CRO 11 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 YEAR 1909. 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 Smallpox Hospital; School Medical Officer. Croydon : l'RINTEI) BY S. H. l'URNELL, IoS, HIGH STREET. 1910. 2 3 TABLE OF CONTENTS. A.— Vital Statistics— page Population 9 Area 9 Births 10 Deaths 10 Ward Death Rates 11 Infantile Mortality 12 Diarrhoea and Epidemic Enteritis 13 Death Certification 15 Inquests 15 Smallpox 15 Croydon and Wimbledon Joint Smallpox Hospital 15 Vaccination 15 Measles 16 Scarlet Fever 17 Return cases of Scarlet Fever 21 Epidemic Influenza 23 Whooping Cough 23 Diphtheria and Membranous Croup 23 Return cases of Diphtheria 24 Enteric Fever 26 Puerperal Fever 29 Erysipelas 29 Tuberculosis 29 Tuberculosis and Milk 29 Midwives' Act, 1902 30 Notification of Births Act, 1907 31 Customs and Inland Revenue Acts 31 Disinfection 32 Local Government Board Returns: Table I. Vital Statistics of whole district during 1909 and previous years 33 Table II. Vital Statistics of separate localities in 1909 and previous years 34 Table II. Cases of Infectious Disease notified during the year 1909 35 Table IV Causes of,and Ages at,Death during year 1909 36 Table V. Infantile Mortality during the year 1909. Deaths from stated causes in weeks and months under one year of age 38 Table VI. Cases notified and deaths from the principal zymotic diseases for the year 1909 and preceding years 47 4 page B.— Sanitary Work— Inspections 48 Notires Served 48 Paving of Back Yards 48 Municipal Common Lodging House 48 Other Common Lodging Houses 49 Houses Let in Lodgings 49 Housing of the Working Classes Act 50 Factory and Workshop Act, 1901 50 Smoke Nuisances 52 Dairies and Cowsheds 52 Ice Cream Vendors 53 Meat and Food 53 Offensive Trades 54 Slaughterhouses 54 Sale ol Food and Drugs Acts (Prosecutions) 56 'l'able VIII. Health Visitors. Summary of work done during 1909 58 1 he work of the Health Visitors 58 Health Lectures 59 Table IX. Work done by the Sanitary Inspectors during the year 1909 60 Table X. Workshops on Register, number of Employees, and visits paid during the year 1909 61 Table XI. Food and Drugs Acts. Number of samples taken during the year 1909 62 Table XII. Food and Drugs Acts. Particulars of samples taken during 1909 and previous years 63 Table XIII. Meteorological Record— Year 1909 64 C.— Work of the Borough Hospital 65 D.— Work of the Borough Laboratory 70 E.— Public Elementary Schools 75 5 Gentlemen, I beg to present my Tenth Annual Report on the Health and Sanitary circumstances of the Borough, together with reports oj the Borough Hospital and Borough Laboratory. The report presented to the Education Committee is also presented herewith, so that the Council may have particulars of the whole of the work'undertaken by the Public Health Department. I am, Gentlemen, Your obedient Servant, H. MEREDITH RICHARDS, M.D. May 28th, 1910. 6 7 COUNTY BOROUGH OF CROYDON. Sanitary Committee 1908-9). The Mayor— Alderman Major J. F. Fox, J.P. Mr. Alderman Allen, J.P. ,, Sir F. T. Fdridge, J.P. King, J.P. „ Lillico, J.P. „ Price. Mr. Councillor Denning, J.P. Mr. Councillor Page. „ Wol.t(Vice-Chairman). „ Peck. „ Hussey. „ Shirley. „ Moss (Chairman). ,, Southwell. Mr. Councill Stewart. Staff of the Public health Department: Chief Sanitary Inspector and Inspector under Food & Drug Acts. P. Saunders (Cert. R. San. Institute). Thos. H. Culver (Cert. R.San. Institute), Deputy Chief and District Inspector. J. C. Earwicker ,, ,, District Inspector. A. D. Peck „ „ F. Richardson „ „ „ ,, William S. Adams ,, „ „ „ W. H. Stokes (Cert. R. San. Institute) „ ,, 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.R.S.I., Inspector under the Factory and Workshop Act and Shop Hours Act. A. Stanley, Disinfector. A. W. Pink S. T. Brown Clerks. F. H. Lennard A. C. Larcombe Miss Tawney Miss Chapman Miss Raw Health Visitors. Miss Stokes Miss Stevens Matron of Borough Isolation Hospital. Miss Bond. Senior Resident Medical Officer and Bacteriologis'. E. D. Parsons, M.R.C.S., D.P.H. (Lond). Assistant Medical Officer, Borough Hospital. R. W. Rees, M.R.C.S., L.R.C.P. Assistant to Medical Officer of Health. Sophie Jackson, M.D., B.S. (Durh.) Medical Officer of Health and School Medical Officer. H. Meredith Richards, M.D. (Lond.). 8 SUMMARY OF ANNUAL HEALTH REPORT FOR 1909. 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, 1909— 161,078. Estimated Inhabited Houses, June, 1909— 32,508. Rateable Value, £1,125,586. General District Rate, 3s. 6d. in the £. Poor Rate, including Education Rate, 3s. 6d. in the £. VITAL STATISTICS, 1909. Birth Rate, per 1,000 living, 24.4. Death Rate, per 1,000 living, 117. Infantile Mortality, per 1,000 births, 79. Isolation Hospitals— For fever at Waddon Marsh Lane. For smallpox at North Cheam. Water Supply— From the Thames, and from deep wells in the chalk. 9 County Borough of Croydon. REPORT of the MEDICAL OFFICER OF HEALTH. For the Year 1909. A.— VITAL STATISTICS. THE POPULATION at the Census of 1891 was 102,625, and had increased at the Census of 1901 to 133,895. The population at the middle of 1909 according to the estimate of the Registrar-General, was 161,078. The number of inhabited houses cannot be ascertained with accuracy. At the last Census, in April, 1901, it was 25,726, while 1,354 houses were empty at that date. From this date until June 30th, 1909, 9040 houses have been passed by the Borough Engineer as fit for occupation. 1 he total number of inhabitable houses has, therefore, been increased to that extent. It is, however, a matter of common knowledge that the number of vacant houses in Croydon was larger than at the time of the census, being about 10 per cent., as compared with about 5 per cent, in 1901, and 9 per cent, in 1908. Taking this into consideration it is probable that the number of inhabited houses in June, 1909, was about 32,508. If the population per house remains the same as in 1901, this will give a total population of 169,041, which is considerably in excess of the Registrar General's estimate. The Registrar General's figure has, however, been used as the basis of the rates calculated for this report. THE AREA of the Borough is 9,012 acres, and the density of the population 179 per acre. 10 The approximate acreage of the Wards is as follows :— Areas in Acres Wards. 1660 (Upper Norwood (sub-division). Thornton Heath do. 980 South Norwood. 998 West. 1181 North. 404 Central. 2209 East. 1580 South. 9012 THE BIRTHS during the year numbered 3,938. Of those born £,035 were boys and 1,903 were girls. The birth rate equalled 24'4 per i,ooo as compared with for England and Wales. Of the total births, 198, or 4^5 per cent., were illegitimate. The births were distributed as follows :— Total Birth rate per 1,000 estimated population. Central Ward 266 15.3 Upper Norwood Sub-Division *151 18.0 South Ward 371 18.0 East ,, 396 20.6 BOROUGH 3938 24.4 Thornton Heath Sub-Division 455 25.0 South Norwood Ward 654 27.0 North Ward 653 28.8 West „ 907 297 The Workhouse 85 *Including 23 births at 89, Central Hill (Servants' Reformatory). The birth-rate for 1909 was the lowest on record, and the number of births registered was actually less than in 1908 in spite of the increase in the population. DEATHS.— During the year, 1974 deaths were registered in the Borough, or 12.3 per 1000. One hundred and seven of the deaths registered in the Borough were those of strangers dying at the Workhouse or Infirmary, 28 of strangers dying at the Croydon General Hospital, 2 at the Cottage Hospital, Purley, 19 at the Cottage Hospital, Upper Norwood, 1 at "Victoria House," 89, Central Hill (Servants' Reformatory), while 8 deaths at the Borough Hospital occurred among patients admitted from Penge, Kingston, and Kennington. Five of the deaths of strangers at the Borough Hospital were due to scarlet fever, two to diphtheria, and one to marasmus. 11 If we deduct these 165 deaths and add 29 deaths at the Mental Hospital, Warlingham, and 41 deaths of Croydon residents known to have occurred outside the district during the same period, we get a nett total of 1879 deaths, which is equal to 117 per 1,000, as compared with 14.5 for England and Wales, 15.6 for the 76 great towns, i4.5 for the 143 smaller towns, 13.6 for England and Wales less the 219 towns. 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, Purley, and Cottage Hospital, Upper Norwood, have been deducted. Formerly, these were included in the total number of deaths on the supposition that they were balanced by Croydon deaths in London institutions. The nett death.rates for the four quarters of the year were 1909. Average for 1899.1908. 1st Quarter 17.4 15.8 2nd Quarter 11.0 11.9 3rd Quarter 8.6 12.3 4th Quarter 9.4 13.2 Year 117 13.3 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 orior to admission to hospital. The Ward deaths for the year were as follows:— Deaths. Death-rate per 1000. South Ward 198 9.6 East Ward 189 9.9 Thornton Heath Sub.Division 184 10.1 Upper Norwood Sub.Division 87 10.4 South Norwood Ward 267 11.0 North Ward 259 11.4 BOROUGH 1879 11.6 Central 11. 12.1 West Ward 462 15.1 12 The Registrar General has not yet published his Annual Summary for 1909. I am therefore unable to say what exact position will be assigned to Croydon on comparing the death-rate with those 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 8.3; Walthamstow, 9.6; East Ham, 9.9; King's Norton, 9.9; Leyton, 10.3; and Willesden, 10.4. INFANTILE MORTALITY is measured by the proportion of deaths under one year to 1,000 births, and amounted to 79 as compared with 99 in 1908, 94 in 1907, 125 in 1906, 96 in 1905, and 128 in 1904. During the year 1909 the rate for England and Wales was 109, while in the 76 large towns it ranged from 61 in Hornsey, 72 in King's Norton, 82 in Leyton to 150 in Nottingham, 156 in Burnley to 159 in Swansea. The figures for the various Wards were :— Births. Deaths under 1 year. Death-rate per 1000 Births (all causes) Death-rate per 1000 births from "diarrhoeal" diseases. †Upper Norwood Subdivision 151 8 53 6 South Norwood Ward 654 39 59 5 South Ward 371 27 73 3 North Ward 653 50 77 4 BOROUGH 3938 313 79 7 East Ward 396 33 83 5 Thornton Heath Subdivision 455 40 88 7 Central Ward 266 24 90 11 West Ward 907 92 101 13 †Including 23 births at "89, Central Hill " (Servants Reformatory). The following table shows the fluctuations since 1892 in the infantile mortality from "all causes," from "diarrhœal diseases*," and from "causes other than diarrhœal." Years. Total Infantile Mortality from all causes. Infantile Mortality from "diarrhoeal" diseases. Infantile Mortality from other than 'diarrhoeal" diseases. 1893— 1897 142 25 117 1898— 1902 143 38 105 1903 104 9 95 1904 128 29 99 1905 96 14 82 1906 125 42 83 1907 94 10 84 1908 99 12 87 1909 79 7 72 *Under "diarrhoeal" disease; 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 It is satisfactory to record that the infantile mortality rate is not only considerably lower than in 1908 but is the lowest ever noted in Croydon. It is also satisfactory to find that there was a similar drop in the rate for England and Wales. Part of this improvement is doubtless due to the climatic conditions which were exceedingly favourable for infant life. There can also be little doubt that more care and more intelligence are now employed in the nurture of infants and that this is having its effect on the mortality rate. DIARRHOEA AND EPIDEMIC ENTERITIS. During 1909 diarrhoea and epidemic enteritis accounted for 19 deaths, of which 13 occurred in children under one year of age. There were also 26 deaths from other forms of enteritis, of which 15 were under one year of age. Thus 2S out of the 45 deaths from what are usually classified as "diarrhœal" deaths occurred in infants under one year of age.* It will be seen from Table VI. that " diarrhoeal " deaths were considerably less numerous than in 1908, and this was one factor that led to the diminished infantile mortality rate. The accompanying chart shews the seasonal distribution of the 28 diarrhceal deaths under one year of age. Though the majority of the deaths occurred in the third quarter, this seasonal distribution is by no means marked, and offers a striking comparison to the chart for 1906, which was the last year in which there was a considerable prevalence of fatal diarrhoea. There can be no doubt that the great difference between 1906 and 1909 must be ascribed to climatic conditions, and especially to the cold wet weather experienced in June and July. On the other hand it is clear that seasonal changes are not directly responsible for diarrhoea mortality, otherwise the short spell of hot weather experienced in the first half of August would have been followed by fatal diarrhoea. As far as they go the facts observed in 1909 lend some support to the suggestion that fatal diarrhoea is, to a considerable extent, diffused by the domestic fly, which in the year under review suffered severely from the absence of sufficient warmth to allow rapid increase in numbers. Whatever may be the exact route by which diarrhoea infection finds its way into the alimentary canals of infants, there is ample evidence that diarrhoea mortality falls especially heavily on those who are brought up by hand. This is clearly shewn in the following tables which have been prepared from information obtained by the health visitors on their visits to houses where children have been born. * Deaths from Gastritis are sometimes classified as "diarrhoeal." If this were done, a further addition of 6 deaths under one year must be made to the total "diarrhœal" deaths. It has not however been the practice to include these in former years, and for the sake of comparison the figures have been prepared as in past years. 14 The following are the particulars as to feeding of infants dying during the first six months of life:— METHOD OF FEEDING. Method of Feeding during the first six months of life of children who survived, and of children who died between one week and six months old. Deaths of infants under one week have been excluded because it is unlikely that methods of feeding can have been responsible for a fatal issue in so short a time, TABLE A. Infants dying from Diarrhccal Diseases. 0-6 months. Infants dying from other than Diarrhocal Diseases. 0-6 months. Infants surviving 6 months. Total investigated. Breast alone 3 50 1129 1182 Breast supplemented by Cow's milk or other foods 4 7 457 468 Condensed Milk 7 9 92 108 Other prepared foods 2 2 46 50 Cow's Milk 5 21 145 171 Number investigated 21 89 1869 1979 Method of Feeding expressed in percentage. TABLE B. All infants investigated under 6 months. Infants dying from Diarrhœal Diseases. Infants dying from other than Diarrhœal Diseases. Breast alone 60 14 56 Breast supplemented by Cow's milk or other foods 23 19 8 Condensed Milk 5 33 10 Other prepared foods 3 10 2 Cow's Milk 9 24 24 15 The relation between diarrhœa and hand feeding is clearly shewn by Table B. Whereas 60 per cent, of all the infants investigated who survived were entirely breast fed until six months old, only 14 per cent, of those dying from diarrhoea were naturally fed. The reasons for the preponderance of diarrhœal diseases in hand fed infants has already been discussed in several previous reports. DEATH CERTIFICATION. All deaths in the Borough were certified by the Medical Attendant or by the Coroner. INQUESTS were held in 163 instances, or 8 6 per cent, of the total deaths. THE ASSIGNED CAUSES OF DEATH are fully set out in Tables IV., V. and VI., but certain of them require special comment. SMALLPOX. Smallpox has been absent from the Borough since April, 1906. CROYDON AND WIMBLEDON JOINT SMALLPOX HOSPITAL. The Smallpox Hospital District comprises the County Borough of Croydon, the Borough of Wimbledon, the Urban Districts of Penge and of Merton, and the Croydon Rural District. The Hospital has not been used for smallpox since August, 1906. During the year 1909 an infant was admitted which had been notified as suffering from smallpox. The disease was subsequently found to be chickenpox, and the child was sent home in a day or so. VACCINATION. During the year ending December 31st, 1909, the number of primary vaccinations in Croydon and Penge amounted to 2,694, as compared with 4,315 registered births. 15 The number of infants vaccinated, therefore, amounted to 62 per cent, of the registered births as compared with 62 per cent, in 1908, 90 per cent, in 1907, and 82 per cent, in 1906. The increase in the proportion of unvaccinated infants is doubtless due to the increased facilities offered to conscientious objectors by the last amendment of the Vaccination Acts. MEASLES. Measles accounted for 21 deaths. As was to have been expected, this number is considerably less than that recorded in 1908, when this disease was extremely prevalent. Though measles is not notifiable in the borough, the relative number of children attacked can be judged from the notifications received from the elementary schools. The following are the figures for 1909 and the preceding five years:— Year. Cases reported to Elementary Schools. Deaths. 1904 1,335 62 I905 1,267 24 1906 595 37 1907 363 8 1908 2,335 92 1909 364 21 The number of deaths was unusually large in proportion to the cases coming under notice, but this is in part accounted for by the fact that the disease was prevalent in the last quarter of 1908 and the first quarter of 1909. It is probable, therefore, that during the intervention of the Christmas holidays many children were suffering from the disease who were not reported to the Health Department. The prevalence of measles was mainly confined to the first quarter, when 15 deaths were notified, as compared with three deaths in the second quarter, three in the third quarter, and no deaths in the fourth quarter of the year. Nineteen out of the twenty-one deaths occurred in small houses. This is approximately the same proportion as was recorded in 1908. 17 SCARLET FEVER. (See Tables III., IV. and VI.) Seven hundred and twenty-seven cases were notified, of which g ended fatally. The disease was more prevalent than in any of the preceding ten years. The increase in numbers is noticed in each of the wards, but the incidence in the South Norwood district was again exceptionally high. This is the third year in succession in which this ward has been singularly unfortunate. On Monday, June 21st, 1909, my attention was attracted by a considerable and sudden increase in the number of notified cases reported during the week end. Concerning this particular group of patients, no community of school or workplace gave any clue to the origin of the disease, and it at once became, evident that some article of food was in all probability responsible for the simultaneous attack of some of the patients. Enquiry as to the milk supply was immediately made of the adult patients admitted into hospital during the last two days, when it was found that several had obtained their milk from a dairyman who bought the supply from a wholesale company. Finally, we were able to ascertain that 28 cases occurred among customers indirectly supplied by the same wholesale firm. As the wholesale dairy obtained its supply from various farms situated in many parts of Hampshire, Wiltshire and Somersetshire, we should have had considerable difficulty in investigating the possible source of infection, but on communication with neighbouring districts it was found that there was a considerable epidemic of scarlet fever in Kingston and in London among the customers of retailers who derived their milk from the dairy company in question. All the information available pointed to infection being conveyed by milk from a particular farm in Hampshire from which Croydon was supplied on the 14th and 15th June. Fortunately, the infected milk only reached Croydon in any considerable quantity on those two days, but had a little previously given rise to trouble in London and Surrey. The London County Council had therefore become cognisant of the danger a day or two before the Croydon outbreak, and had taken steps to stop the supply of milk from the incriminated source, and, thanks to the information supplied by Sir Shirley Murphy and Dr. Hamer, I was able to assure myself by noon on June 21st that further danger from this source was at an end. The whole circumstances were fully investigated by Dr. Hamer on behalf of the London County Council, who was assisted by a veterinary surgeon and a bacteriologist. They were able to show not only that the infected milk was derived from a particular farm, but that there had been a contagious disease 0/ the dairy herd that corresponded in 18 time to the period when the milk was infectious. The source of infection of the cows could not be ascertained. Many of the patients who were infected were admitted to the Borough Hospital, and one therefore had an opportunity of studying the nature of the malady. Briefly, it may be stated that the symptoms were indistinguishable from those of ordinary attacks of scarlet fever. It was, however, noted that there was not that disposition to spread from person to person in the infected houses that one usually observes with scarlet fever of human origin. Thus, of the 28 cases in Croydon eight occurred in four houses. Of these eight it would-seem probable that the infection was due to a common origin, having regard to the dates of onset—(house A, onset June 17th and 18th; house B, onset June 17th and 17th; house C, onset June 16th and 17th; house D, onset June 17th and 18th). Apart from these duplicate cases there were no multiple attacks, and this is all the more striking because there was a considerable number of young persons living in the invaded houses who had not previously suffered from the disease. The exact figures were as follows :— Number of invaded houses 24 Number of scarlet fever patients 28 Total inhabitants of infected houses (exclusive of the 28 patients) 100 Of the total inhabitants (exclusive of the 28 patients), 17 are stated to have previously had scarlet fever, 73 are stated not to have had scarlet fever, and concerning the remaining 10 information could not be obtained. The ages of the persons living in infected houses who did not develop scarlet fever were as follows :— 0—5. 5—10. 10—15. 15—20. 20 & upwards. 11 10 8 6 65 (One of whom (16 of whom are 19 said to have stated to have been previously been previously attacked). attacked). The incidence of scarlet fever varies with the social status of the district, and it is doubtless due in part to the considerable increase of the proportion of smaller tenements that we must ascribe the increased incidence of the disease during the last few years. In order to test this theory, I have investigated the proportion of fatal and non-fatal attacks occurring in various sized houses in the borough during the last four years. 19 The following are the figures :— PARTICULARS AS TO SCARLET FEVER NOTIFICATIONS AND DEATHS Year. Total notifications in small and large tenements (small tenements = 5 rooms and under). Total tenements infected Total deaths. Remarks. Small tenements 516 408 with 1 case 326 9 9 These figures are compiled from notifications, and have not been corrected for errors in diagnosis. „ 2 „ 63 „ 3 ,, 13 „ 4 ,, 5 „ 5 „ 1 141 with 1 case 111 1909 727 Large tenements 187 „ 2 „ 20 „ 3 „ 7 „ 4 „ 1 „ 5 „ 1 * Public Institutions 24 „ 6 „ 1 1908 534 with 1 case 234 . „ 2 „ 43 Small „ 3 ,, 14 tenements 403 300 ,, 4 „ 7 5 ,, 5 „ — ,, 6 ,, 1 „ 7 „ †1 5 with 1 case 71 „ 2 „ 7 Large „ 3 „ 3 tenements 119 86 „ 4 „ †2 „ 5 ,, 1 „ 6 „ †2 'Public Institutions 12 1907 661 Small tenements 576 437 with 1 case 344 8 11 „ 2 „ 61 „ 3 „ 22 „ 4 „ †7 „ 5 „ †2 „ 6 „ †l with 1 case 50 Large tenements 76 61 „ 2 „ 8 3 „ 3 „ 2 „ 4 „ 1 „ 5„ - 6 ,, — * Public Institutions 9 1906 425 Small tenements 321 250 with 1 case 193 8 8 „ 2 „ 47 „ 3 ,, 6 Large tenements 100 „ 4 „ 4 74 with 1 case 58 „ 2 ,, 8 „ 3 ,, 6 „ 4 „ 2 †Public Institutions 4 * Institution notifications are those infected in Public Institutions or, imported case to Public Institutions where the home conditions could not be ascertained, 20 SUMMARY OF THE PARTICULARS AS TO SCARLET FEVER NOTIFICATIONS AND DEATHS. Total notifications in small and large tenements (small tenements = 5 rooms and under.) Total tenements infected. Total deaths. Remarks. 4 Years. 1906 to 1909 2347 Small tenements 1816 1395 with 1 case 1097 30 33 „ 2 „ 214 ,, 3 ,, 55 ,, 4 ,, 23 ., 5 ,, 3 „ 6 „ 2 7 „ 1 Large tenements 482 362 with 1 case 290 3 2 ,, 43 „ 3 „ 18 „ 4 „ 6 ,, 5 „ 2 „ 6 „ 3 ‡ Public Institutions 49 J Institution notifications are those infected in Public Institutions, or imported cases to Public Institutions where the home condition could not be ascertained. It will be noticed that in three out of the four years there was not a single death from scarlet fever in any of the larger houses, while the total figures for the four years show a case fatality of only 0.6 among the children living in larger houses, as compared with a case fatality of 17 among those living in smaller tenements. This is in part to be explained by the more favourable conditions under which children live in the larger tenements, and to the fact that those living in smaller houses are more frequently exposed to infection, and are, therefore, liable to attack at an earlier age, when this disease is more likely to prove fatal. Again, while 1,816 cases were notified in small tenements, only 482 were notified in large tenements. As it is estimated that the number of children living in large tenements is in the proportion of one for every 2½ living in small tenements, it is obvious that the risk of a child living in a small tenement of contracting scarlet fever is half as large again as it is in the case of the more affluent. 21 RETURN CASES OF SCARLET FEVER. In 1909 the number of patients discharged from isolation who subsequently proved infectious was exceptionally large. In no less than 39 instances secondary cases, to the number of 52 in all, arose in homes to which patients had been discharged from hospital. During 1908 some anxiety was felt as to whether the excessive number of return cases might not be due in part to the pressure under which the hospital was working. This pressure was continued in 1909, and I was therefore glad of an opportunity of testing this suggestion. During the last year the hospital became so full that on two occasions it was necessary to transfer patients to other institutions. Six patients were therefore sent to the Mary Wardell Convalescent Home, Stanmore, and 26 patients were admitted to the London Fever Hospital, while during the same period 533 patients were admitted to our own hospital. Of the patients suspected to be chronically infectious one was discharged from the Mary Wardell Convalescent Home, two from the London Fever Hospital, and 36 from the Borough Hospital. The proportion of chronically infectious patients leaving the Borough Hospital was therefore not larger than that found in Croydon patients discharged from other institutions. 22 The particulars of each of the 39 suspected patients are given in the following table:— discharged patient, Notes as to any abnormality on Discharge. 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. 795. 6 M 2/1/09 46 50 Cervical glands enlarged. 11/1/09 (29) 9 days 11/1/09 (30) 9 „ 739 14 F 21/1/09 87 89 Post nasal catarrh Tonsils enlarged. Soft palate red. Occasional nasal discharge. Glands palpable. 26/1/09 (78) 5 „ 718 51 M 21 1/09 95 98 Tonsils enlarged. Post-nasal catarrh 5/2/09 (107) 15 „ 874 6 M 2/2/09 52 53 Glands palpable. 5/2/09 (111) 3„ 860 7 F 21/1/09 43 45 Glands palpable. Feet rough. 22/2/09 (163) 32 880 9 M 6/2/09 53 56 Tonsils much enlarged. Glands palpable. 2/3/09 (179) 24 „ 84 9½ M 11/3/09 41 43 Tonsils enlarged. Glands palpable. 17/3/09 (204) 18/3/09 (207) 6 „ 7 „ 50 4¼ F 4 /3/09. 47 48 Tonsils enlarged. 26/3/09 (227) 22 933 4 F 11/3/09 71 72 Tonsils enlarged Glands enlarged. 30/3/09 (238) 19 „ 85 21 M 18/3,09 48 51 Post-nasal catarrh. , Compound fracture of leg, wound discharging when patient left hospital. 28/3/09 (239) 10 „ 15/4/09 (269) 28 „ 123 10 M 20/3/09 38 41 Nil. (This patient was discharged and returned as a Diphtheria case, and admitted to Diphtheria-Scarlet Fever Ward on February loth). 28/3/09 (244) 8 „ 871 5 M 23/3/09 101 105 Nose slightly sore. Intermittent otorrhoea. 31/3/09 (246) 8 „ 58 12 F 9/3/09 48 49 Fauces granular. Tonsils enlarged. 2/4/09 (247) 24 „ 138 5 M 23/3/09 99 100 Glands palpable. 8/4/09 2621 16 „ 137 8 ll-12ths F 1/4/09 46 49 Tonsils enlarged. Glands + on one side. 16/4/09 (271) 15 „ 170 4½ M 22/5/09 84 86 Glands palpable. 14/6/09 (414) 23 „ 16/6/09 (415) 25 „ 318 5 F 19/6/09 43 45 Tonsils much enlarged (removal recommended, but leave for operation refused). 29/6/09 (468) 10 „ 287 9 F 10/6/09 43 45 Nil. 24/6 09 (—) 14 „ 223 7 7-12ths m 17/7/09 115 137 Cervical glands enlarged. 27/7/09 (534) 10 „ 28/7/09 (546) 11 „ 28/7/09 (547) 11 ,, 404 9 F 24/7/09 42 44 Glands palpable. 5/8,09 (564) 12 „ *513 4 m 1/9/09 48 49 Nil. This patient was discharged from the Mary Wardell Convalescent Home, Stanmore) 14/9/09 (640 13 „ 563 6 m 18/9/09 41 43 Nil 1/10/09 (670a 13 ,, 2/10/09 (671A) H „ 572 9 M 28 9/09 44 40 Fauces granula r. 11/10/09 (717) 13 „ 380 8 F 31/8/09 80 89 Glands palpab e. 22/9/09 (—) 22 „ 539 11¾ F 28/9/09 65 07 Glands palpable. Trace of albumen in urine 24/10/09 (752) 26 „ 484 7 M 12/10/09 100 101 Slight nasal discharge. Tonsils enlarged. 28/10/09 (755) 16 „ 502 11 F 12/10/09 65 66 Feet rough. 28/10/09 (758) 16 „ 3/11/09 1778) 22 „ 616 8 M 4 11 /09 58 59 Tonstls enlarged. 15/11/09 (809) 11 ,, 656 7 M 2/11/09 42 44 Tonsils enlarged. 20/11,09 (8151 18 „ 470 12 F 28/9/09 89 91 Tonsils enlarged. 14/11/09 (820) 47 „ 22/11/09 (8211 55 ,, 687 5 F 16/11/09 46 49 Glands palpable. 23/11/09 (824) 7 „ 669 13 M 10/11/09 52 55 Tonsils enlarged. Heels desquamating. 26/11/09 (834 15/12/09 (883 10 „ 29 „ 621 6¾ F 11/11/09 64 06 Nil. 30/11/09 (852) 19 „ 600 7 M 27/11/09 92 92 Nil. 5/12/09 (8471 8 „ 11/12,09 (872) 14 „ 11/12/09 (873) 14 „ 673a 6½ F 13/11/09 42 43 Tonsils enlarged. 16/12/09 (887) 33 ,, †732 17 M 2/12/09 44 46 Nil. (This patient was discharged from London Fever Hospital). 16/12/09 (890) 14 „ 667 10 M 25/11/09 55 57 Nil. 17/12/09 (894) 22 „ 67C 5 M 7/12/09 73 78 Tonsils enlarged. Glands palpable. 23/12/09 (909) 16 „ †762 6 M 18/12/09 48 52 Nil. (This patient was discharged from London Fever Hospitall. 7/2/10 (79) 51 „ 7/2/10 (801 51 „ * This patient was discharged from the Mary W'ardell Convalescent Home, Stanmore. † This patient was discharged from the London Fever Hospital. The remaining patients were discharged from the Borough ["ever Hospital. — Return case isolated at home. 23 It will be observed that the interval between the discharge of the patient and the onset of the return case varied from three days to 51 days and in 21 instances was more than 14 days. Similar instances of chronic infectivity are also met with in families where children are nursed at home The following are the particulars of an outbreak in a family of seven children. One child failed on November 23rd and another on November 28th. These children were about to be released from quarantine when two other children were attacked on January 4th. All four patients had recovered and the house was disinfected on February 10th. The family thereupon removed to another house, when in the course of a day or two, namely, February 15th, a fifth child failed with scarlet fever, and was in this case removed to the Borough Hospital. It is noteworthy that four out of the five children attacked in this family were suffering from enlarged tonsils or adenoids. EPIDEMIC INFLUENZA was the assigned cause of death in 59 instances, as compared with 52 in 1908. WHOOPING COUGH accounted for 30 deaths, all of which occurred in children under five years of age. The number of deaths is slightly larger than in 1908, when 29 were registered. The number of cases is unknown, but was in all probability larger than in the previous year, as 654 school notices were issued in reference to this disease as compared with 458 in 1908. DIPHTHERIA AND MEMBRANOUS CROUP The number of cases notified amounted to 356, as compared with 405 in 1908, while 24 cases terminated fatally, as compared with 37 deaths in 1908. * Not including a fatal case admitted to General Hospital from Mitcham and thence transferred to the Borough Hospital. The quarterly incidence of cases and deaths in 1909 and previous years is shown in the following table :— Diphtheria. 1904. 1905. Year. 1906. 1907. 1908. 1909 Notified Cases— 1st quarter 50 101 52 93* 101 124. 2nd 35 42 42 49 89 75 3rd 98 44 54 59 92 73 4th 126 80 148 84 123 79 Registered deaths— 1 st quarter 5 12 13 21* 11 13 2nd ,, 5 2 5 3 7 14 3rd 6 2 9 5 7 4 4th 9 7 13 1 12 3 24 It will be seen that there was marked improvement, both in the number of attacks and in the number of deaths from diphtheria during the year. We were particularly fortunate in escaping the usual autumnal rise, which is normally a marked feature in the diphtheria returns. RELATION OF DIPHTHERIA TO DRAINAGE DEFECTS. 356 notified cases occurred in 261 houses. In two instances the drains were not examined. The following is the result of the examination of the drains of the remaining 259 houses:— Number of houses where no defects were found:— 178, or 687 per cent. Number of houses where serious defects were found:— 22, or 8.5 per cent. Number of houses where slight defects were found :—59, or 22.8 per cent. The proportion of houses infected with diphtheria that were found to have serious defects in their drains was 8.5, a figure which is almost identical with that found in 1908, namely, 87. This figure confirms the view previously expressed that drainage defects are not an important factor in the causation of diphtheria. RETURN CASES OF DIPHTHERIA. In four instances diphtheria occurred in houses to which patients had returned from hospital. In each instance steps were taken to test the condition of the discharged patient. In two instances there was no evidence that the discharged patient remained infectious. The following are the facts relating to the other two outbreaks :— Case I.—Sidney R., 6 years, admitted to Borough Hospital with diphtheria 8-12-08, and discharged 19-2-09. A brother, Leslie, aged 3, was away from home from 19-2-09 (before Sidney's return home) till 7-3-09. Leslie failed with diphtheria 20-3-09, and on investigation Sidney was found to have nasal discharge. Swab of his nose taken 22-3-09 proved positive. Further swabs taken weekly proved positive, and on 29-4-09 he was re-admitted to the Borough Hospital. 25 Case II.