SUT 12 URBAN DISTRICT (OR PARISH) OF Sutton, Surrey. Medical Officer's Annual Report With regard to the year 1903. CONTENTS. I. Physical Features. II. Vital Statistics. III. Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and from certain Other Diseases, to which the Infectious Diseases' (Notification) Act, 1889, applies, and of the Action taken for preventing their spread. IV. Summary of Other Sanitary Proceedings, &c. V. Appendix, containing Sanitary Inspector's Annual Returns, certain Tables of Sickness and Mortality, and Me Metrological Notes. Prepared in accordance with Sec. 14 of the Order of the Local Government Board, dated 23rd March, 1891, regulating the duties of Medical Officers of Health. William Pile, Ltd., Printers, "Herald" Office, Sutton. SUTTON URBAN DISTRICT. Area, 1,886 Statute Acres. Number of Inhabited Houses at Census 1881, 1,537; at Census 1891, 2,200; at Census 1901, 2,976. Population (exclusive of South Metropolitan District Schools) at Census 1881, 8,700; at Census 1891, 12,000; at Census 1901, 15,486. MEDICAL OFFICER'S REPORT FOR THE YEAR 1903. Gentlemen, I have the pleasure to submit my Third Annual Report on the health and sanitary administration of the district. The year has been a very favourable one, as far as the mortality is concerned, the death rate the lowest recorded in the district and 2.4 per thousand below the average of the previous ten years, the decrease in the loss of life as here implied being most marked at the two extremes of life, namely, under five years of age and over 60. During this period the meteorological conditions have also been remarkable, the rainfall having exceeded all previous years of which records are available. Taking these two facts in conjunction, the question naturally arises as to how far the latter has influenced the public health as a factor in the cause of the lessened mortality. The constant cleansing of the atmosphere, the washing of germ-laden streets and back-yards, and the flushing of drains by the frequent rains would seem to be of benefit, whilst flies—those little pests of a dry summer—are certainly less prevalent in wet seasons, and are probably a greater factor than we at present conceive in the spread of summer diseases, by the facility with which they carry infectious germs to milk, food, etc. Although other influences may have been concerned in causing the above favourable record, I think we may assume, having regard to the beneficial effects which seem to accrue from the natural cleansing power of rain, that the nearer an approach is made to this by frequent and unstinted flushing by artificial means during dry seasons the better it is likely to be for a community. I.—Physical Features. Sutton in its main direction lies almost due north and south, the High Street continuous on the north with the London Road and on the south with the Brighton Road, intersecting the district in this direction, which is about 2¾ miles long between the boundaries. From east to west the town is divided by the Carshalton Road and Cheam Road, and at this point is about a mile in width. The whole district has an area of 1,836 acres The southern portion of button is beautifully situated, sloping up to the noted breezy Banstead Downs, attaining a height of about 300 feet above sea level, and having a subsoil of Chalk. The northern portion also rises from the lower part of the town about Sutton Green (117 feet above sea level) to Sutton Common and Benhilton, both of which are prettily situated and favourite residential districts. This part of the town is mainly situated on the London clay, but dividing this from the chalk, which may be roughly said to extend to a line drawn east to west, about the level of West Street, are two narrow strips of Thanet sand and plastic clay (Woolwich and Reading beds) an outcrop of the lower London tertiaries. The natural or surface water drainage is mainly to the Pyl Brook, a small tributary of the Beverley Brook, and to a small extent on the east side into a brook running into the Wandle. On the north side Sutton is bounded by Carshalton and Morden, on the south by the parish of Banstead, on the east by Carshalton, and on the west by Cheam and Morden. (2) II.—Vital Statistics: Births and Deaths. 1. Population.—The natural increase of population during the year 1903, viz, the excess of births over deaths was 243, which, with the increased number of inhabited houses, would justify the assumption that as far as the nett population is concerned the increase was in about the same ratio as shown in the late census to have taken place during the previous ten years. There has, however, been a considerable alteration in the number of inhabitants of the South Metropolitan District Schools as previously included in the gross population, the boys' school in the Brighton Road only having been used by one out of the many authorities. viz., the St. Olaves Union, and the girls' school in the Banstead Road having been taken over by the Metropolitan Asylums Board. A census of these schools was taken at Midsummer, giving a population of 471 at the St. Olaves Union School, and 497 at the Metropolitan Asylum Board's School, making a total of 968. as compared with 1738 recorded by the census of 1901. The gross population for the purposes of these statistics will therefore be estimated at 17168, as compared with 17638, and the nett population, excluding the above schools, as 16,200, as compared with 15,900 the previous year. 2. Births.—388 births were registered during the year, 198 boys and 190 girls, the birth rate for the year being 23.9 per 1,000, the average rate for the previous ten years 23.6. The birth rate for the whole of England and Wales was 28.4 during the year. 3. Deaths.