SURBITON URBAN DISTRICT COUNCIL TWENTY-SIXTH ANNUAL REPORT MEDICAL OFFICER OF HEALTH, INCLUDING REPORT OF THE SANITARY INSPECTOR, 1902. Printed by Bull & Son, 20, Victoria Road, Surbiton. THE Urban District Council of Surbiton. Area in Acres 2858½ Total population at all ages 15386 At Census of 1901. Number of inhabited houses 2874 Average number of persons per house 5.225 Death Rates. General—per thousand population 10.9 Zymotic— „ „ 0.84 Infants (under 1 year of age) per 1000 births) registered 118 Birth Rate 18.7 Table showing Population, Number of Inhabited Houses and Average Number of Persons per House in each locality, &c. 1891. District. Area in acres. Population Rateable value 1894. Inhabited houses. Average No. of persons per house. Surbiton 1000 10050 £ 110881 1720 5.843 Tolworth 1198½ 979 £ 6996 197 4.969 Hook & Southborough 660 1147 £ 7473 261 4.394 Total 2858½ 12176 £ 125350 2178 5.509 1901. Surbiton 1000 11075 £ 148562 2094 5.288 Tolworth 1198½ 2458 £ 11879 477 5.153 Hook & Southborough 600 1484 £ 8690 303 4.897 Total 2858½ 15017 £ 169131 2874 5.225 1 902 (Estimated.) Surbiton 1000 11214 £ 148562 Tolworth 1198½ 2643 £ 11879 Hook & Southborough 660 1529 £ 8690 Total 2858½ 15386 £ 169131 Surbiton Urban District Council. Twenty-Sixth Annual Report OF THE MEDICAL OFFICER of HEALTH, 1902. Mr. Chairman and Gentlemen, I now have the pleasure of presenting to you my Annual Report on the health and sanitary condition of the district, this being the twentysixth since my appointment as Medical Officer of Health in July, 1876. 3 Regarding the vital statistics, i.e., facts and figures dealing with population, births, deaths, causes of deaths, &c., the principal details are to be found in the four Tables at the end of the Report, and are those required to be made out by the Local Government Board, on forms supplied by them. The particulars of the past year are added to those of former years, dating from the time these tables were instituted, and for the purpose of comparison they are of interest, as showing the fluctuations of mortality or births, and the incidence of disease, especially in the different localities comprising the district. It is well to mention year by year, for the information of new members of the Council and also for those new residents who may take an intelligent interest in such matters, that the deaths dealt with are not exclusively those that are registered as occurring only in the district itself during the year, but are the "corrected" returns. The "corrections" consist in eliminating the deaths of "non-residents" occurring in public institutions within the district and transferring them to the localities whence they came, and in including those of this district who have died in public institutions elsewhere without the district. 4 The public institutions recognized within the district as receiving sick and infirm persons from outside are the Cottage Hospital and the Isolation Hospital; and the Institutions outside receivingsick and infirm persons from this district are the Union Workhouse and the County Lunatic Asylum at Brookwood. The population at the Census in 1901 was 15,017, this is now officially estimated to be 15,386 at the middle of 1902. Subject to the conditions stated above the nett deaths at all ages for the year were 169, which gives a death rate of 10.9 per thousand of the population, a result that compares very favourably with other localities of the same character as this. It is the more so taking into consideration the large amount of building at Tolworth, together with the proportionate increase of working class population, and also taking in conjunction with this the notification of infectious diseases table ; it shows that the sanitation of the district and the work of the sanitary officials under the direction of the Sanitary Committee and the Council bears good fruit and contributes largely to the satisfactory result obtained. Lives are not only saved, but better health and enjoyment of life is attained by healthy homes and surroundings, and if the 5 community, through its representatives, continues to insist that the same high standard as heretofore shall be maintained in the future, then, humanly speaking, equally good results may be confidently hoped for, but to bring this about money must continue to be spent in sanitary work and sanitary supervision, and in the bringing to book those owners or tenants who are careless or indifferent of themselves, their homes, and their surroundings. Causes of Death. Of these 169 deaths, 35 were under one year of age, and 59 were 65 years and upwards. There died of phthisis, 7; of bronchitis and pneumonia, 30; of cancer, 12; of epidemic influenza, 7; and of violence, 5. Phthisis. I desire to press upon the Council the following recommendation which is in keeping with the advance in our knowledge of this terrible disease. It is, that this Council should institute voluntary notification of cases of phthisis or consumption, as is now being done in several districts. The notification should be verified by bacteriological examination. Small sputum bottles would be forwarded to the practitioners in the district so that they could have an examination 6 made without delay, in any doubtful case, free of charge. If medical practitioners would fall in with this suggestion, and I feel sure they would, then suspicious cases would be early detected and much unsuspected infection would be prevented. A leaflet could be drawn up giving instructions as to the mode of dissemination of infection, and the precautions that should be taken after change of address, or death, &c., and the usual fee should be paid on the diagnosis being verified by a bacteriological examination. Cancer. The Registrar General tells us that contrasting the annual averages of the ten years, 1861-70, with that of the seven years, 1891-97, the increase of deaths from cancer was, in males, 136 per cent., and in females, 70; indicating during 30 years that the prevalence of cancer in males had more than doubled. No satisfactory reason can be given for this disproportionate increase in men, except that cancer in the male sex is more often internal and difficult of diagnosis, and as a consequence less frequently diagnosed in former years. Zymotic Diseases. The deaths due to the seven chief epidemic diseases were 13, being—measles, 10; diphtheria, 3; 7 and none from whooping cough, scarlet fever, smallpox, typhus or typhoid. The zymotic deathrate is therefore 0.84. Infant Mortality. The infantile mortality—i.e. the ratio of deaths of children under one year of age to 1,000 births is 118, which is slightly in excess of the two previous years when it fell below 100. One-fifth of the total number of these deaths is owing to premature birth, and that very materially affects the death-rate. Births. The births were 288 as compared with 324, 295 and 296 in the three preceding years, and were of 161 boys and 127 girls. This shows a considerable falling off. The births in the various districts are shown in the table below:— Males. Females. Total. Surbiton 93 65 158 Tolworth 55 49 104 Hook and Southborough 13 13 26 161 127 288 The Vital Statistics for the year have been published by the Registrar General, and I have placed them in tabular form for comparison. 