PENGE URBAN DISTRICT. ANNUAL REPORT of the Medical Officer of Health, Robert Wilkinson (M.D.Brux.). together with THE ANNUAL REPORT of the Thief Sanitary Inspector Richard T. Pearce (M.S.I.A.) 1935 Urban District Council of frngc. Chairman: Mr. G. L. Wells, J.P. Vice-Chairman: Mr. G. Notley. PUBLIC HEALTH COMMITTEE Chairman : Mr. F. Theobald. Mr. R. C. S. Barnett. Mr. E. Hodges. „ J. F. D. Dixon. ,, J. T. WT. Huckin. ,, F. W. Foreman. „ D. E. Jones. „ J. B. Geale. „ J. Smith. ,, F. P. Hodes. # ,, G. L. Wtells, J.P. Co-opted Members of Maternity and Child Welfare Section Mrs. M. Barson, Mrs. F. Dixon, Mrs. L. Hodges, Mrs. E. Jarvis and Miss Fannie Moore. Representatives on the foint Maternity Home Committee: Mr. R. C. S. Barnett, Mr. J. B. Geale, Mr. F. P. Hodes, Mr. F. Theobald, Mr. G. L. Wells, J.P., and Mrs. F. Dixon. PUBLIC HEALTH DEPARTMENT. STAFF. fMedical 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: R. T. Pearce, Cert. S.I.E.B. (Lond.). Cert. Insp. of Food, S.I.E.B. „ Sanitary Inspector and Shops Acts Inspector : E. G. Thomas, Cert., R.S.I. Cert. Insp. of Food, R.S.I. Health Visitor : Miss E. M. Dell, Cert., C.M.B. Trained Nurse. Clerks: R. W. Rixson. jMiss A. G. Mitchell. f Part tirm Officer. ANNUAL REPORT of the Medical Officer of Health for the / Penge Urban District in the COUNTY OF KENT for the Year ending December 31st, 1935 Town Hall, Anerley, S.E. 20. April, 1936. To the Chairman and Members of the Urban District Council of Penge. Mr. Chairman and Gentlemen, I beg to present my Twenty-seventh Annual Report on the Health of the District for the year ending 31st December, 1935. It is compiled in accordance with Circular 1,492 (1935) of the Ministry of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) ,, 770 Population (Census, 1931) 27,771 Population (Estimated middle of 1935, R.G.) ... 26,010 Number of inhabited dwellings (Census, 1931) ... 5,235 Number of separately rated inhabited dwellings (end of 1935) according to rate books (approximate) ... ... ... ... ... ... 6,218 Number of private families (Census, 1931) ... 7,595 Total dwellings occupied and vacant (Census, 1931) 5,368 Miscellaneous habitations and institutions housing non-private families (Census, 1931) ... ... 62 Rateable value ... ... ... ... ... £203,482 Sum represented by Penny Rate £793 6 The district is situated on the slope of a hill, its highest point being 370 feet above sea level, and the lowest, 95 feet above sea level. The Crystal Palace and greater part of the grounds, occupying approximately 127 acres, are within the District, and provide a much needed " lung." About 20 acres of the grounds are open to the public. The district is mainly residential, the chief industries being button-making, laundry work, dyeing and cleaning, printing and knitted dress making. A large number of the residents are engaged in business in London and a number are employed in the building and allied trades. The density of population per acre is 33-7, this being the highest in the County of Kent. The Manager of the Employment Exchange informs me that there were 935 men and 96 women unemployed in the Penge Urban District at the end of the year. The Poor Law Relief given during the year amounted to £19,984 14s. 7d., of which £7,173 lis. Id. was to able-bodied unemployed and their families, and the balance to the unemployable from age or other causes. This compares with an amount of £16,146 2s. 1 Od., of which £6,431 13s. 8d. was to able-bodied unemployed and their families, in the year 1934. VITAL STATISTICS. Total Male Female Live Legitimate 365 194 171 Births Illegitimate 24 13 11 Birth Rate, per 1,000, of estimated resident population, 14.9. 7 Total Male Female Still Legitimate 12 8 4 Births Illegitimate 1 — 1 Still-Birth Rate per 1,000 total (live and still) births, 32-3. Deaths 333 163 170 Crude Death Rate per 1,000 of the estimated resident population, 12.8. Adjusted Death Rate per 1,000 of the estimated resident population, 11.7. Deaths from puerperal causes :— Rate per 1,000 total Deaths (live and still) births. Puerperal sepsis Nil Nil Other puerperal causes 2 4-97 Total 2 4-97 Deaths of Infants under one year of age :— Legitimate, 24. Illegitimate, 3. Total, 27. Death Rate of Infants under one year of age : All Infants, per 1,000 live births 69.4 Legitimate Infants, per 1,000 legitimate live births 65.7 Illegitimate Infants, per 1,000 illegitimate live births 125.0 Deaths from Measles (all ages)— ,, ,, Whooping Cough (all ages) — Diarrhoea (under two years of age) 6 8 Births. The live births registered during the year numbered 389, of which 207 were males and 182 females. This gives a birth rate of 14-9 per 1,000, compared with 15-3 for 1934. Still Births. The number of still-births registered was 13, of which 8 were males and 5 females. Notification of Births Act. Of the live births occurring in the District, 97 were notified by Medical Practitioners, 150 by midwives, and 1 by a parent. Six notifications of still births were received, 3 being from Medical Practitioners and 3 from midwives. Eleven births were not notified. Deaths. The number of deaths registered in the Urban District of Penge during the year was 209. Thirty-three of these were transferable to other districts; but 157 deaths of Penge Parishioners occurring in public institutions, etc.,outside the District were transferred to Penge. The corrected number of deaths was therefore 333, equal to a crude death rate of 12-8 per 1,000. 