AC 4413(1) SURBITON SUR 7 BOROUGH of SURBITON ANNUAL REPORTS OF THE MEDICAL OFFICER OF HEALTH AND CHIEF SANITARY INSPECTOR For the Year 1936 BOROUGH of SURBITON ANNUAL REPORTS OF THE MEDICAL OFFICER OF HEALTH AND CHIEF SANITARY INSPECTOR For the Year 1936 PHIL POTT & CO. (Surbiton), Ltd.. 40-42. BRIGHTON ROAD SURBITON. 1937 Borough of Surbiton. PUBLIC HEALTH COMMITTEE. Alderman Mrs. A. Woodgate (Chairman). Councillor E. B. Ames (Vice-Chairman). Alderman Durbin „ Reynolds Councillor Andrews „ Mrs. Bradley „ Mrs. Cudbird Councillor Heath „ Hill „ Leach „ McDermott „ Penwill With the Mayor (Alderman Sanger), Alderman Young and Councillor Sayer, ex-officio. PUBLIC HEALTH DEPARTMENT. PERSONNEL. Medical Officer of Health : *N. H. Linzee, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector : †*geoffrey McClelland, M.S.I.A., M.R.San.I. Deputy Sanitary Inspector : †*CYRiL Wilson, Cert.R.S.I., M.S.I.A. Additional Sanilary Inspectors : †*H. J. Eldridge, Cert.R.S.I., M.S.I.A. †*S. W. Simpson-Scott, Cert.S.I.B., A.R.San.I., M.S.I.A. (Appointed 13/1/36). †*N. F. Cripps, Cert.S.I.B., A.R.San.I., M.S.I.A. (Appointed 1/2/36). Senior Clerk : E. D. Elms. Clerk : J. L- WlLLOUGHBY. Junior Clerk: W. F. Acres. Disinfector, Mortuary Attendant, etc. : W. A. Hutchins. *Contributions to salary made from Exchequer. †Certificate of Royal Sanitary Institute as Inspector of Meat and other Foods. 5 Annual Report of The Medical Officer of Health for 1936 Public Health Department, 2, Shalston Villas, Surbiton. July, 1937. To the Mayor, Aldermen and Councillors of the Borough of Surbiton. Ladies and Gentemen, I have pleasure in submitting my fifteenth Annual Report and the first for the Borough of Surbiton. The most important feature during the year was the granting of a Charter to Surbiton by His Majesty King Edward VIII, dated 1st July, 1936, and presented to the Charter Mayor, Councillor H. S. Durbin, by His Majesty's Lieutenant of Surrey (Colonel the Lord Ashcombe, C.B.), on 16th September, 1936. The increase in the population of Surbiton continues, and further flats and houses were erected, chiefly by private enterprise, to accommodate this increase. The population according to the Registrar General is 42, 610 an increase of 2,590 on the previous year. This is a mid-year figure, and is used in arriving at the various vital data. The estimated figure at 31st December, 1936, is 44,200. The number of inhabited houses has increased from 12,007 to 12,771. The number of new houses erected during the year showed a decrease 6 of 175 under last year, but this decrease is more than balanced by the large blocks of flats which were erected during the year, and which have been utilised in housing the better classes of the population. These flats on the whole are of pleasing design. It is essential that the housing of the better class family should be considered. I think there is a tendency for this class to seek accommodation further afield. The remainder of the Council houses in the Addison Gardens Scheme were completed during the year, and a further 10 houses built at Chessington for the purposes of Part I of the Housing Act, 1930. The health of Surbiton still remains very satisfactory and there have been no serious outbreaks of any particular disease. I am pleased to record that, after careful consideration, it was decided to carry out the Schick Test for Diphtheria and to immunise where necessary. The Scheme came into operation on 21st September, 1936, and further details will be found under the heading Diphtheria in the body of the report. The Overcrowding Survey required by the Housing Act, 1935, was completed in the early part of the year and revealed 51 definite cases of overcrowding, together with 9 cases of families who would become overcrowded by the end of the year. Seven additional cases of overcrowding were discovered after the original survey, making a total of 67 cases, 23 of which were in Council Houses and 44 in other houses. During the year 42 cases were abated, 16 in Council Houses and 26 in other houses, leaving 25 7 cases of overcrowding at 31st December. At the time of writing, re-housing proposals for overcrowded families are still under consideration by the Council. I have to thank Mr. McClelland, your Chief Sanitary Inspector, and the remainder of the Staff, for their valuable help during the year, particularly in connection with the Housing Overcrowding Survey. I am, Ladies and Gentlemen, Your obedient Servant, N. H. LINZEE, Medical Officer of Health. PHYSICAL FEATURES AND GENERAL CHARACTERISTICS OF THE DISTRICT. Area of District.—This is officially given as 4,709 acres, and consists of the Civil Parishes of Surbiton, Tolworth, Hook and Chessington. Boundaries.—On the North by the Borough of Kingston-upon-Thames, on the North-West by the River Thames, which has a length within the district of 940 yards and includes within our area the Island known as Ravens Eyot, on the West and partly South-West by the Urban District of Esher, on the East by the Hogsmill River, otherwise locally known as the Maiden River, and by the Borough of Maiden and Coombe, and on the SouthEast by the Epsom Urban District, and on the South by the Leatherhead Urban District. Physical Features. — The Southern Railway runs in a deep cutting through the Northern portion of the district from North-East to South- 8 West. The rising ground known as Surbiton Hill, towards which on the Northern aspect the ground slopes upward from the level of the Rivers Thames and Hogsmill, forms a ridge which extends from Minniedale and the parts known as Clay Hill (now re-christened Villiers Avenue) overlooking Kingston, to just outside the boundary at Cock Crow Hill within the Parish of Long Ditton. The highest part of this ridge within our area is 118.6 feet. In the Southern portion of the district Winey Hill reaches a height of 241 feet and Telegraph Hill 300 feet. Geology.—The greater part of the district is of the Tertiary period embracing the Eocene strata of London Clay. In the portion nearer the river there are post-tertiary deposits of gravel and sand, described in the geological survey as " Valley Brick Earth." This extends from the line of the river up to the railway and then stretches down the Claremont Road to the Kingston Boundary. Fossils have been discovered occasionally, but not in any quantity. In the clay there have been found round stones or boulders with iron stained crystals and deposits of crystalline gypsum. In the Chessington portion of the district the soil is entirely London Clay, undulating considerably. SOCIAL CONDITIONS. The district is a fesidential one. On the North-West it is bounded by the River Thames, but a considerable portion of it is on hill ground at a height of from 100 to 300 feet above ordnance datum. A very large proportion of the adult residents here are engaged in business in London, for access to which the facilities offered by the Southern Railway by both steam and electric trains, and by the 9 L.P.T.B. bus services, are not surpassed when compared with any similar extra metropolitan district. An extension of the Southern Railway is being constructed through the district and will pass through Hook and Chessington. The work is now well in hand. There is also an efficient and adequate service of buses and trolley tramways connecting with most of the adjoining districts, except for the Berrylands Estate, which does not seem to be adequately serviced. There has been a slight increase in the number of factories in the district. The addition of these factories, however, cannot be said to exert any particular influence upon the health of the workers. Of the workers engaged at the factories and workshops the majority are resident within the district. The amount of unemployment in the Borough is small and is for the most part seasonal. The added area of Chessington may still be said to be rural in character, but this is rapidly changing as building development propresses in this part of the Borough. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,709 Resident Population (Census 1931) 29,396 Registrar General's estimate mid-year 1936 42,610 Estimated Population 31st December, 1936 44,200 Number of inhabited houses (end of 1936) according to the rate books 12,771 Number of families or separate occupiers (1931 census) 8,116 Rateable Value £486,688 Sum represented by a penny rate £1,860 10 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. (Based on population of 42,610) Live Births:— Total. M. F. Legitimate 700 368 332 Illegitimate 27 16 11 Birth rate per 1,000 of the estimated resident population 1706 Still Births :— Legitimate 22 11 11 Illegitimate — — — Rate per 1,000 total (live and still) births 29.37 Deaths 387 191 196 Crude death rate per 1,000 of the estimated resident population 9.08 Adjusted death rate (comparability factor 0.98) 8.89 Percentage of total deaths occurring in Public Institutions 52.19 Deaths from puerperal causes :— Deaths Rate per 1000 total Births (live & still) No. 29 Puerperal Sepsis l 1.33 No. 30 Other puerperal causes l 1.33 Total 2 2.67 Death rate of infants under one year of age :— All infants per 1,000 live births 38.51 Legitimate infants per 1,000 legitimate live births 34.28 Illegitimate infants per 1,000 illegitimate live births 148.14 Deaths from Cancer (all ages) 56 Deaths from Measles (all ages) 6 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 5 The natural increment in the population for 1936 is 340 11 Still Births.— The rate per 1,000 population is 0.51, which is below that for England and Wales (Smaller Towns), namely 0.64. The maternal mortality rate per 1,000 live births is 2.75. The maternal mortality rate per 1,000 total births is 2.67. The total number of cases of Puerperal Pyrexia and Septicaemia was 4, out of which 2 deaths were recorded. One case was nursed at home and recovered, one case went to the Kingston and District Hospital and died, and two cases were admitted to Queen Charlotte's Hospital, of which one died. Births.— The statistics supplied by the Registrar General show that during 1936 the total number of registered live births belonging to Surbiton amounted to 727 (384 male, 343 females). Birth Rate 17.06. There were 27 illegitimate births (16 male, 11 females), this number representing 3.71 per cent. of the total births. This shows an increase of 10 over last year. In addition there were 22 still births, representing 2 93 per cent, of the total births (live and still). Out of the total 727 live births there were only two deaths of mothers, thus giving a low rate. Year. No. of Births. No. of Maternal Deaths. 1932 535 3 1933 502 2 1934 612 4 1935 699 1 1936 727 2 There were 727 births registered for Surbiton. 548 births occurred in the District, of which 80 were outward transfers. There were 259 inward transferable births which occurred outside the Borough. 12 TABLE SHOWING BIRTH RATE, DEATH RATE AND ANALYSIS OP MORTALITY FOR THE YEAR, 1936. (PROVISIONAL FIGURES). Rate per 1,000 total population Annual death rate per 1,000 population Rate per 1,000 Live Births live Births Still Births All causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea Enteritis under 2 years Total deaths under 1 year England & Wales 14.8 0.61 12.1 0.01 0.00 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59.00 122 County Boroughs & Great Towns including London 14.9 0.67 12.3 0.01 0.00 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63.00 143 Smaller Towns— resident populations 25,000 to 50,000 at 1931 census 15.0 0.64 11.5 0.00 - 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55.00 London Administrative County 13.6 0.53 12.5 0.01 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66.00 Surbiton— estimated population 42,610 17.06 0.51 8.89 0.04 — 0.14 — 0.02 0.02 0.14 0.70 6.87 38.51 13 CAUSES OF DEATH DURING 1936. (Civilians only). Male Female All causes 191 196 1 Typhoid and Paratyphoid Fevers 1 1 2 Measles 3 3 3 Scarlet Fever — — 4 Whooping Cough 1 — 5 Diphtheria 1 — 6 Influenza 3 3 7 Encephalitis Lethargica — — 8 Cerebro-Spinal Fever — 1 9 Tuberculosis of Respiratory System 4 8 10 Other Tuberculosis Diseases 2 4 11 Syphilis — — 12 General paralysis of the insane, tabes dorsalis 1 — 13 Cancer, malignant disease 30 26 14 Diabetes 4 4 15 Cerebal Haemorrhage, etc. 5 11 16 Heart Disease 41 45 17 Aneurysm 1 1 18 Other Circulatory Diseases 7 10 19 Bronchitis 5 1 20 Pneumonia (all forms) 11 17 21 Other Respiratory Diseases — 5 22 Peptic Ulcer 5 — 23 Diarrhoea, etc. (under 2 years) 1 4 24 Appendicitis 5 — 25 Cirrhosis of Liver 1 1 26 Other Diseases of Liver, etc. — 2 27 Other Digestive Diseases 3 7 28 Acute and Chronic Nephritis 11 6 29 Puerperal Sepsis — 1 30 Other Puerperal causes — 1 31 Congenital Debility, Premature Birth, Malformations, etc. 9 7 32 Senility 5 6 14  Male. Female. 33 Suicide 2 2 34 Other violence 16 10 35 Other defined diseases 13 9 36 Causes ill-defined or unknown — — The total number of deaths for 1936 was 387, one less than in 1935. Out of this number 216 occurred in the Borough, 146 in Public Institutions outside and 25 in other places outside the Borough. TOTAL DEATHS. Year. In Borough. In Public Inst. outside. Other Places, outside. 1935 245—63% 132—34% 11—3% 1936 216—56% 146—38% 25—6% The crude death rate of 9.08 for this District is strictly speaking not comparable with the figure for England and Wales. In order to provide for this the Registrar General introduced a comparability factor which for Surbiton is 0.98, giving an adjusted death rate of 8.89. From the foregoing table it will be seen that the principal causes of death, apart from zymotic diseases, are as follows : — Cancer 56 Heart Disease 86 121 Cerebral Hemorrhage 16 Aneurysm 2 Other Circulatory Diseases 17 Pneumonia 28 39 Bronchitis 6 Other Respiratory Diseases 5 Influenza 6 Tuberculosis (Respiratory) 12 Comparing this table with last year, there has been a drop in all causes of death except those due to respiratory complaints which were up from 27 15 to 39. The big increase was due to Pneumonia. This increase was most marked in the last quarter of the year. Cancer. Cancer (Malignant Disease) was responsible for 56 deaths or 14.4 per cent. of the total number recorded. The following table gives the percentage figure since 1926:— DEATHS FROM CANCER. Year. Total Deaths. Cancer Deaths. Percentage of Total Deaths. 1926 234 25 10.6 1927 264 32 12.1 1928 261 46 17.6 1929 319 51 15.9 1930 288 43 14.9 1931 341 50 14.6 1932 324 40 12.3 1933 358 46 12.8 1934 355 33 9.2 1935 388 63 16.2 1936 387 56 14.4 The slight drop in deaths from Cancer is evidenced throughout the country. No doubt it can be attributed to early diagnosis and earlier operative treatment. Diseases of the Heart and Circulation. An appreciable decline in deaths from Heart and Circulatory Diseases is noticed, this decline occurs in all causes under this group. 86 deaths were due to heart disease. In addition there were 16 deaths from cerebral haemorrhage, 2 from aneurysm and 17 from other circulatory diseases. These 121 deaths occurring from diseases of the heart and circulation represent 31.2 per cent. of the total recorded deaths. 16 Year. Total Deaths. Deaths from diseases of heart and Circulation. Percentage of Total Deaths. 1926 234 76 32.4 1927 264 80 30.3 1928 261 78 29.8 1929 319 94 29.4 1930 288 91 31.5 1931 341 102 29.9 1932 324 103 31.7 1933 358 113 31.5 1934 355 118 33.2 1935 388 133 34.2 1936 387 121 31.2 Bronchitis, Pneumonia and Other Respiratory Diseases. There were 39 deaths under this group representing 10.07 of the total recorded deaths. Year. Total Deaths. Deaths from Pneumonia, Bronchitis or other Respiratory diseases. Percentage of Total Deaths. 1926 234 33 14.1 1927 264 29 10.9 1928 261 33 12.6 1929 319 39 12.2 1930 288 34 11.8 1931 341 41 12.0 1932 324 36 11.1 1933 358 41 11.4 1934 355 41 11.5 1935 388 27 6.9 1936 387 39 10.07 17 INFANT MORTALITY. The causes and ages at death of the children who died under the age of 1 year were as follows: — Marasmus—Gastro Enteritis—Bronchitis 8 months Prematurity 1 month Inanition—Premature Birth 17 hours Prematurity 2 days Asphyxia and inattention at birth Newly Born Atelectasis Pulmonum 30 minutes Infantile Diarrhœa 2 months Broncho Pneumonia 2 weeks Infantile Diarrhœa 3 months Prematurity 1 hour Ac. Generalised Tuberculosis 8 months Asphyxia — Laryngismus Stridulus — Prematurity 2 days Asphyxia after the full establishment of respiration produced by pressure on the mouth and nose and compression of the larynx, murder at the hands of some person or persons unknown 2 days Inanition due to Prematurity Newly Born Prematurity 3 days Prematurity 1 hour Meningo-coccal meningitis — Acute Hydrocephalus 3 months Gastro-Enteritis 5 months Acute Gastro-Enteritis—Fatty Degeneration of Liver 5 months Broncho Pneumonia 6 months Cerebral Haemorrhage—pressure at birth 1 day Pneumonia — Congenital Heart Disease 2 months Shock—Prolonged labour of mother due to contraction of the uterus 6 hours Bronchitis 5 months Weak Heart Action — General Debility 5 days Prematurity 5 days Broncho-Pneumonia — Whooping Cough Exomphalos 3 months Gastro-Enteritis—Operation—Congenital Hypertrophic Pyloric Stenosis 2 months 18 There were 28 deaths of children under 1 year of age which is an increase of 2 compared with the