WIH038 Borough of Wimbleton. SANITARY DEPARTMENT. Annual Report OF THE Medical Officer of Health for the Year ended 31st December, 1907. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Gentlemen, I have pleasure in presenting to you my Annual Report for the year ending 31st December, 1907, it being the thirty-seventh I have had the honour of submitting as Medical Officer of Health for Wimbledon, copies of which will be forwarded as required to the Local Government Board, The Surrey County Council, and also the Secretary of State, Home Office. The returns of vital statistics and infectious diseases drawn up on the forms supplied by the Local Government Board are appended in Tables I., II., III., IV., and V. Population.—The calculations for the deaths and other rates in the tables of this report aie based on an estimated population at the middle of the year as 51,700, which figure is obtained by the Borough Engineer ascertaining the number of occupied houses in each ward and multiplying that figure by the house factor for the respective ward obtained from the official census in 1901. Area.—The area of the Borough (exclusive of area covered by water) is 3,173 acres, and the density of the population was 16'2 per acre. Births.—The number of births registered was 1,121 (587 males, 534 females), which is 64 less than last year, and equal to a birth-rate of 216, which rate is 3 7 below the average for the past ten years. The corresponding rate for England and Wales for the same period is given as 26'3 in the report of the Registrar General. Deaths.—The total number of deaths registered in the district was 480 (237 males, 243 females) equal to a deathrate of 9'2 per thousand of the population per annum. This is 2'5 lower than last year, and 17 below the average for the past ten years which is seen to be 10 9. In the decade, only on two occasions, viz., in the years 1903 and 1905, has the death-rate fallen below that of this year. It will be remembered that last year I remarked on the very low death-rate that Wimbledon enjoyed, seeing that it is a suburb of London, and that the greater part of the population resides in the lower portion of the district, and that if this low rate could be maintained in the future there would be every reason for satisfaction. Under these circumstances it is very gratifying to be able to report that the death-rate for the past year is even lower than that of 1906. The deaths in public institutions outside the district of persons belonging to this Borough were :—49 in Kings'.on Infirmary, and nine in the County Asylum, Brookwood ; the deaths occurring in public institutions within the district of persons not belonging hereto were:—five in ihe Atkinson Morley Convalescent Hospital, Copse Hill; three in the South Wimbledon Cottage Hospital ; and one in the North Wimbledon Cottage Hospital After taking these into account the total number of deaths properly belonging to the district is found to be 529, and the death rate 10'2. The rate for England and Wales for the same period is 15 0. 2 One hundred and twenty-five deaths of children under one year of age were registered, and this infantile mortality is represented by a ratio of 111 deaths per thousand registered births, a decrease of 36 per thousand on the previous year, and 12 on the average for the past ten years. The rate for England and Wales is 118. Here, again, only on two occasions (1903 and 1905) has the infantile mortality rate fallen below that of this year. By the Zymotic death-rate we understand the number of deaths per thousand of the population which are due to the seven common epidemic diseases:— (1) Small Pox; (2) Measles; (3) Scarlet Fever; (4) Diphtheria, including Membraneous Croup; (5) Whooping Cough; (6) Fever, including Typhus, Typhoid, and 111 Defined Fevers; and (7) Diarrhoea. These seven epidemic diseases may be divided into notifiable and non-notifiable, and of the former, six were due to Diphtheria, five to Scarlet Fever, and one to Enteric Fever; and of the latter, 30 were due to Whooping Cough, 17 to Diarrhoea, and ten to Measles, making an aggregate of 69 deaths, or equal to a Zymotic death-rate of 1'3 per thousand of the population. In addition to the deaths from Zymotic diseases, the principal causes of deaths were as follows:— Pneumonia, 47; Bronchitis, 36; Cancer, 46; Phthisis, 40; other forms of Tuberculosis, 17; Heart Disease, 54 ; and Premature Births, 15, For the purpose of comparison the following Table is given, in advance, by courtesy, from the Returns of the Registrar General :— Vital Statistics for 1907. Annual Rates per 1,000 living. Infant Mortality of infants under 1 year per 1,000 Births. Births. Deaths from all Causes. Death-rate seven chief Epidemic Diseases. England and Wales 26.3 15.0 1.26 118 76 Great Towns 27.0 15.4 1.54 127 142 Smaller Towns 25.7 14.5 1.29 122 England and Wales, less the 218 Towns 25.6 14.7 0.91 106 WIMBLEDON 21.6 9.2 1.3 111 3 Table A shows the births, deaths (registered in district) and death-rates, and the deaths at certain ages and for specified causes for the past 5 years. Table B shows for the same years the number of infectious cases notified and the deaths from each disease. Table C shows the death-rates from zymotic diseases, phthisis and other forms of tuberculosis for the past 10 years. Table A. 1907 1906 1905 1904 1903 Births 1121 1186 1146 1142 1204 Deaths 480 684 397 487 389 Death-rales 9-2 11-7 82 102 84 DEATHS- Under 1 year 125 176 80 153 99 Over 1 year and under 60 years 203 260 175 187 169 Above 60 years 152 149 142 147 121 From Measles 10 19 1 23 4 „ Scarlet Fever 5 5 3 0 1 „ Small Pox 0 0 0 0 0 „ Diphtheria 6 9 2 6 4 „ Diarrhœa 17 90 15 43 13 „ Whooping Cough 30 4 10 14 9 ., Enteric Fever 1 6 5 4 2 „ Puerperal Fever 2 0 1 0 2 „ Erysipelas 0 5 1 1 1 „ Influenza 3 10 8 3 5 4 Table B. DISEASES. 1907 1906 1905 1904 1903 Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 0 0 1 0 0 0 0 0 Diphtheria 83 6 56 9 39 2 36 6 58 4 Erysipelas 64 0 32 5 50 1 42 1 40 1 Scarlet Fever 281 5 229 5 110 3 106 0 113 1 Enteric Fever 15 1 11 5 39 5 15 4 15 2 Puerperal Fever 3 2 1 0 1 1 0 0 4 2 * Measles 0 10 0 19 o 1 0 23 104 4 Totals 436 24 328 43 240 13 199 34 324 14 * Measles notifiable from June, 1898 to June, 1903. Table C. Year. Zymotic Death-rate. Dkath-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhoea. Phthisis and other Tuberc'lo's Diseases. 1898 2.0 - .05 .18 .02 .08 .05 1.51 .9 1899 1.83 - .05 .31 .15 .39 .02 .55 105 1900 1.77 - — .25 .12 .12 .43 .48 .6 1901 1.5 - .02 .14 — .31 .24 .57 1.04 1902 1.02 - — .16 .06 .39 .25 13 .7 1903 .73 - .02 .08 .04 .19 .08 .28 1.08 1904 1.9 - - .12 .08 .29 .48 .9 .83 1905 .78 - .06 .04 .12 .20 .02 .31 .82 1906 2.7 - 1 .18 .1 .08 .38 1.8 1.1 1907 1.3 - .09 .11 .05 .58 .19 .32 1.1 5 Scarlet Fever.—Notifications respecting 281 persons were received during the year, representing an attack rate of 54 per thousand of the population, being an increase of 1'9 upon the previous year. This is the greatest number of cases that have occurred in any year since 1893 when 294 were notified, and the attack rate was 10'5 per thousand of the population. The average attack and death rates for the past three quinquennial periods are as follows:— Attack Death Rate. Rate. 1891—1895 4.8 .02 per thousand of the population. 1896—1900 3.3 .04 1901—1905 2.3 .02 The increase during the past year is not attributable to any particular cause of infection, the cases being fairly well distributed throughout the southern portion of the Borough where the density of the population is greatest, and as in the year 1905 the prevalence of Scarlet Fever was not merely confined to Wimbledon, the Borough suffering in common with the Metropolitan area and adjoining Counties. The type of the disease generally continues to be of a mild character, and for this reason there is increased difficulty in keeping it in check. Cases undoubtedly occur which are so extremely mild in character that they are either not recognised at all or not until the peeling stage is reached. The incidence of the disease was greatest in the first and last four months of the year as shown by the chart, there being 111 cases notified from the beginning of January to the end of April, 57 between May and August, and 113 from September to the end of the year. The rather abnormal number of cases in the first four months was really a continuance of the Autumn Scarlet Fever period of 1906. An increase in the prevalence of the disease may generally be expected at this season of the year, and it was found necessary to use the reserve Iron Hospital which was kept in use until the end of June of this year. The number of cases having, however, again gradually increased towards the Autumn, the Hospital was, in October, once more brought into use, together with the Enteric Fever Pavilion, the district, fortunately, being free from this latter disease at the time. The accommodation from time to time proved inadequate, and on several occasions it was necessary to delay the removal of patients for a few days until discharges from the Isolation Hospital took place, when they were admitted in turn or according to the means of isolation at the patients' homes and other circumstances. 