SUT 14 URBAN DISTRICT (OR PARISH) OF Sutton, Surrey. Medical Officer's Annual Report With regard to the year 1906. 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), 1899, 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 23rd March, 1891, regulating the duties of Medical Officers of Health. William Pile, Ltd., Printers, 26, High Street, 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 1891, 2,976. Population (exclusive of South Metropolitan District School) at Census 1881, 8,700 ; at Census 1891, 12,000; at Census 1901, 15,486. Medical Officer's report for the Year 1906. I.— Physical Features. Sutton in its main direction lies almost due north and south, the High Street continuous on the north with the London Load 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 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 from 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 or the excess of births over deaths during the year 1906 was 262. The number of inhabited houses, which at the last Census in 1901 was 2,976, is at the present time about 3,700, so that we may assume that the population is also being still further increased by the influx of new residents. For the purposes of these statistics the gross population will be estimated at 17,983, as compared with 17,512 the previous year, and deducting therefrom the residents at the Metropolitan Asylum Board's Ringworm School (539) and at the Belmont Asylum (224), the net population of Sutton is 17,200, as compared with 16,800 in the previous year. 2. Births.— The births of 434 children were registered during the year, 223 boys and 211 girls, giving a birth-rate of 25.2 per thousand inhabitants, as compared with 23.5 the previous year, and an average of 23.4 during the preceding 10 years. The birth-rate in the whole of England and Wales during 1906 was 27.0. 3. Deaths.— The deaths of 226 persons were registered as having occurred within the district during the year, of which 68 were of persons not belonging to the parish, viz.: 64 at Banstead Asylum, 2 at the Metropolitan Asylum Board's Ringworm School, and 2 at the Sutton Hospital, whilst 14 deaths took place of parishioners removed for treatment to institutions outside the district, nine at (2) the Epsom Union Workhouse and 5 at the Brookwood Asylum. This gives a total of 172 deaths of inhabitants, of which 80 were males and 92 females, and a death-rate of 10.0 per thousand of the estimated population as compared with 8.9 during the previous year, and an average of 11.3 during the 10 preceding years. The death-rate in England and Wales during 1906 was 15.4, and of the 142 smaller towns 14.4. 4. Infant Mortality.— The deaths of 45 children under the age of one year were registered, and the infant mortality as measured by the proportion of deaths of children under that age to the number of births registered during the year was 10.3 per cent, as compared with 8.6 during the previous year, and an average of 10.9 during the preceding 10 years. The infant mortality in the whole of England and Wales during the year was 13.3, and in the 142 smaller towns 13.8. An analysis of the infantiled deaths shows the mortality to have varied considerably, both as regards season and locality. The following table gives the deaths during each month, and shows that 21, or about 47 per cent, of the total, took place in the months of August and September. January 6 April 3 July 1 October 0 February 4 May 6 August 14 November 0 March 3 June 1 September 7 December 0 13 10 22 0 Taking the Carshalton Road and Cheam Road as an artificial division of the district into North and South, and the High Street as a further division of the North portion into East and West, we find the following proportion of registered births to infantile deaths. Registered Births. Deaths under 12 Months Old. South Division 70 1 North-East Division 144 18 North-West Division 220 26 The South portion of the district is mainly residential in character, whilst the others respectively include a larger proportion of the labouring classes amongst their population, and were a further division made in the latter districts it would show a still greater comparative incidence of infantile deaths in the localities where the poorer and least thrifty of their inhabitants dwell. The principal causes of death amongst infants as shown in Table V., at the end of this report, were Diarrhoea (17), so called wasting diseases (14), Whooping Cough (4), and Tubercular Diseases (2). The greater number of deaths from Diarrhoea is mainly responsible for the higher mortality amongst infants during the year and also accounts for the noticeable increment during the months of August and September. Summer Diarrhoea is essentially a microbial disease and deaths occurring therefrom are largely preventible by proper hygienic precautions in the immediate surroundings of the infant, and