PEN 2 Annual Report OF THE Medical Officer of Health FOR THE Penge Urban District, IN THE COUNTY OF KENT, FOR THE Year ending 31st December, 1903. 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, 1903. 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 1903 22,965 Area of District in Acres 770 Density of Population per Acre 29.8 Birth Rate 20.7 Corrected Death Rate 10.9 Zymotic Death Rate 0.69 Infantile Mortality Rate (under one year) 117.64 Under 5 years. Death Rate per cent 27.4 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,og3 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 22,965, and it is upon these figures that my statistics are based. The area of the District is 770 acres and the density of population 29.8 per acre. BIRTH RATE. The births during the year numbered 476, of which 239 were males and 237 females. This gives a birth rate of 20.7 per 1,000. DEATH RATE. The number of deaths registered in the Urban District of Penge during the twelve months was 214, 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 9.3 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 10.9 per r,ooo. Of these deaths 56 were under 1 year of age, giving an Infantile Mortality rate of 117.64 per 1,000 of births registered. 5 This death rate of 10.9 compares very favourably with 12.5 for 1902 and 13.48 for 1901, the only two years for which I am able to give returns. It is a source of great satisfaction to my department to be able to make such a satisfactory report, and though one must not forget that it has been a comparatively healthy year everywhere, yet these low figures are a guarantee that the sanitary and healthy condition of Penge is being maintained. The Infantile Mortality also shows an improvement: 117.64 this year, as against 140.75 in 1902 and 131.29 in 1901. Sixty-nine of the deaths occurred in children under 5 years of age, this being a mortality of 27.4 per cent, of the total number of deaths registered. ZYMOTIC DEATH RATE. During the year, 16 deaths have been referred to the following Zymotic diseases:— Measles 5 Diphtheria 3 Scarlet Fever 1 Influenza 3 Whooping Cough 4 16 This gives a Zymotic death rate of 0.69 per 1,000, but if the three cases of Influenza are omitted, it only amounts to 0.56 per 1,000, and in studying the table above it is satisfactory to note that not a single case of death from Typhoid is included. 6 INFECTIOUS DISEASES. The total number of Infectious Diseases notified during the year under the Infectious Disease Notification Act of 1889 was 71. The number of cases notified shews a great decrease from the 352 of 1902, but that year , included 219 notifications of Chicken-Pox. However, leaving out Chicken-Pox, the other diseases this year only amount to 69, as against 133 in 1902, and were as follows:— Disease. Treated at Home. Removed to Hospital. Total. Diphtheria 12 13 25 Erysipelas 11 - 11 Scarlet Fever 6 24 30 Enteric Fever 2 - 2 *Chicken-pox 2 - 2 Puerperal Fever 1 - I 34 37 71 * Ceased on January 4th, 1903, to be an infectious disease to which the Notification Act applies. SMALL-POX. It is satisfactory to note that not a single case of Small-pox has arisen, but we had one nasty experience, which, however, turned out well. A tramp who had passed two nights in one of the Common Lodging Houses in Arpley Road, developed the disease, evidently while still there, but travelled on to Croydon, where the disease was recognised, and the man isolated. I thought this a justifiable case for the quarantine of the other inmates of the Common 7 Lodging House, and within the next two days we were enabled to find all who had been in contact with the diseased man, and not only did we get them all vaccinated, but we kept them in quarantine for fourteen days. These men were all of the "tramp" class, and I contend that our action in quarantining them was necessary to prevent them spreading the disease, for without quarantine it would have been quite impossible to disinfect them or their clothing. The tramp who developed the disease had been in several lodging-houses about London during the previous days, and is another instance of the danger that accompanies this class of individual—a danger not only to himself, but to everyone else as well. It has been positively proved that in 100 out of 138 towns, the "tramp" was responsible for introducing Small-pox. Surely the time is ripe for some legislation to obtain greater control, if not the suppression, of the large number of men and women who lead this nomadic life. SCARLET FEVER. There were 30 cases of Scarlet Fever notified, as against 74 in the previous year; one of them died. I am glad to note that 24 of these 30 cases were removed to hospital, a step which I am certain is for the good of the individual removed, as it is for friends and neighbours of the diseased person. DIPHTHERIA. Diphtheria gives 25 notifications, as against 17 the previous year, an increase of 8. Of this number only 13 were removed to hospital. 8 TYPHOID FEVER. Two Cases only of Typhoid Fever were notified, as against 11 last year, and neither of them died. DISINFECTION. My department has been very zealous in the carrying out of the necessary disinfection after all these notifiable diseases, and I can personally testify to the thoroughness with which this very necessary work is carried out. I am very anxious, too, that we should not limit the good of disinfection to these Zymotic diseases, and I should like it to be generally known that we are quite ready to disinfect thoroughly after all cases of Phthisis and Cancer, and also that disinfectants can be obtained on application to the Sanitary Inspector for disinfecting the different excreta from cases of Phthisis or Cancer. I need hardly add how glad we shall be to have a disinfector of our own, as articles can then be expeditiously disinfected and returned at once. At present it sometimes happens that the poorer people are obliged to do without their bedding for a night. INQUESTS. There have been 27 Inquests during the year, and were as follows:— Cause of death. Males. Females. Totals. Natural causes 4 11 15 Accidental causes 6 2 8 Suicides 2 1 3 Unknown 1 - 1 13 14 27 9 HOUSE-TO-HOUSE INSPECTION. I am pleased to be able to draw attention to the large and increased amount of this detail of our work (which is very fully set out in Mr. Willett's Report). I have accompanied the Inspector in many of his visits when my presence was known or thought to be necessary. The registers of this work are very thorough, and are well kept. COMMON LODGING-HOUSES AND HOUSES LET IN LODGINGS. Owing to the scare of Small-pox already alluded to, these have had particular attention devoted to them during the year. During the time the contacts were quarantined, I paid daily visits to the common lodginghouses, and besides these visits, have inspected on other occasions. FACTORY AND WORKSHOP ACT, 1901. There are now 64 workshops on the register necessary to be kept under this Act, and we are continually coming upon new premises that have to be registered. The work under this Act has imposed additional duties upon me, and I have made many inspections of premises dealt with under this Statute. Especially would I draw attention to the alterations that were necessary in Underground Bakehouses. With Mr. Willett I made an exhaustive examination of all the Underground Bakehouses, and 10 presented a report to your Committee. A Sub-Committee was then formed, and visited all the premises, and requirements were formulated. Each bakehouse being treated on its merits, no hard and fast rules were laid down. Re-inspections were frequently necessary, and on the completion of the work, after another visit from the Sub-Committee, certificates were issued to 7 out of 8 bakehouses, the remaining one falling out of use. DAIRIES, COWSHEDS AND SLAUGHTERHOUSES. These remain as in the previous year, and have been regularly inspected and attended to. The regulations affecting the cubic capacity of the cowsheds are altering during the coming year, and will require special attention. HOUSING OF THE WORKING CLASSES ACT. No action has been taken under this Act during the past year. It was thought that certain premises were bad enough for me to certify them for closing under the Act, but upon the owner being seen arrangements were made for the houses to be put into a proper state of repair. This was done, and they are therefore not in such a condition that I could recommend the Council to take action. WATER SUPPLY. The District is served by the Lambeth Water Company, and south of the railway the supply is supposed to be constant, whilst on the north it is only intermittent, or the pressure is so reduced that the 11 houses in the higher parts of the District are without water. I am strongly of opinion that every endeavour should be made to ensure a constant and plentiful supply over the whole District. Whilst referring to the Water Supply, a kindred subject might be alluded to, and that is the necessity of keeping the roads in the poorer districts thoroughly well watered. This class of road requires even better scavenging and watering than the better class of roads. GENERAL INSPECTION OF THE DISTRICT. I have above alluded to work that can be classified under special headings, but a great deal remains which is general and comes into the daily routine. The Summary of Inspections and Sanitary Improvements are set out in detail in the Inspector's Report. Many of these inspections have necessitated action on my part, and I have visited not only premises, but roads and passages that have come under notice owing to complaints arising. At the end of the Report will be found the Tables relating to the Vital Statistics of the District for the last ten years. 