ER 1006 Urban District of Erith. ANNUAL REPORT of the Medical Officer of Health and School Medical Offcer For the Year 1913, by A. E. JERMAN, M.B., D.P.H. Public Health Committee, 1913. Chairman—Councillor A. U. Fletcher. Councillor Bayley. Councillor Histed. ,, Buckley. „ Reeves. ,, Dunk. ,, Wilson. Staff. Medical Officer of Health— A. E. Jerman, M.B., D.P.H. Inspector of Nuisances— D. B. Davies, A. R. San. Inst. Assistant Sanitary Inspector— T. Vaughan, A. R. San. Inst. Education Committee, 1913. Chairman—Councillor Martin. Vice-Chairman—Councillor Abbott. Councillor Buckley. Councillor Kibblewhite. „ Dunk. „ Ling. ,, Histed. „ Matthews. Councillor Stubbs. Co-opted Members. Mrs. F. J. Beadle. Mr. W. Charlesworth. ,, Flack. ,, L. Dyer. Mr. H. Ayling. „ H. A. Pilcher. Council Offices, Erith. March 19th, 1914. To the Chairman and Members of the Urban District Council of Erith. Gentlemen, I have the honour to submit to you my Annual Report for the year 1913 in accordance with the Regulations of the Local Government Board. As you are all aware, on the death of Dr. Baddeley, who had been for some years the Medical Officer for the Education Committee, it was decided to reorganise the arrangements for the public health, and school medical services, and to appoint one Medical Officer to devote his whole time to the work of the Council, and act as Medical Officer of Health, School Medical Officer, and Medical Superintendent of the Sanatorium for Infectious Diseases. This arrangement came into force on April 1st, and on that date I took up my duties as a whole time Officer. The present report is somewhat different in its arrangement from previous ones, being based on the scheme outlined in a Memorandum from the Medical Officer of the Local Government Board to Medical Officers of Health on the preparation of their Annual Reports for 1913. My report as School Medical Officer on the work done in that capacity is based on the lines indicated in the Circular No. 596 of August, 1908, issued by the Board of Education. I am, Gentlemen, Your obedient Servant, A. E. Jerman. Annual Report for 1913. A.—Natural and Social Conditions of the District. (1) Physical Features and General Character of the District. The Urban District of Erith is situated on the south bank of the River Thames, immediately outside the County of London, which forms the western boundary; on the eastern side is the parish of Crayford, and south of it is the Urban District of Bexley. The District is one of the towns included in the "Outer Ring," which makes up " Greater London." The northern portion of the District, which lies between the River Thames and the South Eastern and Chatham Railway line, is 1,689 acres in extent, and consists of marsh land, the level of which varies generally between 3 and 7 feet above ordnance datum, and is below that of high water in the river. The remainder of the District rises gradually towards the south to a height of approximately 200 feet above sea level. (2) Population. At the Census of 1911 the population was found to be 27,750, made up of 14,143 males and 13,607 females. The number of inhabited buildings was 5,129, and the number of separate occupiers, 5,897. The average number of persons per inhabited building was 5.41, as compared with 4.85 for all Urban Districts (excluding London, and the County Boroughs) and 5.05 for the whole of England and Wales. The average number of persons per family was 4.71 for all dwellings, and 4.65 for ordinary dwelling-houses, as compared with 4.55 and 4.43 for all Urban Districts, and 4.51 and 4.38 for the whole of England and Wales. The number of vessels lying in the River Thames in the District at the date of the Census was 30, with 153 inhabitants, and the number of persons enumerated in tents, vans, sheds, etc., was 100, viz.: 51 males and 49 females, occupying 23 such erections. The following table is taken from Vol. VI of the Census Returns for 1911, and shows the number of buildings in the District, kind of building, and the number of inhabitants:— 6  1901. 1911. Buildings used as Dwellings. Vessels, Vagrants, Sheds, &c. Separate Flats included in Col, 5. Buildings not used as Dwellings. Total. (cols. 4-11) Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels. Inns & Public Houses Offices, workps fact'r's &c. Institutions. Others. Kind of Building No. Col. 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 Number inhabited 4,291 5.129 4,654 46 357 38 8 10 16 — 102 Places of Worship Govt. & Municipal 18 Separate Occupiers 5,135 5,897 5,275 115 382 38 8 10 16 53 115 Buildings 3 Shops 29 Population 25,296 27,750 24,538 582 1671 210 35 417 44 253 582 Offices 6 Uninhabited 96 507 447 — 60 — — — — — 30 Warehouses, Workshops & Factories 26 Being built 158 15 14 — 1 — — — — — — Theatres, and other places of amusement 2 7 In Vol. VII of the Census Returns are tables showing the number of persons enumerated at the Census for each year of age up to 20, and in quinquennial groups, and the numbers of persons married, single and widowed, and these have been inserted here for the information of those interested. Table showing number of persons enumerated at. each year of age up to 20, and in quinquennial groups, at Census of 1911: — Males. Females Males. Females Under 1 year. 305 341 Under 5 years. 1,701 1,659 1 year 309 309 5 and under 10 1,797 1,870 2 years 341 320 10 ,, 15 1,658 1,564 3 „ 361 343 15 ,, 20 1,248 1,098 4 ,, 385 346 20 ,, 25 976 919 5 ,, 364 357 25 ,, 30 996 1,018 6 ,, 345 393 30 ,, 35 1,083 1,032 7 ,, 367 368 35 ,, 40 1,151 1,070 8 ,, 356 383 40 ,, 45 927 886 9 ,, 365 369 45 ,, 50 796 756 10 „ 363 318 50 ,, 55 562 508 11 „ 357 339 55 „ 60 403 373 12 ,, 333 320 60 ,, 65 291 296 13 „ 312 296 65 ,, 70 211 232 14 293 291 70 ,, 75 170 159 15 „ 267 247 75 ,, 80 120 91 16 ,, 280 230 80 ,, 85 39 48 17 „ 224 226 85 ,, 90 11 24 18 ,, 248 205 90 „ 95 3 4 19 „ 229 190 95 and over — — 20 ,, 223 198 Total all ages 14,143 13,607 Table showing condition as to marriage of the population of the District at the Census in 1911:— Persons. Males. Females. Females 15-45 yrs. Unmarried 15,997 8,399 7,598 2,319 Married 10,653 5,312 5,341 3,610 Widowed 1,100 432 668 94 In 1912 I estimated the population at the middle of the year to be 28,073 persons, this figure being obtained by the Registrar General's method of calculation. For the year 1913, the population calculated by the same method would be 28,338, but I believe that this figure is too low. At the time of the Census, there were 5,129 8 inhabited dwellings, and 507 uninhabited. Since that date 41 new houses have been certified as fit for human habitation up to the end of 1913, and the majority of houses empty then have been occupied; allowing 100 as still unoccupied, and this is an outside figure, there would be in the middle of 1913 approximately 5,577 inhabited houses. If each of these had an average of 5.4 persons inhabiting it the population at the middle of the year would have been approximately 30,100, and believing this estimate to be much nearer the truth than the one mentioned above, I have taken it as the basis for the statistics for the year. The majority of the population in the district are employed at one or other of the Factories established here; these comprise factories in which are carried on : cable making, gun making, oil refining, manufacture of mining and other machinery, and manufacture of asbetos and cement slates and slabs. A small number are engaged in agricultural and horticultural pursuits. B.—Sanitary Circumstances of the District. (1) Water Supply. This is obtained from the Metropolitan Water Board. The water is very hard, but otherwise of good quality, and the supply is ample for the requirement of the district. (2) Drainage and Sewerage. The main portion of the sewage of the District is carried by a sewer which was completed and opened in 1898. This sewer consists of two portions; one taking the sewage from the low-lying part of the District, and running from the western boundary near Abbey Wood Railway Station to Erith. This portion is worked by the Shone Pneumatic System, the ejectors being situated about every half mile throughout its length, and being worked by compressed air from the Outfall works at Anchor Bay. The remaining portion of the sewer brings the sewage from the upper part of Belvedere and from Northumberland Heath; no ejectors are required on this section, as the fall is sufficient to maintain a good flow and keep the sewer clean. 9 The Sewage Outfall Works are situated at Anchor Bay, at the eastern end of the District, and here the sewage is treated by means of septic tanks, aeration beds and percolating filters, the effluent being discharged into the River Thames. There are 5 percolating filters with revolving distributors, and during the year an additional one has been commenced, and is now approaching completion. The plant at the Works consists of:— 1 50 h.p. gas engine, working air compressors. 1 45 h.p. electrically driven air compressor. 2 Gin. and 1 4in. electrically driven centrifugal pumps for lifting the effluent from the septic tank to the filters. 1 4in. electrically driven portable pump for lifting sludge, and "Pressure" gas producing plant in duplicate for working the gas engine. During the year acres of land were purchased by the Council on the west side of the Sewage Disposal Works, for the purpose of future extension when necessary, after an enquiry by one of the Engineers of the Local Government Board. The Port of London Authority periodically take samples of the effluent from these Works for the purpose of Analysis; but for many years past there has been no complaint made as to the quality of the effluent discharged into the River Thames. There are still a few houses in Erith connected to an old brick sewer, which discharges direct into the River Thames. As opportunity arises, these houses are gradually being disconnected from this old sewer, and after reconstruction of the drainage, connected to the new sewer; 17 houses were so connected during 1913. There are a number of houses situated on the Marshes where no sewer is available for their drainage, and these are, in the majority of cases, drained into cesspools. At the upper portion of Abbey Wood there are also a number of houses drained into cesspools owing to there being no sewer available. All these cesspools are emptied by the Council when necessary, on notice of the same being given by the tenant of the house. 10 During the winter and wet weather the cesspools on the Marshes are a constant source of trouble and nuisance. Not only does the condition of the Marshes render it extremely difficult, and sometimes almost impossible for the cesspool emptying vans to reach those spots where the cesspool matter may be deposited, but in many cases the cesspools are not water-tight, and when the marsh ground in waterlogged, the cesspools, after being emptied, rapidly fill again with marsh water through the cracks in the sides and bottoms of the cesspools. During the year 25 houses were re-drained and connected to the new sewer, which before then had been drained into cesspools. (3) Closet Accommodation. The large majority of houses in the District are provided with water-closets of the wash-down type, the sewage passing either to the sewer or cesspools. Eight houses in the District are provided with earth closets, six of these being on the Marshes, the other two being so situated that it was impossible to construct water-closets and connect them to the main sewer owing to the difference in level. Some of the larger factories situated on the Marshes have a system of earth closets, and most of the smaller ones are similarly provided. (4) Scavenging. House refuse is collected by the Council throughout the District twice a week. The Council's Bye-laws require that occupiers should place the refuse in proper sanitary dustbins, with covers, either on the kerb or in the forecourts of the houses, or in cases where there is at the backs of the houses a passage-way sufficiently wide to admit a cart, the receptacle may be placed near the door in the garden leading into the passage. The refuse is deposited on various shoots at Anchor Bay and on the Marshes, there being no dust destructor. A man is employed on these shoots to collect and burn all refuse which can be consumed in this manner, such as paper, etc. During the year the number of loads of refuse removed was 6,350, as compared with 5,998 in 1912, and 5,549 in 1911. A statement showing the number of 11 houses found to be without proper sanitary dustbins will be found under the heading "Housing," and in the table attached. (5) Sanitary Inspections of the District. The following tables have been prepared by the Inspector of Nuisances, and summarise the matters dealt with during the year:— Inspections made during the year. Houses visited for the detection of nuisances 768 Houses inspected under the Housing and Town Planning Act 1236 Slaughterhouses 70 Cowsheds, dairies and milkshops 42 Workshops 44 Outworkers' premises 8 Bakehouses 24 Offensive trades 50 Vans, tents and sheds used for human habitation 86 Complaints enquired into 162 Result of above Inspections. Nuisances detected 461 Preliminary notices served to abate nuisances 238 Statutory notices served to abate nuisances 134 Nuisances abated 363 Notices issued in respect of vans, tents and sheds 4 Notices complied with 4 Notices issued under the Dairies, Cowsheds and Milkshops Order 3 Notices complied with 3 Notices issued under the Factory and Workshops Act 3 Notices complied with 3 Notices issued to provide proper receptacles for house refuse 550 Notices complied with 397 Notices issued to properly pave and drain yards... 