Annual Report OF THE Medical Officer of health) FOR THE Penge Urban District, IN THE COUNTY OF KENT, FOR THE Year ending 31st December, 1902. Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Penge Urban District Council. Gentlemen, I have now the honour to present to you my report for the year ending December 31st, 1902. The principal features of the Vital Statistics for the year are as follows:— Total Population of all ages, Census of 1901 22,468 Number of Inhabited Houses, Census of 1901 3,811 Average number of Persons per House, Census of 1901 5,89 Population, estimated middle of 1902 22,822 Area of District in Acres 770 Density of Population per Acre 29.61 Birth Rate 20.8 Corrected Death Rate 12.5 Zymotic Death Rate 0.7 Infantile Mortality Rate (under one year) 140.75 Under 5 years. Death Rate per cent. 29.4 4 POPULATION. The Census was taken on the 31st of March, 1901, and shewed that the population of the district was 22,468, an increase of 2,093 since 1891. This population was accommodated in 3,811 inhabited houses, which gives an average of 5.89 persons per house. I estimate that the population in the middle of the year would be 22,822, and it is upon these figures that my statistics are based. The area of the District is 770 acres and the density of population 29.61 per acre. BIRTH RATE. The births during the year numbered 476, of which 232 were males and 244 females. This gives a birth rate of 20.8 per 1,000. DEATH RATE. The number of deaths registered in the Urban District of Penge during the twelve months was 250, and to these have to be added 37 which occurred in Public Institutions outside the district. The death rate for the year worked out on these figures is 10.9 per 1,000 for deaths registered in the district, but, with the number of deaths in Public Institutions added, the corrected death rate for the year is 12.5 per 1,000. Of these deaths 67 were under 1 year of age, giving an Infantile Mortality rate of 14075 per 1,000 of births registered. Eighty-five of the deaths occurred in children under 5 years of age, this being a mortality of 29.6 per cent, of the total number of deaths registered. 5 ZYMOTIC DEATH RATE. During the year, 19 deaths have been referred to the following Zymotic diseases :— Small-pox 3 Diphtheria 1 Croup 2 Enteric Fever 3 Influenza 7 16 This gives a Zymotic death rate of 0.7 per 1,000. INFECTIOUS DISEASES. The total number of Infectious Diseases notified during the year under the Infectious Disease Notification Act of 1889 was 352, and were as follows:— Disease. Treated at Home. Removed to Hospital. Total. Small-pox — 25 25 Diphtheria 8 9 17 Membranous Croup 1 — 1 Erysipelas 5 — 5 Scarlet Fever 16 58 74 Enteric Fever 6 5 11 Chicken-pox 219 — 219 255 97 352 6 INQUESTS. Twenty Inquests were held during the year. In connection with the outbreak of Smallpox in St. Hugh's Road, it was necessary to issue an order excluding scholars residing in this and neighbouring roads, from attending School. Although we have passed through a very trying time owing to the epidemic of Small-pox, it is very satisfactory to be able to draw attention to the very low death-rate of 12.5, as compared with 13.48 last year. It will be remembered that we had one case of Small-pox during the last few days of 1901, and it was decided that Chicken-pox should be added to the list of Notifiable Diseases for six months from January 4th, and this period was extended for another six months by resolution of the Council on June 2nd. Early in March I was instructed to visit all cases of Chicken-pox notified in the district, and in the discharge of this order visited over 200 children so notified, and have to thank the Medical practitioners of my district for the very kind help and assistance they gave me in carrying out this duty. The early cases of Small-pox caused us a vast amount of anxiety, and it often gave us many hours' work before we were able to make arrangements for the satisfactory removal of the patients; but when the temporary arrangements were made with the authorities of the Croydon and Wimbledon Joint Smallpox Hospital to take our cases, a great deal of this anxiety was removed. I am indeed relieved to know that this arrangement is now a permanent one. In the management of the small-pox cases, I believe I can claim that a great part of the success that attended our efforts