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, 1903. Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Penge Urban District Council. Gentlemen, I have pleasure in submitting to you herewith my report of the work carried out for the year ending 31st December, 1903. INFECTIOUS DISEASES. It is a cause of congratulation that no case of Smallpox occurred in the District during the whole of the year, although in London and surrounding districts isolated cases have repeatedly occurred. Several persons who had been in contact with Small-pox cases were notified to us. These persons were daily visited and kept under observation for 14 days. In the beginning of the year such a notification came from Croydon that a man suffering from Small-pox had recently stayed at a common lodginghouse in Arpley Road. The inmates of this house were kept in quarantine and vaccinated. 16 I am pleased to be able to state that the authorities of the Croydon Borough Hospital at Waddon have removed all our cases to hospital under an arrangement with this Council, sending a nurse with the ambulance. This is much more satisfactory than the old method, and is greatly appreciated by the patients and their friends. It will be seen in the following table that there were only 30 cases of Scarlet Fever, this number being a decrease of 44 cases on the previous year, but Diphtheria shows an increase of 8 cases; Enteric Fever a decrease of 9; Erysipelas an increase of 6; and Membranous Croup a decrease of 1. Disease. Treated at Home. Removed to Hospital. Total. Small-pox — — Nil Scarlet Fever 6 24 30 Diphtheria 12 13 25 Enteric Fever 2 — 2 Erysipelas 11 — 11 Membranous Croup — — — Chicken Pox* 2 — 2 Puerperal Fever — 1 1 Totals 33 38 71 * Ceased on Jan. 4 to be an infectious disease to which the Notification Act applies. DISINFECTION. We are still indebted to the Croydon authorities for disinfection of bedding. The difficulties pointed out in my former reports still exist, and will continue to do so until the Council have a "disinfector" of their own. 17 Five lots of bedding, not being worth disinfecting, were burnt. I may mention that an arrangement has been made whereby the Librarian of the Public Library has the addresses of all premises where cases of infectious disease occur. Should there be any books belonging to the Library on the premises, they are taken away and disinfected before being allowed to circulate again, or destroyed. The following list shows the number of rooms fumigated, and of beds and other articles disinfected during the year. Number of rooms fumigated 77 „ beds disinfected 96 „ blankets „ 125 „ pillows „ 178 „ sheets „ 73 „ miscellaneous articles 566 Total 1,115 HOUSE-TO-HOUSE INSPECTION. This important work has been proceeded with during the year; 609 houses were inspected, and in 413 cases it was necessary to serve notices. Some of the defects were of a minor character, but were a source of discomfort or a nuisance to the occupier. The principal defects remedied were 116 leaky roofs, 73 defective flushing apparatus, 92 broken ashpits, 98 defective forecourts, and 45 dirty and uncovered drinking water cisterns. This work has entailed a large amount of clerical work, and 1,696 re-inspections, as appears hereunder. 18 No. of Houses Inspected during the Year. Defects discovered. Wordsworth Road 31 at 24 houses Arpley Road 98 „ 73 „ Raleigh Road 43 „ 29 „ Southey Street 17 „ 13 „ Maple Road 190 „ 100 „ Derwent Cottages 6 „ 3 „ St. John's Cottages 12 „ 11 „ Gladstone Mews 4 „ 3„ Challin Street 9 „ 9 „ Jasmine Grove 53 „ 23 „ Cornish Grove 8 „ 8 ,, Lime Tree Avenue 10 „ 5 „ Hawthorn Grove 104 „ 92 „ Hamilton Place 12 „12 „ Hartfield Grove 12 ,, 8 ,, 609 413 HOUSES LET IN LODG1NGS. There are 20 houses in Arpley Road registered as "Houses let in Lodgings." These have been regularly inspected, and midnight inspections have also been carried out. Landlord. No of Houses. Buckingham, J. G. 1 Dunbar, Alexander 3 Osborne, George 2 Osborne, James 6 Stitchman, Mrs. C 8 20 19 The total number of rooms houses let in lodgings is 120. COMMON LODGING HOUSES. The number of these remains the same as last year. They are kept in a much cleaner state than the "Houses let in Lodgings," as under the Public Health Act they must be cleansed every 6 months, and the rooms other than the kitchen may only be used for sleeping purposes, and the room tickets state how many can sleep therein; the keeper must also be registered. In houses let in lodgings it is much more difficult to keep them up to the proper standard. The cleansing is once a year, the rooms may be used for living and sleeping, and the keeper or landlord is not compelled to be registered until he is found out. A person may be the landlord to-day and give particulars of his house after receiving a notice from the Clerk, but next week someone else may be the landlord, and until the change is found out and new notices are served, the landlord does not come within, nor is he liable to penalties under, the By-laws. Common Lodging Houses. Situation. No on Register. No. of Rooms. Registered No. of Lodgers. Arpley Road, Nos. 37, 39. 