URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health, FOR THE YEAR, 1903. ERITH, KENT. 18th March, 1904. To the Urban District Council of Erith. Gentlemen, I beg to submit my Annual Report for the year 1903, in accordance with the Regulations of the Local Government Board. Population and Physical Features of the District. It is difficult to correctly estimate the population of this District, which is peopled chiefly by the Manufacturing and partly by the Agricultural Classes. The Census Returns for 1901 showed the population to be 25,296, with 4,291 inhabited houses. Since then 1,049 houses have been erected; and there has been an increase of Births over Deaths of 2,022, making an increase in the population of 8,316, or, a total of 33,612 ; averaging 6.0 persons per house, but at the time the Census was taken every house was fully occupied, and the majority of the houses were occupied by two families. Whereas it is now known there are 450 houses entirely empty, and many hundreds of others only half occupied. Also from enquiry at five of the largest Factories in the District, I find that there are less men by 2,411 employed than when the Census was taken. The Building and other Trades are almost at a standstill, so this would make a, further reduction of 500 men, and it is known that many of these men and families have left the District. There are now 4,890 occupied houses, which, at 5.5 persons per house would give a population of 26,895, which figures I have taken for statistical purposes. Deaths. There were 286 Deaths registered in the District. This is a decrease of 50 as compared with last year, giving a death rate of 10.63 per 1,000 ; or by deducting 8 deaths which occurred at the Royal Alfred Institution, 3 Suicides, and 16 Accidents, a total of 27; the number of Deaths would be reduced to 259, or a death rate of 9.63 per 1,000 of the population. 2 Inquests. There were 27 Inquests held during the year. Deaths registered each Month, viz.:— January 27 February 23 March 21 April 23 May 21 June 18 July 23 August 22 September 21 October 29 November 24 December 34 Total 286 Births. There were 1,047 Births registered during the year, viz. 515 Males and 532 Females. This is an increase of 104 as compared with last year, or 38 93 per 1,000 of the population. Infectious Disease. There were 140 cases of Infectious Disease notified during the year, which figures eompare very favourably with past years. As will be seen, there was only one case of Small-pox ; this was a Tramp, who obtained lodgings for one night, but who left the house before the notification was received and was traced to the Asylums Board Hospital, Dartford, where he had walked, and was admitted. The house was at once fumigated and thoroughly cleansed, and the inmates re-vaccinated. No further cases occurred. % Comparative Returns of Infectious Diseases notified during the past six years, viz.:— 1898. 1899. 1900. 1901. 1902. 1903. Small-pox 92 228 1 Scarlet Fever 48 65 67 41 57 53 Diphtheria 125 76 71 29 62 38 Membranous Croup 3 2 1 2 Erysipelas 9 21 18 24 26 25 Enteric Fever 23 15 28 48 34 13 Puerperal Fever 2 1 Chicken-pox 187 8 208 177 183 235 595 140 3 Schools Closed. There has not been any notifiable Disease of an epidemic nature during the year, but in the month of February I gave a certificate to close the " All Saints " Infants' Schools, Belvedere, for three weeks owing to an outbreak of Measles. SANATORIUM —Methods of dealing with Infectious Disease. Cases such as Scarlet Fever, Enteric, and Diphtheria, are removed to the Erith Sanatorium, Little Heath, where there are 27 beds. These are seldom all occupied. A special Medical man is appointed by the Council for this Institution, over which I have no control. All Small-pox cases have hitherto been removed to Asylums Board Hospitals, Dartford. Disinfection. The methods of disinfection have been reported from year to year. The system is, Bedding and Weaving Apparel by Hot Air Apparatus, which has proved quite satisfactory. Drainage. The system of Drainage is by Sewers. The majority of the houses on the higher land are connected to the new system. Referring to my report of last year respecting the number of houses in the old part of the town of Erith draining into the old Sewers and discharging