SUR046 ANNUAL REPORT OF THE Medical Officer of Health, OF THE Surbiton Urban District Council, 1908. 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. SURBITON : Bull & Son, Printers, 20, Victoria Road. 1909. Urban District Council of surbiton. SANITARY COMMITTEE, 1908-9. Chairman : W. Sanger, Esq. The Chairman of Council: Rev. A. E. Beavan, M.A. The Vice-Chairman of the council P. G. C. Shaw, Esq. Messrs. Hawkey, Hepworth, Mence, Palmer. Parry, Potter, Ray, and Thirlby. Medical Office of Health Owen Coleman, M.D., D.P.H. Sanitary Inspector W. Nesfield, A.R.San.I. The Urban District Council of Surbiton. 1908-9. general statistics. Area of Urban District Acres 3,026 Rateable Value £189,766 Produce of Penny Rate £634 Populations at Census of 1901 15,017 Number of Inhabited Houses at Census of 1901 2,874 Average Number of Persons per House at Census of 1901 5,225 Population at Middle of 1908, Estimated 18,747 Density of Population per Acre 6.1 Number of Inhabited Houses at Middle of 1908 3,589 Average Number of Persons per House 5.224 Death Rate 1908, per 1,000 Persons living 10.08 Average Death Rate for previous 10 years 10.4 Death Rate from Seven Chief Epidemic Diseases 0.4 Birth Rate 1908 20.5 Average Birth Rate for previous 10 years 20.5 Infant Mortality Rate (under 1 year old) per 1,000 Births 70.1 Average Mortality Rate (under 1 year old) per 1,000 Births for previous 10 years 93.8 The Vital Statistics for the year 1908, consisting' of the Annual Birth Rates and Death Rates, have been published by the RegistrarGeneral, and are here shown in tabular form for comparison. Annual rate per 1,000 living. Deaths under 1 Year to 1,000 Births. Births. Deaths. Principal epidemic diseases. England and Wales 26.5 14.7 1.29 121 76 Great Towns 27.0 15.8 1.59 128 142 Smaller Towns 26.0 14.7 1.26 124 England and Wales, less the 218 towns 26.2 13.8 0.99 110 Surbiton 20.5 10.08 0.42 70.1 Surbiton Urban District Council. Thirty-Second Annual Report of the MEDICAL OFFICER OF HEALTH, 1908. Mr. Chairman and Gentlemen, In accordance with section 3 of the order of the Local Government Board, dated March 23rd, 1901, regulating the duties of Medical Officers of Health, I have the honour to submit to you my Annual Report for the year 1908, being the thirtysecond that I have been called upon to make, and of which copies will be forwarded, as required by the same Order to the Local Government Board and to the Surrey County Council ; also to the Secretary of State for the Home Office in accordance with sec. 132, of the Factory and Workshop Act, 1901. 5 Vital Statistics. The various official tables, as furnished for completion, and as required by the Local Government Board, are to be found at the end of this Report and may be compared in their details with previous years. The population is now estimated to be 18747, and it is probable that in previous years the estimate was unduly low, but towards the end of the decennial period, that is the ten years since the last census was taken, which was in 1901, it becomes increasingly difficult to form more than an approximate calculation of the then existing population. The number of deaths corrected by adding to the deaths of those registered within the district itself, those belonging to it who died in public institutions elsewhere, mainly the workhouse infirmary, and deducting the few from the Cottage and Isolation Hospitals who died there but do not belong to us—were 189. This is much larger than the preceding year, and of course affects the death rate. Nevertheless, the general health of the district, judged by sickness and mortality returns, was perfectly satisfactory. In connection with this, if we are required to add to our returns the deaths occurring in the Union Infirmary of persons belonging to the district, there must, in the future, be some means of obtaining trustworthy records. I 6 have received returns in due course, and both last year and the year before I personally attended at the Infirmary and was most courteously afforded every opportunity of verifying these returns, but I found on both occasions that they were by no means accurate, and indeed were not at all to be relied upon. There seems to be no sufficient record kept there of the addresses where these people previously lived, or even in some instances where they were removed from, and in some cases merely the addresses of relatives who would have to be communicated with for purpose of notification of death. In many doubtful cases the correct address, I was informed, could have been obtained from the Relieving Officers, but it is no part of their duty to forward this information to the various Medical Officers of Health, nor is it any part of the duty of the Infirmary Authorities nor of the Borough Medical Officer of Health, but it is obvious that if, on the one hand, we are required to swell our mortality returns by the addition of this considerable number of deaths, we should, on the other, feel assured that the returns were accurate and reliable. If these returns are to be included in the future—and they should be rendered monthly, not annually—some machinery must be devised for checking, correcting and forwarding, 7 and it appears to me that the Registrar is the most likely authority to whom this duty should be entrusted as he should be best able to obtain correct information from relatives, etc., at the time of registration. The Death rate for the year is 10.08, and the average for the years 1898-1908 is 10.4. Table I. shows these details in the succession of years. Births. The births this year are 385 and are the highest in point of numbers during the last 10 years. The birth-rate is 20.5 the same exactly as the average for the 10 years preceding and comparing with 26.6 for England and Wales. The following table shows how and where these births are distributed and the proportion of the sexes. There were 375 legitimate births and 11 illegitimate though one of these latter was never registered as a birth, but its death was the occasion of an inquest and was registered in accordance with the verdict. 8 BIRTHS—SURBITON URBAN DISTRICT. Surbiton. Tolworth. Hook and Southborough. Totals. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. January 12 5 5 10 3 2 20 17 37 February 11 8 7 l 4 2 22 11 33 March 10 6 9 3 5 1 24 10 34 April 4 7 9 7 1 3 14 17 31 May 9 6 4 6 1 1 14 13 27 June 8 12 3 10 2 4 13 26 39 July 10 16 10 4 2 2 22 22 44 August 11 13 6 3 1 2 18 18 36 September 7 7 6 5 2 4 15 16 31 October 6 4 9 5 2 1 17 10 27 November 8 8 6 3 0 0 14 11 25 December 1 3 13 4 0 0 14 7 21 97 95 87 61 23 22 207 178 385 192 148 45 385 Notification of Births.—This is a permissive Act, and it came up in due course for consideration at the hands of the sanitary committee. It. was not likely to be of any practical use unless a Health visitor were appointed to follow up the notifications by visits, where necessary, and by instructions as to the care and bringing up of the child. This is the course that has been generally followed where the Act has been adopted, and mostly so in the large towns with dense populations and where many of the mothers are engaged in work. The committee considered that at present there was no pressing need for it and that the expense of another appointment was not justified so that its adoption was not recommended. 9 Longevity.—It may be of interest to notice that the table printed below shows that of the 189 deaths that are credited to this district for the past year no less than GO or 307 per cent. of the number were of 70 years and upwards and contained one male registered as being 101 years at death. The deaths under one year of age were 27, and these added to the 60 of 70 years and over leave 102 to represent the mortality between the very young and the very old, or a death rate of 5.4 per 1,000 of the population. Years. Males. Females. Total. 