SUR 048 ANNUAL REPORT OF THE Medical Officer of Health OF THE Surbiton Urban District Council, 1910. BY OWEN COLEMAN, M.D., M.R.C.S.E., Medical Officer of Health; Fellow of this Incorporated Society Medical Officers of Health; Fellow of the Royal Institute of Public Health. SURBITON. Surbiton Times Printing Works, Berry land- Road, Surbiton Hill. 1911. The Urban District Council of Surbiton SANITARY COMMITTEE, 1910-1911. Chairman: W. Sanger, Esq., B.A. The Chairman of the Council: Rev. A. E. Beavan, M.A. The Vice-Chairman of the Council: W. M. Willcocks, Esq. Messrs. Edsell, Hawkey, „ Hepworth, „ Mence, „ Orlopp, Messrs. palmer, „ Parry, „ Ray, „ Ribbins. Medical Officer of Health: Owen Coleman, M.D., D.P.H. Sanitary Inspector: W. Nespield, A.R.San.I. The Urban District Council of Surbiton 1910-11. GENERAL STATISTICS. Area of Urban District (exclusive of water) Acres 8,081 Rateable Value £188,274 Produce of Penny Rate £631 Population 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 1910, Estimated 18,850 Density of Population per Acre 6.2 Number of Inhabited Houses at Middle of 1910 3,581 Death Rate 1910, per 1,000 Persons living 7.5 Average Death Rate for previous 10 years 10.0 Death Rate from Seven Chief Epidemic Diseases 0.26 Birth Rate 1910 17.6 Average Birth Rate for previous 10 years 20.1 Infant Mortality Rate (under 1 year old) per 1,000 Births 75.3 Average Mortality Rate (under 1 year old) per 1,000 Births for previous 10 years 88.0 Vital Statistics for 1910. The following are the provisional figures showing the birth-rates and death-rates in England and Wales in the year 1910:— Annual Rates per 1,000 living. Deaths under One Year to 1,000 Births. Births. Deaths. Principal Epidemic Diseases. England and Wales 24.8 13.4 0.99 106 77 great Towns 25.0 13.4 1.23 115 136 small Towns 23.7 12.4 0.88 104 England and Wales, less the 213 towns 25.0 13.6 0.74 96 Surbiton 17.6 7.5 0.26 75 Surbiton Urban District Council. Thirty-Fourth Annual Report OF THE MEDICAL OFFICER OF HEALTH, 1910. Mr. Chairman and Gentlemen, I have again the pleasure to present to you my Annual Report on the health and sanitary condition of the district under your care during the past year 1910. Speaking in general terms, it has been an unusually healthy year both as to mortality and sickness, especially the latter, and for this we are mainly indebted to the cool wet summer with a comparative absence of dust, scarcity of flies, and very few cases of summer diarrhoea. 5 Vital Statistics. Population.—At the Census in 1901 the population of the whole district was 15,017, and since that date an estimate has yearly to be made as a basis on which to calculate the gross birth and death rates, and this becomes increasingly difficult as the years go by, until towards the end of the decennial period there is so much doubt about it that from a desire to be on the safe side it is more than likely that the estimate formed is below that of the real population. Taking the year now under discussion (1910), which is the last of the cycle, if I have formed too large an estimate, then my death-rate will be found to be too low, but ir my estimate of the population is lower than what will be shown at the Census, to be taken next month (April), then the death-rate will prove to be too high, and low as it is for this year it will be made still lower. As soon as we get the early official statement I shall, if it be necessary, re-cast the rate and report it to the Council at the earliest opportunity. The estimate of population for 1908 was 18,747, and for 1910 it is placed at 18,850, so that the addition made is only just over 100 in the two years. The average number of persons per house at the Census was given at 5.225, and that is largely depended upon as a factor in determining the population, but 6 as there has been a considerable falling off lately in the number of new houses built, that is a chief reason why so small an addition has been made during the last three years. It is reported to me that during the first six years of the decade the average number of houses built was 121 per annum, but for the last four years the average number fell to 59 each year. However, we have but a short time to "wait and see," and then we can start once again on a reliable basis. Deaths.—The total number of deaths registered during the year within the district amounted to 135, and these included all the deaths occurring in the Isolation Hospital and the Cottage Hospital; this gives a death rate of 71 per 1,000 in comparison with a rate of 9.09 for the year before and of 9.4 as the average of the 10 preceding years. The corrected death rate is reckoned by excluding the deaths of non-residents in the local public institutions, amounting to 12, and adding to the balance so obtained the deaths of Surbiton residents that took place in similar institutions beyond the district; these amounted to 19, being made up of 18 in the Union Infirmary and 1 from an asylum at Epsom, thus bringing the total to 142, and these figures give the annual death rate as 7'5 per 1,000 of the population, estimated as being 18,850, which is the nett or corrected death rate for 1910. 7 The nett death rate for 1909 was l0.l, and the average for the ten preceding years was 10 0 per 1,000. This is therefore by far the lowest death rate ever recorded, but, as I have already intimated, it may have to be modified when the Census returns are published. Of the non-resident deaths, there were 11 in the Isolation Hospital, being 8 from diphtheria and 3 from scarlet fever, and in the Cottage Hospital 1, making together the total of 12. These returns were all forwarded to, and are included in, their respective districts, which are Esher are The Dittons, and Molesey. Of the 142 deaths registered, 32 represent those of 70 years and over, that is to say, 22.5 per cent. of the deaths of the year. Of these, 22 were females and 10 males, one woman being 90 years old. The deaths under one year of age were 17.6 per cent., so that 40.1 per cent. of the annual deaths were contributed by the very young and the very old. Births.—There were 332 births registered during the year, which is the lowest number but one for the last seven years, and gives the lowest birth-rate during the decade, 17.6. The average number of births during the ten previous years was 335 and the average birth-rate 20.1, so there is a considerable falling off. A comparison 8 of the birth-rates for the preceding ten years will be found in Table I. at the end of this report. The number of deaths registered as having taken place in the district last year being 135, the natural increase, that is, the difference between the total number of births and the total number of deaths would cause an addition to the population of 197. The following Table shows that the natural increase for the previous ten years has been as follows:— Year. Births. Deaths. Increase. 1900 295 168 127 1901 324 152 172 1902 288 157 131 1903 351 149 202 1904 347 178 169 1905 321 134 187 1906 356 135 221 1907 341 142 199 1908 385 177 208 1909 346 171 175 Average for years 1900 to 1909 335 156 179 1910 332 135 197 The natural increase is, therefore, considerably above the average for the last ten years, but this is due, not to a high birth-rate, but to an exceptionally low death-rate. 9 These births occurred in the three subdistricts as follows:— Hook and Surbiton. Tolworth. Southborough. 159 137 36 Of these 332 births, 159 were males and 173 females. Of the 159 males, 3 were illegitimate, and of the 173 females, 3 were illegitimate. The birth-rate was therefore 17.6 or 2.5 below the average of the preceding ten years, while the birth-rate for England and Wales was 24.8. BIRTHS SURBITON URBAN DISTRICT Surbiton. Tolworth. Hook and South borough. Totals. Total. Boys Girls Hoys Girls Boys Girls Boys Girl January 7 4 9 4 1 4 17 12 29 February 7 3 6 4 0 2 13 9 22 March 9 11 8 7 2 2 19 20 39 April 6 6 7 6 5 0 18 12 30 May 6 9 4 6 3 2 13 17 30 June 5 8 3 7 1 2 9 17 26 July 5 4 2 9 1 2 8 15 23 August 4 10 8 3 0 2 12 15 27 September 3 10 8 6 1 1 12 17 29 October 11 5 2 5 0 1 13 11 24 November 6 5 6 7 1 0 13 12 25 December 5 10 5 5 2 1 12 16 28 74 85 68 69 17 19 159 173 332 159 137 36 332 10 Mortuary.—Statement of bodies received into Mortuary during the last 4 years:— Year. For Inquests. To await burial. Total. 1907 12 1 13 1908 17 2 19 1909 13 4 17 1910 6 0 6 The Mortuary itself and the post-mortem room with all its appliances are in good order, thoroughly clean and always ready for use. Inquests.—There were seven inquests held during the year, and verdicts of "due to Natural Causes" were returned in five, and to "Accident" in two. Zymotic Diseases.—The seven principal zymotic diseases, with the mortality from each during the year, were:—Small pox, 0; measles, 0; scarlet fever, 1; whooping cough, 3; diphtheria, 0; fever (typhus, enteric, and continued), 0; diarrhoea, 1; making a total of 7 deaths from this group. The death rate, therefore, is only 0'26, about as low a rate as could ever be expected in a population of this extent. The rates for various sections of England and Wales will be seen on the first page of this Report under the heading 11 of General Statistics. Epidemic influenza caused 2 deaths. Infectious Diseases (Notification) Acts, 1890 to 1910. EXTRACT FROM NOTIFICATION REGISTER. Scarlet, Fever. Diph. theriaand Memb. Croup. Enteric Fever. Puerperal Fever. Ery sipelas. 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 *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 *1909 30 21 2 0 9 0 0 62 *1910 29 8 8 0 7 0 0 47 *The combined Districts. Hospital Accommodation. (a) For Notifiable Infectious Fever Cases— Tolworth Isolation Hospital. (b) For Small-pox—Surrey County Council Hospital at Clandon for this and other districts. 12 (c) Accidents, Illness, &c.—Surbiton Cottage Hospital; Union Infirmary, Kingstonon-Thames. (d) For the Insane—Surrey County Asylum at Brookwood; ditto at Netherne, Merstham. Table Showing the Number of Cases and Deaths Respectively of the Three Principal Notifiable Diseases since the Infectious Diseases Notification Act has been in Force. Years. Scarlet Fever. Diphtheria. Typhoid. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1890 3 0 36 8 1 0 1891 3 0 21 10 1 0 1892 4 0 16 1 3 0 1893 94 3 23 3 5 8 1894 9 0 20 3 12 2 1895 18 0 12 1 5 2 1896 27 2 9 2 4 0 1897 16 0 9 1 2 1 1898 13 0 6 1 2 0 1899 48 0 2 1 7 2 1900 15 0 22 2 2 0 1901 59 0 47 8 2 0 1902 22 0 19 3 2 0 1903 58 2 9 1 6 1 1904 22 0 10 0 4 0 1905 72 1 3 0 2 0 1906 41 0 7 1 2 1 1907 25 0 15 0 2 1 1908 30 0 13 2 5 0 1909 30 0 21 3 2 0 1910 29 1 8 0 b 0 13 Incidence of Scarlet Fever, Diphtheria and Typhoid Fever during 1910. Scarlct Fever. Diphtheria. Typhoid Fever. January 5 - - February 1 — - March 1 2 - April 4 - - May 2 2 - June 2 - - July 1 2 - August — - — September 2 — - October 1 1 3 November 7 — - December 3 1 - Totals 29 8 3 Scarlet Fever.—There were 29 cases of this disease notified as having occurred during the year, and the Table of Notifications will show the favourable relation which that number bears to those of previous years, but though these cases are comparatively few, and though the type, in common with the experience of the greater part of the country, is now far more beneficent than in former years, yet it is somewhat discouraging to notice the way in which these cases are distributed throughout the year, and that with one solitary exception, the month of August, notifications were made regularly every month. There was no outbreak, no tracing of a small parcel of cases to a "return" case, or to some undiagnosed child found peeling in school, as has occasionally happened, and it was but rarely that the source of infection was satisfactorily ascertained. 