MER 032 Merton Urban District Council. REPORT of Medical Officer of Health on the Sanitary Condition and Vital Statistics, and Report of Sanitary Inspector FOR The Year 1908. Submitted to the Council 26th January, 1909. Wimbledon: W. H. Stoakley & Co., 11, St. George's Road. Merton Urban District Council. HEALTH REPORT FOR 1908. TO THE CHAIRMAN AND MEMBERS OF THE MERTON URBAN DISTRICT COUNCIL. Gentlemen, I have the honour of submitting for the year 1908 my first Annual Report, the first issued since Merton became invested with Urban Powers after its separation from the Croydon Rural District. The figures for the 10 years ending 1907 have been taken from Dr. Fegen's Annual Report issued last year, and 1 am indebted to him for them. The Death Rate registered in the District was 6.7 per thousand population. The addition of Merton residents whose deaths were registered outside the District raised the rate to 7.9, which compares favourably with the average of 11.4 for the past 10 years ending 1907. The lowest rate in this decade being in the year 1906, when it was 8.7, whilst in 1907 it was 10.6. The reduction of the death rate in England and Wales was from 15 in 1907 to 14.7 in 1908, or a difference of .3. Compared with the average of the years 1897-1906, there was a saving of 1.7 lives per thousand in 1907. The Infant Mortality Rate was particularly low, being 48, calculated per thousand registered births. The average for the same preceding 10 years ending 1907 was 108, the lowest recorded for this period being 85 for the year 1905. The infant mortality for 1907 was 90. For the whole of England and Wales, the infant mortality increased from 118 in 1907 to 121 in 1906, and the increase affected not only the 218 towns with populations of 20,000 and upwards, but also the country, less these towns. The average of 10 years to 1906 was 145. The Birth Rate was 28.1 per thousand, against an average of 29.7 for the 10 years, the highest recorded being 36.4 in 1903. In 1907 it was 29.3. For the country, the birth rate rose from 26.27 in 1907 to 26.5 in 1908. In 1907, however, there was a decline of 2.1 compared with the average of 1897-1906. Copies of the Report are required to be sent to the Local Government Board and the County Council of Surrey, for whose information many facts will be mentioned which will no doubt be familiar to members of the Council. In conclusion, I would like to express my thanks to the Council for the help they have afforded me, and to their Officers for the assistance I have received. In the body of the Report will be seen the nature of Mr. Pointon's work, which speaks for itself, but to him is due also my thanks for the great help I have always had. I am, Gentlemen, Your obedient servant, D. A. BELILIOS, D.P.H. Medical Officer of Health. CONTENTS. pages. Physical Features 7 to 9 Vital Statistics—Population, Births and Deaths 10 to 14 Zymotic Disease Death Rate 15 Infant Mortality 16 to 17 Phthisis Mortality 18 Infectious Diseases—Methods of Prevention, including Prevention in Schools 19 to 20 Notified Diseases—Diphtheria, Scarlet Fever, Measles, Enteric and Typhus 21 to 23 General Sanitary Condition—Food Supply 24 to 26 Appendices:— Statistical Tables 28 to 33 Factory and Workshops 34 to 36 Sanitary Inspector's Report 37 to 38 Summary 39 REPORT. PHYSICAL FEATURES. Generally speaking, the District is flat, and has a subsoil for the greater part of loamy gravel, which thins out and merges into the underlying clay at the east, west and southern portions. The acreage is 1,765, the greater part not being yet built on. The surface is drained by the River Wandle, the Pyl, and the Beverley Brooks. For statistical purposes, so that the incidence of disease in any area may be noted, a division has been made into four parts, which are the same as in the Scheme decided by the Council to have been made into Wards. It should, however, be borne in mind that the figures in each are at present too small for any accurate deductions to be made unless a substantial difference is revealed; but the observations extended over a few years, will be sure to give valuable information. The Boundaries, estimated population in the middle of year, etc., are shewn in the Table. 8 TABLE A. Name. Boundaries. Approximate Size in Acres. Estim'td Population. Occupied Houses. Excess of Births over Deaths. West Barnes Western portion of Grand Drive to Maiden Boundary 578 817 199 12 Bushey Mead Eastern portion of Grand Drive to West Cannon Hill Lane 375 5408 1040 129 Merton Park Eastern portion of Cannon Hill Lane to Railway Line, London, B. & S. C. 439 2364 514 54 Morden Road The above Railway line to Mitcham Boundary 371 3960 825 58 12549 say 12550 2578 253 The whole of the north being bounded by Wimbledon, and south by Morden and Mitcham. Bye-laws are in force to ensure proper construction and ventilation of the houses, the greater number having been built in recent years. 221 certificates have been granted for new houses as fit for human habitation. Water is supplied by the Metropolitan Water Board, and there is a constant supply. I have access to the Reports issued monthly by the Board, as to the nature of the supply. The following new streets have been made up:— I Bronson Road (extension). II Branksome Road. III Bournemouth Road. IV Boscombe Road. V Mina Road. VI Shelton Road. VII Winifred Road. VIII Kirkly Road. 9 Roads being made up at present:— I Adela Avenue. II Seaforth Avenue. III Douglas Avenue. IV Estella Avenue. Roads to be made up. Notices have been served:— I Station Road. II St. Mary's Road. III Melrose Road. IV Clifton Park Avenue. V Claremont Avenue. VI Richmond Avenue. 