BOROUGH OF KINGSTON-UPON-THAMES. Annual Report OF THE MEDICAL OFFICER of HEALTH PRESENTED TO THE TOWN COUNCIL OF THE SAID BOROUGH, On Tuesday, the 16th day of March, 1897. KINGSTON-ON-THAMES: Printed by W. Drewett and Sons, Market Place, and East Molesey. REPORT OF THE MEDICAL OFFICER of HEALTH. Clattern House, Kingston-upon-Thames, January, 1897. Gentlemen, In presenting my fourth annual report I shall take the opportunity of referring to certain matters bearing directly, and indirectly, upon public health which are now being discussed in scientific circles, and to which it is my duty, as your Medical Officer, to call your attention. The great progress that has been made in sanitation tends to bring forward the idea that all has been done that can be done. For the last four years the average death rate is 15.6, which at first sight seems highly satisfactory, being lower than the rate for the country districts of England and Wales 1885-94, but when compared with the County of Surrey the satisfaction is lessened, for it is above the average for the county. Surrey is the third healthiest county in England, and it behoves us to see that as the chief town we take a good place in the health returns. I do not think there 4 Would be much difficulty in improving our position, for a glance at the table (A) will show that our death rate is as high as it is in consequence of a high zymotic death rate. Now this zymotic death rate is only slightly below the average for England and Wales. As I have frequently shown, we have a large population of children, and it is at this period of life that the zymotic diseases show their power. Has the best possible means been taken to grapple with this class of disease? I am sorry to be obliged to answer that question in the negative for the following reasons:— Firstly, we have no isolation hospital, and we are almost the last amongst our neighbours to make this provision, whilst from the constitution of our population we are the most in need of one. Secondly, Diphtheria is our most fatal disease, and the fatality arises from the absence of ready means to diagnose the disease early. The establishment of a Bacteriological laboratory, preferably in connection with a hospital, would enable the medical practitioners to arrive at an early diagnosis of the disease, and would also enable them to certify convalescence with greater certainty. Thirdly, because Measles is not at present notifiable, and it is therefore only possible to deal with the disease when it becomes to such an extent epidemic that it is necessary to close schools. Fourthly, because the fatality from Diphtheria and Measles is largely increased by dampness. Though much has been done to remedy this by laying new surface water drains, there still remain many other improvements to be carried out, to which I have, from time to time, drawn your attention. The course of the old Latchmere 5 TABLE A. Average Death Rates of principal Urban Districts in Surrey for the years 1892.5. General Death Rate. Zymotic Death Rate. ENGLAND AND WALES 18.7 2.42 KINGSTON 16.1* 2.2 †FARNHAM 15.7 1.23 CARSHALTON 15.4 1.59 †GUILDFORD 14.17 1.46 †BARNES 14.07 1.69 EPSOM 13.9 .74 †RICHMOND 13.7 .86 GODALMING 13.5 1.24 DORKING 13.5 .77 †REIGATE 12.3 .93 †WIMBLEDON 12.2 1.26 SURBITON 11.1 .66 SUTTON 103 116 * The deaths of persons from other districts in the Union dying in the Workhouse are not included for Kingston, but are included in certain of the other towns. † These Districts may be most properly compared with Kingston from the composition of their populations. 6 Brook still remains in a damp and unsatisfactory state, and though on private property might be improved. There are numerous back lanes in the Borough that all through the winter months are in an unsatisfactory condition; two especially bad ones are behind Acre Road and turning off York Road, but others are only in a less degree insanitary. I would next refer to the Water Supply, for which we are not responsible. An analysis of the water supplied by the different water companies has recently been made by order of the County Council of London, with results far from re-assuring. In view of future legislation I trust you will actively support those authorities who demand right of entry to, and the inspection of the filtration processes for their accredited representatives. With regard to the suggested sources of