—There were registered 131 deaths as having taken place within the district, of which 3 were of persons not belonging thereto, two at the Sutton Hospital and one at the South Metropolitan Schools, whilst 22 deaths occurred of persons removed for treatment to institutions outside the district, viz., Brookwood Asylum 8, Epsom Union Workhouse 14, and Cuddington Isolation Hospital 1. This gives a total of 150 deaths of inhabitants, 65 males and 85 females, and a death rate of 9.2 per thousand of the estimated population, as compared with 12.2 the preceding year, and an average of 11.7 during the ten previous years. In England and Wales the death rate was 15.4 per 1,000, and in the 103 smaller towns in the country 14.6. 4. Infant Mortality.—The deaths of 32 children under 12 months old were registered during the year, and the infant mortality as measured by the proportion of deaths registered under one year old to the number of births registered was 8.2 per cent., as compared with an average of 10'9 during the ten preceding years. The rate in England and Wales during the year was 13.2. 5. Eleven deaths were attributed to Phthisis or Pulmonary Consumption, which is equal to .6 per 1,000, the same as during the two preceding years; and 19 deaths were due to other lung diseases (Bronchitis Pneumonia, &c.), or 1.1 per 1,000 as compared with 2.0 and 2.3 in the two previous years respectively. 6. Epidermic Influenza was but slightly prevalent during the year, and is credited with 1 death, as compared to 6 the previous year. 7. Cancer (Malignant Disease).—Twelve deaths were attributed to Cancer, about 1 in 12 of the total mortality, the rate per thousand of the population being .7, as compared with 1.0 and 1.9 during the two previous years. (3) III.—Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and from certain other Diseases which have to be notified under the Infectious Diseases (Notification) Act, 1889, and of the action taken tor preventing their spread. 1. Smallpox.—No cases of Smallpox have been notified in the district during the year, though there have been a few cases in the immediate vicinity, and in one instance where clothes had been returned home from a laundry outside the district (from which an infected person had been taken to the Small Pox Hospital), it was necessary to remove the clothes for disinfection. Scarlet Fever.—Twenty-one cases of Scarlet Fever were notified as compared with 36, 27 and 127 in the three previous years respectively, and two deaths were attributed to the disease. Nineteen cases were removed to the Isolation Hospital for treatment. Four of the cases came into the district after having contracted the disease outside and in one house where four cases occurred, which unfortunately resulted in the death of one patient, a young lady of 22 years, the origin of the disease was evidently due to a previously unrecognised mild attack of a maid who had recently come into the employ of the householder. Diphtheria.—Seventeen cases were notified as compared with five and 16 for the two previous years respectively; no deaths were attributed to this disease. Fifteen cases were removed to the Isolation Hospital. Of the 17 cases three occurred during the first half of the year and 14 in the latter; 13 were from the lower part of the district, and of these eight previously attended the Benhilton Schools, but on enquiries this I think proved to be merely a coincidence, as the cases were extremely disconnected and, with the exception of a child who was probably infected by a playmate, the situation of the schools in the district mostly affected seemed to be alone responsible for the others. It is very probable that the flooding referred to in another part of this report as occurring several times during the year in this part of the town, may have been of some account as a factor in the cause of the Diptheria. Enteric or Typhoid Fever.—Five cases of Enteric Fever were notified during the year, as compared with seven the previous year, but no deaths were caused thereby. In several of the cases sanitary defects were found to exist at the houses, and one evidently came into the district having contracted the disease outside. Whooping Cough.—Two deaths were attributed to Whooping Cough, one in January and the other in November. Measles.—No deaths were caused by Measles during the year, as compared with six during the previous year, and very few cases have come to my knowledge. Diarrhcea.— Six deaths were attributed to Diarrhcea, as compared with five in the previous year, six in 1901, five in 1900, nine in 1899, 11 in 1898, and 28 in 1897. During the summer handbills were distributed by the order of the Sanitary Committee at my request, calling attention to the causes of Summer Diarrhoea, and the means to be taken by householders in endeavouring to prevent the disease. Zymotic Death Rate.—The total number of deaths from the seven principal epidemic diseases was 10, viz., six from Diarrhœa, two each from Scarlet Fever and Whooping Cough. This is equal to a zymotic death rate of .6 per 1,000 of the estimated population, as compared with 1.1 the previous year, and 1.2 the average for the preceding 10 years. The rate for the whole of England and Wales during the year was 1.46, and for 103 smaller towns 1.41. (4) As to the other Diseases which require Notification under the above Act. Membranous Croup.—No notified cases. Puerperal Fever.—No deaths or reported cases.. Erysipelas.—Five cases of erysipelas were notified during the year. No deaths. Continued Fever.