URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health, FOR THE YEAR, 1904. Erith, Kent, March 9, 1905. TO THE URBAN DISTRICT COUNCIL OF ERITH Gentlemen,— I have the honour to submit my Annual Report in accordance with the Regulations of the Local Government Board. In writing this Report I have had to rely, with regard to the first half ot the year, on the periodical reports to the Council of your late Medical Officer of Health, Dr. Rogers, and his successor pro. tem., Dr. Good, and the assistance of the Inspector of Nuisances. Population and Physical Features of the District, It is difficult to correctly estimate the population of the district, as it is somewhat migratory ; formerly the majority belonged to the Residential or City Class, but these are rapidly dying out or removing, and now the large majority belong to the Manufacturing Class, with a few belonging to the Agricultural Class. The Census returns for 1901 showed the population to be 25,296, with 4291 inhabited houses. Since then 1182 new houses have been built, 133 of them during the past year, making a total of 5,473. At the time the Census was taken every house was fully occupied, employment being plentiful. At the present time quite 500 houses are empty, and many others, let out in flats, are only half-occupied. One large factory, the oldest in the district, employing 652 hands when the Census was taken, has been closed, and many of the men working there have removed from the district with their families. After deducting the deaths from the births in the district I estimate that the population at the middle of the year was 27,582. 2 Births. There were 916 births registered during the year, viz: 463 males and 453 females, giving a birth-rate of 33'21 per 1,000 of the population. There is a decrease of 131 as compared with last year, and a decrease of 5.72 in the birth-rate. Deaths. There were 326 deaths registered during the year, an increase of 40 as compared with the previous year, giving a death-rate of 11.81 per thousand. If we deduct from these 10 deaths of Non-Residents which occurred in public institutions in the district, 18 Accidents and two suicides, a total of 30, the number of deaths would be reduced to 296, giving a death rate of 10 73 per 1,000 of the population. Four of the deaths registered were not certified by medical men. Infantile Mortality. The number of deaths of children under 1 year of age was 121, and above 1 year and under 5 years, 36, a total of 157; so that it will be seen that nearly one half the deaths in the district are those of children under five years of age. The previous year the numbers were respectively 98 and 44, a total of 142. The increase in the number of deaths of children under one year of age was due to the prevalence of Diarrhoea in the months of July and August. The death-rate of children under one year per 1,000 births registered is 132.09, the rate for 1903 being 93.6, and the average for the past 10 years 132.8 per 1,000, so that the ate for 1904, though high, is practically the same as the average. inquests. There were 30 inquests held during the year. Deaths registered each Month, viz.: — January 31 February 19 March 26 April 39 May 22 June 16 July 25 August 53 September 18 October 26 November 27 December 24 Total 326 Infectious Disease. There were 199 cases of Infectious Diseases notified during the year, an increase of 59 on the previous year. There was one case of Small pox, which was at once removed to the Metropolitan Asylums Board Hospitals, Dartford, and the house was thoroughly cleansed and disinfected. It was impossible to trace the source of infection. 3 There has been a considerable increase in the number of Scarlet Fever cases notified, and this increase has been spread over the whole year, and not confined to any particular portion of it, or to any particular quarter of the district. Comparative Returns of Infectious Diseases notified during cue past seven years, viz. 1898. 1899. 1900. 1901. 1902. 1903. 1904. Small-pox 92 228 1 1 Diphtheria 125 76 71 29 62 38 52 Membranous Croup 3 2 1 2 Erysipelas 9 21 18 24 26 25 33 Scarlet Fever 48 65 67 41 57 53 98 Enteric Fever 23 15 28 48 34 13 13 Puerperal Fever 2 1 2 Chicken-pox 187 8 208 177 188 235 595 140 199 Sanatorium. This Hospital is for the admission of Cases of Scarlet Fever, Enteric Fever, and Diphtheria. There are 25 beds. During the year 122 cases were treated, of which 74 were Scarlet Fever, 39 Diphtheria, and 9 Enteric Fever. Two of the cases of Enteric Fever died during the year, but all the Scarlet Fever and Diphtheria cases recovered. Two tables are attached, one showing the number of patients treated during the year, and the second giving the comparative returns oi admissions for the past four years. Scarlet fever. Enteric Fever. Diphtheria. Total. In Hospital, January 1st, 1904 2 2 4 Admitted during year 74 9 39 122 Discharged during year 64 7 33 104 Died during year 2 2 In Hospital, December 31st, 1904 12 8 20 1901. 1902. 1903. 1904. Scarlet Fever 28 38 33 74 Enteric Fever 23 23 6 9 Diphtheria 14 35 20 39 Tots L1 65 96 59 122 Disinfection. There has been no change in the methods of disinfection during the past year. All houses are fumigated, and bedding and wearing apparel disinfected in the Hot Air Apparatus attached to the Sanatorium. Drainage. The system of Drainage is by Sewers. The houses which drain intc the old Sewers are gradually being connected with the new Sewers. 