9 The factor for adjusting the death rate for the District, given by the Registrar-General last year, is 0-92. This factor makes the Adjusted Death Rate 11.7 per 1,000, compared with a rate of 11.8 per 1,000 for 1934. Of the 333 deaths during the year, 180, or 54-0 per cent., were of persons over 65 years of age. Seventy-eight were of persons between the ages of 75 and 85 years, and 30 were of persons over 85 years of age. Misadventure and accidents accounted for 12 deaths, compared with 18 the previous year, and 11 in 1933. Maternal Mortality. Two women died in consequence of childbirth. The certified causes of death were as follows :— 1. Mrs. I.W.G., 24 years. 1 (a) Ante-partum haemorrhage. (b) Placenta praevia. 2. Mrs. A.W.K., 30 years. 1 (a) Haemorrhage. (b) Placenta praevia. (c) Childbirth. Neither of these women attended the Ante-natal Clinic. 10 The following shows a comparison of the maternal mortality rates for the year :— Puerperal Other Sepsis causes T otal England and Wales— per 1,000 live births 1.68 2.42 4.10 Penge ,, ,, ,, Nil 5.11 5.11 England and Wales— per 1,000 total births 1-61 2.32 3.93 Penge „ „ „ Nil 4.97 4.97 The average maternal mortality rates per 1,000 live births for ten years (1926 to 1935 inclusive), are as follows :— England and Wales 4.26 Penge 3.81 Infantile Mortality. The number of Deaths under one year of age was 27, corresponding to a rate of 69.4 per 1,000 births, compared with the rates of 76.1 for 1934 and 37.4 for 1933. Eleven infants died under the age of one week from unavoidable causes. 11 Of the 27 deaths, 3 were from Premature Birth, 4 from Congenital Malformations, 3 from Enteritis and 6 from Pneumonia. Two deaths occurred amongst infants who had attended the Child Welfare Centre. Comparative Vital Statistics. The following table shows the comparative .figures for 1935 :— Rate per 1,000 Population Death rate per 1,000 population Deaths under one year per 1,000 births Livebirths Stillbirths Penge 14.9 0.49 11.7 69 England and Wales 14.7 0.62 11.7 57 121 County Boroughs and Great Towns including London 14.8 0.68 11.8 62 140 Smaller Towns (resident populations, 25,000 to 50,000 at Census, 1931) 14.8 0.64 11.2 55 London 13.3 0.52 11 .4 58 12 Public Mortuary. Six inquests were held in Penge during the year 1935, as follows: Verdict. Males. Females. Total. Misadventure 1 — 1 Natural Causes 1 1 2 Suicide 1 1 2 Open 1 — 1 Totals 4 2 6 In addition, 16 post.mortem examinations were made, the Coroner certifying the cause of death in these cases without holding an inquest. Causes of Sickness. Mumps was prevalent during the Spring of the year. Unemployment of parents is an important contributing, though indirect, factor of malnutrition, especially in young children. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. No developments or changes took place during the year. Ambulance Facilities. The Council's motor ambulance, which is housed at the Fire Station, Croydon Road, is available, at any time, day or night. 13 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. During the year the Council's motor ambulance responded to 622 calls ; 326 for private removals and 296 for accidents. There is a co-ordination scheme between the ambulance services of Penge, Beckenham and Bromley. Nursing at Home. There are no changes or developments to report under this heading. Clinics and Treatment Centres. In April, 1935, a special Ante-natal Clinic, attended by the Medical Officer of Health, was established and held fortnightly. As a result the attendances of expectant mothers increased by 259 and the individual expectant mothers by 49 over those of 1934. The Maternity and Child Welfare Centre, provided by the Council, is held as before at the Council's School Clinic, 17, Oakfield Road, on Tuesday and Wednesday afternoons, and the Medical Officer of Health,who is the Medical Officer for the Centre, attends on Wednesday afternoons for consultations. He is also available for special consultations at the Town Hall. Medical Officer's Consultations. Infants 1,752 Nursing Mothers 469 Ante-Natal 678 2,899 14 Total attendance of children at the Centre 5,102 Individual children who attended 592 Average weekly attendance of children 102.0 Total attendance of nursing mothers 1,350 Individual nursing mothers who attended 235 Average weekly attendance of nursing mothers 27.0 Total attendance of expectant mothers 723 Individual expectant mothers who attended 248 Average weekly attendance of expectant mothers 14-1 During the year 390 urinary analyses were made. The Health Visitor, assisted by ladies who very kindly volunteer their services, and a Nurse from the Maternity Home, manage the weighing, record cards, and distribution of food and drugs. Dried milk is supplied at cost price to mothers and children attending the Centre, and, in necessitous cases, fresh and dried milk are provided free. The following amounts were expended in supplying milk gratis to 46 expectant mothers and 135 nursing mothers and infants during the year :— Dried Milk : £231 14s. 8d. ; Fresh Milk : £6 5s. Od. Malt Extract and Cod Liver Oil, Virol, Ovaltine, Lactagol, etc., are also supplied free or at cost price. The cash receipts for Dried Milk sold were £274 7s. 7d. 15 There is no doubt whatever that the provision of free milk, etc., to necessitous nursing mothers and infants continues to be the main cause in keeping down the rate of Infantile Mortality. Where necessary expectant mothers and infants are referred to the Dental Surgeon for treatment, and during the year this was done in 56 cases. Dentures are not provided. School Clinic. The School Clinic provided by the Penge Council is held in specially adapted premises at 17, Oakfield Road, Penge. The accommodation is as mentioned in previous reports. Further particulars appear in the School Medical Officer's Annual Report. Tuberculosis Dispensary. Penge patients were treated at the Kent County Council Tuberculosis Dispensary, 1, Westbury Road, Penge, on Wednesdays and Fridays. Treatment Centres for Venereal Disease. Patients are treated at the several London hospitals and the Croydon General Hospital. Orthopaedic Clinic. Cases are sent to Croydon General Hospital. 