SUR 044 ANNUAL REPORT Of THE MEDICAL OFFICER OF HEALTH OF THE Surbiton Urban District Council, 1905. BY OWEN COLEMAN, M.D., M.R.C.S.E., D.P.H., Medical Officer of Health ; Fellow of the Incorporated Society Medical Officers of Health; Fellow of the Royal Institute of Public Health. TONBRIDGE: Bradbury, Agnevv, & Co. Ld., The Whitefriars Press. 1906. The Urban District Council of Surbiton, 1905. General statistics. Area of Urban District Acres 3,026 Rateable Value £ 184,838 Produce of Penny Rate £606 Population at Census of 1901 15,017 Number of Inhabited Houses at Census of 1901 2,874 Population at Middle of 1905, Estimated 16,916 Density of Population per Acre 5.5 Number of Inhabited Houses at middle of 1905 3,605 Average Number of Persons per House 4.69 Death Rate 1905, per 1,000 Persons living 8.4 Average Death Rate for previous 9 years 11.14 Deaths from Seven Chief Epidemic Diseases 0.23 Birth Rate 1905 18.9 Average Birth Rate for previous 9 years 20.85 Infant Death Rate (under 1 year old) per 1,000 Births 56.07 Average Infant Death Rate (under 1 year old) per 1,000 Births for previous 9 years 104.5 The Vital Statistics for the year 1905, 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 Deathrate of Infants under 1 Year per 1,000 Births. Births. Deaths from all Causes. Deaths from Seven Chief Epidemic Diseases. England and Wales 27.2 15.2 1.52 128 76 Great Towns 28.2 15.7 1.88 140 141 Smaller Towns England and Wales 26.9 14.4 1.50 132 less the 217 towns 26.3 14.9 1.09 113 Surbiton Urban Dist. 18.9 8.4 0.23 56 Surbiton Urban District Council. TWENTY-NINTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1905. Me. Chairman and Gentlemen, I have the pleasure to submit to you my Report on the health and sanitary condition of the District under your care, for the year ended 31st December, 1905, this being the twenty-ninth 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 Country Council; also to the Secretary of State for the Home Office, as required by Section 132 of the Factory and Workshop Act, 1901. The vital statistics are dealt with in the manner prescribed by the Local Government Board, mainly in the form of Tables, which are to be found at the end of this Report, and concerning which the following brief explanatory comments are made. 3 Table I.—Deals with the births and deaths of the whole District, and the ratio to the population. The census was taken in 1901 and was then 15,017. For the intervening years between each census the population has to be estimated at about the middle of each year, and any increase of population will be based on various more or less known factors, many of them necessarily of merely local import. In practice the most reliable estimate is generally found to be that framed on the excess of births over deaths, the number of new houses multiplied by the average per house as determined by the census, the ratio of unoccupied houses, and any special local reasons there may be for inducing large or fluctuating temporary immigrations or emigrations, such as extensive works, etc., the latter of course not applying to this neighbourhood. Viewed in this way, the population, estimated to have increased from 15,017 in 1901 to 16,460m 1904, will now be taken to be approximately 16,916, the extensive building operations in Tolworth and Surbiton being, of course, the main cause of this addition, which is, nevertheless, I feel assured, well within the mark. The total net deaths that furnish the death rate are those that are registered as having actually occurred in the District itself, with the addition of those deaths occurring in public institutions outside the District to which the sick are sent, namely, the Union Infirmary and the County Lunatic Asylum at Brookwood, and excluding deaths at public 4 tions within our own District of residents belonging to and brought from other places; these are the Cottage Hospital and the Isolation Hospital at Tolworth. In this way, we receive 17 deaths from the Kingston Infirmary and one from Brookwood County Lunatic Asylum, and transfer to their respective districts 8 from the Cottage Hospital and 2 from the Isolation Hospital. Table II.—Deals with variations of population, deaths and births in each of the three localities that go to form the Urban District. Table III.—Shows at a glance the incidence of Infectious Disease notified in each of the three portions of the District, and of the cases transferred to the Isolation Hospital. Table IV.—Differentiates or classifies the causes of death under various headings, at different age groups, and in localities at all ages. Table V.—Is a new table, supplied this year, and concerns Infantile Mortality. Vital Statistics. Death Bate.—The total deaths registered in the District and uncorrected were 134, which gives a death rate of 7.9, and up to the year 1900 the rate used to be calculated in that way, but since then the additions and subtractions I have alluded to have been available, and the result is what is known as a "corrected" death rate. Under this plan, the nett 5 deaths at all ages belonging to the district are 142, and the corrected death rate for the year 1905 is therefore 8.4. Zymotic Diseases.—The deaths from the seven chief epidemic diseases, which are Small-pox, Measles, Scarlet-fever, Diphtheria, Whooping-cough, Typhus and Enteric or Typhoid Fever, and Diarrhoea are only four, namely, one from Scarletfever, one from Whooping-cough, and two from Diarrhoea. This mortality constitutes, I believe, the lowest recorded during my experience, and the death rate is only 0.23 as against 1.52 for England and Wales. Births.—The total number of births registered in 1905 were 321, which gives a birth rate of 18'9 for the year. Notwithstanding the increase of population, and the amount of building for the last three years, the number of births shows a considerable decrease. The births for 1903-4-5 are respectively 351, 347, and 321, and the rate of 18.9 compares with 27.2 for England and Wales. The following table shows the distribution of births in the various localities:— Surbiton Urban District. Boys. Girls. Total. Surbiton 76 81 157 Tolworth 66 65 131 Hook and Southboro' 13 20 33 Totals 155 166 321 Of these, 314 were legitimate and 7 illegitimate. 6 Infantile Mortality.