CRO 4 HEALTH REPORT for 1896 of the Croydon Rural Distrirt by the MEDICAL OFFICER OF HEALTH. Submitted to the Public Health Committee January 21st, 1897. Croydon: Printed at the "Guardian" Office, North End. HEALTH REPORT for 1896 of the Croydon Rural District by the MEDICAL OFFICER OF HEALTH. Submitted to the Public Health Committee January 21st, 1897. Croydon: Printed at the "Guardian" Office, North End. HEALTH REPORT of the Croydon Rural District 1896. To the Members of the Croydon Rural District Council. I have the honour to present to you the Annual Health Report and Statistical Tables for the year 1896, in accordance with the Orders of the Local Government Board. Apart from the accounts of the health of the District, as shown by the mortality and prevalence of infectious disease, the most important question referred to is, perhaps, the drainage of Kenley, which, owing to the magnitude of the public interests involved, and the fear that the water supplies of a large population are in danger, requires careful consideration. I have the honour to remain, Your obedient servant, L. W. DARRA MAIR, M.D. (Lond.), D.P.H., Medical Officer of Health. January, 1897, REPORT. 1.—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 2,484 in 1891. 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; in 1896 the number was 5,431, as compared with 5,257 in the previous year. The average number of persons living in each house in the District in 1891 was 5.4 ; the highest average existed in Ooulsdon, 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 1.29 acres throughout England and Wales. The densest Parishes were Wallington and Mitcham, and the least dense was Sanderstead. 6 Estimated Population in 1896. Calculated in the usual manner from returns of inhabited houses, and by the increase ascertained to have taken place during the last inter-censal period, it may be estimated that at the middle of 1896, the population of the District, exclusive of the three institutions named, numbered 29,350, of which 13,960 were males and 15,390 females. Table 1 in the appendix shows the estimated population of each parish as accurately as possible, seeing that it is now five years since the census was taken. The populations of the parishes of Beddington, Coulsdon, Morden, Sanderstead, and Woodmansterne seem to have increased more rapidly since 1891 than between 1881 and 1891; that of Wallington has increased at the same rate, but those of the remaining parishes have not done so. Natural Increase. The natural increase of the population, by the excess of births over deaths, has been since the census 2,462, and during the year 1896 was 379, as compared with 417 in the previous year. II.—BIRTHS AND DEATHS. Births. The births registered in the District in 1896, numbered 765, of which 399 were of males and 366 were of females. The births of 16 children, 8 of either sex, were registered as illegitimate. The birth rate for the year was 26.1 per 1,000 persons living. The proportion of illegitimate births was 2.1 per cent. of the total births, being identical with the proportion of the previous year. The birth-rate is a very low one, and is the smallest recorded in this District, with the exception of that of 1894. It is 2.8 per 1,000 less than the average annual birth-rate during the preceding ten years. 7 The birth-rate for England and Wales during 1896, was 29.7 per 1,000, as compared with an average of 310 per 1,000 during the preceding ten years. The distribution of the births of 1896 in the District is shown in the following table, from which it appears that in the individual parishes the birth-rate per 1,000 varied from 19.1 in Ooulsdon and 20.9 in Beddington to 30 7 in Mitcham and 41.2 in Woodmansterne:— Births in 1896. Parish. Registered Births. Birth-rate per 1000 of population. Males. Females. Total. Addington 4 15 19 28.4 Beddington 32 31 63 20.9 Coulsdon 43 31 74 19.1 Merton 41 49 90 24.6 Mitcham 195 167 362 30.7 Morden 13 9 22 24.2 Sanderstead 7 9 16 24.2 Wallington 57 42 99 23.0 Woodmansterne 7 13 20 41.2 Deaths. The deaths registered in the District during the year 1896, numbered 557, of which 209 occurred in the three institutions already mentioned, and, as they were of persons not belonging to the District, that number must be deducted. Thirty.eight deaths, 25 of males and 13 of females, must however be added, this number representing the persons belonging to the District who died outside its boundaries, either in Croydon institutions, Kingston Workhouse, or at the Brookwood County Asylum. The corrected number of deaths, therefore, to be accounted to the District in 1896, is 386, of which 203 were of males, and 183 those of females. This mortality corresponds to a death-rate of 13T5 per 1,000 persons living. The death-rate among males was 14.6, and that among females was 11.9, per 1,000 living of the corresponding sexes. 8 The average annual death-rate during the preceding ten years was 12.3 per 1,000 living. The previous highest rate occurred in 1893, when it was 14.5 per 1,000, and the lowest in 1894, when it was 10.6. The death-rate for England and Wales in 1896 was 17T per 1,000, as compared with an average of 18.8 per 1,000 during the ten preceding years. The distribution of the deaths of 1896 in the District is shown in the following table, from which it appears that in the individual parishes the death-rate per 1,000 varied from 5.5 in Morden, and 6.6 in Beddington, to 16'7 in Sanderstead, and 17.9 in Mitcham. *Mortality in 1896. Parish. Deaths. Death-rate per 1000 of population. Males. Females Total. Addington 5 S 8 11.9 Beddington 10 10 20 6.6 Coulsdon 18 20 38 9.8 Merton 20 19 39 10.7 Mitcham 116 95 211 17.9 Morden 3 2 5 5.5 Sanderstead 8 3 11 16.7 Wallington 15 31 46 10.7 Woodmansterne 8 0 8 16.5 The death-rate of the District in each of the four quarters of 1896, ending March 31st, June 30th, September 30th, and December 31st, is shown in the following table. Deaths. Death-rate. 1st quarter 87 11.8 2nd „ 75 10.2 3rd „ 113 15.4 4th „ 111 15.1 The year 386 13.2 "Exclusive of the deaths of non.residents occuring in public institutions in the District, but inclusive of the deaths of residents occurring in public institutions outside the District. 9 Mortality at Different Ages. Infantile Mortality.—The number of infants under one year of age who died in 1896 was 105, as compared with 87 in 1895. The infantile death-rate, which is stated as the proportion of deaths of infants under one year to registered births, was 137 in a thousand, which compares with 113 in 1895, and an average of 109 during the ten preceding years. The infantile death-rate for England and Wales in 1896 was 148 per 1,000 births, as compared with an average of the the same number during the ten preceding years. In the individual parishes the infantile death-rate varied from nil in Addington, 45 in Morden, and 71 in Wallington, to 150 in Woodmansterne, 176 in Mitcham, and 187 in Sanderstead. The comparatively higher mortality among infants in 1896, as compared with that of 1895, was due to an increase in the number of deaths from whooping cough, and dietic and respiratory diseases. The latter increase was probably one of the effects of the measles epidemic, and it was confined to Mitcham, where that disease was the most virulent. Children under 5 years.—The deaths of children under 5 years numbered 160, or 41 per cent, of the deaths at all ages. In proportion to the estimated population under this age in the District in 1896, this number represents a death-rate of 49.1 per 1,000. The corresponding rate in 1895 was 37.0 per 1,000, and the average for the five years 1891 to 1895 was 40.2 per 1,000. The higher mortality of 1896 at these ages was due to an increase in the number of deaths from measles, whooping cough, and respiratory diseases. The deaths of persons between 5 and 15 years numbered 18, or 4.6 per cent. of the total deaths, and represented a death-rate of 2.2 per 1,000 of the population living at those ages, as com" 10 pared with 1.9 per 1,000 in the previous year, and an average of 3.0 per 1,000 during the preceding five years. The deaths of persons between 15 and 25 years numbered 21, representing a death-rate of 3 9 per 1,000 living at those ages, as compared with 2 3 in 1895, and an average of the same number during the preceding five years. The increased mortality at these ages in 1896 was due to a larger number of deaths from pulmonary consumption. The deaths of persons of 25 years of age and upwards numbered 187, representing a death-rate of 14.7 per 1,000 living at those ages, as compared with 16.8 in 1895, and an average of 15.4 per 1,000 during the preceding five years. III.—CAUSES OF DEATH. Zymotic Diseases.—The deaths registered in 1896 included— 18 deaths attributed to Measles 18 „ ,, Diarrhoea 13 „ „ Whooping Cough 5 „ „ Diphtheria 5 „ „ " Fever" Thus 59 deaths were ascribed to these diseases, which with scarlet fever and small pox, constitute the "seven principal zymotic diseases." The number of deaths is in the proportion of 2.01 per 1,000 living, such being the zymotic death-rate, as compared with 1T6 in 1895, and an annual average during the preceding 10 years of 168 per 1,000. The corresponding rate in England and Wales was 2.18 per 1,000, as compared with an annual average during the preceding 10 years of 2.15 per 1,000. Deaths from one or other of the above diseases occurred in every parish except Addington and Morden, and 45 of them occurred at Mitcham, which number corresponds to a zymotic 11 death-rate for that parish of 3.81 per 1,000 living. Of these deaths in Mitcham 17 were due to measles, 14 to diarrhoea, and 7 to whooping cough. The mortality in the whole District from scarlet fever was nil, and that from diphtheria was much lower than the average, but that from measles, whooping cough, " fever," and diarrhoea was higher than the average. Constitutional Diseases.—Sixty-seven deaths were due to constitutional diseases, as compared with 61 in 1895, being in the proportion of 22 per 1,000 living. Tubercular diseases are included in this class. Pulmonary tuberculosis or phthisis accounted for 27 deaths, as compared with 19 in 1895. and 30 in 1894. The death-rate from this disease was -92 per 1,000, as compared with an average annual rate of 1 6 per 1,000 for England and Wales. Of the remaining diseases in this class as many as 17 were ascribed to cancer or malignant disease, as compared with the same number in 1895, and 6 in 1894. Four deaths were due to rheumatic fever. Local Diseases.—More than half the total deaths were due to "local" diseases, the actual number being 171 as compared with 179 in 1895. This number represents a death-rate of 5.8 per 1,000 as compared with 6.3 in 1895. The deaths in this class included 7 ascribed to enteritis or gastro-enteritis, of which 3 were of infants under 1 year of age, and 1 ascribed to " laryngitis " in which tracheotomy had been performed. Violent Deaths.—Deaths due to violence numbered 17, corresponding to a death-rate of '57 per 1,000, as compared with •60 per 1,000 for England and Wales. Sixteen of these deaths were due to accident or negligence, and 1 to suicide. Inquests and Uncertified Deaths.—The deaths of 1896, apart from those which occurred in institutions, included 33 which were the subjects of coroners' inquests, which number is 8.5 per 12 Cent. of the total deaths, as compared with 6.2 per cent. in England and Wales, and of these deaths, 15 were ascribed to natural causes, 17 to accident or negligence, and 1 to suicide. Besides these, however, there were 10 uncertified deaths, that is deaths, the causes of which were not certified either by a medical man or by a coroner after inquest. The following is a list of these deaths:— Uncertified deaths, 1896. Parish. Sex. Age. Alleged Cause of Death. Mitcham F. 87 Senile decay Mitcham F. 86 Senile decay. Syncope Morden M. 87 Failure of heart's action Beddington F. 55 Heart disease Merton F. 61 Heart disease Mitcham F. 2 Convulsions Woodmansterne M. 31 Hæmoptysis Beddington F. 9 mos. Malnutrition Wallington F. 72 Senile decay Merton F. 3 mos. Diarrhoea IV.—DEATHS IN PUBLIC INSTITUTIONS. The deaths in the three institutions already mentioned numbered 209 in 1896. of which 115 were of males, and 94 of females, as compared with 208 in the previous year. At Cane Hill Asylum, Coulsdon, one of the Metropolitan County Asylums for the Insane, 160 deaths occurred, as compared with 169 in 1895. The average daily number resident, in 1896, was 2,110. Ten deaths were ascribed to pulmonary consumption, 16 to other pulmonary diseases, and 1 to influenza. Three deaths were the subjects of coroners' inquests, the cause of death being ascribed to natural causes in two cases, and accidental in the other. At the Holborn Union Workhouse, in Mitcham, 40 deaths occurred, the average daily number resident having been 700. Five deaths were due to pulmonary consumption, 1 to diarrhoea, and 1 to rheumatic fever. 