PEN 011 Urban Distrct Council of Penge. Chairman— Mr. F. P. Hodes, J.P. Vice-ChairmanMr. G. J. Gully. PUBLIC HEALTH COMMITTEE. , Chairman— Mr. J. B. Geale. Mr. H. Culver. Mr. F. W. Foreman. „ S. H. Croucher. ,, D. Jones. ,, J. Edwards. „ G. L. Wells. Mr. A. Wilkinson. Co-opted members oj Maternity and Child Welfare Section M rs. J. B. Geale and Miss F. Moore. Representatives on the Small-pox Hospital Board— The Chairman of the Council (ex-officio). Messrs. H. Culver and E. G. Hopper. Medical Officer of Health R. Wilkinson, M.D. (Brux.), M.R.C.S. (Eng.), L.R.C.P. (Lond.) Sanitary Inspector— H. J. Perrett, Certs. K S.l. Assistant Sanitary Inspector R. 1. Pearce, Cert. S.I.E.B. Health Visitor— Miss E. M. Dell, Cert. C.M.B. Clerk— J. F. Armstrong. ANNUAL REPORT of the Medical Officer of Health for the Penge Urban District in the COUNTY OF KENT for the Year Ending December 31st, 1921. 5 Town Hall, Anerley, S.E. 20. To the Chairman and Members of the Urban District Council of Penge- Gentlemen, I beg to submit to you my Annua] Report on the health of the District for the year ending December 31st, 1921. GENERAL STATISTICS. Area (acres) 770 Population (census 1921) 26278 Population (estimated middle of 1921) 26430 Number of inhabited houses (1921) Number of families or separate occupiers (1921) not avai!aile Rateable value £170,420 Sum represented by a 1d. rate £660 6 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. M. F. Legitimate 541 275 266 Births _ _ Illegitimate 23 13 10 Birth rate (R.G.) 21.3 Deaths 311. Death rate (R.G.) 11.7. Number of. women dying- in, or in consequence of, childbirth 1 From sepsis — Other causes 1 Deaths of infants under one year of age per 1000 births Legitimate 33. Illegitimate 3. Total 36. Deaths from measles (all ages) 1 „ whooping cough (all ages) 1 „ diarrhoea (under 2 years of age) 13 The District is healthily situated on the slope of a hill, its highest point being 370 feet above sea level. The Crystal Palace and greater part of the Grounds occupying about 127 acres are within the District. About 20 acres of the grounds were recently opened to the public, thus supplying another much needed recreation ground for the neighbourhood. The District is mainly residential, there being no staple industry. A large proportion of the residents are engaged in business in London. The Metropolitan Water Board supply a constant service of water, the majority of the premises being connected directly to the rising main. 7 The sewage of Penge goes through the Metropolitan Borough of Lewisham, into the London County Council system of sewers, and a part of the surface water into a local stream. The amount of Poor Law Relief given daring the year amounted to £2433 3s. lid., of which £946 18s. lOd. was to able-bodied unemployed and their families. DEATH RATE. The number of deaths registered in the Urban District of Penge during the year was 222, equal to a death rate of 8.3 per 1000. Twenty-five of these deaths were transferable to other districts, but 114 occurring in public institutions, etc., outside the District were transferred to Penge. The corrected number of deaths was therefore 311, equal to a rate of 11.7 per 1000, as compared with 352 or 13.9 per 1000 for 1920. Of the total 311 deaths during the year, 76 or 24 per cent, were 75 years of age and upwards, and 140 or 45 per cent, were over 65. INFANTILE MORTALITY. The number of deaths under one year of age, among the residents of the District was 36, corresponding to a rate of 63.8 per 1000 births. There were six still-born infants. Of the 36 deaths five had been attending at the Child Welfare Centre. 