SUT 13 URBAN DISTRICT (OR PARISH) OF Sutton, Surrey. Medical Officer's Annual Report With regard to the year 1904. 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 Meteorological Notes. Prepared in accordance with Sec. 14 of the Local Government Board, dated 33rd March, 1891, regulating the duties of Medical Officers of Health. William Pile. Ltd.. Printers. "Herald" Office, Sutton. SUTTON URBAN DISTRICT. Area, 1,836 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 1904. Gentlemen, I have the pleasure to submit my Report on the health and sanitary administration of the district during the year. The low general death-rate, infant mortality, and deaths from preventible diseases testify to the excellence of Sutton as a residential district, which its natural position fully entitles it to assume, and which, with sound government and good sanitary administration, it ought to be able to maintain. I.—Physical Features. Sutton in its main direction lies almost due north and south, the High Street continuous on the north with the London Eoad and on the south with the Brighton Road, intersecting the district in this direction, which is about 2f 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 Sutton 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. II.—Vital Statistics : Births and Deaths. 1. Population.—The natural increase of population, viz., the excess of births over deaths during the year 1904 was 211. This, together with the increased number of inhabited houses, warrants the assumption that as far as the nett population is concerned the increase has been in about the same ratio as during the preceding year, and as shown in the last census to have taken place during the previous ten years. A census taken at the Metropolitan Asylum Board's School at Midsummer gave a resident population of 497 persons, but the South Metropolitan District Schools, which have previously added considerably to the gross population, were closed. The gross population for the purposes of these statistics will therefore be estimated at 16,997 as compared with 17,168, showing a decrease of 171, and the nett population, excluding the above schools, as 16,500, as compared with 16,200 the previous year, an increase of 300 persons. (2) 2. Births.—377 births were registered during the year, 200 boys and 177 girls, giving a birth-rate of 22.8 per 1,000 inhabitants, as compared with an average of 23.6 during the preceding ten years. The birth-rate for the whole of England and Wales during 1904 was 27.9 3. Deaths.—There were registered 154 deaths as having occurred within the district, of which six were of persons not belonging thereto viz., three at the Sutton Hospital and three at the Metropolitan Asylum Board's School, whilst 14 deaths took place at Epsom Union Workhouse and tour at Brookwood Asylum of persons removed to these institutions from within the district. This gives a total of 166 deaths of inhabitants, of which 83 were males and 83 females, and a death-rate of 10.0 per 1,000 of the estimated population, as compared with 9.2 the preceding year, and an average of 11.4 during the ten previous years. The death-rates in England and Wales was 16.2 for the year and in 142 of the smaller towns 15.6. 4.—Infant Mortality. —The deaths of 37 children under the age of 12 months were registered, and the infant mortality, as measured by the proportion of deaths under one year old to the number of births registered during the year, was 9.8 per cent., as compared with an average of 10.6 during the ten previous years. The general rate in England and Wales was 146 per cent. 5. Ten deaths were attributed to Phthisis or Pulmonary Consumption, being at the rate of .6 per 1,000, the same as during three preceding years; and 24 deaths were due to other lung diseases (Bronchitis, Pneumonia, etc.), or 1.4 per 1,000, as compared with 1.1 and 2.0 in the two previous years respectively. 6. Epidemic Influenza was credited with three deaths during the year. 7. Cancer (Malignant Disease).—Thirteen deaths were attributed to Cancer, the rate per 1,000 of the population being .7, the same as in the previous year. 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 for preventing their spread. 1. Smallpox.—No deaths or reported cases. 2. Scarlet Fever.