BRO62. Borough of Bromley THE ANNUAL REPORT ON THE HEALTH AND SANITARY CONDITION OF THE BOROUGH FOR THE YEAR 1919. BY JOHN MATHEWSON, M.B., B.CH., Temporary Medical Officer of Health. PURNELL, PRINTER, CROYDON. Borough of Bromley REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. To the Mayor and Corporation of Bromley. April 13 th, 1920. Gentlemen, I beg to submit, as Temporary Medical Officer of Health, my fourth Annual Report on the health and sanitary condition of the Borough, relating to the year 1919, which is arranged in the order prescribed by the recent memorandum of the Ministry of Health. In doing so it is satisfactory to be able to state that the district shows signs of recovery from the effects of the war, inasmuch as the population is increasing at a greater rate : the birth rate is going up, infant mortality very low, and the general death rate has also gone down, very few empty premises remain and many shops have been reopened for business, and there is more building in prospect than has been the case for some years past. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population (Census 1911—33,646), Estimate June, 1919—36,246. The above population is that given by the Registrar General for estimating the birth rate and compares with 35,375 in 1918, but as a considerable number of Bromley non-civilians were serving at home or abroad and as their deaths are not credited to the district by inward transfer, as is the case with civilians dying away from home, the Registrar General gives 34,795 as the population for estimating the death rate. This compares with 31,572 in 1918. 4 PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. The area of the Borough is 4,696 acres, giving 7.7 persons per acre. It extends some four miles from the Northern boundary—where it joins the- Lewisham and Mottingham districts—to the Southern boundary—where it joins Hayes and Farnborough, and from the Eastern boundary — where it joins Chislehurst — to the Western boundary—where it joins Beckenham and Hayes—the distance varies from three-quarters of a mile to two miles. This area is very open as it contains large private parks, several golf links, as well as Public Recreation Grounds. The parks are fairly well wooded and trees are planted along a number of streets. The built-over areas are well spread out. The elevation of the district varies from 125 feet above sea level in the Shortlands valley in the west to 370 feet in the Bickley Ward. The business part of the town and the surrounding neighbourhood in the northern half of the district lie on fairly level ground about 200 feet above sea level. The greater part of Bromley is gravel and said with chalk at a depth of 70 to 150 feet from the surface. This from a sanitary point of view is an excellent soil to build upon. There is, however, on either side of the road at Bromley Common a large tract of clay some 35 feet deep extending about a mile and a half long—from Mason's Hill to Holy Trinity Church—and half a mile wide. Owing to the impermeable nature of the clay flat tracts are not, on account of their dampness, desirable for building upon, but slopes which drain naturally are not open to this objection. The means of communication are good. The main road to Sevenoaks and coast towns passes through the centre of the town ; motor buses pass through the town from London to the villages around and there are six or seven railway stations and a good service of trains to serve the needs of the inhabitants. Bromley is largely a residential district, many of the inhabitants going to London and elsewhere for business or employment. 5 The number of the shops—600 to 700—indicates the occupations of another large class and that the town supplies some of the needs of the outside districts. The factories and workshops are not numerous, so that not a large proportion of the inhabitants are engaged in such employment. Hospitals. — In addition to the Joint Isolation Hospital for the treatment of certain infectious cases in this and other districts in the Union of Parishes, there are the Bromley Cottage Hospital—42 beds, the Phillips Memorial Hospital (Homeopathic)—18 beds, and the Bromley, Chislehurst and District Maternity Hospital—16 beds. There are also several private nursing homes. A Tuberculosis Dispensary is also maintained by the Kent County Council. It may be interesting to know that the amount of outdoor relief paid by the Board of Guardians for the year 1919 was £2853. BIRTH RATE. The number of births was 534, an increase of 69 over 1918, 271 being males and 263 females, 49 were illegitimate. This gives a birth rate of 14.73 per thousand of the population and is a distinct increase on the low figure reached in 1918 of 13.14 and in 1917 of 13 9. Before the war the birth rate had gradually fallen and was 17.6 per thousand in 1913—the lowest on record during the previous 25 years. MARRIAGES. During the year there were registered 904 marriages, of which number : 626 took place in Churches of the Established Church 69 „ Nonconformist Churches 20 „ the Roman Catholic Church 189 „ the Superintendent Registrar's Office The marriage rate for Bromley was 49 9 per thousand - an enormous increase compared with 183 in 1913. The rate for England and Wales for 1919 was 19. DEATHS. The number of deaths was 407—197 being males and 210 being females—which is equal to a recorded death rate of 11.7 per thousand, 6 a satisfactory reduction on the previous year's figure of 13.3, which was high owing to the large number of deaths from Influenza. The causes of death as set out in the Registrar General's table are as follows:– Enteric fever nil Smallpox nil Measles 5 Scarlet fever 1 Whooping cough 1 Diphtheria and Croup 6 Influenza 30 Erysipelas nil Pulmonary Tuberculosis 22 Tuberculous meningitis 2 Other tuberculous diseases 3 Cancer, malignant disease 45 Rheumatic fever 1 Meningitis 3 Organic heart disease 62 Bronchitis... 