— Owing to the declining birth rate, which has been progressive for some years past, public attention has in all sorts of ways been drawn to the excessive and disproportionate waste of infantile life, especially in the larger towns and in manufacturing districts, and Table V. specifies the majority of the causes of deaths with the cases due to such causes. By the means of reliable statistics, a more accurate knowledge of the causation of death will be arrived at, and efforts will certainly be made to combat the evil and reduce the mortality where excessive. Already in several large towns, and in three of the London Boroughs, a milk supply under municipal control is provided, and elsewhere creches or day nurseries are established where there is a large proportion of female workers, for the proper care of infants and their feeding during the time the mothers are at work. Last year I mentioned that it was "a matter of national importance that Elementary Hygiene should be taught in our Public Bay Schools, as thousands of lives were annually lost to the country by the gross ignorance on the part of mothers of the proper feeding of an infant." Though something has been attempted in this way, much yet remains to be done. Voluntary lectures, if well delivered and under attractive conditions, can do much to disseminate knowledge. Some 25 years ago I gave half-a-dozen courses of six lectures each in "First-aid" or Ambulance work, and I remember there was an average attendance of 40 per lecture; since then these lectures have at 7 various times been conducted by others, and always with good attendances and good results, and now-a-days the police, railwaymen, firemen, factory workers and others are largely instructed. In due time nursing lectures were given, though in this district I have not heard of any for some time, but if a course of nursing lectures together with hygiene and the rearing of infants were given, at very nominal fees, in the districts where the working classes mostly live, and an effort made by district visitors, employers of labour, and the many workers there are, to arrange for lectures and to secure attendances—and this might be done, if thought advisable, under the auspices of this Council—then I am confident that nothing but good could result, and they would be a fitting and extremely useful sequel to the popular Ambulance Classes. Dealing with the deaths under 1 year of age, I would ask a reference to Table I., which shows the number of these deaths year by year for the last 10 years, and it is very satisfactory to find that this last year was by far the most favourable recorded, as the number of deaths (18) compares with an average of 32.3 for the preceding nine years, and the mortality rate is 56 as compared with 128 for England and Wales. The causes of these deaths are shown on Table V. A notable feature is that only one death at that age is due to diarrhœa. Ratepayers should take these favourable figures as largely the result of the excellent sanitary work that has been in progress under the direction of the Council for the last ten 8 years or more. By careful and faithful inspection of houses whenever any sanitary defects are reported or suspected, and by an insistence on an efficient remedying of the evil, an insanitary becomes a sanitary house, and who benefits from that more than the susceptible infant? Add to this good water, properly flushed closets, provision of ash bins, regular removal of refuse, clean and well-kept roads, etc., and all the inmates (especially is this so amongst the dwellings for the working classes) live healthier lives and happier. Members of the Council come and go, but I have had the supervision of this work for 30 years and I feel it is my duty to publicly testify to the great ability, thorough knowledge of his duties, and unsparing efforts to ensure good results, shown by Mr. Nesfield, the Sanitary Inspector, during the last 10 years, and I rightly attribute the undoubted high and up-to-date sanitary condition of this district to the efforts of a vigilant Sanitary Committee, supported by an enlightened Council, and to their instructions being thoroughly and properly carried out by a reliable officer. In connection with a declining birth rate and a greatly-to-be-feared deterioration of the race, there is a matter of national importance that everywhere now-a-days demands attention, and must go hand-inhand with the hygienic surroundings of the infant, and that is the method of rearing it. The crusade against "bottle-fed" infants should be pushed with the utmost vigour, and mothers should be encouraged to perform their maternal duties 9 in all classes of life. Sir William Broadbent, when recently speaking of the india-rubber tube for feeding bottles, said "it was never sweet" and was "infected with microbes," also that the so-called comforter, a rubber teat constantly seen in the mouths of infants and frequently dipped into sugar, glycerine, or the mother's mouth, was an "invention of the devil!" The obvious difficulty against keeping these rubber tubes clean has led largely to their disuse, and the boat-shaped bottle, in cases where handfeeding is absolutely necessary, is much to be preferred. Dr. Hope, Medical Officer of Health for Liverpool, has shown that the incidence of death is no less than 15 times greater amongst children under three months of age, bottle-fed, than amongst an equal number who are breast-fed. INFECTIOUS DISEASES NOTIFICATIONS. The following Table shows the Notifications of the Past and Previous Years. Scarlet Fever- Diphtheria and Memb. Croup. Enteric Fever. Puerperal Fever. Erysipelas Contin. Fever. Small Pox. Totals. 1890 3 36 l 2 4 0 0 46 1891 3 21 l 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 * 1899 48 2 7 1 11 0 0 69 * 1900 15 22 2 0 7 0 0 46 * 1901 59 47 2 0 7 0 0 115 * 1902 22 19 2 1 8 0 0 52 * 1903 58 9 6 0 5 0 1 79 * 1904 22 10 4 1 4 0 0 41 * 1905 72 3 2 0 4 0 0 81 * The combined Districts. 10 Scarlet Fever.