6^' i CHISLEHURST URBAN DISTRICT COUNCIL. ANNUAL REPORT on the. HEALTH of the URBAN DISTRICT OF CHISLEHURST IN THE YEAR 1911 by JAMES SCOTT TEW, M. D., D.P.H. SIDCUP: District Times Office, Sidcup, Kent. 1912. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1911. Area and Population. No. of Regn. Dist. Area in Statute Acres. Inhabited Houses. Population. Census of Census of Land and Inland Water. Inland Water only. 1891 1901 1911 1891 1901 1911 41 2791 5 1155 1403 1824 6557 7429 8668 The Population of the District, at the census of 1911, was 8,668, being an increase of 1,239 over the census of 1901. The estimated population of the intercensal years have been somewhat under-estimated. This cannot be avoided, the method adopted for calculation being a recognised one, but can only be correct so far as the population of a town continues to increase or decrease at the same rate as it had been doing during the preceding decennial periods. The estimated population for 1911 would be 8,440, or 228 lower than that of the census, 4 The number of births registered in the District amounted to 163, including 86 of males, and 77 of females. To this number must be added 2 births (1 male and 1 female) which occurred outside the District, born of parents having a fixed place of residence in the District. The net number of births was therefore 165, which gives a Birth-rate of 19.0 per 1,000 of population, as compared with 22.3 in 1901, 22.2 in 1909, and 19.5 in 1910. Sixty-one deaths were registered, 30 of males, and 31 of females. To this number are added the deaths of 17 persons belonging to the District who died elsewhere, while one death is deducted of a person dying in the District, and who had a fixed place of residence outside its area. The nett total of deaths belonging to the District was 77, giving a Death-rate of 8.8 per 1,000 of population, as compared with 10.2 in 1901, 9.3 in 1909, and 10.4 in 1910. Included among the above total of 77 deaths, are 6 attributable to one or other of the following epidemic diseases :— Diarrhoea and Enteritis (under two years) 6 Diphtheria — Measles — Whooping-cough — Enteric Fever - Scarlet Fever — Small-pox — Pyrexia of uncertain origin — 6 The Infant Mortality, i.e., the number of deaths of infants under one year of age per 1,000 registered births was 84, as compared with 90 in 1901, 65 in 1909, and 85 in 1910. The supervision of the Midwives and other work under the Midwives Act, 1902, is carried out by the County Medical Officer. The Notification of Births Act, 1907, is not in force. In August last I prepared a card giving advice to mothers on feeding and care of infants, and this was distributed throughout the District. The birth-rate in England and Wales in 1911 was 24.4 per 1,000 of the population, which is 0.7 per 1,000 below the rate in 1910, and lower than the rate in any other year on record. Compared with the average in the ten years 1901-1910 the birth-rate in 1911 showed a decrease of 2.8 per 1,000. 6 The death-rate in 1911 was 14.6 per 1,000, which was 1.1 per 1,000 above the rate in 1910, and equal to the rate in 1909, but lower than the rate in any other year on record; compared with the average rate in the ten years 1901-1910, the death-rate in 1911 showed a decrease of 0.8 per 1,000. The rate of mortality among infants under one year of age to 1,000 registered births was 130, which is 24 per 1,000 above the rate in 1910—the lowest on record—but is only 3 per 1,000 above the average in the ten years 1901-1910, notwithstanding the excessive heat and drought which prevailed in the third quarter of the year. A higher infantile mortality than this was experienced in 43 out of the last 50 years. The following shows a comparison between the rates for this District and those for England and Wales:— Birth rate. Death-rate. Infant Mortality. England nod Wales 24.4 14.6 130 Chislehurtt Urban 19.0 8.8 84 In January, 1911, the Local Government Board intimated that it was the intention of the Registrar-General to publish in his Annual Report for 1911 and subsequent years, statistics of births, deaths, and of certain causes of death for administrative instead of, as hitherto, for registration (or poor law) areas, and it was found necessary to revise and modity the Tables in order to minimise discrepancies between the figures of Medical Officers of Health and those of the Registrar-General. Table 1 is altered as to births by the addition of columns showing the uncorrected and corrected numbers, and the RegistrarGeneral supplies Medical Officers of Health, through the County Medical Officer, with the number of births—male, female, legitimate, and illegitimate—to be added or deducted. The RegistrarGeneral also in a like manner supplies particulars of all deaths of persons belonging to the District and who have died outside the area, and it is left to Medical Officers cf Health to exclude deaths of non-residents. Table 2 is now omitted, and in its place is the Infectious Disease Table, which is slightly—though not materially—altered. 6 The list of causes of death (Table 3) has been considerably altered, the Local Government Board having, in conjunction with the Registrar General, adopted a form condensed from that known as the " International List," which is also used widely in other countries. The compilation is systematised by a manual which has been issued by the Registrar-General. In following this manual when compiling Table 3, I noticed that the Table as issued by the Local Government Board did not correspond exactly with that stated in the manual as having been adopted by the RegistrarGeneral and the Local Government Board, i.e., there are headings " meningitis " and " organic heart disease " in the latter which do not appear in the former, and other small differences. In order to make the Table 3 of the Local Government Board correspond with the list of diseases given by the Registrar-General, I found it necessary to re-number the headings, and to separate heart and brain diseases from " other defined " diseases. The Infant Mortality Table is also slightly altered as to headings, and age-periods. (a) NOTIFIABLE INFECTIOUS DISEASES. Under the provisions of the Infectious Disease (Notification) Acts, 1889 and 1899, the following diseases are compulsorily notifiable in the District, viz., Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the disease known as Scarlet Fever or Scarlatina, and the fevers known as any of the following names:— Typhus, Typhoid or Enteric, Relapsing Continued and Puerperal. Only 18 cases of infectious disease were notified, as against 69 in the previous year, and comprised 5 cases of Diphtheria, 7 of Erysipelas, and 6 of Scarlet Fever. Diphtheria. Five non-fatal cases occurred—the same number as in 1910. The first case was a boy, aged 8, resident in Park Road, West Chislehurst, and notified on February 14th. The case was a severe one. and was treated in Hospital for over three months. Case 2 was a girl aged 6, notified from Whitehorse Hill, on February 22nd. The third case was notified from Albany Road, on March 31st —a boy aged 5 years. 