WIM031 Borough of Wimblebon. SANITARY DEPARTMENT. Annual Report of the Medical Officer of Health for the Year ended 31st December, 1908. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Gentlemen, It is with great pleasure that I lay before you my thirtyeighth Annual Report as Medical Officer of Health of the Borough, for the year ending December 31st, 1908. It is most gratifying to state that we have a death-rate as low as 8.3, and that this is, with one exception, viz., 1905, when it was 8.2, below that of any year recorded. Bearing in mind the altered condition of the district since my appointment as Medical Officer, from a village on the hill to a town of over 50,000 inhabitants, we may look upon the past year as a record one. The Zymotic death-rate (.55) is also the lowest, except on one occasion, and, in judging the healthiness of a district, it is a recognised fact that more importance is attached to this rate than to the general death-rate. As compared with last year's deaths under this heading, viz., 69, there has been a decrease of 39. The returns of vital statistics and infectious diseases drawn up on forms supplied by the Local Government Board are appended in Tables I., II., III., IV. and V. Population.—The calculations for the deaths and other rates in the tables of this report are based on an estimated population at the middle of the year as 54,274, which figure is obtained by the Borough Engineer ascertaining the number of occupied houses in each ward, and multiplying that figure by the house factor for the respective ward obtained from the official Census in 1901. Area. -The area of the Borough (exclusive of area covered by water) is 3,173 acres, and the density of the population is 17.1 per acre. Births. -The number of births registered was 1,144 (571 males, 573 females), which is 23 more than last year, and equal to a birth-rate of 21.07, which rate is 3.9 below the average for the past ten years. The corresponding rate for England and Wales for the same period is given as 26.5 in the report of the Registrar General. Deaths.—The total number of deaths registered in the district was 454 (214 males, 240 females), equal to a deathrate of 8.3 per 1000 of the population per annum. This is .9 lower than last year, and 2.4 below the average for the past ten years, which is seen to be 10.7. In the past 20 years, only on one occasion, as previously mentioned, has the death-rate fallen below that of this year. The deaths in public institutions outside the district of persons belonging to this Borough were: —59 in Kingston Infirmary; 6 in the County Asylum, Brookwood; 2 in St. George's Hospital (London); 2 in Charing Cross Hospital (London); 1 in Mount Vernon Hospital (Hampstead); and 1 in the Infants' Hospital, Vincent Square. The deaths occurring in public institutions within the district of persons not belonging hereto were:—3 in the Atkinson Morley Convalescent Hospital, Copse Hill; 2 in the South Wimbledon Cottage Hospital; and 2 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 518, and the death-rate 9.5. The rate for England and Wales for the same period is 14.7. 2 Eighty-two deaths of children under one year of age were registered, and this infantile mortality is represented by a ratio of 71 deaths per thousand registered births, a decrease of 40 per thousand on the previous year, and 51 on the average for the past ten years. The rate for England and Wales is 121. Here, again, only on one occasion has the infantile mortality rate fallen below that of this year, namely, in 1905, when the rate was 69, or 2 below this year. By the Zymotic death-rate we understand the number of deaths per thousand of the population which are due to tho seven common epidemic diseases : —(1) Small Pox ; (2) Measles ; (•3) Scarlet Fever; (4) Diphtheria, including Membranoiis Croup; (5) Whooping Cough; (6) Fever, including Typhus, Typhoid and Ill-Defined Fevers; and (7) Diarrhoea. These seven epidemic diseases may be divided into notifiable and non-notifiable; and of the former, 9 were due to Diphtheria, 3 to Scarlet Fever, and 1 to Enteric Fever; and of the latter, 4 were due to Whooping Cough, 8 to Diarrhœa, and 5 to Measles, making an aggregate of 30 deaths as against 69 last year, or equal to a Zymotic death-rate of .55 and 1.3 last year per thousand of the population. In addition to the deaths from Zymotic diseases, the principal causes of death were as follows:—Pneumonia, 31; Bronchitis, 34; Cancer, 28; Phthisis, 37; other forms of Tuberculosis, 15; Heart Disease, 42; and Premature Births, 20. For the purpose of comparison the following Table is given, in advance, by the courtesy of Dr. Tatliam, M.D., of Somerset House, from the Returns of the Registrar General: — Vital Statistics for 1908 (Provisional Figures). Annual Rates per 1,000 living. Infant Mortality of infants under 1 year per 1,000 Births. Births. Deaths from all Causes. Death-rate seven chief Epidemic Diseases. England and Wales 26.5 14.7 1.29 121 76 Great Towns 27.0 14.9 1.59 128 142 Smaller Towns 26.0 14.0 1.26 124 England and Wales, less the 218 Towns 26.2 14.7 0.99 110 WIMBLEDON 21.07 8.3 .55 71 3 Table A shows the births, deaths (registered in district) and death-rates, and the deaths at certain ages and for specified causes for the past 5 years. Table B shows for the same years the number of infectious cases notified and the deaths from each disease. Table C shows the death-rates from Zymotic diseases, phthisis and other forms of tuberculosis for the past of 10 years. Table A. 1908 1907 1906 1905 1904 Births 1144 1121 1185 1146 1142 Deaths 454 480 584 397 487 Death-rates 8.3 9.2 11.7 8.2 10.2 DEATHS— Under 1 year 82 125 175 80 153 Over 1 year and under 60 years 221 203 260 175 187 Above 60 years 151 152 149 142 147 From Measles 5 10 19 1 23 „ Scarlet Fever 3 5 5 3 0 „ Small Pox 0 0 0 0 0 „ Diphtheria 9 6 9 2 6 „ Diarrhœa 8 17 90 15 43 „ Whooping Cough 4 30 4 10 14 „ Enteric Fever 1 1 5 5 4 „ Puerperal Fever 1 2 0 1 0 „ Erysipelas 1 0 5 1 1 „ Influenza 18 3 10 8 3 4 Table B. DISEASES. 1908 1907 1906 1905 1904 Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 0 0 0 0 1 0 0 0 Diphtheria 94 9 83 6 55 9 39 2 36 6 Erysipelas 35 1 54 0 32 5 50 1 42 1 Scarlet Fever 131 3 281 5 229 5 110 3 106 0 Enteric Fever 5 1 15 1 11 5 39 5 15 4 Puerperal Fever 1 1 3 2 1 0 1 1 0 0 Totals 266 15 436 14 328 24 240 12 199 11 Table C. Year. Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhœa. Phthsis and other Tuberc'los Diseases. 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 1907 1.3 — .09 .11 .05 .58 .19 .32 1.1 1908 .55 — .05 .16 .01 .07 .09 .14 .9 Scarlet Fever.—As is only to be expected after the prevalence of Scarlet Fever during the two preceding years, 1906 and 1907, a marked decrease has occurred this year. 5 One hundred and thirty-one persons from 105 houses were notified as suffering from this disease as against 281 and 229 in the years before mentioned. In one house there were 5 cases; in another house, 4; in three houses, 3; in 16 houses, 2; and in the remainder, 1 case each. The average attack and death-rates for the last three quinquennial periods and the past three years are as follows :— Attack Rate. Death Rate. 1891—1895 4.8 .02 per thousand of the population. 1896—1900 3.3 .04 „ „ „ 1901—1905 2.3 .02 „ „ „ Year 1906 4.5 .1 „ „ „ Year 1907 5.4 .09 „ „ „ Year 1908 2.4 .05 „ „ „ One hundred and three, or 78 per cent., of the patients were treated in the Isolation Hospital, 3 terminating fatally, corresponding to a case rate of 2.3 per cent. and a death-rate of .05 per thousand of the population. The incidence of the disease was fairly even throughout the year, slight rises occurring late in January and November; three consecutive weeks in March and April passed without a notification of this or any other notifiable disease being received. About 55 per cent. of the cases notified were children of school age, namely, 5 to 15 years, and of these 51 attended the following schools:—Effra Road Girls' and Infants' School, 4; Queen's Road Girls' and Infants' School, 10; Queen's Road Boys' School, 4; Trinity Girls' and Infants' School, 6; Trinity Boys' School, 1; Haydon's Road Girls' and Infants' School, 3; Haydon's Road Boys' School, 4; Dundonald Girls' and Infants' School, 2; Dundonald Boys' School, 1; St. Mary's Girls' and Infants' School, 3; Central Girls' and Infants' School, 3; Central Boys' School, 2; Durnsford Road Girls' and Infants' School, 1; Private Schools, 4; Schools outside the district, 3. There has been a steadily decreasing mortality from this disease during the past 30 or 40 years, and, during this period, its character has undergone a marked change. The decreased death-rate is not due to a smaller number of cases occurring, but to the nature of the disease being much less virulent. In fact the average case now is of a very mild type indeed, which may and does account at times for a large increase in the number of cases; the early symptoms not being noticed the patient mixes with others, and the disease is thus spread. 6 As usual a number of children were not known to be suffering from the disease until peeling was noticed, when a medical man was called in. This is not surprising when it is realised that in a mild case it is only possible to make a satisfactory diagnosis during the acute stage (which may not last more than a day or two), and when desquamation commences a week or so later. If the child is seen in the meantime it is impossible to give a definite opinion. Several of what are known as " missed " cases were found in consequence of the arrangement made between the Education and the Public Health Authorities whereby the Head Masters and Mistresses notify to me all children sent home from school, when found unwell either by the School Medical Officer, nurse, or teacher. The house is then visited and the parents advised to call in their own medical attendant, and in all suspicious cases to keep the children at home, and isolated as far as possible for periods varying according to the circumstances. The disinfection of the rooms, bedding, etc., is then carried out by the Sanitary Authority. There have been several return cases (that is, cases of Scarlet Fever which occur in a house after the return of a patient from the hospital, or, if isolated at home, after his or her reception again as one of the family); these occur in all towns and from all isolation hospitals in a varying degree, and it is generally admitted that they cannot be entirely prevented, even though the period of detention be prolonged to many weeks, the chief difficulty encountered being that there is no certain indication when infection ceases. Formerly it was thought that when completion of desquamation was reached infection had terminated, but it is now recognised that in many instances the infectivity has disappeared before this stage, whilst in others it remains long after. The discharges from the nose and ears are found very infectious, and in some instances persists for several months, it being impossible to say just when this ceases. It is also probable that occasionally secondary cases arise owing to some of the patients' toys, books, or clothing having been put away instead of being handed over for disinfection, which are, on the child's return, brought into use. Diphtheria.