KIN 056 borough of KINGSTON-UPON-THAMES. ANNUAL REPORT of the Medical Officer of Health, For the Year ending December 31st, 1905. GUILFORD AND HART, LIMITED, PRINTERS, K1NGSTON-UPON-THAMES, AND 33, FURNIVAL STREET, LONDON, E.C. Estimated Population 38,670. BIRTHS. CLASSES OF BIRTHS. DEATHS Under 1 year. DEATHS at all Ages. Total. Total Deaths 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. Epidemic Influenza. Whooping Cough. Diphtheria. Membranous Croup. Laryngitis. Rheumatism. Epidemic Enteritis (Summer Diarrhœa.) Gastritis. Erysipelas. Syphilis. Other Septic Diseases. Phthisis. Other Tubercular Diseases. Cancer. Bronchitis. Pneumonia. Pleurisy. Other Diseases of Respiration. General Paralysis of Insane. Alcoholism, Cirrhosis. Puerperal Fever. Accidents of Parturition. Premature Birth. Pemphigus. Heart Disease. Injuries. Suicide. Drowning. Other Diseases. Total. No. Rate per 1,000 per annum. Professional Trading. Proletariate Illegitimate No. Rate per 1,000 Births per annum. No. Rate per 1,000 per annum. No. Rate per 1,000 per annum. Vaccinated. Re-vaccinated Unvaccinated. M. F. M. F. M. F. M. F. Under 1 1 1 1 1 1 2 2 2 11 JANUARY 35 41 23.5 4 68 4 7 4 144 37 30 23.2 15 6 1 61 18.9 Over 1 1 2 1 8 1 1 2 8 1 1 7 1 1 15 50 Under 1 1 1 2 1 1 2 8 FEBRUARY 35 42 23.8 15 .58 3 5 3 103 15 25 12.3 15 7 33 10.2 Over 1 1 3 2 1 2 3 1 1 3 8 25 Under 1 3 1 4 MARCH 50 59 33.9 2 20 79 8 2 2 36 18 22 12.3 13 6 34 10.5 Over 1 2 2 1 5 1 2 4 3 10 30 Under 1 2 1 1 2 1 7 APRIL 37 42 24.6 19 54 4 7 88 26 17 13.09 16 10 1 33 10.2 Over 1 2 3 2 3 3 2 1 1 2 1 6 26 Under 1 2 1 1 1 2 7 MAY 37 43 22.9 14 63 3 2 5 87 19 21 12.3 14 6 1 34 10.5 Over 1 1 2 2 2 1 2 2 1 1 10 3 27 Under 1 1 3 1 5 JUNE 42 32 24.7 14 51 9 3 2 67 18 12 9.8 13 8 22 6.8 Over 1 2 2 1 1 1 1 1 2 6 17 Under 1 1 1 1 1 2 1 7 JULY 48 44 28.09 3 10 75 4 4 3 76 20 21 11.3 14 7 34 10.5 Over 1 1 1 2 3 2 1 1 6 1 9 27 Under 1 5 1 1 2 2 11 AUGUST 52 37 27.5 2 15 67 5 9 2 122 23 17 12.3 7 5 35 10.8 Over 1 1 3 2 2 1 2 2 1 10 24 Under 1 5 2 1 8 SEPTEMBER 32 41 22.6 2 14 55 2 5 3 109 19 21 12.3 8 6 34 10.5 Over 1 1 1 3 1 4 1 1 4 10 26 Under l 1 1 3 2 1 8 OCTOBER 54 33 26.9 1 20 64 2 6 2 99 20 32 16.0 19 10 42 12.5 Over 1 1 4 1 3 2 1 3 8 11 34 Under 1 1 1 1 3 NOVEMBER 44 51 29.7 2 16 65 12 2 1 31 14 19 10.2 11 6 1 27 8.3 Over 1 1 1 3 3 4 3 1 1 3 1 3 24 Under 1 4 2 5 1 12 DECEMBER 32 52 25.05 10 64 10 7 5 140 21 31 15.1 14 11 41 12.6 Over 1 5 2 6 2 2 1 1 3 1 6 29 CHILDREN BORN IN WORKHOUSE 28 27 1.4 5 4 Under 1 Over 1 DEATHS IN INSTITUTION OF PERSONS BELONGING TO THE BOROUGH 12 10 6.8 22 22 6.8 Under 1 Over 1 1 3 1 4 2 11 22 Under 1 9 12 1 1 7 3 1 6 13 20 1 1 4 12 91 TOTALS 498 517 26.2 13 171 765 66 59 32 89 262 278 139 159 88 26 452 11.7 Over 1 6 1 4 2 3 3 2 2 3 44 10 10 21 35 15 4 8 4 13 2 1 52 6 2 108 361 REPORT of the MEDICAL OFFICER of HEALTH. Clattern House, January, 1906. Gentlemen, I have the honour to present to you my Thirteenth Annual Report on the Health of the Borough of Kingstonupon-Thames. Birth Rate 26.2 per 1,000 per annum. „ 28.22 „ „ average of previous 10 yrs. „ 27.5 „ „ England and Wales, small towns, 1904. „ 26 8 „ „ England and Wales, rural, 1904. Death Rate 11.6 per 1,000 per annum. „ 14.41 „ „ average of previous 10 yrs. „ 17.6 „ „ England and Wales, do. „ 16.2 „ „ England and Wales, 1904. „ 15.6 „ „ Smaller Towns. „ 15.3 „ „ Country Districts. Death Rate, 89 per 1,000 Births of Infants under 1 year. „ 136 „ „ average of previous 10 yrs. „ 154 „ „ England and Wales, small towns. „ 146 „ „ England and Wales, 1904. A memorandum of the Local Government Board, dated November, 1905, calls for detailed information under certain headings which are dealt with seriatim. 4 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. 21.1 18.1 18.3 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, 1895—1904 16.85 11.67 13.45 13.92 14.5 Death rates of Kingston compared. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. 1895, average population 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 16.8 16.2 10.7 15.3 14.2 1903 „ „ 36,311 15.3 11.3 9.3 12.6 13.5 1904 „ „ 37,741 14.06 11.4 14.4 12.9 13.6 1905 „ „ 38,670 13.4 9.2 10.6 11.6 11.6 5 Physical Features and General Character of the District. The greater part of the District is on flat ground on the south bank of the Thames, but little raised above the level of the river. There is rising ground to the east of the Borough, extending almost to the top of Kingston Hill, a height of 144 feet. There is also high ground near the Cemetery, 59 feet. Nearly the whole of the district is now built over; of the 1,114 acres in the Borough there remain about 35 acres in the neighbourhood of Latchmere Brook bordering on Ham, and about 15 acres near the Dust Destructor, adjoining the Hogg's Mill stream. A few acres remain unbuilt on in the Gloucester Road, and a few large mansions with gardens may be cut up into building plots before many years are past. The higher parts of the town are on clay, the low-lying ground being mostly gravel. In addition to the Thames, a small stream, the Hogg's Mill River, enters the Thames near the Market Place. This stream has a fall of about 25 feet in its passage through the Borough, and if it were not for three mill dams it would drain the district through which it passes very effectively. The banking up of