— Rose H., 9 years, admitted with diphtheria 25-4-09, and discharged 25-6-09. Lily H., 9 years, failed 6-7-09, was admitted to Borough Hospital 8-7-09, but swab taken of Rose on 9-7-09 was negative. Lily H. was discharged on 20-8-09, and Violet, 8 years, failed with diphtheria 22-8-09. Swabs taken of the whole family on 26-8-09 sho ved that Lily was free from infection, but the nose swab of Rose and the throat swab of her father were positive. The father was found negative at the end of fourteen days, and Rose and all other school contacts were finally freed for school on 4-9-09. In case I. it was suspected that the diphtheria germs were lurking at the back of the nose on the child leaving the hospital, and were not capable of detection or producing ill results until the subsequent development of nasal discharge. In the second case it would seem not improbable that the father's throat was persistently infectious. NECESSITY FOR PROMPTNESS IN DEALING WITH DIPHTHERIA. In my last Annual Report I called attention to the fact that many patients die from diphtheria because they do not come under treatment sufficiently early in the course of the disease. The following are the approximate times at which patients came under treatment during 1909:— Day of Disease. Patients. Deaths. Mortality, per cent. 1 11 - - 2 86 3 3.5 3 82 7 8.5 4 34 7 20.6 5 17 4 23.5 6 7 1 14.2 7 8 1 12.5 8 & upwards 16 1 6.2 It is noteworthy that none of the cases admitted on the first day died, and that the mortality of those admitted on the second day of the disease is small, while there is a considerable rise on the third day and a still larger on the fourth and fifth days. It is satisfactory to find that a larger proportion of diphtheria patients came under treatment within the first three days of the disease, and it is probable that this helped to diminish the fatality 26 of the hospital cases. The question is so important that it is necessary to again record the fact that almost every case of diphtheria could be saved if anti-toxin treatment were begun sufficiently early. Every patient who is suspected to be suffering from diphtheria should be given anti-toxin without delay and without waiting for bacteriological confirmation of the diagnosis. Since 1907 the following notice has been issued to medical men, but so far comparatively few have availed themselves of the offer:— "EARLY TREATMENT OF DIPHTHERIA." "As success in treatment is dependent on antitoxin being administered at the onset of the disease, patients who present clinical symptoms of diphtheria should be sent to the Borough Hospital or receive antitoxin at home, without waiting the result of the bacteriological examination." "Antitoxin may be obtained at the Public Health Department, Town Hall, during office hours, and at the Borough Hospital at other times. The price is 2s. 6d. per 2,000 units, but preliminary doses for patients who will be admitted to hospital if the diagnosis is confirmed, may be obtained free of cost if special application be made to the Public Health Department or to the Borough Hospital, Waddon Marsh Lane, Croydon." ENTERIC FEVER. Twenty-one cases were notified, and three deaths from this disease were registered during the year. Eleven cases were removed to hospital, and of these three were subsequently found to be suffering from some other complaint, viz.:— One from enteritis, one from pleurisy with effusion, and one from ulcerative colitis. There were thus iS cases of supposed enteric fever which required investigation. Of these four were due to personal infection from a preceding case in the same house. In the remaining fourteen cases no source of infection could be discovered, but in three instances the blood reaction was negative, and there is considerable doubt as to the correctness of the diagnosis. One of the patients was a nurse at the Croydon Infirmary, the source of whose infection was not definitely traced. Possibly she was infected from a. chronic "carrier" among one of the patients. Another of the notified patients was a missed case which had been admitted to the General Hospital for pneumonia, and the nature of the illness was only discovered through attention being directed by the investigations of the Health Department into the illness of a relative who was notified as suffering from enteric. 27 As epidemics of enteric fever are commonly traceable to infected water, and as Croydon has two distinct sources of water supply, I have once more compared the incidences of the disease in the parts of the Borough supplied by Croydon and by Lambeth (Metropolitan Water Board) water. As the numbers for one year are small, the particulars have been taken out for the ten years, 1900-1909 inclusive. PARTICULARS OF ENTERIC FEVER CASES. 1900 TO 1909 INCLUSIVE. Coses Notified.—396 (including 14 cases of Continued Fever). Removed to Borough Hospital.— 230 cases (including four cases of Continued Fever). On removal to the Borough Hospital rifty-two (52) were found to be suffering from other diseases. Water Supply oj the Cases Notified CROYDON 272 LAMBETH 119 Cases brought to Public Institutions in the Borough from outside Districts 5 Total 390 Concerning the Notified Cases, the following facts were ascertained :— Suffering from other diseases, and not enteric fever 52 Doubtful diagnosis 1 Home case, diagnosis subsequently amended 2 Infected outside the Borough 50 Possibly infected by shellfish, watercress &c 45 Infected from other cases 54 ,, while unstopping of drains J ,, by overflow of sewer 1 206 Source of illness not traced 190 Total 396 28 Of the 190 cases, the source of which was not traced, and which, therefore, might have been water-borne infection, 136 live within the area of the "Croydon" supply, and 54 in the " Lambeth " area. The enteric fever incidence in the two areas was, therefore, 11 per 10,000 in the "Croydon" area, and 14 per 10,000 in the " Lambeth " area for the nine years. The numbers for both water supplies are small, and conclusively disprove the suggestion that there has been any water-borne epidemic in Croydon during recent years. When the ligures for 1909 are examined separately it is found that of the 14 cases, for which no definite cause could be assigned, all were in the Croydon area. When the numbers of cases of enteric fever are so small as they were in Croydon in 1909, the question of a water epidemic does not arise, but knowing what we do of the potential dangers of water infection, it is still essential that the efforts made by the Water Committee to further safeguard the public supplies should be in no way relaxed. Investigation was also made into the sanitary condition of all premises in which cases of enteric fever occurred, which could not be traced to infection outside the borough. As the numbers for 1909 are small, particulars have been extracted for the five years 1905—1909. ENTERIC FEVER. (Deducting wrong diagnosis and definitely imported cases). Year. Houses Infected. Houses Tested. Serious defects, i.e. bad stoppages, and drains requiring to be re-laid. Slight defects, i.e. defective joints of ventilation pipes, &c. Remarks. 1905 16 16 2 1 1906 27 27 4 6 1907 12 12 — 2 1908 31 30 5 6 The Convent at Upper Norwood was not tested. 1909 18 17 2 5 Croydon Union Infirmary not tested. 104 102 13 23 29 PUERPERAL FEVER was notified on 16 occasions, in 11 of which a doctor was present at the confinement. Puerperal fever occurred twice in cases attended by midwives who were suspended from practice for three and 14 days respectively until their clothing and outfits were cleansed and disinfected. Five cases ended fatally. ERYSIPELAS was notified on 92 occasions, and three cases ended fatally. TUBERCULOSIS of all forms was the assigned cause of death in 205 instances, or 1.3 per 1,000 persons living, while phthisis alone was responsible for 152 deaths or .94 per 1,000. It will be seen from Table VI. that there is a slight decline in the mortality from phthisis. Voluntary notification has been in force since the last quarter of 1903, and since January 1st, 1909, all cases treated by Poor Law Medical Officers have been compulsorily notifiable. The number of cases notified in each year was as follows:— Year. Cases Notified. 1903 (part of) 57 1904 129 1905 75 1906 96 1907 83 1908 106 1909 139 Of the 139 cases notified in 1909 fifty-six were notified by the Medical Officers of the Croydon Union Infirmary, and 26 by the local district medical officers. I cannot but think that the notifications received from the latter are incomplete. TUBERCULOSIS AND MILK. Pending fresh legislation, no samples were taken under the Model Milk Clauses during the year. 30 MIDWIVES ACT, 1902. An inspection of the midwives was carried out by Dr. Jackson on two occasions. During the year information was obtained as to the proportion of births attended by medical men, by registered midwives and by unregistered women. The total number of births investigated was 4,022. The results may be summarised as follows :— Number attended by medical men 2404 Number attended by registered midwives (including cases in which medical man was called in for some emergency) 642 Number attended by unregistered women 608 Removals, insufficient address, etc. 368 Total 4022 In the case of the births attended by unregistered women the names and addresses of the persons attending at the confinement were ascertained. In a large number of instances "a friend or "neighbour" assisted, but it was evident that a considerable number of women were carrying on the business of midwifery nurses, though their names were not on the register. Thus :— 1 woman attended 58 cases 1 „ „ 41 „ 1 „ „ 36 „ 1 „ 31 „ 1 „ „ 27 „ 1„ 25 „ 1 „„ 16 „ 1 „„ 14 „ 1 „ 13 „ 1 „ „ 12 „ 1 „ 10 „ 1 „ 8 „ 2 women each attended 17„ 2 „ „ 15 „ 2 „ „ 9 „ 2 „ „ 7 „ 3 „ 6 „ 4 „ 5 „ 7 „ 4 „ 6 „ 3 „ 16 ,, „ 2 „ 82 „ „ 1 „ 31 The practice for gain by these unqualified women became illegal in April, 1910. During the year one registered midwife withdrew from practice, four removed, and six new names were added, leaving 30 on the register on December 31st, 1909. All the midwives' homes, except one outside the Borough, were visited by Dr. Jackson since the last report, and the registers and bags of appliances inspected. Four midwives were cautioned. NOTIFICATION OF BIRTHS ACT, 1907. This Act was adopted by the Council on January 13th, and came into force on February 19th, 1908, after confirmation by the Local Government Board. During the year 3,403 notifications Were received. These births were notified as follows :— Notified by medical men 798 Notified by parents 1487 Notified by certified midwives 671 Notified by uncertified midwifery nurses 447 3,403 The number of births which actually occurred in the borough during the year was3,938. Thenumber ofbirths notified byparents, medical men and midwives therefore amounted to 86 per cent, of the total. The percentage of notified births is considerably larger than in 1908, and there is now a reasonable compliance with the requirements of the Act. After two years' experience of the Notification of Births Act, I am strongly of opinion that it should be repealed, and early registration (say within seven days) substituted. No application under Section 26, 53 and 54 Vict., c. 8, was received dur'ng the year. 32 DISINFECTION. During the year 1,255 houses and 9,774 articles were disinfected. The articles disinfected were as follows:— 659 Beds; 594 Mattresses; 1,698 Blankets; 315 Sheets; 1,491 Pillows; 557 Bolsters; 72 Palliasses; 282 Cushions; 25 Carpets; 4,081 Other Articles. Total, 9.774. The much needed provision of a new disinfecting station is still in abeyance. Plans have been prepared for new premises in Factory Lane, as the proposed alterations in the main sewers will necessitate the demolition of the existing building. These plans include the provision of a limited number of baths, which are required not only for the purposes mentioned in my report to the Education Committee, but for the cleansing of verminous adults and for the complete disinfection of tramps and others who have been exposed to smallpox. 33 TABLE I. For whole District, for Calendar Year 1909. 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-rcsi dents registered ir District. Deaths of Resident registered beyond District. Deaths at all Ages. Nett. d. Number. Rate* Number. Kate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 a 3 4 b 5 6 7 8 c 9 d 10 e 11 12 13 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 £3 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 1905. 147,704 3894 26.4 372 96 1941 13.1 541 142 83 1S82 12.7 1906. 151,011 3886 25.7 485 125 2085 13.8 629 160 94 2019 13.4 1907. 154,342 3967 25.7 371 94 1953 12.5 611 149 97 1901 12.3 1908. 157,698 4017 25.5 398 99 2053 13.0 608 137 105 2021 12.8 Averages for years 1899—1008 142,785 3688 25.8 440 121 1961 13.8 510 118 54 1896 13.3 1909. 161,078 3938 24.4 313 79 1974 12.3 572 165 70 1879 11.7 * Rates calculated per 1,000 of estimated population. a These are total births (uncorrected for Institutions). b These are corrected for Institutions. c Includes all deaths of residents and non-residents in Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, 89, Central Hill (Servants' Reformatory), and Norwood Cottage Hospital. d Deaths of non-residents have been excluded in the case of the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, 89. Central Hill (Servants' Reformatory), and Norwood Cottage Hospital. 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, 25,720; average number of persons per house, 5 2. 34 TABLE II. Vital Statistics of separate Wards in 1909 and previous years. Names of Localities. 1. West Ward 2. Central Ward. 3. East Ward. 4. South Ward. 5. South Norwood Ward. 6. Upper Norwood Sub-Division. 7. Thornton Heath Sub-Division. 8. Undistributed Institution Births and Deaths. Year. Population estimate 1 to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. 1 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 at 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 a'l 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 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 15,691 355 264 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, 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 15,325 361 175 44 18,363 413 222 45 20,899 547 276 75 8,277 156 113 26 13,828 404 158 43 98 83 8 1903 45,540 1355 570 169 16,957 379 210 15 15,835 339 153 34 18,735 378 181 27 21,412 611 250 55 8,302 149 85 7 14,375 443 171 48 72 37 1 1904 46,741 1319 699 199 17,051 362 229 35 16,346 375 191 17 19,107 399 227 55 21,925 621 322 70 8,327 148 90 20 14,922 463 192 63 82 46 3 1905 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 15,562 466 159 39 85 21 .. 1906* 49/219 1451 744 207 7,171 362 255 51 17,530 393 182 51 19,711 366 232 40 22,825 630 276 61 8,343 148 88 7 16,212 447 227 65 89 15 3 1907* 50,500 515 715 171 17,236 351 207 38 18,083 392 172 25 20,022 363 210 29 23,284 643 285 55 8,351 145 91 9 16,866 456 195 44 102 23 .. 1908* 51,801 550 747 185 17,310 340 209 24 18,631 388 190 30 20,329 351 237 36 23,739 647 267 61 8,364 156 119 6 17,521 492 231 53 83 21 3 Averages of Years 1899 to 1908. 46,168 1387 666 184 15,971 360 225 43 16,151 363 171 39 18,854 388 211 41 21,605 591 271 63 8,302 140 97 13 14,731 425 179 50 76 81 6 1909* 53.125 1560 721 142 37,394 225 211 24 19,185 396 189 33 20,636 371 198 27 24,l95 654 207 39 8,377 151 87 8 18,176 455 184 40 85 23 Notes.— For 1900— 1909 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, Norwood Cottage Hospital, Purley Cottage Hospital, 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, and all deaths of Croydon residents whose exact home could not be ascertained, are included in Block 8. * Including North Ward. 35 TABLE III. Cases of Infectious Disease notified during the Year 1909. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 Total. At all Ages. At Ages— Years. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not be distributed. West. North. 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 356 3 91 220 19 23 .. 75 38 43 34 42 65 7 50 2 61 32 34 26 33 46 7 43 1 283 Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. Erysipelas .. 92 2 4 9 8 55 14 28 21 7 3 5 20 2 6 .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 727 6 161 485 45 30 .. 95 97 55 89 56 208 28 94 5 74 69 36 66 40 158 17 68 5 533 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 21 .. .. 4 7 10 .. 7 2 6 2 2 1 .. .. 1 5 1 3 2 .. .. .. .. .. 11 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 16 .. .. .. 2 14 .. 5 5 2 1 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 139 .. 1 17 18 99 4 42 35 10 8 14 13 1 13 3 .. .. .. .. .. .. .. .. .. .. Totals 1351 11 257 735 99 231 18 252 198 123 137 120 309 38 163 11 140 102 73 94 73 204 24 111 6 827 The Borough (Fever) Isolation Hospital is situated in the West Ward. #The Croydon and Wimbledon (Small-pox) Isolation Hospital is at North Cheam. 36 TABLE IV. Causes of, and ages at, Death during Year ending December 31st, 1909, excluding Deaths of Strangers at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, Purley, Cottage Hospital, Upper Norwood, 89, Central Hill (Servants'Reformatory), 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, 1909. Deaths in whole District at Subjoined Ages. Deaths in Localities at all Ages. Institution and Street Deaths which could net be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. all ages. Under 1. 1 and under 5. 5 ami under 15. 15 and under 25. 'Ab and under 65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood, Thornton Heath. Total. M. F. 2 Measles 21 6 15 8 10 9 1 .. .. 4 3 2 .. .. 2 .. 10 .. 3 .. 3 Scarlet Fever 9 2 7 .. 5 4 .. .. .. 1 1 1 2 .. 2 .. 2 .. 8(5) .. 5 Epidemic Influenza 59 17 42 2 2 3 1 14 37 18 10 3 7 6 8 5 2 .. 3 (2) 1 6 Whooping Cough 30 19 11 13 17 .. .. .. .. 5 8 2 6 .. 5 .. 4 .. 1 .. 7 Diphtheria (Mem. Croup) 94 12 12 .. 6 17 1 .. .. 10 .. 1 2 4 3 .. 4 .. 24(3) .. 8 Enteric Fever 3 .. 3 .. .. .. .. 3 .. .. .. 2 1 .. .. .. .. .. .. .. 10 Diarrhœa, Dysentery 16 10 6 11 1 1 .. .. 3 5 1 3 .. l 3 1 2 .. .. .. 11 Epidemic Enteritis 3 .. 3 2 .. .. .. 1 .. 2 .. .. .. .. 1 .. .. .. .. .. 12 Other allied diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus 1 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 1 18 Syphilis 6 4 2 5 .. .. 1 .. .. 3 .. .. 1 2 .. .. .. .. 3(l) .. 19 Gonorrhoea 2 2 .. .. .. .. .. 2 .. 1 .. .. .. .. 1 .. .. .. 1 .. 21 Erysipelas 3 2 1 .. .. .. .. 2 1 .. 2 .. .. .. 1 .. .. .. 1 .. 22 Puerperal Fever 5 .. 5 .. .. .. 1 4 .. 1 .. 2 1 .. 1 .. .. .. 2 .. 23 Pyaemia (Septicaemia) 6 4 2 2 .. 2 .. 2 .. 3 .. 1 1 .. .. .. 1 .. 6(2) 2 94 Infective Endocarditis 4 2 2 .. .. 1 1 2 .. .. 2 .. .. .. 2 .. .. .. 1 .. 25 Other Allied Diseases 7 6 1 1 .. .. .. 4 2 3 1 .. 1 l .. 1 .. .. 3 .. 96 Malarial Fever 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 27 Rheumatic Fever 4 2 2 .. .. 2 .. 2 .. 1 .. .. .. l 2 .. .. .. 1 .. 28 Rheumatism of Heart 1 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 29 Tuberculosis of Brain 24 12 12 5 7 7 1 4 .. 10 3 1 2 .. 5 .. 3 .. 10 (3) .. 30 Tuberculosis of Larynx 1 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. 31 Phthisis 159 77 75 1 3 11 93 107 7 47 22 13 16 13 20 5 14 2 54 (11) 1 39 Abdominal Tuberculosis 10 7 3 2 3 3 1 1 .. 3 1 1 1 1 1 1 1 .. 5(2) .. 33 General Tuberculosis 10 5 5 .. 2 3 1 3 1 4 2 .. .. 1 2 .. 1 .. (1) .. 34 Other forms Tuberculosis 8 7 1 .. 1 1 2 1 3 .. .. 2 1 1 2 2 .. .. 3(2) .. 41 Acute Alcoholism 1 .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 42 Chronic Alcoholism 6 1 5 .. .. .. .. 6 .. 1 1 1 .. 1 1 1 .. .. 1 1 43 Chronic Industrial Poisonings 1 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 2(1) .. 45 Osteo-arthritis 6 .. 6 .. .. .. .. 2 4 1 1 .. .. 2 2 .. .. .. 1 .. 46 Gout 3 3 .. .. .. .. .. 2 1 .. .. 1 2 .. .. .. .. .. .. .. 47 Cancer 170 65 105 .. .. .. 1 107 62 35 15 24 23 18 33 8 14 .. 55 (15) 48 Diabetes Mellius 11 7 4 .. .. .. 3 4 4 3 .. .. 1 3 .. 3 1 .. 5(2) .. 49 Purpura Hemorrhagica 1 .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 50 Haemophilia 2 1 1 .. 1 1 .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. 51 Anaemia 5 3 2 .. .. .. .. 3 2 .. 1 2 .. .. 1 .. 1 .. 4 (1) .. 52 Lymphadenoma 5 2 3 .. .. 1 .. 2 2 1 2 1 .. .. 1 .. .. .. 1 .. 53 Premature Birth 77 40 37 77 .. .. .. .. .. 23 9 8 9 8 10 4 6 .. 2 6 54 Injury at Birth 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 55 Debility at Birth 7 5 9 7 .. .. .. .. .. 2 2 1 .. 1 .. .. 1 .. .. .. 56 Atelectasis 9 4 5 9 .. .. .. .. .. 2 1 .. 1 1 3 .. 1 .. 1 .. 57 Congenital Defects 17 9 8 13 2 2 .. .. .. 2 5 .. 4 .. 3 1 2 .. 4 1 58 Want of Breast Milk 1 1 .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 59 Atrophy. Debility, Marasmus 41 27 14 39 2 .. .. .. .. 19 12 1 4 6 3 2 1 .. 14(6) 3 61 Rickets 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. (!) .. 62 Old Age, Senile Decay 92 24 68 .. .. .. .. .. 92 23 11 6 9 17 9 9 8 .. 5(1) 2 63 Convulsions 19 7 12 18 1 .. .. .. .. 6 2 1 l 2 3 .. 4 .. .. 9 64 Meningitis 7 3 4 2 3 1 .. 1 .. 1 1 .. 2 1 .. .. 2 .. 1 1 65 Encephalitis 4 1 3 .. .. 1 .. 2 1 1 1 .. 1 1 .. .. .. .. 3 1 66 Apoplexy 6 4 2 .. .. .. .. 2 4 1 2 1 .. .. .. 1 .. 1 2 .. 67 Softening of Brain 6 2 4 .. .. .. .. .. 6 1 1 1 .. 1 2 .. .. .. (1) .. 68 Hemiplegia 3 .. 3 .. .. .. .. .. 3 .. .. .. 2 .. .. 1 .. .. .. .. 70 Other forms of Insanity 8 3 5 .. .. .. .. 5 3 1 .. .. 1 .. 1 .. .. 5 10(2) 1 71 Chorea 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 72 Cerebral Tumour 4 3 1 .. 1 1 1 1 .. 1 1 .. .. 1 .. 1 .. .. 1 .. 73 Epilepsy 15 4 11 .. .. .. 2 9 4 4 1 2 .. 1 4 1 1 13(1) .. 74 Laryngismus Stridulus 3 1 2 2 .. 1 .. .. .. .. .. 1 1 .. .. .. 1 .. .. 2 75 Locomotor Ataxy 4 2 2 .. .. .. .. 4 .. 3 1 .. .. .. .. .. .. .. 1 .. 76 Paraplegia 9 8 1 .. .. .. 1 6 2 2 2 .. .. 2 1 1 1 .. 6(3) 77 Other forms, Brain Diseases 5 3 2 1 .. 1 .. 2 1 .. 2 .. .. 1 1 .. l .. 2 .. 78 Otitis 2 1 1 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. 3(2) .. 79 Disease of Nose, Epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (1) .. 80 Diseases of Eye 1 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. 81 Pericarditis 1 .. 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. (1) .. 82 Endocarditis 88 38 50 .. .. 2 6 41 39 21 15 8 11 7 15 2 4 2 25 (9) 12 84 Angina Pectoris 4 1 3 .. .. .. .. 1 3 1 2 1 .. .. .. .. .. .. .. 1 85 Aneurism 3 2 1 .. .. .. .. 2 1 1 1 1 .. .. .. .. .. .. .. .. 86 Senile Gangrene 1 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 87 Embolism Thrombosis 19 7 12 .. .. .. .. 8 11 3 5 2 3 4 .. .. 2 .. 11(6) 1 37 TABLE IV— continued. Causes of, and ages at, Death during Year ending December 31st, 1909. Schedule No. Causes of Death in Croydon during the Year ending December 31st, 1909. Deaths in whole District at subjoined Ages. Deaths in Localities at all Ages. Institution and Street Deaths which could not he distributed. Total 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. North. Central. East. South. South Norwood. Upper Norwood. Thornton Weath. Total. M f. 90 Other Diseases, Heart and Vessels 200 95 105 .. 1 2 .. 63 134 36 25 36 18 14 27 14 21 9 74 (22) 27 91 Laryngitis 5 4 1 .. .. 1 .. 1 1 1 .. 2 .. 1 .. 1 .. .. .. .. 94 Acute Bronchitis 81 37 44 23 7 2 .. 13 36 17 12 12 9 5 13 2 11 .. 12(2) 4 95 Chronic Bronchitis 96 39 57 .. 2 .. .. 18 76 26 9 11 11 15 12 3 8 1 16 (6) 1 96 Lobar Pneumonia 27 17 10 1 2 2 .. 14 8 6 6 4 1 1 4 .. 4 1 17(1) 9 97 Lobular Pneumonia 65 31 34 27 13 2 .. 7 16 13 7 7 7 12 7 1 10 .. 10(7) .. 98 Pneumonia 50 27 23 6 5 1 2 22 14 10 7 3 4 6 7 2 11 .. 10(7) .. 99 Emphysema, Asthma 18 11 7 .. .. .. .. 7 11 7 1 3 .. 2 1 2 2 .. 4 (3) 3 100 Pleurisy 4 2 2 .. 1 .. .. 1 2 1 .. 1 .. 1 1 .. .. .. 4(1) .. 101 Other Diseases Respiratory System 5 1 4 .. 2 .. .. .. 1 .. .. .. .. 2 3 .. .. .. .. .. 102 Diseases of Mouth and Annexa 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 103 Diseases of Pharynx 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. (1) .. 105 Ulcer of Stomach and Duodenum 13 3 10 .. .. .. 12 3 4 3 2 .. 1 2 1 .. .. 6 1 106 Other Diseases of Stomach 13 7 6 4 3 1 .. 2 .. 4 3 1 1 2 1 .. 1 .. 3 .. 107 Enteritis 26 15 11 15 5 1 1 3 1 13 2 3 2 1 .. 1 4 .. 3 .. 108 Appendicitis 8 5 3 .. 1 1 1 5 .. 2 1 .. 1 1 2 .. 1 .. 10 (3) 1 109 Obstruction of Intestine 11 4 7 .. 2 1 .. 4 4 3 1 3 .. 1 2 .. 1 .. 6 (3) .. 111 112 Cirrhosis of Liver Other Diseases of Liver 14 6 9 1 6 5 .. .. 4 2 .. 2 2 1 .. 1 .. .. .. 1 .. 113 Peritonitis 2 .. 2 .. .. .. .. 2 .. .. .. 1 .. .. 1 .. .. .. 1 .. 114 Other Diseases, Digestive System 2 2 .. 1 .. .. 1 .. .. .. .. .. .. .. 2 .. .. .. 1 .. 115 Diseases, Lymphatic System and Glands 7 3 4 1 1 2 2 1 .. 1 .. 1 .. 2 2 .. 1 .. 2 1 116 Acute Nephritis 11 5 6 .. 2 2 .. 3 4 .. 2 3 .. 3 1 .. 2 .. 2 1 117 Brignt's Disease 42 24 18 .. .. 1 .. 18 23 16 5 5 7 4 4 1 .. .. 13(4) 1 118 Calculus 3 2 1 .. .. .. .. 2 1 1 .. .. .. .. 1 .. 1 .. 1 1 119 Diseases of Bladder and Prostrate 12 12 .. .. .. .. .. .. 12 .. 3 1 3 .. 4 .. 1 .. 4(1) .. 120 Other Diseases, Urinary System 2 1 1 .. .. .. .. 1 1 .. 1 .. .. 1 .. .. .. .. .. .. 122 Diseases of Ovaries 3 .. 3 .. .. .. .. 2 1 .. .. 1 .. .. 1 1 .. .. 2 .. 123 Diseases of Uterus and Appendages 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 125 Diseases of Breast 1 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 126 Abortion, Miscarriage 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 127 Puerperal Mania 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 128 Puerperal Convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta Praevia Flooding 1 .. 1 .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. (1) .. 132 Arthritis, Ostis, Periostitis 2 2 .. .. .. .. 1 1 .. .. .. 1 .. 1 .. .. .. .. 2(1) .. 135 Eczema 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 136 Pemphigus 2 .. 2 2 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. Accidents 139 In Vehicular Traffic 2 1 1 .. .. .. .. 2 .. 1 .. .. .. .. .. .. 1 .. 3(1) 2 140 On Railways 1 l .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 3(2) 1 142 In Building Operations .. 1 1 .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 1 145 Burns and Scalds 5 3 2 .. 2 .. 1 1 1 1 .. .. 1 1 .. 1 1 .. 8(5) 5 146 Poisons, Poisonous Vapours 3 3 .. 1 .. .. .. 2 .. .. .. .. .. 1 1 .. 1 .. .. 3 150 Drowning 1 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. ??? 151 Suffocation, Overlaid in Bee 3 2 1 3 .. .. .. .. .. .. 1 .. .. 1 1 .. .. .. .. ??? 152 ,, Otherwise 2 1 1 1 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. ??? 153 Falls not specified 16 8 8 .. 2 1 .. 5 8 5 4 1 1 1 1 1 2 .. 16(6) 16 154 Weather Agencies 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 4 155 Otherwise, not stated 5 4 1 4 .. .. .. 1 .. 2 2 1 .. .. .. .. .. .. 1 4 156 Homicide 1 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Suicides. 157 By Poison 4 1 3 .. .. .. .. 4 .. .. 1 2 .. 1 .. .. .. .. (1) 4 159 By Hanging & Strangulation 5 5 .. .. .. .. .. 5 .. .. .. .. .. 2 2 .. 1 .. .. 5 161 By Shooting 1 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. (1) 1 162 By Cut or stab 5 3 2 .. .. .. .. 5 .. 2 1 .. 1 .. .. 1 .. .. 2(1) .. 164 By Crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165 By other and unspecified method .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168 Ill-defined and Unspecified Causes 5 2 3 .. .. .. .. 4 1 1 .. 1 .. 1 1 1 .. .. (3) 2 Total 1879 6S5 994 313 123 91 60 624 66 3 462 ?59 210 189 198 267 87 184 23 572 63 The total Institution Deaths include those of strangers occurring within the Borougl^ Deaths o su strangers occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospiti, Cottage Hospital, Purley, Cottage Hospital, Upper Norwood, and 89, Central Hill (servants ^et°r tory), are excluded from all other columns of the Table. The numbers so excluded are in brack . 38 TABLE V. County Borough of Croydon— Whole District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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 Month*. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 82 20 12 8 122 38 20 16 10 21 17 16 18 15 9 11 313 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 2 1 2 ... 3 8 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 ... ... ... 1 1 2 1 2 1 3 13 Diarrheal Diseases. Diarrhœa, all forms ... 1 ... ... 1 3 3 ... ... 2 ... 1 1 ... ... 2 13 Enteritis (not Tuberculous) ... 1 ... 1 2 1 1 3 2 3 1 1 1 ... ... ... 15 Gastritis ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... 3 Wasting Diseases. Premature Birth 56 10 4 2 72 3 2 ... ... ... ... ... ... ... ... ... 77 Congenital Defects 14 1 3 1 19 4 1 1 1 1 1 ... 1 ... ... ... 29 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Atrophy, Debility Mar asmus 2 4 1 1 8 7 6 5 2 5 2 2 ... 1 1 ... 39 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 1 ... 5 Tuberculous Peritonitis: Tabes Mesenterica . ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 2 Other Tuberculous D ses ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... 1 ... 2 ... ... 1 ... ... ... ... 1 ... 1 ... 5 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Convulsions 3 2 ... 1 6 1 3 2 1 1 1 1 1 1 ... ... 18 Bronchitis ... ... 1 1 2 5 1 2 ... 2 1 4 3 1 2 ... 23 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 5 1 1 1 4 5 2 5 6 2 ... 34 Suffocation, overlying ... ... 1 ... 1 1 1 ... ... ... ... ... ... ... ... ... 3 Other causes 5 1 1 1 8 4 ... ... 2 2 2 ... 1 ... 1 1 21 82 20 12 8 122 38 20 16 10 21 17 16 38 15 9 11 313 Births in the year Population Estimated to middle of 1909— 161,078. (legitimate, 3740. legitimate Infants, 278. Deaths in the year of illegitimate, 198. illegitimate inlants 35. Deaths from all Causes at all Ages ... 1879. 39 TABLE V.— continued. County Borough of Croydon— West Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 22 6 6 3 37 12 6 8 4 6 3 2 5 6 2 1 92 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... 1 1 ... ... 1 ... ... 1 ... ... ... 4 Enteritis (not Tubtrculous) ... ... ... 1 1 1 ... 3 1 1 ... 1 ... ... ... ... 8 Gastritis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Wasting Diseases. Premature Birth 15 4 2 ... 21 1 1 ... ... ... ... ... ... ... ... ... 23 Congenital Defects 3 ... 1 ... 4 2 ... ... ... ... ... ... ... ... ... ... 6 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... 1 ... ... 1 2 2 3 ... 1 ... 1 ... 1 ... ... 11 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Svphilis 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Convulsions 2 1 ... ... 3 ... 1 1 1 ... ... ... ... ... ... ... 6 Bronchitis ... ... 1 1 2 3 ... 1 ... ... ... ... 1 1 1 ... 9 Laryngitis ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... 1 ... 1 1 1 ... 2 2 ... 1 9 Suffocation, overlying ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Causes 1 ... 1 1 3 ... ... ... ... 1 1 ... ... ... ... ... 5 22 6 6 3 37 12 6 8 4 6 3 2 5 6 2 1 92 Population Estimated to middle of 1909 — 30,481. legitimate, 846. legitimate infants 79. Births in the year • Deaths in the year of illegitimate, 61. illegitimate infants, 13. Deaths from all Causes at all Ages 462, 40 TABLE V.— continued. County Borough of Croydon— Central Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 7 1 1 I 10 3 ... ... 1 2 2 2 1 2 ... 1 24 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 3 Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wastins Diseases. Premature Birth 5 1 1 ... 7 1 ... ... ... ... ... ... ... ... ... ... 8 Congenital Defects ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 4 Suffocation, overlying ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other causes 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 2 7 1 1 1 10 3 ... ... 1 2 2 2 1 2 ... 1 24 Births in the year Population Estimated to middle of 1909—17,394. legitimate, 260. Deaths in the year of illegitimate, 6. Deaths from all Causes at all Ages ... 210. legitimate infants, 23. illegitimate infants 1. 41 TABLE V.— continued. County Borough of Croydon— East Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 9 4 1 ... 14 4 1 1 ... 1 3 4 1 1 2 1 33 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 4 Diarrhœal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 5 3 ... 8 1 ... ... ... ... ... ... ... ... ... ... 9 Congenital Defects 2 ... 1 ... 3 ... 1 ... ... ... ... ... ... ... ... ... 4 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast milk ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... l Atrophy, Debility Marasmus 1 1 ... ... 2 ... ... ... ... ... 1 1 ... ... ... ... 4 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica . ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Bronchitis ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 9 4 1 ... 14 4 1 1 ... 1 3 4 1 1 2 1 33 Populalion Estimated to middle of 1909— 39,185. legitimate, 389. legitimate infants, 31. Births in the year Deaths in the year of illegitimate, 7. illegitimate infants, 2. Deaths from all Causes at all Ages 189. 42 TABLE V.— continued. County Borough of Croydon— South Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 8 1 1 1 11 1 4 1 ... 3 1 1 3 1 1 ... 27 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Wasting Diseases. Premature Birth 7 ... ... 1 8 ... ... ... ... ... ... ... ... ... ... ... 8 Congenital Defects 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... 1 1 ... 2 ... 1 ... ... 3 ... ... ... ... ... ... 6 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Svphilis ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Bronchitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... 4 Suffocation, overlying ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 1 1 1 11 1 4 1 ... 3 1 1 3 1 1 ... 27 Population Estimated to middle of 1909— 20,636. legitimate, 360. legitimate infants, 20. Births in the year Deaths in the year of' illegitimate, 11. illegitimate infants, 7. Deaths from all Causes at all Ages 198. 43 TABLE V.— continued. County Borough of Croydon— South Norwood Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 16 2 ... ... 18 6 2 1 l 3 2 2 ... 1 2 1 39 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Diarrheal Diseases. Diarrhoea, all forms ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Enteritis (not Tuberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Wasting Diseases. Premature Birth 10 ... ... ... 10 ... ... ... ... ... ... ... ... ... ... ... 10 Congenital Defects 5 ... ... ... 5 ... ... ... 1 ... ... ... ... ... ... ... 6 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Tuberculous Peritonitis: Tabes Mesenterica . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 3 Bronchitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 1 ... ... ... 2 1 1 ... 1 ... ... 6 Suffocation, overlying ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other causes ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 3 16 2 ... ... 18 6 2 1 1 3 2 2 ... 1 2 1 39 Population Estimated to middle of 1909— 24,195. legitimate, 646. legitimate Infants, 36. Births in the year Deaths in the year of illegitimate, 8. illegitimate inlants, 3, Deaths from all Causes at all Ages 267. 44 TABLE V.— continued. County Borough of Croydon— Upper Norwood Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 3 1 ... ... 4 2 2 ... ... ... ... ... ... ... ... ... 8 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrheal Diseases. Diarrhœa, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis (not Tuberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Congenital Defects ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Svphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 4 2 2 ... ... ... ... ... ... ... ... ... 8 Population Estimated to middle of 1909-8,377. legitimate, 125. legitimate infants, 7. Births in the year Deaths in the year of illegitimate, †26. illegitimate infants, 1. Deaths from all Causes at all Ages 87. † Including 23 at 89, Central Hill (Servants' Reformatory), 45 TABT.E V.— continued. County Borough of Croydon— Thornton Heath Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1 1-2 Weeks. 1 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 5 4 1 ... 10 2 3 1 1 4 4 3 3 3 1 5 40 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Enteritis (not Tuberculous) ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 4 1 1 ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 Congenital Defects ... 1 ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... 3 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Convulsions ... 1 ... ... 1 ... 1 1 ... ... ... ... ... 1 ... ... 4 Bronchitis ... ... ... ... ... 1 1 ... ... 1 ... ... 1 ... 1 ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... 4 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Other Causes ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... 4 1 4 1 ... 10 2 3 1 1 4 4 3 3 3 1 5 40 Population Estimated to middle of 1909-18,176. ( legitimate, 447. ( legitimate infants, 39. Births in the year Deaths in the year of illegitimate, 8. illegitimate miants, 1, Deaths from all Causes at all Ages 184. 46 TABLE V.— continued. County Borough of Croydon— North Ward District. INFANTILE MORTALITY DURING THE YEAR 1909. 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 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. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 12 1 2 3 18 8 2 4 3 2 2 2 5 1 1 2 50 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 4 Diarrheal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis (not Ttiberculons) ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... 3 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 7 1 ... 1 9 ... ... ... ... ... ... ... ... ... ... ... 9 Congenital Defects 3 ... 1 ... 4 ... ... 1 ... ... ... ... 1 ... ... ... 6 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus ... ... ... 1 1 2 2 2 2 1 1 ... ... ... 1 ... 12 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 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... 3 Suffocation, overlying ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other causes 2 ... ... ... 2 3 ... ... ... ... ... ... ... ... ... ... 5 12 1 2 3 18 8 2 4 3 2 2 2 5 1 1 2 50 Population Estimated to middle of 1909— 22,634. legitimate, 671†. legitimate infants, 43. Births in the year Deaths in the year of illegitimate, 67*. illegitimate inlants, 7. Deaths from all Causes at all Ages 259. ■(•Including 27 at the Workhouse Infirmary. * „ 58 „ 47 TABLE VI. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1909 and ten preceding Years. Disease. 1909. 1908. 1907. 1906. 1905. 1904. 1903. 1902. 1901. 1900. 1899. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths, Cases. Deaths. Cases. Deaths. Cases. Deaths, Cases. Deaths. Cases. Deaths. Notifiable. Small Pox .. .. .. .. .. .. 4 .. .. .. 3 .. 14 2 51 11 5 .. 1 .. .. .. Scarlet Fever 727 9 534 5 661 11 425 8 416 11 291 8 215 2 295 6 391 1 432 5 350 3 Diphtheria and (1) Memb.Croup 356 24 405 37 i86 40 304 40 266 25 312 24 259 18 285 29 448 23 187 25 127 17 (2) Erysipelas 92 3 60 5 73 4 68 2 78 5 68 2 79 4 102 5 79 4 71 6 .. 7 Puerperal Fever 16 5 10 5 7 4 9 2 11 5 9 3 1 8 5 9 3 12 8 7 4 Enteric Fever 21 3 52 5 19 1 34 5 34 4 21 5 32 5 59 9 57 11 56 9 56 8 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 5 .. .. .. 4 .. 1 1 Non-notifiable. Diarrhoea and Epidemic or Zymotic Enteritis .. 19 .. 52 .. 30 .. 142 .. 52 .. 95 .. 37 .. 73 .. 129 .. 88 .. 195 Enteritis .. 26 .. 23 .. 26 .. 61 .. 22 .. 35 .. 14 .. 17 .. 37 .. 25 .. 1 Measles .. 21 .. 92 .. 8 .. 37 .. 24 .. 62 .. 26 .. 30 .. 21 .. 20 .. 18 Whooping Cough .. 30 .. 29 .. 32 .. 28 .. 31 .. 15 .. 58 .. 31 .. 25 .. 56 .. 40 Influenza .. 59 .. 52 .. 31 .. 20 .. 30 .. 27 .. 28 .. 58 .. 37 .. 10b .. 91 Bronchitis, Pneumonia, and Pleurisy .. 323 .. 282 .. 316 .. 218 .. 302 .. 314 .. 247 .. 341 .. 283 .. 367 .. 309 Phthisis .. 152 .. 150 .. 160 .. 173 162 .. 142 .. 151 .. 112 .. 123 .. 135 .. 154 (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, Norwood Cottage Hospital, Purley Cottage Hospital, and "89, Central Hill" (Servants Reformatory), are excluded. Prior to 1903 correction was only made for the first three institutions. 48 B.— SANITARY WORK OF THE YEAR. GENERAL SANITARY WORK. The usual summary is given in Table IX., which gives a fair idea of the various matters engaging the attention of the Sanitary Inspectors. During the year 5,127 house-to-house inspections were made, as compared with 5,812 in 1908. The number of single private drains dealt with during the year was 55. This work was carried out under the provisions of the Croydon Corporation Act, 1905. The cost of carrying out the necessary works amounted to about £679 12s. 2d., 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 255 cases, Council Orders had to be applied for. Of the 255 legal notices, 228 were complied with, and 27 were outstanding at the end of the year. Of the 27 outstanding Council Orders, 19 have been complied with (April 30th, 1910). No prosecutions had to be undertaken for non-compliance with ordinary nuisance notices. PAVING OF BACK YARDS. Eight hundred and fifteen back yards have been paved during the year. There is a considerable increase over the number dealt with in the previous year and is a record of work of considerable sanitary value. MUNICIPAL COMMON LODGING HOUSE. This Lodging House affords accommodation for 17 women and 84 men. The number of occupants during the year amounted to 22,428 men and 4,052 women. The average number of lodgers amounted to 61 men and 11 women per night. The receipts and expenditure (exclusive of sinking fund and interest) for the past five years were :— Receipts. Expenditure. £ s. d. £ s. d. 1905 793 17 7 582 18 5 1906 804 5 8 665 6 10 1907 811 17 9 572 9 7 1908 753 0 9 624 7 5 1909 750 0 0 632 15 7 49 OTHER COMMON LODGING HOUSES. There are ten other houses on the register. The following Table gives the situation of the ten registered houses and the accommodation provided therein:— Premises. No. of Room. Accommodation. 11 & 12, Princess Road 12 54 men and 8 married couples. 9, Prospect Place (late Bell Yard) 6 14 men and 5 married couples. 19. 20, 21, 22, 23 & 24 Lahore Road 30 50 men, 10 w;men, and 6 married couples. "The Jolly Bleachers," Union Street 13 30 men. 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 four common lodging houses now remain in the Borough, with a total accommodation for 196 adults, or if we add the Municipal Common Lodging House, a total of five houses with 259 single beds and 19 double beds. During the year common lodging houses received 516 visits, while 10 houses received night visits. Minor infringements of bye-laws were detected on 8 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. HOUSES LET IN LODGINGS. There are now 64 houses registered under the bye-laws. During the year these houses received 2,029 visits. 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 Road 39 Forster Road 12 Holmesdale Road 4 Ely Road 8 Grant Road 1 64 50 The results of registration and inspection have, on the whole, been satisfactory. HOUSING OF THE WORKING CLASSES ACT. One house was represented under Part II., Section 39, as unfit for human habitation. As the result of the notice, the premises were voluntarily reconstructed. FACTORIES AND WORKSHOPS. FACTORY AND WORKSHOP ACT. Section 132 of the Factory and Workshop Act, 1901, provides:— "The 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." The following is a summary of the work done under this Act in Croydon during 1909. FACTORIES. For the most part, the law relating to Factories is administered by the Home Office. 99 visits were, however, made to Factories, 37 being in reference to sanitary accommodation, 38 in reference to cleanliness of earth closets, 10 in reference to new occupation, four in reference to insanitary condition of messrooms at steam laundries, three in reference to want of w.c. accommodation in a wood yard, three in reference to ventilation of w.c. at a steam laundry, two in reference to smoke, one in reference to the want of screens to w.c.'s at a steam laundry, and one in reference to complaint of effluvium nuisance from a steam laundry. 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 X. 51 The following is a list of the various matters requiring attention :— Factories. Workshops Laundries Bakehouse. Workplaces. Outworkers. Total Premises requiring repair 1 — — 1 — — 2 Cleansing, etc. 1 13 2 8 15 2 41 Insufficient W.C. accommodation 1 2 - 1 — - 4 Defective ditto 6 12 2 4 — — 24 Drains stopped — 1 — — — — 1 Overcrowding — 1 — — — — 1 Dustbins — — — 1 — — 1 Paving — — 1 — 1 — 2 Insufficient ventilation — 2 — — — — 2 9 31 5 15 16 2 78 Notices served— Factories 9 Workshops 30 Laundries 5 Bakehouses 13 Workplaces 16 Outworkers 2 75 All were remedied during the year with the exception of two which have now been complied with (April, 1910.) Sixty-seven notices were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. HOME WORK. One hundred and thirteen lists were received from employers containing the names of 281 outworkers residing in the Borough. Seventy-six further names were received from the Medical Officers 52 of Health of various neighbouring districts, and the names of 48 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. One hundred and sixty visits were paid to outworkers. BAKEHOUSES. At the end of the year there were 116 Bakehouses in occupation of which eight were underground. Eight hundred and fifty-six visits were made by the Inspector during the year, and 15 nuisances discovered and abated. WORKPLACES. At the end of the year there were 66 workplaces on the register. One hundred and twenty-seven visits to eating-house kitchens have been made, and 16 notices served for cleansing, which have been complied with. SHOP HOURS AND SEATS IN SHOPS ACTS entailed 309 visits, and resulted in the discovery of 16 infringements of the Acts, 14 being the non-exhibition of notices, and four the want of seats for female assistants. Written cautions were sent to the 16 offenders and subsequently complied with. SMOKE NUISANCES. Ninety-six observations were made, and 14 persons were cautioned. DAIRIES AND COWSHEDS. There were 39 cowsheds on the register at the end of the year, of which 34 were in occupation as against 42 sheds and 40 in occupation in 1908. The registered cowsheds provide accommodation for 614 cows with 800 cubic feet per head. The number of cows in the registered sheds in December was 482. The number of Cowkeepers in the Borough is now 27 as compared with 28 in 1908, 53 During the year 61 dairies were removed from, and 51 added to the register, leaving 268 on the register at the end of the year. One application for registration was refused, as the premises were unsuitable. Nineteen notices were served during the year for various matters requiring attention on 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 7,371 4,127 11,498 Including 13 carcases. Mutton 584 1,097 1,681 „ 32 „ Pork 8,402 390 8,792 „ 26 „ Veal 112 224 336 „ 4 „ Offal 4,305 1,151 5,456 Fish 2,914 2,914 Cod, Haddocks, Bream, Plaice, Dabs, Whiting, Herrings, Crabs, and Escalops. Other Articles 3,681 3,681 Apples, Black Currants, Tomatoes, and Rabbits. Total lbs. 20,774 13,584 34,358 Including 75 carcases. 54 The whole carcases condemned were affected as undernoted:— Tuberculosis. Peritonitis. Pleurisy. Enteritis. Pneumonia. Jaundice. Diarrhoea. Septicaemia. Nephritis. Pyaemia. Emaciated, various causes. Immatures. Injured, etc. Unsound, Total carcases. Total Weight of carcases in lbs. Cattle 9 1 .. 1 .. .. .. .. .. .. 2 .. .. .. 13 6382 Sheen .. .. 1 .. 2 .. .. .. .. 4 7 .. 7 11 32 1426 Pigs 16 3 .. .. .. 2 .. 2 1 .. .. .. .. 2 26 4932 Calves .. 1 .. .. .. .. 1 .. .. .. .. 1 1 .. 4 336 Totals 25 5 1 1 2 2 1 2 1 4 9 1 8 13 75 13076 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 case of doubt, consults the Medical Officer. OFFENSIVE TRADES. Only three such trades are now carried on in the Borough, viz., one by a knacker and two by a gut-scraper. The premises have been visited from time to time during the year and found in a satisfactory condition. One of the premises occupied by a gutscraper was newly erected during the year on land belonging to the Corporation in Factory Lane. SLAUGHTERHOUSES. There are 16 registered Slaughterhouses and one licensed Slaughterhouse, in addition to the Municipal Slaughterhouses at Pitlake. The following are the approximate number of animals slaughtered at Pitlake:— Municipal. Beasts. Sheep. Pigs. Calves. Total. Private Slaughterhouses 271 4,790 17,938 2,060 25,059 Public „ 308 2,466 2,168 420 5,362 Total 579 7,256 20,106 2,480 30,421 55 Summary of totals for last five years:— Beasts. Sheep. Pigs. Calves. Total. 1905 635 7,779 27,679 2,286 38,379 1906 790 8 284 20,080 4,764 33,918 1907 734 7,080 19,099 5,617 32,530 1908 696 6,365 18,525 3,894 29,480 1909 579 7256 20,106 2,480 30,421 3,434 36,764 105,489 19,041 164,728 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 North. West, Central East. South, S. Nor. U. Nor. Slaughter-houses 788 466 22 160 55 46 1537 Butchers 26 186 261 19 42 36 18 588 Fishmongers 18 23 76 24 13 12 10 176 Markets ... ... 51 ... 51 ... ... 102 Cowkeepers 36 24 20 38 52 8 27 205 Milk Purveyors 66 69 36 69 59 39 51 389 Other Premises 3 2 1 ... ... ... ... 6 Total 149 1092 911 172 377 150 152 3003 56 FOOD AND DRUGS ACTS. Table XI. gives the number of samples taken by Mr. Saunders during the year, the results of the analyses and the action taken thereon. PROSECUTIONS, 1909 Date. Defendant. Charge. Result. Penalty. Costs. £ s d. £ s. d. Jan. 15 A. W. Selling Butter adulterated with 100 per cant, foreign fat Convicted 2 0 0 0 13 6 „ 29 J.W. T. Selling Butter adulterated with 71 per cent, foreign fat „ 10 0 0 1 17 6 July 7 S.K. Selling Milk 20 percent, deficient in fat „ 5 0 0 3 16 6 Oct. 10 J. G. Selling Milk adulterated with 25 per cent, added water and 15 percent, deficient in fat „ 5 0 0 0 13 6 Nov. 28 H. Bros. Selling Cream adulterated with 0.74 per cent, boric acid. „ 5 0 0 0 12 6 Dec. 23 E.R.J. Selling Butter adulterated with 90 per cent, of foreign fat „ 20 0 0 — „ 31 J.F. Selling Butter adulterated with 80 per cent, foreign fat „ 1 0 0 0 5 6 Total 48 0 0 7 19 0 In eight cases the samples of milk were slightly below the standard suggested by the Board of Agriculture. Being first offences, the vendors were written to calling their attention to the fact, and asking them for some explanation, further samples being taken subsequently. Of these eight samples, five contained an excess of water to the extent of an average of 1.4 per cent, and four were deficient in fat to the extent of an average of 6.9 per cent. One sample, it will be noticed, contained additional water, and was also deficient in fat. 57 Of the two prosecutions for selling adulterated milk, one defendant was a retailer, and the other a farmer and wholesale dealer, the sample being taken in course of delivery. The number of prosecutions for selling adulterated milk is considerably below the average, there being as many as eleven during the preceding year. During the year eleven samples of cream were submitted for analysis. Of these, eight contained boric acid in varying amounts, three only having no preservative present. One sample which contained an excessive amount of boric acid (51.8 grains per lb.) was the cause of a successful prosecution. Seven informal samples of Rice were taken during the year of which five were found to be adulterated by facing with small amounts of additional mineral matter varying from 005 per cent, to 10 per cent. Further attention will be given to this question during this year (1910). One hundred and twenty-six informal, or test samples of Butter were purchased, of which nine proved to be not genuine. Subsequent official samples were taken in the adulterated instances, when in two cases the fraud was repeated, and prosecutions followed. In one instance a dairyman was proved to have been carrying on an extensive fraudulent business, and although it was the first time he had been charged the Magistrate remarked that it was a case of wholesale fraud, and inflicted the full penalty of £20. It was only by the Inspector employing as his agent one of the man's regular customers that the defendant was brought to justice. Thirty-eight informal samples were also taken of various articles. They were certified to be genuine with the exception of one sample of coffee. The test samples were mostly purchased by a woman in small quantities with other articles, generally during the busy periods in the evenings. 58 The following table has been prepared from figures kindly supplied by the Borough Analysts (Mr. Lester Reed and Mr. P. G. Sanford):— Total number of Samples of Milk collected and percentage below standard. TABLE VII. 1909. No. of Samples. No. below Standard. Percentage of Samples below Standard. Average percentage of fat of Genuine Samples. Taken in course of delivery to Retailers under contract. New Milk 74 3 4.0 3.5 ,, ,, ,, Separated Milk 2 — — — Taken in course of delivery to Consumers under contract. New Milk 4 — — 3.7 Taken on Milkmen's rounds. Sunday morning. New Milk. 79 5 6.3 3.5 Taken on Milkmen's round Sunday morning. Separated Milk 6 — — — Taken on Milkmen s rounds. Week day. New Milk 40 1 25 3.5 Taken on Milkmen's rounds. Week day. Separated Milk 3 — - — Taken in Dairy Shops 11 1 9.1 3.5 THE WORK OF THE HEALTH VISITORS. This is set out in detail in Table VIII., and again shows a large mass of useful work, conscientiously and efficiently performed. Owing to the increased demands on this department, it became necessary to make certain modifications in the duties of these officers.— The Senior Health Visitor (Miss Tawney) has now been entrusted with the general supervision of the work with much advantage to all concerned. The districts have also been slightly re-arranged, so as to allow of the Superintendent Health Visitor being present on all occasions when children are presented for special examination at the Town Hall. This part of the work is TABLE VIII. HEALTH VISITORS.— The following is a summary of the work done and visits paid by the five Health Visitors. Visits to Houses where the following Diseases have been reported. Miss Tawney. Miss Chapman. Miss Raw. Miss Stokes. Miss Stevens. Totals. School Cases. Other Cases. School Cases. Other Cases. 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 Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits, 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Measles 55 3 ... ... 79 18 ... ... 35 3 ... ... 85 ... ... ... 144 13 ... ... 398 37 ... ... German Measles 2 ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... ... 4 ... ... ... 8 1 ... ... Mumps 14 4 ... ... 19 4 ... ... 47 ... ... ... 39 ... ... ... 23 9 ... ... 706 17 ... ... Whooping Cough 97 18 ... ... 106 31 ... ... 226 3 ... ... 121 3 ... ... 96 12 ... ... 598 77 ... ... Chicken-pox 172 12 ... ... 106 9 ... ... 107 ... ... 55 ... ... ... 158 15 ... ... 677 36 ... ... Sore Throat 158 68 50 103 161 49 ... ... 109 10 ... ... 140 39 ... ... 109 79 70 30 387 245 120 133 Ringworm 92 250 1 ... 74 189 ... ... 69 131 ... ... 90 138 ... ... 72 198 ... ... 31 906 1 ... Verminous Heads 8 4 1 1 ... ... ... ... 17 3 ... ... ... ... ... ... 6 ... ... ... 11 7 1 1 Verminous Bodies 3 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 466 2 ... ... 385 2 ... ... Impetigo Contagiosa 78 129 ... ... 111 218 ... ... 09 ... ... 41 37 ... ... 46 82 ... ... 33 560 ... ... Scabies 11 28 ... ... 5 11 ... ... 9 5 ... ... 2 ... ... ... 6 10 ... ... 573 54 ... ... Other diseases 89 51 ... ... 70 59 42 28 221 82 ... ... 123 37 ... ... 70 82 34 18 311 76 46 Totals 769 567 52 104 792 589 42 28 951 331 ... ... 697 254 ... ... 740 502 104 48 3949 2243 198 180 1st Visits, 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Visits to houses where Infants have been born. 743 596 1101 581 1007 606 1195 393 528 425 4574 2601 Addresses given re Infants feeding, etc ... ... ... ... ... ... 5 ... 8 ... 13 ... Visits to houses where Infants have died under one year of age 33 ... 37 6 68 ... 57 ... 37 7 232 13 Cultures taken 345 398 ... 208 ... 237 ... 302 11 149 ... Phthisis cases visited 18 9 25 14 80 ... 25 2 18 6 166 31 Visits paid to Elementary Schools 59 ... 55 ... 58 ... 46 ... 44 ... 262 ... Number of Children prepared for Medical Inspection 1097 116 1024 138 959 ... 770 20 954 147 4804 421 Visits paid to homes to obtain further information concerning children inspected in Schools 31 ... 7 2 49 16 93 ... 57 61 237 79 Visits paid to the homes of School Children for purpose of giving advice 105 86 102 62 126 7 97 ... 107 57 537 212 59 undertaken on behalf of the Education Committee, and entails an increasing amount of work, not only for the Health Visitors, but for the medical staff also. HEALTH LECTURES. Thirteen health lectures were given during the year by the Health Visitors. As explained in the Report to the Education Committee, arrangements have now been made to co-ordinate this branch of work with that of medical inspection. 60 TABLE IX. Work done by the Sanitary Inspectors during the Year ending December 31st, 1909. NATURE OF CASES DEALT WITH. Insp. Culver. Insp. Earwicker Insp. Peck. Ins. Richardson Insp. Stanley Insp. Bull. Insp. Adams. Insp. Fulker. Insp. Vincent. I nsp. Stokes???ms Insp.Brown I m Total. House to House Inspection 679 630 478 646 .. .. 700 .. 907 1087 5127 Visits to and inspections of houses where zymotic diseases have occurred .. 5 173 254 .. .. 5 1107 6 18 1568 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. .. .. Inspections of Factories, Workshops and Outworkers .. .. .. .. .. 1214 .. .. .. .. 1214 ,, ,, Greengrocers, Fishmongers & Ice Cream Shops 96 611 232 189 .. .. 2003 .. 725 1577 5433 ,, ,, Schools .. .. 9 8 .. .. .. 183 2 15 217 ,, ,, Shop .. .. .. .. .. .. .. .. .. .. 309 ,, ,, Bakehouses .. .. .. .. .. 856 .. .. .. 856 ,, ,, Yards and Stables 347 946 877 921 .. .. 1601 .. 914 1627 7263 ,, ,, Common Lodging Houses .. .. .. .. .. 516 .. .. .. .. 516 „ „ „ (night visits .. .. .. .. .. 10 .. .. .. .. 10 ,, ,, Houses let in Lodgings .. .. .. .. .. .. 2009 .. 12 8 2029 „ „ Urinals 386 555 784 536 .. 1191 .. 757 1001 5210 Smoke observations .. .. .. .. .. 96 .. ... .. 96 House drains tested with smoke 197 560 196 26.5 .. .. 81 .. 398 482 2179 „ ,, ,, water 244 408 122 151 .. .. 4 .. 49 306 1284 ,, ,, on application 81 105 72 95 .. .. 1 .. 11 164 529 ,, drains re-laid 74 17 19 32 .. .. 3 .. 65 116 326 „ „ repaired 41 41 13 45 .. .. 4 .. 49 47 240 Re-inspections of work in progress 1832 2428 1465 1383 .. .. 365 87 1393 2075 11028 Sundry inspections 30-5 436 536 247 .. 102 266 119 277 419 2707 Complaints from public investigated 166 114 91 74 .. .. 198 1 140 67 851 House disinfected .. .. .. .. .. .. .. .. .. .. 1255 Articles disinfected .. .. .. .. 9774 .. .. .. .. .. 9774 NUISANCES DISCOVERED. Premises requiring repair 86 285 61 102 .. 3 123 1 61 52 774 ,, ,, Cleansing and Whitewashing 89 175 80 86 .. 45 170 28 94 48 815 ,, Overcrowded 10 4 ... 6 .. 4 3 1 1 8 37 Drains found defective 80 159 34 57 .. 4 9 1 69 165 578 Defective Sanitary Fittings 86 86 49 70 .. 18 55 7 104 149 624 272 223 209 190 .. 39 51 23 88 173 1268 ,, Yard Surfaces 98 171 76 47 .. .. 96 5 153 169 815 „ Eaves and Downspouts 158 198 49 53 .. .. 26 2 36 76 598 ,, Manure Receptacles 2 5 ... 1 .. .. .. .. ... 11 19 ,, Urinals 4 ... 2 9 .. .. 106 3 3 6 133 „ Ashbins 125 168 64 64 .. 1 140 8 119 88 777 Smoke Nuisances .. .. .. .. .. 14 1 .. 2 17 Animals improperly kept .. 1 6 ... .. .. 3 .. 1 34 45 Infringements of Bye-laws and Regulations .. 3 4 ... .. 16 .. .. 1 16 40 Offensive Accumulations 11 17 15 4 .. ... 5 l 7 57 117 Sundry other Nuisances 124 30 62 11 .. 65 4 5 1 225 527 Total number of Nuisances 1145 1525 711 700 .. 209 792 85 738 1279 7184 Informal Notices served 379 394 360 338 .. 96 182 26 312 212 2299* Informal Notices complied with 381 303 331 332 .. 93 167 46 296 224 2173 ,, ,, In abeyance 65 54 54 38 .. 10 29 2 44 19 315 Number of aDove for which Statutory Notices issued 75 69 43 30 .. 3 ... ... 35 ... 255 * Not including 444 from the year 1908. 61 TABLE X. Workshops on Register, number of Employees, and visits paid during the year. TRADE. No, of Workshops. No. of Employees. No. of Visits. Baking Powder Manufacturers 1 6 2 Blind Makers 5 8 6 Blacksmiths 8 14 8 Bottlewashers 2 3 2 Bootmakers 18 29 25 Brushmakers 1 1 1 Builders 7 10 6 Cabinet Makers and Upholsterers 18 30 25 Cigarette Maker 1 1 1 Carriage Builders 12 34 24 Chemists 1 2 1 Confectioners 2 9 4 Cycle Works 26 48 40 Carpenters and Joiners 4 10 9 Dentists 7 12 7 Dressmakers and Milliners 227 1080 357 Dye Works 1 3 3 Electricians & Engineers 4 9 7 Film Maker 1 5 1 Florist 2 3 2 Glass Works 2 16 4 Greenhouse & Ladder Makers 4 14 4 Ironmongers 9 14 9 Laundries 59 276 89 Modeller 2 4 9 Naturalist 1 3 1 Pharmacy Works 1 12 3 Photographers 7 57 15 Piano Maker 1 3 2 Picture Frame Maker 6 16 3 Ragpicker 2 3 2 Rubber Works 1 4 7 Saddlers 5 18 7 Scenic Artist 1 3 2 Shop Fitters 4 7 10 Sign Writers 3 14 7 Stonemasons 3 11 7 Scale Makers 2 4 2 Tailors 54 144 81 Umbrella Makers 3 6 6 Watchmakers 3 8 4 Wig Makers 5 7 4 Wood Merchants 5 15 19 Totals 531 1976 828 62 TABLE XI. Food and Drugs Acts Total Number of Samples taken during the year 1909. Sample or Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Milk 208 198 10 2 2 8 Skimmed Milk 5 5 — — — — Separated Milk 6 6 — — — — Butter 177 163 14 4 4 1 Coffee 11 10 1 — — — Cream 11 10 1 1 1 — Rice 7 2 5 — — — Sausages 4 4 — — — — Pickles 4 4 — — — — Citric Acid 4 4 — — — — Tartaric Acid 4 4 — — — — Cream of Tartar 4 4 — — — — Dripping 3 3 — — — — Epsom Salts 2 2 — — — — Lard 1 1 — — — — Vinegar 1 1 — — — — Bread 1 1 — — — — Tapioca 1 1 — - — — Citrate of Soda 1 1 — — — — 455 424 31 7 7 9 63 TABLE XII. Particulars of Samples taken during the ten years 1900-1909 inclusive:— Year. Number of Samples taken. Number Genuine. *Number Adulterated. Percentage of Adulterated. Prosecutions. Total amount of Fines and Costs imposed. £ s. d. 1900 246 230 16 6.5 5 7 5 0 1901 299 274 25 8.3 3 6 6 0 1902 291 261 30 10.4 9 23 1 0 1903 294 268 26 8.8 4 5 16 0 1904 354 317 37 10.5 6 30 15 0 1905 356 320 36 10.0 8 36 13 6 1906 400 351 49 12.3 6 15 12 0 1907 448 413 35 7.8 13 86 8 0 1908 438 384 54 12.0 19 40 12 6 1909 455 424 31 6.8 7 55 13 0 * The term adulterated includes samples found to be not up to standard. 64 TABLE XIII, METEOROLOGICAL RECORD—YEAR 1909. Rein 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 Difference 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. in in. in. January 49° 21° 41°.l 34°.2 37°.6 — 0°.9 43°.1 35°.1 0.74 13 1.20 — .61 February 56° 22° 42°.7 31°.0 36°.8 — 2°.7 40°.4 31°.8 .52 6 .71 — .82 March 59° 13° 43°.4 33°.7 38°.5 — 3°.2 39°.3 36°.8 .22 23 3.33 + 1.82 April 72° 28° 59°.0 39°.5 49°.2 + 2°.0 44°.6 43°.6 .11 13 1.95 + .35 May 83° 34° 64°.2 42°.4 53°.3 + 0°.2 50°.0 46°.9 .39 9 1.07 — .88 June 70° 36° 60°.1 48°.2 54°.1 — 5°.3 53°.0 50°.9 .30 20 2.99 + 1.03 July 78° 45° 67°.2 53°.1 60°.1 — 2°.4 55°.6 60°.9 .92 18 2.89 + .44 August 89° 4-5° 71°.8 53°.1 62°.4 + 0°.8 58°.4 58°.4 .00 12 1.85 — .47 September 72° 39° 60° .9 48°.4 54° 6 — 2°.6 55°.8 54°.2 .25 20 2.99 + .75 October 66° 29° 57°.l 47°.7 52°.4 + 2°4 55°.2 51°.4 .57 24 4.34 + 1.63 November 55= 26° 46°.1 35°.7 40°.4 — 2°.8 47°.5 39°.7 .85 16 .98 — 1.30 December 53° 22° 43°.4 35°.1 39°.2 — 0°.5 43°.2 39°.5 .37 21 3.08 + 1.12 Means and Totals for the Year. 89° 13° 54°.7 41°.9 48°.3 —1°.2 48°.8 45°.8 0.43 195 27.38 The Rainfall for the Year was T61 inches above, and the number of days on which rain fell 35 above the average of 40 years at Croydon. GEO. CORDEN, F.R. Met. Soc., Croydon. TABLE XIV. CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 25th, 1909, and four preceding Years. Year ending March. Average No. of Patients. Provisions. Alcohol. Surgery and Dispensary. Domestic, including Coal and Gas. Establishment and Miscellaneous Charges. Salaries and Wages. 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. Total Ordinary Expenditure. Total Average Cost per Bed. Sinking Fund and Interest. Total Cost per Patient, including Sinking Fund and Interest. £ 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. £ s. d. £ s. d 1905 85 2297 6 7 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 S 17 8 1592 6 3 18 14 8 6651 5 4 78 5 0 2272 3 1 104 19 7 1906 89 2529 0 0 28 8 4 27 16 6 6 3 312 1 9 3 17 1 1414 1 8 15 17 9 1097 19 10 262 12 0 1360 11 10 15 5 9 1995 2 7 22 8 4 7938 14 4 89 3 11 2272 3 1 114 14 6 1907 90 2254 19 6 25 5 1 13 17 7 3 1 536 16 11 5 19 3 1299 16 1 14 6 10 694 13 3 156 16 8 851 9 11 9 11 5 1920 6 0 21 1 9 6877 6 0 76 3 5 2272 3 1 101 8 4 1908 121 2588 1 7 21 7 9 5 16 0 0 11 393 16 3 3 5 4 1493 0 9 12 6 9 1074 16 9 197 9 9 1272 6 6 10 10 4 1997 17 1 16 10 3 7752 8 2 64 1 4 2272 3 1 82 16 11 1909 133 2586 11 8 19 9 0 13 5 10 2 0 501 10 8 3 15 4 1697 9 4 12 15 3 1260 10 11 128 18 10 1389 9 9 10 9 0 2361 9 5 17 15 1 8549 16 8 64 8 5 2101 10 9 80 1 8 During the year 1908-9 the sum of £3,385 17s. 5d. was received from other Local Authorities. 65 C.—REPORT OF THE WORK OF THE BOROUGH HOSPITAL. The total nominal accommodation at the Borough Hospital amounts to 146 beds. In 1909 half of the accommodation in Block F had to be allotted to nurses on account of the insufficient number of beds in the Administrative Block. Owing to a considerable increase in the prevalence of scarlet fever the hospital was under great pressure during the late summer and early autumn. A certain amount of relief was obtained by the transfer of 26 acute cases to the London Fever Hospital and six convalescents to the Mary Wardell Convalescent Home, Stanmore. In spite of that, there were many weeks during which the hospital accommodation was unduly strained. It is, therefore, satisfactory to report that during the year the Council approved of plans for an enlargement of the hospital, and sanction has since been obtained for the necessary loan. The following Table shows the Highest and Lowest number of beds occupied on any one night during each month of the year 1909:— TABLE H. 1. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 165 146 July 152 139 February 164 151 August 143 95 March 146 130 September 128 93 April 138 124 October 156 125 May .. 149 128 November 151 102 June 155 137 December 128 105 During 1909 the average daily number of cases under treat men amounted to 142.4 as compared with 127.1 in the previous year. 66 The following Table gives the total number admitted from the Borough and other Districts during the year 1909;— TABLE H. II. Districts. Remaining at end of 1908. Admitted during 1909. Discharged during 1909. Died during 1909. Remaining at end of 1909. *The Ctoydon Union, cases admitted from Penge .. - 1 1 - - Penge Urban D.C., nonpauper cases 15 113 113 6 9 The Borough of Kingston upon Thames 16 6 21 1 - The Borough of Croydon 127 836 813 32 118 * In the above table cases included under the Croydon Union are only those pauper 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 total number of patients admitted was 956 as compared with 941 in 1908. The following Table shows the comparative admissions during 1909 and previous years. TABLE H. III. Cases admitted during 1904. Cases admitted during 1905. Cases admitted during 1906. Cases admitted during 1907. Cases admitted during 1908. Cases admitted during 1909. Scarlet Fever 235 352 338 562 497† 608‡ Diphtheria 233 178 239 249 354 292 Enteric Fever 12 15 20 10 59 11 Puerperal Fever 1 — — — Pulmonary Phthisis 1 — — 1 __ Other diseases 51 64 47 42 31 45 Total 533 609 644 864 941 956 † Includes five cases sent in as Diphtherial. ‡ Including 26 L.F.H. cases. 67 The following Table gives the number of patients admitted for each disease, the number discharged or died, and average duration of stay in hospital and probable detention in hospital, for the year 1909 :— TABLE H. IV. Disease. Remaining at end of 1908. Admitted during 1909. Discharged during 1909. Died during 1909. Remaining at end of 1909. Average Residence in days. Probable detention in Hospital in days. Fatal Cases. Non. Fatal Cases. NonFatal Cases. Fatal Cases. Scarlet Fever 89 608 589 11 97 18 2 581 47 11 Cases admitted to Hospital as but subsequently found not to be Scarlet Fever - 6 6 - - - 14.3 7 - Diphtheria 64 292 306 24 26 14.2 54 44 4 Cases admitted to Hospital as but subsequently found not to be Diphtheria — 21 18 3 — 4 6 6 9 6 1 Enteric Fever 5 11 11 1 4 — 62 7 55 — Cases admitted to Hospital as but subsequently found not to be Enteric Fever - 4 4 - - - 6 5 Other Admissions — 14 14 - - - 22.6 22 — Total 158 956 948 39 127 — — — — The following Table gives the fatality from each disease:— TABLE H. V. 1907. 1908. 1909. Scarlet Fever 2.5 1.6 1.8 Diphtheria 3.6 8.5 7.4 Enteric Fever 9.5 3.6 8-3 Other diseases 4.8 6.3 6.4 All cases 6.1 3.5 3.9 68 4.—Under "Other Diseases" are included the following:— Disease. No. of Cases. Result. Cases notified as Scarlet Fever but not Scarlet Fever—Total 6 Erythema 1 Discharged. Varicella and Erythema 1 „ No disease observed 4 „ Disease. No. of Cases. Result. Cases admitted as Diphtheria and found not to be Diphtheria—Total 21 Measles and Laryngitis 2 Discharged. Tonsillitis 12 „ Slough after Tonsillotomy 1 „ Bronchitis 1 „ Retro-pharyngeal Abscess 1 „ Laryngitis 1 „ Measles and Broncho Pneumonia 2 Died Congenital Syphilis 1 Discharged. Diseases. No. of Cases. Result. Cases admitted as Enteric Fever but found not to be — Total 4 Pelvic Peritonitis Discharged. Pleural Effusion 1 „ Ulcerative Colitis 1 „ Enteritis 1 „ Disease. No. of Cases. Result. Other admissions—Total 14 „ Infant at Breast 1 Discharged. Acute Rheumatism 2 „ Influenza 10 „ Cerebral irritation 1 „ TABLE H. VI. Illness amongst the staff, 1909:— 1 Scarlet Fever 3 cases. 2 Diphtheria 1 case. 3 Other illnesses requiring treatment 12 cases. Total 16 cases. 69 AMBULANCE. During the year 936 journeys were made in removing patients to the Borough Hospital, including 99 journeys to Penge and Anerley. 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 and other Offices. The sum of £82 is. 6d. was received from the Penge Urban District Council and the Croydon Guardians for ambulance services rendered during the year. MAINTENANCE OF BUILDINGS. During 1909 a new vertical steam boiler was erected in place of the old defective boiler, and a new boiler house erected at the Administrative Block. Various minor repairs to rain water guttering and other parts of Buildings have been carried out. All Wards cleaned down. 70 D.—REPORT ON THE BOROUGH LABORATORY. For the following account of the work of the laboratory I am indebted to Dr. Parsons, the Borough Bacteriologist and Senior Resident Medical Officer of the Borough Hospital. For the first few years of its existence comparatively little use was made of the laboratory as is shown by the following table:— Year. Specimens examined for Diphtheria, Enteric Fever, and Tuberculosis. Borough Cases (outside the Hospital). Hospital Cases. Totals 1897 85 not recorded - 1898 125 not recorded — 1899 not recorded not recorded — 1900 199 248 447 1901 784 885 1669 1902 698 859 1557 1903 1089 1322 2411 1904 2027 2494 4521 1905 2276 4164 6440 1906 2257 2485 4742 1907 2105 5154 7259 1908 3621 4582 8203 1909 3247 4876 8123 The total number of specimens examined in 7909 is somewhat smaller than in 1908, thanks to the diminished prevalence of diphtheria and enteric fever. 71 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 suspected Tuberculosis. 1908 1908 1908 Borough Hospital. Borough Hospital Borough Hospital 2942 4857 42 14 263 5 Total 7799 56 268 DIPHTHERIA. During 1909, 7799, specimens were examined in the Laboratory. Of these specimens about one seventh (1,114) 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 with a view of ascertaining whether the bacillus of diphtheria was absent from the throat or nose. In some cases this organism was very persistent, requiring many examinations extending over many weeks 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 present. Of these, 7.6 per cent, were found, on admission, to have bacilli indistinguishable from diphtheria in the nose, while 1.8 per cent, had similar bacilli in the throat. All these patients were specially isolated in order to guard against the introduction of diphtheria into the scarlet fever wards. A large number of the specimens examined were from cases of sore throat or nasal discharge occuring in children attending elementary schools. In some 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. 71 ENTERIC (TYPHOID) FEVER. The total number of specimens from suspected enteric fever patients amounted to 56, of which were received 42 from medical men in the borough, and 14 examinations were made of patients in the Borough Hospital. The following table gives a summary of the serum re-actions obtained in the laboratory during 1909:— RESULTS OF EXAMINATIONS FOR DISEASES SIMULATING ENTERIC FEVER. 1909. Examinations for Borough. Examinations for Hospital. Total. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions tor all purposes. + — Total + — Total + — Total January 2 2 4 — — — 2 2 4 February 1 4 5 — 1 1 1 5 6 March — 1 1 — — — — 1 1 April — 2 2 — — — — 2 2 May — — — — 1 1 — 1 1 June — 1 1 — — — — 1 1 July — S 5 — — — — 5 5 August — 2 2 — 2 2 — 4 4 September 2 5 7 8 — 8 10 5 15 October 1 — 1 — — — 1 — 1 November 4 6 10 - 1 1 4 7 11 December 1 3 4 — 1 1 1 4 5 First Quarter 3 7 10 — 1 1 3 8 11 Second „ — 3 3 — 1 1 — 4 4 Third „ 2 12 14 8 S 10 10 14 24 Fourth „ 6 9 15 — 2 2 6 11 17 Total 11 81 42 8 6 14 19 37 56 73 TUBERCULOSIS. The number of specimens examined during the year amounted to 268, 5 of these being from patients already in the Hospital. Out of the total number of examinations 65 were found to contain the tubercle bacillus. The following table shows the number of specimens examined for the detection of B. Tuberculosis during 1909 :— RESULTS OF EXAMINATIONS FOR TUBERCULOSIS. 1909. Examinations for the Borough. Examinations for the Hospital. Total. All Examinations. All Examinations. All Examinations. + – Total + — Total + — Total January 7 9 16 — 2 2 7 11 18 February 4 24 28 — — — 4 24 28 March 6 24 30 — — - 6 24 30 April 7 22 29 — — — 7 22 29 May 8 13 21 — 1 1 8 14 22 June 5 18 23 — — — 5 18 23 July 5 10 15 — — — 5 10 15 August 2 8 10 — — — 2 8 10 September 9 17 26 — 1 1 9 18 27 October 4 15 19 — 1 1 4 16 20 November 4 14 18 — — — 4 14 18 December 4 24 28 — — — 4 24 28 First Quarter 17 57 74 — 2 2 17 59 76 Second ,, 20 53 73 — 1 1 20 54 74 Third „ 16 35 51 — 1 1 16 36 52 Fourth ,, 12 53 65 — 1 1 12 54 66 Total 65 198 263 — 5 5 65 203 268 74 RINGWORM. The number of specimens examined for the presence of this parasite amounted to 20, of this number 8 were from patients in the Hospital, Of the total examinations 14 showed the presence of ringworm spores or mycelium and the majority were of the small spore variety. The number of specimens now examined at the laboratory is not so great as formerly, many other specimens being now examined at the Town Hall. MISCELLANEOUS EXAMINATIONS. Various other bacteriological and microscopical examinations were made during the year. These included the examinations of a large number of specimens of urine; of faucial exudation for leptothrix; of brain tissue for meningo-coccus; of sputum for pneumo-coccus; and strepto-coccus; and of various other specimens of blood and morbid fluids. PREPARATION OF MATERIAL In addition to the actual examinations of specimens much time has been occupied in the preparation of material needed for bacteriological work. Thus suitable "outfits" for the transmission of specimens to the laboratory in accordance with the requirements of the Postmaster General required careful preparation. 