13 Nine deaths occurred at the Industrial Schools of the Holborn Union, also in Mitcham, 6 of which were due to measles. The average number daily resident was 480. V.—INFECTIOUS DISEASE. The Infectious Disease (Notification) Act has been in force in the District since the early part of 1890; in July, 1890, measles was added to the list of notifiable diseases, and in 1894 diarrhœa was also made notifiable for a few weeks. Tables C and D in the Appendix show the number of infectious cases notified in the District since the adoption of the Notification Act, and the cases notified in each parish during 1896. From these tables it will be seen that, with the exception of measles, the District was again uncommonly free from infectious disease. Excluding measles, 160 cases of infectious illness were notified to the Medical Officer of Health, of which 33 were cases of erysipelas; and this number is the lowest recorded in any year since the adoption of notification, except in the previous year, when the number was 115. Measles, however, was epidemic in a considerable portion of the District, and 850 cases were notified by medical men, and 102 by householders, besides which 131 cases were ascertained by the enquiries of the Health Department to have occurred, making a total of 1,083 known cases of this disease, of which 41 were in a public institution. This District is one of the few which require compulsory notification of this disease, and its value, although very great in leading to a knowledge of its local characteristics and behaviour, is yet much lessened by not being carried out in the surrounding districts. The disease was introduced at the beginning of the year from Wimbledon, where it is not notifiable, and where it became epidemic without the full knowledge either of the local authority, or of this adjoining District, so that no steps 14 were possible to prevent the attendance of infected children at schools in this District. At Beddington, also, it is more than probable that it was first introduced from Croydon, from similar causes. When the disease was introduced into Merton and Mitcham, it rapidly obtained an extensive hold, for both these Parishes were well prepared for invasion, because there had been no prevalence of measles in Mitcham since 1892, or in Merton since 1889. The same remarks apply to Beddington and Coulsdon, where the disease was also prevalent, for in both these Parishes there has been scarcely any occurrence of it since 1892. The more detailed history of the occurrence of infectious disease during 1896, is as follows :— Small-pox.—No case of small-pox was reported during the year 1896. Scarlatina.—This disease was but slightly prevalent during 1896. No more than 65 were notified, as compared with an annual average of 130 during the previous 6 years, that is to say, the period during which notification has been carried out in the District. Thirty cases occurred in three institutions, and the remaining 35 in 26 private houses. The disease first appeared at the Holborn Schools, Mitcham, where in the first 3 months of the year 6 cases occurred, as a sequel to 2 cases which occurred there in the last month of the previous year. During the first quarter 8 cases occurred in private houses, 3 of which were in Wallington, 2 at Beddington Corner, 2 in Mitcham, and 1 at Purley. In April and May there were 2 cases in one house at Beddington Corner, and 1 at Raynes Park. In June the disease appeared in Coulsdon, 5 cases occurring early in the month at Cane Hill Asylum, followed by 3 cases in a house at Smithambottom,* tenanted by one of the Asylum attendants. Another case, contracted in Croydon, was reported *This house is technically in Woodmansterne parish. 15 from Kenley, while in Mitcham a person was attacked 3 days after arrival from Hastings. A further case occurred in Kenley in the following month, in an adult who 4 days prior to his attack arrived from the Continent. In August another case was reported from Mitcham, and in September 3 cases occurred in an isolated house on Mitcham Common. In the latter month another case was reported from the house at Smithambottom occupied by an Asylum attendant, which looked suspiciously like a "return" case, two members of the same family having arrived home after discharge from Hospital 14 days previous to the date of the attack, but the period which elapsed rather pointed to the possible existence of other causation of this last case. In October an outbreak of scarlet fever commenced at the Female Orphan Asylum, in Beddington, but it did not assume large proportions, 19 children being attacked in this and the succeeding months. This epidemic occurred in association with a more wide-spread prevalence of sore throat, which is referred to more fully later on. There was also a case at the Holborn Schools. Two private houses were invaded with scarlet fever in October, 1 in Beddington and 1 in Merton, where the disease was contracted at a school in the neighbouring District of Wimbledon. In November 4 cases occurred at 3 private houses, 1 of which was in Mitcham, where a patient was discovered by the medical attendant to be peeling, with a history of commencement of the attack in London a month previous. Another case occurred at Kenley, and 2 in a house in Merton, where the disease was again contracted in Wimbledon. During the last month of the year 2 cases were reported in a house at Collierswood, Mitcham, where the disease was possibly contracted at a school in Tooting, 2 others in two houses in Lower Mitcham, where an evening entertainment was probably responsible for the infection, and 2 cases in two houses in Merton, one of which was in the house infected in November, the patient being the mother who had been nursing the others. 16 Table E in the appendix, prepared for purposes of reference, shows the occurrence of scarlet fever in each parish for each year of the notification period Diphtheria and Membranous Group.—This malady was somewhat more prevalent, and also more wide-spread, than in 1895, and showed itself, more or less, in 6 of the nine parishes in the District. It was, however, less virulent in character; of 46 cases which were reported 6 proved fatal. The annual average number of cases reported during the 6 years of the notification period, was 31. The disease first appeared in January in a house in Merton and one in Mitcham, the latter being within the Singlegate District, so often alluded to in previous reports. In February cases occurred in Wallington, Beddington, and Mitcham, and in March a case occurred in Kenley, and 1 at the Holborn Schools in Mitcham, the latter being followed by another case in April. During this month solitary cases also occurred at Kenley and Smithambottom, and 3 cases, including 1 of membranous croup which ended fatally in 30 hours, occurred in separate houses in Mitcham. In May 9 cases occurred, of which 5 were in 5 houses in Mitcham, 3 in 2 houses in Merton, and 1 in Morden. No connection was traced among these cases, except perhaps as regards 3, where the patients attended the Singlegate School, in Mitcham. Several of the cases reported during this month were exceedingly mild, but their true nature was established bacteriologically. In June 2 further cases occurred in 1 of the houses in Mitcham infected in May, and a very mild and doubtful case occurred in Merton, but in July the District was free from the disease; while in August there was another case in Mitcham, which was clearly contracted from one of the cases reported in June, in whom the diphtheria bacillus persisted for a very long time. During September a case occurred at Hackbridge, in Wallington Parish, and in the same month a child at the Female Orphan Asylum, Beddington, was attacked with sore throat, 17 which bacteriological examination proved to be associated with the Klebs-LÖffler bacillus. This case was one of the first of an almost general prevalence of sore-throat, more or less mild in character, at this Institution. Six cases in October, and one in November were reported as diphtheria, but the infection, whether diphtheritic or otherwise, was more extensive than was indicated by the number of notifications. In a report on the outbreak I showed that it followed immediately upon the reassembling of the children after the summer holiday, and expressed the opinion that the disease was at that time imported, and spread rapidly by means of personal contagion, this being facilitated by arrangements which are probably common to many Institutions like this. Special allusion was made to the dormitories, where the children seem to be somewhat crowded as regards floor space, and in which much of the ventilating system was interfered with by various obstructions, and by the existence of fixed screens which can only interfere with the free circulation of air. Drainage defects were also found, but I attached no importance to them, as regards this outbreak, in view of its commencement and course. The disease was very mild throughout, and to this extent gave evidence of the healthy surroundings of the inmates of this Orphanage, The throats of nearly all the children were examined bacteriologically, with the result that in 4 the KlebsLÖffler bacillus was found to exist, while in 17 the pseudodiphtheria bacillus was found. By these examinations the real extent of the infection was ascertained, and controlling measures became comparatively easy. Diphtheria became more prevalent in the District itself in October, the first case reported being in Merton, where enquiries elicited that there had been a good deal of sore-throat in connection with one of the schools there. Special attention was directed to a child who had resumed attendance after an attack of sore-throat, and upon bacteriological examination being made, 18 the diphtheria bacillus was found to exist in her throat, and 3 other children in the same house having suffered from sore-throat, all were notified as cases of diphtheria. Another case occurred in Merton in a man who had been employed in cleansing a diphtheria ward at the Tooting Hospital of the Metropolitan Asylums Board. A case also occurred in Wallington at a house where children attended a school in Carshalton, in connection with which there was at the time some prevalence of the disease, and 2 cases were reported from the Holborn Schools, Mitcham, in 2 sisters who had been admitted from London eight days prior to the date of attack. During the last two months of the year two cases occurred in the neighbourhood of Beddington Corner, where again " sorethroats " were ascertained, by a house to house enquiry, to exist amongst a considerable proportion of the children attending the local school, and in one case at least the sore-throat had been followed by diphtheritic paralysis. This patient had nevertheless attended school until the paralysis demanded attention. Several children were excluded from school as a precautionary measure. It should be mentioned that drainage defects were also found to exist at the school. Table E in the appendix shows the history of diphtheria and membranous croup in each parish for each year of the notification period. Fever.—Fourteen cases of enteric or typhoid fever, and 2 of continued fever were reported during 1896, or a total of 16, as compared with an annual average of 15 during the previous 6 years of the notification period. The first case reported was in January in a house in Kenley, where a case had occurred in the last month of the previous year and was contracted in Wimbledon. A case of continued fever was reported at a house in Collierswood, Mitcham, in February, and 2 cases of enteric fever occurred in the same parish in March, 19 1 in a sailor who was a visitor in the District, and the other in the engine driver at the Sewage Works. A man in Sanderstead, employed in Croydon, was also attacked this month. The next case was reported from Wallington in April in a man who was employed in Norwood and came to his family's house on feeling ill, and a case was also reported at Mitcham, while in May a case occurred in Merton, the source of which was by no means apparent. After May, beyond a case which occurred in July at Wallington in a man employed daily in London, the disease was absent until September, when 4 cases were reported, 3 of which were in separate houses in Mitcham and 1 at Purley. The latter case was undoubtedly contracted in Switzerland, while probably 2 of the former also originated outside the District, the patients having arrived in the one instance 10 days and in the other 21 days prior to the date of attack. A case of continued fever was reported from Mitcham in October, and in December a case of enteric fever was notified from a house in the same parish, while another case was reported from Wallington in a man who 14 days previous to the commencement of his illness had been employed in emptying an old cesspool. Puerperal Fever.