—There were 72 cases of this disease during the year, and 60 were removed to the Hospital. I have drawn up a table to show how and where these cases were distributed throughout the year. TABLE, Showing Incidence of Scarlct Fever during 1905. Surbiton. Tolworth. Hook and Southboro. January 5 - - February 1 - - March 1 - - April 1 - - May 1 - - June - - - July - - - August - - - September - 1 - October 1 3 28 November 5 10 8 December 3 1 3 Removed to Hospital 18 15 39 10 14 36 Several of those in Surbiton were imported, two for instance being brought home from a school at Lewisham. But the principal cause of this large number was an outbreak at Hook and Southborough, which, in a measure, overlapped and extended into the Tolworth district. In a great many instances the disease was not recognised at an early date, and consequently was not notified. This gave opportunities for the spreading of infection, and there is good reason for believing that some cases were never seen at all by a medical man. I found in one case 11 that was not notified till an advanced stage, that the laundry work of several families was being taken in at the house, and also that children and others were frequenting a small shop which was part of the premises. Of course this was promptly dealt with as soon as I became aware of it. The Hook Schools were closed from October 19th to December 7th, and a special report on the outbreak was submitted to the Council on November 1st. The distinctive feature of many of the cases was the extreme mildness of the symptoms, so that there was a real difficulty in recognition until, in several instances, desquamation set in. There was only one death, that of a child, who contracted the illness from an earlier case in the house that had never received any medical attendance whatever. The Isolation Hospital, being able to take in only a certain number of patients at a time, and the number would vary according to the prevalence of other diseases and the number of beds available for either sex, many had to be sent to Cuddington and to Wimbledon. This fact has in a great measure brought up the question of the necessity, or otherwise, of adding an additional block to the Hospital, and a decision has not yet (at the time of writing this) been come to. Hospital accommodation is usually provided on the basis of one bed per thousand of the population, but now that the Tolworth Hospital has to provide 12 for Surbiton, Esher and The Dittons, and Maiden, there are nothing like beds in that proportion. The matter is largely one of finance, and not absolutely one of necessity, for as long as there is a surplus of beds at neighbouring hospitals and that a continuance of the accommodation can be reasonably relied upon, it is mainly a question of cost and, as far as I have been able to gather, the cost per case per week at the outlying hospitals is less than the cost would be in maintaining a larger hospital, with an increased staff and interest and sinking fund charges to meet. It should be borne in mind that the idea cannot be entertained of adding sufficient beds to meet an outbreak, and that surplus cases would, under such circumstances, still have to be provided for elsewhere. In any event, in my opinion, it is of real necessity that at least two, or even more, singlebedded observation wards should be provided, so that doubtful cases of either Scarlet Fever or Diphtheria could be at once removed and isolated from their surroundings, and I say distinctly, as a result of my investigations, that had such been available in this recent outbreak, a considerable number of cases would in every probability never have occurred at all, and a saving of from £12 to £20 in each case would have been made. If this be so, it is not at all unreasonable to suppose that 20 out of the 39 Hook cases might not have arisen, and 20 cases with a minimum of from 6 to 7 weeks at £3 a week would 13 approximate £400. Moreover, medical opinion with regard to the causes and duration of infection is undergoing, and is likely still more to undergo, considerable changes. It has been known for some time that what are called "return cases," i.e., cases that after their discharge from hospital, to all intents cured, but which have yet infected others, owe their infection to ear, throat, nasal and post-nasal discharges in most, if not all instances, and not to desquamation. This latter can far more positively be controlled, and the belief is gaining ground that if this is so, hospital detention will come to be considerably shortened. Under such conditions this would, in the case of an epidemic, permit of a larger number of cases passing through the hospital with the same accommodation as exists at present, and greatly diminish the cost. Taking these two points into consideration, viz.:—The more successful control of an outbreak that may result from observation wards, where none have hitherto been provided, and the change that is taking place in medical opinion, having its basis on statistics gathered from the use of Isolation Hospitals in dealing with Scarlet Fever, and the experience accruing from advances in treatment, I would advise that there is no immediate need for large additional expenditure. Diphtheria.—There were 3 cases during the year, but only 1 was removed to the Hospital. No deaths. One case was contracted outside the 14 district and was found to be ailing shortly after arrival. No cause was known for the other two. Enteric Fever.—Two cases of this disease were notified, both were treated in Hospital, and both recovered. In one case the sanitary arrangements in the house were found to be very bad, and there was some evidence in the second case of personal connection with the former, but it was never very satisfactorily made out. Phthisis.—There were 14 deaths from Phthisis and 2 from "other tubercular diseases." Of the deaths from consumption one was in the classification of between 15 and 25 years of age, and 13 between 25 and 65. Twelve deaths were notified and had all the necessary disinfection and cleansing done. In connection with this, voluntary notifications of deaths is not very satisfactory, and I propose making a recommendation to the Council that, as is now done in many other places, all cases should be notified when diagnosed and the usual fee allowed. In this way precautions can more readily and thoroughly be carried out and public attention invited for cooperation. Cancer.