future supply, I should strongly support the proposal to bring water from Wales for the use of London, but whether we should be included in London for water supply is a debateable question. The river supply can never be satisfactory for drinking purposes, as the filter beds are always liable to temporary failure, but the question arises whether it is not possible to procure a good supply locally, either from the chalk, or elsewhere. If we are not able to supply water in the ordinary way and charge a rate for it, might it not be possible to supply water free and charge the cost on the General Rate? Water is not supplied by meter, and it would seem to be immaterial whether paid for by a direct rate or included in an Improvement Rate. In the meantime I would urge upon you once more the necessity for a constant supply. I should like also to refer to that portion of my duties in connection with the School Attendance Committee. The arrangement recently made for visiting these children in their own homes entails 7 considerable time and labour, but gives many valuable opportunities for detecting infectious diseases of a mild character unattended by medical practitioners, as well as cases of overcrowding, dilapidated house property and other nuisances. My attention has also been drawn to matters of great importance, bearing not only on the health of the school children, but upon their future usefulness to society. The duty of a Sanitary Authority is not necessarily confined to the prevention of infectious disease, for it takes measures for the improvement of the general health in paving, draining, lighting, all indirect aids to a sanatory state, and I therefore submit that steps taken to check imperfections in children with a view to making them more useful citizens come well within the scope of its work. Many children attending school are said to be dull, who, on examination, are found to be suffering from defective sight, or hearing. Now these children if systematically examined in early childhood might be put in the right way to obtain proper treatment, so that the defects would be minimised or disappear on approaching adult age. The cost of working out such a scheme in Kingston would be infinitesimal, whilst the benefit would be incalculable. The examination of the teeth of children is also most important, the decay of teeth in childhood often leading to the decay of the permanent teeth and the subsequent dyspeptic trials that lead farther than is commonly imagined. It also causes much absence from school for Neuralgia, &c. Such examination would be more costly than those previously mentioned, but would repay the expenditure in the next generation. 8 The population to the middle of 1897 may be reckoned as 31,089. Plans for 172 new houses were passed, so that the estimate is not likely to be too high. The births were 942, giving a birth rate of 30.2. The deaths were 470, giving a death rate of 15.1; this includes 23 deaths in Brookwood Asylum and 1 in Richmond Hospital. In addition there were 49 deaths in the Workhouse of persons belonging to other sanitary districts included in the Union, and probably some of the deaths in Brookwood were of persons from those districts. A death rate of 15.1 is very favourable, and even more so when it is remembered that the zymotic death rate is as high as 2.2, and that the latter rate can be reduced by means I have pointed out elsewhere. For the last four years I give the death rate for each quarter, and in course of time I hope by this means to show the exact time of year in which the reduction of the death rate will take place. The most deaths from zymotic diseases take place in late summer and autumn, and it is by decreasing the number of those deaths that we must hope to bring our death rate down to an average of 14 per 1,000. (See Table B.) At Maidstone such figures have been kept ever since 1870. Jan.-Apl. Apl.-July. July-Oct. Oct.-Dec. Year. Old Maidstone, 1870-74 21.5 17.9 20.6 18.0 19.5 New Maidstone, 1895 19.4 12.2 12.6 15.6 15.0 In other words, if the present population of Maidstone existed under the same conditions as the population of that town 25 years ago, no fewer than 105 more persons would have died there in 1895 TABLE B. Death Rates. Comparison of Town and Country Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. ENGLAND AND WALES— Population 30,394,087 Ten years' average, 1885—1894. 