Chi 6 URBAN DISTRICT COUNCIL OF CHISLEHURST. ANNUAL REPORT ON THE HEALTH OF THE CHISLEHURST URBAN SANITARY DISTRICT FOR THE YEAR 1914 BY JAMES SCOTT TEW, M.D., D.P.H. ' SIDCUP: District Times Office, Sidcup, Kent. 1915. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914. AREA AND POPULATION The following Table gives the area, population of the District, and other figures, as shown by the Census of 1911. Area in Statute acres (Land and Inland Water). Families or Separate Occupiers. Population. Institutions, Large Establishments, Vessels, etc., 1911, (included in Cols. 4 and 6.) 1901 1911 1901 1911 Pers's Pers's Males Feml's No. Population 1 2 3 4 5 6 7 8 9 10 Chislehurst Urban District and Civil Parish 2,791 1,487 1,824 7,429 8,666 3,725 4,941 13 333 Wards: Lower Chislehurst .. .. 725 .. 3,377 1,554 1,823 2 57 Upper Chislehurst .. .. 1,099 .. 5,289 2,171 3,118 .. 326 4 The Population of the Chislehurst Urban District is estimated to have been 9,110 at the middle of 1914. This is an increase of 139 on the estimated population for 1913, and 444 on the population of the district at the Census of 1911. Births and the Birth-rate.—There were 172 births registered in the district, all of them belonging to it, and four births were transferred to the district from outside, making the nett births 176 (79 males and 97 females) and the Birth-rate 19.3. This is the highest birth-rate since 1910, when there were 163 births and a Birth-rate of 19.5. Deaths and the Death-rate.—There were 61 deaths registered in the district giving a crude death-rate of 6.7, which, corrected by the factor for the district, gives the slightly higher standardised rate of 6.8, comparing very favourably with the same rate both for the whole of England and Wales (13.7), and for the 145 Smaller Towns of England and Wales (13.1). There were 19 deaths to be transferred to the district of residents who had died outside it (seven in the Union Infirmary, Bromley, seven in local Hospitals near, and the remainder chiefly in London Hospitals), and 1 death to be transferred away from the district, making the nett number of deaths 81, 35 males and 46 females, and the nett Death-rate 8.8, compared with a rate of 7.5 in 1913 and 1912 and 8.8 in 1911. Two deaths were certified as due to one or other of the following epidemic diseases, viz.:— Diarrhoea and Enteritis (under 2 years) 0 Diphtheria 2 Measles 0 Whooping-cough 0 Enteric Fever 0 Scarlet Fever 0 Small-pox 0 2 The Death-rate from these Epidemic Diseases was 0.22 per 1,000 of population, compared with 0.33 in 1913, 0.11 in 1912, and 0.69 in 1911. MORTALITY FROM EPIDEMIC DISEASES, 1914. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Chislehurst Urban 10.00 0.00 0 00 0.00 0.00 0.22 per 1,000 living. England and Wales 0.05 0.00 0.24 0.08 0.21 0,15 5 Infant Mortality.— A low infant mortality rate is characteristic of the Chislehurst Urban District, but during the last three years it has been exceptionally low, and 1914 has the lowest rate recorded in the district, having only three infant deaths and a rate of 17 per 1,000 births, although the actual number of births registered (176) is the highest since 1907, and the birth-rate the highest since 1910. In 1913 there were four deaths and a rate of 25 per 1,000 births, in 1912 eight deaths and a rate of 54, and in 1911 fourteen deaths and a rate of 84. The Infant Mortality rate for the whole of England and Wales for 1914 was 105. The Midwives Act, 1902, is administered by the Kent County Council direct. The Notification of Births Act, 1907, has not been adopted. Two cases of Opthalmia Neonatorum have been notified during the year. Maternity and Child Welfare was considered by the Council, and I reported that as the County Council have the supervision of Midwives and the care of School Children in their hands, I thought it was desirable that they should develop a County Organisation to deal with this question also, as suggested in the Local Government Board's Circular Letter on the matter dated July 30th, 1914. The following table gives a comparison between the rates for this District and those for England and Wales:— Birth-rate. Death-rate. Infant Mortality. England and Wales 23.8 14.0 105 97 Great Towns (including London) 25.0 14.7 114 145 Smaller Towns 23.9 12.9 104 England and Wales (less the 242 Towns).. 22.2 13.4 93 Chislehurst Urban 19.3 8.8 17 (A). NOTIFIABLE INFECTIOUS DISEASES. Under the Infectious Disease (Notification) Acts, 1889 and 1899, the following diseases are compulsorily notifiable in the District, viz.: Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the disease known as Scarlet Fever or Scarlatina, and the Fevers known by any of the following names:—Typhus, Typhoid or Enteric, Relapsing, Continued and Puerperal. 6 By a General Order of the Local Government Board, No. 58,962, dated 15th August, 1912, the diseases known as Cerebrospinal Fever and Acute Poliomyelitis were also made compulsorily notifiable. By a General Order of the Local Government Board dated the 5th February, 1914, Opthalmia Neonatorum was made compulsorily notifiable by Medical Practitioners and Certified Midwives from the 1st of April, 1914. By a General Order of the Local Government Board, dated 19th December, 1912, the following Regulations, viz., the Public Health (Tuberculosis) Regulations, 1908; the Public Health (Tuberculosis in Hospitals) Regulations, 1911; and the Public Health (Tuberculosis) Regulations, 1911, were revoked and substituted by the Public Health (Tuberculosis) Regulations, 1912. The last-named Regulations came into operation on the 1st of February, 1913, and had the effect of making all forms of Tuberculosis compulsorily notifiable on and after that date. The total number of notifications received during 1914 is a slight decrease on 1913, being 51 from all forms; of notifiable infectious disease compared with 55 in 1913. There has been a decrease in enteric fever and tuberculosis, and a small increase in diphtheria, scarlet fever, erysipelas, and opthalmia neonatorum. Scarlet Fever. There were IT cases notified during 1914, compared with 15 in 1913. None of the cases were fatal. The first case occurred in February and was a young man aged 22, who was removed to Hospital on February 21st and remained there until March 21st, when he returned home. The same night he had an attack of rheumatism, and the doctor who had first attended him was called in the following day. On April 3rd a sister, aged 16, who had been looking after him, was notified as having scarlet fever, and as the brother had not finished peeling, both sister and brother were removed to Hospital. There was one case notified in March, a youth aged 17, who was employed in London and went there each day, his parents being caretakers in a large house in this district. He also was removed to Hospital. The four other cases notified in April came from cottages adjoining each other, and all the children had attended the same school. A member of one of the families and one of the first cases to be notified had also been visiting London. All four cases were removed to Hospital. 7 Two cases were notified in May, the first case notified having been away from home visiting a few days previously. The second case had attended the same school. Each child was nursed in its own home with a trained nurse in attendance. Two cases notified in June were sisters and had attended the same school as the April cases. Both children were removed to Hospital. There were no other cases notified until November, when a Belgian child, aged 4½ years, who had arrived at "The Gorse," a house opened for Belgian Refugees in Chislehurst, from Folkestone, already suffering from scarlet fever, was notified. It was stated that the mother of the child and two other children were also ill with scarlet fever at Folkestone. The child was removed to the Bromley and Beckenham Hospital. A second case notified in November was a child who had attended the same school as the April and June cases (St. Nicholas), and who had been isolated and under observation for some time, but it was only when slight desquamation began that the medical attendant was able to certify that the case was scarlet fever. * The first case notified in December had attended the same school as two of the May cases, who were nursed at home; one case was notified from a large boarding school in the neighbourhood, and another from a small convalescent home, and in neither case could the source of infection be traced. One case was isolated at the school, most of the boarders being away for the Christmas holidays and the boy's mother arriving to nurse him, and the other case was removed to the Isolation Hospital. The cases were notified at the following age-periods:— 1-5 5-15 15—25 25—45 years. years. years. years. 0 14 3 0 =17 cases. Nine of the patients were treated at the Bromley and Beckenham Joint Isolation Hospital. Diphtheria. There were 12 cases of diphtheria notified during 1914, compared with 11 in 1913, and two of them were fatal, both the deaths occurring in the Isolation Hospital. There were two cases in January: the first had attended the Birkbeck School, and the second, a girl aged 13, was notified from an Orphanage in the neighbourhood. Both cases were removed to Hospital. 8 In February, March and April there were no cases, but at the end of May an adult, residing in a large house in the neighbourhood, was notified. The patient was isolated at home with a trained nurse in attendance. There was nothing to indicate the source of infection in any of these cases. The only case notified in June was a boy, aged 12, who had attended the same day school as the first case notified in January (Birkbeck). The first case in July was a governess at a ladies' school in the town, who had visited Bromley a few days previously, and it was suggested that she had probably received the infection there. No further cases were notified from this (boarding) school. The second case was a girl, aged 19, who was very ill before medical advice was sought. She was, however, removed to Hospital and recovered. A member of the family attended the Foots Cray Council School, whence subsequently on August 31st another case was notified which ended fatally, as did a further case notified from this school in November. No further cases were notified until October, when there were two. One had attended the North Cray School and the other the Sidcup School, neither of which had had any previous cases, but two cases were notified from the latter school in November. Two other cases notified in November had attended the Foots Cray Baptist Sunday School. The following are the age-periods at which the cases were notified:— 1—5 5—15 15—25 25—45 years. years. years. years. 0 9 2 1 =12 cases. Opthalmia Neonatorum. There were two cases of opthalmia neonatorum notified. The necessary precautions were taken. Both cases were attended by a parish nurse, one of whom is also a midwife, and in both cases a doctor was attending the child. Erysipelas.—Eight cases were notified during 1914. All were people over 50 years of age, and two were over 65. The cases were spread over the whole year; all occurred in houses having a constant water supply, ample accommodation for the number of occupants, and apparently in a good sanitary condition. None of the cases seemed to have any association with each other. 9 Enteric Fever.— There were no cases during 1914. Puerperal Fever.—Again no cases have been notified; the last was in June, 1905. Small pox.