 SANITARY INSPECTOR'S REPORT. Health Department, Council Offices, New Malden, January, igog. Rashell Davison, Esq., m.d., Medical Officer of Health. Dear Sir, I have pleasure in submitting my First Annual Report of the work done in the Health Department, and the Sanitary circumstances of the District, for the year ending December 31st, 1908. SANITARY WORK OF THE YEAR. It will be seen that great progress has been accomplished in the general sanitary work of the District during the past year. A tabulated summary of the various inspections made and nuisances discovered (Table I.) is inserted on page 31. During the year, 87 complaints of nuisances in the District were received. All complaints are immediately investigated and the necessary steps in respect thereof at once taken. Systematic inspection of the District has been made in accordance with the General Orders of the Local Government Board and Sec. 92 of the Public Health Act, 1875. Most of the nuisances discovered were remedied upon receipt of informal notices, but in 30 cases Council Orders had to be applied for. In no case, however, have legal proceedings been necessary. At the close of the year there were 19 notices in abeyance, most of the work however being in hand. A house to house inspection of all the small property in the District is being gradually undertaken, and this I find is very necessary. A large number of the cottages (occupied by labourersgenerally), are in a very neglected and insanitary condition indeed. The owners or interested persons in some cases appear to do nothing whatevertowards the general maintenance of the properties, year after year, until the condition of a great many is deplorable, a disgrace to the persons interested and to the District. By this I do not mean to imply that there are no reasonably good landlords who are alive to their true interests, but I would point out that a house in a state of decay, dilapidated, damp and dirty, is enough to dishearten the best inteutioned of occupiers. 28 Undoubtedly the maintenance of a house in an efficient state of repair can be effected by co-operation between landlord and tenant. During the past year the inspection of the cottages in Avenue Terrace (Kingston Road), California Road, Burden's Cottages (Kingston Road), St. John's Road, and parts of Roberts Road, Wellington Crescent, Northcote Road, and Salisbury Road, has been undertaken, and with very satisfactory results. Proper sanitary receptacles for house refuse have been provided, the yards at the rear for a sufficient distance from the back door to the w.c. paved with impervious material with a fall to a properly trapped gully so as to take away all rain or other waste waters from the immediate neighbourhood of the back door, proper sanitary fittings fixed in place of defective or ones of obsolete and insanitary patterns, and the drains re-laid, not to mention many much needed sanitary improvements inside the houses, such as new sinks and sink waste pipes, new scullery floors, and the cleansing of walls and ceilings. It will be my endeavour to accomplish much of this work in the future, and by keeping at it, to do a little to prevent cottage properties from lapsing into the conditions referred to. In this work several clauses in Part 3, " Sanitary Provisions" of the Public Health Acts Amendment Act, 1907, which came into operation in this District on January 1st, 1908, will, I am sure, be found of valuable assistance. I may add that by this Act, " Sec. 35," there is an extension of the definition of a " nuisance " for the purposes of the Public Health Act, 1875, enabling Local Authorities to deal with many cases which were not defined as nuisances under the original " Act." Also under this Act, registers will have to be kept and inspections made of Registries for Servants, and Dealers in Old Metal or Marine Stores. The Paving of Back Yards.—This is a work which requires to be pushed forward. Many of the back yards and also approaches to the rear entrances of property being in a very bad state. This work will now be carried out by notices served under Sec. 25 of the Public Health Acts Amendment Act, 1907. The bye-law which was in force in the district regarding the paving of yards becoming void with the operation of the 1907 Act. Nuisance Bye-laws.—(The model code) were adopted during the year and came into operation on October 30th, 1908. 