WIM 055 Borough of Wimbledon, County of Surrey. REPORT OF THE Medical Officer of Health FOR THE Year ending 31st December, 1906. Borough of Wimbledon. Sanitary Department. ANNUAL REPORT OF THE Medical Officer of Health, FOR THE year ended 31st December, 1906. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Gentlemen, In accordance with my statutory duty I beg to present my Annual Report for the year ending December 31st, 1906, on the health of the inhabitants and the sanitary condition of the Borough, which is the thirty-sixth I have had the honour of preparing as Medical Officer to the town. 2 The tables of vital and other statistics and infectious disease in the appendix are made according to the requirements of the Local Government Board and in form prescribed by them. Population.— All the calculations are based on an estimated population of 49,860, which is obtained by the Borough Engineer ascertaining the number of occupied houses in each ward and multiplying by the house factor for the respective ward obtained fiom the official census at 1901. As compared with last year, considerable differences will be found in the populations of the various wards caused by the readjustment of boundaries made under the scheme of incorporation, when the Cottenham Park Ward was enlarged by the addition of that portion of St. Mary's Ward, bounded by a line commencing at the southern end of West Side and proceeding along South Side, the centre of the High Street, Ridgway and Woodhays Road; and the portion enclosed by a line commencing at the Railway Bridge at Wimbledon Station proceeding along the centre of the Broadway, Russell Road, the district boundary in Kingston Road, the centre of Hartfield Road, was transferred from Trinity Ward to the Dundonald Ward. Area.— The area of the Borough is 3,173 acres and the density of the population was 15.7 per acre. Births.— The number of births registered was 1,185 (596 rrales, 589 females), which is 39 more than last year and equal to a birth-rate of 23'7, being 19 below the average for the past ten years. The corresponding rate for England and Wales for the same period is given as 27.0 in the report of the Registrar General. The illegitimate births numbered 53 and constituted 44 per cent, of the total. Deaths.— The total number of deaths registered in the district was 584 (294 males, 290 females), equal to a death-rate of 11 7 per thousand of the population per annum and 3 5 higher than last year, which was the lowest on record in Wimbledon, and also England and Wales. The average for the past ten years is 10 7. The principle reason of this increased death-rate is due to an epidemic of Diarrhoea, a greater number of deaths of persons aged 60 and upwards, and a larger number of deaths from Measles. 3 It must however, be admitted that a rate of 117 in a town of 50,000 inhabitants, is one on which a Local Authority may congratulate themselves, especially when it is remembered that two-thirds of the population reside in a portion of the district which is practically level and only about 50 feet above ordnance datum. If this rate can be maintained in future we shall have reason for satisfaction. The deaths in public institutions outside the district of persons belonging to Wimbledon, were: 45 in the Kingston Infirmary and 10 in the County Asylum, Brookwood; and the deaths occurring in public institutions within the district of persons not belonging thereto were : four in the South Wimbledon Cottage Hospital, three in the Atkinson Morley Convalescent Hospital, Copse Hill, and one in the North Wimbledon Cottage Hospital. After taking these into account, the total number of deaths properly belonging to the district is found to be 631, and the deathrate 12 6. The rate for England and Wales for the same period is 154. One hundred and seventy-five deaths of children under one year of age were registered; and this infantile mortality is represented by a ratio of 147 deaths per thousand registered births, an increase of 78 per thousand on the previous year, and 28 on the average for the past ten years. The rate for England and Wales is 133. This is chiefly accounted for by the fatal Diarrhoea present in one part of the district, and which was the subject of a report made to and at the request of the Local Government Board. The number of deaths from zymotic diseases was 137, viz.:— Diarrhoea 90, Measles 19, Diphtheria 9, Enteric Fever 5, Scarlet Fever 5, Erysipelas 5, and Whooping Cough 4, giving a zymotic death-rate of 2.7 per thousand of the population, the highest for over 20 years. In addition to the deaths from zymotic diseases, the principal causes of deaths were as follows:— Pneumonia 50, Bronchitis 19, Cancer 48, Phthisis 43, other forms of Tuberculosis 16, Heart Diseases 30, and Premature Birth 17. 4 Table A shows the births, deaths (registered in district) and death-rates, and the deaths at certain ages and for specified causes for the past 5 years. Table B shows for the same years the number of infectious cases notified and the deaths from each disease. Table C shows the death-rates from zymotic diseases, phthisis and other forms of tuberculosis for the past 10 years. Table A. 1906 1905 1904 1903 1902 Births 1185 1146 1142 1204 1144 Deaths 584 397 487 389 455 Death-rates 11.7 8.2 10.2 8.4 10.5 DEATHS— Under 1 year 175 80 153 99 134 Over 1 year and under 60 years 260 175 187 169 192 Above 60 years 149 142 147 121 129 From Measles 19 1 23 4 11 „ Scarlet Fever 5 3 0 1 0 „ Small Pox 0 0 0 0 0 „ Diphtheria 9 2 6 4 7 „ Diarrhœa 90 15 43 13 6 „ Whooping Cough 4 10 14 9 17 „ Enteric Fever 5 5 4 2 3 „ Puerperal Fever 0 1 0 2 0 „ Erysipelas 5 1 1 1 3 „ Influenza 10 8 3 5 6 5 Table B. DISEASES. 1906 1905 1904 1903 1902 Cases Notified. J Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 1 0 0 0 o 0 9 0 Diphtheria 55 9 39 2 36 6 58 4 80 7 Erysipelas 32 5 50 1 42 1 40 1 46 3 Scarlet Fever 229 5 110 3 106 0 113 1 128 0 Enteric Fever 11 5 39 5 15 4 15 2 16 3 Puerperal Fever 1 0 1 1 0 0 4 2 3 0 *Measles 0 19 0 1 0 23 104 4 1026 11 Totals 328 43 240 13 199 34 324 14 1308 24 * Measles notifiable from June, 1898 to June, 1903. Table C. Year. Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhoea. Phthisis and other Tuberc'lo's Diseases. 1897 2 0 - .05 17 .02 .2 .45 .82 .6 1898 20 - .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 1902 1.02 - — .16 .06 .39 .25 .13 .7 1903 .73 - .02 .08 .04 .19 .08 .28 1.08 1904 1.9 - — 12 .08 .29 .48 .9 .83 1905 .78 .06 .04 .12 .20 .02 .31 .82 1906 2.7 - .1 .18 .1 .08 .38 1.8 1.1 6 Scarlet Fever.— Notifications respecting 229 persons were received during the year, representing an attack rate of 1.5, being the highest since 1897 when the rate was 5.5, and the highest number of cases notified in any year since 1893, when the number was 294, and the attack rate 8.4 per thousand inhabitants. For the six years prior to 1906 the number of notifications yearly were very uniform, but signs presented themselves in the autumn of 1905 of a probable large increase during the coming year. In January, 20 cases occurred, and from 10 to 19 monthly to September, reaching 42 in October, declining to 36 in November and 21 in December. This increased number of Scarlet Fever cases was not confined to Wimbledon but present throughout the Metropolis, the counties of Surrey and Kent and the south of England. In September the reserve Iron Hospital was brought into use fot Scarlet Fever patients, as was also the Diphtheria pavilion (the district fortunately being free from Diphtheria at the time). The question as to what should be done with future cases should more occur than could be treated in the above premises was considered, and the following methods taken into account:— (1) the provision of tents, as was done in 1893; (2) the provision of temporary wooden pavilions; (3) the sending of surplus cases to some other Authority's hospital, or nursing at home. I reported that the tents, from every point of view, both of the authority and the patients, in the light of the experience of 1892 and 1893 and especially as winter was approaching, were unsatisfactory. I was against the provision of wooden pavilions on account of the risk from fire, and recommended that arrangements if possible should be made with some other Authority for the reception of a number of patients, and in exceptional circumstances, such as where several cases occurred at one time in a house, of the sending in of a nurse. These recommendations the Committee agreed to. Through the courtesy and kindness of Dr. Meredith Richards, the Medical Officer of Health for the County Borough of Croydon, arrangements were made for a limited number of Scarlet Fever and Diphtheria patients being received into hospitals of that Corporation. The early symptoms of many of the cases were marked by the 7 absence of what might be termed typical symptoms, and owing to the slightness of the rash and absence of an increased or high temperature, nothing wrong was noticed by the parents or persons in charge until the peeling commenced, when a doctor was called in. This occurred in about 25 instances and by their very mildness were probably the means of spreading the disease; again some of these though very slight in their earlier stages were unusually severe and complicated at later periods of illness. 179 patients, or 78 per cent, of the total cases notified, were removed to the hospital, 4 of whom died, the fifth death occurring at home. That some additional hospital accommodation is necesssary if all cases desiring removal are to be treated in the isolation hospital must be admitted, and a sub-committee has had the matter under consideration for some time. A marked change has taken place of late years with regard to this matter. A few years ago pressure had to be applied to obtain the consent for removal of even cases where there was no means of isolation whatever at the home; whereas now, the difficulty is not to persuade parents to permit removal of their children, but in many insiances to point out that there is fair means of isolation at home, and that provision cannot be made for the removal of every case that occurs when there is an unusually large number in a short period, without throwing an undue burden on the rates through management and capital expenses when the hospital is not fairly fully occupied. Ot the notifications received 108 were of children attending the following schools :— Haydon's Road (Girls and Infants), 31; Haydon's Road (Boys), 9; Queen's Road, 19; Dundonald, 13; Effia Road, 5; Holy Trinity, 4; Central, 5; Cottenham Park, 1; Roman Catholic, 1; Private, 6; Schools outside district, 14. Table III. 