—It is also satisfactory to record that no cases of this disease have occurred since May, 1903. Cerebro-spinal Meningitis and Acute Anterior Poliomyelitis are now by the General Order of the Local Government Board of August 16th, 1912, compulsorily notifiable, but during the past year no notifications have been received. Pulmonary Tuberculosis.—There were five deaths during 1914. Four had been notified—one each in January and August, 1912, one in April, 1913, and one in May, 1914. Only two had received Sanatorium treatment—the August case, 1912, had been a patient at the National Hospital for Consumption, Isle of Wight, and the case notified in April, 1913, at the East Anglian Sanatorium. Eight of the notifications were received from Chislehurst, one from Sidcup, and two from Foots Cray part of the District. The following Table gives a comparison of the rates for this District, and the rates for England and Wales for the six years 1907—1912, beyond which the comparative figures for the country generally are not at present available. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. TUBERCULOSIS (all orms) England and Wales 1.61 1.58 1.54 1.43 1.46 1.53 Chislehurst Urban— Death-rate 0.87 0.73 0.97 0.35 0.34 0.34 1.23 0.54 No. of deaths 7 6 8 3 3 3 11 5 PHTHISIS. England and Wales 1.14 1.12 1.09 1.02 1.08 1.039 Chislehurst Urban— Death-rate 0.75 0.49 0.72 0.35 0.34 0.34 0.78 0.54 No. of deaths 6 4 6 3 3 3 7 5 There were 11 cases of tuberculosis (all forms) notified during 1914, compared with 23 in 1913. Of these 8 were of phthisis, compared with 11 in 1913, and 3 of other forms of tuberculosis, compared with 12 in 1913. 10 Table showing cases of Tuberculosis (all Forms) notified during 1914:— Total No. of Cases. Sex. AGES. under 1 1-5 5-10 10—15 15-20 20—25 25—30 30—35 35—40 40—45 45—50 50—55 55—60 60—65 Pulmonary 4 M .. .. .. .. .. 1 .. 1 .. 1 .. .. 1 .. Tuberculosis 4 F .. .. .. .. .. 1 .. 3 .. .. .. .. .. .. Other 1 M .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Forms of Tuberculosis 2 F .. .. 1 1 .. .. .. .. .. .. .. .. .. .. Total 11 .. .. .. 1 1 .. 2 .. .. .. 2 .. .. 1 .. Phthisis. Three of the eight notifications referred to patients from good "houses in the district, where they were employed, one as a governess and two as domestic servants, and in two of the cases other members of the patient's family had had tuberculosis. Two other cases occurred in cottages in good sanitary condition, and in one of these families also there had been a previous case of tuberculosis. Another of the cases was a single man, aged 42, who had come into the district for the fruit picking. He was housed in one of the fruit-picker's huts, and was the sole occupant, and was authorised to attend the Tuberculosis Dispensary at Bromley. Disinfectants and sputum utensils were supplied to him, and the hut was lime-washed periodically. The last case notified in the year was a wounded Belgian soldier, who had been sent to one of the temporary hospitals in the district. He was removed to the Royal Herbert Military Hospital, Woolwich. There were three cases of non-pulmonary tuberculosis notified. One case was a girl, aged 10 years, who was suffering from tuberculosis of the hip joint. She had received treatment five years ago at the Great Ormond Street and the Croydon Hospitals as an outpatient, and at the Workhouse Infirmary a few years ago, but had apparently never been notified. An opportunity had been afforded the parents to have the child received into a local Hospital on payment of a small weekly sum, which the parents were endeavouring to take advantage of. A second case was a man, aged 44, with tuberculosis of the spine. He was receiving treatment at the Sidcup Cottage Hospital. 11 The third case was a child, aged 5 years, who had had tuberculosis of the glands six weeks. In this case there was a record of tuberculosis in the family. The child was being treated at home. As in other parts of the Combined District, notifications of cases of tuberculosis are generally sent direct to the Sanitary Inspector, who thereupon visits the house, inquires into its sanitary condition, directs the patient and friends as to the precautions necessary to prevent the spread of the disease, and carries out any disinfection required, and where the condition of the premises is such as to make the intervention of the sanitary authority desirable the owner is called upon to carry out necessary repairs. Where Sanatorium treatment is desired, the Medical Attendant is advised to get into communication with the Tuberculosis Officer for that district, and is handed his name and address and hours of attendance, and it is suggested that he should arrange a consultation for his patient. On receipt of an intimation that a patient has been received into a Public Institution, the Sanitary Inspector again visits the house and offers to disinfect the rooms vacated by the patient, and any clothing or bedding that the householder may desire to have disinfected. Unless some circumstance arises which necessitates further visits, no re-inspections are made. On receipt of the returns from the Registrar, any deaths from tuberculosis are noted and an advice is immediately sent to the Sanitary Inspector, who visits the house, disinfects the premises, and where there are sanitary defects asks the owner to remedy them. On three occasions during 1914 the Council have paid compensation for bedding destroyed to families having had cases of tuberculosis in the house. B. NON-NOTIFIABLE INFECTIOUS DISEASES. Measles, Whooping-cough, Diarrhoea and Enteritis (under 2 years), and Influenza. There were no deaths from any of these diseases during 1914. C. OTHER DISEASES. There were 14 deaths from cancer during the year, which is the highest number in any year since the district was formed, and is equal to a rate of 1.53 per 1,000 of population, compared with 1.00 in 1913. All the deaths were of adults over 45 years of age, and six were persons over 65. b 12 The following Table shows the number of deaths and deathrates for this District for the years 1907—1913, with the comparative rates for England and Wales up to 1912, beyond which year the latter are not at present available. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914, England and "Wales.. 0.91 0.92 0.96 0.97 0 99 0.99 Chislehurst Urban— Death-rate 0.37 1.61 1.46 0.36 0.69 1.79 1.00 1.53 No. of deaths 11 5 12 3 6 7 9 14 Owing to some interest and discussion on the subject, I made the following report to the Council on the subject of cancer cases in this district:— CANCER CASES. May 25th, 1914. Gentlemen, I have given this matter some considerable attention during the past few years, and beg to advise your Council not to make any hard and fast rule, but to allow your officials as heretofore to treat each case on its own merits with a general instruction to offer disinfection and scraping of the walls of the rooms actually occupied by the patient, and destruction of the bedding or clothing which has been subject to obvious discharges, etc. I am fully aware of the recent articles in the " Times," " Spectator," and other papers, but we are not yet in a position to fully substantiate the fact of the infectious character of the disease. The Local Government Board have just recently on the application of a town in the West of England declined to add cancer to the list of their notifiable diseases on the ground that there was not a general concensus of medical opinion as to the infectious nature of cancer, and the facts on which the Board base their decision are important. I personally made inquiries some short time ago of several cancer medical experts, and their opinions were very divergent as to its infectivity. Although the number of deaths from cancer (9) in 1913 was slightly over those of the three previous years, the average for 7 years (1907—1913 inclusive) is under 8 deaths per annum. I have the honour to be, Gentlemen, Your obedient Servant, J. S. TEW. 13 Six of the 14 deaths were females and eight were males, two occurred in Red Hill and two in Albany Road, but with these exceptions they were scattered up and down the district. Hospital Accommodation and Administration. Twenty cases of infectious disease were treated at the Bromley and Beckenham Joint Hospital, and were admitted as follows:— Diphtheria. Scarlet Fever. January 2 — March — 1 April — 6 June 1 2 July 2 — August 1 — October 1 — November 3 1 10 10 Hospitals. There has been some discussion during the year on the charges made by the Bromley and Beckenham Hospital for patients from this district. The charges have increased considerably since 1901, when the Parish of Chislehurst first became a Constituent Authority of the Joint Hospital District, due to the increase in the Common Fund Charges, but after consideration it was decided that it was not desirable to make application to sever the connection with the Joint arrangements unless, of course, the Common Fund Charges increased so materially that the Council would feel warranted in taking steps to provide a hospital of their own. The Bromley and Beckenham Joint Hospital Board decided during the year to apply to the Local Government Board to amend the Order of 1901, so that the Chislehurst Council may be represented on the Board by any one of its members. Bacteriological Aids to Diagnosis. Copies of reports have been received on the examination of 29 specimens, viz.:— At County Laboratory:— Positive. Negative. Total. Diphtheria 8 14 22 Typhoid — 1 1 Phthisis 2 4 6 Others — — — 10 19 29 14 By Clinical Research Association:— Positive. Negative. Total. Diphtheria — — — Typhoid — — — Phthisis — — — Others - - - — — — Sanitary Inspection of District. The figures and information required by the Sanitary Officers' (outside London) Order, 1910, are appended in Mr. Capon's report. Adoptive Acts. The Infectious Disease (Prevention) Act, 1890, and the Public Health Acts Amendment Act, 1890, were adopted in 1900. 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:— Part 2. Street 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 Sections 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. Sanction for the adoption of Section 51 of the above Act (relating to power to declare a business to be an offensive business) was given under the Order of May 28th, 1909. The Council has declared a list of offensive trades, which after certain modifications was confirmed by a further Order of the Local Government Board. 