70 to 80 15 20 35 80 to 90 8 14 22 90 to 101 1 2 3 24 36 60 EXTRACT FROM NOTIFICATION REGISTER. Scarlct Fever. Diphtheria and MembCroup. 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 1815 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 *1906 41 7 2 0 9 0 0 59 *1907 25 15 2 0 7 0 0 49 *1908 30 13 5 0 7 0 0 55 * The combined Districts. 10 Zymotic Diseases.—These are the seven principal epidemic diseases and the deaths due to them respectively are—Small-pox, o; Measles, 1; Scarlet fever, 0; Whooping cough, 1; Diphtheria, 2 ; Enteric fever, 0; Diarrhoea, 4; or 8 in all, the same as last year, the death rate being 0.42 per thousand of the population, comparing with 1.29 for England and Wales. A feature is that for two years in succession there have been no deaths from scarlet fever, though in that time there were 55 cases. During these same two years there were 5 deaths from measles and 3 from whooping cough. The notifications in the several months of the year, together with the admissions to Hospital, were as follows:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Total. January 6 0 0 2 8 February 6 0 0 1 7 March 4 1 0 0 5 April 0 1 0 1 2 May 4 0 0 1 5 June 1 0 1 0 2 July 1 2 0 0 3 August 1 0 0 0 1 September 1 0 0 0 1 October 3 2 0 1 6 November 2 3 4 1 10 December 1 4 0 0 5 Hospital 30 13 5 7 55 25 11 5 0 41 11 Though this statement of the mortality from zymotic diseases is eminently satisfactory yet it is of course an acknowledged fact that the elementary schools are the principal foci of infection of certain infectious diseases, notably scarlet fever, measles, whooping cough, and diphtheria, equally with the non-notifiable group, which include consumption, chicken pox, mumps, ringworm, &c., and hence the great necessity for school disinfection, as a means of checking the spread of these diseases, especially that of consumption. American and Continental schools are systematically disinfected, not only in the presence of disease, but also as a preventive measure. The Scotch Education Department has adopted the same precautions, and in a Memorandum lately issued epitomises the reasons for doing so in a couple of sentences—" To cleanse a schoolroom properly it is necessary to destroy the germ life as well as to remove the visible dirt. This is why periodic disinfection is advisable, even when no known infectious disease has been present." Under the heading "Schools" I refer to this subject further on. Scarlet Fever.—There were 30 cases of this disease notified during the year, of which Surbiton contributed 12. Tolworth 13, and Hook 5. Twenty-five were removed to the Isolation Hospital, and there were no deaths. They were spread over the entire year, and at no time Was there anything of the nature of 12 an outbreak or epidemic, and in only a few instances was the source of infection traced to contact with another case. Many, indeed most of them, were extremely mild, and it is owing to this attenuation in the matter of virulence and to the added difficulty of diagnosis between mild scarlet fever, roseola, and temporary rashes, that cases run the risk of being labelled scarlet fever when they are not, or of being, as is, I fear, more often the case, altogether overlooked or ignored, and so becoming centres of infection owing to the absence of proper common sense precautions. In the British Medical Journal of October 31st last there appeared a remarkable article by Dr. Milne giving at some length the results of considerable experience in preventive treatment by means of inunction with suitable disinfectants. I was surprised at finding that the subject did not subsequently receive greater notice, because if his experience was confirmed by that of others on a perhaps more extended scale or dealing with more intense cases, then a prospect might be opened up of a more successful and much abbreviated home treatment, or of a greatly diminished stay in Hospital. This is an important, very important matter, viewed in the light of expenditure, for the Isolation Hospital up-keep makes a heavy pull on the pockets of the ratepayers. This method is not 13 a new one, I am aware, but it shall not be lost sight of, and during the present year I shall hope to make myself better acquainted with the subject and its possibilities. Measles.—This disease began to be prevalent in the last quarter of the year, just before Christinas, and has continued over into the New Year, causing a very diminished attendance at all the schools. I should like to draw attention to the false security felt by many of the parents of children affected with measles. These seem to hold the belief that 110 fear need be entertained regarding the ultimate recovery of the little patient, and they often neglect to call in a doctor until some serious condition has arisen which may possibly terminate fatally. I have recently come across several of these cases and I expect the same experience has been met with by other doctors. Measles is now fast becoming a more dangerous disease to children, by reason of its complications, than scarlet fever, which for some years has been taking on a milder type. Measles is now often a disease of great virulence, and it is during convalescence that the more serious complications are apt to arise, and I think that mothers—especially in the poorer classes —should now understand that measles is not necessarily "a mild disease best treated by saffron tea." Enteric Fever.—There were five cases notified of this disease, two of which were 14 employees engaged at the Isolation Hospital, where the disease was presumably contracted, and the other three were from outside. The following are some of the particulars found on investigation. First case—a young man—employed as chauffeur. The drains at the house were examined and found quite in order, but at his place of employment the drains—those of a stable —were defective, and the only water supply was from a cistern supplying, and fixed in, the W.C. It is, of course, impossible to say definitely that this was the cause, because the very nature of the man's calling took him about the country and gave special facilities for contraction elsewhere. The second and third cases were those of father and son living in the same house. The drains were tested and found to be defective inside the W.C. and around the gully, sewage was also found to be leaking into the foundations of the adjoining kitchen. The fourth case was that of a woman newly engaged as cook at the Isolation Hospital. She first of all had pneumonia and subsequently contracted enteric. The fifth, was a young nurse who fell ill at the Hospital, while the three immediately preceding cases were under care there. All of these five cases were treated in the Isolation Hospital, and all recovered. 15 Diphtheria.—More cases than usual this past year, but no semblance of an outbreak or of any common cause. The cases presented the extremes —severe and fatal in a matter of hours and others so mild as to be almost unrecognisable, and if it were not for bacteriological examinations there would in every probability be more of these cases than there are. Unless it be a diagnosis of "rashes," few things are more difficult to determine than whether or no the occasional sore throat is just septic only or has the specific diphtheria germ with its technical name, as its primary cause. Nothing definite seems to be known as to the originating or creative factors in these sporadic or isolated cases, but it is certain that insanitary conditions, filth, dampness and drainage defects, together with personal contact, are the chief predisposing conditions and disseminating causes. There were two deaths belonging to the district out of thirteen cases—one occurred in the Isolation Hospital and one at home, other three deaths were at the Hospital, but they were cases admitted from the Dittonsand Molesey. It should be more generally known that in the case of the necessitous poor, arrangements are in force whereby bacteriological examinations can be made free of charge at the Clinical Research on application at the Council Offices, or on emergency by applying to the Medical Officer of Health or the Sanitary Inspector at their residences. 