Penoo3 Annual Report OF THE medical Officer of health FOR THE Penge Urban District, IN THE COUNTY OF KENT, FOR THE Year ending 31st December, 1904 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, 1904. 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 1904 23,206 Area of District in Acres 770 Density of Population per Acre 30.13 Birth Rate 20.8 Corrected Death Rate 13.4 Zymotic Death Rate... 1.03 Infantile Mortality Rate (under one year) 128.36 Under 5 years. Death Rate per cent 27.3 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 23,206, and it is upon these figures that my statistics are based. The area of the district is 770 acres and the density of population 30.13 per acre. BIRTH RATE. The births during the year numbered 483, of which 249 were males and 234 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 254, and to these have to be added 57 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 13.4 per 1,000. Of these deaths 62 were under 1 year of age, giving an Infantile Mortality rate of 128.36 per 1,000 of births registered. This death rate of 13.40 compares with 10.9 for 1903, 12.5 for 1902 and 13.48 for 1901, the only three years for which I am able to give returns. 5 The Infantile Mortality of 128.36 compares with 117.64 in 1903, 140.75 in 1902 and 131.29 in 1901. Eighty-five of the deaths occurred in children under 5 years of age, this being a mortality of 273 per cent. of the total number of deaths registered. Although the death rate of 13.4 is not as good as it was in 1903, yet at the same time it is a very low and satisfactory figure. The Infantile Mortality is not as good, and it is difficult, too. to see what steps can be taken here to reduce it. The sanitary condition of the premises is of course important, and this part of our duty we are carrying out, and I believe improving, by the house-to-house inspection and the remedying of all defects, but the most practical step would be to educate the mothers in the proper dieting and care of their infants. No doubt the appointment of a Special Visitor would be invaluable, but in our district such work is at present only possible to be carried out by the District Visitors attached to the various religious denominations, and I would appeal to these ladies and gentlemen to make this study their especial duty, and to do their best to help on the education of the public in this matter. The deaths of children under 5 years of age remain about the same. ZYMOTIC DEATH RATE. During the year, 24 deaths have been referred to the following Zymotic diseases:— Measles 2 Diphtheria 6 Scarlet Fever — Influenza 2 Whooping Cough 13 Enteric Fever 1 24 6 This gives a Zymotic death rate of 1.03 per 1,000, but if the two cases of Influenza are omitted, it only amounts to 0.94 per 1,000. INFECTIOUS DISEASES. The total number of Infectious Diseases notified during the year under the Infectious Disease Notification Act of 1889 was 79, which compares with 69 in 1903 and 133 in 1902. Disease. Treated at Home. Removed to Hospital. Total. Diphtheria 9 9 18 Erysipelas 10 - 10 Scarlet Fever 9 38 47 Enteric Fever 2 2 4 30 49 79 This works out at 3.4 notifications per 1,000 of the inhabitants. SMALL-POX. No trouble has arisen in connection with Small-Pox. Not only has no case been notified, but no "contacts" have required watching. In my last report I alluded to the danger that arose from "tramps" disseminating this and other diseases, and am glad to know that this question is now being discussed in various quarters, and I trust that some practical legislative steps may soon be taken. 