PEN 008 Urban District Council of Penge. Chairman— Councillor W. C. Watling, J.P. Vice-Chairman— Councillor F. W. R. Young. SANITARY AND LIGHTING COMMITTEE. Chairman— Councillor E. G. Hopper. Councillor S. H. Croucher. Councillor J. H. Holmes. „ H. Culver. „ J. W. Rudd. „ F. P. Hodes. „ J. B. Smith. „ A. Wilkinson. Medical Officer of Health. Robert Wilkinson, M.D. (Brux.), M.R.C.S., (Eng.), L.R.C.P. (Lond.) Sanitary Inspector. Alfred J. Willett, M.R.S.I., Etc. Assistant Inspector. Joseph E. Hall, A.R.S.I. Health Visitor. Miss Lilian Boulter. Clerk. Richard T. Pearce. ANNUAL REPORT of the Medical Officer of Health for the Penge Urban District in the COUNTY OF KENT for the Year Ending December 31st, 1913. 5 Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Urban District Council of Penge. Gentlemen, I have the honour of presenting to you my Annual Report on the health of the District for the year ending December 31st, 1913. The principal features of the Vital Statistics for the year are as follows:— Population 22,331 Number of Inhabited Houses Census 4,847 Average number persons per house 1911 4.61 Density of population per acre 29 Population 1913 (estimated middle of 1913) 22,434 Area of District in acres 770 Birth Rate, corrected 19.52 Infantile Mortality Rate per 1,000 births 82.19 Under 5 years.— Death rate per cent. of number of deaths registered (corrected) 19.09 Death Rate (corrected) 13.77 Zymotic Death Rate 1.02 Tuberculosis (Pulmonary) Death Rate 0.62 „ (other forms) Death Rate 0.35 6 POPULATION. The estimated population for 1912 was 22,369. There was an excess of 129 births over deaths and it is also to be noted that 9 unoccupied houses have been reconstructed to accommodate 25 families. The majority of these flats are now occupied. I therefore estimate that the population for 1913 is 22,434, an increase of 65 over the preceding year, and it is upon this figure that the various rates are based. DEATH RATE. The number of deaths registered in the Urban District of Penge during the year, was 245, equal to a death rate of 10.92 per 1,000. Seven of these were deaths transferable to other Districts, but 71 deaths which occurred in public institutions outside the District were transferred to this. The corrected number of deaths was therefore 309, equal to a rate of 13.77 per 1000, as compared with 267 or 11.98 per 1000 for 1912, and 312 or 13.97 per 1000 for 1911. INFANTILE MORTALITY. The number of deaths of Infants under 1 year was 36, corresponding to a rate of 82.19 per 1000 births. The following table shows the infantile death rate for the previous 6 years:— 1907 1908 1909 1910 1911 1912 102.56 46.08 117.04 77.50 101.81 75.83 7 ZYMOTIC DEATH RATE. During the year, deaths have been referred to the following Zymotic diseases:— Diarrhœa and Enteritis 6 Diphtheria and Membranous Croup 4 Enteric Fever — Influenza 2 Measles 11 Scarlet Fever — Small-pox — Whooping Cough — Total 23 This gives a Zymotic Death Rate of 1.02 per 1000 against 0.71 for 1912. BIRTH RATE. The births registered during the year numbered 438, of which 200 were males and 238 females. This gives a birth rate of 19.52 per 1000, compared with 18.86 for 1912, and 19.79 for 1911. Of the 438 births registered 416 were visited. NOTIFICATION OF BIRTHS ACT. I am pleased to be able to report that the Notification of Births Act is now working very smoothly and there are fewer instances of non-notification. A supply of stamped addressed postcards is sent to all the Medical Practitioners and Midwives in the district, with the necessary printed matter thereon for the notification of the birth. The following table gives the number of notifications received during 8 the year and particulars of births notified together with corresponding particulars for the two previous years:— 1911. 1912. 1913. Number of births registered with Registrar 442 422 438 Number of births notified to Medical Officer 364 391 414 Percentage of births notified 84.38 93.83 93.66 Percentage of Registered births visited 97.51 94.31 94.97 Number of first visits 421 398 421 Babies under observation — 413 389 N umber notified by doctors 215 249 273 „ „ midwives 107 111 106 „ „ parents 34 26 22 Number not notified 69 26 28 Number of still births notified 8 5 13 Of the 414 notifications received during the year, 384 were visited, 10 were not visited by request, 10 were still-births and 10 were not visited as the doctor was in attendance. Thus 30 children out of a total of 414 were not visited, but of these, six cases will be visited in the early part of 1914. The number of first visits to infants during 1913 was 421, and the subsequent visits were 2,654. Methods of Feeding Infants visited. Breast fed 343 Cows' milk and barley water 34 Partly breast and partly hand fed 16 Patent foods 28 Total 421 9 BABY COMPETITION. A successful baby competition was held in January, when 154 babies were entered, and 119 were actually presented by their mothers in the judging rooms. Owing to the large number of competitors it was decided that there should be six classes; that a first and second prize should be given in each class, and a special prize for the healthiest and best developed baby born and reared in Penge and under the age of two years on the 31st December, 1912. The classes were as follows:— No. of competitors. Class 1. Under 4 months 23 Class 2. Between 4 and 8 months 27 Class 3. Between 8 and 12 months 27 Class 4. Between 12 and 18 months 20 Class 5. Between 18 and 24 months 10 Class 6. Twins (6 pairs) 12 Total 119 Dr. Eric Pritchard kindly consented to act as Judge and Dr. Codd, the Medical Officer of Health for the Borough of Bromley, kindly acted with me in the preliminary judging, after which 49 competitors were left for Dr. Pritchard to make a final selection from. After the prizes had been awarded, Dr. Pritchard said that the selection of the prize-winners had proved a very difficult task because so many of the competitors were first rate specimens of babyhood, and that there was a high standard of excellence all round. A guarantee fund was provided, chiefly by members of the Council, to meet the expenses of the prizes, etc. I cannot help thinking that the competition had a direct beneficial and stimulating influence upon those im- 10 mediately responsible for the health of the babies in our District. My thanks are specially due to Dr. Eric Pritchard and also to Dr. Codd, for kindly consenting to act as judges ; also to the other helpers who made the competition such a success. NOTIFIABLE DISEASES. The total number of cases of infectious diseases notified during the year under the Infectious Disease (Notification) Act of 1889 (excluding Tuberculosis) was 135,which compares with 115 in 1912, 110 in 1911, 107 in 1910, 179 in 1909 and 147 in 1908. This is a rate of 6.01 per 1,000 inhabitants for these diseases, 1.82 for Pulmonary Tuberculosis, and 1.64 for other forms of Tuberculosis, a total of 9.47 notifications per 1,000 inhabitants. Diseases. Treated at home. Removed to hospital. Total. Diphtheria 29 55 84 Enteric Fever — 1 1 Erysipelas 8 — 8 Puerperal Fever 1 — 1 Scarlet Fever 17 24 41 Tuberculosis (Pulmonary) 20 21 41 Tuberculosis (other forms) 20 17 37 Totals 95 118 213 Diphtheria. There were 84 cases of Diphtheria in 1913, as