21.7 18.5 16.7 18.6 18.9 TOWN DISTRICTS— Population 20,550,953 22.3 19.2 17.0 19.8 19.8 COUNTRY DISTRICTS— Population 9,843,125 20.8 17.3 14.5 16.7 17.3 KINGSTON, 1878.81 Figures not available. 17.03 KINGSTON, 1893.96 18.84 13.6 14.1 15.2 15.6 Death rates of Kingston compared. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. 1883.92, average population 25,000 not available. 16.99 1893 „ „ 28,436 21.8 17.4 16.2 16.4 17.9* 1894 „ „ 29,127 17.03 13.5 11.9 14.2 14.2* 1895 „ „ 30,050 23.4 12.7 13.8 13.8 16.3* 1896 „ „ 31,089 13.1 11.06 14.6 16.5 14.1* * Deaths in Brookwood, &c., omitted. 9 10 than did actually die. Were the figures available it would probably be demonstrable that 100 persons are living in Kingston to-day who, under the circumstances of 25 years ago, would have died during the last year. A new notification form has been issued with a second certificate appended, on which it is requested that the medical attendant will notify to the Sanitary Authority the termination of the case, so that disinfection, &c., can be properly carried out. Both forms are stamped, and, it is hoped, that the second certificate may help still further to diminish infectious disease. (See X.) Scarlet Fever. One death was registered out of 51 cases notified. The death, said to be relapse, was probably due to Diphtheria, as the patient was convalescent when several cases of the latter disease occurred in the immediate neighbourhood. No contact was discovered, but it is well known that convalescents from Scarlet Fever are very prone to contract Diphtheria. Diphtheria. This is the most formidable disease with which we have to deal. 51 cases were notified and there were 11 deaths with, in addition, four deaths from Croup or Laryngitis. The origin of this disease is not definitely known, but it is aggravated by insanitary conditions and damp. It has been noticed that persons lately entered into the habitation of newly built houses, apparently hygienically perfect, are often attacked, and I have noticed three such cases in this town. Date Name of Patient Age Sex No. of House and Street Occupier Disease Notice of freedom from Infection forwarded to Medical Officer of Health 18 [X] Borough of Kingston-upon-Thames. Certificate by a Medical Practitioner that a Patient suffering from is now recovered and free from infection. Name of Patient Age Address Disease Has the House and Clothing been disin Yes or No fected under Medical Practitioner's directions Do the House and Yes or No Clothing require dis- infection Dated the day of 18 Signed Medical Practitioner. Note.—The Corporation trust that Medical Practitioners will duly send this Certificate to the Medical Officer of Health, and so co-operate in the prevention of the spread of Infectious Disease. BOROUGH OF KINGSTON-U PON-THAMES. Certificate by a Medical Practitioner under the Kingston-upon-Thames Improvement Act, 1888, when a person is suffering from:—Smallpox, Cholera, Diphtheria, Membranous Croup, the disease known as Scarlatina or Scarlet Fever, and the Fevers known by any of the following names:—Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal, and such other diseases as the Corporation under the provisions of the above mentioned Act may from time to time declare to be infectious. TO THE CORPORATION OF KINGSTON-UPON-THAMES. Pursuant to the above mentioned Act, I hereby certify and declare that in my opinion the undermentioned person is suffering from a disease within the terms of such Act:— Name in Full of Patient Age of Patient Sex of Patient Full Address of House of which Patient is an Inmate Name of Occupier or other person in charge of such House Nature of Disease State whether Patient has been or is intended to be removed and the tination Dated this day of 18 Signed Medical Practitioner, Note.—This Certificate must (under a penalty of Forty Shillings in case of neglect) be forthwith delivered by the Medical Attendant of the infectious patient to the Medical Officer of Health, Clattern House, Kingston-upon-Thames. 