—Thirty-one cases of Scarlet Fever were reported as compared with 21, 36, 27, and 127 in the four preceding years respectively, but no deaths were attributed to the disease. Twenty-five of the cases were removed to the Joint Isolation Hospital at Cuddington for treatment, and two which occurred at the Metropolitan Asylum Board's School in Banstead Road were taken to one of the hospitals under their control. 3. Diphtheria.—Seventeen cases were notified during the year, but no deaths were caused thereby. Thirteen were removed to the Isolation Hospital. Four of these persons had evidently contracted the disease outside the district, but in most of the others enquiries failed to elicit the source of the disease; slight sanitary defects were found existing in some of the houses. Enteric or Typhoid Fever.—Two cases of Enteric Fever were notified as compared with five the previous year ; no deaths occurred. One of the persons had undoubtedly contracted the disease whilst away for a holiday from which he had returned a few days prior to the early symptoms. The other case was also probably of outside origin, although in this house serious sanitary defects were found. (3) Whooping Cough.—No deaths were attributed to Whooping Cough and very few cases occurred. Measles.—This Disease was very prevailent during the month of May, and it was found necessary to close the infant department of the Benhilton, Crown Road, New Town, and West Street Board Schools for three weeks in the early part of June. Three deaths occurred from measles. Diarrhœa.—Nine deaths were attributed to Diarrhoea. During the hot weather hand bills were distributed calling attention to the causes of Summer Diarrhœa, and the means to be taken by householders in endeavouring to prevent this disease which is so disastrous to child life. Zymotic Death Rate.—The total number of deaths from the seven principal epidemic diseases was 12, viz.: nine from Diarrhœa, and three from Measles, giving a zymotic death rate of .7 per thousand of the estimated population, as compared with 1.2, the average for the preceding ten years. The rate for the whole of England and Wales during the year was 1.9 and for 142 smaller towns 2.02. As to the other Diseases which require Notification under the above Act. Membranous Croup—No notified cases. Puerperal Fever.—One death was attributed to Puerperal Fever. Erysipelas.—One case of erysipelas was 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, according to the nature of the case, 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 five 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. Pulmonary Consumption and other Tubercular Diseases.—Although these are not notifiable under the Act, it has been conclusively established that they are infectious, and extremely so where a predisposition to the disease exists. Consumption causes by far the greatest fatality of any infectious disease, and during the . (4) year 22 out of 166 deaths, or about one out of every eight were due to the different varieties of the disease. The importance of disinfection both of expectoration during the course of the disease, and of the rooms inhabited by consumptive persons cannot be over estimated. The Sanitary Authority are fully conscious of this and willing to assist those having charge of these patients by disinfecting all rooms vacated by consumptives and gratuitously providing disinfectants for use during the progress of the case. The disinfection of seven houses after consumption has been undertaken during the year, as compared with five during the preceding 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 130, have been certified by him to be in a healthy condition. The rooms of two 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.—I have found it necessary during the year to certify five houses as unfit for habitation. Two of these were very old and dilapidated, and have been permanently closed by the consent of the owner, two were improved by structural alterations so as to comply with the requirements of the law, and one is still under consideration. Five cases of overcrowding have been found to exist and the nuisance caused to be abated. The regular systematic house to house inspection has been vigorously maintained, and disclosed the usual large number of defects, some inevitable from natural wear and tear, and others the result of carelessness or want of cleanliness, which were duly caused to be remedied. Although most of the houses recently erected in Sutton are of fairly sound construction, there are some erected but few years ago that call for considerably more attention as regards sanitary defects than ought to be expected in so short a period. Anything to improve the homes of the working classes is of benefit to the town, and probably the revised bye-laws for New Streets and Buildings shortly to be adopted by the Council will enable them to exercise still more restraining influence on any who might be inclined to build houses likely to become inimical to the health of their occupants in a very few years. Removal of House Refuse.