to stay the spread of the disease was due to the promptness with which we acted in every case and to the early re-vaccination of all contacts, and I should like to thank the public vaccinator, Mr. Sidney Turner, for the 7 valuable help he gave us in this direction. The policy that was followed in the management of contacts varied ; in a few cases, where it appeared perfectly safe, contacts after being disinfected and re-vaccinated were allowed to go about, but in nearly all the cases the contacts were quarantined and compensated, and, personally, I have a feeling of satisfaction that all the money spent in this way was well invested, and helped to save a much larger expenditure. There is only one other point that needs any notice in this connection and that is, did I find the Notification of Chicken-pox, of any value ? I can certainly answer that I did, for in one case it helped me to trace the origin of the disease, and to detect two other cases, and in another outbreak it also was the means of doing good, for though an initial mistake was made in the diagnosis, we were able to keep the other inmates of the house under observation, and deal with them promptly when they became ill. During the early part of the year the extra work thrown upon Mr. Willett by the epidemic of Small-pox and other infectious disease prevented anything more than the ordinary routine work of the department being carried out, but owing to the wise action of the Council in appointing an Assistant Inspector in September last, it has since then been possible to make a good start in House-to-House Inspection, and I am pleased to be able to draw attention to the very satisfactory figures of the work that has been done in this branch. At present, we are only inspecting houses of the annual value of £30 and under, but it is to be hoped that when all these have been inspected we shall be able to tackle the other houses in the district. The Factory and Workshops Act, of 1901, came into force on the first of January, and has thrown extra work and responsibility on the Sanitary Department. I am able to report that we now have a register in conformity 8 with the requirements of the Act, and the workshops in the district have been visited; most of them have been measured up, and cards issued stating the maximum number of persons who may be employed therein. We have inspected the Bakehouses, and find that there are nine which come under the heading of " Underground Bakehouses." Upon these we propose to make a Special Report to enable the Council to decide as to the granting of a Certificate on the 1st January, 1904. All Slaughter Houses, Dairies, and Cowsheds have been frequently inspected during the year. The Common Lodging Houses, which were formerly under the London County Council, and the Houses let in lodgings, have been measured as to their cubic capacity, copies of the Bye-laws issued to every keeper, and new tickets given out showing how many persons may occupy each room. Registers showing these points are now kept. I am, Gentlemen, Your obedient Servant, HENRY J. PRANGLEY. Annual Report of the Sanitary Inspector for the Penge Urban District, in the COUNTY OF KENT, for the Year ending 31st December, 1902. Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Penge Urban District Council. Gentlemen, I herewith beg to place before you the report on the work done for the year ending the 31st December, 1902. Inconsequence of an outbreak of Small-pox, for several months in the early part of the year much of the ordinary routine work had to be set aside in order that proper supervision could be given in keeping persons under observation who had been in contact with Small-pox cases ; it being decided that these persons should be kept in quarantine for 14 days after the last exposure to infection. The houses and bedding were thoroughly disinfected, the paper stripped from walls, and all foul bedding not worth disinfecting was burned. Every day the persons in quarantine were visited, and directions given to prevent infection. Your Medical Officer and Sanitary Inspector made a House to House inspection of the infected area, and persuaded the people to be vaccinated. In this we were greatly helped by the Public Vaccinator, who promptly vaccinated the people. The measures taken were certainly efficacious, for, with one exception, every