KIN 060 BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, For the Year ending December 31st, 1911. Kingston-upon-Thames: Phillipson's Press, Ltd., Printers. 3 & 5, St. James' Road SALES UNDER "FOODS & DRUGS ACT." Table shewing Number of Samples Purchased and Proceedings Taken in Kingston during the Year 1911. Articles Purchased. Number of Samples. Number Genuine. Slightly Adulterated or Deteriorated. Cases in which Proceedings were taken. Convictions Obtained. Fines Inflicted. Milk 37 29 5 3 3 £6 6 0 Butter 41 41 — — — — Lard 5 5 — — — — Demerara Sugar 4 4 — — — — Spirits 3 3 — — — — Cocoa 2 2 - — — — Dutch Cheese 2 — 2 — — — Baking Powder 1 1 — — — — Mustard 1 1 — — — — White Pepper 1 1 — — — — Iodine 1 1 — — — — Totals 98 88 7 3 3 £6 6 0 R. A HOUGHTON, County Inspector. Estimated Population. 38,076. BIRTHS. Mo. M. F. Rate per 1,000 per annum. CLASSES OF BIRTHS. Professionals Trading Proletariate Illegitimate DEATHS Under 1 year. No. M. F. . Rate per 1.000 Births. DEATHS at all ages. Total. No. M. F. Rate per 1,000 per annum. 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 age. Nett. No. Rate per 1,000 per annum. Years. Small.pox. Vaccinated. Re.vaccinated. Un vaccina ted. Measles. Scarlet Fever, Enteric Fever, Epidemic Influenza. Whooping Cough. Diphtheria. Laryngitis. Rheumatism. Epidemic Enteritis Summer Diarrlicea'). Convulsions. Nephritis. Syphilis. Tubercular Meningitis. Phthisis. other Tubercular Diseases. M Cancer. F Bronchitis. Pneumonia. Broncho.Pneumonia. Other Diseases of Respiration. Alcoholism. Cirrhosis. Puerperal Fever. Accidents of Parturition. Premature Birth. Appendicitis. Other Defined Diseases. Violent Deaths. Suicide. Other Diseases, 111.Defined. Total. JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER BIRTHS IN INSTITUTIONS OF PERSONS BELONG. ING TO THE BOROUGH TOTALS 42 29 44 41 42 44 47 34 32 39 47 31 4 476 33 26 30 32 37 34 41 36 40 30 26 30 2 397 23.4 17'2 23.3 23.3 23.7 23.6 27.0 22.9 230 21.5 23.3 190 22.9 2 2 1 1 2 1 9 15 8 12 9 11 15 14 13 6 8 8 12 1 132 54 41 57 59 63 59 67 55 59 57 62 48 4 68: 4 6 4 4 5 5 6 2 5 5 3 1 50 6 4 5 3 4 8 2 17 6 3 3 4 65 3 6 4 3 1 2 1 9 2 3 1 7 42 120 133 120 80 64 133 40 306 111 80 53 146 17.5 40 21 35 29 31 25 30 35 23 17 22 36 34. •12 37 31 24 26 32 16 36 24 19 21 25 323 23.3 180 21.5 16.5 17 6 176 14.3 230 14.5 111 14 0 18.7 17 5 32 24 27 19 28 29 26 23 23 15 19 22 287 19 15 19 9 15 18 14 11 17 10 9 10 166 4 5 1 2 2 3 2 2 5 4 30 57 48 47 45 44 41 35 62 32 26 39 55 531 17.8 150 14.7 14'4 13.8 13.4 11.6 19.0 10.0 8.1 11.8 17.3 13.9 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 Under 1 Over 1 2 15 2 5 4 20 2 2 1 6 1 5 1 2 2 2 1 8 11 1 1 1 5 1 2 24 5 6 1 1 36 8 3 3 6 2 4 1 2 9 1 1 11 1 9 1 4 28 1 1 6 3 4 17 2 8 2 2 3 24 5 20 124 2 1 2 3 9 2 1 2 7 2 21 2 6 2 4 7 6 5 3 3 11 26 61 23 109 1 1 1 6 2 2 37 16142211 12 2 3l 41 27 92 1 3 11 21 1 15 225842 2 25 4 11499 3 3 3 1 4 33 3 6 2 107 5 33 5 13 18 33 12 14 3 4 7 3 3 10619 384 424 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 or advised under any Statute, so far as such proceedings relate to those conditions ; and also an account. 4 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 his advice, during the year, in regard to offensive trades, to dairies, cowsheds 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, 5 Tt 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 Municipal Offices, January, 1912. Gentlemen, I have the honour to present to you my Nineteenth Annual Report on the Health of the Borough of Kingston.upon.Thames. Estimated Population, 38,076. Birth Rate 22.9 per 1,000 per annum. „ 23.5 „ „ average of previous 10 years. „ 24.4 „ „ England and Wales, 1911. „ 23.4 „ „ „ Small Towns, 1911. „ 23.4 „ ' „ England and Wales, rural, 1911. Death Rate 13.9 per 1,000 per annum. „ 13.6 „ „ average of previous 10 years. „ 14.6 „ „ England and Wales, 1911. „ 14.4 „ „ Small Towns, 1911. „ 13.1 „ „ Rural Counties, 1911. Death Rate 122 per 1,000 Births of Infants under 1 year. „ 101 „ „ average of previous 10 years. „ 130 „ „ England and Wales, 1911. „ 133 „ „ Small Towns, 1911. „ 118 „ „ Rural Counties. Epidemic Diseases 2.1 per 1,000 per annum. „ 2.19 „ „ England and Wales, 1911. „ 198 „ „ Small Towns. „ V40 „ „ Rural 7 A memorandum of the Local Government Board, called calls for detailed information under certain headings which are dealt with seriatim. Physical Features and General Character of the District. The greater part of the District is on flat ground on the south bank of the Thames, but little raised above the level of the river. There is rising ground to the east of the Borough, extending almost to the top of Kingston Hill, a height of 144 feet. There is also high ground near the Cemetery, 59 feet. Nearly the whole of the district is now built over; of the 1,114 acres in the Borough there remain about 35 acres in the neighbourhood of Latchmere Brook bordering on Ham, and about 15 acres near the Dust Destructor, adjoining the Hogg's Mill stream. A few large mansions with gardens remain to be cut up into building plots sooner or later, but they are hardly large enough for a Town Planning Scheme. The higher parts of the town are on clay, the low-lying ground being mostly gravel. In addition to the Thames, a small stream, the Hogg's Mill River, enters the Thames near the Market Place. This stream has a fall of about 25 feet in its passage through the Borough, and if it were not for three mill dams it would drain the district through which it passes very effectively. The banking up of the water keeps this neighbourhood rather damp, as the stream is very sluggish, but great improvements have been made in cleaning out the stream and camp shedding or otherwise improving the bank. Parts have been filled in and the condition of the adjoining houses improved. The effluents from the Sewage Works of Maiden, Ewell and Epsom all discharge into the stream beyond the Borough boundary. The average summer flow is not above 10 or 12 million gallons daily, but this will increase as the effluent