in the materials used in the preparation of its food. Many of the deaths attributed to the so-called wasting diseases might also be influenced by the proper care of the mother during pregnancy and of the infant in its earliest life. Although the general rate of infantile mortality in Sutton is very favourable when compared with that of the country generally it is evident from the above notes that even here we have a loss of child-life especially amongst the lower classes which might to a great extent be avoided. The continued high infant mortality throughout the country generally was considered of such extreme importance to the community that a National Conference of sanitary authorities was held in June to consider the matter. Amongst the urgent recommendations of the Conference were (a) "The Inculcation amongst all classes upper as well as lower of a much higher sense of child bearing and of the preciousness of human life before and after birth." (3) (b) " The education of the mothers of the present and of the future in the hygienic care of infants." (c) " The promotion of breast feeding and of proper methods of artificial feeding where that is unavoidable." The importance of a pure milk supply and of proper housing and prevention of overcrowding were also strongly urged. To most of the matters contained in these suggestions I have referred in previous reports, and with regard to recommendation (b) I have noted the good influence of the parish nurses during the exercise of their daily vocation by the object lessons given when attending and assisting mothers in the care of their sick children. This, I think, might with great benefit be supplemented by an association of ladies of the town to visit and instruct, or in other ways assist some of those unfortunate mothers whose faults are mainly those of incapacity and ignorance of proper methods. 5. Twelve deaths were attributed to Phthisis or Pulmonary Consumption being at the rate of .7 per thousand as compared with 1.0 during the previous year, and 19 deaths were due to other lung diseases (Bronchitis, Pneumonia, etc ) or 1.1 per thousand as compared with .6 during the previous year. 6. Epidemic Influenza was somewhat prevalent in the later months of the year, but no deaths were directly attributed thereto. 7. Cancer (Malignant Diseases).—Fourteen deaths were due to Cancerous Diseases, or a rate of .7 per thousand 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, 1899, and of the action taken for preventing their spread. Small Pox.—No deaths or reported cases. Scarlet Fever.—Twenty-six cases of Scarlet Fever were notified during the year as compared with 37, 31, 21, 36, and 27 in the 5 preceding years respectively. No deaths occurred. Twenty-two of the cases were removed to the Joint Isolation Hospital at Cuddington for treatment. Diphtheria and Membraneous Group.—Five cases were notified during the year, 3 of which were removed to the Isolation Hospital. One child succumbed to the disease. Enteric or Typhoid Fever.—Outside the premises of the Belmont Asylum no cases of Enteric Fever were notified in Sutton during the year, A serious outbreak of the disease, however, occurred at the above premises, one of the Metropolitan Asylums Board's Institutions for the treatment of Imbeciles. 'The earliest cases were notified on May 14th, 2 in number, four more notifications were received on the 17th, and from that date until August llth fresh cases were reported at various intervals. In all, 64 notifications were received, and 11 deaths were attributed to the disease. On the earliest stage of the outbreak I visited the Asylum, and, with the active co-operation of the resident medical officer (Dr. Sherlock), the most stringent precautions were taken to limit the spread of the infection. At this stage all the efforts of Dr. Sherlock and myself to elucidate the origin of the infection proved abortive, and on June 7th 1 made a detailed report on the outbreak to the Council, also to the Local Government Board, suggesting that a special enquiry was desirable on account of a possible danger to the water supply of the district. Dr. S. Monckton Copeman, Medical Inspector of the Local Government Board, was deputed to make (4.) an enquiry as to the cause of the outbreak, and visited Sutton on July 19th. On this and subsequent dates I accompanied Dr. Monckton Copeman to the Belmont Asylum and assisted him as far as possible in making the necessary investigations. Our enquiries failed to associate the infection with the milk, food, or water supply, or with defective sewerage and drainage, and regarding the final conclusion arrived at as to the source of the epidemic I may quote the following extracts taken from Dr. Monckton Copeman's elaborate report to the Local Government Board :— "There can, I think, be little doubt that personal infection has been the chief, if not the