CHI 30 CHISLEHURST URBAN DISTRICT COUNCIL. ANNUAL REPORT ON THE HEALTH OF THE Urban District of Chislehurst IN THE YEAR 1910 BY JAMES SCOTT TEW, M.D., D.P.H. SIDCUP: District Times Office, Sidcup, Kent, 1911, ANNUAL REPORT ON THE HEALTH OF THE URBAN DISTRICT OF CHISLEHURST IN THE YEAR 1910. Constitution, Area, and Population.—By Local Government Board Order, No. 40,686, which came into operation on 1st April, 1900, the Civil Parish of Chislehurst was constituted an Urban District. The following tables give details of the area, number of houses, and census population :— Area, Population and Number of Houses according to 1901 Census. Area in Statute Acres. Inhabited Houses. Population. Census of Census of Land and Inland Water. Inland Water only. 1881 1891 1901 1881 1891 1901 2791 5 941 1155 1403 5391 6557 7429 4 Wards. Houses, 1901. Population, 1901. Uninhabited. Building. Persons. Males. Females. Inhabited *In Occupation. Not in Occupation. Lower Chislehurst 450 5 15 17 2314 1020 1294 Upper Chislehurst 953 12 11 18 5115 2195 2920 * “Uninhabited houses inoccupation " means that the houses were in general occupation for business or other purposes, but no one resident on night of census. The Population of the District, as estimated to the middle of 1910, was 8,338, showing an increase of 909 on the census population of 1901, and of 103 on the estimated population of 1909. The number of registered births amounted to 163, including 86 of males and 77 of females, giving a Birth-rate of 19.5 per 1,000 of population, as compared with 22.2 in the previous year, and 21.1 in 1908. Sixty-eight, deaths were returned, consisting of 27 of males and 41 of females. To this number must be added 19 deaths of residents who died in public institutions outside the District, viz., 9 in the Union Workhouse, 3 in the St. Paul's Cray Cottage Hospital (Bromley Rural District), 1 at the Bromley and Beckenham Joint Isolation Hospital, Bromley Common, and 6 at the Sidcup Cottage Hospital, Foots Cray, making a nett total of 87 deaths. The Death-rate was 10.4 per 1,000 of population, as compared with 9.3 in the previous year, and 6.5 in 1908. The principal epidemic diseases include Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Fever (including the three principal forms—Typhus, Enteric or Typhoid Fever, and Pyrexia of uncertain origin), and Diarrhoea. Only two deaths resulted from any of these diseases, viz., 1 from Scarlet Fever and 1 from Whooping-cough. The Epidemic Disease Death-rate was 0.23 per 1,000 of population, as compared with 0.24 in 1909, and 0.61 in 1908, 5 The Infant Mortality, i.e., the number of deaths of infants under one year of age per 1,000 registered births, was 85, as compared with 65 in the previous year, and 75 in 1908. The birth-rate in England and Wales in 1910 was 24.8 per 1,000 of the population, which is 0.8 per 1,000 below the rate in 1909, and lower than the rate in any other year on record. Compared with the average in the ten years 1900-1909, the birth-rate in 1910 showed a decrease of 2.7 per 1,000. The death-rate in 1910 was 13.4 per 1,000, which was 1.1 per 1,000 below the rate in 1909 and lower than the rate in any other year on record; compared with the average rate in the ten years 1900-1909, the death-rate in 1910 showed a decrease of 2.4 per 1,000'. The rate of mortality among infants under one year of age to 1,000 registered births was 106, which is 3 per 1,000 below the rate in 1909. The rate in 1910 was lower than in any other year on record. Compared with the average in the 10 years 1900-1909, the rate of infantile mortality in 1910 showed a decrease of 26 per 1,000. The epidemic disease death-rate was 0.99 per 1,000 living, against 1.28, 1.34, and 1.13 respectively in the three preceding years. The vital statistics for the District for 1910 are very satisfactory, and, as shown by the following table compare favourably with the rates for England and Wales—the death-rate, the enidemic. disease death-rate, and the infant mortality being respectively 3.0, 0.76, and 21 below the corresponding rates for the country generally. Deatli-rate. Epidemic Disease Death-rate. Infant Mortality. England and Wales 13.4 0.99 106 Chislehurst Urban 10.4 0.23 85 3.8 0.76 21 The Birth-rate for this District was 2.7 below that of the previous year, and 5.3 under that for the country generally. 6 (a) NOTIFIABLE INFECTIOUS DISEASES. The diseases notifiable under the Infectious Disease (Notification) Acts, 1889 and 1899, are:—Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the disease known as Scarlet Fever or Scarlatina, and the Fevers known by any of the following names:—Typhus, Typhoid (Enteric), Relapsing, Continued, and Puerperal, and also to any infectious disease to which the Act has been applied in manner provided by the Act. On the 11th April, 1907, it was resolved that the provisions of the Acts should apply to the disease known as Cerebro-spinal Fever, from the 24th May in that year until further notice*. A definite period of three years was, however, subsequently settled on by the Local Government Board. Sixty-nine cases of infectious disease were notified during the year, as compared with 68 in 1909, and consisted of 5 cases of Diphtheria, 57 of Scarlet Fever, 6 of Erysipelas, and 1 of Enteric Fever. Small-pox. No cases of this disease occurred throughout the year. Diphtheria. Five non-fatal