from the sewage works of these growing districts increases. It is under the control of the Thames Conservancy as regards pollution, but regulations are badly needed in regard to the repair of banks, flooding, etc. This stream for the greater part is outside the Borough, but any damage caused by accident or neglect higher up is felt almost entirely within our boundaries. TABLE I. Vital Statistics of Births and Deaths for Whole District during 1911 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number Rate. 1 2 3 4 5 6 7 8 9 10 12 12 13 1906 36,276 941 26.0 623 17.1 136 23 113 120 488 13.4 1907 36,636 898 24.5 631 17.2 110 33 89 99 521 14.2 1908 36,996 952 25.7 662 17.9 163 23 90 94 497 13.4 1909 37,356 930 24.8 685 18.0 177 16 70 75 498 13.3 1910 37,716 865 22.9 506 13.4 126 16 72 83 430 11.4 1911 38,076 910 873 22 9 667 17.5 166 30 107 124 531 13 9 Area of District in Acres (exclusive of area covered by water) 1,114 Total population at all ages (at Census of 1911) 37,977 Institutions within District receiving sick and infirm persons from outside District:— Kingston Victoria Hospital. Workhouse Infirmary. Royal Cambridge Asylum. Number of inhabited houses (at Cenms of 1911) 8.726 Average number of persons per house ,, 4.3 Institututions outside District receiving sick and infirm persons from the District:— Brookwood Asylum. Richmond Hospital. Surbiton Hospital. Military Hospital, Hounslow. Hampton Isolation Hospital County Small Pox Hospital. TABLE II. Cases of Infectious Disease notified during the Year 1911. NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. Secondary Cases. TOTAL CASES NOTIFIED IN EACH LOCALITY (e.g. Parish or Ward) of the District. TOTAL CASES REMOVED TO HOSPITAL At all Ages. At Ages—Years. 1 2 3 4 5 6 Not belonging to Kingston. Under 1 1-5. 5-15. 15-25 25-45 45-65 65 and over. Town Ward. C'nb'ry Ward. Barracks. Hill Ward. Workhouse. Nrbtn. Ward. Small-pox Cholera Diphtheria (including Membranous Croup) 83 22 53 4 3 1 1 6 5 27 2 19 29 f 1 1* ) 27; Erysipelas 49 1 2 1 16 23 6 3 11 8 17+ 10 Scarlet Fever 93 15 68 6 4 9 9 31 29 24 32 k 1* Typhus Fever Enteric Fever 9 3 3 1 2 3 3 2 1 5 Relapsing Fever Continued Fever Puerperal Fever 5 1 2 2 3t 2 Suspicious Cases (8) Phthisis Under Tuberculosis Regulations, 1908 Under Tuberculosis Regulations, 1911 17 1 9 7 1 4 4 8 23f Others 23 1 8 10 4 3 6 6 8 Totals 279 1 37 127 24 45 38 7 42 24 82 2 68 49+ 54 23f 39 ‡ Secondary Cases in Workhouse Infirmary. † not belonging to Borough. * Taken in at Tolworth Hospital. 10 The low-lying ground adjoining this stream just where it enters this Borough is now being filled in with house refuse and road scrapings. The chief occupations of the inhabitants, and the influence of any particular occupation on Public Health. A large number of men are employed in printing works, and women are engaged in laundry work and in bottling beer and mineral waters. A considerable number of workers are employed outside the Borough, either in London or in the wealthier districts adjoining Kingston. There is no employment directly affecting Public Health. House accommodation, especially for the working classes.— Adequacy and fitness for habitation.—Sufficiency of open space about houses, and cleanliness of snrroundings.—Supervision over erection of new houses.—Action under the Housing of the Working Classes Act. The town is chiefly a working class town. The houses are generally of good character, but a few houses built about the middle of the last century are unsatisfactory. These are now being inspected and the owners called upon to make good defects. There is no closeness of air space round buildings except in the business neighbourhood of the Market Place. Pavement round the backs of houses is being introduced, and there will be little to complain of as regards cleanliness of surroundings when this is complete. Streets are now being treated with impervious in varied forms of "pitch grout." There is good supervision over new houses, no new house being certified for occupation till the requirements of the By-laws have been complied with, but there is not much building work in progress now. 11 Sewerage and Drainage—Its sufficiency in all parts of the District—Condition of sewers and house drains—Method or methods of disposal of sewage—Localities where improvements are needed. The sewerage and drainage of the town is good on the whole. Some parts of the district are flat and trouble occasionally arises during heavy rain storms. This difficulty is gradually being got over by laying separate surface water drains, and it is hoped that in a year or two a double system may be in force throughout the Borough. Manholes are being made over all sewers so that they can be readily cleaned out. This work, it is hoped, will be completed during the coming year in all the main thoroughfares. The house drains in modern property are in good condition. Many of the older houses have been brought into accord with the By-laws and opportunity is taken from time to time to get this done. Some trouble arise from the system of combined drains in certain districts. It is to be hoped that the law on this matter will be amended shortly, so that the present difficulties may be done away, thus obviating expensive law processes. The sewage is treated by the A.B.C. process, but the works are under the direct control of the Corporation. The pressed cake is sold to the Native Guano Company, by whom it is air and sun dried and ground into their native guano The cake is barged away by the Company. Seven filters with thirty-nine revolving sprinklers are now. provided capable of filtering 250 gallons per cube yard daily. Dr. Gilbert Fowler, of Manchester, describes the Kingston effluent as " perhaps the most brilliant clarified effluent produced in this country." A large storm overflow tank has been installed, thereby preventing the discharge of untreated sewage into the river. 