directly into the Thames without any treatment, many of these houses have recently been connected to the Council's New Sewerage System, but much work still remains to be done in this direction. As to the low-lying marsh land, several houses have been erected during the past year and are all drained into Cesspits, the contents of which are deposited upon pasture-land, which, in my opinion, is far from satisfactory, and I do not think any more houses should be erected on this land until a proper system of Sewerage is carried out. I understand that the Council have one in contemplation. Water Supply. The Water Supply of the district is obtained from the Kent Water Company, which is general throughout the district and is very satisfactory. House Refuse Removal. House refuse is removed throughout the district twice a week by the Council. The refuse is placed in pails, etc., in front or forecourt of the houses by the occupants, 5,534. loads were removed during the year. Most of this matter is disposed of and utilised by Brick-m&kers, Farmers, etc. This system works very satisfactorily. Cowsheds and Milkshops. There are 9 Cowsheds, about 100 cows, and 19 Dairymen and Purveyors of Milk in the district. The Cowsheds and Milk Stores have been regularly inspected and found clean. A very large proportion of the milk consumed in the district is imported. Slaughter Houses. There are only four Registered Slaughter-houses in the district, which have been regularly J inspected and found clean. Bake Houses. There are 14 Bake-houses in the district, two of which were underground, and these I have had closed, new ones above ground having been erected on same premises. The whole of the Bake-houses have been inspected and found satisfactory. Factories—Offensive Trades. There are several Factories, such as Fish Guano, Fat Extractors, Chemical Manure, Viscoid, etc., in the district, these have been inspected and found in proper sanitary condition. There have been complaints from the London County Council respecting one of these Factories, viz.: The Thames Fish Guano Company, which has entailed many visits, and reports. I am quite satisfied that the cause of these complaints emanates from a similar Factory situated opposite this district in Essex ; full reports of these matters have been made to my Council. I also communicated with the Local Government Board respecting this latter Factory on 7th July last. Housing of the Working Classes Acts. I gave certificates regarding 4 houses as unfit for human habitation on 11th November last, under the above Act, aud proceedings are being taken for closing the same. Army Blankets. On 20th May last I received acommunication from Dr. Collingridge, M.O.H., City of London, reporting that 27 disused Army Blankets, returned from South Africa, which were supposed to be infected with Typhoid Bacilli, had been sold into this neighbourhood. I traced 17 of these; 3 were at once destroyed by the purchasers ; the remainder I had thoroughly disinfected. These Blankets were sold in this neighbourhood in February, but no cases of Enteric could be traced to them. Factories and Workshops Act, 1901. The Factories and Workshops in the District have been inspected during the year and found in sanitary condition. Inspections. I, with the Inspector of Nuisances, have made various inspections of properties, and have had notices served upon Owners, for the abatement of Nuisances, etc. The result of these notices has been the means of much property being put into thorough repair. I submit synopsis of work done by the Inspector of Nuisances. I am, Gentlemen, Yours faithfully, F. C. ROGERS, Medical Officer of Health. 5 Work done by, and under supervision of the Inspector of Nuisances during the year Inspection made Constant Notices served to abate Nuisances 93 Letters written re Nuisances, etc. 117 Notices to lay water on w.c.'s 53 No. of Houses at which work done 40 Reports made to Council and Committee 31 House to House Inspection. No. of Houses inspected 171 ,, „ where defects were found and owners communicated with 137 (Much of this Work is still in hand and being kept under observation). Houses reported as being unfit for human habitation 4 Other Inspections. Cowsheds, Dairies and Milkshops Frequently Slaughterhouses do. Factories and Noxious Vapours do. Infectious Diseases. No. of Cases enquired into 140 ,, ,, removed to Hospital 60 ,, Houses disinfected after Disease 81 Fish. ,, Boxes of Fish examined and found unfit for consumption and destroyed ... 