number for the previous year. Of the infant deaths, 17 occurred in Hospitals or Public Institutions outside the district of Surbiton. The ages at death were as follows:— one at 30 minutes, 1 hour, 6 hours, 3 days, two at 5 days, one at 2 weeks, three at 2 months, 3 months, 5 months, and one at 8 months. The Infantile Mortality Rate is 38.51 and the Infantile Mortality Rate for England and Wales (Smaller Towns) is 55.0. INFANT MORTALITY RATE. SURBITON England & Wales (Smaller Towns) 1930 56.3 55.0 1931 45.73 62.0 1932 50.46 58.0 1933 41.83 56.0 1934 27.78 53.0 1935 37.19 55.0 1936 38.51 55.0 The various rates compared with those for England and Wales (Smaller Towns) are given in the table below:— Per 1,000 Living. Per 1,000 Births. Births. Deaths. Diarrhœa under 2 years. Under 1 year. England and Wales (Smaller Towns) 15.0 11.5 3.4 55.0 Surbiton 17.06 8.89 6.87 38.51 19 The Infantile Mortality Rate is still satisfactory as compared with the Smaller Towns of England and Wales. The number of deaths from Diarrhoea under 2 years is 5, the same as last year:—one male and four females, and it is only in this rate that Surbiton exceeds the death rates for England and Wales (Smaller Towns). PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. No one part of Surbiton was subject to any severe epidemic. Case rate of attack per 1,000 of the population of certain infectious diseases in this district and in England and Wales (Smaller Towns). Disease. Case rate per 1,000 living. England and Wales Surbiton. (Smaller Towns). Small-pox — — Scarlet Fever 2.11 2.48 Diphtheria 0.23 1.26. Enteric Fever 0.04 0.06 Erysipelas 0.21 0.35 Disease Case rate per 1000 total births Fneland and Wales Surbiton (Smaller Towns) Puerperal Fever 2.67 2.80 Puerperal Pyrexia 2.67 7.57 20 NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Hospital. Total Deaths. Diphtheria 10 10 1 Scarlet Fever 90 86 — Enteric Fever 2 2 2 Pneumonia 51 14 28 Erysipelas 9 1 1 Encephalitis Lethargica — — — Ophthalmia Neonatorum 1 — — Puerperal Fever 2 2 1 Cerebro-Spinal Meningitis — Puerperal Pyrexia 2 1 1 Smallpox — — — Malaria — — — Dysentery 1 1 — Anterior Poliomyelitis 1 — — * Including inward transferable deaths occurring outside the district which are not included in total cases notified. All the above have been notified as occurring in the Borough. Scarlet Fever with 90 cases comes first, followed by Pneumonia and then Diphtheria. There was a sharp rise in the number of notified cases of Pneumonia, these, of course, included Influenzal Pneumonia. 21 ANALYSIS OF PATIENTS ADMITTED TO THE TOLWORTH ISOLATION HOSPITAL FOR THE YEAR ENDED 31st DECEMBER, 1936. Population. Diphtheria. Scarlet Fever. Typhoid. Measles. Other Diseases. Total. Surbiton 42,610 10 86 1 6 12 115 Maiden 34,480 23 42 - 20 14 99 Esher 39,880 28 57 - 6 12 103 Paying Patients (admitted from outside of the Constituent Districts) 8 28 _ 41 5 82 69 213 1 73 43 399 22 NOTIFICATION OF INFECTIOUS DISEASES DURING THE YEARS 1926 to 1936. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Diphtheria 27 29 28 31 40 14 12 7 49 22 10 Scarlet Fever 38 35 82 82 89 43 40 85 87 78 90 Enteric Fever 1 — 3 2 — 2 — 1 2 1 2 Puerperal Fever 1 1 1 1 — 1 2 3 3 2 Puerperal Pyrexia — 2 6 4 5 2 7 2 10 3 2 Pneumonia 50 67 25 46 64 64 68 54 40 30 51 Erysipelas 8 5 5 3 9 2 6 12 7 12 9 Encephalitis Lethargica — 1 3 1 — — — — — — — Cerebro-spinal Meningitis — 1 — 2 — — — — — — Ophthalmia Neonatorum 4 1 1 1 1 3 2 2 5 1 1 Acute Poliomyelitis — — — — — — — — — — 1 Dysentery — — — — — — — — — 4 1 Malaria — — — — — — — 1 1 1 — Total 129 141 154 173 209 130 136 166 204 155 169 The number of cases of Infectious Disease occurring in the Borough increased from 155 to 169. The infectious disease showing the greatest increase was Pneumonia and then Scarlet Fever. 23 TOTAL CASES NOTIFIED. TOTAL DEATHS. AT AGES. AT AGES. Under 1 Year. 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Under 1 Year 1-2 2-3 3-4 4-5 5-10 10-15 15 - 20 20-35 35-45 45-65 65 and over Diphtheria — — la — 1 4 2 — — — — — — — — — 1 — — — — — — — Scarlet Fever — — 2 4 8 46a 17 4 7 2 1 — — — — — — — — — — — — — Enteric Fever — — — — — — — 1 1 — — — — — — — — — 1 — — 1 — — Pneumonia 1 3 3 2 — 4 — 3 4 12 8 12 3 1 1 — — 1 — — 3 — 7 12 Erysipelas — — 1 — — — — — 1 5a 3 — — — 1 — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 1 — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever — — — — — — — — 2 — — — — — — — — — — — 1 — — — Other Puerperal Causes — — — — — — — — — — — — — — — — — — — — — — — — Polyomyelitis — — — — — — — — 1 — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 1 1 — — — — — — — — — — 1 — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — — — — 1 — — — — — — — — — — — — — — (a) Diagnosis not confirmed in one case. (b) „ ,, ,, „ two cases NOTE:- Total deaths include transferable deaths occurring outside the district which are not included in the total cases notified. 24 From the foregoing table the ages at which people are attacked by the various diseases can be seen. Pneumonia was most prevalent in persons over 20 years. The decline in Diphtheria is again shown to be in age groups 5 to 10 and 15 to 20. Scarlet Fever. Ward No. of Cases Treated in Hospital Treated at Home Deaths Berrylands 18 16 2 - Chessington 9 9 - - Hook & Southborough 17 17 - - Seething Wells 2 2 - - St, Mark's 10 10 - - Surbiton Hill 7 7 - - Tolworth East 15 15 - - Tolworth West 8 8 - - Tolworth South 4 2 2 - Ninety cases of Scarlet Fever were notified in the Borough of which 86 were sent to Isolation Hospital and 4 nursed at home. The four nursed at home were properly isolated and all necessary precautions taken to the satisfaction of the Medical Officer of Health. No deaths from this disease occurred. It is a curious fact that referring to the ward distribution the largest number of cases occurred in Berrylands Ward followed by Hook & Southborough and then Tolworth East and St. Mark's. This is almost the reverse of last year. 25 Diphtheria. Ward No. of Cases Treated in Hospital Treated at Home Deaths Berrylands l 1 — — Chessington — — — — Hook & Southborough 7 7 — 1 Seething Wells — — — — St. Mark's 1 1 — — Surbiton Hill — — — — Tolworth East 1 1 — — Tolworth West — — — — Tolworth South — — — — The number of cases of Diphtheria occurring in the Borough was 10 out of which 7 occurred in the Hook & Southborough Ward and of these 7 cases one died. The cases in Hook & Southborough were all in one house and from members of the same family. All cases were nursed at the Isolation Hospital—the death occurred in Hospital. 26 Monthly Table of Diphtheria Incidence Schick Test and Immunisation.— In the previous year the question of introducing the Schick test and immunisation was discussed and after producing the necessary data the Public Health Committee recommended the Council to adopt this treatment. A scheme was put forward for Schick Testing 27 all the children in the District and then to immunise with three doses of T.A.M. and to follow that in 4 to 6 months with a posterior Schick Test. All Schools Trustees were given notice but no propaganda other than issuing a leaflet drawing the parents' attention to the Schick Test was permitted. The doctors also received a similar notice. "Consent" cards were distributed to the various elementary schools in the Borough and it was found necessary to send larger numbers. The County Medical Officer gave me every assistance in the way of giving consent for the use of the clinic in South Place one afternoon per week and arranged to send a health visitor to assist at the Clinic and also at each school. Consent was obtained from the School Managers and the School Education Authorities before commencing treatment. 412 applications for the Schick Test were received up to the end of the year and 114 children were receiving treatment as follows :— Complete Immunisation. (i.e., Initial Schick Test, 3 immunising doses and posterior Schick Test) Nil. Cases not completed. Initial Schick Test and 3 immunising doses 60 Initial Schick Test and 2 immunising doses 12 Initial Schick Test and 1 immunising dose 12 Initial Schick Test only 30 Total 114 23 Pneumonia. Ward No. of Cases Treated in Hospital Treated at Home Deaths Berrylands 4 — 4 — Chessington — — — — Hook & Southborough 5 3 2 — Seething Wells 6 4 2 — St. Mark's 10 3 7 — Surbiton Hill 2 — 2 — Tolworth East 4 — 4 l Tolworth West 11 1 10 — Tolworth South 9 3 6 1 The total number of Pneumonia cases was 51—the wards most affected were Tolworth West, St. Mark's and Tolworth South. Two deaths occurred, one in Hospital and one at home. Enteric Fever. There were two cases of Enteric Fever, one of which was an imported case, the patient having been on holiday at Bournemouth and contracted it there. After being nursed at home the case was admitted to Hospital with complications, from which she died. Encephalitis Lethargica. No cases were notified. Tuberculosis. Under the Public Health Tuberculosis Regulations a register of all notifications is kept and weekly returns of cases are sent to the County Medical Officer. The continual movement of cases from one district to another requires constant supervision so that particulars can be brought upto-date and represent a true record. At the end of this year the following was the number of persons shewn to be suffering from the disease and living within the district. 