ERI 009 Urban District of Erith. ANNUAL REPORT of the Medical Officer of Health For the Year 1918, by L. J. J. BARNES, M.D. Public Health Committee, 1918. Chairman—Councillor T. C. Buckley. Councillor Bayley. Councillor Reeves, ,, Dunk. ,, Wilson. ,, Ling. ,, Watson. ,, Fletcher. Staff. Medical Officer of Health :— L. J. J. Barnes, M.D. Inspector of Nuisances ;— David B. Davies. Assistant Inspector of Nuisances :— Thomas Vaughan. Health Visitors:— Miss Mary A. Cruise. Mrs. Crouch. Clerk :— Miss C. M. Yaughan. Council Offices, Erith, June, 1919. To the Chairman and Members of the Erith Urban District Council. Gentlemen, 1 have the honour to present to you my Annual Report for the year 1918, in accordance with the Regulations of the Local Government Board. As the Local Government Board have made suggestions is to omission of many details usually inserted in the Annual Reports of Medical Officers of Health, having regard to the strict economy in the use of paper and demands on printing establishments, this report will therefore be very much curtailed. I am, Gentlemen, Your obedient Servant, L. J. J. Barnes. Annual Report for 1918. Population. At the Census, 1911, the population was found to be 27,750. The Registrar-General lias estimated the population for the middle of the year to be—33,129. 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 Gun Making, Cable Making, Oil Refining, Manufacture of Mining and other Machinery, and the Manufactur" of Asbestos and Cement Slates and Slabs. A small number are engaged in Agricultural and Horticultural pursuits. Infectious Diseases. There were 379 cases notified during the year, including cases of Tuberculosis and Measles. Of these 68 were Scarlet Fever, 20 Diphtheria, 4 Erysipelas, 3 Enteric Fever, 1 Puerperal Fever, 4 Ophthalmia Neonatorum, 194 Measles, 13 German Measles, and 72 Tuberculosis. Comparative returns of Infectious Disease notified during the past 10 years : — Disease. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Smallpox Diphtheria 45 32 35 42 38 86 105 118 55 20 Measles Not Notifable 131 616 207 German Measles Erysipelas 18 20 19 21 11 7 21 15 13 4 Scarlet Fever 181 129 99 68 115 307 231 182 35 68 Enteric Fever 5 3 5 7 10 22 3 4 7 3 Continued Fever 1 Puerperal Fever 1 2 2 2 1 2 1 Ophthalmia Neonatorum 4 5 4 Poliomyelitis l 1 Cerebro Spinal Fever 1 4 249 185 159 141 176 425 366 454 733 307 5 Scarlet Fever. There were 68 cases notified during the year. The attack rate for the disease was 2.05 per 1,000 of the population. 57 cases were removed to the Sanatorium for treatment. There were no deaths from this complaint during the year. Diphtheria. 20 cases were notified during the year. The attack rate was 0.60 per 1,000 of the population. 18 cases were removed to the Sanatorium for treatment. There was one death from the disease. Enteric Fever. There were 3 cases reported during the year. The attack rate was 0.09 per 1,000 of the population. 2 of tlie cases were removed to hospital. 1 death occurred during the year from this disease. Measles and German Measles. 207 cases were notified during the year. 194 cases of Measles and 13 cases of German Measles. 6 deaths occurred from the disease. 4 cases were removed to hospital for treatment. Tuberculosis. The number of notifications received during the year was:—58 Pulmonary, and 15 other forms of Tuberculosis. There were 52 deaths from the disease. 