8 Vital Statistics of England and Wales, 1902. Annual birth-rates and death-rates and rates from the seven chief epidemic diseases. Annual Rates per 1000 living. Infant Mortality. Annual deathrate of infants under 1 year per 1000 births. Births. Deaths from all causes. Deaths from the seven chief epidemic diseases. England and Wales 28.6 16.3 1.64 133 Rural England and Wales 27.4 15.3 1.14 119 76 Great Towns 30.0 17.4 2.12 145 103 Smaller Towns 27.3 15.3 1.53 135 Surbiton Urban District 18.7 10.9 0.84 118 In connection with these various statistics, it is worth drawing attention to the figures relating to the three different portions of the Urban District, and from these it will be seen how much, as a whole, we are indebted to Hook and Southborough for our low death-rate, and what a high standard can be taken by this bit of "Rural England," when it has the advantages of good drainage, a good water supply, and efficient sanitary administration. 9 District. Population. Births. Birthrate. Deaths. Deathrate. Surbiton 11214 158 1408 128 11.4 Tolworth 2643 104 39 3 35 13.2 Hook and Southborough 1529 26 170 6 3.9 The following Table shows the notifications of the past and previous years:— Extract from Notification Book. Scarlet Fever Diphtheria & Memb. Croup Enteric Fever Puerperal Fever Erysipelas Contin. Fever Small pox Totals. 1890 3 36 1 2 4 0 0 46 1891 3 21 1 0 10 0 0 35 1892 4 16 3 1 5 0 0 29 1893 94 23 5 2 15 2 1 142 1894 9 20 12 2 12 0 0 55 1895 18 12 5 0 2 0 0 37 *1896 27 9 4 1 10 0 0 51 *1897 16 9 2 1 3 0 0 31 *1898 13 6 2 0 6 0 0 27 *1899 48 2 7 1 11 0 0 69 *1900 15 22 2 0 7 0 0 46 1901 59 47 2 0 7 0 0 115 *1902 22 19 2 1 8 0 0 52 * The combined districts. The following are some particulars respecting the notifiable diseases during the past year. 10 Scarlet Fever. There were but 22 cases of this disease notified, as against 59 of the year before, and of these 17 were removed to the Isolation Hospital. All the cases were favourable and there were no deaths. Diphtheria. There were 19 cases notified, distributed thus:—Surbiton 8, Tolworth 3, Hook and Southborough 8. These latter constituted a small outbreak, occurring mostly in one or two roads, and was probably due to personal infection from an undetected case that subseqently came to light, and was found to have been living in a house, the sanitary arrangements of which were very bad, it having at that time no adequate water supply. One case was fatal. Of these 19 cases 16 were treated in the Isolation Hospital. Enteric Fever Two cases, and in neither was the cause satisfactorily ascertained, but in one oysters were strongly suspected, and with some show of reason. Both recovered. Measles. Though this is not a notifiable disease it is necessary to report that the complaint was exceptionally prevalent in the Christ Church district during November and December. As not only were there a very large number of children ill, but as there was great danger of convalescent and ailing children contracting lung troubles from 11 exposure to cold in going to and from school, I recommended the closing of the schools, and this was done from December 1st to January 5th. Notwithstanding this there were no less than 10 deaths, 7 of the children being under 5 years of age. In nearly all of these bronchitis or pneumonia supervened, and was the immediate cause of death. Chicken Pox. Chicken Pox was prevalent during both spring and autumn. The Council, by resolution, required a notification to be made of all cases for a period not exceeding six months. It was deemed advisable to do this consequent on the known difficulty in some cases of making a diagnosis as between the eruptions of chicken pox and that of small pox modified by vaccination. This Order was generally adopted throughout the county, it came into force on February 8th, and lasted till July 27th, when it was not renewed, as small pox in London and elsewhere was decreasing. Small Pox. This disease was firmly established in the Metropolis for many months, and cases occurred all round us, at Kingston, Wimbledon, Ditton, Hampton, Teddington, Epsom, &c., but happily none were reported in Surbiton. All arrangements, however, were made to deal with any case should it appear and the hospital at Cheam was available. The only matter of uncertainty was as 12 to where articles of clothing, bedding, &c., were to be sent for disinfection, as it appears that the Isolation Hospital Board were repudiating their responsibility in the matter. This question is a very important one, and must certainly be settled at an early date, as a recurrence of small pox is very probable, and it is only as an act of grace that disinfection could be permitted at Cheam. Cowsheds and Dairies. The milk supply as it exists in any district is a matter of supreme importance and my experience for many years tells me that the public, and especially that section of it which may be called the milk consuming class is keenly alive to the quality of what is supplied them, being always ready in illnesses, especially if it is of an infectious character, to ask as to the milk being a possible source of danger. To this I have always been able to reply at once that the milk supplied to this neighbourhood is particularly well looked after and everything that it is in the power of this Council and its officers to do to ensure a good quality is done, and further that this is rendered easier and more sure by the willing co-operation of all the milk sellers and producers on the register in facilitating enquiry and giving assistance in pursuing investigations when and where necessary. Milk that comes from long distances has still to be taken on trust to a certain extent, but information is always forthcoming when asked for, and sources 13 of supply and everything necessary to be known are always readily accessible. The bulk of the milk delivered here, and which I am justified in saying is of the best quality, is produced locally and is from a herd of cows that averages about 250 in number. The surroundings connected with this large and important industry are subject to stringent regulations and bye-laws and frequent inspections are made to see that these are complied with and where necessary enforced. This applies to cowsheds, dairies, shops and every one connected with milk distribution. The cows themselves are inspected four times a year by a properly qualified and competent veterinary inspector and his reports are duly submitted to the sanitary committee. From these it appears that the quarterly average number inspected is 246 and as far as tubercular disease is concerned, the report of each inspection during the past year declares that "no cow is found to be affected." As an example, the following statement is an extract from a recent examination,—"No cow was found to be affected with tubercular disease of the udder, nor did any cow present the slightest symptom which could be regarded as suspicious of that disease," and practically each report is identical. A certain number of cows are always to be found with chapped teats, abrasions or chronic inflamation of the organ, and in these latter the milk is not used till recovery takes place. The 14 Inspector further reports, "There