12 The majority of the cases occurred in the Hill Ward, in that part of the ward that is just at the bottom of the hill. These children mostly attended the one school, but only in one or two cases could any, probable, common source of infection be traced. Some of the houses attacked were without concrete basements and the sanitary conditions were not very modern, but nothing definitely bad was discovered. It is to be hoped that the new surface drainage to this neighbourhood may be followed by freedom from this disease. Bacteriological examination is urgently needed in order to properly cope with this disease. Enteric or Typhoid Fever. Four deaths were reported out of 14 cases notified: the highest mortality for four years. In three cases impure water was the means of infection. One case was imported, but on the other hand one case arose in the town which is notified in the district where resident. All wells that are not known to be properly constructed should be opened and remade as Koch has recommended: "A well should be "filled up first with gravel and then with fine sand, "and the pump should be some distance from the "well and connected to it by a lead pipe, or a "pipe may be led directly to a water-bearing "stratum and connected with a pump." Such wells are fairly satisfactory as long as the water-bearing stratum is not contaminated in any way through building operations, &c. How many wells are made in this manner, and how many are less satisfactory, there is no information to show. (See Table C.) Puerperal Fever. Two cases were notified and one died. The death was attributed to improper nursing and attendance. Persons cannot be too careful in their enquiries into the knowledge, character and TABLE C. THE WATER SUPPLY OF THE BOROUGH. Hours of Supply. Area of Supply. Character of the Water. Lambeth Water Company 9 to 5; Sundays 9 to 1. The greater part of the town Complaints are frequently made of the bad colour of the water, especially after heavy rains. Lambeth Water Company Constant Supply The streets in which the mains to supply the Barracks and Workhouse are laid Wells The old parts of the town. The neighbourhood of Richmond Road and Mill Place district. Many of the houses in these districts are now supplied by the Lambeth Company Most samples are found to have from 3 to 10 grains per gallon of Chlorides, but otherwise the waters are fairly pure, sparkling and palatable. The analyses vary greatly from time to time. The water is not recommended for drinking purposes. 13 14 antecedents of midwifery nurses, as great danger arises from the employment of persons who have not been instructed in the observance of scrupulous cleanliness in the nursing of these cases. Erysipelas. One death is recorded. Measles. This year again we have a big mortality, and an epidemic is with us at the end of the year. It is now only two years since we were last visited by an outbreak of this disease, and I think it is well that you should again consider the advisability of placing Measles on the list of notifiable diseases. This has been done in Maiden and is proposed in Esher, and if the other neighbouring authorities would agree to follow these good examples I think it would afford very valuable information, and tend towards reducing the mortality from this disease and make it as mild in its effects as is Scarlet Fever. Sometimes a few cases are noticed to commence during the holidays, and when the children return to school an epidemic bursts upon the districts, and many lives are lost. Notification would give information of the presence of this disease in such cases, and the school opening might be deferred. It might be practical to arrange with medical practitioners in the town to notify only the first case arising in each house, and now that the Householders Notification is strictly enforced, even those cases unattended by medical men would be notified. This is a disease that might be effectively treated by isolation, but it would not be proper to take patients to a hospital used for other infectious diseases. It is not necessary to have a hospital removed from habitations, and an ordinary house 15 would answer most of the requirements. This disease is fatal mostly amongst the poor. 11 is rare for a death to occur in the families of persons in comfortable circumstances, even amongst the working classes it is rare for death to occur except where the circumstances are unduly lowered by irregular employment, or the sad surroundings that bring about a low vitality in child, and slatternly ways in the mothers. The foundation of such a hospital seems to me to be not an unfitting memorial of the longest reign, and fitting in with the expressed wishes of Her Most Gracious Majesty. Whooping Cough. The mortality is