SUR 040 Twenty-second Annual Report OF THE MEDICAL OFFICER OF HEALTH, 1898. BULL AND SON, PRINTERS, VICTORIA TERRACE, SURBITON. THE Urban District Council of Surbiton. Area in Acres 2858½ Population (census 1891) 12176 ,, estimated to middle of 1898 12975 Death Rates (General 12.6 Zymotic 0.69 per 1000 population, estimated to middle of 1898. Infants (under 1 year of age) 127.6 per 1000 births registered. Birth Rate 23.9 per 1000 Surbiton Urban District Council. TWENTY-SECOND ANNUAL REPORT OF THE Medical Officer of Health, 1898. Mr. Chairman and Gentlemen,— This, my Twenty-Second Annual Report, deals as usual with the vital statistics of the Urban District of Surbiton, including Tolworth, Hook and Southborough, and of the sanitary conditions of these localities as far as there is anything instructive or informative. Hitherto I have not included the deaths occurring at the Workhouse during the year, as I ascertained that it was not customary so to do in the other Sanitary Districts of the County ; but as the Medical Officer of the County Council has this year forwarded these particulars to me, I have incorporated them with all the other other cases occurring outside the District due to be included, and of course excluding those belonging to other places occurring in the Public Institutions within our boundaries. By these means it is ascertained that the total number of deaths for the combined Districts during 1898 is 164. Vital Statistics. At the Census of 1891 the population of the whole of the area under your control was 12176. In 1897 the estimated increase raised it 3 to 12869, and for present purposes it is assumed to be 12975 at the middle of 1898. This estimate, however, is a mere calculation worked out on a certain system for all places, and should of course be modified by any local factor known to be operating strongly in one direction or the other. This is notoriously the case as regards Tolworth, owing to the large amount of building that has been going on there during the past year or two; so being desirous of correcting to some extent the estimate of the population of that part of the District by the number of new houses erected, (the birth rate for the year 60.8 per thousand being absurd, since the birth rate for England and Wales is only 29.4), I made application in the proper quarter for the number of new houses erected during the year, but was unable to obtain it, so that the correction cannot be made as applying either to the birth or death rate, and some further deductions and comments I wished to make must consequently stand over. Taking the number, however, at 12975, which is officially given me, the death rate works out at 12.6 per thousand of the estimated population. That for England and Wales for the same period is 17.6. The deaths from the principal Zymotic diseases were nine, giving a rate of 0.69, which is of course extremely low, and approaches that of the rural districts as distinguished from towns, where it is always higher. That for England and Wales is 2.22. Births. The births were 311, divided into 168 boys and 143 girls, comparing favourably with 291 in 1897 and 281 in 1896. This is probably due to the largely increased population at Tolworth, 4 where the birth rate figures abnormally high on the present estimated population, no correction being obtainable. The birth rate for the whole district is therefore 23.9, while for England and Wales it is 29.4. The infantile mortality, i.e., the ratio of deaths of children under one year of age to one thousand births is 127.6, that for England and Wales being 161. The excess of births over deaths is 147. In the following tables I have enendeavoured to differentiate these statistics as amongst the various sub-districts; but for the reasons I have mentioned I have not been able to make them so approximately correct as I might otherwise have done, notwithstanding this, they are interesting for purposes of comparison. Returns for 3 Years. 1896. Districts. Est. Pop. Deaths. Death rate. Births. Birth rate. Surbiton 10407 123 11.81 199 19.1 Tolworth 1085 15 13.82 51 46.9 Southborough 808 11 13.61 22 27.2 Hook 463 6 12.95 9 19.4 12763 155 12.14 281 22.01 1897. Districts. Est. Pop. Deaths. Death rate. Births. Birth rate. Surbiton 10498 109 10.3 209 19.9 Tolworth 1094 14 12.7 46 42.04 Southborough 815 8 9.8 17 20.8 Hook 467 3 6.4 19 40.6 12869 134 10.4 291 22.6 1898. Districts. Est. Pop. Deaths. Death rate. Births. Birth rate. Surbiton 10582 128 12 214 20. 