KIN 059 Borough of KINGSTON-UPON-THAMES. ANNUAL REPORT of the Medical Officer of Health For the Year ending December 31st, 1909. Guilford & Hart, Ltd., Printers, Kingston and London 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 4 shall also record the action taken by him, or on 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. (17.) In matters not specifically provided for in this order, he shall observe and execute any instructions issued by Us, and the lawful orders and directions of the Sanitary Authority applicable to his office. 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, 1910. Gentlemen, I have the honour to present to you my Seventeenth Annual Report on the Health of the Borough of Kingstonupon-Thames. Birth Rate 22.9 per 1,000 per annum. „ 26.9 „ „ average of previous 10 yrs. „ 25.6 „ „ England and Wales, 1909. „ 26.0 „ „ „ small towns, 1908. „ 26.2 „ „ England and Wales, rural, 1908. Death Rate 12.29 per 1,000 per annum. „ 13.48 „ „ average of previous 10yrs. „ 14.5 „ „ England and Wales, 1909. „ 14.0 „ „ Small Towns, 1908. „ 14.7 „ „ Rural Counties, 1908. Death Rate 75.0 per 1,000 Births of Infants under 1 year. „ 125.7 „ „ average of previous 10 yrs. „ 109 „ „ England and Wales, 1909. „ 124 „ „ Small Towns, 1908. „ 110 „ „ Rural Counties. The rates for Birth Rate, Death Rate, and Infantile Mortality are the lowest on record for England and Wales. The Death Rate for Kingston was lower in 1905, but the Birth Rate and the Infantile Mortality Rate are the lowest recorded. 6 TABLE A. Death Rates. Comparison of Town and Country Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Annual. ENGLAND AND WALES, 1909 17.0 14.5 11.9 14.6 14.5 GREAT TOWNS— 1909 Population 15,500,000 17.5 14.7 12.5 15.2 14.9 SMALL TOWNS— Population 4,750,000 16.2 13.9 11.8 14.5 14.3 COUNTRY DISTRICTS— Population 13,750,000 16.9 13.6 10.9 13.2 13.4 KINGSTON, 1899—1908 15.8 11.27 11.27 13.0 13.2 Death rates of Kingston compared. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Estimated average population 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 1907 „ „ 40,000 18.5 12.9 10.1 9.9 13.2 1908 „ „ 40,300 15.5 10.5 9.3 13.2 12.3 1909 „ „ 40,500 17.2 9.1 8.3 13.7 12.2 Notifications of Infectious Diseases. B TABLE III. WARDS AND DISEASES. Primary Cases. Secondary Cases. TOTALS. Populations Estimated. TOWN. Population 7,000— Scarlet Fever 36 7 43 Diphtheria 2 2 Erysipelas 3 3 —48 CANBURY. Population 9,100. Scarlet Fever 66 2 68 Diphtheria 5 5 Enteric Fever 1 1 Erysipelas 4 4 —79 BARRACKS. Population 500. Diphtheria 1 I Cerebro-Spinal Meningitis 1 1 HILL. Population 11,250. —2 Scarlet Fever 100 16 116 Diphtheria 2 2 Enteric Fever 3 3 Erysipelas 5 5 Puerperal Fever 1 1 —127 WORKHOUSE. Population 900. Scarlet Fever 1 1 Diphtheria 6 6 Erysipelas 15 15 Puerperal 1* 1 —23 NORBITON. Population 11,750. Scarlet Fever 110 15 125 Diphtheria 16 16 Erysipelas 11 11 Puerperal Fever 1 1 Enteric Fever 2 2 —155 Under 1 year. 1-5. 5-15. 15-25. Over 25. Totals. Scarlet Fever 2 86 172 50 43 353 Diphtheria 1 9 15 3 4 32 Enteric Fever 1 2 1 2 6 Erysipelas 1 1 3 1 32 38 Puerperal Fever 1 . 2 3 Cerebro Spinal Meningitis 1 1 2 Suspicious Cases 1 9 1 1 12 * Not belonging to Borough. 8 SCARLET FEVER. Three hundred and fifty three cases with five deaths. Reference may be first made to the Milk-borne Epidemic:— Cases of Fever on rounds of Milk Sellers Milk Seller. No. of Cases. Onset of First Cases. Remarks. A 32 June 11th — B 86 June 13th Cases of Sore Throat only at earlier date. C 7 June 12th — D 23 June 15th — E 26 June 17th — F 10 June 17th — Other Sellers 6 — Some of these very mild and only recognised on desquamation. Seller not known, no regular supply, &c. 35 June 17th 225 The first case notified was on June 14th. On June 16th the circumstances of the cases pointing to a milk outbreak, letters were written to the Medical Officers of Hants and Wilts concerning the sources of supply. Later two earlier cases came to my knowledge. The one first on the list if notified earlier would have led me to communicate with Wiltshire two days before I did. Possibly this might have Stopped a portion of the infected milk. The earliest