8 PUBLIC MORTUARY. There have been 18 inquests held in Penge during the year 1921, as follows:— Causes of Death Males Females Total Natural causes 4 3 7 Accidental causes 1 1 2 Suicides 3 2 5 Open verdict 1 3 4 9 9 18 Of the above, two unknown female newly-born children were found dead at the Crystal Palace Low Level Station. BIRTH RATE. The births registered during the year numbered 564 of which 288 were males, and 276 females. This gives a birth rate of 21.3 per 1000, compared with 27.5 for 1920. NOTIFICATION OF BIRTHS ACT. This Act is complied with satisfactorily both by Doctors and Midwives, and little disparity is found between the list of births supplied to me by the Registrar of Births and Deaths and the actual Notifications received. The Notifications for 1921 were:— By Doctors 329 By Midwives 129 Total 458 9 The majority of the cases are visited by the Health Visitor, re-visits are made as is found necessary, and the figures for 1921 are:— Number of first visits 467 „ ,, re-visits 717 Total 1184 MATERNITY AND CHILD WELFARE CENTRE. Medical Officer's consultations—Infants 1104 Nursing mothers 372 Ante-natal 167 Total 1643 Children for weighing only 1800 Total attendance of children at Centre 2904 Individual children who attended 495 Average weekty attendance of children 56.9 Attendance of nursing mothers 963 Individual nursing mothers who attended 205 Average weekly attendance of nursing mothers 18.8 Individual attendance of expectant mothers 92 Average weekly attendance of expectant mothers 3.7 The Maternity and Child Welfare Centre, opened in 1915, has been, and continues to be, very successful, and two afternoons a week are now necessary to cope with the attendance. There is a gratifying increase in the attendance of expectant mothers. The Centre is now held at the new Clinic of the Education Authority, and the accommodation is more commodious and satisfactory in every way. 10 The Ranyard District Nursing Association is very helpful in providing a nurse for attendance upon children suffering from minor ailments, otorrhcea, etc., and is of the greatest assistance amongst the sick and poor of the District generally. If necessary, in an outbreak of measles, the Council specially engage the services of a nurse from the Ranyard Association. The Health Visitor, assisted by ladies who kindly volunteer their services, and a nurse from the Joint Maternity Home, manage the weighing, record cards, and provision of teas for the mothers. A clothing club is contemplated early in the new year. The Creche, which is a voluntary organization, is doing valuable work. I inspect it at intervals and find it to be well managed and carefully carried on, in the best interests of its inmates. The local authority now contributes an annual grant. The Penge and Beckenham Joint Maternity Home, situated in Croydon Road, Beckenham, was opened on August 12th, 1920. There is accommodation for ten cases. During the year 173 cases were admitted. Fifty-four were Penge patients. Expectant mothers from this District are making increasing use of the Home, much appreciating the care and attention they receive there. The antiseptic surroundings and skilled nursing must obviously exert a beneficial effect upon the mortality rate of mothers and infants as time goes on. 11 Patients can be attended at the Home by their own Doctor if they wish. The usual charge made is £2 for the fortnight, but necessitous cases, not in receipt of the Maternity benefit, are, after investigation, admitted free of charge. Dr. J. M. Clements, Medical Officer of Health for Beckenham, is the Medical Officer for the Home, and the staff consists of a Matron and Deputy Matron (who are both midwives) and four nurses. There are also three private nursing homes which receive maternity cases, and five midwives practising in the District. Children, and expectant mothers attending the Centre, are visited at intervals by the Health Visitor. Foster mothers are requested by the Guardians to bring their charges to the Centre, and I have almost invariably found them well cared for. Dried milk is supplied to mothers and children attending the Centre, at cost price, and in necessitous cases, fresh and dried milk free, under a scheme approved by the Ministry of Health. Cod liver oil, Virol, Lactagol, etc., are also supplied free or at cost price. The following amounts were expended in supplying milk gratis or half price:— fresh milk £63, dried milk £136. The cash receipts for dried milk sold were £327. 