URBAN DISTRICT OF ERITH. Annual Report OF THE Medical Officer of Health, For the Year 1908. Erith, March Ist, 1909. TO THE URBAN DISTRICT COUNCIL OF ERITH. Gentlemen,— I have the honour to submit my Annual Report for the year 1908, in accordance with the Regulations of the Local Government Board. Physical Features and Population. The Urban District of Erith is situated on the south side of the River Thames, immediately outside the County of London, which forms the western boundary. It is bounded on the south and east by the districts of Bexley and Crayford respectively. The portion of the district lying between the River Thames and the South Eastern and Chatham Railway line, 1,689 acres in extent, is marsh land and its level is below that of high water. The remaining portion, 2,170 acres in extent, rises gradually from the level of the marsh land to a considerable height. The District contains a number of factories for various purposes, e.g., gun making, cable making, mining machinery, &c., and the large majority of the inhabitants are connected with these factories. There is also a certain number employed in agricultural and horticultural pursuits. The population at the Census of 1901 numbered 25,296, inhabiting 4,291 houses. Since the Census, 1,392 new houses have been built, 22 of them during 1908, making a total of 5,683. Most of these are six or eight roomed cottages, built to meet the demand for this class of property by the workmen who have come into the district to the factories, and in accordance with the Byelaws in force in the district. In my last report I estimated the population at 28,481; during 1908 the work at some of the largest factories was very slack, and there was no increase of population by immigration. At the middle of 1908 there were about 700 houses empty in the district, but in many cases two families occupied one house, where, previously, when work was good they occupied separate houses. The natural increase of population, that is, the excess of births over deaths, was 505 and adding this number to the estimate for 1907, I estimate the population at the middle of 1908 to have been 28,986, which figures I have adopted for statistical purposes. 2 Births. The number of births registered in the district during 1908 was 750, viz.:— 377 males and 373 females. This is a decrease of 102 as compared with the previous year, is the lowest number recorded since 1898, and is 136 less than the average for the previous ten years. In 1898 there were 673 births with a birth rate of 32'95 per 1,000, in 1901 there were 992 births with a rate of 39'26, and in 1903 there were 1,047 births with a rate of 38 93, but since that year there has been a steady decline in the birth rate as can be seen by referring to columns 3 and 4 in Table I. The birth rate for 1908 is only 25.87 per 1,000, considerably lower than that for 1907 and 8.43 below the average for the previous ten years. The number of illegitimate children bora in 1908 was 14, viz.:—7 males and 7 females. Deaths. The number of deaths during 1908 was 245, an increase of 30 on the previous year. This gives a death rate of 8 45 per 1,000. Deducting from these 4 deaths of non-residents which took place in Public Institutions in the district, the number of deaths was 241, which gives a nett death rate of 8.31 per 1,000. In the first quarter of the year the number of deaths was 81, and 59, 47, and 54 in the 2nd, 3rd and 4th quarters respectively. The death rate for the year 1907 was 7"09 per 1,000, this low rate has not been maintained but the rate for 1908 is still well below that for any other previous year, and 3.44 below the average for ten years. Infantile Mortality. The number of deaths of children under 1 year of age was 60, and between 1 year and 5 years 35, as compared with 72 and 18 in the previous year. The death rate for children under 1 year per 1,000 births is 80 as compared with a rate of 84.3 for the previous year, and an average of 118.75 for the previous 10 years. The decrease in the infantile mortality rate has been steady since 1901 (with the exception of 1904, when it rose somewhat) and the rate is now lower than in any previous year on record. Table V. gives the causes of deaths of children under 1 year, and the respective ages at which death took place. During the first four weeks of life 19 deaths occurred, 11 of these being due to premature birth, 5 to marasmus (or debility) and two to convulsions. Seven deaths were due to bronchitis and 1 to pneumonia as compared with 9 from each disease the previous year. The number of deaths of illegitimate infants during 1908 was 4, this is a very large proportion out of 14 births, and gives a death rate of 285.71 per 1,000 illegitimate births as compared with a rate of 76.04 per 1,000 for legitimate children. The question of adopting the Notification of Births Act was considered by the Council during the early part of the year, but it was decided not to adopt it for the present. Comparative returns of Infectious diseases notified during the past ten years, viz.:— 1899. 