6 CHART SH EW I N G W E E K LY NOTIFICATIONS OF SCARLET FEVER In two instances when the Hospital was full, arrangements were made by the parents at their own expense for their children to be admitted into other Fever Hospitals. As has previously occurred in other years, the disease was frequently not recognised until the desquamating stage was leached, the earlier symptoms being so exceedingly slight that they had been overlooked by the parents or persons in charge. This year fifteen patients were found to be peeling at the time a doctor was called in and notification made. Undoubtedly, missed ca^es are somewhat frequent and are among the most effective promoting causes of an epidemic as by reason of their very mildness, through mixing with others at home, at day and Sunday schools, places of entertainment, in the street, etc., they are the means of transmitting the disease. On the other hand these earlier symptoms had in a few cases been overlooked either by neglect or carelessness—the children appearing to be ailing having been sent home from school by the authorities, and the parents advised to call in a medical practitioner. A particular instance of this occurs to me where a child was excluded from school and a notification sent from the Head Mistress to the Sanitary Department The child was immediately visited and examined, when she was found to be desquamating freely, although the parents were quite surprised when the state of the child's health was brought to their notice. At the time, other children of the family were running in and out of the house. Needless to say, the child was removed to the hospital with all possible despatch, but it is significant that the case ended fatally. It is extremely difficult to successfully piosecute in matters of this kind, as it is almost impossible to prove knowledge of the disease and wilful exposure. A severe caution and warning was, however, administered to the parents. Two hundred and sixteen patients, or about 76 8 per cent, of the total cases notified were removed to the Isolation Hospital, four of whom died, a fifth death occurring at home. In this connection, it is interesting to note that the average percentage of removals to hospital for the seven years previous to the year 1901, when the hospital charges for maintenance were abolished, as compared with the seven subsequent years is appreciably smaller, being 68'3 per cent, and 78 0 per cent, respectively. As may be expected, the majority of the cases notified were of children of school age ranging from five to fifteen 7 years, and of the notifications received 171 were of children attending the following schools:— Haydons Road (Girls and Infants), 36; Haydons Road (Boys), 6; Queen's Road (Girls and Infants), 36; yueen's Road (Boys), 10; Effra Road, 24; Holy Trinity, 15; Dundonald, 13; Central, 9; Roman Catholic, 6; Cottenham Park, 1; Private, 7; and schools outside the district, 8. Although, as mentioned previously, the number of cases notified was considerably larger than in previous years, it was fortunately not deemed necessary at any time to advise the closing of any particular school. The investigations made in each case, the distribution of leaflets of precautions to be taken, the measures of disinfection, and the means taken to prevent members of the same household from attending school have been the same as in previous years and referred to in former reports, but the increased number of cases has naturally involved a considerable amount of additional work upon the staff of the Department. Appendix Table III. shows the age distribution for the whole of the infectious diseases, the Wards in which they occurred, and from which they were removed to the hospital. In Table C, on page 5, will be found the death-rate from Scarlet Fever for the past ten years. The Sub-Committee mentioned in my last Annual Report, appointed to consider "the best means of providing a suitable observation ward at the Isolation Hospital, and also as to what extensions to the building are likely to be required during the next few years," reported in December, 1906, after having carefully considered the present hospital accommodation and needs and the probable increase in the population of the Borough, and recommended a scheme providing for additional accommodation in the way of twenty-four beds for Scailet Fever patients, fourteen for Typhoid Fever, and various extensions to the Administrative Block, etc., at an estimated cost of £16,072. The present four-bed pavilion for Enteric Fever cases is proposed to be used as an observation ward. This scheme was under the consideration of the Council for some months, but in April of this year a motion proposing its adoption was negatived, and subsequently the Council instructed the Sanitary Committee to prepare a further scheme. A Sub-Committee was appointed to deal with the question with instructions to limit the proposed enlargements to twenty beds with the necessary accommodation for administrative purposes. The Engineer and Surveyor to the Council was accordingly required to prepare the necessary plans, estimates, etc , 8 and in November the Sanitary Committee made the undermentioned proposals which were confirmed by the Council the following month:— The erection of a Scarlet Fever pavilion containing twenty beds; The extension of the existing Administrative Block so as to provide ten additional bed rooms, needlewoman's room, two bath rooms, and office, store room and coal store; The extension of the Laundry Block, provision for the installation of a combined disinfecter and washer, a larger ironing room, and additional drying closets, the estimated cost of the whole of these proposed extensions being £'7,851. Although, in comparison, there is an appreciable difference in the extent of the accommodation provided for in each scheme, it will be noticed that there is more than a proportional reduction in the estimates, the former costing £423 per bed, whilst the second estimate gives the cost of each bed at £392. As this increased permanent means of isolation is sorely needed if all patients are to be removed for whom application is made, 1 sincerely trust the work will be commenced during the ensuing year and completed as early as possible. Whilst on the subject of hospital accommodation for the reception and treatment of Scarlet Fever patients, I might mention that the question has frequently been discussed of late at some length by various Local Authorities and Public Health Associations as to whether the provision of Isolation Hospitals really tends towards the reduction of the prevalence of the disease and especially as to whether the large sums which are constantly being spent by the ratepayers in providing buildings and equipment are justified by the results achieved. In other words are the benefits derived commensurate with the expense incurred? In this connection it is interesting to note the spirit of a recent resolution of the Metropolitan Asylums Board, viz.:— "That in view of the continued prevalence of Scarlet Fever, notwithstanding the extensive isolation accommodation which has been provided, the Local Government Board be asked to cause an inquiry to be instituted into the cause of the disease, and whether any, and if so, further what means can be adopted for its prevention." An inquiry of this character appears to me to be moving in the right direction and efforts should certainly be made 9 to ascertain the cause of the disease in order that further steps may be taken for its prevention instead of merely continuing to extend the accommodation for treatment. After the prolonged and extended experience of the Metropolitan Asylums Board that body has apparently come to the conclusion that notification and isolation have not had the desired effect of keeping the disease under control, but that greater advantage is to be gained by more attention being paid to research than to the persistent expenditure of vast sums on buildings, etc. From the statistics prepared it would appear that in the Metropolitan Area the annual revenue expenditure at the Asylum Board's Fever Hospitals since 1890 has considerably increased, being more than three times as great during the year 1906, whilst the number of cases and attack rates per thousand of the population vary but slightly. Diphtheria.—Eighty-three cases of this disease were notified, representing an attack rate of 1*6 per thousand inhabitants: against 55 cases last year with a rate of 11, the average rate for the past ten years being 11. Sixty-two of the patients were removed to the Hospital, which constitutes 74 per cent, of the total number notified, several of the cases at the time of removal being in a very critical condition which necessitated the operation of tracheotomy being carried out immediately on their arrival there Six deaths were registered from the disease, all occurring in the Hospital, giving a death-rate of 11 as against '18 last year and an average of '16 for the previous ten years. In Table C. on page 5 will be seen the death-rates for these years. The cases were distributed fairly evenly throughout the Borough, and 46 were of children attending the following schools:— Queen's Road, 12; Holy Trinity, 7; Effra Road, 6; Dundonald, 5; Roman Catholic, 3; Haydon's Road, 2; Central, 2; Cottenham Park, 1; Private, 6; and schools outside the Borough, 2; What may be termed a distinct local outbreak occurred in July and August of children residing in Cross and Derby Roads and adjoining portions of Russell and Palmerston Roads who attended Holy Trinity Schools. The evidence pointed to the infection having been conveyed by one child who was thought to be only suffering from a simple cold. The maximum weekly number of cases notified was in the third week of September and the first week of October when 5 and 7 cases respectively were notified from houses in 10 all portions of the District as widely separated as Havelock Road, St. George's Road, Amity Grove and the Common. Fortunately it was possible to remove all cases requiring admission to the Hospital, the Enteric Fever Ward being available owing to the absence of Enteric Fever at this period. The 83 cases occurred in 75 houses, in one of which there were four patients, in another three, and in three other houses two each. As has been the custom for some years, the drains and sanitary arrangements of every house from which a case was notified were tested and examined At 59 houses no defects were noted; at seven houses slight insanitary conditions such as damp walls, dirty and uncovered cisterns, defective flushing boxes, &c., were found, whilst at seven others the house drains were found in such a defective state as to require their reconstruction, and in two other instances considerable alterations were necessary. It was the general opinion until recent years that exposure to sewer air, defective drainage and insanitary surroundings, were the principal causes of Diphtheria, but apparently, bacteriology has proved this not to be the case. However, insanitary conditions must undoubtedly always be searched for and remedied, for they are unquestionably contributory causes by lowering the general health and thereby rendering the individual more susceptible to any infecting agent bv making the mucous membrane of the nose or mouth unhealthy, and affording a favourable field for the growth of any germ that may gain access. Cerebro Spinal Meningitis or Spotted Fever.