12 VISITS OF HEALTH VISITOR. Number of first visits to infants 467 „ „ re-visits to infants 717 Visits to children over one year 553 ,, expectant mothers 105 „ re pneumonia 10 „ „ poliomyelitis 2 ,, ,, ophthalmia neonatorum 2 14 ,, to tuberculosis cases 230 „ „ non-notifiable diseases. 31 Miscellaneous visits 73 SANITARY CIRCUMSTANCES OF THE DISTRICT. Scavenging. The number of loads collected and taken away by rail was 4900, and the cost £2737. The cost of collection and disinfection of bins amounted to £3238. The house refuse is contained in movable galvanized iron dustbins with proper covers, and is collected throughout the District once in every week. The house refuse is loaded into trucks at Penge Station, by the dustmen, and removed by rail by a contractor who disposes of it. SCHOOLS AND INFECTIOUS DISEASES. During the year 210 notifications have been sent to the School Medical Officer, 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, 13 During a week's holiday at the end of October, the number of cases of diphtheria among scholars in the Infants' Department of the Oakfield Road School was above the average, and after consultation with the School Medical Officer, the Department was closed for another week. SCHOOL CLINIC. Minor ailments are prescribed for by the School Medical Officer and two Medical Inspectors on three afternoons in the week. Particulars appear in the School Medical Officer's Annual Report. DENTAL CLINIC. Mr. D. H. Barr and Mr. S. V. Shrimpton each attend two mornings a week to give dental treatment. INFECTIOUS DISEASES. Notifiable diseases during the year. Disease. Total cases notified. Cases admitted to hospital. Scarlet fever 126 102 Diphtheria 40 32 Pneumonia 13 1 Erysipelas 5 — Puerperal fever 1 — Enteric fever 6 6 Encephalitis lethargica 1 — Poliomyelitis 1 — Tuberculosis—Pulmonary M. 14 3 „ „ „ F 25 14 Total 39 17 „ Non-pulmonary M. 4 1 „ „ „ F 8 5 Total 12 6 14 No cases of Cerebro-spinal fever, or Acute Polioencephalitis were notified during the year 1921. Ophthalmia neonatorum: no cases. The total deaths of cases notified during the year were as follows:—Diphtheria, one aged 5 years; Enteric fever, one aged 19 years; and Pneumonia four, aged 3, 30, 43, and 80 years. Pulmonary tuberculosis seven, three males aged 27, 53 and 68 years; four females aged 11, 14, 14 and 28 years. TUBERCULOSIS. Fifty-one primary notifications of Tuberculosis were received during the year, of which number 40 referred to pulmonary cases. Seventeen notifications were received from Medical Officers relating to patients admitted to Sanatoria and 11 to those discharged. The notification of Tuberculosis by Medical Practitioners is carried out in a satisfactory manner, and of the 17 deaths from pulmonary tuberculosis during the year 14 have been notified in this District. During the year 42 specimens of sputum were sent to the Kent County Laboratory, Maidstone, to be examined for the tubercle bacillus; 16 of these were positive. The Health Visitor makes periodical visits to every house where cases are notified, and, where necessary, paper handkerchiefs, disinfectant and soap are supplied. The number of visits paid to these cases was 230. Disinfection is carried out when the patient vacates the room. 15 The Tuberculosis Officer of the Kent County Council is in attendance at the Beckenham Dispensary on Wednesdays, and Penge patients are treated there, the Dispensary being within easy reach. VENEREAL DISEASES. Notices have been posted within the District giving general instructions and information with regard to the nearest Clinics. PREVENTION OF AND CONTROL OVER INFECTIOUS DISEASES. Cases of notifiable infectious disease are removed to Waddon Isolation Hospital, Croydon, and the Croydon and Wimbledon Joint Small-pox Hospital, Cheam, when adequate isolation cannot be obtained at home. The Hospital authorities provide any beds that may be required, and the number of diseases that can be concurrently treated is six, viz.Small-pox, Diphtheria, Scarlet fever, Enteric fever, Cerebro-spinal meningitis, and Puerperal fever. The following is a list of the Adoptive Acts also Byelaws and Regulations in force in the district:— Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890. Public Health Acts Amendment Act, 1907 (Extracts of parts of 2, 3, 4 and 5). Common Lodging Houses. Houses let in Lodgings. Cleansing, etc., and Removal of Refuse. Slaughterhouses. Prevention of Nuisances. Keeping of Animals. New Streets and Buildings. 