SUR 638 SURBITON Urban District Council Dmentieth Annual Report OF THE MEDICAL OFFICER OF HEALTH, 1896. BULL AND SON, PRINTERS, VICTORIA TERRACE, SURBITON. Surbiton Arban District Council. \ TWENTIETH ANNUAL REPORT of the Medical Officer of Health, 1896. Mr. Chairman and Gentlemen, This is the Twentieth Annual Report that I have had the pleasure to make to you on the health and sanitary condition of the District under your care; and I am glad to be able to say that whether from the point of vital statistics or sanitary work done, it will I think be held to be fairly satisfactory. I have endeavoured to make my returns as accurate as possible by apportioning the deaths in public institutions within the area to the different localities they belong to, and receiving those from the Workhouse and County Asylum for addition to the mortality of their respective districts. 2 vital statistics The number of deaths registered as occuring .within and belonging to the District, i.e., the now enlarged District, is 155, including eight deaths from the Union Workhouse, and one from the County Lunatic Asylum at Brookwood. The population estimated to the middle of 1896 is 12,763, and this gives a death rate of 12.14 per thousand per annum. This compares with the death rate for London of 18'6, and for England and Wales of 17.1. From the principal Zymotic diseases there were recorded 14 deaths, giving a rate of 1.09. That for London is 3'14, and for England and Wales 2.18. The total births amount to 281, with a birth rate of 2201. For London the rate is 802, and for England and Wales 29.7. There is naturally very considerable difference in the birth rate in the different parts of the District, it being in Tolworth nearly 47 per thousand, and in Surbiton only 19. The infant mortality, i.e., the ratio of deaths of children under one year of age to one thousand births is 96. In London it is 161, and for England and Wales 148. The following table serves to differentiate these returns between the various localities forming the Urban District:— Districts Estimated Pop. 1896 Deaths Death Rate Births Birth Rate Surbiton 10,407 123 11.81 199 19.1 Tolworth 1,085 15 13.82 51 46.9 Southborough 808 11 13.61 22 27.2 Hook 463 6 12.95 9 19.4 12,763 155 12.14 281 22.01 The Infectious Disease (Notification,) Act, 1889. This Act continues to work well and the large majority of the cases are notified promptly by the medical man in attendance. This is a very important point, and it is well to direct attention to it. On the other hand notification by the householder is not by any means uniformly carried 3 out. The Act is one for dual notification and throws on the head of the family—independently of the doctor—the duty of himself notifying, for in the words of the Act "the head of the family * * shall, as soon as he becomes aware that the patient is suffering from an infectious disease to which this Act applies, send notice thereof to the medical officer of health of the district." There have been no epidemics this year of any very special character; nothing more than what may from time to time be expected to occur amongst a population containing a large number of susceptible children, at times aggregated for hours together in schools. During the first three months of the year Scarlet Fever was prevalent throughout the whole county, and 20 out of the 27 cases notified for the year occurred during that time; of these 27 cases 14 in all were removed to the Isolation Hospital. In one house in Southborough no less than five cases and one death occurred. These were treated at home. There is a very general disposition on the part of parents to appreciate and take advantage of the benefits of removal of their sick children to the Hospital, not only for the good of the patient, but as undoubtedly offering the best prospect of staying the further spread of the disease in the family. It should be here recorded that though 19 cases of infectious diseases of all sorts were admitted to the Isolation Hospital during the year, there were no deaths, and the Medical Officer, Dr. Ackerley, in his Report alluding to the Scarlet Fever cases, says " A large number were unusually severe, more or less serious complications were frequent, and there is little doubt that under less favourable circumstances, i.e., if the cases had been treated at their own homes, the mortality would have been greater." Of the non-notifiable diseases, Whooping Cough was a good deal 4 in evidence in January and February, and Measles broke out in June, and lasted throughout the summer, delaying in fact the opening of the Schools in the Christ Church district after the summer holidays, and in Tolworth necessitating the closing of the Schools in November and December. Extract from Notification Book. Scarlet Fever Diptheria & Memb. Croup Enteric Fever Puerperal Fever Erysipelas Contin. Fever