ANNUAL REPORTS OF THE MEDICAL OFFICER OF HEALTH AND CHIEF SANITARY INSPECTOR For the Year 1938 BOROUGH OF SURBITON ANNUAL REPORTS OF THE MEDICAL OFFICER OF HEALTH AND CHIEF SANITARY INSPECTOR For the Year 1938 Philpott & Co, (Surbiton) Ltd., Printers 40/42, Brighton Road, Surbiton Surrey. 1939 BOROUGH OF SURBITON PUBLIC HEALTH COMMITTEE. Alderman Mrs. A. WoodgaTE, J.P. (Chairman). Councillor J. Penwill (Vice-Chairman). Alderman Durbin Councillor McDermott „ Reynolds „ Ransom Councillor Ames „ Reynolds, J.P. Mrs. Cudbird „ Scott „ Leach „ Warwick With the Mayor (Alderman Rampton), the Deputy Mayor (Alderman Sanger) and Alderman Bridge, ex-officio. PUBLIC HEALTH DEPARTMENT. PERSONNEL. Medical Officer of Health : *Neville 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., C.A.G.S. Additional Sanitary Inspectors : †*CYRiL Wilson, M.S.I.A. (resigned 28th February, 1938) †*H. J. Eldridge, M.S.I.A. †*G. H. Cockell, M.S.I.A., M.R.San.I. (appointed 3rd January, 1938) ‡†*H. Handscomb, M.S.I.A., A.R.San.I (appointed 1st April, 1938) Senior Clerk : E. D. Elms. *Contributions made to salary from Exchequer. †Certificate of Royal Sanitary Institute as Inspector of Meat and other Foods. ‡Royal Sanitary Institute Smoke Certificate. Clerks : R. W. Turner (resigned 26th October, 1938) W. F. Acres P. E. Whitton Shorthand-Typist : Miss V. Cryer (appointed 5th December, 1938) Mortuary Attendant and General Assistant : A. C. Ball 5 Annual Report of The Medical Officer of Health for 1938 Public Health Department, 2, Shalston Villas, Surbiton. July, 1939. To the Mayor, Aldermen and Councillors of the Borough of Surbiton. Ladies and Gentlemen, I have pleasure in submitting my seventeenth Annual Report dealing with all matters appertaining to the health of the people residing in the Borough of Surbiton. Owing to the extraordinary amount of work devolving upon this Department by reason of Civil Defence measures, the barest of facts only are contained in this year's Report. The population of the Borough is still increasing steadily due to the influx of people into the new housing estates being constructed in the district. The chief areas of development are Hook and Chessington, where many houses of the smaller type are being built, though in the older part of the Borough the erection of large blocks of flats continues. New factories have been built in the neighbourhood of the Kingston By-Pass Road, and some of the existing ones are being enlarged. 6 Details of the various rates will be found in the appropriate sections of the Report, but I should like to draw attention to the Infantile Mortality Rate, the figure of 31.14 deaths per thousand live births is the lowest since 1934, and shows a considerable decrease compared with the previous year. Other items show satisfactory improvements with the exception of the incidence of Tuberculosis. As can be seen from the graph in this section, a steady rise can be traced since 1933 in the number of cases on the Surbiton register. Sixty new cases were notified during the year under review, of these forty-two being primary notifications and eighteen were transfers from other districts. Further comment with regard to Ward distribution will be found in this section. Schick Testing and Immunisation against Diphtheria was inaugurated in September, 1936, and during 1938 there was a decrease in the number of cases of Diphtheria notified. Favourable comparison can also be made with neighbouring districts where schemes are not operated on a similar scale. Perhaps the Council will consider issuing some propaganda in the near future with a view to the extension of this scheme, which, in my opinion, is now proving itself very beneficial. During the year, I submitted a report to the Public Health Committee with regard to disinfection after cases of infectious disease, and a new procedure in this connection has been adopted. Non-disinfection was commenced in November of the year, and the scheme is briefly that no disinfection is now carried out after Scarlet Fever, Diphtheria, etc. In place of disinfection, 7 tions are given to the householder of measures to be taken by thoroughly cleansing rooms and boiling clothes and bedding. A card is handed to the householder giving full particulars of these measures. Special provisions are made for disinfection after such cases as Enteric Fever, and also for the disinfection of books and toys. Where, however, a disinfection is requested by the doctor or parents after a case of notifiable disease it is carried out by this Department free of charge. It would be premature at the moment to comment upon the working of this scheme. In March, Mr. Cyril Wilson, the senior additional Sanitary Inspector, left to take the post of Senior Sanitary Inspector at Cheshunt, and I should here like to record my appreciation of his work during the last seven years. My thanks are once again due to Mr. McClelland and all the other members of the Public Health Department for their loyal and conscientious service during 1938. I am, Ladies and Gentlemen Your obedient Servant, NEVILLE H. LINZEE, Medical Officer of Health. 8. 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 South-East by the Borough of Epsom and Ewell, 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-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 rechristened 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 1186 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 distict 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 9 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 residential one. On the NorthWest 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 L.P.T.B. 'bus services, are not surpassed when compared with any similar extra metropolitan district. The new line of the Southern Railway through Tolworth, Hook and Chessington has made good progress during the year under review and the new station at Tolworth was opened in May, 1938. 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 10 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 for the most part seasonal. The added area of Chessington is being rapidly developed, and when the two new stations there are opened, more extensive development still may be expected. STATISTICS. Area (in acres) 4,709 Resident Population (Census 1931) 29,396 Registrar General's estimate mid-year 1938 46,600 Estimated Population 31st December, 1938 49,816 Number of inhabited houses (end of 1938) according to the rate books 14,541 Number of families or separate occupiers (1931 census) 8,116 Rateable Value £541,009 Sum represented by a penny rate £2,060 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. (Based on population of 46,600). Live Births:— Total M. F. Legitimate 806 434 372 Illegitimate 29 17 12 Birth rate per 1,000 of the estimated resident population 17 92 11 Death rate of infants under one year of age :— All infants per 1,000 live births 3114 Legitimate infants per 1,000 legitimate live births 41 01 Illegitimate infants per 1,000 illegitimate live births 3448 Deaths