CRO 7 HEALTH REPORT FOR 1905 of the Croydon Rural District by the Medical Officer of Health. Submitted to the Council 15th March, 1906. Wallington: William Pile, Ltd., Printers, 19, Manor Road. r< Croydon Rural District Council. HEALTH REPORT FOR 1905. Miss Boobbyer and Gentlemen, I beg to submit to you my eighth Annual Report upon the Health and Sanitary condition of the District. Appended are certain special reports, together with statistical tables, and the report on the working of the Factory and Workshop Act, in accordance with the requirements of the Home Office. The Death Rate, 9.6, is much lower than in any previous year during which I have been your Medical Officer. The Birth Bate is also extremely low being 25.7 per thousand of estimated population. The year 1905, generally speaking, has been a fairly healthy one, with no serious outbreaks of epidemic disease. It is with pleasure that I have again to place on record the kind help and assistance which I have received from the Council and all its officers with whom my work has brought me into contact. I have the honour to be, Your obedient servant, C. M. FEGEN. March 15, 1906. CONTENTS. pages. I.—Area and Population 7 to 9 II.—Vital Statistics 10 to 15 III.—Infectious Disease 15 to 20 IV.—Preventive Measures 20 to 23 V.—Isolation Hospital 23 to 25 VI.—General 25 to 29 VII.—Inspector's Work 29 to 31 Appendices— Statistical Tables34 to 49 Factory and Workshops Act 52 to 55 Infantile Summer Diarrhoea 50 Special Report on Typhoid Fever at Mitcham and Merton 56 to 57 Special Report on Watercress Beds 58 to 60 Index 61 to 63 REPORT. I.—AREA AND POPOLATION. The District consists of nine parishes, and the total area is 22,766 acres. The largest Parish is Coulsdon, with 4,314 acres, and the smallest Wallington, with 823 acres. In the year 1901, at the time of the last Census, the population was 38,071, but omitting the three large institutions, viz.:— The Cane Hill Asylum, the Holborn Workhouse, and the Holborn Schools, the total population was 34,180, of which number 16,202 were males and 17,978 were females. At the middle of 1905, the population was estimated to have increased to 59,507, but omitting all institutions, the corrected number was 54,763, of which number 26,792 were males and 27,971 were females. The number of inhabitants in the three large institutions has increased from 2,468 in 1891 to 3,878 in 1905 ; this shows an increase of 3 since the middle of 1904. The number of occupied houses in the District was : In 1881 3,730 ,, 1891 4,845 „ 1900 6,597 „ 1901 7,027 „ 1902 7,694 „ 1903 8,316 ,, 1904 9,421 ,, 1905 10,493 8 This shows an increase of 6,763 in the number of houses occupied during the last 24 years, and in nearly every parish the supply is unequal to the demand. The subjoined table will show the number of houses in each parish in the years 3891, 1901, 1902, 1903, 1904, and 1905, and also the increases between the years 1891 and 1901, 1901 and 1902, 1902 and 1903, 1903 and 1904, 1904 and 1905, and the total increase during the years 1891-1905. Parish. Number of Houses Increase Between 1891 land 1901 Between 1901 and 1902 Between 1902 and 1903 Between 1903 and 1904 Between 1904 and 1905 Between 1891 and 1905 In 1891 In 1901 In 1902 In 1903 In 19! 4 In 1905 Addington 132 131 120 120 138 134 -1 -11 — 18 -4 2 Beddington 442 751 825 933 1035 1169 309 74 108 102 134 727 Coulsdon 537 818 903 1001 1244 1365 281 85 98 243 121 828 Merton 654 1027 1218 1348 1620 1861 373 191 130 272 241 1207 Mitcham 2055 2743 2934 3076 3337 3806 688 191 142 261 469 1751 Morden 138 186 195 196 210 206 48 9 1 14 — 4 68 Sanderstead 96 203 211 250 309 342 107 8 39 59 33 246 WallingtoN 710 1063 1168 1272 1388 1464 353 105 104 116 76 754 Woodmansterne 81 105 120 120 140 146 24 15 20 6 65 4845 7027 7694 8316 9421 10493 2182 667 622 1105 1072 5648 It will be seen from this table that great activity in building has taken place at Mitcham with 469 new houses, Merton with 241, Beddington with 134, and Coulsdon with 121. In the District generally the average number of persons occupying each house in 1891 was 5.4, but at the census in 1901 it was found to have fallen to 4.8, while for 1905 it is estimated at 5.0. The average number of persons per inhabited house remains as a general rule fairly constant for each locality, 9 though varying considerably in different parishes according to the class of house erected recently. In many parts of the district "tenement" house or houses let in flats have been built, such houses of course having a considerably larger number of inmates. The natural increase during the year has been 879 more births than deaths. In 1897 the increase was 474 „ 1898 ,, 892 „ 1899 „ 379 „ 1900 „ 460 „ 1901 ,, 543 „ 1902 „ 552 „ 1903 ,, 730 „ 1904 „ 763 ,, 1905 „ 879 It has amounted to 7,834 since the census in 1891. The greatest excess of Births over Deaths in 1905 was at Mitcham with 372, Merton with 178, Coulsdon with 111, and Wallington with 93. Excess of Births over Deaths. Deaths in 1905. Births in 1905. Excess of Birtha in 1905. Addington 11 11 Beddington 39 123 84 Coulsdon 39 150 111 Merton 80 258 178 Mitcham 270 642 372 Morden 15 20 5 Sanderstead 8 28 20 Wallington 62 155 93 Woodmansterne 5 21 16 529 1408 879 10 II.—VITAL STATISTICS. Births. The number of Births registered in the District was 1408, as compared with 1284 in 1904, 1161 in 1903, 976 in 1902, 961 in 1901, and 862 in 1900. Of this number 22 children were registered as being illegitimate. This gives an illegitimate birth-rate of 1.5 per cent. of total births. No. of Illegitimate Births, Percentage. Beddington 3 2.4 Merton 4 1.5 Mitcham 14 2.1 Wallington 1 .6 The birth rate for the year for the entire District was 25.7, as compared with 27.3 in 1904, 28.2 in 1903, 26.0 in 1902, 28.11 in 1901, and 23.1 in 1900. The birth rate in England and Wales in 1905 was 27.2 per thousand of the population, which is 0.7 per thousand below the rate in 1904, and is much lower than the rate in any other year on record; compared with the average of the decade 1895-1904 the birth rate for 1905 shows a decrease of 1.8 per thousand of population. Registered Births and Birth Rates. Estimated Population middle of 1905. Registered Births. Birth Bates. 1901 1902 1903 1904 1905 1901 1902 1903 1904 1905 Addington 670 14 10 7 13 11 21.8 16.1 11.3 18.5 16.4 Beddington 5789 85 84 101 144 123 22.1 20.7 22.0 27.8 21.0 Coulsdon 7137 90 108 122 149 150 22.0 23.4 23.6 23.1 21.2 Merton 9150 164 168 '221 219 258 36.3 31.4 36.4 29.3 28.1 Mitcham 20617 409 428 497 542 642 30.3 29.5 32.0 31.8 31.1 Morden 1035 26 27 25 24 20 27.0 27.0 24.5 21.8 19.5 Sanderstead 1660 22 15 26 28 28 21.9 14.3 20.6 18.0 16.3 Wallington 7935 126 120 152 142 155 24.4 20.9 24.0 20.6 19.8 Woodmansterne 770 25 16 10 23 21 46.8 26.2 16.3 31.2 27.2 54763 961 976 1161 1284 1408 28.1 26.0 28.2 27.3 25.7 11 Deaths. Exclusive of those Deaths which occurred in public Institutions situated within the district, the deaths registered during the year numbered 529. This number includes those persons from within the district who died outside, either at the Workhouse, Workhouse Infirmary, or at the General Hospital at Croydon; the Surrey County Asylum at Brookwood; the Cottage Hospital at Carshalton; or the Council's Isolation Hospital at Beddington Corner. The number of these Deaths was 92. The mortality corresponds to a death rate of 9.6 per thousand of population, as against 11.0 in 1904, 10.4 in 1903, 11.3 in 1902, 12.2 in 1901, and 12.0 in 1900, and as against an average of 11.9 during the ten years 1904-1895. The death rate in 1905 for the whole of England and Wales from all causes was 15.2 per thousand, which is 1.0 per thousand below the rate in 1904, and lower than the rate in any other year on record; compared with the average rate in the ten years 1895-1904, the death rate in 1905 shows a decrease of 2.0 per thousand. 12 Mortality.* Parish. Population estimated to middle of 1905. Deaths. Death Rates. 1901 1902 1903 1904 1905 1901 1902 1903 1904 1905 Addington 670 9 12 5 11 11 14.0 19.3 8.0 15.7 16.4 Beddington 5789 29 30 34 45 39 7.5 7.4 7.4 8.7 6.7 Coulsdon 7137 40 31 40 41 39 9.8 6.7 7.7 6.3 5.4 Merton 9150 62 71 70 75 80 13.9 13.2 14.5 10.0 8.7 Mitcham 20617 200 202 195 247 270 14.8 13.9 12.9 14.5 13.0 Morden 1035 13 9 13 7 15 13.5 9.0 12.7 6.3 14.4 Sanderstead 1660 4 7 8 16 8 3.9 6.6 6.3 10.3 4.7 Wallington 7935 54 57 58 74 62 10.4 9.9 9.1 10.7 7.8 Woodmansterne 770 7 5 8 5 5 13.1 8.2 13.6 6.8 6.4 54763 418 424 431 521 529 12.2 11.3 10.4 11.0 9.6 * Exclusive of deaths of non-residents occurring in public institutions in the District, but inclusive of deaths of residents occurring in public institutions outside the District. N..B.—The number of deaths occurring to non-residents in public institutions in the District in 1905 was 178. Mortality at Different Ages. Infantile Mortality.—The number of infants under the age of one year who died during 1905 was 138, as. against 158 in 1904, 109 in 1903, 106 in 1902, 105 in 1901, and 102 in 1900, the infantile mortality rate, therefore, being 98 per thousand births, as against 123 in 1904, 94 in 1903, 108 in 1902, 109 in 1901, and 118 in 1900, and an average of 120 in the ten years 1895 to 1904. The deaths of children under the age of one year, numbering 138, gives a rate of 26.0 of the deaths at. all ages, as against 30.3 in 1904, 25.5 in 1903, 25 0 in 1902, and 25.1 in 1901, and 25 3 in 1900. The rate of mortality in England and Wales among infants under one year of age to thousand registered births was 128, which is 18 per thousand below the rate 18 in 1904, and lower than the rate in any other year on record. Compared with the average in the ten years 1895-1904, the rate of infantile mortality shows a decrease of 22 per thousand. The deaths of children between the ages of one and five years, numbering 41, gives a percentage rate of 7.7 of total deaths, as against 8.0 in 1904, 6.7 in 1903, 9.2 in 1902, and 11.7 in 1901, and 9.2 in 1900. The deaths occurring in persons over 65 years of age, numbering 145, gives a percentage of 27.4 of total deaths as against 22.8 in 1904, 28.3 in 1903, 27.5 in 1902, 25.1 in 1901, and 30.3 in 1900. Parish. Children under One Year. Children between One and Five. People over 65 Years. 1902 1903 1904 1905 1902 1903 1904 1905 1902 1903 1904 1905 Addington 3 1 2 1 .. 1 .. .. 3 3 3 .. Beddington 9 6 15 9 2 1 1 1 6 9 9 9 Coulsdon 7 9 9 8 4 3 3 5 10 10 13 11 Merton 23 20 21 22 5 4 5 2 19 16 19 19 Mitcham 56 57 86 78 25 15 31 26 47 53 44 72 Morden 1 5 3 3 .. 1 .. 2 5 2 3 6 Sanderstead .. 2 6 2 .. 1 .. 1 3 3 3 2 Wallington 4 8 15 13 3 2 2 3 22 23 24 25 Woodmansterne 3 1 1 2 .. 1 .. 1 2 3 1 1 Totals 106 109 158 138 39 29 42 41 117 122 119 145 Causes of Deaths. The deaths registered in 1905 included— 10 from Measles. 4 „ Whooping Cough. 15 ,, Diarrhœa. 38 ,, Phthisis. 7 ,, Influenza. 14,, Injuries (self-inflicted or otherwise). 84 ,, Lung Complaints. 29 ,, Cancer (malignant disease). 11 ,, Alcoholism (cirrhosis of liver). 14 The Zymotic Death Bate is a term commonlyapplied to the rates of deaths occurring from the seven principle zymotic complaints:—Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Diarrhoea and "Fever"; which latter term includes Typhus, Typhoid (or Enteric) and Puerperal Fevers. Failing the year 1S05 the deaths from these complaints numbered 53, the Zymotic Death Pate therefore, being 0.9 per 1,000 of population, as compared with 1.5 in 1904, 1.7 in 1903, 1.04 in 1902, 1.9 in 1901, and 1.2 in 1900. The deaths from Phthisis numbered 38 as against 37 last year, 33 in 1903, 19 in 1902, and 26 in 1901. The Phthisical Death Pate is, therefore, 0 6 per thousand of population as against 0.7 in 1904, 0.8 in 1903, 0.5 in 1902, and 0.7 in 1901. The deaths from Pulmonary Diseases numbered 84 as against 126 last year, 61 in 1903, 74 in 1902, and 89 in 1901. This gives a Death Rate of 1.5, as against 2.6 last year, 1.4 in 1903, 19 in 1902, and 2.3 in 1901, per 1,000 of population. The deaths from Influenza numbered 7 as against 10 last year, 6 in 1903, 8 in 1902, and 7 in 1901. This gives a Death Rate of 01 per 1,000 of population, as against 0.2 last year, 0.14 in 1903, 0.2 in 1902, and 0.2 in 1901. To various forms of Violence, whether self-inflicted or otherwise, 14 deaths were due, in all of which cases inquests were held. This gives a Death Rate of 0.2, as against 0.48 last year, 0.5 in 1903, 0.4 in 1902, and 0.43 in 1901. 15 Birth Rate, heath Rate, and Analysis of Mortality in the year 1905. Annual Rate per 1000 living. Births. Deaths. Principal Epidemic Diseases. (Cols. 4-10) Small-pox. Measles. Scarlet Fever. Diphtheria Whooping Cough. Fever. Diarrhoea. Deaths under one year to 1000 Births. Cols. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. England and Wales} 27 2 15.2 1.52 0.00 0.32 0.11 0.16 0.25 0.09 0.59 128 76 Great Towns 28.2 15.7 1.88 0.00 0.39 0.13 0.16 0.29 0.08 0.83 140 141 smaller Towns 26.9 14.4 1.50 0.00 0.31 0.11 0.15 0.23 0.13 0.57 132 England aud Wales, less the 217 Towns} 26.3 14.9 1.09 0.00 0.24 0.09 0.15 0.20 0 .09 0.32 113 Croydon Rural District 25.7 9.6 0.94 0.00 0.18 0.03 0.32 0.07 0.05 0.27 98 Deaths in Institutions. The Deaths in Institutions situate in the District numbered 178, as against 210 in 1904, 203 in 1903, 219 in 1902, 200 in 1 01, and 249 in 1900. These deaths included :— 16 from Phthisis. 5 ,, Cancer. 24 ,, Lung Complaints. 15 ,, Heart Diseases. III.—INFECTIOUS DISEASE. The Infectious Disease (Notification) Act has been in force in this District since the year 1890. In July of that year Measles was also included in the list of notifiable diseases, and in the summer of 1894, it was considered necessary that Diarrhoea should, for a short period, also be considered a notifiable disease. Owing 16 to the epidemic of Small Pox that existed in and around London, as well as the Croydon Rural District, during the latter part of 1901 and the beginning of 1902, Chicken Pox was also made a Notifiable Disease, and continued to be so until the end of July, 1903. It was of great assistance in combating the outbreak of Small Pox. The Infectious Disease (Prevention) Act is also in force in this District. During the year 1,076 cases of Infectious Disease were either notified to the Sanitary Department or came to its knowledge through the vigilance of its Inspectors. Of this number 679 were due to Measles. Consequently, excluding this disease, there were 397 cases of other Notifiable Diseases, as against 333 in 1904, 227 in 1903, 321 in 1902, 202 in 1901, and 230 in 1900. Reference to Table 111. at the end of the report will show — Firstly, cases notified in the whole District, with the ages of incidence and the nature of the Infectious Disease. Secondly, the total number of cases (and nature of the disease) in each locality. Thirdly, the number of cases removed from each locality to the Isolation Hospital. Scarlet Fever. During the year 181 cases of Scarlet Fever were notified, and the largest number of cases came from Mitch am. The number is in excess of the number of cases notified during 1904, but out of this number the disease had a fatal ending in only two cases. 17 One very instructive outbreak occurred in Mitcham, in which the disease was undoubtedly milk-borne. Within a very short period 28 cases were notified as occurring in Mitcham, and it was found that in 22 instances the milk came from one dealer, in nearly all of the other cases direct contact with infected houses was traced. On visiting the vendor's farm nothing was found to be faulty with the cows or with the general cleanliness, etc.*, of the place, but a child was there looking ill, and on examination he was found to have some swelling of the legs and also desquamation of the hands, feet and body. I was informed that he was under treatment for Bright's disease, and that he was employed scouring out the utensils. Undoubtedly he had Scarlet Fever, and was the cause of the outbreak in the neighbourhood. On removing this source of infection no other cases occurred which could be traced directly to this milk supply. This "missed case" directly and indirectly was the probable cause of between 40 and 50 cases in Mitcham. In three instances "return cases" unfortunately occurred, and in each case it was found that the patient discharged had contracted a "cold" within a few days of returning home, and this nasal discharge may probably have been the source of infection. The practice at the Isolation Hospital is for no patient to be discharged until I am satisfied that no infectivity from the throat, ears, nose, skin, or eyes exists. The following warning is given to parents and friends on thedischarge of the patients, but I find that this recommendation is practically always ignored. 18 Notice to Parents, Guardians, and others. Although every care is taken to prevent carriage of infection by persons discharged from the Hospital, it is impossible in some' cases to ensure against such an accident. Parents and others are cautioned against allowing recently discharged patients to come into unnecessarily close contact with others, nor to be allowed to sleep in the same bed as another, or to attend school for at least a fortnight after discharge. C. M. Fegen, Medical Officer of Health. I believe that "return eases" occur owing to the want of attention given, especially to small children, by parents after return from the Hospital, which is so great; a contrast to the care and attention both in feeding and clothing, which they have received there, that on their return home they speedily contract colds, etc , which possibly induce a recrudescence of the infection, and so give rise to further cases amongst susceptable persons, with whom they are brought into contact. Infantile Summer Diarrhœa. During the year 24 deaths occurred. This compares, favourably with the mortality of the last two years, which was 39 in 1904 and 28 in 1903, Reference to Table XIII. in the appendix will show the circumstances of each individual case, and the condition of the domestic surroundings. 19 During the year street watering and scavenging were more extensively and carefully carried out in the localities, which, in previous years had suffered mostly from this, to a large extent, preventable disease. Diphtheria. During 1905, 134 cases of Diphtheria occurred in the district, as against 169 in 1904. There were 18 deaths, two occurred in cases not admitted to the Hospital, and of the 16 deaths in the Hospital, nine deaths occurred within 72 hours of admission. Formerly the average mortality in Diphtheria was rarely below 40 per cent. of the persons attacked, but since the introduction of antitoxin the general mortality has fallen to about 10 per cent. I consider that in all doubtful cases antitoxin should be administered, and that during the progress of the disease moderate doses should be repeated at about 12 hours interval until the membrane shows signs of separating or the urgency of the symtoms shows materially diminusion. Antitoxin is supplied free of charge to all medical men practising in the district, and as most of the cases occur amongst the very poor, the question of expense to them in providing antitoxin does not arise, so no reason exists why antitoxin should not be given at the earliest possible moment as soon as the disease is even only suspected. 20 Typhoid Fever. During the year 18 cases of Typhoid Fever were notified. A special report in the appendix will be found relating to an outbreak in Mitcham and Merton connected with the sale of "stewed eels." Phthisis. A further increase in the number of deaths occuring from Phthisis will be noticed, namely 38 as against 37 in the previous year. This increase is perhaps not excessive if the large growth of the district is taken into consideration. During the year I have examined the sputum of 47 persons, with a positive result in 40 cases. In all 192 such examinations were made. Disinfection (repeated in several instances) has been largely carried out in the rooms occupied by Phthisical persons, and the clothing, &c., has been systematically dealt with at the Council's Disinfecting Station. IV.—PREVENTIVE MEASURES. During the year 268 patients were admitted to the Isolation Hospital at Beddington Corner, including 3 patients from neighbouring authorities; while to the Small Pox Hospital at North Cheam 1 patient was admitted. The usual routine preventive and precautionary measures have been continued as in previous years to check the extension of infectious disease with most satisfactory results. Isolation, disinfection and quarantine have been carried out under the careful and 21 intelligent supervision of the Sanitary Staff, and outbreaks of infectious disease have been very materially limited. Unrecognised cases as in previous years have been the origin of most outbreaks, and such unrecognised cases are always likely to exist in all diseases especially if the attack is a very mild type, so mild indeed are some of these cases that the advice of a medical man is, by the parents of the patients considered superfluous. These, unfortunately, are the cases which prove the nuclei of almost every epidemic. This has been particularly the case in the outbreaks of Scarlet Fever in Mitcham, Coulsdon and Woodmansterne, and Typhoid Fever in Mitcham and Merton. Immediately on notification being received of the existence of cases of Scarlet Fever, Diphtheria, Typhoid Fever, and Small Pox, it is the custom to offer hospital treatment, and if the offer is accepted the patient is at once removed to the Hospital; in no case should longer than two hours elapse after receiving the intimation of the existence of infectious disease in any house before the patient, if for removal is in the Hospital, unless the ambulance is in use removing another case, when removal may be delayed considerably. This delay is to be deprecated in all cases of diphtheria. In all cases of Typhoid Fever which are not admitted to the Hospital, sanitary pails, of a special character, furnished with air-tight screw lids, are left at the infected houses for the reception of all excreta and other waste products of the sick room. These pails are collected daily, and their contents are dealt with in the destructor at the Hospital. 22 In every case of Notifiable Disease enquiries are made and recorded as to the number of persons in the house, where they are employed, milk supply, water supply, laundry, conditions of drains. etc., together with the history of the case and the probable cause of infection. Notice is at once sent to any school attended by children from infected houses, and these children are then excluded from school on my certificate, and are not allowed to return until due notice has been given to the school authorities. Disinfection of infected rooms is carried out by fumigation with sulphur dioxide or formic aldehyde, and of the bedding and the clothes in the steam disinfector at the disinfecting station at the Isolation Hospital. Disinfectants are supplied free of charge during illness. After the rooms have been disinfected the owners of the premises are required to strip and whitewash the ceilings and walls, under the supervision of the Sanitary Inspectors. This applies to all cases of Infectious Disease, and in the event of cases of Phthisis or Cancer occurring, on request, the rooms, as well as the bedding, clothing, etc., are from time to time disinfected. The Council places at the disposal of all medical practitioners, free of charge, means of having the diagnosis of all cases of infectious or contagious disease confirmed or otherwise by bacteriological examination, and also, at the end of the illness, for determining whether the patient is free from the specific bacterium or not. During the year 779 such examinations have been made. 23 While with regard to Diphtheria it is the custom to consider each case infective until the batriological examination shows the throat to be free from the true or pseudo-diphtheritic bacillus. The Isolation Hospital at Beddington Corner was opened at the beginning of March, 1869, and since that date 1,200 patients have been admitted. Accommodation.—The Isolation Hospital was opened to provide accommodation for 28 patients, namely :—10 beds for Scarlet Fever, 10 beds for Diphtheria, and 4 beds for Typhoid Fever, and 4 beds for doubtful cases. However, almost from its earliest days the accommodation proved unequal to the demand. In 1904, a contract was entered into by the Council to considerably extend the accommodation at the Hospital, and in June 1905, an addition Scarlet Fever pavilion was completed, and has practically been full during the remainder of the year. Staff.—The Staff consists of— During the year 268 patients have been admitted, of which number V.— ISOLATION HOSPITAL. 1 Matron 4 Servants 1 Assistant Matron 4 Wardmaids. 6 Nurses 1 Gardener 3 Probationer Nurses 2 Engineers 2 Laundresses Porter and Portress 1 Seamstress. 145 were suffering from Scarlet Fever 109 ,, Diphtheria 11 „ Typhoid Fever 3 ,, Erysipelas 24 Three cases were admitted by arrangement with other authorities. Twenty-two patients died Two from Scarlet Fever, 16 from Diphtheria, three from Typhoid Fever, and one from Erysipelas. The throat and nasal passages of every patient admitted to your Hospital were examined, and it was found that out of the 254 cases of Scarlet Fever and Diphtheria admitted :—229 had enlarged tonsils, 77 had adenoid growths, 43 had nasal polypi, 31 had previous attacks of tonsilitis, 3 Scarlet Fever and 2 Diphtheria had had a previous attack for which they were admitted, and 37 cases were found to be suffering from both Scarlet Fever and Diphtheria. During the year, after admission to the Scarlet Fever wards, it was found that in several cases Whooping cough, chicken pox, and ringworm were coincident complications of the disease. Every case is regarded as being infectious so long as any congestion of the throat or fauces existed, or where there was any cough or any discharge from either the ears or nose, or when any sore existed, and until these troubles had entirely disappeared no patient is discharged from the Hospital, thus minimising to a large extent the always possible risk of the occurrence of " Return Cases." 25 Parish. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Addington 1 .. .. .. 1 .. .. .. 2 .. Beddington 12 .. 6 1 .. .. .. .. 18 1 Coulsdon 9 .. 11 .. .. .. .. .. 20 .. Merton 24 1 4 .. 7 2 .. .. 35 3 Mitcham 70 .. 77 14 3 1 3 1 153 16 Morden 3 .. 1 .. .. .. .. .. 4 .. Sanderstead 6 1 5 .. .. .. .. .. 11 1 Wallington 10 .. 5 1 .. .. .. .. 15 1 Woodmansterne 7 .. .. .. .. .. .. .. 7 .. Cases admitted by arrangement— Caterham 3 .. •• .. .. .. •• .. 3 •• Totals 145 2 109 16 11 3 3 1 268 22 VI.—GENERAL. Water Courses.—The condition of all water courses is under the constant supervision of your officers, and material improvements have been effected and continued. House Refuse Collection.—The collection of house refuse has again been largely extended during the year. Except in the very rural portions, no part of the district is now without frequent and adequate collection. Nuisances have from time to time been dealt with with regard to the deposits made in this district of house refuse, which is brought in, both by road and rail more particularly from the Metropolis. * Legal Proceedings.—In the following cases legal proceedings were taken :— 26 Particulars. Result. For permitting a nuisance to exist at Grand Drive, Merton, arising from defective drainage. Fined 40s. and 10s. 6d. costs, and an order made to do the necessary work. Proceedings under the Housing of the Working Classes Act, at Common. side East, Mitcham. Summons withdrawn. Owner having carried out an undertaking to. demolish the cottage. For permitting an old tram car and railway carriage to be used as dwellings at Sanderstead. Closing orders granted by the Justices under the Housing of the Working Classes Act, and defendant to pay the costs. For refusing permission to inspect a dwelling house at Godstone Road, Kenley. Case adjourned to allow defendant opportunity of granting facilities for inspection. REGULATED TRADES. (1) Dairies, Cowsheds and Milkshops. There were 98 premises registered under the Dairies, Cowsheds and Milkshops Order at the end of the year. During the year a very considerable amount of attention was paid to all dairies, cowsheds, milkshops, and the milk supply generally in the district. As milk is the staple food for all children and most invalids it is absolutely essential that the milk should be from healthy cows kept in an healthy and natural manner, and that no preservatives whatever should be used. Representations have been made with regard to the manner in which the Food and Drugs Act has been administered, and it is to be hoped that in the future the administration will not be such as it has been during the last three years. 27 (2) Slaughterhouses. There are 20 slaughterhouses in the district, all of which are regulated by the bye.laws of the Council. They have received very full attention from your officers. (3) Bakehouses. There are 35 bakehouses in the District. This is 3 more than the previous year. (4) Piggeries As usual with the hot weather, came several complaints of the piggeries, more particularly in Eastfields, Mitcham. All the piggeries in the District are receiving special attention from your officers. Parish. Dairies. Cowsheds. Milkshops. Butcher's Shops. Slaughterhouses. Piggeries. Bakehouses. Addington .. 2 1 .. .. .. .. Beddington 1 3 5 5 1 3 4 Coulsdon 3 10 4 6 6 .. 4 Merton 4 5 6 11 4 4 6 Mitcham 12 7 18 15 7 53 14 Morden .. 2 .. .. .. 3 1 Sanderstead 2 3 .. .. .. .. .. Wallington 2 2 6 6 2 .. 6 Woodmansterne .. .. .. .... .. .. .. Totals 24 34 40 43 20 63 35 Housing of the Working Classes Act. During the year 14 houses have been dealt with under the Housing of the Working Classes Act, and in 10 instances the houses were put into a satisfactory condition, in 4 instances the houses were closed on Justice's orders. 28 SANITARY SURVEYOR'S DEPARTMENT. I am indebted to Mr. Chart for the subjoined information. Sewers. Main sewers have been extended by the Council at Old Lodge Lane, Higher Drive, and Smitham Bottom, Coulsdon; at Grand Drive, Merton, and Furzedown, Mitcham; in addition to the sewers that have been laid for the drainage of private estates. The rapid development of the portion of the district south of Croydon, in the Parishes of Coulsdon, Sanderstead, and Woodmansteine points to the need in the immediate future of the provision of sewers, and negotiations are proceeding with the Croydon Corporation with the view of extending the area now draining by agreement to the Corporation Sewers. A Scheme has been prepared for the Sewering of the area lying South.West of the Epsom and Leather. head line of Railway at West Barnes, Merton, a neighbourhood which is rapidly being built over, and the development of which is being brought about by the construction of the Tramway line, which will eventually connect London County with Wimbledon and Kingston. Sewage Disposal Works. Plans have been prepared for the construction of one acre of additional filters at the Sewage Works; these plans are now before the Local Government Board. The disposal of the pressed sludge has caused the Council considerable anxiety, the land utilized for this purpose for some years passed being now exhausted; plans were prepared for the erection of a Destructor, but in the 29 meantime an offer was received to convey the sludge away by rail and a contract to effect this has been entered into, and is in operation. The Council has authorised the monthly analysis of the effluent, and the reports show that a good standard of purification is attained. New Streets and Buildings. Plans have been deposited for the laying out of 26 new streets, and for 1,823 buildings in the District. MAKING UP OF NEW STREETS. During the year the following New Streets have been made up, under the provisions of the Private Street Works Act:— Mitcham—Inglemere Road. Beddington—Demesne Road, Foxley Lane. Merton—Chestnut Road, Savoy Road, Beacon Road. Wallington—Park Hill Road, Brambledown Road. VII.—INSPECTORS' WORK. Subjoined appears a summary of the Inspectors' work during the past year. It will be seen that no less than 8,905 visits have been paid by them, as against 7,904 in 1904, 8,083 in 1903, 9,244 in 1902, 7,777 in 1901, and 5,628 in 1900. I have again to bear testimony to the extreme care and accuracy, and the unceasing vigilance which each Inspector displays in the carrying out of his arduous, and very often extremely unpleasant duties. 30 Summary of Inspectors' Work for the Year 1905. lnsnectors. White Rabbetts Payne Poln ton Total Total number of visits paid Number of complaints received and 2130 2661 2718 1396 8905 investigated 87 65 40 43 235 Number of premises inspected 310 655 753 346 2064 Number of nuisances discovered 237 398 188 162 985 Nuisances abated without report 232 242 95 109 678 „ „ after report 5 93 90 53 241 Preliminary notices served 127 174 123 63 487 Legal notices served 5 39 11 24 79 Notices followed by legal proceedings . 2 2 — 4 Character of Work Done— Houses dealt with under the Housing of the Working Classes Act 1 11 3 — 15 Houses cleansed and repaired generally 63 41 36 23 163 Ventilation of houses improved 3 20 2 — 25 Overcrowding abated 1 4 2 1 8 Defective roofs repaired 47 45 25 15 132 Houses under.pinned (damp proof course inserted or damp walls remedied 8 11 4 . 23 Eaves guttering renewed or repaired 50 41 22 8 121 Water.closets renewed or repaired 52 65 18 12 147 Water.closets provided with water for flushing 59 60 19 27 165 Privies or earth.closets reconstructed, improved or abolished 2 2 5 . 9 Privies or earth.closets abolished, and water.closets substituted 1 . 5 . 6 Houses supplied with water from the main 1 . 3 1 6 Water tanks or cisterns cleansed or covered 9 31 2 1 43 Yards of houses paved with impervious material 11 11 4 4 30 Paving of yards repaired 17 15 8 4 44 Floors of sculleries paved or repaired 9 22 5 4 40 Ashpits or dustbins provided 18 82 12 9 121 Cesspools abolished and filled up 1 — 6 — 7 Cesspools cleansed 9 2 15 12 38 Houses at which drains were tested 56 59 70 17 202 Houses at which drains were found defective 41 46 25 16 128 Houses at which drains were re.constructed or new provided 15 45 15 4 79 Houses at which drains were cleansed, ventilated, trapped or repaired 53 109 47 7 216 31  Inspectors. White Rabbetts Payne Pointon Total Number of drain tests made in course of work done under the two previous headings 70 89 49 34 242 Houses at which inspection chambers in drains were provided 24 26 13 4 67 Stables provided with drainage 2 3 4 — 9 Premises at which animals improperly kept were removed 1 13 2 — 16 Number of inspections of food exposed for sale 133 46 150 51 380 Urinals cleansed and repaired 1 2 2 — 5 Smoke nuisances abated 3 — 1 1 5 Offensive accumulations removed 9 45 23 5 82 Piggeries repaired and improved 2 18 — 3 23 Infective houses disinfected and cleansed 51 140 44 48 283 Visits to infective houses 204 335 294 176 1009 Number of dairies and milkshops 19 33 25 21 98 Visits to ditto 153 111 239 76 579 Number of complaints as to un. cleanliness and neglect of regulations 7 15 14 5 41 Number of slaughterhouses 3 5 6 6 20 Number of visits to same 62 81 109 42 294 Number of complaints as to un. cleanliness 4 12 5 1 22 Number of drains opened up for examination (Section 41, P.H.A.) 2 29 4 2 87 Articles Disinfected. January 768 July 860 February 641 August 674 March 668 September 754 April 753 October 607 May 1,171 November 693 June 578 December 880 9,047 APPENDICES. 