29  Pul. Non-Pul. Males 62 20 Females 46 13 Total 108 33 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not necessary to take any action under these Regulations during the year. PUBLIC HEALTH ACT, 1925, SECTION 62. No action was taken under this section. TUBERCULOSIS. Age-Periods. NEW CASES. DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — 1 — — — 1 1—5 — 1 — 2 — — — — 5—10 — 1 1 2 — — — 2 10—15 — — — — — — — — 15—20 4 — — — 1 1 — — 20—25 4 3 2 — — — 1 — 25—35 9 5 1 — 2 3 — — 35—45 9 1 — — — 2 — — 45—55 5 1 1 — 2 1 — — 55—65 1 2 — — 1 1 — — 65 and upwards — — — — — — — — Totals 32 14 5 5 6 8 1 3 Of the fifty-six new cases tabulated above twenty are cases transferred from other districts. 30 Of the total number of deaths from Tuberculosis there were three of patients who had not been notified. There was an increase compared with last year of six new Pulmonary cases of Tuberculosis, while new Non-Pulmonary cases show a decrease of four under last year. The deaths from Tuberculosis all forms show an increase of two. Of the total new cases 29 are resident in new houses and 27 in old. At the commencement of the year there were 132 cases of Tuberculosis on the register and at the close of the year the figure was 141. During the year 47 cases were removed from the register owing to recovery, leaving the district or death, and 56 new cases were added to the register. Of the 56 new cases it is interesting to note that 36 of these were new cases first notified in this district and that 20 were cases of persons coming to reside in the area. 31 TUBERCULOSIS—NEW CASES. Year. Resident in New Houses. Resident in Old Houses. 1933 17 33 1934 25 35 1935 29 25 1936 29 27 There was a tendency for a definite increase in the number of tuberculosis cases which can be traced from 1933. The rise is undoubtedly due to the increase in population. There is a close co-operation between the Surbiton Public Health Department and the Health Department of the Surrey County Council. 32 An inspection of the home conditions of persons suffering from Tuberculosis is carried out either by the Public Health Department or the Tuberculosis Department of the Surrey County Council, with a view to improving the conditions and to mitigate the risk of infection to other members of the household concerned. The Surrey County Council makes all arrangements for the provision of sanatorium and hospital treatment. During the year a survey of the home conditions of persons on the tuberculosis register was undertaken by this Department and a report submitted to the Housing Committee. In the majority of cases the housing conditions were found to be satisfactory and where any insufficiency existed, alternative accommodation in Council houses was offered to the families concerned. Measles. Measles is not a notifiable infectious disease in Surbiton and no accurate records of the number of cases are kept. The Head masters and mistresses notify the cases occurring in the Schools. The Tolworth Isolation Hospital now takes in complicated cases of measles. OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home In Hospital 1 1 — 1 — — — Ophthalmia Neonatorum is a purulent discharge from the eyes within twenty-one days of birth. 33 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals. 1. Fever. The Hospital provided for the isolation of cases of infectious diseases is under the management of a Joint Hospital Board appointed by the Borough Councils of Surbiton and Maiden and the Urban District Council of Esher. The total accommodation of the Hospital is 110 beds. 2. Small-pox. The Small-pox Hospital, situated at Clandon, is controlled by the Surrey County Council, and is subsidised by the Borough Council. 3. Tuberculosis. Cases are admitted into sanatoria through the Surrey County Council. 4. Maternity. Provision is made for these cases at Surbiton Hospital, the Kingston and District Hospital and at homes controlled by the Surrey County Council. 5. Children. Provision is made for these cases at the Surbiton Hospital and the Kingston and District Hospital. 6. Other. The Surbiton Hospital which is supported by voluntary contributions. On the 28th July, 1936. the new Surbiton Hospital, constructed at a cost of £60,000, was opened by H.R.H. the Duchess of Gloucester. 34 The total accommodation comprises 63 beds as follows : General Ward (Male) 13 beds Small General Ward (Male) 2 beds General Ward (Female) 13 beds Small General Ward (Female) 2 beds Twelve Private Wards 12 beds Children's Ward 7 cots Children's Ward 3 beds Four Isolation Wards 4 beds Two Maternity Wards 6 beds Maternity Isolation Ward 1 bed There is an operating theatre, also X-Ray and Casualty Departments, and a Nurses' Home with accommodation for twenty nurses. The new Hospital replaces the old Hospital which building has been taken over by the Surrey County Council and is used as an annexe to the Kingston and District Hospital. The accommodation at the old Hospital was as follows : — General Ward—Male 6 beds General Ward—Female 7 beds Children's Ward 4 beds Five Private Wards 5 beds Institutional provision for unmarried mothers, illegitimate children and homeless children—Nil, but provision is made for the admission of such cases into the Kingston and District Hospital. Institutional provision for the care of Mental Defectives.— Surrey County Council Homes at Ottershaw and Bletchingley, and Hospitals at Netherne and Brookwood. Ambulance Facilities. (a) For Infections Cases.—A motor ambulance is provided by the Joint Hospital Board. 35 (b) For Non-Infectious and Accident Cases.— A motor ambulance is provided by the Council which is available at any time night or day in cases of accident or sudden illness in the street, irrespective of boundaries. The ambulance is also available, within certain limits, for the removal of private cases at any time upon the production of a medical certificate and evidence of accommodation having been arranged at the Hospital, etc., to which the patient is to be taken, and upon payment of the prescribed fee. Owing to the number of calls on the ambulance service during the year under review, it might be advisable for the provision of a second ambulance to be considered. Clinics and Treatment Centres. Combined Maternity and Child Welfare Centre and School Clinic (provided by Surrey County Council), South Place, Surbiton. Tuberculosis Dispensary (provided by Surrey County Council), South Place, Surbiton. Sessions twice weekly or oftener if required. Venereal Diseases. Arrangements are made by the County Council for the treatment of these diseases at various Hospitals and Centres. Professional Nursing in the Home. (a) General. The Surbiton and District Nursing Association, which is affiliated to the Queen's Institute of District Nursing, has a superintendent nurse, three general nurses, one maternity and general nurse, and one maternity nurse available for attending cases in the home, within the Borough of Surbiton. In the Ecclesiastical Parish of Christ Church a parish nurse is provided by the Church Authorities for home nursing. 