27 Pneumonia (all forms) 20 Other respiratory diseases 6 Diarrhoea, etc. (under 2 years) 3 Appendicitis and typhlitis 1 Cirrhosis of liver 1 Alcoholism 1 Nephritis and Bright's disease 7 Puerperal fever 3 Parturition, apart from puerperal fever 3 Congenital debility, etc. 20 Violence, apart from suicide 12 Suicide 5 Other defined diseases 117 Causes ill-defined or unknown nil 407 7 DEATHS, 1919. SEX AND AGE DISTRIBUTION. Under 1 year 1—2 2—5 5—15 15—26 25—45 45—65 Over 65 Totals MALES 15 1 5 10 5 17 55 89 197 FEMALES 23 2 4 8 12 24 47 90 210 TOTALS 38 3 9 . 18 17 41 102 179 407 83 persons died between 70 and 80 years of age, 51 between 80 and 90, 6 were over 90—one being 95 and one 96. INFANT MORTALITY. The number of Infant deaths under one year of age was 38 giving an infant mortality rate of 71 per thousand births. It may be useful to give the death rate, infant mortality rate, and birth rate, officially issued as to other places, with those of Bromley added for comparison. Death Kate. Infant Mortality. Birth Rate England and Wales 13.8 89 18.5 96 Great Towns 13.8 93 19 148 Smaller Towns 12.6 90 18.3 London 13.4 85 18.3 Bromley 11.7 71 14.73 The principal causes of the 38 deaths of Children under one year of age 10 of which were illegitimate—were :— Premature birth 12 Pneumonia and Bronchitis 7 Diatrhœa 3 Of the three deaths from diarrhoea, two occurred in September and one in October, and all were infants under six months of age. 8 SANITARY CIRCUMSTANCES OF THE DISTRICT. Wa/er Supply.—The Metropolitan Water Board serves the whole district with a constant water supply, the water being pumped from deep chalk wells into reservoirs. Almost every house derives its water from this source—a very few private wells still exist—and a great many houses take the drinking water direct from the main, thereby avoiding the risk of contamination by dirty cisterns. The water is sparkling, remarkably pure, free from organic matter, and pleasant to drink. Owing to the large amount of mineral substances held in solution it is very hard. On boiling, the carbonic acid gas which holds the carbonate of lime or chalk in solution is driven off and the chalk is deposited as " fur " in kettles and hot water pipes, and thus the cause of the temporary hardness is removed, but the sulphate of lime, nitrate of magnesium and chloride of sodium causing permanent hardness remain in solution. There are no scientific objections to the use of hard drinking water, and there is no danger of lead being dissolved from the lead supply pipes. Rivers and Streams.—On a few occasions steps were taken to prevent occupiers of premises on the banks of the Ravensbourne throwing rubbish into the river. Drainage ar.d Sewerage.—Almost every house in the district is connected to the Council Sewers, which in turn empty into the sewers of the West Kent Main Sewerage Board. The few houses that have cesspools are those that stand in large grounds and either have inadequate fall to drain to a sewer, or are too far distant therefrom. Closet Accommodation.—For reasons set out above nearly every house has one or more water closets with proper flushing apparatus. Scavenging.—The Council remove house refuse once in each week and it is tipped direct into the cells of the destructor. There are no privies, earth closets or cesspools for the Council to scavenge. Practically all the "ashpits" in use are of the moveable type. The Dust Destructor had been shut down about two years, but was started again in March, 1919, RAINFALL. I am indebted to Mr. Edward Kinder, of 7, Fairfield Road, for the following particulars of the local rainfall:— January, 2.06. July, 2.15. February, 3.02. August, 3.23. March, 3.01. September, .96. April, 2.61. October, .83. May, .24. November, 1.38. June, 1.20. December, 3.44. Total local rainfall, 2413 inches in 1919. In 1916—33.36 inches. In 1917—28.49 inches. In 1915— 30.34 inches. SANITARY INSPECTION OF THE DISTRICT. The report of the Sanitary Inspector is appended. Premises and occupations controllable by Bye-laws and Regulations. Occupations. Premises. Rye-laws, etc., in force. Slaughter Houses 9 Yes. Bye-laws. Dairies & Milkshops 40 Yes. Regulations, (including cowsheds) Common Lodging House 1 Yes. Bye-laws. Houses let in lodgings — No. (Rescinded.) There pre no premises let with underground sleeping rooms. No new offensive trades have been established. There is one fat-melting business in the town, but it has given no cause for complaint since the present steam rendering plant has been adopted. Schools.— The Elementary Schools in the Borough have some 4421 children on their rolls. These schools are all drained to the sewers and provided with a constant water supply. The sanitary conveniences are for the most part of the separate pedestal pattern four of the ten schools having the less satisfactory latrines of glazed stoneware. The Sanitary Staff visit the schools periodically concerning the cleanliness of the sanitary arrangements, and have tested the drains from time to time and found them in a satisfactory condition. 