29 Water Supply.— The District is served with a supply of water from the mains of the Southern District Metropolitan Water Board. Eleven complaints were received during the year of storage cisterns without covers provided and were remedied. Complaints were also received of insufficient storage capacity. This matter was communicated to the Water Board, and I am pleased to say the Board appear to have thoroughly taken the subject in hand, have appointed a new superintendent to this District, and in future sufficient cistern accommodation and the provision of proper close fitting covers to such cisterns are to be provided before any connection is made to the water mains. The Board's regulations are, I am informed, being revised so as to more adequately meet present day requirements. In connection with water supply is the provision of baths in dwelling houses, and it is a step in the right direction for the Water Board to have removed the only possible objection against an enactment compulsorily enforcing the provision of baths in dwelling houses, that is, the unreasonable additional charge on the water rate where a bath is used. The additional charge could only be regarded as an obstacle to what is an actual necessity of life, a penalty on cleanliness or an encouragement to be dirty. The notice issued by the Board dated March 31st, 1908, states that "in future, water supplies for domestic purposes includes water closets and baths." House Accommodation.—During the year, 193 new houses were completed and Certificates of Occupation were granted by the Surveyor. In addition to these, 27 houses were completed but not certified. Two small Dairies were erected. One Laundry (Factory). And One Stable. Housing of the Working Classes Act, 1890.—No work has been done in connection with Part 2 of this Act during the past year. Quarry Fencing Act.—One notice was served during the year under this Act, in conjunction with the Public Health Act, 1875, and complied with. 3° Beverley Brook.— Complaint was made by the Thames Conservancy of a suspected contamination of this brook in Kingston Vale. After exhaustive and careful investigations, including the tracing of the drainage of 23 houses, gullies on the drainage of four houses were found to be connected to an old six inch drain discharging into the stream. These were disconnected and the drain entering the stream entirely abolished. Cesspools were also discovered taking the drainage of Robin Hood Lodge, Richmond Park Gates, the work of re-constructing the drainage and connecting to this Council's sewer is to be undertaken at the commencement of the New Year. Railway Stations.—The sanitary accommodation at the two Railway Stations in the district is periodically inspected. During the year the Water Closet and Urinal accommodation at Worcester Park Station which was in a very insanitary condition, has been re-constructed with very satisfactory results. The Street Dust Nuisance.—The work carried out by the Council under the direction of the Surveyor (Mr. R. H. Jeffes) of treating the main thoroughfares with tar to minimise the dust nuisance was highly successful, and a boon to tradesmen or residents on these main arteries of the District. The Smoke Nuisance.—Four observations were made, four persons were cautioned and two notices served with regard to emissions of black smoke. After careful consideration a time limit of five minutes for the discharge of smoke was fixed by the Council. Private Roads.—Complaints have been received during the year of the nuisances caused by the condition of many of these roads. This is to a certain extent unavoidable in a rapidly developing district. The evil consequences of existing conditions, however, in certain Private Streets within the Urban District and the injurious effects upon the health, especially of the poorer classes is undoubtedly sufficiently serious to justify the New Roads Committee, which has been appointed to deal with the matter, in pressing forward with all possible speed the Scheme under the Private Street Works Act, 1892, the Council are initiating to remedy these conditions. It is anticipated that several of the streets giving greatest cause for complaint will be taken in hand early in the New Year. 31 The following is a tabulated summary of the inspections made and nuisances