WIM054 URBAN SANITARY DISTRICT OF WIMBLEDON, COUNTY OF SURREY. Report or the Medical Officer of Health For the Year ending 31st December, 1904. DRAKE, DRIVER & LEAVER LTD., PRINTERS, LONDON. Wimbledon Urban District Council. SANITARY DEPARTMENT. ANNUAL + REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE YEAR ENDED DECEMBER 31st, 1904. Gentlemen, Herewith I submit my Annual Report on the health and sanitary condition of the Urban District of Wimbledon for the year ending December 31st, 1904. In the following Report it will be found that the health of the District, as measured by the death-rate, has not been so good as in the previous year, the rate having increased from 8.4 to 10.2 per thousand of the population per annum; but, compared with the average of the past ten years (11.2) it must be considered satisfactory, especially taking into account the large increase of population, viz., from 30,000 in 1894 to 47,000 in 1904 and the consequent increase in density, or in other words, the number of persons per acre. It will be remembered that the year 1903 was a most exceptional one throughout England and Wales, the death-rate for Wimbledon being the lowest ever recorded during my 33 years as Medical Officer of Health. Population. The calculations for the death and other rates in the tables of this Report are based on a population estimated to the middle of the year as 47.719, these being the official figures given at the public inquiry ordered by the Privy Council in connection with the petition for the granting of a Charter of Incorporation. Births. The number of births registered was 1142 (596 males, 546 females), which is 62 less than last year, and equal to a birth-rate of 23.9 per thousand per annum, being 2.6 below the average for the past ten years. The corresponding fate in England and Wales for the same period is given as 27.9 in the report of the Registrar General. 2 Deaths. The total number of deaths registered in the district was 487 (228 males and 259 females), equal to a death-rate of 10.2 per thousand living per annum. After making the usual corrections as required by the instructions of the Local Government Board, viz., those in the next paragraph, the total number of deaths properly belonging to the District is found to be 526, and the death-rate 11.02, the death-rate for the same period in England and Wales being 16.2. The deaths occurring in public institutions outside the district among persons belonging hereto which have come to my knowledge were 36 in the Kingston Infirmary, and 8 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 North Wimbledon Cottage Hospital. One hundred and fifty-three deaths of children under 1 year of age were registered, and this infantile mortality is represented by a ratio of 133.9 deaths of infants under 1 year of age to 1000 registered births, being an increase of 51.68 on the previous year and 11.9 above the average lor the past ten years. The same rate for England and Wales for the same period is 146. Between the ages of 1 and 60, there were 187 deaths, and 147 of persons aged 60 and upwards. The number of deaths from Zymotic diseases was 91, viz:— Measles 23, Diphtheria 6, Diarrhoea 43, Whooping Cough 14, Enteric Fever 4, and Erysipelas 1, giving a zymotic death-rate of 19 per thousand of the population per annum. There were 35 deaths from Bronchitis, 38 from Pneumonia, 24 from Phthisis, 3 from Pleurisy, and 3 from other respiratory diseases. See Table 4 in which is classified the whole of the deaths registered in the District, less non-residents, and with the addition of residents who have died in public institutions outside the district For the meaning of the terms "resident" and "non-resident" see foot-note of Table 1. The deaths from Pneumonia and Bronchitis numbered 73, equal to a rate of 1.5 per thousand of the population, against 46 and a rate of 1 per thousand last year. This increase, I think, is chiefly due to the mild weather in November and December and the fogs in the last two weeks of the 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-rates from zymotic diseases, phthisis and other forms of tuberculosis for the past 10 years. TABLE A. 1904 1903 1902 1901 1900 Births 1142 1204 1144 1074 1075 Deaths 487 389 455 457 559 Death-rates 10.2 8.4 10.5 10.97 12.7 DEATHS— Under 1 year 153 99 134 133 156 Over 1 year and under 60 years 187 169 192 206 239 Above 60 years 147 121 129 118 164 From Measles 23 4 11 10 17 „ Scarlet Fever 0 1 0 1 0 „ Small Pox 0 0 0 0 0 „ Diphtheria 6 4 7 6 10 „ Diarrhœa 43 13 6 24 19 „ Whooping Cough 14 9 17 13 5 „ Enteric Fever 4 2 3 0 5 „ Puerperal Fever 0 2 0 0 0 „ Erysipelas 1 1 3 0 3 „ Influenza 3 5 6 9 19 4 TABLE B. DISEASES. 1904 1903 1902 1901 1900 Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 0 0 9 0 3 0 1 0 Diphtheria 36 6 58 4 80 7 60 6 64 10 Erysipelas 42 1 40 1 46 3 52 0 49 3 Scarlet Fever 106 0 113 1 128 0 90 1 112 0 Enteric Fever 15 4 15 2 16 3 12 0 20 5 Puerperal Fever 0 0 4 2 3 0 2 0 0 0 *Measles 0 23 104 4 1026 11 453 10 1069 17 Totals ... 199 34 324 14 1308 24 672 17 1315 35 * Measles notifiable from June, 1900 to June, 1904. TABLE C. Year. Zymotic Death-rale. Death-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhœa. Phthisis and other Tuberc'lo's Diseases. 1895 2.03 — — .51 .03 .74 .06 .48 .9 1896 1.63 .03 .06 .09 .09 .45 .27 .39 .8 1897 2.0 — .06 .17 .02 .2 .45 .82 .6 1898 2.0 — .05 .18 .02 .08 .05 1.51 .9 1899 1.83 — .05 .31 .15 .39 .02 .55 1.05 1900 1.77 — — .25 .12 .12 .43 .48 6 1901 1.5 — .02 .14 — .31 .24 .57 1.04 19(2 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 CHART SHEWING WEEKLY NOTIFICATIONS OF SCARLET FEVER. 5 Scarlet Fever. The number of patients notified as suffering from this disease was 106, all of whom recovered, a slight decrease from the previous year of 113, and also below the average for the past ten years. 83 were removed to the hospital, equal to 78.3 per cent., the attack rate being 2.2 per thousand of the population and the average for the past ten years 3.09. If the four years during which the new hospital has been opened are taken into account the attack rate is 2.49 for that period against 3.45 for the previous four years. Table 3 shows the age distribution for the whole of the infectious diseases notified, the Wards in which they occurred, and from which they were removed to the hospital. 74 of the patients attended schools, viz.:—Queen's Road, 24; Merton, 17; Effra Road, 11; Haydon's Road, 7; Holy Trinity. 