CRO 2 HEALTH REPORT for 1894 for the Crondon Rural District, by the MEDICAL OFFICER OF HEALTH. Croydon : Printed at the " Guardian " Office, North End. HEALTH REPORT of the Crondon Rural District, 1894. To the Members of the Croydon Rural District Council, Mr. Chairman, Mrs. Pitt, and Gentlemen,— I have the honour to present to you the following report and statistical tables for the year 1894. I.—AREA AND POPULATION. The total area of the District is 22,766 acres, and comprises 9 parishes. The largest parish, in point of area, is Coulsdon; and the smallest is Wallington. The population of the District in 1891, when the census was taken, was 28,717. This figure includes the population of three institutions, which must be deducted to obtain the true population of the District, in order to render the statistical deductions reliable. The three institutions are Cane Hill Asylum, in Coulsdon, and the Holborn Union Workhouse and Schools in Mitcham, the inmates of which numbered in 1891, 2,484. The true population of the District in 1891, was thus reduced to 26,233, and was made up of 12,483 males and 13,750 females. The population of the District at the previous census of 1881, after making corresponding deductions was 21,159. The parish with the largest population was Mitcham, and the smallest Woodmansterne. The number of inhabited houses in the District in 1891 was 4,845, having increased from 3,730 in 1881. The average number of persons living in each house in the District was 5.4; the highest average existed in Coulsdon, and the lowest in Woodmansterne and Addington. The density of the population on area in 1891, in the whole District, was .86 acre per person, compared with l.29 acres throughout England and Wales. The densest parishes were Wallington and Mitcham, and the least dense was Sanderstead. 4 From these facts, it is necessary to estimate what was the population of the District and of its constituent parishes, in the year under review. To obtain correct vital statistics, it is essential that the estimation of the population should be as accurate as circumstances will permit, for population is the basis of all vital statistics. The usual method is that known as the Registrar General's method, which is based on the assumption that the rate of increase since the last census year, has been the same as that proved to have existed in the last preceding intercensal period. This method is accurate enough for most cases, especially if large populations are being dealt with, and in the absence of any special disturbing factors. It is useful, however, to correct the results obtained by this method, by obtaining returns giving the number of inhabited houses in the District, as disclosed by the various rate-books, and multiplying the number by the average number of persons living in each house, as ascertained at the last census. Estimated by these methods, the population at the middle of 1894 may be assumed to have consisted of 28,200 persons, of which 13,420 were males, and 14,780 females. The natural increase of the population, which means the excess of births over deaths, has been since the census 1,666, and for the year 1894, was 433. The estimation of the population of the constituent parishes is a more uncertain matter still than that of the District, but, guided mainly by the returns of inhabited houses, I have shown in Table I. the population and sex-distribution of each parish at the middle of 1894, as accurately as possible. While the population of the District, as a whole, appears to be increasing at the same rate as it did during the last intercensal period (1881 to 1891), this does not seem to be the case with each individual parish. Still guided principally by the returns of inhabited houses, it appears that the populations of Addington and Merton are not increasing so rapidly as they did between 1881 and 1891; those of Beddington, Morden, Sander- 6 stead, and Wellington are increasing more rapidly; and those of Mitcham, Coulsdon, and Woodmansterne are increasing at about the same rate. The foregoing facts are shown in detail for each parish in Table I. Table I.—The AREA in Acres, INHABITED HOUSES, POPULATION, and DENSITY of each Parish in the District in 1891 and 1894. Parish. Area in Acres. Number of Inhabited Houses. Population. Density. Acres per person. Average Persons per House, 1891. 1891. Estimated to middle of 1894. 1891. 1894. Persons. Males. Females. Persons. Males. Females. 1891. 1894. Addington 3,605 132 132 670 346 324 670 346 324 5.4 5.4 5.0 Beddington 3,128 442 477 2,607 1,162 1,445 2,807 1,252 1,555 1.2 1.1 5.9 Coulsdon 4.314 537 577 3.335 1,623 1.712 3,568 1,737 1,831 1.3 1.2 6.2 Merton 1,765 654 691 3,360 1,612 1,748 3,517 l,689 1,828 .52 .50 5.1 Mitcham 2 915 2.055 2,223 10,758 5,300 5,458 11,521 5,684 5,837 .27 .25 5.2 Morden 1,475 138 156 763 387 376 852 433 419 1.9 1.7 5.5 Sunderstead 3,150 96 104 509 262 247 547 282 265 6.1 5.7 5.3 Wallington 823 710 802 3,823 1,587 2,236 4,280 1,778 2,502 .25 .20 5.4 Woodmanaterne 1,591 81 88 408 204 204 438 219 219 3.9 3.7 5.0 The District 22,766 4,845 5,250 26,233 12,483 13,750 28,200 13,420 14,780 .86 .80 5.4 N.B.—The above Table excludes the inmates of three institutions, viz., Cane Hill Asylum, Coulsdon, and the Holborn Union Workhouse and Holborn Schools, in Mitcham. The population and mortality of these institutions are included in those of the Metropolis. 6 Age-Distribution. On page 6 of the annual report for 1893, is a table showing the age-constitution of the District as revealed at the census of 1891. After deducting, as accurately as possible, the population of the institutions, the following Table A, the utility of which will be evident later on, has been constructed, and it shows the approximate numbers living in the District at the middle of the years 1891 to 1894, at four groups of ages. Table A.—Persons living in the District at 4 groups of ages. Ages. 1891. 1892. 1893. 1894. Under 5 years 2,930 3,000 3,075 3,130 5 to 15 years 7,210 7,370 7,560 7,700 15 to 25 years 4,830 4,940 5,070 5,160 25 years and upwards 11,430 11,690 12,015 12,210 All ages 26,400 27,000 27,720 28,200 II.—BIRTHS AND DEATHS. Births. The births registered in the District during 1894, numbered 732. Of this number, 358 were males, and 374 were females. Fourteen births, of which nine were males and five females, were registered as illegitimate. The birth-rate for the year was 25.9 per 1000 persons living. The proportion of illegitimate births was 1.9 per cent. of the total births. This is a low birth-rate, and is the lowest of which there is record in the District. The average annual birth-rate in the ten preceding years was 29.9; the highest rate (33.4) having occurred in 1886, and the lowest (27.4) in 1893. The birth-rate for England and Wales during 1894, was 29.6 per 1000, being the lowest ever recorded. The distribution of the births in the District, with the corresponding birth-rates, is shown in the following table. 7 Table B. —Births in 1894. Parish. Registered Births. Birth-rate per 1000 of population. Males. Females. Total. Addington 11 9 20 29.8 Beddington 35 18 53 18.9 Coulsdon 40 47 87 24.4 Merton 43 39 82 23.3 Mitcham 164 201 365 31.7 Morden 8 11 19 22.3 Sanders tead 8 6 14 25.6 Wallington 38 37 75 17.5 Woodmansterne 11 6 17 38.8 Deaths. The deaths registered in the District during the year 1894 numbered 525, of which 259 occurred in the three institutions already mentioned, and must be deducted. To the number thus reduced must be added 33, which is the number of persons, belonging to the District, who died outside its boundaries. The corrected number of deaths to be accounted to the District in 1894, thus becomes 299. Of this number 153 were the deaths of males, and 146 were those of females. This mortality corresponds to a death-rate of 10.6 per 1,000 persons living. The death-rate among males was 11.4, and that among females was 9.8, per 1,000 living of the corresponding sex. This is a very low death-rate, and is the lowest of which there is record in the District. The average annual death-rate of the ten preceding years was 12.9 per 1000 living; the highest rate (15.1) having occurred in 1884, and the lowest (10.9) in 1889. The death-rate for England and Wales in 1894 was 16.6 per 1000, being by far the lowest on record. The distribution of the deaths in the District, with the corresponding death-rates, is shown in the following table. 8 Table 0. Mortality in 1894, exclusive of public institutions. Parish. Deaths. Death-rate per 1000 of population. Males. Females Total. Addington 4 2 6 8.9 Beddington 6 13 19 6.8 Coulsdon 19 14 33 9.2 Merton 16 23 39 11.1 Mitcham 82 72 154 13.4 Morden 3 2 5 6.9 Sanderstead 2 3 5 9.1 Wallington 19 13 32 7.5 Woodmansterne 2 4 6 13.7 The rate thus varies from 5.9 in Morden and 6.8 in Beddington, to 13.4 in Mitcham and 13.7 in Woodmansterne. It is necessary to point out, however, that the death-rates of the various parishes are not strictly comparable. Besides healthiness of surroundings, death-rates vary considerably according to other circumstances, such as sex and age-distribution, and occupation. Thus, the death-rate of persons between the ages of 5 and 55 years is lower than the death-rate for all ages, and the deathrate of females is lower than that for males. Consequently a preponderance of persons between the ages of 5 and 55 years, or of females, would lower the death-rate of the particular place in which such preponderance exists, and vice versa. For example, suppose two Districts, one of which, A, had from various causes a preponderance of persons between 25 and 35 years, and the other, B, had an undue proportion of old people over 65 years of age, the death-rate of A would be lower than that of B, although B's surroundings might be quite as healthy as those of A. There are no data at all, whereby the age-distribution of each parish can be estimated, but as regards sex-distribution, while the District contained in 1891, 1102 females to every 1000 males, yet the proportion varied in each parish from only 926 females in Addington to as many as 1240 in Beddington, and 1410 in Wallington, to every 1000 males. This, however, is quite sufficient to show that the death-rates of the various parishes cannot safely be compared one with the other. 9 To prevent undue congratulation upon the lowness of the death-rate of 1894 in the District as a whole, and in some of the parishes, it is also necessary to point out that a death-rate under 10 or 12, cannot be regarded as a true measure of the longevity of the inhabitants. A rate of 10 per 1000, in a series of years, would mean that every child born reaches the age of 100, or that the average age at death is 100; and a rate of 12 per 1000 would mean an average age at death of over 80. The death-rate of the District in each of the four quarters of 1894, ending March 31st, June 30th, September 30th, and December 31st, is shown in the following table. Deaths. Death-rate. 1st quarter 81 11.6 2nd „ 81 11.3 3rd ,, 71 9.6 4th „ 66 9.1 The year 299 10.6 Mortality at Different Ages. Infantile mortality.