12 There is vacant land available for still further increasing the filtration area, and more settlement tanks could be provided, if necessary. The process shows itself to be increasingly satisfactory in comparison with other systems installed elsewhere, whether on the score of efficiency of treatment or economy in working It has one marked superiority in the production of a useful fertilizer as a bye-product. The filtered effluent contains about 1-pt. per million of Albuminoid Ammonia. It is clear, sparkling and free from odour, and not liable to putrefraction on keeping either at the natural temperature or in an incubator. The sewage of Surbiton (13,000 pop.), Hampton Wick (4000) and Kingston (88,000) produces about 2,500,000 millions daily, but double this amount could be dealt with on the area without nuisance. The works are in the centre of the Town and adjoin the Canbury Promenade and Public Gardens. Sulphate of Alumina for precipitation is now made at the Sewage Works and the steam engines are gradually being replaced by electric motors. Water Closet Accommodation. W.C's are universal in the Borough. Nearly all houses have one or more. The Corporation provide public w.c's adjacent to the Market Place and on the Canbury Gardens. Pollution of rivers and streams in the District—The sources and nature of such pollution and any action taken to check it. The Thames is well looked after by the Thames Conservancy, and prompt action is taken if any sewage, &c., is carried into the river by sudden storms or if the sewage effluent is in any way unfit. The Hogg's Mill stream, which has been referred to, is also under the supervision of the Thames Conservancy, the nature of the water as it comes through the Borough is often most unsatisfactory. The legal difficulties in dealing with nuisances in 13 regard to watercourses seem to be very great, and some simplification of the law is required. The Latch were Brook is partly in this district, and although a portion of it has been filled in it still serves to carry off a certain amount of surface water from the north-east part of the town. It is a very slow running stream and only partly under the control of this Corporation. Excrement Disposal—System in vogue—Defects, if any. Water carriage is universal, and satisfactory. 1 think nearly every closet in the town is now provided with a flushing cistern and the system works well. Removal and Disposal of House Refuse— Whether by public scavenger or occupiers—Frequency and method. Certain streets are subject to a thrice weekly collection. In other streets the collection is every seven days, the dustbins being emptied by the dustmen. The collection is worked by the Corporation and the dust is taken to the Destructors in Oil Mill Lane and burnt. The form of Destructor is that known as the Beaman and Deas, supplied by Meldrum, Limited. It has two cells. Water Supply. A few shallow wells still remain, but the water supply is generally from the mains of the Metropolitan Water Board. There is a constant service and the character of the water is fairly good. A constantly increasing number of houses have taps on the main. Places over which the Council have supervision, e.g., Lodging Houses, Slaughterhouses, Dairies, Cowsheds and Milkshops, Bakehouses, Factories and Workshops, and Offensive Trades. There are two common Lodging Houses under one management. They are well-conducted. One is an old building and one is new. A third lodging House has been opened in an old public 14 house which has lost its license. The house is roomy and wellkept. There are many houses let in lodgings and By-laws in regard to them have been approved and steps will be taken shortly to make a register of the houses. The six Slaughterhouses are used for killing a few sheep and pigs. They are kept in good condition. The four Cowsheds are visited quarterly and are well-kept on the whole. The largest cowkeeper in the town has his shed very well-kept, and has appliances for cooling milk, sterilizing cans, &c., and is always doing everything he can to improve his premises. By-lawt, The By-laws in force are fairly stringent and I do not think any addition is required at the present time. Nuisances. These are dealt with as they arise, and except when elsewhere specially referred to, there is no cause for complaint. Methods of dealing with Infectious Diseases —Notification— Isolation Hospital Accommodation and its Sufficiency— Disinfection. Notification is in force for the usual diseases. Measles is not notifiable. Arrangements are being made by a Joint Committee of the County Council for the use of the Cheam Small-pox Hospital as a Sanatorium for Phthisis. This hospital has been empty for four years. The other two Small-pox Hospitals at Clandon and Whitemoor will be available for Small-pox case6. The Clandon Hospital has never had a single patient in it since it was opened. Arrangements have been made with the Hampton Isolation Hospital for treating cases of Scarlet Fever and with the Molesey Isolation Hospital for Diphtheria from houses when special circumstances render removal advisable. Most of the fatal cases of Diphtheria are moribund when notified, so that Hospital Treat- 15 merit would be of no avail. Enteric Fever is treated in the Kingston Victoria Hospital, payment being made by the Corporation The isolation in hospital of ordinary cases of Scarlet Fever and Diphtheria has not been found necessary. Cases rarely spread in the households and cases of infection being carried to other houses are unknown as far as I have been able to ascertain. Disinfection is by burning sulphur in the rooms or by spraying with formalin. Bedding, &c. is sent to Lacey's, Wandsworth, but a disinfector at the Dust Destructor is under consideration. HOUSING AND TOWN PLANNING ACT. The following 152 houses have been inspected during the year. The general conditions found are set forth and a statement is given of improvements affected and the present condition of affairs. Fairfield South—4 houses; Brook's Passage—2 houses; Brook's Cottages—4 houses: Mill Place—2 houses. These houses are all close together and belong to one owner. Brook's Cottages, 4 houses in a row, are comparatively modern and in good structural condition, the others, semi-detached, are much older, possibly a hundred years, and might be described as wornout houses. The bricks are of poor quality and the design and workmanship indifferent. The requirements set forth were pointing of brickwork, cementing of walls, paving of yards, repair or renewal of guttering and stack pipes, cement concrete over the floor area and proper flushing cisterns to the w.c.'s Some of the work has been done and the rest is in slow progress. The owner has no capital and is obliged to have the work done as she is able to pay for it out of her rents as they are collected weekly. Portman Road.