URBAN DISTRICT OF ERITH. ANNUAL REPORT of the Medical Officer of Health, FOR THE YEAR 1905. Erith, Kent, March 12th, 1906. TO THE URBAN DISTRICT COUNCIL OF ERITH. Gentlemen,— I have the honour to submit my Annual Report for the year 1905 in accordance with the Regulations of the Local Government Board. Population of the District. The returns at the last Census in 1901 showed the population to be 25,296, and the number of inhabited houses 4,291. Since then 1,232 new houses have been built, 50 of them during the year 1905, making a total of 5,523. In my last Report I estimated the population in 1904 at 27,582 at the middle of the year, and there were then about 500 houses empty; at the middle of 1905 about 300 of these had been re-occupied; allowing for these at the rate of five inhabitants to each house, and taking the excess of births over the deaths, I have estimated that the population at middle of 1905 was 29,700. Births. There were 900 births in the district during the year, viz.: 461 males and 439 females. This is a decrease of 16 as compared with last year. The birth rate for the year is 30.30, the lowest during the past ten years, and 5.22 less than the average for that period. There were only eight illegitimate births. ER13 . 2 Deaths. There were 285 deaths registered in the district, a decrease of 41 as compared with the previous year. This gives a death rate of 9"59 per 1000. If we deduct from these four deaths of non residents who died in public Institutions in the district, 13 accidents, and 9 suicides, the number of deaths would be 259, which would give a death rate of 8.72. The death rate is the lowest for the past ten years, the average for that period being 1330 Two of the deaths registered were not certified by medical men. Infantile Mortality. The number of deaths of children under one year of age was 80, and between one year and five years, 38, as compared with totals of 121 and 36 during the previous year. The death rate of children under one year of age per 1000 births is 88.8, the average for the previous ten years being 132.65. The number of children under one year of age who died from diarrhœa in 1904 was 33, in 1905, 9. A new table (Table V.) has been issued by the Local Government Board for this year which shows the Deaths from stated causes in weeks and months under one year of age. This will be found at the end of the report, and shows that the most fatal diseases were Diarrhœa, Pneumonia, and Convulsions. The largest number of deaths due to any one cause was 15 due to Premature birth, and these cases all died during the first three weeks of life, 12 of them dying before they were a week old. Thirty deaths took place before the age of four weeks. Inquests. There were 33 inquests held during the year. Deaths registered each month:— January 17 February 28 March 27 April 26 May 30 June 19 July 25 August 32 September 23 October 22 November 20 December 16 Total 285 3 Infectious Disease. There were 269 cases of Infectious Disease notified during the year, an increase of 70 as compared with the previous year. Of these two were Small-pox, 59 Diphtheria, 1 Membranous Croup, 29 Erysipelas, 15 Enteric Fever, and 163 Scarlet Fever. Small-pox.—These two cases were at once removed to the Metropolitan Asylums Board's Hospital at Long Reach. They had no connection with each other, and the source of infection could not be traced in either case. No further case occurred from either of them. Scarlet Fever.—There were 163 cases of this disease, an increase of 65 on the previous year. The disease was prevalent throughout the district, and did not affect the children attending any one particular school more than those attending another. The majority of cases were of a mild character, and I have no doubt that many cases of a very mild type occur which escape recognition, and that a certain number of cases of slight sore throat unaccompanied by a rash are in reality scarlatinal in their nature, and as such sources of infection. In two cases children were found attending school while desquamating, and were responsible for several cases each. A certain number of cases were "return" cases, but the experience of this district in that respect is in no way different from that of other districts. The Metropolitan Asylums Board only last year issued a voluminous report prepared by a medical man specially appointed to enquire into and report on the "return" cases from their Hospitals. Diphtheria.