KlN048 BOROUGH OF KINGSTON-UPON-THAMES. REPORT OF THE MEDICAL OFFICER OF HEALTH, TO BE PRESENTED TO THE TOWN COUNCIL OF THE SAID BOROUGH, ON TUESDAY, THE 20th DAY OF FEBRUARY, 1894. KINGSTON-ON-THAMES : Printed by W. Drewett, Market Place and Ceres Road and East Molesey. Clattern House, Kingston-upon-Thames, February, 1894. Gentlemen, In presenting my First Annual Report, I wish to make a few remarks upon the soil, position, and history of the Borough with reference to public health. The soil of Kingston is chiefly gravel, with alluvium and clay in places. The situation of the town is on the South bank of the Thames, from which it rises very gradually to the foot of Kingston Hill, whence to the Borough boundary the elevation is more abrupt. The levels are given as: 20 feet at Canbury Gardens, 29 feet at the Barracks, 100 feet at the angle in Liverpool Road, and 142 feet a hundred yards further on at the Borough boundary. The Market Place is 29 feet, the Fairfield 33 feet, and the Junction of Gloucester Road with the Maiden Road is 55 feet. Passing further South, Grove Road is 34 feet, and Uxbridge Road 40 feet ; 40 feet is also the level at the Borough boundary in Marsh Lane near the proposed Isolation Hospital. The top of Kingston Hill is 176 feet. The Hogg's Mill Stream enters the Thames near the Market Place, having its principal source at Ewell, where it bubbles up clear and pure from the chalk. It is probable that this supply of pure water would be gladly welcomed by the villages through which the stream passes, as well as by the town of Kingston at its mouth, had not Government in its wisdom given certain commercial undertakings the right to force indifferent water supplies at a heavy charge upon the inhabitants. Could this stream be tapped at its source it might supply these towns and villages with a good drinking water, which, when it had served its purpose, could be turned into the stream again to flow with the land drainage, as it does at present. 4 Near the banks of this stream are many wells for the drinking supply of the houses, mostly of the labouring classes. The water in these wells may be affected by the character of the water in the stream, for the soil being mostly loose alluvial deposit there is opportunity for free percolation. Now this stream receives the drainage of Old Maiden and various villages, practically untreated. Within the Borough there are three mills, each of them damming back the water for about the height of 5 feet and increasing this tendency to percolate through the loose soil into the wells from which some of the inhabitants draw their drinking water. Passing to the other side of the Borough we find in the Canbury district the remains of a stream called the Latchmere brook. This is now covered over, but apparently followed a course shown by a depression of tbe ground level between Richmond Road and Elm Road. Here again there are more wells for supplying drinking water. In this latter district there has been a number of cases of Diphtheria, and near the Hogg's Mill Stream were many cases of the same disease. The water from these wells when analysed shows varying degrees of impurity. Two analyses are rarely alike, but the average impurity is in most cases insufficient to condemn and forcibly close the well. Yet, considering the surroundings—the river close by, or the remains of the brook; the natural flow of the land water from the high ground past cesspools, farms, &c., towards the Thames; it is not going too far to brand these well waters as suspicious, and to recommend that a constant water supply from the mains should be laid on. This water, though fairly good, has not a very good reputation, and is excessively costly, so that it is hardly a matter for surprise that many persons prefer to go on running the risk. I caution householders to boil their water, and be extra careful when they notice any of the Sanitary Staff visiting their neighbours. 