16 HOSPITALS. Infectious Diseases. Cases are removed to Waddon Isolation Hospital, Croydon, as before, under an agreement with the County Borough of Croydon, 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 treated concurrently, is six, viz. :—Diphtheria, Scarlet Fever, Enteric or Tyhoid Fever, Cerebro-Spinal Fever, Puerperal Fever and Encephalitis Lethargica. Smallpox. Negotiations are taking place regarding new arrangements for the hospital treatment of cases of smallpox. In the meantime Penge cases will be accepted, as before, at the Surrey Smallpox Hospital, Clandon. Tuberculosis. The majority of the cases are admitted into Sanatoria through the Kent County Council. Children. There is no hospital in this District. Patients are usually sent to the following hospitals :— The South Eastern Hospital for Children, Sydenham. The Evelina Hospital for Children, London, S.E. The Hospital for Sick Children, Great Ormond Street, London, W.C. 2. 17 Orthopaedic. Cases are sent to the Croydon General Hospital, those from the Infant Welfare Centre and Elementary Schools being paid for by the Council. Other Hospitals. There are no hospitals in this District. Cases are usually sent to the Beckenham Hospital, Norwood Cottage Hospital and Croydon General Hospital, all being within easy reach. These are all voluntary hospitals. Cases admitted to the County Hospital, Farnborough, Kent, from this district, numbered 390. A number of Penge patients are also treated at various London general hospitals. Extensive use has been made of the facilities offered by the South Eastern Hospital for Children, Sydenham, also by the Croydon General Hospital. Midwifery and Maternity Services. During the year, notifications of births occurring in the District, were received from nine midwives. A district midwife is employed by the Beckenham and Penge Joint Maternity Home to attend patients in their own homes, and pupils obtaining their training at the Maternity Home receive experience in district work under the supervision of the midwife. 18 A consulting obstetrician has now been appointed for complicated maternity cases occurring in the District. Previously his services were available only for patients in the Joint Maternity Home. Maternity Home. The Penge and Beckenham Joint Maternity Home, Croydon Road, Beckenham, with accommodation for 14 beds, is managed by a Joint Committee appointed annually by the Penge Urban District Council,and the Borough of Beckenham, and receives a grant from the Ministry of Health. The facilities provided are intended for those who have not sufficient accommodation, or are unable to pay for, adequate attention in their own homes. One necessitous case, after due enquiry by the Committee, was granted free admission to the Home. The following table gives the numbers of mothers admitted annually for the last five years :— Year Total cases admitted Penge Cases Beckenham Cases Out-District Cases 1931 343 123 217 3 1932 333 93 236 4 1933 324 97 227 — 1934 347 93 254 — 1935 323 97 226 — 19 The average period spent in the Home during the year by each patient was 15-18 days. Patients can be attended at the Home by their own Doctors if they wish. Those who desire it, can be attended in their own home by a qualified midwife from the Maternity Home. She is assisted by a probationer nurse. During the year 56 Penge cases were attended by the visiting Midwives. I am still getting many applications for admission into the Joint Maternity Home too late for acceptance, it being usually necessary for at least six months notice to be given by applicants. The Authorities are considering the provision of a new Maternity Home. Maternal Mortality. The Assistant County Medical Officer enquires into all maternal deaths in this area. Enquiries into cases of Puerperal fever and Puerperal pyrexia are made by myself and the Health Visitor. Institutional Provision for Mothers or Children. Maternity patients whose home conditions are unsuitable for a confinement, and those suffering from abnormal antenatal conditions, are admitted into the Penge and Beckenham Joint Maternity Home. 20 Health Visiting. One Health Visitor is employed, and the following shows the number of visits paid by her :— First visits to infants under one year 343 Subsequent visits to infants under one year 1,414 Visits to children between the ages of one and five years 1,575 First visits to expectant mothers 147 Subsequent visits to expectant mothers 129 Visits to Tuberculosis cases 285 Visits under the Children Act 81 Miscellaneous visits 74 Total 4,048 Infant Life Protection. The Health Visitor is the Inspector appointed under Part One of the Children Act, and she paid 81 visits to the homes of foster-children. Foster-parents are required to have the children in their care examined by a doctor once every three months, and in the majority of cases these examinations are made by the Medical Officer of Health at the Infant Welfare Centre. The standard of Health of the children has been good. Slumber of foster-parents on the Register :— (a) at the beginning of the year 18 (b) at the end of the year 13 21 Number of children on the Register :— (a) at the beginning of the year 20 (b) at the end of the year 14 (c) who died during the year — No legal proceedings were taken. Orthopaedic Treatment. Cases are seen at the Infant Welfare Centre and at the School Clinic, and when necessary referred to the Croydon General Hospital, where out-patient treatment is provided at the cost of the Council. Suitable cases are sent to St. Nicholas and St. Martin's Orthopaedic Hospital, Pyrford, Surrey, for in-patient treatment. In necessitous cases hospital treatment and surgical appliances are provided by the Council free of charge. Maternity and Nursing Homes. The Nursing Homes Registration Act, 1927, is administered by the Kent County Council. 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 directly connected to the rising main. Five drinking water cisterns were cleansed and covered, and at 9 houses water was supplied direct from the rising main. 22 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, which is culverted in certain parts. Rivers and Streams. There are no rivers in the District. There is a stream forming part of the boundary between Penge and Beckenham, portions of which are culverted. It was necessary for cleansing to be carried out periodically. During the year the Penge and Beckenham Councils agreed to culvert another portion of the stream, between Avenue Road and Pelham Road, and the work will be carried out in 1936. The culverting of the remaining portion of the stream is desirable. Closet Accommodation. The whole of the premises—approximately 5,605—in the area, are provided with water closets connected to the main drainage system. Public Cleansing. The house refuse is collected throughout the District by a Contractor, once every week. The refuse is removed in closed vehicles by the Contractor to a controlled shoot situated in another District. The total cost of collection, removal and disposal of house refuse during the year amounted to £6,279. There are no cesspools or privies within the District. 23 Sanitary Inspection of the Area. This is dealt with in the Report of the Chief Sanitary Inspector. Smoke Abatement. Smoke nuisances were found at four factories, and abated after service of a statutory notice in one case, and informal notices in the others. Swimming Baths and Pools. There are none in the area. Schools. The School Medical Officer, the Medical Inspectors and the Head Teachers are notified of cases of infectious diseases that occur in the homes of children attending school. Attendance from infected houses is prohibited for certain periods. Overcrowding. The survey of the district, required by the Housing Act, 1935, to ascertain the number of overcrowded dwelling houses, was taken in hand at the end of the year. HOUSING. Number of new houses erected during the year 29 In addition, 4 houses were converted into 19 self-contained flats. 24 1.—Inspection of Dwelling-houses during the year : (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 590 (b) Number of inspections made for the purpose 652 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 62 (b) Number of inspections made for the purpose 62 (2a) Number of dwelling-houses inspected in connection with dustbin accommodation only 114 (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-head) found not to be in all respects reasonably fit for human habitation 539 (4a) Number of dwelling-houses found with defective dustbins only 114 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 491 Number of dwelling-houses provided with new dustbins only in consequence of informal action by the Local Authority or their Officers 106 25 3.—Action under Statutory Powers : A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 — B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 48 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (a) By owners 45 (b) By local Authority in default of owners — (2a) Number of dwelling-houses supplied with dustbins after service of formal notices : (a) By owners 7 (b) By local Authority in default of owners 1 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930 — D.—Proceedings under section 20 of the Housing Act, 1930 — INSPECTION AND SUPERVISION OF FOOD. These subjects are dealt with in the Chief Sanitary Inspector's Report. 26 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. General. Schick and Dick tests and artificial methods of immunization against diphtheria and scarlet fever have not been used. Patients suffering from measles and whooping cough are not admitted to the isolation hospital. Diphtheria. Forty-two cases were notified (compared with 39 the previous year), 7 of them being nasal. Twelve of the cases occurred in a local Residential School. Six families had two or more cases. Hospital treatment was provided for 39 cases and there were no "return" cases. There were no deaths from diphtheria during the year. Two "carriers" were discovered and isolated at home until certified free from infection. They were probably the source of infection of four cases. Supply of Antitoxin. Anti-diphtheritic serum was used for the treatment of 7 cases, vials being supplied containing 56,000 units. The early administration of antitoxin to all cases of diphtheria is, of course, of vital importance. A supply of antitoxin is always kept at the Public Health Department and at three chemists' shops, and is available for the use of Medical Practitioners upon request. In cases of emergency, antitoxin can be obtained day or night, from the Council's Fire Station, Croydon Road, Penge. 27 Scarlet Fever. There were 61 cases of Scarlet Fever notified, as against 87 in 1934, and 55 of these were removed to hospital. Thirteen of the cases occurred in a local Residential School, and five families had two or more cases. The disease generally was of a mild type, which, of course, contributed to the spread of infection. There were three " return " cases. When adequate isolation and nursing can be obtained, cases are nursed at home. This was done in 6 instances. Puerperal Pyrexia. One case was notified, whilst an inmate of a London Hospital. She recovered. An arrangement exists with a local nurse for the home nursing of cases when required. Ophthalmia Neonatorum. Two cases were notified and nursed at home. In each case a satisfactory recovery was made and the vision unimpaired. Non-Notifiable Diseases. Mumps was prevalent during the Spring of the year. Influenza was moderately prevalent but was not of a severe type. The following cases were notified to me from the local Elementary Schools:—Measles 4, Mumps 120, Whooping Cough 46, Chicken-pox 10, Impetigo 1 and Influenza 4. 28 Disinfection. In addition to the usual disinfection of rooms, bedding and clothing after cases of Scarlet Fever, Diphtheria, etc., disinfection has been carried out at 45 premises after cases of Tuberculosis, and 19 after Cancer. Where vermin are discovered, disinfection of rooms, and, if necessary, bedding and clothing, is carried out. This was done in 93 cases. The following list shows the number of rooms fumigated and of beds and other articles steam disinfected during the year Rooms fumigated 358 Mattresses disinfected 287 Blankets disinfected 593 Pillows disinfected 593 Miscellaneous articles disinfected 2,067 Library books fumigated 142 Bacteriological Work. Bacillus found Bacillus not found Total Diphtheria. County Laboratory 6 68 74 Diphtheria. Clinical Research Association 14 51 65 Tuberculosis. County Laboratory 21 55 76 Typhoid Fever. County Labora- tory 1 4 5 Ringworm. County Laboratory — 1 1 42 179 221 29 Notifiable Diseases (other than Tuberculosis) during the Year, 1935. Disease Total Cases notified Cases admitted to Hospital. Total Deaths Scarlet Fever 61 55 — Diphtheria 41 39 — Paratyphoid Fever 1 1 — Puerperal Pyrexia 1 1 — Pneumonia 6 2 14 (all forms) Erysipelas 12 3 — Ophthalmia Neonatorum 2 2 — Cancer. This disease was the certified cause of death in 51 cases (males 23, and females 28). The organs affected were : Gastrointestinal Tract 20, Breast 6, Liver 4, Respiratory Organs 3, Uterus 3, and other sites 15. The Cancer Death Rate per 1,000 population was 1.96, compared with 2.29 in 1934. Prevention of Blindness. No action was taken under Section 66 of the Public Health Act, 1925, for the prevention of blindness or for the treatment of persons suffering from any injury to or disease of the eyes. 30 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was necessary under these Regulations regarding tuberculous employees in the milk trade. Public Health Act, 1925, Section 62. j No action was taken under this Section. Tuberculosis. Total Primary Cases notified. Total Cases admitted to Sanatoria and Hospitals TotalDeaths Pulmonary (Males) 15 20 5 ,, (Females) 11 15 10 Totals 26 35 15 Non-Pulmonary (Males) 2 5 3 „ „ (Females) 3 2 2 Totals 5 7 5 — — — Fourteen of the 15 deaths from pulmonary tuberculosis and 3 of the 5 deaths from other forms of tuberculosis were of cases notified in this District. 31 In one of the deaths from other forms of tuberculosis of cases not notified, the cause of death was certified after postmortem examination. Cases of tuberculosis are periodically visited and disinfection is carried out as occasion requires. During the year 76 specimens of sputum were sent to the Kent County Laboratory, Maidstone, to be examined for tubercle bacillus ; 21 of these were positive. New Tuberculosis Cases and Mortality during 1935. *New Cases. Deaths. Age Periods. Pulmonary Non-Pul'ary Pulmonary Non-Pul'ary M F M F M F M F 0—1 — — 1 — — — 1 — 1—5 1 — — — — — — — 5—15 1 1 1 1 — — — — 15—25 5 6 2 — 1 2 1 — 25—35 6 4 — 1 2 3 — — 35—45 5 5 — 1 1 1 1 1 45—55 4 2 — — 1 3 — — 55—65 — — — — — 1 — — 65 and upwards 1 — — — — — — 1 Totals 23 18 4 3 5 10 3 2 32 *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, and patients who died from tuberculosis and were not notified previous to death. There were 187 cases of tuberculosis on the register at the end of the year, as follows :— Male Female Total Pulmonary 75 67 142 Non-Pulmonary 25 20 45 100 87 187 I have again to express my thanks to the Chairman and Members of the Public Health and Maternity and Child Welfare Committee for their cordial support during the year, and also to the Staff of the Public Health Department for their co-operation. It gives me pleasure again to register my cordial appreciation of the devoted work of the lady voluntary helpers at the Maternity and Child Welfare Centre. I am, Mr. Chairman and Gentlemen, Your obedient Servant, ROBERT WILKINSON, Medical Officer of Health. Causes of Death in Penge Urban District, 1935. Registrar-General's Figures. Causes of Death. Males Females All Causes 163 170 1 Typhoid and paratyphoid fevers • • • • • • 2 Measles • • • • • • 3 Scarlet fever • • • • • • 4 Whooping cough • • • • • • 5 Diphtheria • • • • • • 6 Influenza • • • 1 7 Encephalitis lethargica « • • • • • 8 Cerebro-spinal fever • • • • • • 9 Respiratory tuberculosis 5 10 10 Other tuberculosis 3 2 11 Syphilis ... • • • 12 General paralysis of the insane, etc. 1 • • • 13 Cancer 23 28 14 Diabetes 1 2 15 Cerebral haemorrhage 3 9 16 Heart disease 43 51 17 Aneurysm • • • 1 18 Other circulatory diseases 10 3 19 Bronchitis 8 4 20 Pneumonia 11 3 21 Other respiratory diseases 5 • • • 22 Peptic ulcer 2 • • • 23 Diarrhoea, etc. (under 2 years) 3 3 24 Appendicitis 1 1 25 Cirrhosis of liver 2 • • • 26 Other liver diseases ... • • • 27 Other digestive diseases 5 5 28 Nephritis 7 4 29 Puerperal sepsis • • • • • • 30 Other puerperal causes • • • 2 31 Congenital causes, etc. 7 6 32 Senility 5 10 33 Suicide 1 2 34 Other violence 6 7 35 Other defined causes 10 16 36 Ill-defined causes ... ... Special causes (included in No. 35 above) Small-pox • • • • • • Poliomyelitis • • • • • • Polioencephalitis ... ... Deaths of Infants under 1 year Total 17 10 Legitimate 15 9 Illegitimate 2 1 Live births Total 207 182 Legitimate 194 171 Illegitimate 13 11 Still births Total 8 5 Legitimate 8 4 Illegitimate ... 