COU 1 Health Report For 1915 OF THE COULSDON AND PURLEY URBAN DISTRICT BY THE Medical Officer of Health. wallington: William Pile, Ltd., 19 and 21, Manor Road. URBAN DISTRICT COUNCIL OF COULSDON & PURLEY. HEALTH REPORT FOR 1915. Ladies and Gentlemen, I beg to present my First Annual Report for the Urban District of Coulsdon and Purley. In order to make the Report as complete as possible, I have included in the Appendix the Tables referring to the Croydon Rural District for the first three months of the year. The Death Rate, which is extremely low, was 7T per thousand of population; the rate for England and Wales being 15.1. The year has been a fairly healthy one, with no serious outbreaks of infectious disease. I am, Ladies and Gentlemen, Your obedient servant, C. M. FEGEN, Medical Officer of Health. Council Offices, Croydon. CONTENTS. pages. I.—Area and Population 5 to 6 II.—Vital Statistics 8 to 6 III.—Infectious Disease 8 to 10 IV.—Preventive Measures 10 to 12 V.—General 12 to 14 Appendices— Isolation Hospital 18 to 20 Statistical Tables 21 to 26 Factory and Workshops Act 27 to 31 Annual Report of Sanitary Inspector 32 to 34 Statistical Tables : Croydon Rural District Inset Index 35 REPORT. I.—AREA AND POPULATION. The Urban District of Coulsdon and Purley was created by an Order of the Surrey County Council and confirmed by the Local Government Board, and came into operation on the 1st April, 1915. The District consists of five Wards, viz., Coulsdon, Kenley, Purley, Sanderstead, and Woodcote. Owing to the unusual state of affairs existing, the estimation of the population was found to be most difficult, and under these circumstances the Registrar-General has for the year under review estimated the civil population for each district throughout England and Wales. The method by which the estimate of the population has been derived by the Registrar-General from the National Register may be briefly described as follows:— The ratio of the total population, less the males aged 15 to 65 years of age to the number of females aged 15 to 65 years at the date of the Census was calculated, and this ratio was applied to the number of females on the National Register; the resulting product, plus the number of males aged 16 to 65 years on the National Register, was taken to be the civil population of the District. Further, the population in Institutions were not taken and this, together with a number of persons of no fixed abode, were distributed evenly over the whole country. The estimate of the population for this District was 17,920. 6 The number of inmates in the Institutions within the District has increased from 3,149 in 1901 to 3,299 in 1915; there has also been an increase of 159 since the middle of 1914. The number of occupied houses in the District was 4,141, showing an average number of 4 3 persons per house. TABLE SHOWING AREA, POPULATION, & INSTITUTIONS. Area in Acres. Number of Houses. Population. Persons. Males. Females. Coulsdon 727 3156 1433 1723 Kenley 389 1683 726 956 Purley 1273 5503 2456 3047 Sanderstead 769 3323 1408 1915 Woodcote 983 4256 1992 2264 Cane Hill Asylum 2618 1088 1530 Reedham Orphanage 320 178 142 Russel Hill Schools 361 183 178 Totals 4141 21219 9164 11755 II.—VITAL STATISTICS. Births. The number of Births registered in the District during the nine months was 231. Of this number 4 children were registered as being illegitimate. This gives an illegitimate birth-rate of 1.7 per cent. of total births as against 1.4 last year. The birth-rate for the District was 17.1 per thousand. The number of births occurring outside the District but belonging to the District was 2; of these 1 was illegitimate. The birth-rate in England and Wales for 1915 was 218 per thousand of population, which is T8 per thousand below the rate in 1914, and lower than the rate in any other year on record. Compared with the average in the 10 years 1905-1914, the birth-rate in 1915 showed a decrease of 3.6 per thousand. 