—There are 18 deaths registered as due to cancer and malignant disease, the same number as in 1904, and there were 17 in 1903, and 12 in 1902. It is a question whether there is really much increase in this disease, and it may rather be that increased facilities, both medical and surgical, are 15 now at hand for making more correct diagnoses. Much valuable work is being done in this and other countries to discover the causes of this terrible disease with a view to its prevention and cure, and it is understood that the progress made in this direction is satisfactory. Cerebro-Spinal, Fever.—In August, the Local Government Board issued a Memorandum to every Sanitary Authority, dealing with the symptoms and diagnosis of this disease, in order that they "should be on the alert to detect it if a case appeared in the district." A copy of this Memorandum together with a letter was sent to every medical man practising within the district. No case, however, was reported. Accidents and Inquests.— Br. M. H. Taylor, H.M. Coroner for Surrey, in his report mentions that 14 inquests were held on Surbiton cases. These inquests of course include the Cottage Hospital deaths, and are from all parts, but of those belonging to the District itself there were 11. These may be classed as follows:— Verdicts of the Juries. Deaths by wilful or criminal acts: " Suicide by hanging" 1 Deaths by accident or misadventure: " Killed by vehicle in street " 1 " Asphyxia at birth and fall " 1 Deaths from natural causes 8 Total 11 16 Sanitary Work.— This is mainly dealt with by the Sanitary Inspector in his report. Water Supply.—This, as formerly given by the Lambeth Water Works, is now taken over by the Metropolitan Water Board, and is abundant and good, but so far only a portion of the district has a constant supply. No complaints were received during the year with reference to its quality, but several as to quantity. As a reminder I would again call the attention of house occupiers who have not a constant supply to the necessity—and this is important—of at least twice a year having their cisterns cleaned out. I mention this because in the frequent movings from one locality to another that is so customary now, it is probable there may be some occupiers who have been hitherto living in a neighbourhood where there is a constant supply and they may not realise the need there is of a periodical cleansing of cisterns. Disinfection.— Methods of disinfection: On receipt of the notification of a case of infectious disease, a visit is paid as soon as possible to the house to ascertain the various particulars of the case and its surroundings, and if there has been a removal to the Isolation Hospital, or a death or recovery, the room or rooms involved are disinfected by Formalin (a) by spraying and (b) with Paraform tablets in the "Alformant" lamp. Or in some cases it may be that sulphur dioxide is used. 17 After the rooms have been disinfected, the wall papers are stripped off when judged to be necessary and burnt, and ceilings, walls and woodwork thoroughly washed. The bedding and such contents of room as are considered requisite to be disinfected are taken to the steam disinfecting apparatus at the Isolation Hospital. For purposes of removal to and fro, two special vans, the property of the Council, are used, one for infected and the other for the disinfected articles. Dairies, Cowsheds, and Milkshops.— The various inspections required under the Acts, and the alterations, cleansings, etc., necessary to be dealt with, are fully detailed in the Inspector's report. Sewage Farm.—There have been fewer complaints about this than in previous years, and with a continuance of the attention now given to the farm itself and to the water-course, it is not likely to be very troublesome during the interval before it is altogether done away with. The main drainage is in the hands of a Committee, but no decision has yet been arrived at. Midwives Act, 1902.— In accordance with Section 8 (5) of the Midwives Act, a copy of the names of all midwives who during L905 notified their intention to practise in this district has been sent to the Central Midwives Board. 18 No notifications have been received during the year (in accordance with Rule 18) as to deaths, still births, or infectious diseases, from the midwives. With respect to the work done, I have had no special information as yet, but I have found them all attentive to advice and general instructions, and alive to their responsibilities, but no detailed instruction has been given. I had on one occasion to suspend from practice for three weeks one midwife, who had been in close personal contact with a case of scarlet fever in a house where a confinement had occurred. After a thorough course of disinfection, etc., she was allowed to resume her work. I have received no complaints of inattention or neglect, and no case of illness or disease attributable to their attendance has come to my knowledge. Number of Midwives on the list—10. Factory and Workshop Act, 1901.—The provisions of this Act have been carefully complied with and a register kept of workshops and factories, together with a list of the outworkers. Visits of inspection have been made, and under sec. 22 of the Public Health Acts Amendment Act, 1890, adopted by the District Council, the number of nuisances occasioned by want of suitable sanitary accommodation in workshops were 17, all of which were remedied by the owners on the necessity being pointed out. The total number of workshops now on the register are 189 as against 182 in 1904. 19 FACTORY AND WORKSHOP ACT, 1901. 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) 3 Workshops (Including Workshop Laundries) 54 2 Nil. Workplaces 4 Homeworkers' Premises 8 Total 69 2 Nil. 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspect'r Nuisances under the Public Health Acts:—* Want of cleanliness Want of ventilation Overcrowding Want of drainage of floors Other Nuisances 31 31 +Sanitary accommodation— Insufficient 1 1 Unsuitable or defective 17 17 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 regards lists of outworkers (s. 107) 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 49 49 * 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, 20 3.