were no cases of the vesicular eruptions on the teats which were found to be prevalent in some of the sheds at the other inspections, and this fact proves that care has been exercised by the owners, and milkers for the cow's teats to be in so perfect a condition, and in one shed out of 84 cows there were only two animals which had any defect of the udder, and these only of a simple character." The nature of the milk consumed in any locality has much to do with the health of the inhabitants, especially with the children, and the above statement ought to be satisfactory and reassuring to the Council and the ratepayers. Factory and Workshop Act, 1901. Section 132 of this Act is as follows, viz.:— "The Medical Officer of Health of every District Council shall in his Annual Report to them, report specifically on the administration of this Act in Workshops and Workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State." In compliance with this Order, I have to make the following statement, viz.:— This Act came into force on the 1st January, 1902, and its chief provisions are noticed in the report of the Sanitary Inspector, who is also an Inspector under the Act. 15 It takes a little time to get a new Act into working order, but during the next few months a good deal will be done in this respect. There are but few factories hereabouts, and they are mainly under the supervision of the Factory Inspector, but in some particulars the District Council is responsible for the sanitary arrangements and for adequate provisions against fire and the safety of the workers. As regards home work—under sections 107 to 115, employers or contractors giving out home work are required to send a list of all persons employed by them to do home work to the District Council twice a year, viz., on or before 1st February and 1st August. As no lists have as yet come in, it will be advisable for the Council to insert the requirements of this section in the local papers, so far as it concerns the following trades, amongst others, "manufacture of wearing apparel, upholstery, cabinet and furniture making, &c." Bakehouses. Another important provision is that connected with bakehouses, and more especially underground ones. Of these latter there are 4 in the district. These have been regularly inspected by the Sanitary Inspector, and have complied generally with the Act as far as cleanliness and ventilation, 16 but close supervision is absolutely necessary, and under the present Act improved structural conditions. Under this Act no underground bakehouse shall be used unless it was so used at the passing of the Act, and after the 1st January of next year every such bakehouse must be certified by the District Council as suitable for the purpose. This matter is of supreme importance, and has been the subject of consideration by the Incorporated Society of Medical Officers of Health in conference with Dr. Whitelegge (Chief Factory Inspector) at the Home Office, at which Mr. Shirley Murphy, Medical Officer of Health, London County Council, was also present. I therefore deem it germane to the matter to quote in extenso the suggestions as drawn up and agreed to. They speak for themselves, and being based on the Act are a guide as to what is required. INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. UNDERGROUND BAKEHOUSES. Factory and Workshop Act, 1901, Sect. 101. In the opinion of the Incorporated Society of Medical Officers of Health, it is desirable that the following suggestions, 17 which have been drawn up for the guidance of Medical Officers of Health, in advising their Sanitary Authorities as to Requirements that may be needed under Section 101 of the Factory and Workshop Act, 1901, should be adhered to, so as to secure uniformity of action throughout the Country:— SUGGESTED REQUIREMENTS FOR UNDERGROUND BAKEHOUSES. A.—Construction. 1.—No underground bakehouse shall be less than 8 feet in height throughout, measured from the floor vertically to the ceiling; and in case the floor area exceeds 300 square feet, such height shall be at least 8ft. 6ins. 2.— No underground bakehouse shall have a cubic capacity, clear of the oven, of less than 1,500 feet. 3.—The floor shall be constructed of hard, smooth, durable, and impervious material. 4.—The walls shall be constructed of a material which is hard, smooth, durable, and impermeable to damp. [Note.—VVhere adjacent ground abuts on a wall, or walls, such walls should be lined with the best glazed bricks, uniformly joined with Portland cement, to form internal walls, separated from the existing walls by a cavity, and bonded to them, the intervening space being ventilated to the outer air.] 5.—The ceiling shall be even, impermeable to damp and dust, and durable. 6.—Every underground bakehouse shall be approached by a suitable staircase, adequately lighted and ventilated. No outside staircase shall terminate within an underground bakehouse. 18 Any opening into the shop above must be so covered as to prevent the entrance of dust. B.—Light. 7.—The underground bakehouse shall be adequately lighted with daylight throughout, to the satisfaction of the Sanitary Authority, and the lighting maintained shall be such that an Official Copy of the Abstract of the Factory Act may ordinarily be read in all parts of such bakehouse, between the hours of 11 a.m. and 3 p.m. C.—Ventilation. 8—Ventilation shall be so arranged that the circulation of air is confined to the underground bakehouse. 9.—Ventilation shall be adequate, that is to say, fresh clean air shall be supplied constantly during working hours, so as to provide not less than 3,000 cubic feet of air, per hour, for each person employed, with any additional amount required for purposes of combustion, in such a manner as to avoid the occurence of draught, and so that the air is sufficienty renewed in all parts of the underground bakehouse; and, by the aid of mechanical power, where, in the opinion of the Medical Officer of Health, such is necessary. Provision shall be made for the removal of steam from the underground bakehouse. Where mechanical power is used, the fresh air shall be taken from a height above the level of the adjoining ground of not less than 6 feet, and be distributed to different parts of the underground bakehouse in such a manner as to change the air of such bakehouse in all parts. [Note.—This will generally require the provision of a fan. Foul air may also be extracted by means of a fan with any aid available from gas and ventilating shafts.] 19 10.— Arrangements for ventilation shall be such that the temperature of the underground bakehouse from October 1st to May 31st shall not exceed 8o° Fahr., except within half-an-hour after a batch of bread has been drawn. D.—All Other Respects. 11.—Proper provision shall be made for the storage of flour elsewhere than in the underground bakehouse itself. 12.—There shall be no opening into the underground bakehouse, for any purpose, which will tend unduly to the admission of dust from the adjoining street. 13.—Conveniences for personal ablution shall be provided in a suitable position, and shall include a water tap, and a sink or lavatory basin of an approved character. [Note.