against 72 in 1912, 71, 46, 41 and 54 in the previous four years. Of the 84 cases 55 were treated in hospital. Anti-Diphtheritic Serum was supplied for the treatment of 23 cases; 49 vials being supplied, containing 98,000 units, 11 Thirty patients discharged from hospital were examined on their return to the District; and, on swabs being taken, 11 were reported to have diphtheritic organisms present. These cases were carefully watched, but no further cases were traced to them, and the bacilli were probably only present in a very attenuated form with slight potentiality for infection. There were 4 deaths from Diphtheria during the year. Three of these were amongst the cases notified, and one death of a Penge resident occurred in an institution outside the District, which is included in this number. The primary swabs from suspected cases of Diphtheria are sent to the Clinical Research Association, and those from contacts and convalescent cases to the County Laboratory, Maidstone. Diphtheria Outbreak. During the closing months of the year a serious outbreak of diphtheria occurred in the Upper Norwood portion of the District. The outbreak was not confined to this District, but affected also the adjoining portions of Beckenham, Camberwell, Croydon, Lambeth and Lewisham. In all, there were about 120 cases, of which 21 were in our District. Upon noticing that the cases were all supplied with milk from a certain dairy outside our area, the Medical of Health of that District was communicated with, full details placed before him, and the dairyman notified. At the same time I informed the County Medical Officer and he subsequently came and consulted with me upon the matter. The outbreak was ultimately traced, after a considerable amount of investigation, to infected milk supplied to this dairy. A special meeting of the Council was called and it was decided, that unless the dairyman gave an undertaking to 12 Pasteurize all milk supplied in the Penge District, a prohibition order would be applied for. The dairyman agreed to do what the Council required, and almost immediately the occurrence of further cases ceased. The Pasteurizing was continued until the primary source of infection in connection with the dairy was discovered. I made a report to the Local Government Board with respect to the outbreak and Dr. Macewen, one of their Medical Inspectors, was deputed to investigate the matter, and I subsequently had an interview with him. I am glad to be able to report that we had no fatal cases. Enteric Fever. One case of Enteric Fever was notified during the year, viz.: a boy aged 10 years. The source of infection was not ascertained. The case was removed to hospital and discharged after six weeks treatment. This is the lowest number notified for some years, the notifications for the past six years being 3, 6, 8, 5, 26 and 5. Puerperal Fever. One case was notified which proved fatal. Scarlet Fever. There were 41 cases of Scarlet Fever notified, as compared with 31 in 1912, 29, 43, 125 and 62 during the previous four years. Twenty four of these cases were treated in hospital. No case was fatal. Twenty three cases were examined on their return from the hospital and all were found to be free from infection. Tuberculosis.. Further Regulations of the Local Government Board in regard to Tuberculosis, came into operation on February 1st, 1913. These provided that all forms of Tuberculosis should 13 be notified to the Medical Officer of Health, whereas the previous regulations had reference to Pulmonary Tuberculosis only. Number of cases (Pulmonary) notified during 1913 41 „ „ (Other forms) „ „ „ 37 „ „ notifications received 113 Notified by Medical Practitioners 41 „ „ School Medical Inspector 1 „ „ Hospitals 25 „ „ Poor Law Institutions 35 „ „ Sanatoria 11 Cases sent to Hospitals, Sanatoria, etc. 38 Six of the notifications received had reference to cases notified in 1912. It will therefore be seen that 107 notifications had reference to 78 cases. The following were the places to which the treated cases were sent:— Burfield Common Sanatorium, Sittingbourne Sanatorium, Northwood Sanatorium, Bromley Common Sanatorium, St. Phillip's Memorial Hospital, Eversfield Chest Hospital, Midhurst Sanatorium, Croydon General Hospital, Great Ormond Street Hospital, St. Bartholomews Hospital, Treloar's Cripple Home, Guy's Hospital, Croydon Infirmary, Charing Cross Hospital, Queen Mary's Hospital, St. Thomas's Hospital, Wainwright Home, Norwood Cottage Hospital, Benenden Sanatorium, Crooksby Sanatorium, St. James's Infirmary, Sydenham Hospital. The Health Visitor makes enquiries at every house where cases are notified and in 58 instances, advice was given, leaflets left, and where necessary, paper handkerchiefs, sputum flasks and disinfectants were supplied. The majority of these cases are kept under periodic observation, and the number of visits paid was 458. During the year there have been 12 deaths among notified Pulmonary cases, and 5 deaths of persons suffering from other forms of Tuberculosis, 14 In regard to Pulmonary Tuberculosis, where the person died in the district the rooms and bedding have been disinfected and where necessary the landlord has been called upon to cleanse the premises. In cases of removal to other premises or where the patient has gone to a sanatorium, disinfection has also been carried out. In addition to keeping an official register of notified cases, I have endeavoured as far as possible to record full notes as regards their progress. I make a practice of notifying all cases leaving the District to the Medical Officer of Health of the locality to which the patient removes, and it would be well, I think, if this practice were reciprocal. It will be seen in reference to the table, that in Ward 1 there were 38 cases notified which is a higher number than that of Wards 2 and 3. This greater number of notifications is due to the cases notified from the North Surrey District Schools, which amounted to 19. Taking this from the total of No. 1 Ward it will be seen that there is very little difference between the figures for the various Wards. SCHOOLS AND INFECTIOUS DISEASES, etc. Notifications to Schools of Notifiable Infectious Diseases. During the year 225 notifications have been sent to the School Medical Officer, and the Medical Inspectors and head teachers of the various schools, informing them of cases of infectious disease that have occurred in the homes of children attending school, and prohibiting attendance from the infected houses for certain periods, 15 St. Paul's Schools 20 St. John's Schools, Maple Road and Beckenham Road 44 Melvin Road Schools 29 Oakfield Road Schools 67 Genoa Road Schools 9 Other Schools 7 Sunday Schools 41 Medical Officers of Schools outside District 8 Total 225 Notifications from Schools of Non-notifiable Infectious Diseases. School. Mumps. Swollen Glands. Tonsilitis. Measles. Chicken Pox. Whooping Cough. Ringworm. Sore Throat. Undefined. Totals Oakfield Road Boys Girls Infants 33 23 1 2 59 St. John's Boys Girls 9 1 10 Infants 6 84 3 11 2 106 Melvin Road Boys 1 1 2 Girls 6 16 6 3 7 38 Infants 2 45 12 22 81 St. Paul's i 2 1 4 Genoa Road 3 4 7 Totals 16 192 50 12 5 32 307 16 EXAMINATION OF PATHOLOGICAL PRODUCTS. During the year the scope of the work