26 specimens of well water were analysed during the year, of which, 9 were declared very suspicious and 8 bad. The houses of Kingston are some of them very ancient, and it would be a good thing if most of these very old houses could be pulled down and rebuilt, as they cannot be brought up to modern requirements. Other houses that are not so very old have in many cases been put all right, but in some other cases much requires to be done. At the present moment there are several houses standing empty, and have been standing empty 5 for a considerable time, at rents varying from £40 upwards. This entails a considerable loss in rates, and this loss the town will continue to suffer until the owners of these properties put them into order. There is plenty of demand for such houses, as is shown by the rapidity with which good houses of this class are snapped up. The chief defects are old pan closets; and insufficiently ventilated, or unventilated, soil pipes; rain water pipes not disconnected over trapped gullies; drains improperly laid and not disconnected from the sewers; and badly arranged basements without a dry area. In all new houses concrete over the basement is obligatory, and rightly so, when it is considered that the heat of the house (more especially in cold, wet, or frosty weather, when the ground is sealed), tends to draw the air that is always present in the interstices of the soil, into the house, unless it is covered over with impermeable material. The cheaper houses are mostly of modern construction and fairly well arranged, but there is a certain amount of property erected before the introduction of the bye-laws, and as a rule occupied by the poorest classes, that requires attention. Several landlords have been called upon to improve their premises and have complied with my requests. The paving of back yards in all houses of this class is most necessary for the health and well being of the occupiers, and every effort is being made to get this improvement carried out. In revising the Bye-Laws provision should be made for dealing with the above-mentioned matters. In the higher rented parts of the town there are many trees in the gardens, and in some of the streets trees have been planted, but in the Canbury district there is a great want of greenery, and I should recommend the planting of trees in these streets, as a protection from glare, and for the health giving properties of green growing leaf in places that are thickly populated. 118 new houses have been built during the year. The site of the town has made the sewerage a very difficult problem, as the requisite fall is not easily attained. The institution of the separate system all over the Borough would, in my opinion, to a great extent remedy this evil, as when the house soil, and slop waste, only is taken a much smaller sewer suffices, and the smaller the sewer the less fall is necessary in order to make the flow self-cleansing. In addition, the street washings 6 do not mix with the soil from the houses, so that the tendency to silt up, which gives so much trouble in the combined system, is obviated. Great objections have been raised on the score of the liability to choke up by the accidental entrance of sticks, brushes, &c., but such impedimenta may be dealt with by administration of bye-laws, and by the interposition of sufficient inspection chambers. Mr. Adams, City Engineer of Brooklyn, has estimated that a 9 inch drain in order to be self cleansing requires a fall of 1 in 248 for the separate system, and of 1 in 90 for the combined system—for the reason that in the separate system the flow would be constant, whereas in the combined system it varies, being to a great extent dependent upon the rainfall. I am not greatly in favour of ventilating sewers, as I think it much more satisfactory to disconnect every house from the main sewer by properly arranged, and ventilated, inspection chambers and disconnecting traps. The Council is to be congratulated upon the installation of the Electric Light in the Borough, and I hope it will not be long before every part of the town is supplied with this cleanly and sanatory method of illumination. My predecessor has called your attention to the want of provision of public conveniences. This is an urgent need in the central portions of the town, both for men and women. I rejoice that his repeated insistance upon the provision of accommodation for isolation of infectious diseases has at length borne fruit, and I hope that it will not be many months before the Borough is provided with a suitable Sanatorium. Deaths. There have been 509 deaths in the Borough, including 6 in Surbiton Cottage Hospital, 1 in the Cambridge Asylum, and 7 in the Barracks. Of these, 259 were males and 248 females. In addition there were 49 deaths in the Workhouse of persons not belonging to Kingston. This gives a death-rate of 17 9 for the Borough. The