7 REGISTERED BIRTHS & BIRTH RATES, APRIL TO DECEMBER, 1915. Ward. Population estimated to 1st April, 1915. Births. Birthrates. Males. Females. Total. Coulsdon 8202 23 29 52 21.7 Kenley 1098 14 9 23 18.0 Purley 5563 24 42 66 15.8 Sanderstead 3357 20 20 40 15.8 Woodcote 4300 28 24 52 16.1 Totals 18120 109 124 233 17.1 Deaths. Exclusive of those deaths which occurred in Public Institutions situated within the district, but belonging to other districts, the deaths registered numbered 96. In this number are included those deaths which were transferred by the Registrar-General of persons who had died outside, but who belonged to this district. The number of these deaths was 18. These deaths chiefly occurred at the Workhouse, Workhouse Infirmary, and General Hospital at Croydon; the County Asylums at Brookwood and Netherne; the Cottage Hospital at Carshalton; and the Wandle Valley Joint Isolation Hospital Board's Hospital at Beddington Corner. The mortality corresponds to a death rate of 7.1 per thousand of population. Infantile Mortality Rate. The number of infants under the age of one year who died was 12, giving an infantile mortality rate of 51. 8 Causes of Death. The deaths registered included:— 1 from Whooping Cough. 1 „ Diarrhoea and Enteritis. 17 ,, Lung Complaints. 12 ,, Phthisis. 14 ,, Cancer. 15 ,, Heart Diseases. The Zymotic Death Rate is a term commonly applied to the rates of deaths occurring from the seven principal zymotic complaints, viz., Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Diarrhœa, and "Fever," which latter term includes Typhus, Typhoid, and Puerperal Fevers. The deaths from these complaints numbered 2, giving a zymotic death rate of 0.1 per thousand of population. III.—INFECTIOUS DISEASE. During the nine months 72 cases of Notifiable Disease (excluding Phthisis) were notified to the Health Department. Reference to Table II. at the end of the Report will show:— Firstly, cases notified, with the ages of incidence and the nature of the Infectious Disease. Secondly, the total number of cases (and nature of the disease) in each Ward. Thirdly, the number of cases removed to the Isolation Hospital. Scarlet Fever. Twenty-eight cases of Scarlet Fever were notified, the largest number being in the Woodcote Ward, viz., 10. Sixteen cases were removed to the Isolation Hospital. 9 Diphtheria. Seven cases of Diphtheria were notified, of which 6 were removed to the Isolation Hospital. I would point out that a supply of antitoxin has been placed at the service of all medical men practising within the district, and also arrangements have been made for bacteriological examinations free of charge. Puerperal Fever. No cases of Puerperal Fever were notified. Erysipelas. Nine cases of Erysipelas were notified, of which number 5 occurred in Cane Hill Asylum. No cases were removed to the Isolation Hospital. Typhoid Fever. Twenty-seven cases of Typhoid Fever were notified, 25 of which occurred to inmates and 1 to an attendant at Cane Hill Asylum. Therefore, excluding these 26 cases, only 1 case was notified within the district. This case occurred in a person aged 24 years, living within the Purley Ward. No source of infection could be traced. Cerebro-Spinal Meningitis. One case of Cerebro-Spinal Meningitis was notified as occurring in the Purley Ward. This case occurred in a boy aged 13 years. No source of infection could be traced, and there was no connection with military cases. Bacteriological examinations were made of all contacts, and no further cases occurred. The patient was removed to the Isolation Hospital, and was discharged as cured. 10 Tuberculosis. Twenty-two cases of Tuberculosis were notified. Of this number 3 were re-notifications. Of the 19 cases, 18 were Pulmonary, and 1 was Tubercular Disease of the foot. Infantile Summer Diarrhœa. No deaths were registered as occurring from Infantile Summer Diarrhœa. Reference to Table V. will show the streets invaded by this disease since 1901. IV.—PREVENTIVE MEASURES. Twenty-four patients were admitted from this District into the Isolation Hospital during the period April to December. The usual routine and precautionary measures have been continued to check the extension of infectious disease with most satisfactory results. Isolation, disinfection, and quarantine have been carried out under the careful and intelligent supervision of the Sanitary Staff, and outbreaks of infectious disease have been very materially limited. The origin of most outbreaks have been unrecognised cases, and these are always likely to exist, especially if the disease is of a mild type. So mild indeed are some of the cases that the advice of a medical man is, by the parents of the patient, considered superfluous. These, unfortunately, are the cases which prove the nuclei of almost all epidemics. Immediately on notification being received of the existence of cases of Scarlet Fever, Diphtheria, Typhoid Fever and Small-Pox, it is the custom to offer hospital treatment and, if the offer is accepted, the patient is at once removed to the hospital; in no case should longer that two hours elapse after 11 receiving the intimation of the existence of infectious disease in any house before the patient, if for removal, is in the Hospital, especially is any delay to be deprecated in all cases of Diphtheria, as abstention from the administration of diphtheria antitoxin until a bacteriological examination proves positive lessons the chance of ultimate recovery very considerably. No harm can possibly be done by administering a dose of diphtheria antitoxin as soon as this disease is even suspected and a great gain accrues. As a rule, however, this administration is generally postponed until the patient reaches the Hospital. In all cases of Typhoid Fever which are not admitted to the Hospital, sanitary pails, of a special character furnished with air-tight screw lids, are left at the infected houses for the reception of all excreta and other waste products of the sick room. These pails are collected daily, and their contents are dealt with in the destructor at the Hospital. In every case of Notifiable Disease enquiries are made and recorded as to the number of persons in the house, where they are employed, milk supply, water supply, laundry, conditions of drains, etc., together with the history of the case and the probable cause of infection. Notice is at once sent to any school attended by children from infected houses, and these children are then excluded from school on my certificate, and are not allowed to return until due notice has been given to the school authorities of their freedom from possible infection. The courtesy of the Managers of Sunday Schools has been much appreciated in falling in with the suggestions that any Sunday School should also be closed during the same period as the ordinary schools. Disinfection of infected rooms is carried out by fumigation with sulphur dioxide or formic aldehyde, and of the bedding 12 and the clothes by steam at the disinfecting station at the Isolation Hospital. Disinfectants are supplied free of charge during illness. After the rooms have been disinfected, the owners of the premises are required to strip and whitewash the ceilings and walls, under the supervision of the Sanitary Inspectors. This applies in all cases of Infectious Disease, and in the event of cases of Phthisis or Cancer occurring, on request, the rooms, as well as the bedding, clothing, etc., are from time to time disinfected. During the year 90 houses were disinfected. The Council places at the disposal of all medical practitioners, free of charge, means of having the diagnosis of all cases of infectious or contagious disease confirmed or otherwise by bacteriological examination, and also, at the end of the illness, for determining whether the patient is free from the specific bacterium or not. During the year 136 such examinations have been made. While with regard to Diphtheria, it is the custom to consider each case infective until the bacteriological examination shows the throat to be free from the true or pseudodiphtheritic bacillus. V.—GENERAL. Water Courses.—Constant supervision has been paid to all water courses within the district. Legal Proceedings.—I am glad to say that in no case has it been necessary to enforce the abatement of any nuisance by legal proceedings. 13 HOUSING OF THE WORKING CLASSES ACTS. The undermentioned houses have been dealt with under the Housing of the Working Classes Acts during the year:— Number of houses inspected 56 Number of houses considered so dangerous or injurious to health as to be unfit for habitation 5 Number of bouses in previous group which were made fit for habitation without representation to Local Authority 5 Number of formal representations to Local Authority with a view to the issue of a Closing Order — Number of Closing Orders made — Number of houses represented unfit for habitation which were made fit without Closing Orders — Number of houses in which defects were remedied after the issue of a Closing Order — Number of houses voluntarily closed by owners — Number of houses voluntarily demolished by owners — MEDICAL INSPECTION OF SCHOOL CHILDREN. The Medical Inspection of School Children is carried out by the Education Department of the Surrey County Council, but on many occasions the Medical Officer of Health has been called in to see children who have been suspected to be suffering from infectious or contagious disease. SCHOOLS. During the year 27 visits have been paid to School premises, 40 home visits have been paid to individual children, and 22 certificates given for school attendance purposes. The following Schools have been closed for the undermentioned reasons:— Kenley C.E. School, from 11th February to 7th March, owing to the prevalence of Measles. Coulsdon Council Infants' School, from 22nd June to 16th July, owing to the prevalence of Measles. 14 REGULATED TRADES. (1) Dairies, Cowsheds, and Milkshops. At the end of the year there were 28 premises registered under the Dairies, Cowsheds, and Milkshops Order, 1885, which is 1 more than last year. All the premises have been systematically inspected, and in only a few cases was it found necessary to complain of uncleanliness or neglect of regulations. (2) Slaughterhouses. The number of Butchers' Shops and Slaughterhouses remain the same as last year, viz., 15. All meat is kept under constant supervision. During the year 310 visits of inspection were made, and in 2 instances complaint was made as to uncleanliness. (3) Bakehouses. There were 5 Bakehouses within the district at the end of the year, as against 4 last year. Twenty-six visits of inspection have been paid, and only on 1 occasion was it found necessary to make any complaint as to uncleanliness. (4) Piggeries. There is 1 Piggery within the district. Sale of Food and Drugs Acts. The administration of the Sale of Food and Drugs Acts is carried out by the Surrey County Council. 15 The following table shows the number of samples from this district analysed during the year:— Articles. Analysed. Genuine. Adulterated. Prosecutions. Convictions. Milk 12 - - - Preserved Cream 1 - 1 - - Butter 14 11 3 - - Cheese 2 - - - - Lard 1 - - - - Tea 2 - - - - Cocoa 1 - - - - Mustard 2 - - - - Drugs 5 4 1 - - Other Articles 5 3 2 - - Totals 45 18 7 - - APPENDICES. 18 ISOLATION HOSPITAL. The Isolation Hospital, which is situated at Beddington Corner, is the Joint Hospital for the Districts of Beddington and Wallington, Coulsdon and Purley, Mitcham, and Merton and Morden Urban District Councils, was opened for the reception of patients at the beginning of March, 1899, since which date 5,174 patients have been admitted. Accommodation.—At the time the Hospital was first opened, the population of the District being '28,000 it was thought that it would be sufficient if accommodation was provided for 28 patients, viz., 10 Scarlet Fever, 10 Diphtheria, 4 Typhoid Fever, and 4 beds for observation cases. In 1905 it was found necessary to increase the number of beds by the addition of a Scarlet Fever pavilion of 22 beds. The hand laundry was also converted into a steam laundry, and some additional accommodation was provided in the Administrative Block. The Hospital was further enlarged in 1910 by the erection of a cubicle block for 12 patients and also quarters for a Resident Medical Officer. Staff.—The Staff at the Hospital consists of:— 1 Resident Medical Officer. 7 Servants. 1 Matron. 6 Wardtnaids. 1 Assistant Matron. 1 Seamstress. 13 Nurses. 2 Gardeners. 3 Laundresses. Porter and Portress. 2 Engineers. Patients.—During the year 444 patients have been admitted, of which number 254 were Scarlet Fever. 2 were Puerperal Fever. 143 ,, Diphtheria. 2 „ Erysipelas. 10 „ Typhoid Fever. 