SURBITON URBAN DISTRICT COUNCIL TWENTY-SEVENTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, INCLUDING REPORT OF THE SANITARY INSPECTOR, 1 9 O 3 . Smrbiton: PRINTED BY BULL & SON, VICTORIA ROAD. the Arban District Council of Surbiton. Area in Acres 2858½ Total population at all ages 15703 Number of inhabited houses 3128 Average number of persons per house 5.02 General—per thousand population 10.3 Death Zymotic— „ ,, 0.25 Rates Infants mortality (under 1 year of age) per 1000 births registered 102.5 Birth Rate 22 3 The Vital Statistics for the year consisting of the annual birth-rates and death-rates have been published by the Registrar General and are here placed in tabular form for comparison. Annual Rates per 1000 living. Infant Mortality. Annual deathrate of infants under 1 year per 1000 births. Births. Deaths from all causes Deaths from the seven chief epidemic diseases. England and Wales 28.4 15.4 1.46 132 Rural England and Wales 27.3 14'8 108 118 76 Great Towns 29.7 16.3 1.89 144 103 Smaller Towns 27.4 14.6 1.41 135 Surbiton Urban District 22.3 10.3 0.25 102.5 Suro 42 (Surbiton Urbmt gltstrtrt (Eounctl. Twenty-Seventh Annual Report OF THE MEDICAL OFFICER OF HEALTH, 1903. Mr. Chairman and Gentlemen, I have the pleasure to submit to you my report for 1903 on the health and sanitary condition of the District under your care, this being- the twenty-seventh Annual Report since my appointment as Medical Officer of Health in July, 1876. 3 The vital statistics are to be found mainly in the four tables at the end of this Report, which are drawn up in accordance with the regulations of the Local Government Board and for purposes of comparison show the figures of former years. From an inspection of these it will be seen that in the matter of births, deaths, sickness and sanitary work the reputation of Surbiton as a healthy and desirable residential locality is well maintained. The population at the census of 1901 was 15017 and includes Surbiton, Tolworth, Hook and Southborough. This is now officially estimated to the middle ot 1903 to be 15703, an increase of 686 If, however, the number of new houses erected since the census was made is taken at 254 and an average of 5 persons allowed for each, together with the increase of births over deaths which is 307, the addition to be made would then be 1577 which added to the census return would make the population to be 16594. However, there are fallacies about this, and so for the purposes of this report I shall take the lower figure, though it is certain that it is considerably below the actual present population. On this basis the death-rate is 10*3 per thousand of the population living, as against 10*9 the year before. The " corrections " necessary and required by the Local Government Board bring into the total 4 of deaths for the district those that have occurred in the Union Workhouse, the County Lunatic Asylum at Brookwood, and in any other Public Institution in London or elsewhere, of residents removed there for treatment, together with those in the Cottage Hospital and the Isolation Hospitals at Tolworth and Cuddington. This naturally increases the number registered as occurring in the district proper considerably, but nevertheless the total is only 10 above the average for the last seven years though the population has increased during that time by over 2000. The nett deaths at all ages belonging to the district are 163 as compared with 169 the previous year and are of 86 males and 77 females. There died of phthisis, 5; of bronchitis, 10+; of pneumonia, 11; of heart disease, 24; of cancer, 17 ; premature births, 10 ; and of violence, 7. The deaths from cancer, i.e., malignant disease in all its forms, were 17 as against 12 the year before and is in keeping with the RegistrarGeneral's notes that this disease is increasing. This increase, which in the seven years 1891—97 was in males 136 per cent and in females 70 per cent over the averages of the 10 years 1861—70, has attracted considerable attention, and investigation and research is being actively prosecuted in all civilised countries with every room to hope 5 that light will eventually be thrown on what is at present so distressingly obscure. zymotic Diseases ^he mortality from the seven chief epidemic diseases is extremely low, in fact I cannot find that it has ever been so low before. There were but 2 deaths from scarlet fever, 1 from whooping cough and 1 from diphtheria. None from typhoid, typhus, measles or small-pox nor any from epidemic influenza. The rate is C25 per thousand of the population. Blrths- The births were 351 as compared with 288, 324 and 295 in the three preceding years and are 53 above the average of the seven years before. The birth-rate is 22^3 per thousand. The births in the various districts are shown in the table below :— Males Females Total Surbiton 90 92 182 Tolworth 62 64 126 Hook and Southborough 29 14 43 181 170 351 6 The vital statistics of the different portions of the Urban District for the last two years are shown in the following table :— 1902. District. Population . Births. Birthrate. Deaths. Deathrate. Surbiton Tolworth .. ,, Hook and Southborough 11214 2643 1529 158 104 26 14-08 393 17'0 128 35 6 11-4 13-2 3-9 Total 15386 288 18-7 169 10-9 1903. Surbiton 11339 182 16-05 123 10-8 Tolworth 2798 126 45 