— These conveniences should be outside the underground bakehouse.] Free access shall be provided to suitable sanitary conveniences suitably situated. 14.—All troughs, tables or other furniture standing on the floor of the underground bakehouse shall be provided with strong ball-bearing castors. 15.—Proper provision shall be made for the depositing of wearing apparel outside the underground bakehouse. 16.—An underground bakehouse shall not be in communication with a wash-house, nor with any room, cellar or area containing objectionable materials. 17.—An underground room, not entirely separated from the underground bakehouse, shall be well lighted throughout, shall be sufficiently protected against the entrance of ground air, shall be properly ventilated, and shall be at all times clean. All statutory obligations shall be fulfilled. 20 19— Before making any alterations with a view of meeting these requirements, the owners or occupiers of underground bakehouses shall submit to the Sanitary Authority a specification (and plans) of the alterations which they purpose making. J. SPOTTISWOODE CAMERON, M.D., President. [Adopted by the Incorporated Society of Medical Officers of Health on November, 21st, igo2.] APPENDIX. General Statutory Requirements. A.—All Bakehouses. 1.—Every room or place used as a bakehouse shall be in such a state as to be, on sanitary grounds, fit for use or occupation as a bakehouse. 2.—No water-closet, earth-closet, privy or ashpit shall be within, or communicate directly with, the bakehouse. 3.—Every cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a water-closet. 4.—No drain or pipe for carrying off fœcal or sewage matter shall have an opening within the bakehouse. 5.—All the inside walls of the rooms of a bakehouse, and all the ceilings or tops of those rooms (whether those walls, ceilings or tops are plastered or not), and all the passages and staircases of a bakehouse, shall be either painted with oil or varnished, or be limewashed, or be partly painted or varnished and partly limewashed; and 21 (а) Where the bakehouse is painted with oil or varnished, there must be three coats of paint or varnish, and the paint or varnish must be renewed once at least in every seven years, and must be washed with hot water and soap once at least in six months; and (б) Where the bakehouse is limewashed, the limewashing must be renewed once at least in every six months. 6.—No place on the same level with a bakehouse, and forming part of the same building, shall be used as a sleeping place, unless it is constructed as follows, that is to say:— (а) is effectually separated from the bakehouse by a partition extending from the floor, to the ceiling ; and (б) has an external glazed window of at least nine superficial feet in area, of which, at the least, four and a half superficial feet are made to open for ventilation ; and unless such sleeping room (if separately occupied) comply with the requirements as to cellar dwellings or underground rooms (so occupied); laid down in the public Health Acts. B.—Underground Bakehouses. 1.—An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of the Factory and Workshop Act, 1901 (i.e., August 17th, 1901). 2.—After January 1st, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose; and an underground bakehouse shall not be certified as suitable unless the District Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects. It should be borne in mind that once these premises are passed they can be used for all time as bakehouses, and now is the golden 22 opportunity for the Council to have them made healthy for the workers, and so constructed that the conditions under which bread, &c., is made are clean and wholesome. The chief difficulties arise in providing suitable ventilation and lighting, and the prevention of dampness and dust. This very much needed building is at last Mortuary, completed, nearly furnished, and will shortly be available for use. In my Report for 1892, now nearly ten years ago, I drew attention to the necessity for a mortuary owing to the growth of the district, and to the distance of that in use at Kingston, which in its turn necessitated the holding of inquests there and occasioned great inconvenience and loss of time to medical men, jurymen, relatives and witnesses. Year-by-year since then I have pressed for this, and possibly it would have been taken in hand earlier but for the difficulty of finding a site sufficiently central and fairly free from objection. At last, however in 1900, after the present land had been acquired by the Council, plans were drawn up and submitted to the Council and Local Government Board for approval. Eventually after many vicissitudes the present erection has resulted, and it will be found to be a 23 considerable improvement on the former state of things, though by no means as perfect as might be. A brief description of the buildings designed and erected for this purpose may not be uninteresting. An up-to-date mortuary should consist of three separate buildings ; one is the mortuary proper or dead-house, the second is the post-mortem room, and the third is for the use of the medical practitioners attending and to serve as a store for such things as are required for use and have to be kept in safety and good order. The estimated cost of the mortuary was £700, and as all expenditure is not completed, I cannot yet say what the total outlay will be. The mortuary buildings as at present consist of two separate rooms both of the same size, placed side by side with a space of some 12 or 15 feet between them. The mortuary proper is 20ft. by 12ft. constructed of brick with tile roof, lighted by two windows 5ft. by 3ft., made to partly open. It is ventilated by two inlet and two outlet tubes, the latter in the roof. The floor is laid with mosaic pavement on concrete and provided with a white glazed channel in the centre covered with an iron grating to convey the drainage outside over a trapped gully. The interior is furnished with a portable enamelled iron ware and sloping table, and also 24 with a very elaborate air-tight container with lifting tackle. The lower end of the room is shut off by a glass screen with separate entrance and exit to enable a Jury to "view the body" with a minimum of inconvenience. The other building is of the same dimensions 20ft. by 12ft., but is lighted by a large lantern light and one window 5ft. by 3ft. made to open. Two patent air inlet tubes and a special flue carried up to the height of the chimney are the means of ventilation; the floor is laid with mosaic paving as in the mortuary, sloping from either end towards the centre to a cross gully running to outside. The inside is furnished with a post-mortem table, a special sink and drainer, and a lavatory with foot-action pipes for hot and cold water made and supplied by Doulton & Co. An open range is provided for supplying hot water if required, and also in addition a Ewart & Co.'s Geyser, which is always available for the immediate supply of hot water as requisite. Both buildings are lighted by gas. There is at present no building for the use of the medical men in which to change or leave 25 their clothing, or to make notes, nor any place for stores or requisites. These may possibly come, but until provided, the establishment is not