BRo 63 Brough of Bromley. THE ANNUAL REPORT on the HEALTH and SANITARY CONDITION of the BOROUGH, FOR THE YEAR 1904, by ARTHUR F. G. CODD, m.b., f.r.c.s., san. sci. cert., MEDICAL OFFICER OF HEALTH. Bromley, kent. Strong & Sons, Ltd., 39, East Street. 1905. Borough of Bromley. THE ANNUAL REPORT on the HEALTH and SANITARY CONDITION of the BOROUGH, FOR THE YEAR 1904, by ARTHUR F. G. CODD, m.b., f.r.c.s., sam. sci. cert., MEDICAL OFFICER OF HEALTH. ®romlcB, H?ent. Strong & Sons, Ltd., 39, East Street. 1905. Brought of Bromley. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR, 1904. To the Mayor and. Corporation of Bromley. March 31st, 1905. Gentlemen, I have the honour to present to you my Sixteenth Annual Report relating to the year ended December 31st, 1904. VITAL STATISTICS. For the purposes of statistics the population is always calculated for the middle of the year. At the census taken April 1st, 1901, our population was 27>354< being an increase since the previous census of 5,669. On the supposition that the rate of increase has been maintained, the population in the middle of 1904 may be approximately estimated at 29,222. The Borough comprises 4,706 acres, having a population of 6.2 persons to the acre. 4 Births. The births during the year were 669, of which 348 were males and 321 were females; this gives a birth rate of 22.8 per 1,000 compared with a rate of 27.9 for England and Wales, and 29.1 for the Outer Ring of London. The mean birth rate for 10 years, 1894-1903, was 24.0, against 29.2 for England and Wales in the same period. The Outer Ring is that portion of the Metropolitan Police District which is outside the district of Registration London, and includes such districts as Croydon, Wimbledon, Richmond, Beckenham, Uxbridge, Harrow, Enfield, and Walthamstow, many of which may be fairly compared, from a health point of view, with our own district. Our birth rate continues to show a steady decline. This is partly to be explained by the fact that Bromley is a residential locality where large numbers of unmarried servants are employed, and that many of the residents are of middle age, having moved out here from the districts nearer London in which the earlier and reproductive years of their married life were spent. 17 illegitimate births were registered, i.e., 2.5 percent. of the total number of births. Marriages. During the year there were registered 238 marriages, of which number: — 156 took place in churches of the Established Church. 17 took place in Nonconformist Churches and the Roman Catholic Church. 65 took place in the Superintendent Registrar's Office. 5 The marriage rate for Bromley was therefore 16.2. The rate for England and Wales for the year ending September 30th was 15.2. The mean marriage rate in Bromley for the 10 years, 18941903, was 17.6, against a mean rate in England and Wales for the same years of 15.8. Deaths. The number of deaths registered in the Borough was 282. To this number must be added the deaths of 31 Bromley persons which occurred in our Union Infirmary, which is outside the district, and 9 must be deducted which occurred in the Infectious Hospital and local institutions, these persons not belonging to the district. There is no means of ascertaining the total number of Bromley residents who may have died away from the district. We have thus a total of 304 deaths, of which 149 were males and 155 were females, which is equal to a recorded death rate of 10.40 per 1,000. The death rate for England and Wales was 16.2, and for the Outer Ring of London 13.2. The mean death rate for 10 years, 1894-1903, in Bromley was 11.5. Years. Death Rate. 1894 13.0 1895 11.2 1896 11.8 1897 10.4 1898 11.9 1899 12.5 1900 11.8 1901 11.3 1902 10.8 1903 10.7 6 The death rates in the 10 years prior to the above were higher than these. Up to and including the year 1900 I have corrected the death rates to correspond with the census returns of population, and for these years the death rates are absolutely correct. In the year 1897 the death rate, to be exact, was 10.42, so that this year, with our death rate at 10.40 per 1,000, we have the pleasure of recording the lowest death rate in Bromley for at least 20 years, and probably, if the figures could be obtained, the lowest death rate ever recorded here. The estimate of our population can never be quite exact in the years between one census and another, and in stating the above figure I have based my calculation on the supposition that the rate of increase of population in Bromley has corresponded with that of the intercensal period 1891-1901. But there is good reason to believe that since the last census our population has increased in a much larger ratio. Comparing the figures in the building register since the year 1891, the number of new houses since 1901 has increased in far larger proportion than in the years 1891-1901. My estimate of our present population must therefore be a low one, and, if that be so, our death rate would be still smaller than I have calculated. It appears to me that it may be necessary in the future to estimate the population on another basis. In any given district, as the data from which the death rate is calculated are practically similar every year, a comparison of the death rate in various years is instructive, but it must be remembered that a comparison of the death rate of our district with that of another is very liable to be fallacious, if one wishes 7 to compare the healthiness of the respective districts. Not only should one scrutinize the figures upon which the calculation is based, but one should compare the individual factors which make up the total. Moreover, the age, sex, occupation and social advantages of the residents of a district have often more influence on the death rate than the situation, soil, or even sanitation. I make these remarks, not to minimise the satisfactory aspect of our health report this year, but merely to call attention to these points in order that wrong inferences may not be drawn from the figures given. The excess of births over deaths was 365, being a natural increase in the population of 12.4 per 1,000. The number of deaths in the various wards of the Borough was as follows:— Town Ward 46 Plaistow Ward 47 Bickley Ward 49 Sundridge Ward 30 Bromley Common Ward 79 Martin's Hill Ward 49 300 Tn addition there were 4 deaths in the Workhouse which I could not apportion to any ward. Owing to building having taken place much more rapidly in some wards compared with others, I have been unable to estimate the population, and therefore the death rates in the respective wards. 8 Deaths under 5 years of age, 111. Deaths over 5 years of age, 193. The proportion of deaths under one year of age to registered births (i.e., the infant mortality) was 131 per 1,000, compared with 146 per 1,000 for England and Wales. DEATHS PROM ZYMOTIC DISEASES. The deaths from all causes included:— Rate per 1000. England Bromley, and Wales. From Scarlet Fever 1 .03 .11 „ Measles 3 .1o .36 „ Whooping Cough 11 .37 .34 „ Enteric Fever 2 .06 .09 „ Diarrhæa 24 .82 .86 There were no deaths from smallpox or diphtheria. Thus 41 deaths were attributed to these principal zymotic diseases, being at the rate of 1.40 per 1,000, compared with a rate of 1.94 for England and Wales, and 2.19 for the Outer Ring of London. Mean of 10 years. Death Rate. Zymotic Death Rate. 1884-1893 12.9 l.6o 1894-1903 11.5 1.57 Generally speaking, the effects of sanitary improvements and precautionary methods are best indicated by a lower death rate from Infectious Diseases, Fever, Diarrhœa, Consumption, and amongst children under 5 years of age from all causes. I therefore show these rates in Bromley during the last 10 years. 9 ■ ' Death Rate from certain diseases in Bromley during the last 10 years. 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 '94.03 1904 Infectious Diseases 1.70 1.03 2.50 1.18 2.20 2.54 1.52 .90 .85 1.32 1.57 1.40 Fever .2 .08 .04 .03 .07 .07 .03 .10 .03 .06 .06 .06 Diarrhoea .4 .73 .39 .66 1.40 1.77 .54 .50 .32 .83 .75 .82 Consumption .7 .73 .91 .81 .71 .96 .72 .90 .74 .45 .75 .51 Children under 5 years of age, from all nauses 3.9 3.9 4.6 3.2 5.0 4.3 3.4 3.30 3.16 4.08 3.8 .79 JOINT ISOLATION HOSPITAL—accommodating 113 Beds. Districts. Population, 1901 Census. Admissions Deaths. Scarlet Fever. Diphtheria Enteric. Erysipelas. Scarlet Fever. Diphtheria Enteric. Erysipelas. Bromley Urban 27,354 27 9 1 2 .. .. 1 .. Beckenham Urban 26,330 32 25 2 2 .. 4 .. .. Chislehurst Urban 7,429 51 2 .. .. .. .. .. .. Bromley Rural 24,636 22 27 1 .. .. 2 .. .. Foot's Cray Urban 3,487 3 .. 1 .. .. .. .. .. 10 INFECTIOUS DISEASES. Under the Infectious Diseases (Notification) Act, 78 cases of the diseases to which this Act applies were reported during the year. The following shows the number of cases reported during the last 5 years:— 1900 1901 1902 1903 1904 Scarlet Fever 50 58 52 39 31 Diphtheria 33 36 38 9 13 Erysipelas 21 21 29 21 24 Enteric Fever 8 8 8 2 9 Puerperal Fever 0 1 1 3 1 Small Pox 0 10 25 2 0 112 134 153 77 78 Of the 78 cases, 39 were removed to the Isolation Hospital and 39 were treated in their own homes. The 78 cases occurred in 68 houses. The accommodation in the Infectious Hospital has not been increased, as it is found to be quite sufficient for the present needs of the districts which it serves. Tenders are being invited for the erection of the new Smallpox Hospital, which is to be situated some half-mile from the Isolation Hospital. The following table shows the time of occurrence of the infectious cases:— 11 Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept Oct. Nov. Dec. Totals Scarlet Fever 2 1 4 1 3 4 2 3 - 2 3 4 31 Diphtheria 1 - - 1 — — - 2 — 3 4 2 13 Enteric — - — 1 — 1 3 1 1 — 2 — 9 Puerperal — - - — — - — — 1 — — - 1 Fever Erysipelas 2 3 - 2 1 1 1 3 1 5 1 4 24 5 4 4 5 4 6 6 11 3 10 10 10 78 The removal of patients is promptly arranged by telephonic communication with the Isolation Hospital. The premises are disinfected directly after the patient's removal. For this purpose formaldehyde (30 tablets per 1,000 cubic feet) is employed, the walls being previously sprayed with a 2 percent. solution of Schering's Formalin. The notices required to be used in c?ses of infectious disease, containing instructions to householders and the precautions to be observed, have been thoroughly revised. SCARLET FEVER. Average of the 10 years, 1894-1903 = 80.9 cases. 31 cases were notified during the year—27 of these were removed to the Isolation Hospital, and the others were treated in their own homes. The disease was of a mild type, there being only ore death. 80 percent. of the cases occurred in the houses of the working classes. 12 The cases were sporadic, and infection of other members of the family affected was exceptional. Although careful enquiry was made in each case, the source of infection was rarely traced. No "return" cases of scarlet fever occurred during the year. MEASLES. This disease is not compulsorily notifiable under the Act. It was very prevalent in the district in the last quarter of the year, and it became necessary to close some of the Public Elementary Schools for a time. It was the cause of 3 deaths. DIPHTHERIA. Average of the 10 years, 1894-1903 = 25.7 cases. 13 cases were notified. There were no deaths. 9 were removed to the Isolation Hospital, and the others were treated at home. 11 of the cases occurred among the children of the working class. They were all sporadic cases. 12 swabs were submitted to the Clinical Research Association, and specific organisms were reported to be present in 5 instances. ENTERIC FEVER. Average of the 10 years,1894-1903 = 8.7 cases. 9 cases were notified, of which 2 died. 2 were removed to the Isolation Hospital, 2 were treated in the Cottage Hospital, and the others in their own homes. 13 2 were almost certainly contracted outside the district, as they had been staying away from home just before their illness. In 2 instances serious drainage defects were found to exist in the houses, and no other cause was discoverable. One of these cases was not suspected for some time to be enteric, until 3 other persons in the same house later on fell ill with the disease. They probably owed their origin to direct infection. In another case no cause was ascertained beyond the fact that the patient was stated to have been in the habit of eating cheap shell-fish. In one case no clue whatever was found. DIARRHŒA. The most unsatisfactory part of my report is the high mortality from zymotic diarrhoea, the number of deaths of infants and young children from this disease, viz., 24, being exactly the same as in the year 1903. This is excessive and calls for serious consideration. It is true that the mortality from diarrhoea in London and the Outer Ring in the third quarter of the year was also very heavy, but when one considers that in Bromley we are dealing with a district which has many advantages fr 111 a healih oi t of view compared with a large citv with its overcrowding, poverty, and slums, we cannot be satisfied that everything possible has been done to cope with this dread disease. In the autumn, owing to the great prevalence of diarrhœa and the large number of deaths, I made a special report on the subject. The source of milk supply was ascertained in each of the fatal cases, but nothing was found to prove that any one supply was specially in fault. 14 In my annual report for 1903 I pointed out how grossly inadequate are the measures at present taken by the milk vendors generally throughout the country to provide the public with pure milk. I have constantly impressed on parents the absolute necessity of using nothing but efficiently boiled milk for their children, especially during the months of August and September, the time at which these cases occur with fatal regularity. The difficulty is to arouse sufficient interest among the poorer classes, who are those who suffer most. I suggest as an additional measure this year that the Corporation should have large posters displayed in the town and in prominent places in the poorer districts calling attention to the danger to which infants and young children are exposed through want of necessarv precautions. In the hot months of the year, the milkman who on his rounds would supplv to those of his customers who require it freshly boiled or pasteurised milk, instead of stale milk laden with preservatives, might extend his business and gain some credit bv supplying an article of food which, although not free from objection would be far safer for consumption than the poisonous supply at present given us. What is really needed is the prohibition by law of the use of any kind of preservative whatever in milk. The farmers who send their milk by rail would be thus compelled in their own interests to see that the milk was collected in a cleanly manner, and was subjected to refrigeration and cold storage before and during distribution. The prohibition of the use of preservatives would have more effect in promoting cleanlv methods in the dairy farms than the system of compulsory 15 forcement of the present regulations under the Dairies, Cowsheds, and Milkshops Order. INFANT MORTALITY. Our infant mortality figure stands at 131, which is much higher than it should be. The influence of diarrhoea in raising it to this height has been already considered. But there are many other causes from which large numbers of infants die in this district every year. A large proportion of these are preventable, and the children's lives in most of the cases could have been saved by attention on the part of the parents to the elementarv principles of the laws of health. Many of the children who survive their illnesses suffer much in after life as a result of this neglect, growing up weakly and stunted. It is difficult to inculcate the importance of observing the rules of health upon adults who have grown up in ignorance of them, but much good would accrue by instructing the children on these subjects in the schools and by training them in the elementary principles and practice of domestic hvgiene. The matter has an important bearing on the future health of the community, and I would suggest to the Council that some steps should be taken to include such training in the education of our Bromley children. As regards the instruction of young women and mothers I think it might be advantageous to arrange for a short course of attractive lectures in the poorer districts on First Aid to Infants. There seems to me no reason why such lectures should not become as popular as First Aid for the Injured is among some of the well-to-do classes. They are certainly very urgently 16 needed, and I recommend the matter to the consideration of the Council. CONSUMPTION. In September the Council decided to adopt a system of Voluntary Notification of Consumption. The medical men of the district have all agreed to this, and a register is now kept of the cases notified. It is felt that the information so given is private, and the action of the Sanitary Authority Is only exercised in those cases in which through poverty or ignorance it is considered that the health of others may be in risk. Up to the end of the year only eight cases had been notified, and I think it would be well if the medical men were periodically reminded by circular of the arrangement to which they have agreed. During the year there were 15 deaths from consumption registered. RAINFALL. I am indebted to Mr. James Batten. J.P., of the High Field, Bickley, for the following particulars of the local rainfall. Inches. Inches. January 3.23 July 1.55 February 3.18 August 1.55 March 1.64 September 1.17 April .99 October 2.03 May 2.15 November 1.54 June .90 December 2.48 Total local rainfall, 22.41 inches. Total Greenwich rainfall, 20.67 inches. The mean rainfall for the years 1894.1903 was—local (elevation 200 ft.), 24.7 inches; Greenwich (elevation 159 ft.), 22.9 inches, showing that our mean rainfall is nearly two inches more than that of Greenwich, 17 WATER. Samples of water taken at regular intervals during the year from the mains of the Kent Water Company for bacteriological examination showed the water to be very pure. The number of micro-organisms which produced colonies when incubated on gelatine plates was 160, 08, 69, and 40 per 1 c.c. of water respectively. One other sample contained a much larger number of organisms. The water company was informed of this, and flushed out the main. A specimen taken shortly after was quite satisfactory. HOUSE ACCOMMODATION. 93 plans were deposited for the erection of 280 houses. 30 plans were deposited for 30 additions. 33 plans were deposited for 33 drainage relays. MILK. In my remarks about diarrhoea, I have referred to our milk supply. Thirty samples of milk were taken for analysis under the Sale of Food and Drugs Act. A few were somewhat deficient in quality, but prosecutions were not ordered, as it was verydoubtful whether successful action could be taken. No samples of milk were submitted for bacteriological examination. In September the Council adopted the model regulations of the Local Government Board under the Dairies, Cowsheds, and Milkshops Order. All of the farmers in the district have made the necessary alterations to conform with these regulations, with 18 one exception, which is still under consideration. I trust that the Council will decide to strictly enforce them in every case. In accordance with the suggestion which I made in my last report, the Council has made arrangements with Mr. Reid, F.R.C.V.S., their Veterinary Inspector, by which all the milch cows in the district are regularly examined every quarter. The utility of this measure was at first considered to be rather doubtful, but experience has shown that it has been most successful. Up to the present time three examinations have been made. On the first examination, out of the 350 cows examined 27 were found to be suffering from mastitis, and 3 were affected with generalised tuberculosis in the last stages. In consequence of this report the Council communicated with the owners of the cows, and as a result they immediately took action to get their herds into better condition. On the second examination there was distinct improvement and on the third examination it was found that the affected cows had been treated, or got rid of, and the herds were in a much healthier state. Only 4 cases of diseased udders were met with, and the general condition of health of the cows was good, the " wasters " having disappeared. This is very encouraging, and is a strong reason for continuing the regular veterinary examinations. THE REFUSE DESTRUCTOR. The refuse destructor was completed in October, and since then has been in working order. It has three cells built on the Horsfall patents, and it has a further capacity for two 19 more cells. There is a boiler capacity of 250 horse power, but at present 60 horse power is sufficient to work the plant, and the dynamo which supplies the electric light. By working two shifts of 8 hours each, the destructor can burn from 8-9 van-loads of refuse per cell per day. By working three shifts, the working capacity is increased by 50 per cent., and would therefore be able to deal with the refuse of 45,000 inhabitants, which is a large margin. The clinker, which is very valuable in the Corporation work for road making, etc., is formed in the proportion of 33 per cent, by weight of the total amount of refuse destroyed. Owing to its being now possible to institute a more economical method of collecting and tipping the refuse, the working expenses of the refuse destructor cause no increased expense to the ratepayers, as the total expenses are now no more than was formerly incurred in collection only. The destructor has now been working for five months, and there have been no complaints arising from dust or offensive effluvia. It is proposed in the future to make a fixed charge for the collection and disposal of trade refuse. The Corporation have the authority of the Board of Agriculture to dispose of the carcases of horses, cows, and pigs, which have been ordered to be destroyed owing to infectious diseases, and the Kent County Council have given permission for the cremation in the destructor of the stray dogs of a large district in this part of Kent. The destructor has been built entirely from the designs of our Borough Engineer, Mr. Stanley Hawkings, and we have 20 the satisfaction of knowing from outside testimony that it is one of the best equipped in the country. During the year it was decided that the time had come to make some improvements in the method of collection of house refuse. The dust carts covered with a tarpaulin were done away with, and their place taken by large vans with wooden covers. Formerly the work for the horses at the tipping ground was very heavy, but when the refuse destructor came into use, with its easy tipping, it was found possible to give the horses a heavier load on the rounds, and thus economise the labour. NUISANCES. In the course of the year many sanitary matters most connected with nuisances of various kinds were brought to my notice, and were dealt with in the usual manner. A record of these will be found in the report of the Sanitary Inspector. FACTORY & WORKSHOP ACT, 1901. The Medical Officer of Health is required to report annually on the administration of this Act, so far as it relates to the duties of the Council, and concerns his department. Matters arising out of inspections by the Sanitary Officers, requiring report, are dealt with by the Health Committee. Each report is entered against the respective premises in the Register, which discloses the results of any action taken in relation to the various matters reported on. There are 229 such premises on the Register, briefly sum marised as follows:— 21  Workshops. Approximate No of Workers. Factories. Approximate. No. of Workers. Bakehouses 21 60 1 About 500. Dressmakers 53 290 ... Tailors 14 35 ... Bootmakers 15 30 1 Laundresses and Cleaners 23 221 14 Miscellaneous 63 220 24 Totals 189 856 40 500 Total Premises, 229. Total Workers, 1,356 (approximately). H.M. Inspectors being responsible for the sanitation of factories, the Council's sanitary staff are chiefly concerned with the inspection of workshops. These are inspected in batches occasionally, and many other inspections are made casually. Comparatively few matters have called for report this year, owing to the fact of there being very little infectious disease in the district, and many defects in the existing workshops having been remedied in the two previous years. The following is an example of the various works carried out to comply with notices under the Act. 22 Workshops cleansed and whitewashed 35 Drains reconstructed entirely 1 „ „ partially 6 W.C.'s repaired, improved, etc 14 Soil pipes and drain ventilators repaired 3 Floor drainage provided to laundry 1 Refuse receptacles provided 2 The report for the year 1904 is, on the whole, most satisfactory. Compared with recent years we have had very little infectious disease, and the sanitary condition of the Borough has been steadilx improving. The neighbourhood has many advantages as regards situation and soil, and very few districts around London can show a better health record than Bromley. Appended is the report of your Sanitary Inspector, showing in detail the sanitary work executed during the year. I am, Gentlemen, Your obedient servant, ARTHUR F. G. CODD, Medical Officer of Health. Borough of Bromten. Annual Report of Sanitary Inspector for Year, 1904. To the Chairman and Members of the Health Committee. 28th March, 1905. Gentlemen, I have the honour to submit the annual record of the various matters dealt with by the sanitary staff, and, in doing so, beg to remind you that the district is worked by a system involving the following methodical inspections. Complaint Inspections (on any information of Nuisance). House to House Inspection (of Cottage Property). Cottage Visitation (of Cottage Property). Inspection of Premises (on occurrence of Infectious Disease). „ „ Dairies, Cowsheds, and Milk Stores. „ „ Workshops, Factories, and Work Places. „ „ Slaughter Houses. „ „ Schools. „ „ Food, Water, etc. „ „"Petroleum" Stores. 24 GENERAL SUMMARY OF WORKS EXECUTED. The following refers only to works carried out, and arising out of the various notices issued. The whole has been carried out without resorting to legal proceedings, except in one instance, when 20s. fine and costs were imposed on defendant. Premises inspected and reported on (re-visits excluded) 1078 House drains renewed entirely 32 House drains renewed partially 135 House drains repaired (small items) 70 House drains unstopped 64 Drain ventilators renewed, repaired, etc. 99 R.W.P.'s, waste pipes, etc., repaired, or disconnected from drains 101 W.C.'s repaired (pans, traps, apparatus, etc.) 292 Sanitary dustbins provided 146 « Cesspools abolished, repaired, or cleansed 6 Overcrowding abated 6 Nuisances from animals abated 11 Houses where roofs, gutters, etc., were repaired to remedy damp walls, etc. 169 Houses or trade premises cleansed and whitewashed throughout 9 Houses or trade premises cleansed and whitewashed partially 67 Cisterns cleansed or repaired 8 Manure pits built, repaired, emptied, etc. 20 25 Dangerous dilapidations remedied (floors, etc.) 23 Yards paved 4 Ditches cleansed 5 Stables and cowsheds drained, paved, etc. 10 Floor drainage provided to workshops 2 Offensive accumulations removed 11 Public-house urinals rebuilt, repaired, enlarged, etc. 25 COMPLAINT INSPECTION. 177 complaints were registered, alleging nuisances in respect of 240 premises. Each matter was promptly investigated, and reported on in the Report Book (with all other matters requiring report or action), for consideration by the Health Committee, and for authority to serve the necessarv notices, etc. The various premises were afterwards re-visited (often frequently), until the notices were complied with, or nuisances abated. HOUSE TO HODSE INSPECTION. This valuable branch of the work has been well attended to, the number of houses dealt with (454), comparing well with former years. This is not a mere inspection only, but includes the testing of the drains of each house with the smoke machine, as well as inspection for all other purposes. The initial inspection takes but a small part of the time, much more work being caused in getting the various items of the notices complied with, after such notices have been served. This work commenced in 1894, when the then Local Board resolved on a "House-to-house inspection of cottage property 26 in the district." Since that date, very few can have escaped inspection, beyond those more recently erected, and many have been inspected twice or more since 1894. There must be quite 3,000 such houses to be dealt with in this wav, being occupied by weekly tenants at rentals of tbout eight to twelve shillings per week, a small proportion being from six to eight shillings. It is not possible to proceed with the work, to any extent, during the winter months, as the more serious nuisances would not be discovered, owing to the frost, etc., which interferes with the testing of drains or fittings, as well as the works of abatement. The nuisances most commonlv found are defective w.c.'s, drain connections, and dustbins, leaky roofs, wet walls, etc., The percentage of defective drains is comparatively low compared with the earlier vears, manv of such drains having been repaired or renewed after former inspections. COTTAGE VISITATION 487 other cottages have been dealt with under this inspection, which is practicallv a "house-to-house inspection" of cottage property, without the testing of the drains. It is found that it takes four or five years to get through all the cottages (about 3,000), with the drain testing, and as there are numerous defects apparent on mere inspection only, these can be discovered and dealt with at times, when, for various reasons, it is inconvenient or impossible to test the drains. It is not intended that the thorough house-to-house inspection shall be in any way neglected, or interfered with. 27 INFECTIOUS DISEASE (Notifiable). The number of cases notified was 78. The number of cases removed to the Isolation Hospital was as follows:- Scarlet fever 27 Diphtheria 9 Enteric 2 Erysipelas 1 39 The remainder were isolated at their own homes, except three, which were notified when already inmates of other hospitals. When necessary, the bedding, etc., is disinfected in the Council's steam apparatus (Washington Lyon's patent). No. of rooms disinfected 104 Beds and other articles disinfected (by steam) 374 Beds destroyed by fire 2 The following is useful to show the effect of disinfection, and other precautions, as well as the sporadic character of the disease:— No. of cases 78 Different houses invaded 68 Different streets invaded 57 In only 10 houses did more than one case occur, which is due in instances, to two cases being notified from one house simultaneously, or following quickly, and being evidently contracted before the first case was discovered. 28 DAIRIES COWSHEDS & MILKSHOPS. There are 30 persons on the Register, carrying on businesses at 37 different premises. Of these, 13 keep cows within the district. The number of milch cows kept bv such persons is about 320. A complete inspection is made of these premises, at least twice a year, in addition to other casual inspections. Any breach of regulations, or matter requiring report, is dealt with in Report Book, and the number of report recorded against the premises in the Register. The 37 premises are all supplied with the Kent Water Company's water, and 30 are drained to Council's sewers; seven of the premises, where cows are kept, have cesspool drainage. Of the 30 drained to sewer, 15 have had the drains constructed, or reconstructed, during recent vears. FACTORY & WORKSHOP ACT, 1901 This branch of work involves the periodical inspection of some 240 premises, as to various sanitary matters, but is not reported on here, as the statute now requires that it be dealt w ith in the annual report of the Medical Officer of Health. SLAUGHTER HOUSES. There are now nine registered or licensed slaughter-houses in the district, one being only a knacker's licence. These slaughter-houses are not much used, as the greater part of the meat sold in the town comes through London markets. All have been inspected at various times, and kept in good condition. 29 SCHOOL VISITATION. The Public Elementary Schools are visited from time to time, especially as to cleanliness of sanitary conveniences, and under directions of the Medical Officer of Health, for the purpose of checking infectious diseases, by excluding scholars from infected houses, etc. Special "Exclusion Notices" are sent to the head teacher, and also the parent, and a copy forwarded to the Education Committee. PETROLEUM ACTS. Nineteen persons were licensed to keep "petroleum to which such Acts apply" (i.e., petroleum flashing below 73 deg. Fahrenheit). The quantity allowed ranges from 10 to 60 gallons, except in two special instances, where 130 and 400 gallons are allowed. For clearness, I use the terms "petroleum spirit" (benzoline, petrol, motor spirit, etc.), and "petroleum oil" (illuminating petroleum, etc.). Five other persons keep the spirit for use only, under the Home Office Regulations. The 24 premises are inspected from time to time, to enforce the requirements of such Acts, Licences, or Regulations. Samples of the oil are taken occasionally and tested in the official apparatus, the flashing point of which varies from 78 deg. to 106 deg. Fahrenheit. The flash point of the spirit is much lower. Fire resisting storage receptacles, in open air. are insisted on for the spirit, and the quantity allowed by the licence is according to distance and flammability of other structures. The spirit is kept or sold mostly for motor cars, cleaning works, etc. 30 FOOD, WATER, &c. The market is inspected two or three times on every market day, and other shops and places occasionally. The following food was seized, the two first mentioned being clearly intended for sale for human consumption:— No. 1.—50 lbs. fish roe. No. 2.—170 lbs. beef. No. 3.—120 lbs. fish (smoked whiting). No. 4.—570 lbs. fruit (plums). No. 5.—40 lbs. fruit (pears). Ail the above were destroyed on magisterial orders. The owners of No. 1 and 2 were proceeded against, when the former was fined £2 and 15s. costs, and the latter £5 and 16s. costs. In the other cases, no further action was taken. Sixtv samples of food and drugs were submitted to ihe Public Analyst:— Milk 30 Butter 14 Coffee 7 Lard 1 Spirits 3 Sugar 1 Cornflour 1 Cheese 1 Mustard 1 Vinegar 1 60 31 Thirteen of the milk samples were certified to be slightly adulterated, or deficient in quality, but no proceedings were ordered, but cautions given by the Council in various instances. The more recent legislation appears to have considerably checked the adulteration of food, both here and in other districts. WATER SUPPLY OP THE DISTRICT Five samples of water were taken from the water mains of the Kent Water Company during the year, and submitted to the Clinical Research Association for bacteriological examination. All were examined quantitatively. The reports thereon were on the whole considered satisfactory by the Health Committee, so that no qualitative examination of the organisms was ordered. All houses have a constant supply from such mains, except in a very few instances where wells exist. Seldom are defective or dirty water cisterns found, as the water is in so manyinstances drawn direct from the main, rendering storage cisterns unnecessary. I have the honour to be, Gentlemen, Your obedient servant, THOMAS BUTLER, Sanitary Inspector, etc.