46. 48, 50, 52, 54 7 33 80 FACTORY AND WORKSHOP ACT, 1901. The work under this statute is being proceeded with. As workshops come under notice they are registered and measured as to their cubic capacity. The attention of the 20 Factory Inspector is also called should the Abstract not be exhibited. Factories are only inspected as to means of egress in case of fire, and sanitary conveniences. No power is given to a Sanitary Authority to make periodic visits to factories; these are under the inspection of the Inspector to the Home Office. Notice has been called to several factories by private individuals as to the watercloset accommodation. In one case 30 men and 30 females were employed, and there were no sanitary conveniences whatever in the factory itself, but two w.c.'s were in a house belonging to same in which the caretaker lived. After a notice had been served, six water-closets and a urinal were constructed. In another case a stable had been converted into a factory without any sanitary convenience for the employes. A water-closet was erected, after notice was given to provide same. Water-closets have also been provided in four workshops where none previously existed. WORKSHOPS. At present there are 64 workshops on the register. The trades or works carried on in such workshops are as follows:— Bootmaking 1 Bottling 1 Box making 1 Carpentering 5 Cycle making 3 Dressmaking 17 Harness making 1 21 Laundry work 16 Mantle making 1 Metal working 3 Millinery 5 Packing 1 Scale making 1 Smithy 1 Tailoring 3 Tie making 1 Upholstering 2 Wheel making 1 64 OUTWORKERS. The Factory and Workshop Act imposes upon occupiers of Factories and Workshops the duty of keeping lists of the names and addresses of all persons employed outside the factory or workshop in certain specified classes of work. The classes of work to which this requirement applies are fixed by the Secretary of State, and may be extended by him from time to time. Outworkers' lists must be kept relating to:— "The making, cleaning, washing, altering, ornamenting, finishing, repairing of wearing apparel and any work incidental thereto. "The making, ornamenting, mending and finishing of lace and of lace curtains and nets. "Cabinet and furniture making and upholstery work. "The making of electro-plate. "The making of files; and "Fur-pulling." 22 Not only must the occupier of the factory or workshop keep these lists open for inspection by the Council's Officers, but he must send twice a year, on or before the 1st February and 1st August, a copy of such lists of outworkers to the District Council. For contravention of this section there is a penalty not exceeding £2 for the first offence, and not exceeding £5 for repeated offences. During the year not one list has been received from any factory or workshop in this District. It is therefore worth considering whether this obligation on the part of occupiers of factories and workshops should not be advertised about the District. We have received £6 lists of outworkers of factories and workshops from other Councils. The principal use of these lists is to show whether, upon a receipt of an infectious disease notification certificate, work is carried on at the address given ; if so the employer of the outworker may be notified, and work stopped until all risk of infection is over. BAKEHOUSES. There are 22 bakehouses in the District, 7 of which are (within the meaning of the Act) underground. The underground bakehouses have entailed a large amount of work during the year. A special report was presented for the consideration of the Works and General Purposes Committee, and the requirements of these bakehouses were specially referred to a Sub-Committee consisting of Councillors Dunk, Fox, Ellis, Grose, and Parnacott. The whole of the eight underground 23 houses were visited, and every bakehouse was specially considered in regard to construction, light, ventilation, and other respects. The requirements applicable to each bakehouse were considered, and the owner was informed of such requirements, and that a certificate would not be granted until the required