7 SCARLET FEVER. There were 47 cases of Scarlet Fever notified, as against 30 and 74 in the previous two years ; none of them died. I am again glad to note that 38 of these 47 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. The type of Scarlet Fever is shown by the fact that not a single case was fatal, but as one often finds when the disease is mild the difficulty of detection is increased, and the disease is more liable to spread. DIPHTHERIA. Diphtheria gives 18 notifications, as against 25 and 17 the previous two years. Of this number only 9 were removed to hospital. Although the notifications for Diphtheria are fewer than last year, the deaths from this disease total six as against three in 1903. Only half of the 18 notifications were removed to hospital. On several occasions during the year I have been appealed to to undertake the bacteriological examination of swabs from throats and other pathological products, and I would recommend that arrangements should be concluded to carry this into effect, for in this way the prompt recognition of infectious disease is determined, and the correct diagnosis verified. TYPHOID FEVER. Four Cases only of Typhoid Fever were notified, as against 11 and 2 the previous two years; and one died. Although I cannot speak definitely as to the source of these cases, there was reason in every case to believe that the disease had been contracted outside the district. 8 DISINFECTION. The disinfection has been carried out on the same lines as last year, but we shall be greatly relieved when the work is under our own control. As a result of the recommendation given last year, I am pleased to report that we have disinfected after several cases of Phthisis and Cancer, and we are anxious that it should be generally known that disinfection after these diseases will be gratuitously carried out by my department, and that in all cases of infectious disease disinfectants can be obtained on application. One new departure has been the undertaking by our own official of the disinfecting of all drains in houses where enteric fever has arisen. INQUESTS. There have been 19 Inquests during the year, and were as follows:— Cause of death. Males. Females. Total. Natural causes 6 5 11 Accidental causes 5 — 5 Suicides 1 2 3 12 7 19 HOUSE-TO-MOUSE INSPECTION. The House-to-house inspection is still progressing, and I am perfectly satisfied with the thoroughness with which it is carried out. Permanent records are kept, and I hope as time goes on every house in the district will be examined and its sanitary condition recorded. 9 COMMON LODGING-HOUSES AND HOUSES LET IN LODGINGS. We have kept a constant watch on the Common Lodging Houses and the Houses Let in Lodgings, and I have personally inspected every room. The Common Lodging Houses are kept in as good a condition as such houses usually are, but it is next to impossible to keep the houses let in lodgings up to the standard one would desire. FACTORY AND WORKSHOP ACT, 1901. There are now 94 workshops on the register kept under this Act, and we still are coming across new premises that have to be registered. I have personally inspected all the underground bakehouses, and find that the requirements are kept up to the original demands. I can also personally testify to the condition of the other bakehouses. There seems to be a desire on the part of the occupiers to keep them in a cleanly and wholesome condition, and we have experienced no difficulty in getting the half-yearly cleansing properly carried out. DAIRIES, COWSHEDS AND SLAUGHTERHOUSES. I have gone through all the dairies, cowsheds and slaughterhouses frequently during the year, and though there are still points to be improved, yet I can report progress during the year. HOUSING OF THE WORKING CLASSES ACT. No action has been taken under this Act during the past year. 10 WATER SUPPLY. The District is served by the Metropolitan Water Board, 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 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. GENERAL INSPECTION OF THE DISTRICT. In conclusion, I would report that besides the work classified under the above headings, a considerable number of drain inspections and other routine work has been found necessary. I am frequently called in by medical practitioners in the district to assist in the diagnosis of infectious disease, and am very pleased to be able to be of any help in this way. At the same time I must express my appreciation at the cordial way in which all the doctors here assist me and my department in any difficulties that may arise. I trust that as years go on I may still be able to report continued progress, but even now I would claim that this Annual Report proves that Penge is a desirable residential neighbourhood. The absence of factories, the purity of the air, the efficient treatment of its sewage by its removal to the main drainage of London, and the absence of overcrowding, all go to prove that our sanitary condition is satisfactory and promises good results to all living amongst us. 11 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, 1904. Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Penge Urban District Council. Gentlemen, I have the honour to submit herewith my Annual Report for the year ending 31st December, 1904. In the early part of the year Mr. G. H. Widger was appointed Assistant Inspector, and commenced his duties on the 15th February. Amongst other things, three items are worthy of special note:— (1) The small number of infectious cases notified during the year. (2) The progress of the House to House inspection. (3) The number of defective drains removed and new drains laid. 16 INFECTIOUS DISEASES. Although eight more cases have been notified during this year than last, twenty-two have been notified as occurring in public institutions in the district. Leaving these out the number of actual cases belonging to the district are very low; only 2 cases being notified for every 1,000 inhabitants, or, more correctly, 2.4 per 1,000. Not one case of Small-Pox, Cholera, Membranous Croup, Typhus, Relapsing, Continued or Puerperal Fevers was notified during the year. As compared with the previous year, Diphtheria shows a decrease of 7 cases, and Erysipelas one, but Enteric Fever an increase of 2 cases. In the following table it will be seen how many were notified in each month. Cases of infectious disease notified during the year— excluding those that occurred in public Institutions:— Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Total. January 4 — 1 1 6 February 1 — 4 — 5 March — - 3 - 3 April — 2 2 — 4 May 2 — — — 2 June 3 2 6 — 11 July — 1 3 — 4 August 1 — — 1 2 September 1 1 3 — 5 October 4 1 2 1 8 November. 2 2 — — 4 December . — 1 1 1 3 Totals 18 10 25 4 57 17 Total cases notified in District:— Disease. Treated at home Removed to Hospital. Total Diphtheria 9 9 18 Erysipelas 10 - 10 Scarlet Fever 9 38 *47 Enteric Fever 2 2 4 30 49 79 *Twenty-two cases of scarlet fever were notified as occurring in Public Institutions. DISINFECTION. Several requests have been received from residents in. the district for rooms, clothing, etc., to be disinfected after cases of Phthisis and Cancer. In many districts the Local Authority undertakes to do this without charge, and, upon the matter being brought before the Sanitary Committee, a resolution was passed giving me authority to disinfect gratuitously after such cases. We still have to remove all bedding to Croydon to be disinfected, but I hope in the near future we shall have a "disinfector" of our own, which will enable us to be more expeditious in the disinfection and returning of the bedding. In the case of Typhoid Fever we now make it a practice to thoroughly flush and disinfect the drains. Where these cases are nursed at home it is done every day. This is carried out by our own men to ensure it being well done. 18 The following list shows the number of rooms fumigated and of beds and other articles disinfected during the year. Number of rooms fumigated 57 ,, „ beds disinfected 72 ,, „ blankets 97 „ pillows „ 152 ,, „ sheets ,, 61 „ „ miscellaneous articles 496 Total 935 HOUSE TO HOUSE INSPECTIONS. This is a record of only nine months' work. The number of inspections is not so large as formerly, but the inspections are of a much more thorough character, and therefore more valuable. The drains have been tested with a smoke machine, which takes more time than the volatile test, but this is a much more satisfactory test. Larger houses have also been examined, the whole of the property in the Road being done, instead of only inspecting the smaller houses. One finds more insanitary fittings and defects in the larger houses, because of the multiplicity of sinks, bath-wastes, lavatories, etc., and these lend themselves to ingenious but dangerous work on the part of ignorant workmen. Such a thing as a D trap and pan of a container water-closet would never be found in a