Zymotic death-rate is 3.29, or including 2 deaths from Small Pox of persons resident in the Workhouse, but not belonging to Kingston, 3.36. Although the returns of deaths show a low mortality in those parts of the town which from situation, or condition of property, would be considered more unhealthy, it must be 7 remembered that the class inhabiting such parts are migratory in character, and usually go into the Infirmary when seriously ill, so that the Workhouse mortality may be divided between Cambridge Square and its surroundings, the backs of the Fairfield, the Back Lanes, and some parts of Canbury, whereas it is now accredited to the Hill Ward. Six cases of uncertified deaths are recorded, viz., 1 Paralysis; 2 Heart Disease; 2 Premature Birth; and 1 Senile Decay. There were 34 Inquests, of which 3 were in the Workhouse on persons not belonging to Kingston. The causes of death were as follows: 8 Inflammation of Lungs ; 5 Heart Disease; 5 Cerebral Hœmorrhage; 1 Accidental Haemorrhage; 4 Fracture of Skull; 2 Tuberculosis; 2 Urœmia; 2 Neglect; 1 Suffocation ; 2 Drowning; and 2 Fall. A table of deaths, and death-rates for the different diseases, is appended. Births. The birth-rate is 29.3, and the greatest number of births was in the month of October, when 90 were recorded. Small Pox. 16 cases of Small Pox have been notified during the year, of which 12 cases occurred in the Workhouse. The first case was a tramp who was taken ill at a lodging house in the Back Lanes, and was removed by the Relieving Officer to the Workhouse, he being unaware what his complaint was. It was afterwards discovered that he had Small Pox. The next case was the man, a pauper, who attended him as nurse, but this second case is doubtful, as the rash did not appear and the patient had Pneumonia. 9 cases appeared at short intervals; all of them being old male paupers working in the neighbourhood of the ward where the affected men were isolated, except 2 who were in the main building of the Workhouse. The Workhouse Isolation Ward is most improperly arranged, and it is situated close to the main buildings and work shops. The building was in bad condition, and consists of 8 only two portions; in one side were Scarlet Fever cases, in the other Small Pox, so that it was fortunate that all the cases were of one sex. An inspection of the Workhouse was made but the reason for the disease spreading in the way it did was not ascertained; but as the infection went round corners, and passed over many who were equally susceptible, as far as can be judged, to those attacked, it appears to me that the entire want of system in the arrangements for the treatment of infectious disease must be credited with the blame. No trained nurse was placed in charge of the sick men, who were handed over to the tender mercies of fellow paupers, who, with the best intentions, could not be. efficient nurses. At least, if efficient nurses, why were they not earning their livelihood as such, instead of burdening the rates? It would, in my opinion, be a much better arrangement if all infectious diseases occurring in the Workhouse were treated in the proposed Isolation Hospital under the direct control of the Sanitary Authority. One other fresh case was introduced into the Workhouse, having been sent there from Hampton. This appears to me to have been a most extraordinary arrangement, as the Hampton authorities have a hospital to which they might have sent this man, at a small cost, instead of sending him into the midst of a crowded workhouse, where if all the susceptible persons had not been already attacked, he would have started an epidemic, in the same way, as did the first case brought from the Back Lanes. If my suggestion were carried out, such a patient would be taken to the Borough Sanatorium, and the cost of his maintenance charged to the district from whence he came. 4 cases have also occurred in the Norbiton district. Each case was carefully isolated, and placed in charge of a trained nurse, and all persons in attendance were re-vaccinated. The houses in each case were subsequently stripped and fumigated and all articles likely to carry infection were destroyed. The cost was considerable, but justified in the result, no case having been the cause of infection spreading to others. One of these cases was a man who had been working at a laundry in connection with the Small Pox hulks at Long Reach. He had declined to be re-vaccinated on going to this work, on the ground that those men whose arms were so much affected by the vaccination as to prevent their working for a day or two, lost the job and received no compensation. If this statement is correct it seems to be a hardship that requires attention. 