works were carried out. Seven out of the eight have completed the required alterations and improvements. Certificates have therefore been granted to these, but in the other case the use of the bakehouse for baking has been discontinued. The principal works carried out have been to increase the height of the bakehouse, the cubic capacity, ventilation, and light : the latter effected by pavement lights and glassframed panels under the stall-board ; the upper portion of the panels having perforated cast-iron panels, 6 inches wide the whole length of the shop front. The walls and ceilings were made impervious and smooth; the floor constructed of 6-inches cement concrete floated to a smooth surface with neat Portland cement; the troughs and tables were put on wheels or castors. The increase of cubic capacity has been accomplished by setting back partitions or taking other rooms in. DAIRIES, COWSHEDS, AND SLAUGHTERHOUSES. There are 20 persons registered as purveyors of milk. Three are registered as cowkeepers. The cowsheds in the district will have to conform to the new regulations which came into operation on the 1st March, 1904, which enacts that at least eight hundred feet of air space be allowed for each cow. The three slaughter-houses in the district have been regularly inspected. 24 UNSOUND FOOD. As in previous years, fishmongers and others have brought fish to the Council's depot for opinion as to it being fit for human food. In this way six trunks of fish and several boxes of haddocks have been condemned. A suspected piece of pork was brought to me that had been purchased the day previous. I considered the same unfit for human food, and a magistrate's order was obtained to have it destroyed. The butcher was cautioned. Renewed Licences for the sale of petrol have been granted in seven cases, viz.: — Messrs. Rickett, Cockerell & Co., 10 gallons of naphtha. W. Verinder, 200 galls, of petrol, 5 galls, benzoline. There have also been two special licences granted to the manager of the Crystal Palace for the sale and storage of petrol spirit during the Automobile Show and Runs. Six samples of petroleum were obtained from various shops and tested as to the flash point. The samples were above the minimum (73 degrees Fahrenheit) prescribed by the Statute. Three samples were only 3 degrees above the minimum. This low-flash oil is a positive danger to the users, especially when used in a lamp with a glass reservoir. The temperature of many rooms used by the poorer classes for living and sleeping is often above that which causes this low-flash oil to give off inflammable vapour. PETROLEUM ACTS. Morgan Davis E. Searle & Co. 50 galls, of petrol. 5 „ beazoline 10 „ 100 „ petrol. 150 „ benzoline A. Olby C. Paffard Messrs. Chambers & Co. 25 Nos. List of Samples Tested. 7 Rock Oil 89 0 F. 8 Zaraline 85 0 F. 9 Tea Rose 76 0 F. 10 Tea Rose Paraffin 76 0 F. 11 Homelight Petroleum 76 0 F. 12 Petrol 89 0 F. PROSECUTIONS. No prosecutions have taken place during the year, and in only two cases has it been necessary to appeal to Magistrates, and these were for authority to enter premises under Sec. 41 of the Public Health Act, 1875, and for an order to condemn unsound food. DRAINAGE PLANS. Much inconvenience and loss of time have been experienced in having to go to the Lewisham Town Hall to obtain the plans of drains deposited in accordance with the Metropolis Management Act, 1855, but I am pleased to report that the plans relating to Penge are being severed from those relating to Lewisham, and at an early date we shall be in possession of these plans. WORK ACCOMPLISHED. The table referring to this shows that a large amount of work has been accomplished. During the past year 6,320 feet of glazed stoneware pipes have been laid in lieu of broken and defective drains; 72 houses have been provided with new drains; 102 forecourts have been paved, much to the comfort of the tenants. 26 This has caused 646 Intimation Notices and 84 Statutory Notices to be served, and also 315 letters have been written. Much of the work has been done on the receipt of the Intimation Notice, and, generally speaking, the owners have agreed that the work required by the notice should be done. The House-to-House Inspection is still progressing, and in time we hope to have a record of all the houses in the District. The honour of being sent as your delegate to the Sanitary Institute Congress at Bradford was much appreciated, and was a subject of a special report to the Works and General Purposes Committee, so that there is no need to go over the ground covered by that report. These Congresses give one a stimulus to better work, and the district correspondingly reaps the benefit. In conclusion I wish to express my thanks for the kind and valuable assistance given by the other officers of the Council in the working of this Department. I am, Gentlemen, Your obedient Servant, ALFRED J. WILLETT, Graduate Municipal and County Engineers. Associate Sanitary Institute. 