only factor responsible for the introduction and subsequent spread of enteric fever at the Belmont Asylum. Reference to such a possibility indeed occurs in the report of Dr. Bower, presented by him to the Sutton Urban District Council under date June 7th, 1906, as also in the third of a series of interim reports to the Belmont Asylum Sub-Committee written by Dr. Sherlock during the progress of the outbreak. In the absence of a knowledge of facts which has accumulated since the respective dates of these reports, both Dr. Bower and Dr. Sherlock expressed the opinion that there did not seem to be sufficient grounds for ascribing the outbreak to personal infection ; both laying stress on the point that the most recently admitted, though not the earliest to be attacked by the disease, of the (then) affected patients had been received into the Belmont Asylum more than three months previously, while the hist arrival at the Asylum from Darenth, where in 1904 there is known to have been a small outbreak of enteric fever, had been admitted on February 23rd, 1906." " Under these circumstances, and in view of the facts detailed above, tending to eliminate all the more generally accepted methods of infection it cannot, I think, be regarded as other than a reasonable hypothesis that enteric fever was originally introduced into the Belmont asylum in the person of one or more patients, transferred originally from Darenth or Tooting Bec Asylums, who were in reality suffering from the disease, although, in the absence of marked symptons, the fact passed unrecognized at the time. " Admitting the probability of infection having been introduced in the manner suggested, the further spread of the disease from patient to patient will find sufficient explanation in their continued propinquity by day and by night, especially when the filthy personal habits of the inmates are taken into consideration The special incidence of the disease in certain wards may perhaps be regarded as consequent in the first instance on infection of a plurality of patients in these particular wards during the period preceding recognition of the true nature of the disease." Amongst the facts referred to by Dr. Monckton Copeman as having accumulated after the earlier reports were that after the deaths of several of the patients at the Asylum who had succumbed to other distinct causes, such as Pneumonia and Phthisis, post-mortem examination revealed the presence of healed typhoid ulcers in the intestine, no symptoms of the latter disease having been previously manifested. The difficulty in tracing the origin of the outbreak was materially increased by the unusual type of the disease, which in all but probably 5 or 6 cases was unaccompanied by any of the usual distinctive diarrhoeal symptoms, but associated with constipation. Whooping Cough.- This disease was somewhat prevalent, both in the earlier part and also in the later months of the year. Eight deaths were attributed thereto. ♦ Measles.—No deaths occurred from Measles, although the disease was prevalent in some districts during December. Diarrh<ea,~ Seventeen deaths were attributed to Diarrhoea, as compared with 3 during the previous year. Sixteen of these occurred during the hot weather in August and September. Bandbills were distributed throughout the district calling (5) attention to the causes of Summer Diarrhoea, and the means to be taken by householders to guard against this disease, which is so apt to prove fatal to the young. Zymotic Death Rate.—The total number of deaths from the seven principal epidemic diseases, excluding the Belmont Asylum, was 26, viz.: 17 from Diarrhoea, 8 from Whooping Cough, and 1 from Diphtheria, giving a Zymotic Death-rate of l.5 per thousand, as compared with 1.0, the average for the preceding ten years. The rate for the whole of England and Wales during the year was 1.7. As to the other Diseases which require Notification under the above Act. Puerperal Fever.—No cases of this disease were notified during the year. Erysipelas.—Seven cases of Erysipelas were notified. No deaths. Continued Fever.—No cases 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 12 occasions during the year. Bacteriological Diagnosis.—Fot 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 being defrayed by the Council. Pulmonary Consumption and other Tubercular Diseases.