7 These 3 cases attended the Prickend School, and although no definite source of infection could be traced, the assumption is that they arose from a mild unrecognised case in school, and this is somewhat borne out by the fact that Case 3, only returned to school on March 20th after 15 weeks' absence with whooping-cough, and had only attended school 4 days before he was taken poorly. Case 4 was an adult male, notified in November. He called on a medical man on his way home from work as he was feeling unwell, and was at once notified. Case 5, a boy aged 12, also occurred in November, at Church Avenue, and attended a private school. The origin of these last 2 cases could not be traced. All the patients were treated in Hospital. Anti-toxin is provided at the Council's expense for administration to the poorer patients and contacts, and the bacteriological examination of throat material in suspicious cases has also been paid for by the Council. Erysipelas. Seven non-fatal cases were notified, as compared with 6 in the previous year, and arose as follows: 2 in January at Garden Cottages, Foots Cray; 2 in July (1 at Lincoln Road, and 1 at Green Lane); 1 in September at Marland Terrace; and 2 in October (1 at Sidcup Hill, and 1 at Victoria Road). All the patients were adults. Scarlet Fever. Six non-fatal cases occurred, as against 57 cases and 1 death in 1910. The first case was that of a girl notified at the end of July. She had been sent home from a school in Belgium with her sister after an illness for a change, and on her arrival, as she was very unwell, a medical man was called in, and examination showed the child to be freely peeling on the feet, and she also had a nasal discharge. I made inquiries directly of the Principal of the school, and found that there had been at least one case of actual scarlet fever at the school, and that other girls had had sore throats. The patient's sister and another girl in Sidcup who came home with them, were kept under observation, but both continued well. The case was treated at home. The second case, a boy aged 10, was notified from Church Avenue, Sidcup, in September, and was also nursed at home. The origin of this case could not be traced. 8 Case 3 was an infant 2 years old, notified from High Street, Foots Cray, on October 25th, and removed to Hospital the same day, and discharged on November 29th. Case 4, a boy aged 11, occurred at Knoll Road, Sidcup, at the end of October, and was removed to Hospital. This case was in all probability contracted in school from another scarlet fever patient resident in an adjoining district who had attended the same school. Case 5 was a girl aged 7, at Whitehorse Hill, on November 10th, and was sent to Hospital the same day. There were three other young children in this house who escaped, and the origin of the case was doubtful. Case 6 was a boy aged 6 years, notified in December, and who attended the same school as Case 4, where there had been several cases among the scholars from an adjoining District, and was no doubt contracted from the same source, as I found one of the scholars peeling profusely from the hands, and who with his brother, had attended school. No cases of Small-Pox, Enteric, or Puerperal Fever occurred throughout the year. Tuberculosis caused 3 deaths during the year (the same number as in 1910), all of which were certified as due to Phthisis (consumption of the lungs). As regards occupations, one was a domestic servant, one an inspector at a large London Stores, and the third a gardener. The Phthisis death-rate was 0.34 per 1,000 of population. The following cases were notified :— I. April 21st. A girl aged 13 years, from St. Joseph's Home. This case was afterwards notified in May from St. Peter's Home, Kilburn, where she died on June 18th, 1911. The patient's mother had died from the same disease, and the girl had been delicate from birth. II. July 9th. A boy aged 8 years, notified from the Royal Sea Bathing Hospital, Margate, admitted from Windsor Cottages. The case was subsequently sent home as incurable and was in December again notified under the Poor Law Regulations. This boy's father died of Phthisis on February 14th, 1910, but it is an early case in which treatment may prove of great value. III. July 25th. A young man (labourer), aged 22, notified from the National Sanatorium, Benenden, home address, Jubilee Cottages, Foots Cray. This patient returned home slightly improved in health. Patient's father and sister died of Phthisis. 