KIN 057 borough of KINGSTON-UPON-THAMES. ANNUAL REPORT of the Medical Officer of Health, For the Year ending December 31st, 1906. Kingston-upon-Thames: G. Phillipson & Sons, Printers, Market Place. Estimated Population 39,500. 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 Diarrhoea.) Gastritis. Erysipelas. Syphilis. Other Septic Diseases. Phthisis. Other Tubercular Diseases. Cancer. Improper Feeding Bronchitis. Pneumonia. Pleurisy. Other Diseases of Respiration. General Paralysis of Insane. Alcoholism, Cirrhosis. Puerperal Fever. Accidents of Parturition. Premature Birth. Pemphigus. Hemophilia Heart Disease. Injuries. Suicide. Drowning. Other Diseases. Total. Vaccinated. Re-vaccinated Unvaccinated 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. M. F. M. F. M. F. M. F. JANUARY 45 39 24.5 8 72 4 4 3 88 29 20 14.7 17 12 37 11.2 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... 1 ...... ...... ...... 3 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 7 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... 2 ...... 1 ...... ...... 2 ...... 1 3 ...... 4 ...... ...... ...... ...... ...... 5 ...... ...... ...... 11 30 FEBRUARY 40 32 21.8 12 58 2 8 90 36 22 16.5 30 14 44 13.3 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 ...... ...... ...... 1 ...... ...... 1 1 ...... ...... ...... 2 8 Over 1 ...... ...... ...... ...... ...... 1 ...... 1 ...... ...... ...... 1 ...... ...... ...... ...... ...... 2 2 ...... 1 ...... 4 3 ...... ...... ...... 2 ...... 2 ...... ...... ...... 5 1 ...... ...... 11 36 MARCH 41 33 22.4 11 55 8 3 5 90 29 24 15.6 24 16 37 11.2 Under 1 ...... ...... ...... ...... ...... ...... ...... 3 ...... ...... ...... ...... ...... 2 ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 8 Over 1 ...... ...... ...... ...... ...... ...... ...... 2 ...... ...... ...... ...... ...... 1 ...... ...... ...... 4 1 1 2 ...... 1 ...... 1 1 ...... ...... ...... ...... ...... ...... ...... 3 1 ...... ...... 11 29 APRIL 35 32 20.3 1 12 51 3 2 3 63 30 24 15.9 27 19 35 10.5 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... 2 5 Over 1 ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... 6 2 1 1 ...... 3 2 1 2 ...... ...... ...... ...... ...... ...... ...... 4 ...... ...... ...... 7 30 MAY 53 44 29.4 18 68 11 3 3 76 26 28 15.6 24 15 39 11.8 Under 1 ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... 2 ...... ...... 1 ...... ...... ...... ...... 6 Over 1 ...... ...... ...... ...... ...... ...... 1 2 ...... ...... ...... 1 ...... 1 ...... ...... ...... 1 1 1 1 ...... 3 2 ...... ...... ...... 2 ...... ...... ...... ...... ...... 4 1 ...... ...... 12 33 JUNE 35 44 24.0 18 54 7 2 5 88 18 19 11.2 13 10 27 8.2 Under 1 ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 3 ...... ...... ...... ...... ...... ...... 2 7 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... 1 1 1 3 ...... ...... 3 ...... ...... 1 ...... ...... 1 ...... ...... ...... 2 ...... ...... ...... 6 20 JULY 41 38 24.0 1 15 57 6 3 2 63 15 12 8.2 6 3 24 7.3 Under 1 ...... ...... ...... ...... ...... ...... ...... 1 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... 1 5 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... 2 1 2 2 ...... 1 ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... 4 1 1 ...... 3 19 AUGUST 42 42 24.5 3 16 60 5 4 8 153 25 17 12.7 8 5 37 11.2 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 5 ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... 1 2 ...... ...... 1 1 ...... ...... ...... 12 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... 2 ...... ...... ...... ...... 1 ...... ...... ...... 2 1 2 1 ...... ...... ...... ...... ...... ...... 2 ...... 1 ...... ...... ...... 1 1 1 1 9 25 SEPTEMBER 34 37 21.5 9 49 13 9 14 209 26 36 18.8 23 10 52 15.3 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 17 ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 1 1 ...... ...... ...... 1 ...... ...... 2 23 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 4 1 ...... ...... ...... 1 3 2 3 ...... 3 1 ...... 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... 9 29 OCTOBER 42 29 21.5 8 57 6 7 4 130 27 24 15.0 18 7 44 13.3 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 7 ...... ...... 1 ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 11 Over 1 ...... ...... ...... ...... 1 ...... 1 ...... ...... ...... 1 ...... 1 1 ...... ...... 1 4 ...... 2 3 ...... 3 ...... ...... 1 ...... 2 ...... ...... ...... ...... ...... 1 ...... ...... ...... 11 33 NOVEMBER 61 56 35.5 29 85 3 5 4 114 24 24 14.8 17 11 1 38 11.5 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 3 1 ...... ...... 1 ...... ...... ...... 1 2 ...... ...... ...... ...... ...... ...... ...... 9 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 6 ...... 1 1 ...... 2 2 ...... 1 ...... ...... ...... ...... ...... ...... ...... 4 ...... 1 11 29 DECEMBER 22 24 13.9 10 33 3 8 4 153 33 33 20.0 22 14 52 15.2 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... 1 ...... ...... ...... ...... 9 ...... ...... ...... ...... ...... ...... ...... 12 Over 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 4 2 ...... 1 ...... 4 ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 7 1 ...... ...... 18 40 CHILDREN BORN IN WORKHOUSE 22 16 .80 7 6 .32 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... 3 ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 13 Over 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... DEATHS IN INSTITU TIONS OF PERSONS BELONGING TO THE BOROUGH 9 13 22 22 .53 Under 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Over 1 ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 4 1 ...... ...... ...... 1 5 ...... 1 2 ...... ...... ...... ...... ...... ...... 2 ...... ...... ...... 6 22 TOTALS 491 450 23.8 5 166 699 71 58 55 120 327 296 15.7 229 136 23 488 12.3 Under 1 ...... ...... ...... 1 ...... ...... ...... 5 1 ...... ...... ...... 29 4 ...... 2 ...... ...... 5 ...... ...... 7 5 ...... ...... 8 ...... ...... ...... 5 20 ...... 1 4 3 ...... ...... 13 113 Over 1 ...... ...... ...... ...... 2 1 3 6 4 ...... 1 2 5 6 ...... ...... 2 39 15 14 19 ...... 27 18 3 11 3 14 ...... 4 ...... ...... ...... 42 6 3 1 125 375 . EXTRACT FROM THE ORDER OF THE LOCAL GOVERNMENT BOARD. 