5; Dundonald, 3; Central, 1; Catholic, 1, and Private Schools, 5. During the first four months there were about the average number of cases, then each month a decrease, until in July there was only one patient in the hospital; quite suddenly a serious increase occurred, cases being reported from all parts of the District, and every indication of what might develope into an epidemic. Fortunately the iron hospital was available for the use of the convalescents, thus relieving the pressure on the Wards of the permanent hospital, and providing beds for the fresh cases. This, together with the speedy removal to the hospital, and the prompt and thorough disinfection of the bedding, clothing and rooms enabled the outbreak to be kept well in hand, but, from appearances it will, I think, be some time before we consider all danger over. The highest weekly number of cases notified was in the first week of December, viz., 10. The disease was of a very indefinite nature, the attacked in many cases showing little, if any, signs of illness, and suspicion was first aroused by the commencement of the peeiing of the hands and feet. In 10 instances medical practitioners were not called in by the parents until this stage had been reached. These mild attacks are difficult to deal with, giving both the medical men and local authority considerable trouble. Occasionally they were found to have been mistaken by the parents for simple colds or sore throats, kept from school for a few days but, after returning, found to be suffering from the disease, having in the meantime spread the infection among the scholars. 6 Between September 16th and October 4th eleven cases occurred amongst the scholars of Classes 1 and 2 of the Infants' Department of the Queen's Road Schools, and, with a view to preventing the spread of the disease, it was thought advisable to close this section for two weeks, during which time the class rooms, passages, cloak rooms and lavatories were thoroughly disinfected. On September 27th the School Attendance Officer had occasion to visit a certain house as to the non-attendance of a boy at Holy Trinity Schools, the period for which he had been detained from school owing to a supposed attack of Measles having expired. He was informed by a person at the house that the boy had had Scarlet Fever, he accordingly reported this to the Sanitary Department, Mr. Johnson at once visited the house, and having ascertained that no doctor was in attendance, asked to see the boy, who at that moment came in from the street and was found to be peeling very profusely. The Inspector asked the parent to call in a doctor; she reluctantly did so. Later in the day a notification was received stating that the boy was suffering from Scarlet Fever. He was immediately removed to the Isolation Hospital, and the room, bedding, etc., disinfected. The matter was reported to the Sanitary Committee at their next meeting: they resolved that, as a warning to others, proceedings should be instituted against the person who wilfully exposed the boy whilst suffering from a notifiable infectious disease. The summons was heard before the Magistrates on November 9th who were satisfied that wilful exposure had been made and fined defendant £1. Diphtheria The number of notifications received was 36 against 58 in the preceding year, the attack rate being .7 per thousand of the population against a corresponding rate of 1.2 last year. Unfortunately the disease was of a more malignant type, there being 6 deaths, a case mortality of 16.6 per cent. against 6.8 per cent. in 1903, the average for the past ten years being 15.09. In Table C will be found this death-rate for the past ten years. Five of the deaths occurred in the Isolation Hospital, 3 of children who at the time of removal were almost in a state of collapse, and one had had tracheotomy performed at home and removed to hospital an hour after. 7 It is interesting to note that during the past five years, in which time anti diphtheritic serum has been provided by the Council for the use of medical practitioners, the case mortality has decreased to 10.5 per cent. from 19.5 per cent. for the previous five years. The removals to hospital numbered 25, or 69.4 per cent. of the cases notified. Twenty-seven per cent. were of school age and attended the following schools, viz.:—Holy Trinity, 4; Haydon's Road, 2; Effra Road, 1; Central, 1; Queen's Road, 1; and Merton, 1. Serious insanitary defects were discovered at 10 of the houses when examination was made after removal to hospital or recovery, and steps taken for their remedy. Typhoid Fever. Notifications in respect to 15 persons suffering from Typhoid or Enteric Fever were received, the same number as last year, and represented by an attack rate of .31 per thousand of the population. Eight patients were removed to hospital, 3 of whom died, the other fatal case occurred at home. In Table C will be found this death-rate for the past 10 years. The case mortality is 26.6 per cent. against 13 per cent. last year, but these numbers are so small that reliable comparison cannot be made. No connection could be found between the several cases, and considering the source of the water supply is from the River, and not from deep wells, this number, 15, in a population of nearly 50,000, can be considered satisfactory. In two instances the diagnosis was confirmed by Widal's test, the rest of the cases were typical, and, therefore, no need for bacteriological examination. 8 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 14. - No evidence. Sanitary arrangements good. 2 St. Mary's Female, aged 13. — Residing at boarding-house out of District until just previous to illness 3 Trinity Male, aged 21. H. No information obtainable. 4 South Park Male, aged 4. H. Drains sound, but cistern very dirty. 5 South Park Male, aged 31. — Fatal. Slight defects in drains. Had complained of smells from sewer grating. 6 South Park Male, aged 36. H. Fatal. Drains and sanitary arrangements satisfactory. Employed in City, all meals away. 7 Trinity Male, aged 13 — Had frequently attended Covent Garden Market. 8 St. John's Female, aged 11. — Contracted before coming to stay in District. 9 South Park Male, aged 4½. H. Falal. Had partaken of shell-fish. 10 South Park Female, aged 26. H. Nurse at Isolation Hospital. Contracted disease in course of her duties. 11 St. Mary's Female, aged 40. — Attributed to water-cress by husband. 12 South Park Female, aged 13. — Drains, etc., satisfactory. Cistern uncovered and dirty, had not been cleaned out for 2 years. 13 St. Mary's Male, aged 11. H. No evidence. Drains and sanitary arrangements good. 14 South Park Male, aged 31. H. Had partaken of shell-fish, oysters and whelks. 15 Trinity Male, aged 42. H. Fatal. No evidence. Third week of illness before doctor called in. Employed outside District. 