from Cancer (all ages) 76 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Deaths from Diarrhoea (under 2 years of age) 3 The natural increment in the population for 1938 is 382 Births. The statistics supplied by the Registrar General show that during 1938 the total number of registered live births belonging to Surbiton was 835 (451 males, 384 females). This gives a Birth Rate of 1792 live births per 1,000 population. Still Births :— Legitimate 26 14 12 Illegitimate — — — Rate per 1,000 total (live and still) births 30.20 Deaths:— 453 227 226 Crude death rate per 1,000 of the estimated resident population 9.72 Adjusted death rate (comparability factor 098) 9.53 Percentage of total deaths ocurring in Public Institutions and Nursing Homes 41.29 Deaths from puerperal causes :— Deaths. Rate per 1,000 total Births (live & still). No. 29 Puerperal Sepsis - - No. 30 Other puerperal causes l 1.16 Totals l 1.16 12 There was a decrease of 10 illegitimate births compared with 1937. The figure for 1938 being 29, composing 17 males and 12 females. This represents 3 47 per cent, of the total births. In addition, 26 still births occurred, representing 3 02 per cent, of the total births (live and still). The Still Birth Rate for Surbiton is thus 0.56 per 1,000 population as compared with 0.60 for England and Wales (Smaller Towns). There were, however, no maternal deaths. The total number of cases of Puerperal Pyrexia and Septicaemia was 8. Of these, six cases were removed to hospital and two were nursed at home. No deaths occurred. Of the 835 live births, only one death of a mother occurred, the cause of death being given as Postpartum Haemorrhage following: premature delivery of twins (6½ months). The following table shows the number of maternal deaths for the last seven years :— Year No. of Births No. of Maternal Deaths 1932 535 3 1933 502 2 1934 612 4 1935 699 1 1936 727 2 1937 785 — 1938 835 1 The number of live births occurring in the Borough was 683 of which 137 were outward transfers. Also, there were 289 inward transferable births belonging to Surbiton occurring outside the district, thus making a total of 835 births. 18 Table sh0wing birth rate, death rate and analysis 0f m0rtality f0r the year, 1938. (pr0visi0nal figures). Rate per 1,000 t0tal p0pulati0n Annual death rate per 1,000 p0pulati0n Rate per 1,000 Live Births Live Births Still Births All causes Enteric Fever Smallp0x Measles Scarlet Fever Wh00ping C0ugh Diphtheria Influenza Diarrh0ea Enteritis under 2 years T0tal deaths under 1 year England & Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.0l 0.03 0.07 0.11 5.5 53.00 126 C0unty B0r0ughs & Great Towns including London 15.0 0.65 11.7 0.00 - 0.05 0.01 0.03 0.07 0.10 7.8 57.00 148 Smaller Towns— resident populations 25,000 to 50,000 at 1931 census 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51.00 London Administrative County 13.4 0.48 11.4 0.00 - 0.06 0.01 0.03 0.05 0.06 13.1 57.00 Surbiton— estimated population 46,600 17. 92 0.56 9.53 — — 0.02 0.02 — — 0.15 3.59 31.14 14 From the foregoing table the various statistical rates of Surbiton, when compared with those of similar towns, show a very gratifying result. With the exception of deaths due to (1) Influenza; and (2) Scarlet Fever, the figures for Surbiton are well below those for England and Wales (Smaller Towns). CAUSES OF DEATH DURING 1938. (Civilians only). Male Female All causes 227 226 1 Typhoid and Paratyphoid Fevers — — 2 Measles — 1 3 Scarlet Fever 1 — 4 Whooping Cough — — 5 Diphtheria — — 6 Influenza 1 6 7 Encephalitis Lethargica 1 — 8 Cerebro-Spinal Fever 2 — 9 Tuberculosis of Respiratory System 4 7 10 Other Tuberculosis Diseases 2 1 11 Syphilis 2 — 12 General paralysis of the insane, tabes dorsalis 1 - 13 Cancer, malignant disease 38 38 14 Diabetes 2 7 15 Cerebral Haemorrhage, etc. 3 12 16 Heart Disease 68 60 17 Aneurysm 4 1 18 Other Circulatory Diseases 16 23 19 Bronchitis 1 2 20 Pneumonia (all forms) 13 12 21 Other Respiratory Diseases 2 4 22 Peptic Ulcer 3 — 23 Diarrhoea, etc. (under 2 years) 3 — 15 24 Appendicitis 2 2 25 Cirrhosis of Liver — — 26 Other Diseases of Liver, etc. 2 2 27 Other Digestive Diseases 2 2 28 Acute and Chronic Nephritis 5 1 29 Puerperal Sepsis — — 30 Other Puerperal diseases — 1 31 Congenital Debility, Premature Birth, Malformations, etc. 9 9 32 Senility 3 2 33 Suicide 3 3 34 Other violence 14 11 35 Other defined diseases 20 19 36 Causes ill-defined or unknown — — The total number of deaths for 1938 was 453, four more than in 1937. Out of this number 287 occurred in the Borough, 141 in Public Institutions outside and 25 in other places outside the Borough. Total Deaths. Year. In Borough. In Public Inst, outside. Other Places outside. 1936 216—56% 146—38% 25—6% 1937 290—65% 134—30% 25—5% 1938 287—63.5% 141—31% 25—5.5% The crude death rate of 9.72 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 098, giving an adjusted death rate of 9.53. 16 From the foregoing table it will be seen that the principle causes of death, apart from zymotic diseases, are as follows : — Cancer 76 Heart Disease 128 187 Cerebral Haemorrhage 15 Aneurysm 5 Other Circulatory Diseases 39 Pneumonia 25 34 Bronchitis 3 Other Respiratory Diseases 6 Influenza 7 Tuberculosis (Respiratory) 11 Cancer. Cancer (Malignant Disease) was responsible for 76 deaths or 17.17 per cent, of the total number recorded. The following table gives the percentage figure since 1928:— Deaths from Cancer. Year. Total Deaths. Cancer Deaths. Percentage of Total Deaths. 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 1937 449 79 17.59 1938 453 76 17.17 17 Diseases of the Heart and Circulation. One hundred and twenty-eight deaths were due to heart disease. In addition there were 15 deaths from cerebral hsemorrhage. and 44 from other circulatory diseases. These 187 deaths occurring from diseases of the heart and circulation represent 41 3 per cent, of the total recorded deaths. Year. Total Deaths. Deaths from diseases of Heart and Circulation. Percentage of Total Deaths. 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 1937 449 163 36.3 1938 453 187 41.3 Bronchitis, Pneumonia and Other Respiratory Diseases. There were 34 deaths under this group representing 7 5 of the total recorded deaths. Year. Total Deaths. Deaths from Pneumonia, Bronchitis or other Respiratory diseases. Percentage of Total Deaths. 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 1937 449 40 8.9 1938 453 34 7.5 18 INFANT MORTALITY. The causes and ages at death of the children who died under the age of 1 year were as follows Injury at birth 30 minutes Blue asphyxia—precipitate labour 1 hour Respiratory failure—delivery 2 hours Prematurity 9 hours Prematurity (30 weeks) 12 hours Congenital heart disease—malformation 14 hours Premature twin birth (6£ months) 19 hours Gastric haemorrhage — Gastritis — Prematurity 22 hours Premature twin birth (6½ months) 1 day Prematurity (8th month) 3 days Prematurity 4 days Acute Broncho-Pneumonia—premature birth 4 days Cardiac failure—congenital heart disease 4 days Prematurity — mother's toxaemia of pregnancy 1 week Heart failure — toxaemia — bronchopneumonia 2 weeks Prematurity 2 weeks Prematurity and Atelectasis 2 weeks Gastro-enteritis—Otitis Media 2 months Pyloric Stenosis (Congenital Hypertrophic) —Laparotomy for relief of obstruction 2 months Diarrhoea and vomiting—broncho-pneumonia 3 months Asphyxia—Inhalation of regurgitated food 4 months Lobar pneumonia—Gastro-enteritis 4 months Broncho-pneumonia 5 months Acute Gastro-enteritis 7 months Diarrhoea and vomiting — Meningococcal meningitis 8 months Subacute plastic peritonitis 11 months There were 26 deaths of children under 1 year of age which is a decrease of 7 compared with the number for the previous year. 19 Of the infant deaths, 12 occurred in Hospitals or Public Institutions outside the district of Surbiton. The ages at death were as follows :— 1 hour, 9 hours, 4 days, 1 week, 2 weeks (2), 2 months (2), 3 months, 7 months, 8 months and 11 months. The Infantile Mortality Rate is 31 14, and the Infantile Mortality Rate for England and Wales (Smaller towns) is 510. Infant Mortality Rate. SURBITON England & Wales (Smaller Towns) 1930 56. 3 550 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 1937 42.04 55.0 1938 31.14 51.0 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. Diarrhoea under 2 years. Under 1 year. England and Wales (Smaller Towns) 15.4 11.0 3.6 51.0 Surbiton 17.92 9.53 3.59 31.14 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Case rate of attack per 1,000 of the population of certain infectious diseases in this district and in England and Wales (Smaller towns). 20 Disease. Case rale per 1,000 living. Surbition. England and Wales (Smaller Towns). Small-pox — 0.00 Scarlet Fever 1.72 2.58 Diphtheria 0.13 1.53 Enteric Fever — 0.04 Erysipelas 0.19 0.39 Pneumonia 0.70 0.98 Case rate per 1,000 total births. Disease. Surbiton. England and Wales (Smaller Towns). Puerperal Pyrexia 929 12 51 Notifiable Diseases during the Year. Diseasse. Total Cases Notified. Cases admitted to Hospital. Total Deaths. Diphtheria 6 6 1 Scarlet Fever 80 77 1 Enteric Fever - - - Pneumonia 33 10 25 Erysipelas 9 4 — Encephalitis Lethargica — — 1 Ophthalmia Neonatorum 3 2 — Cerebro-Spinal Fever — — 2 Puerperal Pyrexia 8 6 — Smallpox — — — Malaria 1 1 — Dysentery — — — Acute Poliomyelitis 1 1 — * Including inward transferable deaths occurring outside the district which are not included in total cases notified. 21 The Clerk to the Tolworth Joint Hospital District Board has kindly supplied me with the following figures for 1938 : Analysis of Patients Admitted to the Tolworth Isolation Hospital for the Year Ended 31st December, 1938. Population. Diphtheria. Scarlet Fever. Typhoid. Measles. Other Diseases. Total. Percentage of Population. Surbiton 46,600 6 80 — 14 36 136 0.292% Maiden 38,820 36 61 1 22 38 158 0.407% Esher 42,420 35 59 1 8 33 136 0.320% Paying Patients (admitted from outside of the Constituent Districts) 9 1 1 30 25 66 - 86 201 3 74 132 496 22 Notification of Infectious Diseases during the Years 1928 to 1938. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Diphtheria 28 31 40 14 12 7 49 22 10 27 6 Scarlet Fever 82 82 89 43 40 85 87 78 90 82 80 Enteric Fever 3 2 — 2 — 1 2 1 2 1 — Puerperal Pyrexia 6 4 5 2 7 2 10 3 2 5 8 Pneumonia 25 46 64 64 68 54 40 30 51 39 33 Erysipelas 5 3 9 2 6 12 7 12 9 13 9 Encephalitis Lethargica 3 1 - - - - - - - 1 — Cerebro-spinal Fever - 2 - - - - - - - 1 - Ophthalmia Neonatorum 1 1 1 3 2 2 5 1 1 1 3 Acute Poliomyelitis - - - - - - - - 1 1 1 Dysentery - - - - - - - 4 1 — — Malaria - - - - - 1 1 1 - - 1 Total 154 173 209 130 136 166 204 155 169 171 141 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 — — 1 — 1 1 2 — 1 — — — — — — — 1 — — — — — — — Scarlet Fever 1 3 5 2 7 21 11 1 4 3 2 — — — — — 1 — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 1 1 1 1 1 4 1 1 3 5 6 8 3 — — 1 — — — — 1 1 9 10 Erysipelas — — — — — — — — 1 1 6 1 — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — 1 — Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — — OphthalmiaNeonatorum 3 — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 4 4 — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — — — — — — NOTE Total deaths include transferable deaths occurring outside the district which are not included in the total cases notified. 24 Scarlet Fever. Ward. No. of Cases. Treated in Hospital. Treated at Home. Deaths. Berrylands 7 7 — — Chessington 12 12 — 1 Hook and Southborough 7 7 — — Seething Wells 3 2 1 — St. Mark's 3 3 — — Surbiton Hill 4 4 — — Tolworth East 11 11 — — Tol worth West 16 14 2 — Tol worth South 17 17 — — Eighty cases of Scarlet Fever were notified in the Borough of which 77 were sent to Isolation Hospital and 3 nursed at home. The three nursed at home were properly isolated and all necessary precautions taken to the satisfaction of the Medical Officer of Health. One death from this disease occurred. Diphtheria. Ward. No. of Cases. T reated in Hospital. Treated at Home. Deaths. Berrylands — — — — Chessington — — — — Hook and Southborough — — — — Seething Wells — — — — St. Mark's 2 2 — — Surbiton Hill 1 1 — — Tol worth East 1 1 — — Tolworth West 1 1 — — Tolworth South 1 1 — 1 In all, 21 cases of Diphtheria were notified and admitted to the Isolation Hospital. Of these 15 were discharged " Not Diphtheria," leaving only 6 cases. 25 Diphtheria antitoxin is supplied free of charge to medical practitioners requiring it for cases within the district. It is kept in stock at the Public Health Department, 2, Shalston Villas, and at the Council Offices, and is available at any time. Every packet of antitoxin bears the date of preparation and a date (2 years later) until which time the contents will be a full unit value. Stocks are therefore arranged to ensure that the antitoxin is distributed well within the time limit specified. Swabbing outfits are also supplied by the Corporation to general practitioners free of charge. The outfits are marked chargeable to the Surbiton Corporation. Of the 178 diphtheria swabs sent by doctors for examination, only 3 proved to be positive. Schick Testing and Immunisation. Schick testing and the immunisation of positive reactors has been carried on throughout the year under review at sessions held twice weekly. Sessions were held at the Surrey County Council Clinic, South Place, on Tuesday afternoons, and at various schools on Friday mornings. Immunisation consists of three lcc. doses at weekly intervals of T.A.M. Prophylactic; a final Schick test is carried out 3 to 6 months after the final immunising dose. Four hundred and sixty-three children were treated during the year as follows:— Treatments Completed Incompleted Children treated at Clinic 185 70 Children treated at Schools 132 76 317 146 26 The division into children of school age and those under is:— Treatments Completed Incompleted Children of school age 274 114 Children under school age 43 32 317 146 The total number of sessions held during the year was 63. Up to the end of the year 1938, the number of children who have been completely immunised since the inception of the Scheme was 624, and there were also 146 undergoing treatment. No cases of diphtheria have been notified amongst children who have been immunised. Pneumonia. Ward No. of Cases Notified. T reated in Hospital. T reated at Home. Deaths. Berrylands 4 — 4 1 Chessington 4 1 3 1 Hook and Southborough 7 1 6 1 Seething Wells 4 2 2 1 St. Mark's 3 1 2 1 Surbiton Hill 4 3 1 3 Tolworth East 2 1 1 1 Tolworth West 4 1 3 1 Tolworth South 1 — 1 1 Enteric Fever. No cases of Enteric Fever occurred during the year. 27 Encephalitis Lethargica. No cases of Encephalitis Lethargica were notified during the year, but there was one death of an un-notified case. 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 the year 187 persons were shewn to be suffering from the disease and living within the district:— Pul. Non-Pul. Males 81 35 Females 54 17 Total 135 52 Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under these Regulations during the year. Public Health Act, 1936, Section 172. No action was taken under this section. 28 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— — 4 '2 — — — — 15— 3 6 2 2 2 3 — 1 25 - 7 4 3 2 2 1 — — 35 - 8 3 1 1 - 1 — — 45- 4 2 1 - 1 1 — — 55- 1 2 - — — — - - 65 and upwards — 1 — - - - - - Totals 23 18 12 7 5 6 1 1 Of the sixty new cases tabulated above, sixteen are cases transferred from other districts. Of the total number of deaths from Tuberculosis, there was one of a patient who had not been previously notified on Form A. The table shows a decrease compared with last year of one new Pulmonary case of Tuberculosis, and the new Non-Pulmonary cases also show a decrease of two. The deaths show a decrease of four. At the commencement of the year there were 159 cases of Tuberculosis on the register and at the end of the year this figure had increased to 187. 29 During the year, 4 cases were notified as recovered from the disease, 13 patients left the district, and there were 13 deaths. Of the 60 new cases, it is interesting to note that 42 of these were cases first notified in this district. The graph below shows the number of cases of Tuberculosis on the Surbiton Register for the years 1928-1938:— 30 Tuberculosis—New Cases. Year. Resident in New Houses Resident in Old Houses. 1933 17 33 1934 25 35 1935 29 25 1936 29 27 1937 29 34 1938 38 22 There seems to be a greater incidence of Tuberculosis in those areas which have been recently developed, and on referring to the table below which shows the distribution of cases into Wards, one notices that the greater number of primary notifications occur in such districts, i.e., Berrylands, Tolworth East, Tolworth West and Tolworth South. Ward. Cases added to Register Cases on Register 31st Dec., 1938 Primary Notifications Transfers etc. 1936 1937 1938 1930 1937 1938 Berrylands 5 4 7 2 2 0 30 Chessington 3 1 2 2 5 4 15 Hook and Southborough 3 3 3 4 3 — 14 Seething Wells 4 4 4 3 1 2 16 St. Marks 1 3 3 — 3 2 10 8urbiton Hill 5 8 0 2 2 3 23 Tolworth East 3 4 5 3 4 2 21 Tolworth West 5 10 7 2 1 — 29 Tolworth South 7 4 9 2 1 3 29 T0TALS 36 41 42 20 22 18 187 31 Sputum pots for use in connection with examinations for Tubercle Bacilli are available to general practitioners at this Department. These are marked chargeable to the Surbiton Corporation. There is a close co-operation between the Surbiton Public Health Department and the Health Department of the Surrey County Council, the County Council making all arrangements for the provision of sanatorium and hospital treatment. The County Medical Officer of Health periodically sends Health Visitors' reports to this Department on the Home Conditions of Tuberculosis patients, and where necessary, visits are made to ascertain if overcrowding exists, and if patients could beneficially be removed to Council Houses. 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 takes in complicated cases of measles. Fourteen such cases were admitted from Surbiton during the year. There was one death from measles during the year. 32 Ophthalmia Neonatorum is a purulent discharge from the eyes within twenty-one days of birth. All notifications of Ophthalmia Neonatorum are now sent direct to the Surrey County Council by the local general practitioners, as the County Council are the authority for Maternity and Child Welfare in this district. Puerperal Pyrexia. Eight cases of Puerperal Pyrexia were notified during the year, six being removed to hospital and the others nursed at home. No deaths occurred. The Public Health Act, 1936, which came into force on the 1st October, 1937, incurred an alteration in the notification of Puerperal Fever. Puerperal Fever is now omitted from the definition of notifiable disease, and the obligation to notify cases of Puerperal Pyrexia now includes the obligation to notify conditions previously notifiable as Puerperal Fever as Puerperal Pyrexia. 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. 33 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 County 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 County Hospital. 6. Blind Persons. The scheme for the welfare of such persons under the Blind Persons Acts is carried out by the Surrey County Council. 7. Other. The Surbiton Hospital which is supported by voluntary contributions. Institutional provision for unmarried mothers, illegitimate children and homeless children—Nil, but provision is made for the admission of such cases into the Kingston County Hospital. Institutional provision for the care of Mental Defectives.—Surrey County Council Homes Ottershaw and Bletchingley, and Hospitals at Netherne and Brookwood. 34 Ambulance Facilities. (a) For Infectious Cases.—A motor ambulance is provided by the Joint Hospital Board. (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. 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 more often 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 35 general nurses and three midwives 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. (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 3 175 178 Tuberculosis Sputum 9 98 107 Total 12 273 285 36 LIST OF ADOPTIVE ACTS, BYE-LAWS, AND LOCAL REGULATIONS RELATING TO PUBLIC HEALTH, IN FORCE IN THE BOROUGH, WITH DATE OF ADOPTION. Local or Adoptive Acts. (Subject to subsequent repeals and amendments). 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). (27th September, 1909). Surbiton Urban District Council 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 and Similar Structures (8th November, 1935). (3) Bye-Laws as to means of Escape in Case of Fire in certain Factories and Workshops (28th March, 1935). (4) Regulations as to LTnderground Rooms habitually used as Sleeping Places (28th March, 1935). (5) Bye-Laws for the Regulation of Offensive Trades (25th May, 1925). (6) Bye-Laws as to Slaughter-houses (6th October, 1925). 37 (7) Bve-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). (10) Fouling of Footpaths by Dogs (9th July, 1937). 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. I am supplied with monthly reports by the Board giving details of their chemical and bacteriological examinations. One sample of water was taken by this Department from a tap off the public supply in July, the sample was reported upon as being quite satisfactory. Drainage and Sewerage. The extensions to the Surbiton Sewage Disposal Works in Marsh Lane have been put in hand and are rapidly nearing completion. The extensions comprise four new percolating filters, humus tank, and increased sludge drying beds. The sewage works at Ruxley is situated in the Borough of Epsom, 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 38 partly by incineration and partly by controlled tipping. The latter method of disposal has only recently been introduced in this district. Closet Accommodation. The whole of the closets in the original Surbiton U'rban 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. Swimming Baths and Pools. Publicly-owned Baths. Surbiton Lagoon, situated in Raeburn Avenue, Surbiton, is an open air pool 165 feet long and 90 feet wide with a depth of 3 to 9 feet. The water is treated by continuous pressure sand filtration, sterilisation 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. In addition, three samples were taken by the Public Health Department which proved to be satisfactory. Privately-owned Pools open to the Public. Ace of Spades Swimming Pool, Kingston ByPass Road, is an open air pool 40 feet by 20 feet with a depth of 4 feet to 7 feet 6 inches. 39 The water is treated by means of a Candy chlorine filtration plant. Two samples were taken by this Department during 1938. Both were reported upon as being satisfactory. FOOD AND DRUGS ACTS. The 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 1938: ARTICLES. ANALYSED. ADULTERATED OR DETERIORATED. PROSECUTIONS. CONVICTIONS. Formal Informal Total Formal Informal Total Milk 45 5 50 — - — — — Cheese 1 — 1 1 - 1 — — Tea 2 — 2 - — — — — Shredded Beef Suet — 2 2 — - — — - Cream Ice 1 - 1 - - - - - Orange Squash — 1 1 — - - - - Liver 1 1 3 - - - - - Total 50 9 59 1 — 1 — — 40 MILK SUPPLY. During the year, eight samples of Ordinary milk (unpasteurised) were taken and examined. The bacteriologist's reports are detailed below: No. Temperature on arrival No. of Bacteria per 1 c c. Presence of B Coli in 48 hours and 3 days <l/100th) Result of Animal Inoculation experiment for Tubercle Bacilli 1 6°C. 16,300 Negative Negative 2 6°C. 18,630 Negative Negative 3 6°C. 92,660 Positive Negative 4 6°C. 16,930 Negative Negative 5 6°C. 73,330 Negative Negative 6 17°C. 46,330 Positive Negative 7 17°C. 94,330 Positive Negative 8 17°C. 33,660 Negative Negative In cases where the report was not considered satisfactory, the dairyman was interviewed and advised as to methods to be adopted to obtain better results. The following licences under the Milk (Special Designations) Order, 1936, were granted during the year:— Dealers' Licences to sell " Pasteurised " milk 15 Dealers' Licences to sell " Tuberculin Tested " milk 6 Dealers' Licences to sell " Tuberculin Tested (Pasteurised)" milk 3 Dealers' Supplementary Licences to sell "Tuberculin Tested" milk 2 26 41 "Tuberculin Tested" milk is milk from cows which have passed a veterinary examination every six months and have been Tuberculin Tested. It may be bottled on the farm or elsewhere, and it may be raw or pasteurised. If it is bottled on the farm it may be described on the caps as "Tuberculin Tested milk (Certified)." If it is not bottled on the farm, the cap must bear the address of the bottling establishment and. the words "Tuberculin Tested milk." If this milk is pasteurised, it is described as "Tuberculin Tested milk (Pasteurised)." Raw "Tuberculin Tested" milk must satisfy the prescribed methylene blue reduction test, and must contain no Coliform Bacilli in l/100th of a millilitre. Milk sold as "Tuberculin Tested (Pasteurised)" must not contain more than 30,000 bacteria per millilitre. Farms on which these milks are produced are licensed by the County Council, and the cattle are examined and tested by officers of that authority. "Accredited" milk is raw milk from cows which have passed a veterinary examination at intervals of three months; it may be bottled on the farm or at some other licensed establishment, and the caps on the bottles must bear the words "Accredited milk," with the words "Farm Bottled" if bottled at the place of production. The milk must satisfy the prescribed methylene blue reduction test and must contain no Coliform Bacilli in 1 /100th of a millilitre. The milk must not be treated by heat. The County Council is responsible for licensing these farms and for examination of the cows. 42 "Pasteurised" milk is milk which has been retained at a temperature of not less than 145°F. and not more than 150°F. for at least 30 minutes and then immediately cooled to a temperature of not more than 55°F. The milk at any time before delivery to the consumer must not contain more than 100,000 bacteria per millilitre, and the receptacles must be labelled "Pasteurised milk." FACTORIES. There were 232 factories on the Register at the end of the year as under:— Bakehouses 17 Laundries 11 Tailors 7 Bootmakers 24 Dressmakers 10 Motor Engineers 38 Builders 27 Electrical and Wireless Engineers 8 Timber Merchants 7 Cycle Repairers 8 Engineers 15 Printers 5 Miscellaneous 55 Total 232 One bakehouse is underground, and was still in use at the end of the year. Twenty-eight visits were made to factories and five to Outworkers' premises, as a result of which six contraventions were dealt with. The number of inspections is abnormally low due to the fact that it was intended to proceed with this work during the autumn after the new Factories Act had come into operation, but the Department was so seriously disorganised by the National Crisis in September that these duties could not be proceeded with till 1939. 43 1.—INSPECTIONS for purposes of provisions as to health. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions Factories with mechanical power 16 3 ... Factories without mechanical power 7 ... ... †Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 5 ... ... Total 28 3 ... †Electrical Stations should be reckoned as factories. 2 - DEFECTS FOUND. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 1 1 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate ventilation 1 1 ... ... Ineffective drainage of floors ... ... ... ... Sanitary conveniences— Insufficient 2 2 ... ... Unsuitable or defective 2 2 ... ... Not separate for sexes ... ... ... ... Other offences (not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) ... ... ... ... Total 6 6 ... ... 3.—OUTWORK IN UNWHOLESOME PREMISES. (Section 108 of Act of 1901 ; Section III of Act of 1937.) NIL. 44 ANNUAL REPORT OF THE 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 1938. This report is compiled in accordance with the directions contained in a Memorandum from the Ministry of Health and as required by Article 27 (18) of the Sanitary Officers (Outside London) Regulations, 1935. COMPLAINTS. (excluding Council Houses) During the year 265 complaints were received with respect to the following matters, viz.:— Defective condition of house drains 51 Insanitary or dilapidated condition of houses and premises 35 Vermin, insects, etc. 20 Dampness 8 Defective or insufficient closet accommodation 3 Defective sink waste pipes, etc. 5 Defective roofs 2 Water supply to dwelling houses disconnected 8 Smoke nuisances 18 Overcrowding 4 Houses infested with rats 20 Houses not provided with sufficient receptacles for house refuse 9 Nuisances from animals improperly kept 3 45 Offensive accumulations of manure, etc. 19 Offensive smells from various causes 15 Flooding of premises 6 Defective water fittings 4 Condition of water-courses 4 Shops Acts infringements 6 Miscellaneous 25 265 INSPECTION OF DISTRICT. Number of dwelling houses inspected for Housing defects (under Public Health and Housing Acts) 267 Number of Council House inspections 926 Number of Council House re-inspections 932 Number of premises inspected for other than Housing defects 783 Premises re-inspected (including Housing) 1,227 Works in progress (including Housing) 528 Miscellaneous visits 604 Total inspections 5,267 Included in the above are the following classified visits:— Visits to slaughterhouses 484 Visits to premises where food is exposed for sale 54 Visits to Houses-let-in-lodgings 7 Visits re Milk & Dairies Order to:— Cowsheds 26 Dairies 16 Milkshops 6 Milk Vehicles 11 Visits to bakehouses 19 Visits to fish friers' premises 6 Visits to factories 9 Visits to outworkers' premises 5 46 Visits to schools 45 Visits re cases of infectious disease 217 Smoke observations made 37 Shops Acts inspections 578 Visits re overcrowding 763 Visits to urinals and public conveniences 6 Visits re withdrawal of water supply 17 Visits re street gullies, sewers, highways 35 Matters referred to other departments 31 Interviews with owners, tradesmen, etc. 384 Verminous premises disinfested (Council Houses) 10 Verminous premises disinfested (Private Houses) 5 Visits to Council House applicants 47 Special visits 116 In addition to the above, 98 interviews with owners, builders, occupiers of shops, etc., took place in the Office. TESTING OF DRAINS AND SANITARY FITTINGS. Drains, soil pipes, etc., tested with smoke, air or chemicals 40 Drains tested with water 59 NOTICES SERVED. Informal notices 254 Statutory Notices under Section 24 of the Public Health Act, 1936, giving notice to owners of premises of proposed work of maintenance on sewer 24 Statutory Notices under Section 93 of the Public Health Act, 1936, to abate nuisance 2 Statutory Notices under Section 107 of the Public Health Act, 1936, giving consent to the establishment of Offensive Trade 1 47 Statutory Notices under Section 9 of the Housing Act, 1936, to make premises reasonably fit for human habitation 60 Statutory Notices under Section 12 of the Housing Act, 1936, of Time and Place 9 Statutory Notices under Section 12 of the Housing Act, 1936—Closing Orders 6 Statutory Notices under Section 66 (2) of the Housing Act, 1936, to abate overcrowding 2 Statutory Notices under Section 66 (3) of the Housing Act, 1936, requiring statement of persons sleeping in a house 3 Statutory Notices under Section 157 of the Housing Act, 1936, to enter and survey premises 114 Statutory Notices under Section 157 (d) of the Housing Act, 1936, to measure premises 93 Statutory Notices under Section 168 of the Housing Act, 1936, requiring information as to ownership 21 Statutory Notices under Section 10 (2) (4) of the Shops Act, 1934, requiring provision of suitable and sufficient sanitary accommodation 2 Statutory Notices under Section 10 (6) of the Shops Act, 1934, granting certificate of exemption 3 Statutory Notice under Section 14 of the Factory and Workshop Act, 1901, granting certificate as to sufficiency of means of escape in case of fire 1 Notices to remedy Smoke Nuisance 2 597 DETAILS OF SANITARY IMPROVEMENTS EFFECTED DURING THE YEAR. (excluding Council Houses) Drainage. Defective drains repaired, cleansed ,etc. 170 Drainage systems re-constructed 8 Drainage systems partly re-constructed 17 48 Additional drains provided 12 Cesspools abolished and premises re-drained to sewer 8 Urinal re-constructed and additional W.C. provided in Public House 1 Water Closets. Additional provided 23 W.C.'s cleansed or repaired 60 New pans fixed 54 Flushing cisterns repaired or renewed 39 Lighted or ventilated 10 Sinks, Baths, etc. New fixed 120 Waste Pipes, etc. Repaired 19 New provided 123 Trapped 7 Water Supply. Draw-off taps disconnected from storage cisterns 6 Water re-instated or laid on 12 Service pipes and cisterns repaired, etc. 8 Paving. Yards paved 15 Yard paving repaired 25 Dust Receptacles. Provided 49 Manure receptacles provided 1 Dampness Roofs repaired 52 Eaves gutters or rain water pipes repaired and renewed 73 Damp courses fixed 39 Site of houses concreted 18 Ventilation under floors provided 18 External walls pointed or rendered 68 House walls treated with a damp-resisting solution 5 49 General Repairs. Windows made to open 34 Windows provided, repaired or renewed 290 House floors repaired or renewed 72 Doors repaired or renewed 146 Ranges and coppers repaired or renewed 85 Rooms ventilated 17 Internal walls and ceilings repaired 145 Rooms cleansed 315 Handrails provided 10 Obstructive buildings removed 2 Smoke nuisances abated 3 Accumulations removed 18 Miscellaneous 62 Disused cesspools abolished 1 Food stores provided or ventilated 32 Chimney stacks repaired 2 Staircases lighted 17 Houses disinfested of vermin (inc. Council Houses) 22 Proper entries made in rent books 43 Basements made to conform to Regulations 6 Ventilated lobby provided between W.C. and restaurant 1 MAINTENANCE OF COUNCIL HOUSES. Works effected during the year. Drains repaired or cleansed 19 W.C.'s cleansed or repaired 13 New W.C. pans fixed 3 W.C. flushing cisterns repaired or renewed 61 New sinks fixed 3 Waste pipes repaired 23 New wastepipes provided 2 Hot and cold water pipes and cisterns repaired, cleansed, etc. 226 New footpaths laid 12 New dustbins provided 3 50 Roofs repaired 79 R.W. gutters and pipes repaired 11 Additional sub-floor ventilation provided 4 External rendering repaired 3 Windows repaired 184 Floors repaired 16 Doors repaired 107 Stoves and coppers repaired or renewed 63 New draining boards provided 5 Gates and fences repaired or renewed 53 Verminous Houses cleansed 6 Rooms redecorated 806 Houses painted externally 72 External renderings treated with stone paint 62 Miscellaneous 11 HOUSING. Number of new houses erected during the year: (a) Total (including numbers given separately under (b) ) 1,053 (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies or persons— Flats 219 Houses 834 (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 Nil (d) For other purposes Nil (ii) By other bodies or persons Nil 51 1. Inspection of Dwelling Houses during the year: (excluding Council Houses). (1) (a) Total Number of dwelling houses spected for housing defects (under Public Health or Housing Acts) 267 (b) Number of inspections made for the purpose 267 (2) (a) Number of dwelling houses (included under sub-heading (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 90 (b) Number of inspections made for the purpose 90 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 219 2. Remedy of defects during the year without service of Formal Notices (excluding Council houses):— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 114 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 9,10, and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 21 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) by Owners 27 (b) by Local Authority in default of owners 1 52 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) by Owners 1 (b) by Local Authority in default of owners Nil C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (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 4. Housing Act, 1936—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 22 (ii) Number of families dwelling therein 22 (iii) Number of persons dwelling therein 179 (b) Number of new cases of overcrowding reported during the year 16 53 (c) (i) Number of cases of overcrowding relieved during the year 11 (ii) Number of persons concerned in such cases 73 (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) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil 5. Proceedings under Part I, Housing Act, 1930:— The position with respect to the Council's Five Year programme is indicated in the table which follows: — 54 Clearance Area No. No. of Houses Comprising Date of Confirmation Order. Persons re-housed Result 1 11 15/35, Maple Road (odd Nos.) 29th January, 1935 22 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 18 Demolished 5 4 1/4, Jennetts Cottages, Surbiton Hill Road 29th January, 1935 12 Demolished 6 3 1/3, Stone Cottages, Leatherhead Road 4th February, 1935 9 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. Leonard's Square, St. Leonards Road Not confirmed Made fit 9 2 291 and 293, Ewell Road 29th January, 1935 4 Demolished 10 5 2/6, Hobill Place 29th January, 1935 13 Demolished 11 20 3/22, Howard Road Council property 70 Demolished 55 Housing—Position at December 31st, 1938. On lines of Form 256a. Houses dealt with in:— clearance areas. under part ii. Demolished:— Demolished :— Up to 31st Dec. 1937 56 Up to 31st Dec. 1937 37 6 & 10, Howard Rd. 2 — 58 37 95 Made fit:— Made fit:— Up to 31st Dec. 1937 36 Up to 31st Dec. 1937 21 36 57 Closed. Closed. nil Up to 31st Dec. 1937 14 184, Ewell Road 1 15 Excluded from Order and no action necessary:— Up to 31st Dec. 1937 1 nil 1 1 73 168 95 N.B.—Closing Order in respect of Basement, 5, Surbiton Hill Park made in 1938, but not operative till 1939. FACTORIES. The total number of factories now on the Register, including bakehouses, is 232. The businesses carried on at the respective premises are given in the report of your Medical Officer of Health. Visits from time to time have been paid and as a result the following contraventions have been dealt with:— Sanitary Conveniences. Insufficient 2 Unsuitable or defective 2 56 Other Defects. Want of cleanliness 1 Inadequate ventilation 1 The Factories Act, 1937, came into operation on the 1st July, 1938. It is a consolidating and amending measure, completely replacing the Factory and Workshop Act, 1901, and consolidating the provisions of sections of at least ten other statutes. BAKEHOUSES. There are 17 Bakehouses in use in the district, one of which is underground. They have been visited regularly during the year, and generally found to be kept in a satisfactory condition. SLAUGHTERHOUSES. There are three slaughterhouses in the district, all of which are registered. Slaughter of Animals Act, 1933. Two licences to act as a slaughterman, subject to the provisions of the Act, were granted during the year. The number of licences in force at the end of the year was seven. DAIRIES, COWSHEDS AND MILKSHOPS. During the year two 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. 57 Twelve applications were received from persons residing in the district to be registered as Retail Purveyors of Milk. There are now sixty-two persons registered in accordance with the Milk and Dairies (Amendment) Act, 1922, as follows:— Wholesale Traders or Producers of Milk 9 Retail Purveyors of Milk residing in the district 44 Retail Purveyors of milk who reside outside the district but retail in the district 9 Total 62 The Dairies, Cowsheds and Milkshops were visited during the year at irregular periods and generally found to be kept in a clean and satisfactory condition, in accordance with the Milk and Dairies Order, 1926. The occupiers of three cowsheds were warned regarding breaches of the Order, and considerable improvements were effected at each farm. Fifteen Dealers' Licences to sell "Pasteurised" Milk, six to sell " Tuberculin Tested " Milk, three to sell " Tuberculin Tested Pasteurised " and two Supplementary Licences to sell " Tuberculin Tested" Milk, were granted under the Milk (Special Designations) Order, 1936. FOOD INSPECTION. Regular visits have been paid to the slaughterhouses in the district for the purpose of inspecting the carcases and offal of animals slaughtered for human food. 58 Nineteen beasts were inspected, 7 cows, 293 calves, 1443 pigs, 803 sheep and 352 lambs, giving a total of 2917 animals. Of this total 202 animals were affected with disease in some part, representing 692 per cent. (last year's figure: 1133 per cent.). There has been a considerable increase in the number of animals slaughtered in the district, necessitating the attendance of inspectors in the late evenings and at week-ends. 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:— Pigs. lbs. ozs. Carcase and offal (4) 341 0 Generalised Tuberculosis Carcase and offal (1) 65 0 Erysipelas Head and tongue (25) 201 0 Tuberculosis Head, tongue, pluck and mesentery (1) 15 0 Tuberculosis Head, tongue and mesentery (4) 51 0 Tuberculosis Head, tongue and pluck (6) 74 0 Tuberculosis Head, tongue and collar (3) 122 0 Tuberculosis Mesentery (51) 53 4 T uberculosis Pluck (7) 37 0 T uberculosis Leg and part loin (1) 24 0 Tuberculosis Heart (17) 15 4 Pericarditis Lungs and heart (11) 26 8 Pleurisy and Pericarditis Pluck (5) 16 0 Pleurisy and Peritonitis 59 Pigs. lbs. ozs. Pluck and spleen (7) 33 0 Pleurisy and Peritonitis Lungs (4) 4 0 Pleurisy Lungs (11) 22 0 Pneumonia Liver (14) 47 0 Cirrhosis Liver (3) 10 0 Parasitic Calves. Carcase and offal (1) 120 0 Generalised Tuberculosis Pluck (1) 4 0 Tuberculosis Heart and lungs (1) 2 0 Parasitic Liver (1) 11 0 Distoma Hepaticum Sheep and Lambs. Liver (12) 21 8 Parasitic Beasts. Carcase and offal of cow (1) 595 0 Generalised Tuberculosis Two forequarters and offal of heifer (1) 128 0 Tuberculosis Head, tongue and offal of heifer (1) 45 0 T uberculosis Head and tongue (1) 28 0 Tuberculosis Hindquarters of cow (1) 71 0 Putrefaction Portion of liver (2) 7 0 Distoma Hepaticum Total 2189 8 60 Carcases Inspected and Condemned. Cattle excluding cows Cows. Calves. Sheep and Lambs. Pigs. Number Killed 19 8 294 1174 1535 Number Inspected 19 8 294 1171 1535 All diseases except Tuberculosis- Whole carcases condemned — — — — 1 Carcases of which some part or organ was condemned 2 1 2 12 77 Percentage of the number inspected affected with disease other than Tuberculosis 10.53% 12.5% 0.68% 1.02% 5.08% Tuberculosis only— Whole carcases condemned — 1 1 — 4 Carcases of which some part or organ was condemned 3 — 1 — 97 Percentage of the number inspected affected with Tuberculosis 15.79% 12.5% 0.68% — 6.58% 61 SCHOOLS. The public elementary and private schools have been visited from time to time and the sanitary accommodation and water supply was found to be satisfactory. The public elementary schools were disinfected as arranged with the Managers and Surrey Education Committee; the classrooms, lobbies and conveniences being sprayed with formaldehyde during the summer holidays. SMOKE ABATEMENT. Eighteen complaints of smoks nuisances were received during the year, and 37 smoke observations were made. Three nuisances were found to exist, and were subsequently abated, two after the service of formal notices and one by informal action. SHOPS ACTS. 1912-1936. The Staff of the Department has spent considerable time during the year in the administration of the Shops Acts, five hundred and seventy-eight inspections being made and many observations kept. As a result of informal action the following infringements of the Acts were rectified:— Forms and notices 3 shops Sink and water supply provided 1 shop Ventilation improved 2 shops W.C.'s repaired 2 shops Staircase lighted 1 shop During the year, the Corporation after consultation with the three local traders' associations, and after a ballot of the occupiers of shops concerned, passed the following resolution:— 62 "That an Order be made under section 2 of the Shops (Hours of Closing) Act, 1928, providing that, as respects the trade or business of selling table waters, sweets, chocolates or other sugar confectionery or ice cream, the general closing hours shall be 9 o'clock in the evening on the late day and 8 o'clock in the evening on any other day." This procedure was in accordance with guidance given in Home Office circular dated 7th August, 1928. Certain offences against the new Order were subsequently observed, and the necessary evidence for prosecutions obtained. The cases were heard before the local Bench, which, after an adjournment, announced its decision against the Corporation in a considered opinion to the effect that as the procedure prescribed in section 10 (3) of the Shops Act, 1912, had not been carried out, the Order made by the Corporation was invalid. 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. DISINFECTION. During the year disinfection has been carried out at 125 premises in which the following cases of infectious diseases have occurred:— 63 Scarlet Fever 76 Diphtheria 22 Tuberculosis 20 Erysipelas 2 Meningitis 1 Anterior Poliomyelitis 2 Typhoid Fever 1 Puerperal Pyrexia 1 125 Disinfection was also carried out at thirty-nine 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 122 and 4 books were destroyed. 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 1 Blankets 217 Bolsters 40 Counterpanes 17 Curtains 10 Cushions 12 Mattresses 122 Mattress Covers 20 Palliasses 13 Pillows 214 Pillow cases 142 Quilts 32 Rugs 4 64 Sheets 114 Toilet covers 8 Towels 40 Wearing apparel 342 Miscellaneous 43 Books 2 1393 No. of rooms disinfected 137 ERADICATION OF BED BUGS. 1.— Number of Council Houses Other Houses Pound to be infested Disinfested Found to be infested Disinfested 6 6 16 16 2.—Methods employed for disinfestation. Council Houses Other Houses (a) Fumigation with Sulphur - 3 (b) Fumigation with Sulphur and spraying with Vermicine l 2 (c) Fumigation with Cimex and spraying with Vermicine 1 (d) Spraying with Vermicine 5 8 (e) Spraying with Zaldecide - 1 (f) Fumigation with Cyanide - 1 6 16 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. 65 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 tenants' consent, the bedding is destroyed. 4.—Disinfestation was carried out by the local authority for Council Houses found to be infested, and in each case a supply of insecticide and a sprayer was given to the tenant to assist with the work. Disinfestation at the other houses was carried out by the owners in five cases, by the tenants in nine cases and by the Local Authority in two cases. 5.—The measures taken by way of supervision or education of tenants to prevent infestation, or reinfestation after cleansing, are as follows:— At the time of cleansing the co-operation of the tenant is sought and information is given to him by the Sanitary Inspector as to the measures necessary to prevent re-infestation. Supervision is obtained by periodic re-inspection after cleansing. LEGAL PROCEEDINGS. Proceedings were taken against a butcher for causing or permitting the carcases and offal of two calves slaughtered for sale for human consumption to be removed from the slaughterhouse before being inspected, or removal was authorised by the local authority; and for slaughtering two lambs without delivering to the local authority notice of the day, time and place at which slaughter took place at least three hours before the time of slaughter. 66 The defendant was fined £5 in each case. Proceedings were also taken against four traders for alleged offences against the Surbiton (Sale of Sugar Confectionery, etc.) Shops Order, 1938, made under the Shops Act, 1928. The bench held that, as the provisions of the 1912 Act had not been complied with in making the Order, the summonses must fail, and they were accordingly dismissed, each defendant being allowed two guineas costs. PUBLIC MORTUARY. During the year, thirty-five bodies were received into the mortuary, thirty-three post mortem examinations carried out, and twenty-two inquests held. The Mortuary was closed at the end of the year for extensive alterations and modernisation. GENERAL. During the year there were several changes in the technical and administrative staff. From September onwards, a check was enforced on the activities of the Department by reason of the International Crisis, and subsequent Civil Defence work. Normal procedure has not yet been resumed, but every effort is being made to keep the work of the Department up-to-date. The Minister of Health requires information in respect of sites used for camping in the Borough during the year, but there are no established sites and no licences have been issued under section 269 of the Public Health Act, 1936. 67 It is with gratitude I again record the keen sense of duty which prevails among the staff of the Department and the loyal manner in which they carry out their work. I have received helpful co-operation from the Medical Officer of Health, principal officers and members of the Corporation which I am pleased to acknowledge. I am, Ladies and Gentlemen, Your obedient Servant, GEOFFREY McCLELLAND, Chief Sanitary Inspector.