—No cases were notified. Summary of further proceedings which were taken to prevent the spread of some of these diseases. Each house, on receipt of notification of infectious disease existing therein, is immediately visited, and isolation or removal to Isolation Hospital insisted on as may be requisite; the premises are examined, and notice given to remedy any defects that may be found; information as regards the milk supply, laundry, schools attended by children, etc., is obtained, and necessary steps taken to prevent the disease spreading by these means; disinfectants for use during illness are supplied where necessary; after the recovery or removal of a patient the disinfection of the rooms and contents is required, bedding, clothing, etc., being taken to the Isolation Hospital for disinfection in the Washington Lyon Steam Disinfector. In all cases where infection seems to point to schools, they are visited and the children inspected, which has been necessary on seven occasions during the year. Bacteriological Diagnosis.—For the purpose of assisting in the diagnosis of doubtful cases of enteric fever and diphtheria, the necessary materials for taking specimens are supplied to the medical practitioners by the Sanitary Authority, and may be obtained at the Municipal Offices; the cost of examination of the specimens by the Lister Institute being defrayed by the Council. This has been taken advantage of frequently, and has proved of great service, as in previous years. Pulmonary Consumption and other Tubercular Diseases.—Although these diseases are not notifiable under the Act, they are without doubt infectious, and persons having charge of consumptive patients should be aware of this, and of the means to be taken to prevent such infection. Circulars have been sent to medical practitioners, calling attention to the Sanitary Authority's willingness to cause the disinfection, free of charge, of all rooms vacated by consumptives; this has been carried out in five cases during the year as compared with three in the previous year. Mr. Vincent, M.R.C.V.S., veterinary surgeon, is appointed by the Council to make periodical inspections of the cows kept by the registered cowkeepers, so as to prevent, if possible, any milk likely to infect the consumers thereof with tubercular disease, from being used, and in each report made quarterly during the year, the cows, averaging in number about 120, have been certified by him to be in a healthy condition. The rooms of three persons dying of Cancer have been disinfected on the request of the occupiers. IV.—Summary of other Sanitary Proceedings, &c., which were taken during the year. Housing of the Working Classes.—During the year the usual regular periodic inspection of the homes of the working people has been carried on with vigour, and the many necessary minor defects from wear and tear, and insanitary conditions resulting from want of cleanliness, where found, were caused to be remedied. (5) It was necessary to close four houses as unfit for habitation under the Housing of the Working Classes Act, 1890, one of which has been improved by structural alterations so as to comply with the requirements of the law. Six cases of overcrowding have been found to exist in houses during the year, and the nuisance caused to be abated. In my report for the year 1901 I commented on the "demand for houses of a somewhat lower rental than the majority of existing ones which generally range from about 8s. per week and upwards," and of the danger this was to the community from its tendency to cause overcrowding, as the occupier is frequently, through lack of means, compelled to sub-let a portion of a house designed for the habitation of one family only, to one or more additional families. The tendency to overcrowding is not the only evil caused by this condition of things, and, moreover, it is one over which we can exercise some control, but it undoubtedly has in some cases a demoralising influence, and makes the word "home," in its best sense, more or less of a parody to many a family, and especially so to the wife. To my mind this is the greatest sanitary problem with which at the present time we have to deal, as with a rapidly growing residential district there must naturally be an increased demand for gardeners, stablemen, labourers, and others, and consequently of houses for their accommodation. The average wages of these people are much under thirty shillings, and the payment of a rental of even eight shillings per week out of this, having to maintain themselves and families on the remainder, seems to be an unreasonable and serious proportion; houses about this rental are few, not by any means always obtainable, and when found are in some instances to my mind not inherently worth this amount from any standpoint except the inexorable law of supply and demand. Though many houses have been erected within recent years, they are mostly of a class that command a rental of 10s. per week or more, and do not in any way assist in solving the problem. If the price of land and building are such as to make it unremunerative to the private builder to put up houses to let at lower rates, I would suggest the erection of small flats built in the form of semi-detached houses, and containing four separate dwellings of three or four rooms, as very suitable for small families, and which I think might be built on appropriate sites so as to let at from five or six shillings per week. Should private enterprise fail to come to the rescue by providing suitable dwellings, it becomes a matter for the Sanitary Authority themselves to seriously consider the necessity and desirability of erecting such property, and I am of the opinion that this could be well and profitably done under the favourable terms of re-payment of money borrowed for such purposes, allowed by the recently passed Housing of the Working Classes Act, 1903. By the terms of this Act money borrowed by a local authority for the erection of workmen's dwellings. as regards the amount payable for the necessary freehold land, 80 years is allowed for re-payment, and for that required for building purposes 60 years. The Removal of House Refuse is undertaken by the Council, being taken to the Sewage Farm, where it has been used for lightening the heavy clay soil of the farm, or to a shoot off Balaam Lane. I am informed by the Sanitary Inspector that 5,585 loads of the refuse were thus removed during the year, as compared with 5,342 in 1902. The refuse deposit in Balaam J ane was the cause of a complaint from the Thames Conservancy, owing to the heavy rains some drainage from this (6) rubbish having found its way into a small stream adjacent thereto. This, on my advice, was placed in the hands of the Surveyor, and the nuisance dealt with in a satisfactory manner, so as to prevent recurrence. Cleansing of Cespools, &c.