14 This persistence throughout the year is more or less common everywhere, and it is in evidence in the official returns that the majority of the districts in our own county week by week report cases of scarlet fever, they are very few, perhaps only two or three per district, but there they are, serving as evidence of infection or of some source of origin beyond our immediate cognizance, and practically incapable of detection. There may everywhere be "carriers" of this disease, as is now recognised to be the case in typhoid and diphtheria, but the exact nature of the infecting organism is not properly known, and as long as we are to that extent still in the dark, we must be content to continue to exercise the most rigid precautions that sanitary science, pathology, bacteriology and experience teach us. All cases of scarlet fever that are considered cured should be kept under observation for many weeks afterwards, and in the event of their "catching cold" and developing nasal discharges it would be prudent and considerate to others to keep them at home and away from school until the catarrh is ended, or at least to seek medical advice. There was but one death, and that was registered as being due to "scarlet fever and concurrent specific parotitis," or, in other words, the child had both scarlet fever and mumps. Two of the 29 cases were those of nurses at the hospital, 15 who contracted the disease from their patients; it is gratifying to know that they both did well. Diphtheria.—Of this much dreaded disease only 8 cases were notified, as against 21 cases the year before. There were no deaths. Twenty years have elapsed since the Infectious Diseases Notification Act has been in force, and the average number of cases recorded during that time is 16 per annum, so that this last year makes a favourable show in point of comparison. The virulence of diphtheria would seem to vary in various years, and its infectivity, too, but it is not a disease to be trifled with, and as its spread, apart from the initial case, is mainly due to personal contact, it is here that the school plays so leading a part in extending it. Owing to the pressure put on parents by attendance and school officers, children are often, I am persuaded, compelled to go to school when they are unfit to do so. Many mothers are very unobservant of, or turn a blind eye to, the commencing feverishness or sore throat, very much as they do to the dirty hands and face, and, worried by their home duties, too often ignore or make light of these early failings. Add to this an extraordinary fatalism or indifference to the risks of infection with consequent inattention to the means of preventing the spread of disease, and there is little room to wonder that the schools become nursing. 16 beds for the propagation of other things than useful knowledge. On one occasion recently three different mothers each brought a child with mumps to my surgery on the same day and at the same time; each mother knew or thought that her child had mumps, but the main object of each of them was to obtain a certificate of the child's inability to attend school rather than that of anxiety to obtain advice and treatment for the little sufferer. They were much astonished and inclined to resent my suggestion that their duty towards their neighbour, in my opinion, included some consideration for the other children who might be and who were in the surgery for other purposes than to contract unnecessary diseases. Typhoid Fever.—Three cases, and all of them notified during the month of October, indeed there has seldom been a case of enteric reported here other than in one of the three autumn months, and of these the large majority, when the source of infection has been conclusively traced, have been imported from a seaside town or from abroad. Of the three cases of last year, one was most certainly contracted elsewhere, as it was that of a visitor shortly after arrival; another was almost as surely an imported case, and the third was 17 living on and off in a house in which all the sanitary arrangements were found to be most satisfactory. All three made good recoveries. Measles.—But few cases, and no deaths. Towards the latter part of the year, however, cases were becoming more frequent, together with a proportion of mumps and German measles, with every prospect of a considerable increase in these latter. It should be borne in mind that an attack of German measles affords no protection to a child from ordinary measles or scarlet fever. Diarrhœa.—Only one death was registered under this heading, whereas four were returned as "enteritis," thus rather leaving open to doubt whether or no some or all of these four were or were not strictly speaking diarrhoea, due possibly to improper feeding, a most common cause, which in its turn may have set up enteritis. Assuming them all to have meant to indicate forms of diarrhoea, they would amount to only 5, and this will contrast for purposes of comparison with 1906, when there were 15, and that was the year of a hot and dry summer, especially so in September, when most of these deaths occurred. Diarrhoeal mortality is greater in hot and dry seasons and less in wet seasons. The summer last year was, generally speaking, wet and cool, and though there were hot spells, we were never very long without rain. Rainfall has a direct favourable 18 influence, in so far as it washes the atmosphere, prevents the dissemination of dust, and cleanses and removes much of the dirt and filth that tends to accumulate so readily around houses, especially the smaller ones, and where built closely together. There is also an indirect influence by preventing probably the rise of the earth's temperature, as it is an established fact that the "maximum mortality of diarrhoea by no means coincides with the highest reading of the air thermometer, as it is found that the summer rise of infantile diarrhoeal mortality does not commence until the mean temperature of the earth, as recorded by a thermometer four feet below the surface, reaches to about 56 degrees Fahrenheit. Last year this temperature was never above 56 degrees, for which, as far as I can ascertain, the only precedent was in 1902. There seems to be, or rather there undoubtedly is, some confusion in terms as to the proper designation of diarrhoeal diseases in death certificates, chiefly by the use of such names as gastroenteritis, muco-enteritis, &c., and as it is important for statistical purposes that all cases of deaths from diarrhoea should be classified as such, 1 desire to draw attention to the following notice that has been issued under the authority of the Registrar-General, viz.:—"Diarrhoea. When this is due to improper feeding, or to any kind of food infection, the fact should be 19 tioned in the certificate. In certifying deaths from diarrhoea, either the authorized term "epidemic diarrhoea," or else its synonym, "Infective enteritis" should invariably be employed. The Royal College of Physicians having recently condemned the use of such names as "gastroenteritis," "muco-enteritis," and "gastric catarrh," as alternatives for epidemic diarrhoea, it is hoped that the use of these terms will be entirely discontinued." As concurrent causes of diarrhoea, the effects of hot weather on food kept in unsuitable storage places, the pollution of milk kept in uncovered vessels, the prevalence of flies and their means of accessibility to food—referred to on another page—the excess of fruit in some years, and above all, the improper feeding of infants, have all to be remembered as factors that assist in promoting cases of this disease so fatal to young children. Diphtheria Anti-Toxin Order, 1910. On October 3rd I made a special report to the Sanitary Committee with reference to the above Order, which now makes it compulsory on all sanitary authorities to provide a supply of this serum for the use of the poorer inhabitants of their districts in accordance with recommendations to be drawn up by the Medical Officer of Health. 20 These recommendations were accepted and adopted by the Council on November 14th, and later on a circular letter was sent to all the medical men practising in the district, acquainting them with the arrangements that were made to give effect to this Order. In referring back I find that on the 7th January, 1895, your Clerk, by order of the Council, and on my earnest recommendation, sent a letter to every medical man known to be practising in the district drawing their attention to the progress in bacteriology as a means of diagnosis in cases of sore throat and "to the great advantage that seems likely to be gained by the subcutaneous injection of serum obtained from immune animals." This was in reference to the then newly-discovered and applied anti-toxin, and the letter further drew attention to the sources whence this assistance could be obtained, and that in necessitous cases I was empowered to supply it free of charge. This was in 1895, and now in January, 1911, sixteen years afterwards, notice is given that this free distribution has been made compulsory, the test of time and experience having fully confirmed the inestimable value of this treatment. Treatment with Anti-Toxin Serum. The following Table is very instructive as to the progressive value of anti-toxin treatment, and is that recorded by the Edinburgh City Hospital. It shows on a large, and, therefore, convincing 21 scale, the mortality from diphtheria according to the day of the disease on which the serum was used. The number of cases recorded is 2,496. Day of Illness. Patients. Deaths. Percentage of Mortality. First 90 2 222 Second 611 20 327 Third 707 38 537 Fourth 504 45 8.92 Fifth 276 26 9.42 Sixth 122 12 9.83 Seventh 104 14 13.46 Later 82 14 17.07 2496 171 6.85 Before the advent of the anti-toxin treatment the published mortality at the Metropolitan Asylums Board Hospitals was 35 per cent., and at the Edinburgh City Hospitals 25 to 30 per cent. Now the mortality in cases treated with anti-toxin is from 3 to 14 per cent., according to the virulence of an epidemic. Lovell Drage, of Hatfield, says:—"Diphtheria anti-toxin is only an antidote to the poison of the Klebs Loeffler bacillus, it is no antidote to the poison of other bacteria." That is to say, if as the result of a bacteriological examination some cases are found to present streptococci, and others have micrococci of various species, and no 22 CHART SHOWING THE COMPARATIVE NUMBER OF DEATHS FROM SOME OF THE DISEASES SPECIFIED IN TABLE IV. AMONG "RESIDENTS," WHETHER DYING WITHIN OR WITHOUT THE DISTRICT. Klebs Loeffler is to be found in any of them, diphtheria anti-toxin is not only useless, but an explanation is to be found of any mortality under anti-toxin treatment. If this is so, it shows the value of a bacteriological examination in determining the nature of a doubtful case, but in cases where the clinical evidence is well marked the remedy should unhesitatingly be resorted to. That this is indicated is shown by the figures in the above table and by universal experience, for the result of an examination could not well be obtained in the first 24 hours, and valuable time would be lost. I have drawn up a chart which shows by means of coloured lines the total deaths from varying causes during the year, marking those that are due to infectious or communicable diseases by red lines, and so forming a comparative table by which the respective mortalities can be seen at a glance. It will at once be noted that cancer, or malignant disease as it is often termed, accounts for a larger number of deaths than that from any other cause. This may appear rather alarming to some, and might lead them to think that this disease is on the increase. I believe that it is generally held that this is not the case, but rather that better and more skilled means of diagnosis are available than heretofore, and that surgery and surgical operations lead to the more accurate determination of causes of illness and 23 death than was formerly possible. It should also be accepted that it is now considered as proved that this disease is not communicable from man to man. Heart diseases of various forms and diseases of the respiratory organs, bronchitis and pneumonia, naturally are responsible for a considerable proportion, especially amongst the aged, and in connection with this it is satisfactory to see how few deaths are due to phthisis. There were no suicides, and only two fatal accidents, one being that of a stranger. Returns of the Vaccination Officer for Surbiton, Hook and Tolworth Districts, 1910. Total births registered 1910 332 Successfully vaccinated 201 Insusceptible 2 Died unvaccinated 17 Removed from district 14 Cases postponed over the year 1 Number of exemptions 53 Not yet legally due 44 The subject of vaccination has an increasing importance now that there has appeared a small outbreak of smallpox in London and in other parts of the country, and this, coupled with the fact that the number of persons availing themselves of the facilities offered them to get their children exempted is rapidly increasing, gives occasion for much anxious thought to all those whose duties are concerned with matters of Public Health. 