Small Pox Totals 1890 3 36 1 2 4 0 0 46 1891 3 21 1 0 10 0 0 35 1892 4 16 3 1 5 0 0 29 1893 94 23 5 2 15 2 1 142 1894 9 20 12 2 12 0 0 55 1895 18 12 5 0 2 0 0 37 *1896 27 9 4 1 10 0 0 51 *The combined Districts. Mortality. The number of deaths for the year 1896 is made up as follows:—In Surbiton itself, 107; in the Cottage Hospital, 8; in the Workhouse, 7; in the County Lunatic Asylum at Brookwood, 1; a total of 123. For 1895 the deaths were 116, but those from the Workhouse were not obtainable. Death Rate. The official estimate of the increase of population to the middle of 1896 is 10,407, and on this basis the death rate is 11.81. Last year the rate was 11.21. Zymotic Diseases. The deaths from the principal Zymotic diseases were 10, being five from measles, one each from scarlet fever, whooping cough and diptheria, and two from diarrhoea. This gives a Zymotic death rate of 0.96 per thousand. 5 Of these 123 deaths, 58 are males, and 65 females. 29 were 70 and upwards, and 19 were under one year of age. There died of phthisis, 8; of other respiratory diseases, 13; of heart disease, 16; of cancer, 5; of violence, 6. There were eight inquests. Causes of Death The births were 199, and of these 100 were boys and 99 girls. The birth rate is therefore 19.1 per thousand. The deaths of infants, children under one year of age, were in the ratio of 95.4 per thousand births registered. Births. The following are some particulars respecting the various diseases of the Zymotic group:— No case of this disease reported. Small pox. Three cases of this disease were notified, and all recovered. As is generally the case, these appeared in the autumn. In two of the cases, the patients were either employed or partially resident in London, and on inspection nothing was found or known to be wrong in the houses, so that the probability is the disease was contracted elsewhere. The third case, and of which the diagnosis was for some time doubtful, was that of a man living at home, but here nothing wrong in drainage or water supply could be found, or in fact any trace as to causation. In addition to these there was the case of a female employed at a house in Victoria Road. She went to Newcastle on the 18th July and returned on the 4th August. On the 20th she became ill and went to her home in Middlesex, and there her illness was diagnosed on the 26th as Typhoid. The Sanitary Inspector examined the premises and found them in an insanitary condition. This house with adjoining ones having combined drains, were re-drained. It is a matter of uncertainty of course whether the disease was contracted when on her visit to the North or on her return home. Enteric Fever. 6 Measles. This disease was existent during the summer and autumn. In June there were some 40 children not attending St. Mark's Schools on this account, and in the Christ Church district the opening of the Schools after the summer holidays, which should have come to an end on the 24th August, was delayed for nearly three weeks, till 11th September. At St. Matthew's there was a severe outbreak, and it was necessary to close the infant school from November 13th, and the mixed school from November 30th, to December 14th. In all there were five deaths registered as due to this disease, and its sequelae, bronchitis, pneumonia, etc. Diphtheria. There were six cases of this disease in Surbiton, but none of them were removed to the Isolation Hospital. The first case was early in January, on Surbiton Hill, and the cause could not be traced. Then in February, a month afterwards, two cases occurred within a few days of each other, in Cleaveland Road, in two separate houses. There may have been some common origin for these, but it could not be ascertained. After this there was no case until August; but that was so instructive in some particulars, that I mention it in detail. A child of eight years old had just returned from a visit to a relative, a medical man in practice in the north of England, when he ailed with a sore throat and constitutional symptoms. An examination could not quite satisfactorily determine whether or no it was diphtheria; so a specimen from the throat was sent to the Laboratory of the Clinical Research Association for bacteriological culture and examination. In a short time a reply was received to the effect that the specific organism was present. The anti-toxin treatment was immediately applied, and after an illness characterised by one or two relapses, the child eventually made a good recovery. During this period it was quite incidentally 7 brought to my notice that the children of this medical man, with whom the patient had been associating till within a few days of his illness, had all been suffering from a mild form of sore throat, which had in no case been suspected to be of a diphtheritic nature. I thereupon communicated the facts of this child's