4 Water Supply. The Water Supply for the District is obtained from the Metropolitan Water Board, which has taken over the Kent Water Company. House Refuse Removal. All house refuse is removed twice a week by the Council. It is placed in pails, etc., in the forecourts of the houses, or on the kerb, by the occupiers. During the year 5,329 loads were thus removed, and were deposited in a gravel pit, or on the marsh land. In the near future some fresh arrange ment should be made for the disposal of this material, as the available places for this are rapidly being filled up. Cow Sheds and Milk Shops. There are 8 Cowsheds, about 90 Cows, and 21 Dairymen and Purveyors of Milk in the district. The Cowsheds and Milk Stores have been under constant inspection and found clean. Slaughter Houses. There are only four Registered Slaughter-houses in the district, these have been regularly inspected and found clean. Bakehouses. There are 14 Bakehouses in the District, all of them above ground. They have been regularly inspected and found clean. Housing of the Working Classes Acts. The four houses referred to by the late Medical Officer of Health, in his report for 1903, as having been condemned by him, were finally closed during March, 1904, under closing orders obtained at the Dartford Petty Sessions on March 4th. Factories and Workshops Act, 1901. The Factories and Workshops in the district have been inspected during the year and found in Sanitary condition. Factories—Offensive Trades. The various Factories, viz.:— Fish Guano, Chemical Manure, Fat Extraction, Viscoid, have been regularly inspected and found in Sanitary condition. I submit herewith synopsis of work done by the Inspector of Nuisances. I am, Gentlemen, Yours faithfully, A. E. JERMAN. Medical Officer of Health. 5 Work done by, and under the supervision of the Inspector of Nuisances. Inspections made Constant Notices served to abate Nuisances 120 Letters written re Nuisances, etc. 59 Notices to lay water on w.c.'s 34 No. of Houses at which work done 91 Reports made to Council and Committee 12 House to House Inspection. No. of Houses Inspected 17 ,, ,, where defects were found and owners communicated with 16 Houses Closed during the year 4 Other Inspections. Cowsheds, Dairies and Milkshops Frequently Slaughter Houses do. Factories and Noxious Vapours do. Fish. No. of Boxes of Fish condemned and destroyed 12 Infectious Disease. No. of Cases enquired into 199 ,, „ removed to Hospital 123 Houses disinfected after Disease 135 House Refuse Removal. No. of Loads removed 5,329 Cesspool Emptying. No. of Cesspools emptied 486 „ ,, Loads of Sewage removed 2,489 A. SAUNDERS. Inspector of Nuisances. TABLE I. Vital Statistics of Whole District during 1904 and previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions be yond the District. Nett Deaths at all Ages belonging to the District. Number Rate* Under 1 year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number Rate.* Number. Rate* l 2 3 4 5 6 7 8 9 10 11 12 13 1894 14,511 473 32.59 51 107.82 168 11.57 7 161 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 12.78 i:s 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 37.43 110 140.66 320 15.33 13 307 14.69 1900 24,166 851 35.21 1-20 141.01 339 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 1903 26,895 1047 38.93 98 93.60 286 10.63 8 8 278 10.33 Averages for years 1894-1903. 20,637.5 735.2 35.67 96.4 132.2 276.2 13.38 10.2 269.1 13.12 1904 27,582 916 33.21 121 132.09 326 11.81 18 10 316 11.45 * Bates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Total population at all ages ... ... ... ... ... 25,296 Number of Inhabited Houses ... ... ... ... 4,291 Average number of Persons per House ... ... ... 5 89 Area of District in Acres (exclusive of area covered by water) ... ... 3,859*513 I. Institutions within the District receiving Sick and Infirm Persons from outside the District. II. Institutions outside the District receiving Sick and Infirm Persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. Eoyal Alfred Institution for Aged Seamen (Merchant). Erith Cottage Hospital. Metropolitan Asylums Board Hospitals, Dartford. Dartford Union Infirmary. London Hospitals. Erith Sanatorium for Infectious Diseases. TABLE II. Vital Statistics of separate Localities in 1904 and previous years Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. 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 19,824 673 369 135 181)9 20,887 782 320 110 1900 144,166 851 339 120 1901 25,296 992 348 141 1902 25,296 943 306 98 1903 26,895 1,047 286 98 Averages of Years 20,637.5 735.2 276.2 96.4 894 to 1903 1904 27,532 910 326 121 TABLE III. Cases of Infectious Disease notified during the Year 1904. Notifiable Disease. Cases Notified in whole District. No. of Cases Removed to Hospital from each Locality. 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 52 3 8 31 8 2 39 Erysipelas 33 1 2 1 4 24 1 Scarlet Fever 98 1 40 50 6 1 74 Enteric Fever 13 7 1 5 9 Puerperal Fever 2 2 Totals 199 5 50 89 19 35 1 123 TABLE IV. Causes of, and Ages at, Death during Year 1904. Cause of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District. Total Deaths whether of Residents or Non"Residents" 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 under 65 65 and upwards Measles 2 1 1 Scarlet Fever 1 1 Whooping-cough 11 5 6 Diphtheria and membranous croup 4 1 2 1 Croup 1 1 Enteric Fever 4 1 3 2 Epidemic Influenza 1 1 Diarrhœa. 39 33 4 1 1 1 Enteritis 4 2 1 1 Puerperal Fever 1 1 Other septic diseases 2 I 1 3 Phthisis (Pulmonary Tuberculosis) 20 1 4 14 1 Other tubercular diseases 7 3 2 Cancer, malignant disease 16 12 4 Bronchitis 18 6 4 2 6 Pneumonia 20 5 5 1 4 5 2 Other diseases of Respiratory organs 2 2 Alcoholism Cirrhosis of Liver 1 1 Premature birth 19 19 Diseases and accidents of parturition 2 1 1 1 Heart diseases 29 1 2 18 8 3 Accidents 16 3 3 2 7 1 3 Suicides 2 1 1 All other causes 89 37 5 5 4 15 23 4 Totals, all causes 316 121 36 12 14 82 51 18 ERI Z URBAN DISTRICT OF ERITH. Annual Report OF THE medical Officer of Health FOE THE YEAR 1904. ERITH URBAN DISTRICT COUNCIL Offices:- BEXLEY ROAD, ERITH, KENT.