15 Water Supply. The Chislehurst Urban District is supplied with water by the Metropolitan Water Board, whose water is derived partly from stored and filtered river water and partly from chalk wells in Kent. The supply is generally considered satisfactory, though from time to time complaints have been received which on investigation have shown that the system of storage in cisterns, which exists in the district at present, is less satifactory than where the water is delivered to the consumer direct from the mains, and in January, in response to inquiries by the Metropolitan Water Board, and at the request of the Council for my opinion on the subject, I reported that " Generally speaking, and especially considering that mains are now easily tapped under pressure, I consider, except under exceptional circumstances, that storage cisterns connected with a reliable constant service could be discarded with advantage," and the Council forwarded the following recommendations which they had adopted, to the representative of the Metropolitan Water Board:— " That the obligation to provide cisterns be abolished, and that the use of such cisterns be discouraged except in cases where boilers are fixed. That in all cases taps be fixed on the rising main for household use. That the Water Board be asked to advertise any contemplated cutting off of mains supplying a considerable area, to give special notice to all important consumers affected by any particular shutting off, and to use an apparatus whereby new services can be attached without shutting off the supply." To which the Metropolitan Water Board replied " that in the case of new supplies and relays to unoccupied premises, the provision of a cistern be demanded wherever the Board have the statutory powers in that behalf ": the Board stated that their Engineer will do all he can to persuade consumers to fix taps on the rising main for household use: that their employees will as far as practicable give notice to consumers, especially large consumers, when temporary cutting off of the supply is intended, and that an apparatus whereby services can be attached without cutting off the supply is in use in the Kent District for tapping mains under pressure, and that if it is not in use in the Council's area it will be made available. Later, however, a communication was received from the Engineer of the Water Board stating that in the majority of cases in the Chislehurst District it is not possible to use the machine for tapping the water mains under pressure. Later in the year some discussion arose as to the hardness of the water, and the advisability of adopting some process of softening before distributing it to the consumer, and at the Council's request I informed them of my opinion on the subject in a letter addressed to the Clerk, as follows:— 16 Re KENT WATER. August 6th, 1914. Dear Sir, I think both for economic and dietetic purposes it is very desirable that the water from the chalk wells in Kent should be subjected to a softening process. I quite agree with the extract from the " Lancet " which you enclosed. The cost has been the objection, and it has always appeared to me somewhat unfair to the consumers of the Kent water that they should have nothing spent on the well water while so much is spent on filtration and sedimentation storage for the river water. It is true that it is an absolute necessity for the immediate safety of the consumers that the river waters should be very efficiently treated, but there is something to be said on the economic question of domestic inconvenience and the undesirability, for many persons, of the drinking of a hard chalk water. I should consider that the time has come when a process of softening ought to be adopted. Yours faithfully, J. S. TEW. J. J. Brown, Esq., Chislehurst. In view of the enormous expense involved, however, the Council decided not to take any action in the matter. Subsequently a letter was received from the local representative of the Metropolitan Water Board stating that he was advised that if a softening process estimated to cost ,£10,000 a year was adopted, there would be no necessity to store the water for any lengthened period, and that the expense of the enormous reservoirs now in contemplation might be saved. He further stated that the Chief Engineers were reporting on a scheme for providing a supplemental supply of 4,000,000 gallons daily to the Kent District from the River Thames, which will probably involve an expenditure of £200,000. The works are necessitated by the rapid growth of the population of the Kent area. I give below a copy of the report received on a sample of water taken from a stand-pipe supplying three houses in Mill Place, on August 26th, and forwarded for analysis to the County Laboratory, Maidstone. 17 Result of Examination Number of organisms per c. c. capable of growth On Agar at 87.5 C. On Gelatine at Room Temperature in 2 days. 31 Liquefying 27 Total 50 McConkey and Bile Salts Glucose Broth. Number of Tests. Acid and Gas. Acid. No Growth. Tubes of 0.01 c.c. water. 0 0 0 10 „ „ 0.1 „ 0 2 8 10 „ „ 1.0 „ 3 3 4 5 ,, ,, 10.0 ,, ,, 4 1 0 2 ,, ,, 50.0 ,, ,, 2 0 0 There does not seem to be any suggestion of pollution: it appears to be one of those waters whose quality fluctuates a good deal and, therefore, needs careful watching. Yours faithfully, CONSTANT PONDER. Refuse Disposal. There is a satisfactory system of collection in the town, in most of the houses the refuse being collected once each week, and during the hot weather twice weekly. The Council have a large area of land on which to dispose of the refuse. In 1911 they purchased theWhite Horse Brick-fields, on which there are large hollows which require to be filled up. The lighter portions of the refuse are burned. Should a destructor be decided on later, there is ample room for one on this land. During the year the Council authorised the distribution of leaflets regarding the fly nuisance. The Chislehurst Urban District Council was one of the first to recognise the danger of flies, and to institute a campaign for their destruction. In January they communicated with the County Council asking if they would co-operate in any action to be taken for the purpose of reducing the number of flies, and received a letter from Dr. A. Greenwood, the County Medical Officer, in which ha stated he would draw up a list of suggestions for furthering the campaign in Kent, and invite other Councils in the County to join in any action taken. The Chislehurst Urban Council have also taken steps to reduce the number of rats in the district. 18 Excrement Disposal. The town is almost entirely on the water carriage system, the effluent being carried into the West Kent main sewer. There are only a few cesspools in the district, and these are in outlying parts not within reach of the sewer. Bye-laws and Regulations. The following is a list of the Bye-laws and Regulations in force in this 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. Bye-laws with respect to the Management of the Cemetery provided by the Council and charges for the use of the same, adopted January 20th, 1913, and confirmed by the Local Government Board, March 18th, 1913. 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. 19 Schools. No Schools have been closed during the year on account of the prevalence of infectious disease. Foods. Action taken under the Food and Drugs Act is detailed in the Sanitary Inspector's Report. Dairies, Cowsheds, etc. One set of premises has changed hands during the year, and slight alterations improving the premises were effected at the time of the transfer on my representing to the Council that they were desirable. Dairies, Cowsheds, and Milkshops. Regulations made under the 1885 Order have been in force in this District since 1903. There are now 16 persons (occupying premises in the district) on the Register, as follows:— Dairymen and Purveyors 1 Purveyors only 13 Cowkeepers 1 Cowkeepers, Dairymen and Purveyors 1 16 Slaughter-houses. There are now only two slaughter-houses being used—one in the Upper and one in the Lower Borough. They have been regularly inspected during the year. Housing, Town Planning, etc. Act, 1909. The number of houses inspected under this Act since it came into force is as follows:— 191 1 104 191 2 173 191 3 233 19114 52 562 20 The following will give the necessary figures required by Article V. of the Regulations:— No. of dwelling-houses inspected 52 ,, 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 0 ,, representations made to the Council with a view to the making of Closing Orders 0 ,, Closing Orders made 0 ,, dwelling-houses the defects in which were remedied without the making of Closing Orders 24 ,, dwelling-houses which, after making of Closing Orders were put into a fit state for human habitation 0 There were 52 houses inspected during 1914. None of them were in a condition so satisfactory as not to require repair: 24 were repaired on receipt of Preliminary Notices, and the remainder were in hand at the end of December. The following is a summary of the defects:— Water: There were no covers to cistern, or the cistern required cleaning out in 6 houses. The provision for the storage of food was unsatisfactory in 3 instances. There were structural defects in the closet accommodation in 25 houses—in some cases there was insufficient light and in others the walls or roof were defective. In two instances defects were due to bad usage. Drains or their accessories were defective in 26 houses and drain ventilation absent in 26 houses. There was defective lighting in the living rooms of three houses owing to their being built close to adjoining buildings. Dampness was present in 22 living rooms, 14 bedrooms and 6 sculleries. Four of the houses had signs of vermin on walls and other places. The external defects were: walls 20, roofs 12, gutters 23, rain water pipes 7, and floor ventilation 1. Internal defects were: living rooms—walls 27, ceilings 32, floors 4, windows 8, staircase 8. Bedrooms—walls 16, ceilings 28, floors 2, and windows 7. Sculleries—walls 25, ceilings 20, floors 2. Many of the internal defects to walls and ceilings were that they were dirty owing to long usage, 21 There were defective sinks and coppers in three houses. The paving in the yard was defective in 23 houses, and the drainage in 26. The refuse disposal was unsatisfactory in 10 houses. Generally speaking there is no actual shortage of housing acommodation for the working classes, but rents are very high, and cottages of a moderate rental are eagerly taken up as soon as empty. Of the 52 houses inspected in 1914 the rentals were as follows: — 2 at 5/- 7 at 10/- 1 at 6/3 10 at 10/6 2 at 6/6 8 at 11/- 3 at 6/8 1 at 12/6 13 at 71- 1 at 7/6 2 at 81- 52 2 at 9/- This gives an average of 8/9. Factory and Workshop Act, 1901. There are 8 Factories and 42 Workshops on the Register, descriptions of which are given in Mr. Capon's appended report. The work of inspection is in his hands, and in cases of difficulty I also inspect and report. The Table giving the figures required by the Secretary of State is also appended. No legal action during the year has been required to enforce the provisions of this Act; verbal or written requests have at once had the effect of rectifying any small defect or irregularity detected. Mr. Capon, who has undertaken the duties of Sanitary Inspector in the absence of Mr. Powell, on active service with H.M. Forces, has furnished a report of the work carried out by him during the year, which together with 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 Workshops Act, 1901, are appended. I have the honour to be, Gentlemen, Your obedient Servant, JAMES SCOTT TEW. June 28th, 1915, Table 1.—Vital Statistics of Whole District during 1914 and five previous years. Year. Population estimated to Middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths. J Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. * Number. Bate. † of Non-Residents registered in the District. Of Residents not registered in the District. Number, † Bate. * Number. Bate per 1,000 Nett Births. *Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 8,666 163 165 19.0 61 7.0 1 17 14 84 77 8.8 1912 8,834 145 149 16.9 55 6.2 .. 11 8 54 66 7.5 1913 8,971 159 160 17.8 38 4.2 •• 29 4 25 67 7.5 1914 9,110 172 176 19.3 61 6.7 1 19 3 17 81 8.8 Area of District in acres (land and inland water), 2,791. At Census of 1911:— Total population at all ages, 8,666 ; number of inhabited houses, 1,811 ; average number of persons per house, 4.8. 