03 30 10-7 Hook and Southborough 1566 43 274 10 6-3 Total 15703 361 22 3 163 10-3 These figures are eminently satisfactory especially as regards Tolworth, where the birthrate is exceedingly high and the deaths very few. There is no doubt that as a place of residence for the working classes it is a very favoured neigbourhood, with its broad, clean and well-kept roads, good class of houses on the whole and exposed to plenty of fresh air from the Downs and open country. Building is proceeding rapidly and I consider it will be good policy not to delay for too 7 long the proper making up of the newer roads, for some of them are and have for long been in a deplorable condition owing to the continued wet weather. The following Table shows the notification of the past and previous years :— Extract from Notification Register. Diphtheria & Memb. Croup Small Pox Scarlet Fever Enteric Fever Puerperal Fever Ervsipelas. Contin. Fever s 1890 36 O 3 1 2 4 O 46 1891 21 O 3 1 O 10 O 35 1892 16 O 4 3 1 5 O 29 1893 23 i 94 5 2 15 2 142 1894 20 O 9 12 2 12 O 55 1895 12 O 18 5 O 2 O 37 *1896 9 O 27 4 1 10 O 5i *1897 9 O 16 2 1 3 O 31 *1898 6 O 13 2 O 6 O 27 *1899 2 O 48 7 1 11 0 69 *1900 22 o 15 2 O 7 O 46 *1901 47 o 59 2 o 7 O "5 *1902 19 o 22 2 1 8 O 52 *1903 9 i 58 6 O 5 O 79 * The combined districts. The following are some particulars respecting the notifiable diseases of the past year. Diphtheria. A reference to the table above shows some curious figures as to the varying prevalence of this 8 disease. For the first six of these years the returns were all in double figures and show an average of over 21 cases a year, followed by four years in succession with an average of only a little over 6 cases per annum. Apart from personal contagion which is without question the main cause of the spread of this disease, prompt notification and speedy and efficient isolation are of extreme value in limiting an outbreak as cases declare themselves, and so far as sanitary shortcomings may act as predisposing causes, the everimproving sanitation of the district ought to be of value, but it may be a fact not generally appreciated that "a close relation between imperfect drainage or a polluted water supply and diphtheria has not been determined." The few cases that occurred were spread over the year, one being notified in each of the months of February, October, November and December and five in July. Of these latter, two were on the Hill and three below. All were in Surbiton and none in Tolworth or Hook. One case of modified small-pox of a very mild Sma11 Pox type was notified early in the year ; it was removed to the Joint Small-Pox Hospital at Cheam and made a good recovery. The other inmates of the house were all promptly re-vaccinated and kept in strict quarantine for the requisite period followed by thorough disinfection and cleansing and no further case occurred. 9 A special Report was made at the time and copies sent to the Local Government Board and County Council. scarlet There were 58 cases notified, 20 in Surbiton and 38 in Tolworth. The outbreak in Tolworth was spread over the summer and autumn months, and was maintained by the children attending St. Matthew's schools, some also of the cases in Surbiton were attending there. There were in all but two deaths and the large majority of the children attacked had the disease mildly. A few cases were due also to infection communicated by patients on their return home from the hospital. In connection with this some criticism has lately been put forward with regard to the advisability of the removal of all cases of this disease to isolation hospitals, and it has been pointed out that no apparent decrease in the average number of cases notified has taken place since this method has been in force, and further, that cases on returning home have in some instances communicated the disease to others. There is a certain amount of truth in these statements and it may be that stress may be laid upon these facts, if they are facts, when the question arises, as it may and probably will arise later on, as to the necessity of enlarging the hospital at Tolworth. If statistics are brought 10 forward they can only be based on the few years that have elapsed since notification and enforced isolation have been practised, and it would not be wise or prudent to form positive deductions as yet from such limited experience. Nor has isolation been universal but on the contrary only partial, so that nothing definite or absolute can be stated. There is little doubt but that some cases of scarlet fever and some outbreaks are more infectious than others, but there are many points with which we are at present not fully acquainted. We are ignorant of the exact nature of the infection, of its origin and of the possible changes that may differentiate one case or one outbreak from another. We know that it is infectious from one person to another and that it is communicable in a certain way and that after a certain time or a certain process is completed the personal infection ceases, but these are facts that clearly point to the advantages of isolation and to that isolation being effective. The most infectious cases, or those in which infection is probably most prolonged are those which have discharges from the mucous membranes—the nose or ear or throat—or in which abscesses or ulcers have arisen. It would be an outrage on common sense to suppose that cases of illness in which the infection is prolonged could be better or even as well treated —as regards danger to others—in a small house II or a crowded home, with the attention of the mother divided between the sick and the sound, as in a well-appointed hospital in which the case is detained as long; as may be necessary and then discharged with all due precautions. In view of the excessive cost per head that hospital isolation entails upon the general body of ratepayers, it certainly could be claimed — supposing it were possible—that a proportion of cases might be safely treated in their own homes provided that the necessary precautions could be carried out to the satisfaction of the medical man in charge and of the Medical Officer of Health as representing the Sanitary Authority, and who has also to consider the public welfare, but this is a point upon which medical opinion must differ and arguments on both sides be advanced, so that the time has hardly yet arrived when it would be either wise or correct to say that hospital isolation has not proved of such advantage to the community as to justify or necessitate any modification of the existing practice. Enteric Fever. Six cases were notified, two each from Surbiton, Tolworth and Hook. Only one case would appear to have had a local origin and that seemed to be due to bad and defective drainage and probably polluted water. An examination showed that the drains were faulty and that sewage had been and was escaping into the foundations of the house. 12 The closets were flushed from the drinking-water cistern and it is difficult to understand how either tenant or landlord could have remained unaware of such insanitary conditions. The house was redrained and the patient recovered. Of the remainder, two were visitors and were ailing at or immediately after arrival and were clearly imported cases. Two others had occupations in London and their houses were in good sanitary state, but in one of them the medical man attending held the opinion that probably infected oysters were the cause. In the remaining case there could be no reasonable doubt that the disease was contracted at Whitstable. The patient, a married woman, had been staying there for a month and fell ill the day after her return home and in a few days the diagnosis of typhoid was confirmed. On enquiry it was ascertained that she had partaken of oysters there eight times during the last ten days of her visit and was the only member of her family who had done so. Of these six cases five recovered and one died, but as the death did not occur until after the turn of the year it does not appear in the present returns. Two only of the cases were removed to the Isolation Hospital. It is remarkable and worthy of notice that an DiarrhC6a unusually small number of fatal cases of diarrhoea in 1903 is associated with the very unseasonable 13 weather of the year. There were only six deaths and all of these were infants under one year of age so the cause was presumably connected with the staple one of "improper feeding," and not materially affected by climatic or weather conditions. The majority of such cases of sickness that did occur were towards the end of July shortly after the spell of hot weather that constituted the summer. It is probable that this comparative immunity was in some measure due to the following influences :— (i) That the temperature at no time during the past year was excessive over periods sufficiently prolonged to have material effect upon the temperature of the soil at a depth of three or four feet from the surface; (2) That rain was never absent for long together during the whole of the year, but was considerably above the average during the third and fourth quarters, the third quarter being the one in which diarrhoea is as a rule most prevalent. How far the influence of the rainfall has been direct, that is by washing the atmosphere and preventing the dissemination of dust and by the cleansing and removal of dirt from the areas around houses, especially of the working classes, and how far indirect by preventing the rise of the earth's temperature at a depth of three or four feet it is impossible to decide. It is however an established fact that " the maximum mortality of diarrhoea by 14 no means necessarily coincides with the highest readings of the air-thermometer, but the temperature of the soil is the essential point and it is found that the summer rise of diarrhoeal mortality does not commence until the mean temperature recorded by the 4-foot earth thermometer has attained somewhere about 56 degrees F." Rainfall is operative mainly by its effect upon the temperature of the soil. Diarrhoeal mortality is greater in dry seasons, and less in wet seasons. The work of the Sanitary Department has Sanitary Work been very considerable and very thorough during the last few years and an impartial inspection of the various reports presented from time to time by the officers will amply confirm this. Taken in conjunction with that of the Surveyor's Department— for the two are working to the same end—the result is a great improvement in the general health and life conditions of the residents in this district. The enlightened policy that this Council has now pursued for many years past is bringing its own reward, and the general health of the locality has never been iri a better condition than of late. Cleanliness is the key note, but cleanliness has to be enforced, and by the vigorous carrying out of the provisions of the Public Health Act and the other sanitary ordinances with a steady unremitting perseverance on the lines hitherto adopted, a result has been obtained that is the best of all encouragements for a continuance of the same policy. 