16 Dairies, Cowsheds and Milkshops. Drainage of Existing Buildings. Cleansing of Earth Closets, Privies and Cesspools. Alteration of Buildings. Pleasure Ground. Music, Music and Dancing, Cinematograph Exhibitions, and Stage Play Licenses. Employment of Children. AMBULANCE FACILITIES. (а) Cases of Infectious Disease are removed by the Hospital Motor Ambulance. (b) A Motor Ambulance Service is provided by the Red Cross and Order of St. John on loan to the Council. Cases of accident and sudden illness in the street are attended free of charge. The Ambulance, which is housed at the Fire Station, Croydon Road, is available at any time, day or night, on request. EXAMINATION OF PATHOLOGICAL PRODUCTS. Bacillus found Bacillus not found Total. Diphtheria. Clinical Research Association 14 38 52 Diphtheria. County Laboratory 21 58 79 Tuberculosis. County Laboratory 16 26 42 Enteric Fever. Clinical Research Association - 3 3 Enteric Fever. County Laboratory - 1 1 Pneumonia. County Laboratory — 1 1 Total 51 127 178 17 Anti-Diphtheritic serum was supplied for the treatment of 19 cases of Diphtheria; vials being supplied containing 86,000 units. HOUSING. (1) General Housing Conditions in the District. Total number of houses in the district 4934 Number of dwelling houses for the working classes 2007 New houses for the working classes built during the year or in course of erection Nil The Council has a scheme in hand for the erection of 217 houses. One house was converted into two flats by the owner. (2) Overcrowding. I think that if a block of workmen's self-contained flats comprising two or three fair sized rooms with a W.C. and small scullery could be provided and let at an inclusive rental of about 10s. per week, it would be a good way of dealing with this matter. Five cases of overcrowding were abated during the year. (3) Fitness of Houses. The general standard of the housing is good. There are four back-to-back houses in the District, but these have ample space around them. (4) Unhealthy Areas. There are none. 18 The Sale of Food and Drugs Acts are administered by the Kent County Council. The Dairies, Cowsheds and Milkshops have been systematically inspected. Their condition is fairly satisfactory and conform to our Bye-laws. Bakehouses, Slaughterhouses, Factories and Workshops have also been inspected. Samples of milk have been periodicallj' taken (informal and formal) and duly analysed, a record of which appears, together with a resume of various inspections in the Sanitary Inspector's Report. I have made several inspections under the Housing Acts with the Sanitary Inspector, prior to the Council proceeding to execute work owing to the owners' default. Tables referring to the vital statistics and infectious diseases are appended. In conclusion, I have again to express my sincere thanks to Miss Fannie Moore and other Lady helpers at the Welfare Centre for their very valuable assistance. Also to the Chairman and Members of the Maternity and Child Welfare and Public Health Committees for their cordial support and help during the year. Mr. H. J. Perrett the Sanitary Inspector who is also Financial Officer to the Welfare Centre has always been most helpful and I have to express my thanks to him and also to the Public Health Staff' in general. I am, Gentlemen, Your obedient servant, ROBERT WILKINSON. Causes of Death in Penge Urban District, 1921. Causes of Death Males Females All Causes 140 171 1 Enteric Fever ... 1 2 Small-pox ... ... 3 Measles 1 • •• 4 Scarlet Fever ... ... 5 Whooping cough ... i 6 Diphtheria ... i 7 Influenza 2 4 8 Encephalitis lethargica ... ... 9 Meningococcal meningitis ... ... 