23rd March, 1891. Duties. Art. 18. The following shall be the duties of the Medical Officer of Health in respect of the District for which he is appointed. (1.) He shall inform himself as far as practicable respecting all influences affecting or threatening to affect injuriously the public health within the District. (2.) He shall inquire into and ascertain by such means as are at his disposal the causes, origin, and distribution of diseases within the District, and ascertain to what extent the same have depended on conditions capable of removal or mitigation. (14.) He shall also make an annual report to the Sanitary Authority, up to the end of December in each year, comprising a summary of the action taken, or which he has advised the Sanitary Authority to take, during the year for preventing the spread of disease, and an account of the sanitary state of his District generally at the end of the year. The report shall also contain an account of the inquiries which he has made as to conditions injurious to health existing in the District, and of the proceedings in which he has taken part or advised under any Statute, so far as such proceedings relate to those conditions; and also an account of the supervision exercised by him, or on his advice, for sanitary purposes over places and houses that the Sanitary Authority have power to regulate, with the nature and results of any proceedings which may have been so required and taken in respect of the same during the year. The report shall also record the action taken by him, or on 2 his advice, during the year, in regard to offensive trades, to dairies, cow-sheds, and milk shops, and to factories and workshops. The report shall also contain tabular statements (on Forms to be supplied by Us, or to the like effect), of the sickness and mortality within the District, classified according to diseases, ages and localities. (15.) He shall give immediate information to Us of any outbreak of dangerous epidemic disease within the District, and shall transmit to Us a copy of each annual report and of any special report. He shall make a special report to Us of the grounds of any advice which he may give to the Sanitary Authority with a view to their requiring the closure of any school or schools, in pursuance of the Code of Regulations approved by the Education Department, and for the time being in force. (16.) At the same time that he gives information to Us of an outbreak of infectious disease or transmits to Us a copy of his annual report or of any special report, he shall give the like information or transmit a copy of such report to the County Council or County Councils of the County or Counties within which his District may be situated. It should be remembered that these reports are for the information of the Board and of the County Council as well as of the Council of the District, and that a statement of the local circumstances and a history of local sanitary questions which may seem superfluous for the latter, may often be needed by the former bodies. REPORT of the MEDICAL OFFICER of HEALTH. Clattern House, January, 1907. Gentlemen, I have the honour to present to you my Fourteenth Annual Report on the Health of the Borough of Kingstonupon-Thames. Birth Rate 23.8 per 1,000 per annum. ,, 27.56 „ „ average of previous 10 yrs. ,, 27.5 ,, ,, England and Wales, small towns, 1904. ,, 26.8 ,, ,, England and Wales, rural, 1904. Death Rate 13.2 per 1,000 per annum. ,, 13.4 ,, ,, average of previous 10 yrs. ,, 17.2 „ ,, England and Wales, 1895-1904. „ 18.755 „ „ Urban Counties, „ „ 13.958 „ „ Rural Counties, „ Death Rate, 120 per 1,000 Births of Infants under 1 year. „ 112 „ „ average of previous 10 yrs. ,, 158 ,, ,, England and Wales, Urban Counties. ,, 117 „ ,, Ditto Rural Counties. ,, 145 ,, ,, England and Wales, 1904. Birth Rate, England and Wales, 1905 27.2 Death ,, ,, ,, ,, 15.2 Infantile Mortality 12.8 4 TABLE A. Death Rates. Comparison of Town and Country Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Annual. ENGLAND AND WALES, 1895—1904 19.2 16.2 16.5 16.9 17.2 GREAT TOWNS— , Population 15,500,000 1905 17.2 14.7 15.2 15.8 15.7 SMALL TOWNS— Population 4,750,000 17.0 13.6 13.3 13.7 14.4 COUNTRY DISTRICTS— Population 13,750,000 18.3 14.5 13.0 14.2 15.0 KINGSTON, 1896—1905 15.8 11.32 13.03 13.7 13.4 Death rates of Kingston compared. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. 1897 average population 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 1906 „ „ 39,500 13.1 10.2 11.4 13.5 13.2 5 INFANTILE MORTALITY. The idea that disease is a visitation of Providence which can be cured by medicine is deeply inured in the minds of all but educated people, and to some extent accounts for our high infantile mortality. A baby, unless born with some such disease as syphilis, will in all probability grow into a healthy man or woman if brought up in a proper way. If the proper way is not agreed upon for the whole of childhood, for the period of babyhood everyone agrees that the mother should nurse her child for nine months or so if possible. If she does this and is able to live in a house in decent repair, free from damp and open to sunlight and air, the baby will thrive so long as the mother keeps herself in decent condition, avoiding drink and worry. Many hand-fed babies survive infancy, but the weaklings succumb, and those who are less strong grow up with lessened vitality. The infantile mortality England and Wales 1904 is 145.33 per 1,000 births, of these 70.9 die under 3 months, 30.12 under 6 months, and 44.31 between 6 months and 1 year. 39.66 died of causes connected with their birth, 31.87 died of diarrhoea, 13.65 of convulsions, and 6.13 of tuberculosis, or 51.65 of diseases more or less directly arising from preventive causes, such as wrong food and want of care. A very small percentage of babies die of these diseases under the age of 1 year amongst the well-to-do, and those few who succumb are bottle-fed not breast-fed. In 1904 the total deaths were 283,206 M.,266,578 F. and these 76,378 M., 61,014 F. were under 1 year age, or almost exactly 1 death in 4 is of a baby under 1 year of age. The proportion varies in different districts, in Surrey it is 1 in 5, in Sussex 1 in 6, in Hunts 1 in 7, Durham nearly 1 in 3, Westmoreland 1 in 8. The returns of our own county show that the Kingston infantile mortality is unduly high. I have shown that the chief causes of death are due to improper feeding, added to which are the numbers who die of infectious disorders, bronchitis and pneumonia. These diseases, like the others, are rarely fatal in the present day amongst breast-fed children 6 of the well-to-do, and are much lower amongst hand-fed children of the richer classes. It may then be conceded that there is this regrettable mortality, and the question will occur to you what can be done to lessen it ? In Huddersfield, Wakefield, and some of the London boroughs steps have been taken lately to grapple with this question. In Huddersfield the Mayor lately offered a guinea to each mother in his own ward who produced a fine healthy child at the end of a year. At the same time a Lady Health Visitor was appointed who went about amongst the poor in a tactful way, giving advice and helping mothers in their difficulties. The result of these two innovations was a reduction in the infantile mortality in that ward, and this good result has, I believe, been kept up. The Lady Health Visitor of Wakefield says:— "An analysis of the 87 infant deaths that have come under my notice will emphasise the point. All these deaths will have figured in the Registrar's report under the familiar terms convulsions, marasmus, bronchitis, etc., but these single words give little clue to the underlying causes as I have seen them in my frequent visits. Of those 87 deaths only 14 were non-preventable : of the remaining 73, in 4 cases there had been serious and continued want of care, and in 9 cases want of care combined with improper food. In 6 cases death was due to infectious disease or accident, from which an infant might have been guarded; 5 were due to excessive dampness of the house; in 16 cases the real cause was improper food or methods of feeding, that is, ignorance; of the remaining 33 I can only say that had these