KIN061 BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT OF THE Medical Officer of Health For the Year ending December 31st, 1913. T. J. S. Guilford & Co., Ltd., Printers, Kingston-on-Thames. 3 ABSTRACT OF WORK OF THE MEDICAL OFFICER. Visits of Enquiry in cases of Infectious Disease 126 „ „ ,, Workshops, etc. 79 ,, in regard to Insanitary Conditions 57 ,, ,, Housing of Working Classes Act. 123 ,, on behalf of the School Attendance Committee 601 „ to Schools 95 ,, ,, Truants 6 ,, ,, Common Lodging Houses 6 ,, ,, Houses to let in Lodgings 7 „ „ Small Pox, Plague and Cholera Contacts 4 ,, Inspection of Markets 35 ,, ,, of Dairies 29 ., ,, of Mortuary 3 Notification of Births Act 56 Visits of Enquiry to Places outside District 4 Consultations with Medical Practitioners, &c. 28 Slaughter Houses 3 Visits to Consumptives 193 Total Visits 1455 Complaints of Bad Food 5 „ of Overcrowding 8 Letters, etc., written 65 Notices served, Reports, etc. 77 Samples of Drinking Water Reported on 6 H. BEALE COLLINS. 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 5 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. 6 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. Municipal Offices, January, 1914. Gentlemen, I have the honour to present to you my Twenty.first Annual Report on the Health of the Borough of Kingstonupon-Thames. Estimated Population, 38,433. Birth Rate 23 per 1,000 per annum. ,, ,, ,, average of previous 10 years. ., 23.9 „ ,, England and Wales, 1913. ,, 23.9 ,, ,, ,, Small Towns, 1913 ,, 22.2 ,, ,, England and Wales, rural, 1913. Death Rate 11.9 per 1,000 per annum. ,, ,, „ average of previous 10 years. ,, 13.4 ,, ,, England and Wales, 1913. ,, 13. ,, ,, Small Towns, 1913. ,, 12.1 ,, ,, Rural Counties, 1913. Death Rate 72 per 1,000 Births of Infants under 1 year. „ „ „ average of previous 10 years. ,, 109 ,, „ England and Wales, 1913. ,, 112 „ „ Small Towns, 1913. „ 96 ,, ,, Rural Counties, 1913. Epidemic Diseases .8 per 1,000 per annum. TABLE 1. Vital Statistics of Births and Deaths for the Whole District during 1913 and previous Years. Year. 1 Population estimated to Middle of each year 2 Births. Total Deaths Registered In the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. of Nonresidents registered in the District 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. Number. 10 Rate per 1,000 NettBirths 12 Number. 12 Rate. 13 Number 4 Rate. 5 Number. 6 Rate, 7 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 1912 38,433 861 835 21.7 613 15.9 144 46 87 96 514 13.3 1913 39,000 892 898 23.0 670 17.1 189 42 65 72 465 11.9 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 Census of 1911) 8,726 Average number of persons per house ,, 4.3 Institutions 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. Molesey Isolation Hospital. Estimated Population. 39,000. 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. Small-pox. Measles. Scarlet Fever. Enteric Fever. Epidemic Influenza. Whooping Cough. Diphtheria. Erysipelas. Rheumatism. Epidemic Enteritis (Summer Diarrhoea). Convulsions. Nephritis. Syphilis & Gon. Opth. Tuberculous Meningitis. Phthisis. Other Tubercular Diseases. Cancer. Bronchitis. Pneumonia, all forms. Other Diseases of Respiration. Alcoholism. Cirrhosis. Puerperal Fever. Accidents of Parturition. Premature Birth. Appendicitis. Other Diseases Defined. Heart Disease. Meningitis. Violent Deaths. Suicide. Suffocation, overlying. Other Diseases, ill-defined. Total. No. Rate per 1,000 per annum. Years Vaccinated. Re-vaccinated. Unvaccinated. Professional Trading Proletariate IIIegitimate No. Rate per 1,000 Births. No. Rate per 1,000 per annum. No. Rate per 1,000 per annum. M. F. M. F. M. F. M. F. JANUARY 44 32 21.4 13 51 12 4 4 106 34 36 21.4 33 20 6 56 15.3 FEBRUARY 40 20 1 11 45 3 3 5 106 24 27 16 16 35 MARCH 48 35 5 3 67 8 3 40 50 38 53 33 4 59 APRIL 40 31 21.4 2 9 57 3 1 1 26 17 34 14.5 30 23 5 33 10. 6 MAY 36 36 12 55 5 3 1 53 23 22 19 15 3 33 JUNE 40 36 15 56 5 3 1 53 27 19 22 17 3 32 Under 1 1 1 15 2 3 2 1 7 5 1 18 4 3 2 65 JULY 50 46 22.9 3 9 80 4 2 1 40 18 17 11.5 14 10 3 28 10.2 Over 1 3 1 14 2 1 1 7 16 1 40 1 20 21 28 24 5 2 8 3 4 127 32 7 23 9 400 AUGUST 40 27 1 18 44 4 4 2 79 22 20 15 7 5 40 SEPTEMBER 27 33 13 43 4 4 3 93 18 16 10 7 5 32 • OCTOBER 32 34 1 11 50 4 5 1 80 21 24 l5.3 19 11 2 36 12.0 NOVEMBER 50 45 11 75 9 5 2 93 32 99 37 19 4 46 DECEMBER 31 39 14 53 3 3 4 93 93 21 20 11 2 35 BIRTHS AND DEATHS IN INSTITUTIONS, OUTSIDE, OF PERSONS BELONGING TO THE BOROUGH] 2 4 2 4 24 18 TOTALS 480 418 23.0 13 139 678 68 40 25 72 349 321 17.1 288 189 42 465 11.9 TABLE II. Cases of Infectious Disease notified during the Year 1913. NOTIFIABLE DISEASES. 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 1 2 3 i 5 6 Not belonging to Kingston. At all Ages. At Agest—Years. Under 1 1-5 5-15 15-25 25-45 45-65 65 and over. Town Ward. C'nb'ry Ward. Barracks. Hill word. Workhouse. Nrbtn. Ward. Diptheria (including Membranous Croup) 71 1 11 31 16 9 3 20 1 21 20 16 13 22 Erysipelas 31 4+ + 3 2 2 10 12 6 1 6 3 13 8 Scarlet Fever 42 1 13 19 7 2 17 1 8 11 9 13 12 Enteric Fever 1 1 1 1 Puerperal Fever 4 1 3 2* 4 2* 12+ + 1* 1* Acute Poliomyelitis 4 1 2 1 1 2 3 Pulmonary Tubercolosis 129 3 7 12 34 57 14 2 18 39 1 24 4 43 79+ Other forms of Tubercolosis 35 1 7 18 2 4 2 1 3 8 1 8 1 14 8+ Totals 7 42 84 63 87 31 9 37 24 82 3 67 45 98 6 125 : Brought in when ill to Workhouse Infirmary. * Case came from Hampton and Teddington. + Sanatorium Treatment, under Insurance Act and otherwise. Kingston Victoria Hospital for Enteric Fever ; Hampton Hospital for Scarlet Fever ; Molesey Hospital for Diphtheria; Surrey Joint Hospital for Small Pox ; and Sanatoria are available for Tuberculosis. 