PEN 007 Urban District Council of Penge. Chairman— Councillor C. H. Rollison, J.P. Vice-Chaittnan— Councillor A. Parnacott. SANITARY AND LIGHTING COMMITTEE. Chairman — Councillor A. Parnacott. 1908-9. Councillor H. Culver. „ D. L. Gooch. „ R. S. Johnston. „ C. Moat. „ W. H. Walford. ,, K. Wilkinson. „ f. W. Young. 1909-10. Councillor H. Culver. „ D. L. Gooch. „ R. S. Johnston. „ W. Marr. „ J. Sidney Turner, J.P. „ W. H. Walford. F. W. Young. Representatives on the Small Pox Hospital Board— Councillors H. Culver and F. Walter Payne. Medical Officer of Health— Robert Wilkinson, M.D. (Brux.), M.R.C.S. (Eng.), L.R.C.P. (Lond.). Sanitary Inspector— Alfred J. Willett, M.R.S.I., Etc. Assistant Inspector— Robert Rutter, Cert. R.S.I. Health Visitor Miss Amelia B. M. O'Reilly. Annual Report OF THE Medical Officer of Health FOR THE Penge Urban District IN THE COUNTY OF KENT FOR THE Year ending December 31st, 1909. Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Urban District Council of Penge, S.E. Gentlemen, I have held the office of Medical Officer of Health since. June 1st, 1909, and have the honour of presenting to you my Annual Report on the health of the district for the year ending December 31st, 1909. 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 1909 24,408 Area of District in Acres 770 Density of population per acre 31.69 Birth Rate 161 Corrected Death Rate 11.3 Zymotic Death Rate (including Influenza) .53 Zymotic Death Rate (excluding Influenza) .32 Infantile Mortality Rate (under one year) 117.04 Under 5 years. Death Rate per cent. of the total number of Deaths registered 21.37 6 The following houses, &c., have been erected during 1909. Feb. 22.—Sixteen houses, Green Lane. Mar. 11.—Conversion of houses into flats, 92, Belvedere Road. April 22.—Two houses, Tremaine Road. May 15.—Two houses, Worbeck Road. May 17.—Three houses, Milestone Road. May 18.—Parish Room, Green Lane. June 10.—Laundry building, 36, Jasmine Grove. July 10.—Two houses, Worbeck Road. July 12.—Conversion of houses into flats, 22 and 24, Weighton Road. July 21.—Conversion of house into flats, 22, Beverley Road. Oct. 8.—Electric Theatre, Beckenham Road. Dec. 1.—New warehouse, Green Lane. birth rate. The births registered during the year 1909 numbered 393, of which 226 were males and 167 females. This gives a birth rate of 161 per 1,000, compared with 17.9 for 1908, 16.3 for 1907, 17.6 for 1906, 19.5 for 1905, 20.8 for 1904, 20.7 for 1903, 20.8 for 1902, 20.3 for 1901. The birth rate for the whole of England for the year 1909 was, according to the Registrar.General's Returns, the lowest on record. death rate. The number of deaths registered in the Urban District of Penge during the year 1909 was 232, equal to 9.5 per 1,000. To these have to be added 44, which occurred in Public Institutions outside the district. The corrected death rate is, therefore, 276, equal to 11.3 per 1,000, compared with 216, equal to 8.9 per 1,000 for 1908; 238, equal to 9.9 per 1,000 for 1907; 11.4 7 for 1906, 12 8 for 1905, 13.4 for 1904, 10.9 for 1903, 12.5 for 1902, and 13.4 for 1901. Of those 276 deaths in 1909, 46 were under one year, giving an Infantile Mortality Rate of 117.04 per 1,000 of births registered, as against 46 08 per 1,000 for 1908. infantile mortality. The death rate of 117.04 per 1,000 compares unfavourably with that of 46.08 per 1,000 for 1908. There was a much diminished infantile death rate for England during 1908, being a decrease of 21 per 1,000 as compared with the average for the ten years previous. The infantile death rate for 1907 was 102.56; 1906, 125.00; 1905, 126.34; 1904, 128.36. There were 59 deaths under 5 years, being a mortality rate of 21.3 per cent. compared with 35 in 1908, being a mortality rate of 16.2 per cent.; and 55 deaths in 1907, being a mortality rate of 18.9 per cent. The death rate of visited infants was 37.2. It is worthy of note that out of the 46 deaths under one year of age, no less than 32 could not be seen by the Health Visitor. Of these 32 deaths, nine were brought into the district and died in the first month of life, without our receiving any information of their presence; eight died during first month of life whilst under medical advice and were not in consequence seen by the Health Visitor; six were premature births; four deaths registered same day as birth; two found dead in district; two born and died in Infirmary; and in one case the mother objected to visit. By the efficient working of the compulsory Notification of Births Act (which has only been in force since June 1st, 1909), together with more stringent measures taken recently with regard to overcrowding, and greater facilities for ensuring a supply of pure milk for the infants of 8 necessitous parents, I anticipate, in the future, a much greater diminution in this Infantile Mortality. I hope also to take such measures as will enable us to obtain earlier knowledge of removals into the district, and thus ensure the Health Visitor seeing such cases. methods of feeding the infants visited. Breast-fed 242 Cows' Milk and Barley Water 47 Nestle's Condensed Milk 49 Partly Breast and partly hand-fed, with either Cows' or Nestle's Milk 26 Patent