the water keeps this neighbourhood very damp, and as the stream is very sluggish there is often a disagreeable odour in the neighbourhood of the middle mill where the stream broadens out to a shallow lagoon. Part of this has just been filled in and I hope will improve the condition of the adjoining houses. That there should be disagreeable odours in summer time is not surprising, as the effluents from the Sewage Works of Maiden, Ewell and Epsom all discharge into the stream higher up. The average summer flow is not above 10 or 12 million gallons daily, but this will increase as the effluent from the sewage works of these growing districts increases. It is under the control of the Thames Conservancy as regards pollution, but regulations are badly needed in regard to the repair of banks, flooding, etc. This stream for the greater part is outside the Borough, but any damage caused by accident or neglect higher up is felt almost entirely within our boundaries. As if these conditions were not serious enough, the Surbiton District Council have recently proposed to remove their 6 sewage from the Kingston Sewage Works, where there is ample room to treat the whole sewage of the district for many years to come, and to treat their sewage at Tolworth, discharging the whole of their effluent into the Hogg's Mill stream. The estimated volume is one million gallons daily, but it must soon exceed that amount, and judging from the class of property now being erected at the south end of Surbiton and the constantly increasing use of baths, the volume is likely to amount in a very few years to nearly 3,000,000 gallons. At the present rate of building, Maiden will soon be putting in 2,000,000 gallons, and Epsom and Ewell must be credited with a like amount. This will mean that the flow of the stream will be doubled, and as it must be remembered that the flow from sewage works is greater at certain times of the day than at others, it is possible that quite sufficient extra volume might be added at a critical moment to cause a flood that would otherwise be avoided. Owing to the tortuous course of the stream through the Maiden meadows the water accumulates on the low-lying ground. Then, if a sudden heavy rainfall comes on, the water comes down with a rush into the town, and if the course of the stream were not hampered by mill dams, etc., it would run away quickly into the Thames. A specially bad obstruction is the brick arch carrying water mains (late Chelsea Co.). When the water rises to the crown of this arch its passage is blocked and the water floods the houses in Fairfield Place. If the volume of effluent is increased, it is clear that in flood time the addition of a few million gallons will cause a flood which would otherwise be avoided, and it is surely reasonable to call on the authorities contributing to this nuisance to so regulate the course of the stream that it will not become an intolerable nuisance to this town. The stream has always been a great trouble to us, and if the sewage effluents of these growing townships are to be allowed to be discharged to an amount that will double the flow of the river it will constitute a grave public danger. As regards Surbiton and Maiden the whole of the sewage from these districts could be treated on the present works at Kingston with both efficiency and economy. 7 The chief occupations of the inhabitants, and the influence of any particular occupation on Public Health. A large number of men are employed in printing works, and women are engaged in laundry work and in bottling beer and mineral waters. A considerable number of workers are employed outside the Borough, either in London, or in the wealthier districts adjoining Kingston. There is no employment directly affecting Public Health. House accommodation, especially for the working classes—Adequacy and fitness for habitation—Sufficiency of open space about houses, and cleanliness of surroundings—Supervision over erection of new houses— Action under the Housing of the Working Classes Act. The town is chiefly a working class town. The houses are generally of good character, but a few houses built about the middle of the last century are unsatisfactory. These are not bad enough to be condemned as unfit for habitation, but are badly built and badly planned and concrete has not been laid below the floors. These houses are confined to Cambridge Road and adjoining streets; upper part of Richmond Park Road; Cowleaze Road; Canbury Place; and the neighbourhood of Mill Street: with a few isolated houses in other parts. There is no closeness of building except in the business neighbourhood of the Market place. Pavement round the backs of houses is being introduced, and there will be little to complain of as regards cleanliness of surroundings when this is complete. Several minor streets and passages might with advantage be paved with impervious material such as "tar-mac." There is good supervision over new houses, no new house being certified for occupation till the requirements of the By-laws have been complied with. No action has been taken under the Housing of the Working Classes Act, but I again draw your attention to my scheme for dealing with the worst area in the Town, that adjoining Cambridge road. I believe an improvement scheme on the lines I have suggested could be carried out with profit. 