10 Tuberculosis of respiratory system 8 9 11 Other tuberculous diseases 4 3 12 Cancer, malignant disease 9 17 13 Rheumatic Fever ... ._ 14 Diabetes 1 2 15 Cerebral haemorrhage, etc. 11 18 16 Heart disease 14 14 17 Arterio-sclerosis 7 9 18 Bronchitis 11 9 19 Pneumonia (all forms) 11 12 20 Other respiratory diseases 1 3 21 Ulcer of stomach or duodenum ... ... 22 Diarrhoea, etc. (under 2 years) 6 7 23 Appendicitis and Typhlitis 1 ... 24 Cirrhosis of Liver 2 1 25 Acute and chronic nephritis 2 8 26 Puerperal sepsis ... ... 27 Other accidents and diseases of pregnancy and parturition ... 1 28 Congenital debility and malformation, premature birth 11 4 29 Suicide 2 3 30 Other deaths from violence 6 5 31 Other defined diseases 29 39 32 Causes ill-defined or unknown 1 ... Special causes (included above) Poliomyelitis ... ... Polioencephalitis ... ... Deaths of infants under 1 year of age Total 19 17 Illegitimate 1 2 Total Births 288 276 Legitimate 275 266 Illegitimate 13 10 Population 26,430 Cases of Infectious Disease notified during the Year 1921. Notifiable Disease NUMBER of cases notified. Total cases removed to H'sptal At all ages. At ages—Years Under I I and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Puerperal Fever 1 ... ... ... ... 1 ... ... ... Diphtheria 40 1 7 22 6 4 ... ... 32 Erysipelas 5 ... ... ... 1 1 2 1 ... Scarlet Fever 126 ... 11 95 16 4 ... ... 102 Pneumonia 13 ... 2 1 1 4 2 3 1 Enteric Fever 6 ... ... 2 2 1 1 ... 6 Encephalitis Lethargica 1 ... ... 1 ... ... ... ... ... Poliomyelitis 1 ... ... 1 ... ... ... ... ... Pulmonary Tuberculosis M 14 ... ... ... 1 4 8 1 3 F 25 ... ... 5 6 12 2 ... 14 Non-PulmonaryTuberculosis M 4 ... ... 2 2 ... ... ... 1 „ „ „ F 8 ... 1 5 1 ... 1 ... 5 Totals 244 1 21 134 36 31 16 5 164 Infant Mortality 1921. 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 Certified All Causes Uncertified 12 3 1 2 18 5 6 4 3 36 Small-pox ... • • • • • • • • • • • • • • • • • • • • • • • • • • • Chicken-pox • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Measles • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Scarlet Fever • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Whooping Cough • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Diphtheria and Croup • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Erysipelas • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Tuberculous Meningitis • • • • • • • • • • • • • • • • • • 1 • • • • • • 1 Abdominal Tuberculosis • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Other Tuberculous diseases • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Meningitis • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Convulsions • • • 1 • • • • • • 1 • • • • • • • • • • • • 1 Laryngitis • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Bronchitis • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Pneumonia • • • • • • • • • • • • • • • • • • • • • • • • 2 2 Diarrhoea • • • • • • • • • • • • • • • 1 1 2 • • • 4 Enteritis • • • • • • • • • • • • 1 • • • 3 2 • • • 6 Gastritis • • • • • • • • • • • • 1 • • • • • • • • • • • • 1 Syphilis ' • • • • • • • • • • • • • • • 1 • • • • • • • • • 1 Rickets • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Suffocation, overlying • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Injury at Birth 2 • • • • • • • • • 2 • • • • • • • • • • • • 2 Congenital Malformations • • • • • • • • • • • • • • • • • • 1 • • • • • • 1 Premature birth 5 • • • • • • • • • 5 1 • • • • • • • • • 6 Atrophy, Debility and Marasmus • • • • • • • • • • • • • • • 2 • • • • • • 1 3 Other causes 5 1 1 1 8 • • • • • • • • • • • • 8 Totals 12 3 1 2 18 5 6 4 3 36 Nett Births registered during the Nett Deaths registered during the calendar year:— calendar year:— Legitimate 541 Legitimate infants 33 Illegitimate 23 Illegitimate „ 3 36 564 ANNUAL REPORT of the Sanitary Inspector for the Penge Urban District in the COUNTY OF KENT for the Year Ending December 31st, 1921. 