3089 Diphtheria, 292 Tuberculosis, 124 Enteric—Total 3505, of these "outfits" were supplied during the year for use by the Public Health staff and the medical men of the borough. The making of serum culture media commenced in 1906 for use in the laboratory has been continued this year. The blood is obtained from the Public Slaughter House and prepared for use by the laboratory attendant (E. Hasler) under the direction of the medical officers. 934 dozen tubes of blood serum were prepared in 1909. The material prepared in this way during 1909 if reckoned at the commercial price, viz., 3s. 6d. per dozen tubes, would have cost £163 9s. 0d. In this way a great saving is made in the working expenses of the laboratory. 75 E.— REPORT TO THE EDUCATION COMMITTEE. I beg leave to present the following report, for the year 1909, on the work carried out by the staff of the Public Health Department, in connection with the Public Elementary Schools of the borough. This is the sixth annual report which I have submitted to the Committee, and the second furnished in accordance with the requirements of the Board of Education. • The scope and arrangement of this report are similar to that adopted for the year 1908, which followed generally the suggestions of Circular 596 of the Board of Education. Though considerable progress has been made during the year, much time has again been spent in elaborating our methods and in improving our organisation. SCHOOL BUILDINGS. On December 31st, 1909, there were within the Croydon area:— 19 Provided Schools, including 55 departments, with recognised accommodation for 20,017 children, and 14 Non-Provided Schools, including 34 departments, with accommodation for 5,345 children. The total provision for Elementary School children in the borough therefore amounted to 33 schools, with 89 departments and accommodation for 25,362 children. The number of children on the register on December 31st, 1909, was 24,150. During 1909, the St. James's School (non-provided) was closed, and Tavistock Grove School (provided) opened in substitution. Tamworth Road School, which was reported in 1903 to be so unsatisfactory as to require closure, is still in use, but will eventually be re-built when the general scheme for re-organisation of the schools in this part of the borough matures. Tavistock Grove School, which was opened in September, 1909, affords accommodation for 868 children. In the main this school is similar in type to the last five central hall schools designed for the Local Education Authority by Mr. Carter Pegg, but provision is 76 made for two departments only, namely juniors and "mixed," instead of the three groups for which accommodation is provided in the older schools. Though the building is similar in essentials to some of its predecessors, many minor improvements have been introduced, which have added to its utility as well as rendered it more attractive. The work-room, provided at small expense by making use of some of the space under the roof, is a specially satisfactory feature. It may not be out of place to emphasize the fundamental importance of gradually modifying the curriculum so as to allow a greater and greater share of handwork being undertaken in all our schools. For this there is a sound physiological and medical basis. Not only is manual dexterity a valuable asset to every future citizen, but it is now generally recognised that mental development is to a considerable degree dependent on the education and training of that part of the nervous system which controls the muscles, and especially the muscles which carry out finer movements, such as those of the hands. Not only are " things done," remembered, and understood more thoroughly than what is simply heard or seen, but the final result is of considerably higher educational value. There is also reason to believe that the too implicit reliance on training through the eye and ear, which is so characteristic of the ordinary curriculum, makes for nervous instability and that lack of resourcefulness that is so often found in children who have done moderately well at book work. EQUIPMENT. Owing to lack of funds no further steps have been taken to re-desk the older schools. This is unfortunate, as in several instances the existing desks are unsuitable and are of such uniform size that appropriate seats cannot be found for children that do not happen to be of average size. Under present circumstances one cannot even meet the difficulty by suggesting the provision of single adjustable desks for those children who show signs of incipient spinal curvature. SANITARY CONVENIENCES. These have recently been inspected. The thirty-four schools in the borough are provided with:— 48 ranges of automatically flushed troughs. 8 ranges of automatically flushed separate closet pans. 39 ranges of wash-down closets with separate flushing cisterns to each closet. 77 The last arrangement is the only absolutely satisfactory one, and is now adopted in all new schools. The automatically flushed troughs are from many points of view unsatisfactory, and should be replaced as occasion offers. The troughs at Mitcham Road, Beulah Road, Birchanger Road, and Sydenham Road are the least satisfactory, and should receive attention at an early date. As previously reported, flushing apparatus is required for the urinals at Mitcham Road Boys', Beulah Road Infants', and Dering Place Infants' Schools. At the latter, the entrance from the playground might with advantage be screened from the public street. During the past few months enquiry was made by the Medical Officer, Local Government Board, as to our experience with ordinary wash-down closets in infant schools. Objection had been raised in certain quarters to the provision of such appliances in infant schools on account of the alleged difficulty in getting young children to make proper use of the flushing apparatus. In order to clear up this point an inspection was made of the condition of the lavatories at all the infant schools where wash-down closets had been fitted. For the sake of comparison, the condition of similar closets in the boys' and girls' schools was also noted. The following is the result of the inspection:— SCHOOL LAVATORIES. Schools with a separate flushing cistern to each W.C. School. Total pans of above kind in Infants' Dep’rtm’nt Condition of pans (How many used and not flushed). Total pans of above kind for Girls. Condition of pans (How many used and not flushed). Total pans of above kind for Boys. Condition of pans (How many used and not flushed). St. Michael's 2 ... 5 2 urine 2 ... Holy Trinity 4 ... 5 2 urine 2 ... St. Mark's 4 ... 2 1 urine ... ... Woodside 4 2 soil, 1 urine ... ... 3 ... Tavistock Grove 10 ... 7 1 soil, 2 urine 6 ... All Saints' 3 1 soil, 2 urine 6 2 urine ... ... Winterbourne Road 10 1 soil 10 2 soil 7 Ingram Road 9 6 urine 8 2 soil, 4 urine ... ... Princess Road 8 1 urine 5 ... 4 ... Davidson Road 7 2 soil 14 ... 5 2 soil Bynes Road 8 1 soil, 3 urine 9 2 soil, 7 urine 7 3 soil Totals 69 7 soil, 13 urine 71 7 soil, 20 urine 36 5 soil 78 It will be seen that in all three departments better use might have been made of the flushing apparatus, and it would be well if the attention of the head teachers and the caretakers were called to this point. There was, however, no evidence that any special difficulty arose in the infant schools. As a matter of fact the smaller children require personal supervision when using the lavatories, whatever form of apparatus is installed. ORGANIZATION AND CO-ORDINATION OF SCHOOL AND OTHER PUBLIC HEALTH WORK. The general organization remains the same as in 1908. The medical officer of health is school medical officer, and is assisted by one whole time assistant medical officer (Dr. Sophie Jackson), together with a part time ophthalmic surgeon, who devotes two half-days per school week to the work. The whole time of one clerk is also taken up with school duties, as is also half the time of each of the health visitors. Assistance is also rendered, when required, by other members of the public health staff, and especially by the senior resident medical officer at the borough hospital, who is not only responsible for the examination of the large number of bacteriological specimens sent from school children, but also assists me, when required, in the examination of children at the Town Hall on Wednesday and Saturday mornings. For the present, medical inspection is limited to those children for whom the present code compels us to make provision, together with a variable number of children presented for special examination at the suggestion of the teachers, attendance officers, attendance committee, or magistrates. The children whom the code at present requires us to inspect are those about to leave school and newly admitted infants. It is found in practice that about 20 children can be inspected at a school session, and it is therefore undesirable to hold an inspection until as many as 20 children have matured for inspection. According to the standing orders, the head teachers should give notice when this point has been reached, and it would have been a great convenience if this information had been forwarded more regularly than at present, as it would then have been possible to map out the work of the staff to greater advantage. Until these notices are received we do not know the exact number of children who are waiting inspection, and I am, therefore, unable to foretell how many school sessions will be taken up by each school. It therefore sometimes happens that preliminary arrangements are made for holding inspections for which there are not sufficient children to occupy the whole of the time allotted to the — County Borough of Croydon — —Town Hall— Public health[epucation]department— Plan of Rooms. Sca l e, 8 Feet to an Inch 79 school. Though any superfluous time can in most instances be profitably spent in other ways, by the re-examination of special children or in other investigations, the present system has the disadvantage of reducing the average number of children inspected in a school session. After Easter, 1910, it is hoped that this difficulty will be met by allotting definite days from Easter to the end of July to the various schools in proportion to their number on the registers. During the past year the ophthalmic surgeon has carried out his work in the schools as heretofore. During the latter part of the year the Council granted further office accommodation to the Public Health Department, and it thus became possible to allot a special suite of rooms for use in the examination of school children, and from January, 1910, arrangements were made to modify the work of the ophthalmic surgeon in accordance with the suggestions made in previous reports to the Committee. All the schools in the borough are now divided into two groups of about equal size. At those nearest the Town Hall the preliminary examination of the sight is made by the school medical officer or his assistant, and any children requiring special examination by the ophthalmic surgeon are referred to him at the Town Hall, where he is in attendance on Tuesday mornings. Eye work in the more distant schools is carried out by Mr. Wray as heretofore. Some of the details of administration connected with this department of the school work are not yet fully worked out, but the general features of the scheme prove satisfactory. After twelve months' experience we shall probably be able to decide whether it will be possible to get the children from the more distant schools to attend the Town Hall or whether a second centre should be established for the examination of the eyes of children who live at a distance from the Town Hall. OFFICE ACCOMMODATION. The additional rooms allotted to the public health department have given us very satisfactory accommodation for school purposes, a suite of four rooms being specially set aside for this purpose. The general arrangement of the rooms is shown on the accompanying block plan. The rooms are situated in immediate proximity to my own office, and have a separate entrance from the street in Mint Walk, thus rendering it unnecessary for the children to use the main entrances of the Town Hall. 8o The following accommodation has been provided:— (1). On the east side of the entrance a convenient room has been allotted to the health visitors for clerical work. A bench has also been fitted in this room for microscopic work, more especially for use in connection with the examination of diseased hairs for ringworm spores. Two of the health visitors have been trained to prepare the specimens for examination, and a considerable saving in time has ensued, as cases of doubtful diagnosis can often be promptly dealt with. (2). Lavatory accommodation for school children has been provided under the entrance steps. (3). To the west of the entrance a suite of three rooms provides a waiting room for parents and children, a light and convenient examination room wherein two or more medical officers can work at the same time, together with a smaller room which serves as a private office for the assistant to the medical officer. Hot and cold water has been laid on to each of these rooms, and a convenient sink provided for use in connection with the preparation and examination of microscopic and other specimens. Arrangements have also been made for transforming the small room into a dark room for the use of the ophthalmic surgeon. Taken altogether, the accommodation is now very satisfactory, and enables the staff to carry out their work with greater ease and rapidity than was hitherto possible. The convenient arrangement of the department also enables us to keep a satisfactory check on the children submitted for examination, and to ensure that the records are kept with greater accuracy than was hitherto possible. BOARD'S SCHEDULE OF MEDICAL INSPECTION. No change has been made in the schedule, which was adopted in its entirety. Speaking generally, the use of this schedule has been much the same as in 1908. The duty cast upon Local Authorities by the Education (Administrative Provisions) Act, 1907, is to provide for the medical inspection of children attending schools, and anything like a complete examination has only been made when the history or the general appearance of the child indicated the necessity for so doing. 81 As mentioned in my last report, only quite a superficial inspection is possible in some of the schools, as there is no spare room in which the necessary privacy and freedom from noise can be secured for a more thorough examination of the children. During 1909, the ophthalmic surgeon inspected the schools and dealt with any children suffering from defective vision on the same lines as in previous years. As these visits were made independently of the ordinary routine medical inspections, and for the most part did not include the same groups of children, it has not been possible to tabulate the results on the medical inspection schedules. This omission will, however, be made good in future years. ASSISTANCE TO THE SCHOOL MEDICAL OFFICER AND HIS ASSISTANT. The work of the Health Visitors is set out in detail in Table E. IX. The teachers have continued to render willing and valuable assistance in the work of medical inspection, and I have once more to acknowledge the ready help rendered by the superintendent attendance officer (Mr. Jones) and his staff. Thanks to constant consultations between the attendance officers and the public health staff, it has been possible to carry on the work of the department without friction and with increasing efficiency. ATTENDANCE OF PARENTS OR GUARDIANS. This has been secured as heretofore by written notices despatched by head teachers prior to the medical inspections. The parents or guardians of children inspected were present in 1,564 instances, out of 4,360 children inspected, or 36 per cent. This proportion is one per cent, higher than in 1908. In the infants' schools 1,309 parents or guardians were present at the inspection of 2,945 children, or 44 per cent. This number compares favourably with 38 per cent, present in 1908. Many parents also attended at subsequent inspections to confer with the Medical Officer. 82 DISTURBANCE OF SCHOOL ARRANGEMENTS. This has been inconsiderable in the newer schools where a special room can always be set aside for the purpose. In the older schools much inconvenience to all concerned is more or less inevitable though the head teachers have done their best to mitigate it as far as possible. Now that a considerable number of children suffering from defective vision and other eye troubles are referred for further examination and treatment, I suggest that the Committee should obtain the consent of the Board of Education to reckon attendance at the medical department, at the Town Hall, as attendance at school. Though the gain in grant would be inconsiderable, such an arrangement would be popular with the children and with the teachers, as children who are in regular attendance, and are qualifying for attendance prizes, are very loth to attend at the Town Hall unless such attendance is counted. Article 44 (h) of the present Code permits such attendances to be reckoned for school purposes, and a similar recognition might be sought for children attending the class for remedial exercises at Whitehorse Road School. EXTENT AND SCOPE OF MEDICAL INSPECTION DURING THE YEAR. For the most part children have been selected for medical inspection in accordance with the requirements of Section 58 (b) of the Code. Further experience has strengthened my opinion that the group of children about to leave school is the least satisfactory that could be selected for inspection. The number of actual objections to medical inspection continued small. There was, however, a tendency in some of the schools for children who should have been medically inspected to be kept from school on the day fixed for inspection. Even if these absentees are taken into account, there is no considerable interference with the work of medical inspection, and I am of opinion that both active and passive resistance will soon disappear if left unnoticed. In several instances there is reason to believe that the children were withdrawn from inspection because they were dirty. When this is found to be the case, the difficulty can be dealt with in other ways, and especially by examining such children at a subsequent date without notice. 83 The following table shows the number of children whose medical inspection schedules were completed during 1909:— TABLE E. 1. Total number inspected during 1909. Age. Number of Boys. Number of Girls. Total. 3-4 113 85 198 4-5 344 306 650 6-6 596 644 1240 6-7 289 323 612 7-8 92 104 196 8-9 22 21 43 9-10 3 ... 3 10-11 3 ... 3 11-12 ... ... 12-13 15 9 24 13-14 765 426 1191 14-15 138 49 187 15-16 11 2 13 Total all ages 2391 1969 4360 The corresponding total for 1908 was only 3,659, but in the former year the full staff was only at work rather less than nine months. In addition to the primary inspections, 453 children were reinspected to ascertain progress, 227 children were examined at the instance of the teachers, and 315 were examined for cleanliness. Many other children were also examined while investigating outbreaks of diphtheria, scarlet fever, and other communicable diseases. GENERAL DIRECTIONS TO PARENTS. In 758 instances written directions were sent to parents, while in 2,932 instances printed or verbal directions were given. 84 THE WORK OF THE OPHTHALMIC SURGEON. The following table prepared by Mr. Wray shows the schools inspected by him for eye trouble, the conditions found, and the number of children concerning whom advice was offered:— TABLE E. II. AM Saints'. Beulam Road. Bo-con Road. Christ Church. Der ng Place Ecclesbourne Road. Holy Trinity. Mitcham Road. Oval Road. Princess Road. South Norwood. Sydenham Road. St. Saviour's. St. Andrew's. St. Michael s. St. Mary's. St. Peter's. Tamworth Road. Whitehorse Road. Woodside. Upper Norwood. Total. Anophthalmos .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Anterior synechia .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Aphakia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Blepharitis .. 4 6 2 1 .. .. 5 .. .. .. 4 .. .. .. .. .. .. 4 2 .. 33 Buphthalmos .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Conjunctivitis 13 24 26 2 14 15 6 10 1 16 8 7 1 1 2 2 3 .. 9 2 .. 154 Coloboma of iris .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Cataract .. 1 .. 1 1 4 .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. .. 10 Chalazion .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 Capsulo pupillary membrane .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. l Dacryocystitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Epiphora .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 3 Granuloma of lower lid .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Hordeolum .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 Iridoplegia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Leucoma .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Keratitis Superficial .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Molluscum contagiosum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Nebula .. .. 1 2 2 1 .. .. .. .. 1 1 .. 1 .. .. .. .. 2 .. .. 11 Nystagmus .. .. 2 .. .. .. .. ] .. .. 1 2 .. .. 1 .. .. .. 3 .. .. 10 Ophthalmia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 2 Phlyctenular Ophth .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. 4 Ptosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Paresis .. .. 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 3 Pigmentation of sclera .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Prolapse of Iris .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Perforating—wound of eye—old .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Neoplasm of canthus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Strabismus .. 14 20 6 .. 10 2 10 .. .. 9 9 2 .. .. 1 2 .. 12 7 10 119 Shrunken lens .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Punctured wound of eyeball (old) .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Tuberculosis of lid .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Tubercle of choroid .. .. .. .. .. .. .. l .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Abscess of lid .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 2 Ulcer of Coruea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Opaque nerve fibres .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Word Blindness .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Refracted .. 41 71 1 18 71 .. 38 27 .. .. 46 10 13 .. 6 .. 27 88 29 18 504 Glasses ordered .. 26 28 .. 10 22 .. 16 14 2 .. 22 3 6 1 3 1 14 32 15 4 219 Princess Road—Four special visits Contagious cases. In addition to the above schools, glasses have been ordered for children at Archbishop Tenison’s, Parish Church, Winterbourne Road, Brighton Road, Davidson Road, and St. James', 85 HEIGHTS AND WEIGHTS. The following tables give the average heights and weights of the children measured in 1909. The numbers are omitted for groups of less than ten. TABLE E. III. HEIGHTS OF BOYS. Age. Number Examined. Height in Centimetres. Height in Inches. B.A. Anthropometric Committee, 1883. All Classes. Number Examined. Average Height Inches. 3-4 113 94.6 37.2 ... ... 4-5 344 94.4 37.2 107 38.46 5-6 596 104.8 41.3 201 41.03 6-7 289 110.8 43.6 266 44.00 7-8 92 115.5 45.5 307 45.97 8-9 22 117.8 46.4 1524 47.05 12-13 15 144.0 56.7 1981 54.99 13-14 765 142.2 56.0 2743 56.91 14-15 138 151.0 59.5 3428 59.33 15-16 11 155.2 59.8 3498 62.24 HEIGHTS OF GIRLS. 3-4 85 92.6 86.5 ... ... 4-5 306 98.6 38.6 99 38.26 5-6 644 103.5 40.6 157 40.55 6-7 323 110.5 43.5 189 42.88 7-8 104 114.8 45.2 173 44.45 8-9 21 118.9 46.8 432 46.60 13-14 426 147.6 58.1 206 57.77 14-15 49 148.6 58.5 240 59.80 86 WEIGHTS. WEIGHTS OF BOYS. Age. Number Examined. Weight in Kilos. Weight in Pounds. B.A. Anthropometric Committee, 1883. All Classes. Number Examined. Average Weight. Pounds: 3-4 113 15.3 38.7 ... ... 4-5 344 15.8 34.8 102 37.3 5-6 596 17.8 39.2 193 39.9 6-7 289 19.5 43.0 224 44.4 7-8 92 21.3 46.9 246 49.7 8-9 22 22.2 49.0 820 54.9 12-13 15 34.7 76.5 1786 76.7 13-14 765 36.2 79.8 2443 82.6 14-15 138 40.7 89.4 2952 92.0 15-16 11 43.4 95.4 3118 102.7 WEIGHTS OF GIRLS. 3-4 85 14.1 30.8 ... ... 4-5 306 15.6 34.5 97 36.1 6-6 644 17.3 38.1 160 39.2 6-7 323 18.9 41.8 178 41.7 7-8 104 20.8 45.6 148 47.5 8-9 21 22.6 49.8 330 52.1 13-14 426 38.6 84.7 209 87.2 14-15 49 39.7 87.6 229 96.7 TABLE E IV. BOYS' SCHOOLS. Age. No. exd. Guardians present. Total Kb. in whom Defects found. Nature of Defects. Written Directions to parents Printed and verbal directions Want of Cleanliness. Clothing. Malnutriton Extl. Eye Disease. Nasopharyngeal Obstrn. Ear Trouble Deformity and Spinal Dis. Affections of the Heart. Lung Trouble. Infectious or Contagious Disease. Teeth. Heads. body. Clothing. Defective Footgear. Lateral Curvative. Other Deformities. Phthisis ? Phthisis. Other Lung Trouble. Mentally Defective Sundry Defects Urgent Defects. Other Defects of any kind. Verminous Nits only. Dirty. Verminous Dirty. Defective. Dirty. 12-13 15 4 13 ... ... ... ... ... ... 1 ... ... 2 5 ... ... ... 1 ... ... ... 1 12 ... 11 5 6 13-14 765 89 750 10 45 ... ... 33 40 33 45 113 ... 175 ... 4 13 31 2 9 2 4 646 113 446 248 442 14-15 138 16 120 ... ... ... ... ... 1 4 ... 7 ... ... 5 ... ... 6 ... 3 ... ... 79 13 87 48 61 15-16 11 3 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 9 6 5 929 112 804 10 47 16 6 34 41 38 48 120 88 208 32 4 21 38 2 12 2 5 742 128 153 307 514 *Including Ringworm 1 Impetigo 1 GIRLS' SCHOOLS. 12-13 9 ... 10 ... 5 ... ... ... ... ... ... 1 2 6 ... ... ... 1 ... ... ... ... 10 ... 7 3 6 13-14 426 127 417 16 154 2 6 16 16 7 20 34 46 113 6 4 14 12 ... 5 ... 5 345 69 256 130 244 14-15 49 15 48 1 9 ... 1 ... ... ... ... 1 3 12 ... 1 3 1 ... ... ... ... 38 5 27 14 29 15-16 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 2 ... 2 486 143 477 17 168 2 7 16 16 7 20 36 51 132 6 5 17 14 ... 5 ... 6 395 74 292 147 281 INFANT'S (BOYS') SCHOOL 3-4 113 56 91 1 5 1 ... 1 4 1 4 8 14 28 ... ... 9 1 ... 5 1 1 75 ... 33 8 60 4-5 344 149 308 6 21 7 2 5 5 4 13 34 38 84 7 3 30 12 (1 ?) 2 5 5 5 257 2 167 24 243 5-6 596 277 567 7 52 17 2 10 20 10 26 58 59 182 18 4 47 15 (2 ?) 4 14 11 6 497 21 368 66 433 6-7 289 122 276 10 23 9 5 8 13 14 24 34 23 88 4 3 14 12 (1 ?) 1 6 2 7 261 16 229 37 220 7-8 92 32 92 5 ... ... ... 3 1 4 16 11 35 2 ... 2 2 2 3 ... ... 85 4 76 10 76 8-9 22 7 19 1 ... 2 ... ... 1 2 4 4 2 10 1 ... 1 1 ... ... 1 ... 18 4 13 6 13 9-10 3 1 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 10-11 3 3 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... 1 1 ... 2 ... 3 1462 647 1357 25 106 36 9 24 46 32 175 155 148 428 32 10 103 44 19 33 *20 20 1195 47 889 152 1054 † including Phthisis 4? * Including Ringworm 9 Impetigo 4 Scabies 4 Whooping Cough 3 INFANTS' (GIRLS') SCHOOLS. 3-4 85 40 72 ... 27 1 ... 1 1 1 4 2 11 10 1 ... 5 ... ... 2 2 1 48 ... 27 4 49 4-5 306 139 268 5 90 I 1 5 1 3 14 22 81 9 ... 16 7 (1 ?) 2 8 4 2 234 7 125 23 208 5-6 644 303 607 27 170 I 5 18 11 8 22 66 54 177 12 2 31 14 3 21 9 3 514 32 409 65 481 6-7 32 3 126 315 14 96 2 1 5 1 9 13 42 32 92 7 ... 14 11 1 6 3 5 273 16 214 40 253 7-8 104 44 95 9 39 ... 3 4 3 5 4 10 4 26 2 1 3 2 ... 2 3 ... 94 7 69 15 79 8-9 21 10 21 ... 10 ... ... 2 1 3 2 2 2 11 1 ... ... 2 2 ... ... 1 18 4 14 5 13 1483 662 1378 55 432 5 10 35 18 29 51 136 125 397 32 3 69 36 †8 39 *21 12 1181 66 858 152 1081 † including Phthisis 1? * Including Ringworm 16 Impetigo 1 Whooping Cough 3 Diphtheria 1 Scarlet Fever 1 TOTALS ALL AGES BOYS' AND GIRLS. 4360 1564 4106 107 753 59 32 109 121 106 194 447 412 1165 72 22 210 132 19 89 43 43 3513 315 2592 758 2932 87 As in 1908, these tables show that the weights of Croydon children are on the average below the British Association figures for all classes. The heights, on the other hand, are approximately the same as the British Association figures, though there are slight variations in both directions at certain age groups. As similar results have been reported in previous years, it is worth considering whether the Board of Education would not agree to the omission of these tables in future reports. They take a considerable time in preparation, and seem already to have fulfilled their only useful purpose, namely, the provision of a local standard of heights and weights at school ages. For comparative Anthropological observations, the work of weighing and measuring would have to be done more thoroughly than is compatible with routine inspection work. Moreover, useful comparisons between different groups of children cannot be made unless the heights and weights are correlated with racial characteristics and other information at present not available. Time so saved might be spent on more careful measurements of children attending selected schools and on the repeated weighing of children of poor nutrition in whom a tuberculous taint or insufficient feeding was suspected. GENERAL RESULTS OF INSPECTIONS. With the exception of heights and weights these are summarised in Table E iv. The defects noted at inspections vary much, both in their extent and in their intrinsic importance. The personal equation of the individual observer has also to be taken into account, and it is therefore obvious that no useful purpose would be served byexpressing all the defects in percentages, or by comparing school with school or town with town. The outstanding facts of medical inspections are the existence of a very large amount of remediable physical inefficiency and the necessity of providing means for its amelioriation together with more frequent and prompt resort to the means provided for treatment. WANT OF CLEANLINESS. Condition of the Heads.—Of the 4,360 children inspected, 107 were infected with live vermin at the time of inspection, and 753 other children had "nits," and 59 children had dirty heads apart from vermin. The proportion showing "nits" is a better criterion of the usual condition of the children than the mere observation of 88 the. number showing actual live vermin at the time of inspection. As previously pointed oat most children are specially cleansed for the medical inspection, and some of the worst cases are actuallykept from school to avoid detection. The extent of this trouble too varies with the school and with the season. Thus, during the autumn, surprise visits to Princess Road and Boston Road Schools gave the following results :— TABLE E V. School. Class. No. Examined. Heads Vermin of the Body. Vermin. Nits only. Princess Road I. Boys 24 4 9 5 Infants' Girls 20 6 9 3 III. Boys 23 5 6 6 Girls 18 7 8 5 Total 85 22 32 19 Boston Road I. Boys 23 5 7 4 Infants' Girls 30 11 12 3 III. Girls only 29 ... 13 11 1 Total 82 29 30 8 In addition to head and body vermin most of the Princess Road and Boston Road children were badly infested with fleas. Of this no figures were extracted, though the condition is obviously injurious and objectionable. On the other hand, in many schools the percentage of dirty children is quite small, and even Princess Road and Boston Road would have given more favourable results at another time of year. It is well known that many children attending these schools are neglected during the hopping season. During the year the method of dealing with unclean conditions was the subject of a special report, together with numerous supplementary reports. As a result, the Committee decided to avail 89 themselves of Section 122 of the Children Act, in order that their officers should have greater freedom in examining children in school. They therefore passed the following resolutions:— (а) That in accordance with the provisions of Clause 122 (Sub-Section 1) of the Children Act, 1908, the Medical Officer, the Assistant Medical Officer, the Health Visitors, and the Head Teachers, be directed to examine in any Public Elementary School, provided or maintained by the Authority, the person or clothing of any child attending the School. (b) That, as provided in Sub-Section 5, when notice is given under this Clause by the direction of the Committee to the parent or guardian of, or other person liable to maintain a child, requiring him to cleanse the person and clothing of the child, he be furnished with written instructions describing the manner in which the cleansing may best be effected. Now that the teachers and the officers of the Public Health Department are armed with statutory authority to inspect children there should be no hesitation in increasing the frequency of the inspections and in dealing promptly with suitable delinquents. In addition to passing the above resolutions, the Committee have also modified the Standing Orders, which now read as follows :— 100.—Treatment of Verminous Children. Verminous heads are extremely common in all schools and are a constant source of anxiety to all concerned. The parents of all children attending school should be advised to constantly be on the watch for this condition. Teachers should examine the heads of children on admission and at intervals during the session. Any child found to be affected with vermin should be given one of the cards marked A. If this is not effectual and the child's head is not clean at the expiration of the week, card B should be issued. Should the child be neglected for a further week, card C should be issued and the child excluded from school and reported forthwith to the attendance officer. Children in an extremely filthy condition should be excluded forthwith and the attendance officer attached to the school notified immediately. 90 The following is the text of the Cards, which are a modification of those used by the L.C.C.:— A. Croydon Education Committee. Parents should pay special attention to the hair of school children. Even clean children are liable to be infected with vermin, and this is why it is necessary to examine the hair both at home and at school. To avoid trouble, the hair should be kept as short as possible and combed each night with a fine comb. Girls with long hair should have it tied back while in school. B. Croydon Education Committee. private notice. Date To the Parents or Guardians of I beg to give you private notice that your child's head requires attention. As it is most important that this complaint should be stamped out of our schools, it is expected that the child will be cured within a week. On the other side you will find directions as to treatment. Signed Head Teacher, School C. Croydon Education Committee. Date To the Parents or Guardians of Your child is excluded from school for seven days on account of the condition of head. If he does not return at the end of that time free from all vermin and nits, you will render yourself liable to prosecution. Directions for cleansing heads are given on the other side. Signed Head Teacher, School. 