SuT 15 Sutton (Surrey) Urban District Council. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1910. SUTTON (SURREY) URBAN DISTRICT COUNCIL. Annual Report of the MEDICAL OFFICER OF HEALTH FOR 1910. List of Councillors. G. H. HOOPER, M.D. (Chairman). A. S. JACKSON, B.A. (Vice-Chairman). G. W. AEDY (Member Sanitary Committee). E. RUSSELL DAVIS. W. DENNETT. J. W. DENTON (Chairman Sanitary Committee). R. H. HOGG (Member Sanitary Committee). E. J. HOLLAND. R. J. HUMPHRIS (Member Sanitary Committee.) F. KEITH JONES (Member Sanitary Committee). G. LEAVER (Member Sanitary Committee). R. W. WOOTTEN (Member Sanitary Committee). To the Chairman and Members of the Sutton (Surrey) Urban District Council. Gentlemen, In accordance with the Regulations of the Local Government Board, I present my Annual Report for the year 1910. The general health of the district has been good, and the death-rate from all causes—9.3 per 1,000 persons living—has twice only (9.2 in 1903, and 8.9 in 1905) been lower, and is 1.3 below the average rate for the previous ten years. With the exception of an outbreak of measles in the spring—evidently of a mild type, as no death of a resident from this disease was registered—there has been a marked freedom from epidemic diseases, the combined death-rate from the seven principal, viz.— Small-pox, Scarlet Fever, Enteric Fever, Diphtheria, Measles, Whooping Cough, and Diarrhœa—being less than half the average rate for the previous ten years. The Infantile Mortality Rate, i.e., deaths under one year of age per 1,000 births, was 65, the same figure as in 1909, and a low one for an Urban District; still, as during the past five years (1906-1910), the rate for infants born in houses rented at or under 10s. per week has been thrice that of those born in houses with a higher rental, one may reasonably hope for a further reduction in the infantile mortality in this district. Leaflets on the feeding and care of infants are sent to all cottages as soon as the Registrar's weekly returns of births are received. These probably have some good effect, but better results should follow if the Notification of Births Act were in force, and home visits made by a competent Lady Health Visitor. This work, however, would not be sufficient to occupy her whole time. Could the office of Health Visitor be combined with that of School Nurse and Supervisor of Midwives, there would be ample work to occupy the full time of one person; but your Council is not the local authority either for the administration of the Medical Inspection of School Children or for the Midwives Act. The Birth-rate—20.7—has recovered 1.2 of the lowest record of the previous year, but is 2.4 below the average rate for the previous ten years. The following Orders and Regulations of the Local Government Board, concerning the public health, were issued in 1910:— The Diphtheria Anti-toxin (outside London) Order; The Housing (Inspection of District) Regulations under Sec. 17 of The Housing, Town Planning, &c., Act, 1909; Regulations as to Plague, Destruction of Rats; Circular as to Offensive Trades; Sanitary Officers (outside London) Order. These were considered by the Sanitary Committee, and are further referred to in the body of this report. I desire to express my thanks to the Health Committee and to the officials of the Council for the kind assistance given me in many ways. I am, Gentlemen, Your obedient servant, WILLIAM HABGOOD. SUTTON URBAN DISTRICT. Medical Officer's Report for the Year 1910. Situation.—Sutton is situated 11 miles south of Whitehall in the watershed of the Thames in the northeast portion of the County of Surrey, the centre of the town being a little above the line where the chalk of the London Basin comes to the surface to form the North Downs. A narrow band of the London Tertiaries, running due east and west, appears between the chalk and the clay. Towards the north and north-west and on the clay is the lowest land—81 feet above sea level—and through it runs the Pyl Brook, receiving the chief part of the surface water of the whole district and the outflow from the sewage works. The rest of the surface water drains into a small brook discharging on the north-east into the Wandle. Further north, where the London and Brighton Road crosses the border, the ground rises to 147 feet. This is the most rural part. Southwards, on the chalk, towards Banstead Downs, there is a gradual ascent to 293 feet. Area.—The length of the district is three miles, and has an average breadth of one mile and an area of 1,836 acres, or nearly three square miles. Boundaries.—It is bounded on the north by Morden, east by Carshalton, south by Banstead, and west by Cheam, and on all sides, except where the towns of Sutton and Carshalton join, has a rural aspect. Rateable value, £161,484. A penny in the £ on the District Rate produces £610 nett. Occupation of Residents.