23 Table 2.—Cases of Infectious Disease Notified during the Year 1914. 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 15. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... Cholera and Plague ... ... ... ... ... ... ... ... ... Diphtheria (including Memb. croup) 12 ... ... ... 2 1 ... ... 10 Erysipelas 8 ... ... ... ... ... ... ... ... Scarlet Fever 17 14 3 10 Typhus Fever ... ... Enteric Fever ... ... ... ... ... ... ... ... ... Relapsing Fever and Continued Fever ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... Cerebro spinal Meningitis ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... Ophthalmia Neonatonum 2 2 ... ... ... ... ... ... ... Pulmonary Tuberculosis 8 ... ... ... 2 5 1 ... ... Other forms of Tuberculosis 3 ... ... 2 ... 1 ... ... ... Totals 50 2 ... 25 7 7 7 2 20 The Isolation Hospital.— Bromley and Beckenham Joint Hospital, in the area of the Borough of Bromley. Table 3.—Causes of, and Ages at Death during the Year 1914. 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. 15 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Causes— Certified 81 3 2 1 3 3 8 24 37 1 Enteric Fever .. .. .. .. .. .. .. .. .. .. Small-Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. .. .. .. Diphtheria & Croup 2 .. .. .. 2 .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 5 .. .. .. .. 1 3 1 .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Cancer, malignant disease 14 .. .. .. .. .. .. 8 6 .. Rheumatic Fever .. .. .. .. .. .. .. .. .. .. .. Meningitis 1 .. 1 .. .. .. .. .. .. .. Organic Heart Disease 9 .. .. .. .. .. .. 3 6 .. Bronchitis 4 .. .. .. .. .. .. 1 3 .. Pneumonia (all forms) 4 .. .. .. .. .. 1 .. 2 .. Other diseases of Respiratory Organs 1 .. .. .. .. .. .. 1 ,. .. Diarrhoea and Enteritis .. .. .. .. .. .. .. .. .. .. Appendicitis and Typhlitis .. .. .. .. .. .. .. .. ,. .. Cirrhosis of Liver .. .. .. .. .. .. .. .. .. .. Alcoholism .. .. .. .. .. .. .. 1 .. .. Nephritis and Bright's Disease 2 .. .. .. 1 .. .. .. 1 .. Puerperal Fever .. .. .. .. .. .. .. .. •• .. Other Accidents and Diseases of Pregnancy & Parturition .. .. .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 3 3 .. .. .. .. .. .. .. .. Violent Deaths, excluding Suicide 3 .. l .. .. 1 .. 1 .. .. Suicide .. .. .. .. .. • • .. • • .. .. Other Defined Diseases 30 .. .. .. .. 1 4 8 17 1 Diseases ill-defined or unknown 2 .. .. •• •• •• •• •• 2 .. 81 3 2 1 3 3 8 24 37 1 Table 4.—Chislehurst Urban District. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages 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 •• •• .. .. •• •• .. •• .. •• Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. ] Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. .. .. .. .. .. Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis .. .. .. .. .. .. .. .. .. .. Congenital Malformations .. .. .. .. .. .. .. .. .. .. Premature Birth 1 1 .. .. 2 .. .. .. .. 2 v Atrophy, Debility and Marasmus 1 .. .. .. 1 .. .. .. .. 1 Other Causes •• •• .. .. .. .. .. .. .. •• 2 1 •• •• 3 •• •• •• •• 3 Nett Births in the year—Legitimate, 167, Illegitimate, 7; Nett Deaths in the year of Legitimate Infants, 3; Llligitimate Infants, 0. 26 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) 7 - - Workshops (including Workshop Laundries) 79 6 — Workplaces — — — Total 86 6 — 2.—DEFECTS FOUND. Particulars Number of Defects. Number of Prosecutions. Found. Remediec Referred to H.M. Inspector Nuisances under the Public Health Acts :— Want of cleanliness 6 6 .. .. Want of Ventilation .. .. .. .. Overcrowding .. .. .. .. Want of drainage of floors .. .. .. .. Other nuisanccs .. .. .. .. 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 6 6 .. •• 3.—HOMEWORK. Two Lists of homeworkers engaged in the making of wearing apparel, were received from other Councils. 27 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses 7 Laundries 6 Trades connected with the making or sale of Clothing 6 Others—various 23 Total number of workshops on Register 42 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. 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 1901) 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 •• J. S. TEW, Medical Officer of Health. June 28th, 1915. 28 To the CHAIRMAN and MEMBERS of the CHISLEHURST URBAN DISTRICT COUNCIL. GENTLEMEN, I have the honour to present to you my 14th Annual Report for the year ended December, 1914. Visits. The number of visits and re-visits made to premises has been 7,230, and 149 nuisances have been discovered, but this latter number does not include the nuisances which have been discovered under the Housing (Inspection of District) Regulations, with reference to which a special report is appended. Complaints. There were only 14 complaints received during the year, being a decrease of two over the number received last year. Of these, one related to an accumulation of house refuse, one to smell from sewer gratings (this nuisance was found to arise from open gratings situate in an adjoining District), five to accumulations of offensive matter, two to defective drains and waterclosets, one to an offensive smell from a surface water ditch, and four to defective and unhealthy dwelling-houses. All the nuisances complained of were investigated and rectified. Notifiable Infectious Diseases. The number of Notifications received and dealt with during the year under the Infectious Disease (Notification) Acts, 1889—1899, was 39, being an increase of 7 over last year. The cases notified were:— Scarlet Fever 17 Diphtheria 12 Erysipelas 8 Opthalmia Neonatorum 2 39 Twenty-sis of these cases occurred in Upper Chislehurst and 13 in Lower Chislehurst, as follows:— Upper Chislehurst: Scarlet Fever 15 Diphtheria 3 Erysipelas 6 Opthalmia Neonatorum 2 26 29 Lower Chislehurst: Scarlet Fever 2 Diphtheria 9 Erysipelas 2 13 It was found necessary to remove 20 of the cases to the Isolation Hospital, which was a decrease of 1 case over the previous year. Of this number 2 patients were still in the Hospital at the end of the year. The parents have readily assented to the removal of their children to the Isolation Hospital, and the Medical Practitioners have rendered valuable assistance by telegraphing or telephoning immediately they have become aware of a case, thus enabling the patient to be removed as speedily as possible. The following table shows the number of Notifications of Infectious Disease which have been notified since the formation of the Urban District in the year 1900, and also the respective Districts in which the cases have occurred:— Upper Chislehurst. Lower Chislehurst. Total. Year 1900* 51 31 82 1901 21 12 33 1902 74 34 108 1903 50 18 68 1904 50 25 75 1905 21 17 38 1906 19 26 45 1907 15 28 43 1908 58 18 76 1909 23 45 68 1910 23 46 69 1911 7 11 18 1912 5 5 10 1913 15 17 32 1914 26 13 39 * This is for a period of eight months only. Tuberculosis. During the year 11 cases of Tuberculosis were notified. This number is a decrease of 12 over those notified the previous year. One of these cases proved fatal soon after notification. Three patients notified in 1912 and one patient notified in 1913 also died during 1914. 30 Sputum utensils and disinfectants are supplied to those patients in needy circumstances. Disinfection. Thirty-six premises, consisting of 58 rooms, were sprayed and fumigated during the year, and the owners and occupiers readily assisted by cleansing the rooms, &c., as soon after disinfection as possible. The fumigation was carried out by means of Formalin Fumigators, the clothing &c., being disinfected in a solution of Izal. The walls and bedding were sprayed with an Equifex Spray Pump, the solution used being Formic Aldehyde as a 2 per cent, solution. Drainage. The drainage of 5 premises was examined and tested during the year. Three of these were found in a bad condition and were entirely re-constructed, one was repaired, and at the remaining premises the drains were found to be in good condition. Ash-pits. Sixty-four premises were provided with properly covered movable receptacles for house refuse during the year. There are still a few brick ash-pits in use in the District, but as these become defective they are replaced with proper galvanized receptacles. Houses unfit for Human Habitation. See special report on Housing (Inspection of District) Regulations. Temporary Shelters. The Temporary Shelters for Fruit Pickers have been regularly inspected during the year, and the usual cleansing and lime-washing in respect of all the occupied shelters have been carried out. Slaughter-houses. The occupied Slaughter-houses in the District have been regularly inspected, and the quarterly lime-washing carried out in accordance with the Regulations. One Slaughter-house in the Lower District became vacant during the year, and there are therefore now two premises unoccupied : one in Upper Chislehurst and one in Lower Chislehurst. Dairies, Cowsheds and Milkshops. These premises have been regularly inspected and have been kept in good condition, and the lime-washing of the Cowsheds has been carried out. 31 Unsound Food. I am pleased to report that ON case of unsound food came to my notice during the year. Factories and Workshops. These premises were periodically inspected, the total number of visits being 87, and attention has been paid to the cleanliness and sanitary accommodation of the persons employed therein. The following were the chief defects found, and on the whole the Factories and Workshops are well kept:— Dirty rooms 4 Defective floor 1 Defective drain 1 These defects were remedied without legal proceedings being taken. The following workshops were given up by the occupiers during the year:— Tailor 1 Laundry 1 Dressmaker 1 Cycle Maker 1 Farrier 1 One Upholsterer's Workshop was registered, and one baker's business changed hands during the year. The correct list of Workshops is as follows:— Bakehouses 7 Laundries 6 Dressmakers and Milliners 6 Carpenters and Builders 8 Farriers and Coachbuilders 5 Saddlers 2 Basket Maker 1 Cycle Makers 2 Upholsterers 4 Organ Builder 1 42 32 The list of Factories is as follows: Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light Works 1 Motor Works 1 Laundry 1 Builder 1 8 Distribution of Leaflets. The annual distribution of leaflets, containing information with respect to the notification, causes, symptoms, &c., of Scarlet Fever and other Infectious Diseases has been carried out during the year in accordance with your instructions. Food and Drugs. In order to avoid overlapping the Kent County Council undertake to send this Council quarterly reports on the samples of food, &c., taken in the District by their Inspector. During the year under review 63 samples were taken, as follows:— New Milk 34 Skimmed Milk 1 Separated Milk 1 Cream 2 Butter 10 Margarine 1 Lard 1 Jam 1 Whiskey 5 Brandy 1 Gin 1 Sugar 1 Tea 1 Golden Syrup 1 Mustard 1 Linseed Oil 1 Three of the samples of New Milk were found to be slightly inferior in quality, but not to such an extent as to warrant proceedings being taken, and the Vendors were cautioned. The sample of cream was found to contain 0.5 of boric acid, but was otherwise genuine. 