—This is undertaken by the Council, and is at present conveyed to a shoot off Balaam Lane. I am informed by the Sanitary Inspector that 5,942 loads of the refuse were removed during the year, as compared with 5,585 the previous year. 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. (5) One butcher was on two occasions during the year served with notice on account of an offence against the byelaws, viz., the stabling of a horse within the pound. Tin matter received the consideration of the Sanitary Committee, and the offender was severely reprimanded, but on being fully assured that the offence would be discontinued no further action was deemed necessary. Dairies, Cowsheds and Milkshops.—The premises in the district connected with the supply of milk, and as given in the following table, have been frequently visited by the Inspector and myself. Generally speaking the sanitary condition of the places was found to be good, and only in one instance was it found necessary to reprimand the owner for the dirty condition in which the cows, cowsheds, and room in which milk was stored, were kept. The Inspector of Dairies, Cowsheds, & Milkshops makes the following return for the year 1904:— Number of registered cowkeepers, dairymen, and purveyors of milk carrying on business at the commencement of the year 17 Number since registered 1 "Number who gave up or transferred their business during the year 1 Number of registered premises inspected during the year 18 Total number of visits paid during the year 79 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 1 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. During the year 108 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:— Dressmakers and Milliners 27 Bakers and Confectioners 14 Laundries 11 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 3 Coach Builders 2 Cricket Bat Manufacturer 1 Stone and Monumental Masons 3 Printers, &c. 3 Shampoo Powder Maker 1 Watchmakers and Jewellers 3 108 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. (6) The retail Bakehouses, 14 in number, were all found in good sanitary condition. Home Work.—Three lists of outworkers have been received, from makers of wearing apparel, employing three home workers in the district and two residing outside. Water Supply.—The usually excellent water supply is from the Sutton Water Company's wells in the chalk. Frequent chemical and bacteriological examinations have been made on behalf of the Council by the Lister Institute of Preventive Medicine. On one occasion during the year the report of the analysts caused some anxiety, and a special report on the subject was made by me to the Council. The latest sample submitted for analysis, however, gave very good results, showing the water to be free from impurity. Great efforts are being made both by the Company and the Council to ensure an excellent and safe supply. The process of sinking new wells in the Chipstead Valley is, I hear, progressing rapidly, from which an excellent addition to the Company's supply may be anticipated. The good work done by your Council in endeavouring to prevent the pollution of the chalk strata from which the present supply is obtained is referred to in another part of this report. 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, where it is submitted to treatment by double contact bacteria beds. This method continues to give perfect satisfaction, and no complaints have been received of any nuisance arising therefrom. During the year a new double contact filter bed at the lower level has been constructed 75 feet in length by 25 in breadth, and having a capacity of 9,720 gallons. I am informed by the Surveyor that the low level beds referred to in my last report continue to give satisfactory results. Bye-Laws Relating to New Streets and Buildings.