25 Town Hall, Anerley, S.E. 20. To the Chairman and Members of the Urban District Council of Penge. Gentlemen, I have the honour to present my Report upon the work carried out by this Department during the year 1921. I have, as far as possible, endeavoured to accomplish the work of the Department by letters and Intimation Notices without resorting to Statutory Notices. The number of letters and Intimation Notices were 1686, Statutory Notices 281 and 828 forms were also written. A great deal of time is occupied by interviews with occupiers, owners and builders, and in answering enquiries. The drainage systems of two houses have been entirely reconstructed, whilst those of 24 were partially relaid and 46 were cleared. 26 In the majority of cases the Notices were readily complied with, but in one instance it was necessary to take legal proceedings before the Magistrates, to enforce compliance under Section 94 of the Public Health Act, 1875, requiring the abatement of a nuisance caused by the whole of the plaster of a bedroom ceiling having fallen, and the laths being in a rotten and dirty condition. The Magistrates made an order for the work specified in the notice to be carried out within 14 days and £3 3s. costs were allowed. The defendant however failed to comply with the Order of the Court and the work was carried out by the Council and the cost charged to the Owner. In eight cases dustbins were supplied by the Council, in default of the owner's compliance with Statutory Notices served under Section 36 of the Public Health Act, 1875, and Section 11 of the Public Health Acts Amendment Act, 1890, and the accounts for the same rendered to the owners. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. Twenty-two certificates have been issued under Section 2, subsection 4 of this Act, that the premises were "not in a reasonable state of repair," and a number of repairs have been executed in consequence. A large number of the residents who apply to this Department to obtain the benefits under this Act, desire to avoid the trouble of making an application to the County Court. Inspections have been made and the Landlord communicated with, calling his attention to certain defects, and in most cases, the necessary repairs have been carried out. 27 HOUSING, TOWN PLANNING, &c., ACT. During the year 160 houses have been inspected, in accordance with the Housing (Inspection of District) Regulations, 1910, in the following roads :— No. Inspected. No. at which defects were found. Hartfield Grove 12 12 Hamilton Place 12 12 Unity Cottages 4 4 Woodbine Place 4 4 Woodbine Grove 115 90 Gladstone Mews 4 2 Heath Square 9 9 Totals 160 133 Notices to remedy the defects were served under the Public Health Acts. All the houses inspected, were occupied. In addition to the above, four houses were inspected and notices served under Section 28 of the Housing and Town Planning Act, 1919, to put the premises into a reasonably fit state for habitation, and in each case, owing to the default of the owner, the work was carried out by the Council, and the cost charged to the owners. No Closing Order was made during the year. Considering the high cost of material and the economic conditions prevailing, it is gratifying to report that a large amount of work has been executed, Houses with defects were as follows :— Water Closets— Defective basin and trap 11 Insufficiently lighted and ventilated 15 Pan foul 23 Defective flushing apparatus 21 28 Drainage— Defective drain 3 Defective soil and vent pipes 8 Choked drain ... 5 Defective fresh air inlet 5 Light and Ventilation— No ventilation in lieu of fireplace 25 Windows not made to open 3 Sinks— Defective sink 4 Defective waste pipe 10 Dampness— Leaky roof 40 Absence of, or defective damp-proof course 3 Defective gutters, rainwater pipes, etc. 49 Through walls, etc. 52 Cleanliness— Dirty rooms 9® Verminous rooms 14 Paving, etc. Defective yard or forecourt paving 27 Arrangements for deposit of Refuse and Ashes— Defective dustbin 15 Other defects— Dilapidated plaster 82 Defective scullery paving 13 Defective kitchen stove 8 Defective flooring or joists 34 Miscellaneous 46 29 FOOD. The following list shows the amount of food which was surrendered and condemned :— Beef 112 lbs. Mutton 139 „ Ham 13 „ Cheese 15 „ Apples 80 „ Condensed milk 44 tins It is worthy of note that no fish was condemned or surrendered. INSPECTIONS, ETC. The butchers, greengrocers, fish