—A great part of the population is engaged in business in London. The remainder consists chiefly of tradesmen and their assistants, gardeners, and those connected with the building trade. 6 Population.—No census having been taken since 1901, the nett population to the middle of 1910 has been estimated upon the number of inhabited houses, 3,944. Allowing 5.1 persons per house, the nett population is 20,114, an increase of 484 since the middle of 1909. At the same period there were 330 children and 77 staff in the Metropolitan Asylums Board Ring-worm School, and 971 inmates and 39 officers in the Fulham Union Workhouse at Belmont. These 1,417, added to the nett population, gives a gross population of 21,531, an increase of 356 above the figure for the previous year. Year. Gross population. Nett population. No. of inhabited houses. No. per house on nett population. Increase of nett population. Increase of inhabited houses. 1881 (census) 8662 1514 5.5 1891 (census) 13977 11987 2202 5.4 3325 688 1901 (census) 17224 15486 2976 5.2 3499 774 1910 21531 20114 3944 5.1 4628 968 Births.—There were 417 births registered, giving a rate of 20.7. In one year only—1909—has so low a rate been recorded. Deaths.—The number of deaths registered, excluding 31 belonging to other districts, was 161, and to these must be added 27 belonging to this district registered in Public Institutions beyond the district, viz.—20 in Epsom Union Workhouse, 4 in the County Lunatic Asylum, 2 in the Cuddington Isolation Hospital, and 1 in the Carshalton Cottage Hospital. These 188 deaths produced a rate of 9.3 per 1,000 persons living, and only 0.4 above the lowest rate (1905) recorded for the district. Well over one-third of the deaths occurred in persons over the age of 65 years. Inquests were held on 16 deaths, 6 of these being deaths in public institutions in the district. 7 All the deaths, except one, were certified. Period. Mean annual birth-rate per 1000 living. Mean annual death-rate per 1000 living. Mean annual rate of increase by excess of births over deaths per 1000 living. Sutton. 1878—1887 33.3 14.5 18.8 1888-1897 25.0 11.8 13.2 1898-1907 23.8 10.9 12.9 1908 21.3 10.8 10.5 1909 19.5 9.9 9.6 1910 20.7 9.3 11.4 England and Wales. 1878-1887 33.7 19.8 13.9 1888—1897 30.4 18.4 12.0 1898-1907 281 16.4 11.7 1908 26.5 14.7 11.8 1909 25.6 14.5 11.1 1910 24.8 13.4 11.4 Annual Birth-rates and Death-rates from all causes, the Death-rates from the Principal Epidemic Diseases, and the Infantile Mortality rates. 1910. Annual Rate per 1000 living. Deaths under One Year to 1000 Births. Births. Deaths. Principal Epidemic Diseases. Crude. Corrected* England and Wales 24.8 13.4 13.4 0.99 106 76 great towns 25.0 13.4 14.3 1.23 115 143 smaller towns 23.7 12.4 12.9 0.88 104 England and Wales less the 219 towns 25.0 13.6 12.8 0.74 96 Sutton 20.7 9.3 ? 0.34 65 * The corrected death-rates are the rates which would have been recorded had the sex and age constitution of the populations of the several areas been identical with that of England and Wales enumerated in the last census, 1901. 8 Infant Mortality.—Only in 1907 has a lower rate been recorded, and the figure for 1910—65—is only four above the best year, and is 21 per 1,000 better than the average for the previous ten years. In England and Wales, out of 100 deaths at all ages in 1908, 21.8 occurred in infancy. The percentages for Sutton for the following periods are:— 1878—1887 (10 years) 24.1 1888—1897 „ 22.8 1898—1907 „ 21.8 1908—1910 (3 years) 13.4 Cold and wet summers, with consequent diminution in deaths from diarrhœa, have done much towards reducing the rate in the last three years; but, as diarrhoea is to a great extent a preventible disease, a consideration of the following tables gives reason to hope that the present low death rate may continue and even be further reduced. The Local Government Board has recently issued a report by the Principal Medical Officer, Dr. Newsholme, on infant and child mortality, which allows a comparison to be made between the infant mortality rates for certain causes in those counties in England and Wales giving the highest and lowest rates for the year 1908, and for this district for the six years 1905— 1910. Infantile mortality rates from certain causes for the counties in England and Wales, showing the lowest and highest rates for the year 1908, and for Sutton the average rates for six years, 1905—1910. Sutton. Best County in England & Wales. Worst County in England & Wales. 