—Notifications of 94 persons suffering from this disease were received during the year, the attack rate being 1.7 per thousand of the population. This rate is .1 above last year, and the highest with one exception (1902) since the year 1891. The attack rates in the various wards were as followsDundonald, .61; St. John's, 1.08; St. 7 Mary's, 1.16; Cottenham Park, 1.31; South Park, 2.11; Trinity, 3.03. The 91 cases occurred in 88 houses, in one of which there were 5 cases, and iu two others, 2 each. The cases were spread fairly evenly over the year, the second aud fourth quarters being somewhat higher; but at no time was there anything which could be considered in the nature of an epidemic. In a considerable number diagnosis was only possible after a swab from the throat or nose had been taken and a bacteriological examination made. Undoubtedly the increased number of notifications of late years is partially accounted for by the extended use of bacteriological investigations, a proportion which formerly were considered sore throats or Tonsilitis, now being rightly termed Diphtheria. This increase in numbers is amply compensated for by the discovery, through bacteriological examination, of cases which, if not revealed, would become what is known as " carriers," that is, whilst the infected persons themselves enjoy immunity from any ill-effects, they are carrying unknown in their mucous membrane the organism known to be typical of Diphtheria, which, under altered conditions in their own health, or by transmission to other more susceptible persons, may assume a virulent form. This mode of the propagation of the disease, which is only the discovery of recent years, and as to the reality of which there can be no doubt, suggests new and heretofore unsurmised hazards, but promises to elucidate some hitherto obscure and puzzling problems in connection with outbreaks of Diphtheria and other diseases of microbic origin. Further, as showing the mildness of a proportion of the cases, it is not an uncommon occurrence for the recovery certificate requesting disinfection to be received within fourteen days from the notification of the illness, but isolation is generally continued until one or often two bacteriological examinations give negative results. These apparently mild cases must not be considered less important than the severe ones, and from a public health point of view anything which can insure early discovery and notification is most important. It is interesting to note the effects of notification, isolation, and treatment of the disease since the Notification of Infectious Diseases Act came into force in January, 1890. Records of cases in Hospital some few years before that date are complete, but as we have no available information as to the total number of persons attacked, the following table only deals with cases from the adoption of the above Act. 8 Year. Total Cases. Cases treated in Hospital. Deaths in Hospital. Percentage of Deaths in Hospital. Cases treated at Home. Deaths at Home. Percentage of Deaths at Home. Attack Rate. Case Mortality Rate. 1890 10 3 2 66.6% 7 3 42.8% .4 50% Durnsford Lodge used for all Infectious Diseases except during 1893 when, owing to the prevalence of Scarlet Fever, Diphtheria patients could not be admitted. It was closed on Oct. 10th, 1895, because of its insanitary condition. 1891 16 2 1 50% 14 6 42.8% .5 43.7% 1892 18 2 1 50% 16 8 50% .6 50% 1893 39 Nil. Nil. — 39 4 10.2% 1.3 10.2% 1894 44 24 6 25% 20 4 20% 1.4 22.7% 1895 39 27 8 29.6% 12 10 83.3% 1.1 46.1% 1896 30 Nil. Nil. — 30 3 10% .9 10% Bacteriological examination and the use of Anti-Toxin first adopted in Wimbledon. Iron Hospital, Durnsford Road, in use except for Diphtheria. 1897 43 Nil. Nil — 43 7 16.2% 1.1 16.2% 1898 60 Nil. Nil. - 60 7 11.6% 1.5 11% 1899 64 Nil. Nil. — 64 12 18.7% 1.5 18.7% 1900 64 2 Nil. Nil. 62 10 16.1% 1.4 15.6% 1901 60 38 3 7.9% 22 3 13.6% 1.4 10% Present Hospital, Gap Road, opened December, 1900. 1902 80 29 6 20.7% 51 1 1.9% 1.8 8.7% 1903 58 35 1 2.8% 23 3 13% 1.2 6.9% 1904 36 27 5 18.5% 9 1 11.1% .7 16.6% 1905 39 25 2 8% 14 Nil. Nil. .8 5.1% 1906 55 28 3 10.7% 27 6 22.2% 1.1 16.3% 1907 83 59 6 10.1% 24 Nil. Nil. 1.6 7.2% 1908 94 66 7 10.6% 28 2 7.1% 1.7 9.5% 1890—1895 Average Attack Rate .8 Average case Mortality Rate 37.1% 1896-1900 „ „ „ 1.2 „ „ „ „ 14.3% 1901-1908 „ „ „ 1.2 „ „ „ „ 10% From this it will be seen that for the period of six years previous to the closing of the old Durnsford Lodge in December, 1895, whilst the average attack rate was only .8 per thousand of the population, the case mortality was 37.1 per cent. During the following five years, ending December, 1900, the attack rate had risen to 1.2, but the case mortality rate had dropped to 14.3 per cent., and it was in this period that bacteriological diagnosis was commenced here, as was also the use of anti-toxin in the treatment. A number of Diphtheria cases were removed to different London hospitals for 9 treatment owing to the fact that the Iron Hospital in Gap Road was used exclusively for Scarlet Fever patients, and, allowing for a number of deaths occurring amongst such cases, the actual mortality rate would, however, be somewhat higher. Then for the past eight years, during which time the present Isolation Hospital in Gap Road has been opened, the average attack rate has remained the same, but the mortality rate has dropped to 10 per cent., owing, no doubt, iu a great measure to the use of anti-toxin and the complete isolation of Diphtheria patients in a separate block of the hospital. From Returns publishtd by the Metropolitan Asylums Board it is clear that if any benefit is to be derived from the use of serum it must be used as early as possible, and the earlier it is given in the course of the illness the greater the probability of recovery. The experience of the Superintendents of the Board's hospitals is that, since the inception of anti-toxin treatment, the death-rate from the disease has shown a wonderful decrease. This coincides with the experience of Wimbledon. Enteric or Typhoid Fever.—During the year five persons in five different houses were notified as suffering from this disease, two being in Cottenliam Park Ward, two in Trinity Ward, and one in St. John's Ward. One case occurred in May, two in June, and two in September. The attack rate is the extremely low one of .09 and the death-rate .01 per 1,000 of the population. Not only is this the lowest attack rate recorded in Wimbledon, but it is also the lowest number of cases occurring since 1890, when the population was but half what it is now. In accordance with the usual procedure, the drains and sanitary arrangements of the respective houses were tested, but in only one instance were defects found. In this case the existing conditions necessitated the re-construction of the drains, w.c.'s, etc., and this work was subsequently carried out in a satisfactory manner. One patient, a nurse in a Poor Law Infirmary, undoubtedly contracted the disease before coming to Wimbledon after her summer holidays. The origin of infection was somewhat obsctire, but in three instances shell-fish or water-cress had been eaten by the persons attacked, about the time which would agree with the incubation period. Puerperal Fever.—One case only was notified during the year (last year there were three), this proving fatal. It occurred in the practice of a registered midwife, and was reported upon in detail to the Surrey County Council, the Local Supervising Authority tinder the Midwives Act. She 10 was suspended from work until after disinfection, as required by the rules of the Central Midwives Board, had been carried out. Whooping Cough was the registered cause of deaths in 4 instances, representing a death-rate of .07, against 30 deaths last year and 14 in the previous year, and a death-rate of .58 and .28 respectively. The deaths were distributed over the age periods as follows:—Under one year, 1; between one and two years, 3. Two occurred in Trinity Ward and two in South Park. Erysipelas.—This disease was less prevalent than during last year. Thirty-five notifications were received and one death registered, as compared with 54 cases in 1908 when no deaths from Erysipelas occurred. Influenza was certified as the cause of 18 deaths, whilst last year there were 3, and in 1906, 10. Sixteen of these took place in the months of February and March, and the majority were, as usual, complicated with pneumonia and pleurisy. They were distributed through the wards as follows: — St. Mary's, 1; St. John's, 2; Cottenham Park, 2; Dundonald, 2; Trinity, 8; South Park, 3. Fifteen of the deaths were of persons over 35 years of age. Measles.—Measles was responsible for 5 deaths during the year, equivalent to a death-rate of .09, as compared with 10 last year and a death-rate of .19, and 19 and a death-rate of .39 in 1906. Measles not being notifiable there is no definite information as to the number of persons affected, and it is therefore impossible to give the attack rate, but some idea of its prevalence can be gauged by the returns sent in by the Head Teachers of the Public Elementary Schools giving the names of children absent or sent home from school owing to the fact that they are suspected to be suffering from the disease. Thirty-one lists containing the names of 95 scholars were received, as against 93 lists and 401 scholars last year. Of the deaths three were of children under one year of age, one 15 months, and the other six years. One incurred in the month of February, three in July, and one in August. Four of the deaths were in Trinity Ward and the other in South Park Ward—all in the portion of the Borough south of Haydon's Road. The influence of school attendance upon the spread of Measles and of school closure on its restriction has been the subject of much inquiry of late years. Investigations over a number of years made by the Medical Officer to the Education Department of the London County Council and in several large towns show that: — 11 "The disease tends to spread in a class whenever a class accumulates unprotected members to the extent of between 30 and 40 per cent.; and when spread has begun it continues until the proportion is reduced to between 15 and 20 per cent. unprotected." By an "unprotected" child is meant one who has not previously contracted the disease. Second attacks may occur, but are rare. With a view to affecting as little as possible the school attendance, and at the same time protecting other scholars from any unnecessary risks, it was considered advisable, after consultation with Dr. Hay ward, the Medical Officer to the Local Education Authority, to adopt the following rules: — (1) Children actually suffering from Measles must be cluded from school for at least one month. (2) Children not the subjects of Measles, but coming from houses where Measles exists, are dealt with as follows: — (a) Infants' Schools.—Children attending these schools, whether they have had Measles or not, must be excluded until the Monday following the expiration of 14 days from the commencement of the last case. (b) Schools other than Infants' Schools.—Children who have already had Measles need not be excluded. Children who have not had Measles must be excluded until the Monday following the expiration of 14 days from the occurrence of the last case. This was subsequently approved by the Education Committee, and its working has certainly been satisfactory during the year. The Infants' Department of the Haydons Road School was closed in consequence of an outbreak of Measles from July 16th to 23rd, the week prior to the commencement of the summer vacation, and on re-opening no further cases were found. During the summer and Christmas holidays all the Public Elementary Schools were disinfected throughout by the Staff of the Sanitary Department. Phthisis and other Tuberculous Diseases were the assigned cause of the death of 58 persons, 29 males and 29 females, during the year, equal to a death-rate of one per thousand of population. Last year there were 57 deaths and the previous year 59. Included in this number are seven persons formerly residents in Wimbledon who died in the Workhouse at Kingston. 12 In Table IV. is shown the distribution over the age periods and in Wards, the majority being between the ages of 25 and 45. Twenty-three followed outdoor occupations and 28 indoor, 13 being Shop Assistants and Clerks. Only 25 notifications under the voluntary system in force were received. This is most disappointing, but it is the experience of all places where voluntary notification has or is being tried. It is to be deplored that more demand is not made for disinfection of dwellings where cases of these diseases have occurred. Although it has been made known that disinfection will be carried out free of charge, neither landlords or occupiers have shown much disposition to avail themselves of the offer. Where request has been made or permission sought for disinfection, it has generally been by the Medical Attendant, but it is the exception rather than the rule to have disinfection done, as can be seen when we note that in only 18 houses was it carried out. Taking three times the number of deaths as the number of persons in the district suffering from Phthisis, it is observed that in only about one in ten is the offer to disinfect taken advantage of. There is a strong objection to notification on the part of sufferers from the disease, which can readily be understood. Compulsory notification is now being advocated by those who have made a special study of the disease as it affects dense communities, but public opinion is not yet ripe for this step. In Ireland consumption has largely increased, and compulsory notification has been made and a systematic national crusade embarked upon, but in England and Scotland it has for the past sixty years shown a steady and marked decline. In pursuance of Section 130 of the Public Health Act, 1875, as amended and extended by the Public Health Act, 1896, the Local Government Board has issued an Order to provide for the notification to the Medical Officers of Health of Sanitary Authorities of cases of Pulmonary Tuberculosis occurring amongst the inmates of Poor Law Institutions, or amongst persons under the care of District Medical Officers, and for the taking of certain measures in such cases. The Order which is designated " the Public Health (Tuberculosis) Regulations, 1908," comes into force on the 1st January, 1909, and applies to England and Wales, and is to be enforced and executed by every Council, every Board of Guardians, every Joint Committee, and every Board of Managers. Its chief points are as under: — Article IV. of the Order directs that the Medical Officer of a Poor Law Institution shall, within 48 hours after his 13 first recognition of the symptoms of pulmonary tuberculosis in the case of a poor person who is an inmate of the institution, post to the Medical Officer of Health for the sanitary district in which the person resided immediately before he became an inmate of the institution a notification of the case. The notification must be made on a printed form as set out in the Schedule to the Order. Article V. directs that a similar notification shall be posted to the Medical Officer of Health by the District Medical Officer in the case of any poor person suffering from pulmonary tuberculosis on whom he is in medical attendance, according to his agreement with a Board of Guardians. The notification must be posted within 48 hours after the District Medical Officer has first recognised the symptoms of pulmonary tuberculosis, and must be addressed to the Medical Officer of Health acting for the sanitary district in which the residence of the poor person is situate. Under Article VI. it will be the duty of the Superintending Officer of a Poor Law Institution to post to the Medical Officer of Health on a printed form, as set out in the Schedule to the Order, a notification of the actual or intended place of destination and address at that place of any person leaving the institution in respect of whom a notification has been made by the Medical Officer of the Institution under Article IV. The notification must be posted within 48 hours after the departure of the person to whom it relates, and must be sent to the Medical Officer of Health of the sanitary district in which the intended destination of the person is situate. Article VII. provides that a Relieving Officer shall notify any change of address (other than admission to a Poor Law Institution) of a person in respect of whom a notification has been made under Article V. by a District Medical Officer. The notification must be made on a printed form as set out in the Schedule to the Order, and must be sent to the Medical Officer of Health for the sanitary district in which the address to which the person moves is situate. The notification must be posted within 48 hours after the Relieving Officer has obtained accurate information respecting the change of residence. The Board have provided by Article IX. that nothing in the Regulations shall have effect so as to apply or to authorise any one to put in force with respect to a person, in relation to whom a notification has been made, any enactment which renders him or any other person liable to a penalty or subjects him to any restriction, prohibition, or disability affecting him or his employment, occupation, means of 14 hood, or residence on the ground of his suffering from pulmonary tuberculosis. Subject to what is stated in the preceding paragraph, it is desirable that Sanitary Authorities, acting on the advice of their Medical Officers of Health, should utilise their powers for the purpose of preventing the spread of infection from pulmonary tuberculosis. The Order confers some special powers which the Board are advised are suitable for this purpose, and which are set out in Article IX. of the Order. On the result of the working of these regulations and the Notification Act for Ireland will probably depend whether or not a compulsory notification is, in the future, instituted in England. Cancer.—During the year 31 deaths have been registered as due to the different forms of malignant disease or cancer, 8 males and 23 females. Very little is known of the causes which produce these diseases. By some it has been contended that the disease is more likely to be prevalent in the low-lying portion of a district, but examination of the death returns for some years here does not support this view. The cases have been very evenly distributed through the Borough. The following table shows the different parts of the body invaded and the age incidence:— Part Affected. Male. male. Total. Age Incidence. Male. Female. Total. Stomach and Bowels 4 9 13 Under 35 years 1 1 2 Liver — 4 4 35 to 40 „ — 2 2 Urinary and Generative Organs - 2 2 40 to 45 ,, 2 2 4 Breast - 5 5 45 to 50 „ — 1 1 50 to 55 ,, 2 3 5 Head and Face 2 1 3 55 to 60 1 5 6 Tongue, Neck and Throat — 1 1 60 to 65 „ — 1 1 Other Parts 2 1 3 65 to 70 „ - 5 5 70 to 75 „ - 3 3 75 to 80 „ 1 — 1 80 and upwards 1 — 1 Total 8 23 31 Total 8 23 31 15 The death-rate for the year is .57, as against .88 last year and .96 in 1906, the average for the past five years being .76. Diarrhoea and Epidemic Enteritis was responsible for 9 deaths, corresponding to a death-rate of .14. Last year there were 17 deaths and a death-rate of .32, whilst the average for the past ten years is .54. There were also registered 19 deaths due to Enteritis, which term also includes Muco-enteritis, Gastro-enteritis and Gastritis, giving a death-rate due to diarrhœal diseases of .51. The mortality in Wards and age periods is shown in Table IV. Infantile Mortality.—By the term "Infantile Mortality" is meant the proportion of infants who died before reaching the age of twelve months to the total number born during the year. This is the method required by the Local Government Board in their statistical tables and permits of accurate comparison with other localities, as in taking the number of deaths only no reliable data is given for comparison, and to calculate the infantile death-rate on the population, or on the deaths at all ages, as is sometimes done, is absolutely valueless. There were 82 such deaths during the year or 71 per 1,000 births, a decrease of 40 on last year's rate, when there were 125 deaths and a rate of 111. The previous year there were 175 deaths and the rate 147. The average for the past ten years is 122. Only once previously, as pointed out in the commencement of the report, has this low figure been surpassed. This was in 1905, when the rate was 69. The average for the 142 smaller towns in the Registrar-General's returns, that is, towns with populations from 20,000 and under 50,000 at the last census, is 124. Wimbledon's figure compares very satisfactorily with this. During the period (the past seven years) that records have been obtainable of infantile mortality in the various wards, it is found that South Park Ward has had the highest rate in three years, St. Mary's in two years, and Dtmdonald and Trinity Wards one each, the average for the North Wimbledon Wards for those years being 72, as against 117 in the South Wimbledon Wards. Reference to Table V. shows that compared with last year a marked decrease of deaths due to Whooping Cough (14), Atrophy, Debility and Marasmus (14), and Pneumonia (13) has taken place. Eighteen babies, or about 22 per cent. of the total deaths, failed to survive the first week of life, and 34 per cent. the 16 first month. Thirty-three per cent. of the infants died from what may be termed "pre-natal causes." This is about the same proportion as shown in the Registrar-General's figures for England and Wales. The death-rate per 1,000 amongst infants must necessarily be largely in excess of the death-rate per 1,000 at any other yearly age period, owing to the frailty of the infants, to immaturity, to congenital defects, inherited weakness and inability to resist ailments which in children of an older growth would have but trifling effects, and from many other causes. Amongst infants in both urban and rural areas there has been a marked increase in the deaths from gastro intestinal maladies and premature birth, and these and other influences have counteracted the benefits to the infant population of the generally improved sanitary conditions of the people, and the fruits of over a quarter of a century of compulsory education. This excessive infant mortality is principally confined to the poorer classes, and it is the result of many forces, some of which are very complex; but the main factors are: The employment away from home of those about to become mothers, and of those recently confined who should be nourishing their infants, the infants being badly cared for and ill-fed while their mothers are at work; and the ignorance among women as to feeding, clothing, and managing of infants. This maternal ignorance and neglect offend against every law of hygiene, and is responsible for so many children failing to complete their first year of life. Here, in passing, I should like to testify to the excellent work being done by the Day Nursery in Haydon's Road in taking care of infants and children whilst their mothers are away from home following some employment. It is pleasing to note that on each of the occasions I have visited the Home, I have been very much struck with the kind and thoughtful attention bestowed on them. Diarrhœal diseases and deaths from defective nutrition are always truly referred to as the chief dangers to which hand-fed children are exposed, and this fact emphasises the argument against rearing a child by hand except in cases of absolute necessity. The proportion of hand-fed children to those who are suckled increases yearly, and everywhere the same testimony is forthcoming that children fed naturally from the breast have a prospect in life far in excess of those who are fed artificially. Even under the most favourable con ditions the substitution for the infant's natural food of an artificial diet is disadvantageous, but when we find the mother's milk is very often substituted by such products as cheap brands of condensed milk and of artificial foods, administered by those who have little knowledge of the 17 infant's requirements and none of the composition of the stuffs they are giving it, can we wonder at the appalling amount of preventable sickness and death ? But it is not only in the actual number of deaths that one sees the evil of this state of things reflected. One has to think of the far greater number of infants who escape death, but grow up with constitutions permanently damaged. It is obvious that there are two main directions in which we must seek our remedy. We must get in touch with the mothers of to-day both before and after the baby has made its appearance, guide and help them, and educate the mothers of the future while they are under our control at school, and while their minds are plastic and receptive. It is in this connection that I believe the opening, towards the end of the year, by the Wimbledon Mothers' and Babies' Welcome Society of the School for Mothers at Wandle Bank House (initiated through the efforts of Mrs. Collier, Dr. Beatrice MacGregor and other ladies), and the employment by the Society of a Lady Health Visitor, should prove of very great value, there being a wide scope for the work they have undertaken. Notification of Births Act, 1907.—In December, 1907, the Town Clerk submitted a report to the Sanitary Committee upon this Act, when it was resolved that the consideration of the report should be deferred to the next meeting of the Committee, and I was directed in the meantime to report and advise whether the Council should adopt this Act. I reported accordingly and recommended that the Act should not be adopted. This was considered by the Committee in January and deferred, it being directed that a copy of the report should be sent to each Member of the Council. The report was again considered at the following meeting, when it was resolved:—"That the General Purposes Committee be informed that, in the opinion of this Committee, no advantage would be gained by the adoption of the Notification of Births Act, 1907, in this Borough." This was approved by the General Purposes Committee, but at the Council meeting in March, an amendment in the following terms was carried:—"That this Council, being of opinion that the Notification of Births Act, 1907, would, if adopted in this Borough, tend to diminish the death-rate amongst young children, and to improve their physical condition, hereby directs the Sanitary Committee to consider and report what steps may best be taken by the Council to carry out the main object of the Act, namely, the giving of advice and instruction to those who have charge of infants." After this the matter was referred to a Sub-Committee of the General Purposes Committee, which was called together 18 on three occasions, but at neither meeting was there a sufficient number of members present to warrant the transaction of any business. The matter then stood over until the commencement of the new Municipal year (November) when a new Sub-Committee of the General Purposes Committee was constituted, and on November 25th they recommended the adoption of the Act by the Council, and that arrangements should be made with the " Wimbledon Mothers' and Babies' Welcome Society " to carry out its objects. Up to the end of the year the formal resolution to adopt the Act had not been submitted to the Council. [Whilst this Report was in the press the Council, at their meeting on February 3rd, passed a resolution to adopt the Notification of Births Act.] Medical Inspection of School Children.—By Section 13 of the Education (Administrative Provisions) Act, 1907, "the duty to provide for the medical inspection of children immediately before or at the time of or as soon as possible after their admission to a public elementary school, and on such other occasions as the Board of Education direct, and the power to make such arrangements as may be sanctioned by the Board of Education for attending to the health and physical condition of the children educated in public elementary schools," devolves upon the Local Authority. In Memorandum Circular No. 576 issued by the Board of Education, it states, inter alia, that " in non-county boroughs which are Local Authorities for elementary education, their Medical Officers of Health should be instructed to advise the Education Committee, and should make him responsible for the new work or for the supervision of such medical assistance as is needed to carry it out. Where appointments of school medical officers already exist, the Board do not suggest that they should be disturbed, provided always that the officers are competent and sufficient for the new duties, and that the arrangements for supervision by the Medical Officer of Health are satisfactory." The Sub-Committee of the Education Committee appointed to consider and report upon the above-mentioned Memorandum reported in July that after December, 1908, Dr. Hayward's services would not be available as Medical Officer of the Education Committee, and submitted a scheme for carrying out the medical inspection. This scheme and other proposals on the same subject were not accepted by the Education Committee. In July I was asked to draw up a scheme in conjunction with Dr. Hayward, it being pointed out that it was necessary that the inspections should be commenced at the earliest possible date to ensure the grants not being imperilled. 19 Bearing this in mind and having myself given up private practice, I wrote to the Education Authority stating that I was prepared to inspect, in accordance with the Board of Education's Circular and Schedule, the children entering and leaving the elementary schools during the year ending 31st July, 1909. I may state that I had previously entered into communication with several Medical Officers of Health and Inspecting Medical Officers of Schools in various districts, and through their courtesy had seen the inspections in progress. This offer was not accepted. No doubt the School Medical Officer will submit a report of the work in the schools during the past year, and it may be mentioned that in December a Lady Medical Inspector of Schools was appointed to take up the duties in January, 1909. South Wimbledon District Nursing Association and the South Wimbledon Day Nursery.—The good work carried out through these institutions is increasing and must have beneficial effects upon the public health of the neighbourhood. No less than 4,568 visits were paid to patients in their own homes by nurses attached to the former, and at the latter there were 6,015 attendances made by children whilst their mothers were at work in laundries and other places. Isolation Hospital.—The following table furnished by the Hospital Medical Attendant, Dr. Clapham, gives the number of patients treated in the Hospital for each disease during the year. Cases Admitted in 1908. Over 5 years. Under 5 years. Total. Deaths. Remarks. Over 5 years. Under 5 years. Total. Scarlet Fever 65 35 100 1 2 3 Average daily number of Patients— 26. Diphtheria 44 24 68 3 4 7 Enteric Fever 2 — 2 — — — Influenza 1 — 1 — — — Tonsilitis 1 — 1 — — — Average number of days in Hospital per case— 39. Total 113 59 172 Carried over from 1907 Scarlet Fever 28 5 33 — — — Diphtheria 3 6 9 — — — Total number of Cases treated during 1908 144 70 214 4 6 10 20 Disinfection.—The following table shows the number of rooms and articles disinfected:— Disease. Mattresses Palliasses Beds. Pillows and Bolsters. Blankets and Sheets. Dresses. Suits. Other Articles No. of Rooms. Totals. Scarlet Fever 126 67 55 304 751 151 46 3489 178 5070 Diphtheria 131 66 66 308 541 77 9 2686 139 4023 Enteric Fever 5 — 3 15 16 1 — 13 — 53 Erysipelas 3 — 1 4 4 — — 17 1 30 Puerperal Fever 2 — — — 1 — — 8 1 12 Measles 14 — 1 20 74 9 2 518 13 651 Whooping Cough 4 — 1 6 3 1 — 44 5 64 Cancer 8 — 3 35 14 — — 27 7 94 Consumption 22 8 8 61 45 14 14 275 14 461 Sundries 46 26 19 105 105 3 — 367 373 1044 Totals 361 167 157 858 1554 256 71 7444 731 11502 There were 31 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. Thirty-three bottles of anti-diphtheritic serum were supplied through the Sanitary Department for use by medical practitioners for the treatment of Diphtheria. Mortuary.—From information received from the Superintendent of the Cemetery, there were 71 bodies received into the mortuary during the year, and 35 post-mortems held (21 males, 14 females). Inquests were held by the Coroner with respect to 35 bodies, being equal to 7.7 per cent. of all deaths registered in the Borough. Factory and Workshop Act, 1901.—Section 132 requires the Medical Officer of Health to specifically report annually 21 on the administration of the Act in workshops and workplaces, and to send a copy of such report to the Secretary of State. The details on the forms prescribed and supplied by the Home Office have been forwarded. In the Tables below is shown the work done in the supervision of workshops and workplaces:— Premises. Inspections. Written Notices. Prosecutions. Factories 53 7 - Workshops 313 43 - Workplaces 42 8 - Total 408 58 - Defects found. Nature. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 13 8 — — Overcrowding 1 1 — — Want of drainage of floors 2 1 — — Other Nuisances 23 18 — — *Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 26 20 — — Not Separate for Sexes - - — — Total 65 48 — — *Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted, and the standard of efficiency and suitability required is that contained in the Secretary of State's Order, dated 4th February, 1903. 22 Home work, Lists received : — Twice in the year 6 Number of Out-workers 19 Once in the year 8 Number of Out-workers 12 Number of addresses received from other Councils 40 Number of addresses forwarded to other Councils 28 Notices served on Occupiers as to keeping or sending lists 3 Inspections of Out-workers' premises 46 Registered "Workshops. The following are the principal classes of workshops on the register at the end of the year: — Boot Repairers 48 Dressmaking 55 *Bakehouses 27 Laundries 26 Tailoring 24 Millinery 28 Dining Rooms 20 Other Trades 69 Total 297 OTHER MATTERS. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of Act 12 Action taken in matters referred by H.M- Inspector as remedial under the Public Health Act Notified by H.M. Inspector 2 Reports of action taken sent to H.M. Inspector 2 Other 4 Underground bakehouses in use at the end of the year 3 *Including four Factory Bakehouses. As a result of the inspection of the workrooms, workshops and workplaces in the Borough, it was found that for the most part they were in a satisfactory condition, and that the requirements of the Act were duly observed by the occupiers. Systematic examination has been made of the eatinghouses, cook-shops, and other places where food is prepared for sale, and the occupiers of these, speaking generally, have kept their places in good and cleanly order. 23 The difference in the table between the number of defects and nuisances found and abated or remedied is accounted for by the fact that a number of the premises were visited towards the end of the year, and there was consequently insufficient time for the work to be completed. It was possible during the year for more time to be devoted to the work of inspecting premises which come under the Factory and Workshop Act than has been the case in previous years. Reference to the table will show that 408 premises are now entered on the register as against 198 at the commencement of the year, an increase of 210. In no instance was it necessary to take legal proceedings to enforce compliance with the requirements set out in the notices served for the abatement of nuisances. In addition to the ordinary inspections made of outworkers' premises, each address contained in the lists received in the early part of the year, i.e., previous to February, and not including those received in August, were visited in order to ascertain if work was still carried on, and if breaches of the Act had been made by reason of the employer failing to notify the name and address of the out-worker. In no instance was this found to be the case. Water Supply.— The Borough's water supply is derived through the mains formerly owned by the Southwark and Vauxhall and the Lambeth Companies. The water is either well water from Streatham or river water from the Norwood or Hampton reservoirs. Alterations have now been made by the Water Board, and the portions of the district which formerly suffered much inconvenience owing to insufficient pressure have now generally a good supply. The well water both chemically and bacteriologically is much the purer. Complaints have been received about the amount of chalk present in the water supplied to parts of the Borough. This chalk, although not injurious to the material of boilers, will cause deposit and incrustation to take place which will necessitate frequent cleansing of domestic boilers. Both the permanent and temporary hardness of the well water, as shown in the Metropolitan Water Board's Returns, is much less than that portion of the Water Board's supply derived from the Kent wells, but slightly harder than that derived from river sources. Careful testing and examinations are made, and each month a report is presented to the Water Board on the condition of the Metropolitan Water Supply by the Water 24 Examiner (Dr. Houston), appointed under the Metropolis Water Act. The last monthly report issued shows that chemical analysis was made of 66 samples of raw river water, 190 samples of filtered water, and the bacteriological examination of 66 samples of raw water and 531 samples of filtered water. It will, therefore, be seen that anything of a harmful nature will be promptly discovered. Information was received that the water supply has been withdrawn, during the year, from 37 houses for the following reasons:— Thirty-two owing to leakages, four by request, and one owing to arrears of rates. In this connection it is noticeable that the Board have rendered great assistance to Local Authorities by their instructions to their officials, which has had the effect of minimising the number of supplies withdrawn, and when this action has been found necessary there has not been the delay in re-connecting the supply as was the case until quite recently. House Refuse.— The collection of House Refuse by the staff of the Surveyor's Department is carried out weekly throughout the Borough, with the exception of that portion of the district east of Haydon's Road, where a daily collection has been made during the past year, whilst in the summer months the dust was also removed each day from Queen Alexandra's Mansions and other blocks of flats. During the year 9,694 loads of house refuse were removed to the Durnsford Road Works and destroyed by heat in the refuse destructor. Sanitary Improvements: Sewers.— Amongst the works carried out by the Borough Surveyor's Department, which affect the sanitary condition of the Borough, the following should be mentioned:— Middle Level Sewer, the unsatisfactory condition of which has been the subject of report by the Surveyor for many years, and upon which I also reported in May, 1906, was re-constructed from Springfield Road to Arterberry Road at an estimated cost of £9,500, a portion of it being in 24in. iron pipes and the remainder in 3ft. by 2ft. egg-shaped brickwork. A further portion from Arterberry Road to Langham Road has been constructed in 2ft. 10in. by 1ft. 11in. brickwork, at the cost of the Devas Trustees, making in all "8,598 feet of this main sewer re-constructed at a total cost to the Council of about £8,820. Woodman Sewer.— This was re-constructed with an increased carrying capacity to cope with the development of the 25 Ashen Grove Estate, 9in. and 12in. pipes being substituted by a 2ft. 3in. by 1ft. Gin. brick sewer, discharging into a trunk main sewer before reaching the Pumping Station. Camp Road Sewer.— This sewer, which was constantly blocked on account of insufficient fall, was relaid from Caesar's Camp House to opposite the National Rifle Association's old store-house, near the Central Girls' School at the corner of the Common. The Church of England Surface Water Sewer, from Herbert Road, down Hartfield Road and Kingston Road to a point near the Salvation Army Barracks, was relaid at a lower level with increased gradient, and enlarged from 9in. and 12in. to 18in. and 24in. pipes, and old brick barrel sewer to 24in. and 27in. concrete tubes. The outlet of this sewer, which now discharges into the old course of the River Wandle at the back of Miller's Mead Cottages, will be diverted so as to pass down Wandle Bank Road, across the Mill Pond, to a point lower down the course of the river, where a better outfall at a lower level will be obtained, this being part of the scheme prepared in 1903 by the Borough Surveyor (Mr. Cooper) for the prevention of flooding. Nuisance from Flies.— For many years past it has been thought that the common house-fly is a carrier of infection, and although a number of Medical Officers of Health and others have been somewhat sceptical on this point, it has been proved by investigations carried out by such eminent men as Sir James Crichton-Browne, Professors Nuttall and Delepine, Dr. Jackson of New York, the Medical Officers of Health of Manchester and Liverpool and others, who have devoted their lives to solving problems pertaining to public health, that this is only too true. Botanists of repute also confirm this theory, and there is no doubt that this is the explanation of a certain proportion of the summer incidence of zymotic diarrhoea. It is common knowledge that the fly-nuisance is promoted to a great degree where manure heaps, stables, cowsheds and offensive trade premises exist, especially accumulations of horse manure, and houses in the immediate neighbourhood of these are almost invariably affected in the summer by swarms of these apparently harmless— and yet insidious— insects. It is clear, therefore, that in the interests of public health that, where flies do congregate, practical steps must be taken, and bearing this in mind, the Officers of your Sanitary Department have paid no less than 771 regular visits to places where horses are kept, and have insisted upon the provision of suitable receptacles for stable manure and the periodical removal of their contents. It may here be mentioned that the 26 Council's Bye-laws only provide for the clearance of these once in seven days, but when they are revised it would be advantageous to make provision to compel all occupiers of stables to clear their manure receptacles at least twice a week. Furthermore, twenty-two accumulations of various kinds of refuse and dirt have been removed from vacant land in close proximity to dwellings at the instigation of this Department, and the fly-nuisance in Wimbledon has thus been systematically attacked by the strict supervision of all likely breeding places of the fly. The report of Mr. Johnson, the Chief of the Sanitary Staff, shows how much good work has been done under his supervision, and how onerous and varied are the duties entrusted to him. They have been carried out, as usual, in a thoroughly conscientious and satisfactory manner. To him and his Staff I am much indebted for their cordial and unfailing support in all investigations of infectious disease and other matters appertaining to the public health. I beg to remain, Gentlemen, Your obedient Servant, E. POCKLINGTON, Medical Officer of Health. 