—The number of infants under one year of age who died in 1894 was 71. The infantile death rate, or proportion of deaths of infants under one year to registered births, was 97 in a thousand, and lower than in any year since 1884, except in 1890, when the rate was 92 in a thousand. The average annual death-rate of infants during the 10 preceding years was 114 per 1000 births. The rate in 1893 was 142. The infantile death-rate for England and Wales in 1894 was 137 in a thousand, being 10 below the average. The low infantile death-rate of 1894 was due mainly to the reduction in the mortality from diarrhoea, which, in turn, was due to the unusually cool summer which characterised that year. It was also partly due to a considerable diminution in the deaths from whooping cough. The infantile mortality in each parish is shown in Table D. 10 Table D.—Infantile Mortality in 1894. Pariah. Deaths of Infants under 1 year. Deaths in a 1000 Births Registered. Addington 1 50 Beddington 2 38 46 Coulsdon 4 Merton 9 110 Mitcham 46 126 Morden 2 105 sanderstead 3 214 Wellington 3 40 Woodmansterne 1 59 Children under 5 years.—The deaths of children under 5 years of age numbered 102, or 34 per cent. of the deaths at all ages. Expressed in proportion to population living in the District under 5 years, which is a much more reliable method, it is found that the above number represents a death-rate of 32.6 per 1000 living at those ages. The corresponding death-rate in 1893 was 48.1, and the average annual rate in the three years 1891 to 1893, was 43.8 per 1000. This death-rate, expressed as above, is believed to form a more important sanitary test than the death-rate at any subsequent group of ages, because very few indeed leave their homes under 5 years ; consequently up to this period of life the population of any particular place may be looked upon as practically stationary, and therefore fully exposed to all the healthy and unhealthy influences which may exist in it. It is satisfactory, therefore, that the average annual rate for the last four years, is considerably below the average annual rate for England and Wales, which is 63.5 per 1000. The deaths of persons between 5 and 15 years numbered 34, or 11.4 per cent. of the total deaths. In this case also it is far more reliable to state the deaths in proportion to the population living at those ages, and, expressed in this way, they represent a death-rate of 4.4 per 1,000, as compared with 33 per 1,000 in 1893, and an average annual rate for the three years 1891 to 1893 of 2 8. The corresponding average annual rate for England and Wales was, for the same years, 3 8 per thousand, 11 This death-rate is of considerable importance, as the agegroup in question represents that portion of the population exposed to the influence and effects of school life. Since 1891 it has steadily increased in this District. For the country at large, the rate has continuously fallen from 6.3 in the decade 1861 to 1870, to 5.1 in the decade 1871 to 1880, and to 41 in the decade 1881 to 1890. The deaths of persons between 15 and 25 years numbered 13, representing a death-rate of 3.5 per 1,000 living at those ages. The corresponding rate in 1893 was 2 per 1,000, and the annual average rate for the 3 years 1891 to 1893 was 2.2 per 1,000. The corresponding average annual death-rate for England and Wales was for the same years 4.7 per 1,000. In the following table the above rates are fully shown, and from it, it will be seen that, although the general death-rate was bo low in 1894, yet the reduction only affected the first and last groups of the population, and that the death-rate of the remaining groups was higher than the average. The most probable explanation of the former fact is, that the coolness of the summer and the mildness of the winter, which characterised 1894, were the main causes of a reduction in the normal mortality of infants and old people respectively. Table E.—Annual death-rate at four groups of ages. 1891 to 1894. Year. Deaths per 1000 living. Ages. All Ages. Under 5. 5 to 16. 15 to 26. 25 & upwds. 1891 12.3 42 2.2 2.5 15.2 1892 13.2 41.3 3 2 14.5 1893 14.5 48.1 3.3 2 18.2 Mean 13.3 43.8 2.8 2.2 16 1894 10.0 82.6 4.4 3.5 12.3 Mean for England and Wales, 1891 to 1893. 19.5 63.6 3.8 4.7 22 (1893 only). 12 The foregoing rates are calculated on the estimated population at each given group of ages, as shown in Table A, page 6 Causes of Death. Zymotic Diseases.—The deaths registered in 1894, included— 1 death attributed to Measles 5 deaths „ Scarlet Fever 21 „ „ Diphtheria 2 „ „ Whooping Cough 2 „ „ " Fever" 9 „ ,, Diarrhœa Thus 40 deaths were ascribed to these zymotic causes, being in the proportion of 1.41 per 1000 living, as compared with an annual average in the ten preceding years of 1.93 per 1000. The corresponding rate in 1894 in England and Wales was 1.76, against an annual average rate in the ten preceding years of 2.25 per 1000. Deaths ascribed to one or other of the above causes, occurred in the parishes of Addington, Coulsdon, Merton,. Mitcham, and Wallington, but not in the other parishes. The above deaths include no less than 10 which occurred outside the District, although belonging thereto; 3 were due to scarlet fever and 7 to diphtheria. The mortality from each of the above diseases, in proportion to 1000 persons living, was as follows:—Measles .04, scarlet fever .2, diphtheria .7, whooping cough .07, "fever" 07, and diarrhoea .3. The mortality from measles, whooping cough, diarrhoea, and "fever," were considerably below the annual average; that from scarlet fever was nearly equal, and that from diphtheria was much higher. The number of deaths from diphtheria in 1894, which has once been exceeded, namely, in 1888, represents a death-rate of 745 per million living, against an annual average of 279. 13 The corresponding death-rate for the whole country in 1894 was 218 per million, as compared with an annual average of 191 per million. As regards diphtheria, therefore, the District compares very unfavourably with England and Wales, both in its annual average and its death-rate last year. The mortality, moreover, affected only the parishes of Mitcham and Merton, and, if expressed in proportion to the population of those two parishes, represents a death-rate of no less than 1386 per million living. Constitutional Diseases.—Sixty deaths were due to constitutional diseases, being in the proportion of 2.1 per 1000, which is a low rate. The most important of this class are tubercular diseases. Phthisis, or pulmonary consumption, caused 30 deaths, giving a rate of l.06 per 1000, against an annual average of 1.16. The annual average for England and Wales is about l.6. Other tubercular diseases caused 14 deaths, and of the remaining deaths in this class, six were ascribed to cancer or malignant disease. Local Diseases.—The diseases of this class caused 133 deaths, giving a rate of 4.72 living, which is also a low rate. Diseases of the nervous, circulatory, and respiratory systems caused 105 of these deaths, or 33, 30, and 42 deaths respectively, corresponding to death-rates of 1.17, 1.07, and 1.5 per 1000, all of which are materially less than the corresponding averages for England and Wales. Violent Deaths.—Deaths due to violence numbered 15, giving a death-rate of .52 per 1000, against an average rate of about .6 per 1000 for England and Wales. Forty-seven per cent. of the deaths were due to accidental causes. The number of deaths due to suicide, was more than double the average relative number in England and Wales. Inquests and Uncertified Deaths.—The deaths of 1894, apart from those which occurred in institutions, include 33 which were the subjects of coroners' inquests. This number is 11 per cent. of the total deaths, which is a somewhat high percentage, and 14 compares with 6.3 per cent. for England and Wales in 1894. It includes 16 deaths which were described in the verdicts as due to natural causes, 10 as due to accident or negligence, 6 to suicide, and 1 to homicide. Besides these deaths, there were four uncertified deaths, that is, deaths which were not certified either by a medical practitioner or by a coroner after inquest. The following is a list of these deaths. Table F.—Uncertified Deaths, 1894. Parish Date of Death Sex Age Stated Cause of Death Beddington Jan. 6th F. 45 Fits and Weak Heart Mitcham Feb. 6th F. 79 Syncope, due to Senile Decay Woodmansterne May 20th F. 85 Decay of Nature Mitcham June 30th M. 50 Heart Disease It need hardly be explained how unsatisfactory it is that there should be any deaths to record under this heading. Statistical Tables.—Attention may here be drawn to the accompanying Statistical Tables, which I have endeavoured to make as complete as possible, and the results of which, I have taken great care, at the cost of considerable labour, to render accurate and reliable. The vital statistics of the District are now shown, for the first time, compiled in a systematic manner, and members of the Council will be in a position to study the records of the past ten years, in conjunction with those of the year under review. It is necessary to point out, however, that the records of mortality during the years previous to 1893, are not strictly comparable with those of 1893 and 1894, because the deaths occurring outside the District among persons belonging to it, were not included before 1893. The inclusion of these deaths, which both in 1893 and 1894 numbered 33, involves a material increase in the death-rate, probably as much as 1.3 in most years. 15 Table II.—Showing the POPULATION, MARRIAGES, BIRTHS, and DEATHS, for the year 1894, and 10 years preceding. GROSS NUMBERS. The Year. Estimated Popula tion. Marriages. Registered Births. Corrected No. of Deaths. Deaths in Publio Institutions. Total all Ages. Under One Year. Under Five Years. 1894 28200 NO RETURNS. 732 299 71 102 259 189S 27720 760 402 108 148 274 1892 27000 7«5 355 91 126 221 1891 26400 790 325 90 123 182 1890 25810 722 291 66 104 151 1889 25265 746 274 78 117 172 1888 24730 736 307 73 122 154 1887 24200 726 316 74 120 171 1886 23690 793 296 83 119 102 1885 23180 769 326 89 154 128 1884 22690 673 343 99 158 91 Average of 10 years 1884-93. 25090 748 323 85 129 165 N.B.—Before 1893, the deaths occurring outside the District among persona belonging thereto, were not included in the above figures: such deaths would probably number between 30 and 40 for each year, 16 Table III.—Showing the Annual BIRTH and DEATH RATES, and DEATH RATES OF INFANTS, for the Year 1894 and 10 Years preceding. In the Year. Birth Kate per 1000 of the Population Corrected Death Rate per 1000 of the Population. Deaths of Children under 1 year, per 1000 of Registered Births. 1894 25.9 10.6 97 1893 27.4 14.5 142 1892 28.3 13.2 119 1891 30.0 12.3 114 1890 28.0 11.3 92 1889 29.5 10.9 105 1888 29.7 12.4 99 1887 30.0 13.1 102 1886 33.4 12.5 105 1885 33.1 14.1 116 1884 29.7 15.1 147 Average of 10 years. 1884 to 1893 29.9 12.9 114 N.B.—Before 1893, the deaths occurring outside the District among persons belonging thereto, were not included in the above figures: the inclusion of such deaths in 1893 and 1891 has increased the death rates considerably, 17 Table IV.