9 IV. October 4th. A man aged 45 (caretaker) voluntarily notified from Walden Road. This case has been under observation since December, 1909. V. November 11th. A man aged 35 (cashier) (Poor Law case), in Victoria Road. The illness was of 3 years' duration, and the patient had previously been treated in two hospitals. VI. November 3rd. A girl aged 13, in-patient St. Catherine's Hospital, Ramsgate, admitted from Crown Lane, Chisleliurst. This case was notified on her return home in December, again notified as a Poor Law case. The child had been weakly from birth, but there was no history of consumption in the family. Disinfection is thoroughly carried out in all necessary cases and after deaths, and disinfectants freely supplied as required. Printed instructions are also given to patients and those in charge. Under the Poor Law Regulations, 1908, Phthisis was made compulsorily notifiable among poor persons, and by the Tuberculosis in Hospitals Regulations, 1911, all persons suffering from the disease, and being treated in hospitals and sanatoria are required to be notified. By the Public Health (Tuberculosis) Regulations, 1911, dated November 15th, 1911, and numbered 57,807, all cases of Phthisis are compulsorily notifiable as from January 1st, 1912, medical men and school medical inspectors being required to notify to the Medical Officer of Health of the District in which the patient is resident, or the school is situate—as the case may be—all cases coming to his notice within 48 hours, with the exception of cases which have been previously notified. (See Art. 4.) Art. 9 gives special powers to Councils to " do such acts and make such arrangements as may be necessary " in supplying medical or other assistance, facilities and articles for detecting and for preventing infection, &c., including power to appoint officers to carry out the work, and also to supply literature, &c. These Regulations do not affect or interfere with the Poor Law or the Hospital Regulations, which remain in force as heretofore. (Art. 10.) By Art. 13 Medical Officers of Health or Councils are not required to take any action in respect of patients notified where such action would interfere with the patient's occupation, or means of livelihood, &c., it being deemed advisable to deal with such cases according to the circumstances under which they arise, with a certain amount of latitude and discretion. 10 It will now be a matter for the Council to consider what steps should be taken to provide accommodation, and other means for treatment, of cases of this disease, and in this direction I have attended several meetings of Medical Officers of Health to consider and discuss the question generally. At present it seems to me that the only practical way will be for the County Authorities to provide an adequate number of sanatoria, and divide the County into hospital or sanatoria areas. I conferred with and advised your Sanitary Inspector how we should proceed, and sent a circular letter, dated December 22nd, 1911, to medical men residing in the area, asking for their co-operation, and informing them that infective material could be examined in the interests of the public health free of charge to them at the County Laboratory, Maidstone. In addition to the prescribed registers, details are collected on cards (of which I have drawn up a special form to suit the requirements of the District) which are filed, and to which further notes of the history of each case can be added from time to time. The special return of the Local Government Board on "Phthisis: Sanatorium and Hospital accommodation" is not included in this Report, as there are no facts to insert for this District. The advance copy of the form has been sent to the Board, as requested. HOSPITAL ACCOMMODATION. Nine cases of infectious disease were treated in the Bromley, Beckenham Joint Hospital, and were admitted as follows:— February. 2 cases (Diphtheria). March. 1 ,, (Diphtheria). October. 2 ,, (Scarlet Fever). November. 3 ,, (1 Scarlet Fever, 2 Diphtheria). December. 1 ,, (Scarlet Fever). Total ... 9 cases (5 Diphtheria, 4 Scarlet Fever). No deaths occurred at the Hospital among patients admitted from this District in 1911. A County Laboratory (at present at Mill Street Chambers, Maidstone) is to be established at the commencement of 1912. where Diphtheria swabs, specimens of sputum, suspected typhoid blood, &c., can be examined free of direct charge, if for the interests of public health, and when sent in the special outfits to be 11 provided and with an accompanying prescribed form filled in. A small stock of the outfits will be kept by the Sanitary Inspector. (b) NON-NOTIFIABLE INFECTIOUS DISEASES. It is highly satisfactory to record that not a single death resulted either from Measles, Whooping-cough or Influenza. Diarrhoea and Enteritis (under 2 years). Six deaths were caused by these diseases, viz., 1 in May at Adelaide Road, 3 in July (2 at Windsor Road and 1 at Sussex Road), and 2 in August, 1 each at Park Road and Red Hill Villas. There were no infant deaths from diarrhoea in 1910, but with the exceptionally hot summer and autumn of 1911, the number of infant deaths showed its usual increase. Under this heading are now scheduled deaths from Diarrhoea and Enteritis of children under 2 years of age, but all deaths from both diseases over that age are scheduled under " other defined diseases." Acting on suggestions contained in the Local Government Board's circular letter of August 18th, 1911* on " the prevalence of epidemic Diarrhoea amongst children," visits were made to most of the smaller houses, with a view to taking steps to the removal of any accumulations of an offensive nature, &c., and I also advised that bi-weekly collections of house refuse from the smaller class of house should be made during the autumn, and this was carried out. I also included in the pamphlet on the feeding and care of infants, advice to mothers as regards this complaint, and of the precautions which should be taken as regards milk, cleanliness, feeding, &c. One of the District Nurses (Nurse Foster), on receiving information, co-operates with the Kent Education Committee by following up cases found at the medical inspection of children requiring home attention or advice. Inspection. The particulars of the work done and notices served by the Sanitary Inspector, as required by the Sanitary Officers' (Outside London) Order, 1910, are appended in Mr. Powell's Report. There are no Common Lodging Houses in the District, and no bye-laws have been adopted. 