33 Two samples of whisky were found to be inferior in quality; one containing 1.4 percent. and the other 8 percent. of excess water. During the year 44 examinations were also made by the County Inspector of the weights of coal, all of which were found correct. Water Sampling. During the year 3 samples of water were taken for analysis; one for chemical examination and two for bacteriological examination. These samples were forwarded to the County Laboratory, and from the Reports of the County Analyst it would appear that the water supply of this District is on the whole satisfactory. House Refuse Removal. The collection of the house refuse by our own workmen has again worked well, and the refuse has been collected regularly from the inhabited houses. The total number of loads of refuse removed during the past year was 2,289½. Petroleum. Ten persons were licensed during the year for the Storage of Petroleum in respect of amounts varying from 50 to 1,000 gallons. About 25 visits have been made in connection with the Private Petroleum and Traders Stores. Carbide of Calcium. Three persons were licensed for the Storage of Carbide of Calcium in respect of amounts varying from 112 to 336 lbs. Summary of work carried out during the year:— Number of complaints received and investigated 14 Nuisances discovered (not including those discovered under the Housing (Inspection of District) Regulations 149 Nuisances outstanding at end of year 17 Legal Notices served 12 Number of Letters written, reports made, School Notices served, and other minor notices 475 Character of Work carried out (not including work carried out under the Housing (Inspection of District) Regulations:— Houses cleansed and generally repaired 19 Cowsheds, Slaughter-houses, and Bakehouses cleansed 26 Dust-bins provided 64 Houses at which drains were examined and tested 5 34 Houses at which drains were found defective 4 Houses at which drains were re-constructed 3 Houses at which drains were repaired, cleansed, ventilated, and trapped 15 Offensive accumulations removed 11 Drinking water cisterns covered and cleansed 4 Infectious Houses cleansed and fumigated 26 Houses found with defective roofs, eaves' gutters, rainwater down-pipes, &c. 11 Premises at which animals were so kept as to be a nuisance 1 HOUSING (TOWN PLANNING, &c.) ACT, 1909. During the year 52 houses were inspected under the Housing (Inspection of District) Regulations, and the defects at 24 of these were remedied by the end of December. The work at 174 houses previously reported upon was also completed during the year. The repairs in many cases were proceeded with slowly, and in the case of cementing of walls, defective paving, &c., this work has to stand over until favourable weather, when it can be more effectually carried out. The matter found requiring most attention was, as in the past, that of dampness, and this arises from various causes, such as the want of proper damp-proof courses, defective eaves' gutters and roofs, rainwater down-pipes, pervious brickwork, &c., and this latter defect was one of the chief causes of dampness. Houses unfit for Human Habitation. The three houses at Foots Cray known as "Thorn," "Fern," and "Picketts Cottage," reported upon last year, and in respect of which Closing Orders under Section 17 of the Housing, Town Planning, &c. Act, 1909, were served, are still vacant. Repairs have been undertaken by the owner of two of the cottages to render the premises fit for human habitation, but the works have not yet been completed. Summary of Defects. The following is a summary of the defects found and matters reported upon under these Regulations:— Dampness, caused by the want of or insufficient dampproof courses, porous brickwork, defective eaves' gutters and rainwater down-pipes, defective roofs, &c., &c. 50 35 Dirty or defective W.C. pans and traps 3 Insufficient flush of water to W.C's. and defective flushing cisterns 8 Defective drainage appurtenances 23 Dirty walls and ceilings 142 Defective floors and interior paving 19 Defective or insufficient yard paving and surface water drainage 43 Drinking water cisterns in a dirty condition or not properly covered 6 Absence of or defective dust-bins 11 Drains unventilated 26 Defective interior walls and ceilings 21 Rooms in a verminous condition 6 Overcrowding 1 Miscellaneous defects: steps, washing coppers, fireplaces, absence or defective handrails, &c., &c. 37 I have the honour to be, Gentlemen, Tour obedient Servant, WILLIAM GEORGE POWELL (A. & C.R.S.I.), Inspector of Nuisances. (JETHRO A CAPON (C.R.S.I.), (Acting Inspector of Nuisances). URBAN DISTRICT COUNCIL OF CHISLEHURST. ANNUAL REPORT ON THE HEALTH OF THE Chislehurst Urban Sanitary District, FOR THE YEAR 1915 BY JAMES SCOTT TEW, M.D.,D PH. LONDON: Hadden, Best & Co., 5, West Harding Street, & 26, Fetter Lane. 1916. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1915. AREA AND POPULATION The following Table gives the area, population of the District, and other figures, as shown by the Census of 1911. Area in Statute acres (Land and Inland Water). Families or Separate Occupiers. Population. Institutions, Large Establishments, Vessels, etc., 1911 (included in Cols. 4 and 6). 1901 1911 1901 1911 Pers's Pers's M ales Feml's No. Population 1 2 3 4 5 6 7 8 9 10 Chislehurst Urban District and Civil Parish 2,791 1,487 1,824 7,429 8,666 3,725 4,941 13 383 Wards: Lower Chislehurst ... ... 725 ... 3,377 1,554 1,823 2 57 Upper Chislehurst ... ... 1,099 ... 5,289 2,171 3,118 11 326 a 2 4 At the request of the Local Government Board the Vital Statistics for 1915 have been based on two populations: the estimated population at the middle of 1914 has been used in calculating the birth-rate and the civil portion only of the population, based on the figures yielded by the National Register taken in August 1915, has been used us a basis for the death-rate, and all military deaths have been excluded from the tables, which thus relate exclusively to the civilian population. According to the figures supplied by the Local Government Board the civil population for the Chislehurst Urban District is 8,341. Births and the birth-rate.—There were 164 births registered in the district and three births were trauferred to it from outside, making the net births 167 (84 males and 83 females) and the net birth rate 18.3 which, though lower than in 1914, is about the average in this district for the five years 1910-1914. The birth-rate for the whole of England and Wale3 was 21.8 Deaths and the death-rate.—Sixty-seven deaths were registered in the district giving a crude death-rate of 8.0. Two deaths of non-residents were transferred away and 22 deaths of residents which took place outside the district were transferred to it, making the net deaths 87 and the net death-rate 10.4, both number and rate being identical with those for 1910. Had the rate been calculated on a normal population instead of on the basis of the civil portion only, it would have been 9.4, The rate for the whole of England and Wales was 15.1. Eight deaths were certified as due to one or other of the following epidemic diseases, viz:— Diarrhoea and Enteritis (under 2 years) 0 Diphtheria 1 Measles 1 Whooping-cough 5 Enteric Fever 0 Scarlet Fever 1 Small-pox 0 8 The Death rate from these Epidemic Diseases was 0.97 per 1,000 of population, compared with 0 22 in 1914, 0.33 in 1913, 0.11 in 1912, and 0.69 in 1911. The following table gives the rates for this district in comparison with those for the whole of England and Wales for the six chief epidemic diseases. MORTALITY FROM EPIDEMIC DISEASES, 1915. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Chislehurst Urban 0.00 0.00 0.12 0.12 0.60 0.12 Per 1,000 living. England and Wales 0.04 0.00 0.43 0.06 0.21 0.15 5 Infant Mortality.—There has been an unusually large number of deaths (18) under one year during 1915 with an Infant Mortality Rate of 107 compared with three deaths and a rate of 17 in 1914. The increase has been due to deaths from measles (1), whooping cough (2), diphtheria (1) and pneumonia (2), all nil under one year in 1914, and to seven deaths from premature birth compared with two in 1914. With one exception, a child aged four months who died of convulsions, all the deaths were certified and all were legitimate children. The rate for the whole of England and Wales was 110. The Midwives Act, 1902, is administered by the Kent County Council direct. There were no cases of Ophthalmia Neonatorum notified during 1915. The Notification of Births (Extension) Act, 1915.—In the report for 1914 I briefly remarked that the circular of the Local Government Board dated July 28th 1914 on the subject of Maternity and Child Welfare had been discussed by the Council, but that no local tcheme was organised as it seemed desirable than a County organisation should deal with this subject having in view the fact that they already had the supervision of Midwives and the care of School Children. By the passing of the Notification of Births (Extension) Act, 1915, however, the original Act, the Notification of Births Act, 1907, hitherto adoptive, came into force in all those districts not having previously adopted it, the Act taking effect from September 1st, 1915. Under this Act it is necessary for all. Medical Practitioners and Certified Midwives to notify to the Medical Officer of Health of their respective areas, particulars of all births attended by them, and the Medical Officer of Health is required to forward to the County Medical Officer of Health duplicates of all notifications he receives. In their Circular of July 29th, 1915, explaining to Local Authorities the scope of this Act, and advising them of their obligations under it, the Local Government Board urge the immediate adoption of local schemes for the care of mothers and young children, and expressly desire that where a complete scheme is not feasible at the present time provision should be made for home visiting by the employment of a salaried Health Visitor, and they point out that where Sanitary Authorities fail to avail themselves of the facilities offered under the Act to effect this, either by independent action or in combination with other areas uniting to form a joint area for the purpose, County schemes will be formed to include such districts. At the end of 1915 no scheme had been agreed upon in this district. 6 The following table gives a comparison between the rates for this District and those for England and Wales :— fiirth.rate. Death.rate. Infant Mortality. England and Wales 21.8 15.1 110 96 Great Towns (including London) 22.8 15.6 117 148 Smaller Towns 21.6 140 114 England and Wales (less the 244 Towns) 20.7 14.8 98 Chislehurst Urban 18.3 10.4 137 A.—NOTIFIABLE INFECTIOUS DISEASES. Under the Infectious Disease (Notification) Acts, 1889 and 1899, or by Orders or Regulations under the Public Health Act, 1875, the following diseases are compulsorily notifiable in the District, viz.: Small.pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the disease known as Scarlet Fever or Scarlatina, and the fevers known by any of the following names:— Typhus, Typhoid or Enteric, Relapsing, Continued, and Puerperal. Also Cerebro.Spinal Fever, Acute Poliomyelitis, Tuberculosis, Ophthalmia Neonatorum, Measles and German Measles. As required by the Measles Order, 1915, Notification Forms were supplied to all the medical practitioners in the district, and notices drawing the attention of parents and guardians to their duties under this Act were posted in public places and also distributed in various suitable ways. There were 63 cases of infectious disease notified, compared with 51 in 1914. The increase has been in all forms of infectious disease, but chiefly in pulmonary tuberculosis, with 15 cases compared with 7 in 1914. Scarlet Fever.