discovered during the year ending December 31st, 1908. TABLE I. NATURE OF CASES DEALT WITH NO. Notifications of infectious disease 517 Visits to houses where zymotic diseases have occurred 88 Houses disinfected 64 Lots of clothing and bedding disinfected 66 Inspections of Houses 184 ,, ,, Houses let in Lodgings — ,, ,, Factories 8 ,, ,, Workshops and Workrooms 37 ,, ,, Outworkers' Premises 5 ,, ,, Bakehouses 16 ,, ,, Dairies, Cowsheds and Milkshops 67 ,, ,, Slaughterhouses 110 ,, ,, Butchers, Greengrocers, Fishmongers, and Ice Cream Shops 102 ,, ,, Schools 20 ,, ,, Yards and Stables 222 ,, ,, Urinals 30 Sundry Inspections 249 Re-inspection of work in progress 515 Contraventions of Bye-laws 2 Complaints received and investigated 87 Smoke observations 4 Lots of food condemned and destroyed 8 Drains tested 266 Drains re-laid 103 Drains repaired 9 Loads of Refuse Removed 2671 NUISANCES DISCOVERED. Premises requiring repair 25 ,, ,, Cleansing and Whitewashing 28 ,, Overcrowded 9 Drains found defective 91 ,, ,, stopped 51 Defective Sanitary Fittings 116 ,, Yard Surfaces 40 ,, Eaves and Downspouts 21 ,, Manure receptacles 4 ,, Urinals 5 ,, Ashbins 66 Smoke Nuisances 2 Animals improperly kept 4 Infringements of Bye-laws and Regulations 2 Offensive Accumulations 63 Sundrv other Nuisances 40 Total number of Nuisances 567 Informal Notices served 159 Informal Notices complied with 140 In Abeyance 19 Referred to Committee 30 32 Van Dwellings.— The occasional camping of Caravans in the District, usually on vacant building land of easy access and adjoining a main road, has been the cause of complaints during the year. In one instance several vans settled on land adjoining the Burlington Road Schools. With no sanitary conveniences whatever provided for a camp of about 30 people, this is to say the least very undesirable and especially so near a public School, I am of opinion that some of these van-dwellers are frequently the carriers of disease from one District to another. The Bye-laws Committee are considering the Model Bye-laws for Tents, Vans, Sheds, &c., and these will be put into force in the District as quickly as possible. DRAINAGE. During the year 266 drains were tested. 91 drains were found defective, and 103 drains have been re-laid. Under the provision of Sec. 41 of the Public Health Act, 1875, 15 notices of intention to open the ground and examine the drains were served. Upon the ground being opened and the drainage of these premises examined, in every case the drainage had to be reported defective. Proper notices were served and the drainage entirely reconstructed. The sewer at the rear of the houses in California Road was found in a bad condition, and has been partly re-laid, with an improved gradient and inspection chambers erected on it where necessary. In the re-drainage of Nos. x, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 St. John's Road, notices were served under Sec. 41 of the 1875 Act in conjunction with Sec. 19 of the Amendment Act, 1890. There being in this case three different owners all draining into one common drain and the work has been done by the joint owners. It was decided during the year that requests by intending occupiers or purchasers of houses in the District for the testing of drains and sanitary fittings be not acceded to. A general sanitary survey of all fittings, &c., including the testing of drains is carried out in all cases of Diphtheria, Scarlet Fever or Typhoid Fever occurring in the District and the proper notices served to remedy any defects found. 33 The controversy over the virtues and failings of the intercepting trap on house drains is not yet dead. It has, it is true, been in a comatose condition for some time past. Now, however, the Local Government Board has revived it by the announcement that the President has appointed a Departmantal Committee to institute inquiries and report with regard to its use. This Committee have issued a circular letter under date of October 29th, asking for information. The Committee inquiry includes " consideration of the need or otherwise of the intercepting trap ; of any disadvantages of the trap ; of the effect on the community of emanations from sewers or drains ; to some extent also of the ventilation of sewers or drains ; and of the bsaring of existing conditions on the question." I may say that of the 