case of Small-pox came 12 from an entirely new source from without the district. This one case had been suffering from this disease some days before it was diagnosed, and had consequently spread the infection. INFECTIOUS DISEASES. The arrangement entered into with the Croydon Authority is much appreciated, whereby they, if it is convenient, remove cases occurring in this district to their hospital at Waddon. If they cannot conveniently do this, we remove the cases ourselves, and when this is done, surprise is often expressed, that a nurse does not accompany the ambulance. It would be much more satisfactory if the arrangement with the Hospital Authorities could be extended so as to include the removal of all cases by them. Disease. Treated at Home. Removed to Hospital. Total. Small-Pox — 25 25 Scarlet Fever 16 58 74 Diphtheria 8 9 17 Enteric Fever 6 5 II Erysipelas 5 — 5 Membranous Croup 1 — 1 Chicken-Pox 219 — 219 Totals 255 97 352 DISINFECTION. The difficulty pointed out last year is still experienced in getting the bedding and other articles disinfected expeditiously. No doubt hardship is experienced 13 by poor families in the District, who have to make shift until the bedding is returned, but under existing conditions this cannot be avoided. The matter of providing our own " disinfector " is before the Works and General Purposes Committee, and no doubt before long the Council will have its own "disinfector," when this difficulty will be surmounted. The following list shows the number of rooms fumigated, and of beds and other articles disinfected during the year. Number of rooms fumigated 137 ,, beds disinfected 132 „ blankets „ 188 ,, pillows ,, 279 ,, sheets ,, hi ,, miscellaneous articles 1642 Total 2489 HOUSE TO MOUSE INSPECTION. In October last Mr. Morley was appointed Assistant Inspector. He has been principally engaged in making a systematic House to House inspection. It will be seen that 248 houses have been inspected. In 169 houses defects were found, but it is only fair to say, that almost without exception these defects were of a minor character, consisting principally of dirty walls and ceilings, defective yard paving, guttering, etc. A uniform record is being kept, corresponding printed headings having been arranged both in the Report Book and Register; and in course of time it is hoped that a complete record will be obtained of all the houses in the District that are subject to inspection. 14 On page 12 a copy of this Register will be seen. Situation. No. of Houses Inspected. No. of Houses requiring Notices. St. Hugh's Road 108 96 Vineleigh Road 80 32 Heath Square 9 8 Wordsworth Road 51 33 Totals 248 169 HOUSES LET IN LODGINGS. The registered houses are all situated in Arpley Road. During the year 3 more have been registered, and 1 has lapsed, the total now being 21. Premises so registered are subject to greater supervision as to cleansing and overcrowding than other houses, but they require much watching to keep them up to the standard. COMMON LODGING HOUSES. These are also all situated in Arpley Road. During the past year the rooms have all been measured, new room tickets and apportionment sheets supplied. room tickets and apportionment sheets supplied. The registered number of lodgers remains the same as when they were under the supervision of the London County Council. Situation. No. of C. L. No. of Registered Houses. Rooms. No. of Lodgers. Arpley Road 7 33 80 15 BAKEHOUSES. There are 23 bakehouses in the District, 7 of which must not be used as such on and after the 1st of January, 1904, unless the Council are satisfied that they are " suitable for the purpose in regard to construction, light, ventilation, and in all other respects, and have given the owners a certificate of suitability." An underground bakehouse is to be deemed such if the surface of the floor is more than 3 feet below the surface of the adjoining ground. FACTORY AND WORKSHOP ACT, 1901. As required by the above-named Act a Register has been kept of the Factories and Workshops in the District, up to the present time 101 are entered therein. The workshops are gradually being measured as to their cubic capacity, and cards supplied indicating the number of persons whp may work therein. Means of escape in case of fire are also being considered where more than 40 persons are employed ; and when it is considered