2 Tolworth 1102 19 17.2 67 60.8 Southborough 821 6 7.3 15 l8.2 Hook 470 11 23.4 15 31.9 12975 164 12.6 311 23.9 5 Causes of Deaths Of the 164 deaths registered, four occurred in the Cottage Hospital, five in the Workhouse, and one in the Isolation Hospital. Seventy-six were males and 88 females. Forty were under one year of age, and 24 were 75 and upwards. There died of phthisis 15, of bronchitis, pneumonia and pluerisy 15, of heart diseases 19, of cancer 10, of violence five. There were 16 inquests. Zymotic Diseases. The deaths from the principal Zymotic diseases were nine; being two from measles, three from whooping cough, one from diphtheria and three from diarrhoea. There were also three deaths from influenza. The Zymotic death rate works out at 0.69 per thousand. The following are some particulars respecting the various diseases of this group. Small Pox No cases of this disease. This disease is happily and necessarily an extremely rare one to occur in Surbiton, unless as an imported case contracted elsewhere, for the water supply is good and not liable to pollution, and all the houses are drained excepting Minniedale and possibly a few others. Typhoid Fever. A case in 1897 was reported as due to oysters, but most of the other cases in the last few years had contracted the disease abroad or elsewhere. This year two cases were notified me on the same day, April 15th. Both were children, one aged 13 years and the other one year and four months. They were of separate families, but living in a row of cottages within a few doors of each other. I at once visited the houses and made enquiries of the parents, thinking that some cause common to both cases would be found. The 6 result of my enquiries was of a distinctly negative character as to any cause, local or otherwise, and no sanitary defects were found on either of the premises, nor were any other cases reported, though all these houses and others on either side were fully occupied, and all the occupants living under precisely the same conditions. Epidemic Influenza. Was prevalent in February, lasting well into March. Three deaths are attributed to it. Erysipelas. Six cases were notified, one was removed to the Isolation Hospital. All recovered. Measles. There were two deaths from this disease. Even when very prevalent, measles is not now-adays a very fatal complaint if the patients are well looked after during convalescence. This is practically demonstrated by the fact that in families of the well-to-do a fatal case of measles is extremely rare, mainly by reason of the constant care and nursing. But though, unfortunately, this watchfulness is impossible to the same extent in the houses of the working classes, where the mothers have got the house duties and other children to attend to, yet in a large number of cases there is a disposition to treat measles far too lightly. A doctor is by no means always called in, the child is put to bed for a day or two, given a little saffron tea or some such rubbish, and allowed to get up when the rash disappears. A cold is easily contracted under these circumstances, and bronchitis or pneumonia may be the consequence. Notification provides no adequate remedy for its prevalence, nor for the control of the patients, and as far as I am able to observe no advantage in any way commensurate with the cost of notification. Scarlatina. There were only thirteen cases notified during the year, of which twelve were in Surbiton. 7 There was no distinct outbreak, for they occurred throughout the year at intervals, and were mostly of a very mild type ; in fact for some years past this has been the characteristic feature of scarlatina, and the severe and malignant cases formerly met with years ago seem to have quite disappeared. In two instances two children in a family were affected, one case came from the country and shewed the rash almost directly after arrival, and three were young adults. Five were sent to the Hospital, and all the cases recovered. In Tolworth the only case notified was that of a servant at the Hospital, who contracted the disease there and was admitted a patient. Diphtheria. Six cases of this disease were notified, and two deaths. In the registered returns only one death appears, that of a child who was admitted to the Isolation Hospital, and who after a long course of treatment ultimately succumbed. The other death was one of two cases notified on the last day of the year, belonging to the same family, and who died on the day of notification; but as the death was not registered until the following day it will appear in the returns for the next year. The sanitary arrangements of the house were not in good order, and the greater part of the drainage was relaid, but it is not at all certain that the disease was due to these defects. In connection with these cases it seems to be necessary to again draw attention to the fact that when the Medical attendant deems it desirable to have a bacteriological examination made for the purpose of diagnosis, and will certify that the patient's family is not able to afford the expense, it can be arranged for by communicating with the Medical Officer of Health. Notwithstanding that attention was drawn again 8 to this subject, and full particulars given of the facilities offered by the Council in the Report presented to you last