KIN 054 BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT OF THE Medical Officer of Health For the Year ending December 31st, 1903. KNAPP, DKEWETT AND SONS LIMITED, PRINTERS, KINGSTON-ON-THAMES.—17,272. ERRORS AND OMISSIONS. In Table IV.—1 death from Influenza, 45-55; 1 from Enteritis, 65-75; 1 from Pneumonia, under 1 year: and 1 from Heart Disease, 5-15. The deaths in Institutions outside Borough, 19, are not included in Table IV. In the large table of Births and Deaths, 2 deaths front Erysipelas have been entered under Syphilis. Estimated Population 36,311. BIRTHS. CLASSES OF BIRTHS. DEATHS Under 1 year. DEATHS at all Ages. Total. Total heaths in Public Institutions in the Borough. Deaths of Non-residents registered in the Borough. Deaths of Residents registered beyond the Borough DEATHS at all Ages Nett. Years. Small-pox. Measles. Scarlet Fever. Enteric Fever. j Epidemic Influenza. Whooping Cough. Diphtheria. Membranous Croup. Laryngitis. Rheumatic Fever. Epidemic Enteritis (Summer Diarrhoea.) Gastritis. Plumbism. Syphilis. Other Septic Diseases. Phthisis. Other Tuberculous Diseases. Cancer. Bronchitis. Pneumonia. Pleurisy. Other Diseases of Respiration. Alcoholism, Cirrhosis. Accidents of Parturition. Premature Birth. Heart Disease. Injuries. Suicide. Drowning. Other Diseases. Total. Vaccinated. Re-vaccinated Unvaccinated No. Rate per 1,000 | per annum. Professional Trading. Working. Illegitimate No. Kate per 1,000 Births per annum. No. Rate per 1,000 per annum. No Rate per 1,000 1 per annum. M. F. M. F. M. F. M. F. JANUARY 48 39 28 2 12 66 7 5 4 104 34 26 19 26 14 46 15 Under 1 1 1 5 1 1 9 Over 1 1 1 1 1 7 1 1 2 1 2 1 1 1 2 2 12 37 FEBRUARY 57 47 34 9 89 6 10 7 198 35 26 19 14 11 50 16 Under 1 3 2 1 4 2 1 4 17 Over 1 1 1 3 3 1 3 1 1 2 1 2 1 2 1 1 9 33 MARCH 40 30 22 13 55 2 5 3 94 30 30 19 22 14 46 15 Under 1 1 1 1 3 2 8 Over 1 1 1 5 1 2 3 2 1 1 1 3 1 1 15 38 APRIL 46 30 25 1 10 59 6 7 4 128 20 23 14 13 7 1 37 11 Under 1 1 1 1 3 5 11 Over 1 1 1 1 1 3 1 3 2 2 1 1 3 6 26 MAY 34 38 23 2 17 48 5 4 2 69 24 24 15 20 11 37 11 Under 1 1 1 1 1 1 1 6 Over 1 1 1 1 1 3 4 1 1 1 7 2 8 31 JUNE 62 48 36 4 20 82 4 7 5 139 22 22 14 16 5 1 40 12 Under 1 1 1 8 2 12 Over 1 1 1 1 2 1 1 1 1 1 1 4 1 1 11 28 JULY 49 39 29 2 14 69 3 6 4 126 18 13 10 10 4 1 28 9 Under 1 2 3 1 2 1 1 10 Over 1 1 1 4 2 1 2 1 3 1 2 18 AUGUST 31 40 23 19 50 2 1 3 46 19 15 11 16 10 24 7 Under 1 1 2 1 4 Over 1 1 1 3 2 2 2 1 1 7 20 SEPTEMBER 40 48 28 2 16 62 8 6 6 139 24 29 17 21 13 40 12 Under 1 5 2 3 2 12 Over 1 4 1 3 1 1 1 7 10 28 OCTOBER 32 36 22 1 11 54 2 4 4 94 14 21 11 12 4 1 32 10 Under 1 1 1 1 1 1 1 2 8 Over 1 1 1 4 1 2 1 3 1 10 24 NOVEMBER 34 50 27 17 63 4 1 11 18 31 15 19 13 36 11 Under 1 1 1 Over 1 1 1 1 1 1 3 1 3 2 8 1 1 11 35 DECEMBER 49 43 30 13 76 3 8 6 163 33 34 22 26 14 53 17 Under 1 1 2 1 1 2 4 1 2 14 Over 1 1 2 2 1 2 2 2 1 4 1 11 10 39 CHILDREN BORN IN WORKHOUSE 11 9 2 20 1 3 250 4 4 Under 1 2 2 4 Over 1 DEATHS IN INSTITUTIONS OF PERSONS BELONGING TO THE BOROUGH 8 11 6 19 19 Under 1 1 1 Over 1 3 2 2 1 10 18 Under 1 1 1 6 9 4 5 10 5 2 3 5 3 1 1 25 117 TOTALS 533 497 283 14 171 773 72 64 52 112.6 299 303 16.6 213 124 23 492 13.5 Over 1 3 5 2 4 3 7 1 4 2 5 2 3 43 17 18 21 8 14 5 5 8 4 36 55 9 3 2 121 375 REPORT of the MEDICAL OFFICER of HEALTH. Clattern House, January, 1904. Gentlemen, I have the honour to present my eleventh annual report on the Health of the Borough of Kingstonupon-Thames. Birth Rate 28.3 per 1000 per ann. 29.0 „ average of previous 10 yrs. „ 29.6 „ „ England and Wales, ditto. „ 28.4 ,. „ England and Wales, 1903. This is lower than any year on record. Death Rate 13.5 per 1000 per ann. 15.0 „ average of previous 10 yrs. „ 17.9 „ „ England and Wales, ditto. " 15.4 ,, England and Wales, 1903. „ 14.6 „ ,, Smaller Towns, 1903. „ 14.8 „ „ Country Districts, 1903. Death Rate 112.6 per 1000 Births of Infants under 1 year. " 134 " average of previous 10 yrs. ,, 154 ,, England and Wales, ditto. ,, 132 ,, England and Wales, 1903. Lowest for England and Wales was 130 in 1881. TABLE A. Death Rates. Comparison of Town and Country Districts. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Year. ENGLAND AND WALES— TOWN DISTRICTS— Ten years' average, 1891—1900. 211 181 183 18.6 18.7 Population 22,410,658 COUNTRY DISTRICTS— 20.0 16.5 14.4 16.0 17.5 Population 10,034,737 KINGSTON, 1893.1902 17.8 12.4 13.7 14.4 15.0 Death rates of Kingston compared. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Y ear. 1893, average population 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 15.1 1897 " " 32,516 21.03 8.9 14.3 13.1 15.2 1898 „ „ Estimated 17.1 12.5 13.8 13.4 14.2 1899 „ „ 14.9 12.0 15.9 13.6 15.3 1900 „ „ 16.1 11.3 12.5 14.2 14.06 1901 34,558 16.8 9.4 14.2 13.8 13.6 1902 35,970 168 16.2 10.7 15.3 14.2 1903 " " 36,311 15.3 11.3 9.3 12.6 13.5 5 As a means towards improving Public Health the most important event to record is the coming into force of the new Education Act. By this Act education is municipalized. In the Borough, the Health Authority becomes also the Education Authority. Students of hygiene have long been of opinion that the great numerical increase of infectious diseases during recent years has been due to the bringing together of children into schoolrooms where the close association is highly favourable to the spread of infectious disorders and that the measures for limiting the spread of these diseases are to be found chiefly in the observation and examination of the children in schools. From these remarks you will see the great importance of sufficient air space and supply of fresh air in schools. The report of the Architect recommends that the number of places in certain schools should be reduced from 3,138 to 2,466. This is a recommendation of the highest importance and should be rigidly adhered to. Ten square feet and 120 cubic feet is usually provided by enlightened educational authorities, and this should be your minimum for the present. Ample air space is not only a safeguard against infection, but also against stupidity. Many a child is stupid in a close room who shows fair intelligence when taught in an airy, well ventilated classroom. A great difficulty in ventilation is the draughts that arise in the frequent and rapid changing of the air of the room, and the more persons in the room the oftener is the change necessary and the greater the draught, which to children indifferently nurtured, gives colds and coughs. Children may be said to be indifferently nurtured from inherited taint, from insufficient or improper food, or from defective training. "With the first we cannot concern ourselves, and with the second the question is not yet sufficiently settled to be generally adopted, but physical training is generally recognised as an important part of an educational course, for unless the body is brought up to a certain standard of development it often happens that the brain breaks down under pressure. 