—The Inspector reports that 27 covered cesspools, containing 125 loads of sewage, were emptied after being deodorized with an acid solution of manganate of soda, and the contents removed to the depot by the Council's plant and men. As to the "supervision which was exercised over places and houses that the Sanitary Authority has power to regulate." Slaughterhouses.—These were frequently visited by your Inspector and myself during the year, and were generally found in a good condition, though the construction of some of the older ones gives plenty of room for improvement. Dairies, Cowsheds and Milkshops.—The necessity of extreme cleanliness in these places is important, owing to the great readiness with which milk absorbs bacteria, which may be the means of causing changes in the milk itself, making it inimical to the consumer especially to young infants, or of conveying various infectious diseases. The premises in the district connected with the supply of milk have been frequently visited. and, generally speaking, the sanitary conditions found to be good, any defects being of a slight nature, and easily and willingly remedied; in one instance only it has been found necessary to severely caution an owner for the dirty condition in which the cows and cowsheds were kept, and the improper condition of the room used for the storage of milk. It is extremely difficult to make such people realise the necessity of grooming the cows, ensuring the personal cleanliness of the milker, and keeping the surroundings in a more hygienic condition than is usually associated with the pigstye. The Inspector of Dairies, Cowsheds, & Milkshops makes the following return for the year 1903:— Number of registered cowkeepers, dairymen, and purveyors of milk, carrying on business at the commencement of the year 17 Number since registered 0 Number who gave up or transferred their business during the year 1 Number of registered premises inspected during the year 17 Total number of visits paid during the year 71 Number of cowsheds and dairies at which improvements in the lighting, ventilation, paving, drainage, means of cleansing, or water supply, were made during the year 2 Number of cowsheds or dairies which were found in a dirty state 2 Number of premises at which the milk vessels were found in an unclean state 0 Number of new cowsheds erected 0 Factory and Workshops' Act, 1901. During the year 101 workshops, &c, have been inspected by the Medical Officer of Health, and the Sanitary Inspector. The following list shows the various industries as carried on in the workshops:— (7) Dressmakers and Milliners 24 Bakers and Confectioners 15 Laundries 9 Plumbers, &c. 8 Builders, Carpenters, &c. 9 Bootmakers and Repairers 6 Cabinet Makers and Upholsterers 4 Cycle Makers and Repairers 6 Farriers 3 Tailors and Outfitters 4 Saddler and Harness Makers 2 Coach Builders 2 Cricket Bat Manufacturer 1 Stone and Monumental Mason 3 Printer, &c. 1 Shampoo Powder Maker 1 Watchmakers and Jewellers 3 101 The inspections as a rule showed the various premises to be in a satisfactory sanitary condition; three notices to cleanse under Section 2 were served, and five under the Public Health Acts ; in no case were legal proceedings necessary. The Retail Bakehouses, 15 in number, were all found in good condition except in one case the yard paving surrounding the bakehouse was in holes consequently not kept clean, and notice was served to remedy the same. The only underground bakehouse existing in the district at the end of the previous year has now been discontinued. Home Work.—Three lists of outworkers have been received, from makers of wearing apparel, employing three homeworkers in the district and two residing outside. WATER SUPPLY. The district is supplied with water by the Sutton District Water Company, obtained from wells in the chalk, chemical and bacteorological examinations of which were frequently made on behalf of the Council by the Lister Institute of Preventive Medicine. The generally excellent reports submitted by the analysts were somewhat unfavourable at the earlier portion of the year, pointing to some possible contamination. A special report on this matter was made by me to the Council, showing source of the pollution and means of remedying the same, and I am pleased to note that recent analyses are very favourable. In January it was determined by this Council, "having regard to my report that the softening of the water was very desirable in the interests of the consumers," and "that the Water Company were seeking for powers under a new Act to construct additional waterworks in the parish of Woodmansterne," to invite a conference of delegates from the Epsom Rural, Croydon Rural, Carshalton Urban, and Sutton Urban District Councils (whose districts are supplied with water by this Company), that they might consider the desirability of requesting powers to compel the Company to soften the water, etc. After several meetings it was resolved by all the Authorities concerned, with the exception of the Epsom Rural, to conjointly oppose the new Act unless certain concessions were granted The matter was amicably arranged with the Water Company, and the Sutton District Waterworks Act, 1903, passed, Section 7 of which enacts that:— (8) “From and after the first day of August, 