10 MEDICAL INSPECTION OF SCHOOL CHILDREN. The Bromley Borough Council as the Education Authority employ a whole time School Medical Officer. Dr. Charles Price is the S.M.O. in charge of the inspection of the school children. Two school nurses are also employed, and minor ailments are treated at the Clinic at 12, Park Road Defective teeth, defective vision, and the presence of enlarged tonsils and adenoids are noted and arrangements made to have the defects relieved by part-time dental and medical practitioners. The dentist and ansesthetist carry out dental work in a room at the Wharton Road School, while the ophthalmic surgeon occupies a room at 12, Park Road, and at the latter place also tonsils and adenoids are removed by operation under an nnsesthetic. In all action, apart from the actual inspection, involving alteration of procedure the S.M.O. and M.O.H. confer together. Contacts with infection are excluded from school attendance when necessary on the occurrence of certain infectious diseases, an enquiry card being filled in and dealt with for each notified case. Classes are frequently closed with the object of preventing second crops of measles on discovery of a primary case which has already sown a first crop in school. A measles enquiry card is filled up giving, among other information, day of rash, last date at school, class attending, medical aid or not. These cards are filled up by the Health Visitor when visiting cases brought to notice. Closure of classes in infants' or junior departments took place on ten different occasions for a few days to check the spread of measles. Children below the age of compulsory school attendance were also excluded at the end of May from both the Raglan Road and Widmore Schools. Bromley National Girls' School was also closed for a few days in February to check influenza. The School Medical Officer is often consulted in such matters and co-operates also in connection with diphtheria contacts, swabbing throats and noses, and has sent 109 diphtheria swabs out of a total of 419 from this district to be bacteriologically examined. 11 FOOD. Milk Supply.—About 300 cows are kept at the thirteen dairy farms in the district and about one quarter of the milk consumed in the district would probably be produced by such cows, the remainder being brought in by road or rail. There has been no reason to suppose any of the supply is unwholesome nor has the supply been inadequate to meet the demand. Twenty samples were taken and submitted for analysis to the Public Analyst for Kent, and only one was certified as not genuine— being deficient in fat. The Council warned the Vendur. Seven other samples of food were analysed and found genuine, viz. : milk powder 1, evaporated milk 1, butter 3, sausages 1, lard 1. Local dairy farms are inspected periodically and on occasions at the milking time to see if the Council's Regulations are observed. Milk (Mothers and Children's) Order.—The Maternity and Child Welfare Committee of the Council administer this order. In urgent cases the Health Visitor reports to the M.O.H who signs for the amount of milk and price at which it is to be supplied until the next meeting of the Committee. During the year the amount of relief given in the shape of milk at rrduced price or free increased considerably, costing some £375. The Committee also provide at cost price other articles such as dried milk, malt and oil, etc. Other Foods.—The following lots of food were taken possession of and destroyed, being unfit for human consumption, viz.:— Dates 14 Boxes totalling 1140 lbs. (at 4. different times). Herring 3 Barrels „ 336 lbs. (at 2 „ ). Hake 1 Box „ 112 lbs. Corned Beef 2 Boxes „ 24 lbs. (at 2 „ ). Mutton Hot „ 14 lbs. Bacon 1 lot „ 11 lbs. Rabbits 1 Box of 24 The above food was inspected on application by local tradesmen, being found bad on opening the packages. No legal proceedings were involved, but certificates were given by the M.O.H. as each lot was inspected. 12 The condition of places where food is prepared, stored or deposited for sale is fairly satisfactory, being covered by the visits of the staff under the Shops Acts, Factory and Workshops Acts, the Public Health Acts, Dairy Regulations, etc. There is no public abattoir, and the registered - or licensed slaughter houses are kept in a satisfactory state. They are not used to great extent, and killing takes place at irregular intervals, the district being almost entirely supplied with meat brought in mainly from the London markets. No carcases or parts were condemned for tuberculosis. INFECTIOUS DISEASES. Under the Infectious Diseases Notification Act, 225 cases were notified. Removed to Isolation Hospital. Diphtheria 107 95 Scarlet Fever 72 62 Enteric 4 4 Cerebro-Spinal Fever 4 2 Puerperal Fever 4 — Erysipelas 26 — Opthalmia Neonatorum 5 — Acute Poliomyelitis 3 — 225 163 The following were notified under other regulations:— Encephalitis Lethargica 2 Malaria 11 Trench Fever 2 Pneumonia 40 Measles and German Measles 548 (20 being German measles). The notifications of some of the Infections Diseases during the months of the year is shown as follows :— 13  Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total. Diphtheria 11 8 15 12 6 9 5 4 4 6 9 18 107 Scarlet Fever 2 2 2 9 4 2 3 … 4 9 16 19 72 Enteric 1 1 1 … 1 … … … … ... … … 4 Totals 14 11 18 21 11 11 8 4 8 15 25 37 183 The Diphtheria and Scarlet Fever cases occurred in houses scattered over the district, the 107 diphtheria cases occurring in 84 different houses; the 72 scarlet lever cases in 60 different houses. The total of over 200 cases notified under the Infectious Diseases Notification Act is above the average of past years and I understand an increase was also marked in the districts surrounding Bromley. DIPHTHERIA. The large number of notifications with a case mortality of 5.6 per cent. indicates the mildness of the disease in the majority of the cases. Three of the six deaths were children who were unwell three or four days before