—The following table shows the work done under these Bye-Laws in 1904, and the ten preceding years:— In 1894 In 1895 in 1896 In 1897 In 1898 In 1899 In 1900 In 1901 In 1902 In 1903 In 1904 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the ByeLaws, was 89 110 132 227 263 257 153 201 174 192 171 The number of new streets, ditto, was 4 none 7 2 4 5 2 3 1 4 5 The number of times that legal proceedings were taken for breach of the Byelaws relating to streets and buildings was none 1 1 none none 1 none |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 111 premises were connected with the sewers of the district during the year, viz., 104 house drains, 6 stables, and 1 shop. (7) Cesspools in the Chalk.—Having regard to the protection of the water supply, a circular letter was sent out by me in February to the owners of all cesspools known to exist in the chalk, requesting their assistance in safeguarding the purity of the water by disconnecting all drainage into these pits. 1 am informed by the Sanitary Inspector that the drains of fourteen houses were thus disconnected during the year, the cesspools filled up, and the drainage taken into the sewers provided by the local authority. There only remain, to the best of my knowledge, 19 houses on the chalk formation still draining into cesspools, situated as follows:—3 each in Brighton Koad, Langley Park Eoad, and Mulgrave Eoad; 2 in Carshalton Road; and 1 each in the Cheam Eoad, Cedar Road, Grange Road, Grove Road, Hill Hoad, St. James' Road, Western Road, and Sutton Court Road. Of these 3 only are within a radius of quarter of a mile of the water works, viz., 2 in Carshalton Road and 1 in Sutton Court Road, the latter of which is, I believe, in process of disconnection at the present time, whilst the two former, previously unable to connect owing to difficulties as regards the level of the sewer, are to be met by the Council lowering the sewer so as to be able to receive the drainage at an early date. The new auxiliary storm water sewer rendered necessary by the occasional flooding of the lower part of the town, as referred to in my last report, is now in course of construction. During the year the Council have decided to considerably increase the length of this sewer so as to enable it to take the surface drainage from the Langley Park district, which has for some time past been conveyed on to land near the chalk pit in Carshalton Koad. This, from the close proximity to the water company's wells, was very undesirable. The question of hospital provision for smallpox patients has been frequently under consideration, and on June 6th a deputation from the Sanitary Committee attended a conference of local authorities convened by the County Council at the County Hall, Kingston. In July a special report was called for from me on the accommodation required for dealing with outbreaks of smallpox in Sutton. It was ultimately decided not to oppose the County Council's scheme for a conjoint hospital on being assured that no undue expenditure was contemplated on either permanent buildings or staff. Amongst other matters coming before the sanitary authority during the year was the question of a nuisance arising from the smoke emitted from the chimney at the works of the Electricity Supply Company. This was the cause of numerous complaints, and although after a special inspector had been employed for some time in taking notes it was found that the emission of smoke was not such as would warrant legal action being taken, strong representations were made to the company concerned and also to the London, Brighton & South Coast Railway, as it was considered that the large amount of smoke emitted from their locomotives whilst engaged in shunting operations contributed to the nuisance. A nuisance arising from a foul ditch in the Angel Hill district was the cause oi numerons complaints early in the year, and temporary measures were adopted by the Council to remedy the evil until the extension of the sewerage system into this portion of the district. The sanitary condition of all the public and private schools have been the subject of reports by the sanitary inspector and myself during the year. Appended are the Sanitary Inspector's report of nuisances abated, various tables of statistics, and meteorological notes. I am, gentlemen, yours faithfully, GEO. BOWER, D.P.H. Municipal Offices, Medical Officer of Health. Sutton, Surrey. February 8th, 1905. ' . : (8) APPENDIX. THE SANITARY INSPECTOR'S REPORT For the year ending December 31st, 1904. Number of complaints received in writing — 92 Number of premises inspected under Sec. 9.2 of the Public Health Act, 1875 462 Number of