CAR 033 ANNUAL REPORT ON THE URBAN DISTRICT (OR PARISH) OF CARSHALTON, SURREY, For the Year 1898, 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, 1S91, regulating the duties of Medical Officers of Health. William Pile, Printer, "Herald" Works, Caeshalton. CARSHALTON URBAN DISTRICT. Area, 2,926 Acres. Population at Census in 1871, 3,668 ; in 1881, 4,841 ; in 1891, 5,425. Number of inhabited Houses at Census in 1871, 732 ; in 1881, 910; in 1891, 1,091. MEDICAL OFFICER'S REPORT FOR THE YEAR 1898. I.— Vital Statistics: Births and Deaths. 1. Judging from the number of the inhabited houses, the population of the Parish, in the middle of the year, may be estimated at 6,300 persons. 2. The number of Births registered in the Parish during the year was 169, or eight more than in the previous year. The Birth-rate for the year, therefore, was 27 per 1,000 of the estimated population. 3. The number of Deaths registered in the Parish during the year was 70 (as against 76 in the preceding year), to which must be added nine deaths in the Epsom Workhouse, Isolation Hospital, and County Asylum of persons belonging to the Parish. These 79 deaths represent an Annual Death-rate of 12.5 per 1,000 of the population, estimated as above. 4. As to the Infant Mortality. The Deaths of Infants under one year were 27 in number, as against 29 in the preceding year, and were equal to 16 per cent, of the registered births, which is much above their previous average rate in the Parish. This high infant mortality was chiefly due to the unusually large number of deaths from diarrhoea. 5. The deaths from Pulmonary Consumption (three in number) were at the rate of 0.4 per 1,000 of the estimated population, and were below the previous average rate in the Parish. 6. . The deaths from other lung diseases (Bronchitis, Pleurisy, and Pneumonia) were 11 in number, as against 16 in the preceding year, and were at the rate of 1.7 per 1,000 of the estimated population, which is below their previous average rate in the Parish. (See also Tables I. and II. 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 no death. 3. Whooping Cough caused no death. 4. Scarlet Fever (otherwise called Scarlatina) was rather prevalent in the district during the first three and the last two months of the year, as will be seen on reference to Table III. at the end of the report. Altogether, 32 cases were notified in 20 houses, and 30 of the sick were removed to the Joint Isolation Hospital. None of the illnesses ended fatally. In one house there were five cases ; in another there were four cases ; in five there were two eases per house, and in each of the remaining 13 houses there was only one case. 5. Diphtheria was notified in January at a house in Carshalton Grove; in May at one in Carshalton Eoad ; in June at one on the Hackbridge Road, and at one in Pound Street; and in December at one on Park Hill and at another in Carshalton Road. Altogether there were six cases in these six houses. None of the illnesses ended fatally, and two of them were probably contracted out of the district. Three of the sick were removed to the Isolation Hospital, and one, whose illness was detected at a London Hospital, was detained there for treatment. At two of the houses certain sanitary defects were discovered, which might have played some part in causing the appearance of the disease in them. (3) 6. Of Enteric (otherwise called Typhoid) Fever there were four eases, the chief features of which are shown in the following Table. None of these attacks proved fatal, but one case, which had been notified in the previous year, ended fatally in January of this year. Situation of Premises. Persons attacked. Dates of attacks. Remarks. Wandle Mount Boy, Aged 5. January The drains at the back of the house were found to be leaking badly, and to be otherwise defective. He was removed to Hospital on January 26th. Hackbridge Road Man, Aged 28. August 22nd He was attacked two days after his return from the West of England, where he had been staying for a month. Laburnum Villas Girl, Aged 15. November 11th She was removed to Hospital on January 10th. Harold Road Man, Aged 25. December 10th Patient was removed to the Joint Hospital on December 28th. He worked daily in another district. 