34 TABLE I.—Vital Statistics of Whole District during 1905 and Previous Years Year. Population estimated to middle of each year. Births. Deaths under One Year of Age. Deaths Ages. at all Total. Deaths in Public Institutions. Deaths of Non.residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Deaths Ages. at all Nett. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate,* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 29329 769 26.2 87 113 530 18.0 208 208 30 352 12.0 1896 30099 765 25.4 105 137 557 18.5 209 209 38 386 12.8 1897 30896 821 26.5 80 97 544 17.6 228 228 31 347 11.2 1898 31681 790 24.9 119 148 571 18.0 205 205 32 398 12.5 1899 32515 823 25.4 129 156 622 19.1 227 227 49 444 13.6 1900 33304 862 25.8 102 118 603 18.1 249 249 48 402 12.0 1901 34180 961 28.1 105 109 551 16.1 200 200 67 418 12.2 1902 37500 976 26.0 106 108 585 15.6 219 219 58 424 11.3 1093 41120 1166 28.2 109 94 58.5 13.0 203 203 49 431 10.4 1904 47030 1284 27.3 158 123 654 13.9 210 210 77 521 11.0 Averages for Years, 34765.4 921.7 26.3 110.0 120.3 580.2 16.7 215.8 215.8 479 412.3 11.9 1895—1904 1905 54763 1408 25.7 138 98 615 11.2 178 178 92 529 9.6 * Rates calculated per 1,000 of estimated population, 35 Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the Dumber in Column 10, and the addition of the number in Column 11. By the term "Non.residents" is meant persons brought into the district on account of sickness or infirmity, and dying in Public Institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in Public Institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have bten made should be given on the back of this Table. Total population at all ages 38071 Number of inhabited houses 7027 Average number of persons per house 4.8 Area of District in acres (exclusive 22766 of area covered by water) Institutions within the District receiving sick and infirm persons from outside the District Cane Hill Lunatic Asylum, in the Parish of Codlsdon. Holborn Workhouse, in the Parish of Mitcham. Holborn Union Schools, in the Parish of Mitcham. Institutions outside the District receiving sick and infirm persons from the District— Surrey County Asylum, at Brookwood. Carshalton Cottage Hospital, at Carshalton. Croydon Rural District Isolation Hospital, at Carshalton. Joint Small Pox Hospital, in Parish of Cheam. Croydon General Hospital, at Croydon. Croydon Infirmary and Workhouse, at Croydon. Other Institutions, the deaths in which have been distributed among the several localities in the District. Russell Hill School, in Parish of Beddington. Royal Female Orphanage, in Parish of Beddington. Reedham Orphanage, in Parish of Coolsdon. At Census of 1901. 36 table ii.—Vital Statistics of separate Localities in 1905 and previous years Names of Localities WHOLE DISTRICT. 1 Addington. 2 Beddington. 3 coulsdon. 4 Merton. 5 Mitcham. 6 Morden. 7 Sanderstead. 8 Wallinoton. 9 Woodmansterne. 10 Year. Population estimated to middle of each year. Births registered. | Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. . Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. d. a b. c d. 1895 29329 769 352 86 670 14 7 0 3186 63 25 4 3577 80 30 7 3809 93 41 15 11780 379 146 47 836 17 12 4 693 16 3 0 4325 93 51 7 453 14 6 2 1896 30099 765 386 104 670 19 5 0 3243 63 19 6 3671 74 32 11 3935 90 36 10 12057 362 197 63 851 22 5 1 739 16 9 3 4463 99 38 7 407 20 6 3 1897 30896 821 347 79 670 14 7 1 3360 57 31 8 3747 109 32 6 4039 103 38 9 12343 389 155 39 876 27 8 2 787 13 3 0 4601 93 35 13 473 16 7 1 1898 31681 790 398 118 672 13 8 1 3469 53 24 4 3821 93 47 10 4123 94 64 20 12638 388 192 67 898 21 9 4 845 15 8 1 4727 103 43 10 488 10 3 1 1899 32515 823 444 129 675 14 19 2 3608 69 39 11 3S85 94 29 9 4280 109 50 12 12892 381 216 78 921 24 5 1 892 11 8 1 4860 103 70 13 502 18 8 2 1900 33304 802 402 102 663 11 9 1 3732 69 31 4 3960 92 50 12 4398 116 48 14 13155 409 185 54 943 13 14 3 936 19 8 0 5002 113 49 10 515 20 8 4 1901 34180 961 418 105 642 14 9 1 3846 85 29 9 4042 90 40 6 4510 164 62 18 13493 409 200 56 960 26 13 3 1001 22 4 1 5152 126 54 10 534 25 7 1 1902 37500 976 424 106 620 10 12 3 4050 84 30 9 4600 108 31 7 5350 168 71 23 14500 128 202 56 1000 27 9 1 1050 15 7 0 5720 120 57 4 610 16 5 3 1903 41120 1161 431 109 620 7 5 1 4750 101 34 6 5150 122 40 9 6060 221 70 20 15500 497 195 57 1018 25 13 5 1260 26 8 2 6330 152 58 8 612 10 8 1 1901 47030 1284 £21 158 700 13 11 2 5170 144 45 15 6450 149 41 9 7450 219 75 21 17000 542 247 86 1100 24 7 3 1550 28 16 6 6875 142 74 15 735 23 5 1 Averages of years, 1895— 1901 34765. 921. 412. 109. 660.2 12.9 9.2 1.2 3841.4 78.8 30.7 7.6 4290.3 101.1 37.2 8.6 4795.4 137.7 55.5 16.2 13535.8 418.4 193.5 60.3 940.6 22.6 9.5 2.7 975.3 18.1 7.4 1.4 5205.5 114.4 52.9 9.7 538.9 17.2 6.3 1.9 1905 54763 1403 529 138 670 11 11 1 5789 123 39 9 7137 150 39 8 9150 258 80 22 20617 642 270 78 1035 20 15 3 1660 28 8 2 7935 155 62 13 770 21 5 2 Note.(a) The separte localities adoptedfor this table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts, Block 1 may, if desired,be used for the wholw district: and blocks 2,3,&c., for the several loccalites. In smal districts without recognised divisions of known population this Table need not be filled up. (b) Deaths of residents occurring in public intitutions beyond the district are to be included in sub-columns c of this table, and those of non-registerd in public institutions in the district excluded. (See note on Table I. as to meaning of terms "resident" and "non-resident.") (c) Deaths of residents occurring in public institutions, whether within or without the district, are to be allotted to the respective localities according to the addresses of the deceased. (d) Care should be taken that the gross totals of the several columns in this Table respectively equal the corresponding totals for the whole districts in Tables I. and IV. ; thus the totals of sub-columns, a,b, and c should agree with the figures for the year in the coumns 2,3, and 12 repectively, Table I. the gross total of the sub-columns c should agree with the total of column 2 in Table IV., and the gross total of sub column 3 in Table IV. 37 TABLE III.—Cases of Infectious Disease notified during the year 1905. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. No of Cases Removed to Hospital from each Locality. At Ages—Years. 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 Totals. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Addington. Beddington. Coulsdon. Merton. Mitcham | Morden. Sanderstead. Wallington. Woodmanst'rne Addington. Beddington. Coulsdon. Merton. Mitcham. Morden. Sanderstead. Wallington. Woodmanst'rne Small Pox 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 134 3 35 81 11 4 .. .. 10 13 6 91 1 5 8 .. .. 6 11 4 77 1 5 5 .. 109 Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 44 2 .. 4 7 29 2 .. 3 7 7 23 1 .. 3 .. .. .. .. .. 3 .. .. .. .. 3 Scarlet Fever 181 2 46 107 14 12 .. 1 12 11 2/ 93 5 7 16 9 1 12 9 24 70 3 6 10 7 142 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 18 .. 4 6 2 6 .. 1 .. 1 8 8 .. .. .. .. 1 .. .. 7 3 .. .. .. .. 11 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 697 14 258 391 21 13 .. .. 133 158 56 202 16 21 111 .. .. .. .. .. .. .. .. .. .. .. Totals 1077 21 343 589 56 66 2 2 158 191 104 418 23 34 138 9 2 18 20 35 153 4 12 15 7 268 The Isolation Hospital is situated at Beddington Corner, Mitcham Junction, but is within the Carshalton Urban District. The Small Pox Hospital is situated at Cheam, and is the Joint Hospital for Croydon Borough, Wimbledon, Penge, and the Croydon Rural Councils. TABLE IV.—Causes of, and ages at, Death during 1905. Causes of Death, Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of all " Residents " belonging to Localities, whether occurring in or beyond the District. Total Deaths whether of Residents or non" Residents" in Public Institutions in the District. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 All ages. Under 1. 1 and under 5. 5 and under 15 15 & under 25. 25 & under 65. 65 & upwards. Addington. Beddington. Coulsdon. Merton. Mitcham. Morden. Sanderstead. Wallington. W oodmanst'rne 18 19 Cane Hill Asylum Holborn Union Workoouse Measles 10 3 6 1 .. .. .. .. .. 3 .. 4 1 .. 2 .. .. .. Scarlet Fever 2 .. 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough 4 2 1 1 .. .. .. .. .. .. .. 4 .. .. .. .. .. .. Diphtheria and Membranous Croup 18 .. 5 13 .. .. .. .. 1 .. .. 16 .. .. 1 .. .. .. Croup 2 .. 1 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 Typhoid Fever 3 .. .. .. .. 3 .. .. .. .. 2 1 .. .. .. .. .. .. Epidemic Influenza 7 1 .. .. .. 4 2 .. 1 1 1 3 .. .. 1 .. .. .. Diarrhoea 15 12 2 .. .. .. 1 .. .. .. 6 8 1 .. .. .. .. .. Enteritis 31 27 1 .. 1 1 1 .. 1 .. 6 28 1 .. .. .. .. .. Puerperal Fever 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. Erysipelas 2 .. 1 .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. Other Septic Diseases 11 .. 1 1 .. 5 4 .. .. 1 1 7 1 .. 1 .. 1 3 Phthisis (Pulmonary Tuberculosis) 38 1 2 3 7 24 1 1 5 4 2 21 .. .. 4 .. 11 5 Other Tubercular Diseases 15 3 3 3 2 4 .. .. .. 2 2 9 .. .. 1 1 .. 2 Cancer, malignant disease 29 .. .. .. 1 16 12 1 2 .. 8 9 .. .. 9 .. 5 .. Bronchitis 36 9 4 1 2 5 15 1 3 2 4 22 .. 1 3 .. 1 15 Pneumonia 38 12 6 1 .. 12 7 2 3 3 4 23 .. 1 9, .. 5 3 Pleurisy 3 .. 2 .. .. .. 1 .. .. 1 .. 2 .. .. .. .. .. .. Other Diseases of Respiratory Organs 7 1 1 1 .. 3 1 .. 1 .. 2 3 1 .. .. .. .. .. Alcoholism—Cirrhosis of Liver 11 .. .. .. .. 7 4 .. 1 1 .. 5 2 1 1 .. .. .. Venereal Diseases 2 2 .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. Premature Birth 28 28 .. .. .. .. .. .. 2 5 5 12 .. 1 3 .. .. .. Diseases and accidents of Parturition 7 2 .. .. 1 4 .. .. 2 .. .. 4 .. .. 1 .. .. .. Heart Diseases 63 4 .. 1 1 29 28 .. 4 7 15 27 1 1 6 2 6 9 Brain 33 .. 2 4 2 12 13 1 3 1 3 18 1 .. 6 .. 93 1 Kidneys 12 .. .. .. .. 5 7 .. 1 3 2 3 .. .. 3 .. 3 2 Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. Accidents 8 3 1 .. .. 3 1 1 1 .. 2 4 .. .. .. .. 1 .. Suicides 6 .. .. .. 3 3 .. 2 .. 1 .. 1 .. .. 2 .. .. .. Homicide .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. All other causes 87 28 1 2 .. 9 47 2 8 4 13 37 4 1 16 2 6 3 All causes 529 138 41 34 20 151 145 11 39 39 80 270 15 8 62 5 134 44 38 Notes, .(a) In this Table ail deaths of "Residents" occurring in public institutions, whether within or without the district, are to be included with the other deaths in the columns for the several age groups (columns 2.8). They are also, in columns 9.15, to be included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-Residents " occurring in public institutions in the district are in like manner to be excluded from columns 2.8 and 9.15 of this Table. (b) Sec notes on Table I. as to the meaning of "Residents" and "Non-residents," and as to the "Public Institutions" to be taken into account for the purposes of these Tables. The "Localities" should be the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of "Residents" or of "Non-residents," are, in addition to being dealt with as in note (a), to be entered in the last column of this Table. The total number in this column should equal the figures for the year in column 9, Table I. (c) The total deaths in the several "Localities " in columns 9.15 of this Table should equal those for the year in the same localities in Table II., sub.columns c. The total deaths at all ages in column 2 of this Table should equal the gross total of columns 9.15, and the figures for the vear in column 12 of Table I. (e) Under heading of "Diarrhœa" are to be included deaths certified as from diarrhoea, alone or in combination with some other cause of ill.defined nature; and also deaths certified as from Epidemic enteritis; Zymotic enteritis; Epidemic diarrhoea. Summer diarrhoea ; Dysentery and dysenteric diarrhoea ; Choleraic diarrhoea, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of "Enteritis" are to be included those certified as from Gastro.enteritis, Muco.enteritis, Gastric catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term "Diarrhoea." Deaths from diarrhoea secondary to some other well.defined disease should be included under the latter. 39 Table V.—The Area in Acres, Inhabited Houses, Population, and Density of each Parish in the District in 1891 and 1905. Parish, Area in Acres. Inhabited Houses. Population. Density. Persons per house. 1891. 1905. Persons per acre. 1891. 1905. Persons. Males. Females. Persons. Males. Females. 1891. 1905. 1891. 1905. Addington 3605 132 134 670 346 324 670 345 325 •18 •18 5.0 5.0 Beddington 3128 442 1169 2607 1162 1445 5789 2819 2970 •8 1.8 5.9 4.9 Coulsdon 4314 537 1365 3335 1623 1712 7137 3550 3587 •7 1.6 6.2 5.2 Merton 1765 654 1861 3360 1612 1748 9150 4500 4650 1.9 5.1 5.1 4.9 Mitcham 2915 2055 3806 10758 5300 5458 20617 10012 10605 3.6 7.0 5.2 5.4 Morden 1475 138 206 763 387 376 1035 504 531 .5 •7 5.5 5.0 Sanderstead 3150 96 342 509 262 247 1660 808 852 .1 •5 5.3 4.8 Wallington ,, 823 710 1464 3823 1587 2236 7935 3884 4051 4.6 9.6 5.4 5.4 Woodmansterne. 1591 81 146 408 204 204 770 370 400 •25 •4 5.0 5.2 22766 4845 10493 26233 12483 13750 54763 26792 27971 11 2 .8 5.4 5.0 In no instance are Institutions considered in this calculation, 40 TABLE VI.—Showing Parishes with Institutions. Parish. Area in Acres. Inhabited Houses. Population. Density of persons per acre. Average number of persons per house. 1891. 1905. 1891. 1905. 1891. 1905. 1891. 1905. Persons. Males. Females. Persons. Males. Females. Beddington 3128 442 1169 2607 1162 1445 5789 2819 2970 •8 5.9 Royal Female Orphanage .. .. .. .. .. .. 160 - 160 (Russell Hill School .. .. .. .. .. .. 363 218 145 6312 3037 3275 Coulsdon 4314 537 1365 3335 1623 1712 7137 3550 3587 •7 6.2 Cane Hill Asylum .. .. .. .. .. .. 2419 1013 1406 Reedham Orphanage .. .. .. .. .. .. 343 212 131 9899 4775 5124 Mitcham 2915 2055 3806 10785 5300 5458 20617 10012 10605 3.6 5.2 Holborn Workhouse .. .. .. .. .. .. 1058 702 356 „ Schools .. •• •• •• •• .. 401 228 173 22076 10942 11134 41 42 TABLE VII.—Showing the Annual Birth and Death Rates, and Death Rates of Infants for the Year 1905 and 10 preceding years. In the Year. Birth Rate per 1,000 of Population. Corrected Death Rate per 1,000 of Population. Children under 1 year per 1,000 of Registered Births. 1905 25.7 9.6 98 1904 27.3 11.0 123 1903 28.2 10.4 94 1902 26.0 11.3 108 1901 28.1 12.2 109 1900 25.8 12.0 118 1899 25.4 13.6 156 1898 24.9 12.5 148 1897 26.5 11.2 97 1896 25.4 12.8 137 1895 26.2 12.0 113 Average of 10 Years, 1894—1903. 26'3 11.9 120.3 N.B.—Before 1893, the deaths occurring outside the District among. persons belonging to the District were not included in the above figures the inclusion of such deaths since 1893 has increased the death-rates considerably. 48 TABLE VIII— Showing the Population, Births, and Deaths for the Year 1905, and 10 years preceding. GROSS NUMBERS. Year. Estimated Population. Registered Births. Corrected No. of Deaths. Deaths in Institutions. Total. Under 1 year. Under 5 years. 1905 54763 1408 529 138 41 178 1904 47030 1284 521 158 42 210 1903 41120 1161 431 109 29 203 1902 37500 976 424 106 145 219 1901 34180 961 418 105 154 200 1900 33304 862 402 102 139 249 1899 32515 823 444 129 163 227 1898 31681 790 398 118 166 205 1897 30896 821 347 79 121 228 1896 30099 765 386 104 160 209 1895 29329 769 352 86 117 208 Average of 10 years, 1895. 1904 34765.4 921.2 412.3 109.6 123.6 215.8 44 TABLE XI—Ascertained Cases of Infectious Disease since the adoption of the Notification Act. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905. Small-pox .. 7 1 2 .. .. 3 .. .. .. .. 29 9 5 1 Scarlatina 85 117 316 99 51 65 262 144 84 115 81 161 131 125 181 Diphtheria 17 16 44 63 26 45 35 107 38 62 87 77 48 169 134 Membranous Croup .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. Typhoid Fever 9 12 24 12 18 14 13 15 19 15 13 14 11 9 18 Continued Fever .. .. 1 .. 1 2 .. .. .. .. .. .. .. .. .. Puerperal Fever 1 1 4 6 1 .. 2 2 .. 4 1 5 5 8 2 Cholera .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 13 22 31 18 18 33 26 23 29 34 20 35 23 27 44 Measles 237 579 138 458 29 1083 172 1023 251 420 862 636 280 1085 679 Acute Diarrhœa .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. *Chicken Pox .. .. .. .. .. .. .. .. .. .. .. 162 188 .. •• Totals 362 754 560 664 144 1243 513 1314 421 650 1064 1119 695 1428 1076 * Chicken Pox was a notifiable disease until July 31st, 1903. 45 TABLE XII.—Cases of Typhoid Fever (including Continued Fever) in each Parish since Notification was adopted. Addington Beddington Coulsdon Merton Mitcham Morden Sanderstead Wallington W oodmansterne Institutions The District * † ‡ ‡ * † * * 1890 .. 6 .. .. 3 .. .. 4 .. 1 14 1891 .. 2 2 1 2 .. 1 1 .. .. 9 1892 .. 2 .. 2 4 .. .. 3 .. 1 12 1893 .. .. 4 4 12 .. .. 1 .. 1 25 1894 .. .. 4 2 2 .. .. 4 .. .. 12 1895 .. 1 1 4 6 .. .. 3 .. 3 19 1896 .. 1 2 1 9 .. 1 2 .. .. 16 1897 .. l 2 1 6 .. .. 3 .. .. 13 1898 .. .. 1 2 11 .. .. .. .. .. 15 1899 .. 1 2 4 4 .. 2 1 4 .. 19 1900 .. l 2 3 3 .. .. 3 3 .. 15 1901 .. .. 3 4 3 .. 2 1 .. .. 13 1902 .. 2 1 2 3 .. 2 2 .. .. 14 1903 .. .. 5 2 4 .. .. .. .. .. 11 1904 .. 1 .. .. 5 .. 1 2 .. .. 9 1905 1 .. 1 8 8 .. .. .. .. .. 18 3 20 30 40 95 4 9 30 7 6 234 * Water supplied by Sutton Water Company, † „ ,, ,, East Surrey Water Company. ‡ ,, ,, ,, Lambeth Water Company. Addington is principally supplied by the Croydon Corporation. 46 INFECTIOUS DISEASE during 1905. Showing Disease; also place and month of incidence. TYPHOID FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. 1 .. .. .. .. .. .. .. 1 Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. 1 .. .. .. 1 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton .. .. .. .. .. 2 2 1 1 1 1 .. 8 Mitcham 1 .. .. .. .. .. .. 7 .. .. .. .. 8 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1 .. .. .. 1 2 2 8 2 1 1 .. 18 SMALL POX. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addoington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Conlsdon .. .. .. .. .. .. .. .. .. .. .. .. .. CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. .. .. .. .. .. .. .. .. .. .. .. Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. 1 .. .. .. .. .. 1 Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. .. .. .. .. 1 .. .. .. .. .. 1 47 PUERPERAL FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. 1 .. .. .. .. .. .. 1 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. .. .. .. .. .. .. 1 .. .. .. 1 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. .. .. .. 1 .. .. 1 .. .. .. 2 MEASLES. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. 4 8 6 .. 2 .. .. .. .. 36 77 133 Coulsdon 1 3 5 5 .. 2 .. .. 13 20 59 50 158 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton 1 .. 14 9 14 9 1 2 3 .. 2 1 56 Mitcham 2 .. 7 3 25 62 47 4 1 .. 1 22 174 Holborn Schools .. .. .. .. .. 19 9 .. .. .. .. .. 28 and Workhouse Morden .. .. 3 7 3 .. 2 1 .. .. .. .. 16 Sanderstead .. .. .. 1 .. 4 .. 1 .. .. 3 12 21 Wallington 7 1 8 3 4 3 2 2 .. 1 13 67 111 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 11 8 45 34 46 101 61 10 17 21 114 229 697 48 ERYSIPELAS. Parishes. January. February. March. April. May. June. July. August. September. October November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. 1 .. 2 .. .. 3 Coulsdon .. .. .. .. .. .. 1 .. .. .. .. 1 .. CaneHill Asyl'm .. 1 2 1 .. 1 .. .. .. .. .. .. 5 Merton .. 1 .. 1 .. .. 1 .. 1 .. 3 .. 7 Mitcham 3 4 1 1 2 .. 2 1 .. .. 3 3 20 Holborn Schools .. .. .. .. .. .. .. .. .. 1 .. .. 1 and Workhouse 1 .. .. .. .. 1 .. .. .. .. .. .. 2 Morden .. .. 1 .. .. .. .. .. .. .. .. .. 1 Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington 1 1 .. .. .. .. .. .. 1 .. .. .. 3 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 5 7 4 3 2 2 4 2 2 3 6 4 44 SCARLET FEVER. Parishes. . January. February. March. April. May. June. July. August. September. October. November. December Grand Totals Addington .. .. .. .. .. .. 1 .. .. .. .. .. 1 Beddington .. .. 5 .. .. 2 .. 2 2 1 .. .. 12 Coulsdon .. .. .. .. .. 3 2 .. .. .. 1 5 11 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton 4 6 4 7 4 .. .. .. .. 1 l 27 Mitcham 9 9 12 5 29 10 6 3 4 2 2 1 92 Holborn Schools .. .. .. .. .. .. .. .. .. .. 1 .. 1 and Workhouse Morden .. 4 1 .. .. .. .. .. .. .. .. .. 5 Sanderstead .. .. .. .. 1 .. 3 .. 1 1 . . 1 7 Wallington 1 1 4 2 2 .. 3 .. 1 .. 1 1 16 Woodmansterne 1 .. .. .. .. .. .. .. 1 1 3 3 9 Totals 15 20 26 14 36 15 15 5 9 6 9 11 181 49 DIPHTHERIA. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington 2 1 .. 1 .. .. .. 5 .. 1 .. .. 10 Coulsdon .. 1 .. 2 1 .. 4 2 1 .. .. 2 13 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Merton 2 .. 1 .. .. 2 .. .. .. .. 1 .. 6 Mitcham 11 5 4 8 9 6 8 5 11 3 10 11 91 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse Morden .. .. .. .. .. .. .. .. .. 1 .. .. 1 Sanderstead .. .. .. .. .. 2 1 .. .. 2 .. .. 5 Wallington 2 2 2 .. .. .. .. .. 2 .. .. .. 8 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 17 9 7 11 10 10 13 12 14 7 11 13 134 50 Table XIII.—Deaths from Infantile Summer Diarrhoea, showing place of incidence and condition of domestic surroundings. Address. Age. Sex. L. or 111. Number in Family, and how many have died of similar Complaints. How fed : Cow, Breast, or Tinned Milk. Note condition and cleanliness of Cooking Utensils. Condition. Notes Interior of house. Back and Front Yards. W.C's. Foxley Lane, Beddington 2 months M. L. None Fed from the breast during the first four weeks. Afterwards on cows' milk, lime water, and water mixed, and on the last day of life from the breast (wet nurse). Utensils very clean. Clean Clean Slightly corroded in traps from hard water. This is a house where there could be no suspicion of uncleanliness to set up Diarrhoea. The child was out a good deal in the open air, and the hot weather of July and early part of A :?ust may have had some effect on tne child. Reform Place, Merton 4 months M. L. None Fed on Dr. Allen's Food mixed with water and milk, from O.J. White, Morden Farm, Merton, and after illness set in barley water and lime water were both used. Food boiled in enamel saucepans, which parents state were kept very clean. Clean Front area is used as a flower garden. Back yard fairly clean, but garden not cultivated. These houses are somewhat hemmed in, but there is an opening for a little air to pass through back gardens. W.C. pan recently soiled, otherwise pan is not corroded. The front room of the house is stuffy owing to want of ventilation, the stove register being down. Kingston Road, Merton 14 weeks M. L. None By bottle, with cows' milk and barley water. Utensils very clean. Very clean Very well kept, and with good sanitary In good condition Dupont Road, Merton 11 months F. L. Four in family; two died of similar complaints Cows' milk and several patent foods, by good shaped bottle. Utensils clean. Clean ings. In good condition, very clean. One W.C. outside in garden. Chestnut Road, Merton 16 months M. L. Ten in family By bottle, correct shape, with cows' milk and Neave's Food. Utensils very clean. Very clean Yards well kept One W.C. in yard, in good order. This child was delicate from birth Kingston Road, Merton 3 months M. L. Three in family Bottle, with cows' milk, and Allenbury's Patent Food. Utensils very clean. Clean In good condition In good order This is the first child, and was delicate from birth. Grove Road, Mitcham 10 months F. L. Four in family ; one died of similar complaint in 1902 By good shaped bottle, with Allen & Hanbury's and Nestle's Condensed Milk. Utensils very questionable. Clean Dirty and badly paved. Vegetable refuse thrown about. One W.C. inside scullery. Filthy bedroom utensils about kitchen and scullery. Fortescue Road, Mitcham 10 months M. L. Five in family; two died of similar complaints, one in Fed by breast till five months old, then Robinson's Groats, cows' milk and barley water, in good bottle. Utensils only fairly clean ; the whole place suffers from neglect. Fairly clean. Very poorly furnished. Damp and very squalid. Vegetable refuse lying about. One W C. in yard, in good order. Father was out of work for some time Fortescue Road, Mitcham 10 months F. L. 1900 and one in 1903 Piccadilly, Mitcham 11 months M. L. Eight in family Cows' milk and Allen & Hanbury's Food. Utensils clean. Fairly clean Paved court. No back yard. In good condition There are only two very small bedrooms in this property. Grove Road, Mitcham 9 months F. L. Four in family; three died of similar complaints Totally from breast. Utensils clean. Fair condition Very badly kept back yard. In good condition. Princes Road, Mitcham 6 months F. L. Five in family; two died of similar complaints Partial breast and bottle, Nestle's Milk. Utensils clean. In good condition Kitchen very dirty, a large number of flies. Front yard very good. Back very dirty and squalid. In good order Father out of work for some time. Belgrave Road, Mitcham 7 months F. L. Four in family Bottle, with Nestle's Milk and malted food. Utensils good. Bedrooms require cleansing, otherwise very good, Good condition One W.C., in fairly good condition. No proper dustbin, and drinking water from cistern in roof space, with defective cover. Chapel Road, Mitoham 7 months M. L. Four in family Frame Food and cows' milk, by bottle. Utensils very clean. Very clean In good condition In good condition, perfect flush. Seaton Road, Mitcham 3 months F. Illeg. None At the breast to five weeks old, then on cows' milk and barley water, given in ordinary feeding bottle. Latterly milk was not boiled. Utensils generally clean. The air of the kitchen was unwholesome at time of visit. Back yard is partly paved W.C. in order. The mother of this child is a single woman who had to go out to work, consequently the child was taken from the breast and left to the care of the occupier of the house during the day. Lilian Road, Mitcham 5 months F. L. Two living On Nestle's Milk and patent barley, in tubeless New house. Kept in a Back yard is paved W.C. is situated in yard, Heaton Road, Mitcham 5 months bottle. Utensils very clean. Condensed milk. very cleanly state. is in good order. The case was the subject of an inquest, the child died somewhat suddenly, and it was alleged by the father to be due to tainted milk, as he found some rust at the bottom of the condensed milk tin. At the inquest it was not proved that the rust had anything to do with tainting the milk, but fermentation had set in. Fountain Road, Mitoham 9 months F. L. Six living; two previous deaths from diarrhoea Nestle's in ordinary feeding bottle. Utensils not kept in a cleanly state. The interior of house is in a very dirty and bad repair. The occupants are poor and dirty in their habits. The back is paved, but very defective. W.C. is situated in yard, and is being re-constructed. Steps have been taken to have the house cleansed and repaired. Fountain Road, Mitcham 7 months F. L. One living Cows' milk and corn flour by ordinary feeding bottle. Utensils generally clean. The house is kept in a fairly cleanly state. The back yard is paved, but is defective. Rubbish strewn all over the place. W.C. is in yard abutting, against the dwelling, is stopped (a frequent occurrence). The mother of this child works at a laundry from 8 a.m. to 8 p.m., during which time the child was left in the care of its grandmother in the next street. Church Road, Mitcham 9½ months M. L. Two living Cows' milk and Robinson's barley. Utensils very clean. House kept in a cleanly state. Both yards are paved W.C. is in yard, and is in good order. Gladstone Road, Mitcham 10 months F. L. Five living On Nestle's Milk and Robinson's biscuits. No feeding bottle used. Cooking utensils clean. House is in a fairly cleanly state. Back yard paved, but is defective. W.C. pan is a long hopper, foul & broken. The water storage oistsrn is in scullery, over the copper, and is without a Western Road, Mitcham 9 months M. L. None Mellin's Food given by ordinary feeding bottle. Utensils ver clean. The house is somewhat overcrowded, is kept in a cleanly state. Back yard is paved. In good order The house consists of four rooms and a washhouse, and is occupied by two families. Westfields, Mitcham 8 months M. L. None Nestle's Milk n ordinary feeding bottle. Utensils not kept in a cleanly state. Food is kept in a cupboard alongside the fire place, where the pots and kettles are kept. The house consists of three rooms on the ground floor, and all are in a cleanly state. The back yard is paved. The private cartway in front of the house is in a very bad state. W.C. is in yard, and is in good order. The mother of the child is a flower seller. The father a carman. Leonard Road, Mitcham 2 months M. L. Four living; two others have died of diarrhoea Nestle's Milk given in an ordinary feeding bottle. Utensils clean. The walls and ceilings of the house are in a cleanly state. The back yard is paved and in good order. W.C. is situated in yard and is in good order. 51 TABLE XIV.—Table showing Total Deaths from Infantile Summer Diarrhoea, during the five years, 1901, 1902, 1903, 1904, and 1905 in each Parish, and in every Street invaded:— ADDINGTON. 1. Keeper's Lodge. 1. Badger's Hole. BEDDINGTON. 1. Beddington Lane. 1. Bandon Hill. 1. Foxley Lane. COULSDON. 1. Coulsdon. 1. Godstone Road. 1. Lower Road, Kenley. MERTON. 2. High Street. 1. Dorien Road, 1. Pincott Road. 1. Savoy Road. 1. Crown Road. 2. Dupont Road. 1. Nelson Grove Road. 3. Kingston Road. 1. Nursery Road. 1. Edna Road. 1. Reform Place. 1. Chestnut Road. MITCHAM. 1. Manor Road. 3. Princes Road. 2. Love Lane. 2. Smith's Buildings, C.E. 1. Grange Villas, Eastfields. 1. The Broadway. 1. Hare wood Road. 1. Concrete Cottages. 1. Fieldgate, Western Road. 1. The Terrace, Grove Road. 1. Bond's Road. 2. Gladstone Road. 4. Lilian Road, Lonesome. 6. Fountain Road. 4. Marian Road, Lonesome. 2. Willow View. 1. Allen's Cottages, Lonesome. 1. Nicholl's Cottages, Eastfields. 1. Greyhound Terrace, Lonesome 1. Bailey Road. 1. Lonesome. 1. Lewis Cottages. 4. Queen's Road. 1. Lewis Road. 4. Sibthorpe Road. 4. Seaton Road. 6. Bath Road. 1. Robinson Lane. 8. Church Road. 3. Heaton Road. 2. Church Buildings. 1. Portland Road. 1. Spencer Road. 1. Caithness Road. 1. Upper Green. 1. Lock's Lane. 2. Robinson Road. 1. Palestine Grove. 2. Tramway Terrace. 1. Courtney Road. 1. Norfolk Road. 2. Chapel Road. 1. Benedict Walk. 1. Marlboro' Road. 1. Homewood Road. 1. Aberdeen Road. 2. Grove Road. 2. Fortescue Road. 1. Westfields. 1. Belgrave Road. 1. Western Road. 1. Piccadilly. 1. Leonard Road. WALLINGTON. 1. Seymour Road. 1. Wood Street. 1. Hackbridge. SANDERSTEAD. 1. Riddlesdown Road. WOODMANSTERNE. 1. Chipstead Valley Road. 52 The visits paid by Inspector Low in connection with the milk and meat trades are shown in the following Table :— Nature of Premises. WARD. No. of Inspections. Total West, Central East. South, S Nor. U. N ">r. Slaughter-houses 932 422 15 364 69 66 1868 Butchers 222 233 20 52 62 27 616 Fishmongers 18 61 11 11 17 15 133 Markets 49 50 99 Cowkeepers 74 16 36 53 24 52 255 Milk Purveyors 145 25 47 61 45 77 400 Total 1391 806 129 591 217 237 3371 FOOD AND DRUGS ACTS. — Table IX. gives the number of samples taken by Mr, Saunders during the year, the results of the analyses and the action taken thereon. PROSECUTIONS, 1905 Date. Defendant. Charge. Result. Jan. 3 W. T. D. Selling Butter adulterated with 89 per cent. Foreign Fat Convicted, and Fined £5 and 7s. 6d costs. Feb. 14 W. E. E. Selling adulterated Brandy Convicted, and Fin d £5 and £12 18s. 6d. costs. May 9 K. H. Selling Butter adulterated with 80 per cent. Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. June 24 H. G. W. Selling Butter adulterated with 55 per cent. Foreign Fat Convicted, and Fine.l 10s. and 7s. 6d. costs. June 24 E. W. W. Selling Butter adulterated with about 20 per cen'. Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. Oct. 21] F. W. G. Selling Mi k adulterated with about 11 per cent Additional Waer Convicted, and Fined £5 and 7s. 6d. costs. Oct. 21 J. E. C. Selling Coffee adulterated with 80 per cent, of Chicor/ Convicted, and Fined £1 and 7s. 6d. costs. Dec. 9 W. S. R. S. Selling Butter adulterated with 50 per cent Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. Dec. 30 J. L. Selling Butter adulterated with 95 per cent. Foreign Fat Convicted, and Fined £1 and 7s, 6d. costs. Dec. 30 Messrs. D. & C. Trading as Wholesale Dealers in Margarine without Registration Defendants subsequently Registered, and summons was withdrawn on payment of 5s. costs. 53 In 11 cases where the samples of Milk were slightly below the standard fixed by the Hoard of Agriculture, the vendors were written to calling their attention to the fact and asking for some explanation, further samples being taken subsequently. Of these 11 samples 9 contained an excess of water to the extent of an average of 6 per cent., whilst 2 were deficient in fat to the extent of an average of 6.5 per cent. One sample contained a trace of boric acid. The following table has been prepared from figures kindly supplied by the Borough Analyst (Mr. Lester Reed):— Total Number of Samples of Milk collected and percentage below standard. 1905. No. of Samples. No. below Standard. Percentage of Samples below Standard. Average percentage of fat of Genuine Samples. Wholesale taken in course of delivery at Railway station. New Milk. 70 6 8.5 3.7 Wholesale taken in course of delivery at Railway Station. Separated Milk 2 1 50.0 - Retail taken on Milkmen's rounds. Sunday morning. New Milk. 73 6 8-2 3-6 Retail taken on Milkmen's rounds. Sunday morning. Separated Milk 7 - - 1 Retail taken on Milkmen's rounds. Weekday. New Milk 15 1 6 6 3 7 Retail taken on Milkmen's rounds. Week day. Separated Milk. 1 — - — 54 II.—DEFECTS' FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts':— 9 9 Want of Cleanliness — — Want of Ventilation — — Overcrowding — — Want of drainage of floors 2 2 Other Nuisances 8 8 Sanitary accom modation insufficient 4 4 unsuitable or defective 11 11 not separate for sexes - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) Breach of special sanitary requirements for bakehouses (s.s. 97 -100) 1 1 Failure as regards list of outworkers (s. 107) - - Giving out work to be done on premises which are unwholesome (s. 108) — — infected(s. 110) — — Allowing wearing apparel to be made in premises infected by Scarlet Fever or Small Pox (s. 109) — — Other Offences — — Total 35 35 55 III.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories ;— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 4 Action taken in matters Notified by H.M. Inreferred by H.M. In- spectora spectors as remediable under the Public Heath Act but not under the Reports (of action taken) Factory Act (s. 5) sent to H.M. Inspectors Other Undergrround Bakehouses (s. 101) Certificates granted during the year In use at end of the year 2 Homework— Number of List of Outworkers (s. 107) Lists received Lists. Outworkers 1 forwarded to other Addresses of Outworkers ] Authorities received from other Authorities 32 Homework in unwholesome or infected premises:— Notices prohibiting homework in unwholesome premises (s. 108).. Wearing Apparel. Other. Cases of Infectious disease notified in homeworkers premises Orders prohibiting homework in infected premises (s. 110) 1 Workshops on the Register (s. 131) at the end of year 117 Bakehouses 22 *Including those specified in sections 2, 3, 7, and 8 of the Factory Acts a* remediable under the Public Health Acts. 56 To the Chairman and Members of the PUBLIC HEALTH COMMITTEE. Miss Bgobbyer and Gentlemen, During the months of July and August, 10 cases of Typhoid Fever were notified to me as occurring in the parishes of Mitcham and Merton. Two cases occurring in the same family were undoubtedly contracted while on a visit to Margate, and that it was not until the return of the parents to Mitcham that it was recognised to be Typhoid Fever. Excluding these two cases, therefore, the remaining eight cases suggested, that, as they occurred much about the same time that there was a common cause for this outbreak. After much enquiry, I am able to determine the probable reason of this outbreak. I would mention here that in Wimbledon a certain number of cases also occurred during this period of which I have no full particulars, but 1 understand that the cause of that outbreak is probably identical with that in the parishes of Mitcham and Merton, namely, contaminated fish. A man named Jeffries, residing at 62, High Street, Merton (on the Wimbledon side of the road), has been for some time past in the habit of selling stewed eels outside local public houses, particularly "The Albion," "The Prince of Wales," and "The Nelson." Six of the patients undoubtedly ate these eels, another case denies having had any of them, and as it was extremely doubtful whether he had Typhoid Fever, it would be as well to exclude him from further consideration. Two cases, children, probably contracted the disease from their father, who in the light of subsequent events, seems undoubtedly to have had Typhoid 57 Fever, although it was not recognised as such, early in July. Bo far as can be ascertained, it is certain that on one evening early in July the eels that were then being sold were in such a condition that at any rate one purchaser could not eat them, and told Jeffries that they were bad, and Jeffries said that everybody was grumbling about them. In addition several men had stewed eels, which was followed by acute diarrhoea and vomiting. On enquiry being made by the Wimbledon Authorities, it was found that at Jeffries (the eel vendor's house), all the children had been suffering from diarrhoea, and that a child of lodgers occupying the first floor of Jeffries house was taken away while so suffering by its relatives, and several of them contracted Typhoid Fever from this case. Unfortunately, in three instances the cases ended fatally. These three cases died in the Isolation Hospital, Beddington Corner, and the type of disease was extremely severe. The Typhoid bacillus undoubtedly gained access to the stewed eels, and the gelatinous condition of this stew when cold would prove an almost ideal medium for the propagation of these bacilli. Possibly a larger number of cases of either true or abortive Typhoid Fever have resulted from eating these eels without having come to my knowledge. C. M. FEGEN. 5th October, 1905. 58 To the Chairman and Members of the PUBLIC HEALTH COMMITTEE. Miss Boobbyer and Gentlemen, In accordance with the instructions of the District Council, I beg to make the following report on the growing of watercress within the area of the Rural District. Practically the whole of the watercress grown is derived from plants which are obtained early in each spring from France, and these plants are then set in properly prepared beds. The beds are kept in running water during the whole time of growth of the plants. This industry provides employment for a large number of hands during many months in the middle of the year, and the total area for the growth is 16 acres, 1 rood, 27 poles. As certain diseases have been known to be produced through eating watercress grown either on sewage polluted soil, or watered with sewage contaminated water, it has been the custom during the time which I have been your Medical Officer of Health, to keep all watercress beds under careful observation, and in the event of intestinal disease, to make enquiries as to whether the patients have or have not had watercress to eat within a reasonable time before the onset of the attack, if the watercress has been eaten it has than been necessary to find out which bed the watercress was obtained from. Four years ago, a bed in the Parish of Mitcham, at Beddington Corner was gravely under suspicion. This bed occupied an area of l½ acres, and was fed entirely by the undiluted effluent from the Croydon Borough 59 Sewage Farm. Steps were taken immediately to do away with such a means of watering, and the use of this watercress bed was finally discontinued. The following is a schedule of the watercress beds, together with their source of water supply ; No. 1. Guy Road, Beddington, the area in actual growth is 1 acre 17 poles. The beds are supplied only by river water, which has not received any sewage effluent at all. No. 2. 2, London road, Hackbridge, has an area of 15 poles, and the water supply is entirely from springs. No. 3. Wandle road, Hackbridge, has an area of 3 acres, 37 poles, and is supplied by water coming from the previous beds, and also more extensively by local springs. No. 4. Spencer road, Beddington Corner, has an area of 1 acre, 3 roods, 20 poles, and is fed by water from the River Wandle, just below the outfalls of the Croydon Borough Avenue Carrier, and the Carrier from the Carshalton Sewage Farm. No. 5. Beddington Corner, in the Parish of Mitcham. These beds occupy an area of 3 acres, 2 roods, 23 poles, are also fed in a similar way to the previous, but the river water and local springs tend to materially increase the proportion of pure sewage contaminated water. No. 6. Situate in Willow Lane, and No. 7. At Willow Farm, occupy a total area of 6¼ acres, and are fed by the water that has passed through No. 5, together with water from springs rising on the beds of themselves. 60 No. 8. Is situated below the previous beds, and occupy an area of 3 acres, 35 poles, and the source of water is derived partly from water that has already passed from beds 5, 6 and 7, together with a fresh supply from a small stream which joins the Wandle close to these beds. A further bed exists still farther down the Wandle at Merton, having an area of 11/8 acres, which is fed entirely by water from the Wandle. This bed was originally of much larger extent, being somewhere about 16 acres. However, it has been very largely curtailed during the past few years. Samples of water from each bed have been examined, and the nitrogenous organic matter present was not of sufficient bulk to indicate that any danger was likely to occur to persons eating cress grown on these beds. Bacteriological examination showed that the bacillus Coli Communis was found in the cress grown on Beds 5, 7 and 8, but the number of Coli in each cubic centimetre was in no instance excessive. I would mention that in all samples of cress examined such cress was thoroughly washed in sterile water before examination. I am, Miss Boobbyer and Gentlemen, Your obedient Servant, C. M. FEGEN. 2nd November, 1905. 61 INDEX. Accommodation, Isolation Hospital 23 Ages at Death 12, 13, 38 Appendices— Tables I. to XIII. (see " T ") 84—51 Factory and Workshop Act 52 Infectious Diseases (number of cases, month, and parish) 46—49 Report on Typhoid Fever 56 Report on Watercress Beds 58 Area 7, 40, 41 Articles Disinfected 31 Bakehouses 27 Births in 1905 10 Births (1895 to 1905) 84, 42 Birth Rates 10 Birth Rates (1895- 1905) 34,42 Birth Rates (England and Wales) 11 Buildings 29 Bye-Laws, Contravention of 26 Cancer, Disinfecting after 22 Cane Hill Ayslum (inmates, deaths, &c.) 7, 38, 41 Causes of Infections Diseases (ages, parishes, &c. 37, 44, 46—49 Cases of Removal to Hospital 23—25 Cases of Typhoid Fever (1890 1905) 45 Causes of Death 13, 14, 38 Collection of House Refuse 25 Contravention of Bye-Laws 26 Cowsheds, &c. 26,27 Dairies, Cowsheds &c. 26, 27 Deaths 11—15 Deaths (1895—1905) 84, 43 Deaths from Zymotic Disease 14 Deaths in Isolation Hospital 24,25 Deaths, Causes of 13,14,38 Deaths, Ages at 12, 13, 38 Deaths in Public Institutione 11,15,38,43 Deaths and Death Rates from various causes (Zymotic Diseases, Phthisis, &c.) 13, 14 Death Rates 12, 13, 14 Death Rates (1895—1905) 34, 42 Death Rates (England and Wales) 15 Death Rates of Infants 42 Death Rates of various Infectious Diseases in Hofpital 25 Density of Population 8,40,41 Diarrhoea Deaths (Table XIII.) 50 Diphtheria 19 Diphtheria Cases (month and parish) 49 Disinfecting Articles 31 62 Disinfecting Houses 22 Erysipelas Cases (month and parish) 48 Factory and Workshop Act 52 Holborn School and Workhouse (Inmates, Deaths, &c.) 7, 38, 41 Hospital, Isolation 23,24,25 Hospital, Small Pox 20 Hospital, cases removed to 24, 25 House Refuse Removal 25 Houses (Number and Increase) 8,9,40,41 Housing of the Working Classes Act 27 Illegitimate Births 10 Increase in Number of Houses 8,9 Increase of Buildings 29 Infantile Mortality 12, 13, 42 Infantile Mortality (England and Wales) 15 Infantile Summer Diarrhœa 18 Infectious Diseases 15—20, 37, 44, 46—19 Inspectors' Work 29, 30, 31 Institutions (Inmates, Deaths, &c.) 7, 11, 15, 38, 41 Isolation Hospital— Accommodation 23 Patients admitted 24, 25, 37 Staff 23 Deaths and Death Rates from various Infectious Diseases 25 Legal Proceedings 26 Measles Cases (month and parish) 47 Milkshops, &c. 26,27 Mortality at different ages 12, 13 Mortality Rate (Infantile) 42 Mortality Rate (England and Wales) 15 Notified Cases of Infectious Disease 37 Patients admitted to Hospital 24, 25, 37 Phthisis 20 Phthisis, Disinfecting after 22 Phthisical Death Rate 14 Piggeries 27 Population 7,36,40,41,43 Population, Density 8, 40, 41 Preventive Measures 20—23 Public Institutions (Deaths, &c.) 7, 11, 15, 38, 41 Puerperal Fever Cases (month and parish) 47 Pulmonary Death Rate 14 Rates, Birth 10 Rates, Death 12, 13, 14 Regulated Trades 26, 27 Removal of House Refuse 25 Removals to Hospital 24, 37 Scarlet Fever 16—18 Scarlet Fever Cases (month and parish) 48 63 Sewage Works 28, 29 Sewers 28 Slaughterhouses 27 Small Pox (month and parish) 46 Small Pox Hospital, Cheam 20 Staff, Isolation Hospital 23 Table I.—Vital Statistics (1895—1905) 34,35 Table II.—Vital Statistics (1895—1905), separate parishes 36 Table III.—Infectious Disease Cases (ages, parishes, removals to Hospital) 37 Table IV.—Causes of, and Ages at, Death 38, 39 Table V.—Area, Houses, Population, Density (each parish) 40 Table VI.—Area, Houses, Population, Density (parishes with Institutions) 41 Table VII.—Birth, Death, and Infantile Death Rates (1895-1905) 42 Table VIII. — Population, Births, and Deaths (1895— 1905) 43 Table XI.—Cases of Infectious Disease (1890—1905) 44 Table XII. —Typhoid Fever Cases in each parish (1890—1905) 45 Table XIII.—Deaths from Infantile Summer Diarrhœa 50 Table XIV.—Deaths from Infantile Summer Diarrhœa (parish and street) 51 Trades, Regulated 26, 27 Typhoid Fever Cases (1890—1905) 45 Typhoid Fever Cases (month and parish) 46 Typhoid Fever, Report 56 Vital Statistics (Tables I. to XIV.) 34—51 Water Courses 25 Watercress Bed, Report 58 Zymotic Death Rate 14 Zymotic Death Rate (England and Wales 15 County Borough of Croydon. ANNUAL REPORT on the HEALTH and SANITARY CIRCUMSTANCES of CROYDON, together with THE REPORTS OF THE BOROUGH HOSPITAL AND OF THE BOROUGH LABORATORY, and THE REPORT TO THE EDUCATION COMMITTEE FOR THE YEAH 1905, by H MEREDITH RICHARDS, M.D., B.S. (Lond.), Member of the Royal College of Surgeons, and Licentiate of the Royal College of Physicians; Fellow of University College, London, and of the Royal Sanitary Institute; Medical Officer of Health; Medical Superintendent of the Borough Hospital, and of the Croydon and Wimbledon Joint Small-pox Hospital; Medical Officer to the Croydon Education Committee. Croydon: PRINTED BY S. H. PURXELL, HIGH STREET. 1906. 3 TABLE OF CONTENTS. A.—Vital Statistics— Page. Population 9 Area 9 Births 10 Deaths 10 Ward Death Rates 11 Infantile Mortality 12 Death Certification 13 Inquests 13 Small-pox 13 Croydon and Wimbledon Joint Small-pox Hospital 13 Vaccination 14 Measles 14 Scarlet Fever 14 Return cases of Scarlet Fever 14 Epidemic Influenza 16 Whooping Cough 16 Diphtheria and Membranous Croup 16 Enteric Fever 17 Diarrhoea and Epidemic Enteritis 18 Erysipelas 21 Puerperal Fever 21 Midwives' Act 22 Tuberculosis 25 Tuberculosis and Milk 26 Disinfection 27 Customs and Inland Revenue Act 27 Gas Testing 28 Local Government Board. Returns:— Table I. Vital Statistics of whole District during 1905 and previous years 29 Table II. Vital Statistics of separate localities in 1905 and previous years 30 Table III. Cases of Infectious Disease notified during the year 1905 31 Table IV. Causes of, and Ages at, Death during year 1905 32 Table V. Infantile Mortality during the year 1905. Deaths from stated causes in weeks and months under one year of age 34 Table VI Cases notified and deaths from the principal zymotic diseases for the year 1905 and preceding years 42 B.—Sanitary Work— Inspections 43 Notices Served 43 Lodging Houses 46 4 PAGE Housing of the Working Classes Act 47 Factory and Workshop Act 47 Smoke Nuisances 49 Dairies and Cowsheds 50 Ice Cream Vendors 50 Meat and Food 50 Offensive Trades 51 Slaughterhouses 51 Sale of Food and Drugs Act (Prosecutions) 52 Refuse Collection and Disposal 54 Health Visitors (Summary of work done during 1905) 55 Health Lectures 56 Table VII. Work done by the Drainage and Sanitary Inspectors during the year 1905 57 Table VIII. Workshops on Register, number of Employees, and visits paid during the year 1905 58 Table IX. Food and Drugs Act. Number of samples taken during the year 1905 59 Table X. Meteorological Record—Year 1905 60 C.—The Water Supply 61 D.—Work of the Borough Hospital 67 E.—Work of the Bacteriological Laboratory 76 F.—Public Elementary Schools 85 Appendix 107 5 Gentlemen, I beg to present my Sixth Annual Report on the Health and Sanitary circumstances of the Borough, together with a Report of the Borough Hospital and Borough Laboratory. It will be seen that 1905 was a healthy year, especially as far as infants under one year ef age were concerned, the mortality at this age being only 96 per thousand as compared with an average of 138 for the previous ten years. My thanks are once more due to the Council and to the Staff of the Public Health Department and Borough Hospital, and especially to the successive Resident Medical Officers for the assistance they have at all times afforded me. I am, Gentlemen, Your obedient Servant, H. MEREDITH RICHARDS, M.D. April 11th, 1906. 7 COUNTY BOROUGH OF CROYDON. Sanitary Committee (1904-5). The Mayor—Alderman G. J. Allen, J.P. Mr. Alderman Lillico (Chairman). „ Sir F. T. Edridge, J.P. „ Morland. „ Rymer, J.P. Mr. Councillor Denning. Mr. Councillor Price (Vice- „ Helps. Chairman). ,, King, J.P. ,, Smith. ,, Moore. „ Stewart. ,, Moss. ,, Stranks. „ Peck. ., Trythall. Mr. Councillor Waller. Starr of the public health Department: Drainage Inspectors. Thos. H. Culver (Cert. San. Institute). J. C. Earwicker „ „ A. D. Peck „ „ F. Richardson „ „ District Inspectors. William S. Adams. H. Hunter (Cert. San. Institute). W. H. Stokes „ „ Chas. J. Vincent ,, ,, Fredk. F. Fulker ,, ,, (Inspector for Infectious Diseases). A. Low, C.S.A. (Inspector of Meat, Dairies, Cowsheds and Milkshops). Jos. H. Bull, C.S.I. (Inspector under the Factory and Workshops Act and Shop Hours Act). A. Stanley (Disinfector). A. W. Pink (Senior Clerk). S. T. Brown (Junior Clerk). F. H. Lennard „ Miss F. Eggleston (Health Visitor). Mrs. Nolan-Slaney „ Miss Tawney ,, Matron of Borough Isolation Hospital. Miss Bond. Resident Medical Officer and Bacteriologist. J. A. H. Brixcker, M.B., D.P.H. (Cantab.) Assistant Medical Officer. T. Evans, M.B. (Lond.) Chief Sanitary Inspector and Inspector under Food & Drugs Act. P. Saunders (Cert. San. Institute). Medical Officer of Health. H. Meredith Richards, M.D. 8 SUMMARY OF ANNUAL HEALTH REPORT FOR 1905. COUNTY BOROUGH OF CROYDON. Area—9,012 acres. Soil and Situation—Croydon is situated in the County of Surrey, 10 miles south of London Bridge. The greater part of the Borough is in the watershed of the Wandle, the remainder draining towards the Effra and Ravensbourne. The subsoil in the north of the Borough is London clay, while the upper chalk comes to the surface in the south, the clay and chalk being separated by a strip of lower London tertiaries comprised of beds of clay, sand and pebbles. Both the London clay and chalk are in parts overlaid by irregularly disposed beds of gravel. Altitude-—The height above ordnance datum varies from 375 feet at All Saints' Church, Upper Norwood, to 110 feet at Mitcham Road ; Average about 250 feet above ordnance datum. Population—Census of 1901—133,895. Estimated Population, June, 1905—147,704. Estimated Inhabited Houses, 1905—29,397. Rateable Value, £1,047,906. General District Rate, 3s. rod. in the £. Poor Rate, including Education Rate, 3s. iod. in the £. VITAL STATISTICS, 1905. Birth Rate, per 1,000 living, 26-4. Death Rate, per 1,000 living, 127. Infantile Mortality, per 1,000 births, 96. Isolation Hospitals—For Fever at Waddon Marsh Lane. For Small-pox at North Cheam. Water Supply—From the Thames, and from deep wells in the chalk. 9 County Borough of Croydon. HEPORT of the MEDICAL OFFICER OF HEALTH. For the Year 1905. A.—VITAL STATISTICS. THE POPULATION at the Census of 1891 was 102,695, and had increased at the Census of 1901 to 133,895. The population at the middle of 1905, according to the estimate of the Registrar-General, was 147,704. The number of inhabited houses cannot be ascertained with accuracy. At the last Census, in April, 1901, it was 25,726. From this date until June 30th, 1905, 5219 houses have been passed by the Borough Engineer as fit for occupation. The total number of inhabitable houses has, thefore, been increased to that extent. It is, however, a matter of common knowledge that the number of vacant houses in Croydon is larger than for some years past, being about 10 per cent., as compared with about 5 per cent. in 1901. Taking this into consideration it is probable that the number of inhabited houses in June, 1905, was about 29,397. If the population per house remains the same as in 1901, this will give a total population of 152,864, or more than 5,000 in excess of the Registrar General's figure. This estimate, however, cannot be given with any great amount of confidence, and it is to be regretted that the Local Government Board has not arranged for a quinquennial census, in order that vital statistics might be prepared with greater accuracy. In the meantime the Registrar-General's figure is used as the basis of the rates calculated in this report. THE AREA of the Borough is 9,012 acres, and the density of the population was 16.4 per acre. 10 The approximate acreage of the Wards is as follows:— Areas in Acres. Wards. 1660 flipper Norwood (sub-division). (Thornton Heath do. 980 South Norwood. 2179 West. 404 Central. 2209 East. 1580 South. 90I2 THE BIRTHS during the year numbered 3,894, of which 1979 were boys and 1915 were girls. The birth rate equalled 26.4 per 1,000 as compared with 27.2 for England and Wales. Of the total births, 180, or 4.6 per cent., were illegitimate. The births were distributed as follows:— Total, Birth rate per 1ooo estimated populat on, Upper Norwood Sub-division *134 l6.I South ,, 384 19.8 Central ,, 344 20.1 East ,, 387 22.8 BOROUGH 3894 26.4 South Norwood Ward 648 29.0 Thornton Heath 466 29.9 West Ward 1446 30.2 The Workhouse 85 *lncluding n births at 89, Central Hill. DEATHS.—During the year, 1941 deaths were registered in the Borough or 13.1 per 1000. One hundred and five of the deaths registered in the Borough were those of strangers dying at the Workhouse or Infirmary, 21 of strangers dying at the Croydon General Hospital, 15 at the Cottage Hospital, Upper Norwood, while one death from scarlet fever at the Borough Hospital occurred among patients admitted from Penge. If we deduct these 142 deaths and add 30 deaths at the Mental Hospital, Warlingham, and 53 deaths of Croydon residents known to have occurred outside the district during the same period, we get anett total of 1,882 deaths, which is equal to 127 per 1,000, as compared with 15.2 for England and Wales, 157 for the 76 great towns, 14.4 for the 141 smaller towns, 14.9 for England and Wales less the 217 towns. 11 Corrections for deaths of strangers occurring within the Borough and of deaths of Croydon people dying outside the Borough are more complete than was formerly possible. This is due to returns being now available for the deaths of Croydon lunatics occurring at the Mental Hospital, Warlingham, and of Croydon people dying in London institutions. The latter return has been furnished by the courtesy of the Superintendent of Statistics, Somerset House, and has been available since 1903. Since these deaths have been added to those registered in the Borough, all deaths of strangers occurring at the General Hospital, Cottage Hospital, Upper Norwood, and other similar institutions in the Borough have been deducted. Formerly, these were included in the total number of deaths on the supposition that they were balanced by Croydon death in London institutions. The nett death-rates for the four quarters of the year were 1905. Average for 1895-1904. 1st Quarter 15.2 15.8 2nd Quarter 11.4 12.4 3rd Quarter 1O.5 13.5 4th Quarter 13.5 13.1 Year 12.7 13.7 The death-rate for the year is satisfactory, being one per thousand less than the average for the years 1895—1904, and lower than that recorded in any previous year, except 1903 with a deathrate of 11'8 per thousand. WARD DEATH-RATES. —Table II gives the number of deaths assignable to each district in the Borough. Institution deaths have been, as far as possible, debited to the Wards in which the deceased lived prior to admission to hospital. In as many as 21 cases of persons dying at the Workhouse Infirmary we were unable to do this, and I have, again to call attention to the necessity of the Local Government Board making such changes in the Poor Law Registers as would enable the previous addresses of deceased paupers to be quickly and accurately obtained. The Ward deaths for the year were as follows :— Deaths, Death-rate per 1000, East Ward l6l 9.5 South Ward 197 10.2 Thornton Heath Sub-Division 159 10.2 Upper Norwood Sub-Division 105 12.6 BOROUGH 1882 12.7 South Norwood Ward 297 13.3 Central Ward 236 13.8 West Ward 706 14.7 12 The Registrar General has not yet published his Annual Summary for 1905. I am therefore unable to say what exact position will be assigned to Croydon in comparing the death-rate with that of the other 76 towns, but from an examination of the four quarterly reports, it would seem that Croydon maintains its position at the head of what were the 33 great towns. The death-rate, however, was considerably lower in many of the other 76 towns. For instance Hornsey had a recorded death-rate of 7.6, King's Norton 9.l, Handsworth 10.1, Leyton 10.3, Walthamstow 1o.8, Willesden 11.6, and East Ham 117. INFANTILE MORTALITY is measured by the proportion of deaths under one year to 3,000 births, and amounted to 96 as compared with 128 in 1904, 104 in 1903, 133 in 1902, and 140 in 1901. This is the lowest infantile mortality rate in Croydon of which we have any record. During the year 1905 the rate for England and Wales was 128, while in the 76 large towns it ranged from 66 in Hornsey, 80 in Handsworth, 83 in Bournemouth, 87 Burton-on-Trent, 89 in King's Norton, 94 in Leyton, to 153 in West Ham, 155 in Nottingham, 174 Grimsby, 193 in Merthyr Tydfil, 195 in Hanley, to 200 in Rhondda. The figures for the various Wards were:— Births, Deaths under i year. Death-rate per joco Births. Upper Norwood Subdivision T34 IO .. 75 East Ward 387 30 78 Thornton Heath Subdivision 466 39 84 South Ward 384 34 89 South Norwood 648 60 93 BOROUGH 3894 372 96 Central Ward 344 37 108 West Ward 1446 162 112 The following table shows the fluctuations since 1892 in the infantile mortality from "all causes," from "diarrhoeal diseares*," and from " causes other than diarrhoeal." Years. Total Infantile Mortality from all causes. Infantile Mortality 1 from " diarroceal ' diseases. Infantile Mortality from other than " diarrhoeal" diseases 1893—1897 142 25 117 1898—1902 143 38 105 1903 104 9 95 1904 128 20 99 1905 96 14 82 *Under "diarrhoeal" diseases are included deaths from 'diarrhoea," from epidemic and zymotic enteritis, and from enteritis, that is, from the causes classified in schedules 10, 11, and 107 of Table IV. 13 Though the yearly variations in the infantile mortality rate are largely due to variations in the number of deaths from " diarrhoeal " diseases, it will be seen that the favourable rate in 1905 was not due to this alone, the infantile mortality rate from other than " diarrhoeal " diseases being 17 per thousand less than in 1904, and 13 per thousand less than in 1903. Table V has been added at the request of the Local Government Board to show the precise age at which infants under one year of age die from certain selected diseases. DEATH CERTIFICATION.—All deaths in the Borough were certified by the Medical Attendant or by the Coroner. INQUESTS were held in 145 instances, or 7.7 per cent of the total deaths. THE ASSIGNED CAUSES OF DEATH are fully set out in Tables IV., Y. and VI., but certain of them require special comment. SMALL POX.—During the year 1905 no single case of small pox was notified in the Borough. This is the first year we have been so fortunate since 1899. CROYDON AND WIMBLEDON JOINT SMALL POX HOSPITAL.— The Small Pox Hospital District now comprises the County Borough of Croydon, the Borough of Wimbledon, the Urban District of Penge, and the Croydon Rural District. Only five patients were admitted during the year, viz.:—Two from the districts owning the hospital, one from the Epsom Rural District, one from the Godstone Rural District, and one from the District of the Bromley and Beckenham Hospital Board. The last case was admitted under a temporary arrangement made with that Board pending the completion of their Small Pox Hospital. The case from the Godstone Rural District was admitted at the urgent request of that authority, and at considerable inconvenience to the hospital staff. Though the Urban and Rural Districts of Surrey have been combined under the Isolation Hospitals Acts in order to provide hospital accommodation for small-pox, no active steps seem to have, been taken in the matter. In the meantime the Joint Board has, in 1905 and in previous years, come to the rescue of many of these authorities, who should now come to some permanent arrangement with the Board or provide a separate hospital. 14 VACCINATION.- -During the year ending December 31st, 1905, the number of primary vaccinations in Croydon and Penge amounted to 4,033, as compared with 4,366, registered births. MEASLES accounted for 24 deaths during the year as compared with 62 deaths in 1904. As measles is not notifiable in the Borough, the actual number of children who suffered from the disease is unknown, but must have been very considerable, as during the year no less than eight schools were closed for this disease and 1,267 notifications were sent to various elementary schools after enquiry into suspected cases by the Health Visitors. It is once more noteworthy that all the fatal cases occurred in small houses. The influence of school attendance and measles is referred to in the report to the Education Committee. SCARLET FEVER (see Tables III., IV. and VI.). Four hundred and sixteen cases were notified, of which 11 ended fatally, as compared with 291 cases and eight deaths in 1904. From Table VI. it will be seen that the disease was more prevalent than in any year since 1900, and the number of deaths was greater than in any year since 1897, when 13 cases ended fatally. The cases were pretty generally distributed throughout the Borough, but the East and West Wards had rather more than their share, while the Upper Norwood Sub-Division was singularly free from this disease. One of the elementary schools was closed on account of the disorganisation produced by a small outbreak. Three hundred and thirteen cases or 75 per cent, were isolated at the Borough Hospital. RETURN CASES OF SCARLET FEVER. —In 16 instances 23 other cases of Scarlet Fever arose in homes to which patients had been discharged from hospital. 15 The following are the chief particulars in reference to these cases:— RETURN CASES OF SCARLET FEVER, 1905. Discharged Patient. Notes as to any abnormality on Discbarge. Onset and number of return case. Interval between discharge of patient and onset of return case. No- in Register Age' Sex. Date of Discharge. Days in Hospital. Length of illness. 461 8 F 3/1/05 40 44 All noimal. 6/1/05 (16) 3 days 10/1/05 (20) 7 ,, 2/2/05 (64) 30 ,, 370 4 M 24/1/05 101 107 Uvula? red, external naresred, head scurf}, tonsils + . 1/2/05 (60) 8 ,, 469 5 M 10/1/05 45 47 Tonsils +. 2/2/05 (65) 23 ,, 331 6 M 26/1/05 119 122 Tonsils +, ex'.crna! nares? little red. 9/2/05 (78l 14 ,, 322 5 M 4/2/05 132 134 All normal. 16/2/05 1102) 12 ,, 107 8 M 15/4/05 53 56 All normal, except for toughness on heels. 10 5/05 (204) 25 ,, 20/5/05 (220) 35 ,, 276 14 F 5/8/05 46 49 All normal, except for desquamation of feet. 8/8/05 (340 30/8/05 (355) 3 ,, 25 ,, 308 6 F 29/8/05 47 48 Glands palpable. 1/10,05 (411) 33 ,, 400 6 F 7/11/05 43 45 All normal 11/11/05 (520) 4 ,, 405 4 M 11/11/05 44 48 All normal. 19/11/05 (549) 8 „ 508 1½ M 16/12/05 42 45 Glands +, scar right side of neck. 22/12/05 (583) 6 ,, 29/12/05 (593) 13 „ 509 7 F 30/12/05 56 57 Noimal. 3/1/06 (6) 4 ,, 3/1/06 (7) 3/1/06 (8) 4 ,, 4 ,, 460 9 F 30,12/05 73 75 External nares a litt'e rough. 4/1/06 (9) 5 ,, 465 4 M 30/12/05 70 71 All normal. 3/1/06 (10) 4 ,, 413 4 F 7/12/05 66 68 T hroat a little red, tonsils +, glands palpable 4/1/06 (11) 28 ,, 464 51 M 28/12/05 69 90 Remains of scab on left heel secondary to a blister, tonsils +. 7/1/06 (18) 10 „ In several instances the interval that elapsed between the discharge of the patient and the onset of the second case was considerable, and raises some doubt as to whether the discharged patient and the infected case were really cause and effect. From all one knows of the chronicity of scarlet fever, I am, however, disposed to believe that the return cases were really due to persistent infectiousness of the discharged patient in the majority of instances. It will be noticed that no less than 13 out of the 16 discharged patients, who were suspected of carrying infection, left the hospital either in January February, November, or December. During these four months 151 patients were discharged, and 9 per cent, were therefore suspected of carrying infection. During the remainder of the year 212 patients were discharged, and of these only 1 per cent, were 16 similarly suspected. It is impossible to be certain what this means, but various explanations suggest themselves :— (1). During the winter months children are much more subject to " common colds." Should a child take " cold " on its way home from the hospital it will suffer from nasal discharge, and that nasal discharge will in all probability be capable of conveying to other children any residual infection remaining in the nose of the discharged patient. - Similarly slight sore throats are potentially capable of re-lighting infection. (2). ft is possible that children do not throw off infection so rapidly in the winter time, when outdoor exercise is naturally somewhat curtailed. (3). The wards are usually fuller during the winter months, and though there has never been any overcrowding, it is possible that the fact that ventilation not being so thorough as in the summer time acts prejudicially on scarlet fever patients. It is for this, among other reasons, that the Hospital Committee are considering the advisability of installing additional heating apparatus, so that freer ventilation may be maintained without any inconvenience to the inmates and with, it is hoped, advantage to their health. EPIDEMIC INFLUENZA was the assigned cause of death in 30 instances as compared with 27 in 1904. WHOOPING COUGH accounted for 31 deaths, 30 of which occurred in children under live years of age. The number of cases is unknown, but 353 school notices were necessitated by those coming to the knowledge of the department. DIPHTHERIA AND MEMBRANOUS CROUP: —The number of cases notified amounted to 266 as compared with 312 in 1904, and 259 in 1903, while 25 cases terminated fatally. Seventy per cent, of the cases were isolated at the Borough Hospital. The cases were fairly evenly distributed throughout the Borough but Thornton Heath and Upper Norwood had less than their share of this disease. The method of dealing with the cases is substantially the same as that prescribed in the last Annual Report. 17 Though the disease has been kept in check, and the result of dealing with special localised epidemics is usually quite satisfactory, we are still far from being able to stamp out the disease. This seems to be due to the large number of cases of mild diphtheria which escape recognition, and the sti II larger number of uncontrolled " contacts." School teachers could do much to lessen the number of unrecognised cases by reporting every case of sore throat, however mild, and however little resembling diphtheria. Were this done in every case where school children suffered from sore throat, there would be fewer missed cases and a smaller number of fatalities, as efficient treatment could be resorted to at an earlier stage of the disease. As stated in the report to the Education Committee 259 cases of " sore throat" were reported from the schools and many of them were found to be diphtheria. ENTERIC FEVER: —Thirty-four cases were notified, and four deaths from this disease were registered during the year. Twentythree cases were removed to hospital. Of these, nine were subsequently found to be suffering from some other complaint, viz :— two pneumonia, one influenza, one cirrhosis of liver, one colitis, one acute rheumatism, one septicaemia, one Malta fever, and one constipation. There were thus 25 cases of supposed enteric fever which required investigation. Of these, nine appeared to have contracted the disease outside the borough. Of the remaining 16 cases the origin was indefinite in no less than eight cases, while in six instances, shell-fish, and, in two instances, personal infection from preceding cases was the suspected cause of illness. As epidemics of enteric fever are commonly traceable to infected water, and as Croydon has two distinct sources of water supply, it seemed useful to compare the incidence of the disease in the parts of the Borough supplied by Croydon, and by Lambeth (Metropolitan Water Board). As the numbers for one year are small, the particulars have been taken out for the six years, 1900-1905, inclusive. PARTICULARS OF ENTERIC FEVER CASES. 1900 to 1905, inclusive. Cases Notified.—270 (including 11 cases of Continued Fever). Removed to Borough Hospital.—145 cases (including 2 cases of Continued Fever). On removal to the Borough Hospital, thirty six (36) Were found to be suffering from other diseases. 18 Water Supply of the Cases Notified:—• CROYDON 171 LAMBETH 95 Cases brought to Public Institutions in the Borough from outside Districts 4 Total 270 Concerning the Notified Cases, the following facts were ascertained :— Suffering from other diseases, and not enteric fever 36 Home case, diagnosis subsequently amended 1 Infected outside the Borough 43 Probably infected Dy shellfish, watercress, &c. 32 Infected from other cases 29 ,, while unstopping ot drains 1 „ by overflow of sewer 1 Total 143 Source of illness not traced 127 Of the 127 cases, the source of which was not traced, and which, therefore, might have been water-borne infection, 83 live within the area of the "Croydon" supply, and 44 in the "Lambeth" area. The enteric fever incidence in the two areas was, therefore, 7 per 10,000 in the "Croydon" area, and 12 per 10,000 in the " Lambeth" area for the six years. The numbers are in both cases, so small, as practically to exclude any suspicion or infection of either public water stfpply during the six years in question, and are sufficient to refute the suggestion that Croydon water has during recent years produced any ill effect. DIARRHœA AND EPIDEMIC ENTERITIS accounted for 52 deaths, of which 42 occurred in children under one year of age. There were also 22 deaths from other forms of enteritis, of which 13 were under one year of age. Thus of the total, 74 deaths from " diarrhoeal " diseases, no less than 55 were those of infants under one year of age. It will be seen from Table VI. that " diarrhoeal " deaths were considerably less than in any year for the past decade except 1903. The accompanying chart shows the seasonal distribution of the deaths under one year from diarrhoeal diseases. It will be seen that 35 out of the 55 deaths were in the third quarter. This curve again shows that a high mean temperature of the air does not in itself affect diarrhoeal mortality as it should do if putrefaction of 19 insufficiently cooled milk from dirty farms were the main cause of the disease. It is also apparent that the connection between diarrhoeal prevalence and the temperature of the soil is not so close as Dr. Ballard supposed. Inverse relation of diarrhoea in wet weather is also manifest from the following figures. In the third quarter of 1903 there were 49 days on which rain fell, with only 22 deaths under one year from diarrhoeal diseases; in 1904 there were 28 wet days and 96 deaths under one year from diarrhoeal diseases, while 1905, with 41 wet days, occupies an intermediate position with 55 deaths. It will be seen from Table V. that diarrhoeal deaths were more numerous at ages 0-3 months and 6-9 months than at other periods under one year of age. This is contrary to previous experience, and is perhaps the accidental result of dealing with a limited number of observations. During the year investigations were made by the three health visitors into the method of feeding employed during the first six months of life in respect to 1,383 infants who survived this length of time. The following is a summary of the figures :—■ Entirely breast fed 864 62 per cent. Breast and cow's milk 116 8 per cent. Breast and other foods 246 18 per cent. Cow's milk 70 5 per cent. Condensed Milk 40 3 per cent. Other prepared foods 47 4 per cent. 1383 Similar enquiries were made in respect to no deaths from all causes and 18 deaths from "diarrhoeal" diseases occurring among infants who survived for at least one week and died before reaching six months. The following is a summary of the figures :— Deaths from all causes. Diarrhoeal and Enteritis deaths. Entirely breast fed ... 69 = 63 per cent. 6 33 per cent. Breast and cow's milk 10 = 9 per cent. O 11 per cent. Breast and other foods 9=8 per cent. O 0 per cent. Cow's milk .... ... 9 = 8 per cent. 3 17 per cent. Condensed milk ... 8 = 7 per cent. 7 39 per cent. Other prepared foods 5 = 5 per cent. 0 0 per cent. 110 18 2 O Owing to the very large number of enquiries made by the Health Visitors concerning children absent from school on account of suspected infectious disease and to changes in the staff, only some of the deaths under one year were investigated. As, however, similar enquiries have been made during the last four or five years, and the total number investigated is now considerable, it has been thought well to summarise the results obtained up to and including the year 1905. The following are the figures :— During the years 1900, 1903 and 1905, investigations were made by the three health visitors into the method of feeding employed in respect to 800 deaths from all causes and 185 deaths from " diarrhoeal " diseases occurring among infants who survived for at least one week and died before reaching six months. The following is a summary of the figures :— Deaths from all causes. Deaths from Diarrhoea and Enteritis. Entirely breast fed 402 50 per cent. 29 16 per cent. Breast and cow's milk 22 3 per cent. 4 2 per cent. Breast and other foods 24 3 per cent.. 4 2 per cent. Cow's milk 181 23 per cent. 84 45 per cent. Condensed milk 145 18 per cent. 59 32 per cent. Other prepared foods 26 3 per cent. 5 3 per cent. 800 185 During the three years 1903-5, investigations were made by the Health Visitors into the method of feeding employed during the first six months of life in respect to 4,446 infants who survived this length of time. The following is a summary of the figures :— Entirely breast fed 2 745 62 per cent. Breast and cow's milk. 357 8 per cent. Breast and other foods 872 20 per cent. Cow's milk 232 5 per cent. Condensed milk 92 2 per cent. Other prepared foods 148 3 per cent. 4446 21 Similar returns have been so fully discussed on previous occasions that it is only necessary to refer briefly to the inferences that may fairly be drawn from these figures. (1) The death rate from all causes is nearly half as large again among children receiving more or less artificial food as compared with those that are entirely breast fed for the first six months of life. (2) The mortality from diarrhoeal diseases is nearly eight times higher among those receiving artificial food as compared with that of children who are entirely breast fed. (3) Though the number of children fed on condensed milk is comparatively small they furnish a considerable proportion of the deaths of infants from all causes and a still more considerable share of diarrhoeal deaths. PUERPERAL FEVER was notified on 11 occasions. Five of these cases ended fatally. Three of the cases were attended by registered midwives. In every instance the disinfectant used by the midwife was only Condy's fluid, which is practically useless for this purpose. Even where more efficient chemical substances are stated to be used it is doubtful whether any real disinfection of the midwife or of the patient is carried out. Efficient disinfection in every case means scrupulous cleanliness as a preliminary and the careful use for a definite time of a definite strength of an efficient disinfectant. Few midwives working among the poor attempt more than the wetting of their hands in a "bowl of water to which they have added an unknown but extremely small portion of a disinfecting fluid whose name they have usually forgotten. In one instance a registered midwife made no pretence at disinfection, not even taking her bag to the case. Puerperal fever shortly developed, and the facts were reported to the Central Midwives' Board, who instituted an enquiry and removed the midwife's name from the roll. Though no longer registered, this midwife still continued her employment, and has already had another case of puerperal fever in her practice (January nth, 1906). In only three out of the 11 cases of puerperal fever was a medical man actually present at the confinement. ERYSIPELAS was notified on 78 occasions, and five cases ended fatally. 22 MIDWIVES ACT, 1902.—During the year one of the registered midwives (P.B., No. on Roll 1,465) was removed from the roll, and her certificate cancelled for negligence and misconduct, and 24 remained on the register on December 31st. The case books and bags of appliances of all ihe midwives, with the exception of one (No. on Roll 20,936), whose present address is unknown, have been inspected. The result of the inspection was much the same as last year, the majority of the women being very ignorant, and for the most part incapable of either understanding or carrying out the rules of the Board. Certain midwives require special reference, I.C. (No. on Roll 2,091). This midwife continued to keep her register in a very imperfect manner, though personally warned on this point last year. She is not worse than many of the other midwives, but as she is younger than most of them and likely to continue at her work for several years, she was asked to attend before the Committee so that she could show cause why she should not be reported to the Central Midwives Board for negligence. She apologised to the Committee, and undertook to adhere to the rules for the future. M.A.W. (No. on Roll 2,105). This midwife had no appliances and no case book, and would not undertake to provide them. She preferred being removed from the roll to undertaking responsibility for which she did not feel fit. This was reported to the Central Midwives' Board, and in all probability her name will be removed from the roll. S.H. (No. on Roll 20,373). This midwife also had no case book or bag of appliances, and would not undertake to provide them. She was also reported to the Central Midwives' Board, who will doubtless remove her name from the roll. E.D. (No. on Roll 20,342). E.M. (No. on Roll 2,991). E.P. (No. on Roll 20,935). 23 Neither of these midwives were able to produce a case book. They have been warned that they will be required to keep a proper case book next year, and formal notice to this effect has been given them. I may add that in many instances notifications that should have been sent to the supervising authority have not been received. With regard to the midwife whose name has been removed from the roll, the facts are as follows :—- On June 19th, 1905, a notification was received from Dr. E. that M.T., of 2, Lion Road, was suffering from puerperal septicaemia. On enquiry it seemed that M.T, was confined on June 15th, and was attended at her confinement by P.B. (No. on Roll 1,465). It was found that she had disobeyed the following rules framed by the Central Midwives' Board :— E. 2. In that she attended the case without her bag and without any disinfectants. E. 3. In that she did not disinfect her hands and forearms. E. 7. In that she did not disinfect the patient. E. 11. In that the patient was not kept in a cleanly condition. E 17. In that she allowed more than 36 hours to elapse after the shivering lit before a doctor was sent for. Furthermore, her case book was not properly kept, and she did not appear to have sent either to the doctor or myself the necessary notice required by Rule 19 (b). On ascertaining these particulars she was requested to attend before the Committee, who found a prima facie case of malpractice and negligence established against her, and directed the same to be reported to the Central Midwives' Board. The Board summoned her to appear before it with a view to the removal of her name from the roll, should the charges made against her appear to be proved. The. doctor in attendance was also requested to attend to give evidence. After careful consideration of the facts of the case, and after hearing the midwife's defence, the Board cancelled her certificate and removed her name from the roll. 24 At the end of the year I received the following letter from the Midwives' Board :— Central Midwives' Board, 6, Suffolk Street, Pall Mall, London, SAV. December 19th, 1905. Sir, Midwives' Act, 1902. Rules of Central Midwives' Board. I am directed to advert to the fact that the period of validity of the present code of rules exoires on the 12th August, 1906, and to state that the Board will be glad to have an opportunity of considering any amendments that your experience of the administration of the Act and Rules may have indicated as desirable. As the Board proposes to commence the consideration of the revision of the Rules in January, I shall be much obliged if you will be good enough to let me have by the 10th of that month any amendments that you may wish to suggest for adoption by the Board. I am, sir, Your obedient servant, G. W. Duncan, Secretary. The Medical Officer of Health for Croydon. In reply thereto I addressed the following letter:— Public Health Department, Town Hall, January 6th, 1906. Sir, Midwives' Act, 1902. Rules of Central Board. In reference to your communication of December 19th, 1905, I beg to make the following suggestions :— (a.) I think it would be an advantage if Section E were printed separately. At present, midwives are given a copy of all the Rules, and finding Section A beyond their comprehension give up the attempt to understand them. 25 (6.) I think it would be an advantage if there were a rule that midwives should attend at the office of the Local Supervising Authority when required. This would facilitate inspections, and economise the time of the supervising medical officer. (c.) It should be made clear that midwives are required to enter in their Case Book, the names and addresses of patients whom they attend under medical supervision. (d.) Paragraph 3 of Rule 1 should also apply to midwives who have been attending any septic case. Many midwives are also District Nurses and go straight from dressing an ulcerated leg to a confinement. Possibly, this point could better be met by amending Rule 5. (e.) Most of the midwives registered in Croydon are far too ignorant to be trusted to give vaginal douches. Rule 2 (Sub-section c.) refers to an antiseptic for douching in special cases. I think it would be well to define special cases as those which are under medical care. (f.) If possible, provision should be made whereby the Local Supervising Authority could delegate to their executive officer the power of suspending a midwife pending a meeting of the Authority. Yours faithfully, H. Meredith Richards. G. W. Duncan, Esq., Central Midwives' Board. TUBERCULOSIS of all forms was the assigned cause of death in 220 instances, or 1.49 per 1,000 persons living, while phthisis alone was responsible for 162 deaths, or 1'o9 per 1,000. It will be seen from Table VI that the deaths from phthisis were more numerous than in any of the ten preceding years. Phthisis has now been voluntarily notifiable in the borough since 1903. From that date until the end of the year 57 notifications were received. During 1904, 129 cases were notified, and in 19°5, 75 cases were notified. It will be noticed the number of notifications is less than in 1904, and only corresponds to less than half the number of deaths. Probably, therefore, not more than one-sixth of the total cases came to the knowledge of the Health Department. All notified cases are visited by one of the medical officers from the Borough Hospital or myself, so that patients and their friends may be advised as to the precautions they 26 must take to prevent the infection of others. Subsequent visits with a like object are also made by the Health Visitors at quarterlyintervals in the case of patients who seem to need this supervision. While notification, however, embraces such a small proportion of the actual cases of phthisis, it is hardly likely that any considerable progress can be made, and I can only repeat once more my opinion that measures for the prevent ion of phthisis will not become popular, nor, indeed, can be considered to have been seriously begun, until some amount of hospital accommodation has been provided for suitable cases. suitable cases. It is true that the Workhouse Infirmary already accommodates a considerable number of dying patients; thus, during the last five years we have the following figures :— Year. Total deaths of Croydon persons in Institutions. Total deaths of Croydon persons from Phthisis. 1901 23 123 1902 29 112 1903 35 151 1904 31 142 1905 43 162 Total 161 690 There remains, however, a need for the hospital treatment of advanced cases occurring in families somewhat above the pauper class. Beds are also needed for the reception of a limited number of moderately early cases occuring among the poor, who should be taken into hospital for a limited time, with the object of receiving training in personal hygiene on the lines followed at Brighton. Provision should also be made for the segregation of the cases treated at the Infirmary. Until some such provision is made, I do not see that any further advance is possible, and I can only reiterate my opinion, that the Council and the Guardians should consider the advisability of making a combined effort to deal with these cases. Disinfection of the premises for phthisis has been carried out in 87 instances, and is always offered after a fatal termination, or in any other cases where house infection appears likely to have taken place. TUBERCULOSIS AND MILK.-—No samples were taken under the Model Milk Clauses during the year. This course was adopted because previous experience had shown that it was almost impossible to take adequate precautions even when samples were found 27 to be tuberculous. With a view, however, of calling the attention of dairymen to the importance of producing milk free from tuberculous contamination, I propose taking further samples during the current year. DISINFECTION.—During the year, 592 houses and 645 lots of clothing were disinfected. The latter mumber included 69 lots of infected material from the Urban District of Penge. The articles disinfected were as follows :—294 Beds ; 293 Mattresses; 710 Blankets; 90 Sheets; 730 Pillows; 225 Bolsters; 115 Palliasses ; 1,604 Other Articles. Total, 4,061. CUSTOMS AND INLAND REVENUE ACTS.—Under Sect. 26, 53, and 54 Vict., c. 8, exemption from inhabited house duty is granted to houses divided into tenements of the annual value of less than £20, provided the medical officer of health certifies that they afford suitable accommodation for each of the families or persons dwelling therein, and that due provision is made for their sanitary requirements. By Sect. 11, 3 Edward VII.. this provision was extended to houses of the annual value of not more than £4.0. During the year applications were made in respect of the following Hats •— Houses examined and certified under the Customs and Inland Revenue Act, during 1905 Name of Street. Number of Houses. Number of Dwellings. Number of Certificates Granted- Date of Inspection 1 and 3, Cargieen Road 2 4 Nil. Feb. 24'h, 190-5. 2, 3, 6, 7, 8, 9, 10, 11. 12, 13 14, 15, 16, 18, 19, 20, 23, and 2-5, Royal Parade, Lund or. Road .. 9 18 18 March 2nd, 1905. 21 and 22, Royal Parade, London Road 2 4 4 April 19th, 1906. 82, South End 1 3 Nil. May 18th, 1906. 28 GAS TESTING.—The following are particulars of Official Tests of Gas during the year 1905:— Date. Gas Works, Croydon. Gas Works, Lower Syd nham. Testing Station, Beckenham. 1905. IHuminating Power. Candles. Sulphur in Grains. Sulphur'd Hydrogen. IHuminating Power, Candles. Sulphur in Grains. Sulphur'd Hydrogen. IHuminating Power. Candles. Sulphur in Grains. Sulphur'd Hydrogen. January 5 ... ... ... 1.5.30 28.95 none ... ... ... „ 6 ... ... ... 15.76 30.12 none ... ... ... ,, 23 ... ... ... ... ... 14 7 19.8 none. February 13 ... ... ... ... ... ... 15.1 26.1 Average 30.7 none. „ 14 ... ... ... ... ... ... 28.6 1 ... „ 15 ... ... ... ... ... ... 31.2 ... „ 16 ... ... ... ... ... ... 31 1 ... „ 17 ... ... ... ... ... ... 161 31.9 none „ 18 ... ... ... ... ... ... ... 35.3 J ... April 3 ... ... ... ... ... ... 15.8 331 none. „ 18 ... ... ... 14.8.5 33.51 none ... ... ... May15 ... ... ... ... ... ... 16 0 35 1 none. June 8 14 45 ... none. ... ... ... ... ... ... „ 15 15.54 ... none. ... ... ... ... ... July10 ... ... ... ... ... ... 15.6 34 6 none. August14 ... ... ... ... ... ... 15.3 35.3 none. „ 30 ... ... ... 15 31 ... none. ... ... ... September 18 ... ... ... ... ... ... 15.3 ... none. „ 19 1603 none. ... „ 29 ... ... ... 154 ... none. ... ... ... October 30 ... ... ... ... ... ... 15 03 no test. none November 14 ... ... ... ... ... 15.4 no test. none. „ 30 15.57 ... none. ... ... ... ... ... ... The figures for the South Suburban Gas Company are from the London County Council's official tests. 29 TABLE I. For whole District, for Calendar Year 1904. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Non-residents registered in Disti ict. Deaths of Residents registered beyond District. Deaths at all Ages. Nett. d. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* a b c d e 1 2 3 4 5 6 7 8 9 10 11 12 13 1895. 114,923 2906 25.3 397 136 1687 14.7 271 58 15 1629 14.2 1896. 118,006 2964 25.1 457 154 1721 14.6 283 73 21 1669 14.1 1897. 121,171 3034 25.0 423 139 1622 13.4 315 64 10 1568 12.9 1898. 124,421 3150 25.3 482 153 1777 14.3 347 85 18 1710 13.7 1899. 127,759 3204 25.1 500 156 1993 15.6 431 101 7 1899 14.9 1900. 131,186 3270 24.9 432 132 1977 15.1 419 63 6 1920 14.6 1901. 134,665 3578 26.6 501 140 1829 13.6 383 83 2 1748 12.9 1902. 137,917 3576 25.9 476 133 1965 14.3 429 74 13 1904 13.8 1903. 141,157 3726 26.4 386 104 1740 12.3 454 129 57 1670 11.8 1904. 144,419 3769 26.1 483 128 2071 14.3 598 148 75 1998 13.8 Averages for years 1895—1904 129,562 3318 25.6 454 138 1838 14.2 393 88 22 1772 13.7 1905. 147,704 3894 26 4 372 96 1941 13 1 541 142 83 1882 12-7 * Rates calculated per 1,000 of estimated population. a These are total births (uncorrected) for Institutions. b These are corrected for the Borough Hospital and Workhouse. c Includes all deaths of residents and non-residents in Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, 89, Central Hill '.Servants' Reformatory), and Court Royal Convalescent Home, South Norwood Hill. d Deaths of non-residents have been excluded in the case of the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, 89, Central Hill (Servants'Reformatory), and Court Royal Convalescent Home, South Norwood Hill. Prior to 1903 correction was only made for the first three institutions. e In 1903 arrangements were made for the first time whereby deaths of Croydon persons in the London district were notified to the Medical Officer of Health. Area of District in acres (exclusive of area covered by water), 9,012. At Census of 1901.—Total population at all ages, 133,895; number of inhabited houses, 25,726 ; average number of persons per house, 5.2. 30 TABLE II Names of Localities. 1. West Ward. 2. Central Ward. 3. East Ward. 4. South Ward. 5. South Norwood Ward. 6. UiM'f.r Norwood Sub-Division. i7. Thornton Heath Sub-Division. 18. Undistributed Institution Births and Deaths. Year Population estimated to middle of each year. Biiths Registered. Deaths at all ages. Deaths under 1 Yearj Population estimated to middle of each year. " . . i Births Registered. Deaths at all ages. Deaths uoderl Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated at middle of each year. , Births Registered. Deaths at all ages. ! Deaths under 1 Year Population j estimated to middle of each year. Births Registered. Deaths at a ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. ' Deaths at all ages. Deaths under 1 Year a b c d a b c d a b c d a b c d a b c d a b .c d a b c d * Prior to 1900, Institution Deaths could not be distributed as the Registrar did not supply the necessary information. b c d 1895 * 35,778 1136 502 150 16,201 395 197 49 11,627 204 143 26 15,827 373 192 48 17,333 432 184 52 8,191 130 95 9 9,966 236 103 35 271 28 1896 * 36,955 1158 506 195 16,283 390 218 57 12,145 255 121 36 16,179 426 178 46 17,850 394 215 52 8,198 111 81 14 10,396 230 119 42 283 15 1897 * 38,162 1135 418 136 16,365 395 203 43 12,658 279 138 34 16,511 381 177 6 1 18.322 450 195 62 8,206 130 90 23 10,947 *64 86 40 315 24 1898 * 39,379 1072 443 156 16,460 387 230 66 13,186 295 132 45 16,863 431 200 57 18,829 510 235 74 8,216 108 83 15 11,488 277 107 45 347 24 1899 * 40,606 1100 521 182 16,553 388 223 59 13,734 323 153 58 17,235 421 193 48 19,346 488 248 62 8,228 102 91 13 12,057 315 133 49 431 29 1900 * 41,839 1142 662 175 16,694 355 264 46 14,241 327 177 33 17,624 394 246 52 19.852 501 234 62 8,241 129 96 11 12,685 353 157 43 69 84 10 1901 * 43,136 1230 640 208 16,778 397 200 48 14,799 345 158 45 18,011 409 197 49 20.399 571 245 73 8,254 132 93 16 13,288 414 164 57 80 51 5 1902 * 44,361 1271 658 191 16,863 326 219 44 15,326 361 175 44 18,363 413 222 45 20.899 547 276 75 8,277 156 113 26 13,828 404 158 43 98 83 1903 * 45,540 1355 570 169 16,957 379 210 45 15,836 339 156 34 18,735 378 181 27 21,412 611 260 55 8,302 149 85 7 14,375 443 171 48 72 37 1 1904 * 46,741 1319 699 190 17,051 362 229 35 16,346 375 193 47 19,107 399 227 55 21,925 621 322 70 8,327 148 90 20 14,922 463 192 63 82 46 3 Averages ot | Years > 1895 to 1904. ) 41,249 1192 561 175 16,220 377 219 49 13,991 310 155 40 17,446 403 201 49 19,617 513 241 64 8,244 130 92 15 12,395 350 139 47 80 195 15 1905 t 47,944 1446 706 162 17.106 344 236 37 16,983 387 161 30 19,404 384 197 34 22,370 648 297 60 8.335 134 105 10 15.562 4fiB 159 39 85 21 Notes.—fFor 1900, 1901, 1902, 1903, 1904 and 1905 deaths of residents occurring beyond the district are included in sub-columns c of this table, and those of non-residents occurring at the WorkhoUse, Workhouse Infirmary, Borough Hospital, General Hospital, "Court Royal," Upper Norwood, and 89, Central Hill (Servants' Reformatory) are excluded. Deaths of residents occurring in Public Institutions are allotted to the respective localities, according to the addresses of the deceased, but deaths of strangers at the Workhouse, Workhouse Infirmary, General Hospital, Norwood Cottage Hospital, "Court Royal," Upper Norwood, and 89, Central Hill (Servants' Reformatory), and also all deaths of Croydon residents whose exact home could not be ascertained, are included in Block 8. 3i TABLE III. Cases of Infectious Disease notified during the Year 1905. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 Total. At all Ages. At Ages—Years. West. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not he distributed. West. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution Cases. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 & upwd. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 266 5 73 150 20 18 .. 100 32 34 27 33 5 15 20 70 20 25 20 3 10 20 185 Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 78 2 2 5 7 49 13 37 9 6 5 13 2 4 2 .. .. .. .. .. .. .. .. .. Scarlet Fever 416 3 112 250 35 16 .. 149 30 77 32 50 4 58 16 109 21 69 20 35 2 41 16 313 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 34 .. 2 8 9 15 .. 9 3 6 1 7 3 4 1 5 2 5 1 5 2 3 •• 23 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 11 .. .. .. 2 9 .. 5 1 1 .. 4 •• .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 75 .. 1 1 12 58 3 35 12 4 8 5 5 6 .. .. .. .. .. .. .. .. .. .. Totals 880 10 190 414 85 165 16 335 87 128 73 112 19 87 39 184 43 99 38 60 7 54 36 521 The Borough (Fever) Isolation Hospital is situated in the West Ward. The Croydon and Wimbledon (Small-pox) Isolation Hospital is at North Cheam. 32 TABLE IV. Causes of, and ages at, Deaths during Year ending December 31st, 1903, excluding Deaths of Strangers at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, 89, Central Hill (Servants' Reformatory), and Court Royal Convalescent Home, South Norwood, and adding Deaths of Croydon Residents known to have occurred outside the District. Schedule No. Causes of Death in Croydon during the Year ending December 31st, 1904. Deaths in whole District at Subjoined Ages. Deaths in Localities at all Ages. Institution and Street Deaths which could n«t he distributed. '1 otal institution Deaths distributed and not distributed. Inquest Cases. all ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 'ZD and under 65. 65 and upwards. ]West. Central. East. South. South Norwood. Upper Norwood, Thornton Hejith. Total. M. F. 1 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 24 14 10 7 14 3 .. .. .. 12 3 1 .. 4 2 2 .. (2) .. 3 Scarlet Fever 11 6 5 .. 8 3 .. .. .. 3 3 2 .. 2 .. 1 .. 12(1) .. 5 Epidemic Influenza 30 13 17 1 1 .. .. 14 14 10 2 4 4 6 1 3 .. 4(1) •• 6 Whooping Cough 31 14 17 21 9 1 .. .. .. 11 5 .. 5 6 .. 4 .. 3(2) .. 7 Diphtheria (Mem. Croup) 25 12 13 .. 13 12 .. .. .. 12 3 2 3 1 .. 4 .. 17 .. 8 Enteric Fever 4 3 1 .. .. 1 1 2 .. 1 .. 2 .. .. 1 .. .. 4 .. 10 Diarrhoea, Dysentery 24 13 11 21 1 .. .. .. 2 11 3 2 1 5 1 1 .. 1 3 11 Epidemic Enteritis.. 28 8 20 21 6 1 .. .. .. 12 3 3 2 8 .. .. .. .. .. 12 Other Allied Diseases 1 .. 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 15 Tetanus 1 1 .. 1 .. .. .. .. .. .. .. .. 1 .. •• .. .. 2(1) .. 18 Syphilis 2 1 1 2 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 19 Gonorrhoœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedena 1 .. 1 .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 2(1) .. '21 Erysipelas 5 2 3 2 .. .. 1 1 1 '2 1 .. .. 2 .. .. .. 3 1 22 Puerperal Fever 5 .. 5 .. .. .. 1 4 .. 3 1 .. .. 1 .. .. .. (1) l 23 Pyaenva (Septicaemia) 3 1 2 1 1 .. .. 1 .. 2 .. .. 1 .. .. .. .. 1 l 24 Infective Endocarditis 3 .. 3 .. .. .. 1 1 1 .. .. .. 3 .. .. .. .. .. .... 25 Other Allied Diseases 11 8 3 2 .. .. 5 4 2 1 .. 2 2 1 1 2 8(1) .. 27 Rheumatic Fever 12 6 6 .. 2 3 1 6 .. 3 1 2 3 3 .. .. .. 5(1) .. 29 Tuberculosis of Brain 21 11 10 7 8 4 .. 2 .. 10 2 .. 3 2 1 3 .. 5(1) .. 30 Tuberculosis of Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (1) .. 31 Phthisis 162 93 69 1 2 4 33 117 5 67 l6 13 17 30 5 13 1 56(13) 3 32 Abdominal Tuberculosis 9 4 5 2 1 3 2 1 .. 4 • • .. 1 2 .. 1 1 4(2) .. 33 General Tuberculosis 17 6 11 6 2 3 3 3 .. 9 4 1 1 1 1 .. .. 5(2) 1 34 Other forms Tuberculosis 11 4 7 •• 1 4 2 2 2 3 1 .. 2 3 .. 2 .. 3 .. 38 Hydatid Diseases 1 .. 1 .. .. .. .. 1 .. .. .. l .. .. .. .. .. 1 .. 39 Scurvy 1 .. 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. (1) .. 41 Acute Alcoholism 2 2 .. .. .. .. .. 2 .. .. .. .. .. 1 1 .. .. 1 .. 42 Chronic Alcoholism 3 1 2 .. .. .. .. 2 1 2 .. .. .. 1 .. .. .. .. l 45 Osteo-arthritis 8 3 5 .. .. 1 .. 1 6 4 2 .. .. .. 2 .. .. 1 .. 46 Gout 2 2 .. .. .. .. .. 2 .. 1 .. .. .. .. 1 .. .. .. .. 47 Cancer 140 55 85 .. 1 .. 4 86 49 45 22 10 16 24 13 9 1 58(18) l 48 Diabetes Melli'us 11 6 5 .. .. .. .. 8 3 4 2 1 2 .. 2 .. .. 2 .. 51 Anaemia 7 2 5 .. .. .. .. 3 4 1 .. 3 1 1 .. 1 .. 3(2) 1 52 Lymphadenoma 1 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 53 Premature Birth .. 67 37 30 66 1 .. .. .. .. 24 7 7 2 18 1 8 .. 2(3) 4 54 Injury at Birth 3 1 2 3 .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. 55 Debility at Birth . 9 6 3 9 .. .. .. .. .. 5 1 .. 2 .. .. 1 .. .. .. 56 Atelectasis 6 5 1 6 .. .. .. .. .. 2 .. 1 i 1 1 .. .. (1) .. 57 Congenital Defects 14 11 3 13 1 .. .. .. .. 2 4 .. I 5 .. 2 .. 9(4) 1 58 Want of Breast Milk 3 2 1 3 .. .. .. .. .. .. .. 1 .. 2 .. .. .. .. .. 59 Atrophy. Debility, Marasmus 49 28 21 47 1 .. .. 1 .. 22 5 2 5 6 2 7 .. 12(4) l 60 Dentition 3 2 1 3 .. .. .. .. .. 1 1 .. .. 1 .. .. .. .. .. 61 Rickets 4 3 1 2 2 .. .. .. .. 2 .. .. .. 1 .. 1 .. .. .. 62 Old Age, Senile Decay .. 79 26 53 .. .. .. .. .. 79 30 10 3 11 13 5 3 4 18(5) 1 63 Convulsions 30 13 17 25 4 .. .. .. 1 18 2 1 3 2 2 2 .. .. 8 64 Meningitis 14 7 7 3 6 1 2 2 .. 4 2 3 2 3 .. .. .. (1) .. 65 Encephalitis 2 2 .. .. 1 .. .. 1 .. 2 •• .. .. .. .. .. .. 2 1 66 Apoplexy 35 15 20 .. .. .. .. 12 23 12 3 4 6 4 3 3 .. 7 .. 67 Softening of Brain 3 3 .. .. .. .. .. 1 2 1 .. .. 1 1 .. .. .. 1 .. 68 Hemiplegia 1 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 69 General Paralysis of Insane 10 8 2 .. .. .. .. 10 .. 4 2 1 .. 1 1 .. 1 10 .. 70 Other forms of Insanity 11 4 7 .. .. .. .. 8 3 3 1 1 .. 1 1 3 1 11 1 71 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 72 Cerebral Tumour 1 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 73 Epilepsy 7 5 2 .. .. .. 1 2 4 2 2 .. .. 2 .. .. 1 3 2 74 Laryngismus Stridulus 3 2 1 2 1 .. .. .. .. 1 .. .. .. 1 1 .. .. .. l 75 Locomotor Ataxy 3 2 1 .. 1 .. .. 2 .. '2 .. .. .. .. 1 .. .. .. .. 76 Paraplegia b 3 2 .. 1 .. 1 2 1 1 1 2 .. .. 1 .. .. 1(1) .. 77 Other forms, Brain Diseases 8 4 4 .. 1 2 l 3 1 3 3 .. .. 1 1 •• .. 5(2) .. 78 Otitis .. 9 5 4 1 2 1 2 3 2 1 3 .. 2 1 .. .. 7(1) .. 81 Pericarditis 2 .. 2 .. .. 1 .. 1 .. 1 .. .. 1 .. .. .. .. .. .. 82 Endocarditis 87 47 40 .. 1 7 5 40 34 38 12 8 7 12 2 7 1 28(8) 12 83 Hypertrophy of Heart 4 1 3 .. .. .. .. 2 2 .. .. .. 1 2 1 .. .. 1 1 84 Angina Pectoris 4 2 2 .. '.. .. .. .. 4 3 .. .. .. .. 1 .. .. .. .. 80 Aneurism 4 4 .. .. •• .. .. 3 1 1 1 .. 1 .. 1 •• .. 2 1 86 Senile Gangrene 3 1 2 .. .. .. .. .. 3 1 2 .. .. .. .. •• .. 2(1) .. 87 Embolism Thrombosis 8 3 5 .. .. .. .. 3 5 3 1 2 1 1 .. .. .. 1 1 88 Phlebitis 1 .. 1 .. •• .. .. 1 .. .. .. 1 .. .. .. •• .. .. .. 33 TABLE IV—continued. Causes of, and ages at, Death during Year ending December 31st, 1905. Schedule No. Causes of Death in Croydon during the Year ending December 31st, 1904. Deaths in whole District at subjoined Ages. Deaths in Loc\lities at all Ages. Institution and Street Deaths which could not be distributed. lotal Institution Deaths distributed and not distributed. Inquest Cases all ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards,. | West. Central. East. South. South Norwood. Uppe Norwood. Thornton Heath. Total. 1 M. F. 90 Other Diseases, Heart and Vessels 189 85 104 .. 1 1 1 57 129 68 29 12 17 35 10 14 4 69(16) 18 91 Laryngitis 2 .. 2 .. 2 .. .. .. .. .. 1 .. .. 1 .. .. .. 2(1) .. 92 Croup 1 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 94 Acute Bronchitis 59 36 93 28 7 .. .. 9 15 28 6 6 4 10 1 4 .. 1 2 95 Chronic Bronchitis 80 35 45 .. .. .. .. 16 64 28 11 1 11 11 4 5 .. 22(6) 2 96 Lobar Pneumonia .. 36 15 21 3 4 1 3 16 9 7 5 4 5 4 2 8 1 15(6) .. 97 Lobular Pneumonia 55 27 28 19 17 .. .. 5 14 15 9 7 9 3 5 6 1 9(2) 3 98 Pneumonia 52 27 25 8 7 3 3 22 9 19 8 8 7 4 3 3 .. 11 4 99 Emphysema, Asthma 6 2 .. .. .. .. 3 3 3 1 .. 1 .. .. 1 .. 2(1) 1 100 Pleurisy 11 5 1 .. .. .. 8 2 2 3 .. 1 2 2 1 .. 5(3) 1 101 Other Diseases Respiratory System 3 1 2 .. .. 1 .. 1 1 2 1 .. .. .. .. .. .. 1 .. 102 Diseases of Mouth and Annexa 2 2 .. .. .. .. 1 .. 1 .. .. .. .. 1 .. 1 .. .. .. 105 Ulcer of Stomach and Duodenum 11 5 6 .. .. .. 1 9 1 5 1 1 3 1 .. .. .. 4(2) .. 106 Other Diseases of Stomach 13 9 4 6 .. .. .. 4 3 6 .. .. 4 2 .. 1 .. 1(1) .. 107 Enteritis 22 12 10 13 2 .. .. 2 5 11 3 2 2 .. .. 3 .. 2 1 108 Appendicitis 3 .. 3 .. .. 1 .. 1 1 1 1 1 .. .. .. .. .. 1(1) 1 109 Obstruction of Intestine 20 6 11 .. 1 .. 1 7 11 11 1 1 3 .. 3 .. 10(2) .. 110 Other Diseases of Intestine 2 .. 2 .. .. .. .. 1 1 .. .. .. .. .. 1 .. 1 4(3) .. 111 Cirrhosis of Liver 30 17 13 .. .. .. .. 20 10 14 .. 1 1 5 1 6 .. 5 .. 112 Other Diseases of liver 8 2 6 .. 1 .. .. 4 3 3 .. .. .. 3 1 .. .. 2(2) .. 113 Peritonitis 8 5 3 .. .. 1 .. 5 2 1 2 .. .. 3 1 1 .. 7(3) 2 114 Other Diseases, Digestive System 5 3 2 .. .. .. .. 4 1 2 1 1 .. .. 1 .. .. 2 .. 115 Diseases, Lymphatic System and Glands 7 2 5 .. .. 1 1 4 1 2 .. .. 1 .. 2 2 .. 2 .. 116 Acute Nephritis 5 2 3 .. .. .. 1 4 .. 3 .. 1 .. .. 1 .. .. .. .. 117 Brignt's Disease 48 27 21 .. .. .. .. 24 24 15 3 8 5 9 4 4 .. 17(3) .. 118 Calculus 2 1 1 .. .. .. .. 2 .. 1 .. .. .. 1 .. ... .. .. .. 119 Diseases of Bladder and Prostrate 11 10 1 .. .. .. .. 1 10 2 1 .. 4 1 1 2 .. 8(3) .. 120 Other Diseases, Urinary System 3 2 1 .. .. .. .. 2 1 2 .. .. .. .. 1 .. .. 2(1) .. 121 Diseases of Testis 8: Penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of Ovar.es 1 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 .. 123 Diseases of Uterus and Appendages 3 3 .. .. .. .. 3 .. 1 .. .. 1 .. 1 .. 2 .. 128 Puerperal Convulsions 2 .. 2 .. .. 1 .. 1 .. 2 .. .. .. .. .. .. .. .. .. 129 Placenta Prasvia Flooding .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 131 Other Diseases, Pregnancy and Childbirth 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 132 Arthritis,Otis,Periostitis 2 1 1 1 .. .. .. .. 1 .. .. .. 1 1 • • .. .. .. .. 134 Ulce; Bedsore 3 .. 3 .. .. .. .. 2 1 1 .. .. .. 2 .. .. .. .. .. 135 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 136 Pemphigus 1 .. 1 •• 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. Accidents. 139 In Vehicular Traffic 3 2 1 .. .. i .. 1 1 2 .. .. 1 .. .. .. .. 2 3 140 On Railways 1 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1(1) 1 142 In Building Operations 2 2 .. .. .. .. .. 2 .. 1 1 .. .. .. .. .. .. .. 2 143 By Machinery 1 1 .. .. .. .. .. 1 .. .. .. 1 .. •• .. .. .. .. 1 145 Burns and Scalds 8 3 5 .. 4 .. .. 3 1 2 3 1 .. .. .. 1 1 7(2) 8 150 Drowning 3 3 .. .. .. 2 .. 1 .. .. .. .. .. 2 1 • • .. .. 3 151 Suffocation, Overlaid in Bed 8 3 5 8 .. .. .. .. .. 5 .. .. 1 1 .. 1 .. .. 8 152 ,, Otherwise 1 1 .. .. .. .. .. .. 1 •• .. .. .. .. .. 1 .. 1 1 153 Falls not spec'ficd 13 9 4 .. 2 .. 2 8 1 5 2 2 1 .. 1 2 .. 8(1) 13 154 Weather Ag ncies 3 3 .. • • .. .. 1 2 .. 1 .. .. 1 .. 1 .. .. .. 3 155 Otherwi: e, not stated 5 2 3 5 .. .. .. .. .. 2 1 1 .. 1 .. .. .. 1(1) 5 156 Homicide 2 2 .. 1 .. .. 1 .. .. 1 .. .. 1 .. .. .. .. 1 2 S cidrs. 157 By Poison 5 3 2 .. .. .. .. 5 .. 2 .. 1 .. .. 1 1 .. 1 5 161 By Drowning 1 •• 1 .. .. .. .. 1 .. .. .. .. .. 1 • • .. .. .. 1 162 By Cut or Stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 164 By Crushing 2 1 1 .. .. .. .. 2 .. .. 1 • • .. l .. .. .. .. 2 165 By Other and unspecified methods 2 2 .. .. .. .. 1 1 .. 1 .. .. .. .. 1 .. .. .. 2 168 Ill-defined and unspecified causes 5 1 4 .. .. .. .. 2 3 1 .. 1 .. l .. 2 .. .. 2 Total 1882 926 956 372 144 69 79 633 585 706 236 161 197 297 105 159 21 541 (142) 145 The total Institution Deaths include those of strangers occurring within the Borough. Deaths of such strangers occurring at the Workhouse, Workhoure Infirmary, General Hospital, Borough Hospital, 89, Central Hill (Servants' Reformatory), and Court Royal Convalescent Home, South Norwood Hill, are excluded from all other columns of the Table. The numbers so excluded are in brackets. 34 TABLE V. Borough of Croydon— Whole District. INFANTILE MORTALITY DURING THE YEAR 1903. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Wcks. 3-4 Weeks. Total Numbtr 1 Montn. 1-2 Months. 2-3 Months. 3-4 Mon hs. 4-5 Months. 5-6 Mom J is. 6-7 Months. 7-8 Month*. 8-9 Months. 9-10 Months. 10-ir Months. 11-12 Monrhs. Total Deaths Under One Year All Causes. Certified 78 8 19 11 116 44 45 16 14 21 22 21 24 14 17 16 372 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 4 1 1 1 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 4 1 1 2 3 3 ... ... 3 3 21 Diar hœal Diseases. Diarrhoea, all forms ... ... 3 1 4 3 6 3 2 4 2 7 3 2 4 2 42 Enteritis, (not Tuberculous) ... ... ... ... ... 1 4 1 ... 1 3 1 1 ... ... 1 13 Gastritis ... ... 1 1 2 1 1 1 ... ... ... ... 1 ... ... ... 6 Wasting Diseases. Prem iture Birth 41 5 7 2 55 6 2 2 ... 1 ... ... ... ... ... ... 66 Congenital Defects 5 2 1 ... 8 1 1 ... ... 1 ... 1 ... ... 1 ... 13 Injury at Birth 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Want of Breast-millc ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 3 Atrophy, Debility, Marasmus 8 ... 2 4 14 12 13 3 4 4 1 2 2 ... 1 56 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 4 ... ... 1 ... 1 7 Tuberculous Feiitonitis: Tabes Mesenteriea ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 Other Tuberculous D'ses ... ... ... ... ... ... ... ... 1 1 1 1 1 1 ... 1 7 Erysipelas ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 2 Syphilis ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 3 Convulsions 6 ... 2 ... 8 1 5 4 1 2 ... ... 2 1 1 ... 25 Bronchitis ... ... 1 2 3 8 4 1 ... 2 2 1 3 3 ... 1 28 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 1 1 ... ... 2 ... 2 ... 3 2 4 4 4 3 3 3 30 Suffocation, overlaying . 2 ... ... ... 2 3 2 ... 1 ... ... ... ... ... ... ... 8 Other Causes 12 ... 1 1 14 3 ... ... 1 ... 1 1 3 ... 2 1 26 78 8 19 11 116 44 45 16 14 23 22 21 24 14 17 16 372 Births in the year legitimate 3714 illegitimate 180 Population. Estlmated to middle of 1905 Deaths from all Causes at all Ages 1882 147704 35 TABLE V.—continued. Borough of Croydon—West Ward District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OK DEATH. Under 1 Week. 1-2 Weeks. 2-3 We-ks. 3-4 Weeks. Total Number 1 Month. [-2 MootOS. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Monrhs. Total Deaths Under One Year. All Causes. Certified 34 ... 10 3 47 15 20 10 7 18 8 9 12 3 7 6 162 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 1 ... 1 2 2 ... ... 2 ... 9 Diar'hœal Diseases. Diarrhoea, all forms ... ... ... 1 1 2 2 3 1 2 2 2 2 ... 2 1 20 Enteritis, [not Tuberculous) ... ... ... ... ... 1 2 1 ... 1 ... 1 ... ... ... 1 7 Gastritis ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Wasting Diseases. Premature Birth 16 ... 4 1 21 1 1 ... ... 1 ... ... ... ... ... ... 24 Congenital Defects 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 6 ... 2 1 9 1 6 1 4 3 ... 1 1 ... 1 ... 27 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 3 Tuberculous Peritonitis: Tabes Mesenteriea . ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... 1 5 Erysipelas ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis [not Tuberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 2 Convulsions 5 ... 1 ... 6 1 3 2 ... 2 ... ... ... ... 1 ... 15 Bronchitis ... ... 1 ... 1 5 2 1 ... 2 2 1 ... 1 ... 1 16 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 1 ... ... ... 1 ... ... 1 1 2 ... ... 4 ... ... 1 10 Suffocation, overlaying 1 ... ... ... 1 1 2 ... 1 ... ... ... ... ... ... ... 5 Other Causes 4 ... ... ... 4 1 ... ... ... ... ... 1 3 ... ... ... 9 34 ... 10 3 47 15 20 10 7 18 8 9 12 3 7 6 162 Births in the year 1,446. Population. Estimated to middle of 1905 47,944. Deaths from all Causes at all Ages 706. 36 TABLE V.—con tinned. Borough of Croydon—Central Ward District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under I Week. 1-2 Wet ks. 2-3 Week?. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Mo tlis. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 5 2 3 1 11 5 2 3 2 2 3 3 1 3 2 ... 37 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chn ken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 Diarrheal Diseases. Diarrhcea, all forms ... ... 1 ... 1 ... ... ... 1 1 ... 1 1 ... ... ... 5 Enteritis (not Tubercnlous) ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases, Premature Biith 3 1 1 ... 5 1 ... 1 ... ... ... ... ... ... ... ... 7 Congenital Defects 1 1 1 ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Injury at B rth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... ... ... 1 1 3 ... 1 ... ... ... I ... ... 1 ... 6 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other T uberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 .. ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Bronchitis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 2 ... 6 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 5 2 3 1 11 5 2 3 2 2 3 3 1 3 2 ... 37 Births in the year 344. Population Estimated to middle of 1905. Deaths from all Causes at all Ages 236. 17,106. 37 T ABLE V. —-continued. Borough of Croydon—East Ward District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Cau-es in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 We-kst 3-4 Wetks. Total Numbtr i Month. 1-2 Mo- tns. 2-3 Mo ths. 3-4 Mon hs. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 M nth®. 8-9 Month*. q-to Months. 10-ir Months. n-12 Monrlis. Tota' Deaths Under One Year. All Causes. Certified 6 2 1 2 11 3 2 ... 3 1 ... ... 2 2 2 2 30 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cliicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diar hceal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 ... 4 Enteritis, (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth ... 1 1 ... 6 1 ... ... ... ... ... ... ... ... ... ... 7 Congenital Defects ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Atrophy, Debility, Marasmus ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenteriea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Convulsions ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Bronchitis ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 1 ... ... 1 ... 1 ... ... ... ... ... 2 ... 1 5 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 2 ... ... ... 2 ... ... ... 1 ... ... ... ... ... 1 ... 4 6 2 1 2 11 3 2 ... 3 1 ... 2 2 2 2 2 30 Births in the year 387. Population. Estimted to midd eof 1905 Deaths from all Causes at all Ages161. 16,983. 38 TABLE V.—continued. Borough of Croydon—South Ward District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total Number 1 Month. 1 -2 Mooths. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 M< nth . 8-9 Month. 9-10 Months. 10-11 Months. 11-12 Monrhs. Total Deaths Under One Year. All Causes. Certified 6 ... 3 1 10 7 3 2 ... 1 3 2 1 3 2 ... 34 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... ... ... I ... ... 1 ... 3 Diarrhoeal Diseases. Diarrhoea, all forms ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 1 ... 3 Enteritis, (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Wasting Diseases. Premature Birth 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Congenital Defects 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 1 ... ... ... 1 4 ... 1 ... 1 ... ... ... ... ... ... 7 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Tuberculous Peritonitis: Tabes Mesenteriea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 Bronchitis ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 3 Suffocation, overlaying ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Causes 2 ... 1 ... 3 2 ... ... ... ... ... ... ... ... ... ... 5 6 ... 3 1 10 7 3 2 ... 1 3 2 1 3 2 ... 34 Births in the year 384. Population. Estimated to middle of 1905 Deaths from all Causes at all Ages 197. 19,404. 39 TABLE V.—continued. Borough of Croydon—South Norwood Ward District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under I Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. io-ii Months. 11-12 Months. Total Deaths Under One Ytar. All Causes. Certified 18 3 1 4 26 7 10 1 1 1 1 2 4 ... 3 4 60 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chit ken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 4 Diarrheal Diseases. Diarrhoea, all forms ... ... 1 ... 1 1 3 ... ... ... ... 2 1 ... ... ... 8 Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Wasting Diseases. Premature Birth 12 2 ... 2 16 ... ... 1 ... ... ... ... ... ... ... ... 17 Congenital Deftcts 2 1 ... ... 3 ... 1 ... ... ... ... ... ... ... 1 ... 5 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus ... ... ... ... ... 1 4 ... ... ... ... ... ... ... ... ... 5 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Svnhilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 Bronchitis ... ... ... ... ... 3 ... ... ... ... ... ... 1 ... ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Suffocation, overlaying 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Causes 2 ... ... 1 3 ... ... ... ... ... ... ... ... ... 1 1 5 18 3 1 4 26 7 10 1 1 1 1 2 4 ... 3 4 60 Births in the year 648. Population Estimated to middle of 1905, Deaths from all Causes at all Ages 297. 22,370. 4° TABLE V.—continued. Borough of Croydon—Upper Norwood Sub-Division District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under I Week. 1-3 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 3-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 2 ... ... ... 2 ... 3 ... ... ... 1 ... 2 1 ... 1 10 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Enteritis (not Tuberculous') ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Congenital Defects ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 ... 3 ... ... ... 1 ... 2 1 ... 1 10 Population Births in the year 134. Estimated to middle of 1905 8,335. Deaths from all Causes at all Ages 105. 41 TABLE V —continued. Borough of Croydon—Thornton Heath Sub-Division District. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total Number 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-ix Months. 11-12 Monrhs. Total Deaths Under One Year. All Causes. Certified 8 1 1 1 11 5 4 1 1 1 5 2 3 2 1 3 39 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 3 Diar hœal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Enteritis, (not Tuberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... I ... ... ... ... ... ... ... ... 1 Wasting Diseases. Premature Birth 6 1 ... ... 7 1 ... ... ... ... ... ... ... ... ... ... 8 Congenital Defects ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atiophy, Debility, Marasmus 1 ... ... 1 2 2 2 ... ... ... 1 ... 1 ... ... 8 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Tuberculous Pe:itonitis: Tabes Mesenteriea ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Oiher Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 M ningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 J.arvngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 1 5 Suffocation, overlaying ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 1 1 1 11 5 4 1 1 1 5 2 3 2 1 3 39 Population. Estimated to middle of 1905 Births in the year 46b. 15,563. Deaths from all Causes at all Ages 169. TABLE VI. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1905 and ten preceding Years. Disease. 1905. 1904. 1903. 1902. 1901. 1900. 1899. 1898. 1897. 1896. 1895. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. J Cases. Deaths. Notifiable. Small Pox .. .. 3 .. 14 2 51 11 5 .. 1 .. .. .. .. .. .. .. 1 .. .. .. Scarlet Fever 416 11 291 8 215 2 295 6 391 1 432 5 350 3 301 9 563 13 284 4 157 4 Diphtheria and (i) Memb.Croup 266 25 312 24 259 18 285 29 448 23 187 25 127 17 162 19 131 7 172 30 132 22 (2) Erysipelas 78 5 68 2 79 4 102 5 79 4 71 6 .. 7 .. 6 .. 4 .. 11 .. 5 Puerperal Fever 11 5 9 3 7 1 8 5 9 3 12 8 7 4 6 5 9 1 6 4 6 6 Enteric Fever 34 4 21 5 32 5 59 9 57 11 56 9 56 8 64 9 50 7 108 17 43 15 Simple Continued Fever .. .. .. .. 2 . . 5 .. .. .. 4 .. 1 1 2 1 1 .. 12 .. 4 .. Non-notifiable. Diarrhoea and Epidemic or Zymotic Enteritis .. 52 .. 95 .. 37 .. 73 .. 129 .. 88 .. 195 .. 200 .. 127 .. 72 .. 64 Enteritis .. 22 .. 35 .. 14 .. 17 .. 37 .. 25 .. 1 .. 6 .. 12 .. 7 .. 45 Measles .. .. 24 .. 62 .. 26 .. 30 .. 21 .. 20 .. 18 .. 32 .. 17 .. 67 .. 16 Whooping Cough 31 .. .. 15 .. 58 .. 31 .. 25 .. 56 .. 40 .. 36 .. 32 .. 62 .. 27 Influenza 30 .. .. 27 .. 28 .. 58 .. 37 .. 106 .. 91 .. 39 .. 20 .. 18 .. 78 Bronchitis, Pneumonia, and Pleurisy .. 302 .. 314 .. 247 .. 341 .. 283 .. 367 .. 309 .. 232 .. 190 .. 309 .. 298 Phthisis .. 162 .. 142 .. 151 .. 112 .. 123 .. 135 .. 154 .. 133 .. 115 .. 142 .. 149 (1) Notifiable since May, 1897. (2) Notifiable since January, 1900. In the above Table deaths of Non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, "Court Royal," Upper Norwood, and ''89, Central Hill" (Servants' Reformatory), are excluded. Prior to 1903 correction was only made for the first three institutions. 42 43 B -SANITARY WORK OF THE YEAR. GENERAL SANITARY WORK.—T he usual summary is given in Table VII., which gives a fair idea of the various matters engaging the attention of the Sanitary Inspectors. During the year 6,293 house-to-house inspections were made, as compared with 5,816 in 1904. This is a satisfactory feature of the Report, as there is no doubt that the systematic inspection of smaller houses is the most useful work in which the inspectors can be engaged. The number of combined drains dealt with during the year was 35. The cost of carrying out the necessary works amounted to about £"341 19s. 1 id., and was borne by the owners instead of by the inhabitants at large. Most of the nuisances discovered were remedied on receipt of informal notices, but in 119 cases, Council Orders had to be applied for. Of the 119 legal notices 99 were complied with, and 20 were outstanding at the end of the year. Of the 20 outstanding Council Orders, 11 have now been complied with (March 31st, 1906). No prosecution had to be undertaken for non-compliance with ordinary nuisance notices. During the year, the Croydon Corporation Act, 1905, received Royal Assent. Under this Act, the Corporation obtained the following powers of public health interest:— Provision in lieu of Section 19 of Public Health Acts (Amendment) Act 1890. Where two or more houses or premises are connected with a single private drain which conveys their drainage into a pnblic sewer the Corporation shall have all the powers conferred by Section 41 of the Public Health Act 1875 and the Corporation may recover any expenses incurred by them in executing any works under the powers conferred on them by that section from the owner or owners of such houses or premises and if there be more than one such owner in such proportions as shall be settled by the surveyor or (in case of dispute) by arbitration under the Public Health Act 1875 or by a court of summary jurisdiction and such expenses shall be recoverable summarily as a civil debt or the Corporation may declare them to be private improvement expenses and may recover them accordingly. (2) Section 19 of the Public Health Acts (Amendment) Act 1890 shall cease to be in force within the borough. 44 (3) For the purposes of this section the expression " single private drain " includes any sewer or drain whether on private land or not and whether constructed before or after the passing of this Act with which two or more houses or premises (whether belonging to the same or different owners) are at the date of the passing of this Act or may at any time hereafter be connected or which is used or capable of being or intended to be used for the conveyance of the drainage of such houses or premises directly or by means of any other sewer or drain to any public sewer situate under a street repairable by the inhabitants at large but shall not include any sewer which has been constructed to the satisfaction of the Corporation under Section 152 of the Public Health Act 1875 or any sewer which has been constructed by the Corporation for the effectual drainage of the borough. Corporation may order houses to be drained by a combined operation. If it appear to the Corporation that two or more houses may be drained more economically or advantageously in combination than separately and a sewer of sufficient size already exists or is about to be constructed within one hundred feet of any part of such houses the Corporation may when the drains of such houses are first laid order that such houses be drained by a combined drain to be constructed either by the Corporation if they so decide or by the owner or owners in such manner as the Corporation shall direct and the costs and expenses of such drain and of the repair and maintenance thereof shall be paid by the owner of such houses (if there be only one) or shall be apportioned between the owners of such houses in such manner as the Corporation shall determine and if such drain is constructed by the Corporation such costs and expenses may be recovered by the Corporation from such owner or owners in a summary manner before a court of summary jurisdiction. Any combined drain constructed in pursuance of this section shall be deemed to be a single private drain within the meaning of the section of this Act the marginal note of which is " Provision in lieu of Section 19 of Public Health Acts (Amendment) Act 1890." Provided that the Corporation shall not exercise the powers conferred by this section in respect of any house plans for the drainage of which shall have been previously approved by the Corporation. Poiver «f entry for purposes of Section 75 of Act of 1900. For the purposes of Section 75* of the Croydon Corporation Act 1900 the Corporation and their officers shall have the like power of entry on any premises as a local authority and their officers have under Section 102 of the Public Health Act 1875 for the purposes of that section. * This section empowered the Corporation to disinfect, and, if necessary, destroy filthy bedding or body clothing. 45 Power of medical officer of health to examine school children. The medical officer of health may enter any public elementary school within the borough at all reasonable times and examine the scholars attending the same and may exclude from attendance thereat for such period as he shall consider requisite any scholar who in his opinion is suffering from infectious disease or is likely to spread infection. The medical officer of health shall upon the exclusion of any scholar in manner aforesaid give notice thereof in writing to the principal or person in charge of such school or (if such school is divided into separate departments and there is no principal or person in charge of the whole school) the person in charge of the. department which such scholar attend and shall send a copy of such notice to the parent or guardian of the scholar. Any person who obstructs the medical officer of health in carrying into effect the provisions of this section or who permits any scholar to attend school after he shall have been excluded as aforesaid and before the expiration of the period of exclusion shall be liable to a penalty not exceeding forty shillings. Occupier to furnish information as to premises occupied by any person suffering from infectious disease. (1) The occupier of any building in the borough which is used for human habitation and in which there is or has been any person suffering from a dangerous infectious disease shall on the application of the medical officer of health at any time during the illness of such person or within six weeks from the occurrence of such illness furnish such information within his knowledge as the medical officer of health may reasonably require far the purpose of enabling measures to be taken to prevent the spread of the disease. (2) Any occupier knowingly furnishing false information shall be liable on summary conviction to a penalty not exceeding forty shillings. (3) " Occupier" shall have the same meaning as in the Infectious Diseases (Notification) Act, 1889. Registration of common lodging houses and keepers. Notwithstanding anything in the Public Health Act 1875 or the Croydon Corporation Acts 1884 or 1895 the registration of a common lodging house or of the keeper of a common lodging house shall operate for one year only and application for the renewal of such registration shall be made to the Corporation on or previous to the 31st day of December in every year, 46 It is hoped that Section 34 will settle the question of " combined drain or sewer " as far as Croydon is concerned. Section 37 gives the Medical Officer of Health power to examine school children. This was required to enable the Medical Officer to carry out his school work with any hope of success. Until this Act was passed there was no legal warrant for the examination of school children. MUNICIPAL COMMON LODGING HOUSE.—This Lodging House affords accommodation for 17 women and 84 men. The number of occupants during the year amounted to 25,004 men and 4,003 women. The average number of lodgers amounted to 68 men and 11 women per night. The receipts and expenditure (exclusive of sinking fund and interest) for the past four years were :—■ Receipt*. Expenditure. £ s. d. 1902 766 0 O ... £734, including £68 for alterations. 1903 790 0 O ... £570. 1904 800 17 7 — £679 is. 6d. 1905 793 J7 7 ••• £582 18s. 5d. OTHER COMMON LODGING HOUSES.—1 here are nine other houses on the register. The following Table gives the situation of the nine registered houses and the accommodation provided therein. Premises. No. of Rooms. Accommodation. 11 & 12, Princess Road 12 54 men and 8 married couples. 9, Bell Yard 6 14 men and 5 married couples. 19, 20, 21, 22, 23 & 24, Lahore Road .. 30 50 men, 10 women, and 6 married couples. Nos. 19 to 24, Lahore Road.—These houses are under one management and worked as one establishment, as also are Nos. 11 and 12, Princess Road. Practically, therefore, only three common lodging houses now remain in the Borough, with a total accommodation for 166 adults, or if we add the Municipal Common Lodging House, a total of four houses with 229 single beds and 19 double beds. The number is 57 less than in 1902, and in my opinion 47 not sufficient for the needs of the town. There is still urgent need for additional accommodation in the neighbourhood of Old Town, though the Committee have not yet seen their way to make the necessary provision, and private enterprise shows no signs of doing so. During the year common lodging houses received 446 visits and 18 night visits. Minor infringements of bye-laws were detected on 10 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. HOUSES LET IN LODGINGS.—There are now 73 houses registered under the bye-laws. During the year these houses received 1801 visits, 81 having been made at midnight. On no occasion were offences discovered for which prosecutions were necessary. At the present moment the following houses are registered as houses let in lodgings Houses, Wilford Road43 Forster Road 12 Princess Road 4 Ely Road 8 Sundry Roads 6 The results of registration and inspection have, on the whole, been very satisfactory. HOUSING OF THE WORKING CLASSES ACT.—Three houses were represented under Part II. Sect. 30, as unfit for human habitation. The six houses in Mercer Place, Gloucester Road, outstanding at the end of last year, were re-represented, as the outstanding notices had lapsed. As the result of the notices, all were voluntarily closed during the year and subsequently demolished. FACTORIES AND WORKSHOPS. FACTORY AND WORKSHOP ACT. —Section 132 of the Factory and Workshop Act, 1901, provides : " Tne Medical Officer of Health of every District Council, shall' in his Annual Report to them, report specifically on the administration of this Act in workshops and workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State," 48 The following is a summary of the work done under this Act in Croydon during 1905. FACTORIES. —For the most part, the law relating to Factories is administered by the Home Office. 129 visits were, however, made to Factories, 122 being in reference to sanitary accommodation, five in reference to a complaint at a steam laundry, and one in reference to a manure receptacle. All the defects noted were remedied during the year. WORKSHOPS.—The number of workshops on the register, the various trades carried on therein, the number of workpeople employed, and the number of visits paid by the Inspector, are shown in Table VIII. The following is a list of the various matters requiring attention :—- Factories. Workshops Laundries Bakehouses. Workplaces. Outworkers. Total. Premises requiring repuii — — — 1 — — 1 Cleansing, etc. .. — 12 5 8 1 — 26 Insufficient W.C. accommodation 2 1 — 3 Defective ditto 5 10 1 3 — 19 Eaves and gutters — — — 1 1 — 2 Ventilation — 2 — — — — 2 Dustbins .. — 1 — 2 1 1 5 Paving — — — 2 — — 2 Offensive Accummulation — 1 1 — — — 2 Stoppage! .. — 2 — — — — 2 Sundry 13 1 1 1 16 7 51 9 18 4 1 90 49 Notices served— Factories 7 Workshops 31 Laundries 6 Bakehouses 13 Workplaces 1 Outworkers 1 59 All were remedied during the year with the exception of four which have since been complied with (March 31st, 1906). Sixty notices were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. HOME WORK. —Ninety-nine lists were received from employers, containing the names of 247 outworkers residing in the Borough. Twenty-six further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 45 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. Seventy-eight visits were paid to outworkers. BAKEHOUSES.—At the end of the year there were 131 Bakehouses in occupation, of which 12 were underground. 695 visits were made by the Inspector during the year, and 18 nuisances discovered and abated. WORKPLACES. —At the end of the year there were 72 workplaces on the register. 38 visits to eating-house kitchens have been made, and one notice served for the repair of roof, which has been complied with: SHOP HOURS AND SEATS IN SHOPS ACTS entailed 277 visits, and resulted in the discovery of 22 infringements of the Acts, 12 being the non-exhibition of notices, five employing young persons excessive hours, and five the non-provision of seats. Written cautions were sent to the 22 offenders and subsequently complied with. SMOKE NUISANCES.—Eighty-one observations were made, and seven persons were cautioned. 50 DAIRIES AND COWSHEDS.—There were 37 cowsheds on he register at the end of the-year, of which 34 were in occupation as against 44 sheds and 32 in occupation in 1904. Seven of the sheds formerly on the register are now used for other purposes. The occupied cowsheds provide accommodation for 538 cows with 800 cubic feet per head. The number of cows in the registered sheds in December was 438. The number of Cowkeepers in the Borough is now 24 as compared with 22 in 1904. During the year 15 dairies were removed from, and 31 added to the register, leaving 209 on the register at the end of the year. Three applications for registration were refused, as the premises were unsuitable. Thirty-six notices were served during the year for various matters requiring attention 011 the premises of dairymen, all of which were complied with at the end of the year. ICE CREAM VENDORS.— All premises where ice cream was known to be made were regularly visited during the season. All were found in a fairly satisfactory condition, and there was no occasion to serve any notices during the year. MEAT AND FOOD.—The following is a summary of the meat and other articles of food destroyed as unfit for consumption during the year. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 7,900 3,666 11,566 Including 15 carcases. Mutton 175 1,072 1,247 „ 16 „ Pork 4,252 314 4,566 ,, 23 Veal 296 24 320 „ 3 Offal 3,815 1.191 5,006 Fish .. 1,482 1,482 Fruit .. .. 60 60 Other Articles •• 681 681 Rabbits. Total lbs. 16,438 8,490 24,928 Including 57 carcases. 51 The whole carcases condemned were affected as undernoted :— Tuberculosis. Peri ton itis. Jaundice Pneumonia. Diarrhcea Emaciated and Dropsical Unsound and Bruised. Total No. Weight in lbs. Cattle 6 4 .. 2 .. 2 1 15 8,071 Sheep .. 1 .. 1 .. 3 11 16 816 Pigs .. 16 2 1 2 .. .. 2 23 3,446 Calves •• .. 1 •• 2 •• •• 3 296 22 7 2 5 2 5 14 57 12,629 In no cases had legal proceedings to be taken against the owner of any diseased or unsound meat. The large quantity destroyed was voluntarily submitted to the judgment of the Inspector, who, in cases of doubt, cqxisults the Medical Officer. OFFENSIVE TRADES.—Only two such trades are now carried on in the Borough, viz., one by a knacker and one by a gut scraper. The premises of both have been visited from time to time during the year and found in a satisfactory condition. SLAUGHTERHOUSES.—There are 16 registered Slaughterhouses and one licensed Slaughterhouse, in addition to the Municipal Slaughterhouses at Pitlake. One registered Slaughterhouse has been removed from the register during the year. The following are the approximate number of animals slaughtered at Pitlake Municipal. Beasts. Sheep. Pigs. Calves. Total. Piivate Slaughterhouses ... 374 7,061 26,951 1,988 36,374 Public „ 261 718 728 298 2,005 Total 635 7,779 27,679 2,286 38,379 52 The visits paid by Inspector Low in connection with the milk and meat trades are shown in the following Table :—• Nature of Premises. WARD. No. of Inspections. Total West, Central EaFt. South, S Nor U. Nor Slaughter-houses 932 422 15 364 69 66 1868 Butchers 222 233 20 52 62 27 616 Fishmongers 18 61 11 11 17 15 133 Markets ... 49 ... 50 ... ... 99 Cowkeepers 74 16 36 53 24 52 255 Milk Purveyors 145 25 47 61 45 77 400 Total 1391 806 129 591 217 237 3371 FOOD AND DRUGS ACTS. — Table IX. gives the number of samples taken by Mr, Saunders during the year, the results of the analyses and the action taken thereon. PROSECUTIONS, 1905 Date. Defendant. Charge. Result. Jan. 3 W. T. D Selling Butter adulterated with 89 per cent. Foreign Fat Convicted, and Fined £5 and 7s. 6d costs. Feb. 14 W. E. E Selling adulterated Brandy Convicted, and Fin.d £5 and £12 18s. 6d. costs. May 9 K. H Selling Butter adulterated with 80 per cent. Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. June 24 H. G. W Selling Butter adulterated with 55 per cent. Foreign Fat Convicted, and Fined 10s. and 7s. 6d. costs. June 24 E. W. W Selling Butter adulterated with about 20 per cen'. Foreign Fat Convicted, and Fined £1 and 7s. 66. costs. Oct. 21] F. W. G Selling Mi k adulterated with about 11 per cent Additional Wa er Convicted, and Fined £5 and 7s. 6J. costs. Oct. 21 J. E. C Selling Coffee adulterated with 80 per cent, of Chicor/ Convicted, and Fined £1 and 7s. 66. costs. Dec. 9 W. S. R. S Selling Butter adulterated with 50 per cent Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. Dec. 30 J- L Selling Butter adulterated with 95 per cent. Foreign Fat Convicted, and Fined £1 and 7s. 6d. costs. Dec. 30 Messrs. D. & C. Trading as Wholesale Dealers in Margarine without Registration Defendants subsequently Registered, and summons was withdrawn on payment of 5s. costs. 53 In 11 cases where the samples of Milk were slightly below the standard fixed by the Hoard of Agriculture, the vendors were written to calling their attention to the fact and asking for some explanation, further samples being taken subsequently. Of these II samples 9 contained an excess of water to the extent of an average of 6 per cent., whilst 2 were deficient in fat to the extent of an average of 6.5 per cent. One sample contained a trace of boric acid. The following table has been prepared from figures kindly supplied by the Borough Analyst (Mr. Lester Reed):— Total Number of Samples of Milk collected and percentage below standard. 1905. No. of Samples. No. below Standard. Percentage of Samples below Standard. Average percentage of fat of Genuine Samples. Wholesale taken in course of delivery Railway station. New Milk 70 6 8.5 3.7 Wholesale taken in course of delivery at Railway Station. Separated Milk 2 1 500 - Retail taken on Milkmen's rounds. Sunday morning. New Milk. 73 6 8.2 3.6 Retail taken on Milkmen's rounds. Sunday morning. Separated Milk. 7 - - - Retail taken on Milkmen's rounds. Weekday. New Milk 15 1 6 8 3 7 Retail taken on Milkmen's rounds. Weekday. Separated Milk. 1 — — — 54 REFUSE COLLECTION AND DISPOSAL.—During the year the weekly collection of house refuse has been maintained, and the daily collection has again been extended, while Lodging Houses, Schools, and other large establishments are cleared twice or three times a week. The refuse collected during the year consisted of Loads. House Refuse 31602 Trade ,, 928 Garden ,, 1ll 32,641 this was tipped At Factory Lane 18,105 At various brick yards 9,596 At Pavvson's Road and other places to raise low-lying ground for allotments and other gardens 4,940 32,641 In May last the Destructor at Factory Lane was completed. The plant was designed by the Borough Engineer, and consists of ten furnaces, a Babcock and Wilcox boiler, and an engine for producing the necessary forced draught and sufficient electrical energy for lighting the works. It is estimated that when working at its capacity the destructor can deal with about 500 tons of refuse per week, or 25,000 tons per annum. At present only about 280 tons per week are dealt with at this depot, as it is found more economical to deal with the refuse from the northern part of the borough by some other means. Attached to the destructor is a chamber in which diseased meat or the carcases of horses can be cremated. The total cost of the destructor was as under :— £ s. d. The construction of ten furnaces, Babcock and Wilcox boiler, engine, dynamo and fans for forced draught 5,886 14 0 The erection of buildings 2,672 J4 3 Ironfounders' work 955 18 5 Erection of chimney shaft 1,689 8 11 Drainage, water supply, installation of electric light, and approach road 1.495 4 5 £12,700 0 0 HEALTH VISITORS.—The following is a summary of the work done and visits paid by the three Health Visitors. Visits to Houses where the following Diseases have been reported. Miss ]iggleston. Mrs. Nolan-Sianey. Miss Tawney. Totals. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Vjsits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Measles 352 35 .. .. 422 47 .. .. 317 4 .. .. 1091 86 .. .. Mumps 24 1 .. .. 106 14 .. .. 7 .. .. .. 137 15 .. .. Whooping Cough 151 1 .. .. 147 32 .. .. 157 13 2 .. 455 46 2 .. Chicken-pox 111 23 .. .. 71 18 .. .. 100 3 2 282 44 2 Sore Throat 175 67 81 184 153 189 68 29 189 46 .. .. 517 302 149 213 Ringworm 276 420 .. .. 227 414 .. .. 122 309 6 .. 625 1143 6 .. verminous Heads 15 5 .. .. 10 10 .. .. .. .. .. .. 25 15 .. .. verminous Bodies 16 7 .. .. 2 .. .. .. .. .. .. .. 18 7 .. .. Impetigo 24 17 .. .. 4 4 .. .. .. .. .. .. 28 21 .. .. Itch 21 8 .. .. .. .. .. .. .. .. .. .. 21 8 .. .. Ophthalmia 19 22 .. .. .. .. .. .. .. .. .. .. 19 22 .. .. Other diseases 294 195 16 41 211 266 62 132 163 108 18 31 668 569 96 204 Total 1478 801 97 225 1353 994 130 161 1055 483 28 31 3886 2278 255 417 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Visits to houses where Infants have Deen born 886 593 520 595 872 383 2278 1571 Addresses given re Infant feeding, etc. 17 •• 23 .. 17 •• 57 •• Visits to houses where Infants have died under one year of age 182 38 94 43 103 •• 379 81 55 56 HEALTH LECTURES. — In August, 1905, and in accordance with the precedent of 1904, the following circular letter was addressed to those responsible for the organisation of the various " Mothers' Meetings " held in the Borough— 31st August, 1905. Dear Sir or Madam, During last winter a number of short addresses on Domestic Hygiene, with special reference to the Care of Infants, were given in connection with various organisations in the borough Similar arrangements will be made for the coming winter, and I should be glad to hear whether you would wish me to arrange for such addresses to be delivered at your Mothers' Meetings, or similar gatherings. It is proposed that the addresses should be given in sets of three, and that each should last for about half-an-hour. An early reply on the accompanying form will oblige. Yours faithfully, H. MEREDITH RICHARDS, M.D. Medical Officer of Health. I am pleased to say that the suggestion was again very favourably received, and 58 addresses were arranged to be given between November, 1905, and April, 1906. Attendances have been very satisfactory, amounting to as many as 200 on some occasions. General satisfaction has been expressed at the way in which the Health Visitors performed their task. As far as possible, three talks or lectures were given at each place of meeting. In the appendix will be found the syllabus used for these talks. 57 TABLE VII. Work done by the Drainage and Sanitary Inspectors during the Year ending December 31st, 1905. NATURE OF CASES DEALT WITH. Insp. Culver. Insp. Earwicker Insp. Peck. Ins. Richardson Insp. Stanley. Insp. Bull. Insp. Adams. Insp. Fulker. Insp. Vincent. Insp. Hunter. Insp. Stokes. Total. Mouse to Mouse Inspection 253 141 161 127 .. .. 1199 477 1306 1357 1272 6293 Visits to houses where zymotic diseases have occurred .. .. .. .. .. .. .. 1133 7 34 .. 1174 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. .. .. .. Inspections of Factories, Workshops and Outworkers. .. .. .. .. .. 824 .. .. .. .. .. 842 ,, ,, Greengrocers, Fishmongers & Ice Cream Shops .. .. .. .. .. .. 1369 ... 466 643 672 3150 ,, ,, Schools .. .. .. .. .. .. .. 102 .. .. .. 102 ,, ,, Shops .. .. .. .. .. 277 .. .. .. .. .. 277 ,, ,, Bakehouses .. .. .. .. .. 695 .. .. .. .. .. 695 ,, ,, Yards and Stables .. .. .. .. .. .. 1438 .. 1273 1364 1630 5705 ,, ,, Common Lodging Houses .. .. .. .. .. 446 .. .. .. .. .. 446 „ ,, ,, (night visits) .. .. .. .. .. 9 .. .. .. .. 9 18 ,, ,, Houses let in Lodgings .. .. .. .. .. .. .. .. 1720 .. . . 1720 ,, „ ,, ,, (night visits .. .. .. .. .. 1 .. .. 40 .. 40 81 ,, ,, Urinals .. .. .. .. .. .. 1147 .. 1009 808 1678 4642 Smoke observations .. .. .. .. .. 81 .. .. .. . . .. 81 House drains tested with smoke 163 578 194 426 .. .. 15 154 54 180 233 1997 ,, ,, ,, water 434 879 436 730 .. .. .. .. .. .. .. 2485 ,, ,, on application 52 40 61 122 .. .. .. .. .. .. .. 275 ,, drains re-laid 95 194 87 208 .. .. .. .. .. .. .. 584 ,, ,, repaired 42 111 100 87 .. .. .. .. .. .. .. 340 Re-inspections of work in progress 1038 950 1007 932 .. .. 524 160 1160 1192 947 7910 Sundry inspections 676 66 395 275 .. 335 ... 5 341 73 377 2543 Complaints from public investigated .. .. .. .. .. .. 75 5 156 185 56 477 Houses disinfected .. .. .. .. 592 .. .. .. .. .. .. 592 Lots of clothing and bedding disinfected .. .. .. .. 645 .. .. .. .. .. .. 645 NUISANCES DISCOVERED. Premises requiring repair 18 11 7 5 .. 6 212 24 109 226 40 658 ,, ,, Cleansing and Whitewashing .. .. .. .. 51 42 246 30 67 146 143 725 ,, Overcrowded .. .. .. .. .. 14 .. 1 9 25 12 61 Drains found defective 353 157 105 105 .. 1 27 41 9 28 120 946 ,, ,, stopped 52 50 33 58 .. 11 167 25 116 89 61 662 Defective Sanitary* Fittings 255 136 115 138 .. 52 98 66 132 215 91 1298 ,, Yard Surfaces 127 137 37 79 .. 1 .. 36 135 111 55 718 ,, Eaves and Downspouts 76 93 25 46 .. 4 .. 25 90 127 53 539 ,, Manure Recentacles .. .. .. .. .. .. .. 2 1 16 3 22 ,, Urinals .. .. .. .. .. .. 102 .. 1 .. 2 105 ,, Ashbins 33 3 7 19 .. 5 159 37 172 132 141 708 Smoke Nuisances .. .. .. .. .. 16 .. .. .. .. . . 16 Animals improperly kept .. .. .. .. .. .. .. 2 2 18 19 41 Infringements of Bye-laws and Regulations .. .. .. .. .. 20 .. .. .. 22 3 45 Offensive Accumulations .. .. .. .. .. 10 .. 9 12 29 9 69 Sundry other Nuisances .. .. 5 •• .. 65 •• 7 •• 13 12 97 Total number of Nuisances 914 587 329 450 51 247 1011 305 855 1197 764 6710 Informal Notices served 128 40 125 115 51 58 170 111 421 445 424 2088 Informal Notices complied with 57 45 96 155 51 57 175 101 384 439 419 1979* In abej'ance 22 8 31 31 .. 5 10 10 76 39 5 237 Referred to Committee 8 14 18 7 .. 8 4 .. 34 26 .. 119 * Including 54 from the year 1904. TABLE VIII. Workshops on Register, number of Employees, and visits paid during the year. TRADE. No. of Workshops. No. of Employees. No. of Visits. Asphalte Works .. 1 2 1 Baking Powder Manufacturer 1 5 1 Blind Makers 2 5 3 Blacksmith.. 7 22 23 Bottlewasher 2 6 3 Boilersmith 1 2 2 Bootmakers 9 23 16 Brass Workers 1 3 16 Builders 5 11 3 Cabinet Makers & Upholsterers .. 20 92 35 Carriage Builders 7 50 11 Collar Maker 1 10 1 Confectioner 1 5 3 Cricket Outfitters 1 2 1 Cycle Works 17 38 16 Carpentry and Joinery Works 4 13 5 Dentists 5 11 8 Dressmakers 179 1022 223 Dye Works 1 5 1 Film Maker 1 5 1 Glass Works 2 7 7 Greenhouse Maker 1 6 2 Ironmonger 6 14 3 Ladder Maker 4 6 2 Laundries 52 297 87 Leather Works 1 2 1 Modeller 1 3 3 Pharmacy Works 1 6 1 Photographers 6 15 4 Plumber 2 2 2 Picture Frame Makers 7 15 5 Saddler 5 13 3 Shop Fitter 2 6 1 Sign Writer 1 7 1 Stonemasons 2 6 4 Scale Maker 1 3 1 Tailors 32 92 43 Tin Works 1 8 1 Undertaker 2 5 2 Umbrella Makers 2 5 3 Watchmakers 2 11 3 Wheelwrights 11 44 25 Wig Maker 1 2 1 Wood Merchants 1 8 1 Total 412 1915 579 58 59 TABLE IX. Food and Drugs Act. Total number of Samples taken during the Year 1905. Sample of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions Milk †l58 145 13 1 1 10 Separated Milk †10 9 1 .. .. 1 Butter 106 100 6 5 5 1 Margarine 13 13 .. .. .. .. Lard 12 12 .. .. .. .. Cheese 3 3 .. .. .. .. Cocoa 1 1 .. .. .. Coffee 39 34 5 1 1 4 Brandy 13 2 11 1 1 10 Malt and Cod Liver Oil 1 1 •• •• •• •• Totals 356 320 36 8 8 26 † Country Milk taken in course of delivery at Railway Stations 64 † Sunday morning taken on Milkmen's rounds 88 †Week-day taken on Milkmen's rounds 16 168 TABLE X. METEOROLOGICAL RECORD—YEAR 1905. Rain Gauge 5-in. in diameter, 1-ft. above ground, 146-ft. above sea level. Temperature taken in the shade of a Stevenson's Screen, 4-ft. from the ground. The Ground Thermometer is suspended in an iron tube, the bulb being 4-ft. below the level of the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Difference from average 50 years at Greenwich. Mean Temperature of Ground at 4-ft. Mean Temperature of the Dew Point. Mean Tensional Differen e between Ground and Dew Point at 9 a.m. and 3 p.m. Rainfall. Highest. Lowest Mean of No. of Days on which Rain fell. Amount collected in Inches. Difference from average 85 years at Greenwich All Highest. All Lowest. January 54° 20° 43°.9 33°.1 38°.5 None. 42°.0 35°.0 in. 0.063 7 in. 1.21 in. — 0.59 February 54° 31° 47°.0 38°.0 42°.5 + 3°.0 41°.6 39°.2 •024 13 0.96 — 0.56 March 63° 27° 52°.4 38°.9 45°.6 + 3°.9 43°.1 42°.1 .010 22 3.26 + 1.74 April 66° 32° 54°.7 40°.7 47°.7 + 0°.5 46°.0 43°.3 •031 16 1.70 +. 09 May 82° 32° 65°.1 43°.3 54°.2 + 1°.1 49°.5 46°.0 .044 8 0.95 — 1.00 June 81° 46° 68°.7 52°.4 60°.5 + 1°.1 54°.5 56°.4 + .031 17 5.80 + 3.83 July 87° 48° 77°.5 57°.2 67°.3 + 4°.8 59°.6 60°.1 + .009 9 0.71 — 1.74 August 79° 46° 69°.3 53°.2 61°.2 — 0°.4 60°.1 56°.8 .058 17 2.64 + .31 September 74° 39° 63°.0 49°.5 56°.2 — 1°.0 56°.7 53°.8 •046 16 2.06 — 1.9 October 59° 27° 52°.5 38°.0 45°.2 — 4°.8 50°.9 43°.4 .092 10 1.05 — 1.67 November 53° 23° 47°.2 36°.1 41°.6 — l°.6 45°.9 40°.7 .055 19 3.96 + 1.67 December 57° 26° 44°.8 36°.8 40°.8 + 1°.1 43°.7 39°.4 0.044 11 0.55 — 1.40 Means and Totals for the Year. 87° 20° 57°.2 43°.1 50°.l + 0°.6 49°.5 46°.3 0.042 165 24.85 The Rainfall for the Year was 0'92 inches below, and the number of days on which rain fell 5 above the average of 40 years at Croydon. GEO. CORDEN, F.R. Met. Soc. Croydon. 60 6i C.—THE WATER SUPPLY. WATER SUPPLY OF CROYDON.—This important matter has on many occasions been the subject of special reports to the Water Sub-Committee, but hitherto it has not been thought desirable to refer to the matter in detail in my annual report, as it seemed that the scheme which the Sanitary Committee long had under consideration would afford sufficient guarantees for the future safeguarding of the supply. As, however, the burgesses have for the moment decided to content themselves with the present supply it is necessary to put on record certain conclusions which I have formed, after very careful consideration, concerning the purity and safety of the present supply to the " Croydon " water area. SOURCE OF SUPPLY FOR THE "CROYDON" AREA—As is well known the " Croydon" area is supplied by (1) The Surrey Street Wells. (2) The Addington Well. (3) Waddon Bore-hole. (4) Stroud Green Well. THE SURREY STREET WELLS. —When the first Local Board was elected in 1849 there was no public water supply, and one of their first acts was to remedy this deficiency. Accordingly in the year 1850 the Surrey Street site was acquired, an existing well enlarged, a new well sunk and pumping machinery erected for raising the water to Park Hill Reservoir. Those works were completed in less than two years, so that the " Croydon" area (extending for a radius of two miles from the Town Hall) was first supplied from the Surrey Street Wells in December, 1851. A third well was added in 1867 and a fourth in 1876. All these wells pass through three or four feet of made ground and about 11 feet of valley gravel before entering the chalk, which is therefore uncovered except by pervious strata, which offer no serious obstacle to the passage, under certain circumstances, of polluted water into subjacent fissures and so into the wells. Though this precaution was not taken in the first instances, three of the wells are said to be now provided with an impervious lining for from 50 to 75 feet from the surface. The fourth well (No. 2) which is lined for a distance of 37 feet only, has not been used since 1899, as the water which it yielded was found to be contaminated. Each well is further bored to a depth varying from 150 to 264 feet from the ground level. 62 In the year 1887 the water supply of the "Croydon Area," was augmented by the Addington Well, which is situated at Hares Hank, half a mile south of Addington village. This well is in an area of uncovered chalk, has a diameter of 10 feet and is sunk to a depth of 200 feet, headings having been driven in three directions at a level of 142 feet from the surface. From the Addington well the water is pumped to the Mental Hospital and to the Addington Reservoirs for the supply of the higher portions of the Borough. In the year 1897-8 application for a loan was made to the Local Government Board for permission to sink and equip another well near Waddon. A local enquiry was held and much evidence was given for and against the proposed scheme. Finally the Local Government Board declined to sanction a loan. It was understood that this refusal was based on the fact that the site of the proposed well was in an area of uncovered chalk that might some day be built over and that there was also a possibility that fissures might extend from Purley and Caterham to Waddon. In view, however, of the importance of getting more water, it was decided to make boreholes at the Waddon site, and to establish temporary pumping machinery pending the adoption of a more complete scheme. It was also decided to endeavour to obtain water by sinking a well at Stroud Green Road, where the chalk is overlaid by impervious beds of London clay and other tertiary strata, to a depth of 140 feet from the surface, and therefore not open to the objection raised by the Local Government Board. These works were carried on until July, 1905, the well being sunk to a depth of 391 feet, passing through chalk and flint, and was bored to a further depth of 146 feet, making a total depth of 537 feet. Headings have been driven at 230 feet for 2,827 feet 6 inches, and also at 365 feet from the surface for 1,395 feet. Both upward and downward boreholes have been made in both sets of headings. The yield of water from this well is about 700,000 gallons per day, which was made available during the summer of 1905 bv means of temporary plant. At the present moment permanent piachinery is being prepared for the equipment of this well. 63 The part of Croydon outside the "Croydon Water Area." which is, for convenience, termed the '' Lambeth Area," was supplied by the Lambeth Water Company from the year 1850 to the year 1904, when the works within the Borough were purchased from the Metropolitan Water Board, who also unde'rtook to supply 500 million gallons per annum at 21/8d. per 1,000 gallons. This water is derived from the Thames at Hampton, and is purified by sedimentation followed by sand filtration. SAFETY OF THESE SUPPLIES.—Practically the problem of the safety of a given water supply depends on what answer can be given to the following question. Is there any substantial reason for fearing that the water is or may become contaminated with the germs of enteric (typhoid) fever? In other words, can unpurified sewage gain access to the well ? Unfortunately the answer to this question is specially difficult in the case of a well sunk in fissured strata such as chalk, and can only be given after careful weighing of the evidence afforded—(1) by the records of epidemics; (2) by inspection of the well and its gathering ground; (3) by regular chemical and bacteriological examinations of the water. To discuss all these matters in detail is outside the scope of the present report, and I must therefore content myself with summarising certain of the more important conclusions to which I have been led. SURREY STREET WELLS. —As already stated these wells were first used by the public in December 1851. From that time until now there have been two epidemics of "fever," one in 1853 and one in 1875. Concerning the nature of the epidemic of 1853 considerable doubt exists. Probably diarrhoea and enteric fever were prevalent contemporaneously. How far these diseases may have been spread by the public water supply cannot now be estimated, as the records are too meagre. At the time the epidemic was thought to be due to the disturbance of the soil consequent on the sewering of the town and to the emptying of cesspools. The possibility of pollution of the wells by these same sewerage works and by the Bourne, which was also flowing, cannot, however, be disregarded. In 1875 a considerable epidemic of enteric fever occurred in the " Croydon" water area. Though drainage defects were thought at the time to have been largely concerned in the causation of the 64 epidemic, there can be little doubt that the disease was for the most part waterborae. It is not quite clear, however, whether pollution occurred centrally or peripherally. Both central pollution of the well itself and peripheral pollution of the watermains were shown to be possible. Probably both were concerned in the epidemic, though 1 should personally be inclined to ascribe the larger share to the central source of contamination. Shortly after this epidemic steps were taken to line the wells for a greater depth, and, from that time till now, enteric fever has never been epidemic in Croydon. Comparison of the "Croydon" and " Lambeth " water areas of the Borough also shows that the small amount of enteric fever that has been prevalent during recent years has been fairly equally distributed over both areas. (See page 18.) Unfortunately, however, the situation of the wells and certain analytical results render it very doubtful whether the reputation of the last thirty years can long be maintained. As already stated, Well No. 2 has had to be abandoned because it has become contaminated and the connection between all four wells is so intimate that there is no guarantee that the remaining wells may not suffer a similar misfortune, especially as the area from which the wells derive their supply is becoming more and more thickly populated. The reality of this risk is emphasised by the fact that bacteriological examinations already indicate occasional departures from the high standard of purity which should be maintained by wells in the chalk. A fissure is also known to exist from Surrey Street to the Addington Hills, and there must therefore be some increased risk of pollution on the growth of the town in that direction. The demand for water always tends to overtake the supply and thus lead to over-pumping with the obvious risk of unduly extending the cone of depression, and so sucking sewage into the wells. It is true that the sewers and drains within a radius of a ¼ mile of the well have been carefully constructed, and are constantly inspected, but it is impossible that all should be watertight. Unfortunately, neither the capacity of the sewers to keep sewage in, nor the capacity of the well linings to keep sewage out, can be thoroughly tested while we are dependent on Surrey Street for the bulk of our water supply. Should an intermittent supply have to be. substituted for the present constant service there would also be some risk of the water mains being infected, as was said to have occurred in 1875. 65 For these, and other reasons, I am of opinion that the water from Surrey Street wells requires filtration, and that, as soon as an additional supply has been obtained, the whole of the wells should be overhauled, their linings examined and probably extended, and further tests made as to the risk of contamination from adjacent sewers and drains. ADDINGTON WELL.—On no occasion has this well been suspected of conveying disease. Water from this well is usually extremely satisfactory fiom both a chemical and a bacteriological standpoint. Unfortunately, however, during recent years it has been found that the well is subject to intermittent pollution within 24 to 48 hours after excessive rainfalls. For reasons which need not now be discussed it is believed that this pollution is due to surface water, which finds its way into a fissure extending over two miles to the south of the well. Now where surface water finds its way to-day there is considerable risk in a populous district that infected sewage may get to-morrow, and it is clear that this risk is increased by the considerable growth which is taking place in the population on the gathering ground. 1 have, therefore, no hesitation in recommending that steps should be taken by sand filtration or otherwise to purify Addington water before distribution and thus avoid the risks attendant on the intermittent pollution which we know to exist. WADDON B0RE=H0LE.—'1 he report of the Local Government Board has already been quoted. Taking all the facts into consideration, and especially our complete ignorance as to the course of any fissures that may communicate with this well, I am of opinion that this water should eventually be filtered. The possible existence of such fissures is, indeed, in all probability, of more significance than the mere fact that the Waddon site is situated on bare chalk. Indeed it is probable that less risk attaches to a gathering ground of uncovered chalk than to one which is partially covered like that at Warlingham, where in times of heavy rainfall a large volume of water collects on the overlying impervious clay, forces its way through some defect in this stratum into the chalk which is thus undermined, producing more or less defined underground channels which may carry pollution to some distant well. STROUD GREEN WELL. —The site of this well is covered by many feet of impervious strata, and there is therefore no risk of contamination from any source of pollution in the immediate neighbourhood. 66 It is possible however that fissures may extend from the well to some point in the uncovered chalk where contamination might take place. Careful bacteriological examinations at frequent intervals and especially after heavy rains will show whether any steps need be taken to further safeguard this well. These frequent examinations of this and of the other wells are especially desirable, because we know that contamination, should it occur, is likely to be intermittent, and might therefore pass unrecognised if the examinations are made at long intervals. GENERAL CONSIDERATIONS.- -It further seems to me that while the Council will be well advised to proceed at once with a scheme for safeguarding and extending the present supply, they may reasonably look to the Local Government Board for assistance and advice on the whole question of water supply from the chalk. In this matter Croydon does not stand alone, as it is common knowledge that other than Croydon wells have given rise to anxiety in recent years. In fact to my mind the time has arrived when the whole question of water supplies derived from the North Downs and the sewerage and sewage disposal of the gathering ground should be minutely investigated by some independent authority, which should not only advise as to the purification of present supplies but take steps to prevent the culpable contamination of our underground reservoirs which certain sanitary authorities not only permit but encourage.* Probably a Joint Water and Sewerage Board with extensive powers over a large area will be the final solution of this extremely important and difficult problem. * In one district in the North Downs builders are permitted to dig cesspools thirty or forty feet deep so as to get well into the chalk and avoid the trouble of emptying the sewage. 67 D -REPORT OF THE WORK OF THE BOROUGH HOSPITAL. The following table shows the number of patients under treatment, and their average stay in Hospital during the year:— I.—Total cases in Hospital, 1905, and. average residence in Hospital. Disease. Remaining at end of 1904. Admitted during 1905. Discharged during 1905. Died during 1905. Remaining at end ot' 1905. Average Residence in days. Probable detention in Hospital in days. Fatal Cases. NonFatal Cases. Nonfatal Cases. Fatal Cases. Scarlet Fever 47 348 335 13 47 24 23 64 68 52 11 Cases admitted to Hospital as but subsequently found not to be Scailet Fever - 24 24 - — — 13.66 - - Diphtheria 43 178 177 18* 26 11 66 7018 59 9 Cases ad mil ted to Hospital as but subsequently found not to be Diphtheria 1 28 28 1 - 10 7.32 — — Enteric Fever 1 15 10 2 4 25 5 63 6 63 — Cases admitted to Hospital as but subsequently found not to be knteiic Fever - 10 9 1 - 18.0 44.88 29 - Other Diseases ... ... — 6 6 — - — 58.16 - — Total 92 609 589 77 17 0 61.43 51 11 2.—The jollmving comparative table shows the admissions of the various diseases during 1901, 1902, 1903, 1904 and 1905. Cases admitted during 1901. Cases admitted during 1902. Cases admitted during 1903. Cases admitted during 1904. Cases admitted during 1905. Scarlet Fever 304 231 172 235 352 Diphtheria 286 198 178 233 178 Enteric Fever 38 30 19 12 15 Puerperal Fever — — — 1 - Pulmonary Phthis's — — — 1 - Other diseases 2 22 28 51 64 Total 630 481 397 533 609** *This includes a case which was admitted with mild Diphtheria but died from Phthisis. ** Including four cases sent in as diptherii. 68 3.—The fatality of the various diseases was as under* :— 1904. 1935. Scarlet Fever 4.65 3.73 Diphtheria 10.24 9.09 Enteric Fever 26.66 14.28 Enteric Fever for last 4 years (114 cases) - 20.17‡ Other diseases 13.20 4.3 All cases 8.14 5.6 * The fitality is calculated according to the Registrar-General's formula, i.t., by dividing the number of deaths multiplied by 100 by half the.sum of the admission-, discharges and deaths. ‡Four years, 114 cases. 4.—Under "Other diseases" are included the following :— No. of Cases. Result. Cases notified as Scarlet Fever but not Scarlet Fever-Total 24 No death. Rotheln ... 6 Discharged. Measles 6 „ Acute Rheumatism 1 „ Erythema Scarlatiniforme 1 „ Acute. Follicular Tonsillitis 2 „ No disease observed 6 „ Septic wound of scalp with depressed fracture of skull 1 „ Drug rash 1 „ No. of Cases. Result. Cases admitted as, but found not to be Diphtheria—Total 28 - Scarlet Fever 4 Transferred. Acute Follicular Tonsillitis 14 Discharged. Acute Septic Throat 1 „ Influenza 2 „ Epidemic Diarrhoea complicated with Thrush 1 Died. Angina Ludovici 1 Operated on. Broncho-pneumonia 1 Discharged. No apparent disease 4 „ 69 5.—Cases admitted from the Croydon Union and from Outside Districts under Hospital treatment during 1904. Districts. Remaining at end of 1904. Admitted during 1905. Discharged during 1905. Died during 1905. Remaining at end of 1905. *The Croydon Union, cases admitted from Penge - 1 1 - - Penge Urban D.C., nonpauper cases 2 49 38 - 13 The Borough of Kingston upon Thames 1 11 9 - 3 The Borough of Wandsworth - 1 1 - - Private Cases — — — — — The Borough of Croydon 89 547 540 35 61 * In the above table cases included under the Croydon Union are only those paucer patients who have contracted the disease in Penge. Patients resident in the Infirmary or Workhouse who become infected whilst residents in these Institutions are reckoned as Croydon cases. The patient from Wandsworth was admitted via the General Hospital, having been brought to that institution for tracheotomy, After operation this patient was removed to the Borough Hospital,  No. of Cases. Result Cases admitted as, but found not to be Enteric Fever—Total 10 - Acute Septicaemia, secondary to Otitis Media 1 Died. Pelvic Cellulitis (? Secondary to Appendix) 1 Transferred. Constipation I Discharged. Influenza 2 „ Ulcerative Colitis ... I „ Lobar Pneumonia ... 2 „ Cirrhosis of Liver ... I „ Mediterranean (or Malta) Fever I „ No. of Cases. Result. Other Diseases—Total 6 Tonsillitis 2 Discharged Injury to a Hip (previously Tuberculosis) 1 „ Appendicitis 1 „ Gastric Ulcer 1 )> Neurasthenia 1 J) 70 6.—Analysis of 351 completed Scarlet Fever cases itnde treatment during 1905. No. of cases affected. Percentage of completed cases. 1. Complications : — Abscess 13 3.70 Adenitis—primary 121 34.47 ,, secondary 92 26.21 Albuminuria 30 8.54 Bronchitis 2 0.57 Broncho-pneumonia 18 5.13 Endocarditis 3 0.85 Pericarditis 1 0.28 Chorea 1 0.28 Conjunctivitis 1 0.28 Acute Delirium 3 0.85 Severe Diarrhoea 4 1.14 Eczema of Face 6 1.72 Epistaxis 3 0.85 Laryngeal Obstruction 1 0.28 Mastoiditis 6 1.72 Meningitis 2 0.57 Nephritis 9 2.56 Otorrhoea 55 15.67 Phagedenic ulceration of Fauces 3 0.85 Psoriasis 1 0.28 Pyaemic Abcesses 1 0.28 Relapse 11 3.13 Rheumatism .. 20 5.70 Rhinorrhcea .. 125 35.61 Septicemia 3 0.85 Secondary Sore Throat 5 1.42 Secondary Rash 7 1.99 Tonsillar Abscess 2 0.57 ,, Membrane 4 1.14 ,, Sloughing.. 3 0.85 Urcemic Fits 1 0.28 B. Diphtherise present in Throat 62 17.76 B. Pseudo-diphtherije present in Throat 119 33.90 2. Scarlet Fever complicated with : — Clinical Diphtheria 34 9.69 Whooping Cough 2 0.57 Chicken-pox 8 2.28 Measles 8 2.28 Rotheln 5 1.42 Ringworm 25 7.12 3. Operations performed for :— Cervical Abscess 11 3.13 Other Abscesses 2 0.57 Tonsils and Adenoids 13 3.70 Mastoid 6 1.72 71 7.—Analysis of 195 completed Diphtheria cases under treatment during 1905,' No. of cases affected. Percentage of completed cases. 1. Complications :— Severe Anaemia 1 0.51 Abscess 3 1.53 Adenitis - primary 29 14.87 ,, secondary 21 10.77 Albuminuria 11 5.64 Broncho-pneumonia . 8 4.10 Endocarditis 1 0.51 Epistaxis 5 2.56 Cardiac failure 13 6.67 Severe Diarrhoea 2 1.02 EntensiveGangreneofFauc.es 11 5.64 Haemorrhage from Mucous Membrane 2 1.02 Diphthe itic Rhi-nitis 2 1.02 Nephritis 1 0.51 Otorrhoea 13 6.67 Paralysis—Loss of Kneejerks 6 3.08 ,, Faucial 4 2.05 ,, Palatal 18 9.23 ,, Ocular 4 2.05 ,, Muscular 1 0.51 Relapse 7 3.59 Second Relapse 1 0.51 Joint Pains 11 5.64 Rhinorrhoea 31 15.90 Secondary Sore Throat 1 0.51 Rash - Antitoxin 76 38.97 ,, Septic.. •2 1.02 Persistent Vomiting 14 7.18 2. Diphtheria associated with:— Scarlet Fever 25 12.8 Measles 1 0.51 Rotheln 1 0.51 Enteric Fever 1 0.51 Ringworm 14 7.18 3. Operations performed for :— Cervical Abscess .. .. 4 2.05 Intravenous injection of Antitoxin.. 8 4.10 Intubation 4 2.05 Mastoid disease 1 0.51 Tonsils and Adenoids 6 3.08 Ludu igs Angina 1 0.51 Tracheotomy, wiih and without previous Intubation 13 6.67 Tracheotomy Cases—recovered 8 61-60 Intubation Cases-recovered 4 100% 72 8.—Analysis of 12 completed cases of Enteric Fever under treatment during 1905, and 114 completed Enteric Fever cases under treatment during 1901—1905. No. of cases affected in 12 completed cases for 1905. No. of cases affected in 114 completed cases for 1901—1905. Percentage of 114 completed cases. 1. Complications :— Adenitis 1 — 0.9 Abscess 1 6 5.3 Bronchitis 2 4 3.5 Hæmorrhage 2 20 17.5 Perforation 2 7 6.2 Peritonitis .. .. .. 1 7 6.2 Pleurisy .. .. 1 4 3.5 Pneumonia 3 22 19.3 Relapse 3 11 9.4 Venous Thrombosis 1 2 1.8 2. Diagnoses:— Widal's reaction—po iiive 12 100% 3. Enteric Fever complicated with :— Diphtheria 1 — 8.3 Phthisis 1 — 8.3 4. Operations performed for :— Perforation — 8.3 Abscess 1 — 8.3 5. Disease possibly traced to :— Cockles 4 33.2 Watercress 1 — 8.3 Winkles 1 — 8.3 Previous case in house 1 — 8.3 Cause undetected 5 — 41.6 73 9.—The following Table shows the Highest and Lowest number of beds occupied on any one night during each month of the year 1905:— Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. Januaiy 109 90 July 95 74 February 120 92 August 75 50 March 118 94 September 69 50 April 94 85 October 123 68 May .. 98 81 November 129 110 June 97 80 December 115 74 The average number of beds occupied per day during the year was 91.3. 1o.—Illness amongst staff, 1905 : — Scarlet Fever 5 cases. Diphtheria 1 case. Other illnesses necessitating treatment in Hospital 6 cases. Total 12 cases. AMBULANCE.—During the year 536 journeys were made in removing patients to the Borough Hospital, and one journey to the Joint Smallpox Hospital at Cheam. The ambulance also made sundry other journeys in connection with the removal of patients to their homes, in addition to the collection of parcels from the Town Hall. The sum of £44 2s. was received from the Penge Urban District Council, the Croydon Guardians, and the Epsom Rural District Council, and others, for ambulance services rendered during the year, 74 MAINTENANCE OF BUILDINGS.—No important alterations were carried out during 1905. The following painting and repairs were done Ward A.—Corrugated iron roof painted (iron building). Ward C.—Inside, distempering ; outside, painted and sundry small repairs. Ward D.—Inside, painted and sundry small repairs. Ward E.—Outside, corrugated iron roof painted (iron building). Ward F.—Inside, some painting and small repairs. Ward G.—Outside painted, with exception of roof (iron building). Ward H.—Outside painted, including roof. Administrative Block, inside.—Vestibule, Corridor, and Nurses' Dining Room painted and distempered. Emergency, all painting, Administrative Block.—Inside, walls and ceilings of bedrooms distempered, corridor, staircase and dado painted ; outside, painted Discharging Block.—Some painted, outside. Entrance Lodge.—Inside, distempering and small repairs. The floor of half of Pavilion B was laid with Euboeolith on top of the existing deal boards which had become worn and roughened. The roads within the Hospital gates were also repaired, the main road being laid with flint and gravel. A roller was also purchased during the year so that the gardeners can now maintain the paths in good condition. Additional surface water gullies were also fixed along the road leading from the entrance gate to Pavilion C. Numerous minor repairs were very efficiently carried out by the engineer (Levey). TABLE XI. CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 25th, 1905, and four preceding Years. Year ending March. Average So. of Patients. Provisions. Alcohol. j Surgery aud Dispensary. .Domestic, including Coal and Gas. Establishment and Miscellaneous Charges. Salaries and Wages. Total Ordinary Expenditure. Total Average Cost per Bed. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Establishment Charges and Repairs. Miscellaneous Charges. Total. Average Cost per Bed occupied. Medical Dispensing, Nursing & other. Average Cost per Bed occupied. £ s. d. £ s. d. £ s. d. s. d. £ s. d. £ s. d £ s. d £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 1901 77 1435 10 3 18 12 10 9 0 0 2 4 307 9 9 3 19 10 1024 19 6 13 6 3 479 8 6 140 15 8 620 4 2 8 1 1 1426 10 9 18 10 7 4823 14 5 62 12 11 1902 88 1954 15 9 22 4 3 26 18 3 6 1 400 5 5 4 11 0 1281 15 5 14 11 4 904 14 3 105 7 5 1010 1 8 11 9 6 1611 19 11 18 6 4 6285 19 5 71 8 7 1903 68 1905 19 8 28 0 7 20 11 0 6 0 403 8 4 5 18 8 1135 11 11 16 14 0 9-54 18 7 123 16 9 1078 15 4 15 17 3 1603 4 9 23 11 7 6147 11 9 90 8 1 1904 53 1728 7 7 32 12 3 29 9 2 11 1 394 9 0 7 8 10 936 11 9 17 13 5 755 13 10 129 11 0 885 4 10 16 14 1 1581 14 2 29 16 11 5555 16 6 104 16 7 1905 85 2297 6 1 27 0 6 16 13 8 4 0 744 4 1 8 15 1 1160 14 9 13 13 1 639 4 2 200 15 10 840 0 0 g 17 8 1592 6 3 18 14 8 6651 5 4 78 5 0 During the Year 1904-5 the sum of £1,211 0s. 8d. was receivable from other Local Authorities and Private Patients. 75 76 E—REPORT ON THE BACTERIOLOGICAL AND CHEMICAL LABORATORY. In the year 1896, a small bacteriological laboratory was fitted up at the Borough Hospital. This was designed to assist in the recognition of obscure cases of diphtheria or phthisis occurring in the Borough. Subsequently, this assistance was extended to the examination of blood from doubtful cases of enteric fever. For the first few years of its existence comparatively little use was made of the laboratory as is shown by the following tabic :—- Year. Specimens exarr.ined for Diphtheria, Enteric Fever, and Tuberculosis. Borough Cases (outside the Hospital). Hospital Cases. Total 1897 85 not recorded. — 1898 125 not recorded. — 1899 not recorded. not recorded. — 1900 199 248 447 1901 784 885 1669 1902 698 859 155 7 1903 1089 1322 2411 1904 2027 2494 4521 1905 2276 4164 6440 The figures for the year 1905 again show a very large increase in the number of specimens examined at the Laboratory. For the following account of the results obtained in the laboratory during the year, I am indebted to Dr. Brincker, the Borough Bacteriologist and Senior Resident Medical Officer of the Borough Hospital. Bacteriology (i).—Material from suspected cases of diphtheria, enteric fever, and phthisis, is examined free of cost for all medical 77 men in the Borough. For this purpose suitable "outfits," containing the necessary apparatus for transmitting material to the laboratory have first to be prepared. These "outfits" can be obtained on application at the Town Hall, or at any of some six depots situated in various parts of the town. Accompanying these "outfits" are printed directions as to how the material should be obtained and forwarded to the laboratory. On arrival at the laboratory the contents of the " outfit" are examined bacteriologically, and the result communicated to the medical attendant, either by telephone or by telegram, if the result is positive, and the case be one of diphtheria or enteric fever. All other reports are sent by post, unless there is any special urgency. (2).—Similar examinations are made of cases of " sore throat " reported to the medical officer by school teachers, and of a large proportion of " contacts " in invaded houses. (3).—Specimens of milk are examined from time to time for special purposes. Should inoculation be necessary, the samples are sent to the Lister Institute. (4).—Specimens of the public water supply are examined from time to time. Arrangements should also be made for this to be done periodically, though under present conditions this is not practicable on account of the large amount of other routine work. (5).—Sundry specimens from cases of suspected glanders and other rare diseases, and specimens of diseased meat are also examined when required. Microscopical Examinations are made in cases of suspected ringworm ; also in certain cases of the tissues of diseased animals slaughtered for human consumption. Chemical Examinations are made in connection with special investigations of the *public water supply, and of various sewage effluents. * Specimens from the various wells are also examined periodically by Mr. Dibdin- 78 Clinical Bacteriology.—The following is a summary of the number of specimens examined for suspected diphtheria, enteric fever, or tuberculosis :— Suspected Diphtheria. Serum reaction for suspected Enteric Fever. Sputum for suspecte Tuberculosis. 1904. 1905. 1904. 1905. 1904. 1905. Boro. Hosp. Boro. Hosp Boro Hosp Boro Hosp Boro Hosp Boro Hosp January 70 105 278 387 3 3 .. 2 13 1 17 .. February 68 101 232 235 5 .. 1 .. 15 18 .. March 104 127 262 318 3 .. 4 .. 11 3 18 .. April 49 163 193 260 2 .. 1 2 7 5 11 3 May 77 59 158 409 1 .. 5 5 12 3 16 .. June 103 131 52 366 3 .. 3 7 16 10 .. July 141 131 89 381 4 4 1 1 13 3 22 .. August 190 141 93 259 4 4 15 2 7 3 7 2 September 219 194 93 215 10 1 3 12 11 1 14 .. October 294 379 237 455 5 4 1 4 12 9 1 November 239 428 194 327 2 .. .. 6 13 2 17 .. December 220 491 186 501 3 5 6 4 18 2 10 .. First Quarter 242 333 772 940 11 3 5 2 39 4 53 .. Second ,, 289 353 403 1035 6 .. 9 14 35 8 37 3 Third „ 550 466 275 855 18 9 19 15 31 7 43 2 Fourth ,, 753 1298 617 1283 10 9 7 14 43 4 36 1 Yearly Total Grand Total 1834 2450 2067 4113 45 21 40 45 148 23 169 6 4284 6180 66 85 171 175 Diphtheria.—During 1905,6,180 specimens were examined in the Laboratory. Of these specimens about one sixth (1024) were primary examinations for diagnostic purposes. The remaining specimens were from "contacts" who had been exposed to diphtheria, or from the throats of convalescents. The latter were examined 79 with a view of ascertaining whether the bacillus of diphtheria was absent from the th-roat. In some cases this organism was very persistent, requiring many examinations before it was found to have disappeared. Every case of scarlet fever admitted to the Hospital was also examined bacteriologically, in order to ascertain if diphtheria was also present. In 62 instances diphtheria bacilli were found to be present. These patients were isolated with a view to checking the spread of diphtheria among scarlet fever convalescents. In this way we were entirely successful, as there was no case of post-scarlatinal diphtheria during the year, though this complication was a very common and severe one in pre-bacteriological days. In ng instances pseudo-diphtheria bacilli were found in the throats of scarlet fever patients. These bacilli are probably of little significance, but are a source of great trouble, as they are frequently difficult to differentiate from the true diphtheria bacilli and necessitate repeated examinations to avoid the risk of missing the true baccillus. A large number of the specimens examined are from cases of sore throat occurring in children attending elementary schools. In many instances these " sore throats " turned out to be mild cases of diphtheria in which infection persisted for many weeks or months though the children showed very little, if any, signs of ill-health. RESULTS OF BACTERIOLOGICAL EXAMINATION: I.—DIPHTHERIA. 1905. Examinations of Specimens from Borough. Examinations of Specimens from Hospital. Total Examination from all sources. Specimens from Primary Cases. Specimens from Contacts. Total Examinations from Borough. Exainin'tns from Cases admitted for Diphtheria Examinations from ail other Cases. To'al Examinations from Hospital. 1st Examination. 2nd Examination. 1st Examination. 2nd Examination. 1st Examination. Subsequent Examin'tn. 1st Examination. Subsequent Examin'tn. B. Diphth. B. Pseudo. ; Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. J.'iphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphfch. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. B. Diphth. B. Pseudo. Negative. Total. Jan. 17 3 55 75 4 2 10 16 7 23 32 62 13 22 90 125 41 50 187 278 15 1 2 18 31 77 160 268 5 11 17 33 1 23 44 68 52 112 223 387 93 162 410 665 Feb. 26 4 42 72 2 3 16 21 6 5 26 37 16 15 71 102 50 27 155 232 25 1 5 31 35 54 36 125 7 14 26 47 2 4 26 32 69 73 93 235 119 100 248 467 Mar. 23 5 55 83 8 7 24 39 4 4 16 24 15 49 52 116 50 65 147 262 20 2 7 29 53 41 131 225 2 3 7 12 2 5 45 52 77 51 190 318 127 116 337 580 April 13 8 33 54 7 3 16 26 1 2 5 8 8 57 40 105 29 70 94 193 11 — 9 20 31 37 84 152 1 6 10 17 — 13 58 71 43 56 161 260 72 126 255 453 May 8 2 39 49 — 1 15 16 3 1 14 18 4 33 38 75 15 37 106 158 8 2 17 27 44 40 169 253 3 16 27 46 2 11 70 83 57 69 283 409 72 106 389 567 June 9 4 19 32 1 — 2 3 2 - 9 11 — 1 5 6 12 5 35 52 15 13 28 85 27 62 174 9 16 15 40 3 39 82 124 112 82 172 366 124 87 207 418 July .. 10 3 23 36 2 — 4 6 4 5 8 17 5 3 22 30 21 11 57 89 13 1 12 26 57 29 125 211 — 11 18 29 — 31 84 115 70 72 239 381 91 83 296 470 Aug. .. 9 3 26 38 6 - 8 14 — 3 17 20 4 3 14 21 19 9 65 93 3 1 6 10 34 8 97 139 2 7 13 22 3 8 77 88 42 24 193 259 61 33 258 352 Sept. 8 5 33 46 5 2 9 16 1 3 7 11 6 2 12 20 20 12 61 93 18 — 7 25 25 3 41 69 7 10 3G 53 — 5 63 68 50 18 147 215 70 30 208 308 Oct. 24 9 64 97 13 7 37 57 6 — 25 31 12 6 34 52 55 22 160 237 20 4 14 38 61 3 94 158 21 23 37 81 14 68 96 178 116 98 241 455 171 120 401 692 Nov 12 8 68 88 8 2 9 19 3 3 13 19 23 10 35 68 46 23 125 194 20 — 10 30 101 9 89 199 2 14 33 49 1 18 30 49 124 41 162 327 170 64 287 521 Dec. 8 5 37 50 1 — 7 8 9 1 9 19 39 10 60 109 57 16 113 186 14 — 8 22 161 37 158 356 3 8 25 36 4 3 80 87 182 48 271 •501 239 64 384 687 1st Q. 66 12 152 230 14 12 50 76 17 32 74 123 44 86 213 343 141 142 489 772 60 4 14 78 119 172 327 618 14 '28 50 92 5 32 115 152 198 236 506 940 339 378 995 1712 2nd Q. 30 14 91 135 8 4 33 45 6 3 28 37 12 91 83 186 56 112 235 403 34 2 39 "A 160 104 315 •579 13 38 52 103 5 63 210 278 212 207 616 1035 268 319 851 1438 3rd Q. 27 11 82 120 13 2 21 36 5 11 32 48 15 8 48 71 60 32 183 275 34 2 25 61 116 40 263 419 9 28 67 104 3 44 224 271 162 114 579 855 222 146 762 1130 4th Q. 44 22 169 235 22 9 53 84 18 4 47 69 74 26 129 229 158 61 398 617 54 4 32 90 323 49 341 713 26 45 95 166 19 89 206 314 422 187 674 1283 580 248 1072 1900 Total 167 59 494 720 57 27 157 241 46 50 181 277 145 211 473 829 415 347 1305 2067 182 12 110 304 718 365 1246 2329 62 139 264 465 32 228 755 1015 994 744 2375 4131 1409 1091 3680 6180 81 The Bacteriological (Serum) Diagnosis of Enteric Fever.—The value of this test was again manifested. Daring the year there were 12 completed cases of enteric fever, and all these gave a positive serum reaction. In one instance a nurse (E.R.), suffering from fever was admitted with the following history:—She left Malta with her mistress who was suffering from Malta fever, 011 July 2nd, and arrived in England July 10th. After arrival in England, the mistress had a relapse and E.R. was in attendance on her at intervals until August 1st., when she failed, with symptoms which suggested enteric fever. On admission it was found that E.R.'s symptoms were anomalous, and a specimen of blood was therefore examined to see if it would aggluntinate a culture of Micrococcus melitensis. This was found to be the case, and the subsequent progress of the patient quite confirmed the diagnosis of Malta fever. This is a disease of which we had no previous experience, and it is not easy to understand how the patient became infected. If she brought the disease with her from Malta the infection is longer than is commonly supposed, whilst if she acquired the disease from her mistress in England personal infection must occur, though this has been though to be impossible, 82 The following table gives a summary of serum reactions performed in this Laboratory during 1905:— RESULTS OK EXAMINATIONS FOR DISEASES SIMULATING ENTERIC FEVER. 1905. r. ' L - Examinations for Borough. Examinations in Hospital. Total. Agglutinative Reactions conducted with B. Typhosus. Agglutinative Reactions conducted with other Micro-organ tMns. Agglutinative Reactions conducted with B. Typhosus. Agglutinative Reactions conducted with othe Micro-organisms Agglutinative Reactions for all purposes. + — Total + — Total + — Total + Total + — Total January — — — — — — — 2 2 — — 2 2 February 1 — 1 - - - - - - - - - 1 — 1 March 1 3 4 — - - - - - - - - 1 3 4 April — 1 1 — - — — 2 2 — - — — 3 3 May 1 4 5 — — — 2 3 5 - - — 3 7 10 June - 3 3 — — — 2 5 7 - — — 2 8 10 July - 1 1 — — — 1 — 1 — — 1 1 2 August 4 8 12 3 — 3 2 — 2 — — 9 8 17 September 3 — 3 — — — 8 — 8 3 1 4 14 1 15 October 1 — 1 — — — 1 2 3 1 — 1 3 2 5 November - - - - - - 3 3 6 - — — 3 3 6 December 5 1 6 — — — 4 — 4 — — — 9 1 10 First Qu't'r 2 3 5 — — — — 2 2 — — — 2 5 7 Second ,, 1 8 9 — — — 4 10 14 — — 5 18 23 Third „ 7 9 16 3 — 3 11 — 11 3 1 4 24 10 34 Fourth ,, 6 1 7 — — 8 5 13 1 — 1 15 6 21 Total 16 21 37 8 — 3 23 17 40 4 1 5 46 39 85 83 Examination for the Bacillus Tuberculosis in Sputum, Urine, and other specimens. The following table shows the number of specimens sent for the detection of B. Tuberculosis during 1905 RESULTS OF EXAMINATIONS FOR TUBERCULOSIS. 1905. Examinations Tor the Borough. Examinations for the Hospital. Total. Primary Examinations (for diagnosis). 'Secondary Examinations (for cure). A" Examinations. All Examinations. + — Total + — Total + — Total + — Total January 1 13 14 1 2 3 — — — 2 15 17 February 8 9 17 1 — 1 — — — 9 9 18 M arch 6 12 18 - - - - - - 6 12 18 April 1 10 11 — — — — 3 3 1 13 14 May 3 11 14 1 1 2 — — — 4 12 16 June 1 5 6 — 4 4 - — — 1 9 10 July 8 13 21 1 — 1 — — — 9 13 22 August 5 2 7 — — - 1 1 2 6 3 9 September 6 6 12 1 1 2 — — — 7 7 14 October 3 6 9 — — — — 1 1 3 7 10 November 6 8 14 3 — 3 — — — 9 8 17 December 1 8 9 — 1 1 - - — 1 9 10 First Quarter 15 34 49 2 2 4 - — — 17 36 53 Ssiond ,, 5 26 .31 1 5 6 - 3 3 6 34 40 Thin! ,, 19 21 40 2 1 3 1 1 2 22 23 45 F ourth ,, 10 22 32 3 1 4 — 1 1 13 24 37 Total 49 103 152 8 9 17 1 5 6 58 117 175 84 Miscellaneous Examinations.—Examinations were also conducted during 1905 in the Borough Laboraiory on the following : 1. Urines— (1) Chemical examinations (6). (2) Bacteriological For detection of B. Typhosus in cases convalescent of Enteric Fever. Thirty specimens, of which eight gave positive results. 2. Blood— (t) Blood from three patients ; the examination of their blood was of great assistance in diagnosis and prognosis. The one led to an operation for an abscess, and recovery, and the second was one of Splenic AnEemia followed rapidly by death. A third case shewed Lencocytosis after Pulmonary Tuberculosis, but as death occurred from a subsequent complication, the examination was not of great help. (2) Blood and tissues from a supposed case of Anthrax in a bullock gave negative results. The bullock had died from advanced Tuberculosis of the lungs and internal organs. (3) Several specimens of blood were also examined of a case of Malta Fever, but this gave no definife results. (4) Further investigations were also conducted on the blood of severe and malignant cases of Scarlet Fever. 3. Pus — (1) Three for gono-coccus (all j ositive). 4. IVater— (1) The experiments on the softening of the Croydon Water Supply were continued during the earlier part of the year. Altogether 20 samples of water were analysed. In artificially polluted water it was shown that the bacteria could be diminished in the water (by softening and sedimentation) by 92 to 96 per cent. 5. Ringworm— Thirty-six specimens of hair were examined microscopically ; of these, 26 shewed Ringworm spores (all small spored— M. Audouini) and 10 shewed 110 spores. 85 F.—REPORT TO THE EDUCATION COMMITTEE. HEALTH OF THE SCHOLARS.—During the year the undermentioned cases have been dealt with on notification by the Education Committee or Public Health Department :— Cases of illness as reported by Attendance Officers or School Teachers Illness. ISt Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Measles 22 144 78 887 1131 Mumps no 31 6 73 220 Whooping Cough 77 82 86 42 287 Chicken Pox 37 91 20 77 22 5 Sore Throat 58 27 56 118 259 Ringworm H5 141 85 102 473 Other Cases 85 93 81 154 413 Totals 534 609 412 J453 3°°S Cases of illness reported to Education Committee by the Public Health Department:— Illness. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Scarlet Fever 54 67 60 69 250 Diphtheria 27 . 31 26 38 122 Enteric — 2 2 ■-) 6 Measles 33 186 81 967 1267 Mumps 126 49 17 33 225 Whooping Cough 92 118 98 45 353 Chicken Pox 48 i°5 34 1 r3 300 Sore Throat 67 40 69 iog 285 Ringworm 149 159 91 110 5°9 Impetigo 28 24 11 27 90 Itch 8 11 2 14 35 Vermin 3 9 — 7 19 Ophthalmia 21 5 5 15 4<> Other Cases 2 17 -4 38 81 Totals 658 823 520 1587 3588 86 STANDING ORDERS AS TO HEALTH.—No changes have been made daring the year, and on the whole few difficulties have been encountered. Towards the end of the year the Committee authorised me to obtain medical certificates in reference to those children excluded from school on account of suspected infectious disease. It is found in practice that for one reason or another only a small number of cases have thus to be dealt with, but the new arrangement has already proved useful on several occasions. Sometimes it has resulted in the prompt return to school of the suspected case, and in other times infectious cases have been diagnosed when they would otherwise have been missed. A fee of 2s. 6d. is paid for these medical certificates. The procedure in relation to the following diseases, however, requires modification :— OPHTHALMIA CASES.—No special mention is made ol inflammatory diseases of the eye in the Standing Orders. Some of these complaints are communicable, though the majority of them are only so to a very limited extent. Hitherto, teachers have been in the habit of reporting most of these cases to me under Standing Order i, which includes "other communicable diseases." On visiting these cases the Health Visitors often find that no medical man has been called in, and they are therefore unable to say for what, period the children need be excluded from school. I am of opinion that it would be an advantage if the assistance of the Ophthalmic Surgeon could be obtained in these cases. VERMINOUS CONDITIONS.—T eachers continue to make use of the advisory cards referred to in the .report for 1904. Though I believe some improvement has been effected the result has not been as marked has I had hoped. This partial failure is due to two causes. First and foremost, to the fact that in many of the schools systematic inspection of the children's heads is not undertaken, and only the grossest and more obvious cases are given warning cards. I am therefore of opinion that the time has come when a Nurse should be appointed to visit 2ach schooi in rotation and seek out and, if necessary, exclude all children suffering from verminous conditions. The matter is not a trivial one, as in some schools about half the children appear to be infected, and it is certainly not fair that the remaining half of the school should run the risk of suffering from such an extremely disagreeable complaint. Personal cleanliness must also be regarded as the first step in school hygiene, and it would be the duty of the school nurse to devote her energies to promoting this first essential. Similar remarks apply to verminous conditions of the body. 87 RINGWORM.— 1 his disease was discussed in my last annual report, and has been the subject of several special reports to the Elementary Education Sub-Committee, who, in February, 1906, resolved that a representation be made to the Sanitary Committee as to the desirability of the Council undertaking the treatment of ringworm. This resolution was duly considered by the Borough Hospital Committee and by the Sanitary Committee, but further action was postponed pending a full report which was to embody the results of enquiries as to the success of recent methods of treatment. It is for this reason that it is necessary, at the risk of some repetition, to discuss the question in some detail on this present occasion. THE CAUSE OF RINGWORM is a minute fungus which grows readily on the surface of the skin or in the hair of young people. When the body is affected it is only the superficial layers of the skin that are invaded by the fungus. On the other hand, when the scalp is attacked the fungus penetrates to the roots of the hair and invades the. hairs themselves, which in consequence lose their vitality, break off and produce the characteristic partially bald patches. Ringworm is for the most part spread by contact of healthy with diseased children, by changing caps and by imperfectly cleansed brushes at barbers' shops. TREATMENT OF RINGWORM. — Ringworm of the body can be readily cured by numerous ointments and lotions, which need only to be applied to the affected part until the fungus has been destroyed. This usually requires only a few days, and ringworm of the body may therefore be regarded as a comparatively trivial ailment. Ringworm of the scalp, on the other hand, is an entirely different matter. For while quite recent cases may occasionally be rapidly cured by the application of suitable lotions and ointments, this is quite impracticable when the disease has penetrated deep down to the roots of the hair. The reason for this difficulty is not far to seek. Ointments and lotions which are sul'liciently strong to destroy the fungus in the deeper layer of the skin and to penetrate to the roots of the hair, in many instances produce so much irritation as to produce considerable local inflammation and risk of permanent injury. Individuals also differ materially in their reaction to different drugs, and an application which will be quite satisfactory in one child will excite a dangerous amount of inflammation in another. No routine treatment is therefore available for the cases usually met with in practice, and the prolonged application of drugs, made just as strong a the patient can stand, was until recently the only known method 88 of dealing with ringworm. True that from time to time one or another nostrum has been vaunted as a speedy and safe specific, but, as has been pointed out by others, these specifics owe their popularity to the fact that they have been used for the readily curable ringworm of the body 01* for the treatment of very recent cases of ringworm of the scalp, or for chronic cases that have almost yielded to other drugs. In any case, the drug treatment of ringworm can only be described as extremely unsatisfactory, entailing, as it does, prolonged medical supervision, considerable expenditure of time in the daily application of drugs and dressing, and frequent disappointing result?. Relapses, too, are quite common, and after many years experience in treating children I know of few questions calling for more caution than the apparently simple query—when is a given case lit to return to school ? In many instances this can only be answered by a microscopic examination of some of the doubtful hairs. Within the last few years, however, it has been found that exposure of the scalp for a certain time to what are known as the X rays results in temporary baldness, and this observation has been applied to the treatment of ringworm. Within a week to a fortnight after exposure the diseased hairs, and the fungus contained therein, fall out, and the portion of the scalp that has been treated remains bald for some weeks. During this time any fungus in the superficial layers of the skin can readily be destroyed, so that when the new hair begins to grow it cannot be re-infected. ADVANTAGES OF THE X-RAY TREATMENT.—If skilfully applied the X-Ray treatment appears perfectly effectual, and at the same time, as safe as any efficient local application. At first, difficulties were experienced in measuring the activity of the rays, but this has been surmounted, and after consultation with several of the most prominent London specialists and visits to several hospitals, I am convinced that the electrical treatment fulfils the requirements of curing " quickly, safely, and pleasantly." With regard to speed there is much to be said. If neglected cases of ringworm may persist for years, while even when under skilled treatment, the cure is usually tedious. Dr. Crocker, whose authority on ringworm is second to none, when discussing drugs, says :—" In a very recent case, six weeks to three months would be a reasonable time for a cure For many chronic cases, six months is a short, and twelve months, a fair time ; but some cases take longer even in the most experienced and skilful hands, and a large proportion of the cases reported as cured in a month or six weeks, are only examples of unskilled observation." With this, my own comparatively limited experience is in entire agreement. Fictitious cures after a few weeks' treatment are specially common 89 among school children, as parents will insist that the disease is cured as soon as it is checked. With X-Ray treatment, infection would be at an end in one month, and return to school might even take place sooner if suitable precautions were, taken. EXTENT OF RINGWORM AMONG ELEMENTARY SCHOOL CHILDREN .-—At the moment of writing this Report (March 23rd, igo6), no less than 180 children are excluded from school on account of ringworm. Many other less obvious cases would also be found to be still attending school were the children systematically examined. Of the 180 children : 2 have been excluded since November, 1904 = 17 months. 2 „ „ „ January, 1905 =15 1 „ ,, „ February, 1905 = 14 ,, 3 „ „ „ March, 1905 = 13 4 .. „ „ April, 1905 =12 5 „- „ .. May, 1905 =11 1 „ „ „ June, 1905 = 10 7 „ „ „, -Tuly, 1905 =9 4 „„ „ „ August, 1905 —8 10 „ „ „ September, 1905 =7 11 „ „ ,, October, 1905 6 „ 130 for periods less than 6 months. REASONS WHY THE COUNCIL SHOULD UNDERTAKE THE TREATMENT OF RINGWORM.—(1) School attendance is compulsory, and it is therefore incumbent on the local authorities to check, and, if possible, to stamp out all communicable diseases of school children. They also have some moral responsibility for the treatment of a complaint which has probably been contracted in a school. (2) The parents cannot afford to pay for the prolonged treatment necessary if drugs alone are used. (3) The X-Ray treatment, cannot, at present, be obtained in Croydon, nor is it likely to be placed within reach of the poor. (4) It is a serious matter, from the financial point of view, that 180 children should be excluded from school and consequently unable to earn the Exchequer grant of £2 per child per annum. It is still more serious that so many children should be deprived for many 90 weeks or months, of the educational advantages which are provided at such cost to the ratepayers. RECOMMENDATIONS RESPECTING RINGWORM. I have, therefore, most strongly to recommend:—(i) That a systematic examination for suspected early cases of ringworm should be made by the school nurse, whose appointment has already been suggested. The salary of such nurse would be £80 to £100 per annum. (2) That the Borough Hospital House Sub-Committee should be empowered to arrange for the X-Ray treatment of ringworm occurring among Elementary School children at a further expense of not exceeding £100 per annum. This treatment might, at the discretion of the Committee, be undertaken either by installing an apparatus at the Town Hall, or by arrangement with some medical man who possessed the necessary equipment. From enquiry, I find that the latter suggestion is practicable, and would have the advantage of allowing me more time to examine the cases submitted by the nurse. The ground would thus be covered more quickly, and the disease be sooner checked. EXAMINATION OF PUPIL TEACHER CANDIDATES.—Seventyfive young persons, who desired to become pupil teachers, were medically examined during the year. Of these 67 were passed and eight rejected. Six re-examinations were also made. A record of each physical examination together with the family history of the candidate is entered on a card and filed for subsequent reference. This system has been found most useful when, for various reasons, it has been found necessary to re-examine candidates or pupil teachers. SPECIAL EXAMINATION OF TEACHERS. —Thirteen teachers were interviewed on one or more occasions by the Medical Officer. In six instances the interview had reference to the existence of infectious disease at the home of the teacher, while in seven cases the Committee required special reports concerning the health of the teacher. BLIND, DEAF, AND DEFECTIVE CHILDREN. -The children attending the Deaf Class were examined during the year and a 91 special report made as to their physical condition. Seven other children were also examined at the Town Hall and reported upon. Many other children were examined at the schools, but as no certificates were required no record was kept of these examinations. TRUANTS.—Thirty-four children were examined before despatch to truant schools, and the necessary certificates given to the Police. EXAMINATION OF CHILDREN UNFIT TO ATTEND SCHOOL. —Eighty-three children alleged to be physically unfit for school attended at the Town Hall for examination. Recommendations were made in each case as to school attendance. SCHOOL CLOSURE.—The following schools were closed during 1905 on account of Measles Upper NorwoodMixed School. Whitehorse Road(Infants' Department). St. Mary's do. Parish Church do. British do. Ecclesbourne Road do. All Saints' do. Owing to certain special circumstances St. Saviour's School was also closed on account of scarlet fever. During the year I have seen no reason to modify my opinion that school closure is rarely of much, if of any, avail in combating an epidemic of measles. Probably some good would be done if prompt notice were given of the very first case, and the class in which that case had occurred were closed for a week at about the time when the secondary crop of cases might be expected. This is not done, partly because one does not always get early intimation of the first case, and partly because there is a natural inclination not to interfere unduly with the grant earning capacity of the school. Were Article 101* of the old Code re-instated, teachers and all concerned would be more ready to close classes on the occurrence 92 of one or two cases as no grant would be lost by so doing, f Under present conditions, however, school managers find it more profitable to close the whole school than to lower the average attendance by closing one or more classes. Thus the Board of Education places a high premium on antiquated and unsatisfactory methods of dealing with school epidemics. To illustrate how the present method works out, I obtained from the Head Teacher of the British Infants' School certain particulars relating to the epidemic of measles prevalent in that school at the end of the year. One hundred and thirty-five children attended this school of whom 59 were stated to have suffered from measles at some previous epidemic, 75 were stated not to have had measles, and concerning one no statement was made. On October 3rd one of those who had not previously suffered from the disease was attacked with measles and his illness was followed by the following cases:— 1905. No. of Cases. October 26. 1 27 3 28 3 „ 30 1 November 1. 1 4 1 5 1 7 4 9 2 1 0 3 1 1 4 1 2 5 1 3 6 „17 4 1 9 3 2 0 17 School Closed. „ 21 4 „ 22. i „ 23 2 ,, 28 2 1906. January 28. 2 t Article 101* read :—" Where the Department arc satisfied that by reason of a rotice of the Sanitary Authority under Article 88 or any provision of an Act of Parliament requiring the exclusion of certain children, or by reason of the exclusion under medical advice of children from infected houses, the average attendance has been seriously diminished and that consequently a loss of grant would, but for this Article, be incurred, the Department have power to make a special grant not exceeding the amount of such loss in addition to the ordinary grant." 93 Thus from October 3rd to January 28th, 1906, there were 70 attacks, of which 63 occurred in children who were stated not to have previously suffered from the disease, while seven were stated to have suffered from measles at some previous epidemic. It is, however, doubtful whether these seven children really suffered from second attacks as we can only be guided by the statements of the parents, who, in many instances, give the name of measles to any rash from which their children may suffer. The figures are in any case interesting as showing that the history as to previous illness obtainable by the teachers is for the most part reliable, and could be fairly used in administrative work. On November 20th the school attendance had dropped to 33 per cent., and the managers were then anxious to close the school as the work was disorganised and the grant consequent on a high average attendance in jeopardy. At that time 21 children were stated not to have had the disease in any previous year, and of these seven were attacked during the next eight days, while two failed a couple of months later when the school was open again. Thus at the most only about 12 children could possibly have been benefitted by school closure, while it is probable that several of these were naturally insusceptible and would not have been attacked even had the school been allowed to remain open. There are several other points of interest in connection with this outbreak. First, it will be noticed that there is an interval of 23 days between the first and second case reported from the school. Now, as the incubation period of measles is usually something under a fortnight, it is almost certain that there must have been one or more missed cases about October 12th to 17th, and if the class in which the first case had occurred had been closed from October 10th to October 21st, it is very likely that the epidemic might have been checked. Secondly, it is sometimes stated that school closure should be resorted to when 10 per cent, of the children have been attacked. Had this rule been followed the school would have been dismissed on November 7th, but it is fairly certain that such a step woidd have had practically no effect, as 47 out of the 54 subsequent cases were attacked on or before November 21st, and were therefore in all probability infected on November 7th or earlier. I am therefore stroagly of opinion that representations should once more bs made to the Board of Education to re-enact Article 94 101* of the old Code, so that one might have a greater amount of freedom in closing classes, or temporarily excluding children who are known to be susceptible to measles. In default of closure, I am of opinion that it would be useful to issue a warning notice, such as the following, which is now used in the London County Council Schools :— LONDON COUNTY COUNCIL. Notice to The Parent or Guardian of From woolvvich. 1'he Head Teacher (Infants' Dept). School. As a case of measles has occurred among the scholars in the class which your child attends, it is possible that may have contracted the disease. As it requires about twelve days for measles to develop after infection, you are requested to pay particular regard to the state of your child's health during the NEXT THREE WEEKS, and upon the slightest sign of illness to abstain from sending to school. Date Signature NOT E. Measles may be a very serious illness in young children, and many die from it. The early symptoms are those of a cold, which may be at first slight; there is generally running at the eyes and nose, sneezing and possibly cough. Many children lose their lives because parents allow them to go out of the house, thinking that the indisposition is only a slight cold, when it is really measles. Were this notice sent to the parents of every child attendingy class in which measles has occurred some benefit would undoubtedls result, as parents would gradually be induced to take a more seriou view of measles, and by proper treatment, diminish the risk of a fatal issue. 95 The following form, for which I am also indebted to the Medical Department (Education) of the London County Council, might also usefully be employed in all cases when classes or schools are closed for measles:— LONDON COUNTY COUNCIL. Notice to The Parent or Guardian of From The Head Teacher (Infants' Dept), School. As a case of measles has occurred anong the scholars in the class which your child attends, it has been decided to close the class till . Measles is an infectious disease. You are therefore cautioned, in the event of your child showing any signs of this disease, to keep from contact with other children or from exposure in public places until a fortnight shall have elapsed after exposure to the infection, A child who appears only to have a slight cold may have contracted measles and be dangerous to others. Any child who has contracted measles must not resume school attendance for one month. Date __ Signature. School closure for scarlet fever was resorted to on one occasion. As stated in previous Reports, school closure is rarely warranted when dealing with this disease, as it is quite sufficient to visit the school on the occurence of more than one case in the same class, and by an inspection of the children, to exclude any suspicious cases that may be found to be in attendance. This course was followed in the case of St. Saviour's School, and resulted in the discovery of several missed cases of scarlet fever. These children were promptly excluded, but, as several cases of scarlet fever were of a very severe type, parents became alarmed and refused to allow their children to resume attendance, and it was therefore thought wise to close the school until the premises had been disinfected and alarm had subsided. AGE OF SCHOOL ATTENDANCE.—The desirability of admitting children under five years of age was the subject of a special report during the year. It will be seen from the following figures the 96 problem is not one of very considerable importance in Croydon, as only 25 per cent, of the'population aged 3-5 are at present attending school:— Children aged. Population March, 1904. Attending School. Percentage. 3-5 6064 1516 25 5-io 14792 11553 78 10-13 8540 6751 79 I3-H 2822 1356 48 Stated shortly, I am of opinion that in a town like Croydon it is only exceptionally that children under five years of age world not be better off in their own homes, and I should like to have seen the admission of children under five years of age generally discouraged and only permitted under certain conditions. It must be acknowledged that the question is one of great difficulty, but these conclusions are based on the following grounds :—Firstly, only n per cent, of mothers of the artizan class are employed from home in Croydon, in some parts of the town the proportion is less, thus, of 54 children aged 3-5 attending Oval Road School it was found that only in four instances was the mother employed from home. Of the 50 mothers not employed 2 had 3 younger children not attending school. 14 had 2 younger children not attending school. 17 had 1 younger child not attending school. 17 had no younger children. Thus of the 50 mothers at least 34 could reasonably be expected to give the necessary care to their children. At Princess Road School, on the other hand, 20 out of 40 mothers were employed, and of the 20 not employed 8 had 2 younger children not attending school. 9 had 1 younger child not attending school. 3 had no younger children. Thus even in this district there were a considerable number of mothers who were perfectly capable of looking after their children. With regard to the children of mothers who are employed from home, it is doubtless better for the children to attend school rather 97 than to be unattended at home, and on the other hand, it is doubtful whether more harm than good is not being done by the facilities thus afforded for the employment of married women. Secondly, the aggregation of infants in schools tends to assist in th spread of measles and whooping cough, and to the infection of children at a somewhat earlier age than would take place if the age of school attendance were raised. Forty-eight fatal cases of measles were recently enquired into. In eleven instances parents had moved, or for some other reasons the information could not be obtained; in eleven instances the history was indefinite ; eight fatal cases were probably infected at school", while in eighteen other instances, measles was introduced into the household by some other school child who was suffering from the diseases and subsequently infected the deceased. Similarly of 33 fatal cases of whooping cough; one was stated to have been infected at school, and fifteen were stated to have been infected by another member of the family who caught the disease while attending school. In the remaining seventeen other instances, no connection with school could be traced, or no statement could be obtained. Were the school age raised, epidemics of measles and whooping cough would still occur, but those infected at school would be older and less likely to suffer severely, and the introduction of measles and whooping cough into the family would, in most cases, occur at less frequent intervals so that the ages of the susceptible children not attending school would be rather greater. In the case of measles and whooping cough the question of age incidence is of vital importance, as practically all the. fatal cases occur in children under five years of age. Thirdly, in the past the work in the baby rooms has not been conducted on satisfactory lines. Too much formal teaching has been attempted, free movements have been restrained, and overcrowding has frequently been permitted. The hours of school attendance are also, in my opinion, too long for infants, who should be encouraged to sleep during part of the morning or afternoon at this early age. The whole question was fully considered by a Sub-Committee, who were more impressed by the educational value of attendance under live years of age. than I have been, and the following recommendations of this Sub-Committee were adopted by the Council:— " I he Sub-Committee are convinced that while in many " parts of Croydon the baby school is a boon to both parent 98 "and child, and the expense to the rates of maintaining such " schools is very small, the lessons given to such children should " not be of a "formal character, but that the aim of the teacher " should be to utilise and direct natural tendencies and activities " rather than to impart definite instruction in any of the subjects " taught to older children." The Sub-Committee therefore recommend:— " (i) That children under five be only admitted to those schools where a properly equipped baby-room is provided and only to the extent of the accommodation of such room " (2) That in schools where a suitable room is available, baby-rooms, arranged and furnished as at Ingram Road be provided. " (3) That the Attendance and School Accommodation Sub-Committee be authorised to refuse admission to children under four or under five in any school. " (4) That in certain schools the experiment be tried of admitting children under five as half-time scholars for morning only and afternoon only. "(5) That no children at present in the schools be excluded, and that the proposed alterations to the rooms be made in the next summer holidays. " (6) That in these recommendations, and in all questions arising under any regulations adopted in pursuance of them, the term ' under five' shall be taken to mean ' under five at the end of the current school term.' " Recommendation (1) will, if strictly adhered to, remove, to some extent, the objection as to overcrowding, and the decision to abandon any attempt to impart formal instruction to the babies will remove another objection. '$9 Recommendation (4) obviates the difficulty as to sleep. In schools where half-time is not tried an afternoon's nap should find its place in the time-table. One of the teachers has already told me that she intends trying this. I would also add that the Council's decision to continue the baby classes makes it imperative that Article 101* should be re-instated in the Code, so 'that young infants may be excluded from school without affecting the grant-earning power of the department. 99 PHYSICAL EXAMINATION OF CHILDREN. — In December, 1905, I presented a special report on the physical examination of the children attending Princess Road and Oval Road Schools. Since then I have been able by the. kindness of Mr. Andrew (Whitgift Grammar Scnool), Mr. Jones (Whitgift Middle School), Mr. Scott (Elmhurst School), Miss Leahy (High School for Girls), and Miss Walford (Woodford House School) to obtain comparative figures for boys and girls attending certain of the Secondary Schools. As the comparision between height and weight of Secondary and of Elementary School children was of interest, and many inquiries have been made as to the results obtained, I have reprinted the tables previously presented, together with similar tables of heights and weights for children attending Secondary Schools. I should also like to thank the Head Mistresses and Head Masters named for their kind assistance in permitting me to take the necessary measurements of their children. LIMITS AND METHODS OF ENQUIRY—As a complete physical examination was for obvious reasons impracticable, it was decided to limit the enquiry to the following points :— Age in years and months. Height in inches and quarter inches without shoes. Weight in pounds and quarter pounds in ordinary clothes, but without boots. The date of inspection, name of child, standard, and sufficiency of clothing was also noted in each instance. Though the metric system offered many advantages, it was thought better to use standards with which the teachers had greater practical familiarity. The observations were all entered on cards, white cards being used for boys and red cards for girls. This method minimises the considerable labour involved in tabulating the results, and supplies a convenient permanent record. It is useful to note that the actual weighing and measuring did not take very long In one school 1,005 children were weighed and measured in 22 hours. METHOD OF TABULATION —As at Dundee, Mr. Francis Galton's method has been preferred to that of simple averages. 100 This is fully . described in the British Association Report for 1881, but is shortly as following:—Each series is arranged in order of magnitude, the middle number of the group is then tabulated as the median average of the group. This can be done somewhat more quickly than when averages have to be estimated, and also avoids the introduction of error from the inclusion of extreme cases in the group under discussion. Thus in the Oval Road Boys. School (Table I.) at the age n to 12 years 55 observations were made, and of these the median height was 54!. inches, i.e., there were 27 boys who were taller and 27 shorter than the 54I. inches. Each group was also further analysed by ascertaining the lower and upper quartiles, but it is not proposed to discuss these figures at the present moment. In all 1,474 boys and 975 girls were examined, but in the following tables groups containing less than ten observations have been omitted. BOYS. HEIGHTS—It will be seen that at every age period the Princess Road boys are shorter than those attending Oval Road, while the latter conform fairly closely to the British Association Committee.s figures for all classes. The height of the children attending certain Secondary Schools is at each age period as much in excess of that of the Oval Road boys as those exceed Princess Road. Table I.—BOYS. Height. Age last Birthday Certain Secondary Schools. Oval Road School. Princess Road School. B.A. Anthropometric Committee, 1883. All Classes. Number Examined. Median height. Number Examined Median height. Number Examined. Median height. Number Examined. Average height. Inches. Inches. Inches. Inches. 4 .. .. 29 39.25 29 3S.oo 107 38.46 5 .. .. 39 41.00 15 40.50 201 4I.°3 6 10 45.75 45 43.00 29 42.00 266 44.00 7 12 48.50 61 46.25 24 44.25 307 45.97 8 17 49.50 49 48.50 31 46 00 1524 47.05 9 33 52.00 63 4975 33 48.25 2275 49.70 10 63 54.25 57 52.25 33 50.00 1551 51.84 11 87 55.00 55 51.5° 23 51.00 1766 53.50 12 97 57.50 70 55 00 3° 53.5° 1981 54.99 13 120 59..00 35 56.25 23 55.oo 2743 56.91 14 118 6l. OO 3428 59.33 15 81 62.50 .. .. 3498 62.24 16 41 66.25 •• 2780 64.J1 101 GIRLS HEIGHTS. .Similar remarks apply, but the differences between the two Elementary Schools are less marked, though the Secondary School girls are individually taller than Oval Road girls or the B.A. Committee.s average. Table II.—GIRLS. Height. Age last Birthday. Certain Secondary Schools. Oval Road School. Princess Road School. B.a. Anthropometric Committee, 1883. AH Classes. Number Examined. Median height. Number Examined. Median height. Number Examined. Median height. Number Examined. Werage height. Inche.. Inches. Inches. Inches. 4 22 38.13 16 37 .50 99 38.26 5 41 41 .OO 29 40 .00 157 40.55 6 ii 46,.75 45 44.00 32 41.63 189 42 .88 7 io 49.0O 54 45.75 28 44.00 173 44.45 8 I A. 50.50 52 46.75 20 46.25 432 46.60 9 ii 52.50 57 49.75 33 48.00 499 48.73 io 21 54.00 51 51.00 25 50.50 480 51.05 ii 28 55.50 57 53.00 20 52.86 441 53.10 12 30 58.25 52 54 .00 20 54.00 225 55.66 13 45 61.25 35 56.50 14 55.50 206 57.77 14 44 62.25 .. .. 240 59.80 15 32 53.50 .. .. 201 60.93 BOYS. WEIGHTS —Here again the Princess Road Boys are inferior at all ages to those attending Oval Road School. The Oval Road children are also below the B.A. standard for all classes, though this was not so when height was compared. The Secondary School boys are for the most part well in excess of all the other groups. Table III.—BOYS. Weight. Age last Birthday. Certain Secondary Schools Oval Road School. Princes? Road School. B.A. Anthropoinetiic Committee, 1883. All Classes. Number Examined. Median weight. Number Examined. Median weight. Number Examined. Median weight. Number Examined. Average weight. Pounds. Pounds. Pounds. Pounds. 4 29 36.75 29 35 .75 102 37.3 5 39 40.00 *5 38.00 193 39.9 6 10 49.50 45 43.00 29 224 44.4 7 12 5°.5° 61 49.00 24 46.50 24O 497 8 17 6o*oo 49 52.5° 31 5 2 .OO 820 54.9 9 33 64.00 63 57.25 56.00 1425 60 4 10 63 68.oo 57 62.86 33 61.co 146; 67.5 1 r 87 7i.50 55 69.00 23 65.00 1599 72.0 12 97 77.00 70 71.75 30 71.50 17S6 76.7 13 120 35.50 35 76.50 23 75.00 2443 82.6 14 118 94.00 .. .... .. .. 2952 92.0 15 81 I07.00 .. .. .. .. 3118 102.7 16 41 I24.00 .. .. .. .. 2235 119.0 102 GIRLS' WEIGHTS —Similar remarks apply, but the differences between the three schools are greater than in the case of the boys' schoofs. Table IV.—GIRLS. W EIGHT. Age last Birthday. Certain Secondary Schools. Oval Road School. Princess Road School. B.A. Anthropometric Cornmi'tee, 1883. All Classes. Number Examined. Medium weight. Number Examined. Median weight. Number Examined. Median weight. Number Examined. Average weight. 4 ... Pounds. 22 Pounds. 34.50 16 Pounds. 32.86 97 Pounds. 36.1 5 ... ... 41 38.50 29 37.25 160 39.2 6 11 47'00 45 42.25 32 40.25 178 41.7 7 10 52.00 54 46.00 28 44.25 148 47.5 8 14 56.25 52 49.50 26 48.25 330 52.1 9 II 62-10 57 56-00 33 52.50 535 55.5 10 21 67.00 51 59.00 25 56.00 495 62.0 11 28 74.00 57 65.50 20 63.00 456 68.1 12 30 82.50 52 71.25 20 63.00 419 76.4 13 45 95.00 35 82.00 14 75.00 209 87.2 14 44 101.50 ... ... ... ... 229 96.7 15 32 117.25 ... ... ... ... 189 HEIGHT AND WEIGHT OF ELEMENTARY SCHOOL CHILDREN IN VARIOUS STANDARDS —I 'his was investigated to see if there were any relation between the place taken in school and the physical condition of the scholars, as ascertained by measurement of height and weight. I do not propose at the present moment to report the results in extenso, as the number of observations are possibly not sufficiently large. It is notable, however, that the boys and girls in Stardards VI. and VII. were superior in height and weight to other children of the same age. It would seem, therefore, that the conditions which favour physical growth are also favourable to intellectual development. SUFFICIENCY OF CLOTHING IN ELEMENTARY SCHOOLS. —Teachers were asked to mark on the card whether in their opinion the clothing of the children was above or below the average of the school, The children at each school were then divided into three groups, namely, those possessing an average amount of clothing and those above and those below that standard. The height and weight of each of these groups was 103 then investigated in the light of the information tabulated in Tables I., III., II, and IV. The following are the results:— Princess Road School.—BOYS. Sufficiency of Clothing. Total Number. Proportion below height for age of child. Proportion below weight for age of child, Below Average 70 61% 60% Average 1.51 44% 44% Above Average 51 27% 35% Oval Road School.—BOYS. Sufficiency of Clothing. Total N umber. Proportion below weight for age of child. Proportion below height for age of child. Below Averags 29 55% 62% Average 438 38% 38% Above average 56 23% 28% Princess Road School.—GIRLS. Sufficiency of Clothing. Total Number. Proportion below height for age of child. Proportion below weight for age of child. Below Average 39 72% 60% Average 164 43% 50% Above Average 44 41% 25% Oval Road School.—GIRLS. Sufficiency of Clothing. Total Number. Proportion below height for age of child. Proportion below weight for age of child. Below Average 23 49% 52% Average 389 56% 58% Above Average 70 31% 36% 104 This investigation was made with a view of ascertaining whether poverty, or neglect were the probable causes of the deficient height and weight of the children. If poverty and neglect can be gauged by insufficiency of clothing (as I think they may well be), it will be noticed that the relation between sufficiency of clothing and height and weight is clearly brought out. Thus in the case of the Princess Road Boys 61 per cent. of the children classified as insufficiently clothed were below the average height for their age and 60 per cent. were below the average weight. On the other hand, 73 per cent. of those who were said to have more than the average of clothing were above the average height for their age, while 65 per cent were also above the average weight. GENERAL CONCLUSIONS. —The most obvious fact ascertained during the enquiry is the inferiority of the Princess Road children. This fact, of course, was previously familiar to anyone who had had an opportunity of visiting both schools. It was, however, well worth putting the matter to the test of the measuring rod and the balance, as it is only by the tabulation of actual facts that knowledge can be advanced and trustworthy conclusions drawn. With regard to the cause of the physical inferiority of Princess Road children, I think we have a valuable indication in the fact just noted as to the correlation of inferior height and weight with insufficient clothing. It may, I think, be taken for granted that children who are insufficiently clothed come from poor homes, but the cause of poverty could only be ascertained by careful investigation of each case. This, however, is beyond the limits of our present enquiry. I believe it would also be found that much of the deficiency in height and weight of the Princess Road children is due to imperfect cooking and to the selection of articles of diet that for their cost are comparatively deficient in nutritive value. Were the principle of co-operative meals adopted in the schools, it would have the great advantage of teaching the next generation how cheap and nutritious food may be selected and palatable meals prepared therefrom. In the meantime the most useful results of this investigation have been (1) To demonstrate the practicability of measuring the children. (2) Demonstration of the fact that simple measurements are trustworthy indications of the physical condition of the children. 105 Before extending these measurements to other schools, it has been decided that at the end of about six months the children attending the Oval Road and Princess Road Schools shall be remeasured and reweighed. When this is done the children at each age group will be arranged in order of weight, and the lower quartile, i.e., the children who form the lowest quarter in each group will be subjected to further special examination. By this means it is hoped that attention will be directed to those most requiring it. It is indeed, as a means of selecting children for further examinotion that these physical measurements seem to be most likely to prove useful. Were they extended to the rest of the schools they would also serve to call the attention of the head teachers to departures from health that might otherwise pass unnoticed. SCHOOL. HYGIENE FOR TEACHERS.— During the winter months, Dr. Thomas has given two courses of lectures to head teachers on Hygiene, with special reference to School Life. The lectures have been thoroughly appreciated, and I hope that in future years similar lectures will be given to assistant and pupil teachers, who might, I think with advantage, be required to attend. The Committee might also consider whether it would not be as well to encourage the assistant teachers to pass some examination in School Hygiene. TEACHING OF HYGIENE TO SCHOOL CHILDREN.—The teaching of Hygiene in elementary schools, must, in the main, be indirect. I believe that more can be done by a teacher with a keen appreciation of first principles, and working in a clean and healthy schoolroom, than by all the text books and syllabuses ever printed. If the laws of health are to be brought home to children it must be by practical example rather than by committing to memory a few sanitary shibboleths. It was felt, however, that teachers should have, some guidance as to the various points in relation to the care of the body on which they should talk to their scholars. A brief outline scheme was therefore drawn up in collaboration with the Committee's School Inspector, Mr. Robertson, and the Committee thereupon directed that this outline, together with that issued by the Board of Education, should form a basis of a scheme of instruction to be given in all the schools. I repeat, however, that it will be very little good teaching about the cleanliness of the homes if the school floors are as dirty as some that I have seen in Croydon, or of fresh air, if ventilation of the school-room is consistently omitted. SCHOOL BUILDINGS.—T here are no features requiring mention on this occasion. Any minor defects found on visiting schools are 106 at once reported to the Surveyor. Particulars as to the cubic capacity, heating, lighting, etc., of each school, are also being tabulated on special cards, and it is hoped that this thorough sanitary inspection of the buildings will be completed during the next few months. TESTING OF VISION.—This has been continued as heretofore by the Ophthalmic Surgeon. 107 APPENDIX. COUNTY BOROUGH OF CROYDON. SCARLET FEVER OR SCARLATINA. HOME CASE. Children from this [house must not attend day or Sunday School until permission is given by the Medical Officer of Health. All cases of " sore throat," " lumps in the neck," or of " peeling skin " occurring in the household are probably scarlatinal and should be immediately reported to your Medical Attendant. Suspicion should also be aroused by any sudden attack of illness, especially if beginning with vomiting. Public Library Books must be taken to the Public Heath Department, Town Hall, and no books borrowed until the house has been disinfected. If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. No children should be allowed to visit the infected house. A patient suffering from this disease is generally DANGEROUS TO OTHERS for six to eight weeks, and must not be allowed to mix with other people until the Medical Attendant certifies that there is no danger. There is risk of infection while there is any discharge from ear or nose, or while the throat remains sore or unhealthy. DISINFECTION. i.—All soiled linen should be at once placed in a tub of water to which ahandful of ordinary washing soda has been added, soaked for twelve hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 108 2.—Special cups, saucers and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4.— During recovery the patient should have a warm bath every day, unless the doctor orders otherwise. The body should be freely lathered with soap, special precaution being taken to thoroughly cleanse the hair and scalp. 5.—When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on application to the Public Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m till 1 p.m.). H. MEREDITH RICHARDS, M.D., Medical Officer of Heath. Town Hall, Croydon. The following handbill is used in those cases in which the primary case is removed to hospital. Similar leaflets are issued for diphtheria and enteric fever :— COUNTY BOROUGH OF CROYDON. SCARLET FEVER OR SCARLATINA. Hospital Case. Children from this house must not attend day or Sunday School until permission is given by the Medical Officer of Health. All cases of " sore throat," "lumps in the neck" or of " peeling skin " occurring in the household are probably scarlatinal, and should be immediately reported to your medical attendant. Suspicion should also be aroused by any sudden attack of illness, especially if beginning with vomiting. 109 Public Library books must be taken to the Public Health Department, Town Hall, and no books borrowed until the house has been disinfected. All articles exposed to infection should be placed in the room occupied by the patient before removal to the Hospital, and the room then locked until the Inspector calls to arrange for disinfection. He will instruct you what to do. The Hospital is in Waddon Marsh Lane, Croydon. Information as to the condition of patients may be obtained at The Hospital Gate, The Public Health Department, Town Hall (during office hours), and The Fire Station (after 10 a.m.). Enquiries may also be made by telephoning to the Hospital (No. (6 Croydon) between 2 and 4 p.m. The Resident Medical Officer can be seen at the Hospital between 1 and 1.15 each day. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of ^5 is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. DIPHTHERIA AND MEMBRANOUS CROUP. HOME CASE. Children from this house must not attend day or Sunday school until permission is given by the Medical Officer of Health. All cases of " sore throat," croupy cough," or " lumps in the neck'' occurring in the household are probably diphtheritic, and should be immediately reported to your Medical Attendant. Any suspicious cases can be examined bacteriologically at the Borough Laboratory, free of charge. Public Library Books must be taken to the Public Health Department, Town Hall, and no books borrowed until the house has been disinfected, 110 If treated at home the patient must be confined to one room, and no one except the person in charge alloived to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniiure should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and other clothes before going off duty. No domestic animal should he allowed to enter the sick room. A patient suffering from this disease is generally DANGEROUS TO OTHERS for a period of at least Three Weeks, and must not be allowed to mix with other people during that period, or while there is any sore throat, or any discharge from ear or nose, or while diphtheria germs can be detected in the throat. Examinations for the detection of diphtheria germs are made at the Borough Labatory, free of cost. The necessary arrangements will be made by your Medical Attendant, disinfection. 1.—All soiled linen should at once be placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.—Special cups, saucers and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose and mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4. —When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, etc., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on application to the Public Health Department, Town Hall, between he hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p.m.) H. MERIDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of £5 is attached to the exposure of infected persons and things, 111 COUNTY BOROUGH OF CROYDON. TYPHOID (ENTERIC) FEVER. HOME CASE. All cases of " diarrhoea," '' severe headache," or " feverishness occurring in the household should be immediately reported to your Medical Attendant. Any suspicious cases can be examined bacteriological]}- at the Borough Laboratory, free of charge. Public Library books must be taken to the Public Health Department, Town Hall, and no books borrowed until the house has been disinfected. If treated at home, the patient must be confined to one room, and no one, except the person in charge, allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. Scrupulous cleanliness is essential. Nurses should keep their nails short, and should scrub their hands and disinfect them immediately after attending the patient. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally DANGEROUS TO OTHERS for a period of a fortnight after return to ordinary food. DISINFECTTON 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.—Special cups, saucers and spoons should be used for the patient, and any spare food from the sick room destroyed. 112 3.— Everything passing from the patient should be received into a mixture of water and disinfectant, sufficient being used to completely cover it, and be allowed to stand for half-an-hour before being thrown away, the vessel being covered with a cloth soaked in the disinfectant. Nothing coming from the patients must be thrown into the ash-bin, or upon the surface of the soil, or into the drains, without disinfection. 4.—Discharges from ear, nose or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 5.—When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week 0.1 application to the Public Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturday 9 a.m. till 1 p.m). H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of £5 is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. PUERPERAL FEVER AND OTHER ACCIDENTS OF CHILDBIRTH. These are best avoided by attention to the following simple rules during pregnancy — Diet should be plain, easy of digestion, nutritious, and taken at regular intervals. Milk should be taken freely, and beer, wine, or spirits, only sparingly, and under medical advice. Exercise should be moderate in amount, and in the fresh air, Violent exercise ana fatigue should be avoided. 113 Rest should be taken daily in the afternoons, and mental excitement avoided. Clothing should be loose and warm, woollens being worn next the skin. Bathing should be carefully attended to, especially towards the end of pregnancy. The Bowels should act daily—cascara is a useful, simple laxative. Infectious Disease. Pregnant women should avoid contact with any kind of infectious disease, and with patients suffering from discharging sores. The Nipples during the last two months of pregnancy should be bathed with boiled warm water, and glycerine of borax applied daily. When taken in labour, the patient should have a warm bath, plenty of soap and water being used, and fresh clean underclothing be put on. The Lying-in Room. The room should be scrupulously clean, the window and grate register opened. In cold weather a small fire is necessary. The room should not have been recently used for any case of infectious disease. If there is any doubt about this, the room will be disinfected free of charge on application to the Medical Officer of Health. Two wash basins, a nail brush, soap and hot water, an efficient antiseptic, scissors, thread, and plenty of clean towels, and a binder with safety pins, should be prepared ready beforehand. The patient should he on a firm mattress with a clean mackintosh and sheets. The Maternity Nurse. The nurse must be scrupulously clean in every way, and should not have been recently engaged in nursing any case of puerperal fever or other infectious disease. All maternity nurses are advised to procure a copy of the instructions issued by the Central Midwives' Board, and to follow the rules given therein in respect to clothing, disinfection of hands, disinfection of appliances, and disinfection of the patient. 114 COUNTY BOROUGH OF CROYDON. PUERPERAL FEVER. Directions as to the Disinfection of Midwives and Maternity Nurses. No Midwife or Nurse in attendance on a patient suffering from Puerperal Fever or other infectious illness should visit or attend any other patient. Whenever a Midwife or Nurse has been in attendance upon a patient suffering from Puerperal Fever or from any other illness supposed or suspected to be infectious, she should conform to the following methods of disinfection at the conclusion of the case;— 1. All washable clothing should be steeped in water to which a little soda has been added and then boiled. Gloves" should be boiled. 2. All other clothing should be disinfected at the Public Disinfecting Station. This will be done free of cost by the Corporation, Application should be made at the Town Hall. 3. The Nurse's bag should be disinfected by washing thoroughly inside and out with 1 in 1,000 perchloride of mercury solution. 4. All instruments and nail-brushes should be boiled. 5. A complete bath should be taken, soap being freely used The nails should be cut short and the hands first scrubbed and then immersed for five minutes in 1 in 1,000 perchloride of mercury solution. Midwives and Nurses should not resume work until they have satisfied the Corporation that the requirements of the Medical Officer of Health as regards disinfection and other precautions have been complied with. H. MEREDITH RICHARDS, M.D. 115 COUNTY BOROUGH OF CROYDON. HEALTH TALKS. 1. HEALTHY HOMES. 1.—The Ideal House. Site—Clean, dry, elevated. Aspect—open space. Paved Yard. Large living room—no useless parlour—number of bedrooms. Windows, floors, walls, and fittings that can be readily cleansed. Cupboards. Drainage and sanitary fittings—simplicity and efficiency. No smells, no leaks, no stoppages. 2.—Duty of the Householder. Health depends more on the use to which the house put than on its construction. It is the ideal tenant which makes the " ideal home." Care of the house and fittings. Use of ashbin. Site improved by avoiding useless temporary buildings, dirty fow runs, and collections of refuse. Yard to be swept and swilled. Smallness of rooms compensated by open windows, and by absence of unnecessary furniture. No useless old clothes. Walls, floors, and fittings to be regularly cleansed. 3.—Causes of Bad Smells. Insufficient Ventilation—Old clothes and other rubbish. Improper use of dustbin. Rats and mice. Domestic animals. Stopped drains, dry rot, mildew. 116 4.—Occasions for seeking assistance of the Health Department. Dampness of ceilings, floors or walls. Dirty or Broken Walls, not due to the carelessness of the tenant. Unpaved Yards. Obstructed Drains and sanitary fittings. Defective w.c. cisterns and Leaky Taps. Failure to remove refuse, In any of these emergencies send a postcard to the Health Department, Town Hall. 2. THE FIRST BABY. 1. Preparation for the Confinement—The Mother. The Room. The Bed. 2. What to do, and what not to do, during labour. During delivery. After delivery. 3. Care of new-born Infant—The eyes. The bath. Baby's clothes. To be suckled after bath, or after mother's first nap. The cot. 4. Advantages of breast feeding—No danger in mixing milks, 5. Comparison of mother's milk, cow's milk, and condensed milk. Uselessness and risk of starchy food for young infants. Best substitute for mother's milk. Kind of bottle. Baby's ailments. " Wasting." Thrush. Bronchitis. Diarrhoea. Spasmodic Croup. How avoided. Careful dieting, regular meals, fresh air, warm clothes, cleanliness. 117 3. HINTS ON THE MANAGEMENT OF INFANTS IN HEALTH AND DISEASE. Baby's Habits—Soon formed. Important as regards sleep, meals, excretions, bath. Necessity for tact, firmness, and especially of consistency in the mother. Bad Temper. Don't Frighten Children. Don't say " Don't." Meaning of Lumps in the Neck. Care of the Hair. Hints concerning Measles, Whooping Cough, Chicken-pox, Sore throat, Sores on face and head, Ringworm, Itch.