cottage. The particular D trap and pan shewn in the photograph were removed from a house rented at £60 per annum. (See Figs. 1 and 2.) Fig. 1. A Pan of a Pan Closet. Fig. 2. D Trap Corroded with Solid Matter. A Connection to soil pipe. D Container of closet fixed here, B 1½ inch vent pipe. E inch waste from bath. Q 1 inch waste from sink. Fig. 3. Drain composed of 12-inch semi-circular Tiles covered with Wood. 19 No. of Houses Inspected during the Year. Defects discovered. Woodbine Grove 115 at 107 houses Unity Cottages 4 „ 4 „ Woodbine Place 4 „ 4 „ Laurel Grove 73 „ 54 „ Heath Square 9 „ 9 „ Clarina Road 14 „ 9 „ Evelina Road 22 „ 22 „ Heath Grove 18 „ 18 „ 259 227 Although there appears to be a large number of defects found, a large percentage are small items. The principal defects discovered were 84 dirty premises, 38 leaky roofs, 52 defective flushing apparatus, 45 insufficient ashpits, 56 water-closets badly lighted and ventilated, and in 31 cases the drains were so defective as to require new drains throughout. This entailed 1,492 re-inspections and a large amount of clerical work. DRAINAGE WORKS. During the year 127 houses have been provided with new drains. In 53 cases authority has been given to open up and examine the drains under Section 41, Public Health Act, 1875. 29 houses that drained into cesspools have now been connected to the public sewer. These, so far as I am aware, are the last of the cesspools in the district. 9,126 feet of glazed stoneware pipes have been laid, the whole being subject to the water test before being covered over. 20 One of the worst cases of a defective drain was found in Woodbine Grove. I was assured by the owners' representative that the drains had all been relaid a few years ago. Mr. H. W. Longdin, the Surveyor to the Council, kindly took a photograph of the drain. The drain was composed of 12-inch semi-circular tiles, butted together, with a piece of wood laid on top, the ground all round being saturated with sewage. (See Fig. 3). HOUSES LET IN LODGINGS. There are 18 houses in Arpley Road registered as "Houses let in Lodgings." These have been regularly inspected, and midnight inspections have also been carried out. On four occasions overcrowding was found to exist in various rooms. Summonses were taken out in these cases. Mrs. Stitchman was fined 1. 20s. and 42s. 6d. costs. 2. 40s. and 17s. costs. 3. 20s. and 10s. costs. James Osborne 4. £5 and 19s. 6d. costs. After this last summons four of the houses were given up, but two were taken by another landlord, so that there are now 18 houses registered, as against 20 houses last year. 21 Landlord. No. of Houses. Buckingham, J. G. 3 Dunbar, Alexander 3 Osborne, George 2 Osborne, James 2 Stitchman, Mrs. C 8 18 COMMON LODGING HOUSES. There are 7 Common Lodging Houses in Arpley Road. These are in the hands of 3 persons who also are landlords of some of the Houses let in Lodgings. The Common Lodging Houses are for single men only, there being none for women or married couples, but these latter get over the difficulty by taking a furnished room from the same landlord in one of the Houses let in Lodgings. Landlord. No. of Houses. Registered No. of Lodgers. Buckingham, J. G. 3 35 Dunbar, Alexander 2 26 Stitchman, Mrs. C. 2 19 7 80 FACTORIES AND WORKSHOPS. A detailed list will be found at the end of the report. The semi-annual list of Outworkers that should be sent in by employers is not a success. There appears to be much misconception as to who are "Outworkers." 24 The lime-washing of these premises was carried out both in May and October and the cowsheds were regularly inspected. The three slaughterhouses have been inspected at least once every week throughout the year, the lime washing being done in every case in March, June, September and December. SALE OF FOOD AND DRUGS ACT. The work under this Act is mainly done by one of the Kent County Councils' Inspectors. The work that is done by us is supplemental and only for taking samples for analysis on emergency. During the year 4 samples of Food have been submitted to the Analyst, viz.:— No 1. Butter ,, 2. Cheese ,, 3. Butter ,, 4. Cheese All samples were certified to be pure. PETROLEUM ACTS. One new licence and six renewed licences for the sale of petroleum have been granted, viz.:— Messrs. Spicer & Orford 50 galls, of petrol W. Verinder, 200 galls, of petrol, 5 galls, of benzoline Morgan Davis 50 galls, of petrol E. Searle & Co 5 ,, benzoline A. Olby 10 „ „ C. Paffard 100 ,, petrol Messrs. Chambers & Co. 150 ,, benzoline 25 Six samples of petroleum were obtained from various shops and tested as to the flash point. All the samples were above the minimum (73 degrees Fahrenheit) prescribed by the Statute. The average of three samples was 10 degrees above the minimum. 