Mal 030 THE MAUDENS AND COOMBE URBAN DISTRICT COUNCIL MEDICAL OFFICER'S REPORT, 1903. New Malden: Printed by F. J. Hawkins, Market Place. TO THE URBAN DISTRICT COUNCIL OF THE MALDENS AND COOMBE. New Malden, January, 1904. Mr. Chairman and Gentlemen, I beg to lay before you my Eighth Annual Report for The Maidens and Coombe Urban District for the year 1903 The Births and Deaths registered were as follows:— BIRTHS. Males 96 Females 99 Total 195 DEATHS. Males 36 Females 31 Total 67 The total deaths occurring in the District were 67—seven of these occurred in individuals who were visiting the district, six amongst resident inmates of Public Institutions, viz., two of scarlet fever at Cuddington and four at the Kingston Union Workhouse Infirmary, making the net total number of deaths for the district 66, and a death rate of 9.1 per 1,000. Deducting three cases of suicide and two deaths from accident the net death rate from disease is 8.4 per 1,000. 4 This is the lowest death rate since 1896, which was 7.5 per 1,000 Ninety-three houses have been built and occupied, and 39 partially built during the year. The estimated population for the whole district, to the middle of 1904, is 7,199. Maiden has sustained its reputation as one of the healthiest districts in the County of Surrey. Fifty feet above sea level, protected from the malarial influence of the Thames Valley by the high grounds of Coombe, and swept by the fresh breezes from the Downs, it presents an ideal spot to the builder, who seems willing to profit by its advantages. The population of the whole district in 1895, when the three districts were combined, was found, by a house to house census, to be 5,621. 1895 1903 Coombe 1168 1202 Old Maiden 563 586 New Maiden 3890 5411 5621 7199 Deaths occurred as follows:— Under 1 year Whooping Cough 3 „ Enteritis 4 „ Heart Disease 2 „ Convulsions 2 „ Premature Birth 1 „ Scarlet Fever 1 „ Other causes 2 15 Under 5 years—Scarlet Fever 1 „ Pneumonia 1 „ Tubercular Disease 2 „ Dentition 1 5 Amongst other causes: Malignant Disease, 2; Phthisis, 6; Heart Disease, 10; Accidents, 2; Suicide, 3. Inquests were held on 10 cases. Verdict returned: Heart Disease, 3; Suicide, 3; Accident, 2; Natural Causes, 2. 5 name of localities. Acres. Population. Houses. Births. Deaths. Birth Rate per 1,000. Death Rate per 1,000. Coombe 1201 1202 136 6 3 5.0 2.5 Old Maiden 843 586 110 7 3 11.9 5.1 New Maiden 1056 5411 1584 182 60 33.6 11.7 Total 3100 7.99 1830 195 66 27.1 9.1 Death rate during the last eight years:— 1896 7.5 per 1,000 1897 10.3 „ „ 1898 9.9 „ „ 1899 9.2 „ „ 1900 9.3 „ „ 1901 10.2 „ „ 1902 10.5 „ „ 1903 giving an average of 9.5 per 1,000. 9.1 „ „ CASES NOTIFIED UNDER THE INFECTIOUS DISEASES ACT. Seventy-seven cases were notified during the year as follows :— Scariet Fever. Measles, Diptheria. Erysipelas, Typhoid Coombe 0 0 0 0 0 Old Maiden 0 13 0 1 0 New Maiden 38 16 2 6 1 38 29 2 7 1 6 Scarlet Fever 38 Diphtheria 2 Measles 29 Erysipelas 7 Enteric Fever 1 Total 77 SCARLET FEVER. The 38 cases were distributed as follows:— Coombe 0 Old Maiden 0 New Maiden 38 No case was notified either in Coombe or Old Maiden. The 38 cases occurred in New Maiden. Last year 29 cases were notified in New Maiden, 12 in Old Maiden, and 1 in Coombe. Although there are 8 cases less than last year in the whole district, New Maiden has 9 cases more. Thirty-five were sent to the Isolation Hospitals. Owing to want of room at Tolworth 13 cases were placed at Cuddington—Epsom Rural Hospital—and three at their own homes. Two cases sent to Cuddington proved fatal. Eleven cases were notified in July: 1 came from the North of London, 2 atttended school in an adjoining district, and 7 attended our National Schools, contracting the disease from a mild case which had not been recognised by the parents, and so sent to school when in a peeling condition. Fortunately the Master of the School discovered the peeling, and sent the boy to me. He was immediately isolated, and the schoolroom thoroughly disinfected. During August, September, and October 14 cases occurred. These were certainly not due to imperfect house disinfection, for of the total number—38—in one house there were 5 cases, in one 3, in one 2, and in 28 a single case in each. I drew attention last year to two cases contracted from a returned case from a London Asylum Board Hospital, with purulent discharge from nose and ears. I have this year to report two instances of contagion from returned cases in our own district. One of the five cases in one house, notified on July 14th, was sent to Tolworth Isolation Hospital. As this Hospital had no bed vacant, the case was sent on to Cuddington—Epsom Rural Isolation Hospital. The house in which this case occurred was thoroughly disinfected, the mother and three other children going so the seaside for change. 7 On September 4th and 5th the family returned from the seaside and the child from the Hospital. Two days afterwards the mother and three other children contracted the disease. The Medical Officer of Health of the seaside town from which the family had just returned kindly inspected the house at which they had resided, and investigated the case for me. He reported, "No case of scarlet fever here; can find no cause for the outbreak." The child returned from the Hospital had a slight ear discharge, which certainly seemed, in this case, the only cause of contagion. Then, again, on November 25th, two cases occurred in Northcote Road. On July 4th a child from this house was sent to the Hospital, and returned in September. In October the child complained of deafness. The ears were syringed, but no discharge discovered. On November 24th his two brothers contracted the disease, and his mother informed me he had had periodical discharge from his nose, No other cause could be discovered. We have, therefore, six cases due to contagion from returned cases. I do not think this was due to want of care by the Hospital authorities, but rather to the length of time these discharges may prove contagious. It points out the necessity of every Isolation Hospital having a Convalescent Ward isolated from the main building, that these cases may not be sent to their homes while still being in a contagious condition. Hospital treatment is becoming so costly that the question must be settled in the near future, whether this method, or the old one of home isolation, proves the less expensive. DIPHTHERIA. Coombe 0 Old Maiden 0 New Maiden 2 Two cases were reported in New Maiden, one in January and one in November, the latter certainly due to old and worn out drainage, which has since been renewed. This is a convenient occasion, once more, to call the attention of all owners of property, whose drainage was laid down ten years or more ago. It was then not the custom to lay the pipes on concrete, the joints were not properly cemented, and pipes of too large a diameter were used, which, of necessity, only allowed half the capacity of the pipe to be flushed, the other portion becoming foul after long usage. MEASLES. Twenty-nine cases were notified: Coombe 0 Old Maiden 13 New Maiden 16 of very mild type, occurring in the first three months of the year. ERYSIPELAS. Old Maiden 1 New Maiden 6 8 TYPHOID. One case was reported in November. A man who had been six weeks away at work in another district, the disease appearing four days after his return to New Maiden. SMALL-POX. Although we have not had a single case, we have had the risk from contact with other districts. On the morning of 9th of May, I received notice from the Medical Officer of Health for Battersea, that a resident in New Maiden had been in contact with a Small-pox patient. By 12 (mid-day) he, his family, and lodger were all vaccinated and in quarantine. On the 29th they were released, all well, the house disinfected, and the clothes the "contact" was wearing burnt. TOLWORTH ISOLATION HOSPITAL. Thirty-eight cases treated: Scarlet Fever 22 „ 13 (Sent to Cuddington, as no room at Tolworth). Diphtheria 2 Typhoid 1 38 During the year the Council have taken into serious consideration the condition of the Sewage Outfall Works. In 1902 I reported, "There are five acres of land used for irrigation by the side of the Hogg's Mill. The owner of the mill lower down this stream has lately asserted his legal right to dam back the river as high as the topmost level of the banks, which renders this low-lying land water-logged and useless for the purposes of purification." The authorities interested are taking steps to have this so-called right cancelled, but the Council, recognising that this water-logging does, and will, render a large proportion of the land, hitherto used for sewage irrigation, useless, and also preparing for a largely increasing population in the near future, have instructed the well-known Sanitary Engineer, Mr. Midgley Taylor, to report and advise them how best to provide for the effectual treatment of a much larger quantity of sewage than is at present treated at our works. This will entail not only increased plant for raising the liquid at the 9 Sewage Works, but a fresh area of land for sewage treatment, and alteration in our present system of the main drainage, to enable the mains to carry off a sufficient quantity of sewage and prevent surcharging and flooding of the lower levels, as has taken place on one or two occasions during the year. COWSHEDS AND DAIRIES. Last year five farms supplied milk to the district. One farm during the year moved over the boundary into the Croydon district. This year our supply comes from four farms within the district, and from Croydon, Cheam, Kingston, Raynes Park, and Railwayborne milk from without the district. The care of the sheds is, on the whole, satisfactory. The cows are all healthy and well fed, but there is still slackness in detail of cleanliness that one would like to see removed. The subject of pure milk is so important that one must refer to it again and again. For my own part, I do not think that the dairy farmer who supplies milk straight from his cows to the consumer recognises the advantages of his position. The contamination of railway-borne milk is well known. When it starts from a far-off farm, the farmer thinks it necessary to add a little preservative, to make it keep on the journey. On the railway it is exposed to every kind of contamination and adulteration, natural and artificial. When at last it arrives at the retailer's milk shop, he thinks it necessary to add still a little more preservative, " for fear it should go wrong." The result is that neither the producer or retailer knows how much is used, and so the consumer has to swallow an unknown quantity. Coming, as I did, seven years ago from a strictly rural district, I have been struck by the effect the preservative used in milk has upon the infant, and even on the adult. I feel sure that a large number of deaths registered under enteritis and other infantile complaints, is due directly to the use of preservatives; at any rate, I never remember to have met with similar cases in the country; and further, some of the infantile rashes we meet with, so like scarlet fever as even to make the diagnosis of that disease difficult, are undoubtedly caused by these substances. If the public, and the dairy farmer selling milk directly to the consumer, would only recognise that the milk with the least chance of contamination is that taken straight from the cow to the consumer, and, therefore, it should be possible for the consumer to receive a milk pure and unadulterated. The Woking epidemic, caused by milk from cows suffering from that well-known disease garget, should make the isolation of all cows suffering from any inflammatory disease of like character not only a common, but imperative custom. I should like to see the whole of our milk supplied by cows kept in our own district. In this the public can assist, in a great measure, by consuming only milk that is produced in this way. 10 The milk shops have always been inspected regularly, and found clean and in good sanitary condition, and all the necessary alterations and improvements have been carried out. SANITARY INSPECTOR'S REPORT. Tht late Sanitary Inspector, Mr. Simmons, was appointed, early in the year, Surveyor to our District, and Mr. A. W. Hobbs, from the Epsom Rural District, succeeded him as Sanitary Inspector. It speaks well for the selection of these candidates by the Council, that although these gentlemen were not qualified when appointed, they subsequently both succeeded in obtaining the necessary qualifications. I have assisted Mr. Hobbs in the inspection of various houses and drainage. I herewith append their detailed Report of the Sanitary improvements carried out during his own and Mr. Simmons' regime, from which I feel satisfied Mr. Hobbs will prove himself a zealous and efficient officer to the Council. I have the honour to be, Mr. Chairman and Gentlemen, Yours faithfully, RASHELL DAVISON, m.d., m.r.c.s., eng., Medical Officer of Health.. 11 New Malden, 20th January, 1904. Rashell Davison, Esq., m.d., Medical Officer of Health, Maidens and Coombe Urban District Council. Dear Sir, I have pleasure in submitting to you a Report showing the inspections of premises made within this District by my predecessor, Mr. T. B. Simmons, and myself, the nuisances found, and the means taken for abating same during the year ending 31st December, 1903. SUMMARY. Inspections made 297 Notices served 103 Houses disinfected 77 Complaints received 14 Cesspools abolished 13 Drainage of houses recon structed and connected with sewer. COOMBE. The drainage of five houses on Kingston Hill, viz:— ''Ladder Stile," "Burches Lodge," "Coombe Lodge," "Fairlight," and "Coombe Bank," were found to be defective, being drained by means of cesspools. The drainage of these premises was reconstructed and connected with the main sewer, and the cesspools were done away with. Choked drains- One notice was served to unstop and cleanse choked drains at "Fairlight," Kingston Hill. House in filthy condition and injurious to health. Notice was served with respect to a house in Kingston Vale requiring the owner to cleanse the walls, ceilings and floors, as they were in a filthy condition, and to pave the yard at rear of house with concrete. W.C. cisterns without sufficient water supply. The W.C. cistern to Bugler's Cottages, Kingston Hill, was found to be without adequate water supply. The cistern was repaired and now provides a good flush to the W.C. pan. 12 Premises drained and connected to the Main Sewer. NEW MALDEN. Two notices were served to reconstruct drainage of two "houses in Acacia Grove and connect the same with the main sewer. These premises were drained by means of cesspools, which have now been cleansed and filled in with dry earth. Cesspool. Burden's Cottages, Kingston Road. The drains of these cottages were connected with the sewer some years ago, but the cesspool which was formerly used for the drainage of these premises was never emptied and cleansed, and so became a nuisance. The cesspool has now been emptied, cleansed and filled in. Drains defective and relaid. Notices were served in respect of the defective drainage of the following places, and all the drains were taken up and re-laid, viz., 1, Wellington Villas, Burlington Road; Coombefields, Maiden Road; 1, Beaconsfield Villas, Kingston Road; 1, Acacia Grove; 9, 10, 11, St. John's Road; Maiden College; 1, 2, 3, 4, 5, 6, and 7, Maskell's Cottages, Kingston Road. The combined drain at the rear of Maskell's Cottages which takes the drainage of all these houses was found to be defective. This has now been relaid by the Council. Choked drains. Nine notices were served to unstop and cleanse drains which were choked in Queen's Road, Roberts Road, Lime Cottages, Kingston Road; and Cleveland Road. Manure accumulations and vegetable garbage. Ten notices for the periodical removal of manure and vegetable garbage had to be served owing to the nuisances arising from collections of such matter in the Market Place, Maiden Road and the Kingston Road. Drains defective and repaired. Notices were served to repair defective drains at the following places, viz., St. Helliers, Penrith Road; 1, 3, and 5, St. John's Road. Unhealthy Houses, no concrete under ground floors. In consequence of the houses being in an unhealthy condition owing to the dampness of the soil under the ground floors, three notices were served to lay concrete 6 ins. thick under all such floors at the following houses, viz., 1 and 2, Lime Cottages, Kingston Road; 1, Beaconsfield Villas, Kingston Road; and 1, The Oaklands, Acacia Grove. Houses in filthy condition injurious to health, cleansed. Two notices were served to cleanse the walls, ceilings and floors of rooms at 10 and 11, St. John's Road, as they were in a filthy condition. 13 Stables drained and connected to sewer. Three notices were served to drain undrained stables and connect same with the sewer, viz., Stable in the Fire Station Yard; Bell's Stable in Buzwell's Yard, Grafton Road; and the stable at the rear of Argyle Cottage, Acacia Grove. Yards and passages drained and paved. Notice was served to pave and drain the yard and the passage leading to same from the Maiden Road, at a Dairy in Market Place. Gullies defective and replaced by new ones. New stoneware gullies, to replace defective ones, were provided at the following premises; Burden's Cottages, Kingston Road; 6, Avenue Road; 1 to 7, Maskell's Cottages, Kingston Road; 1 to 4, The Flats, Gloucester Road; 1, Devonshire Villas, Lime Grove; and 4, St. John's Road. Difective W.C.pansand traps. New W.C. pans and traps (L.C.C. straight back pattern) have been provided at the following houses to replace defective long hopper pans and traps, viz., 1, 2, 3, and 4, Oak Cottages, Kingston Road; 2, California Road; Prince of Wales P.H.; 6, 7 and 8, Avenue Road; 1 to 7, Maskell's Cottages; 3, The Flats, Gloucester Road; 1, 2 and 4, Bailey's Cottages, St. John's Road; and 1, 3, 6, 8, 9, 10 and n, St. John's Road. W.C. cisterns repaired and provided with adequate water supply. The cisterns to the W.C.'s at the following houses were found to be defective and were repaired, and now provide an adequate supply of water for flushing purposes, viz., 1 to 7, Maskell's Cottages; 3, Burden's Cottages, Kingston Road; Prince of Wales P.H.; 6, Dickerage Lane; 3 and 4, The Flats, Gloucester Road; Three houses in Kingston Road; 2 and 4, Bailey's Cottages, St. John's Road; 2, 5, and 8, St. John's Road. Overcrowding Two cases of overcrowding occured in Wellington Road, and were abated; in the one case by the subtenants leaving, and in the other case by the whole family, 14 in number, leaving the district. I am pleased to state, after making many inspections of suspected ;ases, this district is free from houses in an overcrowded condition. House to house inspections are being made of the smaller houses inhabited principally by the working classes, at the Norbiton Common end of New Maiden, also in Queen's Road, George Road, and Albert Road. Sanitary Dustbins provided 28 Defective gutters repaired 5 Ditches cleansed 2 14 OLD MALDEN. Drainage of houses connected with the Main Sewer. The drainage of 1 to 8, Idmiston Square, Motspur Park Farm Lodge, and Fulbrook's Lodge was reconstructed and the drains were connected with the public sewer. The cesspools which were previously in use were cleansed and abolished. Notice was served to reconstruct the drainage of the Plough Inn and connect the drains with the sewer, and the work of so doing has just been begun. House in dirty condition. The walls and ceilings of rooms at 6, Idmiston Square, being in such a state as to be injurious to health notice was served to cleanse the same. NEW BYE-LAWS. The coming into force of the revised Bye-laws which I hope will take place within the next few months, will greatly assist me with regard to certain nuisances which I am at present unable to properly deal with. I trust it will not be long before the Council adopts Part 3 of the Public Health Act Amendment Act, 1890, as this would enable me to deal with certain nuisances over which at present I have no control. I am, Dear Sir, Yours faithfully, ALFRED W. HOBBS, C.S.I., Sanitary Inspector. 15 Table I.— Vital Statistics of Whole District during 1903 and Previous Years. Name of District—THE MALDENS AND COOMBE. 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 Residents registered in Public Institutions beyond the District. Net 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 1895 5621 113 20.1 15 132.7 59 10.49 ... ... 59 10.49 1896 5698 122 21.4 12 98 43 7.5 2 ... 43 7.5 1897 5728 127 21.8 4 31 60 10.4 ... ... 60 10.4 1898 6047 138 23 22 160 60 9.9 ... ... 60 9.9 1899 6180 130 22 16 129 57 9.2 2 ... 57 9.2 1900 6243 129 22 11 80 66 10.9 ... ... 66 10.9 1901 6322 146 23.1 18 123 70 11.1 5 ... 70 11.1 1902 6647 170 25.7 18 106 73 10.5 ... ... 70 10.5 Average for years 1895-1902. 6061 134 22.4 13 108 61 10.0 1.1 ... 61 10 1903 7199 195 27.1 15 77 67 9-3 ... 4 66 9.1 Table II.-—Vital Statistics of separate Localities in 1903 and previous years in the Maidens and Coombe Urban District Year. The Maldens & Coombe New Malden. Old Malden. Coombe. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all ages Deaths under i year. 1895 5621 "3 59 15 389° 97 51 14 563 11 1 i 1168 5 7 1896 5698 122 43 12 3957 97 30 10 565 11 1 1170 *4 10 2 00 5728 127 60 4 3981 iii 50 4 565 3 1 "74 !3 9 1898 6047 60 22 4299 119 52 20 569 8 4 1181 ii 4 2 I§99 6180 130 57 16 4422 112 46 16 574 6 3 1184 12 8 i900 6243 129 66 11 4485 118 55 11 575 4 3 1183 7 8 i i90i 6322 146 70 18 4551 126 62 16 576 6 6 2 1195 14 2 1902 6647 170 73 18 4866 151 64 18 582 9 3 H99 10 6 Averages of Years 1895 :o 1902. 6061 I34 61 !3 4306 Il6 51 H 571 7 27 4 1180 io-8 6-8 •6 1903 7199 195 67 r5 5411 182 61 !3 586 7 3 1202 6 3 2 17 Table III.—Cases of Infectious Disease notified during the Year 1903, in the Maidens and Coombe Urban District. 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. Under 1 year. 1 to 5. 5 to 15. 15 to 25 25 to 65. 65 and upwards New Maiden. Old Maiden. Coombe. New Maiden. Old Maiden. Coombe. Diphtheria 2 ... 1 ... 1 ... ... 2 ... ... 2 ... ... Erysipelas 7 ... ... ... ... 7 ... 6 1 ... ... ... ... Scarlet Fever 38 ... 6 30 1 1 ... 38 ... ... 35 ... ... Enteric Fever 1 ... ... ... 1 ... ... 1 ... ... 1 ... ... Measles 29 ... 10 18 1 ... ... 16 13 ... ... ... ... Totals 77 ... 17 48 4 8 ... 63 14 ... 38 ... ... Tolworth Isolation Hospital is available for all infectious Cases. 18 Table IV.—Causes of, and Ages at, Death during year 1903, in the Maidens and Coombe Urban District. Causes of Death. Deaths In whole District at subjoined ages. Deaths in Localities at all Ages. Deaths in Public Institutions. All Ages. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Coombe. Old Maiden. New Maiden. Scarlet Fever 2 ... 1 1 ... ... ... Whooping-cough 3 3 ... ... ... ... ... Epidemic influenza 1 ... ... ... ... ... 1 Diarrhoea 2 ... ... ... ... 1 1 Enteritis 4 4 ... ... ... ... ... Phthisis 6 ... ... ... 1 5 ... Other tubercular diseases 2 ... 2 ... ... ... ... Cancer, malignant disease 2 ... ... ... ... 1 1 Bronchitis 2 ... ... ... ... 1 1 Pneumonia 2 ... 1 ... 1 ... ... Alcoholism 1 ... ... ... ... 1 ... Cirrhosis of liver Premature birth 1 1 ... ... ... ... ... Heart diseases 10 2 ... ... ... 6 2 Accidents 2 ... ... ... ... 1 1 Suicides 3 ... ... ... 1 2 ... Aneurism of Aorta 2 ... ... ... ... ... 2 All other causes 22 5 1 3 3 2 8 All causes 67 15 5 4 6 20 17 RASHELL DAVISON, m.d., m.r.c.s., eng. Medical Officer of Health.