6 The teaching of games is made a part of the educational course in Germany. Usually a large field is obtained to which scholars are taken twice a week and are there instructed in games by the teachers, who receive extra remuneration. In this country boys usually learn games for themselves, but for girls some instruction of this Kind is needed. Exercises axe usually given on variations of the Swedish system, but an important part of the Swedish system is neglected in this country. In Sweden all children are medically examined, measured, and weighed, with their clothes off, at the beginning and end of each term, and records are kept showing the progress in development of each child so that the effect of the different exercises can be rightly gauged. It is always advisable that the teachers should acquire the exercises and themselves teach the children. At least twenty minutes a day should be given to such exercises, and tins need not be considered as time lost to other branches of learning, Mr. Paget having shown long ago, by experiment in a country school where half the children worked their full time in the classroom and the other half worked only half time at books and half at gardening, that in the examination those who spent all the time at books were hopelessly beaten. Dumb bells, wands, and skipping ropes may be used in exercises with great advantage. Flat shoes should be provided for the exercises, and the drills are greatly enhanced in brightness if the girls are set to work to make suitable uniforms in which to carry them out. This was done in a Board School under Miss Kingston, with cheap blue serge dresses trimmed with red twill. Swimming is a heathful summer exercise. I should like to see a large open-air swimming pond made in the low-lying and almost useless land adjoining the Hogg's Mill Stream near the rifle butts. Dressing places, protected by trees and shrubs, could be arranged for both boys and girls, so that the water might- be free to swimmers at all times. Shallow at one end and deep at the other, it would be suited for children 7 of any age or proficiency in swimming, and the water constantly running could be filtered through rough clinker beds at tne upper part falling over a weir below. With a view to increase the average attendance (average attendance 1902, 83.8 per cent.; Surrey, 81.8 per cent; Leicester 91'2 per cent.) one of your first steps will probably be the appointment of an Assistant School Attendance Giticer. As such officer would be trained in his duties under Mr. Saull, I would suggest that a young man with the certificate of a Sanitary Inspector would be the most suitable for such a post. With an increased staff it would probably be possible to see every absentee child on the second morning of his absence from school. In such case it would be easy for the School Attendance Officer to post a card to the Health Department whenever he had reason to suspect infectious or contagious disease—or the existence of any nuisance. Medical notification often fails because the doctor is not called in till the disease is well developed, whilst sometimes he is not called in at all. This is usually the case in measles and whooping cough, and these diseases are often established before their presence is known. These suggestions are for things that can be easily carried out; there are other things of great importance both to education and health to which I will do no more than allude, such as eyesight, hearing, and defective teeth. A very considerable improvement has been made by the Managers of the different schools in accordance with the demands for improved sanitary conveniences, drainage, ventilation, etc. This is a tangible benefit and is, I hope, an earnest of the improvements we may hope for from municipal control. HOUSING OF THE WORKING GLASSES. Action under the Act has been taken in the case of five cottages in Hampden Road. These houses were dealt with four years ago and are of such construction and condition that 8 nothing short of demolition would be really satisfactory. The repairs are being carried out and the houses will be just habitable for a short time, when the Act will have to be put in force again. Iu these cases I believe the best procedure is to take proceedings before the magistrates as soon as the Committee is satisfied that the representations of the Medical Officer of Health are correct. Cases are rarely brought before the Committee till persuasion has failed and the owners either will not or cannot do what is required. The houses in Hawk's Road, previously reported on, are being slowly put into passable condition. The owner's attention will at once be called to this slow progress. In other cases it has not been necessary to do more than call the attention of tiie owner to the requirements and the work has been done. This applies to certain houses in Elm Road, Canbury Park Road and Shortlands Eoad. The difficulty of effecting improvements under these Acts is greatly increased by the fact that when repairs and alterations are carried out in poor property, the rents are almost invariably raised, and such raising of rents often leads to rents in adjoining property being raised also. The question of housing the poorest classes is becoming as serious in Kingston as in other places. Houses let at 4s. 6d. a week, ten years ago, are now let at 7s., and beyond more frequent cleansing of ceilings and proper water supply to closets, there is no appreciable improvement in the buildings. It seems, therefore, the time has arrived when it is my duty to offer some suggestions as to the way of improving the housing accommodation for the poorest classes in this town. Some years ago, land was purchased in Oil Mill Lane for an isolation hospital. As circumstances have arisen which make it improbable that the whole of the land will be required for hospital purposes, I would suggest that it might be made serviceable for a housing scheme. 