1900. 1901. I902. 1903. 1904. 1905 1906. 1907. 1908. Small-pox 92 228 1 1 2 Diphtheria 76 71 29 62 38 52 59 106 44 60 Membranous Croup 2 1 2 1 Erysipelas 21 18 24 26 25 33 29 35 19 14 Scarlet Fever 65 67 41 57 53 98 163 145 150 I40 Enteric Fever 15 28 48 34 13 13 15 29 I I 13 Puerperal Fever 2 1 2 1 2 Chicken-pox 187 8 Phthisis 10 l6 12 6 mths. 177 188 235 595 140 199 269 326 240 241 Scarlet Fever. Of the 140 cases of this disease 94 were children between the ages of 5 and 15 years, that is, children attending school, and 36 were children between 1 year and 5 years, leaving only 10 cases which occurred in persons over 15 years of age. In many of the cases occurring between 1 and 5 years of age, the disease was taken from an older child attending school. In the majority of cases it was impossible to trace the infection to any particular source, and there is practically no doubt that it was contracted in school. There was however at no time during the year any special incidence of the disease on any particular school or any particular class in any school. Most of the cases are of a very mild character and I am certain that other still milder cases occur which escape detection altogether owing to the fact that only a very slight sore throat, and a very faint rash, if any, are present, and that these undetected cases are sources of infection. There were four " return " cases during the year. The number of deaths from Scarlet Fever during the year was nil. 3 Inquests. There were 26 inquests held during 1908. Deaths registered during each month:— January 23 February 25 March 34 April 24 May 19 June 17 July 16 August 17 September 16 October 21 November 16 December 17 Total 245 Infectious Disease. There were 241 cases of infectious disease notified during the year, an increase of 1 as compared with 1907. Of these 140 were Scarlet Fever, 60 Diphtheria, 14 Erysipelas, 13 Enteric Fever, 2 Puerperal Fever, and 12 Phthisis. 4 Diphtheria. There were 60 cases of this disease notified during 1908, 39 of them in children between 5 years and 15 years of age, 18 between 1 year and 5 years, 1 under 1 year and 2 over 15 years. In the case of this disease again the source of infection could not be definitely traced in the majority of cases, but the incidence of the disease, as does that of Scarlet Fever, shows what a large proportion of the cases occurs in children at or about school age, and how favourable contact in school is for the dissemination for this disease. All cases of Diphtheria which are admitted to the Sanatorium, are bacteriologically examined before being discharged, to see that they are free from the germ of the disease, and as a consequence of this we have had no ''return" cases. There were 8 deaths from Diphtheria during the year. Puerperal Fever. There were two cases of this disease during the year both o£ which were fatal. Phthisis. The notification of this disease is voluntary and only a small proportion of the cases are notified, the number for the year being only 12, while the number of deaths was 22. From other Tuberculous diseases (which are not notifiable) the number of deaths was 12. In cases notified the house is visited, a card with instructions as to precautionary measures to be taken, left, and disinfectants supplied on request. In cases where deaths from Phthisis have occurred, the house is disinfected on application by the occupier. Sanatorium. The Sanatorium for infectious diseases is situated near the boundary of the district, no houses being within a quarter of a mile of it. It consists of an administration block, one block of two wards containing 8 beds for Diphtheria, and an iron building with two large wards, containing 8 beds each, and a small ward with 1 bed for Scarlet Fever. Early in 1908 negotiations were opened with the owner of the land adjoining the Sanatorium for the purchase of 2 acres. This purchase was completed during the summer, and plans were then passed by the Council for the erection of a building for a new laundry and a steam disinfector. Hitherto the disinfector has been of the hot air type, but the one now intended to be put in is a steam disinfector of the "Thresh " pattern. When completed the laundry and disinfector will be thoroughly efficient for the needs of the hospital even when much larger than at present. During the year 139 cases were admitted, viz.:—107 Scarlet Fever, and 32 Diphtheria. Two tables are attached, one showing the number of patients treated during 908, and the second giving comparative returns of admissions during past 8 years. Scarlet Fever. Diphtheria. Total. In Hospital, January 1st, 1908 24 1 25 Admitted during year 107 32 139 Discharged 114 25 139 Died 1* 2 3 In Hospital, December 31st, 1908 16 6 22 * This case was found on admission to be suffering from Diphtheria as well as Scarlet Fever, and the death was due to Diphtheria not the Scarlet Fever, and is only shown here owing to its being notified and admitted as Scarlet Fever. 5  1901. 1902. 1903. 1904. 1905 1906. 1907. 1908. Scarlet Fever 28 38 33 74 107 90 102 107 Enteric Fever 23 23 6 9 1 16 2 — Diphtheria 14 35 20 39 33 35 22 32 Total 65 96 59 122 141 141 126 139 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 two portions, one a low level sewer running from Abbey Wood Station to Erith and worked by the Shone pneumatic system, having ejectors situated about every half mile throughout its length ; the other portion runs from Belvedere and Northumberland Heath and requires no ejectors, the fall being sufficient to keep up the flow. This sewer discharges into the outfall works situated at Anchor Bay where the sewage is treated, and the effluent discharged into the river Thames. There is also in Erith itself an old brick sewer, to which a certain number of houses are still connected, and which discharges into the river Thames. During 1908, 130 of these houses were disconnected from this old sewer, and the drains reconstructed and connected on to the new sewer. Early in 1908 a new sewer was constructed near Abbey Wood Station to take' the sewage from the houses on the Marsh near that spot, and is now working satisfactorily. There are still in other parts of the marshes a number of houses draining into cesspools, which have to be emptied at frequent intervals. The matter taken from these cesspools is spread on the marsh land, away from the proximity of any houses, with the permission of the owners. The drains in recently built houses are for the most part in good condition, having been constructed under the Council's byelaws, but in old houses they are frequently found defective on examination. When this is the case, notice is served on the owners to remedy the defects, and this is usually complied with at once. Medical Inspection of School Children. This has been carried out by a special medical man appointed by the Education Committee. With regard to notifiable infectious diseases, lists of infected houses are furnished weekly to the Education Committee by myself, and a weekly return is supplied me by that Committee showing the number of children away from school owing to non-notifiable diseases, such as measles, whooping cough, &c., as ascertained by the enquiries of the school attendance officers. Water Supply. The District is supplied by the Metropolitan Water Board. The water, though hard, is of good quality. 6 House Refuse Removal. The house refuse is removed twice weekly by the Council. It is placed in sanitary dust bins, pails, &c., on the kerb or in the forecourts of the houses by the occupiers. During the year 5,490 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 100 cows and 29 dairymen and purveyors of milk in the district. The cow sheds and milk stores have been kept under constant inspection and found clean. The cattle in the district are kept under inspection by a Veterinary Surgeon, appointed by the Council, who reports at intervals. No cattle suffering from Tuberculous disease were found in 1908. 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 which are underground. They have been regularly inspected and found clean. Housing of the Working Classes Acts. In October I gave certificates, under the above Acts, for closing orders for 11 houses in Crayford Road. The work required to put them into proper sanitary condition was afterwards done, and further proceedings were unnecessary. Factories and Workshops. The Factories and Workshops in the district have been regularly inspected and found in proper sanitary condition. Factories—Offensive Trades. The various Factories, viz.:—Fish Guano, Chemical Manure, Fat Extraction, Tallow Melting, &c., have been kept under constant inspection and found in satisfactory condition. Inspections. I have, with the Inspector of Nuisances, made various inspections of property during the year, 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 good 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. 7 Work done by and under the supervision of the Inspector of Nuisances. Inspections and Re-inspections made Constant Notices served to abate Nuisances 25 „ ,, „ „ and connect to main sewer 36 Letters written re Nuisances, &c. 79 Notices to lay water on w.c.'s 2 Reports made to Council and Committee 12 Other Inspections. Cowsheds, Dairies and Milkshops Frequently Slaughter Houses 36 Factories and Noxious Vapours 150 Fish. No. of Boxes of Fish condemned and destroyed 7 Infectious Disease. No. of Cases enquired into 241 ,, „ removed to Hospital 149 „ Houses disinfected after disease 182 House Refuse Removal. No. of loads removed 5,490 Cesspool Emptying. No. of Cesspools emptied 464 ,, ,, Loads of sewage removed 2,766 „ ,, Gallons ,, ,, 1,106,400 A. SAUNDERS, Inspector of Nuisances. TABLE I. Vital Statistics of whole District during 1908 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 the District. Number. Rate. Under I year of age At all Ages. Number. Rate per 1,000 Births registered. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 I I I 2 13 1898 19,824 673 3 2 .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 13.20 1902 25,296 943 37.27 98 103.92 306 12.09 11 I I 326 12.88 1903 26,895 1,407 38.93 98 93.60 286 10.63 8 8 278 10.33 1904 27,582 916 33.21 121 132.09 326 1 I.8I 18 10 316 11.45 I905 29,700 900 30.30 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 1907 28,481 852 29.91 72 84.50 215 7.54 23 13 202 7.09 Averages for years J898-I907 25,846.1 886.7 34.30 105.3 118.75 307.4 11.89 14.0 300.9 11 .64 1908 28,986 750 25.87 60 8o.oo 245 8.45 10 4 241 8.31 . 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 At Census Average number of Persons per House 5.89 of 1901. Area of District in acres (exclusive of area covered by water) 31859.513 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 Bow Arrow Hospital for Infectious Disease, Dartford. Erith Sanatorium, Little Heath, for Infectious Diseases. TABLE II. Vital Statistics of Separate Localities in 1908 and previous years. Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year 1898 19,824 67 3 362 135 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 1905 29,700 900 281 80 1906 30.331 911 273 78 I907 28,481 852 202 72 Averages of Years 1898 to 1907. 25,846.1 886.7 300.9 105.3 1908 28,986 750 241 60 TABLE III. Cases of Infectious Disease notified during the year 1908. Notifiable Disease. Cases Notified in whole District. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages. Years. Under I. 1 to 5. 5 to 15. 15 to 25. 25 to 65 65 and upw'ds. Diphtheria 60 I 18 39 I I 39 Erysipelas 14 1 I 11 1 Scarlet Fever 140 36 94 7 3 105 Enteric Fever 13 3 6 4 5 Puerperal Fever 2 2 Phthisis 12 1 3 8 Totals 241 2 55 137 17 29 I 149 ■ TABLE IV. Causes of, and Ages at, Death during Year J 908. Causes of Death. Deaths at the subjoined ages of " Residents " whether occuring in or beyond the District. 1'otal Deaths whether of " Residents " ur " NonResidents " in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under I5. 15 and under 25. 25 and under 65. 65 and upwards Measles 6 i 5 Whooping-cough 8 5 2 I Diphtheria & Membranous Croup 8 5 3 3 Epidemic Influenza 10 1 1 1 4 3 Diarrhoea 5 4 1 Enteritis 5 4 i Puerperal Fever 2 2 Phthisis, (Pulmonary 22 2 7 12 i culosis) Other tuberculous diseases 12 3 6 3 Cancer, malignant disease 15 7 8 Bronchitis 20 7 3 6 4 Pneumonia 12 1 6 4 1 Other diseases of piratory organs 3 1 1 1 Alcoholism 1 1 Cirrhosis of liver Premature birth 12 12 Heart diseases '7 4 9 4 i Accidents 10 1 3 4 2 i Suicides 2 2 2 All other causes 71 21 5 2 3 20 20 i All causes 241 60 35 16 13 72 45 10 TABLE V. Infantile Mortality during the Year 1908. 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 11 I 5 2 19 7 8 5 4 2 4 3 1 I 6 60 Uncertified Common Infectious Diseases Chicken-pox I 1 Measles 1 j Whooping Cough 1 1 3 5 Diarrhoeal Diseases. Diarrhoeal, all forms 1 2 I 1 Enteritis, 4 teritis, Gastro-enteritis 1 Gastritis, 2 intestinal Catarrh 1 1 2 Wasting Diseases. Premature Birth 8 2 I 11 1 12 Congenital Defects 1 1 1 2 Atrophy, Debility, Marasmus 2 2 I 5 2 1 3 I 1 1 14 Tuber- culous Diseases Tuberculous Meningitis 1 Tuberculous Peritonitis 1 I Tabes Mesenterica 1 Other Tuberculous 1 Diseases 1 1 Convulsions 1 1 2 1 1 4 Bronchitis. 1 2 1 I I I 7 Laryngitis I 1 Pneumonia 1 1 Other Causes 1 1 Total 11 I 5 2 9 7 8 5 4 2 4 3 1 1 6 60 Population estimated to middle of 1908 8986 Births in the year 736 Illegitimate Deaths in the year legitimate Infants 56 Illegitimate Infants Deaths from all Causes at all Ages ER15 URBAN DISTRICT OF ERITH. Annual Report of the Medical Officer of Health, FOR THE YEAR 1908. ERITH URBAN DISTRICT COUNCIL, Offic es BEXLEY ROAD, ERITH, KENT. R. H. Starkey The Randal Press, Erith. 3154.