complete. Sanitary Work. During the past year two roads have been made up, Lovelace Road and Cranes Park Avenue, and one new road made up, taken over and opened, Kingsdown Road. But some of the roads in the poorer parts of the district are sadly in need of being properly put in order and taken over, I particularly refer to Beaconsfield Road, to which attention was drawn last year, as it is now in a worse condition than ever; also the upper part of Ellerton Road. In connection with roads I would draw the attention of the Council to the fact that the majority of the roads in Tolworth (and they are continually increasing) have no name plates erected ; the need of them is pressing, as I can testify. It would also be beneficial and save much trouble if the Council could get the Bye-laws amended so as to give power to insist upon the back or side approaches to property, which, while being private are in reality semi-public, being properly paved, where such is deemed to be necessary on sufficient grounds. It.often happens that these approaches are used in common by various tenants or owners of adjacent property, and the onus of up-keep is repudiated, with the result 26 that they become a nuisance and an eyesore. The case of the road between the shops near the Post Office on Surbiton Hill well exemplifies the necessity, and there are similar instances in lower Surbiton waiting attention. Surface water drainage works are in progress North of the railway, that on the South side having been completed. Public urinals are very much needed in the district, especially in the neighbourhood of the railway station. New sewers are to be laid in Victoria, Claremont and Glenbuck Roads, all of which are in a defective condition. The present Bye-laws do not give the Council Bye-aws. power to insist that notice shall be given when house drains are going to be relaid, and it not infrequently happens that houses are thus redrained in a very careless and unworkmanlike manner without the knowledge of the Sanitary Inspector and consequently without his supervision. A tenant finds "something wrong with the drains," he calls in a builder who condemns them and gets the order to put them right, he does the work, and in a few months it is all wrong again. Two such cases have recently been reported to me by the Sanitary Inspector, in 27 which the drains were being relaid by a tradesman without any notice being given to the Council, both of these had previously been relaid by the same tradesman, in the one case within the last eighteen months and in the other within three years. Bye-laws dealing with this subject are in force in one neighbouring Authority and two others are, I am informed, making application for powers. Sewage Farm. A somewhat improved state of the effluent has been maintained during the past few months. A visit of inspection was made by Mr. Otto Hehner on July 25th, and a detailed report was subsequently received and considered by the Sanitary Committee. The sewage disposal was considered in all its bearings as far as Tolworth was concerned, and various suggestions were made, bearing on the abatement of the nuisance complained of, which was to be brought about by the improvement of the effluent. These were carried out, and they included more frequent and thorough cleansing of the brook, and certainly there is 28 no great cause for complaint at present. The whole question of the disposal of the sewage of the District has now been referred to a Special Committee—the Main Drainage Committee—who are considering the subject in view of the approaching termination of the existing contract with the Kingston Corporation. Appended to this Report is that of the Sanitary Inspector, of whose worth as an efficient and painstaking officer it is impossible to speak too highly. I am, Mr. Chairman and Gentlemen, Yours obediently, OWEN COLEMAN, m.d., d.p.h., Medical Officer of Health. March 31st, 1903. To the Medical Officer of Health. Sir,— I beg to submit my Seventh Annual Report, showing the Sanitary Inspections made by me during the year ending December 31st, 1902, together with particulars of nuisances abated and improvements effected in the District in consequence of such inspections. Abatement of Nuisances. During the year a systematic inspection of the District has been made, in order to comply with the General Orders of the Local Government Board, and Section 92 of the Public Health Act, 1875, which renders such inspection compulsory. In all 320 houses and premises have been inspected, these including houses from which complaints of nuisances have been received, and others in which cases of infectious disease have occurred. House to house inspections have been made in King Charles' Crescent, Mayberry Place, Vale Road and German Place. Notices Served. As the result of these inspections, 77 preliminary notices were served, most of which were promptly complied with. 30 In 159 instances, nuisances were reported to the Sanitary Committee, and legal notices were ordered to be served. As will be seen from the following summary, a large number of nuisances have been dealt with and several important sanitary improvements carried out. 3,370 visits were made from time to time whilst the various works were in progress. Details of Sanitary Improvements effected during the year. Defective drains cleansed, repaired, trapped, &c. 19 Stoneware gullies fixed in lieu of defective brick and iron bell traps 436 Cesspools abolished 1 Water-closet apartments rebuilt 28 Water-closet apartments lighted or ventilated 13 Water-closet pans cleansed or repaired 24 Water-closet flush pipes disconnected from storage cisterns and separate flushing cisterns fixed 134 Water closets supplied with water 1 Defective water-closet flushing cisterns repaired 92 Soil pipes ventilated 5 Soil pipes repaired 14 New soil pipes fixed 29 Storage cisterns newly provided 2 Soil pipes inside dwelling houses removed and fixed outside 1 Storage cisterns repaired 18 Storage cisterns cleansed 17 Storage cisterns provided with covers 9 Sink and other waste pipes disconnected from drain 208 Sink and other waste pipes repaired 115 31 Rainwater pipes disconnected from drain or soil pipe 127 Defective rainwater pipes repaired 114 Defective eaves gutters repaired 14 Defective roofs made watertight 11 Stable floors paved and drained 9 Public house urinals re-constructed 1 Privies converted into water closets 2 Sites of houses concreted to prevent dampness 21 Dry areas built to prevent dampness 2 Houses provided with damp courses 2 Dirty houses cleansed and whitewashed 14 Nuisance from overcrowding abated 3 Accumulations of manure, &c. removed 2 Of the three cases of overcrowding referred to in the foregoing schedule, one occurred at Hook and two at Tolworth. They were all very bad cases, but in each instance the service of a formal notice had the desired effect of causing an abatement of the nuisance. Twenty-one houses have been provided with sanitary dust bins where none previously existed. Two hundred and thirty-one old iron container and long hopper pans have been abolished, and closets of an approved form substituted. House Drainage. As in previous years a very large amount of time and attention has been paid to the condition of house