24 The Table that appears above shows how we in this district are being affected, and how we are incurring the risk of losing our reputation of a healthy suburb. Last year there were 332 births registered; deduct from these the deaths, removals, and those not yet legally due, amounting to 75, and there remain 257 who should have been vaccinated. Of these, 204 were vaccinated or otherwise accounted for, and the remaining 53 were those who had exemptions, so that nearly 26 per cent. of those who should have been done had escaped, or, in other words, approximately one out of every four eligible children are not vaccinated. In 1909 there were 59 objectors, and the year before that 45, so that in these three years we have 157 unprotected children in our midst utterly defenceless against smallpox if it appears, and I am sorry to record that almost without exception these are children of the working classes. Now how and why is this? The more educated and better informed classes are in the main content to believe in and to be guided by those who know most about the value of vaccination and re-vaccination as a preventive of smallpox, while those on the other hand who from the very force of circumstances must necessarily know the least about it, are the most prejudiced against it. 25 Having been a public vaccinator for some 35 years, with ample opportunities for hearing the views of those who "don't believe in vaccination," I am surely qualified to know something of the nature of their objections. I believe it is mainly due to ignorance, absolute ignorance of what a terrible disease smallpox is, and of what ravages it is capable when it attacks the utterly unprotected. No longer do they hear about its possibilities or see the pock marked faces of those who have been through it and recovered, as those of us who are older were accustomed to see in our earlier days before vaccination was compulsory, and so there has gradually arisen a prejudice against vaccination, created partly from a natural tenderness towards their children, and partly from the grossly exaggerated and untrue stories of harm that has followed the operation, and a belief that the lymph used was the cause of it. If only as much trouble were taken to instruct the present and the coming generations as to the efficacy and importance of vaccination as is taken by a certain noisy section to prejudice them against it and to play upon their fears, then I am persuaded they would be more amenable to the teachings of science, and the more ready to avail themselves of that protection that every civilised country in the world has by its laws required its peoples to subject themselves to. 26 Already this comparatively small outbreak in London conveys its lesson to those who can see and understand, as the following statement will show. It is officially recorded that during this month of March there were admitted into the Smallpox Hospital at Joyce Green eight little children under eight years of age, and of these little ones three had been vaccinated and five were unvaccinated. Now mark what followed. The three vaccinated had the disease extremely lightly, and all of them got well. Of the five unvaccinated ones, four died! What sort of a disease is it that when it attacks five entirely unprotected children slays four out of five ? Does not that convey some idea of what smallpox can do when it gets a fair field to work in ? Does the vaccination of those three count for nothing? Had it no share in saving their lives? Though these figures are but few from which to draw deductions, yet it is the same story that has to be told over and over again when smallpox gets among us. This is just an example of what this disease can do and used to do on a large scale, and makes it easy to understand why it was so dreaded in the past, and why those who are conversant with its past history the whole world over are doing all they can to offer protection to the unprotected, and to enforce the doctrine that not only is "prevention better than cure," but that in this case it is far wiser to take the preventive measures that experience tells us are so 27 valuable than to run the risk of getting a disease for which no cure is known. To these remarks of mine, which I know represent the considered opinions of the very large majority, if not all, of the medical profession, I should like to add, with an appreciative acknowledgment, the somewhat pungent and forcible views expressed by the Medical Officer of Health of Plympton St. Mary, in his annual report, on this same attitude of a growing section of the people towards vaccination. "I am afraid"—says he—"that there is still a growing evasion of vaccination, but this is, I think, more due to an idea that an epidemic of small pox is a remote contingency which need not be provided against than to any definite disbelief in the efficiency of vaccination to prevent small pox. People now-a-days are so confident of the power which Sanitary Authorities have of dealing with any infectious disease when it arises that they have become somewhat careless of personal protective measures. That this is a foolish position to assume should be obvious to any reasonable person who gives a few minutes' thought to the subject. The first line of defence against any infectious disease is the repelling power of the individual, and no wise man can afford to debar himself of any measure which will increase his resistance to disease. With regard to small pox, the experience of all the medical profession 28 throughout all the world, and under all possible conditions, is that no sanitary measure is of such inestimable and proved value against small pox as vaccination and re-vaccination, and a further proof of this is always found in the fact that when small pox appears in a community the antagonists of vaccination either run away from the neighbourhood or else run with all speed to obtain that vaccination which they have hitherto shrieked themselves hoarse in decrying. If I had my way I would compel the anti-vaccinators and the Anti-Vaccination League to nurse and attend on the small pox patients, and then they would have an object lesson which even the most "convinced" and "conscientious" of them could not fail to be convinced by. The certainty is, how ever, that if such an opportunity occurred, all the anti-vaccinators would so quickly become patients or corpses that the nursing and treatment of the patients would, as at present, have to be undertaken by doctors and nurses who had undergone vaccination, and who, by that vaccination, would then do, as they do now, walk unscathed through all the terrible scenes of a small pox hospital." As showing the tendency for the spread of the exemption folly in certain districts of late years, the case of Blackburn may be cited. This is a town where last year there were 2,948 births, with 234 deaths before vaccination, thus leaving 2,714 eligible for vaccination, and the returns 29 show that 1,159 obtained exemption. During the last six years, from 1905 to 1910 inclusive, the number of exemptions there have been successively 190, 305, 407, 887, 980, 1,159. In another part of the country, Paignton returns 77 vaccinations and 113 exemptions, and very many other examples can, unfortunately, be adduced. Housing, Town Planning, &c., Act. This Act that came into operation during the year is one of considerable importance. It places upon your Sanitary Committee and Health Department duties in connection with house inspection that will add considerably to their labours. No houses were reported to the Committee during the year under this Act as being in a state so dangerous or injurious to health as to be unfit for human habitation, all action in this respect being deferred until the present year. The following is an abstract:— Section 17 (S.S. 1). It is the duty of every local authority to cause to be made from time to time inspection of their district with a view to ascertaining whether any dwelling-house therein is in a state so injurious to health as to be unfit for human habitation, and for that purpose it shall be the duty of the local authority, and of every officer of the local authority, to comply with such 30 lations, and to keep such records as may be orescribed by the Board. The procedure adopted in the Regulations published by the Local Government Board to give effect to the requirements of Sub-Section 1 requires a thorough inspection of the District, to be carried out from time to time according to the circumstances of the District. The Local Government Board specify the matters concerning which a report should be obtained on each house inspected. These are as under:— 1. The arrangements for preventing the tamination of the water supply. 2. Closet accommodation. 3. Drainage. 4. The condition of the dwelling-house in regard to light, the free circulation of air, dampness, and cleanliness. 5. The paving, drainage and sanitary dition of any yard or outhouses, belonging to or occupied with the dwellinghouse. 6. The arrangements for deposit of refuse and ashes. 7. The existence of any room which would in pursuance of Sub-section 7 of Section 17 of the Act of 1909 be a dwellinghouse so dangerous or injurious to health as to be unfit for human habitation. 31 8. Any defects in other matters which may tend to render the dwelling-house dangerous or injurious to the health of an inhabitant. These records have to be kept in a book, or on sheets or cards, and to have correct information concerning:— 1. The situation of the dwelling-house and its name or number. 2. The name of the officer who made the inspection. 3. The date when the dwelling-house was inspected. 4. The date of the last previous inspection, and a reference to the record thereof. 5. The state of the dwelling-house in regard to each of the matters referred to. 6. Any action taken by the Medical Officer of Health or other officer of the local authority, either independently or on the direction of the local authority. 7. The result of the action so taken. 