CAR 03 ANNUAL REPORT ON THE URBAN SANITARY DISTRICT (OR PARISH) OF CARSHALTON, SURREY, For tine Year 1896, By E. L. JACOB, Medical Officer of Health. CONTENTS. I. Statistics : Births and Deaths. II. Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and from certain Other Infectious Diseases, and of the Action taken for preventing their spread. III. Summary of other Sanitary Proceedings which were taken during the year. IV. Appendix, containing certain Tables. Prepared in accordance with Sec. 14 of the Order of the Local Government Board, dated 23rd March, 1891, regulating the duties Medical Officers of Health. W. Pile, Printer, " Herald " Works, Carshalton. Carshalton Urban Sanitary District. MEDICAL OFFICER'S REPORT FOR THE YEAR 1896. I.—Vital Statistics: Births and Deaths. 1. The population of the Parish in the middle of the year may be estimated at 5,700 persons. 2. The number of Births registered in the Parish during the year was 174, or one less than in the previous year. The Birth-rate for the year, therefore, was 30.5 per 1,000 of the estimated population. 3. The number of Deaths registered in the Parish during the year was 67, to which must be added nine deaths in the Epsom Workhouse and County Asylum of persons belonging to the Parish. These 76 deaths represent an Annual Death-rate of 13.3 per 1,000 of the population, estimated as above. In the other portions of the Surrey Combined Sanitary District the highest Birth-rate for the year was 26.3, and the lowest was 17.0 ; while the highest Death-rate was 13.0, and the lowest was 9.3. 4. As to the Infant Mortality. The Deaths of Infants under one year were 20 in number, as against 31 in the preceding year, and were equal to 10 per cent. of the registered births, which is below their previous average rate in the Parish. 5. The deaths from Pulmonary Consumption (8 in number) were at the rate of 1.4 per 1,000 of the estimated population, and were about the previous average rate in the Parish. 6. The deaths from other lung diseases (Bronchitis, Pleurisy, and Pneumonia) were 7 in number, as against 18 in the preceding year, and were at the rate of 1.2 per 1,000 of the estimated population, which is below their previous average rate in the Parish. (See also Tables I., II., and V. at the end of the Report.) II.—Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and from the other Diseases which must be notified under the Infectious Diseases (Notification) Act, 1889, and of the action taken for preventing their spread. 1. No case of Small Pox was reported during the year. 2. Measles caused one death. 3. Whooping Cough caused no death. 4. Scarlet Fever (otherwise called Scarlatina) was notified at three houses, viz. : In January, at a house in Rochester Row ; in March, at a shop in Carshalton Road, where a second case was notified in June ; and in November, at a house in Harold Road. Two of the four patients were removed to the Isolation Hospital at Sutton. None of the illnesses ended fatally. 5. Diphtheria, Croup, and Laryngitis. In February a child was fatally attacked with Diphtheria at a cottage in Mill Lane ; in March there were two cases at a cottage in Palmerston road, Mill Lane. No further cases were reported until September, in which month eight cases were notified in four houses in Pound Street, Harold Road, and Beddington Corner. In November, a case occurred at a house in Carshalton Road, and, in December, one case was reported in St. Andrew's Road. No case of Membranous Croup was notified, and no death was attributed to Laryngitis. Altogether there were 13 cases of Diphtheria in eight houses, with one death. I availed myself of the permission given me by the Council to get a bacteriological examination made, at their expense, as an aid to diagnosis in doubtful cases of sore.throat, on five occasions, with the result that only one of the cases was declared to be genuine diphtheria. 6. Enteric (otherwise called Typhoid) Fever. In May, a boy was attacked with this fever at a cottage in St. John's Road, at which several defects of drainage were subsequently discovered. In September, a woman who had been nursing her son in Essex through an attack of this disease, failed shortly after her return to her home in West Street, and died in the following month. (3) 7. Diarrhoea caused three deaths, all of which were among children under five years of age. The total deaths from the Seven Principal Zymotic Diseases were 6 in number, viz.: One from Measles, one from Diphtheria, three from Diarrhoea, and one from Enteric Fever, and were at the rate of 1.05 per 1,000 of the population. In other portions of the Surrey Combined Sanitary District the highest Zymotic Death-rate was 1.5, and the lowest was 0.23. (See also Tables III., IV., and VI. at the end of the Report.) As regards the other infectious diseases which have to be notified under the above-mentioned Act: No case of Erysipelas or of Puerperal Fever was reported. The following is a summary of the further action which was taken for preventing the spread of some of these diseases:—The houses infected with Enteric Fever, Scarlet Fever, or Diphtheria were visited by the Inspector and myself; isolation of the sick was inculcated; disinfectants for use during illness were supplied and their proper use explained; all nuisances and sanitary defects discovered upon the premises were remedied as far as was practicable; and, after the death, removal, or recovery of the sick, formal notices to cleanse and disinfect the infected rooms and their contents were, in most instances, served on the owners or occupiers. From the houses of the poor, the infected bedding was removed and was disinfected by Mr. R. F. Holloway, of Hackbridge, at the expense of the District Council. As to the Joint Isolation Hospital on Cuddington Downs, for the use of persons residing in this district, and in the Epsom Rural, the Sutton Urban, and the Leatherhead Urban, Districts: Early in the year the Local Government Board approved of the plans, which had been submitted to them, of the buildings and other works necessary to the erection and equipment of the hospital, on condition that the sewage should be treated by chemical precipitation aud filtration over a specially prepared plot of land, without under-drainage, of half-an-acre in extent, and with four feet of sarface-soil over the chalk. The Joint Hospital Board accepted these conditions, and the work was begun in May, and is now nearly completed. III.—Summary of other Sanitary Proceedings, &c., which were taken during the year. 1. As in previous years, the Council contracted for the removal of house refuse from premises in their district. 2. The slaughterhouses, the bakehouses, and the premises of the registered cow-keepers, dairymen, and purveyors of milk were inspected. 3. As to the Bye-Laws relating to new streets and buildings: The Surveyor has been good enough to inform me that— In 1884 In 1885 In 1886 In 1887 In 1888 In 1889 In 1890 In 1891 In 1892 In 1893 In 1894 In 1895 In 1896 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the Bye-Laws, was 41 9 12 13 9 6 10 12 13 24 54 62 48 The number of new streets, ditto, was 3 none none 4 4 4 4 none 4 none 4 none none The number of times that legal proceedings were taken for breach of the Bye-Laws relating to streets and buildings was none none none none none none none none 2 none 3 none none 4. Proceedings under Sees. 150 and 152 of the Public Health Act, 1875, and under the Private Street Work* Act, 1892. The Surveyor informs me that the number of streets (not being highways repairable by the inhabitants at large), which were sewered, levelled, paved, metalled, flagged, channelled, or lighted, during the year, after notice to their respective frontagers, under these Acts, with a view to their being declared to be highways, were four, as against three in 1884, two in 1886, two in 1887, four in 1888, two in 1889, four in 1890, two in 1891, three in 1892, one in 1893, none in 1894, and none in 1895. 5. As to Works of Sewerage and Sewage Disposal. At the beginning of the year, Mr. Baldwin Latham, C.E., presented another scheme for the sewerage of the district, and for the treatment of the sewage upon an area of land in Wrythe Green Lane, which the owner was willing to sell for that purpose. Under this scheme, two-thirds of the sewage would be passed on to the land by gravitation, and the remaining third would have to be pumped to a height of 45 feet; and the treatment would consist of chemical precipitation, followed by filtration, partly through artificial filters and partly through the land, of which over twelve acres are available for the purpose, and which is sandy to a depth of two feet. The Council adopted the scheme, and applied to the Local Government Board for permission to borrow £37,000 for carrying it out, and in April an Enquiry was held. The application was opposed by owners of property in the neighbourhood and others, upon various grounds, but in July the sanction of the Local Government Board was obtained, and the Council decided to proceed. In due course, the land was purchased, and the contract for the work was let to Messrs. Cunliffe, who are now engaged in carrying it out. (4) During the year, the drains of all the houses in Harold Road, which had not been connected already, were diverted to the sewer in that road, which discharges at present into the Sutton system of sewers. 6. A systematic inspection, or house-to-house visitation, of certain parts of the district which are most in need of it, including Pound Street, Wrythe Lane, and Harold Road, was frequently made by the Inspector of Nuisances and ourselves, and defects of the closets, of the drainage, and of the dwellings, were remedied as far as was practicable, but there are many defects there and elsewhere, which can only be effectually dealt with by the provision of the proposed sewers. 7. The following is the Sanitary Inspector's return of the Nuisances dealt with, and other work done, from the time of his appointment in October to the end of the year:— Number of Complaints received in writing 5 Number of Premises inspected under Sec. 92 of the Public Health Act, 1875 152 Number of Nuisances discovered 85 Ditto remedied without being reported — Ditto reported to the Sanitary Authority 85 Ditto remedied after report 85 Number of Notices served for the Abatement of Nuisances, under Section 94 27 Particulars of Work done by owners or occupiers, for the Abatement of Nuisances, in compliance with notices:— Number of privies, cesspools, ditches, pools, watercourses, urinals, ashpits, and drains, cleansed, and number of deposits removed 60 Number of old privies re-constructed as water closets — Number of old privies re-constructed, with small water-tight vaults or with pails — Number of Premises at which the drains were re-constructed, ventilated, trapped, or disconnected from the house pipes or rain-water pipes 27 Number of Premises at which new drains or cesspools were provided under Sec. 23 or Sec. 94 27 Number of Premises from which animals, improperly kept, were removed — Number of Houses which were provided with efficient ventilation — Number of Houses at which injurious overcrowding was abated — Number of damp, unwholesome Houses which were repaired 5 Number of filthy Houses which were cleansed and whitewashed 6 Legal proceedings taken, under Sec. 96, for Abatement of Nuisances (number of times) — Houses condemned by the Justices as unfit for human habitation, under Sec. 97 — Number of Samples of Water sent to the Medical Officer of Health for Analysis — Number of Wells permanently or temporarily closed, after notice, under Sec. 70 of the Public Health Act, 1875, as unfit for drinking or domestic purposes — Number of Houses to which water was supplied by owners of premises after notice, under Sec. 62 of that Act — E. L. JACOB, M.O.H. J. WILLIAMSON, Deputy M.O.H. 8, Altenburg Gardens, New Wandsworth, S.W. February, 1897. (The usual Tables are appended to the Report.) (5) APPENDIX. TABLE I. TABLE OF DEATHS in the District during the year 1896, classified according to Diseases and Ages and shewing also the Population of the District and the Births therein during the year. Population at all ages. Mortality from all causes at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Persons under 5 years of age. At Census 1891. Estimated to middle of 1896. Registered Births. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Age. Small Pox. Measles. | Scarlatina. | Diphtheria. Membranous Croup. Whooping Cough. Contind. Fever. Diarrhoea. Rheumatic Fever. Erysipelas. Puerperal Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Typhus. Enteric or Typhd Other or doubtful. 5425 5700 174 67 '20 5 2 4 23 13 Under 1 3 3 18 5 and upwards 1 1 8 3 6 1 22 At all ages 1 1 1 3 8 6 6 1 40 The subjoined numbers have to be added to the above, in judging of the mortality in this District. Deaths outside the District of persons belonging thereto. 9 2 7 Under 5 5 and upwards 1 1 7 TABLE II. Shewing the estimated population, the Annual Birth-rate, and certain Death-rates, for each of the twenty-three years, 1874-96. Years. POPULATION Estimated to middle of each year. Registered Births. Deaths from all Causes. Deaths of Infants under 1 year Deaths from Pulmonary Consumption. Deaths from other 1 Lung Diseases. Number. Rate per 1000 of the population. Number. Rate per 1000 of the population. Number. Per cent. to Regd. Births. Number. Rate per 1000 of the population. Number Rate per 1000 of the 1 population. 1874 4035 137 33.9 68 16.8 20 14½ 2 0.5 4 1.0 1875 4148 136 32.7 80 19.2 12 18¾ 6 1.4 5 1.2 1876 4261 143 33.5 77 18.0 23 16 7 1.6 13 3.0 1877 4374 145 33.3 63 14.4 11 8 5 1.1 9 2.0 1878 4460 140 30.8 73 16.3 22 15¾ 8 1.8 11 2.5 1879 4510 170 37.4 83 18.4 22 13 7 1.5 22 4.9 1880 4610 149 32.8 74 16.0 26 17¼ 6 1.5 12 2.6 1881 4850 151 31.1 78 16.1 19 12½ 10 2. 9 1.9 1882 4900 176 36.0 89 18.0 29 16½ 7 1.2 13 2.6 1883 4950 136 27.5 75 15.1 14 10¼ 10 2.2 18 3.6 Average of 10 years 32.7 16.8 13¼ 1.5 2.5 1884 5000 144 28.8 71 14.2 16 13¼ 3 0.6 10 2.3 1885 5050 152 30.2 61 12.0 20 13¼ 5 1.0 12 2.3 1886 5100 145 28.4 71 14.0 15 10½ 8 1.5 13 2.5 1887 5150 144 28.0 67 12.0 13 9 5 0.9 5 0.9 1888 5200 135 26.0 77 15.0 16 12 6 1.1 12 2.2 1889 5300 180 34.0 65 12.2 21 13¾ 6 1.1 6 1.1 1890 5400 148 27.4 83 15.4 24 16¼ 12 2.2 14 2.6 1891 5450 167 30.6 88 16.1 16 9 ½ 8 1.5 8 1.5 1892 5500 158 29.0 84 15.3 19 12 5 .9 2.7 1893 5550 158 28.5 75 13.5 14 9 4 0.7 12 2.2 Average of 10 years. 29.1 14.0 11½ 1.2 2.0 1894 5600 162 29.0 81 14.5 23 14 2 0.4 14 2.5 1895 5650 175 31.0 101 17.9 31 17¾ 10 1.8 18 3.2 1896 5700 174 30.5 76 13.3 20 10½ 8 1.4 7 1.2 N.B.—The deaths of Parishioners in the Workhouse are included in this table. TABLE III. Shewing the Sickness and Mortality recorded in the District from the under-mentioned Zymotic Diseases in each month of the year 1896, and in the six preceding years. 1896. Small Pox. Scarlet Fever. Diphtheria. Enteric (or Typhoid) Fever. Cases Houses Deaths Cases Houses Deaths Cases Houses Deaths Cases Houses Deaths January 1 1 February 1 1 1 March 1 1 2 1 April May 1 1 June 1 July Augest September 8 4 October 1 1 1 November 1 1 1 1 December 1 1 Total in 1896 4 3 13 8 1 2 2 1 Total in 1895 15 10 8 2 1 1 1 1 Total in 1894 6 6 1 I 5 5 1 Total in 1893 25 16 3 3 Total in 1892 4 4 Total in 1891 5 4 8 5 2 2 2 1 Total in 1890 22 8 16 10 1 4 3 TABLE IV. Shewing the number of Deaths in the District from each of the seven principal Zymotic Diseases during the twenty-three years, 1874—1896, and the Zymotic Death-rate for each of those years. Year. Small Pox. Measles. Scarlatina. Diphtheria. Whooping Cough. Continued Fever. Diarrhœa. TOTAL. Typhus. Enteric or Typhoid other kinds. Number. Rate per 1000 of the population. 1874 .. 5 .. 1 4 .. .. .. 2 12 3.0 1875 .. .. 18 .. 1 .. 1 .. .. 20 5.3 1876 .. 6 8 .. 2 .. 3 .. 4 23 5.4 1877 .. .. .. .. .. .. .. .. 1 1 0.2 1878 .. .. .. 3 1 .. 2 .. 4 10 2.2 1879 .. .. .. 1 4 .. .. .. .. 5 1.1 1880 .. .. .. 1 9 .. .. .. 2 12 2.6 1881 .. 2 8 .. 2 .. .. .. 3 15 3.1 1882 1 6 1 .. 1 .. .. .. 2 12 2.4 1883 .. 1 .. .. .. .. 1 .. 2 4 0.8 1884 .. 2 .. 1 3 .. 2 .. 1 9 1.8 1885 .. 2 .. .. .. .. .. .. 2 4 0.8 1886 .. 8 .. .. 6 .. .. .. 1 15 3.0 1887 .. .. .. .. .. .. 1 .. 2 3 .6 1888 .. 1 .. .. .. .. .. .. 3 4 .8 1889 .. 2 .. 1 5 .. .. .. .. 8 1.5 1890 .. .. .. 1 2 .. .. .. 2 8 1.5 1891 .. 6 .. 2 .. .. 1 .. 1 10 1.8 1892 .. .. .. .. 1 .. .. .. 1 2 .4 1893 .. . . .. . . 4 .. .. .. 3 7 1.3 1894 .. 8 .. . . .. .. 1 .. .. 9 1.6 1895 .. 3 .. 1 .. .. l .. 5 10 1.8 1896 .. 1 .. 1 •• .. l .. 3 6 1.05 (7) TABLE V. hewing certain DEATH RATES, and the BIRTH RATES, for the Year 1896, in each Rural and Urban District of the Surrey combined Sanitary District. SANITARY DISTRICTS. Estimated Population at middle of 1896. Births. Rate per 1,000 of the Population. Annual Rate of Mortality per 1,000 of the Population, from Per centage of Deaths under One Year to Registered Births. Number of Deaths from All Causes. The 7 principal Zymotic Diseases. Pulmonary Consumption. Other Lung Diseases. Small Pox. Measles. Scarlatina. Diphtheria. Membranous Croup. Whooping Cough. Fevers. Diarrhoea. Chertsey Rural 10,800 25.4 10.4 0.55 0.6 20 5.8 2 2 2 Chertsey Urban 12,400 26.3 13.0 0.97 1.4 1.6 11.3 1 2 4 2 1 1 3 Weybridge Urban 4,400 23.2 10.2 0.7 0.9 2.3 6.8 2 1 Walton Urban 8,600 22.7 9.3 0.23 1.2 1.7 6.7 2 Dorking Rural 10,670 21.6 11.3 1.1 0.65 1.8 7.0 6 2 3 1 Dorking Urban 7,500 20.4 13.0 1.3 1.6 2.1 10.5 1 6 1 2 Epsom Rural 16,450 23.2 11.2 0.85 0.9 1.9 10.0 6 2 3 4 2 Epsom Urban 8,850 21.6 11.7 0.56 1.6 1.9 10.0 1 4 Carshalton Urban 5,700 30.5 13.3 1.05 1.4 1.2 10.5 1 1 1 3 Sutton Urban 13,500 240 10.8 1.5 0.4 1.5 10.8 11 1 2 6 Leatherhead Urban 4,750 17.0 10.3 1.3 0.63 1.7 14.8 2 1 1 2 Reigate Rural 14,960 24.7 11.2 1.4 0.60 2.7 10.0 2 1 2 10 1 5 Reigate Urban 24,000. 20.8 12.7 1.04 1.1 1.8 10.0 5 3 13 4 Entire District 142,580 23.15 11.65 0.96 0.97 1.83 9.63 — 34 3 21 7 47 4 31 Note,—The Population and Deaths at the Basted Asylum and at the Kensington and Chelsea District Schools, in the Epsom Rural District; at the South Metropolitan District Schools, in the Sutton Urban District; and at the Earlswood Asylum, in the Reigate Urban District, have been excluded from the Table. The Deaths in the Chertsey, Dorking, Epsom, and Reigate Workhouses and Cottage Hospitals of resons belonging to the adjoining Rural Sanitary Districts have been transferred to those Districts. (8) TABLE VI. Shewing the NEW CASES OF INFECTIOUS SICKNESS coming to the knowledge of the Medical Officer of Health during the years 1896, 1895, 1894, and 1893, in the undermentioned Sanitary Districts. Sanitary Districts. Aged under 5 or over 5. New Cases of Sickness in each District, coming to the Knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Districts for Treatment in Isolation Hospital. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Enteric Fever. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Chertsey Rural Under 5 3 3 1 1 2 5 upwards 9 11 4 3 7 3 1 Chertsey Urban Under 5 8 6 2 3 6 3 5 upwards 44 19 3 1 22 29 9 Weybridge Urban Under 5 4 2 3 1 5 upwards 9 7 1 1 3 5 3 Walton Urban Under 5 5 5 5 upwards 11 7 1 2 10 5 Epsom Urban Under 5 3 1 1 3 5 upwards 3 4 7 2 1 Sutton Urban Under 5 8 1 8 5 upwards 34 7 5 4 29 Carshalton Urban Under 5 1 1 5 upwards 3 13 2 1 2 Epsom Rural Under 5 14 1 1 1 7 1 5 upwards 47 7 1 2 7 37 2 Leatheriiead Urban Under 5 4 2 3 5 upwards 15 10 3 1 9 3 Dorking Rural Under 5 4 5 upwards 1 11 6 Dorking Urban Under 5 1 3 5 upwards 1 10 12 2 2 Reigate Rural Under 5 8 2 2 1 5 upwards 23 10 7 19 15 4 Reigate Urban Under 5 42 10 24 5 upwards 108 8 4 13 69 1 Totals in 1896 Under 5 101 33 5 2 6 62 8 5 upwards 1 313 116 1 34 1 1 90 214 26 1 Totals in 1895 Under 5 50 28 2 1 2 5 31 9 5 upwards 221 112 1 51 2 8 77 122 35 3 Totals in 1894 Under 5 60 27 11 2 1 6 29 7 5 upwards 3 267 100 1 48 2 10 109 1 139 24 4 Totals in 1893 Under 5 107 33 20 5 14 38 3 5 upwards 31 735 145 4 66 2 18 168 12 256 15 1