BRO 65 Borough of Bromley THE ANNUAL REPORT on the HEALTH and SANITARY CONDITION of the BOROUGH. FOR THE YEAR 1911, by ARTHUR F. G. CODD, m.b., f.r.c.s., san. sci. cert., MEDICAL OFFICER OF HEALTH. Bromley Rent. Strong & Sons, Ltd., 39, East Street, 1911. Borough of Bromley REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1911. To the Mayor and Corporation of Bromley. March 25th, 1912. Gentlemen, I have the honour to present to you my Twenty-Third Annual Report, relating to the year ended December 31st, 1911. POPULATION. At the Census taken April 2nd, 1911, our population was 33,649. In 1811 our population was under 3,000. The first considerable increase was between the years 1861 and 1871, when the population increased from 5,500 to 10,674. Since that time, up to 1901, our increase has averaged about 5,500 for the ten years. Our increase in the decade 1901—1911 is 6,291, so it will be seen that the growth of the population in Bromley has been well maintained. 4 There were 14,448 males, and 19,201 females living in 7,440 houses. In 1901, the proportion of males to females was 100 to 129. In 1911 the proportion of females had increased to 133. i.e., there are about 4 females to every 3 males. This excess of female population is to be explained to a great extent, no doubt, by the fact that in a residential district like Bromley, a large number of female domestics are employed. I hope next year to be able to give fuller particulars of the Census, showing the number of males and females at the various age periods, in the respective Wards of the Borough. For the purposes of statistics, the population is always calculated for the middle of the year. On the supposition that the intercensal increase will be maintained, it may be estimated that our population in the middle of 1911 was 33,806. In my Report for 1910, I over-estimated the population, owing to the-fact that my calculations were based mainly on the number of inhabited houses in the Borough, which showed a large increase. In the previous Census, the number of persons per house was 5.3, and as this figure in the previous decades had been fairly constant, it was again used as a reliable basis for calculation. 5 Bat the Census of 3911 has shown that the number of persons per house has fallen to 4.5. Without further data, I have no explanation of this fact to offer. The Borough comprises 4,706 acres, having a population of 7.1 persons to the acre. In September, 1911, the Rateable Value was £280,286, and the Assessable Value, £260,863. BIRTHS. The Births registered during the year were 649. To this number, 11 " Transferable " births have to be added, making a total of 660, of which 348 were males and 312 were females. There were 22 illegitimate births, i.e., 3.3 per cent, of the total number of births. This gives a birth-rate of 19.5, compared with a rate of 24.4 for England and Wales, and 23.8 for the Outer Ring of London. This is exactly the same birth-rate as that recorded in 1910. In 1889, when I made my first Report, the birth-rate was 28.8. Since that time there has been an almost continuous fall. The low birth-rate 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 lives were spent. 6 The Outer Ring of London 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. MARRIAGES. During the year there were registered 301 marriages, of which number— 152 took place in Churches of the Established Church. 4 took place in Nonconformist Churches. 4 took place in the Roman Catholic Church. 141 took place in the Superintendent Registrar's Office. The marriage rate for Bromley was 17.8, the rate for England and Wales for the year ending September, 30th, was 14.9. DEATHS. The number of deaths registered in the Borough was 303. Under the new Rule, which came into force at the beginning of the year, the deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided, are transferred to the locality in which they previously resided. The same method of allocation has been applied to the Births, so that this year, for the first time, we have been able to attain absolute accuracy in the vital statistics of our Births and Deaths. 7 Of the transferable deaths, 19 were "outward" and 58 were "inward" Transfers, the large majority of the latter being the deaths of those persons who died in the Bromley Union Infirmary, which is at Locksbottom, just outside the boundary of the Borough. We have thus a total of 342 deaths, of which 164 were males and 178 were females, which is equal to a recorded death-rate of 10.1 per 1,000. The death-rate for England and Wales was 14.6. The rate for the Outer Ring of London was 11.8. The effect of the new Rule, with regard to Transferable Deaths, will be that death-rates throughout the Country will appear to be raised. In the past, the M.O.H.'s have been in the habit of excluding the deaths of non-residents in their calculations, without including the deaths of those residents occurring outside their districts, of which they had no official notification. The average death-rate of the five years, 1906-1910 inclusive, corrected from the figures of the 1911 Census, was 9.8 per 1,000. These rates compare very favourably with those of most of the residential districts round London. INFANT MORTALITY RATE. The proportion of deaths under 1 year of age to registered births was 74 per 1,000, compared with 130 per 1,000 for England and Wales, and 115 for the Outer Ring of London. 8 DEATHS FROM ZYMOTIC DISEASES. The deaths from all causes included: — Rate per 1,000 Bromley. England & Wales From Small Pox 0 .00 .00 „ Measles 9 .26 .36 ,, Scarlet Fever 1 .02 .05 ,, Diphtheria 4 .11 .13 ,, Whooping Cough ] .02 .21 ,, Fever 0 .00 .07 ,, Diarrhœa 17 .50 1.06 (under 2 years of age) 32 Thus 32 deaths were attributed to these principal Zymotic Diseases, being at the rate of .94 per 1,000, compared with a rate of 1.88 for England and Wales, and 1.88 for the Outer Ring of London. The deaths from Measles were more numerous than in any year since 1900, when 11 were recorded. Considering the exceptionally hot and dry summer, the number of deaths from Diarrhoea was not remarkable. Generally speaking, the effects of sanitary improvements and precautionary methods are best indicated by a lower deathrate, from Infectious Diseases, Fever, Diarrhoea, Consumption, and amongst children under 5 years of age, from all causes. 9 I therefore append these death-rates in Bromley during the last 10 years:— 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Infectious Diseases. .85 1.32 1.40 .83 1.21 .61 .52 .62 .28 .97 Fever .03 .06 .06 .00 .00 .00 .05 .00 .00 .00 Diarrhoea .32 .83 .82 .26 .97 .05 .02 .08 .02 .53 Consumption .74 .45 .51 .65 .27 .76 .46 .54 .45 .62 Children under 5 years of age, from all causes 3.16 4.08 3.79 1.98 3.03 2.12 2.23 .20 1.38 2.07 INFECTIOUS DISEASES. Under the Infectious Diseases (Notification) Act. 153 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:— 1907 1908 1909 1910 1911 Scarlet Fever 162 121 48 73 90 Diphtheria 51 72 36 13 44 Erysipelas 37 14 17 12 .14 Enteric Fever 5 7 0 2 2 Puerperal Fever 2 2 1 4 3 257 216 102 104 153 Of the 153 cases, 116 were removed to the Infectious Hospital, and the others were treated at home. In order that there should be some means of comparing the proportion of cases of Notifiable Infectious Disease in our 10 Borough, with that in some other districts, 1 have abstracted the following figures from the Quarterly Reports for 1911 of the Local Government Board, taking for comparison, London, Croydon, and three residential suburbs, as in my last Report. PROPORTION TO POPULATION OF CASES OF INFECTIOUS DISEASE. Cases per 1,000. London 5.27 Croydon 6.54 Beckenham 4.73 Bromley 4.30 Wimbledon 5.31 Ealing 4.74 Croydon and the three suburbs named were chosen, merely as being most suitable for comparison, but it is satisfactory to record that Bromley has shown the lowest proportion of cases for the last three years. SCARLET FEVER. Of the 90 cases of Scarlet Fever, 8 occurred in persons over 14 years of age, and 82 in children below that age . In the former class, 4 were adults who had been working out of Bromley in the few days preceding the onset of the illness. Another adult caught the disease from her child. Three cases were in young persons; one was contracted out of the district, another occurred in a private school with others to be mentioned later on, and one was untraced. 11 In the latter class, 56 occurred in children attending Elementary Schools, 21 in children who were either below school age or had not been attending school, and 5 in children attending a private school. Careful enquiries were made in all cases, in order, if possible, to trace the source of infection. In some instances the source was fairly obvious, these being those in which the disease had already appeared in some member of the family, or in one of the playfellows or schoolmates, with whom there had been recent contact. In others, the patient had been up to London or to some place of entertainment, and may have been there exposed to infection. When cases occur, as they will do, sometimes at long intervals, in areas remote from one another without its being possible to connect them with any previous case, directly or indirectly, one can onty class them as sporadic, but when Scarlet Fever is unduly prevalent in any given area, the explanation of failure to trace the infection among school children especially, lies generally in the fact that some cases have been overlooked, and that the children, while still attending school are infecting others. Such cases are now and then discovered accidentally. Sometimes they have to be sought for by the systematic examination of all the children in a class or school, and the task is not an easy one, for there may be little more than slight redness of the throat or tongue, more or less indefinite, to guide one. Among the 56 children attending Elementary Schools: infection traced, 18; infection untraced, 38. Exactly half of b 12 the latter had attended Infant Schools, and the other half, Schools for older children. Among the 21 below school age, infection was traced in 8, untraced in 13. In the private school, 5 out of the 6 cases were traced. Of the total number of cases of Scarlet Fever, 90 in all, the source of infection was either traced or surmised in 37, i.e., over 40 per cent. This proportion is much larger than in past years, but is not very reliable, as evidence which would satisfy one enquirer might be rejected by another. There was one " return " case during the year. A child of 8 years was discharged from the Isolation Hospital on February 16th, after a detention of nearly 8 weeks. Later on he had a bad cold and discharge from his nose, and on March 13th, i.e., 25 days after his return, his brother of 2} years fell ill with Scarlet Fever. One boy, who was discharged from the Isolation Hospital on December 1st, after an attack of Diphtheria, fell ill the next day, and on the following day showed the rash of Scarlet Fever. As he fell ill so soon after his discharge, and as there was no illness at home, it is presumed that he took the infection at the Hospital. A child, aged 18 months, who had been severely scalded some days before, developed Pneumonia, followed by a rash, which was at first supposed to be Septic. Within a few days, his brother of 6 years and his mother both fell ill with wellmarked Scarlet Fever, and the scalded child was then found 13 to be desquamating. His illness terminated fatally. No previous source of infection was traced. This was evidently a case of what is termed surgical Scarlet Fever. The six cases in a private school (three day pupils and three boarders) occurred in July, and commenced in one of the day pupils. The first to fall ill among the boarders, had no rash, and for the time his case escaped recognition. He accounted for the infection of the other two, and for that of his mother, who had visited him and developed Scarlet Fever after her return home. In connection with this school, there is another, a small Elementary Private School, the scholars of which do not mix with those in the private school. Scarlet Fever appeared among 5 of these, the first one nearly a month after the first case among the private pupils, and although we were not able to trace the transmission, there is little doubt the cases in the two schools were in some way connected with one another. Two children had to be re-admitted to the Hospital, one after an interval of only two days, suffering from a nasal discharge; the other after a month, owing to a discharge from the ear. In each case there were other children in the house, but no infection followed. The greatest number of cases occurred in October, when 30 were reported, but the remaining cases were distrinted fairly evenly over the other months of the year. They were scattered throughout the Borough, and with the possible exceptions of Farwig Lane and Park End, there was no marked incidence in any particular street or district. 14 Careful investigations were made with regard to the milk supply, but we failed to trace infection to this source in any instance. In the course of systematic enquiries, no evidence was obtained of transmission of infection by clothing or books. With regard to the preventive measures taken, the patients were promptly removed to the Isolation Hospital in nearly every case, and disinfection was carried out by Formaldehyde (30 tablets per 1,000 cubic feet), the walls being previously sprayed with a 2 per cent, solution of Cyllin. DIPHTHERIA. Of the 44 cases of Diphtheria, 6 occurred in persons over 14 years of age, and 38 among children below that age. In the former class, there were three adults who contracted the disease from their children, who were suffering from Diphtheria. One in this class was a visitor, who had been staying here 10 days before she fell ill. The other two cases were in young persons. One, a ship's boy, who had been about in London for a day or two before falling ill. The other was a "return" case, and will be referred to later. In the latter class, among the children, 25 attended the Elementary Schools, and one a private school. Among the 25, in about 4 cases, the source of infection was traced. In the remainder, no clue was obtained. Eight of these attended Infant Schools, and 17 the Schools for older children. 15 Among the children, 12 in number, who were not attending School, the probable source of infection was found in 5 cases only. Thus of the total number of Diphtheria cases, the source of infection was traced or surmised in rather less than a third of the cases (31 per cent.). In the Scarlet Fever cases, about 41 per cent, were accounted for. In my past Reports, I have referred to the similarity of infection in these two diseases, in their being both spread not only by infection from the definite cases, which are recognised, notified and promptly removed to Hospital, but by the indefinite cases—the so-called " missed " and " carrier " cases, which give us so much trouble, especially among the children attending the Elementary Schools. Among the well-to-do classes, the parents are better informed, are able to be more watchful with regard to any little ailment occurring in their children, and can obtain prompt medical attention, and early isolation, all of which facts help to minimise the risk of the occurrence of these indefinite cases. There were apparently two " return " cases during the year. One occurred in a boy of 14 years, who fell ill 3 weeks after the return of his sister from Hospital, where she had been detained for 32 days. Another was in a child of 4 years, who first showed signs of Diphtheria eight days after the return of his brother from Hospital, after a detention of 5 weeks. 16 In each of the primary infecting cases, the usual rule of obtaining 2 negative swabs, at an interval of 3 days before the discharge of the patient from Hospital, had been adhered to, so that it was evident that these two patients became again infectious after returning home. The relighting up of infectivity after an interval, occurs also after Scarlet Fever, and serves to emphasize the necessity of extreme caution, in allowing intercourse with other children convalescent from either Scarlet Fever or Diphtheria. There were 4 deaths from Diphtheria, which represents a case mortality of 9 per cent, a fairly satisfactory result. The antitoxin treatment, introduced towards the end of 1894, has been one of the principal agents in the reduction of the fatality. If parents were all aware of this fact, and would obtain medical advice for their children in the early stages of any throat affections, this fatality could be much lowered, for medical men are all agreed that the essential point in the treatment of Diphtheria is the early use of antitoxin. The cases were scattered fairly evenly over the district, 37 of these occurred in the last quarter of the year, which is the time at which Diphtheria is usually most prevalent. One hundred and ten Swabs were taken, and submitted to the Clinical Research Association, with a positive result in 23 cases and negative in 87. In 22 of the cases of Diphtheria which were removed to the Hospital, that is in exactly half the number, no swabs were 17 taken, presumably because the Clinical symptoms left no room for doubt, and in 3 cases, which for the same reasons were at once removed, Swabs which had been taken before removal were reported negative. These latter cases, after admission to the Hospital, were treated for the usual length of time and recovered. It is well known that the result from one Swab, if it is negative, is not to be entirely depended upon, and it is probable that if a second Swab had been taken in these cases, the result would have been positive. Of the cases notified, as suffering from Diphtheria, in 19, Swabs were reported to be positive. Three only were treated at home, 40 were removed to the Hospital, and one died on the way during removal. One adult, after a detention of 5 weeks in the Hospital, died from Diphtheritic paralysis, two days after her discharge. ENTERIC FEVER. Our record for this disease has been somewhat remarkable during the last three years. In 1909 no cases occurred; in 1910 two were reported—both in city men who lunched in town every day, and who almost certainly contracted tha disease there. In 1911 we also had two cases. One a horsekeeper, who went with his family to Ramsgate from August 20th to 26th, and there ate shellfish. He fell ill about the middle of September. 18 The other—a domestic servant, who fell ill on November 26th. She had been to London 9 days before, and had taken some light refreshment in a tea-shop. If she were infected on this occasion, the period of incubation was rather short. In both of these cases, Weidal's Test showed a Positive Reaction. They both recovered. MEASLES. An epidemic of Measles was due last year, and accordingly as happened in 1909, we found cases occurring with some frequency in the early months of the year. At once, acting on the school intimations, a Sanitary Inspector was deputed to ascertain from the parents the date when the rash appeared on the child, whose illness had been reported. In the case of the classes for the younger children, notice was served on the school authorities to close the class from the 9th to the 14th day inclusive, counting from 3 days before the date of the rash. During this interval children who had contracted the disease from the first child would be "sickening " for Measles, and in this infectious period would be away from school. In the case of the classes for the older children, the Sanitary Inspector attended at the school, and by the direction of the Schoolmaster, all boys or girls who had had Measles stood up in the class. If it were found that a large majority had already had Measles, no closure was ordered. The above method was in accordance with the plan advised by the Board of Education, and, on the whole, the results have been 19 factory, as on several occasions many children fell ill with Measles during the closure, so that the infection of the second crop of cases was not disseminated in the School. Up to midsummer, short closures of classes were advised in the various Schools of the Borough on 33 occasions. In those instances, in which Saturday and Sunday came in at the beginning or end of the closure, actual school closure was shortened by two days. EPIDEMIC DIARRHGEA. In the month of May the Health Committee considered the steps advised by the M.O.H., with a view of minimising a possible epidemic of Infantile Diarrhoea in the autumn, and the following precautionary measures were adopted. Collection of House Refuse. Orders were given for a collection of house refuse twice a week for a limited period of 8 weeks, from July 20th to September 20th, in those parts of the Borough occupied by the poorer classes. The streets numbered 89, and comprised nearly 4,000 houses, and the estimated extra cost of this measure was £110. Early in July, the special leaflets, which had been issued in former years, were revised, reprinted, and circulated. In August and September, the attention of the Sanitary Inspectors was specially directed to stable premises and cottages in the more congested areas. A rapid house to house inspection was made of some 300 cottages in various localities, and warning was given that, in view of the hot and dry weather which prevailed, dangerous diarrhoea amongst children might be expected. c 20 The householders were advised to keep the ground round the houses swept, and, if possible, watered, to boil their milk and keep it and other food protected from flies. Information was obtained from the medical men, and district nurses, of any cases of Diarrhoea, and those houses in which the cases occurred, and the neighbouring ones, were visited to inspect and warn. It was encouraging to find evidence that many of the householders were acting on the advice given in the leaflets, and were alive to the risks that their children ran at this time of the year. The Bromley Health Society did splendid work by reiterated warnings to the mothers who attended their meetings, and by asking them to spread notice among their neighbours of the danger of Diarrhoea amongst their children. At the beginning of August, I wrote a warning letter to the local papers, the publication of which in a prominent position, attracted some attention. The extreme heat and drought in the early summer had prepared us to expect a heavy incidence of Diarrhoea, and, although we might have done more if voluntary workers had been more numerous, the measures taken last summer were undoubtedly more efficient than in any previous year. INFANT MORTALITY. The Bromley and District Health Society, which was formed in 1908, is doing a very useful and increasing work in the Borough—a work which is most important to the welfare 21 of the poorer classes, and one deserving of far more support and encouragement from the residents of Bromley than it has hitherto received- The objects of the Society are chiefly to assist the mothers of the working classes to bring up their children healthily. Meetings at three centres are held every week, at which mothers are individually instructed in every detail of Infant Bearing, such as feeding, clothing, and nursing. The babies are weighed regularly, and a register is kept of all particulars, any deviation from the usual health of the child is noticed, and advice is given with regard to the smaller ailments or disorders by a doctor, who attends the meetings regularly. In 1911 there were 165 mothers on the books, and 1,179 attendances were made, and the present year has started with an average of 40 attendances per week. In addition, pregnant women are advised as to their health, and in necessitous cases, proper infant clothing has been sold at a much reduced price. In special cases, on the recommendation of the Committee, milk has been supplied to mothers for their children by a supporter of the Society. At each of the mothers' meetings, a plain tea is provided, and two or three ladies, who take an interest in the mothers and children, attend regularly to entertain and assist in details of the work. By recommendation, the Society is enabled to send mothers with or without their baby for a rest to the seaside, to obtain admission of children into Hospitals or Convalescent Homes, and to hire women to keep the house clean during illness. 22 Leaflets are distributed. Cases of confinement, unattended by a doctor, are afterwards watched, and in cases of illness, the attendance of a doctor is advised. The prevalence of diarrhoea in the intensely hot and dry summer was anticipated, and the mothers were very urgently warned to take measures to avoid the danger. The mothers not only appreciated the risks their own children ran, but, by communication with their neighbours at home, information was widely spread, generally with good results. The evil dependent upon the plague of flies was specially dwelt upon, and advice was given to combat the trouble. Among the ailments which came most frequently under notice at the meetings, were disordered digestion, sore eyes, and ears, commencing rickets, and minor respiratory troubles. Advice on treatment and prevention was frequently given, and in cases of more serious illness, the mother was advised to consult her own doctor. The mothers are visited in their homes by Mrs. Keif, the voluntary Health Visitor of the Society, who during the year paid 238 visits. Mrs. Keif was for some years a Sister at the Evelina Hospital for Sick Children, and she has undertaken the visiting, and teaches cleanliness, sanitation, economy, responsibility and self-respect, by individual instruction and occasional lectures. She also attends at the weekly meetings in conjunction with a lady doctor—Dr. Mordaunt, or the Medical Officer of Health. A report is made to the Committee, and the M.O.H. once a month. 28 The Society is working in co-operation with the Bromley Charitable Society, the Care Committee, the District Visitors, the Queen's Nurses, and the Society for the Prevention of Cruelty to Children. The mothers' meetings are a great success, and admit of considerable expansion without entailing much more work or expense, but the Home Visiting, which is of equal or even greater importance, is limited by the time which the honorary Health Visitor is able to spare from her own hone duties. Mrs. Keif has brought to the notice of the Society many facts, which show the urgent need for more time being given to this work, but the Society is not yet strong enough financially to become responsible for the payment of the salary of a whole-time Health Visitor. The duty of the Council, through its officers, is to see that the town is kept in a sanitary condition, by the enforcement of the various Health Acts and bye-laws, but so far little has been done in the direction of helping the working classes to lead healthy lives in their homes. Sanitary Authorities throughout the Country are now, however, awakening to the fact that the health and well-being of a community can be greatly aided by an extension of the work which is being carried on by the various Health Societies. I am strongly of opinion that the time has come for the appointment of such an officer in Bromley, not only from the facts stated above, but also, because until it is done, we are debarred from putting into force the Notification of Births Act, which is undoubtedly a most useful measure in combating Infantile mortality. 24 MEDICAL INSPECTION OF SCHOOL CHILDREN. The inspection of School children is under the charge of the School Medical Officer, Dr. Mabel Russell, who acts in conjunction with the M.O.H. In all action, apart from the actual inspection, involving any alteration of procedure, the S.M.O. and the M.O.H. confer together. If there is any undue prevalence of infectious disease in the Schools, the Officers meet, and, if necessary, make individual examination of all the children, and, if it is decided, to advise the closure of a School, the decision is by mutual agreement. In the recent prevalence of Diphtheria the S.M.O. took Swabs from the throats of any children considered suspicious, and communicated the result to the M.O.H. If, during medical inspection, or subsequently, the facts pointed to an insanitary condition of the home, the Public Health Department was notified. The S.M.O. is responsible for supervision within the Schools; the sanitary arrangements, the condition of the lavatories and W.C.'s, etc., are under the supervision of the M.O.H. TUBERCULOSIS. Twenty-eight cases of Pulmonary Tuberculosis were notified, four being under the voluntary system, which is now superseded by the last Public Health (Tuberculosis) Regulations, put in force. Five others were notified from Poor Law Institutions, and nineteen under the Public Health (Tuberculosis in Hospitals) Regulations. Of the above twenty-eight, 25 thirteen have died, thirteen were found to have had Sanatorium experience, including three of the deceased. The number of cases in the total referred to, relates to different persons, so that where a person has been notified more than once from different institutions, only one case is reckoned. This would account for the notifications being somewhat more than the actual number of cases. In addition to the above, a few deaths from Phthisis have been deait with, as discovered in the Registrar's weekly return of deaths, and followed up for the purpose of applying fumigation and purification of the sick rooms, and steam disinfection or destruction of the bedding. Rooms have been fumigated on twenty occasions, on termination or removal of consumptive cases, in ten instances the bedding has been disinfected in our superheated steam disinfector, and in three others bedding has been, burnt in the Destructor. In one instance some bedding was about to be disposed of without being satisfactorily disinfected and purified. Steps were taken to prevent this, which resulted in such bedding being burnt in our Destructor. The homes of patients were visited, and sputum flasks, cards of rules for consumptives, and disinfectants often supplied. Any insanitary conditions were noted and dealt with, and the necessary disinfection attended to, from time to time, as occasion arose. MILK SUPPLY. There has been little or no change in the character of our Milk Supply during the past year. 26 All the conditions and methods of inspection have been fully dealt with in my last Report. No case was discovered of the adulteration of milk, although the usual number of samples were taken. I think it would be a good plan to have a few samples of milk taken periodically every year for bacteriological examination, with a view to ascertaining whether any tuberculous milk is being supplied to the Borough from outside sources. The 365 cows kept in our own Borough were examined, and reported upon by our Veterinary Inspector, Mr. Reid, F.R.C.V.S., twice in the year, and were reported to be in good health and sound condition. WATER SUPPLY. The water supply is under the control of the Metropolitan Water Board, and is constant throughout the district. There are no private drinking water supplies in the shape of wells. In most instances the tap for drinking water is connected directly with the main, and, therefore, the danger from dirty cisterns is done away with. Four bacteriological examinations were made during the year, by the Clinical Research Association. The reports were all satisfactory. The number of organisms producing visible colonies on gelatine plates incubated 27 at 20°-25°C for 3 days, were found to be 12, 25, 20, and 6 respectively per cubic centimetre. The water is well known to be very pure in its freedom from organic matter, and is bright and palatable for drinking, but for washing, steam and industrial purposes generally, the hardness is a serious objection. The action on the skin in washing is rather drying and astringent, and it is therefore not suitable for those people who have a tendency to Eczema. It was at one time considered that the drinking of calcareous waters predisposed to Dyspepsia, Constipation, Rheumatism, Gout, Gravel, and Urinary calculi. Good evidence has lately been produced to show that this opinion is not supported by the experience of medical men, and that there are no scientific objections to the use of a hard drinking water. It is certain that the prejudice has always existed much more strongly in the public than in the professional mind. At any rate, the facts brought forward have certainly given us grounds for revising our opinion as to the injurious effects of a hard drinking water. I have mentioned the subject as intending residents often attach much importance to the character of the water supplied in the Borough. 28 RAINFALL. I am indebted to Mr. David G. Simpson, of Rosefield, Widmore Road, for the following particulars of the local rainfall:— January 1.07 ins. on 13 days. February 1.01 „ „ 13 „ March 1.71 „ „ 17 „ April 1.91 „ „ 14 „ May .68 „ „ 7 „ June 2.23 „ „ 13 „ July .43 „ „ 6 „ August 1.01 „ „ 8 „ September 1.14 „ „ 9 „ October 2.95 „ „ 17 „ November 3.90 „ „ 20 „ December 4.87 „ „ 25 „ Total local rainfall = 22.91 inches on 162 days. „ London „ =23.6 „ „ 151 „ In London the mean Temperature for the third quarter of the year was 65.6°, which was 4.5° higher than the average for the 35 years 1871-1905, and the Bright Sunshine was 777 hours, being 290 hours more than the average for the same years. HOUSE ACCOMMODATION. 17 plans were deposited for 43 houses. 32 „ „ „ „ 32 additions. 24 „ „ „ „ 24 drainage relays. The houses for the working classes are nearly all modern, and are kept in very fair structural order. 29 There are proportionately few old cottages, and so strict a supervision is kept over these, that they are kept in good habitable condition. In the past the owners have been obliged in many cases to make very extensive improvements in these cottages, in conformity with the bye-laws, and the Public Health Acts, and in some instances, the notices served have resulted in closure and subsequent demolition. THE HOUSING (INSPECTION OF DISTRICT) REGULATIONS, 1910. The systematic house-to-house inspection of working class dwellings has been continued throughout the year, 688 cottages having been inspected and reported on. It was not found necessary to advise the making of any Closing Orders, but the defects were specifically dealt with by the service of Notices under the various powers of the Council. In three instances, where Closing Orders were made at the end of 1910, the houses remained empty for some months, until the Owners put them into thorough repair, externally and internally, to my satisfaction. The Closing Orders were then withdrawn, and the houses were soon re-occupied. The following gives an idea of the character of the work carried out:— EXTERNALLY. All brickwork raked and repointed from foundations to chimney pots, and rotten renderings of back additions stripped and renewed; roof slating, rain water pipes, 80 and eaves gutters overhauled and made good; back yards paved; walls protected from damp with concrete and cement plinths; ventilation provided under ground floors; and all painting renewed three coats. INTERNALLY. Some of the floors were entirely renewed and others repaired; all windows put into thorough working order, some renewed; ceilings and wall plasterings made sound; all walls and ceilings stripped, stopped, cleansed and whitewashed; and wood work repainted. Some fifteen fireplaces were made sound with new grates; new cisterns were provided and draw off taps from the main; drains repaired, and new dustbins supplied. In another case a terrace of eighteen Cottages was externally very dilapidated, but the interiors did not justify their being dealt with under Closing Orders. Various notices were served, and the Owner's attention otherwise specially called to the dilapidations. The result was that a contract was entered into, to carry out a considerable amount of work, which may be briefly summarised as follows:— In addition to moderate internal repairs, all exterior brickwork was raked and repointed; cement plinths to protect the base of the walls from damp, inserting all necessary air bricks; slate roofing overhauled and repaired, and many new chimney pots; a number of stone door and window sills were renewed, others repaired; all doors and windows put in thorough repair, some renewed; fourteen back addition W.C.'s pulled down, and rebuilt with new roofs and doors, closets otherwise put into sanitary 31 tion; portion of yard against rear of each house paved; all gutters and rain water pipes put into order; and outside painting renewed. As mentioned in my last Report, very few houses are likely to be found bad enough to be dealt with by Closing Orders for some time to come, owing to the system of houseto-house inspection which has been carried on for over 17 years, during which period the whole of the working class dwellings have been several times subjected to inspection, and the service of notices to remedy the defects. There are no congested areas, such as alleys or courts, that are likely to require to be dealt with on the ground of unhealthiness, owing to want of external light, or deficient air space and cellar dwellings do not exist in the district. No. of houses on working schedule for house- to-house inspection 3870 No. inspected in 1911 688 No. of representations with a view of making Closing Orders 0 No. as to which Closing Orders were made 0 No. where defects were remedied without making Closing Orders 18 No. made fit for habitation after Closing Orders (made end of 1910) 3 The character of defects remedied in the 688 inspected is set out in tabular form below, but such items are also reckoned in Table C. in the Inspector's Report (appended). Premises where drains were renewed entirely 10 Premises where drains were renewed partially or repaired 80 32 Drains unstopped only 19 Soil pipes and drain ventilators renewed or repaired 39 W.C.'s repaired (new pans, traps, flushing tanks, etc.) 135 Dilapidated brick closets rebuilt 14 Houses provided with sinks 16 Sanitary dustbins provided 112 Houses cleansed and whitewashed (wholly or partially 36 No. of rooms so cleansed and whitewashed 134 Dampness remedied (roofs, R.W.P.'s, wall footings, floors, etc., repaired) 96 Yards paved to carry surface water away from houses 73 Defects to water cisterns remedied 5 Houses where windows were made to open for ventilation 12 Other small items, viz:—Floors repaired, drain channels made good, ceilings and wall plastering repaired, air bricks cleared and made good, etc., etc. 52 By constant reference to the said working schedule of 3,870 cottages which comprise slightly more than half of the inhabited houses in the district we are able to pick out from time to time the streets for inspection which are most likely to require it, due regard being given to the date when the last inspection took place, and the age of the cottages. 33 MEAT INSPECTION. There are seven slaughterhouses in the district where animals are killed for human food, and one knacker's yard. Owing to the way these premises are scattered about the Borough, the irregularity of the killing times, and the small number of animals killed, inspection of the meat is more frequent in the shops than in the slaughterhouses. Two of the Sanitary Inspectors are Certified Inspectors of Meat and other Foods, having undergone the Special Course of instruction and examination of the Royal Sanitary Institute. No tuberculous meat was found during the year under review. GENEEAL SANITARY MATTERS. OFFENSIVE TRADES. A prolonged correspondence took place with the Local Government Board with reference to the order proposed to be made by the Council under section 112 of the Public Health Act, 1875, as amended by section 51 of the Public Health Acts Amendment Act, 1907, declaring certain trades to be offensive trades in the Borough. It was eventually resolved by the Council that the Declaratory Order in the form revised and suggested by the Local Government Board should be made, under which the following trades should be declared offensive trades in the Borough, viz:— Tanner, Leatherdresser, Blood-drier, Gluemaker, Sizemaker, Gut Scraper, Fat Melter or Extractor, Shin or Hide dealer. 34 DEPOSIT OP LONDON REFUSE. Owing to the action of the Kent County Council, in calling attention to the offensive refuse which the Contractors to the Metropolitan Boroughs deposited on land, in the County of Kent, acquired by them for the purpose, our Town Council drew up a series of bye-laws, with respect to the unloading or deposit of filth or rubbish, which came into force, after being approved by the Local Government Board. An order was made by the Council, by which the disease of acute Polio-Myelitis (or Infantile Paralysis) was added to the list of notifiable diseases in the Borough, under the Infectious Disease Notification Act, 1889, and later on Cerebro-Spinal Fever was also included. In accordance with my suggestion the Council gave orders for a collection of house refuse twice a week for a limited period from July 20th to September 20th, in those parts of the Borough occupied by the poorer classes. Complaints were made of smells from the sewers in Martin's Road, and the two ventilators objected to were closed by order of the West Kent Main Sewerage Board. In September, a complaint was made of offensive smells from the premises of a tradesman in the town, due apparently to fat-boiling. Inspection was made, but nothing objectionable was found, although the premises were kept under observation for some time. A smoke nuisance from a large laundry works was complained of, but the subsequent observations did not warrant any legal action being taken. 35 Complaints were made with reference to the engines on the S.E. and Chatham Railway between Bromley South and Bickley Stations, emitting smoke and ashes. The Railway Company immediately took effective action to prevent a repetition of the nuisance. The desirability of making Infantile Ophthalmia a notifiable disease under the Notification of Infectious Diseases Act was considered by the Council, and Dr. W. J. Howarth, the Kent County Medical Officer, was communicated with on the subject. As he stated that he had a scheme in hand dealing with the matter, and as it was felt that it would be well that action throughout the County should be uniform, further consideration was postponed until Dr. Howarth should be prepared to state his views. In the meantime, I have taken the opinions of many of the medical men in the Borough, and I find that the majority agree that the measure is not needed in Bromley. Appended are my Report in relation to the Factory and Workshops Act, and the Report of your Sanitary Inspector, showing in detail the work executed during the year. I am, Gentlemen, Your obedient Servant, ARTHUR P. G. CODD, Medical Officer of Health. Table 1.—Vital Statistics of Whole District during 1911 and previous Years. Year. Population estimated to Middle of each year corrected. Births. Total Deaths Registered in the District. Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. Of Nonresidents registered in the District. Of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number * Rate Number † Rate Number. * Rate per 1,000 Nett Births. Number * Rate † † 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 30,660 729 23.7 289 9.4 14 31 83 113 306 9.9 1907 31,289 712 22.7 305 9.7 17 31 50 70 319 10.1 1908 31,918 728 22.8 289 9.0 17 34 53 72 306 9.5 1909 32,547 716 21.9 314 96 18 45 49 68 341 10.5 1910 33,176 647 19.5 269 8.1 16 48 39 60 301 9.0 1911 33,806 649 660 19.5 303 8.96 19 58 49 7.42 _ 342 10.11 Total population at all ages, 33,649. Number of inhabited Houses, 7.440. Average number of persons per House 4 5. Cases of Infectious Disease Notified during the Year 1911. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Ward. Total cases removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65 65 and upwards. Town. Martin's Hill. Plaistow. Sundridge. Bickley. Bromley Common. Diphtheria (including Memb. croup) 44 1 11 27 1 4 ... ... 5 3 18 ... 8 10 40 Erysipelas 14 1 ... ... ... 4 7 2 2 2 3 6 ... 1 ... Scarlet Fever 90 ... 18 64 5 3 ... ... 7 14 25 12 9 23 75 Enteric Fever 2 ... ... ... 1 1 ... ... ... ... ... 1 1 ... 1 Puerperal Fever 3 ... ... ... 2 1 ... ... 1 ... ... 1 ... 1 ... Phthisis— Under Tuberculosis Regulations, 1908 5 ... ... ... ... 2 3 ... 2 ... ... ... ... 3 ... Under Tuberculosis Regulations, 1911 19 ... ... 4 5 10 ... ... 3 ... 5 4 2 5 ... Others 4 ... ... ... 2 2 ... ... ... ... 1 1 2 ... ... Totals 181 2 29 95 16 27 10 2 20 19 52 25 22 43 116 Table III.—Causes of, and Ages at, Death during Year 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 year. 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. 1 2 3 4 5 6 7 8 9 10 11 All Causes- Certified .. .. .. .. .. .. .. .. .. .. Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. 2 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 9 1 4 2 2 .. .. .. .. .. Scarlet Fever 1 .. 1 .. .. .. .. .. .. 2 Whooping-cough 1 1 .. .. .. .. .. .. .. .. Diphtheria and Croup 4 1 .. .. 2 .. 1 .. .. 5 Influenza 1 .. .. .. .. .. .. .. 1 .. Erysipelas 1 .. .. .. .. .. .. .. 1 .. Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. 1 .. .. .. Phthisis (Pulmonary Tuberculosis 21 .. .. .. .. 3 11 7 .. .. Tuberculous Meningitis 2 1 .. .. 1 .. .. .. .. .. Other Tuberculous Diseases 4 .. 1 1 .. .. 1 1 .. 1 Rheumatic Fever .. .. .. .. .. .. .. .. .. 1 Cancer, Malignant Disease 48 .. .. .. 1 .. 4 21 22 4 Bronchitis 24 .. 1 .. .. 1 1 5 16 .. Broncho Pneumonia.. 8 .. 4 .. .. .. .. 1 3 .. Pneumonia ,all other forms) 7 1 1 .. .. .. .. 2 3 2 Other Diseases of Respiratory Organs .. .. .. .. .. .. .. .. .. .. Diarrhœa and Enteritis 18 15 2 .. .. .. .. .. 1 7 Appendicitis and Typhlitis 3 .. .. .. 2 1 .. .. .. 2 Alcoholism .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 3 .. .. .. .. .. .. 1 2 .. Nephritis and Bright's Disease 8 .. .. .. .. .. 2 4 2 1 Puerperal Fever 2 .. .. .. .. 1 .. 1 .. .. Other Accidents and Diseases of Pregnancy and Parturition 3 .. .. .. .. 1 2 .. .. .. Congenital Debility and Malformation, including Premature Birth 26 26 .. .. .. .. .. .. .. 1 Violent Deaths, excluding Suicide 4 1 .. .. .. 1 1 .. 1 1 Suicides 1 .. .. .. .. .. 1 .. .. .. Other Defined Diseases 141 2 2 1 1 6 11 26 92 10 Diseases ill-defined or unknown 1 .. .. 1 .. .. .. .. .. .. 342 49 16 5 9 14 36 69 144 3 Table IV.—Infantile Mortality during the Year 1911. 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 .. .. .. .. .. .. .. .. .. .. Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Whooping Cough .. .. .. .. .. .. .. .. 1 14 Diarrhœa .. .. 1 .. 1 2 5 2 4 I Enteritis .. .. .. .. .. .. .. .. 1 1 Tuberculous Meningitis .. .. .. .. .. .. .. 1 .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Congenital Malformations .. .. .. .. .. .. .. .. .. 11 Premature Birth 8 .. .. .. 8 3 .. .. .. 15 Atrophy, Debility and Marasmus 6 3 1 2 12 1 .. 1 1 .. Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculosis) .. .. .. .. .. .. .. 1 .. 1 Convulsions .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. 1 .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. .. .. 1 .. 1 Suffocation, overlying 1 .. .. .. 1 .. .. .. .. 1 Other Causes .. .. .. .. .. .. .. .. .. .. 15 3 2 2 22 7 5 7 8 49 Births in the year— Legitimate, 638; Illegitimate, 22. Deaths in the year of Legitimate Infants, 44; Illegitimate Infants, 5. 40 Factories, Workshops Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections Written Notices. Prosecutions. Factories (including Factory Laundries) 9 2 Nil. Workshops (including Workshop Laundries) 254 20 Nil. Workplaces (other than Outworkers' Premises included in part 3 of this Report) Total 263 (at least) 22 Nil. 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied Referred to H. M. Inspector Nuisances under the Public Health Acts:— Want of Cleanliness 32 32 Nil. Nil. Want of Ventilation 6 6 .. .. Overcrowding 1 1 .. .. Want of drainage of floors .. .. .. .. Other nuisances 25 25 .. .. Sanitary Accommodation insufficient .. .. .. .. unsuitable or defective 22 22 .. not separate for sexes. 1 1 .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) .. .. .. .. Breach of special sanitary requirements for house (ss. 97 to 100) 28 28 .. .. Other offences .. .. .. .. Total 115 115 .. .. 3.—HOMEWORK. Nature of Work. Outworkers' Lists, Section 107. Inspections of Outworkers' premises. Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keeping or sending Lists. Sending twice in the year. Received from other Councils. Forwarded to other Councils Lists. Outworkers Contractors. Workmen. Wearing Apparel— making, etc. 28 19 59 .. .. 36 .. Furniture and Upholstery 2 .. 4 .. .. 2 .. Umbrellas, etc. 2 .. 2 .. .. 2 .. Total 32 19 65 .. .. 40 .. 4.—REGISTERED WORKSHOPS. Workshops on the Register at the end of the year. Number. Bakehouses 23 Dressmakers and Milliners 45 Tailors 15 Bootmakers 13 Laundresses and Cleaners 26 Restaurants, Eating Houses, etc. 16 Miscellaneous 67 Total number of workshops on Register 205 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 2 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 1 Reports (of action taken) sent to H.M. Inspector. 1 Other 3 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 2 42 Borough of Bromley. ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE YEAR 1911 (As required by the Sanitary Officers' (outside London) Order, 1910) To the Chairman and Members of the Health Committee A. NUMBER AND NATURE OF INSPECTIONS. Premises inspected on Complaint 223 Houses inspected re Infectious Disease or Disinfections 261 Houses inspected re House-to-House Inspection of Cottages 688 Inspections of Dairies, Cowsheds and Milk- shops 156 Inspections under Factory and Workshop Acts 263 Slaughter-house Inspections 28 Elementary School Inspections 76 Inspections of Common Lodging House 5 Market and Miscellaneous Inspections 154 Total (less re-visits) 1854* * From diary entries it. is estimated that the total visits and re-visits in connection with the above return is roughly about 6000 43 B. NUMBER OF NOTICES SERVED IN 1911. Under Public Health Act, 1875— Formal Notices. Informal Notices. Sec. 94, re Nuisances 346 145 Sec. 36, re Dustbins 126 25 Sec. 36, re W.C.'s — 3 Sec. 46 re Cleansing 42 8 Sec. 41, re Drains 1 — Under Public Health Act, 1907— Sec. 49, re Sinks 9 — Sec. 25, re Yards 64 2 Under Factory and Workshop Act— Sees. 2 and 99, re Cleansing, etc. - 33 Under Dairy Regulations, re Cleansing, Limewashing, etc. — 29 588 + 245 Total 833 C. The result of the service of such Notices and nature of the works carried out to remedy the defects reported:— Premises where drains were renewed entirely 22 Premises where drains were renewed partially or repaired 144 Drains unstopped only 90 Soilpipes and drain ventilators renewed or repaired 84 44 W.C.'s repaired (new pans, traps, flushing tanks, etc. 229 Houses provided with sinks 18 Sanitary dustbins provided 162 Houses cleansed and whitewashed (wholly or partially) 52 Number of rooms so cleansed and whitewashed 187 Trade premises cleansed and whitewashed 61 Bakehouse floors repaired 5 Dampness remedied (roofs, r.w.p.'s wall footings, floors, etc., repaired) 113 Overcrowding abated 5 Yards paved to carry surface water away from houses 83 Defects to water cisterns remedied 12 Public water supply substituted for well water 1 Houses where windows were made to open for ventilation 12 Nuisances abated re keeping of animals (stables, etc.) 16 Cesspool nuisances abated 5 Smoke nuisances abated 2 Other small items, viz.:—Floors repaired, drain channels made good, ceilings and wall plastering repaired, air bricks cleared and made good, etc., etc. 103 In getting the above work carried out, no actual legal proceedings were resorted to, but defaults in compliance with Notice were periodically reported to the Council, who 45 ably instructed the Town Clerk to communicate with the defaulters, which was sufficient to bring about the desired result. In reviewing the details of the year's work it will be seen that the house-to-house inspection of cottages has been kept well up to the mark, but it was not thought necessary for various reasons, to test the drains at half the 688 houses visited. There was a less amount of work done under the Factory and Workshop Acts, but more attention was necessarily directed to infectious cases, Consumption, and precautions against Summer Diarrhœa. As to the latter disease, a rapid inspection was made of over 300 of the smallest houses in the month of August, when the insanitary conditions found were not numerous. It was also obvious that precautions were being taken by the occupiers, particularly as to the cleansing of the back yards, many of which had been paved in consequence of previous notices served, and it generally appeared that the warning leaflets, issued to householders, resulted in much good, having regard to the standard of cleanliness which was found by the Inspectors. A few urgent defects were promptly remedied, and other matters were dealt with in the routine way. OFFICE STAFF. The Staff in the Sanitary Department consists of one Inspector and two Assistant Inspectors, the same as for the past ten years. 46 INFECTIOUS DISEASES AND DISINFECTIONS. These duties are carried out under the directions of the Medical Officer of Health. Fortunately almost every medical practitioner in the district is on the telephone, as are also the Medical Officer of Health, the Joint Hospital, and the Council Offices, so that there is little loss of time in getting cases removed or other matters in connection therewith attended to. Over 85 per cent. of the Scarlet Fever and Diphtheria cases notified were removed to the Joint Hospital for treatment. The 44 Diphtheria cases occurred in 33 separate houses, in 25 different streets. The 90 Scarlet Fever cases occurred in 76 separate houses, in 53 different streets. Rooms are disinfected with Formalin gas after being sprayed with Cyllin, and the bedding disinfected in the Council's superheated steam disinfector, when advised by the Medical Officer of Health or medical attendant. Disinfections re Scarlet Fever 88 „ „ Diphtheria 41 „ „ Typhoid 2 „ „ Puerperal Fever 2 „ „ Consumption 20 „ „ Cancer 9 „ „ Miscellaneous 10 Total 172 47 Number of rooms, disinfected 240 Beds and other Articles disinfected (by steam) 993 „ „ „ burnt 21 When a case of Infectious Disease is reported, the necessary removal or disinfection is first attended to, and tabulated particulars obtained for the use of the Medical Officer of Health. The premises are inspected for insanitary conditions, drains tested, and in most cases some disinfectant left at the house, which aids in bringing about a general scrubbing and cleansing of the room or rooms. When a patient is removed to the hospital, school notices are made out in triplicate and sent to the occupier, the head teacher of the school, and the School Medical Officer, giving the names of the house contacts to be excluded from school attendance for a short period as laid down by the Medical Officer of Health. If the case is isolated for treatment at home, the school exclusion extends until a certificate of disinfection has been given from the Sanitary Department, on recovery of the patient. Anti-toxin and bacteriological outfits are kept ready for use in the office, and at the residences of the Medical Officer of Health and Sanitary Inspector, so that they can be promptly given out, or dispatched, at any time, on application by telephone or otherwise. The number of doses of Anti-toxin given out in the year was 21. Curative and prophylactic doses are kept in stock. Bacteriological examinations for Diphtheria, Tubercle Bacilli, and serum test for Typhoid have for many years been 48 carried out by the Clinical Research Association, but from 1st March, 1912, the Council have decided to try the arrangement for sending them to the laboratory of the County Medical Officer of Health. DAIRIES, COWSHEDS AND MILKSHOPS. There are 13 farms registered for dairy purposes in the Borough, and 28 other premises, where milk businesses are carried on, making 41 premises on the Register. All the premises are inspected regularly twice a year, to see that the regulations as to cleansing and limewashing are complied with, an abstract of the Council's dairy regulations being previously sent to each person on the register. Casual visits are also made at other times, particular notice being taken of the cleanliness of the milk churns and cans, and the swilling down of the cowshed floors. Fifty-nine special milking inspections (mostly in the early morning) were also recorded to see how the regulation as to cleanliness in that process is observed. Beyond urging an employee, here and there, to exercise more care, it has not been thought necessary to report any decided infringement during the year in this respect. The number of milch cows kept is found to vary slightly, and is about 350, and the milkers employed in connection therewith total 35 persons. FACTORY AND WORKSHOP ACTS. There are some 205 registered workshops, beside about 50 other premises that would come under the definition of 49 tory." The number of visits recorded to these is 263. This is rather low for reasons previously stated. The principal objects for inspection are the condition of the workrooms as to cleanliness, ventilation, and whether there is sufficient air space for the number of persons present; the condition of the sanitary conveniences is also always noted. The workshops most frequently visited are laundries, dressmakers', milliners', tailors', bakehouses, eating houses, etc. Men's workshops, embracing persons employed in the building, cycle, and other mechanical or metal work trades, get less attention. Any default or other matter found is reported to the fortnightly meeting of the Health Committee for instructions as to any action necessary to be taken. SLAUGHTER HOUSES. There are seven registered or licensed slaughter houses, where meat is killed for human food, and one knacker's yard. These are inspected every three months under the regulations and casually at other times. As reported in past years, the slaughter houses are used only to a moderate extent, for it is obvious, from particulars obtained as to the number of animals slaughtered in the year, only a small fraction of the meat consumed here is killed locally. From recent enquiries, I estimate that the average weekly number killed in the Borough would be approximately 6 bullocks and calves, 80 pigs, and 53 sheep and lambs. A 50 large proportion of the pigs are killed at one particular slaughter house, and appear to be mostly disposed of through the Central Meat Market, London. SCHOOL INSPECTION. The sanitary conveniences of the elementary schools are inspected at monthly intervals, and the drains tested once annually. The former were kept in a very satisfactory condition, and, as a result of the alterations and improvements in previous years, no defects were found in the drainage. FOOD INSPECTION. No food was found in the year that warranted formal seizure under the Public Health Acts, but the destruction of a small quantity of unsound shell fish, and on another occasion, two boxes of plaice, was secured on being voluntarily submitted by local vendors for inspection. Sixty-one samples of food were sent to the Public Analyst, viz.:—Milks, 33; butter, 15; coffee and coffee mixtures, 5; sausages, 2 ; miscellaneous, 6. There were no prosecutions, as no certificates of adulteration were given, but 11 of the milk samples were reported to be either slightly watered, or below the limit for fat or non-fatty solids. One of the County Inspectors also takes samples in the district, in addition to the 61 already mentioned. Milk samples are usually taken from the churns on arriving by rail from other districts or from the hand cans of milkmen, when serving their customers on their rounds.