of the County Laboratory has been considerably extended. In regard to Diphtheria it is now possible to have organisms from "carriers," who may retain diphtheria bacilli for a long period, tested for virulence, if required. Samples of food suspected to have caused food poisoning will be examined, and if necessary, a bacteriologist will be sent to the District to collect samples, in conjunction with the Medical Officer of Health. The Laboratory also now arranges to test samples of milk for the presence of tubercle and diphtheria bacilli, and also for examining specimens taken in connection with any infectious, contagious or communicable disease. The results of the examinations were as follows:— Bacillus found Bacillus not found Total Diphtheria. Clinical Research Association 64 104 168 Diphtheria. County Laboratory 58 99 157 Tuberculosis. „ „ 15 20 35 Ringworm. „ „ 42 18 60 Enteric fever. Clinical Research Association 1 1 2 ,, ,, County Laboratory — 2 2 Totals 180 244 424 From the above it will be seen that the examinations made by the Clinical Research Association amounted to 170, and by the County Laboratory to 254, making a total of 424. This compares with 424 in 1912, 195 in 1911, 153 in 1910, and 123 in 1909. 17 HOUSING AND TOWN PLANNING, &c., ACT, 1909. As in previous years the systematic house to house inspections have been continued, and 163 houses have been inspected. The details of the defects remedied will be found in the Sanitary Inspector's Report. In addition to these inspections, each house is thoroughly inspected in the same manner as under the Housing and Town Planning Act after every case of infectious disease. In regard to dampness in the houses, in many cases this has been found to be due to absence of damp-proof course. On taking up the floor boards to insert a damp-proof course in the walls, floor boards have been found practically resting on the clay. In such cases owners have been called upon to remove the clay and lay concrete over the site. I attach special importance to this as a means of making houses more habitable. A special inspection was made of a house that had formerly been used as a public house, but the license had been extinguished and the licensees compensated. The premises being unoccupied fell into a dilapidated condition, and the brewers then sold the premises to a private individual. Repeated letters were sent to him as to the condition of the property, and a request made to put it into a habitable state of repair. Nothing, however, was done, and I, therefore, recommended that a Closing Order be made. On December 22nd the Council considered the recommendation and the Closing Order was made. There have been no new houses erected during the year but nine houses have been converted into flats for the accommodation of 25 separate lettings, as shown in the following list:— 27, Waldegrave Road. 30, Royston Road. 25, Anerley Park. 32, „ „ 2, Derwent Road. 74, Anerley Park. 36, Anerley Park. 203, Anerley Road. 95, Anerley Road. 18 PUBLIC MORTUARY. There have been 12 Inquests during the year 1913, as follows:— Causes of death. Males. Females. Total. Natural causes 5 3 8 Accidental causes 2 - 2 Suicides 2 - 2 Totals 9 3 12 COLLECTION & DISPOSAL OF HOUSE REFUSE. The house refuse is contained in movable galvanized iron dustbins with proper covers, and is collected throughout the District from each house once in every week, except during the months of June, July and August, when there is a bi-weekly collection. The refuse is loaded into trucks at the Penge Station (S. E, & C. Railway), by our dustmen, and is removed by rail out of the District by a Contractor, who disposes of it. The number of loads collected during the year was 4,732, against 4,855 during 1912. The cost of collection from houses, and disinfection of dustbins amounted to £1141 16s. 11d., and the cost of removal by rail to £828 2s. 0d., making a total cost of collection and disposal of house refuse of £1969 18s. 11d. INSPECTIONS, &c. I have frequently and systematically inspected the Dairies, Cowsheds and Milkshops, more particularly during the outbreak of diphtheria in the Autumn. Every source of milk supplied to the dairies was obtained and tabulated for 19 reference ; this information should be of the greatest value, should the question of contaminated milk again arise. On the whole the sanitary arrangements and precautions against fly-contamination were satisfactory. In the small dairies and milkshops, the importance of boiling the milk-cans is not always appreciated, nor cleanliness in the strictest scientific sense always obtained. The careful grooming of cows, disinfection of udders, and the cleanliness of the milkers' hands is not always satisfactory. I have again to express my opinion that more stringent by-laws relating to the dairies, milkshops, cowsheds, etc., should be in operation. By-laws have already been drafted, but have been held in abeyance in expectation of a Government measure dealing with the milk question. The usual inspections have been made of bakehouses, slaughter houses, factories and workshops. I have observed a few cases of overcrowding which have been promptly attended to, but owing to the migratory habits of the offenders, this nuisance is apt to recur in another part of the district. I should like again to make reference to the Metropolitan Water Board's Regulations, prohibiting the use of 3 gallon flushing tanks for W.C's and allowing only tanks of a capacity not exceeding 2 gallons. I regard this as a mistake, as the flushing is not nearly so good, consequently the drains and interceptors are more liable to get blocked. I should like to express my appreciation of the valuable help of the Sanitary Inspector (Mr. A. J. Willett), during the diphtheria outbreak. A considerable amount of extra work occurred at this time, and not a little anxiety was felt by those responsible for the health of the District. Particulars of the various inspections will be found in the Sanitary Inspector's Report. 20 Tables referring to the Factory and Workshops Acts, Vital Statistics, Infantile Mortality, Infectious Diseases, Rainfall, and Sunshine, are appended. In conclusion, I have again to express my sincere thanks to the Chairman and Members of the Sanitary Committee for their cordial support and help during the past year. I am, Gentlemen, Your obedient Servant, ROBERT WILKINSON. TABLE 1. Vital Statistics of Whole District during 1913 and previous Years. Year Population estimated to Middle of each Year BIRTHS Total Deaths Registered in the District Transferable Deaths NETT DEATHS BELONGING TO THE DISTRICT Uncorrected Number Nett of Nonresidents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages Number Rate per 1000 Nett Births Number Rate Number Rate Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 24,161 434 17.9 177 7.3 - 39 20 46.08 216 8.9 1909 24,408 393 16.1 232 9.5 - 44 46 117.04 276 11.3 1910 24,658 400 16.2 164 6.6 - 47 31 77.50 211 8.5 1911 22,331 442 19.79 247 11.05 4 69 32 101.81 312 13.97 1912 22,369 422 18.86 243 10.86 3 27 45 75.83 267 11.93 1913 22,434 438 19.52 245 10.92 7 71 36 82.19 309 13.77 This table is arranged to show the gross births and deaths in the District and the births and deaths properly belonging to it, with the corresponding rates. "Transferable deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. Total population at all ages 22,331 Area of District— Number of inhabited houses 4,847 770 acres. Average number of persons per house 4.61 At Census 1911 21 TABLE II. Cases of Infectious Disease notified during the Year 1913. Notifiable Disease. number of cases notified. Total Cases Notified ineach Ward Total cases removed to H'sptal At all ages. At ages—Years Under I 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards No. 1 C. Pal. Ward. No. 2 Penge Ward No. 3 Anerl'y Ward Diphtheria (including Membranous Croup) 84 ... 