—No case of this disease was reported during the year. Erysipelas.—This disease was more prevalent than in the preceding year, 30 cases having been notified in 1896, half of which were in institutions, as compared with an annual average of 18 during the previous 6 years. There were 13 cases during the year at the Holborn Schools in Mitcham. Measles.—The prevalence of this disease has been one of the features of the year under review, and since this District is exceptional in requiring its compulsory notification, it is desirable that some space should be devoted to an account of it. 20 The disease showed itself in 6 Parishes, but assumed epidemic proportions in 3 only, viz., Merton, Mitcham, and to a less extent Beddington. In all, 1,042 cases of measles were ascertained to have occurred iD 552 houses, of which 809 were notified by medical attendants, 102 by householders, and 131 were discovered by other means. Besides these, 41 cases also occurred at an institution. In proportion to population, taking the figures of the last census of 1891, the Parish most affected was Merton, where the attack rate was 6.1 per cent. of the population, while in Mitcham it was 5.8 per cent., and in Beddington 4.8 per cent. As regards the other Parishes where cases occurred, the rate in Coulsdon was 1.6 per cent., or, exclusive of Kenley, where there were no cases, 2.5 per cent., and in Wallington and Morden only 0.8 and 0.7 per cent. respectively. A public institution, the Holborn Schools, in Mitcham, was also affected, and it was here that the disease first showed itself in the District. Thirty-seven cases occurred there in the course of the first 8 weeks of the year, and four others in April, June, and August. In Merton the disease made its first appearance in February, mainly in connection with the pupils of schools in the neighbouring District of Wimbledon, where, it appears, the malady was prevalent. Towards the end of February a considerable number of cases had been reported, but in the first week of March a great outburst suddenly occurred, and during the next fortnight the epidemic was maintained, after which it rapidly subsided, and finally disappeared at the beginning of June. One school was principally affected, and it was closed on March 5th for 4 weeks, the result being admirable. It was ascertained that 205 cases occurred in this parish in 98 houses, and there was not one death. It was feared that this epidemic would spread to the neighbouring Parish of Mitcham, and indeed, it appeared as if the school nearest to Merton had, at the end of March, 21 become involved, but the disease then subsided. A few cases, however, were reported in other parts of Mitcham as early as February, and the number of fresh cases increased gradually but very irregularly until the middle of May, when there was a distinct lull until the end of June. A considerable increase took place early in July, however, and in the second week the epidemic proper commenced, was at its height in the last week of that month, and gradually declined during August, after which it rapidly subsided, and soon came to an end. Practically all the Elementary Schools were involved in this epidemic, and they were all closed from July 16th to September 8th, and the Sunday Schools, with few exceptions, were closed a week later. During the year 626 cases were known to have occurred in this parish in 347 houses. The mortality from measles in Mitcham was very different from that in Merton, for 16 deaths occurred ; this number being in the proportion of 1.35 per 1,000 of the estimated population. The fatality of the disease, that is, the ratio of deaths to the number of known cases, was a little over l½ per cent. of all those attacked, but of those who were under 2 years of age at the date of attack nearly 83/4 per cent. died, and of those between 2 and 4 years of age over 3½ per cent. died. There was only one death among the 373 persons over 4 years of age who were attacked. During the first six months of the year there was only one death among 175 known cases, while there were 15 deaths amongst 451 cases in the latter half of the year, or 31/3 per cent.; and it may be stated generally, that as the epidemic subsided, the fatality increased, showing that the disease tended progressively towards a more malignant type. At the Holborn Schools the fatality was very high, for of the 37 cases which occurred there at the commencement of the year, 6, or 16 per cent., proved fatal. With one exception the ages of the latter were under 3 years. In Beddington measles first showed itself at the end of January, and was prevalent, scarcely, however, in epidemic 22 proportions, among those living at Bandon Hill during the first three months of the year, but had almost disappeared in April and the beginning of May. Towards the end of the latter month it began to increase again, but mainly amongst those connected with the Beddington Central School, and during June and July was epidemic in that neighbourhood, after which it rapidly subsided, and had disappeared before the end of the summer holidays. Altogether 124 cases occurred in this Parish during the year, in 69 houses, and no death was recorded. In the other parishes affected with the disease the prevalence was only slight, and in Coulsdon existed mainly in June, and again in August, after which no further case was reported, while in Wallington, where there was an extensive epidemic in 1894, one or two cases were reported nearly every month. The above is a summary of the measles prevalence of the year under review, but the facts are detailed fully in the tables in the appendix, which show the weekly incidence of the disease in Merton, Mitcham, and Beddington, the parishes in which it was the most pronounced. Whooping-cough.—Reliable information about the prevalence of this disease is wanting, the only indication of its existence being given when a death occurs and it appears in the Registrar's weekly returns. These returns show that the disease appeared in 6 parishes, and caused 13 deaths. In Mitcham there were 7 deaths, of which 4 occurred in the months of August, September, and October, and no doubt there was some prevalence then, as was to be expected, the association of this disease with or its immediate succession upon an epidemic of measles being commonly experienced. The only prevalence approaching epidemic proportions which came to my knowledge occurred in Woodmansterne at the beginning of February, where it was found by a house-to-house 23 enquiry that more than half the houses which sent children to the village school were infected, and the school was accordingly closed for 4 weeks in that month. Two deaths occurred during the epidemic, which it should be mentioned spread from the neighbouring districts of Purley and Smithambottom, where there had been some prevalence at the close of the preceding year. Besides these parishes, solitary deaths also occurred in Sanderstead, Wallington, Smithambottom, and Merton. Diarrhoea.—Nineteen deaths were recorded as due to diarrhoea in 1896, as compared with an annual average of 13 during the previous 10 years. With one exception all these deaths took place in June, July, August, and September, the summer months, when there is generally a heavy loss of infant life from this disorder. All the deaths except one occurred in infants under 2 years of age, while 12 were in infants less than 12 months old, the average age of the latter being 44 months. The majority of the deaths—15—occurred in Mitcham, while 2 occurred in Merton, and 1 each in Beddington and Wallington. Influenza.—The information about this disease is very unreliable. There seem to have been several cases in the early part of the year, and towards its close it again made its appearance. Only 2 deaths were registered as attributable to it, 1 in January at an institution and 1 in November in Mitcham. VI.—PREVENTIVE MEASURES. During the first half of the year the District remained without any Isolation Hospital for the infectious sick, except for the few who were in receipt of parish relief, but in July the Council made an arrangement with the Croydon Corporation to admit cases of scarlet fever, diphtheria, and typhoid fever into their Hospital at Waddon, pending the erection of the proposed Hospital for this District at Beddington Corner. The payment 24 made for this accommodation is £1 per week for each patient admitted. Fifteen patients had at the close of the year been sent there. Progress has been made towards the provision of a Hospital for the District, for which a site at Beddington Corner was secured in 1895. Soon after the commencement of the year, Mr. Chart, the Surveyor, was entrusted with the task of preparing plans for the necessary buildings, for the accommodation of 28 beds, or about 1 per 1,000 of the population. These plans, which have been submitted informally to the Medical Officer and Architect of the Local Government Board, and amended generally in accordance with their suggestions, are now practically complete. There will be three blocks for patients, two of ten beds each, and an isolation block of eight beds, where more than one disease can be simultaneously treated. Besides these there will also be (1) the administrative building, where the entire staff of nurses and servants will be housed, and which will also include a laboratory for bacteriological and chemical work; (2) the disinfecting block, which will include the hospital laundry and disinfecting station for the District as well as the Hospital; and (3) a mortuary and small discharging room, the latter of which it is hoped will also prove useful for disinfecting people exposed to infection. The Council has already purchased an ambulance, which will be ready for use at the commencement of the year. The District is now, therefore, temporarily equipped for the isolation in hospital of cases of scarlet fever, diphtheria, and typhoid fever, and ought soon to be provided with a Hospital of its own. This is a matter for congratulation, especially as it is easy to forecast that the first mentioned disease will make its appearance felt more decisively in the coming year. There has been no real prevalence of scarlet fever since 1893. 25 No provision exists, however, for the isolation of small-pox. The Croydon Corporation and this Council have been trying to secure the co-operation of the various authorities in NorthEast Surrey to provide a Small-pox Hospital for an extensive area; the Surrey County Council, who might deal with the question in a comprehensive manner, has declined to take action at the present. At the time of the Gloucester epidemic, a special report was presented to the Committee on the subject, and I was authorised, in the event of invasion taking place, to do everything possible in the way of isolation at home, and to employ trained nurses for this purpose, to offer re-vaccination to those exposed to infection, and, if necessary, to promise compensation for loss of employment to those kept in quarantine. Representations were also made to the Board of Guardians to enforce vaccination, and a similar step was taken by the Croydon Corporation. It was stated that the Rural District was well vaccinated, but that in the town there were a large number of unvaccinated children. The Guardians have since resolved to take no action to enforce the Vaccination Acts in the Union against defaulters, a decision which most affects the town of Croydon, but nevertheless will affect the Rural District too, and can only be regretted.