9 Small Pox. Fortunately the District was quite free from this disease. I was asked by a medical man to see a doubtful and suspicious case which proved not to be Small Pox. Measles. Measles accounted for 23 deaths, as compared with 4 last year, ten of whom were children under 1 year of age, twelve between 1 and 5 years and 1 over 5, all occurring in South Wimbledon. In Table C will be found this death-rate for the past 10 years. The actual number of patients is not known, but notifications were received from the principals of the public elementary schools in respect to 439 scholars who were absent and found to be suffering from Measles. Three distinct and local outbreaks occurred. The first of these, and which commenced in February and extended over March and April, was confined almost solely to the South Park and Trinity Wards, the scholars of the Infants' Departments of the Effra Road, Queen's Road and Holy Trinity Schools being chiefly affected. With a view to preventing the spread of the disease the first mentioned was closed for 3 weeks and the others for two weeks each with beneficial results. The form of the illness was very marked, and no less than 19 deaths occurred during this epidemic. The second happened in June and July, and was restricted to the scholars attending the Haydon's Road Schools and that part of the District. Five deaths were registered at this period, and the Infants' Department of the School was closed for 3 weeks. The last occurred in Cottenham Park, was very widespread and further complicated with epidemics of mumps, whooping cough and ring worm, but fortunately was of a mild character, no case ending fatally. It commenced among the children of the Central Infants' School, and spread later to those attending Cottenham Park School, at the same time many of the latter scholars reside in the Raynes Park portion of the District, which is in the Croydon Rural District Council's area where an extensive epidemic also took place. The Infants' Department of the Central Schools was closed for two weeks, and the Cottenham Park School for a month. The first intimation of Measles at this school I had on November 16th, when I received a list containing the names of 37 children suspected to be 10 ill with the disease, but everything points to the fact that at an earlier date there must have been in this school some child cr children affected with Measles to account for such a large number falling at once, or possibly a child from a house where a brother or sister was down with the disease was attending school. I am of opinion that the constant use of school buildings nightly, Saturday afternoons and Sundays for meetings, etc., have anything but a beneficial effect. It is absolutely necessary that buildings used for education purposes should have rest, whereby the air of the rooms can become purified. Erysipelas. Forty-two persons were notified as suffering from this complaint, and one death was registered, as against 40 cases and one death last year, and 46 cases and three deaths the previous year. Whooping Cough. Fourteen deaths were registered from this disease, 7 of which were under 1 year of age and 7 between the ages of 1 and 5. A somewhat extensive outbreak occurred in that part of the District east of Haydon's Road during the months of February and March and accounted for 8 out of the 9 deaths in the South Park Ward. Two deaths occurred in each of the (Tottenham Park and Dundonald Wards and one in Trinity Ward. Influenza. Influenza was responsible for 3 deaths, one being a child three years old, and the other two persons over 65. There were 5 deaths last year and 6 the year before. Tuberculosis The total number of deaths ascribed to Phthisis and other forms of Tuberculosis was 40, 24 of the former and 16 of the latter, a satisfactory decrease from the previous year when 50 deaths were recorded. In Table C will be found this death-rate for the past 10 years. On the termination of the illness or the vacation of the rooms by consumptive patients, fumigation was carried out at 9 houses, and the bedding and clothing removed for steam disinfection in all but two instances. The houses fumigated are about one-third of those in which fatal cases have occurred, but it is proposed to circularise the local medical practitioners, pointing out that the Sanitary Authority will carry out fumigation and disinfection after this disease, free of charge, whenever request is made. 11 Diarrhœa and Epidemic Enteritis. The number of deaths from Diarrhoea is higher than has been the case for seven years, viz., 43, of which 34 were under 1 year of age, 8 between the ages of 1 and 5, and 1 of a person over 65. The death-rate for this disease was .9. Diarrhoea constituted 47 per cent. of the total fatalities from Zymotic Diseases, as compared with 38 per cent. last year, 13 per cent. in 1902, and 38 per cent. in 1901, these being the three years since which the rules for the classification of Diarrhoea deaths were made by the Royal College of Surgeons and the Registrar-General. The late Dr. Ballard was instructed by the Local Government Board, at the close of the year 1880, to investigate and report upon "the causation of the annual mortality from Diarrhœa which is observed principally in the summer season of the year," in consequence of the exceptional high Diarrhœa mortality throughout England and Wales that year, and which had only once before been exceeded since the commencement of death registration in 1837. He pointed out in his Report, amongst other things, the important relationship between the deep earth temperature and Diarrhœa mortality, also the influence of soil on the same. "The summer rise of diarrhœal mortality does not commence until the mean temperature recorded by the four foot earth thermometer has attained somewhere about 56° Fahr., no matter what may have been the temperature previously attained by the atmosphere or recorded by the one foot earth thermometer." "The maximum diarrhœal mortality of the year is usually observed in the week in which the temperature recorded by the four foot earth thermometer attains its mean weekly maximum." "Excessive wetness and complete dryness of soil appear to be both unfavourable to Diarrhœa. A degree of moisture specially favourable is an amount of habitual dampness which is decided although not sufficient to preclude the free admission of air between the constituent physical elements of the soil. Such a degree of dampness occurs when, in the diarrhœal season, the subsoil water stands sufficiently near to the surface to maintain, by capillary attraction, the dampness brought about by previously greater nearness of the water to the surface; or when the soil, as in the case of marls, contains sufficient of the clayey elements to imprison enough 12 of the water saturating it at some time previously. It is scarcely necessary to add that the requisite degree of dampness may be produced, not only from a source below, but from a surface source: for instance, it may be the result of a previous flood, or of watery matter habitually soaking in from the surface about houses, or from leakages of such conduits as sewers and drains." These conditions were to a very great extent present in Wimbledon at the end of June, and continued during July, August and September, as will be seen from the following table giving the mean maximum temperatures and deaths in fortnightly periods:— Mean Temperature for Fortnight. Number of Deaths in Fortnight. Fortnight ending July 9 59 2 „ „ „ 23 62 0 „ „ Aug. 6 64 5 „ „ „ 20 63 16 „ „ Sept. 3 61 8 „ „ „ 17 59 2 „ „ Oct. 1 57 1 „ „ „ 56 0 The larger proportion of deaths, 24, took place in that portion of the District bounded by the railway (Tooting and Wimbledon branch), the River Wandle, High Street, Merton and Haydon's Road, where the soil is by reason of the nearness of the ground water in a constant state of dampness; and where many of the houses are particularly liable to the access of ground air and moisture, having been built before the bye-laws requiring the provision of a cement concrete covering of the site were in force. It is interesting to note that not one fatal case occurred in the newer streets in the same neighbourhood or the adjoining ones, which are practically at the same level or very little higher, but where the sites of the houses are concreted. At the same time there are other factors which cannot be ignored, as social position, method of feeding (whether maternal or hand-fed) and domestic dirtiness and fustiness, etc. 13 On many occasions when the ground has been opened in this locality for the purpose of examining the condition of drains, it has been noticed that the subsoil water has been within one to three feet of the surface, and when, as is frequently the case, the drains have been found so defective in construction, or by the improper manner in which they have been repaired, bearing in mind the results of Dr. Ballard's investigations, it is easy to imagine the amount of mischief such leakages may cause. Working on the following lines may possibly in time bring about the desired result, viz., the decrease of this high rate:— Prompt removal of all liquid and other filth from neighbourhood and dwellings, thereby preventing the fouling of the soil with matters out of which the material of Diarrhœa can be produced. Frequent scavenging, specially in the poorer streets. The remedying of insanitary defects, drains, waterclosets, etc. The lowering of ground water (where possible). Prevention of access of ground air to dwellings, which is done in the case of new buildings. Every opportunity should also be taken to accomplish this in old buildings, by paving the site and the space immediately surrounding same with impervious material. The exercise of care to protect food of all kinds, specially milk, by providing a well-constructed, lighted and ventilated place for the storage of same. Domestic cleanliness and ventilation of dwellings. Infantile Mortality. The number of infants under one year of age who died during the year was 153, and is represented by a ratio of 133.9 to every 1000 births registered, which is an increase of 51.68 on last year, and 11.95 above the average for the past ten years. While the general death-rate for the country has for some years shown a substantial decline, the infantile rate has either remained stationary or shown a slight increase. As to what should be considered a normal or standard infantile death-rate is a much debated point amongst those who have studied the question. 14 At the Congress of the Sanitary Institute held at Glasgow during the year, a wide divergence of opinion on this question was exhibited by the speakers, most of whom have had many years of experience in Public Health and other similar work, some giving as a standard rate to be sought after of from 80 to 100 per thousand births for other than small urban or rural districts, while others looked upon this as altogether an idealistic standard, and thought that any rate up to 150 was not unreasonable. Personally, I am of opinion that a rate of from 80 to 100 per thousand at the most for Wimbledon is what we should aim at, and that we should not be content until this is attained. That the causes for this high infantile mortality are many and varied is admitted, some of the most important of which are influences which produce their results mainly through their effects on the mother, such as.:— Intemperance and deficient feeding, Insanitary surroundings, Early and improvident marriage, Others have their effect direct upon the infant as:— Ignorance or carelessness on the part of the mother, leading to improper feeding, Undue exposure of young infants when suffering or recovering from common Zymotic Diseases, such as Measles or Whooping Cough. Insanitary condition of home and surroundings, not only in those cases which can be dealt with under the nuisances clauses of the Public Health Acts, such as defective drains and sanitary conveniences, accumulations of manure, garbage and refuse of various kinds, but the more common domestic insanitary condition such as dirty house, floors, tables, cooking utensils, sinks and the strewing of garbage, litter and refuse about the dwelling, dirty and closed windows (the former keeping out light and sunshine, the latter preventing proper ventilation of the rooms). Meteorological conditions. These have the most far-reaching effects on the prevalence or otherwise of "summer diarrhœa." 15 To the unusual conditions (meteorological) was due the immense reduction in the infantile death-rate for 1903, therefore in the consideration of this question, owing to the reason stated, that year should be looked upon as exceptional, and not one that can be taken as a basis for accurate comparison with other years, or as a standard for infantile mortality. It will be well in considering this question to take into account two sets of figures. 1st. Those in which the deaths due to premature birth are included, and 2nd. Those in which they are excluded, the difference representing the pre-natal influences, which are not nearly so much under control as the post-natal. Thus, allowing for this difference, the infantile mortality rate would be 106 per thousand births instead of 133. Causes of Death of Children under one year of age in the District. (Extended from Table 4.) Diseases. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Measles 4 4 2 — 10 Whooping Cough 5 1 1 — 7 Diarrhœa 3 3 26 2 34 Enteritis 2 — — — 2 Syphilis — — 2 — 2 Tubercular diseases 3 1 1 1 6 Respiratory system 5 2 — 3 10 Stomach 2 2 4 1 9 Convulsions and Dentition 3 4 3 2 12 Accidents at Birth and Suffocation 2 2 — — 4 Premature Birth & Congenital Defects 4 3 5 8 20 Debility & Atrophy (dying in first week) 1 3 2 1 7 Debility, etc 4 5 7 — 16 Other causes 1 3 5 5 14 Totals 39 33 58 23 153 16 By far the larger proportion of deaths occur amongst hand-fed children and illegitimates, the latter for obvious reasons seldom receiving the care they should if they are to surmount the many risks of babyhood. The number of deaths among illegitimates was 26, of whom 22 were under one year of age, and are therefore included in the preceding table, and is an infantile mortality of illegitimate infants of 500 per thousand as compared with 114 per thousand legitimate. Hand-fed children have to be reared chiefly on cow's milk in some form or another, or various substitutes for human milk, which if of any real value are quite beyond the reach of the poorer classes (amongst whom the mortality is highest) owing to the cost, and for this reason they are left out of account here. Thus cow's milk is the hand-fed babe's chief food, and this, unfortunately, is subject to contamination in very many ways in its journey from the cow to the infant's stomach—the filthy udders and hind-quarters of cattle, dirty hands of the milkers, dirty receptacles and cow-sheds, milk