8 ,, Measles. 24 „ Cerebro-spinal 1 was Mumps. Meningitis. 19 Patients admitted to Hospital, April to December, 1915. District. Scarlet Fever. Diphtheria. Typhoid Fever. Cerebrospinal Meningitis. Puerperal Fever. Erysipelas. Measles. Mumps. Grand Totals. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Beddington and Wallington 31 .. 11 1 .. .. .. 1 .. .. 1 .. .. .. .. .. 43 2 Coulsdon and Purley 10 .. 6 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 24 .. Mitcham 86 .. 61 4 3 .. 3 .. 1 1 .. .. .. .. .. .. 154 5 Merton 24 2 15 1 5 1 1 1 .. .. .. .. .. .. .. .. 45 5 Hospital Staff .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. Caterham 17 1 5 .. .. .. 1 2 .. .. .. .. .. .. .. .. 23 3 Carshalton 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. Morden .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 2 .. Dorking .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. 3 Totals 175 3 101 6 10 1 6 7 1 1 1 .. 1 .. 1 .. 296 18 20 Patients admitted to Hospital, January to March, 1915. Parish. Scarlet Fever. Diphtheria. Cerebro spin'l Meningitis. Puerperal Fever. Erysipelas. Measles. Total. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Addington .. .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington 9 .. 2 1 .. .. .. .. .. .. .. .. 11 1 Coulsdon 2 .. 4 l .. .. .. .. .. .. .. .. 6 1 Mitcham 23 .. 10 l .. .. 1 1 1 .. .. .. 35 2 Sanderstead 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. Wallington 16 .. 14 l 1 .. .. .. .. .. .. .. 31 1 Woodmansterne 1 .. .. .. 2 .. .. .. .. .. .. .. 3 .. Merton & Morden 17 .. 7 3 .. .. .. .. .. .. .. .. 24 3 Caterham 6 .. 3 1 7 2 .. .. .. .. 1 .. 17 3 Reigate 4 .. 2 .. 7 3 .. .. .. .. 6 1 19 4 Croydon .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. Totals 79 .. 42 8 18 5 1 1 1 .. 7 1 148 15 21 TABLE 1.—Vital Statistics of Whole District from April to December, 1915. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Bate. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Bate per 1,000 Nett Births. Number. Rate. Number. Bate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1915 17920 231 233 17.1 241 17.7 163 18 12 51 96 7.1 22 TABLE II.—Cases of Infectious Disease notified from April to December, 1915. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. At all Ages. At Ages—Years. 1 2 3 4 5 Total Cases Removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Coulsdon. Kenley. Purley. Sanders tead. Woodcote. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. •• .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 7 .. 1 5 1 .. .. .. 1 .. 2 1 3 6 Erysipelas 9 .. .. .. .. 3 4 2 8 .. .. .. 1 .. Scarlet Fever 28 .. 6 18 3 1 .. .. .. .. 7 4 10 16 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 27 .. .. .. 2 16 9 .. 26 .. 1 .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. 1 .. .. 1 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 18 .. .. 3 5 9 .. 1 4 1 8 3 2 .. Other forms of Tuberculosis 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 91 .. 7 27 11 29 13 4 46 2 19 8 16 24 The Isolation Hospital is situated at Beddington Corner, Mitcham Junction, but is within the Carshalton Urban District. The Small Pox Hospital is situated at Cheam, and is the Joint Hospital for Croydon Borough, Wimbledon, Penge, Croydon Rural and Merton Councils. 23 TABLE III.—Causes of, and ages at, Death, April to December, 1915. 1 Deaths at the subjoined apes of "Residents" whether occurring in or beyond the District. 11 Causes of Death. 2 3 4 5 6 7 8 9 10 Total Deaths whether of Residents or non "Residents' in Public Institutions in the District. All ages. Under 1. 1 & under 2. 2 & under 5. 5 and under 15. 15 & under 25. 25 & under 45. 45 & under 65. 65 & upwards. All causes Certified (c) 96 12 4 3 2 5 18 26 26 .. Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. 4 Small Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 1 .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza 3 .. .. .. .. .. .. .. 3 1 Erysipelas .. .. .. .. .. .. .. .. .. 1 Phthisis (Pulmonary Tuberculosis) 12 .. .. .. .. 1 8 2 1 7 Tuberculous Meningitis 4 1 1 2 .. .. .. .. .. .. Other Tubercular Diseases .. .. .. .. .. .. .. .. .. 