* It cannot be denied that the whole question of vaccination is, at present, in a stage of transition, and that the remarkable report of the Royal Commission, which has at last been issued, will no doubt lead to some alteration of the law. But it is necessary to point out that the Commissioners positively state that the evidence submitted to them proves that both primary vaccination and re-vaccination, when properly per formed, diminish the liability to small-pox and modify the character of the disease, rendering it less fatal and of a milder *Since this report was written, the resolution of the Guardians has been rescinded by a majority of one. 26 type: that so far as concerns isolation, they "see nothing to warrant the conclusion that vaccination in this country might safely be abandoned and replaced by a system of isolation," and that if such a change were made "it is impossible to contemplate it without dismay": and that, although they had proof that certain dangers attend the present system, yet that " when considered in relation to the amount of vaccination work done, they are infinitesimal." As regards other diseases, the preventive and precautionary measures described in former reports have been pursued during the past year. These involve visits and revisits to every infected house, and the giving of advice as to the best means of isolation and of preventing the spread of the disease. Altogether 1,250 visits were paid to infected houses by the Inspectors. Enquiries are made into every case, particulars in accordance with the form reproduced in the appendix are obtained, and immediate notice is sent to any school attended by the children of infected households. Disinfectants are issued free of cost, the fumigation of rooms and disinfection by steam of bedding and clothing are always carried out by officers of the Council, except after cases of measles, and the subsequent cleansing of dwellings is carried out by owners under their supervision. The total number of articles disinfected by steam was 2,293. No complaints of damage were made. Medical certificates are required before the termination of an infectious case is recognised, except in cases of diphtheria, in which a bacteriological examination is made, and if no specific bacilli are found, precautions are allowed to be relaxed, but not unless. These examinations, which were commenced in 1895, have been successfully continued, and have yielded good results. Of course, the failure to find specific bacilli in a particular case may be accidental, and does not absolutely prove their absence, but I am satisfied that these examinations constitute an important additional safeguard, and are to be recommended as an eminently practical preventive measure. 27 The measles epidemic taxed the resources of the Health Department very heavily, as may be imagined from its extent. Nevertheless enquiry was made into every case, and particulars obtained, and in Mitcham and Merton many revisits were paid to infected houses. House to house enquiries were made in certain to discover unreported cases, and while the schools remained streets open, lists of absentee children were obtained from the teachers, and their houses visited for the same reason. It was by these means that so many unreported cases came to be known. Nearly 1,000 visits were paid to houses in connection with this disease. The failure of a number of householders to notify cases of measles was reported to the Committee, but no steps were taken to enforce the Act by the prosecution of those in default, and in a case of exposure of a patient while in an infectious condition, an apology by the parents was considered sufficient. Circulars were widely circulated—one of advice to parents how to manage the disease and prevent its spread, such as was distributed in 1894, and another calling special attention to the requirements of the Notification Act—but it is impossible to say that they were followed by the exercise of greater care, or more general notification (except in Coulsdon). The public seem to have an ineradicable indisposition to regard measles seriously, and one of the medical practitioners in Mitcham states that in his opinion the mortality from this cause was almost entirely due to gross carelessness. The effect of school-closure will be seen on reference to the tables in the appendix, but it is a moot point whether this step was taken early enough. It is very difficult to decide exactly when such a step ought to be taken, and there is always a disposition to put it off as long as possible. Its effect in Mitcham was marred by the occurrence of a number of summer school treats and other entertainments which it was hopeless to stop, and by the continued assembling of Sunday Schools, over 28 which there is no control, until I made a general appeal to those responsible. One of the latter, however, in the Singlegate area, declined for two Sundays to accede to the request, and the continued presence of the disease in that neighbourhood after August 15th was probably attributable to that cause. An important and exhaustive report by Dr. Theodore Thomson has been issued by the Local Government Board "upon the measures that may be and which have been adopted by Sanitary Authorities with a view to obtaining control over measles," in which the sources whence information may be derived, and the measures which may be taken to limit the disease within the dwelling and the district respectively, are discussed. The action taken by various Authorities is described, amongst others that in this District in 1894, and the circular issued at that time is reproduced. Dr. Thomson says, however, that in no district is everything possible done, which is not very surprising, for such would necessitate the doubling or trebling of the sanitary staff, who even then would be baffled to a great extent by the carelessness of householders. Amongst many other important recommendations, he says that:— "It is open to Sanitary Authorities to enter into an arrangement with School Authorities, whereby the latter are to acquaint the former with any known or suspected cases of measles of which they gain information. This arrangement may be made with those controlling public elementary, Sunday, and private schools. The information needs to be given systematically, that is to say, during inter-epidemic periods as well as when epidemics prevail. Sanitary Authorities should regard knowledge of cases in this way reported as possible clues to the detection of other and unknown cases." The essential points of this plan are that the information should be regularly given in inter-epidemic periods, and that private and Sunday schools should be included, which may 29 involve considerable difficulty in a scattered Rural District. The information should be given in this District in return for that habitually supplied to schools, warning them of the existence of infectious disease in houses that send children to them, and, of course, should include diseases other than measles. This leads me to observe, however, that schools, and school arrangements generally, are greatly in need of medical supervision. That the aggregation of children in schools favours the spread of infectious disease is an established fact, but beyond that many of the school operations themselves, and even their domestic arrangements, seem to have been expressly devised to facilitate the introduction and dissemination of diseases of this class. An intimate association of medical supervision with even the smallest details of school life is the only means by which dangerous customs, deeply ingrained in school authorities by long continued use, could be broken down, and by which at the same time valuable information as to various diseases common in children could be secured first hand and systematically, while preventive and corrective measures would be under direct medical control. VII.—WATER SUPPLY. The District is mainly supplied with water by three water companies, viz., the Lambeth Water Company, who obtain water from the River Thames, and the Sutton and East Surrey Water Companies, both of whom obtain their supplies from the Chalk at Sutton and Kenley respectively. The Croydon Corporation also supplies a small population at Addington. About 16,000 persons consume water derived from the River Thames, and 15,000 that derived from the Chalk, and there are some 200 to 250 persons who have no supply except rain-water collected in tanks. Beyond these sources there are, of course, private wells here and there. The difficulty of providing the bulk of those without any supply but rain-water, which was referred to on page 41 of the 30 last annual report, has not been overcome. The Council requested the East Surrey Water Company to extend their mains to supply the houses, but the Company declined to accept a reasonable offer made by the Council for part payment of the cost of extension, and insisted on their own terms, which were exorbitant. The dangers alleged to threaten water supplies derived from the Chalk are frequently heard of at the present time, and it is understood that the County Medical Officer is making enquiry into the question. The Croydon Corporation, who derive their main supply from a well situated in the centre of that town, complained to this Council at the end of 1895 that the purity of their water was endangered by the existence of cesspool drainage in this District on the outskirts of the town. A report was presented in December in which I pointed out that the cesspools in question were between two and three miles distant from the Croydon well, and that, although it is alleged that disease producing matter can travel even such distances along the channels in the chalk, yet the immediate surroundings of this well seemed to involve more likely dangers than the cesspool drainage of which complaint was made. At Kenley, however, one of the places alluded to as drained in this manner, and which is a growing place, at present populated with some 1,300 persons, there are four wells of great importance belonging to the East Surrey Water Company, situated within a quarter of a mile of a considerable proportion of this population. I indicated that the cesspool drainage in the neighbourhood of the wells must be regarded as a danger to their purity, even if the dangers alleged to exist in consequence of the channels in the Chalk are fanciful. In other words, the danger to this extent would be there irrespective of the character of the soil (clay excepted), unless the cesspools in their vicinity were completely watertight. 31 If, on the other hand, the allegation that channels exist in the chalk by which disease-producing matter can travel any distance unaltered, is accepted as a working hypothesis, and this appears to be what Croydon contends, the question becomes a much wider one, for the channels are said to commence beyond Caterham and to continue along the "Valley past Kenley to Purley, and thence to Croydon, and in the area beyond Kenley towards and including Caterham there are five or six times as many houses as there are in Kenley itself, drained in the same manner. The danger from this point of view thus becomes a much more extensive one, as regards both the wells in Kenley and those in Croydon, but also becomes somewhat complicated, for the area referred to beyond Kenley is not under the jurisdiction of this Council. It is obviously one, however, which from its importance must be treated in a comprehensive and logical manner, and not so as to exclude danger from Kenley only and allow other and much larger sources of danger to remain in existence. (See page 32.) VIII.—SEWERAGE AND SEWAGE DISPOSAL. During the year the Council commenced the works of improvement at the Merton Sewage Works, in accordance with the scheme described generally in previous reports. These improvements are called for to remedy defects in the means of sewage disposal, and partly also, in the sewerage of the District. The extension of the low-level sewer, referred to in the previous report, was completed early in the year. This was called for on account of the flat gradient and inadequate size of the old sewer, which led to extensive "heading back" of sewage from the outfall, while this condition led to similar heading back in certain house drains in the neighbourhood. In the course of the year, all the drains liable to be affected in this manner, were connected with the new sewer, so that no heading back can now occur. 