8 Sewerage and Drainage—Its sufficiency in all parts of the District — Condition of sewers and house drains — Method, or methods of disposal of sewage—Localities where improvements are needed. The sewerage and drainage of the town is good on the whole. Some parts of the District are flat and trouble occasionally arises during heavy rain storms. This difficulty is gradually being got over by laying separate surface water drains, and it is hoped that in a year or two a double system may be in force throughout the Borough. The house drains in modern property are in good condition. Many of the older houses have been brought into accord with the By-laws and opportunity is taken from time to time to get this done. Some trouble arises from the system of combined drains in certain districts. It is to be hoped that the law on this matter will be amended shortly, so that the present difficulties may be done away, thus obviating expensive law processes. The Sewage is treated by the A.B.C. process, under contract with the Native Guano Co. Six filters have recently been added to bring the effluent up to the standard of the Thames Conservancy. Five of these filters are 100-ft. sq. by 3-ft. 9-ins. in depth and one is 100-ft. sq. by 3-ft. in depth. There is vacant land available for still further increasing the filtering area, and six new settlement tanks could be provided without difficulty. The process is satisfactory and the filtered effluent is as good as can be desired, being often under 0.5 per million of albuminoid ammonia, clear, sparkling, free from odour, and not liable to putrefaction on keeping either at the natural temperature or in an incubator. There is no doubt that the process is effective, and as regards other systems the only dispute is with regard to the cost. At the Sewage works the sewage of Surbiton (13,000), Hampton Wick (4,000), and Kingston (38,000) is dealt with. The effluent amounts to about 3,000,000 gallons daily flow, and there would be no difficulty in dealing with double the amount on the area. The Surbiton District Council recently proposed to break away from this central drainage area, and establish works in another district where they must cause 9 damage to the interests of this town. The scheme has been defeated for the present, but may be renewed in another form, which should for the reasons stated meet with your strenuous disapproval. Pollution of rivers and streams in the District—The sources and nature of such pollution and any action taken to check it. The Thames is well looked after by the Thames Conservancy, and prompt action is taken against the Corporation if any sewage, &c. is carried into the river by sudden storms or if the sewage effluent is in any way unfit. The Hogg's Mill stream, which has been referred to, is also in a measure under the supervision of the Thames Conservancy, but the inspectors appear to take less interest in this tributary watercourse than in the main stream of the Thames. Reports often reach us of bad effluents being turned into the river from the Sewage Works on the banks, but on reaching the outfall the nuisance is always found to have been stopped. Our only evidence is the nature of the water as it comes through the Borough and this is often most unsatisfactory. The legal difficulties in dealing with nuisances in regard to watercourses seem to be very great, and some simplification of the law is required. The Latcbmere Brook is partly in this district, and although a portion of it has been filled in it still serves to carry off a certain amount of surface water from the north-east part of the town. It is a very slow running stream and only partly under the control of this Corporation. Excrement Disposal—System in vogue—Defects, if any. Water carriage is universal, and satisfactory. I think every closet in the town is now provided with a flushing tank, and the system works well. Removal and Disposal of House Refuse—Whether by public scavenger or occupiers—Frequency and method. Certain streets are subject to a daily collection, in which case the refuse is placed outside the house in a suitable receptacle and removed by the dustmen. In other streets the collection is weekly, the dustbins being emptied by the dustmen. The collection is worked by the Corporation and the dust is 10 taken to the Destructors in Oil Mill Lane and burnt. The form of Destructor is that known as the Beaman and Deas, supplied by Meldrum, Limited. It has two cells. Water Supply. A few shallow wells still remain, but the water supply is from the mains of the Metropolitan Water Board. There is a constant service and the character of the water is fairly good. Places over which the Council have supervision, e.g., Lodging Houses, Slaughterhouses, Dairies, Cowsheds and Milkshops, Bakehouses, Factories and Workshops, and Offensive Trades. There are two common Lodging Houses under one management. They are well-conducted. One is an old building and one is new. There are many houses let in lodgings and By-laws in regard to them have been approved and steps will be taken shortly to make a register of the houses. The six Slaughterhouses are used for killing a few sheep and pigs. They are kept in good condition. The four Cowsheds are visited quarterly and are well kept on the