1 Cancer, malignant disease 14 .. .. .. .. .. 4 6 4 3 Rheumatic Fever .. .. .. .. .. .. .. .. .. .. Meningitis (Sen note (d)) 1 .. .. 1 .. .. .. .. .. .. Organic Heart Disease 15 2 .. .. .. .. 1 7 6 68 Bronchitis 3 .. .. .. .. .. 1 .. 2 6 Pneumonia (all forms) 14 3 2 .. 1 2 2 3 1 11 Other Diseases of Respiratory Organs .. .. .. .. .. .. .. .. .. 7 Diarrhoea and Enteritis (See. note (e)) 1 .. .. .. .. .. .. 1 .. .. Appendicitis and Typhlitis 1 .. .. .. .. .. .. 1 .. .. Cirrhosis of Liver .. .. .. .. .. .. .. .. .. 1 Alcoholism .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 1 .. .. .. .. .. .. .. 1 1 Puerperal Fever .. .. .. .. .. .. .. .. .. .. Other accidents and diseases of Pregnancy and Parturition.. .. .. .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 2 2 .. .. .. .. .. .. .. .. Violent Deaths, exeluding Suicides 5 2 .. .. .. .. 1 2 .. .. Suicides 1 .. .. .. .. 1 .. .. .. .. Other Defined Diseases 17 .. 1 .. 1 1 1 4 9 50 Diseases ill-defined or unknown 1 1 .. .. .. .. .. .. .. .. Total 96 12 4 3 2 5 18 26 26 161 Sub-Entries included in above figures. (a) Cerebro-spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. (b) Brain .. .. .. .. .. .. .. .. .. 36 (а) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are to be included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner to be excluded from these columns. For the precise meaning of the term " transferable deaths," see footnote to Table I. The total deaths in column 2 of Table III. should equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, are to be entered in the last column of Table III. (c) All deaths certified by registered Medical Pract'tioners and all Inquest cases are to be classed as "Certified;" all other deaths are to be regarded as " Uncertified." {d) Exclusive of " Tuberculous Meningitis (10), but inclusive of Cerebro-spinal Meningitis. (e) Title 19 should be used for deaths from Diarrhoea and Enteritis at all ages. (In the "Short List" deaths from Diarrhoea and Enteritis under 2 years are included under Title 19; those at 2 years and over being placed under Title 28.) 24 TABLE IV.—Infantile Mortality April to December, 1915. 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—3 Months. 3—0 Months, 6—9 Months. 9—12 Months. Totals Deaths under One Year. All causes Certified 3 1 1 1 6 2 1 1 2 12 Uncertified .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .... .. .. Whooping Cough .. 1 .. .. 1 .. .. .. .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 1 .. .. .. 1 .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. .. 1 1 1 .. Diarrhœa .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis .. .. .. .. .. .. .. .. .. .. Congenital Malformations 1 .. .. 1 2 1 .. .. .. 3 Premature Birth .. .. .. .. .. 1 .. .. .. 1 Atrophy, Debility, and Marasmus .. .. .. .. .. .. .. .. .. .. Other Causes .. .. 1 .. 1 .. .. .. .. 1 3 1 1 1 6 2 1 1 2 12 Nett Births— Legitimate 229. Illegitimate 4. Nett Deaths— Legitimate infants 12. Illegitimate infants —. 25 TABLE V.—Table showing Total Deaths from Infantile Summer Diarrhœa during the fifteen years, 1901-1915, in each Street invaded:— Brighton Road 1 Chipstead Valley Road 1 Coulsdon 1 Edward Road 1 Ellen Avenue 3 Foxley Lane 1 Godstone Road 1 Kensington Terrace 1 Lower Road, Kenley Mayfield Road 1 Riddlesdown Road 1 Rutland Cottages 1 Roke Avenue, Kenley 1 St. Dunstan's Cottages 1 Silverdale Terrace, Sanderstead 1 Sunnydene Road 1 Woodcote Valley Road 1 Woodman Road 1 26 Table VI.—Infectious Disease, showing month of incidence. April May June July August September October November December Grand Totals Scarlet Fever 4 5 3 2 1 .. 7 5 1 28 Diphtheria .. 3 .. .. .. .. 1 2 1 7 Cerebro-spinal Meningitis 1 .. .. .. .. .. .. .. .. 1 Typhoid Fever .. .. 7 9 3 1 .. 1 2 4 27 Erysipelas 1 1 1 .. .. 1 2 .. 3 9 6 16 13 5 2 1 11 9 9 72 Included in the above figures are the following cases which occurred in Cane Hill Asylum— Typhoid Fever, 26; Erysipelas, 5. 