32 The overflow from one. of the main sewers in the same locality into a tributary of the River Wandle, referred to in the last report, has been disused during the year, and it is to be hoped that the Council will not permit its use again. The Council have continued to erect ventilating shafts in place of road manhole ventilators where these have been the cause of much nuisance, and care is being taken that they are of substantial construction and well elevated above the roofs of dwellings. The Council, like other local authorities, have frequently had to consider that class of house drains known generally as "combined drains," which, since they drain more than one house, have been held to be "sewers," and whenever there has been any question of this kind, the Council have done the work themselves. As much as £516 was spent by the Council during the latter half of the year in making satisfactory this class of house drains. The above remarks refer generally to that part of the District known as the Drainage District, which includes Mitcham Merton, Morden, Beddington, and Wallington. In the remaining parishes of Addington, Sanderstead, Woodmansterne, and Coulsdon, no general change has taken place. In these more rural parishes cesspool drainage is universal, except at Parley and Badger's Hole, Addington, and since no bye-laws exist in these parishes, the cesspools are with few exceptions mere excavations in the ground. The drainage of Kenley has been already referred to under water supply (page 30). The Croydon Corporation, when drawing attention to the alleged danger to their water supply, offered, on, I understand, favourable terms, to connect a sewerage system for Kenley with their system near Purley. This offer applied also to a portion of Sanderstead adjoining the town, where building operations are active, and the drainage of which it is thought desirable to assimilate to that of the borough. At 33 Kenley, however, I have pointed out that the safety of the important wells there must be the paramount consideration, and that if Kenley alone is dealt with, other and far greater sources of danger will remain, assuming that the reason for Croydon's intervention, viz., the danger due to the channels in the chalk, is accepted. The Croydon offer, however, does not extend beyond the geographical boundary of Kenley, or rather that part of Coulsdon parish, and however tempting the offer may be, it should be remembered that outside this District these greater sources of danger exist, and that the public safety demands that care should be taken that the removal of one danger does not interfere with or postpone the removal of a greater one, or that a feeling of security is engendered for which there is no real warrant. There is a large group of houses at Smithambottom, near Cane Hill Asylum, which have recently been built, and which will probably extend shortly in consequence of the increased railway accommodation which is being provided there. I have recommended that they ought to be provided with a proper system of drainage, more especially as nearly all are small closely aggregated artizans' dwellings, while the Asylum authorities have expressed some concern for the safety of their well, which is within 100 yards of a number of these houses. A report has also been presented as to the drainage of the village of Addington where an old brick barrel surface-water sewer has gradually become connected with house drains in the village. The contents of the sewer discharge into a cesspool in a field near the village, and the latter overflows almost constantly. The house drains, too, are directly connected with this sewer, aud there is no system of ventilation. The Council has appointed a Committee to enquire into this matter. Allusion must again be made to the Sewage Farm of the Croydon Corporation at Beddington, in this District. During the summer months complaints were again made of the nuisance, 34 and they came from householders living on the south, east, and especially on the west boundaries of the farm, there being a very considerable population at Beddington Corner, near the latter. The complaints were brought to the notice of the Croydon Corporation, and finally a deputation waited upon the Farm Committee, but it can only be said that they seemed incredulous, and little hope was given that any alteration would be made in the system of discharging crude untreated sewage upon the land, the deposit from which, remaining on the surface, appears to be the main cause of the nuisance. IX.—RIVER POLLUTION. The pollution of the River Wandle by the drainage of Carshalton, a neighbouring District, still continues, but it is satisfactory to record that at length a sewage scheme has been settled for that parish, and that its construction will be commenced early in the coming year, so that pollution from this cause ought before long to disappear. The scheme referred to does not, however, include the disposal of refuse from several mills and dwellings situated on the banks of the river in the neighbourhood of Beddington Corner, but arrangements are being made with this Council to receive this drainage into the sewers of this District in that neighbourhood. The general condition of this river in this District is fair, but at certain points it is very unsatisfactory, and its bed still needs the cleansing which was recommended in a report presented at the close of 1895. Nothing, however, could be done until one of the most unsatisfactory portions of the river near the Waddon Mills had been cleansed. The Croydon Corporation commenced operations there shortly before the close of the year, and when this is done it will be within the province of this Council to require the stream lower down to be attended to, especially in Beddington, Hackbridge, and Merton. 35 Some minor cases of pollution of water-courses have arisen, one being that of a small roadside tributary of the river at Hackbridge, which was polluted by drainage from Carshalton, by which much nuisance was created in the hot weather. The Carshalton authority, on complaint made by this Council, called upon those responsible to prevent the pollution. Attention was attracted during the year to a proposal of the Croydon Corporation to sink new wells and adits in the chalk at Waddon. It is alleged by geologists that this action will tap the main underground channels supplying the springs at the head of the Croydon Wandle, and that the amount of water thus diverted from the river will only be limited by the engine power provided for pumping. The matter has been taken up by the riparian and mill owners interested in the volume of water in the river, but in mentioning the proposal to the Committee I pointed out that if there is justification for the fears of the geologists, the difficulty of minimising the effects of river pollution will be exaggerated by the diminution of the river water's diluting and flushing powers. X.—REFUSE COLLECTION AND DISPOSAL. At the commencement of the year the systematic collection of house refuse was carried out as formerly in Mitcham, Merton, Beddington, Wallington, and Purley, part of Coulsdon parish Before the close of the year the Council 'commenced arrange ments, as a result of representations made by the Inspectors of Nuisances, to carry out similar collection from all the houses in the parish of Morden, and from those of the cottage class in Kenley and Smithambottom in Coulsdon parish. In the latter parts of the District the collection is to be made every fortnight, but in the former it is made weekly. The collected refuse is disposed of on waste ground, but the Council have been invested with urban powers recently to 36 enable them to store and dispose of it in a systematic manner. I have had reason to draw attention to the disposal of refuse in Mitcham, where it is cast upon a brickfield, in common with a quantity from London, in such close proximity to dwellings that a risk of danger to health seems to be involved. XI.—CEMETERIES. In the early part of the year a public enquiry was held at Coulsdon, by an Inspector of the Local Government Board, into the merits of a petition of the Council for a Provisional Order to obtain, by compulsory purchase, a site for a cemetery for the parish mentioned, this course having been prompted by the Parish Council. As indicated in the last annual report, much controversy was involved in the matter. The site in question was one in close proximity to the old churchyard, and had been selected by the Council because the chalk soil, which is almost universal in this neighbourhood, is there protected by a superincumbent stratum of clayey composition, and also because the parishioners had repeatedly expressed a wish to have the new burial ground as near as possible to the old one. The owner of the land objected to the selection of this site as damaging to his estate, and before the local enquiry suggested alternative sites, which, however, were objectionable, mainly because their soil consisted of unprotected chalk, but at the close of the enquiry he suggested another site on his estate, situated some three-quarters of a mile from the old burial ground, which appeared to be similar as regards composition of soil to the site selected by the Council. The Provisional Order was granted by the Local Government Board, but when the matter came before the House of Commons, and nothing unsatisfactory could be said as to the last-mentioned 37 site from a sanitary aspect, the Order was annulled upon the owner giving an undertaking that he would sell that site by the ordinary procedure. No further practical progress has been made, however, to provide this parish with a burial ground. After the matter came before the House of Commons, its solution was left to the Parish Council, who have as yet settled nothing, and it is evident that, unless the difficulty is shortly overcome, the District Council, as guardians of the public health, ought to take steps to provide the necessary accommodation. Two other parishes, Beddington and Wellington, are in much the same position. These two parishes have, up to the present time, used in common the churchyard in Beddington, being, as I understand, parts of one ecclesiastical parish, although they are distinct for rating purposes. The churchyard will shortly be filled, and some desire has been expressed, especially on the part of Beddington, to have separate burial grounds in the future. The Parish Council of Beddington, with this desire in view, selected a site near the existing churchyard for their own new burial ground, but as it could not be obtained by agreement, the District Council was asked to obtain it by compulsory purchase. A report was presented by Mr. Chart and myself in due course, in which it was advised that on public health grounds nothing should be done to encourage the provision of two burial grounds instead of one, and that the site selected by Beddington was undesirable from both a sanitary and a legal point of view. Since both parishes are composed mainly of chalk, the difficulty of finding a site free from objection was enhanced, but it was indicated that there was land in a suitable position where the chalk was protected by a thick layer of Thanet sand of a dense nature. 38 The District Council in November conferred with the two Parish Councils involved, and it was left to them to come to some agreement within a reasonable time, failing which the former would act on its own responsibility and powers. It should be added that Coulsdon parish seems to be willing to co-operate with Beddington and Wallington in providing a combined burial ground for the three parishes, but it is doubtful whether such a plan would be practicable, although from a sanitary point of view nothing, per se, could be more desirable. XII.—BYE-LAWS. Bye-laws respecting nuisances, scavenging, new buildings and streets, and slaughterhouses, are in force in the Parishes comprised in the Drainage District, and also in Purley, except as regards slaughterhouses. Amended bye-laws respecting nuisances and new streets and buildings, including the drainage of old buildings, were adopted by the Council in 1895 and sent to the Local Government Board for confirmation. These bye-laws are to apply to the entire District, and towards the close of 1896 those relating to nuisances were formally sanctioned after certain amendments had been made by the central Authority, but nothing had been heard at the end of the year concerning those affecting buildings. Bye-laws for securing the decent accommodation of persons engaged in the picking of fruit, hops, and vegetables were also adopted and finally confirmed by the Local Government Board in October. The new building bye-laws are urgently required, especially in Kenley, Smithambottom, and Sanderstead, where considerable numbers of houses have been and still are being erected without supervision. In the former place it has just been announced that 80 to 100 new labourers' cottages are to be shortly built, and it is to be hoped that bye-lawa will be in existence before they are erected. 39 The following table kindly supplied by the Surveyor, relateg to new buildings in the Drainage District:— New Buildings. Approved. Disapproved. Wallington 81 2 Mitcham 61 5 Merton 12 11 Morden 4 — Beddington 9 — 167 18 XIII.—HOUSING OF THE WORKING CLASSES. During the year, 48 houses have been represented by the Medical Officer of Health as so dangerous to health as to be unfit for habitation, a number considerably exceeding that of the previous year. The table on page 40 shows in detail the houses so dealt with, with the action taken by the Council, and the results that had accrued at the close of the year. Besides the houses thus enumerated, 18 others have been closed by their owners, in consequence of unofficial representations made to them, or to obviate the expense of alterations required by notices served under the Public Health Act. They are as follows:—2 cottages in Byegrove Road, 8 cottages (Simmons') at Westfields, and 4 cottages in Lock's Lane, Mitcham; 2 cottages at Wallington Corner; and 2 in the village of Coulsdon. The 5 railway huts at Hooley, Coulsdon, referred to in the table, are buildings of a temporary character, which have been erected for the accommodation of labourers employed in con. structing new railway lines in that neighbourhood. Several of these structures have been erected during the past 18 months, and some 150 persons are at the present time housed in this manner. 