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. In Table C on page 5 will be found the death rate from Scarlet Fever for the past ten years. 8 Owing to an outbreak of Scarlet Fever amongst the scholars attending the girls' and infants' departments of the Haydon's Road schools, and in order to stay the spread, I advised the closing of the school, which was done from October 3rd to the 13th, and during this time the whole of the class rooms and apparatus used in them was disinfected. On several occasions children were found in attendance at schools in the peeling or desquamation stage of the disease, and in consequence Queen's Road and Dundonald schools were disinfected, the former on two different occasions. Diphtheria.— Fifty-five cases were notified, which is represented by an attack rate of 1.1 against 39 last year, and a rate of .8, the average rate for the past ten years being 12. In Table C on page 5 will be found the death-rate yearly for the past ten years. Thirty patients were removed to hospital, which is 54 per cent, of the total number notified, and of the nine deaths three took place in the hospital. Twenty-one were of school age attending the following schools:— Central, 8; Haydon's Road Girls, 2; Roman Catholic, 2; Effra Road, 1; Holy Trinity, 3; Private, 5. At nine houses more or less serious defects were found in the drainage systems, and notices served requiring their amendment were complied with. For some years it has been recognised that when Diphtheria is prevalent, a condition of the throat which used to be considered an ordinary sore throat is likeiy to be really a diphtheritic sore throat, and, when a swabbing is taken and a bacteriological examination made, found to contain the Klebs Loeffler Bacillus, the particular organism generally held to be the cause of Diphtheria; and, that this is also the case with the throats of apparently healthy children who have been in contact with others suffering from Diphtheria, and may be the carriers of the disease to other children, although not appearing to be affected themselves. Notable examples of this occurred at the Central Schools early in November. Several children attending these schools were notified between the 6th and 10th, and enquiries show that one child who was away from school for several days with what was thought to be a simple cold and sore throat, returned to school apparently well on November 1st, when within a few days four other children in the same class room were notified 190 6. CHART SHEWING WEEKLY NOTIFICATIONS OF SCARLET FEVER. 9 as suffering from Diphtheria. No further case occurred until November 19th, but the period since the previous case had discontinued attendance at school was too long for there to be any direct connection. I visited the schools and examined the throats of all children present and took swabs from several suspicious ones, and respecting one in which there was only the slightest clinical signs of ulceration, the bacteriologist's report was to the effect "good growth Bacillus Diphtherae found." This child, whose throat at an ordinary lime would, if examined, been looked upon as of no importance, had undoubtedly been the means of spreading the disease. The child was isolated at home and no further cases occurred. Enteric and Typhoid Fever.— A marked decline has taken place in the number of Enteric Fever cases, only 11 having been notified, the lowest number since 1898. Generally they were of a very severe type and 5 terminated fatally, giving a case mortality of 45 per cent. In two instances the disease appears to have been contracted outside the district, one at a volunteer camp; at the homes of two of the patients the drainage and sanitary arrangements were found to be seriously defective. Puerperal Fever.— One case only was notified during the year, this in the practice of a registered mid-wife. She was suspended from practice until thorough disinfection as required by the rules of the Mid-wives Board had been carried out. Erysipelas.— Thirty-two notifications were received during the year and 5 deaths registered, as against 50 with 1 death last year, and 42 and 1 death the previous year. Measles.— During the months of March, April and May, an extensive outbreak of Measles was prevalent and 19 deaths occurred (8 in March, 6 in April, 3 in May, and 1 each in the months of June and August). Below is shown the schools closed and the period, in order to prevent the spread of infection:— Haydons Road Infants, March 13th to April 12th; Holy Trinity Infants, March 20th to April 12th; Cottenham Park (all departments), April 25th to May 23rd; Dundonald Infants and Girls, June 8th to July 9th. 10 The outbreak at the Cottenham Park School was combined with Ringworm and Chicken Pox. In the summer holidays the whole of the public elementary schools were disinfected by the Staff of the Sanitary Department for the Education Authority. 151 lists containing the names of 590 scholars attending public elementary schools and suspected to be suffering from Measles weie received from the head teachers and investigated. Whooping Cough was the registered cause of death in 4 instances against 10 last year and 14 the previous year. Influenza was responsible for 10 deaths as compared with 8 last year and 3 the previous year. Phthisis and other forms of Tuberculosis was the assigned cause of 59 deaths as against 40 the two previous years, and is represented by a death-rate of l.l, which is slightly higher than any other for the past ten years as will be seen from Table C on page 5. The deaths were distributed through the various Wards as follows :— South Park, 25; Trinity, 18; Dundonald, 7; Cottenham Park, 5; St. John's, 2; and St. Mary's, 2. The Sanitary Committee on April 18th considered a memorandum issued by the National Association for the Prevention of Consumption upon the means for preventing the spread of Consumption which might be adopted by Local Authorities, and I was requested to report whether any, and, if so, what steps should be taken by the Council to prevent the spread of Consumption and other forms of Tuberculosis within this Borough. I prepared and submitted the following report to the Sanitary Committee at their meeting on June 14th, and it was resolved (a) that a copy of the report be forwarded to each member of the Council; (6) that the Town Clerk be directed to forward a copy of the report to the Honorary Secretary of the Wimbledon and District Medical Society, and suggest that the members of that Society should meet this Committee at an early date and discuss the Medical Officer's recommendations. 11 Report. In the first place I would like to point out the favourable position the town holds as regards Phthisis and other forms of Tuberculosis. The only figures I can give which are absolutely accurate are those of the deaths recorded from these diseases, and for practical purposes it may be taken for granted that the cases are four or five times the number of recorded deaths. The average death rate from Tuberculous diseases in Wimbledon for the past ten years is 1.2 per thousand, or 12 per 10,000 (including deaths of Wimbledon persons in public institutions beyond the district). The accompanying chart * shows the corresponding rate for England and Wales and the remarkable decline which has occurred since the year 1851, from which date statistics for England and Wales as regards this disease are available. The decline in the Phthisis death rate since 1838 in England and Wales is from over 3,800 to 1,100 per million, a fall of over 70 per cent., a reduction of more than two-thirds. It is interesting to note the progress of events since 1832 (the Cholera year) which had the effect of awakening the medical profession and conductors of the public press to the necessity for alterations in the system of Public Hygienic Conservancy. The first of these measures in 1838 was the institution of the Registrar-General's returns of Births, Oeaths and Marriages. The revelations made by his earliest reports as to the enormous waste of life then proceeding in all large towns brought about in 1842 the " Health of Towns Commission," and shortly afterwards steps were taken to mitigate their unhealthiness. Medical Officets of Health were appointed in . several towns, noticeably the City of London and Liverpool, and from this beginning sprang the sanitary service as at present constituted. In 1845 laws were passed containing regulations respecting buildings, their drainage and ventilation, and others followed in the same direction. In 1847 an Act for the improvement of towns which included the appointment of Inspector of Nuisances was passed, and in 1848 the first Sanitary Act was passed; also the law against the sale of diseased meat, and other beneficial measures followed, such as the abolition of Window Tax, the Diseases Prevention Act of 1855, the Removal of Nuisances Act, also in 1855, the Local Government Act * Chart not reproduced in this Annual Report. 