10 A memorandum of the Local Government Board 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 two 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. 11 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. Social Conditions and Occupations. The population is roughly about 1000th of the total population of England and Wales. The distribution of population is about the same as for the country generally as to Male and Female, Rich and Poor and numbers of Children. There is no staple industry. A large number of women are employed in Laundries, Soda Water Works, Beer Bottling, &c. In many cases these women are the keepers of the house as the men are only casually employed, on the river, &c. There are fewer empty houses in the Borough than last year. Those of the better class are old-fashioned in design and not now popular. There is also less demand for big houses as the families of the well-to-do of all classes tend to be smaller. Amongst working class property there are not a great number of empty houses. Trading is largely restricted to the centre of the town since the advent of trams and motor omnibusses. A large flying machine manufactory has recently been started. 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 12 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 has now been completed 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 arises from the system of combined drains in certain districts. It is to be hoped that the law on this matter will be amended shortly, so that the present difficulties may be done away, thus obviating expensive law processes. The sewage on arrival at the works is deodorized before pumping by mixture with Charcoal and Clay. It is then precipitated with Sulphate of Aluminia, manufactured on the Works, in eight large settling tanks and is then conveyed through percolating filters before discharge into the Thames. The tank capacity is 1,200,000 gallons, and the filter capacity 7,566 cubic yards. The average daily flow from Kingston (pop. 39,000) and Hampton Wick (pop. 4,000) is about 1,640,000 gallons, equal to 39 gallons per head of population. The sludge from the tanks is pressed. The treatment is known as the A.B.C. and at the works are under the sole control of the Corporation. The sludge is barged away by the Native Guano Co. who complete the process elsewhere. Dr. Gilbert Fowler, of Manchester, describes the Kingston effluent as "perhaps the most brilliant clarified effluent produced in this country." 13 A large storm overflow tank has been installed, thereby preventing the discharge of untreated sewage into the river, on the occasions of heavy rainfall. 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 furtilizer 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 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 have been 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 and urinals adjacent to the Market Place and on the Canbury Table of Average Analysis of Effluent for the Year ending December 31st, 1912. Chlorine grs. per gallon. Free NH3 parts per Mill. Albd. NH3 parts per Mill. % Purification. Final Discharge 5.75 24.47 1.37 Filtrate 5.69 18.85 .88 Average Results of Tests for Purification: % of Filters :— Tank Effluent 6.1 46.1 3.3 Filtrate No. 7 Filter 6.2 25.2 .97 70.6 14 Gardens. New public urinals are to be erected near the Railway Station and on the widened Kingston Bridge, making a total of eight under municipal control. Those attached to Public Houses are all under regular supervision. 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 regard to watercourses seem to be very great, and some simplification of the law is required. The Latchmere 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 northeast part of the town. It is a very slow running stream and only partly under the control of this Corporation. Excrement Disposal—System in vogue—Defects, if any. Water carriage is universal, and satisfactory, I think 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, 15 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. Some low lying ground outside the Borough but the property of the Corporation is being filled up with refuse from those streets adjacent thereto. The Corporation have recently purchased 32 acres of land adjacent to the land round the Dust Destructor. 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 ond 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 house which had lost its license. The house is roomy and well-kept. There are many houses let in lodgings, and By-laws in regard to them have been approved and a register of the houses is now being established. The six Slaughterhouses are used for killing a few sheep and pigs. They are kept in good condition. The five Cowsheds are visited quarterly and are wellkept on the whole. The largest cowkeeper in the town has his shed very well-kept, and has appliances for cooling milk, terilizing cans, &c., and is always doing everything he can to improve his premises. 16 By-laws. The By-laws in force are fairly stringent and I do not think any addition is required at the present time, though they might be varied in certain particulars. 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 made by a Joint Committee of the County Council for the use of the two Smallpox Hospitals at Clandon and Whitemoor. 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 local Hospital Treatment would have little effect upon such cases. 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. Enteric Fever is treated in the Kingston Victoria Hospital, payment being made by the Corporation. 