15 During the last eight years the total number of houses re-drained is 937. In every instance this re-drainage was consequent upon complaint or knowledge of an existing nuisance or of defective sanitary conditions and all of these have been abated or remedied. The amount of illness with its concomitants of suffering, distress and expense thereby prevented must be enormous and very well worth both the public and private expenditure, and the chances of the dirt diseases—which are all of a preventable character—flourishing and making headway are remote indeed as long as such a system prevails. The measures taken to bring about these results are good sewers and drains, good water, sanitary houses, fresh air and wholesome food. Add to theseefficient scavenging, clean roads, well swept and watered, the frequent emptying of dustbins and the removal of offensive matter— then surely the health, happiness and well-being of people living in such surroundings must be vastly better than in those where narrow-minded, interested or prejudiced views obtain. Owing to the extensive operations in connection with the laying down of the new surface water drainage, new sewers in anticipation of the coming of the tramways, electric lighting cables and telephone wires, combined with much wet and changeable weather, the main roads, the pavements and a large number of streets have been broken up and have been in an unusually muddy and disagreeable condition. Such drawbacks are however unavoidably associated with the disturbances of the soil incidental to such operations, and but for the careful carrying out of the work by those engaged in it the state of affairs would easily have been much worse. These works are now practically completed and after the roads have received the necessary attention they still in many places require, we must seek for compensation in the advantages of electric light, telephones and improvements in sanitation. New sewers have been laid in Claremont Road, Claremont Crescent, Victoria Road and Glenbuck Road. These were practically all old brick sewers and very defective, they have now been relaid with stoneware pipes on concrete. This is a subject that is likely to be of con- Dust and Road Watering siderable importance this summer especially if it should prove fine and dry. A few years ago I drew the attention of the Council to the great need there was for watering certain of the roads on Sundays, but at first nothing was done, then the need being very apparent the Portsmouth Road was watered early in the morning and though that was of some benefit to the residents on and the users of that road, yet in other parts of the district the necessity was on 17 occasions quite as great. Since then, however, a new factor in dust creation has arisen in the motor cars and cycles that are so numerous and so ubiquitous, particularly on Sundays. It is not merely a nuisance to endure, destructive as it is to clothing and injurious to tradesmen's goods in shops and elsewhere, but it is, and certainly will be a serious matter to the health of many people. The dust of towns is worse and more harmful than the dust of the country, inasmuch as it is a foul dust abounding in septic matter, that is organic matter in various stages of decomposition, germs of disease and filth of every description. This, in increasing quantities, will come in contact with eyes, throats and lungs, and is potent for mischief of a grave character. The nuisance threatens to be excessive this year and means should certainly be taken at once to cope with it ; all the main roads should be watered on Sunday at least once and thoroughly. Theoretically and correctly the amount of water put on the roads should vary somewhat with the state of the weather, a hot sun and an easterly wind obviously requiring more water to lay the dust than would a cloudy windless day, and if it were possible, and it should be, water carts ought to be provided with the means of using a larger or a smaller amount of water according to the state of 18 the weather and the roads. Dust in the country roads cannot well be dealt with at present, but in the towns and inhabited roads it can and ought to be, and if not attended to this summer more thoroughly than ever before, sore throats and sore eyes and much more may have to be endured as may be. Situate as Surbiton is, with main roads from London running through it to the beautiful country beyond, motors naturally come this way in ever and rapidly increasing numbers, and though the public will soon get accustomed to the increased speed, yet the dust nuisance will be sure to raise an outcry and a call for some speedy means of lessening it. The traffic cannot be dealt with but the dust can. Besides watering, the Council has approved of Westrumite being tried and as this has answered so well in other districts, great hopes of a substantial mitigation of the evil maybe indulged in, only it should be tried as early as possible as the demand may at first exceed the supply. There are 204 registered workshops and 64 Factory & Work. shop Act,1901 domestic factories ; these have been regularly visited by the Sanitary Inspector and are referred to in detail in his report. These unless they have more than two hands Lrundries employed in addition to the family are not registered, and the majority are under that category, but there are 22 that are registered and duly inspected. 19 Bakehouses Originally there were four underground, but of these two have been transferred above ground and one has been done away with altogether, so that of the 13 that are registered there is only one now below ground. This has been the subject of frequent careful inspections with a view to alterations in compliance with the Act and extensive improvements have been effected, and it is now in a sufficiently good and satisfactory condition to receive a certificate, all statutory obligations having been fulfilled. Hook and portions of Tolworth and a limited part of Surbiton have a continuous water supply, and it may be that when the new Water Authority is constituted an application for the whole district to be so supplied may be successful. The character has been good throughout the year, though at flood times there was some discolouration and a slight deposit. This building was opened on May 1st, after an inspection by Dr. M. H. Taylor, the Coroner for the Kingston District of Surrey, who expressed his thorough approval of all he saw, but made some recommendations which are now on the point of being carried into effect, and which will materially facilitate the carrying out of the work of the sanitary department. An enquiry was held by an Inspector of the Local Government Board, and a 20 loan was sanctioned for a sum of ^360 to provide additional accommodation. There will be a room to serve as a waiting room for relatives or those having business in connection with funeral arrangements or inquests, and which will also be used as a room at the disposal of medical men officially engaged ; also a room as a store for disinfectants and appliances therewith, and as a washing and cleaning room, coal shed and sheds for the housing of the two disinfecting vans. If at some future time, as is quite possible, each of the constituent bodies having access to the Isolation Hospital should be required to arrange for their own disinfection, and not depend on its being done as at present at Tolworth, then, if it should be thought suitable, space is here available where the necessary plant could be erected. Tenders for the work have been accepted. Total number of bodies received into the mortuary 18; number of postmortem examinations made 15; number of Coroner's inquests 21. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, m.d., d.p.h., Medical Officer of Health. March 31st, 1904. 21 To the Medical Officer of Health. Sir,— I beg- to present to you my Eighth Annual Report, for the year ending December 31st, 1903, showing the action taken and the amount of work done in the abatement of nuisances under the provisions of the Public Health Acts, the Factory and Workshop Act, 1901, and the Bye-laws in force in the District. Summary of Work Done. Number of houses and premises inspected 311 „ Visits to works in progress 1837 „ „ Schools 6 ,, ,, Bakehouses 35 ,, ,, Slaughter houses 57 ,, „ Dairies, Cowsheds and Milkshops 31 „ „ Workshops and workplaces 144 ,, „ re cases of infectious disease 61 ., Miscellaneous inspections 241 ., Drains examined under section 41 of the Public Health Act, 1875 64 „ Drains tested with water 102 „ „ „ „ smoke 40 ,, Houses and premises disinfected 57 ,, Complaints received and attended to 125 „ Preliminary notices served 119 „ Legal notices served 237 ,, Letters written on the business of the department 611 ,, Plans of houses re-drained prepared 117 22 Description of Nuisances dealt with. Defective drains cleansed, repaired, trapped, etc. 23 Stoneware gullies fixed in lieu of defective brick and iron bell traps 349 Houses subsoil drained 1 Cesspools abolished 1 Water-closet apartments rebuilt 16 Water-closet pans cleansed or repaired 29 Old iron container and long hopper pans abolished and pans of an approved form fixed 154 Water-closet flush pipes disconnected from domestic supply cisterns and separate flushing cisterns fixed 103 Closets supplied with water 5 Defective water-closet flushing cisterns repaired 16 Defective flushing cisterns removed and new ones fixed 15 Soil pipes repaired 21 New soil pipes fixed 24 Soil pipes inside dwelling houses removed and fixed outside 10 Storage cisterns cleansed 10 ,, ,, repaired 2 ,, ,, new provided 3 Sink and other waste pipes trapped or disconnected from drain 102 Sink and other waste pipes repaired 55 New waste pipes provided to sinks, etc. 76 Rainwater pipes disconnected from drains or soilpipes 76 Defective rainwater pipes repaired 98 „ eaves gutters repaired 9 Houses and premises provided with eaves gutters 20 Defective roofs made watertight 31 Stable floors paved and drained 11 Public house urinals reconstructed 1 Privies converted into water-closets 6 23 Description of Nuisances dealt with. (Continued.) Sites of houses concreted to prevent dampness 4 Dirty houses cleansed and whitewashed 42 Accumulations of manure, etc., removed 7 Manure receptacles provided 1 Yards cleansed 3 Nuisances from animals improperly kept abated 3 Miscellaneous nuisances abated 2 Overcrowding of Dwelling Houses. During the year five houses were found to be badly overcrowded so as to constitute a nuisance which would be likely to be injurious to health. In each case the nuisance was abated on notice being served. Dust Receptacles. Section 36 of the Public Heath Act, 1875, empowers the Council to call upon owners of property to provide each house with a sufficient ashpit of such size, pattern and construction as they shall approve. Under this section twenty-nine houses have been provided with portable galvanised iron dust bins, where no ashpit previously existed or where the existing ones were broken or in a bad state of repair. Paving of Yards. The yards and, where necessary, the side passages of 65 houses have been paved with concrete or other durable and impervious material, so sloped as to ensure the speedy removal of surface water, etc., thus preventing many nuisances that must of necessity arise where the yards are unpaved and in a filthy condition. It is found most beneficial in the smaller property, as cleansing is greatly facilitated and encouraged thereby. House Drainage. In consequence of written complaints alleging nuisances arising from defective drainage, the Council gave instructions in 63 instances for the ground to be opened and the drains examined under the provisions of section 41 of the Public Health Act, 1875. In each case where they were found to be in a defective condition, notices were served upon the persons responsible, requiring the drains to be relaid or repaired as the case required. Generally the notices were promptly complied with, and in three instance where the premises were drained by a combined system, the Council at the request of the owners, executed the work and charged them with the cost. 25 At the September meeting of the Sanitary Committee the Surveyor reported that a large quantity of sub-soil water was discharging into the public sewer from the drains belonging to the Tolworth Isolation Hospital, and I was instructed to examine the drainage and report thereon. The result of such examination revealed most serious sanitary defects, which were set forth in detail in a special report which I made to the Sanitary Committee at their October meeting. A copy of this report was sent by the Committee to the Joint Hospital Board with a request that they would give it their earliest attention. The Board forthwith appointed a Surveyor to examine and test the drainage. He confirmed my report, and they at once gave instructions for a new system of drainage to be constructed on the lines set out in my report. The work is now in progress and proceeding in a satisfactory manner. During the year 122 defective drains have been entirely relaid and made to withstand the water test. These cases generally include the amendment of every defect in the drainage system that can be discovered on the premises. 26 Every opportunity is taken to secure the provision of a sufficient number of manholes on the line of each drain for inspection and cleansing purposes, also the affixing of ventilating shafts with proper air inlets and intercepting trap where none have previously existed. In every instance where the drain was laid under a house, strong cast iron pipes coated with Dr. Angus Smith's solution and surrounded with six inches of Portland cement concrete have been used. The following table shows the houses which have been re-drained during the year:— Mombasa Cottage, Adelaide | Oaklawn, Claremont Road. Road. Laurel Villa, Clayton Road. Spencer house, Adelaide Road. Yew Tree Cottage, Clayto Angel Inn, Alpha Road. Road. I and 2, Arlington Road. I to 8, Jeff's Cottages, Clayton Dunallie, Avenue, Berrylands. Road. Eastbourne Lodge, Avenue, I and 2, Grosvenor Villas Berrylands. Cleaveland Road. Scarsdale, Avenue, Berrylands. 1, Cleaveland Road. 19 and 20, Avenue Elmers. 23—26, 27—32 and 45 and 46 Clifford, Berrylands. Cottage Grove. Collyns, Berrylands. Castle Douglas, Crane's Park. Penshurst Lodge, Berrylands. Elmcroft, Crane's Park. 10, 88 and 89, Brighton Road. Kingshill, Crane's Park. 13 and 14, Britannia Road. Merrivale, Crane's Park. Stanley Lodge, Cadogan Road. Senga, Crane's Park Avenue. Fairholme, Christ Church Road. Herschell, Ditton Road. 27 8, Utica Villas, Ellerton Road. Brackendale, Lovelace Road. Chichester House, Ewell Road. Mandeville, Lovelace Road. Tolworth Court, Ewell Road. Glenthorpe, Lovelace Road. Wesleyan'Chapel, Ewell Road. Newlands, Oak Hill. 7 to II, German Place. St. Catherine's Villa, Maple Heathfield, Grove Road. Road. 2 and 3, Haycroft Road. 9, 10, 18, 23, 24, 25, 27 and 28, Hotei Cottage, Hook Road. Paragon Grove. Middlecot, Hook Road. 1 t0 8 Paragon Place. Self's Cottage, Hook Road. Delgada, Parklands. Shop occupied by Mr. Aggas, Ormonde House, Parklands. Hook Road. Ashmore, Park Road. Shop occupied by Mr. Brooker, Riverbank, Portsmouth Road. Hook Road. Park View House, Portsmouth Shop occupied by Mr. Warren, Road. Hook Road. 35 to 43, Richmond Grove. Shop occupied by Mrs.Thornton Glencairn, South Terrace. Hook Road. 1, St. Andrew's Square. Homeleigh, King Charles' Road 8, St. Philip's Road. Kingslynn, King Charles' Road. The Beacon, Surbiton Hill Offley House, Kingsdowne Road. Road. 18, 24, 68, 69, 70 and 71 Rokeby, Kingsdowne Road Victoria Road. Richboro' House Stables, Stables at rear of 69, Victoria Langley Road. Road. Houses Unfit for Human Habitation. On inspection the eight houses known as Tolworth Terrace, situate in the road branching out of Red Lion Lane, were found to be in a most dilapidated and insanitary condition and unfit for human habitation. 28 A report upon their condition was made to the Sanitary Committee, and notices were ordered to be served to put them into a satisfactory state of repair. After considerable difficulty with the various owners, and the eviction by them of several of the tenants the necessary works were commenced and are now in progress. Disinfection. In accordance with the instructions of the Medical Officer of Health, in all cases where infectious disease has been notified, I have visited the premises, supplied disinfectants and on removal of the case to the Isolation Hospital or recovery at home, had the clothing, bedding, etc., removed to the Isolation Hospital for steam disinfection, which is carried out under the supervision of the Hospital staff. The walls and ceilings of the infected rooms have also been sprayed with a two per cent solution of Formaline and the rooms fumigated with the Formaline lamp to ensure thorough disinfection. Factories and Workshop Act, 1901. The Register of Workshops in the District, required by section 131 of the Factory and Workshop Act, 1901, to be kept by the Council, has been completed and a list of all domestic workshops 29 has been sent to the Factory Inspector as requested by his letter dated March, 1902. There are in the district 204 registered workshops, and of these, 64 are domestic workshops, i.e., a private house or place which, though used as a dwelling, is by reason of the work carried on there, a workshop within the meaning of the Act, but the only persons employed are members of the same family dwelling there. Under this Act, 144 visits have been made to the workshops and workplaces in the district during the year, and I am pleased to report that generally they are kept in a clean and satisfactory condition. In no case has complaint of any nuisance been received from the Factory Inspector. The following table shows the nuisances abated in workshops during the year. Number of Workshops cleansed and whitewashed 2 ,, Drains unstopped, cleansed, repaired, etc., 1 „ Workshops redrained 6 ,, Defective water closet pans abolished and new ones fixed 7 ,, W.C. flush pipes disconnected from drinking water cisterns and separate flushing cisterns fixed 5 „ W.C. flushing cisterns repaired 1 30 Number of Workshops provided with additional W.C. accommodation 1 ,, Defective sink waste pipes repaired 7 ,, Defective roofs, eaves gutters and rainwater pipes repaired 16 „ Yards attached to workshops paved 4 Bakehouses. There are 13 bakehouses in the district, all of which have been inspected twice during the year, and found to be kept in a satisfactory condition. A verbal intimation has sufficed in every instance to secure the requisite limewashing. Of the four underground bakehouses, one has been closed and the business discontinued, two have been abolished and new ones built above the ground, and the other has been altered and improved so as to comply with the Council's requirements to obtain a certificate of fitness under the Act. Slaughter Houses. There are six slaughter houses in the district, all of which have been frequently and at irregular periods inspected to ascertain if they are kept in accordance with the Bye-laws regulating the same. In one instance the drainage was found to be defective and a notice was served to put it in order. The work is now in hand. 31 Application was made to the Council for a license to erect a slaughter house upon premises in Ewell Road. The Sanitary Committee gave the matter their careful consideration and eventually decided not to grant the application as the proposed new slaughter house did not comply with the recommendations of the Local Government Board as regards the distance from the adjoining houses. Dairies, Cowsheds and Milkshops. The dairies, cowsheds and milkshops have been inspected quarterly during the year, and at irregular periods as occasion required. The object being to see that they are kept clean, that all refuse is regularly removed, that there is no overcrowding of the sheds and that the drainage is maintained in good order. In no case has it been necessary to report to the Sanitary Committee any breach of the regulations. There are 16 persons registered under the Act, as follows:—Cowkeepers, I; Cowkeepers, Dairymen, and Purveyors of milk, 3; Purveyors of milk, 5; Dairymen and Purveyors of milk, 7. The average number of cows kept by the persons registered is 252; and all are under periodical inspection by the Council's Veterinary Inspector. 32 Legal Proceedings. Legal proceedings were taken before the Magistrates against the owner of 41, Cleaveland Road, to recover the sum of the cost of providing the premises with a sufficient water closet, and against the owner of Tolworth House, to recover £52 7s. 6d. for reconstructing the drainage, in default of compliance with the notice served. The case against the owner of 41, Cleaveland Road, was withdrawn on payment, previous to the case being heard, of the amount claimed and one guinea costs. In the case of Tolworth House, the owner disputed his liability to pay for the work as the house was let on a repairing lease, but the Magistrates made an order for the amount claimed and five guineas costs. I am, Sir, Yours obediently, W. NESFIELD, Assoc. San. Inst., Sanitary Inspector. 33 Table showing Population, Number of Inhabited Houses and Average Number of Persons per House in each locality, &c. District. 1891. Area in acres. Population Rateable value 1894 | Inhabited houses. Average No. of persons per house. Surbiton 1000 10050 £ 110381 1720 5.843 Tolworth 1198 ½ 979 £ 6996 197 4.969 Hook & Southborough 660 1147 £ 7473 261 4.394 Total 28581½ 12176 £ 125350 2178 5.509 1 901 (Census). Surbiton 1000 11075 £ 148562 2094 5.288 Tolworth 1198½ 2458 £ 11879 477 5.153 Hook & Southborough 660 1484 £ 8690 303 4.897 Total 2858½ 15017 £ 169131 2874 5.225 1902 (Estimated) . Surbiton 1000 11214 £ 148513 2126 5.274 Tolworth 1198½ 2643 £ 12967 566 4.669 Hook & Southborough 660 1529 £ 8938 319 4.793 Total 2858½ 15386 £ 170418 3011 5.109 1 903 (Estimated). Surbiton 1000 11339 £ 145967 2152 5.269 Tolworth 1198½ 2798 £ 14448 629 4.448 Hook & Southborough 660 1566 £ 9519 347 4.512 Total 2858½ 15703 £ 169934 3128 5.02 T A B L E 1. Vital Statistics of Whole District during 1903 and Previous Years. Year. Population estimated to Middle of each Year. Births Total Deaths Regib tered in the District Total Deaths in Public Institutions in the District Deaths of Nonresidents registered in Public Institutions in the District Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at All Ages Belonging to the District Number Rate* Under 1 Year of Age. At all Ages. Number Rate per 1,000 Births registered Number Rate* number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 13,596 281 20.66 27 96.08 164 11.98 24 16 9 123 9.04 1897 13,880 291 20.96 37 127.1 143 10.3 9 6 1 135 9.65 1898 14,164 311 21.95 40 128.6 179 12.56 15 10 5 164 11.57 1899 14,458 296 20.47 23 77.7 164 11.34 17 8 7 161 11.13 1900 14,732 295 20.02 29 98.3 168 11.4 14 5 13 165 11.2 1901 15,017 324 21.57 24 74.07 152 10.12 19 9 15 158 10.52 1902 15,386 288 18.7 34 118.0 157 10.2 13 5 17 169 10.9 Averages for Years 1896.1902. 14,462 298 20.60 30 102.8 161 11.13 16 8 9 153 10.6 1903 15,703 351 22.3 36 102.5 149 9.4 11 5 19 163 10.3 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water) 2858J I Number of inhabited houses (at Census of 1901) 2,874 Total population at all ages (at Census of 1901)15017 | Average number of persons per house ,, 5.225 TABLE 2 Vital Statistics of separate Localities in 1903 and previous years. Year. Surbiton. Tolworth. Hook and Southborough. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population esti1 mated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Denths under 1 year. 1896 .. 10560 199 123 19 1718 51 15 3 1314 31 17 2 1897 .. 10663 209 109 30 1866 46 14 4 1348 36 11 3 1898 10766 214 138 41 2014 67 19 5 1382 30 17 4 1899 .. 10*69 185 119 15 2162 71 20 8 1416 40 22 1 1900 .. 10972 191 129 18 2310 68 23 7 1450 36 11 4 1901 11075 195 117 12 2458 94 30 10 1484 35 11 2 1902 .. 11214 158 128 21 2643 104 35 13 1529 26 6 0 Averages of i Years 1896 J to 1902. ) 10874 193 123 22 2167 71 22 7 1417 33 13 2 1903 .. 11339 182 123 22 2798 126 30 9 1566 43 10 5 TABLE 3. Cases of Infections Diseases notified during the Year 1903. Notifiable Diseases. Cases notified in whole District. At Ages—Years. Total Cases Notified in each Locality. No. of Cases removed to Hospital from each locality d o £ j-t 3 m A "E o fc o H % = § 2 §6 HH o o 3 t-i 3 gq ^3 *4 o j* "o ^ o §3 Kg m At all Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Small Pox 1 1 i 1 Diphtheria 9 6 3 9 6 Erysipelas 5 5 3 2 Scarlet Fever 58 16 36 4 2 20 38 14 36 Enteric Fever 6 3 3 2 2 2 1 1 Totals 79 22 39 7 11 35 42 2 21 37 1 TABLE 4. Causes of, and Ages at, Death during Year, 1903. Causes of Death. Deaths in or Belonging to whole District at subjoined Ages. Dkaths in or belonging to Localitiks (at all ages.) Total Deaths in Public Institutions in district. All ages Under 1 Year. 1 and under 5. 5 and under 15 15 and under 25 25 and under 65 65 and upwards Surbiton Tolworth Hook and Southboro Scarlet Fever 2 .. 1 1 .. .. .. 1 1 .. 2 Whooping Cough 1 1 .. .. .. .. .. 1 .. .. .. Diphtheria and membraneous Croup 1 .. .. .. .. .. .. 1 .. .. .. Diarrhoea 6 6 .. .. .. .. .. 4 1 1 .. Phthisis 5 .. .. .. 4 .. 2 3 .. .. Other Tubercular Diseases 1 .. 1 .. .. .. .. .. 1 .. 1 Cancer, malignant disease 17 .. .. .. .. 9 8 14 .. .. 1 Bronchitis 10 2 .. .. .. 1 7 5 5 .. 1 Pneumonia 11 3 1 .. .. 2 3 10 1 .. 1 Pleurisy 1 .. .. .. .. 1 .. 1 .. .. .. Other Diseases of Respiratory Organs 3 2 .. .. .. 1 .. .. 2 1 .. Alcholism—Cirrhosis of Liver 4 .. .. .. .. 4 .. 3 1 .. .. Venereal Diseases 2 .. .. .. .. 2 .. 2 .. .. .. Premature Birth 10 10 .. .. .. .. .. 7 2 1 .. Diseases and Accidents of Parturition 1 .. .. .. .. 1 .. 1 .. .. .. Heart Diseases 24 3 .. .. .. 14 7 22 1 i .. Accidents 6 .. 1 1 3 .. 1 4 2 .. 2 Suicides 1 .. .. .. .. 1 .. .. 1 .. .. All other causes 57 9 .. 3 .. 15 26 45 9 3 4 All causes 163 36 7 6 7 55 52 123 30 10 11