10 VITAL STATISTICS. Population. For the proper understanding of the health conditions of a place, it is important that as accurate as possible an estimate should be made of the population, and this importance is all the greater in a place like Merton, because even a small addition or subtraction makes an appreciable difference in the statistics. The estimate for 1908 is 12,550. Unfortunately, the Census is taken at periods of ten years only, and the difficulty of a fairly proximate estimate becomes greater in proportion to the remoteness from the last actual count. The difficulty becomes greater in Merton, because the place has expanded in quite a different ratio to the period previous to the Census of 1901, and has become more urban in type. Therefore, the only method I have employed for calculating, has been to take the number of houses actually in occupation in the middle of the year (and for this I am indebted to Mr. Downing, and his assistant, Mr. Greig), and multiply by a factor ascertained from a partial Census in each area. The results are shewn in Table A and Table II. Owing to the reasons given, it would be erroneous to act on the assumption that the same average rate of persons occupied each house as in 1901. For the better appreciation of the figures one other point is deserving of mention. The ages of the inhabitants influence 11 statistics, even when all other conditions are equal. The larger the proportion at the reproductive ages, the greater the birth rate; a lesser death rate also follows, because these ages have low rates of mortality. The high birth and low death rates of Merton tend to show that there is a fair proportion of people at the healthy periods of life; but, on the other hand, it may be fairly assumed that the high birth rate and low infant mortality for the past five years have also increased the comparative number of children at the unfavourable age period of under five. Another factor which comes into play is the proportion of people over 45, this again having an appreciably higher rate of mortality than the periods between 5 and 45. How far the favourable influences counteract the unfavourable in giving a correct value to our figures it would be impossible to state, without knowledge of the exact numbers alive under the ages of 5 and over 45, and the proportion they bear to those alive between 5 and 45. But it may be usefully borne in mind that 75 per cent. of our deaths took place at ages before 5 and after 45 years. The following figures from the Registrar General's returns at the last Census may make my points clear:— For every thousand of all ages the proportions were:— TABLE B. All ages. Under 5. 5-10. 10-15. 15-20. 20-25. 25-35. 35-45. 45-55. 55-65. 65-75. 75 and upwards. 1,000 129 119 110 100 90 149 114 85 58 33 13 Numbers alive. M. M. M. M. M. M. M. M. M. M. M. M. Mortality rates at each age period of Males and Females per thousand. 20.2 61.7 5.3 2.9 4.3 5.7 7.7 12.3 19.3 34.7 70.2 160.2 F. F. F. F. F. F. F. F. F. F. F. F. 18 52 5.2 3.1 4.4 5.5 7.3 10.5 15 28.4 60.1 147.3 12 Therefore, if in Merton, out of each 1,000 of its population, there were— (A) 318 people, made up of ages under 5 years and over 45, (B) 682 „ „ „ „ between 5 and 45 years, the statistics in Merton and England and Wales would be fairly comparable, that is to say, if the age periods are in the same proportion as in 1901. So far as the age periods go, in my opinion, the statistics are fairly comparable with the uncorrected rates of the 142 smaller towns, specially of the suburban towns, of the Registrar General's return. Generally speaking, the population is suburban in character, and there are no industries liable to affect public health. House accommodation is ample, and the average number of inhabitants per house is estimated at 4.1 in West Barnes, 5.2 in Bushey Mead, 4.6 in Merton Park, and 4.8 in Morden Road. I believe, however, these factors are too low, and an extended Census, which is intended to be taken this year, will probably show higher figures. The majority of the houses are let on weekly tenancies, with probably the average rental prevailing in that class of London suburban property. 13 BIRTHS. Of the 353 births registered during the year, 188 were males; and 165 females ; 5 were illegitimate, 1 of whom died. Although the rate of 28.1 per thousand population was lower than the average for the past decade of 29.7, and sensibly lower than the highest recorded of 36.4 in 1903, it was higher than the rates in England and Wales, as shewn in the Table by 1.6. The rate for England and Wales has been steadily declining, with slight fluctuations, so that, whereas in 18761880 the average was 35.33 per thousand, in the year 1908 it was 26.5. DEATHS. The total number was 100, this including the deaths of Merton residents at the Union Infirmary and other public Institutions, as recorded in Table I. Communications have been addressed to the Medical Officers of Health of the Districts in which the various London Hospitals are situated, for information of deaths of our inhabitants. Included in the 100 are three inquests of strangers who have met their death in the highways. The rate was 7.9 per thousand. Mortality at Age Periods.