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 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. Inspectors Reports (of action taken) sent to H.M. Inspectors. Other Underground Bakehouses (s. 101) Certificates granted during the year In use at the end of the year 1 Homework:— Number of List of Outworkers* (s. 107):— Lists. Outworkers. Lists received 2 12 Addresses of Outworkers forwarded to other Authorities received from other Authorities 2 Homework in unwholesome or infected premises:— Wearing 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 Register (s. 131) at the end of the year:— Important Classes of Workshops, such as Workshops, Bakehouses 14 Dressmakers 33 Bootmakers 30 Laundries 20 Bakehouses, may be enumerated here. Tailors 13 Milliners 13 Otber Trades 66 Total number of workshops on Register 189 * The Lists should be received twice in the Year. 21 New Houses.—The Revenue Act of 1903. In 1890 the Customs and Inland Revenue Act granted exemption from Inhabited House Duty to all houses used solely for providing separate dwellings at rents not exceeding 7s. 6d. per week for each dwelling, if the Medical Officer of Health certified that the premises afforded suitable accommodation for each of the persons inhabiting them, and that due provision was made for their sanitary requirements. This exemption was in order to encourage the erection of artisans' dwellings on good lines, and it has proved a useful piece of legislation. The Revenue Act of 1903 extends the provisions of the former Act, and now where a dwelling house is used for the sole purpose of providing separate dwellings it is enacted that (a) Any dwelling which is of an annual value of below £20 shall be exempt from Inhabited House Duty; (b) The rate of Inhabited House Duty in dwellings of an annual value of £20 but not exceeding £40 is reduced to 3d.; and (c) The rate in respect of dwellings beyond an annual value of £40 and not exceeding £60 is reduced to 6d. Applications under these Acts were made for certificates with respect to the following properties:— Nos. 5 to 18, Ripley Villas, Ellerton Rd. 14 houses Nos. 19 & 20, Ripley Villas, „ 2 houses Nos. 3 & 4, Essex Villas, ,, 2 houses No. 3, Claremont Gardens, 1 house 19 houses 22 After inspection of the premises, letters were written to the owners pointing out the works necessary to be done before certificates could be granted. At Nos. 5 to 18, Ripley Villas, all the soil pipes were repaired, the sink waste pipes trapped, and air inlets at top ends of drain repaired. On the completion of these alterations the certificates were granted. No defects were found in the other houses. The following table shows the building that has been in progress during the last five years—just upon 600 houses. Year. HOUSES BUILT. Total. Surbiton. Tolworth. Hook and Southboro'. 1901 19 94 6 119 1902 28 79 16 123 1903 18 61 33 112 1904 41 81 9 131 1905 27 69 18 114 Total for 1901-5 133 384 82 599 Average number of persons per house (1901 Census) 5.225. Works.—There have been no very extensive works carried out, as for the greater part of the year the roads have been largely in the hands of the Tramway Contractors, but the following roads have been made up and taken over by the Council:— Thornhill Road, Bond Road, Ellerton Road (top end). 23 Roads widened:—Ewell Road and Ditton Road (part of). The sewer in the Railway Footpath collapsed and was reinstated. State of the Roads.—Now that there is such a great length of roadway paved with wood, it is very noticeable how imperative it is that some efficient mode of scavenging should be adopted with a view to mitigating not only the dust nuisance but preventing the offensive smells that will surely be in evidence during the hot and dry weather. The removal of horse droppings continuously is of prime importance, and that before the traffic grinds it into the wood, for sweeping once a day is next to no use. Road watering will dry up far quicker on wood than on macadam because there is no depth of moisture, consequently this manure will the more quickly decompose and become disintegrated into offensive septic dust, which is very injurious to eyes, throat, and lungs. The expense attendant on this ought not to be grudged—it is a sanitary necessity—but it will be money thrown away if the work is not done effectively. This plan is universally adopted in London on the asphalte and wood pavings. In conclusion, Gentlemen, I should like to mention how much I appreciate in the carrying out of the multitudinous duties of my office, the kind and ready assistance that I have received on every possible occasion from my colleagues in the medical profession in Surbiton. Also, I have to thank you, Mr. Chairman, and the Members of the 24 Council generally, and my brother Officers, for the consideration and courtesy I have ever received at your hands, the knowledge of which goes a long way to lighten the many difficulties that inevitably beset the work of sanitary officials, especially when the carrying out of duties and instructions require, as it often does, no inconsiderable sacrifices to be made on the part of both owners and tenants. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, M.D., D.P.H., Medical Officer of Health. March 29th, 1906. 25 March, 1906. To the Medical Officer of Health. Sir, I beg to present to you my Tenth Annnal Report for the year ending December 31st, 1905, showing the action taken and the amount of work done in the abatement of nuisances under the provisions of the Public Health Acts, the Factory and Workshop Act, 1901, and the Bye-laws and Regulations in force in the district. Complaints. During the year 83 complaints relating to nuisances were received, viz.:— Defective condition of house drainage 24 Insanitary condition of premises 10 Offensive smells 25 Offensive accumulations 10 Non-removal of house refuse 5 Insufficient water supply to dwelling houses 3 Smoke nuisances 2 Miscellaneous 4 Total 83 Each complaint was immediately investigated, and where a nuisance was found to exist, immediate steps were taken for the abatement thereof. The complaints as to the non-removal of house refuse were acknowledged, and referred to the Surveyor's Department, under whose supervision the removal of house refuse is carried out. 26 Inspection of District. In accordance with the provisions of Section 9'2 of the Public Health Act, 1875, and the General Orders of