drains. This is one of the most important departments of sanitary work. It is certainly the 32 greatest in amount and involves a far greater expenditure of time than any other; in fact the attention necessitated by works under this head occupies the larger part of my time. Visits are made to each job from time to time when the work is in progress, to see that it is being executed in accordance with the notices served and the Bye-laws in force in the District. All drains re-laid are tested with water before the trenches are filled in and again when the work is finished to ensure their being left in a watertight condition. After the drainage of any premises is completed a plan of the work carried out is prepared by me and filed in the office for future reference. During the year the Council have given me authority under Section 41 of the Public Health Act, 1875, to open the ground and examine the drains of 39 houses. In each case insanitary conditions were found to exist, and notices were served upon the persons responsible requiring the reconstruction of the drains and other sanitary work. In ten instances the necessary work was carried out by the Council under specifications and plans prepared by me and the costs recovered from the owners. Three of these were cases of combined drainage which was reconstructed by 33 the Council at the request of the owners, and on their agreeing to pay the expense apportioned. The default of the owners necessitated the Council's action to enforce the remaining seven notices. At the beginning of the year a house to house inspection was made in King Charles' Crescent and Mayberry Place, with the result that the drains and sanitary arrangements of each house were found to be in a defective condition. Notices were served upon the owner, to reconstruct the drains and provide each house with a sufficient water-closet. The owner agreed to comply with all the Council's requirements with the exception of re-laying the combined drain to which the house drains were connected. He objected to this on the ground that under the provisions of Section 4 of the Public Health Act, 1875, it was a sewer, and the Council were responsible for keeping it in a proper state of repair. As it was a questionable point whether the combined drain was a sewer or not, it was subsequently agreed that the Council should execute the whole of the work, the owner to pay half the cost of reconstructing the combined drain and the whole of the cost of the house drainage and other necessary sanitary work. The work has now been completed in accordance with a plan and specification prepared by 34 me and under my supervision at a total cost of £458 IOS. In each instance where the Council have executed drainage works either at the request of the owner or in default of compliance with the notices served, a charge of 5 per cent. on the cost of the work is made for preparing plans, specifications, &c. The total income from this source during the year amounts to £56 7s. Iod. On inspection the drains belonging to the Hook Elementary Schools were found to be in a defective condition. The Manager's attention was drawn to this fact, and they at once gave instructions for the drains to be re-laid, the old insanitary trough latrines abolished and new School Board pedestal closets with separate flushing cisterns to be provided. During the year the drains of 212 houses and premises have been entirely relaid and provided with manholes for inspection and cleansing purposes and all up-to-date improvements. The following table shows the number of house drains relaid during the past seven years:— 1896 1897 1898 1899 1900 1901 1902 Total 70 120 105 97 76 135 212 815 35 Name and Situation been redrained 2, 3, 4, 5, 6, 7, 63, 64, 65, 66 and 67, Alpha Road 1 to 22 (inclusive), Alpha Place 6, 81, 82, 83 and 84 Brighton Road 5, Avenue Mews, Surbiton Hill Road Westbourne House, Cadogan Road 1 to 12 and 16 to 22 (inclusive), Richmond Grove 8, St. Andrew's Road Trevangor, The Avenue Argyle House, The Avenue Glencoe, The Avenue Preston St. Mary, Langley Avenue 7, 8 and 12, St. Andrew's Square 9, 10 and 17, Avenue Elmers 3, 4, 5, 6, 9 and 10 Britannia Road 15, St. James' Road Kenmare, King Charles Road Coniston, King Charles Road Springhill, King Charles Road Woodstock, King Charles Road Glenallen, King Charles Road Henley House, Grove Road Grove Lodge, Grove Road 33 to 36 (inclusive), Cottage Grove Hillside, Parklands 11, 12 and 31 to 39 (inclusive), Brown's Road oF Houses which have During the Year. 1 and 2 Vine Cottages, Brown's Road Moray House, Adelaide Road Elementary Schools, Orchard Road, Hook Elm Lodge, Ditton Road 11, Paragon Grove Sandilands, Surbiton Hill Park Nenehurst, Park Road 7 to 12 (inclusive), Warwick Grove Chylton Dene, Langley Road Richborough House, Langley Road Netley Villa, Berrylands Borva, Lovelace Road Smith's Stables, Grove Footpath Gleneric, Ewell Road Northcoates, Ewell Road Aldenham House, Ewell Road Anchor Coffee Tavern, Ewell Road Butcher's Shop, occupied by Messrs. Wilcox & Son, Ewell Road Tolworth House, Ewell Road, Tol worth 1 and 2 Smith's Farm Cottages, Ewell Road, Tolworth 4 and 5 Wyburn Villas, Ewell Road Spencer House, Ewell Road Victoria Inn, Ewell Road Isherwood House, Ewell Road 36 Florence, Ellerton Road Underwood, Ellerton Road Clyde Villa, Ellerton Road 1 to 4 (inclusive), Clydesdale Villas, Ellerton Road 11 to 18 and 31 to 42 (inclusive), King Charles Crescent Corrin, Southborough Road 1 and 2 Bath Cottages, Dennan Road 1 and 2, Dennan Villas, Dennan Road Thisleton, Cotterill Road Manor Farm, Hook 1 and 2, Leigh Cottages, Brook Road 1 and 2, Woodland Cottages, Brook Road Lynton, Balaclava Road Clovelly, Balaclava Road Glenthorne, Balaclava Road 1, Haycroft Road, Southborough 1 and 2, Wingrave Cottages, Haycroft Road, Southborough 16, Douglas Terrace, Douglas Road 1 to 6 (inclusive), German Place 1, 2 and 3, Aysgarth Villas, Worthington Road 1 and 2, Walton Cottages, Gladstone Road 1 to 10 (inclusive), Mayberry Place 20 and 21, South Place 55 to 63 (inclusive), 81 and 82, Cleaveland Road Chiswick Cottage, Ewell Road Paving of Yards. Considerable attention has again been given to the paving of yards, 114 having been paved wholly or in part with impervious material. This work is greatly appreciated by the occupiers of small property and tends to promote more cleanly conditions in and around the houses as well as to prevent nuisances arising from damp walls, stagnant water, &c. Disinfection. In accordance with the instructions of the Medical Officer of Health, 40 infected rooms have 37 been fumigated with sulphur or sprayed with formalin, and the bedding, clothing, &c., removed to the Isolation Hospital for steam disinfection. Two separate vans have now been provided by the Council, one for conveying the infected bedding, &c , from the. premises where the case occurred to the disinfecting apparatus, and the other for returning it after being disinfected. Slaughter Houses There are five slaughter houses in the district, all of which have been regularly inspected. One was found to be in a dilapidated and insanitary condition, and a formal notice was served to put it into a proper state of repair. The owner then had the walls and roof repaired, the drains reconstructed and the floor of the slaughter house and yard adjoining repaved. Factory and Workshop Act, 1901. The Factory and Workshop Act, 1901, came into force on the 1st January, 1902. It repeals or consolidates all previous legislation on the subject, and imposes several new and important powers and duties on Local Authorities. District Councils hare now duties to perform in connection with every place of work coming under the Act, but these duties vary according as the particular place comes within the term "Factory," "Workshop," or other description. 