cases were notified as against 12 cases with one death in 1909. The cases were notified one in each of the months of March, April, May, September, and October, from Camden Terrace, Green Lane (2), Shepherd's Green, and Blackhorse Road respectively. One of the patients was an infant aged 12 months, and the others ranged from 8 to 18 years. All were treated at the Bromley and Beckenham Joint Isolation Hospital. On the 15th August, 1910, an Order, cited as " The Diphtheria Anti-toxin (Outside London) Order, 1910, was issued by the Local Government Board. This Order sanctions the provision by District Councils of a temporary supply of diphtheria anti-toxin, and of medical assistance in connection with the temporary supply of diphtheria anti-toxin, for the poorer inhabitants of their district, subject to the arrangements with respect to the keeping, distribution, and use of the diphtheria anti-toxin being made in accordance with the advice of the Medical Officer of Health. 7 I may here state that Diphtheria anti-toxin has been provided in this District free of charge in necessitous cases since 1900, when a resolution was passed by your Council that the Sanitary Inspector should keep a supply in readiness for use, medical men applying for same as occasion arose for use where persons were too poor to pay for it themselves. In order to advise the medical men in the District of this Order, and to remind them of the conditions under which anti-toxin is provided, I addressed (with the approval of your Council) the following circular letter to all the medical practitioners in the District:— “Dear Sir,The Diphtheria Anti-toxin (Outside London) Order, 1910. “In view of the fact now generally recognised, viz., that “in cases of Diphtheria—and more particularly in laryngeal “diphtheria or membranous croup—the chances of the patient's “recovery are vastly increased by the injection of anti-toxin “at the earliest possible stage of the disease, the Chislehurst “Urban District Council wish me to inform you that they “intend at once to carry out the suggestions contained in the “above Order. “A stock of Diphtheria Anti-toxin will be kept at the “office of the Sanitary Inspector (Mr. Powell, Church Row, “Chislehurst). “This will be for the injection of patients before they go “to hospital and who are too poor to pay for so expensive a “remedy themselves. “Any qualified medical practitioner can obtain a dose or “doses on giving the name and address of the patient for “whom it is intended. In some cases it may be more con“venient and may facilitate the early use of the remedy if the “Medical practitioner uses his own anti-toxin and later on “refunds it from the Council's store. “It must be clearly understood that the early administra“tion of anti-toxin shall in no way substitute prompt removal “to the Isolation Hospital, but be an adjunct to such removal. “This free provision of anti-toxin as above suggested “applies to poor persons and also those who are in receipt of “parish relief.” 8 Scarlet Fever. Fifty-seven cases, with one death, were re ported, as compared with 52 non-fatal cases in the previous year. The cases were spread over the year as follows:— January 5 cases. February 5 „ March 11 „ April 1 case. May 2 cases. June 9 „ July 10 „ August 4 „ September 4 „ October 2„ November 2 „ December 2 „ Total 57 cases. Locally the cases were reported from:— Sidcup Hill 13 cases. Mill Place 5 „ Sussex Road 4 „ Cray. Road 4 „ Green Lane 3 „ Lincoln Road 3 „ Durham Road 2 „ Jubilee Road 2„ Blackhorse Road 2„ Suffolk Road 2 „ Royal Parade 2„ Warwick Road 2 „ Nelson Place 2 „ Clare Terrace 2 „ Summerhill Villas 1 case. Garden Cottages 1„ Camden Grove 1„ St. Meddows 1„ Elm Road 1„ Queen's Road 1 „ Church Avenue 1„ Botany Bay 1„ The Park 1„ Total 57 cases. 9 The following shows the age-periods at which the cases and death occurred— 1—5 5—15 15—25 25—65 years. years. years. years. 11 38 5 3 = 57 cases. 1 = 1 death. The fatal case was that of a boy three years of age notified from Durham Road and removed to Hospital on January 2nd, where he died three weeks later. There were three instances of gross neglect on the part of parents. Case 1.—The younger of two boys who attended a private school was kept at home for a month prior to June 15th. In consequence of information received I visited the house on June 16th and found the younger boy peeling profusely and the elder also showing signs of the disease. Both boys were subsequently notified as suffering from Scarlet Fever by an independent medical man. There is no doubt but that the elder boy had attended school in a highly infectious state, and an outbreak of Scarlet Fever occurred in this boy's class at school, one boy (resident in an adjoining District) dying from the disease. A summons was issued against the parents (l)for failing to notify,and (2) for exposing the elder boy. The father was fined the maximum penalty with costs on the first summons, and both parents 40s. each with costs on the second. Case 2.