51 stoppages in drains discovered since I took up duties on June 1st last, 40 out of the 51 stoppages were caused at the interceptor, and generally I found through the displacement of the stopper in the cleaning arm. Another point I have also observed is, that the stoppages through this cause occur mostly where the ventilation provided to the sewers is the least. Only one complaint was received of sewer ventilation shafts in the District and this has been removed to a more satisfactory point by the Surveyor. The drafting of Bye-laws for the drainage of existing Buildings is now receiving earnest attention and it is hoped these will be put in force in the District as early as possible. SCHOOLS. The Sanitary Accommodation of all the schools in the District is periodically inspected to ensure an efficient state of cleanliness at all times. There are nine private schools in the District and it was decided during the year that these schools be also periodically inspected. Lime Grove Schools.—During the Summer Holidays the drainage of these schools was partially re-laid. All rain-water downspouts disconnected from the drains, proper automatic flushing cisterns of adequate capacity fixed to the closet accommodation, and the urinal re-constructed, besides an additional water closet provided for the exclusive use of the teachers. The drain to the school-house was also re-laid and the defective sanitary fittings made good. 34 Old Maiden School?.—The drainage of these schools was also thoroughly overhauled during the Summer Holidays. The water closet and urinal drainage being re-constructed, a new urinal and two additional water closets being provided. The drainage of the School Hcuse was also re-laid. DISINFECTION. The rooms and bedding, clothes, &c., have been disinfected in 57 cases of infectious disease upon removal to the Isolation Hospital, recovery, or death of the patient: Scarlet Fever 21 Diphtheria 11 Typhoid Fever 2 Consumption 6 Measles 15 Whooping Cough 1 Cancer 1 The class-rooms were disinfected at the Burlington Road Schools during the epidemic of measles on four occasions, and at the Lime Grove Schools on three occasions. The slates and books were disinfected at Lime Grove Schools during December on account of several bad throats occurring. Disinfectants were supplied to occupiers of all infected premises, and where necessary the owners or occupiers were called upon to strip and cleanse the walls and whitewash the ceilings of the infected rooms. The houses were also inspected as to their sanitary condition and the drains tested. Notices were forthwith served upon the persons responsible to remedy any defects found. SLAUGHTER-HOUSES. There are now two slaughter-houses in the district, one being registered and one licensed. One slaughter-house was closed during the year. The quarterly limewashing of these premises has on all occasions been carried out as required. The paving and drainage at one slaughter-house, has been remedied and additional lairage provided. Attention was called to the necessity of using a proper airpump for purposes of the introduction of air during the dressing process of calves and lambs, and these were procured. 110 inspections of slaughter-houses and meat were made during the year. 35 During the year a struggle has been going on between the meat trade and cattle breeders and dealers, the butchers asking for a warranty from the vendor with all cattle bought at a fair market price, in the event of such cattle upon slaughter being found to be affected with tuberculosis. The attempt to eradicate tuberculosis is a task of great magnitude but it should be done in the interests of Public Health, Dairy Farming and Cattle Breeding. Legislation should be introduced without delay for enabling compensation to be made for all cattle slaughtered for food, but found to be infected with tuberculosis, and thereupon voluntarily surrendered for destruction (that is providing a fair market price was paid for the cattle) in some similar way as compensation is made to owners of cattle that are destroyed under the powers of the Contagious. Diseases (Animals) Acts. Bye-laws for the regulation of Slaughter-houses are being considered by the Bye-laws Sub-Committee and will be put in force in the District as early as possible. FOOD SUPPLY. During the year, 102 inspections have been made