12 Part V. of the Public Health Acts Amendment Act, 1907, which deals with the regulating of Common Lodging Houses, was, on the request of the Council, put into force by an Order of the Local Government Board, dated May 28th, 1909. Dairies, Cowsheds, and Milkshops. There are 15 persons on the Register, viz.:— Dairymen and Purveyors 3 Purveyors only 8 Cowkeepers 1 Cowkeepers and Purveyors 2 Cowkeeper and Dairyman 1 15 I regard the quality of the milk supply as well up to the average, and the condition of the cowsheds and dairies is generally satisfactory. Regulations under the Dairies, Cowsheds, and Milkshops Order have been in force since 1903. An Application for Registration was received in June in respect of premises, the former occupier of which had died. I made a thorough inspection of the 6 cowsheds, and found the drainage defective, and advised that registration be refused until it was all reconstructed, and connected with the sewer. The overflow from the cesspool had previously passed into a pond. The work was in hand at the end of the year. No special action is taken by your Council in regard to the detection of tuberculous milk, but 40 samples were examined at j,he instance of the County Council, and one prosecution was made for diluted milk, and a fine imposed on the seller, and 2 convictions were also obtained against sellers of butter and margarine, which had on examination been found to contain foreign fat. Slaughter-houses. The 4 slaughter-houses (one now vacant) have been found on inspection to be conducted in a satisfactory manner. No tuberculous or unsound meat has been found, and the quality of the meat exposed for sale is above the average. 13 Factory and Workshops Act, 1901. Your Sanitary Inspector carries out the work of inspection under this Act, and he has only on one occasion found it necessary to call on me to inspect a laundry, which I found to be in an unsatisfactory condition. The tenant in this case vacated the house. The other matters requiring attention were remedied on notice being given. The following is a summary of the premises now on the Register:— Factories: Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light Works 1 Cycle Works 1 Motor Works 2 Laundry 1 Builder 1 10 Workshops: Bakeries 7 Other trades connected with foods or drinks 0 Laundries 5 Other trades connected with clothing 10 Various 22 44 54 Housing, Town Planning, &c. Act, 1909. A system for carrying out the necessary inspection according to the Housing (Inspection of District) Regulations, 1910, has been approved by this Council; the Sanitary Inspector being the officer designated to make the inspections. Where difficulties arise I also visit and inspect. Details are taken on the spot in a note-book with special headings, and these are afterwards transferred to duplicated foolscap sheets. This record with any resulting correspondence, copies of notices, &c., in respect of each house is placed in a paper folder, numbered, filed, and card indexed; so that the particulars respecting any house which has been inspected under the Regulations can be easily referred to. 14 The first inspection was made on March 9th, 1911, and in all hut one of the houses inspected defects were found. The following will give the necessary figures required by Article V. of the Regulations:— No. of dwelling-houses inspected 104 ,, dwelling-houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 ,, representations made to the Council with a view to the making of Closing Orders 2 ,, Closing Orders made 0 ,, dwelling-houses the defects in which were remedied without the making of Closing Orders 34 ,, dwelling-houses which, after making of Closing Orders were put into a fit state for human habitation 0 No Closing Orders were made in above cases, as the work was done voluntarily. I have made a detailed analysis of the 104 reports presented by the Inspector. Dampness has been the prevailing fault in the houses examined. The bedrooms in 60 houses, the living-rooms in 55, and the sculleries in 16, were reported as more or less damp. Dampness was caused by defective roofs (41), guttering (16), pervious walls (14), and also by defective chimneys, rain-water down-fall pipes, rain-water disposal, low floor levels, and insufficient floor ventilation. Damp courses were absent in 13 cases. I dealt with the causes of dampness in detail in a Report to your Council dated May 30th, 1911. A considerable number of the yards (49) had bad paving, and the yard drainage in 12 was also inefficient. Closet accommodation required improving in 39 cases, and in 19 others it appeared that the defects (some slight) were due to bad usage on the part of the tenants. Refuse and ashes disposal were unsatisfactory at 19 houses— usually due to absence of or defective kind of receptacle. 15 In 12 houses the water cistern was in an unsatisfactory condition, without cover, or in an unsuitable place. I have found on several occasions on bacterioligical examination a considerable deterioration in the quality of the water coming from cisterns kept under bad conditions, and the Council have had a card circulated to householders as follows- CHISLEH URST URBAN DISTRICT COUNCIL. WATER SUPPLY CISTERNS. The Council hereby draw attention to Section 35 of the Public Health Acts Amendment Act, 1907, which provides that any Cistern used for the supply of water for Domestic Purposes so placed, constructed, or kept as to render the water therein liable to contamination causing, or likely to cause risk to health shall be deemed to be a nuisance. Occupiers of houses should therefore see that their water supply cisterns are in a clean condition, water-tight, properly covered, and provided with a Valve Ball-tap or inlet pipe securely fixed to the side of the Cisterns so that the ball-tap shall not be submerged. The Cistern should be so placed as to readily admit of inspection. By order, H. E. KNIGHT, Clerk of the Council. The want of working-class housing accommodation is not acute, but houses of smaller rentals are needed to meet the requirements of small wage earners who in bad times now join others in a house, and thus produce overcrowding. Refuse Removal is undertaken by the Council in the whole of the District, and the work has been satisfactorily carried out during the past year. Reference to Mr. Powell's Report will show the cost entailed as compared with former years, and other details. Owing to the increasing amount of refuse to be dealt with and the ever increasing local difficulty of hiring suitable sites for refuse disposal, the Council decided to purchase the Whitehorse Hill brickfields for this purpose. I previously inspected the site on several occasions, and advised the desirability of acquiring it as soon as possible. 