illness, and the confirmation of the diagnosis by culture, to the father of these children; drawing his attention to the extreme probability of their having also had this disease in a mild form. His reply was to the effect that he had had no suspicion at the time that it could have been diphtheria; but that they had now all recovered, and that it might well have been so. The moral here is the advisability of having a bacteriological examination of the discharges from the throat made when two or more sore throats occur in a household. The diagnosis of diphtheria was confirmed by bacteriological examination in about half the cases notified, it would be desirable if that means of diagnosis were freely resorted to in all dubious cases of throat illness, for besides making certain that about which there may have previously been considerable doubt, it would also tend to prevent cases being notified and treated as diphtheria that are nothing of the sort. Such errors are not difficult to make and they occasionally happen. The last two cases were at the end of November in one household. A patient had been submitted to an operation, and was attended by a hospital nurse. The wound did not do satisfactorily, and some septic mischief was feared, and the drainage of the house suspected. Then the nurse fell ill with a sore throat, and went to a London hospital, where diphtheria was diagnosed. The theory advanced was that diphtheria poison had attacked the operation wound, and that the 8 nurse had become infected while dressing the wound. The patient died; and it was stated later on that prior to attending this case, the nurse had been in attendance on a case of diphtheria; but an interval of fully a month had elapsed, and thorough disinfection] had been practised. The drainage was not found in fault. The following table records some facts in connection with the diphtheria cases of this and former years. Houses invaded. Cases. Deaths. Average Age per case. Case mortality per cent. 1890 31 36* 3 19.5 8.3 1891 16 21 10 9.8 47.6 1892 14 16 1 18.1 6.2 1893 19 23 3 18.7 13.0 1894 13 20 3 17.3 15.0 1895 12 12 1 13.5 8.3 †1896 8 9 2 14.4 22.2 *27 of these cases were due to an infected milk supply, †The combined districts. Erysipelas. 10 cases, one of which was removed to the Isolation Hospital, and proved severe and tedious. No deaths. Epidemic Influenza. This disease is now a species of annual, recurring year by year, much about the same time; for referring to my notes I find it reappeared almost suddenly on the 18th February, 1895, and now I have to report that last year, 1896, it was again very prevalent in February, exhausting itself in the course of a few weeks, to appear again in October, though not so severely. At the time of writing it is once more in evidence. No deaths are attributed to it. Scarlet Fever. A total of 19 cases and one death. The majority of these were notified in the first quarter of the year, and of the remainder three or four were in the summer, and three 9 in the autumn. Twelve patients were removed to the Isolation Hospital. Some of the cases were severe in themselves and in their complications and one terminated fatally. There was unfortunately reason to fear that after their return home from the Hospital some of the patients might have communicated the disease to others. This possibility naturally occasioned considerable anxiety to the Medical Officer of the Hospital and myself. We consulted together and made all possible investigations and enquiries, and the conclusion arrived at was that while there was such a possibility, yet there was no proof that infection had actually been conveyed, though there undoubtedly were coincidences difficult of explanation and that justified suspicion. This institution, situate now within the bounds of your district, has again been doing most useful work. A long time seems necessary for, or at any rate is taken up in, negotiations between possible constituent districts, and for settlement with those retiring, or becoming absorbed consequent on the disestablishment of the Kingston Rural Sanitary Authority. Apparently the initial difficulties seem to have been overcome, and in the future the Hospital will serve for Surbiton, Esher and the Dittons, Coombe and the Maidens and Ham Urban and Rural. I trust it will be early taken into consideration by the Authority that telephonic communication should be established between the Hospital and the Council's offices, and if this is entrusted to the National Telephone Company, who are about to work this district and establish a public call office, it would be of immense advantage to all medical men, and to relatives of patients, who would much appreciate the possibility of getting daily and speedy Isolation Hospital. 