adequate certificates are granted. DAIRIES, COWSHEDS AND SLAUGHTER-HOUSES. These remain the same as last year, with the exception that an additional slaughter-house has been built which may be considered a model slaughter-house. One slaughter-house and premises adjoining have been entirely re-drained. The usual notices for cleansing, etc., have been served, and in every case complied with. 16 UNSOUND FOOD. Several trunks of fish have been brought by the retail dealers for opinion as to their being fit for human food. It is much to the dealers' credit that this voluntary procedure of having unsound fish destroyed is taken instead of selling them to the public, who would be the sufferers thereby. In one instance information was received that pork pies were sold in a condition unfit for human food. Your Inspector bought one, the last the vendor had, which was subsequently condemned by a Magistrate. A letter was written to the vendor cautioning him for this. PETROLEUM ACTS. Eight Premises are licensed under the Petroleum Acts. 7 samples of paraffin were purchased from various Oilshops in the District, and tested as to the temperature at which inflammable vapour was given off. All the samples were above the minimum (73 degrees Fahrenheit) prescribed by the Act. No. Sample. Flash Point. 1 Paraffin 82 0 F. 1A Testafas 100 0 F. 2 Paraffin 92 0 F. 3 (Best) 105 0 F. 4 „ 89 0 F. 5 Kerozine 106 0 F. 6 Paraffin 87 0 F. PROSECUTION. In only one case was it necessary to take proceedings before the Magistrates, which was for the recovery of costs incurred in relaying a drain under Section 41, Public Health Act, 1875, at Nos. 1, 2, and 3 Cornish Grove. The amount claimed was recovered, and costs were allowed. 17 The year has been a busy one. It will be seen that, in the table at the conclusion of this Report, 4,623 feet of stoneware glazed pipes have been laid. This has all stood the water test, and every foot was examined by your Inspector before the ground was allowed to be filled in. The notices and other clerical work consequent upon the house to house inspection has also been heavy. The office provided by the Council is much appreciated, and in conclusion I beg to thank the Officers of the Council for assistance so readily given whenever it has been required. I am, Gentlemen, Your obedient Servant, ALFRED J. WILLETT, Graduate Municipal and County Engineers Associate Sanitary Institute. 18 SUMMARY OF INSPECTIONS. Cases of infectious disease 352 Inspections through complaints received 226 House-to-House Inspections 248 Trades Inspections 256 Houses let in Lodgings Common Lodging Houses 462 Factories and Workshops 63 Re-inspections of works in hand 2,860 Total number of inspections 4,467 19 TABLE OF SANITARY IMPROVEMENTS. Number of Houses, Premises, &c., cleansed repaired, whitewashed, &c. 51 Roofs, Gutters, Rainwater pipes, &c., repaired 64 House Drains— Repaired, cleansed Rainwater pipes disconnected from drains 21 Stoneware syphon gullies provided 172 Ventilated 22 Houses provided with new drains 52 Inspection Chambers constructed 59 Aggregate length of 4 in. and 6 in. stoneware glazed pipes laid 4,623 ft. Water-closets— Repaired, &c. 20 Additional provided 2 Re-constructed 113 Soil pipes re-constructed 57 Ditto repaired and ventilated 24 Flushing apparatus renewed or repaired 88 Water Supply— Water supply to houses re-instated 19 Cisterns cleansed, repaired, or covered 58 Miscellaneous— Galvanized iron dust bins provided 46 Overcrowding in rooms abated 6 Yards to houses paved or amended 33 Forecourts 27 Removal of accumulation of dung, stagnant water, animal or other refuse 12 Receptacles for dung erected or improved 5 Animals removed, being improperly kept 4 Smoke nuisances abated 3 Other defects remedied 54 20 COPY OF REGISTER. House to House Inspection. Ref. No. Date of Inspection Situation of Premises Description of Premises Name of Occupier Name and Address of Owner or Agent No. of Rooms :— Living :— Sleeping:— No. of Inmates :— Adults, Male:— Female:— Children. Male Female:— Ages of Children, Male :— ,. „ Female:— W.C. Accommodation and Condition Condition of Flushing Apparatus Drainage :— Water Supply, if direct from Main Description of Cistern, if any Description of Ashpit or Dustbin Condition of Roof and Gutters Description and Condition of Pavement Nuisances from any other cause General Remarks Works required to be executed to remedy defects TABLE I. Vital Statistics of Whole District during 1902 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. Under 1 Year of Age. At all Ages. Number. Rate per 1.000 Births Registered Number. Rate.