shops, and stalls, are constantly inspected, particularly during the summer months. The stores and yards of the wholesale greengrocers receive frequent visits, but still the standard of tidiness leaves much room for improvement. Dairies. There are two cowsheds in the District and 15 premises registered as dairies and milkshops, and regular inspections of these premises have been made. One hundred and ten test samples of new milk were, purchased. Of these, 103 samples were reported genuine ; three deficient in fat, and four slightly watered. The seven unsatisfactory samples were only just below standard and it was therefore only considered necessary to take one formal sample, which was found to be genuine and of very fair quality. Slaughterhouses. There are two registered and 2 licensed slaughterbouses in the District, 30 These have been periodically limewashed and inspected. Very little slaughtering is now done in the District. The approximate number of animals slaughtered during the year is :— Cattle 114 Pigs 271 Sheep 420 Total 805 Bakehouses. There are 17 bakehouses in the District, four are underground, the other certificated underground bakehouses being now disused. The limewashing has been duly carried out twice in the year, and on the whole the conditions are satisfactory. Petroleum Acts. The following list shows the licences granted for keeping petroleum. Gallons. Gallons. F. L. Brewster 50 S. Epps 40 J. W. Brown 24 R. Furness & Co. 60 Carter, Paterson & Co. 1000 R. J. Harding 30 Chambers & Co. 500 E. Moore 48 W. F. Cliff 100 C. W. Notley 300 J. A. Collins 50 A. Olby & Son 100 J. L. Collins 40 Penge Motors Ltd 60 E. Corris 100 Raynor & Fenn 60 J. H. Dixon 40 W. J. Wood 250 31 Rag Flock Act. There are no flock manufactories in the District. I have found that in all cases the bags which contain the flock used bear a label: "Washed flock, Guaranteed up to L.G.B. Standard." Old Metal and Marine Store Dealers. Eight persons are registered. Books are kept by them in accordance with the Act, and periodical inspections have been made of the premises and books. Factories and Workshops. There are 116 factories and workshops on the register, which includes 17 bakehouses. They have been regularly inspected. Forty-six notices have been served respecting cleansing, etc. Lodging Houses. The number of Common Lodging Houses is five. They are all situated in Arpley Road, and are registered for 61 male lodgers. The cleansing has been carried out in accordance with by-laws. Surveillance is kept of these houses. There are 21 houses in Arpley Road registered as Houses let in Lodgings. These contain 105 furnished rooms which are kept in a cleanly condition. Disinfection. Disinfection has been carried out at 38 premises after cases of tuberculosis, and 12 after cancer, in addition to those premises where other notifiable diseases occurred. Where vermin are discovered, disinfection of rooms, bedding, and clothing is carried out. This has been done in 60 cases. 32 The following list shows the number of rooms fumigated and of beds and other articles steam disinfected during the year. Number of rooms fumigated 284 „ „ beds disinfected 279 „ ,, blankets disinfected 467 „ pillows 501 „ „ sheets „ 367 „ „ miscellaneous articles disinfected 928 Rats and Mice (Destruction) Act, 1919. The Kent County Council delegated its powers to the Council. All complaints received are investigated, poisons supplied, and traps lent, and where practicable the rats are driven from their holes by the use of a smoke generating machine (used for testing drains), the occupiers borrowing dogs to kill the rats as they are driven out. This has been found to be very successful. The bulk of the complaints appear to arise from occupiers of premises who keep fowls, etc. There is apparently no infested area in the District, mainly owing to the fact that it is purely residential. Sanitary Conditions of Theatres, Music Halls, etc. In accordance with a circular letter issued by the Ministry of Health, dated August 25th, 1920, all the places of public entertainment have been visited, and with the exception of a few minor defects, which the managements remedied on being notified, are kept in a satisfactory condition. A tabulated statement of the works effected will be found at the end of the Report, by which it will be seen that the activities of the Department cover a wide field and involve a great amount of responsibility. 