PEN12 E PENGE URBAN DISTRICT. Annual report OF THE Madical officer of Health, TOGETHER WITH The Annual Report OF THE Chief Sanitary Inspector. 1925. P. B. Beddow, "Press" Printing Works, Anerley, S.E. Urban District Council of Penge Chairman: Mr. R. C. S. Barnett, J.P. Vice-Chairman: Mr. F. W. Foreman. PUBLIC HEALTH COMMITTEE. Chairman: Mr. J. T. W. Huckin. Mr. R. C. S. Barnett, J.P. Mr. F. Herrington. „ S. H. Croucher. „ S. Hill. „ H. Culver. „ F. P. Hodes. „ J. F. D. Dixon. „ E. Hodges. „ F. W. Foreman. „ G. Jones. „ J. B. Geale. „ G. L. Wells. Co-opted Members of Maternity and Child Welfare Section Mrs. J. B. Geale, Mrs. E. Hodges 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. PUBLIC HEALTH DEPARTMENT. STAFF. Medical Officer of Health: R. Wilkinson, M.D. (Brux.), M.R.C.S. (Eng.), L.R.C.P. (Lond.) Chief Sanitary Inspector: H. J. Perrett, Cert. R.S.I. Cert. Insp. of Food, R.S.I. Sanitary Inspector: R. T. Pearce, Cert. S.I.E.B. Cert. Insp. of Food, S.I.E.B. Health Visitor: Miss E. M. Dell, Cert. C.M.B. Clerk: F. O. Hersee. ANNUAL REPORT of the Medical Officer of Health for the PENGE URBAN DISTRICT in the COUNTY OF KENT for the Year Ending December 31st, 1925. Town Hall, Anerley, S.E. 20. April, 1926. To the Chairman and Members of the Urban District Council of Penge. Gentlemen, I beg to present my Seventeenth Annual Report on the Health of the District for the year ending December 31st, 1925. It is compiled in accordance with the Memorandum of the Ministry of Health, issued in December, 1925, and forms the first of a series of "Survey Reports," which will be required at intervals of five years. NATURAL AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 770 Population (Census, 1921) 26,430 Population (Estimated middle of 1925, R.G.) 27,340 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 approximately 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. 6 Number of inhabited houses (Census, 1921) ... 4,815 Number of families or separate occupiers (Census, 1921) 6,501 Rateable value (Poor Rate) £184,244 Sum represented by a penny rate £740 The district is mainly residential, there being no staple industry. A large proportion of the residents are engaged in business in London, and a number are retired business and professional people. The Census returns of 1921 give the number of inhabitants working outside the District as 6,398, of which 4,986 were working in the County of London. 1,738 persons enumerated in other districts were found to be working in Penge. Occupied Persons over 12 years of age (and Students over 18) enumerated in Penge Urban District. Males. Females. Total 7,462 3,729 With workplace in area 1,932 1,572 With no fixed workplace 612 166 Workplace not stated 304 207 With workplace outside the area 4,614 1,784 Occupied persons over 12 years of age (and Students over 18) working in the area but enumerated elsewhere in London or the Home Counties 1,181 557 7 The following Table shows the principal occupations of the inhabitants in 1921: Males. Females. Agricultural Occupations 147 7 Metal Workers 517 13 Electrical Apparatus Makers and Fitters, and Electricians 131 22 Makers of Articles of Dress and Textile Goods 158 314 Makers of Food, Drink and Tobacco 120 54 Workers in Wood and Furniture 284 15 Makers of and Workers in Paper; Printers, etc. 263 90 Builders, Bricklayers, Stone and Slate Workers; Contractors 307 3 Painters and Decorators 313 2 Persons employed in Transport and Communication 961 78 Commercial, Finance and Insurance Occupations (excluding Clerks) 1,241 410 Persons employed in Public Administration and Defence (excluding Professional Men and Typists) 367 115 Professional Occupations (excluding Clerks) 350 345 Persons engaged in Personal Service (including Institutions, Clubs, Hotels, etc.) 252 1,292 Clerks and Draughtsmen (not Civil Service or Local Authority); Typists 992 736 Warehousemen, Storekeepers and Packers 182 77 Other and undefined workers 545 28 Retired, or not occupied in remunerative work 1,568 7,826 8 VITAL STATISTICS. Total. Male Female Births Legitimate 473 221 252 Illegitimate 18 9 9 Birth rate (R.G.), 17.9 per 1,000. Deaths, 296. Death rate (R.G.), 10.8 per 1,000. Number of women dying in, or in consequence of, childbirth from sepsis Nil. other causes Nil. Deaths of Infants under one year of age: Legitimate, 30. Illegitimate, 3. Total, 33. This equals a death rate of 67.2 per 1,000 births. Deaths from Measles (all ages) Nil. „ Whooping Cough (all ages) 3 „ „ Diarrhoea (under 2 years of age) 7 Births. The births registered during the year numbered 491, of which 230 were males and 261 females. This gives a birth rate of 17.9 per 1,000, compared with 18.4 for 1924. Birth Rate. Comparative Figures. 1925 1924 1923 1922 1921 17.9 18.4 20.4 19.0 21.3 Notification of Births Act. Two hundred and two births were notified by Medical Practitioners, 143 by midwives, and five by parents. Six were not notified. Five notifications of still-births were received. 9 Deaths. The number of deaths registered in the Urban District of Penge during the year was 199. Twenty-three of these were transferable to other districts; but 120 occurring in public institutions, etc., outside the District were transferred to Penge. The corrected number of deaths was therefore 296, equal to a rate of 10.8 per 1,000. Death rates are, however, markedly influenced by the average age of the population and the relative proportions of males and females. In a population which has a particularly large number of aged persons, say between the ages of 75 and 85, the death rate will be increased. If there be a large proportion of young people between the ages of 10 and 15, a period of life when there are fewest deaths, the death rate in this case will be lowered. Again, the death rate among males at all ages, except between 5 and 15, when they are nearly identical, is higher than that among females. If, therefore, the number of males in a community be above the average, the death rate tends to be raised. Due allowance, then, must needs be made for the age and sex distribution of the population. In order to compare mortality conditions with the greatest degree of justice, the specific death rates relating to areas, classes and groups rather than the death rates of the general population should be the basis of comparison. Susceptibility to disease differs appreciably with variable factors, notably age and sex. Good comparative figures may be obtained by their restriction to special classes, and expressing them as rates for deaths of infants, children, adults or the aged. 10 The amount of labour, however, involved in the calculation and use of so many specific death rates, necessitates their combination into a single rate, which, after allowance for age and sex, is then said to be standardized. The Registrar-General has calculated this year standardizing factors for correcting the death rate for each Urban and Rural District with a population of 10,000 or over at the last Census. The factor for this District is 0.853, thus making the standardized death rate 9.2 per 1,000, instead of 10.8. Of the total 296 deaths during the year, 76, or 25.6 per centum, were 75 years of age and upwards, and 135, or 45.6 per centum, were over 65 years. Death Rate. Comparative Figures. 1925 1924 1923 1922 1921 10.8 11.2 12.3 12.7 11.7 (Standardized.) 9.2 Infantile Mortality. The number of deaths under one year of age was 33, corresponding to a rate of 67.2 per 1,000 births. Seven of these infants only had been attending the Child Welfare Centre. There were five still-born infants. Comparative Figures. 1925 1924 1923 1922 1921 67.2 58.2 71.3 43.4 63.8 11 Public Mortuary. There have been 26 inquests held in Penge during the year 1925 as follow:— Causes of Death. Males. Females. Total. Natural Causes 7 9 16 Accidental Causes 2 3 5 Suicides 2 2 4 Open Verdict - 1 1 11 15 26 POOR LAW RELIEF. The Poor Law Relief given during the year amounted to £5,154 5s. Id., of which £1,911 6s. 7d. was to ablebodied unemployed and their families, and the balance to the unemployable from age or other causes. This compares with an amount of £5,414 Is. 6d., of which £2,853 12s. 2d. was to unemployed and their families in the year 1924. CAUSES OF SICKNESS. Influenza. An outbreak of Influenza, in 1922, was of a rather widespread nature, but fortunately not of a very fatal character. Protracted convalescence caused a good deal of invalidity. The following table shows the comparative mortality figures for the preceding five years: 1925 1924 1923 1922 1921 8 7 8 26 6 12 Cancer. Comparative Mortality Figures. 1925 1924 1923 1922 1921 36 39 45 36 26 Paratyphoid Fever. In 1925, an outbreak of Paratyphoid Fever occurred. The details are as follow: The outbreak of Paratyphoid Fever, numbering in all 12 cases, of which five were notified from one house and two from another, commenced on the 22nd August, 1925. On the 9th September, 1925, the Medical Officer of Health of the County Borough of Croydon, Dr. H. P. Newsholme, in investigating a case of Paratyphoid B, occurring at a baker's and confectioner's shop in his district found that several of the assistants had had acute symptoms suggesting enteric infection, and that one assistant resided in Penge. There was a suspicion that the cause of infection in the persons taken ill, one definitely with Paratyphoid B and the others with suspicious symptoms, was associated with one or other of two batches of veal and ham pies delivered at the Upper Norwood branch of the bakery concerned, on Tuesday, the 25th August, and Thursday, the 27th August. At this stage, four cases had actually been notified to me, and several other patients had very suspicious symptoms. A day or so later, viz.: the 10th September, seven further cases were notified, and the last case was notified on the 15th September. 13 Strict enquiries were made with regard to all our cases, and it was found that almost every case had consumed either veal and ham pies, or fancy cakes from one or other of the various branches of the suspected bakery. The earliest batch of cases in the Croydon area were, without exception, connected with the consuming of veal and ham pies, and it was found that other forms of confectionery such as fancy cakes, madelines, cherry flans, etc., had undoubtedly given rise to infection. It would appear that the foreman pastrycook at this shop was a mild case, and accounted for nearly all the cases which occurred since early in August. I had a consultation with Dr. E. Wilkinson, from the Ministry of Health, and furnished him with full notes of the cases in this area. Of the 12 cases notified, 5 were seriously ill. There were no deaths. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals provided or subsidized by the Local Authority or by the County Council. Tuberculosis. Cases are admitted into Sanatoria through the Kent County Council. During the year, Penge patients were admitted to the following: Royal Sea Bathing Hospital, Margate; Preston Hall, near Maidstone; Keycol Hill Sanatorium, Sittingbourne; 14 Grosvenor Sanatorium, Kennington, Kent; Lenham Sanatorium, Kent; Croydon Boro' Sanatorium, North Cheam, Surrey; Royal National Hospital for Consumption, Ventnor; Victoria Home for Invalid Children, Margate; Cranbrook Convalescent Home, Kent; Oak Bank Open-Air School, near Sevenoaks, Kent; and Mayday Hospital, Croydon. Maternity. The Penge and Beckenham Joint Maternity Home, which was established in June, 1920, with accommodation for 10 beds, is managed by a Joint Committee appointed annually by the Penge and Beckenham Urban Councils, and receives financial aid from the rates as well as a grant from the Ministry of Health. The facilities are primarily provided for those who have not sufficient accommodation or are unable to secure adequate attention in their own homes. For mothers who attend the Infant Welfare Centres at Penge and Beckenham, and who are entitled to "Maternity Benefit," the inclusive charge for the "lying-in" period of fourteen days is £2. Other residents in Penge and Beckenham are admitted to the Home upon terms which may be ascertained from the Matron. Necessitous cases, after due enquiry by the Committee, are granted free admission to the Home. During the year, 272 cases were admitted. Of the total number of patients, 82 were from Penge, 156 from Beckenham, and 34 from other districts. Dr. J. M. Clements, the Medical Officer of Health of Beckenham, is the Medical Supervisor; and the Staff consists 15 of a Matron, three Nurses and three Probationers, a Gardener and Handyman, Cook and two Kitchenmaids. The average period spent in the Home by each patient was 16-8 davs. Accommodation available—14 beds. Patients can be attended at the Home by their own doctor if they wish. The expenses of the Home are allocated as between the two Districts, as follows: Capital expenditure and the cost of maintenance of the staff are allocated in proportion to the rateable value of the Districts; this works out at approximately three-fifths for Beckenham and two-fifths for Penge. The cost of maintenance of patients is borne by the District in which the patient resides. The following Table shows the number of cases admitted yearly to the Home since its opening in 1920: Year. Penge Cases. Total Cases. 1920 (five months) 8 31 1921 54 173 1922 73 185 1923 89 238 1924 80 240 1925 82 272 Children. There is no Hospital provided in the District. Patients are usually sent to the following Hospitals: The South-Eastern Hospital for Children, Sydenham; The Evelina Hospital for Children, London, S.E.; and The Hospital for Sick Children, Great Ormond Street, London. 16 Fever. An agreement has been in force for a number of years with the County Borough of Croydon for cases of notifiable infectious diseases to be removed to Waddon Isolation Hospital, Croydon, when adequate isolation cannot be obtained at home. The Hospital authorities provide any beds that maybe required, and the number of diseases that can be concurrently treated is six, viz.: Diphtheria, Scarlet Fever, Enteric Fever, Cerebrospinal Fever, Puerperal Fever and Encephalitis Lethargica. Small-pox. Arrangements are in force for cases from this District to be sent to the Small-pox Hospital, Clandon, Surrey. Other. There are no Hospitals in this District. Cases are generally sent to the Beckenham Cottage Hospital, Norwood Cottage Hospital and Croydon General Hospital, all being within easy reach. These are all voluntary Hospitals. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the area. Unmarried mothers are received into the Penge and Beckenham Joint Maternity Home under the following conditions: (a) That all applications from unmarried mothers be referred to the local welfare centre. (b) That if the dofnestic conditions are suitable, arrangements be made for the attendance of a midwife at the applicant's home. 17 (c) That if the domestic conditions are unsuitable, subject to approval by the House Committee, applicants be admitted to the private wards of the Home. There is no institutional provision for homeless children in the area. Ambulance Facilities. (a) For Infectious cases. Cases of infectious disease are removed by the Hospital Motor Ambulance. (b) For Non-infectious cases. An up-to-date Clement-Talbot motor ambulance is provided by the Council. Cases of accident and sudden illness in the street are attended free of charge, and other cases removed as wished, according to a fixed scale. The ambulance, which is housed at the Fire Station, Croydon Road, is available at any time, day or night, on request. Clinic and Treatment Centres. The Maternity and Child Welfare Centre is held at the Council's School Clinic, at 17, Oakfield Road, on Tuesday and Wednesday afternoons, and the Medical Officer of Health, who is Medical Officer for the Centre, attends on Wednesday afternoons for consultations. The accommodation is as follows: Waiting room, weighing room, consulting room and a storeroom. The Centre is provided by the Council. 18 Day Nurseries. No Day Nurseries are open in the District at present. School Clinics. Minor ailments are prescribed for by the School Medical Officer or a Medical Inspector once a week (Friday). The School Nurses attend daily. The Dental Surgeon attends four times a week. The Ophthalmic Surgeon attends every two weeks as required. Particulars appear in the School Medical Officer's Annual Report. The School Clinic is held in specially adapted premises at 17, Oakfield Road, Penge. The accommodation for the treatment of minor ailments consists of two rooms (one a waiting room) on the first floor. The Eye Clinic was opened on the 1st October, 1925; the room used by the Ophthalmic Surgeon is on the ground floor, and there is a dark room opening from it. The waiting room, used by his patients, is the same as that used by the children with dental defects. The room used by the Dental Surgeon is also on the ground floor. Tuberculosis Dispensaries. Penge patients are treated at the Kent County Council Tuberculosis Dispensary, Beckenham, on Tuesdays and Wednesdays. Treatment Centres for Venereal Diseases. Patients are treated at the several London Hospitals and the Croydon General Hospital. 19 Public Health Officers of the Local Authority. *Medical Officer of Health, and Medical Officer to the Maternity and Child Welfare Centre: R. Wilkinson, M.D. (Brux.), M.R.C.S. (Eng.), L.R.C .P. (Lond.) * Chief Sanitary Inspector : H. J. Perrett, Cert. R.San. Inst. „ „ „ (Meat and Foods). *Sanitary Inspector: R. T. Pearce, Cert. San. Insp. Exam. Bd. „ ,, „ (Meat and Foods). *Health Visitor: Miss E. M. Dell, Cert. Cent. Mid. Bd. Clerk: F. O. Hersee. *Contributions to salaries are made under the Public Health Acts or by Exchequer Grants. With the exception of the Medical Officer of Health, all the above are whole-time appointments. Professional Nursing in the Home. (a) General. The Penge and Anerley District Nursing Association provides two whole-time Nurses for general nursing in the poorer areas. It is entirely supported by voluntary efforts, and does excellent work in the District. (b) For Infectious Diseases, e.g., Measles, etc. Arrangements have been made with the Nursing Association, by means of which nursing is provided for cases of whooping cough, epidemic diarrhoea and ophthalmia neonatorum, as well as for measles. Payment is made (per visit) by the Local Authority. 20 Midwives. There are 10 Midwives practising in the District, under the supervision of the Kent County Council, and there are 4 private nursing homes which receive maternity cases. Legislation in Force. Infectious Disease (Prevention) Act, 1890 adopted 1900 Public Health Acts Amendment Act, 1890 adopted 1900 Public Health Acts Amendment Act, 1907 (Extracts of parts 2, 3, 4 and 5) adopted 1910 Common Lodging Houses allowed 1902 Houses Let in Lodgings allowed 1902 Slaughterhouses allowed 1902 Prevention of Nuisances allowed 1902 New Streets and Buildings allowed 1902 Drainage of Existing Buildings allowed 1906 Cleansing of Earth Closets, Privies and Cesspools allowed 1902 Sanitary Conveniences allowed 1922 Alteration of Buildings allowed 1905 Pleasure Ground allowed 1919 Music, Music and Dancing, Cinematograph Exhibitions and Stage Play Licences adopted 1916 Employment of Children 1910 Dairies, Cowsheds and Milkshops Regulations 1902 Sanitary Circumstances of the Area. Water. All the houses in the District are supplied with a constant service of water by the Metropolitan Water Board, the majority of the premises being connected directly to the rising main. 21 Rivers and Streams. There are no rivers in the District. In 1924 the open stream in Kent House Lane, the boundary of the Penge and Beckenham Districts, was culverted with twin 3-feet concreted pipes, and a footpath to the road made over same. Drainage and Sewerage. All the premises in the District are connected to the public sewers. 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. Closet Accommodation. The whole of the premises in the area are provided with water closets connected to the main drainage system- Scavenging. The number of loads of house refuse collected during the year was 6,130. The cost of removal of same by rail, etc., was £2,084 ; and also, during the Summer months, to the Beckenham destructor, £316. The cost of collection and disinfection of bins amounted to £2,856. The house refuse is contained in movable galvanized iron dustbins with suitable covers, and is collected throughout the District once in every week. Sanitary Inspection of the Area. This is fully dealt with in the Report of the Chief Sanitary Inspector. 22 Smoke Abatement. There are no large factories in the District and no action has been necessary. Premises or Occupations which can be controlled by Byelaws or Regulations. No. in District Mo. of Visits No. of Defects f'nd No. of Defects remedied  Dairies, etc 21 40 2 2 Slaughterhouses 3 205 — — CommonLodgingHouses 5 45 2 2 Houses Let in Lodgings 21 23 5 5 Byelaws with respect to the trade of fish friers would be useful. Other Sanitary Conditions requiring Notice. Since 1921 several of the old urinals of the public houses have been reconstructed, enlarged and brought up to present-day requirements. In 1924 the Local authority provided a much needed underground covenience for ladies in the High Street. Schools. The sanitary condition and water supply of the Schools are satisfactory. The School Medical Officer, the Medical Inspectors and the Head Teachers are notified of all cases of infectious 23 disease that occur in the homes of children attending school. Attendance from infected houses is prohibited for certain periods. Prevalence of, and Control over, Infectious Diseases. (Infections Diseases generally.) In 1921 there was a moderate outbreak of mild Scarlet Fever. No mortality. In 1922 Diphtheria was above the average ; half the number of cases coming from a large Poor Law Institution in the District. Diphtheria Antitoxin is provided for prompt distribution on application by Medical Practitioners. Encephalitis Lethargica, 8 cases in 5 years. " Return cases " very rare. Pneumonia, rather prevalent; average for 5 years— 21 cases per annum. Schick and Dick tests have not been used. Cases of Measles are notified to me from the Schools, and duly visited. Bacteriological Work. Bacillus found Bacillus not found Total  Diphtheria. County Laboratory 22 87 109 Diphtheria. Clinical Research Association - 5 5 Tuberculosis. County Laboratory 8 42 50 Enteric Fever „ 6 7 13 Total 36 141 177 24 Anti-diphtheritic serum was supplied for the treatment of 5 cases, vials being supplied containing 28,000 units. A supply of anti-toxin is always kept at the Public Health Department and at two chemists' shops, and is available for the use of Medical Practitioners upon request. Notifiable Diseases (other than Tuberculosis) during the year 1925. Disease Total cases notified Cases admitted to Hospital Total deaths  Scarlet Fever 31 24 1 Diphtheria 27 25 5 Enteric Fever (including Paratyphoid) 15 7 - Puerperal Fever 1 — — Pneumonia 32 4 20 (all forms) Erysipelas 5 1 — Encephalitis Lethargica 3 — 1 Malaria 3 — — Ophthalmia Neonatorum 1 — — Comparison Table of Cases notified during the five years. disease. 1925 1924 1923 1922 1921  Scarlet Fever 31 27 25 63 126 Diphtheria 27 10 24 62 40 Pneumonia 32 21 13 29 13 Erysipelas 5 9 3 5 5 Malaria 3 1 — — — Encephalitis Lethargica 3 2 1 1 1 Enteric Fever 15 — 3 — 6 Ophthalmia Neonatorum 1 — — — — Puerperal Fever 1 — — — 1 Poliomyelitis — — 1 — 1 25 Tuberculosis. Total cases notified Cases admitted to Sanatoria Total Deaths  Pulmonary (Males) 14 12 13 ,, (Females) 12 9 3 Totals 26 21 16 — — — Non-Pulmonary (Males) 7 2 4 „ „ (Females) 7 4 5 Totals 14 6 9 — — - Forty primary notifications of Tuberculosis were received during the year, of which number 26 referred to pulmonary cases. Twenty-seven notifications were received from Medical Officers relating to patients admitted to Sanatoria, and 19 to those discharged. Notification of cases of this disease is carried out in a satisfactory manner, and each of the 16 deaths from pulmonary tuberculosis which occurred during the year had been notified. Of the deaths from other forms of tuberculosis 2 were not notified, each case being diagnosed in Hospital where they died. All cases of tuberculosis are periodically visited, and disinfection is carried out as occasion requires. During the year 50 specimens of sputum were sent to the Kent County Laboratory, Maidstone, to be examined for tubercle bacillus ; 8 of these were positive. Judging from the number of negative sputum specimens received, it is evident that the Medical Practitioners of the 26 District are fully alive to the importance of availing themselves of the facilities for diagnosis provided by the County Laboratory. New Cases and Mortality during 1925. Age Periods. New Cases*. Deaths. Pulmonary Non-Pul'ary Pulmonary Non-Pul'ary M F M F M F M F  0 - 1 - - - - 1 1 1 1 — 5 - — — 2 — 5 — — 2 2 — — — — 10 — — 1 — — — — 1 15 — 3 1 3 — — 1 1 20 2 3 — — 3 — — — 25 5 6 — 1 2 1 — 1 35 3 3 — 1 2 2 — — 45 5 1 — — 2 — — — 55 5 —— — — 2 — — 1 65 and upwards 1 — — — 2 — — — Totals 22 17 9 7 13 3 4 5 *In addition to primary notifications, all other new cases coming to the knowledge of the Medical Officer of Health are included in these figures, such as cases which have been previously notified in other districts and transferred to Penge. MATERNITY AND CHILD WELFARE. Maternity and Child Welfare Centre. Medical Officer's Consultations : Infants 788 Nursing Mothers 295 Ante-Natal 152 Total attendance of Children at the Centre 3,540 Individual children who attended 437 Average weekly attendance of children 70.8 Total attendance of nursing mothers 1,169 Individual nursing mothers who attended 182 27 Average weekly attendance of nursing mothers 23-4 Total attendance of expectant mothers 152 Individual expectant mothers who attended 116 Average weekly attendance of expectant mothers 34 The Maternity and Child Welfare Centre, opened in 1915, has been, and continues to be, very successful, and two afternoons a week are necessary to cope with the attendances. The Centre is held at the new Clinic of the Education Authority, and the accommodation is commodious and satisfactory in every way. There is still a good deal of unwillingness of the very necessitous to attend at the Centre, but every effort is being made to encourage them to come. I am, every year, more impressed by the useful results of the Centre, and am endeavouring to enlarge the scope of the pre-natal section. 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 mothers. 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 scale approved by the Ministry of Health. Malt Extract and Cod Liver Oil, Virol, Lactagol, etc., are also supplied free or at cost price. The following amounts were expended in supplying milk gratis during the year : Dried Milk £66. Fresh Milk £8. The cash receipts for Dried Milk sold were £262. Sanction has recently been received from the Ministry of Health for providing Home Helps—if necessary—in cases where a woman is unwilling to leave her home for her 28 ment. Also, under certain conditions, for sending nursing mothers and their infants to a Convalescent Home. Visits of Health Visitor. Two hundred and eighty primary and 688 subsequent visits were paid by the Health Visitor to infants under the age of 12 months, and 856 visits to children between the ages of 1 and 5 years. Sixty-six expectant mothers received 143 visits, and 272 visits were paid to Tuberculosis cases. One hundred and fifteen miscellaneous visits were paid, the latter including those to cases of Measles. Two hundred mothers were interviewed by the Health Visitor. Ophthalmia Neonatorum. Cases Vision unimpaired Vision impaired Total blindness Deaths  Notified Treated At home In Hospital 1 Yes — Yes - - - I once more express to the Chairman and Members of the Public Health and Maternity and Child Welfare Committee my cordial thanks for their unvarying help and support during the year, and to the Staff of the Public Health Department for their loyal co-operation. I am also much indebted to the Lady Voluntary Workers at the Maternity and Child Welfare Centre for their regular attendance and devotion to the work. I am, Gentlemen, Your obedient Servant, ROBERT WILKINSON, Medical Officer of Health. Causes of Death in Penge Urban District, 1925. Registrar-General's Figures. Causes of Death. Males. Females. All Causes 147 149 I Enteric Fever — — 2 Small-pox — — 3 Measles — — 4 Scarlet Fever — 1 5 Whooping Cough 2 1 6 Diphtheria 3 2 7 Influenza 1 7 8 Encephalitis Lethargica 1 — 9 Meningococcal Meningitis — — 10 Tuberculosis of respiratory system 13 3 11 Other tuberculous diseases 4 5 12 Cancer, malignant disease 18 20 13 Rheumatic Fever — — 14 Diabetes — 1 15 Cerebral Haemorrhage, etc 9 13 16 Heart Disease 18 22 17 Arterio-sclerosis 8 13 18 Bronchitis 6 5 19 Pneumonia (all forms) 11 9 20 Other respiratory diseases 2 — 21 Ulcer of stomach or duodenum 1 2 22 Diarrhoea, etc. (under 2 years) 4 3 23 Appendicitis and Typhlitis 2 — 24 Cirrhosis of liver — — 25 Acute and Chronic Nephritis 7 1 26 Puerperal Sepsis — — 27 Other accidents and diseases of pregnancy and parturition - - 28 Congenital Debility and Malformation, premature birth 6 3 29 Suicide 4 2 30 Other deaths from violence 4 4 31 Other defined diseases 23 31 32 Causes ill-defined or unknown — 1 Special causes (included above) : Poliomyelitis — — Polio-encephalitis — — Deaths of infants under 1 year of age : Total 15 18 Illegitimate 1 2 Total Births 230 261 Legitimate 221 252 Illegitimate 9 9 Population (estimated middle of 1925, R.G.) 27,340. Nett Births registered during the Nett Deaths registered during the calendar year : calendar year : Legitimate 4731 ,Q, Legitimate Infants 30) Illegitimate 18) Illegitimate „ 3) Infant Mortality, 1925. Nett deaths from stated causes at various Ages under One Year. Causes of Death. Under one 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 7 2 - 2 11 14 2 3 3 33 [ Uncertified — — — — — — — — — — l Small-pox — — — — — — — — — — 2 Chicken-pox — — — — — — — — — — 3 Measles — — — — — — — — — — 4 Scarlet Fever — — — — — — — — — — 5 Whooping Cough — — — — — — — — 1 1 6 Diphtheria and Croup — — — — — — — — — — 7 Erysipelas — — — — — — — — — — 8 Tubercular Meningitis — — — — — — 1 — — 1 9 Abdominal Tuberculosis — — — — — — — — 1 1 10 Other Tuberculous diseases — — — — — — — — — — 11 Meningitis — — — — — — — — — — 12 Convulsions — — — — — — — — — — 13 Laryngitis — — — — — — — — — — 14 Bronchitis — — — — — 2 — — — 2 15 Pneumonia (all forms) — 1 — — 1 1 1 — — 3 16 Influenza — — — — — — — — — — 17 Diarrhoea — — — — — — — — — — 18 Enteritis — — — — — 4 — — — 4 19 Gastritis — — — — — — — — — — 20 Syphilis — — — — — — — — — — 21 Rickets — — — — — — — — — — 22 Suffocation, Overlying — — — —— — 2 — 1 — 3 23 Injury at Birth 1 — — — 1 — — — — 1 24 Congenital Malformations 2 1 — — 3 1 — — — 4 25 Premature Birth 3 — — — 3 1 — — — 4 26 Atrophy, Debility, Marasmus 1 — — 2 3 3 — 1 — 7 27 Other Causes — — — — — — — 1 1 2 Totals 7 2 — 2 11 14 2 3 3 33 Notifiable Diseases during the Year 1925. Notifiable Disease. cases notified. Cases admit'd to Hospital deaths of notified cases. At all ages At ages—Years At all ages At ages—Years Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Under 1 I to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards  1 Diphtheria 27 - 7 13 5 2 - - 25 5 - 1 3 - 1 - - 2 Encephalitis Lethargica 3 - - - - 1 1 1 - 1 - - - - - 1 - 3 Enteric Fever 15 - 1 2 4 4 4 - 7 - - - - - - - - 4 Erysipelas 5 1 - - 1 - 1 2 1 - - - - - - - - 5 Malaria 3 - 1 - - 1 1 - - - - - - - - - - 6 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - 7 Pneumonia 32 4 2 5 3 8 6 4 4 20 3 5 - - 2 2 8 8 Puerperal Fever 1 - - - 1 - - - - - - - - - - - - 9 Scarlet Fever 31 - 9 18 2 2 - - 24 1 - 1 - - - - - Totals 118 6 20 38 16 18 13 7 61 27 3 7 3 - 3 3 8 Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories Including Factory Laundries 25 4 - Workshops Including Workshop Laundries 95 44 - Workplaces Other than Outworkers' premises 128 10 - Total 248 58 - Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects Number of Prosecutions Found Remedied Referred to HM. Inspect'r Nuisances under the Public Health Acts:—* Want of cleanliness 36 36 - - Want of ventilation — — - - Overcrowding - — - - Want of drainage of floors - — - - Other nuisances 16 16 - - Sanitary accommodation : Insufficient 2 2 - - Unsuitable or defective 2 2 - - Not separate for sexes 2 2 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse - - - - Other offences (Excluding offences relating to outwork pnd offences unler the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). - - - - Total 58 58 - - including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. ANNUAL REPORT of the Chief Sanitarg Jnspector for the PENGE URBAN DISTRICT in the COUNTY OF KENT for the Year Ending December 31st, 1925. Town Hall, Anerley, S.E. 20. April, 1926. To the Chairman and Members of the Urban District Council of Penge. Gentlemen, I have pleasure in submitting my Sixth Annual Report for the year ending the 31st December, 1925. Six hundred and fifty-two Intimation Notices and 31 Statutory Notices were served under the Public Health and Housing Acts. In addition Statutory Notices were served periodically for the cleansing of the following : Bakehouses, Common Lodging Houses and Cowsheds (semi-annual) ; Slaughterhouses (quarterly) ; and Houses Let in Lodgings (annual) ; and 842 letters were sent out during the year. The drainage systems of three houses have been entirely reconstructed, whilst those of 20 were partially relaid, and 48 cleared. Some difficulty was experienced with a few owners regarding repairs, and the necessary works were only effected after summonses had been threatened. A number of applications were made by tenants anxious to receive advice as to repairs, etc., under the Rent and Mortgage Interest (Restriction) Acts, 1920-23. Inspections were therefore made, the owners communicated with and requested to carry out various works. In three instances only was it necessary to issue a certificate that the premises were " not in a reasonable state of repair." These Acts are most useful to tenants for getting repairs carried out that are outside the purview of the Public Health Acts. 36 GENERAL HOUSING CONDITIONS AND OVERCROWDING IN THE AREA. Census 1921. Number of Private Families occupying the following number of Rooms : I 2 3 4 5 6.7 8.9 10 and over Total Private Families 366 794 1,066 1,255 995 1,220 521 284 Population in Private Families 629 2,046 3,784 4,782 4,414 5,613 2,360 1,471 Rooms occupied 366 1,588 3,197 5,020 4,975 7,725 4,327 3,151 1921. — Percentage of Families living in various units of occupation 5.6 12.2 16.4 19.3 15.3 18.8 8.0 4.4 1911. — Percentage of Families living in various units of occupation 4.0 6.8 12.5 12.9 15.6 23.0 13.4 11.8 It will be seen from these figures that 366 families occupied one room, with a total population of 629 ; and 794 families, numbering 2,046 occupants, occupied two rooms each. A great number of these families comprise only one or two persons, whereas others range from three to six persons. The principal causes of overcrowding are increase of population, little building of working class houses at a low rental and inability of tenants to pay the present rents without subletting. 37 The increase of population is shown by the following figures: Census, 1911 22,330 Census, 1921 26,278 Estimated, Middle of 1925 (R.G.) 27,340 Houses of the smaller working class type, or a block of workmen's self-contained flats, about 50 in number, to let at an inclusive rental of about 10s. Od. per week are urgently needed. Most of the available land in the District is, however, now being built on by private enterprise. These houses are for sale only and consequently beyond the reach of the poorer section of the community. Unfortunately the new houses are not relieving the overcrowding, which apparently shows little diminution, as the purchasers are mainly from other districts. The Council prepared a Housing Scheme in 1919, proposing to build 218 houses. A site was acquired, laid out and sewered, but the Ministry of Health only agreed to the erection of 50 houses, and the remainder of the land has now been sold for private building, and houses are being erected for sale only, from £750 upwards. In addition to the aforementioned 50 houses built by the Council, 134 houses have been built by private enterprise during the preceding five years ; others are in course of erection and 21 houses have been converted into 47 flats. Twelve additional cases of overcrowding were found, and 8 cases were abated during the year. Fitness of Houses. The general standard of the housing is fairly good considering that there is a number of old houses. There are 38 four back-to-back houses, but there is ample open space around them. The usual defect in unsatisfactory cases is dampness, due to leaky roofs, absence of damp-proof courses, etc., and also defective plastering. Some owners are reluctant to execute repairs, and very little supervision is given to their property ; and there is also a class of careless and irresponsible tenants. Difficulty is experienced with certain owners who allow the time given in the Notices served on them under the Housing Act to expire, and only after estimates have been obtained from local builders do they start the work and proceed slowly in executing same. There appears no provision in these Acts to compensate the builders for their wasted time and energy. Byelaws relating to Houses, Houses Let in Lodgings, and to Tents, Vans, Sheds, etc. The Byelaws relating to New Streets and Buildings are at present being revised. The Byelaws