—No fewer than 75 deaths took place up to 5 years and over 45. Of ages of 70 and over, 15 were registered. The deaths were made up as follows. The total being 100, the figures can be read as percentages:— 70 to 80 Over 80 Up to 5 years. 25 5 to 35. 12 35 to 45. 13 45 to 70. 35 70 to 75. 75 to 80. 3 4 80 to 90. Over 90. 7 1 7 8 14 TABLE C. Birth Rate, Death Rate, and Analysis of Mortality, 1908. Annual Rate per thousand living. Deaths under 1 year per 1000 registered births. Births. Deaths. Principal zymotic diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhæa. England and Wales 26.5 14.7 1.29 0.00 0.22 0.08 0.15 0.27 0.07 0.50 121 76 Great Towns 27. 14.9 1.59 0.00 0.31 0.10 0.16 0.29 0.08 0.65 128 142 smaller „ 26. 14. 1.26 ... 0.20 0.06 0.15 0.25 0.08 0.52 124 England and Wales, less the 218 towns 26.2 14.7 .99 0.00 0.13 0.06 0.15 0.25 0.07 0.33 110 Merton 28.1 7.9 .55 ... ... ... .39 ... .07 .07 48 15 ZYMOTIC DISEASE DEATH RATE. Under this heading are included deaths from Small-pox, Measles, Scarlet Fever, Diphtheria, Typhus, Enteric and Puerperal Fevers, Whooping Cough and Epidemic Diarrhoea. They number 7, or 7 per cent. of our total deaths, or .55 of our total population. The Table, C, will shew at a glance the various rates. The diseases will be spoken of under their respective headings later. In Table III will be seen that much the largest incidence of infectious disease is experienced up to 15 years, the proportion being 103 to 25 for all the. remainder of the ages put together. The total of 128 notified cases, included 60 Measles. Assuming the numbers of the population of Merton are made up of the same proportion of ages as in the last Census in England and Wales, it will be noted that, whilst the chance of catching infection at the early periods of life is about eight times as much, the deaths per notified cases is nearly 50 per cent. more. The lesson to be learnt from these figures, and they apply everywhere, is that the younger the child the greater is the need for protection, notably because the chances of recovery are greater as they get older, and the remark applies more forcibly to ages before 5 years. Too many people have the idea that, the earlier a child contracts infectious disease, the greater is the chance of recovery. 16 INFANT MORTALITY. The statistics for infant mortality are exact, because, whilst the rates in general are worked on the basis of an estimated factor, viz., the population, the infant death rate is calculated on the actual number of births registered in the year. Out of the 17 registered deaths taking place before one year, 7 were in a sense unavoidable, as 6 were due to prematurity and 1 to suffocation. It is also (noticeable that 11 of the total occurred in the first 4 weeks of life. The infant mortality of a district is largely influenced by summer or epidemic diarrhoea. Although 1 death was registered from epidemic diarrhoea, 2 deaths out of 4 were caused by gastro-enteritis or enteritis in the late summer and early autumn. As soon as the earth temperature, 4 feet below the surface, .began to register 56 degrees, a temperature which experience has proved to be associated with the disease, the following pamphlet, approved by the Public Health Committee, was delivered to every house ;n the District. Merton Urban District Council. SUMMER DIARRHCEA IN INFANTS. Important Notice. Summer diarrhoea in children, specially up to two years of age, is a serious disease, parents ought therefore to at once consult their doctors on the very outset of the complaint. It is caused by germs which live specially in polluted soil, and gain entrance into the body through the mouth by means of contaminated food, milk, etc. All yards 17 should, therefore, be kept clean and well flushed. Material liable to decompose should be kept away from the premises. Where possible, all babies under one year are to be nursed. If this is impossible, both the milk and the water with which it is diluted should be boiled just before use. All feeding bottles must be kept scrupulously clean. If comforters are given (which is very inadvisable) they should be kept soaked in clean water when not in use. Under no circumstance give a child a comforter picked up from the floor without first washing. All food and milk should be stored in light, airy places, protected from flies and dust, and away from sinks, drains, etc. Do not keep milk in bedrooms. Water cisterns should be inspected and cleaned out. Fruit and vegetables are to be thoroughly cleaned. No tainted food or overripe or unripe fruit should be eaten. Issued by the Public Health Committee, Merton Urban District Council. The sanitary arrangements of the house in which the death of summer diarrhoea occurred were investigated. 