16 Pulmonary Pathisis. On and after the 1st January, 1909, all cases of Pulmonary Phthisis occurring either in institutions under the Poor Law or in the practice of Poor Law District medical officers will be notified to the Medical Officer of Health of the District in which they reside, and removal will entail this information being passed on to the other Authority. It is distinctly stated that no restraint or interference is to be exercised on the consumptive, who is still at perfect liberty to continue to be a source of danger to those about him, and to move about as he will, so that at present it is not very clear what good is to be derived from this notification of infection; but as a further memorandum is promised shortly, it is perhaps more with a view to obtaining reliable figures as to the number of cases under observation to serve as a basis for further legislation. Tuberculosis. The importance of having a pure milk supply is becoming more and more recognised both by Sanitary Authorities and private consumers. Hitherto the conditions under which cows are kept and milk produced, have been the more considered as bearing on the cleanliness and purity of the milk, but latterly the condition of the cows 17 themselves as regards tuberculosis and health has become a matter of close investigation. It will be remembered that at the International Congress on Tuberculosis, held in London in 1901, Professor Koch stated that as a result of certain investigations made by him, he believed that human and bovine bacilli are different in kind, and the statement was made that the likelihood of human beings becoming infected to any serious degree with bacilli of bovine origin was so slight that it might be regarded as of little practical moment. Naturally the opinion of so eminent a Bacteriologist was widely used by those interested in the matter financially for their own ends. The report of the Royal Commission, however, has disproved the opinion of Professor Koch, and it is hoped will put an end to this erroneous theory which has had such a baneful influence upon the interests of the public health. The Commissioners stated "there can be 110 doubt but that in a certain amount of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacilli of bovine tuberculosis; and there can also be no doubt that, in the majority at least of these cases, the bacilli are introduced through cow's milk. 18 Cow's milk is clearly a cause of tuberculosis, and of fatal tuberculosis in man." In the third interim report of the Royal Commissioners on Tuberculosis, a further most important relationship has been demonstrated. Experiments have been made, and it has been found "that in the case of cows observed to be suffering" from tuberculosis of the lungs or alimentary canal, the excrement has been found to contain large numbers of living and virulent tubercle bailli, and that this, from the point of view of accidental tuberculous contamination of the milk, is much more dangerous than the matter discharged from the mouth and nostrils." The presence of tubercular cows in the cowshed is therefore distinctly dangerous. Some of the bacilli which escape from their bodies in this way are almost certain to find their way into the milk. Milk is a nutritive medium in which a great number of pathogenic micro-organisms grow and multiply. They find easy access to it from the udder of the cow when diseased, from the hands or dress of the milkers when not clean, the atmosphere when polluted by germ-laden dust or effluvia, and by dirty utensils used in dairy work, &c. Consumption is common to man and beast, and the latest researches, as mentioned above, prove to demonstration that it is communicable. When the udder of a cow is affected with 19 losis colonies of the germs of this disease are of course conveyed to the milk at the time of milking, and the milk of this one cow mixed with the milk from other cows may pollute the whole supply of a dairy. The bacillus of tubercle is very tenacious of life, but can readily be killed by boiling, hence one reason—amongst others—why it is so desirable that boiled milk should be used in the nursery and generally. Children, as a rule, dislike boiled milk because of the flavour imparted to it, but that dislike can for the most part be overcome by encouragement, perseverance, and, if necessary, insistence. It is a fact that French children are rarely or never given raw milk, and a little careful thought on the subject of "cooked" versus " raw " milk should soon supply plenty of argument, all in one way, to the mind of the thinker. Of course the deduction from this is, the strictest possible enforcement of the law as to cleanliness and ventilation of cowsheds, the proper grooming of the cows, the cleansing of the udders, and the hands of the milkers, these latter particulars apparently receiving too little attention from cowkeepers. In this district, I am glad to be able to say, for the interest of milk consumers—and that means everyone—the District Council, acting on the advice of the Sanitary Committee and its officers, have hitherto immediately availed themselves to 20 the utmost of all the powers given by law to ensure a good and proper milk supply, and they may be relied upon to continue to do so, but the present powers are not nearly sufficient or sufficiently comprehensive. I have alluded more than once in previous reports to the fact that 50 per cent. of our milk comes from far away country districts in Wiltshire, Dorsetshire, Somersetshire, etc., and where veterinary inspection of cows may or may not be carried out efficiently or otherwise, since the Act that empowers that to be done is permissive and not compulsory, and unless, and until some further legislation is adopted for the purpose of ensuring a pure milk supply little else will be of any use, and for this we must look to Parliament. It has been reported that a Bill dealing with the milk supply is shortly to be introduced by Mr. John Burns, and if that is so, we may be satisified that it will be a step forward, and ensure a considerable gain to the consumer. Vaccination. There is an increasing disposition to take advantage of the clause in the Vaccination Act of 1907. that allows of the "conscientious objector; " and those who do so avail themselves of it invariably show the most astounding ignorance of the subject, and seldom have anything more to fall back upon than rank prejudice. 21 In course of time there will, apparently, be an ever-increasing per centage of unprotected persons for every 1,000 of the population, and these in their turn will probably be the fuel that will have to be consumed in the outbreak of Small Pox that most certainly must sooner or later occur. All this is in strong contrast with the practice in Germany and Japan ; for in these progressive countries, vaccination and re-vaccination are practiced periodically, with the result that Small Pox does not occur, and there are no Small Pox Hospitals. As I believe in keeping alive some little knowledge of the subject, I quote for the information of those residents in the district who may be tempted to stray out of the way of safety, an extract from a recent report. "At the time vaccination was introduced by Jenner, Small Pox caused more than one-tenth of all the deaths of the human race. Fifty million people died in Europe from this disease during the eighteenth century. In the sixteenth century the disease appeared in Mexico, and 3,500,000 of the population died from it in a few years, leaving some provinces almost depopulated. In one year, 1707, in Iceland, 18,000 died, the entire population being but 50,000. In Greenland 70 per cent. (think of it) of the people died of this complaint in 1734." 