Nuisances discovered — 349 Ditto remedied without being reported 22 Ditto reported to the Sanitary Authority 327 Ditto remedied after report 311 Number of preliminary notices served by the inspector for the abatement of nuisances —— 146 Number of notices for the abatement of nuisances served by order of the Sanitary Authority 35 Particulars oj Worlc 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 91 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 — 104 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 3 Number of houses which were provided with efficient ventilation 10 Number of houses at which injurious overcrowding was abated 5 Legal proceedings taken under Sec. 96, for abatement of nuisances (number of times — Houses closed as unfit for human habitation 5 Number of houses at which disinfection was carried out, after notice under Sec. 5 of the Infectious Diseases (Prevention) Act, 1890 44 Number of foul houses cleansed and whitewashed, after notice under Sec. 46 of the Public Health Act, 1875 70 Number of premises from which offensive accumlations have been removed after notice, under Sec. 49 of the Public Health Act 48 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. KA1N, Sanitary Inspector. '' '■ , r r. (9) TABLE I. Vital Statistics of Whole District during 1904 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 Eesidents 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 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 1890 15,800 324 23.4 108 133 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 16,41.0 324 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 1903 17,168 388 23.9 32 82 131 8 10 3 22 150 9.2 Averages for years 1894.1903. 16,441 346 23.6 37 IC6 153 10.5 6 4 17 167 11.4 1904 16,997 377 i2.8 35 82 154 9.3 11 6 18 166 100 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population, excluding Metropolitan Asylums Board School, Banstead Road, 497 at Census taken Midsummer, 1904. Note.—The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non.residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Institutions within the District receiving sick and infirm persons from outside the District— Sutton Hospital and Metropolitan Asylum Board's Ringworm School. Institutions outride the District receiving sick and infirm persons from the District— Epsom Workhouse, Brookwood Asylum, and Cuddington Isolation Hospital. Area of District in acres. Total population at all ages 17,221. At (exclusive of area 11886 Number of inhabited houses 2,976 Census covered by water). Average number of persons per house 5.7 (of 1901. Table II.—Showing the Sickness recorded in the district from the undermentioned Zymotic Diseases in each month of the year 1904, and in the ten preceding years. 1904. Small Pox. Scarlet F ever. Diphtheria. EntericFever. Membranous Croup. Puerperal Ferer. Erysipelas. Cases. House* invaded. Cases. House* invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houser in.vaied. Capes. bouses in.* aded. Cases. Houses invaded. January 2 2 1 1 1 1 February 5 4 2 2 March 4 4 3 3 April 8 5 3 3 May 1 1 1 1 June 2 2 1 1 1 July 1 1 1 1 August 1 1 1 September 1 1 1 1 October 1 1 2 2 November 3 3 1 1 December 2 2 2 2 Total in 1904 31 27 17 17 2 2 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 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 I 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 (10) Table III.—Cases of Infectious Disease notified during the year 1904. 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 4 6 3 4 .. 13 Membranous Croup .. .. .. .. . .. .. .. .. Erysipelas 1 .. .. .. 1 •• .. .. Scarlet Fever 31 .. 10 16 2 3 .. 25 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. 2 .. -• Relapsing Fever .. .. .. .. • • .. .. .. .. Continued Fever.. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. •• Plague .. .. .. •• .. .. .. .. Totals 51 .. 14 22 6 9 .. 88 * Isolation Hospital, Sutton, Carshalton, and Leatherhead (Urban) and Epsom (Rural) Joint Hospital at Cuddington. TABLE IV. Causes of, and Ages at, Death during year 1904. Causes of Death. Deaths in ok 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 cinder 15. 15 and under 25. 25 and under65. 65 and upwards. 1 2 3 4 5 6 7 8 9 Small-pox .. .. .. .. .. .. .. .. Measles 3 .. 3 .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. .. Diphtheria and Membranous Croup .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. .. Other continued .. .. .. .. .. .. .. .. Epidemic Influenza 3 1 .. .. 