8. Any further action which should be taken in respect of the dwelling-house. As far as may be necessary, the Sanitary Committee has at each ordinary meeting to take into consideration these records, giving such directions as may be necessary or desirable. 32 Particulars of the work done have to be included in tabular form in the Annual Eeport of the Medical Officer of Health. The Committee have the power of issuing Closing Orders, and the appeal is to the Local Government Board. The limits of their power in regard to dealing with unfit houses are only to be determined by the Local Government Board with expert sanitary advisers. In the matter of the particular forms in which reports on these inspections are collected, I have, in consultation with the Sanitary Inspector, prepared forms of our own designs, and I think that the Committee will find these forms simple and comprehensive in character, and a useful method of collecting the reports. The requirements of the Local Government Board will be met by the production of these reports at the meetings of the Sanitary Committee. The Town Planning, &c., portion of this Act deals with another subject altogether, and is a matter of surpassing interest to those who wish to look ahead, and who, having observed and noted in what respects they had suffered from the failures or short sighted policies of their predecessors in bygone days with respect to the amenities of the district in which they were concerned, were now hopeful, by its aid, of being 33 able to do something for posterity as well as for themselves. It was much needed, and is a wise piece of legislation, and is just the Act to give the necessary impetus to galvanize into life and action the ideas that are dormant and that are compelled to remain dormant in men's minds for lack of the means whereby they can give them expression. A special committee has been formed, and will take such action as may be necessary from time to time as occasion requires. Surbiton Urban District. Elementary Schools and Number on the Books. Parish. Boys. Girls. Infants. Total. St. Mark's 158 152 132 442 Christ Church 160 136 136 432 Tolworth 314 350 264 928 Hook 55 82 56 193 687 720 588 1995 District. Occupied Houses. Population at 5.225 per house estimated. Surbiton 2,230 11,651 Tolworth 934 4,880 Southborough 285 1,489 Hook 123 643 Total 3,572 18,663 34 Prevention of Plague. On November 10th, 1910, the Local Government Board issued an Order, together with Regulations, as to Plague, and accompanied it with a Memorandum, which in Part I. enters very fully into the symptoms, the diagnosis, and the methods of the spread of the disease, and explaining how rats, being infected, are the source from whence the disease is spread to man. Part II. dilates (a) upon the measures to be taken against Plague as regards the individual, and (b) describes the precautions to be taken in regard to inanimate objects, and (c) the precautions against rats. The Memorandum states that:—"After frequent recurrences during several centuries, ending with the great outbreak of Plague in 16641679, the disease disappeared from Great Britain for more than 200 years. In 1894 it became prevalent at Hong Kong, and since that time it has spread from Asia into various parts of Europe, America, Africa and Australia. In 1900 and in two subsequent years small outbreaks have occurred at Glasgow, and one or more cases have also occurred at Liverpool, Cardiff, and Leith during the last ten years. During the present year (1910) cases suspected to be pneumonic plague were associated in Suffolk with definite occurrence of plague in rats and other rodents. 35 The pneumonic form of plague is directly infectious from patient to patient, the expectoration when the patient coughs containing plague bacilli. Plague for administrative purposes may be regarded as a disease of rats, and it has been conclusively established that fleas form the intermediary between rats and man." On receipt of this Order I issued on November 28th a circular letter to all occupiers of farms, shops dealing in food of all sorts for humans, dairies, all licensed houses, all dealers in forage, etc., asking their views on certain points, and asking for information as to evidence of rat sickness or mortality, with the object of being in a position to advise my sanitary authority as to what steps, if any, should be taken to deal with any threatened outbreak. I had a fair number of replies, and from those and from enquiries made by the Inspector of Nuisances and from my own personal knowledge and observation, I was satisfied that there was no evidence of any infected rats in the immediate neighbourhood. It is important, however, to remember that the Plague is dormant and not eradicated as yet, therefore any information bearing on the subject in this district at any time from anyone in a position to impart it should be sent to me direct. 36 The Memorandum further says:—"In view of likely migration, medical officers of health and inspectors of nuisances, as well as private persons, should make enquiries at intervals, and should submit suspected rats found dead or ill for bacteriological examination." Summarised, the recommendations are:— 1st—Persistently and systematically destroy all rats. 2nd—Remove and obliterate their nests, burrows, and habitual haunts. 3rd—Make each dwelling, as far as practicable, rat-proof, and remove all known harbourage for rats in or near dwellings. 4th—At the same time do not allow waste food (whether for human beings, chickens, or other animals) to accumulate in or about the house. The House Fly. The house fly holds a very strong position as to the spread of disease. With him I would certainly couple the common blow fly, as he is a bigger fellow, stronger, and travels further. The tendency of the fly is to visit manure heaps or collections of any sort of filth when available, and also in turn to pay attention to our food supplies if permitted, especially visits of inspection and 37 something more to milk, sweets and things of that sort beloved by children; he is also disposed to visit an infectious individual and then seek the companionship of a healthy person. These habits are matters of common knowledge, and have hitherto been but little considered, except as to the nuisance they create when their numbers are too large. Attention has now been most pointedly directed to this undoubted means of spreading disease, and much thought is being given as to the best methods of lessening their numbers and their potentiality for serious mischief. The fly per se is only a nuisance, but as a carrier of disease he is a power for evil and he must be combated. Flies are attracted by filth and rubbish, especially organic, that is, animal or vegetable refuse. The accumulation of filth of this sort in hot weather in proximity to houses is largely within the control of the occupants. See to it, therefore, that these accumulations are not allowed; cover, well cover, and keep covered, your dust receptacles; lime-whiten and clean generally, using plenty of water, with disinfectants if possible, as these are not at all to the liking of flies, and, above all, spare no trouble to exclude these inquisitive creatures from the larder and all places where food is stored. Use wire gauze meat covers, and have perforated gauze 38 ventilators put across the windows of larders, pantries, etc., so as to thereby exclude flies and dust, but to allow the admission of fresh air. Last year I received some samples of a very suitable gauze cotton material cut into squares of different sizes and weighted with little lead clips at the corners, making them very adaptable for spreading over a jug, bottle, butter dish, jam pot, etc., and effectually preventing the wandering fly from obtaining access. Formalin gas and spray do not seem to be effective in killing flies. I am informed that Izal sprayed on flies answers the purpose; the flies so treated become stupified and fall; they can then be swept up and burnt. Water Supply.—There is now a constant water supply for the whole of the district furnished by the Metropolitan Water Board, who a few years back took over the obligations of the various Water Companies that at that time supplied Greater London. The source is Thames water, and the intake is at Sunbury, whence, after the necessary filtrations, it is distributed to this neighbourhood by what used to be the Lambeth Water Works mains. It is a particularly good and wholesome water, and is supplied by this agency to a large part of South London, including Brixton, Streatham, Penge, Anerley, 39 and all the intermediate towns and villages along the South Western Railway as far as and including Esher. The supply is under the direct supervision of the Local Government Board as well as under the scrutiny of the London County Council, and is, moreover, daily examined and analysed by the skilled advisers of the Water Board itself as well as of the other Authorities, so that any further examination, so far as this Council is concerned, would be superfluous excepting so far as relates to the distributing mains, &c. There is no need whatever for the use of filters if the drinking supply is drawn direct from the main, but if and where drinking water is supplied through storage cisterns, it then becomes a vital necessity for the householder to take care that these are properly cleansed two or three times a year, kept covered—to exclude light, dust and foreign bodies—and that the particular cistern in question has no direct communication with any drain or closet. Tolworth Brook.—When the transfer to the new sewerage works is made and the Tolworth Sewage Farm ceases to be used, some considerable time must elapse for the necessary purification of the soil before any use can be made of it beyond cultivation, and with that disuse the duties of the now notorious (in the 40 past) Tolworth Brook will terminate, in so far as it will serve as a conduit for the sewage effluent. We are told with reference to brooks that "Men may come and men may go, But I go on for ever." and this may be so with respect to the idyllic brook, but the Tolworth Brook threatens, when that time arrives, to be a brook without water. It is a natural easement, and drains the valley from and beyond Hook, and at one time, in my boyhood, was always full of water and had fish in it, but now what with sewers and deep drainage and the taking away of storm water, &c., it may and probably will become an eyesore and a nuisance of another sort, solely from lack of a continuous and sufficient water supply. An example of this is to be seen in the case of the River Rythe, and the view of that pellucid stream, with sometimes less than two inches of water in it, as seen from Winter's Bridge, Long Ditton, is not in any way suggestive of the claims or charms of Tennyson's brook. This matter, when the time arrives, will merit due consideration. Swimming Baths.