—In cases in which death occurs, or in which there has been removal of a patient suffering from consumption the Sanitary Authority undertakes the disinfection of the rooms which have been occupied whenever consent is given for the purpose. This has been done on ten occasions during the year. It has been the practice of this Council for some years to cause a veterinary inspection of the cows kept by the registered cowkeepers in the district, so as to prevent, if possible, the admission of milk from any animal suffering from tubercular diseases into the general supply. Mr. Vincent, M R.C.V.S., was appointed for this purpose, and in his reports, made quarterly during the year, has certified the whole of the cows, averaging in number about 130, to have been in a healthy condition. The interim report of the Royal Commission of Tuberculosis, recently issued, proves the desirability of active inspection of cows, as the following extracts from their summary shows :— "There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacillus of bovine tuberculosis ; and there also can be no doubt that in the majority at least of these cases the bacillus is (6) introduced through cows' milk. Cows' milk containing bovine tubercle bacilli is clearly a cause of tuberculosis and of fatal tuberculosis in man." "Our results clearly point to the necessity of measures more stringent than those at present enforced being taken to prevent the sale or the consumption of such milk." IV.—Summary of other Sanitary Proceedings, etc., which were taken during the year. Housing of the Working Classes.—The usual systematic house to house inspection of the houses of the working classes has been carried on during the year, and the necessary alterations and repairs required to remedy any insanitary defects found to exist have been enforced. The great number of such defects occurring in houses which have been comparatively recently erected has from time to time engaged the attention of the Sanitary Committee, and without doubt we have within the last few years seen some fine efforts of the jerry builder in solving the problem of " how to build wretched and ill-found property in spite of the bye-laws." This class of building, unable to withstand the necessary wear and tear, is likely to become in a few years a serious legacy to the Sanitary Department, requiring its constant attention to keep them in such a condition as not to be inimical to the health of their inhabitants. By the adoption of the new bye-laws for buildings it is to be hoped that more stringent provisions may enable the Council to limit the undesirable efforts of such builders. Four cases of overcrowding in houses were found, and the nuisance abated. Removal of House Refuse.—This is undertaken by the Council, and is conveyed either to land adjoining the Sewage Farm or other available shoot. I am informed by the Sanitary Inspector that 5,989 loads of the refuse were removed during the year, as compared with 5,930 during 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 visited on several occasions during the year, and found to be in a satisfactory condition as regards cleanliness. No offences against the bye-laws were noted. Dairies, Cowsheds, and Milkshops.—These places were frequently visited, and the Dairies and Milkshops were found to be generally kept in good condition. Improvement was manifested in the way in which the animals were housed in most of the cowsheds, since the action taken during the previous year to prevent overcrowding and promote cleanliness. The passing of the milk through a proper refrigerator is not at present adopted by some of the cowkeepers, and as a Sanitary Authority has not the power to demand this it is desirable that purchasers should insist on it for themselves. Experience has shown that if fresh milk be cooled immediately after drawing, put into properly cleaned vessels and kept cool in transit, changes in the milk which may be a source of great danger to life, especially in infants and during hot seasons, may be largely prevented. The changes occurring in milk, either from the admission of putrescent matter either at the farm, in transit, or in the hands of the consumer, is a recognised important factor in the production of Summer Diarrhoea Probably the handling of the milk by the consumer is the most frequent source of dirt, in the unclean vessels, hands, or places in which it is kept before using, but it is very essential that a clean milk supply should be insisted on by the Sanitary Authority. (7) The Inspector of Dairies, Cowsheds, <& Milkshops makes the following return for the year 1906:— Number of registered cowkeepers, dairymen, and purveyors of milk carrying on business at the commencement of the year 19 Number since registered — Number who gave up or transferred their business during the year 2 Number of registered premises inspected during the year 19 Total number of visits paid during the year 81 Number of cowsheds and dairies at which improvements m 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 0 Number of premises at which the milk vessels were found in an unclean state 0 Number of new cowsheds erected 0 Factory & Workshops Act.