9 All these persons had been vaccinated in youth except one, who had been inoculated; consequently, they" all had the disease very lightly. The two deaths occurred in persons who suffered from other diseases, one man never showing any spots, and it was only from his having been in attendance on the other patient that Small Pox was given as the cause of death, which I ascribe to Pneumonia, from which disease he was also suffering. Scarlet Fever. 277 cases have been notified during the year. The type of the disease was very mild, there having been only 7 deaths, or 2.7 for every 100 attacked. A great many of the cases were introduced into the town, and a large proportion were considered to be secondary cases, having been contracted from play-fellows. During a warm summer such as was experienced last year it is quite impossible, with such mild cases as in the present epidemic, to ensure efficient isolation in the poorer quarters. The children feel quite well and slip out to play when their mothers' backs are tunned. It will be noted that the proportion of secondary cases was much higher during the warmer months. Could the first cases have been removed to hospital the epidemic would never have assumed the proportions it attained. Diphtheria. Great difference of opinion exists about the origin of this disease, but the general consensus of opinion is that sore throats arising from dampness, or bad drains, will by aggregation of cases in schools, or other assemblies, develop into Diphtheria. For this reason I should like to see Infectious Sore Throat, and Membranous Croup, added to our list of notifiable diseases. Infectious Sore Throat if notified may, by precautionary measures, be prevented from forming the nucleus of a Diphtheria out-break, and though the word Diphtheria is sufficient to cause a scare, the term Infectious Sore Throat would merely put persons on their guard, without causing undue alarm, and had this been possible during the past year, I think that, quite 75 per cent. of the non-fatal cases of Diphtheria would have been notified as Infectious Sore Throat. The cases of Diphtheria notified are grouped together in the accompanying tables, together with the cases of infectious 10 sore throat that I discovered by visiting all absentee scholars from St. John's Schools. This inspection was carried out so long as cases of Diphtheria continued to be notified in the scholars attending that School. It will be noticed that a large number of these cases occurred in the neighbourhood of either the Hogg's Mill Stream, or in the course of the old Latchmere Brook. Should this suggestion of mine be carried out, the inspection of absentee school children whenever Infectious Sore Throat is notified in a school, would, in my opinion, prevent these epidemics developing into Diphtheria, when combined with other sanitary measures. The disease appearing first in one school and then in another, it would be comparatively easy, by the help of a conveyance, to carry out this inspection systematically. Unfortunately by waiting till sore throat has developed into Diphtheria the cases occur very frequently in two or three schools at the same time. Another difficulty arises when some of the scholars live in the district of a different Sanitary Authority, but this in our case will be avoided when that imaginary line that confines Kingston within its narrow bounds is stretched out to the natural limits to which the town has spread. Having received several notifications of Diphtheria, I visited all the absentee scholars from one elementary school and, also, several small private schools, but as the disease is frequent amongst infants the labour is considerable, as infants are very irregular in their attendance and much walking is necessary to find the few cases of Sore Throat that may be discovered. It will be seen that several of the groups were first noticed in houses where there was something wrong with the Sanitation. I do not say the cases arose from defective drainage, but there was such a cause present, and I was unable to ascertain any other source of infection. Enteric Fever, or Typhoid. 