40 Description of Houses. When Reported. Reasons fob Representation. Action Taken. Results. 10 houses, Sarah Place, Mitcham Jan. 30th Dampness, insufficient accommodation, and neglect of repairs Notices served to render fit for habitation within 28 days Increased accommodation provided, with improved ventilation, and general repairs sufficient to preserve houses for a time. Bishop's Cottage, Lower Morden Jan. 30th Dampness of living rooms and neglect of repairs Ditto No work done until proceedings threatened. Ultimately house thoroughly repaired; practically transformed. Domestics' dwellings, adjoining Thatched Cottage, Beddington Lane March 26th Insufficient light and ventilation in sleeping rooms, and contiguity to stables and places for animals and fowls Ditto Nil. Occupier stated that occupation of premises would be discontinued. 14 houses, Ebenezer Cottages, Lonesome, Mitcham May 28th General decay, damp, filthy condition, and dirty surroundings Ditto within 3 months Houses cleansed and repaired, and surroundings much improved. Dampness not yet remedied. Station-master's house, Beddington Lane July 23rd General decay of wooden structure: dampness and insufficient accommodation Ditto within 28 days New house erected, and old one to be demolished as soon as possible. 2 cottages, near Battersea Cemetery, Morden Oct. 22nd General decay, filthy condition, absence of water supply, insufficient accommodation Closing order made under Building Byelaws Closed. House near Russell Hill, Purley Oct. 22nd Filthy condition, want of repair, dampness, and dilapidation Notices served to render fit for habitation within 28 days Nil. 5 railway huts, Hooley, Coulsdon Oct. 22nd Filthy surroundings, insufficient domestic accommodation, and dampness Proceedings taken for closing order, 18th December Magistrates' order to close unless made fit within 28 days. Surroundings transformed, future dampness prevented, and accommodation increased. 6 houses, Reform Place, Merton Nov. 19th Dampness of living rooms, filthy condition, general dilapidation and want of repair; dirty surroundings Notices served to make fit for habitation within 28 days Houses cleansed, some general repairs effected, and some dampness concealed with woodwork: unsatisfactory. 3 houses, Pincott Road, Merton Dec. 17th General decay, filthy condition, dampness of walls, and defective roofs Ditto Nil. 3 houses. Western Road, Mitcham Dec. 17th Extreme general decay and neglect, and filthy condition: wooden structures Ditto Nil. Coachman's dwelling, Morden Dec. 17th Insufficient light and ventilation Ditto Owner promises to close. 41 They are all constructed of wood, protected externally with tarred felt, and consist, generally, of a living room and washhouse, a bedroom for the occupying family, and a bedroom for the labourers, the total number occupying each dwelling varying from 8 to 14, or occasionally more. Such dwellings, most of which, although temporary, will be required for two years or more, have entailed considerable care in order that the conditions of the tenants may be as healthy as is possible under the circumstances. Speaking generally, the buildings have been fairly satisfactory, except those referred to in the table, in which there was lack of ordinary domestic accommodation, and dampness, while their surroundings were so filthy that it was imperative to regard them as unfit for habitation, especially in view of the large number of persons— 63—found to be inhabiting them. Proceedings having been instituted, closing orders were made to take effect in 28 days, but during that period the surroundings, and in some respects the dwellings, too, were so transformed that no objection was ultimately raised to the order being rescinded. A thorough administration of the Housing of the Working Classes Act is called for in parts of this District, if the conditions and surroundings of a considerable number of its inhabitants are to be really improved. As time goes on, the number of houses in certain parts of the District, which can only be described as unfit for habitation, must increase, and it is desirable that the powers conferred by the Act on the Council should be completely applied. Houses which the Council are satisfied are unfit for habitation should be closed by order as quickly as legal procedure will permit, for any repairs and alterations carried out subsequent to such proceedings must inevitably be more thorough and complete than those effected before, when there is every temptation to do work sufficient only to ward off proceedings for a time. Beyond this, such procedure would have its due effect on other 42 owners, who would, no doubt, take greater care to prevent dilapidation, and so avoid the possibility of their houses becoming tenantless. It cannot be denied, however, that one of the great difficulties in the way of this procedure is the want of any surplus accommodation for the working classes in the District, so that if houses are closed, the tenants may find it extremely difficult to obtain accommodation elsewhere. The Act gives the Council the means of overcoming this difficulty to some extent by empowering it to provide accommodation for the working classes by means of a "scheme" under the adoptive third part of the Act, and it is probable that it may be necessary to advise the Council, before long, to consider the necessity of taking action in this direction. XIV.—ROUTINE SANITARY WORK, HOUSE INSPECTION, &c. The following summary, prepared by the Inspectors, speaks for itself as to the amount of work done by them during the year :— Summary of Inspectors' Work. Inspectors White Rabbets Payne Total Number of complaints received and investigated 64 38 13 115 Number of Premises inspected 296 405 501 1202 Total number of Visits paid 1609 1579 1536 4724 Nuisances discovered 150 312 153 615 * „ abated without report 81 220 104 405 * „ „ after report 39 39 37 115 Preliminary notices served 84 163 84 331 Legal notices served 29 45 14 88 Notices followed by legal proceedings — 2 — 2 Character of Work done— Houses cleansed and repaired generally 15 93 31 139 Ventilation of houses improved — 8 1 9 Overcrowding abated 2 1 1 4 43  Inspectors White Rabbets Payne Total Defective roofs repaired 4 24 3 31 Houses under - pinned (damp - proof course inserted) 4 1 5 Eaves-gutters renewed or repaired 14 33 4 51 Water-closets renewed or repaired 29 101 21 151 Indoor soil - pipes abolished, and new ones provided outside and ventilated 4 4 " D " traps abolished 6 — — 6 Water closets provided with water for flushing, and disconnected from domestic supply 4 20 4 28 Privies reconstructed with small movable receptacles, or converted into earth-closets 1 6 7 New receptacles provided for earth-closets or privies 3 2 5 Bath, lavatory, and sink waste-pipes disconnected from drain, and caused to discharge over gully-traps – 11 2 13 Houses supplied with water from main 2 6 3 11 Water-tanks or cisterns cleansed or covered 3 67 — 70 Yards of houses paved with impervious material 4 58 15 77 Paving of yards repaired — 9 1 10 Floors of sculleries paved or repaired 3 36 3 42 Ashpits or dustbins provided 62 75 6 143 ,, „ cleansed and covered 1 12 4 17 Cesspools abolished and filled up 3 — 2 5 ,, cleansed — — 8 8 New cesspools provided — 2 3 5 Houses at which drains were tested 68 76 28 172 ,, ,, „ found defective 64 71 24 159 Houses at which drains were reconstructed or new provided 42 113 21 176 Houses at which drains were cleansed, ventilated, trapped, or repaired 35 58 21 114 Number of drain tests made in course of work done under the two previous headings 147 208 53 408 Houses at which inspection chambers in drains were provided 20 39 16 75 Stables provided with drainage 2 10 4 16 Premises from which animals improperly kept were removed 4 2 1 7 Number of inspections of food exposed for sale 44 38 45 127 Urinals cleansed or repaired 3 1 — 4 Smoke nuisances abated — — — — Offensive accumulations removed 11 25 20 56 Paving of piggeries repaired — 8 — 8 Infected houses fumigated and cleansed 22 22 12 56 44 XV.—REGULATED TRADES AND BUSINESSES. (a) Dairies, Cowsheds, and Milkshops. There were 63 premises registered under the Dairies, Cowsheds, and Milkshops Order of 1885, at the close of the year, as compared with 59 in 1895. They are distributed as follows :— Addington 2 Morden 2 Beddington 4 Sanderstead 5 Coulsdon 15 Wallington 8 Merton 9 Woodmansterne 0 Mitcham 18 Total 63 Five premises in Mitcham, 1 in Beddington, 1 in Coulsdon, and 1 in Sanderstead, were newly registered during the yeari while 2 premises in Coulsdon, 1 in Mitcham, and 1 in Woodmansterne were discontinued. The following are particulars of inspections of these premises during the year:— Total number of visits paid 248 Premises at which structural improvements were effected 4 „ found unclean 20 Notices served for cleansing 12 (6) Slaughterhouses, There are 24 premises in which the slaughtering of animals for the food of man is carried on, of which 20 are regulated by the Bye-laws of the Council. The following are particulars of the inspection of these premises during the year:— Number of visits paid 181 „ of meat inspections 127 „ of seizures of unsound meat 3 Premises which required to be cleansed 19 On three occasions meat was seized by the Inspectors as decomposed so as to be unfit for the food of man, and removed to be dealt with by a magistrate. In two instances prosecutions 45 were instituted by the Council, and substantial penalties inflicted ; but in the third and last case no such steps were taken. All the seizures were made in Merton. (c) Bakehouses. There were 24 bakehouses in use in the District at the close of the year, to which 100 visits were paid altogether. On five occasions verbal requisitions to cleanse were called for and readily complied with. (d) Offensive Businesses. Piggeries and their accessories constitute the principal offensive businesses in the District, and they are numerous and extensive in Mitcham, and to a less extent in Merton. Nearly 200 visits have been paid by the Inspectors in the course of the year, and on 60 occasions some definite nuisance was found to exist either from defective paving, uncleanliness, or from filth accumulations. Some of the accessories, particularly the boiling of waste food, are even more offensive than the piggeries themselves, and sometimes a trade of dealing and sorting refuse of various kinds is combined with that of pig-keeping and food-boiling, which, together, result in the causation of intolerable nuisances, especially during the warmer months of the year. In one of the worst cases the Council ordered notices to be served upon the owner and occupier to make certain structural alterations and repairs to render the premises fit for the trade carried on, and this led to legal proceedings towards the close of the year, by which a Magistrates' order to abate the nuisance was obtained. It is difficult, however, to deal adequately with these businesses, unless they are controlled by a series of stringent bye-laws or regulations, as was mentioned in the last Annual Report. APPENDIX. 3 Table I.—The AREA in Acres, INHABITED HOUSES, POPULATION, and DENSITY of each Parish in the District in 1891 and 1896. Parish. Area in Acres. Number of Inhabited Houses. Population. Density. Acres per person. Average Persons per House, 1891. 1891. Estimated to middle of 1896. 1891. 1896. Persons. Males. Females. Persons. Males, Females. 1891. Addington 3 605 132 132 670 346 324 670 346 324 5.4 5.0 Beddington 3,128 442 512 2,607 1,162 1,445 3,020 1,350 1,670 1.2 5.9 Coulsdon 4,314 537 623 3,335 1,623 1,712 3,860 1,880 1,980 1.3 6.2 Merton 1,765 654 713 3,360 1,612 1,748 3,655 1,750 1,905 0.52 5.1 Mitcham 2,915 2,055 2,268 10,758 5,300 5,458 11,790 5,810 5,980 0.27 5.2 Mordern 1,475 138 165 763 387 376 910 460 450 1.9 5.5 Sanderstead 3,150 96 125 509 262 247 660 340 320 6.1 5.3 Wallington 823 710 796 3,823 1,587 2,236 4,300 1,780 2,520 0.25 5.4 Woodmansterne 1,591 81 97 408 204 204 485 244 241 3.9 5.0 The District 22,766 4,845 5,431 26,233 12,483 13,750 29,350 13,960 15,390 0.86 5.4 N.B.—The above Table excludes the inmatetes 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. 4 Table II.