16 Application was made to the Local Government Board for sanction to borrow £1,575 for the purchase of the llj: acres of land, including the old brick kilns, &c., and to include incidental expenses. The Inquiry was held on May 3rd, by Major J. Stewart, R.E., and the approval of the Board subsequently obtained. I conferred with your Sanitary Surveyor on several occasions as to the best means of disposing of the refuse, and also inspected several destructors, but came to the conclusion that I was not justified in advising the expenditure of some £1,000 to £1,500, considering the area and character of the available land. With the Council's approval, we made some experiments in burning the refuse after the manner practised in military camps, and also were at the end of the year experimenting with the refuse in one of the old kilns. I believe that we shall be able to dispose of all the refuse of the District on this site without nuisance. Drainage. No special drainage or sewerage works have been carried out during the year, further than the 11 premises referred to by the Inspector. Elementary Schools. The medical inspection of school children is in the hands of the County Medical Officer of Health, who is also school medical officer, but other work in connection with schools and the public health is carried out by me in conjunction with him. I did not certify for the closure of any of the Elementary Schools during the year. Fruit Picking. The premises used for the temporary accommodation of pickers were regularly inspected, and were conducted satisfactorily, a great improvement being made at one of the farms by the erection of a separate structure for drying clothes, and cooking purposes. Bye-laws have been in force for securing decent lodging and accommodation for pickers since 1907. 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:— 17 Part 2. Streets and Buildings. ,, 3. Sanitary Provisions. ,, 4. Infectious Disease. ,, 5. Common Lodging Houses. Order made by the Local Government Board on May 28th, 1909, and to come into operation on 16th July, 1909. Date of Order in London Gazette: June 11th and 18th, 1909. Part 7. Police (Part of Section 81). ,, 8. Fire Brigades. „ 9. Sky Signs. Order made by the Home Office on April 2nd, 1909. Date of Order in London 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 Septembej 7th, 1908, and allowed by the Local Government Board on October 28,1908. Bye-laws with respect to drainage of existing buildings, adopted September 2nd, and allowed by the Local Government Board on November 8th. 1907. 18 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 Milkshops Order of 1885, adopted June 8th, and came into force August 12th, 1903. Water Supply. With the exception of some dozen houses, the position of which renders connection impracticable, the whole of the houses in the District are connected with the mains of the Metropolitan Water Board, and the supply is of excellent quality, constant, and sufficient. I made 4 bacteriological examinations of samples during the year, two of which were quite satisfactory. Local conditions were the cause of the two other samples showing somewhat unsatisfac tory results, and in one case the water passed through a cistern in the scullery with no cover, and the occupiers appeared very uncertain when the cistern had last been cleaned out. 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 record ing action taken under the Factory and Workshop Act, 1901, are appended. I have the honour to be, Gentlemen, Your obedient Servant, JAMES SCOTT TEW. Inn- 14th, 1912. 19 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 1911. By an Order recently issued by the Local Government Board is is now compulsory for the 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 District Council. The number of visits and re-visits made to premises has been 3,757, and 203 nuisances have been discovered. Complaints. Twenty-four complaints were received and investigated. Of these three related to accumulation of house refuse, two to smells from sewer gratings, one from the alleged pollution of the River Cray, four to accumulation of offensive matter, seven to defective drains and water-closets, one from sulphurous fumes from a greenhouse, one from contamination by petrol, two from carpet beating, one from a defective and insanitary house, one from the keeping of fowls in an insanitary condition, and one from defective surface water drainage. On investigating the three complaints relating to the non-removal of house refuse, in two of the cases complained of the refuse was found to be that of garden and trade refuse. One of the complaints relating to the smell from sewer gratings was found to be an offensive accumulation of garden refuse near the sewer grating complained of. This grating was closed at the time of visit. The complaints show an increase of four over those of the previous year. 20 Infectious Disease. Eighteen cases of Infectious Disease were notified and dealt with during the year, viv.:— Scarlet Fever 6 Diphtheria 5 Erysipelas 7 18 Scarlet Fever shows a decrease of 51 cases, Diphtheria the same number of cases as last year, viz., 5, and Erysipelas an increase of one case. It was found necessary to remove nine cases to the Isolation Hospital, which was a decrease of 45 cases over the previous year. During the past year the number of cases recorded proved to be a record for the smallest number notified since the formation of the Urban District, the lowest number previously recorded being 33 cases in the year 1901. Six cases of Phthisis were notified during the year, two cases being notified under the Voluntary Scheme, one under the Poor Law Regulations, and three under the Tuberculosis (in Hospitals) Regulations. This is a decrease of four over the previous year. One of the cases proved fatal, and one of the cases notified in the year 1909 also proved fatal. Disinfectants were regularly supplied to the patients. Fourteen houses or parts of houses were sprayed and fumigated during the year, 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 per cent, solution