WIM O53 Wimbledon Urban District Council. SANITARY DEPARTMENT. ANNUAL-REPORT of the MEDICAL OFFICER OF HEALTH, FOR THE YEAR ENDED DECEMBER 31st, 1903. Gentlemen, I have the honour to submit my Annual Report for the year ending December 31st 1903, with statistical returns of deaths and infectious diseases in the District, the methods adopted for the prevention of disease and the general work of the Sanitary Department. It is my privilege to again congratulate the Council on the exceptionally healthy state of the District as shown by the extraordinary low death-rate of 8.22, which is the lowest it has ever fallen to my duty to record. The past year has been an unusual one in many respects, as for instance the abnormal rain-fall of about 405 inches, which is 14" above the average for the last 25 years, but it certainly has had its beneficial effects ; the constant washing of the atmosphere and the thorough cleansing and scouring of the drains and sewers undoubtedly being important factors in the reduced general, infantile and zymotic death-rates. Population. The calculations for the deaths and other rates in the tables of this report are based on a population estimated to the middle of the year as 46,000, and checked on the assumption that the birth-rate will remain the same for a number of years as it was found to be at the last census. Births. The number of births registered was 1204 (591 males, 613 females), which is 60 more than last year, and equal to a birth-rate of 26.1 per thousand per annum, .5 per thousand lower than last year, 2 the average for the last ten years being 26 45. The corresponding rate in England and Wales for the same period is given as 28'4, in the report of the Registrar General. Deaths. The total number of deaths registered was 389 (180 males and 209 females), equal to a death-rate of 8'4 per thousand living per annum. After making the usual corrections as required by the instructions of the Local Government Board the total number of deaths properly belonging to the District is found to be 424, and the death-rate 9.2, the death-rate for England and Wales for the same period being 15'4. The deaths occurring outside the district among persons belonging hereto which have come to my knowledge were 35 in the Kingston Infirmary, and 5 in the Brookwood Asylum. The deaths which occurred in public institutions within the District of persons not belonging thereto were 4 in the Atkinson Morley Convalescent Hospital, Copse Hill, and 1 in the South Wimbledon Cottage Hospital. Ninety-nine deaths of children under 1 year of age were registered, and this infantile mortality is represented by a ratio of 82.22 deaths of infants under 1 year of age to 1000 registered births, being a decrease of 34'91 from the previous year and is the lowest rate of any year for which we have records. The same rate for England and Wales for the same period is 132. Between the ages of 1 and 60, there were 169 deaths, and 121 of persons aged 60 years and upwards. The number of deaths from Zymotic diseases was 34, viz:— Scarlet Fever 1, Measles 4, Diphtheria 4, Diarrhoea 13, Whooping Cough 9, Enteric Fever 2, and Erysipelas 1, giving a zymotic death-rate of .73 per thousand of the population per annum. There were 24 deaths from Bronchitis, 22 from Pneumonia, 27 from Phthisis, 3 from Pleurisy, and 8 from other respiratory diseases. See Table 4 in which is classified the whole of the deaths, their causes and ages, and in column 3 will be found the chief causes of mortality amongst infants under 1 year of age. Comparing the deaths from respiratory diseases with those that occurred last year a satisfactory decrease is noted, and in some measure this may be accounted for by the mildness of the Winter and Spring. The deaths from Pneumonia number 22 against 46, and from Bronchitis 24 as against 36 last year. 3 Table A shows the births, deaths 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-rate from zymotic diseases for the past 10 years. TABLE A. 1903 1902 1901 1900 1899 Births 1204 1144 1074 1075 1031 Deaths 389 455 457 559 547 Death-rates 8.4 10.5 10.97 12.7 13.02 DEATHS— Under 1 year 99 134 133 156 163 Over 1 year and under 60 years 169 192 206 239 230 Above 60 years 121 129 118 164 154 From Measles 4 11 10 17 1 „ Scarlet Fever 1 0 1 0 2 „ Small Pox 0 0 0 0 0 „ Diphtheria 4 7 6 10 12 „ Diarrhœa 13 6 24 19 21 „ Whooping Cough 9 17 13 5 15 ., Enteric Fever 2 3 0 5 6 „ Puerperal Fever 2 0 0 0 1 „ Erysipelas 1 3 0 3 1 „ Influenza 5 6 9 19 19 4 TABLE B. DISEASES. 1903 1902 1901 1900 1899 Cases Notified. Deaths. Cases Notified. j Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 9 0 3 0 1 0 0 0 Diphtheria 58 4 80 7 60 6 64 10 64 12 Erysipelas 40 1 46 3 52 0 49 3 72 1 Scarlet Fever 113 1 128 0 90 1 112 0 149 2 Enteric Fever 15 2 16 3 12 0 20 5 47 6 Puerperal Fever 4 2 3 0 2 0 0 0 4 1 *Measles 104 4 1026 11 453 10 1069 17 273 1 Totals 324 14 1308 24 672 17 1315 35 609 23 *Measles notifiable from June, 1898 to June, 1903. TABLE C. 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 Zymotic Rate. .73 1.02 1.5 1.77 1.83 2.0 2.0 1.63 2.03 1.5 CHART SHEWING WEEKLY NOTIFICATIONS OF SCARLET FEVER. 5 Scarlet Fever Notifications respecting 113 cases of Scarlet Fever were received during the year, only 1 terminating fatally, and this child was in a comatose condition when removal to the Isolation Hospital was requested. 80.5 per cent. of the patients were removed to the Isolation Hospital for treatment, the remainder being nursed at home. Table 3 shows at a glance the age distribution of the whole of the infectious diseases notified and the Wards in which they occurred and from which they were removed to Hospital. The attack rate for this disease was 2.4 per thousand of the population. Of the 113 cases notified 63 attended school, viz:—Queen's Road, 12; Merton 9; Effra Road, 7; Dundonald, 7; Central, 6; Haydons Road, 5; Holy Trinity, 4; Roman Catholic, 1, and Private Schools 12. The type of the disease was very mild and in several instances the parents were unaware that their children were suffering from anything more than ordinary colds, owing to there being so little constitutional disturbance. These mild cases are undoubtedly frequent sources of infection to others by the very fact of their being so slight and consequently less care taken, and probably Medical Men not called in until a later stage of the illness is reached Diphthena. Fifty-eight cases of Diphtheria were notified during the year against 8o for last year, representing an attack rate of i'2 per r,ooo of the population against 1.8 for 1902. There were four deaths, 3 of which took place at home and the other at the Isolation Hospital where it had been removed after tracheotomy had been performed. Of the three, two at the time of notification were too ill to be removed and consequently the operation of tracheotomy was carried out at home ; in the other fatal case it was unknown to be Diphtheria until the post mortem examination ordered by the coroner had been made. See table three which shows the distribution of the whole of the infectious diseases notified and the wards in which they occurred and from which they were removed to Hospital. Of the fifty-eight patients, 30 (51%) attended schools viz:— Holy Trinity 7, Queens Road 6, Central 4, Haydon's Road 3, Roman Catholic 2, Effra Road 1, Cottenham Park 1, and private schools 6. 6 The fifty-eight cases occurred in fifty houses, in two houses three patients and in four others two each. Serious defects of the sanitary arrangements or drainage systems were discovered in eight of the premises. In past reports I have expressed an opinion that Diphtheria is not attributable to defective drains and insanitary conditions to the extent that it is often thought to be, but more to dampness and wet subsoil, although undoubtedly the former are means of lowering the system and making one more susceptible to the disease. This appears to be borne out by the fact that over 51% of the total cases of this disease have occurred South of Trinity Road, and in only 2 of these houses were either defective drainage or insanitary arrangements found to exist. Several instances occurred where the evidence points strongly to the infection having been received from what was looked upon as an ordinary sore throat and for which it was not deemed necessary to seek medical advice. Typhoid Fever Fifteen persons were notified as suffering from Typhoid or Enteric Fever during the year, representing an attack rate of '32 per thousand of the population. Seven of the patients were removed to the Isolation Hospital, one of whom died, and the other fatal case which occurred took place in the North Wimbledon Cottage Hospital. The case mortality from this disease was 13%. Last year there were 16 cases and 3 deaths, in 1901, 12 cases and no deaths, in 1900, 20 cases and 5 deaths, and in 1899, 47 and 6 deaths. Patients ages are shown in Table 3. Of the cases notified none were confirmed by Widal's test through the Sanitary Department, but whether they were tested privately I have not been able to ascertain. At only one house was there defective sanitary arrangements or drainage found. In three instances the disease appears to have been contracted either at the seaside when on holidays or before the patient took up residence in Wimbledon. With the exception of some of the patients who were removed to the Isolation Hospital, the disease was of a mild type and ran its normal course. In only one house did a secondary case occur. 7 The following are details of each case as far as obtainable:— No. Ward. Person attacked. H.-Removed to Hospital. Probable Source of Infection, and Remarks. 1 Dundonald Male, aged 39. — New house. No insanitary defects. Meals in Town. No evidence as to infection. 2 Trinity Male, aged 13½. H. From shell fish. Remainder found to be bad. New house. 3 Trinity Male, aged 12. H. Fell in stagnant water whilst fishing. Sanitary arrangements at home good. 4 Trinity Male, aged 17. H. No evidence. Sanitary arrangements good. 5 St. John's Female, aged 34. — Notified from the Cottage Hospital. Admitted for acute anaemia. Fatal. 6 Trinity Male, aged 13. — House drains and sanitary arrangements defective. 7 Dundonald Female, aged 23. — Defective sanitary arrangements. 8 St. John's Female, aged 29. H. Employed at West End Office. Illness commenced immediately on return from seaside. Sanitary airangements of home satisfactory. 9 South Park Male, aged 26. 11. New house. Infection probably contracted at work place outside district. Fatal. 10 Dundonald Female, aged 6. H. No evidence. Drains and sanitary arrangements ot house satisfactory. II Dundonald Male, aged 40 H. Secondary case. 12 St. Mary's Female, aged 25. - Probably contracted before coming to reside in District. '3 St. John's Female, aged 18. — No evidence. Drains and sanitary arrangements in good order. 14 St. John's Female, aged 4§. — No evidence. Drains and sanitary arrangements in good order. 15 Trinity Male, aged 1½. - No trace of Infection. Drains and sanitary arrangements good. 8 Small Pox. The district was quite free from this disease during the year but several suspicious cases of illness occurred in which I was asked by the Medical Attendant to assist in the diagnosis. Fortunately these proved not to be Small Pox. Measles. The period of five years, for which the Local Government Board sanctioned the inclusion of Measles amongst the notifiable diseases under sections 6 and 7 of the Infectious Disease Notification Act 1899, expired in June last, and it will be within the recollection of the Council that I reported to the Sanitary Committee at their Meeting in September 1902, and gave reasons why it was not advisable in my opinion that the Local Government Board should be requested to extend the time. The chart appended gives a graphic illustration of the number of notifications received and the deaths month by month during that period. When I advocated the compulsory notification of Measles I hoped it would have enabled us to prevent the spread of the disease in epidemics and decrease the extent of the mortality. The 5 years experience proved that my hopes were not realised. Although I could not recommend the Council to continue the compulsory notification, yet no steps which the Local Authority, Philanthropic bodies, district visiters or nurses can take in educating the public to the knowledge that the disease is a dangerous one, should be neglected. For the purpose of my report to the Sanitary Committee in October 1902, enquiries were made of some 70 places in which Measles had been for some period a notifiable disease, and of the 60 replies received it was shown that in 41 compulsory notifications had been revoked, and the 19 places in which it was still in force 9 expressed the opinion that the benefits were doubtful, 5 considered it useless, and the remaining number stated that it was beneficial in preventing excessive mortality only. The reply from the Medical Officer of Health of the City of Edinburgh, where the notification had been tried for 22 years and where Hospital Isolation of Measles had as far as possible been carried out, is most significant, and I therefore quote the following extract from his report:— " Unfortunately, I have to acknowledge that my hopes have been falsified. Owing to the fact that the infection has usually become disseminated to a considerable extent before the noti- Uhart shewing number ot Notifications of Measles received each month during the 5 years for which it was a notifiable disease viz-- June 1888 to June 1303. 9 fication of the first case is received, and also to the fact that we have only a limited power to compel isolation in hospital, epidemics have continued to recur. So swift and general is the spread, that the City from a state of apparent immunity from the disease one month, during the next few weeks, two or three thousand cases may occur, rendering the work of disinfection and isolation of the houses by the ordinary staff impossible. It is also evident that to provide hospital accommodation sufficient to deal with a disease which within a few weeks attains such vast proportions, is not possible." The system in force before the compulsory notification, by which the heads of the elementary schools sent to the Sanitary Department the names and addresses of any children absent and the cause of which was suspected to be Measles, was of good service, but the passing of the last Education Bill under which the District Council has become the Education Authority will greatly facilitate the making of arrangements whereby the Sanitary Department can be as early as possible acquainted with the non-attendance of any scholar whose absence is suspected to be due to any of the many infectious diseases, both notifiable and otherwise, and thus give the Medical Officers of Health and Officers of the Sanitary Authority an early opportunity of visiting the homes, making enquiries and taking such steps as are necessary in the interests both of the scholars, schools and public. Diarrhœa. During the year the deaths of 13 persons were attributed to this disease, 9 of which were under 1 year of age. There were also 6 deaths from Enteritis. It is difficult to make comparison with the numbers for previous years, as the effects of the memorandum issued at the end of the year 1900 by the Society of Medical Officers of Health, and the instructions of the Registrar General to registrars of births and deaths (a copy of which was included in my annual report for 1901) is only just seen, but in future this more uniform system of classification will enable reliable and comparable statistics to be obtained. Crysipelas. Forty cases of this complaint were notified and one death registered, against 46 cases and 3 deaths last year, and 52 cases and no deaths in 1901. Whooping Cough. Nine deaths occurred from this disease all of children under 5 years of age. There were 3 deaths each in Dundonald and South Park Wards, 2 in Holy Trinity Ward, and 1 in Cottenham Park Ward. 10 The remarks as to the danger in neglecting suitable treatment in Measles applies with equal force to Whooping Cough, but fortunately the warning cough in the early stages of the illness speaks for itself. Last year there were 17 deaths, 13 in 1901, and 5 in 1900. Influenza. Influenza was the cause of 5 deaths, against 6 last year. This disease is undoubtedly looked upon too lightly by many people. Persons attacked should not stand out against the disease, but at once seek rest and warmth, preferably taking to bed immediately at the onset or appearance of the symptoms ; on no account should they attend public meetings, and where possible avoid travelling in public vehicles, as when suffering from Influenza they are particularly liable to contract other infectious disease including Phthisis and Pneumonia. Tuberculosis Fifty deaths occurred from Phthisis and other forms of Tuberculosis, against 33 last year, and 43 in 1901. At first sight it would appear that this number is much in advance of that of last year, but really this is not so, as owing to a new form (Table 4), in which the sub-divisions of several of the diseases are different, some of the deaths formerly placed under the heading "constitutional" are now included in "other forms of tuberculosis." The following Table shows the death-rate per thousand of the population from Tuberculosis in Wimbledon during 1903, and the previous 10 years, with the averages for those years:— Year. Estimated Population Number of Deaths. Death Rate. 1893 28,000 28 1 1894 30,000 34 1.1 1895 31,000 38 .9 1896 33,000 28 .8 1897 35,000 21 .6 1898 37,000 35 .9 1899 38,000 40 1.05 1900 39,500 25 .6 1901 41,630 43 1.04 1902 43,000 33 .7 Averages for years 1893-1902. 35,613 32 .89 1903 46,000 50 1.08 11 Puerperal Fever Four notifications of Puerperal Fever were received during the year, two of which proved fatal. Infantile Mortality The number of Infants who died during the year under 1 year of age was 99, and is represented by a ratio of 82 22 to every thousand births registered, being a decrease of 34.91 from last year, and 46.23 of the average for the past 10 years. This satisfactory result is due to several reasons, such as to the lesser number of deaths from such diseases as Whooping Cough, Pneumonia and Enteritis, but chiefly to the meteorological conditions which have prevailed. The past 2 or 3 years have been comparatively sunless ones, and the summers distinguished by the total absence of any spell of hot or extremely dry weather. Isolation Hospital During the year 136 patients were removed to the Hospital, 91 being notified as suffering from scarlet fever, 38 Diphtheria, and 7 from typhoid fever. There were 3 deaths in the Hospital, 1 from scarlet fever, 1 from diphtheria, and 1 from typhoid fever. The percentage of admissions to notifications in the 3 classes of disease were as follows:—Scarlet fever 80%, diphtheria 65%, and typhoid fever 46%. The following is a return of the Medical Officer for the Isolation Hospital, Dr. Clapham, showing particulars of the patients treated in the Hospital during the year. 12 ISOLATION HOSPITAL. Cases admitted in 1903. Over 5 years. Under 5 years. Total. Deaths over 5 years. Deaths under 5 years. Total deaths. Remarks. Scarlet Fever 64 30 94 1 ... 1 Diphtheria 22 13 35 ... 1 1 Enteric Fever 7 7 1 1 Measles 2 2 ... ... ... Tonsillitis 2 2 ... ... ... Total 97 43 140 2 1 3 Daily average number of Patients in Cases carried from 1902 Average length of detention of each Patient in Hos- Scarlet Fever 12 11 23 Diphtheria 4 10 14 Enteric Fever 1 1 Total number of eases treated during year 1903 114 64 178 2 3 18//2 January, 1904. (Signed) EDWARD CLAPHAM, M.D., Medical Officer. 13 Disinfection The following Table shows the number of rooms and articles disinfected after each disease— Diseases. Mattresses. Paliasses. Beds. Pillows and Bolsters. Blankets. Dresses. Suits. Other Articles. Rooms. Totals. Scarlet Fever 133 87 87 365 459 63 38 3711 144 5087 Diphtheria 67 54 52 174 203 38 13 2063 78 2742 Typhoid Fever 13 12 5 34 34 1 1 208 5 313 Measles 27 — 1 35 81 2 6 293 9 454 Puerperal Fever 5 2 — 7 8 1 1 58 3 85 Erysipelas 1 2 1 3 2 — — 29 2 40 Other Diseases 20 6 6 38 38 14 6 500 15 643 Totals 266 163 152 656 825 119 65 6862 256 9364 There were twenty-eight Library books disinfected. On the removal of the patients to the hospital, or when nursed at home on their recovery, disinfection is carried out as follows:— The rooms are fumigated either by sulphur di-oxide, or sprayed by means of the "Invicta" sprayer with formalin solution, sometimes in combination with the Alformant lamp; the clothing and bedding is removed to the disinfecting station and there disinfected by steam. When investigating cases of infectious disease, the attention of the occupier is called to the provisions of the Public Health Act, 1875, and the Infectious Disease Prevention Act, 1890 by means of leaflets, against the exposing of infected persons and clothing, one of which is a notice required by Act of Parliament to be given calling attention to sections 7 and 14 of the latter Act. The second leaflet gives instructions as to the process of disinfection required after each particular disease, as follows:— 14 Wimbledon Urban District Council. SANITARY DEPARTMENT. NOTICE. Infectious Disease (Prevention) Act, 1890, Dangerous Infectious Diseases. DISINFECTION. TO THE OWNER OR OCCUPIER. An infected room and its contents being unable to be effectually disinfected without skilled supervision and special appliances, the Officers of the Sanitary Department of the Council are instructed to fumigate the room and disinfect the bedding, clothing, etc., in accordance with the requirements of the Medical Officer of Health. The complete process of cleansing and disinfecting required is as follows:— 1. *To remove the bedding, clothing, and unwashable articles to the steam or hot air disinfecting apparatus, and useless articles for destruction by fire. 2. To well boil the washable articles. 3. *To fumigate the air of the room. 4. To strip the walls and burn the paper in the room, to wash the ceilings and walls, and to wash and cleanse all paint and woodwork, including the floor and furniture etc. After Small Pox, Scarlatina or Scarlet Fever, Diphtheria, or Membranous Croup, and Typhus Fever, the complete process (1, 2, 3 and 4) is required. After Cholera, Typhoid or Enteric, Continued, Relapsing and Puerperal Fevers, Parts 1 and 2 only of the process are required. After Erysipelas and other Infectious Diseases no action is taken except by special request. *Parts Nos. 1 and 3 are performed by the Sanitary Authority, without charge during the day. Special request must be made for night disinfection. Parts Nos. 2 and 4 to be carried out by the Owner and Occupier. N.B.—The Owner of the infected bedding, clothing, or other articles, is liable to a penalty for refusing to deliver them over to the Officer of a Sanitary Authority for removal for the purpose of disinfection, when required to do so by notice. 15 In the case of measles or deaths after consumption, cancer, etc., disinfection is encouraged, and on the request of the occupier or medical attendant the rooms are fumigated and the clothing and bedding, etc., disinfected. Diagnostic The number of specimens of secretion and blood submitted to the Clinical Research Association, and the Lister Institute of Preventive Medicine during the year in doubtful cases of diphtheria and typhoid fever, and the results of examination were as follows:— Bacillus found. Bacillus not found. Total. Diphtheria Secretion 15 38 53 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) — 5 5 These numbers are somewhat less than last year. Mortuary. There were 92 bodies received into the mortuary during the year, and 37 post-mortems made (35 males and 12 females). Inquests were held by the Coroner with respect to 37 bodies, being equal to 9.5 per cent. of all deaths registered in the district. Water Supply The district is supplied with water by two of the companies which supply the Metropolis, viz:—The Southwark and Vauxhall for that part of the district north of a point some little distance above Worple Road, and the remaining portion by the Lambeth Water Compiny. From time to time during the year complaints were received from house-holders complaining of the dirty condition of the water, who before complaining had thought their storage cisterns required cleansing and had this done, but still the water continued to be dirty. When water was drawn from the rising main it was of a deep brown colour. Mr. Croper, your Surveyor, reported to his committee the condition of the water supplied to the public swimming bath in Latimer Road and stated that the colour of the water when the pond was filled was of a deep brown colour. 16 The following table gives the mean of the analyses of samples taken during the year 1903 and extracted from Professor T. E. Thorpe's monthly reports to the Registrar General; from these figures it will be seen that the supply of the Lambeth Water Company is the least satisfactory. Company Supplying. Oxygen consumed in 4 hours at 8o° F. (Measure of organic pollution.) Organic Nitrogen found. Albuminoid Ammonia. (Measure of Nitrogenous organic pollution.) Remarks. Kent. .008 .005 .0015 Supplied from deep wells. New River. .064 .014 .0050 Supply partly from wells. East London. .113 .024 .0100 Chelsea. .126 .023 .0102 Supply from the Thames. West Middlesex. 130 •024 0106 Southwark. .136 .024 .1100 Grand Junction. .141 .028 .0200 Lambeth. .147 .028 .0116 The following extracts are from the same monthly reports, and will be of interest:— January.—All the Thames derived supplies contained considerably larger amounts of organic matter than were found in November. The Grand Junction and Lambeth Companies supplies were the worst in this respect, and also contained the highest mean proportion of organic matter, and were senerally inferior in quality to the supplies of the other companies. February.—The supplies of the Grand Junction and Lambeth Companies contained considerably larger proportions of organic impurities than were found in the previous month, and were of in- 17 different quality. On several occasions the proportions actually found were greater than had been observed in any of the filtered Thames waters for more than two years past. April.—The Lambeth and Grand Junction supplies were, owing to the insufficient storage possessed by these companies, adversely affected, and at the times when the monthly samples were collected were found to be of somewhat indifferent quality on account of their containing excessive proportions of vegetable organic matter. July.—The water drawn from the mains of the Southwark, Grand Junction, and Lambeth Companies on the 23rd June was of very unsatisfactory quality, owing to its deep brown colour and the excessive amount of organic impurity which it contained ; the Southwark Company's water was by far the worst, and from a search through the analytical records it appears that not since February, 1869, has such a large amount of organic matter been observed in a filtered London water. NOVEMBER.—The water distributed by the Southwark, Grand Junction, and Lambeth Companies on the same date was of very unsatisfactory quality, the amount of organic impurity present, being practically as great as that contained in certain samples taken from these Companies mains in May and June, when the quality of the water was exceptionally bad. For purposes of comparison the Kent Water Company might be taken as a standard, the Analyst's Report invariably reading—"this supply was as usual of high organic purity and excellent in quality." Dairies,Cowneeds and Milshope The Register kept in accordance with the provisions of the Dairies, Cowsheds and Milkshops Orders contains the names of 7 cowkeepers and 45 dairymen and purveyors of milk. Four have been added during the year, and immediately on registration the premises have been visited, and any insanitary conditions or circumstances which rendered them unsuitable for the business to be carried on remedied, and brought into compliance with the regulations of this Authority. Three have been removed from the Register on account of the person registered either giving up business, or having removed from the district. The cowsheds have been inspected quarterly, and the premises of dairymen and purveyors of milk at irregular intervals. 