12 in 1858, the "Bakehouse Regulation Act in 1863, the Sanitary Act in 1866, the Workshop Regulation Act in 1867, the Artizans' and Labourers' Dwellings Acts in 1868, and an Act to amend the laws for the Prevention of Adulteration of Food and Drink and of Drugs in 1872, besides various amendments to former Acts and another Public Health Act in 1872. Eventually the Statutes relating to the Public Health became so numerous that it was deemed desirable to frame a special Act for consolidating and amending them. This was done in the Public Health Act, 1875, which with the Amendment Act of 1890 gives the powers under which the sanitary authority now work. All this activity in the cause of public health had an effect not only on the general death rate but a greater one on the Phthisis rates, although no idea was entertained at that time that this disease was at least as preventable as some others. These Acts brought about among other things, better ventilation about buildings, land drainage, sewerage systems and some amelioration of social conditions, and their effects are seen on the tuberculosis rate on the chart. Since 1894 the rate of diminution has somewhat slackened, pointing to the fact that possibly the measures of general sanitation which have done much for other diseases have reached a point where, with Tuberculosis, something more is needed, and special measures adopting for dealing with the prevalence of Tuberculosis and especially the pulmonary form of Consumption. It is well known that under certain conditions Consumption is a communicable disease, and the cause of it and other Tuberculous affections is a microbe, the Tubercle Bacillus. These are present in large numbers in the expectoration of those affected and they obtain access to the lungs and to food in the form of dust after the sputum has dried on floors, walls, furniture, carpets and clothing and has been pulverised and dispersed in the air of the room. They are also dispersed in the air as spray in the act of coughing and in this a great danger lies. It is recognised that in the non-expectorating types of Tuberculosis there is little risk of communicability and if all expectoration could be destroyed as soon as coughed up the disease would be stopped at its source and soon become much less prevalent. We will now consider special measures which may be of service. Diagnosis.— Early recognition of the disease is highly desirable. This must depend on the trained skill of the medical attendant, but if expectoration is present it becomes a matter for the 13 protection of the public that he should be assisted in making a correct diagnosis and so the first conclusion is arrived at that the Sanitary Authority should provide facility for the bacteriological examination of sputum for Tubercle Bacilli. The discovery of this practically amounts to the voluntary notification of expectorating pulmonary tuberculosis for those cases in which the sputum is examined at the public expense. Notification.— Many persons are of opinion that Phthisis should be placed in the same category as Scarlet Fever, Diphtheria, Typhoid, and other statutory notifiable diseases mentioned in the Infectious Diseases Notification Act, but it must be remembered that the diseases which are notifiable under the Infectious Diseases Notification Act, are from the time of attack to recovery or death, only of short duration; on the other hand a person may be suffering from Phthisis for several years, so that the regulations and enactments in question could not be made applicable to Phthisis or Consumption. Many local authorities have applied to the Local Government Board to make it notifiable, but all have met with refusal. In only one town in England, and that by a Private Bill in Parliament, has Consumption been made compulsorily notifiable. That a form of compulsorily notification will come in time there is little doubt, and until this time does come and with a view to educating the public up to it, I should strongly recommend that voluntary notification be adopted and that the same fee be paid as under the Infectious Diseases Notification Act. To voluntary notification objection is often raised that it is an infringement of professional confidence between patient and medical attendant, and in view of a high legal opinion recently given that in the case of a medical practitioner notifying without the consent of the patient he might possibly be subject to an action, it should be understood that notification be made only with the consent of the patient, and in order to get the best results from voluntary notification I would suggest, before any steps be taken, that either myself, the Chairman of the Sanitary Committee, or whoever the Committee desire, should communicate with the local Medical Association with a view to obtaining their co-operation. Disinfection. — That after removal on account of change of residence or of entry into a hospital, sanatorium or home, or after 14 death, the room previously occupied by the patient and also the bedding should be disinfected by the Sanitary Authority. Sanatoria.— At the present time there is a disposition to overrate the value of Sanatoria and some people consider that these are being constructed and equipped on extravagant lines. It should be borne in mind that without Sanatoria Phthisis has been reduced in this country some 70 per cent, during the last 65 years. Institutions are wanted not primarily for the benefit of patients but for the isolation of the patient for the benefit of others and which may therefore be fairly supported out of pnblic funds. So far as I am aware there are no such institutions in London or Surrey if we exclude the provision made by the Poor Law Authorities for pauper patients, and until these are provided one of the essential provisions for coping with the disease is lacking. Whatever the extent of the provisions made in the Sanatorium or Isolation Hospital the majority of the sufferers from Phthisis would remain at home with their families, and work until the latest stages of the disease is reached, rather than enter an Institution for several months. Consumption then must be dealt with in its different stages, in the first stages education and open-air treatment for those able and willing to avail themselves of it is wanted; in the later stages isolation is needed, as every cough is the cause of the dissemination of the Tubercle Bacillus. Regarding the treatment of Expectorating Pulmonary Tuberculosis away from home there are three classes of cases to be provided for, Incipient, Pronounced and Advanced. This means for the incipient cases Sanatoria proper, for the pronounced cases Consumption Hospitals, and for advanced cases Homes for Incurable Consumptives or Homes for the dying. The provision may be made either by separate institutions or within the precincts of the same institution in separate structures as has been done in connection with some Workhouse Infirmaries. In the homes of the poorest, the advanced cases are by far the most dangerous. For pronounced or intermediate and incipient cases Sanatorium treatment affords the most promising and permanent results. For the well-to-do their means enable them to get suitable treatment and they need not be considered by the Local Authority, 15 and for persons chargeable to the rates the Poor-Law Authority are making provision. About 20 per cent, of the deaths from Tuberculous Diseases are Poor-Law cases. At Kingston the Guardians have provided a special separate ward for Phthisical patients where the open-air treatment is carried out, and if a stay in a Sanatorium is likely to be of lasting benefil and thereby enable the patient, either man or woman, to again earn their livelihood they are sent to a Sanatorium at Peppards Common, but for the large class of people between the well-to-do and poorest there is a great want. How is this to be provided for? Possibly combination between Local Authorities will be found possible on somewhat the same lines as Joint Hospital Boards or possibly the County Council may deal with a scheme for the whole County. I do not think hasty action advisable, possibly to watch the experiments by other Local Authorities will be best and when a workable scheme is found to adopt its principles. Briefly my recommendations are :— (1) To adopt a voluntary system of notification and to confer with the Wimbledon Medical Association with a view to obtaining the co-operation of the medical profession, so that as much good as possible may be derived from notification. (2) To have bacteriological examination of sputum made in suspected cases at the cost of the Local Authority, as is now done for Enteric Fever and Diphtheria. (3) To disinfect at intervals as circumstances require bedding used and rooms occupied by Phthisical patients, and also after death or removal. (4) To ask the Guardians of the Poor to request or permit their Medical and other officers in Wimbledon to co-operate with the officers of the Sanitary Authority, so that special efforts may be made to assist the poorer who are least able to do anything for themselves. (5) To make Bye-Laws prohibiting soitting in public places. (6) To print for distribution, pamphlets on the prevention of Consumption and suggestions for the guidance of consumptive patients. QUERIES re CONSUMPTION. Summary. Metropolitan Boroughs— Number of queries sent out 29 Number where system of voluntary notification in force 20 16 Metropolitan Borought (continued)— Number where system of voluntary notification not in force 8 Number from which replies not received 1 Of the 20 Boroughs where voluntary Notification in force 9 spoke favourably of the system and 3 unfavourably. Three of the 8 Boroughs where voluntary notification not in force have the subject under consideration. Towns out si!e the Metropolitan Area— Number of queries sent out 47 Number where system of voluntary notification in force 11 Number where sysiem of voluniary notification not in force 33 Number of towns from which replies not received 3 Of the 11 towns where voluntary notification in force 2 spoke favourably of the system, 5 unfavourably, and 4 expressed no opinion. Ten of the 33 Towns where voluntary notification not in force have the subject under consideiation. A conference between the Sanitary Committee and the Wimbledon and District Medical Society was held at the Town Hall on July 7, when the recommendations set out in the report were considered seriatim and the resolutions passed were briefly as follows:— (1) That a system of voluntary notification of phthisical cases be adopted for 3 years, and that the members of the Medical Society pledge themselves to use their best endeavours to ensure its success, provided (а) that a separate register of phthisical cases notified be kept, (b) that each notification be regarded as confidential, and (f) that the Sanitary Department take no action unless at the request or with the approval of the doctor notifying. (2) That bacteriological examinations of sputum in suspected cases should be made at the cost of the Local Authority. (3) That disinfection be carried out by the Sanitary Department at intervals, as circumstances require, of bedding used and rooms occupied by phthisical patients, upon request. (4) That