91 On the whole the present standing orders are a distinct improvement on those previously in force in respect to these conditions, but I am still of opinion that Card A should have been given to the parent of every child newly admitted to school, and that Card B should have been issued as soon as any verminous condition was noted. However, this is not a matter of very great importance, as most of the trouble arises with the old offenders, and in those cases Card B or C can be used according to circumstances without the loss of time that would ensue were it necessary to use Card A for each new offence. Probably the greatest difficulty arises from the fact that the standing orders are not absolutely enforced in a few of the worst schools. If one takes a comprehensive view of the whole subject of dirty heads, I am of opinion that while the more flagrant cases have been checked by the activity of the last five years, there is still need for more systematic inspection of heads throughout our schools, together with sustained pressure on the parents of all children found dirty. Though one is loath to urge frequent prosecutions, there is no doubt that a certain proportion of parents are so indifferent to the interests of their own children and the rights of their neighbours' children, that they can only be taught their duty by the aid of the law. I trust that during the current year resort to prosecution in selected cases will make the Committee's new standing orders as effective in practice as they now are in theory. This can be accomplished without difficulty if the magistrates who deal with these cases appreciate the simple fact that prosecutions are undertaken primarily in defence of the children of clean, selfrespecting parents, who naturally object to their little ones associating with verminous and filthy classmates. As a check on the general cleanliness of school children Dr Parsons has again extracted particulars from the hospital notes concerning patients of school age admitted to the borough hospital. During 1909, 400 children entered the wards, and the following is a summary of the condition noted on admission:— Children with clean heads, 194, or 48 per cent. Children with nits on their hair, 139, or 35 per cent. Children with nits and live stock, 67, or 17 per cent. The proportion of quite clean children is exactly the same a in 1908. verminous conditions of the body were noted in 32 instances. 92 It will be seen from the tables that the condition is about as frequent in girls as in boys, thus forming a contrast with dirty heads, which are always more frequent in the girls. This condition is now dealt with in the following way. Every infested child is excluded from school and the following card sent to the parents:— D. CROYDON EDUCATION COMMITTEE. private notice. Date To the Parents or Guardians of Your child is excluded from school for seven days on account of the condition of body and clothing. If does not return at the end of that time free from vermin and nits you will render yourself liable to prosecution. Directions for cleansing are given on the other side. Head Teacher School. COUNTY BOROUGH OF CROYDON. directions for destroying vermin of the body. Take a warm bath, use plenty of soap. Boil all underclothing and iron with a very hot iron all cloth or other garments that cannot be boiled. Special attention should be paid to the creases and folds of the garments as eggs are often deposited in these places. Repeat this process on three successive days and keep a careful watch for any return of the trouble. Should more than one member of the family be infected, it is important that all should be treated at the same time. In many instances bed clothes and bedding are also infested. These can be treated at the Public Disinfecting Station. This will be done free of charge if application is made at the Public Health Office, Town Hall, Croydon. At the same time notification is sent to the Public Health Department, so that arrangements may be made for the disinfection of the premises, including the bedding and any clothing that the parents will submit to this operation. In the more aggravated cases permanent improvement cannot be secured until the whole household can be bathed and have their personal clothing submitted 93 to disinfection. In the smaller tenements this is not always practicable, and I have again to urge the necessity of providing limited accommodation for this purpose at the new disinfecting station. It is certain that so far from impairing the responsibility of parents for the cleansing of their children we should be in a much stronger position if we had to take a case into court, as we could then convince the magistrates that parents who neglected the means provided for cleansing were not using the best available means for rendering their children fit to attend school. CLOTHING. Defective clothing was noted in 121 instances. In most instances this refers to ragged and insufficient underclothing. On the other hand a very large proportion of children are overclothed, and it is a pity there is no easy way of averaging the amount per chdd. As heretofore, opportunity is taken at each inspection for distributing a leaflet on children's clothing. Similar remarks apply to footgear, which were noted as defective in 194 instances. Clothing was dirty, and required cleansing in 106 instances. MALNUTRITION. This is obviously a somewhat indefinite term, but is intended to include children that are not merely under weight but might in addition be suspected to be suffering from insufficient food, the effects of disease or injudicious dietary. I am convinced that the last group is very considerable, and have therefore arranged for the health visitors to give courses of instruction to mothers on this very important subject. Full particulars of these are given in another part of the report. EYE DISEASES. Defects of one kind or another were noted in 412 instances. As already explained, vision was not tested at the General Inspections, in 1909. Most of the defects here noted consisted of inflamed lids, conjunctivitis, squints, or other obvious external diseases. During the year under review, these children were referred to their own doctor or to a special hospital, but in future those requiring the assistance of an ophthalmic surgeon will be referred to Mr. Wray at the Town Hall. 94 NASO-PHARYNGEAL OBSTRUCTION. Enlarged tonsils or adenoids were noted in 1165 children. In many instances the mere fact that the tonsils were enlarged is of little practical importance, but parents are urged to secure treatment whenever the obstruction of the upper respiratory passages leads either to mouth breathing by night or day, and whenever there is a history of recurrent sore throat or of chronic or recurrent ear trouble. The exact number of children for whom operative treatment was urged was not ascertained at the time that the cards were analysed, but from figures supplied by the House Surgeons at the Croydon General Hospital, 1 find that 158 Croydon school children were operated upon at that institution. 1 have again to thank the House Surgeons for kindly supplying me with a list of patients treated week by week for tonsils and adenoids. This information is of practical value, as it enables us to write to the teachers and emphasise the importance of after treatment. EAR DISEASE. This was noted in 72 instances. DEFORMITIES. Lateral curvature of the spine was noted in 22 instances. The rational treatment for this condition consists of remedial exercises. A special class for such exercises was arranged by Miss Appleton, with the valuable co-operation of Miss Higgins. Selected children to the number of 6 attended twice a week for ten weeks during the last quarter of the year. On re-examination of the children by Dr. Jackson, all were found to be improved. These results were so encouraging, that Miss Appleton kindly volunteered to carry on the class herself in 1910, as it was found to be impracticable to secure the services of an assistant. Other deformities were noted in 210 instances. For most of these children little could be done, but in several instances advice was given as to the choice of apparatus which some children were found to have outgrown. AFFECTIONS OF THE HEART. Affections of the heart were noted in 132 children. Many were simply the result of debility, but others were due to injury from rheumatism. Appropriate advice was given in either case. Too 95 great emphasis cannot be laid upon the importance of recognising rheumatic troubles in children. In most instances the only obvious symptom of rheumatic fever in a child is the recurrence of so-called "growing pains." Every child that complains of pains of this nature should be overhauled, as these apparently trivial symptoms are often accompanied by serious heart disease, which could in most instances be arrested if the disease were recognised and treatment secured. LUNG DISEASES. In 14 instances phthisis was diagnosed at the inspection, and in 5 additional children this disease was suspected. Other lung diseases were noted in 89 instances. Hygienic advice was tendered to the parents of all these children. The rule followed in respect to phthisis is to exclude all children with active mischief, as they are considered to be a danger to others. Children with quiescent disease are excluded from school or not, according to circumstances. When the home conditions are such that the children could be properly looked after, exclusion is advised until convalescence is fully established. When the mother goes out to work, or the home is otherwise unsatisfactory, children are allowed to attend school at an earlier stage in their recovery. The means for dealing with children of this sort cannot be considered satisfactory until a class for physically defective children has been established. COMMUNICABLE DISEASES At the routine inspections communicable diseases were diagnosed in 43 instances. These included ringworm 26, impetigo contagiosa 6, scabies 4, whooping cough 6, diphtheria 1, and scarlet fever 1. These numbers are, of course, in addition to the children who are specially examined on account of the known prevalence of some communicable disease in the school. MENTAL DEFECTS. Forty-three or one per thousand children were noted to be mentally defective. In addition, a number of infants entered as "very dull" may prove, on further observation, to be mentally slightly defective. 96 DENTAL DEFECTS. The prevalence of dental trouble is shown by the following table. TABLE E VI. BOYS. Age. Number Examined. Urgent Defects of Teeth. Other Defects of Teeth. Number with sound Teeth. Percentge with sound Teeth. 3.4 113 ... 33 80 70.8 4.5 344 2 167 175 50.9 5.6 596 21 368 207 34.7 6.7 289 16 229 44 15.2 7.8 92 4 76 12 13.0 8.9 22 4 13 5 22.7 12.13 15 ... 11 4 26.7 13.14 765 113 446 206 26'9 14.15 138 13 87 38 27.5 15.16 11 2 9 ... ... GIRLS. 3.4 85 ... 27 58 68.2 4.5 306 7 125 174 56.8 5.6 644 32 409 203 31.5 6.7 323 16 214 93 28.8 7.8 104 7 69 28 26.9 8.9 21 4 14 3 14.3 13.14 426 69 256 101 23.7 14.15 49 5 27 17 34.7 15.16 2 ... 2 ... ... 97 Respecting the importance of securing treatment, I cannot do better than quote the following extracts from a circular recently issued by the British Dental Association:— "This condition represents a great amount of unnecessary suffering, inattention to work, and loss of school-time, on the part of the children. Furthermore, dental caries, although in itself not an immediately dangerous disease, is the forerunner of many grave conditions. Diseased teeth in early childhood are a direct cause of malnutrition, and hence of an arrest of both mental and physical development at the age when growth is making the most urgent demands on the organs of digestion ; the poisons produced in the mouth cause inflamed and enlarged glands in the neck, and thereby pave the way for tuberculosis ; and the general health is severely impaired by the constant swallowing of the products of putrefaction and the germs of disease which abound in unhealthy mouths. It has been shown that the serious complications of scarlet tever are much more common and severe in the case of children with diseased teeth and unhealthy mouths. A detailed examination of the children in a large London County Council School proved that those with unhealthy mouths were as a rule unhealthy in appearance, under the average in weight, and below the average for their age in school-work. In fact, the serious consequences of dental caries, which is especially a disease of childhood, are now generally recognised by medical men and those having the care of large numbers of children. Among the practical consequences of neglect are rejection for the public services, naval, military, and civil; and increase of unemployment, on account of physical unfitness, in all vocations of life. For many years dental surgeons have been employed in a large number of Poor Law Schools, and the medical officers of several of these schools have testified to the great benefits which accrue to the children, and have recognised the improved general health of the school. Much might be done to diminish the prevalence of dental disease by teaching dental hygiene to the children, and enforcing the daily cleansing of the teeth. These two recommends 98 tions were made by the Admiralty and War Office InterDepartmental Committee on Physical Deterioration. It is quite certain that, if they were carried out, the total amount of dental disease would be much reduced, and the problem of treatment brought within more manageable limits. The spending of comparatively small sums on the teaching of dental hygiene would be the highest form of economy; the teaching should be given by the school teachers themselves, who should receive instruction by means of lectures given by dental surgeons. However, the utmost that may be done in the way of prevention is not likely to do more than ameliorate the evil, and the question of actual treatment remains for consideration. The British Dental Association wishes to lay special emphasis on the particular portion of the Report of the Special Sub-Committee of the Education Committee of the London County Council which deals with this matter. There can be little doubt that the establishment of school clinics of a modest character, for the simple treatment of children's teeth, would not only be a great boon to the children themselves, but would prevent at the outset many serious conditions. The maintenance of a healthy mouth would go far towards allowing the children to reach maturity with a physique that would enable them to earn their living in the face of industrial competition, and thereby save them from being thrown upon charity or the State for partial or complete maintenance at an early age. It would in the long run be the truest economy." Suggestions as to dental treatment are made in a later part of this report. METHODS EMPLOYED OR AVAILABLE FOR THE TREATMENT OF DEFECTS. During 1909 the Public Health Department continued to undertake the treatment of ringworm and minor skin complaints. RINGWORM. The arrangements described in my previous annual reports have continued in force during the past year. The following table shows the number of cases supervised by the Public Health Department during 1909. 99 TABLE E. VII. RINGWORM, 1909. Total number outstanding Jan. nth, 1909 Scalp 122 136 Body Total number reported during 1909 Scalp 252 392 528 Body 140 Total number freed during 1909 Scalp 308 446 446 Body 138 Total number outstanding Jan. 10th, 1910 Scalp 66 82 82 Body 16 On the whole the results for the year may be considered highly satisfactory. The more serious cases are certainly less frequent than formerly, and the number of children excluded from school at the end of the year was only 82 as compared with 136 twelve months previously. Of the 392 new cases 273 were treated at the Town Hall, 63 by application of X-rays, 210 by drugs, while a further 32 of the previous year's cases were also given X-rays. Altogether 1,390 attendances were made by children at the Town Hall in connection with the treatment of this disease. The methods adopted for the treatment and supervision of ringworm have been so fully described in previous reports that it is unnecessary to discuss them further on this occasion. TREATMENT OF EYE DEFECTS. As already mentioned, the new organisation did not come into force until 1910. During 1909, however, I was instructed by the Committee to obtain prices for the supply of suitable spectacles for school children at a fixed price. Samples and prices were secured from reliable opticians, who undertook to supply spectacles equal in quality to the sample submitted, and in accordance with the prescription given to the patient. All the samples received were compared by the ophthalmic surgeon, with a result that an arrangement was entered into with Mr. J. F. Wolfle to supply school children at the following prices:— Spectacles with spherical lenses 1/9 „ with piano-cylindrical lenses 2/9 „ with sphero-cylindrical lenses 3/9 100 ACTION TAKEN TO PREVENT SPREAD OF INFECTIOUS DISEASES. The method of dealing with notifiable disease is dealt with in the report to the Sanitary Committee of the Council. During the year the undermentioned cases have been dealt with by my department :— TABLE E. viii. Cases of illness reported by School Teachers or Attendance Officers:— Illness. ISt Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Measles 205 91 28 23 347 Mumps 54 45 12 42 153 Whooping Cough 206 196 80 35 517 Chicken-pox 111 95 47 278 531 Sore Throat 113 93 107 94 407 Ringworm 122 84 41 71 318 Other Cases 172 130 104 154 560 Totals 983 734 419 697 2833 Cases of illness reported to Education Committee by the Public Health Department:— Illness. ISt Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter, Totals, Scarlet Fever 79 151 130 150 510 Diphtheria 72 49 50 58 229 Enteric Fever 2 1 1 3 7 Measles 202 98 46 18 364 Mumps 62 38 9 38 147 Whooping Cough 240 334 55 25 654 Chicken-pox 137 117 29 395 678 Sore Throat 104 56 117 90 367 Ringworm 153 93 68 78 392 Impetigo 79 59 49 68 255 Scabies 7 20 12 14 53 Other Cases 9 14 5 59 87 Total 1146 1030 571 996 3743 In many instances the above reports dealt with the exclusion of several children. 101 WORK OF THE HEALTH VISITORS. The five health visitors have largely been employed in visiting houses where non-notifiable infectious diseases have been reported by school teachers, and in generally assisting in the work of medical inspection. The number of visits paid in connection with this part of their duty is shown in the following table:— TABLE E. ix. Visits to houses where the following Diseases have been reported. 1st Visits. 2nd Visits. Measles 398 37 German Measles 8 1 Mumps 142 17 Whooping Cough 706 77 Chicken-pox 598 36 Sore Throat 677 245 Ringworm 387 906 Verminous Heads 31 7 Verminous Bodies 11 2 Impetigo Contagiosa 385 560 Scabies 33 54 Other Diseases 573 311 Totals 3949 2243 Cultures taken 1490 — Visits paid to Elementary Schools 262 — Number of children prepared for medical inspection 4804 — Number of children prepared for re-inspection 421 — Visits paid to homes to obtain further information concerning children inspected in schools 237 79 Visits paid to the homes of school children for purpose of giving advice 537 212 As the number of children seen at the Town Hall has increased, it has been found necessary to slightly vary the districts allotted to each health visitor, so that one of the staff may be on duty at the Town Hall on all occasions when children are presented for special examination. The general work has also been rearranged, so that the Senior Health Visitor is responsible to the Medical Officers for the work of this part of the staff. 102 Since 1903 the Health Visitors have delivered addresses to suitable audiences on "The care of young infants and domestic hygiene." During the past winter it was thought desirable to somewhat vary this work, and to bring it more specifically into relation with a scheme for medical supervision of school children. It was therefore decided to arrange for the delivery of a short course of three lectures on "The health of the school child." In order to emphasize the relation of these lectures to medical inspection, it is intended to arrange for their delivery at various schools throughout the borough. So far, this has been attempted at Oval Road, where the co-operation of Mr. Field, Miss Metcalfe, and Miss Joyes, secured an audience of about 45 parents on three occasions. The lectures evoked considerable interest, and useful discussions followed. I hope as opportunity offers to arrange for similar conferences at the other schools in the Borough. In the appendix will be found a somewhat modified syllabus of the lectures which I suggest may be reprinted for distribution to the parents. It is only right to add that in the preparation of the section on diets and food values I have obtained much valuable assistance from the writings of Dr. Niven, of Manchester SCHOOL CLOSURE. During the year 1909 five infant schools were closed in accordance with Article 45 (t) of the code. The prevalence of measles or whooping cough accounted for each of these closures. EXCLUSION OF CHILDREN FROM SCHOOL. During the year 45 children were excluded under Article 53 (b) of the code. This is in addition to the large number dealt with in accordance with the ordinary Standing Orders of the Committee. PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. At the end of the year the following Croydon children were under treatment in residential institutions outside the Borough Blind children 9 Deaf children 4 Mentally defective children 4 Epileptic children 5 103 At present no serious attempt is being made to deal with the problem of the mentally defective child. While the funds at the disposal of the Committee for educational purposes are so limited I do not feel that any useful purpose would be served by discussing any scheme for the establishment of a special school. Certainly as a matter of educational economics better return can be insured by expenditure on normal children. On the other hand, if the mentally defective are regarded, as they should be, from a social standpoint there is little doubt that permanent institutional care must eventually be provided. This would be one way of thinning the ranks of the unemployable. AUXILIARY CLASS. In June, 1908, the Committee opened a small class at Whitehorse Road for the reception of children whose mental progress was retarded, and who could not be satisfactorily dealt with in ordinary schools. This class was intended for children whose education for one reason or another had been neglected and for those who could not be taught to read and write without more individual attention than is possible in an ordinary class. On the other hand it was not intended to admit children who were obviously mentally defective, though it could not be expected that the selection of children would in all cases be made with absolute accuracy, and in a few instances children were purposely admitted on trial so that one might judge from experience what their mental condition really was. The following is the result up to the end of 1909. In all 16 children have been admitted. Four have been transferred back to ordinary schools, two have left for other reasons, and ten were in attendance in December, 1909. Of the ten remaining in December, seven are likely to be transferred to ordinary schools, and three are mentally defective. It was hoped that during the coming summer the Committee would have been able to transfer this class to Grange Wood where facilities would have been afforded for increasing its-scope and adding to its usefulness. The Committee has not however found it possible to make any provision for this extension in the current estimates. NECESSITY FOR FURTHER TREATMENT. This subject was dealt with at some length in my last annual report. I then stated that while the present arrangement for securing medical treatment for the poor left much to be desired, we 104 could meet the more urgent needs discovered by school inspection if adequate provision were made for the prompt and efficient treatment of skin, eye, throat, ear and teeth defects. For diseases of the skin in school children, which are mainly infectious, satisfactory provision has already been made by the. Borough Hospital Committee. The re-arrangement of Mr. Wray's work will also meet most of the requirements in respect to eyes. With respect to throats, ears and teeth, the Committee decided last summer to approach the General Hospital and to enquire if special facilities would be granted for the treatment of school children. To this the Hospital Committee demurred, as while anxious in every way to meet the wishes of the Education Authority they were of opinion that the general treatment of elementary school children did not fall within the scope of their work, and that it would be unfair to exploit the honorary staff in order to meet public requirements. At the end of 1909 a special investigation was made into a limited number of cases respecting the extent to which treatment was secured. For this purpose, live typical schools were selected, namely, Whitehorse Road, Brighton Road, Mitcham Road, Princess Road and Davidson Road. The children for whom advice was tendered were divided into three classes, namely:— (1) Those needing medical or surgical attendance. (2) Those needing a dentist. (3) Those for whom hygienic advice sufficed. The following table shows the result of the enquiry :— MEDICAL TREATMENT REQUIRED. TABLE E x. School. Number of Children. Treatment secured. Yes. ? No. Whitehorse Road 12 9 1 2 Brighton Road 9 3 - 6 Mitcham Road 9 9 - - Princess Road 13 8 1 4 Davidson Road 20 10 1 9 Totals 63 39 3 21* *Including 5 where poverty was the alleged reason. 105 DENTIST ADVISED. School. Number of Children. Treatment secured. Yes. ? No. Whitehorse Road 30 5 4 21 Brighton Road 20 1 1 18 Mitcham Road 10 3 - 7 Princess Road 15 1 2 12 Davidson Road i 2 3 - 9 Totals 87 13 7 67* *Including 32 where poverty was the alleged reason. GENERAL HYGIENIC ADVICE GIVEN BY MEDICAL OFFICER. School. Number of Children. Yes. Advice followed No. ? Whitehorse Road 1 1 - - Brighton Road 9 4 - 5 Mitcham Road 5 4 - 1 Princess Road 24 23 - 1 Davidson Road 15 9 1 5 Totals 54 41 1 12* *Including 1 where poverty was the alleged reason. Generally speaking, it will be seen from these figures, which are fairly typical, that hygienic advice has been followed to as considerable an extent as one could reasonably have expected. It is in respect to dental trouble that the need for treatment in Croydon is most evident. Concerning the importance of this matter 1 can add nothing to the extract from the British Dental Association's circular already quoted in an earlier part of this report. The whole matter, however, is one of very great difficulty, and I should be glad if the Committee would seriously consider the various alternatives. Those that suggest themselves to me are four in number:— (1) The Committee may decide to allow things to remain as they are. This cannot be considered a satisfactory solution, and is economically unsound, as much permanent ill-health in after life is due to neglect of dental hygiene. 106 (2) The Committee might consider the advisibility of throwing the responsibility for treatment on the Guardians of the Poor, who, according to a recent decision of the Local Government Board, are at present the responsible authority. This is shewn by a letter addressed by the Local Government Board to the Guardians of the Havant Union, which reads as follows:— Local Government Board, Whitehall, S.W. Sir, I am directed by the Local Government Board to advert to your letter of the 26th ultimo with reference to the question raised by Mr. L. E. W. Stephens, District Medical Officer in the Havant Union, in regard to medical attendance upon school children. In reply the Board direct me to state that it appears to them that if the children do in fact need medical attendance, though not for acute illness, and the parents cannot obtain it, the Relieving Officer's Order for the attendance of the District Medical Officer should not be refused. The Board direct me to add that if any children should be found to require operation or specialized attention, they would be prepared to approve of payments to the Medical Officer or other special arrangements. I am, Sir, Your obedient Servant, John Lithiby, Assistant Secretary. The Clerk to the Guardians of the Havant Union. The Croydon Guardians have not, however, any staff for dealing with dental out-patients, and if provision has to be made at public expense, it would doubtless be more convenient and not more costly for the local Education Authority to take the matter into their own hands. (3) The Committee might follow the example of Kettering and endeavour to establish a dental provident dispensary where children could be treated at fixed fees. The following is an outline of the Kettering scheme:— kettering urban district education committee. Scheme for the Provision of Dental Treatment for the Elementary School Children of Kettering. A room to be provided by the Education Authority, and fitted up by the Dental Surgeons. 107 Hours of Attendance.- Monday, Tuesday, Wednesday, Thursday and Friday, 9 to 10 daily; Saturdays, 9 to 12 o'clock. Scate of Maximum Fees.—Extractions is., with gas (ti.e Dental Surgeon to decide whether gas is necessary or not) 5s. Stoppings 2s. 6d. (except in cases where nerve treatment was necessary, then by arrangement). Reduced rate for more than one extraction- Regulation Cases.—By arrangement. Charts.—Showing the proposed work and the total fee would be given to each patient before work was commenced (except in cases of emergency). Fees to be paid for each operation at the time it was done and not left until the completion of the case. If possible the School nurse to assist the Dental Surgeons by making appointments, cleaning instruments, helping with gas cases, etc. June, 1907. I am informed, however, that this scheme has not been successful in practice, as very few parents avail themselves of the services of the selected dentists. (4) The scheme which most clearly commends itself to my judgment is the appointment of a dental surgeon who would attend at the Town Hall on one or two mornings a week, and assist in inspection for the next twelve months. By that means we would secure treatment for the absolutely urgent cases, and be able to gauge the amount of time required for treating school children, together with the expense to the local authority and the possibility of securing payment from the parents. At the end of twelve months, we should be in a position to consider the matter in all its bearings, and bring before the Council a scheme based on the experience thus gained. Failing the adoption of this plan, I am of opinion that the Committee might usefully consult local dentists as to the practicability of the provident dispensary scheme. EXAMINATION OF PUPIL TEACHER CANDIDATES. Fifty-five young persons who desired to become pupil teachers were medically examined during the year. Of these 54 were passed and one rejected. 108 SPECIAL EXAMINATION OF TEACHERS. Eight teachers were interviewed on one or more occasions by the medical officer. In three instances the interview had reference to the existence of infectious disease at the home of the teacher, while in five cases the Committee required special reports concerning the health of the teacher. TRUANTS. Eighteen children were examined before despatch to truant schools, and the necessary certificates given to the police. EXAMINATION OF CHILDREN UNFIT TO ATTEND SCHOOL. A large number of children referred by the Attendance Committee, attendance officers or teachers, in addition to others specially selected by the medical officers, attended at the Town Hall for medical examination. Owing to the very indifferent accommodation provided for school purposes prior to December, 1909, it was impossible to keep a reliable list of children seen in this way. Among those seen were the following, many being seen on several occasions:— Children seen for the first time in 1909— Diseases of the Lungs 46 „ Hear 7 „ Ear 3 „ Skin 3 Mentally defective children 12 Other nervous diseases 13 Deformities 11 Examined for special schools 12 Various diseases 17 124 Re-examination of children seen in 1908— Diseases of the Lungs 7 „ „ nervous system 5 Other diseases 3 15 H. MEREDITH RICHARDS, M.D., Medical Officer. 109 APPENDIX. Syllabus of Lectures to Parents. THE HEALTH OF THE SCHOOL CHILD. School children must be healthy if they are to make the best use of their school time. The attention of parents is therefore directed to tho following rules for health. Care of the Skin.—The skin cannot be kept healthy unless a warm bath is given at least once a week. Daily cold sponging of the neck and chest strengthens healthy children and helps to ward off " colds." The hands should be washed before each meal to avoid swallowing harmful dust and dirt. Care of the Teeth.—Decayed teeth injure digestion, and are harmful in other ways. Children should use a tooth brush the last thing each night. Clean teeth rarely decay. Read the leaflet on Teeth. Too much pappy food is bad for the teeth. Care of the Hair.—The hair of young children is best worn short. Older girls should have the hair tied back or plaited. Every child's hair should be carefully combed with a fine comb each week in order to guard against the risks of vermin. Clothing.—The most suitable outfit for a school boy consists of:— (1) A combination garment. (2) Knickerbockers. (3) Woollen stockings. (4) Jersey of knitted wool. (5) Lace boots. (6) Straw hat or cloth cap. The combination garment should have sleeves, and reach just below the knees. The best material is wool, either woven or one of the unshrinkable flannel mixtures. If flannelette is used it must be the kind that will not burn. Ordinary flannelette is dangerous. For children in the baby class the combination is best replaced by a vest and drawers. 110 The knickerbockers should be of corduroy or stout serge, and supported by braces, or by being buttoned to a bodice in the case of infants. Suspenders should be used for the stockings. A knitted vest is a useful addition in the winter time, when an overcoat is also required. While it is a mistake to endeavour to harden children by exposing the limbs, too many garments hinder the free movement of the body and the proper use of the lungs. Over-clothing also leads to sweating during exercise, and consequent risk of chills. The boots should be of the natural shape of the foot, straight on the inside edge, and allow plenty of room for the toes. Girls should be dressed in the same way as boys (suitable knickerbockers included), but with the addition of a kilt supported from the shoulders by a cotton bodice. If preferred the jersey and kilt may be replaced by a long-sleeved yoke frock reaching just below the knee, made. of material suitable for the season. Patterns for making suitable garments for boys and girls may be borrowed from the Health Visitors. Sleep.—All underclothing should be changed at night. A child should be accustomed to sleep on its side, in a quiet room with an open window. Children in the infant school require twelve hours' sleep, and half-an-hour's rest in the middle of the day. Older children require at least ten hours. Medical advice should be sought for children who persistently snore at night. Care of the Eyes- —Children must not sew, read or write in a bad light. When reading or working, children should sit with their feet on the floor, their backs straight, and the book or work not less than a foot from the eyes. Children who constantly work in awkward, twisted positions are likely to get twisted backbones. The attention of the head teacher should be directed to any child who cannot see properly, or has pain after reading, in order that the sight may be tested by the medical officer. The Feeding of School Children.—Food is required for growth and to enable the body to do its work and keep up its warmth. 111 To enable food to perform its work it must be chewed and digested, hence children require not only sufficient, suitable food, but regular meals and sufficient time for meals with subsequent rest for half an hour. Children should not eat standing and be hurried back to school directly they have finished the. last morsel. The bowels must also be relieved each day. Three necessary kinds of Food which must all find their place in the daily supply:— (1) Starches and sugars. Such as potatoes, rice, sugar, etc (2) Fats. (3) Meat and meat substitutes. In selecting articles for diet we must consider:— (1) Their digestibility. (2) Their food value. (3) Their cost, i.e., the amount we can buy for a given sum. The real (strength giving) value of common food materials is best estimated by enquiring how much we can buy for say is., judged on this basis Flour, bread, oatmeal and sugar are the four cheapest articles of food. Other really cheap foods are peas, lard, dripping, margarine and herrings. A satisfactory diet must contain all three great classes of food stuffs. Some articles of food, such as milk, contain all three. Meat and Meat substitutes.—‘Pieces" of lean meat can be bought for 3d. a lb. and are just as nutritious as a joint which costs twice as much. Hence pieces" made in a stew or meat pudding are twice as good value as a joint. 