—Ten pairs of Houses, semi-detached on either side of the road. Buildings of indifferent materials and workmanship. The remaining houses in the road are quite modern 16 and built under By-laws. The houses inspected have had their drainage improved, tar paving laid on yards and paths, manhole inspection chambers fitted and general repairs carried out. Fairfield North.—Eight houses, probably structurally about the worst in the Borough. Small rooms, low ceilings, very old decayed brickwork, drainage and sanitary appliances most indifferent. With one exception they were inhabited by migratory tenants. A closing order was applied for. This was granted for five out of the eight houses. The owners agreed to repair three houses on a strict specification drawn up by the Borough Surveyor. After the closing order was enforced the mortgagees submitted plans for renovation and partial re-building of two of the houses closed. Work is now in hand for re-draining of the houses, 6in concrete under floors, adding to the size of rooms by bay windows, raising of roofs to make bedrooms 8ft. 6in. high, provision of a w.c. for each house, a proper water supply and fencing in of the gardens of each house. The yards and ground adjoining the houses to be concreted 4in. deep. The work is being supervised by the Inspector of new buildings. Three houses still remain closed. Fairfield North.—Four houses on the opposite side of the way—uneven numbers. These are small two roomed houses backing on to an enclosed narrow yard in which are two w.c's for the four houses. The only through ventilation is through the back doors, which open directly facing the w.c's. The windows are all facing the street. The rooms are very low and the floors of the sitting rooms are below the level of the pavement. The staircases are narrow and steep. It was barely possible to improve these houses and a closing order was applied for and granted. They are now closed. Fairfield North.—Ten other houses on the same side of the road. Eight of these houses in a row are badly planned and in indifferent repair. The backs are lower than the street level and 17 open no to a narrow yard in which are w.c's, and one tap for supply of water. A list of requirements have been sent to the owners but there is a probable change of ownership in contemplation and a short time is being allowed before further proceedings are taken. There is combined drainage for these houses. Second water tap put on and dustbins provided. Two other houses are in somewhat better condition and are being repaired. Fairfield North.—Ten houses distinct from the above. Only minor dilapidations were found in three houses which are being set right. Elm Grove.—Thirty-six houses on either side of this road have been inspected and attention called to lesser structural defects. These houses are drained by combined drains running through the gardens into Elm Road, Elm Crescent and Canbury Park Road. These drains work well. Roofs and general repairs have been made good. Walter Street.—Twelve houses, all poorly built and of considerable age. The street is narrow and the houses open directly on the footpath. General dilapidations are being set right and the houses are being cleansed. Elm Road.—Two houses requiring general repairs and six others in a row with combined drainage and in need of more extensive structural work. These houses are occupied by migratory tenants and the owner can only pay for repairs weekly when the rents are collected. Cleansing of rooms, paving of yards, repair of guttering and pointing of brickwork is being done one house at a time. Elton Road.- Thirty-two houses in a cul-de-sac. The houses on either side have a combined drain, that on the north side having been recently re-laid with manholes and proper connections. Two of the houses have pump water, but the rest have storage cisterns supplied with M.W.B's. water, with taps on the house 18 pipes. Their are several ownerships here and the tenants are mostly very poor. Some of the houses are let directly by the owners to lodgers. Constant supervision is required for these houses at all times. The requirements in the way of repairs are being complied with—withr eluctance. The result of these inspections may be considered satisfactory. The results are not satisfactorily obtained without many visits, letters and conferences, and the Inspector, Mr. Pierce, has gone steadily and thoroughly through the work. One of the difficulties experienced has been with owners who are little, if any, better off than their tenants. Another difficulty is with the tenants. Many of these persons are well-known to the officials. Their children are frequently absent from school with parasitic complaints and they are constantly on the move from one undesirable dwelling to another. It is to be hoped by insistance on sanitary conditions these classes of persons may improve. In selecting houses for inspection a previous knowledge of the property has been used. The Inspector has not begun in one quarter and gone steadily through the district but has moved about the town. In this way owners have been kept alive, as they do not know when the inspection of their own property will be taken. In those cases where some time has been allowed for making improvements, further inspections will be made and when necessary closing orders will be applied for. SCARLET FEVER. There were niney-three notifications of Scarlet Fever and two deaths. One of the deaths was in a child of two, returned as Bronchitis after Scarlet Fever of a very mild character. The other death was in a tuberculous case sent from Richmond Hospital to the Richmond Isolation Hospital. 