—Showing the number of DEATHS from the Principal Zymotic Diseases in the 10 Years 1884 to 1893, and in the Year 1894. Disease. 1884. 1S85. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. Annual Average of 10 years, 1884-1893. Proportion of Deaths to 1000 Population in 10 years, 1884—1893. Total Deaths in 1894. Proportion of Deaths to 1000 Population in 1894. Small-pox - - - - - - - - 1 - .1 .00 0 - Measles 13 16 3 25 3 4 12 6 17 7 10.6 .42 1 .03 Scarlet Fever 2 2 5 5 3 0 19 1 3 4 4.4 .17 5 .18 Diphtheria 6 7 4 9 22 6 4 5 5 2 7.0 .3 21 .74 Whooping Cough 19 13 14 0 2 21 2 11 3 22 10.7 .4 2 .67 Fever Typhus — — — — — — Enteric 2 3 1 4 1 2 1 1 4 4 2.3 .09 2 .07 Simple continued - - - - - - - - - - - - - - Diarrhœa 18 9 20 16 7 2 11 11 20 20* 13.4 .53 9 .32 Totals 60 50 47 59 38 35 49 35 53 59 48.5 1.93 40 1.41 Zymotic Death-rate 2.64 2.16 2.0 2.44 1.54 1.38 1.82 1.33 1.96 2.13 1.93 — 1.41 Zymotic Death-rate in England and Wales 2.81 2.23 2.42 2.42 1.88 2.23 2.15 1.91 2.0 2.47 2.25 — 1.76 * Including a case of cholera. N.B.—Before 1893, the deaths occurring outside the District among persons belonging thereto were included in the above figures 18 Table V.—Showing the number of DEATHS at all ages in 1894, from certain groups of Diseases, and proportions to 1000 of Population, and to 1000 Deaths from all causes; also the number of Deaths of Infants, under one year of age, from other groups of Diseases, and proportions to 1000 Births, and to 1000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 40 1.41 134 2. Pulmonary Diseases 42 1.45 140 3. Principal Tubercular Diseases 45 1.60 150 Division II. (Infants under One Year). Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under One Year. 4. Wasting Diseases 20 27 282 6. Convulsive Diseases 11 15 155 NOTICE. 1. Includes small pox, measles, scarlet fever, diphtheria, whooping cough, typhus, enteric (or typhoid), and simple continued fevers, and diarrhoea. Ten of the deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes phthisis, scrofula, tuberculosis, rickets, and tabes. 4. Includes marasmus, atrophy, debility, want of breast milk, and premature birth. 5. Includes hydrocephalus, infantile meningitis, convulsions, and teething 19 Table VI—DEATHS Registered from all Causes during the Year 1894. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Ages. Totals. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwds I. Specific Febrile, or Zymotic Diseases 9 12 18 3 1 1 1 45 II. Parasitic Diseases III. Dietetic Diseases 1 1 IV. Constitutional Diseases 6 7 6 8 5 13 6 5 3 1 60 V. Developmental Diseases 14 5 11 6 36 VI. Local Diseases 31 11 9 3 6 5 14 13 22 16 3 133 VII. Deaths from Violence 3 1 2 2 3 3 1 15 VIII. Deaths from Ill-Defined and Not fied Causes 7 1 1 9 Totals 71 31 34 13 16 22 23 18 32 29 10 299 I —SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Small-pox Vaccinated Unvaccinated No statement Measles 1 1 Scarlet Fever 2 3 5 Typhus Wooping Cough 1 1 2 Diphtheria 8 13 21 Simple Continued and Ill-defined Fever Enteric or Typhoid Fever 2 2 Influenza 1 1 2.—Diarrhceal Diseases. Simple Cholera Diarrhœa, Dysentery 7 1 1 9 3.—Malarial Diseases. Remittent Fever Ague 4 —Zoogenous Diseases. Cowpox and Effects of Vaccination Other Diseases (e.g., Hydrophobia, Glanders, and Splenic Fever) 5.—Venereal Diseases. Syphilis Gonorrhœa, Stricture of Urethra G.—Septic Diseases. Erysipelas 1 1 Pyæmia, Septicæmia 1 1 Puerperal Fever 1 1 2 20 Deaths Registered from all Causes—continued. Ages. Totals. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwds II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases Worms, Hydatids, and other Animal Parasitic Diseases III.—DIETETIC DISEASES. Want of Breast Milk, Starvation 1 1 Scurvy Chronic Alcoholism Delirium Tremens IV—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart 2 1 1 4 Rheumatism 1 1 Gout 1 1 Rickets 1 1 Cancer, Malignant Disease 2 1 2 1 6 Tabes Mesenterica Tubercular Meningitis, Hydrocephalus 2 4 1 7 Phthisis 1 2 5 4 10 3 4 1 30 Other forms of Tuberculosis, Scrofula 3 2 1 1 7 Purpura, Hæmorrhagic Diathesis 1 1 Anæmia, Chlorosis, Leucocythæmia Glycosuria, Diabetes Mellitus 1 1 2 Other Constitutional Diseases V.-DEVELOPMENTAL DISEASES. Premature Birth 9 9 Atelectasis 3 3 Congenital Malformations 2 2 Old Age 5 11 6 22 VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 1 2 1 4 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 3 1 3 2 2 12 Insanity, General Paralysis of the Insane 1 1 Epilepsy 1 1 Convulsions 8 2 10 Laryngismus Stridulus (Spasm of Glottis) 1 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 1 1 1 3 Other Diseases of Nervous System 1 1 2.—Diseases or Organs of Special Sense. (e.g., of Ear, Eye, Nose) 21 Deaths Registered from all Causes—continued. Ages. Totals. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwds 3.—Diseases of Circulatory System. Pericarditis Acute Endocarditis 1 1 Valvular Diseases of Heart 1 1 1 3 Other Diseases of Heart 1 1 2 5 4 6 5 24 Aneurism Embolism, Thrombosis 1 1 Other Diseases of Blood Vessels 1 1 4.—Diseases of Respiratory System. Laryngitis Croup Emphysema, Asthma 1 1 Bronchitis 9 2 2 2 3 4 22 Pneumonia 3 4 2 2 3 2 1 1 18 pleurisy 1 1 Other Diseases of Respiratory System 5.—Diseases op Digestive System. [Dentition 1 1 [Sore Throat, Quinsy Diseases of Stomach 2 1 3 Enteritis 2 2 Obstructive Diseases of Intestines 2 1 3 Peritonitis Ascites Cirrhosis of Liver 1 1 1 3 Jaundice and other Diseases of Liver 1 2 1 4 Other Diseases of Digestive System 1 1 6.—Diseases or Lymphatic System. e.g., of Lymphatics and of Spleen) 7.—Diseases or Gland-like Organs or Uncertain Use. e .jr., Bronchocele, Addison's Disease) 8.—Diseases of Urinary System. Nephritis 1 1 2 4 Bright's Disease, Albuminuria 1 1 Disease of Bladder or of Prostate 1 1 1 3 Other Diseases of the Urinary System 9.—Diseases or Reproductive System. A. Of Organs of Generation. Male Organs Female Organs B. Of Parturition. Abortion, Miscarriage Puerperal Convulsions Placenta Previa, Flooding 2 2 Other Accidents of Childbirth.. 22 Deaths Registered from all Gauus—continued. Ages. Totals. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 88 85 & upwds 10.—Diseases of Bones and Joints. Caries, Necrosis Arthritis, Ostitis, Periostitis Other Diseases of Bones and Joints 11.—Diseases of Integumentary System. Carbuncle, Phlegmon Other Diseases of Integumentary System 1 1 VII.—DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures or Contusions Gunshot Wounds Cut, Stab 1 1 2 Burn, Scald Poison Drowning 1 1 2 Suffocation 2 1 3 Otherwise 1 1 2.—Homicide. Manslaughter Murder 1 1 3. —Suicide. Gunshot Wounds 1 1 2 Cut, Stab 2 2 Poison 1 1 Drowning Hanging Otherwise 1 1 4.—Execution. Hanging VIII.-DEATHS FROM ILL-DEFINED and NOT SPECIFIED CAUSES. Dropsy Debility, Atrophy, Inanition 7 1 8 Mortification Tumour Abscess 1 1 Hemorrhage Sudden Death (cause not ascertained) Causes not Specified or Ill-defined 23 SUMMARY OF TABLE VI. No of Deaths. I.—SPECIFIC FEBRILE, or ZYMOTIC DISEASES. 1. Miasmatic Diseases 32 2. Diarrhœal „ 9 3. Malarial „ - 4. Zoogenous „ - 5. Venereal „ - 6. Septic „ 4 II.-PARASITIC DISEASES - III.—DIETETIC DISEASE3 1 IV.-CONSTITUTIONAL DISEASES 60 V.-DEVELOPMENTAL DISEASES 36 VI.—LOCAL DISEASES. 1. Diseases of Nervous System 33 2. Diseases of Organs of Special Sense - 3. Diseases of Circulatory System 30 4. Diseases of Respiratory System 42 5. Diseases of Digestive System 17 6. Diseases of Lymphatic System - 7. Diseases of Gland-like Organs of Uncertain Use - 8. Diseases of Urinary System 8 9. Diseases of Reproductive System— (a) Diseases of Organs of Generation - (b) Diseases of Parturition 2 10, Diseases of Bones and Joints - 11. Diseases of Integumentary System 1 VII.—VIOLENCE. 1. Accident or Negligence 8 2. Homicide 1 3. Suicide 6 4. Execution - VIII.—ILL-DEFINED AND NOT SPECIFIED CAUSES 9 Total 299 24 Deaths in Public Institutions. The deaths in institutions in the District numbered 263 in 1894, 132 being those of males, and 131 those of females. One hundred and eighty-five deaths occurred at Cane Hill Asylum, in Coulsdon parish, which is one of the large Metropolitan County Asylums for the Insane, and contained on an average 2,016 inmates in 1894. One death was due to erysipelas, one to diarrhoea, and 35 to pulmonary consumption. There were also 2 deaths, concerning which coroners' inquests ware held, the cause of death in each being attributed to natural causes. Sixty-nine deaths occurred at the Holborn Union Workhouse, in the parish of Mitcham, which contained on an average 872 inmates. Nine of the deaths were due to pulmonary consumption. Three of the deaths were referred to the coroner, an inquest being held on two; the "uncertified" death being ascribed to "haemoptysis." One of the deaths, concerning which inquests were held, was due to "accidental," and the other to "natural" causes. Five deaths occurred in the Industrial Schools of the Holborn Union, also in Mitcham parish, the average number of residents being 447 ; 3 of these deaths were due to whooping cough. Two deaths also occurred at Reedham Orphanage, in Coulsdon parish; and 2 at the Russell Hill School, in Beddington parish ; these deaths have been included in those accounted to the District itself. III.—INFECTIOUS DISEASE. The Infectious Disease (Notification) Act has been in force in the District since the early part of 1890 ; and in July, 1890 measles was included as one of the notifiable diseases. During 1894, 664 cases of infectious disease were notified : 81 of which occurred in public institutions. 25 The following table shows the number of cases of infectious disease notified in the District for each year since the Act came into force. 1890. 1891. 1892. 1893. 1894. Private Houses. Public Institutions. Small-pox - - 7 1 1 1 Scarlatina 109 83 117 316 80 19 Diphtheria 19 17 16 44 63 - Membranous Croup 1 - - - 1 - Typhoid Fever 14 8 12 23 12 - Continued Fever - - - 1 - - Puerperal Fever 1 1 1 4 6 - Cholera - - - 1 - - Erysipelas 4 13 22 31 13 5 Measles 134 247 579 138 402 56 *Acute Diarrhœa - - - - 5 - Totals 282 369 754 559 583 81 The following table shows the number of notified cases in each parish in the District. Table G.—Notified cases of infectious disease in 1894, including institutions. Parishes. Addington. Beddington. Coulsdon. Merton. Mitoham. Morden. Sanders tead. Wallington. W oodmansterne. The District. Small-pox - 1 1 2 Scarlatina 1 8 2 17 53 4 5 9 99 Diphtheria and 6 6 50 2 64 Membranous Croup Typhoid Fever 4 2 2 4 12 Puerperal Fever 3 2 1 6 Erysipelas 3 3 5 6 1 18 Measles 14 19 4 83 2 336 458 Acute Diarrhœa 5 5 Totals 1 25 35 34 203 8 5 353 664 *Acute diarrhoea was a notifiable disease for a few weeks in September, 1894. 26 Small-pox—Two mild cases of this disease were reported. The first case was notified on April 26th, from a house in Kenley, in the parish of Coulsdon. The household consisted of 5 adults, 3 females, and 2 males, both of whom were ergaged daily in business in London. There was also a domestic servant, who slept at her own home near at hand. The information given was that all had been re-vaccinated about 15 years previously, except one of the sons, aged 30. This gentleman was attacked with lumbar pain on April 2nd, and had some spots on the 4th, but thinking that he had an attack of influenza, did not consult a medical man at all, and, indeed, travelled daily by railway to London, and went about his occupation as usual. On April 22nd his sister first complained of feeling unwell, and after consulting a medical man, the case was pronounced to be one of modified small-pox, and was so reported on the 26th. Upon this diagnosis, the brother, who had first been unwell, made enquiries, and found that on March 21st, exactly 12 days before he felt ill, he had conversed for some little time with, and had received some cash from, a man whose wife and children had just previously been removed to a small-pox hospital, and who, moreover, was himself removed 2 days later. There cannot be much doubt, therefore, but that this gentleman had in reality suffered from a mild attack of small-pox, and that his sister caught the disease from him. Another sister left her home in Kenley to stay with friends on April 13th, and it appeared that she was also attacked with lumbar pain on April 20th, but although 1 communicated with the Medical Officer of Health, the only information obtained was that the diagnosis was influenza. The domestic servant alluded to above, was a daughter of the local constable, whose family consisted of a wife and 4 children. The girl was employed daily at the infected house until 26th April, and when the diagnosis of small-pox was made, was promptly sent home. Steps were immediately taken with a view to prevent the spread of the disease in this household, and on my urgent representations, the entire family was re-vaccinated successfully, except the father, who, in 27 accordance with police regulations, had been vaccinated 4 or 5 times. As regards the infected house, it was only with the greatest difficulty that I succeeded in getting the most ordinary precautions observed, and re-vaccination was strenuously opposed, although urged by Dr. Seaton as well as myself. The persons concerned were opposed on principle to vaccination, and the medical attendant also declined to advise it. The disinfection of the house was carried out thoroughly, and quarantine was maintained with great difficulty for nearly 14 days afterwards. Under the circumstances it was fortunate that no further case occurred. The other case occurred at the Holborn Union Workhouse, in Mitcham; this was also a very mild case, and as soon as diagnosed, was removed to the South Eastern Fever Hospital, and everything possible was done in the way of disinfection. Nearly all the inmates of this Workhouse had been re-vaccinated about 18 months previously, the person attacked having been among them. There was no clue to the source of this case, except that he had slept in a bed next to one, which had been occupied, for a few nights only, by a casual inmate. Scarlatina.—This disease was not very prevalent during 1894, only 80 cases having been reported from private houses, which is a great reduction from the record of the previous year, when 316 cases were notified. There were five deaths, including two in the Croydon Infirmary, registered as due to "(1) scarlatina, and (2) diphtheria;" which gives a case-mortality of 6¼ per cent. Nineteen cases occurred in institutions; 12 being at the Holborn Schools, and 7 in a charitable home in Merton parish. The first outbreak (4 cases) occurred here in July; the cases were removed, and the premises disinfected; but 12 days afterwards another case occurred, whereupon I examined all the boys, and succeeded in finding one who was in the "peeling" stage, and who had had no observed eruption. 28 Only one more case occurred, soon after this boy was isolated, but doubtless others would have arisen from this hidden one, had no examination been made. Diphtheria and Membranous Group.—The prevalence of diphtheria has been one of the features of 1894. Sixty four cases (including one of membranous croup) were notified from 37 houses. Special reports, dealing in detail with the prevalence of this disease, have been laid before the Sanitary Authority and the Council, and therefore it will only be necessary to record here the salient points. The monthly incidence of the disease is shown in the following table. Table H.—Cases of diphtheria notified in 1894. Mitcham. Merton. Other parts of District. Total. Cases. Houses Infected Cases. Houses Infected Cases. Houses Infected Cases. Houses Infected January 2 1 1 1 3 2 February 9 6 1 *1 10 7 March 1 *1 4 3 5 4 April 16 6 16 8 May 4 2 2 6 June 3 3 3 3 July 1 1 1 1 2 2 August 4 1 1 1 5 2 September 2 2 1 1 3 3 October November 4 1 4 1 December 5 4 2 1 7 5 Total 50 25 6 5 8 7 64 37 The number of deaths was 21, including one from membranous croup, giving a case-mortality of 32.8 per cent. All the fatal cases occurred in Mitcham and Merton, the casemortality being 37½ per cent. for those parishes. * These two houses closely adjoin Mitcham parish. 29 Thirty-four males and 30 females suffered from the disease, and 13 males and 8 females died. The ages of those suffering from the disease is shown in the following table :— Cases Deaths Case-mortality Under 5 years 19 8 42 per cent. 5 to 10 years 26 8 30½ per cent. 10 to 15 years 10 S 50 per cent. 15 years and upwards 9 nil — The majority of the cases is thus seen to have occurred in those of school age (5 to 15 years). The special feature of this disease in 1894, namely, its disproportionate incidence upon a particular portion of Mitcham, and closely adjoining portion of Merton, has been the subject of one of the special reports above alluded to, which attempted to show that serious conditions affecting the sewerage of that locality, resulting from the "heading back" of sewage in the sewers, have led to pollution of the soil by sewage, which has in turn contributed to the extensive prevalence of unhealthy throats among the population, as was proved by examination of the children attending the Board School in this neighbourhood, where no less than 47 per cent. of the scholars were discovered to be the subjects of chronic tonsillitis and a very pronounced form of granular pharyngitis. Diphtheria is now known to be caused by a bacillus, known as the Klebs and Loffler bacillus, which usually takes up its position in the throat, 'and there produces various substances, which are absorbed by the system generally, and cause symptoms of profound poisoning. The development of this bacillus, like that of all bacilli, is greatly influenced by the soil on which it has to grow, and the resistance it has to overcome. It is only reasonable to conclude that an "unhealthy" throat is, in itself, more favourable for its reception and development than a healthy one, and when this is combined with a somewhat lowered vitality such as must exist 30 among those living in a locality, the soil of which is more or less polluted with sewage, it is by no means surprising that in the conflict for supremacy which takes place between the individual and the bacillus, the latter should frequently gain the upper hand. Although, therefore, it would not be accurate to say that sewage-polluted soil caused, or could have caused, the diphtheria prevalence, yet, given the initial presence of the diphtheria bacillus—and near London it would be difficult to exclude it altogether—it is obvious that such a condition must in time render the locality a favoured spot for the disease, since it produces conditions which are favourable for the reception of its microorganism, its multiplication, and the development of its most vigorous properties. In consequence of recent researches, the view taken now by the best authorities, is that diphtheria is not a "filth" disease as was once so commonly thought; that is, that the presence of unsanitary conditions, such as bad drainage, accumulations of filth, dampness, or offensive nuisances, cannot actually cause diphtheria, provided that the specific bacillus is absent. Evidence is constantly accumulating, which tends to prove this in regard to diphtheria, as well as most infectious disorders; but this evidence also points to the conclusion that there must be some other factors, besides the presence of bacilli, which determine whether an individual is attacked with such diseases or not; otherwise, infectious disorders would be much more universally prevalent. Briefly stated, the most important factor is what is called the susceptibility of the individual, and probably the most potent agents which influence this susceptibility, are the healthy or unhealthy conditions under which the individual lives. Although, then, the opinion now prevails that "smells," "bad drains," and so forth, cannot cause diphtheria, or, probably, any infectious disease, as was once firmly believed, yet such 31 conditions operate very largely indeed in determining the susceptibility of persons, when the specific micro-organism happens to appear, so that it is as important as ever that such matters should receive attention, and that their causes should be removed. Nevertheless, it is very important that as much as possible should be done to discover the existence of these active organisms ; and it may be presumed that at some future time every District will have a centre, at which investigations in this direction can be carried out, not only to determine the possibility of certain diseases appearing, but also to determine the positive existence of such disease. In the case of diphtheria, it is becoming a more and more common practice to decide by such bacteriological methods whether the disease is diphtheria or not; and also to decide when the disease, or rather its infectivity, has come to an end. The necessity for the latter was shown in a striking way in this District. Two persons, suffering from diphtheria, were removed from a house in Mitcham to the Croydon Infirmary, towards the end of August, and one of them died there. The other was detained until the second week in November, owing to protacted cardiac weakness; nevertheless, after this prolonged detention, as soon as the patient returned home, the disease reappeared among her relatives, and the patient herself had a second attack. I understand, also, that a young man living in Croydon, to whom this patient was engaged, was also attacked with the disease, and died. Consequently, on my advice, arrangements wtre made towards the close of the year for the bacteriological examination of throats after diphtheria, to determine the actual termination of the illness, and in the future this will be carried out in every case in the District before isolation is relaxed, or disinfection performed. Fever.