of the various shops and premises in the District where articles of food, meat, fish, &c., are sold or prepared for sale. One carcase of mutton, part of a carcase of pork, two beast's livers, two boxes of kippers, 25 tins of salmon, and one trunk of mixed fish have been destroyed as unfit for food. During the year the Kingston Guardians have established pigbreeding at the Union Farm, Kingston Road, for the supply o pork for their own consumption. The use of preservatives in food is an important question in connection with food supply. The introduction of drugs into foods for preservation or colouration is now practised to an enormous extent, and in view of the conflicting and varying opinions upon this matter it is highly desirable that legislation was introduced to fix a standard as to the amount (if any) of preservative or colouring matter to be used in the preservation or colouration of different fqods. The Public Health Foreign Meat Regulations which came into operation on January 1st, 1909, are intended to control imported boneless and boxed meats. By these regulations imported pork, tripe, tongues, and kidneys will be more rigorously inspected. 36 OFFENSIVE TRADES. There is not up to the present time any "offensive trades" (within the meaning of Sec. 112, Public Health Act, 1875), carried on in the District. The term "offensive trade" as defined by Sec. 112 of the 1875 Act was a restricted one but now by Sec. 51 of the Amendment Act, 1907, in substitution thereof it is defined as "any other noxious or offensive trade, business or manufacture," moreover a Local Authority may now make bye-laws with respect to any offensive trade in order to prevent any noxious or injurious effects arising therefrom. FACTORY AND WORKSHOPS ACTS. Factories—With the exception of that part of the law dealing with sanitary accommodation and conveniences the legislation regarding factories is administered by the Home Office. There are now eight factories on the register. Three notices were served during the year and complied with. Workshops.—There are now 37 workshops and one Workplace on the register. Forty-one inspections of workshops were made during the year. Six notices were served for various matters requiring attention in workshops. The following is a table of the various workshops and the various trades carried on therein :— TABLE II. WORKSHOPS ON REGISTER AND TRADES CARRIED ON THEREIN. TRADE. NO. OF WORKSHOPS. Bakehouses 6 Laundries 4 Plumbers and Glaziers 3 Boot and Shoe 4 Dressmaking; and Millinery 5 Blacksmiths, Coachbuilders, and Wheelwrights 6 Cycle Works and Carpenters 4 Sundry other Workshops 5 Total 37 37 The following is a tabulated sumaiary of the various matters requiring attention and notices served:— TABLE III. Matters requiring attention. Bakehouses Factories. Laundries. Workshops. Workplaces. Homewark'rs Totals. Cleansing and Limewashing 2 — — — — 1 3 Drains stopped — — — 2 — — 2 Insufficient ventilation — — 1 — — — 1 Defective Sanitary Fittings — 2 — 1 2 — 5 Yard Paving — — 1 — 1 — 2 Sundry other Nuisances — 1 — 1 — — 2 Totals 2 3 2 4 3 1 15 All defects found were remedied during the year. Five notices were sent to H. M. Inspector of Factories in accordance with the requirements of the Acts. Bakehouses.— Six bakehouses are now on the register, all of which have been inspected at intervals during the year. There is no underground bakehouse in the district. Workplaces.— Only one workplace is on the register. Additional legislation with regard to Factories and Workshops came into operation on Jan. ist, 1908. This is an Act to amend the Factory and Workshops Act of 1901, and provides additional regulations for Laundries, application of provisions to Domestic Workshops, and also brings certain institutions, which hitherto have not been controlled by the above Acts, now under these operations. HOME WORK. There were no homeworkers notified during the year in the district Four homeworkers were notified to this by other local authorities, however. One notice was served. 