MAL034 13 the urban district OF the maldens and coombe. ANNUAL REPORT OF THE HEALTH and SANITARY CONDITIONS for the Year 1909. RASHELL DAVISON, M.D., M.R.C.S.E., Fellow Society Medical Officers of Health, Medical Officer of Health. The Urban District of the Maldens and Coombe. PUBLIC HEALTH COMMITTEE. 1909-10. Chairman: C. H. Davis. The Chairman of the Council: A. T. E. Mursell, J.P. The Vice-Chairman of the Couucil: G. C. Parnaby, J.P. Messrs. H. Bailey, A. W. High, G. C. Hodgson, G. H. Holloway, F. T. Medhurst, T. W. Milward, H. J. Palmer, A. Woollacott. OFFICIALS OF THE HEALTH DEPARTMENT, Sanitary Inspector: Harry Hunter, M.R.San.I., Cert. Inspector of Meat and Other Foods. Veterinary Surgeon: J. E. Lloyd Still, M.R.C.V.S. (Lond.) Medical Officer of Health: Rashell Davison, M.D., M.R.C.S.E., Fellow Society Medical Officers of Health. THE Urban District Council of the maldens and Coombe. 1909. GENERAL STATISTICS. Area—3,220 Acres. Situation—Ten miles south from Charing Cross, in the County of Surrey, the greater part of the district lying between the Hogg's Mill Stream and the Beverley Brook. Population Census, 1901—6,232. Estimated Population, 1909—12,005. Estimated Inhabited Houses, 1909—2491. Rateable Value— £107,216 0s. 0d. Assessable, £86,965 13s. 6d. General District Rate—1s. 8d. Poor Rate, including Education Rate—1s. 8d. For current half year. 5 maldens and Coombe Urban District Council. ANNUAL REPORT OF THE medical officer OF health, 1909 New Malden, Surrey, January, 1910. Mr. Chairman and Gentlemen, I have the pleasure to lay before you my Thirteenth Annual Report on the Health and Sanitary condition of the Urban District of the Maidens and Coombe under your care, for the year ending December 31st, 1909, together with detailed reports of the Sanitary Inspector and Veterinary Surgeon. VITAL STATISTICS, 1909. Birth Rate per 1000 living:— 22.4 per 1000. England and Wales, 25.6 per 1000. Death Rate per 1000 living:— 7.4 per 1000. England and Wales, 14.5 per 1000. Infantile Mortality per 1000 Births:— 66.92. Isolation Hospital, Tolworth— Fever and Diphtheria. Small Pox, County Combined Hospital, Clandon. Water Supply from Thames—Metropolitan Water Board. 6 BIRTHS. During' the year there were 269 births, of which 139 were boys and 130 girls. The birth rate equalled 22.4 per 1,000 inhabitants, as compared with 25.6 for England and Wales. Of the total births, 3 or 1.1 per cent. were illegitimate. The births were distributed as follows:— Coombe 17 Old Maiden 9 New Maiden 243 Total 269 DEATHS. During the year there were 114 deaths registered, an increase of 26 over last year's return; of these no less than 13 were nonresidents, and have not been calculated in the net number of deaths; the net number being 89. The deaths in each ward were as follows:— District. London Hospitals. Kingston Workhouse. Brookwood Asylum Total. Coombe 8 … … … 8 Old Maiden 4 … 1 … 5 New Maiden 77 12 11 1 101 89 12 12 1 114 The greatest age registered was in New Maiden, a male aged 92. Twenty-three deaths occurred between 70 and 92 years of age, 15 between 70 and 80, 7 between 80 and 92, averaging 81.7 years. 12 deaths occurred in Kingston Workhouse. 1 death occurred in Brookwood Asylum. 12 deaths occurred in London Hospitals. 7 Amongst the causes of death were the following diseases:— Influenza 8 Senile Decay 7 Heart Disease 7 Cerebral Disease 6 Cancer 5 Phthisis 5 During the last ten years the infantile mortality has been:— 1900 11 1901 18 1902 18 1903 15 1904 27 1905 15 1906 14 1907 24 1908 18 1909 18 Total 178 Average number for 10 years, 17.7. Infantile Mortality per 1,000 births for 1909:—66.92. Two of these were infants unknown, found dead in Coombe District; the net number of deaths was 18. The figures for the various wards were:— Coombe 2 Old Maiden - New Maiden 16 Total 18 Premature Birth 5 Congenital Defects 1 Debility 5 Diarrhœa 2 Bronchitis 2 Rickets 1 There were five deaths from Tuberculous Disease, two from Diphtheria (treated at home), and one death from Nasal Erysipelas causing Meningitis. Three illegitimate children were born; no death occurred. All deaths were duly certified by the Medical Attendant or by H.M. Coroner. 8 INQUESTS. Dr. H. M. Taylor, H.M. Coroner for the division of Surrey, held inquests on nine cases:— Coombe 2 Old Maiden - New Maiden 7 Total 9 The verdicts returned were as follows:— District. Disease. Verdict of Juries. Total. Coombe Want of attention at birth. Want of attention at birth. Found dead. Found dead. 2 New Maiden Heart disease. Heart failure. Heart failure. Pneumonia, Exposure. Asphyxia. Heart failure. Malnutrition. Natural. Natural. Want of attention at birth. Accidental. Suicide whilst temporarily insane. Want of attention at birth. Premature birth. 7 Total 9 The inquests are held at the Council Offices. The postmortems take place in the mortuary, which is now under the supervision of the Health Department. The number of new houses certified by the Surveyor as fit for occupation during the year was 165. Houses Occupied. Coombe 174 Old Maiden 109 New Maiden 2208 Total 2491 9 The new Workhouse Buildings, Norbiton Common, and the Scattered Homes for Children, both under the control of the Kingston Guardians, contain inmates and officials as follows:— Inmates. Officials. Workhouse Buildings 265 6 Scattered Homes 83 14 Total 348 20 Population estimated to be 12,005. THE NOTIFICATION OF BIRTHS ACT. This act has not been adopted in this District. Districts. Acres. Estimated population. Estimated Houses Occupied. Births. Deaths. Birth Rate Death Rate. Coombe 1337 1442 174 17 8 11.8 5.5 New Maiden 1041 9964 2208 243 77 24.4 7.7 Old Maiden 842 599 109 9 4 15.0 6.7 Total 3220 12005 2491 269 89 22.4 7.4 There has been no change in the general character and occupation of the inhabitants of the district. The house accommodation is ample for the population, but owing; to low wages and unemployment the number of families occupying one house have increased. The open spaces about the houses are sufficient, and the yards are paved. The erection of new houses is under the control of the Surveyor and his Department; all new houses have a concrete foundation and the drains are laid according to the latest improvements. The water to the whole district is supplied by the Metropolitan Water Board from the Thames. The Sale of Food and Drugs Act is carried out by the County Inspector from Kingston. The Sanitary Inspector has also been appointed an Inspector under these Acts to take independent samples when required. 10 All meat exposed for sale is inspected at slaughtering, by the Sanitary Inspector, who has specially qualified himself for the duties of this office. INFECTIOUS DISEASES. Tolworth Hospital admits Diphtheria, Scarlet Fever and Typhoid cases; Small Pox cases are admitted to the Combined Hospital at Clandon. Circulars are sent to every house where infectious disease occurs advising as to treatment, isolation and disinfection, details being given in 1908 Report, and are attached to this Report. Tuberculosis is a voluntary notification; when notified the patient receives a circular explaining the necessity for open-air treatment, the disinfection of sputum, etc. All removals are notified to the responsible Sanitary Authority. CASES NOTIFIED UNDER THE INFECTIOUS DISEASES ACT. One hundred and fifty-five cases have been notified, distributed in the three districts as follows:— Old Maiden. New Maiden. Coombe. Total. Scarlet Fever … 63 20 83 Diphtheria … 25 … 25 Erysipelas 1 11 … 12 Measles 1 28 … 29 Typhoid Fever … 1 … 1 Puerperal Fever … 1 … 1 Phthisis … 4 … 4 Total 2 133 20 155 Cases Treated at Tolworth Isolation Hospital. Scarlet Fever 45 6 51 Diphtheria 19 — 19 Typhoid Fever - - 1 64 6 71 11 The classification at the Hospital when the diseases had more fully developed were:— Scarlet Fever 48 Diphtheria 17 Diphtheria and Scarlet Fever 5 Enteric* 1 71 * This case was not returned in Hospital as Enteric. One case of diphtheria died before the notification was received, and one from heart failure, both treated at home. One case sent in to the Infectious Hospital as scarlet fever was diagnosed at the hospital as diphtheria. Two cases sent in as diphtheria, (the diphtheria bacillus being first found), were found afterwards, when in hospital, to be peeling, and were returned as scarlet fever. The monthly distribution is:- Measles. Erysipelas Diphtheria Scarlet Fever. Typhoid. Puerperal Fever. Phthisis. January 1 … 6 6 … … 1 February 5 1 6 1 … … … March 2 … 2 12 … … 2 April 1 1 7 2 … … … May 1 4 … 1 … … … June 1 1 1 39 … … … July 11 … … 3 … … … August 5 1 1 5 … … … September … … … 2 1 … … October 1 … … 3 … … 1 November … … 2 5 … … … December 1 4 … 4 … 1 … Total 29 12 25 83 1 1 4 Total, 155. 12 Last year, 468 cases of measles were notified; this year, only 29 cases were notified, the smallest number since 1895, when 26 cases were notified. Two epidemics of scarlet fever occurred, in March 12 cases were notified caused by house to house visiting, and that in June by contaminated railway borne milk and was distinguished by the large number of adults that contracted the disease, 12 between the age of 16 and 46. One case of enteric fever was notified, which had been contracted in London, and one case of puerperal fever which proved fatal ; the first case notified in the district for 14 years. SCARLET FEVER. From February 27th to March 31st, an epidemic of scarlet fever and diphtheria occurred in George, Queens and Albert Roads, streets running parallel to each other from Burlington Road. Seven cases of Diphtheria and nine of Scarlet Fever were notified. The epidemic was peculiar as it was almost impossible to distinguish, in the early stages, the two diseases. On February 27th a lad of eighteen had been suffering from sore throat; diphtheria was suspected; bacteriological examination gave a negative result; he became seriously ill, the difficulty of breathing being so great that Tracheotomy was performed; after four days diphtheretic membrane appeared, he was removed to the Hospital; the Hospital note said, a most severe case of diphtheria. On the two following days three sisters living in the same house were notified as diphtheria; bacteriological examination gave a positive result (presence of Klebs bacillus). Before leaving the Hospital all these had the usual skin peeling of scarlet fever. On March 8th a man who had sat up with the first case the night of the operation, contracted scarlet ever. On March 20th an adult aged 39 was notified as scarlet fever; in his house was found a child peeling ; the man's shirts were washed at an infected house number 6, and his wife had paid numerous visits to number 12; five cases were notified in this house. At number 10 one case of scarlet fever and one case of diphtheria were notified. There is no doubt that the disease, in spite of warnings to the contrary, was caused by the constant visiting of the occupants; it is also clear that at least four cases had the dual disease, diphtheria and scarlet fever. The drainage was defective, but the greater portion has since been re-laid. 13 SCARLET FEVER IN MILK. Thirty-seven cases were notified from June 13th to June 30th, caused by railway borne infected milk, and were distributed in the three districts as follows:— Total. June:— 13 16 17 18 19 22 