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. The Condition of the Streets and Scavenging. This work is well done all over the town. The roads have wood paving in the central district and on the main roads where trams run, and further out rodament, tar 17 macadam, plascom, or simple tarring has been laid down to prevent dust and mud. Watering is carried out daily in Summer, Sundays included. A special tank van is used for flushing sewers. This is used with greater frequency in Summer weather. The road surfaces compare very favourably with those in neighbouring districts, and the clean hard surface must to some extent diminish the amount of fog and enables people to get about in wet weather with much less discomfort and liability to colds. HOUSING AND TOWN PLANNING ACT. Notes on Houses reported in year 1912. Cowleaze Road.—No. 23.—This house has been thoroughly repaired, and a new scullery with small bedroom over, has been built. The drainage has been relaid with inspection chambers and the ground area has been laid in concrete with new flooring. Damp courses were put in. The house is now fit for habitation. Closing order has been removed. Hawks Road.—Six old houses. Closing order served 28th January. These are being used as a builders store and advertisement station. The approach by the side passage has been closed by a locked gate. Fairfield, N.—These houses have been put into fair condition. They are now habitable but not very first rate. Waller's Cottages.—1, 2, 3, 4, 5. These houses have been closed. The property is for sale. 1913. The further inspection of the district known as the Bittoms has been proceeded with. Berry Cottage.—Six roomed house, 10x9½x7 four rooms, two rooms 12 x 7 X 7. General repairs carried out. 18 Oaklea Passage.—22, 23, 24, 25, 26. Two roomed houses. Rooms both 13xllx7½ with a cellar under living room. These houses have a blank wall at back. There is no through ventilation but they are mostly occupied by man and wife only. One couple have one child, one couple two children, W.C.'s. are outside the buildings. In good condition. Oaklea Passage.—17, 18, 19, 20, 21. Four roomed houses. 11X 11½x8 Parlour. 10 X 11½ X 8 Kitchen. 11x11 x 8 Bedroom. 10 x 11 x8 ,, No. 17 has six persons, the others all less. Tap on main. General repairs. Paving of yards. 1 and 2, Bays Cottages.—These houses were very damp. Damp courses inserted. Concrete under floors, and air bricks inserted. Drains relaid with manholes, &c. Now in fair repair and condition. Rooms all of fair size. Ht. 7½ feet. Millis Cottages.—1, 2, 3, 4. Four rooms. 11X 11 X 7½ Parlour and Bedroom over. 8½x8½x7½Kitchen and Bedroom over. General repairs and drainage attended to. Peppers Cottages.—1, 2, 3, 4, 5, 6. One storey buildings, three rooms. 14 xl2x8 10½ x 10 x 8 10½ x 10 x 8 Some of the houses varied slightly in size. There are also basement or rather cellar rooms. These were condemned as living rooms, but allowed to be used as wash houses, store rooms, &c. Damp courses were inserted and the external walls repaired. Drains were opened up and 19 relaid. New W.C.'s built, one for each house. Sink and water supply for each house separately. These houses have large gardens. They are now fairly satisfactory. Thair's Cottages.—1, 2, 3, 4. Similar houses to the above. In fairly good condition. General repairs and drainage attended to. Oaklea Passage.—1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Four rooms and scullery. 11x11x7 Parlour and Bedroom. 1, 2, 23. 10x8½x7 Kitchen and Bedroom. 9 x 7½ x 8 Scullery No. 4 is an 8 roomed house, larger rooms. The other houses vary slightly in size. Nos. 9, 10, 11, 12, 13, 14, 15 and 16, have a third bedroom. These houses are not very old. General repairs, drainage paving, &c. were attended to. The houses are now fairly satisfactory. Vine Cottage and 1 and 2, Bittoms Lane.—General repairs carried out. This concludes the inspection of the district of the Bittoms. Barn Yard Cottages, Mill Street.—1, 2, 3, 4, 5, 6. These houses have been thoroughly repaired. Damp courses have been put in, the ground areas concreted, new floors put in and roofs and gutterings repaired. A cement channel was made the whole length of these houses in front to carry the water from the roofs to the gullies and to prevent the heaping up of garden mould against the walls of the houses, thus causing dampness. The W.C.'s and washhouses have been entirely re-built. The drainage has been put in good order. 20 Mill Place.—14, 16, 18, 20. These houses were damp in places. Damp courses have been inserted, concrete under floors and general repairs carried out. An improved drainage system has been laid with manholes, etc. Nos. 8, 10, 12. Damp houses treated as the above. Nos. 6, 22, 24. Remarks apply as above. These houses were all old brick buildings of fair design, but with small rooms. They are now in habitable condition, Fairfield Place.—la, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. These houses are occupied by persons whose labour is more or less of a casual nature. Most of the houses were dirty and after cleansing and redecorating soon lapse into dirt again. The road is a cul-de-sac, which is another disadvantage, a thoroughfare is at any rate superficially tidy. The houses have all been put in fair general repair. Nos. 19 to 34. The above remarks apply to these houses also which are on the opposite side of the street. Swan Cottages.—1, 2, 3, 4. Structurally these houses are not as good as the last lot. They have been put into fair repair. Fairfield South.