18 PHTHISIS MORTALITY. Ten deaths were registered, and their distribution is shewn in Table IV. The mortality was .7 per thousand. Divided into areas, the rate in West Barnes was 2.4 per thousand population, .9 in Bushey Mead, .4 in Merton Park, and .5 in Morden Road. In 1907 the deaths were 12. In reading these figures, however, it must be remembered, that the place with the largest mortality has much the smallest population, so that the error from the element of chance is liable to be great. The disease is due to a germ, and is, therefore, infectious. From the sputum of the consumptive the germ gets into the air, and can get into the human body by inhalation or swallowing, but it depends on the bodily resistance of the individual whether the seed bears fruit. The prevention lies in a great way on the provision of plenty of fresh air, both because it increases the resisting power, and kills the germs. The doctrine of heredity, held in past years, is not now considered of importance, except that it has some influence on the soil, but much can be done, and much has been done by sanitary means, to reduce this factor of inheritance to a minimum. An Order of the Local Government Board has just come into force, making the notification of Poor Law consumptives compulsory; and an attempt will be made to educate these patients in the methods of preventing the spread. The Public Health Committee have made provisions as to the distribution of pamphlets and sputum flasks in the suitable cases. Two deaths have been registered from other tubercular diseases, against 4 in 1907. OTHER RESPIRATORY DISEASES. From Bronchitis, Pneumonia, and other respiratory diseases, 16 out of the total 100 deaths have been registered. This gives a mortality of 1.2 per thousand. 19 INFECTIOUS DISEASES. Methods of Prevention.—The diseases to be notified by the Medical Practitioners are Small-pox, Measles, Diphtheria, Erysipelas, Scarlet, Typhus, Enteric, Puerperal and Continued Fevers, and Cholera. On receipt of a notification, the house is visited, and enquiries made as to the possible source of infection. The surroundings, and the number of persons living in the premises are noted, and the drains examined. Care is taken that the infected linen does not go to the laundries. The question of action in outworkers' premises has not arisen, as no case was notified. Hospital accommodation is offered in Diphtheria, Typhoid and Scarlet Fever, and the cases are removed as early is possible. In cases treated at home, it is seen that proper isolation is available, and instructions are given as to the disinfection of clothing and articles liable to be contampinated. Special instructions are given as to the excreta in typhoid. At the termination of tne illness, the walls of the infected rooms are stripped, and disinfected, and all contaminated articles are removed to the Croydon Rural Isolation Hospital, at Beddington Corner, for disinfection by steam. Children from infected households are prohibited from attendance at school for the full incubation period. Means are placed at the disposal of the practitioners for the early diagnosis of Diphtheria and Typhoid Fever. A wire is sent them as to the result of the bacteriological examination. A stock of diphtheria antitoxin is kept for the use of doctors. 20 Disinfection is offered also in houses where deaths have occurred from Tuberculosis of the lungs and Cancer. Schools.—The segregation of children in schools at a susceptible age is an important way in which infectious disease may be spread; and the recognition at an early period if symptoms should result in limiting the number. The Education Authority is the Surrey County Council, whose system of notifications, under the able directions of Dr. T. Henry Jones, gives great assistance to our public health work. The Teachers in the schools have had sent them a memorandum, issued by the County, giving the early symptoms and signs of the infectious and contagious diseases likely to occur among the scholars, so that suspicious cases may be at once excluded. These names are notified to me, as are also the names of suspected absentees, unless known to have been otherwise notified. As occasions arise, I visit the schools, and classes have been examined by me for Diphtheria, Scarlet Fever and Measles. Head Teachers are informed by us of the cases to be excluded on account of disease, either in the scholars themselves, or in their homes, and notices are again sent when they are to be re-admitted. The systematic medical inspection of school children, from the point of view of limiting infection, is sure to be of service, and it has already happened that Dr. Kidner detected an early case of Diphtheria, which would, under ordinary circumstances, have proved a source of further trouble. The information given enabled me to make an examination of the throats of the other children in the class. 21 NOTIFIED DISEASES Diphtheria.—Thirty-three cases were notified, as against 28 in 1907. There were 5 deaths. The mortality rate is .39 per thousand, and the rate of incidence 2.6. Twelve were what might be termed localized cases, seven having occurred in the members of one family in one house, two in another, and, in January, three scholars attending one class had the disease, the remainder of whom I examined. All the precautions desoribed were taken, and for all the cases above referred to antitoxin was available for prevention purposes. In a mild form, the disease may give very few symptoms, so that apparently healthy people may convey the infection. An example of this has already been mentioned when speaking of the systematic inspection of school children, and my practice is to visit the school when there is a suspected focus, and examine for the purpose of eliminating it The remainder < f the cases were scattered over the District, and there was no factor common to them. DIPHTHERIA. January. February. March. April. May. June. July. August. September. October. November. December. West Barnes Over 5 1 0 0 0 0 0 0 0 0 0 0 0 1 1 Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 Bushey Mead Over 5 2 1 3 3 1 1 1 0 1 0 0 0 13 1 17 Under 5 2 1 0 0 0 0 0 0 0 1 0 0 4 Merton Park— Over 5 0 0 3 0 1 0 0 0 0 0 1 0 5 9 Under 5 0 0 2 2 0 0 0 0 0 0 0 0 4 Morden Road Over 5 