36 (b) Infectious Disease. There are no arrangements for the home nursing of cases of Measles and Whooping Cough. Provision is made in the Isolation Hospital for the admission of complicated cases of Measles and Whooping Cough. Midwives. The Corporation does not employ or subsidise any midwives. The Surrey County Council is the supervising authority under the Midwives Act. There are nine midwives practising in the District, excluding those employed at Surbiton Hospital. LABORATORY FACILITIES. Pathological and Bacteriological examinations are made for the Corporation by the Clinical Research Association. During the year the following examinations were carried out: — Disease Suspected. Nature of Specimen. Result. TOTAL. Positive. Negative. Diphtheria Swabbings G 164 170 Tuberculosis Sputum 11 92 103 Tuberculosis Blood — — — Tuberculosis Swabbings — — — Typhoid Fever Blood 2 2 4 Typhoid Fever Faeces 2 — 2 Typhoid Fever Urine — 1 1 Total 21 259 280 37 Diphtheria antitoxin is supplied free of charge to medical practitioners requiring it for cases within the district. It is kept in stock at 2, Shalston Villas, and is available at any time. Every package of antitoxin bears the date of preparation and a date (2½ years later) until which time the contents will be of full unit value. Stocks are arranged to ensure that the antitoxin is distributed well within the time limit specified. Out of 170 diphtheria swabs sent by the general medical practitioners for examination, only 6 proved to be positive. List of Adoptive Acts, Bye-Laws, and Local Regulations relating to Public Health, in force in the District, with Date of Adoption. Local or Adoptive Acts. The Surbiton Improvement Act, 1855. Infectious Disease (Prevention) Act, 1890. (By resolution of 26th January, 1891). Public Health Acts Amendment Act, 1890 (part of). (By resolutions of 26th January, 1891, and 13th June, 1910). Private Street Works Act, 1892. (13th March, 1893, and 13th June, 1910). Public Health Acts Amendment Act, 1907 (part of). September 27th, 1909). Surbiton Urban District Countil Act, 1910. Public Health Act, 1925 (part of). (14th December, 1925). Bye-Laws and Regulations. (1) Bye-Laws with respect to Nuisances (28th March, 1935). (2) Bye-Laws with respect to Tents, Vans, Sheds and Similar Structures (8th November, 1935). 38 (3) Bye-Laws as to means of Escape in Case of Fire in certain Factories and Workshops (28th March, 1935). (4) Regulations as to Underground Rooms habitually used as Sleeping Places (28th March, 1935). (5) Bye-Laws for the Regulation of Offensive Trades (25th May, 1925). (6) Bve-Laws as to Slaughter-houses (6th October, 1925). (7) Bye-Laws as to New Streets and Buildings (18th January, 1937). (8) Bye-Law as to Emission of Smoke (7th May, 1929). (9) Bye-Laws with respect to Houses let in Lodgings (30th March, 1932). SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The water supply throughout the District is furnished by the Metropolitan Water Board and is a constant supply of excellent quality. No samples have been taken for analysis by the Surbiton Council during the year. Drainage and Sewerage. There have been no important extensions to sewerage during the year. With regard to sewage disposal, important extensions to the works at Surbiton and Ruxley are proposed and at the time of writing, applications for loan have been made to the Ministry of Health. The sewage works at Ruxley is situated in the Epsom Urban District; but it also serves the parish of Chessington. Public Cleansing. The collection of house refuse is carried out on the tractor-trailer system and refuse disposal is 39 by incineration. There have been no important alterations in this service during the year. Closet Accommodation. The whole of the closets in the original Surbiton Urban District are on the water carriage system and most of the properties in the added parish of Chessington have been put on the water carriage system. SANITARY INSPECTION OF AREA. This is fully dealt with in the report of the Chief Sanitary Inspector, which is attached hereto. Sale of Food and Drugs Acts. The Sale of Food and Drugs Acts in this district are administered by an Inspector acting under the direction of the Surrey County Council who has kindly furnished the following particulars for 1936 :— ARTICLES. ANALYSED. ADULTERATED OR DETERIORATED. PROSECUTIONS. CONVICTIONS. Formal Informal Total Formal Informal Total Milk 42 9 51 — — — — — Meat 4 — 4 — — — — — Lemon Squash — 1 1 — — — — — Extract Malt & Cod Liver Oil — 1 1 — — — — — Minced Beef 1 — 1 — — — — — Sausages 8 — 8 2 — 2 — — Spirits 1 — 1 — — — — — Total 56 11 67 2 — 2 — — 40 Swimming Baths and Pools. Publicly owned Baths. Surbiton Lagoon, situated in Raeburn Avenue, Surbiton, is an open air pool 165ft. long and 90ft. wide with a depth of 3 to 9ft. The water is treated by continuous pressure sand filtration, sterilization by injection of chlorine and oxygenation over an ornamental cascade. Periodic samples of the water are taken by the Borough Engineer and Surveyor and the plant adjusted accordingly. Two samples were also taken by the Public Health Department at peak periods, both of which proved satisfactory. Privately owned Pools open to the Public. Ace of Spades Swimming Pool, Kingston ByPass Road is an open air pool 40ft. by 20ft. with a depth of 4ft. to 7ft. 6ins. One sample was taken during the year and this was reported upon as being satisfactory. The water is treated by means of a Candy chlorine filtration plant. Milk Supply. The Milk (Special Designations) Order, 1936, which came into force on 1st June, 1936, abolished the existing designations "Certified," "Grade A (T.T.)" and "Grade A" and prescribed new designations as follows :— Tuberculin Tested. Accredited. Pasteurised. These changes should go far to clear up the misunderstanding which has existed regarding the relative value of the various grades. There is one producer of Tuberculin Tested Milk in the Borough. Eight samples of Certified milk were taken 41 during the year and four samples of Grade A (T.T.) milk. Copies of the reports relating to Certified milk are forwarded by the Laboratory direct to the Ministry of Health and any necessary action is taken by that Department. Three samples of Ordinary milk were taken during the year under review. The presence of Streptococci and Tuberculosis were not detected in any of the 15 samples. The following is a summary of the Bacteriologist's reports:— No. of Sample. Temperature on arrival. Number of Bacteria per 1 cubic centimetre. Presence of Bacillus Coli. in 48 hours and 3 days. CERTIFIED MILK. 1 13°C 1,010 Negative. 2 15°C 6,430 Negative. 3 13°C 2,960 Negative. 4 17°C 740 Negative. 5 17°C 3,330 Negative. 6 17°C 1,980 Negative. 7 13°C 990 Negative. 8 14°C 720 Negative. GRADE A T.T. 1 13°C 4,500 Negative. 2 17°C 1,040 Negative. 3 17°C 2,500 Negative. 4 13°C 780 Negative. ORDINARY MILK. 1 14°C 4,550 Negative. 2 14°C 16,760 Negative. 3 13°C 10,400 Negative. 42 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries) 20 ... ... Workshops (Including Workshop Laundries) 50 4 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 7 ... ... Total 77 4 ... 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 3 3 ... ... Want of Ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 5 5 ... ... Sanitary accommodation Insufficient ... ... ... ... Unsuitable or defective 3 3 ... ... Not separate for sexes ... ... ... ... Offences under the Factory and Workshop Acts Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Other Offences:— Excluding offences under the sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order 1921 ... ... ... ... Total 12 12 ... ... * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 43 3. —HOME WORK. NATURE OF WORK OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers premises OUTWORK IN UNWHOLESOME PREMISES, SEC. 108. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances Notices served Prosecutions Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists Outworkers. Lists. Outworkers. Contractus Workmen. Contractus Workmen. Wearing Apparel— (1) Making, &c 4 ... 2 ... ... ... 4 ... ... 13 ... ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... Lampshade Painting ... ... ... ... ... ... ... ... ... ... ... ... ... Total 4 ... 2 ... ... ... 4 ... ... 13 ... ... ... 