—A child was found in a peeling state on August 3rd. The Sanitary Inspector had called at the house on July 14th in consequence of his having received information that a child was ill, and advised the mother that Scarlet Fever was prevalent. He called again on August 3rd, and found the child peeling, and a medical man was called in, who notified the case. Proceedings were taken for failure to notify and for exposure, and a fine of 5s. with costs was inflicted on each summons.. Case 3 was very similar to Case 2, but the summons was withdrawn owing to a serious matter which befel the father the day before the hearing. Erysipelas. Six non-fatal cases occurred, as compared with 2 in the previous year. They were notified: 1 in February from Lincoln Road, 1 in March from Adelaide Road, 1 in April from Church Road, 2 in June from Townshend Road, and 1 in September from Jubilee Road. 10 Enteric Fever. Only one non-fatal case of this disease was notified, as against 2 in 1909. The patient was a young lady who arrived at Southampton from Madeira on February 5th, and was notified as suffering from Enteric Fever on the 18th of that month ; her maid also developed the disease in another district. They undoubtedly contracted the disease at Madeira, where there was an extensive water-produced epidemic at that time. No cases of Puerperal Fever were notified. Tuberculosis caused 3 deaths during the year, all of which were certified as being due to that form of the disease known as Phthisis (consumption of the lungs). The rate for all forms of the disease will, therefore, be the same as the Phthisis death-rate, 0.35 per 1,000 of population. The death-rate in this District from all forms of the disease in 1909 was 0.97 and the Phthisis death-rate 0.72 per 1,000 of population, as compared with rates of 1.52 and 1.08 for England and Wales in that year. The comparative figures for 1910 are not yet available. Under the voluntary system of notification adopted in this District, two notifications were received by me—one in July from Whitehorse Hill of an aged female, which terminated fatally; and one in September at Kemnal Road, also an adult female. No notifications were forwarded to me under the Public Health (Tuberculosis) Regulations, 1908, under which all cases of Phthisis occurring among poor persons are compulsorily notifiable. Disinfection of premises is carried out in notified cases and papers of instructions and advice given to those in charge of patients. The same procedure is adopted after all deaths, of which I keep the Sanitary Inspector informed, obtaining the necessary information from the death returns. 11 (b) NON-NOTIFIABLE INFECTIOUS DISEASES. Of the infectious diseases which are not notifiable, viz., Measles, Influenza, Whooping-cough, and Diarrhœa, only one death resulted: from Whooping-cough in July at Jubilee Road—a child aged two years. HOSPITAL ISOLATION. Fifty-five cases of infectious disease were treated at the Bromley and Beckenham Joint Isolation Hospital, and were admitted as follows:— January. 4 cases (Scarlet Fever). February. 5 ,, (Scarlet Fever). March. 8 ,, (7 Scarlet Fever, 1 Diphtheria). April. 2 ,, (1 Scarlet Fever, 1 Diphtheria). May. 3 ,, (2 Scarlet Fever, 1 Diphtheria). June. 7 ,, (Scarlet Fever). July. 10 ,, (Scarlet Fever). August. 4 ,, (Scarlet Fever). September. 5 ,, (4 Scarlet Fever, 1 Diphtheria). October. 3 ,, (2 Scarlet Fever, 1 Diphtheria). November. 2 ,, (Scarlet Fever). December. 2 ,, (Scarlet Fever). Total 55 cases (50 Scarlet Fever, 5 Diphtheria). One death occurred at the Hospital from Scarlet Fever in January, to which I have previously referred. Inspections. Inspections have been made by me during the year in connection with the following matters:—Various schools in the District; insanitary dwellings at Jubilee Road and Whitehorse Hill; dairies, cowsheds, and milkshops; drainage in various parts of the District; slaughter-houses; Housing and Town Planning Act; laundry at Sidcup; bakehouses; these inspections were in addition to many inspections and visits in connection with cases of infectious disease, especially Scarlet Fever and the subsequent legal proceedings. 12 Common Lodging Houses. There are no Common Lodging Houses in the District. Should there be any premises coming under this heading in the future, they could be dealt with under Part V. of the Public Health Acts Amendment Act, which has been adopted. Dairies, Cowsheds and Milkshops. There are 14 persons on the Register who carry on business in the Urban area:— Dairymen and Purveyors 3 Purveyors only 7 Cowkeepers 1 Cowkeepers and Purveyors 2 Cowkeeper and Dairyman 1 14 About 12 other persons send milk into the District from outside. I have no reason to think that the supply generally is otherwise than as satisfactory as it can be under the present insufficient powers which Local Authorities (having no special local Act) have in proving the existence of tuberculosis and in dealing with diseased dairy cattle. Slaughter-houses. There are four slaughter-houses on the register, two in the Upper and two in the Lower Borough. One is now unused, owing to the occupier of the premises having given up business. These premises are regularly visited by the Sanitary Inspector. Bye-laws are in force. No special arrangement is made for the inspection of slaughterhouses at the time of slaughtering by an Inspector with a special certificate in meat inspection. No carcases or parts of carcases have been found in a tuberculous condition. Factory and Workshops Act, 1901. The Register now contains the following entries:- 13 Factories: Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light Works 1 Cycle Works 1 Motor Works 2 Laundry 1 9 Workshops: Bakeries 7 Other trades connected with foods or drinks 0 Laundries 