207 Notices complied with 139 Number of prosecutions 4 Nuisances. Showing the number and nature of the nuisances dealt with during the year by notices served under the Public Health Acts:— 12 Defective and choked drains 135 To repair damp and dilapidated dwellings 76 To pave yards 27 To provide and repair w.c. flushing cisterns 18 To provide water to w.c. cisterns 23 To repair rainwater guttering and downpipes 33 To remedy insanitary water cisterns for domestic use 27 To repair scullery sink wastes 65 To provide manure receptacles and drainage for stables 4 To cleanse and remedy insanitary urinals 4 To remove foul accumulations 23 To prevent overcrowding 4 Animals, fowls, etc., so kept as to be a nuisance 13 To cleanse dwelling houses 19 461 Complaints. 162 complaints were received during the year, as compared with 131 in the previous year. Each complaint was investigated, and the list shows the nature of the nuisances found:— Defective and choked drains 54 Cesspools overflowing 7 Insanitary urinals 2 Dirty houses 8 Damp and dilapidated premises 28 Re water supply 5 Overcrowding of premises 7 Back yards in bad state of repair 2 House refuse not collected 19 Accumulation of filth, fish offal, etc 14 Animals improperly kept 8 Absence of stable drainage 2 Re caravan dwellers 2 Smoke nuisance 2 Re sanitary conveniences in Factories 2 162 13 Infectious Disease. Number of cases enquired into 254 Number of cases removed to Sanatorium 140 Number of cases removed to Bow Arrow Hospital 7 Number of houses disinfected 168 Food Inspection. The following were surrendered to me as unfit for human consumption: — 3 Boxes of Fish (2 of herrings and 1 of witches). 1 Box of Kippered Herrings. 2 Bags of Shell Fish (winkles). No Tuberculous meat was detected during the year. Cleansing. Number of cesspools emptied 449 Number of loads of sewage removed 2697 Number of loads of house refuse removed 6350 Housing and Town Planning Act, 1909. Owing to a number of houses, which had been already inspected under the Inspection of District Regulations, being found on re-inspection to have had nothing done to them to remedy the defects found, I was instructed to re-inspect them, and where possible to serve statutory notices under Section 94 of the Public Health Act, 1875. The following is the result of those inspections:— Number of houses inspected 510 Number of houses where defects had been remedied 134 Number of houses where work was being done 225 Number of houses where nothing had been done 151 Number of houses where nuisances existed 87 Number of statutory notices served 76 Number of statutory notices complied with 47 Number of statutory notices not complied with 15 Number of statutory notices served where the work is being done 14 Prosecutions. Four persons were proceeded against during the year for infringement of the Council's Bye-laws relating to Tents, Vans and Sheds used for human habitation. In all four cases the defendants were ordered to pay the costs. 14 Overcrowding. Seven complaints were received during the year that houses were overcrowded. These were all investigated, and in four instances overcrowding was found. Notices were served in each of these cases, and were complied with. (a) The house consisted of G rooms; 3 living and 3 sleeping rooms. The number of occupants were 2 families; husband, wife and 4 children, and mother and six children, a total of 14 persons. (b) The house consisted of 7 rooms; 3 living and 4 sleeping rooms. Three familes occupied it; husband, wife and 5 children; a mother and two sons; an old man and his nephew; total of 12 persons. (c) The house consisted of 4 rooms; 2 living and 2 sleeping. Occupiers: 2 families; husband and wife and 2 female lodgers; husband and wife six children; total 12 persons. (d) The house consisted of 2 rooms, occupied by 2 families. The exact numbers of each family could not be ascertained, but the house was overcrowded. (6) Premises and Occupations which can be controlled by Bye-laws and Regulations. Tents, Vans and Sheds. There are a number of vans and sheds situated on the Marshes at Abbey Wood which are permanently occupied by persons carrying on the trade of hawkers. In former years the numbers of these have been augmented at various periods of the year by others, who are occupied in fruit and hop-picking during the summer and autumn. Numerous complaints have been received from time to time as to the insanitary conditions under which these people exist, and some of them have been prosecuted for breach of the Council's Bye-laws with success. During the past year these vans have been very frequently inspected, and in three cases the occupiers were prosecuted for breach of the Bye-laws, a conviction being secured in each case. The effect of the rigorous inspection carried out and of the prosecutions has been a material improvement in the mode of life and the surroundings of those people permanently located at this place. 15 The action of the South Eastern and Chatham Railway Company in closing and locking the gates of the Railway Crossing giving access to the land on which these vans are, and only allowing keys to approved persons, has very greatly assisted the Council in this matter, and has prevented this year the immigration of several vans and their occupiers. Factories, Offensive Trades. In 1911, Section 51 of the Public Health Acts Amendment Act, 1907, was adopted in the District, and in July, 1912, the Council made an Order declaring each of the following trades and businesses to be an Offensive Trade, viz.:—Blood-drier, Tanner, Leather Dresser, Fat Melter or Fat Extractor, Glue Maker, Size Maker, Gut Scraper, Fish Frier, Manufacture of Manure from Fish, Fish Offal, Blood or other putrescible Animal Matter, and the Manufacture of Animal Charcoal. The Bye-laws regulating the carrying on of these trades were revised, and afterwards received the consent of the Local Government Board, and these are now in force in the District. The trades of this description at present carried on in the District are those of Fish Frier, Fat Melter, Fat Extractor, and the Manufacture of Manure from Fish and Fish Offal. The various premises at which these trades are carried on have been periodically inspected during the year, and have been found satisfactory on each occasion, so that no notices of any kind whatever have been necessary. (7) Schools. See annual Report of School Medical Officer. (8) Food. (a) Milk Supply. There are 11 cowsheds in the occupation of 5 cowkeepers, and 23 dairymen and purveyors of milk registered in the District. There are about 70 cows, and these have been regularly inspected by the Veterinary Surgeon appointed by the Council. This gentleman furnishes a report quarterly to the Council, and during 1913 no case of tuberculosis was found among the cows. During the year the cowsheds, dairies and milkshops have been regularly inspected, and have on the whole 16 been found in satisfactory condition. Three notices were served under the Dairies, Cowsheds and Milkshops Order; one to limewash buildings, and repair the floor and open channel; one to provide proper lighting and ventilation ; and one to limewash buildings. Samples of the milk sold in the District are taken by the Inspector of the Kent County Council, and out of 62 samples taken during the year, 9 were found to be slightly deficient in some way, and 1 sample was so much adulterated that the vendor was fined £5 and costs on prosecution. (b) Slaughter Houses. There are 3 Slaughter Houses on the Register, these have been regularly inspected, and found in a clean and satisfactory condition. These inspections have been made both at times when slaughtering is in progress and at other times, but no tuberculous meat was found during the year. The animals slaughtered in the District have been in good condition, and have produced meat of good quality. (c) Bakehouses. There are 14 Bakehouses in the District, none of them being under ground. One has not been in use during the year. They have been kept under regular inspection, and with one exception have been found clean and satisfactory; in this case notice was served to limewash walls and ceilings, and was complied with. (d) Other Food. The following fish were surrendered to the Inspector of Nuisances during the year as unfit for human consumption:— 3 boxes of fish (2 herrings, and 1 witches). 1 box of kippered herrings. 2 bags of shellfish (winkles). (e) Sale of Foods and Drugs Acts. The Local Authority for the administration of these Acts is the Kent County Council. I have obtained from the Clerk to the County Council a return showing the number of samples taken by their Inspector in this District during 1913, with the result of the examination of the samples and any subsequent action taken in connection therewith. The return shows that 116 samples were taken, as compared with 84 the previous year 17 One sample of milk contained 22.1 per cent. of added water, and the Vendor was prosecuted, and fined £5. A Table is attached showing number and description of samples taken during 1913. Article. No. of Samples taken. Genuine. Doubtful. Adulterated. Cautioned. Convicted. Remarks. New Milk 62 52 9 1 9 1 (a) 4 samples were slightly below the legal limit for fat. (b) 4 samples slightly below limit for non-fatty solids. (c) 1 sample slightly deficient in both fat and nonfatty solids. (d) 1 sample contained 22.1 percent. of added water. The vendor was prosecuted and convicted, penalty £5 and 11s. costs. Skimmed Milk 5 4 1 1 Slightly deficient in nonfatty solids. Butter 26 24 2 2 (a) 1 sample contained 3.3 per cent. excess of water. (6) 1 sample contained .5 per cent. excess of water. Lard 3 3 Whiskey (Irish) 4 3 1 1 1.67 degrees below legal limit. ,, (Scotch) 2 1 1 1 .70 degrees below legal limit. Brandy 1 1 1 .32 degrees below legal limit. Rum 1 1 Gin 1 1 Margarine 1 1 Flour 1 1 Ground Bice 1 1 Fine Oatmeal 1 1 Coffee 1 1 Mustard 1 1 Malt Vinegar 1 1 1 Slightly deficient in acetic acid. Cream 2 2 2 (a) 1 sample contained .5 per cent. of Boric Acid declared on label in accordance with Milk and Cream Regulations 1912. (b) 1 sample contained .16 per cent. Boric Acid = 11 grains per pound. Cream of Tartar 1 1 1 Slightly below limit allowed by British Pharmacopoeia. Demerara Sugar 1 1 Totals 116 96 19 1 19 1 18 (9) Housing. The majority of the houses in the District are cottages containing 4 or 6 rooms, some built in terraces, some in flats of two stories, while others are detached or semi-detached. A very great number of these have been built in recent years in accordance with the bye-laws of the Council, and these have ample airspace both at back and front. Some of