higher than usual. It has in some cases been associated with Measles, and in nearly every case the death has been in an infant under one year of age. Diarrhoea. Infantile Diarrhoea accounts for 18 deaths. The rate per 1,000 is .57, which is considerably better than .99 in 1893, but still it is much too high. This is another disease that rarely occurs amongst those in comfortable circumstances. Damp soil, improper feeding, and overcrowding all tend to aggravate the disease, which in this town is almost entirely confined to a few roads. Influenza. Two of the deaths recorded were in children under five years of age. 16 Bronchitis and Pneumonia. The death rate from these diseases has been a little lower this year, and probably would have been lower still but for the dampness of November and December, 30 out of 80 deaths having occurred in those two months. Phthisis. The death rate this year is the lowest for four years. Tuberculosis. The death rate is about the average. 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 2 5 1 8 Diphtheria 2 1 3 Enteric Fever 1 1 2 Puerperal Fever ] 1 — 14 CANBURY *Scarlet Fever 12 2 4 2 20 Diplitlieria 2 3 4 0 Typhoid or Enteric Fever 3 1 1 5 Puerperal Fever 1 1 —35 NORBITON— Scarlet Fever 2 2 1 1 6 Diplitlieria 3 2 2 4 11 Typhoid or Enteric Fever 1 3 1 5 22 HILL— Scarlet Fever 4 6 4 2 1 17 Diphtheria 15 5 4 2 1 1 28 Typhoid Fever 2 2 -47 25 40 23 14 9 5 2 118 Scarlet Fever 18 15 11 1 5 1 51 Diphtheria 5 17 11 8 4 5 1 51 Typhoid Fever 1 7 1 5 14 Puerperal Fever 1 1 2 Barracks: Scarlet Fever: 5. Grand Total 118 „ „ 1. „ „ 2. 18 Housing of the Working Classes Act, 1870. This Act has been put in force in Kingston with the results shown in table D. These results are not as satisfactory as might be wished, because clever, though seemingly stupid, persons can during the period which the report is passing from Committee to Council, or to Court, do just sufficient in the way of repair to persuade tenderhearted magistrates that they are doing their best. Other more cunning owners do these little repairs, and so keep just above the level of badness that enables the sanitarian to make a statement on oath condemning the premises as injurious or dangerous to health. Bye-laws for houses let in lodgings have been approved by you, and merely await the confirmation ot the Local Government Board, and with this aid it is to be hoped that more satisfactory progress may be made, though it is difficult to see how an already overworked Sanitary Inspector is to find time for the inspections. Common Lodging Houses. These have all been frequently inspected. I regret to say that although three have disappeared from the Back Lanes a new one is threatened in Norbiton. This is a very paying business, and the law needs strengthening so that Sanitary Authorities may be given powers not only for more stringent regulation, but also for limitation of the number of such houses. Cowsheds. Three cowkeepers whose cowsheds were overcrowded have been called upon to comply with the regulations. TABLE D. Proceedings taken under the Housing of the Working Classes Act, 1890. Part II. Date. Situation of Property. State and Condition. Action Taken. Further Procekdinus. Present Condition. Remarks. Nov., 1894 Sun Passage Dilapidated and ancient buildings, dirty yard, insufficient W.C. accommodation Notice served In fairly good repair, yard paved, W.C. accommodation sufficient This is a narrow court behind the Market Place. The houses are very ancient, timber and plaster. June 7, 1895 Cambridge Square, Norbiton Old brick buildings, floors below the ground level, defective guttering, dampness of walls, W.C. out of order and improperly kept. General state of disrepair Notice served Summoned. Closing older granted, but sus pended for a month, if work not then completed to pay a penalty of £20 These houses have been patched UP The structure of these houses is so defective that nothing short of re-building will be satisfactory. Waterman's Lane, now Vicarage Road Tumble-down old houses let in lodgings Notice served ... ... ... ... ... The houses were pulled down by the owner A new and properly constructed common lodging house has been built on the site. Old Bridge Street Two ancient cottages, general dilapidations and insanitary condition Notice served ... ... ... ... ... Houses put into thorough repair as far as was possible with such ancient constructions