—Showing the POPULATION, MARRIAGES, BIRTHS, and DEATHS, for the year 1896, and 10 years preceding. GROSS NUMBERS. The Year. Estimated Population. Marriages. Births. Corrected No. of Deaths. Deaths in Public Institutions. Total all Ages. Under One Year. Under Five Years. 1896 29350 NO RETURNS. 765 386 105 160 209 1895 28500 769 352 87 117 208 1894 28200 732 299 71 102 259 1893 27720 760 402 108 148 274 1892 27000 765 355 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 1880 23690 793 296 83 119 102 Average of 10 years 1886-95. 26150 754 322 82 120 189 N.B.—Before 1893, the deaths occurring outside the District among persons belonging thereto, were not included in the above figures : such deaths would probably number between 30 and 40 for each year. 5 Table III—Showing the Annual BIRTH and DEATH RATES, and DEATH RATES OF INFANTS, for the Year 1896 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. 1896 26.1 13.2 137 1895 27.0 12.4 113 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 Average of 10 years, 1886 to 1895 28.9 12.3 109 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 since 1893 has increased the death rates considerably. 6 Table IV.—Showing the number of DEATHS from the Principal Zymotic Diseases in the 10 Years 1886 to 1895, and in the Year 1896. Disease. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. Average Annual Deaths in 10 years, 1886—1895. Total Deaths in 1896. Death Rate per 1000 Population in 10 years, 1886—1895. Death Rate per 1000 Population in 1896. Small-pox - - - - - - 1 - - - - - .00 .00 Measles 3 25 3 4 12 6 17 7 1 — 8 18 .31 .61 Scarlet Fever 5 5 3 — 19 1 3 4 5 2 5 - .18 .00 Diphtheria 4 9 22 6 4 5 5 2 21 7 8 5 .31 .17 Whooping Cough 14 — 2 21 2 11 3 22 2 3 8 13 .31 .44 Fever Typhus — — — — — — — — — — — - .00 .00 Enteric 1 4 1 2 1 1 4 4 2 4 2 5 .08 .17 Simple continued - - - - - - - - - - - 0 .00 .00 Diarrhoea 20 16 7 2 11 11 20 20* 9 ! 7 13 18 .49 .61 Totals 47 59 38 35 49 35 53 59 40 33 44 59 1.68 2.01 Zymotic Death-rate 2 0 2.44 1.54 1.38 1.82 1.33 1.96 213 1.41 1.16 - — 1.68 2.01 Zymotic Death.rate in England and Wales 2.42 2.42 1.88 2.23 2.15 1.91 2 0 2.47 1.81 2.17 — — 2.15 2.18 * Including a case of cholera. N.B.—Before 1893, the deaths occurring outside the District among persons belonging thereto were not included in the above figures. 7 Table V.—Showing the number of DEATHS at all ages in 1896, 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. (At all ages). Total Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 59 2.01 153 2. Pulmonary Diseases 51 1.74 132 3. Principal Tubercular Diseases 39 1.33 101 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 37 48 352 5. Convulsive Diseases 13 17 123 NOTICE. 1. Includes small pox, measles, scarlet fever, diphtheria, whooping cough, typhus, enteric (or typhoid), and simple continued fevers, and diarrhoea. 3. Includes phthisis, scrofula, tuberculosis, rickets, and babes. 4. Includes marasmus, atrophy, debility, want of breasb milk, and premature birth. 6. Includes hydrocephalus, infanbile meningitis, convulsions, and teething. 8 Table VI— DEATHS Registered from all Causes during the Year 1896. Note.—The Deaths of Noil-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 & up- wds I. Specific Febrile, or Zymotic Diseases 25 27 4 2 ... 1 1 1 ... ... 1 62 II. Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... III. Dietetic Diseases 6 ... ... ... 1 1 ... 1 ... ... ... 9 IV. Constitutional Diseases 9 5 4 9 6 9 7 12 5 1 ... 67 V. Developmental Diseases 18 .. .. . ... ... ... ... 2 11 11 42 VI. Local Diseases 31 19 9 8 9 9 16 23 25 19 3 171 VII. Deaths from Violence 1 3 1 2 2 1 4 1 1 1 ... 17 VIII. Deaths from Ill-Defined and Not Specified Causes 15 1 ... ... 1 ... ... ... ... ... 1 18 Totals 105 55 18 21 19 21 28 38 33 32 16 386 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Small-pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 14 1 ... ... ... ... ... ... ... ... 18 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... Typhus .. .. .. ... ... ... ... ... ... ... ... Whooping Cough 8 5 .. ... ... ... ... ... ... ... ... 13 Diphtheria and Membranous Croup ... 4 2 . ... .. ... ... ... ... ... 6 Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever .. .. .. 2 ... 1 1 1 ... ... ... 5 Influenza 1 ... ... ... ... ... ... ... ... ... ... 1 2. —Diabrhœal Diseases. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 13 4 1 ... ... ... ... ... ... ... ... 18 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. ... ... ... ... ... ... ... ... ... ... ... ... Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... G.—Septic Diseases. Erysipelas ... ... ... ... ... ... ... ... ... ... 1 1 Pyæmia, Septicæmia ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... 9 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 6 ... ... ... ... ... ... ... ... ... ... 6 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 ... ... 1 ... ... ... 2 Delirium Tremens ... ... ... ... ... 1 ... ... ... ... ... 1 IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 2 1 ... 1 ... ... ... ... ... 4 Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... Gout ... ... ... ... ... ... 1 1 1 ... ... 3 Rickets I 1 ... ... ... ... ... ... ... ... ... 2 Cancer, Malignant Disease ... ... ... ... 1 2 3 8 2 1 ... 17 Tabes Mesenterica 4 ... ... ... ... ... ... ... ... ... ... 4 Tubercular Meningitis, Hydrocephalus 1 1 ... ... ... ... ... ... ... ... ... 2 Phthisis I 2 1 7 5 5 2 2 2 ... ... 27 Other forms of Tuberculosis, Scrofula 2 1 1 1 ... ... ... 1 ... ... ... 6 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... 1 ... ... ... ... ... 1 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... 1 ... ... ... ... 1 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... V.-DEVELOPMENTAL DISEASES. Premature Birth 16 ... ... ... ... ... ... ... ... ... ... 16 Atelectasis 1 ... ... ... ... ... ... ... ... ... ... 1 Congenital Malformations 1 ... ... ... ... ... ... ... ... ... ... 1 Old Age ... ... ... ... ... ... ... ... 2 11 11 24 VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 1 1 2 ... ... ... 1 ... ... ... ... 5 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... 1 ... 3 3 5 5 4 2 23 Insanity, General Paralysis of the Insane ... ... ... ... ... ... 1 1 ... ... ... 2 Epilepsy ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 9 3 ... ... ... ... ... ... ... ... ... 12 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... 1 ... ... ... ... 2 1 ... 4 Other Diseases of Nervous System 1 ... ... 1 ... ... 1 ... ... ... ... 3 2, —Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... ... ... ... ... ... ... ... ... ... ... ... 10 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 ... ... ... ... ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... ... ... 2 2 2 2 2 2 ... 12 Other-Diseases of Heart ... ... 1 2 ... ... ... 4 6 6 1 20 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... 4.—Diseases of Respiratory System. Laryngitis ... 1 ... ... ... ... ... ... ... ... ... 1 Croup ... ... ... ... ... ... ... ... ... ... ... ... Emphysena, Asthma ... ... ... ... 1 ... ... 1 ... ... ... 2 Bronchitis 9 6 2 ... 1 1 ... 2 3 1 ... 25 Pneumonia 7 8 ... 1 2 ... 3 1 ... 2 ... 24 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... 5.—Diseases of Digestive System. Dentition 1 ... ... ... ... ... ... ... ... ... ... 1 Sore Throat. Quinsy ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Stomach ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 3 ... 1 1 1 ... ... ... 1 ... ... 7 Obstructive Diseases of Intestines ... ... ... ... ... ... ... 2 2 ... ... 4 Peritonitis ... ... 2 1 ... ... ... 1 ... ... ... 4 Ascites ... ... ... ... 1 ... ... ... ... ... ... 1 Cirrhosis of Liver ... ... ... ... 1 1 2 ... ... ... ... 4 Jaundice and other Diseases of Liver ... ... ... ... ... ... ... ... ... 1 ... 1 Other Diseases of Digestive System ... ... 1 ... ... ... ... ... ... ... ... 1 6.—Diseases of Lymphatic System. {e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... ... ... ... 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease Myxoedema) ... ... ... ... ... ... ... 1 ... ... ... 1 8.—Diseases of Urinary System. Nephritis ... ... ... ... ... ... ... ... ... ... ... ... Bright's Disease, Albuminuria ... ... ... ... ... 1 I 3 1 ... ... 6 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... 2 1 ... 3 Other Diseases of the Urinary System ... ... ... ... ... ... 2 ... ... 1 ... 3 9.—Diseases of Reproductive System, a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ... ... b. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Childbirth ... ... ... ... ... 1 ... ... ... ... ... 1 11 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 10—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Integumentary System Carbuncle, Phlegmon ... ... ... ... ... ... ... ... 1 ... ... 1 Lupus ... ... ... ... ... ... ... ... ... ... ... ... VII.—DEATHS FROM VIOLENCE. 1.—Accident or Negligence Fractures or Contusions 1 1 ... 1 1 ... 1 ... 1 ... ... 6 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 1 1 1 ... ... ... ... ... ... ... 3 Poison ... ... ... ... ... ... ... ... ... ... ... Drowning ... 1 ... ... ... 1 1 ... ... ... ... 3 Suffocation ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... 1 ... 2 ... ... 1 ... 4 2 —Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... 3 —Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... ... ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... ... 1 ... ... ... 1 4 —Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... VIII.-DEATHS FROM ILL-DEFINED and NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 14 1 ... ... ... ... ... ... ... ... ... 15 Mortification ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage ... ... ... ... 1 ... ... ... ... ... ... 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined 1 ... ... ... ... ... ... ... ... ... 1 2 12 SUMMARY OF TABLE VI. No. of Deaths. I—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1. Miasmatic Diseases 43 2. Diarrhceal ,, 18 3. Malarial „ — 4. Zoogenous „ — 5. Venereal ,, — 6. Septic ,, 1 II.—PARASITIC DISEASES — III.—DIETETIC DISEASES 9 IV.—CONSTITUTIONAL DISEASES 67 V.-DEVELOPMENTAL DISEASES 42 VI.—LOCAL DISEASES. 1. Diseases of Nervous System 49 2. Diseases of Organs of Special Sense — 3. Diseases of Circulatory System 32 4. Diseases of Respiratory System 52 5. Diseases of Digestive System 23 6. Diseases of Lymphatic System — 7. Diseases of Gland-like Organs of Uncertain Use 1 8. Diseases of Urinary System 12 9. Diseases of Reproductive System— (a) Diseases of Organs of Generation — (b) Diseases of Parturition 1 10, Diseases of Bones and Joints — 11. Diseases of Integumentary System 1 VII.—VIOLENCE. 1. Accident or Negligence 16 2. Homicide — 3. Suicide 1 4. Execution — VIII.—ILL-DEFINED AND NOT SPECIFIED CAUSES 18 Total 386 13 Table A.—Persons living in the District at 4 groups of ages. Ages. 1891. 1892. 1893. 1894. 1895. 1896. Under 5 years 2,930 3,000 3,075 3,130 3,160 3,260 5 to 15 years 7,210 7,370 7,560 7,700 7,780 8,020 15 to 25 years 4,830 4,940 5,070 5,160 5,210 5,370 25 yrs. and upwds. 11,430 11,690 12,015 12,210 12,350 12,700 All ages 26,400 27,000 27,720 28,200 28,500 29,350 Table B.—Annual Death-rate at 4 groups of ages. Year. Deaths per 1000 living. Ages. All Ages. Under 5. 5 to 15. 15 to 25. 25 & upwds. 1891 12.3 42.0 2.2 2.5 15'2 1892 13.2 41.3 3.0 2.0 14.5 1893 14.5 48.1 3.3 2.0 18.2 1894 10.6 32.6 4.4 2.5 12.3 1895 12.3 37.0 1.9 2.3 16.8 Average 12.6 40.2 3.0 2. 3 15.4 1896 13.2 49.1 2.2 3.9 14.7 Mean for England and Wales, 1891 to 1893. 19.5 63.5 3.8 4.7 22.0 14 Table C.—Notifications since adoption of the Notification Act. 1890. 1891. 1892. 1893. 1894. 1895. 1896. Private Houses. Public Institutions. Small-pox - - 7 1 2 - - - Scarlatina 109 85 117 316 99 51 35 30 Diphtheria 19 17 16 44 63 26 34 11 Membranous Croup 1 — - — 1 — 1 - Typhoid Fever 14 8 12 23 12 18 14 - Continued Fever — — — l — 1 2 - Puerperal Fever 1 1 1 4 6 1 — - Cholera — — — 1 — — — - Erysipelas 4 13 22 31 18 18 17 16 Measles 134 237 579 138 458 29 911 41 *Acute Diarrhœa — — - ~ 5 - - - Totals <82 361 764 559 664 144 1014 98 *Acute diarrhœa was a notifiable disease during September, 1894. Table D.—Notified cases of Infectious Disease in 1896, including institutions. Parishes. Addington. JBeddington. Coulsdon. Merton. Mitcham. Morden. Sanderstead. Wellington. Woodmansterne. Institutions. The District. Small-pox - - - - - - - - - - - Scarlatina — 1 4 6 12 — — 8 4 30 65 Diphtheria and Membranous Croup - 3 3 11 13 1 — 4 — 11 46 Typhoid Fever 1 2 1 7 — 1 2 — — 14 Continued Fever - - - - 2 - - - - - 2 Cholera — — — — — — — - Puerperal Fever - - - - - - - - - - - Erysipelas - 2 1 2 9 1 - 2 - 16 33 *Measles Medical - 112 28 133 499 5 - 27 5 41 850 Householders — 7 17 17 68 — — 3 — — 102 Totals — 126 55 170 600 7 1 46 9 98 1112 *Besides the notified cases of Measles, 131 others were discovered, through enquiries made by Inspectors and otherwise, to have occurred. 