children been born in homes where they would have received skilled attention or the whole attention of an intelligent mother, they would have survived. Many of them were really fine infants, and had the mothers only known how to treat slight illnesses instead of answering every cry by giving more food, and putting down every ailment to teething, they should have been living now. And for one baby that succumbs to any particular form of error we must remember that there are three or four who struggle through more or less maimed for life, ricketty maybe, or with the beginnings of chronic bronchitis, lifelong indigestion, decayed teeth or deafness implanted in them before they are out of their cradles." In 1905 her second year of work the infantile mortality of Wakefield, which had hitherto been above the average for England and Wales, was for the first time 22.5 below it. There were only 119 deaths, at the old rate there would have been 191 or a saving of 72 lives. She now finds that mothers are offended if she does not call. In the first half of her register 8 births were notified to her by father, mother, or near relative, in the second half 77 were so notified. 7 Under her care charitable persons in the town instituted a "Baby's Welcome Club" for helping poorer mothers with the necessaries for their confinements. This is very much wanted here, as I hear from the midwives, who are now under my supervision, that the absence of the most necessary appliances causes great hardship amongst many of the poor. I have little faith in the creche. If the baby is taken care of the mother goes out to work, and our object should be to keep the mother at home to suckle her child and look after it. There are too many men idle nowadays whilst their wives work for lower wages than men will take. Suitable milk for babies can be made by proper mixtures of milk and cream. Not as good as human milk, but very fair if supplied in aseptic stoppered bottles, each containing sufficient for one meal according to age. Any dairyman with his own cows could provide such milk. I trust you will very carefully consider the question of appointing a Lady Health Visitor. I have written enough to show you that a suitable woman would save many lives, and what perhaps is better still save much illness in childhood which would otherwise lay the foundations of a diseased constitution for adult years, when you would have to keep the person in workhouse or lunatic asylum. Any three persons you might thus save would cost you as much in the future as a Lady Health Visitor would in the present, and as the figures I have given you will show the people saved from workhouse or asylum would be nearer 30 than 3. These 30 healthy workers would mean wages in circulation instead of 30 paupers annually added to the charge on your poor rates. If the Lady Health Visitor did not find enough work amongst the babies, you have some 500 or more children kept away from school for weeks at a time with ringworm, etc., who all the time are losing the attendance grant. With care and early attention these heads might often be cured in as many days as it now takes weeks. There is therefore a large field of work for a Lady Health Visitor, and I trust you may see your way to find the small sum of money necessary to establish such a useful addition to your staff. 8 INFANTILE MORTALITY IN SURREY. 1901 1902 1903 1904 1905 Kingston 111 118 99 151 91 Wimbledon 134 134 112 153 80 Barnes 78 57 76 83 72 Reigate 61 52 49 49 45 Richmond 57 59 57 83 61 Woking 44 38 44 52 52 Sutton 43 40 32 35 34 Esher 28 21 23 27 17 Surbiton 24 34 36 41 18 Maiden 18 18 15 27 15 Weybridge 14 9 4 10 11 No. of persons per inhabited house No. of persons engaged in drink trade, (approximate.) No. of tenements of less than five rooms. No. of Infants under one year of age in proportion to population. Kingston 5.2 230 1798 24 Wimbledon 5.5 225 2605 23 Barnes 5.2 107 1295 22 Reigate 5.3 153 1371 19 Richmond 5.2 203 2249 18 Woking 5.7 76 702 24 Sutton 5.7 81 435 19 Esher 4.7 48 566 19 Surbiton 5.2 92 572 17 Maiden 4.9 29 310 21 Weybridge 4.8 32 188 20 CONSUMPTION AND TUBERCULOSIS. 35 deaths from consumption and 17 from tuberculosis are recorded. This compares with 40 and 26 the average for 1901-05 for this Borough, but the average for 1899-1903 England and Wales was 1,274, only reduced to 1,236 for 1904. The number of deaths from tuberculosis was fewer by 3,526 in 1904 than in the preceding decennium corrected for population. This shows that the newer methods of prevention and cure are having a marked effect upon this disease, and should encourage us to do more. On March 10th, 1906, the L.G.B. for Scotland issued a circular in which it is stated that "pulmonary phthisis (that is, tuberculosis of the lungs, or consumption) is an infectious disease within the meaning of the Public Health Act, 1897 (Scotland) .... the obligation resting on the local authority to deal with and control infectious disease extends to pulmonary phthisis." 9 It is beyond doubt that consumption is an infectious disease, and it is probable that in a few months the law as now in force in Scotland will be extended to England. Although infectious consumption is not infectious in the same way as measles, scarlet fever, small-pox, or diphtheria. A healthy person runs little or no risk of contracting consumption from being in contact with a person affected with the disease, provided that proper precautions with regard to cleanliness, ventilation, and the destruction or disinfection of the "spit" are being carried out, but there is danger of infection from sleeping with a person with consumption, as persons give out a fine sort of spray in breathing, which carries the consumption bacteria to some distance from the mouth of the sick person. A healthy person is a person with healthy lungs, but healthy lungs are easily weakened by want of exercise or by infectious diseases, such as pneumonia, measles, whooping cough, &c. As these diseases are very common in children the necessity of games in the open air and breathing exercises for the expansion of the lungs as a necessary part of education, is shown. Dr. Huber points out that the death roll for all wars in the nineteenth century was about fourteen millions, whilst the death roll for consumption was more than double. This horrible and unnecessary mortality was slowly decreasing in the decade 1881-90. The total mortality from tuberculosis in proportion to all other diseases was as 1 to 8 reduced in 1891-1900 to less than 1 to 9. The causes of this disease are well known. Dirt, damp, absence of sunlight and fresh air, and drink are the chief things that lower the vitality of the body and make it a suitable breeding ground for the bacillus of consumption. Now I imagine the most rigid economist would be prepared to spend money out of the rates if it could be shown that by investing a portion of the rates in simple preventive measures they were putting their money into a paying concern. This I think, those who take the trouble to study the question, will admit the prevention of consumption must prove to be in the immediate future. 