13 House Refuse Removal. No. of Loads removed 5,534 Cesspool Emptying. No. of Cesspools emptied 475 Loads of Sewage removed 2,492 No. of Gallons removed 996,800 A. SAUNDERS, Inspector of Nuisances. TABLE I Vital Statistics of Whole District during 1903 and previous Years. Year. Population estimated to middle of each year Births. Total Deaths Registered District. in the Total Deaths in Public Institutions in the District Deaths of Non- residents registered in Public Institutions in the District Death s o Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number Rate* Under 1 Year of Age. At all Ages. Number Rate per ,1000 Births registered. N umber Rate0 Number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1893 14,206 460 32.38 42 91.3 179 12.6 9 170 12.18 1894 14,511 473 32.59 51 107.82 168 11.57 7 l6l 11.09 1895 16,000 506 31.62 64 126.48 197 12.31 11 186 11.62 1896 16,500 531 31.18 77 145 211 1278 l3 198 12.00 1897 17,000 554 32.58 70 126.35 218 12.82 9 209 12.3 1898 19,824 673 32.95 135 200.59 369 18.61 7 362 18.26 1899 20,887 782 37.43 ll0 140.66 320 15.33 l3 307 14.69 1900 24,166 851 35.21 120 141.01 339 14.03 9 330 13.65 1901 25,296 992 39.26 141 141.12 348 13.7 14 334 13.2 1902 25,296 943 37.27 98 103.92 306 12.09 11 11 326 12.88 Averages for years 1893 1902 19,3686 6765 34.34 90.8 132.4 265.5 13.67 10.3 10.3 258.3 13.18 1903 26,895 1047 38.93 98 93.60 286 10.63 8 8 278 10.33 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Total population at all ages 25296 Number of Inhabited Houses 4,291 Average number of Persons per House 5.8 Area of District in Acres (exclusive of area covered by water) 3,859,513 X. Institutions within the District receiving Sick and Infirm Persons from outside the District. II. Ins itutions outside the District receiving Sick and Infirm Persons from the District. III. Other Institutions, the deathi in which have been distributed among the several localities in the Distriot. Royal Alfred Institutfon for Aged Merchant Seamen. Asylums Board Hospitals, Dartford. Dartford Union Infirmary, London Hospitals TABLE II Vital Statistics of separate Localities in 1903 and previous years. Year. Population estimated to middle of each year • Births Eegistered. Deaths at all Ages. Deaths under 1 year. 1893 14,206 460 179 42 1894 14,511 473 168 51 1895 16,000 506 197 64 1896 16,500 531 211 77 1897 17,000 554 218 70 1898 19,824 673 369 135 1899 20,887 782 320 110 1900 24,166 851 339 120 1901 25,296 992 348 141 1902 25,296 943 326 98 Averages of Years 1893 to1902. 19,368.6 676.5 265.5 90.8 1903 26,895 1,047 286 98 TABLE III. Cases of Infectious Disease notified during the Year 1903. . Notifiable Disease. Cases Notified in whole District. No. of Cases Removed to Hospital. At all Ages. At Ages. Years. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-pox 1 1 1 Diphtheria 38 1 15 18 1 3 20 Membranous Croup 2 2 Erysipelas 25 2 3 2 15 3 Scarlet Fever 53 20 26 2 5 33 Enteric Fever 13 3 4 1 5 6 Chicken-pox 8 1 5 2 Totals 140 4 45 53 7 28 3 60 TABLE IV. Causes of, and Ages at, Death during Year 1903. Causes of Death. Deaths in or belonging to whole district at subjoined ages. Total deaths in Public Institutions in the District. All ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under65 65 and upwards Measles 4 2 1 1 Scarlet Fever 1 1 Whooping-cough 2 1 1 Diphtheria and membranous croup 5 1 1 3 Croup 1 1 Enteric Fever 5 1 1 1 1 1 Epidemic influenza 1 1 Diarrhoea 14 11 3 Enteritis 6 4 1 1 Erysipelas 1 1 Phthisis 22 1 5 16 Other tubercular diseases 10 2 5 2 1 Cancer, malignant disease 9 6 3 Bronchitis 16 5 6 2 3 Pneumonia 20 7 8 3 2 Other diseases of Respiratory organs 1 1 Alcoholism Cirrhosis of Liver 2 2 Premature birth 23 23 Diseases and accidents of parturition 1 1 Heart diseases 18 1 1 1 8 7 Accidents 16 1 3 2 3 6 1 Suicides 3 1 1 1 All other causes 105 37 11 1 2 19 35 8 Totals, all causes 286 98 44 13 15 64 52 8 ER 1 1 URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health for the Year 1303, ERITH URBAN DISTRICT COUNCIL. Offices:— BEXLEY ROAD, ERITH, KENT.