1906, all water delivered by the Company from their works to their consumers within the limits of supply as existing at the date of the passing of this Act, shall be softened to a degree of hardness not exceeding nine degrees and according to the process known as Clark's process, or such other process as shall be at least as applicab'e and efficacious, and the Company may enter into such arrangements and generally do all such things as may be expedient for such purpose. “Provided that if the Company make default in complying with the provisions of this Section it shall be lawful for the High Court of Justice, upon the application of any Local Authority within the area of supply, to enforce the same by mandatory order or otherwise as the circumstances of the case shall require." Other important concessions were also granted dealing with “charges for water supply for public purposes," “supply by meter for other than domestic purposes," “reduced charges for private dwelling houses used in part as retail shops (for which water is not required for trade purposes)", etc. From the greater safety in the use of boilers, the saving in the cost of the present necessary repeated cleansing of the same, and also in the quantity of soap necessary for washing purposes, the softening of the water supply will be financially a great boon to the consumers, but in addition to this the water, in my opinion, will be much improved for dietetic use, and the process of softening, as is well known, becomes a further safeguard against any possible accidental contamination. Sewage Disposal.—The sewage of the district is conveyed by a system of sewers to a farm situated in the north-west portion of the district, that from the higher level by natural gravitation, whilst from the lower part of the town pumping has been required to enable the liquid to reach the works. The system of treatment adopted is by double contact bacteria beds or filters, and was first inaugurated here in 1896, on the suggestion of Mr. Dibdin, F.I.C., at that time a member of the Council, the sewage up to this period having been dealt with by chemical precipitation. The single coarse grain bed originally constructed, which was the first of its kind in the country, gave such good results that the Council subsequently converted the chemical tanks into coarse grain filters, and also constructed additional beds, both coarse and fine, so that at the present time the number of beds comprises six coarse grain and six fine, at the high level, capable of treating 400,000 gallons, when cleared twice a day, as necessary. The depth of the coarse beds varies from 3ft. 6in. to 8ft., and that of the fine grain ones from 2ft. 9in. to 4ft. Originally the coarser matters in the sewage were extracted by a rotary screen propelled by the sewage, but on the advice of Mr. Chambers Smith, the Council's engineer and surveyor, this was dispensed with, and sedimentation tanks, having a capacity of 100,000 gallons, or one-fifth of the daily flow, were adopted with considerable success. During the past year the capacities of No. 1 coarse grain and No. 4 fine bed have been increased by the addition of new material, and new works have been inaugurated on a lower level, by which the considerable cost of pumping may be saved. The latter consists of a new system of triple contact, the three beds, coarse, medium and fine, being arrranged on one level and worked automatically by the use of Adam's siphons. This system promises to be very successful and of considerable service, especially in places where but little fall is available. The general results of the treatment of the sewage still continues to give great satisfaction, the beds being maintained in a condition free from odour, and no complaints of nuisance arising from the works have been received by me during the last three years, whilst samples of the effluent, which I have analysed, were very satisfactory. The effluent is discharged into the Pyl Brook, a tributary of the Thames, consequently under the constant supervision of the Thames Conservancy Inspectors, from whom no complaint has been received during recent years. (9) The works continue to be visited by representatives of local authorities and persons interested in the treatment of sewage, both in this country and abroad. The capacity of the beds is at present not too great for the effective treatment of the sewage, and as the population is rapidly increasing, and with it naturally the volume of sewage, the extension of the system in the future will, of course, become necessary, and require to be provided for. Bye-Laws Relating to New Streets and Buildings.—The following table shows the work done under these Bye-Laws in 1902, and the ten preceding years:— In 1893 In 1894 In 1895 In 1896 In 1897 In 1898 In 1899 In 1900 In 1901 In 1902 In 1903 The number of new buildings, and of additions to buildings, of which plana were submitted for approval under the ByeLaws, was 87 89 110 132 227 263 257 153 201 174 192 The number of new streets, ditto, was 2 4 none 7 2 4 5 2 3 1 4 The number of times that legal proceedings were taken for breach of the Byelaws relating to streets and buildings was none none 1 1 none none 1 none none none none Five private streets were metalled, channelled, paved, &c., during the year under the Private Streets Works Act, 1892. As to House Drainage, &c.