—The number of workshops on the register at the end of the year was 121, and 253 visits of inspection were made. The various premises were generally found to be in a satisfactory condition. N otices to cleanse were served in eight instances, and to remedy defective sanitary accommodation in three. No other offences under the Factory & Workshops Act were reported. The following list gives the various industries as carried on at the registered workshops:— Bakehouses 14 Laundries 17 Dressmakers and Milliners 29 Tailors, Outfitters, Watchmakers, Bootmakers, and others 61 Water Supply.—The district is supplied with water by the Sutton District Water Company from wells in the chalk, and the various analyses made for the Council during the year have shown the water to be of excellent quality. Under the Sutton District Water Company Act, 1903, Section 7, it was required that from tht 1st day of August, 1906, that all water supplied to the consumers within the district should be softened to a degree of hardness not exceeding 9 degrees. Owing to difficulties in connection with the completion of the extensive plant required for the process, the softening was delayed for some months, but a recent analysis shows the Water Company to be now complying with the requirements of the Act, the hardness being estimated at 8 6 degrees. From the greater safety in the use of boilers, the saving in cost of the previous necessary repeated cleansing of the same, and also in the quantity of soap required for washing purposes, the softening of the water supply will be a great boon to the consumer, but in addition to this the process of softening, as is well known, is a further safeguard against any possible accidental contamination. By the advent of " softening " the water also becomes, in my opinion, of greatly increased value for dietetic purposes, and may now be adjudged as being unsurpassed inusefulnessby any water supply in the country. Sewage Disposal.—The sewage of the district is conveyed by high and low level sewers to a farm situated in the north-west portion of the district, and treated by double contact bacteria beds, on what is generally known as the Sutton system. In a previous report I observe that " 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" During the year extensions have been made to the bacteria beds, and for the following description of the work done I am indebted to the Engineer and Surveyor. One coarse and one fine grain bacteria bed have been constructed at the low level (8) works, which treat 24,000 gallons per day, and a new fine grain bed has been completed at the high level works to treat 100,000 gallons per day. The whole of the high level beds are now capable of treating 400,000 gallons, and the low level beds 100,000 gallons per day when the beds are charged twice a days. The average daily dry weather flow of sewage is about 450,000 gallons per day at the high level, and 150,000 gallons at the low level. This amount of sewage is, of course, considerably increased with heavy rainfall. The regulations of the Local Government Board in sanctioning sewage works on this principle prescribe that the capacity of the contact beds should be sufficient to treat three times the dry weather flow when the beds are cleared twice daily, and also require the provision of additional storm water filters for use in times of heavy rainfall. The present capacity of the Sutton beds is, therefore, only about one third of that prescribed, and, although good results are obtained by the available treatment, a further increase of plant by the local authority as opportunity offers is manifestly desirable. Bye-Laws Relating to new Streets and Buildings.--The following table shows the work done under these Bye-Laws in 190(5, and the 10 preceding years :— in in in in in in in in in in In 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the ByeLaws, was 132 227 263 257 153 201 174 192 171 355 223 The number of new streets, ditto, was... 7 2 4 5 2 8 1 4 5 2 2 The number of times that legal proceedings were taken for breach of the Byelaws relating to streets and buildings was 1 none none 1 none none none none none none none The number of private streets metalled, channelled, paved, &c., under the Private Streets Works Act, 1892, during 1906 was 7. As to House Drainage, &c.—I am informed by the Surveyor that the drains of 270 premises were connected with the sewers of the district during the year. 