—In connection with these remarks on brooks and running water I think it opportune to refer to another matter that is increasingly becoming a pressing one, and is now one that serious and sustained attention 41 should be directed to. Elsewhere I have noted that the number of children attending the district schools alone is just upon 2,000, with another thousand or two to be added within the few years after school age, also that the population is verging towards 20,000. We are counted as a beautiful Thames side residential district, and sometimes spoken of, though mostly by ourselves, as the "Queen of Suburbs," yet with what should at first sight appear to be every favourable opportunity, we have no swimming baths or facilities for bathing. This is distinctly a matter of Public Health, and the Council has the power of adopting the Baths and Washhouse Acts where they are not already in force in the district; also the provisions of the Town Police Clauses Act, 1847, in so far as they concern public bathing, are for the purposes of regulation in Urban Districts, incorporated with the Public Health Act. Now it is not on the grounds of cleanliness alone by any means that I draw attention to this, but it is mainly as an advantageous recreation, and for the provisions of facilities for learning to swim. There is practically no bathing hereabouts so far as the mass of the population is concerned. Those who have the means and opportunities have certain limited facilities for bathing early in the morning in the river. Boys 42 cannot do this because it is not safe, and there is no place for them. I suppose some of them still resort to the Maiden River when and where they can, but they are mostly trespassing when they do so, and the delight of it should be, even if it is not, tempered by the knowledge that sewage effluents are now being discharged into the stream. Girls have no chance at all. A large, commodious and perfectly safe open air swimming bath could easily be provided here in some readily accessible and not too distant part of the district. I have been looking round and have two possible sites in my mind that appear to me to be in every way suitable, and so far as I am able to form an estimate, I do not think the expense would be at all a heavy one, quite the contrary. For obvious reasons I do not here make mention of where they are, but if such a bathing place could be provided and inducements be forthcoming, as no doubt they would, to learn swimming, then I consider it would be a great public benefit to the whole neighbourhood. Presently there will be, I presume, suggestions for a Coronation Memorial, and this proposal might be debated on its merits, but if not acceptable in that respect, it can be and should be provided by the ratepayers for their own use and enjoyment. 43 Food Supply.—Though not, strictly speaking, within the events of the year, yet at a date antecedent to that at which I write, a question has arisen of such vital importance to the national well-being that I think it desirable, as a Health Officer, that I should express my views on it in the hope that they may be of some service in directing attention to a matter that is far from being properly understood and appreciated, and that to secure success has to win its way against sturdy opposition and not a little prejudice. I refer to the notice recently issued by some of the leading medical men in the country with respect to the wholly unsuitable bread that is being consumed by the nation at large and which they hold is to a considerable extent responsible for the deterioration in the standard of health and physique of the present and on-coming generations. They have issued a Manifesto to the effect that "they believed it to be a national necessity that a standard should be fixed for the nutritive value of what is sold as bread, and that the flour used should contain the whole of the nutritive substances in the wheat berry. The physical deterioration of the nation in recent years has been largely caused by the general consumption of white bread which does not contain this nourishment." With this pronouncement I thoroughly and wholeheartedly agree, and give as my opinion that it can be proved beyond a doubt. 44 To appreciate the difference between white and Standard flour and why the former is so inferior to the latter as a bone and tissue forming food, it is quite important to understand something of the structure of the berry and wherein this difference consists. The berry has first an outer husk or bran which has no food value and is indigestible; the bulk of the central body, or endosperm, as it is called, is chiefly starch, and contained in it is the germ and semolina; besides this there is the inner bran which also contains valuable elements. These elements are the proteids and mineral matters, that is, the iron and phosphorus which are absolutely essential for the proper growth and formation of bone and muscle tissue in the growing child. The whole of the berry excepting this outer husk is contained in Standard flour, the germ and the semolina are the most nourishing parts of the whole berry, and the colour of Standard bread is due to these being retained. Only the endosperm, which is chiefly starch, is used in making white flour, the germ and inner bran being removed in order to secure dead whiteness. When the outer husk is stripped off the remainder constitutes 80 per cent. of the berry, that is why it is called "Standard." Starch in the various formations in which it is to be found— bread, potato, rice, sago, etc., is a valuable and useful food product, but it does not contain the elements necessary for the proper development of bone and muscle, and the digestion of over much 45 starch is a strain upon the digestive powers of many people. From personal observation of the use of Standard bread, I became convinced that there was more benefit in it than the mere addition of the essential elements contained in the germ and semolina, because I found, quite unexpectedly, that where the chief difficulty bad been the digestion of starch foods and that ordinary bread could not be tolerated, with Standard bread that difficulty was largely removed, and that though the same quantity of starch was there as before it could now be better digested. The explanation of this was to be found later on in the statement made by Dr. Gowland Hopkins, F.R.S., who is Reader in Chemical Physiology to the University of Cambridge, and an investigator of European fame and universally regarded as one of the greatest living authorities with regard to human nutrition. In a report on Standard bread he says:— "After definitely proving that young animals grow with very much greater rapidity on brown flour than on white flour, I have been able to improve the tissue-building rate of the white flour subjects by adding to their white flour an extract made from the brown flour. This suggests not so much that the 80 per cent. flour contains more proteins, iron, phosphorus, etc., used in building up tissues, but that it contains more of certain as yet little studied 46 substances which allows us to make better use of the various ingredients of the wheat berry." Since bread and flour form two-fifths of the weight of food consumed by the working classes, and constitute almost the whole diet of many poor children, it is an absolute essential that the flour from which bread is made should contain a sufficient amount of all the nutritive parts of the grain. The poorer the family the more does bread become the chief staple of their dietary, hence its importance. Amongst the poorer classes the prejudice is in favour of white bread as being better because of its colour, and the darkercoloured bread as necessarily being of inferior quality. This view is now proved to be entirely misleading, and since prejudice is always a difficult thing to combat, I most sincerely hope that those of my readers who have not a thorough knowledge of all the facts of the case bearing on the merits and demerits of commercial flour, will at least refrain from helping to perpetuate this present-day evil by ridiculing the efforts now beingmade to substitute an improved food, the more so as it is beyond question that no reasonable and humane man would of himself do anything harmful to the masses of his fellow countrymen and those mainly of the poorer classes. I will conclude these few remarks upon a subject of deep interest and of vast importance by 47 stating a little incident that has just come under my own observation. I had occasion a few days ago to go to a small baker's shop in one of the back lanes of Kingston, where the trade was evidently with the poorer folk, and noticing some Standard bread on the counter I asked how the sale of it was doing. The baker's wife said, "Well, sir, at first we did very well; indeed, I may say are still doing so, but there is perhaps a little falling off now." "Why is that?" I remarked. "I think it is for two reasons," she said; "one is that at first there was of course the novelty, but the other is that many of the women say that the children like it so much and eat so much that they are afraid they cannot afford to go on with it!" I mentioned this to a baker well known to most people in Surbiton, and his remark was, "Quite true, sir, that is my own observation, too." There is one point to remember: "If the Standard bread you buy is not nice, it is not Standard bread." Sanitary Work. In connection with the Surveyor's Department and in addition to the usual work and to that provided for in the annual estimates, the following works have been carried out:— The streets made up under the Private Street Works Act, 1892, are:—Lenelby Road, Tolworth Park Road, Tolworth Road, St. Matthew's Avenue, and Crane's Park Avenue, in all of which 48 artificial stone paving has been used in the paths, and in each of the latter two there is a margin at the side for trees. In St. Matthew's Avenue and Crane's Park Avenue tarred macadam was used for the roadways, and it is found that this works out almost as cheaply as ordinary flint roadway, and will in all probability be used in future in all the private street works. It is a much more sanitary material for roadways and requires less repair. Many of the owners of these two roads raised objections to the proposed stone paving and tarred macadam carriage-way, and the matter was dealt with by the County Bench, who, after a long hearing, confirmed the Surveyor's specification. Preliminary notices have been served for Malvern Road and Fire Bell Alley to be made up, both of which were reported by the Medical Officer of Health to be in an insanitary condition. Several additional ventilating columns have been put up to increase the ventilation of the sewers. A small portion of storm water relief drain has been laid at Broomfield Road, Tolworth. The lighting in Brighton Road and St. Mark's Hill has been improved by attaching the latest pattern of inverted burners to the iron standards carrying the tramway overhead construction. Trees have been planted in Lenelby Road, 49 Tolworth Park Road, Tolworth Road, Crane's Park Avenue, and St. Matthew's Avenue. The Local Government Board held an Enquiry with respect to certain Permanent Works to be carried out in the district, these principally consisting in transferring existing gravelled footpaths to paths paved with artificial stone with gravelled margins, and after hearing the opposition, sanctioned the loan. A valuable clause of the Public Health Acts Amendment Act, 1907, has made it possible to obtain substantial repairs to undedicated streets which are dangerous to pedestrians and vehicular traffic. This clause has been put into force in the case of Upper Marsh Lane and Minniedale with marked improvement to the sanitary aspect of this part of the district. Three of the irrigation areas at the Tolworth Sewage Farm have been trenched to a depth of 2 feet 6 inches, and a percolating filter has been constructed 80 feet in diameter with a rotary distributor. These have considerably improved the character of the effluent, and no complaints have been received from the Thames Conservancy since these works have been carried out. The number of new dwelling houses erected during the year is 30. Surbiton, 11; Tolworth, 18; Hook and Soutliborough, 1. 50 The Urban District Council of Surbiton. 1910 Sanitary Certificates have been granted under the Inland Revenue Act for the following that have been converted into tenement houses:— 19, Claremont Gardens. Hambledon and Hurley, Grove Road. 34 and 34a, St. Andrew's Square. 