9 The Dust Destructor occupies a portion of the site, but I think it would be possible to leave about three acres for a hospital if required, enough land for extension of the Destructor, and still find space to house one hundred families in fifty houses two storeys high, each house being well isolated and garden space being available for cultivation. Under last year's Amending Act, the period of repayments for purchase of land has been extended to 80 years, and for the erection of buildings to 60 years. Under the second condition, £100 at 3 per cent. costs £3 12s. 3d. per annum, or Is. 4^d. per week for the repayment of capital and interest, so that if each house erected cost £600, including land, a weekly rent of 4s. lid. would pay off the capital and interest—a rent of 6s. a week should therefore leave ample margin for higher interset and expenses. ±'he class of home required should consist of one large sitting room, with a scullery, and two bedrooms, with w.c. and a good larder on the shady side of the house. A two-storeyed cottage with this accommodation upstairs and downstairs could be so built that the entrance to the two flats should be at opposite sides of the house and the dwellings therefore quite distinct. The dust could be placed outside every morning and collected daily. The house would be kept dry by a narrow piece of paving round it. As the roads would not be thoroughfares, 40ft. would be needlessly wide for the road and footpaths, and the space would be better utilized as garden ground. By building in the neighbourhood of the Destructor it would be possible to provide a laundry and kitchen, worked by steam from the Destructor boilers. It might be possible even further to utilize the steam in heating the houses, etc. I have shown where new dwellings can be placed, as in every improvement scheme the great difficulty is the rehousing of the displaced tenants. The part of the town most suitable to deal with first appears to me to be certain houses abutting on Cambridge Notifications of Infectious Diseases. B. WARDS AND DISEASES IN EACH. Primary Cases. Secondary Cases Totals TOWN—Population 6617. Scarlet Fever 20 3 23 Diphtheria 15 ... 15 Small Pox ... 8 8 Enteric Fever 6 ... 6 Erysipelas 1 ... 1 — 53 CANBURY—Population 8190. Scarlet Fever 55 6 61 Diphtheria 20 ... 20 Enteric Fever 4 ... 4 Small Pox 1 2 3 Erysipelas 1 ... 1 Barracks— Scarlet Fever 1 ... 1 — 90 HILL—Population 10,505. Scarlet Fever 60 3 63 Diphtheria 23 3 26 Enteric Fever 3 ... 3 Small Pox ... 1 1 Erysipelas 4 ... 4 Workhouse—Population 729. Small Pox 1 1 2 Puerperal Fever 1 ... 1 —100 NORBITON—Population 9,063. Scarlet Fever 63 7 70 Diphtheria 17 ... 17 Enteric Fever 3 ... 3 Small Pox 2 2 Erysipelas 1 ... 1 — 93 Under 1. 1-5. 5-15. 15-25. Over 25. Totals. Scarlet Fever 4 51 139 16 7 217 Diphtheria ... 17 41 9 11 78 Enteric Fever ... ... 5 7 3 15 Erysipelas ... ... ... 1 6 7 Puerperal Fever ... ... ... 1 ... 1 Small Pox 1 1 ... 1 12 15 Chicken Pox ... 59 ... ... ... 59 TABLE C.—Analys1s of Scarlet Fever Cases, 1903. Ital1cs 1nd1cate Dupl1cate Returns. Date when reported to San1tary Comm1ttee. Number of cases reported at each Comm1ttee. Cases sent to Hospital Secondary Cases Total number of days under treatment of each case notified and treated at home. Number of Single Cases. Number of days under treatment of each single or solitary case. Days under treatment of cases sent to Wad don Hospital. Deaths 1n Hospital. Deaths when treated at home. Return Cases. Incomplete Returns. Still under treatment. After return from Hosp1tal. In Home after or1g1nal case declared well. Notified at Fame time as first case. Cases giving r1se to secondary cases. Secondary cases occurr1ng during treatment of primary case in home. Not1f1ed after removal of f1rst case to Hosp1tal. * remaining 1n Hospital. L.F.H.—London Fever Hospital. Jan. 15 2 1 46 1 46 63 Feb. 3 18 1 2 47 51 36 40 49 38 24 35 44 42 40 41 13 47 36 40 49 24 35 44 42 40 71 1 ” ” 32 40 39 52 41 32 40 52 „ 19 12 2 2 43 28 42 40 40 83 83 30 37 37 33 44 5 43 42 37 37 33 50 94 ” ” 40 41 Mar. 5 6 2 44 40 41 3 44 40 41 47 76 1 „ 19 11 2 3 41 36 33 33 33 33 39 36 4 36 33 39 36 41 55 1 Apr1l 2 19 1 6 1 45 46 46 46 34 26 26 26 35 43 25 43 10 44 42 42 36 43 25 35 34 46 45 51 1 1 ” ” 36 42 42 44 „ 16 4 2 1 1 35 53 1 35 L F.H L.F.H „ 30 14 1 2 5 3 23 35 31 41 30 29 36 27 29 25 42 28 3 31 42 28 L.F.H ” ” 1 32 May 14 4 1 1 42 42 40 1 42 1 June 4 6 1 1 40 49 39 46 7 4 40 49 39 46 49 1 „ 18 7 1 41 43 32 42 48 30 6 41 43 32 42 48 30 July 2 1 1 53 „ 16 7 1 32 58 34 49 32 33 49 6 32 58 34 49 32 33 Sep. 3 34 6 o 3 9 1 32 42 41 39 39 68 37 34 37 66 68 68 12 32 68 37 42 30 54 45 33 47 31 37 138* 93 42 1 ” ” 30 54 54 43 45 33 40 47 34 31 40 32 27 45 52 L.F.H ” ” 37 27 42 „ 17 7 1 1 59 42 32 71 28 28 5 42 32 71 28 28 48 Oct. 1 10 1 1 2 60 51 41 47 43 45 44 44 42 6 60 51 41 47 43 42 7 1 „ 15 16 4 1 42 39 44 41 41 41 41 41 45 40 30 44 2 ” ” 60 „ 29 9 3 44 45 45 50 48 30 5 44 45 45 48 30 43 3 Nov. 19 . 