whole. The largest cowkeeper in the town has his shed very well kept, and has appliances for cooling milk, sterilizing cans, &c., and is always doing everything he can to improve his premises. By-laws. The By-laws in force are fairly stringent and I do not think any addition is required at the present time. It has not been possible to carry out the By-laws for Houses let in lodgings at present, but arrangements are being made to make them effective. Nuisances. These are dealt with as they arise, and except when elsewhere specially referred to, there is no cause for complaint. Methods of dealing with Infectious Diseases—Notification—Isolation Hospital Accommodation and its Sufficiency—Disinfection. Notification is in force for the usual diseases—neither Measles nor Phthisis are notifiable. Arrangements are being 11 made by a Joint Committee of the County Council for the treatment of Smallpox cases. In the meantime cases would be sent to Darenth or Barnet. Arrangements have been made with the Croydon Borough Hospital for treating cases of Scarlet Fever and Diphtheria from houses when special circumstances render removal advisable, and the arrangement answers well. Enteric Fever is treated in the Kingston Victoria Hospital, payment being made by the Corporation. The isolation in hospital of ordinary cases of Scarlet Fever and Diphtheria has not been found necessary. Cases rarely spread in the households and cases of infection being carried to other houses are unknown as far as I have been able to ascertain. Disinfection is by burning sulphur in the rooms or by spraying with formalin. Bedding, &c., is sent to Lacey's, Wandsworth, but a disinfector at the Dust Destructor is under consideration. MEASLES. Nine deaths from this disease ; two under one year of age and the rest in very-young children. The epidemic was considerable all over the Borough. There was no definite spread from one school to another, but the schools were not all attacked at the same time. On my recommendation the Elementary Schools were closed for 16 days, so as to tide over the incubation period, from April 14th. After this the epidemic soon died out, but the continuance of isolated cases and secondary cases amongst children who had been attacked at the beginning of the outbreak, show that the force of infection had worn itself out rather than that it had been checked by school closure. The inquiry instituted in Woolwich in 1902, at the instance of Dr. Kerr, by the School Board for London, has been carried on since, under the London Education Committee, by Dr. Thomas, and Dr. Davies the medical officer of health. Owing to the circumstance that in the eastern half of the borough an attempt was made to suppress every appearance of measles in a school by rigorous class closure, while in the western half the system of excluding individual children was followed, the inquiry has something of the value of a scientific experiment. The result of the experiment in 1903 was interesting. The statistics showed that class closure had been much more costly in interfering TABLE III. Notifications of Infectious Diseases. B. WARDS AND DISEASES. Population Estimated. Primary Cases. Secondary Cases. TOTALS. TOWN. Population 6,630— Scarlet Fever 3 3 Diphtheria 7 1 8 Erysipelas 1 1 —12 CANBURY. Population 9,210. Scarlet Fever 10 1 11 Diphtheria 3 3 Enteric Fever 1 1 Erysipelas 5 5 Puerperal 1 1 —21 HILL. Population 11,250. Scarlet Fever 16 8 24 Diphtheria 7 7 Enteric Fever 2 2 Erysipelas 7 7 Puerperal Fever 1 1 WORKHOUSE. Population 820. Erysipelas 1 1 —42 NORBITON. Population 10,760. Scarlet Fever 14 14 Diphtheria 11 1 12 Enteric Fever 1 1 Erysipelas 8 8 —35 Under 1. 1-5. 5-15. 15-25. Over 25. Totals. Scarlet Fever 12 31 4 5 52 Diphtheria 9 16 3 2 30 Enteric Fever 1 3 4 Erysipelas 4 1 2 5 10 22 Pueperal Fever 2 2 13 with school work than the exclusion of individual children; in the eastern division of the borough 195 cases of measles had entailed a loss of 26,287 attendances, an average of 135 lost attendances for each case of measles; in the western division, 215 cases of measles had entailed a loss of 13,563 attendances, an average of 63 lost attendances for each case of measles. The loss of attendances under the system of individual attendance was thus less than half the loss under the other system of class or school closure. SCARLET FEVER. 52 cases were notified during the year. Eight were sent to Hospital: two, because the mothers were too nervous to attend to the children: one mother had an abortive attack: a mother and child being attacked at the same time: and one as a paying patient. Infection was traced to Hampshire, Wandsworth and Ascot. Two children were attacked five days after a sister returned from Stockwell Hospital, where she. had been under treatment for Diphtheria. She was apparently free from infection. A boy who had been sent out of the house whilst his brother was ill, was attacked seven days after his return, and nineteen days after the first patient had been declared well. There was no sign of desquamation or of discharge from nose or ears, and another child who had remained in the house all the time escaped. Clothing and toys had been disinfected or burnt. In four houses more than one case occurred. DIPHTHERIA. Thirty cases were notified, with three deaths. The cases were mostly of mild type, and no connection was traced between any except three secondary cases occurring in three families. ENTERIC FEVER. Only four cases were notified. There was no death from this disease. In all, recovery resulted. Two cases were sent to Hospital. One suspected source of infection was water from the River Mole taken just below a sewage outfall, whilst out fishing. 