10 information as to the progress made by those inmates of the Hospital in whose welfare they might be interested. As to another matter, it is my undoubted duty to again call the attention of the Hospital Committee to the necessity for an alteration from the present old-fashioned, out of date, and unreliable method of disinfection by dry heat now in vogue there, to that by super-heated steam, which is held by all scientists to be far preferable and more trustworthy, both in application and in result. I referred to this matter in my Report last year, mentioning that "The present method is that of dry heat obtained by gas, "and known as Dr. Schollick's. In the light of experience "that system has been long since condemned as unreliable, "and superheated steam is now the only process sanc"tioned by the Metropolitan Asylums Board for use in "their Hospitals." It will be also desirable to have some more rational and less expensive method of collecting and returning bedding and other articles that it may be desired to send for disinfection, to that at present in use; the method now being to fetch the articles in the ambulance, leaving them to be brought home by any other conveyance the owner likes to employ. There should be two light closed vans; one might be painted red and the the other white, for fetching and returning, to avoid any possibilities of mistake; and those desiring to make use of them should be allowed to do so at their own expense for horse hire or haulage, the present charge of seven shillings being exorbitant; the more so when the distance, as it often is, would be well under one mile. In his report the Medical Officer of the Hospital says:—" It would greatly assist the "Medical Officer if medical practitioners who send "patients to the Hospital would send him a short account 11 "of the main facts of the illness. In cases sent in such "as diphtheria or typhoid fever, this is especially "desirable." The following table refers to cases admitted since we had the right to send patients. Scarlet Fever Diphtheria. Typhoid. Small Pox. Erysipelas. Total. 1893 35 6 3 l 0 45 1894 5 6 2 0 0 13 1895 14 2 1 0 0 17 *1896 14 1 3 0 1 19 *Combined Districts. The number of admissions to the Surbiton Cottage Hospital during the past year were 254 as against 153 in Cottage Hospital. 1895 and 220 in 1894. The total number of deaths were 22. The distribution of patients and deaths were :— District Admitted. Relieved. Unrelieved. Died. Remaining in Hospital 1st Jan. 1897. Surbiton, Hook, Tolworth, and Southboro' 115 98 3 8 6 Kingston and Norbiton 104 80 2 18 9 The Dittons and Claygate 16 14 l 1 Middlesex 8 8 Other places 11 11 254 211 6 22 15 The need of a mortuary is really very great. There is no doubt considerable difficulty in finding a suitable site which should be sufficiently central to meet the Mortuary 12 ments of the district and convenient of access for Coroner, medical men, and juries, but with a little earnestness of purpose surely it should be provided this year. I am aware that the matter has been talked of and I have myself endeavoured to obtain a site that would in my belief fully meet all the requirements put forward, but as for the present a final decision may be said to be still sub judice I may not do more than mention this. As a year has elapsed it may be of service to members of the Council anxious to settle this question if I again repeat some of the reasons previously put forward and which I venture to consider would justify much more cogent arguments being used. In the matter of accidents or deaths necessitating an inquest the Coroner has for some time past taken to ordering the removal of the body, in nearly all instances to the mortuary at Kingston, and then holding the inquest in that town. This is a subject of very considerable importance to relatives, witnesses, jury and medical men, as the distance, one or two miles or more, and the bringing back of the body in many cases involves expense and much waste of time. But in addition to this the Infectious Disease (Prevention) Act, 1890, adopted by your Council, requires the removal of bodies under certain circumstances to a mortuary. I do not know what right or powers, if any, we have of access to the Kingston mortuary for the purposes of the Act, i.e. those dying of infectious diseases, but I think the matter should be arranged for in some more suitable way than at present, and better and more convenient premises provided in our own district than those we have to put up with at present. Since now our acreage has been nearly trebled, and the distances are consequently much further, and with an increased population the need is considerably greater. 18 The section of the Infectious Disease (Prevention) Act, 1890, referred to above is as follows:— Prohibiting Retention of Dead Bodies in Certain Cases. "8.