—There were 59 cases of this disease, and one of Membranous Croup, an increase of eight on the previous year. Comparative returns of Infectious Diseases notified during the past eight years, viz.:— 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. Small-pox 92 228 1 1 2 Diphtheria 125 76 71 29 62 38 52 59 Membranous Croup 3 2 1 2 1 Erysipelas 9 21 18 24 26 25 33 29 Scarlet Fever 48 65 67 41 57 53 98 163 Enteric Fever 23 15 28 48 34 13 13 15 Puerperal Fever 2 1 2 Chicken-pox 187 8 208 177 188 235 595 140 199 269 - V. - " 4 Closure of Schools. In September I gave certificates for the Closure of the Infants' Departments of the "Central" Schools, and of the "St. Augustine's" Schools, owing to an outbreak of measles. Sanatorium. During the year 141 cases were treated, of which 107 were Scarlet Fever, 33 Diphtheria, and 1 Enteric Fever. Two tables are attached, one showing the number of patients treated during the year, and the second giving the comparative returns of admissions for the past five years. Scarlet Fever. Enteric Fever. Diphtheria Total. In Hospital, January 1st, 1905 12 - 8 20 Admitted during year 107 1 33 141 Discharged during year 105 1 31 137 Died during year 5 - 2 7 In Hospital, December 31st, 1905 9 - 8 17 1901. . 1902. 1903. 1904. 1905. Scarlet Fever 28 38 33 74 107 Enteric Fever 23 23 6 9 1 Diphtheria 14 35 20 39 33 Total 65 96 59 122 141 Drainage. The system of Drainage is by Sewers. The main portion is carried by the sewer which was laid in 1898. This consists of a high level portion which takes the sewage from the upper parts of the District, and a low level portion which runs parallel to the railway from Abbey Wood to Erith. This latter portion is worked by the Shone pneumatic system. This system conveys the sewage to the outfall works at Anchor Bay, where it is treated before being discharged into the river Thames. In Erith there is in addition a sewer known as the Old Sewer, with which at the beginning of 1905, 374 houses were connected. During the year I have examined the drains of a little over 200 of these houses, and found them in almost every case in bad condition. These drains were laid many years ago and in many cases they have sunk, so that they are lower in the middle than at the outlet, and consequently always full of sewage. In many cases the pipes were broken, or the joints were not watertight, and sewage escapes into the surrounding soil. There are no ventilating shafts, or inspection chambers to these drains, and in many cases I found that sinks inside the houses were directly connected to the drains thus admitting sewer gas to the houses. 5 During the year only 20 of the houses which had been connected with the old sewer were connected with the new sewer, aad pressure should be brought to bear on owners of property still connected with the old sewer to have the drainage re-constructed and connected with the new sewer. A good number of houses built on the Marshes at Belvedere and Abbey Wood drain into cesspools, owing to the fact that no sewer is available for them. I have in my periodical reports to you drawn attention to the condition of matters prevailing on this marsh property. Water Supply. The water supply for the District is obtained from the Metropolitan Water Board. The water is very hard but of very high purity as shown by the monthly reports of the analyses made by the Analyst to the Board. House Refuse Removal. The house refuse in the District is removed twice a week by the Council. It is placed in sanitary dustbins, pails, &c., on the kerb in front of the houses or in the forecourts of the houses by the occupiers. During the year 5499 loads were thus removed, and deposited at Anchor Bay and on the marsh land. In my last report I drew the attention of the Council to the fact that the places available for disposal of this refuse were being rapidly filled up, and to the necessity of making some fresh arrangements. There are now only two places where the refuse can be deposited, and these will not be available for long. Cow Sheds and Milk Shops. There are eight cow sheds, about 90 cows, and 21 Dairymen and Purveyors of milk in the District. The cow sheds and milk stores have been under constant inspection and found clean. Slaughter Houses. There are four registered Slaughter Houses in the District; these have been regularly inspected and found clean. Bakehouses. There are 15 Bakehouses in the District, not one of them being underground. These have been regularly inspected and found clean. Housing of the Working Classes Acts. In February I gave certificates for Closing Orders under the above Acts for nine houses in Northumberland Heath. These houses were afterwards put into a proper sanitary condition, and further proceedings for closing them were not taken. - . 6 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, Viscose Development, &c., have been regularly inspected and found in satisfactory condition. Inspections. During the year I have, with the Inspector of Nuisances, made various inspections of property in the district, and have had notices for the abatement of nuisances served upon the owners. The result of this is that in many cases the property has been put in a state of thorough repair. I submit synopsis of work done by the Inspector of Nuisances. I am, Gentlemen, Yours faithfully, A. E. JERMAN, Medical Officer of Health. 