pamphlets on the prevention of Consumption and suggestions for the guidance of consumptive patients be prepared by the Medical Officer of Health in conjunction with the President and Secretary of the Medical Society, printed at the cost of the Sanitary Authority and that the same be handed to the medical practitioners for distribution. The Sanitary Committee at their meeting on July 12th, agreed to the foregoing resolutions and the Council at its next meeting ordered that a voluntary system of notification of Pulmonary Phthisis or 17 Consumption within the Borough be instituted and continued for a period of 3 years from the 1st October. The Kingston Board of Guardians stated that they would be pleased to assist the Council, and had instructed their Medical and other officers in Wimbledon to co-operate with the officers of the Sanitary Authority in dealing with consumptive cases. Ten notifications were received from the 1st October to the end of the year, and at 21 houses disinfection of rooms, bedding, &c., was carried out, an increase of ten houses over last year and 12 the previous year. Diarrhoea and Epidemic Enteritis were the assigned cause of 90 deaths—63 being of children under 1 year of age, 26 between 1 and 5 years, and 1 between 1 and 15 years. The first two deaths took place in the third weeks in January and June. Seventy-nine deaths occurred in the third or summer quarter, and were the subject of the undermentioned report made by me to and at the request of the Local Government Board, the death-rate for this quarter for the whole of Wimbledon being 63. Of the remaining 9 deaths three were in the first week and two in each of the second, third, and fourth weeks of October. The annual death-rate per thousand living is 1.8 as against '31 last year, .9 the previous year and an average of the past ten years of .58. This excessive mortality was accounted for by an epidemic commencing in June, continuing through the summer months and terminating at the end of October. Although to an extent all parts of the town and persons of all ages were affected, yet it is most significant that the mortality was, with few exceptions, confined to one part of the district—a part which has suffered in a large measure in previous summers and specifically mentioned in my report for tbe year 1904. In the table is set out the streets principally affected, with details as to population, birth and death-rates. In only three of the largest towns mentioned in the weekly and other returns of the Registrar General was the death-rate in the summer quarter equal or greater to that of Wimbledon, viz:- Grimsby, 6.4; Hanley, 6.5; Coventry, 6.5. In no Metropolitan Borough was the rate so high, the highest being Poplar, 543, and the rate for the whole of London, 2.6. 18 If the portion of Wimbledon in the rectangle mentioned in the report having a population of 6,000, or one-eighth of the whole of the town, is compared with the three East London Boroughs having the highest rate for the quarter under review, viz:— Shoreditch, Poplar and Stepney, with a combined population of 593,500, or about oneeighth of the population of the County of London, the result is a rate of 4.8 as against 30.2 in favour of the said London Boroughs; or taking the whole of London and the whole of Wimbledon, 2.6, as against, 6'3. The chart prepared from the Registrar General's Returns as regards deaths, the records for the Meteorological Office for the deep earth temperature (3ft. 2in. at Greenwich) and the readings furnished by the Borough Surveyor respecting rainfall at the sewage farm, Durnsford Road, show forcibly that so far as Wimbledon is concerned Dr. Ballard's theory as to the close relationship between the deep earth temperature to Diarrhoea Mortality is true. The first fatal case occurred when 56 degrees Fah. was registered, the maximum earth temperature and deaths coinciding week by week and ceasing when the earth temperature had fallen to 56 degrees Fah. Report on Diarrhoea Mortality in Wimbledon during the 13 weeks ending September 30th, 1906, being the Third or Summer Quarter. During the thirteen weeks ending September 30th, 1906, there were 79 deaths registered as due to Diarrhœa; commencing with two each in the first and third weeks, three in the third, and four each in the fifth and sixth ; the number reached 13 in the seventh week, declining to five and nine in the eighth and ninth weeks respectively. Again rising to thirteen, ten and thirteen in the tenth, eleventh, and twelfth weeks respectively, it suddenly dropped to one in the thirteenth week. The Chart shews the deaths week by week, the mean temperature of the air and the deep earth (3ft. 2in. Greenwich) temperature respectively, not only during the quarter in question but also through October, as the deaths from Diarrhœa which occurred in this month were those of children whose illness, of one or two months duration, although terminating in October had commenced in August and September. In Trinity Ward there were 30 deaths; South Park Ward, 42; Dundonald Ward, 4; Cottenham Park Ward, 2; St. Mary's Ward, 0; St. John's Ward, 0. Total 78. 19 Table SHEWING Population, Birth Rate and Diarrhoea Rate in streets most affected. Also Diarrhoea Rate in portion of district tinted blue on map of Borough sent to the Local Government Board with report. Also for each of the 3 South Wimbledon Wards separately and for the whole district— Road Population Deaths. Death Rate Births Birth Rate. In Third Qrtr. In Year* For Third Qrtr. For Year* Wandle Road 368 5 5 54.3 13.5 22 59-7 Leyton Road 426 5 5 46.9 11.7 16 37 *5 Lodge Road 140 1 1 28.5 7.1 16 114-2 Haydons Road 1641 9 9 21.8 5.4 82 49-9 South Road 568 4 4 28.1 7.0 18 31-6 Milton Road 291 4 4 54.9 13.7 13 44-5 Dryden Road 187 12 12 256.6 64.1 15 80-2 Cowper Road 249 7 9 112.4 36.1 29 116-4 Cowper, Milton, and Dryden Roads 727 23 25 126.5 34.3 ... ... Portion of district bounded by River Wandle, High Street (Merton), Haydons Road, and Railway (tinted blue on map) 6207 47 52 30.2 8.3 ... ... Trinity Ward 10634 30 32 11.2 3.0 ... ... South Park Ward 14360 42 50 11.6 3.4 ... ... Dundonald Ward 8279 4 5 1.9 0.6 ... ... Whole of South Wimbledon 33273 76 87 9.1 2.6 ... ... Whole of Wimbledon 50000 79 90 6.3 1.8 ... ... * These columns have been added since Report made to the Local Government Board. 20 SUMMARY OF INVESTIGATIONS. There were 78 deaths (39 males, 39 females) 14 of whom were illegitimates. (17.7 per cent.) These occurred in 70 houses (63 houses with one death in each, 6 houses with two deaths, and 1 house with three deaths). Fourteen of the children were weak from birth. In fifteen instances the mothers went out to work regularly for periods varying from one to six days weekly. 10 (12.6 per cent.) children were breast fed entirely in early infancy. 10 children were breast fed short time, then bottle fed. 44 children were bottle or hand fed entirely. 9 children were fed on ordinary food. 5 cases (particulars unobtainable), 4 families had removed — and in one case the information was refused. 78 11 children were fed on breast milk. 23 children were fed on cow's milk. 15 children were fed on condensed milk. 10 children were fed on ordinary food. 14 children were fed on combined foods. 5 cases particulars unobtainable (as above.) 78 The ages of the children were as follows:—Under one month, 1; over one month and under three months, 9; over three months and under six months, 21; over six months and under nine months, 9; over nine months and under one year. 13; over one year and under fifteen months, 8; Over fifteen months and under eighteen months. 5; over eighteen months and under twenty-one months, 3; over twentyone months and under two years, 5; two years, 4. Total, 78. An investigation of the names shews that the deaths in Trinity Ward numbered 30 (14 males and 16 females), four of whom were illegitimates (equal to 12 9 per cent.) These cases occurred in 30 houses (28 houses with one death in each, and one house with two deaths.) Eight of the children were found to have been weak from birth. In five instances the mother went out to work regularly for periods varying from one day to six days weekly. 21 3 (10 per cent.) children were breast fed entirely in early infancy. 2 children were breast fed short time, then bottle fed. 21 children were bottle or hand fed entirely. 2 children were fed with ordinary food. 2 cases the families had removed. 30 3 children were fed on breast milk. 11 children were fed on cow's milk. 7 children were fed on condensed milk. 2 children were fed on ordinary food. 5 children were fed on combined foods. 2 cases the families had removed. 30 The ages of the children were as follows:—One to two months, 2; two to three months, 2; three to four months, 2; four to five months, 6; five to six months, 2; six to seven months, 1; seven to eight months, 2; eight to nine months, 0; nine to ten months, 1; ten to eleven months, 1; eleven to twelve months, 3; twelve to fifteen months, 4; fifteen to eighteen months, 2. One child was two years old and one 9 years. South Park Ward. In this Ward the deaths numbered 42 (20 males and 22 females) 10 of whom (equal to 23.8 per cent.) were illegitimates. These cases occurred in 35 houses, (29 houses with one death in each, 5 with two deaths in each, and one with three.) Six of the children were found to have been weak from birth. In ten instances the mothers went out to work regularly for periods varying from one to six days weekly. 7 (16.6 per cent.) children were breast fed entirely in early infancy. 8 children were breast fed short time, then bottle fed. 18 children were bottle or hand fed entirely. 7 children were fed with ordinary food. 1 family had removed. 1 case the particulars were refused. 42 7 children were fed on breast milk. 10 children were fed on cow's milk. 7 children were fed on condensed milk. 9 children were fed on combined foods. 7 children were fed on ordinary foods. 1 family had removed. 1 case the particulars were refused. 42 22 The ages of the children were as follows:—Under one month, 1; one to two months, 1; two to three months, 4; three to four months, 4; four to five months, 2; five to six months, 5; six to seven months, 2; seven to eight months, 0; eight to nine months, 3; nine to ten months, 1; ten to eleven months, 3; eleven to twelve months, 1; twelve to fourteen months, 4; fifteen to seventeen months, 3; eighteen to twenty months, 3; twenty-one to twenty-three months, 4, and one aged two years. Total 42. Dundonald Ward. In this Ward there were four deaths (3 males and 1 female) in four houses. 