Bromley Rural District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1898, BY JAMES SCOTT TEW, M.D.H., BROMLEY: Printed by S. BUSH & SON, 42, High Street. 1899. Annual Report on the Health OF THE Bromley Rural Sanitary District in 1898. Census 1881. No. of Acres 31751 Inhabited Houses 3901 Population 20760 Census 1891. No. of Acres 33129 Inhabited Houses 5025 Population 26852 The Population of the Bromley Rural District was estimated, by the method adopted by the Registrar-General, to be 31,513 at the middle of 1898, showing an increase of 687 since the middle of 1897. Six hundred and eighty-eight births were registered, which included 345 of males and 343 of females, and giving a Birth-rate of 21.8 per 1,000 of population, as against 25.1 in 1897, and 24.4 in 1896. The registered deaths amounted to 401, consisting of 211 of males and 190 females, and including 10 deaths occurring outside the District among persons belonging thereto. Thirty-four deaths occurred in the District among non-residents. The Death-rate was 11.6 per 1,000 of population, as against 12.5 in the previous year and 11.4 in 1896. 4 Of the total 401 deaths 48 were caused by one or other of the seven principal Zymotic Diseases, viz.: 14 by Diphtheria, 3 by Fevers, 5 by Measles, 7 by Whooping-cough, and 19 by Diarrhœa. The Zymotic Death-rate was 1.5 per 1,000 of population as compared with 1.6 in 1897 and 1.1 in 1896. The Infant Mortality, i.e., the number of deaths of Infants under one year of age to each 1,000 registered births was 129, as against 140 and 112 in the two previous years. During the year 1898 the birth-rate throughout England and Wales was 29.4, the general death-rate 17.6, and the Zymotic death-rate 2.2 per 1,000 of population. The rate of mortality amongst infants under one year of age to each 1,000 registered births was 161. A.—Notifiable Diseases. Under the provisions of the Infectious Disease (Notification) Act, 1889, 165 cases were reported as compared with 181 in the previous year and 198 in 1896. They included 47 of Scarlet Fever, 63 of Diphtheria, 24 of Enteric Fever, and 31 of Erysipelas. The District was free from Small-pox throughout the year. Scarlet Fever. This disease was much less prevalent during 1898 than during the previous year, only one half of the number reported in 1897 having occurred. Four parishes were entirely free from the disease, viz.: Hayes, Keston, North Cray, and St. Paul's Cray. The remaining parishes contributed to the number as follows : Chelsfield 5 cases Chislehurst 7 „ Cudham 2 „ Downe 2 „ Farnborough 2 „ Foot's Cray 7 „ Knockholt 8 „ Mottingham 3 „ Orpington 7 „ St. Mary Cray 2 „ West Wickham 1 case and at the Workhouse 1 case occurred. Total 47 cases. 5 The disease was prevalent throughout the year, every month adding to the number as below : January 2 cases February 9 „ March 6 „ April 2 „ May 3 „ June 3 „ July 1 case August 2 cases September 5 „ October 9 „ November 3 „ December 2 „ Total 47 cases. It is gratifying to report that not a single case ended fatally, and the following shows the age-periods at which the cases occurred:— 1—5 years 5—15 years J5—25 years 25—65 years 5 32 8 2 =47 cases. Diphtheria produced more than twice as many cases in 1898, than in the previous year, viz : 63, as compared with 29 in 1897. Only two parishes were free from Diphtheria throughout the year, viz: Downe and Knockholt; and the cases occurred in the remaining parishes as follows :— Chelsfield 2 cases. Chislehurst 4 „ Cudham 1 case. Farnborough 1 „ Foots Cray 6 cases. Hayes 5 „ Keston 1 case. Mottingham 1 „ North Cray 1 „ Orpington 27 cases. St. Mary Cray 5 „ St. Paul's Cray 5 „ West Wickham 3 „ and at the Workhouse lease. 63 cases. 6 The District was entirely free from this disease during two months of the year only, viz: in May and July. Up to the beginning of November, comparatively few cases were reported, one in each of the months of January, March, April, June, August and September, whilst February contributed 4 cases and October 6. The latter month marked the beginning of a somewhat serious and obstinate epidemic, November and December producing 22 and 25 cases of Diphtheria respectively, i.e. 47 cases out of the 63 reported during the year. The epidemic was chiefly confined to the parish of Orpington, where 25 cases occurred during the last 3 months of the year, and the neighbouring parishes of St. Mary Cray and St. Paul's Cray, added 5 each during the same period. Numerous investigations were made during the epidemic, in order to discover the cause. The sanitary arrangements of the Board Schools were overhauled at the commencement of the epidemic, but no defects could be discovered, and everything pointed to the disease being spread by personal infection. Both the Board Schools were closed from November 5th, to the beginning of the Christmas holidays, and thoroughly cleansed and disinfected. The milk supply was also enquired into, and found to be above suspicion. The majority of the cases were removed to the Bromley and Beckenham Joint Hospital, some within a few hours of the receipt of the notification, and the homes were disinfected as speedily as practicable. During the year 14 cases of Diphtheria ended fatally, giving a Diphtheria death-rate of 0.4 per 1,000 persons living, and a casemortality of 22.2 percent. Nine cases ended fatally at the Bromley and Beckenham Joint Hospital, and one at the Dartford Isolation Hospital,.where a case had been removed in error, the house being near the boundary line of the two Districts. The following shows the age-periods at which the cases and deaths occurred :— 0—1 years 1—5 years 5—!5 years 15—25 years 25—65 years 2 13 35 9 4 =63 cases. 2 4 8 = 14 deaths. 7 Enteric Feyer. Twenty-four cases were notified as follows :— In February 4 cases. „ March 4 „ „ August 2 „ „ September 3 „ „ October 4 „ „ November 3 „ „ December 4 „ 24 cases. They occurred in the various parishes thus:— Chislehurst 9 cases. Cudham 1 case. Downe 1 „ Farnborough 1 „ Foot's Cray 4 cases. Mottingham 1 case. Orpington 2 cases. St. Mary Cray 2 „ St. Paul's Cray 1 case, and 2 cases at the Workhouse Total 24 cases. The fatal cases occurred: one in the parish of Downe, which had been notified in October of the year 1897, and which succumbed to the disease on March 11th, 1898, the patient being a girl, aged 15 years. The remaining two fatal cases were that of a young man, aged 17 years, who had contracted the disease at Malta, and developed it on his return to his home at Chislehurst, and that of a man, aged 47 years, living at St. Paul's Cray. The cases and deaths occurred at the following age-periods:— 1—5 years 5—15 years i5—25 years 25—65 years 2 6 5 11 =24 cases. 2 1 =3 deaths. Erysipelas. Thirty-one cases were reported, one or more in each month of the year, and two of which ended fatally. The first fatal case was in January at Chislehurst, and the second in November at Mottingham. 8 The cases and deaths were reported as occurring at the following age-periods:— year 5—15 years 15—25 years 25—65 years 65 years & upwards 1 4 3 17 6 =31 cases. 1 1 = 2 deaths. B.—Non-notifiable Diseases. Measles was prevalent during the middle of the year, 2 deaths occurring during the second, and 3 during the third quarter. One death occurred at Chelsfield, 3 at Orpington, and 1 at Foot's Cray, and the ages of the patients are shown below :— 0—1 1—5 year years 2 3=5 deaths. Whooping Cough caused 7 deaths, viz.: 2 at Orpington in January, 2 at St. Paul's Cray in January and March, one at Chislehurst in March, and 2 at Mottingham in March. The ages of the patients varied from 7 months to four years. Diarrhcea. The cases of Diarrhoea were excessive during the 3rd quarter of the year, and 16 deaths occurred during that period, which were followed by 3 more in October. The parishes chiefly affected were : Chelsfield with 2 deaths. Farnborough with 1 death. Foot's Cray with 5 deaths. Knockholt with 2 „ Mottingham with 2 „ Orpington with 7 „ Total 19 deaths. Sixteen of the patients were infants under one year of age, 2 between 1 and 2 years of age, and one was over 65 years of age. Influenza. Eight deaths from this disease were returned, one from Chislehurst, one from Farnborough, 2 from Foot's Cray, 2 from Keston, one from North Cray, and one from West Wickham, and the ages of the patients varied from 2 months to 78 years, 9 Isolation.— Eighty-four cases of infectious disease, or a little more than one- half of the notified cases, were removed to the Bromley and Beckenham Joint Isolation Hospital during the year as follows: January 3 (2 Scarlet Fever, one Diphtheria.) February 8 (5 „ „ 2 „ and one Typhoid Fever.) March 4 (3 Scarlet Fever, one Diphtheria.) May 2 (Scarlet Fever.) June 2 (One Scarlet Fever, one Diphtheria.) July 1 (One Scarlet Fever.) August 3 (2 Scarlet Fever, one Diphtheria.) September 4 (4 Scarlet Fever.) October 16 (10 Scarlet Fever, 5 Diphtheria, and one Enteric Fever.) November 21 (2 Scarlet Fever, 18 Diphtheria, and one Enteric Fever.) December 20 (One Scarlet Fever, 16 Diphtheria, and 3 Typhoid Fever.) Total 84 cases. Thirty-eight of those treated were males, and 46 females. The ages of the patients varied from 4 months to 49 years. The longest stay at the Hospital was 86 days, the shortest days, and the average 43 days. Nine deaths occurred at the Hospital, all from Diphtheria, and in addition to these, a patient from St. Mary Cray died at the Dartford Isolation Hospital to which he was removed. Reports.— During the year 1898, I have presented 18 Reports to your Council on various subjects, viz.: 4 on insanitary houses in different parts of the District. 1 on cesspools at Orpington. 1 on drainage of a private school. 4 on the condition of the River Cray. 1 on the condition of the Mottingham Sewers. 2 on the discharge of brewery waste at Green-Street-Green. 1 on manure nuisance at Orpington Station. 1 on an epidemic of Mumps at West Chislehurst. 1 on cottages imperfectly drained at West Wickham. 1 on the drainage at the Union Workhouse. 1 on the Diphtheria Epidemic at Orpington. 10 Inspection.— During the year I made 52 visits of inspection to different parts of the Bromley Rural District, which had reference to insanitary dwellings, infectious disease and and other matters requiring attention. The Parishes in the District are apportioned as follows between the two Sanitary Inspectors:— Mr. Dunlop. Mr. Powell. Chelsfield. Chislehurst. Cudham. Foot's Cray. Farnborough. Mottingham. Keston. North Cray. Knockholt. Orpington. Hayes. St. Mary Cray. Down. St. Paul's Cray. West Wickham. The great increase in the requirements of the parishes on the main sewerage system, and the large amount of re-draining, alterations in defective and insanitary property and other matters render it absolutely necessary that the inspecting staff shall be increased ; this matter is referred to in my recommendations at the end of this report. The Dairies, Cowsheds and Milkshops have been regularly inspected during the year, but there is yet very much to be done in this direction, and cowkeepers, with very few exceptions, have as yet not realised the importance of the provision of proper drainage, ventilation or lighting of the cowsheds, and without workable regulations it is impossible to make adequate improvements, except perhaps with regard to the drainage and water supply. The cubic space, means of ventilation and lighting, are, as a rule, very inefficient. Drainage.— In September a number of complaints were received from inhabitants of Mottingham, on account of the alleged bad smells arising from sewers, drains, or storm water courses. 1 made a detailed inspection of all the manholes, etc., and laid the details before your Council in a Report. On three occasions 1 inspected the effluent from the Oak Brewery, Green-Street-Green, which discharges into a gravel pit 11 close to the road and at times becomes a nuisance. I have recommended that a sewer extension should be made to Green-StreetGreen, which would deal with this nuisance effectually and also supply a much needed main drainage system for that locality. At your request I made a detailed inspection of the drainage at Workhouse at Farnborough, and also of the St. Anne's Orphanage in the same parish. At the former I found the sanitary arrangements in fairly good order, but made a number of recommendations as regards necessary improvements. At the latter institution the sewage disposal is carried out as well as can be, but an improved system is certainly desirable, and the above-mentioned sewer extension, which would pass the front of the Orphanage, and with which the whole of the drainage could connect would be an immense advancement on the existing state of affairs. On several occasions the drainage of houses was overhauled in different parts of the District, where cases of Typhoid Fever had occurred, and all defects found were remedied as speedily as possible. Elementary Schools.— Several schools were closed on account of the prevalence of Measles amongst the scholars, viz.: Infant and Mixed School, Farnborough, from May 9th. to June 6th. Green-Street-Green School, May 9th. to June 6th. Chislehurst Road Board School, Orpington, June 16th. to July 8th. Knockholt School, June 22nd. to July 8th. This school was also closed on account of Scarlet Fever, from October 10th. to November 7th. The Annunciation School, Infants Department, West Chislehurst was closed on account of Mumps from October 31st. to November 21st. Diphtheria necessitated the closure of 3 schools, viz.: Chislehurst Road Board School and Wellington Road Board School, Orpington, from Nov. 14th. to Dec. 23rd., and Hayes School from December 8th for a period of 6 weeks. 12 River Cray.— Several lengthy reports have already been laid before your Council on this matter, and the decision of the Local Government Board, after the Inquiry, held on November 30th, will in some measure be a guide for future action. Unsound Meat.— On August 31st, a quantity of unsound meat was seized by your Inspector, Mr. Dunlop, at a butcher's shop at West Wickham. The case was heard at the Bromley Petty Sessions on Sept. 12th, when the vendor was fined £5 and costs. Nuisance.— On November 3rd, I reported upon a nuisance arising from the unloading of offensive manure at Orpington Station and recommended your Council to make representations to the South Eastern Railway Company with a view of having the nuisance abated. The unloading of manure takes place under more or less objectionable conditions and to a varying extent at all stations in the agricultural, fruit-growing, or hop-growing districts down the line; and although it is of course a necessary evil I think the nuisance might be reduced to a minimum if only the less offensive kinds of manure were delivered in this manner, and more expeditious means were adopted for its removal from the rail and conveyance to the land. It might also be possible for the times of removal to be regulated so that it might be done at night or in the very early morning. The carts might possibly be covered with tarpaulin or some such covering when it is necessary to cart manure through populous places, and certainly some more care should be taken to prevent its being shaken out of the carts as they go along the road, which constantly occurs and often to a considerable extent. Failing these simple means, it will be well to consider what measures can be taken to compel the Railway Companies to provide sidings for unloading, more remote from the passenger platforms. It is difficult to actually prove that this smell is injurious to health, but it certainly constitutes a nuisance, and common sense would suggest that it is at any rate not conducive to health. Some of the so-called stable manure delivered is extremely rank and unpleasant. 13 Insanitary Dwellings.— I had occasion to inspect unhealthy houses on several occasions. On January 25th, I reported on the state of a cottage at North Cray which I had inspected on the previous day, and which I found in a state unfit for habitation. In February my attention was called to a group of houses at Farnborough. and I reported to your Council the condition I found them in, recommending substantial alterations. In July I inspected a small house in Foot's Cray, occupied by a man, wife and grand-daughter, and which was totally unfit for habitation. A further inspection of unhealthy houses was made in August at Chelsfield, and I laid the details of my inspection before your Council in a report dated August 31st. I also reported on insanitary houses at West Wickham and Farnborough at the end of the year, and in all there cases repairs and alterations were carried out as seen in your Inspector's Reports. Recommendations. The number of houses, particularly in the sewered portions of the District, with deficient and defective drainage renders the amount of detailed inspection very heavy. This is materially increased by the fact that in rows of houses the testing and reconstruction of the drains can only be done in sections, as some portion must be left available for the use of the occupiers, consequently several visits are required in such cases. It is quiet impossible for the already overworked Inspector to cope with the work and carry out much more which is needed. I beg, therefore, to suggest that an assistant be appointed to work under Mr. Powell's supervision, and that such assistant, among other duties, be especially delegated to carry out the fumigation of the houses where infectious disease has occurred, and also the disinfection of bedding and infected clothes by means of a steam disinfector, should you see fit to provide this much needed adjunct. I have already brought to your notice in reports made during the latter part of the year, the necessity for the further adoption of Building Bye-laws, notably in the parishes of Farnborough and Chelsfield. 14 Bye-laws for securing the decent lodging and accommodation of hop pickers have been in force in this District since the year 1875, but as a great number of persons come into the District for fruitpicking, the District Council have thought it desirable to extend these bye-laws to include those engaged in the picking of fruit and vegetables. These bye-laws are now framed, and only await the sanction of the Local Government Board. Mr. Powell's and Mr. Dunlop's Reports of work done during the year, and the customary Tables and Vital Statistics are appended. I have the honour to be, Gentlemen, Your obedient servant, JAMES SCOTT TEW. March nth, 1899. 15 BROMLEY RURAL DISTRICT COUNCIL. To the Chairman and Members of the BROMLEY 11URAL DISTRICT COUNCIL. GENTLEMEN, I have the honour to present to you my Annual Report tor 1898. The number of visits made to the Parishes was as follows:— Chelsfield, 4; Chislehurst, 114; Cudham, 1; Downe, 1; Farnborough, 4; Foot's Cray, 101; Hayes, 5; Mottingham, 36; North Cray, 45; Orpington, 129; St. Mary Cray, 86; St. Paul's Cray, 58; West Wickham, 5. Complaints.—Sixty-seven complaints were received and investigated. Of these, 20 related to accumulations of house refuse; 10 to defective drainage; 2 to damp houses; 10 to smell from sewer gratings; 2 to animals kept in a filthy condition; 19 to offensive accumulations; 1 to cesspool overflowing; 2 to smoke nuisances; and 1 to a fish frying nuisance. Water Supply.—Owing to the drought in the Cray Valley, a large number of wells failed, and also several springs, with the result that 35 houses have had a supply laid on from the mains. A large number of other houses had also to have a supply from this source, but they did not come directly under my notice. Infectious Disease.—One hundred and fifteen cases of Infectious Disease have been dealt with. It was found necessary to fumigate 95 houses, the fumigation being carried out with liquified Sulphur Dioxide, the clothing, etc., being disinfected with a solution of Perchloride of Mercuiy. Several applications from large houses were made to have the bedding, etc. disinfected by means of a steam apparatus, but their applications could not be acceded to, owing to one not being available in the District. The fumigation of rooms takes up a good deal of valuable time, and it may be necessary in the near future, to ask your Council to relieve me of this work. 16 Drainage and Drain Testing.—The drains of 127 premises have been examined and tested, and it has been necessary to re-construct the same. In most cases they were found to be very faulty, owing to the pipes having insufficient fall, being badly jointed, and having no ventilation. The work of drain testing has not by any means been confined to cottage property, several large houses having been dealt with during the year, and it is possible that an increase of work in this direction will take place in the future. The water test is still applied to all new drains. A large number of visits have had to be made to the various houses, and I have had great difficulty in coping with this work. Owing to most of the premises being occupied during the reconstruction, it is necessary to test the drains in sections, so as to cause as little inconvenience to the occupiers as possible. I am glad to say that the Owners fall in with the view of providing a large number of inspection chambers to the drains, and this will no doubt assist them very materially in removing any obstruction that may occur, and do away with the usual tapping of pipes, which, to say the least, is a dangerous practice. During the time I have been in the service of your Council, 272 houses have been re-drained, and it has been found necessary to serve only 14 statutory notices, a fact I think that speaks for itself, and in no case have legal proceedings been resorted to. The work in connection with the 33 premises outstanding in my last report, has been completed. The drainage to a further 86 premises has been re-constructed during the year, and at 29 other premises the work of re-construction is well in hand. The manner in which the drainage of the 119 premises has been dealt with is as follows:— 90 premises were re-drained by Verbal notice or by corresponding with the Owners. 9 by preliminary notices. 10 by legal notices. In addition to the above drainage work, reports were made to your Council on houses on the line of the Crofton New Sewer. Most of these are now connected to this sewer, the work being done under the supervision of your Surveyor, Mr. W. J. Winter. 17 Insufficient Waterclosets.—Flushing cisterns with water laid on thereto, new soil-pans and traps have been provided at 112 houses. Insufficient Ashpits.—One hundred and seventy one houses have been provided with moveable receptacles. Common Lodging-houses, Slaughter-houses, Bake-houses, and Cowsheds.—One hundred and thirty-two visits have been paid to these places during the year. The Common Lodging-house at Foot's Cray, in the parish of Chislehurst, has been closed during the year owing to the premises having become unsuitable for the purpose intended. Factory and Workshops Act.— Twelve dressmaking establishments have been inspected and 22 laundries. Several were found without the necessary regulations, and in each case they were immediately obtained. Defective sanitary arrangements have been dealt with at five premises Bye Laws.—-The new Bye-laws for securing the decent lodging and accommodation of persons engaged in hop, vegetable, and fruit picking having been sanctioned, it is hoped the owners of temporary shelters will give effect to the wishes of your Council, and that an appreciative improvement will be made during the coming year. Houses Unfit for Human Habitation. It has been found necessary to bring to the notice of the Medical Officer of Health, several houses unfit for human habitation, and he will no doubt deal with this matter in his report. Unfortunately, no small houses are being built in my district, and the question of the Housing of the Working Classes Act, 1890, will I hope obtain the favourable consideration of your Council. River Cray.— During the summer, as your Council are well aware, the river became in a bad condition owing to the failure of several springs, and as a result frequent visits were made both by the Medical Officer of Health and myself. Numerous reports were submitted as to its condition and several plans suggesting improvements. And with a view of carrying out the work suggested, an application was made to the Local Government Board for the sanction of a loan, but up to the end of the year the Board's decision had not been received. 18 Summary of Work Done. Number of complaints received and investigated 67 Nuisances discovered 272 Nuisances abated without report 251 „ after report 12 Preliminary notices served 67 Legal notices served 16 Notices served dealing with insufficient waterclosets 3 „ „ „ ashpits 86 No. of letters written 985 Character of Work done. Houses cleansed and generally repaired 36 Cowsheds, slaughter-houses and bake-houses cleansed 61 Overcrowding abated 4 Houses underpinned and damp-proof courses inserted 2 Ventilation of houses improved 2 Defective roofs and gutters repaired 19 Indoor soil-pipes abolished and new ones provided outside and ventilated 3 D traps abolished 5 Privies or earthclosets converted into waterclosets 7 Privies constructed with small removable receptacles or converted into earthclosets 7 Bath, lavatory and sink waste pipes disconnected from drains and caused to discharge over gully traps 10 Bell traps abolished and gully traps substituted 58 Houses supplied with water from main 35 Dustbins provided 171 Water laid on to waterclosets 112 Cesspools cleansed 11 Cesspools abolished 7 Privies cleansed 19 Houses at which drains were examined and tested 127 Houses at which drains were found defective 127 Houses at which drains were reconstructed or new ones provided 119 Houses at which drains were cleansed, ventilated, trapped and repaired 67 Number of tests made in course of work under the two previous headings 198 Urinals cleansed and repaired 1 Offensive accumulations removed 21 19 Premises from which animals, improperly kept, were removed 7 Paving of piggeries repaired 2 Infected houses fumigated and cleansed 95 New waterclosets provided 12 New wash-houses provided 7 I have the honour to remain, Gentlemen, Your obedient servant, WILLIAM GEORGE POWELL, (Assoc. &> Cert. Sanitary Institute.) Inspector of Nuisances. 20 BROMLEY RURAL DISTRICT COUNCIL. No. 2 DISTRICT. Office of Inspector of Nuisances, 2, Chester Villa, Wellbrook Road, Farnborough, R.S.O., Kent. To the Chairman and Members of the BROMLEY RURAL DISTRICT COUNCIL. GENTLEMEN, 1 have the honour to present to you my first report, (July 6th to December 31st, 1898). Inspections.—The number of inspections made in the several parishes in my District during this period were as follows:— Chelsfield, 26; Cudham, 14; Downe, 19; Farnborough, 65; Hayes, 15; Keston, 31; Knockholt, 14, and West Wickham, 43. Complaints.—Fifty-five complaints were received and investigated. Of these, 20 related to cesspools; 18 to defective drainage; 8 to offensive accumulations; 4 to animals kept so as to be a nuisance; 3 to water supply, and 2 to offensive ponds. Infectious Disease.—Thirty-eight cases of infectious disease have been notified and dealt with in No. 2 District since my appointment, namely :—Scarlet Fever, 16; Diphtheria, 13; Erysipelas, 8; and Enteric, 1. Thirty houses were fumigated with liquid Sulphur Dioxide; the clothing, etc. was disinfected with a solution of Perchloride of Mercury. The total number of infectious cases notified in this District during the year was 52, made up as follows:—Scarlet Fever, 21; Diphtheria, 14; Erysipelas, 12; Typhoid, 3, and Enteric, 2. Total number of houses disinfected, 40. Factory and Workshops' Act.—Sixteen Laundries have been inspected, in two cases, nuisances arose from ineffectual drainage, and this has since been rectified. 21 Eleven Slaughter-houses and 17 Hake-houses are regularly inspected; and the cleansing and limewashing of these premises at least twice a year, is stringently enforced. During one of my visits to a Slaughter-house, I found a quantity of putrid meat exposed for sale, which I seized. The Butcher was summoned, and fined £5 and costs. Dairies and Cowsheds, Milk Shops' Order, 1885.—Eleven persons are engaged in the Milk trade, and under supervision. The Cowsheds and Dairies are cleansed and limewashed at least twice in each year, viz.: April and October. Summary of Work Done. No. of complaints received and investigated 55 Nuisances discovered 137 Nuisances abated without report 127 „ after report 10 Preliminary notices served 50 Legal notices served 10 Nuisances being dealt with at the end of the year 12 Character of Work done. Water Supply:— Number of houses supplied from waterworks 8 Houses:— Number cleansed and limewashed 24 „ closed as unfit for habitation 2 „ made fit for human habitation 2 Overcrowding:— Number of cases abated 2 House Drains:— Number laid or relaid and tested 32 „ cleansed, trapped and ventilated 16 „ of defective waste pipes rectified 8 „ of insanitary lavatories, sinks & urinals rectified 6 Privies and Ashpits:— Number of combined privies and ashpits provided 4 „ converted to w.c. or slop closets 12 Water Closets:— Number of additional waterclosets with flush cisterns provided 26 Number repaired and ventilated 8 22 Accumulation of Offensive Refuse:— Number of cases of removal on notice 48 Animals kept as to be a Nuisance:— Number of cases of removal on notice 4 Food:— Number of seizures as unfit for consumption 1 Clerical Work:— Number of official letters written 300 I have the honour to remain, Gentlemen, Your obedient servant, ANDREW DUNLOP, (Assoc. & Cert. Sanitary Institute.) Sanitary Inspector. 23 Supplementary to Annual Report, January 1st to December 31st, 1898. NO. 2 DISTRICT. Inspections.— The total number of inspections made in the several Parishes during the year were as follows: Chelsfield 51, Cudham 31, Downe 37, Farnborough 80, Hayes 40, Keston 37, Knockholt 30, and West Wickham 74. Complaints.- Eighty complaints were received during the year and investigated; 30 related to cesspools, 23 to defective drainage, 18 to offensive accumulations, 4 to animals kept so as to be a nuisance, 3 to water supply, and 2 to offensive ponds. Factories and Workshops Act.—See previous Report. Dairies, Cowsheds and Milkshops Order, 1885.—See Previous Report. Infectious Cases.—See previous Report. Summary of Work Done. Total No. of complaints received and investigated 80 „ „ nuisances discovered 173 „ „ nuisances abated without report 153 „ „ nuisances abated after report 20 „ „ preliminary notices served 55 „ „ legal notices served 13 „ „ nuisances being dealt with at the end of the year 12 Character of Work Done. Water Supply:— Total No. of houses supplied from Waterworks 12 Houses:— Total No. cleansed and limewashed 34 „ „ closed as unfit for habitation 2 „ „ made fit for habitation 2 24 Overcrowding:— Total No. of cases abated 2 House Drains:— Total No. laid or re-laid and tested 50 „ „ cleansed, trapped and ventilated 24 „ „ of defective waste pipes rectified 16 „ „ of insanitary lavatories, sinks and urinals rectified 10 Privies and Ashpits:— Total No. converted to waterclosets or slop closets 30 „ „ repaired and ventilated 12 ANDREW DUNLOP, Sanitary Inspector. 25 TABLE I. The number of deaths from all causes, and from the seven principal Zymotic Diseases with their Death-rates; the principal causes of Death, and the Infant Mortality in the Bromley Rural District, in each Quarter of 1898. Quarters. Total Deaths. Death-rate per 1000. Death from 7 principal Zymotics. Zymotic Death-rate. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Cholera. Erysipelas. Measles. Whooping-cough. Diarrhoea. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia. Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Deaths of Infants under 1 year per 1000 births. 1St. 113 12.9 10 1.2 ... ... 2 1 ... ... 1 ... 7 ... ... 8 20 ... 5 8 1 60 156 2nd. 71 8.5 2 0.2 ... ... ... ... ... ... ... 2 ... ... ... 8 7 ... 10 ... 2 42 64 3rd. 120 14.2 19 2.4 ... ... ... ... ... ... ... 3 ... 16 ... 9 8 ... 11 ... 2 71 186 4th. 97 10.7 17 2.1I ... ... 12 2 ... ... 1 ... ... 3 ... 4 13 ... 8 ... ... 54 109 Total 401 11.6 48 1.5 ... ... 14 3 ... ... 2 5 7 19 ... 29 48 ... 34 8 5 227 129 26 TABLE II. Deaths from Zymotic Diseases during the past ten years, and in 1898. Zymotic Diseases. 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 Average of 10 years. 1898 Small-pox ... ... ... ... 1 ... ... ... ... ... 0.1 0 Scarlet Fever ... 2 ... ... 1 3 2 2 2 3 1.5 0 Diphtheria 5 14 6 5 9 16 19 4 5 6 8.9 14 Fevers 3 1 2 1 2 1 6 ... 2 1 1.9 3 Measles ... 1 8 8 2 7 1 3 14 11 5.5 5 Whooping-cough 9 5 15 14 2 10 7 5 3 21 9.1 7 Diarrhœa 8 9 2 1 6 9 6 12 8 9 7.0 19 Total of Zymotics 25 32 33 29 23 46 41 26 34 51 34.0 48 Other Zymotics 4 7 8 6 26 22 11 15 6 8 11.3 10 Totals 29 39 41 35 49 68 52 41 40 59 45.3 58 27 TABLE III. The number of deaths from all causes, and from the seven principal Zymotic Diseases in the Parishes of the Bromley Rural District in 1898. The number of deaths from all causes, and from the seven principal Zymotics, include in each parish those outside the parish among persons belonging thereto, and the parishes are ranged in order of their general death-rates. Parishes. Population Census, 1891. Total Deaths. Death-rate per 1,000. Deaths from seven principal Zymotics. Zymotic Death-rate Cudham 1103 7 5.8 0 0.0 West Wickham 1262 11 7.1 2 1.2 Knockholt 872 9 8.0 3 2.0 Farnborough 1627 15 8.2 3 1.6 Hayes 804 8 8.3 0 0.0 Chislehurst 6557 64 8.6 2 0.2 Downe 581 8 11.4 1 1.4 Mottingham 1037 15 11.5 4 3.0 Foot's Cray 3487 58 12.0 7 1.5 St. Mary Cray 1988 28 12.6 1 0.4 Chelsfield 1122 17 13.0 2 1.5 Orpington 4099 75 15.2 19 3.8 Keston 746 15 17.0 0 0.0 St. Paul's Cray 1028 29 22.5 4 3.1 (A) TABLE OF DEATHS during the Year 1898, in the Bromley Rural Sanitary District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Mortality from All Causes, at Subjoined Ages. Mortality from Subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Smallpox. Scarlatina. Diphtheria. Membranous Croup. fevers. Cholera. Erysipelas. Measles. WhoopingCough. Diarrhœea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Chelsfield 15 3 2 .. 1 4 5 Under 5 .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 .... .... .... .... .... .... 3 5 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 2 1 .... 1 5 10 Chislehurst 57 17 5 3 3 13 16 Under 5 .... .... .... .... .... .... .... .... .... .... 1 .... 1 .... .... 1 1 .... .... .... 18 22 5 upwds. .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... 5 3 3 1 .... 22 35 Cudham 6 .. .. 1 .. 1 4 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... 5 6 Down 7 .. .. .. 1 3 3 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 upwds. .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... 2 1 .... .... .... 3 7 Farnborough 11 3 .. .. .. 5 3 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... .... 2 3 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 2 1 .... 2 8 Foot's Cray 51 16 3 1 2 9 20 Under 5 .... .... .... .... .... .... .... .... .... .... .... 1 .... 4 .... .... 1 1 1 .... 11 19 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 3 5 4 1 .... 18 32 Hayes 6 .. .. .. .. 3 3 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 1 .... .... 3 6 Keston 14 4 .. .. .. 5 5 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 4 4 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 3 2 .... 3 10 Knockholt 8 5 .. .. .. .. 3 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... 3 .... .... .... .... .... .... 2 5 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... 2 3 Mottingham .. 13 3 2 .. 2 4 2 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 1 .... .... .... 5 5 upwds. .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... 1 .... .... .... .... 6 8 North Cray 7 2 .. 1 .. 2 2 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... 1 .... .... 2 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 .... .... .... 3 5 Orpington 58 16 8 7 3 18 6 Under 5 .... .... .... .... .... .... .... .... .... .... .... 3 2 7 .... .... 6 .... .... .... 6 24 5 upwds. .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... 5 3 4 .... 1 20 34 St. Mary Cray.. 24 7 3 1 .. 7 6 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... 9 10 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 4 3 .... .... 5 14 St. Paul's Cray 28 8 4 2 3 9 2 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... 2 .... .... 1 4 .... .... .... 5 12 5 upwds. .... .... 1 .... .... 1 .... .... .... .... .... .... .... .... .... 1 1 2 .... 3 7 16 West Wickham 11 2 4 .. .. 2 8 Under 5 .... .... 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 4 0 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 2 1 .... 1 5 Workhouse 75 3 3 .. 1 26 42 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 .... .... .... 4 6 5 upwds. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 4 6 .... .... 54 69 Totals .. 391 89 34 16 16 111 125 Under 5 .... .... 2 .... .... .... .... .... .... .... 1 5 7 18 .... 3 16 1 2 .... 68 123 5 upwds. .... .... 2 .... .... 3 .... .... .... .... 1 .... .... 1 .... 26 32 33 6 5 159 268 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district to persons belonging thereto. 10 1 3 6 .. .. .. Under 5 .... .... 4 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 4 5 upwds .... .... 6 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 6 Deaths occurring within the district to persons not belonging thereto. 34 •• 1 .. 1 15 17 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 5 upwds .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 2 .... .... .... 28 33 (B) Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Bromley Rural Sanitary District; classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases .Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Last Census. Estimated to middle of 1898. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fever*. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing Puerperal Typhus. Enteric or Typhoid. Continued. Relapsing Puerperal Chelsfield 1122 1305 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 5 2 .. .. .. .. .. .. .. 2 .. .. .. 4 2 .. .. .. .. .. .. .. .. .. .. Chislehurst 6557 7370 Under 5 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 7 4 .. .. 9 .. .. .. .. 6 .. .. .. 3 1 .. .. 2 .. .. .. .. .. .. .. Cudham 1103 1199 Under 5 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 .. .. .. 1 .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. Downe 581 696 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Farnborough 1627 1816 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 1 .. .. 1 .. .. .. .. 5 .. .. .. 2 1 .. .. .. .. .. .. .. .. .. .. Foot's Cray 3487 4651 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 7 6 .. .. 4 .. .. .. .. 3 .. .. .. 3 5 .. .. 2 .. .. .. .. .. .. .. Hayes 804 960 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. Keston 746 878 Under 5 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 5 upwds .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Knockholt 872 1012 Under 5 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 6 .. .. .. .. .. .. .. .. 1 .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. Mottingham 1037 1300 Under 5 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 1 .. .. 1 .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. North Cray 549 460 Under 5 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Orpington 4099 4905 Under 5 .. 2 9 .. .. .. .. .. .. .. .. .. .. .. 1 9 .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 5 18 .. .. 2 .. .. .. .. 6 .. .. .. 5 15 .. .. .. .. .. .. .. .. .. .. St. Mary Cray 1988 2127 Under 5 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 5 .. .. .. .. .. .. .. 2 .. .. .. 1 4 .. .. .. .. .. .. .. .. .. .. St. Paul's Cray 1028 1286 Under 5 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 5 upwds. .. .. 4 .. .. 1 .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. West Wickham 1262 1548 Under 5 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Workhouse Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 1 1 •• •• 2 .. .. .. .. l .. .. .. 1 1 .. .. 2 .. .. .. .. .. .. .. Totals 26852 31513 688 Under 5 .. 5 15 .. .. 2 .. .. .. .. 1 .. .. .. 4 11 .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 42 48 .. .. 22 .. .. .. .. 30 .. .. .. 29 34 .. .. 6 .. .. .. .. .. .. ..