in respect to Common Lodging Houses and Houses Let in Lodgings work satisfactorily. There are no Byelaws operating in the District for tents, vans and sheds. There are 5 Common Lodging Houses and 21 Houses Let in Lodgings on the Register, all situated in Arpley Road. They are periodically inspected and cleansed, and are kept in a fair condition. GENERAL AND MISCELLANEOUS. Disinfection. In addition to the usual disinfection of rooms, bedding, etc., after cases of Scarlet Fever, Diphtheria, etc., disinfection 39 has been carried out at 49 premises after cases of Tuberculosis, and 21 after Cancer. In regard to the latter disease, enquiries were made at each house where a fatal case occurred and disinfection was offered. It is evident that an increasing number of persons now avail themselves of the opportunity of having this done. Where vermin are discovered, disinfection of rooms, and where necessary bedding and clothing, is carried out. This has been done in 63 cases. The following list shows the number of rooms fumigated and of beds and other articles steam disinfected during the year : Number of rooms fumigated 285 ,, ,, beds disinfected 243 ,, ,, blankets disinfected 495 „ ,, pillows disinfected 524 ,, ,, sheets disinfected 353 ,, ,, miscellaneous articles disinfected 1,017 One hundred and thirty-seven beds and 1,503 articles were also disinfected for the Beckenham Urban District Council during the time a new steam disinfecting plant was being installed by them. HOUSING STATISTICS FOR THE YEAR 1925. Number of new houses erected during the year : (a) Total (including numbers given separately under (b) ) 75 (b) With State assistance under the Housing Acts: (i) By the Local Authority — (ii) By other bodies or persons — 40 1. Unfit Dwelling Houses. Inspections: (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 680 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 179 (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 subheading) found not to be in all respects reasonably fit for human habitation 594 2. Remedy of Defects without Service of Formal Notices: Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 563 3. Action under Statutory Powers: A—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repairs 15 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 15 (b) By Local Authority in fault of owners — 41 (3) Number of dwelling houses in respect of which Closing Orders became operative 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 16 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 16 (b) By Local Authority in default of owners — C—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (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 molished in pursuance of Demolition Orders — 42 House-to-house Inspection. During the year 179 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. Blenheim Road 46 39 Crampton Road 50 43 Ridsdale Road 83 71 Totals 179 153 The following list gives some idea of the nature of the principal defects found during the course of House-to-house Inspection : Water Closets: No. of houses Defective basin and trap 2 Insufficiently lighted and ventilated 3 Pan foul 23 Defective flushing apparatus 14 Defective flush pipe to pan 6 Defective door or seat 6 Drainage: Defective drains 1 Defective soil or vent pipes 16 Choked drains 11 Defective fresh air inlet 3 No grid to gully 3 43 Light and Ventilation: No ventilation in lieu of fireplace 23 Shed built over window 3 Defective sashlines of windows 7 Sinks: Defective sink 4 Defective waste pipe 17 Dampness: Leaky roof 26 Defective gutters, rainwater pipes, etc. 37 Through walls, etc. 22 Cleanliness: Dirty rooms 87 Verminous rooms 25 Paving, etc: Defective yard or forecourt paving 53 Arrangements for Deposit of Refuse and Ashes: Defective dustbin 21 Other Defects: Defective plaster 91 Defective scullery paving 20 Defective kitchen stove or copper 14 Defective flooring or joists 26 Animals improperly kept 5 Miscellaneous 57 44 Summary of Work executed during the year. Water Supply. Water supply reinstated to houses 10 Water service pipes repaired 40 Draw-off taps provided on rising main 9 Cisterns cleansed, covered or covers repaired 10 Water Closets. New pans and traps fixed 45 Flushing apparatus renewed or repaired 60 Foul pans and traps cleansed 36 Connection of flushing pipes to pans made good 12 Seats and doors provided or repaired 26 Ventilation provided or improved 6 Drainage. Drains cleared 48 Houses provided with new drains 3 Houses with drains partially relaid 20 Aggregate length of 4" and 6" pipes laid feet 710 Inspection chambers constructed or improved 15 Interceptors provided 3 Soil and ventilation pipes fixed or repaired 30 Sinks, lavatory basins and baths provided 33 Waste pipes renewed, repaired or trapped 63 Fresh-air inlets provided or repaired 14 Gullies provided 28 Rainwater pipes disconnected from drains 3 Dampness. Dampness in premises remedied 23 Roofs repaired121 Gutters repaired 63 Rainwater pipes repaired 39 Ventilation under floors provided or improved 31 45 Cleanliness. Dirty rooms cleansed, whitewashed, etc. 625 Verminous rooms fumigated 89 Miscellaneous. Premises with defective floors, joists, etc., repaired 46 Premises with defective plaster repaired 158 Premises with new sash lines provided 19 New dustbins provided 69 Yards and forecourts to houses paved or repaired 68 Scullery paving repaired 19 Overcrowding abated 8 Animals removed 10 Accumulation of manure, stagnant water, animal or other refuse removed 23 Ventilation and light of rooms provided or improved 30 Kitchen stoves repaired or renewed 8 Scullery coppers repaired or renewed 17 Other stoves repaired or renewed 11 Miscellaneous repairs, etc. 123 Summary of Inspections and Visits. The following summary shows, to some extent, the number of inspections and visits made. Inspections through complaints received 275 Inspections under the Housing, etc., Acts 179 Visits re cases of infectious diseases 330 Houses Let in Lodgings and Common Lodging Houses 49 Food Trade Inspections (including Bakehouses, Cowsheds, Slaughter houses, etc.) 495 Trade Inspections under the Petroleum Acts, Rag Flock Act, Marine Store Dealers' Act, Game Dealers' Act, etc. 123 46 Factories, Workshops and Workplaces (excluding Inspections in previous items) 