—27, 28, 29, 30. These houses were reported on in 1912. The owner is a person in narrow circumstances, and was allowed time to do the work, but it was found necessary to threaten her with a closing order if she did not carry out the work more expeditiously. The houses are old and a better plan would have been to pull them down and rebuild, as the site is superior to the buildings. Damp courses have been inserted, concrete has been laid under floors and repairs have been carried out under contract with a fairly satisfactory result. The houses are now fairly habitable. 21 1 and 2, Brooke's Cottages.—These houses, in the same ownership, stand behind the above. They have been put into thorough repair and are now fairly habitable. Mill Cottages.—1, 2, 3, 4. General repairs and cleansing required. This is part of the same property. Mill Place.—15 and 17. The same remarks apply as to Fairfield South above. Canbury Passage.—60, 62, 64, 66. Inspection was requested by the owner who carried out the requirements, mostly general repairs. Nos. 19, 21, 23. Damp and in general disrepair. Drain under house was relaid. Now fairly habitable. Asylum Road.—1, 3, 5, 7. Four rooms and Scullery. No. 9 five rooms and scullery. Nos. 11 to 31 four rooms and scullery. Nos. 2 to 32 north side, all five rooms and scullery. This is a narrow side road running from Cambridge Road to Washington Road. It is inhabited by casual labourers, vagrant persons and Italians. General repairs and cleansing were required, and in fact these are constantly recurring requirements. The houses are in fair structural repair, but the road has become infamous in the comparative respectability of a suburban town, on account of the class of people inhabiting the street. We are told, such people must live somewhere, but there is no necessity for putting them altogether in certain streets. By distributing them in single families, amongst the more respectable quarters, they would adopt the ways of the majority and improve. Hampden Road.—4, 6, 8, 10, 12, 14, 16, 18, 20. These houses were in need of general repairs. They are houses built 50 or 60 years ago and for that period are fairly good. 22 Acre Road.—178 and 180. These houses were inspected by request of the owner, who has carried out the requirements in a fairly satisfactory manner. Union Street.—17 and 19. Two very old houses. They have been pulled down. Cambridge Road.—63, 64, 65, 66, 67, 68, 69, 70, 71. These houses are a row of very small houses built right against the footpath. There is a step down into the sitting room from the front door. They are not at all satisfactory from the point of view of arrangement of rooms, &c., but are in fairly good structural repair. They have been subject to cleansing and general repairs. Nos. 73, 74, 75, 76. A closing order has been applied for, and was served on the owner January 27, 1914, and the houses will probably be demolished. These are very small dilapidated little houses. Some of the walls are in a dangerous state. Nos, 49, 50, 51, 52. Living room and front bedroom 11½ x 11 X 7 Scullery and back bedroom 11 x 9x7 Very old property. Damp walls; imperfect roofs; defective gutterings and R.W. pipes. Floors below the ground level; cemented. Nos. 53, 54. Living room and front bedroom 11 x lO½x 7½ Scullery and back bedroom 10 x 9½ X 6½ Back bedroom not fit for a sleeping room. General repairs needed. Nos. 55 and 56. Living room 11½ x 11X 7 Front bedroom 14 x 12 x 6½ Back bedroom 11 x 7½ X 5½ Washhouse 10½x9 x 6½ 23 The walls of the ground floor are very thick. The floor is cemented but is below the ground level. The back bedroom is not fit for a sleeping room. Nos. 57, 58, 59, 60, 61. Similar to 49 but the floors are on the ground level. These houses are all very old, Nos. 55 and 56 probably dating back some centuries. They have been a constant source of trouble to the Sanitary Authority. About 19 years ago the then owner was prosecuted and fined £"40. The houses were then put into sufficient repair to make them possible as dwelling houses. Each house was provided with a separate W.C. with water supply. Sinks were put in each house with water laid on. Since then complaints have been numerous. On my report, the Sanitary Committee visited the houses and decided to apply for a closing order. The owner asked for a list requirements which was furnished to him. This included raising the roofs of the very low bedrooms referred to; porches over doors to protect the rooms from the weather —all internal walls and ceilings to be properly made good and replastered—window frames, gutterings, R.W. pipes and roofs to be renewed or repaired—two taps to be fitted on the main for drinking purposes. The storage cistern to be cleaned out and properly covered. The drainage to be opened up and put into good order with manholes, &c. Yards and pathways to be paved. The owner declined to carry out these requirements, and a closing order was served on him on January 27, 1914. He has since appealed to the L.G.B. Cambridge Road.—22, 23, 24, 25, 26. General repairs required. Work is being carried out. Canbury Park Road.—1, 3, 5, 7. These are a row of four storied houses usually let in tenements. They are being thoroughly repaired inside and out (15th-23rd December). 24 Nos. 9, 11, 13, 15, 17, 19. These are a row of some what similar houses three stories high. Since last put in order they have been greatly neglected. The owner has been informed of what is required generally. It is considered that each tenement should have a separate W.C., and also be provided with a sink and water supply. He was advised to do one house at a time, so as not to displace too many persons at once. A closing order has been served in respect of No. 15. No work has been begun yet (March 1914). Kings Road.—162, 164, 166, 168, 170, 172, 174. These houses which are let as separate flats one upstairs and one down, were in need of general repairs. These repairs have been carried out and the houses are now satisfactory. It was found impractical to arrange for a W.C. for each flat. Vincent Road.