—Twelve cases of Enteric or Typhoid Fever were notified, the diagnosis of one of which was afterwards reviewed and altered. Of the eleven remaining cases, three occurred in 32 persons who had arrived in the District, either actually suffering from the disease, or who were attacked within a few days, and therefore could not have contracted the disease in the District. There were two other cases, which might also have been contracted outside the District. Besides these, there was one which occurred in a person who had frequently consumed water from the river Wandle; another in a person who had slept for twelve nights with a friend, a visitor in the District, who was then detained at St. Bartholomew's Hospital for typhoid fever; and another was in a young man who was occupied as a watercress seller. The possibility that watercress can give rise to this disease was brought prominently before the public towards the end of the year, and the matter being one which very closely concerns portions of the District, I suggested to the Council at its first meeting, without expressing any opinion as to the probability of the danger, that it would be advisable to have a bacteriological examination made by Dr. Klein, and this the Council agreed to at a subsequent meeting. The result of this investigation will be awaited with great interest. Four of the eleven cases of typhoid occurred in Wallington, 3 in Coulsdon (1 in Purley and 2 in Kenley), 2 in Mitcham, and 2 in Merton. Two of the cases were fatal. Puerperal Fever.—Six cases of this disease occurred, in four of which the patients had been attended by midwives. Two of the cases occurred in the practice of one midwife, and she was cautioned not to attend any more women for some time, and her clothing was disinfected. There were two deaths. 33 The monthly occurrence is shown in th« following table :— Table J.—Oases of measles notified in 1894. Month. Cases at the Holborn Schools. Cases in Private Houses. Private Houses infected. January 36 3 3 February 1 10 6 March 1 1 April 2 2 May 10 6 June 5 4 July 12 10 August 2 11 8 September 11 10 8 October 2 196 100 November 4 120 58 December 22 10 Total 66 402 215 Exclusive of the cases notified from the Holborn School, the incidence of the disease on the separate parishes, was as follows: 2 cases occurred in Morden, 4 in Merton, 14 in Beddington, 19 in Coulsdon, 27 in Mitcham, and 336 in Wallington. Assuming, for the present, that every case was notified, it is thus seen that the disease, although present to a greater or less extent in most of the parishes, was epidemic in Wallington only. The epidemic in this parish commenced towards the end of September, was at its height in October and November, and came to an end with the close of the year. Of 348 cases notified in these last four months, 326 occurred in the parish of Wallington. It commenced in Upper Wallington and South Beddington by means of a few scattered cases, which, being unnotified, were not discovered until the schools in Wallington proper had become infected, and the great outburst occurred. The National Schools were closed on October 3rd, and it is worthy of note, that after the 20th of that month no fresh house was invaded, from which children had attended either of the National Schools. The date of invasion was almost invariably regarded as the date 34 on which the rash was first noticed, and since the rash appears usually on the fourth day of illness, the above fact shows that the incubation period was in no case longer than thirteen days ; which is in general accordance with the records of most observers. From Wallington proper, the disease spread towards the end of October to the Hackbridge and Beddington Corner divisions of the parish, but as the cases were not so numerous, the National School at the latter place was not closed. It is a remarkable fact that but one death was registered as due to measles throughout this epidemic—one death in 336 known cases, it being more than probable that there were several other cases which were not notified. The District is, I believe, the only district in the County of Surrey, and one of the very few in England and Wales, where measles is a notifiable disease. The utility of the notification of this disease is a very debateable question, and the opinion 1 have formed from the experience of this epidemic is, that if notifiable at all, it should be so on a basis somewhat different from that of other diseases. Measles is a disease which is highly infectious for several days before it can be recognised and notified, owing to the late appearance of its distinctive rash; consequently much of the mischief is done before notification. Numerous cases are so mild that no medical man is consulted, and no medical notification is obtained; the only notification being then from householders, which is frequently not forthcoming, and even when it is, it is obvious that the diagnosis must frequently be faulty, and thus notification from such a source is not of very great value. In the epidemic in question, the first or most important cases thus escaped notification. The disease, moreover, spreads so rapidly, that it is absolutely impracticable, in a district such as this, to carry out those measures of disinfection which we regard as essential in other diseases; and finally, it is a disease that is not seriously regarded by the public, which renders it extremely 35 difficult to secure the adoption of proper precautions. If the last reason was the only one that could be put forward against the notification of measles, it would be argued that no doubt, in time, the public would gradually become alive to the importance of co-operating in checking its spread, but, apart from this, the characteristics of the disease seem to be such that notification fails in leading to appreciable prevention, and therefore entails an expenditure which does not yield an adequate return. If the notification, in regard to measles, of first cases only, or infected houses, could be required, as much benefit would accrue as under the present system, and the saving thereby effected could be more usefully employed by requiring the notification of Diarrhoea and Phthisis. Whooping Cough.—This disease caused only two deaths, and it is safe to presume that it was not very prevalent in 1894, a fact of some interest, because it has frequently been observed that epidemics of measles and of whooping cough occur concurrently. Diarrhoea.—The year 1894 was, almost everywhere, marked by an unusually low prevalence of this disease, due mainly, no doubt, to the cold, wet summer of that year, contrasting sharply with the experience of the previous hot year. Nine deaths, only, occurred in the District, as compared with 20 in 1893, and an annual average during the preceding 10 years of over 13. Six of the deaths occurred in Mitcham. In accordance with a suggestion from the Local Government Board, made in view of a possible reappearance of cholera, the Sanitary Authority adopted "acute diarrhoea" as a notifiable disease from the beginning of September until the 30th of that month. During that period, five case were notified, all of which occurred in Mitcham. Three of the cases occurred in two adjoining houses, supplied with water from the same cistern, which had evidently become fouled in some way; everybody who drank the water suffered from diarrhoea, or other abdominal trouble. 36 Diarrhœa is a disease which is so commonly intimately dependent on sanitary shortcomings, that great benefit would, beyond a doubt, accrue to the District if it were, in its acute form, a notifiable disease, as has been mentioned under the subject of measles. Notification of Infectious Disease outside the District.—A report was presented to the Sanitary Authority during the year, showing that it would be very useful if periodical information could be given of the prevalence of infectious disease in the Districts adjoining this, and, in consequence, a communication was addressed to the Surrey County Council, asking if arrangements could be made by which this could be effected. The County Council received the suggestion cordially, and it is understood that in the coming year, provided it can be mutually arranged, Dr. Seaton will be enabled to supply the various Medical Officers of Health in the county with periodical returns for their information, showing the prevalence in each District of certain diseases—returns which will necessarily be of great value, and probably tend to check the spread of disease from one District to another. IV.—ISOLATION AND DISINFECTION. The'year 1894 has been the first complete year during which this District has been without an Isolation Hospital. Until September, 1893, patients from the District were admitted into the infectious wards of the Croydon Union Infirmary, but in consequence of the objections of the Local Government Board, since that date this accommodation has not been available, except for the comparatively small number who are classed as " paupers." Our means of dealing with outbreaks of infectious disease have thus been seriously interfered with, and the result is plainly shown in the history of the prevalence of diphtheria in the District in 1894, when it frequently happened that several cases occurred in a house, owing to the impossibility of procuring anything like efficient isolation. 37 As soon as the Croydon Union Infirmary was closed to the infectious sick of this District, the Sanitary Authority took steps to find a suitable site for an Isolation Hospital of their own. Enquiries were made of a large number of owners of land in the most central portions of the District, but for a long time unsuccessfully. The Croydon Corporation was approached as to some land in their possession near Beddington Corner, but without buccess. The Conservators of Mitcham Common were also approached, but they replied that they had no power to sull land for this purpose, which was very unfortunate, for several suitable sites, inconveniencing nobody, could have been found on the fringes of the common. The Ecclesiastical Commissioners were also approached in regard to some land near Waddon Marsh-lane, but although willing to sell a portion to the Authority, they declined to proceed further, upon Croydon objecting to the proposal, the land in question being just within the borough boundary, though not far from the Borough Isotion Hospital. Several private owners were also approached, but while some were willing to sell very large areas only, others were willing to sell suitable sites, until the purpose for which land was required had to be explained. However, towards the end of the year a site was found, the owner of which was willing to entertain the subject, and eventually the Sanitary Authority decided to purchase it, provided the sanction of the Local Government Board was obtained. The site is on sloping ground adjoining the river Wandle) near Beddington Corner, and is just within the boundary of Carshalton parish. It is central, approached by very good roads, and provided with easy means of water supply and sewerage, its only fault being that it is somewhat large. As the year closed, application was made to the Local Government Board to sanction a loan of £4,500, for the purchase of this site. In the absence of any outside means of isolation, as much as possible has been done to prevent the spread of infectious disease. 