the older houses, however, are somewhat cramped at the backs. In 1900 the works in the District were very busy, and practically every house in the District was occupied, while building proceeded rapidly to supply the demand for houses by the workmen who came to the District. Towards 1906, however, slackness of work, and labour troubles caused the emigration of a large number of workmen, and at one time about 750 of these cottages were empty. At the time of the Census in 1911, there were 447 uninhabited houses, the large majority of them being cottages. Since then, however, there has been a revival of trade in the District, and at the middle of 1913 there can have been only a few houses empty. At the present time the accommodation provided in the District seems to be equal to the demand made on it; should, however, any more works or factories be established in the District, with a corresponding influx of workmen, the men would have some difficulty in obtaining suitable houses. Before the depression in trade occurred, many men were buying their own houses, through Building and other similar Societies, and when the bad times came they were unable to keep up their payments, and were obliged to sell at a loss. In many other cases houses which had stood empty for some time were taken over by the mortgagees, as the man who built them was unable to keep the interest paid up regularly. The effect of all this was to stop any building in the District, and it is only in the last two years that builders have regained confidence, and have started to build again. During the year 1,236 houses were inspected; 437 were found to have some defect in the water supply, 263 in closet accommodation, 351 in drainage, 326 in 19 tion; 454 had some evidence of dampness, 221 were dirty, in 534 the yard paving was in bad condition, in 486 there was some defect in the disposal of house refuse, while in 938 there was some defect other than those specified. As the result of these inspections, preliminary notices were served in 1,142 cases, pointing out the defects noted at the time of inspection, and requesting the owner to have them remedied. In the majority of cases the work necessary was carried out. If, on re-inspection, it was found that no steps were being taken to remedy defects, where it was possible, statutory notices were served. Wherever notices were served, re-inspection was carried out, some houses having to be visited on 3, 4 or even more occasions. The total number of visits of re-inspection made was 1,944. The result of the notices was that 603 houses had had the defects remedied by the end of the year, 37 were in course of repair, while in 502 nothing had been done. At the end of 1912 there were 144 houses which were inspected during that year, where nothing had been done to remedy the defects found. During 1913 these houses were re-inspected, and in 110 the necessary work was carried out. In the remaining 34 the defects were of quite a minor character, and such as not to constitute a nuisance, or to be in any way detrimental to the health of the tenants. Number of houses inspected 1,236 Number of houses which were considered to be in such a state, or so dangerous, or injurious to health as to be unfit for human habitation 19 Number of houses represented 19 Number of Closing Orders made 14 Number of houses in which defects were remedied without a Closing Order 645 Number of houses which, after the making of a Closing Order, were put into a state fit for human habitation 8 Number of Orders for Demolition made 3 Number of Orders determining Closing Orders 10* * Two of these have reference to houses where Closing Orders had been made in previous years. As a rule the owners of property in the District have proved quite ready and willing to do such work as is necessary to keep their houses in good condition. In a 20 good many cases the dilapidations are due to the tenants themselves, and houses which have been put into good condition have become in a short time almost as bad as before through the carelessness and dirtiness of the tenant; soap and water are cheap enough, but in many cases the use of them seems to be regarded as superfluous. Nineteen houses were represented by me as unfit for human habitation, and Closing Orders were made in 14 cases. Houses Represented. Whether C. O. made or not. Result. Orient Cottages, 7 Houses C.O. made Houses thoroughly renovated 9, High Street C.O. made House thoroughly renovated 95, 95a and 97, High Street C.O. made Demolition order made Bedonwell Road C.O. made House demolished Abbey Wood Marshes (2 huts) C.O. made Albert Road (4 houses) C.O. not made Houses renovated by owner University Place (1 house) C.O. not made Owner has agreed to do necessary work. In addition to the above houses a number of houses which were dilapidated have been put into good repair by the owners on their attention being called to the defects by letter. These were not considered to be unfit for habitation, but their condition was such as to be seriously detrimental to the health of the tenants, or to be a nuisance. A table showing the Inspections made under the Housing (Inspection of District) Regulations of the Local Government Board is appended, which also shows the defects found and number of notices served. Water Supply. In 437 houses, some defect in this was found. In the large majority of these cases the drinking water was obtained from a cistern which had no proper cover to prevent the access of dust to the water; in many cases also the cistern was found to be fixed in an unsuitable position, such as in an outhouse communicating with a water closet, in the floor of a bedroom, or so close to the ceiling of a scullery that it was impossible to obtain ac- 21 cess to it for the purpose of cleaning it out. The Metropolitan Water Board require every house supplied by them to be provided with a storage cistern, but it is always advisable for a house to have in addition, a tap supplying water direct from the main, so that drinking water, or water used in the preparation of food need not pass through the cisterns. These cisterns should always be so fixed as to be easily accessible for cleaning, they should be cleaned out regularly and covered with a closefitting dust-proof cover. Cases were noticed where a few loose boards were placed on the top of the cistern, and where there was a thick, dirty deposit in the cistern, which had not been cleaned out for months. Closet Accommodation. In 263 houses some defect was found in respect of closet accommodation. In the majority of cases the defect lay in the flushing apparatus, the flushing cistern being out of order in some cases, and in others there; being a leaking joint between the flushing down pipe and the pan. In still other cases the pan was cracked and leaking, and in others again there was no flushing apparatus at all, the closets being flushed by hand. In a certain number of cases the building itself was in a dilapidated condition. Drainage. There was some defect in the drainage in 351 houses. In most cases the defect was of a minor character, such as the absence of the mica flap in the fresh-air inlet pipe. In some cases the top of the fresh-air inlet was broken off and the pipe filled up with rubbish; in a few cases the joints of the upcast ventilating shaft were not properly made, allowing escape of drain air, and in others the iron cover of the inspection chamber was broken. In some cases the drain was choked, and sewage accumulated in the inspection chamber and the whole of the drains. Ventilation. In 326 houses there was some defect in the ventilation. In every case this defect was in the ventilation of the space under the ground floor. Some houses were found to have no means of ventilating this space, while in others the air-bricks or gratings were broken and blocked up with earth or rubbish. 22 Dampness. There was dampness to some appreciable extent found in 454 houses. In some cases this was due to the porosity of the bricks used, the aspect of the outer walls, and the want of pointing. In other cases it was due to defective guttering and down pipes, which allowed the rain-water from the roof to run down the walls. Other cases again were caused by defective slates in the roof, while in some of the older houses the damp was due to absence of a proper damp-proof course above the foundations. Condition of Yards, etc. In 534 houses The yards at the back were found to be unpaved, or to have the paving broken and defective, or to be so laid as not to have a proper and sufficient fall to carry off the surface water. As the Council have adopted Section 25 of the P.H. Acts Amendment Act (1907), it was possible, when a preliminary notice failed to result in the defects being remedied, to serve a statutory notice under this section; 207 such notices were served, and by the end of the year 139 had been complied with. Disposal of Refuse. In each of the 486 cases where there was a defect in this matter, it was due to the absence of a proper sanitary dust-bin with cover. Various kinds of substitutes were in use, buckets, zinc baths, pails, and wooden boxes, none of them being provided with a properly fitting cover; 550 notices were served to provide proper dustbins, and in 397 cases were complied with. Other Matters. In 938 houses some defect was found which could not be classified under any of the preceding heads. These were of various kinds; sink waste-pipes either not discharging into a proper gulley, or broken off at the point where they issued through the wall, and allowing the waste water to run down the wall; defective kerbs to gulleys; absence of rain-water guttering; defects in floors, wooden or paved; dilapidated walls, plaster, and ceilings; and broken or defective window frames and doors. 23 (10) Workshops, Workplaces, etc. There are 90 workshops and workplaces on the Register, which is required to be kept by the Local Authority, but of these a number are " Domestic " workshops, i.e., only members of the family are employed. These have been inspected during the year, and in 3 cases it was found necessary to serve notice to remedy some defect. One notice referred to overcrowding in the workshop, one notice required the lime-washing of walls and ceiling, and the third required the remedying of a defective sanitary convenience. They were all complied with. Eight lists of " Outworkers " were received from other Local Authorities, but none from employers in the District; the premises occupied by these outworkers have been inspected, and found satisfactory in every case. C.—Sanitary Administration of the District. (1) Staff ; Work of Inspector of Nuisances and other Officers engaged in Sanitary Work. The Staff consists of myself as Medical Officer of Health, Medical Officer in charge of the Sanatorium for Infectious Diseases and School Medical Officer; D. B. Davies, as Inspector of Nuisances, he holds the certificate of the Royal Sanitary Institute as Inspector of Nuisances, and for the inspection of Meat and other foods; T. Vaughan as Assistant Sanitary Inspector, he holds the same certificates, and his duties have been chiefly the inspection of houses under the Housing and Town Planning Act, 1909; no Clerk is provided, and this necessitates the Inspectors themselves doing the clerical work of the department, which could be equally well done by a Clerk, an arrangement which would relieve the highly-trained Inspectors, and give them more time for their own special duties. (2) H ospital Accommodation. The Sanatorium for Infectious Diseases is situated at Little Heath, Belvedere, near the centre of the southern boundary of the District. It consists of an administration block, one block of two wards (containing four beds each) for Diphtheria, and two wards (14 beds in each) for Scarlet Fever. These are all brick-built. 