10 1 2 1 3 38 34 46 43 46 47 47 23 2 46 23 1 Dec. 3 6 1 1 55 27 45 43 3 55 45 43 3 1 1 „ 17 7 1 2 47 42 42 52 46 41 4 47 46 41 52 22* 2 217 24 21 14 25 8 2 94 2 2 1 3 Incomplete returns 11 Days under treatment per case: Days under treatment per case: Days under treatment per case: Sent to hospital, Waddon 20 Still under treatment 8 407 40.6 561 „ L.F.H. 4 11 Road. Starting at the corner of Eureka Road and Hawk's lload and proceeding towards Maiden, it will be found that with few exceptions the houses are badly designed and not of a character to make satisfactory homes for even the poorest. A clearance of this district would offer a fine site at one of the main entrances to the town likely to increase considerably in value. SCARLET FEVER. The arrangements made for the isolation of special cases at the Croydon Borough Isolation Hospital, works satisfactorily. The rules for the use of this hospital laid down by the Sanitary Committee, should be known and understood by the public generally. The arrangement has been entered into for the removal of patients from houses, where they could only be treated with danger, either to themselves, or to the public. The hospital is not available for those who merely wish to be relieved of the inconvenience of an infectious case in the house. The character of the disease shows some tendency to vary from the mild and harmless ailment to which we have been accustomed for some years past. There has been shown a much greater tendency to spread when the disease has been once introduced into the house. There have also been a larger proportion of fatal cases and these were due to increased virulence in the nature of the attack in the particxilar cases. In one set of cases a family pre-disposition was shown, but in several others the type of disease has been more malignant. Should this tendency show itself to be more than temporary it will be necessary to reconsider the question of isolation in hospital, as serious cases would need to be treated in complete isolation with special attendant nurses. An abstract of the cases is given as in former years. Table C. 12 SMALL POX. Between the dates of March 7th and March 21st, two tramps wandered from Uxbridge, through Beaconsfield and Chelsea, to Kingston, arriving at the Common Lodging House in Vicarage Road about the 19th or 20th. On March 21st, the tramp A applied for medical attention at the Workhouse and was found to be suffering from Small Pox. He was immediately sent to hospital, and all contacts were isolated and kept under observation for fifteen days, re-vaccination being offered in every case. No further case occurred at the Workhouse. The Common Lodging House was visited and the inmates examined, three being re-vaccinated, none of whom contracted Small Pox. It was found that one lodger had left for Chertsey and London (G) and several had gone to unknown destinations—one of these (H) was later on found in Elm Grove suffering from Small Pox and was sent to hospital. On Sunday, April 5th, at 10.30 a.m., the proprietor of the Common Lodging House came up to my house to say he thought there was another case. On arriving at the Common Lodging House I found four cases and sent them to hospital at once. Three cases were mild and one semioonfluent. On the 8th, another case (I) went to the Workhouse and thence to hospital, and the same day the lodger (H) was found to be ill in Elm Grove. He was sent to hospital forthwith. H had shared a bed in Elm Grove with an omnibus driver (K), who was at once relieved from duty and kept under observation until April 18th, when a few spots having appeared he was promptly sent to hospital. This man had been re-vaccinated when H was found to be ill, but as he was then at the third day of the incubatory period the vaccination could only have a modifying ettect on the Small Pox. The case was a mild one. On April 8th I visited the Common Lodging House in the evening and found one mild case. I then made arrangements for inspecting all the inmates and by the offer of certain inducements, 44 submitted to re-vaccination. 13 There were no more cases of Small Pox in the Common Lodging House. The next case may possibly be put down to aerial connection, or infection through domestic animals, but all I can say is that I could not trace the disease to any known cause of infection. The house was about 200 yards from the house whence H had been removed on April 8th. This gives an incubation period of 16 days. The child had never been out, nor had the mother since her confinement; none of the inmates were traced to any suspicious contact. Wo doctor was in attendance and infection could not be traced to the mid-wife. The baby was only three weeks old, was unvaccinated, and died in hospital. On April 27 th a tramp came from Molesey and called at the house of the Public Vaccinator. He was at once sent to hospital. This case was a possible link between the tramp who came from Beaconsfield with A and the cases which follow. On May 8th a case of Small Pox (N) was notified from Canbury Park Road, and was removed to hospital. The inmates had been re-vaccinated, but not recently, and declined further re-vaccination. No further cases occurred. A tramp had called at the house some time previously, who appeared to be ill. On June 4th a child (P) was found to be suffering from Small Pox. This child had been to a house in Canbury Park Road near the house where N lodged. It iiad then seen a relative who was ill and who kissed the child. This man (0) had left Canbury Park Road and removed to Hudson's Road, but his work was at Molesey. I have every reason to believe he had suffered from a mild attack of Small Pox. The patient was kept under observation and no further cases occurred. On June 17th, the father of the child (P) was taken ill, and on the 21st, Mr. Gobey, the disinfector, was attacked. The latter was a conscientious objector and had not been vaccinated since childhood. He unfortunately died in hospital. This was the last case. 14 I sincerely regret the death of Mr. W. Gobey, who had worked very hard throughout the Small Pox epidemic, as Disinfector. He was a very trustworthy man and nis death is a loss to the Corporation. I would suggest that before permanently tilling his vacancy, you should consider the advisability of appointing a man qualified as a Sanitary Inspector. Such an appointment need entail no additional cost on the rates, and the man who is now doing the work could return to his former occupation under the Surveyor. COST OF OUTBREAK. £ s. d. Treatment of Cases in Hospital, Borough 305 1 0 ,, ,, „ Union Workhouse (app.) 35 0 0 Ambulance, Compensation, &c. 61 10 2 Total £401 11 2 VACCINATION. During the year a great deal of vaccination has been done, more especially re-vaccination during the Small Pox scare. Table D shows the position of the town as regards vaccination. Re-vaccination should be made compulsory for vagrants, etc. These persons have not conscientious objections, they are idle and careless. Through their carelessness this town, like many others, has had to pay big sums for stopping Small Pox outbreaks introduced by vagrants. The success of re-vaccination has been most marked during the epidemic. In the Glasgow outbreak 400,000 persons were re-vaccinated, and not one of them contracted Small Pox, whilst amongst those who refused protection, 2,255 cases occurred. In Prussia, from 1866-74, before re- TABLE D. Vaccination in the Borough. YEAR and MONTH. Total Births. Deaths of Children before Vaccination age. Total Births available for Vaccination. Postponements Insusceptible. Total successful Vaccinations. Percentage of Vaccinations to Birttis including postponements & insusceptible Removals. Exemptions. Summoned. Unaccounted for. Percentage of Births Unvaccinated remaining in Borough. May, 1899, to April, 1900 922 100 822 6 3 702 86.4 98 †19 7 5 3.7 May. 1900, to April, 1901 990 120 870 9 5 706 82.7 116 †24 6 4 3.9 May, 1901, to April, 1902 966 74 892 22 2 774 89.4 48 †39 1 4 4.9 May, 1902, to April. 1903 838 71 787 28 2 706 89.7 37 †47 16 2 8.2 1902. May 88 7 81 67 82.7 14 June 61 7 54 1 50 92.5 4 July 85 10 75 1 69 92.0 4 2 2.3 August 73 8 65 2 59 90.7 4 2 2.7 September 77 14 63 55 87.3 7 1 1.2 October 96 9 87 2 75 86.2 5 6 1 7.2 November 49 9 40 35 87.5 3 2 4.07 December 81 8 73 1 66 90.4 6 1 1.2 1903. January 88 8 80 1 69 86.2 5 5 1 6.8 February 104 19 85 3 80 94.1 2 2 1 2.8 March 70 10 60 4 53 88.3 4 1 2 4.2 April 76 7 69 4 62 89.8 4 †2 1 3.9 948 116 832 18 1 740 88.9 62 23 4 3 3.1 As nearly all "Postponements" are finally vaccinated, they are reckoned amongst the vaccinated, † In several cases when Exemption Certificates have been granted the child has shortly afterwards died. The true cause of death "after Vaccination" in the families of conscientious objectors may possibly be inherited constitutional deficiencies, and not the vaccination. 16 vaccination was made compulsory, the deaths per million were:— 1866-74 620 432 188 194 175 2,432 2,624 357 95 Re-vaccination compulsory in 1874. After several years working the rates are: 1892 98 1.0 1.0 3.0 4.0 3.0 .08 0.2 0.2 0.4 In Austria, where vaccination is voluntary, the rates are: 1892-96 250 290 260 250 110 47 35 In England, where vaccination is compulsory, with exceptions: 1892-98 0.6 1.7 14.7 49.3 27.3 7.3 17.6 0.8 8.1 The recent epidemic is not included in these years. None of the persons notified with Small Pox in this town had been recently re-vaccinated, except one, after Small Pox had been contracted, and one unvaccinated person died. DIPHTHERIA. This disease still remains fairly constant. There have been a great number of sporadic cases, untraceable to any definite source. The history is usually somewhat as follows. Child of three years; not attending school; not been with other children; went out with mother to market, shopping, or church, from two to seven days before onset of illness. House in sanitary condition. It is known that the infection of Diphtheria persists in persons apparently in good health and the supposition is that a child in a susceptible condition, if brought into temporary contact with a person carrying the infective germ, may become infected very readily. In all cases recovered from Diphtheria and Scarlet Fever, the parents are informed of the earliest date at which it is safe for children to return to school, and the Masters and Mistresses of the schools are notified at the same time. It is usual to allow a lapse of about a 17 night between the date when the patient is declared well by the doctor in attendance and the return to school, but this is varied by particular circumstances coming to my knowledge. There were 78 cases with 7 deaths. ENTERIC FEVER. June In one case the only clue was to the eating of watercress—K.V.H. Age 15. July Defective Drainage. Age 15. February Winkles bought in the town. Age 9. „ Disease contracted in Lewisham - sanitation unsatisfactory. Age 6. „ Probably contracted in Berkshire—K.V.H. Age 24. August Complaint of smell in workroom—Beyond district. Age 17. „ Away from home, where disease must have been contracted. Age 7. October *Works at a Rag and Bone Collectors. Age 27. „ *Dirty house—Croydon Hospital. Age 10 „ *Contracted in West of England. Age 40. „ *No cause ascertained—K.V.H. Age 23. November *Sanitary defects. Age 16. „ *No cause ascertained—Office in London. Age 19. December No cause ascertained. Age 35. „ Water on premises had been of very dirty colour and disagreeable in odour. Age 11. OTHER INFECTIOUS DISEASES. Measles and Whooping Cough have been prevalent at times, but not assuming epidemic form. Chicken-Pox was made notifiable for two periods of six months on account of the epidemic of Small Pox. Any cases in persons of older years were visited and examined, and a certain number of the young children. * Water drawn from tap was often brownish in colour, with .06 pts. per million of Albuminoid Ammonia. Complaint made to Lambeth Water Co. 18 PHTHISIS AND TUBERCULOSIS. It is not necessary to add much to what has been said before about the prevention of this disease. Spitting should be prohibited in public places, and disinfection of houses carried out after removal or death, but the great safeguard is to make the body resistant to the germ by physical training—by an open-air life—by rational food, and above all, by strict temperance. EPIDEMIC ENTERITIS OR SUMMER DIARRHŒA. Owing to the variable weather there has been a low death-rate from this disease. Nine deaths were registered during the