These houses should have been pulled down, as they will soon become as bad as ever again. Feb. 27, 1896 „ „ „ A common lodging house of several old buildings quite unfit for habitat ion Notice served ... ... ... ... ... ... Purchased for demolition. Feb. 27, 1896 „ „ „ Rice's lodging house, dirty and dilapidated, insufficient W.C. accommodation Notice served Repaired and extra W.C. built These houses should have been pulled down, as they will soon become as bad as ever again. Feb. 21, 1896 River Lane Common lodging house, insufficient W.C. accommodation Notice served Negociations for purchase in progress This house should be pulled down. „ „ Three old houses, general disrepair, dampness Notice served Pulled down. Sept., 1896 Elton Road Four houses, general disrepair Letter written Houses thoroughly repaired These houses now in a satisfactory condition. 19 Slaughter Houses. Greater power requires to be vested in the Sanitary Authority, as compliance with the very mild regulations gives no control over the quality of the meat, as the killing is rarely done in the presence of an inspector, and therefore it is easy to remove portions that would lead to detection in infringement of the law. A large amount of tuberculous meat is sold in this country, and this will continue to the detriment of the public until the slaughtering of meat is placed under sanitary control. Factories and Workshops. You requested me to carry out the duties devolving on the Sanitary Authority under these Acts. I have been thoroughly through four streets, and in so doing have paid G8 visits, and discovered 22 workshops with insufficient or improper sanitary conveniences. It is not sufficient to make one visit to each workshop, several being necessary in order that it may be seen that the work ordered to be done has been carried out. Considerable correspondence is involved and much time is needed. I shall continue the work as opportunity affords. The Sanitary Staff. I would venture to suggest that the present staff is inadequate to thoroughly do the work that is now necessary, not only by Act of Parliament but by the force of public opinion. The proper inspection of Workshops and Tenement Buildings, which is most important from a sanitary point of view, cannot be done by a Medical Officer of 20 Health who only gives a portion of his time, and a Sanitary Inspector, who holds several other appointments. This places the staff in a worse position than any of the neighbouring districts. In none of them does the Medical Officer give the whole of his time,, but in each the number of Inspectors is greater. In Wimbledon there are two, in Richmond there are three, whilst in Surbiton, with less than half our population, there is one. It may be argued that these places are better off than Kingston (though actual money spent in this respect is in each case less than in Kingston), which is comparatively a poor place, but then it is notorious that the poorer the population the greater the amount of work for the Sanitary Staff. My best thanks are due to the Chairman and Members of the Sanitary Committee who have supported me in the suggestions and reports I have laid before them. H. Beale Collins. 21 Abstract of Work of Medical Officer of Health. Visits to Insanitary Property, &c 90 „ for Infectious Cases, &c. 131 ,, for School Attendance Cases 116 ,, in Consultation with Medical Practitioner in doubtful cases of Infectious Disease 26 ,, to Workshops 68 ,, for Overcrowding 2 to Schools 7 ,, to Common Lodging Houses 9 ,, to Bakehouses 75 Various 5 Attendance at Enquiries 3 ,, at Magistrates' Court 5 ,, at Sub-Committees 9 ,, at Inquest 1 Analysis of Water 5 ,, of Sewage Effluent 2 Letters and Communications about 100 INQUESTS DURING 1896. Date. Age. Cause of Death. - Jan. 20 73 years Haemorrhage in skull Natural. „ 30 48 „ Fracture of skull— meningitis. Accident. March 11 69 „ .. Fracture of femur Accident. ,, 18 49 „ Internal Haemorrhage —Alcoholism. — April 11 7 „ . Pneumonia, measles — „ 23 1 month Suffocation in bed with parents. Accident. „ 30 5 months Acute pneumonia Natural. May 21 New born Want of attention at birth. — „ 21 3 months Pneumonia — June 9 21 years Puerperal fever — „ 25 69 „ Wound in throat— Suicide. Insane. „ 25 34 years Hanging suicide Insane. „ 30 4 months Suffocation in bed with parents. Accident. July 22 34 „ Drowning suicide Insane. „ 28 58 „ Poisoning suicide Insane. Aug. 17 36 „ Heart Disease „ 57 „ Heart Disease — „ 27 3 weeks Suffocation in bed Accident. Sept. 7 62 years Heart disease — ,, 7 40 „ Hanging suicide Insane. Oct. 10 7 days Unascertainable — Nov. 12 60 years Heart disease — „ 12 59 years Ruptured blood vessel Accident. Dec. 3 43 „ Chronic alcoholism Self neglect. „ 3 New born Asphyxia Wilful murder. „ 3 27 years Gunshot wound Insane. Uncertified Deaths. Jan. 21 2 months Premature birth - Dec. 24 18 months Measles - Estimated Population 31,089. 