onset of notified Scarlet Fever was in Seller A on June 11th, but several cases of suspicious Sore Throat were observed amongst customers of other milk sellers before definite symptoms led to notification. Only 72 cases were of ages for compulsory school attendance, and many of these were attending private schools. When the presence of a big epidemic seemed to be clearly in front of us on June 18th, the Elementary Schools were closed for 14 days. Sunday Schools were advised to be closed and school treats recommended to be stopped during that period. At the end of the fortnight, the epidemic having abated, the schools re-opened. Nine cases were subsequently notified—apparently arising from the school meetings. The children in the schools affected were inspected, but no one was found with symptoms of recent illness. Of those thus notified, four were exceedingly mild. 9 Notes on the Outbreak.— Eleven cases were notified on desquamation. Two cases showed no desquamation. Two cases had recently had Scarlet Fever. One case had been recently exposed to Scarlet Fever and had not then contracted it. In one house full of boarders from a large school, only one case occurred, although all partook of the same milk, and as far as I know, none were protected by a previous attack. In many cases mild sore throats were noted in other members of the family. Fifteen cases were sent to Hampton Hospital. On the return of one of these, four cases occurred in the house, and these in addition were sent to Hampton Hospital. Seven cases were sent privately to the London Fever Hospital and six cases were sent to the Wardell Convalescent Home. Ten cases may be considered as secondary, that is, contracted from original cases under treatment at home. There were five fatal cases. One case, secondary in origin, died in hospital. The certificates of the other fatal cases give Pericarditis (old standing), Laryngeal obstruction (Hoffman's bacillus), Pneumonia, Cardiac failure, as secondary causes of death. The cases were generally mild in character, but a considerable number were complicated with Nephritis as a secondary complaint. The majority of cases occurred in the better class houses amongst persons who can afford to drink large quantities of milk; those in the poorer houses appearing somewhat later in the outbreak. The disease has continued in the town up to this date, (August 4th), and I fancy some of the cases may be due to secondary infection, though not traced, as the character of the epidemic shows greater infectivity than is usual in recent milk outbreaks of Scarlet Fever. Mildness of attack with lengthened infectivity seem to be the prevalent characteristics of the outbreak. The throat symptoms seem to have been comparatively severe considering the mildness of the attacks generally. Gastrointestinal symptoms not specially marked. Peeling early in most cases. Very few cases of nose or ear discharges reported. In one of the early cases notification was delayed, as the disease was supposed to be a teething rash. Several patients only drank milk in tea—one of these a young baby. 10 Remarks on the Ordinary Cases.— Apart from the outbreak, the cases of Scarlet Fever have been about the average, the epidemic cases being in addition to the normal. 128 have been notified, in addition to the 225 of the Epidemic. These small outbreaks were mild in character and not showing any connection with one another. There were no fatalities apart from the five in the Epidemic. The non-epidemic cases showed a greater tendency to spread in the households. Twenty-five cases were sent to Hospital in addition to the fifteen during the epidemic. DIPHTHERIA. Thirty-two cases and six deaths. These cases do not call for special remark. In seventeen cases the KlebsLocffler bacillus was found, and in fifteen the Hoffmann pseudo-bacillus. In a large number of instances the medical men send swabbings to the Lister Institute after recovery and the patients are not declared well until two negative results have been noted. This is now being carried out as part of the routine in the Workhouse Infirmary. ENTERIC FEVER. Six mild cases were notified all making good recoveries. Four of these were sent to the Kingston Victoria Hospital. ERYSIPELAS. Two deaths, one being a baby under one month old— not connected with vaccination. Twenty-five cases were notified. DIARRHCEA. There were very few cases of Epidemic Diarrhoea. Seven deaths under one year and one over one year. One occurred in August, four in September, and three in October—two of these were in premature children. The hot weather in August was of short duration. The summer was a rainy one. PUERPERAL FEVER. Two deaths. The cause was not discovered in either case. Both were attended by qualified practitioners. 