27 SUMMARY OF INSPECTIONS. Cases of infectious disease 69 Inspections through complaints received 234 House-to-House Inspections 605 Trades Inspections 276 Houses let in Lodgings 672 Common Lodging Houses Factories and Workshops 64 Re-inspections of works in hand 3,782 Total number of inspections ... 5,702 28 TABLE OF SANITARY IMPROVEMENTS. Number of Houses, Premises, &c., cleansed, repaired, whitewashed, &c. 62 Roofs, Gutters, Rainwater pipes, &c., repaired 143 House Drains— Repaired, cleansed 57 Rainwater pipes disconnected from drains 34 Stoneware syphon gullies provided 235 Houses provided with new drains 72 Inspection Chambers constructed 67 Aggregate length of 4 in., 6 in. and 9 in. stoneware glazed pipes laid 6,320 ft. Water-closets— Repaired, &c 40 Additional provided 14 Re-constructed 118 Soil pipes and ventilation shafts reconstructed 61 Ditto, ditto repaired 23 Flushing apparatus renewed or repaired 381 Water Supply— Water supply to houses re-instated 14 Cisterns cleansed, repaired or covered 59 Water pipes and taps repaired 21 Miscellaneous— Galvanized iron dust bins provided 116 Overcrowding in rooms abated 9 Yards to houses paved or amended 51 Forecourts 102 Removal of accumulation of dung, stagnant water, animal or other refuse ... 20 Receptacles for dung erected or improved 15 Animals removed, being improperly kept 5 Smoke nuisances abated 2 Damp-proof courses inserted 11 Air bricks provided 33 Other defects remedied 63 TABLE I. Vital Statistics of District during 1903 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 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Births Registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1893 — 442 — - — 280 — — - - — — 1894 _ 417 - — — 271 — — — — — — 1895 — 488 — — — 281 — - — — — — 1896 — 414 - — — 238 - - - - - — 1897 — 500 — - 237 - — - — — — 1898 — 439 — — — 277 - - — — — — j899 — 465 - — — 289 - - - - — — 1900 — 481 — — — 256 — - — — — — 1901 22,468 457 20.3 60 131.29 271 12.0 - — 32 303 I3.48 1902 22,822 476 20.8 67 140.075 250 10.9 - — 37 287 12-5 Averages for year 1893-1902 — 458 — — — 265 — - — — — — 1903 22,965 476 207 56 117.64 214 9.31 - - 37 251 10-92 *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 11. 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" to be 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 770 covered by water) Total population at all ages 22,468 At Census of 1901. Number of inhabited houses 3,811 Average number of persons per house 5.89 TABLE II. I Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. 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 1903. Notifiable Disease. At all Ages Cases Notified in District. No. of Cases Removed to Hosfital. At Ages—Years. Under 1. 1 to 5. 5 to 15. 15 to 2J. 25 to 65. 65 and upwards. Small-pox — — — — — — — — Cholera — — — — — — — — Diphtheria 25 — 7 13 4 1 — 13 Membranous Croup — — — — — — — — Erysipelas 11 1 1 — 2 5 2 — Scarlet Fever 30 — 9 16 2 3 — 24 Typhus Fever — — — - - — — — Enteric Fever 2 — — — 2 — — — Relapsing Fever — — — — — — — — Continued Fever — — — — — — — — Puerperal Fever 1 — — — — 1 - 1 Plague — — — — — — — — Chicken-pox 2 — 2 — — — — — Totals 71 1 19 29 10 10 2 38 Croydon Borough Hospital, Waddon. Isolation Hospitals Croydon and Wimbledon Joint Small-pox Hospital, Cheam. TABLE IV. Causes of, and Ages at, Death during Year 1903. Causes of Death. Deaths in or belonging to 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. Small-pox — - - — — - — Measles 5 3 2 — — - — Scarlet Fever 1 - 1 — — — — Whooping Cough 4 2 2 — — — - Diphtheria and Membranous Croup 3 — 1 2 — — — Croup — — - — — — — Fever Typhus - — — — — — — Enteric — — — — — — - Other Continued — — — — — — - Epidemic Influenza 3 1 — — — 2 - Cholera — — — — — - - Plague — — — — — — — Diarrhoea 4 3 1 — — — — Enteritis 2 2 — — — — — Puerperal Fever — — — — — — — Erysipelas — — — — — — — Other Septic Diseases — — — — — — - Phthisis 18 — — 1 2 15 — Other Tubercular Diseases 10 1 4 3 1 1 — Cancer, Malignant Disease 19 — — — — 12 7 Bronchitis 17 2 1 1 — 4 9 Pneumonia 11 4 1 1 1 3 1 Pleurisy — — — — — — — Other Diseases of Respiratory Organs 3 1 — — — 2 — Alcoholism Cirrhosis of Liver 4 - - - - 4 - Venerea] Diseases 2 1 — — — 1 — Premature Birth 14 14 — — — — — Diseases and Accidents of Parturition 4 — — — 1 3 — Heart Diseases 26 3 — — 1 11 11 Accidents 10 4 — 1 1 — 4 Suicides 3 — — - — 3 — All other causes 88 15 — 3 1 22 47 All Causes 251 56 13 12 8 83 79 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.