—In consequence of this disease having been somewhat prevalent in parts of Ireland and Scotland, the Local Government Board, on the 20th February, sent a circular letter to all Local Authorities together with a memorandum prepared by their Medical Officer dealing generally with the characteristic symptoms of the disease, and especially with its minor and anomalous manifestations, asking in the event of any cases occurring in the District that the Board shouldbeimmediately notified, and further stating that they would be prepared to render the Sanitary Authority such advice or assistance as in the circumstances might appear to be necessary. They also pointed out that the Sanitary Authority could, if they thought fit, make an order to the effect that the disease should be compulsorily notifiable in their District. I advised the Sanitary Committee that if the disease was made notifiable it would probably create a scare. A copy of the memorandum was, however, sent to each member of the medical profession practising in Wimbledon, with a the request that I should be acquainted at the earliest possible moment of any case that might come under his notice. On the 15th March, Dr. Findlay asked me to see with him a child who he suspected as suffering from the disease. This I did, and confirmed his opinion. The case terminated fatally the same night after less than 24 hours illness. The body was removed to the mortuary and the disinfection of the bedding, room, and premises carried out before the morning. The Local Government Board suggested that a post mortem examination should be made, and requested that a portion of the spinal cord and cerebro spinal fluid be forwarded for examination by the Board's bacteriologist. Accordingly, with the parents consent, a post mortem was made by Dr. Findlay and myself, the case being undoubtedly one of Cerebro Spinal Meningitis. A detailed report of the examination was subsequently sent to the Local Government Board, and a few days after a communication was received in return stating that the bacteriological examination of the material sent confirmed the diagnosis. Typhoid Fever.—Fifteen persons were notified as suffering from this disease, nine in South Wimbledon and six in North Wimbledon; two occurring in each of the months of January and February, one in June, two in both July and August, one in September, three in October and two in November. The attack rate is 2 and the death rate 01 per thousand inhabitants, the case mortality being 6 per cent. Two of the patients contracted the illness in Cuba and Italy respectively, being ill when they returned home ; five were attributed to the eating of oysters and other shell fish when away from Wimbledon or on holidays, and from one of these three other persons in the same house contracted the disease, one terminating fatally; one case developed the disease after removal to the Hospital with Scarlet Fever. In one instance the drains of the house were extremely defective, and at another the interior of the house and all its sanitary fittings, sinks and gullies, etc., were in a most neglected and filthy condition ; at two other premises no insanitary conditions were found or anything to which the cause of the illness could be attributed; whilst one person after a short detention in the Hospital was returned as " not Enteric Fever." At the house where the four cases occurred, when the first patient was notified removal to the Isolation Hospital was not desired by the parents and when the others occurred it was not possible to do so owing to the Enteric Fever Ward being used for Scarlet Fever, therefore one of the 12 cases was removed to the North Wimbledon Cottage Hospital and a nurse engaged by the Corporation to attend the other patients. Puerperal Fever.—During the year three cases were notified. Two of these, occurring in January, were attended by a registered Midwife trained and certified by the London Obstretical Society. Immediately an undue rise of temperature occurred in the first of these patients the Midwife, as required by the Rules of the Central Midwives Board, called in medical aid. It was some days before the Doctor could certify as Puerperal Fever, and in the meantime she had been in attendance on the second patient. Immediately on receipt of the notification the Midwife was warned not to attend further cases, and she readily gave me all information possible. Both patients died. Enquiries were made from the practitioners called in to each case, who agreed there was no fault or neglect on the part of the Midwife, and this is borne out by the fact that lying in cases at her own home and attended by her were not affected, or did any further cases occur in her practice. The clothing and person of the Midwife was disinfected under my supervision, but her kit bag and contents instead of being disinfected were burnt in the fire in my office by the Midwife and on her own initiative. The third case, in September, was of a Poor Law patient who was removed to the Workhouse Infirmary at Kingston. Erysipelas.—This disease was somewhat more prevalent than during the previous year. There were 54 cases notified, but no death registered—against 32 cases last year with five deaths. Whooping Cough.—An outbreak of Whooping Cough commencing in a portion of South Park Ward, East of Haydon's Road in January rapidly extended to all carts of the Borough, being most severe in the first four months of the year when twenty-four deaths were registered ; this was the cause of an unusually high infantile mortality rate for the same period, one death occurring in each month of the year except August made the total number of deaths from this disease 30, giving a death-rate of '58, the highest for many years. Quite ninety per cent, of the deaths were of children of either the working or poorer classes in whose homes, for many and well-known reasons, the requisite precautions against exposure to cold cannot be taken or the necessary nursing and warmth provided. 13 Measles accounted for 10 deaths during the year as compared with 19 in 1906. This disease not being notifiable the actual number of children who suffered is unknown, therefore the attack rate cannot be ascertained. Ninety-three lists containing the names of 401 scholars suspected to be suffering from Measles were received from the Head Teachers. When an outbreak occurs in the Winter or early Spring the probabilities are that a much larger number of deaths will take place than if in the Summer time. As instances of this, in 1904, when an outbreak occurred in February and March, the number of deaths amounted to 23, whilst in 1905, when the epidemic was in April, May and June, and the number of children (measured by the returns received from the Head Masters and Mistresses giving names of absentees from school) was considerably more, and all departments of Cottenham Park and the Infants Department of Holy Trinity, St. Mary's, Central, and Haydon's Road Schools were closed, no deaths were recorded. Again, in 1906, when the disease was chiefly prevalent in March and April, the deaths numbered 19, whilst this year, during the outbreak in the Summer months, the deaths numbered eight, two others in December being registered as Malignant Measles. Of the deaths five were of children under one year of age, two betveen one and five, and three between five and 15. Two deaths re re in St. Mary's, three in Trinity, and five in South Park Ward. Following is shown the Schools and the period for which they were closed in order to stay the spread of the disease :— Central Infants, May 15th to June 2nd; Haydon's Road Infants, July 5th to July 25th; Effra Road Infants, December 3rd to December 21st. Before reopening, all class rooms, cloak rooms, lobbies, &c., were disinfected, and during both the Summer and Christmas vacations the whole of the Public Elementary Schools were similarly treated by the Staff of the Sanitary Department for the Education Committee. Influenza was the registered cause of death in three instances, as against 10 last year, and eight the previous year. Two deaths were of children under five years of age and the other a person over twenty-five. Phthisis and other forms of Tuberculosis were the assigned cause of 57 deaths (equal to a death rate from the disease of 11) as compared with 59 during last year and 40 the previous year. These numbers include nine persons formerly resident in Wimbledon who died during the year in the Workhouse Infirmary, Kingston, and one in the Surrey County Asylum, Brookwood. 14 The deaths were distributed through the various Wards as follows:—South Park, 20; Trinity, 11; Dundonald, 8; Cottenham Park, 5; St. Mary's, ; and St. John's, 2. Last year the Council decided to adopt a voluntary system of notification, this only to be made with the consent of the patient, there generally being strong objections to notification by persons suffering from Phthisis. During the year notifications respecting 38 persons were made either by their friends or Medical Practitioners. In the majority of instances the patients when notified were in an advanced stage of the disease. Disinfection was offered in all cases, and in 23 houses one room was disinfected, in two houses two rooms, and in one house three rooms, in 12 houses this was not deemed necessary, or fumigation had already been carried out by the nurse in attendance. Mattresses, Palliasses, Beds. Pillows, and various articles of clothing and wearing apparel to the number of 519 were removed, disinfected by steam, and returned. A pamphlet, setting out the precautions to be taken and giving useful information as regards the disease, for the benefit of the patients and persons living with them, was prepared in conjunction with the President and Secretary of the Wimbledon Medical Society, and a number of copies were sent to all Medical Practitioners in the District, the Relieving Officer, and also distributed in other ways. Five years ago the President of the Local Government Board (the Rt. Hon. Walter Long) instructed Dr. Timbrell Bulstrode, one of the Board's Medical Inspectors, to inquire into and report on "Sanatoria for consumption and other aspects of the Tuberculosis question." As a result of the comprehensive investigations and inquiries made, the report has just been issued. It will be reassuring to many who have been under the impression that Phthisis and other forms of Consumption have of late years been on the increase in England to find the opposite to be the fact. Eighty years ago the annual toll from the disease was about 60,000. and it had fallen to less than 40,000 (a decline of 33 p^r cent.) two years ago, or from a death rate of 39'9 to 115 per 10.000 of population. This decline has been consistently gradual year by year, and if continued in the same proportion lor another 30 years, would result in the Mortality from Tuberculosis almost disappearing. Cancer During the year -16 deaths were registered as due to Cancer and various forms of Malignant Disease, 16 males and 30 females. 15 Examination of the death returns show the different parts of the body affected, and the age incidence, as follows:— Part Affected. Male. Female. Total. Age Incidence. Male. Female Total. Stomach and Bowels 7 10 17 35 to 40 years 1 2 3 Liver 1 2 3 40 „ 45 „ - 2 2 Urinary and Generative Organs - 5 5 45 „ 50 „ — 3 3 50 „ 55 „ 1 4 5 Breast — 11 11 55 ,, 60 „ 4 1 5 Head and Face 1 — 1 60 „ 65 „ 3 4 7 Tongue, Neck and Throat 6 — 6 65 „ 70 „ 2 3 5 Other Parts 1 — 1 70 „ 75 „ 4 4 8 Parts not Specified — 2 2 75 „ 80 „ 1 3 4 80 & upwards — 4 4 Total 16 30 46 Total 16 30 46 The death rate for the past year is .88, against 96 in 1906, .87 in 1905, and .52 in 1904; the average rate for the past five years being '76, and for the previous five years .62. Diarrhoea and Epidemic Enteritis accounted for 19 deaths during the year, one being registered in the first quarter, three in the second, eight in the third, and seven in the fourth. Last year there were 90 deaths, one in each of the first two quarters, 79 in the third, and nine in the fourth. The death-rate for the year is .36 as against 1.8 last year, and an average for the previous ten years of .73. This large decrease is due to the cool wet weather and absence of sunshine in the spring and summer, conditions which always mean a low mortality from diarrhceal diseases in the summer quarter. Fourteen deaths were of children under one year of age (seven being under three months); two between one and five years, two were of persons between 25 and 65 years, and one over 65. The mortality in Wards was as follows:—St Marys, 1; Dundonald, 4; Trinity, 6; and South Park, 8. Infantile Mortality.—By this term is meant the ratio between the deaths of infants under one year of age and the number of births in the year. 16 There were *125 of these deaths during the year, equal to 111 per 1,000 births, against 175 deaths and a rate of 147 per 1,000 last year, and an average for the past ten years of 123. The infantile death-rate is mainly influenced by the extent of the fatal epidemic diarrhoea, which occurs amongst children in the summer and early autumn, and by the epidemics of Whooping Cough and Measles. Fortunately, the deaths from Diarrhoea and Measles were much less than last year, and the mortality rate would have been very low but for an outbreak of Whooping Cough, more serious than anyxin my experience as Medical Officer of Health here, which occurred during the first four months of the year, no less than 24 of the 30 deaths from this disease taking place in this period, causing infantile death rates of 253, 179 and 145 per 1,000 births during the months of January, February and March respectively. Under the circumstances the rate of 111 per 1,000 births for the year can be looked upon as a favourable one. In Table V. is shown the deaths from stated causes in weeks and months under one year of age. Sterilized Milk Supply.—The Sanitary Committee, at their meeting in October, 1906, passed the following resolution:— " (a) That the Medical Officer of Health be directed to report to this Committee whether it is desirable " for the Council to undertake the supply of sterilized milk to the public, and (b) that information on the subject be obtained from towns where sterilized milk depots have been established by the Local Authority." I prepared an extensive report on the subject, accompanied inter alia by Tables showing:— (a) The infantile mortality rates in towns and districts where milk depots had been established and in Wimbledon. (b) Replies from the following towns: Battersea, Bradford, Burnley, Dundee, Finsbury, Glasgow, Liverpool, Leith, Lambeth, Woolwich, St. Helens, and York, giving date of establishment, initial cost, number of officials employed and salaries paid, annual cost of maintenance, amount expended on milk supply, the number of persons using depot, and income from sale of milk. *The difference between this and the total number shown in Table V. is accounted for by the inclusion in the latter of seven children dying in the Kingston Workhouse Infirmary. 17 (c) An account of the difference in the methods adopted in the working of the Battersea and Finsbury depots; the conditions contained in the contract between the Battersea Corporation and the farmer supplying the milk; the working methods at the farm which supplies Finsbury's milk. (d) Opinion from towns where efforts have been devoted to obtaining a "clean and pure milk supply from its source " rather than the establishment of sterilized or humanized milk depots. The report was considered by the Sanitary Committee at their meetings on April 16th and June 30th, who resolved:— "That it is not desirable, at the present time, for the Council to establish a Municipal Milk Depot within the Borough, and that the Town Clerk be directed to write the Wimbledon Citizens' Association and the Wimbledon Division Branch of the Middle Classes Defence Organisation to this effect." This decision was confirmed by the Council at their next meeting. Two important Bills on the subject of "pure milk supply " are promised during the coming session of Parliament, one by the London County Council to apply to London, and the other by the President of the Local Government Board. Although the exact nature of the latter is not yet public, it is understood that prominent features will be:— National and not local treatment of the milk problem. A stricter, universal and compulsory control of cowsheds, milk shops and dairies. South Wimbledon District Nursing Association and the South Wimbledon Day Nursery.- Both these Institutions are carrying on a good and increasing work, which must have an important influence on the public health. The number of visits paid to patients at their homes during the year by the Nurses (excluding the School Nurse) and Midwives of the former Institution amounted to about 4,500, and at the Day Nursery no less than 6,040 attendances were made by children while their mothers were out at work. 18 19 Isolation Hospital.—The following table furnished by the Hospital Medical Attendant, Dr. Clapham, gives particulars as to number of patients treated in the Hospital for each disease during the year. Cases admitted in 1907. Over 5 years. Under 5 years. Total. Deaths. Remarks Over 5 years. Under 5 years. Total. Scarlet Fever 179 42 221 3 2 5 Diphtheria 39 20 59 3 3 6 Tonsillitis 1 1 ... ... ... Diarrhoea 1 ... 1 ... ... ... Average daily number of Patients... 40 Total 220 62 282 ... ... ... Carried over from 1906: Scarlet Fever 25 12 37 ... ... ... Average number of days in Hospital 46 Diphtheria 2 ... 2 ... ... ... Total number of Cases treated during 1907 247 74 321 6 5 11 Disinfection.—The following table shows the number of rooms and articles disinfected:— Disease. Mattresses. Palliasses. Beds. Pillows and Bolsters. Blankets. Dresses. Suits. Other Articles. No. of Rooms. Totals. Scarlet Fever 344 251 243 866 1377 334 54 8810 331 12610 Enteric Fever 14 6 5 44 38 14 — 106 6 233 Diphtheria 87 52 63 243 252 64 22 1927 93 2803 Chicken Pox - - - - - - - 1 — 1 Measles 10 — 3 11 20 2 2 185 37 270 Consumption 38 17 18 101 71 6 11 519 30 811 Puerperal Fever 5 4 2 8 7 - — 41 2 69 Sundries 61 21 20 201 110 34 5 830 312 1594 Totals 559 351 354 1474 1875 454 94 12419 811 18391 There were 34 library books disinfected. Diagnostic Tests.—The number of specimens of serum, sputum and blood submitted for bacteriological examination to the Clinical Research Association, the Lister Institute of Preventive Medicine and St. George's Hospital during the year in doubtful cases of Diphtheria, Pulmonary Tuberculosis and Typhoid Fever, and the results of such examinations are given on page 38. Sixty-eight bottles of anti-diphtheritic serum was supplied through the Sanitary Department for use bymedical practitioners for the treatment of Diphtheria. Mortuary.—From information received from the Superintendent of the Cemetery there were 83 bodies received into the mortuary during the year, and 61 post mortems held (38 males, 23 females). Inquests were held by the Coroner with respect to 51 bodies, being equal to 106 per cent, of all deaths registered in the Borough. Factory and Workshop Act, 1901.—-Section 132 requires the Medical Officer of Health to specifically report annually on the administration of the Act in workshops and workplaces, and to send a copy of such report to the Secretary of State. The details on the forms prescribed and supplied by the Home Office have been forwarded. 20 In the Tables below is shown the work done in the supervision of workshops and workplaces Premises. Inspections. Written Notices. Prosecutions. Factories 15 2 — Workshops 110 17 — Workplaces 9 — — Total 134 19 — DEFECTS FOUND. Nature. Number of Defects. Prosecutions. Found Remedied. Referred to H.M. Inspector. Want of cleanliness 12 11 — — Overcrowding 2 2 — — Want of drainage of floors — — — - Other Nuisances 3 3 — — fSanitary Accommodation— Insufficient 1 1 — — Unsuitable or Defective 12 12 - - Not Separate for Sexes — — - — Total 30 29 - — fSection 22 of the Public Health Acts, Amendment Act, 1890, has been adopted, and the standard of efficiency and suitability required is that contained in the Secretary of State's Order, dated 4th February, 1903. 