11 PHTHISIS. The number of deaths is twenty-five and there are eighteen deaths from other forms of tuberculosis. The notification of this disease by the Poor Law Officers adds considerably to our knowledge of the extent of this scourge in the Borough and we also get some comparative statistics of a limited nature. Under Form A are notified the number of cases of Tuberculosis in the Workhouse. Nineteen of these had their home in Kingston; fifteen in Wimbledon; five in Molesey; three in New Maiden and one in Tolworth. This gives a rather heavier incidence to Kingston than to the other districts, but that may be due to the conditions of the different districts in regard to the percentage of pauperism. I have persuaded several persons to take advantage of the Infirmary for remedial treatment who, but for illness, would not have come within the cognizance of the Poor Law. Under Form B we have the cases in the town which have come under the care of the Parish Medical Officer. These persons were six in number and resided in Church road, Vincent road, Fairfield place, and Hudson's road. In addition, four voluntary notices were received from the Brompton Consumptive Hospital, and one case came under my notice through the School Attendance Officer. Nineteen visits were paid to these persons, or to houses from which they had been removed to the Infirmary. Cards of advice and warning were given to the friends and the homes were inspected with a view to insanitary conditions. Three of the persons affected had relatives suffering from the same complaint. Three were notified at the time of death. One patient was an engineer's pattern maker and this seemed the only case in which occupation could be put down as an exciting cause, and this very doubtfully. Cards have been left in workshops, common lodging houses, and in all the schools. The illustrated card copied from one in use in America seems to be much appreciated. A copy of the card of advice is appended. 12 BOROUGH OF KINGSTON-UPON-THAMES. PREVENTION OF CONSUMPTION. Consumption is a germ disease, and in England causes one in every ten deaths. This disease is not inherited, but some persons are by constitution more liable to contract the disease than others. Such persons should follow out-door occupations and feed well on fatty foods, but avoid alcohol. They may go out in all weathers, provided care is taken to avoid chills from damp clothing. Persons affected with this disease spread the infection by means of the spit. The disease is also spread by milk, and, possibly, by meat, but in such cases, mostly children, the bowels are affected. The spit is comparatively harmless when moist, but when dry the germs are freely distributed by the air and will readily infect persons who are rendered liable to contract this disease through general ill-health, overcrowding, intemperance, bad air, dampness, &c. PRECAUTIONS TO BE TAKEN. Fresh air and sunlight should be freely admitted to rooms occupied by persons with Consumption, or liable to the disease. They are the best disinfectants. When indoors a Consumptive person should use a spitting cup containing water and some disinfectant, or cheap handkerchiefs may be used that can afterwards be burnt. Never spit on the footpath, or in trams, omnibus or other public conveyance, or in any church, theatre or public place. If possible spit into a bottle carried for this purpose, or into a street gully. The contents of spitting cups and bottles should be emptied down the w.c. 13 Soiled handkerchiefs should be kept moist until they can be washed or