14 44 13 8 5 ... 46 18 20 55 Erysipelas 8 ... ... 1 ... 2 4 1 ... 8 ... ... Scarlet Fever 41 ... 8 29 4 ... ... ... 12 17 12 24 Enteric Fever 1 ... ... 1 ... ... ... ... ... 1 ... 1 Puerperal Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... Pulmonary Tuberculosis 41 ... ... 5 6 19 11 ... 14 12 15 21† Other forms of Tuberculosis 37 ... 6 23 6 2 ... ... 24 9 4 17† Totals 213 - 28 103 29 32 20 1 97 65 51 118 Note.— There were no cases notified of the following notifiable Infectious diseases, Small Pox, Cholera, Plague, Typhus Fever, Relapsing Fever, Continued Fever, Cerebro-Spinal Meningitis, Poliomyelitis. Isolation Hospitals.— Croydon Isolation Hospital, Waddon; Croydon & Wimbledon Joint Small-pox Hospital, Cheam. Total available beds (the Hospital Authorities provide any beds that may be required). Number of Diseases that can be concurrently treated, 4; viz. Small-pox, Diphtheria, Scarlet Fever, Enteric Fever. t Tuberculosis—The following are the Hospitals, etc., to which Tuberculosis patients were sent:—Eversfield (2); Croydon Infirmary (3); Broadstairs, Wainwright Home (7); Sittingbourne (2); Burfield Common (I); Northwood (2); Bromley Common (3); St. Phillip's Memorial (1); Midhurst (1); Croydon General (2); Great Ormond Street (3); St. Bartholomew's (I); Treloar's Cripple Home (1); Guy's (1); Charing Cross (1); Queen Mary's (3) St.Thomas' (4); Norwood Cottage (I); Benenden (3); Crooksby (1); St. James' Infirmary (I); Sydenham Sick Home (1). Note.— Seven cases went to more than one hospital. 22 23 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 yrs 2 and under 5 yrs 5 and under 15yrs 15 and under 25yrs 25 and under 45 yrs 45 and under 65 yrs 65 and upwards l 2 3 4 5 6 7 8 10 11 All causes Certified 309 36 13 10 7 9 49 60 125 309 Uncertified Enteric Fever Small-pox Measles 11 1 4 5 1 11 Scarlet Fever Whooping Cough Diphtheria and Croup 4 1 1 2 4 Influenza 2 1 1 2 Erysipelas Phthisis (Pulmonary Tuberculosis) 14 9 4 1 14 Tuberculous Meningitis 6 1 2 1 1 1 6 Other Tuberculousd'ses 8 1 1 3 3 8 Cancer, malignant 32 3 10 19 32 Rheumatic Fever 1 1 1 Meningitis 3 1 1 1 3 Organic Heart Disease 34 1 2 4 12 15 34 Bronchitis 24 2 4 18 24 Pneumonia (all forms) 22 5 2 2 1 1 4 7 22 Other diseases of respiratory organs Diarrhoea and Enteritis 6 6 6 Appendicitis &Typhlitis 2 2 2 Cirrhosis of Liver 6 1 5 6 Alcoholism Nephritis and Bright's Disease 16 5 2 9 16 Puerperal Fever 1 1 1 Other accidents and diseases of Pregnancy and Parturition 3 1 2 3 Congenital Debility and malformation including premature birth 5 5 5 Violent Deaths, excluding Suicide 4 1 1 1 1 4 Suicide 3 1 1 1 3 Other defined diseases 63 7 1 1 1 2 11 14 26 63 Cerebral Hæmorrhage 17 1 4 12 17 Diseases ill-defined or unknown 22 4 1 1 16 22 Totals 309 36 13 10 7 9 49 60 125 309 24 TABLE IV. Infant Mortality 1913. Nett deaths from stated causes at various Ages under One Year. Causes of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year. All Causes Certified 4 2 1 2 9 8 7 7 5 36 Uncertified Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... 2 1 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 1 ... 2 Pneumonia ... ... ... ... 1 1 2 ... 1 5 Diarrhœa ... ... ... ... 1 ... 1 2 ... 4 Enteritis ... ... ... ... ... ... 1 1 2 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... 1 ... ... 1 ... 2 Premature birth 2 ... ... 2 4 1 ... ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... 1 ... ... ... 1 Other causes ... ... ... ... ... 3 ... ... 1 4 Totals 4 2 1 2 9 8 7 7 5 36 Nett Births in the year: Nett Deaths in the year of Legitimate 412. 438 Legitimate infants 30. Illegitimate 26. Illegitimate „ 6. 36 25 FACTORIES AND WORKSHOPS. The following are the tables required by the Home Office in regard to the administration of the Factory and Workshop Acts in this District. Table 1.—Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections Written notices Prosecutions Factories (Including Factory Laundries) 28 3 Nil. Workshops (Including Workshop Laundries) 210 51 Workplaces (Other than Outworkers' premises included in Table 3 of this Report.) Total 238 54 — 26 Table 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects No. of Prosecustions. Found Remedied Referred to H.M. Inspector. Nuisances tinder the Public Health Acts.* Nil. Want of cleanliness 10 10 Want of Ventilation Overcrowding Want of drainage of floors 1 1 Other nuisances 13 13 †Sanitary accommodation Insufficient, unsuitable or defective 6 5 Not separate for sexes Offences under the Factory and Workshop Acts: Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouse (ss. 97 to 100) Other offences (excluding offences relating to outwork which is included in Table 3 of this Report) 4 Totals 30 29 4 * Including those specified section 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. † Sec. 22 of the Public Health Acts Amendment Act, 1890, is in force in the District. The standard adopted is that set forth in the Sanitary Accommodation Order of 4th of February, 1903, made by the Secretary of State. 27 Table 3. Homework. NATURE OF WORK OUTWORKERS' LISTS, SECTION 107. Numb'r of Inspections of Outwork'is pr'mis's Outwork in unwholesome premises, Sec. 10S Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Sending twice in the year. Sending twice in the year. Failing to keep or permit inspection of lists Failing to send lists Lists Outworkers Lists Outworkers Contract'rs Workmen Contract'rs Workmen Wearing Apparel—making, &c. 6 6 5 18 19 16 Brush making — — — 1 1 1 Totals 6 6 5 19 20 17 23 — — — — — — 28 Table 4. Registered Workshops, &c. On the Register at the end of the year. Workshops, &c. Factories. Bakehouses 18 — Basket Making 1 — Brushmaking 2 — Bone Grinding — 1 Bookbinding — 1 Boot Polish Manufactory — 1 Boot Making and Repairing 12 — Bottling 1 — Carpentering (Builders' workshops) 6 — Cycle Repairing 3 — Dressmaking and Millinery 30 1 Dry Battery Works 1 — Dyer and Cleaner — 1 Ivory Works — 1 Joinery Works — 1 Laundry Work 13 8 Metal Working 1 — Miscellaneous 11 — Motor Cycle Making — 1 Motor Repairing 3 — Photo printing 1 1 Picture framing 1 — Printing — 4 Restaurant kitchen 1 — Saddlery and Trunk Making 1 — Scalemaking 1 — Smithies 2 — Tailoring 9 — Upholstering and Furniture Repairing 4 — Wheelwrights 2 — Total 124 21 145 Table 5.—Other Matters. Class No. Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Act (Sec. 133) 4 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector 2 Report of action taken sent to H.M. Inspector 2 Other : Underground bakehouses (S. 101) Certificates granted during the year Nil. In use at end of year 3 29 METEOROLOGY, 1913. Rainfall. Sunshine. Week ending Saturday. Penge Inches. Greenwich Inches. Penge Hours. Greenwich Hours. Jan. 4 0.16 0.15 9.05 15.9 „ 11 0.26 0.66 6.35 11.3 „ 18 0.55 0.66 9.65 17.8 „ 25 0.72 0.70 1.00 2.2 Feb. 1 0.94 0.78 9.50 16.6 „ 8 0.14 0.26 7.50 9.3 „ 15 0.18 0.19 5.50 5.7 „ 22 0.02 0.04 15.50 26.2 March 1 0.07 0.08 9.67 16.9 „ 8 0.18 0.24 21.50 27.2 „ 15 0.69 0.28 14.75 23.0 „ 22 1.30 1.42 15.53 26.3 „ 29 0.49 0.49 8.75 13.3 April 5 0.50 0.33 15.75 20.9 „ 12 0.51 0.53 10.50 19.7 „ 19 0.48 0.50 18.75 26.3 ,, 26 0.33 0.32 32.75 40.5 May 3 0.92 0.60 26.50 29.2 „ 10 0.42 0.62 16.00 20.5 „ 17 0.07 0.05 42.25 48.6 „ 24 0.00 0.02 55.33 53.7 „ 31 0.41 0.40 59.75 65.2 June 7 0.11 0.12 42.00 53.7 „ 14 0.00 0.14 26.25 35.5 „ 21 0.07 0.41 44.50 67.3 „ 28 0.04 0.06 23.50 33.1 July 5 0.11 0.21 21.00 25.6 „ 12 0.17 1.30 12.00 20.7 „ 19 o.75 0.52 6.50 6.2 „ 26 0.06 0.05 35.25 27.1 August 2 0.00 0.00 22.00 40.4 „ 9 0.22 0.09 30.75 37.1 „ 16 0.08 0.14 22.75 15.5 „ 23 0.31 0.36 31.75 35.0 „ 30 0.64 0.51 38.75 44.5 Sept. 6 1.77 1.43 3.50 4.4 „ 13 0.11 0.06 35.25 46.0 „ 20 0.36 0.60 24.50 33.6 „ 27 0.14 0.13 31.25 39.8 October 4 0.34 0.22 31.50 40.1 „ 11 1.19 1.28 15.50 21.3 „ 18 0.11 0.12 20.25 32.0 „ 25 0.79 0.69 22.25 21.0 Nov. 1 1.36 1.27 22.25 22.9 „ 8 0.32 0.40 19.75 22.7 „ 15 1.29 1.50 8.25 17.7 „ 22 0.59 0.63 8.50 15.6 „ 29 0.02 0.03 17.00 13.8 Dec. 6 0.50 0.31 5.25 4.6 „ 13 0.03 0.02 5.00 2.6 „ 20 0.00 0.01 9.25 7.9 „ 27 0.49 0.53 2.50 3.4 Totals 21.31 22.46 1050.55 1327.3 1908 24.66 23.74 1640.25 1627.1 1909 26.41 27.25 1654.00 1648.4 1910 27-39 28.06 1294.20 1379.3 1911 24.11 23.65 1710.75 1788.8 1912 27.16 24.98 1247.20 1360.9 The rainfall is registered at the Recreation Ground and the sunshine is recorded at the Town Hall. ANNUAL REPORT OF THE Sanitary Inspector FOR THE Penge Urban District IN THE COUNTY OF KENT FOR THE Year Ending December 31st, 1913. 33 Town Hall, Anerley Road, Anerley, S.E. To the Chairman and Members of the Urban District Council of Penge. Gentlemen, I have the honour of presenting to you my thirteenth Annual Report for the year ending the 31st December 1913. Four hundred and thirty-six premises, excluding those under the heading of food trade inspections, factories and workshops, and lodging houses have been inspected and 2,347 miscellaneous inspections and re-inspections made of urinals, stables, &c., and also in following up the work in hand, testing drains &c. The number of letters written was 1,266 against 1,187 and 881 in the previous two years, 766 intimation notices, against 758 and 696, and 244 statutory notices compared with 181 and 175 were served. DRAINAGE. Twenty-six houses have been provided with entirely new drains, and twenty-five have had the drains repaired or partially re-laid; 1,862 feet of glazed stoneware pipes with water-tight joints were laid on cement concrete; 41 inspection chambers have been constructed; 54 water closets, 96 gullies, and 35 soil and ventilation pipes were fixed. 34 A great amount of controversy has for many years ranged around the necessity or otherwise, of providing intercepting traps on house drains, and recently a Departmental Committee of the Local Government Board presented a report upon this matter to the Houses of Parliament. The conclusions of the Committee are very important and should be more widely known. They report that:— "The necessity of the intercepting trap, on bacteriological or epidemiological grounds, has not therefore been established. It appears, in fact, that the characteristic of sewer air which is of practical importance is its smell, and that, therefore, the question, as to the necessity or otherwise of the intercepting trap, is narrowed down to the issue whether, in any given case, sewer air will be more perceptible or less perceptible to the sense of smell, with or without the trap. Nevertheless, the question is one of serious public health importance. Human beings vary greatly in their perception of smells, and offensive and unpleasant odours affect the comfort and physical well-being, and probably the health, of the individual." It also appears from the evidence given that the splashing of sewage in drains may be far more harmful to health than any thing else connected with drainage. The Committee report that:— "The relationship between the splashing of sewage and the temporary presence of sewage microbes in drain air, and the wafting of such microbes to considerable distances by currents of air, which has been established in the course of our enquiry, appears to be a matter of practical importance, whether the intercepting trap is present or not. The bacteriological evidence suggests that if exposure to drain air is related, as many suppose 35. it is, to attacks of sore throat or other septic affections, the explanation may be found in the liability of drain air, unlike sewer air, to carry in suspension large numbers of microbes of sewage origin (pars. 78 to 97, and 112). It is desirable, therefore, that the possibility of splashing should be taken into account in the construction of drains, in order that it may be reduced to a minimum." Inspection Chambers. Following the Departmental Committee's report on Intercepting Traps etc., whenever in the course of examination of drains, inspection chambers are found where undue splashing occurs, Owners are asked to have them altered in the following manner to remedy the nuisance:— (a) When the benchings are level with the top edge of the channel pipe, the sewage, coming from branch drains, runs over the benching and remains there for some time before finally being washed back into the main drain. In such cases, the benching is raised and brought up straight for about six inches, so that sewage, coming from side connections, impinges against the flat surface and is directed towards the flow in the main drain. (b) In the case of branch connections discharging into the main channel at right angles, or even in a slightly opposite direction to the flow of the drain, proper section bends are provided, so that the sewage is discharged into the main drain, in the direction of the flow. (c) The greatest amount of splashing is caused by sewage, which is conveyed by pipes, that discharge some distance above the main channel through the walls of inspection chambers. To relay the length of drain, that discharges in this manner, would be expensive ; the method recommended is to connect pipes to the existing outlet and take them down the wall of the chamber, with a section bend at the foot, to discharge in the direction of the flow, 36 Interceptors. On all new interceptors, a locking cap with chain is provided to the clearing arm. This obviates the risk of the cap falling into the trap and blocking the interceptor. Where it is found, upon inspection of drains, that the cap to an interceptor is missing, we have asked owners to provide a locking cap with chain; during the year five of these have been provided to existing drains. In several cases, where two interceptors were found to be on the same line of drain, the unnecessary one was taken out. Rainwater pipes connected directly to the drain. Sec. 37 of the Public Health Acts Amendment Act, 1907, requires all rainwater pipes acting as drain ventilators to be disconnected from the drains. When making an inspection of the drains of the various Sunday Schools, 24 rain water pipes were found to be directly connected to the drains and acting as ventilating shafts. These have all been disconnected and stoneware gullies provided. In one case it was necessary to have a ventilating pipe fixed, as when the rain water pipes were disconnected, there was no means of ventilation for the drain. COMPLAINTS. One hundred and thirty-nine complaints have been received during the year and inspections made. Some of the complaints, however, have nothing to do with the Public Health Department. An occupier, of a certain house, made repeated complaints that people in the adjoining houses used bad language, and expected the Sanitary Inspector to put a stop to it at once. At various times during the year complaints have been received that very obnoxious smells pervade certain streets at midnight, or in the early hours of the morning. I have 37 made very careful enquires and know that such an obnoxious smell appears to be wafted over certain parts of the district. I had no doubt, in my own mind, that the smells emanated from the Gasworks at Lower Sydenham. The smell appears to be similar to that of sulphuretted hydrogen. I am, however, assured by the Engineer of the Gas Company, that it does not come from the Bell Green Gasworks. It is certainly a complaint that should be thoroughly investigated and the cause found out, and I am, therefore, making further diligent enquiries into the matter. Another nuisance that is difficult to remedy, is that of tramps and others, who make use of certain roads and open spaces in the District, to sort filthy rags, etc. The people move on and leave the waste refuse behind them. We have the refuse removed and the places cleansed and disinfected. The following is a list of the complaints received during the year:— Accumulations of refuse 16 Non-removal of house refuse 10 Dustbins damaged by dustmen 3 Dampness in houses 6 Overcrowding 8 Smells from sewers 15 Smells from drains and urinals (choked drains, etc.) 19 Rats and vermin 6 Animals improperly kept 8 Water supply 6 Absence of, or defective dustbins 2 Insanitary premises 11 Defective w.c's 4 Smells from trade premises 4 Various other complaints 21 Total 139 38 Section 31, Public Health Acts Amendment Act, 1907. Complaints were also received as to unoccupied premises and lands being unfenced or in a dilapidated and an insanitary condition. Notices were served upon the owners to erect a fence and to carry out all other works necessary to remedy the nuisance. In one case, the notice was complied with, but in the other nothing was done until the Council passed a resolution to apply to the Local Government Board to take proceedings as prescribed by the section, when the owner agreed to do the work and ultimately this was done. The terms of the section are as follows:— "If any land (other than land forming part of any common) adjoining any street is allowed to remain unfenced or if the fences of any such land are allowed to be or remain out of repair, and such land is, owing to the absence or inadequate repair of any such fence, a source of danger to passengers, or is used for any immoral or indecent purposes, or for any purpose causing inconvenience or annoyance to the public, the Local Government Board on the application of the local authority may by Order empower the local authority to proceed under this section, and, in that case, at any time after the expiration of fourteen days from the service upon the owner or occupier of notice in writing by the local authority requiring the land to be fenced or any fence of the land to be repaired, the local authority may cause the land to be fenced or may cause the fences to be repaired in such manner as they think fit, and the reasonable expenses thereby incurred shall be recoverable from such owner or occupier summarily as a civil debt." HOUSING & TOWN PLANNING, &c., ACT, 1909. During the year, 163 houses have been inspected in accordance with the regulations of the Local Government Board, in the following roads:— No. Inspected. No. of houses at which defects were found. Anerley Vale 49 40 Brunswick Place 14 13 Arpley Road 99 82 Hawthorn Grove 1 1 Totals 163 136 39 A sanitary survey is made of each house, the drains tested with smoke, all inspection covers taken off and the chambers inspected. Where the house has a drinking water cistern it is examined, and the tenants informed when it is found to be dirty. There are many tenants, even in the better class houses, who are under the impression that it is not their duty to keep the cisterns cleansed. The following works were carried out as the result of house-to-house inspections:— Water Supply— Cisterns cleansed 20 Cisterns provided with covers or covers repaired 7 Water Closets— New water closet basins and traps 8 Flushing apparatus renewed or repaired 20 Foul pans cleansed 5 Drainage— Drains cleansed 5 Houses provided with new drains 4 Houses with drains repaired or partially relaid 3 Aggregate length of pipes laid (in feet) 162 Number of syphon gullies provided 5 Grids provided to existing gullies 6 Inspection chambers constructed 2 Inspection chambers improved 2 Fresh air inlets provided or repaired 5 New soil and ventilating pipes fixed 9 Ventilating pipes repaired 13 Other defects remedied 6 Sinks— Sink waste pipes renewed, repaired or trapped 3 40 Dampness— Dampness in premises remedied 28 Cleanliness— Dirty rooms cleansed, limewashed, etc. 88 Paving, Sanitary Condition of Yard, etc.— Yards and forecourts to houses paved and amended 14 Arrangement for the deposit of Refuse & Ashes— New dustbins provided 18 Other Defects— Roofs repaired 37 Gutters, rainwater pipes, etc., repaired 18 Premises with dilapidated floors, plaster, etc., repaired 25 Animals removed 4 Accumulations of manure, stagnant water, etc., removed 7 Total number of defects remedied 354 The usual enquiries were made as to the number of persons inhabiting certain premises, to find out whether any overcrowding existed. Of the 162 houses inspected 153 were occupied. The details of the manner and use of the rooms are as follows:— Number of Living Rooms 230 Number of Sleeping Rooms 320 Number used for both Living and Sleeping 107 Number used for other purposes 111 Unoccupied 64 Total 832 41 The number of inhabitants were:— Number of persons over 10 years 345 Number of persons under 10 years 120 Total 465 Average persons per house occupied 6.42 ,, ,, ,, over 10 years 4.56 „ „ „ under 10 years 1.86 ,, ,, „ sleeping room 2.10 SUNDAY SCHOOLS, &c. An inspection has been made of all the Sunday Schools in the District and the attention of Ministers and Superintendents called to various sanitary defects. Almost without exception these have been remedied. Two of the Sunday Schools, which are also used as Day Schools, had series of trough closets for the sanitary conveniences. The matter was considered by the Sanitary Committee and letters were written to the Managers, asking them to provide separate water closets, in place of these conveniences. The matter was duly considered, and I understand that alterations will be carried out during 1914. The following hints may be of service to those responsible for institutions in the District. 1.—Drainage. The inspection chambers should be examined periodically, gullies cleansed and the drains thoroughly flushed. 2.— Water Closets. Flushing apparatus should be kept in working order, the seats and pans of W.C's frequently scrubbed. 3.— Ventilation of Halls, etc. Openings for air inlets should be kept uncovered and any tubes likely to harbour dust should be cleansed occasionally. A frequent thorough ventilation by opening all windows to their full extent is essential. 42 4.—Cleansing. In sweeping it is an advantage for damp sawdust or some dust allaying substance to be used, so that the dust is not distributed about the rooms. In addition to the usual cleansing, a thorough cleansing at least once a year, of the whole school should be attempted. Everything that can be scrubbed should be scrubbed, everything that can be washed should be washed. All wall cards, maps, pictures, etc., should be taken down and cleansed, and all ledges and places likely to hold dust, should be attended to. The importance of having clean windows should not be overlooked. Accumulations of rubbish, around the building, should be removed. If the school is heated by means of hot water pipes, the troughs in the floor, covered by gratings, are very likely to retain dust and dirt and should be regularly cleansed. 5.—Water supply. As children are liable to drink water from any tap to which they can gain access, every cistern supplying any such tap should be thoroughly cleansed at least three times a year, and a dustproof cover kept fitted to each cistern. A good plan, also, is to have a draw off tap from the rising main, for drinking-water purposes, and to have in addition, a distinctive label on the tap. INSPECTION AFTER INFECTIOUS CASES. The number of premises inspected subsequent to cases of infectious disease occurring was 112, viz.: Diphtheria 70, Enteric Fever 1, Erysipelas 8 and Scarlet Fever 33. In each case, a thorough inspection is made, similar to that carried out under the Housing Regulations. DISINFECTION. In addition to the usual disinfection of rooms, bedding, etc., after cases of Scarlet Fever, Diphtheria and Enteric Fever, disinfection has been carried out at 26 premises, after cases of Pulmonary Tuberculosis. In regard to Cancer, 43 enquiries were made at each house where a fatal case occurred, and an increasing number of persons now avail themselves, of the opportunity of having rooms and bedding disinfected. Disinfection was carried out after 13 cases, out of a total of 27 deaths in the District, due to this disease, A somewhat unusual case requiring disinfection occurred. A complaint was received from the owner of a block of high-class flats, that one of them, was infested with " lice," which were discovered upon the furniture, floors and walls. Upon investigation, it was found, that these insects were not pediculi or true lice, but belonged to the family of insects called Psocidae, and were a form of " book lice," which are a totally different insect. A thorough disinfection of the premises was carried out, the floors and skirtings being sprayed with a special vermin killing solution, and the walls with formalin. As these insects harbour in damp books, the occupiers were recommended to expose all books to the air and to thoroughly dry them. Where upon enquiry, in an infected house, we find books borrowed from the Public Library, steps are at once taken to have them disinfected. The books are then returned to the Public Library. The Librarian was also notified by telephone of every house at which a case of infectious disease occurred. During the coming year, however, notifications to the Library will be sent on a printed form. The following list shows the number of rooms fumigated and of beds and other articles disinfected during the year:— Rooms 200 Beds 229 Blankets 316 Pillows 455 Sheets 125 Miscellaneous articles 897 Total 2,222 44 LODGING HOUSES. There are 5 Common Lodging Houses and 25 Houses Let in Lodgings on the register, all situated in Arpley Road. Some of these Houses Let in Lodgings are kept in a very fair condition, but in others, owing to a great extent, to the habits of the lodgers, the sanitary conveniences are found in a bad state, and continual inspections are necessary to get broken W.C. pans replaced, flushing apparatus repaired, and recurring nuisances abated. Midnight and day inspections were paid to these premises. In several cases, overcrowding was discovered, but upon calling the landlords' attention to this, it was speedily abated. FACTORIES & WORKSHOPS. There are 145 factories, workshops and workplaces on the register. These have been regularly inspected, 54 notices have been served, and cleansing, etc., has also in many cases been carried out on calling the occupiers attention to the matter, without the necessity of serving a notice : 238 visits have been paid to these premises. In the tables relating to the administration of the Factories and Workshops Act, will be found particulars of the various trades, and the nuisances abated. SALE OF FOOD & DRUGS ACT. Seventy-nine samples under the Sale of Food and Drugs Acts, and nine "test" samples were taken in the District, making a total of 88 samples. The County Council Inspector for this Division of Kent, Mr. Alexander Quinlan, took 67 of these samples, 64 of which, were returned by the County Analyst as genuine, as follows:— 45 No. of Samples No. of Samples 1 Ammoniated tincture of quinine 2 Jam (Raspberry) 2 Lard 2 Brandy 19 Milk (New) 19 Butter 1 Milk (Skimmed) 1 Cocoa 1 Mustard 1 Cod Liver Oil 1 Olive Oil 2 Coffee 1 Preserved Peas 1 Flour 1 Rum 2 Gin 1 Sugar (Demerara) 1 Ground Ginger 2 Whisky (Irish) 3 Whisky (Scotch) Two milk samples were slightly deficient in fat, and one sample of cream contained 0.33 per cent, of boric acid preservative. In addition to these, 11 samples of new milk and 1 of skimmed milk were taken by your Inspector, and the report of the Analyst was that they were genuine. The constituent parts were as follows:— Fat Non-fatty Solids Total Solids Government Standard (New Milk). 3.00 8.50 11.50 1 3.67 9.05 12.72 2 13.38 7.80 21.18 3 3.19 8.60 11.79 4 4.12 8.60 12.72 5 3.96 8.87 12.83 6 3.67 8.85 12.52 7 3.66 8.52 12.18 8 4.31 8.46 12.77 9 3.67 8.51 12.18 10 4.03 8.77 12.80 11 3.80 8.86 12.66 Government Standard (Skimmed Milk). — — 9.00 1 0,13 9.15 9.28 46 Eight of the 9 informal or "test" samples were bought from small milk sellers, a half-pennyworth of milk being bought in each case, so that a true sample of what was being sold to ordinary customers was obtained. The constituent parts of these 8 samples were as follows:— Fat Non-fatty Solids Total Solids Government Standard (New Milk). 3.00 8.50 11.50 1 3.76 8.80 12.56 2 3.42 8.98 12.40 3 3.85 9.30 13.15 4 3.90 9.30 13.20 5 3.50 8.50 12.00 6 3.80 9.02 12.82 7 3.10 8.91 12.01 8 3.20 8.82 12.02 The remaining "test" sample was taken in course of delivery, and the analyst reported as follows:— " It is an extremely poor milk, being slightly deficient not only in fat, but also slightly in non-fatty solids as well. It is one of those samples skilfully manipulated to just evade proceedings, and must be regarded as not genuine." TRADES INSPECTIONS. Dairies. There are 3 cowsheds in the District and 25 premises registered as dairies or milkshops. We received complaints regarding the smells from one of the dairies, apparently caused by the washing of the churns. The owners were communicated with, and they are taking steps to prevent a recurrence of the nuisance, 47 Slaughter Houses. The 3 slaughter houses in the District have been periodically limewashed, and inspections have been frequently made. Killing takes place at various times, so that it is difficult to be present on all occasions, when the animals are slaughtered, although an endeavour is made to attend whenever possible, so that the organs, as well as the carcases, can be examined. From enquiries made, of the various butchers slaughtering in the District, it appears that the approximate number of animals slaughtered per annum is as follows:— Cattle 290 Pigs 572 Sheep 2895 Total 3757 Food. The above figures show only a small proportion of the meat supply of the District. Being so near to London, the larger proportion of the local butchers buy their meat from the London markets. A systematic inspection of the butchers' shops and stalls has been made, mostly on Friday and Saturday evenings, and care on the part of vendors, is apparently exercised as to the meat sold, the reason probably being, that butchers can return doubtful meat to the market, and obtain their purchase-money from the wholesale dealers. During the year, 30 lbs. chitterlings, a shoulder of mutton, one trunk whiting, one trunk coalies, and a trunk of chats, have been surrendered and destroyed. Bakehouses. There were 18 bakehouses in use at the end of the year. These have all been regularly inspected, and limewashed, as required by the Factory and Workshop Acts, 48 Game Dealers. Game dealers' licences have been granted in three cases, and the premises of such licensees inspected. Petroleum Acts. The following list shows the licences granted for petroleum or benzoline stores. galls. galls. C. P. S. Abrams 30 R. Furness 60 J. E. Atherton 100 J. Honey 100 F. L. Brewster 50 C. W. Notley 200 Carter, Paterson &Co. 1000 A. Olby 100 Chambers & Co 250 E. Searle 10 J. L. Collins 80 S. E. Locke 10 W. J. Wood 250 galls. Old Metal and Marine Store Dealers. Eight persons are registered. Books are kept by them, in accordance with the Act, and periodical inspections made of the premises and books. Registries for Servants. Fifteen premises are registered and 28 visits have been made to these premises by the Health Visitor. Rag Flock Act. It does not appear that there are as many shops using rag flock in the trade as formerly. The flocks are mostly used by mattress makers and upholsterers, and where rag flocks are now used, they are delivered in bags bearing a certificate or declaration that the flocks have been purified in accordance with the Act. In some cases, the rag or black flocks are not used at all, but white cotton flocks have been substituted, 49 There is no doubt, that the Rag Flock Act has been exceedingly useful in taking off the market the flocks that were formerly made out of foul and dirty rags. The summaries, appended, give particulars of the various works carried out, nuisances abated, and inspections and reinspections. I am, Gentlemen, Your obedient Servant. ALFRED J. WILLETT. Sanitary Inspector. 51 SUMMARY OF WORK EXECUTED DURING THE YEAR. Water Supply— Water supply to houses reinstated 3 Cisterns cleansed 46 Cisterns covered or covers repaired 23 Cisterns abolished 2 New draw-off taps provided off the rising main 4 W.C. flush disconnected from drinking-water cistern 1 Water Closets— New water-closet basins and traps 54 Flushing apparatus renewed or repaired 41 Foul pans cleansed 12 Joint of flushing pipe to pan made good 2 New seats provided 2 Ventilation lobbies provided 1 New cement floor in place of wood 1 Drainage— Drains cleansed 42 Houses provided with new drains 26 Houses with drains repaired or partially relaid 25 Aggregate length of 4", 6" and 9" pipes laid 1862 ft. Number of syphon gullies provided 96 Grids provided to existing gullies 13 Curbs fixed around gullies 2 Inspection chambers constructed 41 Inspection chambers improved 15 Broken inspection covers repaired or replaced 8 Interceptors fixed 9 New locking caps and chains fixed to existing interceptors 1 52 Caps to clearing arm of interceptors greased in 2 Fresh air inlets provided 11 Fresh air inlets repaired 15 New soil and ventilating pipes fixed 35 Ventilating pipes repaired 25 Defective openings sealed oft" 3 Rainwater pipes disconnected from drains 25 Sinks— New glazed stoneware sinks provided 5 Sink waste pipes renewed, repaired or trapped 13 Dampness— Dampness in premises remedied 70 Concrete laid over site 4 Cleanliness— Dirty Rooms cleansed, whitewashed, etc. 299 Miscellaneous— Roofs repaired 54 Gutters, rainwater pipes, etc., repaired 35 Premises with dilapidated floors, plaster, etc., repaired 35 New dustbins provided 143 Yards and forecourts to houses paved and amended 16 Other defects in houses remedied 12 Overcrowding abated 9 Animals removed 8 Accumulations of manure, stagnant water, animal or other refuse removed 39 New manure receptacle provided 1 Covers provided to manure receptacles 5 Stable yards paved 1 Urinals cleansed 1 Passageway cleansed 1 53 Shed excluding light and air removed 1 Gas range in workshop ventilated 1 Defective flue in workshop remedied 1 Nuisance from burning ballast abated 1 SUMMARY OF INSPECTIONS. Houses attacked with infectious disease 112 Inspections through complaints received, etc. 324 Inspections under the Housing etc., Act 163 Housings Let in Lodgings and Common Lodging Houses 172 Food Trades Inspections (including bakehouses,cowsheds, slaughter houses, etc.) 422 Trades Inspections under the Petroleum Acts, Rag Flock Act, Marine Store Dealers Act and Game Dealers Act 72 Factories and Workshops (excluding inspections included in previous items) 238 Miscellaneous inspections and re-inspections of works in hand 2566 Total number of inspections 4069 55 INDEX. PAGE. Bakehouses 47 Baby Competition 9 Birth Rate 7 Collection and Disposal of House Refuse 18 Complaints 36 Dairies 46 Death Rate 6 Diphtheria 10 Diphtheria Outbreak 11 Disinfection 42 Drainage 33 Enteric Fever 12 Examination of Pathological Products 16 Factories and Workshops 44 Food 47 Game Dealers 48 Housing and Town Planning, etc., Act 1909 17, 38 Infantile Mortality 6 Inspections, etc. (M.O.H.) 18 Inspections after Infectious Cases 42 Inspection Chambers 35 Interceptors 36 Lodging Houses 44 Notifiable Diseases 10 Notification of Births Act 7 Old Metal and Marine Store Dealers 48 Petroleum Acts 48 Population 6 Public Mortuary 18 Puerperal Fever 12 Rag Flock Act 48 Rainfall and Sunshine 29 Registries for Servants 48 56 PAGE. Sale of Food and Drugs Act 44 Scarlet Fever 12 Schools and Infectious Diseases, etc. 14 Slaughter Houses 47 Summary of Inspections 53 Sunday Schools, etc. 41 Summary of work executed 51 Table I. Vital Statistics during 1913 and previous years. 21 ,, II. Cases of Infectious Disease during 1913 22 „ III. Causes of and ages at death during 1913 23 „ IV. Infantile Mortality 24 „ 1 Inspections of Factories and Workshops 25 ,, 2 Defects found in Factories and Workshops 26 „ 3 Homework (Outworkers) 27 „ 4 Registered Workshops 28 „ 5 Other Matters 28 Trades Inspections 46 Tuberculosis 12 Vital Statistics 5 Zymotic Death Rate 7