—I am informed by the surveyor that the drains of 177 premises were connected with the sewers of the district during the year, viz., 173 houses, 2 stables, 1 shop, and 1 blacksmith's forge The Sanitary Inspector reports that the house drains were disconnected from three cesspools in the chalk, and that these were afterwards emptied and filled up. At the end of the year there were 39 cesspools in use in the chalk, three only remaining within a quarter of a mile of the waterworks, which we hope will be closed within a short time. During the year many complaints were received of the flooding occurring at various times in the lower level portion of the town owing to the unprecedently heavy rainfall, and a petition was presented by many of the inhabitants in the neighbourhood affected, asking the Council to try and deal with the matter so as to do away with the great inconvenience and damage caused thereby. In my report to the Council on September 3rd, "the possible danger to public health by the deposit of the solid matter on the surface of the various premises and streets on the subsidence of the flood water" was called attention to, and the desirability, if possible, of making increased provision to enable the drains to more effectually remove the storm water, The Surveyor advised that the present storm water sewer was of insufficient capacity, and the Council decided to put in a new auxiliary sewer in order to prevent the above nuisance recurring and which would also serve in the future as an outlet for a complete system of storm water drainage. (10) Appended are the Sanitary Inspector's report of nuisances abated and other work done during the year, various tables of statistics, and meteorological notes compiled from records taken by F. Campbell Bayard, Esq. To the latter I tender my thanks for his kind permission to produce these, and also to the Surveyor for particulars supplied as to the work at the sewage farm, &c. I am, gentlemen, yours faithfully, GEO. BOWER, D.P.H., Municipal Offices, Medical Officer of Health. Sutton, Sukrey. February 1st, 1904. (11) APPENDIX. THE SANITARY INSPECTOR'S REPORT For the Year ending December 31st, 1903. Number of complaints received in writing 105 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 466 Number of nuisances discovered 331 Ditto remedied without being reported 17 Ditto reported to the Sanitary Authority 314 Ditto remedied after report 302 Number of preliminary notices served by the inspector for the abatement of nuisances 157 Number of notices for the abatement of nuisances served by order of the Sanitary Authority 41 Particulars oj Work done by owners or occupiers, for the abatement of nuisances, in compliance with notices: Number of privies, cesspools, ditches, pools, water courses, urinals, ashpits, and drains, cleansed, and number of deposits removed 143 Number of new privies or water-closets provided — Number of premises at which the drains were re-constructed, ventilated, trapped, or disconnected from the house pipes 92 Number of houses at which the water-closets were provided with water under Sec. 36 of the Public Health Act, 1875 — Number of premises from which animals, improperly kept, were removed 5 Number of houses which were provided with efficient ventilation 14 Number of houses at which injurious overcrowding was abated 6 Legal proceedings taken under Sec. 96, for abatement of nuisances (number of times) — Houses closed as unfit for human habitation 4 Number of houses at which disinfection was carried out, after notice under Sec. 5 of the Infectious Diseases (Prevention) Act, 1890 47 Number of foul houses cleansed and whitewashed, after notice under Sec. 46 of the Public Health Act, 1875 93 Number of premises from which offensive accumulations have been removed after notice, under Sec. 49 of the Public Health Act 21 Seizure of unwholesome meat, poultry, fish, fruit, vegetables, corn, bread, flour or milk, under Sec. 116 of the Public Health Act, 1875 5 Legal proceedings and convictions, under Sec. 117 — Water Supply— Number of samples of water sent to the Medical Officer of Health for analysis — Number of wells permanently or temporarily closed, after notice under Sec. 70 of the Public Health Act, as unfit for drinking purposes — Number of water supply provided by owners of property, after notice under Sec. 62 (number houses) — F. W. KAIN, Sanitary Inspector. (12) TABLE I. Vital Statistics of Whole District during 1903 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 Year 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 1893 14,600 303 24.0 36 119 153 12.1 10 10 7 150 11.9 1894 15,000 317 24.4 28 88 127 9.8 9 9 4 122 9.4 1895 15,400 319 23.8 22 69 128 9.5 2 2 14 140 10.4 1896 15,800 324 23.4 35 108 133 9.6 2 2 15 146 10.6 1897 16,000 317 22.5 44 139 172 12.3 4 4 16 184 13.2 1898 16,400 324 22.4 44 136 160 11.2 5 5 20 175 12.3 1899 16,700 366 24.8 51 139 160 10.9 2 2 19 177 12.0 1900 17,000 380 25.0 31 81 177 11.6 4 4 17 190 12.6 1901 17,310 367 23.5 43 117 175 11.2 8 4 20 191 12.2 1902 17,638 364 22.9 40 109 171 10.7 14 5 29 195 12.2 Averages for years 1893-1902. 16,184 338 23.6 37 110 155 10.8 6 4 16 167 11.6 1903 17,168 388 23.9 32 82 131 8 10 3 22 150 9.2 *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population, excluding South Metropolitan District Schools and Metropolitan Asylums Board School, 968 at Census taken Midsummer, 1903. Institutions within the District receiving sick and infirm persons from outside the District— The above Schools and Sutton Hospital. Institutions outside the District receiving sick and infirm persons from the District— Ensom Workhouse. Joint Isolation Hospital, and Brookwood Asylum. Area of District in acres (exclusive of area covered by water). 1836 Total population at all ages 17,224 Number of inhabited houses 2,976 Average number of persons per house 5.7 At Census of 1901. Table II.—Showing the Sickness recorded in the district from the undermentioned Zymotic Diseases in each month of the year 1903, and in the ten preceding years. 1903. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Membranous Croup. Puerperal Fever. Erysipelas. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. Oases. Houses invaded. Cases. Houses invaded. January 4 1 1 1 1 1 2 2 February 3 3 1 1 March 3 3 1 1 1 1 April 1 1 May 3 3 June 1 1 1 1 2 2 July 2 2 1 1 August 2 2 September 2 2 2 2 October 2 2 1 1 November 4 4 December 2 2 4 4 1 1 Total in 1903 21 18 17 17 5 5 5 5 Total in 1902 2 2 36 31 5 5 7 7 6 6 Total in 1901 1 1 27 20 11 8 6 6 13 12 Total in 1900 127 78 7 7 2 1 3 3 10 10 Total in 1899 129 84 38 32 2 2 1 1 2 2 5 5 Total in 1898 59 44 60 46 4 4 1 1 4 4 Total in 1897 28 18 9 7 11 11 3 3 Total in 1896 42 33 7 5 5 5 1 1 4 4 Total in 1895 20 15 8 3 10 8 8 8 Total in 1894 35 19 5 5 6 6 3 3 1 1 4 4 Total in 1893 4 2 71 43 2 2 6 6 1 1 3 3 13 13 (13) Table III.—Cases of Infectious Disease notified daring the year 1903. Notifiable Disease. Cases notified in Whole District. No. of Cases Removed to Hospital * At all Ages. At Ages—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small pox . .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. Diphtheria 17 .. .. 9 2 3 .. 15 Membranous Croup .. .. .. .. .. .. .. .. Erysipelas 5 1 .. 1 .. .. 3 .. Scarlet Fever 21 .. .. 11 5 1 .. 19 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 5 .. .. 1 1 3 .. .. Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Totals 48 1 7 22 8 7 3 34 *Isolation Hospital, Sutton, Carshalton, and Leatherhead (Urban) and Epsom (Rural) Joint Hospital at Cuddington. TABLE IV. Causes of, and Ages at, Death during year 1903. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Total Deaths in Public Institutions in the 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. 1 2 3 4 5 6 7 8 9 Small-pox .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. Scarlet Fever 2 .. .. .. .. .. .. .. Whooping-cough 2 .. .. .. .. .. .. .. Diphtheria and Membranous Croup .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. .. Other continued .. .. .. .. .. .. .. .. Epidemic Influenza 1 .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Diarrhœa 6 6 .. .. .. .. .. .. Enteritis 1 1 .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. Other septic diseases 1 .. .. .. .. 1 .. .. Phthisis 11 .. .. .. .. 9 .. 1 Other tubercular diseases 3 2 1 .. .. .. .. .. Cancer, malignant disease 12 .. .. .. .. 7 4 .. Bronchitis 6 3 .. .. .. .. 3 .. Pneumonia 10 2 1 2 .. .. 5 1 Pleurisy 3 .. .. .. .. 2 .. .. Other diseases of Respiratory Organs .. .. .. .. .. .. .. .. Alcoholism Cirrhosis of Liver 1 .. .. .. .. 1 .. .. Venereal diseases .. .. .. .. .. .. .. .. Premature Birth 8 8 .. .. .. .. .. .. Diseases and Accidents of Parturition .. .. .. .. .. .. .. .. Heart Diseases 19 .. .. .. 2 10 7 .. Accidents 7 2 1 .. .. 3 1 3 Suicides 1 .. .. .. .. 1 .. 1 All other Causes 56 6 4 1 1 18 26 4 All Causes 150 32 8 3 9 52 46 10 (14) TABLE V. Shewing the Number of Deaths in the District (exclusive of those in the South Metropolitan District Schools), from each of the seven principal Zymotic Diseases, during the twenty years, 1883—1903, and the Zymotic Death-rate for each of those years. Year. Smallpox. Measles. Scarlet Fever. Diphtheria Whooping Cough. Continued Fever. D'rrhœa. TOTAL. Typhs. Enteric or Typhoid Other kinds N umber Rate per 1000 of the population 1883 .. 1 2 13 .. .. .. .. 3 19 2.0 1884 .. .. .. 7 7 .. .. .. 7 21 2.2 1885 .. .. .. 1 .. .. 2 .. 4 7 0.7 1886 .. 20 1 .. 16 .. .. 7 44 4.2 1887 .. .. .. 2 .. .. .. .. 4 6 0.5 1888 .. .. .. .. .. .. .. 3 3 0.3 1889 .. 4 .. 3 14 .. 1 .. 3 25 2.2 1890 .. .. .. 2 4 .. .. .. 3 9 0.7 1891 .. .. 1 .. .. .. 1 .. 2 4 0.33 1892 .. .. .. 2 3 .. .. .. 8 13 1.0 1893 .. 4 l .. 3 .. 1 1 10 20 1.6 1894 .. 3 2 2 9 .. 3 .. .. 19 1.5 1895 .. .. .. 1 1 .. 1 .. 1 4 0.3 1896 .. 11 .. 1 2 .. .. .. 6 20 1.5 1897 .. .. .. 3 6 .. 3 .. 23 35 2.5 1898 .. 5 1 5 5 .. 1 .. 11 28 1.9 1899 .. .. 3 2 .. .. .. .. 9 14 0.9 1900 .. 1 5 .. .. .. .. .. 5 11 0.7 1901 .. 4 .. 1 13 .. 1 .. 6 25 1.5 1902 .. 6 1 •• 5 .. 1 .. 5 18 1.1 1903 .. .. 2 • • 2 .. .. .. 6 10 0.6 (15) METEOROLOGICAL NOTES, 1903. January. February. March. April. May. June. July. August. September. October. November. December. Total for year 1903. Total for year 1902. inch inch inch inch inch inch inch inch inch inch inch inch inch inch Rainfall as recorded at— (a) Sutton 2.28 1.49 2.34 1.70 2.49 6.67 4.28 4.53 3.06 5.97 2.28 2.31 39.40 21.71 (b) Wallington 2.32 1.38 2.40 1.69 5.39 7.09 4.65 4.09 2.76 6.06 2.48 2.13 42.64 22.38 Hours of sunlight 54.3 92.1 165.2 153.2 189.5 174.1 191.1 201.8 183.3 97.5 42.2 28.3 1575.6 1222.9 (recorded at Wallington) Mean temperature 40.8 44.7 46.3 44.0 53.6 55.7 61.1 59.6 57.6 52.8 44.3 38.5 49.9 46.5 (recorded at Wallington) RAINFALL FOR 1903 at Sutton Sewage Farm, As compared with that of previous years. Year. Total Depth. Greatest Fall in 24 Hours Number of Days upon which .01 or more fell. Depth. Date. 1897 24.11 Inches. 1.48 Inches. Sept. 30th. 142 1898 19.31 do. 1.11 do. Dec. 6th. 136 1899 22.76 do. 1.50 do. Nov. 5th. 140 1900 24.21 do. .90 do. Feb 15th. 165 1901 21.27 do. 1.12 do. Dec. 12th. 144 1902 21.03 do. .97 do. Sept. 10th. 183 1903 3764 do. 1.78 do. Juue 10th. 190 January.—The month was very warm; somewhat wet. The third week was very cold, but the other weeks were mild. The rainfall is about one-third of an inch above the average at Greenwich. The mean temperature of the month is about three degrees above the average, and was at Wallington 40.8 degrees. There were recorded at Wallington 54.3 hours of sunlight, which is 12.1 hours, or 5 per cent., above the January average of the 15 years 1886-1900. February.—The month was the warmest for February for a great many years. It was dry during the first three weeks, and very stormy and wet during the last week. The heavy gales on the 22nd and 27th caused much damage. The rainfall is about four-tenths of an inch below the February average. The mean temperature of the month is nearly six degrees above the February average, and was at Wallington 44.7 degrees. There were recorded at Wallington 92.1 hours of sunlight, which is 30 hours, or 11 per cent., above the February average of the 15 years 1886-1900. March.