1 Population (estimated middle of 1935 R, G.) 26,010 Infant Mortality, 1935. 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 13 1 14 5 2 5 1 27 Uncertified 1 Small-pox ... ... ... ... ... ... ... ... ... ... 2 Chicken-pox ... ... ... ... ... ... ... ... ... ... 3 Measles ... ... ... ... ... ... ... ... ... ... 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7 Erysipelas ... ... ... ... ... ... ... ... ... ... 8 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 9 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10 Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... 11 Meningitis ... ... ... ... ... ... ... ... ... ... 12 Convulsions ... ... ... ... ... ... ... ... ... ... 13 Laryngitis ... ... ... ... ... ... ... ... ... ... 14 Bronchitis 1 ... ... ... 1 1 ... ... ... 2 15 Pneumonia (all forms) 1 ... ... ... 1 3 ... ... ... 6 16 Influenza ... ... ... ... ... ... ... ... ... ... 17 Diarrhoea ... ... ... ... ... ... ... 1 ... 1 18 Enteritis ... ... ... ... ... ... ... 3 ... 3 19 Gastritis ... ... ... ... ... ... ... ... ... ... 20 Syphilis ... ... ... ... ... ... ... ... ... ... 21 Rickets ... ... ... ... ... ... ... ... ... ... 22 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... 23 Injury at Birth ... ... ... ... ... ... ... ... ... ... 24 Congenital Malformations 4 ... ... ... 4 ... ... ... ... 4 25 Premature Birth 3 ... ... ... 3 ... ... ... ... 3 26 Atrophy, Debility, Marasmus 2 1 ... ... 3 ... ... ... ... 4 27 Other causes 2 ... ... ... 2 ... ... ... 1 3 Totals 13 1 — — 14 5 2 5 1 27 Nett live Births registered during the calendar year :— Legitimate 365 389 Illegitimate 24 Nett Deaths registered during the calendar year :— Legitimate infants 24 27 Illegitimate „ 3 BIRTH-RATES, DEATH-RATES, AND ANALYSIS OF MORTALITY IN THE YEAR, 1935. Rate per 1,000 Total Population. Annual Death~(rate per 1,000 Population. Rate per 1,000 Live Births Live Births. Still-births. All Causes. Typhoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under one year. Penge U.D 14.9 0.49 11.7 0.00 — 0.00 0.00 0.00 0.00 0.07 0.61 15.4 69 England and Wales 14.7 0.62 11.7 0.00 — 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns including London 14.8 0.68 11.8 0.00 — 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (Resident Populations, 25,000 to 50,000 at Census, 1931) 14.8 0.64 11.2 0.00 — 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 Notifiable Diseases (other than Tuberculosis) during the Year 1935. Notifiable Disease. CASES NOTIFIED. At ages—Years. Cases admitted isolat'n hospital At all ages. Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 & upwards. Scarlet Fever 61 • • • 1 2 4 1 25 17 4 5 1 1 • • • 55 Diphtheria 41 • • • 1 1 4 6 17 10 • • • 2 • • • • • • • • • 39 Paratyphoid Fever 1 • • • • • • • • • • • • • • • • • • • • • 1 • • • • • • • • • • • • 1 Puerperal Pyrexia 1 • • • • • • • • • • • • • • • • • . • • • • • • 1 • • • • • • • • • • • • Pneumonia 6 • • • • • • • • • 3 • • • • • • • • • • • • • • • 1 1 1 • • • Erysipelas 12 • • • • • • • • • • • • • • • ... • • • • • • • • • 1 5 3 3 • • • Ophthalmia Neonatorum 2 2 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Totals 124 2 2 3 11 7 42 27 5 9 7 5 4 95 Deaths of notified cases—Nil. Inspection of Factories, Workshops and Workplaces, 1935 Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. Factories ncluding Factory Laundries 65 6 ... Workshops Including Workshop Laundries 44 ... ... Workplaces Other than Outworkers' premises 10 • • • ... Total 119 6 ... Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts :—* Want of cleanliness 2 2 • • • • • • Want of ventilation • • • ...• • • • • • • • • Overcrowding • • • • • • ... .• • • • • • Want of drainage of floors • • • • • • • • • • • • Other nuisances 14 14 • • • • • • Sanitary accommodation :— Insufficient • • • • • • • • • • • • Unsuitable or defective 4 4 • • • • • • Not separate for sexes • • • • • • • • • • • • Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse • • • • • • • • • • • • Other offences • • • • • • • • • • • • (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order 1921). Totals 20 20 • • • • • • *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 Sanitary Inspector for the Penge Urban District in the COUNTY OF KENT for the Year ending December 31st, 1935 •• • .-V Town Hall, Anerley, S.E. 20. April, 1936. To the Chairman and Members of the Urban District Council of Penge. Mr. Chairman and Gentlemen, I have the honour to place before you the Annual Report on the work of the Sanitary Inspectors for the year ended the 31st December, 1935. Six hundred and twelve written Intimation Notices and 71 Statutory Notices were served under the Public Health Acts. In addition, notices were served for the periodical cleansing of the following:—Bakehouses and Common Lodging Houses (semi-annual); and Slaughter Houses (quarterly) Five hundred and forty-one Intimation Notices and 67 Statutory Notices were complied with. Difficulty was experienced in 15 cases regarding repairs, and the necessary works were effected only after summonses had been served or threatened. 42 Prosecutions were taken for non-compliance with notices served under sections 91-94 of the Public Health Act, 1875, regarding nuisances caused by general housing defects, with the following results:— 1. Order made to comply with Notice within 21 days. Defendant ordered to pay £1 1s. 0d. costs and Court Costs. 2. Order made to comply with Notice within 7 days. Defendant ordered to pay £1 1s. 6d. costs. 3. Order made to comply with Notice within 14 days. Defendant ordered to pay £3 3s. Od costs. The orders of the Court were complied with in each case. The drainage systems of 4 houses were entirely reconstructed, the drains of 43 houses partially relaid, and 46 cleared. Premises or Occupations which can be Controlled by Byelaws or Regulations. No. in District. No. of Visits. Notices served. Notices complied with. Slaughter Houses 2 327 — — Common Lodging Houses 5 20 4 4 Houses Let in Lodgings 53 85 21 21 Dairies 13 55 5 5 Stables 32 118 6 6 Fried Fish Shops 9 20 1 1 Butchers'Shops 31 67 6 6 43 Lodging Houses. There are 5 Common Lodging Houses and 53 Houses Let-in-lodgings on the registers. They are periodically inspected and cleansed. Housing Consolidated Regulations, 1925. During the year 62 houses in various roads were inspected, the drains tested and particulars recorded, in accordance with these Regulations. Notices requiring defects to be remedied were served in 56 instances. SUMMARY OF INSPECTIONS AND VISITS. The following summary shows the number of visits and inspections made:— Inspections through complaints received 439 Inspections re defective dustbins 181 Inspections under the Housing Consolidated Regulations, 1925 62 Visits re cases of infectious diseases 187 Visits re transferable deaths 58 Visits re housing applications 52 Houses Let-in-Lodgings and Common Lodging Houses 105 Slaughterhouses 327 Bakehouses 58 Dairies 55 Milkshops 39 Meat shops 67 44 Fish shops 30 Ice cream shops 20 Other food shops, stores and stalls 189 Urinals 40 Stables 118 Visits under Rats and Mice (Destruction) Act 99 Factories, Workshops and Workplaces 119 Visits under Shops Acts 691 Smoke observations 120 Inspections and re-inspections of work in hand and various visits 2,426 Drain tests 160 SUMMARY OF WORK EXECUTED DURING THE YEAR. Water Supply: Water supply reinstated to houses 4 Water service pipes repaired 38 Draw-off taps provided on the rising main 9 Cisterns cleansed, covered, or covers repaired 5 Water Closets: New pans and traps fixed 65 Flushing apparatus renewed or repaired 45 Foul pans and traps cleansed 15 Connections of flushing pipes to pans made good 14 Seats and doors provided or repaired 39 Ventilation provided or improved 53 Flooring or paving repaired 5 45 Drainage: [/$$$] Drains tested with smoke, water or colour 160 Drains cleared 46 Houses provided with new drains 4 Houses with drains partially relaid 43 Inspection chambers constructed or improved 35 Interceptors provided 4 Soil and ventilation pipes fixed or repaired 34 Sinks, lavatory basins and baths provided 85 Sinks repaired. 6 Waste pipes renewed or provided 74 ,, ,, repaired or trapped 52 ,, ,, cleared 12 Fresh air-inlets provided or repaired 16 New gullies provided 30 Grids provided to gullies 3 Dampness: Houses with:— Walls repointed or rendered 21 Dampness in ground floor rooms remedied 45 Roofs repaired 164 Gutters repaired or renewed 52 Rainwater pipes repaired or renewed 30 Ventilation under floors provided or improved 21 Water service pipes repaired 38 Cleanliness: Dirty rooms, etc., cleansed or whitewashed 634 Verminous rooms fumigated 206 46 Miscellaneous: [/$$$] Houses with defective floors, joists, etc., repaired 52 Houses with defective plaster repaired 112 Houses with new sash lines provided to windows 73 Houses with window frames, etc., repaired 59 Houses with yards or forecourts paved or repaired 31 Houses with scullery paving repaired 13 Houses with air bricks renewed 19 Houses with fireplace jambs and mantels repaired 16 Ventilation and light of rooms provided or improved 32 Kitchen stoves repaired or renewed 30 Scullery coppers repaired or renewed 11 Other stoves repaired or renewed 44 Food cupboards provided 36 New dustbins provided 195 Premises with miscellaneous defects repaired, etc. 74 Overcrowding abated 6 Animals removed 6 Manure pits repaired 2 Accumulations removed 32 Smoke nuisances abated 4 Shops provided with heating facilities 27 Shops provided with washing facilities 9 Shops provided with sanitary conveniences 2 INSPECTION AND SUPERVISION OF FOOD. Milk Supply At the end of the year there were 13 premises registered as dairies. Periodical inspections have been made and in five instances defects were discovered. These were remedied after informal action. 47 In addition, 44 persons are registered to sell milk in sealed containers only. Fourteen dairymen, with dairies outside the district, who sell milk in Penge, are also registered. There are no cowsheds in the district. The analyses of 66 informal samples obtained during the year show the following average:— Fat 3.65% Solids not fat 8.82% Four samples were obtained and bacteriologically examined. One of the samples, taken on arrival at a local dairy, was not satisfactory and the local authority of the district where the milk was produced was informed. The following licenses were issued under the Milk (Special Designations) Order, 1923:— Dealers' Licenses— Grade A (Tuberculin Tested) Milk 2 Pasteurised milk 8 Supplementary Licenses:— Certified milk 3 Grade A (Tuberculin Tested) milk 2 Grade A (Pasteurised) milk 1 Grade A milk 1 Pasteurised milk 1 Meat. Most of the meat sold in the district is obtained from the London Meat Market. 