124, 126, 128, 130, 132 and 134 Douglas Road. Sewerage Scheme. The year that has passed will be a distinctive one in the annals of Surbiton inasmuch as within that period of time the practical assent of the Local Government Board has been given to the largest work and the most costly expenditure that this governing authority has ever embarked upon, viz., the sewerage of the entire district. As this is a sanitary work of the highest importance, I think it would be as well to give here a brief sketch of the history of this sewerage scheme in its entirety, and to recapitulate from its commencement and from my previous reports the sequence of events that have led up to the development of this idea, so as to afford the residents of Surbiton, new as well as old, an opportunity or making themselves acquainted with its salient features and of understanding the necessity for a scheme of this magnitude. 51 Originally Surbiton, like Kingston and all riparian towns, sent their crude sewerage into the Thames, and likewise drew their drinking water therefrom. As time went by, and the 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 continue to be used for dietetic purposes, or that a new and separate supply of drinking 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 the matter, considerable stress was laid on the great waste of fertilising organic matter that was being thrown away, and sewage farms and treatment came under discussion. It was then that a Board was formed, and representatives of all the towns from Barnes to Hampton on both sides of the river, including Mortlake, Isleworth, Richmond, Twickenham, Teddington, and Kingston, were united under the imposing title of The Lower Thames Valley Main Sewerage Board, with the object of, if possible, agreeing upon some comprehensive scheme that should meet the needs of so large and diverse an area with a rapidly increasing population. 52 It held many meetings and went into the merits of many plans, but after holding the field from 1877 to 1885, and having presented many lengthy and exhaustive schemes for enquiry, it was finally dissolved by Act of Parliament without having done anything whatever of practical value towards solving the question under consideration, as, for various reasons, unanimity or anything like it was never attainable. Then Kingston evolved a scheme of its own to which we ultimately became a contributor. Surbiton entered into an agreement with Kingston for the treatment of its sewage for a term of twenty-five years, which came into being on the 1st July, 1887, and will now expire on the 30th June, 1912. The first essential work was the collection and diversion of the sewage of Surbiton, for at that time Tolworth, Hook and Southborough had not been taken over by us but formed a separate special drainage district of itself within the area of the Kingston Rural Sanitary Authority, and they had devised and started the idea of the present Tolworth Sewage Farm which was taken over by Surbiton in 1896 as a going concern and maintained as such from that date to the present time. To effect this collection, Surbiton, at a cost of between £5,000 and £6,000, constructed a main 53 iron outfall sewer 27 inches in diameter, which started from the lower boundary of the district in the Portsmouth Road at a spot midway between the Catherine and Uxbridge Roads, and then passing along the Portsmouth Road and through the Market Place and Thames Street, delivered at the Kingston Corporation Sewage Works at Down Hall Road, close by Canbury Gardens and just beyond the Railway Bridge. The agreement between the two places was that Surbiton should first pay a fixed charge of £300 per annum, then 2½ per cent. on £27,357 which represented the original capital outlay, also a sum equal to the product of a rate of 3d. in the pound on the rateable value, and a proportion, according to the rateable value, of the cost of treatment, maintenance and repairs. These charges for some years worked out at something over £3,000 a year and were paid until 1901, when a fresh agreement was entered into to meet the cost of extra pumping consequent upon the amount of sewage when swollen with storm water, as delivered at the works, being under those circumstances in excess of the maximum agreed upon and involving additional and continuous pumping; so to meet this another £600 a year had to be paid, with the result that at present the total cost works out at from £3,800 to £4,000 a year, irrespective of the cost of the Tolworth Sewage Farm. 54 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 land in Maiden Parish, along the banks of the Maiden stream, with a view to ultimate possibilities as to sewage works, a forcible reason for this purchase being that Kingston had just shortly before been putting forward at the Incorporation Enquiry the argument that as they treated our sewage it was a justification for seeking to incorporate us with them. This was stoutly repudiated, and in order to protect ourselves against possible eventualities the then Council thought it wise to acquire this ground. Time went on, and as it drew nearer to the expiration of the agreement with Kingston, steps began to be taken to formulate some plan for the treatment of the sewage of our now enlarged district by ourselves and at our own cost. The land in Maiden Parish was not now available, as building operations had developed in its proximity, and these have changed its character from that of agricultural land, as it was when bought, to that of building value, and it is now an asset of considerable worth. It has proved a blessing in disguise, and when realised will bring in a substantial profit to the ratepayers, and bear convincing testimony to the value of the foresight of the Chairman and the then members of the Council of that time. 55 Eventually an engineer was selected, land was provisionally obtained near Tolworth Court on the banks of the Maiden river, and the proposed site and plan became the subject of a Local Government Board Enquiry in February, 1907. This plan was finally set aside by the upper Board mainly on the ground of cost, but also on 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 been considered and reported upon by the late Mr. Mather, a former Surveyor to the Council. The result of this was that the site was approved of and the Engineer was set to work to produce a scheme. In due course this second scheme was submitted to the Local Government Board and formed the subject of yet another Enquiry in November, 1908, when there was developed some sharp criticism and opposition to it on certain specific grounds, and a very long wait followed before the upper Board gave any decision. This they did in the form of not absolutely rejecting the plan, but of allowing it to be clearly understood that they withheld their sanction to it in its then present condition. We had now got well into 1909, but in the end the Engineer produced an amended scheme that was sent up to the Local Government Board for their further consideration. A long delay again 56 ensued, and it was not until in the Autumn—13th September of that year—that a reply was received, which was to the effect that without expressing any general disapproval they indicated certain points on which they would require modifications, and if the Council ultimately adopted this again amended plan they would direct a fresh Enquiry to be held. This naturally necessitated frequent and prolonged discussions and examinations with the object of elucidating and thoroughly understanding all the points that were being subjected to criticism, and it was during these discussions that there were developed no little differences of opinion as to the next step to be taken. Finally on November 8th, 1909, the Council passed a resolution not to adopt an amended plan at all, but to entrust to Mr. H. T. Mather, their present Surveyor, the preparing of a new scheme altogether on certain lines that were first of all to be submitted to them, and that if this scheme, when elaborated, met their views the work was then to be carried out by him, subject, of course, to the approval of the Local Government Board. These preliminary plans were presented in due course and thoroughly examined and gone into by the Committee appointed for that purpose, and when passed by the Council Mr. Mather was instructed to prepare the full and detailed scheme for submission to the Local Government Board. 57 This was done, and on September 29th and 30th, 1910, an Enquiry was held by the Local Government Board, when the only opposition was from the Kingston Corporation and the owners of Lingfield Avenue, Kingston, who jointly objected to the new sewers being constructed in the roads belonging to the Borough or in any way traversing their area. As an outcome of this opposition a conference was held during the Enquiry by the representatives of the two Authorities, and a Provisional Agreement was entered into with Kingston whereby the sewers are all to be kept within the Urban District of Surbiton, and the effluent outfall into the Thames was to be removed from the place marked in the plan to a point further away from the Kingston boundary. This would entail an addition to the estimate as a consequence of the diversion from the original plans. On December 2nd, 1910, a communication was received from the Local Government Board stating that the proposals of the District Council were generally satisfactory. They sanctioned a loan for £10,000 for proceeding with the Southern Sewers, i.e., the part of the work designed to relieve the Tolworth Sewage Farm, and also pointed out a few small amendments in the construction of tanks, filters and sewers, and they further notified that they would defer their general and formal sanction to the loan until the Council had ascertained what would be the additional expense of keeping 58 the sewers within the Surbiton District as settled by the Agreement with Kingston. The Engineer was instructed to get out fresh plans and estimates to comply with these requirements, and they will shortly be laid before the Board. The scheme, as accepted, proposes to treat the sewerage of the whole district, on its reception at the Lower Marsh Lane, by chemical precipitation and subsequent filtration through artificial filters, the effluent then going direct to the Thames. In connection with this, the earliest portion of the undertaking will be directed to the doing away of the works at Tolworth, and the carrying off of the sewage, hitherto treated there, by new and direct gravitating sewers along the valley where the Tolworth brook now runs past the Alexandra Recreation Ground, up to a certain point before its confluence with the Maiden River, at which point it will turn left-handed and be conducted by a tunnel under the hill and railway to the new site. This portion of the work will, it is hoped, be completed and the sewage diverted within some eighteen months or so from the work being started. It is also the intention of the Council, with a view to economy, to erect a Destructor on the site and to use the house refuse as a fuel in a steam producing plant for the purpose of driving the various engines required on the sewage works. I particularly ask the attention of the members of the Council to the excellent report of the 59 year's work drawn up by Mr. Nesfield. It represents not only a great deal of work, but an ever increasing amount, brought about largely by the numerous Acts and Local Government Board Orders that have been issued. I willingly testify to his worth as a most efficient officer, and my thanks are due to him for his courtesy and thoroughness under all circumstances. Also I wish to express my obligations to all the other officers of the Council for their kindly consideration and co-operation on all occasions, for in the course of my multifarious duties I come in contact from time to time with them all. I am, Mr. Chairman and Gentlemen, Yours obediently, Owen Coleman, M.D., D.P.H., Medical Officer of Health. 