38 DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. There are now 23 names on the register. Only 22 of the 23 persons registered are, however, now carrying on business, viz.:— Fifteen Purveyors of Milk. Six Cowkeepers. Two Cowkeepers and Dairymen. The number of milch cows in the District is 130, an increase of 20 upon the number last year. During the year one cow was taken from a herd of dairy cattle on account of its suspicious appearance of tuberculosis. Eight persons have been registered during the past year. During the year bills were posted in various parts of the district calling the attention of persons interested, to the requisitions of the Dairies, Cowsheds and Milkshops Orders, with regard to registration, and the penalty if found carrying on these trades without registration. The Cowsheds in the district are kept in a very clean condition. The model regulations are in force in the district and no difficulty has been experienced in carrying them out. Additional legislation affecting persons carrying on the milk trade is provided under Part 4 (infectious diseases) of the Public Health Act Amendment Act, 1907. Power is provided to require dair) men to furnish lists of the sources of their milk supply in certain cases. And also dairymen are compelled to notify any case of infectious disease existing among their servants. THE COLLECTION AND DISPOSAL OF REFUSE. House refuse is systematically collected once a week from the rear of all houses throughout the entire district. During the year, 2671 loads of house refuse have been collected and destroyed by incineration. This work is ever on the increase, the district being a rapidly growing one, each successive week finds a slight increase in the number of premises to collect from. Disinfectant powder is carried on all the Dust Carts, for use if necessary after the refuse receptacles have been emptied of their contents. 39 The advantages of this work being superintended by the Health Department will be understood, when it is seen that sixty-six new sanitary dust-bins have been provided in place of defective ones, or where none previously existed, and that fifty-one accumulations of rubbish have been removed from the rear of houses, and this is only for the period from June ist. to Dec. 31st. 1908, when this work was taken over by this Department. The filthy insanitary dust-bin is one of the blots on our sanitary adminstration, and yet it is a fact that the principle of cleansing receptacles constantly in use for the storage of noxious matters is never applied to dust-bins. The neglected dust-bin in addition to being offensive and unhealthy has a short career, and is therefore financially unprofitable. The putrescent crust rots the material of which it is constructed ; it becomes perforated ; it passes away ; and is most difficult to replace, in fact the uniform provision of successive dustbins is a very difficult task. Attention was drawn to the great desirability of a secondary means of access being provided to all houses for purposes of refuse collection and this matter is receiving the earnest attention of the Committee. Trade Refuse (with the exception of offal or obnoxious refuse from Fishmongers, Poulterers, Butchers, &c.), is now collected at a small charge, as is also garden, builder's, &c., refuse, so there is now no excuse for the accumulation of these matters, which are in every district the cause of complaints. Dirt has been defined as matter in the wrong place and the sooner all accumulations of dirt are removed the better for the health of the district. Regulations for the control of the Collection of Refuse, including the sweeping or depositing in the streets any dirt, litter, rubbish, ashes, &c., were adopted by the Council on Nov. 10, 1908. I may mention that by Sec. 48 of The Public Health Acts Amendment Act, 1907 a local authority "must" now remove trade refuse if called upon to do so upon payment of a reasonable sum. In conclusion I should like to express my thanks for the kindness and courtesy I have received from the officials of the Council. I am, Sir, Yours faithfully, HARRY HUNTER, A.R. San. I., Mem. San. Inspt. Assoc. 4° Table I.— Vital Statistics of Whole District during 1908 and Previous Years. Name of District.— THE MALDENS AND COOMBE. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Net Deaths at all Ages belonging to the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1000 Births registered. Number. Rate. 1898 6049 138 23 22 160 60 9.9 ... ... 60 9.9 1899 6180 130 22 l6 129 57 9.2 ... 2 59 9.6 1900 6243 129 22 11 80 66 10.9 ... ... 66 10.9 1901 6322 146 23.1 l8 123 70 11.1 ... 5 75 11.8 1902 6647 170 25.7 18 106 73 10.5 ... ... 