year, copies of which were duly forwarded to every medical man practising in the district, a case came to my knowledge in which the doctor in charge was unaware that this privilege existed, and inability to pay the charges was the reason why an examination was not made at the time ; but later on it was done through the Medical Officer of the Hospital, and the case was found not to be diphtheria. The following table serves as a record of this disease for some years past:— 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 13 16 1 18.1 6.2 1893 19 23 3 18.7 13 1894 13 20 3 17.3 15 1895 12 12 1 13.5 8.3 ‡ 1896 8 9 2 14.4 22.2 ‡1897 9 9 1 14.4 11.1 ‡ 1898 5 6 1 13.5 16.6 * 27 of these cases were due to an infected milk supply. ‡ The combined districts. Infectious diseases Notification Act, 1889 This Act continues on the whole to work satisfactorily, though later on I may perhaps have occasion to bring to the notice of the Council some cases of unreasonable delay in forwarding the necessary notice. The district has been singularly free from infectious diseases, and the fact of only 27 such cases having occurred during the year in a population of nearly 13000 is worthy of notice, as is also the fact that no cases are reported from Tolworth, notwithstanding the large working class population now living there. The following table shows the notifications made since the Act came into force:— 9 Extract from Notification Book. Scarlet Fever Diphtheria & Memb. Croup Enteric Fever Puerperal Fever Erysipelas Contin. Fever Smallpox 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 *1897 16 9 2 1 3 0 0 31 *1898 13 6 2 0 6 0 0 27 * The Combined Districts Isolation Hospital. A joint Board has at length been formed, and the Hospital is now the property of, and available for use by, Surbiton, Esher and the Dittons, Ham, and Maiden Councils. One of the first acts of the Board has been to submit for approval and to adopt new rules. An essential alteration is that giving discretionary power to the Medical Officer as to the attendance by other Medical Practitioners on the patients sent in by them. This has been necessitated by an abuse of the privilege on a particular occasion, but the rule will not, it is understood, be enforced without good and sufficient reason. This is very necessary, as were the Hospital to be arbitrarily closed to other medical men there might be a hesitancy in sending patients for treatment. Another rule reads "That infected Bedding, Clothing, etc., "from premises within the district of the Joint " Hospital Board be disinfected at the Hospital " in all cases where desired, the Owner paying the "costof the disinfection and of the removal to and 10 "from the Hospital, such cost to be determined "by the Joint Board, who shall have discretion to "remit all or any part thereof." To make this effective, a more up-to-date disinfecting apparatus should be acquired, and proper vehicles be provided for the transmission to and fro of articles to be disinfected. At present there is nothing but the ambulance itself for the purpose. There is also pressing need for telephonic communication, and this cannot in fairness to all concerned be much longer delayed. It is in common use in nearly every Fever Hospital within a telephone area, and it only remains for your Council to recommend and give facilities, and it could be carried out at a trifling cost. The most important alteration in the rules, however, is that for the future "No "charge is to be made for maintenance or treat"ment in Hospital;" but to those who can afford and are willing to pay, the charges are on the same scale, based on Rateable value, as heretofore. In my last Report I dwelt strongly on the question of whether it was politic to keep to the present scale of charges and shewed reasons against it, and offered as a suggestion that patients from houses of the lowest Rateable value should be admitted free. The Joint Board have gone further, and in throwing it open free of all compulsory charges, deserves the congratulations and thanks of the inhabitants of the Districts concerned. During the past year the cases admitted from this district were only eight, being six Scarlatina, one Diphtheria and one Erysipelas. There was only one death. Four cases which were admitted under observation proved to be not notifiable. The following table shews admissions since we acquired the right to send patients:— n  Scarlet Fever Diphtheria Typhoid * Smallpox Erysipelas Total 1893 35 6 3 1 0 45 1894 5 6 2 0 0 13 1895 14 2 1 0 0 17 *1896 14 1 3 0 1 19 *1897 7 3 1 0 0 11 *1898 6 1 0 0 1 8 * Combined Districts. SurbitonCottage Hospital. The number of admissions to the Surbiton Cottage Hospital during- the past year were 263, as against 243 in 1897 and 254 in 1896. The total number of deaths was eleven. Now that Kingston has as a Jubilee Memorial built, and opened a Cottage Hospital of its own, there will probably