1. Premature Birth 14.9 16.3 30.3 Congenital Defects 2. Atrophy, Debility, and Marasmus 10.5 8.6 27.1 3. Convulsions 8.9 4.3 29.2 4. Diarrhœa 15.7 3.5 27.1 5. Measles 6.9 2.0 14.0 Whooping Cough 6. Bronchitis 7.2 10.9 28.7 Pneumonia 9 It will be seen from the above table that the death rates in this district in the groups 1—2, compare favourably with those for the county giving the lowest rates, whereas those for groups 3 and 4 are considerably higher. It is probable that in group 1, owing to the cause being due to parental defects, there is less chance of amelioration than in the other groups. Groups 3 and 4 are generally considered due to improper food, and possibly much of group 2. It should be stated that the high figure for this district in group 4 is due to a disproportionately (17) large number of deaths in 1906 affecting the small total of 38 deaths in the five years' period, yet it is in these groups 3 and 4 that a lessening of deaths may be expected as mothers become better instructed in the feeding and care of their infants. With regard to 5 and 6—it is probable that the marked difference between the figures for this district and those for the Best County are due partly to the earlier attendance of a doctor in an urban district, enabling him to diagnose bronchitis or pneumonia as due to measles or whooping cough, and so correctly certify the death as due to one of these two infectious diseases; and partly to the more ready spread of these infectious diseases in a thickly populated district. That such instruction is required seems probable, on consideration of the figures in the following table, which show that the infant mortality rate in this district for the five years—1906-1910—has been three times greater in houses rented at, or under, 10s. a week than in those above that rental. House Rental. Births. Deaths. Rate. Above 10s. per week 699 20 29 At or below 10s. per week 1383 131 93 Total 2082 151 72 10 L.G.B. Table 1.—Vital Statistics of Whole District during 1910 and Previous Years. Year. Gross Population estimated to Middle of each Year, including residents in Public Institutions in the District. 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 population estimated to middle of each year, excluding residents in Public Institutions in the District, Birth Rate Nett Deaths Registered in the District. Number. Rate per 1 ,000 of the gross population. Under 1 Year of Age. At all Ages. Per 1,000 of the nett population Under 1 Year of Age. At all Ages. Number. Rate per 1,000 registered Births Number. Rate per 1,000 of the gro s population. Number. Rate per 1.000 registered Births. Number. Rate per 1,000 of the nett population. 1 2 3 4 5 6 7 8 9 10 11 * * * * 12 13 1900 17,990 380 21.1 31 82 177 10.0 4 4 17 16,000 23.7 31 82 190 12.0 1901 17,310 367 21.2 43 117 175 10.1 8 4 20 15,572 23.4 43 117 191 12.2 1902 17,638 364 20.6 40 109 171 9.7 14 5 29 15,900 22.9 40 109 195 12.3 1903 17,168 388 22.6 32 82 131 7.6 10 3 22 16,200 24.0 32 82 150 9.2 1904 16,997 377 22.2 37 98 154 9.0 11 6 18 16,500 22.8 37 98 166 10.0 1905 17,512 395 22.5 34 86 138 7.9 10 6 18 16,800 23.5 34 86 150 8.9 1906 17,983 434 24.1 45 103 226 12.5 70 68 14 17,200 25.3 45 103 172 10.0 1907 18,355 443 24.1 27 61 211 11.5 46 42 23 17,600 25.2 27 61 192 10.9 1908 19,812 405 20.5 27 67 230 11.6 45 44 19 19,040 21.3 27 67 205 10.8 1909 21,175 383 18.1 58 151 243 11.5 86 80 32 19,630 19.5 25 65 195 9.9 Average for the ten years. 18,755 394 21.0 37 94 186 9.9 30 26 21 17,044 23.1 34 86 181 10.6 1910 21,531 417 19.4 27 65 192 9.0 42 31 27 20,114 20.7 27 65 188 9.3 11 Note.—The deaths to be included in Column 7 of this Table are the whole of those registered daring 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 bo 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. Area of District in acres (exclusive of area covered by water) 1836 Nett population at all ages 15,486 Number of inhabited houses 2,970 Average number of persons per house 5.2 At Census of 1901. N.B.—The four columns marked * have been inserted to show the birth, death, and infantile mortality rates of Sutton excluding the public institutions in the district. 12 Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. 1 2 3 Fulham Union Workhouse, Belmont County Asylums The Cottage Hospital, Sutton Metropolitan Asylums Board Ringworm Schools Epsom Union Workhouse The Cottage Hospital, Carshalton The Cottage Hospital. Cuddington Isolation Hospital The Union Workhouse is in the Epsom Urban District. L.G.B. Table III.—Cases of Infectious Disease notified during the year 1910. Notifiable Disease. Cases notified in Whole District. Total Cases Removed to Hospital * At alt 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 (including Membranous Croup) 10 .. 2 6 1 1 .. 6 Erysipelas 6 .. .. .. 1 5 .. .. Scarlet Fever 28 1 7 16 4 .. .. 15 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. .. 2 1 2 Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 1 1 .. .. Plague .. .. .. .. .. .. .. .. Totals 49 1 9 22 7 9 1 23 * Isolation Hospital, Sutton, Carshalton, and Leatherhead (Urban) and Epsom (Rural) Districts Joint Hospital at Cuddington. Total available beds, 92. Number of diseases that can be concurrently treated, 3. 13 L.G.B. Table IV.—Causes of, and Ages at, Death during year 1910. Causes of Death. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond THE DISTRICT. Total Deaths is 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 Measles .. .. .. .. .. .