1 1 .. .. Cholera .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. Diarrhoea 7 2 .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. Puerperal Fever 1 .. .. .. .. 1 .. .. Erysipelas ... .. .. .. .. .. .. .. Other septic diseases .. .. .. .. .. .. .. Phthisis io .. .. 1 .. 8 1 .. Other tubercular diseases 12 5 5 .. .. 1 l .. Cancer, malignant disease 13 .. .. .. .. 6 7 .. Bronchitis 13 2 .. .. 1 6 4 .. Pneumonia 11 4 1 .. l 5 .. 3 Pleurisy .. .. .. .. .. .. .. .. Other diseases of I Respiratory Organs . .. .. .. .. .. .. .. .. Alcoholism 3 .. .. 1 .. 2 .. .. Cirrhosis of Liver .. Venereal diseases .. .. .. .. .. .. .. .. Premature Birth 9 9 .. .. .. .. .. .. Diseases and Accidents of Parturition. 1 1 .. .. .. .. .. .. Heart Diseases 28 2 .. 2 .. 14 10 3 Accidents 4 1 .. .. 1 2 .. 3 Suicides .. .. .. .. .. .. .. .. All other Causes 46 5 1 1 10 29 2 All Causes 166 37 12 4 5 56 52 11 (11) 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, 1884-1904, and the Zymotic Death-rate for each of these years. Year. Smallpox. Measles Scarlet Fever. Diphtheria Whooping Cough continUed Fever. TOTAL. Typhs. Enteric or Typhoid Other kinds D'rrhoea. Number Rate per 1000 of the Population 1884 .. .. .. 7 7 .. .. .. 7 21 2.2 1885 .. .. .. 1 .. .. 2 .. 4 7 .7 1886 .. 20 1 .. 16 .. .. .. 7 44 4.2 1887 .. •• .. 2 .. .. .. .. 4 6 .5 1888 .. .. .. .. .. .. .. .. 3 3 .3 1889 .. 4 .. 3 14 .. 1 .. 3 25 2.2 1890 .. .. .. 2 4 .. .. .. 3 9 .7 1891 .. .. 1 .. .. .. 1 1 2 4 .33 1892 .. .. .. 2 3 .. .. .. 8 13 1.0 1893 .. 4 1 .. 3 .. 1 .. 10 20 1.6 1894 .. 3 2 2 9 .. 3 .. .. 19 1.5 1895 .. .. .. 1 1 .. 1 .. 1 4 .3 1896 .. 11 .. 1 2 .. .. .. 6 20 1.5 1897 .. * * .. 5 6 .. 3 .. 23 35 2.5 1898 .. 5 1 2 5 .. 1 .. 11 28 1.9 1899 .. .. 3 .. .. .. .. .. 9 14 .9 1900 .. 1 5 1 .. .. .. .. 5 11 .7 1901 .. 4 .. .. 13 .. 1 .. 6 25 1.5 1902 .. 6 1 .. 5 .. 1 .. 5 18 1.1 1903 .. .. 2 2 .. .... 6 10 .6 1904 .. 3 .. .. .. .. .. 9 12 .7 (12) METEOROLOGICAL NOTES, 1904. January. February. March. April. May. June. July. August. Septemb'r. October. November. December. Total for year 1904. Total for year 1903. Total for year 1902. inch inch inch inch inch inch inch inch inch inch inch inch inch inch inch Rainfall as recorded at— Sutton Sewage Works 3.22 3.05 1.51 1.26 2.79 •81 1.56 1.59 1.17 1.94 1.56 2.42 22.88 39.40 21.71 Hours of sunlight (recorded at Wallington) 39.3 75.7 92.3 172.3 157.8 218.4 278.7 242.6 180.1 97.4 65.3 34.9 1654.? 1575.6 1222.9 Aver. Aver. Aver. Mean temperature 38.8 39.4 40.4 49.4 53.8 57.G 65.1 61.6 55.0 50.3 42.1 40.8 49.5 49.9 j 46.5 (recorded at Wallington) RAINFALL FOR 1904 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 1.48 Inches. Sept. 30th. 142 1898 19.31 do. 1.11 do. Dec. 6th. 136 1899 22.76 do. 1.5 0 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 1904 22.89 do. •82 do. Dee. 6th. 184 January.—The month has been an extremely wet one, and if we may take the record of Greenwich as fairly representing the district, it has not been exceeded since January, 1894. A thunderstorm occurred on the 13th. The month's rainfall is nearly double the average. The mean temperature of the month is about one degree above the average, and was at Wallington 38.8 degrees. There were recorded at Wallington 39.3 hours of sunlight, which is 2.9 hours, or one per cent., below the January average of the 15 years 1886.1900. February.—The first three weeks were mild and wet, and the last week was cold, with frequent snow showers. There was a thunderstorm, with hail, throughout the district on the night of the 12th.13th. The rainfall is over one inch above the average. The mean temperature of the month is about one degree above the average, and was at Wallington 39.4 degrees. There were recorded at Wallington 75.7 hours of sunlight, which is 13.6 hours or five per cent. above the February average of the 15 years 1886.1900. March.—The month may be divided into three parts, from the 1st to 9th wet, with frequent snow showers, from the 9th to 19th fine; and from the 19th to 31st wet with frequent snow showers. The rainfall is about one.fifth below the average. The mean temperature of the month is about a degree and a half below the average, and was at Wallington 10.4. There were recorded at Wallington 92.3 hours of sunlight, which is 22.7 hours or six per cent. below the March average of the 15 years 1886.1900. April.