be fewer cases from the Borough. The distribution of patients and deaths were as shown in the following table:— District. Under Treatment. Relieved. Unrelieved. Died. Remaining in Hospital 1st Jan. ???99 Surbiton, Hook, Tolworth and Southborough 147 142 1 4 7 Kingston and Norbiton 78 67 5 6 5 The Dittons and Claygate 17 15 1 1 Middlesex 2 2 Other places 19 19 263 245 7 11 12 Mortuary, After repeated representations on my part of the urgent need for a Mortuary, it happened that the Coroner for this district had occasion during the summer to forward to the Council the 12 presentment of a Jury, representing the loss and inconvenience caused them by having to go to Kingston to attend inquests, and requesting that steps might be taken to provide the necessary accommodation. Efforts have now been made to find a suitable spot on which to build, but so far without success, and presumably it will have to be erected in the rear of the new buildings ; but though the difficulty is now the greater to find a proper location, it is indispensable and must be arranged for, and in as central a part as possible. The Surbiton Cottage Hospital have enlarged and added to the one under their management, and it is much to be regretted that the Committee did not see their way to accept the proposal of the Council, and erect one that would have answered all purposes ; for though difficulties were raised they were not apparently insuperable, and two Mortuaries need not have been built when one would have sufficed. Inquests. There have been 16 inquests during the year, a rather larger number than usual, and as nearly everyone of them necessitated a postmortem examination being made, it is convincing evidence of the urgency of a proper post-mortem room being provided in connection with a Mortuary or dead house. The following is a list the cases and ages:— Ages. Causes of Death. 72 years Apoplexy. 48 „ Alcoholism. 19 „ Asphyxia. 4 months Improper Feeding. 11 „ Convulsions. 41 years Suicide (shot). 89 „ Fall. 65„ Suicide (drowning). 13 Ages. Causes of Death. 4 years Burns. 67 „ Plomaines. 68 „ Ptomaines. 43 „ Alcoholism. 32 ,, Opium Poisoning, 69 „ Heart Disease. 73 „ Syncope. 57 „ Pleurisy. Vaccination. There are few subjects just now of greater interest or importance as concerning the public health than this, owing to the retrograde action of part of the Vaccination Act of last year, whereby the enfranchisement of the conscientious objector has been brought about. There is a universal medical concensus of opinion that it is only a question of sooner or later when epidemics of smallpox must occur. This deadly and loathsome disease is not known to the present generation at all, and parents, in refusing to have their children vaccinated are taking on themselves a responsibility likely, indeed almost certain, to result in calamitous consequences, and are seemingly entirely wanting in a proper conception of what is their duty to their children and to their neighbours. The Government and Parliament have accepted the conclusions of the Medical Profession and of the Royal Commission—have accepted what is indeed the teaching of a century of world-wide experience— regarding the value and necessity of vaccination and re-vaccination if smallpox is to be prevented or controlled in this country. The result is the Vaccination Act of 1898, which would be excellent if it had not the conscience clause. It is the bounden duty therefore of Sanitary Authorities to do their best to minimise the dangers that may 14 and will most certainly accrue, if, owing to the laxity of this Act the conscientious objector is to be allowed to increase and multiply. The question at once arises "How can these dangers be averted?" To that the obvious reply is "By the diffusion of a proper knowledge of the subject," for the mass of the people are fully alive to their own interests when they rightly know when and how those interests are to be safeguarded. Nothing is more difficult to successfully combat than prejudice begotten of ignorance, and the ignorance shewn on this subject is something appalling, and unfortunately to some extent the Medical Profession is not free from blame. I would therefore wish to draw attention to what is a most essential feature in vaccination, and that is the having it done thoroughly and as efficiently as possible. Every qualified Medical man is instructed in vaccination, and knows what is required of him to vaccinate successfully and efficiently. Nevertheless, to make the matter as certain as can be, the Government, acting on the highest medical wisdom and experience, has in the Local Government Board Orders distinctly laid down how vaccination is to be performed, and if it is to be performed properly it must be done in that way. It says "The Public Vaccinator must aim at "producing four separate good-sized vesicles or "group of vesicles not less than half an inch from "one another." This makes it obligatory on him (the Public Vaccinator) to vaccinate in that way and to that extent, and by such means if the result is successful the child is protected against smallpox for a certain period. The medical man, other than the Public Vaccinator, follows suit, and vaccinates his cases similarly, and with probably equally 15 good results. But there are everywhere some exceptions, and throughout the country there are unfortunately to be found certain Doctors—a small but real minority—who pander to the prejudices and fears of their patients. They will vaccinate in one or two places, often in only one instead of four, and assure the parents of the child that it is quite sufficient. This all-complacent Doctor knows well how vaccination to be effective ought to be done, and he either believes in vaccination or he does not. I would say, (and it is necessary to say it) "Let him act as an honest man, "and as one having the courage of his convic"tions, when other people's lives are at stake." If he believes in vaccination let him do it as he knows it should be done, or let him say he does not believe in it and declines to have a hand in it. But to vaccinate in one spot, and to sign a certificate that a child is thereby successfully (and by implication efficiently) vaccinated, may be an easy matter to reconcile with his conscience and his duty to his patient since the parent is presumably a consenting party; but it is another matter if he conceives he has done his duty by his countrymen and women. He thereby assists very materially in bringing discredit on vaccination in the eyes of the ignorant and unthinking as a protective against smallpox. Such a child is not efficiently protected, but goes out into the world as if it were, and later on possibly contracts the disease and appears in the returns, amongst numbers of similar cases, as "having contracted smallpox though "successfully vaccinated." Through this Council, as your adviser in matters of public health, I would say to all those whose health and well-being is committed to your care:—"Let it be known that the highest 16 "Authority puts it that vaccination is no efficient "protective when done in only two places, and still "less if only in one, and let it be known that every "mother if she believes in vaccination at all should "refuse to have her child done in this way. If "she does not believe in vaccination let her too "have the courage of her belief, and avail herself "of the clause that has been so inadvisedly in"serted in the Act, and enrol herself as a con"scientious objector; but don't let her deceive "herself or be deceived into believing" her child is "properly protected when vaccinated in only one "or two spots." Again, I would advise all employers of labour, and most certainly all householders, to see to it that those in their employ are vaccinated and re-vaccinated. The various Proviident Clubs should insist that their members are vaccinated, for now that smallpox has received an invitation to come once more amongst us, their funds will be woefully diminished if member after member falls ill or dies from this disease. This rule has been adopted already in some of the large Benefit Societies in the North of England, where far-seeing and prudent members have become alarmed at the prospect that was being unfolded before them. With regard to the conscientious objector, fortunately the inhabitants of this part of the country have not been led astray to the same extent as those in some other districts; but evil example soon spreads, and it is necessary that every man and woman should approach this question seriously. It will very soon be a part of the duty of Sanitary Authorities to consider what steps they are prepared to take in the not unlikely event of this disease re-appearing. Isolation Hospitals alone will not meet the case, and there is one point well worth remembering, viz., when 17 smallpox appears a large majority of the cases will have to be removed "somewhere," as they will not he allowed to remain at home to the common danger. They will have to be medically attended and nursed by "somebody," probably (and rightly) at very high charges. All this, including wholesale disinfection and destruction of bedding, will have to be paid for by "somebody," and that "somebody" will turn out to be the long-suffering Ratepayer; that is where the conscientious objector will end bv landing us ! Sanitary Work. A much desired work has been now completed in the thorough making up of Ellerton, Worthington, Dennan, Cotteril and Douglas Roads. Attention has more than once been drawn in these reports to the absolute necessity of these roads being put in order, at least so far as foot passengers were concerned, on account of the large number of children having to go to and from school. The tar paved paths are particularly suitable and besides being satisfactory to the residents should tend materially to keep the district healthy. Tolworth seems destined to be the head quarters of a large industrial population and consequently such radical improvements as broad well made roads and dry footpaths are improvements in the right place. In contra distinction to all this is the utterly neglected condition of Minniedale. For years the approaches to this place have been disgraceful, but nothing has been done, and no attempt has ever been made, in spite of representations, to either cleanse or repair the tracks, for they are not roads, or compel the owners to do it. Since the above was written, efforts are being made to bring about some much needed improvements, and it is to be hoped these will not be desisted from till some good results are obtained. 18 Having written strongly in the Report of last year about the unsatisfactory condition of Alpha Place and having also furnished a special Report, it is fitting that I should now mention that the owner has carried out several alterations for the better in these blocks. The tar paving in the yards has been extended three feet which is of real benefit, since it tends to promote both dryness comfort and cleanliness, all the w.c.'s have been renewed, dirty rooms have been cleansed and several case of over-crowding abated. Alpha Place. The work of dealing with the sewage at this Farm is being carried out as well as perhaps is possible in such an unsuitable soil, it is at best but an indifferent success, and sooner or later will probably have to be dealt with on methods more in accordance with advancing scientific knowledge, and in compliance with the growth of the districts dealt with. Sewage Farm. The nuisance created by the Pyne Road watercourse being fouled has now been abated, and the various works necessary for the prevention of pollution have been carried out. Pyne Road Watercourse. These having received the assent of the Local Government Board came into force on 21st July, 1898. Amongst other powers, they require in the future that a manhole and intercepting trap be provided for every new house. The bye-law requiring this is an important one as marking a forward step in sanitation, for it tends in the case of combined drains—common in small property— to make more absolute the isolation of each individual house from the possibility of nuisance and infection from its neighbours. It is obvious New Bye-Laws. 19 that this risk exists in no small degree where several cottages discharge into a combined drain, besides the nuisances created by obstructions caused by carelessness which may affect other houses than the one creating it, and consequently the separate manhole tends in a marked degree to diminish this risk. Moreover, since it is universally conceded that it is desirable that the drains of a house should be adequately and absolutely cut off from a sewer, as a source of danger, and from every extraneous source of contamination, by means of a suitable trap together with an inspection chamber or manhole as a means of access to such trap, why in the name of common sense should the occupants of a cottage, because they live in a cottage, be exposed to the additional risks incurred by having a more or less free communication with the drains of their neighbours ? There has been some opposition to the application of this bye-law to cottage property on the ground that the expense of providing separate manholes is too heavy a charge for small property, but it is found that the additional cost is but slight and is more than set off by the great protection afforded. We live in an age when advances in sanitary matters are constant, and we must fall in with and accept these advances if we wish to keep in the forefront and maintain the reputation of this place as a healthy one to live in and as sanitarily perfect as means admit of. Dairies. These have been inspected from time to time by the sanitary Inspector as required, but it is now imperative, in view of the public requirements as to the purity of milk and the ascertaining of the sources of supply, that the Council should require 20 all purveyors of milk to register or rather reregister. Since the last registration some have discontinued and other have transferred their businesses, and the purchasers have not in every case notified their succession and registered. Following this is the report furnished by the Sanitary Inspector, Mr. Nesfield. The volume of work done under his personal supervision and on his advice is a continually increasing one, and a perusal of his statement furnishes incontestable evidence as to his zeal and ability. I am well able to testify that the sanitary work of this department has never been so thorough and so up-to-date. Since his appointment now some 2½ years, no less than 295 houses have been re-drained, for the most part entirely, and a considerable amount of drainage work is at present in progress. The deduction from all this is that by degrees houses of all criptions in the place will of necessity become well drained and increasingly healthy, and its character as a residential neighbourhood be immensely added to. Owners have no option but to have their houses re-drained in a thorouhgly serviceable manner when defects are discovered, and it is this process of discovery that is going on apace and must and will go on until houses are well drained, for a house of any pretensions is now scarcely ever let on lease without the incoming tenant employing experts to test and report on the sanitary arrangements, with the result as I have stated above, that drainage that is wrong must be put right. The working of the Notification Act also tends in the same direction, for following on infectious illness or other illness, either as the consequence of an inspection by the Sanitary Inspector, or acting on the advice of the Medical Practitioner, tests are applied, defects discovered, Sanitary Inspector's Report. 21 and remedial measures insisted on, and if necessary enforced by your Council. The experience gained by the Sanitary Inspector during his term of office has been most valuable, and the Council and the whole district can congratulate themselves on the way their interests in these respects are looked after. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, M.D., D.P.H., Medical Officer of Health. March nth, 1899. The following' is the Report of the Sanitary Inspector:— To the Medical Officer of Health. Sir,— I beg to present my Third Annual Report, showing the action taken and the amount of work done in the abatement and suppression of nuisances for the year ending December 31st, 1898. In conformity with the General Orders of the Local Government Board, a systematic inspection of the district has been carried out during the year, and every means taken to keep it in a satisfactory sanitary condition. Summary of Work Done. Houses and premises inspected 302 Houses and premises where nuisances were found to exist 266 Houses and premises in which nuisances have been abated 196 Notices served for the abatement of nuisances 187 Complaints received and attended to 88 Re-inspections of houses and premises 2150 Letters written respecting nuisances 197 Description of Nuisances dealt with. Defective drains cleansed and repaired 34 Surface water drains provided 1 Houses subsoil drained and site concreted 1 Houses provided with open areas to prevent dampness 2 Cesspools abolished 4 Drains opened for examination under Sec. 41 of the Public Health Act, 1875 3 23 Stonework gullies fixed in lieu of defective brick and iron bell traps 232 Inside soilpipes removed and fixed outside 14 Soilpipes ventilated 5 Soilpipes repaired 10 Soilpipes (new) provided 31 Privies converted into water closets 4 Water closets rebuilt 10 Water closet pans cleansed and repaired 8 Water closets provided with flushing cisterns 5 Water closet flushing cisterns repaired 12 Water closet flush pipes disconnected from storage cisterns and separate cisterns provided 69 D traps under water closet apparatus removed and syphon traps fixed 5 Houses provided with storage cisterns 21 Storage cisterns repaired 28 Storage cistern overflow pipes disconnected from soilpipes and arranged to discharge through external wall 10 Sink and other waste pipes trapped or disconnected from the drain 101 Sink waste pipes repaired 9 Stack pipes disconnected from the drain 97 Public-house urinals re-constructed 1 Roofs and spouting repaired 51 Houses supplied with water 1 Wells closed 1 Defective floors repaired 9 Manure receptacles provided 2 Filthy and unwholesome premises cleansed and whitewashed 47 Houses disinfected after cases of infectious disease 9 Dirty yards cleansed 9 Nuisances from animals improperly kept abated 5 24 Nuisances from overcrowding abated 10 Accumulations of manure removed 7 In the above list it will be seen that ten cases of overcrowding have been dealt with. These occurred in Alpha Road, James Street and Alpha Place. In two instances it was found necessary to institute legal proceedings before the magistrates in order to obtain the abatement of the nuisance. One case was withdrawn, the nuisance having been abated before the time of hearing. In the other case the magistrates made an order for the abatement of the nuisance and ordered the defendant to pay 23/- costs. Forty-nine houses have been provided with sanitary dust bins where none previously existed, eight brick ashpits have been abolished and portable dust bins provided, and ten dilapidated ashpits have been repaired. One hundred and eighty-seven old iron container and long hopper pan closets have been abolished and closets of an approved form substituted. House Drainage. Entirely new drains have been laid to 105 houses, and at several other houses the drains have been repaired. A good deal of drainage work is at the present time in progress in the district, which will be accounted for in the report for 1899. The following table shows the houses that have been re-drained during the year — "Glenedin," Church Hill Road. Ivy Cottage, Pyne Road, Tolworth. 