1913. ANNUAL REPORT OF THIS MEDICAL OFFICER OF HEALTH for the URBAN DISTRICT OF BEXUTY in respect of the year 1913. To The Chairman and Members of the BEXLEY URBAN DISTRICT COUNCIL. Gentlemen, I beg to submit to you my Twenty-third Annual Sanitary Report, viz, that in respect of the year ended 31st December 1913. A. NATURAL AND SOCIAL CONDITIONS OF TH5 DISTRICT- (1). Physical features and general character. There is little to comment upon under this heading. The making up of Broomfield Road has been completed and a locality occupied by good class residences thereby much improved. The continued activity of factories in the adjoining districts has created a good demand for small houses, and unemployment has been practically non-existent. The building of new houses, however, has been almost at a. standstill. (2). Population. I estimate the population at the middle of the year at 17,000 against 15,895, at the time of the last Census. Residents in the District may be divided into three principal classes, viz:- (a) Those engaged in Engineering works in adjoining Districts: (b) Those engaged in Market gardening, Fruit Growing and Agriculture in the District: and (c) Those who travel daily to business in town. B. SANITARY CIRCUISTANC OF THE DISTRICT. Water supply. With the exception of three houses the whole District is supplied with water from the mains of the Metropolitan Water Board. The water is derived from deep wells sunk into the chalk and the water, though hard, is of great purity. Of the three houses supplied from other sources one has spring water laid on to the house, another has a well and the third used rain water. Rivers and Streams. The practical completion of the sewerage of the whole District (except small out-lying areas) has caused an almost complete cessation of the pollution of streams, which was a very unsatisfactory feature of the district some years ago. Drainage and Sewerage. With the exception of a low-lying area (one of those above mentioned) practically the whole of the District drains by gravitation to the valley of the River Cray, and a smell tributary thereof. In the valleys of these streams ere laid the West Kent Main Sewer and the Cray Valley branch thereof, and the whole of the Council's sewers discharge into one or other of these main sewers, the sewage being disposed of by the West Kent Main Sewerage Board at their outfall works at Joyce Green, near Dartford. The Councils sewers are of stoneware pipes, and are sufficient for the needs of the District. The low lying area, which forms part of the Eest Wickham Ward, will not drain by gravitation into the Council's main system of sewers* This area,which lies in the watershed of a smell stream flowing from the Bexley District through the Metropolitan Borough of Woolwich and discharging into the River Thames,comprises about 200 acres. The population of this area is approximately 150 persons, and the dwellings are drained into cesspools. The higher part of the water-shed is unpopulated at present, but as the area adjoins the Metropolitan Borough of Woolwich future developments may be expected. There are 110 cesspools in the District receiving sewage. The number is being gradually reduced as connections are made to the Council's sewers. The Council undertake the cleansing of cesspools, and influence is constantly brought to beer on owners of property to connect their premises to the sewers. Closet Accommodation. The water-carriage system is almost exclusively used in the District. A very few privies now exist. Scavenging. The removal of house refuse is supervised by the Sanitary Inspector and the cleansing of cesspools, earth closets, and privies, by the Surveyor. From time to time the Council have discussed the advisability of adopting a weekly in lieu of fortnightly collection of house refuse. The additional service involves considerable increased cost owing to difficulties in the matter of cartage of the refuse, but the Council, carried out an experimental weekly collection in one of the Wards during the summer months of 1913 and upon the information thus obtained it is to be hoped that they will see their way to put into operation a weekly collection throughout the District all the year round. The refuse is disposed of on arable land and ploughed in. BEX1 The Deposit of London Refuse in the District has been continued but there have besn no complaints as to nuisances arising therefrom. The powers of control conferred on the Council under Bye-Laws approved by the Local Government Board have proved very effective, and I consider that it is in consequence of these powers having been put into force by the Council that complaints, which used to be so frequent, have now ceased. A small quantity of London Refuse was brought by rail to a Station in another part of the District during the early part of the year, but most of this refuse was taken outside the District. The small quantity deposited within the District was promptly ploughed into agricultural land. Sanitary Inspections of District. The Sanitary Inspector's statement as to his work during the year is as follows:- No.of In- Purpose and description. spectiona 6 To certify compliance with orders for cleansing and whitewashing. 39 To arrange for disinfection after infectious disease and to make enquiries as to source of infection. 2 Inspections of Common Lodging House. 24 Inspections of Cowsheds. 40 Inspections of Slaughterhouses. 4 Inspections of Fruit Pickers Lodgings. 66 Special Inspections of Workshops. 2 Special Inspections of Factory. 5 Inspections of premises of outworkers. 491 Premises inspected and records taken in course of House-to-House Inspection (See Note X below). 2 Other Sanitary Inspections. (See Hote X below). 681 X Detailed records of inspections necessary to advise as to compliance with notices served and to certify compliance therewith, are not kept, find such inspections are not included above. Notices served and work done in consequence of such visits are dealt with under the heading of Housing (Inspection of District) Regulations 1910. Schools. Towards the end of the year attention was called by the spector tocthe insanitary condition of the paving of the sanitary offices of one of the public elementary schools in the District, and a communication was addressed to the School Managers on the subject with a request that the matter should receive their attention. Apart from this the sanitary condition of and water supply to public ele?.nentary schools in the District is satisfactory. The Public Elementary Schools in the District and the approximate number of children on the books are as follows Bexley Church of England. 380 Bridgen Church of England. 105 Bexleyheath Church of England. 610 Upland Council. 1070 Welling Council. 610 Posters Endowed Schools, East Wickham. 320 TOT AT;. 3095 With a view to obviating the spread of infectious disease among scholars, notice is sent by the Sanitary Inspector to the head master of the school attended by any child of school age residing in a house in which a case of infectious disease occurs, so that the child may be watched and any sign of illness detected at an early stage. FOOD. (a) Milk Supply. At the commencement of the year there were in the District 12 sheds registered for the keeping of cows for the supply of milk to the public. Cowkeeping in one of the sheds was discontinued during the year. The premises were inspected twice and were liraewashed in Hay and October. All the cows in the registered sheds were inspected monthly by the Council's Veterinary Inspector. The number of animals inspected varied from 149 in January to 115 in December. In August a case of tuberculosis of the udder was detected and on the advice of the Veterinary Inspector was reported by the owner to the County Council under the Diseases of .Animals Acts (Tuberculosis Order of 1913). A microscopical examination of the milk was made and an Order for the slaughter of the animal issued by the County Council. A post-mortem examination con- ducted by the officers of the Font County Council showed that the animal was suffering from advanced tuberculosis. The carcase was condemned as unfit for food and was buried in lime. With this exception all the animals inspected were found to be in healthy condition. A very large proportion of the milk consumed in the District is imported by rail from Wiltshire and elsewhere. In every case of infectious disease which occurs inquiry is made as to the source of the milk supply in use, but during the past year there has been nothing to indicate that any cases of disease could be attributed to unwholesome milk. (b) Other goods. No action has been taken or needed during the year with regard to unsound foods. The sanitary condition of premises where foods are prepared, stored or exposed for sale, is satisfactory. There are 16 registered bakehouses in the District, all of which are inspected at least twice in the year. They are limewashed every six months and their condition is satisfactory. Hone are underground. The Sanitary Inspector is not qualified for meat inspection, and no such inspection is made in the District. Practically the whole of the beef and a very large proportion of the mutton and pork consumed in the District is slaughtered elsewhere and is subject to inspection before it reaohes the District. Quarterly inspections of the 10 registered slaughterhouses in the District are made and they are periodically limewaBhed in a satisfactory manner. These alaughter houses continue to be used only to a very limited extent. (c) The Sale of Food and Drugs Act are administered in this District by the County Council. Housing of the working CLASSES ACTS 1890 to 1909. Work under the Housing (inspection of District)Regulation 1910 has been continuously carried on during the year, 491 houses having been systematically inspected under and for the purposes of Sec., 17 of the Housing, Town Planning etc. Act, 1909, In addition 3 houses in respect of which the Council took action in the year 1912 under Sec. 15 of the Act were re-inspected with a view to action under Sec. 17, the omission on the pert of the owner to give the written notice prestribed by Sub-Sec. a of Sec. 15 of the Act having left the Council in doubt as to their legal position on the previous proceedings. A tabulated statement of action under Sec. 17 of the Housing, Town Planning etc. Act 1909; follows, viz:- Number of houses inspected under and for the purposes of the Section. 494 Number of houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation, 4 Number of representations made to the Local Authority with a view to the making of Closing Orders. 4 Number of Closing Orders made. 4 Number of dwellinghouses the defects in which were remedied without the making of Closing Order. (Representation made in the year 1912). 1 Number of dwellinghouses which after the making of Closing Orders .were put into a fit state for human habitation. 1 Number of houses demolished after issue of Closing Orders. 3 Five Closing Orders issued in December 1912 became operative and the premises were closed for human habitation in January 1913. They remained closed for several months, the owner taking no steps to render them fit for human habitation. At my suggestion the Council in October considered the question of demolition of the property, due notice of such consideration being given to the owner, whose agent appeared before the Sanitary Committee and admitted that the owner recognised that it was not possible to make the premises fit for human habitation, but desired them to be left standing in order that they might at some future time be used for some other purposes A motion to serve demolition orders was ultimately defeated by a vote of the Council. The demolition of the property being in. my opinion necessary, and the Council's decision in the matter according to the Act being wrong, I took steps to have the question of demolition reconsidered, and as a result the Council in December 1912 ordered fresh statutory notice of consideration of the question of demolition to be served on the owner. Three of the houses in respect of which Closing Orders were issued had been vacant for several months and were in a ruinous condition; the fourth was generally dilapidated, and was thoroughly restored before the Closing Order was determined. Action under Sec 35 of the Housing, Town Planning etc Act, 1909, was teken during then year in respect of 4 houses. Pour esses of overcrowding have "been detected and abated during the year beside one case in respect of which notice was served towards the end of 1912. The condition of houses intended for the accommodation of the working clesses in the District may generally be described as satisfactory, although minor defects, usually capable of easy remedy, are constantly found in the course of the house-to-house inspection, The improved demand for houses of this class is responsible for a tendency towards increased rents, but it cannot be said that there is any shortage of such houses. During the year 6 new houses have been certified complete and 12 other were nearing completion at the end of December. FACTORY And WORKSHOP ACT 1901, Workshops. Workplaces etc. A list of the workshops in the District is as follows:- 1912. 1913. Bakehouses 16 16 laundries 7 6 Dressmakers and Milliners Workshops 11 11 Builders 9 9 Blacksmiths and Wheelwrights 10 9 Cycle makers 3 4 Miscellaneous 20 20 76 75 66 Inspections of workshops were made during the year. Outworkers. Notifications were received in respect of five outworkers living in the District. Their premises were inspected end found to be in satisfactory condition. During the year attention was called by H.M. Inspector of Factories to the fact that separate sanitary accommodation for female employees was not" provided at a factory in the District. A notice was served requiring the occupier to make the necessary provision and temporary arrangements were made pending the expected removal of the factory to other premises. This removal has not yet taken place, but the occupier has ceased to employ females end no action has been taken to enforce compliance with the notice. (C). SALTITARY ADMINISTRATION OF THE DISTRICT. Staff Hr. Edmund Reeve Boulter continues to hold office as Inspector of Huisances. The question of termination of his appointment on grounds of age has been under consideration by the Council on two occasions during the year and they have decided to take no action in the matter. I certainly think that taking into consideration his great age, viz, 84, and his 34 years service with this and the previous authority, that some arrangement should be come to whereby he could be relieved of some of his duties. I cannot say but that he has done a large amount of work during the past few years, and he has dons it -sell but it not right that a man of his age should be called upon to carry out all the trying duties of a Sanitary Inspector, and I feel that should any serious outbreak of infectious disease occur he would be unable to deal with it satisfactorily. The Hospital Messenger and Attendant engaged in December 1912 proved unsatisfactory and was dismissed in June, hie place being filled by a person until recently engaged in a similar capacity at the East Ashford Rural District Council's Isolation Hospital, who has proved an efficient and satisfactory officer. The clerical assistance provided for the Sanitary Inspector from the staff of the Clerk's Department has been continued with good results. Hospital Accommodation. The accommodation available at the Isolation Hospital is the same as at the time of my last Annual Report. During the year the local Government 3oard expressed the view that the site of the Hospitals was not suitable for the isolation of cases of small-pox and for this and ether reasons the proposed alterations to the Pavilion have been deferred. I am, however, of opinion that there is no substantial objection to the site for the purpose named end that the Council should proceed with the alterations to the Pavilion so as to make it available for the use of diphtheria patients of both sexes in lieu of the lower Hospital, or that the Lower Hospital now dilapidated should be demolished and another similar one erected. The accommodation at the Isolation Hospital was at all times during the year sufficient for the needs of the District. The Lower Hospital , used for the isolation of diphtheric patients was closed during the following periods, viz:Januery 1st to 18th. February 8th to 11th. March 4th to May 20th. June 4th to December 8th, The Upper Hospital was also closed (So far as patients were concerned) as follows, viz:- February 5th to 17th. April 16th to May 5th. June 7th to 12th. July 24th to August 1st. September 10th to 23rd. The approximate expenses of maintenance of the Ho 'Spital compared with the year 1912 were as follows:- 1912. 1913. £ £ Provisions 107 84 Attendant & Pettjr Cash (including Temporary ITurses) 63 55 Fuel 15 14 ITurses (excluding Temporary ITurses) 58 58 Medical Sundries 5 3 Disinfectants 6 5 Miscellaneous end repairs 81 26 Telephone 7 6 Medical superintendent 25 25 £367 £276 In consequence of the expression of opinion by the Local Government Board above mentioned,the Council communicated with the Metropolitan Asylums Board with a view to the withdrawal of their notice terminating the arrangement for isolation by the Board of cases of small-pox from the Council's area. The Board declined to renew the arrangement, but agreed to deal with one or two sporadic cases of the disease in case of need. Taking into ation the fact that smallpox is little to be feared in this District except as a consequence of the proximity of the Metropolitan Asylums Board's Hospitals I do not advise the Council to be quite satisfied with this decision of the Board, more particularly as I am informed that the Board give facilities to an adjoining District, having no greater claim than Bexley, for isolation of all cases of small-pox. During the year the Council decided to adopt the notification of Births Act 1S07, end to bring same into operation after 1st April 1914. At the end of the year arrangements for the appointment of a Female Health Visitor for the purposes of the Act were under consideration. The following adoptive Acts ere in force in the District:- Public Health Acts Amendment Act 1890. Public Health Acts Amendment Act 1907 (except Sections, 50,61,66, 78 to 86, 92,93 and 94). Infectious Disease Prevention Act 1890. The Bacteriological Laboratory established by the Kent County Council was made use of on several occasions during the year for work in connection with Scarlet Fever and Diphtheria, and other cases. (D) PREVALENCE OF AND C0NTRCL 0VSR ACUTE INFECTIONS DISEASE. The following cases were notified under the Infectious Lisea.se Notification Act 1889. The correspondings figures for 1912 are also given, viz:- 1912. 1913. Scarlet Fever. 48 35 Diphtheria. 23 12 Erysipelas. 7 13 Puerperal Fever. 2 Tuberculosis. 24 38 Poliomyelitis. 2_ 106 98 20 deaths were caused by Zvaotia diseases, viz:- 1912. 1913. Measles. 1 9 Diphtheria. 2 2 Whopping Cough. 4 1 Diarrhoea, 3 8 10 20 giving a Zymotic Death Hate of 1.17 per 1000 of the population. The corresponding figure for 1912 was .6 Scarlatina. During the summer months the district was remarkably free from this disease, only 7 cases being notified from the middle of April to the middle of September. In the closing months there was a small outbreak entirely among children of school age, but the patients were so widely scattered that the source of infection could not be traced to any particular school. 7 cases were clearly due to contact with earlier cases from the same houses( one particular family supplied 4 patients), and 4 cases were imported into the District, in some instances causing the infection of other members of the family. No setter how exhaustive enouiries are made it is often impossible owing to the fact that the district is to such a large extent a dormitory for workers elsewhere, to trace conclusively the source of infection. 33 of the cases were treated at the Isolation Hospital and 2 at home. Diphtheria. In January, the Council, acting under the powers conferred upon them by Sec. 67 of the Public Health Acts Amendment Act 1907, provided nursing attendance at home for two cases of Diphtheria where the patients were unfit for removal to the Isolation Hospital. One of these cases proved fatal and the other made a good recovery. There was a second fatal case in .February 1913. Three of the cases notified were clearly imported, one of them,who had been in attendance at the London Hospital as a Clerk, having contracted the disease on his eye. 7 of the patients were treated at home, and 5 were removed to the Isolation Hospital. A child from this District on a visit to friends in the Metropolitan Borough of Woolwich was taken ill with diphtheria, and as a precautionary measure the house waff disinfected. The question of period of isolation of cases of Scarlatina and Diphtheria is interesting. Many hospitals keep patients suffering from scarlet fever under treatment for two or three months or even longer. In the Council's hospital a patient is seldom detained longer than five weeks and I think four weeks will eventually be found long enough. In cases of diphtheria it is in my opinion often impossible to obtain negative swabs until the patient has left the Hospital. As a rule I dismiss the patient in three weeks with instructions to abstain from close contact with other persons for a further period of a week. Prom a Blue Book issued by the Medical Officer of the Local Government Board it appears that the incidence of scarlet fever and diphtheria per 1,000 of the population in Bexley and the neighbouring Districts during the year 1913 was as follows:- Scarlet Sever. Diphtheria. BEXLEY UR3AST DISTRICT. 2.2 .6 Dartford Urban District. 3.0 .78 Erith Urban District. 4.2 1.4 Foots Cray Urban District. 3.3 2.3 Dartford Rural District. 2.7 1.7 Woolwich Borough. 5.3 3.3 Rules somewhat similar to those adopted here have been in operation at Southampton and Leicester for some years, without resulting in any increase of infections. In those places patients are discharged without regard to whether desquamation or peeling is complete. Shortening of time mates a great difference the amount of accomnodation required, and in the cost of maintenance. Measles. Owing to the prevalence of measles among the scholars, the Upland Council Schools (Infants Department) were closed from January 23rd to February 14th inclusive; the Bexley heath Church of England Schools (infants Department) from February 7th to 28th; and the Bexley Church of England Schools (infants Department) from Larch 17th to April 6th., with a view to preventing the spread of disease. This disease is not notifiable in the District, nor do I consider it necessary that it should be notifiable. There is in operation an arrangement with the head-masters of the Public Elementary Schools whereby cases of suspected illness among their scholars aer reported to me. Infectious Disease Frevention Act 1890, Ho orders for the cleansing and disinfacting of pvemitses under the provisions of Section 5 of the above Act 3vve been required or issued during the year. Seven Orders for the cleansing and whitewashing of premises under Sec. 46 of the Public Health Act 1875 were made, and all but two (which were made in December) were complied with at the end of the year. A notice outstanding at the end of December 1912 was also complied with during the year. (s) PRTVALECE OF AND CQNTRUT OVER TOLERCULOSIS 38 Cases of tuberculosis were were notifiedduring the year, many of them several times over, from different sources. These duplicate notifications are quite unnecessary, and are a source of confusion, "but it is difficult to see hiw they can be avoided. A Tuberculosis Dispensary available for this District will shortly be opened at 41 Overy Street, Dartford, where treatment will be under the direction of the District Tuberculosis Officer. The admission of patients will be on the recommendation of Medical Practitioners only. Premises where deaths from tuberculosis have taken place are disinfected at the cost of the Council. (F) INVESTIGATION OF OTHER DISEASES. There is very little Rickets, Syphilis or Gonorrhoea in the District, and Acute Rheumatism, is almost unknown. (G) MEANS FOR PREVENTING MORTALITY IN CHILDBIRTH AND IN INFANCY. The Midwives Act 1902 is administered in this District by the Kent County Council. I have already referred to the fact that the Council have decided to adopt and administer the Notification of Births Act, 1907, (H) VITAL STATISTICS OF THE DISTRICT. Death. Rate. 163 Deaths occurred in the District during the year, 3 of which were transfereble to other Districts, while 41 deaths which occurred elsewhere ere transferable inward, giving 201 as the total number of deaths. On the estimated population of 17,000 this gives a total death rate of 11.82 per 1,000 living, compared with 12.1 for England and Wales less the 241 large towns. Omitting the 41 transferable inward deaths of persons whose connection with the District during life was in many cases remote, the death rate is 9.41. The corresponding figures for the District last year were 11.4 and 8.78. 79 Deaths occurred in persons of 65 years of age and upwards. 41 Children under one year of age died giving en infantile death rate of 109 per 1,000 births registered comparable with 96 per 1,000 for England and 'ales less the towns above mentioned. 13 Deaths of newly born infants were due to prematurity or debility at birth. Birth Rate. 180 male and 193 female children were born and registered during the year, giving a birth rate of 21.9 per 1,000 of the population compared with 22.2 for England and Wales less the towns already referred to. The rate for the 3exley Urban District in 1912 was 24.3 The births include 11 registered elsewhere, but transferable to this District. 16 illegitimate children were born. I am, Gentlemen, Yours obediently, BEXLEYHEATH. (3D) O. STJEDERLAED. March 21st 1914. Hedical Officer of Health. APP-2TDI2.. HO. 1. HSTtner 0? BIRTH-RAT3S .AED DEATH-RATES 12* rSHGLiKD ALTD WALES HI THE Y5i.AR 1913 . j Annual rates per 1000 living. Deaths under one year to 1000 Births. iBirths. , Deaths. 1 Crude. Standardised. Encland and Wales, 23.9 13.7 13.4 109 96 greet towns, including London. 25.1 14.3 14,7 116 145 smaller towns. 23.9 12.8 13.0 112 England and Wales less the 241 towns. | 22.2 13.1 12.1 96 lOiTL'Oli, 24 8 14.2 14 2 104 The standardised death-rates (formerly called corrected death--xates) are the rates which would have been recorded had the sex and age constitution of the populations of the several areas been identical with that of England and Wales as enumerated in 1901. The foregoing Schedule is extracted from a Return of the Registrar General. APPENDIX NO. 2. HOUSE- TO- HOUSE INSPECTION: SUMMARY OF SANITARY AND OTHER NOTICES SERVED: YEAR 1913. Statute. Section. Work. Notices. Outstanding Served Complied with. Outstanding 31/12/12, 31/12/13. Public Health Acts Amendment Act 1907. 25. To pave yards. 34 117 114 37 Ditto. 49. To provide sinks. 9 8 12 5 Ditto. 35. To remedy nuisance from cisterns. 32 139 104 67 Ditto. 35. To remedy nuisance from defective guttering. 6 40 34 12 Public Health Act 1875. 91. To abate nuisance from overcrowding 1 4 5 Ditto. 36. To provide sufficient W,Cs. 104 189 146 145 Ditto. 36. To provide sanitary dustbin. 11 79 57 33 Ditto. 91 and Bye-Laws. To provide manure receptacles. 2 7 5 4 Ditto. 44 and B'e-laws. To remedy nuisance from keeping of fowls. 1 1 Ditto. 91. To limewash & cleanse a workplace (Contractor's stabling) and provide sanitary accommodation thereat. 1 1 mm Ditto. 46. To cleanse and whitewash. 1 7 6 2 Housing (Inspection of District) Reglnsl910. . Direction to remedy defective conditions. 60 151 133 78 Housing, Town Planning etc Act 1909. 15. To make fit for human habitation. 4 4 - TOTALS. 260 747 624 383