27 FACTORY AND WORKSHOP ACT, 1801. The title of this Act is "An Act to consolidate with amendments the Factory and Workshop Acts." It will be seen from the subjoined list that there are now 55 Factories and Workshops on the Register. All these are periodically visited, and due attention has been paid to maintaining them in such a condition as to comply with the requirements of the Act. During the year 58 visits of inspection were paid, and 5 instances or irregularities were found. Trades fact.rie3. Workshops. Total. No. of Employees. Laundries - 6 6 36 Cycle Works - 8 8 16 Carriage Makers and Wheelwrights - 3 3 7 Printing — 1 1 3 Carpenters and Builders — 5 5 12 Shoeing Forges — 7 7 16 Bakeries — 5 5 13 Bootniaking & Repairing — 9 9 21 Saw Wills & Timber Yards 3 — 8 3 Tailoring — 3 8 6 Upholsterers — 5 5 7 Totals 8 62 55 140 28 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES, 1915. Including Inspections made by Sanitary Inspectors or Inspectors or Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 6 Workshops (including Workshop Laundries) 52 Workplaces (other than Outworkers' premises included in Part 3 of this Report ... Total 58 29 2.—DEFECTS FOUND, 1915. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts—* Want of cleanliness 3 3 Want of ventilation — — Overcrowding — — Want of drainage of floors - - Other nuisances 1 1 Sanitary accommodation - insufficient 1 - unsuitable or defective — — not separate for sexes — — Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse (s.101) — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — Total 5 4 ♦Including those specified in sections 2, 3, 7, and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 30 3—HOME WORK NATURE OF WORK* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, Sec. 108 OUTWORK IN INFECTED PllEM ISER, Sec 109, 110- Lists received from Employers. Notice served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110), Prosecutions (Sections 109, 110) Twice in the year Once in the year Failing to keep or permit inspection of lists. Failing to send list. Lists.* Outworkers. † Lists. Outworkers.† Contractors Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, etc. (2) cleaning and washing Household linen Lace, lace curtains and nets Curtains and furniniture hangings Furniture and upholstery Electro plate File making Brass & brass articles Fur pulling Cables and chains Anchors & grapnels Cart gear Locks, latches & keys Umbrellas, etc. Artificial flowers . Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, &c. of buttons, Ac. Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Xmas crackers, stockings, &c. Textile weaving Total *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 81 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 181) at the end of the year Number, 1915. (1) (2) Bakehouses 5 Laundries 6 Other Trades 44 Total number of Workshops on Register 55 5.—OTHER MATTERS. Class. Number, 1915. (1) (2) Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Acts (s 133, 1901) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5,1901) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year - 82 ANNUAL REPORT OF THE SANITARY INSPECTOR. Ladies and Gentlemen, I beg to present to you my First Annual Report of the sanitary work carried out in the district during the year ending December 31st, 1915. Notwithstanding the abnormal times and the increasing difficulty in getting sanitary work carried out—especially structural work—a very satisfactory amount of sanitary repairs have been effected. House Drains.—Constant attention has been given to the sanitary condition of the surroundings to dwelling houses, and in this direction 20 drainage systems have been tested, 11 of which were found defective. The drains at 4 houses have been re-constructed or new provided, and 36 cleansed, trapped, ventilated, or repaired. Water Supply.—There are only a few houses in the outlying portions of the district which are not supplied with water from the main. They are dependent on a rainwater supply collected from the roofs of the buildings and stored in underground cement tanks. These are periodically inspected, and the owners called upon to cleanse them when necessary. In all the above cases the houses are situated a long distance from the mains. Food.—A regular inspection of the slaughterhouses, shops( and hawkers' carts, etc., is made, and in this connection about 801bs. of unsound fruit was surrendered during the year. Dairies and Cowsheds.—Regular inspection of the Dairies and Cowsheds in the district is made, primarily with a view to maintaining cleanliness of the premises, cattle, utensils, and operatives when milking, so as to ensure, as far as possible, a clean supply of milk. There has been much improvement in this direction during the past few years. 38 Factories and Workshops.—The number of Workshops and Workplaces registered in the district is 55. Of these, 7 are bakehouses, 2 of which are unoccupied. All receive periodic inspection. Dust Removal.—Owing to certain difficulties which have been experienced this year, a greater amount than usual of my time has been taken up in looking after the removal of house refuse. I am, Ladies and Gentlemen, Your obedient servant, Thos. Payne, Sanitary Inspector. TABULATED SUMMARY OF SANITARY WORK COMPLETED DURING THE YEAR 1915. Total number of visits paid ... ... ... ... 2040 Number of complaints received and investigated ... ... 119 Number of premises inspected ... ... ... ... 152 Number of nuisances discovered ... ... ... 58 Number of nuisances abated without report ... ... 50 ,, ,, after report ... ... ... 8 Preliminary notices served ... ... ... ... 44 Legal notices served ... ... ... ... ... 6 Notices followed by legal proceedings ... ... ... 0 Character of Work Done— Houses dealt with under the Housing of the Working Classes Acts ... ... ... ... ... ... 0 Houses inspected under the Housing and Town Planning Act 66 Houses repaired and cleansed generally ... ... ... 8 Ventilation of houses improved ... ... ... ... 2 Overcrowding abated ... ... ... ... ... 3 Defective roofs repaired ... ... ... ... 88 Houses under-pinned (damp proof course inserted) or damp walls remedied ... ... ... ... ... 82 Eaves guttering renewed or repaired ... ... ... 7 Water-closets renewed or repaired ... ... ... 6 Water-closets provided with water for flushing purposes ... 2 Privies or earth-closets re-constructed, improved or abolished 1 34 Houses supplied with water from the main 2 Water cisterns or tanks cleansed or covered 8 Yards of houses paved with impervious material 4 Paving of yards repaired 5 Floors of sculleries paved or repaired 1 Ashpits or dustbins provided 16 Additional w.c. provided 0 Houses at which drains were tested 20 Houses at which drains were found defective 12 Houses at which drains were re-constructed or new provided 4 Houses at which drains were cleansed, ventilated, trapped, or repaired 86 Number of drain tests in course of work done under the two previous headings 11 Houses at which inspection chambers in drains were provided 2 Stables provided with drainage 0 Premises at which animals improperly kept were removed 2 Number of inspections of food exposed for sale 152 Urinals cleansed or repaired 1 Smoke nuisances abated 0 Offensive accumulations removed 11 Piggeries repaired and improved 0 Infective houses disinfected and cleansed 90 Number of visits to infective houses 218 Number of visits to dairies and milkshops 98 Number of complaints as to uncleanliness and neglect of regulations 8 Number of visits to slaughterhouses 158 Number of complaints as to uncleauliness 2 Number of visits to bakehouses 26 Number of complaints as to uncleanliness 1 Manure pits provided or repaired 2 Unsound food destroyed—801bs. fruit. INDEX. page. Ages at Death 23 Appendices- Isolation Hospital 18—20 Tables I. to VI. 21—26 Factory and Workshop Act 27 — 31 Inspector of Nuisances Report 32—34 Bakehouses 14 Births 6, 7 Birth Bates 7 Causes of Death 8 Cerebro-Spinal Meningitis 9 Dairies, Cowsheds, etc 14 Deaths 7, 8 Diphtheria 9 Erysipelas 9 Factory and Workshops 27—31 Hospital, Isolation 18—20 Housing of the Working Classes Act 13 Illegitimate Births 6 Infantile Mortality 7 Infantile Summer Diarrhoea ... ... ... 10, 25 Infectious Disease 8—10 Isolation Hospital 18—20 Legal Proceedings 12 Medical Inspection of School Children 13 Piggeries 14 Population 5, 6 Preventive Measures 10—12 Puerperal Fever 9 Regulated Trades 14 Sale of Food and Drugs Act 14 Scarlet Fever 8 Schools 13 Slaughterhouses 14 Tables I. to VI. 21-26 Typhoid Fever 9 Water Courses 12 Zymotic Death Rate 8