24 There is also an iron building containing 2 wards (for 8 beds each), but this is not in use at present, though it is kept in thorough repair so as to be available should an epidemic occur, and render the accommodation in the brick wards insufficient. In addition there are a porter's lodge, laundry and drying room, steam disinfector, mortuary and ambulance sheds. Two ambulances are kept, and a van for removal of infected bedding. No horses are kept at the Sanatorium, but are hired from a local contractor as necessity arises. The Staff at the Sanatorium consists of a Matron, 4 Nurses, with the necessary domestic staff, a laundress, and a porter, who resides in the porter's lodge. On January 1st, 1913, there were in the Sanatorium 15 patients, viz., 7 Scarlet Fever and 8 Diphtheria; during the year there were admitted 105 cases of Scarlet Fever, and 34 cases of Diphtheria, and there were discharged 89 cases of Scarlet Fever and 37 cases of Diphtheria. One case of Scarlet Fever and one of Diphtheria died in the Sanatorium. On December 31st there were in hospital 26 patients, viz., 22 Scarlet Fever, and 4 Diphtheria. In addition 2 cases were admitted which had been notified as suffering from Scarlet Fever, but were found to be suffering from Measles. One of these died on the second day after admission from Broncho-pneumonia. No patient who has been suffering from Diphtheria is discharged from the Sanatorium until a bacteriological examination of a swab taken from the throat, or from any discharge that may exist, shows that the Bacillus of Diphtheria is no longer present, at least two consecutive negative results being required. Table showing the number of patients treated during the year. Scarlet Fever. Diphtheria Total. In Hospital, January 1st, 1913 7 8 15 Admitted during year 105 34 139 Discharged „ „ 89 37 126 Died „ „ 1 1 2 In Hospital, December 31st, 1913 22 4 26 25 Table showing comparative returns of admissions during the past 10 years. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Scarlet Fever 74 107 90 102 107 122 84 78 50 105 Enteric Fever 9 1 16 2 Diphtheria 39 33 35 22 32 29 21 27 27 34 Total 122 141 141 126 138 151 105 105 77 139 Table showing period of detention in the Sanatorium of the cases under treatment there during 1913. Disease. Number of Patients. Total Number of days in Hospital. Average stay per patient. Diphtheria 38 2110 55.5 Scarlet Fever 90 3843 42.7 Diphtheria. Under 3 weeks 1 3-4 weeks 2 4-6 weeks 11 6-8 weeks 12 8-12 weeks 5 12 weeks and over 7 The longest period that a patient suffering from Diphtheria was detained was 21 weeks 1 day, and the shortest 3 weeks 3 days. Scarlet Fever. Under 5 weeks 13 5-6 weeks 36 6-8 weeks 31 8-10 weeks 6 Over 10 weeks 4 The longest period that a patient suffering from Scarlet Fever was detained was 11 weeks 2 days, and the shortest 3 weeks. (3) Administration of Local Acts or General Adoptive Acts in force in the District. The following adoptive Acts or portions thereof are in force in the District: — 26 The Infectious Diseases (Prevention) Act, 1890. The Public Health Acts Amendment Act, 1890. The Public Health Acts Amendment Act 1907 (Sections 19, 21, 22, 23, 25, 31 and 33 in Part II., and Section 51 in Part III.). (4) Chemical and Bacteriological Work during the Year. No laboratory is attached to the Public Health Department, but the County Laboratory, established at Maidstone, carries out any necessary bacteriological examinations. Under present arrangements each medical man practising in the District is supplied by the County Medical Officer with the necessary apparatus for taking swabs or blood, and when taken these are forwarded to Maidstone for examination. Reports on the results found are forwarded both to the medical man concerned, and also to myself as Medical Officer of Health, and at the same time fresh apparatus is forwarded to the medical man to replace the one used. During 1913, 184 swabs were sent for examination for Diphtheria Bacilli. Of these 16 were sent by Medical Practitioners, 4 with positive and 12 with negative results ; 11 were sent by myself from persons who had been in contact with cases of Diphtheria, and 2 were found to be harbouring the Bacillus in their throats, although they had no clinical symptoms of the disease. The remaining 157 were swabs taken from convalescent patients in the Sanatorium, 77 proved to be positive, and 80 negative. During the same period 17 specimens of sputum, and 1 of pleuritic effusion were sent up for examination for the presence of the Tubercule Bacillus; the result was positive in 6 cases, and negative in 11 cases where sputum was examined, and negative in the case of the examination of pleuritic fluid. D.—Prevalence of and Control over Acute Infectious Diseases. There were 176 cases of Infectious Disease (not including cases of Tuberculosis) notified during 1913, as compared with 141 in 1912. Of these 115 were Scarlet Fever, 38 Diphtheria, 11 Erysipelas, 10 Enteric Fever, and 2 Puerperal Fever. 27 Comparative returns of Infectious Disease notified during the past 10 years :— Disease. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Smallpox 1 2 Diphtheria 52 59 106 44 60 45 32 35 42 38 Membranous Croup 1 Erysipelas 33 29 35 19 14 18 20 19 21 11 Scarlet Fever 98 163 145 150 140 181 129 99 68 115 Enteric Fever 13 15 29 11 13 5 3 5 7 10 Continued Fever 1 Puerperal Fever 2 1 2 1 2 2 Chicken-pox 52 6 rnths. Poliomyelitis 1 199 269 316 224 229 249 185 211 141 176 Scarlet Fever. There were 115 cases of Scarlet Fever notified during 1913, as compared with 68 in 1912. Of these 79 occurred in children between 5 and 15 years of age, and 26 in children between 1 and 5. Two cases in children under 1 year old which were notified as Scarlet Fever proved to be measles, and these are not included in the above number. The large majority of these cases were notified during the latter half of the year, and the rise in the number of cases began in July and August, while the schools were closed for the summer holiday. One school was affected to a much larger extent than any of the others, but although several inspections were made of various classes in this school, for the purpose of detecting missed cases, no case was so found. At the Routine Medical Inspection, however, 1 child was found to have a slight rash which proved to be due to Scarlet Fever. The number of houses affected by the disease was 95 ; in 82 houses only one case occurred, in 8 two cases, in 3 three cases, and in 2 four cases. The attack rate for the disease was 3.82 per 1,000 of the population, as compared with 2.42 per 1,000 the previous year. Out of the 115 cases which occurred, 106 were removed to the Isolation Hospital for treatment, a percentage of 92.2. 28 One death occurred from the disease, which gives a death rate of .033 per 1,000, aud a case mortality of .87 per cent. In a number of cases which were notified, the child was found to be desquamating; no sore throat had occurred, and no rash had been noticed by the parents, so that no suspicion of the nature of the illness had been aroused until the child was found to be peeling. It is cases of this nature that cause the spread of the disease, and render it almost impossible to entirely prevent further cases. Return cases occurred in connection with 6 patients discharged from the Sanatorium. As stated in previous reports, it is impossible to eliminate these entirely. In an endeavour to prevent their being a source of infection, a leaflet is given to the parents or relatives of each case discharged from the Hospital, pointing out that it is a potential source of infection, and advising such precautions as may obviate trouble. Diphtheria. The number of cases of Diphtheria notified during 1913 was 38, as compared with 42 in 1912. Of these 20 occurred in children between the ages of 5 and 15 years, and 15 in children between 1 and 5. One case occurred in a child which had been taken to one of the London Hospitals, some days after its admission as an in-patient, and two cases were cases which presented no clinical symptoms, but were found on bacteriological examination to be harbouring the bacillus of Diphtheria in their throats, after contact with a case of clinical Diphtheria. The number of houses affected by this disease was 32; in 27 one case only occurred, in 4 two cases, and 1 in three cases. The attack rate for the disease was 1.26 per 1,000 of the population, as compared with 1.42 the previous year. The number of deaths was 3, which gives a death rate of .099 per 1,000, and a case mortality of 7.9 per cent. Thirty-four of the cases notified were removed to the Sanatorium for treatment, a percentage of 89.47. There were no return cases, a result due to the fact that before a case which has been suffering from Diph- Diphtheria 1912 and 1913. Scarlet Fever. 1912 and 1913. 29 theria is discharged from the Sanatorium the bacteriological examination of swabs taken from the throat must show a negative result on two consecutive occasions. Table showing the number of cases of Scarlet Fever and Diphtheria which have occurred in any particular school in 1913. School. Scarlet Fever. Diphtheria. Crescent Road 9 3 Manor Road 2 1 Central 3 3 St. Augustine's Road 33 4 St. Fidelis' 5 — Belvedere Boys' 1 1 All Saints' 16 7 Brook Street 2 1 Picardy 11 — Private and County 3 — Not attending any school 30 18 Totals 115 38 Enteric Fever. Ten cases of Enteric Fever were notified during the year with 2 deaths. Five cases occurred in children between 5 and 15 years of age, one between the ages of 15 and 25, and 4 between the ages of 25 and 45, and it was among the last four that the two deaths occurred. The death rate from Enteric Fever was .066 per 1,000, and the case mortality 20 per cent. The attack rate for the disease was .33 per 1,000, as compared with .24 in 1912. Seven of the cases mentioned above were all clearly connected with each other, four of them occurring in one family between February and April, one occurring in a next door neighbour, one in a girl who had been looking after some of the children in that family who were not ill, while the other case was that of a mother who nursed her child with an attack, which was thought to be diarrhoea, but in all probability was Enteric Fever, this child having been nursed by the girl above mentioned, before she became ill. The cause of the disease in the first case, 30 a boy of 12, could not be ascertained, but there was no history of any illness in any of the family previously which might have been Enteric Fever. In the other 3 cases, the origin of the disease could not be traced. Measles. This disease is not notifiable in the District, so that it is not possible to ascertain what number of cases occurred during the year. The disease was much less prevalent during the year 1913 than it had been the year before, and only 3 deaths occurred, one being that of an infant under 1 year of age, and two between the ages of 1 and 2 years. Whooping Cough. This disease was much less prevalent in 1913 than it had been in the previous year, and there were no deaths due to it. Mumps. This was very prevalent in the early part of 1913, but there were no fatal cases. E.—Prevalence of, and Control over Tuberculosis. On February 1st, 1913, all forms of Tuberculosis became notifiable under Regulations of the Local Government Board; before that, only Pulmonary Tuberculosis was notifiable. Pulmonary Tuberculosis has been notifiable in this District since July, 190G. At first this notification was voluntary, but in 1908 the Local Government Board issued Regulations making all cases of Phthisis in Poor Law Institutions or receiving Poor Law Medical relief, compulsorily notifiable. A further advance was made in 1911, when all cases of Phthisis attending a Hospital or Dispensary were made 31 compulsorily notifiable, while in January, 1912, all cases of Phthisis, whether in institutions or under the care of medical practitioners in private practice, were made notifiable. While voluntary notification was in force the number of cases notified was only very few, but after the introduction of compulsory notification, the number went up considerably. The number of notifications during each year since the adoption of voluntary notification is as follows: — 1906 1907 1908 1909 1910 1911 1912 1913 10 6 months only 16 12 14 24 43 59 63 Pulm. 17 other A table showing classification of notifications received during 1913, according to sex, age, and organ affected by the disease is shown on page 32. There were 27 deaths from various forms of Tuberculosis during 1913; of these, 20 were due to Pulmonary Tuberculosis, 4 to Tuberculous Meningitis, 2 to abdominal Tuberculosis, and 1 to General Tuberculosis. The death rate from all forms of Tuberculosis in 1913 was .89 per 1,000, as compared with 1.38 in 1912, and the rate from Pulmonary Tuberculosis was .66 per 1,000, as compared with 1.14 in 1912. On Page 33 is a table showing the deaths from Tuberculosis daring 1911, 1912, and 1913, classified according to sex, age, and organ affected. 32 Tuberculosis. MALES. FEMALES. Total M. & F. all Ages. 0-1 1-2 2—5 5-15 15—25 25—45 45-65 Ov. 65 Total all Ages. 0—1 1—2 2—5 5—15 15—25 25—45 45—65 Ov. 65 Total all Ages. Pulmonary 4 9 15 9 1 38 5 5 11 4 25 63 General 1 1 1 Meninges 3 3 3 Peritoneum, &c. 1 1 1 Cervical Glands 2 2 2 2 4 Spine 1 1 2 1 1 3 Hip joint 2 2 2 Kneejoint 1 1 1 1 2 Skin 1 1 1 Totals 1 3 11 10 15 9 1 50 10 5 11 4 30 80 33 1911. MALES. FEMALES. Total M. &F. all Ages. 0—1 1—2 2—5 5—15 15—25 25—45 45—65 Ov. 65 Total all Ages. 0—1 1—2 2—5 6—15 15—25 25—45 45—65 Ov. 65 Total all Ages. Pulmonary 1 2 5 1 9 1 1 3 3 8 17 Meninges 2 2 2 General 1 1 2 1 1 3 Peritoneum, &c. 2 2 1 i 1 3 5 Totals 3 3 2 6 1 15 2 1 2 3 4 12 27 1912. Pulmonary 1 11 7 1 20 4 7 1 1 13 33 General 1 2 1 4 1 1 2 6 Totals 1 2 2 11 7 1 24 1 1 4 7 1 1 15 39 1913. Pulmonary 2 2 5 2 11 2 2 4 1 9 20 Meninges 3 3 1 1 4 General 1 1 1 Peritoneum, Ac. 1 1 1 1 2 Totals 1 1 5 2 5 2 16 1 3 2 4 1 11 27 34 I give diagrams showing (A) comparative returns of deaths from Tuberculosis during the past 11 years, distinguishing those due to Pulmonary Tuberculosis from those due to other forms of Tuberculosis ; (B) the percentage of total deaths each year due to (1) all forms of Tuberculosis, and (2) Pulmonary Tuberculosis, and (C) death rates per 10,000 of the population from (1) all forms of Tuberculosis, and (2) Pulmonary Tuberculosis. All cases of Tuberculosis are visited, and in the case of those suffering from the pulmonary form of the disease, disinfectants and pocket sputum cups are supplied, together with cards giving short directions as to the mode of life, and the precautions to be taken to prevent, as far as possible the infection of other inmates of the house. Where deaths have occurred from Tuberculous disease, or on the removal of a person who has been suffering from such disease, the house is disinfected by the Sanitary Authority, and such disinfection is carried out at other times on request. No Sanatorium or Tuberculosis Dispensary has been provided by the Sanitary Authority, but those persons who are entitled to benefit under the National Insurance Act, have received Sanatorium treatment in 19 cases, and domiciliary treatment in other cases. Other cases which were not entitled to benefit under the National Insurance Act, have received treatment either as in-patients or outpatients at one or other of the London Hospitals. Of the 17 cases notified as suffering from some form of Tuberculosis other than Pulmonary, 10 were at the time of notification inmates of a London Hospital, or some other institution of a similar nature. The facilities for treatment of persons suffering from Tuberculosis have been greatly augmented by the establishment of a Dispensary by the Kent County Council in the District, in January this year. The educational value of a stay in a Sanatorium is already becoming evident; those cases who have had the advantage of such a stay, have learned by practical experience the best mode of life for themselves, and the measures best calculated to minimise the danger of their being a source of infection to other people, and they have, as far as possible, after their return home, put in practice the lessons learnt by them. Diagram showing comparative returns of Deaths from Tuberculosis during past II years. P. Pulmonary Tuberculosis 0. Other forms of Tuberculosis. Percentage of Deaths each year due to all Tuberculous Diseases & Pulmonary Tuberculosis. Black Line All Tuberculous Diseases including Pulmonary Tuberculosis. Red Line Pulmonary Tuberculosis. Death Rates per Ten Thousand Population from all Tuberculous Diseases and from Pulmonary Tuberculosis. Black Line All Tuberculous Diseases includinq Pulmonary Tuberculosis Red Line Pulmonary Tuberculosis 35 Tuberculosis of all kinds is a disease very closely associated with poverty, and its attendant conditions. Overcrowding, badly ventilated houses, intemperance, and want of proper nourishment, all tend to render persons living under such conditions more susceptible to the onset of the disease. The disease itself is due to a bacillus, and it is infectious. Persons of all ages are liable to attack, but in young children the commonest sites of the disease are the glands, the joints, and the abdomen. In adults by far the commonest type of the disease is the pulmonary one, Phthisis, or Consumption. In these cases the organism causing the infection is very commonly present abundantly in the expectoration, and in the breath and spray driven out by coughing. If a person suffering from consumption spits on the floor or on the street, the spit in warm weather soon dries up, and the germs in it are carried about attached to particles of dust, and are a potential source of infection to any susceptible person. It is for this reason that consumptives are advised to carry pocket sputum cups, and to use them for the reception of the sputum, or to spit into pieces of paper or old linen, which can be burned in the fire. Open windows and an open-air life, as far as possible, abstention from alcohol, and good, nourishing food, all help to sustain the system against the attacks of the disease, which is usually of a chronic nature, and may last for years before carrying off the patient. It was at one time thought that Consumption was incurable, but greater knowledge has proved this to be erroneous, and many persons alive and well at the present day have at one time or other suffered from the disease; the earlier the disease is discovered, and the sufferer carries out the appropriate treatment, the greater the chance of recovery. The establishment of Tuberculosis Dispensaries, which is now in progress all over the country, will bring the most modern methods of diagnosis and treatment almost into the homes of the people, and the results produced by them by means of actual treatment of cases, and as educational centres, should soon be evident. The hearty and intelligent cooperation of the community at large, and especially of all sufferers from Tuberculosis, is, however, essential, in order to produce the best results in the way of diminishing the incidence of the disease. 36 F.—Means for Preventing Mortality in Childbirth and Infancy. The Mid wives Act, 1902, is administered by the Kent County Council. There are 8 niidwives practising in the District, and they attend about one-half the number of confinements that occur. During the latter part of the year the Council had under consideration the question of adopting the Notification of Births Act, 1907, and it was decided to adopt it, and to appoint a Health Visitor to carry out the work (and also to act as School Nurse). The necessary formalities for its adoption were in progress at the close of the year, and the formal resolution of the Council was passed at a meeting held in January, 1914, the Act to come into force on April 1st, 1914. No special measures directed towards the lowering of the Infantile mortality are in force in the District, but during the summer frequent inspection of the District is carried out with the object of' detecting nuisances, and getting them abated, and of preventing the accumulation of refuse. G.—Vital Statistics. Births. During the year 1913 there were 758 births registered in the District, and notification was received that 13 births, occurring elsewhere, were transferable here, making a total of 771. This gives a nett birth rate of 25.61 per 1,000 of the population, as compared with 23.65 during 1912, and 23.9 for England and Wales in 1913. Of these births 746 were legitimate, made up of 368 males, and 378 females, while 25 were illegitimate, viz., 11 males, and 14 females. The birth rate for 1913 is a considerable improvement on that for 1912, and compares very favourably with that for England and Wales as a whole. The natural increase of population, i.e., the excess of births over deaths, was 475. 37 Deaths. The number of deaths registered in the District during 1913 was 235, giving a death rate of 7.8 per 1,000. The deaths of 10 persons whose homes were in other Districts must be deducted from this number, but to it must be added 71 deaths of residents who died in other districts, making a nett total of 296 deaths belonging to the District. This gives a nett death rate of 9.83 per 1,000, as compared with 11.89 for 1912. In making comparisons of death rates of different districts allowance has to be made for the differences in sex and age distribution of the population, and to do this the Registrar-General has had worked out for each district what he calls a "Standardizing Factor," a figure by which the death rate as ascertained in the ordinary way has to be multiplied to give the "Standardized" death rate. The method by which this factor for correction is ascertained is described in the Twenty-fourth Annual Report of the Registrar-General (for the year 1911), on pp. xxvii-xxx. The "Standardizing Factor" for this District is 1.0028, which gives a "Standardized" death rate of 9.857, a very slisrht increase. For purposes of comparison, I give below the provisional figures for England and Wales for 1913, showing birth rates, death rates, and infantile mortality:— Annual Kate per 1000 living Deaths under one year to 1000 births. Births. Deaths. Crude, Standardized. England and Wales 23.9 13.7 13.4 109 96 great towns, including London 25.1 14.3 14.7 116 145 smaller towns, including Erith 23.9 12.8 13.0 112 England and Wales, less the 241 towns 22.2 13.1 12.1 96 London 24.8 14.2 14.2 104 ERITH 25.61 9.83 9.857 76.52 It will be seen that the rates for Erith compare very favourably with those given, the birth rate being higher than the average, and the death rate and infantile mortality rate being considerably lower than the average. 38 Of the 71 deaths occurring outside the district which were transferred here, 40 took place in the Union Infirmary, Dartford (22 males and 18 females), 16 (13 males and 3 females) at the various London Hospitals, and 7 (5 males and 2 females) at the County Lunatic Asylum, Maidstone. During the first quarter of 1913 there were 87 deaths, and 75, 68, and 66 during the second, third, and fourth quarters respectively, as compared with 98, 81, 79 and 76 during the corresponding quarters of 1912. There were 6 deaths in Public Institutions in the District, all of them being those of residents. One death only was not certified by a medical man, equal to .33 per cent. Table showing ages and groups of ages at which deaths have occurred, compared with the previous year:— Year. All Ages. Under 1 year. 1 and under 2 yrs. 2 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 yrs. and over. 1912 334 46 23 22 9 14 48 81 91 1913 256 59 15 10 19 8 41 56 89 It will be noticed that with the exception of the age groups "under 1 year" and "5 and under 15 years" there has been a decrease in the deaths during 1913 as compared with 1912 in every age croup. The chief causes of death during the year were:— Organic heart disease 35 Pneumonia (all forms) 28 Cancer 26 Pulmonary Tuberculosis 20 Congenital Debility and Malformation (including Premature Birth) 29 Thirteen deaths are classified as being due to ill-defined diseases, or unknown causes; these were all persons over 65 years of age, whose deaths were attributed to senile decay, and not to any definite disease. Inquests. There were 27 inciuests held durintr the year. The causes of death were as shown in the following table: — 39 Natural Causes 14 Accidental Injury 6 Suicide, Drowning 1 „ Poison 1 „ Cut-throat 1 Accidental Drowning 1 Burns 1 Suffocation 9 27 Deaths registered during each month:— January 16 February 28 March 27 April 21 May 20 June 19 July 12 August 17 September 24 October 15 November 12 December 24 235 Cancer. The number of deaths due to Cancer during 1913 was 20. This is a disease which is almost entirely confined to persons who are of middle age and over; 4 deaths occurred between the ages of 25 and 45; 10 between 45 and 65; and 12 over 65 years of age. The following table shows the deaths from Cancer classified according to age, sex, and the organs affected: 40 Organ affected by Cancer, &c. MALES- FEMALES. Total M. & F. all Ages. 0—1 1—2 2—5 5—15 15—25 25—45 45—65 Ov. 65 Total all Ages. 0-1 1—2 2—5 5—15 15—25 25—45 45—65 ' Ov. 65 Total all Ages. Mouth 1 1 2 4 4 Oesophagus and stomach 3 1 4 1 2 1 4 8 Peritoneum, Intestines and Rectum 1 1 3 5 2 3 5 10 Female Genital Organs 1 1 1 Breast 1 1 1 Other 1 1 1 1 2 Totals 3 5 6 14 1 5 6 12 26 Diagram showing number of Deaths of Infants under 1 year of age during each month of 1912 and 1913. Red Line 1912. Black Line 1913. Infantile Mortality Rate. 1900-1913. 41 Infantile Mortality. During 1913 the number of deaths of children under one year of age was 59; between 1 year and 2 years, 15; and between 2 years and 5 years 10; as compared with 46, 23, and 22 during 1912. It will be noticed that the number of deaths of children under 1 year is increased, but at the other ages has considerably decreased. The death rate for children under 1 year per 1,000 births is 76.52, as compared with 69.27 for 1912, and an average of 87.22 for the past 10 years. If the infantile mortality rates of legitimate and illegitimate children are compared, it will be seen that the rate for illegitimate children is very much higher than that for legitimate children. In this district there were 746 legitimate births during 1913, with 54 deaths, giving a rate of 72.38 per 1,000 births, while there were 25 illegitimate births and 5 deaths during the same period, giving a rate of 200 per 1,000 births. In the latter part of 1913 a supplement to the Annual Report of the Medical Officer of the Local Government Board for 1912-1913 was issued, containing a Report on Infantile Mortality in towns with a population of more than 20,000, during the years 1907-1910, and 1911. During the 4 years 1907-1910, Erith's infantile mortality rate was 78.7, and there were only 16 towns with a lower rate out of the 241 towns included in the Report. The death rate for 1907-1910:— at ages 0-1 month was 28 per cent. below at ages 0-3 months was 26 „ „ „ „ „ 3-6 „ „ 42 „ „ „ „ „ 6-12 „ „ 47 „ „ „ from Measles & Whooping Cough was 36 „ „ „ „ Bronchitis and Pneumonia was 43 „ „ „ „ Diarrhœa was 56 „ „ „ for the first year of life was 35 „ „ „ at ages 1 year—5 years was 39 „ „ „ the average rate for the 241 urban areas. For the same period, as compared with the 111 smaller towns (with populations between 20,000 and 50,000), Erith was 10th lowest in the death rate for the first year of life. 42 Table IV. shows the causes of' deaths of children from birth to 1 year of age. Sixteen deaths, or over 27 per cent, took place during the first week of life, while 28, or 47 per cent occurred during the first month. Fourteen deaths were due to premature birth, and of these 8 occurred in the first week, and 13 in the first month; three were due to congenital malformations; and 12 to Debility or Marasmus, of these 5 occurred during the first month of life. Diarrhœa was the cause of 5 deaths, as compared with 3 in the previous year. With the adoption of the Notification of Births Act, and the appointment of a Health Visitor, I hope that we shall find in future years a reduction of the infantile mortality rate. The sanitary conditions of the District are all favourable, we have no slums, no back-to-back houses, plenty of open spaces and fresh air, there are no industries employing female labour to any large extent, and work being plentiful in the District, there is little or no poverty due to unemployment. Table I.—Vital Statistics of Whole District during 1913 and previous years. Year. Population estimated to middle of each year. Births. Ttl. Deaths registrd. in Transferable Deaths'. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Resid'ts not registered in the District-. Under 1 year of age. At all Ages. N'mber. Rate. No. Rate per 1000 nett Births. No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 27,076 750 245 9.04 4 60 1909 27,321 731 258 9.44 6 57 1910 27,566 691 233 8.45 10 49 1911 27,811 700 715 25.70 214 7.69 5 58 50 69.93 267 9.60 1912 28,073 653 664 23.65 266 9.47 8 76 46 69.27 334 11.89 1913 30,100 758 771 25.61 235 7.8 10 71 59 76.52 296 9.83 Area of District in Acres (land and inland water) 3859.513 Total Population at all Ages 27,750 Number of Inhabited Houses 5,129 Average Number of Persons per House 5.41 At Census 1911. 43 Table II.—Cases of Infectious Disease notified during the Year 1913. Notifiable Disease. Number of cases notified. Total cases removed to Hospital. At all Ages. At Ages—Years. Under 1 1 and under 5 years. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. .45 and under 65 yrs. 65 and upwards. Smallpox Cholera, Plague Diphtheria (including Membranous Croup) 38 15 20 3 34 Erysipelas 11 1 1 1 3 5 Scarlet Fever 115 2 26 79 5 3 106 Typhus Fever Enteric Fever 10 5 1 4 7 Relapsing Fever Continued Fever Puerperal Fever 2 2 Poliomyelitis Cerebrospinal Meningitis Pulmonary Tuberculosis 63 9 15 25 13 1 Other forms of Tuberculosis 17 1 3 12 1 14 Totals 256 4 44 126 26 37 18 1 161 Isolation Hospital or Hospitals, Sanatoria, &c. Erith Sanatorium for Infectious Diseases, Bow Arrow Hospital, Dartford, various London General Hospitals and Special Hospitals, Sanatoria at Bromley, &c., &c. 44 Table III.—Causes of, and Ages at Death during the year 1913. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total deaths whether of "residents" or "non-residents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs, 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 295 59 15 10 19 8 39 56 89 6 Uncertified 1 1 Enteric Fever 2 2 Small-pox Measles 3 1 2 1 Scarlet Fever 1 1 1 Whooping Cough Diphtheria & Croup 3 2 1 1 Influenza 3 3 Erysipelas 1 1 Phthisis(Pul'm'n'ry Tuberculosis) 20 4 4 9 3 Tuberculous Meningitis 4 4 1 Other Tuberculous Diseases 3 2 1 Cancer, malignant disease 26 4 10 12 Rheumatic Fever 2 2 Meningitis 5 1 1 2 1 Organic Heart Disease 35 5 12 18 Bronchitis 19 4 1 1 2 11 Pneumonia (all forms) 28 5 4 3 3 1 2 4 6 Other diseases of respiratory organs 2 1 1 Diarrhoea and Enteritis 10 5 3 1 1 Appendicitis and Typhlitis Cirrhosis of Liver Alcoholism 1 1 Nephritis & Bright's Disease 11 2 1 2 6 Puerperal Fever Other accidents & diseases of pregnancy and parturition 1 1 Congenital Debility and Malformation including Premature Birth 29 29 Violent Deaths, excluding Suicide 11 2 1 1 1 2 3 1 2 Suicide 2 1 1 Other Defined Diseases 61 10 3 1 2 9 15 21 Diseases, ill-defined or unknown 13 13 296 59 15 10 19 8 40 56 89 6 Sub-entry (included in above figures). Pneumonia (other than Bronchopneumonia) 14 2 2 1 1 2 4 2 45 Table IV.—Infantile Mortality during the Year 1913. Nett Deaths from stated causes at various ages under 1 year of age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 wks. & under 3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All causes Certified 16 5 3 4 28 7 9 8 7 59 Uncertified Small-pox Chicken-pox Measles 1 1 Scarlet Fever Whooping Cough Diphtheria & Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis 1 1 Other Tuberculous Diseases 1 1 Meningitis (not Tuberculous) 1 1 Convulsions 1 1 2 Laryngitis Bronchitis 1 1 2 4 Pneumonia (all forms) 1 1 2 1 1 5 Diarrhœa 1 3 1 5 Enteritis Gastritis Syphilis 1 1 Rickets Suffocation, overlying 1 1 1 2 Injury at birth Atelectasis 2 2 2 Congenital Malformations 3 3 3 Premature birth 8 1 1 3 13 1 14 Atrophy, Debility and Marasmus ... 2 2 1 5 3 3 1 12 Other causes 2 1 3 2 5 Totals 16 5 3 4 28 7 9 8 7 59 Nett Births in the year:—Legitimate, 746; Illegitimate, 25. Nett Deaths in the year of:—Legitimate Infants, 54; Illegitimate Infants, 5. 46 Factory and Workshop Act, 1901. Factories, Workshops, Workplaces and Homework. 1.—Inspection of Factories, Workshops and Workplaces (including inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections Written Notes. Prosecutions. 1 2 3 4 Factories (including Factory Laundries) 50 1 Workshops (including Workshop Laundries) 68 2 Workplaces (other than Outworkers' premises included in Part 3 of this Report Total 118 3 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecu- tions. Found. Remedied. Referred to H.M. Inspectors. 1 2 3 4 5 Nuisances underthe Public Health Acts— Want of Cleanliness 2 2 Want of Ventilation Overcrowding 1 1 Want of drainage of floors Other nuisances Sanitary accommodation: Insufficient Unsuitable or defective 1 1 Not separate for sexes Offences under the Factory and Workshop Acts: Illegal occupation of underground bakehouse Breach of special sanitary requirements for bakehouses Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 4 4 47 3.—Home Work. (Nil). 4.—Registered Workshops. Workshops on the Register at the end of the Year. Number. 1 2 Bakehouses 12 Dressmaking 18 Boot Repairing 20 Others 40 Total number of Workshops on Register 99 5.—Other Matters. Class. Number. 1 2 Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Acts Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act. Other Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Underground Bakehouses— Certificates granted during the year None. In use at the end of the year None. 6.—Outworkers. Lists received from other Local Authorities, and not from Employers within the Urban District of Erith. Wearing Apparel. Ties, &c. 1 Embroidery, Trimmings, &c. 2 Shirt-making, &c. 1 Tailoring, &c. 1 Babies' Shoes, &c. 1 Tennis Balls 1 7 48 Housing, Town Planning, etc., Act, 1909. Summary of Work done under the Housing (Inspection of District) Regulations, 1910, for period January 1st to December 31st, 1913. Street. No. of Houses Inspected. Defects found in No. of Preliminary Notices served. Result of Notes. Water Supply. Closet Accom'dtn. Drainage. Ventilation. Cleanliness. Condition of Yard. Dampness. Disposal of Refuse. Other Matters. Work done. Work in hand. Work not done. Colebrook Street 28 16 11 6 27 13 25 22 25 28 28 18 10 Coastguard Cott. 6 6 6 5 1 6 6 6 5 6 6 Pier Road 16 3 9 4 5 3 13 5 6 14 16 6 10 Manor Road 10 3 7 3 2 5 7 10 10 10 10 Crayford Road 108 8 21 13 38 20 57 81 83 94 107 62 45 South Road 49 24 9 10 1 26 7 22 26 42 30 12 Boundary Street 2 2 2 2 2 2 High Street 88 7 3 13 4 19 41 16 52 60 78 59 19 Queen Street 12 5 12 1 4 12 2 12 12 12 Avenue Road 6 1 22 1 3 3 2 4 2 2 Bexley Road 43 14 10 9 24 5 20 14 7 25 40 29 11 Coldharbour Pl'ce 19 2 4 5 7 4 11 4 5 18 19 13 6 Clare Road 11 2 2 2 2 6 9 6 3 Cross Street 60 3 17 3 23 17 29 38 39 57 57 20 37 Queen's Road 15 3 2 12 2 4 13 13 W est Street 164 33 27 48 48 26 69 39 66 119 150 90 18 42 Maxim Road 17 16 4 4 10 5 8 12 3 15 17 11 6 Maximfeldt Road 48 42 10 19 16 16 33 18 24 44 48 29 19 Winifred Road 18 14 5 1 7 4 3 7 14 18 14 4 Mildred Road 12 2 1 2 4 2 6 10 12 2 10 Battle Road 53 19 5 17 10 18 13 24 13 48 50 29 21 Willis Road 13 3 3 5 1 3 2 8 5 12 9 3 Glendale Road 32 7 3 9 9 2 7 3 14 19 25 11 14 St. Augustine'sRd 30 17 8 12 2 3 13 15 3 17 25 13 12 Gilbert Road 42 25 9 19 3 11 19 14 15 38 41 22 19 Heron Hill 4 4 2 4 1 4 4 3 4 4 4 Paroma Road 38 30 13 14 S 13 9 8 7 31 36 8 28 Sheridan Road 44 15 12 22 11 1 18 19 12 62 37 19 18 Edwards Road 23 16 3 9 6 3 5 7 5 18 23 19 4 Coleman Road 56 32 8 26 7 7 19 23 9 13 52 5 47 Ripley Road 64 42 11 25 6 4 10 11 6 45 57 23 34 Gertrude Road 39 18 4 17 12 4 15 3 6 31 37 10 13 14 Ina Road 4 2 1 1 1 1 2 2 2 Upper Abbey Rd. 56 19 13 15 18 10 25 28 17 36 47 9 6 32 Lyndon Road 1 1 1 1 1 1 Lower Road 2 1 1 1 1 2 2 Kentish Road 1 1 1 1 1 1 1 1 Bunker's Hill 2 1 1 1 1 1 2 2 2 1236 437 263 351 326 221 534 454 486 338 1142 603 37 502 Visits for Re-inspections, 1944. 49 Report of School Medical Officer. A.—General Review of the Hygienic Conditions Prevalent in the District, etc. There are nine Provided Schools in the District, with 18 Departments, and two Non-provided Schools, with 3 Departments. Most of the provided schools are of modern design and construction; one is a temporary building; the remainder of the provided schools and the non-provided schools are considerably older, and though not in accordance with modern ideas as to design, are in excellent condition. The surroundings on the whole are excellent, but 3 of the schools are rather cramped; it is, however, hardly possible to improve this, as they are among the oldest schools in the District. Ventilation, on the whole, is good; one school is warmed and ventilated by hot air, and complaints are sometimes made as to the difficulty of properly regulating the temperature. Heating is, on the whole, good; one or two of the schools are, however, inadequately heated in cold weather, the method of heating being by closed stoves in a corner of the class-room; children near the stove are too hot, while away from the fire the temperature of the room was 51 deg. F. only, as registered by the thermometer on one occasion when I visited one of these schools. The equipment generally, and the sanitation are good; the latrine accommodation at one of the Boys' schools might be improved. Water supply is from the mains of the Metropolitan Water Board; at the Crescent Road Schools all the water passes through a cistern in the open air, but I would recommend that taps be provided direct from the main for the supply of drinking water. 50 The lighting of the schools, as a whole, is good, so far as natural lighting is concerned, but the artificial lighting of most of the older schools is not good; in many cases where gas is used, the old form of burner is in use, and the lighting would be materially improved by the provision of incandescent burners. One school lit by electric light is connected to the electric street lighting main, so that in dull weather in the winter the light is not available unless the lamps in the street are lit. The schools are well looked after, and kept clean. "Dustolio" is used on the floors with the object of preventing dust. The number of scholars which can be accommodated in the provided schools is 5,682, and in the non-provided schools 642, a total of 6,324. The average number of scholars in attendance during the year was 5,559, and the number on the roll 6,204. B.—Description of arrangements made for the Correlation of the School Medical Service with the Public Health Service, for the Organisation and Supervision of Medical Inspection, and an account of the Methods of Inspection adopted. As I hold both the office of School Medical Officer and that of Medical Officer of Health, no difficulty has been experienced in the arrangements for the correlation of the two services. All the inspections are carried out by myself, usually in the afternoons. About a week before the inspections are made, a notice is sent to the head teacher advising him (or her) of my intention, and stating how many children are likely to be examined. This gives the teacher time to prepare notices inviting parents to be present at the inspection, and to send them out. Parents have been present in the case of 641 children, viz., 287 boys and 354 girls; by far the majority of these were entrants, viz., 217 boys and 179 girls; at the later inspections comparatively few parents attended. On the day of the inspection those children who are to be inspected in the afternoon are weighed and 51 sured in the morning by the teacher, who is also present in the afternoon. When the School Nurse has been appointed she will undertake this portion of the work. The card used for the record of the inspection is that of the Board of Education. In very few of the schools is there a room available for inspections, which is not in use as a class-room ; when an inspection is in progress, however, the class usually occupying a room is either held out of doors (in summer) or is amalgamated with some other class. C.—General Statement of Extent and Scope of Medical Inspection carried out during the year. (1) Number of Visits paid to the Schools during the year. For the purposes of routine inspection 118 visits were paid to the various schools and departments by myself. During the first three months of the year, before 1 took up the duties of School Medical Officer, a number of children had been examined by the acting School Medical Officer, but I am not able to state the number of visits paid hy him. In addition, a certain number of additional visits were paid for re-inspection of children found defective, search for cases of Infectious Disease, and inspection of school buildings. (2) Principle on which Children have been selected for Inspection. All children who entered schools and who were leaving school during the year have been inspected in accordance with the code requirements of the Board of Education. The "entrants" included children under 5, between 5 and 6, and 6 years of age. " Leavers " included those children who would attain the age of 14 years at some time during the year. Children at two other ages have been examined during the year, viz., those who attained the ages of 8 years and 11 years. In addition a few children were presented by the teacher for the purpose of ascertaining whether they were fit to attend school or not, owing to some suspected contagious disease or for some other reason. These children 52 were not submitted to routine inspection, but were examined for the purpose of saying whether they were fit or unfit to attend school. (3) The Number of Children Inspected. No. of Inspections. Age at Inspection. Boys. Girls. Total. 1st " Entrants" 4—6 years 404 329 733 2nd 8 years 277 310 587 3rd 11 years 284 297 581 4th " Leavers " 14 years. 202 187 389 Totals 1167 1123 2290 (4) Directions for Treatment were given in respect of 729 Children, viz., 361 Boys and 368 Girls. Recommended for Treatment. Entrants. Age 8. Age 11. Leavers. Totals. B'ys G'ls Ttl. B'ys G'ls Ttl. B'ys G'ls Ttl. B'ys G'ls Ttl. B'ys G'ls Ttl. 107 100 207 110 114 224 93 94 187 51 60 111 361 368 729 Defective Teeth 96 88 184 62 76 138 65 41 106 15 29 44 238 234 472 Defective Sight* 2 4 6 40 32 72 30 37 67 21 23 44 93 96 189 Enlarged Tonsils 3 3 6 9 10 19 9 11 20 7 6 13 28 30 58 Adenoids 3 2 0 3 3 6 2 4 6 4 6 10 12 15 27 Tonsils and Adenoids 5 5 10 8 11 19 4 4 8 6 2 8 23 22 45 Ear disease 1 1 2 1 — 1 1 — 1 1 — 1 4 1 5 Other defects 1 1 2 - - - - - - - - - 1 1 2 Total number of defects 111 104 215 123 132 255 111 97 208 54 66 120 399 399 798 "This includes cases where directions were given for treatment of some external eye disease. There were a certain number of children in whose cases more than one defect required treatment. Thirty-four children (10 boys and 24 girls) were excluded owing to pediculi in the head, six (3 boys and 3 girls) owing to pediculi on body, four (3 boys and 1 girl) owing to ringworm, and five (2 boys and 3 girls) for impetigo. One child at the time of inspection was found to have a rash which proved to be due to Scarlet Fever, and was excluded. 53 (5) Average time per head occupied by Inspection. One hundred and eighteen visits were paid to the Schools, and about 2¼ hours was occupied on each occasion by the inspection; 2,203 children were inspected, which gives an average of just over 7 minutes for each child inspected. D.— General Review of the Facts disclosed by Medical Inspection. Previous Medical History. (1) Entrants. Boys. Per cent Girls. Per cent. Total. Per cent. Number examined. 404 329 733 Measles 247 61.1 197 59.8 444 60.5 Whooping Cough 176 43.5 162 49.2 338 46.1 Chicken-pox 107 26.4 90 27.3 197 26.8 Scarlet Fever 15 3.7 19 5.7 34 4.6 Diphtheria 6 1.4 5 1.5 11 1.5 Other Diseases 45 11.1 61 17.9 106 14.4 (2) Aged 8 Years. Boys. Per cent. Girls. Per cent. Total. Per cent. Number examined. 277 310 587 Measles 221 80 278 89.7 499 85 Whooping Cough 131 47.3 202 65.1 333 56.7 Chicken-pox 106 38.2 153 49.3 259 44.1 Scarlet Fever 22 7.9 40 12.9 62 10.5 Diphtheria 9 3.2 6 1.9 15 2.5 Other Diseases 43 15.5 38 12.3 81 13.8 (3) Aged 11 years. Boys. Per cent. Girls. Per cent. Total. Per cent. Number examined 284 297 581 Measles 233 82 261 87.8 494 85 Whooping Cough 183 64.1 175 58.9 358 61.6 Chicken-pox 128 45 118 39.7 246 42.3 Scarlet Fever 40 14.1 29 9.7 69 11.8 Diphtheria 14 4.9 12 4 26 4.4 Other Diseases 33 11.6 47 15.8 80 13.7 54 (4) Leavers. Boys. Per cent. Girls. Per cent. Total. Per cent. Number examined. 202 187 389 Measles 149 73.7 171 91.4 320 82.2 Whooping Cough 51 25.2 87 46.5 138 35.4 Chicken-pox 54 26.7 70 37.4 124 31.3 Scarlet Fever 26 12.8 21 11.2 47 12.0 Diphtheria 12 5.9 6 3.2 18 4.6 Other Diseases 26 12.8 36 19.2 62 15.7 The percentage of children who have suffered from any particular disease corresponds very closely with the percentage found in the previous year, but is slightly higher in the case of the diseases Whooping Cough, Chicken Pox, and Diphtheria. Measles and Whooping Cough are the two diseases which show very high figures; not quite one quarter of the children in school escape the infection of Measles, and not quite half escape that of Whooping Cough. The following table gives the average age, with average height and weight at each of the inspections:— Age. Average. Height. Weight. Yrs. M'ths. Feet. Ins. Lbs. 1st Inspection, Boys 5 3½ 3 5 38¾ ,, „ Girls 5 4½ 3 5 39 2nd ,, Boys 7 11¾ 3 11 48¾ Girls 7 11½ 3 10½ 47¾ 3rd ,, Boys 11 — 4 4 62¾ ,, Girls 11 — 4 4½ 64 4th „ Boys 13 7 4 9 79½ ,, ,, Girls 13 8 4 9¾ 83¾ All Children Examined. Boys. Per cent. Girls. Per cent. Total. Per cent. Number examined. 1167 1123 2290 Measles 850 73.7 907 80.7 1757 76.7 Whooping Cough 541 46.3 626 55.7 1167 51 Chicken-pox 395 33.8 431 38.3 826 36 Scarlet Fever 103 8.8 109 9.7 212 9.2 Diphtheria 41 3.5 29 2.5 70 3.1 Other Diseases 147 12.6 182 16.2 329 14.3 55 These averages are much the same as in previous years, with the exception of the weights of the boys at the 2nd and 3rd inspections, which are about 3 lbs. less in each case. The figures are also somewhat lower than the averages given in the tables published in the last Annual Report of the Chief Medical Officer of the Board of Education. Cleanliness, (a) Of Heads. Number of Inspection. Number inspect'd Nits only. Pediculi. Number. Percent. Number. Per cent. First (Entrants) Boys 404 31 7.6 3 .7 Girls 329 107 32.5 4 1.2 Second (Age 8 years) Boys 277 23 8.3 4 1.4 Girls 310 155 50.0 10 3.2 Third (Age 11 years) Boys 284 25 8.8 2 .7 Girls 297 150 50.5 9 3.0 Fourth (Leavers) Boys 202 17 8.4 1 .5 Girls 187 75 40.1 1 .53 Totals Boys 1167 96 8.3 10 .85 Girls 1123 487 43.3 24 2.1 This is an increase on the numbers found in the previous year; it will be noticed that the percentage remains practically constant at each inspection among the boys, but that among the girls, those inspected at the two intermediate ages show a very much higher percentage with nits. There is nothing in these figures to show whether the nits were numerous, or otherwise, but the number of nits varied from two or three in some cases to hundreds in others. Every case in which pediculi were found was excluded until it was found to be free on subsequent examination. (b) Of Body. There were only six children found to have pediculi on the body—three boys and three girls. Twenty-five boys were found to be dirty, but only ten girls. Nutrition and Clothing. Only 4.6 per cent. of children were found to be badly nourished; 4.37 per cent. had unsatisfactory clothing. 