44 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the Year. Number. Bakehouses 17 Laundries 7 Tailors 11 Bootmakers 12 Dressmakers 14 Milliners 5 Sundry Other Trades 80 Total number of Workshops on Register 146 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, 1901) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5, 1901). Notified by H M. Inspector 2 Reports (of action taken) sent to H.M. Inspector. — Other — Underground Bakehouses (S. 101), in use at the end of the year 1 Certificates granted during the year — In use at the end of the year 1 45 Annual Report of Chief Sanitary Inspector. To the Mayor, Aldermen and Councillors of the Borough of Surbiton. I have the honour to present the Annual Report on the work of your Sanitary Inspectors for the year 1936. This report is compiled in accordance with the directions contained in a Memorandum from the Ministry of Health and as required by Article XIX (15 of the Sanitary Officers (Outside London) Regulations, 1935. COMPLAINTS. During the year 1173 complaints were received with respect to the following matters, viz :— Defective condition of house drains 66 Insanitary or dilapidated condition of houses and premises 63 Verminous rooms 13 Nuisances from dampness in walls and floors 26 Defective water closets 43 Defective sink waste pipes, etc. 17 Defective roofs 42 Defective eaves, gutters and rainwater pipes 11 Defective stoves and ranges 67 Water supply to dwelling houses disconnected 35 Smoke nuisance 11 Caravans 4 Overcrowding 4 Underground rooms — Houses infested with rats 15 46 Houses not provided with sufficient receptacles for house refuse 408 Nuisances from animals improperly kept 3 Offensive accumulation of manure, etc 20 Offensive smells from various causes 16 Flooding of premises 6 Defective water fittings 160 Miscellaneous 140 Cesspools 2 Condition of water-course 1 INSPECTION OF DISTRICT. Number of houses and premises inspected (ordinarily) 837 ,, houses inspected and particulars recorded (Housing Act) 176 „ houses and premises re-inspected 1342 „ miscellaneous visits 1006 ,, visits to works in progress 1255 „ visits to slaughterhouses 247 „ visits to dairies, cowsheds and milkshops 48 „ visits to bakehouses 24 „ visits to schools 16 „ visits to workshops 29 „ visits to workplaces 7 „ visits to factories 17 „ visits to homeworkers' premises 13 ,, visits re cases of infectious disease 135 „ visits to premises where food is exposed for sale 43 „ visits to fried fish shops 4 „ visits under Shops Acts 10 „ visits under Petroleum Acts 21 „ Council houses inspected 733 „ Council houses re-inspected 1623 „ visits re overcrowding 3612 „ smoke observations 4 47 TESTING OF DRAINS AND SANITARY FITTINGS. Drainage systems exposed for examination under Section 41 of the Public Health Act, 1875 22 Drains, soil pipes, etc., tested with smoke, air or chemicals 28 Drains tested with water 86 NOTICES SERVED. Informal Notices 99 Statutory Notices under Section 36 of the Public Health Act, 1875, to provide a sufficient dust receptacle 174 Statutory Notices under Section 36 of the Public Health Act, 1875, to provide a sufficient water closet 8 Statutory Notices under Section 41 of the Public Health Act, 1875, or Section 45 Public Health Acts Amendment Act, 1907, to examine and test drains 22 Statutory Notices under Section 41 of the Public Health Act, 1875, to relay drains 22 Statutory Notices under Section 94 of the Public Health Act, 1875, to abate nuisance 33 Statutory Notices under Section 19 of the Housing Act, 1930, of Time and Place 39 Statutory Notices under Section 19 of the Housing Act, 1930—Demolition Orders 30 Statutory Notices under Section 20 of the Housing Act, 1930, of Time and Place 8 Statutory Notices under Section 20 of the Housing Act, 1930—Closing Orders 12 Statutory Notices under Section 127, Housing Act, 1925, to enter and survey premises 219 Statutory Notices under Section 127, Housing Act, 1925, and Section 6, Housing Act, 1935, to measure premises 262 48 Statutory Notices under Section 17 of the Housing Act, 1930, to make premises reasonably fit for human habitation 312 Statutory Notices under Section 42 of the Housing Act, 1930, to require information re ownership of premises 187 Satutory Notices under Byelaws (Houses let in Lodgings), Clause 14, to provide particulars for registration 4 Statutory Notices under Section 23 of the Public Health Act, 1875, to provide a covered drain 8 Statutory Notices under section 47 of the Public Health Acts, Amendment Act, 1890, to cease polluting a stream. (Stat. 36) 2 Statutory Notices Notices to quit after Demolition Order. Form 7. 4 Statutory Notices under Section 25, Public Health Acts, Amendment Act, 1907, and Section 20, Public Health Act, 1925, to pave common passage 6 1451 DETAILS OF SANITARY IMPROVEMENTS EFFECTED DURING THE YEAR. Drainage. Defective drains repaired, cleansed, etc. 157 Drainage systems re-constructed 13 Drainage systems partly re-constructed 42 Additional drains provided 29 Water Closets. Additional provided 33 W.C.'s cleansed or repaired 41 New pans fixed 78 Flushing cisterns repaired or renewed 61 Lighted or ventilated 4 49 Sinks, Baths, Etc. New fixed 204 Waste Pipes, Etc. Repaired 23 New provided 128 Disconnected or trapped 13 Water Supply. Draw off taps disconnected 3 Water re-instated or laid on 5 Service pipes and cisterns repaired, etc. 242 Paving. Yards paved 55 Yard paving repaired 16 Dust Receptacles. Provided 294 Dampness. Roofs repaired 132 Eaves gutters or rain water pipes repaired and renewed 63 Damp courses fixed 18 Site of house concreted 14 Ventilation under floors provided 11 External walls pointed and rendered 60 House walls treated with solution 29 General Repairs. Windows made to open 8 Windows provided, repaired or renewed 315 House floors repaired or renewed 76 Doors repaired or renewed 267 Ranges and coppers repaired or renewed 198 Rooms ventilated 14 Internal walls and ceilings repaired 114 Rooms cleansed 812 External and internal painting 38 Handrails provided 28 Obstructive buildings removed 2 50 Animals removed 5 Accumlations removed 8 Miscellaneous 156 Cesspools abolished 6 Pail closets abolished 2 HOUSING. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b) ) 764 (i) By the Local Authority 36 (ii) By other Local Authorities Nil (iii) By other bodies or persons 728 (b) With state assistance under the Housing Acts :— (i) By the Local Authority— (a) For the purpose of Part II of the Act of 1925 Nil (b) For the purpose of Part III of the Act of 1925 Nil (c) For the purpose of Part I of the Act of 1930 10 (d) For other purposes Nil (ii) By other bodies or persons Nil 1. Inspection of Dwelling Houses during the year:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 910 Number of inspections made for the purpose 910 (2) Number of dwelling houses (included under sub-heading (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 176 Number of inspections made for the purpose 176 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 20 51 (4) Number of dwelling houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 790 2. Remedy of defects during the year without service of Formal Notices :— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 473 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 135 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) by Owners 68 (b) by Local Authority in default of owners — B.—Proceedings under Public Health Acts : — (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 223 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) by owners 178 (b) by Local Authority in default of owners 3 C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 10 52 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 20 (3) Number of dwelling houses in respect of which notices of Time and Place at which the question of making a Demolition Order will be considered—Section 19 (1) 21 (4) Number of undertakings to carry out works accepted 2 (5) Number of houses rendered fit 4 (6) Undertakings cancelled—the works having been carried out 4 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 13 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Housing Act, 1935.—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 25 (ii) Number of families dwelling therein 25 (iii) Number of persons dwelling therein 232 (b) Number of new cases of overcrowding reported during the year 67 (c) (i) Number of cases of overcrowding relieved during the year 42 (ii) Number of persons concerned in such cases 278 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil E.