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 previous year I had to report that there were only two cesspools remaining in the chalk formation within a quarter of a mile of the waterworks, and that there was a difficulty in connection with the removal of these owing to the inability to connect the house drains with the existing sewer in the Carshalton Road. During the year the Urban Council have laid a new sewer in this road at a lower level so as to enable the drains from the above premises to be connected thereto, and the cesspools, undesirable in their present situation, to be done away with. The most important public work executed during the year, and a great sanitary improvement, has been the extension of the sewerage system to the Angel Hill district, which was urgently called for, and the absence of which had been the cause of numerous complaints, received in late years, of nuisance arising from a ditch in the neighbourhood, into which some of the overflow sewage found its way. (9) The asphalting of several footpaths passing behind streets of houses, as in the rear of Warwick Road, Crown Road, and Sidney Road, is worthy of being recorded as a sanitary improvement, for these passages are much used as playgrounds by children, and the evils arising from such whilst in an unpaved condition are well recognised. The erection of buildings on land adjacent to the Belmont Asylum for the stabling of horses used in the preparation of Diphtheria Anti-toxin has received the active consideration of the Sanitary Authority during the year. Although one cannot advise that any appreciable danger is likely to arise from the process of manufacture, it is to be regretted that a site was not chosen by the Metropolitan Asylums Board where the buildings would have been less conspicuous and unlikely to prove a perpetual eyesore to the many residents in the immediate vicinity. Appended are the Sanitary Inspector's report of nuisances abated, etc., various tables of statistics, and meteorological notes, compiled from records taken by F. Campbell Bayard, Esq., of Wallington, and the Surveyor at the Sutton Sewage Farm, to whom I tender my thanks for the particulars supplied. GEO. BOWER, D.P.H., Municipal Offices, Medical Officer of Health. Sutton, Surrey. February 12th, 1^07. (10) APPENDIX. The Sanitary Inspector's Report For the Year ending December 31st, 1906. Number of complaints received in writing 130 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 562 Number of Nuisances discovered 443 Ditto remedied without being reported 33 Ditto reported to the Sanitary Authority 410 Ditto remedied after report 387 Number of preliminary notices served by the Inspector for the abatement of nuisances 168 Is umber of notices for the abatement of nuisances served by order of the Sanitary Authority 31 Particulars of 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 189 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 105 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 24 Number of houses at which injurious overcrowding was abated 4 Legal proceedings taken under Sec. 96, for abatement of nuisances (number of times) Houses closed as unfit for human habitation 2 Number of houses at which disinfection was carried out, after notice under Sec. 5 of the Infectious Diseases (Prevention) Act, 1890 31 Number of foul houses cleansed and whitewashed, after notice under Sec. 46 of the Public Health Act, 1875 32 Number of premises from which offensive accumulations have been removed after notice, under Sec. 49 of the Public Health Act 27 Seizure of unwholesome meat, poultry, fish, fruit, vegetables, corn, bread, flour or milk, under Sec. 116 of the Public Health Act, 1875 3 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. T' TABLE I. Vital Statistics of Whole District during 1906 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 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 17,838 364 22.9 40 109 171 10.7 14 5 29 195 12.2 1903 17,168 388 23.9 32 82 131 8.0 10 3 22 150 9.2 1904 16,997 377 22.8 37 98 154 9.3 11 6 18 166 10.0 1905 17,512 395 23.5 34 86 138 8.2 10 6 18 150 8.9 Averages for years 1896-1905. 16,852 360 23.4 39 109 157 10.3 7 4 19 172 11.3 1906 17,983 434 25.2 45 103 226 13.0 70 68 14 172 10.0 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population, excluding residents at Belmont Asylum and Metropolitan Asylum Board School, Banstead Road. Note.—The deaths 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, Metropolitan Asylum Board's Ringworm School, and Belmont Asylum. Institutions outside the District receiving sick and infirm persons from the District— Ensom Workhouse, Brookwood Asylum, and Cuddington Isolation Hospital. Area of District in acres (exclusive of area 1836 covered by water). Total population at all ages 17,224, At Number of inhabited houses 2,976 Census 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 1906, and the ten preceding years. 1906. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Membranous Croup. Puerperal Fever. Erysipelas. Cases. Houses invaded. Cases. House invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. Cases. Houses invaded. January 3 3 1 1 February 3 3 March 1 1 April 4 2 May 2 2 12 1 June 1 1 44 1 1 1 July 2 2 5 1 August 3 1 September 1 1 1 1 1 1 October 8 5 2 2 November 2 2 December 3 2 2 2 Total in 1906 26 20 4 4 64 1 1 1 7 7 Total in 1905 37 25 15 14 2 2 1 1 1 1 3 3 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 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 (12) Table III.