14 ERYSIPELAS. Careful enquiry was made in all cases in young children and all were found to be idiopathic in character. Two deaths resulted. PEMPHIGUS. One fatal case occurred in a newly-born child. The Midwife was excluded from practice for 14 days. PUERPERAL FEVER. Two cases were notified, both fatal. One case was in the practice of a Midwife who has now had her name removed from the Roll of Midwives. She did not wash her patient after the birth of the child and did not visit the patient again for sixteen hours. When the patient became seriously ill she ceased attendance, suggesting that a doctor should be sent for, but she did not herself send for medical aid, neither did she notify the case to me. The coroner's jury censured her for neglect. RINGWORM AND INFECTIOUS IMPETIGO AND ITCH. 228 children were reported to me with these complaints. If thirty absences are allowed for each of these cases, and many of them are away from school for months at a time, 6,840 school attendances have been lost. With the greatest care it would be impossible to avoid a few cases, but I think the greater part of these absences might be avoided if proper care were taken of the cases. Working mothers have not the time to attend to these cases properly, but if a nurse could see each case two or three times a week and keep the hair cut and the head clean, the cases would get well much quicker. About three hours daily would be sufficient time for the nurse to give, including a visit to the schools to help the teachers in finding out cases in the early stages, so that it would be only necessary to engage a nurse for a part of her time. This should not run into any great expense, probably much less than the loss on the school attendances. Since the attendances have been more closely looked after the number of cases of Itch has increased. I imagine the dirtier children have been brought into the schools. This disease is highly infectious and if not treated in its early stage TABLE C.—Analysis of Scarlet Fever Cases, 1905. Italics indicate Duplicate Returns. Date when reported to Sanitary Committee. Number of cases reported at each Committee. 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 Waddon Hospital. •remaining in Hospital. L.F.H.—London Fever Hospital. Deaths in Hospital. Deaths when treated at home. Return Cases Incomplete Returns. Still under treatment. Notified at same time as first case. Cases giving rise to secondary cases. Secondary cases occurring during treatment of primary case in home. Notified after removal of first case to Hospital. After return from Hospital. In Home after original case declared well. Jan. 16 10 1 3 1 2 50 47 47 47 47 41 43 46 2 46 50 ... ... 43 ... ... ... ... ... ... ... 1 Feb. 2 2 ... ... ... ... ... 37 37 ... ... ... ... ... ... 1 37 ... ... ... ... ... ... ... ... ... ... 1 1 ,, 10 1 ... ... ... ... ... 44 ... ... ... ... ... ... ... 1 44 ... ... ... ... ... ... ... ... ... ... Mar. 2 3 ... 1 ... 1 ... 24 24 22 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ 16 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 67 ... ... ... ... ... ... ... ... Apl. 6 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 42 ... ... ... ... ... ... ... ... May 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1† ,, 18 1 ... ... ... ... ... 25 ... ... ... ... ... ... ... 1 25 ... ... ... ... ... ... ... ... ... ... ... ... June 1 2 ... ... ... ... ... 46 46 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ 15 ... ... ... ... ... ... 45 66 ... ... ... ... ... ... ... 45 ... ... ... ... ... ... ... ... ... ... ... ... July 6 3 ... ... ... l ... 45 36 44 ... ... ... ... ... 2 43 36 ... ... ... ... ... ... ... ... ... ... ... „ 17 2 ... ... ... 1 ... 27 52 ... ... ... ... ... ... 2 27 52 ... ... ... ... ... ... ... ... ... ... ... Sept. 7 5 1 ... ... ... ... 47 43 42 48 ... ... ... ... 3 47 43 42 ... 62 ... ... ... ... ... ... ... ... „ 21 4 ... ... ... ... ... 48 42 44 ... ... ... ... ... 3 44 48 ... ... ... ... ... ... ... ... ... ... 1 ... Oct. 9 . 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 ... ... ... ... ... ... ... 1 ... Nov. 13 4 ... 1 ... ... ... 37 43 43 46 ... ... ... ... 2 37 46 ... ... ... ... ... ... ... ... ... ... ... ... Dec. 8 7 3 ... ... ... ... 42 42 47 45 ... ... ... ... 4 42 42 47 45 18 34 29 ... ... ... ... ... ... 2 „ 21 1 ... ... ... ... ... 54 ... ... ... ... ... ... ... 1 54 ... ... ... ... ... ... ... ... ... ... ... ... ... 