medical advice was obtained. The number of swabs s.ent for bacteriological examination was 419 ; in 94 of these the Diphtheria bacillus was present, in four doubtful. Primary swabs were sent to the Clinical Research Association, London, where owing to the better postal facilities results are more quickly obtained, the others being sent to the County Medical Officer at Maidstone ; 76 of the 107 diphtheria cases were children attending elementary schools and 93 were under 14 years of age. A supply of swabs and diphtheria anti-toxin is kept at the Health Department and at the house of the M.O.H., and may be obtained at the former place during office hours, and at the latter place at any time, by any medical practitioner. By the use of the telephone, however, in notifying removal the majority of cases are conveyed so quickly by motor ambulance to the Hospital that injections of serum are generally carried out there. 14 There can be no doubt that many cases of Diphtheria are now diagnosed that would have been overlooked a few years ago before such facilities existed for bacteriological examination ; at the same time cases thought to be Diphtheria are found not to be so. Most medical men have had cases in which the result of the examination of the swab has been contrary to their expectations. A more extended use of swabs in cases of sore throat in which the cause is at all doubtful is needed and that there should be no obstacle in the way on account of postage expenses the Council now refund the cost of same. It frequently happens that the diphtheria bacillus is present in the nose while absent in the throat. RETURN CASES. Two instances in the year appear to require report under this heading: Diphtheria case 94/1919 was discharged from Hospital January 15th, 1920, after 38 days detention, there brothers sickened and were removed to Hospital for Diphtheria between January 19th and 26th, one after a positive swab. Case 94 was then swabbed with positive result and sent back to Hospital. Diphtheria case 97/1919, discharged after Scarlet Fever November 12th after 43 days detention. On December 13th had a nasal discharge, was swabbed with positive result and sent back to Hospital, was again discharged on December 24th. On February 6th, 1920 four children including case 97 were notified for Diphtheria after positive swabs, but being ill with measles were not sent to Hospital. SCARLET FEVER. 72 Cases of scarlet fever were notified during the year. This may be regarded as a moderate number. One death occurred. In tne preceding three years there had been an extraordinary decrease in the number, viz.:—27 in 1916, 21 in 1917, 30 in 1918, against 108 in 1915 and nearly 200 in our worst year. Careful records were kept of the milk supply in each case, but we failed to trace infection to this source in any instance. 15 The cases were distributed over the district, the 72 occurring in 60 different houses, and 46 attended elementary schools. ENTERIC FEVER. Four notifications of this disease were received. In one case an error in diagnosis would appeal to have been made, as two days after removal to hospital death took place from a different disease. The other three cases recovered. Two of these were visitors, and were either ill on arrival in Bromley or within a day or two after. The remaining case probably contracted the disease in London. INFLUENZA. The 30 deaths recorded from this disease show how prevalent it was, especially in the early part of the year. Two of the deaths took place in January, 22 in February and March, two in April and four for the rest of the year One died at three years of age, 15 between 20 and 45 years, eight between 45 and 65 years and six between 65 and 81 years. TUBERCULOSIS The number of notifications of this disease has fallen, 35 pulmonary cases being notified and 29 other cases. 29 were notified by the tuberculosis officer. There has also been a decline in the number of deaths from this disease, being 27 against 36 in 1918 and 44 in 1917. 22 of the deaths were due to pulmonary tuberculosis. The Health Visitor calls from time to time on the patients entered in the Tuberculosis Register. Disinfectants are supplied, as well as sputum flasks and cards of "Rules for Consumptives." Any insanitary conditions are noted and dealt with, and the necessary disinfection attended to as occasion arises. Examinations of sputum are made at the Kent County Council Laboratory without charge, and free outfits are supplied to medical practitioners for the purpose. Of 66 reports received of sputum examined 10 contained Tubercle Bacilli. 16 MEASLES AND GERMAN MEASLES. The total notifications were 548, 20 of which were German measles. The greater number of cases occurred from May to end of August, viz., 457, 13 cases before May and 78 after August. A typical instance of how measles is introduced and spread in the district came to light. At the end of May a crop of cases occurred in an elementary school. It was then found that a child had been on a visit to London and in contact with a case of measles there, and had measles on its return home, but as the case was not notified and the absence from school was not discovered in time to prevent a second crop, measles (a few hundreds cases) became rather widespread in that district and affected the school attendance considerably. Fortunately other parts of the district had comparatively few cases, so that the majority of the schools were not affected. As the father of the child was blind the Council sent him a strong warning instead of prosecuting. VENEREAL DISEASES. Owing to the facilities for the treatment of venereal diseases in London it