48 Visits are paid to meat purveyors' premises from time to time, and attention drawn to the requirements of the Public Health (Meat) Regulations. Six intimation notices were served requiring defects in butchers' premises to be remedied. The notices were complied with. Slaughterhouses. Registered 2 These have been regularly limewashed and inspected. The total number of visits to the slaughterhouses was 327. The number of animals examined after slaughter in the district during the year is as follows:— Cattle 37 Calves 254 Sheep 1,351 Pigs 137 Goat 1 Total 1,780 The following were surrendered and condemned at the slaughterhouses:— Cattle: 1 Forequarter Tuberculosis 2 Sets of lungs „ 1 Set of lungs Abscesses 2 Livers Parasitical 49 Calves: [/$$$] 1 Carcase Tuberculosis 3 Plucks „ 1 Set of lungs Melanosis 1 Set of lungs • Abscesses Pigs: 3 Heads and tongues Tuberculosis 1 Mesentery „ 1 Pluck „ 1 Set of lungs „ 1 Carcase and offal Swine fever 6 Livers Necrosis 2 Livers Cirrhosis 4 Sets of lungs Pneumonia 1 Heart Pericarditis Sheep: 13 Livers Parasitical 1 Liver Adenoma 1 Liver Carcinoma 3 Sets of lungs Parasitical cwts. qrts. lbs. Total weight of tuberculous meat 1 3 5 Total weight of diseased non - tuberculous meat 1 2 0 Total . 3 1 5 50 Other Foods. There are 15 bakehouses in the district, 2 being underground. These have been periodically inspected and cleansed. Four informal notices to remedy defects were served and complied with. In addition to visits to the slaughterhouses, 458 visits were made to premises and stalls where foods are prepared, stored or exposed for sale, and, with a few exceptions, these were found to be kept in a satisfactory condition. The following list shows the amount of food which was surrendered and then condemned from shops and stalls, and afterwards destroyed:— Chickens 6 lbs. Potatoes 280 lbs. Haddocks 70 lbs. Bream fillets 14 lbs. Cod fillets 14 lbs. Condensed milk 84 tins Lemon squash crystals 164 tins Tinned fruits 52 tins Brisling 30 tins Brawn 1 tin Honey 7 jars Total weight: 4 cwts. 2 qrts. 22 lbs. Adulteration, etc. The Kent County Council administers the Food and Drugs (Adulteration) Act in this District. 51 The Clerk to the Kent County Council has kindly furnished the following statement of the 101 samples taken:— 57 New Milk 1 Jam 1 Baking Powder 2 Lard 1 Brandy 4 Margarine 4 Butter 1 Condensed Milk 1 Castor Oil 1 Mustard Compound 1 Cheese 2 Oatmeal 1 Ground Cinnamon 1 Olive Oil 3 Cocoa 4 Rice 3 Coffee 1 Rum 2 Dried Fruit 3 Sausages 1 Gin 2 Shredded Suet 1 Tincture of Iodine 2 Sugar 1 Whisky All samples were found to be genuine. In addition, 66 informal samples of new milk were purchased by your Inspectors and submitted for analysis. Of these, 59 samples were reported genuine and 7 slightly below standard. Subsequent samples in the latter cases proved to be genuine. Chemical and Bacteriological Examination of Food. Informal samples of milk are analysed by an analytical chemist in London and formal samples by the Public Analyst for Kent. Facilities are available at the Kent County Laboratory and the Clinical Research Association for the bacteriological examination of food. 52 Factories and Workshops. There are 124 factories and workshops on the register, in the great majority of which very few people are employed. Six notices were served respecting cleansing, defective sanitary accommodation, etc., and complied with. Rats and Mice (Destruction) Act, 1919. Complaints were received from various parts of the district and investigated, 99 visits being paid in this connection. Poisons were supplied, traps set and lent, and rat-runs gassed. Poison baits were also laid in the sewers from time to time. When considered necessary, the drains of premises were tested with smoke. Shops Acts. The Shops Act, 1934, which came into force on the 30th December, 1934, imposes upon Sanitary Authorities the duty of enforcing the requirements of the Act relating to the ventilation, temperature and lighting of shops, and the provision of sanitary accommodation and washing facilities for the use of persons employed in or about shops. The following gives information of action taken and work done in this connection:— Shops inspected 439 Shops without suitable and sufficient:— (1) means to maintain a reasonable temperature 27 (2) sanitary conveniences ... 14 (3) washing facilities 17 53 Exemption certificates issued:— (1) Sanitary conveniences 12 (2) Washing facilities 8 Informal notices requiring the provision of suitable and sufficient:— Served Complied with (1) means to maintain a reasonable temperature 27 26 (2) sanitary conveniences 2 2 (3) washing facilities 9 8 Statutory Notices requiring the provision of suitable and sufficient :— (1) means to maintain a reasonable temperature 1 1 (2) washing facilities 1 1 Mr. E. G. Thomas, the Shops Acts Inspector, reports as follows on the administration of the Shops Acts on matters other than the above:— Individual premises visited 439 Total number of visits 691 Premises where assistants were employed Premises where young persons were employed 237 134 Minor contraventions (official forms and records not posted or incorrect) 142 Shops not closed on weekly half-holiday 2 54 Customers served after prescribed hours 15 Warnings given respecting contraventions ... 16 Evening patrols 39 Legal proceedings were taken against a shopkeeper for serving a customer after the prescribed hours. The defendant was fined £1 and ordered to pay £1 1s. 0d. costs. Hairdressers' and Barbers' Shops (Sunday Closing) Act, 1930. Visits paid on Sundays 149 No contraventions were found. I desire to express thanks to the Chairman and Members of the Public Health Committee for their ready consideration and support, and to the staff for their painstaking work. I am, Mr. Chairman and Gentlemen, Your obedient servant, R. T. PEARCE, Chief Sanitary Inspector.