—Nineteen civilian cases were notified, compared with 17 in 1914, and all made a good recovery. There was also one military case notified to me, a soldier whose home was in this district, but this case was not included in Table II. The outbreak was chiefly confined to the Chislehurst portion of the district, and most of the schools appear to have had isolated cases. Five cases were notified in January and four in October, the remainder being fairly evenly distributed over the year. One of the April cases was a child whose sister had returned home from the Isolation Hospital five days previously, to which she had been admitted on account of scarlet fever. 7 Fifteen cases were admitted to the Bromley and Beckenham Isolation Hospital. The cases were notified at the following age-periods :— 1—5 5—15 15—25 25—45 45—65 Over years. years. years. years. years. 65 years. 3 13 2 0 0 1 = 19. Diphtheria.—There were 14 notifications received relating to 13 cases compared with 12 in 1914. Twelve of the 14 notifications were received from the Chislehurst part of the district, and 6 of this number related to cases notified from an Orphanage in the district, where 4 cases occurred from May 8-14. The patients were removed to the Bromley and Beckenham Isolation Hospital, and the premises disinfected and other children who had been in contact placed under observation. No further cases occurred until July 24, when a boy, aged 12, was notified. As the boy first notified in May had been discharged from the Isolation Hospital and returned to the Orphanage on July 21st, a swab was taken from his throat and sent to the County Laboratory for examination, giving positive results, and both boys were sent to the Isolation Hospital. No further cases were notified from the Orphanage. Of the remainder of the cases from the Chislehurst portion of the district, in two instances the disease had probably been contracted elsewhere, as in both cases the patients had been away from home until a few days previous to notification. Fourteen cases were removed to the Bromley and Beckenham Joint Isolation Hospital. The following are the age-periods at which the cases were notified:— 1—5 5—15 15—25 25—45 years. years. years. years. 1 11 1 1 = 14. Erysipelas.—There were ten cases notified compared with eight during 1914. Two were stated to be very bad cases and were removed to the Bromley Union Infirmary for treatment. In all cases the premises appear to have been in a satisfactory sanitary condition. There were no deaths from this disease. Enteric Fever.—Two cases were notified, one in May and one in August. The August case was a governess at a private school in the neighbourhood and had only returned to her duties five days previous to notification : she was nursed at the School Sanatorium. The May case was removed to the Isolation Hospital. 8 Puerperal Fever.—Again no cases have been notified; the last was in June, 1905. Small.pox.—It is also satisfactory to record that no casesof this disease have occurred since May, 1903. Cerebro.spinal Meningitis and Acute Anterior Poliomyelitis. No cases have been notified during 1915. Tuberculosis.—There were five deaths from all forms of tuberculosis and four of them were due to phthisis, all cases notified during 1915. The following Table gives a comparison of the rates for this District, and the rates for England and Wales for the six years 1907—1912, beyond which the comparative figures for the country generally are not at present available. TUBERCULOSIS (all forms) 1907 1908 1909 1910 1911 1912 1913 1914 1915 England and Wales 1.61 1.58 1.54 1.43 1.46 1.53 Chislehurst Urban— Death.rate 0.87 0.73 0.97 0.35 0.34 0.34 1.23 0.54 0.60 No. of deaths 7 6 8 3 3 3 11 5 4 PHTHISIS England and Wales 1.14 1.12 1.09 1.02 1.08 1.039 Chislehurst Urban— Death rate 0.75 0.49 0.72 0.35 0.34 0.34 0.78 0.54 0.36 No. of deaths 6 4 6 3 3 3 7 5 3 Phthisis.—Fifteen new cases were notified during 1915. One referred to a Belgian Refugee who had come to this district. The medical attendant and myself had some correspondence with the County Authorities and the Local Government Board with reference to securing sanatorium treatment for him. Before the arrangements were completed however, the man left this district and the matter was left in the hands of the Local Government Board. In nine of the cases notified it was apparently not possible to provide separate sleeping accommodation for the patient, but in all cases as far as facilities were available, efforts were being made to prevent the spread of 9 infection. The Sanitary Inspector supplied disinfectants, and also, where necessary, sputum cups. In one instance there were 13 members in the household and only three bedrooms. In seven cases other members of the family had died of tuberculosis. The following Table relating to all forms of Tuberculosis gives the agegroups in which the cases occured during 1915. Total No. of Cases. Sex. AGES. Under 1 1— 5 5—10 10—15 15—20 20—25 25—30 30-35 35—40 40—45 45—50 50-55 55—60 60-65 Pulmonary 7 M ... ... 1 ... ... 3 ... 1 ... 1 ... 1 ... ... Tuberculosis 8 F ... ... ... 1 1 1 1 1 ... ... ... 2 ... 1 Other Forms of Tuberculosis 1 M ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 F ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Total 18 ... ... 1 1 1 2 4 1 3 ... 1 ... 3 ... 1 The Council paid compensations to the value of £\ for bedding, etc., destroyed on my instruction, on account of having been used for some time by a case of advanced tuberculosis. B. NON-NOTIFIABLE INFECTIOUS DISEASES. Measles.—There was one death, a child, aged 9 months, who died in April, broncho-pneumonia was given as a secondary cause of death. Whooping Cough.—Five deaths were registered during 1915. The first case was a little girl, aged 18 months, who died in March, meningitis being given as a secondary cause of death. Two deaths occurred in July, and were male children aged 3 years and 5 months respectively. In the second case broncho-pneumonia, and in the first case broncho-pneumonia and meningitis were given as secondary causes of death. The single death in August was a female child, aged 15 months, and zymotic enteritis was given as a secondary cause of death, and in the September death meningitis was given as a secondary cause. The three deaths in July and September all occurred in the same road in Chislehurst. b 10 Influenza.—There were three deaths, one each in January, February and March. The first death was a male, aged 27, who died of influenza with pleurisy and lobar-pneumonia. The February death was a female, aged 87, and the March death a female, aged 84. Diarrhœa and Enteritis (under 2 years).—The only death was a female child, aged 15 months, whose death is tabulated under whooping cough, which was given as the primary cause of death. C. OTHER DISEASES. Cancer.—The following Table shows the number of deaths and deathrates for this District for the years 1907—1915, with the comparative rates for England and Wales up to 1912, beyond which year the latter are not at present available :— 1907 1908 1909 1910 1911 1912 1913 1914 1915 England and Wales 0.91 0.92 0.96 0.97 0.99 0.99 Chislehurst Urban— Death-rate 0.37 1.61 1.46 0.36 0.69 1.79 1.00 1.53 1.19 No. of deaths 11 5 12 3 6 7 9 14 10 There were 10 deaths compared with 14 in 1914; all were over 57 years of age and 5 over 70. Seven of the deaths were of females. Four deaths were transferred to the district from outside. Hospital Accommodation and Administration.—Thirty cases of infectious disease were treated at the Bromley and Beckenham Joint Hospital, and were admitted as follows:— Diphtheria. Scarlet Fever. Enteric. January 2 2 — February 4 1 — March — 1 — April — 1 — May 1 1 1 June — — — July 2 — — August — — — September 1 3 — October 1 5 — November — 1 — 14 15 1 11 Bacteriological Aids to Diagnosis.—Copies of reports have been received on the examination of 36 specimens, viz.:— At County Laboratory:— Positive. Negative. Total. Diphtheria 8 20 28 Typhoid — — — Phthisis 3 5 8 Others — — — 1 25 36 Disinfection. The question arose during the year as to the best method of disinfecting rooms after cases of infectious disease, and I reported to the Council on the subject, advising that where rooms had been occupied for many weeks by cases of Pulmonary Tuberculosis or Cancer, the walls should be stripped and scraped and the ceilings cleansed and that this procedure was also desirable after Scarlet Fever, Diphtheria, Typhoid Fever, or Cerebro-spinal Fever where the walls and ceilings were in a dirty condition, but that in cases where the conditions were clean and satisfactory it was sufficient to disinfect by means of moist spray and vapour. I pointed out however, that it is desirable to let the manner of disinfection be as far as possible in proportion to the persistency of the particular disease for which disinfection is required. In June there was some discussion as to delay on the part of some Medical Practitioners in injecting anti-toxin in cases of Clinical Diphtheria before confirmation by bacteriological examination and at the request of the Council I drafted and had sent out a circular letter reminding Medical Practitioners of the facilities afforded by the Council for obtaining and administering anti-toxin where advisable. At the end of 1914 the Council had under consideration the advisability of applying to the Local Government Board for sanction to the permanent continuance of the arrangement under which Medical Practitioners who have been in attendance on cases of infectious disease previous to the patient being admitted to the Isolation Hospital, have visited their paitients on their return and reported to me on their condition, the Council paying a fee of 2/6 for each report sent to me. Application was duly made to the Local Government Board who gave their sanction to the continuance of the payments until they should otherwise direct. In June the matter was again before the Council and it was decided to carry out this arrangement in regard to Scarlet Fever and Diphtheria for the twelve months ending June, 1916. b 2 12 Sanitary Inspection of District. The figures and information required by the Sanitary Officers' (outside London) Order, 1910, are appended in Mr. Capon's report. Adoptive Acts. The Infectious Disease (Prevention) Act, 1890, and the Public Health Acts Amendment Act, 1890, were adopted in 1900. 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:— Part 2. Street 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 16 th 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. Sanction for the adoption of Section 51 of the above Act (relating to power to declare a business to be an offensive business) was given under the Order of May 28th, 1909. The Council has declared a list of offensive trades, which after certain modifications was confirmed by a further Order of the Local Government Board. Water.—There has been no alteration in the arrangements in force in 1914. The town is supplied with water by the Metropolitan Water Board, and the supply is satisfactory. Refuse Disposal.