52 8 6 2 5 26 1 5 2 Incomplete returns Still under treatment 5 2 Days under treatment per case : 40.5 Days under treatment per case: 32.7 Days under treatment per case: 52.1 Sent to hospital, Waddon 8 Doubtful case. 15 is often very troublesome. The nurse would recognise these cases in children at school and they could be excluded before they had spread the disease to cleaner children. DEFECTIVE CHILDREN. The physically defective children found on inspection of the schools were thirty-two. Twenty of these are now being taught at the Guild House School in Church Road by a specially qualified teacher. The room has been made light and bright by the insertion of two large windows at the side. Special desks, hammock chairs, and reclining chairs have been provided, and the class is making good progress. The mentally defective children number thirty-three, and separate class rooms will soon be ready for some of these cases. At present some are at home and some are in the general schools which is neither good for them nor the other scholars. Epileptic children are few in number and can be best treated in special institutions. The consumptive children are unprovided for and are kept at home. A special open-air school is much needed for the ten known bad cases and possibly for certain others at present in the general schools. One hundred and twenty-one children were found to have grossly defective vision. These children were unable to read the blackboard clearly, or read from ordinary books, or suffered from considerable degrees of squint. Unless supplied with proper glasses these children can only benefit by a small part of the education provided for them. Probably 40 per cent. of the cost is wasted upon them. I think it would be possible to find a surgeon occulist who would undertake the examination of the eyes of the children, at a nominal charge if a properly fitted room and apparatus were provided for his use. The experience gained would lead to more lucrative work and there must be many young surgeons who would be glad to accept such an appointment. In most cases the parents could purchase glasses themselves, and for those who are too poor, I feel sure it is only necessary to mention the want and a charitable society would be formed to assist those who had not the means to provide glasses, which in some cases would cost a considerable amount. 16 VACCINATION AND SMALL POX. No case of Small Pox has occurred this year. The vaccination is well carried out. It may be advisable to refer to the recent report of the Local Government Board on Hospitals in Germany for the isolation of Small Pox. From this article, it will be seen that so efficient is compulsory vaccination and re-vaccination in Germany, that it is possible "to dispense with separate Small-Pox Hospitals altogether. It is not necessary there to provide for Small-Pox a separate site nor separate administration. Germany is, in this way, freed from great expense, not to speak of the suffering and inconvenience which fall upon the English nation." Death from Small-Pox in Germany, and England and Wales: Country and Date of Census. Pop. 1891. 1892. 1893 1894. 1895. 1896. 1897. 1899. l899. 1900. 1901. 1902. Total in Years. Germany (1900) 56,367,178 49 108 157 88 27 10 5 15 28 49 56 15 607 England and Wales (1901) 32,520,075 49 431 1457 820 223 541 25 153 174 85 242 2461 6761 Most of these cases in Germany were in the persons of foreigners; Russians, Austrians, and Italians employed as navvies; and most of the outbreaks were near the Russian or Austrian frontiers. Small Pox cases in Germany are in most cases removed to a pavilion in the grounds of the General Hospital of the town. EPIDEMIC ENTERITIS. Only twelve deaths from this disease this summer. There were no long periods of drought this year, the rain falling at frequent intervals and not in large amounts at a time. Such climatic conditions seem unfavourable to the spread of this disease. TABLE D. Vaccination in the Borough. year AND month. Total Births. Deaths ot Children before Vaccination age. Total Births available for Vaccination. Postponements. Insusceptible. Total successful Vaccinations. Percentage of Vaccinations to Births including postponements & insusceptible Removals. Exemptions. Summoned. Unaccounted for. Percentage of Births Unvaccinated remaining in Borough. May, 1998, TO April, 1899 922 100 822 6 3 702 86.4 98 †l9 7 5 3.7 May, 1899, to April, 1900 990 120 870 9 5 706 82.7 116 †24 6 4 3.9 May, 1900, to April, 1901 966 74 892 22 2 774 89.4 48 †39 1 4 4.9 May, 1901, to April, 1902 838 71 787 28 2 706 89.7 37 †47 16 2 8.2 May, 1902, to April, 1903 948 116 832 18 1 740 88.9 62 23 4 3 3.1 May, 1902, to April, 1904 1054 105 949 8 4 852 90.0 54 27 4 3.4 1904 May 70 8 62 1 56 91.9 4 1 9.3 June 70 10 60 1 54 91.6 4 1 10.0 July 81 6 75 3 1 66 93.3 4 1 12.0 August 89 14 75 1 67 90.6 2 5 10.6 September 92 8 84 82 97.5 1 1 2.3 October 61 1 60 1 55 93 3 1 3 8.3 November 73 7 66 1 59 90.9 4 2 10.6 December 73 10 63 60 95 3 2 1 4.5 1905. January 76 8 68 61 89 6 3 3 1 10.2 February 77 3 74 71 95.9 1 1 1 4.0 March 99 4 95 1 89 94.7 1 4 7.0 April 79 2 77 1 1 70 93.5 4 1 9.0 940 81 859 7 5 790 93.3 31 23 3 8.0 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. 18 RAINFALL AND EPIDEMIC ENTERITIS. Year. Days on which rain fell during August. Rainfall in inches. No. of Deaths. in August. REMARKS. 1899 6 .74 44 1904 10 1.96 32 1901 11 2.1 22 Rain only at end of the month half on one day 1900 11 3.61 4 Rain distributed throughout the month 1905 16 2.86 *5 Rain distributed throughout the month. 1902 18 3.17 4 Rain distributed throughout the month. 1903 19 4.09 1 Rain distributed throughout the month. Average Rainfall for August, 2.35 in. *One case came home ill from North of England. PUBLIC HOUSE URINALS. These have all been inspected. Those near the roadway with access for the public have all been fitted with properly flushing apparatus. There is urgent need for properly fitted Public Urinals near the Railway Station and near the Barracks. TABLE E. Factories,Workshops, Laundries,Workplaces & Homework 1.—INSPECTION. Including Inspections made by Sanitary Inspector or Inspector of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 7 Workshops (including Workshop Laundries) 91 Nil Workplaces Homeworkers' Premises 5 Total 103 Nil 2.—DEFECTS FOUND. Number of Defects. Number of Prosecutions. Particulars. Found. Remedied. Referr'd to H.M. Insp'ct'r Nuisances under the Public Health Acts: Want of Cleanliness 5 5 3.—OTHER MATTERS. Class. Number. Underground Bakehouses (S. 101):— In Use during 1903 4 Certificates granted in 1904 2 in 1905 2 In use at the end of 1901 2 Homework:— Number of List of Outworkers (S. 107) :— Lists Outw'rk'rs Lists received 2 8 Addresses of. Outworkers forwarded to other Authorities Nil received from other Authorities 3 Workshops on the Register (S.131) at the end op 1904: Important classes of workshops, such as workshop bakehouses, may be enumerated here Bakehouses 32 Workplaces where food is prepared 19 Workshops 174 Total number of workshops on Register 225 20 ABSTRACT OF WORK OF THE MEDICAL OFFICER. Visits of Enquiry in cases of Infectious Disease 106 ,, „ ,, „ Workshops, etc. 118 „ in regard to Insanitary Conditions 127 ,, on behalf of the School Attendance Committee 931 ,, of Inspection to Schools 30 „ to Common Lodging Houses 2 ,, Inspection of Markets 39 „ „ of Dairies 18 „ to Plague and Small Pox Contacts 9 Visits of Enquiry to Places outside District 8 Consultations with Medical Practitioners, &c 37 Other Visits 52 Visits to Midwives 47 Total Visits 1,524 *** Average annual visits for last ten years—865. Complaints of Bad Food 3 „ of Overcrowding 4 Letters, etc., written 79 Notices served, Reports, etc. 12 Samples of Effluent Analysed 46 „ of Drinking Water Analysed 4 21 RAINFALL RECORDS FOR THE DISTRICT. Rainfall since 1st January, 1900. * 1900. * 1901. 1902. * 1903. † 1904. ‡ 1905. Inches. Inches. Inches. Inches. Inches. Inches. January 2.84 1.08 .78 2.44 2.74 .61 February 3.30 .82 .73 1.12 2.41 .80 March 1.07 2.24 1.69 2.57 1.39 4.03 April .80 2.17 .64 1.69 1.03 1.68 May 103 .44 2.53 2.07 2.16 103 June 3.49 1.04 3.79 6 37 .8 4.84 July 1.25 2.14 1.56 4.48 1.5 1.07 August 2.85 1.74 2.70 4.30 1.59 2.85 September .73 1.75 2.57 3.21 1.5 1.67 October 1.85 1.78 1.46 5.02 1.54 1.36 November 2.02 .43 1.61 204 1.56 3.39 December 2.36 3.24 1.49 1.51 1.97 .60 Total 22.59 18.87 21.55 36.82 20.16 23.93 County Hall, † West Molesey. ‡ Kingston Sewage Works. In the records for the immediate neighbourhood, there are considerable differences between West Molesey, Surbiton, and Kingston (Sewage Works), amounting to over an inch in a year. It will be seen that the Report shows a steady, if slow, improvement. H. BEALE COLLINS. 22 INQUESTS DURING 1905. Date. Description. Age. Sex. Cause of Death Verdict. Jan. 13 Son of Carpenter 5J mths M. Improper Feeding „ 17 Son of Compositor 7 wks. M. Improper Feeding „ 20 Butler 71 M. Exposure to cold „ 23 Son of a Porter 4 days M. Overlaying in bed with parents , 31 Son of Housekeeper 3J mths M. Overlaying in bed with parents ,, 31 Compan Director 48 M. Drowning „ 31 Widow of Labourer 94 F. Senile Decay Feb. 22 Labourer 29 M. Rupture of Aneurism „ 23 Son of Labourer 6 mths. M. Overlaying in bed with parents „ 23 Widow 68 F. Heart Disease April 11 Daughterof Labourer 2 F. Double Pneumonia „ 11 Wife of Cabman 38 F. Chronic Gastritis „ 28 Gardener 54 M. Acute Alcoholism May 2 Porter 39 M. Pneumonia „ 6 Son of Labourer 7 mths. M. Broncho-Pneumonia ,, 23 Wife of Labourer 32 F. Gastro-enteritis from Irritant Poison June 15 Wife of Waterman 38 F. Concussion of Brain Accidental „ 27 Carman 51 M. Fracture of Ribs and Sternum Accidental July 27 Clerk 29 M. Drowning ,, 29 Daughterof Coachman 4 mths. F. Pleurisy „ 29 Machinist 79 F. Heart Disease Aug. 22 Widow of Carpenter 83 F. Fracture of Femur,Senile Decay „ 31 Wife of Sergeant 30 F. Septicœmia Puerperal Accelerated by neglect 23 Date. Description. Age. Sex. Cause of death. Verdict. Sept. 7 Son of Servant 9 mths. M. Improper Feeding „ 25 Gardener 54 M. Double Pneumonia „ 25 Wife of Labourer 58 F. Heart Failure Oct. 5 Gardener 47 M. Heart Disease 14 Widow of Tin PlateWorker 50 F. Heart Disease ,, 19 Labourer 36 M. Heart Disease „ 25 Child 4 wks. F. Malnutrition „ 25 Gardener 60 M. Cerebral Haemorrhage Natural Nov. 14 Son of Stoker 6 mths. M. Overlaying in bed with parents „ 6 Son of Farrier 3 M. Burns and Pneumonia „ 9 Daughter of Carpenter 2 mths. F. Broncho-Pneumonia ,, 9 Daughter of Labourer 6 wks. F. Malnutrition „ 30 Wife of Brick Layer 37 F. Alcoholic Neuritis 24 SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1905. Choked and Defective drains 220 New drainage to houses 18 Defective closets and syphons 22 Defective soil pipes and ventilators 24 Defective water apparatus to closets 52 To lay on water supply to closets 10 To provide separate cisterns for flushing closets 6 Foul drinking water cisterns 56 To cleanse and lime wash houses 40 To cleanse and disinfect houses To cleanse urinals adjoining the public roads 58 To repair and alter urinals adjoining the public roads 4 Inspecting urinals adjoining the public roads 920 Dilapidated houses 12 Dilapidated manure and ash pits 6 Accumulation of manure, offal, etc. 180 Pig keeping (a nuisance) 2 Fowl keeping (a nuisance) 8 Overcrowding of houses 4 Canal Boats Act, &c. Canal Boats and Barges inspected 65 Offences in Contravention of Canal Boats Acts 11 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 220 Notices served to Householders, etc. 90 Notices served to School Attendance Officer 80 Notices served to Schools 150 Notices served to Librarian 180 Disinfecting houses after Infectious Diseases 80 Testing drains after Infectious Diseases 30 25 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 clean and satisfactory. Petroleum Acts. Premises and tanks under this Act have been kept in a satisfactory condition, and have afforded no cause for complaint. Markets. All the stalls have been kept under close observation, and there has been no cause for complaint. During the year the following articles outside the precincts of the Market have been condemned:— 119 stone, 3 lbs. of Beef. 2 boxes of Cod Fish. 1 barrel of Conger Eels. 2 boxes of Haddock. 2 boxes of Skate. 8 boxes of Tomatoes. 2 pads of Watercress. FRED. J. PEARCE, A.R.S.I., Sanitary Inspector. January, 1906. TABLE 1. Births and Deaths Returns for Whole District. Births. Deaths under One Year of Age. Deaths at all Deaths at all Ages. Total. Deaths in Public Institutions, f Deaths ol Nonresidents registered in District. Deaths of residents registered beyond District Ages. Nett. Year. Population estimated to Middle of each Year. Number. Rate. * Number. Rate per iooo Births registered Number. Rate. * Number. Rate. * 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 30,050 954 31.7 155 162.4 540 17.9 58 50 10 490 16.3 1896 31,089 942 302 119 126.3 519 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 25.7 111 125 552 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 1903 36,31 1,030 31.09 116 112.6 602 16.6 208 119 19 492 13.5 1904 37,741 973 26.2 151 154 645 17.9 242 129 22 516 13.6 Averages for years 34.319 958 2822 130 1365 580 16.9 120 86 15 496 14.4 1895-1904 1905 38,670 1,015 262 91 89 540 13.9 159 88 26 452 11.6 * Rates calculated per 1000 of estimated population. Area of District in Acres (exclusive of area covered by water) 1,114 Total population at all ages (at Census of 1901) 34.375 Institutions within District receiving sick and infirm persons from outside District:— Kingston Victoria Hospital. Workhouse Infirmary. †Increase due to enlargement of Workhcuse Infirmary. Number of inhabited houses (at Census of 1901) 6,507 Average number of persons per house ,, 5 2 Institutions outside District receiving sick and infirm persons from the District:— Brookwood Asylum. Richmond Hospital. Surbiton Hospital. Croydon Isolation Hospital. TABLE IV. Causes of, and Ages at, Death during Year 1905. Causes of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District. Deaths in Public Institutions. 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. Non " Residents " in Public Institutions in the District. Small-pox Measles 15 9 6 .. .. .. .. .. .. .. .. .. 1 Scarlet Fever 1 1 Whooping Cough 2 .. 2 Diphtheria & Membranous Croup 3 .. 1 2 Croup Fever:— Typhus Enteric Other continued Epidemic Influenza 4 .. .. .. 1 .. .. 1 2 .. .. .. .. 1 Cholera Plague Diarrhoea 12 12 .. .. .. .. .. .. .. .. .. .. 1 6 Enteritis 2 .. .. .. .. .. .. .. .. .. .. 2 Puerperal Fever 2 .. .. .. .. 1 1 Erysipelas 3 1 .. .. .. .. .. .. .. .. 1 1 1 Other Septic Diseases 3 .. .. 1 .. .. 1 1 .. .. .. .. 1 2 Phthisis (Pulmonary Tuberculosis) .. 44 .. .. .. 9 13 6 5 7 3 1 .. 14 3 Other Tubercular Diseases 11 1 6 .. .. 2 1 .. 1 .. .. .. 2 2 Cancer, Malignant Disease 31 2 6 9 6 5 3 8 11 Bronchitis 42 7 2 1 . . 3 1 8 14 5 1 5 2 Pneumonia 18 3 2 1 2 2 3 1 1 2 1 2 3 Pleurisy 5 1 2 Other Diseases of Respiratory Organs 14 6 4 1 1 2 4 Alcoholism Cirrhosis of Liver 13 1 3 7 1 •• 1 3 3 4 Premature Birth 20 20 Diseases & Accidents of Parturition 14 13 1 3 1 Heart Diseases 53 1 2 4 4 11 9 12 9 1 20 14 Accidents 10 4 2 1 2 l 1 I Drowning 2 1 l 1 Pemphigus 1 1 All Other Causes 127 12 2 4 3 4 14 26 26 24 8 28 31 All Causes 452 91 30 8 16 28 30 42 54 64 49 16 89 88 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under one Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year All Causes:— Certified 16 5 10 6 37 6 8 4 3 5 7 3 4 i i 2 81 Uncertified 2 1 3 2 1 1 2 1 10 Common Infectious Diseases:— Pemphigus 1 ... 1 1 Chicken-pox Measles ... 1 1 4 1 2 9 Scarlet Fever ... ... Diphtheria: Croup Whooping Cough Diarrhœal Diseases: Diarrhoea,all forms ... Enteritis Epidemic (not Tuberculous) 1 3 2 1 3 1 1 12 Gastritis, Gastrointestinal Catarrh Wasting Diseases: Premature Birth 7 2 4 3 16 1 1 18 Congenital Defects I 1 1 Injury at Birth 1 1 2 2 Want of Breastmilk 1 1 Atrophy, Debility, Marasmus 7 2 4 13 2 15 Tuberculous Diseases: Tuberculous Meningitis Tuberculous Peritonitis: Tabes Mesenterica Other Tuberculous Diseases 1 1 Erysipelas 1 1 Syphilis Improper Feeding ... 1 1 1 1 3 Meningitis (not Tuberculous) Convulsions 1 1 1 2 Bronchitis ... 1 1 1 2 1 1 1 1 1 9 Laryngitis Pneumonia 1 3 1 1 1 6 Suffocation, overlaying 1 1 1 1 1 4 Other Causes 2 1 1 2 6 18 5 10 7 40 8 8 5 4 7 7 3 5 1 1 2 91