3 children were bottle or hand fed entirely. 1 child was fed with ordinary food. 4 2 children were fed on cow's milk. 1 child was fed on condensed milk. 1 child was fed on ordinary food. 4 The ages of the children were as follows:—Six months, eleven months, nine months and one over a year. cottenham park ward. In this Ward the deaths numbered two, both males, and occurred in two houses. One child was fed with cow's milk, barley water and rusks and the other family had removed. The ages of the children were as follows:—Eleven months, and twenty-three months. The portion of the Borough principally affected was that tinted blue on the accompanying map,* being roughly in shape a rectangle enclosed between Haydons Road, part of High Street, Merton, the River Wandle from Terrier's Bridge to where the Wimbledon and Tooting Branch of the London, Brighton and South Coast Railway crosses the river, and the railway lines to Haydons Road. Isolated cases also occurred as shewn in several streets in both Trinity and South Park Wards. From the street list® and spot map* it will be seen that the streets where the highest mortality occurred were all within this * Included in report sent to Local Government Board and not reproduced in this Annual Report. 23 area, viz.:- Cowper, Dryden and Milton Roads, the part of Haydons Road opposite these roads, and Wandle and Leyton Roads. In looking for the cause of this excessive mortality, I have first considered generally the contributary causes or excitants of Diarrhoea as follows:— 1. Meteorological conditions, e.g., 3ft. to 4ft. earth temperature of about 55 degrees Far., low rainfall. 2. Topographical and geological conditions, e.g., low lying, flat, and water-logged positions, with a damp subsoil. 3. Polluted condition of soil, arising from defective sewers and drains, leaky cesspools, made grounds, etc. 4. Insanitary and dirty surroundings in and around houses, e.g., domestic darkness and general dirtiness of dwellings, overcrowding, emanations from foul and offensive accumulations in ashpits and dustbins, accumulations of manure, vegetable refuse and the throwing of liquid refuse on ground immediately adjoining dwellings 5. Tainted foods and impure water, e.g., milk and other things kept in living and bed rooms, or in badly ventilated places, such as cupboards under stairs where it is exposed to emanations from the earth, w c.'s, sinks, accumulations of manure, etc., etc., or in dirty jugs. Drinking water charged with vegetable matter from dirty and uncovered cisterns. 6. Improper or artificial feeding, maternal neglect arising from outdoor employment of mothers or otherwise, such as working in laundries, charing, etc.; the use of cordials and soothing mixtures, early and improvident marriages, constitutional weakness of parents, and debility of children (congenital, or the result of previous illnesses, insanitation, etc.) 7. Illegitimacy. In their bearing on the area in question:— 1. Shewn graphically on the chart. 2. The streets before mentioned are the lowest lying in the Borough, the road surface being from 41ft. to 41ft.6in. above Ordnance Datum Line, and ate also the poorest in the District. The houses are on damp and porous ground, which before being built upon was farm land, or was cultivated as market gardens and allotments, which, even in the dry season now, is kept more or less in a constant state of dampness owing to che close proximity of underground or subsoil water. 3. Owing to the large increase in the number of houses in recent years draining into the main sewer which passes through this part of the District, it is in times of heavy rains surcharged, and heading back occurs in some of the tributary sewers and house drains. These 24 latter may be satisfactory to the smoke test in the negative sense, insomuch as there is no escape of smoke through the ground, yet, when surcharged and under pressure considerable leakage and ground pollution must take place. Ground pollution from leaky drains must also be considered, because,although many of the older houses in this neighbourhood have within the last few years had the drains reconstructed, the effects of the defective drains did not disappear with the provision of the new drains. The vast amount of liquid faecal and other matter which had sunk into the ground is still a source of mischief. 4. The conditions under this heading are present more or less in other streets where fatal Diarrhœa is absent. 5. The enquiries shewed especially in the older houses the utter lack of any suitable provision for food storage. In many instances the space under the stairs is boarded in and used for this purpose, the presence of a gas meter in the same part being detected by the smell. In other instances the only provision for food storage is by old boxes attached by the tenants to the walls of the kitchen or scullery. 0. These conditions are also present equally in other streets not affected. 7. Illegitimacy is of account chiefly because the child, through the mother's circumstances, is often placed under the care of persons not interested in them by the close ties of affection, which alone are likely to bring forth the constant attention and care so necessary to their well being, and the hand fed numbers are thereby increased by 14, or 17 per cent. of the whole deaths. Whilst making every possible allowance for the causes enumerated in paragraphs, Nos. 4, 5 and 6, and referred to in my report for the year 1904, they are only contributary causes, and accepting the conclusions of the late Dr. Ballard in his report ("embodying the experiments and investigations covering a period of several years on the causation of Diarrhœa) it is due to an organism which lives and propogates in superficial layers of earth contaminated with organic matter, and arrives at its most active development when the soil has become thoroughly heated to a considerable depth and thence finds its way into milk and other organic foods in which it gives rise to an intense chemical poison productive of Diarrhcea in susceptible consumers of such foods. The principal causes must therefore be looked for in Nos. 1, 2 and 3, viz., the meteorological and geological conditions, and bearing in mind that the sites of these houses are low lying, flat and water logged with a damp subsoil and were, before being built upon, market gardens and allotments, the essential factor for the production of Epidemic Diarrhœa, viz., a sustained high temperature of the air 25 and soil, especially the latter, were present as shewn by the accompanying chart. The true cause of Diarrhoea is a microbial organism, the germ growing under the action of heat in the subsoil and gaining access to the alimentary system mostly through the medium of food, liquid and solid, and here is seen the great risk in communicating such affection through the food of infants other than breast fed, in such ways as the sucking of dummy comforters, dirty fingers and a variety ot other ways. The evil effects of a high earth temperature on a damp and polluted soil is minimised to a very great extent when the area upon which the house stands is sealed against the access of contamination from the soil below by a bed of concrete, as shewn by the fact that in 28 per cent. of the houses in which cases occurred the sites were concreted, and in 72 per cent. they were not. The latter figure may be really higher because those houses where any doubt existed have been classed as concreted. REMEDIAL MEASURES. A systematic house-to-house inspection of all the houses in the roads of the part of the Town tinted blue on map was completed early in the year, and all matters that could be dealt with under the Nuisances Clauses of the Public Health Act were remedied, sixty houses also being placed on the Register of Houses Let in Lodgings. The Town Council are making new Bye-Laws dealing with various matters, and in this connection further powers will be sought to deal with the paving of forecourts and spaces adjoining houses before they become a nuisance. The Borough Engineer and Surveyor submitted a scheme three or four years ago dealing with the excessive flooding which took place then, and made certain recommendations, inter alia, the construction of additional surface water sewers and new outfall, which would relieve the low level sewer. Up to the present time, owing to difficulty with the owners of the land as to easements, this has not been accomplished, but I have great hopes that when this is done, it may cause the lowering of the subsoil water in the area under review. 26 At the commencement of the early part of the summer, as has been the practice for some years, leaflets re Diarrhœa were distributed from house to house in all the roads mentioned. (Signed) EVELYN POCKLINGTON, Medical Officer of Health of the Borough Dec. ith, 1906. of Wimbledon Infantile Mortality.— By this is meant the number of deaths of infants under one year of age. The rate is estimated by comparing this number with the total births and calculating the number of deaths per thousand births. There were 175 of these deaths, or 147 per thousand births, which is 28 above the average rate for the previous ten years of 119. Last year the rate was 69, the lowest on record, but it was an exceptionally favourable year from a meteorological point of view. The greatly increased rate is accounted for by the excessive mortality from summer Diarrhœa, dealt with in the previous paragraphs, wasting diseases and various other causes such as Convulsions and Pneumonia. Of the legitimate births 14 per cent. died before attaining one year of age, while of the illegitimate 34 per cent. died. South Wimbledon Day Nursery.—The number of children received into this institution increases year by year. The outbreak of Measles in February and March caused a temporary decrease in the daily attendance, but the total attendances during the year numbered 5,948, an increase of 750 on the previous year. Isolation Hospital.