27 Borough of Wimbledon. SANITARY DEPARTMENT. ANNUAL REPORT OF THE Sanitary Inspector FOR THE Year ended 31st December, 1908. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Gentlemen, I have the honour to submit my Report for the year ended 31st December, 1908, on the work carried out by the Sanitary Department in connection with the abatement and suppression of nuisances and other matters under the Public Health Acts, the Factory and Workshops Acts, the Sale of Food and Drugs Acts, and also in connection with the enforcement of the various Bye-laws made by the Local Authority, including house-to-house inspection, supervision and testing of drainage work, the inspection of Workshops, Bakehouses, Restaurants, Slaughter-houses, Butchers' and Fishmongers' Shops and Dairies, Cowsheds and Milkshops. Notices Served.— In connection with the abatement of nuisances under the Public Health Acts and the remedying of contraventions of the Bye-laws and other Statutes which are under the jurisdiction of an Inspector, 774 Notices in respect of 1,038 houses were served, and it is pleasing to note that it was only found necessary to serve 158 Statutory Notices respecting 189 houses at the instance of the Sanitary Authority, the experience being that in the majority of cases 29 owners of property are willing to carry out work when a request in the form of an ordinary letter is made by this Department, without the necessity of further steps being taken. Every facility is given at all times by means of letters, telephone messages and personal interviews to give full information of the work found necessary, and I think it may be truly said that the Department has, during the past year, carried out its somewhat difficult duties in conjunction with property owners, agents and builders with almost perfect harmony. Proof of this is undoubtedly demonstrated by the very rare occasions upon which we are compelled to resort to legal proceedings. The time of the Inspectors is greatly taken up by the inspection of house drains and sanitary fittings, in the course of house-to-house inspection and after the occurrence of cases of infectious disease, and the investigation of all complaints which reach this Department either verbally or in a written statement. Appendix Table VI. shows the sanitary work carried out and the nuisances abated during the year. House Drainage.— At 102 houses the drainage systems and sanitary fittings have been entirely re-constructed, and repairs, in most instances of an extensive nature, have been executed at 60 other houses. The following groups of houses were re-drained:— 2 to 16, Graham Road. 50, 51, and 52, Alexandra Road. 9 to 15, Palmerston Road (main under house re-laid by Council as sewer). 1, North View, Ivy Cottage, North View, and 13, 14, and 15, North View. 2, 4, and 6, Kingswood Road. A new main was put in at the rear of 2 to 26, Kingswood Road and junctions provided, so that the houses may be connected from time to time and the old drains running at present under the houses abolished. There were 30 (15 pairs) houses re-drained, 12 being in Russell Road, 4 in Gladstone Road, and 2 in each of the following roads:— Graham Road, Pelham Road, Kingswood Road, Amity Grove, The Broadway, Herbert Road, and Hartfield Crescent. At Nos. 4 and 6, Herbert Road, and 69 and 77, Hartfield Road, the work was, in each case, carried out by the Council 30 in default of the owner, and whilst the amount due in respect of No. 69, Hartfield Road, was paid, the cost of the work at No. 77 is now the subject of an appeal made by the owner to the Local Government Board under Section 268 of the Public Health Act, 1875. The work at Nos. 4 and 6, Herbert Road, was not completed till the end of the year, and will be included in the accounts for 1909. The smoke and water tests were applied to drains and sanitary fittings on 764 occasions. Opening up of Drains for Examination under Section 41.— As the result of either smoke or chemical tests, applications were made to the Sanitary Committee for authority to enter the premises, open the ground and examine the drains under the provisions of Section 41 of the Public Health Act, 1875, at twenty-eight houses. After examination the ground was made good, and the conditions found reported to the Sanitary Committee, who authorised the serving of notices requiring the re-construction of the drains, water-closets, etc. House-to-House Inspection was made at 389 houses, principally in the following streets:— Leyton Road, Nos. 1—65; 64—86. Russell Road, Nos. 8—12; 20—54; 62—118. Wandle Road, Nos. 2—60; 1—25. Cowper Road, Nos. 14—64; 5, 5a—53, 53a. Milton Road, Nos. 1—53; 2—60. Dryden Road, Nos. 2—40; 1—47. South Road, Nos. 100—120. Pelham Road, Nos. 119—127. Palmerston Road, Nos. 17—23. Caroline Road, Nos. 2—26; 1—27. A searching inspection was made at each house visited in order that, in addition to having any nuisances which existed promptly remedied, a detailed record of the premises could be kept for reference. The sanitary condition of each house was investigated, its general cleanliness noted, and each room was measured to determine whether any overcrowding existed. Common Lodging Houses.— The only Common Lodging House registered in Wimbledon is situated in High Street, Merton, and this has been regularly inspected. Marked improvement has been noted in the manner in which these premises have been kept, and the periodical cleansing and other matters requiring attention have been carried out. 31 Houses Let in Lodgings.— The number of houses registered under the Bye-laws for Houses Let in Lodgings is 71. It is only houses which on inspection are found to be kept in a neglected and insanitary condition and occupied by members of more than one family that are recommended to the Sanitary Committee for placing on the register. In some instances the threat to do so has had a salutary effect on the landlords, and a satisfactory improvement in the property has resulted. During the year 373 visits of inspection have been made to these houses. Some of this class of property requires almost constant attention by the officials of the Department, owing in some measure to the neglect of the owners or agent, but chiefly to the untidy habits of the tenants. The houses 62 to 76, High Street, Merton, are an example of this unsatisfactory class. To these eight houses no less than 125 visits were paid, and through the instrumentality of this Department, 55 rooms and four passages and staircases at this property have been stripped and cleansed during the year. Time after time the landlady has cleared out a number of dirty and verminous tenants only a few weeks later to be replaced by others equally bad. It is only by constant visits and re-visits that any improvement of this class can be made, whose present position is not due to poverty but to their own habits and neglect of the most obvious duties. Some of these have removed to other districts, saying they were worried by the Inspectors too much when their places are not kept clean, but where possible we have found out the districts to which these people remove and acquainted the Sanitary Authority, with a view to lessening the nuisance caused by such persons to those with whom they come in contact. Cowsheds, Dairies and Milkshops.– Under the Dairies, Cowsheds and Milkshops Order of 1885, it is necessary for all persons carrying on the trade of a Cowkeeper, Dairyman or Purveyor of Milk to be registered by the Local Authority. During the year twelve applications for registration as Dairymen and Purveyors were received. There have been six changes of occupation, one has given up the business during the year, whilst one has surrendered the certificate and withdrew the application for registration on it being pointed out 32 the alterations required to the premises in order to comply with the regulations made under the above Orders. The number of persons on the register at the close of the year was as follows:— Two Cowkeepers, 47 Dairymen and Purveyors, and 14 Purveyors. Periodical inspections of all the registered premises have been made during the year, and at the spring inspection the necessity was pointed out of properly covering with muslin or other suitable material all counter-pans and other utensils containing the milk to prevent the access of dust. This precaution has always been necessary, but since the advent of the motor-car its importance has greatly increased in consequence of the amount of dust thrown up laden with injurious germs. Slaughter-houses.— Frequent inspections have been made of the Slaughter-houses during the year, especially when slaughtering was in progress. There are six in the Borough, and at three of these a considerable amount of slaughtering is done. No breach of the regulations was found, and the provisions as to periodical lime-washing were, in all cases, strictly complied with. Notifiable Infectious Diseases.