19 An outbreak of seven oases occurred amongst scholars attending a small private school in the early spring. After the summer holidays a somewhat similar outbreak was noted in another private school. These cases were all exceedingly mild. A child coming from Norfolk in September developed Scarlet Fever about 17 or 18 days after arrival, and two other persons in the house were taken ill eight days later. There was no apparent possibility of infection after arrival. Thirty-four cases were sent to Hampton Isolation and two to Tolworth Hospital, the latter two being persons belonging to Maiden, who developed the disease in Kingston; one in a private school aud one in the Kingston Victoria Hospital. The average stay in hospital during the whole year was 49 days per case sent, but it was noted that during the very hot weather the stay was somewhat longer, being 56.3 days against 46 9 for the rest of the year. DIPHTHERIA. The chief matter of interest, in the incidence of this disease was the outbreak in two schools in the month of October. On October 29th a notification of Diphtheria was received and by the same post a copy of the registration of death. The child was attending Richmond Road Infants' School. On the 31st another fatal case was notified under similar circumstances. This child was in the same class as the first case. Eleven other cases occurred during the following fortnight, all in the same class except one. The school was visited and the children inspected. From three children whose throats looked most suspicious swabbings were taken before they were sent home. The other children in the class who had enlarged tonsils or enlarged glands under the angle of the jaw were sent home with a cautioning letter. One of the swabbings was reported to contain Klebs-Loeffler bacilli. This child was the sister of a child who had suffered from 20 Diphtheria on October 4th, 1910. The medical man in attendance on this last year's case described it as quite mild in character, but the presence of the bacilli was very persistent. The child was declared well on November 8th and allowed to return to school on November 21st. I visited this house and took swabbings from the throats of the children. Both the patient of last year and the suspected child from the infected class were found to have the bacilli present, and it was not until January, 1912 that two successive negative reports showing absence of Diphtheria bacilli were received from the Lister Institute. At the expiration of fourteen days from the receipt of this freedom report these children were allowed to return to school. One of the children sent home from the class as somewhat suspicious went.away on a visit to cousins in Middlesex. Eight days after his arrival with them a Diphtheria case occurred in the family which proved fatal. On his return to Kingston his throat was swabbed and the Diphtheria bacillus reported as present. The result was communicated to the Medical Officer of Health for the district. It was not until January 13th, 1912 that a negative result was obtained. As already indicated only one case occurred in a child attending this school who was not in the infected class. The last case notified in connection with this outbreak was on Nov. 21. The outbreak at St. Luke's Infants' School ran almost simultaneously. On October 31st a case of Diphtheria was notified, followed almost directly by a registration of death. This family, after the house was disinfected, removed to another street where a secondary case was notified in a child not of school age on Dec. 5. The next fatal case died on November 1st—notified October 24th —was secondary to a case notified on October 2lst. Nine further cases occurred in children attending this school. This school has not separate rooms for all classes, three classes being taught in a large hall separated by movable curtains. All the children who complained of sore throat were inspected and several swabbings taken with negative results. A case was notified from Great 21 Ormond Street Hospital with Diphtheria in a child under school age. This child was the brother of a child attending this school, and this scholar was excluded during the course of the outbreak. One fatal case in a very young child was reported to me, and on enquiry found to be in connection with this outbreak. A sister was also attacked later on. It was found when the case was visited that an elder child who had been at St. Luke's School was suffering from a slight sore throat and the bacillus, was detected in a swabbing. As at the other school every child found with signs of recent sore throat was excluded from school. In both schools the children were given Formalin lozenges containing 1/8-grain dry Formalin with Sacch. Lact. gr. 2 and Acid Citric Sacch. Alb. and Rose flavouring. One lozenge was given on assembling in the morning; one before leaving at mid-day; one on re-assembling in the afternoon and one on leaving at 4 p.m. Another child from the school died in the course of the outbreak, and also a child of two whose sister had been attending but had large tonsils. Swabbings were not taken in the latter case. In the other fatal case the swabbings gave a negative result on two occasions. Other cases of Diphtheria have been notified during the year but these were isolated cases such as are frequently observed in this Town. In addition there were 29 cases in the Workhouse, apparently arising from two primary cases. The Medical Officers at the Workhouse believe these children get infected originally by visitors This Union consists of the sanitary districts of Kingston, Wimbledon, Surbiton, Maiden, Ham, The Dittous and Molesey in Surrey, and Teddington, Hampton and Hampton Wick in Middlesex. The friends of the Workhouse children are mostly of a migratory class and frequently move from one district to another, and they are of the careless class who rarely call in medical aid until the patient is dangerously ill. It seems to be almost impossible to make any regulations that would keep infection of this kind out of the Workhouse. A reduction in the size of the wards in which the children are nursed seems to be almost the only preventive 22 measure, and this means a very large increase in structural expense and in the cost of supervision. In only a small number of these cases was the Diphtheria bacillus detected, and all were very mild cases. The arrangements for the supply of Anti-toxin have proved quite satisfactory in working. Two chemists undertake to keep a supply obtained from wholesale houses of good repute, and the doctor can obtain supplies at any hour of the day or night. The account is sent in to the Borough Accountant and approved for payment by the Committee on my signature. All the cases which are reached in time are treated with Anti-toxin. The medical men are asked to obtain two negative reports from the Lister Institute before declaring the patient well. Several of the doctors make a practice of this and the practice is being extended. The examinations are paid for under contract with the Lister Institute by the Corporation. MEASLES (26 deaths). There was a considerable prevalence of this disease in January, February and March. On February 28th the attendances in the Infants' Schools was so poor that I advised closure of that department in all schools for a month. Later on St. Agatha's Mixed School was also closed, partly on account of Measles and partly for Mumps. MUMPS. This disease has still continued to be prevalent and was an additional trouble during the Measles epidemic. St. John's Girls School was closed in March for three weeks on account of the very poor attendance. The closure of St. Agatha's Mixed Department was partly due to this disease. There are still a few cases in the schools, but it seems to be gradually dying out after nearly two years' prevalence. 28 TUBERCULOSIS AND CONSUMPTION. This disease will henceforth be compulsorily notifiable. Hitherto the Poor Law Medical Officers and Hospitals, only, have notified ; and such cases, only, are referred to here. Under the Insurance Act the Commissioners will shortly issue regulations concerning the provision of Sanatoria by Local Authorities. It will be necessary for you to consider this subject very carefully, as the two questions of Prevention and Treatment may both of them be dealt with under the Act. As a Sanitary Authority Prevention has the first claim upon you and it is for this reason that the term Tuberculosis is used rather than Consumption. Tuberculosis may apply to the disease in any stage, affecting any part of the body, and it will be by observing commencing cases. particularly amongst the young, that the prevention, and it is hoped the extermination, of this disease may be achieved. The term Consumption is usually applied to definite Tuberculosis affecting the lungs. A few of these cases may be benefitted by sanatorium treatment and in nearly all cases life would be prolonged by continued residence in such institutions. It will however be hardly possible to treat all cases and it will therefore be necessary to consider what is most beneficial considering the means likely to be placed at our disposal. Sanatorium treatment can be carried out, as at Benenden and elsewhere, in quite inexpensive shelters when the cases are in early stages likely to reap permanent benefit. This of course, from a preventive point of view, is of great importance, but we shall hav® also to consider what is to be done with the more advanced cases. Persons with the disease fairly well advanced can receive great benefit by a change to fresh country air and pleasant surroundings, but such cases cannot be treated in light shelters, they need the care and attention of a hospital, and this implies great increase in the expenses of upkeep and management. It must also be borne in mind that such cases have little or no hope of permanent health when they return to their old surroundings after discharge from the hospital sanatorium in apparent health. This as you will see 24 will for some years to come be a great difficulty in Sanatorium treatment as the Insurance Committees will be anxious to see these people well cared for, and the Local Authorities will be glad to see them removed from surroundings where they cannot but get worse, but will also be the means of spreading the disease to others with whom they are in daily contact. There is also to be considered the class of case which is in its final stage. The Workhouse Infirmary would seem to be the proper place for these unfortuuate persons were it not for the odium that attaches to the workhouse in the minds of the poor. The only suggestion I can make on this point is the erection of a Consumption Ward, at, or the renting of one of the houses adjoining the Kingston Victoria Hospital, in which such cases could be housed and cared for under the superintendence of the Hospital Authorities. The charge would come under the working of the Insurance Act. From a prevention point of view the greatest hope would be in the treatment of the young. There are many chiidren in our schools who are in a condition liable to degenerate into Tuberculosis and Consumption, and there are also children too ill to attend an ordinary elementary school who would benefit greatly, and in most cases permanently, if cared for in an open-air school. They would in all probability quickly get back to normal health and many would on return to the elementary school, do well educationally and grow up into useful citizens. Such a school must of course be regarded more in the light of a sanatorium than a school. Whilst children are in the open-air school the teaching must be only the