being used for this purpose. Three premises were disinfected after the occurrence of fatal cases of Phthisis, although two of the cases were not notified until after death had occurred. Infantile Diarrhœa. In August a circular letter was received from the Local Government Board advising flying visits being 21 made to the smaller houses in the District for dealing with offensive accumulations and other matters. After consultation with the Medical Officer of Health, it was decided to collect the house refuse twice in each week from the smaller houses during the months of September and October, and I personally visited nearly the whole of the small houses in the District. Leaflets drawn up by the Medical Officer of Health were also distributed to the smaller houses throughout the District. Drainage. The drains of eleven premises were examined and tested during the year, all of which were found to be defective. Four of these were reconstructed, and the remaining seven are now being reconstructed. Insufficient Water-closets. Water for flushing purposes was laid on to seven houses during the year. Insufficient Ash-pits. One hundred and forty-one premises were provided with movable receptacles for house refuse. Houses Unfit for Human Habitation. See special report on the Housing (Inspection of District) Regulations. Temporary Shelters. The twenty-four shelters for Fruit Pickers in the District were not all occupied last season, owing to one of the farmers practically having given up for the time being the growing of strawberries, and of the twenty shelters at this farm only two were occupied. These two shelters with four at Thongs Farm, were regularly inspected. At the latter Farm a structure was erected for the cooking of food and drying clothes, and this proved to be of great benefit to the occupiers. The shelters were occupied by 12 men, 6 women, and 4 children under the age of 14 years. Slaughter-houses, Dairies, Cowsheds, and Milkshops. These have been regularly inspected, and generally kept in good condition throughout the year. Notices were sent to the occupiers in the year 1909, calling their attention to the Public Health Amendment Act, 1907, Sections 53 and 54, as to Infectious Disease among the employers. 22 During the year one new Milkseller was registered in the place of one who had given up the business. Respecting the Cowkeeper's business mentioned in last year's report as being given up, application was made for these premises to be again registered. The premises were inspected by the Medical Officer of Health and myself, and it was found necessary that the cesspool drainage should be abolished and new drains constructed and properly connected to the sewer, and other defects made good. These works are now well in hand, and the registration will in due course be granted when the premises are satisfactory. One Licensed Slaughter-house is still vacant. Factories and Workshops. One hundred and fifteen visits have been made to the Workshops. Four cases of dirty rooms, two cases of dirty W.C. pans and one case of defective paving were dealt with. One dressmaker and one laundry have been registered during the past year, and one workshop has been converted into a factory. The corrected list is as follows:— Bakehouses 7 Laundries 5 Dressmakers and Milliners 7 Carpenters, Joiners, Builders, and Plumbers 8 Farriers, Coachbuilders, and Wheelwrights 7 Saddlers 2 Basket Makers 1 Cycle Makers 1 Bootmakers 2 Tailors 1 Upholsterers 3 44 One house at Foots Cray used as a Laundry was inspected by the Medical Officer of Health and found in bad condition, and the occupier left the premises and the same were therefore not registered . The sanitary conveniences at the Factories have been regularly inspected, and only in one case was it found necessary to deal with the cleanliness of the water-closets and urinal. 28 The present list is as follows Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light Works 1 Cycle Works 1 Motor Works 2 Laundry 1 Builder 1 10 One Motor Works was registered during the year, but was afterwards closed. Samples. To avoid overlapping, the Kent County Council kindly undertook to send this Council a monthly report on the samples taken by their Inspector. During the year under review 88 samples were taken as follows:— Milk (New and Separated) 40 Cream 1 Butter 15 Margarine 3 Sugar 2 Flour 1 Cheese 1 Lard 1 Coffee 1 Jam 1 Mustard 1 Oatmeal 1 Baking Powder 1 Beeswax 1 Preserved Peas 1 Tapioca 1 Vinegar 1 Whisky 5 Brandy 1 Gin 3 Rum 3 Olive Oil 1 Citric Acid 1 Mercurial Ointment 1 88 24 One sample of new milk was found on analysis to be slightly deficient in fat, but not such as to warrant legal proceedings being taken. One sample of separated milk on examination was found to contain 15.8 per cent, of added water, and the Vendor was fined 10s. and costs 10s. One sample of butter was found to contain 91 per cent, of foreign fat, and the Vendor was fined £3 and 10s. costs. One sample of margarine was also found to contain 91 per cent, of foreign fat, and the same was also sold to the Inspector in an unlabelled wrapper. Vendor was fined £2 and 10s. costs. All these proceedings were instituted by the Kent County Council. During the year there were also forty-three examinations made by the County Inspector of the weights of coal, all of which were found to be correct. House Refuse Removal. The collection of the house refuse by our own workmen has again worked well, and the dust has been collected regularly. The cost this year has been nearly £30 more than last year, but this accounted for by the circular letter of the Local Government Board respecting Infantile Diarrhoea, for during the months of September and October the house refuse was removed twice in each week instead of only once from the smaller houses in the District. Having regard to the fact that the number of houses from which house refuse has been removed has materially increased since 1906, the steps taken by the Council must be regarded as very satisfactory. The amounts expended during the past six years are as follows:— £ s. d. £ s. d. 1906 472 8 2 Contract. 1907 448 2 6 Direct Labour. 