33 To the Chairman and Members of the Public Health Committee I must tender my thanks for their kind consideration at all times, and I am pleased to acknowledge the ready assistance that I always receive from the Assistant Sanitary Inspector and the Clerk to the Department. I am, Gentlemen, Your obedient servant, H. J. PERRETT, Sanitary Inspector. 34 Summary of Work executed during the year. Water Supply— Water supply reinstated to houses 14 Water service pipes repaired 45 Cisterns cleansed, covered or covers repaired 16 Water Closets— New pans and traps 58 Flushing apparatus renewed or repaired 70 Foul pans and traps cleansed 22 Connection of flushing pipes to pans made good 21 Seats and doors provided or repaired 22 Ventilation provided or improved 34 Drainage— Drains cleared 46 Houses provided with new drains 2 Houses with drains partially relaid 24 Inspection chambers constructed or improved 15 Soil and ventilation pipes fixed and repaired 31 Waste pipes renewed, repaired or trapped 52 Fresh air inlets provided or repaired 15 Number of syphon gullies provided 16 Rainwater pipes disconnected from drains 4 Dampness— Dampness in premises remedied 74 Damp-proof courses inserted 7 Roofs repaired 132 Gutters, rainwater pipes, etc., repaired 147 Ventilation under floors provided and improved 33 Cleanliness— Dirty rooms cleansed, whitewashed, etc. 962 35 Miscellaneous— Premises with dilapidated floors, plaster, etc. repaired 230 New dustbins provided 382 Yards and forecourts to houses paved or repaired 62 Scullery paving repaired 25 Overcrowding abated 5 Animals removed 5 Accumulation of manure, stagnant water, animal or other refuse removed 20 Ventilation and light provided or improved 21 Kitchen stoves and scullery coppers repaired or renewed 38 Miscellaneous 159 Summary of Inspections and Visits. The following summary shows, to some extent, the number of inspections and visits made. Inspections through complaints received 450 Inspections under the Housing, etc., Acts . 164 Visits re cases of Infectious disease 315 Houses Let in Lodgings and Common Lodging Houses 95 Food Trade Inspections (including Bakehouses, Cowsheds, Slaughter-houses, etc.) 325 Trade inspections under the Petroleum Acts, Rag Flock Act, Marine Store Dealers Act, Game Dealers Act, etc. 70 Factories, Workshops and Workplaces (excluding inspections in previous items) 291 Inspections and re-inspections of work in hand and various visits 2535 36 Housing. Number of new houses erected during the year :— (a) Total — (b) As part of a municipal housing scheme — 1. Unfit Dwelling Houses. Inspection— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 743 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 160 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 696 2. Remedy of Defects without Service of Formal Notices. dumber of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 530 37 3. Action under Statutory Powers. (a) Proceedings under section 28 of the ing, Town Planning, &c., Act, 1919. (1) Number of dwelling houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling houses which were rendered fit: (a) By owners 1 (b) By Local Authority in default of owners 4 (3) Number of dwelling houses in respect of which Closing Orders became oper ative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 132 (2) Number of dwelling houses in which defects were remedied :— (a) By owners 123 (.b) By Local Authority in default of owners 9 38 (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909 : (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling houses in respect of which Closing Orders were made (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit (4) Number of dwelling houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders