CAR 034 ANNUAL REPORT ON THE URBAN DISTRICT (OR PARISH) OF Carshalton, Surrey For tine Year 1904, BY J. WILLIAMSON, M.D., D.P.H., Medical Officer of Health. CONTENTS. I. Preliminary. II. Population, Births, and Deaths, 1904. III. Infectious Diseases. IV. Summary of Proceedings which were taken during the year under the Sanitary Acts. V. Factories and Workshops. VI. Appendix, containing certain Tables of Sickness and Mortality. Prepared in accordance with Sec. 14 of the Order of the Local Government Board, dated 23rd March, 1891, regulating the duties of Medical Officers of Health. William Pile, Ltd., Printers, "Herald" Office, Carshalton. CARSHALTON URBAN DISTRICT. Medical Officer's Report for the year 1904. I.—Preliminary. Constitution and Extent.—The district, which comprises the parish of Carshalton, was constituted an Urban District in 1883. It is roughly rectangular in shape, about 3½ miles in length from north to south, and slightly over one mile in breadth from east to west, and covers an area of 2,926 acres. Physical Features and Soil.—The town is situated at the foot of the Chalk Downs, upon the chalk and the outcrop of the London tertiaries—Thanet Sand and Woolwich and Reading beds—at a height varying from 100 feet to 150 feet above sea level. An outlying district to the south, known as Carshalton-on-ihe-Hill, is situated on the chalk at a height of 250 feet, and the Wrythe to the north is upon the London clay at a height of 100 feet. A bed of river gravel overlies the greater part of the London Clay and Tertiaries. In the extreme south of the district the Chalk rises to a height of 400 feet. The natural drainage is into the river Wandle, of which one of the heads arises from a number of springs and ponds in the district. Population and Inhabited Houses.—The following are the figures from the last five Census returns:— Census year. Population. Inhabited houses. 1861 2,538 492 1871 3,668 732 1881 4,842 910 1891 5,425 1,091 1901 6,746 1,329 Water Supply.—The whole of the district is supplied by the Sutton Water Company from a well in the chalk in the Sutton district. Drainage.—The main sewerage scheme was completed in 1899, and the sewers have since been extended to include Carshalton-on-the-Hill and the whole of the southern portion of the district, which was not provided for in the original scheme. The sewage passes at the outfall into septic tanks, the effluent from which is treated by downward intermittent filtration through artificially prepared beds, and finally by irrigation over land. The effluent has at all times been satisfactory. Water closets with flushing apparatus have been provided, with few exceptions, for each house, and the drains of practically all premises in the district have been relaid, ventilated, trapped, and connected with the sewers during the past six years. II.—Population, Births, and Deaths, 1904. Population.—The Population of the district in the middle of the year under review may be estimated at 7,250, assuming that it has increased at the same rate since the Census 1901, as it did during the preceding decade. Births.—The number of Births registered in the district during the year was 195, representing a Birth-Hate of 27 per thousand of the estimated population, which is also the average rate for the preceding 10 years. The rate for England and Wales was 27.9 for the year. Deaths.—The number of Deaths registered in the District during the year was 117, to which must be added 11 deaths of parishioners in the Epsom Infirmary and the Brookwood County Asylum. Of the 117 deaths, 84 occurred in the town, 9 in the Cottage Hospital, 1 in the Home for Friendless Girls, and 23 in the Croydon Rural Isolation Hospital; five of the persons who died at the Cottage Hospital were parishioners of Carshalton, but the remaining 28 deaths in these Institutions occurred among patients belonging to other districts, and have to be deducted in estimating the Death-Rate. The nett deaths, therefore amounted to 103, which represent an Annual Death-Rate of 14.2, as against an average rate of 13.4 for the preceding ten years, and a rate of 16.2 for England and Wales for the year. Forty-six deaths were those of males, and 57 those of females. Causes of Death.—Three deaths were ascribed to Whooping Cough, 9 to Diarrhoea, 1 to Influenza, 6 to Phthisis, 14 to other Diseases of the Lungs, 7 to Cancer, 5 to Heart Diseases, 2 to Appendicitis, and 10 to Old Age. Four deaths certified to be due to Enteritis were transferred to Diarrhoea, and two deaths certified to be due to Abdominal Tumour were transferred to Cancer, as the result of information which I obtained by enquiry from the certifying practitioners. (4) Infant Mortality.—The deaths of Infants under one year were 30 in number, and were at the rate of 154 per thousand registered births, as against an average of 134 for the preceding ten years, and a rate of 146 for England and Wales for the year. Three of the children, who died in Institutions, did not belong to the District. Premature triplets and three other premature births accounted for six deaths, two deaths were due to Whooping Cough, seven to Diarrhoea, one to Erysipelas, three to Pneumonia, and one to Tubercular Meningitis. The Zymotic Death-Rate was 1.24 per thousand of the population. III.—Infectious Diseases. Small Pox.—No case was reported. Scarlet Fever.—Fourteen cases were notified in 11 houses. The was no special outbreak, and in five cases the disease was known to have been contracted in other districts. Thirteen of the patients were removed to the Isolation Hospital. Diphtheria.—Two cases only were notified. One of the patients, living at the lodge of the Croydon Rural Isolation Hospital, was removed into that Institution. No application was made during the year for the examination of any specimen from patients suspected to be suffering from the disease. Enteric Fever.—Two cases were notified. Diarrhœa caused nine deaths, seven of which occurred among infants. Measles caused no death. Whooping Cough caused three deaths, in January, July, and August; two of the children were eight months old, and one 15 months. Of Erysipelas, one case was reported. Of Puerperal Fever, two cases were reported, in January and March. Tubercular Diseases.—The deaths from Pulmonary Consumption (Phthisis) were six in number, and were at the rate of 0.83 per thousand of the population, which is about the average rate for the preceding ten years. One death was caused by Tubercular Meningitis. No application was made during the year for the examination of any specimen from patients suspected to be suffering from Phthisis. Fumigation of rooms was done by the Inspector in five houses at which deaths from Phthisis had occurred. Other Preventive Measures.—After the removal or recovery of patients suffering from Diphtheria, Scarlet Fever, Enteric Fever, and Puerperal Fever, the infected rooms were fumigated by the Sanitary Inspector, the walls were stripped and limewashed, and all articles likely to retain infection were removed and steamed in the Washington Lyons Disinfector at the Hospital; disinfectants were supplied to the occupiers, who were instructed in their use; and a sanitary inspection of the premises was made. Small Pox Hospital Accommodation.—Upon the expiration, in March, of the agreement between the Surrey County Council and the Croydon and Wimbledon Joint Small Pox Hospital Board, under which patients from this district suffering from Small Pox had been removed to the Board's Hospital at Cheam, the County Council made an arrangement with the Metropolitan Asylums Board for the accommodation of patients; and the County Council subsequenty issued an Order under the Isolation Hospital Acts, after an enquiry had been held at Kingston, including this district in a Hospital District consisting of all districts in the County which had not already provided for the isolation of this disease. IV.—Summary of other Sanitary Proceedings, &c., which were taken during the year. 1.—Inspections.—Systematic inspections were carried out by the Inspector and myself in various parts of the district, including house-to-house inspections in three roads on the Wrythe, and a complete reinspection of the houses in Harold Road ; notices were served on the discovery of nuisances, by the Inspector, who continued to visit and to report until the nuisances had been abated. A large number of houses were repaired, cleansed, and redrained, yards were paved, ashbins were provided, &c., as set out in the Inspector's Report on page 7. A house in The Square, upon which I had made a representation under the Housing of the Working Classes Act, 1890, was closed by the owner. By agreement with the Sutton Urban District Council, a new surface-water drain was provided at the back of Harold Road, in order that the damp condition of the yards and the foundations of houses might be remedied. A number of nuisances caused by insufficient cesspool accommodation for houses in Avenue Road, upon which I reported to the Council, were abated by the connection of the drains with the new sewer. (5) 2.—New Streets and Buildings.—The Surveyor informs me that 102 plans for new buildings were submitted for approval under the Bye-laws during the year. The corresponding numbers for the ten years 1894 to 1903 were 54, 62, 48, 39, 50, 80, 82, 69, 120, and 60 respectively. Plans for two new streets were also submitted. 3.—The Dairies, Cowsheds, and Milkshops were regularly inspected, and, with the exception of want of lime-washing, were found to be kept in compliance with the Regulations (Model) adopted in 1899. The number of Cowkeepers, etc., on the Register, and the action taken under the Regulations were as follows:— Registered Cowkeepers at end of 1903 4 Registered Cowkeepers added during the year 1 Registered Cowkeepers at end of 1904 5 Registered Dairymen and Purveyors 2 Cowsheds limewashed under notice 4 Visits by Sanitary Inspector 25 Visits by Veterinary Inspector 19 At the beginning of the year, tbe Council appointed a Veterinary Inspector, who made quarterly examinations of the cows, about 100 in number, belonging to the registered cowkeepers. No case of tubercular disease was discovered, but one unhealthy cow was slaughtered under the advice of the Inspector. 4.—The Slaughter Houses were frequently inspected, and were found to be kept in compliance with the Bye-laws. The Council instructed their Inspector to comply with the suggestions in the Memorandum issued by the Local Government Board with regard to the seizure of Tuberculous Meat. 5.—Water Supply.—Water from the mains of the Sutton Water Company was laid on to two houses in compliance with notices under Sec. 62 of the Public Health Act, 1875. 6.—Sewers and Sewage Disposal.—The Southern Sewerage Extension was completed during the year, and Sewers were also laid in three new roads. Nearly the whole of the premises upon the line of new sewers had been connected with the sewers before the end of the year. The Surveyor informs me that the drains of 80 existing premises and of 82 new houses, were connected with the sewers during the year. The Council by agreement carried out works of drainage at a large house in Carshalton Road, connecting the drains with the sewer and doing away with the cesspools. • 7.—Removal of House Refuse.—The weekly removal of house refuse was again satisfactorily carried out by the Contractor. The refuse was deposited at the Sewage Farm end at a brickfield in Wrythe Lane. V.—Factories and Workshops. The number of employees in the workshops in the district is very small, the majority of workpeople being employed in Skin and Parchment Mills, a Paper Mill, and Iron Works. The premises were inspected, and the sanitary conditions, as set out under the following headings, were found to be generally satisfactory:- (a) Cleanliness.—Four workshops which required cleansing were limewashed at the request of the Sanitary Inspector; two workshops were being cleansed by the occupiers at the time of our visits, and all others were found to be kept in a clean condition. (b) Air-space.—The number of employees was in all workshops found to be within the limits defined in the Act. (c) Ventilation.—The means of ventilation appeared to be sufficient in all cases. (d) Drainage of Floors.—Two workshops were paved and drained at the request of the Sanitary Inspector. (e) Sanitary Conveniences.—Section 22 of the Public Health Acts Amendment Act, 1890, is in force in the district. The question of sanitary accomodation at the larger factories had received, in the two previous years, the attention of the Council, who enforced the provision of new conveniences and the reconstruction of defective closets at several premises ; they also caused the drains of all premises to be connected with the sewers, with the exception of one factory, which is situate between two branches of the river, and can only with difficulty be drained to the sewer. Homework.—Lists of outworkers were obtained from two firms, and the names of seven persons living in other districts were forwarded to the respective Councils. (6) Bakehouses.—All these premises complied with the special requirements of the Act with regard to bakehouses, and limewashing was regularly done. There is no underground bakehouse in the district. Abstract of Act.—I gave notice to H. M. Inspector of Factories of one workshop in which no Abstract of the Act was affixed, where women were employed. Register.—The following premises were on the Register at the end of the year : Total Number of Workshops 41 Number of Retail Bakehouses 6 Number of Laundries 5 Number of other Workshops 30 Number of Factories employing more than 40 persons 5 Number of Factories employing less than 40 persons 7 J. WILLIAMSON, M.D. Homeleigh, Heathcote Road, Epsom. February, 1905. (7) THE SANITARY INSPECTOR'S REPORT For the Year ending December 31st, 1904. The following is the Sanitary Inspector's return of the Nuisances dealt with, and other work done during the year:— Number of Complaints received, including six complaints of Non-removal of House Refuse 58 Number of visits to premises, including re-inspections, viz.: — Under Sec. 23, Drainage 139 Ditto 92, Nuisances 455 Infectious Cases 50 Factories 8 Workshops 20 Slaughter-houses 7 New Building, Drain Testing 185 864 Number of premises on which Nuisances were discovered 123 Ditto reported to the Sanitary Authority 864 Ditto remedied after report 109 Ditto work in hand and under notice 14 Number of Notices served for the Abatement of Nuisances, under Section 94 100 Ditto ditto new drainage under Section 23 8 108 Ditto ditto under Sec. 32 of Housing of the Working Classes Act, 1890 1 Legal proceedings taken, under Sec. 96, for Abatement of Nuisances (number of times) — Ditto under Bye-Laws, for improper keeping of animals — Ditto under Sec. 32 of Housing of Working Classes Act, 1890 (No. of times) — Houses condemned by the Justices as unfit for human habitation, under Section 97 — Particulars of Work done by Owners or Occupiers, for the Abatement of Nuisances, in most cases in compliance with notices : Number of privies and cesspools emptied, and accumulations removed 5 Number of old privies re-constructed as water closets - Number of new earth closets constructed — Number of Premises at which new drains were provided under Sec. 23 or Sec. 94 27 Ditto ditto ditto without notice 62 Number of New Houses connected to the sewers 82 171 Number of Premises from which animals, improperly kept, were removed 1 Number of Houses which were provided with sanitary ashbins 13 Number of Houses at which injurious overcrowding was abated 4 Number of damp, unwholesome Houses, which were repaired 76 Ditto ditto paved at rear 45 Number of Houses which were cleansed and whitewashed 65 Scheduled diseases 20 Number of Houses which were disinfected after disease ' Phthisis 5 27 Other Diseases 2 Houses closed by Owners after notice under the Housing of the Working Classes Act, 1890 1 Houses repaired under Justices order — Number of Houses to which water was supplied by Owners of premises after notice 2 WM. WILLIS GALE, A.M.I.C.E., Surveyor and Sanitary Inspector. 14th February, 1904. (8) Table I.—Vital Statistics of Whole District during 1904 and Previous Years. Year. Population estimated to Middle of each year. Births. Total Deaths Registered 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 Distbict. Under One Year of Age. At all Ages. ber Rate.* ber Rate per 1000 Births ber Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 5825 162 27.8 23 142 74 12.7 .. .. 7 81 13.9 1895 5955 175 29.4 31 177 91 15.3 .. .. 10 101 17.0 1896 6085 174 28.6 20 115 67 11.0 .. .. 9 76 12.5 1897 6220 161 25.9 28 174 76 12.2 .. .. 11 87 14.0 1898 6355 169 26.6 25 148 70 11.0 .. .. 9 79 12.4 1899 6500 180 27.7 25 139 102 15.7 9 9 13 106 16.3 1900 6640 189 28.4 17 90 80 12.1 17 17 13 76 11.4 1901 6790 169 24.9 26 154 82 12.1 10 10 9 81 11.9 1902 6940 178 25.6 17 96 88 12.7 12 12 12 88 12.7 1903 7090 182 25.7 20 110 87 12.3 15 13 8 82 11.5 Averages for years 1894—1903 6440 174 27.1 23 134 82 12 .7 6 6 10 86 13.4 1904 7250 195 27.0 30 154 117 16.1 33 28 14 103 14.2 *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the District. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. Institutions within the district receiving sick persons from outside the district are the Cottage Hospital and the Croydon Rural Isolation Hospital. Institutions outside the district receiving sick and infirm persons from the district are the Epsom Workhouse, the Cuddington Joint Isolation Hospital, and the Brookwood County Asylum. Area of District in Acres Total population at all ages 6,746 At Census of 1901. (exclusive of area 2,904. Number of inhabited houses 1,329 covered by water) Average number of persons per house 5.1 Table II. Cases of Infectious Disease notified during the Year 1904. Notifiable Diseases. Cases notified in Whole District. No. of Cases removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. Diphtheria 2 .. .. 1 .. 1 .. 1 Membranous Croup .. .. .. .. .. .. .. .. Erysipelas 1 .. .. .. .. 1 .. .. Scarlet Fever 14 .. 1 7 3 3 .. 13 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. 2 .. .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 1 1 .. .. Plague .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. Totals 21 .. 1 10 4 6 .. 15 Note.—The Isolation Hospital, used by the sick of the District, is the Joint Isolation Hospital, situated on Cuddington Downs, in the Epsom Rural District. (9) Table III. Shewing the number of deaths from the Seven Chief Zymotic Diseases, and from Phthisis, and the number of cases notified in each of the years 1874—1904. Year. Small Pox. Fever. Diphtheria. Enteric Fever. Diarrhœa. Measles. Whooping Cough. Phthisis. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Deaths Deaths Deaths Deaths 1874 .. .. .. .. .. 1 .. .. 2 5 4 1875 .. .. .. 18 .. .. .. 1 .. .. 1 1876 .. .. .. 8 .. .. .. 3 4 6 2 1877 1 .. 10 .. .. .. .. .. 1 .. .. 1878 .. .. .. .. 6 3 3 2 4 .. 1 1879 .. .. .. .. 1 1 2 .. .. .. 4 1880 .. .. 14 .. 1 1 1 .. 2 .. 9 1881 3 .. 35 8 1 .. 1 .. 3 2 2 1882 8 1 43 1 .. .. .. .. 2 6 1 1883 .. .. 4 .. 2 .. 1 1 2 1 .. 1884 1 .. 6 .. 4 .. 12 2 1 2 3 1885 .. .. 1 .. 2 .. 1 .. 2 2 .. 1886 .. .. 7 .. 1 .. 7 .. 1 8 6 1887 .. .. 14 .. .. .. 1 1 2 .. .. 1888 .. .. .. .. .. .. .. .. 3 1 .. 1889 .. .. 5 .. 1 1 1 .. .. 2 5 1890 .. .. 22 .. 16 1 4 .. 2 .. 2 1891 .. .. 5 .. 8 2 2 1 1 6 .. 1893 .. .. 4 .. .. .. .. .. 1 .. 1 1893 .. .. 25 .. .. .. 3 .. 3 .. 4 4 1894 .. .. 6 .. 1 .. 5 1 .. 8 .. 2 1895 .. .. 15 .. 8 1 1 1 5 3 .. 10 1896 .. .. 4 .. 13 1 2 1 3 1 .. 8 1897 .. .. 28 2 2 .. 4 .. 14 .. .. 7 1898 .. .. 32 .. 6 1 4 .. 11 .. .. 3 1899 .. .. 31 2 9 2 6 2 6 3 2 4 1900 .. .. 16 1 25 5 5 1 6 .. .. 4 1901 .. .. 12 .. 6 1 .. .. 3 1 10 8 1902 1 1 6 .. 18 3 2 1 4 4 1 7 1903 3 .. 10 .. 10 1 1 .. .. .. 1 6 1904 .. .. 14 .. 2 .. 2 .. 9 .. 3 6 (10) Table IV. Causes of, and Ages at, Death during year 1904. Causes of Death. Deaths in of belonging to whole District at subjoined Ages. Total Deaths in Public Institutions in the 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. Small Pox .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. 2 Whooping Cough 3 2 1 .. .. .. .. .. Diphtheria and Membranous Croup .. .. .. .. .. .. .. 19 Croup .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. Enteric Other continued Epidemic Influenza 1 .. .. .. .. .. 1 .. Cholera .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Diarrhœa 9 7 .. .. .. .. 2 .. Enteritis .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. 1 Erysipelas 1 1 .. .. .. .. .. .. Other Septic Diseases .. .. .. .. .. .. .. 1 Phthisis 6 .. 2 1 .. 3 .. .. Other Tubercular Diseases 1 1 .. .. .. .. .. .. Cancer, Malignant Disease 7 .. .. .. 1 4 2 1 Bronchitis 5 .. 1 .. .. 1 3 .. Pneumonia 8 3 1 .. .. 2 2 .. Pleurisy .. .. .. .. .. .. .. .. Other Diseases of Respiratory Organs 1 .. .. .. .. 1 .. .. Alcoholism 1 .. .. .. .. 1 .. .. Cirrhosis of Liver Venereal Diseases .. .. .. .. .. .. .. .. Premature Birth 6 6 .. .. .. .. .. .. Diseases and Accidents of Parturition .. .. .. .. .. .. .. .. Heart Diseases 5 .. .. .. .. 5 .. .. Accidents 1 .. .. .. .. .. 1 3 Suicides .. ... .. .. .. .. .. .. All other Causes 48 7 2 2 3 16 18 6 All Causes 103 27 7 3 4 33 29 33