SUR 043 Annual Report of the MEDICAL OFFICER OF HEALTH of the SURBITON URBAN DISTRICT COUNCIL, 1 9 O 4. BY 3WEN COLEMAN, M.D., M.R.C.S.E., D.P.H., Medical Officer of Health, Surbiton ; Fellow of the Incorporated Society Medical Officers of Health ; Fellow of the Royal Institute of Public Health. SURBITON : " Surbiton Times" Printing Works. Cbe Erfnm District Council of SmrMton, 1904. general statistics. Area of Urban District Acres 3026 Rateable Value £175,171 Produce of Penny Rate £580 Population at Census of 1901 15017 Number of Inhabited Houses at Census of 1901 2874 Population at middle of 1904 16460 Number of Inhabited Houses at middle of 1904 3276 Death Rate 1904, per 1,000 persons living 11.8 Average Death Rate for previous 8 years 11.0 Birth Rate 1904 21'0 Average Birth Rate for previous 8 years 20'7 Infant Death Rate (under 1 year old) per 1,000 Births 118T Average Infant Death Rate (under 1 year old) for previous 8 years 101'9 The Vital Statistics for the year 1904, consisting of the Annual Birth Rates and Death Rates, have been published by the Registrar General, and are here shown in tabular form for comparison. Annual Rates per 1,000 Living. Infant Mortality, Annual Death. rate of Infants under 1 Year per 1,000 Births. Births. Deaths from all Causes. Deaths from Seven Chief Epidemic Diseases. England and Wales 27.9 16.2 1.94 146 76 Great Towns 29.1 17.2 2.49 160 142 Smaller Towns 27.5 15.6 2.02 154 Rural England and Wales 26.8 15.3 1.28 125 Surbiton Drban Dist. 21.0 11.8 0 .85 118 Surbiton Urban district Council. TWENTY-EIGHTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1904. Mr. Chairman and Gentlemen, I have the pleasure to submit to you my Report for 1904 on the health and sanitary condition of the District under your care, this being the twentyeighth Annual Report since my appointment as Medical Officer of Health in July, 1876. Copies of this will be forwarded in accordance with the Order, Art. 18, Sec. 14, of March 23rd, 1891, to the Local Government Board and to the Surrey Countv Council ; also to the Secretarv of State for ✓ ' j the Home Office as required by Section 132 of the Factory and Workshop Act, 1901. The Report is made in compliance with the requirements of the Local Government Board. The Returns of Vital Statistics drawn up on the forms supplied by the Local Government Board, are 3 appended at the end of the Report, in Tables I., II., III. and IV., concerning which a few explanatory remarks are now given. Table I.—The population is estimated, as required, to the middle of the year, and is based partly on the excess of births over deaths and the number of new houses built and occupied. The birth-rates and death-rates are thus calculated upon a population of 16,460 in the middle of 1904, which is probably well under the real population, the return at the Census of 1901 being 15,017. The 195 nett deaths belonging to your Urban District include the deaths of 21 who died in the Workhouse Infirmary formerly resident in this District, 2 at the County Lunatic Asylum at Brookwood, and 1 at the Friedenheim Home at Hampstead. Table II.—Deals with the population, births and deaths in each of the three localities that go to form the Urban District. Table III.—Classifies the notifications of Infectious Disease as to localities, ages of patients and removals to the Isolation Hospital, and from this it will at once be seen whether any special locality has had a greater incidence of disease than another. Table IV.—Deals with the causes of death under various headings and at different age groups, and in localities at all 'ages. 4 For the guidance of the certifying medical practitioner the following instructions of the Local Government Board should be noted, as it is of importance that the causes of death should be classified according to the system desired by the Board, in order to facilitate the inclusion of them by the Medical Officer of Health under their respective headings. Under the heading of " Diarrhoea" are to be included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature ; and also deaths certified as from Epidemic enteritis ; Zymotic enteritis ; Epidemic diarrhoea. Summer diarrhoea ; Dysentery and dysenteric diarrhoea; Choleraic diarrhoea, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of "Enteritis" are to be included those certified as from Gastro-enteritis, Muco-enteritis and Gastric catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term " Diarrhoea." Deaths from diarrhoea secondary to some other well-defined disease should be included under the latter. 5 Under the headings of "Cancer" and "Puerperal Fever" should be included all registered deaths from causes comprised within these general terms. Vital Statistics. Birth Rate.—The births registered in 1904 were 347, representing a rate of 2 1-o per 1,000 of the population. This number is nearly the same as in 1903, when it was 351, but with that exception is higher than in any of the previous seven years. This is probably clue to the considerable increase in building that has been going on, especially in Tolworth, nevertheless the birth rate at 21 'o is exceedingly low and compares with that for England and Wales at 2j'g. Infant Mortality.—The figures dealt with are too small to enable one to draw conclusions of value, but to anyone who has had a long and intimate experience with the methods of feeding and rearing children that prevail amongst the working classes, it is lamentable to see the little progress that has been made during the last 30 years, and beyond what may be put down to a better selection of foods and certainly—in this district—better and purer milk, the maternal knowledge has not advanced to any great extent. How could it be otherwise, when no instruction is available and experience is only gained by crude experiment on their own offspring ? I am not alone of the opinion that it is a matter of national importance that Elementary Hygiene 6 should be taught in our Public Day Schools. Thousands of lives are lost annually in this country from absolute ignorance as to the proper feeding of an infant, and too often when the Doctor is called in, he finds disease has got a firm hold, and that it is almost hopeless to strive for a real and lasting alteration in the mothers' system of rearing. With a declining birth rate and a "lowering of the physical standard of health, this matter is a very important one. Something has been attempted and with some measure of success, but the future mothers of our race should, as girls, get some instruction in their school days, and I am sure it would be found to bear excellent fruit in due course. Scarlet Fever.—There were but 22 cases of this disease and no deaths, and 21 of them were removed to the Isolation Hospital. There have been a few "return cases" of Scarlet Fever, and this naturally causes a certain amount of misgiving, more especially in the families where it occurs. This subject has received a considerable amount of attention lately and many papers have been read, discussions held, and various views put forward, but it has been abundantly confirmed that the occurrence of a certain proportion of "return cases " from time to time is to be expected, and that they are within the experience of all Isolation Hospitals, although in these Institutions they are as particular as it is possible to be with regard to the 7 cleansing of hair and skin, the use of baths and lotions for nose, mouth, and ears, and the disinfection of clothes. It is generally admitted that the reason for these cases and the secondary desquamation that sometimes occurs is beyond our present knowledge and control, and that it is impossibly to guarantee absolute freedom from infection after discharge. Home infection occurred in two houses after the removal of successive patients and the disinfection of the houses. In connection with this subject 1 would report that the removal of patients to the Hospital and the disinfection of premises have been done with the most commendable despatch by the Sanitary Inspector and his Staff, together with the zealous and ever-ready co-operation of the Matron of the Hospital, and though their actions in the various directions of their duties are known to few beyond those immediately concerned, yet Irom the point of view of efficiency, promptitude and consideration for all concerned, they are deserving of the highest credit. The telephone installation has proved, as was anticipated, a most valuable auxiliary to all concerned. The subject of disinfection is dealt with by the Sanitary Inspector in his Report, and I would direct 8 attention to it, merely adding that this Authority is now the owner of two excellent vans, one for the conveyance of infected "goods" to the disinfecting chamber, and the other for the return of the " goods" when purified, and that these are available for, and are made use of by the conjoined districts, at an agreed rate of hire. They are kept in sheds on the Council's premises in Alpha Road. Diphtheria. —Only a few cases, 10 in number, were notified and these were spread over the whole year, there was no sembance of an outbreak and with few exceptions no known cause for most of them. These outbreaks we have had from time to time, as is well known to most of you, and of course we may have them again, the danger lies mainly in the spread of the complaint by personal contact in schools or in the home, and also in its conveyance by milk or other food, hence the importance of early recognition of the nature of the throat illness. From time to time cases are notified that turn out not to be diphtheria, for it is not by any means of a nature to be easily recognised in its early stages, but it is far better to notify early and take precautions than let the case develop without and possibly spread to others. I will again mention that this Council some years ago passed a resolution that any medical man practising in the District can have a bacteriological examination made in doubtful cases free of charge, where the expense cannot otherwise be borne, by making application to the office of the Sanitary 9 Department when a proper apparatus for the. purpose will be supplied. This offer has not hitherto been taken advantage of to the extent that it might be, and I am now making arrangements whereby this very necessary and most efficient aid to diagnosis shall be more available. Measles.—There were varieties of this illness at intervals throughout the year but mostly of a favourable type, though one fatal case was registered. Epidemic Influenza.—Was not so prevalent or so fatal as in some former years and the character has varied considerably, being as a rule milder and not of so long duration. One death only was certified as due to it. Whooping Cough.—There were three deaths attributable to this and, as in nearly all such cases, were due to some complication. If the disease occurs during the winter months then the liability to contract pneumonia or bronchial affections is so much the greater, the convalescence being so protracted and the necessity for continued care and watchfulness not being so obvious as in the earlier stages of the illness. Enteric Fever.—The one death that appears in the returns is that of a case that was notified on 28th December, 1903, and was referred to in the report for that year, the cause was suspected to be from eating oysters and the patient died early in 1904. For the year that is past four cases were notified, two being inmates of a house on Surbiton 10 Hill where the drainage and sanitary arrangements were found very defective, they were removed to St. Thomas's Hospital and both recovered. The third case was that of a man from Westfield Road, but the cause was not ascertained to satisfaction, and the fourth was a nurse at the Isolation Hospital who contracted it while in attendance on a patient, she also recovered. Phthisis, Or Consumption, the name by which it is more generally known, has this year 12 deaths against it compared with 5 of the year before, and this number is a good deal beyond the average for this locality. Attention is now everywhere being given to methods having for their object the disinfection of the spitting of those who are unfortunately attacked with this very prevalent complaint. The habit of expectoration in public places is so beastly that everyone will welcome the crusade that is being made against it in consequence of its being the chief means by which the disease is spread. Amongst the many disinfectants offered for use Cyllin (Jeyes' Sanitary Compounds) occupies a high position as one of the most powerful of the coal-tar disinfectants (see " British Medical Journal," April 9th, 1904, p. 853 ; " Lancet," August 20th, 1904, p. 524 ; "Public Health," June, 1904, p. 563), and has the merit of being ten times less poisonous than pure carbolic acid. A solution of Cyllin of the strength of one ounce to a one gallon pail of water might be 11 advantageously sprinkled at night on the floors of bars of public houses, railway station offices, and similar places, and swept out every morning. On a death from Consumption, or indeed any of the notifiable infectious diseases, a special intimation is sent by the Registrar to the Medical Officer of Health, and the house where the death has occurred is visited and an offer made to disinfect the room and to do what is necessary ; but in many instances not much is required to be done owing to the more cleanly practices prevailing and to the adoption of the fresh-air treatment. But if a case is reported by the certifying medical practitioner as having been in his experience exceptionally dangerous to subsequent occupiers of the room, and that disinfection is urgently required, then compulsory measures would be taken if any difficulties were thrown in the way— a thing which it is difficult to conceive as likely, but is certainly possible. Diseases of the Respiratory Organs. This heading accounts for no less than 23 deaths from Bronchitis, 10 from Pneumonia, and 4 from various other diseases Many of these cases are secondary to other complaints, but of the 23 Bronchitis cases 16 were in persons of 65 years of age and upwards. As is generally known, it is one of the deadliest illnesses for the aged in the winter and early spring months. 12 Cancer and Malignant Disease. In 1902-3-4 the deaths have been 12-17-18, so that, taking the increase of population into consideration, the disease is not increasing hereabouts, and that there is no local connection is obvious. Hopes are still high that science will ere long do something towards lessening the mortality from this dreaded disease. Accidents and Inquests. There were 7 fatal accidents and one suicide, the railway having a rather larger responsibility than usual. There were 16 inquests held, of which 8 were on the above cases, and 8 on deaths occuring under circumstances that rendered an inquiry necessary. The Mortuary has been of the greatest possible assistance to all concerned in these sad cases, and as a post-mortem examination is mostly ordered, the up-to-date room and conveniences are much appreciated by the medical men of the district. There is a note at the foot of the Report issued by Dr. M. H. Taylor, H.M. Coroner for Surrey, that is well worth embodying in this Report : " The Home Office now require that deaths from burning at unprotected fire grates, and of persons who at the time of death were wearing flannelette clothing, are to be scheduled and noted in the Annual Returns. No death from either of these causes has occurred in the district during the past year. The number of cases of infants whose deaths have been either caused or accelerated by 13 improper feeding is on the increase. The number of children suffocated whilst in bed with their parents or others is larger than it was last year, but the percentage is much under that of England and Wales (Kingston District = 2"6, England and Wales = 45, of the number of inquests.)" Dairies, Cowsheds and Milkshops. As reported by the Sanitary Inspector these registered premises have been frequently inspected, and the cows kept in the district—which average about 250—have been periodically examined by the Veterinary Inspector appointed for that purpose. All work required has been done and so far it is fairly satisfactory. It is about correct to say that not quite 50% of the milk consumed here is produced within the district, that is from cows that are under our own supervision, and their sheds under inspection and regulations ; the larger half of the milk comes from somewhere—from anywhere—and certainly, in probably a large proportion, from localities where veterinary inspection for tuberculosis and adequate supervision and control of sheds and storage is either non-existent or only nominal. The cases of Woking and of Ealing and Aylesbury show what can happen as regards cows and the transmission of disease, but I am strongly of opinion—confirmed by personal knowledge and experience—that much closer