15 Table E.—History of Scarlet Fever, Diphtheria, and Measles in each Parish since Notification was adopted. Scarlet Fever Addington Beddington Coulsdon Merton Mitcham Morden Sanderstead Wallington Woodmansterne Institutions The District 1890 ... 4 9 2 63 ... ... 12 ... 19 109 1891 ... 10 13 4 29 1 ... 28 ... ... 85 1892 1 7 9 13 64 11 3 9 ... ... 117 1893 9 17 5 38 122 18 2 21 ... 84 316 1894 1 8 2 10 41 4 5 9 ... 19 99 1895 ... 3 6 2 27 4 ... 7 ... 2 51 1896 ... 1 4 6 12 ... ... 8 4 30 65 11 50 48 75 358 38 10 94 4 154 842 Diphtheria (including Membranous Croup) 1890 4 1 3 1 4 ... 2 5 ... ... 20 1891 ... 2 9 ... 5 ... ... 1 ... ... 17 1892 1 1 1 2 8 ... ... 3 ... ... 16 1893 3 12 ... 2 14 ... 4 9 ... ... 44 1894 ... ... 6 6 50 ... ... 2 ... ... 64 1895 ... ... 1 3 22 ... ... ... ... ... 26 1896 ... 3 3 11 13 1 ... 4 ... 11 46 8 19 23 25 116 1 6 24 ... 11 233 Measles 1890 ... 21 50 7 21 ... ... 35 ... ... 134 1891 ... 10 82 29 43 ... ... 73 ... ... 237 1892 13 53 79 26 342 38 22 6 ... ... 579 1893 2 8 9 15 64 1 ... 19 ... 20 138 1894 ... 14 19 4 27 2 ... 336 ... 56 458 1895 ... ... 5 8 7 ... ... 9 ... ... 29 1896* ... 124 47 205 626 5 ... 30 5 41 1083 15 230 291 294 1130 4G 22 508 5 117 2658 *Including 131 cases not notified. 16 Table F.— Measles in Mitcham, 1896. Week Ending. Fresh Gases. Houses freshly invaded. Schools attended by First Case in freshly invaded houses. No School. Schools outside District. Private. British. Killick's Road Lower Green Upper Grade. Singlegate. Catholic. Feb. 1 1 1 ... ... ... 1 ... ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... 15 ... ... ... ... ... ... ... ... ... ... ... 22 2 2 ... ... ... 2 ... ... ... ... ... 29 4 3 ... ... ... 2 ... 1 ... ... ... March 7 5 2 1 ... ... 1 ... ... ... ... ... 14 5 3 ... 2 ... ... ... ... ... 1 ... 21 5 4 ... 1 1 2 ... ... ... ... ... 28 14 12 4 ... 1 ... ... 1 ... 6 ... April 4 6 4 1 ... 1 ... ... ... ... 1 ... 11 7 5 ... 1 3 ... ... ... ... 1 ... 18 13 3 ... ... 2 ... ... ... ... 1 ... 25 14 5 2 ... 1 ... ... ... ... 1 1 May 2 8 5 1 ... ... ... ... 1 1 2 ... 9 25 15 1 1 ... 1 2 4 ... 3 4 16 8 7 ... ... ... 1 2 1 ... 3 ... 23 11 7 ... 1 ... 1 ... 2 1 2 ... 30 10 8 ... 1 ... ... 2 1 ... 4 ... June 6 4 2 ... 1 ... ... ... ... ... 1 ... 13 5 3 ... ... ... 2 ... ... 1 ... ... 20 11 5 3 1 ... ... 1 ... ... ... ... 27 17 8 2 ... 2 2 ... ... 2 ... ... July 4 22 18 6 ... 1 4 4 ... 2 1 ... 11 66 47 3 ... 4 17 15 3 3 2 ... 18 63 34 3 1 ... 11 11 ... 7 1 ... 25 93 48 22 ... ... 2 16 4 1 1 2 Aug. 1 53 31 7 ... 1 2 5 3 1 12 ... 8 46 15 7 ... ... 2 2 3 ... ... 1 15 35 15 6 ... ... 1 ... 1 ... 7 ... 22 15 9 3 ... ... ... 1 ... ... 5 ... 29 23 11 6 ... ... ... 1 ... ... 3 1 Sept. 5 11 4 1 ... ... ... ... 1 ... 2 ... 12 6 2 2 ... ... ... ... ... ... ... ... 19 3 1 ... ... ••• ... ... ... ... 1 ... 26 4 1 1 ... ... ... ... ... ... ... ... Oct. 3 3 2 1 ... 1 ... ... ... ... ... ... 10 1 1 ... ... ... 1 ... ... ... ... ... 17 3 3 1 ... 1 1 ... ... ... ... ... 24 ... ... ... ... ... ... ... ... ... ... ... 31 4 ... ... ... ... ... ... ... ... ... ... Dee 19 1 l 1 ... ... ... ... ... ... ... ... 626 347 84 11 19 56 62 26 19 61 9 Note. - The thick lines represent the period during which Day Schools were closed. One private school was closed in July. Sunday Schools were closed on July 26th until September 6th, except Singlegate, which was closed August 9th until September 13th, and the Salvation Army School closed 16th August. 17 Table G.—Measles in Merton and Beddington, 1896. Week Ending. MERTON. BEDDINGTON. Fresh cases. Houses freshly invaded. Schools attended by First Case. Fresh cases. Houses freshly invaded. Schools attended by First Case. No School. School outside District. Merton Abbey. Merton Park. Private. No School. Bandon Hill. Beddington Central. Others. Jan. 25 ... ... ... ... ... ... ... 1 1 ... 1 ... ... Feb. 1 1 1 ... ... ... ... 1 3 2 1 1 ... ... 8 1 1 ... ... ... 1 ... ... ... ... ... ... ... 15 11 4 ... 3 ... 1 ... 6 3 ... 3 ... ... 22 12 8 ... 5 1 1 1 5 3 ... 3 ... ... 29 8 1 ... 1 ... ... ... ... ... ... ... ... ... March 7 52 34 2 4 27 1 ... 1 1 ... 1 ... ... 14 31 13 ... 1 9 2 1 3 3 ... 2 ... 1 21 42 15 5 1 8 ... 1 ... ... ... ... ... ... 28 19 9 1 1 1 2 4 6 4 3 1 ... ... April 4 6 1 1 ... ... ... ... ... ... ... ... ... ... 11 7 ... ... ... ... ... ... 1 1 ... ... 1 ... 18 3 2 2 ... ... ... ... 2 2 ... 1 1 ... 25 2 1 ... ... 1 ... ... 3 3 3 ... ... ... May 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 2 1 ... 1 ... ... ... 2 1 1 ... ... ... 16 1 1 1 ... ... ... ... 1 1 ... ... 1 ... 23 ... ... ... ... ... ... ... 3 3 ... ... 3 ... 30 3 3 ... ... 3 ... ... 7 6 ... 1 4 1 June 6 2 2 ... ... 2 ... ... 11 4 1 ... 3 ... 13 1 1 ... ... 1 ... ... 7 3 1 ... 2 ... 20 2 ... ... ... ... ... ... 0 5 ... 1 4 ... 27 ... ... ... ... ... ... ... 5 2 1 ... 1 ... July 4 ... ... ... ... ... ... ... 11 5 1 2 ... 2 11 ... ... ... ... ... ... ... 11 4 2 ... 2 ... 18 ... ... ... ... ... ... ... 7 2 2 ... ... ... 25 .. ... ... ... ... 4 2 ... 2 ... ... Aug. 1 ... ... ... ... ... ... ... 4 1 1 .. ... ... 8 ... ... ... ... ... ... ... 8 6 2 4 ... ... 15 ... ... ... ... ... ... ... ... ... ... ... ... ... 22 ... ... ... ... ... ... ... 1 ... ... ... ... ... 29 ... ... ... ... ... ... ... ... ... ... ... ... ... Sept. 5 ... ... ... ... ... ... ... 1 1 ... 1 ... ... 205 98 12 17 53 8 8 124 69 19 24 22 4 Merton Abbey School was closed from March 9th to April 6th. No school was closed in Beddington. 18 Table H.—Cases of Measles classified according to 4 age=groups. Ages. Mitcham Merton. Beddington. Under 2 years 114 26 18 . 2 to 4 years 139 55 26 4 to 6 years 159 55 22 6 years and upwards 214 69 58 Total 626 205 124 Inspectors' Form of particulars obtained at houses infected with Infectious Disease. To the Medical Officer of Health. Nature of disease Date of visit Name and address of occupier Name and address of owner Names and ages of patients : Dates of attack : Ages and sexes of persons in house, with occupations, schools attended, &c. :— Sex, Age. Occupation. Place of work or school, j Last at work or school. Sunday schools attended and dates of last attendance Occupation (if any) carried on in house Name and address of milkman Place from which milkman obtains milk Name and address of laundry Describe water supply Describe cistern (if any), its position, materials, state of cover, its connec- tions with water closets and overflows, and the condition of its contents If supplied by well water, describe well completely Any other illness in house, now or recently State any facts pointing to source of infection Name of Medical Attendant Sanitary condition of premises and sur- roundings State if drains are outside premises Any other particulars Action (if any) taken by Inspector, and further proceedings proposed to be taken by him LOCAL GOVERNMENT BOARD TABLES. TABLE OF DEATHS during the Year 1896, 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 cadses, at subjoined ages. Mortality from 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. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy Heart Disease. Influenza. 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 ... 2 2 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 5 BEDDINGTON 19 6 1 2 2 4 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... 4 7 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 ... 1 5 12 coulsdon 32 11 2 1 ... 13 5 Under 5 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... ... ... 9 13 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 6 ... 1 9 19 merton 36 10 4 3 1 11 7 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 2 ... ... ... 9 14 5 upwds. ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... 3 ... 1 13 22 mitcham 197 63 40 7 9 39 39 Under 5 ... ... 2 1 ... ... ... ... ... ... ... 16 7 13 ... 3 19 ... ... 3 38 103 5 upwds. ... ... ... ... ... 2 ... ... ... ... ... 1 ... 1 1 12 11 11 ... 4 51 94 morden 5 1 ... ... ... 3 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 4 sanderstead 9 3 2 ... 1 2 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... 2 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 4 WALLINGTON 38 7 5 1 2 13 10 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 3 ... ... 1 6 12 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 2 ... 1 17 26 WOODMANSTERNE 6 3 ... ... ... 3 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 FEMALE ORPHAN ASYLUM BEDDINGTON ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... RUSSELL HILL SCHOOL, BEDDINGTON ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... REEDHAM ORPHANAGE, COULSDON 1 ... ... 1 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 CANE HILL ASYLUM, COULSDON 160 ... ... 1 7 107 45 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 16 16 1 1 116 160 HOLBORN WORKHOUSE, MITCHAM 40 ... ... ... ... 16 24 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 13 10 ... 1 9 40 HOLBORN SCHOOLS, MITCHAM 9 ... 5 4 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 4 Gross Totals 557 104 59 21 22 213 138 Under 5 ... ... 2 1 ... ... ... ... ... ... ... 22 13 17 ... 3 30 ... 1 4 70 163 5 Upwds. ... ... 2 ... ... 3 ... ... ... ... ... 2 ... 2 5 36 47 53 1 11 232 394 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 38 1 1 2 6 16 12 Under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 5upwds. ... ... ... ... ... 2 ... ... 1 ... ... ... ... 2 4 5 ... 4 18 36 Deaths occurring within the District among persons not belonging thereto, and which must be deducted from above 209 ... 5 5 7 123 69 Under 5 ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... 5 5upwds. ... ... ... ... ... ... ... ... ... 1 ... 1 1 15 29 26 1 2 128 204 CORRECTED TOTALS 386 105 55 18 21 106 81 Under 5 ... ... 3 1 ... ... ... ... ... 17 13 17 ... 3 30 ... 1 4 71 160 5 upwds. ... ... 2 ... ... 5 ... ... 1 1 ... 1 4 23 22 32 ... 13 122 226 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 1896, 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 op Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospitals. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Small-pox. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Census 1891. Estimated to middle of 1896. Typhus. Enteric or Typhoid Continued. Relapsing. Puerperal 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13 1. 2. 3. 4. ADDINGTON 670 670 19 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... BEDDINGTON 2607 3020 63 Under 5 ... ... ... ... ... ... ... ... ... ... 1 56 ... ... ... ... ... 5 upwds. ... 1 3 ... ... 1 ... ... ... ... 1 68 ... ... 1 1 ... COULSDON 3335 3860 74 Under 5 ... ... ... ... ... ... ... ... ... ... ... 21 ... ... ... ... ... 5 upwds. ... 4 3 ... ... 2 ... ... ... ... 1 26 ... ... ... ... 1 MERTON 3360 3655 90 Under 5 ... ... 2 ... ... ... ... ... ... ... ... 102 ... ... ... ... ... 5 upwds. ... 6 9 ... ... 1 ... ... ... ... 2 103 ... ... 2 ... ... MITCHAM 10758 11790 362 Under 5 ... 2 5 1 ... ... ... ... ... ... ... 332 ... ... 1 2 ... 5 upwds. ... 10 7 ... ... 7 2 ... ... ... 9 294 ... ... 6 1 1 morden 763 910 22 Under 5 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... 3 ... ... ... ... ... Sanderstead 509 660 16 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 WALLINGTON 3823 4300 99 Under 5 ... ... ... ... ... ... ... ... ... ... 1 11 ... ... ... ... ... 5 upwds. ... 8 4 ... ... 2 ... ... ... ... 1 19 ... ... 2 1 ... WOODMANSTERNE 408 485 20 Under 5 ... 2 ... ... ... ... ... ... ... ... ... 3† ... ... 2 ... ... 5 upwds. ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... FEMALE ORPHAN ASYLUM BEDDINGTON ... (145)* ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 18 7 ... ... ... ... ... ... ... 1 ... ... ... 1 l ... RUSSELL HILL SCHOOL, BEDDINGTON ... (275)* Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... REEDHAM ORPHANAGE, COULSDON ... (300)* ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... CANE HILL ASYLUM, COULSDON 1115 2110 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 5 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... HOLBORN WORKHOUSE, MITUHAM 892 700 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... HOLBORN SCHOOLS, MITCHAM 477 480 ... Under 5 ... ... 3 ... ... ... ... ... ... ... ... 22 ... ... ... 1 ... 5 upwds. ... 7 1 ... ... ... ... ... ... ... 14 19 ... ... 6 1 ... Totals 28717 32640 765 Under 5 ... 4 10 1 ... ... ... ... ... ... 3 549 ... ... 3 3 ... 5 upwds. ... 61 35 ... ... 14 2 ... ... ... 30 534 ... ... 20 5 3 (Excluding last 3 Institutions) 26233 29350 * Included in Beddington and Coulsdon. † These cases were at Smitham Bottom, practically in Coulsdon parish,but technically in the parish of Woodmansterne.