—Cases of Infectious Disease notified during the year 1906. 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 4 .. .. 1 2 1 .. 3 Membranous Croup 1 .. 1 .. .. .. .. .. Erysipelas 7 .. l 1 .. 4 1 .. Scarlet Fever 26 .. 5 15 4 2 .. 22 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 64 .. .. 40 24 .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever .. .. . .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Totals 102 7 57 30 7 1 25 *Isolation Hospital, Sutton, Carshalton, and Leatherhead (Urban) and Epsom (Rural) Joint Hospital at Cuddington. TABLE IV. Causes of, and Ages at, Death during year 1806. 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 4 5 6 I 8 9 Small-pox .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. Whooping-cough 8 4 4 .. .. .. .. .. Diphtheria and Membranous Croup 1 .. 1 .. .. .. .. .. Croup .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. 11 Other continued .. .. .. .. .. .. .. .. Epidemic Influenza .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Diarrhœa 17 16 1 .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. Other septic diseases 1 .. 1 .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 12 .. .. .. 3 9 .. 8 Other tubercular diseases 12 6 2 3 .. 1 .. 3 Cancer, malignant disease 14 .. .. .. .. 7 7 2 Bronchitis 6 .. 1 .. 1 1 3 .. Pneumonia 14 2 1 .. .. 7 4 12 Pleurisy .. .. .. .. .. .. .. .. Other diseases of Respiratory Organs .. .. .. .. .. .. .. 1 Alcoholism 4 .. .. .. .. 4 .. .. Cirrhisis of Liver Venereal diseases .. .. .. .. .. .. .. 2 Premature Birth 9 9 .. .. .. .. .. .. Diseases and Accidents of Parturition .. .. .. .. .. .. .. .. Heart Diseases 24 1 .. .. 1 16 6 5 Accidents 4 1 .. .. .. .. 3 1 Suicides 1 .. .. .. .. 1 .. .. All other Causes 45 6 1 .. 1 15 22 25 All Causes 172 45 12 3 6 61 45 70 (13) TABLE V. INFANTILE MORTALITY DURING THE YEAR 1906. Deaths from stated Causes in Weeks and Months under One Year of Age CAUSE OF DEATH. Under 1 Week. 1 1-2 Weeks. 1 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes— Certified 8 2 3 2 15 4 7 3 1 4 1 1 1 5 1 .. 43 Uncertified .. .. .. 1 1 .. 1 .. .. .. .. .. .. .. .. .. 2 Common Infectious Diseases — Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 1 .. 4 Diarrhœal Diseases— Diarrhœa, all forms .. 1 .. 1 2 3 3 1 1 2 1 .. .. 4 .. .. 17 Enteritis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gastritis, Gastro-intestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases— Premature Birth 7 1 .. 8 .. .. .. .. .. .. .. .. .. .. .. 8 Congenital Defects .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus 1 1 .. 1 3 .. 2 1 .. .. .. .. .. .. .. .. 6 Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Convulsions .. .. 2 .. 2 .. .. .. .. 1 .. .. 1 .. .. .. 4 Bronchitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. 1 1 .. 1 .. .. .. .. .. .. .. .. .. 2 Suffocation, overlaying .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Other Causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 2 3 3 16 4 8 3 1 4 1 1 1 5 1 .. 45 Births in the year- Legitimate 417. Illegitimate 10. Deaths from all Causes at all Ages 172. Deaths in the year— Legitimate Infants 43. Illegitimate Infants 2. Population—Estimated to middle of 1906, 17,200. (14) TABLE VI. 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, 1886—1906, 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 Number Rate per 1000 of the population 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 1 .. 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 1904 .. 3 .. .. .. .. .. .. 9 12 0.7 1905 .. 4 •• 1 1 .. .. .. 3 9 0.5 1906 .. .. .. 1 8 .. .. .. 17 26 1.5 (15) METEOROLOGICAL NOTES, 1906. January. February. March. April. 1 May. June. July. August. Septemb'r. October. November. December. Total for year 1906. Total for J year 1905. Total for year 1904. Total for year 1903. Rainfall as recorded at— Sutton sewage Works inch inch inch inch inch inch inch inch inch inch inch inch inch inch inch inch 3.79 1.65 1.14 .51 1.20 2.40 .51 .68 1.62 3.21 3.91 1.91 22.72 23.61 22.88 39.40 Hours of sunlight (recorded at Wallington) 72.3 70.7 97.4 216.9 166.9 236.7 234.8 230.6 175.1 122.1 31.9 18.2 1673.6 1582.5 1654.8 1575.6 Mean temperature (recorded at Wallington) 42.2 39.3 42.0 46.0 53.9 58.1 63.2 65.1 58.9 54.1 45.9 37.4 Aver. 30.5 Aver. 49.8 Aver. 49.5 Aver. 49.9 RAINFALL FOR 1906 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 37.64 do. 1.78 do. June 10th. 190 1904 22.89 do. .82 do. Dec. 6th. 184 1905 23.61 do. 1.12 do June 6th. 177 1906 22.72 do. 1.98 do. June 28th. 162 January.—The month was exceeding wet and mild, with a total absence of snow. The rainfall is nearly double the January average. The mean temperature of the month was 42.2 degrees, and is four degrees above the January average. There were recorded at Wallington 72.3 hours of sunlight, the highest January value, with the exception of January, 1905, which is 26.4 hours or 11 per cent. above the January average of the 20 years 1886-1905. February.