watch is required over the handling of milk, from the time 14 it passes frorti the cow, during the transit by rail, and the distribution by the retail dealer, than is provided for by the Law as it stands at present. The Council passed a resolution on the 14th December, 1903, dealing with the matter of cooperation in veterinary inspection of cows on the part of neighbouring districts, and 011 the 8th November, 1904, a letter was addressed to the Local Government Board urging them to make this examination compulsory instead of optional. It is interesting to trace the history of the outlying milk supply—not to Surbiton only, of course, but to London and the suburbs as it is at present. The milk is obtained from cows in the country farms—in Dorsetshire, Wilts and Somerset, and possibly even further—(generally under insanitary conditions), leaving the cow at, say, 5 a.m., and reaching the ordinary customer, at the earliest, on the evening of the same day, but more often on the following morning, i.e., twelve to twenty-four hours (or even more) after milking, and after having travelled, in the meantime, varying distances up to as much 200 miles. Or if it should be the afternoon milk, it travels during the night to allow of its being on the breakfast table in the morning. Bearing these simple facts in mind, it will be readily understood that milk collected under possibly—nay, probably—insanitary conditions, with an interval of twelve to twenty-four hours for bacterial growth to take place therein, must of necessity be unwholesome 15 and unclean, and therefore dangerous to the health of those, partaking of it, more especially infants, young children and invalids. This long interval which is the same in summer as in winter, necessitates the use of preservatives to some extent, and that is another question. As matters are now, so they have been for years and years, and as milk is a necessity, and must be produced in the country and not in towns, what is needed is universal compulsory — not optional — inspection of cows, sheds, means of transit, and generally of all that is included in the term "handling." The key to safety is "greater cleanliness," and that can only be ensured by the authorities enforcing it on those who deal in it, and educating them to the necessity for these measures ; but it is with the consumers after all that the matter mainly rests. Let them—the public, for all are consumers—get rid of their apathy, and demand that they be given pure, clean and wholesome milk, and it will be forthcoming. A word of caution bv way of reminder to the inhabitants here, the very large majority of whom are not in any sense old residents. Since I have held office, we have had five or six distinct outbreaks of illness due to infected milk, in some instances with fatal results, and all these were preventable ; they were detected and traced approximately, and absolutely in some cases, to 16 their cause—contaminated milk. What has occurred here has occurred everywhere else ; we need protection for ourselves, and our milk-distributors will welcome it, for they have no control, and no possible means of a daily knowledge of the milk supplied by them, and I have always found them willing co-operators in all the regulations that have been laid down to ensure purity of supply. The Council have always moved with the times, and have availed themselves of every means of preventing mischief, but it is felt that this is of little use if the districts from whence our main supply comes are not at least as well looked after. The County Council are taking action in support, and it is for the consumers to insist upon everything being done that science and hygiene can suggest. Sewage Farm. Until other arrangements are possible this method of treatment of the sewage of what was formerly the Kingston Rural Sanitary District has to be continued, and every care and consideration is bestowed on it that present circumstances allow, but from time to time, and most frequently during summer weather, complaint is made of a nuisance arising from the farm itself or more frequently from the effluent. In August last complaint was made of a special case of illness "caused by the foul smells arising from the sewage farm," but I had no reason 17 for believing that the cause was that stated, and while there is no disputing that a nuisance of a most objectionable character does at times exist, yet the vital statistics of Tolworth—the district immediately concerned—show not the slightest corroboration of this charge and my repeated inspections and intimate personal knowledge of the locality bring nothing in support of the allegation, and I maintain that there is no more evidence of the nuisance being a nuisance injurious to health than in the case of smells from gas works or a brickfield. Nevertheless the obligation remains on the Sanitary department and the Council to do all and everything possible and reasonable to abate or minimise this nuisance. This is being, and will continue to be, done, until such time as the sewage is treated elsewhere. The suggestions of piping the effluent or covering over the stream are of course possible, but the cost is prohibitive and as the nuisance is after all only occasional and only temporary, and less frequent than formerly and is not dangerous or likely to be, a little further patience is necessary and there will be an end of the matter. Sanitary Work. The Sanitary Department, consisting of the committee and its officers, is one of the most important departments of the Council because it comes in touch directly with the inhabitants in their homes, and because the well-being, i.e., the sanitary 18 