73 10.5 1903 7199 195 27.1 15 77 67 9.3 ... ... 67 9.3 1904 7675 176 22.9 27 107 90 10.4 12 102 13.3 1905 8642 193 22.3 15 77 62 7.1 6 68 7.9 1906 9686 208 21.5 14 67 76 7.8 3 79 8.1 1907 10268 223 21.7 24 108 82 8.0 8 90 8.8 Averages for years 1898-1907. 7491 170*8 23.1 18 103.4 70.3 9.4 ... 3.6 73.9 10.0 1908 11085 255 23 18 70.6 86 7.8 ... 10 96 8.7 Table II.—Vital Statistics of Separate Localities in 1908 and previous years. Name of District—MALDENS AND COOMBE. Year. The Maldens & Coombe. New Malden. Old Malden. Coombe. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 1898 6047 138 60 22 4299 119 52 20 569 8 4 ... 1181 11 4 2 1899 6180 130 59 l6 4422 112 48 16 574 6 3 ... 1184 i 2 8 ... 1900 6243 129 66 11 4485 118 55 10 575 4 3 ... 1183 7 8 1 1901 6322 146 75 18 4551 126 67 16 576 6 6 2 1195 14 2 ... 1902 6647 170 73 l8 4866 151 64 18 582 9 3 ... 1199 10 6 ... 1903 7199 195 67 15 5441 182 61 13 586 7 3 ... 1202 6 3 2 1904 7675 176 102 27 5876 164 91 24 588 5 3 1211 7 8 2 I905 8642 193 68 15 6816 186 60 14 584 2 6 ... 1242 5 2 1 1906 9686 208 79 14 7763 187 64 13 585 8 7 ... 1338 11 8 1 1907 10268 223 90 24 8338 205 79 23 583 7 9 ... 1347 11 2 1 Averages of Years 1898 to 1907. 7491 170.8 73.9 18 5683 155 64.1 16.7 580 6.2 47 .3 1228 9.6 5.1 1 1908 11085 255 96 l8 9112 228 85 17 59o 11 4 ... 1383 16 7 1 41 42 Table III.— Cases of Infectious Disease notified during the year 1908 in The Maidens aud Coombe Urban District. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages. Under 1 year. 1 to 5. 5 to 15. 15 t° 25. 25 to 65. 65 and upwards. New Malden. | Old Malden. Coombe. New Malden. Old Malden. Coombe. Total. Diphtheria 9 1 2 5 ... 1 ... 9 ... ... 7 ... ... 7 Erysipelas 9 ... ... 1 2 4 2 7 2 ... ... ... ... ... Scarlet Fever 21 ... 1 16 4 ... ... 15 1 5 12 1 4 17 Enteric Fever 3 ... ... 2 1 ... ... 3 ... ... *2 ... ... 2 Measles 468 23 149 278 7 11 ... 468 ... ... ... ... ... ... Phthisis 7 ... ... 1 1 5 ... 7 ... ... ... ... ... ... Totals 517 24 152 303 15 21 2 509 3 5 21 1 4 26 *One case removed to St. Bartholomew's Hospital. Tolworth Isolation Hospital is available for all Infectious Cases. 43 TABLE IV.— Causes of, and Ages at, Death during year igu8, in the Maidens and Coombe Urban District. Causes of Death. All Ages. Deaths in whole District at subjoined Ages. Total DEaths. Under 1 year. 1 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. New Maiden. Old Malden. Coombe. Measles 6 1 4 1 ... ... ... 6 ... ... 6 Diphtheria 1 1 ... ... ... ... ... 1 ... ... 1 Epidemic influenza 8 2 1 ... ... 2 3 6 ... 2 8 Diarrhœa 1 1 ... ... ... ... ... 1 ... ... 1 Pthisis 5 ... ... ... ... 5 ... 5 ... ... 5 Other tuberculous diseases 1 1 ... ... ... ... ... 1 ... ... 1 Cancer, malignant disease 8 ... ... ... ... 3 5 7 1 ... 8 Bronchitis 6 1 ... ... ... 1 4 6 ... ... 6 Pneumonia 4 ... ... ... ... 4 ... 3 1 ... 4 Pleurisy ... i ... ... ... ... 1 ... 1 ... ... 1 Premature birth ... 5 5 ... ... ... ... ... 4 ... 1 5 Diseases and accidents of parturition i ... ... ... 1 ... ... 1 ... ... 1 Heart diseases 4 ... ... ... ... 1 3 4 ... ... 4 Accidents ... ... ... ... 1 ... 1 ... ... 1 Suicides ... 2 ... ... ... ... 2 ... 2 ... ... 2 Senile decay i i ... ... ... ... ... 11 9 1 1 11 Sunstroke i ... 1 ... ... ... ... 1 ... ... 1 Diabetes i ... ... ... ... ... 1 1 ... ... 1 Gastric Ulcer 3 ... ... ... ... 3 3 ... ... 3 All other causes 28 6 2 1 1 11 7 24 1 3 28 All causes 98 18 8 2 2 34 34 87 4 7 co 44 Table V.— Infantile Deaths from stated Causes in Weeks and Months under One Year of Age during the year igo8 in the Urban District of the Maidens and Coombe. Cause of Death. Under I Week. Total under I Month 1 to 2 Months. 2 to 3 Months. 3 to 4 Months. 5 to 6 Months. 6 to 7 Months. 7 to 8 Months. 10 to 11 Months. 11 to 12 Months. Total Deaths under one Year. Diphtheria ... ... ... ... ... ... ... ... 1 ... 1 Diarrhoea ... ... 1 ... ... ... ... ... ... ... 1 Premature Birth... 5 5 ... ... ... ... ... ... ... ... 5 Congenital Defects 2 2 ... ... ... ... ... ... ... ... 2 Starvation 1 1 ... ... ... ... ... ... ... ... 1 Marasmus ... ... ... ... ... ... ... ... ... ... 4 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... ... 1 ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... 1 ... ... 1 ... 2 Total 8 8 3 1 1 1 0 1 2 1 18 RASHELL DAVISON, m. d., m. r. c. s., Medical Officer of Healths