—The month was very warm, and also rather wet. The heat on the 25th was very unusual, and the hottest part of the day would seem to have occurred at about 8.30 p.m., and to have lasted till about 9 p.m. The month was very stormy, and the gales have done a good deal of damage. The rainfall of the month is about 34 per cent. above the average. The mean temperature of the month is about 40.7 degrees above the average, and was at Wallington 46.3 degrees. There were recorded at Wallington 165.2 hours of sunlight, which is 50.2 hours, or 14 per cent., above the March average of the 15 years 1886-1900. April.—The first four and the last six days were wet and warm, whilst the rest of the month was very cold, with sharp frosts. There were snow showers in the district between the 11th and 16th. The rainfall is about a quarter of an inch above the average. The mean temperature of the month is between two and three degrees below the average, and was at Wallington 44.0 degrees. There were recorded at Wallington 153.2 hours of sunlight, which is 6'7 hours or one per cent. below the April average of the 15 years 1886-1900. May.—The month was extremely wet during the first 10 days, and then again on the 16th and 17th, and again on the 28th, 29th, and 30th. The fail was above the average of the 10 years (1891-1900) at every station; in some cases more than three times. Though thunderstorms were experienced throughout the district on the 9th, 17th, 28th, 30th, and 31st, the only ones that may be worth noticing are those on the 30th and 31st, which were most severe. In the storm of the 30th 2.77 inches of rain fell in 65 minutes at Wallington. The damage done was very great in the district round Croydon, where this storm was centred. The storm in the early morning of the 31st was not so bad, though the lightning and thunder were incessant. The month was warm, and the mean temperature is about one degree above the average, and was at Wallington 53.6 degrees. There were recorded at Wallington 189.5 hours of sunlight, which is 11.1 hours or three per cent. below the May average of the 15 years 1886-1900. (16) June.—The month was a most remarkable one. It was certainly the wettest, if not the coldest June, so far as the records of the district are concerned. The low temperatures and the wet have been prejudicial to all crops, some of which have been totally destroyed, but has not affected the health of the people so much as might have been expected. Ground frosts have been reported in some places. The mean temperature of the month was about 3½ degrees below the average, and was at Wallington 55.7 degrees. There were recorded at Wallington 174.1 hours of sunlight, which is 31.9 hours or seven per cent, below the June average of the 15 years 1886—1900. July.—The month can be divided—the first 15 days being practically rainless, and the second 16 days being extremely wet. One of the most remarkable features of this and the previous months was the number of falls exceeding one inch. The mean temperature was about the average, and was at Wallington 61.1 degrees. There were recorded at Wallington 194.1 hours of sunlight, which is 16 hours or three per cent. below the July average of the 15 years 1886—1900. August.—The month has again been wet; in fact, it is the wettest August since 1891. We have again the phenomenon of further falls of rain exceeding one inch. The rainfall is about double the August average. The mean temperature is about two degrees below the average, and was at Wallington 59.6 degrees. There were recorded at Wallington 201.8 hours of sunlight, which is 8.5 hours or one per cent. above the August average of the 15 years 1886-1900. September.—The month was somewhat cool, with about an average temperature; whilst the rainfall is somewhat variable, being slightly below the average at Greenwich, but three-quarters of an inch above the 20 years' average at Wallington. 'J he gale on the 10th was general throughout the district, and caused great destruction amongst the trees. The mean temperature of the month was at Wallington 57.6 degrees. There were recorded at Wallington 183.3 hours of sunlight, which is 23.1 hours or five per cent above the September average of the 15 years 1886-1900. October.—The month was extremely warm, but the most remarkable feature is the amount of rain, the large number of rainy days, and the number of days having a fall of one inch and above. With reference to the total fall of rain, if we take the long record of Greenwich as fairly representing the district, the present October fall has only been exceeded seven times in the same month, viz., in the years 1835, 1841, 1.846, 1855, 1865, 1880, and 1882. The rainfall is about two inches above the average. The mean temperature of the month is about three decrees above the average, and was, at Wallington, 52.8 degrees. There were recorded at Wallington 97.5 hours of sunlight, which is 2.9 hours, or one per cent. below the October average of the 15 years 1886-1900. November.—The month was mild and open, with very little rain till towards the end. The rainfall is about half an inch below the average whilst the mean temperature was very variable, though, on the whole, above the average by from one half a degree to a degree. The mean temperature of the month was, at Wallington, 44.3 degrees. There were slight snow showers on the 29th and 30th. There were recorded at Wallington 42.2 hours of sunlight, which is 9.1 hours or three per cent. below the November average of the fifteen years 1886-1900. December.—The month was cold at the beginning and end, and very mild about the middle. There was a dense black fog on the 5th. The mean temperature of the month is slightly below the average and was 38.5 at Wallington. There were recorded, at Wallington, 28.3 hours of sunlight, which is 10.6 below the December average of the 15 years 1886 to 1890.