112 There are also other substitutes (some cheap and some dear) for joints-of meat, thus a 5-lb. joint costing 2s. 6d. can be replaced by the consumption of :— S. d. 5-lbs. "pieces" at 3d. 1 3 5-lbs. ox liver at 4d. 1 8 18 herrings 1 0 3-lbs. cheese at 6d. 1 6 11-lbs. flour at 7-lbs. for is. 1 7 7-lbs. oatmeal at 2½d. 1 6 15-lbs. bread at 1½d. 1 10 6-lbs. split peas 7 5-lbs. lentils at 2½d. 1 0 S-lbs. haricots 1 1 12 quarts milk at 4d. 4 0 12 quarts skim milk at 2d. 2 0 61 eggs at Id. each 5 1 This table shows the wisdom of baying "pieces," herrings, cheese, peas and beans. Many of the foods in this table can not only take the place of a joint, but contain large amounts of other valuable food materials. Thus cheese contains as much fat as it does "meat." while peas and beans contain not only "meat," but more than half their weight of starch. Cheese, peas and beans should therefore be eaten in larger quantities than is now usual. The second class of food which requires consideration is Fat.—This includes butter, margarine and dripping, lard, suet. Margarine is as nutritious as butter, and only one-third the cost. Dripping is well worth buying. It is an extremely valuable food for children who will take it readily with bread or toast or as dripping pudding. Suet pudding should be given to children who dislike fat meat. Starch and Sugars.—Sugar, bread, rice, oatmeal, etc., are usually eaten in sufficient quantity. It should be noted that jam is not a cheap substitute for butter. There is as much real food in I-lb. of butter as in 3-lb. of jam. If cost is an object it is cheaper and better to substicute margarine or dripping for butter. Fats must be given to growing children, and cannot be replaced by sugars and starch. Avoid patent foods, which are invariably dear. Cook potatoes in their jackets in order to improve their flavour and make use of all the food. 113 Fluids for Children.—Milk is the best drink for a growing child. Skim milk is valuable if full milk cannot be spared. If any other beverage is given let it be cocoa, and not tea or coffee. Water should be given at dinner. Beer or spirits should never be given except under medical advice in case of illness. Cooking.—Not only choose the right material, but make it digestible and appetising by proper cooking. Advice may be sought from the Health Visitors, who will give you directions concerning the preparation of cheap, nourishing dishes, which have all been carefully selected for the purpose. HEALTH REPORT for 1909 of the Croydon Rural District by the Medical Officer of Health. Submitted to the Council 3rd February, 1910. WALLINGTON William Pile, Ltd., 5 and 6, Danbury Terrace. Croydon Rural District Council. HEALTH REPORT FOR 1909. Gentlemen, I beg to submit to you my twelfth Annual Report upon the Health and Sanitary condition of the District. Appended are the statistical tables, the report on the working of the Factory and Workshops Act, in accordance with the requirements of the Home Office, and a tabulated list of all Dairies, Cowsheds, etc., situate within the district. The Death Rate, 9.0 per thousand of population, is much lower than in any previous year which I have been your Medical Officer. The Birth Rate is also very low being 25 0 per thousand of population. The year 1909, generally speaking, has been a fairly healthy one, with no very 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. 3rd February, 1910. CONTENTS. PAGES. I.—Area and Population 7 to 10 II.—Vital Statistics 11 to 17 III.—Infectious Disease 17 to 25 IV.—Preventive Measures 25 to 27 V.—Isolation Hospital 27 to 31 VI.—General 32 to 36 VII.—Inspector's Work 37 to 38 Appendices— Statistical Tables 40 to 59 Factory and Workshops Act 60 to 65 Tabulated list of Dairies, etc. 66 to 68 Index 69 to 71 REPORT. I.—AREA AND POPULATION. The District consists of eight parishes, and the total area is '21,001 acres. The largest Parish is Coulsdon, with 4,314 acres, and the smallest Wellington, 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 1909 the population was estimated to be 64,688, but, omitting all institutions, the corrected number was 60,300, of which number 28,825 were males and 31,475 were females. The number of inhabitants in the three large institutions has increased from 2,468 in 1891 to 3,564 in 1909. There has been, however, a decrease of 78 since the middle of 1908. 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 „ 1906 11,614 „ 1907 13,086 „ 1908 11,362 „ 1909 11,905 8 It will be seen that there has been an increase of 8,175 in the number of houses occupied during the last 28 years. The subjoined table shows the number of houses in each parish in the years 1891, 1901, 1902, 1903, 1904, 1905, 1906, 1907, 1908, 1909, and also the increases between the years 1891 and 1901, 1901 and 1902, 1902 and 1903, 1903 and 1904, 1904 and 1905, 1905 and 1906, 1906 and 1907, 1907 and 1908, 1908 and 1909, and 1891 and 1909. 9 Parish. Number of Houses Increase Between 1891 and 1901 Between 1901 and 1902 Between 1902 and 1903 Between 1903 and 1904 Between 1904 and 1905 Between 1905 and 1906 Between 1906 and 1907 Between 1907 and 1908 Between 1908 and 1909 Between 1891 and 1909 In 1891 In 1901 In 1902 In 1903 In 1904 In 1905 In 1906 In 1907 In 1908 In 1909 Aldington 132 131 120 120 138 134 139 139 139 140 1 11 - 18 -4 5 - - 1 8 Boddington 44 2 751 825 933 1035 1169 1442 1480 1700 1858 309 74 108 102 134 273 38 220 158 1416 Coulsdon 537 818 903 1001 1244 1365 1512 1643 1720 1817 281 85 98 243 121 147 131 77 97 1280 Mitcham 2055 2743 2934 3076 3337 3806 4177 4874 5131 5359 688 191 142 261 469 371 697 257 228 3304 Morden 138 186 195 196 210 206 205 224 236 225 48 9 1 14 -4 -1 19 12 -11 87 Sanderstead 96 203 211 250 309 342 425 492 545 577 107 8 39 59 33 83 67 53 32 481 Wallington 710 1063 1168 1272 1388 1464 1546 1564 1668 1714 353 105 104 116 76 82 18 104 46 1004 Woodmansterne 81 105 120 120 140 146 183 206 223 215 24 15 - 20 6 37 23 17 -8 134 4191 6000 6476 6968 7801 8632 9629 10622 11362 11905 1809 476 492 833 831 997 993 740 543 7714 10 From this table it will be observed that activity in building has taken place at Mitchain with 228 and Beddington with 158 new houses. 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 1909 it is estimated at 5.0. The average number of persons to each inhabited house remains, as a general rule, fairly constant for each locality, though varying considerably in different parishes, according to the class of house erected. In many parts of the district "tenement" houses or houses let in flats have been built, and these houses have, of course, a considerably larger number of inmates. More particularly is this the case in Mitcham. The “Natural increase” during the year was 968, as against 903 in the previous year. In 1897 the increase was 474 „ 1898 „ 392 1899 „ 379 „ 1900 „ 460 „ 1901 „ 543 „ 1902 „ 552 „ 1903 „ 730 „ 1904 „ 763 „ 1905 „ 879 „ 1906 „ 921 „ 1907 „ 986 „ 1908 „ 903 „ 1909 „ 968 And this has amounted to 11,612 since the census in 1891. The "Natural increase" was greatest in 1909 in Mitcham with 478, Coulsdon with 174, and Beddington with 136. 11 Excess of Births over Deaths. Deaths in 1909. Births in 1909. Excess of Births in 1909. Addington 5 14 9 Beddington 58 194 136 Coulsdon 49 223 174 Mitcham 318 796 478 Morden 11 29 18 Sanderstead 15 54 39 Wallington 80 165 85 Woodmansterne 9 38 29 545 1513 968 II.—VITAL STATISTICS. Births. The number of Births registered in the District was 1513, as compared with 1487 last year. Of this number 33 children were registered as being illegiti- mate. This gives an illegitimate birth-rate of 2.1 per cent, of total births, which should be considered satisfactory. No. of Illegitimate Births. Percentage. Beddington 3 1.5 Coulsdon 4 1.7 Mitcham 22 2.7 Morden 2 6.8 Sanderstead 1 1.8 Wallington 1 0.6 The birth rate for the entire District was 25.0, as compared with 25.8 last year. The birth rate in England and Wales in 1909 was 25.6 per thousand of the population, which is 09 per thousand below the rate in 1908, and lower than the 12 rate in any other year on record. Compared with the average in the 10 years, 1899-1908, the birth rate in 1909 shows a decrease of 2.2 per thousand. Registered Births and Birth Rates. Parish. Estimated Population middle of 1909. Registered Births. Birth Bates. 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 Addington 695 11 11 7 11 14 16.4 15.8 101 15 9 201 Beddington 8740 123 157 162 176 194 21.0 22.2 22 8 22.0 22.1 Coulsdon 9300 150 183 163 200 223 21.2 23.2 19.1 22.7 23.9 Mitcham 27900 642 721 716 863 796 311 31.9 27.7 32.3 28.5 Morden 1125 20 29 24 26 29 19.5 28.2 21.8 220 25.7 Sanderstead 2700 28 35 49 53 54 16.3 17.1 16.5 20.6 20.0 Wallington 8750 155 155 138 139 165 19.8 18.5 16.4 16.0 18.8 Woodmansterne 1090 21 29 44 19 38 27.2 30.5 41.5 16.5 34.8 60300 1150 1320 1303 1487 1513 25.7 26.7 24.6 25.8 25.0 Deaths. Exclusive of those Deaths which occurred in Public Institutions situated within the district, the deaths registered during the year numbered 545. 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 104. The mortality corresponds to a death rate of 9.0 per thousand of population, as against 10.1 last year, 9.7 in 1907, 11.3 in 1906, 9.6 in 1905, 11.0 in 1904, and 10.4 in 1903, and as against an average of 11.1 during the ten years 1899-1908. 13 *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 1909 was 208. Mortality at Different Ages. Infantile Mortality.—The number of infants under the age of one year who died during 190!) was 130, as against 1'26 in 1908, 170 in 1907, 199 in 1906, 138 in 1905, and 158 in 1904, the infantile mortality rate, therefore, being 85 per thousand births, as against 84 in 1908, 103 in 1907, 124 in 1906, 98 in 1905, and 123 in 1904, and an average of 111 in the ten years 1899 to 1908. The deaths of children under the age of one year, numbering 130, gives a percentage rate of 23.8 of the deaths at all ages, as against 21.5 in 1908, 26.1 in 1907, 29.3 in 1906, 26.0 in 1905, and 29.3 in 1904. Mortality.* Parish. Population estimated to middle of 1909. Deaths. Death Bates. 1905 1906 1907 1908 1909 1905 1906 1907 1903 1909 Addington 695 11 4 7 2 5 16.4 5.7 10.1 2.9 7.1 Beddington 8740 39 48 55 56 58 6.7 6.8 7.7 7.0 6.6 Coulsdon 9300 39 79 69 88 49 5.4 100 8.1 100 5.2 Mitcham 27900 270 308 286 330 318 13.0 13.6 110 12.3 11.3 Morden 1125 15 9 12 10 11 14.4 8.7 109 8.4 9.7 Sanderstead 2700 8 11 16 13 15 4.7 5.3 6.8 5.0 5.5 Wallington 8750 62 96 76 77 80 7.8 11.5 90 9.0 9.1 Woodmansterne 1090 5 6 8 8 9 6.4 6.3 7.5 6.9 8.2 60300 449 561 529 584 545 9.6 11.3 9.7 10.1 9.0 14 The rate of Mortality in England and Wales among infants under one year of age to 1000 registered births, was 109, which is 11 per 1000 below the rate in 1908. The rate in 1909 was lower than the rate in any other year on record. Compared with the average in the ten years 1899-1908, the rate of infantile mortality in 1909 showed a decrease of 29 per 1000. The deaths of children between the ages of one and five years, numbering 57, gives a percentage of 10.4 of total deaths, as against 12.8 in 1908, 10.7 in 1907, 12.9 in 1906, 7.7 in 1905, and 8.0 in 1904. The deaths accurring in persons over 65 years of age, numbering 141, give a percentage of 25.8 of total deaths, as against 26.0 in 1908, 22.9 in 1907, 21.5 in 1906, 27.4 in 1905, and 22.8 in 1904. Parish. Children under One Year. Children between One and Five. People over 65 Years. 1906 1907 1908 1909 1906 1907 1908 1909 1906 1907 1908 1908 Addington .. 1 .. 1 2 1 .. .. 1 3 1 2 Beddington 11 5 6 17 6 7 6 4 14 14 19 22 Coulsdon 14 22 17 9 9 7 6 4 18 13 26 18 Mitcham 118 92 92 84 54 37 48 41 47 53 69 69 Morden 1 .. 2 3 .. .. 3 1 2 6 2 2 Sanderstead .. 3 1 4 1 1 3 .. 3 2 2 3 Wallington 19 13 7 9 6 4 7 7 31 25 32 23 Woodmansterne 4 4 1 3 .. 1 2 .. 2 1 1 2 Totals 167 140 126 130 78 58 75 57 118 117 152 141 15 Causes of Deaths. The deaths registered during 1909 included— 17 from Measles. 10 „ Scarlet Fever. 6 „ Whooping Cough. 18 „ Diphtheria. 16 „ Diarrhœa. 2 „ Typhoid Fever. 2 „ Puerperal Fever. 40 „ Phthisis. 10 „ Influenza. 19 „ Injuries (self-inflicted or otherwise). 97 „ Lung Complaints. 50 „ Cancer (malignant disease). 8 „ Alcoholism (cirrhosis of liver). The Zymotic Death Rate is a term commonly applied 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. During the year 1909 the deaths from these complaints numbered 71, the Zymotic Death Rate therefore, being 1.1 per 1,000 of population, as compared with 1.5 in 1908, 1.6 in 1907, 1.7 in 1906, 0.9 in 1905, and 1.5 in 1904. The deaths from Phthisis numbered 40, as against 50 last year, 51 in 1907, 42 in 1906, 38 in 1905, and 37 in 1904. The Phthisical Death Rate is, therefore, 0.6 per thousand of the population, as against 0.8 last year. 0 7 in 1907. 0.7 in 1906, 0.6 in 1905, and 0.7 in 1904. The deaths from Pulmonary Diseases numbered 97, as against 94 last year, 97 in 1907, 88 in 1906, 84 in 1905, and 126 in 1904. This gives a Death Rate of 1.6, as against 1.6 last year, l.4 in 1907, 1.4 in 1900, 1.5 in 1905, and 2.6 in 1904. 16 The deaths from Influenza numbered 10 as against 14 last year, 14 in 1907, 8 in 1906, 7 in 1905, and 10 in 1904. This gives a Death Rate of 0.1 per thousand of population, as against 0.2 last year, 0.2 in 1907, 0.1 in 1906, 0.2 in 1905, and 0.2 in 1904. To various forms of violence, whether self.inflicted or otherwise, 19 deaths were due, in all of which cases inquests were held. This gives a death Rate of 0'3, as against 0.3 last year, 03 in 1907, 0.3 in 1906, 0'2 in 1905, and 0'48 in 1904. The Death Rate in England and Wales in 1909 was 14.5 per 1000 of estimated population, and this was 0.2 per 1000 below the rate in 1908, and lower than the rate in any year on record. Compared with the average in the ten years 1899.1908, the death rate in 1909 showed a decrease of 1.6 per 1000. Birth Bate, Death Bute, and Analysis of Mortality in the year 1909. 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 oneyear to 1000 Births. Cols. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. England and Wales 25 6 14.5 1.12 0.00 0.35 0.09 0.14 0.20 0.06 0.28 109 76 Great Towns 25.7 15.6 1.42 0.00 0.48 0.11 0.15 0.24 006 0.38 118 143 smaller Towns 24.8 14.5 1.08 000 0.33 0.09 0.16 0.17 0 06 0 27 111 England and Wales, less the 218 Towns 25.6 136 0.80 0.00 0.21 0.06 0.14 0.16 006 0.17 98 Croydon Rural District 25.0 9.0 1.17 0.00 0.28 0 16 019 0.09 0.06 026 85 17 Deaths in Institutions. The Deaths in Institutions situate in the District numbered 208, as against 161 in 1908, 239 in 1907, 204 in 1906, 178 in 1905, and 210 in 1904. The deaths included:— 18 from Phthisis. 19 „ Cancer (malignant disease). 33 „ Lung Complaints. 28 „ Heart Diseases. 83 „ Brain 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 continued to be a notifiable disease until June, 1909. In the summer of 1894 it was considered necessary that Diarrhoea should, for a short period, also be considered a notifiable disease. Owing 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. In April, 1907, Cerebro-Spinal Meningitis was also made a notifiable disease for twelve months. The Infectious Disease (Prevention) Act is also in force in this District. During the year 883 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 472 were due to Measles. Consequently, 18 excluding this disease, there were 411 cases of other notifiable diseases, as against 475 in 1908, 591 in 1907, 439 in 1906, 397 in 1905, and 333 in 1904. Reference to Table III. 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. Infantile Summer Diarrhcba. During the summer 10 deaths were registered as occurring from Infantile Summer Diarrhoea. It is a very satisfactory feature that the deaths from this complaint have fallen from 71 in 1906 to 40 in 1907, to 21 in 1908, and from that number to 10 this year. This gives a death rate of 0.16 per thousand of population, as against 0.36 last year, and 0.79 in 1907. In every case a careful enquiry was made, and reference to Table XIII. in the appendix will show the circumstances, feeding, and family history of the victims to this, to some large extent, preventable disease in 1909. The parishes and roads (or streets) invaded during the past nine years will be found in Table XIV. Scarlet Fever. During the year 212 cases of Scarlet Fever were notified, which is only three cases more than were notified last year, and is 105 less than the number notified during 1907. Of the 210 cases the disease had a fatal 19 ending in only 10 cases. One hundred and sixty-five cases were removed to the Isolation Hospital. Diphtheria. During the year 150 cases of Diphtheria came under the notice of the Sanitary Authority. Of this number 124 were removed to the Hospital, and the remainder, viz., 26, were nursed at home. Of the number removed to the Hospital, 16 died, giving a death rate of 12.9 per 100 cases; of those remaining at home 2 died, giving a death rate of 7.6 per 100 cases. Mitcham, as might be expected with its larger and poorer class population, was responsible for no less than 108 cases, Beddington coming next with 19 cases. It may be fairly assumed that schools influence very materially the incidence of the disease. More particularly is this influence felt when the epidemic of Diphtheria is not of a very severe type, and this is frequently noticed at the commencement of an epidemic. It should be remembered that for practical purposes cases of Diphtheria may be divided into two classes, viz., Clinical Diphtheria, in which all the symptoms of true Diphtheria are found at once in the patient, and the patient can at once be segregated, and all infection by direct contact be avoided for persons who are not immune to Diphtheria. These cases offer but little trouble to the Sanitary Authority, as all necessary steps can be at once taken to prevent any further spread. But it is to the second class of case, viz., the Bacteriological Diphtheria, in which the symptoms are so vague and so indeterminate that the true diagnosis of the disease can only be arrived at by bacteriological examination, that is the source of most outbreaks. Now, in a certain 20 number of cases it is by no means uncommon for no medical man to be called in, and, unfortunately, in some few instances, even when medical assistance has been sought, none of the secretions of the throat or nose have been submitted to bacteriological examination for the determination of the disease from which the patient is suffering, and it is these cases, which are possibly of a mild nature, that are the occasion of much of the increase in the number of cases of Diphtheria, more particularly in the case of children who have been so little affected during the few days of their unrecognised condition that they are allowed to return to school in a highly infective condition. The Council has placed at the service of all medical practitioners in the district, not only a supply of Diphtheria Antitoxin, but also has made the necessary arrangements for having a bacteriological examination made free of charge, so that on the score of cost no reason should now exist for any medical practitioner not availing himself of the facilities placed at his disposal. The Council, it would be well here to mention, has done this most excellent service in the way of securing early detection and treatment of this most fatal form of . disease since 1901, and it was, I believe, one of the first, if not the first, Councils to take such steps. With regard to a certain class of cases which in themselves are not either typically clinical or bacteriologically true Diphtheria, the difficulty in dealing with them arises. The symptoms are practically only identical with an ordinary case of sore throat, possibly associated with some slight nasal discharge, and on bacteriological examination of swabbings from the throat 21 or nasal passages there are found the so-called pseudo diphtheritic or Yon Hoffman bacilli. Now, bacteriologists say that there is no connection, directly or indirectly, between the bacillus of Klebs Loffler (the true Diphtheria) and the bacillus of Von Hoffman (the pseudo Diphtheria); this is true from an academic point of view, but it is a coincidence that in many outbreaks of Diphtheria at schools it has been found that a large number of the children in an invaded classroom have the bacillus of Von Hoffman in the throat or nasal passages, and that it is impossible to find that the children themselves have been ill at all. It is also a remarkable fact that in a great number of cases where repeated bacteriological examinations of the throat have been made throughout the whole of the illness, the Klebs Loffler bacilli has alone been found during the earlier weeks, although every endeavour has been made to find co-existing with the Klebs Loffler the Yon Hoffman; still, as the case approaches convalescence the Klebs Loffler bacillus disappears and the Yon Hoffman appears. Now, excluding the direct evidence of bacteriologists with regard to the relationship of the two bacilli, it would seem, from a purely clinical point of view, that the one bacillus is merely an attenuated form of the other, and it is most desirable that some definite decision amongst sanitarians should be come to as to what should be done in all cases where the bacillus of Von Hoffman alone is found. Personally, I am inclined to consider and treat them as mild cases of true Diphtheria, and not to confine the term "Diphtheria" to merely those cases where the Klebs Loffler bacillus 22 alone is found, but to treat and consider all these cases as coming under the generic team of Diphtheria. It is interesting to note that the infective condition in patients who either have the true or pseudo bacillus of Diphtheria has been prolonged owing to the existence of decayed teeth, and in many cases where I have been able to remove the teeth the bacilli have very rapidly disappeared. During the year it was noted that in 73 per cent. of the cases of Diphtheria decayed teeth were found to be present. No case is discharged from the Hospital until such time as all congestion of the throat or fauces has disappeared, or where there has been any cough or any discharge, such patient is not considered free from infection until cured ol these sequelas, as well as the absence of either of the bacilli associated with the disease on two swabbings on following days. In attempting to trace outbreaks of Diphtheria during the last few years, I have been struck with the large number of cases which have occurred as a result of infection from a primary case which has not been recognised, nor has the individual even been appreciably unwell, but in whom I have discovered in many instances either the bacillus of Diphtheria or the existence of some one or other of the nervous sequelae associated with an attack of Diphtheria, and that, in addition to the usual forms of paralysis, that there have been dilations of the pupils, which do not react readily to light; this dilation of pupils I find existing in a large number of cases sent in to the Hospital for treatment in the earlier stages of disease. It cannot 28 be too forcibly urged that in all cases of sore throat which may suggest the possibility of Diphtheria, antitoxin should be at once given, pending the result of an examination of swabs of the throat, as in this way much valuable time in the treatment of the disease will not be lost, and the sooner the antitoxin is used the greater the chance of ultimate recovery of the patient is assured. It would be well to controvert a statement that one hears very often, viz., that the Diphtheria antitoxin sometimes kills the patient by inducing heart failure. Now what really happens is, firstly, that the case has not come under treatment sufficiently soon, and therefore the dose of antitoxin has not been given sufficiently early to ensure complete recovery, but it has prevented the immediate death of the patient, and has given the patient a chance which, without the antitoxin, it would not have had of ultimate recovery. The poison of Diphtheria, although local at first, soon becomes a constitutional one, and unless counteracted by the administration of antitoxin, may act upon the muscular walls of the heart, inducing a condition of fatty degeneration (myocarditis). Occasionally, however, such degeneration is not found upon post-mortem examination, and the death of the patient may be due to heart failure, owing to paralysis of the cardiac branches of the par vagum, or possibly the little understood condition status lymphaticus may exist. It is noticeable that most cases of failure of the heart occur between the end of the first week and the end of the third week of the disease, and that in such cases, where vomiting occurs of a "coffee ground" material, death is always to be expected. 24 Typhoid Fever. A large decrease also took place in the number of Typhoid Fever cases notified during the year, viz., 9, as against 16 last year, 15 in 1907, and 33 in 1906. Five of these cases were removed to the Isolation Hospital. Of the 9 cases the disease had a fatal ending in 2 cases. Phthisis. A decrease took place in the number of deaths registered as occurring from Phthisis, viz., 40, as against 50 last year. During the year I have examined the sputum of 41 persons, with a positive result in 31 cases. Disinfection has again been largely carried out in the rooms occupied by Phthisical persons, and the clothing, bedding, etc., has been systematically dealt with at the Council's Disinfecting Station. Erysipelas. A slight decrease took place in the number of cases of Erysipelas notified, viz., 33, as against 36 last year. Three of these cases were removed to the Isolation Hospital. Of the 33 cases, 2 had a fatal ending. Puerpebal Fever. During the year 5 cases of Puerperal Fever were notified, as against 10 last year. Cerebro-Spinal Meningitis. Two cases of Cerebro-Spinal Meningitis were notified during the year, both cases occurring in the parish of Mitcbam, one case being a child of 2½ and the other in a child of six months. One case was removed to the Isolation Hospital. 25 Measles. During the year it was deemed advisable to discontinue Measles as a notifiable disease, and the notification of this disease therefore ceased during June. The number of cases notified or reported during the first six months of the year were 472. Seventeen deaths were registered during the year as occurring from Measles. IV.—PREVENTIVE MEASURES. During the year 388 patients were admitted to the Isolation Hospital at Beddington Corner, including 90 patients from neighbouring authorities. 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 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. Ihese, unfortunately, are the cases which prove the nuclei of almost every epidemic. Immediately on notification being received of the existence of cases of Scarlet Fever, Diphtheria, Typhoid 26 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. Any 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. 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 of their freedom from possible infection. 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. 27 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. During the year 355 houses and 8,740 articles were 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 896 such examinations have been made. While with regard to Diphtheria it is the custom to consider each case infective until the bacteriological examination shows the throat to be free from the true or pseudo-diphtheritic bacillus. V.—ISOLATION HOSPITAL. The Isolation Hospital, which is situated at Bed, dington Corner, was opened at the beginning of March; 1899, and since that date '2,788 patients have been admitted. Accommodation.—At the time the Council approved of the plans for the erection of the Isolation Hospital, 28 the population of the district being about 28,000, it was thought that it would be sufficient if accommodation was provided for 28 patients, viz., 10 Scarlet Fever cases, 10 Diphtheria cases, 4 Typhoid Fever cases, and 4 beds for observation purposes. Between the approval of the plans by the Local Government Board and the completion of the Hospital, a very material increase had taken place in the population of the district, so that almost from its being thrown open for the reception of patients, the accommodation proved unequal to the demand. In each succeeding year the shortage of beds became more pronounced, and in 1905 a very considerable enlargement took place by the provision of an additional Scarlet Fever Pavilion of 22 beds. At this time the hand laundry was converted into a steam laundry, and also some additional dormitory accommodation provided in the Administrative Block. In 1907 and 1908 very great pressure was placed upon the resources of the Hospital, indeed, on many occasions it was unavoidably overcrowded, and in April, 1909, after much consideration, the Council decided to apply to the Local Government Board for sanction to considerably increase the accommodation of the Hospital itself, and, in addition, to provide quarters for a Resident Medical Officer. The Local Government Board, however, not entirely agreeing with all the proposals for extension, reduced the number of beds to be provided, and considerably curtailed the scheme of enlargement of the Administrative Block. 29 However, part of the scheme of extension put forward by the Council seems to be in a fair way to be carried out, and it is hoped that within the next six months there will be in working order a new Pavilion of 1'2 beds- Staff.—The Staff consists of— 1 Matron 1 Assistant Matron 10 Nurses 2 Laundresses 2 Engineers 5 Servants 5 Wardmaids. 1 Seamstress. 1 Gardener Porter and Portress Patients.—During the year 388 patients have been admitted, of which number 228 were Scarlet Fever 151 ,, Diphtheria 5 ,, Typhoid Fever 1 was Cerebro-Spinal Meningitis. 3 were Erysipelas Twenty of these patients were admitted by arrangement with other authorities, and 70 were admitted from Merton. Of the 388 patients admitted, 357 were discharged as cured, and 31 died (7 from Scarlet Fever, 21 from Diphtheria, 1 from Typhoid Fever, 1 from Cerebro Spinal Meningitis, and 1 from Erysipelas). Very careful examination of the throat, nasal passages, and the teeth of every patient admitted to the Hospital was made, and it was found that out of the 379 Scarlet Fever and Diphtheria patients admitted, 206 had 30 enlarged tonsils, 29 had adenoid growths, 5 had nasal polypi, 31 had had attacks of tonsilitis, 4 Scarlet Fever and 3 Diptheria patients had had previous attacks of the same disease for which they were admitted, and 43 were found to be suffering from both Scarlet Fever and Diphtheria. 81 During the year, after admission to the Scarlet Fever wards, it was found that several cases Whooping cough, measles, chicken pox, and ringworm were coincident complications of the disease. Parish. Scarlet Fever. Diphtheria. Typhoid Fever. Cerebrospinal Meningitis. Erysipelas. Total. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Addington .. .. 1 1 .. .. .. .. .. .. 1 1 Beddington 24 .. 15 .. .. .. .. .. .. .. 39 .. Coulsdon 26 2 2 .. .. .. .. .. .. .. 28 2 Merton 47 .. 23 5 .. .. .. .. .. .. 70 5 Mitcham 84 2 96 14 4 .. 1 1 3 1 188 19 Morden 7 .. 1 1 .. .. .. .. .. .. 8 1 Sanderstead 6 1 1 .. .. .. .. .. .. .. 7 1 Wallington 9 .. 7 .. 1 .. .. .. .. .. 17 .. Woodmansterne 9 2 1 .. .. .. .. .. .. .. 10 2 Cases admitted by arrangement— Caterham 16 •• 4 •• •• •• .. •• •• 20 •• Totals 228 7 151 21 5 1 1 1 3 1 38S 31 32 VT.—GENERAL. Water Courses.—The condition of all water courses is kept under the constant supervision of your officers. House lie fuse Collection—'J he collection of house refuse has been again extended during the year, and there is practically no part of the district which is without a frequent and adequate collection. Nuisances have been dealt with with regard to the deposits made in this district of house refuse, which is brought in, both by road and rail, from the Metropolis. Legal Proceedings.—In the following case legal proceedings were taken:— Particulars. Result. For contravention of the Bye laws for securing the decent lodging accommodation of persons engaged in picking fruit, vegetables, etc. (two summonses) Fined £2 and costs on each summons. REGULATED TRADES. (1) Dairies, Cowsheds and Milkshops. There were 102 premises registered under the Dairies, Cowsheds and Milkshops Order, 1885, at the end of the year. This is 9 more than the previous year. A very considerable amount of attention is paid to all the dairies, cowsheds, milkshops, and the milk supply generally in the district. During the year 527 visits of inspection have been paid. 33 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 a healthy and natural manner, and that no preservatives whatever should be used. It will be found that if milk be properly cooled immediately, it will keep sweet for a considerable time, provided that any utensil which is used for its reception, either in milking or subsequent handling, is kept perfectly clean. An appendix will be found in which the state of every dairy, cowshed, etc., is set forth. (2) Slaughterhouses. There are 1(5 slaughterhouses in the district, this being one less than in the previous year. All slaughterhouses are regulated by the bye-laws of the Council. The total number of visits paid to these premises during the year was 317, and on 8 .occasions complaint had to be made of uncleanliness. (3) Bakehouses. There are 32 bakehouses in the District. This is 2 less than the previous year. (4) Piggeries There are 35 piggeries in the district. This is the same number as in the previous year. 34 All the piggeries are receiving special attention from your officers, but several complaints were received during the hot weather respecting the piggeries, particularly referring to those in the Eastlields, Mitcham. Parish. Dairies. Cowsheds. Milkshops. Butcher's Shops. Slaughterhouses. Piggeries. Bakehouses. Total. Addington .. 2 .. .. .. .. .. 2 Beddington 1 3 4 5 1 2 5 21 Coulsdon 5 10 11 9 5 2 5 47 Mitcham 12 8 26 18 7 27 16 114 Morden .. 4 .. .. .. 4 2 10 Sanderstead 2 4 .. 1 .. .. .. 7 Wallington 2 2 6 6 3 .. 4 23 Woodmansterne .. .. .. .. .. .. .. .. Totals 22 33 47 39 16 35 32 224 Housing of the Working Classes Act. During the year 6 houses were dealt with under the Housing of the Working Classes Act. In four instances the houses were put into a satisfactory condition, and the other two houses were voluntarily closed, and remained so at the end of the year. Notification of Pulmonary Tuberculosis. No system of notification, voluntary or otherwise, with regard to human tuberculosis is in operation in the district, except with regard to pauper patients, when the cases are notified under the Public Health (Tuberculosis) Regulations, 1908, but in many cases the sputum of tuberculosis persons has been submitted to bacteriological examination, and disinfection of the rooms and clothing is periodically carried out. Notification of Births Act, 1907. The Notification of Births Act, 1907, has not been adopted, although I recommended to the Council the advisability of so doing. 35 Medical Inspection of School Children. The medical inspection of school children is carried out by the Education Department of the Surrey County Council, but I have in many instances been called in to see children who have been suspected to be suffering from infectious or contagious disease, and my services are always available for this purpose on an application from the Heads of the various schools. The sanitary condition of the schools within the area of the Croydon Rural District has received ample attention. SANITARY SURVEYOR'S DEPARTMENT. I am indebted to Mr. Chart for subjoined information :— Sewage Disposal Works. The use of the new contact bed has considerably improved the condition of the land filtration area by the relief afforded it, but it will be necessary, owing to the increasing population, to extend these beds during the ensuing year. Sewer extensions are being proceeded with at Smithambottom Lane and new roads abutting thereon, and Hayes Lane and Welcomes Road, Coulsdon, to obviate the necessity of draining the houses to cesspools; a new outfall sewer being constructed through the Woodcote Valley to Purley to receive the first-named sewer. 36 New Streets and Buildings. The number of new streets and buildings for which plans have been deposited during the year have been as follows:— New Streets. Public Buildings. Houses. Other Buildings. Total. Addington .. .. .. .. .. Beddington 1 .. 204 36 241 Coulsdon 5 2 196 25 228 Mitcham 5 2 368 27 402 Morden .. 1 2 .. 3 Sanderstead 3 .. 38 6 47 Wallington 2 2 103 10 117 Woodmansterne •• .. 5 1 6 Total 16 7 916 105 1044 The following new streets have been made up and taken over during the year:— In the Parish of Beddington. Beddington Grove. In the Parish of Coulsdon. Foxley Hill Road. Cross Road. Elm Road. Foxley Gardens. Hillside Avenue. Purley Vale. Silverdale Road. Sunnydene Road. In the Parish of Mitcham. Devonshire Road West. Rutland Road. Graham Avenue. In the Parish of Sanderstead. Sanderstead Hill East. Sanderstead Hill West. In the Parish of Morden. Queen's Road. Stanley Road. Queen's Place. 37 VII.—INSPECTORS' WORK. Subjoined appears a summary of the Inspectors work during the past year. It will be seen that 6,396 visits have been paid by them, as against 8,798 last year, 10,469 in 1907, 9,660 in 1906, 8,905 in 1905, 7,904 in 1904, and 8.083 in 1903. 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 trying duties. Summary of Inspectors' Work for the Year 1909. Inspectors. White Payne Rabbetts Total Total number of visits paid 1394 2412 2590 6396 Number of complaints received and investigated 102 133 78 313 Number of premises inspected 379 365 563 1307 Number of nuisances discovered 190 146 361 697 Nuisances abated without report 151 100 283 534 ,, ,, after report 39 42 90 171 Preliminary notices served 147 123 161 431 Legal notices served 39 14 25 78 Notices followed by legal proceedings — 1 — 1 Character of Work Done— Houses dealt with under the Housing of the Working Classes Act - - 6 6 Houses cleansed and repaired generally 55 32 61 148 Ventilation of houses improved 3 5 - 8 Overcrowding abated — 6 9 15 Defective roofs repaired 21 12 38 71 Houses under-pinned (damp proof course inserted; or damp walls remedied 11 5 15 31 Eaves guttering renewed or repaired 9 11 25 45 Water-closets renewed or repaired 23 15 57 95 Water-closets provided with water for flushing 2 2 82 86 Privies orearth-closets re-constructed, improved or abolished 1 3 1 5 Houses supplied with water from the main - 1 1 2 38  Inspectors. White Payne Rabbetts Total Water cisterns or tanks cleansed or covered 8 2 26 81 Yards of houses paved with impervious material 16 8 16 40 Paving of yards repaired 8 14 20 87 Floors of sculleries paved or repaired 17 10 25 52 Ashpits or dustbins provided 22 81 77 130 Additional w.c. provided 1 — — 1 Cesspools abolished or filled up 1 15 1 17 Cesspools cleansed 5 41 — 46 Houses at which drains were tested 84 72 36 142 Houses at which drains were found defective... 81 51 30 112 Houses at which drains were re-constructed or new provided 9 16 36 61 Houses at which drains were cleansed, ventilated, trapped or repaired 28 60 109 192 Number of drain tests made in course of work done under the two previous headings 27 63 80 170 Houses at which inspection chambers in drains were provided 11 15 20 46 Stables provided with drainage 2 2 — 4 Premises at which animals improperly kept were removed 4 8 4 11 Number of inspections of food exposed for sale 109 119 116 344 Urinals cleansed and repaired 1 2 6 9 Smoke nuisances abated 1 1 2 4 Offensive accumulations removed 6 27 21 54 Piggeries repaired and improved 1 1 6 8 Infective houses disinfected and cleansed 128 81 146 855 Number of visits to infective houses 274 336 348 958 Number of dairies and milkshops 23 36 43 102 Number of visits to ditto 218 148 111 477 Number of complaints as to uncleanliness and neglect of regulations 2 4 6 12 Number of slaughterhouses 6 5 5 16 Number of visits to ditto 147 75 95 317 Number of complaints as to uncleanliness - 8 5 8 Number of drains opened up for examination (Section 41.P.H.A.) 23 6 15 44 Manure pits provided or repaired 1 — 1 2 Unsound food destroyed 1 Carease - 56 1bs. — 39 Articles Disinfected. January 926 July 316 February 1021 August 620 March 810 September 993 April 431 October 366 May 801 November 862 June 987 December 607 8,740 40 TABLE I.—Vital Statistics of Whole District during 1909 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. Bate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1903 41120 1166 28.2 109 94 585 13.0 203 203 49 431 10.4 1904 47030 1284 27.3 158 123 654 13.9 210 210 77 521 11.0 1905 54763 1408 25.7 138 98 615 11.2 178 178 92 529 9.6 1906 59800 1600 26.7 199 124 781 13.0 204 204 102 679 11.3 1907 66300 1635 24.6 170 103 775 11.6 239 239 113 649 9.7 1908 57600 1487 25.8 126 84 639 11.0 161 161 106 584 10.1 Averages for Years, 1899—1908 46411.2 1220.2 26.3 134.2 111.7 641.0 14.2 209.0 209.0 76.1 508.1 11.1 1909 60300 1513 25.0 130 85 649 10.7 208 208 104 545 9.0 *Rates calculated per 1,000 of estimated population. 41 Note.—The deaths included in Column 7 of this table are the whole of those registerd 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 substraction of the number in Column 10, and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in Public Institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in Public Institutions elsewhere. 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, sue has hospitals, workhouses, and lunatic asylums. Alist of the institutions in respect of the deaths in which corrections have been 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 At Censeus of 1901. Area of District in acres (exclusive 2766 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 Coulsdon. 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 Brook wood. Carshalton Cottage Hospital, at Carshalton. Croydon Rural District Isolation Hospital, at Carshalton. Joint Small Pox Hospital, in the 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 the Parish of Beddington. Royal Female Orphanage, in the Parish of Beddington. Reedham Orphanage, in the Parish of Coulsdon. 42 TABLE II.—Vital Statistics of separate Localities in 1909 and previous years Names or Localities WHOLE DISTRICT. Addington. Beddington. coulsdon. Merton. Mitcham. Morden. Sanderstead. Wallington. Woodmansterne. 1 2 3 4 5 6 7 8 9 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. Deafcns at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. . Deaths under 1 year, i Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year, j 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. c. d. a. b. c. d. 1899 32515 823 444 129 675 14 19 2 3608 69 39 11 3885 94 29 9 4280 109 50 12 12892 381 216 78 921 13 5 1 892 11 8 1 4860 103 70 13 502 18 8 2 1900 33304 862 402 102 663 11 9 1 3732 69 31 4 3960 92 50 12 4398 116 48 14 13155 409 185 54 943 26 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 27 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 428 202 56 1000 25 9 1 1050 15 7 0 5720 120 57 4 610 16 5 3 1903 41120 1166 431 109 620 7 5 1 4750 101 34 6 5150 122 40 9 6060 221 70 20 15500 497 195 57 1018 24 13 5 1260 26 8 2 6330 152 58 8 612 10 8 1 1904 47030 1284 521 158 700 13 11 2 5170 144 45 15 6456 149 41 9 7450 219 75 21 17000 542 247 86 1100 20 7 3 1550 28 10 6 6875 142 74 15 735 23 5 1 1905 54763 1408 529 138 670 11 11 1 5789 123 39 9 7137 150 39 8 9150 258 80 22 20617 642 270 78 1035 29 15 3 1660 28 8 2 7935 155 62 13 770 21 5 2 1906 59800 1600 679 199 695 11 4 0 7050 157 48 11 7860 183 78 14 9290 280 117 32 22550 721 310 118 1025 27 9 1 2040 35 11 0 8340 155 96 19 950 29 6 4 1907 66300 1635 649 170 690 7 7 1 7100 162 55 5 8500 163 69 22 25800 716 286 92 1100 24 12 0 2350 49 10 3 8400 138 76 13 1060 44 8 4 1908 57600 1487 584 126 690 11 2 0 8000 176 56 6 8800 200 83 17 26700 863 330 92 1180 26 10 2 2580 53 13 1 8500 139 77 7 1150 19 8 1 Averages of years, 1899— 1908 46411.2 1220.2 508.1 134.2 664.5 10.9 8.9 1.2 1 5309.5 117.0 40.6 8.5 6038.4 135.1 50. 11.3 18220.7 560.8 244.1 76.7 1028.2 23 5 10.7 2.2 1531.9 28. 9.9 1.6 6711.4 134.3 67.3 11.2 743.8 22.5 6.8 2.3 1909 60300 1513 545 130 695 14 5 8740 194 58 17 9300 223 49 9 27900 796 318 84 1125 29 11 3 2700 54 15 4 8750 165 80 9 1090 38 9 3 Notes.—(a) The separate localities adopted for 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! mav if desired he used for the . , blocks 2, 3, iSrc., for the several localities. In small districts without recognised divisions of known population this Table need not be filled up. ' ' trict. and (b) Deaths of residents occurring in public institutions beyond the district are to be included in sub.columns c of this table, and those of non.residents registered in public institutions in the district excluded. (See note on Table I. as to meaning of terms " resident" and non.iesident. | (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 fieures for the vear in the 2, 3, and 12 respectively, 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 columns d with the total of column 3 in Table IV. TABLE III.—Cases of Infectious Disease notified during the year 1909. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 Totals. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Addington. Beddington. Coulsdon. Mitcham. Morden. Sanderstead. Wallington. Woodmanst'rine Addington. Beddington. Coulsdon. Mitcham. Morden. Sanderstead. Wallington. Woodmanst'rine Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including 150 .. 41 86 13 10 .. 1 19 6 108 2 5 8 1 1 15 2 96 1 1 7 1 124 Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 83 2 3 2 5 18 3 .. 2 8 20 .. .. 3 .. .. .. .. 3 .. .. .. .. 3 Scarlet Fever 212 3 39 138 24 8 .. .. 33 37 100 7 6 19 10 .. 24 26 84 7 6 9 9 165 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... Enteric Fever 9 .. 1 .. 4 4 .. .. 1 .. 7 .. .. 1 .. .. .. .. 4 .. .. 1 .. 5 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. .. 5 .. .. 1 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro Spinal Meningitis 2 1 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. 1 Measles 472 24 157 248 32 11 .. .. 26 53 283 20 18 70 2 .. .. .. .. .. .. .. .. .. Totals 883 30 242 474 78 56 3 1 82 106 522 29 29 101 13 1 39 28 188 8 7 17 10 298 The Isolation Hospital is situated at Beddingt on 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 tha Croydon Rural Councils. 13 TABLE IV.—Causes of, and ages at, Death during 1909. 1 Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ayes 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 All ages. Under 1. 1 and under 5. 5 and under 15 15 & under 25. 25 & under 65. 65 & upwards. Addington. Beddington. Coulsdon. Mitcham. Morden. Sanderstead. Wallington. Woodmanst'rne 17 18 Cane Hill Asylum Holborn Union Workoouse Mensles 17 4 11 2 .. .. .. .. .. .. 17 .. .. .. .. .. .. Scarlet Fever 10 1 5 2 2 .. .. .. 1 3 3 .. 1 .. 2 .. .. Whooping Cough 6 1 4 1 .. .. .. .. 1 .. 4 .. .. 1 .. .. .. Diphtheria (including Membranous Croup) 18 1 5 12 .. .. .. 1 .. .. 16 1 .. .. .. .. .. Enteric Fever 2 .. 1 .. .. 1 .. .. .. .. 2 .. .. .. .. .. .. Epidemic Influenza 10 .. .. 1 .. 6 3 .. .. 1 5 1 .. 3 .. .. 2 Diarrhoea 4 2 1 .. .. 1 .. .. .. .. 4 .. .... .. .. .. .. Enteritis 11 7 .. .. .. 1 1 .. .. .. 9 .. .. 1 .. .. .. Gastritis 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. 1 .. 1 .. .. .. .. .. .. Erysipelas 2 1 .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 40 .. 1 2 10 24 3 .. 7 7 19 2 .. 3 .. 7 6 Other Tubercular Diseases 22 7 10 1 3 1 .. 1 1 5 9 .. .. 5 1 3 .. Cancer, malignant disease 50 .. .. .. 3 25 22 2 4 8 22 .. 3 11 .. 9 10 Bronchitis 41 11 4 .. .. 9 17 .. 4 3 30 1 .. 1 2 1 17 Pneumonia 44 21 .. .. .. 8 9 .. 7 6 23 1 .. 5 1 12 1 Pleurisy 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. Other Diseases of Respiratory Organs 11 2 .. 1 1 4 3 .. .. .. 8 1 .. 2 .. 2 .. Alcoholism—Cirrhosis of Liver 8 .. .. .. .. 7 1 .. .. 1 6 .. .. 1 .. .. 1 Venereal Diseases 3 3 .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. Premature Birth 15 15 .. .. .. .. .. .. 3 .. 7 .. 1 3 .. .. .. Diseases and accidents of Parturition 24 20 .. .. .. 4 .. .. 4 3 13 .. 1 3 .. .. .. Heart Diseases 53 .. 1 .. 2 22 26 .. 4 a 32 1 1 10 .. 20 8 Brain „ 37 .. .. .. .. 19 18 .. 3 3 14 1 4 12 .. 71 12 Kidney ,, 13 .. .. .. 1 9 3 .. .. .. 8 .. .. 5 .. 5 .. Accidents 13 2 1 1 .. 7 2 .. 2 ?. 8 .. .. 1 .. .. .. Suicides 6 .. .. 1 .. 5 .. .. .. 5 .. .. 1 .. .. .. Cerebro-Spinal Meningitis 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. All other causes 80 30 4 1 5 8 32 .. 16 3 46 2 .. 11 2 11 9 All causes 545 130 57 26 27 164 141 5 58 49 318 11 15 80 9 142 66 45 Notes.—(a) In this Table all deaths of " Residents " occuring 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 9-16 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 9-16 of this table. (b) See 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. (d) The total deaths in the several "Localities" in columns 9-16 of this Table, should equal those for the yeai 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 9-16, and the figures for the year in column 12 of Table I. (e) Under the heading "Diarrhoea" 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 specifiec term "Diarrhoea." Deaths from diarrhcea secondary to some other well-defined disease should be included under the latter. 46 TABLE V.—Infantile Mortality during the Year 1909. 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 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. 10—11 Months. 11—12 Months. Totals Deaths under One Year. All Causes— Certified or Inquest 25 5 4 6 40 15 8 8 7 7 10 6 8 10 6 5 130 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..•• Common Infectious Diseases— Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... . Measles .. .. .. .. .. .. .. .. .. .. .. .. 1 2 1 .. 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Diphtheria (including Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Diarrhœal Diseases— Diarrhœa, all forms .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. 2 Enteritis, Muco-entaritis, Gastro-enteritis .. .. .. .. .. 2 .. 1 2 .. 1 1 .. .. .. 7 Gastritis, Gastro-intsstinal Catarrh .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Wasting Diseases- Premature Birth 10 3 .. .. 13 3 .. .. .. .. .. .. .. .. .. .. 16 Congenital Defects 2 .. .. 2 4 .. 1 1 .. .. .. 1 .. .. .. .. 7 Injury at Birth 5 .. .. .. 5 1 .. .. .. .. .. .. .. .. .. .. 6 Want of Breast-milk, Starvation .. .. 2 .. 2 1 .. .. .. .. .. .. .. .. 1 .. 4 Atrophy, Debility, Marasmus 4 2 .. 8 9 2 1 O 2 3 .. .. 2 .. .. .. 21 Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. 2 .. .. 1 1 1 ...... 5 Tuberculous Peritonitis: Tabes Mesenterica.. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Other Causes— Erysipelas ...... .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Syphilis 1 .. .. .. 1 1 1.. .. .. .. .. .. .. .. .. .. 3 Rickets .. .. .. .. .. .. .. .. .. .. .. L .. .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Convulsions 3 .. 1 .. 4 .. 1 .. .. .. .. .. .. 2 .. .... 7 Bronchitis .. .. .. .. .. 2 .. .. .. 2 3 .. 1 1 1 1 11 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 2 .. 3 .. 2 1 2 2 4 3 2 21 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes .. .... 1 1 2 .. 2 .. .. .. 3 .. .. .. .. .. 7 25 5 4 6 40 15 8 8 7 7 10 6 8 10 6 5 130 Births in the year- Legitimate 1480. Illegitimate 33. Deaths from all Causes at all Ages, 545. Deaths in the year of— Legitimate infants 116. Illegitimate infants 14. Population—Estimated to middle of 1909, 60,300, 47 Table VI.—The Area in Acres, Inhabited Houses, Population, and Density of each Parish in the District in 1891 and 1909. Parish. Area in Acres. Inhabited Houses. Population. Density. Persons per acre. Persons per house. 1891. 1909. 1891. 1909. 1891. 1909. 1891. 1909. Persons. Males. Females. Persons. Males. Females. Addington 3605 132 140 670 346 324 695 355 340 .18 .18 5.0 4.9 Beddington 3128 442 1858 2607 1162 1445 8740 4160 4580 .8 2.7 5.9 4.6 Coulsdon 4314 537 1817 3335 1623 1712 9300 4400 4900 .7 2.1 6.2 5.1 Mitcham 2915 2055 5359 10758 5300 5458 27900 13350 14550 3.6 9.5 5.2 5.2 Morden 1475 138 225 763 387 376 1125 530 595 .5 .7 5.5 5 .0 Sanderstead 3150 96 577 509 262 247 2700 1250 1450 .1 .8 5.3 4.6 Wallington 823 710 1714 3823 1587 2236 8750 4280 4470 4.6 10.6 5.4 5.1 Woodmansterne 1591 81 215 408 204 204 1090 500 590 .25 .68 5.0 5.0 21001 4191 11905 22873 10871 12002 60300 28825 31475 1.1 2.8 5.4 5.0 In no instance are Institutions considered in this calculation. 48 TABLE VII.—Showing Parishes with Institutions. Parish. Area in Acres. Inhabited Houses. Population. Density of persons per acre. Average number of persons per house. 1891. 1909. 1891. 1909. 1891. 1909. 1891. 1909. Persons. Males. Females. Persons. Males. Females. Beddington 3128 442 1858 2607 1162 1445 8740 4160 4580 .8 2.7 5.9 4 6 Royal Female Orphanage .. .. .. .. .. .. 145 — 145 .. .. .. .. Russell Hill School .. .. .. .. .. .. 358 210 148 .. .. .. .. 9243 4370 4873 Coulsdon 4314 537 1817 3335 1623 1712 9300 4400 4900 .7 21 6.2 5 1 Cane Hill Asylum .. .. .. .. .. .. 2166 937 1229 Reedham Orphanage .. .. .. .. .. .. 321 185 136 11787 5522 6265 Mitcham 2915 2055 5359 10785 5300 5458 27900 13350 14550 3.6 9.5 5.2 .5 2 Holborn Workhouse .. .. .. .. .. 929 554 375 „ Schools .. .. .. ...... .. .. 469 267 202 29298 14171 15127 49 TABLE VIII.—Showing the Annual Birth and Death Rates, and Death Rates of Infants for the Year 1909 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. 1909 25.0 9.0 85 1908 25.8 10.1 84 1907 24.6 9.7 103 1906 26.7 11.3 124 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 Average of 10 Years, 1899—1908. 26.3 11.1 111.7 50 TABLE IX—Showing the Population, Births and Deaths for the Year 1909, 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. 1909 60300 1513 545 130 57 208 1908 57600 1487 584 126 75 161 1907 66300 1635 649 170 70 239 190G 59800 1600 679 199 88 204 1905 54763 1408 529 138 41 178 1904 47030 1284 521 158 42 210 1903 41120 1166 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 Average of 10 years, 18991908 46411.2 1220.2 508.1 134.2 94.6 209.0 51 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 1906 1907 1908 1909 Small-pox .. 7 1 2 .. .. 3 .. .. .. .. 29 9 5 1 1 .. .. .. Scarlatina 85 117 316 99 51 65 262 144 84 115 81 161 131 125 181 189 317 209 212 Diphtheria 17 16 44 63 26 45 35 107 38 62 87 77 48 169 134 161 190 204 150 Membranous Croup .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Typhoid Fever 9 12 24 12 18 14 13 15 19 15 13 14 11 9 18 33 15 16 9 Continued Fever .. .. 1 .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 1 4 6 1 .. 2 2 .. 4 1 5 5 8 2 3 5 10 5 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Cerebro-spinal Meningitus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 .. 2 Cholera .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 13 22 31 18 18 33 26 23 29 34 20 35 23 27 44 52 56 36 33 ***Measles 237 579 138 458 29 1083 172 1023 251 420 862 636 280 1085 679 954 326 999 472 Acute Diarrhoea .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. *Chicken Pox .. .. .. .. .. .. .. .. .. .. .. 162 188 .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Totals 362 754 560 664 144 1243 513 1314 421 650 1064 1119 695 1428 1076 1393 917 1474 883 * Chicken Pox was a notifiable disease until July 31st, 1903. ** Cerebro-spinal Meningitis was a notifiable disease from the 22nd April, 1907, to April, 1908. *** Measles ceased to be a notifiable disease on the 19th June, 190!). 52 TABLE XII.—Cases of Typhoid Fever (including Continued Fever) in each Parish since Notification was adopted. Addington * Beddington ‡Coulsdon ‡ Mitcham * Morden †Sanderstead * Walling ton * Woodmansterne Institutions The District 1890 .. 6 .. 3 .. .. 4 .. 1 14 1891 .. 2 2 2 .. 1 1 .. .. 8 1892 .. 2 .. 4 .. .. 3 .. 1 10 1893 .. 2 4 12 1 .. 1 .. 1 21 1894 .. .. 4 2 .. .. 4 .. .. 10 1895 .. 1 1 6 1 .. 3 .. 3 15 1896 .. 1 2 9 .. 1 2 .. .. 15 1897 .. 1 2 6 .. .. 3 .. .. 12 1898 1 .. 1 11 .. .. .. .. .. 13 1899 .. 1 2 4 1 2 1 4 .. 15 1900 .. l 2 3 .. .. 3 3 .. 12 1901 .. .. 3 3 .. 2 1 .. .. 9 1902 1 2 1 3 1 2 2 .. .. 12 1903 .. .. 5 4 .. .. .. .. .. 9 1904 .. 1 .. 5 .. 1 2 .. .. 9 1905 1 .. 1 8 .. .. .. .. .. 10 1906 .. 2 1 20 .. 1 3 1 .. 28 1907 .. 1 2 10 .. .. .. .. .. 13 1908 .. 3 .. 11 1 .. 1 .. .. 16 1909 .. 1 •• 7 .. .. 1 •• .. 9 3 27 33 133 5 10 35 8 6 260 * Water supplied by Sutton Water Company. † „ „ „ East Surrey Water Company. ‡„ ,, ,, Lambeth Water Company. Addington is principally supplied by the Croydon Corporation, 53 INFECTIOUS DISEASE during 1909. 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 .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. 1 .. .. .. .. .. .. .. .. .. .. 1 Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 1 .. .. .. .. 2 .. 2 .. .. 1 1 7 Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. 1 .. .. .. 1 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1 1 .. .. .. 2 .. 2 1 .. 1 1 9 PULMONARY TUBERCULOSIS. Public Health (Tuberculosis) Regulations, 1908. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. 1 .. .. .. .. .. .. .. 1 Coulsdon 1 .. 1 1 1 .. .. .. .. .. .. .. 4 Cane Hill Asyl'm 1 .. .. .. .. .. .. .. .. .. .. .. 3 Mitcham 3 4 11 5 4 2 4 .. 4 5 .. 5 47 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse 1 .. .. 1 .. 1 .. .. .. .. .. .. 3 Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. 1 .. .. .. .. .. 1 3 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 6 4 12 7 6 4 4 2 4 5 1 6 61 54 PUERPERAL FEVER. Parishes. January. February. March. April. May. June. July. August September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. 1 .. 1 Coulsdon .. .. .. .. .. .. .. .. 2 .. .. .. 2 CaneHill Asyl'm.. .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. 2 .. .. .. .. .. .. .. .. .. .. 2 Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. 2 .. .. .. .. .. .. 2 .. 1 .. 5 MEASLES. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals, Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington 8 7 .. 3 5 3 .. .. .. .. .. .. 26 Coulsdon 19 11 10 5 2 6 .. .. .. .. .. .. 53 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 17 19 44 56 114 33 .. .. .. .. .. .. 283 Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. 11 9 .. .. .. .. .. .. 20 Sanderstead 2 2 10 2 1 1 .. .. .. .. .. .. 18 Wallington 3 11 17 18 20 1 .. .. .. .. .. .. 70 Woodmansterne .. .. .. .. 2 .. .. .. .. .. .. .. 2 Totals 19 50 81 84 155 53 .. .. .. .. .. .. 472 Measles ceased to be a notifiable disease on 19th June, 1909. 55 ERYSIPELAS. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. 2 .. .. .. .. .. .. .. .. 2 Coulsdon .. 1 .. 2 2 1 .. 1 .. 1 .. .. 8 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. 3 1 .. 4 1 4 .. 2 2 i 2 20 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. 2 1 3 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. 4 3 2 6 2 4 1 2 3 3 3 33 SCARLET FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December Grand Totales Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington 1 3 1 2 .. 1 2 2 13 4 2 2 83 Coulsdon 7 2 2 5 1 4 1 2 3 5 2 1 37 CaneHill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 8 6 11 7 9 7 10 7 13 7 8 7 100 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. 1 6 .. .. .. .. .. .. 7 Sanderstead .. .. 2 .. .. .. .. .. 1 3 .. .. 6 Wallington .. 3 2 3 2 .. .. .. 2 2 3 2 19 Woodmansterne 1 .. 1 5 .. 1 1 .. .. .. 1 .. 10 Totals 17 14 19 22 13 19 14 11 34 21 16 12 212 56 DIPHTHERIA. Parishes. January. February. March. April. May. June. July. August. September October. November. December Grand Totals. Addington .. 1 .. .. .. .. .. .. .. .. .. .. 1 Beddington 5 3 2 4 1 .. .. 2 .. .. 1 1 19 Coulsdon .. 3 1 .. .. .. 1 .. .. .. 1 .. 6 Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 9 16 5 5 4 7 3 7 3 18 15 16 108 Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden 1 .. .. .. .. .. .. .. .. .. .. 1 2 Sanderstead .. .. .. .. .. .. .. .. 5 .. .. .. 5 Wallington 1 2 .. .. 1 1 .. 1 .. 1 1 .. 8 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. 1 1 Totals 16 25 8 9 6 8 4 10 8 19 18 19 150 CEREBR OSPINAL MENINGITIS. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane HillAsyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. .. .. .. .. .. 1 1 .. .. .. 2 Holborn Schools and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Morden .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. .. .. .. .. .. 1 1 .. .. .. 2 57 TABLE XIII.—Deaths from Infantile Summer Diarrhoea, showing place of incidence and condition of domestic surroundings. Address. Age. Sex. L. or Ill. Number in family and how many have died of similar complaints. How fed : Cow, Breast or Tin Milk. Note conditions and cleanliness of Cooking Utensils. Condition of Notes. Interior of house. Back and front yards. W.C's. Upper Road, Bandon Hill 4 months M. Leg. Four in family Fed by bottle with milk and barley water ; also with Savory & Moore's Food. Utensils olean Clean throughout Paved and clean Clean This child is one of twins, both of whom are deceased Ashbourne Road, Miteham 6 months F. Illeg. None Cows' milk and barley water previous to illness, afterwards with Nestle's Condensed Milk and barley water by a tubeless bottle. Utensils clean Clean Back yard partly paved W.C. is in good order Commonside East, Miteham 4 months M. Leg. Six living; one died previously of diarrhoea, and nine of other complaints Breast milk. Utensils clean Back to back houses, with three rooms. Clean Back yard is unpaved, but is well drained W.C. is in good order The mother was employed at a laundry prior to birth of child Sarah Place, Miteham 7 months F. Leg. Three living Nestle's Condensed Milk and barley water taken by a tubeless bottle. Utensils clean Interior of house dirty. Slop sink, copper, and food cupboard are all in kitchen Unpaved W.C. is situate in yard, and is in good order A notice was served to cleanse premises Fortescue Road, Miteham 6 weeks M. Leg. None Cows' milk and water at birth, later with cows' milk and barley water. Utensils clean Clean, but kitchen is small and close Front yard is paved with bricks W.C. is foul Seeley Road, Miteham 1 month M. Leg. None Cow's milk by tubeless bottle. Utensils clean House very clean Back yard partly paved W.C. is in good order Miller Road, Miteham 4 months F. Leg. Five living Cow's milk and Dr. Ridge's Food given by a bottle with rubber tube. Utensils clean House kept fairly clean Very small back yard, and partly paved W.C. is in good order Deceased was a very delicate child child from birth Devonshire Road, Miteham 1 month M. Leg. One previously died of diarrhœa Breast milk for first few days, afterwards cow's and condensed milks. Utensils very clean House kept clean and in good order Both back and front yards paved Two w.c.'s inside house, well ventilated and in good order This house is of good class, and the occupants are of extremely clean habits Boundary Road, Miteham 3 months M. Leg. Two living Cow's milk boiled, given by tubeless bottle. Utensils not kept clean House is kept fairly clean Back yard is partly paved W.C. is in back yard, and is in good order Grove Terrace, Miteham 2 months M Leg. One living Boiled cow's milk and barley water, given by tubeless bottle. Utensils clean This is a new house, and is kept in a cleanly state, but was built on the site of a piggery. A new piggery has now been built at the rear of the premises Back yard is paved W.C. is in back yard, and is in good order Deceased had recently undergone a slight operation Maldon Road, Wallington 4 months F. Illeg. .. Utensils clean Very clean and good In good order Good These cases are of the illegitimate children of a laundrymaid who came here from Salford to be attended during confinement Maldon Road, Wallington 4 months M. Illeg. * 58 TABLE XIV.—Table showing Total Deaths from Infantile Summer Diarrhoea, during the nine years, 1901—1909, in each Parish, and in every Street invaded :— ADDINGTON. 1. Badger's Hole. 1. Keeper's Lodge. BEDDINGTON. 4. Bandon Hill. 1. Francis Road. 1. Beddington Lane. 1. Guy Road. 1. Foxley Lane. COULSDON. 1. Brighton Road. 3. Iiower Road, Kenley. 1. Coulsdon. 1. Roke Avenue, Kenley. 1. Godstone Road. MITCHAM. 1. Acre Road. 3. Lewis Road. 1. Allen's Cottages, Lonesome. 3. Leonard Road. 2. Allen's Terrace. 3. London Road. 1. Aberdeen Road. 1. Lonesome. 1. Ashbourne Road. 2. Love Lane. 9. Bath Road. 4. Lilian Road. 2. Bailey Road. 1. Lock's Lane. 2. Belgrave Road. 3. Manor Road. 1. Benedict Walk. 9. Marian Road, Lonesome. 1. Bond Road. 1. Miller Road. 1. Boundary Road. 1. Miles' Lane. 1. Broadway. 1. Nicholls' Cottages, Eastfields. 2. Bruce Road. 1. Norfolk Road. 1. Byegrove Road. 1. Marlboro' Road. 2. Caithness Road. 3. Palestine Grove. 5. Chapel Road. 3. Park Avenue. 1. Chestnut Road. 3. Phipp's Terrace. 2. Church Buildings. 1. Piccadilly. 9. Church Road. 1. Pitcairn Road. 3. College Road. 1. Portland Ro&d. 2. Commonside. 5. Princes Road. 1. Concrete Cottages. 8. Queen's Road. 1. Courtney Road. 1. Robinson Lane. 3. Denison Road. 3. Robinson Road. 2. Devonshire Road. 1. St. Mark's Road. 1. Durham Place. 1. Sarah Place. 1. Eastfields. 5. Seaton Road. 2. Firework Road. 1. Seeley Road. 4. Fortescue Road. 5. Sibthorpe Road. 1. Fernlea Road. 3. Smith's Buildings, 59 2. Fountain Place. 1. Spencer Road. 8. Fountain Road 1. Ravensbury Cottages. 2. Gladstone Road. 2. Tramway Terrace. 1. Grange Villas, Eastfields 4. Tynemouth Road. 2. Greyhound Terrace. 1. Upper Green. 4. Grove Road. 1. Waterfall Road. 1. Grove Terrace. 1. Warren Road. 1. Hare wood Road. 4. Western Road. 7. Heaton Road. 2. Westfields. 1. Homewood Road. 1. Whitford Gardens. 1. Lewis Cottages. 2. Willow View. MORDEN. 1. Bishop's Cottages. 1. Crown Road. SANDERSTEAD. 1. Mayfield Road. 1. Riddlesdown Road. WALLINGTON. 2. Hackbridge. 2. Ross Parade. 2. Maldon Road. 1. Seymour Road. 2. Manor Road. 1. Wood Street. 2. Percy Road. WOODMANSTERNE. 1. Chipstead Valley Road. 1 St. Dunstan's Cottages. 1. Rutland Cottages. 1. Woodman Road. 60 FACTORY AND WORKSHOP ACT, 1901. The title of this Act is "An Act to consolidate with amendments the Factory and Workshop Acts." It will be seen from the subjoined list that there are now 226 Factories and Workshops on the Register, which is 13 less than last year. All these are periodically visited, and due attention has been paid to maintaining themin such a condition as to comply with the require ments of the Act. During the year 272 visits of inspection were paid, and in 4 instances nuisances or irregularities were found. FACTORIES AND WORKSHOPS. Trades. Factories. Workshops. Total. No. of Employees. Laundries 9 17 26 380 Cycle Works 2 11 13 23 Carriage Makers and Wheelwrights 2 6 8 27 Distilleries and Essential Oils 1 2 3 12 Printing 2 4 6 52 Brickmaking 2 1 3 28 Carpenters and Builders 6 14 20 73 Shoeing Forges — 15 15 26 Dressmaking — 15 15 49 Bakeries — 21 21 39 Harness Making — 4 4 2 Bootmaking & Repairing — 13 13 19 Bottle Washing & Marine Stores - 1 1 5 Snuff Mills 1 — 1 — Buff, Parchment, and Chamois leather, Patent leather and Degreasing 2 4 6 115 Dye Extractors 1 — 1 12 Chaff Cutting and Corn Grinding 1 - 1 8 Flour Mills — - — — Electrical Works - - — — Bedding Manufacturers - 1 1 1 Cardboard ditto 1 - 1 40 Motor ditto 2 - 2 7 Brewers 2 - 2 37 61 T'ADES. Factoriks. W orkshops. Total. No of Employer. Varnish Making 10 4 14 146 Confectionery Making 1 4 5 258 Paper Making — — — — Saw Mills & Timber yards 3 — 3 11 Silk and Chintz Printing — — — — Block Cutting — — — — Artificial Horse Hair Manufacturers 1 - 1 10 Lamp Maker 1 — 1 65 Gas Works 2 — - 104 Watch Making 1 1 2 3 Firework Making 1 — 1 103 Mineral Water 1 — 1 22 Chemical Works 3 1 4 83 Margarine Works 1 — 1 20 Well Boring 1 — 1 3 Iron Works 1 — 1 50 Cork Cutting 1 — 1 25 Organ Building 1 — 1 2 Brush Making — 4 4 30 Belt Making 1 — 1 12 Sack Making — 1 1 12 Trunk Cloth & Leather Substitute Making - 1 1 2 Golf Club Making — 2 2 4 Smelting Works 1 1 2 34 Engineering 2 — 2 18 Glove Cleaning — 3 3 30 Furniture Making — 1 1 1 Tailoring — 4 4 4 Art Printers on Iron, etc. 1 — 1 50 Tobacco Mills 1 — 1 37 Floor Cloth Makers — 1 1 6 Totals 69 157 226 2100 62 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 102 1 Workshops (including Workshop Laundries) 160 3 Workplaces (other than Outworkers' premises included in Part 3 of this Report 10 Total 272 4 63 2.—DEFECTS FOUND. Particulars. (1) Number of Defects Number of Prosecutions. (5) Found. Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Act—* Want of cleanliness 6 6 Want of ventilation — — Overcrowding 1 1 Want of drainage of floors 1 1 Other nuisances, insufficient lighting 1 1 Sanitary accommodation insufficient 2 2 unsuitable or defective 3 3 not separate for sexes — — (Sec. 22 oi the Public Health Acts Amendment Act, 1890, has been adopted.) The standard of sufficiency and suitability enforced being that in the Order of the Secretary of State, of 4th February, 1903. Offences under the Factory and W orkshop Act— Illegal occupation of underground bakehouse (s.101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 4 4 Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — Total 18 18 *Including those specified in sections 2, 3, 7, and 8 of the factory and Workshop Act as remediable under the Public Health Acts. †For districts not in London state here whether section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council ; and if so what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 64 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number. (2) Workshop Bakehouses 24 ,, Confectioners 4 „ Dressmakers 16 ,, Laundries 23 Other Workshops 90 Total number of Workshops on Register 157 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act (s 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, (s. 5) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 1 65 3 —HOME WORK. NATURE OF WORK* OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers' Premises. OUTWORK IN UNWHOLESOME PREMISES, Sec. 108 OUTWORK IN INFECTED PREM ISES, Sec. 109, 110 Lists received from Employers. Addresses of Outworkers Notice served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. ^Orders made (S. 110), Prosecutions (Sections 109, 110), Twice in the year Once in the year Received from Other Councils. Forwarded to other Councils. Failing to keepor permit inspection of lists. Failing to send list. Lists.* Outworkers. † Lists. Outworkers.† Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13, (14) (15) (16) (17) (18) (l9) Wearing Apparel— (1) making, etc. 8 20 29 39 (2) cleaning and 1 3 washing Lace, lace curtains and nets Artificial Flowers .. Nets, other than wire nets Tents Sacks Furniture, Upholstry Fur pulling Feather sorting Umbrellas, etc. Carding, &c. of buttons, Ac Paper bags & boxes Basket making Brush making Racquet and tennis balls Stuffed Toys File making Electro plate Cables and Chains Anchors & Grapnels Cart Gear Lock, Latches & Keys Pea picking • Total 8 21 29 42 *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 4 as the case may be) against the principal class only, but the outworkers should be assigned in column 3 (or 5) into their respective classes. A footnote should be added to show that this has been done. The figures required in column 2 and 3 are the total number of lists received from employers who sent them both in February and August as required by the Act and of the entries of names of outworkers on those lists. They will, therefore, usually be double of the number of such employers and (approximately) double of the number of individual outworkers whose names are given, since in the February and August list of the same employer the same outworkers name will often be repeated. § In view of the wide discrepancies found to exist between the totals when the returns aqe added together, it is desired that care may be taken to give exact figures. Only those addresses should be counted which have actually been received from or forwarded to other Councils during the year covered by the report. TABULATED REPORTS OF FARMS, DAIRIES, AND MILKSHOPS IN 1909. THE HOUSE. THE DAIRY THE COWSHEDS. WATER SUPPLY. MILK. No. of Farm. General Sanitary Condition. Health of Residents and Employees. Structural Condition (including Lighting ana Ventilation). Sanitary Condition and General Cleanliness. For what other purpos used. Structural Condition and Drainage. Window Space to Floor Space. Ventilation. General Cleanliness and Manure Heaps. How Cattle are Stalled, and Number of Stalls. Number of Cattle. Cubic Space per Head. What Precaution, taken to prevent Fouling of Mill. Health and Condition (including recent Deaths and cause) For Household end Dairy Purposes. For Cattle. Destination of Milk. GENERAL LEMARKS. A 1 Good. Good. Built in brickwork, with glazed tiles inside; window for light and louvre for ventilation. Clean, and drained to outside gully. None. Brick built and rendered inside with cement; drained to farm. 1 to 58; 10 addirional skylights. 11 openings in wall and open windows in gable. Sheds clean ; no manure pit. 17 double stalls. 12; numbers much reduced. 