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. Whooping-cough 5 3 2 .. .. .. .. .. Diphtheria (includ'g Membranous Croup 2 .. 2 .. .. .. .. .. Croup 3 .. 2 1 .. .. .. 1 Fever Typhus .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. .. Other continued .. .. .. .. .. .. .. .. Epidemic Influenza 1 .. .. .. .. 1 .. 1 Cholera .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Diarrhœa .. .. .. .. .. .. .. .. Enteritis 1 1 .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. Erysipelas 2 .. .. .. 1 1 .. .. Tetanus 3 2 .. 1 .. .. .. .. Phthisis (Pulmonary Tuberculosis) 16 .. .. .. 3 13 .. .. Other tuberculous diseases 4 1 2 .. .. 1 .. 1 Cancer, malignant disease 11 .. .. .. 1 3 7 4 Bronchitis 15 1 .. .. .. 3 11 5 Pneumonia 10 3 1 1 .. 3 2 2 Pleurisy .. .. .. .. .. .. .. .. Other diseases of Respiratory Organs 1 .. .. .. •• 1 .. 1 Alcoholism 3 .. .. .. .. 3 .. .. Cirrhosis of Liver Venereal diseases 1 .. .. .. 1 .. .. .. Premature Birth 4 4 .. .. .. .. .. .. Diseases and Accidents of Parturition.. 2 .. .. .. .. 2 .. .. Heart Diseases 27 .. .. .. 1 11 15 4 Accidents 2 .. .. .. .. 1 1 6 Infanticide 1 1 .. .. .. .. .. .. Cerebral hemorrhage 16 .. .. .. .. 6 10 3 Chronic Nephritis 4 .. .. .. .. 1 3 2 Old Age 7 .. .. .. .. .. 7 2 All other Causes 45 11 1 3 4 9 17 9 All Causes 188 27 10 6 11 61 73 42 14 L.G.B. Table v.—INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-1 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes — Certified 7 5 1 1 14 1 3 2 2 .. .. .. 2 1 1 1 27 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases — Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 .. .. .. .. .. 1 .. .. .. 3 Diarrhceal Diseases— Diarrhoea, all forms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis, Muco-enteritis, Gastro-enteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Gastritis, Gastro-intestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases— Premature Birth 2 1 1 .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 Congenital Defects 3 .. .. .. 3 .. .. .. .. .. .. .. .. .. .. .. 3 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus 1 2 .. 1 4 .. 1 1 .. .. .. .. .. .. .. .. 6 Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes— Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 2 Bronchitis .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 1 .. .. 2 .. .. .. .. .. .. .. 3 Infanticide 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Tetanus .. 2 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 7 5 1 1 14 1 3 2 2 .. .. .. 2 1 1 1 27 Births in the year— Deaths in the year— Legitimate 406. Legitimate Infants 23. Illegitimate 11. Illegitimate Infants 4. Deaths from all Causes at all Ages 188. Nett Population—Estimated to middle of 1910, 20,114. 16 Small-pox.—No case has been notified since 1902, and no death has occurred since 1882. Vaccination.—During the year the proportion of children born returned as successfully vaccinated was 62 per cent. The last two years the figures were 74 and 70 per cent. Scarlet Fever.—Twenty-eight cases were notified, and the rate per 1,000 persons living—1.4—was 1.2 below the mean rate for the previous ten years. No death was registered. Fifty-four per cent. of the cases were removed to the Isolation Hospital. There were two instances in which "return cases" arose; the intervals between the day of discharge from the Isolation Hospital and the onset of the new cases being respectively 21 and 18 days. Diphtheria.—Ten cases were notified, and the rate—0.5—was 0.3 below the mean rate for the previous ten years. Two cases, both under five years of age, ended fatally. Sixty per cent. of the cases were removed to the Isolation Hospital. The Council defrays the expense of bacteriological examinations of swabs (at the Lister Institute), sent to the Health Offices by medical men. The Local Government Board, under its Diphtheria Antitoxin (outside London) Order of 1910, has sanctioned the provision by Councils of antitoxin for the poorer inhabitants of their districts. For this district it was decided that, as the incidence of Diphtheria was slight, it would not be advisable to keep a supply of antitoxin at the Health Office, but rather that the medical practitioners of the district be informed that the Council would repay them any sums expended in its provision for their poorer patients. Enteric, or Typhoid, Fever.—Three cases were notified. In one of these the infection was certainly contracted outside the district; in another, owing to his occupation, this was highly probable ; in the third there is reason to doubt whether the illness was enteric 17 fever, as, although he had suffered from diarrhoea for two months, the blood gave no "widal reaction," and his death was certified six weeks after notification by the same doctor as due to bronchitis and dilatation of the heart. Measles.