7 cases were notified, including 1 case contracted at Woking, and 1 following on Influenza. The cause was not discoverable in any of the cases, with the exception of one case of a school girl who was attending a private school where some defects were found. These defects have been remedied. The other cases may probably have been contracted away from home. There were 2 deaths, viz.: the case following SPORADIC CASES. Notifications numbered. Sanitary defects noted. Locality. Date. 1 March 17 2 Defective drain ,, 20 3 Defective drain April 8 4 ,, 8 5 „ 27 6 Contracted abroad „ 17 7 At a dairy May 3 8 Moveable dwelling First ill at Godalming. ,, 5 14 Defective sanitation June 6 15 ,,7 16 ,, 7 17 At a dairy ,, 12 20 Using milk from above dairy ,, 15 25 ,, 21 26 ,, 18 27 ,, 25 42 No particular sanitary ^ defects discovered. Schools: St. Luke's, Public, and All Saints'. Neighbourhood of Acre Road. July 14 43 ,, 14 44 ,, 14 45 ,, 14 46 ,, 18 47 ,, 19 48 ,, 21 49 ,, 15 50 ,, 25 51 Aug. 19 52 ,, 31 53 Sept. 4 54 ,, 5 55 ,, 6 56 Defective sanitation All in and around the Market Place. ,, 10 57 ,, 14 58 ,, 14 59 ,, 14 60 ,, 14 61 ,, 14 62 ,, 14 63 „ 14 64 ,, 15 68 Oct. 6 69 „ 17 Group 3. Private School. Group 2. Private School. GROUP I. Cases in an Elementary School. Locality. No. of Notification. Sanitary Defects. Dates. Un-Notified Cases. Locality. Sanitary Defects and nature of Disease. No. 9 Drain defective May 6 Same house as last „ 14 Close to Hogg's Mill stream un-notified case No. 10 „ 18 Pnmp water condemned June 1 | Near Fairfield Slight sore thioat „ 4 No doctor in attendance Banks of Thames No. 19 ,, 14 „ 15 Near Spring Grove Diphtheric throat No. 21 „ 18 ,, 18 Near Splash Slight sore throat Near Mill Street No. 22 „ 20 No. 23 „ 20 No. 24 „ 20 „ 20 Near Hogg's Mill stream Very slight „ 20 „ 23 „ 23 „ 23 Near Fairfield London Street No. 11 Old house Very dilapidated May 23 No. 12 „ 23 No. 13 „ 29 Beginning of June Children living near London Road Several cases of sore throat. No medical attendance. New House No. 18 June 13 „ 20 Slight case. Norbiton No. 28 „ 26 School Closed June 30. No. 29 House in open situation No medical attendance „ 27 No. 30 ,, 29 No. 31 „ 30 No. 32 July 1 End of June Gibbon Road Slight case of sore throat On course of Latchmere Brook No. 33 Defective Sanitation July 5 School closed July 7. No 34 ,, 5 No. 35 ,, 8 No. 36 Insanitary house ,, 7 No. 37 ,, 10 No. 38 ,, 13 No. 40 ,, 14 No. 41 ,, 14 No. 51 Aug. 17 In the same house as several previous cases. 11 Influenza, and one case that was rather late in seeking medical aid. Though the case mortality is rather high, the death rate per 1000 is considerably below that of England and Wales. Puerperal Fever. 2 cases are recorded, with 1 death. The source of infection was not traced. Continued Fever. 1 case was recorded, but does not call for any comment. Phthisis. The death rate from this disease was about the average for England and Wales. The greater number of deaths took place in the Infirmary, and were those of Phthisis in advancing years. This disease has now been fully established to be due to a definite infection. Persons suffering from this disease should be careful to avoid expectorating in public places, except into cloths, or spitting pots, the contents of which should be destroyed by burning on reaching home. On a consumptive patient removing, or dying, the room and its contents should be disinfected, and where possible, whitewashed and re-papered. It should be remembered that a tendency to this disease is increased by impure air, so that consumptives should live in well ventilated rooms, the windows being always kept slightly open day and night, if there be no special means of ventilation. Consumptives should not attend crowded assemblies, such as Churches, Chapels, Theatres, &c. Erysipelas. One case was returned as arising after Vaccination. Erysipelas when inoculated develops within three days; in the present case it appeared after the vesicles were formed, and was of the same character as any attack of this disease would be that followed upon the improper treatment of a wound. 4 other deaths from this disease are of no special interest. 