URBAN DISTRICT OF ERITH. Annual Report OF THE Medical Officer of Health, For the Year 1907. ERith, Kent, March 23rd, 1908. TO THE URBAN DISTRICT COUNCIL OF ERITH. Gentlemen,— I have the honour to submit my Annual Report for the year 1907, in accordance with the Regulations of the Local Government Board. Population of the District. The returns at the Census of 1901 showed the population to be 25,296, and the number of inhabited houses 4,291. Since then 1,370 houses have been built, 55 during the past year, making a total of 5,661. In my last report I estimated the population at 30,331, at that time there were only a few houses empty in the district, but owing to slackness of work at the factories here during the past year, and a strike at one of the works, a number of men have left the district with their families. At the middle of last year there were about 500 houses empty, and taking the average number of inhabitants at 5 per house, it gives a population of 2,500 who have left, deducting this number from the estimate of last year, and adding the natural increase, that is the excess of births over deaths, viz. 650, I estimate the population at the middle of 1907 to have been 28,481, which figures I have adopted for statistical purposes. Births. The number of births in the district during the year was 852, viz., 449 males and 403 females. This is a decrease of 59 as compared with last year. There were 14 illegitimate births during the year, viz., 8 males and 6 females. The birth rate for the year is 29.91, slightly lower than last year, and 4.78 lower than the average for the previous 10 years. 2 Deaths. The number of deaths during 1907 was 215, a decrease of 65 on the previous year. This gives a death rate of 7.54 per 1,000. Deducting from these 13 deaths of non-residents which occurred in Public Institutions in the district the number of deaths was 202, which gives a death rate of yog per 1,000 The death rate for 1905 was 9.59, and that for 1906, 9.00 per 1,000, but in 1907 the mortality has been extraordinarily small, and the rate is one which will probably stand for many years as the lowest on record. In the first quarter of the year there were 71 deaths which is about the average number for that quarter for many years past, but the other three quarters only show 40, 42, and 49 deaths respectively. This low mortality is undoubtedly due to the mildness of the spring and early winter, and the cool summer. Infantile Mortality. The number of deaths of children under 1 year of age was 72, and between 1 year and 5 years 18, as compared with 78 and 43 the previous year. The death rate for children under 1 year per 1,000 births is 84.5 per 1,000, the rate for the previous year being 85.62, and the average for 10 years being 122.65. The number of children under 1 year of age, who died from diarrhosa in 1907, was 7, as compared with 29 the previous year. Table V. at the end shows the causes of deaths of children under 1 year, and the respective ages at which death took place. The decrease in the deaths from diarrhoea was due largely to the coolness of the summer, this disease is always much more prevalent and fatal during hot and dry summers—the months of July, August and September being almost the only ones in which it occurs. The number of deaths due to premature birth was 9, as compared with 15 the year before. Bronchitis and pneumonia were each the cause of 9 deaths, as compared with 2 and 5 the previous year. These deaths occurred chiefly in the first quarter of the year. During the first four weeks of life, twenty deaths occurred, the same number as in 1906, and 40 before the age of three months was attained. Inquests. There were 18 Inquests held during the year. Deaths registered each month :— January 30 February 22 March 22 April 15 May 20 June 10 July 18 August 15 September 12 October 19 November 12 December 20 Total 215 3 Infectious Disease. There were 240 cases of infectious disease notified during the year, a decrease of 86 as compared with the previous year. Of these 150 were Scarlet Fever, 44 Diphtheria, 19 Erysipelas, 11 Enteric Fever, and 16 Phthisis. The decrease is due mainly to a decrease in the number of Diphtheria cases ; only 44 were notified during 1907 as compared with 106 in 1906, when the disease was prevalent over the whole district. The number of Scarlet Fever cases is practically the same as in 1906. Many of the cases are extremely mild in character, and I have no doubt that the disease is spread chiefly by mild cases that escape detection, owing to the absence of a rash or any sore throat. The Notification of cases of Phthisis is voluntary. Comparative returns of Infectious diseases notified during the past ten years, viz.:— 1898. 1899. 1900. 1901. 1902. T9°3- 1904. 1905. 1906. 1907. Small-pox 92 228 1 1 2 Diphtheria 125 76 71 29 62 38 52 59 106 44 Membranous Croup 3 2 1 2 1 Erysipelas 9 21 18 24 26 25 33 29 35 19 Scarlet Fever 48 65 67 41 57 53 98 163 145 150 Enteric Fever 23 15 28 48 34 13 13 15 29 11 Puerperal Fever 2 1 2 1 Chicken-pox 187 8 Phfhisis 10 16 6 mths. 208 177 188 235 595 140 199 269 326 240 Sanatorium. During the year 126 cases were admitted, viz.:—102 Scarlet Fever, 2 Enteric Fever, 22 Diphtheria. Two tables are attached, one showing the number of patients treated during the year, the second giving the comparative returns of admissions for the past 6 years. Scarlet Fever. Enteric Fever. Diphtheria. Total. In Hospital, January 1st, 1907 3 3 — 6 Admitted during year 102 2 22 126 Discharged during year 79 5 20 104 Died during year 1 — 2 3 In Hospital, December 31st, 1907 25 - - 25 4  1901. 1902. 1903. 1904. 1905. 1906. 1907. Scarlet Fever 28 38 33 74 107 90 102 Enteric Fever 23 23 6 9 1 16 2 Diphtheria 14 35 20 39 33 35 22 Total 65 96 59 122 141 141 126 Drainage. The system of Drainage is by Sewers. The main portion of the sewage is carried by the sewer laid down in 1898. This consists of a high level portion taking the sewage from the upper portion of the District, and a low level portion from the lower parts of the district and running from Abbey Wood to Erith. This portion is worked on the Shone pneumatic system. The outfall works are situated at Anchor Bay, and the sewage is treated here before being discharged into the river Thames. In Erith there is also an old sewer, with which a number of houses are still connected. During 1907 a certain number of these houses were transferred to the new sewer. A number of houses built on the Marshes at Abbey Wood and Belvedere drain into cesspools. During the latter portion of the year a new sewer was commenced to take the sewage from the houses on the Marshes near Abbey Wood station; hitherto the leaky condition of the cesspools attached to these houses has been the cause of much pollution of the Marsh ditches, but I hope that the menace to the health of the district from this will soon be ended. Water Supply. The water supply is obtained from the Metropolitan Water Board. The water is very hard but of good quality. 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, or in the forecourts of the houses by the occupier. During the year 5,784 loads were thus removed and deposited on the various shoots at the disposal of the Council. Cow Sheds and Milk Shops. There are 8 Cow Sheds, about 96 cows, and 26 Dairymen and Purveyors of Milk in the district. The cow sheds and milk stores have been under constant inspection and found clean. 5 Slaughter Houses. There are 3 registered Slaughter Houses in the district. These have been regularly inspected and found clean. Bakehouses. There are 15 Bakehouses in the district, none of them being underground. They have been regularly inspected and found clean. Housing of the Working Classes Acts. In March I gave certificates for Closing Orders for 5 houses in Bedonwell Road, Northumberland Heath, and in May for 9 houses in Bedonwell, Belvedere. These houses were afterwards put into thorough repair and sanitary condition, and further proceedings were unnecessary. Factories and Workshops Acts. The Factories and Workshops in the district have been inspected regularly during the year, and found in good sanitary condition. Factories —Offensive Trades. The various Factories, viz.:—Fish Guano, Chemical Manure, Fat Extraction, Tallow Melter, &c., have been regularly inspected and found in satisfactory condition. Inspections. I have, during the year, made, with the Inspector of Nuisances, various inspections of property in the district, and where necessary have had notices for the abatement of nuisances, &c., served on the owners. As the result of this, in many cases the property has been put into thorough repair. I submit synopsis of work done by and under the supervision of the Inspector of Nuisances. I am, Gentlemen, Your obedient Servant, A. E. JERMAN, Medical Officer of Health. 6 Work done by, and under the supervision of the Inspector of Nuisances. Inspections and Re-inspections made Constant Notices served to abate Nuisances 169 „ ,, ,, „ and connect to main sewer 73 Letters written re Nuisances, etc. 70 Notices to lay water on w.c.'s 13 Reports made to Council and Committee 11 Other Inspections. Cowsheds, Dairies and Milkshops Frequently Slaughter Houses 36 Factories and Noxious Vapours 150 Fish. No. of Boxes of Fish condemned and destroyed 5 Infectious Disease. No. of Cases enquired into 240 ,, „ removed to Hospital 138 ,, Houses disinfected after Disease 156 House Refuse Removal. No. of Loads removed ... ... ... ... ... 5.784 Cesspool Emptying. No. of Cesspools emptied 495 ,, ,, Loads of Sewage removed 2,993 „ „ Gallons removed 1,197,200 A. SAUNDERS, Inspector of Nuisances. TABLE I. Vital Statistics of Whole District during 1907 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. Net Deaths at all Ages belonging to theDistrict. Number. Rate* Under I year of age. At all Ages. Number. Rate* Number. Rate per 1,000 Births registered. Number. Rate* 1 2 3 4 5 6 7 8 9 10 11 I 2 13 1897 I 7,000 554 32.58 90 126.35 218 12.82 9 209 12.30 1898 19,824 673 32.95 135 200.59 369 1861 7 362 18.26 1899 20,887 782 37.43 110 1 40.66 320 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 13.20 1902 25,296 943 37.27 98 103.92 30 6 12.09 11 11 326 12.88 1903 26,895 1047 38.93 98 93.60 286 1063 8 8 278 10.33 1904 27,585 916 33.21 121 132.09 326 11.81 18 10 316 11.45 1905 29,700 900 30.3° 80 88.8o 285 9.59 16 4 281 9.46 1906 30,331 911 30.03 78 85.62 280 9.23 21 7 273 9.00 Averages for years 1897-1906 24,697.7 856.9 34.69 105.1. 122.65 307.7 12.45 I 2.6 301.6 12.61 1907 28,481 852 29.91 72 8450 215 7.54 23 13 202 7.09 *Rates in Columns 4, 8, and 13 calculated per 1,000 of the estimated population. Total population at all ages 25,296 Number of Inhabited Houses 4,291 At Census Average number of Persons per House 5.89 of 1901. 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. Royal Alfred Institution for Aged Merchant Seamen. Erith Cottage Hospital. Dartford Union Infirmary. Erith Sanatorium, Little Heath, for Infectious Diseases. TABLE II. Vital Statistics of Separate Localities in X 907 and previous years. Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. 1897 1 7,000 554 209 70 1898 19,824 673 362 !35 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 1905 29,700 900 281 80 1906 30,331 911 273 78 Averages of Years 1897 to 1906. 24,6977 856.9 301.6 105.1 1907 28,48 852 202 72 IV. Causes of, and Ages at, Death during year 1907. Causes of Death. Deaths at the subjoined ages of "Residents'' whether occurring in or beyond the District. Total Deaths whether of "Residents" or "NonResidents" 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 5 1 3 1 Scarlet Fever 1 1 1 Whooping-cough 7 4 3 1 Diphtheria & Membranous Croup 5 2 3 2 Enteric Fever 1 1 Epidemic Influenza 4 1 1 2 Diarrhoea 7 3 1 1 Enteritis 1 1 Other septic diseases 2 1 1 Phthisis (Pulmonary Tuberculosis ) 9 1 8 1 Other tubercular diseases 10 4 3 3 1 Cancer, malignant disease 10 7 3 Bronchitis 21 9 1 4 7 2 Pneumonia 16 9 5 2 2 Pleurisy 1 1 1 Other diseases of Respiratory organs 1 1 1 Alcoholism Cirrhosis of liver 5 2 3 1 Venereal diseases 2 2 Premature birth 9 9 Heart diseases 20 1 10 9 3 Accidents 11 2 2 2 5 3 Suicides 2 2 All other causes 8 22 2 2 11 11 4 All causes 202 72 18 11 5 57 39 23 TABLE V. Infantile Mortality during the Year 1907. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under l 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 i year. All Causes. Certified Uncertified 15 3 2 20 9 11 5 7 5 4 4 4 2 1 72 Common Infectiou Diseases Measles 1 1 Whooping Cough 1 1 1 1 4 Diarrhoea Diseases Diarrhoea, all forms 3 1 1 2 7 Wasting Diseases. Premature Birth 8 1 9 9 Congenital Defects 2 2 3 Injury at Birth 2 2 2 (Atrophy, Debility, Marasmus 3 2 2 7 3 2 1 1 1 15 Tuber- culous Diseases. Tuberculous Meningitis 2 2 Tuberculous Peritonitis: Tabes Mesenterica 1 1 2 Syphilis 2 2 Meningitis (not Tuberculous) 1 1 Convulsions 1 1 Bronchitis 2 1 2 1 1 1 1 9 Pneumonia 1 2 1 1 1 2 i 9 Suffocation, overlying 1 1 2 Other Causes 1 1 1 3 Total 15 3 2 20 9 11 5 7 5 4 4 4 2 1 72 Population estimated to middle of 1907 28,481 Births in the year legitimate 838 Illegitimate 14 Deaths in the year 69 Illegitimate Intants 3 Deaths from all Causes at all Ages 202 ERI4 URBAN DISTRICT Of ERITH. Annual Report OF tHE Medical Officer of Health, FOR THE YEAR 1907. ERITH URBAN DISTRICT COUNCIL, Offices BEXLEY ROAD, ERITH, KENT. r. h. Starkey, The Randal Press, Erith