— The following table furnished by the Hospital Medical Attendant, Dr. Clapham, gives particulars as to number of patients treated in the Hospital for each disease during the year. Cases admitted in 1906 Over 5 years. Under 5 years. Total. Deaths. Remarks. Over 5 years. Under 5 years. Total. Scarlet Fever 132 43 175 3 1 4 Diphtheria 18 10 28 1 2 3 Enteric Fever 7 ... 7 3 ... 3 Tonsillitis 2 ... 2 ... ... ... Erythema Nodosum 1 ... 1 ... ... ... Ulcerative Colitis 1 ... 1 1 ... 1 Total 161 53 214 ... ... ... Daily average number of Cases 37 Carried over from 1905: Average number of days in Hospital 57 Scarlet Fever 12 3 15 ... ... ... Diphtheria 6 1 7 ... ... ... Enteric Fever 1 ... 1 ... ... ... Total number of Cases treated during 1906 ... 180 57 237 8 3 11 27 28 Disinfection.— The following table shows the number of rooms and articles disinfected: Disease. Mattresses. Palliasses. Beds. Pillows and Bolsters. Blankets. Dresses. Suits. Other Articles. No. of Rooms. Totals Scarlet Fever 335 200 201 802 1162 255 50 6370 288 9663 Enteric Fever 15 12 9 45 33 6 — 457 4 581 Diphtheria 96 22 37 195 210 55 8 1246 98 1967 Chicken Pox 5 — 2 9 8 — 4 69 4 101 Measles 18 2 2 33 37 5 — 513 92 702 Tuberculosis 35 14 13 60 49 2 1 278 26 478 Sundries 91 24 26 220 141 12 4 737 251 1506 Totals 595 274 290 1364 1640 335 67 9670 763 14998 There were 23 library books disinfected. Diagnostic Tests.— The number of specimens of serum, sputum and blood submitted for bacteriological examination to the Clinical Research Association, the Lister Institute of Preventive Medicine and St. George's Hospital during the year in doubtful cases of Diphtheria, Pulmonary Tuberculosis and Typhoid Fever, and the results of such examinations are given on page 40. 31 bottles of anti-diphtheritic serum was supplied through the Sanitary Department for use by Medical Practititoners for the treatment of Diphtheria. Mortuary.— From information received from the Superintendent of the Cemetery there were 68 bodies received into the mortuary during the year, and 52 post-mortems (29 males and 23 females). Inquests were held by the Coroner with respect to 50 bodies, being equal to 8.5 per cent. of all deaths registered in the Borough. 29 Factory and Workshop Act, 1901.—Section 132 requires the Medical Officer of Health to specifically report annually on the administration of the Act in workshop and workplaces and to send a copy of such report to the Secretary of State. The details on the forms prescribed and supplied by the Home Office have been forwarded In the Tables below is shown the work done in the supervision of workshops and workplaces: Premises. Inspections. Written Notices. Prosecutions. Factories 9 3 - Workshops 88 14 - Workplaces 9 Total 106 17 - DEFECTS FOUND. Nature. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 11 10 - - Overcrowding 1 1 — — Want of drainage of floors - - 1 - Other Nuisances 8 7 — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 6 0 — — Not Separate for Sexes - - - - Total 26 23 1 — Home Work. Lists received:— Twice in the year 12 Number ot outworkers 22 Once in the year 12 Number of outworkers 15 Number of addresses received from other Councils 15 Number of addresses forwarded to other Councils 4 30 Prosecutions Failing to keep lists — Failing to send lists 1 Number of inspections of outworkers premises 33 Outwork in unwholesome premises :— Instances 2 Notices served 2 Prosecutions — Outwork in infected premises:— Instances 1 Orders made 1 Prosecutions — Registered Workshops. The following are the principal classes of workshops on the register at the end of the year:— Boot repairers 29 Dressmakers 38 Bakehouses 27 Laundries 22 Tailors 14 Milliners 17 Other Trades 54 Total 201 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 1 Action taken in matters ( Notified by H. M. referred by H.M. Inspector 3 Inspector as remedial - under the Public Reports of action taken Health Act sent to H.M.Inspector 3 Other — Underground Bakehouses:— Certificates granted during the year — In use at the end of the year 3 During the investigation of a case of Scarlet Fever, removed to hospital, it was discovered that the occupier of the house was employed as an outworker for a local tailor and had also other persons working on the premises for him. No list of outworkers had been received from the employer as is required to be furnished twice 31 yearly by Section 107 of the Factory and Workshop Act, or was an abstract affixed in the workshop, to which the attention of H.M. Inspector was called in accordance with the statute. I gave a certificate under Section 110 and an order prohibiting the giving out of homework for a period of seven days was served on the employer, signed by two members of the Council as provided for in cases of emergency. This neglect to send in outworkers lists was reported to the Sanitary Committee, who instructed the Town Clerk to take out a Summons which was withdrawn with the consent of the Committee on payment of costs after the list had been furnished. The number of bakehouses on the register is 27, an addition of two. Three new bakehouses have been built and comply in all respects with modern requirements; the use of one underground bakehouse was discontinued. Only three notices were received from the Factory Inspector of defects found during his inspections in this district throughout the year, two being for the want of cleanliness and one for overcrowding. The occupiers of the workshops to which the two former referred complied with the requirements immediately their attention was called, but as regards the case of overcrowding it was not discontinued until after a preliminary and statutory notice had been served. That the workshops, etc., are generally well kept is shown by the small number of notices necessary to be served. The occupiers on every occasion have given every facility for inspection. Water Supply.—On several occasions in the early part of the year complaints were received from occupiers of houses complaining of the dirty condition of the water. I communicated with the Metropolitan Water Board who stated that the causes of the complaints were due to the water being shut down for alteration to the mains in Coombe Lane and Maiden, necessitated by the laying of the tramlines; and in other cases to sand and dirt having gained access to the pipes during connection of the service pipes to new and other houses. 32 The samples taken confirmed this, and the Water Board promised to, and had the mains flushed daily for sometime. In August I called the attention of the Water Board, and afterwards the Sanitary Committee, to the action of the Officials in cutting off water supplies for repairs in consequence of leakages on service pipes and the delays taking place before reconnection is made. A particular gross instance was of six houses at which the supply was withdrawn during the hot weather in August. The leakage was at the stop cock and the tenants stated that it had existed for over a year. Periods of five to eleven days elapsed before the supplies were restored. It is needless to point out the danger to health from such proceedings, to say nothing of the inconvenience caused to the occupiers. The Council made strong representations to the Water Board and asked that steps should be taken to prevent a recurrence. Notices in respect of 51 houses were received during the year notifying that the supplies had been withdrawn for the following causes:—26 for leakage, 7 premises empty, and 18 for non-payment of water rate. In all cases where the premises were found to be occupied notices were served compelling either the occupier or owner whichever was responsible for the payment of the rates or repairs of defective fittings or pipes, to reinstate the supply. This the Water Board will not do until after the arrears and in some instances a quarter in advance, and also the cost of opening the road has been paid. The Sanitary Authorities are therefore in practice made a lever whereby the Water Board recover their debts, although generally the person by whose act or default the supply is withdrawn is not the person put to the inconvenience but the tenants. It is therefore under such circumstances very undesirable in the interests of the community that the Water Board should have the power to make a house insanitary through the non-payment of the water rates. They should be compelled to recover their debts through the Courts in the same way as a gas company does. 33 The following Pages, including Table VI., give particulars of some of the work carried out by the Staff of the Sanitary Department (tor which Mr. Johnson is directly responsible), in addition to the work in the investigation of cases of Infectious Diseases, Disinfection of Clothing and Rooms, Inspection of Workshops, etc., set out in the foregoing Pages:— House Drainage.—It will be seen on reference to the Appendix Table VI. that the drainage systems of 130 houses have been entirely reconstructed, while repairs or alterations of a more or less extensive character have been carried out at 62 houses, as against about 50 during last year. At 14 houses the main drains were reconstructed as sewers within the meaning of the Public Health Act, 1875, at the Corporation's expense, and the following groups of houses were redrained during the year:— 83 to 89, South Road—4 houses. ** 63 to 73, Hubert Road—6 houses. 72 to 76, South Road—3 houses. 12 to 18, Deburgh Road—4 houses. 14 to 20, Dundonald Road—4 houses. 56 to 60, Hubert Road—3 houses. 30 to 38, Deburgh Road—5 houses. * 27 to 39, Hartfield Road—7 houses. 72 to 86, Russell Road—8 houses. * 42 to 58, Hill Road—9 houses. ** 88 and 90, Amity Road—2 houses. 72 to 76, Norman Road—3 houses. ** 28 to 34a, Russell Road—5 houses. The question of liability for the repairs and maintenance of combined drains is a complicated one, and is becoming more so in consequence of the recent decisions of the Courts. That which is a drain to-day may become a sewer to-morrow, and a drain again shortly afterwards, simply through change of ownership of one or more houses. It is particularly hard that the public should be called upon to pay for the reconstruction or repair of combined drains originally constructed at the cost of the building owner at a considerable saving, by reason of the Local Authority not insisting on a separate drain for each house. Had the Authority not granted this concession it would have necessitated the drain passing under each house, a method that *The main drain reconstructed by the Corporation at the cost of the owners, they having made default by non-compliance with the notices served upon them. ** The main drain reconstructed by the Corporation as a sewer within the meaning of the Public Health Act, 1875. 