Foods 12 Total 376 Notifications of Births from Medical Men 150 Notifications of Births from Midwives 32 Notifications of Births from Parents 4 Total 186 Still Births notified 3 Notification Cards received 186 Babies visited 150 Not visited 36 Not visited, by Doctor's request 9 Doctors in attendance 27 36 9 inspections. First Visits to Infants 376 Subsequent Visits 1,761 Visits to Consumptive Patients 295 „ Outworkers' Premises 34 ,, Factories and Workshops 108 (Where females are employed). „ Restaurant Kitchens 37 „ Milk Shops 15 ,, Houses Let in Lodgings 116 Re-inspections 127 With regard to the work done in dealing with the Infantile Mortality, in addition to my acknowledgment of the Health Visitor's efforts, I should like to express my best thanks to the District Nurses, who have done valuable work in this respect. zymotic death rate. During the year 13 deaths have been referred to the following Zymotic diseases :— Measles 0 Diphtheria and Membranous Croup 2 Scarlet Fever 4 Influenza 5 Whooping Cough 1 Enteric Fever 1 Small Pox ???0 13 This gives a Zymotic Death Rate of .53 per 1,000, but if the five cases of influenza are omitted, it only amounts to .32 per 1,000. 10 infectious diseases. The total number of Infectious Diseases notified during the year, under the Infectious Diseases Notification Act of 1889, was 179, which compares with 147 in 1908, 110 in 1907, 108 in 1906, 80 in 1905, 79 in 1904, 69 in 1903, and 133 in 1902. Diseases. Treated at Home. Removed to Hospital. Total. Diphtheria 9 32 41 Erysipelas 8 – 8 Scarlet Fever 19 106 125 Enteric Fever 1 4 5 Membranous Croup – – – Puerperal Fever – – – 37 142 179 This works out at 7.33 notification 5 per 1,000 of the inhabitants. Re-examination of discharged patients from hospital. No. Examined Reported free from Infection. Diphtheria 30 28 Scarlet Fever 62 59 Enteric 2 2 small-pox. We have had no cases of Small-pox during the past year, 1909. scarlet fever. There were 125 cases of Scarlet Fever notified, as against 62, 64, 70, 41, 47, 30 and 74 in the previous seven 11 years. Four cases were fatal. 106 of those cases were treated in hospital. 26 cases were notified from the North Surrey District Schools. The outbreak of Scarlet Fever took place shortly after I took office in June. In conjunction with the School Medical Inspectors I took immediate measures to cope with it by isolating contacts, individual inspections of scholars, &c. The outbreak was traced to two "missed cases" at Oakfield Road School. These cases, when there is a slight sore throat, a transient rash and little or no malaise, are very easily overlooked by parents, the first intimation of the malady being peeling of the hands or feet, the child having meanwhile spread infection broadcast. diphtheria and membranous croup. There were 41 cases of diphtheria in 1908, as against 54, 36, 21, 23, 18 and 25 for the previous six years. Of this number 32 were treated in Hospital, two of whom died. enteric fever. Five cases of enteric fever were notified, as against 26, 5, 1, 5, 4, and 11 in the previous six years. One of these cases was discharged from hospital as not suffering from enteric. Case 1. Female, age 29. Notified on the 4th July, 1908, and Case 10, notified Aug. 8th, 1908. Female, age 31. Both referred to in last year's Report continue, I regret to say, chronic " carriers." Dr. Theodore 12 Thomson, C.M.G., of the Local Government Board, and Dr. Ledingham, of the Lister Institute, continue their invaluable investigations with regard to these cases, and numerous examinations of faeces and blood have been made. The present state of affairs is, that the two "carriers" referred to are being kept under constant observation and as far as possible the faeces disinfected. malignant disease (cancer). The deaths for the past year, 1909, 28, equal to 10.14 per cent. of the total deaths registered, against 22 in 1908, and a rate of 10.2. We disinfect the rooms and bedding, &c., after those fatal cases, whenever possible. inquests. There have been 19 Inquests during the year 1909, as follows:— Causes of death Males. Females. Total. Natural Causes 5 4 9 Accidental Causes 4 3 7 Suicides 2 1 3 Totals 11 8 19 examination of pathological products. There were 123 specimens, against 115 in 1908, of serum and blood submitted to the Clinical Research Association during the year. The results were as follows:— Bacillus found. Bacillus not found. Diphtheria Secretion 40 78 Total. 118 13 Reaction Reaction not obtained. obtained. Total Typhoid (blood) 1 4 5 Anti.Diphtheritic Serum was supplied for the treatment of seven cases. Five specimens of sputum were also examined, two being positive and three negative. pulmonary tuberculosis and other tubercular diseases. The deaths from pulmonary tuberculosis at all ages for the past year, 1909, are 25, equal to 9.05 per cent. of the total number of deaths registered, as against 22 in 1908. The deaths from other tubercular diseases are 4 for 1909, equals 1.44 percent. of total deaths registered, as against 13 for 1908. The total number of deaths from these diseases in 1909 was 29, as against 35 in 1908, which is equal to a rate of 10.5 per cent. of deaths registered, as against 16.2 for 1908. Voluntary notification of phthisis has been fairly general in the district since the adoption of the principle by the Council in June last, and is a step in the right direction towards compulsory notification, without which no really effective measures can be taken to deal with this still far too devastating disease. medical inspection of schools. The following Report was submitted to the Sanitary Committee and approved:— Method of Co.operative Procedure between the Medical Officer of Health and the School Medical Inspectors, with regard to the Prevention of Infectious Diseases, based upon the recommendations suggested in the Memorandum of the Local Government Board on '' Closure of and 14 Exclusion from School," of September, 1909, adopted for the Penge Urban District. I have, in conjunction with the School Medical Officer and School Medical Inspectors drawn up the following scheme:— School Closure.—The Medical Officer of Health and School Medical Officer shall consult together in cases of serious outbreaks of disease, with regard to the advisability or otherwise, of resorting to this procedure. Exclusion of Children.—Immediately upon receiving notification that a child is suffering from an infectious disease, the Medical Officer of Health will notify the School Medical Inspector attached to the School attended by the child, and also the Head Teacher, with regard to the exclusion of the child and such contacts as can be discovered. The School Medical Inspectors shall, in like manner, notify the Medical Officer of Health of any cases of infectious disease they may exclude, present or suspected, notifiable or non-notifiable. It is suggested that school teachers notify the Medical Officer of Health and School Medical Inspectors at once of any cases they may send home from school suffering from symptoms pointing to infectious disease, and of children away from school for illness when a medical man is not in attendance. That the School Attendance Officer or other official shall make periodical visits to such cases and report to the School Medical Inspector and Medical Officer of Health. That in cases of outbreaks of serious infectious disease the Medical Officer of Health and School Medical Inspectors make periodical inspections together of the Schools, and if thought necessary, inspect the scholars individually. 15 That the School Medical Inspectors notify the Medical Officer of Health of such sanitary defects in the Schools as may come to their notice. Only with regard to co-operative working with the Medical Inspectors in dealing with infectious diseases am I able to report, as the Annual Report of the School Inspections does not pass through my hands. school closure. The following School Classes have been closed :— Genoa Road Catholic School—Infant Department, from March 29th to April 23rd, 1909, for Measles. Melvin Road Council School—Standard V., from January 22nd to July 6th, for Measles. St. John's, Infant Department—Class V., from July 12th to end of session. Whole department, from July 15th to end of session, for Measles. inspections. In addition to special inspections at various times, of infected premises, I have made inspections of all the bakehouses in the district. Five are underground, and were altered to meet the requirements of the Council prior to certificates being granted. I find it difficult to ensure that means of ventilation originally provided is at all times maintained. The cleansing is periodically carried out, and generally speaking, the sanitary condition is good. I have paid particular attention to the Cowsheds and Milkshops. In the general shops the conditions as regards cleanliness are by no means as good as they should be, and in none is the ideal arrived at. The 16 ventilation of the Cowsheds and general cleanliness leave, in some instances, much to be desired; the grooming of the cows is not good, and much ignorance and prejudice exist in this respect. The storing of milk is often carelessly done, and the churns and milk cans are sometimes barely clean. Sufficient care is rarely taken by ensuring sufficient covering to milk-containing utensils in shops to exclude that potent factor of serious contamination, the common house-fly. The regulations as regards these matters are, I think, not nearly stringent enough. Factories and workshops have received their share of inspection and are on the whole satisfactory. It would appear that there cannot be many workpeople employed as "out workers," as I have only received two lists from firms within the district. Personal enquiries have been made at likely places where such outworkers might be employed, but it appears that there were none so employed. The lodging houses of both kinds, ''common" and ''houses let in lodgings" have been inspected. Some were decidedly damp, and in the case particularly of ''houses let in lodgings'' the bedding was dirty. Tables referring to the Vital Statistics, Infectious Diseases, Factory and Workshop Acts, Rainfall and Sunshine are appended. In conclusion, I have to tender my sincere thanks to the Chairman and Members of the Sanitary Committee for their constant support and courtesy to me during my first year of office. I am, Gentlemen, Your obedient Servant, ROBERT WILKINSON. 17 the factory and workshop act, 1901 By Section 132 of the above Act the Medical Officer of Health of every District Council is required in his Annual Report to report specifically on the administration of this Act in workshops and workplaces, and a copy of the Annual Report, or so much of it as deals with this subject, is to be sent to the Secretary of State. Tables 1 to 5, which follow, are the forms prescribed by the Home Office for the purpose of the Report. 1.—Inspection. Premises. 1 Number of Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories (Including Factory Laundries.) 401 4 Workshops (Including Workshop Laundries.) 67 Nil. Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) Total 401 71 18 2.—Defects Found. Particulars. Number of Delects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Nuisances under the Public Health Acts :—* Want of cleanliness 58 58 ... ... Want of ventilation 3 3 ... ... Overcrowding ... ... ... ... Want of drainage of floors 3 3 ... ... Other nuisances 8 8 ... ... † Sanitary accommoda tion insufficient 1 1 ... ... unsuitable or defective 7 7 ... ... not separate for sexes ... ... ... ... Offences under the Factory and Workshop Act :— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... Other offences 3 ... 3 ... (Excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 83 80 3 *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 4 Sec. 22 of the Public Health Acts Amendment Act, 1890, is in force in the District. The standard adopted as to sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops is that set forth in the Sanitary Accommodation Order of 4th of February, 1903, made by the Secretary of State. 3.—home work Nature of Work. Outworkers' List, Section 107. Inspections of Out. work, ers' premises. Outwork in Unwholesome premises. Sec. 108. Outwork in Infected Premises. Sections 109,110- Lists received from Employers. Addresses of Outworkers received from other Councils. Addresses of Out. workers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instan- ces. Orders made (S. 110). Prosecutions (Sections 109,110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors Work, men. Con. tractors Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Wearing Apparel— (1) making, &c 2 3 14 2 34 (2) cleaning & washing Lace, Lace curtains & nets Artificial flowers Nets, other than wire nets Tents Sacks Furniture and upholstery Fur pulling Feather sorting Umbrellas, &c Carding,&c.,of buttons,&c. Paper bags and boxes Basket making Brush making 1 Racquet and tennis balls Stuffed toys File making Electro-plate Cables and chains Anchors and grapnels Cart gear Locks, latches and keys... Pea picking Total 2 3 15 2 34 20 4—registered workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number (2) Bakehouses 21 Boot making 6 Carpentering 3 Cycle making 5 Dress making 11 Laundry Work 11 Millinery 8 Miscellaneous 16 Smithy 3 Tailoring 10 Upholstering 6 Wheelwright 3 Total number of workshops on Register 103 5 —other matters. Class. (1) Number. (3) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters re- Notified bv H.M. InsDector 4 ferred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Reports (of action taken) , sent to H.M. Inspector 3 Other 3 Underground Bakehouses (s. 101) :— Certificates granted during the year ... In use at the end of the year 5 21 meteorological reports. The rainfall is registered at the Penge Recreation Ground and the sunshine recorded at the Town Hall. The following tables show the results thus obtained and compared with those at Greenwich. rainfall, 1909. Recorded at PENGE Recreation Ground. Week Ending Saturday Jan. 2 0.49 of an inch. 9 019 „ 16 0.59 „ 23 0.11 „ 30 0.02 „ Feb. 6 0.09 „ 13 0.33 „ 20 0.02 „ 27 0.00 „ Mar. 6 1.52 inches. 13 0.50 of an inch. 20 0.31 „ 27 0.54 „ Apr. 3 0.41 „ 10 0.00 „ 17 0.22 „ 24 0.67 „ May 1 0.95 „ 8 0.00 „ 15 0.08 „ 22 0.08 „ 29 0.91 „ June 5 1.01 inches. 12 0.72 of an inch. 19 0.00 „ 26 1.44 inches. July 3 0.44 of an inch. 10 0.92 „ 17 0.49 „ 24 0.27 „ 31 1.33 inches. Recorded at GREENWICH. Week ending Saturday Jan. 2 0.48 of an inch. 9 0.13 „ 16 0.49 „ 23 0.12 „ 30 0.02 „ Feb. 6 0.04 „ 13 0.29 „ 20 0.01 „ 27 0.08 „ Mar. 6 1.23 inches. 13 0.46 of an inch. 20 0.41 „ 27 0.51 „ Apr. 3 0.66 „ 10 0.00 „ 17 0.22 „ 24 0.72 „ May 1 0.77 „ 8 0.00 „ 15 011 „ 22 013 „ 29 0.95 „ June 5 0.94 „ „ 12 0.79 „ 19 0.05 „ 26 1.45 inches. July 3 0.44 „ 10 0.99 „ 17 0.71 „ 24 015 „ 31 1.31 inches. 22 rainfall, 1909 {continued). Recorded at PENGE Recreation Ground. Recorded at GREENWICH. Week ending Saturday Aug. 7 0.19 of an inch. 14 0.00 „ 21 0.92 „ 28 0.62 „ Sept.4 0.22 „ 11 0.59 „ 18 0.74 „ 25 0.36 „ Oct. 2 101 inches. 9 0.64 of an inch. 16 0.61 „ 23 0.36 „ 30 2.10 inches. Nov. 6 0.25 of an inch. 13 012 „ 20 0.20 „ 27 0.04 „ Dec. 4 1.25 inches. 11 031 „ 18 0.48 „ 25 057 „ Jan. 1 018 „ Total2641 inches „. Week ending Saturday Aug. 7 0.26 of an inch. 14 000 21 0.82 28 0.70 Sept.4 0.30 „ 11 0.32 18 0.58 25 0.57 Oct. 2 0.72 9 1.01 inches. 16 0.59 of an inch. 23 0.46 30 1.87 inches. Nov.6 0.15 of an inch. 13 003 20 0.28 27 001 Dec. 4 140 inches. 11 0.36 of an inch. 180.43 25 0.46 Jan. 1 0.27 Total 27 25 inches. 23 sunshine, 1909. Recorded at the Town Recorded at Hall, ANERLEY. GREENWICH. Week ending Saturday Week ending Saturday Hours. Hours. Jan. 2 5.75 Jan. 2 5.7 9 8.50 9 8.1 16 22.75 16 22.7 23 10.00 23 10.9 30 17.00 30 18.9 Feb. 6 8.50 Feb. 6 7.7 13 20.75 13 21.1 20 32.00 20 36.3 27 19.25 27 22.4 Mar. 6 13.00 Mar. 6 16.2 13 15.25 13 17.0 20 14.25 20 17.7 27 19.75 27 20.7 Apr. 3 23.75 Apr. 3 23.8 10 73.75 10 83.7 17 41.50 17 42.2 24 55.75 24 53.4 May 1 67.25 May 1 64.0 8 90.75 8 92.4 15 67.00 15 62.7 22 75.75 22 75.9 29 59.50 29 55.9 Tune 5 30.00 June 5 31.2 12 26.50 12 25.4 19 36.00 19 37.4 26 31.00 26 30.1 J uly 3 37.75 July 3 37.0 10 34.75 10 31.2 17 23.75 17 25.2 24 61.25 24 63.0 31 3625 31 34.4 Aug. 7 53.75 Aug. 7 54.4 14 82.00 14 81.5 21 53.25 21 40.2 28 34.75 28 30.2 24 sunshine, 1909 (continued). Recorded at the Town Hall, ANERLEY. Recorded at GREENWICH. Week ending Saturday Week ending Saturday Hours Hours. Sept.4 41.75 Sept.4 41.7 11 34.25 11 35.0 18 24.25 18 20.9 25 28.75 25 27.7 Oct. 2 5.75 Oct. 2 6.0 9 31.00 9 33.7 16 22.25 16 22.5 23 14.75 23 16.7 30 17.50 30 13.9 Nov.6 20.25 Nov. 6 20.1 13 22.00 13 22.2 20 24.00 20 14.0 27 14.25 27 14.7 Dec. 4 . 14.75 Dec. 4 13.2 11 19.25 11 16.7 18 2.00 18 0.4 25 22.75 25 18.1 Jan. 1 7.75 Jan. 1 8.3 Total 1654.00 Total 1648.4 Annual Report OF THE HaiutariJ Inspcctar FOR THE Penge Urban District IN THE COUNTY OF KENT FOR THE Year ending December 31st, 1909. Town Hall, Anerley Road, Anerley. January, 1910. To the Chairman and Members of the Penge Urban District Council. Gentlemen, I have the honour to place before you my Annual Report for the year ending the 31st December, 1909. I have now completed ten years' service in the district, being appointed in June, 1899, by the late Lewisham Board of Works. In former reports I have dwelt upon the various branches of the work, but as nothing exceptional has been carried out in the past year I have thought it sufficient to record the work done. On the 26th April, the Medical Officer of Health, Dr. G. Roe-Carter suddenly passed away. Dr. Robert Wilkinson was subsequently appointed, and in June commenced duties as Medical Officer of Health. For the first two months of the year I was without an Assistant, owing to Mr. Widger obtaining another appointment. Mr. Robert Ruttar, of Colne, was appointed to fill the vacancy, and commenced duties on the 23rd February. 638 premises, excluding those under the heading of food trade inspections, factories and workshops, and 28 lodging houses, have been inspected, and 2,831 miscellaneous inspections and re-inspections made of urinals, stables, &c., and also in following up the works in hand, testing drains, &c. Sixty-eight premises have been provided with entirely new drains; 3,546 feet of glazed stoneware pipes with water-tight joints were laid on cement concrete; 43 inspection chambers have been constructed; 96 water-closets, 146 gullies, and 63 soil-pipes fixed. 804 letters have been written against 712 and 588 in the previous two years, 636 intimation notices against 554 and 508, and 220 statutory notices were served. It will thus be seen that the clerical work continues to increase. The work accomplished and nuisances abated may be classified as follows:— Number of houses, premises, &c., cleansed, repaired, whitewashed, &c 258 Roofs, gutters, rainwater pipes, &c., repaired 82 House Drains— Repaired or cleansed 27 Ventilated 21 Stoneware syphon gullies provided 146 Houses provided with new drains 68 Houses with drains partially relaid 19 Inspection chambers constructed 43 Interceptors fixed 13 Aggregate length of 4 in., 6 in., and 9 in. glazed stoneware pipes laid 3,546ft. Sink and bath waste pipes renewed, repaired or trapped 54 29 Water-Closets— Lighted and ventilated 20 Repaired, &c 50 New water-closet basins and traps 96 Soil pipes and ventilation shafts reconstructed 63 Ditto, ditto repaired 57 Flushing apparatus renewed or repaired 59 Water Supply— Water supply to houses re-instated 4 Cisterns cleansed, repaired or covered 47 Miscellaneous— Galvanized iron dust bins provided 200 Overcrowding in rooms abated 4 Yards and forecourts to houses paved or amended 93 Removal of accumulations of dung, stagnant water, animal or other refuse 17 Animals removed, being improperly kept 5 Damp premises remedied 27 Rooms provided with improved ventilation 18 Other defects remedied 84 INSPECTIONS AFTER INFECTIOUS DISEASES. 108 premises were inspected subsequent to cases of infectious diseases occurring, and the drains tested by a smoke machine. The drains in some cases were found to be defective. The number of premises attacked by each disease were as follows:— Scarlet Fever 62 Diphtheria 35 Enteric fever 3 -Erysipelas 8 30 DISINFECTION. Eighteen premises have been disinfected after cases of Cancer and Phthisis, in addition to those premises where notifiable infectious diseases occurred. A large number of Library Books have been disinfected which had been lent out at the infected houses. The following list shows the number of rooms fumigated and of beds and other articles disinfected during the year. Number of rooms fumigated 157 ,, „ beds disinfected 213 „ ,, blankets ,, 303 ,, ,, pillows ,, 472 ,, ,, sheets ,, 188 ,, ,, miscellaneous articles 1,739 Total 3,072 NOTIFICATION TO SCHOOLS. During the year 124 notifications have been sent to the head teachers of the various schools, informing them of cases of infectious disease that have occurred in the homes of children attending school, and prohibiting attendance from the infected houses for a certain period. St. Paul's Schools, Hadlow Place 8 St. John's Schools, Maple Road and Becken- ham Road 14 Melvin Road Schools 11 Oakfield Road Schools 46 Genoa Road Schools 4 Other Schools 6 Sunday Schools 35 Total 124 31 HOUSE TO HOUSE INSPECTION. During the year 183 houses have been inspected, as follows:— No. Inspected. Defects found at Houses St. Hugh's Road 50 37 Hamilton Place 12 12 Mosslea Road 21 15 Palace Road 21 19 Vineleigh Road 79 70 Totals 183 153 The principal defects discovered were:—103 dirty and dilapidated premises, 19 leaking roofs, 47 premises with defective gutters and rainwater pipes, 29 defective flushing apparatus, 34 defective W.C. basins and traps, 33 insufficient ashpits, 83 paving of yards or forecourts defective, 17 water closet basins dirty, 30 drinking water cisterns dirty or without covers, and drains were relaid at 46 premises. This entailed 718 re-inspections of works in hand. A detailed report of Vineleigh Road was made to the Sanitary Committee. There are 79 houses in the road and all but eight are let as flats for two families. The flat consists of two rooms, kitchen and scullery, and one W.C. for two flats (one house). 104 flats and six single houses were occupied, and accommodated 606 persons; 168 males, 153 females, and 185 children under 14 years of age. In five instances two families, or members of more than one family, inhabited one flat. Four cases of overcrowding were found, which have since been abated. LODGING HOUSES. The number of Common Lodging Houses are the same as last year, viz., seven. They are all situate in 32 Arpley Road. The seven houses are registered for 80 lodgers. Frequent day and midnight inspections are made. The keeper of two of these houses is very infirm, and hardly capable of looking after the conduct of the lodgers. Under the Public Health Acts Amendment Act, the keepers in future will have to have deputy keepers residing on the premises. This should be conducive of better control of the premises. There are 24 houses in Arpley Road registered as Houses Let in Lodgings. Thesecontain 120 furnished rooms, and have been measured as to their cubic capacity. This information has been given to the various landlords, so that there can be no excuse for overcrowding. A great amount of time is taken up in visiting these houses, for as soon as one nuisance is abated another appears, due mainly to the habits of the occupants who are continually changing, being often only 2 or 3 days in the rooms. The cleansing has been carried out in accordance with the Bye-laws. FACTORIES AND WORKSHOPS. There are 103 workshops and workplaces on the register. Nineteen additional workshops were registered during the year. Four hundred and one visits have been made to these premises. Seventy-one notices have been served, and, besides these, many verbal notices were given to remedy some slight defects. In the table relating to the work done under the Factory and Workshop Act will be found particulars of the various trades and of the nuisances abated. 33 FOOD TRADES INSPECTION. Under this heading are included bakehouses, slaughter-houses, cowsheds, dairies, butchers' shops, fish shops, and stalls where food is prepared and sold. These premises have been regularly visited and various defects, from time to time found, have been remedied. There are 26 bakehouses, seven of these being underground, for which certificates were granted in 1903. Two underground bakehouses are not now used. All the bakehouses have been cleansed twice during the year in accordance with the Factory and Workshop Act. The number of slaughter-houses is the same as in the previous year, namely three; the cleansing took place in March, June, September and December, as provided for in the Bye-laws. Three persons are registered as cow-keepers and 25 as purveyors of milk. Seven additional purveyors of milk have been registered during the year. The limewashing of the cowsheds has been carried out twice during the year, in accordance with the regulations. UNSOUND FOOD. The practice still continues of tradesmen bringing for inspection suspicious articles of food. Amongst a great variety of food so brought were rabbits, two dozen baskets of raspberries, trunks of hake and gurnet, &c. Hitherto it has been the practice of the wholesale dealers to allow the tradesmen the money paid for such food on production of a letter that the food has been destroyed by the Sanitary Authority, but recently the Fishmongers' Company, Billingsgate Market, have objected to do this,consequently there maybe a tendency on the part of some dealers to sell fish which ought not to be consumed. A greater vigilance will therefore have to be kept upon those shops where the fish is cut up in pieces and fried. About a 34 pound of pieces of meat was brought to me, the person stating he had just bought them from a butcher's. I at once went to the shop and found upon the stall board pieces of beef which were partially decomposed and stinking. I seized the pieces and obtained an order from a Justice of the Peace to destroy the meat. This was done and the proceeding reported, but it was not thought to be a case for prosecution. Game Dealers' Licences have been granted in the following cases and the premises of such licensees inspected, viz.:— James Quilter, 118, Beckenham Road. Messrs. Carter & Co., 117, Anerley Road. Messrs. J. Woods & Sons, 100, Anerley Road. SALE OF FOOD AND DRUGS ACTS. The following samples were obtained within the District by Mr. Alexander Quinlan, the Kent County Council Inspector for this division of Kent:— 39 samples of New Milk. 5 ,, Pepper. 15 „ Butter. 7 „ Mustard. 4 ,, Coffee. 3 „ Demerara Sugar. 2 „ Arrowroot. 5 „ Ground Ginger. 3 „ Ground Rice. 1 sample Cayenne Pepper. 1 ,, Separated Milk. 1 „ Cream of Tartar. 1 „ Fine Oatmeal. 1 „ Cheese. 1 „ Pearl Barley. 1 „ Citrate of Magnesia. 35 1 sample Baking Powder. 1 „ Ground Almonds. 1 „ Ground Cinnamon. 1 „ Ground Maize. Total 94 Upon analysis, eighty-eight samples were found to be genuine, two new milks were doubtful, three were adulterated, and also one separated milk. Legal proceedings were taken in the doubtful and adulterated samples, as follows:— 1. New Milk, 26 per cent, of added water and 9 per cent, deficient of milk fat. Defendant fined £\, and 15s. cost. 2. New Milk, 6.3 per cent, of added water. Defendant fined £20, and £3 13s. costs (third conviction). 3. New Milk, 16 per cent, deficient of milk fat. Defendant fined £'2, and 10s. costs. 4 and 5. New Milk, adulterated to small extent with boric acid. Defendant cautioned. 6. Separated Milk, adulterated with 12.7 per cent, of added water. Defendant fined £10, and 10s. costs (second conviction). PETROLEUM ACTS. Two new licences and ten renewal licences for the sale of petroleum, &c., have been granted, viz.:— Varnum & Bull 50 galls, of petrol E. Searle & Co 10 ,, ,, A. Olby 40 „ Chambers & Co 250 „ benzoline 36 G.Turner 20 galls. petrol. J.L.Collins 80 ,, „ F.L.Brewster 50 ,, „ J. Honey 100 „ „ W.J.Wood 250 „ „ C.W. Notley 200 ,, „ H.L.Bennett 5 cwt. Carbide of Calcium. C. T. Brock & Co. 2 „ ,, ,, ,, Samples of petroleum were purchased from shops in different parts of the district, and tested as to the flash-point, i.e., the temperature at which the spirit or oil gives off inflammable vapour. All the samples were above the minimum (73 degrees Fahrenheit) prescribed by the statute. SUMMARY OF INSPECTIONS. Houses attacked with infectious disease 108 Inspections through complaints received, &c 347 House-to-House Inspection 183 Houses let in Lodgings and Common Lodging Houses 560 Food Trades Inspections (including bakehouses, cowsheds, slaughterhouses, &c.) 625 Factories and Workshops (excluding inspections included in previous items) 317 Miscellaneous Inspections and Re-inspec- tion of works in hand 2,831 Total number of inspections 4,971 I am, Gentlemen, Your obedient Servant, ALFRED J. WILLETT. TABLE I. Vital Statistics of District during 1909 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 Non. residents registered in Public Institu. tions in the District. Deaths of Residents registered in Public Institu. tions beyond the District. Net Deaths at all Ages belonging to the District. Number. Rate* Under I Year of Age. At all Ages. Number Rate per 1.ooo Births registered Number. Rate* Number. Rate* 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 1899 ... 465 ... ... ... 289 ... ... ... ... ... ... 1900 ... 481 ... ... ... 256 ... ... ... ... 1901 22,468 457 20.3 60 131.29 271 12.0 ... ... 32 303 13.4 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 9.3 ... ... 37 251 109 1904 23,206 483 20.8 62 128.36 254 109 ... ... 57 311 13.4 1905 23,440 459 19.5 58 126.36 254 10.8 2 1 47 301 12.8 1906 23,678 416 17.6 52 125.00 234 9.8 7 2 39 271 11.4 1907 23,918 390 16.3 40 102.56 196 8.1 ... ... 42 238 9.9 1908 24,161 434 17.9 20 46.08 177 73 ... ... 39 216 8.9 Averages for years 1899-1908 ... 453 ... ... ... 239 ... ... ... ... ... ... 1909 24,408 393 161 46 117.04 232 9.5 ... ... 44 276 11.3 *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. 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" taken into account for the purpose 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 are given in the following table. Total population at all ages 22,468 At census of 1901. Area of District in Acres (exclusive of area covered by water) 770 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. 11. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among several localities in the District. Nil. 1. Workhouse Infirmary, Croydon. Nil. 2. Borough Hospital, Croydon. 3. Croydon Borough Isolation Hospital, Waddon. 4. Croydon and Wimbledon Joint Small-Pox Hospital, Cheam. The Union Workhouse is not within the District. TABLE III. Cases of Infectious Disease notified during the year 1909. Notifiable Disease. Cases Notified in Whole District. No. of Cases Removed to Hospital. At all Ages Deaths Registered At Ages—Years. Under 1. 1 to 5 5 to 15. 15 to 25 25 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... Diphtheria 41 2 ... 8 29 2 2 ... 32 Membranous Croup ... ... ... ... ... ... ... ... ... Erysipelas 8 ... ... ... ... 3 4 ... ... Scarlet Fever 125 4 ... 19 90 11 5 ... 106 Typhus Fever ... ... ... ... ... ... ... ... ... Enteric Fever 5 1 ... ... 2 1 2 ... 4 Relapsing Fever ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis (under Poor Law Regulations) 25 ... ... ... 7 3 13 2 ... Pulmonary Tuberculosis (Notified Voluntarily since June) 10 ... ... ... ... 1 9 ... ... Totals 214 7 ... 27 128 21 35 3 142 Croydon Isolation Hospital, Waddon. Isolation Hospitals- Croydon and Wimbledon Joint Small-pox Hospital, Cheam. TABLE IV. Causes of, and Ages at, Death during 1909. Causes OF Death. Deaths at the subjoined Ages of " Residents whether occurring in or beyond the district." Total Deaths whether of Residents or Non.Resi. dents in Public Institn tions in the District 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) (9) Small-pox ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... Scarlet Fever 4 ... 1 3 ... ... ... ... Whooping Cough 1 ... 1 ... ... ... ... ... Diphtheria, including Membranous Croup 2 ... 1 1 ... ... ... ... Croup ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... •• Enteric 1 ... ... ... ... 1 ... ... Other continued ... ... ... ... ... ... ... ... Epidemic Influenza 5 ... ... ... 1 ... 4 ... Cholera ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... Diarrhoea 2 1 1 ... ... ... ... Enteritis 1 1 ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 25 ... ... 1 6 18 ... ... Other Tubercular Diseases 4 2 2 ... ... ... ... ... Cancer (Malignant Disease) 28 1 ... ... 1 15 11 ... Bronchitis 26 2 1 ... ... 5 18 ... Pneumonia 20 10 3 ... 1 6 ... ... Pleurisy 1 ... ... ... ... ... 1 ... Other Diseases of Respiratory Organs 3 1 ... ... ... 2 ... ... Alcoholism Cirrhosis of Liver 3 ... ... ... ... 2 1 ... Venereal Diseases ... ... ... ... ... ... ... ... Premature Birth 7 7 ... ... ... ... ... ... Diseases and Accidents of Parturition ... ... ... ... ... ... ... ... Heart Diseases 35 ... ... 2 1 17 15 ... Diseases of the Nervous System 17 8 ... ... 1 6 2 ... Diseases of Genito-Urinary System 10 ... ... ... ... 4 6 ... Senile Decay 18 ... ... ... ... ... 18 ... Arterio Sclerosis 5 ... ... ... ... ... 5 ... Cerebral Haemorrhage 15 ... ... ... ... 6 9 ... Diabetes 4 ... ... ... ... 2 2 ... Accidents 7 1 ... 1 1 2 2 ... Suicides 4 ... ... ... ... 3 1 ... All other causes 28 12 3 ... 3 5 5 ... All causes 276 46 13 8 15 94 100 ... 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 from columns 1—7. See note on Table I. as to meaning of "Residents " and " Non-Residents." (b) Under the heading of " Diarrhoea " are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Dysentery and Dysenteric diarrhoea Choleraic diarrhoea, Cholera and Cholera Nostras. In addition, and as regards deaths of children under one year of age, under the heading " Diarrhoea " in column 2 (Table IV.) are included all deaths classified as " Diarrhoeal diseases " in Table V. Under the heading of " Enteritis" in Table IV., are included only deaths over one year of age registered as due to Enteritis, Muco-enteritis, Gastro-enteritis, Gastric catarrh, Gastritis, and Gastro-intestinal 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, under the specific term "Diarrhoea." Deaths from diarrhoea secondary to some other well-defined disease are included under the latter. Under the heading of "Cancer" and "Puerperal Fever" are included all registered deaths from causes comprised within these general terms. TABLE V. Infantile Mortality during the Year, 1909. Deaths from Stated Causes in Weeks and Months under One Year of Age CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks Total under 1 Month 1-2 Months. 2 3 Months 3-4 Months 4-5 Months. 5-6 Months. 6-7 Months. 7 8 Months. 8-9 Months 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes— Certified 11 1 4 5 21 3 2 5 5 3 2 1 2 1 1 46 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (Including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoeal Diseases— Diarrhoea, all forms ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Enteritis Muco-enteritis, Gastro-enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Gastritis, Gastro-intestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases— Premature Birth 6 ... ... ... 6 1 ... ... ... ... ... ... ... ... ... ... 7 Congenital Defects ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus ... ... 1 1 2 ... 1 1 1 2 1 ... ... ... ... ... 8 Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 1 1 1 4 ... ... 2 ... ... ... ... ... ... ... ... 6 Bronchitis ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 2 2 1 ... 1 2 1 1 ... 1 ... 1 ... 10 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 4 ... ... ... 4 1 1 ... ... ... ... ... ... 1 ... 1 8 11 1 4 5 21 3 2 5 5 3 2 ... 1 2 1 1 46 Population, estimated to middle of 1909 ... 24,408. (legitimate 381 legitimate infants 37 Births in the year 393 Deaths in the year 46 (illegitimate 12 illegitimate „ 9 Deaths from all Causes at all Ages, 276.