10 Consumption is not beginning when a patient goes to the doctor and learns that one lung is slightly affected. The disease is then firmly established. Consumption is beginning in hundreds of young people who live in insanitary dwellings. Practically every house in Kingston which has not been built under the modern bye-laws, or has not been improved up to the standard of those bye-laws, is insanitary. I should like to be given the power to paint a large I in yellow paint on the wall of every house where the landlord after due warning did not bring his house up to the proper standard. Under present conditions before a house can be improved it is necessary to prove a nuisance, and as tenants who are not consumption proof usually move from these insanitary houses before the disease is well developed the proof is very difficult. If the house is difficult to deal with, the place where the child spends the rest of his time is more readily managed. You have recently built some magnificent schools. Those in Bonner Hill Road, standing as they do in an isolated position, are especially open to the beneficent influences of sunlight and fresh air. The new schools in the Richmond Road would have been better from the health point of view could room have been found to set them back to the building line of the old schools, but both schools are hygienic buildings. The St. Luke's Schools are less well arranged but with fewer scholars would be fairly acceptable, and for a small school St. Agatha's and All Saint's Infant's might pass. The other schools cannot be considered as modern educational buildings. Now 15 out of the 52 deaths from consumption and tuberculosis have occurred in young people under 15 years of age. That is of school age, so that we may reckon a considerable number of consumptives amongst our school children. This number increases in proportion in the younger years of adult life and increases largely because so little is done for possible consumptives in childhood. One of the great necessities of child life is milk, and under the Act for the feeding of school children I hope arrangements may be made to provide milk for the children in the infants' schools at the morning break. The indoor and outdoor relief of England and Wales cost in 1903-4 £10,027,858 a year, and one-eleventh of this charge 11 is on account of consumption, so that at the present time you are spending quite £1,000,000 a year on consumption. Now if a million were successfully spent on the prevention and cure of consumption you may think you would only save one-eleventh of the cost of pauperism, but you would save much more. One-fourth of all the deaths between 15 and 55 years of age are due to consumption, and these deaths are amongst workers who, if prevented from consumption, could go on earning wealth for the State in our great industries for many years. At death each man's technical knowledge is lost to the State. One human machine is destroyed, the wages he would have earned cease to circulate amongst the traders of our towns, and his widow and orphans become a charge on the charitable or the rates. The money thus lost is overlooked by the public generally because there is no means of calculating it, but the charges on insurance offices and friendly societies are keenly realised by those interested. Now what are the means of prevention and the methods of cure ? It is from the poor and crowded populations that the vast death-rate from consumption arises; it is from them that the great bulk of poison material emanates. They are continually discharging the consumption bacteria into the air of workshops, houses, conveyances, and places of amusement and religious worship. The first warning to be impressed upon those who have consumption is that they must keep their infection to themselves. This can be done by each person taking proper means to destroy or disinfect his spit. Cheap spitting bottles can be purchased which can be readily cleansed and disinfected, or paperhandkerchiefs may be used and afterwards burnt. When such precautions are taken the bacteria instead of being discharged wholesale into the air are kept about the person of the consumptive until he can dispose of his dangerous poison by burning or disinfection. In many places bye-laws against spitting are in force and should be extended to Kingston and all other places. On March 22nd, 1906, a man was fined £1 for persistently spitting on a tramcar from Dalkey to Dublin. 12 The improvement and re-planning of areas of badly built houses is referred to elsewhere, as is also the advantages of a lady health visitor, who elsewhere has been shown to easily gain the confidence of the poorer mothers, and whose advice on feeding babies has been followed in Huddersfield and other places by a most remarkable decline in the infantile mortality. I have already referred to school buildings, but I should like you to bear in mind that 12 square feet of floor space in all elementary schools is a very modest desideratum. The further means of preventing the spread of this disease may be summed up shortly. I should like to see a free dispensary for tuberculosis where any one feeling out of sorts might be thoroughly examined and a diagnosis made. Patients could be given advice on the conduct of their lives, but should be referred to medical practitioners or charitable institutions for medicine, &c. Such a dispensary might be held in the evening twice or thrice a week in some room belonging to the local authority and a small honorarium to the medical men doing the work need be the only expense. Sanatoria ought not to be required in great numbers after preventive measures have begun to show their efficacy. They could be arranged at small expense if treatment were carried out in single huts with buildings of brick and stone for administration only. A hospital for dying cases would be for some time necessary as the crowded dwelling rooms of the poor must aid in spreading the disease amongst the comparatively healthy living under crowded conditions. Such persons have rarely strong healthy lungs and break down easily under a little extra stress. Special class rooms, or rather open-air shelters, should be provided in connection with every school for those children showing a tendency to consumption. This is the open-air prevention which in time should do away in large measure with the need for open-air cure in sanatoria for the consumptive poor. After school days the most satisfactory means of prevention would be the establishment of working colonies, such 13 as I have described at some length in several articles in the medical reviews. Such working colonies are very difficult to arrange under the conditions at present exis'ting, when the Sanitary and Poor Law administrations are each of them invited to work some portion of the machinery devoted to Public Health work, with the result that much energy is wasted in the jealousy which seems inseparable from differing authorities and is not always absent in committees of the same authority. In concluding these remarks let me advise those who cannot give their children pure milk to make use of skim milk, and to add fat to the diet in the shape of butter substitutes, such as margarine and dripping. If rooms are overcrowded, especially sleeping rooms, don't be afraid to open the window at night. The night air is very pnre, it contains less smoke than the day air. Keep the children out of doors as much as possible. If your house is damp keep on worrying the Sanitary Department till the landlord has done his duty and made the house dry. HOUSING OF THE WORKING CLASSES ACT. No action has been taken during the year. Several small blocks of houses have been put into tenantable repair, but such work is only makeshift. Houses of this class in most cases want to be pulled down and rebuilt, though in some instances a thorough overhaul might suffice. Owners of properties get out of their liabilities on one of two grounds, either they know the law very thoroughly and frighten the authorities by raising technical points, or they raise commiseration by pleading poverty. I would refer you again to the scheme I have already outlined for the Cambridge Road area, and there are certain small areas might be dealt with—two groups of about ten or twelve houses, each abutting on the Fairfield, and small lots of houses in Shortlands Road, and Cowleaze Road. A street cut through from Richmond Road to Lower Ham Road would get rid of a lot of old property hardly fit for people to live in if consumption is to be prevented. TABLE III. Notifications of Infectious Diseases. B. WARDS AND DISEASES. Population Estimated. « Primary Cases. Secondary Cases. TOTALS. TOWN. Population 6,630— Scarlet Fever 8 4 12 Diphtheria 3 3 Erysipelas 1 1 —16 CANBURY. Population 9,210. Scarlet Fever 11 2 13 Diphtheria 7 7 Enteric Fever 1 1 Erysipelas 1 1 - 22 HILL. Population 11,250. Scarlet Fever 17 2 19 Diphtheria 8 8 Enteric Fever 4 4 Erysipelas 4 4 HAMPTON WICK in K.V.H. Enteric Fever 1 1 —36 NORBITON. Population 10,760. Scarlet Fever 24 15 39 Diphtheria 9 1 10 Enteric Fever 1 1 2 Erysipelas 8 8 —59 Under 1. 1-5. 5-15. 15-25. Over 25. Totals. Scarlet Fever 2 15 50 14 2 83 Diphtheria 16 10 2 28 Enteric Fever 1 1 4 2 8 Erysipelas 1 1 12 14 15 MEASLES. There was only one death from measles during the year. Signs of epidemic prevalence appeared in the middle of December, and it was considered advisable to expedite the closure of the Infants' Schools at All Saints and Richmond Road for the holidays by a few days. In one school the closure seems to have been fairly successful, in the other there has only been a slight interference with the epidemic, but in neither has it been necessary to consider re-closure on re-assembling after the holidays. SCARLET FEVER. 83 cases were notified during the year of which 19 were sent to hospital on account of special circumstances. In one family the mother had the complaint herself, in one there was insufficient accommodation, in one the mother was near her confinement, one patient had a running sore on his leg which was likely to retain the infection if not cured before recovery from the fever, others on account of occupation or want of accommodation for treatment, and one because they lived in a flat where four tenements opened on the same porch. The building of rows of flats with the front door of each set of flats opening on to one porch is a most objectionable arrangement. These houses have to be drained to a common drain in a passage at the back, and this has obvious disadvantages. Drains can easily be carried under a house if good workmanship and first rate materials are used. Possibly the extra expense necessary might induce the speculators to build semi-detached houses, each flat with a separate entrance. If this class of dwelling makes much increase in the Borough you may find the provision of isolation hospital accommodation become very urgent. With the usual conditions prevailing in this town of one family with children and lodgers of adult age, isolation has been fairly easy to arrange in the homes with accommodation at Croydon for special rases; but if flats with practically four families in one house, and six-roomed cottages are let to two families with children, epidemics will be almost impossible to cope with. This tendency to overcrowding is due to a rise in the rents of old houses let on weekly tenancies to working class families. This rise amounts in some cases to 16 as much as 2/- a week and brings up the rents of old property almost to the level of the new. The tenant consequently is obliged to take in lodgers to make up the difference in his rent, and you have to pay for more patients at the Isolation Hospital from overcrowded tenements. Notable features in the cases recorded this year are six cases notified when desquamating? No further cases were traced to these. There were seven family outbreaks with twenty-one cases. In each of these the patients were nearly always notified together. There were also nine cases in young people mostly travelling to their work at a distance. One case occurred in the K.V.H. and was removed to her own home without accident. One case occurred in a house where boys were received for change of air. There was some history of a rash in one of their visitors, but no signs of discharges or desquamation. One fatal case in a delicate girl of 15. One child with severe hip disease died in hospital. DIPHTHERIA. 28 cases and 5 deaths. In four or five cases there were slight sanitary defects in the house, but most of the patients were young children, rarely leaving the house. The cases usually were described as beginning with a cold. One fatal case occurred in a breast-fed baby. Three cases were traced as coming from places where diphtheria was prevalent. In one case notified on the 1st of January, 1907, the mother had taken the child to London to a hospital the day before. The officials at the hospital were not certain of the diagnosis, but took a swabbing from the throat and sent the child back to Kingston. The diphtheria bacillus was isolated the next day and the case notified. There is a growing practice, doubtless extending to other suburbs, of parents taking children to London hospitals instead of consulting local medical men. The workman's ticket is only 7d. by workmen's train in the early morning, but the parent loses a day's work, and the child runs great personal risk, as well as in infectious cases causing infection to spread to 17 others in the trains, trams, omnibuses, or waiting rooms where the day may be spent. The real cost must be more than the local doctor's fee and it is always possible to consult the Poor Law Medical Officers. This case was reported to the L.G.B. ENTERIC FEVER, Van boy—going to Isleworth, Hounslow, &c., to K. V.H October. Case notified as occuring in a London Hospital. Friends had moved away, house undergoing repairs and re-drainage. September. Boy in eating house—to K.V.H. September. Typewriter—doubtful case. May. Two children in poor house — Well water condemned. K.V.H. April. Sewage works man—at drying cylinder for guano. K.V.H. April. Child of six years—mild case—nursed at home. January. Drayman—seven weeks ill—K.V.H. January. In none of these cases was any history of shell-fish or other fish eating. There was one death. EPIDEMIC ENTERITIS. A severe outbreak in September at a time of very hot weather. RINGWORM, INFECTIOUS IMPETIGO AND ITCH. These diseases have, as usual, meant the loss of attendance grants for many school children. The