38 In all cases of small-pox, scarlet fever, diphtheria, typhoid fever, puerperal fever, and measles, visits have been paid by the Medical Officer of Health or one of the Inspectors, instructions have been given as to the most efficient means of isolation, and the precautions to be observed to prevent the spread of infection. Disinfectants (perchloride of mercury in cases of typhoid fever, and carbolic acid in other cases) have been issued free of charge. Notifications, prohibiting attendance, have been sent to schools ; and, where necessary, persons have been warned not to pursue their occupations. Whenever possible, cases have been removed to the Croydon Infirmary. Upon the receipt of a certificate of the termination of a case from the medical attendant, infected rooms have been fumigated by the officers of the Council, and subsequently cleansed thoroughly by owners. Disinfection of 111 houses was thus carried out. Ultimately, after periods varying for different diseases, notices permitting attendance at school have been given. At the commencement of the year, arrangements were completed for the removal of all infected bedding and clothing to the steam disinfector, attached to the Croydon Infirmary, where 2,675 articles have been disinfected during the year, with comparatively very few complaints of damage from owners of the clothing. In cases of typhoid fever, the excreta pails have always been provided for the reception of all infected material, and periodically removed to the Sewage Works, where the contents are burnt. In cases of puerperal fever, infected bedding has been destroyed, and compensation paid. The shelter for the accommodation of persons temporarily displaced from their homes during disinfection, which was provided at the end of 1893, has been very useful occasionally, and, doubtless, when better known, advantage will be more frequently taken of it. 39 V.—WATER SUPPLY. The mains of several Water Companies extend through the different parishes in the District, and form the main source of supply to the inhabitants. Part of Addington is supplied from the waterworks belonging to the Croydon Corporation; Kenley and Purley, in Coulsdon parish, and Sanderstead, are supplied by the East Surrey Water Company; Beddington, Wallington, Woodmansterne, and Morden, by the Sutton Water Company; and Mitcham and Merton by the Lambeth Water Company. Other sources of supply, such as deep wells, artesian wells, and shallow surface wells, exist in various parts, and in eight cases have been analysed by Dr. Stevenson. Five of these water supplies were condemned by him as unfit for drinking purposes, Water Company's water being in each case substituted ; one was stated to be suspicious, while the remaining two were certified to bo of high organic purity. As the year closed, a room was provided, and the necessary materials and chemicals obtained at a small outlay, for establishing a laboratory for the chemical examination of water-samples, and in the coming year the Medical Officer of Health will be in -a position to analyse drinking waters, and samples of effluent from the Sewage Works, at a much diminished cost to the District, It would be as well if apparatus were obtained, to enable the more important bacteriological investigations connected with water, as well as certain diseases, to be carried out at this laboratory. Besides the above cases, there were two others where it was unnecessary to analyse the water, and in which steps have been taken to remove the existing source of supply. One was the case of four houses supplied by a spring, on the banks of the river Wandle in Beddington, which was unprotected from contamination by surface water from the adjoining road, and was also occasionally fouled by escapes of gas from the 40 contiguous mains in the road. As the year closed, the Sanitary Authority were about to connect the houses with the water mains, in default of the owner. The other case has been previously referred to in the annual report for 1893, page 24. The Sanitary Authority, in consequence of reports made to them, requested the East Surrey Water Company to extend their mains for the benefit of several houses at Coulsdon Common, supplied by rain water. Upon this request being complied with, a notice was duly served upon the owner to connect the houses with the extended main. After some delay the necessary pipes were laid, and fittings and taps supplied in the various houses, but as soon as the water was turned on from the main, it was turned off by order of the owner. This proceeding was reported to the Council at its first meeting, and the owner was called upon to comply with the notice, but at the close of the year, the occupiers of these houses were still consuming rain-water, which is stored in underground tanks, is possessed of distinct odour and taste, always thick, and very thick when disturbed by a shower of rain, and, moreover, in which are animalculse, visible to the naked eye. VI.—SEWERAGE AND SEWAGE DISPOSAL. The questions of improving the sewerage of the parishes of Beddington, Wallington, Mitcham, Merton, and Morden, and of remedying the defects at the Sewage Works have been burning questions throughout the year 1894, and have been at almost every meeting under consideration in some form or other. Early in the year, Mr. Chatterton, who had been requested to advise the Sanitary Authority, presented bis report, and, briefly stated, he recommended that alterations should be made at the works, so that chemical precipitation might be employed as a preliminary treatment of the sewage, before final treatment on the land or on artificial filters. He further recommended 41 that it would not be justifiable to interfere largely with the sewers, which admittedly allowed the entry of large volumes of subsoil water, but advised that those most defective in this respect should be dealt with from time to time. Shortly after this report was received, changes occurred in the staff of the Authority, and the new surveyor, Mr. Forder, was instructed to report and draw up a scheme for the improvement of the Sewage Works. Mr. Forder also recom mended chemical precipitation, and ultimately complete plans of the proposed settling tanks, plant, and so forth, were prepared. Very careful consideration was given to these plans, and at length, as the term of office of the Authority had almost expired, it was decided to take no decisive action until the District Council had had an opportunity of considering the subject; and a* the close of the year the matter remained there. One of the difficulties at the works consists in the large amount of detached " sewage-fungus" which finds its way into the river with the effluent. Mr. Forder recommended, as a temporary expedient, the adoption of a system of wire-screens, which has now been completed. These screens require the attention of three men, employed in shifts, and although the screens do not exclude all the fungus, yet they undoubtedly do prevent a very large quantity of fungus from daily entering and polluting the river. In considering the best way out of the difficulties connected with the sewage scheme of this District, it is necessary to bear in mind that, when first designed, it was intended that the sewage should be purified by means of intermittent downward filtration, owing to the restricted area of the land available. For this process the preliminary settlement, as complete as possible, of the solid matters suspended in sewage is an essential, and for this purpose a " settling-tank," with coke screens was provided. In consequence, however, of the volume of sewage being under-estimated, owing to the admission of large volumes of subsoil water into some of the sewers, the so-called "settling- 42 tank " by no means answers its purpose. The volume of sewage is so large, that it passes through this tank far too rapidly to permit more than a comparatively trifling deposit of solid matter in it, and, instead, the solids pass on to the land, and are there deposited, where they interfere completely with the action of the soil as a rapid filtering medium. This constitutes the main difficulty, but there is no reason to suppose that it would not be removed, if settling or precipitation tanks were provided large enough to ensure very slow or intermittent passage of sewage through them, whereby, especially if assisted by chemical precipitants, the vast bulk of the solids would be left behind, and the soil would be enabled to rapidly purify the thus clarified sewage. Improvements at the works are essential to prevent river pollution and nuisance in their neighbourhood, arising from the stagnant pools of sewage, and from the decomposition of the foul solid matters deposited upon the surface of the soil. But it is necessary to point out that it is of more immediate concern, that sewage should be, at all times, effectually removed from the sewers in the District, and it is to be hoped that the Council will adopt no improved scheme, which will in any way permit of the " heading back " of sewage in the sewers. Closely connected with this " heading back " of sewage, for it is dependent upon it, is the overflow, which exists in Mitcham, from one of the main sewers into the river Wandle; an overflow which at the present time permits the escape of volumes of sewage into the river, after slight rainfall, and which occurs, moreover, at a spot near which there is a considerable population. These matters are, no doubt, bound up intimately with the contemplated improvement at the works, but their existence within the District itself, affecting, as they have been shown to do, the health of the population, is an additional and most pressing reason for urging, without delay, the completion of the improvements. 43 Since whatever is done will entail considerable cost, over and above the already large amount of money spent upon the sanitary improvement of this part of the District, it will be useful to enquire whether these improvements have resulted in any substantial benefit to the health of the community. The original scheme of sewerage was instituted about the year 1881, the parishes included being Beddington, Wallington, Mitcham, Merton, and Morden, and it so happens that these parishes, together with Woodmansterne, constitute the Mitcham Registration sub-district, the returns of which, from the year 1871, have, with the consent of the Registrar-General, been placed at my disposal. The inclusion of Woodmansterne is not sufficient to vitiate any facts to be learned from these returns, which have been analysed as follows, on the well-recognised plan adopted in similar enquiries in other parts of the country. For purposes of comparison, two periods have been taken; the first being the 10 years 1871-1880, which immediately pre ceded the institution of the sewage scheme, and other sanitary improvements accompanying it; the second period being the succeeding 10 years 1881-1890. The death-rate for the first period was 15 5 per 1000, while that for the second was 13*7, a difference of 1*8 per thousand. Expressed in another way, this means that, had the deathrate remained during the decade 1881 to 1890 at its mean level in the preceding decade, the total deaths from 1881 to 1890, inclusively, would have been 2,980, whereas, they were actually 2,630 ; thus 350 persons, who would have died under the old conditions, were, as a matter of fact, still living at the close of 1890.