38 Factories are defined generally as all places in which mechanical power is used in aid of any manufacturing process, and there is a list of 18 classes of work which are defined to be factories and not workshops, whether mechanical power is used in them or not. Factories. In the case of factories the duties of the Council are limited to seeing that every factory in the district is provided with sufficient means of escape in case of fire, and in districts where Part III of the Public Health Acts, Amendment Act, 1890, is in force ; the enforcement of the requirements of Section 22 of that Act, as to the provision of suitable and sufficient sanitary conveniences. The following are defined as Workshops viz.:— Workshops. 1. Any premises in which manual labour is exercised for the purpose of altering, repairing, ornamenting, finishing or adapting goods for the purpose of gain, provided that no mechanical power is employed, and that the employer of the persons working there has a right of access or control. 2. Tenement Workshops. That is workplaces in which two or more persons carry on work on their own account, under agreement with the owner or occupier, as in the case of journeymen tailors who hire sittings from the owners or occupiers of workshops. 3. Laundries in which no mechanical power is used, and which are not in connection with any 39 institutions subject to inspection under other Acts, or are not worked by members of the family with the assistance of not more than two persons from outside. 4. Workplaces. This term is not defined by the Act, but under a recent decision of the Courts it is taken to mean any place where people assemble to work permanently. The Council is responsible for the sanitary condition of workshops, the duty as regards factories being laid upon the Factory Inspectors. In order that this responsibility may be properly discharged, the Council are required to keep a register of all workshops situated in their district. The provisions of Section 91 of the Public Health Act, 1875, are made to apply to workshops, and the following additional requirements are prescribed, viz. :—Factories and worshops, (а) Must be kept clean and free from effluvia. (b) Must have the prescribed air space of 250 cubic feet for each person employed therein, and during overtime work, 400 cubic feet. (C) Must be provided with proper ventilation to mitigate, as far ar possible, the harmful character of any gases, vapours, dust, or other impurities generated in the business carried on. (d) Where the business is of such a character that the moisture produced is capable of being removed by means of drainage, the necessary drainage must be provided for this purpose. This provision does not apply where men only are employed. 40 (e) Where Part 3 of the Public Health Acts, Amendment Act, 1890, has been adapted, it is also the duty of the Council to see that all workshops are provided with suitable and sufficient sanitary conveniences. As regards both factories and workshops, the District Council have powers and duties in the matter of means of escape in case of fire. The owner or occupier of factories of which the construction was commenced after the 1st January, 1892, and workshops commenced after 1st January, 1896, must, if more than forty persons are employed therein, obtain from the District Council a certificate that the means of escape in case of fire are such as may be reasonably required in the circumstances of the case. Before giving this certificate it is the duty of the Council to have each such factory or workshop examined. The certificate must state specifically what means of escape are provided, and in the case of a factory or workshop being used without such certificate the Council may take proceedings against the occupier. The Act also defines ''Domestic Factories'' to mean private houses where members of the family carry on without the aid of mechanical power any of the kinds of work enumerated in Schedule VI of the Act. It is also the duty of the Council to see that domestic factories are kept Domestic factories and Workshops. 41 in a cleanly condition, that the specified air space is provided for each worker and that the rooms are properly ventilated. Home Work. In addition to the control of places under the designation of factories and workshops, the new Act also gives the Council some jurisdiction in cases where work is done in the homes of the workers. The objects of the Act are to prevent work being done under insanitary conditions arising from overcrowding, insufficient ventilation, &c., or where there is dangerous infectious disease. In any case the Council have power by notice, to prohibit any occupier of a factory or workshop from giving out work to be done in such insanitary or infected place. This power applies only to certain classes of work specified by the Secretary of State. Employers of outworkers are required to keep lists of persons so employed, and to send to the Council copies of such lists twice a year. Bakehouses. The Act imposes new and important duties upon District Councils with regard to underground bakehouses, Section 101 provides : — I. An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of this Act. 42 2. Subject to the foregoing provision, after the first day of January, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose. 3. For the purpose of this section an underground bakehouse shall mean a bakehouse, any baking room of which is so situate that the surface of the floor is more than three feet below the surface of the roadway of the adjoining street, or of the ground adjoining or nearest to the room. The expression " baking room," means any room used for baking, or for any process incidental thereto, 4. An underground bakehouse shall not be certified as suitable unless the District Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects. 5. This section shall have effect as if it were included among the provisions relating to bakehouses which are referred to in Section 26 of the Public Health (London) Act, 1891. 6. If any place is used in contravention of this section, it shall be deemed to be a workshop not kept in conformity with this act. 7. In the event of the refusal of a certificate by the District Council, the occupier of the bakehouse may, within twenty-one days of the refusal, by complaint apply to a court of summary jurisdiction, and if it appears to the satisfaction of the Court that the bakehouse is suitable for uses as regards construction, light, ventilation, and in all other respects, the Court 43 shall thereupon grant a certificate of suitability of the bakehouse, which shall have effect as if granted by the District Council. 