— In accordance with the usual practice, the notifications of infectious disease have been inquired into and reported upon to the Medical Officer, under whose instructions and guidance detailed attention has been given to the special points required for his information and which vary for the different diseases. The form of inquiry furnishes the Medical Officer of Health with a comprehensive history of the cases, persons in contact, etc., and such inquiries have led in several instances to the discovery of infectious patients hitherto unnoticed. After the removal of the patient to the hospital or on recovery if nursed at home, a careful examination of the drainage and sanitary arrangements of the house is made. Owing to the amount of drainage work re-constructed and the number of houses where detailed house-to-house inspection have been made during recent years, the detection of serious sanitary defects where infectious disease occurs is not very frequent. Should the patient be removed to the Isolation Hospital, the bedding is immediately after removed for steam disinfection, and a letter sent to the owner or occupier, as circumstances require, calling attention to the provisions of Section 5 of the Infectious Diseases (Prevention) Act, 1890, requesting the stripping and cleansing of all the walls, ceiling and woodwork, etc., of the room. The Act mentioned gives authority 33 for immediate action by the officers of the Local Authority so that no time is lost in carrying out the complete disinfection of the room. Inquiries were made into 271 cases of notifiable infectious diseases, and 731 rooms were disinfected either by Sulphur Cylinders and Candles, Formalin Lamps and the spraying of walls, floors and ceilings. In 194 rooms the paper was stripped from the walls, the ceilings white-washed, and the floors and the woodwork cleansed, and in only 29 instances was it necessary to follow up the letter by a Statutory Notice to obtain compliance with the provisions of the above Act. Each day letters are sent to the Head Teachers of the Schools if attended by patients notified, and all other children from the same house, prohibiting their re-attendance until completion of disinfection and the expiration of the period of incubation required by the Medical Officer of Health. A letter is also sent to the Free Library so that books if not given up for disinfection at the time inquiries are made may be obtained to be disinfected or destroyed. The School Medical Officer is also informed of all cases of scholars attending the Public Elementary Schools, who are notified as suffering from infectious diseases. Paving of Yards.— Every opportunity was taken, as in past years, to obtain, where possible, the covering with impervious material of the spaces round the back walls of dwellings, especially in the poorer streets of the district. During the year this was carried out at 118 houses. Section 25 of the Public Health (Amendment) Act, 1907 (Adoptive Act) gives additional powers to the Local Authority in this respect. The consent of the Local Government Board to its adoption had not been received at the end of the year. Shop Hours Acts, 1892-1895. —These Acts until the granting of the Charter of Incorporation were administered by the County Council as the Local Authority. The object of these Acts is to prevent the employment of young persons for such an excessive number of hours as may prejudice the health of the employees. The Watch Committee in June, 1906, directed me " to ascertain and report to the next meeting of this Committee 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 exhibited by the employer in a conspicuous 34 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 the Seats for Shop Assistants Act, 1899, are being observed in this Borough." Later in the year I submitted the following returns:— Total number of premises visited 436 Number of premises where young persons are employed 198 Number of premises where Notice under Section 4 of Shop Hours Act, 1892, is exhibited 93 Number of premises where Notice under Section 4 is not exhibited 105 Number of premises where females are employed 64 Number of premises where seats are provided 62 Number of premises where seats are not provided 2 It was then resolved "that the Town Clerk be directed to prepare a Notice under Section 4 of the Shop Hours Act, 1892, for exhibition in Shops within the Borough in which young persons are employed, that such Notice be printed, and that copies be supplied gratis to employers of young persons." All officials of the Department being engaged in work principally in connection with the amount of infectious disease prevalent in 1907, it was not possible until early in 1908 to resume the work under the Shop Hours Acts. The following table shows the result of the completed inspection:— Number of premises visited. Employment of young persons as defined by the Act of 1892. Exhibition of Notice under Section 4 of the Act of 1892. Provision of Seats for Females. Yes. No. Yes. No. Places where females employed Where seats provided. 634 271 363 82 191 187 187 Note.—Notices were exhibited in 30 2 per cent. of the shops where young persons were employed. It cannot be said that the employers have tried to carry out the spirit of the Acts when it is seen that in only 30.2 per cent. of the Shops was the Notice exhibited. 35 At every Shop where a notice was not exhibited one was left, the provisions of the Act were explained, and a signature taken acknowledging its receipt. There cannot be any reasonable excuse pleaded now if the Notice is not conspicuously exhibited. A re-inspection of the premises where a card was provided by the Council was not completed at the close of the year. Petroleum Acts, 1871-1879.— In accordance with these Acts, 25 applications to keep Petroleum, one for Carbide of Calcium, and one for Hydrocarbon were received during the year, six being new licences and 19 renewals, all of which were granted by the Council on the recommendation of the Sanitary Committee. Nineteen of the applications were for the keeping of Petrol, chiefly for use in connection with motorcars, two for Benzoline, two for both Petrol and Benzoline, and one for Hydrocarbon. The premises have been inspected from time to time in order to see that the conditions attached to the licences have been carried out. The conditions are those which have been suggested by the Home Secretary for the guidance of Local Authorities, with modifications or additions as the circumstances of the cases require. During the year new regulations came into force which were made by the Secretary of State under Section 5 of the Locomotives on Highways Act, 1896, as to the keeping and use of Petroleum for the purposes of light locomotives. It was ordered, inter alia, that any person keeping Petroleum in a store-house within twenty feet of any other building should give notice in January of each year to the Local Authority under the Petroleum Acts, and that they should permit any authorised officer of the Local Authority to inspect such petroleum spirit at any reasonable time. It is unfortunate that the Local Authority have no means of obtaining a complete list of motor-car owners, and undoubtedly Petroleum is stored in many places without the knowledge of the Local Authority. By another Order in Council, dated 7th May, 1907, it was ordered that a certain portion of the Petroleum Acts, 1871-1881, should apply to mixtures of petroleum. Where these mixtures contain an undissolved sediment, as in the cases of some metal polishes, which can be separated by filtration or by settlement and decantation, the sediment may be so separated and the decanted liquid may be tested in the manner set forth in Schedule 1 to the Petroleum Act, 1879. Where the Petroleum Mixture is such that sediment cannot be separated by the afore-mentioned means, or where it is 36 of a viscous nature, as in the case of india-rubber solution, quick-drying paints, etc., such mixture shall be tested in apparatus specified in the new Order. In order to comply with the provisions of these Orders it was necessary that the Petroleum Tester in use should be altered. It was accordingly sent to the makers for this to be done, and subsequently tested and approved by the Board of Trade. Sale of Food and Drugs Acts, 1875 to 1899.— The following Table shows the number and nature of articles purchased during the year:— ARTICLE. Test Samples. Official Samples. Prose, cutions No. Genuine Adulterated or Inferior Slightly inferior or deteriorated. No. Genuine. Adulterated or Inferior Slightly inferior or deteriorated. Milk 99 84 7 8 4 2 1 1 1 Butter 109 97 7 5 7 7 ... ... ... Milk Blended Butter 3 3 ... ... ... ... ... ... ... Demerara Sugar 9 6 ... 3 ... ... ... ... ... Jam 1 1 ... ... ... ... ... ... ... Vinegar 2 1 ... 1 ... ... ... ... ... Pepper 1 1 ... ... ... ... ... ... ... Coffee 11 11 ... ... ... ... ... ... ... Coffee Mixture 6 6 ... ... ... ... ... ... ... Tartaric Acid 4 2 ... 2 ... ... ... ... ... Citric Acid 4 3 ... 1 ... ... ... ... ... Cream of Tartar 2 1 ... 1 ... ... ... ... ... Mustard 3 3 ... ... ... ... ... ... ... Brawn 4 4 ... ... ... ... ... ... ... Flour 1 1 ... ... ... ... ... ... ... Margarine 2 2 ... ... ... ... ... ... ... Cocoa Mixture 1 1 ... ... ... ... ... ... ... Pea Flour 1 1 ... ... ... ... ... ... ... Bread 1 1 ... ... ... ... ... ... ... Cream 14 6 8 ... ... ... ... ... ... Pork Sausage 4 3 1 Boric Acid added. ... ... ... German ,, 4 3 1 ... ... ... ... ... ... Total 286 241 24 21 11 9 1 1 1 Observations: Milk.— Of the 99 test samples of Milk taken, 15 were returned as not pure, 2 were noted as slightly skimmed, 7 had an amount of added water, and 6 a small amount of fat abstracted. Butter.— Of the 109 samples of butter, 12 were returned as not pure, and of these 5 contained an excess of water, 2 were margarine, 1 contained margarine, and 4 contained a small amount of foreign fats. 37 The circular letter issued by the Council last year warning Milk Sellers that an offence was committed when Milk plus a preservative was supplied, has had a most beneficial effect. From the commencement of taking samples to the date of that circular the majority contained preservatives, some in very excessive quantities. In not a single sample of milk duriug the past year has a preservative of any kind been found. Similar procedure was adopted with respect to cream this year. After the first samples were taken which showed Boric Acid present in excessive quantities, the Cream Sellers were circularised with equally good results, the second lot of samples being found free. The only prosecution taken was against a Milk Seller found to be selling milk contrary to an undertaking given the magistrates in 1906, when a case against her for selling milk containing 18 per cent. of added water was heard. She was now fined with costs, for selling milk containing 9 per cent. of added water, £6 10s. 6d., and for keeping milk (in a bedroom) contrary to the Dairies, Cowsheds and Milkshops Regulations, £3 9s. 6d., or £10 in all, or in default 21 days' imprisonment. Food Inspection.— The usual inspection at irregular periods have been made at fruiterers, fishmongers, butchers, and other shops where food is prepared and sold, and on Saturday afternoons and evenings, the stalls and barrows as well as the shops in the Broadway, Merton Road, and High Street, Merton. Legal Proceedings to enforce compliance with the requirements of the Public Health Acts or the Council's Bye-laws were necessary in two instances only. The first case was against a firm of house agents for permitting a nuisance to continue at No. 24, High Street, Merton, the house being occupied without having a proper water supply. The Magistrates permitted the summons to be withdrawn on the payment of £1 10s. 6d. costs. The second was against the occupier of a portion of the house No. 62, High Street, Merton, for causing a nuisance by the improper keeping therein of dogs. An order to cleanse the premises and remove the dogs within seven days was made with 10s. 6d. costs. Diseases of Animals Acts.