12 Diarhœa It will be seen from the table that the death rate under one year (17 out of 28) is somewhat above the average. These deaths mostly occurred during the hot weather in the same neighbourhood as the Diphtheria cases, viz., near the Hogg's Mill Stream and the old Latchmere Brook. There was a considerable epidemic of mild diarrœha in older children during the fruit season. Whooping Cough. The deaths from this disease were chiefly in infants, and amongst the poor and imperfectly nourished. Measles. The town has been singularly free from Measles, and no death has been recorded from this disease. Influenza. There was a mild outbreak of this disease in May, and a more prevalent one in November and December. Persons suffering from this complaint should not frequent public assemblies, as the disease is more infectious even than Small Pox. Strict isolation till the termination of all expectoration would soon effectually stamp out this pest. Other Diseases. There is nothing special to call attention to in the other causes of death that are shown in the tables, though Tuberculosis is rather prevalent, perhaps, from causes referred to under slaughter houses. A special table is appended, showing the incidence of the death rates in certain diseases in Kingston compared with the rate for England and Wales for the years 1886-90 Overcrowding. Two cases were brought to my notice, both being caused by the same family, who having been got rid of in one place, removed to another house. They finally left the town. INSPECTION OF SCHOOLS, MARCH, 1893. Name. W.C. accommodation. Flushing General Condition. Soil Pipes and Drainage. Remarks. Present Condition 1894. St. JOHN'S Fair Fair Good No Ventilator A few minor defects. ALL SAINTS Good Fair Good Ventilator and Interceptor NOBBITON Insufficient Indifferent Antiquated No Ventilator Requires general overhaul Work in progress PUBLIC Fair Fair Good Ventilator Water supply from well St. LUKE'S Insufficient Good Good Ventilator Alterations have been made St. PAUL'S Improvement in progress at time of Inspection Alterations completed. TIFFINS' Good Good Good No Interceptor Interceptor has been fixed. GRAMMAR Fair Fair Antiquated No Interceptor Imperfect Ventilator Thorough re-organizing recommended Alterations completed. MILK SELLERS. No. Dairy. Cowsheds. Milk Supply. Water Supply. Remarks Arrangments Washing Cans. 1 Clean None Petersfield Company No vent. of drains. Alterations in progress. W.C out of order Fair 2 Clean None Semley ,, Clean and well kept. Drainage beneath house ! Good 3 Clean None Semley ,, No vent. of drains. Good condition. Fair 4 Clean Cows, about 500 cb. ft. out in summer Own cows ,, The W.C. is unsuitably placed. No vent. of drains Good 5 Clean None Coombe Pump W.C. out of order. No vent. of drains Fair 6 Clean None Semley Company W.C. out of repair. Drain vent. ,, 7 Clean None Freeth & Pocock ,, W.C. out of repair. Drain unvent. ,, 8 Clean 11 cows, always in shed 500 cb. ft. Own cows ,, Drains ventilated. Interceptor trap Good 9 Clean 3 cows, always in shed, about 500 cb. ft. Own cows and Maiden ,, Soil pipe inside wall, and un-ventilated ,, 10 Clean 3 cows, always in shed, fair condition Own cows and Berrylands ,, Old premises, not altogether satisfactory Fair 11 Clean 10 cows, about 400 cb. ft. Own cows ,, No vent. of drain, no interceptor ,, 12 Clean None Petersfield ,, W.C. out of order. Not yet registered Good 13 Clean 4 cows, 5 or 600 cb. ft. Own cows and Ham ,, Drain vent. W.C. out of order Fair 14 Clean None Hook ,, Drains vent. Interceptor trap Good IS Clean None Semley ,, Drains vent. Interceptor trap ,, 16 Shop only None Petersfield ,, Only sold over counter. Shop is a general store None 17 Clean 21 cows, 600 cb. ft., cows out in summer Own cows ,, No vent. or interceptor to drains Good 18 Full of lumber None Freeth & Pocock ,, Only one cistern. Unsuitable premises Indiff. 19 Shop only None Hampton Wick ,, Various defects not in direct communication with the milk shop None 20 Clean 6 cows, not in first rate condition, about 450 cb. ft. Own cows, Ham, &c. Pump Catch pit for drainage from cowshed. Cleaned out weekly. No vent. of drain Fair 21 Clean but confined in space 10 cows, under 300 cb. ft. Own cows Company Accumulation of dung. W.C. very dirty ,, 22 Clean None Various, but all kept separate ,, Dairy is close to stables in another occupation Good 23 Clean. Requires whitewashing 4 cows, about 400 cb. ft. Own cows ,, There is a pump, said to be unused. W.C. out of repair. Old house ,, 24 Clean. Requires whitewashing None Petersfield Company Drain vent. Fair BIRTHS. DEATHS. AGES OF THE DYING. CAUSES OF DEATHS. Month. Males. Females. Total. Males. Females. Total. Legitimate, under 1 year. Illegitimate, under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. Over 65. j Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus. Puerperal Fever. Erysepelas. Measles. Whooping Cough. Diarrhoea. Influenza. Rheumatic Fever. Phthisis. Bronchial Pleurisy and Pneumonia. Heart Disease. Tuberculosis. Cancer. Injuries. All other Diseases JANUARY 31 28 59 26 34 60 8 9 i i 24 17 Under 5 ... 