—No person without the sanction in writing of the "Medical Officer of Health or of a registered medical "practitioner, shall retain unburied elsewhere than in a "public mortuary or in a room not used at the time as a "dwelling place, sleeping place, or workroom, for more "than forty-eight hours, the body of any person who has "died of any infectious disease." During the past year 15 deaths were registered asTolworthoccurring in Tolworth, including one from the Union Workhouse; of these nine were males and 6 females. Only two children were under one year of age. There was one death from diphtheria and one from measles. The births were 51 comprising 25 boys and 26 girls. The estimated population being 1085 this gives a death rate of 13.82, and the very large birth rate of 46.9. The district has received considerable supervision at the hands of the Sanitary Inspector, and much has been done to effect improvements. The Ellerton, Worthington, Douglas, Denham and Cotterill Roads are about to be made up and put into good condition, this will be a much needed sanitary improvement and conduce to the well-being of the children who for some long time past must have had much difficulty in going about dry shod in wet weather. It would be an improvement also if the names of the roads were put up as they are at present conspicuous by their absence. With an estimated population of 808 there were 11 deaths, four males and seveu females, giving a death rate of 13.61, and 22 births, 10 boys and 12 girls, a birth rate Southborough. 14 of 27.2. Five deaths were of children under one year of age. There was one death from measles and one from scarlatina. All the private roads are very bad. The Surveyor has instructions to prepare plans and estimates, and the Council will, I understand, then take into consideration what shall be done. Hook In this hamlet there were six deaths, five males and one female. With an estimated population of 468 this gives a death rate of 12.95. The births were nine, boys four, girls five, and a birth rate of 19.4. There were no deaths from any of the Zymotic diseases. General Sanitary Work. During the first two months of the year the weather was fine and dry, March was somewhat rainy and was followed by a hot dry summer, but in the last week of August rain commenced and the autumn and winter months have been exceptionally wet, with a temperature above the average. These weather conditions do not seem to have had any very appreciable effect on the public health, unless it be the unusual amount of diarrhoea which prevailed in October and November was due to the consequent abnormal atmospheric humidity, though certainly this complaint was largely associated with epidemic and catarrhal influenza, which was very general about that time. During April the Council elected as Sanitary Inspector from a large number of applicants, Mr. Nesfield, who brought excellent credentials from Idle in Yorkshire, where he held the post of Sanitary Inspector and Water Works manager. He commenced duty at the end of the month and I take this opportunity to gladly recognise the energy, tact and ability which he has shown in the varied and multitudinous duties he has had to perform. His report, which 15 is appended, shows in detail that during the eight months since his appointment he has got through a large amount of very useful work. It will be satisfactory for the Council to learn that in this period alone some 70 houses were re-drained under his supervision. The occasions that necessitated these works were in many instances the result of sanitary inspections required by incoming tenants, in others, obstructions of house drains leading up to the thorough over-hauling of the sanitary system of the house, drain testings consequent upon nuisances complained of, and those following cases of infectious illness. It was found that re-drainage was mostly required, some from the systems in use being antiquated and not complying with the primary principles of latter-day drainage, some from faulty construction, and others from fair wear and tear. No less than 124 houses were provided with dust bins and there are many more that will yet have to obtain them. These are mainly of course in the Tolworth and Southborough districts. Since the houses of the working classes are now mostly fitted with water closets and flushing cisterns, there is a greater need for close and frequent inspections of them, owing to their getting out of repair and remaining so. For instance, as a consequence of frost, flushing pipes get frozen and burst, and the tenants' complaints—when they do complain—often remain unattended to at the hands of their landlords for many weeks together, or the flushing apparatus or closet mechanism gets out of order, and to get these repaired, pressure on the part of the Inspector is frequently besought, in fact, to some extent, the Sanitary Inspector stands between the working man tenant and the landlord and his assistance is constantly invoked for that