23 28 New Maiden 2 2 3 3 3 4 1 1 19 June:— … … … 18 19 21 22 … Coombe … … … 11 5 1 1 … 18 37 On the thirteenth, two cases were reported from Maiden Hill; they attended different schools, but neither school had had a case of scarlet fever. On the sixteenth, two cases were reported, one a school case, the other a lad of sixteen living at home; as there was a dairy next door to this case I visited the house at once, and found that the lad had had no communication with any other case, but that he was in the habit of going to the dairy next door and having a glass of milk every morning from the vessel on the counter; a sample was taken and sent to the Clinical Research Association for examination, who reported that streptococci similar to the organism found by Prof. Klein in the serum from the teats of the cows in the Hendon disease was present. The wholesale vendor was at once communicated with by telephone. The next day June the 17th the vendor came to the Health Department at the Council Offices and was informed of all the facts. He was most anxious to do all he could to mitigate the further spread of the disease, and he volunteered to send mik from another district and pasteurize it before dispatch; on the same day I attended a consultation at Worcester Park, meeting Dr. Jones, Assistant M.O.H. for the County, and Dr. Williamson, M.O.H. for Epsom; we agreed that everything had been done locally, but 14 that further, as I had already been in communication with the vendor sending the infected milk into the districts, I should impress on him in writing the necessity of giving his personal supervision to pasteurizing all milk before it left his premises, and further that he should at once have all his employees, their wives, children and houses medically examined, and to send no milk from the suspected area into our district; this he informed me by letter on the 19th he had done. On June 18th 11 cases were notified in Coombe; by the 22nd 18 cases in all were reported, all supplied from one dairy, situated outside the district, but receiving milk from the iniected area. On June 22nd, with Mr. Still, the Veterinary Surgeon to the Council, I personally examined every cow in the district, 125 cows and heifers. 119 were found to be perfectly healthy, six were found to be suffering from vesicular eruption on their teats, and as a precaution these were isolated; I took swabs from these and had them examined bacteriologically, with a negative result, so that these were harmless vesicles due to irritation, and not vesicles of the same character as reported by Prof. Klein on the teats of the cows in the Hendon epidemic in 1885. During the epidemic I visited the Burlington Road Schools daily, examined and excluded 120 children; 112 suffered from sore throat, and 8 scarlet fever. The prompt communication with the vendor of the milk, by telephone, on the 16th, giving him the first information of milk infection; and the confirmation of the disease by bacteriological examination placed the Health Department in a position to take direct and prompt measures to prevent a further spread of the disease. DIPHTHERIA. Twenty-five cases of Diphtheria, all notified in New Maiden; nineteen were treated at the Infectious Hospital, Tolworth, and six in their own homes. Two deaths were notified; both cases were treated at home. 15 MEASLES. Twenty-nine cases of Measles only were notified, all of which were of a mild character. Coombe 1 New Maiden 28 Old Maiden - 29 Nine cases were between 15 and 30 years. Thirteen were under school age, one attended a public, and six private schools. No disease effects school attendance more than an Epidemic of Measles, great assistance would be afforded the School Managers, if medical practitioners would adhere to the regulations for exclusion in this disease lately issued by the Surrey Education Committee, viz Rules for exclusion of Individuals. Children attacked by Measles should be kept from school for four weeks. As regards other children living in Infected Houses:— Districts in which the majority of children over seven years of age attending Public Elementary Schools have had measles, the practise adopted, when measles breaks out in a household is to exclude from school attendance, only those children of the same household who attend the infant school and those older children of the same household who have not had measles. These children should be excluded from school for 21 days from the date of onset of the illness of the last patient with measles in the house. That is to say those children over seven years of age who have had measles are permitted to attend school enabling them to gain full advantage of tuition. This procedure assists generally in preventing the closure of the school; which is always a loss to to the scholars, teachers, and school managers. TUBERCULOSIS. Five deaths occurred, all of which were notified in New Maiden; one case was that of a non-resident. 16 TYPHOID FEVER. One case was reported in New Maiden, which was subsequently found to have been contracted in London. SCHOOLS. The number of cases effecting the National Schools during the epidemic due to milk were as follows:— June 14—July 16, 1909. Scarlet Fever. Contacts. Sore Throats. Total. No. on Roll. Burlington Road Schools. Cases examined Children from West Barnes and Worcester Park. 1 4 31 36 87 Kingston Road (West of Railway Bridge) 1 1 26 28 72 New Maiden 6 5 31 42 262 8 10 88 106 421 Elm Road Schools … … … … 245 Lime Grove Schools 2 4 5 11 386 Old Maiden Schools 1 2 … 3 116 Coombe (Robin Hood) Schools … … … … 61 11 16 93 120 1223 Dates of infection, June:—13 16 17 18 22 28 1 1 2 2 1 1 Total:—8 During the epidemic I visited Burlington Road Schools daily and examined personally over 120 children: of the 11 effected children, the first five cases were due to milk infection, three to school contact and three contracted the disease in other districts. I had a circular printed and read out in every school warning the parents that during the epidemic all milk should be boiled before consumption, 17 Cases of Infectious Diseases notified during the last ten years, recording cases in each district, with number of deaths:- Year. Number notified in each Year. Number of Deaths. Cases treated at Tolworth Isolation Hospital. Cases treated at Home. Population. Year. Year. Diphtheria. Scarlet Fever. Typhoid Fever. Measles. Erysipelas. Total. Diphtheria. Scarlet Fever. Typhoid Fever. Measles. Erysipelas. Total. Diphtheria. Scarlet Fever. Typhoid Fever. Total. Diphtheria. Scarlet Fever. Typhoid Fever. Total. 1900 1 6 … 32 6 45 … … … … … … … 5 … 5 … … … … 6243 1900 1901 4 12 3 284 2 305 1 … 1 2 … 4 4 10 3 17 … 2 … 2 6322 1901 1902 14 46 2 40 3 105 1 1 … … 1 3 10 41 … 51 … … … … 6647 1902 1903 2 38 1 29 7 77 … 2 … … … 2 2 35 1 38 … 3 … 3 7199 1903 1904 2 27 2 145 12 188 … … … 2 … 2 2 19 2 23 … 8 … 8 7675 1904 1905 11 29 2 60 9 111 1 … … … … 1 8 23 … 31 3 16 2 21 8642 1905 1906 2 19 2 81 12 116 … … … … … … 2 15 1 18 … 4 1 5 9686 1906 1907 11 17 … 60 7 95 1 … … … … 1 9 14 … 23 2 3 … 5 10268 1907 1908 9 21 3 468 9 510 1 … … 6 … 7 7 11 2 20 2 10 1 13 11085 1908 1909 25 83 1 29 12 150 2 … … … 1 3 19 51 … 70 6 22 … 28 12005 1909 Total 81 298 16 1228 79 1702 7 3 1 10 2 23 63 224 9 296 13 68 4 85 Average 8.1 29.8 1.6 122.8 7.9 170.2 .7 .3 .1 1 .2 2.3 6.3 22.4 .9 29.6 1.3 6.8 .4 8.5 18 SCARLET FEVER. LEGAL PROCEEDINGS. In July, the Sanitary Inspector, when investigating a case of scarlet fever, discovered that a child infected had been in contact with children living in Sussex Road; he called at the house ; the mother, whom he first saw, denied that there was any illness in the house, but her husband admitted that three children had been suffering from a rash with sore throats; he treated the matter lightly and stated he had not called in a medical man. The Inspector suspecting scarlet fever offered to bring the Medical Officer of Health or any medical man at the Council's expense, but this was flatly refused. He then consulted the Medical Officer of Health. Fourteen days after, I with the Inspector, called at the house and after some hesitation was permitted to inspect three children, all peeling from scarlet fever; printed instructions as to disinfection and isolation was left at the house, the children were not isolated, nor had any medical man been called in. The Council had no alternative but to take proceedings against the head of the family, under the Infectious Diseases Notification Act 1889, and the Infectious Diseases Extension Act, 1899, which provides (inter alia): "The head of the family to which such patient belongs shall as soon as he becomes aware that the patient is suffering from an infectious disease to which the act applies, send notice thereof to the Medical Officer of Health of the district." The case was tried before the Kingston Bench of Magistrates; the defence was that the defendent and his wife did not know it was scarlet fever, and that the Sanitary Inspector did not inform them of its presence in the house. The defendent, was convicted in the maximum penalty with costs, including costs of the Council. The chairman commented severely on the case, and asked:— "Wherein was the use of Public Authorities doing their utmost to eradicate infectious disease, when an obstinate man like the defendant deliberately went and spread it about; the case ought to be a warning to people to act with more common sense." 19 SCHOOLS. The Children attending the Schools in the district number 1,400, seven less than last year. Coombe (Kingston Vale) 61. Old Maiden 116 New Maiden—Elm Road 245 „ Lime Grove 380 „ Burlington Road 598 1400 I have visited the Schools frequently for infectious and contagious diseases. The record of infectious diseases for the year was as follows:— Public Schools. Private Schools. No. School. Total. Scarlet Fever 24 16 4 44 Diphtheria 12 2 — 14 Measles 1 6 - 7 Typhoid — - - - The sanitary condition of the Schools is now satisfactory. The alteration for cloak rooms at the Lime Grove Schools has not been carried out. The Soup Kitchen is again carrying out its good work, having provided 6,500 free meals to necessitous children during the winter; and it has now taken a permanent and honourable place among the societies of the district. The Private Schools are regularly inspected, and the sanitary improvements which have been recommended have been carried out. One of these schools was closed on account of Diphtheria. 20 FACTORY AND WORKSHOP ACT. Premises on the register for the year are as follows Factories 8 Workshops and Workrooms 41 49 The Factories, described as such, are in most cases laundries. The workshops and rooms are occupied by Milliners, Dressmakers, Fancy Work and Hand Laundries. The district is residential, and has no industry of a staple character. BAKEHOUSES AND EATING HOUSES. These are frequently inspected, and the desired standard of cleanliness is maintained. DAIRIES, COWSHEDS AND MILKSHOPS ORDER. Thirty-two persons under the above Orders are on the register for the year. One hundred and twenty-five cows and heifers produce milk for sale; the cowsheds, dairies and milkshops are frequently inspected, and samples of milk are taken at the railway stations, at all dairies and from carts in the streets. Quarterly inspections of the cows are made by the Veterinary Inspector, whose report is appended. There is no change in the method of procedure respecting the inspection of cowsheds, dairies and milkshops. Cowsheds in the District 7 Milkshops and Dairies in the District 21 The Veterinary Surgeon makes quarterly inspections of every milch cow in this district, making special examination of the throat and udder in each case, and reports to the Committee. Any animal reported unfavourably upon is kept under observation by the Sanitary Inspector. 21 The following is a summary of Mr. Still's examinations and results:— Three Months Ending March 31st, 1909. Cowsheds visited 7 Milch Cows and Heifers Examined 107 Results of Examination. Cows and Heifers in a Healthy Condition 105 Tuberculosis of the Udder 1 Actinomycosis 1 107 Three Months Ending June 30th, 1909. Cowsheds visited 7 Milch Cows and Heifers Examined 109 Results of Examination. Cows and Heifers in Healthy Condition 103 Cows with Vesicular Eruption on Teats 6 109 The cows with eruption on teats were isolated, and treated antiseptically under the personal supervision of the Inspector. Three Months Ending September 30th, 1909. Cowsheds visited 7 Milch Cows and Heifers Examined 114 Result of Examination. Cows and Heifers in a Healthy Condition 111 ,, ,, with Actinomycosis 1 ,, ,, with quarter atrophied 2 114 The owners of the above cows found in a diseased condition undertook to remove the same from the district within seven days. This was carried out. 22 Three Months Ending December 31st, 1909. Cowsheds visited 7 Milch Cows and Heifers Examined 106 Result of Examination. Cows and Heifers in a Healthy Condition 105 Tuberculosis 1 106 Special Report made by the Veterinary Surgeon (J. E. Lloyd Still M.R.C.V.S.) on the cows supplying milk in the district during the Scarlet Fever Epidemic:— At the request of the Medical Officer of Health (Dr. Rashell Davison) I made in company with him a personal inspection of every cow in the district ; six cows were found to be suffering from a vesicular eruption on the teats. I was unable to decide if this condition had any connection with the epidemic, but it is well to note that I did not discover a similar condition in the cows of other districts, and it was not present in my previous inspections. It had entirely disappeared at my subsequent inspection. The Vesicular condition of the teats was a purely local lesion, the animals being in all respects healthy. The infected cows were not in the same shed, and the eruption showed little tendency to spread : in a shed of 30 cows, three only were affected : the teats were treated antiseptically, and the hands of the milkers were disinfected. The local lesion consisted of two or three vesicles the size of a sixpence, oval or round, on the teats : they represented a different appearance according to the stage they were in : those that had not burst contained sero purulent fluid, and those that had ruptured presented a raw surface. Those vesicles that were situated near the base of the teat, and by their situation had escaped rupture at the hands of the milkers, appeared to go through a vesicular and crustaceous stage ; eventually the crust or scab desquamated, leaving for a short period a flat round area, red in colour. 23 The Medical Officer of Health took specimens of the fluid from several vesicles which were bacteriologically examined and proved to be innocent, proving that they could not have had any connection with the epidemic of scarlet fever due to infected railway borne milk which was at this period prevalent in the district. Signed, J. Lloyd Still, M.R.C.V.S. London. MEAT AND FOOD INSPECTION. Pursuant to the Orders of the Local Government Board, I have this year to report on the number of slaughter houses in the district ; if they are visited at the time of slaughtering by an Inspector with a special certificate in meat inspection : how many carcases or parts of carcases were found to be tuberculous, and what action was taken in each case. There are thirteen butchers' shops in the district and two slaughter houses, one licensed, the other registered. The inspection of food and meat is performed by the Sanitary Inspector, in addition to the duties undertaken as Sanitary Officer when appointed in 1908. He visits and inspects frequently all the shops in the district where food is exposed for sale:—butchers, milk shops, dairies, greengrocers, bakers, etc., or any premises where food is prepared for sale. The slaughterhouses have been in use for many years ; they are placed too near the existing dwelling houses, and have not the facilities of the modern abbatoirs for slaughtering. Now that the district has reached a population of 12,000, the question of a public abbatoir is being taken into consideration ; no doubt the larger quantity of meat is obtained from the Central Meat Markets in Smithfield, and is of high quality, but the killing that does take place should be performed in a slaughter house further removed from dwelling houses, and under more modern improvements. All meat exposed for sale, including that brought into the district, is examined by the Inspector. Regarding the condemnation of any meat affected with tuberculosis the practise followed in this district is : to carry out the principals as laid down by the Royal Commission on Tuberculosis, to be observed regarding the inspection of tuberculous carcases:— In the case of the pig, in view of the greater tendency to generalisation of tuberculosis, the presence of tubercular deposit 24 in any degree involves seizure of the whole carcase and of the organs. In the ox, however, if only evidence of tuberculosis can be found in part of the carcase, (localized) after careful investigation, then the affected parts only are condemned. Should any doubtful case occur, the Inspector consults the Medical Officer of Health. Mr. Hunter has passed through the special course of instruction in meat inspection and other foods, held by the Royal Sanitary Institute, and also had the good fortune to be a pupil of the late James King, M.R.C.V.S., Superintendent of the Islington Metropolitan Cattle Markets and Abbatoirs, and the leading authority on meat inspection of his time. Mr. Hunter is a certificated meat inspector, and has a thorough practical knowledge of his duties. It will be seen, by reference to the Sanitary Inspector's detailed report, that, if we are to have a pure food supply, this inspection is very necessary, the amount of diseased food seized since the Inspector took up his duties in June 1908, proves the necessity beyond a doubt. MALDEN GREEN. Since issuing the last report the Council have been able to secure Byelaws for the regulation of Maiden Green, which have been duly fixed in different parts of the Common. Important works are at present in progress by the Clerk of the Council in relation to the management and use of the respective greens. This I understand will be dealt with shortly by the Allotments and Open Spaces Committee, when it is hoped that the existing conditions and unsightly deposits of soil, etc., will be put an end to, so that the approach from Worcester Park Station will be greatly improved in so beautiful a part of the district. RECREATION AND SPORTS. Beverley Park.—During the year the Allotments and Open Spaces Committee have made a further advance in regard to the developing a scheme for the laying out of this Recreation Ground. This Park, as it has now been called, provides a glorious breathing space of 20 acres for the benefit of public health. A considerable number of seats has been provided and also a number of trees planted. 25 The Council have appointed a groundsman who devotes the whole of his time to this Park. If this progress is only maintained during the coming year, Beverley Park will soon, no doubt, be more frequented in the bright weather, especially by children, and so take them away from the busier thoroughfares. Allotments.—There are now 92 holdings at the Council's allotments, and these are quite inadequate to meet the demands, showing how highly the Council's endeavour to provide ground for the healthy occupation of gardening are appreciated. SANITARY POWERS OBTAINED BY THE COUNCIL. The Council has secured by its adoption of the Public Health Acts Amendment Act, 1907, one of the most powerful levers to operate sanitary improvements in the district. It cannot be denied that the Council are well to the front in securing reforms, but the powers conferred by the Local Government Board and Secretary of State will considerably assist the Public Health Officers. The Council are well in advance of many districts, and it is anticipated that good work will follow. EXCREMENT DISPOSAL. The water carriage system is the method of removal of sewage from the dwellings in this district. Every opportunity is taken advantage of for the improvement or amendment of drainage of existing buildings, the whole of which is carried out by the Health Department, modern sanitary fittings replacing defective or obsolete ones, and thoroughly modern drainage systems replacing the old ones. SCAVENGING AND CLEANSING. Collection and disposal of all refuse is now carried out by the Health Department, viz., the collection, removal, and destruction of house and trade refuse. The effective disposal of dry refuse, paper, rags, and other more or less combustible material constitutes one of the greatest difficulties which every sanitary authority has to face. Some 2,704 loads are collected yearly. Much of this might be obviated and expense to the ratepayers reduced if individual householders would burn in their own grates such material as paper, rags, potato peelings, cabbage leaves, and similar substances ; few do so, with the result that the average dustbin contains an objectionable amount of readily decomposing material. 26 SEWAGE WORKS.—TREATMENT AND DRAINAGE. The Local Government Memorandum for the year especially asks for information as to:— Sewerage and Drainage. Method or Methods of Disposal. Localities where improvements are needed. In the report of 1908, I went exhaustively into the treatment of sewage, most suitable to the position and locality of our sewage works, taking into consideration the increase of our population, explaining the Dibden system of Slate Beds, its economy combined with efficiency, and producing an effluent satisfying all the conditions of the Local Government Board. During the year, the Sewerage and Public Health Committee had many meetings on this subject, and in March last asked Mr. Dibden to inspect the works and to advise them as to their future working. Mr. Dibden made the following immediate recommendation, viz., the lowering of the sump at the bottom of the pump well, and additional pump force to regulate the flow of sewage into the tanks, to cleanse the surfaces of the No. 5 and 6 contact beds and render them capable of doing useful work instead of standing idle. To construct inlets three feet wide to each of the six contact beds, thus enabling the beds to be worked in rotation ; with the effect that the maximum degree of drainage and aeration can be obtained from each bed, instead of the bottom layers being always practically under water. The irrigation plots to be cleaned and levelled, which will make them in fair working order. The two plots on the island which were covered with fungas to be drained and allowed to dry, and to be thoroughly cleansed by the removal of years' of accumulation of debris and foul growth. The storm water plot to be levelled and one half covered with hard core, thus forming a horizontal filter. A temporary connection to be made to the two tanks used as slate beds to prevent the discharge from the slate beds being sent to the pump well to be re-pumped as hitherto, to enable the slate beds to be properly worked, the bottom layers of which have been under water for prolonged periods, thus converting them into septic tanks. The area of the present site of the works is ample for the extension of such additional works as may be required for years to come. 27 After having the works under his personal control for three months, Mr. Dibden recommended the following permanent reconstructions. The Works at the present time are capable of treating the whole of the sewage, but certain points require attention in order to put them in the best working condition. The dry weather flow especially ascertained is equal to 420,000 gallons per day. For the treatment of this quantity, plus 54,000 gallons, the estimated increase in two years, extra slate beds and fine clinker beds will be required. The clinker contact bed capacity can be obtained by raising the level of the surface of the beds. The additional slate bed capacity can be provided by filling the existing sedimentation tank and two slate tanks to the top of the walls with slate, constructing one new slate bed and arranging the level of the floors of all the beds so that they drain properly to the fine chamber beds. After leaving the slate beds the effluent should pass through a humus collecting chamber, the deposit in which will be passed on to drainage and drying beds, the fine beds will thus be protected and the labour otherwise necessary to keep them in the best working order will be reduced. The present annual cost for chemicals and sewage disposal is practically sufficient to repay the loan and interest on the amount required for these alterations, so that by the adoption of this treatment it can be made without actual further cost to the ratepayers. In addition to this, all risk of nuisance from the accumulation of sludge will be absolutely avoided. The expert appointed by the Royal Commission in the year 1909 to report upon the working of the slate beds at Devizes (investigated and reported to the Council by me in 1906) reported as follows:— This sludge causes no nuisance during the process of drying, and when dry, breaks up easily into a substance very like ordinary soil. No offensive odour could be detected in the bed even when standing at the bottom of it on a hot day, in fact it smelt exactly like a damp cellar. The system of beds can be extended as required, but care must be taken to secure the system of beds being kept well up to date, and not allowed to fall behind the requirements of the growing population, overworking the existing plant by not following out this method, difficulties will arise which by careful forethought can be easily avoided. 28 Additional beds will be necessary at intervals. On the basis of a steady increase of population at the rate of goo per annum at 30 gallons per head will equal 2700 gallons. In two years the present flow will be increased by 54000 gallons, and it will be necessary to proceed with extra slate and fine beds for dealing with this further 54000 gallons per day, in order that they may be finished and in working order by the time they are required. I append a detailed report of Mr. Jeffes, your Surveyor, on the alteration, and method of sewage disposal carried out at the sewage works in California Road. To R. Davison. Esq., M.D., New Maiden. The Maldens and Coombe Urban District Council. February 24th, 1910. REPORT ON METHOD OF SEWAGE DISPOSAL. The sewage from all parts of the District gravitates to the Sewage Works and is discharged through a 6ft. barrel sewer, which also acts as a storage for the night flow, into a sump or pump well, situated under the pump house. Owing to the floor of the sump being at a higher level than the invert of the sewer delivering into it, it has not been possible to clear the barrel sewer of the accumulated sludge deposited therein, with the result that this barrel sewer has gradually sludged up to a considerable extent. In accordance with plans prepared under my direction, alterations of an arduous and difficult nature have recently been completed, involving the deepening of the sump to a depth of about 3ft. 6in. below the barrel sewer, and provision of a new and wider channel from the barrel sewer to the pumps ; also an extension to the suction of the 12in. centrifugal pump, and other general improvements to the sump, which will have the effect of clearing the barrel of sludge, and enable the sewage to be delivered to the tanks in a more uniform character than has been formerly done. The sewage, after reception in the sump, is lifted by means of a 12in. Tangye centrifugal pump and two three-throw plunger pumps, of 12in. and loin, diameter respectively, into the delivery 29 chamber situated immediately on the north side of the Engine House, from whence it flows into three concrete tanks, each 108ft. by 31ft. by 4ft. 3m. deep. Two of these tanks are filled with slates on the Dibdin principle. These are given two fillings per day, with two hours' rest. The remaining tank is used as an intermittent sedimentation tank, a small amount of " alumina ferric " being used to facilitate precipitation. The total dry weather flow of sewage treated at the works is approximately 420,000 gallons, and of this amount about 181,000 gallons is treated through the slate beds, the remainder being passed through the sedimentation tank, which also takes the excess flow during storm times. Owing to the practice of allowing roof water from the rear of houses to enter the soil sewers, the volume of sewage received at the Works in wet or stormy weather is very greatly increased, and each year the difficulty of proper disposal is intensified. The effluent from the tanks passes along an open carrier, and is treated through six contact beds, each bed being approximately 171ft. long by 51ft. wide and 3ft. deep. Four of these beds are constructed with concrete walls and bottoms, but the remaining two have earth bottoms and enclosing walls. The first four beds are capable of dealing with approximately 418,000 gallons per day, with two fillings apiece The other two beds being of much older date have not nearly the same relative capacity each for each as the previous beds, but the effluent obtained from them at the present time is slightly better than the newer beds, owing probably to their more matured condition. Alterations involving the enlargement of the inlets were recently made with regard to the method of filling these beds, which has led to an improvement, and the beds can now be filled much more quickly than previously. The capacity of three of the filters could be increased by raising the outlet end so as to bring the beds level longitudinally, in the same manner as Contact Bed No. 4, the last one re-constructed. The general condition of the contact beds is satisfactory. The effluent, after passing through the filters, is conducted over about 31/3 acres of land, and is finally discharged into the Hoggsmill River, a tributary of the Thames. A portion of the 30 land is set apart for the reception of the storm overflow water, which is provided to give relief to the sewers during heavy rains. The level of the land receiving the effluent is very low, being very little above the water level of the Hoggsmill River, and is subject to flooding, several floods having occurred during the year ending 31st December last. The land is also insufficient in area to deal with the volume of water which has of necessity to be put upon it. A considerable amount of labour is necessary to keep the land in a proper condition, but it undoubtedly performs a useful purpose, in retaining the suspended matters which at times pass from the contact beds. It is a matter for regret, that owing to the levels not being satisfactory, the adjoining land, owned by the Council, and purchased for sewage purposes, cannot be used for irrigating the effluent after passing through the contact beds. The final effluent can be regarded as a good one, and satisfies the Thames Conservancy. Sludge Disposal. -The sludge deposited in the sedimentation tank is cleared at regular intervals into a sludge well, and from thence it is pumped by means of a chain pump into carriers, which gravitate into shallow lagoons, situated near the press house. The sludge is allowed to settle, dried, and is then disposed of locally. I have not received any complaints regarding this method of disposal since its inauguration. Until about four months ago the sludge was pumped into tumblers and carted to a remote part of the farm, a method which was both offensive and costly, and a considerable sum has been saved in horse labour by the adoption of the improved method. R. H. JEFFES, Assoc. M. Inst. C.E., Engineer and Surveyor. In closing the report, I draw attention to the very excellent and detailed report of Mr. Hunter, your Sanitary Inspector, who has supported me in the various duties of the Health Department, loyally throughout the year. To the Clerk and those officials who I have had the pleasure to consult, I return grateful thanks for courteous and ready advice and assistance rendered to me on many occasions. I am, Mr. Chairman and Gentlemen, Yours faithfully, RASHELL DAVISON, m.d., m.r.c.s., England. 31 One of the appended leaflets is left at the house in any case not removed to the Isolation Hospital. INFORMATION FOR CONSUMPTIVE PEOPLE AND FOR THOSE LIVING WITH THEM. 1.—Consumption is a preventible disease which is caused by minute living germs, called "tubercle bacilli," which usually enter the body with the air breathed. 2.—The matter which consumptive people cough or spit-up contains the germs of the disease in great numbers. If this matter is spat upon the floors, or the walls of any public or private place, or elsewhere, as soon as it becomes dry the germs of the disease which it contains are blown about and float in the air, like any other minute particles of dust, and are inhaled by anybody breathing that air : or they may fall upon milk or other food, and gain access to the body with that food. These are the commonest ways in which the seeds of the disease enter the body of a healthy person. 3.—It is dangerous to sleep with or to live in close relationship with a consumptive, unless the patient is careful that what he coughs up is destroyed. A pocket bottle or a cup containing a little water and disinfectant should be used to spit in, so that the matter may not dry, and it should be emptied in the closet (not into the ashpit, or upon the footwalk or the roadway), and carefully washed afterwards with boiling water. If the consumptive prefers to use soft paper, linen or calico cloths or handkerchiefs to spit in, they should be thrown upon the fire and burnt forthwith. He should take care that his hands, face, and clothing do not become soiled with the matter coughed up. He should never swallow the expectoration : it is dangerous. When coughing he should always cover the mouth with the hand and turn the head aside. 4.—A consumptive should sleep alone ; the windows should always be wide open, except when dressing and undressing. The bedclothing and personal clothing should be boiled and washed separately from the clothing of other people. 5.—Tubercle bacilli are not only the cause of ordinary consumption of the lungs, but they may also give rise to consumption of the bowels and other parts of the body, and therefore milk and other uncooked food should be carefully protected from the tubercle bacilli. If such food be kept in a place to which a consumptive patient of careless habits has access and who may spit upon the floor, the dry particles of the matter spat up may blow about with dust and find access to milk and other food, and in this way contaminate it. Mothers who are consumptive should not suckle their children. 32 6.—Cows suffer from consumption, and the milk from consumptive cows is liable to contain the tubercle bacilli. Milk had better be boiled for a few seconds unless the consumer is sure that it comes from a healthy cow, and that it has not been exposed to danger of contamination afterwards. These precautions should be specially observed in the case of children. 7.—Consumption is a disease from which large numbers of patients recover if the rooms they occupy are always kept thoroughly well-ventilated, clean, and free from dust. 8.—Sunshine and fresh air destroy tubercle bacilli, and are the principal curative agents ; the more sunshine and fresh air the consumptive patient gets, the more likely he is to recover. 9.—Sanitary improvements which have been carried out with a view to admit more pure air and sunshine to dwellings, and to lessen overcrowding, have reduced the mortality from consumption to about one-half of what it was 30 years ago, but, to reduce it still further, the people must help themselves by keeping their rooms clean and well-ventilated, and by maintaining strictly temperate habits. 10.—Rooms that have been occupied by consumptives should be thoroughly disinfected and cleansed before they are again occupied, and the carpets and bedding should be disinfected ; in fact, so far as these precautions are concerned, consumption may be regarded in precisely the same light as any other infectious disease. 11.—The Sanitary Inspector will undertake the necessary disinfection, both of rooms and of clothing, free of charge. By order of the Council, RASHELL DAVISON, M.D., M.R.C.S., Medical Officer of Health. DIPHTHERIA AND MEMBRANOUS CROUP. Home Case. Children from this house must not attend day or Sunday School until permission is given by the Medical Attendant. All cases of " sore throat" or " lumps in the neck " occurring in the household are probably diphtheritic, and should be immediately reported to your Medical Attendant. Public Library Books must be taken to the Health Department, Council Offices, New Maiden, and no books borrowed until the house has been disinfected. 33 If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally dangerous to others for period of at least three weeks, and must not be allowed to mix with other people during that period, or while there is any sore throat, or any discharge from ear or nose, or while diphtheria germs can be detected in the throat. Disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.—Special cups, saucers, and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose, or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4.—When the patient is free from infection, the Council undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on application to the Sanitary Inspector, Council Offices, New Maiden, between the hours of 9 a.m. and 10 a.m RASHELL DAVISON, M.D., M.R.C.S., Medical Officer of Health. A penalty of £5 is attached to the exposure of infected persons and things. 34 MEASLES. In towns, the attack-rate is highest in the third, fourth and fifth year of life, while the death-rate caused by the disease is highest in the second year of life. After the age of five the deathrate caused by it is relatively very small. These facts clearly indicate the importance of postponing an attack of measles, and of adopting special measures to ensure increased safety for children under five. The early infectiousness of measles, while the symptoms are only those of a common cold, is a marked feature of this disease. It is not unlikely that a majority of the total cases are infected by patients in this early stage. The incubation period from infection to the commencement of cold symptoms is 12 to 14 days with fair constancy. Rules for Exclusion of Individuals. Children attacked by measles should be kept from school for four weeks. When measles breaks out in a household, all children under seven years of age, and any children over seven years of age who have not had measles, should be excluded from school until 21 days from the date of onset of the illness of the last patient with measles in the house. Warnings to Parents. Measles is an infectious disease, and as such is notifiable in this district, under the Notification of Infectious Diseases Acts. If a case of measles occurs in a household, call in your Medical Attendant immediately, and he will at once notifiy the disease as required under the Acts. Failing a Medical Attendant, the person who must notify the Medical Officer of Health, Health Department, Council Offices, New Maiden, is the parent, or failing the parent, then the person who is in charge of, or in attendance on, the patient at the time. The penalty upon conviction, of failing to notify an infectious disease, is Forty Shillings. 35 SCARLET FEVER OR SCARLATINA. Home Case. Children from this house must not attend day or Sunday School until permission is given by the Medical Attendant. All cases of "sore throat," "lumps in the neck" or of "peeling skin" occurring in the household are probably scarlatinal, and should be immediately reported to your Medical Attendant. Suspicion should also be roused by any sudden attack of illness, especially if beginning with vomiting. Public Library Books must be taken to the Health Department, Council Offices, New Maiden, and no books borrowed until the house has been disinfected. The patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. . Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. No Children should be allowed to visit the infected house. A patient suffering from this disease is generally dangerous to others for six to eight weeks, and must not be allowed to mix with other people until the Medical Attendant certifies that there is no danger. There is a risk of infection while there is any discharge from the ear or nose, or while the throat remains sore or unhealthy. Disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant and then washed. 2.—Special cups, saucers and spoons, should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose, or mouth, should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 36 4.—When the patient is free from infection, the Council undertake the disinfection of the sick room, bedding-, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week, on application to the Sanitary Inspector, Health Department, Council Offices, New Maiden, between the hours of 9 a.m. and 10 a.m. RASHELL DAVISON, M.D , M.R.C.S., Medical Officer of Health. A Penalty of £5 is attached to the exposure of infected persons and thing's. TYPHOID (ENTERIC) FEVER. Home Case. All cases of "diarrhoea," "severe headache" or " feverishness " occurring in the household should be immediately reported to your Medical Attendant. All Library books must be taken to the Sanitary Department, Council Offices, New Maiden, and no books borrowed until the house has been disinfected. If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, and should always wash their hands and faces, and change their shoes and outer clothes before going off duty. Scrupulous cleanliness is essential. Nurses should keep their nails short, and should scrub their hands and disinfect them immediately after attending the patient. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally dangerous to others for a period of a fortnight after return to ordinary food. Disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for 12 hours and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 37 2.—Special cups, saucers and spoons, should be used for the patient, and any spare food from the sick room destroyed. 3.—Everything passing from the patient should be received into a mixture of water and disinfectant, sufficient being used to completely cover it, and be allowed to stand for half-an-hour before being thrown away, the vessel being covered with a cloth soaked in the disinfectant. Nothing coming from the patient must be thrown into the ash-bin, or upon the surface of the soil, or into the drains without disinfection. 4.—Discharges from ear, nose, or mouth, should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 5.—When the patient is free from infection, the Council undertake the disinfection of the sick room, bedding, &c., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week, on application to the Sanitary Inspector, Council Offices, New Maiden, between the hours of 9 a.m. and 10 a.m. RASHELL DAVISON, M.D., M.R.C.S., Medical Officer of Health. A Penalty of £5 is attached to the exposure of infected persons and things. 38 SANITARY INSPECTOR'S REPORT. Health Department, Council Offices, New Malden. January, 1910. Rashell Davison, Esq., m.d., Medical Officer of Health. Dear Sir, I have pleasure in submitting my Second Annual Report of the work done in the Health Department, and the sanitary circumstances of the District during the past year. A tabulated summary of the various inspections made and nuisances discovered is inserted on page 42. Systematic inspection of the District has been made in accordance with the General Orders of the Local Government Board and Sec. 92 of the Public Health Act, 1875. During the year 71 complaints of nuisances in the District have been received. All complaints are immediately investigated and the necessary steps in respect thereof at once taken. Most of the nuisances discovered were remedied upon receipt of informal notices, but in 13 cases Council Orders had to be applied for and served. In no case, however, have legal proceedings been necessary. 146 sanitary notices were served, 135 of which were complied with, of the 11 notices remaining in obeyance at the close of the year, 9 are now complied with, the 2 outstanding ones being cases where the property has become unoccupied since serving the notices. The work of house to house inspection of the small property is being gradually undertaken, but owing to my numerous duties cannot be proceeded with as quickly as I would like. There is not the least doubt that this is a very necessary work, and if continued, exercises considerable influence both mental and practical over the occupiers of the smaller properties. During the past year, the inspection of properties in Albert Road, George Road, Queen's Road, Burlington Road, Northcote Road, Grafton Road, Kingston Road, Wellington Crescent, Roberts Road, and Cleveland Road, has been undertaken, and with very satisfactory results. 39 Proper galvanized iron sanitary dustbins for the reception of house refuse have been provided, the yards at the rear for a sufficient reasonable distance from the back door around to the w.c. paved with impervious material with a fall to a properly trapped gully connected to the drains, so as to take away all rain or other waste water from the immediate neighbourhood of the back door, proper sanitary fittings fixed in place of defective or ones of obsolete and insanitary patterns, and the drains re-laid, not to mention many much needed sanitary improvements inside the houses, such as new sinks, sink waste pipes, new or repaired floors, and the repair and cleansing of walls and ceilings. In carrying out this work I have found several clauses in Part 3 (Sanitary Provisions) of the Public Health Acts Amendment Act, 1907, which was adopted in this district extremely useful, particularly Sec. 35, dealing with defective rainwater gutters, stack pipes, etc., causing damp walls Sec. 37, rainwater stack pipes not to be connected direct to drains, and Sec. 49, giving power to compel the provision of sinks and sink waste-pipes for the proper carrying off of waste water The Paving of Back Yards.—During the year 46 yards have been paved, in most cases from the main building around the back addition to the party fence, and in each case this has been executed in six inches of Portland cement concrete worked up to a good impervious surface with a good fall in every way to a properly trapped gully. Very often the gully utilised is the one taking the sink waste water. This work is now carried out under Sec. 25 of the Public Health Acts Amendment Act, 1907. A paving notice having been drawn up to fulfill the requirements of that statute. Water Supply.—The District is served with a supply of water from the mains of the "Southern District" Metropolitan Water Board. Four complaints were received during the year of insufficient storage cistern capacity. Nine houses were found to have water cisterns without any covers to same. This is a very dangerous practice, instances have been found during the year where birds have gained access to the roof and become drowned in the cistern referred to, gradually decomposed, and polluted the entire water service of the house. 40 Owing to either ignorance or want of interest in such matters by the occupiers, nothing was suspected until the occupants developed very bad throats and diarrhoea, when upon investigation this was found to be the cause. Sec. 35 of the Public Health Acts Amendment Act, 1907, now gives power to remedy the evils of improperly placed, constructed, or neglected cisterns. During the year ten notices of withdrawal of water supply have been received from the Water Board. Samples of the water from a well found to be the only water supply to premises in New Maiden were taken and submitted for analysis. As the report was very unsatisfactory, notices were served to provide a proper and efficient water supply, and to discontinue the use of the water from the well. At the close of the year this matter is in hand. House Accommodation.—During the year the following buildings were completed and Certificates of Occupation granted by the Surveyor. 165 new houses, 1 Milk Store, 1 Bathroom and W.C., 1 Store and Coal House, and 1 Stable building. In addition to these the Dormitories at the Kingston Guardians Union Farm were completed. Housing of the Working Classes Act, 18)0.—During the year 4 notices were served under Part 2 of this Act. In all cases the condition of the premises was owing to continual neglect on the part of the owner, nothing evidently having been done in maintenance for a number of years, and consequently the premises going from bad to worse. In one instance it was found that only one W.C. was provided for 3 houses. This has been remedied ; a W.C. now provided for each house, sinks provided inside the houses, a necessity to cleanliness which hitherto had not existed, and the premises redrained, etc. Beverley Brook.—No complaint has been received during the past year from the Thames Conservancy regarding this stream. I found, however, that there existed a source of pollution in the Old Maiden district from the overflowing of the contents of a cesspool. The conditions were drawn to the owners attention, and the premises were entirely redrained and connected to the Council's sewer. 41 Railway Stations.—The sanitary conveniences at the railway stations in the district are periodically inspected. And at the time of writing improvements are being requested. The Street Dust Nuisance.—The work carried out by the Council under the direction of the Surveyor (Mr. R. H. Jeffes) of treating the main roads with tar to minimise the dust nuisance was extended during the past year and proved highly successful, and a boon to tradesmen and residents on the roads affected. Owing to the many advantages derived from this treatment of the road surface both from the public health standpoint, as well as the preservation of the road itself, it is to be hoped this work will be extended each year. The Smoke Nuisance.—Very little cause for complaint has arisen during the year. Private Streets. —Complaints have again been received during the year of the conditions of many of these streets. This has of course occurred particularly during the continuous wet weather we have experienced, and is a condition which one must rather expect in a growing district, with new streets being formed and estates opened up. During the year Burlington Road (part of), Dunbar Road, and Wellington Crescent (part of) have been made up with artificial stone footpaths, granite curb, channelling, etc., and these great improvements upon past conditions are highly appreciated by the inhabitants. The existence of soft roads, and still softer footpaths, absorbing as they undoubtedly do all the rain and other waste waters and products (with numerous accumulations of stagnant water, etc.), in some of these private streets is without a doubt a continual menace to the public health, and in the streets comprising small property in particular these conditions encourage unclea'nliness on the part of the occupiers, for however industrious a housewife may be, it is impossible to keep the house clean under these conditions, with the result that things get from bad to worse. The Highways and New Roads Committee and the Council have done their utmost in endeavours to make headway with the making up of these streets, but owing to continuous opposition and objections on the part of owners, it is very disappointing to find that the progress made during the year, is far from what was confidently anticipated twelve months ago. 42 The following is a tabulated summary of the inspections made and nuisances discovered during1 the year ending December 31st, 1909. NATURE OF CASES DEALT WITH. NO. Notification of infectious disease 155 Visits to houses where zymotic diseases have occurred 259 Houses disinfected 112 Lots of clothing1 and bedding disinfected 101 Inspections of Houses 157 ,, ,, Houses let in Lodgings 2 ,, ,, Factories 9 ,, ,, Workshops and Workrooms 40 ,, ,, Outworkers Premises 6 ,, ,, Bakehouses 24 ,, ,, Dairies, Cowsheds and Milkshops 93 ,, ,, Slaughterhouses 188 ,, ,, Butchers, Greengrocers, Fishmongers, and Ice Cream Shops 246 ,, ,, Schools 22 ,, ,, Yards and Stables 302 ,, ,, Urinals 48 Sundry Inspections 2 79 Re-inspections of work in progress 994 Contravention of Bye-laws 4 Complaints received and investigated 71 Smoke observations 2 Lots of food condemned and destroyed 10 Drains tested 355 Drains re-laid 185 Drains repaired 9 Loads of Refuse Removed 2775 NUISANCES DISCOVERED. Premises requiring repair 24 ,, ,, Cleansing and Whitewashing 23 ,, Overcrowded 10 Drains found defective 109 ,, ,, stopped 43 Defective Sanitary Fittings !59 ,, Yard Surfaces 46 ,, Eaves and Downspouts 17 ,, Manure receptacles 3 ,, Urinals 2 ,, Ashbins 43 Smoke Nuisances 2 Animals improperly kept 2 Infringements of Bye-laws and Regulations 6 Offensive Accumulations 56 Sundry other Nuisances 46 Total number of Nuisances 561 Informal Notices served 146 Informal Notices complied with 135 In Abeyance 11 Referred to Committee 13 43 DRAINAGE. During the year 355 drains were tested, 109 drains were found defective, and 185 drains were relaid. These include 36 entirely new drainage systems. In 7 cases necessitating entirely new connections with the Council's sewers, and also include the abolition in the district of 5 cesspools. Re-drainage work was completely carried out, necessitating entirely new systems on the following properties. Coombe Cottage, Coombe. Coombe Bury House, Coombe. Robin Hood Lodge, Richmond Park. "The Grange," Old Maiden. New Malden. Burlington Road, "Burlington Lodge." Chestnut Grove, "Oak Cottage." Elm Road, "Sway." Grafton Road, Nos. 2, 4, 6, 8, 10. 12, 14, 16, 18, 20, 22, 24, and 26. Kingston Road, "Lime Cottages," Nos. 1, 2, 3, 4, and 5. Maiden Road, "Brampton Lodge." Maiden Road, "Market Place," No. 1, No. 3. Maiden Road, "Market Place," No. 17 (Stable drainage). Maiden Road No. 12 "The Pavement." Northcote Road, Nos. 18, 20, 22, and 24. Wellington Crescent, No. 4. Under the provisions of Sec. 41 of the Public Health Act, 1875, 31 notices of intention to open the ground and examine the drains were served. Upon the ground being opened and the drainage of these premises examined, in every case the drainage had to be reported defective, notices were served and the drains put in a satisfactory condition. 44 In house to house inspection, or upon complaint, or in case of illness in the house, and the drains are suspected of being unsatisfactory, the smoke test is applied by smoke machine under pressure. All drains, however, upon being relaid or in any way repaired, are required to be laid on six inches of Portland cement concrete, the joints made watertight with Portland cement, the drain packed up to two-thirds the vertical height of the pipes with concrete, and are tested with the hydraulic or water test with a head of at least two feet of water. Wherever possible I always endeavour to persuade the owner to put in an iron drain with caulked lead joints, indeed the difference in cost is very small and especially in those parts of the district (New Maiden Ward) with a clayey soil the trifling difference in cost is more than compensated by the assurance thus obtained against any future trouble. A general sanitary survey of all fittings, etc., including the testing of drains is carried out in all cases of Diphtheria, Scarlet Fever, or Typhoid Fever occurring in this district, and the proper notices served to remedy any defects found. There was only one drainage notice outstanding at the close of the year, and this was on account of the premises becoming unoccupied. The compilation of drainage bye-laws for the drainage of existing buildings was completed in the early part of the year, but were postponed for consideration, sine die. I am pleased to say these are at the time of writing being considered by the Committee for submission to the Local Government Board for their approval. These bye-laws are very much needed in the district, for the better control of the carrying out of this work. Especially is this required in the carrying out of repairs to drainage systems, as frequently the knowledge of such work is only obtained by observation in going about the district. Van Dwellings.—The camping of caravans in certain parts of the district has not given so much trouble as in the preceeding year. On one occasion only has the trouble been serious and that was on the land adjoining the Burlington Road Schools, during the summer. With the aid of the Police and consent of the owner, 45 the Council's horses were taken to the vans with a view to pulling the vans out on to the highway, when the Police can deal with them, but upon seeing we meant business the owners soon decamped. The only remedy for this nuisance is to compel owners of land to fence the land in and recognise their responsibilities. The model Bye-Laws of the Local Government Board are in force in the district, but are quite inadequate to deal with this nuisance. SCHOOLS. The Sanitary accommodation of all the Schools in the District is periodically inspected to ensure an efficient state of cleanliness at all times. There are eight private schools in the District. These schools are periodically inspected. During the year one school was discontinued and one new one opened. In was found upon examination that the drainage at four of the schools was defective, the proper notices were served and the defects remedied. Small defects in the sanitary fittings were found at the Elm Road Schools, and were remedied. It would be a step in the right direction if the Rules to be observed in the planning and fitting up of Public and Elementary Schools presented by the Board of Education were so worded as to forbid the system of trough closets in Schools. Owing to the irregular flush and certain parts of the apparatus which become splashed with faecal matter and which cannot be removed automatically, these closets are liable to become serious nuisances and a danger to the school children. Separate water-closets each provided with apparatus for flushing by the users are much preferable. DISINFECTION. The rooms and bedding, clothes, etc., have been disinfected in 107 cases of infectious disease upon removal to the Isolation 46 Hospital, recovery, or death of the patient:— Scarlet Fever 69 Diphtheria 25 Typhoid Fever 2 Consumption 2 Measles 5 Erysipelas 1 Chicken Pox 2 Sore Throat 1 107 One private school was disinfected on account of measles. Disinfectants were supplied to occupiers of all infected premises, and in the cases of home treatment disinfectants were supplied during the whole time. Printed instructions are always left at the house in all home cases. Where necessary after disinfection the owners or occupiers are required to strip the walls of any old paper, cleanse the walls and cleanse and whitewash the ceilings. The houses are always inspected as to their sanitary condition, and the drains tested with the smoke machine test, upon the occurrence of any infectious disease. In small property constantly inhabited the only safe course for the prevention of infection is to insist upon the walls being stripped clean to the surface every time the walls are redecorated by papering or distemper. Even if this was done only when houses changed tenants, it would be a great gain in the prevention of the spread of disease. It is quite as important as defective drainage, because the infection spread in this manner is more insidious and difficult to detect. A table will be found on page 54, giving the streets in the District where Infectious Diseases occurred, and will be found very useful for comparison in future years. 47 SLAUGHTER-HOUSES. There are two slaughter-houses in the district, one being licensed and one registered. During the year, 188 inspections of slaughter-houses were made. The tables given under Food Supply give the particulars of the inspections. The quarterly limewashing of these premises has on all occasions been carried out as required. Neither of the present slaughter-houses can be looked upon as desirable premises to carry on the trade for which they are used, both being adjacent to property, very dark, badly ventilated premises with none of the necessary modern equipments of slaughter-houses. The supervision of these premises takes up a considerable amount of time, being nearly two miles apart, and more time is taken up than should be, on account of the irregular and even unreasonable times of slaughtering. This is the greatest objection to private slaughter-houses. If an occupier had to give notice before slaughtering, a great deal of time and anxiety might be saved. At present the occupier of a private slaughter-house can commence slaughtering at any unreasonable hour, such as Sundays and at night-time, to suit his own convenience. If a clause could be inserted in the Local Government Slaughter-house Bye-Laws restricting the hours of slaughtering to, say, between 6 a.m. and 9 p.m. (unless by special permission), and the owner or occupier not allowed to remove a carcase of any animal from his slaughterhouse for a period of at least six hours after slaughter, great assistance would be rendered towards efficient inspection. The only proper solution of this difficulty is the compulsory slaughter of all animals in a public slaughter-house, or abbatoir, but this, of course, would be of little avail unless carried out in every district, and is a step which is very necessary, the occupiers of the private slaughter-houses, however, should be compensated according to length of establishment, etc., for the loss of their present legal privilege. 48 This would be the solution of all the difficulties of controlling the meat supply; it certainly would cost a little more, but the public surely would not mind a little additional cost with the satisfaction of efficient supervision. The Tuberculosis Order, 1909, of the Board of Agriculture, Which was to come into force on January 1st, 1910, but which was unfortunately referred back, it was hoped would be the commencement of the compensation question, but this Order contained many very weak clauses. A bovine animal must be "emaciated" from tuberculosis before it can be dealt with, and therefore is allowed to spread infection amongst other cattle; with regard to slaughter, the owner or person in charge can have the affected animal which is isolated slaughtered at "any" time, but the Act says nothing of notifying the Local Authority, and the Local Authority is the Local Authority administering the Diseases of Animals Acts, which, of course, is the County; so the Act simply ignores Urban Districts, who may be doing their utmost to tackle the question of disease of cattle and milk supply. The Urban District on the spot with responsible officials is much more likely to be able to solve, or at any rate go a long way to solve, this question than the County Authority, who know none of the local conditions, etc. The Urban District has officials on the spot who can keep in touch with these matters, but the County officials may be here to-day and not seen again until sent for. Although the Order not only included cows and heifers, in its operation, but all bovine animals emaciated from tuberculosis, its main object was protection to the public health from risk of the spread of tuberculosis by milk rather than the eradication of tuberculosis in animals. The proposal to place the whole cost of the carrying out of this Order, including the slaughter and compensation of animals, upon the County ratepayer, is, however, indefensible. The principle that cost incurred for the benefit of the whole public should be paid from the general taxation of the country is sound, local taxation for this purpose is manifestly unjust to the ratepayers, while taxation on the basis of the Order, which was payable by county ratepayers only, is both unjust and unequal. 49 FOOD SUPPLY. During the year frequent inspections have been made of the various shops and premises in the district where articles of food, meat, fish, etc., are sold or prepared for sale. The following is a table of the premises and inspections :— nature of premises. no. of inspections. Slaughterhouses 188 Butchers' Shops 172 Fishmongers 26 Bakehouses 24 Cowkeepers 30 Dairies and Milkshops 63 Hawkers of Food 32 Total S35 The following is a statement of food destroyed as unfit for the food of man. P. H. Act, 1875, and P.H.A.A. Act, 1890. description. weights in lbs. Beef 20 Mutton 138 Pork 98 Offal 31 Fish — Other Articles 8 Total 295 There has not been any legislation introduced during the past year with regard to the use of preservatives in foods, as was expected by the majority of people interested in this important question. The sooner a proper standard is fixed for the use of all preservatives, as was recommended by the Departmental Committee of the Local Government Board in its report of 1901, the better it will be for all concerned. Further legislation was enacted during the past year regarding Foreign Meat. The Public Health (Foreign Meat) Amending Regulations, 1909, came into operation on Sept. 30th, 1909. These regulations give greater powers for the examination and rejection of certain foreign meats, and additional "Official Certificates" are recognised. 50 FACTORY AND WORKSHOPS ACTS. Factories.—With the exception of that part of the law dealing with sanitary accommodation and conveniences the legislation regarding factories is administered by the Home Office. There are now eight factories on the register. No notice was served during the year. Workshops.—There are now 44 workshops and 2 Workplaces on the register. Seven notices were served for various matters requiring attention in connection with workshops. The following- is a table of the various workshops and the various trades carried on therein :— workshops on register and trades carried on therein. trade. no. of workshops. Bakehouses 8 Laundries 5 Plumbers and Glaziers, etc 3 Boot and Shoe 4 Dressmaking1 and Millinery 8 Blacksmiths, Wheelwrights, etc 4 Cycle Works and Carpenters 5 Sundry other Workshops 7 Totals 44 The following is a tabulated summary of the various matters requiring attention and notices served :— Matters requiring attention. Bakehouses Factories. Laundries. Workshops. Workplaces. Homew'rk'rs Totals. Infectious disease occurring — — 1 — — — 1 Cleansing and Limewashing — — 2 2 1 — 5 Defective Sanitary Fittings — — 2 1 1 — 4 Defective Drainage — — 1 3 2 — 6 Yard paving required — — — 1 1 — 2 Totals — — 6 7 5 — 18 51 All defects found were remedied during the year. Three notices were sent to H.M. Inspector of Factories in accordance with the requirements of the Acts. Bakehouses.—Eight Bakehouses are now on the register, all of which have been inspected at intervals during the year. There is no underground bakehouse in the district. HOME WORK. There were no homeworkers notified during the year in the district. Four homeworkers were notified to this by other Local Authorities, however. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. There are now 41 names on the register. Only 32 of the 41 persons registered are, however, now carrying on business in the District, viz.:— Cowkeepers 9 Dairymen 10 Milkshops 4 Purveyors of Milk (residing in the District) 2 Purveyors of Milk (residing outside the District, but carrying 011 trade in the District) 7 32 The number of milch cows in the District at the close of the year is 106, a decrease of 24 upon the number of last year. Ten persons have been registered during the year. During the year bills were posted in various parts of the district calling the attention of persons interested, to the requisition of the above Orders, with regard to registration, and the penalty if found carrying on these trades without registration. The power provided under the P.H.A. Amendment Act, 1907, requiring dairymen to furnish lists of the sources of their supply. was enforced on one occasion during the year. 5 2 One sample of milk was taken and sent for analysis when the milk was first suspected as the cause of infection in connection with the Scarlet Fever outbreak. Two samples of milk were taken owing to suspicions of tubercle infection, but in each case the result was negative. Power should be given to a local Authority to compel the slaughter of any dairy cow with the slightest sign of tuberculosis, and then the suspicious cows would soon be no more in our dairy herds. CLEANSING DEPARTMENT. The Collection and Disposal of Refuse. House refuse is systematically collected from the rear of all houses, once a week throughout the entire district. During the year, 2,775 loads of house refuse have been collected and destroyed by incineration This work is ever on the increase, the district being a rapidlygrowing one, each successive week finds a slight addition in the number of premises from which to collect, entailing considerable effort and perseverance on the part of the men engaged in this work; especially will this be understood when it is explained that there has been no additional labour provided, excepting on special occasions, such as holidays; in fact, I cannot speak too highly of the perseverance the men have shown on all occasions, under most trying weather, during the past year. I have found that the practice of building rows of houses with a common back entrance to, say, six or eight houses with only one entrance to same, takes up a very considerable time and involves considerable labour. If an entrance could be provided at "each" end of a row of houses, or better still, an additional one down the centre, a great saving in labour and time could be accomplished. From this point of view, amongst others, the erection of semi-detached and the abolition of the practice of building terrace houses would be welcomed. Disinfectant powder is carried on all the Dust Carts for use, if necessary, after the refuse receptacles have been emptied of 53 their contents. Neglected dust-bins very soon become most offensive and a nuisance generally close to the back doors of premises. If only occupiers of premises would take a little interest in such matters and have the dust-bins thoroughly washed out and put to dry occasionally, a great deal of the cause of the complaint would be removed. It is a frequent occurrence to find an occupier complaining of the dust-bin, and upon investigation the offending article is found in a wet, filthy and neglected condition by the occupier himself. A very good plan is to always put a good piece of paper in the bottom of the bin after it has been emptied, then the paper will be removed with the contents and the bins kept clean. During the year 43 galvanized iron sanitary dust-bins have been provided in place of defective ones, and 15 notices have been served upon persons for depositing sweepings, etc., from premises in the gutter. It is a general practice for the dust-men to report any premises without any proper receptacle or with an unsatisfactory one, when the matter is investigated and the proper notice served. Trade refuse (with the exception of offal or obnoxious refuse from fishmongers, poulterers, butchers, etc.) is now collected at a small charge, as is also garden, builders', etc., refuse, and I have found this provision very useful in obtaining the removal of accumulations. In conclusion, I should like to express my thanks for the kindness and courtesy I have received on all occasions from my fellow Officers. I am, Sir, Yours faithfully, HARRY HUNTER, M. R. San. I., Mem. San. Inspt. Assoc. Table showing the Streets in which the Infectious Diseases Notified occurred, during the Year 1909. Street or District. Cases Notified. Totals. Deaths. Cases Resulting Fatally. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. Measles. Tuberculosis. Diphtheria. Puerperal Fever. NEW MALDEN. Acacia Grove 3 ... ... 3 ... ... ... 6 ... ... ... Alric Avenue 1 ... ... ... ... 1 ... 2 ... ... ... Albert Road 1 ... ... ... ... ... ... 1 ... ... ... Albany Road ... 1 ... ... ... 2 ... 1 ... ... ... Albemarle Gardens ... 1 ... ... ... ... ... 1 ... ... ... Burlington Road 8 1 ... 1 ... ... ... 10 ... ... ... Blagdon Road 7 ... ... 2 ... ... 1 12 ... ... ... Beech Grove 2 ... ... ... ... ... ... 2 ... ... ... Cambridge Road ... ... ... ... ... 2 ... 2 ... ... ... Chestnut Grove 2 1 ... 1 ... 2 ... 6 ... ... ... Cleveland Road 1 1 ... ... ... ... 1 3 ... ... ... Coombe Gardens 1 ... ... 1 ... ... ... 2 ... ... ... Dickerage Lane 1 ... ... ... ... ... ... 1 ... ... ... Elm Road ... ... ... ... ... 2 ... 2 ... ... ... Georœe Road ... ... ... ... ... ... ... ... ... ... ... Dickerage Lane 1 ... ... ... ... ... ... 1 ... ... ... Elm Road ... ... ... ... ... 2 ... 2 ... ... ... George Road 4 7 ... ... ... 1 ... 12 ... ... ... Grafton Road 3 2 ... ... ... 2 ... 7 ... ... ... Kingston Road ... 1 ... ... ... 3 1 5 ... ... ... Kingscote Road 1 1 ... ... 1 2 ... 5 1 ... 1 Kings Avenue ... ... ... ... ... 2 ... 2 ... ... ... Lime Grove ... 1 ... 1 ... ... ... 2 ... ... ... Maiden Road 4 ... 1 ... ... ... ... 5 ... ... ... Maiden Hill 5 ... ... ... ... 1 ... 6 ... ... ... Nelson Road 2 ... ... ... ... ... ... 2 ... ... ... Northcote Road 1 2 ... 1 ... 3 ... 7 ... ... ... Poplar Grove 1 ... ... ... ... ... ... 1 ... ... ... Queen's Road 6 ... ... ... ... 2 ... 10 ... ... ... Rodney Road 1 ... ... ... ... ... ... 1 ... ... ... Roberts Road ... 1 ... ... ... ... ... 1 ... ... ... Salisbury Road 1 ... ... ... ... ... ... 1 ... ... ... Selwyn Road ... ... ... ... ... 1 ... 1 ... ... ... Sussex Road 3 1 ... ... ... ... ... 4 1 1 ... St. John's Road 1 ... ... ... ... ... ... 1 ... ... ... Thetford Road ... ... ... ... ... 1 ... 1 ... ... ... Wellington Crescent 2 2 ... ... ... 1 ... 5 ... ... ... OLD MALDEN. ... ... ... 1 ... 1 ... 2 ... ... ... COOMBE. 20 ... ... ... ... ... ... 20 ... ... ... 83 25 1 12 1 29 4 155 3 2 1 Table I.—Vital Statistics of Whole District during 1909 and Previous Years. Name of District.—THE MALDENS AND COOMBE. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages Belonging to the District. Number. Rate. Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births registered. Number. Rate. Number. Rate. 1899 6180 130 22 16 129 57 9.2 ... 2 59 9.6 1900 6243 129 22 11 80 66 10 .9 ... ... 66 10.9 1901 6322 146 23.1 18 123 70 11 .1 ... 5 75 11.8 1902 6647 170 25.7 18 106 73 10.5 ... ... 73 10.5 1903 7199 195 27.1 15 77 67 9.3 ... ... 67 9.3 1904 7675 176 22.9 27 107 90 10.4 ... 12 102 13 .3 1905 8642 193 22.3 15 77 62 7.1 ... 6 68 7.9 1906 9686 208 21.5 14 67 76 7.8 ... 3 79 8.1 1907 10268 223 21.7 24 108 82 8.0 ... 8 90 8.8 1908 11085 255 23 18 71 86 7.8 ... 10 96 8.7 Averages for years. 1899-1908. 7995 182 23.1 17.6 95 73 9.2 ... 4.6 77.5 9.9 1909 12005 269 22.4 18 67 89 7.4 ... 22 105 8.7 56 Table II.—Vital Statistics of Separate Localities in 1909 and previous years. Name of District.—THE MALDENS AND COOMBE. Year. The Maldens & Coombe. New Malden. Old Malden. Coombe. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered Deaths at all Ages. Deaths under 1 year. 1899 6180 130 59 16 4422 112 48 16 574 6 3 ... 1184 12 8 ... 1900 6243 129 66 11 4485 118 55 10 575 4 3 ... 1183 7 8 1 1901 6322 146 75 18 4551 126 67 16 576 6 6 2 1195 14 2 ... 1902 6647 170 73 18 4866 1 51 64 18 582 9 3 ... 1199 10 6 ... 1903 7199 195 67 15 5441 182 61 13 586 7 3 ... 1202 6 3 2 1904 7675 176 102 27 5876 164 91 24 588 5 3 1 1211 7 8 2 1905 8642 193 68 15 6816 186 60 !4 584 2 6 ... 1242 5 2 1 1906 9686 208 79 14 7763 187 64 13 585 8 7 ... 1338 l3 8 1 1907 10268 223 90 24 8338 205 79 23 583 7 9 ... 1347 11 2 1 1908 11085 255 96 18 9112 228 85 17 590 11 4 ... 1383 16 7 1 Averages of Years 1899 to 1908. 7995 182 77.5 17.6 6165 166 67.4 16.4 582 6.5 .3 1248 9.5 5..4 .9 1909 12005 269 114 18 9964 243 101 16 599 9 5 1 1442 17 8 1 57 58 Table III.—Cases of Infectious Disease notified during the year 1909 in the Maidens and Coombe Urban District. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages. Under 1 year. 1 to 5. 5 to 15 15 to 25. 25 to 65. 65 and upwards. New Malden. Old Malden. Coombe. New Malden. Old Malden. Coombe. Total. Diphtheria 25 ... 8 14 3 ... ... 25 ... ... 19 ... ... 19 Erysipelas 12 ... ... 1 2 9 ... 11 1 ... ... ... ... ... Scarlet Fever 83 1 13 47 11 11 ... 63 20 45 ... 6 51 Enteric Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... Measles 29 ... 14 7 6 2 ... 28 1 ... ... ... ... ... Phthisis 4 ... ... ... ... 4 ... 4 ... ... ... ... ... ... Totals 155 1 35 69 22 28 ... 133 2 20 64 ... 6 70 Tolworth Isolation Hospital is available for all Infectious Cases. 59 Table IV.—Causes of, and Ages at Death during year 1909, in the Maidens and Coombe Urban District. Causes of Death. Deaths in whole District at subjoined ages. Deaths at all ages of " Residents" belonging to Localities, whether occurring in or beyond the District. Total Deaths. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. New Malden. Old Malden. Coombe. Diphtheria 2 ... ... 2 ... ... ... 2 ... ... 2 Epidemic influenza 8 ... 2 1 1 ... 4 8 ... ... 8 Diarrhoea 2 2 ... ... ... ... ... 2 ... ... 2 Gastritis 2 ... 1 ... ... 1 ... 2 ... ... 2 Puerperal fever 1 ... ... ... ... 1 ... 1 ... ... 1 Erysipelas 1 ... ... ... ... 1 ... 1 ... ... 1 Phthisis 5 ... 1 ... 1 3 ... 4 1 ... 5 Cancer, malignant disease 5 ... ... ... ... 5 ... 5 ... ... 5 Bronchitis 5 ... 1 ... ... ... 2 4 1 ... 5 Pneumonia 4 ... 2 ... ... 2 ... 4 ... ... 4 Alcoholism 3 ... ... ... ... 2 1 2 ... 1 3 Premature birth 5 5 ... ... ... ... ... 5 ... ... 5 Heart diseases 8 ... ... ... 1 2 5 8 ... ... 8 Suicides 1 ... ... ... ... 1 ... 1 ... ... 1 Appendicitis 3 ... 1 1 ... 1 ... 2 ... ... 3 Apoplexy 6 ... ... ... ... 2 4 6 ... ... 6 Senile decay 7 ... ... ... ... ... 7 6 1 ... 7 All other causes 46 9 2 1 4 18 12 38 2 6 46 All causes 114 18 10 5 7 39 35 101 5 8 114 Table V.—Infantile Deaths from stated causes in Weeks and Months under One Year of Age during the year 1909 in the Urban District of the Maidens and Coombe. Cause of Death. Under 1 Week. 1-2 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 5-6 Months. 6-7 Months. 7-8 Months. 10-11 Months. 11-12 Months. Total Deaths under one Year. Diarrhœa ... ... ... ... ... ... ... 1 1 ... ... 2 Enteritis ... ... ... 1 ... ... ... ... ... ... ... 1 Premature Birth 5 ... 5 ... ... ... ... ... ... ... ... 5 Congenital Defects 1 1 2 ... ... ... ... ... ... ... ... 2 Marasmus 5 ... 5 ... ... ... ... ... ... ... ... 5 Rickets ... ... ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... ... 2 ... ... ... ... ... ... ... 2 Other Causes 2 ... 2 ... ... ... ... ... ... ... ... 2 Total 13 1 14 3 ... ... ... 1 1 ... 1 20 RASHELL DAVISON, m.d., m.r.c.s., Medical Officer of Health. 60