was not considered necessary to have a clinic in Bromley, at least at present. Posters stating where free treatment could be obtained were exhibited in urinals where consent was given. POLIOMYELITIS. Of the three cases of this disease two occurred in neighbouring streets in the Bromley Common area and ore in Martin's Hill district, over a mile away. More or less permanent paralysis resulted in each case. OPHTHALMIA NEONATORUM. Of the five cases notified one was illegitimate and died from convulsions within two months of birth The other four cases were legitimate and satisfactorily recovered. CEREBRO SPINAL MENINGITIS. In reference to the four cerebro spinal fever notifications, the first was dead when notified in January, being a carpenter of 46 years who worked in an adjoining district. The nature of the disease appears not 17 to have been suspected till the death suddenly occurred. The Medical Officer of Health of the other district was informed of the circumstances, but found nothing to account for the case. The second case, notified and died same day (June 30th), was a boy scout of 11 years who had a fall and bumped his head 9th June, had two days at a scout camp, and went to two swimming baths and swallowed some of the water and felt sick after it. In the above two cases the contacts were swabbed with negative results. The third case was a non-resident child of 11 admitted to the Cottage Hospital from an adjoining district on November 29th, notified 5th December for cerebro spinal fever, removed to Isolation Hospital and died 9th December. The disease was considered to have been contracted before coming to this district, and the M.O.H. of adjoining district was informed. The fourth case on 9th December was a female of 80 years of age, who recovered with slight paralysis. There was no confirmatory test of spinal fluid and no contacts to swab except the patient's one nurse attendant, who continued the care of the aged invalid. TRENCH FEVER. This disease affected our troops abroad and recurrences in two cases in military men were notified. One case was a visitor to Bromley. MALARIA. Eleven cases were notified ; all were relapses in men who had served abroad and all reside in the southern or Bromley Common distri t. ENCEPHALITIS LETHARGIC A. This is a new disease and may probably be found to be in some way allied to Influenza. Two cases were notified and both completely recovered. SMALL POX. Notice was received from Croydon that a maid was detained who had been in contact with a case of small pox there, and as she was in the service of a family in Bromley four persons were re-vaccinated. 18 VACCINATION. Mr. Banner, the Vaccination Officer, informs me that 253 children in the Borough were vaccinated in 1919; this leaves a very large balance unvaccinated and means that only half the children born are vaccinated. At the present time there must be hundreds of, children unvaccinated. Should an outbreak of small pox occur almost certainly numbers of these children would be victims, and the attention of parents and guardians should be drawn to the great responsibility they are incurring by allowing their children to remain unvaccinated. DISINFECTION. Disinfection is carried out by fumigating the rooms with Formalin gas combined with the spraying with Formalin in solution, and the Council's super-heated steam disinfecting apparatus is used on an average about twice a week for disinfecting articles of bedding, clothing, etc. Such disinfections are carried out for other reasons than notifiable diseases, such as in connection with cancer cases, skin diseases, septic cases in hospitals and in connection with removal or deaths of tuberculous patients. MATERNITY AND CHILD WELFARE. The powers under the Midwives Act are exercised by the County Council. There are three trained midwives practising in Bromley. There are three Infant Welfare Centres in the Borough : — j. St. Luke's Institute, Bromley Common 2. St. Mary's Hall, Farwig Lane 3. Wesleyan Hall, Widmore Mothers and Children meet weekly at the Centres. Miss Day, Health Visitor, acts as Superintendent of the Centres. Mothers are instructed in every detail of Infant Rearing. The babies are weighed regularly and any departure from the usual health of the child is noted and advice is given with regard to the smaller ailments by a doctor who attends the meetings. For some time the work of the Health Visitor has been very much increased and if was felt assistance was desirable and at the present time an Assistant Health Visitor has been appointed. 19 THE BROMLEY -CHISLEHURST AND DIS TRICT MATERNITY HOSPITAL. Owing to the difficulty of finding suitable house accommodation and to the increased cost of living this Hospital is greatly appreciated and some applicants for admission have to be refused. During the year 13 2 children were born in the Hospital. One death occurred from puerperal fever. The Council have made an arrangement with the Hospital that payment at the rate of 5/- a day is made for women admitted, who, on the certificate of the M.O.H. cannot with safety be confined at home. Some ^74 was paid for eleven cases so certified and confined in the Hospital in 1919. An Ante-Natal Clinic is now held twice monthly at the Hospital. BROMLEY DAY NURSERY. The Day Nursery has been moved from Homesdale Road to more convenient and larger premises at 87, Mason's Hill. It is situated near that part of the Borough where most women are employed at Laundries. There is accommodation for 35 children who are cared for from 7.30 a.m. to 7 p.m, except on Saturdays and Sundays. Four children can also be taken as residents, and the Council have now decided to give a grant of ,£50 per annum to the Nursery on condition that a bed is placed at the disposal of the Maternity and Child Welfare Committee of the Council. SANITARY ADMINISTRATION. Staff.—The Council employ one Sanitary Inspector, one Assistant Inspector, and a clerk for the department, who also assists in the clerical work of the Health Visitor. The Inspector carries out the duties as laid down by the Local Government Board, the assistant assists him generally with the inspection of houses. The Inspector decides on the manner in which the defects are to be treated and howinsanitary conditions are caused, prepares the wording of the notices and supervises the more important repairs personally. 20 General Housing Conditions.— The total number of houses in the distr ct is about 8,200. About half these are considered to be houses for the working-classes and are on our schedule for house to house inspection. As during the war building gradually came to an end, it cannot be said that any houses were built or in course of erection during 1919. The demand for houses is great In the autumn there were only about 20 empty (now less) in the whole district; most of these were large, and a few shops. Many smaller houses are occupied by more than one family owing to the house shortage. The measures taken to meet the shortage mainly consist of the Council's Housing Scheme, which has bee i approved by the Ministry of Health and has made such progress that a considerable number of houses wiil probably be erected in 1920, Some plans have been approved for dwellings to be built by private individuals, and work on these has been started at Blackbrook Lane and Page Heath Lane. OVERCROWDING. There is very little that may be fairly called overcrowding, though there are frequent instances such as a family of six or seven in a cottage of four small rooms or 10 to 12 in a small house of six rooms. In other casts persons have to be satisfied with unfurnished rooms or furnished.apartments because they are unable to find houses for themselves. FITNESS OF EXISTING HOUSES. '! here is a considerable proportion of cottages in the district with three small rooms and a scullery, and of the houses that may be styled working-class houses most are without a bath. The absence of pantry and cupboard room is also common, as well as sufficient daylight to the stairs and passages. The Housing Inspection by the Sanitary Staff during the past 25 years has been the means of bringing most of these houses up to a good standard for sanitary arrangements, but many of the carcases are very old, so that roofs, external pointings, chimney stacks and floors require overhauling and repairing. During the year 82 houses here had either vertical or horizontal damp courses provided to comply with sanitary notices to remedy the damp condition of the 21 ground floor rooms. It is very comn.on to find the surface of the ground floor on a level with the adjoining street, so that obviously the damp course to be below the floor timbers must be 7—9 inches under ground, and consequently a plinth from the offset of the foot'ngs to nine inches above the groundline is necessary to keep the ground moisture from soaking up into the walls. In a very few instances no horizontal damp course could be found, and to prevent further decay to the floor timbers the owners have without hesitation inserted one. Another common defect was found to be decay in joists and wall plates in ground floor rooms. Though it is uncommon to find the house walls without a damp course, the same cannot be said of the piers or sleeper walls carrying ground floor joists, so that there is nothing to prevent the damp from the ground soaking into the wall plates and rotting the floors. To shew the various times that elapse before a floor without a damp course will shew decay, the following instances are useful:— A house in Bickley built about 15 years; floor boards decaying and floors sinking, joists found decayed about half-way through and no damp course under floor timbers; floor taken up and relaid on damp course. A house in Page Heath Lane, built about 28 years ; kitchen floor boards decayed, ends of joists almost disappeared through resting on sleeper wall without a damp course ; new floor boards, wall plates, and joists put in on damp course. Two houses in Widmore Road, built about 60 years; complaint of damp floors in half-basement roorrs ; wood plates on sleeper walls but sand half-way up the plates and no damp course under any of the floor timbers ; parts of the plates fairly sound, elsewhere rotted through or nearly so, all basement room floors in two houses (six rooms) taken up, earth excavated, joists, wall plates and floorboards nearly all renewed with a damp course under the new plates. Another defect frequently dealt with is the cleansing and white washing of houses or parts thereof, as will be seen by the table in the Inspector's report. Defects to drains are not numerous, but the number of defective W.C.'s repaired, damp walls from leaky roofs and 22 gutterings remedied, and dilapidated dustbins renewed is rather numerous owing to property owners being somewhat in arrears in the maintenance of their properties. Only one house was declared unfit for habitation and put under a closing order, but after considerable delay it was heavily repaired and the closing order removed. The defects in other houses are dealt with as in past years by serving notices under the Public Health Acts. The difficulties during the year in getting repairs carried out to make houses more fit for habitation were the delay in getting the Sanitary Inspector's assistant back from military service till the year was nearly half gone, combined with the shortage of workmen and the dearth and high prices of materials. As to water supply, closet accommodation, and refuse disposal, all houses in the Borough are provided with the two first mentioned except that in a few instances there is a common tap in a yard for a block of houses. The Council attend to the disposal of the refuse and all houses have separate and moveable receptacles. There are no unhealthy areas in the Borough and no work has been done or appears necessary in connection with bye-laws relating to tents, vans, sheds or houses let in lodgings. No complaint was made by a householder during the year as to the unfitness of the house for habitation. The number of dwelling houses of the working classes inspected under our House to House Inspection was 238. This compares with some 700 per annum under pre-war conditions with the pre-war staff. One was considered unfit, and the great majority of the others were defective and more suitably dealt with by serving notices under the Public Health Acts. It should be here explained that in addition to the 238 houses already mentioned there was an unusual number of complaints from occupiers as to the state of their houses, which were dealt with in the same manner but are not counted under the heading "Housing" or "House to House " Inspection. These amounted to over 300, so that nearly 600 houses of the working classes were 23 inspected during the year, and the defects Which existed in some 90 per cent. of the larger number referred to were dealt with. No action has been taken under Section 28 of the Housing Act, 1918, there having been no necessity to apply such procedure. No demolition orders were made nor am I aware of any houses demolished during the year voluntarily. No representation was made or action taken as to any alleged obstructive building under Section 38 of the Housing Act, 1890. Appended are the reports of the Health Visitor and the Sanitary Inspector. I am, Gentlemen, Your obedient servant, J. MATHEWSON, Temporary Medical Officer of Health. 24 BOROUGH OF BROMLEY. Health Visitor's Report for 1919. The number of births notified in 1919 amounted to 581, an increase of 90 over the previous year. Of these 87 were attended solely by midwives and 112 took place in the Maternity Hospital. There were 17 still births as compared with 10 in 1918. Notices were received from the Master of Farnborough Workhouse and Medical Officer of other districts as to 24 incoming infants. These were visited as were also the infants notified by the Infant Life Protection Officers as boarded out in the Borough. The work under the Milk (Mothers and Infants) Order 1918 has much increased owing to the high price of milk and the unemployment. All applicat;ons were carefully enquired into by your Health Visitor and reported to the Sub Committee. 324 Orders were issued for varying periods at a reduction of fiom fourpence to eightpence per quart, and in cases of extreme poverty free grants were made. Through the courtesy of the Infant Health Society I continued to visit the Infant Welfare Centres at Bromley Common and at Kitchener Club until October, when the work was taken over by the Council. From that date I acted as Superintendent of the Centres. The Town Centre was transferred to St. Mary's Church Hall as being more suitable premises, and a new Centre opened in the Wesleyan Hall at Widmore. At the end of the year the average weekly attendance at the three Centres amounted to 80 mothers and 100 infants. Drs. Cogswell, McArthur, and Montgomery have continued to act as honorary Medical Officers at the Clinics, and we are indebted also to the band of ladies who have given such excellent voluntary help. 25 Total visits paid number 2,664, and are classified as under:- Expectant Mothers 65 Prime Visits 369 Re-visits1687 Special Visits 97 Infant Welfare Centres96 Peurperal Fever2 Ophthalmia Neonatorum 2 Measles 276 Tuberculosis 63 Workshops 7 2664 NORA DAY, 15 : 3 : 20. Health Visitor. 26 BOROUGH OF BROMLEY. Annual Report of the Sanitary Inspector for the Year 1919. A. NUMBER AND NATURE OF INSPECTIONS. Premises inspected on complaint 371 Houses inspected re Infectious Disease 156 Houses inspected under the Housing (Inspection of District) Regulations, 1910 238 Inspections of Dairies, Cowsheds and Milkshops 131 Inspections under Factory and Workshops Acts 121 Slaughter-house Inspections 42 Elementary School Inspections (drains, etc.) 38 Inspections of Common Lodging House, Market, and miscellaneous visits 107 Total (less many re-visits) 1,204 Visits per incomplete Diary entries 3,350 B. NUMBER OF NOTICES SERVED IN 1919. Statutory Informal Notices. Notices. Under Public Health Act, 1875 Sect. 94 re Nuisances 395 51 ,, 36 re Dustbins 31 1 ,, 46 re Cleansing 86 „ 41 re Drains 6 3 Under Factory and Workshops Acts— Sees. 2 and 99 re Cleansing, etc. 13 Under Dairy Regulations — Re Cleansing, limewashing, etc. 28 518 †96 614 Plus School Notices, Letters, Reports, and Forms, etc. written, — over 4,750 27 e. the result of the service of notices, and NATURE OF THE WORKS CARRIED OUT TO REMEDY THE DEFECTS REPORTED. Premises where drains were renewed entirely 9 Preuises where drains were renewed partially or repaired 44 Drains unstopped only 95 W.C.'s repaired (new pans, traps, flushing tanks, etc.) 116 Sanitary dustbins provided 80 Number of rooms in dwellings cleansed and whitewashed226 Trade premises cleansed and whitewashed 47 Damp courses provided to house walls, horizontal or vertical 82 Dampness remedied (Roofs, R.W.P.'s, etc., repaired) 191 Room,floors renewed or repaired 50 Water supply re-instated to houses 4 Yard and Scullery pavings repaired 10 Refuse removed (stables, etc.) 8 Other miscellaneous items, viz.:— Drain channels made good, ceilings and plasterings repaired, air bricks cleared and made good, stoves and sinks renewed or repaired, etc. 136 DISINFECTIONS. There were 95 steam disinfection jobs during the year, as well as 186 houses where rooms were fumigated with Formalin Gas. This work includes disinfections after Cancer, Tuberculosis, Skin affections, etc., as well as for infectious cases reported under the Infectious Diseases (Notification) Act. DAIRIES, BAKEHOUSES, Etc. The dairies, cowsheds and milkshops, bakehouses and slaughter-houses were visited at certain intervals, and were kept in a fairly satisfactory state. 