—1, 3, 5, 7, 9, 11, 13, 15, 17. General repairs are being carried out in these houses. Youngs Buildings.—14. This house was very small with low ceilings and in very bad repair. Closing order served March 18. House is closed. Hawks Road.—82, 84, 86, 88, 90, 92, 94, 96, 98, 100, 102, 104, 106. These houses are old structures in need of general repairs. The work has been carried out. Washington Road.—2. This is a very small house apparently the wing of the adjoining house. Rooms very small Dirty and dilapidated. Closing order served December 23rd. The house is now closed. Coombe Road.—1, 3, 5, 7. These are very old cottages. Damp and badly arranged, but the owners agreed to carry out all that was required. The work is carried out slowly and it is hoped the result will be fairly satisfactory. Cambridge Grove Road.—35 and 35a. General repairs needed. The work is being carried out. 25 HOUSING OF THE WORKING CLASSES ACTS. Borough of Kingston-upon-Thames. No. of dwelling houses, Census 1911 7356 New houses built since 71 7427 Number of houses closed by San. Authority 14 ,, ,, demolished for ments and rebuilding 4 Total number of dwelling houses 7409 Estimated number of dwelling houses within limit of rent £16 yearly 4141 Number of houses inspected under £16 226 Above that limit 10 When inspection of such houses will be completed about'1916 A.D. Number of houses found dangerous or injurious to health Under £16 limit 50 Above 6 How many still in that state? Under £16 limit 17 Above 6 Number of dwelling houses found seriously defective from point of view of danger to health or with structural faults Below £16 rental 22 Above 4 26 Number of houses still in such defective condition? Below £16 rental All now are put in fair repair. Above Four are being put in repair. Number of vacant houses suitable for persons of the working classes and in all respects fit for habitation? Possibly 50. Number of houses over- Census return of tenements crowded on the basis of more than two persons per Census returns? room, 312 viz: more than two persons approximate number of to a room? houses containing such ments, 153. Number of new houses Possibly 100 would suffice required for persons of the but must be let at rents that working classes? would make it likely that families would be able to rent sufficient rooms to avoid overcrowding. SCARLET FEVER. 42 cases and no death. 12 were sent to Hospital and did well. The cases were spread fairly over the year. Jan., 2; Feb., 1; March, 3; May, 3; June, 2; July, 1; August, 6; Sept., 5; Oct., 5; Nov., 6 ; Dec., 8. There were9 cases reported from the Workhouse supposed to have originated from visitors. 27 These cases were all of a very mild type, and the history of the following 5 cases seem to suggest that there may be cases so mild as to pass quite unnoticed by those affected. (1) a young dressmaker working at A in a neighbouring district. Nine days later (2) a girl whose sister worked at A, and the same day (3) in another household, but having a sister working at A, were notified. Eleven days later (4) a Master at an evening school who had been in close contact with a boy, the brother of (3), was suddenly attacked with pain in his throat and had relaxed tonsils for several days. The boy referred to had no symptoms. Seven days after the Master's attack, his child (5), who had been away since her father's sudden attack, was notified with a very mild attack of Scarlet Fever. At the house where she had been staying a young woman of 21 developed Scarlet Fever four days later (6). The child's mother subsequently developed a sore throat but no other symptons. 1, 2, 3, 5 and 6 desquamated. The father and mother of 5 had no desquamation. I was unable to visit A being outside my district, and the persons who may have formed the links in the chain moved away from their homes so as to continue at their work, and I was unable to see them. This shows one of the disadvantages of a town being divided by an artificial boundary. As was only natural A resented the suggestion that their workshop had anything to do with any of the cases except No. 1, and she, it was proved, had not been in contact with any of the other persons. Probably some person with a purulent discharge of some kind may have been the carrier from the original case (1) to the other rooms of the workshop, and the schoolboy may have had a very mild attack which he passed on to the master. On the other hand the cases may have been curious coincidences. 28 INFANTILE DIARRHŒA There were no deaths in June or July; 3 in August; 4 in Sept.; and 2 in Oct. This was a mild summer with occasional rainy days. The infant mortality for the year is very low, only 72 per 1,000 Births. MEASLES. There were 4 deaths from this disease. All in the first three months of the year at a time when some of the schools were troubled with a mild epidemic. ENTERIC FEVER. There was only 1 case notified. The Patient was sent to the Kingston Victoria Hospital where he died of heart failure. He had eaten oysters 14 days before the date of notification, and prawns at an earlier date. His work was in London, and the place of business seems to have been in good condition. No one had been ill there. DIPHTHERIA. 71 cases notified, 20 of which were secondary in the houses affected. The only death was in an infant who died before the notification was received. The cases were nearly all very mild in type. The seasonal influence was as follows: Jan., 6; Feb., March, 6 April 2; May, 5; June, 2; July, 3; Aug., 1; Sept., 6; Oct., 20 ; Nov., 5; Dec., 5. Half the cases in October occurred in two tenement houses affecting three families. In one of these houses there were numerous sanitary defects and a closing order has been served on the owner. 29 WHOOPING COUGH. Two deaths. There have been a good many cases in town. The attendance at the Infants' Schools have been rather low at times, but it was not considered necessary to close the schools. ACUTE POLIOMYELITIS. Case No 1. J. D., male, age 9 months, living in Norbiton Ward. This child came from a Bungalow at Shorehamby-Sea, on the 1st July, where the family had been staying for a holiday. No other known cases in that district. The parents did not agree to spinal puncture, but the doctor considered the symptoms well marked. The case was fatal on the 18th July. Duration of illness about one month. He was removed to the Kingston Victoria Hospital for a few days when he was withdrawn by the parents. Casi No. 2. K. A., female, age 14 months, Aug. 30th. This case occurred in Barracks and was a very mild one. The Barracks are over a mile from the home of Case 1. There was no history of nasal discharge but the child had a cough. The case was treated in the Kingston Victoria Hospital and made some improvement. Case No. 3. A. W., male, age 1½ years, living in Norbiton Ward, ¾ of a mile from Cases 1 and 2, in a direct line. This child was sent to the Kingston Workhouse Infirmary on the 3rd October. The duration of illness was at least six weeks. Mother is a lodger. Father is a labourer. Small house with two families. Seven other children in the house, quite well. Right leg of patient has some strength, but left leg almost useless. No history of nasal discharge. This is a very poorly nourished child. Case No. 4. E. G., female, age 8 years, living in Hill Ward, ½ mile from Case 3, nearly 1 mile from the others. Another 30 child who had lived in the same house up to the 1st Oct., was removed to Wandsworth where she died. She seemed very nervous during her stay with her cousins in Kingston. She also complained of a painful toe and suffered from sick headache. E. G. had been away from home for most of the time during which the other child had stayed in the house, and returned home on the 6th Oct., the two children having last met about the 24th Sept. E.G. was first seen by a doctor on Friday, the 17th Oct. The symptoms were squint, nystagmus, retraction of neck and paresis of deltoid and other shoulder muscles. Was seen by a specialist on the 18th Oct., who advised that lumbar puncture should not be performed unless the child got worse, as he considered it useless as an aid to diagnosis. The child is now better. A brother had an obscure attack of vomiting and slightly marked nervous symptoms about Oct. the 8th, but is now quite well. The cases mentioned under No. 4 were in a house of a rental of about £50, and is about 60 yards from the ward of the Infirmary where No. 3 is under treatment, and about 200 yards from Kingston Victoria Hospital where No. 2 is under treatment. No. 3 went into the Infirmary on the 3rd Oct., and her home is half a mile away. No. 2 went into the Victoria Hospital on Aug. the 30th, and was still under treatment there when the other cases were notified. Spinal puncture was not resorted to in either of the cases in Kingston. I have no information concerning the Wandsworth case. The case in the Workhouse Infirmary and the case in the Kingston Victoria Hospital were treated in the ordinary wards, but they, neither of them, were in the acute stage. No. 4 case was isolated at the top of the house with a trained nurse in charge, and she made a fairly good recovery. There is some weakness and wasting of the shoulder muscles. 31 NOTIFICATION OF BIRTHS ACT. Came into Force Feb. 1st, 1909. 1909. 1910. 1911. 1912. 1913. Total Births 850 863 873 861 898 Notified 792 738 762 743 748 Mothers Visited 48 30 37 38 56 Still Births Notified 14 13 8 6 6 Attended by Midwives 254 343 376 346 418 Five Midwives have registered to practice in the Town. Other Midwives act temporarily. One eighth of the mothers attended by Midwives were visited. The greater number suckled their own children, a few of them only partly, but those who were unable were only two in number. One Midwife has had her name taken off the Register for neglect in Puerperal Fever. There were four cases of Puerperal Fever notified during the year. None of them proved fatal; other cases notified were sent into the Infirmary with Puerperal Fever contracted in other districts of the Kingston Union. 150 Births were not notified. I am aware that some of the Medical Men protest against this Act, but I would ask them to consider whether a protest of five years is not sufficient. Their protest has no effect at all on the framers of the Act, but entails an extra amount of unnecessary trouble on the officials who have always done their utmost to save trouble to the Medical Men of the Town. 32 INCIDENCE OF INFECTIOUS DISEASE IN ADJOINING DISTRICTS. In Order of Prevalence. Statistics supplied by L.G.B. SCARLET FEVER:— Pop. Cases. Rate. 18,074 84 4.65 Surbiton. 9,539 31 3.25 Hampton. 33,426 94 2.81 Richmond. 12,919 34 2.63 Maidens. 56,729 148 2.61 Wimbledon. 12,919 22 1.70 Esher and Dittons. 18,352 30 1.63 Teddington. 15,288 24 1.60 Merton. 2,392 3 1.25 Hampton Wick. 38,452 44 1.14 Kingston-on-Thames. 1,0000 1 .70 Ham. 6,553 3 .46 Molesey. DIPHTHERIA:— 56,729 132 2.33 Wimbledon. 12,919 29 2.24 Maldon and Coombe. 1,432 3 2.09 Ham. 38,452 66 1.72 Kingston-on-Thames. 2,392 4 1.67 Hampton Wick. 33,426 55 1.65 Richmond. 18,074 27 1.49 Surbiton. 15,288 20 1.33 Merton. 6,553 7 1.07 Molesey. 12,919 8 .62 Esher and Dittons. 18,352 8 .44 Teddington. 9,539 2 .21 Hampton. 33 Only one case of Enteric Fever occurred during the year, this gives a rate of 0.03 per 1,000. There were three cases in Surbiton and eight each in Esher and Wimbledon. In the other places there was one case each in Teddington, in Merton, and in Richmond. No cases in any of the other places. TUBERCULOSIS. Conditions as to Housing and Employment as affecting results. Satisfactory. In Workhouse Infirmary. Left Borough. Remaining under Private Treatment. Domiciliary Treatment L.C.C. In Sanatorium. In Hospital. Died. Died of other Diseases. Disease arrested. Said to be well. Good 5 - - 2 3 - - - 1 - Fair 12 3 2 11 10 6 5 7 10 1 Indifferent 11 11 28 18 35 19 11 5 24 - Deaths from Tuberculosis of persons not notified, in Workhouse 3 ,, ,, Private cases 8 Persons belonging but resident elsewhere at time of death 4 10 From Tuberculosis, total deaths 45 From other disease 1 35 TUBERCULOSIS. The accompanying Tables give fairly full particulars of the cases of Tuberculosis notified during 1913, and of 76 other cases carried forward from 1912. Housing and employment has been grouped together for convenience. In a town with special trades it would be convenient to separate the cases under these headings, but where the employments are so varied it would mean a detailed account of almost every case. The returns are necessarily somewhat incomplete as I have only a limited knowledge of the cases, and in some instances no knowledge at all. Amongst the well-to-do I am often asked not to visit, and in such cases the medical attendant gives such advice as I might be able to offer. Other cases are only slightly affected and being at work are difficult to find, whilst others are only notified from an institution outside the Borough. The cases in which noparticulars could be obtained number only 20 out of 250. There were 10 deaths of persons not notified. Probably the diagnosis was only made after death. One or two special cases are of general interest. A young wife was attacked by the disease just as the husband showed signs of recovery. Both are doing well. A patient with slight symptoms of Tubercle died of Cancer. In one family three young persons have died on reaching adolesence. In another family three young women have, one after the other, been sent to a Sanatorium and have returned with the disease arrested, and, with care in management of life, cured. A large number of young children have come under notice and nine of these have been treated in the Infirmary, nine at various Hospitals, three have been sent to Sanatoria (privately). One has had Tuberculin treatment, and ten are 36 at home getting occasional advice and treatment. It is hoped that before long Sanatorium treatment may be available for dependents as well as for insured persons. The term Fair as regards housing and employment means that the patient was given a separate room and could be fairly well supplied with nourishment. The occupation was not for over long hours and the places of business were fairly good as regards air space and means and conditions of going and returning. The term Good means a house in every respect suitable for treatment. Good, clean rooms—open surroundings and comfortable condition of friends. Indifferent includes all the other cases, but the number in which the conditions could be called bad were fewer than those described as good. Treatment of Tuberculosis Cases Notified. No. of Cases. Satisfactory Results. In Workhouse Infirmary. Left Borough. Remaining under Private Treatment. Domiciliary Treatment S.C.C. In Sanatoria. In Hospital. Dead. Died of other Diseases. Result of Sanatorium Treatment. Result of Hospital Treatment. Result of Tuberculu Treatment. Turbercle Bacillus found. Insured persons. No. treated in Infirmary. Disease arrested. Said to be well. Arrested Relieved Arrested Relieved Arrested Relieved Cases brought over from 1912 6 7 10 17 14 5 6 1 10 - 11 4 9 14 1 3 5 10 18 76 NewCases notified during 1913 22 7 20 14 34 20 10 11 25 1 23 10 9 24 - 3 17 56 26 164 TUBERCULOSIS. Conditions as to Housing and Employment and Nature of the Disease. HOUSING AND EMPLOYMENT. FORM OF DISEASE. Males. Females. Unsuitable or Indifferent. Fair. Good. With or without Tuberculosis History. 4 1 - Aged persons without Tubercle in family 3 2 1 1 - Lungs. ,, ,, with ,, ,, 1 1 85 27 4 Active persons without ,, ,, ,, 70 46 26 18 3 ,, ,, with ,, ,, ,, 24 23 - - 1 Very rapid cases without ,, ,, ,, - 1 1 1 - ,, ,, with ,, „ 1 1 2 1 - Meningitis without ,, ,, ,, 2 1 1 - - ,, with „ ,, - 1 - 1 - Lupus without ,, ,, - 1 1 - - ,, with ,, ,, „ - 1 2 - - Acute Miliary Tuberculosis, without ,, ,, ,, - 2 1 - - ,, ,, ,, with ,, ,, ,, - 1 - 1 - Eye disease without ,, ,, ,, - 1 2 1 - Spinal disease without ,, ,, ,, 3 - 1 - - ,, ,, with ,, ,, ,, - 1 1 - - Upper extremities without ,, ,, ,, - 1 - 1 - ,, ,, with ,, ,, ,, - 1 1 4 - Lower extremities without ,, ,, ,, 5 - 1 - - ,,. with ,, ,, ,, 1 - 2 3 - Abdominal without ,, ,, ,, 1 4 6 4 2 Glands without ,, ,, ,, 6 6 2 3 - ,, with - 5 20 1 2 No particulars obtained 11 12 10 - - Deaths in cases not notified 5 5 170 68 12 133 117 250 250 39 SALES UNDER “FOODS AND DRUGS ACT.” Return of Samples Analysed during Year ended 31st December, 1913, in the Borough of Kingston-upon-Thames. Articles. Analysed. Adulterated or Deteriorated. Milk 55 3 Cream 1 1 Butter 49 - Cheese 2 - Margarine 1 - Lard 7 - Bread - - Flour - - Tea - - Coffee - - Cocoa 2 - Sugar - - Mustard 1 - Confectionery and Jam - - Pepper - - Wine - - Beer - - Spirits 5 1 Drugs - - Other Articles 16 3 Totals 139 8 TABLE IV. INFANT MORTALITY, 1913. Nett Deaths from stated causes at various Ages under One Year of Age Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year All Causes, Certified 12 1 2 1 15 20 9 10 11 65 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 ... 2 Abdominal Tubeculosis ... ... ... ... ... ... ... ... ... ... Other Tubercolosis Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 ... 1 3 Convulsions ... ... ... ... ... ... ... 1 ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 3 3 2 ... 8 Pneumonia (all forms) ... ... ... ... ... 1 ... ... 4 5 Diarrhœa ... ... ... ... ... 4 1 1 2 8 Enteritis ... ... ... ... ... 2 1 ... 1 4 Gastritis ... ... ... ... ... 2 ... ... 1 3 Syphilis ... ... 1 ... 1 1 1 ... ... 3 Rickets ... ... ... ... ... ... ... ... ... 3 Suffocation,overlaying 1 ... ... ... 1 2 ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations (c) 2 ... ... ... 2 1 ... ... ... 3 Premature Birth 8 ... ... ... 8 1 ... ... ... 9 Atrophy, Debility and Marasmus ... ... 1 1 2 1 ... ... ... 3 Influenza ... 1 ... ... ... Other Causes ... ... ... ... ... 2 1 2 ... 5 12 1 2 1 15 20 9 10 11 65 Nett Births in the Year Legitimate 830 Nett Deaths in the Year Legitimate Infant 58 Illegitimate 61 Illegitimate 7 41 RAINFALL AT SEWAGE WORKS, Kingston-on-Thames, 1913. † 1904 † 1905 ‡ 1906 ‡ 1907 ‡ 1910 ‡ 1911 ‡ 1912 ‡ 1913 Inches. Inches. Inches. Inches. Inches. Inches. Inches, Inches Jan. 2.74 0.61 3.85 .82 1.85 1.34 3.77 2.93 Feb. 2.41 .80 1.67 1.3 3.18 1.23 1.70 .91 Mar. 1.39 4.03 1.15 .85 1.19 1.59 2.90 2.89 Apr. 1.03 1.68 .49 3.45 1.36 2.06 .06 2.84 May 2.16 1.03 1.26 1.73 1.89 2.36 1.44 1.88 June .8 4.84 2.71 2.27 2.73 2.35 3.78 .44 July 1.5 1.07 .90 1.13 3.84 .78 1.82 2.01 Aug. 1.59 2.85 1.21 2.42 2.97 1.11 5.71 1.78 Sept. 1.5 1.67 2.97 .51 2.87 1.39 2.50 2.36 Oct. 1.54 1.36 4.37 3.99 3.15 3.21 2.53 5.59 Nov. 1.56 3.39 4.19 2.24 3.23 3.62 2.12 2.33 Dec. 1.97 .60 2.22 3.56 4.0 5.23 3.03 1.13 Total 20.16 23.93 26.99 24.27 30.26 26.27 31.30 27.09 † West Molesey. ‡ Kingston Sewage Works. BIRTH-RATE, DEATH-RATE, and ANALYSIS of MORTALITY during the Year 1913. ANNUAL RATE per 1,000 living. Births. Total Deaths. Deaths From. Crude. Standardised Enteric Fever Small-pox Measles. Scarlet Fever. Whooping Cough Diptheria. Violence. ENGLAND AND WALES 23.9 13.7 13.4 0.04 0.00 0.28 0.06 0.14 0.12 0.53 96 GREAT TOWNS (including London) 25.1 14.3 14.7 0.04 0.00 0.34 0.07 0.17 0.13 0.2 145 SMALLER TOWNS 23.9 12.8 13.0 0.05 0.00 0.30 00.5 0.13 0.11 0.4 ENGLAND AND WALES, less the 241 Towns 22.3 13.1 12.1 0.04 0.00 0.20 0.05 0.12 0.11 0.8 LONDON 24.5 14.2 14.2 0.02 — 0.34 0.04 0.17 0.09 0.56 DEATH-RATE and ANALYSIS of MORTALITY during the Year 1913. Annual Death Rate per 1,000 Births. Annual Death Rate per 1,000 Living. Percentage of Total Deaths. Diarrhœa and Enteritis (under 2 years). Total under 1 year. Aged 1 to 65 years. Aged 65 years and upwards. Deaths in Public Institutions Certified Causes. Inquest cases. Uncertified Causes. ENGLAND AND WALES 23.41 109 7.5 80.3 21.2 91.6 7.2 1.2 96 GREAT TOWNS (including London) 29.33 117 8.2 84.1 27.8 91.3 7.9 0.8 145 SMALLER TOWNS 24.73 112 6.9 79.7 14.7 92.6 5.9 1.5 ENGLAND AND WALES, less the 241 Towns 14.39 96 6.7 76.9 14.0 91.7 6.6 1.7 LONDON 27.50 105 8.0 84.0 43.6 89.6 10.3 0.1 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) 4 Workshops (including Workshop Laundries) 70 Nil Nil Workplaces 5 Total 79 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 6 6 Want of Drainage of Floors Nil Nil Other Nuisances 2 2 Nil Nil Total 8 8 Nil Nil 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 6 14 Addresses of Outworkers (forwarded to other Authorities (received from other Authorities 7 7 Inspection of premises 3 Workshops on the Register (S.131) at the end of 1908: Important classes of workshops, such as workshop bake houses, may be enumerated here Dressmakers (mostly small places) 46 Hand laundries 30 Eating places (not hotels) 15 Sausages, etc, 4 Bakehouses 29 Various 106 Total number of workshops on Register 230 45 SANATORIUM BENEFIT UNDER THE INSURANCE ACT. Number sent to Sanatoria 24 Resumed work 11 Improved in health 12 *Dead 1 Number sent to Hospital 10 Resumed work 1 Improved 7 Dead 2 Number given Domiciliary treatment 11 Stationary 5 Dead 6 •This patient had also Hospital and Domiciliary treatment. Four persons had' both Hospital and Sanitorium treatment. Other persons were sent to Hospital or Sanitoria through private efforts or were provided for by organisations outside the Act, e.g., Water Board, Railways, &c. SANITARY INSPECTOR'S REPORT. Abstract of Notices for the Year 1913. Choked and defective drains 350 New drainage to houses 35 Defective closets and syphons 34 Defective interceptors, traps, etc. 30 Defective soil pipes and ventilators 18 Defective water apparatus to closets 72 To lay on water supply to closets 10 To provide separate cisterns for flushing closets 2 Foul drinking water cisterns 46 To cleanse and limewash houses 106 To cleanse and disinfect houses 120 To cleanse urinals adjoining public roads 30 To repair and alter urinals 2 46 Inspecting urinals adjoining public roads 1600 Dilapidated houses 50 Accumulation of manure, offal, etc. 82 Pig keeping (a nuisance) 2 Fowl keeping (a nuisance) 36 Overcrowding of houses 16 Canal Boats Act, &c. Canal Boats and Barges inspected 71 Offences in contravention of Canal Boats Acts 13 Notification of Infectious Diseases Acts. Visits to Infectious Diseases 380 Notices served to Householders, etc. 320 Notices served to School Attendance Officer 190 Notices served to Schools 250 Notices served to Librarian 80 Disinfecting houses after Infectious Diseases 170 Testing drains after Infectious Diseases 44 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 has been condemned:— 980 lbs. of Beef. 22 Sheep's plucks. 3 Sheep. 50 lbs. Tripe. 156 lbs. Ox Livers. 40 lbs. Skate. 30 lbs. Ox Kidneys. 20 boxes of Tomatoes. 48 lbs. Beef Suet. FRED. J. PEARCE, A.R.S.I., M.S.I.A., Sanitary Inspector.