well-being, and general health of the population depend largely on the way it takes its work in hand and does it. The general sanitation of the district has for years past been directed in a liberal spirit and carried out with intelligence and discretion, and the proof of this is apparent in the favourable character of the statistics shown and in the pages of the Sanitary Inspector's report. During the last nine years no fewer than 1,029 houses have been re-drained, and the benefit that this means to the occupiers, present and future, and to the reputation of the neighbourhood as a desirable place of residence must be very considerable. There is one point, however, that offers room for improvement and that is the almost universal want of adequate accommodation for the storage of food in most of the houses built for and occupied by the working classes. The late Prince Consort laid it down that " every working man's home should have a porch and an oven," and to this might now well be added —a larder. All food requires care in storage, and close unventilated cupboards or open shelves in a living room or wash house are hardly in accordance with well known principles of hygiene, and while some articles of food are more susceptible than others, yet changes by decomposition and taint occur so rapidly to all that ill health must be and often is due to causes of this nature. Nor is this danger confined to only the smaller houses, for in many of the larger and better class the larders are often—very often — dirty, damp and ill ventilated and require far more 19 attention and supervision than is commonly given to them. Under the " Housing of the Working Classes Act," four houses in Glencairn Villas were found unfit for habitation and were dealt with by the landlord upon official representation being made, and are now occupied by a better class of tenant. The construction and opening of Walpole Road as a direct route to the Railway Station on the South or Down side is a great improvement, and a good class of house is being built on both sides and in Oak Hill, and it will be a further gain when that most obstructive barrier—too long tolerated—in Lovelace Road is done away with. Schools. In July the schools at Hook, and in Surbiton for St. Mark's Infants, were closed temporarily for measles and whooping cough. Factories and Workshops. The Act is now in working order and, when necessary, action has been taken in cases brought to our notice by H.M. Inspector. The form of report required by the Home Office is here appended and the details are referred to by the Sanitary Inspector in his report. 20 Factories, Workshops, Laundries, Workplaces & Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 4 Workshops (including Workshop Laundries) 84 8 Workplaces 2 Homeworkers' Premises Total 6 96 8 2.-DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Refeir'd to H.M. Insp'ct'r Nuisances under the Public Health Acts :—* Want of Cleanliness 1 1 Want of Ventilation . . 1 1 Overcrowding 1 1 Want of Drainage of Floors Other Nuisances 10 10 tSanitary Accommodations— Insufficient Unsuitable or Defective 6 6 Not separate for Sexes Offences under the Factory and Workshop Act:— Illegal Occupation of Underground Bakehouse (S. 101) Breach of Special Sanitary Requirements for Bakehouses (SS. 97 to 100) Failure as regard Lists of Outworkers (S. 107) 1 1 Giving out work to be done in premises which are— Unwholesome (S. 108) Infected (S 110) Allowing Wearing Apparel to be made in premises infected by scarlet fever or smallpox (S. 109) Other Offences Total 20 20 * Including those specified in Sections 2, 3, 7 and 8, of the Factory Act as remediable under the Public Health Acts. † For Districts not in London state here whether Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council; and if so, what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. * The Lists should he received twice in the year. 3.—OTHER MATTERS. Class. Number. Matters Notified to H. M. Inspector or Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) 'Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspectors 2 Other Underground Bakehodses (S. 101):— In Use during 1903 4 Certificates granted - in 1903 1 in 1904 In Use at the end of 1904 1 Homework :— Number of List of Outworkers* (S. 107):— Lists. Outwr'k'rs Lists received 4 10 Addresses of Outworkers forwarded to other Authorites received from other Authorities 1 Homework in Unwholesome or Infected Premises :— W earing Apparel. Other. Notices prohibiting Homework in Unwholesome Premises (S. 108) Cases of Infectious Disease notified in Homeworkers' Premises Orders prohibiting Homework in Infected Premises (S. 110) Workshops on the Reoister (S. 131) at the end of Number. 1904:— Bakehouses 14 Important Classes of Workshops, such as Workshop Bakehouses, may be enumerated here Dressmakers 31 Bootmakers 30 Laundries 20 Tailors 13 Milliners 11 Other Trades 63 Total Number of Workshops on Register 182 Last year I drew attention at some length to the inadequate watering of the roads and to the serious evil caused by the dust, especially on Sundays. There is now an improvement in this latter respect, for which everyone is grateful, but the watering will require to be done very thoroughly if it is to cope at all with the immense amount of dust that will follow the ever increasing number of motor cars. I have no hesitation in drawing attention again to this subject as it is most serious to the public health. The dust of towns abounds in septic matter and is fruitful in damage to eyes and throats, and until a radical improvement in road making and road material is discovered the only means at command is to keep it down by watering. Even mud is better than dust. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, m.d., d.p.h., Medical Officer of Health. March 31st, 1905. 23 March, 1905. To the Medical Officer of Health. Sir, I beg to present to you my Ninth Annual Report of the work carried out in the Sanitary Department, during the year ending December 31st, 1904. Complaints. During the year 105 complaints were received relating to nuisances. Each complaint was duly registered in the Complaint Book and promptly investigated, and all necessary steps taken in respect thereto. Inspection of District. As in previous years, a systematic inspection of the district has been made, in order to comply with the General Orders of the Local Government Board and Sec. 92 of the Public Health Act, 1875. The total number of visits paid to premises was 2,412; this number includes visits to premises from which complaints of a nuisance have been received, and in which cases of infectious disease have occurred; also visits to works in progress, inspection of dairies, cowsheds, bakehouses, slaughterhouses, workshops, &c. 24 Notices Served. As a result of these inspections, 106 preliminary notices were served, most of which were promptly complied with. In 125 instances, nuisances were reported to the Sanitary Committee, and Statutory notices were ordered to be served. At the close of the year nearly all the notices had been complied with, and in the remaining cases the work was in hand. The following matters have received attention during the year:— Drainage. A great amount of time and attention has again been paid to the condition of house drains. In consequence of written complaint having been made alleging that the drainage system was in such a state as to be a nuisance or injurious to health, the Council gave instructions in 46 cases for the ground to be opened and the drains examined under the provisions of section 41 of the Public Health Act, 1875, and in 45 instances it was found necessary to serve notices upon the owners to take up the defective drains and replace them with new glazed stoneware or cast-iron pipes, laid upon a bed of concrete, and made watertight. 25 Ill one instance, where five houses were drained by a combined system, the necessary work was carried out by the Council at the request of a majority of the owners, under specifications and plans prepared by me, in consequence of their being unable to agree as to the extent of their individual responsibility. When the work was finished, the expense was apportioned as provided by the Act. All the owners, with one exception, have paid the amounts claimed, and it is anticipated that this will be recovered without further legal proceedings. In two instances where premises were drained by a combined system, the Council have reconstructed the combined part of the drain at a cost of £42, in consequence of its being a sewer within the meaning of section 4 of the Public Health Act, I875. During the year the drains of 92 houses and premises have been reconstructed. In each case a manhole, with an efficient intercepting trap, has been provided on the line of the drain, and an outlet shaft to ensure sufficient ventilation has been fixed at the head. Twenty-one house drains have been cleared from obstruction or repaired. Three cesspools have been abolished, and the drains connected with the public sewer. 26 Three wet basements have been provided with a subsoil drain, and the site covered with concrete. Two hundred and sixty-nine defective brick or iron traps have been removed, and replaced with properly trapped stoneware gullies. Six stables have been provided with effectual drainage. All drains re-laid were tested with water before the trenches were filled in, and again when the work was finished, to ensure their being left in a watertight condition. Soil and Ventilating Pipes. Nineteen defective soil pipes have been repaired. Forty defective light iron soil pipes have been removed, and replaced with strong cast-iron pipes, with molten lead caulked joints. One defective soil pipe inside the house has been removed and fixed outside and ventilated. All new soil and ventilating pipes are now tested with the smoke machine. This I find to be very essential, as quite 90 per cent. of the new pipes fixed do not withstand the test, and a second, and in some cases a third, test is necessary. 27 Water Closets. One hundred and thirty-four old iron container and long hopper w.c. pans have been abolished, and pans of an approved type fixed. One hundred and five water closet flush pipes have been disconnected from the domestic supply cistern, and separate flushing cisterns fixed. Eighteen defective water closet flushing cisterns have been repaired. Five closets not previously supplied have had a supply of water laid on. Eleven dirty and defective water closet pans have been cleansed and repaired. Eleven dilapidated water closets have been pulled down and re-built. Eleven water closets have been lighted and provided with constant means of ventilation. Storage Cisterns. Three houses, where the storage was insufficient, have been provided with an additional storage cistern. Two storage cisterns have been provided with covers. 28 Two storage cistern overflow pipes have been disconnected from the soil pipe and made to discharge through an outside wall into the open air. Five dirty storage cisterns have been cleansed. Waste Pipes. Eighty-one new waste pipes have been provided to sinks, baths, lavatory basins, &c. Thirty-seven bath, sink and lavatory waste pipes have been repaired. Eighty-four bath, sink and lavatory waste pipes have been disconnected or trapped. Rainwater Pipes, Roofs, &c. Seventy-two rainwater pipes have been disconnected from drains or soil pipes, and arranged to discharge over trapped gullies. Ninety-six defective rainwater pipes, causing damp walls, have been repaired. Five houses have been provided with eaves gutters to convev away rainwater. Twenty-five defective roofs, causing dampness inside dwelling houses, have been made weatherproof. 