—Early in the year a complaint was received from a number of householders in regard to the refuse disposal of the Council, which up to this date had been deposited in hollows on a large piece of land which the Council purchased for the purpose in 1911, and where the lighter refuse was burned. The nearest dwelling house is 500 feet away. I made a 13 detailed inspection of the refuse disposal arrangements and could not detect any nuisance there or on the roads leading up to the shoots, but 1 suggested that certain matters should receive the Council's attention. Though nothing objectionable appeared to have been used in making up the roads I thought it required making up with harder material and with a wider base as the surface was very rough with deep ruts entailing heavy wear and tear on the horses and carts engaged in the work. I suggested that all the pap :r and light burnable material should be collected and burned and that some of the fire bricks and other useful material of which there was a good quantity about should be made use of to erect a small incinerator, plans of which I should be pleased to submit to any Committee appointed to deal with the matter. The Council agreed to my suggestion and a small incinerator was built at a cost not exceeding £5 including labour, iron doors, etc., which is capable of consuming 3½-4 loads a day and this was so satisfactory in working that at the end of the year the Council agreed to a second, slightly larger incinerator being put up in the same way as soon as practicable. I further suggested that the man who had until that time collected the tins for sale again, should be employed at a wage to collect and sort the refuse, and this the Council agreed to. It was also agreed to treat the surface of the water which had drained into some of the pits with paraffin once a fortnight to prevent the breeding of gnats and flies, etc. Owing to the shortage of labour on account of the war the Council decided to restrict collections of house refuse to once a fortnight instead of weekly as hitherto. Drainage and Excrement Disposal.—A draft of a Provisional Order which it was proposed to issue for partially repealing and altering the Local Acts of the West Kent Main Sewerage Board was submitted to the Council. After conferring with some of the other Constituent Authorities the Clerk notified the Local Government Board that this Council had no observations to make in regard to the Order. In June I was asked to report to the Council on the condition of the drainage system at Mill Place. This is an area occupied by about 45 houses and attention was directed to it some years ago and temporary repairs undertaken. It is sloping ground and in a hollow and the drainage is very complicated and some of the main pipes were old pattern, and many of the connections were made with clay which has perished leaving practically open joints. The whole system requires reconstruction. I am of opinion that further investigation will show that the re-laying of any special part of it will be costly and insufficient, and that if a definite improvement is to be made it is necessary to carry out a new and comprehensive scheme of drainage. 14 Bye laws and Regulations The following is a list of the Bye-laws and Regulations in force in this 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 Building 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. Bye-laws with respect to the Management of the Cemetery provided by the Council and charges for the use of the same, adopted January 20th, 1913, and confirmed by the Local Government Board, March 18th, 1913. 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 Diaries, Cowsheds, and Milkshops Order of 1885, adopted June 8th, and came into force August 12th, 1903. Schools.—There was only one School closed during 1915 on account of the prevalence of infectious disease, and that was the Chislehurst Prickend Infants School which was closed from December 13th to the 23rd on account of whooping cough. 15 Foods.—Action taken under the Food and Drugs Act is detailed in the Sanitary Inspector's Report. Dairies, Cowsheds, etc.—The premises have been frequently inspected and have generally been found satisfactory. One name has been added to the register. Regulations made under the 1885 Order have been in force in this District since 1903. There are now 17 persons (occupying premises in the District) on the Register:— Dairymen and Purveyors 1 Purveyors only 14 Cowkeepers 1 Cowkeepers, Dairymen and Purveyors 1 17 Slaughter-houses.—Application was received for a licence in regard to a slaughter-house which it was proposed to open at Cray Road, Foots Cray. I inspected the premises and advised the Council to grant the licence. All three slaughter-houses have been regularly inspected, and it has not been necessary to report any nuisances. Housing, Town Planning, etc., Act, 1909.—Owing to the difficulty of carrying on the work of inspections under this Act with the present limited staff, and also on account ot the general shortage of labour and high prices ruling for building materials, it was decided to discontinue the inspections for the time being, and only two houses have been inspected during 1915, particulars of which will be found in Mr. Capon's report. The number of houses inspected under this Act since it came into force is as follows:— 1911 104 1912 173 1913 233 1914 52 1915 2 564 16 Factory and Workhop Act, 1901.—There are 8 Factories and 39 Workshops on the Register, and particulars of them are given in Mr. Capon's appended report. They have been inspected, as required under the Act, and the only defects found have been of a trifling character and have been remedied on attention being directed to them. Mr. Capon, who has undertaken the duties of Sanitary I nspector in the absence of Mr. Powell, on active service with H.M. Forces, has furnished a report of the work carried out by him during the year, which, together with 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. June 30th, 1916. 17 Table 1.—Vital Statistics of Whole District during 1915, and five previous years. Year. Population estimated to Middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths. ‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. * Number. Rate. Of Non.Residents registered in the District † Of Residents not Registered 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 4 5 6 7 8 9 10 11 12 13 1910 8,338 ... 163 19.5 68 8.1 ... 19 14 85 87 10.4 1911 8,666 163 165 190 61 70 1 17 14 84 77 8.8 1912 8,834 145 149 16.9 55 62 ... 11 8 54 66 7.5 1913 8,971 159 160 17.8 38 42 ... 29 4 25 67 7.5 1914 9,110 172 176 19.3 61 6.7 1 19 3 17 81 8.8 1915 8,341 164 167 18.3 67 80 2 22 18 107 87 10.4 Area of District in acres (land and inland water), 2,791. At Census of 1911:—Total Population at all ages, 8,666 ; number of inhabited houses, 1,811; average number of persons per house, 4.8. 18 Table 2.—Cases of Infectious Disease Notified during the Year 1915, Notifiable Disease. Numbers 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 upwards Small-pox ... ... ... ... ... ... ... ... ... Cholera and Plague ... ... ... ... ... ... ... ... ... Diphtheria (including Memb. Croup) 14 ... 1 11 1 1 ... ... 14 Erysipelas 10 ... ... 1 ... 4 1 ... Scarlet Fever 20 ... 3 13 2 1 ... 1 15 Typhus Fever ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... 2 ... ... ... ... 1 Relapsing Fever and Continued Fever ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... Cerebro spinal Meningitis ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 15 ... ... 2 5 4 4 ... 1 Other forms of Tuberculosis 3 ... 1 ... 1 1 ... ... ... Totals 64 ... 6 29 9 11 8 2 31 The Isolation Hospital.—Bromley and Beckenham Joint Hospital, in the area of the Borough of Broruley. 19 Table 3.—Causes of, and Ages at Death daring the Year 1915. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the Disttict. Total Deaths whether of "Residents" or "NonResident"in Institutions in the District. All age3 Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 ?5 and under 45 45 and under 65 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Alt, Cacsbs— Certified 84 17 2 2 3 1 6 15 40 ... Uncertified 3 1 ... ... ... ... ... ... 2 ... Enteric Fever ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... ... ... ... ... ... ... Scarlet Fever 1 ... ... 1 ... ... ... ... ... ... Whooping-cough 5 2 2 1 ... ... ... ... ... Diphtheria and Croup 1 1 ... ... ... ... ... ... ... ... Influenza 3 ... ... ... ... ... 1 ... 2 ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 4 ... ... ... ... 1 1 2 ... ... Tuberculous Meningitis 1 ... ... ... 1 ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Cancer, malignant disease 10 ... ... ... ... ... ... 4 6 ... Rheumatic Fever ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... Organic Heart Disease 11 ... ... ... ... ... ... 2 9 ... Bronchitis 9 ... ... ... ... ... ... 1 8 ... Pneumonia (all forms) 8 2 ... ... ... ... 1 2 3 ... Other Diseases of Respiratory Organs 1 ... ... ... ... ... ... ... 1 ... Diarrhœa and Enteritis ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... Alcholism ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 2 ... ... ... ... ... ... ... 2 ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy & Parturition 1 ... ... ... ... ... 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 9 ... ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide ... ... ... ... ... ... ... ... ... ... Suicide ... ... ... ... ... ... ... ... ... ... Other Defined Diseases 18 3 2 2 4 7 ... Diseases ill-defined or unknown 2 ... ... ... ... ... ... ... 2 ... 87 18 2 2 3 1 6 15 40 ... 20 Table 4.—Chislehurst Urban District. INFANT MORTALITY. 1915. Nett Deaths from Stated Causes at various Ages 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 uuder One Year All Causes Certified 4 1 2 7 3 3 1 3 17 Uncertified 1 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ...I Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 2 Diphtheria and Croup ... ... ... ... ... 1 ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia all forms) ... ... ... ... ... ... 1 ... 1 2 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... 1 ... 6 1 ... ... ... 7 Atrophy, Debility and Marasmus ... ... 1 ... 1 ... ... ... ... 2 Other Causes ... ... ... ... ... ... ... 1 ... 1 4 1 2 ... 7 3 4 1 3 18 Nett Births in the Year—Legitimate, 159; Illegitimate, 8; Nett Deaths in the year of Legitimate Infan'.s, 18; Illegitimate Infants, 0. 21 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) 10 - — Workshops (including Workshop Laundries) 79 — — Workplaces — — — Total 89 — — 2—DEFECTS FOUND. Particuiars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to ILM. Inspect'i Auisances under the Public Health Acts:— Want of Cleanliness 2 2 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 1 1 ... ... 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 3 3 ... ... 3.—HOMEWORK. Two List-, of homeworkers engaged in the making of wearing apparel, were received from other Councils. 22 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses 7 Laundries 6 Trades connected with the making or sale of Clothing 6 Others—various 23 Total number of workshops on Register 42 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. Action taken in matters referred by , H.M. Inspector as remediable under Notified by H.M. Inspector the Public Health Acts, but not under Reports (of action taken) the Factory and Workshop Act sent to H.M. Inspector (s. 5 1901) Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at t he end of the year J. S. TEW, Medical Officer of Health. June 28th, 1915. 23 To the CHAIRMAN and MEMBERS of the CHISLEHURST URBAN DISTRICT COUNCIL. GENTLEMEN, I beg to present to you my Annual Report for the year ended December, 1915. Visits.—The number of visits and re-visits made to premises has been 6,123, and 169 nuisances have been discovered, but this latter number does not include the nuisances which have been discovered under the Housing (Inspection of District) Regulations, with respect to which a special report is appended. Complaints.