—The month was very changeable, but without severe or continuous frosts or heavy snow. The rainfall is about one-fifth above the February average. The mean temperature of the district was 39.3, and is about the average. There were recorded at Wallington 70.7 hours of sunlight, which is 6.8 hours or two per cent. above the February average of the 20 years 1886-1905. March.—The month was very changeable, with, after the first week, a prevalence of cold northerly winds with occasional snow showers. The rainfall is about half-an-inch below the March average. The mean temperature of the month is about the average, and was at Wallington 42.0 degrees. There were recorded 97.4 hours of sunlight, which is 18 hours or four per cent. below the March average of the 20 years 1886-1905. April.—The month was cold and very dry, with a great prevalence of northerly winds. There has been an absolute drought at most places throughout the district or 22 days—that is, from March 27th to April 17th, both inclusive. The rainfall for the month is only about one-third of the average. The mean temperature is between one-half and a whole degree below the average. There were recorded at Wallington 216.9 hours of sunlight, which is 59.3 hours, or 15 per cent. above the April average of the 20 years 1886-1905. May.—The month was a peculiar one, with very great variations of temperature. The rainfall is about half-an-inch below the average. The mean temperature is very variable, being about the average, and was 53.9 degrees at Wallington. There were recorded 166.9 hours of sunlight, which is 32 hours or six per cent. below the May average of the 20 years 1886-1905. June.—The month was a treacherous one, with great changes. The days have been warm, but the nights cold, and in many places a frost was registered on the grass. The rainfall of the month is about halfan-inch above the average. The mean temperature of the month is somewhat below the average, and was 58.1 degrees. There were recorded 236.7 hours of sunlight, which is 34.5 hours or seven per cent. above the June average of the 20 years 1886-1905. This amout has only been exceeded four times in June during that period. (16) July.—The month was hot and very dry. The rainfall was only about one quarter of the average. The mean temperature is high, and above the average, and was at Wallington 63.2 degrees. There were recorded 234.8 hours of sunlight, which is 19.2 hours or three per cent. above the July average of the 20 years 1886-1905. August.—The mouth was very dry and hot. It is the smallest August rainfall since 1899, and the mean temperature of the month is the greatest since that date. The rainfall of the month is about an inch below the average. The mean temperature of the month is about three and a half degrees above the average, and was at Wallington 65.1. There were recorded 230.6 hours of sunlight, which is 32.5 hours or seven per cent. above the August average of the 20 years 1886-1905. September.-The month was a most extraordinary one. The very high temperature on the first three days constitutes a record. Ground frosts and fogs occurred in the district during the last week. The rainfall is from a half to a quarter of an inch below the average. The mean temperature of the month is between one and two degrees above the average, and was at Wallington 58.9 degrees. There were recorded 175.1 hours of sunlight, which is 15.4 hours or four per cent. above the September average of the 20 years 1886-1905. October.—An exceedingly warm October—in fact, the warmest at Greenwich since 1861, and then back to 1831. The mouth has also been a wet one. The mean temperature of the month is about five degrees above the average, and was at Wallington 54.1 degrees. There were recorded 122.1 hours of sunlight, which is 24.3 hours or seven per cent. above the October average 1886-1905, and has only been exceeded three times in such period. November.—A most extraordinary month, one of the warmest and wettest Novembers for many years past. The rainfall was one and a half inches above the average. The mean temperature of the month was about three degrees above the average, and was 47.9 degrees. There were recorded at Wallington 31.9 hours of sunlight, which is 19 hours or seven per cent. below the November average of the 20 years 1886-1905. December.—The month was as a whole, dry, cold, and sunless, snowstorm on the night of the 25th-26th, snow also fell on the 27th, 28th, 29th, and 30th. The rainfall of the month was about the average. The mean temperature of the month was below the average, and was 37.4 degrees. There were recorded at Wallington 18.2 hours of sunlight, which is 19.6 hours or nine per cent. below the December average of the 20 years 1886-1905. This is the lowest December value since 1890.