destroyed. Spoons, cups, &c., used by Consumptives should be for their special use and put into hot water when done with. No mother who is Consumptive should suckle a child. All milk should be boiled before use, so that the germs may be killed. Medical Practitioners in the Borough can have specimens of sputum bacteriologically examined free of charge, so that persons consulting a medical man can ascertain whether they are suffering from this disease or not. DISINFECTION. In cleansing rooms occupied by Consumptives avoid dust. Use damp dusters; sprinkle tea leaves before sweeping. After, burn tea leaves and boil dusters. After the death or removal of a patient the room should be disinfected, and in addition all walls should be stripped and ceilings and paintwork cleaned. Consumption is not caught by the breath or the skin, and provided proper precautions are taken there is no danger in living in the same house with persons suffering from this disease. H. BEALE COLLINS, Health Department, Clattern House. Medical Officer of Health. May, 1899. 14 NOTIFICATION OF BIRTHS ACT. This Act came into force on February 1st, 1909. During the eleven months 792 cases were notified out of a total of about 850. The midwives notified 354, medical men notified 380, and the remainder were by relatives. Only a small minority of the medical men have shown any opposition to the Act, and these, though declining to notify, have instructed the friends to do so. I visited 48 mothers who had been attended by midwives, and a few others notified by friends in very poor streets. I found the conditions on the whole satisfactory. Only five of the mothers were not nursing their babies and three others could not give enough milk, so that artificial feeding had to be used as a supplement. The mothers in all cases welcomed my visit. Cards of advice were sent to all mothers except those in the Workhouse, who received advice from the Poor Law Officers. In two cases objection was raised to the sending of the cards, but it was explained that no distinction of persons was made, and no further trouble is expected. Fourteen still births were notified. At one visit it was found that two older children were desquamating from Scarlet Fever. No further cases occurred. Two mothers died of Puerperal Septicœmia. One mother suffered from mild Enteric Fever during convalesence from child birth. TABLE V. INFANTILE MORTALITY DURING THE YEAR 1909. 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 20 5 4 4 33 11 4 5 3 2 4 2 3 .. 4 71 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases: Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including branous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 2 Diarrhœal Diseases: Diarrhcœ, all forms .. .. 1 .. 1 .. 1 1 1 .. .. .. 1 .. .. 1 6 Enteritis, Mucoenteritis,Gastro enteritis .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 Gastritis, Gastrointestinal Catarrh 1 .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. 3 Wasting Diseases: Premature Birth 10 8 1 1 15 2 .. 1 .. .. .. .. .. .. .. .. 18 Congenital Defects 8 .. .. .. 8 1 .. .. .. .. .. .. .. .. .. .. 9 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breastmilk, starvation. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. TuberculousDiseases: Tuberculous Meningitis.. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Tuberculous Peritonitis : Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 2 Other Causes: Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Improper Feeding .. .. .. .. .. .. .. 2 .. 1 .. .. 1 .. .. .. 4 Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (not Tuberculous) Convulsions .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Bronchitis .. 1 1 2 4 2 .. 1 .. .. .. .. .. 1 .. .. 8 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Pneumonia .. 1 1 .. 2 3 .. .. 1 .. .. 1 .. 1 .. 1 9 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes 1 .. .. .. 1 .. .. .. .. .. .. 2 1 .. .. .. 4 20 5 4 4 33 11 4 5 3 2 .. 4 2 3 .. 4 71 Population (estimated to middle of 1909)—40,500. Legitimate, 848. Legitimate Infants, 62. Birth in the year Illegitimate 82 Deaths in the year Illegitimate „ 9. Deaths from all causes at all ages — 497. 