churns left near accumulations of manure at the farm, or close to trucks laden with house and other refuse in the railway siding, dust from street or yard, foul sinks, dust bins and sour feeding bottles, as well as the other risks inside the house, such as direct contamination of the food or milk with faecal or decomposing matter conveyed by flies, etc. 1 have seen some dwellings (well-built and drained and with modern sanitary appliances) in which the children were under conditions little better than the worst housed animals, the atmosphere of some of the rooms being almost beyond description. I have seen a mother trying to feed an infant on raw arrowroot, and on another occasion, when called in to see a baby a few months old, and enquiring how it had been fed, the answer given was, "Oh, the same as us," meaning the rest of the family. Is it any wonder that under such circumstances there is a high infantile mortality? The ignorance of some mothers respecting feeding is truly surprising, and this remark is not confined solely to the poorer classes. As the infant death-rate is influenced to such a great extent by the presence and amount of epidemic diarrhœa, the remedies 17 suggested in connection with that disease, with others, apply equally to infantile mortality. The most important effects in the future may be expected from general educational efforts, including lectures and addresses at evening classes, instruction of the elder girls attending elementary schools in personal, domestic and infant hygiene, and also by the distribution of leaflets and pamphlets on the feeding and management of infants. There are other factors, more of a moral nature, which affect this rate as well as the birth-rate, but for obvious reasons cannot be entered into here. South Wimbledon Day Nursery. This nursery received 4091 children during the year, a great reduction from the number admitted in 1903 which was 6502. The institution which for some years has been doing good work in the district of Haydon's Road in the care of infants whilst the mothers are at work, was greatly hampered in its uselulness during the past year by reason of the epidemics of Measles and Whooping Cough prevalent from January to July; also, in consequence of a large number of men and women being unemployed later in the year, and who were thus unable to afford the few pence necessary to obtain the benefits of the institution. Isolation Hospital. The following table furnished by the Hospital Medical Attendant, Dr. Clapham, gives particulars as to the number of patients treated in the Hospital for each disease during the year :— 18 ISOLATION HOSPITAL. Cases admitted in 1904. Over 5 years. Under 5 years. Total Deaths over 5 years. Deaths under 5 years. Total deaths. Remarks. Scarlet Fever 71 13 84 ... ... ... Diphtheria 21 6 27 2 3 5 Enteric Fever 6 2 8 2 1 3 Measles 1 1 ... ... ... Tonsillitis 1 ... 1 ... ... ... Burn 1 1 ... ... ... Total 100 22 122 4 4 8 Daily average number of Patients in 1904 16 Cases carried from 1903 : Scarlet Fever 13 3 16 Average length of detention of each Patient in Hospital 40 days Diphtheria 2 2 Enteric Fever 2 2 Tonsilitis 1 1 Total number of cases treated during year 1904 118 25 143 4 4 8 (Signed) EDWARD CLAPHAM, M.D., 25th January, 1904. Medical Officer. 19 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 152 66 73 354 346 67 42 2759 125 3984 Diphtheria 55 17 23 122 127 25 9 967 54 1399 Typhoid Fever 20 5 9 42 42 1 1 104 4 228 Measles 30 2 3 57 72 8 28 282 50 532 Chicken Pox 5 — — 2 9 — — 112 2 130 Sundries 45 8 11 99 60 6 5 457 90 781 Totals 307 98 119 676 656 107 85 4681 325 7054 There were nine Library books disinfected. Diagnostic Tests. 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 13 44 57 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 2 5 7 20 Mortuary. There were 89 bodies received into the Mortuary during the year, ar.d 39 post-mortems made (24 male and 15 female). Inquests were held by the Coroner with respect to 39 bodies, being equal to 8 per cent, of all deaths registered in the District. Water Supply. The monthly reports of Professor Thorpe, from the Government Laboratory, giving the results of the chemical analysis and physical examination of the water supply to London by the Water Board during the year, show a marked improvement as compared with last year. Dairies, Cowsheds and Milkshops. Nine applications were received for registration under the Dairies, Cowsheds and Milkshops Order of 1885. Three of these were in respect to new buildings, where of course the drains and sanitary arrangements are modern ; at two of the premises it was found necessary to have the drains reconstructed, and the remainder complied with the regulations. Ten names have been removed from the register on account of the persons having given up business. The number it now contains is 6 cowkeepers and 43 dairymen and purveyors of milk. The cowsheds have been inspected monthly, and the premises of dairymen and purveyors of milk at irregular intervals of about a month. Each of the cowsheds have been measured up, and plans made, and these, together with a complete record as to the cubic space, number of cows, lighting, ventilation and sanitary condition, filed. The latter particulars were also obtained in the case of dairymen and purveyors of milk. With the exception of the circular letter calling attention to the periodical limewashing it was unnecessary to serve any notices, and there appears to be every desire on the part of the persons registered to carry out their business in strict accordance with the regulations. Slaughter houses. The number of slaughter-houses on the register is 6, but at only 3 is there much slaughtering done. All have been frequently visited both day and night, and no breach of bye-laws discovered. Twenty-four notices calling attention to the requirements as to limewashing were complied with, and several diseased lungs and livers were destroyed by the owners. 21 Common Lodging Houses. The only registered common lodging-house, Nos. 186 and 188, High Street, Merton, has been visited and the periodical cleansing enforced. No breach of bye-laws has been found. Several night visits were made to two other sets of premises used somewhat similarly to common lodging-houses, but found on each occasion kept in a cleanly state and well managed, and it was decided to deal with these under the bye-laws for houses let in lodgings. Factory and Workshops Act 1901. There are 34 factories on the register and 188 workshops, a reduction of 15 since last year. Report to Secretary of State. The following is a summary of inspections made, written notices served, defects found and remedied, etc. :— Premises. Inspections. Written Notices. Factories 21 6 Workshops 108 8 Workplaces 7 1 Homeworkers' Premises 18 – Total 154 15 DEFECTS FOUND. Nature. Found. Remedied. Want of Cleanliness 3 3 Overcrowding 2 2 Want of Drainage of Floors 1 1 Sanitary Accommodation Insufficient 2 1 Unsuitable or Defective 12 10 Not separate for Sexes 2 2 Total 22 19 22 OTHER MATTERS. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract 2 Notices from H.M. Inspector as to Nuisances, and Reports of action taken 4 Underground Bakehouses :— In use in 1903 6 Certificates granted 4 In use at end of 1904 4 Homework :— Lists received 11 Outworkers 11 Adresses of Forwarded to other Authorities 1 Outworkers Received from other Authorities 12 Workshops on the Register at end of 1904 : — Boot Repairers 33 Dressmakers 28 Bakehouses 24 Laundries 22 Tailors 15 Milliners 13 Other Trades 53 Total 188 Circular letters were sent to the proprietors of the different workshops who carried on the class of trade specified in the Secretary of State's Orders respecting outworkers, calling attention to the provisions of the Act requiring lists of persons employed as outworkers to be kept, and copies sent twice a year to the Local Authority. The bakehouses on the Register number 24, of which 20 are above ground and 4 below. These have all been frequently inspected, and the statutory requirements, such as periodical limewashing, enforced. Until the end of 1903 there were 6 underground bakehouses in use in the District, 4 of which prior to January 1st, 1904 carried out the following alterations, certificates being granted to the occupiers under Section 101 of the Factory and Workshop Act, 1901. 23 No. 30 Hill. Road. Construction.—New flooring in shop, double thickness. New ceiling between bread and confectionery bakehouses. Walls rendered in cement. Ceiling and walls of bread bakehouse scraped and painted. Cupboard made for hats and coats. Floors levelled and concreted. Sheet zinc placed between each joist in ceiling and fixed with fillet. Ceiling painted. Light.—Shop floor cut away in two positions, and semi-prism lights with tiled surrounds put in. Ventilation.—Four fresh air inlets (downwards) fixed and carried into bakehouse 6 feet from floor. An 18 inch ventilating shaft carried from the bread bakehouse along passage into area, taken above roof and fitted with extractor. Other Rcspects.—New 2 inch waste sink provided and fixed, disconnecting same over gully outside. New soilpipes (heavy iron) fixed. Waste pipes from bath and scullery altered. Furniture placed on casters. No. 3, Bank Buildings, Hill Road. Construction.—New 4 inch iron drain provided under bakehouse, manhole built with interceptor and fresh air inlet. New branch drains from watercloset and soilpipe. Old w.c. compartment abolished. Angular lavatory and new w.c. fixed. The ceilings, walls and woodwork in the pastry room washed, rubbed down and painted. The bakehouse ceilings were washed, scraped and painted, and the walls tiled with crystopal tiles. Light.—Old windows in pastry room removed, new frames and sashes made, so that the whole may open at once for proper ventilation. Ventilation.—Two air inlets tubes (downwards) with openings at top protected with cast iron giatings and regulating panels, brass wire screens and cleansing door at foot provided. A galvanized hopper, 14 inch by 12 inch, fixed in face of wall, a 12 inch pipe with self-acting valves across top of ovens, through flour room and carried up above roof and finished with an air pump ventilator with 24 inch diameter head. Other Respects.—All furniture on casters, and separate room for men's clothing. 24 No. 9, High Street. Construction.—Premises redrained, old paving stones removed from floor and good concrete floor laid, cement faced. Area of bakehouse enlarged by taking in other portion of premises. Walls rendered with Portland and faced with Keene's cement, painted and varnished. Old ceilings covered with match boarding and painted. New ovens put in with white glazed brick fronts. Old internal w.c. abolished, new w.C. with lavatory basin and a compartment for workmen's clothing provided separate from bakehouse or flour store, and ventilated to open air. Light.—Two pavement lights put in in front and sides, areas extended and lined with white glazed tiles. Ventilation.—Two ventilating inlets fixed, disused chimney flues used as upcast shafts. Other Respects.—All troughs and other furniture made movable and casters fitted. No. 29, Merton Road. Construction.—New concrete floor laid. Walls rendered and painted. Height increased. Iron tongued floor laid in shop above. Stall board ventilation abolished. Door opening made at rear and area constructed, providing entrance from yard. Light.—New floor light in shop and additional window in front. Ventilation.—Two inlets (downward) fixed and disused chimney shaft used as outlet with extractor above. House to House Inspection. Systematic inspection was made of the houses in North and East Roads. The drains and sanitary arrangements were found to be generally in a most defective condition, and were entirely reconstructed at 38 of the houses, a large amount of improvements and repairs also being made. House Drainage. At 119 houses the drainage system and sanitary arrangements have been reconstructed on modern principles with manholes, etc., and to stand the water test. 25 The following blocks of houses have been redrained :— * 1 to 11, Palmerston Grove, 11 houses. 46 to 52, High Street, Merton, 4 houses. 89 to 99, Deburgh Road, 6 houses. 210 to 228, Haydon's Road, 10 houses. 79 to 89, Norman Road, 6 houses. 22 to 30, North Road, 6 houses. 32 to 42, North Road, 6 houses. 13 to 21, North Road, 5 houses. 60 to 64, North Road, 3 houses. * * 57 to 73, Graham Road, 9 houses. * 2 and 4, North Road, 2 houses. 47 to 69, North Road, 12 houses. * * 1 and 2, Moore's Cottages, 2 houses. 1 to 5, East Road, 3 houses. * * 11 to 17, South Road, 4 houses. * 47 to 57, South Road, 6 houses. A'os. 51 to 81, Hartfield Crescent.—It will be remembered that in August, 1903, Mr. Jackson, the owner of Nos. 51 to 73, was ordered by the Magistrates to pay the sum of ,£35 Is. 0d., together with the costs of the proceedings, the amount incurred by the Local Authority in reconstructing the main drain at the rear of his houses. The Bench stated a case for the opinion of the High Court on a point of law. This came before a divisional court, consisting of the Lord Chief Justice (Lord Alverstone), Mr. Justice Wills, and Mr. Justice Kennedy, who decided against the Council, holding that the line of drain in question was a sewer, but gave the Council authority to appeal. About the same time several somewhat similar drainage cases went against the local authority, and in each instance it was decided to appeal. Thompson v. Mayor, &c., of Eccles, and Haedicke v. Friern Barnet Urban District Council, were two of the most important, and which had a bearing on the Wimbledon case. These appeals were heard in the Court of Appeal on November nth, 12th and 14th, before the Master of the Rolls, Lord Justice Stirling, and Lord Justice Matthews, and were allowed, being unanimous decisions in favour of the local authorities. * The main diain reconstructed by the Council at the cost of the owners, they having made default in complying with the notices served upon them. ** The main drain was reconstructed by the Council as a sewer within the meaning of the Public Health Act, 1875. 