MAL 029 Maldens and Coombe URBAN DISTRICT COUNCIL. MEDICAL OFFICER'S REPORT 1895 TO THE URBAN DISTRICT COUNCIL OF THE MALDENS & COOMBE. New Maiden, Surrey, 20th February 1896. Mr. Chairman and Gentlemen, In presenting you ray report for the year 1895, I would remind you that this is ray first annual report since the enlargement of your district. Your combined district now consists of 3 wards, viz., Coombe, New Maiden and Old Maiden. It consists of 3,100 acres. It has a population of 5,621. It consists of 1,078 houses. The number of people per acre is 1.1. The number of inhabitants per house is 5.2. It is bounded on the North by Richmond Park, on the East by the Beverly Brook, on the West by the Kingston Borough, and on the South by the Hogg's Mill Stream or river. With reference to the population of Coombe: As parts were taken from other districts and added to yours, and I could not ascertain from previous census, the exact population of these portions, also finding it was absolutely necessary to have the exact population to enable me to reckon the birth rate, and death rate, I decided to take a census of Coombe myself. This involved a great deal of work, correspondence, and a little expense in postage, but the end justified the means. I wrote to, or visited every house in that Ward, and I should like to take this opportunity of thanking those householders who showed me so much courtesy in the matter. 4 The population turned out to be 1168. I am not able to give you any information as to Sanitary Work in the two newly added Wards before July 1st, when we became a combined district, but I have been enabled to obtain the births and deaths for the whole year. The number of births for your whole and combined district has been 113, giving a birth rate of 20.l per thousand, 53 were boys and 60 girls. 59 deaths have been registered, giving a death rate of 10.49 per thousand. Of these deaths 30 were males, and 29 females. I append a table showing how these are distributed in the different Wards, together with the acreage, population, persons per acre, and per house, and the birth and death rate. Wards Acres Population Person per Acre Houses Person per House Births Dths Birth rate Dth rate Coombe 1211 1168 .96 136 8.5 5 7 4.28 5.09 New Maiden 1046 3890 3.6 834 4.6 97 51 24.9 13.1 Old Maiden 843 563 .67 108 5.2 11 1 19.53 1.77 Totals 3100 5621 1078 113 59 You will see that your Ward, Old Maiden, has the extremely low death rate of 1.77 per thousand, a death rate that I have never for smallness before heard of. If you will kindly refer to the tables furnished by the Local Government Board, at the end of this report, you will see that of the 59 deaths, 15 were under the year, and 22 over 65 years of age. This is a great improvement on the previous year. The death rate for the 7 usual zymotic diseases was .1 per thousand, as against .5 in 1894. The death rate for Phthisis or Consumption, was .3 per thousand, as against .7 in 1894. As to diseases:— 11 deaths were due to Chest diseases, such as Pneumonia, Bronchitis and Pleurisy. Heart disease caused 4 deaths, being half the number of 1894. 8 deaths were due to diseases of the Brain and Nervous System, and 4 were caused by Cancer. Under the diseases Notification Act, I received during the year, 37 certificates. This number is ten less than in the year 1894, and 22 less than in 1893. This decrease shews the value of the act when in force. 5 These 37 certificates comprised, Scarlet Fever 8, as against 15 in 1894. These 8 cases of Scarlet Fever occured in 4 families. The first case occurring in March was a single case, caught out of the district, and brought to Sycamore Grove. Isolation was able to be carried out, and it soon got well, without producing others. The next case occurred in the Market Place in July. The origin of which was not able to be traced. The next 5 cases occurred in one family in Northcote Road. The origin was traced to a relation in London. Isolation was most difficult to carry out. Nevertheless the family took great pains to carry out all the directions given. The last case of Scarlet Fever arose on Kingston Hill or Coombe, and in due course recovered. Enteric Fever, two cases. One case occurred in the Market Place in January. No cause could be discovered. The drains and water supply were good. The other case occurred in Elm Grove in December and terminated in death. The drainage was overhauled and found satisfactory on the whole, but one drain was found blocked with grease, and one of the cisterns had not been cleaned out for two years. The water however, in the cistern used for drinking purposes was analysed and found good. The patient had been very much out of health, and had lived very much on oysters, but no information could be ascertained, where they were obtained, or as to their quality. Diphtheria, one case, being 13 less than in 1894. This occurred in a shop in the Market Place. The case was a sporadic one, no origin could be discovered, but the premises were dirty and badly kept. Erysipelas, one case. Measles, 26 cases, occurring in 16 families, 16 were primary and 10 secondary, or caught from the first 16. These occurred in New Maiden and Old Maiden at various times during the year. They were isolated, all precautions taken, and in due course recovered. During the year there have been a few cases of Chickenpox, and several cases of Whooping Cough. Influenza was very prevalent in January and February, in quite an epidemic form, and was followed by Tonsillitis in at least 33 per cent. Lately several cases have again occurred, so that we have not yet seen the end of our enemy. 6 Every succeeding year now your district is larger and your population increases, and more houses built, more need is felt for an Isolation Hospital. Several of these infectious cases would have been less in number, if the first case in a family could have been sent away. Your Board are I know full well, hoping and trying to get a share in the Tolworth Hospital, but as this still seems in the far distance, it would be well in the meantime, if you could take a cottage or make other provision, for a hospital of your own, which could be done at less expense to the ratepayers, now your district is so much larger. A great many would gladly pay any reasonable sum to send their friends into a well conducted hospital, and not incur the heavy expense, as well as that of nursing, at their own houses. These payments would materially lessen the expense of maintenance. With reference to the Notification diseases Act:— The medical men attending an infectious disease always notify the same, but the householders often neglect to do so. The public don't yet understand that a householder is as much required to notify an infectious disease as the doctor in attendance. I would suggest to you to adopt the "Infectious Disease Prevention Act" which gives us far more power to grapple with infectious diseases. The Kingston Rural Sanitary Authority adopted it in 1891, and it applied to Coombe and Maiden. New Maiden, however, has never done so. It would be very little expense to do so. The advantages are fully set out in a circular from the Local Government Board, dated November, 1890. 1 have had one case of overcrowding during the year, which was soon rectified, by which proceedings became unnecessary. I now come to the Sanitary work done during the year:— Mr. Davison reports that 34 new houses have been built. 22 nuisances abated, 15 cesspools done away with, one private road reformed, made up, and footpath kerbed, and the ditch from Mr. Andrews to the Parish Church on the east side of Coombe Road filled up. I have myself made 209 visits besides visiting the houses at Coombe, when taking the census of that ward. Water supply:— Cisterns have often been found dirtv, and wanting 7 cleaning out. This should often be done. Invariably when water is found to be deficient in quality, dirty cisterns have been found to be the fault. This is all the more reason that we should have a constant instead of intermittent supply, which we have at present. Of course in frosty weather, such as we had in the early part of last year, water may be imperfectly filtered, but as a rule the water supply is excellent. I have been over the water works myself and know full well the amount of trouble the water companies take to produce a pure filtered water, so essential to health. In 7 cases I found closets supplied direct from cisterns, and I have found many closets deficient in water supply. Flush cisterns often get out of order and unless the tenants take interest in looking after them, and in helping the landlords to keep them in order, the latter often are blamed, when the fault lies with the occupier entirely. In January, 1895, Beaconsfield Terrace was in a bad state as to the drainage and water supply, and the houses would not let. The property changed hands. The present owner carried out all suggestions. The drainage and water supply are now good, and all the houses are let. In South View Villas, very many defects were pointed out to your Board. The owner after some considerable delay, carried out all the directions given. Several defects in drainage and water supply in South Lane were found out. These were rectified as far as possible, but all these houses sadly want a good sewer along this road, which will be accomplished, when the Old Maiden Sewerage Scheme is carried out. The Sanitary conditions of houses in your district improve every year. A great many defects as to drainage continually crop up and are rectified. It is a great pity that all houses are not connected with our sewers. We may be pretty certain that the cesspools of these houses, not connected with our Sewerage System, overflow indirectly into our road drains and cause a nuisance. The houses in Kingston Vale are still in a very unsatisfactory state, and several sanitary defects, which I brought to your notice, have been remedied. These houses drain into cesspools of limited capacity, and these cesspools have often to be emptied. This cannot be rectified till the contemplated Sewage Scheme of your Cooiube Ward is completed, 8 I have inspected the whole of the houses in Kingston Vale twice since July. The Bake-houses, Cowsheds and Dairies and Slaughter houses have been visited and inspected at frequent intervals. As a whole they are clean and well kept, though now and then one or two require extra looking after. Your sewage works have been much improved this year. The effluent has been analysed from time to time and found satisfactory. I have had three complaints of nuisances of pigs during the year, but these have been rectified before proceedings were taken. I have the honour to remain Yours faithfully, EDWIN CHILD. F. S. Merryweather, Esq., J.P. TABLE OF DEATHS A During the Year 1895, in the Maidens and Coombe Urban Sanitary District, classified according to Diseases, Ages and Localities. NAME OF LOCALITY. Mortality from All Causes, at Subjoined Agen. Mortality from Subjoined Causes, Distinguishing Deaths of Children under Five Years 'of Age. At all Ages. Under 1 year. 1 and under 5. 5 and under 15. 16 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small-pox. Scarlatina. Diphtheria. Membraneous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentry. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia & Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Coombe Ward 7 1 4 2 Under 5 5 upwds 1 1 5 7 New Maiden Ward 51 14 1 2 2 12 20 Under 5 2 1 1 11 15 5 upwds 1 2 9 2 2 20 36 Old Maiden Ward 1 1 Under 5 1 1 5 upwds Totals 59 15 1 2 3 16 22 Under 5 2 1 1 12 16 5 upwds 1 2 9 3 3 25 43 Area and Population of the District or Division to which this return relates. Area in Acres, 3,100 Population in 1891, 5,056 Death Rates General, 10.49 per 1,000 of population. Infants (under one year of age), 132.7 per 1,000 of Registered Births. State here whether "Notification of Infectious Disease" is compulsory in the District.—Yes. Since when?—1891. The Isolation Hospital is situated at Tolworth. Available for Coombe and Old Maiden Wards only. New Maiden Ward does not yet participate in the use of the Isolation Hospital. TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, B Coming to the knowledge of the Medical Officer of Health, during the year 1895, in the Urban Sanitary District of the Maidens and Coombe, classified according to Diseases and Ages. NAME OF LOCALITY. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their Homes for Treatment in Isolation Ward of Kingston Infirmary. Census 1801. Estimated to middle of 894. Small-pox. Scarlatina. Diphtheria. Membraneous Croup. Fevers. Cholera. Erysipelas Measles. Small-pox. Scarlatina. Diphtheria. Membraneous Croup. Fevers. Cholera. Erysipelas. Measles Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Coombe Ward 1091 1168 5 Under 5 5 upwds 1 New Maiden Ward 3437 3890 97 Under 5 3 13 5 upwds 4 1 2 1 12 Old Maiden Ward 528 563 11 Under 5 5 upwds Totals 5256 5621 113 Under 5 3 13 5 upwds 5 1 2 1 12