7. Diarrhaa, which was very fatally prevalent among infants last summer in some other parts of the county, caused 11 deaths, all of which were among children under five years of age. The total deaths from the "Seven Principal Zymotic Diseases" were 12 in number—viz., one from Enteric Fever and 11 from Diarrhoea—and were at the rate of 1-9 per 1,000 of the population. (See also Tables III. and IV. at the end of the Eeport). As regards the other infectious diseases which have to be notified under the above-mentioned Act: No case of Membranous Croup, Puerperal Fever, or "Continued Fever" was notified. Of Erysipelas, there was one case in October. 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, and was assisted by the removal of 36 to the Isolation Hospital; disinfectants for use during illness were in some cases 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 to the Isolation Hospital, and was disinfected in the Washington Lyon Steam Disinfector. The number of patients who were removed to the Joint Isolation Hospital for treatment during the year, from each of the districts forming the United District, with the nature of their illnesses, is shown in the following Table:— Epsom Rural. Sutton Urban. Carshalton Urban. Leatherhead Urban. Total. Scarlet Fever 22 50 30 3 105 Diphtheria 12 52 3 — 67 Typhoid Fever — 2 3 — 5 III.—Summary of other Sanitary Proceedings, &c., which were taken during the year. 1. The Council this year again contracted for the WEEKLY removal of house refuse from premises in their district, instead of for its fortnightly removal as in previous years, with the result that fewer complaints were made of its non-removal. 2. The slaughterhouses, the bakehouses, and the premises of the registered cow-keepers, dairymen, and purveyors of milk, weie inspected. (4) 3. As to the Bye-Laws relating to new streets and buildings : The Surveyor has been good enough to inform me that— In Tn In Iii In In In In In In In In In In In 1884 1885 1886 1887 1888 1889 18901891 1892 1893 1894 1895 1896 1897 1898 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the ByeLaws, was 41 9 12 13 9 6 10 12 13 24 54 62 48 39 50 The number of new streets, ditto, was 3 none none 4 4 4 4 none 4 none 4 none none 3 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 none 5 4. Proceedings under Sees. 150 mid 152 of the Public Health Act, 1875, and under the Private Street Works 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, was one, 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, none in 1895, four in 1896, and one in 1897. 5. Proposed Cemetery. No steps were taken, during the year, for the provision of a Cemetery on the land which the Council had acquired for this purpose in the previous year, but an additional piece of ground was purchased by voluntary contributions, and added to the churchyard, and will be available for interments within a few months. 6. As to Works of Sewerage and of Sewage Disposal. Some progress, (though not so much as was expected), was made with the task of laying sewers in all the populous parts of the district, and with the buildings, tanks, and other works for the disposal of the sewage at the outfall. Unfortunately, a sewer which had been laid for the reception of the trade refuse of some mills, and the sewage of some houses, near Beddington Corner, was found to require some improvement, and could not be used before the year closed. 7. A systematic inspection of houses was again made of the cottages in various parts of the district, 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 when the new sewers are ready for use. The Council again considered the question of providing houses for the Working Classes, under Part III. of the Act of 1890, and in June they decided, subject to the approval of the Local Government Board, to buy six acres of land north of the Wrythe for this purpose, but they afterwards abandoned the scheme on the ground of its expense. 8. As to Water Supply. Samples of water, which were sent me from wells and pumps at the undermentioned places, were examined, with the results shown in the following table :— When the Samples were taken. Source of Supply. Situation of Premises. The Water was found to be Action taken by Owners or Occupiers. January 12 th Pump Racehorse Yard, West Street Polluted The well was cleaned out February 25th Same pump Ditto Ditto Water was provided from Company's main, after order by magistrates to close well January 12 th Well, with 4 pumps West Street Lane Ditto Ditto ditto 12th Pump Pound Street Of good quality 22nd Pump Greyhound Orchard Ditto „ 22nd Well, with 2 pumps Greyhound Hotel Ditto 22nd Well, with 2 pumps High Street Of suspicious quality Ditto ditto August 30th Stream from park The Square Without signs of contamination „ 30th Ditto Ditto Ditto (5) In January the Council decided to join the Croydon Rural District Council in the cost of obtaining reports from Dr. Klein on the results of his bacteriological examination of the water supplied to their respective districts by the Sutton Water Company, and in March they received his first report upon the water, which was to the effect that the sample contained a comparatively small number of microbes, and that none of the microbes present were harmful; but that the water contained certain bacilli and their spores, from which he concluded that it contained "in a small degree admixture with surface microbes." Subsequently, the Council decided to be content with the periodical reports on the water which are issued by the Water Company, and which have proved to be satisfactory. In January a conference of delegates from the Council and from the three other District Councils whose districts are supplied with water from the Sutton Water Works, was held at Suttton, on the question of the possibility of the contamination of the water supplied from these works by soakage from the cemetery at the Banstead Lunatic Asylum, which is two miles from the Works. After considerable discussion it was decided to recommend the District Councils to petition the Home Secretary and the London County Council to stop the interments, and to adopt cremation, at the Asylum, and the Councils in due course forwarded their petitions, but so far nothing has resulted from them. 9. The Sanitary Inspector's statement as to the nuisances that were dealt with, and as to other work done during the year, will be found on the next page. 17, Spencer Park, Wandsworth Common, S.W. January, 1S99. E. L. JACOB. (6) THE SANITARY INSPECTOR'S REPORT For the Year ending December 31st, 1898. The following is the Sanitary Inspector's return of the Nuisances dealt with, and other work done during the year :— Number of Complaints received in writing 42 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 1,077 Number of Nuisances discovered 187 Ditto reported to the Sanitary Authority 137 Ditto remedied after report 187 Number of Notices served for the Abatement of Nuisances, under Section 91 88 Ditto Ditto under Sec. 82 of the Housing of the Working Classes Act, 1890 1 Particulars of Work done by owners or occupiers, fur the abatement of Nuisances, most cases in compliance with notices : Number of privies, cesspools, ditches, pools, watercourses, urinals, ashpits, and drains, cleansed, and number of deposits removed 287 Number of old privies re-constructed as water-closets — Number of Premises at which the drains were re-constructed, ventilated, trapped, or disconnected from the house pipes or rain-water pipes 72 Number of Premises at which new drains or cesspools were provided under Sec. 23 or Sec. 94 29 Number of Premises from which animals, improperly kept, were removed 5 Number of Houses which were provided with efficient ventilation 3 Number ot Houses at which injurious overcrowding was abated 4 Number of damp, unwholesome Houses, which were repaired 28 Number of filthy Houses which were cleansed and whitewashed 40 Legal proceedings taken, under Sec. 96, for Abatement of Nuisances (number of times) ... 