26 Wimbledon Urban District Council v. Jackson was heard before the same court, which on December 9th sent the matter back to the Magistrates who originally stated the case for the following facts to be ascertained :— 1. How and when the drains in the said case referred to were originally constructed. 2. When and by whom the houses Nos. 51 to 81, odd numbers and both numbers inclusive, in Hartfield Crescent were built. 3. When they came into the possession of the present owners respectively. 4. Whether the Appellant, David Jackson, or his predecessors, ever executed any repairs to the said drain B to C, and if so, when and under what circumstances. 5. Whether any repairs were ever executed by the Respondents to the drains or sewers to the said houses in Hartfield Crescent, and if so, when and under what circumstances. Smoke Nuisances. Several complaints were received alleging nuisances from black smoke emissions from certain chimneys, principally from two laundries. Observations were taken for some time, and notices for the abatement of the nuisances were served on the occupiers and complied with. Paving of yards. The work of paving the spaces immediately around dwellings in the poorer neighbourhoods for the purpose of abating nuisances and remedying insanitary conditions caused by dampness in the walls due to wet or polluted earth abutting thereon, has been carried out at 73 houses. There can be no question that both the paving of the open space immediately around the dwelling and the discontinuance of keeping domestic animals about dwelling houses are matters which require careful consideration. Owing to the absence of bye-laws, the paving with impervious material can only be insisted on where the nuisance already exists. The work would be much easier if the bye-laws were applicable to the prevention of insanitary conditions as well as their rpmniro 1 Nuisances. General. Elm Lodge, Dumsford Road.—For some two or three years complaints have been made by the occupier of the adjoining premises, Wellington House, of offensive smells from the keeping of 27 pigs here. The place has been visited continuously at all hours, but on only one occasion has any breach of the Council's Bye-laws been found. The complainant was several times informed that there was no nuisance that this Authority could deal with, but that his remedy was at common law. In October, Mr. Sullings, the occupier, sought to obtain in the Court of Chancery an injunction to restrain Mr. Robert Abrahams of Wellington House from committing a trespass by building sheds and fixing timbers to his wall. Mr. Abrahams and his wife counterclaimed for an injunction to restrain Sullings from continuing to cause a nuisance alleged to arise from the keeping of pigs. In both cases damages were claimed. The Chancery Judge granted the injunctions asked for in each case, but suspended the one respecting pigs for three months to enable Sullings to dispose of them, and stated that the nuisance was not one that could have been dealt with by the Local Authority under the Public Health Acts or Bye-laws. Ashen Grove Farm, Durnsford Road.—In the course of the work of covering the portion of the ditch near Durnsford Road, which forms the boundary between Wimbledon and Wandsworth, a quantity of sewage matter was noticed going down the culvert. Examination was made, and eventually the sewage matter was traced to proceed from several cesspools on this farm which received the drainage from piggeries, cowsheds and farm buildings. Notices were served on the occupier under the Rivers Pollution Prevention Act 1876. The ditch was cleaned out throughout its entire length and the overflow from the cesspools into it abolished. The condition of the drainage system was such that a permanent abatement of the nuisance could only be obtained by its entire reconstruction and connection with the sewer which is more than a hundred feet away, but as the farm land was being rapidly developed for building purposes the Council accepted the undertaking from the occupier to abolish the piggeries, cowsheds, etc., within six months, subject to such steps being taken for the temporary abatement as the Sanitary Inspector might require. During the year several gardens and vacant plots of land in South Wimbledon, which were undoubtedly serious nuisances and unhealthy for the inhabitants of the neighbourhood in consequence 28 of water becoming stagnant on them, were dealt with. The owners were served with notices, or their attention drawn to the matter, which resulted in the gardens being subsoil drained, and the vacant spaces filled in with earth. Appendix table 5 shows a summary of the nuisances abated. House refuse ; "ollection ind Disposal The collection of house refuse and disposal of same by means of burning at the refuse destructor is carried out by the Surveyor's Department, 9141 loads being so dealt with during the year. When the estimates for the half-year ending in March last were submitted to the Council the amount allowed by the Surveyor for disinfectant powder for use in dustbins and collecting carts was disapproved, and as a result the practice which had been existant for many years of sprinkling the bins at the time they were emptied by the Council's men was discontinued. In the hot weather of June, July and August, many complaints were received from house-holders of nuisances from the receptacles. These complaints were considered by the Council, and a Joint Committee consisting of members of the Road and Drainage and Sanitary Committees was appointed in August to consider and report upon "the present system of dust and house refuse collection, and the advisability of a more frequent collection." The matter is now under consideration. Housing of theWorking Classes Act 1890. A closing order was made with respect to Nos. 2 to 11, Thornton Road, and 2 to 14, South Place, on the 4th of March, 1903, prohibiting the use of these premises for the purpose of human habitation. Two or three of the houses were demolished at that time, but it is only quite recently the whole site was cleared. In connection with this it is interesting to see the time that it has taken to deal with this matter. I first gave a certificate that in my opinion the houses were unfit for human habitation in May, 1894, and a notice was served on the owner by order of the Local Board in the same month, but for various reasons nothing more was done in the matter until August, 1901, when I, together with the Sanitary Inspector, submitted a report to the Sanitary Committee, which resulted in the matter being taken through its different stages as required by the Act. The site was cleared late in the year. 29 Customs and Inland Revenue Acts Applications for certificates under Section 26 of the Customs and Inland Revenue Acts 1890 and 1891 were made with respect to the following properties:— Nos. 46, 48 and 50, Milton Road. Nos. 1 to 15, Garfield Road. After inspection of the premises and the carrying out of certain requirements a certificate was