—Proceedings under Part I of the Housing Act, 1930:— In May, 1934, official representation was made 53 Clearance Area No. No of Houses Comprising Date of Confirmation Order Persons re-housed Result of ten clearance areas comprising seventy-four houses and during 1936 a further area was represented comprising twenty dwellings belonging to the Council. The position with respect to these areas is indicated in the table which follows :— 1 11 15/35, Maple Road (odd Nos.) 29th Januarv, 1935 17 Demolished 2 12 1/12, Ivy Place Undertaking accepted - Work carried out in accordance with Undertaking 3 3 78, 79 and 80, Portsmouth Road 4th February, 1935 9 Demolished 4 5 4/8, Grove Footpath 29th January, 1935 14 Demolished 5 4 1/4, Jennetts Cottages, Surbiton Hill Road 29th January, 1935 8 Demolished 6 3 1 /3, Stone Cottages, Leatherhead Road 4th February, 1935 7 Demolished 7 5 23/31, Gladstone Road (odd Nos.) 29th January, 1935 18 Demolished 8 24 1/12, Spring Cottages, St. Leonards Road, and 1/12, St. Leonards Square, St Leonards Road Not confirmed — Made fit — 9 2 291 and 293, Ewell Road 29th January, 1935 3 Demolished 10 5 2/6, Hobill Place 29th Januarv, 1935 11 Demolished 11 20 3/22, Howard Road Council property 55 Action not completed 54 HOUSING-POSITION AT DECEMBER 31st, 1936, ON LINES OF FORM 256a. Houses dealt with in :— clearance areas. UNDER PART II. Totals Demolished. Demolished :— Up to 31st Dec., 1935 12 Up to 31st Dec., 1935 16 291, 293, Ewell Road 2 1 & 2, Phipps Cottages 2 4/8, Grove Footpath 5 3, Grove Footpath 1 15/35, Maple Road 11 1/6, Lambs Cottages 6 2/6, Hobill Place 5 3, 2, 1, Berry Lodge 3 1/3, Stone Cottages 3 Anderson's Cottage 1 Caravan and Hut, Kirby's Piggeries 1 Old Harrow P. H. 1 Rushett Cottage 1 Plough Cottage 1 3, 4, Alms Cottages Wooden dwelling, adjacent to ' Ivymay,' 2 Fullers Way 1 - 38 36 74 Made Fit:— Made Fit:— Up to 31st Dec. 1935 24 Up to 31st Dec. 1935 14 1/12, St. Leonards Sq. 12 13, South Place 1 24, Grove Road 1 46a, Claremont Road 1 5, St. Leonard's Road (basement) 1 - 36 18 54 Closed, etc. :— 0 Closed etc:— Up to 31st Dec. 1935 Nil 36, St. Mark's Hill 1 26, Cadogan Road 1 5a, Berrylands 1 5 & 7, Berrylands Mews 2 1, St Mary's Mews 1 1, 2, 3, Royal Mews 3 120, Maple Road 1 6, 7, 8, Grove Road 3 - 0 13 13 Excluded from Order end no action necessary :— Up to 31st Dec., 1935 1 1 75 1 67 142 Action not completed by 31st December, 1936 :— Action not completed by 31st December, 1936:— 3/22, Howard Road 20 25, 26, Cottage Grove 2 " Roma," Green Lane 1 20 3 23 55 HOUSING—SUMMARY OF POSITION AT 31st DECEMBER, 1936. Houses in Clearance Areas in respect of which action was not completed by 31st December, 1935 38 Houses rendered fit informally 473 Houses rendered fit after procedure under section 17 of the Housing Act, 1930 68 Houses (excluding Clearance Areas) in respect of which action was not completed by 31st December, 1935 127 Houses rendered fit after procedure under Public Health Acts 181 Houses found during the year not to be in all respects reasonably fit 790 Houses rendered fit after undertaking to carry out works (sec. 19 Housing Act, 1930) 4 Houses found during the year to be unfit 20 Houses demolished (sec. Housing Act, 1930) 19 20 Tenements or underground rooms closed (sec. 20 Housing Act, 1930) 13 Houses dealt with in Clearance Areas :— Not confirmed—subsequently rendered fit 12 Demolished 26 - 38 Houses in Clearance Areas in respect of which action was not completed by 31st December, 1936 20 Houses (excluding Clearance Areas) in respect of which action was not completed by 31st Dec1936 178 Total 995 Total 995 56 FACTORY AND WORKSHOP ACT, 1901. The total number of workshops now on the Register, including bakehouses, is 146. The businesses carried on at the respective premises are given in the report of your Medical Officr of Health. Visits from time to time have been paid and as a result the following nuisances have been dealt with :— Water Closets. Unsuitable or defective 3 Other Nuisances. Want of cleanliness 3 Want of ventilation 1 Smoke nuisances abated 2 Dust bins provided 2 Miscellaneous defects 1 SLAUGHTERHOUSES. There are three slaughterhouses in the district, all of which are registered. They have been regularly inspected and generally found to be well kept. BAKEHOUSES. There are 17 Bakehouses in use in the district, one of which is underground. They have been visited regularly during the year, and found to be kept in a satisfactory condition. DAIRIES, COWSHEDS AND MILKSHOPS. During the year four persons have discontinued carrying on the trade of Retail Purveyors of Milk, and one has discontinued carrying on the trade of wholesale producer and they have been struck off the register. Five applications were received from persons 57 residing in the district to be registered as Retail Purveyors of Milk. There are now fifty persons registered in acordance with the Milk and Dairies (Amendment) Act, 1922, as follows :— Wholesale Traders of Producers of Milk 12 Retail Purveyors of Milk residing in the district 31 Retail Purveyors of milk who reside outside the district but retail in the district 7 Total 50 The Dairies, Cowsheds and Milkshops were visited during the year at irregular periods to ascertain if they were kept in a clean and satisfactory condition and in accordance with the Milk and Dairies Order, 1926. Five Dealers' Licences to sell "Certified" Milk, fifteen to sell "Pasteurised" Milk, six to sell "Grade A (Tuberculin Tested)" Milk, three to sell "Grade A Pasteurised," and two Supplementary Licences to sell "Grade A (Tuberculin Tested)" Milk, were granted under the Milk (Special Designations) Order, 1923. By the Milk (Special Designations) Order, 1936, which came into operation on 1st June, 1936, these licences continue in operation, a licence to sell milk as "Certified" or "Grade A (T.T.)" being deemed to be a licence to use the new designation "Tuberculin Tested" and a licence to sell "Grade A" being deemed a licence to use the new designation " Accredited." The new order makes no. change in the designation ''Pasteurised" except that further conditions are imposed with regard to thermometers and temperature records. 58 The Milk (Special Designations) Order, 1936, prescribes that "Tuberculin Tested" milk, if raw, must, until the 31st December, 1936, be so produced that a sample taken at any time before delivery to the consumer shall not contain more than 200,000 bacteria per millilitre; after that date it must satisfy a prescribed methylene blue reduction test for cleanliness. At all dates it must contain no coliform bacillus in one hundredth of a millilitre if pasteurised, it must be described as "Tuberculin Tested Milk (Pasteurised)" and must not contain more than 30,000 bacteria per millilitre. If it is bottled on the farm the word "(Certified)" may be added to its description. The conditions for "Accredited" milk are similar to those prescribed in the Order of 1923 for " Grade A " milk. It is raw milk from cows which have passed a veterinary examination; it may be bottled on the farm or elsewhere. It must satisfy the same bacteriological tests as are prescribed for raw "Tuberculin Tested" milk. ''Pasteurised" milk is milk which has been retained at a temperature of 145°F to 150°F for at least thirty minutes; and does not contain more than 100,000 bacteria per millilitre. In accordance with instructions received from the Ministry of Health, eight samples of "Certified" Milk were taken from the local Dairymen and sent to the Clinical Research Association for Bacteriological Examination. FOOD INSPECTION. Regular visits have been paid to the slaughterhouses in the district for the purpose of inspecting the carcases of animals at the time of, or immediately after slaughter. 52 beasts were inspected, 62 calves, 470 pigs, 59 445 sheep and 59 lambs, giving a total of 1,112 animals. Of this total 83 animals were affected with disease in some part, representing 746 per cent (last year's figure: 5 9 per cent.). Visits have also been made to the shops, restaurants, etc., where food is prepared or exposed for sale. The following foodstuffs found to be unfit for human food were surrendered by the owners, and subsequently destroyed:— lbs. ozs. Head & Tongue of beast (1) 28 0 Actinomycosis. Head & Tongue of beast (1) 15 0 Tuberculosis Head, tongue and lungs of beast (1) 35 0 Tuberculosis Portion of beast's liver (1) 2 0 Local Abscess Livers of beasts (2) 14 8 Tuberculosis Liver of beast (1) 8 0 Tuberculosis and Distomatosis Head, Tongue, lungs and mesentery of beast (1) 48 0 Tuberculosis Lungs of beast (1) 11 0 Tuberculosis Lungs and mesentery of beast (1) 7 0 Tuberculosis Portion of brisket of beast (1) 12 0 Localised Abscess Lungs of calf (1) 4 0 Tuberculosis Livers of pigs (9) 35 8 Milk Spot Livers of pig (2) 6 8 Cirrhosis Liver of pig (1) 4 0 Tuberculosis Heads, tongues and lungs of Pigs (2) 30 0 Tuberculosis Heads and tongues of pigs (4) 45 8 Tuberculosis Mesenteries of pigs (21) 25 8 Tuberculosis Lungs and heart of pig (1) 3 0 Tuberculosis Head, tongue, lungs & heart of pig (1) 9 0 Tuberculosis Head, tongue & pluck of pig (1) 12 0 Tuberculosis 60 Head, tongue and mesentery of pig (1) 10 0 Tuberculosis Head, liver and mesentery of Pig (1) 12 0 Tuberculosis Heads of pigs (7) 68 0 Tuberculosis Lungs of pigs (2) 3 8 Pneumonia Lungs of pig (1) 1 8 Congestion Hearts of pigs (2) 1 8 Pericarditis Lungs and stripped pleura of pig (1) 1 0 Pleurisy Carcases & offals of pigs (2) 280 0 Generalised Tuberculosis Heart and lungs of pig (1) 2 0 Pericarditis and Pneumonia Liver, lungs and mesentery of pig (1) 6 0 Tuberculosis Lungs of pig (1) 6 0 Tuberculosis Kidney of pig (1) 1 8 Hydronephrosis Livers of sheep (5) 5 8 Strongylus Rufescens Liver of sheep (1) 3 0 Abscess Lungs of lambs (2) 2 0 Strongylus Rufescens Rabbits (24) 50 0 Decomposition Golden Cutlets 7 0 Unsound Strawberries 24 0 Decomposed Salmon 16 0 Blown Tripe (5 pieces) 2 6 Unsound Total 858 6 61 POST MORTEM INSPECTION. Number Inspected Number of Condemnations Entire carcases Parts of carcases or organs Tuberculosis Other diseases Tuberculosis Other diseases Cattle (other than cows) 52 — — 8 3 Cows — — — — — Calves 62 — — 1 — Sheep 445 — — — 6 Lambs 59 — — — 2 Pigs 470 2 — 42 19 SCHOOLS. The public elementary schools have been visited from time to time and the sanitary accommodation and water supply was found to be satisfactory. New schools have been built in the area during the year and others are contemplated. SMOKE ABATEMENT. Informal action was taken during the year in respect of a nuisance from smoke at three premises in the area. The nuisances were abated and no further action was necessary. SHOPS. No formal action was taken during the year under the provisions of the Shops Act, 1934, relating to the ventilation and temperature of shops and to sanitary conveniences. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Arrangements are made for this work to be carried out at the Laboratories of the Clinical Research Association, York Buildings, Adelphi, W.C.2. 62 DISINFECTION. During the year disinfection has been carried out at 115 premises in which the following cases of infectious diseases have occurred: — Scarlet Fever 81 Diphtheria 10 Tuberculosis 9 Scabies 2 Erysipelas 3 Cancer 3 Pneumonia 1 Typhoid Fever 5 Puerperal Pyrexia 1 115 Disinfection was also carried out at twentyone premises after cases of non-notifiable diseases on the occupiers of the houses in which the cases occurred agreeing to pay the expense. Library books from infected households were disinfected by fumigation. The books from the Public Library treated in this way numbered 221 and 16 books were destroyed. The Public Elementary Schools were disinfected as arranged with the Managers and Surrey Education Committee: the walls, floors and ceilings being sprayed with formaldehyde during the holidays. The following articles of bedding, wearing apparel, etc., were removed to the Tolworth Isolation Hospital for steam disinfection under the superintendence of the Hospital staff: — Beds 7 Bed Valances 7 Blankets 366 Bolsters 43 Carpets 12 63 Counterpanes 98 Curtains 5 Cushions 24 Mattresses 129 Mattress Covers 97 Palliasses 4 Pillows 255 Pillow cases 241 Quilts 11 Rugs 37 Sheets 247 Toilet covers 11 Towels 90 Wearing apparel 390 Miscellaneous 220 2294 No. of rooms disinfected 132 1.—Eradication of Bed Bugs. Number of Council Houses Other Houses Found to be infested Disinfested Found to be infested Disinfested 19 19 6 6 2.—Methods employed for disinfestation. Council Houses Other Houses (a) Fumigation with Sulphur 2 1 (b) Fumigation with proprietory fumigating blocks 4 - (c) Spraying with proprietory insecticide 13 5 19 6 64 3.—To ensure that the belongings of tenants are free from vermin before removal to Council houses, an inspection is made by a Sanitary Inspector before removal. Where bed bugs are found, the furniture and other belongings are treated by spraying with insecticide and the bedding by steam disinfection or, with the tenant's consent, the bedding is destroved. 4.—The work of disinfestation is carried out by the local authority. LEGAL PROCEEDINGS. Legal proceedings were taken against a builder for failing to give notice of intention to reconstruct or alter drains as provided by section 39 of the Public Health Act, 1925. A fine of ten shillings was imposed with £2 2s. Od. costs. SPECIAL REPORTS. During the year special reports were presented to the Council on the following matters :— Housing Overcrowding Survey. Offensive Trades: Fish Friers. Pig-sties on Allotments. Housing conditions in the Alpha Road Area. Milk (Special Designations) Order, 1936. Housing Act, 1936. MORTUARY. The mortuary, situate in Alpha Road, is of solid construction and well equipped. During the year twenty-three bodies were received into the mortuary, nineteen post mortem examinations carried out, and nineteen inquests held. The mortuary has been much less used than during 1935. The building does not compare very well with the modern type of mortuary and the Committee have under consideration suggestions for improvements. 65 GENERAL. At the end of 1935 enumerators were engaged on the preliminary survey required by Part I of the Housing Act, 1935. The information obtained was carefuly recorded and report sheets were collated indicating "possible" and "definite" cases of overcrowding according to the standards laid down. The additional information required was considered to be of such a nature as to need experienced knowledge of housing matters and technical training. The rapid extension of the Borough also called for additional assistance in the Department, and two additional Inspectors were appointed in January of this year with a view to their completing the information necessary to deal with overcrowding, and later to take over a district of the Borough for ordinary Sanitary Inspector's work. The survey was completed in May and showed a percentage of '77 of the population to be overcrowded, and gave information of families who would become overcrowded before the end of the year and during succeeding years. The tabulated results were circulated to all Members of the Council (Form C). The house-to-house visits in connection with the Overcrowding Survey gave your Officers an excellent opportunity of acquainting themselves very fully with the housing conditions generally throughout the Borough, and the systematic inspection of houses to be dealt with under the repair sections of the Acts has since been directed to the areas found to be most urgently requiring attention. It is gratifying to be able to report that the whole of the Council's slum clearance schemes have been dealt with and completed. A brief summary of these areas and of individual houses demolished and the numbers of persons re-housed is shown on pages 53.54 and 55. 66 During the first eight months of the year the efficiency of the Department was retarded by the insufficiency of office accommodation, but in August new offices were provided to house the staff of the Public Health Department, and the improved accommodation has tended to much better administration and more congenial surroundings for the staff. It will be observed that the number of animals slaughtered in the Borough has again fallen. During the last ten years there has been a steady decline in the number of animals killed in the Borough, but there has been no relaxation of inspection of all animals killed and of meat exposed for sale in the shops. Little difficulty has been experienced in securing the compliance with Housing and Public Health notices served, and the relations between your Officers and property owners have been good. It is unfortunate that large numbers of owners of new houses are finding it necessary to take in a second family in order to meet their financial commitments. In many of these cases small front bedrooms are being converted into kitchens and in a number it was found that the waste pipes had been arranged to discharge into the surface water instead of the soil sewer, and without any notice being given to the Council of the execution of drainage work. The known cases have been remedied. Proceedings were necessary in one case as a warning to builders operating in the Borough that notice must be given of drainage work being done by them. The maintenance of the Council's Housing 67 Estates has proceeded smoothly, and the only heavy expenditure was in the replacement of defective stoves and renewals of hot water services generally. Eight men are continuously engaged on the decoration of the houses, and the Estates generally are in a much better condition than they have been for some years. In September, Borough status was conferred upon the district and the number of Councillors was increased to thirty-six. To many new Members the work of the Sanitary Inspectors may not be well known, and I hope they will visit the offices and acquaint themselves with the varied and interesting activities of the Public Health Service, and also bring to my notice any matters they think need attention. The volume of work throughout the year has been exceedingly heavy, and all members of the staff have been called upon to surrender much of their leisure time. This they have done willingly, and I am pleased to record my appreciation of their assistance which is always so conscientiously given. To the Medical Officer of Health and the officials engaged in other Departments I am grateful for their ready co-operation. I am, Ladies and Gentlemen, Your obedient Servant, GEOFFREY McCLELLAND, Chief Sanitary Inspector.