6 influenza This malady was very prevalent throughout the district during October, November and December. It was found necessary to close all the schools in the district, including the Infant Welfare Centres, for the period October 25th to November 18th; and from October 25th to November 25th, the following schools were closed:— All Saints', Belvedere. Albert Road, Belvedere. St. Augustine's, Belvedere. The Belvedere Infant Welfare Centre was closed from October 25th to December 3rd. The whole of the Schools and Infant Welfare Centres were thoroughly disinfected. The following table shows the number of deaths from Influenza each week for the last quarter of the year:— Week ended Males. Females. Total. October 5th 1 — 1 ,, 12th — 1 1 ,, 19th — 3 3 ,, 26th 4 4 8 November 2nd 9 8 17 ,, 9th 7 7 14 ,, 16th 3 3 8 ,, 23rd 3 2 5 ,, 30th — 2 2 December 7th 2 5 7 ,, 14th — — — ,, 21st — 1 1 ,, 23th 1 1 2 30 39 69 Sex and Age Distribution. Under 1 year. 1—2 2—8 5—15 15—25 25—45 45—65 65 and over. Males 2 2 2 1 6 13 2 2 Females 1 1 3 8 10 11 5 — 7 These figures include 9 deaths from Influenza, etc., which occurred outside the district, and are transferable here, and also 3 deaths of persons who lived outside the district. The total deaths from Influenza for the year was .71. Ophthalmia Neonatorum. 4 cases reported during the year. Chicken Pox. This disease is not notifiable. Whooping Cough. This disease is not notifiable. There were 7 deaths during the year. Means for Preventing Mortality in Childbirth and Infancy. The Midwives' Act, 1902, is administered by the Kent County Council. There are tour Midwives practising in the districit. Notification of Births Acts, 1907 and 1915. The Council have 2 Health Visitors, who carry out the necessary work under these Acts. The number of births notified during the year was G27, viz., 302 males, 321 females, and 4 in which the sex was not stated. Of these 8 were still births The Health Visitors paid 3,010 visits during the year, made up as follows:—1st Visits after notification of births, 680; 2nd and subsequent Visits, 2,005; visits to Measles and other Infectious Case;, 157; visits to Antenatal cases, 168. Two Infant Welfare Centres are in working or lor, one at Erith, and one at Belvedere. During the year they have been open on 114 occasions, and 2,372 attendances have been made at them, viz., 1,203 at Erith, and 1,169 at Belvedere. 8 Ante-Natal Clinic. This was opened on March 5th, 1918, after a meeting had been held to which the Midwives working in the district were invited; they were addressed by the Lady Medical Officer, and promised to co-operate. 92 cases attended this clinic, making 267 attendances. On April 16th Dr. Sophia Seekings, Local Government Board Inspector, visited this Clinic, and reported favourably on the work. A stock of the following foods, etc., is kept, and sold at the Centres at cost price : — Cow and Gate Milk. Marylebone Cream. Glaxo. Lactagol. Virol. Cod Liver Oil and Malt. The expenditure during the year on these was £26S 17s. 6d. Model Baby Clothing. This department is in charge of Mrs. Reeves, one of the members of the Maternity and Child Welfare Committee, and a large number of patterns have been sold. Mrs. Reeves has also given demonstrations to mothers in cutting out the garments. Demonstrations of Haybox Cookery, the making of Albumen Water, etc., have been given at the Centres. Vital Statistics. Births. 660 Births were registered during the year. This gives a birth-rate of 17.98 per 1,000 of the population, as compared with 19.85 during 1917. Of these births 28 were illegitimate. Deaths. The nett deaths at all ages belonging to the district number 432; giving a death-rate of 13.18 per 1,000. Infantile Mortality. During the year the number of deaths of children under one year of age was 50. The infantile death-rate being 75.75, as compared with 80.30 for the previous year. Table Showing the Birth and Death Rates and Infantile Mortality Rate for the Year 1918 Annual Rate per 1000 Population. Hate per 1000 Births. Births. Deaths. Diarrhoea & Enteritis (under 2 years). Total Deaths under 1 year. All . Causes. Enteric Fever. Measles. Scarlet Fever. Whooping Cough. Diphtheria. England and Wales 17.7 17.6 0.03 0.28 0.03 0.29 014 10.99 97 96 Great Towns, including London (population over 50,000) 17.6 18.2 002 0.36 0.04 0.34 0.15 14.46 106 148 Smaller Towns, including Erith (population 20.000—50,000) 17.9 16.1 003 0.25 0.02 0.25 0.14 9.73 94 London 16.1 18.9 0.02 0.42 0.03 0.43 0.17 15.67 107 ERITH 17.98 13.18 0.03 0.18 0.00 0.27 0.03 4.7 75.75 9 10 Sanitary Inspection of the District. The following Report has been prepared by the Inspector of Nuisances:— Inspections Made During the Year. Houses visited for the detection of nuisances 428 Houses inspected under the Housing and Town Planning Act 265 Slaughterhouses 167 Cowsheds, dairies and milkshops 25 Workshops 64 Outworkers' premises Bakehouses 22 Offensive trades 16 Vans, tents and sheds used for human habitation 87 Complaints enquired into 165 Result of Above Inspection. Nuisances detected 556 Preliminary notices served to abate nuisances 307 Statutory notices served to abate nuisances 33 Nuisances abated 313 Infectious Diseases. Number of cases enquired into 379 Number of cases removed to Sanatorium 77 Number of houses disinfected 112 Cleansing. Number of Cesspools Emptied 439 Number of loads of house refuse removed 6225 Food Inspection. The following were surrendered to me as unfit for human consumption:— 11 Article of Food. Quantity. Beef 588 lbs. Bacon 34 lbs Mutton 1 Carcase. Corned Beef 13 Tins. Sausages 25 lbs. Tripe 1 Crate. Eggs 1 Box. Condensed Milk 2 Casks. Margarine 4 Boxes. Smoked Haddock 6 Boxes. Kippered Herrings 3 Boxes. Winkles (Shell Fish) 1 Bag. Mixed Fish 17 Boxes. Sale of Food and Drugs Act. The Local Authority for the administration of these Acts is the Kent. County Council. The following is a return showing the number and nature of the Samples taken by their Inspector during the year:— Article. No. of Samples taken. No. Genuine. No. Adulterated. Remarks. New Milk 39 36 3 1 Vendor fined £10 and costs, 1 Vendor fined £5 and costs, 1 case dismissed. Margarine 6 6 Mustard 5 5 Ground Ginger 3 3 Skimmed Milk 1 1 Gin 1 1 Citrate of Magnesia 1 1 Cocoa 10 10 Coffee 6 6 Baking Powder 5 5 Flour 3 3 Whisky 1 1 Fine Oatmeal 1 1 Cheese 1 1 Pepper 7 7 Butter 6 6 Lard 4 4 Honey 2 2 Cocoa Butter 1 1 Rum 1 1 Brandy 1 1 105 102 3 12 Housing. As already pointed out in my Reports for 1915 and 1916, there is still a great lack of Housing Accommodation in the district. It is true that a large number of Huts, Hostels, etc., have been erected, but this does not fully supply the demand. Housing Inspection Regulations. 265 houses were inspected during the year. There were no houses represented as unfit for habitation. Owing to the scarcity of labour very little work has been accomplished in order to remedy defects. Hospital Accommodation for Infectious Diseases. The Sanatorium for Infectious Diseases is situated at Little Heath, Belvedere. There is accommodation for 52 Patients, namely:— 86 Scarlet Fever and 16 Diphtheria. By an arrangement with the Metropolitan Asylums Board, Enteric Eever cases are removed to Joyce Green Hospital, Dartford. There is a similar arrangement with regard to Small Pox cases. Table showing the number of patients treated during the year at the Sanatorium:— Measles. Enteric Fever. Scarlet Fever. Diphtheria. Total. Admissions 1 1 57 18 77 Discharged 1 2 59 22 84 Died — — — — — Table 1.—Vital Statistics of Whole District during 1918 and previous years. Year. Population estimated to middle of each year. Births. Ttl. deaths registrd. in the Distr't 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 1912 28,073 653 664 23.65 266 9.47 8 76 46 69.27 334 11.89 1913 30,100 658 771 25.61 235 7.8 10 71 59 76.52 296 9.83 1914 30,562 786 834 27.28 290 9.81 — 103 76 91.1 393 12.85 1915 35,232 724 738 20.94 305 8.65 8 73 54 73.17 370 10.5 1916 35,011 807 827 21.71 307 8.76 21 95 48 58.04 381 10.88 1917 33,129 695 734 19.85 256 7.72 10 102 59 80.38 358 10.80 1918 32,755 620 660 17.98 334 10.19 6 104 50 75.75 432 13.18 Area of District in Acres (land and inland water) 3859.513 Total Population at all Ages 27,750 Number of Inhabited Houses 5,129 At Census 1911. 13 14 Table II.—Cases of Infectious Disease notified during the Year 1918. 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) 20 5 11 3 1 18 Erysipelas 4 1 1 2 Scarlet Fever 68 1 13 48 4 2 57 Typhus Fever Enteric Fever 3 1 2 3 Relapsing Fever Continued Fever Puerperal Fever 1 1 Cerebrospinal Meningitis Poliomyelitis Ophthalmia Neonatorum 4 4 Pulmonary Tuberculosis 58 3 19 33 2 1 Other forms of Tuberculosis 15 2 5 3 2 2 ] Measles 194 6 89 93 5 1 3 German Measles 13 3 9 1 1 Totals 380 13 115 168 35 42 4 3 81 Isolation Hospital or Hospitals, Sanatoria, etc. Erith Sanatorium, Bow Arrow Hospital, Dartford, various London General Hospitals and Special Hospitals, Sanatoria at Bromley, Joyce Green M.A.B. Hospital, Dartford. 15 Table III.-Causes of. and Ages at Death during the year 1918. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without 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 All causes Certified 432 50 20 18 28 42 88 85 101 Uncertified Enteric Fever 1 1 Small-pox Measles 6 2 2 1 1 Scarlet Fever Whooping Cough 7 3 3 1 Diphtheria & Croup 1 1 Influenza 71 3 3 5 8 18 24 8 2 Erysipelas 1 1 Phthisis(Pul'm'n'ry Tuberculosis) 42 3 11 24 4 Tuberculous Meningitis 5 1 2 2 Other Tuberculous Diseases 5 3 1 1 Cancer, malignant disease 30 1 18 11 Rheumatic Fever 1 1 Meningitis 4 2 1 1 Organic Heart Disease 43 2 8 15 18 Bronchitis 33 2 2 1 1 8 19 Pneumonia (all forms) 59 8 8 5 5 3 18 10 2 Other diseases of respiratory organs 3 2 1 Diarrhoea and Enteritis 7 4 2 1 Appendicitis and Typhlitis 4 3 1 Cirrhosis of Liver Alcoholism Nephritis & Bright Disease 8 1 1 1 3 2 Puerperal Fever Other accidents diseases of pregnancy and parturition 1 1 Congenital Debility and Malformation including Premature Birth 18 17 1 Violent Deaths, excluding Suicide 9 1 1 1 1 1 1 3 Suicide Other Defined Diseases 72 5 1 1 1 7 15 42 Diseases, ill-defined or unknown 1 1 Totals 432 50 20 18 28 42 88 85 101 16 Table IV.—Infantile Mortality during the Year 1918. Nett Deaths from stated causes at various ages under 1 year of age. Causes of Death. J 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 9 4 1 14 9 5 9 13 50 Uncertified Small-pox Chicken-pox Measles 2 2 Scarlet Fever Whooping Cough 1 1 1 3 Diphtheria & Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis 1 1 2 Other Tuberculous Diseases 1 1 Meningitis (not Tuberculous) 1 1 2 Convulsions 1 1 1 3 Laryngitis Bronchitis 1 1 2 Pneumonia (all forms) 2 1 3 3 9 Diarrhœa 1 1 Enteritis 1 1 1 2 Gastritis 1 1 Syphilis Rickets Suffocation, overlying 1 1 1 Injury at birth 1 1 1 Atelectasis Congenital Malformations 1 1 2 1 3 Premature birth 5 1 6 6 Atrophy, Debility and Marasmus 1 1 2 2 2 6 Other causes 1 1 1 3 5 Totals 9 4 i 14 9 5 9 13 50 Nett Births in the year :—Legitimate, 632 ; Illegitimate, 28. Nett Deaths in the year of:—Legitimate Infants, 46 ; Illegitimate Infants, 4. Still-birfhs, 9.