granted with respect to the former block of dwellings, but not to the latter, where the conditions were such that I could not certify that the houses were constructed as to afford suitable accommodation for the persons or families inhabiting them, and that "due provision was made for their sanitary requirements." Petroleum Acts *871-79- There are 14 persons on the register licensed for the storage and sale of petroleum, an increase of 2 on last year. Samples have been taken from each vendor and tested as required by the Act, and in no instance was the flash point below 76° F. Thirty visits were paid to the licensed premises, and the regulations and conditions of the license found to be complied with on each occasion. I take this opportunity of expressing my appreciation of the valuable assistance rendered to me by Mr. Johnson during my illness resulting from a carriage accident early in the year. The tact and zeal displayed by him in dealing with fmatters requiring special attention is beyond praise, and the thoroughly efficient organisation of the Sanitary Department and the excellent manner in which the whole of the Staff have carried out their duties during the year speak volumes for Mr. Johnson's untiring energy. Pages 19 to 29 and Table 5 give particulars of work carried out by the Staff under his supervision. I have the honour to be, Your obedient Servant, E. POCKLINGTON, Medical Officer of Health. 30 Wimblefcon Tllrban district. Birth and Death Rates of each Ward, 1904. Ward. Birth-rate. Death-rate. St. Mary's 14.0 5.5 St John's 10.3 7.2 Cottenham Park 23.0 11.2 North Wimbledon 15.1 7.6 Dundonald 23.9 10.2 Holy Trinity 29.7 10.2 South Park 28.4 13.0 South Wimbledon 28.1 11.4 Whole District 23.9 10.2 Wimbledon Urban District. TABLE 1. Vital Statistics for Whole District during 1904 and previous Years. YEAR. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents registered in Public Institutions in the District. Deaths ol Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1000 Births Registered. N umber. Rate.* Number. Rate.* 1 2 3 I 4 5 6 7 8 9 10 11 12 13 1894 30,000 794 26.4 81 102.01 310 10.3 No record for this year. 1895 31,000 857 27.6 102 119.01 377 12.1 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 26.02 145 150.57 415 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 24 570 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 1903 46,000 1204 26.1 99 82.22 389 8.4 18 5 40 424 9.2 Averages for years 1894-1903. 37,413 984 26.3 120 121.95 421 11.2 14 6 30 459 12.2 1904 47,719 1142 23.9 153 133.9 487 10.2 29 5 46 526 11.02 * Rates in Columns 4, 8, and 13 calculated per 1000 ot 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 Total 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 Wimbledon Urban District. TABLE 2, Vital Statistics of separate Localities in 1904 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.—Holy 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. 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. 1894 30,000 794 ... 81 1 1895 31,100 857 374 102 1 1896 33,000 875 365 96 1897 35,000 828 398 98 Pa rti culars for these years not obtai liable. 1898 37,000 903 442 145 1899 38,000 1,031 568 163 1900 39,500 1,075 570 15F 1901 41,031 1,074 493 133 1902 43,000 1 144 497 134 5,270 ... 48 1 I 5,044 ... 4,-) 6 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 12,488 437 120 39 14,298 423 133 40 Averages of Years 1894 to 1903. 37,413 984 45S 121 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 Wimbledon Urban District. TABLE 3. Cases of Infectious Disease notified during the year 1904. 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 05 65 and upwards 1 2 3 4 5 6 (H.) 1 2 3 4 5 6 (H.) Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 36 ... 14 13 4 5 ... ... 3 7 2 11 13 ... 1 4 1 10 9 Membranous croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 42 1 2 5 6 25 3 4 4 8 3 12 11 ... ... ... ... ... ... Scarlet fever 106 ... 17 75 9 5 ... 9 6 5 7 21 58 5 2 6 4 18 48 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 15 ... 9 ... 3 4 ... 4 1 ... ... 3 7 1 ... ... ... 2 5 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 199 1 35 99 22 39 3 17 14 20 12 47 89 6 3 10 5 30 62 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. Wimbledon Urban District. TABLE 4. Causes of, and Ages at, Death during year 1904. 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 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. Holy Trinity Ward. South Park Ward. 1 2 3 4 9 6 7 8 9 10 11 12 13 14 15 16 Small-pox — — — — — — — — — — — — — — — Measles 23 10 12 1 — — — — — — 3 4 16 — — Scarlet fever — — — — — — — — — — — — — — — Whooping-cough 14 7 7 — — — — — — 2 2 1 9 — — Diphtheria & membranous croup 6 — 4 2 — — — — 2 2 — 1 1 — 5 Croup — — — — — — — — — — — — — — — Fever. Typhus — — — — — — — — — — — — — — — Enteric 4 — 1 — — 3 — — — — — 1 3 — 3 Other continued — — — — — — — — — — — — — — Epidemic Influenza 3 — 1 — — — 2 — — — — 2 1 — — Cholera — - — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — Diarrhœa 49 38 10 — — — 1 — — 5 5 18 21 — — Enteritis 10 8 1 — — 1 — 1 1 — — 3 5 — — Puerperal fever — — — — — — — — — — — — — — — Erysipelas 1 — — — — 1 — — 1 — — — — — — Other septic diseases 2 — — — — 2 — — — 1 — — 1 — — Phthisis (Pulmonary Tuberculosis) 27 2 1 3 — 18 3 3 1 2 2 11 8 — 1 Other tubercular diseases 15 5 4 3 — 2 1 — 1 3 3 5 3 — 2 Cancer, malignant disease 25 — — — 1 13 11 4 1 — 3 6 11 — 1 Bronchitis 37 6 1 1 — 8 21 1 4 1 10 13 8 — 1 Pneumonia 40 4 10 — 2 13 11 4 1 4 3 12 16 — — Pleurisy 3 1 — — - 1 1 — — — — 3 — — Other diseases of respiratory organs 3 — — — — 3 — — — — 1 1 1 — — Alcoholism 6 — — — 3 3 1 1 1 2 — 1 — 1 Cirrhosis of Liver Venereal diseases 5 4 — — — 1 — 1 — — — 4 — — — Premature birth 15 15 — — — — — 1 — 1 1 7 5 — — Diseases and accidents of parturition 2 1 — — — 1 — 1 — — — 1 — — — Heart diseases 37 6 — 1 2 12 16 2 9 5 5 12 4 — 2 Accidents 10 2 2 1 — 5 — — 1 2 1 2 4 — 2 Suicides 6 — — — 1 5 — 1 — 1 — 1 3 — 1 All other causes 183 52 13 5 5 42 66 20 17 14 20 53 59 — 10 All causes 526 161 67 17 11 134 136 40 40 44 61 158 183 — 29 TABLE 5. The following is a summary of the nuisances abated and sanitary mprovements made under the supervision of Mr. Johnson, the Sanitary Inspector Accumulations Removed 42 Cisterns Provided 6 Cisterns Repaired, Cleansed or Covered 49 Drains, New, Provided 119 Drains, Repaired or Altered 58 Drains, Stoppages Removed 44 Dustbins Provided 29 Flushing Boxes, New, Provided 116 Flushing Boxes Repaired 45 Manure Receptacles Provided 4 Overcrowding Nuisances Abated 5 R.W. Pipes Disconnected 49 Roofs Repaired 29 Rooms Disinfected 325 Rooms Stripped and Cleansed 244 Soil Pipes, New, Provided 43 Soil Pipes Repaired or Altered 11 Ventilating Pipes, New, Provided 222 Ventilating Pipes Repaired or Altered 11 Waste Pipes, New, Provided 84 Waste Pipes Repaired, Disconnected or Trapped 25 Water Closets, New, Provided 167 Water Closets Repaired or Ventilated 11 Water Service Restored 13 Yards Cleansed 38 Yards Paved 73 Other Nuisances Abated 38 Total 1,900