secondary, the recovery of health the primary consideration. Luckily there is land belonging to the Corporation on which such a school could be established at a comparatively small cost. Sixty-one notifications were received during last year, twentyseven being from the following Hospitais and Sanatoria:— Brompton Hospital 11 ; City Road Hospital 1 ; Mount Vernon 25 Hospital 2; Richmond Hospital 1; King's College Hospital 1; St. Thomas' Hospital 1 ;Royal Waterloo Hospital 3; St. Anthony's Sanatorium, Cheam 1; Benenden Sanatorium 1; Frimley Sanatorium 1; Ventnor Sanatorium 2; Private Sources 2. Total 27. Thirty-nine cases were notified by the Poor Law Medical Officers. Seven of these were persons residing in their own homes in Kingston; 32 were in the Workhouse Infirmary. These came from the following places—10 belonged to Kingston; 7 to Wimbledon; 1 to London; 5 to Molesey; 3 to The Dittons; 1 to New Maiden; 1 to Surbiton; 2 to Teddington; 1 to Merton; and 1 was a Casual. Visits were paid to 31 houses and advice given to the patients on adapting their mode of life to the treatment of their disease, and the prevention of spread of infection to others. Cards of advice were given and changes of occupation, emigration to a more suitable climate, and other matters were discussed with the patients. Letters were written to the War Office and Chelsea Hospital on behalf of an Army Reserve man and a small pension was eventually secured for him. The exciting cause, trade influence, or family history wiis given by certain of the patients and is herein noted :—(1) Weakness coming on after fracture of leg. His wife died of Phthisis. —(2) Standing in mantle department, for many hours daily.—(3) Brother died of Phthisis.—(4) Mother died of Phthisis.—(5) History unknown, but daughter is a cripple from Tuberculosis.— (8) Chronic Bronchial Catarrh for some years.—(7) Hot workshop and chill on coming out.—(8) Enteric Fever in India, followed by Catarrh.—(9) Trade of bookbinder.—(10) Trade as potman.—(11) Tubercular Meningitis.—(12) Sister died of Phthisis.—(13) Attack of Pleurisy four years ago, never well since. In the other cases no cause could be ascertained. ENTERIC FEVER. Ten cases notified. No deaths. Mar. 16. This patient, aged 16, was stated to have suffered recently from Appendicitis, not operated on. No cause traced 26 Aug. 28. A boy aged 13 taken ill a week after coming into the Borough. Previously in Chiswick and Cornwall. No definite history. Sent to Kingston Victoria Hospital. Aug. 29. A woman aged 54. Complained of bad smells from gully. This gully was flushed frequently. No nuisance detected. Sept. 8. .A girl aged 12½. A mild case with indefinite symptoms. Sent to Kingston Victoria Hospital. 62 days in hospital. ' Sept. 27. Girl aged 14. Ill about eight days. Had been at seaside in August. Said not to have had any shell fish. House not of best period as regards sanitary arrangements but no defects or probable exciting cause found. A younger sister developed a mild attack in beginning of November. Possibly contracted from the previous case—then convalescent. Oct. 7. A man aged 48. Ill ten days. Ate oysters at Yarmouth three weeks before first ill. A plumber, he had been engaged on various drainage works. Kingston Victoria Hospital 47 days. Oct. 31. A man aged 24. Had been at Norwich less than three weeks before illness. No disease notified where he stayed. Drinks pump water. Fairly good on analysis. Has used the water all his life. Kingston Victoria Hospital 54 days. Nov. 6. A boy aged 15. Works as a printer. Delicate lad, no definite history. Kingston Victoria Hospital 65 days. Dec. 14. A man aged 33. Had been 14 days in Kingston Victoria Hospital before the disease was diagnosed. Ate oysters November 17. They were not purchased locally—address of shop not known. Works on a steam tug between Kingston and Woolwich. 62 days in hospital. WHOOPING COUGH. This disease showed signs of commencing epidemic before the Christmas holidays.* * The epidemic assumed considerable dimensions in one large school and two smaller ones, 2 7 INFANT ILK DIARRHœA. It was to be expected that deaths from this disease would occur during the excessively hot Summer. The numbers for the quarter April to June were 1 under 1 year of age and 2 over, for the quarter July to September, 24 under 1 year of age and 5 over, and for the last quarter 6 under 1 year of age and 1 over. In the Jnly quarter the deaths were 26 under 2 years of age as compared with 32 in Aldershot and 38 in Wimbledon. The Surrey rates for Infantile Mortality during the same period : — Aldershot, 182 per 1000 births. Guildford, 142 „ Kingston, 174 „ Penge, 152 „ Reigate, 137 „ Richmond, 170 „ Wimbledon 139 „ The number of deaths from this disease under 2 years works out at 26 per 1000 births. Amongst the lowest rates are 146 in Hornsey and 1.88 in Bournemouth. In certain manufacturing towns the rate went up to 7 and 8 per 1000. The rate for England and Wales minus the 77 great towns was 2 47 per 1000. almost identical with our own. In other years of epidemic prevalence the rates have been in this town:— 1899 5.8 per 1000 1904 5.0 „ 1906 2.5 „ In other years the rate has been below 1 per 1000. 28 NOTIFICATION OF BIRTHS ACT. Came into Force Feb. 1st, 1909. 1909. 1910. 