the Local Government Board, the district has been systematically inspected as in previous years, and all necessary steps have been taken to enforce the proper observation of the Council's Byelaws and Regulations, and to secure the abatement of nuisances where found to exist. The total number of visits paid to premises during the year was 2,848, which includes visits to premises in respect of which complaints of a nuisance had been received, and those in which cases of infectious disease had occurred; also visits to works in progress, inspection of dairies, cowsheds, bakehouses, slaughterhouses, workshops, etc. Notices Served. The notices served as a result of these inspections amounted to 392. At the close of the year, nearly all these notices had been complied with, or the work necessary to abate the nuisances was in progress. The following matters have received attention during the year :— Overcrowding of Dwelling Houses. Overcrowding of dwelling houses was dealt with in two instances as a nuisance dangerous to the health of the inmates. They were both very bad 27 cases, but in each the service of a notice had the desired effect of securing an abatement of the nuisance. Dust Eeceptacles. As the result of notices served under Section 36 of the Public Health Act, 1875, 17 dwelling houses have been provided with galvanized iron dustbins, with tight fitting lids, where no ashpit or dustbin previously existed; and two brick ashpits which were in such a state as to constitute a nuisance have been abolished and replaced by portable galvanized iron dustbins. Paving of Yards. Clause 89 of the Council's Bve-laws provides, that where it is necessary for the prevention or remedy of insanitary conditions, the Council may require the owner of any dwelling with which there is any yard or open space, to pave the whole or part of such yard or open space with a hard, durable and impervious pavement of flagging, paving bricks, concrete, or other suitable material. Under this Bye-law the yards, and, where necessary, the side passages, belonging to 69 dwelling houses have been properly paved with concrete or other durable and impervious material, thus preventing many nuisances that must of necessity arise where the yards are unpaved. In no instance during the year has it been found necessary to take legal proceedings against 28 the owner of any dwelling house to enforce the execution of this work; on the contrary, the service of a notice has always resulted in the work being promptly put in hand. Occupiers of small property greatly appreciate this class of sanitary improvement, as cleanliness is greatly facilitated and encouraged, and rain and other water rapidly drains away into the gully provided, instead of soaking into the foundations, causing damp walls, or standing in pools upon the surface until it becomes offensive. The Council's Bye-laws relating to the paving of yards and open spaces were approved by the Local Government Board in August, 1898. The following table shows the number of yards and open spaces in connection with dwelling houses, which have been paved since that date, viz.:— 1899 1900 1901 1902 1903 1904 1905 Total, 13 14 32 114 65 75 69 382 House Drainage. During the year under review the drains of 59 houses and premises have been examined and tested after complaint made as provided by Section 41 of the Public Health Act, 1875, and in every case were found to be defective. In 57 instances it was found necessary to entirely re-construct the drainage system, and in 2 instances the drains were efficiently repaired. 29 The drains belonging to 13 houses were re-laid by the Council at the request of the owners, on their agreeing to repay the expense. In one instance, a combined drain taking the drainage from a terrace of 8 houses, belonging to different owners, was relaid by the Council, in default of compliance with the notices served. In every case where the Council executed drainage work, either at the request of the owners or in default, a charge of 5 per cent. on the cost of the work was made for preparing plans, specifications, etc. The total income from this source during the year amounted to £12 0s. 6d. Combined drains used for the drainage of 7 blocks of houses, each block belonging to one owner, have been re-laid at the Council's expense, they being sewers within the meaning of Section 4 of the Public Health Act, 1875. Tlie following table shows the position of each drain and the cost of its re-construction, viz.— Premises. Cost of Reconstruction. 5 to 9, Gladstone Road £18 18 4 Ivy Cottages, Ditton Eoad 16 13 6 1 to 6, St. Leonards Square 59 3 3 7, 8, and 9, Westfield Eoad 28 7 0 1 to 7, Stanley Cottages, Hook 29 18 9 13 to 16, Cleaveland Road 46 15 11 1, 2, and 3, St. Leonards Road 62 17 6 Total £262 14 3 30 During the year, 80 defective house drains have been entirely re-laid. In each case a plan of the work done has been made and filed in the office for future reference. Twenty-eight house drains have been cleared from obstruction or repaired. Two houses have been provided with separate surface water drains. Three cesspools have been abolished, and the drains connected with the public sewer. Four overflowing cesspools have been emptied and cleansed. Four wet basements have been provided with subsoil drains and the sites covered with concrete. One hundred and fifty-four defective brick or iron traps have been removed, and replaced with properly trapped gullies. Four stables have been provided with effectual drainage. All drains re-laid are tested with water, and soil pipes and ventilating shafts with smoke, when the work is completed. One hundred and fifty-five water tests were applied to drains, and 118 smoke tests to soil pipes and ventilating shafts. 31 Soil Pipes. Five defective and unventilated soil pipes inside dwelling houses have been abolished, and new ventilated soil pipes fixed outside the buildings. Twenty-two soil pipes have been repaired and the joints made sound. Twenty-one defective light iron or zinc soil pipes have been abolished, and replaced with lead or strong cast-iron pipes. Water Closets. Nineteen dilapidated water closets have been pulled down and re-built in an improved manner or position. Three w.c. apartments have been efficiently lighted and ventilated. Nine pans have been cleansed or repaired. Eighty-nine old iron container or long hopper pans have been abolished, and pans of an approved type fixed. Fifteen water closet flush pipes have been disconnected from the domestic supply cisterns, and separate flushing cisterns fixed. Fifty-nine defective or insufficient flushing cisterns have been removed, and valveless syphon cisterns, of full 2-gallon capacity, fixed. Twenty-two defective flushing cisterns have been repaired. 