8. Where any place has been let as a bakehouse, and the certificate required by this section cannot be obtained unless structural alterations are made, and the occupier alleges that the whole or part of the expenses of the alterations ought to be borne by the owner, he may by complaint apply to a court of summary jurisdiction, and that court may make such order concerning the expenses of their apportionment as appears to the court to be just and equitable under the circumstances of the case, regard being had to the terms of the Contract between the parties or in the alternative the court may, at the request of the occupier, determine the lease. There are 13 bakehouses in the District, 4 of which are situate underground. They have been inspected twice during the year and found generally to be kept in a clean and satisfactory condition. The attention of each of the occupiers of the underground bakehouses within the District has been drawn to the foregoing section of the Act, in order to give them the opportunity where possible, to carry out the necessary structual alterations required to obtain the Council's certificate. On the 13th January, 1902, I was appointed by the Council Inspector under the Act, but in 44 consequence of my multifarious duties, I have been unable to give much attention to this work. The number of workshops registered is 98, but there are many more in the District. I hope during the coming year to complete the register, after which a thorough inspection of the workshops and workplaces will be made. The following is a list of nuisances abated in workshops during the year:— Defective drains cleansed, repaired, trapped, &c. 1 Defective drains re-laid 2 Water-closets repaired, cleansed, &c. 7 New water-closets fixed 3 Sink waste pipes repaired or trapped 4 Workshops, limewashed and cleansed 2 Workshops, walls or floors repaired 5 Dairies, Cowsheds and Milkshops. The dairies, cowsheds and milkshops have been inspected quarterly during the year, and at irregular periods as occasion required. There are 16 persons registered under the Act, as follows:—Cowkeepers, 1; Cowkeepers, Dairymen and Purveyors of Milk, 3; Purveyors of Milk, 5 ; Dairymen and Purveyors of Milk, 7. 45 The average number of cows kept by the persons registered is 256; and all are under periodical inspection of the Council's Veterinary Inspector. I found it necessary to call the owner's attention to the insanitary condition of the drainage of the cowsheds at Manor Farm, Hook, with the result that an entirely new and up-todate system of drainage has been constructed and the adjoining yard paved. Legal Proceedings. Legal proceedings before the Magistrates were taken against the owner of 73, Cleaveland Road, to recover the sum of £11 9s. 6d. the cost of reconstructing the drainage in default of compliance with the notice served. When the summons came on for hearing the defendant did not appear, but wrote a letter admitting his liability. The Magistrates made an order for the amount claimed and two guineas costs. Summary of Work of Department. Number of houses and premises inspected 320 „ visits to works in progress 3370 „ „ re cases of infectious disease 45 „ ,, to Schools 11 46 Number of miscellaneous inspections 199 „ visits to bakehouses 18 „ „ slaughter houses 22 „ „ dairies, cowsheds and milkshops 64 „ ,, factories and workshops 35 „ complaints received and attended to 122 „ preliminary notices served 77 „ legal notices served 169 „ letters written on the business of the department 671 „ drains opened up for examination under Section 41 of the Public Health Act, 1875 39 „ drains tested with smoke 45 „ plans of houses redrained prepared 120 „ houses and premises disinfected 40 I am, Sir, Yours obediently, W. NESFIELD, Assoc. San. Inst., Sanitary Inspector. 47 TABLE 1. Vital Statistics of Whole District during 1902 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 Nonresidents 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 Tear of Age. At all Ages Number Rate per 1,000 Births registered Number Rate * Number Rate * 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 13,596 281 20.66 27 96.08 164 11.98 24 16 9 123 9.04 1897 13,880 291 20.96 37 127.1 143 10.3 9 6 1 135 9.65 1898 14,164 311 21.95 40 128.6 179 12.56 15 10 5 164 11.57 1899 14,458 296 20.47 23 77.7 164 11.34 17 8 7 161 11.13 1900 14,732 295 20.02 29 98.3 168 11.4 14 5 13 165 11.2 1901 15,017 324 21.57 24 74.07 152 1012 19 9 15 158 10.52 Averages for years 1896.1901 14,308 299.6 20.92 30 100.3 161.6 11.28 16.3 9 8.33 151 10.51 1902 15,386 288 18.7 34 118.0 157 10.2 13 5 17 169 10.9 * Rates in Columns 4. 8. and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water) 2858½ Total population at all ages (at Census of 1901) 15017 Number of inhabited houses (at Census of 1901) 2,874 Average number of persons per house ,, 5.225 TABLE 2. Vital Statistics of separate Localities in 1902 and previous years. Year. Surbiton. Tolworth. Hook and Southborough. 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. 1896 10560 199 123 19 17718 51 15 3 1314 31 17 2 1897 10663 209 109 30 1866 46 14 4 1348 36 11 3 1898 10766 214 138 41 2014 67 19 5 1382 30 17 4 1899 10869 185 119 15 2162 71 20 8 1416 40 22 1 1900 10972 191 129 18 2310 68 23 7 1450 36 11 4 1901 11075 195 117 12 2458 94 30 10 1484 35 11 2 Averages of Years 1896 to 1901. 10817 198 8 122.5 22.5 2088 661 20.5 6.1 1399 34.6 14.8 2.6 1902. 11214 158 128 21 2643 104 35 13 1529 26 6 0 TABLE 3. Cases of Infectious Disease notified during the Year 1902. Notifiable Diseases. 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. Surbiton Tolworth Hook and Southborough Surbiton Tolworth Hook and Southborough Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Diphtheria 19 1 3 11 2 2 .. 8 3 8 6 3 7 Erysipelas 8 .. 2 .. 1 4 1 7 1 .. .. .. Scarlet Fever 22 .. 7 12 1 2 .. 18 2 2 15 1 1 Enteric Fever 2 .. .. 1 1 .. .. 2 .. .. 1 .. .. Puerperal Fever 1 .. .. .. .. 1 .. .. 1 .. .. .. .. Totals 52 1 12 24 5 9 1 35 7 10 22 4 8 TABLE 4. Causes of, and Ages at, Death during Year 1902, Causes of Death Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages) Total Deaths in Public Institutions in district All ages Under 1 Year 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards Surbiton Tolworth Hook and and South borough Measles 10 2 5 3 .. .. .. 10 .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. 1 Diphtheria and Membraneous Croup .. .. .. 3 .. .. .. .. 2 1 2 Epidemic Influenza 7 .. .. .. 1 5 1 5 2 .. .. Diarrhœa 5 5 .. .. .. .. .. 3 2 .. 1 Puerperal Fever 1 .. .. .. .. 1 .. .. 1 .. .. Erysipelas 1 .. .. .. .. .. 1 1 .. .. .. Other Septic Diseases 2 1 .. .. 1 .. .. 2 .. .. .. Phthisis 7 .. .. .. .. 7 .. 5 2 .. 1 Other Tubercular Diseases 2 1 1 .. .. .. .. 2 .. .. .. Cancer, malignant disease 12 .. .. .. .. 4 8 11 .. 1 .. Bronchitis 16 4 .. .. .. 3 9 11 4 1 1 Pneumonia 14 6 1 1 .. 4 2 11 2 1 .. Alcoholism — Cirrohosis of Liver 7 .. .. .. .. 6 1 6 1 .. 1 Venereal Diseases.. 1 .. .. .. .. 1 .. 1 .. .. .. Premature Birth 7 7 .. .. .. .. .. 4 3 .. .. Heart Diseases 17 .. .. .. .. 7 10 11 5 1 .. Accidents .. 2 1 .. .. .. 1 .. 2 .. .. .. Suicides 3 .. .. .. 1 2 .. 3 .. .. 1 All other causes 52 8 1 1 4 11 27 40 11 1 1 All causes 169 35 8 8 7 52 59 128 35 6 13