56 On referring to the Table at the end it will be seen that the percentage of badly nourished children found increased with their ages. At the examination of entrants only 1.6 per cent. were badly nourished; at the age of 8., 3.2 per cent.; at the age of 11, 6.36 per cent., and leavers 9.76 per cent. There was in no case any obvious cause for the condition, such as any definite disease, or want of proper food. Nose and Throat. On referring to the table at the end, it will be seen that 71.27 per cent. of all the children examined were found to be free from any disease of the nose and throat. The commonest defect was enlargement of the tonsils, in 3 per cent. of the children this was marked, and in 19 per cent. slight; the defect found to be next in frequency of occurrence was enlargement of the cervical glands, which was present in 16 per cent. of all cases. Adenoids were found in some degree in 5.5 per cent. of all cases. Teeth. The table at the end gives the figures showing the percentage of children with all teeth sound, those having fewer than four decayed, and those having four or more decayed. It will be noted that only a little over 27 per. cent. of all children examined have sound teeth, 30 per cent. have four or more decayed, and 42 per cent. fewer than four decayed. At the two intermediate age periods the percentage of children with sound teeth is as low as 19 and 22, respectively, with corresponding increase in the number of those with decayed teeth. The pareuts seem to regard any attention paid to the decayed milk teeth of their children as waste of time and money, and do not'realise the fact that the presence of decayed temporary teeth renders the infection of the permanent teeth almost certain, and judging by what I have been told by many parents, there seems to be considerable reluctance on the part of many dentists to extract milk teeth, even when very much decayed and very foul. Ear Disease. In only 28 cases was any ear disease found at the inspection, while 52 children were found to have some degree of deafness in one or both ears. 57 Eye. In not quite 2 per cent. of the children examined some external eye disease was noted. The number of children with defective vision who were recommended for spectacles, was 189; this number, however, does not include all cases of defective vision, as many children were found to be already provided with spectacles at the time of the examination. In all cases when vision was worse than 6/9 in either eye, a recommendation was made that the child should be provided with spectacles if this had not already been done. Deformities. In 15 children there was some deformity found at the inspection. In two cases among the entrants the deformity was congenital; one, a boy aged 5 years and 11 months, had all phalanges absent on the right hand, the metacarpal bones were present, but very badly developed, while the wrist and forearm appeared to be normally developed; the other case was a girl aged 5 years and 8 months, in the righthand the terminal phalanx of the thumb, and all phalanges of the fingers were absent, while in the left hand the thumb and fourth finger were perfect, but the two distal phalanges on the 1st, 2nd, and 3rd fingers were absent, the right side of the face was somewhat smaller than the left, with slight muscular paresis. The other deformities found were slight lateral curvature of the spine, torticollis, talipes, genu valgum, and some slight deformities of chest due to old rickets. E.—General Review of the Relation of Home Circumstances and Social and Industrial Conditions to the Health and Physical Condition of the Children Inspected. The social and industrial conditions in the District are, on the whole, good, and there is at present a demand for workmen with practically no unemployment. The large majority of the men are mechanics, and earn good wages, so that the children, on the whole, are well fed. There is plenty of open country in the District and around 58 it, and there is very little overcrowding, either of houses on areas, or of inmates in houses. The general sanitary condition of the District is good, the birth rate is above the average, while the death rate and the infantile mortality rate are well below the average. F.—Review of Methods employed or available for Treatment of Defects, etc. No treatment is available in the district other than that given by medical practitioners in private practice. Very many of the defects of all kinds are, however, treated at one or other of the London Hospitals. During the latter half of the year re-inspection of those children who had been examined during the first half of the year, was carried out, with the object of ascertaining how many had received treatment; the number so re-inspected was 269, 147 girls and 122 boys, and the following table shows the result of the re-inspection. Number of Children Re-inspected. Tonsils. Adenoids. Teeth. Sight. No. of children suffering from. No. Treated. No. untreated. No. of children suffering from. No. treated. No, untreated. No. of children with defective No. treated. No. untreated. No. of children with defective. No. treated. No. untreated. Boys 122 28 6 22 11 2 9 84 16 68 29 7 22 Girls 147 26 7 19 11 5 6 78 26 52 29 16 13 Total 269 54 13 41 22 7 15 162 42 120 58 23 35 No School Nurse was employed during last year, but early this year a School Nurse and Health Visitor has been appointed. G.—Miscellaneous Work. During the year children who have been absent from school, or who have been thought to be unfit to attend school for some reason or other have been referred to me for examination. 59 These examinations are made at the offices of the Medical Officer of Health, between the hours of 9.30 and 10.30 a.m. every day. The examinations have been solely for the purpose of certifying whether a child is fit to attend school or not, and advice is given, but no treatment. During the period of my service as School Medical Officer, 523 children were examined, 358 attended on one occasion only, 124 attended twice, 32 three times, 8 four times, and one case 8 times, making a total of 742 attendances. On each attendance a certificate was given, 374 being certificates that the child in question was unfit to attend school, and 368 certificates of fitness to attend. The following table shows the principal reasons for which certificates of unfitness were granted :- Disease. Boys. Girls. Total. Ringworm 49 28 77 Pediculi Capitis — 50 50 Impetigo 19 23 42 Scabies — 2 2 Scarlet Fever 3 2 5 Chickenpox 1 1 2 Whooping Cough — 1 1 Mumps 2 2 4 Chorea 4 4 8 Tonsillitis 16 31 47 External eye disease 5 9 14 Eczema 8 2 10 Otitis Media 2 3 5 Tuberculosis, Pulmonary 4 3 7 „ Skin 1 — 1 „ Hip joint 1 — 1 „ Glands 1 — 1 Other 45 52 97 Totals 161 213 374 Table Showing Physical Condition of Children Inspected. Entrants. Aged 8. Aged II. Leavers. Total. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Percent. Boys. Girls. Total. Per Cent. Total Examined. 404 329 733 — 277 310 587 — 234 297 581 — 202 187 389 — 1167 1123 2290 — Clothing Satisfactory 395 326 721 98.34 267 293 560 95.4 263 284 547 94.15 184 178 362 93.06 1109 1081 2190 95.63 Unsatisfactory 9 3 12 1.66 10 17 27 4.6 21 13 34 5.85 18 9 27 6.94 58 42 100 4.37 Footgear Satisfactory 404 329 733 100. 273 306 579 98.64 279 293 572 98.45 183 182 365 93.84 1139 1110 2249 98.19 Unsatisfactory — — 4 4 8 1.36 5 4 9 1.55 19 5 24 6.16 28 13 41 1.81 Cleanliness of Head Clean (no nits nor pedi. culi) 370 218 588 80.23 250 145 395 67.3 257 138 395 67.99 184 111 295 75.84 1061 612 1673 73.07 Nits only 31 107 138 18.82 23 155 178 30.32 25 150 175 30.12 17 75 92 23.65 96 487 583 25.45 Pediculi 3 4 7 .95 4 10 14 2.38 2 9 11 1.89 1 1 2 .51 10 24 34 1.48 Cleanliness of Body Clean 403 328 731 99.73 269 303 572 97.45 273 293 566 97.25 194 187 381 97.96 1139 1110 2249 98.19 Dirty — — — — 7 6 13 2.21 11 4 15 2.58 7 — 7 1.79 25 10 35 1.55 Pediculi present 1 1 2 .27 1 1 2 .34 — 1 1 .17 1 1 .25 3 3 6 .26 Nutrition Normal 396 325 721 98.34 269 299 568 96.77 261 283 544 93.64 183 168 351 90.24 1109 1075 2184 35.38 Below normal 8 4 12 1.66 8 11 19 3.23 23 14 37 6.36 19 19 38 9.76 58 48 106 4.62 Nose and Throat No disease 264 247 511 69.71 197 221 418 71.23 213 227 440 75.74 140 123 263 67.65 814 818 1632 71.27 Mouth breathers 7 1 8 1.09 4 3 7 1.19 4 1 5 .86 — — — 15 5 20 .87 Tonsils: much enlarged 16 9 25 3.41 5 4 9 1.53 2 7 9 1.55 11 15 26 6.67 34 35 69 3.01 slightly „ 92 61 153 20.87 56 61 117 19.93 54 48 102 17.55 37 33 70 17.99 239 203 442 19.30 Adenoids, slight or doubtful 11 5 16 2.18 9 5 14 2.38 4 4 8 1.38 7 7 14 3.59 31 21 52 2.27 Adenoids, marked 14 6 20 2.74 6 16 22 3.74 7 10 17 2.92 7 9 16 4.10 34 41 75 3.28 External Eye Disease No disease 396 322 718 97.97 268 304 578 97.45 281 293 574 98.81 199 185 384 98.73 1144 1104 2248 98.16 Blepharitis 7 5 12 1.63 4 1 5 .85 1 2 3 .51 1 1 2 .51 13 9 22 .97 Conjunctivitis 1 — 1 .13 5 2 7 1 .19 1 2 3 .51 2 1 3 .76 9 5 14 .61 Corneal opacities — — •— — 1 1 .17 — — — — — — — — — 1 1 .04 Other disease — 2 2 .27 — 2 2 .34 1 — 1 .17 — — — — 1 4 5 .22 Ear Disease No disease 401 325 726 99.06 275 307 582 99.15 280 288 568 97.77 200 186 386 99.24 1156 1106 2262 98.78 Otorrhœa, right 2 2 4 .54 1 2 3 .51 2 4 6 1.03 1 1 2 .51 6 9 15 .65 „ left 1 2 3 .40 1 1 2 .34 2 5 7 1.20 1 — 1 .25 5 8 13 .57 Teeth Sound 125 98 223 30.42 59 56 115 19.60 49 83 132 22.71 84 77 161 41.39 317 314 631 27.55 Less than 4 decayed 158 128 286 39.03 99 112 211 35.94 141 147 288 49.57 86 91 177 45.5 484 478 962 12.01 4 or more decayed 121 103 224 30.55 119 142 261 44.46 94 67 161 27.72 32 19 51 13.11 366 331 697 10.44 Heart and Circulation No disease 403 328 731 99.73 273 306 579 98.64 280 294 574 98.80 194 185 379 97.43 1150 1113 2263 98.82 Organic disease 1 1 2 .27 4 4 8 1.36 4 3 7 1.20 8 2 10 2.57 17 10 27 1.18 Glands Normal 358 305 663 90.45 232 246 478 81.44 232 256 488 84.0 147 141 288 74.04 969 948 1917 53.72 Enlarged 46 24 70 9.55 45 64 109 18.56 52 41 93 16.00 55 46 101 25.96 198 175 373 6.28 Lungs No disease 382 316 698 95.24 276 306 582 99.15 282 294 576 99.14 201 186 387 99.5 1141 1102 2243 J 97.94 Chronic Bronchitis and Bronchial Catarrh 20 12 32 4.36 1 4 5 .85 2 3 5 .86 — - 23 19 42 1.85 Tuberculosis 1 1 .13 — — — —. — 1 — 1 .25 1 1 2 .08 ,, suspected. 2 — 2 .27 — — — — - 1 1 .25 2 1 3 .13 Nervous System No disease 399 329 728 99.33 276 309 585 99.66 282 296 578 99.49 202 186 388 99.75 1159. 1120 2279 99.54 Epilepsy 1 1 .13 — — — — — — — — — — 1 — 1 .04 Chorea — — — - — 1 1 17 — — — 1 1 .25 — 2 2 .08 Other disease (Infantile paralysis of old standing ) 4 — 4 .54 1 — 1 17 2 1 3 .51 — — 7 1 8 .34 Skin No disease 397 324 721 98.4 270 304 574 97.79 282 294 576 99.14 199 182 381 97.97 1148 1104 2252 98.35 Ringworm — 1 1 .13 1 1 17 1 — 1 .17 1 — 1 .25 3 1 4 .17 Impetigo 2 1 3 .40 — — — — — — — 2 2 .51 2 3 5 .22 Other disease 5 3 8 1.07 6 6 12 2.04 1 3 4 .69 2 3 5 1.27 14 15 29 1.26 Deformities No deformity 398 328 726 99.05 277 310 587 100 283 293 576 99.14 201 185 386 99.24 1159 1116 2275 99.35 Deformity present 6 1 7 .95 — — — 1 4 5 .86 1 2 3 .76 8 7 15 .65 Tuberculosis (non. pulmonary) None 404 329 733 100. 276 310 586 99.83 283 297 580 99.83 202 187 389 100 1165 1123 2288 99.92 Glands — - — — - 1 — 1 .17 — — 1 — 1 .04 Skin — - — — 1 1 .17 — — — — — 1 — 1 .04 Speech No defect 395 327 722 98.52 274 308 582 99.15 280 296 576 99.14 201 186 387 99.49 1150 1117 2267 99.01 Defective articulation. 8 2 10 1.35 2 1 3 .51 2 1 3 .51 — — — - 12 4 16 .69 Stammering 1 — 1 .13 1 1 2 .34 2 — 2 .35 1 1 2 .51 5 2 7 .30 Mental Condition Normal 402 329 731 99.73 271 306 577 98.30 269 292 561 96.56 199 185 384 98.73 1141 1112 2253 98.37 Dull or backward 2 — 2 .27 6 4 10 1.70 15 5 20 3.44 3 2 5 1.27 26 11 37 1.63 Hearing No defect 399 325 724 98.78 270 302 572 97.45 280 287 567 97.6 197 178 375 96.41 1146 1092 2238 97.72 Deafness 5 4 9 1.22 7 8 15 2.55 4 10 14 2.4 5 9 14 3.59 21 31 52 2.28 Vision 6/6 Each Eye 167 175 342 58.28 212 183 400 68.8 159 117 276 70.9 538 470 1008 54.7 Right Eye 13 17 30 5.11 11 20 31 5.3 8 16 24 6.1 32 53 85 5.4 6/6 Left Eye 17 10 27 4.59 10 18 28 4.8 12 7 19 4.8 39 35 74 4.7 Right Eye 49 63 112 19.08 28 35 63 10.8 14 26 40 10.2 91 124 215 13.8 6/9 Left Eye 44 71 115 19.6 22 37 59 10.1 14 36 50 12.7 80 144 224 14.4 Right Eye 13 20 33 5.62 8 11 19 3.3 9 6 15 3.8 30 37 67 4.3 6/12 Left Eye 19 20 39 6.63 10 6 16 2.7 7 8 15 3.8 36 34 70 4.5 Right Eye 10 10 20 3.4 10 9 19 3.3 5 6 11 2.8 25 25 50 3.2 6/15 Left Eye 8 3 11 1.87 9 4 13 2.1 6 8 14 3.6 23 15 38 2.4 Right Eye 8 8 16 2.72 7 4 11 1.8 2 6 8 2.0 17 18 35 2.2 6/21 Left Eye 7 11 18 3.06 5 12 17 2.9 3 1 4 1.0 15 24 39 2.5 Right Eye 3 2 5 .85 3 7 10 1.7 2 3 5 1.3 8 12 20 1.3 6/30 Left Eye 1 4 5 .85 5 5 10 1.7 — 5 5 1.3 6 14 20 1.3 Right Eye 2 2 .34 2 3 5 .8 — 3 3 .75 4 6 10 .6 6/60 Left Eye 2 - 2 .34 5 5 10 1.7 2 2 .5 7 7 14 .9 Right Eve — — — — 1 1 .17 — — — — 1 1 .06 Less than 6/6Left Eye 1 - 1 .17 1 - 1 .17 — 1 1 .25 2 1 3 .18 Right Eye 1 - 1 .17 — — — — — 2 2 .5 1 2 3 .18 Blind Left Eye — 1 1 .17 2 1 3 .5 — — — 2 2 4 .26 Squint 6 4 10 1.7 3 5 8 1.3 1 2 3 .75 10 11 21 1.4