32 One water closet has had a sufficient supply of water laid on. Three w.c. apartments have been provided with a weatherproof roof. Storage Cisterns. Eleven houses, where the storage was insufficient, have been provided with an additional storage cistern. Four dirty storage cisterns have been cleansed, and Four have been provided with covers. Waste Pipes. Sixty-two new trapped waste pipes have been provided to baths, sinks, lavatory basins, etc. Four bath, sink or lavatory basin waste pipes have been repaired. Thirty-three bath, sink or lavatory basin waste pipes have been trapped or disconnected from drain. Four defective sinks have been abolished and new ones fixed. Rain-water Pipes, Gutters, etc. Forty-two rain-water pipes have been disconnected from drains or soil pipes, and arranged to discharge over or into properly trapped gullies. 33 Ninety-two defective rain-water pipes have been repaired. Eight houses have been provided with eave gutters to convey away the rainfall from roof. Fifty defective eave gutters have been repaired. Dampness. Nine defective roofs, causing dampness inside dwelling houses, have been repaired and made weatherproof. One open area has been built around basement walls of house to prevent dampness. Six houses have been provided with a proper damp-course. Thirteen houses have had the space under the floors covered with concrete to prevent dampness. Miscellaneous. Six offensive accumulations have been removed. Fifty-nine dirty or unwholesome houses have been cleansed, white-washed, etc. Ten defective or dangerous floors have been repaired or renewed. Twenty-two defective house walls have been repaired. 34 Seven houses have had a sufficient supply of water laid on. Six dirty yards have been cleansed. Houses Unfit for Human Habitation. Four houses, situate in Orchard Place, Hook, were reported to the Sanitary Committee as being unfit for human habitation. They were damp and dilapidated, and the drainage was defective. Notices were served upon the owner under Section 32 of the Housing of the Working Classes Act, 1890, to put them into a proper habitable condition. The work necessary to make the houses fit for habitation was subsequently carried out. Factory and Workshop Act, 1901. The total number of workshops on the register is 189, of which seven were newly registered during the year. The businesses carried on at the various premises are as follows:— Bakehouses 14 Dressmakers 33 Bootmakers 30 Laundries 20 Tailors 13 Milliners 13 Other trades 66 Total 189 35 Visits from time to time have been paid to each, and as a result the following nuisances have been dealt with:— Drains unstopped and repaired 1 W.c. apartments lighted and ventilated 1 W.c. pans cleansed and repaired 3 Defective w.c. pans abolished and new ones fixed 7 W.c. flush pipes disconnected from drinking water cisterns, and separate flushing cisterns fixed 5 Flushing cisterns repaired 1 Sink waste pipes repaired or trapped 2 New trapped waste pipes provided to sinks 6 Defective roofs, eave gutters, and rainwater pipes repaired 14 Workshops cleansed 1 Yards attached to workshops paved, etc. 8 Bakehouses. The whole of the bakehouses in the district have been visited twice during the year, and generally speaking, were found to be kept in good order. Cleasing and lime-washing had, however, to be ordered in two instances. Slaughter-houses. There are six registered slaughter-houses in the district, all of which have been frequently and at irregular periods inspected, to ascertain if they are kept in accordance with the Bye-laws regulating the same. 36 One was found to be in an insanitary and dilapidated condition, and not provided with a sufficient sanitary convenience for the use of the persons employed therein. The owner's attention was called to these defects, and he forthwith had the walls and roof repaired, the drains reconstructed, the floor of the slaughter-house and the yard adjoining re-paved, and a water closet built for the use of his employees. In two instances, it was found necessary to serve notices to cleanse and lime-wash the walls and ceilings. Dairies, Cow-sheds and Milkshops. The dairies, cow-sheds and milkshops have been inspected quarterly during the year, and at irregular periods as occasion required, the object being to see that they are kept clean, that all refuse is regularly removed, that there is no overcrowding of the sheds, and that the drainage is maintained in good order. In the month of March, report was presented to the Sanitary Committe by the Veterinary Inspector and myself, to the effect that the sheds at one of the farms were in such a dilapidated and insanitary condition as to be unfit for use as cowsheds, the construction being such that there was insufficient air space, and it was impossible for the cows to be kept clean. The attention of the owner and occupier was immediately called to this fact, with the result that 37 the sheds are now being remodelled in accordance with the Council's requirements. There are 16 persons registered under the Act as follows:—Cowkeepers, 1; cowkeepers, dairymen and purveyors of milk, 3; purveyors of milk, 5; dairymen and purveyors of milk, 7. The average number of cows kept by the persons registered is 264; and all are under periodical inspection by the Council's Veterinary Inspector. Disinfection. During the year, 68 premises, in which 92 cases of infectious disease have occurred, have been disinfected with Formalin upon removal, recovery, or death of the patient. Of these, 48 were in consequence of scarlet fever; 3 of diphtheria; 2 of typhoid fever; 1 of erysipelas; 12 of consumption ; and 2 of measles. Disinfection has also been carried out after one case of cancer. All bedding and other articles likely to retain infection were removed to the Tolworth