very object. In many instances, however, these defects 16 are not complained of for various—and some of them very obvious—reasons, hence the value of systematic inspection. In this way it has been brought about that the large number of repairs to closets, &c., appears in the summary of work. At Minniedale two overflowing cesspools were cleansed, but these will be abolished when the drainage scheme of this long neglected part of the district is at last carried out, which appears likely soon to be the case, as a short length of sewer is to be constructed from the north end of Minniedale along Clay Hill to the Cranes Park System. No complaints have been received in connection with the sewage farm, and the effluent as it passes at the back of some of the houses in Ellerton Road has occasioned no nuisance. New sewers have been laid in Grove Road, Cadogan Road and South Bank. The sewers in James Street and Etwell place having been found defective and full of sediment are about to be renewed. Factory and Workshop Acts It is hardly yet appreciated that the Local Authority, through its officials, under these Acts inspect all premises where articles are manufactured, and this inspection will in due course necessarily lead to considerable sanitary improvements. This includes laundries where two persons at least, are employed in addition to the members of the family. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, M.D., D.P.H., Medical Officer of Health, March 13th, 1897. 17 The following is the Report of the Sanitary Inspector, but it should be borne in mind that it deals with little more than eight months:— To the Medical Officer of Health. Sir, I beg to present my report showing the amount of work undertaken and carried out in the abatement and suppression of nuisances from April 14th, the date of my appointment, to the year ending December 31st, 1896. The inspection of the district has been systematically carried out and every means taken to keep it in a good sanitary condition, and wherever nuisances were found to exist, notices were served upon the responsible person to abate the same. I am pleased to state that in the majority of cases great readiness was shown by the persons who had notices served upon them to comply with the same, and in no case has it been found necessary to take summary proceedings to compel the abatement of any nuisance. 44 complaints were received at the office, and action was taken and notices served where necessary. Summary of Work Carried Out. Defective drains cleansed and repaired 20 Houses subsoil drained and site concreted 8 Earthenware gullies fixed in lieu of defective bell and brick traps 54 Soilpipes inside houses removed and fixed outside 14 Soilpipes ventilated 9 18 Foul and defective water closet pans cleansed and repaired 33 Old pan and long hopper closets removed and pans and traps of approved form substituted 69 D traps under water closet apparatus removed and syphon traps fixed 8 Water closets rebuilt 3 Windows fixed in water closets 5 Water closet flush cisterns provided 31 „ „ repaired 32 Water closet flush pipes disconnected from storage cisterns 45 Storage cisterns repaired 3 Cistern overflow pipes disconnected from soilpipe and arranged to discharge through external wall 10 Rainwater, sink and other waste pipes disconnected from drain 42 Lead syphon traps fixed on bath, lavatory and sink waste pipes 35 Sink and other waste pipes provided and repaired 28 Roofs and spouting repaired 13 Overflowing cesspools cleansed 2 Houses provided with dust bins 124 Dirty premises cleansed and whitewashed 21 Drains opened for examination under sect. 41 Public Health Act 2 Premises disinfected 4 Nuisance from overcrowding abated 3 „ animals improperly kept abated 13 Accumulations of manure and other offensive matter removed 9 Overcrowding in cowsheds abated 1 Cowsheds cleansed and whitewashed 1 19 Inspections. The following are a list of inspections made since the date of my appointment:— Houses and premises inspected 257 Inspections of works in progress1002 „ bakehouses 37 „ slaughterhouses 14 „ dairies and cowsheds 46 „ factories and workshops 63 Inspections with regard to infectious disease 18 Total 1,437 Correspondence. Preliminary notices 136 Legal notices 19 Letters 151 Total 306 Drainage Since the date of my appointment the drainage of 70 houses have been entirely re-constructed. In carrying out this work I have endeavoured as far as practicable, to secure the following provisions, as the circumstances of each case require :— (aj That a separate drain be provided for each house. (bj A manhole with air tight cover, intercepting trap, and fresh air inlet fixed as near the boundary of the premises as practicable. (cj A ventilating pipe of sufficient diameter and proper materials terminating in a suitable position in relation to the windows and chimneys of the house. 