children are not properly cared for, and in one very bad case the mother was fined. VACCINATION AND SMALL POX. As it has recently been rashly stated that Infantile Mortality is due to Vaccination, it is well to point out that the majority of deaths in children under one year occur before the age for vaccination, and consequently die un-vaccinated. The deaths, the causes, and the ages are shown in the table. TABLE C. Deaths of Infants from different Diseases under and over the Vaccination Age of 6 Months. Excema. Whooping Cough. Measles. Diarrhoea. Bronchitis. Heart. Tuberculous. Erysipelas. Syphilis. Diphtheria, S. Fever, Enteric. Injuries. Accidents at Birth. Food Poisoning. Convulsions. Small Pox. Other Complaints Under or over 6 Months. Under Over Under Over Under Over Under Over Under Over Under Over Under Over Under Over Under Over Over 6 M'ths. Under Over Under Over Under Over 1898 to 1899 4 4 4 3 8 13 9 4 1 14 6 1 1 4 1 40 11 1899 to 1900 1 1 31 16 15 5 1 6 2 2 1 2 40 7 5 1900 to 1901 1 1 2 2 4 24 4 4 1 2 7 2 1 3 28 9 18 9 1902 to 1903 1 17 4 4 7 15 3 1 3 48 3 7 6 6 1903 to 1904 4 1 9 3 12 7 6 1 4 1 4 40 3 14 4 1 6 1904 to 1905 1 6 36 17 TOTALS 1 11 8 6 14 135 57 40 21 11 48 12 3 9 6 13 196 6 30 46 1 12 14 *1901 to 1902 1 34 11 1 9 1 1 3 19 15 *Particulars of Age accidentally destroyed. TABLE C.—Analysis of Scarlet Fever Cases, 1906. 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. 1 1 ... ... ... ... ... 62 ,, 10 3 ... ... ... 2 ... 57 53 37 ... ... ... ... ... 1 37 Feb. 1 2 ... ... ... ... ... 20 33 ... ... ... ... ... ... 2 20† 33 Mar 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 15 2 1 ... ... ... ... 32 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1* Apl. 5 1 ... ... ... ... ... 15‡ ... ... ... ... ... ... ... 1 15‡ 19 2 ... ... ... ... ... 59 44 ... ... ... ... ... ... 2 59 44 2 ... ... ... ... ... 26 72 ... ... ... ... ... ... 2 26 72 2 1 ... ... ... ... 28 ... ... ... ... ... ... ... 1 28 ... ... ... 51 21 7 2 1 ... ... ... 49 35 44 35 35 ... ... ... 3 35 44 49 ... 52 52 July 5 4 3 ... ... ... 45 46 46 46 ... ... ... ... 1 45 19 4 2 1 ... ... ... 13† 13† ... ... ... ... ... ... ... ... ... ... ... 49 49 Sept. 6 13 5 3 ... 1 ... 60 34 35 43 41 43 44 ... 7 60 34 35 43 51 40 51 48 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 41 44 ... ... 42 20 4 3 ... ... 2 ... 38 ... ... ... ... ... ... ... 1 38 ... ... ... 41 43 48 2 ... ... 1 ... 39 61 60 57 4‡ ... ... ... 3 39 60 4‡ ... 42 42 ... ... ... 1 ,, 22 ... 7 1 ... ... ... ... 42 51 51 66 60 44 ...... ... 4 44 60 42 66 65 9 ... 2 ... 1 ... 52 39 37 37 37 43 29 40 3 39 29 40 Dec. 6 3 ... ... ... ... ... 40 49 42 3 40 49 42 „ 20 3 ... 2 ... 1 ... 37 37 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 77 18 12 8 34 1 1 1 Incomplete and doubtful cases 6 Days under treatment per case: Days under treatment per case: Days under treatment per case: Sent to hospital, Waddon 18 Still under treatment 1 4.1 4. 4.0 7 50*7 *Severe Hip Joint Disease. †Doubtful case. ‡Desquamating when notified. 19 COST AND WORK OF THE SANITARY DEPARTMENT. A table has lately been prepared by the Town Clerk giving the cost of Municipal work in certain towns of about the same population as Kingston. Many of the towns are hardly comparable with Kingston except for number of population, but these towns have been given and on behalf of my department I wish to point out that the bald figures given show only a part of the money spent on sanitary work special to my department and give no clue to the measure of success obtained in comparison to the expenditure. Besides the M.O.H. and S.I. a certain number of officials are, elsewhere, on the staff of isolation hospitals and the cost of isolating infectious disease whether in hospital or the home must be considered in making comparisons between places. The measure of success achieved must be of greater moment in considering the cost of a health department than the actual amount paid in salaries, and if the results, whether measured by lowness of infantile mortality, or general death rate, or by comparative freedom from infectious diseases, is good, I think the department must be considered a success, provided always that the success has not been obtained by an unreasonable expenditure. That there is not excessive cost in Kingston is shown by the fact that taking the whole cost this town is almost the lowest on the list in charges per head of population, and taking the salaries only, it is half way down the list, whereas in results on the criteria instanced we are nearly at the top in each case. In working out the results the latest population figures have been taken in each case for the same period of time from the Registrar General's reports. The cost of isolation has been obtained from the officials of the towns. Some of the towns did not give figures, but in those cases there is no reason to believe that the expenditure was lower than elsewhere. 20 COST OF HEALTH DEPARTMENTS, AND RESULTS OF WORKING IN KINGSTON AND OTHER TOWNS. Death Rate. Infantile Mortality. Cases of Infectious Disease per 1,000 of pop. Total Cost of Health Dept., including Isolation Hospital. Pence per head of population. Salaries, Health Department. Pence per head of population. Rochester 10.8 Tunbridge Wells 84 Torquay 1.6 Luton *4.4 Burslem 1.2 Folkestone 10.9 Folkestone 2.5 Kingston-onThames 4.8 Ashton.u. Lyne 1.32 Peterboro' 11.1 Oxford 91 Bath 2.6 Kingston-onThames 11.4 Peterboro' 96 Tunbridge Wells 2.8 Carlisle *5.8 Longton 1.44 Luton 101 Eccles 6.4 Accrington 1.56 Wimbled'n 11.4 Torquay 104 Crewe 3.0 Gillingham 6.6 Luton 1.92 Bedford 11.5 Folkestone 108 Jarrow 3.4 Bedford 7.3 Stoke-onTrent 2.04 Crewe 11.6 Kingston-onThames 1- 109 Kingston-on Thames 3.5 Darwen 9.0 Tunbridge Wells 11.8 Wakefield 10.2 Dudley 2.04 Gillingham 109 Exeter 3.6 Jarrow 11.1 Gillingh'm 2.04 Gillingh'm 12.5 Bath 111 Dudley 3.8 Stoke-onTrent. 11.2 Hyde 2.28 Accrington 12.8 Chatham 111 Darwen 4.7 Crewe 2.5 Oxford 13.2 Maidstone 112 Accrington 4.8 Chatham 12.4 Macclesfield 2.52 Chatham 13.3 Wakefield 118 Longton 5.1 Exeter 12.6 Luton 13.4 Bedford 119 Peterboro' 5.2 Hyde 12.8 Leigh 2.64 Maidstone 13.7 Crewe 129 Chatham 5.3 Bath 13.3 Darlington 2.7 Darwen 13.8 Exeter 130 Wimbledon 5.4 Crewe 14.0 Darwen 2.76 Stoke-onTrent 13.9 Eccles 132 Darlington 5.5 Peterboro' 14.4 Jarrow 2.8 Macclesfield 132 Rochester 5.7 Tunbridge Wells 14.5 Peterboro' 3.12 Wakefield 13.9 Luton 5.7 Carlisle 3.36 Torquay 14.1 Stoke-onTrent 133 Eccles 6.1 Maidstone 147 Oxford 3.36 Eccles 14.2 Ashton-uLyne 6.2 Leigh 16.0 Eccles 3.48 Bath 14.3 Ealing 135 Southend 16.1 Kingston-onThames 3.74 Exeter 14.4 Jarrow 135 Burslem 6.8 Rochester 19.0 Leigh 15.1 Rochester 136 Gillingham 7.2 Wimbled'n 20.4 Folkestone 3.76 Darlington 15.6 Darlington 143 Chester 7.4 Ealing 25.3 Bedford 3.8 Carlisle. 15.6 Darwen 145 Southend 7.9 Chester 27.0 Chatham 3.96 Ealing 15.6 Southend 146 Wakefield 7.9 Eccles† Wimbledor 4.2 Southend 16.0 Wimbledon 146 Ealing 8.0 Dudley† Exeter 4.2 Dudley 16.2 Accrington 147 Stoke-onTrent 8.1 Burslem† Bath 4.2 Burslem 16.4 Chester 147 Accrington† Maidstone 4.56 Hyde 16.7 Carlisle 154 Bedford 8.2 Longton† Wakefield 4.56 Jarrow 16.7 Ashton-uLyne 156 Oxford 9.3 Folkestone‡ Ealing 5.4 Ashtonu.