—There was a marked freedom from this disease after the epidemic in the first quarter of 1909 until, in May, 1910, it was introduced into an infant school by a London child who was visiting relatives, and attended school in the early stages of the disease. An outbreak, chiefly in the families whose children attended the school, arose, but no death was registered. Whooping Cough.—Five deaths were registered, three under one year of age and two between one and five years. Excepting diarrhoea, this has been the most fatal infectious disease in the district during the past 33 years. Diarrhœa.—No death was registered. This freedom has occurred but twice before in the past 33 years, viz.—in 1879 and 1894. Zymotic Diseases.—Taking these seven principal Zymotic diseases as a whole, there were 7 deaths, equal to a rate of 0.34 per 1,000 persons living, and nearly a third less than the average rate for the previous ten years. Infectious Diseases Notifications per 20,000 persons living in 1910, and in the three previous ten-year periods. Period. Smallpox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. 1910 0.0 28 10 3.0 6.0 2.0 1900-1909 0.0 52 16 3.0 8.2 0.7 1890-1899 0.6 60 11 8.8 1880-1889 4.8 92 28 8.6 18 Death-rates per 20,000 persons living for the seven principal Zymotic diseases (separately and combined), and the percentage of these Zymotic deaths to deaths from all causes for 1910, and in the three previous ten-year periods. Period. Smallpox. Scarlet Fever. Diphtheria Enteric Fever. Measles. Whooping Cough. Diarrhœa. All seven diseases. Percentage to total deaths from all causes. 1910- 0.0 0.0 2.00 0.00 0.00 5.00 0.00 7.00 3.7 1900-1909 0.0 1.18 0.91 .24 2.70 5.98 7.52 19.30 8.1 1890-1899 0.0 0.60 2.20 1.60 3.60 6.80 9.40 24.0 10.6 1880-1889 0.80 6.40 7.00 2.20 7.60 9.60 10.0 44.0 14.1 Methods of Dealing with Infectious Diseases..On receipt of a notification of an infectious disease the house is forthwith visited by the Medical Officer of Health and Sanitary Inspector, the case, where possible, removed to the Isolation Hospital, and the disinfection of the house carried out. All infected clothing remains in the sick room, which is sealed until the following day, when it is removed to the Isolation Hospital for steam disinfection. On the notification of a case in a house where there are children attending either Day or Sunday Schools, noice is sent by post to the Head Teacher, to the Attendance Officer of the Day Schools, and to the Manager of the Sunday School. If the case be removed to the Isolation Hospital, further notice is sent to the School of the date of discharge; where the case is isolated at home notice is sent when disinfection of the house is completed. With this information teachers can, by reference to the Education Committee's memorandum, decide the date for re-admission to School. Sutton, Carshalton, and Leatherhead Urban Districts, and Epsom Rural District, with, in 1909, an estimated gross population of 82,950, have an Isolation Hospital at Cuddington, under the management of a Board of representatives of the four Councils. The Hospital receives cases of Scarlet 19 Fever, Diphtheria, and Enteric Fever, and has, I have been informed, accommodation for 92 beds, of which number about 46 are in general use. Pulmonary Tuberculosis.—Sixteen deaths were registered, giving a rate of 0.80, the average rate for the previous ten years being 0.7 per 1,000 persons living. Method of Control.—One case was notified under the Public Health (Tuberculosis) Regulations, 1908; and three under the voluntary system adopted by the Council in March, 1909. Seven of the 14 deaths which occurred in the district were in houses with a rental under 10s. a week. On receipt of notification the house is visited by the Medical Officer of Health, and advice upon methods of prevention of infection and surroundings of patient given. In co-operation with the medical attendant, the possibility of sanatorium treatment is considered. The poorer classes have, however, no choice between the Union Infirmary and charity. In houses where knowledge of the existence of the disease is first gained by the Registrar's death returns to the Health Department, disinfections is carried out after burial. Other Tubercular Diseases.—Four deaths were registered, a rate of 0.2 per 1,000, and half the average for the previous ten years. Puerperal Fever.—Two cases were notified ; both terminated fatally. Apparently this disease is exceptionally fatal when occurring in this district. During the last ten years, out of six cases notified, five have died, a case mortality of 83.3 per cent.; and for the past 19 years, out of 12 cases notified, nine have died; a case mortality of 75 per cent. Supervision of Midwives.—The County Council is the local Supervising Authority, and the Medical Officer of Health has no control in this district. Influenza.—One death; rate of 0.05; average rate previous ten years, 0.26. Erysipelas.—Six cases notified; two deaths; rate, 0.1; average rate previous ten years, 0.03. 20 Cancer and Malignant Diseases.—Eleven deaths; rate, 0.55; average rate previous ten years, 0.86. Diseases of Respiratory System, excluding Phthisis.—Twenty-six deaths, of which ten were due to pneumonia; rate, 1.3; average rate previous ten years, 1.4. Death-rate from various causes per 20,000 persons living in 1910, and in the three previous ten-year periods. Period. Phthisis. Diseases of the Respiratory System, 1 excluding Phthisis. Other Tubercular Diseases. Influenza. Erysipelas. Puerperal Fever. Cancer. 1910- 16 20 4 1 2.0 2.0 11 1900-1909 14 28 8 5 0.7 0.6 17 1890-1899 17 38 18801689 25 39 Milk Supply.—The greater portion of the supply comes from outside the district, the average number of milch cows examined quarterly by the Council's veterinary surgeon being only 123. There were six cowkeepers with grazing land attached, and one cowkeeper without. Improvements in ventilation, lighting, and drainage have been carried out at some farms, and is in hand at another. Some of the cowkeepers keep their cows well groomed; others leave much to be desired. The milk-shops have been well kept, and the milk always protected against dust and flies. During the past year outbreaks of infectious disease due to milk have been reported by Medical Officers of Health in other districts. The risk of drinking unboiled milk is therefore considerable. The Council's Veterinary Surgeon, Mr. Vincent, in his quarterly reports, stated that he had found no instance of tuberculosis of the udder in the milch cows of the district. 21 Sale of Food and Drugs Act,—The administratration, so far as the taking of samples is concerned, is carried out by the County Council's officials, and details relating to separate districts are not obtainable. Other Foods.—The only unsound food dealt with has been fish brought by tradesmen and hawkers to the Health Office. Such, as after examination has been found to be unfit for food, has been condemned and disposed of by the Department. Bakehouses.—There are 16 bakehouses. These have been regularly inspected and found to be satisfactory. There is no underground bakehouse. Slaughterhouses.—There are six slaughterhouses, and they have been efficiently inspected, both at times of slaughtering and other, and found in decent order. No carcases or parts of carcases were found to be tuberculous. The Inspector has not a special certificate in meat inspection. The greater part of the meat consumed is from animals slaughtered outside the district. Offensive Trades.—Application has been made to the Local Government Board, that, under Sec. 51, Public Health Acts (Amendment) Act, 1907, Brickburning, Fried-fish Shops, and Paraffin-oil Stores should be offensive trades under Sec. 112 of the Public Health Act, 1875. House Accommodation.—There is an ample supply of good cottages, chiefly from 6s. to 10s. per week rental, and it is noticeable how few are supplied with properly lighted and ventilated store-places for food. There is a sufficiency of space around even the oldest houses, and the surroundings are clean and yards paved. The newer cottages, which form a large proportion, arc in wide streets and with ample space at the back. The supervision over the erection of new houses is thoroughly carried out under the District Bve-laws. No action under Parts I., II., or III. of the Housing of the Working Classes Act has been taken or needed. 22 A list of houses, according to the Housing (Inspection of District) Regulations, issued by the Local Government Board in 1910, has been made, but past inspection has been fairly complete, and there are very few houses in which there has been any difficulty in getting the repairs required by the Health Department executed by the owners. Bye-Laws as to Houses Let in Lodgings.—The Council passed in 1902 Bye-Laws as to Houses let in Lodgings. Registration of such houses, however, has not been enforced, but inspection has been carried out, and there has been only very rarely any difficulty in getting notices for amending defects and nuisances complied with. Greater difficulty is encountered in dealing with careless tenants than with owners, and the Health Department finds the amending of ordinary nuisances a simple matter compared with the cleansing of houses, bedding, and clothes infested with vermin. Fortunately this is confined to moderately few families, and an improvement is taking place owing to the combined action of the Local Education Authority and the District Council. A nurse under the Education Authority is visiting the schools, and following the verminous children to their homes. In bad cases the parents have been prosecuted and fined. Water Supply.—The water supply is from deep wells in the chalk just above the strip of London Tertiaries and situated in the town. The Sutton District Water Company is bound by Act to soften the water to not less than 9 degrees of hardness, and it has been found by frequent analyses made at the Health Office that this standard was rarely exceeded. Recent analyses carried out by experts engaged by the District Council have shown the chemical and bacteriological purity of the water to be of a very high standard. Sewerage and Drainage.—The district is sewered, except with regard to a few houses in the outlying rural and sparsely populated parts on the clay, where cesspools are still in use, and emptied from time to time by the Health Department. 23 The sewage is treated by contact beds and percolating filters, three of which, with rotating sprinklers, are now in use. Treatment by irrigation has ceased. There is a separate system for storm water, and this year the extension to the district's boundary at Belmont has been completed. Except in rare instances in the rural parts, and beyond the limit of the sewers, where excreta can be treated by the dry earth system, water-closets are used. There are eight cesspools in the chalk, and 28 in the clay. Of these 28, 19 are situated beyond the limit of the sewers. Regarding those within reach of the sewers, there is difficulty with levels. Plans for dealing with these are being considered. Removal of House and Trade Refuse and Stable Manure.—The removal of house and trade refuse is carried out by the Council's servants under the direction of the Sanitary Inspector, the refuse being tipped at the sewage farm well away from dwellings. Men are employed in rendering the tip as little offensive as possible. When, as in warm weather, the prevalence of flies is evident, a layer of chloride of lime is spread over the more recent tippings. Stress has been laid upon the importance of the weekly removal of manure, as required by the bye-laws, of owners of stables, and especially in warm weather, as horse manure forms the favourite breeding place for flies. It would be well if nursery gardeners would avoid, as far as possible, the collection of large heaps in the warm season of the year. Nuisances.—Most of the owners of property are readv to carry out the necessary steps for the abatement of nuisances on receipt of a preliminary notice. Twenty-two statutory notices were issued, but no legal proceedings were taken. Systematic and house-tohouse inspections were made. 24 Schools.—There are 5 public elementary schools, with accommodation for over 2,707 children. The average number on the register in 1910 was 2,574, and of those attending 2,289. The sanitary condition of these schools and the water supply were, on the whole, satisfactory. A hot-water system for heating has been placed in the New Town Roys', Girls', and Infant Schools, and shelters in the playgrounds. The lighting and sanitation of the old West Street School has been improved, but here there are no outdoor shelters, and in wet weather drilling has to be done in the class-rooms. The Mixed School in the Banstead Road and the Mixed and Infant Schools at Benhilton, are also without shelters. Plans for the re-construction of the Benhilton Schools are now before the Education Authority. Infectious Diseases in Schools.—Prompt notification of the notifiable diseases—Scarlet Fever and Diphtheria—is made by the Health Department to the school teachers, and of measles, whooping cough, etc., and contagious diseases, by the teachers to the Medical Officer of Health, and schools and homes are visited. Printed instructions are sent to all homes where the teachers report measles or whooping cough. The Medical Officer of Health also examines any children sent to his office by the teachers, on account of contagious disease, or by the Attendance Officer, where children are absent on account of ailments, and no medical practitioner's certificate is forthcoming. School Closure.—No school closure was required. Factory and Workshops Act.—The number of workshops on the register at the end of the year was 136, and 292 visits of inspection were made. The various premises were generally found to be in a satisfactory condition. The following list gives the various industries as carried on at the registered workshops :— Bakehouses 16 Laundries 18 Dressmakers and Milliners 32 Tailors, Outfitters, Watchmakers, Bootmakers, and others 70 25 Section 22 of the Public Health Act (Amendment) Act is in force, and sufficient accommodation provided. Bye-Laws Relating to New Streets and Buildings.—The Table and two succeeding paragraphs are from the department of Mr. W. Hedlev Grieves, the District Surveyor and Engineer:— 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the ByeLaws, was 201 174 192 171 355 223 175 142 119 103 The number of new streets, ditto, was 3 1 4 5 2 2 3 2 ... ... The number of times that legal proceedings were taken for breach of the Byelaws relating to streets and buildings was 0 0 0 0 0 0 0 0 0 0 The number of private streets metalled, channelled, paved, etc., under the Private Street Works Act, 1892, during 1910, was 5. House Drainage, &c.—The drains of 80 premises were connected with the sewers of the district during the year. 26 THE SANITARY INSPECTOR'S REPORT For the Year ending December 31st, 1910. Number of complaints received ill writing 75 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 432 Number of nuisances discovered 340 Ditto remedied without being reported 11 Number of nuisances reported to the Sanitary Authority 329 Number of nuisances remedied after report 319 Number of preliminary notices served by the Inspector for the abatement of nuisances 136 Number of notices for the abatement of nuisances served by order of the Sanitary Authority 22 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 52 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 81 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 4 Number of houses which were provided with efficient ventilation 2 Number of houses at which injurious overcrowding was abated 2 Legal proceedings taken under Sec. 96 for abatement of nuisances (number of times) — Houses closed as unfit for human habitation — 27 Number of houses at which disinfection was carried out, after notice under Sec. 5 of the Infectious Diseases (Prevention) Act, 1890 26 Number of foul houses cleansed and whitewashed, after notice under Sec. 46 of the Public Health Act, 1875 20 Number of premises from which offensive accumulations have been removed after notice, under Sec. 49 of the Public Health Act, 1875 9 Seizure of unwholesome meat, poultry, fish, fruit, vegetables, corn, bread, flour or milk, under Sec. 116 of the Public Health Act, 1875 6 Number of registered cowkeepers, dairyman, and purveyors of milk carrying on business at the commencement of the year 25 Number since registered 3 Number who gave up or transferred their business during the year 3 Number of registered premises inspected during the year 28 Total number of visits paid during the year 89 Number of cowsheds and dairies at which improvements in the lighting, ventilation, paving, drainage, means of cleaning, or water supply, were made during the year 3 Number of cowsheds or dairies which were found in a dirty state 1 Number of premises at which the milk vessels were found in an unclean state — Number of new cowsheds erected - F. W. KAIN, Sanitary Inspector. 28 METEOROLOGICAL NOTES, 1910. January. February. March. April. May. June. July. August. September. October. November. December. Total for year 1910. Total for year 1909. Total for year 1908. Total for year 1907. Total for year 1900. Rainfall (inches) as recorded at— Sutton Sewage Works 2.26 3.48 1.32 1.58 1.80 2.53 2.41 2.55 1.26 2.44 3.04 4.26 28.93 28.31 24.96 22.88 22.72 Hours of sunlight (recorded at Wallington) 62.3 68.4 122.6 111.1 186.9 162.6 97.2 154.2 119.2 65.2 55.6 17.3 1223.1 1447.4 1581.5 1381.9 1673.6 Mean temperature (recorded at Wallington) 40.0 42.2 42.9 46.6 53.6 60.4 58.6 61.0 55.8 53.1 38.7 44.2 Aver. 49.7 Aver. 48.4 Aver. 49.8 Aver. 494 Aver. 50.5 RAINFALL 1910 for at Sutton Sewage Farm, As compared with that of previous ten years. Year. Total Depth. Greatest Fall in 24 Hours. Number of Days upon which .01 or more fell. Depth. Date. 1900 24.21 Inches. .90 Inches. 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 1907 22.88 do. .90 do. April 6th. 180 1908 24.96 do. 1.10 do. Jan. 7th. 165 1909 28.31 do. 1.10 do. Oct. 28th. 181 Average 24.95 do. 1.17 do. 173 1910 28.93 do. 0.85 do. Jan.27th. 196 The total rainfall at Greenwich for 1910 was 28 064 ; and the average for the past 70 years 24.178. In 13 years only has the 1910 rainfall been exceeded in these 70 years. In the last 30 years it was exceeded only in 1903, when the highest record—35.543—for the 70 years was attained. 29 SUMMARY OF NOTES FROM MONTHLY RECORDS SUPPLIED BY F. CAMPBELL-BAYARD, Esq., F.R.Met.Soc., and Honorary Secretary of the Croydon Natural History and Scientific Society. January.—First 20 days mild and showery; latter part cold with snow and sleet and stormy. February.—Very warm and wet, with a large number of rainy days. Rainfall highest since 1900 and more than double the average. March.—1st—18th wet and mild, remainder cold and dry. April.—Cold and sunless. Very heavy rainfall and thunderstorm on 16th. May.—First half cold and showery with white frosts; second half cool and dry. June.—1st—10th cloudy, but little rain; nth—23rd warm and dry; the rest cold and showery. July.—Cloudy and cool. First len days showery; next ten dry, cloudy, and cold; 20th—27H1 showery; then fine to the end. Comparatively sunless month. August.—Cloudy, cool, and showery to 6th, then rather finer till 22nd, and then wet and stormy. September.—Extraordinarily dry, rather cool, and sunless. October.—Exceedingly warm and sunless. November.—The coldest for a number of years, one record states for 34 years. December—One of the wettest and warmest for many years. In the last 25 years only 1886 and 1901 were wetter, and 1898 and 1900 warmer.