1 0 1 0 0 0 0 0 0 1 0 1 4 6 Under 5 0 0 0 2 0 0 0 0 0 0 0 0 2 6 2 9 7 2 1 1 0 1 2 1 1 Total 33 22 SCARLET FEVER. Eighteen cases were notified, as against 50 in 1907. The incidence of the disease was 1.4 per thousand population. On one occasion, a girl, who had attended school for two days in the peeling stages of Scarlet Fever, was notified as suffering from the disease, the parents not being aware of the fact. I inspected the class, and no further cases occurred. The schoolroom was, of course, disinfected. SCARLET FEVER. January. February. March. April. May. June. July. August. September. October. November. December. West Barnes Over 5 0 0 0 0 0 0 0 0 0 0 0 0 0 Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 Bushey Mead Over 5 1 0 1 0 0 0 0 0 0 0 1 0 3 4 Under 5 1 0 0 0 0 0 0 0 0 0 0 0 1 Merton Park— Over 5 0 0 0 0 1 0 0 0 0 1 2 0 4 5 Under 5 0 0 0 0 0 0 0 0 1 0 0 0 1 Morden Road Over 5 0 1 1 1 0 0 0 1 1 2 0 2 9 9 Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 2 1 1 0 0 1 2 3 3 2 Total 18 MEASLES. The provisions of the Infectious Diseases Notification Act extend also to Measles, and 60 certificates were received. Owing to the prevalence of the disease, and specially in the surrounding districts, a watch was kept in our schools, so that suspicious cases might he excluded. 23 ENTERIC FEVER. This disease was responsible for four notified cases, occuring: 1 in March, 1 in June, 1 in July, 1 in August. The incidence rate was .31, and 1 death was recorded. Last year, two cases were notified. In the investigation as to the cause of this disease, special enquiries were made as to the food taken previous to the outset, particularly as to shellfish, watercress, etc, TYPHUS FEVER. One case was notified from the new part of West Barnes District, in a semi-detached 7-roomed house, occupied by six members of one family. The house has plenty of air space both back and front, open fields facing it both ways. Nothing was wrong with the sanitary arrangements. Full investigations were made as to any possible source of infection, and enquiries addressed to the Local Authority where the man had visited a sick relative, but without result. 24 GENERAL SANITARY CONDITION. FOOD SUPPLY. During 1908, I made a systematic inspection of the District, which included all the cowsheds, milk shops, bakeries, slaughter-houses, etc. I have satisfied myself that efficient and thorough attention is paid by your Inspector, Mr. Pointon, to all the conditions, and more specially to the way in which the food supply is prepared and stored. All places where people congregate, such as laundries, workshops and factories, were also visited. Mr. Pointon also made a house to house inspection in parts of Kingston and Pincott Roads. MILK SUPPLY. There are 5 cowsheds and 14 milk shops registered in the District. Regulations are in force under the Dairies Cowsheds and Milk Shops Order. Attention is paid to the lighting, ventilation, cleanliness, drainage and water supply, so as to ensure, as far as possible, the proper health of the cows and the prevention of contamination of milk. The cows themselves have been found in clean and good condition. The milk in the shops is required to be kept covered, and efficient arrangements are insisted on for the scalding of cans. Of all articles of diet, milk is perhaps the most easily affected by its surroundings, and, because of its being largely used, as it should, by children and other people in a weak state of health. potent for mischief. It is only by exercising cleanliness and care from the time of milking to its consumption in the home, that health can be preserved. Attention should be paid by consumers, so that milk is kept in clean vessels and in places where it is not liable to get dirty or absorb smells. In every case of infectious disease the milk supply is investigated. 25 MEAT. There are three registered slaughter-houses, and the Byelaws provide for the cleanliness, water supply, etc., of the places. Four diseased carcases were surrendered, and, after having been examined, were wholly destroyed in two instances, and surrender accepted for parts in the others. In coming to a decision as to whether the whole or parts of a carcase should he destroyed in tuberculosis, the recommendations of the Royal Commission on Tuberculosis have been borne in mind. Your Sanitary Inspector visits frequently, for the purpose of inspecting, both the buildings and the condition of the meat. My observation of tne places showed that the Byelaws were obeyed. The meat in the butchers' shops is kept under supervision for disease or decomposition. Fish.—Notice is taken of the condition of fish sold. Bread. — There are six bakehouses, all of which are built above ground. SEWERAGE AND DRAINAGE. The level of Merton varies from about 100 feet above Ordnance Datum in the highest part at Cannon Hill, to Coombe Bridge, where it is 41 feet. In Merton Park and Morden Road it is about 50. Separate conduits are employed for the carriage of foul and surface waters in the new and greater portion of the District The sewage is treated at the Works in Colliers wood by precipitation and filtration. New Works are in progress at West Barnes to drain about 300 acres, which hitherto was impossible to drain by means of a natural gradient. These Works include a new line of sewers and pumps to lift the sewage into the existing system. 26 Drains of houses are tested as a routine measure after Diphtheria, Enteric and Scarlet Fevers, and in all other instances of suspected defects. Streams.—The streams receive full attention, and on one occasion, on the report of your Inspector, you took steps to remedy a nuisance, caused by pollution. House Refuse.— Weekly removal is effected by contractors in covered vans. Portable zinc bins with tight-fitting covers are required to be provided in the houses. Nuisances.—The details of the work of your Inspector of Nuisances, Mr. Pointon, are separately reported on, and I would here like to place on record the ability and tact he displays in his work. His assistance in the Public Health work of the District has been of great value and always willingly rendered. APPENDICES. 28 TABLE I.—Vital Statistics of Whole District during 1908 and Previous Years. 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 Non-residents registered 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.* Number. Rate per 1000 births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 4123 94 22.7 20 212 64 15.5 1899 4280 109 25.4 12 110 50 11.6 1900 4398 116 26.3 14 120 48 10.9 1901 4510 164 36.3 18 109 62 13.7 1902 5350 168 31.4 23 136 71 13.2 1903 6060 221 36.4 20 90 70 11.5 1904 7450 219 29.3 21 95 75 10 1905 9150 258 28.1 22 85 80 8.7 1906 9290 280 30.1 32 114 117 12.5 1907 11300 332 29.3 30 90 120 10.6 Averages for Years, 1898—1907 6591.1 196.1 29.7 21.2 108 75.7 11.4 1908 12550 353 28.1 17 48.1 85 6.7 Nil Nil 15 100 79 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. 29 Note.—The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness of infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Institutions in respect of the deaths in which corrections have been made are given at the foot of this Table. Total population at all ages 4510 Number of Inhabited houses 937 Average number of persons per house 4.8 At Census of 1901. Area of District in acres (exclusive of area covered by water). 1765. Institutions within the District receiving sick and infirm persons from outside the District. Nil. Institutions outside the District receiving sick and infirm persons from the District. Brookwood Asylum. Croydon Union Infirmary. Croydon Rural District Council's Isolation Hospital, Beddington Corner, Mitcham. Other Institutions, the deaths in which have been distributed among the several localities in the District. Lock Hospital, Dean Street, Soho. The Union Workhouse is not situated within the District. 30 TABLE II.—Vital Statistics of separate Localities in 1908. Names of Localities. 1. West Barnes. Acres 578. 2. Bushy Mead. Acres 375. 3. Merton Park. Acres 439. 4. Morden Road. Acres 371. 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. Population estimated to middle of each year. Births registered Deaths at all Ages. Deaths under 1 year. 1908 818 24 12 1 5408 168 39 8 2364 68 14 2 3960 93 35 6 31 TABLE III.—Cases of Infectious Disease notified during the Year 1908. 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—Years. 1 2 3 4 1 2 3 4 5 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. West Barnes. Bushey Mead Merton Park. Morden Road West Barnes. Bushey Mead. Merton Park. Morden Road. Total Cases removed to Hospital. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup). 33 ... 10 16 3 4 ... 1 17 9 6 ... 16 8 4 28 Erysipelas 12 ... ... 2 ... 10 ... 1 6 2 3 ... ... ... ... ... Scarlet fever 18 1 1 11 2 3 ... ... 4 5 9 ... 1 5 9 15 Typhus fever 1 ... ... ... ... 1 ... i ... ... ... ... ... ... ... ... Enteric fever 4 ... ... 2 1 1 ... ... 1 1 2 ... 1 ... 2 3 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 60 6 27 27 ... ... ... 14 17 5 24 ... ... ... ... ... Totals 128 7 38 58 6 19 ... 17 45 22 44 ... 18 13 15 46 The Isolation Hospital is situated at Beddington Corner (joint Hospital with Croydon Rural). The joint Small-pox Hospital is situated at North Cheam (joint with Wimbledon, Croydon Borough, Croydon Rural, and Penge Urban Districts). Number of Diseases that can be concurrently treated—Small-pox, Enteric, Scarlet Fever and Diphtheria. 32 TABLE IV.—Causes of, and Ages at, Death during Year 1908. l Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to localities, whether occurring in or beyond the District. 16 Causes of Death. Total deaths whether of "Residents" or "Non-residents" in Public Institutions in the District. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 All ages. Under 1 year. 1 & under 5. 5 & under 15. 15 & under 25. 25 & under 65. 65 & upwards. West Barnes. Bushey Mead. Merton Park. Morden Road. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 5 ... 3 1 ... 1 ... ... 3 1 1 ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Enteritis 4 4 ... ... ... ... ... ... 2 ... 2 ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 10 ... ... ... 1 9 ... 2 5 1 2 ... ... ... ... Other tuberculous diseases 2 ... 1 ... l ... ... ... 2 ... ... ... ... ... ... Cancer, malignant disease 12 ... ... ... ... 9 3 2 5 1 4 ... ... ... ... Bronchitis 6 ... 1 ... ... 2 3 3 2 ... 1 ... ... ... ... Pneumonia 8 ... 1 ... ... 6 1 ... 1 2 5 ... ... ... ... Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other diseases of Respiratory organs 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... Alcoholism—Cirrhosis of liver 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Venereal diseases 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... Premature birth 6 6 ... ... ... ... ... ... 3 1 2 ... ... ... ... Diseases and accidents of parturition 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... Heart diseases 6 ... ... ... ... 3 3 ... ... 3 3 ... ... ... ... Accidents 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Suicides 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... All other causes 32 5 1 2 *2 12 10 3 13 5 11 ... ... ... ... All causes 100 17 8 4 4 47 20 11 40 14 35 ... ... ... ... Notes.—(A) In Table IV., all deaths of "Residents" occurring in public institutions, whether within our without the district, are to be included with the other deaths in the columns for the several age groups (columns 2-8). They are also in columns 9-15, to be included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents" occurring in public institutions in the district are in like manner to be excluded from columns 2-8 and 9-15 of Table IV. (B) See notes on Table I. as to the meaning of "Residents" and "Non-residents," and as to the "Public Institutions" to be taken into account for the purposes of these Tables. The "Localities" in Table IV. should be the same as those in Tables II. and III. (C) All deaths occurring in public institutions situated within the district, whether of " Residents" or of "Non-residents," are, in addition to being dealt with as in note (A), to be entered in the last column of Table IV. The total number in this column should equal the figures for the year in column 9, Table I. (D) The total deaths in the several "Localities" in columns 9-15 of Table IV. should equal those for the year in the same localities in Table II., sub column c. The total deaths at all ages in column 2 of Table IV. should equal the gross total of columns 9-15, and the figures for the year in column 12 of Table I. (F.) Under the heading of "Diarrhoea" are to be included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Dysentery and Dysenteric diarrhoea, Choleraic diarrhœa, Cholera and Cholera Nostras. Deaths from diarrhoea secondary to some other well-defined disease should be included under the latter. Deaths from Enteritis, Muco-Enteritis, Gastro-Enteritis, and Gastritis (see under the heading Diarrhœal Diseases in Table V) in Tables IV. and V. should be placed immediately below, but separately from, those enumerated under the heading Diarrhoea as defined by enumeration above. This is particularly important for deaths under one year of age, as many of the deaths in infancy returned as due to Enteritis are really caused by Epidemic Diarrhoea. In the course of years, by the adoption of this recommendation, it will be practicable to ascertain the probable amount of transfer between these different headings. (F) Under the headings of "Cancer" and "Puerperal fever" should be included all registered deaths from causes comprised within these general terms. Thus: Under "Cancer" should be included deaths from Cancer, Carcinoma, Malignant disease, Scirrhous, Epithelioma, Sarcoma, Villous tumour, and Papilloma of bladder, Rodent ulcer. Under "Puerperal Fever" are to be included deaths from Pyaemia, Septicaemia, Sapræmia, Pelvic peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (G) Under "Congenital Defects" in Table V. are to be included deaths from Atelectasis, Icterus torum, Navel haemorrhage, Malformations and Congenital hydrocephalus. (H) Under "Tuberculous Meningitis" are to be included deaths from Acute hydrocephalus. (I) Under "Other Tuberculous Diseases " are to be included deaths from Tuberculosis, Tuberculosis of bones, joints and other organs, Lupus and Scrofula. (J) All deaths certified by registered Medical Practitioners and all Inquest cases are to be classed as "Certified"; all other deaths are to be regarded as "Uncertified." In recording the facts under the various headings of Tables I., II., III., IV. and V., attention has been given to the notes on the Tables. 33 TABLE V.—Infantile Mortality During the Year 1908. Deaths from stated Causes in Weeks and Months under One Year of Age. (See notes to Table IV.) CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes. Certified 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... i. Common Infectious Diseases Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup) Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ii. Diarrhœal Diseases. (See Notes to Table IV) Diarrhœa, all form ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Enteritis, Muco-enteritis, ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastro-enteritis Gastritis, Gastrointestinal Catarrh) ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... 3 iii. Wasting Diseases. Premature Birth 3 2 1 ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 Congenital Defects (See Notes to Table IV.) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Marasmus iv. Tuberculous Diseases. Tuberculous Meningitis (See Notes to Table IV ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis : ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica Other Tuberculous ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases (See Notes to Table IV.) v. Other Causes Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Causes ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 3 3 3 2 11 2 1 1 - 1 1 - - - - - 17 Population (estimated to middle of 1908), 12,550. Births in the Year:- Legitimate, 348; Illegitimate, 5. Deaths in the year of legitimate infants, 16 ; Illegitimate infants, 1, Deaths from all Causes at all Ages, 100. . 