-Lyne 16.8 Leigh 9.7 Torquay‡ Tunbridge Wells 6.12 Hyde 157 Hyde 11.4 Oxford‡ Chester. 17.5 Dudley 159 Maidstone 11.7 Darlington 18.6 Rochester 6.12 Macclesfield 18.5 Leigh 164 Macclesfield 11.8 Macclesfield§ Southend 6.36 Burslem 166 Chester 6.6 Longton 20.6 Longton 223 Carlisle 14.3 Torquay 6.8 *Isolation Hospital; special foundation advantages, †Using Joint Hospitals, or special difficulties in calculating cost. ‡Large and complete Hospitals; cost not given. §No particulars of Hospital. 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) 2 Workshops (including Workshop Laundries) 64 Nil Workplaces 19 Homeworkers' Premises 9 Total 94 Nil 2.—DEFECTS FOUND. Particulars. Number of Defects. N umber of Prosecutions. Found. Remedied. Referr'd toH.M. Insp'ct'r Nuisances under the Public Health Acts: Want of Cleanliness 3 3 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 1906 2 Homework:— Number of List of Outworkers (S. 107):— Lists Outworkers Lists received 2 9 Addresses of Outworkers (forwarded to other Authorities Nil (received from other Authorities 3 Workshops on the Register (S.131) at the end of 1906: Important classes of workshops, such as workshop bakehouses, may be enumerated here Bakehouses 34 Workplaces where food is prepared 19 Workshops 179 Total number of workshops on Register 232 22 INQUESTS HELD IN 1906. Date. Description. Age. Sex. Cause of death. Verdict. Jan. 3 Labourer 76 M. Syncope from Pericarditis... ,, 5 Wife of Saddler 54 F Fatty Degeneration of Heart ,, 11 Gardener 60 M Epilepsy ., 11 Widow of Brush- 82 F Congestion of Lungs, Fracmaker ture of Femur „ 19 Telephone Jointer 30 M Heart Disease ,, 20 Son of Barmaid 3&mths M Convulsions Feb. 1 Gardener 87 M Brights Disease and Senile Decay ,, 9 Engineer 79 M Senile Gangrene and Fractured Ribs ,, 9 Wife of Labourer 55 F. Syncope from Heart Disease ,, 23 Son of Dealer 3 wks M Convulsions due to Congestion of Lungs Mar. 2 Lather 69 M Angina Pectoris ,, 13 Tobacco Packer 56 M Heart Failure from Enteritis ,, 13 Laundress 42 F. Coma Acute Meningitis ,, 21 Labourer 56 M. Syncope, Heart Disease ,, 30 Shoeing Smith 43 M Pneumonia, Overdose of Opium Accident Apl. 6 Labourer 59 M. Syncope, Heart Disease ,, 11 Gardener 86 M. Aedema of Brain—Fracture of Femur , 19 Son of a Carman 6 mths. M Convulsions ,, 25 Son of a Labourer 10 mths. M. Heart Failure, enlarged Thymus gland ,, 27 Cutter 47 M. Phthisis May 2 82 M. Asphyxia from smoke ,, 5 Bricklayer 77 M. Perforation of Bowel ,, 9 Widow 40 F Cerebral Haemorrhage ,, 23 Son of a Laundress 13 M. Pneumonia ,, 26 Tinsmith 85 M. Senile Decay, Neglect ,, 29 Servant 23 F. Acute Dyspepsia June 7 Widow 77 F. Cancer ,, 9 ... Engineer 42 M. Phthisis July 16 . Housemaid 22 F. Heart Disease ,, 20 Carpenter 57 M. Fracture of Spine by Fall from Scaffold ,, 24 Wheelwght.46 M. Heart Disease ,, 25 Son of Agent 5 wks. M. Improper Feeding ,, 25 Gardener 38 M. Poisoning by Phosphorus Suicide 23 Aug. 6 Son of a Blacksmth. 6 days M. Premature Birth ,, 9 Paprhnger. 16 M Drowned whilst Bathing . ,, 25 Gen. Dealer 54 M. Run over by Motor Car Sep. 3 Bricklayer 40 M. Corrosive Poison Suicide ,, 7 Daughter of Servant 3 mths. F Convulsions ,, 22 Son of Bookbinder 2 days M Asphyxia, cause not ascertained Oct. 3 Gardener 75 F Senile Decay „ 4 Draper 53 M. Apoplexy ,, 24 S. of House Painter 2 mths M Asphyxia in Bed ,, 31 Butcher 48 M Pneumonia Nov. 3 House Decorator 84 M Fracture of Femur, Senile Decay ,, 15 Firewood Dealer 66 M Wound of Throat Suicide ,, 23 Widow 70 F Senile Decay ,, 26 Daughterof Coachman 4 mths. F. Convulsions and Bronchitis Dec. 4 Maltster 40 M. Heart Failure ,, 4 Barrister 50 M Knocked down by Cart ,, 10 Cabman 28 M Fracture of Pelvis, &c. ,, 13 Son of Porter 6wks M Enteritis ,, 14 Labourer 31 M General Paralysis of Insane ,, 21 Engine Driver 63 M. Tetanus Accident ,, 24 Gardener 79 M Senile Decay 24 ABSTRACT OF WORK OF THE MEDICAL OFFICER. Visits of Enquiry in cases of Infectious Disease 111 „ ,, ,, „ Workshops, etc. 83 ,, in regard to Insanitary Conditions 74 „ on behalf of the School Attendance Committee 1085 ,, of Inspection to Schools 29 „ to Common Lodging Houses 4 ,, Inspection of Markets 29 „ ,, of Dairies 14 ,, to Plague and Small Pax Contacts 3 Visits of Enquiry to Places outside District 5 Consultations with Medical Practitioners, &c 13 Other Visits 38 Visits to Midwives 40 Total Visits 1,528 Average annual visits for last ten years—865. Complaints of Bad Food 2 ,, of Overcrowding 3 Letters, etc., written 140 Notices served, Reports, etc. 3 Samples of Effluent Analysed 36 ,, of Drinking Water Analysed 4 H. BEALE COLLINS. RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE LONDON WATERS FOR THE SIX MONTHS ENDED APRIL 30, 1906. During the six months ended April 30th, 1906, 5,533 samples of water have been examined either chemically or bacteriologically, exclusive of 309 samples collected for special purposes. The chief analytical results may be summarised very briefly, as follows :— I. Bacteriological Results. Table 1.—Average number of microbes per c.c. Raw Waters. Filtertd Waters (including Kent uniiltered water). Inclusive. 1 Exclusive 2 Kent 3.2 2.0 New River 859 New River 6.2 6.0 River Lee 2,728 East London (Lee) 9.8 7.7 East London (Thames) 13.9 11.7 Chelsea 5.9 3.5 River Thames 1,282 Grand Junction 8.4 6.4 West Middlesex 7.1 6.7 Southwark and Vauxhall 25.0 13.9 Lambeth 8.6 7.9 Thames derived Waters 11.2 8.0 Grand Total 9.8 7.3 1 Inclusive of all the results. 2 Exelusive of samples containing 100 or more microbes per c.c. II. Chemical Results. 1 (Parts per 100,000, unless otherwise stated.) Table 5. Albuminoid Nitrogen. Oxygen absorbed from Permanganate. Colour (paper filtered) m.m. brown, 2 ft. tube. Turbidity, Saccharated Carbonate of Iron. Raw Water New River .0083 .0722 34 2.51 R. Lee .0175 .1698 77 4.37 R. Thames .0162 .1739 77 3.66 Filtered Water (including Kent unfiltered Water). Kent. .0016 .0078 0 Practically all the samples of filtered water were free from any appreciable amount of suspended matter. .0035 .0319 9 E. London (Lee) .0063 .0663 17 E. London (Thames) .0066 .0696 18 Chelsea .0067 .0823 20 W. Middlesex .0072 .0687 18 G. Junction (Hamp.) .0082 .0671 18 G. Junction (Kew) .0080 .0704 18 Lambeth .0075 .0945 23 S. anti Vauxhall .0072 .0846 22 \Thames derived Waters .0073 .0767 20 1 The chief results only are given. From Report by A. C. HOUSTON. TABLE IV. Causes of, and Ages at, Death during Year 1906. 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 1 1 .. .. .. .. .. .. .. .. .. .. 1 Scarlet Fever 2 .. .. 1 1 Whooping Cough 11 5 6 Diphtheria & Membranous Croup 5 1 4 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Fever: Typhus Enteric 1 .. .. .. 1 Other continued Epidemic Influenza 3 .. .. 1 .. .. 1 1 .. .. .. .. .. 1 Cholera Plague Diarrhœa 34 29 5 .. .. .. .. .. .. .. .. .. 1 2 Enteritis 10 4 .. .. .. .. .. 1 3 1 .. 1 Puerperal Fever Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Septic Diseases 2 .. .. .. .. .. 1 .. 1 .. .. .. 1 5 Phthisis(Pulmonary Tuberculosis) 39 .. .. 1 3 10 10 7 4 3 1 .. 14 7 Other Tubercular Diseases 20 5 3 5 1 1 3 1 .. 1 .. .. .. 3 Cancer, Malignant Disease 33 .. 1 .. .. .. 1 6 11 6 6 2 8 12 Bronchitis 32 4 1 .. .. 1 1 2 4 8 9 2 5 7 Pneumonia 18 .. 2 1 2 2 2 3 2 4 .. .. 