22 Small Pox is the most fearful disease inflicted on the human race, leaving" on those whose lives it spares the hideous marks of its power, and attacking rich and poor, high and low, alike. Unfortunately these facts are forgotten or really not known, and though, thanks to vaccination, it is now the exception and not, as it once was, the rule to see pock-marked faces at every turn, we are yet, with the help of the law, providing the means for creating victims for future epidemics. The following table, which is now being included by an increasing number of Medical Officers of Health in their Annual Reports, provides some interesting and instructive particulars. Returns of the Vaccination Officer for Surbiton, Hook and Tolworth Districts, 1908. Total births registered 1908 385 Successfully vaccinated 271 Insusceptible 3 Died unvaccinated 22 Removed from district or gone away 12 Cases postponed over the year 12 Certificates granted to '' Conscientious jectors " 45 Unaccounted for 20 N.B. — Many of the unaccounted for are not yet 6 months old. Midwives' Act.—By this Act of 1502 those women then practising as midwives on their own 23 account "for gain" had to be registered and none were allowed to practise unless they came up to a certain standard of knowledge, cleanliness, intelligence, etc., but after 1911 only those will be registered who hold a proper certificate by examination from the Central Midwives' Board or some other legally recognized Authority. In 1907 there were five so practising in this district who between them attended 116 cases or 34.1 per cent. of all the births of that year. Last year these same five attended 132 cases or 34/2 per cent. of all the births registered. They are under the supervision and direction of the Medical Officer of Health and are visited from time to time, their registers and appliances examined, and their work and experiences gone into. They were favourably reported on, but as only one of them is a qualified midwife by examination and the others have no probable prospect of becoming qualified by examination or of being retained on the register at the expiration of the appointed time, it remains still uncertain as to who will then have to take up their work. Mortuary.—Statement of bodies received into Mortuary during 1907 and 1908 : — Year. For Inquests. To await burial. Total. 1907 12 1 13 1908 17 2 19 24 The above table shows the number of bodies received at the Mortuary during' the year. The Mortuary itself and the post-mortem room with all its appliances are in good order, thoroughly clean and always ready. Inquests.—By the courtesy of Dr. M. H. Taylor, H.M. Coroner for the division of Surrey, I have received a return of the inquests held in the district during the year. There were 16 enquiries in all, of which 12 were on cases resident in Surbiton, 2 in Tolworth and 2 on deaths in the Cottage Hospital, these latter belonging. 1 to Peckham and 1 to Kingston. The verdicts returned were :— Deaths from natural causes 9 ,, accidental injuries 3 „ drowning 1 „ suicide-poison 1 ,, want of attention at birth 1 ,, improper feeding 1 16 Schools—The Surbiton Urban District Council is not the Local Authority under the Education Act of 1902. There are five public elementary schools in the district, viz.: St. Andrew's Road Church of England Schools, Hook, Tolworth St. Matthews, Christ Church and the Tolworth Council Schools. A new public elementary school is about to be built at Tolworth 25 as the accommodation there, in view of the extensive building- operations and consequent increase of population, is not at all adequate to the requirements of the district—this is not an addition, but will take the place of the temporary iron building" at present in use—and also tor similar reasons a new Council school for infants has been built and will shortly be opened in the Christ Church district, Alpha Road. The sanitary condition of all these schools has been under the supervision of the sanitary officials, and frequent visits of inspection have been made, as referred to by the Sanitary Inspector in his report, from which it will be seen that as a result of these inspections three of them were found to require attention, in two of these the defects are in process of rectification, while the third is still under the consideration of the school managers. There is, however, one matter that should receive attention from the school managers, and that is the condition of the playground or area immediately surrounding the Hook schools. In the case of all the others, the open spaces are tar paved or asphalted and have been for some years, but that at Hook is most unsuitable, having only a surface dressing' of furnace ashes, and moreover is not properly drained. This is a most necessary work and should be done at the earliest opportunity in the interests of the children attending the school. 26 The health and well-being of school children is now the subject of legislation, and great attention is being paid to their physical and mental conditions with the object of detecting and bringing under suitable treatment the various ailments that, if neglected, prejudice their healthy growth and form serious obstacles to their ability to profit by the education sought to be given them. Of course the daily aggregation of large numbers of children even in the best constructed buildings must and does favour the development and spread of germ diseases, and more attention should be given to the proper cleansing of school, class and cloak rooms. I therefore recommend that for the future, for hygienic reasons, a proper and thorough cleansing of all the occupied rooms, to be followed by a spraying of the walls, &c., with a suitable disinfectant, should be resorted to during the holidays, that is, three times a year, as this will assuredly tend to lessen the extent and severity, and diminish the liability to spread, of the various infective and contagious diseases. Accumulated dust may and does contain the germs of tubercle and ringworm when any of these complaints have been found on children frequenting the schools, besides those of the ordinary infective and notifiable ailments. These methods are in practice in many districts, and the best and most satisfactory results are reported. 27 All these measures come under the heading" of " preventive treatment." The Dust Problem. The greatly increased and increasing motor traffic, not only of pleasure cars but of business cars as well, has caused, and is causing, the "Dust Problem" to reach an acute stage. The dust of itself, especially in urban districts where of necessity it is a foul dust, is a great nuisance, and the evil is intensified when as a consequence doors and windows are more frequently kept closed than heretofore, and the entry of fresh air into dwellings prevented. The various Motor Societies, County and District Councils, Corporations, Surveyors and Engineers, are all busy in experimenting and striving to arrive at some solution of the question ; but in the meanwhile the application of tar in various forms and mixtures, is being extensively used, and with some satisfactory results as to efficiency and cost where properly applied, notably in Kent, and where it fails it is generally due to the want of up-to-date knowledge on the part of the Authority using it. Oil tar applied to road surfaces is considered to have a most beneficial effect in controlling or limiting infantile diarrhoea during the hot summer months, since, when effectively done, it is far more continuous in minimizing and controlling dust than 28 is merely road watering, which, from the necessity of circumstances, must be more intermittent in action. Road dust is a great deal more than a nuisance, it is a very serious matter now-a-days, it prejudicially affects health to a greater degree than the ordinary man suspects, it damages tradesmen's goods, and it deteriorates clothing, especially women's, to an extent that would be difficult to exaggerate. The clouds of dust that are raised by motor cars, and especially by tram cars, constitute a nuisance so injurious to health and well-being, to say nothing of comfort, that the controlling authorities are amply justified, in the public interest, in availing themselves of the experiences of other districts, and in sparing 110 reasonable expense in doing all they can to allay it. It is interesting' to learn from a lecture recently given by the Birmingham City Engineer, Mr. H. C. Stilgoe, that the cost of tar spraying, which amounts to ^d. per square yard, is, he finds, more than recuperated by the greater life of the roads so treated, and the diminished cartage of mud. Two coats of tar give at least six months wear. Sanitary Work.—At the end of the year the number of inhabited houses in the district were :— Surbiton 2,253 Tolworth 928 Southboro 283 Hook 125 3,589 29 and the following table shows the progress of building during the last eight years :— Year. HOUSES BUILT. Total. Surbiton. Tohvorth. 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 1906 35 71 23 129 1907 19 44 5 68 1908 22 42 12 76 Total for 1901 -8 209 541 122 872 Average number of persons per house (1901 census), 5'225. Ambulance.—The wheeled ambulance, which was provided by public subscription as a result of the energy and at the instance of Mr. West, of Victoria Road, and is located in a shed in the railway station yard, has been found of great service and has been used almost weekly for accidents and removals. It is under the care of the Council and is properly cleansed by their men under direction of the Sanitary Inspector after every time of using. Water Supply.—The change from an intermittent to a constant water supply has at last been practically effected by the Metropolitan Water Board though not without a certain amount of friction in many quarters, and the gain, in the end, will no doubt be greatly to the advantage of the consumers. It is, however, very necessary to note 30 that in houses where the cisterns have been retained, and that is so in most cases, the necessity still holds of having these cisterns properly cleansed, never less than twice a year, and perhaps oftener in some cases. Sewerage Scheme. This matter is still in abeyance and nothing definite has so far been settled. A brief narrative of the facts connected with this difficulty will be of interest to all, and an information to most of our latest residents. Originally, Surbiton, like Kingston and all riparian towns, sent their crude sewerage into the Thames, and likewise drew tlieir drinking water therefrom. As time went by, and population increased ; and as we also came to know much more about the sources of disease and that many of them were water-borne, it was obvious that one at least or both of these systems must be altered, either that the sewage must be taken elsewhere if the river water was to be used for dietetic purposes, or that a new and separate supply of water must be found for all the towns on its banks if the Thames and its tributaries were to be used as conduits to convey the sewage to the sea. When public attention was first directed to this matter, considerable stress was laid on the great waste of fertilising organic matter that was 31 being thrown away, and sewage farms and treatment came under discussion. It was then that a Board was formed, and representatives of all towns from Barnes, Mortlake and Isleworth upwards, on both sides of the river, including Teddington, Richmond and Kingston to Hampton, united under the imposing title of the lower Thames Valley Main Sewerage Board. It held many meetings, and went into the merits of many plans, and after holding the field from 1877 to 1885, and having presented many lengthy and exhaustive schemes for enquiry, was finally dissolved by Act of Parliament without having done anything whatever of practical value towards solving the question under consideration, as unanimity or anything like it was never attainable. * Then Kingston evolved a scheme of its own to which we ultimately become a contributor. Surbiton entered into an agreement with Kingston for the treatment of its sewage for a term of twentyfive years, which came into being on the 1st July, 1887, and will expire on the 30th June, 1912. The first essential work was the collection of the sewage of the entire district, for at that time, Tolworth, Hook and Southborough formed a separate special drainage district within the area of the Kingston Rural Sanitary Authority, and they devised the idea of, and started, the present Tolworth Sewage Farm ultimately taken over by Surbiton. 32 To effect this collection, Surbiton, at a cost of between £5000 and £6000, constructed an iron outfall sewer '27 inches in diameter, starting from the boundary of the District in Portsmouth Road, midway between Catherine and Uxbridge Road, and passing along the Portsmouth Road, through the Kingston Market Place and Thames Street, to the sewage works. The agreement between the two places was that Surbiton should pa)' a fixed charge of £300 per annum, then 2| per cent, on €27,357, which represented the original capital outlay, and a proportion according to the rateable value of the cost of treatment, maintenance and repairs; also the sum equal to the product of a rate of 3d. in the pound on the rateable value, and these charges for some years worked out at something over £3,000 per annum until 1901, when a fresh agreement was entered into to meet the cost of extra pumping consequent upon the amount of sewage delivered at the works when swollen with storm, water being in excess of the maximum agreed upon the involving additional and continuous pumping, and to meet this another £600 a year had to be paid, so that at present the total cost works out at from £3,800 to £4,000 a 3Tear. The next thing was that Mr. Guilford, who was Chairman of this Council from 1887 to 1896, was instrumental with the Council in acquiring some 52 acres of ground in Maiden Parish, along 33 the banks of the Maiden stream, with a view to ultimate possibilities as to sewage works, a forcible reason for this being that Kingston had, shortly before been putting forward the argument at the Incorporation Inquiry that, as they treated our sewage, it was a justification for incorporation with them. This was stoutly repudiated, and to protect ourselves, the then Board consequently thought it wise to acquire this land. Time went on, and as it drew nearer to the expiration of the agreement with Kingston, steps began to be taken to formulate a plan for the treatment of our own enlarged district by ourselves at our own cost, and eventually an engineer was selected, land provisionally obtained at Tolworth Court, on the banks of the Maiden river, and the proposed plan and site became the subject of a Local Government Board Inquiry in February 1907. This plan was finally set aside by the upper Board mainly on the ground of cost, and a refusal to allow the effluent to be discharged into the stream. Next, an enquiry was held in February 1908, as to the merits', or otherwise, of a site in the Lower Marsh Lane, a site that had been indicated by the Local Government Board, and which had also been considered and reported on bv the late Mr. Mather, a former Surveyor to the Council. The land in Maiden Parish was not now available as building operations had developed in its proximity, but it has immensely increased in value 34 and is now an asset of considerable worth. The result of this was that the site was approved, and the engineer was set to work to produce a scheme. This scheme was, in the end, submitted to the Local Government Board and formed the subject of an inquiry in November last, when there was developed some sharp criticism and opposition to it on certain specific grounds. After a very long wait, the Local Government Board, without absolutely rejecting the scheme, allowed it to be clearly understood that it withheld its sanction in its then present condition. The scheme is now referred back to the Engineer for amendment, and the future is, so to speak, "in the lap of the Gods." The report of the Sanitary Inspector, Mr. Nesfield, is appended to this, and I must again mention to the Council my very high appreciation of his painstaking and able work which is increasing considerably year by year with the growth of the district and the adoption of new Acts and Regulations. Also my sincere thanks are due to all my brother Officers for their courteous and ready assistance at all times when required. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, M.D., D.P.H., Medical Officer of Health. April 3rd, 1909. 35 SANITARY INSPECTOR'S ANNUAL REPORT. To the Medical Officer of Health. Sir, I beg" to submit my Thirteenth Annual Report upon the work carried out in the Sanitary Department during the year ending December 31st, 1908. Summary of Work Done. Number of houses and premises inspected 255 ,, houses and premises re-inspected 361 ,, miscellaneous inspections 49 „ visits to works in progress 1561 „ ,, bakehouses 42 ,, „ slaughter houses 46 ,, ,, dairies, cowsheds and milkshops 65 „ ,, factories 9 ,, ,, workshops 46 ,, „ home workers' premises 7 ,, ,, workplaces 3 „ ,, re cases of infectious disease 89 ,, drains examined under section 41 of the Public Health Act, 1875 58 ,, drains tested with water 171 ,, ,, ,, smoke or air 175 ,, complaints received and investigated 130 ,, preliminary notices served 155 ,, statutory notices served 130 36 ,, letters written on the business of the department 800 ,, houses and premises disinfected 48 Number and Nature of Nuisances dealt with. Defective drains cleansed, repaired, trapped, etc. 39 Stoneware gullies fixed in lieu of defective brick and iron bell traps 173 Houses subsoil drained 4 Water-closet apartments re-built ' 4 Water-closet apartments lighted or ventilated 3 Water-closet pans cleansed or repaired 5 Old iron container and long hopper pans abolished and pans of an approved form fixed 135 Water-closet flush pipes disconnected from domestic supply cisterns and separate flushing cisterns fixed 26 Closets supplied with water 6 Defective water-closet flushing cisterns repaired 67 Defective flushing cisterns removed and new ones fixed 50 Soil pipes repaired 11 New soil pipes fixed 50 Soil pipes inside dwelling-houses removed and fixed outside 2 Soil pipes ventilated 1 Defective ventilating pipes repaired 5 Storage cisterns cleansed 7 Storage cisterns provided with covers 7 Storage cisterns (new) provided 1 Sink and other waste pipes trapped or disconnected from drain 30 Sink and other waste pipes repaired 12 Defective sinks abolished and new glazed stoneware sinks fixed 22 New waste pipes provided to sinks, etc. 73 37 Rainwater pipes disconnected from drains or soil pipes 68 Defective rainwater pipes repaired 70 Defective eaves gutters repaired 10 Houses and premises provided with eaves gutters 13 Defective roofs made watertight 6 Public-house urinals re-constructed 2 Sites of houses concreted to prevent dampness 2 Dirty houses cleansed and whitewashed 38 Accumulations of manure, etc., removed 12 Yards cleansed 13 Nuisances from animals improperly kept abated 5 Defective floors repaired 4 Houses provided with a supply of water 1 Smoke nuisances abated 2 Total 979 Overcrowding of Dwelling-Houses. During the year one house was found to be overcrowded so as to constitute a nuisance likely to be injurious to health. The nuisance was abated on a preliminary notice being served. Dust Receptacles. Under Section 36 of the Public Health Act, 1875, the Council have power to compel owners of property to provide each house with a sufficient ashpit of an approved pattern. In accordance with this Section, portable galvanized iron dustbins have been provided to 38 twenty houses where the existing ashpit was in a bad state of repair, or where no ashpit previously existed. Paving of Yards. As a result of Notices served under Clause 89 of the Council's Byelaws, the yards, and where necessary, the side passages, of thirty-five dwelling houses have been paved with concrete or other durable and impervious material. The Council have power under this Bye-law to require the owner of any dwelling house with which there is any yard or open space, to pave the whole or part of such yard or open space, if it is necessary to prevent or remedy insanitary conditions. The Bye-law came into force in this District in August 1898. Since that date the yards and open spaces of 458 dwelling houses have been dealt with. Drainage. During the year the Council gave instructions in 58 instances for the ground to be opened and the drains examined under the provisions of Section 41 of the Public Health Act, 1875. The drains examined were, with two exceptions, found to be defective, and notices were served upon the persons responsible to repair or reconstruct the drains as occasion required. 89 Two single private drains, one receiving the drainage of four houses and one the drainage of o o two houses belonging to different owners, and the drains of eleven houses have been re-laid by the Council in default of the owners complying with the notices served. Combined drains, used for the drainage of three blocks of houses, each block belonging to the same owner, have been re-laid at a cost to the Council of £79 12s. 7d., each drain being a sewer within the meaning of Section 4 of the Public Health Act, 1875. Owing to a report I made upon the insanitary condition of the drainage of a private school, the Council considered it desirable that the drains belonging to all schools, both public and private, should be examined and tested annually, and they instructed the Clerk to write to the managers and owners of the various schools asking for their permission for the Sanitary Inspector to make such examination. There are five public elementary and fourteen private schools in the district. The managers of all the public elementary schools and seven of the owners of the private schools gave their consent. Six did not reply to the letter sent, and one, the principal of a girls' school refused, but at the same time stated that she preferred her own Surveyor to make the 40 examination. The drains belonging to this school were subsequently examined and tested by her own Surveyor and were found to be defective, and instructions were given for them to be re-laid and brought up to date. When the drains were exposed they were found to be constructed of half tiles and not connected with the sewer. The sewage passing down the drains had for years been escaping out of the defective pipes and joints into the ground. The drains belonging to the public elementary schools were all examined and tested. Two were found to be satisfactory, one slightly defective, and two so defective as to constitute a nuisance. A report upon the condition of the drains and the work necessary to put them into a satisfactory sanitary condition was sent to the Managers in each case. In two instances the remedial works are in progress, and in the third my report which has only just been submitted to the Managers is having- their consideration. Of the seven private schools whose owners agreed to the drains being tested, the drains of three were found to be so defective that it was necessary to re-lay them throughout. At one school a defective sanitary convenience was found and was subsequently put in order. The necessary work of re-laying" the drains at two of these J J O schools has been carried out and in the third case 41 the owner who has only just received my report., has informed me that arrangements are being made for the work to be commenced as early as possible. The results attained by the tests that have been carried out prove the importance and utility of the Council's resolution. A great responsibility rests upon those owners of schools, who, by not replying to the Clerk's letter, have not complied with the Council's request. I strongly recommend that the Clerk be again instructed to write to such owners pointing out to them the great importance of the matter and again asking them to give the necessary permission for their drains to be examined, both in their own interests and in the interests of public health. Altogether the drains of 81 houses and premises have been entirely reconstructed and brought up to date, and 39 drains have been cleared from obstruction or repaired. In every case where a house has been redrained, a plan of the drains has been prepared, and filed in the office for future reference. All drains re-laid are tested with water, and the soil pipes and internal sanitary fittings with smoke or air 011 completion of the work. During the year 171 water tests have been applied to drains and 175 smoke or air tests have been applied to soil pipes, ventilating pipes, etc. 42 Factory and Workshop Act, igoi. There are 205 workshops and workplaces now on the register, compared with 200 at the end of 1907. One hundred and seven inspections were made during the year to ascertain that the various premises were kept in accordance with the provisions of the Act. The following sanitary defects were discovered and remedied, viz.:— Separate closet accommodation for the sexes provided 1 Defective drains repaired 2 Defective pans in w.c.'s removed and new ones fixed 2 Defective flushing cisterns in W.c.'s removed and new ones fixed. 2 Filthy W.C. pans cleansed 1 New seat provided to W.c. pan 1 W.C. flushing cisterns repaired 4 Defective soil pipe removed and new one fixed 1 14 The Factory Inspector notified one Factory which was not provided with a sufficient number of sanitary conveniences. The owner's attention was at once drawn to this fact, and he has promised to provide the additional conveniences. 48 Bakehouses. There are 14 bakehouses now on the register, one of which is situated underground. They have all been inspected at least twice during the year and generally speaking were found to be well kept. Notices had, however, to be served to repair one defective drain, cleanse one dirty w.c. pan, repair one defective w.c. flushing cistern, and cleanse one dirty floor. Slaughter Houses. Thersare only six registered slaughter houses in the district, none of which are very much used. They have all been regularly inspected and have generally been found to be well kept. One slaughter house was found to be in a dirty condition, but was cleansed 011 the service of a preliminary notice. Food Supply. During the year frequent visits have been paid to the various shops and premises where articles of food, meat, etc., are sold or prepared for sale. Six rabbits and four ducks have been destroyed as unfit for food. 44 Dairies, Cowsheds and Milkshops. During- the year one person applied to be registered as a Cowkeeper and Purveyor of Milk, and nine persons as Purveyors of Milk. All their applications were granted. One person carrying on the business of a Dairyman and Purveyor of Milk, and two carrying on the business of Purveyors of Milk, have discontinued their businesses, having sold them to a larger firm who carry on the business of Cowkeepers, Dairymen and Purveyors of Milk within the district. Two Purveyors of Milk, residing in the district, have transferred their businesses to other persons. At the end of the year the register contained the names of Persons who carry on the business of Cow- keepers and Purveyors of Milk 3 Cowkeepers, Dairymen and Purveyors of Milk 3 Dairymen and Purveyors of Milk 5 Purveyors of Milk 11 Purveyors of Milk who reside outside the district but retail Milk within the boundary 8 Total 30 The dairies, cowsheds and milkshops in the district have been inspected quarterly and at irregular periods as occasion required. In two 45 instances it has been necessary to call the attention of cowkeepers to their neglect in keeping the udders and hind quarters of their cows clean. At another cowshed the floor was found to be defective, and a preliminary notice had to be served before it was repaired. The average number of cows found to be kept in the registered cowsheds during the year was 231, all of which have been inspected quarterly and at irregular periods as occasion required by the Council's Veterinary Inspector. In no cowshed has any cow been found to be suffering from Tuberculosis of the Udder or of Generalised Tuberculosis. A few cases of simple eruptive disease of the teats were found, and where they were likely to affect the milk the infected cows were isolated and the milk destroyed until the Veterinary Inspector certified the cows were well and the milk fit for human consumption. Disinfection. The disinfection of houses where cases of infectious disease have occurred has been carried out by the staff of the Sanitary Department under the supervision of the Sanitary Inspector. All articles of clothing and bedding have been removed to the Tolworth Isolation Hospital in a covered van, and after being disinfected in a Manlove, Alliot & Co.'s high pressure steam apparatus 46 by the Hospital staff, have been returned in another van to the owners. The walls and ceiling's of the infected rooms and all furniture and other articles left in the rooms have then been sprayed with a solution of Formaline or fumigated with Formaline gas. Notice, where necessary, has been sent to the owners of the infected premises, to strip and cleanse thewalls, whitewash theceilings and wash the floors and other woodwork with a suitable disinfectant. All necessary disinfectants has been supplied by the Council free of charge. In no case has it been found necessary for the Council to execute the work in default of the owners complying with the notices served. Persons upon whom notices have been served, have generally given instructions within a few hours of receiving the notice for the work to be done. The drainage, water supply and sanitary arrangements at houses where cases of infectious disease have occurred have been inspected, and any defects found at once brought to the notice of the persons responsible together with a request that they should execute the necessary remedial works forthwith. During the year 48 premises, in which 53 cases of infectious disease have occurred, have been disinfected upon the removal, recovery or death of the patient. 47 Of these, 29 were in consequence of Scarlet Fever ; 12 of Diphtheria ; 4 of Typhoid Fever ; 2 of Erysipelas ; 5 of Consumption ; and 1 of Measles. Disinfection has also been carried out after one case of Cancer, one of Scabies, and one of Septic Poisoning, at the expense of the occupiers of the premises in which the cases occurred and on their application for the work to be done. One cab was disinfected which had conveyed a person suffering from Scarlet Fever. The following articles of bedding, clothing, etc., have been disinfected in the steam disinfector at the Tolworth Isolation Hospital : — Beds 23 Mattresses 70 Palliassses 32 Bolsters 43 Pillows 116 Sheets 75 Blankets 172 Counterpanes 46 Carpets 69 Rugs 27 Cushions 44 Toilet covers 80 Towels 38 Wearing apparel 1274 Curtains 108 Blinds 26 Sundries 237 48 Bed valances 15 Quilts16 Pillow cases 71 Mattress covers 11 Total 2593 Legal Proceedings. Legal proceedings were taken before the Magistrates against the owners of Nos. 67 and 68, Cleaveland Road, to recover the sum of £27, the cost of reconstructing the drainage ; and also against a purveyor of milk residing outside the district who was retailing- milk in the district without being- registered. o O In the first case the Magistrates made an order for the payment of the amount claimed, together with £10 10s. od. costs; and in the second, the defendant was fined 5/- and £1 is. od. costs. I am, Sir, Yours obediently, W. NESFIELD, A.R.San.I. 20th March, 1909. Sanitary Inspector. 