28 THE PETROLEUM ACTS AND ORDERS. As Inspector for the purposes of the Petroleum Acts and Regulations of the Secretary of State for the Keeping of Petroleum Spirit, I beg to report that there are twenty-eight licenses in force in the district, the quantities ranging from eight gallons up to 15,000 gallons, viz.:- Licenses for under 20 gallons ... 6 ,, 20 to 100 „ 14 „ 100 „ 300 „ 4 „ 300 „ 600 „ 2 „ 14000 ,,15000 ,, 2 Total 28 licenses Carbide of Calcium licenses issued, 5 (for quantities from 144 to 336 lbs.) There are also 10 registered keepers of petroleum who have given notice under Home Office Regulations as to keeping the spirit for use in their own cars. Legal proceedings were taken in one instance, where some 70 gallons of petrol were found kept within a building, in part of which employees assembled for meals, and no licence had been applied for or notice given that the substance was kept on the premises. The Magistrate inflicted a penalty of five pounds. The storage receptacles for the keeping of the petrol are not approved unless they are in the open air and detached from other buildings. They are constructed of brick or iron, and usually partly let into the ground and suitably ventilated. FACTORY AND WORKSHOPS ACTS. The following approximately shew the number and description of the various premises on the register under the above Acts, viz:— Workshops. Factories. Dressmaking, etc. 46 - Tailoring 17 - Laundries 22 17 Bootmaking 137 29 Bakehouses 14 9 Upholstery12 - Restaurants and Eating Houses 15 - Watch-making, etc 6 - Joinery and Plumbing 14 5 Coach-building, Cycle and Motor Works 16 7 Forges and Smiths 9 5 Printing - 7 Saw Mills - 3 Miscellaneous 229 Totals 20669 THE SHOP ACTS. The Inspector and his assistant are appointed to carry out the necessary duties under these Acts. The number of shops in the Borough as per Shops Register is 689, approximately classified as follows:- Drapers 38, Clothing 28, Tailors 13, Bootmakers 42 121 Grocers 48 Butchers 34 Fishmongers 19 Bakers, etc, 22, Confectioners 29 51 Greengrocers 34, General Shops 33, Oil Shops, etc., 10 77 Tobacconists 39, Hairdressers 17, Domestic Stores 4 60 Watchmakers etc., 13, Photographers 6, Musical Instruments 4 23 Dairy Shops 13, Eating Houses 7, Provision Stores 6, Restaurants 5 31 Chemists 14, Opticians 3 17 30 Cycles, Ironmongery, etc, 19, Motor Trades 8 27 Second-hand Dealers 10, Rustic Works 5, Corn, etc., Stores 722 Furniture Shops 15 15 Coal Offices 15, Saddlers 6, Dyers and Cleaners 7 28 Stationers, Newsagents, etc29 Bazaars 2 Licensed Victuallers 40, Wine Merchants 4 44 Other miscellaneous businesses 41 The bulk of these take Wednesday for their half day closing, 380 closing altogether and 92 only keeping open for sale of exempted goods. 57 close on Saturday, and 29 on Monday, and about 100 appear to be exempt altogether. Any defect or failure to comply with the Acts or Regulations is reported with all other matters to the Health Committee and dealt with, and defects remedied are included in Table C. FOOD INSPECTION. Twenty-seven samples of food were taken for analysis. Twenty of the samples were milk, one evaporated milk, one milk powder, three butter, one lard, and one beef sausages. One milk sample was deficient of at least 11'3 of milk fat. The vendor was warned and not proceeded against. A certain quantity of other food was destroyed, but is reported on by the Medical Officer of Health. HOUSING INSPECTION AND STAFF. I was able to resume the house-to-house inspection during the latter half of the year, on my Assistant returning from Military service and 238 cottages were inspected in Pope Road, Sharp's Cottages and Orchard Place, Walter's Yard, Beckenham Lane, Lewes Road, Wharton Road, Recreation Road, and Newbury Road. Owing to the selective process of taking such roads or batchas of houses Known to most require attention, notices were necessary in the great majority of instanced to remedy the insanitary conditions found. The works carried out are included in Table C. 31 There was not much difficulty in getting the owners to comply with the notices, and legal proceedings were only taken against one owner, though at first conditions were such that much delay occurred, but circumstances are now more favourable, so that it is probable that at the end of twelve months of the resumption of this branch of the work, the pre-war number will be reached of working-class dwellings inspected and dealt with in this way. Some of the 4,000 small houses on our Inspection Schedule are in a somewhat deplorable state, but arrears are being overtaken, and the increasing complaints coming in from householders help in discovering insanitary conditions, which get attended to and remedied in the usual way. THOMAS BUTLER, Sanitary Inspector. Cert. and Assoc. Royal Sanitary Institute, Inspector of Meat and other Foods, and Advanced Building Construction (S.K.). 8th April, 1920.