* Number Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1892 — 465 — - — 308 — — — — — — 1893 — 442 — - — 280 — — — — — — 1894 — 417 — — — 271 — — — — — — 1895 — 488 — — — 281 — — — — — — 1896 — 414 — — — 238 — — — — — — 1897 — 500 — — — 237 — — — — — — 1898 — 439 — — 2.77 — — — — — — 1899 — 465 — — — 289 — — — — — — 1900 — 481 — — — 256 — — — — — — 1901 22,468 457 20.3 60 131.29 271 12.0 — — 32 303 13.48 Averages for years 1892-1901 — 456.8 - - — 270.8 — — — — — — 1902 22,822 476 20.8 67 14075 250 10.9 — — 37 287 I2.5 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column n. 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. The "Public institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given in Table II. Area of District in Acres (exclusive of area covered by water) 770 Total population at all ages 22,468 Number of inhabited houses 3,811 Average number of persons per house 5.89 At Census of 1901. TABLE II. 1. II. III. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions the deaths in which have been distributed among the several localities in the District. (1.) Workhouse Infirmary, Croydon. (2.) Borough Hospital, Croydon. (3.) Rural Isolation Hospital, Croydon. (4). Small Pox Hospital, Cheam. TABLE III. Cases of Infectious Disease notified during the Year 1902. Notifiable Disease. Cases Notified in Whole District. No. of Cases Removed to Hospital. At Ages—Years. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25 25 to 65. 65 and upwards. Small-pox 25 — I 8 3 12 I 25 Cholera — — — — — — — — Diphtheria 17 — 6 5 3 3 9 Membranous Croup I — — 1 — — — — Erysipelas 5 — — — 1 3 i — Scarlet Fever ... 74 — 19 48 5 2 — 58 Typhus Fever ... — — — — — — — Enteric Fever ... 11 — — 2 4 5 — 5 Relapsing Fever — — — — — — — — Continued Fever — — — — — — — — Puerperal Fever — ... — — — — — — Plague... — — — — — — — — Chicken-pox 219 14 89 111 5 — — Totals 352 14 115 175 21 25 2 97 Isolation Hospitals Croydon Borough Hospital, Waddon. Croydon and Wimbledon Joint Small-Pox Hospital Cheam. TABLE IV. Causes of, and Ages at, Death during Year 1902. Causes of Death. Deaths in or belonging to Whole District at subjoined Ages. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 Small Pox 3 — — — — 2 1 Measles — — — — — — — Scarlet Fever — — — — — — — Whooping Cough — — — — — — — Diphtheria and Membranous Croup i — 1 — — — — Croup 2 — 1 1 — — — Fever Typhus — — — — ~~ — — Enteric 3 — — — i 2 — Other Continued — — — — — — — Epidemic Influenza 7 — — — I 2 4 Cholera — — — — — — — Plague — — — — — — — Diarrhoea 4 4 — — — — — Enteritis 2 2 — — — — — Puerperal Fever — — — — — — — Erysipelas — — — — — — — Other Septic Diseases — — — — — — — Phthisis 30 — — — 4 24 2 Other Tubercular Diseases 6 3 3 — — — — Cancer, Malignant Disease 17 — — — — ii 6 Bronchitis 32 8 2 — — 4 18 Pneumonia 16 4 5 — — 3 4 Pleurisy — — — — — — — Other Diseases of Respiratory Organs 2 1 — — — 1 — Alcoholism 6 — — — — 5 1 Cirrhosis of Liver Venerea Diseases 2 2 — — — — — Premature Birth 23 23 — — — — — Diseases and Accidents of Parturition 1 — — — — 1 — Heart Diseases 31 1 — — 1 18 11 Accidents 6 4 — — — — 2 Suicides 3 — — — — 2 1 All other causes 90 20 1 1 4 23 41 All Causes 287 72 13 2 11 98 91 Notes.—(a) The deaths of residents occurring beyond the limits of the district are included in this Table, and deaths of non-residents occurring in the district are excluded. See note on Table I. as to meaning of " Residents " and " Non-Residents." (b) Under the heading of "Diarrhoea" are included deaths certified as from Diarrhoea alone or in combination with some other cause of ill-defined nature ; and also deaths as certified from Epidemic Enteritis ; Zymotic Enteritis ; Epidemic Diarrhoea; Summer Diarrhoea ; Dysentery and Dysenteric Diarrhoea; Choleraic Diarrhoea, Cholera, Cholera Nostras (in the absence of Asiatic Cholera). Under the heading of " Enteritis " are included those certified as from Gastro-Enteritis, Muco-Enteritis and Gastric Catarrh ; unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term "Diarrhoea." Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter.