BR09 RURAL DISTRICT COUNCIL OF BROMLEY. ANNUAL REPORT ON THE HEALTH OF THE Bromley Rural Sanitary District FOR THE YEAR 1911, BY JAMES SCOTT TEW, M.D., D.P.H. Bromley, Kent: Kentish District Times Co., Ltd., 39, East Street. 1912. BROMLEY RURAL DISTRICT. AREA AND POPULATION. No. of Registration District. Area in Statute acres. Inhabited Houses. Population. Land and Inland Water. Inland Water only. 1881 1891 1901 1911 1881 1891 1901 1911 41 28839 40 2770 3237 3655 4845 14303 16818 18808 21958 Sub Registration Districts. Area in Statute acres. Inhabited Houses. Population. Land and Inland Water. Inland Water only. 1881 1891 1901 1911 1881 1891 1901 1911 2. Beckenham R. 3942 3 319 409 447 508 1657 2066 2166 2227 Hayes 1282 .. 143 160 188 214 694 804 838 925 West Wickham 2660 3 176 249 259 294 963 1262 1328 1302 3. Orpington 21117 21 2038 2336 2607 3580 10458 12138 13442 16075 Chelsfield 3378 .. 193 232 330 428 947 1122 1522 1790 Cudham 5925 1 217 217 230 389 1029 1103 1111 1604 Downe 1652 .. 117 127 139 164 555 581 610 649 Farnborough 1429 .. 237 258 285 524 1451 1627 2262 3210 Keston 1487 8 151 150 171 235 731 746 832 986 Knockholt 1701 1 171 191 217 244 789 872 952 943 Orpington 3517 7 581 760 830 1139 3050 4099 4259 5036 St. Mary Cray 2028 4 371 401 405 457 1906 1988 1894 1857 4. Chislehurst 3780 16 413 492 601 757 2188 2614 3200 3656 Mottingham 642 .. 130 172 219 316 779 1037 1332 1534 N. Cray 1484 10 130 117 143 140 635 549 661 655 St. Paul's Cray 1654 6 153 203 239 301 774 1028 1207 1467 Total for whole District. 28839 40 2770 3237 3655 4845 14303 16818 18808 21958 The Population of the Bromley Rural District at the census of 1911, was 21,958, being an increase of 3,150, since the census of 1901. The estimated population of the intercensal years has been somewhat underestimated. This cannot be avoided, the method adopted for calculating the figures being a recognised one, but can 4 only be correct so far as the population continues to increase or decrease at the same rate as it had been doing during the preceding decennial periods. The estimated population for 1911 would be 21,093, or 865 lower than that of the census. The number of births registered in the District amounted to 469, including 254 of males, and 215 of females. To this number must be added 5 births (of males) which occurred outside the district, born of parents having a fixed place of residence in the district, while 24 births (18 male and 6 female) not belonging to the district are deducted. The nett number of births was, therefore, 450, which gives a Birth-rate of 20.4 per 1,000 of population, as compared with 26.0 in 1901; 25.4 in 1909; and 24.3 in 1910. Three hundred and twenty-two deaths were registered, 173 of males, and 149 of females. To this number are added the deaths of 28 persons belonging to the District who died elsewhere, while 102 are deducted of persons dying in the district, and who had a fixed residence outside the district. The nett total of deaths belonging to the district was 248, giving a Death-rate of 11.2 per 1,000 of population, as compared with an exactly similar rate in 1901 : 11.6 in 1909: and 11.1 in 1910. Among the above total of 248 deaths, 35 were attributable one or other of the following Epidemic Diseases, viz.:— Diarrhoea and Enteritis (under 2 years) 25 Diphtheria 0 Measles 3 Whooping Cough 6 Enteric Fever 1 Scarlet Fever 0 Small-pox 0 Pyrexia of uncertain origin 0 35 The Infant Mortality, i.e., the number of deaths of infants under one year of age per 1,000 registered births, was 122, as compared with 91 in 1901; 64 in 1909; and 100 in 1910. The birth-rate in England and Wales in 1911 was 24.4 per 1,000 of the population, which is 0.7 per 1,000 below the rate in 1910, and lower than the rate in any other year on record. Compared with the average in the ten years, 1901—1910, the birthrate in 1911 showed a decrease of 2.8 per 1 ,000. The death-rate in 1911 was 14.6 per 1,000, which was 1.1 per 1,000 above the rate in 1910, and equal to the rate in 1909, but lower than the rate in any other year on record; compared with the average rate in the ten years, 1901-—1910, the death-rate in 1911 showed a decrease of 0.8 per 1,000. 5 The rate of mortality among infants under one year of a age to 1,000 registered births, was 130, which is 24 per 1,000 above the rate in 1910—the lowest on record—but is only 3 per 1,000 above the average in the ten years, 1901—1910, notwithstanding the excessive heat and drought which prevailed in the third quarter of the year. A higher infantile mortality than this was experienced in 43 out of the last 50 years. The following table shows a comparison between the rates for ;his District and those for England and Wales. Birthrate. Death-rate. Infant Mortality. England and Wales 24.4 14.6 130 Bromley Rural 20.4 11.2 122 In January, 1911, the Local Government Board intimated that it was the intention of the Registrar-General to publish in his Annual Report for 1911 and subsequent years statistics of births, deaths, and of certain causes of death, for administrative instead of, as hitherto, for registration (or poor law) areas, and it was found necessary to revise and modify the Tables in order to minimise discrepancies between the figures of Medical Officers of Health and those of the Registrar-General. Table 1 is altered as to births by the addition of columns showing the uncorrected and corrected numbers, and the Registrar-General supplies Medical Officers of Health, through the County Medical Officer, with the number of births—male, female, legitimate, and illegitimate—to be added or deducted. The Registrar-General also in a like manner, supplies particulars of all deaths of persons belonging to the District, and who have died outside its area, and it is left to Medical Officers of Health to exclude deaths of non-residents. Table 2 is now omitted, and in its place is the Infectious Disease Table, which is slightly—though not materially—altered. The list of causes of death (Table 3) has been considerably altered, the Local Government Board having, in conjunction with the Registrar-General, adopted a form condensed from that known as the "International List," which is also used widely in other countries. The compilation is systematised by a manual which has been issued by the Registrar-General. In following this manual when compiling Table 3, I noticed that the Table as issued by the Local Government Board did not correspond exactly with that stated in the manual as having been adopted by the Registrar-General and the Local Government Board, i.e., there are headings "meningitis" and "organic heart disease" in the latter, which do not appear in 6 the former, and other small differences. In order to make the Table 3 of the Local Government Board correspond with the list of diseases given by the Registrar-General, I found it necessary to re-number the headings and to separate heart and brain diseases from " other defined" diseases. The Infant Mortality Table is also slightly altered as to headings, and age-periods. A.-NOTIFIABLE INFECTIOUS DISEASES. Under the provisions of the Infectious Disease (Notification) Acts, 1889 and 1899, the following diseases are compulsorily notifiable in the District, viz., Small-pox, Cholera, Diphtheria, Membranous croup, Erysipelas, the disease known as Scarlet Fever or Scarlatina, and the fevers known by any of the following names:— Typhus, Typhoid or Enteric, Relapsing, Continued, and Puerperal. During the year 1911, 59 cases of infectious disease were notified, as against 60 in the previous year, and included 14 cases of Diphtheria, 22 of Erysipelas, 17 of Scarlet Fever, 5 of Enteric Fever, and 1 of Puerperal Fever. Small-pox. No cases of this disease were notified, in the District, making the third successive year of freedom. Scarlet Fever. Seventeen non-fatal cases were reported, as compared with 31 cases and one death in 1910. They were notified as follows:— January 1 case. March 4 cases. July 1 case. October 2 cases. November 1 case. December 8 cases. Total 17 cases. The cases were spread over the District thus:— Chelsfield 4 cases. Cudham 4 „ Knockholt 4 „ Mottingham 3 „ Orpington 1 case. West Wickham 1 „ Total 17 cases. 7 They were notified at the following age-periods:— 1—5 years. 5—15 years. 25—45 years. 4 12 1 =17 cases. The methods adopted for dealing with cases of this disease, and for prevention of its spread, are prompt isolation of the patient, exclusion of contacts from School, at the same time keeping them under observation, thorough disinfection, inquiries respecting absentees from School, and instructions to parents. In regard to the case at Orpington in March—that of a child 12 months old—the circumstances point to its being a "return" case, i.e., contracted from another child in the family who had returned from the hospital. A sister of the patient was admitted to the Bromley and Beckenham Joint Hospital with Scarlet Fever on December 21st, 1910, and was discharged on March 4th, 1911. No cases occurred in the family (or in the whole parish during this interval or throughout the year) until March 15th, when the baby commenced. The extreme incubation period is, I am aware, only 6 or 7 days, but it by no means follows that the discharged patient communicated the disease at once; and the instructions very properly given by the Hospital Authorities to the patient on leaving, viz., to go to a convalescent home or "keep" apart from other susceptible members of the family for a fortnight, tends to prevent—and I daresay in some cases, to actually prevent—spread of infection, and is certainly likely to postpone it. The reliable investigation of several hundred return cases showed that about half developed within a week, one-quarter in the second week, and about 11% in the third. As regards the remaining cases up to December, there is nothing calling for special comment. Three of the cases in December occurred in one family at Knockholt, and it is probable that these children (who were in the peeling stage when notified) communicated the disease to others. The mother pleaded ignorance of the nature of the complaint. Sixteen cases were treated in Hospital. 8 Diphtheria. Fourteen non-fatal cases were notified, as compared with 11 in the previous year, and were spread over the year as follows:— February 1 case. March 2 cases. May 1 case. June 3 cases. September 1 case. October 3 cases. November 1 case. December 2 cases. Total 14 cases. Locally the cases were notified from:— Orpington 4 cases. St. Paul's Cray 3 „ Keston 2 „ Farnborough 2 „ North Cray 1 case. Mottingham 1 „ St. Mary Cray 1 „ Total 14 cases. The following shows the age-periods at which the cases occurred:— 1—5 years. 5—15 years. 15—25 years. 45—65 years. 4 8 1 1 =14 cases. The method of procedure and precautions taken are similar to those mentioned as regards Scarlet Fever, with the addition of swabbing throats, and bacteriological examination of the material, and the free administration of anti-toxin, both to patients and contacts. Twelve of the cases were treated in Hospital. Erysipelas.—Twenty-two cases were notified, with one death, as compared with 13 cases and 2 deaths in 1910. Twelve of the cases occurred at the Union Workhouse, 3 at St. Paul's Cray, 2 each at Orpington, and Farnborough, and 1 each at North Cray, Mottingham, and St. Mary Cray. 9 The following shows the age-periods at which the cases and death occurred:— 5—15 years. 15—25 years. 25—45 years. 45—65 years. 65 and upwards. 3 3 4 6 6 = 22 cases. 1 = 1 death. The fatal case occurred at the Union Workhouse in January— an aged male—admitted from Farnborough. Disinfectants are supplied in cases of this disease as required, and instructions given. Enteric Fever. Five cases of this disease were reported, with one death, as compared with one non-fatal case in each of the two previous years. Case I. was an adult male, resident at Orpington, notified on June 9th, and removed to Hospital the following day. The patient had partaken of tinned fish and oysters, and the inference is that the former was the cause of the disease. Case II. was notified in July from Orpington—also an adult male. The patient had a mild attack and was discharged from hospital cured. Case III, was that of a girl, aged 6 years, notified at the end of August, from St. Paul's Cray—the disease was of a mild form, and after a stay of 6 weeks in hospital, the patient made a good recovery. Case IV. was reported from Farnborough on September 1st, was treated at home, and made a good recovery. Case V. The patient was a boy, aged 14 years, notified on September 27th and removed to Hospital the same day. The attack was a severe one, and the patient died in Hospital on October 7th. With the exception of the first case no definite source of infection could be traced. Puerperal Fever. One fatal case of this disease was notified, as against 4 non-fatal cases in the previous year. The patient was an inmate of the Union Workhouse, whence she had been admitted from Bromley. The death does not appear in Table III., as it is transferred to Bromley. Acute Polyomyelitis and Cerebro-spinal Fever. The question of taking the necessary procedure to extend the Infectious Diseases (Notification) Act, 1889, to include these diseases, was under the consideration of the Council at the end of the year. Tuberculosis in all its forms caused 30 deaths during the year, as compared with 23 in 1910. Of these 30 deaths, 24 were certified as due to Phthisis (consumption of the lungs), as against 19 in 1910. and 18 in 1909. The death-rate from all forms of the disease was 1.36, and the Phthisis death-rate 1.09 per 1,000 of population. 10 No cases were notified under the Voluntary System of Notification. Under the Poor Law (1908) Regulations, 14 cases were notified, 12 being patients in the Union Infirmary, 1 a poor person resident at North Cray, and another at Farnborough. Sixteen notifications were received under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, were received from various Sanatoria, of patients resident in this District. Disinfection is thoroughly carried out in all necessary cases and after deaths, and disinfectants freely supplied as required. Printed instructions are also given to patients and those in charge. Under the Poor Law Regulations, 1908, phthisis was made compulsorily notifiable among poor persons, and by the Tuberculosis in Hospitals Regulations, 1911, all persons suffering from the disease and being treated in hospitals and sanatoria are required to be notified. By the Public Health (Tuberculosis) Regulations, 1911, dated 15th November, 1911. all cases of phthisis are compulsorily notifiable as from January 1st, 1912, medical men and school medical inspectors being required to notify to the Medical Officer of Health of the District in which the patient is resident or the school is situate—as the case may be—all cases coming to his notice within 48 hours, with the exception of cases which have been previously notified. (See Art. 4.) Art. 9 gives special powers to Councils to "do such Acts and make such arrangements as may be necessary "in supplying medical or other assistance, facilities and articles for detecting and for preventing infection, etc., including power to appoint officers to carry out the work, and also to supply literature, etc. These Regulations do not affect or interfere with the Poor Law or the Hospital Regulations, which remain in force as heretofore. (Art. 10.) By Art. 13, Medical Officers of Health or Councils are not required to take any action in respect of patients notified, where such action would interefere with the patient's occupation, or means of livelihood, etc., it being deemed advisable to deal with such cases according to the circumstances under which they arise, with a certain amount of latitude and discretion. It will now be a matter for the Council to consider what steps should be taken to provide accommodation and other means for treatment of cases of this disease, and in this direction I have attended several meetings of Medical Officers of Health to consider and discuss the question generally. At present it seems to me that the only practical way will be for the County Authorities to provide an adequate number of sanatoria, and divide the County into hospital or sanatoria areas. 11 I conferred with and advised your Sanitary Inspectors how we should proceed, and sent a circular letter, dated December 22nd, 1911, to medical men residing in the area, asking for their co-opera tion, and informing them that infective material could be examined in the interests of the public health free of charge to them at the County Laboratory, Maidstone. In addition to the prescribed registers, details are collected on cards (of which I have drawn up a special form to suit the requirements of the District) which are filed, and to which further notes of the history of each case can be added from time to time. The Special Return, required by the Local Government Board, on "Phthisis, Sanatorium, and Hospital Accommodation," is not included in this report, as there are no facts to insert for this District. The advance copy of the form has been sent to the Board as requested. Hospital Isolation. Thirty cases of infectious disease were treated in the Bromley and Beckenham Joint Isolation Hospital, and were admitted as follows:— January. 1 case (Scarlet Fever). March. 5 cases (4 Scarlet Fever, 1 Diphtheria). May. 1 case (Diphtheria). June. 4 cases (3 Diphtheria, 1 Enteric Fever). July. 2 „ (1 Scarlet Fever, 1 Enteric Fever). August. 1 case (Enteric Fever). September. 2 cases (1 Diphtheria, 1 Enteric Fever). October. 4 „ (3 Diphtheria, 1 Scarlet Fever). November. 1 case (Diphtheria). December. 9 cases (7 Scarlet Fever, 2 Diphtheria). Total 30 cases (14 Scarlet Fever, 12 Diphtheria, 4 Enteric Fever). Two cases of Scarlet Fever were treated in the Brook Hospital of the Metropolitan Asylums Board; the patients being a boy and a girl, from Mottingham, who were being treated for a throat affection in the Eltliam Cottage Hospital, where they developed Scarlet Fever. A County Laboratory (at present at Mill Street Chambers, Maidstone), is to be established at the commencement of 1912. where diphtheria swabs, specimens of sputum, suspected typhoid blood, etc., can be examined free of direct charge if for the interests of nublic health, and when sent in the special outfits to be provided and with an accompanying prescribed form filled in. A small stock of the outfits will be kept by the Sanitary Inspectors. 12 B.—NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. Three deaths resulted from this disease, viz., 1 in February at West Wickham; 1 in April at St. Elizabeth's Home, East Ham, of a child belonging to Orpington; and 1 in May at Mottingham. The ages of the patients were 7 years, 6 months, and 2 years respectively. Whooping-cough caused 6 deaths—1 in January at Orpington; 2 in April (1 at West Wickham, and 1 at Keston); 1 in August; and 1 in September at Orpington; and 1 in November at St. Paul's Cray. Influenza. Only one death was scheduled as due to this disease, that of an adult female in October at West Wickham. Diarrhoea and Enteritis. Twenty-five deaths of children under 2 years of age were attributed to these diseases. In point of time they occurred as follows:— April 1 death. May 1 „ June 2 deaths. July 1 death. August 15 deaths. September 2 „ October 3 „ Total 25 deaths. Locally the deaths were distributed over the Rural area thus:— Orpington 7 deaths. St. Mary Cray 6 „ West Wickham 3 „ Farnborough 2 „ St. Paul's Cray 2 „ Hayes 1 death. Cudham 1 „ Chelsfield 1 „ North Cray 1 „ Mottingham 1 „ Total 25 deaths. There were only 8 deaths in 1910 from Diarrhoea (including Epidemic or Zymotic Enteritis), but with the exceptionally hot summer and autumn of 1911, the number of infant deaths showed its usual increase. This increase, however, is partly due to the fact that under the altered nomenclature deaths from diarrhoea and enteritis of children under 2 years of age are scheduled under this heading. Deaths over that age from both diseases are scheduled under "other defined diseases." 13 Inspection of District. The District, which now includes 13 parishes, is divided into two parts for the purposes of inspection, viz.:— No. 1 District (Mr. Nightingale) includes the parishes of:— Population at Census of 1911. Mottingham 1534 North Cray 655 Orpington 5036 St. Mary Cray 1857 St. Paul's Cray 1467 10,549 No. 2 District (Mr. Dunlop) includes the parishes of:— Chelsfield 1790 Cudham 1604 Downe 649 Farnborough 2141 Hayes 925 Keston 986 Knockholt 943 West Wickham 1302 Union Workhouse, Farnborough 654 St. Joseph's Home, Farnborough 415 11,409 21,958 I have made special visits of inspection in connection with the following matters:—Slaughter-house at Farnborough, Mottingham sewers, insanitary and dilapidated dwellings at Chelsfield, Knockholt, Downe, Farnborough, and Green-Street-Green, proposed slaughter-houses at Farnborough and Mottingham, unsound meat at Green-Street-Green, sanitary conveniences at Keston School, Knockholt School, drainage of Keston, flooded cellar at Farnborough, premises used for gutscraper's business at Orpington, London refuse heaps. These inspections were in addition to ordinary routine visits in connection with infectious disease, Dairies, Cowsheds and Milkshops Order, Factory and AVorkshop Act, and Housing, Town Planning, etc., Act. The particulars as to the inspections made and work done by the Sanitary Inspectors as required by the Sanitary Officers (Outside London) Order, 1910, are appended in Mr. Nightingale's and Mr. Dunlop's Reports. 14 Common Lodging Houses. The only common lodging house in the District is at Ford croft, Orpington, and although it is situated in one of the poorest localities in the District, it has been conducted in a very satisfactory manner, and in accordance with the Bye-laws. Dairies, Cowsheds, and Milkshops. The Registers now contain the following entries:— No. 1 District. No. 2 District. Cowkeepers, Dairymen, and Purveyors 4 9 Cowkeepers only 6 13 Dairymen and Purveyors 2 — Cowkeepers and Purveyors 4 — Purveyors only 4 1 20. 23 =43 The premises have been found on inspection to be generally in a satisfactory condition, and no serious breach of the Regulations found; and notices to limewash, and remedy minor defects have been remedied on notice being given. A new system of drainage has been installed to the sheds of a farm at Cudham. Practically the whole of the milk consumed in the District is produced locally, and I regard the supply as being above the average. No systematic examinations for the detection of tuberculous milk are undertaken by the Council, but a sharp look out is kept for animals bavins any signs of tuberculosis. Slaughter-houses. There are 19 slaughter-houses in the District, viz.:— No. 1 District. No. 2 District. Orpington 5 Cudham 1 St. Mary Cray 5 Downe 1 Mottingham 1 Farnborough 2 Hayes 1 Knockholt 1 West Wickham 2 11 8=19 The premises have been regularly inspected, and generally found to be in a satisfactory condition, small defects such as lime washing, etc., being remedied on request. I found one undressed carcase of a full-grown beast, which was tuberculous. It had been slaughtered in premises which were not licensed, but as it could not be shown that the flesh was intended for human consumption, no proceedings were taken. 15 Bye-laws for the control of the premises are in force. Your Inspector, Mr. Nightingale, continues to attend the cattle market at Orpington for the purpose of keeping in touch with any sales of old worn-out cows, with a view of ascertaining their destination. Ceneral Food Supplies. Articles for human consumption, such as those brought round on hawkers' carts, including fish, fruits, etc., sold in shops other than butcher and bakers, have also been kept under observation. About 501bs. of meat was voluntarily surrendered and destroyed in February, at a farm at West Wickham. Special observation has been kept on the manner in which the fruit and vegetables grown in the District have been gathered and packed for market, with special reference to the tubs in which perishable fruit is generally packed. No cause for complaint has been found. (See hop, fruit picking, etc.) The 27 bakehouses in the District have with one exception (limewashing required) been found to be clean and in good condition. No action has been taken under Section 117 of the Public Health Act, 1875. No outbreaks of food poisoning have been met with, but the Local Government Board's circular as to food poisoning has been noted. Factory and Workshop Act, 1901. There are 164 premises on the Register, viz.:— FACTORIES. Bakehouses Other trades connected with foods or drinks Laundries 4 Other trades connected with clothing Various 19 23 WORKSHOPS. Bakehouses 27 Other trades connected with foods or drinks — Laundries 18 Other trades connected with clothing 14 Various 77 136 WORKPLACES. Various 5 164 16 The premises have been regularly inspected, and the various defects found have been remedied on request; on the whole they are in a satisfactory condition. Drainage, Sewerage, and Sewage Disposal. No public drainage works have been carried out during the past year, but the necessity of improved drainage at Keston and West Wickham is very apparent. Refuse Removal. Weekly removals of house refuse are made in the Parishes of Orpington, St. Mary Cray, St. Paul's Cray, Mottingham, Farnborough, and Hayes; and fortnightly in the Parishes of North Cray, Chelsfield, Keston, and West Wickham. The work is carried out under contract. London House Refuse. Complaints were made of nuisance caused by the deposition of London refuse near the Bournewood Crossing Box of the S.E. and C. Railway, in the parish of St. Mary Cray. I reported on the nuisance on the 24th June, describing the conditions existing, which I did not consider satisfactory, and made the following suggestions, viz.:— That the quantity of refuse should be reduced to at least half the present quantity. No strawberries or fruit which is capable of being eaten raw should be grown within at least 50 yards of the heap. If the material is carted through the public streets, means should be taken to prevent nuisance in transit. The refuse should be deposited further from the public footpath, and be railed in to prevent access of unauthorised persons. The upper surface of the heap should be covered with 6 inches of soil as the superficial area progresses. The working face of the tip should be limited to about the width of 3 carts, and be covered once a week with fresh earth. Effective supervision should be maintained respecting the picking of rags and other materials in the heap by unauthorised persons. The paper should systematically be collected and be covered with earth or be burnt. I inspected again on 16th September, and found the conditions but little improved. I attended a meeting of the District Council on September 19th and discussed the matter, and it was resolved that a Committee should be formed with a view of framing and adopting Bye-laws for the control of such-like refuse heaps. 17 Water Supply. The mains of the Metropolitan Water Board are available in most parts of the District. The well waters are generally of good quality, and local conditions, such as badly constructed and protected tops, are usually the cause of any inferior water. Elementary Schools. The medical inspection of school children, under Section 13 of the Education (Administrative Provisions) Act, 1907, is carried out by the County Medical Officer of Health (who is also School Medical Officer) and his assistants. In many public health matters connected with the schools and school children, it is now essential that a close co-operation should exist between the School Medical Officer and the local Medical Officer of Health, as the boundary line separating their spheres of work is not always clearly defined. Hop, Fruit, and Vegetable Picking. The gathering of each of these crops brings a considerable influx of men, women and children of the itinerant class into the District, and the conditions under which they are temporarily housed require special investigation and control. In 1899 Bye-laws for securing the decent lodging and accommodation of persons engaged in hop-picking were adopted, and in 1906 Bye-laws with respect to tents, vans, sheds, etc., used for human habitation. By the careful and continuous work of your Sanitary Inspectors and by keeping strictly to the Bye-laws, the conditions year by year have gradually improved, and I am glad to be able to say that in the year 1911 the accommodation has been the best I have seen. Although in some few cases there is still difficulty with owners, on the whole they readily comply with suggestions for improvement. In some instances the pickers abuse good accommodation when provided. No complaints have, during last year, been received as to uncleanliness of tubs used for the conveyance of strawberries and other fruit to market. I am also glad to say that we have had no instance last year of that objectionable practice of putting unclean straw under the strawberries to keep them off the ground. 18 Housing, Town Planning, etc., Act, 1909. A system for carrying out the necessary inspections according to the Housing (Inspection of District) Regulations, 1910, has been approved by this Council; the Sanitary Inspector being the officer designated to make the inspections. Where difficulties arise I also visit and inspect. Details are taken on the spot in a note-book with special head ings, and these are afterwards tranferred to duplicated foolscap sheets. This record, with any resulting correspondence, copies of notices, etc., in respect of each house, is placed in a paper folder, numbered, filed, and card indexed; so that the particulars respecting any house which has been inspected under the Regulations can be easily referred to. Two hundred and eight houses were inspected, as follows:— No. 1 District. Mottingham 33 101 North Cray 11 Orpington 35 St. Marv Cray 8 St. Paul's Cray 14 No. 2 District. Chelsfield 0 107 Cudham 5 Downe 35 Farnborough 27 Hayes 0 Keston 0 Knockholt 4 West Wickham 36 208 The first inspection was made on July 4th, and in 180 of the houses inspected defects of some kind were found, the remaining being in a satisfactory condition. The following will give the necessary figures required by Article V. of the Regulations:— Number of dwellinghouses inspected 208 Number of dwellinghouses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 Number of representations made to the Council with a view to the making of Closing Orders 7 Number of Closing Orders made 7 19 Number of dwellinghouses, the defects in which were remedied without the making of Closing Orders 114 Number of dwellinghouses which, after making of Closing Orders, were put into a fit state for human habitation. 0 In order to obtain a correct estimate of the general character of the defects, I have made an exhaustive analysis of each of the 208 reports, which brings out the following facts:— By far the most prominent defect was the paving of yards, which was noted in 83 cases to be defective. It is well known that but few damp courses were put in the older houses, and there were none in at least 106 of those examined. Dampness of either living rooms, bed rooms, or scullery occurred in 28 cases. Roofs were defective in 62. Rain water gutters, absent or defective in 40. In 43 there was either no sink or the existing one was out of repair. The disposal of ashes and refuse was not satisfactory in 35—generally from absence of or dilapidated condition of the receptacle. The conditions as to water supply and sufficiency of light were especially satisfactory, and only 2 cases of overcrowding were noted in these houses. I cannot point to any special parish in which the shortness of artizans' dwellings is specially marked; the great trouble is that the rents are usually too high in comparison with the wages, leading to 2 families frequently occupying one house, or a large family occupying too small a house, and in some cases a shortness of food and clothing. Bye-laws and Adoptive Acts. The following Eye-laws, Regulations, and Adoptive Acts are in force in the District:— Bye-laws with regard to Common Lodging Houses, adopted 24th June and confirmed by the Local Government Board, July 10th, 1902. Bye-laws with regard to Slaughter-houses, adopted January 4th and allowed by the Local Government Board, 30th January, 1901. Bye-laws with respect to tents, vans, sheds, and similar structures used for human habitation, adopted 6th November and allowed by the Local Government Board, 27th November, 1906. Bye-laws for securing the decent lodging and accommodation of persons engaged in hop-picking or in the picking of fruit amd vegetables, adopted 24th February, 1899, and allowed 7th March, 1899. 20 Bye-laws with respect to New Streets and Buildings in the following portions of the Rural District which comprise the contributory places of:—West Wickham, Chelsfield, New Chelsfield Special Drainage District, Cudham, Farnborough, Keston, Knockholt, Orpington, St. Mary Cray, and Mottingham. Regulations with respect to Dairies, Cowsheds, and Milkshops, adopted 15th January, 1907, and came into force 1st March, 1907. The following portion of the Public Health Acts Amendment Act, 1907, are in force in the whole of the Rural District:— Part 2 (Streets and Buildings). Sections 20, 21, 22, 23, 24, 29, 31, 32, and 33. Part 3 (Sanitary Provisions). Sections 36, 37, 38, 43, 44, and 45, 49 and 51. Part 4 (Infectious Disease). Sections 52 to 68 (both inclusive). and Part 2 (Streets and Buildings). Sections 15, 16, 17, 18, and 27, in the contributory places of New Chelsfield Special Drainage District, Downe, Farnborough, Keston, Knockholt, Mottingham, Orpington, St. Mary Cray, and West Wickham. The Notification of Births Act, 1907, has not been adopted in this District. With the exception of a small outbreak of Scarlet Fever among children attending the Knockholt School, the health conditions of the District at the end of the year were satisfactory. The reports of the work carried out by the Sanitary Inspectors, the statistical tables required by the Local Government Board, and the Table provided by the Secretary of State for recording action taken under the Factory and Workshop Act, 1901, are appended. I have the honour to be, Gentlemen, Your obedient Servant JAMES SCOTT TEW. April 15th, 1912. 21 BROMLEY RURAL DISTRICT COUNCIL. No. 1 District. Sanitary Inspector's Office, Orpington. January 31st, 1912. To the CHAIRMAN and MEMBERS of BROMLEY RURAL DISTRICT COUNCIL. GENTLEMEN, I have the honour to pres.ent to you my Annual Report for the year ending 31st December, 1911. Infectious Disease. During the year twenty-four cases of Infectious Disease were notified, namely:—Scarlet Fever, 4; Diphtheria, 10; Typhoid Fever, 2; Erysipelas, 8; being a decrease of thirteen as compared with the previous year, and the lowest number of cases occurring in one year, during the past 16 years. The cases occurred in the respective Parishes as follows:— Orpington, 8; St. Mary Cray, 2; North Cray, 2; St. Paul's Cray, 7; Mottingham, 5. The Scarlet Fever, Diphtheria, and Typhoid Fever cases were removed to the Isolation Hospital. The houses or parts of houses were disinfected immediately after the cases were removed, and in no instance did the disease spread outside the house where it originated. Complaints. A large number of complaints were received relating to nuisances from various causes. Fifteen hundred inspections were made, and 358 nuisances dealt with. Drainage. The drains in connection with fifty-eight houses were examined and tested, and it was found necessary to take out and relay the drains at thirty-seven houses. 22 A number of complaints were made in respect to nuisances from cesspools on the Knoll Estate, Orpington. The contents of the cesspools are emptied on the gardens, or on the vacant land, and the residents cause no little annoyance to each other in this respect. It is to be regretted that the Estate was not sewered before building operations commenced. With a system of main drainage this Estate would make a most desirable residential neighbourhood, and have many advantages from a Health point of view. Insufficient Waterclosets and Ashpits. Flushing cisterns with water laid on thereto have been provided to the W.C.'s at 7 houses, and forty-five houses have been provided with moveable dustbins. Dirty and Defective Dwellinghouses. Ninety-five houses have been generally repaired, cleansed, and limewashed. Overcrowding. Only four cases of overcrowding were discovered during the year. Common Lodging House. The Lodging House at Fordcroft, Orpington, was frequently visited during the year, and no breach of the Bye-laws was discovered. Slaughter-Houses. There are eleven Slaughter-houses in the District; these were frequently visited, and the Bye-laws were generally observed. I have also regularly attended the weekly Cattle Market at Orpington, and observation was made upon "screwy" looking Cows which were now and then sold in the Market. These suspicious looking animals are sold at figures ranging from ten shillings to £3, and invariably go to one farm, and are probably slaughtered at isolated farms outside the District, where no Bye-laws are in force. Food Inspection. The butchers' shops, fish shops, hawkers' carts, etc., were frequently inspected during the year. I also inspected as far as possible, the strawberry and raspberry tubs used for conveying the fruit to market. No complaint was received from London Authorities alleging that fruit was put into dirty tubs. Dairies, Cowsheds, and Milkshops. There are 20 persons on the register as cowkeepers and purveyors of milk and the premises where trade is carried on are frequently inspected. 23 The Regulations require the cowsheds to be limewashed during the months of May and October each year. In one instance it was necessary to serve a Statutory Notice upon the occupier of a cowshed to enforce the limewashing. The greater part of the milk retailed in the district is produced locally, and under satisfactory conditions, but greater care should be taken by the milkers to prevent particles of dirt, etc., from the cows' udders, falling into the pails during the process of milking. M ore care is also needed in straining the milk. I find a second strainer in the form of a flannel bag is very effectual. Fruit Pickers Huts. The huts for temporary accommodation of persons engaged in Fruit Picking were frequently visited during the season, and I found the Bye-laws were generally observed. A few cases of measles occurred among the pickers at North Cray and Orpington, but the disease did not spread to any serious extent. It is very rare that a case of infectious disease is notified from the huts, and no doubt the open air life has a good deal to do with this. Factory and Workshops Act, 1901. The Register required to be kept under this Act, contains entries of 17 Factories, 11 Workshop Bakehouses, 52 other Workshops, and 5 Workplaces. One complaint was received from His Majesty's Inspector of Factories, this related to a Bakehouse at Mottingham, the limewashing of which was a few weeks overdue. Housing and Town Planning Act, 1909. Housing (Inspection of District) Regulations, 1910. A start was made under this Act and Regulations, in July, and up to the end of the year, 101 houses were inspected. Defects were recorded at 89 houses. The defects were as follows:— Defective Drains 31 Defective Waterclosets 36 Defective Earth Closets 2 Defective Paving, back yards 54 Defective Roofs, spouting, windows, and pointing 76 Internal defects, dirty walls and ceilings 86 Want of sinks 25 Very few of the houses have a proper damp course, but there is very little dampness from want of this. As far as possible, the worst houses are being inspected first. At the end of the year the defects at 42 houses were remedied; at 45 houses the works were well in hand, and the remaining two were in abeyance, as the owner proposed to close them voluntarily. 24 Summary of Work Done. Number of Inspections made 1500 Number of Nuisances discovered 358 Number of Statutory Notices served 13 Number of Preliminary Notices served 102 Number of Letters, Reports and School Notices sent 1021 Houses at which drains were examined 58 Houses at which drains were relaid 37 Houses generally repaired and cleansed 95 New flushing cisterns provided to W.C.'s 7 New dustbins provided 45 Back yards paved 44 Cowsheds, Milkshops, Bakehouses, and Slaughterhouses cleansed 46 I have the honour to be, Gentlemen, Tour obedient Servant, HENRY NIGHTINGALE, (Cert., Royal Sanitary Institute), Sanitary Inspector 25 BROMLEY RURAL DISTRICT COUNCIL. No. 2 District. Sanitary Inspector's Office, Wellbrook Road, Farnborough, February 1st, 1912. To the CHAIRMAN and MEMBERS of the BROMLEY RURAL DISTRICT COUNCIL. GENTLEMEN, I have the honour to present to you my fourteenth annual report. During the year 1911 the number of visits made in the several Parishes is as follows:—Chelsfield, 80; Cudham, 40; Downe, 46; Farnborough, 126; Hayes, 32; Keston, 42; Knockholt, 30; and West Wickham, 72. Complaints. Fifty-four complaints were received and investigated. Of these, 30 related to cesspools, 6 to offensive accumulations, 4 to sewer gratings, 4 to animals kept in a filthy condition, 3 to offensive ponds. 3 to offensive urinals, and 4 to insanitary dwellings. Infectious Disease. Thirty-five cases were notified as follows :— Erysipelas, 14; Scarlet Fever, 13; Diphtheria, 4: Typhoid Fever, 3; and Puerperal Fever, 1, per population of 11,409 inhabitants. It was found necessary to "fumigate" twenty houses with "Sulphume," or Formalin, and the owners readily assisted in cleansing the rooms. Pulmonary Tuberculosis. The disinfection of rooms was carried out at different houses where fatal cases of this disease occurred during the year. Water Supply. Ten houses were found to be without an available supply of wholesome water, and these are now connected with the Metropolitan Water Board's Main. 26 Four notices were received from the Board relative to supplies being cut off through leakages, etc.—Farnborough 3, and Chelsfield 1. With the exception of the "Coach and Horses" Inn, Farnborough—still vacant—the supply has since been reinstated. Drainage and Drain Testing. The drainage of sixty-one houses was found defective, and afterwards reconstructed. In many instances the work was carried out (without serving any notice) after personal interview with the owner concerned. Dilapidated and Insanitary Dwellings. The premises known as Nos. 1 to 4, Eade's Cottages, Green-Street-Green, were closed under the Housing, Town Planning, etc., Act, 1909. Two cottages at Sunny Bank, Prattsbottom, and one at Singles Cross, Knockholt. were closed—voluntarily—by the respective owners, the cottages not being considered worth repairing to render them fit for human habitation. Inasmuch as the whole of the above-named dwellings are still vacant, they are gradually becoming in a worse dilapidated condition. Dairies, Cowsheds, and Milkshops. There are 23 persons on the Register classed as follows:— Cowkeepers only 13 Cowkeepers, Dairymen, and Purveyors of milk 9 Purveyors of milk only 1 23 The Cowsheds, on the whole, have been kept in a satisfactory condition, though I would like to see improvements in several cases of more frequent cleansing of the yards where manure is often deposited too near the sheds. A new drainage system has been carried out at Little Portlands Farm, Cudham. All the Cowsheds, Dairies, and Milkshops are supplied with water laid on from the Metropolitan Water Board's Main. Bakehouses. There are 16 Registered Bakehouses, which were regularly cleansed and whitewashed, as required by Section 99 of the Factory and Workshops Act, of 1901. Slaughter-houses. There are 8 licenced Slaughter-houses distributed over the following Parishes as follows:—Farnborough. 2; West Wickham, 2; Downe, 1; Knockholt, 1; Hayes, 1; and Cudham, 1. Fifty-two inspections of these were made during the year, and the Bye-laws were generally complied with. All licences have been renewed for another year. Insufficient Waterclosets. Flushing cisterns, with water supply, have been provided in connection with 32 houses. 27 Insufficient Ashpits. Thirty-eight houses have been supplied with moveable receptacles. Overcrowding. Four cases of overcrowding were found and abated upon notice. Insanitary Ponds. The village ponds at Green-Street-Green, Locksbottom, Downe, and Hayes were thoroughly cleansed during the summer. Nuisances discovered. The number of nuisances discovered and abated was as follows:—128 relative to cesspools, 54 to blocked drains. 32 to closets of various kinds, 16 to animals kept in a filthy condition, 20 to urinals, and 4 to overcrowding. Total 254. Food inspection. During the year the regular inspection of the Slaughter-houses and Butchers Shops was carried out, and 511bs. of unsound beef was voluntarily surrendered and destroyed. It is not possible to always inspect the animals at the time of slaughter, but an effort is made as far as time will permit. Fruit Pickers' Shelters. There are 200 of these used for the decent lodging and accommodation of persons engaged in the picking of fruit and vegetables. Thirty-eight visits of inspection were made, and an improvement in the class of persons engaged was maintained The Bye-laws were generally complied with. Factory and Workshops Act, 1901. The Register contains the names of 73 Workshops and 6 Factories ; periodical inspections were made, and sanitary improvements carried out where necessary. West Wickham Sanitation. The sanitation of the village still remains very unsatisfactory. Many complaints were received of recurring nuisances arising from the frequent overflowing and emptying of the cesspools which, no doubt, is detrimental to the health of the inhabitants. Housing, Town Planning, etc., Act, 1909. Housing (Inspection of District) Regulations, 1910. A system has been adopted for the carrying out of the Regulations of the Act, and a house to house inspection was commenced in July. One hundred and seven houses were inspected, and various sanitary improvements carried out as follows:— Number of houses cleansed and repaired 60 Number of houses redrained 17 Number of sinks provided 17 Number of yards paved 50 Number of dustbins provided 12 Overcrowding abated 3 Improvements to cottages have in a large number of cases been voluntarily carried out. 28 Summary of Work Done. Number of inspections 1400 Number of complaints received and investigated 54 Number of houses, premises, etc., inspected 480 Number of re-inspection of houses, premises, etc. 226 Number of houses cleansed, repaired, whitewashed, etc. 82 Number of houses redrained 61 Number of nuisances discovered and abated 128 Number of back yards paved 64 Number of sanitary dustbins provided 38 Number of houses supplied with water from "Main" 10 New flushing cisterns provided and water laid on to W.C. 32 Number of houses (parts of) disinfected (Infectious Disease) 20 Overcrowding—number of cases abated 4 Number of letters written, reports, etc. 688 Number of Preliminary Notices served 33 Number of Statutory Notices served 11 I have the honour to be, Gentlemen, Your obedient Servant, ANDREW DUNLOP, (Cert., Royal Sanitary Institute), Sanitary Inspector. Table 1.—For Whole District. Year. Population estimated to Middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. *Number. Rate. Of Non-Residents registered in the District. Of Residents not registered in the District. Number. Rate. *Number. Rate per 1,000 Nett Births, Number.* Bate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 19,946 .. 533 26.7 332 16.6 50 3 61 114 285 14.2 1907 20,172 489 24.2 322 15.9 72 1 55 112 251 12.4 1908 20,397 528 25.8 326 15.9 78 6 50 94 254 12.4 1909 20,626 525 25.4 326 15.8 86 34 64 240 11.6 1910 20,858 508 24.3 322 15.4 96 6 51 100 232 11.1 1911 21,958 469 450 20.4 322 14 6 102 28 55 122 248 11.2 Notes.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates probably will not be available. The rates should be calculated per 1,000 of the estimated gross population. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. *In Column 6 are to be included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is to be entered the number in Column 6, corrected by subtraction of the number in Column 8, and by addition of the number in Column 9. Deaths in Column 10 are to be similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. Area of District in acres (exclusive of area covered by water), 28,799. At Census of 1911:—Total population at all ages, 21,958; number of inhabited houses, 4,845; average number of persons per house, 4.5. Table 2.—Cases of Infectious Disease Notified during the Year 1911. Notifiable Disease. Number of Cases Notified. Total cases Notified in each Locality. (Parish or Ward) of the District. Total cases removed to Hospital. At all Ages. At Ages†Years. Chelsfield. Cudbam. Downe. Farnborough. Hayes. Keston. Knockholt Mottingham. North Cray. Orpington. St. Mary Cray, St. Paul's Cray. W. Wickham. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small pox .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Memb. croup) 14 ... 4 8 1 ... 1 ... ... ... ... 2 ... 2 ... 1 1 4 1 3 ... 12 Erysipelas 22 ... ... 3 3 4 6 6 ... ... 14 ... ... ... 1 1 2 1 3 ... ...... Scarlet Fever 17 ... 4 12 ... 1 ... ... 4 4 ... ... ... ... 4 3 ... 1 ... ... 1 16 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 5 ... ... ... ... 3 ... ... 1 ... ... 2 ... ... ... ... ... 1 ... 1 ... 4 Relapsing Fever ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under Tuberculosis Regulations, 1908 14 ... ... 1 3 7 3 ... ... ... ... 13 ... ... ... ... 1 ... ... ... ... ... Under Tuberculosis Regulations, 1911 16 ... ... 3 3 9 1 ... 1 ... 1 ... 1 ... ... 3 1 5 2 1 1 16 Others ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 89 ... 8 29 10 24 12 6 6 4 1 32 1 2 4 8 4 13 4 8 2 48 Notes.—State in space below the name and position within or without the district of the isolation hospital, if any, to which residents in the district, suffering from infectious disease, are usually sent, the accommodation available for the district afforded by it, and the name of the authority by whom the hospital is provided. * This space may be used for record of other diseases the notification (compulsory or voluntary) of which is in force in the district. † These age columns for notifications should be filled up in all cases where the Medical Officer of Health, by inquiry or otherwise, has obtained the necessary information. Bromley and Beckenham Joint Isolation Hospital, Bromley Common, Kent—Total beds available, 113; number of diseases that can be concurrently treated, 5. Small Pox Hospital—Total available beds. 33; number of diseases that can be concurrently treated, 1. Table 3.—Causes of, and Ages at, Death during 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65, 65 and upwards. All Causes Certified 247 55 10 9 5 12 28 38 90 133 Uncertified 1 .. .. .. .. .. .. .. 1 .. Enteric Fever 1 .. .. .. .. .. .. .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles 3 1 .. 1 1 .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough 6 4 1 1 .. .. .. .. .. .. Diphtheria & Croup .. .. .. .. .. .. .. .. .. .. Influenza 1 .. .. .. .. .. 1 .. .. .. Erysipelas 1 .. .. .. .. .. .. .. 1 2 Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 24 1 .. .. 1 4 15 1 2 12 Tuberculous Meningitis 2 .. 1 1 .. .. .. .. .. 1 Other Tuberculous Diseases 4 .. 2 .. 2 .. .. .. .. 1 Rheumatic Fever .. .. .. .. .. .. .. .. .. 1 Cancer, malignant disease 20 .. .. .. .. .. 2 6 12 15 Bronchitis 18 5 .. .. .. .. .. 4 9 9 Broncho- Pneumonia 7 3 1 2 .. .. .. .. 1 .. Pneumonia (all other forms) 9 1 .. 1 .. .. 2 3 2 5 Other diseases of Respiratory Organs 2 .. .. .. .. .. .. 1 1 .. Diarrhœa and Enteritis 25 23 2 .. .. .. .. .. .. 1 Appendicitis and Typhlitis 2 .. .. .. .. 2 .. .. .. 1 Other septic diseases .. .. .. .. .. .. .. .. .. .. Alcoholism 1 .. .. .. .. .. 1 .. .. .. Cirrhosis of Liver .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 4 .. .. .. .. .. .. 2 2 .. Puerperal Fever .. .. .. .. .. .. .. .. .. 1 Other Accidents and Diseases of Pregnancy & Parturition .. .. .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 10 10 .. .. .. .. .. .. .. 8 Heart Diseases 32 .. .. .. .. 2 2 10 18 14 Brain Diseases 18 2 .. .. .. .. 1 5 10 8 Violent Deaths, excluding Suicide 7 1 .. 2 .. 2 1 1 .. 3 Suicides 1 .. .. .. .. .. .. .. 1 2 Other Defined Diseases 49 4 2 1 .. 2 3 5 32 49 Diseases ill-defined or unknown 1 .. 1 .. .. .. .. .. .. .. All causes 248 55 10 9 5 12 28 38 91 133 Table 4.—Bromley Rural District Infantile Mortality during the Year 1912.—Deaths from stated Causes in Weeks and Months under One Year of age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes—Certified 1 1 4 1 7 8 21 10 9 55 Small-pox .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 1 2 4 Diarrhœa .. .. .. .. .. 1 1 .. 1 3 Enteritis .. .. .. .. .. 5 8 4 3 20 Tuberculosus Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculosus Diseases .. .. .. .. .. .. .. .. 1 1 Congenital Malformations .. .. 1 .. 1 .. 1 .. .. 2 Premature Birth .. .. 3 .. 4 .. .. .. .. 4 Atrophy, Debility and Marasmus .. .. .. 1 1 1 2 .. .. 4 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculosus) .. .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. 1 2 .. .. 3 Gastritis .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. 1 .. 3 .. 1 5 Pneumonia (all forms) .. .. .. .. .. .. .. 4 .. 4 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Other Causes .. .. .. .. .. .. 3 .. .. 3 1 1 4 1 7 8 21 10 9 55 Nett Births in the year—Legitimate, 418; Illegitimate, 32. Nett Deaths in the year of Legitimate Infants, 46; Illegitimate Infants, 9. 33 FACTORY AND WORKSHOP ACT, 1901. FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. I.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Inspections. Number of Written Notices Prosecutions. Factories (including Factory Laundries) 10 0 0 Workshops (including Workshop Laundries) 164 6 0 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 10 0 0 Total 184 6 0 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. No. Found. No. Remedied. Referred to H.M Inspector. No of Prosecutions. Nuisances under the Public Health Acts:—* Want of cleanliness 20 20 0 0 Want of ventilation 0 0 0 0 Overcrowding 0 0 0 0 Want of drainage of floors 0 0 0 0 Other nuisances 0 0 0 0 Sanitary accommodation insufficient 2 2 0 0 Total 22 22 0 0 *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable tinder the Public Health Acts. 3.—HOMEWORK. Wearing apparel—making, etc. 2 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Workshop Bakehouses 27 Other trades connected with foods or drinks 0 Laundries 18 Other trades connected with clothing 14 Various 77 Total number of workshops on Register 136 84 5.—OTHER MATTERS Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. In spector 2 Total 4 J. S. TEW, Medical Officer of Health. April 15th, 1912.