31s£ March, 1911. 60 SANITARY INSPECTOR'S ANNUAL REPORT. February, 1911. To the Medical Officer of Health. Sir, I beg to present to you my Fifteenth Annual Report for the year ending December 31st, 1910, showing the action taken and the 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. Summary of Work Done. Number of Houses and Premises Inspected 242 „ House and Premises re-inspected 604 „ Miscellaneous Visits 193 „ Visits to Works in progress 2,449 „ „ Bakehouses 48 „ „ Slaughter-houses 74 „ „ Dairies, Cow-sheds & Milkshops 86 „ „ Factories 6 „ „ Workshops 43 „ „ Homeworkers' Premises 10 „ „ re cases of Infectious Disease 84 „ Drains examined under Section 41 of the Public Health Act, 1875 30 „ Drains tested with Water 273 „ „ „ „ Smoke or Air 284 „ „ „ „ Chemical 4 61 Number of Complaints received and investigated 119 „ Preliminary notices served 133 „ Statutory notices served 106 „ Letters written on the business of the Department 732 „ Plans of houses re-drained prepared 92 „ Houses and premises disinfected 48 Description and Number of Nuisances Dealt With. Defective drains repaired, cleansed, trapped, etc. 39 Approved iron or glazed stoneware gullies fixed in lieu of defective stoneware, brick, or iron bell traps 225 Cesspools abolished 1 Houses subsoil drained 1 Overflow pipes disconnected from drains or soil pipes and made to discharge into the open air 1 Dilapidated water closets pulled down and rebuilt .11 Floors of water closets paved or repaired 24 Defective water closet walls rendered internally with cement 14 Water closet apartments lighted and ventilated 4 Water closet pans cleansed or repaired 7 Old iron container, long hopper or washout pans abolished and pans of an approved type fixed 152 Water closet flush pipes disconnected from domestic supply cisterns, and separate flushing cisterns provided 16 Defective water closet flushing cisterns repaired 67 Defective water closet flushing cisterns removed and new ones fixed 46 Closets supplied with water 1 Defective soil pipes repaired 24 Defective soil pipes removed and new ones fixed 35 Defective soil pipes inside dwelling houses removed and new soil pipes fixed outside 1 62 Defective ventilating pipes repaired 2 New ventilating pipes fixed 53 Additional ventilating pipes provided 7 Sink and other waste pipes trapped or disconnected from drain 37 Sink and other waste pipes repaired 10 New trapped waste pipes provided to sinks, baths, etc. 82 Defective sinks and lavatory basins abolished and new glazed stoneware sinks, etc., fixed 43 Rainwater pipes disconnected from drains or soil pipes 50 Defective rainwater pipes repaired or renewed 64 Defective eaves gutters repaired 16 Houses and premises provided with eaves gutters 15 Defective roofs repaired and made weatherproof 7 Sites of houses concreted to prevent dampness 2 Open areas built around houses to remedy dampness in basement walls 3 Ventilation provided under floors 1 Defective house walls repaired 3 Defective house floors repaired 3 Defective house ceilings repaired 1 Dirty houses cleansed and whitewashed 40 Yard paving repaired 6 Accumulations of manure removed 14 Manure receptacles provided with covers 1 Storage cisterns cleansed 1 Storage cisterns provided with covers 9 Storage cisterns abolished and water fittings connected direct to main 33 Water supplies to houses reinstated 6 Houses water laid on 1 Buildings blocking light and air removed 1 Nuisances from animals improperly kept abated 3 Piggeries cleansed and floors repaired 1 Public house urinals reconstructed and provided with a sufficient flushing apparatus 1 Stables paved and drained 4 63 Dust Receptacles. As the result of notices served under Section 36 of the Public Health Act, 1875, which requires a sufficient ashpit to be provided to each house, portable galvanized iron dust bins with tightfitting covers have been provided to nineteen houses where none previously existed, and at five houses defective brick ashpits have been abolished and suitable dust bins substituted. Paving of Yards. The importance of paving the yards and open spaces in the vicinity of dwelling houses with concrete or other durable and impervious material is becoming more and more recognised by owners of property as a necessary sanitary provision, as it not only assists to keep the house free from dampness but also tends to greater cleanliness both inside and outside the dwelling house. Tenants also greatly appreciate the benefit of a sufficiently paved area around the house, and now frequently apply to the Sanitary Department for this requirement to be enforced. During the year a sufficient area of the yards and open spaces of fifty dwelling houses have been paved, principally with six inches of concrete, so sloped that all water falling on the surface is conveyed into a properly trapped gully. 64 The total number of yards dealt with since the Bye-laws were adopted, is 569; but there still remain many yards and open spaces which require paving. These will be dealt with as early as possible and as time for inspection permits. House Drainage. During the year, complaints alleging nuisances from defective drainage at thirty houses, were made to the Council, who gave instructions for the ground to be opened and the drains examined under the provisions of Section 41 of the Public Health Act, 1875. Sanitary defects were found to exist in each case and notices requiring the drains to be relaid or repaired, as the case required, were served upon the persons responsible. At thirteen houses, the drainage was reconstructed by the Council at the request of the owners, a charge of 5 per cent. on the cost of the work being made for preparing the necessary plans and specifications. Seven combined drains, for the repair of which the Council were responsible under Section 4 of the Public Health Act, 1875, were reconstructed by the Council at a total cost of £584 13s. lid., made up as follows:— 65 Position. Cost of Reconstruction. £ s. d. 1 to 3, St. Leonard's Villas, St. Leonard's Road 31 9 9 1 to 6, Lamb's Cottages and 26 to 29, Alpha Road 53 14 1 26, 28 and 30, Worthington Road 29 16 3 57 to 75 (odd Nos.), Red Lion Road 36 8 3 Berrylands Mews, Berrylands Road 43 15 3 12, 13 and 14, Maple Road 180 19 4 72 and 74, Brighton Road, 1 to 11, Alderton's Cottages, and 1 to 4, Maple Terrace, Maple Road 208 11 0 £584 13 11 The increasing annual expenditure in relaying these drains, led the Council to promote a Bill in Parliament for relieving them of the responsibility thrown upon them in this respect; and I am pleased to report that this Bill passed both Houses of Parliament and received the Royal Assent in July. The relief to the ratepayers of the district, owing to the passing of this Bill, is likely to be considerable, the expense incurred by the Council in relaying combined drains since 1904, being as shown in the following table:— 66 £ s. d. 1904 42 0 0 1905 262 14 3 1906 172 6 6 1907 263 0 8½ 1908 79 12 7 1909 305 16 0 1910 584 13 11 £1710 3 11½ The drains and sanitary fittings at 90 houses have been reconstructed in accordance with modern requirements; and at 39 houses the drains have been repaired. Iron pipes have again this year been frequently used in drainage work, and at 57 per cent. of the houses redrained, iron pipes have been principally used. As 1 pointed out in my last report, the superiority of iron over stoneware pipes for house drains more than compensates for the small extra cost. In every case where a house is redrained, the water test is applied to the drains and the smoke Or air test to the sanitary fittings at completion. A plan of each new system of drainage is prepared and filed in the office for future reference. 67 Two hundred and seventy-three water tests have been applied to drains, and 284 smoke or air tests have been applied to soil pipes, ventilating pipes, etc. Schools. The public elementary schools have, as usual, all been disinfected by arrangement with the Managers and the Surrey County Education Committee, the walls, floors, and ceilings being sprayed with formaline during the Easter, Summer and Christmas vacations. The drains belonging to the non-provided schools—four in number—have, as usual, been examined and tested, and, with the exception of a slight defect at Hook Schools, all were found to be satisfactory. The defect at Hook Schools was caused through the drain being damaged by a roller when the playground was being repaired, and was made good upon the Managers' attention being called to the same. Defects having been found in the drainage of two schools under the control of the Surrey Education Committee, permission to make an annual inspection and test of the drains of the schools under their control was withdrawn. Since the withdrawal of their permission, the drains have not been tested, and I am therefore unable to report upon their condition. In view of the 68 fact that all other schools have consented to an annual inspection and test in accordance with the Council's resolution of the 13th January, 1908, I am of opinion that the action of the Surrey Education Committee is most regrettable and not in the interests of the health of the district, and I sincerely hope that the Council will take such steps as are possible with the object of inducing them to reconsider their decision. During the year two new private schools have been opened and one has been discontinued. There are now fourteen private schools in the district. The drains belonging to the two new schools were, at the request of the principals, tested and examined, and in both cases were found to be defective. Report was at once sent to the respective owners, who gave instructions for the work set forth in my report to be carried out. In each case the drains and internal fittings were put into a thoroughly sanitary condition. The defects at the four schools which I mentioned in my last report as outstanding, have all been remedied during the year. Of the eight remaining schools, the drains at seven have been examined and tested, and minor defects were found in two instances. These were immediately made good upon the owners' attention being called to the same. 69 The drains at the other private school have not been tested and examined, the owner having refused permission. Proceedings under the Public Health Acts were threatened, and the owner subsequently agreed to the drains being tested during the coming Easter vacation. Apart from this school, I am now able to report that the drains and sanitary fittings belonging to all the private schools in the district are in a thoroughly satisfactory sanitary condition. Factory and Workshop Act, 1901. During the year, seven new workshops have been placed on the register and eight have been cancelled, the businesses having been discontinued. The number of workshops and workplaces now on the register is 213. Inspections have been made from time to time in order to ensure that they are kept in accordance with the provisions of the Act. One hundred and seven visits have been paid, and as a result the following sanitary defects have been remedied:— Defective drains relaid "5 Defective w.c. pans removed and new ones fixed 5 Defective w.c. flushing cisterns repaired 4 Separate w.c. accommodation provided for the sexes 1 70 Foul and insufficient trough closets abolished, and pedestal closets each provided with a separate flushing cistern fixed 3 W.c. made to open into the open air instead of into workshop 1 Defective floor of workshop paved and drained 1 Defective floor of w.c. apartment paved 1 New sink provided in workshop 1 Dirty workshops cleansed 3 Overcrowding in workshop abated 1 26 In no case has it been necessary to take legal proceedings to enforce compliance with the notices served. Bakehouses. There are fourteen bakehouses in the district, all of which have been frequently inspected during the year. In no case has it been found necessary to serve a notice for the abatement of sanitary defects, although in eleven instances the requisite limewashing had not been carried out. This work was, however, at once executed upon the owners' attention being called to the fact. 71 Slaughter Houses. There are only six registered slaughter houses in the district, and none of these are very much used. Frequent inspections have been made, as far as possible, during the time when slaughtering was in progress, but in no instance has any infringement of the regulations been detected. Dairies, Cowsheds, and Milkshops. Periodical inspections of the dairies, cowsheds and milkshops within the district have been made, and on the whole a high standard of cleanliness has been found. In two instances, however, it was necessary to serve a notice to enforce the cleansing required by the regulations. Three applications for registration were received during the year, one from a dairyman and two from purveyors of milk residing outside the district, and their names have been placed on the register. The businesses of one cowkeeper, one dairyman, and two purveyors of milk residing in the district and one outside, have changed 'hands. One dairy and one milkshop have been closed. 72 There are thirty-two persons now on the Register, viz.:— Cowkeepers and Purveyors of Milk 3 Cowkeepers, Dairymen and Purveyors of Milk 3 Dairymen and Purveyors of Milk 5 Purveyors of Milk residing in the district 10 Purveyors of Milk who reside outside the district, but retail milk in the district 11 32 Two unregistered purveyors of milk were found to be carrying on business within the district and were reported to the Council, who ordered summary proceedings to be taken against them. One case was dismissed by the Magistrates on payment of 8/6 costs, and in the other case they imposed a fine of £1, including costs. r The cows belonging to the registered cowkeepers have been inspected quarterly by the Council's Veterinary Inspector, the average number of cows examined being 258. The reports made show the cows generally to be in a very good condition and very free from disease. No case of tubercular disease of the udder was detected. Disinfection. Disinfection is carried out after the removal, recovery or death of the patient in all cases of infectious disease, including Consumption, by the staff of the Sanitary Department, the rooms being 73 sprayed with formaline and fumigated with formaline gas, and all bedding, clothing and other articles likely to retain infection are removed to the Tolworth Isolation Hospital for steam disinfection. Where necessary, the owners are required to strip and cleanse the walls, distemper the ceilings, and wash all woodwork with a suitable disinfectant which is supplied by the Council. During the year, disinfection has been carried out at 48 premises, in which the following cases of infectious disease have occurred:— Scarlet Fever 29 Diphtheria 10 Typhoid Fever 3 Consumption 10 Measles 2 Total 54 Disinfection has also been carried out after two deaths from Cancer, one from Syncope, one from Appendicitis, and one from Pneumonia, at the request of the occupiers, and upon their agreeing to bear the expense. Enquiries have been made after each case of infectious disease in order to ascertain, if possible, the source of infection, and an examination of the drains, sanitary fittings and water supply has been 74 made. Disinfectants have been supplied without charge during illness. The following goods have been disinfected at the Tolworth Isolation Hospital under the supervision of the Hospital Staff:— Beds 43 Mattresses 58 Palliasses 54 Bolsters 54 Pillows 145 Sheets 70 Blankets 204 Counterpanes 47 Carpets 86 Rugs 58 Cushions 79 Toilet Covers 28 Towels 38 Wearing Apparel 794 Curtains 66 Blinds 1 Sundries 172 Bed Valances 30 Quilts 36 Pillow Cases 79 Mattress Covers 14 2,156 75 Legal Proceedings. Legal proceedings were taken in respect of the following cases, viz.:— No. Nature of Offence. Result of Proceedings. 1 For carrying on the business of a Purveyor of Milk without being registered Case dismissed with a warning on payment of 8/6 costs. 2 For carrying on the business of a Purveyor of Milk without being registered Fined £1 including costs. 3 Failing to provide a cover to manure receptacle as required by the Bye-Laws Fined 5/- and £1 1s. costs. I am, Sir, Yours obediently, W. NESFIELD, Assoc. R. San. Inst., Sanitary Inspector. 76 TABLE I.—For the Whole District of Surbiton. 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 1900 14,732 295 20.02 29 98.3 168 11.4 14 5 13 176 11.9 1901 15,017 324 21.57 24 74.07 152 10.12 19 9 15 158 10.52 1902 15,386 288 18.7 34 118.0 157 10.2 13 5 17 169 10.9 1903 15,703 351 22.3 36 102.5 149 9.4 11 5 19 163 10.3 1904 16,460 347 21.0 41 118.1 178 10.8 20 7 24 195 11.8 1905 16,916 321 18.9 18 56.07 134 7.9 15 10 18 142 8.4 1906 17,367 356 20.4 36 101.0 135 7.7 13 4 22 153 8.8 1907 17,639 341 19.3 22 64.5 142 8.05 13 11 12 143 8.1 1908 18,747 385 20.5 27 70 1 177 9.4 12 5 17 189 10.08 1909 18,800 346 18.4 27 78.03 171 9.09 14 5 25 191 10.1 Averages for years 19001909 16,676 335 20.1 29.4 88.0 156 9.4 14.4 6.6 18.2 167.9 10.0 1910 18,850 332 17.6 25 75.3 135 7.1 16 12 19 142 7.5 * Rates in columns 4, 8 and 13 calculated per 1,000 of estimated population. The "Public Institutions" to be taken into account for the purposes of these Tables arc 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. At Census of 1901. Total population at all ages, 15,017. Number of Inhabited Houses, 2,874. Average number of persons per house, 5.225. 77 Area of District in acres (exclusive of area covered by water), 3,031. I. II. III. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. Surbiton Cottage Hospital. Long Grove Asylum, Epsom. None. Isolation Hospital. Union Infirmary, Kingston. 78 79 TABLE II.—Surbiton District. Year. Names of Localities. SURBITON. TOLWORTH. HOOK AND 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. 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 11,214 159 128 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 1905 11.005 157 104 10 3,556 131 30 7 1,695 38 8 1 1906 11,787 172 94 14 3,804 138 44 17 1,776 46 15 0 1907 11,803 159 96 10 3,980 139 29 10 1,796 43 18 2 1908 11,772 192 119 14 4,848 148 49 9 2,127 45 21 4 1909 11,788 178 127 14 4,880 136 47 11 2,132 32 17 2 Avgs. of yrs. 1900 to 1909 11,503 176 116 15.7 3,455 120 36 10.8 1,717 38 13.5 2.9 1910 11,800 159 87 16 4,916 137 39 11 2,134 36 16 1 81 TABLE III.—Cases of Infectious Disease notified during the Year 1910, in the Urban District of Surbiton. 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 & South boro Surbiton Tolw'rth Book & Southboro. Total cases Removed to Hospital. Small Pox Cholera Diphtheria (incl. Memb. Croup) 8 1 4 1 2 6 2 3 2 5 Erysipelas 7 1 5 1 6 1 Scarlet Fever 29 3 20 4 2 21 7 1 19 6 1 26 Typhus Fever Enteric Fever 3 1 2 2 1 1 1 Relapsing Fever Continued Fever Puerperal Fever Plague Phthisis Totals 47 1 4 24 6 11 1 35 9 3 23 8 1 32 * Tolworth Isolation Hospital, Surbiton District. Total available Beds 38. Number of Diseases that can be concurrently treated 3. TABLE IV. Causes of, and Ages at, Death during Year 1910. Causes of Death. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Deaths in Localities (at all Deaths in Public Institutions in the District. district. Ages). All ages. Under 1. 1 & under 5 5 & under 15. 15 & under 25. 25 & under 65. 65 & upwards. Surbiton. Tolworth. Hook & Southboro Small-pox Measles Scarlet fever 1 1 1 4 Whooping-cough 3 1 1 1 1 2 Diphtheria (including membranous croup) 8 Croup Fever:— Typhus Enteric Other continued Epidemic influenza 2 2 1 1 Cholera Plague Diarrhœa 1 1 l Enteritis 4 3 1 1 3 1 Gastritis Puerperal fever Erysipelas 1 1 l Phthisis (Pulmonary Tuberculosis) 8 8 6 1 1 Other tuberculous diseases 3 2 1 2 1 Cancer, malignant disease 21 9 12 17 1 3 Bronchitis 11 1 1 2 7 6 4 1 Pneumonia 10 2 2 3 9 7 4 5 1 Pleurisy Other diseases of respiratory organs Alcoholism 3 2 1 1 2 Cirrhosis of liver Venereal diseases 1 1 1 Premature birth 3 3 1 1 1 Diseases & accidents of parturition 1 1 1 Heart diseases 19 3 1 4 11 11 5 3 Accidents 2 1 1 1 1 Suicides Other septic diseases 1 1 1 All other causes 41 12 1 1 9 18 28 12 1 2 All causes 142 28 8 4 3 41 58 87 39 16 16 83 TABLE V.—Surbiton District. Infantile Mortality during the Year 1910. Deaths from stated Causes in Weeks 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 7 3 2 2 14 5 1 3 2 2 1 28 Uncertified Common Infectious Diseases: Small-pox Chicken-pox Measles Scarlet Fever Diphtheria Whooping Cough 1 1 Diarrheal Diseases: Diarrhoea, all forms 1 1 Enteritis,Muco-enteritis Gastro-enteritis 1 1 1 2 Gastritis, Gastrointestinal Catarrh 1 1 1 Wasting Diseases: Premature Birth 2 2 1 3 Congenital Defects 3 1 4 1 5 Injury at Birth Want of Breast Milk, Starvation Atrophy, Debility, Marasmus 1 2 3 1 4 Tuberculous Diseases: Tuberculous Meningitis Tuberculous Peritonitis: Tabes Mesenterica OtherTuberculous Diseases Other Causes: Erysipelas 1 1 Syphilis 1 1 Rickets Meningitis (not Tuberculous) 1 1 Convulsions 1 1 Bronchitis 1 1 2 Laryngitis Pneumonia 1 1 2 Suffocation, overlying Other Causes 2 1 3 _ 3 7 3 2 2 14 5 1 3 2 2 1 28 District (or sub-division) of Surbiton ... Population, estimated to middle of 1910, 18,850. Birth. Deaths in the year of Legitimate Infants, 27 Illegitimate „ 1 Deaths from all Causes at all Ages. 142. 85 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. Factories (Including Factory Laundries) 6 Workshops (Including Workshop Laundries) 91 2 Workplaces (Other than Outworkers' premises included in Part III. of this Report) Total 97 2 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of Cleanliness 2 2 Want of Ventilation Overcrowding 1 1 Want of drainage of floors 1 Other Nuisances 7 11 Sanitary accommodation— . Insufficient 1 1 Unsuitable or defective. 6 Not separate for sexes 1 Offences under the Factory and Workshop Act:— Breach of special sanitary requirements for bakehouses (ss. 97 to 100). 11 11 Total 24 34 * Including those specified in Sections 2, 3, 7, and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. The number of defects remedied during the year include those which were outstanding at the end of 1909. 87 89 3—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Lists received from Employers. N umbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Instances. Notices served. Prosecutions. Twice in the year. Once in the year. Lists. Outworkeis. Lists. Outworkers. Wearing Apparel— (1) making, &c. 10 29 1 1 10 (2) cleaning and washing Total 10 29 1 1 10 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the Year. N umber. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses 14 Dressmakers 37 Bootmakers 24 Laundries 20 Tailors 19 Milliners 16 „ Other trades 83 Total number of workshops on Register 213 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) Action taken in matters inferred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) 'Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector. Other Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 1 91