29 Miscellaneous. Sixteen houses have had the space under the floors concreted to prevent dampness. Fifty-five dirty houses have been cleansed and whitewashed. Four stables have been provided with manure receptacles, built in accordance with the Bye-laws. Thirteen offensive accumulations have been removed. Two dirty vards have been cleansed. Six nuisances, arising from animals being kept in an insanitary condition, have been abated. Overcrowding of Dwelling Houses. During the year three houses were found to be badly overcrowded, so as to constitute a nuisance likely to be injurious to health. In each case the nuisance was abated on notice being served. Paving of Yards. The carrying out of this work has again received considerable attention. Under clause 89 of the Council's Bye-laws the yards of 73 houses have been paved, wholly or in part, with Portland cement concrete, or other suitable hard impervious material. 30 It is hardly possible to over-estimate the value of this work in connection with cottage property, and I am certain the occupiers greatly appreciate it. It is very difficult, and in many cases impossible, to keep the surface of an unpaved yard in a clean and wholesome condition; but when a yard is paved, it is not only conducive to cleanliness, but prevents the many nuisances that are bound to arise where the surface of the yard is in an insanitary condition. Damp walls and floors are also very often the outcome of unpaved yards, and when owners recognise how detrimental this is to their property, they are generally more ready to comply with the notices served, without the case having to be reported to the Council for further legal proceedings. Dust Receptacles. New portable galvanized iron dust bins have been provided to 23 houses under the provisions of section 36 of the Public Health Act, 1875 In two instances dust bins were provided by the Council in default. The owner then paid the expense without magisterial proceedings. Disinfection. The disinfection of all premises where cases of infectious disease have occurred is carried out by the staff of the Sanitary Department, under the supervision of the Sanitary Inspector. 31 All bedding, clothes, &c., are removed by the staff of the Sanitary Department in a covered van to the Tolworth Isolation Hospital, and disinfected by the Hospital Authority in a Manlove, Alliott & Co.'s high-pressure steam apparatus. The interior of the infected room and all furniture, &c., is then sprayed with Formalin or fumigated with Formalin Gas. Notice is then sent to the owner to strip and cleanse the walls, whitewash the ceilings, and wash the floors and other woodwork with a solution of corrosive sublimate or other suitable disinfectant, which is supplied by the Council. During the year 41 premises, in which 49 cases of infectious disease have occurred, have been immediately disinfected upon the removal, recovery or death of the patient. Of these, 26 were in consequence of Scarlet Fever, 10 of Diphtheria, 4 of Typhoid Fever. 1 of Erysipelas, 6 of Consumption and 2 of Measles. Disinfection has also been carried out after one case of Cancer, at the expense of the occupier of the premises, who made an application for the work to be done. In one instance the owner refused to comply with a notice served to strip and cleanse the room 32 after a death from Consumption, and the Council carried out the work in default of compliance under the provisions of section 46 of the Public Health Act, 1875. The owner then paid the amount claimed. The following is a list of goods disinfected at the Tolworth Isolation Hospital under the superintendence of the Hospital Staff:— Beds 30 Mattresses 53 Paliasses 35 Bolsters 49 Pillows 108 Sheets 56 Blankets 145 Counterpanes 45 Carpets 58 Rugs 22 Cushions 44 Toilet Covers 44 Towels 19 Wearing Apparel 342 Curtains 83 Blinds 65 Sundries 199 Bed Valances 4 Quilts 17 Mattress Covers 3 Furniture (Chairs, &c.) 8 Total 1429 33 Slaughter Houses. There are six registered slaughter houses in the district, and these throughout the year have been kept in a clean and satisfactory condition. The quarterly limewashing, as required by the Bye-laws, has on all occasions been carried out by the occupiers on receipt of verbal notice. One slaughter house has been re-drained, and the floor, which was paved with bricks, has been relaid with Portland cement concrete. Dairies, Cowsheds and Milkshops. There are now 20 persons registered under the Act, as follows:—Cowkeepers, 2; Cowkeepers and Purveyors of Milk, 2; Dairymen and Purveyors of Milk, 9; Purveyors of Milk, 7. The average number of cows kept by the persons registered is 251, all of which are under periodical inspection by the Council's Veterinary Inspector. Regular and frequent inspections have been made of all the cowsheds, dairies and milkshops in the district, special attention being given to the cleanliness of the premises, vessels and appliances. In one instance the owner refused to carry out the requisite limewashing of his cowsheds, and the matter was reported to the Sanitary Committee, who 34 ordered a Statutory notice to be served. The necessary work was then carried out. The cowsheds at the Tolworth Court Farm have been entirely re-drained, and the floor of the dairy has been re-paved. As the Council's sewer does not extend to this extreme end of the district, the drainage was arranged to discharge into a septic tank, and then passed over a bacteria filter bed, finally discharging into a tributary of the Hogg's Mill Stream. Legal Proceedings. In consequence of a number of complaints having been received from residents and occupiers of premises in Ewell Road of the insanitary condition of the road at the rear of Nos. 2 to 12 and other premises, notices were served upon the owners to pave and make up the same. As the notices were not complied with, summonses were taken out against the owners to enforce compliance. At the hearing none of the owners appeared, but all wrote and admitted the insanitary condition ot the roadway and their liability to do the work. The magistrates then made an order for the work to be done within one month, and for payment of costs, amounting in all to £10 10s. The order was not complied with, and the work was carried out by the Council under a specification and plan prepared by your Sanitary Inspector at a cost of £286. 35 Summary of Work of Department. Number of Houses and Premises inspected 258 „ Visits to Works in progress 1604 „ „ Bakehouses 29 „ „ Slaughter Houses 37 „ „ Dairies, Cowsheds and Milkshops 55 „ „ Workshops and Workplaces 55 „ „ re cases of Infectious Disease 46 „ Miscellaneous Inspections 328 „ Drains examined under section 41 of the Public Health Act, 1875 46 „ Drains tested with Water 85 „ „ „ Smoke 54 „ Houses and Premises Disinfected 41 „ Complaints received and attended to 105 „ Preliminary Notices served 106 „ Legal Notices served 219 „ Letters written on the Business of Department 522 „ Plans of Houses re-drained prepared 90 I am, Sir, Yours obediently, W. NESFIELD, Assoc. R. San. Inst., Sanitary Inspector 36 TABLE I.—For Whole District. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of age. Deaths at all ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered beyond District. Deaths at all Ages. Nett. Number. Rate. Number. Rate per 1000 Births registered Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 13,596 281 20.66 27 96.08 164 11.98 24 16 9 157 11.5 1897 13,880 291 20.96 37 127.1 143 10.3 9 6 1 138 9.9 1898 14,164 311 21.95 40 128.6 179 12.56 15 10 5 174 12.2 1899 14,458 296 20.47 23 77.7 164 11.34 17 8 7 163 11.2 1900 14,732 295 20.02 29 98.3 168 11.4 14 5 13 176 11.9 1901 15,017 324 21.57 24 74.07 152 10.12 19 9 15 158 10.52 1902 15,386 288 18.7 34 118.0 157 10.2 13 5 17 169 10.9 1903 15,703 351 22.3 36 102.5 149 9.4 11 5 19 163 10.3 Averages for years 18961903 14,617 304 20.7 31 101.9 159 10.8 15 8 10 162 11.0 1904 16,460 347 2.0 41 118.1 178 10.8 20 7 24 195 11.8 * Rates calculated per 1,000 of estimated population. Total population at all ages, 15,017. Area of District in acres (exclusive of area covered by water), 3,026. Number of Inhabited Houses, 2,874. Average number of persons per house, 5.225. Census, 1901. TABLE II.—Surbiton Urban Sanitary District. Yeah. Names of Localities. SURBITON. TOLWORTH. HOOK & SOUTHBORO' 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. 1896 10,560 199 123 19 1,718 51 15 3 1,314 31 17 2 1897 10,663 209 109 30 1,866 46 14 4 1,348 36 11 3 1898 10,766 214 138 41 2,014 67 19 5 1,382 30 17 4 1899 10,869 185 119 15 2,162 71 20 8 1,416 40 22 1 1900 10,972 191 129 18 2,310 68 23 7 1,450 36 11 4 1901 11,675 195 117 12 2,458 94 30 10 1,484 35 11 2 1902 11,214 158 128 21 2,643 104 35 13 1,529 26 6 0 1903 11,339 182 123 22 2,798 126 30 9 1,566 43 10 5 Avgs. of yrs. 1896 to 1903. 10,932 191 123 22 2,246 78 23 7 1,436 34 13 2 1904 11,557 181 129 22 3,280 124 48 15 1,623 42 18 4 TABLE III.—Cases of Infectious Disease Notified during the Year 1904. In the Surbiton Urban Sanitary 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—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Surbiton. Tolworth Hook &S'thboro. Surbiton. Tolworth Hook & S'thboro. Small Fox Cholera Diphtheria 10 ... ... 7 2 1 ... 5 5 ... ... 2 5 Membranous Croup Erysipelas 4 ... ... ... 2 2 ... 4 ... ... ... 1 Scarlet Fever 22 ... 6 12 2 2 ... 12 9 1 ... 11 9 1 Typhus Fever Enteric Fever 4 ... ... ... 1 3 ... 3 1 ... ... 2 Relapsing Fever Continued Fever Puerperal Fever 1 ... ... ... ... 1 ... ... 1 Plague Totals 41 ... 6 19 7 9 ... 24 16 1 16 14 1 TABLE IV. Causes of, and Ages at, Death during Year 1904. Causes of Death. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. All ages. Under 1. 1 & under 5. 5 & under 15. 15 & under 25. 25 & under 65. 65 & upwards. Surbiton. Tolworth. Hook&Southbr' Small-pox Measles 1 ... ... ... ... 1 ... 1 Scarlet fever Whooping-cough 3 2 1 ... ... ... ... 2 1 Diphtheria & membranous croup ... ... ... ... ... ... ... ... ... ... 1 Croup Fever:— Typhus Enteric 1 ... ... ... ... 1 ... 1 Other continued Epidemic influenza 1 ... ... ... ... ... 1 1 Cholera Plague Diarrhœa 9 6 3 ... ... ... ... 2 6 i Enteritis 2 1 ... ... ... 1 ... 2 Puerperal fever Erysipelas Other septic diseases 2 1 ... ... ... 1 ... 2 Phthisis 12 ... ... ... 4 8 ... 9 1 2 2 Other tubercular diseases 1 1 ... ... ... ... ... ... 1 Cancer, malignant disease 18 ... ... ... ... 14 4 17 1 ... 1 Bronchitis 23 2 2 ... ... 3 16 17 3 3 Pneumonia 10 1 2 1 1 3 2 6 3 1 2 Pleurisy Other diseases of respiratory organs 4 1 1 ... ... 1 1 3 1 Alcoholism 6 ... ... ... ... 5 1 3 3 Cirrhosis of liver Venereal diseases Premature birth 7 7 ... ... ... ... ... 4 1 2 Diseases & accidents of parturition Heart diseases 20 1 ... ... 2 10 7 13 7 ... ... 4 Accidents 7 1 1 1 1 3 4 3 ... ... 2 Suicides 1 ... ... ... ... 1 ... 1 ... ... ... ... All other causes 67 17 1 1 1 13 34 41 18 8 8 All causes 195 41 11 2 9 63 69 129 48 18 20