1896. Month. BIRTHS. DEATHS. AGES OF THE DYING. CAUSES OF DEATHS. 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. Small Pox. Scarlet Fever. Diphtheria. Croup and Laryngitis. Enteric Fever. Typhus Fever. Puerperal Fever. Erysipelas. Measles. Whooping Cough. Diarrhoea. Influenza. Rheumatic Fever. Bronclits.,Pleursy and Pneumonia. Phthisis. Tuberculosis. Heart Disease. Cancer. Injuries. All other Diseases. Total. JANUARY 45 36 81 15 17 32 3 1 4 3 13 8 Under 5 1 1 1 5 8 1 4 4 1 3 1 1 9 24 FEBRUARY 20 40 60 12 22 34 7 7 1 11 8 Under 5 1 8 1 4 14 6 2 1 2 9 20 MARCH 55 52 107 20 20 40 12 2 4 1 3 12 6 Under 5 2 1 2 2 5 6 18 5 3 4 2 1 7 22 APRIL 49 44 93 21 22 43 4 i 7 1 2 16 11 Under 5 2 4 3 1 1 2 13 1 8 4 1 3 12 30 MAY 35 34 79 16 11 27 3 2 7 2 11 2 Under 5 2 3 1 6 12 1 1 1 1 3 8 15 JUNE 33 32 65 15 11 26 7 5 1 2 6 5 Under 5 1 1 2 1 1 2 4 12 1 1 1 I 3 1 2 4 14 JULY 47 37 84 18 10 37 5 2 4 2 3 17 4 U nder 5 4 2 2 3 11 2 2 3 2 1 2 14 20 AUGUST 35 27 62 22 21 43 18 3 4 2 7 9 Under 5 3 2 9 4 1 6 25 1 1 1 1 1 1 2 1 9 13 SEPTEMBER 38 37 75 19 15 34 4 1 2 1 14 12 Under 5 1 4 5 1 1 4 1 4 4 2 12 29 OCTOBER 37 45 82 14 18 32 6 2 1 1 2 12 8 Under 5 1 1 2 5 9 1 3 4 2 1 12 23 NOVEMBER 53 44 97 22 20 42 18 7 1 1 10 5 Under 5 1 4 11 1 8 25 1 4 4 1 1 6 17 DECEMBER 31 35 66 26 30 56 15 2 13 3 12 11 Under 5 1 5 2 1 10 1 1 30 Deaths in Brookwood Asylum, &c. 16 8 24 2 16 6 1 1 6 2 4 2 1 9 9,(\ 4 2 18 24 TOTALS 479 463 942 236 234 470 102 17 63 20 16 157 95 1 11 4 4 1 1 16 11 18 4 86 30 25 34 17 15 192 470 Deaths in Workhou Be (not belonging to Kingston) 26 23 49 2 4 1 1 1 19 21 2 1 5 3 5 1 4 28 49 Rate per 1000, 1896 15.4 14.9 30.2 7 5 7.5 151 3.2 .5 2. .6 .5 5. 3.5 .02 .35 12 .12 .02 .09 .51 .35 .57 .12 2.7 .9 .8 109 .56 .4 6.1 „ „ „ 1895 16.4 15.2 31.7 8.5 7.7 163 4.4 .7 1.3 .4 .6 4.5 4. .09 .13 .03 19 .20 .60 .30 3.7 1.7 11 11 .60 .3 5.7 „ „ „ 1894 15.5 14.5 30 1 7.7 6.4 14.2 31 .3 1.9 .4 .6 3.7 3 7 .24 .24 .06 0.3 06 .60 .27 .30 .30 .03 2.2 1.2 .7 11 .40 .5 5.3 „ „ „ 1893 15 3 13.9 29.2 915 8.78 17.9 3.5 .03 2.2 .77 .8 6.18 3.71 .035 0.24 .80 .21 .07 0.3 .21 .28 .99 .42 .10 3.4 1.5 .8 1.5 .30 .3 6.4 23 HEALTH DEPARTMENT. Showing the work done by the Sanitary Inspector. Abstract ok Notices for the Year 1896. Choked and defective drains 147 Defective closets and syphons 32 Defective soil pipes and ventilators 10 Defective yard, sink, and bath waste traps 35 Defective water apparatus to closets 75 To provide separate cisterns tor flushing closets 14 Foul drinking water cisterns 47 To lay on water supply to houses 3 To cleanse and limewash houses 89 To cleanse and disinfect houses and cellars 24 To cleanse and limewash closets and yards 12 To cleanse urinals adjoining public thoroughfares 14 To screen urinals adjoining public thoroughfares 1 Dilapidated house roofs, floors and yards 18 Dilapidated and damp bedroom walls 6 Dilapidated manure and dust places 18 Accumulations of manure, offal, &c. 51 Pig keeping (a nuisance) 4 Fowl keeping (a nuisance) 15 Undrained stables and yards 10 Overcrowding of houses 6 Canal Boats Acts, &c. Canal Boats and Barges inspected 32 Offences in Contravention of Canal Boats Acts Nil 24 Notification ok Infectious Diseases Acts. Notices served to Householders 116 Notices served to Attendance Officer 116 Notices served to Schools 130 Disinfecting houses after Infectious Diseases 110 The Slaughter Houses, Cowsheds, Dairies and Milkshops have been visited at various times, and found in a fairly satisfactory condition. Lodging Houses. Registered Lodging Houses, to the number of six, have been kept clean and satisfactory. The total number of Lodgers for the year using these houses amounted to 75,243, being a decrease of 12,140 upon the previous year. 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 110 cause to make any complaint. FRED. J. PEARCE, Assoc. San. Inst., Sanitary and Buildings Inspector. January, 1897.