7 Work done by, and under the supervision of the Inspector of Nuisances. Inspections made Constant Notices served to abate Nuisances 37 ,, ,, ,, ,, and connect to main sewer 55 Letters written re Nuisances, etc. 34 Notices to lay water on w.c.'s 10 Reports made to Council and Committee 18 House to House Inspection. No. of Houses Inspected 37 „ ,, where defects were found and owners communicated with 27 No. of Re-inspections 112 Other Inspections. Cowsheds, Dairies and Milkshops Frequently Slaughter Houses 96 Factories and Noxious Vapours 141 Fish. No. of Boxes of Fish condemned and destroyed 17 Infectious Disease. No. of Cases enquired into 269 „ ,, removed to Hospital 149 ,, Houses disinfected after Disease 186 House Refuse Removal. No. of Loads removed 5,499 Cesspool Emptying. No. of Cesspools emptied 480 „ „ Loads of Sewage removed 2,556 ,, ,, Gallons removed 1,022,400 A. SAUNDERS, Inspector of Nuisances. TABLE I. Vital Statistics of Whole District during 1905 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 beyond the District. Nett Deaths at all Ages belonging to the District. Number Rate0 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 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 13 198 12.60 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 35.21 120 141.01 339 14.03 9 330 13.65 1901 25,296 992 39.26 141 141.12 348 13.70 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 1904 27,582 916 33.21 121 132.09 326 11.81 18 10 316 11.45 Averages for years 1895-1904. 21,944.6 779.5 35.52 103.4 132.65 292.0 13.30 11.3 284.6 12.96 1905 29,700 900 30.30 80 88.8 285 9.59 16 4 281 9.46 *Rates 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. II. III. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. Royal Alfred Institution for Aged Merchant Seamen. Erith Cottage Hospital. Erith Sanatorium for Infectious Diseases. TABLE II. Vital Statistics of separate Localities in 1905 and previous years. Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. 1895 16,000 506 186 64 1896 16,500 531 198 77 1897 17,000 554 209 70 ] 898 19,824 673 362 135 1899 20,887 782 307 110 1900 24,166 851 330 120 1901 25,296 992 334 141 1902 25,296 943 326 98 1903 26,895 1.047 278 98 1904 27,582 916 316 121 Averages of Years 1895 to 1904. 219,44 6 779.5 284.6 103.4 1905 29,700 900 281 80 TABLE III. Cases of Infectious Disease notified during the Year 1905. 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 2 2 2 Diphtheria 59 2 19 28 5 5 36 Membranous croup 1 1 Erysipelas 29 1 2 24 2 Scarlet Fever 163 2 63 87 9 2 106 Enteric Fever 15 1 6 2 6 5 Totals 269 4 84 122 18 39 2 149 TABLE IV. Causes of, and Ages at, Death during Year 1905. Causes 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 i year. i and under 5 5 and under 15 15 and under25 25 and under65 65 and upwards Measles 14 4 9 1 Scarlet Fever 6 2 3 1 5 Whooping-cough 7 2 4 1 Diphtheria and Membranous Croup 8 6 2 2 Enteric Fever 1 1 Diarrhœa 10 9 1 Enteritis 2 1 1 Other septic diseases 2 1 1 Phthisis (Pulmonary Tuberculosis) 18 1 3 14 Other tubercular diseases 8 5 1 2 1 Cancer, malignant disease 21 11 10 Bronchitis 17 4 2 1 2 8 Pneumonia 22 9 8 1 3 1 Other diseases of Respiratory organs 1 1 Alcoholism 2 1 1 Cirrhosis of Liver Premature Birth 15 15 Diseases and accidents of par turition 6 1 5 Heart Diseases 30 2 2 8 18 Accidents 13 3 1 3 5 1 4 Suicides 9 6 3 1 All other causes 69 29 5 3 1 11 20 3 Totals, all causes 281 80 38 18 13 70 62 16 TABLE V. Infantile Mortality during the Year 1905. Deaths from stated Causes in Weeks and Months under One Year of Age, CAUSE OF DEATH. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 year. All Causes. Certified 20 4 5 1 30 3 7 5 3 3 3 4 7 5 4 4 78 Uncertified 1 1 1 2 Common Infectious Diseases. Chicken-pox 1 1 Measles 1 1 2 4 Whooping Cough 1 1 2 Diarrhœal Diseases. Diarrhœa, all forms 1 4 1 1 1 1 9 Gastritis, Gastrointestinal Catarrh 1 1 1 3 Wasting Diseases Premature Birth... 12 1 2 r> 15 Congenital Defects 1 1 1 2 Injury at Birth 1 1 1 Atrophy, Debility, Marasmus 1 1 2 1 1 1 5 Tuberculous Diseases. Tuberculous Meningitis ... 1 1 Tuberculous Peritonitis: Tabes Mesenterica 1 1 Other Tuberculous Diseases 1 1 2 3 Meningitis (Not Tuberculous) 1 2 3 Convulsions 3 1 4 1 1 1 1 1 9 Bronchitis 1 1 1 1 1 4 Pneumonia 1 1 1 1 2 1 2 9 Suffocation, overlaying 1 1 2 3 Other Causes 3 1 1 5 5 Total 21 4 5 1 31 3 7 6 3 3 3 4 7 5 4 4 80 Population estimated to middle of 1905 29,700. Legitimate892. Births in the year Illegitimate 8. Deaths from all Causes at all Ages 281. ; ' Urban District of Erith. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1905. ERITH URBAN DISTRICT COUNCIL. Offices:-BEXLEY ROAD, ERITH, KENT. F. J. Mansfield, Printer, 19, High Street, Erith.