4 Other trades connected with clothing 9 Various 23 43 52 Mr. Powell reports satisfactorily on the general condition of the workshops and of the factories as far as comes in the scope of Sanitary Officials. Refuse Removal has been carried out by the Council's own men under the supervision of the Surveyor and has been successful both as regards efficiency and cost. Only one complaint was received of excessive accumulation, and this could not be supported on enquiry. The cost during the year has been fully £30 under the price in 1906, when the contract system prevailed. The difficulty of disposing of the refuse collected becomes more acute each year and the Council has now decided to purchase the Whitehorse Hill Brickfields on which are many excavated hollows and these will take an immense quantity of refuse. This is also a spot at which a destructor could be put up later on if necessary. Drainage. A new 9-inch sewer, 750 feet in length, was laid in Mead Road, West Chislehurst. The houses have been connected up and the cesspools which existed have been done away with. A private 9-inch sewer has been laid from Scadbury to Watery Lane, a distance of about 1,000 yards, and to this Scadbury, including the cottages, cowsheds, stables, &c., have been connected and a system of cesspools thereby done away with. 14 Water Supply. Practically the whole of the District is supplied by the Metropolitan Water Board. I made three bacteriological examinations of samples taken in May, July, and September, and these were without exception satisfactory. The samples on an average gave 45 colonies on nutritive gelatine per cubic centimetre after three days' incubation at 20-22° C., and one colony per c.c. on agar in 48 hours at 37° C. No streptococci or bacteria coli were found. Housing, Town Planning, &c., Act, 1909. On November 24th, I attended a meeting of the Health Committee and explained as far as possible the requirements for inspections under Section 17 of this Act, and proposed a method of inspection and of keeping the records. On December 5th the Council approved of the recommendations of the Health Committee, which were, briefly, that the inspection of certain houses should be commenced in January by the Sanitary Inspector under the supervision of the Medical Officer of Health; that details for keeping the records, &c., should be settled by the Medical Officer of Health in conjunction with the Clerk, and produced at each ordinary monthly meeting. Elementary Schools. Owing to a number of children being affected with Scarlet Fever I recommended closure of the Chislehurst Sidcup Hill School for a week previous to the commencement of the summer holidays. Overcrowding. Three cases of overcrowding came to the notice of your officials, and were abated on notice. Adoptive Acts. The following Parts of the Public Health Acts Amendment Act, 1907, have been adopted by the Council and sanctioned by the Local Government Board and Home Office:— Order made by the Local Government Board on Part 2. Streets and Buildings. May 28th, 1909, and to ,, 3. Sanitary Provisions. come into operation on ,, 4. Infectious Disease.. 16th July, 1909. ,. 5. Common Lodging Houses. Date of Order in London Gazette: June 11th and 18th, 1909. 15 Order made by the Home Part 7. Police (Part of Section 81). Office on April 2nd, ,, 9. Sky Signs. 1909. Date of Order in London ,, 8.Fier Brigades. Gazette: April 16th, 1909. The Infectious Disease (Prevention) Act, 1890, and the Public Health Acts Amendment Act, 1890, were adopted in 1900. No action has been necessary under the Housing of the Working Classes Act. Bye-laws and Regulations. The following is a list of the Bye-laws and Regulations in force in the District:— Bye-laws with regard to Slaughter-houses, adopted October 7th and confirmed by the Local Government Board on December 30th, 1901. Bye-laws with respect to New Streets and Buildings and the Alteration of Buildings, adopted September 2nd, 1907, and confirmed by the Local Government Board on the 8th November following. Bye-laws for securing the Decent Lodging and Accommodation of persons engaged in Hop-picking or of the Picking of Fruit and Vegetables, adopted October 17th, 1907, and came into force November 28th, 1907. Bye-laws for the Prevention of the Keeping of Swine on any premises within the Urban District of Chislehurst, so as to be injurious to Health, adopted September 7th, 1908, and allowed by the Local Government Board on October 28th, 1908. Bye-laws with respect to drainage of existing buildings, adopted September 2nd, and allowed by the Local Government Board on November 8th, 1907. Regulations made under the Public Health Act, 1875, as to the mode of Constructing and Laying-out of Drains and their connection with the Public Sewage Sewer, adopted November 4th, 1907. Regulations under the Dairies, Cowsheds, and Milk shops Order of 1885, adopted June 8th. and came into force August 12th, 1903. 