1 3 1 ... ... ... ... ... 2 1 ... ... 2 16 8 2 ... ... 7 1 16 FEBRUARY 28 27 55 34 18 52 8 8 1 1 18 16 Under 5 1 ... ... 2 1 ... ... ... ... 1 1 ... ... 5 5 7 1 2 ... 6 11 9 MARCH 41 32 73 19 24 43 8 3 4 4 3 15 6 Under 5 ... 1 ... ... ... ... ... ... ... 1 3 ... 1 5 4 1 ... 1 ... 6 5 15 APRIL 40 28 68 28 15 43 9 1 3 1 2 17 10 Under 5 ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 1 2 3 1 1 5 3 3 6 14 MAY 30 32 62 18 17 35 4 2 5 3 ... 11 10 Under 5 ... 1 3 1 ... ... ... 2 ... ... ... ... ... 2 3 4 ... 1 2 5 4 7 JUNE 47 31 79 21 25 46 9 1 3 5 4 11 13 Under 5 ... 2 2 ... ... ... ... 1 ... 2 2 ... 1 6 1 4 ... ... 3 7 2 13 JULY 31 35 66 21 20 41 11 2 5 2 4 12 5 Under 5 ... ... 3 ... 1 ... ... ... ... ... 9 ... 1 6 5 2 3 2 ... 3 1 5 AUGUST 43 26 69 14 21 35 8 2 5 1 1 15 2 Under 5 ... ... 2 ... ... ... 1 1 ... ... 4 ... ... 4 2 4 1 ... ... 6 2 8 SEPTEMBER 26 33 59 18 19 37 7 1 6 3 15 5 Under 5 ... 1 4 2 3 2 2 ~2~ 2 3 1 6 3 6 OCTOBER 38 52 90 11 19 30 10 4 2 12 2 Under 5 ... 1 1 2 2 2 3 1 1 7 1 1 8 NOVEMBER 46 35 81 21 12 33 6 1 6 2 1 10 7 Under 5 ... ... 1 2 1 1 4 3 2 1 3 9 DECEMBER 33 35 68 30 23 54 11 2 5 4 19 13 Under 5 ... ... 1 ... ... ... ... 1 ... ... 1 8 ... 5 12 4 1 ... 1 4 1 6 1 8 TOTALS 434 394 828 260 249 509 99 15 63 22 24 180 106 Under 5 1 3 19 5 2 ... 1 1 ... 8 26 1 3 1 32 45 17 10 10 65 4 4 1 5 2 11 42 66 6 118 Rate per 1000 Living 153 139 29 2 9 15 8 78 17 9 35 03 22 77 8 6 18 371 All ages .035 .4 . .1 .7 .035 .1 .28 99 .42 .105 1.5 3.4 155 806 .35 .35 6.4 In Workhouse, not belonging to Kingston, for the Year 11 7 18 33 16 49 2 2 25 20 Under 5 2 ... ... ... ... ... ... 2 ... ... 1 ... ... 6 8 3 ... 4 3 2 18 13 Schools. All the public schools, and several private schools, have been inspected, and such recommendations as I have made have been carried out, or are in progress. As regards the elementary schools, there was a deficiency in closet and lavatory accommodation, below the standard laid down in the Code. In addition to this the schools were all of them too full, and 1 am glad to see the new school is rapidly approaching completion. Children when learning require plenty of light and air, expensive articles which the public must make up its mind to pay for, if they wish the children to take full advantage of the education, and grow into healthy men and women. The Grammar School has been thoroughly overhauled, and I think it is now in a satisfactory condition. Several private schools have been put into a better sanitary condition, but the carrying out of these improvements in some of the older houses is very expensive, and compulsory powers are not as extensive as I should wish. Now that the electric light is available, the question arises whether it would not be advisable to commence afternoon school somewhat later during the winter months, so that the scholars might get fresh air and exercise during the better part of the day. I believe they would learn all the better for this advantage, if it could be arranged. Dairies. The dairies and milkshops have been inspected and found to be fairly satisfactory. In some cowsheds there has been found to be not sufficient air space for the number of cows. These people have been warned and will be further dealt with if necessary. Purveyors of milk are very numerous, and their shops have been, with one or two exceptions, found to be satisfactory. Slaughter Houses. These places are mostly in crowded parts of the town, and although complying with the regulations are far from satisfactory. It is to be hoped that when the Borough is extended, that a public abattoir under proper control will be established. It would be worth the while of opponents of 14 enlargement to cease their opposition for the sake of this benefit alone. 