49 Table 1. Vital Statistics of Whole District during 1908 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births registered Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 14164 311 21.95 40 128.6 179 12.56 15 10 5 174 12.2 1899 14458 296 20.47 23 77.7 164 11.34 17 8 7 163 11.2 1900 14732 295 20.02 29 98.3 168 11.4 14 5 13 176 11.9 1901 15017 324 21.57 24 74.07 152 10.12 19 9 15 158 10.52 1902 15386 288 18.7 34 118.0 157 10.2 13 5 17 169 10.9 1903 15703 351 22.3 36 102.5 149 9.4 11 5 19 163 10.3 1904 16460 347 21.0 41 118.1 178 10.8 20 24 195 11.8 1905 16916 321 18.9 18 56.07 134 7.9 15 10 18 142 8.4 1906 17367 356 20.4 36 101.0 135 7.7 13 4 22 153 8.8 1907 17639 341 19.3 22 64.5 142 8.05 13 11 12 143 8.1 Averages for years 18981908. 15784 323 20.5 30.3 93.8 155.8 9.9 15 7.4 15.2 163.6 10.4 1908. 18747 385 20.5 27 70.1 177 9.4 12 5 17 189 10.08 * Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. The "Public Institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made should be given on the back of this Table. Total population at all ages, 15017. Number of inhabited houses, 2874. At Census of 1901. Average number of persons per house, 5 225. Area of District in acres (exclusive of area covered by water), 3026. I. Institutions within the District receiving sick and infirm persons from outside the District. Surbiton Cottage Hospital. Isolation Hospital. Frascati Nursing Home. II. Institutions outside the District receiving sick and infirm persons from the District. Brookwood Asylum. Union Infirmary, Kingston. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. None Table II. Vital Statistics of Separate Localities in 1908 and previous Years. 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. 1898 10766 214 138 41 2014 67 19 5 1382 30 17 4 1899 10869 185 119 15 2162 71 20 8 1416 40 22 1 1900 10972 191 129 18 2310 68 23 7 1450 36 11 4 1901 11075 195 117 12 2458 94 30 10 1484 35 11 2 1902 11214 158 128 21 2643 104 35 13 1529 26 6 0 1903 11339 182 123 22 2798 126 30 9 1566 43 10 5 1904 11557 181 129 99 3280 124 48 15 1623 42 18 4 1905 11665 157 104 10 3556 131 30 7 1695 38 8 1 1906 11787 172 94 14 3804 138 44 17 1776 46 15 5 1907 11863 159 96 10 3980 139 29 10 1796 43 18 2 Avgs. of yrs. 1898 to 1907. 11311 179 4 117.7 18.5 2900 106.2 30.8 10.1 1571 37.9 13.6 2.8 1908 11772 192 119 14 4848 148 49 9 2127 45 21 4 Table III. Cases of Infectious Disease notified during the year 1908 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 Tolw'rth Hook & S'tliboro'. Surbiton Tolw'rth Hook V S'thboro'. Small-pox Cholera Diphtheria(including Membranous Croup) 13 ... 2 7 2 2 7 6 ... 7 4 ... Erysipelas 7 ... ... 1 1 4 1 4 1 2 ... ... ... Scarlet Fever 30 ... 5 18 3 4 12 13 5 10 13 2 Typhus Fever Enteric Fever 5 ... ... 1 1 3 1 4 ... 1 4 ... Relapsing Fever Continued Fever Puerperal Fever Plague Totals 55 ... 7 27 7 13 1 24 24 7 18 21 2 TABLE IV. Causes of, and Ages at, Death during Year 1908. Causes ok 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 & under 15. 15 & under 25. 25 & under 65. 65 & upwards Surbiton. Tolworth. Hook&S'thbro' Small-pox Measles 1 ... 1 ... ... ... ... 1 ... ... Scarlet fever ... ... ... ... ... ... ... ... ... Whooping-cough 1 ... 1 ... ... ... ... ... 1 ... Diphtheria and membranous croup 2 ... 1 1 ... ... ... 1 1 ... 4 Croup Fever:— Typhus Enteric ... ... ... ... ... ... ... ... ... Other continued Epidemic influenza 3 ... ... ... ... ... 3 3 ... ... Cholera Plague Diarrhœa 4 3 ... ... ... ... 1 2 1 1 Enteritis ... ... ... ... ... ... ... ... ... Puerperal fever Erysipelas ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 7 ... ... ... 1 5 1 5 2 ... Other tubercular diseases 6 2 2 1 1 ... ... 2 3 1 Cancer, malignant disease 11 ... ... ... ... 6 5 10 ... 1 Bronchitis 21 ... 1 ... ... 3 17 10 4 7 Pneumonia 15 1 1 1 1 5 6 10 3 2 1 Pleurisy 2 ... ... ... ... ... 2 1 ... 1 Other diseases of Respiratory organs 3 1 ... ... ... 1 1 2 1 ... Alcoholism: Cirrhosis of liver 8 ... ... ... ... 3 5 5 2 1 Venereal diseases Premature birth 9 9 ... ... ... ... ... 3 5 1 Diseases & accidents of parturition ... ... ... ... ... ... ... ... ... Heart diseases 28 ... ... 1 2 12 13 19 8 1 Accidents 3 ... ... ... ... 3 ... 1 1 1 2 Suicides 1 ... ... ... ... ... 1 1 ... ... All other causes 64 11 1 3 3 19 27 43 17 4 5 All causes 189 27 8 7 8 57 82 119 49 21 12 TABLE V. Surbiton Urban District. INFANTILE MORTALITY DURING THE YEAR 1908. Deaths from stated Causes in AVeeks and Months under One. Year of Age. 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 6 1 2 6 15 3 2 3 1 1 1 1 27 Common Infectious Diseases: Small-pox Chicken-pox Measles Scarlet fever Diphtheria: Croup Whooping Cough Diarrhœal Diseases: Diarrhoea, all forms ... ... 1 1 2 ... ... ... ... ... 1 ... ... ... ... ... 3 Enteritis, Muco-enteritis, Gastro-enteritis Gastritis, Gastro-intestinal Catarrh. ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Wasting Diseases: Premature Birth 5 1 1 2 9 ... ... ... ... ... ... ... ... ... ... ... 9 Congenital Defects ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk, Starvation Atrophy, Debility, Marasmus ... ... ... 1 1 3 ... ... ... ... ... ... ... ... ... ... 4 Tuberculous Diseases: Tuberculous Meningitis Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 Other Tuberculous Diseases Erysipelas Syphilis Rickets Meningitis(no Tuberculous) Convulsions ... ... ... 1 1 ... 2 1 ... ... ... ... ... ... ... ... 4 Bronchitis Laryngitis Pneumonia ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Suffocation(overlying) Other Causes ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 6 1 2 6 15 3 2 3 1 1 1 1 27 District (or sub-division) of Surbiton. Births in the year Legitimate, 375. Illegitimate, 11. Population, estimated to middle of 1908, 18747. Deaths from all Causes at all Ages. 189. Deaths in the year of Legitimate Infants, 24. Illegitimate Infants, 3. Report on the Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces and Homework. 1. INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 9 1 Nil. Workshops (including Workshop Laundries) 88 9 ,, Workplaces (Other than Outworkers' premises included in part III. of this Report) 3 2 „ Total 100 12 ,, 2. DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspect'i (1) (2) (3) (D (5) Nuisances under the Public Health Acts: Want of Cleanlinesss 2 1 - - Want of Ventilation Overcrowding Want of drainage of floors Other Nuisances 4 4 - - Sanitary accommodation Insufficient 9 Unsuitable or defective 12 12 - - Not separate for sexes 1 1 - - 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) Other Offences (Excluding offences relating to outwork which are included in Part III. of this Report) Total 21 18 Nil. Nil. 3. HOME WORK. Nature of Work. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Inspections of Outworkers* Premises. Lists. Outworkers. Contractors. Workmen. Making and Altering Wearing Apparel 10 6 21 1 7 4. REGISTERED WORKSHOPS. Workshops on the Register (s. 131 at the end of the Year. Number. (1) (2) Important Classes of Workshops, such as Workshop Bakehouses, may be enumerated here. Bakehouses 14 Dressmakers 33 Bootmakers 28 Laundries 17 Tailors 17 Milliners 15 Other Trades 81 Total number of Workshops on the Register 205 5. OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) ' Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector Other Nil. Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 1