20 Cdj Disconnection of rain water pipes from drain and prohibition of their use as drain ventilators. Cej That a lead syphon trap be fixed on all waste pipes. Cf) An efficient flush to w.o., both with respect to the flushing cistern and as to its communication with the pan of w.c. (gj The fixing of an efficient washdown pan and the abolition of the insanitary seat and riser. (h) The sound and permanent connection of the w.c. trap to the soilpipe, discountenancing red lead or similar imperfect method of jointing. List of Houses Bedrained. Myrtle Cottage, Surbiton Hill Eoad. Everdon, Cadogan Eoad. Oakleigh, Ewell Eoad. Ashford Lodge, Cadogan Eoad. Ventnor Villa, Cadogan Eoad. Hazlemere, Cadogan Eoad. Ashbrook, Cadogan Eoad. Eiverdale, Cadogan Eoad. Leigh Grove, The Avenue. Langley House, Langley Avenue. 85 and 86 Cleaveland Eoad. St. Mary's Mews, St. Mary's Eoad. Allen Bros.' Dairy, St. James' Eoad, Southborough. 1 and 2 St. Andrew's Boad. 3 and 4 St. Andrew's Square. 2 and 3 Wyburn Villas, Ewell Boad. 1 and 14 St. Philip's Boad. 2 North Boad. 2 The Crescent. 21 39 to 46 Cleaveland Eoad. 32, 33 and 34 Cleaveland Eoad. 79 and 80 Brighton Eoad. 24 to 26 Eichmond Grove. 2 to 8 even numbers, Smith Street. 1 to 15 odd numbers, James Street. 2 to 12 even numbers, James Street. 12 to 17, Victoria Terrace. 45 to 49 Alpha Eoad. i 1 South Terrace. 3 Christ Church Eoad. Factory and Workshop Act, 1895. Under this Act numerous inspections of Workshops, &c., have been made, and I am pleased to report that generally they have been found in a satisfactory condition, in four instances the Factory Inspector has notified sanitary defects and notices were served forthwith for the abatement of the same. The following is a list of nuisances dealt with : Workshops Cleaned and Whitewashed 8 Ditto Ee-drained 1 Ditto Floors concreted 8 Ditto Overcrowded 1 Ditto Not properly ventilated 4 Ditto Ceilings repaired 1 Slaughterhouses. The slaughterhouses in the district have been frequently and at irregular periods inspected to ascertain if they are kept in conformity with the Bye laws regulatiag the same. Combined Drains. 22 In no case have I had to report to the Council any occupier for breach of any of the Bye laws. Bakehouses. These premises are periodically inspected to ascertain if they are kept clean, properly ventilated, and free from any impurities generated in the course of the work, it is satisfactory to note that they are generally kept in a good condition, verbal notices to cleanse have been given which have had the desired effect. Dairies, Cowshed and Milkshop Act. The requirements of the said Act with reference to Dairies, Cowsheds and Milkshops have also been carried out, one case of overcrowding has come under my notice and was dealt with by legal notice. Yours obediently, WILLIAM NESFIELD, Assoc. San. Inst. Sanitary Inspector. February 9th, 1897. (A) TABLE OF DEATHS during the Year 1896, in the Surbition Uraban District, classified to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all Causes, at Subjoined Ages. Mortality from Subjoined Causks, Distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15 15 and under 25 25 and under 65 65 and upwards Scarlatina. Diphtheria. Enteric or Typhoid Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea and Dysentery. Phthisis. Bronchitis, Pueuinonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. SURBITON 107 19 13 2 5 32 36 Under 5 1 5 1 1 4 2 18 32 5 upwds. 1 i 1 8 5 15 4 40 75 TOLWORTH 14 2 6 4 2 Under 5 1 1 1 5 8 5 upwds. 1 1 4 6 HOOK 6 1 5 Under 5 1 1 5 upwds. | 2 1 1 1 5 SOUTHBOROUGH 11 5 1 2 3 Under 5 1 1 4 6 5 upwds. i 4 5 COTTAGE HOSPITAL 22 2 2 4 12 2 Under 5 1 1 2 5 upwds. 2 4 2 5 7 20 ISOLATION HOSPITAL 3 2 1 Under 5 5 upwds. 1 2 3 Totals 163 27 22 8 10 53 43 Under 5 1 1 7 1 1 6 3 29 49 5 upwds. 2 3 i 1 12 10 19 10 56 114 Deaths occurring outside the district among persons belonging thereto. 9 1 1 1 2 4 Under 5 1 1 5 upwds. 1 1 1 5 8 Deaths occurring within the district among persons not belonging thereto. 17 4 4 7 2 Under 5 5 upwds. 1 2 2 4 1 4 3 17 (B) TABLE OF POPULATION, BIRTHS, and of NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1896, in the Surbiton Urban District; classified according to Diseases, Ages, and Localities. Names op Localities adopted for the purpose of these Statistics ; Public Institutions beiug shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. Estimated to middle of 1896. Smallpox. Scarlatina. Diphtheria. Enteric or Typhoid. Continued. Puerperal. Erysipelas. Smallpox. Scarlatina. Diphtheria. Enteric or Typhoid. Continued. Puerperal. Erysipelas. SURBITON 10050 10407 199 Under 5 5 i 3 5 upwds. 14 5 3 1 8 9 2 1 TOLWORTH 979 1085 - 51 Under 5 1 2 5 upwds. 1 1 HOOK 418 463 9 Under 5 5 upwds. 1 1 1 SOUTHBOROUGH 729 808 22 Under 5 2 1 5 upwds. 5 1 I Totals. . 12176 12763 281 U nder 5 8 3 4 5 upwds. 19 6 4 1 10 10 I 3 1