16 INQUESTS HELD IN 1908-9. Date. Occupation. Age. Sex. Cause of Death. Verdict when stated. Dec. 28 Tobacconist 40 M Oxalic Acid poisoning Suicide Jan. 3 Son of Painter 14 dys M Heart Failure,Bronchitis Natural „ 8 „ Engineer 3 dys M Improper Feeding „ 13 , Unknown 40 M Metallic Irritant poisoning Suicide „ 26 W. of Gardener 86 F Congestion of Lung, Heart Failure Natural „ 26 Unknown 70 M Epileptic Fit, Heart fail. „ Feb. 2 Blacksmith 77 M Heart Disease „ „ 4 Shoemaker 65 M Chronic Bronchitis „ „ 9 Wid. of Butcher 65 F Heart Disease „ „ 9 D. of Painter 10 wks F Acute Bronchitis „ „ 17 Unknown 80 M Senile Decay, Fall „ Mar. 2 Widow of Gardener 81 F Heart Disease „ „ 22 Wid. of Carman 63 F Pneumonia „ „ 30 Son of Carriage Cleaner 6 mths. M Improper Feeding April 1 .. W. of Painter 55 F Heart Disease Natural „ 7 Flower Seller 40 F Heart Disease „ „ 14 . Painter 69 M Fall— fracture of ribs, pelvis and femur Accident May 6 D. of Needlewoman, newly bron F . Asphyxia Found Dead „ 25 Widow 58 F Heart Disease Natural „ 27 Labourer 67 M Heart Disease „ „ 27 Pedlar 67 M Pneumonia June 15 Waiter 40 M Drowning July 5 Widow 66 F Heart Disease Natural „ 10 Widow 79 F Hœmorrhage of Lungs „ „ 13 Unknown 70 M Heart Disease „ 17 Date. Occupation. Age. Sex. Cause of Death. Verdict when stated. July 25 Constable 37 M Drowning Suicide „ 29 W. of Caterer 48 F Heart Disease Natural Aug. 3 Servant 25 F Fall from Tram Car Accident Sept. 1 Son of Tailor 1 mth. M Improper Food—Status Lymphaticus Oct. 4 Carman 53 M Heart Disease Natural „ 10 Draughtsman 23 M Wound in throat Suicide „ 14 Wife of Telegraphist 29 F Cerebral Tumour Natural „ 27 , Seedsman 35 M Nicotine poisoning Suicide Nov. 22 . Daughter of Stonemason 2 F Shock from burns Accident Dec. 9 Pensioner 77 F Heart failure—senile decay Natural „ 16 S. of Carman 3 dys. M Atelectasis „ „ 23 W. of Bailiff 65 F Heart Disease „ „ 25 Son of Carpenter 4 mths M Pneumonia „ 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 in Public Institutions.† 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.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 3109 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 26.2 91 89 540 13.9 159 88 26 452 11.6 1906 39,500 941 23.8 113 120 623 15.7 229 136 23 488 12.3 1907 40,000 898 22.42 89 96.8 631 16.0 231 110 33 521 13.2 1908 40,300 952 23.6 90 94.5 662 16.4 314 163 23 497 12.3 Averages for years 1899-1908 37,843 959 25.9 112 117.2 608 16.0 189 110 20 494 13.3 1909 40,500 930 22.9 70 75 685 16-9 287 177 16 498 12.2 * 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. Royal Cambridge Asylum. †Increase due to enlargement of 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. Military Hospital, Hounslow. Hampton Isolation Hospital. County Small Pox Hospital. TABLE IV. Causes of, and Ages at, Death during Year 1909. 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 8 2 4 2 .. .. .. .. .. .. .. .. .. Scarlet Fever 6 .. 4 1 1 Whooping Cough .. 2 2 .. .. .. .. .. .. .. .. .. .. .. 1 Diphtheria (including Membranous Croup) 6 .. 5 1 .. .. .. .. .. .. .. .. 1 1 Croup & Laryngitis 1 1 .. .. .. .. .. .. .. .. .. .. Fever: Typhus .. .. .. .. .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. .. .. .. .. .. Other continued Epidemic Influenza 11 .. 1 .. .. 1 1 1 .. 5 2 .. .. 5 Sp. Spinal Meningitis 1 .. .. .. 1 .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea 8 7 1 .. .. .. .. .. .. .. .. .. 2 6 Enteritis 4 3 .. .. .. .. .. 1 .. .. .. .. Puerperal Fever 2 .. .. .. .. 1 1 .. .. .. .. .. Erysipelas 2 1 .. .. .. 1 .. .. .. .. .. .. 2 Other Septic Diseases 5 .. 1 .. .. 1 1 .. .. 1 1 .. 3 6 Phthisis (Pulmonary Tuberculosis) 25 .. .. 1 4 6 5 5 3 1 .. .. 10 10 Other Tubercular Diseases 18 3 9 1 1 1 9 1 .. .. .. .. 5 2 Cancer, Malignant Disease 40 .. .. .. .. .. 2 9 16 11 2 .. 8 8 Bronchitis 55 8 2 .. .. .. 2 4 1 20 14 4 19 14 Pneumonia .. 35 9 7 1 1 2 5 2 3 2 3 .. 4 6 Pleurisy .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Diseases of Respiratory Organs 5 2 .. .. .. .. .. .. 1 2 .. .. .. Alcoholism 9 .. .. .. .. 2 4 1 2 .. .. .. 2 4 Cirrhosis of Liver Venereal Diseases 3 .. .. .. 1 1 .. 1 .. .. .. .. 