34 should only be resorted to when it is impossible to do otherwise. The whole question in fact is ambiguous and urgently needs the attention of the legislature. House Refuse Collection and Disposal.—The collection and disposal of house refuse is carried out by the staff of the Surveyor's Department, and the number of loads of house refuse disposed of at the refuse destructor during the year was 9,334. Several of the occupiers of Queen Alexandra's Court requested the Corporation to collect house refuse at more frequent intervals than once a week, and arrangements were made for a by-weekly collection from these buildings and also Alwynne Mansions during the months of June, July, August and September. Dairies, Cowsheds and Milkshops.—Thirteen applications for registration as dairymen and purveyors of milk have been received during the year, and such alterations to the premises as were necessary to comply with the regulations carried out. Three cowsheds have not been occupied during the year; at the one in use the light and ventilation has been improved, the drain inside the shed abolished, and a channel discharging over a gully outside substituted. This shed was also found to be overcrowded, and a statutory notice was served which had not been complied with at the close of the year. At the premises of two dairymen the drains and sanitary arrangements have been entirely reconstructed. On inspection the premises generally have been found in a satisfactory condition. Only one notice was necessary to be served for breach of regulations. Slaughterhouses.—These (six in number) have been inspected on several occasions during the year. The trade is regularly carried on in the case of 3 of the premises only. Notices requiring the premises to be limewashed were sent quarterly to the respective occupiers, and such notices were duly complied with. Some few years ago the occupier of a registered slaughterhouse made application to the Local Authorities for a license to erect and use new premises on the site of his existing old and dilapidated 35 building. The application was refused, as he was unable to comply with the requirements of the Local Government Board. Since this, at intervals of a year or so, the walls have been rebuilt singly and faced internally with glazed bricks. During the past year a new roof has also been added. Practically a new building has thus been erected and the bye-law evaded. Houses Let in Lodgings.—The undermentioned premises, in consequence of their neglected and general insanitary condition, were reported to the Sanitary Authority, by whose instructions they were placed on the register. Nos. 11 to 25, and 10 to 48, Dryden Road. Nos. 33 to 43, Wandle Road. Nos. 87 and 89, Hartfield Crescent; and Nos. 194 to 200, Haydon's Road. The premises No. 83 to 87, Deburgh Road, were also reported. The owners wrote to the Committee stating thai they were willing to comply with all the Corporation's requirements, but asked that the houses should not be placed on the Register, which request was acceded to after considerable repairs had been made to the property. Fifty eight houses are now registered. The owner of No. 74, High Street, Merton, was summoned on October 24th, for a breach of the Corporation's Bye-laws in permitting a water-closet to remain choked for some days after her attention had been called to the same by written notice. The Defendant was lined 40/- and 9/6 costs. Common Lodging Houses.—The registered Common Lodging House in High Street, Merton, was inspected on several occasions, and the keeper's attention called to the requirements of the Public Health Act, as regards periodical cleaning, also to breaches of the Corporation's Regulations, which were complied with after demur. House to House Inspection in South Wimbledon has been continued. Seventy premises in Deburgh Road have been examined, at 14 of which the drainage and sanitary arrangements have been renewed, while at the majority of the other houses, work such as repairs to the drains, water-closets, paving of yards, covering of cisterns, ventilation of floors, cleansing of rooms, repairing of roofs and provision of guttering, etc., has been carried out. 36 Sale of Food and Drugs Act, 1875-1899. The Watch Committee on several occasions had under consideration the administration of these Acts within the Borough by the Surrey County Council; and deciding to supplement the work, recommended the Town Council in June "to direct the Inspector of Nuisances, at the cost of the Council, to procure and submit for analysis samples of food and drugs." Arrangements were made for the examination of preliminary or test samples by Mr. J. H. Johnston, M.Sc., of 6, Leopold Road, Wimbledon. The samples taken in accordance with the provisions of the Acts were submitted to Sir Thomas Stevenson, M.D., the public Analyst. The following returns show the number of samples taken, the result of analyses, legal proceedings and fines imposed. ARTICLE. Test Samples. Official Samples. Prosecutions Instituted. No. Genuine Adulterated. No. Genuine Adulterated Milk 58 46 12 12 7 5 4 Butter 19 18 1 ... ... ... ... Flour 8 8 ... ... ... ... ... Bread 8 8 ... ... ... ... ... Pepper 6 6 ... ... ... ... ... Jam 3 3 ... ... ... ... ... Brawn 2 ... 2 1 ... 1 ... Pork sausage 2 ... 2 1 ... l 1 German Sausage 2 ... 2 1 ... l ... Corned Beef 1 1 ... 1 ... ... ... Coffee 11 10* 1 ... ... ... ... Total 120 100 20 16 8 8 5 * Three labelled "sold as mixture of Coffee and Chicory." One sample of Milk adulterated with 2% of added water. A summons was not issued, a warning to the Vendor being deemed sufficient. 37 PROSECUTIONS. No. ARTICLE. Offence. Result of Proceedings Remarks. Fines. Costs. £ s. d. £ s. d. 9 Milk 5 per cent. added water 2 0 0 1 10 6 10 „ 10 per cent. added water 10 0 0 2 0 0 11 „ 4 per cent. added water 10 0 1 0 0 12 „ 18 per cent. added water 1 10 6 Vendor undertook to surrender certificate as milk seller. 13 Pork Sausage 31 per cent. or 21¾ grains per lb. of Boric Acid ... ... Summons not heard at end of year. Obstructing Officer and refusing to sell 1 0 0 ... Defendant undertook to surrender certificate as milk seller. The Local Government Board suggested in a circular letter (dated July, 1906) to Local Authorities, that milk traders should be notified, by circular or otherwise, that action would be taken under the Sale of Food and Drugs Acts where preservatives are found in milk. The Council accordingly directed that a copy of the following notice should be sent to all cowkeepers, dairymen and purveyors of milk in the Borough. BOROUGH OF WIMBLEDON. PRESERVATIVES IN MILK. The Town Council of Wimbledon desire to warn Milk Dealers carrying on business in the Borough against the objectionable practice of adding preservatives to milk. Experience shews that the use of preservatives is unnecessary, even in hot weather, and where milk travels long distances by rail. It is of the highest importance that milk which forms so large a part of the food of infants, invalids, and convalescents, should be supplied in a pure state. 38 A purchaser who asks for milk and is supplied with milk plus a preservative, does not receive an article of the nature, substance, and quality demanded, and the seller commits an offence against the Sale of Food and Drugs Acts. The Council therefore give notice that prosecutions will be instituted under the Acts in all cases in which the Public Analyst reports that a preservative has been added to milk. By Order, A. Steele Sheldon, Town Clerk. Town Clerk's Office, Wimbledon, December, 1906. Shop Hours Act, 1892, and Seats for Shop Assistants Act, 1899.—The Watch Committee instructed Mr. Johnson in June to ascertain and report how far Section 4 of the Shop Hours Act, 1892—which provides that in every shop in which a young person is employed, a notice shall be kept exhibited by the employer in a conspicuous place, referring to the provisions of the Act, and stating the number of hours in the week during which a young person may lawfully be employed in that shop—and that the Seats for Shop Assistants Act, 1899, are being observed in the Borough. In the portion of the town which was inspected, 436 shops were visited. Young persons as defined by the Act were employed at 198, at which 93, or 47 per cent., the notice as required by Section 4 was exhibited. Females were found to be employed at 61 of the premises visited, and at 59 of these, seats for assistants were provided. In order to prove that the shop-keeper is aware of the provisions of the Act, and to avoid difficulty should it be necessary to take legal proceedings in the future, it was decided that the notice should be provided by the Council and one sent to the occupier of each shop. Petroleum Acts, 1871 to 1879.—Twenty licenses for the storage or sale of petroleum have been granted during the year, 16 being renewals. Samples have been taken at all premises where petroleum as defined by the Acts is sold. These were tested and found to be well above the standard flash point. The premises have also been inspected to see that the conditions attached to the licenses were complied with. No breach of regulations or statute was discovered. Unsound Food.—The stalls and barrows in the Broadway and High Street, Merton, from which food and fruit is sold have been inspected each Saturday night, and shops throughout the district at irregular intervals. 39 Eleven baskets of mackerel, 20 barrels of plums and 56 rabbits, of a doubtful character, were brought for inspection, found unsound, and, with the written consent of the owner, disposed of at the refuse destructor. A certificate giving particulars of the article destroyed, the day and time when inspected and found unsound is handed to the owner, which usually enables him to recover the amount paid by him for the goods; this prevents the tendency, which would otherwise exist, to expose such articles for sale. Legal Proceedings other than under the Sale of Food and Drugs Acts and Council's Bye-laws were necessary on two occasions. The owner of No. 38, Norman Road, was summoned for failing to comply with a notice requiring certain repairs to the drains. An abatement order was made by the Magistrates, with 9s. 6d. costs on May 23rd. A summons was issued against Messrs Nelson & Sons, Ltd., under Section 117 of the Public Health Act, 1875 and Section 28 of the Public Health Acts Amendment Act, 1890, for selling at 114, High Street, Merton, a leg of mutton which was unsound, unwholesome and unfit for food. The Magistrates imposed a penalty of £1, with 20s. 6d. costs on June 13th. The time involved in the investigation of an increased number of cases of infectious disease, enquiries made at more than 80 houses for information for my report on Diarrhoea mortality, and the administration of the Food and Drugs and Shop Hours Acts has necessarily caused less attention to be given to general sanitary work. The work in the Sanitary Department this year has been unusually heavy. Mr. Johnson has carried out his duties with the ability and tact which is characteristic of him, and has been ably seconded in his efforts by the staff. I have the honour to be, Your obedient Servant, E. POCKLINGTON, Medical Officer of Health. 40 Borough of Wimbledon. Population, Birth, and Death Rates for each Ward, 1906. WARD. Occupied Houses. Factor. Population. Birth Rate. Death Rate. St. Mary's 1052 5.45 5733 13.7 8.8 St. John's 933 5.66 5280 7.9 7.5 Cottenham Park 1093 5.10 5574 20.2 11.1 North Wimbledon 3078 5.38 16587 14.1 9.2 Dundonald 1408 5.88 8279 22.1 11.3 Trinity 1824 5.84 10634 32.6 15.5 South Park 2767 5.19 14360 29.3 15.2 South Wimbledon 6099 5.45 33273 28.5 14.3 Whole District 9177 5.43 49860 23.7 12.6 Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 21 45 66 Phthisis (Sputum) 2 5 7 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 8 11 19 BOROUGH OF WIMBLEDON. TABLE 1, Vital Statistics of Whole District during 1906 and previous Years. YEAR. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents registered in Public Institutions in the Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per r000 Births Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 33,000 875 26.5 96 109 343 10.3 10 3 25 365 11.06 1897 35,000 828 23.6 98 118 367 10.4 6 2 33 398 11.3 1898 37,000 963 26.02 145 150 415 11.2 11 5 32 442 11.9 1899 38,000 1031 27.13 163 158 547 14.3 18 12 33 568 14.9 1900 39,500 1075 27.21 156 145 559 14. 1 18 13 24 5.70 14.4 1901 41,631 1074 25.79 133 123 457 10.9 20 4 40 493 11.8 1902 43,000 1144 26.6 134 117 455 10.5 21 4 46 497 11.5 19113 46,000 1204 26.1 99 82 389 8.4 18 5 40 424 9.2 1904 47,719 1142 23.9 153 133 487 10.2 29 5 46 526 11.02 1905 48,240 1146 23.7 80 69 397 8.2 29 6 35 426 8.8 Averages for years 1896-1905. 40,909 1048 25.6 125 119 441 10.7 18 5 35 470 11.4 1906 49,860 1185 23.7 175 147 584 11 7 31 8 55 631 12.6 * Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there ; and by the term " Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. Area of District in acres (exclusive of area covered by water) 3,173 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 Alterations to the boundaries of all the Wards, except South Park, were made under the Charter of Incorporation. (See page 2, as to remarks on population.) BOROUGH OF WIMBLEDON. TABLE 2 Vital Statistics of separate Localities in 1906 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 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. 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. 1896 33,000 875 365 96 1897 35,000 828 398 98 Parti culars for the se years notbtai nable. 1898 37,000 963 442 145 1899 38,000 1,031 568 163 1900 39,500 1,075 570 156 1901 41,031 1,074 493 133 1902 43,000 1,044 497 134 5,270 ... 48 11 5,044 ... 45 5 3,204 ... 37 7 4,858 ... 57 14 11,783 ... 169 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 4,600 199 41 10 12,488 437 126 39 14,298 493 133 40 1904 47,719 1.142 526 161 6,104 80 40 8 5,393 56 40 5 3,990 92 44 11 5,480 131 63 17 13,326 396 167 54 13,426 381 170 66 1905 48,240 1,146 426 80 6,556 78 45 3 5,326 42 39 4 4,075 69 27 2 5,580 127 63 11 13,251 424 127 31 13,452 406 125 29 Averages of Years 1896 to 1905. 40,909 1,048 470 125 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1906 49,860 1,185 631 175 5,733 79 51 6 5,280 42 40 4 5,574 113 62 13 8,979 183 94 24 10,634 347 165 59 14,360 421 219 96 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. BOROUGH OF WIMBLEDON. TABLE 3 Cases of Infectious Disease notified during the year 1906. Notifiable Disease. Cases Notified in whole District. Total cases Notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. St. Mary's Ward. St. John's Ward. Cottenham . Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. 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 ... ... ... ... ... ... ... ... ... ... ... ... (H.) ... ... ... ... ... (H.) ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 55 ... 14 27 7 7 ... 5 2 13 7 16 12 1 1 4 4 14 6 Membranous croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 32 1 2 3 6 18 2 1 ... 3 7 10 11 ... ... ... ... ... ... Scarlet fever 229 1 58 146 12 12 ... 14 8 7 30 84 86 7 5 7 19 78 63 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 11 ... 1 2 4 4 ... ... 1 1 ... 3 6 ... ... l ... 3 4 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 328 2 75 178 30 41 2 20 11 24 44 114 115 8 6 12 23 95 73 BOROUGH OF WIMBLEDON. TABLE 4. Causes of, and Ages at, Death during year 1906. CAUSES OF DEATH. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the district. Total Deaths whether of "Residents" or " nonresidents " in Public Institutions in the District. All ages. Under 1 year. 1 and under 5. 5 and under 15 15 and under 25. 25 and under 65. 65 and upwards. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16  Small-pox - - - - - - - - - - - - - - - Measles 19 4 10 2 1 2 - 1 1 1 4 8 4 — — Scarlet fever 5 — 1 4 — - — — — - — 1 . 4 — 4 Whooping-cough 4 2 2 — — — - — - 1 1 — 2 — — Diphtheria & membranous croup 9 — 5 3 — 1 — — - 2 1 1 5 — 3 Croup - - - - - - - - - - - - - - — Fever Typhus — — — — — — — - — — — — — — — Enteric 5 — — 1 — 4 — — 1 — — 2 2 — 4 Other continued - - - - - - - - - - - - - - - Epidemic Influenza 10 1 — 1 — 4 4 2 — — 2 2 4 — - Cholera - - - - - - - - - - - - - - - Plague — — - - - - - - - - - - - - — Diarrhœa 90 63 26 1 — — — 1 - 2 5 32 50 - — Enteritis 8 5 1 — - 1 1 - — 1 2 3 2 — - Puerperal fever — — — — — - — - - — — — — — — Erysipelas 5 — — 1 2 1 1 — 1 — 1 2 1 — — Other septic diseases 2 — — — — 2 — — - — 1 1 — — 1 Phthisis (Pulmonary Tuberculosis) 43 1 2 - 8 29 3 1 1 3 6 16 16 — — Other tubercular diseases 16 4 6 2 — 4 — 1 1 2 1 2 9 — 1 Cancer, malignant disease 48 — — — — 25 23 5 3 10 5 11 14 — 1 Bronchitis 19 2 — — — 7 10 2 — 1 8 3 5 — — Pneumonia 50 13 9 3 3 15 7 3 3 4 8 18 14 — - Pleurisy 2 — — — - 1 1 — — — — 1 1 — — Other diseases of respiratory organs 5 2 - - — — 3 1 — 1 — 1 2 — — Alcoholism Cirrhosis of Liver 14 — — — - 12 2 2 2 2 3 1 4 — 1 Venereal diseases 2 2 — — — — - — 1 — 1 - — — — Premature birth 17 17 - — — — — 1 1 3 2 4 6 — — Diseases and accidents of parturition 8 4 - - - 4 - 3 - 1 2 1 1 — - Heart diseases 30 1 — — 2 12 15 7 3 4 3 5 8 — 3 Accidents 14 5 1 — 1 6 1 1 — 1 2 4 6 — 2 Suicides 5 — — 1 — 4 - 1 1 — 2 1 — — — All other causes 201 55 7 3 7 58 71 19 21 23 34 45 59 ... 11 All causes 631 181 70 22 24 192 142 51 40 62 94 165 219 — 31 BOROUGH OF WIMBLEDON. TABLE 5 Infantile Mortality during the Year 1906. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months 11-12 Months Total Deaths under One Year. All Causes. Certified 25 6 9 4 44 14 20 15 14 12 9 9 7 10 6 15 175 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 Diarrhœal Diseases. Diarrhœa, all forms ... ... ... 1 1 4 8 8 8 8 3 3 3 6 4 7 63 Enteritis, Muca enteritis, Gastro enteritis ... ... ... ... ... 1 ... 2 ... ... ... ... 1 ... ... 1 5 Gastritis, Gastro- intestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Births in the year—Legitimate, 1,132. Deaths in the year of—Legitimate Infants, 157. Illegitimate, 53. Illegitimate Infants, 18. Deaths from all Causes at all Ages, 584. Population—Estimated to middle of 1906—49,860. Wasting Diseases. Premature Birth 10 2 3 2 17 ... ... ... ... ... ... ... ... ... ... ... 17 Congenital Defects 3 ... 1 ... 4 ... 1 ... ... ... ... ... ... ... ... ... 7 Injury at Birth 5 1 1 ... 7 ... ... ... ... ... ... ... ... ... ... ... 7 Want of Breast-milk, Starvation ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus 2 1 3 ... 6 1 6 2 2 1 ... ... ... ... ... ... 18 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... 1 ... ... ... 1 1 ... ... 2 ... ... 5 Tuberculous Peritonitis Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes. Meningitis (not Tuberculous) ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... 3 Convulsions 1 2 ... ... 4 1 1 ... 1 ... 2 1 1 ... ... ... 14 Bronchitis 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... 1 2 2 ... 2 1 1 ... 2 13 Suffocation, overlying ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Other Causes 3 ... 1 ... 4 ... ... 2 1 ... 1 1 1 ... 1 ... 11 25 6 9 4 44 14 20 15 14 12 9 9 7 10 6 15 175 48 TABLE 6. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision of the Sanitary Department:— Accumulations Removed 38 Cisterns Provided 5 Cisterns Repaired, Cleansed or Covered 113 Drains, New, Provided 130 Drains, Repaired or Altered 62 Drains, Stoppages Removed 50 Dustbins Provided 44 Flushing Boxes, New, Provided 104 Flushing Boxes, Repaired 70 Manure Receptacles Provided 11 Overcrowding Nuisances Abated 6 R. W. Pipes Disconnected 69 Roofs Repaired 47 Rooms Disinfected 737 Rooms Stripped and Cleansed 485 Soil Pipes. New, Provided 51 Soil Pipes, Repaired or Altered 10 Ventilating Pipes, New, Provided 209 Ventilating Pipes, Repaired or Altered 15 Waste Pipes, New, Provided 61 Waste Pipes Repaired, Disconnected or Trapped 31 Water Closets, New, Provided 177 Water Closets, Repaired or Ventilated 6 Water Service Restored 17 Yards Cleansed 10 Yards Paved 94 Guttering Repaired 27 Floors Ventilated 26 Nuisance Abated from Damp Walls 52 Other Nuisances 113 Total 2870 Printed by Drake, Driver & Leaver, Rosebery Avenue, London, E.C.