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 lowflash oil to give off inflammable vapour. Nos. List of Samples Tested. 13 Petroleum 88º F. 14 Bear Creek 81º F. 15 Rocklight 88º F. 16 Petroleum 108º F. 17 Petroleum 85º F. 18 Petroleum 83º F. MAGISTERIAL PROCEEDINGS. The only instances in which it has been found necessary to apply to the Magistrates, have been in relation to infringements of the Bye-laws with respect to " Houses let in Lodgings." WORK ACCOMPLISHED. The table referring to this enumerates under the various headings the work accomplished during the year. This work has entailed 6,034 inspections, the writing of 431 letters, serving of 543 Intimation Notices and 348 Statutory Notices; we have also dealt with about 750 communications. 26 I have to thank the Council for appointing me a delegate to the Sanitary Inspectors' Association Congress at Bournemouth. A special report has been made about this. In conclusion, I wish to express my thanks for the 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, Member Royal Sanitary Institute. Graduate Municipal and County Engineers. 27 SUMMARY OF INSPECTIONS. Cases of infectious disease 79 Inspections through complaints received 299 House-to-House Inspections 259 Trades Inspections (including bake-houses, cowsheds, slaughter-houses, etc.) 496 Houses let in Lodgings Common Lodging Houses Factories and Workshops 146 Re-inspections of works in hand 4,064 Total number of inspections 6,034 28 TABLE OF SANITARY IMPROVEMENTS. Number of houses, premises, &c., cleansed repaired, whitewashed, &c 127 Roofs, gutters, rainwater pipes, &c., repaired 86 House Drains— Repaired, cleansed 56 Ventilated 15 Stoneware syphon gullies provided 286 Houses provided with new drains 127 Inspection Chambers constructed 92 Aggregate length of 4 in., 6 in., and 9 in. stoneware glazed pipes laid 9,126ft. Sink and bath waste pipes renewed or repaired 49 Water-closets— Lighted and ventilated 67 Repaired, &c. 52 Additional provided 13 New water-closet basins and traps 134 Soil pipes and ventilation shafts reconstructed 71 Ditto, ditto repaired 34 Flushing apparatus renewed or repaired 130 Water Supply— Water supply to houses re-instated 11 Cisterns cleaned, repaired or covered 29 Miscellaneous— Galvanized iron dust bins provided 165 Overcrowding in rooms abated 9 Yards and Forecourts to houses paved or amended 68 29 Removal of accumulation of dung, stagnant water, animal or other refuse 33 Receptacles for dung erected or improved 15 Animals removed, being improperly kept 12 Smoke nuisances abated 2 Other defects remedied 93 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOME-WORK. 1.—Inspection. Number of Premises. Inspections. Written Notices. Factories 34 5 (Including Factory Laundries) Workshops and Work-places 336 63 (Including Workshop Laundries Home workers' Premises 18 2 388 70 2.—Defects Found. Number of defects Particulars. Found. Remedied. Nuisances under the Public Health Acts:- Want of cleanliness 6 6 Want of ventilation – – Overcrowding 3 3 Want of drainage of floors 2 2 Other nuisances 8 8 Sanitary accommodations— Insufficient 1 1 Unsuitable or defective 6 6 Not separate for sexes – – 3° Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (S. 101) – – Breach of special sanitary requirements for bakehouses (SS. 97 to 100) – – Failure as regard lists of outworkers (S. 107) – – Giving out work to be done in premises which are unwholesome (S. 108) – – infected (S. 110) – – Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox (S. 109) – – Other offences – – 26 26 Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5): Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspectors 4 Other – 31 Underground Bakehouses (S. 101):— In use during 1903 8 Certificates granted in 1903 7 „ „ 1904 – In use at the end of 1904 7 Homework:— Lists cf Outworkers (S. 107):— Number of Lists. Outworkers. Lists received 13 18 Addresses of outworkers:— Forwarded to other Authorities 2 Received from other Authorities 14 Homework in unwholesome or infected premises:— Number of Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) Cases of infectious disease notified in home workers' premises – – Orders prohibiting homework in infected premises (S. 110) – – Workshops on the Register (S. 131) at the end of 1904 73 Workshop Bakehouses 21 Total number of workshops on Register 94 TABLE I. Vital Statistics of District during 1904 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. * Number. Rate per 1,000 Births Registered Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 – 417 – – – 271 – – – – – – 1895 – 488 – – – 281 – – – – – – 1896 – 414 – – – 238 – – – – – – 1897 – 500 – – – 237 – – – – – – 1898 – 439 – – – 277 – – – – – – 1899 – 465 – – – 289 – – – – – – 1900 – 481 – – – 256 – – – – – – 1901 22,468 457 20.3 60 131.29 271 12.0 – – 32 303 13.48 1902 22,822 476 20.8 67 140.75 250 10.9 – – 37 287 12.5 1903 22,965 476 20.7 56 117.64 214 9.31 – – 37 251 10.92 Averages for years 1894-1903 – 461 – – – 258 – – – – – – 1904 23,206 483 20.8 62 128.36 254 10.9 – – 57 311 13.40 *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 substraction 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" 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 should be given on the back of this table. 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. 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. 4. Small-pox Hospital, Cheam. TABLE III. Cases of Infectious Disease notified during the year 1904. Notifiable Disease. Cases Notified in Whole District. No of Cases Removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 65. 65 and upwards. Small-pox – – – – – – – – Cholera – – – – – – – – Diphtheria 18 – 6 11 – 1 – 9 Membranous Croup – – – – – – – – Erysipelas 10 – – 1 – 9 – – Scarlet Fever 47 – 6 35 5 1 – 38 Typhus Fever – – – – – – – – Enteric Fever 4 – – – 1 3 – 2 Relapsing Fever – – – – – – – – Continued Fever – – – – – – – – Puerperal Fever – – – – – – – – Plague – – – – – – – – Totals 79 – 12 47 6 14 – 49 Isolation Hospitals Croydon Isolation Hospital. Croydon, Wimbledon and Penge Joint Small-pox Hospital, Cheam. TABLE IV. Causes of, and Ages at, Death during 1904. Causes of Death. Deaths in or belonging to the 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 2 2 – – – – – Scarlet Fever – – – – – – – Whooping Cough 13 3 10 – – – – Diphtheria and Membranous Croup 6 – – 6 – – – Croup – – – – – – – Fever Typhus – – – – – – – Enteric 1 – – – – 1 – Other continued – – – – – – – Epidemic Influenza 2 – – – – 1 1 Cholera – – – – – – – Plague – – – – – – – Diarrhœa 12 11 1 – – – – Enteritis 6 6 – – – – – Puerperal Fever 1 – – – – 1 – Erysipelas – – – – – – – Other Septic Diseases 1 – – – – 1 – Phthisis (Pulmonary Tuberculosis) 32 – – – 9 20 3 Other Tubercular Diseases 8 4 1 1 2 – – Cancer (Malignant Disease) 23 – – – – 9 14 Bronchitis 26 5 1 – 1 5 14 Pneumonia 12 1 5 – 1 2 3 Pleurisy 2 – – – 1 – 1 Other Diseases of Respiratory Organs 1 – – – – 1 – Alcoholism 3 – – – – 3 – Cirrhosis of Liver Venereal Diseases 1 – 1 – – – – Premature Birth 7 7 – – – – – Diseases and Accidents of Parturition – – – – – – – Heart Diseases 46 2 – 2 3 17 22 Accidents 5 – – – – 3 2 Suicides 3 – – – – 2 1 All other causes 98 21 4 1 1 25 46 All causes 311 62 23 10 18 91 107 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 Diarrhœa; Summer Diarrhœa; Dysentery and Dysenteric Diarrhœa; Choleraic Diarrhœa, 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 has had reason for including such deaths, especially those of infants, under the specific term "Diarrhœa." Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. Under the headings of "Cancer" and "Puerperal Fever" is included all registered deaths from causes comprised within these general terms.