16 Hop and Fruit Picking. The huts and shelters used for the accommodation of pickers of fruit, &c., have been, with two exceptions, conducted in a satisfactory manner, and a great improvement has been effected by paving the floors. One case of overcrowding was found to exist and remedied, and in another case the cooking and other arrangements were unsatisfactory, and the owner of the latter premises has given an undertaking to provide proper accommodation before the fruit season commences. Reports during Year. I have made special reports to your Council during the year in reference to the following matters:—Closure of and exclusion from Schools; Enteric Patients; Water Supply; Dairies and Cowsheds (3); Water Analyses; Water Supply, Chislehurst Station; Scarlet Fever (3); Diphtheria Anti-toxin; Housing and Town Planning Act; Employment of Children Act, 1903. The Sanitary Officers (Outside London) Order, 1910. On the 13th December, 1910, the Local Government Board issued a General Order and Regulations revising the regulations relating to Medical Officers of Health and Inspectors of Nuisances of Urban and Rural Districts. This Order reproduces certain of the provisions contained in the Orders of 23rd March, 1891, and prescribes some new provisions. Article 19, sub clause (13) requires a Medical Officer of Health to furnish the Board with a weekly list of all cases of infectious disease, and to furnish the County Medical Officer of Health with a duplicate of such list. ,, Sub clause (15) requires a Medical Officer of Health to report to the Board any cases of Plague, Cholera, or Small-pox. ,, Sub clause (16) requires a Medical Officer of Health to supply the Board with three copies of his annual report and one copy of any special report, and urges Councils to have these former reports printed. Article 20 deals with the duties of Inspectors of Nuisances. I addressed a letter to the Board on the subject of sending the weekly returns of infectious disease, and on receiving their reply made an arrangement for sending these returns which should prove satisfactory. 17 In return the Board furnishes a weekly summary of the main contents of the returns for all sanitary Districts in England and Wales. An Inquiry was held by the Local Government Board into an application under the Public Health Act, 1875, for a loan for the making up of Knoll Road, Sidcup Hill. The application was subsequently granted. No legal proceedings were instituted with respect to matters affecting the public health, with the exception of those already mentioned under Scarlet Eever. At the end of the year the health of the District was satisfactory and the only cases of infectious disease notified during November and December were four mild cases of Scarlet Fever. Mr. Powell's report of the work carried out by him during the year, the statistical tables required by the Local Government Board, and the Table required by the Secretary of State for recording action taken under the Factory and Workshop Act, 1901, are appended. I have the honour to be, Gentlemen, Your obedient Servant. JAMES SCOTT TEW. April 8th, 1911. 18 CHISLEHURST URBAN DISTRICT COUNCIL. To the CHAIRMAN and MEMBERS of the CHISLEHURST URBAN DISTRICT COUNCIL. GENTLEMEN, I have the honour to present to you my Annual Report for the year 1910. By an Order recently issued by the Local Government Board it is now compulsory for Inspector of Nuisances to make an Annual Report to the Medical Officer of Health. As a matter of fact, I have always prepared an Annual Report since the formation of the Urban Council. Unfortunately at the beginning of the year I had to undergo an operation for Appendicitis and I was unable to carry out my duties for some weeks. During my absence the Sanitary Work was supervised by Mr. H. N ightingale, one of the Inspector of Nuisances to the Bromley Rural District Council and the matters carried out by him are included in this Report. The number of visits and re-visits to premises has been 2,848 and 127 nuisances were discovered. Complaints. Twenty complaints were received and investigated. Of these, one related to accumulation of house refuse, two to smells from sewer gratings and vent shafts, three to offensive accumulations, two to foul ponds, seven to defective drains and waterclosets, three to damp and defective houses, one from smoke from a greenhouse, one from the alleged pollution of the River Kidd (a small stream situate on the boundary between the Borough of Bromley and our District), but as the nuisance, arose within the Borough it was dealt with by that Authority. 19 The complaints show an increase of eight over that of the previous year. Infectious Disease. Sixty-nine cases of infectious disease were dealt with, viz.: 57 cases of Scarlet Fever, 5 cases of Diphtheria, 0 cases of Erysipelas, and 1 case of Enteric Fever. This is an increase of one case over the year of 1909. Scarlet Fever shows an increase of 5 cases and Erysipelas 4 cases, but there was a decrease of 7 cases in Diphtheria and one in Enteric Fever. It was found necessary to remove 54 cases to the Hospital, which was a decrease of 9 cases on the previous year. One case of Erysipelas was removed to the Workhouse Infirmary. Two cases of Phthisis were notified under the Voluntary Scheme. This was a decrease of four cases over the year 1909. One of the cases proved fatal. One of the cases notified last year also proved fatal. Disinfection has been carried out in each case. Fifty-three houses or part of houses were sprayed and fumigated and the Owners, I am glad to say, readily assisted by cleansing the rooms as soon as possible. The fumigation was carried out by Sulphur Dioxide and Formalin Fumigators, the clothing, &c., being disinfected with a solution of Izal. The rooms and bedding were also sprayed with an Equifex Spray Pump, Formic Aldehyde as a 2% solution being used for this purpose. Drainage. The drains of eight premises were examined and tested and four were found defective and were re-constructed. Two were provided with better means of ventilation. No defects were found at two premises. I made a special report on the cesspool drainage of the then 11 houses in Mead ltoad, Chislehurst West, and found 14 cesspools, 11 of which were percolating. In consequence of such report, a sewer was afterwards laid in the road and the whole of the 11 houses connected to it. The cesspools were emptied and abolished. After the report two houses were erected in the road with 20 porary cesspool drainage, but they have now been connected to the sewer as arranged with the Council. Insufficient Water Closets. Water for flushing purposes was laid on to 10 premises. Insufficient Ash Pits. Eleven houses were provided with moveable receptacles. Overcrowding. Three cases were reported and dealt with. Houses unfit for Human Habitation. One house was found in a bad condition and voluntarily closed by the Owner. Temporary Shelters. The twenty-four temporary shelters for Fruit Pickers in the District were regularly inspected during the season. The occupiers of the shelters found the paving of the floors very beneficial, especially during the wet weather. One case of overcrowding was dealt with. At one set of four shelters it was found that the arrangements for cooking food and drying clothes were not satisfactory, and the Owner has given an undertaking to the Council to provide suitable accommodation before the next season commences. The huts were occupied by 12 men, 20 women, and 22 children under 14 years of age. Slaughter-houses, Dairies and Milkshops. These have been regularly inspected and generally kept in good condition. Respecting the Dairies and Milkshops, notices were sent to the occupiers calling their attention to the Public Health Amendment Act, 1907, Sections 53 and 54. During the year four new Milksellers and one Cowkeeper and Purveyor were registered, and one Cowkeeper's business has been discontinued. One licensed Slaughter-house became vacant owing to the occupier having given up his business and leaving the neighbourhood. Factory and Workshops Act. Sixty visits have been made to the Workshops. Two cases of dirty rooms, one case of no water to the W.C., and one case of defective paving were dealt with. 21 One Tailor and one Bootmaker have given up their premises, and two Dressmakers, one Bootmaker, and two small Laundries have been registered. The number of orkshops has increased by three over the previous year. The corrected list is as follows:— Dressmakers 6 Basket Makers 1 Carpenters, Joiners, Plumbers, Painters, and Builders 9 Coachbuilders, Farriers, and Wheelwrights 7 Tailors 1 Upholsterers 3 Saddlers 2 Bootmakers 2 Cycle Makers 1 Laundries 4 Bakers 7 43 The sanitary conveniences at the Factories have been inspected and generally found in good condition. One Factory (Brickworks) is still closed. No water supply to the water closets was dealt with at one premises. The present list is as follows:— Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light W orks 1 Cycle Works 1 Motor Works 2 Laundry 1 9 Samples, To avoid overlapping, the Kent County Council kindly undertook to send this Council a monthly report on the samples taken by them. During the year under review 38 samples were taken as follows:— 22 Milk 31 Butter 1 Pepper 1 Oatmeal 1 Whiskey 1 Brandy 1 Rum 1 Gin 1 38 With one exception all were genuine, and the Vendor of this sample (Milk) was prosecuted by the County Authorities and fined 20s. and costs 14s. House Refuse Removal. The collection of the House Refuse by our own workmen has again worked well and not only has the dust been collected regularly, but the cost this year has been slightly under that of last year. The amounts expended during the past five years are as follows:— £ s. d. £ s. d. 1906 472 8 2 Contract. 1907 448 2 6 Direct Labour. 1908 455 11 0 1909 481 7 7 1910 Wages 231 19 0 Hire of Horses and Carts 178 7 5 Shoots 49 15 9 Tools 10 0 0 470 2 2 ,, Having regard to the fact that the number of houses from which house refuse has to be removed has materially increased since 1906, the steps taken by the Council must be regarded as very satisfactory. Only one complaint was received during the year, but on investigation it was found that no real grounds for complaint existed. River Cray. The works carried out by this Council and two private owners, which were described in my last report, have had the effect of considerablv improving the condition of this River so 23 far as this District is concerned. No complaints have been received during the year. I have kept the River under close observation. Petroleum (Traders). Ten persons were licensed for the storage of Petroleum in respect of amounts varying from 50 to 500 Gallons. Carbide of Calcium. One person was licensed for the storage of 2001bs. of Carbide. Petroleum (Private). During the year a special inspection has been made of the whole of the premises in tlie District where Petroleum is kept for the use of light locomotives, and my report on the subject is still under the consideration of the Committee which deal with these matters. In all, 145 visits were made by me in connection with this report and to the Traders' Stores. Prosesutions. Owing to the frequent small outbreaks of Scarlet Fever in the Sidcup Hill District the Council gave instructions for a careful investigation to be made, with the result that after a long search five children were found to be suffering from the disease and had reached the peeling stage. In two cases the Council came to the conclusion that the parents had wilfully neglected their duties and decided to prosecute. The cases were heard at the Bromley Police Court, and in both cases the defendants were convicted for failing to notify and exposure. In one case the maximum penalties were inflicted. Distribution of Leaflets. At the end of the year 1909 the Council decided that there should be an annual distribution of leaflets containing information with regard to the notification, causes, and symptoms of Scarlet Fever and other Infectious Diseases, including Phthisis. During the month of September last cards relating to Scarlet Fever were left at each of the small houses in the District, and cards and posters relating to Phthisis were left at the Elementary Schools, Barbers' Shops, &c. On the instructions of the Council I have had posters and leaflets relating to the extermination of rats distributed 24 out the District, and I am destroying the rats in the Dust Shoots and other property in the occupation of the Council. Housing (Inspection of District) Regulations. I hope shortly to commence the Inspection of the District in accordance with the resolution of the Council passed 011 the 5th of December, 1910. I beg to take the opportunity of stating that to carry out the duties prescribed by the Housing and Town Planning Act and these Regulations and my many other duties, the time has arrived when the Council should provide me with regular clerical assistance. The Clerk of the Council has always allowed one of the Assistant Clerks to type reports and letters for me, but it can be readily understood that such an arrangement cannot be entirely satisfactory either to the Clerk or to me. SUMMARY OF WORK DONE. Number of complaints received and investigated ... 20 Nuisances discovered 127 Nuisances abated without report 114 Nuisances abated after report 10 Nuisances'outstanding 3 Legal Notices served 7 Preliminary Notices served — Notices served for insufficient water-closets — Notices served for insufficient ashpits — Number of letters written, reports made, School Notices and other minor Notices 769 CHARACTER OF WORK DONE. Houses cleansed and generally repaired 27 Cowsheds, Slaughter-houses, and Bakehouses cleansed 25 Overcrowding abated 3 Defective roofs and gutters repaired 15 Water laid on to water-closets 10 Dustbins provided 11 Cesspools cleansed 21 Cesspools abated 13 Houses at which drains were examined and tested 8 Houses at which drains were found defective 5 Houses at which drains were re-constructed 4 25 Houses at which drains were cleansed, ventilated, trapped or repaired 23 Houses at which surface water drainage was provided 1 Houses connected to Sewer 13 Offensive accumulations removed 11 Urinals cleansed 1 Infected houses cleansed and fumigated 53 Hoxises where back yards have been paved or repaired 16 New water-closets built 4 Water-closets repaired 2 Drinking water cisterns covered 21 I have the honour to be, Gentlemen, Your obedient Servant, WILLIAM GEOKGE POWELL, (issoc. and Cert. Royal Sanitary Inst.), Inspector of Nuisances. TABLE 1. Year. Population estimated to Middle of each year. Births. Total deaths registered in the District. Total Deaths in Public Institutions in the District, Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Under One Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 7858 106 17.9 10 94 45 7.6 - - 11 56 9.5 1901 7429 166 22.3 15 90 67 9.0 - - 9 76 10.2 1902 7545 157 20.8 20 127 75 9.9 - - 10 11.2 1903 7640 190 24.8 19 100 71 9.2 - - 9 80 10.4 1904 7736 181 23.3 15 82 60 1.1 - - 12 72 9.3 1905 7833 192 24.5 11 57 58 7.4 - - 8 66 8.4 1906 7932 180 22.6 18 100 86 10.8 - - 7 93 11.7 1907 8032 186 23.1 11 59 58 7.2 - - 13 71 8.8 1908 8132 172 21.1 13 75 47 5.7 - - 6 53 6.5 1909 Avr. for years 1900.1909. 8235 183 22.2 12 65 64 7.7 — - 13 77 9.3 7837 171 22.2 14 84 63 8.2 — — 9 72 9.5 1910 8338 163 19.5 14 85 68 81 - - 19 87 10.4 *Rates calculated per 1,000 of estimated population. Area of District in Acres (exclusive of Area covered by water). 2,791. Total Population at all Ages 7,429 Number of Inhabited Houses 1,403 Average number of Persons per house 5 At Census of 1901. Institutions outside the District receiving sick and infirm persons from the District—St. Paul's Cray Cottage Hospital, St. Paul's Cray; Bromley and Beckenham Joint Isolation Hospital, Bromley Common, Kent; Union Workhouse, Bromley Common, and Sidcup Cottage Hospital, Sidcup. 27 TABLE III. Cases of Infectious Disease notified during the Year 1910. Notifiable Disease. Cases notified in whole District. No. of Cases removed to Hospital. At all Ages. At Ages—Years. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 5 .. 1 3 1 .. .. 5 Erysipelas 6 .. .. 1 2 .. .. Scarlet fever 57 .. 11 38 5 3 .. 50 Typhus fever .. .. .. .. .. .. .. .. Enteric fever 1 .. .. .. 1 .. .. .. Relapsing fever .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. Puerperal fever .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Phthisis .. .. .. .. .. .. .. .. Voluntary 2 .. .. .. .. 1 1 .. Poor Law cases .. .. ... .. .. .. .. .. Totals 71 .. 12 42 9 7 1 55 Isolation Hospital—Bromley and Beckenhnm Joint Isolation Hospital, Bromley Common; total available beds, 113; number of diseases that can be concurrently treated, 5. Joint Small-Pox Hospital; total available beds, 33; number of diseases that can be concurrently treated, 1. SCHEDULE B. Causes of, and Ages of, Deaths during the Year 1910. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. In Public Institutions. All Ages. Under 1. 1-5. 5-15. 15-25. 25-65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. Scarlet Fever 1 .. 1 .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. Epidemic Influeuza .. .. .. .. .. .. .. .. Whooping-cough 1 .. 1 .. .. .. .. .. Diphtheria,Membranous Croup .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. Asiatio Cholera .. .. .. .. .. .. .. .. Diarrhoea, Dysentry .. .. .. .. .. .. .. .. Epidemic or Zymotic Enteritis .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. Other continued Fevers 2 .. .. .. .. 2 .. .. Erysipelas .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. Other septic diseases .. .. .. .. .. .. .. .. Intermittent Fever and Malarial Cachexia .. .. .. .. .. .. .. .. Tuberculosis of Meninges .. .. .. .. .. .. .. .. Tuberculosis of Lungs 3 .. .. .. .. .. .. .. Other forms of Tuberculosis .. .. .. .. .. .. .. .. Alcoholism .. .. .. .. .. .. .. .. Cancer 3 .. .. .. .. 1 2 .. Premature Birth 1 1 .. .. .. .. .. .. Developmental Diseases 10 9 1 .. .. .. .. .. Old Age.. 10 .. .. .. .. .. 10 .. Meningitis .. .. .. .. .. .. .. .. Inflammation and Softening of Brain 1 .. .. .. .. .. 1 .. Organic Diseases of Heart 3 1 .. .. 1 .. 1 .. Acute Bronchitis .. .. .. .. .. .. .. .. Chronic Bronchitis 5 .. .. .. .. .. 5 .. Lobar (Croupous) Pneumonia 2 .. .. .. .. 2 .. .. Lobular (Broncho-) Pneumonia 2 1 .. .. .. .. 1 .. Diseases of Stomach 2 .. .. .. .. 2 .. .. Obstruction of Intestines .. .. .. .. .. .. .. .. Cirrhosis of Liver .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 10 .. .. .. .. 3 7 .. Tumours and Other Affections of Female Genital Organs .. .. .. .. .. .. .. .. Accidents and Diseases of Parturition .. .. .. .. .. .. .. .. Deaths by Accident or Negligence l 1 .. .. .. .. .. .. Deaths by Suicide 2 .. .. .. .. 2 .. .. Deaths from ill-defined Causes .. .. .. .. .. .. .. .. All other Causes 28 1 1 1 .. 10 15 .. All causes 87 14 4 1 1 24 43 - 29 TABLE V. Infantile Mortality during the Year 1910. 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. l-'Z Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. | Total Deaths under 1 year. All Causes Certified 2 .. .. 1 3 2 2 2 .. 1 .. .. 1 1 1 1 14 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. \.. Common Infectious. Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœal Diseases. Diarrhoea, all forms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis, Muco-enteritis, Gastroenteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gastritis, Gastro intestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases. Premature Birth 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Congenital Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus .. .. .. .. .. .. .. 1 .. 1 .. .. 1 1 .. .. 4 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculous Peritonitis : Tabes Mesenterica| .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes. Erysipelas ,, .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 1 1 1 1 .. .. .. .. .. .. 1 .. 5 Bronchitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Suffocation, overlying .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Other Causes .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 2 .. .. 1 3 2 2 2 .. 1 .. .. 1 1 1 1 14 Population, estimated to middle of 1910 8338. Births in the year legitimate 160 illegitimate 3 Deaths in the year of legitimate infants 13 illegitimate infants 1 Deaths from all Causes at all Ages 87 30 Factories, Workshops, Laundries, 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) 13 Nil Nil. Workshops (including Workshop Laundries) 60 — — Workplaces — — — Total 73 Nil 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 2 2 Nil, Nil. Want of Ventilation .. .. .. .. Overcrowding .. .. .. .. Want of drainage of floors 1 1 .. .. Other nuisances .. .. .. .. †Sanitaiy Accommodation insufficient .. .. .. .. unsuitable or defective 2 2 .. .. not separate for sexes. .. .. .. .. Offences under the Vactory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (ss. 97 to 100) .. .. .. .. Other offences .. .. .. .. Total 5 5 .. .. †Public Health Acts Amendment Act, 1890, is in force. 3.—HOMEWORK. One List received from another Council of persons engaged in making wearing apparel. Inspections or Outworkers' Premises. - I, 31 4.—REGISTERED WORKSHOPS. Workshops on the Register at the end of the year. Number. Bakehouses 7 Laundries 4 Dressmakers and Milliners 6 Carpenters and Joiners, Builders, Painters and Plumbers 9 Farriers, Coachbuilders and Wheelwrights 7 Saddlers 2 Basket Maker 1 Cycle Maker 1 Bootmakers 2 Tailors 1 Upholsterers 3 Total number of workshops on Register 43 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Nil. Failure to affix Abstract of the Factory and Workshop Act (s. 133) 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 Reports (of action taken) sent to H.M. Inspector. Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year April 9 th, 1911• J. S. TEW, Medical Officer of Health.