—There were 9 complaints received during the year, being a decrease of 5 over the number received during the year 1914, Of these, two related to accumulations of offensive matter, one to an offensive smell near a large residence, one to an overflowing cesspool, one to stables in an unclean condition, one to a dog kept in an unclean condition, one to defective drainage appurtenances, and two to the emission of smoke. All nuisances complained of were investigated, and where just grounds for complaint were found matters were rectified. Notifiable Infectious Diseases.—The number of Notifications received and dealt with during the year under the Infectious Disease (Notification) Acts, 1889-1899, was 46, being an increase of 7 over last year. The cases notified were:— Scarlet Fever 20 Diphtheria 14 Erysipelas 10 Typhoid Fever 2 46 Thirty of these cases occurred in Upper Chislehurst, and 16 in Lower Chislehurst, as follows:— Upper Chislehurst: Scarlet Fever 17 Diphtheria 6 Erysipelas 5 Typhoid Fever 2 24 Lower Chislehurst: Scarlet Fever 3 Diphtheria 8 Erysipelas 5 It was found necessary to remove 30 of the cases to the Isolation Hospital, which was an increase of 10 cases over the previous year, and two cases were removed to the Bromley Union Infirmary. One patient was still under treatment at the Isolation Hospital at the end of the year. In the majority of cases parents have readily assented to the removal of their children to the Hospital, and the Medical Practitioners, by telegraphing or telephoning immediately they have become aware of a case, have rendered valuable assistance in getting the patients removed as speedily as possible. The following table shows the number of Notifications of Infectious Disease which have been notified since the formation of the Urban District in 1900, and also the respective Districts in which the cases have occurred:— Upper Chislehurst. Lower Chislehurst. Total. Year 1900* 51 31 82 1901 21 12 33 1902 74 34 108 1903 50 18 68 1904 50 25 75 1905 21 17 38 1906 19 26 45 1907 15 28 43 1908 58 18 76 1909 23 45 68 1910 23 46 69 1911 7 11 18 1912 5 5 10 1913 15 17 32 1914 26 13 39 1915 30 16 46 *This is for a period of eight months only. 25 Tuberculosis—During the year 18 cases of this disease were notified as follows:— Upper Chislehurst 9 Lower Chislehurst 9 This number is an increase of 7 over those notified in 1914. Five of the cases notified during the year under review proved fatal. Sputum utensils and disinfectants are supplied to those patients in needy circumstances where necessary. Disinfection.—Forty-one premises, consisting of 74 rooms, were sprayed and fumigated during the year and the owners or occupiers readily assisted by cleansing the rooms, ifcc., as soon after disinfection as possible. The fumigation was carried out by means of Formalin Fumigators, the clothing, &c., being disinfected in a 1 in 40 per cent. solution of Izal. The walls and bedding were sprayed with an Equifex Spray Pump, the solution used being Formic Aldehyde as a 2 per cent. solution. Drainage.—The question of the drainage of the area known as Mill Place, in which about 45 houses are involved, was brought before your notice in the early part of the year. A definite improvement of the system at present existing in this area can only be effected by means of a new and comprehensive scheme, and the matter stands adjourned for the present. Ash-pits.—Fourteen premises were provided with properly covered movable receptacles for house refuse during the year. There are still existing a few brick ash-pits, but as these become defective they are being replaced with proper galvanized bins. Houses unfit for Human Habitation.—See special Report on Housing (Inspection of District) Regulations. Temporary Shelters.—The Temporary Shelters for Fruit Pickers at Town Court Farm and Thongs Farm have been regularly inspected during the summer months, and the usual cleansing and lime-washing in respect of all the occupied shelters has been carried out. Slaughter houses.—The occupied Slaughter-houses in the District have been regularly inspected at various times, and the quarterly limewashing, in accordance with the Regulations, has been done. 26 On the application of a new tenant, a licence was granted during the year in respect of the Slaughter-house in Lower Chislehurst which became vacant in 1914, and therefore there is now only one unoccupied Slaughterhouse in the District, that is in Upper Chislehurst Dairies, Cowsheds, and Milkshops.—These premises have been regularly visited and have been kept in good conditiou. and the limewashing of the Cowsheds, &c., has been carried out. A person resident at Bromley was found retailing milk in this District without being Registered, and on the matter being brought to his notice, application was made for a Certificate of Registration, which was granted. Unsound Food.—No case of unsound food came to my notice during the year. Factories and Workshops.—These premises have been periodically inspected, the total number of visits being 89, and attention has been paid to the cleanliness and sanitary accommodatiou of the persons employed therein. The following were the chief defects found, and on the whole tho Factories and Workshops are well kept:— Dirty Work-rooms 2 Dirty and defective paving 1 These defects were remedied without legal proceedings. The following Workshops were given up by the occupiers during tho year Sadler 1 Upholsterers 2 No new Workshops were registered. The list of Workshops in the District is as follows:— Bakehouses 7 Laundries 6 Dressmakers and Milliners 6 Carpenters and Builders 8 Farriers and Coachbuilders 5 Sadler 1 Basket Maker 1 Cycle Makers 2 Upholsterers 2 Organ Builder 1 39 27 The list of Factories is as follows:— Brickworks 1 Printers 2 Mineral Water Works 1 Electric Light Works 1 Motor Works 1 Laundry 1 Builder 1 8 Distribution Of Leaflets.—The annual distribution of leaflets containing information with respect to the notification, causes, symptoms, etc., of Scarlet Fever and other Infectious Diseases, was carried out during the year according to your instructions. Food and Drugs.—In order to avoid overlapping the Kent County Council still undertake to send this Council quarterly reports on the samples of food, etc., taken in this District by their Inspector. During the year under review 53 samples were taken, as follows:— New Milk 23 Cream 2 Butter 12 Margarine 3 Lard 1 Whiskey 4 Brandy 1 Gin 1 Rum 1 Flour 1 Preserved Pears 1 Mustard 1 Liniment of Camphor 1 Ammoniated Tincture of Quinine 1 Tincture of Iodine 1 Two of the samples of New Milk were found to be slightly inferior in quality, and the sample of Cream was found to contain 0.11 of boric acid. The Vendors were cautioned in these cases. One sample of Butter proved, on analysis, to be Margarine, and the Vendors were fined 40s., and costs 8s. 28 One sample of Margarine was delivered in an unlabelled wrapper. Vendors fined 2s. 6d., and 8s. costs. Two samples of Whiskey contained 8 and 104 per cent., respectively, of excessive water. Vendor fined £3. The sample of Rum contained 8.1 of excessive water, and the Vendor was fined £3, During the year 26 examinations were also made by the County Inspector of the Weights of Coal, all of which were found to be correct Water Sampling.—During the year two samples of Water were taken for bacteriological examination. These samples were forwarded to the County Laboratory, and from the Reports of the County Analyst it would appear that the water supply of this District is, on the whole, satisfactory. House Refuse Removal.—It will be remembered that the Council, with a view to economy in expenditure, decided to curtail the arrangements with respect to the collection of house refuse, and from the 21st October a fortnightly instead of a weekly collection of refuse was made. The collection of the house refuse by our own workmen has again worked well. The total number of loads of refuse removed during the year was 2,107. Destruction of Flies, &C.—During the breeding season the pits, &c., at the Whitehorse Hill Refuse tip were treated with paraffin, according to your instructions, with a view to the destruction of these pests, and fly campaign leaflets were also distributed throughout the District. Petroleum.—Ten persons were licensed for the Storage of Petroleum in respect of amounts varying from 50 to 1,000 gallons. About 25 visits have been made in connection with the Private and Traders Petroleum Stores. Carbide of Calcium.—Three persons were licensed for the Storage of Carbide of Calcium in respect of amounts varying from 112 to 336 lbs. Summary of Work caried out during the year:— Number of complaints received and investigated 9 Nuisances discovered (for summary see under) 169 Nuisances out-standing at end of year 14 Legal Notices served 16 Number of letters written, reports made, school notices and other minor notices served 409 29 Character of Work carried out (not including work carried out under the Housing (Inspection of District) Regulations:— Number of houses cleansed generally repaired internally 35 Cowshed, Slaughter houses, and Bakehouses cleansed 23 Number of houses found with defective roofs, eaves' gutters, rainwater down-pipes, yard paving, &c. 26 Offensive accumulations removed 3 Number of Infectious Houses cleansed and fumigated 41 Premises at which animals were so kept as to be a nuisance 1 Summary of Nuisances Discovered (not including those discovered under the Housing (Inspection of District) Regulations:— Dampness, caused by the want of insufficient damp-proof courses, porous brickwork, defective eaves' gutters, defective or absence of rainwater down-pipes, defective roofs, &c. 22 Dirty or defective W.C. pans and traps 2 Insufficient flush of water to W.C.'s and defective flushing cisterns 4 Defective drainage appurtenances (sinks, gullies, &c.) 12 Dirty walls and ceilings 76 Defective floors and interior paving 8 Defective or insufficient yard paving and surface water disposal 15 Drinking water cisterns in a dirty condition or not properly covered 2 Absence of or defective dust-bins 14 Defective interior walls and ceilings 14 Miscellaneous defects: steps, washing coppers, fireplaces, &, 8 Housing, Town Planning, &c., Act, 1909. Two Houses were inspected under the Housing (Inspection of District) Regulations during the year. The work at 7 houses reported upon last year was also completed during 1915. Houses unfit for Human Habitation.—The three cottages at High Street, Foots Cray, known as "Thorn," "Fern," and "Picketts Cottage" previously reported upon, and in respect of which Closing Orders under Sec. 17 of the Housing, Town Planning, &c., Act, 1909 were served are still vacant. 30 Various repairs have been carried out by the Owner of two of the cottages to render the premises fit for human habitation, but the works have not yet been completed. Summary Of Defects.—The following is a summary of the defects found at the two houses inspected this year:— Defective roofs and eaves' gutters Defective rainwater down-pipes No floor ventilation Defective sink drain Defective yard paving and rainwater disposal Absence of dust-bin Defective brickwork of house and outbuildings Dirty walls and ceilings of interior. I have the honour to be, Gentlemen, Your obedient Servant, JETHRO A. CAPON (C.R.S.I.), (Acting Inspector of Nuisances).