1911. Total Births 850 865 873 Notified 792 738 762 Mothers Visited 48 30 37 Still Births notified 14 13 8 Attended by Midwives S54 343 376 A larger proportion of the births notified this year have been attended by medical men. Nine midwives have registered to practice in the town. One-tenth of the mothers attended by midwives have been visited. The visit was appreciated in every case. Nearly all the mothers nursed their babies. Most of the fathers were in work, and in no one case did I find any signs of extreme poverty. The three cases of Puerperal Fever notified in the Workhouse Infirmary did not belong to Kingston. Of the two others one followed on a case of absortion. Cards of Advice are sent out in every case, and one further objection has been raised to their being sent. 114 more births were registered than notifications received, and four were notified to me but escaped registration, having left the Borough. The notifications in the later weeks of the year are of births that will be registered far on in the new year. 67 Registrations in 1212 refer to births in 1911. The checking of the two returns causes considerable labour and time, and the work would be greatly facilitated if all the medical men would send in cards, or make certain that they are sent in, as the Act directs. * The period of this return does not quite coincide with that of total births. CONDITIONS AS TO VACCINATION. Successfully Vaccinated. Insusceptible. Exempted by Statutory Declaration. Died unvaccinated. Postponed. Removed. Removed to places unknown. Defaulters. Total Births in Kingston, Maiden, and Ham, Jan., 1909, to June, 1910. , 1819 1178 10 381 109 20 8 105 8 July, 1910, to June, 1911. 1168 677 2 294 86 29 4 62 14 Births in Kingston only during these periods, Figures supplied by Mr. W. D. Elsam, Vaccination Officer. INQUESTS IN 1911. Disease. Injury. Drowning. Poison. Not belonging to Borough. January 3 2 — — 1 February 4 4 — — 1 March 2 4 — — — April 8 1 — — — May 1 — 1 — 1 June — - 1 3 1 July 1 2 1 — 1 August 6 — — — 2 September 2 2 — — 3 October — 1 — — 3 November 2 2 1 — — December — 1 — — 2 TABLE E. Factories, Workshops, Laundries, Workplaces and 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) Workplaces 66 14 Nil Nil 1 l OMEWORKERS' PREMISES 10 Total 91 Nil Nil 3. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts : Want of Cleanliness 5 5 Insufficient Sanitary Accommodation 1 — 1 Total 6 5 1 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) :— Li-ts Outworkers Lists received 6 14 Addresses of Outworkers forwarded to other Authorities 1 received from other Authorities 2 Inspection of Premises... 10 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) 36 Hand laundries 25 Fating places (not hotels) 14 Sausages, etc 4 Bakehouse 29 Various 106 Total number of workshops on Register 214 TABLE IV. INFANT MORTALITY, 1911. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 912 months. Total Deaths under 1 year. All Causes Certified All Causes Uncertified 20 7 5 1 33 14 22 21 16 107 Small-pox 4 4 Chicken-pox Measles Scarlet Fever Diphtheria and Croup. Whooping Cough Diarrhoea 5 13 10 7 36 Enteritis Tuberculosis Meningitis 2 1 3 Abdominal Tuberculosis (6) 1 2 3 Other Tuberculosis Diseases Congenital Malforma- tions (c) 4 2 6 6 Premature Birth 8 4 2 14 1 2 1 18 Atrophy, Debility and Marasmus 2 2 1 5 4 9 Atelectasis 1 1 I Injury at Birth 2 1 3 3 Erysipelas Syphilis 1 1 1 Rickets Meningitis (not Tuberculosis) Convulsions 2 1 3 2 1 6 Gastritis Laryngitis . 1 1 Bronchitis 1 1 1 3 Pneumonia (all forms) 1 3 1 5 Suffocation, overlaying 1 1 1 3 Other Causes 1 2 1 1 5 20 7 5 1 33 14 22 21 16 107 Nett Births in the Year Legitimate 823 Illegitimate 50 Nett Deaths in the Year of Legitimate Infants 94 Illegitimate ,, 13 32 RAINFALL AT SEWAGE WORKS. Kingston-on-Thames, 1910. 1902 * 1903 † 1904 † 1905 ‡ 1906 ‡ 1907 ‡ 1910 ‡ 1911 Inches. Inches. Inches. Inches. Inches. Inches. Inches. Inches Jan. .78 2.44 2.74 .61 3.85 .82 1.85 1.34 Feb. .78 1.12 2.41 .80 1.67 1.3 3.18 1.23 Mar. 1.69 2.57 1.39 4.03 1.15 .85 1.19 1.59 Apr. .64 1.69 103 1.68 .49 3.45 1.36 2.06 May 2.53 2.07 2.16 1.03 1.26 1.73 1.83 236 June 3.79 6.37 .8 4.84 2.71 2.27 2.73 2.35 July 1.56 4.48 1.5 1.07 .90 1.13 3.84 .78 Aug. 2.70 4.30 1.59 2.85 1.21 2.42 2.97 1.11 Sept. 2.57 3.21 1.5 1.67 2.97 .51 .87 1.39 Oct. 1.46 5.02 1.64 1.36 4.37 3.99 3.15 3.21 Nov. 1.61 2.04 1.56 3.39 4.19 2.24 3.23 8.62 Dec. 1.49 1.51 1.97 .60 2.22 8.56 4.0 5.23 Total 21.55 86.82 20.16 23.93 26.99 24.27 30.26 26.27 * Countv Hall. †West Molesey. ‡ Kingston Sewage Works. 33 SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1911. Choked and defective drains 340 New drainage to houses 26 Defective closets and syphons 30 Defective interceptors, traps, etc 20 Defective soil pipes and ventilators 16 Defective water apparatus to closets 70 To lay on water supply to closets 6 To provide separate cisterns for flushing closets 2 Foul drinking water cisterns 40 To cleanse and limewash houses 48 To cleanse and disinfect houses 180 To cleanse urinals adjoining public roads 26 To repair and alter urinals 8 Inspecting urinals adjoining public roads 1500 Dilapidated houses 20 Accumulation of manure, offal, etc. 74 Pig keeping (a nuisance) 1 Fowl keeping (a nuisance) 20 Overcrowding of houses 10 Canal Boats Act, &c. Canal Boats and Barges inspected 72 Offences in Contravention of Canal Boats Acts 20 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 320 Notices served to Householders, etc. 280 Notices served to School Attendance Officer 240 Notices served to Schools 250 Notices served to Librarian 129 Disinfecting houses after Infectious Diseases 170 Testing drains after Infectious Diseases 40 34 The Slaughter-houses, Cowshed, 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 :— 106 lbs. of Beef. 82 lbs. of Ox Livers. 3 Sheep. 18 lbs. Beef Kidneys. 36 Sheeps Plucks. 20 lbs. of Tripe. 64 lbs. of Lamb. 3 cases of Herring. 12 lbs. of Lambs Tongues. 2 cases of Mackerel. 5 Ox Tongues. 6 bushels of Winkles. 101 Ox Tails. 167 Rabbits. 17 lbs. Ox Sweetbreads. 24 Chickens. 4 boxes of Tomatoes. FRED. J. PEARCE, A.R.S.I., Sanitary f nspector. January, 1912. SALES UNDER "FOODS & DRUGS ACT." Table shewing Number of Samples Purchased and Proceedings Taken in Kingston during the Year 1911. Articles Purchased. *o . oc JH 2 S- II .S S 3 3 o JM ° TS £ •5% « pC C8 o tc u •— -o - jq o co . •3 tpfl "t c d ^ id s s3 ., o » (U O u o CD %■* ■ H O o .3 *> c3 C ^ u° Fines Inflicted. Milk 37 29 5 3 3 £6 6 0 Butter... 41 41 — — — — Lard ... 5 5 — — — Demerara Sugar 4 4 — — — — Spirits 3 3 — - — — — Cocoa o 2 — — — — Dutch Cheese 2 — 2 — — — Baking Powder 1 1 — — — — Mustard 1 1 — — — — White Pepper... 1 1 — — — — Iodine 1 1 — — — — Totals 98 88 7 3 3 £6 6 0 R. A HOUGHTON, County Inspector.