1908 455 11 0 do. 1909 481 7 7 do. 1910 470 2 2 do. 1911 Wages 248 18 3 Hire of Horses and Carts 198 5 2 Shoots 40 0 0 Tools 12 0 0 499 3 5 do. 26 The Council have now acquired 11¼ acres of land for the disposal of house and other refuse at Whitehorse Hill, Chislehurst, and this will be utilised for this purpose in April next. This will abolish the present unsightly refuse heaps in the District. Petroleum (Traders). Nine persons were licensed during the year for the storage of Petroleum in respect of amounts varying from 50 to 500 gallons. Petroleum (Private). During the year in all 67 visits were made by me in connection with the Private Petroleum Stores and Traders' Stores. Carbide of Calcium. Four persons were licensed during the year for the storage of Carbide of Calcium in respect of amounts varying from 114 to 224 lbs. Distribution of Leaflets. In the year 1909 the Council decided that there should be an annual distribution of leaflets containing information with regard to the notification, causes, symptoms, treatment, &c., of Scarlet Fever and other Infectious Diseases, including Phthisis. During the month of September last cards relating to Scarlet Fever and during the month of October last cards relating to Infantile Diarrhoea were left at each of the small houses, and cards and posters relating to Phthisis were left at the Elementary Schools, Barbers' Shops, &c., throughout the District. Extermination of Rats. During the year rats have been destroyed on the various dust shoots, allotments, &c., in the District. Summary of Work carried out during the past year (not including works carried out under the Housing (Inspection of District) Regulations, for which see special report) :— Number of complaints received and investigated 24 Nuisances discovered 203 Nuisances abated without report 180 Nuisances abated after report 12 Nuisances outstanding 11 Legal Notices served 6 Preliminary Notices served - Notices served for insufficient ash-pits 5 Notices served for insufficient water-closets 1 Number of letters written, reports made, School notices, and other minor notices 625 26 Character of Work carried out (not including works carried out under the Housing (Inspection of District) Regulations, for which see special report):— Houses cleansed and generally repaired 17 Cowsheds, Slaughter-houses, and Bakehouse cleansed 26 Overcrowding abated 1 Defective roofs, gutters, and rainwater down pipes repaired 11 Water laid on to water-closets 7 Dustbins provided 141 Cesspools cleansed — Cesspools abated — Houses at which drains were examined and tested 11 Houses at which drains were found defective 11 Houses at which drains have been reconstructed 4 Houses at which drains are now under reconstruction 7 Houses at which drains were cleansed, ventilated, trapped, or repaired 51 Houses at which surface water drainage has been provided 4 Houses connected to the sewer — Offensive accumulations removed 13 Urinals cleansed 3 Water laid on to water-closets 3 Infectious houses cleansed and fumigated 17 Houses where back-yards have been paved or repaired 22 New water-closets built — Water-closets repaired — Drinking water cisterns covered and cleansed 23 Premises on which animals were so kept as to be a nuisance 28 HOUSING (INSPECTION OF DISTRICT) REGULATIONS, 1911. In March last the Council gave me instructions to inspect that part of the District known as Whitehorse Hill. Steps were immediately taken to comply with the Council's instructions, and this became possible by the Council very kindly providing me with a capable assistant. 27 In the first report some twenty houses were dealt with, but a good deal of time was taken up in discussing the reports and procedure, and a Sub-Committee was appointed by the Council to inspect the houses in question. After this time the work proceeded more rapidly, and at the end of the year one hundred houses had been inspected and reported upon in the above part of the district and four in Ferry Street. Two of the houses in Perry Street were certified by the Medical Officer of Health to be unfit for human habitation, and these were afterwards put into thorough repair, and are now again occupied. The matter requiring most attention was that of dampness. This arose from various causes, viz., want of damp-proof course, ground above the level of damp-proof course, defective eaves, gutters and rainwater-down pipes, defective sills and frames of windows, defective roofs, and from pervious brickwork. This latter defect was, I think, the chief cause of the dampness, and it is a very open question whether 9in. solid brickwork houses built in exposed situations do not require cementing or provided with some impervious surface to the outer walls. Hollow walls would, of course, naturally stop the dampness, but this would largely increase the initial cost of the building. The outer walls of three of the damp houses were cemented and fourteen were treated with patent damp-proofing solution, but it is questionable whether the latter will have any permanent effect Those houses without damp-proof courses were provided with slate and cement damp-proof courses, and where the ground was above the original damp-proof course, horizontal courses with slates and cement were provided. Of the 104 houses inspected, the works at thirty-four were completed at the end of the year and at most of the other houses the work was in hand, but it is necessary in several instances that various work, such as cement work, should stand over until the Spring, when the work can be more effectually carried out. Summary of Defects. The following is a Summary of Defects found and matters reported upon under these Regulations:— Dampness, caused by the want of or insufficient damp-proof courses, porous brickwork, defective eaves, gutters and rainwater down-pipes, defective roofs, &c., &c. 226 28 Dirty or defective W.C. pans 26 Insufficient flush of water to W.C.'s 24 Defective drainage appurtenances: Sinks, gullies, waste-pipes, &c 34 Dirty walls and ceilings 113 Defective flooring and paving indoors 33 Defective yard paving and surface water drainage 51 Drinking water cisterns in dirty or defective condition, or uncovered 13 Insufficient Dust-bins 17 Floors imventilated 18 Miscellaneous defects found: Steps, washing-coppers, fire-places, &c. 41 I have the honour to be, Gentlemen, Your obedient Servant, WM. GEO. POWELL (Assoc. 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. Transferable Deaths. J Nett Death® belonging to the District. Uncorrected Number. Nett. * Number. Rate. †of Non-Residents registered in the District. † Of Residents not registeied in the District. Under 1 Year of Age. At all Ages. Number. † Rate. * Number. Rate per 1,000 Nett Births. *Number. Rate. 1 2 3 1 5 6 7 8 9 10 11 12 13 1906 7,932 .. 180 22.6 86 10.8 .. 7 18 100 93 11.7 1907 8,032 .. 186 23.1 58 7.2 .. 13 11 59 71 8.8 1908 8,132 .. 172 21.1 47 5.7 .. 6 13 75 53 6.5 1909 8,235 .. 183 22.2 64 7.7 .. 13 12 65 77 9.3 1910 8,338 .. 163 19.5 68 8.1 .. 19 14 85 87 10.4 1911 8,668 163 165 19.0 61 7.0 1 17 14 84 77 8.8 Notes.— This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates probably will not be available. The rates should be calculated per 1,000 of the estimated gross population. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. *In Column 6 are to be included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is to be entered the number in Column 6, corrected by subtraction of the number in Column 8, and by addition of the number in Column 9. Deaths in Column 10 are to be similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. Area of District in acres (exclusive of area covered by water), 2,786. At Census of 1911:— Total population at all ages, 8,668; number of inhabited houses, 1824; average number of persons per house, 4. 30 TABLE II. Cases of Infectious Disease notified during the Year 1911. Notifiable Disease. Number of Cases notified. 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 up. Small-pox .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 5 .. .. 4 .. .. 1 .. 5 Erysipelas 7 .. .. .. .. 1 4 2 .. Scarlet fever 6 .. .. 5 .. .. .. .. 4 Typhus fever .. .. .. .. .. .. .. .. .. Enteric fever .. .. .. .. .. .. .. .. .. Relapsing fever .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. Puerperal fever .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. Phthisis. Under Tuberculosis Regulations, 1908 Under Tuberculosis Regulations, 1911 1 .. .. .. .. 1 .. .. .. 3 .. .. 2 1 .. .. .. .. Others 2 .. .. 1 .. .. 1 .. .. Totals 24 •• 1 12 1 2 6 2 9 Isolation Hospital— Bromley and Beckenham 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. Table 3.— Causes of, and Ages at, Death during 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65, 65 and upwards. All Causes— Certified 77 14 3 2 1 4 10 14 29 2 Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. .. .. .. Diphtheria & Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 3 .. .. .. .. 1 2 .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Rheumatic Fever .. .. .. .. .. .. .. .. .. .. Cancer, malignant disease 6 .. .. .. .. .. 2 3 1 .. Bronchitis 4 1 .. .. .. .. .. .. 3 .. Broncho- Pneumonia 1 .. 1 .. .. .. .. .. .. .. Pneumonia (all other forms) 4 l .. 1 .. 1 .. .. 1 .. Other diseases of Respiratory Organs 2 1 .. .. .. 1 .. .. .. .. Diarrhoea and Enteritis 6 1 .. .. .. .. .. .. .. .. Appendicitis and Typhlitis .. .. .. .. .. .. .. .. .. .. Other septic diseases 1 .. .. .. .. .. 1 .. .. .. Alcoholism .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 1 .. .. .. .. .. 1 .. .. .. Nephritis and Bright's Disease 2 .. .. .. .. .. .. .. 2 .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. Other Accidents and Diseases of Pregnancy & Parturition .. .. .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 2 2 .. .. .. .. .. .. .. .. Heart Diseases 7 .. .. .. .. .. .. 3 .. .. Brain Diseases 7 .. .. .. .. 1 3 .. 3 1 Violent Deaths, excluding Suicide 2 .. .. 1 1 .. .. .. .. 1 Suicides 1 .. .. .. .. .. .. .. 1 .. Other Defined Diseases 25 3 .. .. .. .. 1 7 14 .. Diseases ill-defined or unknown 3 .. 2 .. .. .. .. 1 .. .. All causes 77 14 3 2 1 4 10 14 29 2 Table 4.— Chislehurst Urban District. 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 2 1 — — 3 2 3 4 2 14 Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. Diarrhoea .. .. .. .. .. 1 1 1 .. 3 Enteritis .. .. .. .. .. .. 1 1 1 3 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Congenital Malformations .. .. .. .. .. .. .. .. .. .. Premature Birth .. .. .. .. .. .. .. 1 .. 1 Atrophy, Debility and Marasmus 1 .. .. .. 1 .. .. .. .. 1 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions .. 1 .. .. 1 .. .. .. .. 1 Gastritis .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 1 .. .. .. 1 Pneumonia (all forms) .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Other Causes l .. .. .. 1 .. l 1 .. 3 2 1 — — 3 2 3 4 2 14 Nett Births in the year—Legitimate, 161 ; Illegitimate, 4. Nett Deaths in the year of Legitimate Infants, 13 ; Illegitimate Infants 1. 83 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) 15 - - Workshops (inclnding Workshop Laundries) 115 1 — Workplaces — — — Total 130 1 — 2.— DEFECTS FOUND. Particulars. Number of Defects. Number of proaecutions. Found. Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts :— Want of Cleanliness 4 4 .. .. Want of Ventilation .. .. .. .. Overcrowding .. .. .. .. Want of drainage of floors 1 1 .. .. Other nuisanccs 2 2 .. .. Sanitary accommodation insufficient .. .. .. .. unsuitable or defective .. .. .. .. not separate for sexes .. .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (ss. 97 to 100) .. .. .. .. Other offences .. .. .. .. Total 7 7 .. .. 3.— HOMEWORK. One List received from another Council of persons engaged in linking: wearing apparel. Inspections of Outworkers' Premises.—1 34 4.-REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses 7 Laundries 5 Dressmakers and Milliners 7 Carpenters, Joiners, Builders, Painters and numbers 8 Farriers, Coachbuilders and Wheelwrights 7 Saddlers 2 Basket Maker 1 Cycle Maker 1 Bootmakers 2 Tailor 1 Upholsterers 3 Total number of workshops on Register 41 5.— OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop (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 .. 1 Other .. Underground BakehouseR (s. 101) :— Certificates granted during the year .. In use at the end of the year .. J. S. TEW, Medical Officer of Health. June 14th, 1912,