18 A serious epidemic of illness, which occurred at Woking, and alleged to be due to a contaminated milk supply, brought into prominence the question which has been much discussed of late years, viz., as to the advisability of all milch cows being under proper veterinary inspection, with a view to preventing the sale of milk from cows suffering from tuberculosis or other diseases, and many local authorities have appointed veterinary surgeons for that purpose. Enquiries were made of all milk sellers in Wimbledon as to the source of their supplies, but none came from the district in question. In Wimbledon the number of milch cows kept decreases yearly, as they must, as building operations extend, requiring the land hitherto used for pastures. The cows kept here are under private veterinary inspection, which I have every reason to believe to be thorough, and 1 do not think the appointment of a veterinary surgeon by the Council would be of much benefit or protection, seeing that the greater part of the milk supply is obtained from districts some considerable distance away. However I would strongly support any measures which would bring about a national system of veterinary inspection, and thereby ensure uniformity throughout the Kingdom. Slaughterhouses The number of premises on the slaughter-house register remains the same as last year, viz., 6. At three of these a considerable amount of slaughtering is carried on. Frequent inspections have been made at all hours, day and night, and they are generally well kept, the byelaws being complied with in every way. These premises are all registered or licensed under the provisions of the Public Health Act, 1875, which licenses can only be withdrawn or revoked by the Justices after two convictions for non-observance or breach of bye-laws. Local authorities are now empowered by the Public Health Acts Amendment Act, 1890 to grant licenses for a specified time, not less than a year, which is to be mentioned on the licence, for slaughter-houses erected after that date. Common Loding Houses The common lodging-house in High Street, Merton, which was fist registered as such in December of last year, has been visited from time to time for the purpose of seeing that the requirements of the Public Health Act, and the bye-laws of the Council have been complied wilh. 19 Houses let in Considerable difficulty is experienced in dealing with this pro- Nos.'ci2-76 Pert)'j which is undoubtedly the worst kept in the district. The High Streei houses are of modern construction, with good drainage, are provided Merton. . with sanitary conveniences, including baths ; but owing to the apathy of the owner and the class of some of the tenants, the drains and water- closets are continually choked, the walls damp from the defective roofs and guttering, and some of the rooms when inspected were found in a most filthy condition. The matter was reported to the Sanitary Committee by the Sanitary Inspector in September last, with a view to the premises being registered as houses let in lodgings or occupied by members of more than one family. The bye-laws with respect to this class of house authorise the Authority to require certain information from the owner concerning the rooms and occupants, and gives authorised officers powers of access at all times, regulates the number of persons who may occupy such rooms, promotes the cleanliness and ventilation, and requires the periodical limewashing and cleansing, paving of yards, etc. Unfortunately when the return required from the owner was sent in the rents paid in most instances was found to be above the limit to which the bye-laws applied, viz., 7/- per week unfurnished, or 9/6 per week furnished for each letting. The procedure under these bye-laws for the remedying of insanitary defects (penalties being imposed for the non-observance) would have been much more simple than under the provisions of the Public Health Act which necessitates the serving of a notice requiring the abatement of the nuisance which has to be proved, and although remedied may recur from time to time, calling for the repetition of the service of a notice. In order to keep this property in anything like sanitary condition, constant inspections have had to be made by your officers. Factory and The making of the register of all workshops in the district as Workshops Act 1901. quired hy section 131 of this Act, which was commenced last year and Report to suspended on account of an outbreak of measles, has been completed. Secretary of There are 237 workshops on the register :— State. Bakehouses 24 Boot Repairers 30 Cabinetmakers and Upholsterers 7 Cycle Makers 12 20 Dressmakers 42 Ironmongers 7 Laundries 39 Milliners 15 Printers 8 Tailors 13 Watchmakers 9 Other Trades 31 Number of additional workshops notified by Government Inspector 6 Number of workshops found to be occupied and not notified 37 Number of domestic workshops on register 21 Number of firms employing outworkers 6 Number of outworkers notified 20 Number of reference to H.M. Inspector of Factories 3 On the completion of the register the re-inspection was commenced, but in consequence of the short time which had elapsed since the premises were first inspected, they were, with one or two slight exceptions, such as dirty walls and ceilings, flushing cisterns and water-closets out of order, found in good condition and in conformity with the Act. BAKEHOUSES. The number of bakehouses on the register is 24, one less than last year, two of the underground ones being abolished and a new bakery opened. All of these have been inspected twice in order to see that the periodical cleansing and limewashing has been carried out, and at other times to see that the general provisions of the Act were complied with. Underground Bakehouses.—The circular addressed by the Home Office to District Councils and dated May 14th 1903, respecting the Factory and Workshops Act 1901, said, "with a view to preventing hardship to the occupier and dislocation to trade, that ample notice should be given before January 1st 1904, to the occupier of any bakehouse which is considered unsuitable by the Council, in 21 order that he may be able to complete the necessary alterations by that date, or in the event of a certificate being refused altogether, to give notice to terminate his tenancy." The Secretary of State suggested that the Council, if they had not already moved in the matter, should now take steps to carry out their duties in connection with the certification of bakehouses under Section 101; and should intimate to occupiers at as early a date as possible whether a certificate would be granted or refused, and, in the event of a refusal, by what alterations (if any) the bakehouse could be brought into conformity with the requirements of the Council. Previous to this I had visited each of the premises, the Sanitary Inspector having on several occasions done so, and had pointed out to the occupiers what would be necessary to be done before a certificate of fitness could be granted. On June 17th a joint report by myself and Mr Johnson was submitted to the Sanitary Committee, showing the exact condition of each of these bakeries, suggesting, that as representatives of the Incorporated Society of Medical Officers of Health and the Master Bakers Association had recently met in conference the Head Officials of the Factory Departmental the Home Office and discussed a provisional schedule of requirements for underground bakehouses as adopted by the former body,, that these, as modified by the conference, should be taken as a basis of requirements for premises to which it referred in Wimbledon, with any modification or extension that any individual case may require, and with the understanding that the occupier could appeal to the committee if he considered the requi' ements unreasonable or contrary to the spirit of the Act. A copy of the schedule of requirements (as below) was sent to the occupier of each. REQUIREMENTS FOR UNDERGROUND BAKEHOUSES. A.—Construction. 1. No underground bakehouse shall be less than 7ft. 6in. in height throughout measured from the floor vertically to the ceiling, and in case the floor area exceeds 300 sq. ft., such height shall be at least 8ft. 2. The floor shall be constructed of hard, smooth, durable and impervious material. 3. The walls shall be constructed of a material which is hard, smooth, durable and impermeable to damp. 22 4. The ceiling shall be even, impermeable to damp and dust, and durable. 5. Every underground bakehouse shall be approached by a suitable staircase adequately lighted and ventilated. No outside staircase shall terminate within an underground bakehouse. Any opening into the shop above must be covered to prevent the entrance of dust. B.—Light. 6. The underground bakehouse shall be adequately lighted with daylight throughout, to the satisfaction of the Sanitary Authority, and the lighting maintained shall be such that an Official Copy of the Abstract of the Factory Act may ordinarily be read in all parts of such bakehouse between the hours of 11 a.m. and 3 p.m. C.—Ventilation. 7. Ventilation shall be so arranged that the circulation of air is confined to the underground bakehouse. 8. Ventilation shall be adequate, that is to say, fresh, clean air shall be supplied constantly during working hours, so as to provide not less than 3.000 cubic feet of air per hour, for each person employed, with any additional amount required for purposes of combustion, in such a manner as to avoid the occurrence of draught, and so that the air is sufficiently renewed in all parts of the underground bakehouse ; and by the aid of mechanical power, where, in the opinion of th° Medical Officerof Health, such is necessary. Provision shall be made for the removal of steam. Where mechanical power is used, the fiesh air shall be taken from a height above the level of the adjoining ground of not less than 6 feet, and be distributed to different parts of the underground bakehouse in such a manner as to change the air of such bakehouse in all parts. 9. Arrangements for ventilation shall be such that the temperature of the underground bakehouse from October 1st to May 31st shall not exceed 8o° Fahr., except within half-nnhour after a batch of bread has been drawn. 23 D.—All Other Respects. 10. Proper provision shall be made for the storage of flour elsewhere than in the bakehouse itself. 11. There shall be no opening into the underground bakehouse for any purpose which will tend unduly to the admission of dust from the adjoining street. 12. Conveniences for personal ablution shall be provided in a suitable position, and shall include a water tap, and a sink or lavatory basin of an approved character. Free access shall be provided to suitable sanitary conveniences, suitably situated. 13. All troughs, tables or other furniture standing on the floor of the undeiground bakehouse shall be provided with strong, ball-bearing castors. 14. Proper provision shall be made for the depositing of wearing apparel outside the bakehouse. 15. An underground bakehouse shall not be in communication with a wash-house, nor with any room, cellar or area containing objectionable materials. 16. An underground room, not entirely separated from the underground bakehouse, shall be well lighted throughout ; be sufficiently protected against the entrance of ground air, be properly ventilated, and be at all times clean. All statutory obligations shall be fulfilled. 17. Before making any alterations with a view of meeting these requirements, the owners or occupiers of underground bakehouses shall submit to the Sanitary Authority a specification and plans of the alterations which they purpose making. At four of these bakehouses the alterations required were executed, 011 the completion of which plans, sections and particulars of the premises were made and filed for future reference, and a report made to the Sanitary Committer to the effect that the requirements had been carried out, recommending that the certificates be granted. The occupiers were subsequently informed of this. 24 Only by a great expenditure of money was there the slightest possibility of putting one of the underground bakehouses in such a state that a certificate could be obtained, so the tenant decided to abolish it, and constructed a modern bakery above ground. Respecting the other one for which a certificate was not granted, the necessary alterations could have been carried out at a very small cost, but the tenant, in consequence of having only about four years of his lease unexpired, and also being the occupier of an above ground bakehouse quite near, resolved not to make any alterations or apply for the certificate. Neither did the owner, who was served with a copy of the requirements, make application for the certificate, consequently after January 1st, 1904 the bakehouse cannot be used as such again. House The drains of 150 houses and premises have been entirely re- Drainage. Consteucted, and laid to stand the water test, with manholes, etc., for inspection and cleaning purposes. The following blocks of houses have been redrained :— * 24 to 40, Hartfield Crescent, 9 houses. 147 to 153, Haydon's Road, 4 houses. 128, 129, 130, Alexandra Road, 3 houses. * 51 to 81, Harifield Crescent, 16 houses. 83 to qi, Hartfield Crescent, 5 houses. * •* 2 to 12, Haydon's Road, 6 houses. 15 to 22, West Place, The Common, 8 houses. 33 t0 39, Hubert Road, 4 houses. 66 to 72, Palmerston Road, 3 houses. 5, 7, 9, Cross Road, 3 houses. 222 to 226, Merton Road, 3 houses. × 74, 75- Denmark Road, , , 75 to Si, The Ridgwav, 6 nouses- 121 to 124, Alexandra Road, 4 houses. I to 6 Harcoiirt Road, 6 houses. 1 to 6, Derby Road, 6 houses. 2 to 10, South Road, 5 houses. 17 to 23, East Road, 4 houses. ** 67 to 81. South Road, 8 houses. 221 to 231, Haydon's Road, 6 houses. 14 to 20, Haydon's Road, 4 houses. * The main drain reconstructed by the Council at the cost of the owners, they having made default in complying with the notices served upon them. ** A portion of the main drain was reconstructed by the Council as a sewer within the meaning of the Public Health Act, 1875. 25 The single private drain between Nos. 73 and 75, Hartfield Crescent, and taking the drainage of Nos. 51 to 73, and Nos. 75 to 81, was reconstructed in default of the owners (3 in number) 2 of whom paid their proportion when the account was rendered. The main drain at rear was also relaid in default of the owner, and a summons for the recovery of the costs incurred was heard before the Magistrates on the 19th of August. After a lengthy hearing and considerable legal arguments, the Bench decided in favour of the Council, but consented to state a case for the opinion of the High Court on a point of law, at the request of the Defendant's solicitor which is pending. Public A considerable amount of work of a sanitary nature has been Elementary rarried out at these schools on the instruction or representation of the Local Education Authority ; such as the ventilation improved, sanitary conveniences cleansed and repaired, ceilings whitened, upper part of walls distempered, and woodwork painted, at the Central, Effra Road, Haydon's Road, Cottenham Park and Roman Catholic Schools; the play-grounds paved at the Effra Road, Dundonald, and Queen's Road Schools ; and the Drainage repaired at the Central Infants, Haydon's Road Girls and Infants, Cottenham Park, Roman Catholic and Queen's Rpad Schools. The collection and delivery of house refuse at the refuse des- House refuse Collection & tructor is executed by the Surveyor's Department, and has, I believe, disposal. been carried out in a thoroughly satisfactory manner. 9172 loads of refuse were burnt at the refuse destructor during the year. Gypjjgj Early in March a number of gypsies with their caravans, tents, Plough lane &c., encamped on a piece of land opposite the Plough Inn, Plough Lane, and on March 9th several letters v/ere received complaining principally of thefts committed by these people and the serious nuisance from them. The spot was visited by the Sanitary Inspector, who found 28 caravans, several tents, between 80 and 90 children and a large number of adults. There were no sanitary conveniences of any kind, the field was low lying and swampy, water standing from 1 to 6 inches deep over the surface, and the whole encampment was in a most insanitary condition. The occupiers were instructed to move away and were given until 5 p.m. to do so. Notices were served on them under the byelaws relating to tents, vans, sheds and similar structures, but, as some delay would have necessarily occurred before proceedings 26 could have been taken before the Magistrates, and possibly illness broken out, seeing they did not comply with the request to move, the owner gave authority for their ejectment, and several horses were taken down, and 24 of the vans drawn off on to the highway. The Inspector of Police who was present with 8 officers for the purpose of keeping order then dealt with them and ordered their dispersal. Four of the vans were permitted to remain on account of some of the children in them appearing to be ill. The following day I visited the encampment with Mr. Johnson and examined the children, and in consequence of their critical condition consented to their staying for a few days. During the night for about a week several of the caravans with their occupants returned, but each morning were removed. Four of the children died, 3 from bronchitis and pneumonia, and the other from measles coupled with broncho-pneumonia, undoubtedly accelerated by the adverse surroundings. The owner of the land was communicated with, but for a few days took no steps in the matter which was becoming dangerous to the health of the community. Had a serious infectious disease broken out here it might easily have started an epidemic. Your Clerk, Mr. Butterworth, promptly communicated with the owner, and pointed out to him that unless he took immediate steps to prevent the return of the gypsies to his land after their ejectment, legal proceedings would be instituted for an injunction, restraining him from permitting the ground to be used in such a way as to be a nuisance and injurious to health. He commenced fencing in the field, which when completed put an end to the trouble. On several occasions during the year other gypsies have for a night or two encamped on a piece of ground in High Street, Merton, but as soon as their presence was made known their removal was effected promptly. Unsound O'1 several occasions complaints have been received from Food. persons alleging that they have been supplied with unsound food by certain shop-keepers, but on account of the time which has generally elapsed between the sale of the article and its being brought to the notice of the inspector, it was not thought advisable for legal proceedings to be taken. In three instances I have given certificates that the food was diseased, unsound, unwholesome, or unfit for the food of man, and the Magistrate has condemned the same, the offenders being severely cautioned and warned to be more careful in future dealings. 27 Smoke Several complaints have been received alleging nuisances and Nuisances, inconveniences from the smoke emitted from the chimney shafts of several laundries. Careful observations were made, and where necessary notices served on the offenders requiring the abatement of the nuisance, which notices were complied with either by the using of hard Welsh coal, coke, or by more careful stoking. It has also been found necessary to call the attention of the Railway Companies to nuisances arising from the emission of black smoke from their engines, the nuisance being especially unpleasant to the foot-passengers over the bridge, and to occupiers of shops adjoining. Improvement has taken place for some time after each • communication, but if there is further cause for complaint I should strongly recommend legal proceedings to be taken against the offenders. House to house inspection was carried out in the Cowper, Milton and Dryden Roads, and resulted in a considerable amount of insanitary conditions being remedied, such as the cleansing of dirty cisterns and the providing of covers to same, leaky roofs, damp condition of walls from defective eaves gutters and down spouts, the cleansing of dirty and verminous rooms, the removal of stoppages from water-closets and drains, and several cases of overcrowding abated. The number of verminous rooms in one of the roads was surprising. At ioo houses, principally in the poorer parts of the district, has a portion of the yards immediately surrounding the walls of the back additions been either cement or tar paved for a width varying from 3 to 5 feet, which is undoubtedly beneficial to and much appreciated by the tenants ; not only does it prevent the access of dampness to the walls, but is a strong inducement to cleanliness. Customs and Applications for certificates under section 26 of the Customs and Tnland Rev- Xtiland Revenue Acts, 1890 and 1891 were made with respect to the enue Acts 1890-91. following properties :— Nos. 21, 22, 23, Kingston Road. Nos. 1 to 24, Alwyne Mansions, Alwyne Road. Nos. 17 to 53A, Cowper Road. Nos. 18 and 20, The Ridgway. House to House Inspection. Paving of yards. 28 After inspection of the premises letters were written to the owners pointing out the work necessary to be done before the certificate could be granted. At Nos. I to 24, Alwyne Mansions the cisterns were covered and the coal cellars drained; Nos. I7-53A, Cowper Road, the cisterns covered; and at Nos. 18 and 20, The Ridgway the drainage system reconstructed. On the completion of these alterations the certificates were granted. P^circaleum There are 12 persons on the register licensed for the storage 1879'. ;md sale of petroleum, as defined by these Acts. The license is for one year, and must be renewed on the 1st January. Samples from each vendor have been taken on several occasions, and tested as required by the Act, and the premises visited to see that the conditions endorsed on each license were complied with. It is again my pleasure to express my great appreciation of the work done by Mr. Johnson and the staff under his supervision during the year. The high state of efficiency of the Sanitary Department reflects great credit on him, and his prompt and capable manner of dealing with any emergency is to be highly commended. I have the honour to be, Your obedient Servant, E. POCKLINGTON. Medical Officer of Health. Wimbledon Urban District. TABLE 1. Vital Statistics for Whole District during 1903 and previous Years. YEAR. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. 9 Deaths of NonResidents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Deaths at all Ages belonging to the District. Number. 3 Rate.* 4 Under 1 Year of Age. At all Ages. Number. 12 Rate. * 13 Number. 5 Rate per iooo Births .Registered. 6 Number. 7 Rate.* 8 1893 28,000 780 27-8 107 13717 363 12-9 \ No records for these years. 1894 30,000 794 26-4 81 102 01 310 10-3 1895 31,000 857 27-6 102 119 01 377 121 6 6 3 374 12.06 1896 33,000 875 26-51 96 109-71 343 10-3 10 3 25 365 11-06 1897 35,000 828 23 65 98 118 35 367 10-4 6 2 33 398 11-3 1898 37,000 963 2602 145 150-57 415 11-2 11 5 32 442 11-9 1899 38,000 1031 27-13 163 158'09 547 14-3 18 12 33 568 14-9 1900 39,500 1075 27-21 156 145-11 559 14 1 18 13 24 r.70 14-4 1901 41,631 1074 25-79 133 123-85 457 10-9 20 4 40 493 11-8 1902 43,000 1144 26-6 134 117 13 455 10-5 21 4 46 497 11-5 Averages for years 1893-1902. 35,613 942 26-45 121 128-45 419 11-7 13 6 29 463 13 1903 46,000 1204 26-1 99 82-22 389 8-4 18 5 40 424 9-2 * Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. By the term "Non-residents1' 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 I Number of inhabited houses (at Census of 1901) 7,572 Total population at all ages (at Census of 1901) 41,631 | Average number of persons per house ,, 5-49 Wimbledon Urban District. TABLE Vital Statistics of separate Localities in 1901 and previous years. Names of Localities. 1.-Whole District. 2.—St. Mary's Ward. 3.—St. John's Ward. 4.—Cottenham Park Ward. 5.—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 yea r. Population estij 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 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 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. 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. 1893 28,000 780 107 \ Pa rti culars for these years not ob tai nable. i 1894 30,000 794 81 1895 31,000 857 374 102 1896 33,000 875 365 96 1897 35,000 8W 398 98 1898 37,000 963 442 145 1899 38,000 1,031 568 163 19(10 39,500 1 075 570 156 1901 41,631 1 074 493 133 1902 43,000 1,144 497 134 5,270 ... 48 11 5,044 ... 45 5 3,204 ... 37 7 4,858 ... 57 14 11,783 ... 162 51 12,841 ... 148 46 Averages of Years 1893 to 1902. 5,613 942 121 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1903 46000 1,204 4-24 104 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 14,298 423 133 40 Wimbledon Urban District. TABLE 3- Cases of Infectious Disease notified during- the year 1903. 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. Holy Trinity Ward. South Park Ward. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Holy Trinity. Ward. South Park Ward. 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 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 58 ... 19 31 7 1 ... 1 ... 6 6 20 25 ... ... 4 4 13 17 Membranous croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 40 2 1 2 8 22 5 4 6 2 n 14 9 ... ... ... ... ... ... Scarlet fever 113 1 27 70 6 9 4 12 10 16 27 44 3 8 9 13 22 36 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 15 ... ... 6 2 7 ... 1 4 ... 4 5 1 ... 1 ... 2 3 1 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 4 ... ... ... ... 4 ... 1 ... ... ... ... 3 ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Measles 104 8 45 44 5 2 ... 5 12 6 12 31 38 ... ... ... ... ... ... Totals 334 11 92 153 28 45 5 16 34 24 43 97 120 3 9 13 19 38 54 The Isolation Hospital 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. * Measles notifiable from June 1898 to June 1903. Wimbledon Urban District. TABLE 4- Causes of, and Ages at, Death during year 1903. CAUSES OF DEATH. 1 Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Age?>). Total Deaths in Public Institutions in the District. 16 All ages. 2 Under 1 year. 3 1 and under 5. 4 5 and under 15 5 15 and under 25. 6 25 and under 65. 7 65 and upwards. 8 St. Mary's Ward. 9 St. John's W ard. 10 Cottenham Parle Ward. 11 Dundonald Ward. 12 Holy Trinity Ward. 13 South Park Ward. 14 15 Small-pox - - - - - - - - - - - - - - - Measles 4 2 1 1 — — - — — — — — 4 — — Scarlet fever 1 — - 1 — - — — - - — — 1 - 1 Whooping-cough 9 5 4 — - - - — - 1 3 2 3 — — Diphtheria & membranous croup 4 1 3 - — — - — — — — 1 3 — 1 Croup — — — — — — — — — — — — - — — . Fever Typhus — — — — — — — — — — — - — — Enteric 2 — — — — 2 — — 1 — — _ 1 — 2 Other continued - - - - - - - - - - - - - - - Epidemic Influenza 5 — 1 — — 2 2 — 2 1 - - 2 — - Cholera — - — — — — — — — — — — — — - Plague — - — — — — — — — — — - — — Diarrhoea 13 9 1 — 1 1 1 1 2 — 1 5 4 — — Enteritis 6 3 — — - 2 1 i - — — 2 3 — — Puerperal fever 2 — — — — 2 - — - — — 2 — — Erysipelas 1 1 - — — — — — — — 1 — - — Other septic diseases 2 — — 1 1 — — — _ 1 — - 1 — — Phthisis 27 2 — - 8 16 1 2 2 1 3 11 8 - Other tubercular diseases 23 6 3 2 2 9 1 3 — 2 4 8 6 — - Cancer, malignant disease 27 1 — — 16 10 5 3 1 2 7 9 — 2 Bronchitis 24 7 4 — — 3 10 1 3 1 1 9 9 — — Pneumonia 22 4 5 1 1 7 4 2 2 1 1 8 8 — 1 Pleurisy 3 — 1 — 2 — — — — 1 — 1 1 — - Other diseases of respiratory organs 8 2 1 — — 4 1 1 2 — 1 3 1 — — Alcoholism 5 — — — — 4 1 2 1 — — — 2 — —1 Cirrhosis of Liver Venereal diseases 3 3 — — — — — — — — — 1 2 — — Premature birth 18 18 — — — — — 3 1 1 3 4 6 — — Diseases and accidents of parturition 2 — — — 2 — — — — — 1 1 — — Heart diseases 57 5 2 1 1 24 24 7 7 5 11 17 10 — — Accidents 7 — — — — 7 — 1 — — — 3 3 — 3 Suicides 1 — — — 1 — — 1 — — — — — — All other causes 148 36 12 3 2 38 57 18 12 22 11 42 43 7 All causes 424 104 39 10 18 140 113 47 39 38 41 126 133 — 18 TABLE 5- The following is a summary of the nuisances abated and sanitary improvements made under the supervision of Mr. Johnson, the Sanitary Inspector :— Accumulations Removed 30 Cisterns Provided 3 Cisterns Repaired, Cleansed or Covered 98 Drains, New, Provided 150 Drainsj Repaiied or Altered 60 Drains, Stoppages Removed 33 Dustbins Provided 50 Flushing Boxes, New, Provided 150 Flushing Boxes Repaired 62 Manure Receptacles Provided 3 Overcrowding Nuisances Abated 3 R.W. Pipes Disconnected 36 Roofs Repaired 5'1 Rooms Disinfected 256 Rooms Stripped and Cleansed 242 Soil Pipes, New, Provided 38 Soil Pipes Repaired or Altered 11 Ventilating Pipes, New, Provided 275 Ventilating Pipes Repaired or Altered 21 Waste Pipes, New, Provided 34 Waste Pipes Repaired, Disconnected or Trapped 26 Water Closets, New, Provided 180 Water Closets Repaired or Ventilated 14 Water Service Restored 10 Yards Cleansed 47 Yards Paved 100 Other Nuisances Abated 117 Total 2,100 ??? T at 1 s rhoninr of Birth and Oeath Rates each ":,-rd. Ward. B in th—r ate. Death-rate. St Mary1s 12.2 0 S t J ohn's 16.5 ".0 Cottenham Park 10.1 10 Horth "'inbledon 14." 8*4 Dundonald 28 0.9 Holy Trinity 34.9 10 South TJark 29.6 9.. 3 South ""inblcdon 31.5 9.5 ""hole District 26 »1 9.2