3,020. Water kept at hand for washing during milking, and milk removed to dairy for cooling. Good; no deaths. Company's mains. Company's mains. Borough Hospital and Croydon. Manure moved on to the farm. a 2 Good. Good. 2 sheds do. do. None. Brick built and walls cemented to 4ft. high; drained to farm. 1 to 39 and 10 skylights. 2 louvres in roof and 8 air-brioks in wall. do. 14 do. Only now used casually. ... ... .. ... do. do. do. do. do. a 3 Good. Good. Brickbuilt and brick floor; glazed tiles on walls; 2 windows for light and ventilation. Clean and in good sanitary condition. None. No. 1 Shed. Brick built, brick floor, walls cemented throughout; channels to gully outside ; drains to cesspool. 1 to 47. Louvre© in roof and tiles fairly open. Shed clean ; manure deposited in field 200 yards from shed. 4 double and 1 single stalls. 7 1,554. Mater supplied for washing of hands; cows' teats and udders cleaned, and milk removed to dairy. Health of cattle good; no deaths. Deep well on premises (70ft.). Well adjoining cow shed; depth no known, but sunk to chalk. Beddington, Wallington and Carshalton. Number of cows vary here. a 4 Good. Good. do. do. do. No. 2 Shed. Do. 1 to 120. 2 louvres in roof. do 2 single stalls and 16 double. 15 1,990. do. do. do. do. do. do. A 5 Good. Good. Brick built; slate slabs inside; light, 2 zinc panels in door and 2 in roof. Good. None. Brick built, and rendered to 6ft. high with cement; paving black brick ; drain to gully outside and to sewer. 1 to 14. 4 louvres in roof and opening in gable end. Premises kept clean; marure kept in manure pit; brick built pit and situate 6ft. from shed. 4 double stalls. 4 at present. 1,485. Men's hands are washed before milking, and milk strained and cooled at dairy. ; Health of cattle good; no deaths. Company's mains. do. Retailed in Bed dington and Wallingbon. Cows vary. a 6 Good. Good. Milk shop clean and well lighted. Good. Sale of eggs, butter, broad and minerals. Milk shop; no drain. ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. ... ... ... ... ... ... ... Company's mains. .. .. do. a 7 Good. Good. Shop clean and well lighted; no dairy. Good. do. ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. Retail at shop and Beddington andWallington. a 8 Good. Good. Do.; dairy also clean. Good. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... .. .. .. .. do. A 9 Good. Good. Shop clean and well lighted; milk store clean. Good. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. do. a 10 Good. Good. Shop clean and well lighted; dairy large and airy Good. do. and general refreshments. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... .. .. .. .. do. a 11 Good. Good. Shop well lighted and clean; no dairy. Good. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. Retailed at shop. a 12 Good. Good. Shop well lighted ; dairy clean. Good. Sale of eggs, butter and teas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. Do. and Wallington and Beddington. a 13 Good. Good. Dairy brick built, with stone slab concrete floor; well lighted and ventilated. Good. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. Do. and at Carshalton. a 14 Good. Good. Milk shop well lighted and ventilated; also clean. Good. Sale of eggs and butter. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. .. .. do. a 15 Good, but old. Good. Brick built, and lighted by a window in end wall. Good. None. Timber built, but walls brought up in brick and cement to 5ft. ; concrete floor and tiled mangers; channel to gully outside. 2½ to 27. Part of floor removed so as to ventilate through pantiled roof. Shed clean; manure depositd in manure pit on premises. 2 double stalls. 3 800. Water is plentiful for cleansing hands, and milk is brought outside for cooling. No deaths; cowshed recently re-opened. Company's mains. Company's mains. Wallington, S. Beddington and Carshalton. a 16 do. do. Shop clean; no dairy. do. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. .. .. On premises. Sale of milk is generally for or with food. A 17 do. do. Brick built, and lighted and ventilated by window. do. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. .. .. Beddington Corner and Hackbridge. a 18 do. do. Brick built, and ventilated by window. Good. None. Brick built and lime-whited inside; impervious floor, and channel drains to gully outside. 1 in 27. Air holes in gable ends and open pantiles. Clean, and manure removed aily. 2 double and 2 single stalls. 4 690. This mnn does his own milking, and is careful to clean teats and udders and wash his hands. No deaths; cattle healthy. Company's mains. Company's mains. Beddington Corner. These cows are turned out every day. A 19 do. do. No dairy. Shop only, with small milk trade. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... do. .. .. Sold in shop over counter. A 20 Slightly damp. Good. Brick built, with one window for light and ventilation. Clean and no drain. Dairy not used now as a dairy. No. 1 Shed. Timber built, cased in iron: tile mangers, concrete floor, channel to gully outside. 1 to 15, with 4 lights in roof of 12ft. Half doors and open pantiles. Sheds clean ; manure stored in garden away from sheds 2 double and 1 single stall. 5 800. The milkman is ordered to cleanse teats and udders and his hands before milking. Health good generally; one cow ill after calving, but reoovered. do. do. Wraight and Dumbrill, London Road, Mitcham. Number of cows vary; cows are turned out every day. A 21 do. do. do. do. do. No. 2 Shed. Timber built; paved with impervious material; cement mangers; channel to gully outside. 1 in 108. Open tiles in roof. do. 6 double stalls. 5, but number varies. 800. da Good. do. do. do. do. a 22 Good; recently improved. Good. Brick built and lime-whited inside; lighted by window in gable end; ventilated by openair bricks. Clean. None Timber built, but built up with cement to about 4ft. ; brick and stone floor and chan ncls, gully inside, drain to open catchpit. 1 to 27. Open tiled roof and openings in walls. Sheds kept clean ; manure stored in yard and removed weekly. 6 double stalls. 12 815. do. Good; no deaths. do. do. Mitcham. Sold wholesale to Wraight and Dumbrill; cows are turned out every day. a 23 Good. Good. No dairy. Timber built shed: match lined and limewhited ; Staffordshire brick floor, and drained to sewer. 1 in 30. Windows open with wire guards. Shed clean and manure moved to a field 100 yards distant. 2 single stalls. 2 800. ao. Good; no deaths. Company's mains. do. Mitoham. do. Cows are turned out every day. a 24 Good. Good. Brick built and lighted by three windows, and ventilated in centre of roof. Clean. Store for butter and eggs. No. 1 Shed. Timber built shed and man gers; paved with bricks; channels to gullies inside shed to catchpit and sewer. 1 to 57. Louvre in gable ends and half doors. Sheds kept clean and manure stored in an enclosed yard paved with impervious material, 5 double and 5 single stalls. 12 1,007. Milk removed to dairy, and milkmen clean udders and teats. Cows all in good health. do. do. Wimbledon and Merton. Cows are turned out every day. a 25 do. do. do. do. do. No. 2 Shed. Timber built, with mangers, constructed with brick cemented floor; brick paved. 1 to 41. Louvre in roof and openings in tiled roof. do 18 single and 1 double stall. 12 1,820. do. do .. .. .. .. .. .. do. a 26 do. do. Brick building, lighted by window, but milk not stored here. Clean. Storing food now. Timber built, impervious manger and floors : tiled roof. 1 to 63, with 48 roof lights. Louvre in roof and open tiles. Shed clean; manure deposit in farm yard. 9 double and 1 single stall. Average 10. 1,474. Men are required to clean teats, udders, and hands. 1 cow lost during year after calving. do. do. Merton. do. Milk sold wholesale a 27 do. do. do. do. do. Brick walls, cement mangers and floor. 1 to 23. Louvre in roof and air gratings in walls. do. 8 double stalls. Average 10. 1,520. do. Nil. do. do. Merton. A 28 Good. Good. Brick building ; paved in concrete. Good. None. Brick building, tiled mangers, concrete floors, and channels draining to gully. 1 to 40 and 36 roof lights. 3 louvres and 13 windows, opening 1ft. by 3ft. Manure moved away to farm; shed clean. 14 double and 2 single stalls. Average 20; holds 30 when full. 800 when full. Care ia taken in regard to cleansing teats, udders and hands Good : no deaths. Company's mains. Company's mains. Merton. Sold wholesale; cows turned out d^i'v a 59 Fair. Good. Timber built. Good. None. Timber built, with cement walls in front of manger to 4ft. 6in. 1 to 200 Louvre in roof and open tiles. Manure moved to heap in yard and stored for removal later. 6 double stalls. Average 8. 930. do. Good ; no deaths. Company's mains. Company's mains. Morden and Merton. a 0 Good. Good. No dairy; small quantity sold in grocer's shop. .. .. .. .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Company's mains. .. .. In neighbourhood. TABULATED REPORTS OF FARMS, DAIRIES, AND MILKSHOPS IN 1909. THE HOUSE. THE DAIRY THE COWSHEDS. WATER SUPPLY. MILK. No. of Farm. General Sanitary Condition. Health of Residents and Employees. Structural Condition (including Lighting and Ventilation). Sanitary Condition and General Cleanliness. For what other purpos used. Structural Condition and Drainage. Window Space to Floor Spacs Ventilation. General Cleanliness and Manure Heaps. How Cattle are 8talled, and Number of Stalls. Number of Cattle. Cubic Space per Head. What Precautions taken to prevent Fouling of Milk. Health and Condition (including recent Deaths and cause) For Household and Dairy Purposes. For Cattle. Des ination of Milk. GENERAL REMARKS. B 1 Good. Good. No Dairy. Old structure, fairly good condition; Drainage into culvert in road. Two drains inside Cowshed. 1 to 22. None in roof, which is lofty, but otherwise sufficient Shed kept clean; manure in yards each side of the cowshed. 12 double stalls with with wood partions. 24 854 cu. ft. Milk strained and cooled; men's hands washed. Health of cattle good; no recent death. 1 Company's mains. Company's mains. Wholesale to H. Still, S. Norwood. Cows turned out daily for water; lie out in summer. B 2 Good. Good. No Dairy. No. 1. Brick and flint structure, fairly good; Cement floor; open channel drainage; liquid drainage irrigated on surface of land some distance from sheds. 1 to 47. None in roof; number of openings in eaves and walls, but ventilation cannot be regulated. Sheds kept fairly clean; manure deposited in yard close to shed; yard is drained. 5 double stalls with wood partitions. 10 831 cu. ft. Milk strained and cooled in separate buildin away from sheds; men's hands washed. Health of oattle good; no recent death. Company's mains. Company's mains. Wholesale to F. Still and Son, S. Norwood. Cows turned out daily for water; lie out in summer. No. 2. do. 1 to 67. Open tile roof; open eaves; permanent openings over doors. do. 3 double stalls with wood partitions. 6 792 cu. ft. No. 3. do 1 to 88. do. do. 6 double stalls. 12 7H6 cu. ft. No. 4. . do. 1 to 40. do. do. 5 double stalls. 10 871 cu. ft. No. 5. do. 1 to 53. do. do. Open byres. 10 704 cu. ft. No. 6. do. 1 to 31. do. do Open byres. 10 831 cu. ft. B 3 Good. Good. No Dairy No. 1. Tile roof; wall at rear of cows is oemented ; ooncrete floor; channel drains; drainage to sewer. 1 to 93. None in roof; permanent opening in external walls; sufficient. Shed kept clean; manure heap at end of, and away from, shed. 11 double stalls with wood partitions. 19 782 cu. ft. Milk strained and cooled; men's hands washed; udders and teats oleaned. Health of cattle good; no recent death. Company's mains. Company's mains. Kenley, Purley, and Croydon Cows turned out daily for water; lie out in summer. No. 2. Slate roof, lofty, very good structure; ooncrete floor; channel drains; drainage to sewer. 1 to 16. Good and sufficient. do 6 double stalls, wood I>artitions. 12 1,280 cu. ft. B 4 Good. Good. No Dairy. None. Tile roof, fairly good good structure ; channel drains; drainage to cesspool. 1 to 36. Fairly good, but oould be improved. Cleanliness is neglected at times, both of oattle and premises; manure in yard near shed. Open byres. 13 672 cu. ft. Milk strained; teats and men's hands washed; dirty udders cleaned. Health of oattle good; no recent death. Company's mains. Company's mains. Wholesale to Goddard, of Croydon. Cows turned out daily; lie out in summer. B 6 Good. Good. Very good structure; light and ventilation good. Very good. Old structure ; low tiled roof ; channel drains; drainage on to surface of field a good distance away from shed. 1 to 31. None in roof; eaves good; fairly good. Shed kept clean; manure in stock yard near shed. Open byres. 10 730 cu. ft. Milk strained; men's hand washed; teats and udders cleaned. Health of cattle good; no recent death. Company's mains. Company's mains. Retailed in Kenley and Caterham. Cows turned out daily; lie out in summer. B 6 Fairly good. Good. Good structure; light and ventilation good. Good. None. Good brick and flint structure; slate roof; channel drains; drainage on to land some distance away. 1 to 38. Louvre in roof; good windows; sufficient. Shed kept clean; manure in yard near shed. Open byres. 12 867 cu. ft. Milk strained; men's hands washed; dirty udders cleaned. Health of oattle good; no recent death. Rain water in underground tank. Tank in field near shed supplied from mains. Retailed in Coulsdon. Cows turned out daily for water; lie out in summer. B 7 Good. Good. No Dairy. None. No. 1. Good structural; channel drains; drainage on to fields some distance from sheds. 1 to 35. Windows to open; eaves open; sufficient. Cattle kept olean ; sheds kept clean : manure in yards near sheds. Open byres. 6 1,060 cu. ft. • Milk strained; men's hands washed. Health of cattle good; no recent death. Company's mains. Company's mains. Retailed in Coulsdon. Cows turned out daily for water; lie out in summer. No. 2 do. 1 to 35. do. do. Open byres. 7 1,100 cu. ft. B 8 Good. Good. Very good structure; light and ventilation good. Good. No. 1. Good new structure; cement floors; open channel drains; drainage on to surface of land. 1 to 26. Windows to open; open eaves; sufficient. Cattle and sheds kept clean; manure in field near sheds. 4 double stal' 8 630 cu. ft Milk strained and cooled: men's hands washed; udders and teats cleaned. Health of oattle good; one recent death from pleurisy; veterinary surgeon in attendance. Company's mains. Company's mains. Retailed in Coulsdon and Purley. Cows turned out daily; He out in summer. No. 2. do. 1 to 15. do. do 4 double stalls. 8 650 cu. ft. B 9 Good. Good. No Dairy. No. 3. do 1 to 28. do do. 4 double stalls. 8 768 cu. ft. Good new structure; channel drains; drainage to sewer. 1 to 8. Windows to open; openings in walls; sufficient. Cattle and shod kept clean; manure in pit in yard away from shed. Open byres. 3 990 cu. ft. Milk strained; men's huids washed; udders and teats cleaned. Health of cattle good; no death. Company's mains. I Company's mains. Retailed in Coulsdon. Cows turned out in summer. B 10 Fairly good. Good. No Dairy. Od structure, fairly good: channel drains; drainage into fields away from shed. 1 to 55. Permanent openings in walls and lofty roof. Cattle and shed kept clean; manure in yard near shed. Open byres. 16 880 cu. ft. Milk strained and cooled; men's hands washed. Health of cattle good; no death From deep well on t on to the premises. le Hooley Estate laid Wholesale to Baines and Son, Croydon. Cows turned out daily; lie out in summer. B 11 Good. Good. No Dairy. Good structure; brick and flint walls: slate roof; open channel drains; drainage to cesspool. Good structure; open channel drains; drainage to sewer. 1 to 50. Windows and skylight to open; open eaves. Cattle and shed kept clean; manure in yard away from shed. Open byres. 10 860 cu. ft. Milk strained; men's hands washed; udders cleaned. Health of cattle good; no death. Company's mains. Company's mains. W h olesale t o Caterham. Cows turned out daily; lie out in summer. B 12 Good. Good. Very good structure; light and ventilation good. Good. None. 1 to 25. Good and sufficient. Cattle and shed kept clean; manure in good pit. 16 double stalls, but only part of shed 6 1,000 cu. ft. for part of shed. Milk strained and cooled; udders and teats cleaned; men's hands washed. Health of oattle good; no death. Company's mains. Company's mains. Retailed in neighbourhood. Cows turned out daily. B 3 Good. Good. Very good structure; well lighted and ventilated. Very good. None. No. 1. Structure good : open channel drains; drainage to cesspool in yard. 1 to 37. Good louvres in roof; windows to open; ventilation good. Cattle and premises always kept clean; manure heaps in yard near sheds. now used. 28 double stalls with good partitions. 55 870 cu. ft. Milk strained and cooled; men's hands washed; udders cleaned. Health of oattle good; no death. Company's mains. Company's mains. Retailed in Croydon and neighbourhood. do. Cows kept in sheds most of the year. No. 2. Old wood structure: tile roof; drainage to same cesspool as No.l. 1 to 93. Open tiles in roof; open eaves; openings in walls; also windows to open. do. 17 double stalls ; also open byre at end of shed. 39 826 cu. ft. do do. do. do. do. B 14 Good. Good. No Dairy. Verv good new structure; drainage irrigated on land some distance from shed. 1 to 34; one end of shed is very dark. 3 largo louvres in roof; all the windows open ; ventilation good. Cattle and promises kept clean; manure in yard near shed. 22 double stalls ; one half of shed only 21 966 cu. ft. Milk strained and cooled; men's hands washed, and udders cleaned. Health of cattle good; no recent death. Company's mains. Company's mains. Wholesale to Sydenham. Cows turned out daily; lie out in summer. B 15 Good. Good. No Dairy. Structure good: open channel drains; drainage irrigated on field rear of shed. 1 to 25. 2 louvres in roof; permanent openings in walls; good. Cattle and premises kept clean; manure in yard near shed. used. Open byres. 14 851 cu. ft. Milk strained and oooled; men's hands washed. Health of oattle good; no death. Company's mains. Company's mains. Wholesale to Welford's, Purley. Cows turned out daily; lie out in summer. B 16 Good. Good. No Dairy Structure fairly good; open channel drains; drainage to cesspool. 1 to 40. Open tiles in roof; window to open; fair. Cattle and premises kept clean; manure in yard near shed. Open byres 21 728 cu. ft. Milk strained; men's hands washed; udders cleaned. Health of cattle good; no death. Company's mains. Company's mains. Wholesale to Welford's, Purley. Cows turned out daily; lie out in summer. TABULATED REPORTS OF FARMS, DAIRIES, AND MILKSHOPS IN 1909. THE HOUSE. The dairy the cowsheds. water supply. milk. No. of Farm. General Sanitary Condition. Health of Residents and Employees. Structural Condition (including Lighting and Ventila ion). Sanitary Condition and General Cleanliness. For what other purpos used. Structural Condition and Drainage. Window Space to Floor Space. Ventilation. General Cleanliness and Manure Heaps. How Cattle are Stalled, and Number of Stalls. Number of Cattle. j Cubic Space per Head. What Precautions taken to prevent Fouling of Milk, Health and Condition (inc'uding recent Deaths and cause) For Household and Dairy Purposes. For Cattle. Destination of Milk. GENERAL REMARK*. C 1 Good Good. Wood and lath and plaster structure; in good order; lighted by windows;louvre ventilation in roof. Good; no drain inside. None. No. 1. Shed. Old Wood, lean to, structure; tile roof, in good repair; brick floor; channelling leads to a drain in the yard. 1ft. to 87ft. Wood flaps under eaves and spaces between the tiles. Kept fairly clean having regard to the nature of the structure; very iittle manure kept near the cowsheds. 5 double stalls; iron feeding troughs about 5ft. from wall; cattle are fed from this passage thus formed. 10 780 cu. ft. per animal. Water is provided for milkers to wash their hands; milk deposited in the dairy. The cattle are in good condition; no recendeaths . Water is laid on tc the manager's cot tage from the Wate Board's main. Tap in cowshec supplied from the r main. Croydon. The provision of channelling and drainage and another site for manure heap far re moved from the cowsheds was carried out during the past year. do. do. do. do. do. No. 2 Shed. Ditto. lft. to 670ft. do do. 10 double stalls, 1 single stall. 13 1,382 cu. ft. per animal. uo. do do. do. do. do. do. do. do. do. No. 3 Shed. Old Wood, span roof structure; tile roof; brick floor, channelled and drained, and in good repair. No windows; light obtained through opening in structure. No special provision; very lofty building. This building not being in constant use is not kept as cleanly as the others. 6 double stalls in two rows; path between heads for feeding the animals. 10 2,034 cu. ft. per. animal. do. do. do. do. do. Cows are turned out every day unless the weather is very bad. C 2 Brick structure;, m fairly good sanit^T condition. Good. Specially built wood structure in farm yard ; . lighted by a window and ventilated over the door. Good; no drain inside. None. No. 1. Shed. Old wood structure; pantile roof, in bad repair; good brick floor, and channel drain outside. No windows; openings at rear of stalls, 7ft. x 9ft.; lft. to 68ft. By openings between the tiles and at rear of stalls. Clean; manure heap in field adjoining. 2 double stalls, 4 single do.; feeding troughs fixed to the wall. 9 585 cu. ft. per animal. Water is provided for milkers to wash their hands; milk is taken at once on the round. do. Water is laid on from the Water Board's mains. Water laid on in the yard from the main; iron trough for the cattle. ; Mitcham. do do. do. do. do. do. No. 2 Shed. Ditto Do., lft. to 39ft. do. Clean. 2 double stalls; brick troughs fixed against wall. 3 859 cu. ft. per animal. do. do. do. do. do. do. do, i r do. do. do. do. No. 3 Shed. Wood structure; felt roof; in fair state of repair; concrete floor; drain outside. Do., lft. to 7ft. do. Clean. do. 3 593 cu. ft. per animal do. do. do. do. do. do. C 3 Old brick structure; clean, and in good repair. do New brick building adjoining the house; lighted by three windows, also used for ventilation; wire gauze protection. do do. Good brick structure, with hay loft over; concrete floor; drain outside. lft. to 18ft. Four louvre ventilators. 4ft. 6in. x 4ft. Oin., which also serves to light. Clean; manure pit 12ft. from the shed. 7 double stalls, 1 single stall; concrete troughs fixed against external walls. 15 740 cu. ft. per animal. Cattle are groomed: udders wiped when dirty; water provided for washing hands. No complaints regarding the cattle; several are in poor condition. do. Water is laid on to troughs; a tank is also provided in yard from the main. Mitcham and Tooting. do. C New structure; good. Good. Specially built wood structure outside the house, lighted by window and louvere ventilation. Good. None. Wood structure; in good repair; loft over it; good brick and concrete floor; drain outside. lft, to 44ft. By openings between the joints carrying floor above. Clean ; manure is taken to market gardening fields at rear of .farm buildings. 2 double stalls; iron feeding troughs fixed against the wall. 4 646 cu. ft. per animal. Water provided for washing hands; milk is taken to the dairy, situate ¾ mile away from the farm. Good; no recent deaths. From the Water Board's mains. From the Water Board's main to a tank in the yard. Mitcham; delivered in bottles. This dairy is of a private character. C 5 Good substantial structure. Good. There is no dairy; surplus milk is taken directly by a dairyman on to the round. An old brick and galvanised iron structure; tile roof; brick floor; drains to cesspool outside. None. By openings at the head of stall and between tiles. Clean; manure taken out into the fields. Originally four stalls, now one. One, occasionally two. 1,966 cu. ft. per animal. Every precaution is taken by proprietor to prevent fouling of milk. Good. do. Water taken to the shed in a pail from the house service. Mitcham. This is a private dairy; most of the milk is used in the house; a little surplus is sold to a. dairyman. C 6 Good ! Good. Shop properly adapted for the business of a dairyman. Good do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... Retail trade. A special can washing shed is provided in yard. C 7 do. do. Good structure; no special means of ventilation. do. General grocery business. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. About a quart of milk only sold per day. C 8 do. do. Shop properly adapted to the business of a dairyman. do. Bread, tea, tinned provisions. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. The bulk of milk brought to these premises is sold on the round; means for cleansing cans, etc., provided at the rear of premises. C 9 Old wooden cottage ; fair repair. do. Milk is received from the last mentioned dairyman and taken immediately on the milk round. No dairy. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. C 10 C 11 C 12 New premises; good condition do. do. Good Shop specially built for a dairyman. Adapated for dairyman's busines Good. Bread, tea, and dairy produce. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. do ... ... do. do. do. The business is a large one; means for cleansing cans, etc., is provided in a shed at the near of premises. Milk is sent out in sealed bottles. A very small quantity of milk is sold here; precautions are taken against fouling of milk. do. Good. This milkshop is in good structural condition. do. Good. do. General grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.W.B. main. ... ... C 18 do. do. This milkshop is structurally good, but very much crowded with other goods. do. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. C 14 do. do. Premises specially constructed for a dairy business; well lighted and ventilated. do. Dairy produce. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do ... ... do. Means are provided in the basement for cleansing of cans, etc C 15 Indifferent. Old ; does not enjoy good health. The front room of a ground floor that has been set apart for storing cans and any milk left over off the round. Indifferent; premises not suitable for milkshop. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. An application for registration by the occupier for this address has been refused. C 16 Good. Good. Shop specially adapted for a dairyman. Good. Dairy produce. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Means are provided in a shed in the yard for the cleansing of cans, etc. C 17 do. do. do. do. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do ... ... do. do. C 18 Not kept as clean as could be wished. do do. Have had occasions to complain of uncleanliness do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. The bulk of the milk sold by these dairymen is deposited in a shed at the rear, adjoining can washing shed. C 19 Good. do. Milk sold from this shop is kept in a larder at the rear of premises. Good. Food kept in larder; tobacco and confectionery sold in the shop. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. The quantity of milk sold is very small. C 20 Old. but in good condition. do. Shop is fitted up for a dairy business. do. Dairy produce. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do ... ... do. A large quantity of milk is dealt with: some taken out by employes and some by other dairymen; milk is deposited in a shed at the rear next to the can washing shed; the premises are not well adapted for a business of this size. C 21 Good. Good. Structurally good, but shop much crowded with other goods. Good. General grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. The occupier is careful to prevent fouling of milk as far as is possible. C 22 do. do. . The shop was built specially for a dairy. do. Dairy produce. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Most of the milk brought here is sold on the round. C 23 Bad. do. This shop is structurally good, but is orowded with other goods of an objectionable character. The shop is as clean as permissable, having regard to the nature of the business carried on. Coal blocks, general grocery, wood, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. An application by the occupier to be registered was refused. C 24 C 25 Good. Good do. do Shop is structurally good; well lighted. do. j Good, do. Bread and confec- tionery. General grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do do. ... ... do. do Milk is kept on the counter and protected from contamination; a very small quantity is sold. do. C 2G do do. Front room set apart for storing milk left unsold on the round. Clean, but ill adapted for storing milk. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Most of the milk is sold on the round. C 27 do. do. New shop premises; well lighted and ventilated. Good. Grocery business. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Occupier is careful to prevent the fouling of C 28 do. do Milkshop is an old building, but clean, well lighted, and ventilated. do. Grocery and haberdashery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Do.; small quantity sold. C £9 do. do. This shop is structurally good, badly ventilated and lighted. The shop is overcrowded with other goods; fairly clean. General grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. The premises are situated amongst the poorer classes. C 30 Bad. do. Old premises; badly ventilated. The shop is crowded with other articles, many of which give off an objectionable odour. Grocery, sweets, haberdashery, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Do., and most unsuitable for storing milk. C 31 Good. Good. Wooden structure at side of house; window and a small opening for ventilation. Clean. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... There is no cowshed ; the cows are kept in the field all the year round. 2 ... ... Milk is taken to the dairy attached to the house. Good. do. M.W.B. main. Lonesome and Mitcham. The cows are shifted to different fields for grazing from time to time. C 82 Bad. Good. The shop is an old one; badly ventilated: well lighted; in bad repair. Impossible to keep clean on account of overcrowded state; an objectionable General grocery, i brushes, crockery, etc., etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... Retail trade. The premises are most unsuitable for a milkshop. odour pervades the place. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... C 33 Good. do. Good structure; well lighted and ventilated- Good. Grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. Every precaution is taken by the occupier to prevent the fouling of milk. C 84 G'ood. do. Structurally good; badly ventilated; fairly well lighted. Difficult to keep clean end air pure on account of its overcrowded state. General grocery, vegetables, and numerous other articles. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... There is no water supply at present; the supply has been cut off on account of leak. ... ... do. Litigation is pending between the Water Board and occupier respecting the water supply and notice has also been served by order of the District Council. C 85 Good. do Wood structure, with glass roof, in yard; in good condition. Good. None. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.W.B. main. ... ... do. Very little milk is sold at the premises; the bulk of supply is sold on the round in Mitcham. C 86 Bad. do. Structurally good, but badly ventilated. The premises are not kept clean and sweet None ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. I have frequently complained, and have served a notice on the occupier to cleanse the place and deodorise it: all the milk is taken or sold on the round. C 87 Good. do. Good. Good. Grocery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do Occupier is careful to prevent the fouling of milk on the premises. C 88 Good. do. The premises were built specially for a large dairy business. Good. Dairy produce only. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do The business is well conducted. C 89 do. do. Good. do. Grocery, oil, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. A very small quantity of milk is sold; occupier is careful to prevent the fouling of milk. C 40 Good. Good. Good. Good. Grocery. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. A very small amount of milk is sold here; every precaution is taken to prevent fouling of milk. C 41 do. do. do. do. Sweets, minerals. etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. ... ... do. do ' 69 INDEX. Accommodation, Isolation Hospital 27, 28 Ages at Death 12, 13, 44, 46 Appendices- Tables I. to XIV. (see "T") 40—59 Factory and Workshop Act 60—65 Infectious Diseases (number of cases, month, and parish) 53,56 Tabulated list of Dairies, Cowsheds, etc. Area 7,47 Articles Disinfected 39 Bakehouses 33 Births in 1909 11—12 Births (1899 to 1909) 40, 49, 50 Birth Rates 12 Birth Rates (1899-1909) 40, 49 Birth Rates (England and Wales) 11, 16 Buildings 35, 36 Bye-Laws, Contravention of 32 Cancer, Disinfecting after 27 Cane Hill Asylum (inmates, deaths, &c.) 44, 48 Cases of Infections Diseases (ages, parishes, &c.) 43, 51—56 Cases of Removal to Hospital 29—31, 43 Cases of Typhoid Fever (1890—1909) 52 Causes of Death 15—17,44 Collection of House Refuse 32 Contravention of Bye-Laws 32 Cowsheds, &c. 32,33 Dairies, Cowsheds &c. 32, 33 Dairies, Cowsheds, etc. (tabulated list) 66—68 Deaths 12—17,44,46 Deaths (1899—1909) 40, 50 Deaths from Zymotic Disease 15 Deaths in Isolation Hospital 29, 31 Deaths, Causes of 15—17,44 Deaths, Ages at 13, 14, 44 Deaths in Public Institutions 12, 13, 16, 17, 40, 44, 50 Deaths and Death Kates from various causes (Zymotic Diseases, Phthisis, &c.) 15 — 16 Death Rates 12,13,14,15,16,49 Death Rates (1899—1909) 40,49 Death Rates (England and Wales) 13 Death Rates of Infants 18,14 Density of Population 47 Diarrhoea Deaths (Table XIII.) 57 Diphtheria 19—23 Diphtheria Cases (month and parish) 56 Disinfecting Articles 39 Disinfecting Houses 27 70 Erysipelas Cases (month and parish) 55 Excess of Births over Deaths 11 Factory and Workshop Act 60—65 Holborn School and Workhouse (Inmates, Deaths, &c.) 44, 48 Hospital, Isolation 27—31 Hospital, cases removed to 29, 43 House Refuse Removal 82 Houses (Number and Increase) 7—10 Housing of the Working Classes Act 34 Illegitimate Births 11 Increase in Number of Houses 8, 9 Increase of Buildings 85 Infantile Mortality 13, 14, 40, 44, 46 Infantile Mortality (England and Wales) 14 Infantile Summer Diarrhœa Infectious Diseases 17—25, 43, 51—56 Inspectors' Work 37, 38 Institutions (Inmates, Deaths, &c.) 16, 17, 44, 48 Isolation Hospital — Accommodation 27, 28 Patients admitted 29,31 Staff 29 Deaths from various Infectious Diseases 29, 31 Legal Proceedings 82 Measles 25 Measles Cases (month and parish) 54 Milkshops, &c. 32, 33 Mortality at different ages 13, 14, 44 Mortality Rate (Infantile) 49 Mortality Rate (England and Wales) 13 Notified Cases of Infectious Disease 43, 51 Patients admitted to Hospital 29, 31 Phthisis 24 Phthisis, Disinfecting after 27 Phthisical Death Rate 15 Piggeries 33 Pulmonary Tuberculosis (month and parish) 53 Population 7, 40, 42, 47 Population, Density 47 Preventive Measures 25, 27 Public Institutions (Deaths, &c.) 44, 48 Puerperal Fever Cases (month and parish) 54 Pulmonary Death Rate 15 Rates, Birth 12 Rates, Death 12, 13, 14, 15, 16, 50 Regulated Trades 32—34 Removal of House Refuse 32 Removals to Hospital 29—31 Scarlet Fever 18 71 Scarlet Fever Cases (month and parish) 55 Sewage Works 35 Sewers 85 Slaughterhouses 38 Staff, Isolation Hospital 29 Table I.—Vital Statistics (1899—1909) 40,41 Table II.—Vital Statistics (1899—1909), separate parishes 42 Table III.—Infectious Disease Cases (ages, parishes, removals to Hospital) 43 Table IV.—Causes of, and Ages at, Death 44, 45 Table V.—Deaths of Infants at ages 46 Table VI.—Area, Houses, Population, Density (each parish) 47 Table VII.—Area, Houses, Population, Density (parishes with Institutions) 48 Table VIII.—Birth, Death, and Infantile Death Rates (1899-1909) 49 Table IX.—Population, Births, and Deaths (1899—1909) 50 Table XI.—Cases of Infectious Disease (1891—1909) 51 Table XII.—Typhoid Fever Cases in each parish (1891—1909) 52 Table XIII.—Deaths from Infantile Summer Diarrhœa 57 Table XIV.—Deaths from Infantile Summer Diarrhoea (parish and street) 58 Tabulated list of Dairies, Cowsheds, etc. 66- 68 Trades, Regulated 32—34 Typhoid Fever Cases (1891—1909) 52 Typhoid Fever Cases (month and parish) 53 Vital Statistics (Tables I. to XIV ) 40—58 Water Courses 32 Zymotic Death Rate 15—16 Zymotic Death Rate (England and Wales 16