2 5 Pleurisy 3 .. .. .. 1 .. .. .. .. .. 2 .. .. 1 Other Diseases of R espiratory Organs 18 7 3 l 1 1 2 .. .. 2 1 .. .. 4 Alcoholism 14 .. .. .. .. 1 3 7 1 1 .. 1 3 5 Cirrhosis of Liver Venereal Diseases 2 2 .. .. .. .. .. .. .. .. .. .. .. 4 Premature Birth 20 19 1 Diseases & Accidents of Parturition 9 5 .. .. 1 2 1 .. .. .. .. .. 3 Heart Diseases 46 4 2 .. 2 3 3 7 9 10 4 2 20 7 Accidents 9 3 1 .. .. 1 1 1 .. .. 1 1 1 1 Drowning 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Hœmophilia 1 1 All Other Causes 154 23 7 3 6 3 11 10 22 22 33 15 • 22 71 All Causes 488 113 36 13 19 25 40 46 57 58 57 24 83 136 TABLE D. SALE OF "FOODS AND DRUGS ACT." Report supplied by Courtesy of the County Inspector. Articles Purchased. Number of Samples. Genuine. Slightly Adulterated or Deteriorated. Cases in which proceedings were taken. | Convictions, obtained. Total Fines. £ s. d. Milk 50 41 5 4 3 6 7 6 Butter 17 16 1 Cheese 8 8 Spirits 7 7 Coffee 1 1 Tea 2 2 Bread 1 1 Beer 1 1 Port Wine 1 1 Brawn 5 .. 5 Cream 2 .. 1 1 1 1 3 6 Ketchup 1 1 Sugar 3 3 German Sausage 2 .. 1 1 1 1 2 6 Dripping 1 1 Mustard 3 3 Preserved Peas 1 .. 1 Lime Juice 3 .. 3 Tinned Meats 4 4 Elder Wines 1 1 Pepper 1 1 Sweets 1 1 Coffee 1 .. 1 Margarine 2 2 Vinegar 1 1 Cod Liver Oil 1 1 Pea Flour 1 1 Glycerine 1 1 Camphorated Oil 1 1 Baking Powder 1 1 Totals 125 101 18 6 5 £8 13 6 R. A. HOUGHTON, County Inspector. TABLE 1. 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 Deaths Deaths of Nonresidents register'd in District. Deaths of residents register'd beyond District. Deaths at all Ages. Total. Ages. Nett Number. Rate.* Number. Rate per 1000 Births register'd Number. Rate.* in Public Institutions.f Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 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 36,311 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 1905 38,670 1,015 262 91 89 540 13.9 159 88 26 452 11.6 Averages for years 1896-1905 35,290 969 26.75 123 129.2 582 16.5 130 89 16 492 14.0 1906 39,500 941 23-8 113 120 623 15-7 229 136 23 488 12-3 *Rates calculated per 1000 of estimated population. f 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 Institutions within District receiving sick and infirm persons from outside District:— Kingston Victoria Hospital. Workhouse 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 V. INFANTILE MORTALITY DURING THE YEAR 1906. 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 j 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 pauses: Certified 21 8 4 4 37 14 9 6 4 5 11 2 .. 1 4 9 102 Uncertified 3 .. .. .. 3 2 3 1 .. 2 .. .. .. .. .. .. 11 Common Infectious Diseases:— Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. .. .. .. .. .. 1 1 1 .. .. .. .. 2 5 Diarrhœal Diseases: .. .. .. Diarrhoea,all forms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis Epidemic (not Tuberculous) 1 .. 1 .. 2 4 7 4 2 1 4 .. .. .. 3 2 29 Gastritis.Gastrointestinal Catarrh .. .. .. 1 1 1 .. 1 .. .. 1 .. .. .. .. .. 4 Wasting Diseases: Premature Birth 15 1 2 1 19 1 .. .. .. .. .. .. .. .. .. .. 20 Congenital Defects 2 .. .. .. 9 .. 1 .. .. .. .. .. .. .. .. .. 3 Injury at Birth 4 2 .. .. 6 .. .. .. .. .. .. .. .. .. .. .. 6 Want of Breastmilk .. 1 .. 2 3 .. .. .. .. .. .. .. .. .. .. .. 3 Atrophy, Debility. Marasmus 1 .. .. .. 1 1 1 .. .. .. .. .. .. .. .. .. 3 TuberculousDiseases: Tuberculous Meningitis .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. 1 4 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 2 Improper Feeding .. .. .. .. .. .. 2 1 .. .. 1 .. .. .. 1 .. .. 5 Hœmophilia .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Convulsions .. .. .. .. .. 1 1 1 .. 1 1 .. .. .. .. 1 6 Bronchoitis .. .. 1 .. 1 2 .. .. .. .. 1 .. .. .. 1 1 6 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia, &c. .. .. .. .. .. 1 .. .. .. .. 2 2 .. .. .. .. 5 Suffocation, overlaying 1 .. .. .. 1 1 .. 1 .. .. .. .. .. .. .. .. 3 Other Causes .. 3 .. .. 3 .. .. .. 1 1 .. .. .. .. .. .. 5 24 8 4 4 40 16 12 7 4 7 11 2 1 4 9 113 30 SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1906. Choked and Defective drains 200 New drainage to houses 14 Defective closets and syphons 18 Defective soil pipes and ventilators 20 Defective water apparatus to closets 50 To lay on water supply to ciosets 14 To provide separate cisterns for flushing closets 3 Foul drinking water cisterns 42 To cleanse and limewash houses 46 To cleanse and disinfect houses 90 To cleanse urinals adjoining the public roads 40 To repair and alter urinals adjoining the public roads 2 Inspecting urinals adjoining the public roads 890 Dilapidated houses 14 Dilapidated manure and ash pits 8 Accumulation of manure, offal, etc. 160 Pig keeping (a nuisance) 2 Fowl keeping (a nuisance) 6 Overcrowding of houses 6 Canal Boats Act, &c. Canal Boats and Barges inspected 63 Offences in Contravention of Canal Boats Acts 9 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 230 Notices served to Householders, etc. 110 Notices served to School Attendance Officer 90 Notices served to Schools 180 Notices served to Librarian 140 Disinfecting houses after Infectious Diseases 90 Testing drains after Infectious Diseases 20 31 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:— 29 stone 5 lbs. of Beef. 16 Rabbits. 4 boxes of Codlings. 2 pads of Mackerel. 4 boxes of Skate. 13 flats of Peaches. 4 cases of Oranges. FRED. J. PEARCE, A.R.S.I., Sanitary Inspector. January, 1907. 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 Births including postponements & insusceptible Removals. Exemptions. Summoned. Unaccounted for. Percentage of Births Unvaccinated remainin the Borough. May, 1898, to April, 1899 922 100 822 6 3 702 86.4 98 119 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, 1903, to April, 1904 1054 105 949 8 4 852 90.0 54 27 4 3.4 May, 1905, to April, 1906 940 81 859 7 5 790 93.3 31 23 3 8.0 1905. May 80 6 74 67 90.5 5 2 2.9 JUne 74 9 65 62 95.3 1 2 4.6 July 92 7 85 1 73 84.8 4 4 4.7 August 89 9 80 67 80.3 7 5 1 7.5 September 73 4 69 1 66 95.6 2 2.0 October 87 6 81 74 91.3 4 3 3.7 November 95 6 89 82 92.1 6 1 1.1 December 84 7 77 2 67 87.2 87.0 3 3.9 1906. January 84 4 80 1 78 97.5 2 0.0 February 72 5 67 1 69 89.5 4 3 4.4 March 74 4 70 1 63 90.0 2 5 7.1 April 67 1 66 64 96.9 1 1 1.4 971 68 913 6 1 832 90.9 44 29 1 3.3 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. 33 RAINFALL RECORDS FOR THE DISTRICT. Rainfall since 1st January, 1901. * * * † † ‡ 1901 1902 1903 1904 1905 1906 Inches. Inches. Inches. Inches. Inches. Inches. January 1.08 .78 2.44 2.74 .61 3.85 February .82 .73 1.12 2.41 .80 1.67 March 2.24 1.69 2.57 1.39 4.03 1.15 April 2.17 .64 1.69 1.03 1.68 .49 May .44 2.53 2.07 2.16 1.03 1.26 June 1.04 3.79 6.37 .8 4.84 2.71 July 2.14 1.56 4.48 1.5 1.07 .90 August 1.74 2.70 4.30 1.59 2.85 1.21 September 1.75 2.57 3.21 1.5 1.67 2.97 October 1.78 1.46 5.02 1.54 1.36 4.37 November .43 1.61 2.04 1.56 3.39 4.19 December 3.24 1.49 1.51 1.97 .60 2.22 Total 18.87 21.55 36.82 2016 23.93 26.99 *County Hall. †West Molesey. ‡Kingston Sewage Works. In the records for the immediate neighbourhood, there are considerable variations between West Molesey, Surbiton, and Kingston (Sewage Works), amounting sometimes to as much as an inch in a year. H. BEALE COLLINS.