248 Inspections and re-Inspections of work in hand and various visits 2,127 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There is one cowkeeper in the area and 20 premises registered as dairies and milkshops. These premises are peroidically inspected. The bulk of the milk brought into the district is generally of a fair quality, and no legal action has been necessary. The analyses of the 69 formal samples obtained during the year showed the following average : Fat 3.37 per cent. Solids, not fat 8.88 per cent. Dealers' Supplementary Licences were issued in respect of two Dairies, for the sale of "Pasteurized Milk," and also for " Grade A Pasteurized Milk," in each case. Meat. A mutual arrangement has been made with the occupier of the chief slaughter house in the district for a visit to be paid regularly four mornings a week to his premises for inspection of animals slaughtered, in addition to occasional visits. Other slaughter houses are visited as notified. 47 Nine hundred and ninety-one animals have been examined after slaughter. No application has been received for marking under the Public Health (Meat) Regulations, 1924. There is no special arrangement for the disposal of condemned meat. A few of the butchers' shops have very wide forecourts, and where these have been suitably screened it has not been deemed necessary to ask for glazed windows to be provided. The only meat stall in the Market has been reconstructed to comply with the Regulations. Slaughter Houses. In 1920 In Jan., 1925 In Dec., 1925 Registered 2 2 2 Licenced 2 1 1 Totals 4 3 3 These have been regularly limewashed and inspected. The approximate number of animals slaughtered in the district during the year is: Cattle 123 Calves 654 Sheep 413 Pigs 480 Total1,670 The following were surrendered and condemned at the slaughter houses during the year. Cattle. 2 Carcases and offal Tuberculosis. 1 Head and tongue „ 5 sets of Lungs „ 2 Livers „ 48 5 Livers Parasitical. 20 Livers (parts of) „ 2 sets of Lungs Abscesses. 1 set of Lungs Pleurisy. 2 Ribs (broken) Abscesses. 2 Udders Mammitis. Calves. 2 Plucks Tuberculosis. 1 set of Lungs Congestion. Pigs. 2 Carcases and offal Tuberculosis. 2 Heads and tongues „ 1 Pluck ,, 3 Livers Cirrhosis. 1 set of Lungs Congestion. 1 set of Lungs Abscesses. Sheep. 6 Livers Parasitical. 4 sets of Lungs „ Cwts. qrs. lbs. Total weight of tuberculous meat 14 3 5 Total weight of diseased non-tuberculous meat 2 2 16 Total 17 1 21 Other Foods. There are 18 bakehouses in the district, 3 of these being underground, for which certificates were granted in 1903. 49 These have all been regularly inspected, and limewashing has been carried out twice in the year as required by the Factory and Workshops Acts. Four hundred and ninety-five visits have been made to premises and stalls where foods are manufactured, prepared, stored or exposed for sale, and these are usually found to be kept in a satisfactory condition. The stores and yards of the greengrocers receive frequent visits, but the standard of tidiness is far from high. The following list shows the amount of food which was surrendered and condemned from shops and stalls, and then destroyed : Haddocks 702 lbs. Herrings 50 lbs. Pears 368 lbs. Plaice 84 lbs. Turkeys 150 lbs. Winkles 75 lbs. Total weight 12 cwts. 3 qrs. 1 lb. Sale of Food and Drugs Acts. Sixty-nine informal samples of new milk were purchased and submitted for analysis. Of these, 64 samples were reported genuine and five just below standard. Formal samples were taken in respect of two of the latter cases, and both were found to be genuine. One hundred and three samples were obtained within the district by the County Council Inspector for this Division of Kent. 50 The Clerk to the Kent County Council has kindly furnished the following particulars respecting such samples: 47 samples of New Milk. 5 ,, Lard. 5 ,, Margarine. 3 ,, Butter. 4 ,, Pepper. 4 ,, Cocoa. 3 ,, Coffee. 3 ,, Cornflour. 2 „ Scotch Whisky. 2 ,, Gin. 2 ,, Vinegar. 2 ,, Rice. 2 ,, Tea. 2 ,, Mustard. 2 ,, Self-raising Flour. 2 ,, Raspberry Jam. 2 ,, Ground Rice. 1 sample of Preserved Peas. 1 ,, Flour. 1 ,, Tapioca. 1 ,, Oatmeal. 1 „ Custard Powder. 1 ,, Ground Ginger. 1 ,, Pearl Barley. 1 ,, Condensed Milk. 1 „ Syrup. 1 ,, Glycerine. 1 ,, Ammoniated Tincture of Quinine. 103 51 Upon analysis, 100 were found to be genuine. One sample of milk was adulterated and proceedings were taken. The case was dismissed on the payment of costs—£5 5s. 0d. One sample of whisky and one of gin were inferior. Old Metal and Marine Store Dealers. Ten persons are registered as Old Metal and Marine Store Dealers. Books are kept by them in accordance with the Act. Factories and Workshops. There are 99 factories and workshops on the register. They have been regularly inspected. Notices have been served respecting cleansing, etc. Petroleum Acts. Thirty licences were issued during the year to store a total of 8,944 gallons of petrol, 6,300 gallons being stored in underground tanks. One licence was issued during the year to store 3 cwt. of carbide of calcium. Rats and Mice (Destruction) Act, 1919. The Kent County Council delegated its powers under this Act to the Council. Complaints are mainly from occupiers of premises where animals are kept. 52 Complaints are investigated, poisons supplied and traps lent. I take this opportunity of tendering my thanks to the Chairman and Members of the Public Health Committee for their kind consideration and support during the year, and to the Staff for their able assistance. I am, Gentlemen, Your obedient Servant, H. J. PERRETT, Chief Sanitary Inspector. 53 REGISTERED WORKSHOPS, Etc. On Register at end of Year. Workshops Factories. Bakehouses 18 — Banana Foods manufactory — 1 Basket making 1 — Blacksmith 1 — Bootmaking and repairing 8 — Builders' workshops, etc. 4 1 Colour printing — 1 Cycle making and repairing 2 — Dressmaking and millinery 11 2 Dry battery works 1 — Dyeing and cleaning 1 1 Engineering 1 2 Laundry work 6 6 Mattress manufactory 1 — Meat extract manufactory 1 — Motor repairing 6 1 Photo printing 1 — Pickle making and bottling 1 — Printing — 4 Saddlery and trunk making 1 — Stonemason's workshop 1 — Tailoring 6 — Toy manufactory 1 — Tramway works 1 — Upholstering and repairing furniture 4 — Wheelwrights 2 - Total 80 19 99