Isolation Hospital for steam disinfection. This work is carried out by the officials of the Hospital Board. A gratuitous supply of disinfectants was provided where required, and, when necessary, notices were served upon the owner or occupier of the premises for the interior walls of the infected 38 rooms to be stripped and cleansed, and the ceilings white-washed. The following is a list of goods disinfected at the Tolworth Isolation Hospital, under the superintendence of the hospital staff:— Beds 88 Mattresses 71 Paliasses 67 Bolsters 85 Pillows 169 Sheets 143 Blankets 228 Counterpanes 78 Carpets 134 Bugs 61 Cushions 53 Toilet covers 92 Towels 49 Wearing apparel 759 Curtains 158 Blinds 60 Sundries 310 Bed valances 22 Quilts 27 Mattress covers 14 Furniture (chairs, etc.) 4 Total 2,672 Legal Proceedings. Legal proceedings were taken before the Magistrates against the owners of The Broadway and Electric Parade, Brighton Road, to enforce 39 compliance with notices served upon them to abate a nuisance arising from the filthy and insanitary condition of the road at the rear. Three of the owners, viz.:—Messrs. Ainslie Brothers, Mr. O. F. Walker, and Mr. T. A. Deacock, defended the summonses, on the grounds that they were not the owners of the road, and had only a right of way over it. After a hearing of nearly two days, the Magistrates decided in favour of the Council, and made an order for the work to be carried out in accordance with the notices served, within six months, and allowed ten guineas costs. Summary of Work of Department. Number of Houses and Premises Inspected 210 „ Visits to Works in progress 1,951 „ „ Bakehouses 33 „ „ Slaughter-houses 26 „ „ Dairies, Cow-sheds and Milkshops 49 „ „ Workshops 54 „ „ Factories 3 „ „ re cases of Infectious Disease 97 „ Miscellaneous Inspections 425 „ Drains examined under Section 41 of the Public Health Act, 1875. 59 , Drains tested with Water 155 „ „ „ „ Smoke 118 „ Complaints received and attended to 83 Preliminary notices served 67 40 Number of Legal notices served 325 „ Letters written on the business of Department 714 ,, Houses and premises disinfected 69 „ Plans of houses re-drained prepared 80 I am, Sir, Yours obediently, W. NESFIELD, Assoc. R. San. Inst., Sanitary Inspector. 41 Table I.—Surbiton Urban. 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 the District. Deaths of Residents registered beyond the 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 10 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 1.12 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 1904 16,460 347 21.0 41 118.1 178 10.8 20 7 24 195 11.8 Averages for years 1896. 1904. 14,822 309.3 20.85 32.3 101.5 161.5 10.9 15.7 7.9 12.2 165.9 11.14 1905. 16,916 321 18.9 18 56.07 134 7.9 15 10 18 142 8.4 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 3,026. Total population at all ages, 15,017. Number of inhabited houses, 2,874. Average number of persons per house, 5.225. A Census of 1901. TABLE II.—Surbiton Urban Sanitary District. Year. Names op 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 11,075 195 117 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 1904 11,557 181 129 22 3,280 124 48 15 1,623 42 18 4 Avgs. of yrs. 1896 to 1904 11,002 190.4 129.3 22.2 2,361 83.4 26.0 8.2 1,457 35.4 13.6 2.7 1905 11,665 157 104 10 3,556 131 30 7 1,695 38 8 1 TABLE III.— Cases of Infectious Disease Notified during the Year 1905 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'th boro'. Surbiton Tolworth Hook & S'thboro' Small-pox Cholera Diphtheria 3 ... 1 2 ... ... ... 3 ... ... 1 ... ... Membrano’s Croup Erysipelas 4 ... 1 ... 1 ... 2 3 ... 1 ... ... ... Scarlet Fever 72 ... 14 48 7 3 ... 18 15 39 10 14 36 Typhus Fever Enteric Fever 2 ... ... 1 ... 1 ... 1 1 ... ... 1 1 ... Relapsing Fever Continued Fever Puerperal Fever Plague Totals 81 ... 16 51 8 4 2 25 16 40 12 15 36 TABLE IV. Causes of, and Ages at, Death during Year 1905. Causes of Death. Deaths in whole Districts at Subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 & under 25. 25 & under 65. 65 & upwards. Surbiton. Tolworth. Hook&S'thbro' Small-pox Measles Scarlet fever 1 ... 1 ... ... ... ... ... ... 1 Whooping-cough 1 ... ... 1 ... ... ... ... 1 ... 1 Diphtheria and membranous croup ... ... ... ... ... ... ... ... ... ... 1 Croup Fever:— Typhus Enteric Other continued Epidemic influenza Cholera Plague Diarrhoea 2 1 1 ... ... ... ... 2 ... ... Enteritis 1 ... ... ... ... ... 1 1 ... ... Puerperal fever Erysipelas Other septic diseases Phthisis 14 ... ... ... 1 13 ... 8 5 1 2 Other tubercular diseases 2 1 ... 1 ... ... ... 2 ... ... Cancer, malignant disease 18 ... ... ... ... 11 7 14 3 1 1 Bronchitis 13 2 1 ... ... 2 8 7 6 ... 1 Pneumonia 9 2 1 ... ... 6 ... 8 1 ... 2 Pleurisy Other diseases of Respiratory organs 2 1 ... ... ... ... 1 ... 2 ... Alcoholism: Cirrhosis of liver 2 ... ... ... ... 2 ... 1 1 ... Venereal diseases Premature birth 4 4 ... ... ... ... ... 2 2 ... Diseases and accidents of parturition 3 3 ... ... ... ... ... 2 1 ... Heart diseases 24 ... ... 1 1 11 11 21 3 ... Accidents 1 ... ... ... ... ... 1 1 ... ... 2 Suicides 1 ... ... ... ... 1 ... 1 ... ... All other causes 44 4 1 l 2 13 23 34 5 5 5 All causes 142 18 5 4 4 59 52 104 30 8 15 Table V. Surbiton Urban District. INFANTILE MORTALITY DURING THE YEAR 1905. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 months. Total Deaths under One Year. All Causes : Certified Uncertified Common Infectious Diseases: Small-pox Chicken-pox Measles Scarlet Fever Diphtheria: Croup Whooping Cough Diarrhœal Diseases: Diarrhœa, all Forms 1 1 Enteritis (not Tuberculous) Gastritis, Gastro-intestinal Catarr Wasting Diseases: 4 Premature Birth 4 4 1 Congenital Defects 1 1 3 Injury at Birth 3 3 Want of Breast-milk Atrophy, Debility, Marasmus 1 1 1 Tuberculous Diseases: Tuberculous Meningitis 1 1 Tuberculous Peritonitis Tabes Mesenterica Other Tuberculous Diseases Erysipelas Syphilis Rickets Meningitis (not Tuberculous) 1 1 Convulsions Bronchitis 1 1 l 2 Laryngitis 1 2 Pneumonia 1 Suffocation (overlaying) Other Causes 1 1 1 2 10 10 1 1 2 1 1 1 1 18 District (or sub-division) of Surbiton. Birth of year legitimate, 314. population, Illegitimate, 7. estimated to middle or 19056, 16,9916 Deaths from all Causes at all Ages, 142.