21 Home Work Lists received : — Twice in the year 10 Number of Outworkers 19 Once in the year 24 Number of Outworkers 32 Number of addresses received from other Councils 22 Number of addresses forwarded to other Councils 14 Inspections of Outworkers premises 38 Outwork in unwholesome premises:— Instances 2 Notices served 2 Prosecutions Outwork in infected premises:— Instances 1 Orders made — Prosecutions — Registered Workshops. The following are the principal classes of workshops on the register at the end of the year:— Boot Repairers 27 Dressmakers 35 Bakehouses 28 Laundries 24 Tailors 14 Milliners 16 Other Trades 54 Total 198 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 1 Action taken in matters referred by H. M Inspector as remedial under the Public Health Act "Notified by H.M. Inspector 3 Reports of action I taken sent to H.M. Inspector 3 Other 1 Underground bakehouses in use at the end of the year 3 Particular attention has been paid to cookshops, eating houses, and premises in which food is prepared for sale, and at the close of the year these premises were beiny systematically examined. With few exceptions they were found to be clean and well kept. 22 Breaches of the Act, consisting principally in want of cleanliness as regards the walls and ceilings of the kitchens, were remedied without delay. The number of bakehouses on the register is now 28, an addition of one, and the underground bakehouses, three in number, are still in use. During the investigation of a case of Diphtheria, removed to hospital, it was discovered that the occupier of the house was employed as an outworker for a local trader in wearing apparel, although no work was on the premises at the time of the infectious illness. No list of persons so employed had been received from the employer, and a communication was therefore immediately despatched directing his attention to the requirements of the Act. In the absence of a prompt reply the neglect was reported to the Sanitary Committee, who instructed the Town Clerk to take such steps as were necessary to enforce compliance with Section 107 of the Act. After the final request the list was eventually received, and the employer warned. The two instances mentioned in the Table where homework was being carried on in unwholesome premises have reference to the dirty condition of the walls or ceilings of the rooms in which the work was carried on. These were cleansed immediately notices were served on the owner. In addition to the ordinary inspections made of outwoikers' premises, each address contained in the lists received in the early part of the year, i.e., previous to February, and not included in those received in August, were visited in order to ascertain if work was still carried on, and if breaches of the Act had been made by reason of the employer failing to notify the name and address of the outworker. In no instance was this found to be the case. The workshops and workplaces, etc., inspected were, generally speaking, found to be well kept, and earnest endeavours made by the occupiers to comply with the requirements of the Act. Where any defects or nuisances were found to exist, measures were taken by the occupiers to remedy the same promptly, and in no case was it necessary to resort to legal proceedings. Water Supply. Last year I called attention to the serious inconvenience and risk to health caused to the occupiers of certain houses in consequence of the delay of the Water Board in reconnecting the water supply which had been disconnected on account of leakages in communication pipes. Strong remonstrances on the subject were addressed to the Water Board, who promised that everything possible should be done to prevent a recurrence. 23 No cause for complaint in this respect has been brought to my knowledge during the year. Respecting the practice of cutting off for non-payment of the water rate, I pointed out that in certain cases the person by whose act or default the supply was withdrawn was not the person inconvenienced, but that the occupiers were the sufferers. The Water Board have had the matter of "withdrawal of supplies" under their consideration, and a circular in the following terms showing the procedure to be observed in future, which promises the co-operation of their officials and those of Local Authorities in cases where danger to public health is at all likely to be caused, was received WITHDRAWAL OF SUPPLIES. 1. We have in the last few weeks received a number of letters from the Metropolitan Borough Councils and from Local Authorities outside London, on the subject of the disconnection of supplies consequent on non-payment of waterrates, and suggesting that the Board should discontinue what is described as the practice of the Companies in this matter. We caused the actual facts of the case to be communicated to the Authorities in question, but in view of the public interest which is no doubt taken in this matter, we have thought that it would be convenient to also deal with the subject in our report to the Board. The communications from the Borough Council and other Local Authorities originated in a resolution of the Islington Borough Council asking the Board to adopt legal proceedings instead of "cutting off," as a means of recovering water rates. In view of the statements which have been made in various quarters, it is, however, important to point out that by far the greater number of "cutting off" cases have no connection whatever with non-payment of water rate (which was the only subject dealt with in the Islington resolution), but are attributable to cases where a remedy is required by the Engineering Department for defective or irregular fittings and waste of water. We are quite sure, from the information before us, that the Board's critics have overlooked this important fact, and have taken it for granted that substantially all cases of "cutting off " are attributable to non-payment of rates. We, however, confine our attention in this Report to the particular matter raised by the Islington resolution, viz., "cutting off "for non-payment. It is a fact, no doubt, that to some extent the Board are continuing the practice of the Metropolitan Water Companies in this matter, but we think there is an essential difference in the present practice, inasmuch as the power of "cutting off" for non-payment of rates is now very sparingly used, whereas with the Companies it was almost the only method of recovery. We are fully alive to the objections against the practice of cutting off supplies, and our Sub-Committee, who examine the list of defaulters, at once recognised the force of the objections by instituting, as far as circumstances would permit, legal proceedings in lieu thereof, and arrangements are being made whereby summary proceedings for the recovery of arrears will be taken in the great majority of cases. Considerable administrative changes have had to be adopted in order to modify the practice of the Companies, and these are being carried out as rapidly as possible with a view of reducing the necessity of disconnecting supplies. 24 We would, however, point out that the effect of our operations has been to considerably reduce the number of "cutting off" notices issued, and that the process of reduction will be continued as rapidly as circumstances permit. We would suggest that if at any time the Local Authorities find that the disconnection of a supply is likely to occasion the slightest danger to the public health, they should direct their officials to communicate with the Board's officials, who would promptly act in concert with them in order to obviate the possibility of the danger referred to. Dealing with the present procedure the facts are as follows:— No supply is "cut off " for non payment of rates— (a) Without an order of the Committee after a full inquiry into the whole of the circumstances. (b) Where the premises are known to be occupied by more than one family. (c) Where inability to pay by reason of real poverty is established. (d) Where the owner and not the occupier is responsible by law or agreement for the payment of the water rate. We may add— (1) That notice to "cut off" is sent to both the Clerk and the Medical Officer of Health of the Local Authority concerned, instead of only to one of those officers as formerly. (2) That during the half-year ending Michaelmas, 1906, with 1,100,000 supplies, only 214 were withdrawn for non-payment of waterrate, and of these only about 150 were inhabited houses. (3) That with a view to giving the Local Authority information as to the reason of disconnection, we have arranged that the notices sent to them shall in future declare in all cases the reason for the withdrawal. In conclusion, we deem it advisable to call the attention of the Board to the appreciable loss of income which might result if "cutting off" as a remedy for non-payment of rates were immediately and wholly abandoned. A. B. PILLING, Clerk. Savoy Court, Strand, W.C. 1st March, 1907. Intimations were received that the water supply had been withdrawn from 18 houses for the following reasons:— 13 on account of leakages; 3 premises empty; and 2 by request. Last year the number was 51, 18 being for non-payment of water rate. Two or three complaints as to the dirty condition of the water were received. Samples were taken at each house, and, when examined, showed the presence of small particles of rust, which had probably gained access to the pipes when repairs or extensions were in progress. Alterations, such as coupling up dead ends of mains and extensions of mains, have undoubtedly improved the water supply in certain portions of the Borough, which for years has been a subject of complaint, especially in the summer time, but there is still room for improvement. 25 I understand the Water Board have in contemplation a scheme which, if carried out, will give a good supply at all times to all portions of the District. House Refuse generally is collected weekly by the Staff of the Surveyor's Department, except during the summer months, when a daily collection is made at Queen Alexandra's Court and several blocks of flats. Since May last a daily collection has been in operation in all roads on the east side of Haydons Road as an experiment. During the year 8,729 loads were disposed of at the Refuse Destructor. The appended report of the Sanitary Inspector contains a detailed record of the work carried out by the Staff of the Sanitary Department under his supervision, and I am glad to acknowledge his able and ever ready assistance on all occasions, as also the good work of the Assistant Inspectors. Mr. Johnson's duties, which are often of a most difficult and delicate nature, are carried out by him with great ability and tact, and the energy displayed by him in the public's interest at all times is too well known to be dwelt upon by me. I have the honour to be, Your obedient Servant, E. POCKLINGTON, Medical Officer of Health. 26 Borough of Mimblebon. SANITARY DEPARTMENT. Annual Report OF THE Sanitary Inspector FOR THE Year ended 31st December, 1907. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon, Gentlemen, I beg to submit my Report for the year ended 31st December, 1907, on the work carried out bv the Sanitary Department in connection with the abatement and suppression of nuisances and other matters under the Public Health Acts, The Factory and Workshops Acts, The Sale of Food and Drugs Acts and also in connection with the enforcement of the various Bye-laws made by the Local Authority, including house-to-house inspection, supervision and testing of drainage work, the inspection of Workshops, Bakehouses, Restaurants, Slaughterhouses, Butchers and Fishmongers Shops and Dairies, Cowsheds and Milkshops. Notices Served. - For the abatement of nuisances under the Public Health Acts and the remedying of contraventions of the Bye-laws and other Statutes, which come under the duties of an Inspector, one thousand and fifteen notices were served. Of this number only one hundred and ninety three 27 were Statutory Notices and were served at the instance of the Sanitary Authority. The remaining eight hundred and twenty-two were Preliminary Notices respecting defects and other matters which were complied with before the ensuing Sanitary Committee Meeting, thereby obviating the necessity for further steps. Every effort has been made to procure the abatement of nuisances, the remedying of breaches of Bve-laws, insanitary conditions, etc., by means of intimations or letters sent to the owner, agent or person concerned, or by interview. All possible information is at all times afforded by the Department, and it is pleasing to report that, speaking generally, owners of property carry out the requirements made without friction. Resort to legal proceedings is seldom necessary, and when taken it is because all efforts at persuasion and reasoning have failed. The inspection of house drains and sanitary fittings, either in the course of house-to-house inspection or after the occurrence of infectious disease, or on complaint, usually occupies the major portion of the Inspector's time. A summary giving some details of the sanitary work carried out and nuisances abated during the year will be found in appendix table VI. House Drainage.-The drainage systems at 92 houses have been entirely reconstructed and alterations and repairs, in many instances of an extensive nature, have been carried out at 52 other houses. In every case where the drains have been relaid a plan has been prepared showing the work as completed, and this is filed for future reference. The following groups of houses were redrained during the year:- * 27 and 29. Hartfield Crescent—2 houses. 1 and 2. Railway Villas 5 houses. 1, 2 and 3, Ranway Cottages 106 and 110, Palmerston Road and Stables at rear 5 houses. 83, 85 and 87 Russell Road. - 3 houses. 1-6, Granville Road -6 houses. 36, 37, 39 and 40, Quicks Road- 4 houses. 23, 25 and 27, Russell Road—3 houses. 120-126, Graham Road—4 houses. * 68-80, Pelham Road—7 houses. 105-113, Russell Road 5 houses. Of the houses re-drained during the year forty-four were included in combined systems. * The main drain reconstructed by the Corporation at the cost of the owners they having made default by non-compliance with the notices served upon them. 28 The question as to who is liable for the relaying of combined drains is a very vexed one, and the cause of much contention on the part of property owners and agents, owing to the unsatisfactory and conflicting state of the law on the subject. It has been necessary only in the case of nine houses for the Local Authority to execute the work in default of the owners. In several instances the owners have willingly reconstructed combined drains at their own expense rather than contest the legal points at issue. Frequent visits of inspection during the progress of work are necessary to ensure that the reconstruction of defective house drainage is efficiently carried out. On these occasions, owing chiefly to the employment of unskilled workmen, it is frequently found that sanitary fittings and traps of obsolete and objectionable patterns are being fixed; intercepting traps are fixed carelessly, thereby destroying the seal provided for cutting off aerial communication with the sewer; or that the drains are laid with insufficient fall, etc., etc. By making these visits at short intervals the faults are discovered before the work is far advanced, and can therefore be remedied at a minimum of trouble and expense. The smoke and water tests were applied to drains and sanitary fittings on six hundred and seventy-two occasions. All new drains had the water test applied before concreting in and again after the ground was filled in. Opening up of Drains for Examination under See. 41.— As the result of either smoke or chemical tests, applications were made to the Sanitary Committee for authority to enter the premises, open the ground and examine the drains under the provisions of Section 41, of the Public Health Act, 1875, at eighty-one houses. After examination the ground was made good, and the conditions found reported to the Sanitary Committee, who authorised the serving of notices requiring the reconstruction of the drains, water-closets, etc. Intercepting Traps.—During the month of March the Sanitary Committee had under consideration a letter from the Architect to the Local Government Board, requesting the Council to allow their officers to assist in the investigations then being made by the Board into the use of modern intercepting traps, whether in combination or not with inspection chambers, and considering the importance of the subject to the Borough, it was decided to direct the officials of the Sanitary Department to assist the Local Government Board in the proposed investigations. Examination was made of the manholes and intercepting traps at 412 premises, and a report giving the details and information asked for was sent to the Local Government Board. 29 The Board's Architect, in acknowledging its receipt, stated: "We are much obliged for the trouble and care taken in preparing the particulars asked for—the information supplied will be of much value." House-to-House Inspection was made at three hundred and thirty-seven houses in the following Streets:— Cowper Road, Nos. 2—64 and 5—53. Dryden Road, Nos. 1—49. Milton Road, Nos. 1—53 and 2—60. Garfield Road, Nos. 1—67, 72—84, and 110. Tennyson Road, Nos 1—21. Haydons Road, Nos 1—25, 29—39, and 45. Russell Road, Nos. 89—153, 61-81, 3—17, 23-31, 39-59. Railway Place, Nos. 1—13. Graham Road, Nos. 122—126. Ley ton Road, Nos. 2—50. The inspection of houses in Cowper, Dryden, Milton, Tennyson, and Garfield Roads was carried out in the Spring with a view, as far as possible, of getting the houses in a cleanly condition prior to the commencement of the hot weather. As a result of notices served no less than one hundred and fifty-eight rooms were thoroughly cleansed, the walls being stripped and repapered or distempered, and the ceilings whitewashed. Notifiable Infectious Diseases.—The measures taken under the directions of the Medical Officer of Health for dealing with cases of infectious disease are as follows:— Each case, upon receipt of the notification, is at once registered and a visit is paid to the house, an inquiry form being filled up which embodies every possible detail necessary for tracing or checking infectious disease. If removal to Hospital is required, the Matron is at once informed by telephone, and upon removal of the patient or upon recovery, if nursed at home, the bedding, clothing, etc., is immediately taken away, disinfected by steam, and the infected room fumigated. A notice is sent the same evening to the Head Masters or Mistresses of the schools attended by the patient, and all other children in the house, prohibiting their re-attendance until disinfection has been completed, and until the period of incubation fixed by the Medical Officer of Health has expired. A notice is also sent to the School Medical Officer, and to the Free Library. In addition to disinfection after cases of Notifiable Infectious Diseases rooms which have been occupied by patients suffering from other diseases, such as Consumption and Measles, are also similarly treated. During the year eight hundred and eleven rooms were disinfected either by 30 the use of Sulphur Candle or Formalin Lamp, and the spraying of walls, floors and ceilings. In three hundred and twenty-seven rooms, the paper was stripped from the walls, the ceilings whitewashed, and the floors and woodwork cleansed. Houses Let in Lodgings.- The number of houses registered under the Bye-laws is one hundred and forty-two. Only houses occupied by more than one family which on inspection are found to be in a very unsatisfactory and neglected condition are reported to the Committee for registration. Bye-law 27 requires the Landlord of every such house to cause every part of the premises to be cleansed in the month of April. Each of the one hundred and forty-two houses referred to were inspected during the month named and where the necessary work had not been done, notices were served on the Landlords calling attention to their defaults which were remedied in every case. Paving of Yards.-Intimately connected with the sanitary conditions of dwelling-houses is the necessity for imperviously paving a portion of the yards and open spaces in close proximity to buildings, and where this condition obtains, a greater inducement is given to the occupiers of houses to observe cleanly habits both in the house and surroundings. The number of houses dealt with in this manner during the year was 133. At present this requirement can only be enforced in cases where the conditions are such as can be described as a nuisance or injurious to health. While there are many houses where the conditions are far from satisfactory, it would be difficult to prove that they were a nuisance or even injurious to health. The Building Committee have under consideration a proposed bye-law for new buildings which will confer powers to require the provision of a certain amount of paving around dwellings, and the Sanitary Committee are also considering a bye-law which provides for a certain amount of paving to be done where it is necessary for the prevention or remedy of insanitary conditions, whilst the Public Health Acts Amendment Act passed last Session gives additional powers for dealing with this question. Dairies, Cowsheds and Milkshops Orders.—Under the Dairies, Cowsheds and Milkshops Order of 1885, it is necessary for all persons carrying on the trade of a Cowkeeper, Dairyman or Purveyor of Milk to be registered by the Local Authority. During the year 14 applications for registration as Dairymen and Purveyors and one as a Cowkeeper were received. There have been six changes of 31 occupation, and one has given up the business during the year. The number of persons on the Register at the close of the year was as follows:—Two Cowkeepers, 40 Dairymen and Purveyors, and 17 Purveyors. The new cowshed registered is situated on the Ashen Grove Estate, and was built during the year. The building complies in every way with the latest regulations and ideas as to construction, light, ventilation, air space, etc., and provides accommodation for 18 cows. Periodical inspections of all the registered premises have been made during the year, and in five instances breaches of regulations found, the necessary steps being at once taken to obtain compliance. Slaughter-houses.—There are six private slaughterhouses in the Borough, but at three of these only is there any considerable amount of slaughtering done. Frequent inspections were made during the year, especially when slaughtering was in progress. The provisions as to periodical lime washing were properly carried out, and in no instance was any breach of regulations discovered. Common Lodging-houses.—Only one is registered in the Borough, and is situated in High Street, Merton. It has been regularly inspected during the year, and the Bye-laws as to periodical cleansing and other matters enforced. Sale of Food and Drugs Acts, 1875 to 1899.—The following Table shows the number of samples taken, the results of the analyses, the legal proceedings taken, and the fines imposed:— ARTICLE. Test Samples. Official Samples. Prosecutions Instituted. No. Genuine Adulterated Inferior. No. Genuine Adulterated Inferior. Milk 147 133 14 ... 9 4 1 4 1 Butter 126 111 15 ... 6 i 5 ... 5 DemeraraSugar 15 8 ... 7 ... ... ... ... ... Jam 19 18 ... 1 ... ... ... ... ... Pepper 9 9 ... ... ... ... ... ... ... Vinegar 7 7 ... ... ... ... ... ... ... Coffee 6 6 ... ... ... ... ... ... ... Tartaric Acid 6 6 ... ... ... ... ... ... ... Coffee Mixture 5 5 1 ... ... ... ... ... ... Mustard 3 2 ... 1 ... ... ... ... ... Epsom Salts 3 3 ... ... ... ... ... ... ... Cream ofTartar 3 ... 3 3 ... ... ... ... ... Brawn 1 1 ... ... ... ... ... ... ... Bloater Paste 1 1 ... ... ... ... ... ... ... Margarine 1 1 ... ... ... ... ... ... ... Total 352 311 29 12 15 5 6 4 6 32 PROSECUTIONS. No. ARTICLE. Result of Analysis. Result of Proceedings Remarks.  Fines. Costs. £ s. d. £ s. d. 20 Butter A sample of margarine 2 10 0 2 0 0 26 Milk Abstraction of 10 per cent, of the milk fat ... ... Case dismissed without costs, the Magistrate being of opinion that the milk was consigned as given by the cow and not adulterated by the Defendant. 29 Butter A sample of margarine 3 10 0 2 0 0 30 „ A sample of margarine 2 0 0 2 0 0 31 „ A sample of margarine 5 0 0 2 0 0 34 „ A sample of margarine 10 0 0 2 4 0 The test samples are examined by the Council's Analyst, and those taken in accordance with the Act by the Public Analyst, Sir Thomas Stevenson. The case dismissed by the magistrates was in respect to milk sampled in course of delivery at the railway station. The consignee, a Wimbledon Dairyman, had for some time suspected the milk received by him from a certain farmer. He, himself, had 13 or 14 samples taken on consecutive days, all of which showed a marked deficiency in fat. The Public Analyst's certificate of the sample taken by me immediately the churn was put out of the train showed "a deficiency of milk fat corresponding to the abstraction of 10 per cent." A summons was accordingly issued, and after hearing the evidence of defendant and his servants to the effect that they had not added water nor abstracted fat, the magistrates dismissed the summons, being of opinion that it was as given by the cow and not adulterated by defendant. It is interesting to note that from the day the farmer received the sealed portion of the milk taken by me, thus letting him know that legal proceedings were contemplated, the milk sent by him to the same dairyman was up to the proper standard. If the milk had not been tampered with by him or his servants, the trouble he was put to by the proceedings would have been avoided had he taken the measures set out 33 in the Board of Agriculture's leaflet, No. 146, which is:— "It is a well-known fact that in the vast majority of cases the milk given by the cows of this country exceeds in butter fat and other milk solids the percentage specified in the 'Sale of Milk Regulations, 1901,' made by the Board of Agriculture. It happens, however, occasionally, that for one reason or another a cow may give milk which does not contain those percentages (3 per cent, of butter fat and 8.5 per cent, of other milk solids); and in such cases the dairyman, when prosecuted, is required to prove that the milk is genuine. In order to avoid the trouble and annoyance of a prosecution, farmers, dairymen and all other cowkeepers are strongly recommended to have samples of the milk of their cows tested from time to time. By this means they will be able to watch the seasonal and other variations in the fat contents of the milk, and by modifications in the feeding, housing or time of milking their cows, and, if necessary, by disposing of animals that give milk of low quality, to keep the quality of their milk at a satisfactory level. The Board have ascertained that, with the object of assisting farmers in the direction indicated, most of the Agricultural Colleges and Agricultural Departments of the Universities have made arrangements for determining the percentage of butter fat for a fee of sixpence per sample." Food Inspection.—Frequent inspections at irregular intervals have been made at fruiterers, fishmongers, fried fish shops, butchers, and other places where food is prepared and sold, as well as on Saturday afternoons and evenings when stalls and barrows in the streets, particularly in the Broadway and High Street, Merton, have been inspected. In several instances the vendor's attention has been called to the doubtful condition of fruit and meat exposed for sale, which have in such cases been destroyed by the vendor. One barrel of apples and five barrels of fish, purchased at Billingsgate, were brought by retailers resident in the Borough to me for inspection and destroyed at the refuse destructor. This prevents the articles being exposed for sale, as a certificate is given which enables the retailer to recover from the wholesale dealer the amount paid for the goods. Petroleum Acts, 1871 to 1879.—These Acts provide for the safe keeping of Petroleum which, when tested in the manner prescribed in Schedule 1 of the Act of 1879, gives off an inflammable vapour at a temperature below 73 degrees Fahrenheit. The ordinary Petroleum Oil, commonly used for burning in houshold lamps, flashes above 73 degrees Fahrenheit, and is therefore exempt from the operations of these Acts. Twenty-two applications to keep Petroleum and one for Carbide of Calcium were received during the year; three 34 being new licenses and 19 renewals, all of which were granted by the Council on the recommendation of the Sanitary Committee. Seventeen of the applications were for the keeping of Petrol, chiefly for use in connection with motor cars, four for Benzoline, and one for both Petrol and Benzoline. The premises have been inspected from time to time in order to see that the conditions attached to the licenses have been carried out. The conditions are those which have been suggested by the Home Secretary for the guidance of Local Authorities with modifications or additions as the circumstances of the cases require. Carbide of Calcium is kept at many of the cycle and motor shops, which are not required to be licensed as the amount is below 5 Ids. in 1 lb. tins. The same applies to several oilshops selling Benzoline, etc., where the total amount kept is below three gallons, and no single vessel is of more than one pint capacity. Legal Proceedings.—Legal proceedings under the provisions of the Public Health Acts or bye-la ws were necessary on two occasions. The first, in respect of a piece of tripe brought to me by the person to whom it had been sold by the butcher's foreman. It was certainly at the time unsound and unfit for food. The analyst examined it 14 hours after the sale, and gave a certificate describing its condition, stating:— "The tripe must have been in the condition approaching that described above at least 24 hours before being received by me, and such condition would be evident to the unaided senses." The Sanitary Committee ordered a prosecution, and the case came before the magistrates on April 10th. The Town Clerk, having stated the circumstances, which were admitted by the Solicitor for the defence, withdrew the case on the understanding that the Corporation's costs in the matter would be paid by the defence. The second case, heard on April 22nd, against the occupier of premises at the rear of Nos. 32 and 34, North Road, for the improper keeping of pigs and breach of the Sanitary Bye-laws, was adjourned for three weeks to enable the pigs to be disposed of. This was not done, and the magistrates allowed a further 14 days. The pigs having been disposed of in the meantime, the summons was dismissed on payment of costs. Diseases of Animals Acts.