6 Ditto under Sec. 82 of Housing of Working Classes Act, 1890 (No. of times) Houses condemned by the Justices as unfit for human habitation, under Sec. 97 — Ditto Ditto under Housing of the Working Classes Act — Number of Samples of Water sent to the Medical Officer of Health for Analysis 9 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 3 Number of Houses to which water was supplied by owners of premises after notice, under Sec. 62 of that Act. 17 (7) APPENDIX. Table I.—TABLE OF DEATHS in the District during the year 1898, 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. Begistered Births. 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 1898. All ages. | Under 1 year. | 1 and under 5. | 5 and under 15. | 15 and under 25. j 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 6300 109 70 25 7 2 2 14 20 Under 5 11 3 i 17 5 and upwards .. 2 7 8 21 At all ages 11 2 10 8 i 38 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 1 2 4 Under 5 1 1 5 and upwards i 1 5 Table II.—Shewing the estimated population, the Annual Birth-rate, and certain Death-rates, for each of the twenty-four years, 1874-98. Years POPULATION Estimated to middle of each year. Begistered Births. Deaths from all Causes. Deaths of Infants under 1 year. Deaths from Pulmonary Consumption. Deaths from other Lung Diseases. Number. Kate per 1000 of the population. Nunber. Hate per 1000 of the population. Number. Per cent, to Regd. Births. Number. Rate per 1000 of the population. Number Rate per 1000 of the 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 4-510 170 37.4 83 18.4 22 13 7 1.5 22 4.9 1880 4610 149 32.8 74 16.0 26 17¼ 6 1.3 12 2.6 1881 4850 151 31.1 78 16.1 19 12½ 10 2.0 9 1.9 1882 4900 176 36.0 89 18.0 29 16½ 7 1.4 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 13 ¼ 5 1.0 12 2.3 1886 5100 145 28.4 71 14.0 15 10¼ 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 11¾ 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 9½ 8 1.5 8 1.5 1892 5550 158 28.5 84 15.1 19 12 5 0.9 15 2.7 1893 5650 158 28.0 75 13.2 24 9 4 0.7 12 2.1 Average of 10 years. 1 1 29.0 14.0 11½ 1.2 2.0 1894 5750 162 28.1 81 14.0 23 14 2 0.3 14 2.4 1895 5850 175 30.0 101 17.2 31 17¾ 10 1.7 18 3.0 1896 6000 174 29.0 76 12.7 20 10½ 8½ 1.3 7 1.1 1897 6150 161 26.2 87 12.5 29 18 7 1.1 16 2.6 1898 6300 169 27.0 79 12.5 27 16 3 0.4 11 1.7 N.B.—The deaths of Parishioners in the \Vorkhouse and other Public Institutions are included in this table. (8) Table III.—Shewing the Sickness and Mortality recorded in the District from the under-mentioned Zymotic Diseases in each month of the year 1898, and in the eight preceding years. 1898. Scarlet Fever. Diphtheria. Enteric (or Typhoid) Fever. Cases Houses Kem'd to Hospl. Cases Houses Kem'd to Hospl. Cases Houses Rem'd to Hospl. January 2 1 2 1 1 1 1 1 February 12 8 12 March 7 5 7 April 2 1 2 May 1 1 1 1 1 June 2 2 1 July 1 1 1 August 1 1 September 1 1 October November 4 1 4 1 1 1 December . 2 1 2 2 2 1 1 1 1 Total in 1898 32 20 30 6 6 3 4 4 3 Total in 1897 28 20 27 1 2 2 4 4 4 Total in 1896 4 3 13 8 2 2 Total in 1895 15 10 8 2 1 1 Total in 1894 6 6 1 1 5 5 Total in 1893 25 16 3 3 Total in 1892 4 4 Total in 1891 5 4 8 5 2 2 Total in 1890 22 8 16 10 4 3 Table IV.— Shewing the number of Deaths in the District from each of the seven principal Zymotic Diseases during the twenty-five years, 1874—1898, and the Zymotic Death-rate for each of those years. Year. Small Pox. Measles. Scarlatina. Diphtheria. Whooping Cough. Continued Fever. Diarrhoea. TOTAL. Typhus Enteric or Typhoid Other kinds. Number. Rate per 1000 of ihe 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 .. .. .. .. 3 1.1 1880 .. .. .. 1 9 .. .. .. 2 12 2.6 1881 .. 2 8 .. 2 .. .. .. 3 15 3.1 1882 1 6 1 .. 1 .. .. .. 2 12 2.1 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 1 3.0 1887 .. .. .. .. .. .. 1 .. 2 3 0.6 1888 .. 1 .. .. .. .. .. .. 3 4 0.8 1889 .. 2 .. 1 5 .. .. .. .. 8 1.5 1890 .. .. 2 l 2 .. .. 1 2 8 1.5 1891 .. 6 .. 2 .. .. 1 .. 1 10 1.8 1892 .. .. .. .. 1 .. .. .. 1 2 0.4 1893 .. .. .. .. 4 .. .. .. 3 7 1.2 1894 .. 8 .. .. .. .. 1 .. .. 9 1.5 1895 .. 3 .. 1 .. .. l .. 5 10 1.7 1896 .. 1 .. l .. .. l .. 3 6 1.0 1897 .. .. 2 .. .. .. .. .. 15 17 2.7 1898 .. .. .. .. .. .. l .. 11 12 2.0