3, Claredale Villas, Victoria Road. 25 Fishponds Cottage, Brown's Road. "Rosetta," King Charles' Road. 5 and 6, St. Andrew's Road. 11, Avenue Elmers. 12, Alpha Road. Drayton House, Arlington Road. 13, St. Phillip's Road. 3 and 10, St. James' Road. 8, Brighton Terrace, Brighton Road. "Kirklands," Adelaide Road. "Woodhay," Ewell Road. 14, North Road. St. Cleather, Christ Church Road. "Fairholm," Victoria Road. Carmarthen Lodge, King Charles' Road. Ormonde House, Parklands. 4 and 5, Morrill Villas, Victoria Road. River Nook, King Charles' Road. 9, Orchard Place, Hook. "Elmdene," Victoria Road. 6, Wyburn Villas, Ewell Road. "Newstead," King Charles' Road. "Broadstone," Berrylands Avenue. Draycot Lodge Farm, Red Lion Lane. "Ecclesholm," Ditton Road. "Mayfield," Maple Road. Vine Lodge, Surbiton Hill Road. 5 and 21, Paragon Grove. 9 and 10, Surbiton Hill Park. "Pyrmont," Berrylands Avenue. "Nyr Chur," Adelaide Road. "Thorniloe," Christ Church Road. House and Shop, 3, Ewell Road. Villas, Ewell Road. 3, South Terrace. "Elmwood,' Park Road. "Derwent," Oak Hill Road. "Oatlands," Ewell Road. 26 Rochester House, Maple Road. Mr. T. H. Moon's Dairy, Victoria Road. Tower House, Maple Road. Fern Villa, King Charles' Road. " Hurley," Lovelace Gardens. Combined Drains. 1 and 2, South Bank Terrace. 1, 2, 3, 4 and 5, Dover Cottages, Fleece Road. 52, 53, 54, 55, 56 and 57, Alpha Road. 1 to 12, Ivy Cottages, Alpha Road. 69, 70 and 71, Alpha Road. 74, 75, 76, 77, 78, 79 and 80, Cleveland Road. 7 and 8, Paragon Grove. 11, 13 and 15, Smith Street, Alpha Road. 3, 4, 5, 6, 19, 20, 21 and 22, Cottage Grove. 58, 59, 60, 61 and 62, Alpha Road. 3 and 4, Surbiton Hill Road. Bakehouses. The bakehouses in the district have been inspected twice during the year, viz., in March and September. Two required limewashing, and the occupier of another was served with a notice to repair a defective drain. Factory and Workshop Act. Under this Act ninety-six visits have been made to workshops during the year, and I am pleased to report that generally they have been found to be in a satisfactory sanitary condition. In one instance the Factory Inspector notified sanitary defects, which were remedied under a preliminary notice. 27 The following is a list of nuisances abated. Workshops cleansed and whitewashed 7 ,, redrained 1 ,, floors repaired 4 ,, roofs repaired 2 ,, ceilings repaired 1 ,, W.C. accommodation improved 4 Slaughter Houses. There are only five slaughter houses in the district, and none of them are much used. They have been frequently, and at irregular periods inspected to ascertain if they are kept in conformity with the Bye-laws regulating the same. It was found necessary to serve a notice upon one owner to cleanse and whitewash the walls and ceilings, and on a second to repair a defective drain. Dairies, Cowshed and Milkshops Act. The requirements of the above Act have also been carried out. One dairy has been re-drained and the floor and yard adjoining concreted. Yours obediently, W. NESFIELD, Assoc. San. Inst.. Sanitary Inspector, 20th February, 1899. (A) TABLE OF DEATHS during the Year 1898, in the Surbiton Urban District, classified according 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 Sub-joined Causes, 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. P»ronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. SURBITON 128 26 10 5 8 37 42 Under 5 2 2 4 27 35 5 upwds. 1 1 11 6 16 2 5 51 93 TOLWORTH 19 9 2 6 2 Under 5 1 1 1 8 11 5 upwds. 3 0 2 8 SOUTHBOROUGH 6 1 1 2 2 Under 5 5 upwds. 2 4 6 HOOK 11 5 2 1 3 Under 5 1 6 7 5 upwds. 1 1 1 1 4 COTTAGE HOSPITAL 11 1 1 1 7 1 Under 5 1 1 5 upwds 1 1 8 10 ISOLATION HOSPITAL .. 4 1 2 1 Under 5 1 1 5 upwds. 2 1 3 Totals 179 40 16 9 10 54 50 Under 5 2 1 3 3 5 1 41 55 5 upwds. 2 1 15 10 19 3 7 66 124 Deaths occurring ontside the district among persons belonging thereto. 5 1 2 2 Under 5 1 1 5 upwds. 2 2 4 Deaths occurring within the district among persons not belonging thereto. 10 2 2 1 5 Under 5 1 1 2 5 upwds. 1 1 1 1 4 8 (D) TABLE OF POPULATION, BIRTHS, and of NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Surbiton Urban District; classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being 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. Smallpox. Scarlatina. Diptheria. Enteric or Typhoid. Continued. Puerperal. Erysipelas. Smallpox. Scarlatina. Diphtheria. Enteric or Typhoid. Continued. Puerperal. Erysipelas. Census 1891. Estimated to middle of 1898. SURBITON 10050 10582 214 Under 5 1 2 1 5 upwds. 11 3 1 4 5 1 TOLWORTH 979 1102 67 Under 5 5 upwds. 1 1 1 SOUTHBOROUGH 729 821 15 Under 5 5 upwds. HOOK 418 470 15 Under 5 5 upwds 2 1 Totals 12176 12975 311 Under 5 1 2 1 5 upwds. 12 4 1 6 6 1 1