—An outbreak of Swine Fever occurred early in the year at premises in Plough Lane, and came to the knowledge of the Council. Proceedings were 35 instituted in the Police Court against the occupiers for "having in their possession fifteen pigs affected with or suspected of having Swine Fever, and for not giving notice of the fact to the police." Evidence was given by two inspectors from the Board of Agriculture and the chief Veterinary Surgeon for the county of Surrey. The magistrates deemed it a bad case, but on a technical point felt compelled to dismiss it. An outbreak of Glanders occurred in some stables in Hubert Road, and the affected animals were destroyed. In each instance the necessary steps for isolation of the animals in contact, and the cleansing and disinfecting of the premises, were taken. I take this opportunity to record the loyal support I have received from the Assistant Inspectors, and the willingness with which they have, when circumstances required it, worked overtime, which is often the case in the work of a Sanitary Department. I am, Gentlemen, Your obedient Servant, HENRY JOHNSON, Chief Sanitary Inspector. 36 Borough of Wimbledon. Population, Birth, and Death Rates for each Ward, 1907. WARD. Occupied Houses. Factor. Population. Birth Rate. Death Rate. St. Mary's 1243 5.43 6749 15.4 8.1 St. John's 954 5.66 5399 10.9 6.2 Cottenham Park 1128 5.10 5752 14.4 6.4 North Wimbledon 3325 5.38 17900 13.7 6.9 Dundonald 1388 5.88 8160 21.0 10.4 Trinity 1908 5.84 11140 28.0 12.1 South Park 2796 3.19 14500 26.9 12.6 South Wimbledon 6092 5.45 33800 25.8 11.9 Whole District 9417 5.49 51700 21.6 10.2 Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 27 36 63 Phthisis (Sputum) 2 12 14 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 1 5 6 38 39 BOROUGH OP WIMBLEDON. TABLE I. Vital Statistics of Whole District during 1907 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 iooo Births Registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1897 35,000 828 23.6 98 118 367 10.4 6 2 33 398 11.3 1898 37,000 963 26.02 145 150 415 11.2 11 5 32 442 11.9 1899 38,000 1031 27.13 163 158 547 14.3 18 12 33 568 14.9 1900 39,500 1075 27.21 156 145 559 14.1 18 13 24 570 14.4 1901 41,631 1074 25.79 133 123 457 10.9 20 4 40 493 11.8 1902 43,000 1144 26.6 134 117 455 10.5 21 4 46 497 11.5 1903 46,000 1204 26.1 99 82 389 8.4 18 5 40 424 9.2 1904 47,719 1142 23.9 153 133 487 10.2 29 5 46 526 11.02 1905 48,240 1146 23.7 80 69 397 8.2 29 6 35 426 8.8 1906 49,860 1185 23.7 175 147 584 11.7 31 8 55 631 12.6 Averages for years 1897-1906. 42,595 1079 25.3 133 123 465 10.9 20 6 38 497 11.6 1907 51,700 1121 21.6 125 111 480 9.2 44 9 58 529 10.2 * Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. 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. Area of District in acres (exclusive of area covered by water) 3,173 Tota population at all ages (at Census of 1901) 41,631 Number of inhabited houses (at Census of 1901) 7,572 Average number of persons per house ,, 5.49 40 BOROUGH OF WIMBLEDON. TABLE II, Vital Statistics of separate Localities in 1907 and previous years. Names of Localities. 1.—Whole District. 2.—St. Mary's Ward. 3.—St. John's Ward. 4.—Cottenhara Park Ward. S.—Dundonald Ward. 6.—Trinity Ward. 7.—South Park Ward. Year Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year Births registered Deaths at all Ages. Deaths under 1 year. Population esti mated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. j Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle , of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c.. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b c. d. a. b. c. d. a. b. c. d. 1897 35,000 828 398 98 Particulars for the se years not obtainable. 1898 37,000 963 442 145 1899 38,000 1,031 568 163 1900 39,500 1,075 570 156 1901 41,631 1,074 493 133 1902 43,000 1,044 497 134 5,270 ... 48 11 5,044 ... 45 5 3,204 ... 37 7 4,858 ... 57 14 11,783 ... 162 51 12,841 ... 148 46 1903 46,000 1,204 424 104 5 857 72 47 8 4,968 82 39 3 3,789 61 38 4 4,600 129 41 10 12,488 437 126 39 14,298 4?3 133 40 1904 47,719 1,142 526 161 6,104 86 40 8 5,393 56 40 5 3,990 92 44 11 5,480 131 63 17 13,326 396 167 54 13,426 381 172 66 1905 48,240 1,146 426 80 6,556 78 45 3 5,326 42 39 4 4,075 69 27 2 5 580 127 63 11 13,251 424 127 31 13,452 406 125 29 1906 49,860 1,185 631 175 5,733 79 51 6 5,280 42 40 4 5,574 113 62 13 8,279 183 94 24 10,634 347 165 59 14,360 421 219 96 Averages of Years 1897 to 1906. 42,595 1,079 497 134 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1907 51,700 1,121 529 132 6,749 104 55 8 5,399 59 34 4 5,752 83 37 2 8,160 172 85 19 11,140 312 135 43 14,500 391 183 56 Alterations to the boundaries of all the Wards, except South Park, were made under the Charter of Incorporation, 1905. 41 BOROUGH OF WIMBLEDON. TABLE III Cases of Infectious Disease notified during the year 1907. Notifiable Disease. Cases Notified in whole District. Total cases Notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Total cases removed to . Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards 1 2 3 4 5 6 1 2 3 4 5 6 7 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... (H.) ... ... ... ... ... (H.) ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 83 ... 23 46 6 7 1 7 3 9 16 18 30 3 1 6 15 12 25 62 Erysipelas 54 3 1 4 5 38 3 3 1 6 4 18 22 ... ... ... ... ... ... ... Scarlet fever 281 2 65 182 21 11 ... 15 6 24 36 84 116 9 2 20 29 71 85 ... Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 15 ... 1 4 4 6 ... 1 2 ... 4 3 3 ... ... ... ... ... 2 2 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 3 ... ... ... 1 2 ... ... ... ... 2 1 ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 436 5 90 236 37 64 4 26 12 41 62 124 171 12 3 26 44 83 112 280 The Isolation Hospital, provided by the Corporation, for Scarlet Fever, Enteric Fever, and Diphtheria Patients is situated in Gap Road, Wimbledon, and the Hospital for Small Pox (Croydon and Wimbledon Joint Board) at Cheam, Surrey. 42 B0R0UGH 0F WIMBLEDON. TABLE IV Causes of, and Ages at, Death during year 1907. CAUSES OF DEATH. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to localities, whether occurring in or beyond the district. Total Deaths whether of "Residents" or "nonresidents" 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. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 19 Small-pox - - - - - - - - - - - - - - Measles 10 5 2 3 — — - 2 - - - 3 5 - Scarlet fever 5 — 2 1 1 1 - 2 - 1 1 1 - 4 Whooping-cough 30 15 13 2 - - - 2 2 1 6 7 12 1 Diphtheria (including membranous croup) 6 - 3 3 - - - - - - 2 1 3 6 Croup - - - - - - - — - - - - - - Fever Typhus — — — — — — — — - — - - - - Enteric 1 — — — — 1 - — - - 1 - - - Other continued — — — — — - - - - - - - - - Epidemic Influenza 3 1 1 — — 1 - 1 - - - 1 1 - Cholera — — — — — - - - - - - - - - Plague — — - - — — — — — - — - - — 43 Diarrhœa 17 14 2 - - 1 - 1 - - 4 6 6 - Enteritis 2 — — — — 1 1 - - - - - 2 — Puerperal fever 2 — — — — 2 — — — 1 — 1 - 1 Erysipelas - - - - - - - - - - - - - - Other septic diseases - — — — — — — — — — — — — 1 Phthisis (Pulmonary Tuberculosis) 40 2 1 1 6 28 2 3 2 4 7 8 16 2 Other tubercular diseases 17 5 4 4 1 2 1 2 — 1 1 3 10 1 Cancer, malignant disease 46 — — — — 25 21 9 3 6 9 10 9 4 Bronchitis 36 8 3 — — 6 19 3 2 4 5 6 16 — Pneumonia 47 17 6 — 1 13 10 1 1 2 7 19 17 2 Pleurisy 1 — — — - — 1 — — — 1 — - — Other diseases of respiratory organs 6 1 1 — — 2 2 — — — — 2 4 - Alcoholism Cirrhosis of Liver 4 — — — — 3 1 — — — — 2 2 1 Venereal diseases 2 2 - - - - - - - - - 1 1 — Premature birth 15 15 — — — — — 1 2 1 1 6 4 — Diseases and accidents of parturition 1 - - - - 1 - - - - - - 1 - Heart diseases 54 2 — 1 3 20 28 6 3 6 10 14 15 4 Accidents 10 3 2 1 1 3 — — — 2 — 3 5 6 Suicides 2 — — — — 2 — 1 — — — — 1 — All other causes 172 42 7 6 6 42 69 21 19 8 30 41 53 11 All causes 529 132 47 22 19 154 155 55 34 37 85 135 183 44 BOROUGH OF WIMBLEDON. TABLE V. Infantile Mortality during the Year 1907. 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. 3-4 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 27 4 8 6 45 9 13 8 10 4 12 5 5 4 9 8 132 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 1 1 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 1 2 ... 4 ... ... 3 1 3 15 Diarrhceal Diseases. Diarrhœa, all forms ... ... ... ... ... ... 1 1 3 1 1 ... ... ... ... ... 7 Enteritis, Muca enteritis, Gastro-enteritis ... ... 1 ... 1 2 2 ... ... ... ... ... ... ... 2 ... 7 Gastritis, Gastro- intestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 45 Wasting Diseases. Premature Birth. 10 ... 1 1 12 1 2 ... ... ... ... ... ... ... ... ... 15 Congenital Defects 6 1 1 ... 8 1 1 ... ... ... ... ... ... ... ... ... 10 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 6 1 ... 3 10 1 2 3 ... ... ... ... 1 ... ... ... 17 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 3 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 Other Causes. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Convulsions ... 2 1 ... 6 ... ... ... 1 ... ... ... ... ... ... ... 9 Bronchitis ... ... 1 1 2 1 ... 1 1 1 1 ... ... ... 1 ... 8 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... 1 1 2 ... 2 2 1 1 4 ... ... ... ... 2 18 Suffocation, overlying ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other Causes 2 ... 1 ... 3 ... 1 ... 1 ... 1 ... 1 ... 2 1 10 27 4 8 6 45 9 13 8 10 4 12 5 5 4 9 8 132 Births in the year—Legitimate, 1,074. Illegitimate, 47. Deaths from all Causes at all Ages, 529. Deaths in the year of—Legitimate Infants, 129. Illegitimate Infants, 3. Population— Estimated to middle of 1907—51,700. TABLE VI. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision of the Sanitary Department:— Accumulations Removed 23 Cisterns Provided 1 Cisterns, Repaired, Cleansed or Covered 82 Drains, New Provided 92 Drains, Repaired or Altered 52 Drains, Stoppages Removed 45 Dustbins Provided 64 Flushing Boxes, New Provided 57 Flushing Boxes, Repaired 79 Manure Receptacles Provided 2 Overcrowding Nuisances Abated 9 R.W. Pipes Disconnected 38 Roofs Repaired 50 Rooms Disinfected 811 Rooms Stripped and Cleansed 700 Soil Pipes, New Provided 33 Soil Pipes, Repaired or Altered 4 Ventilating Pipes, New Provided 90 Ventilating Pipes, Repaired or Altered 9 Waste Pipes, New Provided 26 Waste Pipes, Repaired, Disconnected orTrappec 39 Water Closets, New Provided 92 Water Closets, Repaired or Ventilated 18 Water Service Restored 18 Yards Cleansed 13 Yards Paved 133 Guttering Repaired 32 Floors Ventilated 32 Nuisances Abated from Damp Walls 25 Other Nuisances 331 Total 3,000 46