2 4 Premature Birth 17 17 .. .. .. .. .. .. .. .. .. .. 2 5 Diseases & Accidents of Parturition 5 4 .. .. .. .. 1 .. .. .. .. .. .. 4 Heart Diseases 68 .. .. 1 4 3 4 8 14 21 11 2 14 14 Accidents 4 .. 1 .. .. 1 .. .. 1 1 .. .. 4 9 Suicides 5 .. .. .. 1 1 .. .. .. .. .. .. .. 1 Improper Feeding 5 4 1 .. .. .. .. .. .. .. .. .. .. 2 Gen. Paralysis,Insane 3 .. .. .. .. .. 1 2 .. .. .. .. Rheumatism 2 .. .. 1 .. .. .. .. .. .. 1 .. .. 1 Drowning 2 .. .. .. .. .. 2 .. .. .. .. .. .. 3 All Other Causes 141 8 3 2 4 5 2 10 22 29 36 20 31 50 All Causes 498 71 39 11 18 25 36 45 63 93 70 26 110 157 20 ABSTRACT OF WORK OF THE MEDICAL OFFICER. Visits of Enquiry in cases of Infectious Disease 464 „ „ „ „ Workshops, etc. 77 „ in regard to Insanitary Conditions 66 „ on behalf of the School Attendance Committee 679 „ to Schools for Inspection of Scholars 131 „ to Schools for Sanitary Enquiries, etc. 60 „ to Scholars on whom Notices had been Served 41 „ to Small Pox, Plague and Cholera Contacts 3 „ Inspection of Markets 28 „ „ of Dairies 24 „ „ of Mortuary 6 „ „ of Common Lodging Houses 8 Visits of Enquiry to Places outside District 5 Consultations with Medical Practitioners, etc. 14 Visits to Midwives 23 „ in Connection with Notice of Births 33 „ for other purposes 70 Total Visits 1,732 *** Average Annual Visits for last 10 years—1,060. Complaints of Bad Food 2 „ of Overcrowding 2 Letters, etc., written 98 Notices served, Reports, etc. 279 Samples of sets of Effluent Analysed 28 „ of Drinking Water Analysed 2 H. BEALE COLLINS. 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) 1 Workshops (including Workshop Laundries) 57 Nil Nil Workplaces 12 Homeworkers' Premises 3 Total 73 Nil Nil 2.—DEFECTS FOUND Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referr'd toH.M. Insp'ct'r Nuisances under the Public Health Acts: Want of Cleanliness 1 1 • Insufficient sanitary accommodation 2 2 Total 3 3 3.—OTHER MATTERS. Class. Number. Underground Bakehouses (S. 101):— In use at the end of 1909 (technically underground but well lighted and ventilated to open air) 2 Homework:— Number of List of Outworkers (S. 107):— Lists Outworkers Lists received 3 9 Addresses of Outworkers forwarded to other Authorities Nil received from other Authorities 5 Inspection of premises 4 Workshops on the Register (S.131) at the end of 1908: Important classes of workshops, such as workshop bakehouses, may be enumerated here Dressmakers (mostly small places) 33 Hand laundries 26 Eating places (not hotels) 12 Sausages, etc. 4 Bakehouses 30 Various 100 Total number of workshops on Register 205 22 SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1909. Choked and defective drains 234 New drainage to houses 23 Defective closets and syphons 20 Defective interceptors, traps, etc. 16 Defective soil pipes and ventilators 14 Defective water apparatus to closets 62 To lay on water supply to closets 3 To provide separate cisterns for flushing closets 2 Foul drinking water cisterns 18 To cleanse and limewash houses 22 To cleanse and disinfect houses 290 To cleanse urinals adjoining public roads 24 To repair and alter urinals 18 Inspecting urinals adjoining public roads 980 Dilapidated houses 10 Accumulation of manure, offal, etc. 65 Pig keeping (a nuisance) 3 Fowl keeping (a nuisance) 15 Overcrowding of houses 4 Canal Boats Act, &c. Canal Boats and Barges inspected 65 Offences in Contravention of Canal Boats Acts 14 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 350 Notices served to Householders, etc. 310 Notices served to School Attendance Officer 300 Notices served to Schools 330 Notices served to Librarian 250 Disinfecting houses after Infectious Diseases 340 Testing drains after Infectious Diseases 26 23 The Slaughter-houses, Cowsheds, Dairies, Milkshops and Lodging Houses have been visited at various times and found in a satisfactory condition. 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:— 3 boxes of Whiting. 8 boxes of Soles. 6 boxes of Plaice. 5 boxes of Skate. 3 trunks of Haddock. 2 boxes of Cod's Roe. 2 boxes of Mackerel. 2 boxes of Bloaters. 32 boxes of Tomatoes. 40 baskets of Strawberries. FRED. J. PEARCE, A.R.S.I., Sanitary Inspector. January, 1910.