six summer months as against an average of 26.5 and a maximum of 59. When rain falls heavily at frequent intervals during summer weather, it has been observed that this disease is little prevalent. I have shown in previous reports that this disease is most prevalent in a certain class of property, and there is no doubt that the soil around the backs of houses becomes impregnated with tilth, which is washed away by the heavy rains. Paved backyards are easily cleansed by flushing, and the frequent watering of roads is required, even where the traffic is not great, together with more frequent scavenging. A hard impermeable surface is needed, but prejudice seems against this improvement. The advent of mechanical propulsion of vehicles will doubtless help public health in this way. DAIRIES AND COWSHEDS. The cowsheds have been inspected quarterly. The number of cows has been reduced to 52. Two cow-keepers have ceased to milk their own cows and are now distributing railway milk. This is very unsatisfactory, as the place of origin is unknown, and as it is frequently mixed by the wholesale purveyors, the milk from one farm might possibly infect a large milk supply. At Harrow, last year, an epidemic was traced to milk brought from Cherbourg. Protection of milk supplies is urgently needed and would 19 not be a hardship to anyone. A Danish farmer recently took a farm near York, and by just carrying out the simple sanitary methods he had been taught in Denmark, he was able to supply pure milk uncontaminated by either disease or preservatives. The establishment of this farm was started as a charity, but has now become a remunerative concern. With a little energy and co-operation the country round Kingston should be able to give us a supply of pure milk direct from the cow. The largest cow-keeper in the town has now an apparatus for cleansing his cans bv steam. This is a very satisfactory method. HOGG'S MILL STREAM. This stream still causes trouble. The backwater near Portland Road is generally almost stagnant water; there is a thick deposit of mud at the bottom, and there are often bad smells. I consider this branch of the stream particularly bad. It is generally considered that this part of the town is the most unhealthy part of the Borough. This is difficult to prove as the population is migratory, but the particulars of infectious disease already published may be given again. The district is l-20th part of the area, but has 1-13th of the infectious diseases. It has always appeared to me that this backwater from Kelly's Mill to St. John's Schools should be filled in. This would give increased garden ground to the adjoining owners, who might reasonably be expected to contribute to the cost. The main stream would then require straightening, the banks of reeds, etc., cleared away, and the banks protected by campshedding. I do not think this improvement would cause flooding of the neighbourhood when the water was high in the river, as by diverting the whole stream to a straight, broad channel, the current would be relatively increased and the river deepened. For the future care of the stream certain workmen of the Corporation should be given a punt and wading boots, and obstructions and rubbish should be cleared away at regular times just as any highway is cleansed and scavenged. 20 SEWAGE WORKS. The experimental contact filter beds have now got into working order and are giving an excellent effluent, bright, clear, without smell, and averaging about one pint per million of alb. amm. This is by working the beds three times in the twenty-four hours. It may be possible to work the beds satisfactorily with four fillings, but that is the utmost that can be expected. The experimental beds of the Native Guano Company are worked three times in the twelve hours, and the results are given in the table. It must be remembered that these beds are well matured, having been working now for four or five years. In the same table the results are shown of distributing the effluent on to the contact bed by means of a revolving sprinkler. Sprinklers to serve a filter bed 100ft. sq. would cost about £175. This is a rough estimate of Mather and Platt for their open channel revolving sprinkler. It may be remembered that the experimental filter with Candy's distributor, became covered on the surface with sewage fungus. This growth was also found in the contact bed but was carried away when the penstock was raised and the filter emptied, and could be seen in the effluent channel in large pieces. The experimental sprinkler on the contact bed of the Native Guano Company shows a considerable excess of purifying power over the contact beds. The cost of the revolving sprinkler is not greatly in excess of any other distributor, and it can be worked with much less cost for attendance, as the beds could be worked a great part of the time on the continuous system, it only being necessary to fill up the beds sufficiently to clear them out—in any case they could always be allowed to run continuously during the night time. Eight contact beds with revolving sprinklers would do the work of ten contact beds with ordinary distributors. Considering the difficulties in providing a large number of filters, it would seem advisable to enquire care- KINGSTON SEWAGE WORKS. E. NATIVE GUANO COMPANY'S FILTERS. Result of Analyses of Tank Effluents and Filtrates for six months from 1st July to 31st December, 1903. The figures in Italics show results obtained on the experimental Filter Beds of the Corporation— Analyses of Medical Officer of Health. Date. Albuminoid Ammonia. Parts per Million. Tank Effluent run on to Filters. Filtrates. 1903. Coke. Contact. Bed. Clinker. Contact Bed. Sprinkler Fed Contact Bed. July 4 ... 2.60 ... 1.20 ... .94 1.20 „ 6 ... 3.00 ... 1.20 ... 1.36 1.00 „ 8 ... 2.32 ... 1.10 ... 1.14 1.00 „ 13 ... 3.48 ... 1.06 ... 1.30 .96 „ 15 ... 3.40 ... 1.20 ... 1.60 .96 „ 28 ... 2.12 ... .94 ... 1.10 .70 August 4 1.82 ... 1.00 ... .8 „ 5 ... 2.48 ... 1.20 ... 1.40 1.06 „ 8 ... 2.60 ... 90 ... 1.20 .84 „ 10 ... 2.32 ... 1.00 ... 1.00 .90 „ 12 ... 1.92 ... .80 ... 1.00 .64 „ 14 ... 1.68 ... .66 ... .80 .56 „ 18 ... 2.40 ... 1.10 ... 1.60 .96 „ 22 ... 2.68 ... .90 ... .90 .80 „ 25 ... 1.80 ... .70 ... .80 .56 September 2 1.82 1.16 ... 1.3 „ 7 ... 2.36 ... .80 ... 1.00 .80 „ 13 2.3 1.27 1.05 „ 14 ... 1.88 ... .92 ... 1.06 .84 „ 17 2.5 1.1 ... 1.2 „ 24 2.3 1.56 ... 1.4 „ 25 ... 2.00 ... .84 ... 1.20 .80 „ 28 ... 2.20 ... .94 ... 1.14 .70 October 3 ... 1.96 ... .78 ... 1.06 .70 „ 9 ... 2.40 ... .82 ... 1 06 .78 „ 14 2.2 ... 1.4 ... 1.3 „ 16 ... 2.12 ... .80 ... 1.00 .90 „ 20 ... 2.60 ... .94 ... 1.30 .94 „ 24 1.7 ... 1.1 ... 1.00 „ 28 1.96 ... 1.7 ... 1.2 November 7 ... 2.72 ... 1.00 ... 1.30 .96 „ 9 ... 2.20 ... 1.00 ... 1.10 1.06 „ 11 ... 2.28 ... .90 ... 1.14 .90 „ 14 ... 1.60 ... .76 ... .90 .78 „ 17 ... 2.30 ... 1.00 ... 1.16 1.10 „ 21 ... 2.20 ... .96 ... 1.30 .80 „ 24 ... 2.80 ... 1.10 ... 1.40 .88 „ 28 ... 1.50 ... .72 ... .86 .62 „ 30 ... 2.14 ... .94 ... 1.06 .82 December 2 ... 2.20 ... .90 ... 1.30 .80 ,, 7 ... 2.60 ... 1.04 ... 1.40 .84 „ 8 ... 2.50 ... .96 ... 1.40 .78 „ 11 ... 2.00 ... .80 ... 1.04 .64 „ 19 ... 1.90 ... .94 ... 1.04 .80 „ 21 ... 2.20 ... .70 ... 1.00 .70 „ 28 ... 2.40 ... 1.00 ... 110 .90 „ 31 1.7 2.00 1.00 .90 .9 1.50 .80 Averages 2.03 2.30 1.24 .93 1..11 1.15 .84 Purification ... ... 39% 60% 46% 50% 63% London, 27th January, 1904. 22 fully into this system and try one of the present experimental beds with a revolving sprinkler to see whether the system shown to be so successful with the small sprinkler filter of the Native Guano Company, would also be successful when carried out on a large scale. BYE-LAWS FOR HOUSES LET IN LODGINGS. These Bye-laws are still under your consideration, and I would urge upon you the necessity of putting them into force. It is only intended to use them in bad cases, and I fail to see in what way hardship would fall upon anyone. It is absolutely necessary, if the general standard of health is to be improved, that dirt and overcrowding must be dealt with systematically. A standard of space per person is given in these Bye-laws; it is all too little, but I trust you will establish it. FACTORY AND WORKSHOP ACT, 1901. New workshops are constantly being opened and old ones closed, but as far as can be ascertained every workshop in the Borough has now been inspected. Out workers have only been notified to me to the number of seven and these have been visited. There is little fault to be found with the workshop accommodation. In a few cases whitewashing was required or small sanitary defects required attention. In respect to workplaces it was found in one case that drain openings existed in a shed where food was being prepared. This is being remedied, and in the case previously reported the alteration has been carried out. With the reports of ptomaine poisoning at Derby and elsewhere, it is satisfactory to know that such a condition can be dealt with. Technically speaking, there are two underground bakehouses in the Borough, the floor in each case being more 23 than 3ft. below the level of the adjoining roadway, but both bakehouses are lofty, well ventilated and lighted, and are now the best in the town. One hundred and eighty visits have been paid to workshops, factories, and workplaces. In cases under the Fire Clauses the matter has been referred to the Fire Brigade Committee. Any complaints found on inspection have been dealt with as they occurred, and only in one case was it necessary 10 apply for a formal notice to abate a nuisance. (Signed) H. BEALE COLLINS. 24 ABSTRACT OF WORK OF THE MEDICAL OFFICER. Visits of Enquiry in cases of Infectious Disease 314 „ „ „ „ „ Small Pox 120 „ in regard to Insanitary Conditions 105 „ on behalf' of the School Attendance Committee 382 „ of Inspection to Schools 25 „ to Common Lodging Houses 27 „ Inspection of Markets 27 „ „ of Dairies 6 „ to Plague Contacts 2 Visits of Enquiry to places outside District 10 Consultations with Medical Practitioners 34 Other Visits 101 Total Visits 1153 *#* Average annual visits for last ten years—698. Complaints of Bad Food 8 „ of Overcrowding 2 Letters, etc., written 103 Notices served, Reports, etc. 17 Samples of Effluent Analysed 137 „ of Drinking Water Analysed 7 25 RAINFALL RECORDS SUPPLIED BY THE COUNTY MEDICAL OFFICER. Rainfall since 1st January, 1899.—Recorded by Mr. E. Underwood, County Hall, Kingston-on-Thames:— 1899. 1900. 1901. 1902. 1903. Inches. Inches. Inches. Inches. Inches. January 2.56 2.84 1.08 .78 2.44 February 2.33 3.30 .82 .73 1.12 March .46 1.07 2.24 1.69 2.57 April 2.32 .80 2.17 .64 1.69 May 1.28 1.03 .44 2.53 2.07 June .67 3.49 1.04 3.79 6.37 July .97 1.25 2.14 1.56 4.48 August .44 2.85 1.74 2.70 4.30 September 2.65 .73 1.75 2.57 3.21 October 2.28 1.85 1.78 1.46 5.02 November 4.16 2.02 .43 1.61 2.04 December 1.39 2.36 3.24 1.49 1.51 Total 21.51 22.59 18.87 21.55 36.82 Other County Returns.—The Rev. T. W. Side. botham, The Bourne, Farnham, says the total rainfall of the year 1903 amounts to 40.87 inches, i.e., 14.09 inches above the average for 25 years. Mr. Stenning, of Lingfield, gives the total of the year 1903 as 46.79 inches. The November, 1903, return for Chelsham was 2 98 inches. 26 INQUESTS HELD IN 1903. Date. Age. Cause of Death. Verdict. Jan. 12 15 Tuberculosis, accelerated by immersion in Thames „ 12 63 Syncope—Disease of Heart „ 30 11 Syncope—Pleural Effusion „ 30 3 hours Atelectasis Premature Birth. „ 30 3 minutes Atelectasis Premature Birth. Feb. 5 2 days Shock after operation ,, 5 2½ years Heart Failure after Diphtheria „ 12 26 Coma from Epilepsy „ 20 — Asphyxia Inattention at Birth. „ 21 25 Poisoning by Prussic Acid Suicide. „ 24 8 months Exhaustion from Convulsions „ 24 82 Shock from Fall Accident. „ 27 2 days Atelectasis Premature Birth. March 7 5 weeks Coma, due to Convulsions ,, 7 49 Asphyxia from meat in air passages—Epilepsy „ 12 74 Syncope from diseased blood vessels „ 14 55 Rupture of Heart „ 21 4 days Rupture of artery in Brain Premature Birth. „ 24 53 Wound in Throat Suicide. „ 24 79 Pneumonia „ 28 79 Asphyxia Drowning. April 6 83 Old Age „ 7 18 Rupture of Heart „ 24 6 Meningitis May 1 66 Dilated Heart—Syncope „ 4 45 Fracture of Skull Accidental. ,, 15 71 Injuries from being knocked down by Tram Car „ 18 52 Heart Disease „ 22 44 Fatty Degeneration of Hear 27 Date. Age. Cause of Death. ct June 3 8 months Pneumonia, etc. „ 3 29 Aortic Aneurism „ 20 18 hours Atelectasis Premature Birth. „ 22 45 Wound in Throat Suicide. „ 22 51 Fracture of Skull Accident. July 18 65 Heart Disease, etc. „ 20 61 Uræmic Poisoning „ 25 44 Phlebitis, etc. Accident. Sept. 18 60 Heart Disease „ 19 7 months Convulsions Oct. 1 3 months Congestion of Lungs ,, 5 9 hours Atelectasis Premature Birth. ,, 5 74 Heart Disease, etc. „10 52 Tuberculosis „ 10 56 Cerebral Hœmorrhage „ 20 53 Fractured Ribs—Pneumonia Accident. „ 31 7 months Convulsions Nov. 5 64 Fatty Degeneration of Heart „ 11 12 Fracture of Skull Accident. „ 26 16 Double Pleurisy „ 28 38 Asphyxia Drowning. Dec. 19 78 Heart Disease „ 19 3 months Convulsions „ 24 53 Heart Disease „ 31 70 Fatty Degeneration of Heart 28 SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1903. Choked and defective drains 230 New drainage to houses 28 Defective Closets and syphons 24 Defective soil pipes and ventilators 34 Defective water apparatus to closets 68 To lay on water supply to closets 24 To provide separate cisterns for flushing closets 6 Foul drinking water cisterns 64 To cleanse and lime wash houses 40 To cleanse and disinfect houses 260 To cleanse urinals adjoining the public roads 66 To repair and alter urinals adjoining the public roads 6 Inspecting urinals adjoining the public roads 820 Dilapidated houses 20 Dilapidated manure and ash pits 18 Accumulation of manure, offal, etc. 140 Pig keeping (a nuisance) 2 Fowl keeping (a nuisance) 10 Overcrowding of houses 7 Canal Boats Acts, &c. Canal Boats and Barges inspected 57 Offences in Contravention of Canal Boats Acts 5 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 560 Notices served to Householders 280 Notices served to School Attendance Officer 220 Notices served to Schools 260 Notices served to Librarian 500 Disinfecting houses after Infectious Diseases 210 Testing drains after Infectious Diseases 50 29 The Slaughter Houses, Cowsheds, Dairies and Milkshops have been visited at various times, and found in a fairly satisfactory condition. The Registered Lodging Houses have been constantly visited, and have been kept fairly clean and satisfactory. Petroleum Acts. Premises and tanks under this Act have been kept in a satisfactory condition, and have afforded 110 cause for complaint. Markets. All the stalls occupied by perishable goods have been kept under close observation, and I have had no cause to make any complaint to the Committee. FRED. J. PEARCE, Assoc. San. Inst., Sanitary Inspector. January, 1904. TABLE I. Births and Deaths Returns for Whole District. 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 Nonresidents registered in District Deaths of Residents registered beyond District. Deaths at all Ages. Nett. Number. Rate. * Number. Rate per 1000 Births registered. Number. Rate. * Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1893 28,436 846 29.2 114 134.7 558 19.6 63 49 509 17.9 1894 29,127 878 30.1 104 118.2 455 15.5 57 41 414 14.2 1895 30,050 954 31.7 155 162.4 540 17.9 58 50 10 490 16.3 1896 31,089 942 30.2 119 126.3 519 16.6 50 49 24 470 15.1 1897 32,516 945 29.06 143 151.4 585 17.9 59 88 9 497 15.2 1898 ... 960 28.2 147 153.1 554 16.2 69 70 8 484 14.2 1899 ... 979 27.09 137 139.9 612 17.1 82 94 15 518 15.3 1900 ... 988 26.9 110 111.3 596 16.2 78 81 17 515 14.06 1901 34,558 880 257 111 125 552 15.9 150 76 13 468 13.5 1902 35,970 940 26.1 113 129.7 624 17.06 206 105 15 511 14.2 Averages for years 1891-1901 34,534 931 28.4 129 135 559 16.9 107 70 11 487 14.9 1903 36,311 1,126 31.09 112 99.4 208 119 19 * Rates calculated per 1000 of estimated population. † Increase due to enlargement of Workhouse Infirmary. Area of District in Acres (exclusive of area covered by water) 1,114 Total population at all ages (at Census of 1901) 34,375 Number of inhabited houses (at Census of 1901) 6,507 Average number of persons per house ,, 5.2 TABLE IV. Causes of, and Ages at, Death during Year 1903. Causes of Death. Deaths in or Belonging to Whole District at Subjoined Ages. Total Deaths in Public Institutions in the District. All Ages. Under 1. 1-5. 5-15. 15-25. 25-35. 35-45. 45-55. 55-65. 65-75. 75-85. Over 85. Belonging. to District. Not belonging to District. Small-pox 4 1 ... ... ... 1 ... 1 ... 1 Measles Scarlet Fever 5 ... ... 5 Whooping Cough 9 6 3 Diphtheria & Membranous Croup 7 ... 3 4 Croup Fever:— Typhus Enteric 2 ... 1 1 Other continued Epidemic Influenza 4 1 1 ... ... ... 1 ... 1 ... ... ... 1 1 Cholera Plague Diarrhoea 11 9 2 Enteritis 8 4 ... ... ... ... ... ... 1 1 2 ... ... 1 Puerperal Fever †1 ... ... †l ... ... ... ... ... ... ... ... †l Erysipelas 2 ... ... ... ... ... ... ... 1 1 ... ... 2 2 Other Septic Diseases 3 ... ... 1 ... ... ... ... 1 1 ... ... ... 1 Phthisis 41 ... ... ... 6 3 15 9 7 1 ... ... 12 Other Tubercular Diseases 27 10 7 4 ... ... 3 2 1 ... ... ... 2 4 Cancer, malignant disease 38 ... ... ... ... ... 1 9 11 12 5 ... 10 15 Bronchitis 13 5 ... ... ... ... 1 ... 1 3 3 ... 3 Pneumonia 15 1 3 ... 2 1 3 2 ... 2 1 ... 4 2 Pleurisy 5 ... ... ... 1 ... 1 1 ... ... 1 1 Other Diseases of Respiratory Organs 8 3 2 ... ... ... ... ... ... 2 1 ... 2 2 Alcoholism, Cirrhosis of Liver 8 ... ... ... ... ... 2 ... 2 2 2 ... 2 3 Venereal Diseases 3 3 ... ... ... ... ... ... ... ... ... ... 3 6 Premature Birth 36 36 ... ... ... ... ... ... ... ... ... ... 2 5 Diseases and Accidents of Parturition 9 5 ... ... 1 2 ... 1 ... ... ... ... ... 2 Heart Diseases 56 3 ... 2 4 3 3 8 8 17 7 1 14 11 Accidents 10 1 ... 1 ... ... 2 3 1 1 1 ... 1 1 Suicides 3 ... ... ... ... 1 ... 2 Rheumatism 4 ... ... ... ... 1 ... 1 ... 1 1 ... 1 Drowning 3 1 ... ... ... ... 1 ... ... ... 1 All other causes 134 23 8 3 1 5 5 9 16 25 27 12 33 52 All Causes 469 112 30 22 15 17 38 48 51 69 52 14 89 119 t Notified in Borough but belonging to Esher.