34 FACTORY AND WORKSHOPS. By the Factory and Workshops Act, 1901, I am required to "report specifically on the administration of this Act n workshops and workplaces," and to send a copy to the Home Secretary. The details will be found appended, and it will be seen that three defects were found and remedied. In my personal visits, I saw that there was sufficient airspace, ventilation, and proper sanitary conveniences separated for the sexes. Mr. Pointon visits the places regularly, so that no conditions inimical to health may arise. Annual Report of the Medical Officer of Health for the year 1908 for the Urban District of Merton on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.-NSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Factories (Including Factory Laundries) 21 Workshops (Including Workshop Laundries) 91 Workplaces (Other than Outworkers' premises included in Part 3 of. this Report) - Total 112 30 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Found. Remedied. Nuisances under the Public Health Acts:—* Want of cleanliness — — Want of ventilation — — Overcrowding — — Want of drainage of floors — — Other nuisances 1 1 † Sanitary accommodation insufficient — — unsuitable or defective 1 1 not separate for sexes 1 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s.101) - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this report) - - Total 3 3 3.—HOMEWORK. OUTWORKERS' LISTS, SECTION 107. Nature of Work—Wearing Apparel. Addresses of Outworkers'. Lists received from other Councils 14 Lists forwarded to other Councils 8 Inspections of Outworkers' premises 8 Total 30 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Laundries 10 Bakehouses 6 Silk Printers 3 Farriers 2 Block Cutters 1 Metal Workers 1 Total number of workshops on Register 23 * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. † The whole of the Public Health Amendment Act, 1890, is now in force (January, 1909). 36 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts,but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector - Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year — 37 TO THE CHAIRMAN AND MEMBERS OF THE MERTON URBAN DISTRICT COUNCIL. Council Offices. Merton. January, 1909. Gentlemen, I beg to present my Report of the work carried out in the District, during the year 1908. INFECTIOUS DISEASE. It has been my practice whenever possible to be present to assist in the removal of patients suffering from Diphtheria, Scarlet Fever, or Enteric. As the notifications are chiefly received over the telephone, this often enables me to investigate the source of infection, and report to the Medical Officer some hours before the notification is received by post. A supply of Diphtheria Antitoxin and outfits for diagnosis are kept at my residence, and it is possible to obtain these at any time during the day or night. Where any cases is attributed to school attendance, the class-room has been disinfected, upon the instructions of the Medical Officer. This has been done in each of the four schools in the District. During the year, the total number of disinfections carried out was 65, with the addition of disinfection carried out at schools. FOOD INSPECTION. The premises visited for this purpose include Slaughterhouses, Cowsheds, Dairies, Butchers', Fishmongers', and Bakehouses. During the year, 224 visits were paid to the Slaughter-houses in the District; these visits were paid at irregular hours, on any day or night of the week, and to the uncertainty of these visits I attribute the practice of the occupiers in 38 requesting my attendance to inspect animals which appeared to have been diseased or unsound. Under these circumstances, whenever this proved to be the case, I accepted the surrender of the meat. Altogether, 481 carcases were examined, which consisted of Oxen, Sheep and Pigs. Frequent cleansing and limewashing has been carried out at all Slaughter-houses. DAIRIES AND COWSHEDS. Frequent visits have been paid to premises registered under The Dairies, Cowsheds and Milk Shops Order, and the Statutory obligations imposed by this Order are carefully carried out. The Bakehouses have also been visited, and the periodical cleansing carried out. Butchers' and Fishmongers have been kept under observation, and inspection of food exposed for sale has been made. Total number of food inspections, 425. During the year the following quantities of food have been destroyed as unfit for human food:— Beef 380 lbs. Pork 800 lbs. 1 Trunk of Fish 120 lbs. In the general work of the Department, it was found necessary to serve Statutory Notices upon the owners of nine houses, all of which were complied with without any further proceedings. Seventy-three Preliminary Notices were served, but verbal notice was often sufficient to secure the abatement of the nuisance. On no occasion was it found necessary to take legal proceedings. Your obedient, servant, J. B. POINTON. 39 SUMMARY. Total visits paid 2124 Whole houses cleansed 2 Rooms cleansed 46 Premises disinfected after Infectious Disease 65 ,, Cleansed after Infectious Disease 49 Drains tested 66 Drains repaired 12 Drains reconstructed 17 Obstructions removed from 8 Inspection Chambers provided 5 Roofs repaired 13 Cisterns cleansed or covered 1 Dustbins provided 15 Water closets repaired 5 Yard paving repaired 10 Premises where animals were improperly kept 5 Offensive accumulations removed 11 Piggeries repaired and improved 1 Water supply re-instated 1 Overcrowding abated 1 Stables paved and drained 1 Manure receptacles provided 2 Articles disinfected at Isolation Hospital 569