— An outbreak of Sheep Scab took place in February amongst a flock of 130 sheep at Warren Farm, Wimbledon Common. The infection was undoubtedly brought by sheep bought at Shrewsbury. A detention order 38 was served. The sheep were dipped from time to time, and the detention order was finally withdrawn by Mr. Chamberlain, the Veterinary Surgeon, on May 22nd. In April an outbreak of Glanders occurred in Haydon's Road Mews, where eleven horses were stabled. The animal first affected was slaughtered, and all others in contact tested with mallein. Three which reacted to the test were slaughtered, the post-mortem examination confirming the test, all four being badly glandered. Compensation as provided by the Glanders Orders was paid by the Borough Council. In connection with this and the outbreak of Sheep Scab, all necessary Notices were served for the isolation of animals in contact, and steps taken to see that the disinfection and cleansing, etc., required by the orders of the Board of Agriculture properly carried out. During the year Mr. Baldwin, one of the Assistant Inspectors, obtained a more lucrative appointment under the Hornsey Council. Mr. Edmondson, the Junior Clerk, also resigned, and Mr. Linkhorn was appointed to fill the vacancy, a beneficial change in the interests of the keeping of the records. In conclusion, I have to bear testimony to the efficient manner in which the Assistant Inspectors have discharged their duties and co-operated with me in the execution of the work of the Department. I am, Gentlemen, Your obedient Servant, HENRY JOHNSON, Member of Royal Sanitary Institute, Chief Sanitary Inspector. 39 Borough of Wimbledon. Population, Birth and Death Rates for each Ward, 1908. WARD. Occupied Houses. Factor. Population. Birth Rate. Death Rate. St. Mary's 1586 5.43 8612 15.9 6.1 St. John's 975 5.66 5518 10.7 6.3 Cottenham Park 1197 510 6105 17.5 6.7 North Wimbledon 3758 5.38 20235 14.9 6.2 Dundonald 1384 5.88 8138 20.1 9.8 Trinity 1920 5.84 11213 28.8 11.4 South Park 2830 5.19 14688 24.1 8.1 South Wimbledon 6134 5.45 34039 24.7 9.6 Whole District 9892 5.49 54274 21.07 8.3 Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 34 72 106 Phthisis (Sputum) 5 13 18 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 1 3 4 40 TABLE 1. BOROUGH OF WIMBLEDON. Vital Statistics of Whole District during 1908 and Previous Years. YEAR. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births Registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 37,000 963 26.02 145 150 415 11.2 11 32 442 11.9 1899 38,000 1031 27.13 163 158 547 14.3 18 12 33 568 14.9 1900 39,500 1075 27.21 156 145 559 14.1 18 13 24 570 14.4 1901 41,631 1074 25.79 133 123 457 10.9 20 4 40 493 11.8 1902 43,000 1144 26.6 134 117 455 10.5 21 4 46 497 11.5 1903 46,000 1204 26.1 99 82 389 8.4 18 5 40 424 9.2 1904 47,719 1142 23.9 153 133 487 10.2 29 5 46 526 11.02 1905 48,240 1146 23.7 80 69 397 8.2 29 6 35 426 8.8 1906 49,860 1185 23.7 175 147 584 11.7 31 8 55 631 12.6 1907 51,700 1121 21.6 125 111 480 9.2 44 9 58 529 10.2 Averages for years 1898-1907. 44,265 1108 25 03 136 122 477 10.7 23 7 40 510 11.5 1908 54,274 1144 21.07 82 71 454 8.3 35 7 71 518 9.5 4J * 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) 3173 Total population at all ages at Census of 1901) 41,631 | Number of inhabited houses (at Census of 1901) 7572 Average Number of persons per house ,, 5.49 TABLE II. BOROUGH OF WIMBLEDON. Vital Statistics of separate Localities in 1908 and previous years. Names of Localities. 1.— Whole District. 2.— St. Mary's Ward. 3.— St. John's Ward. 1. Cottenham Park Ward. 9.– Dundonald Ward. 6.— Trinity Ward. 7.— South Park Ward. Year Population estimated to middle of each year. Births regis tered. 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 e d a b c d 1898 37,000 963 442 145 1899 38,000 1031 568 163 Particulars for these years not obtainable 1900 39,500 1075 570 156 1901 41,631 1074 493 133 1902 43,000 1144 497 134 5270 — 48 11 5044 — 45 5 3204 — 37 7 4858 – 57 14 11,783 — 162 51 12,841 — 148 46 1903 46,000 1204 424 104 5857 72 47 8 4968 82 39 3 3789 61 38 4 4000 129 41 10 12,488 437 126 39 14,298 423 133 40 1904 47,719 1142 526 161 6104 86 40 8 5393 56 40 5 3990 92 44 11 5480 131 63 17 13.326 396 167 54 13,426 381 172 66 1905 48,240 1146 426 80 6556 78 45 3 5326 42 39 4 4075 69 27 2 5580 127 63 11 13,251 424 127 31 13,452 406 125 29 1906 49,861 1185 631 175 5733 79 51 6 5280 42 40 4 5574 113 62 13 8279 183 94 24 10,634 347 165 59 14,360 421 219 96 1907 51,700 1121 529 132 6749 104 55 8 5399 59 34 4 5752 83 37 2 8160 172 85 19 11,140 312 135 43 14,500 391 183 56 Averages \ of Years 1898 to 1907. 44,265 1108 51C 138 – – – – – – – – – – – – – – – – – – – – – – – – 1908 54,274 1144 518 86 8612 137 53 3 5518 58 39 1 6105 107 43 3 8138 164 98 14 11,213 323 147 37 14,688 354 138 28 42 Alterations to the boundaries of all the Wards, except South Park, were made under the Charter of Incorporation, 1905. TABLE III. BOROUGH OF WIMBLEDON. Cases of Infectious Disease Notified during the Year 1908. notifiable disease. Cases Notified in Whole District. Total Cases Notified in Each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Total Cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards 1 2 3 4 5 6 1 2 3 4 5 6 7 (H) (H) Small-pox – – – – – – – – – – – – – – – – – – – – Cholera — — — — — — — – — — — — — — — — — — – — Diphtheria (including Membranous croup) 94 – 23 54 9 8 – 10 6 8 5 34 31 2 3 5 4 28 24 66 Erysipelas 35 1 – 2 5 24 3 4 1 3 5 9 13 — — — — — — — Scarlet fever 131 3 32 72 15 9 — 7 4 20 19 30 51 2 2 15 16 28 40 103 Typhus fever – – — — — — — — — — — — — — — — — — — — Enteric fever 5 — 1 1 1 2 — — 1 2 — 2 — — — 1 — 1 — 2 Relapsing fever – – – – – – – – – – – – – – – – – – – – Continued fever – – – – – – – – – – – – – – – – – – – – Puerperal fever 1 – – – – 1 – – – – – – – – – – – – – – Plague – – – – – – – – – – – – – – – – – – – – Totals 226 4 56 129 30 44 3 21 12 33 29 75 96 4 5 21 20 57 64 171 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, Surrey. 43 TABLE IV BOROUGH OF WIMBLEDON. Causes of, and Ages at, Death during year, 1908. CAUSES OF DEATH. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District. Deaths at ali. ages of " Residents" belonging to Localities, whether occurring in or beyond the district. Total Deaths whetherof Residents or 'NonResidents ' in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 16. 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 Small-pox – – – – – – – – – – – – – Measles 6 4 1 1 — — — — — — — 4 2 — Scarlet Fever 3 — 2 — — 1 — — — — — 2 1 3 Whooping Cough 6 1 4 1 — — — — — — — 4 2 — Diphtheria (including Membranous Croup) 9 — 5 4 — — – – 1 1 – 5 2 7 Croup — — — — — — — — — — — — — — Fever Typhus — — — — — — — — — — — — — — Enteric 1 — — — — 1 — — — — — 1 — — Other continued — — — — — — — — — — — — — — Epidemic Influenza 18 1 — 1 — 9 7 1 2 2 2 8 3 — Cholera — — — — — — — — — — — — — Plague — — — — — — — — — — — — — 44 Diarrhœa 9 8 – – – 1 – – – – 1 3 5 – Enteritis 19 13 3 1 — — 2 — 1 — 3 7 8 – Puerperal Fever 1 — — — — 1 — — — – — — 1 — Erysipelas 2 — — — — 1 1 — — — 2 — — — Phthisis (Pulmonary Tuberculosis) 43 2 1 1 11 26 2 6 1 2 7 13 14 1 Other tuberculous diseases 15 2 7 3 — 3 — 1 1 2 2 5 4 1 Cancer, malignant disease 31 — 1 — — 20 10 8 4 2 6 2 9 3 Bronchitis 37 6 2 — — 13 16 1 2 1 6 15 12 1 Pneumonia 36 5 5 2 — 10 14 6 1 4 10 13 2 – Pleurisy 4 — — — — 1 3 1 — — — 2 1 — Other Diseases of Respiratory organs 7 1 1 — — 3 2 1 2 — 2 1 1 — Alcoholism Cirrhosis of liver 10 — — — — 7 3 — 2 1 2 1 4 — Venereal Diseases — — — – — — — — – – – – – – Premature birth 20 20 — — — — — — — 1 3 9 7 – Diseases and accidents of parturition 2 1 – – – 1 – 1 – – – 1 – – Heart Diseases 51 1 — — 4 27 19 3 4 7 12 12 13 2 Accidents 5 1 — 2 1 1 — — 1 — 1 1 2 5 Suicides 5 — — — 1 2 2 — 2 — 1 2 — 3 All other causes 178 20 5 10 3 58 82 24 15 20 38 36 45 13 All causes 518 86 37 26 20 186 163 53 39 43 98 147 138 39 45 TABLE V BOROUGH OF WIMBLEDON. Infantile Mortality during the Year 1908. 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 18 4 1 7 30 4 4 8 4 5 7 5 4 3 4 4 82 Uncertified – – – — – – – – – – – – – – – – – Common Infectious Diseases. Small-pox – – – – – – – – – – – – – – – – – Chicken-pox – – – – – – – – – – – – – – – – – Measles – – – – – – – – – – – – 1 1 — 1 3 Scarlet Fever – – – – – – – – – – – – – – – – — Diphtheria (including Membranous Croup) – – – – – – – – – – – – – – – – – Whooping Cough – – – – – – – – 1 – – – – – – – 1 Diarrhœal Diseases. Diarrhoea, all forms — – – 1 1 1 1 1 – 2 – 2 – – – – 8 Enteritis, Muco-enteritis, Gastro-enteritis — — — 2 2 — — 4 1 1 1 — — — 1 1 11 Gastritis, Gastro-intestinal Catarrh — — — 1 1 — 1 — — — — — — — — — 2 46 47 Wasting Diseases. Premature Birth 14 2 — 2 18 — 1 — — — 1 — — — — — 20 Congenital Defects 2 1 1 — 4 — — — — — — — — — 1 — 5 Injury at Birth 1 — — — 1 — — — — — — — — — — — 1 Want of Breast-milk, Starvation — — — — — — — — — — — — — — — — — Atrophy, Debility, Marasmus 1 — — 1 2 1 — — — — — — — — — — 3 Tuberculous Diseases. Tuberculous Meningitis — — — — — — — — 1 — — — — 1 — — 2 Tuberculous Peritonitis: Tabes Mesenterica — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — 2 — — — — 2 Other Causes. Erysipelas — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — 1 1 — — — — 1 3 Convulsions — — — — — — — 1 1 — — — — — — — 2 Bronchitis — — — — — 1 1 — — 1 1 — 1 — 1 — 6 Laryngitis — — — — — — — — — — — — — — — — — Pneumonia — — — — — — — — — — 2 — 2 1 — — 5 Suffocation, overlying — — — — — — — — — — — — — — — — — Other Causes — 1 — — 1 1 — 2 — — 1 1 — — 1 1 8 18 4 1 7 30 4 4 8 4 5 7 5 4 3 4 4 82 Births in the year— Legitimate, 1,108. Illegitimate, 36. Deaths from all Causes at all Ages, 454. Deaths in the year of— Legitimate Infants, 73. Illegitimate Infants, 9. Population— Estimated to middle of 1908— 54,274 TABLE VI. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision of the Sanitary Department:— Accumulations Removed 24 Cisterns Provided 3 Cisterns, Repaired, Cleansed or Covered 131 Drains, New Provided 102 Drains, Repaired or Altered 60 Drains, Stoppages Removed 67 Dustbins Provided 102 Flushing Boxes, New Provided 86 Flushing Boxes, Repaired 103 Manure Receptacles Provided 13 Overcrowding Nuisances Abated 24 R.W. Pipes Disconnected 53 Roofs Repaired 62 Rooms Disinfected 731 Rooms Stripped and Cleansed 440 Soil Pipes, New Provided 39 Soil Pipes, Repaired or Altered 14 Ventilating Pipes, New Provided 131 Ventilating Pipes, Repaired or Altered 23 Waste Pipes, New Provided 52 Waste Pipes Repaired, Disconnected, or Trapped 33 Water Closets, New Provided 160 Water Closets, Repaired or Ventilated 17 Water Service Restored 27 Yards Cleansed 20 Yards Paved 118 Guttering Repaired 37 Floors Ventilated 26 Nuisances Abated from Damp Walls 37 Other Nuisances 613 Total 3,348 48