* Add to these saved lives the avoidance of at least four times as many attacks of non-fatal illness, and we have the total profits as yet received from past expenditure for sanitary improvements. *Dr. Farr bas estimated that £150 i» the mean net value of each member of the male population estimated by the standard of the agricultural labourer. 44 The death-rate from typhoid fever is usually regarded as one of the most sensitive tests of the sanitary condition of a District, and the facts revealed by the above returns in connection with this disease are still more remarkable. In the ten years preceding the sewage scheme, the death-rate from this disease was 295 per million living, while during the succeeding 10 years it was only 104 per million, a reduction of no less than 65 per cent. It needs no further comment to show that the money, spent in the past, upon the sewage scheme, and upon improving the water supply and healthiness of houses, has already resulted in some profit. In other parts of the District, except at Purley in Coulsdon, and at Badger's Hole in Addington, where there are sewers iu connection with those of the Borough of Croydon, cesspools are the means generally adopted for disposing of rewage. The position of Kenley in this respect is well worth the earliest consideration of the Council as a part of the District which requires better means of sewage disposal than by cesspools. It is also to be hoped that bye-laws relating to the construction, position, ventilation, and cleansing of cesspools, will soon be in force throughout the District. At the same time, the character of Kenley is such that systematic collection of house-refuse should be carried out, as is done at Purley and all the parishes (except Morden) which are included in the sewage scheme. It is desirable, too, that such collection, wherever made, should be made weekly, instead of fortnightly, as at present. VII.—NEW STREETS AND BUILDINGS. The Surveyor, Mr. W. Forder, has furnished the following return of new streets and buildings constructed during 1894 :— New Buildings. Plans of New Buildings submitted to the Authority 125 Of which were approved 79 Of which were disapproved 46 Amended, re-submitted, and approved 20 Plans for Additions to New Houses submitted 20 Of which were approved 9 Of which were disapproved 11 45 Plans of Iron Buildings submitted 6 Of which were approved or licensed 4 Plans for Drainage only, submitted 17 Of which were approved 11 New Streets. Plans for New Streets and Sewers submitted and approved 10 Streets made un, metalled, and kerbed under Sections 150, 151, and 152, of the Public Health Act 8 Of which have been declared Highways 8 The Bye-laws, dealing with streets and buildings, and all other matters, are still undergoing revision, and it is to be hoped that early in the year there will exist a complete set of modern Bye-laws, applicable to the whole of the District, instead of part only as at present. VIII.—RIVER POLLUTION. The condition of that portion of the river Wandle which traverses the District, and that of its various tributa. ies, has received careful attention during the year, and they have been under close observation from time to time. Complaint was made early in the year that sewage was, by some means, finding its way into the river at Beddington, from the adjoining Corporation Sewage Farm. Examination revealed that when a certain plot was being irrigated, an increased volume of water found its way into a neighbouring surface-water drain, which finally discharged into the river. An analysis of this water showed that it consisted, largely, of very imperfectly purified sewage. Since the pollution was discovered, care has, I believe, been taken not to irrigate the land near the drain in question, and it is understood that permanent alterations are about to be made, to prevent any danger of pollution in future. The pollution from the chemical factory, at Lonesome, in Mitcham, referred to on page 35 of the last annual report, has been under observation several times, and the proprietors, after great delay, have constructed filtering apparatus to prevent the 46 pollution of the watercourse by the chemical effluents. However, there is every reason to fear that it has not answered expectations, and that additional precautions will be necessary. An uncommon pollution in connection with another chemical factory came to light during the year. A pond near this factory was noticed to be distinctly tinged with a yellow colour, and water pumped from an adjoining gravel-pit was also bright yellow. Inspection of the factory showed that, although a connection with a sewer was in existence, the " washings of nitronaphthalene" had been allowed to discharge into an unused ditch, and that the colouring matter had finally reached the subsoil water. There was no evidence to show that this pollution was injurious to cattle or poultry, and, although stopped at once at its source, the colouring matter is still occasionally pumped out with the subsoil water. The pollution of the "Pyl Brook," a tributary of the Beverley Brook, at Raynes Park, was also under consideration during the year. Until recently, when sewage works were constructed, the whole of the Sutton sewage was discharged into this brook ; and even now an appreciable portion of it still discharges into it. A special report was laid before the Sanitary Authority, detailing this source of pollution as well as other less important ones. The pollution from Sutton still remains, but after a conference between the members of the Sutton Local Board, the Sanitary Authority, and Dr. Seaton, it was arranged that, if the pollution had not disappeared by April, steps would be taken to divert the contents of the brook at the Sutton Sewage Works, and purify them there. Complaints have occasionally been received of pollution of the river between Beddington Corner and Mitcham, by manufacturing effluents, and even, as alleged, by sewage matter from the Croydon Farm, at Beddington. This portion of the river is under frequent observation, and it may safely be said that its condition is not very bad, nor so bad 47 as it was ; the existence, however, of a Fishing Association here renders any slight pollution an important consideration. In connection with this subject, the occurrence of "flooding" from overflow of streams last November may be recorded here. The most serious flooding occurred at Beddington Corner, and at Merton Abbey. Flooding was almost universal at that time of the year, but much might be done in this District, by strengthening the banks of streams in various places, and enlarging communicating culverts, to prevent future occurrences of this sort. IX.—ROUTINE SANITARY WORK, HOUSE INSPECTION, &c. A great deal of work has been done during the year to improve the sanitary condition of premises by the Inspectors of Nuisances, under the supervision of, and in conjunction with, the Medical Officer of Health. This work employs the whole time of two Inspectors, one giving his attention to the parishes of Mitcham, Merton, and Morden, with a population of nearly 16,000, and the ot her to the parishes of Addingtori, Sanderstead, Coulsdon, Woodmansterne, Wallington, and Beddington, with a population of over 12,000, scattered over a very wide area. Early in the year, the Inspector of the latter portion of the District resigned his appointment, and Mr. W. Powell, who came from Southampton with excellent credentials, was appointed in his stead. He has, up to the present time, given satisfaction, and has done valuable work, already, in bringing to light many conditions inimical to the health of the District, and both he and Mr. White, the Inspector of the other portion of the District, and an officer of long standing, have assiduously performed all the various duties which have devolved upon them. In the course of the year, the Sanitary Authority resolved that they should be provided with uniforms. 48 The supervision of the Inspectors' work, by the Medical Officer of Health, referred to in the last annual report, has been continued, including the regular examination of books and registers. The following is a summary of the work which has been done under the Health Department during the year Mr. White's District Mr. Powell's Distriot Total Number of complaints received and attended to 76 88 164 Number of Premises inspected 1817 832 2049 Total number of Visits paid 2093 2295 1388 Nuisances discovered 312 289 601 „ abated without report 247 203 450 „ „ after report 46 42 87 " Preliminary " notices served 312 181 493 Legal notices served 81 35 116 Notices followed by legal proceedings 1 1 2 Chabacter of Work done— Houses cleansed and repaired generally 70 27 97 Houses ventilated 1 2 8 Overcrowding abated 6 8 13 Defective roofs repaired 28 15 43 Houses under-pinned (damp-proof course inserted) 0 3 8 Eaves-gutters renewed or repaired 19 14 33 Water-closets renewed or repaired 83 33 116 Indoor soil-pipes abolished, and new ones provided outside and ventilatd 3 3 6 " D " traps abolished 11 16 27 Water closets provided with water for flushing, and disconnected from domestic supply 40 27 67 Privies or earth-closets converted into water-closets 0 7 7 Privies reconstructed with small movable receptacles, or converted into earth-closets 0 8 8 New receptacles provided for earth-closets or privies 0 6 6 Bath, lavatory, and Bink waste-pipes disconnected from drain, and caused to discharge over gullytraps 20 5 25 Houses supplied with water from a water-main 21 4 25 Water-tanks or cisterns cleansed or oovered 28 13 41 Yards of houses paved with impervious material 30 9 39 Paving of yards repaiied 10 9 19 Ashpits or dustbins provided 36 17 S3 ,, „ cleansed aud covered 17 15 32 Cesspools abolished and filled up 1 2 3 49  Mr. White's District. Mr. Powell's District. Total New cesspools provided 2 — 2 Drains tested with smoke teat 28 8 36 ,, ,, ,, and found defective 25 7 32 Drains tested with water-tesb 4 13 17 ,, „ ,, and found defective 4 10 14 Houses at which drains were reconstructed or new provided 33 13 46 Houses at which drains were cleansed, ventilated, trapped, or repaired 105 77 182 Drains cut off from discharging into water-courses 2 — 2 Stables provided with drainage 1 3 4 Premises from which animals improperly kept were removed i 5 4 9 Seizures of unwholesome food 2 1 3 Convictions for selling 1 — 1 Urinals cleansed or repaired 2 1 3 ,, supplied with water for flushing 4 — 4 ,, reconstructed 7 — 7 Smoke nuisances abated 1 1 2 Offensive accumulations removed 15 11 16 Paving of piggeries repaired 3 1 4 Drainage ,, ,, 2 1 3 Infected houses fumigated and cleansed 96 15 111 Besides the above, and resulting from house-to-house inspections made by the Medical Officer of Health with the Inspectors of Nuisances, ten houses were certified to be unfit for human habitation under the Housing of the Working Classes Act, 1890. A cottage in Woodmansterne was,in consequence, thoroughly repaired, four dwellings in Sanderstead are being replaced by new buildings, and as soon as the latter are completed, the former will be demolished; two dwellings in Beddington were closed voluntarily by the owner; and as to three dwellings in Addington, the necessary notices in regard to them had not expired when the year closed. There were also three houses at Purley dealt with under the Public Health Act, which were closed by the owner, and have since been demolished. Application was made for " closing orders " in regard to the three houses in Mitcham (Piccadilly), referred to in the last 50 annual report, and were granted on the evidence of the County Medical Officer and myself. Subsequently, in consequence of the air-space near these houses being considerably increased, the Sanitary Authority did not oppose the determination of the closing orders in regard to two of the houses. The long-standing nuisance caused by encampments of gipsies at Beddington Corner, Wallington, close to a considerable population, was, it is hoped, finally abated during the year. Notices were served on a great many individual gipsies, and followed in a number of instances by magisterial proceedings. Convictions were always obtained, accompanied by strong remarks from the Bench, and finally, with the assistance of the police, the ground was forcibly cleared; for a time it was necessary to make special arrangements for watching the ground, but no attempt has been made for several months by the gipsies to regain possession of this land. Other gipsy encampments have also required to be dealt with elsewhere, mainly in Merton and Mitcham. X.—REGULATED TRADES AND BUSINESSES, (a) Dairies, Cowsheds, &c. There are 57 premises registered under the Dairies, Cowsheds, and Milk-shops Order of 1885, five having been newly registered during 1894. They are distributed as follows :— Addington 2 Morden 2 Beddington 3 Sanderstead 4 Coulsdon 15 Wallington 8 Merton 10 Wood manst erne 1 Mitcham 12 Total 57 The following are the particulars of inspections of these premises during the year:— Total number of visits paid to cowsheds, &c 317 Premises at which improvements in lighting, ventilation, drainage, paving, means of oleansing, or water-supply were effected 13 Premises found unclean 20 Cases where notices for cleansing were necessary 4 51 Every cowshed in the District has also been accurately measured, to enable overcrowding to be checked. Eight hundred cubic feet is the space allowed for each cow by the regulations in force. (b) Slaughter-houses. There are 20 premises, in which the slaughtering of animals for the food of man is carried on, of which 16 are regulated by the Bye-laws of the Council. Seven are registered, and 9 are licensed, two new licenses, each for one year, having been granted in the year 1894. The following are the particulars of the inspections of these premises made during the year :— Number of vitits paid 136 „ meat inspections 51 Premises at wbich improvements in lighting, ventilation, drainage, paving, water-supply, or means of cleansing have been effected 9 Premises found unclean 10 Verbal notices for cleansing complied with 10 The amended Bye-laws for slaughter-houses, and the proposal to extend them to all slaughter houses, are still under consideration. A public slaughter-house for Mitcham and Merton is greatly needed, and would be of great benefit. (c) Bakehouses. There are 24 bakehouses, to which 68 visits have been paid. Four of these premises are underground. In two cases, improvements in lighting and ventilation have been effected during the year, four premises were found unclean, two notices for cleansing being necessary. (d) Offensive Trades. There is one slaughter-house used for the slaughtering of horses, and other animals not intended for the food of man ; and in conjunction with this business, the offensive trade of "boiling" is carried on. These premises were first licensed many years ago, 52 and at the close of 1893 the proprietors had given an undertaking not to carry on any "boiling" process until the permission of the Authority had been given. Apparatus was constructed with a view to minimising the nuisance arising from this process, and, after consideration, the necessary permission was given. The apparatus resembles other apparatus of a similar nature, in that it is not altogether successful, and occasionally nuisance has been caused. The District Council is now empowered to grant or refuse the license for the future use of these premises upon the expiration of the present license. At the commencement of the year there were two "gutfactories," but, happily, one has disappeared, mainly in consequence of the successful prosecution instituted in the previous year. The remaining one is situated in the midst of a considerable population, and is occasionally productive of very serious nuisance. It has received frequent attention, and has been the subject of more than one report. Besides these premises, there is a large number of "piggeries," which, especially when "boiling" of refuse food is carried on as well, are the source of considerable offence. In the case of a large newly-established piggery in Morden, great complaint was made, but the nuisance has almost disappeared with the adoption of apparatus for destroying by fire the offensive fumes given off from the boiling tanks. These piggeries ought to receive more constant supervision than they now can, and it would also be very useful if a series of Bye-laws for their regulation could be devised. (e) Factories and Workshops. All the known factories and workshops have been inspected by Mr. Butterworth, who was engaged to take the place of the Inspectors during their absence on annual leave, and remained for some weeks for this work, and to assist in house inspection. It appears that there are over 50 premises of this nature, for the supervision of which, in regard to certain sanitary matters, the Council is responsible. 53 This work has not been done in the past, and it will be obvious that it cannot properly be done in the future, unless there is an addition to the staff of Inspectors. The hands of the present Inspectors are full with the work at present thrown upon them, and if this additional duty also devolves upon them, their usefulness in other respects must necessarily be greatly diminished. The Legislature, however, has cast these duties upon the Council, and if they are to be properly performed, an additional Inspector should be appointed. Such an additional officer would, besides the work in connection with the Factory Acts, be able to exercise more constant supervision over the offensive businesses already alluded to, as well as slaughter-houses and other regulated trades ; could assist the Medical Officer of Health with the houseto-house inspection of the District, and, probably, also relieve the present Inspectors of their disinfecting work, which frequently and most inconveniently intei feres with their routine duties. I am, Your obedient servant, L. W. DARRA MAIR, M.D. (Lond.), D.P.H. (Lond.), &c., &3. LOCAL GOVERNMENT BOARD TABLES. A. TABLE OF DEATHS during the Year 1894, in the Croydon Rural District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined ages. Mortality prom subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards. Smallpox. Scarlatina. Diphtheria Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Eheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid Continued. Relapsing. Puer. peral. (a) (b) (c) (d) (e) (f) (g) (h) (i) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. ADDINGTON 5 1 — 3 — — 1 Under 5 1 1 5 upwds. 1 1 2 4 BEDDINGTON 15 2 2 — 1 5 5 Under 5 1 3 4 5 upwds. 1 1 9 11 COULSDON 29 4 2 2 1 12 8 Under 5 1 1 1 3 6 5 upwds. 1 1 6 2 5 8 23 MERTON 37 9 3 4 — 13 8 Under 5 1 2 1 8 12 5 upwds. 3 1 2 3 1 2 3 10 25 MITCHAM 130 46 16 11 7 29 21 Under5 1 5 1 1 5 i i3 2 33 62 5 1 1 1 13 5 13 2 26 68 MORDEN 5 2 1 1 - 1 — Under5 1 1 1 3 5 upwds. 1 1 2 SANDERSTEAD 5 3 — — — 1 1 Under 5 3 3 5 upwds. 1 1 2 WALLINGTON 31 2 2 2 1 8 16 Under 5 1 3 4 5 upwds. 1 1 4 3 6 12 27 WOODMANSTERNE 5 1 1 — — — 3 Under 5 1 1 2 5 upwds. 1 2 3 RUSSELL HILL SCHOOL, BEDDINGTON 2 — — 2 — - — Under 5 5 upwds. 2 2 BEDDINGTON ORPHANAGE Under 5 5 upwds. REEDHAM ORPHANAGE, COULSDON 2 — — 2 — — — Under 5 5 upwds. 1 1 2 CANE HILL ASYLUM, COULSDON 185 — — 1 11 132 41 Under 5 5 upwds. 1 1 35 26 12 112 185 HOLBORN WORKHOUSE, MITCHAM 69 — — — — 26 43 Under 5 5 upwds. 9 24 13 1 22 69 HOLBORN SCHOOLS, MITCHAM 5 — 4 1 — — - Under 5 3 1 4 5 upwds. 1 1 Gross Totals 525 70 31 29 21 227 147 Under 5 l 5 1 5 8 1 19 1 3 57 101 5 upwds. l 8 1 2 2 1 1 2 4 68 70 59 11 194 424 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the District among persons belonging thereto, and which must be added to above 33 1 4 7 3 10 8 Under 5 l 3 1 e Supwds 2 4 5 3 3 2 9 28 Deaths oocurring within the District among persons not belonging thereto, and which must be deducted from above 259 4 2 11 158 84 Under 5 3 1 4 5 upwds. 1 1 44 50 35 1 123 255 CORRECTED TOTALS 299 71 31 34 13 79 71 Under 5 2 8 1 2 8 1 19 1 3 57 102 5 upwds. 3 12 1 2 2 1 1 4 29 23 27 12 80 197 B, TABLE OF POPULATION, BIRTHS, and OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1894, in the Croydon Rural District, classified according to Diseases, Ages, and Localities. NAMES OF LOCALITIES, adopted for the purpose of these statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. New Cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number op such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospitals. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Diarrhoea. Small-pox. Scarlatina. Diphtheria. Census 1891. Estimated to middle of 1894. Typhus. Enteric or Typhoid Continued. Relapsing. Puerperal 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 12. 13. 1. 2. 3. ADDINGTON 670 670 20 Under 5 5 upwds. 1 BEDDINGTON 2607 2807 53 Under 5 2 3 5 upwds. 6 1 11 2 COULSDON 3335 3568 87 Under 5 2 8 5 upwds. 1 2 4 4 11 MERTON 3360 3517 82 Under 5 3 1 6 5 upwds. 7 6 2 5 3 MITCHAM 10758 11521 365 Under 5 7 17 1 19 1 2 3 5 upwds. 34 32 1 2 3 5 8 4 16 6 MORDEN 763 852 19 Under 5 4 1 5 upwds. 2 2 SANDERSTEAD 509 547 14 Under 5 5 upwds. 5 WALLINGTON 3823 4280 75 Under 5 3 109 5 upwds. 6 2 4 1 1 227 WOODMANSTERNE 408 438 17 Under 5 5 upwds. RUSSELL HILL SCHOOL, BEDDINGTON — — — Under 5 5 upwds. 1 BEDDINGTON ORPHANAGE — — — Under 5 5 upwds. 1 REEDHAM ORPHANAGE, COULSDON — — — 5 upwds. 1 OANE HILL ASYLUM, COULSDON 1115 2016 — Under 5 5 upwds 2 HOLBORN WORKHOUSE, MITiJHAM 892 872 — Under 5 1 5 upwds 1 HOLBORN SCHOOLS, MITCHAM 477 447 — Under 5 2 26 2 5 upwds 10 30 10 GARFIELD HOME, MERTON — — — Under 5 5 upwds. 7 6 Totals 28717 31535 732 Under 5 21 19 1 166 1 5 3 5 upwds. 2 78 44 1 12 6 17 292 4 1 40 6 (Excluding Imtitutiom) 26233 28200 Notification of Infectious Disease has been compulsory in the District since 1890. The Workhouse Infirmary at Croydon, is used for the isolation of pauper patients only. Every Institution, except) the last, possesses isolation accommodation of its own. Diarrhoea was a notifiable disease during September.