3,322 tuberculous carcases were seized last year in England and Wales, mostly in towns were there was a public abattoir. How many carcases are likely then to pass into the market where the inspection is irregular and not subject to constant veterinary inspection. Bakehouses. These have been inspected twice during the year, and in two cases it was necessary to communicate with the Factory Inspector for minor infringements of the Act. Remarks. 595 visits of Inspection were made. 13 visits to schools. 105 letters were written to 25 visits to milkshops. recommend improvements. 14 visits to slaughter-houses. 7 notices were served. 78 visits to bakehouses. Total visits by Medical Officer, 725. Apart from the high Zymotic death-rate, the health of the town has been good. It stands generally at about the average for towns of the same size, but I hope in time it may be brought into an even more favourable position as regards its place in the health statistics. After this great epidemic of Scarlet Fever we may reasonably look forward to a very few cases of this disease in the next few years. In conclusion, gentlemen, I have to thank you for the consideration you have shown me during my long illness, and for the congratulations you have tendered to me on my recovery. Yours faithfully, H. BEALE COLLINS, D.P.H., Etc. Medical Officer of Health. TABLE I. wards and diseases in each. Primary Cases. Secondary Cases. Totals. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Town— Scarlet Fever 4 7 12 8 1 3 3 5 43 Diphtheria 1 3 5 5 4 11 29 Puerperal 1 1 Enteric Fever 1 1 — 74 Norbiton— Scarlet Fever 8 33 21 12 2 24 4 1 105 Diphtheria 11 4 4 9 1 29 Puerpera 1 1 Enteric Fever 1 1 2 Small Pox 1 3 4 — 141 Can bury— Scarlet Fever 4 8 22 13 2 13 9 71 Diphtheria 5 1 18 9 1 9 43 Enteric 1 1 2 — 116 hill— Scarlet Fever 9 10 13 14 2 5 4 1 58 Diphtheria 5 1 9 3 3 3 2 26 Enteric 1 1 2 Small Pox 1 1 4 6 12 Continued Fever 1 1 — 99 Scarlet Fever 25 58 68 47 7 45 20 7 277 Diphtheria 11 16 36 21 1 16 24 2 127 Puerperal 1 1 2 Enteric Fever 3 1 1 2 7 Continued Fever 1 1 Small Pox 2 4 4 6 16 Barracks—Scarlet Fever, 15 cases. Grand Total 430 Table shewing the total Notified Diseases for England and Wales, 1892, compared with Kingston 1893. Also the mortality per cent, of cases notified for England and Wales 1892, compared with Kingston 1893. First line in each section shows cases notified per 1000 of population Second line in each section shows deaths per cent, of cases notified. 15 HEALTH DEPARTMENT. Showing the work done by the Sanitary Inspector. Abstract of Notices for the Year, 1893. Choked and defective drains 103 Defective closets and syphons 26 Defective soil pipes and ventilators 18 Defective yard, sink and bath waste traps 23 Defective water apparatus to closets 61 To provide separate cisterns for flushing closets 22 Foul drinking water cisterns 61 To lay on water supply to houses 8 To cleanse and lime wash houses 109 To cleanse and disinfect houses and cellars 32 To cleanse and lime wash closets and yards 15 To cleanse urinals adjoining public thoroughfares 8 To abolish urinals „ „ 2 To screen urinals „ „ 6 Dilapidated house roofs, floors and yards 17 Dilapidated and damp bedroom walls 40 Dilapidated manure and dust places 12 Accumulations of manure, offal &c. 60 Pig keeping (a nuisance) 10 Fowl keeping (a nuisance) 36 Undrained stables and yards 7 Overcrowding of houses 2 Samples of well water procured for analysis 27 Canal Boats Acts, &c. Canal Boats and Barges inspected 25 Offences in Contravention of Canal Boats Acts 2 Notification of Infectious Diseases Acts. Notices served to Householders 410 Notices served to Attendance Officer 410 Notices served, to Schools 410 Disinfecting houses after Infectious Diseases 380 The Slaughter Houses, Cowsheds, Dairies and Milkshops have been visited at various times and found in a satisfactory condition FRED. J. PEARCE, Assoc. San. Inst., Sanitary and Buildings Inspector. January, 1894. 16 REPORT OF THE LODGING HOUSES, MARKETS, AND PETROLEUM INSPECTOR FOR THE YEAR 1893. Lodging Houses. Registered Lodging Houses, to the number of 9, have been kept clean and satisfactory. The total number of Lodgers for the year using these houses amounted to 100,879, being a decrease of 2,580 from the previous year. 3 deaths only occurred during the 12 months. Petroleum Act. Premises and tanks licensed under this Act have been kept in a satisfactory condition and have afforded no cause for any complaint. Markets. All stalls occupied by perishable goods have been kept under close observation, and I have had no cause to make any complaint. WILLIAM COOK, Inspector. January, 1894.