—The month has been warm and dry, with rather more than the average amount of sunshine. A thunderstorm occurred throughout the district on the night of the 12th and 13th. The mean temperature of the month is about 2.5 above the average, and was at Wallington 49.4. The rainfall is about half au inch below the average. There were recorded at Wallington 172.3 hours of sunlight, which is 12.4 hours or three per cent. above the April average of the 15 years 1886.1900. May.—The month was was cold and stormy for the first ten days, then fine and warm for nine days, and then rainy and unsettled for the remaining days. The weather on the 27th was very remarkable, There was a thunderstorm between 8 a.m. and 9 a.m. in which, at Sutton .26in. of rain fell; and then at 9.45 a.m. there was another thunderstorm in which .26in. fell in 15 minutes, then followed intense darkness for about an hour. The rainfall for the month is about one half an inch above the average. The mean temperature is about one degree above the average, and was at Wallington 53.8. There were recorded at Wallington 157.8 hours of sunlight, which is 42.8 hours, or nine per cent, below the May average of the 15 years 1886.1900. (13) June The month has been very dry, and also cool, though the sunlight is rather above the average. Both the day and night temperatures have been below the average. The rainfall is the smallest June fall since 1895. The mean temperature of the month is about one and a half degrees below the average, and was at Wallington 57.6. There were recorded at Wallington 218.4 hours of sunlight, which is 12.4 hours or two per cent, above the June average of the 15 years 1886.1900. July.—An exceedingly warm and also a dry month. With the exception of July 1899 and 1900, the mean temperature is the highest for July for a great many years. The rainfall varies in amount from the mean to about one half the mean. The mean temperature is about three degrees above the average, and was at Wallington 65.1. There were recorded at Wallington 278.7 hours of sunlight, which is 68.6 hours or 14 per cent. above the July average of the 15 years 1886.1900, and has only been exceeded in 1887 and 1900. August.—The month has been dry, in fact it is the dryest August since 1899, and fairly warm though the nights have been somewhat cold. There was a thunderstorm on the 4th through the district, and a slight one in places on the 22nd. The mean temperature of the month has been slightly above the average, and was at Wallington 61.6. There were recorded at Wallington 242.6 hours of sunlight, which is 44.3 hours or ten per cent. above the August average of the 15 years 1886.1900, and has only been exceeded in 1887 and 1899. The sunlight on the 3rd viz.: 14.2 hours, is the highest daily value for August in my record. September.—The month has been dry and very cold. It has also been somewhat unhealthy, there having been many cases of influenza. The rainfall is nearly an inch below the average. The mean temperauwe of the month is about Wo degrees below the average, and was at Wallington 55.0 degrees. l?ogs occurred on several days between the 15th and 28th. There were recorded at Wallington 180.1 hours of sunlight, which is 19.9 hours or five per cent. above the September average 1886.1900. The five days 17th to 21st had a mean sunlight of over 91 per cent., and the amount 12.2 hours on the 5th has only been exceeded on September 4th, 1899. October.—The month has been dry and mild, but somewhat unhealthy. The rainfall is about one inch below the average. The mean temperature of the month is about one degree above the average, and was at Wallington 50.8 degrees. There were recorded at Wallington 97.4 hours of sunlight, which is three hours below the October average of the 15 years 1886.1900. November.—The month has been cold and dry, and extremely foggy from the 11th to 19th. Snow fell on the 22nd and 23rd throughout the district, and the cold from that date till the end of the month was severe. The rainfall varied from one.half to one.quarter below the average, and was at Wallington 42.0 degrees. There were recorded at Wallington 65.3 hours of sunlight, which is 14.3 hours or six per cent. above the November average of the 15 years 1886.1900. December.—The month has been warm, very foggy, and with a rainfall above the average. The mean temperature is about 1.8 above the average, and was at Wallington 40.8. There were recorded 34.9 hours of sunlight, which is 4 hours or two per cent. below the December average of the 15 years 1886.1900.