PEN15 library PENGE URBAN DISTRICT, Annual Report of the Medical Offiar of Health Robert Wilkinson (M.D.Brux.). together with the annual report of the Chif Sanitary Inspector Richard T. Pearce (M.S.I.A.). 1937 Urban District Council of Denge. Chairman: Capt. F. W. R. Young, J.P; Vice-Chairman: Mr. F. W. Foreman. \ PUBLIC HEALTH COMMITTEE. Chairman: Mr. J. Smith. Mr. R. C. S. Barnett. Mr. F. P. Hodes, J.P. „ G. R. Deal. „ D. E. Jones. „ A. Emery. „ F. A. Smith. „ F. W. Foreman. ,, F. Theobald. „ J. B. Geale, J.P. ,, A.R.Thompson. Capt. F. W. R. Young, J.P. Co-opted Members of Maternity and Child Welfare Section : Mrs. M. Barson, Mrs. F. Dixon, Mrs. E. Jarvis, Miss Fannie Moore and Mrs. A. Theobald. Representatives on the joint Maternity Home Committee : Mr. R. C. S. Barnett, Mr. J. B. Geale, J.P., Mr. F. P. Hodes, J.P., Mrs. E. Jarvis, Dr. S. Pope, and Mr. J. Smith. PUBLIC HEALTH DEPARTMENT. STAFF. 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: R. T. Pearce, Cert. S.I.E.B. (Lond.) Cert. Insp. of Food, S.I.E.B. (Lond.) 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. Miss A. G. Mitchell. Part-time Officer. ANNUAL REPORT of the iftMical ©iter ai Health for the Penge Urban District in the COUNTY OF KENT for the Year ending December 31st, 1937 Town Hall, Anerley, S.E. 20. April, 1938. To the Chairman and Members of the Urban District Council of Penge. Mr. Chairman and Gentlemen, I beg to present my Twenty-ninth Annual Report on the health of the District for the year ending the 31st December, 1937. It is compiled in accordance with Circular 1,650 (1937) of the Ministry of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 770 Population (Census, 1931) 27,771 Population (Estimated middle of 1937, R.G.) 25,560 Number of separately rated inhabited dwellings (end of 1937) according to rate books (approximate) 6,476 Rateable value £199,310 Sum represented by Id. rate £775 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. 6 The remains of the Crystal Palace and the greater part of the grounds, occupying approximately 127 acres, are within the district, and provide a much needed "lung." About twenty 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 33.1, this being the highest in the County of Kent. The Manager of the Employment Exchange informs me that there were 828 men and 70 women unemployed in the Penge Urban District at the end of the year. The Out-door relief given during the year amounted to £19,253 16s. 9d., of which £4,512 l1s. Od. 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 £18,303 Is. 10d., of which £7,468 7s. 2d., was to able-bodied unemployed and their families, in the year 1936. VITAL STATISTICS. Total Male Female Live- Legitimate 392 190 202 Births) Illegitimate 22 13 9 Birth rate per 1,000 of estimated resident population, 16.1. Still- Legitimate 15 6 9 Births Illegitimate 2 — 2 Still-birth rate, per 1,000 total (live and still) births, 39.4. 7 Deaths 332 141 191 Crude Death Rate per 1,000 of the estimated resident population, 12.9. Adjusted Death Rate per 1,000 of the estimated resident 'population, 11.9. Deaths from puerperal causes : Rate per 1,000 total Deaths. (live and still) births. Puerperal Sepsis — Other puerperal causes 1 2.32 Total 1 2.32 Deaths of Infants under one year of age : Legitimate, 22. Illegitimate, 2. Total, 24. Death Rate of Infants under one year of age : All Infants, per 1,000 live births 57.9 Legitimate Infants, per 1,000 legitimate live births 561 Illegitimate Infants, per 1,000 illegitimate live births 90.9 Deaths from Cancer (all ages) 39 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under two years of age) 8 Births. The live births registered during the year numbered 414, of which 203 were males and 211 females. This gives a birth rate of 16.1 per 1,000, compared with 16.7 for 1936. 8 Still-Births. The number of still-births registered was 17, of which 6 were males and 11 females. Notification of Births. Of the live births occurring in the district, 71 were notified by Medical Practitioners, 191 by Midwives, and 1 by a Parent. Eight notifications of still-births were received, 3 being from Medical Practitioners and 5 from Midwives. Twenty-three births were not notified. Deaths. The number of deaths registered in the Urban District of Penge during the year was 204. Thirty-seven of these were transferable to other districts; but 165 deaths of Penge Parishioners occurring in Public Institutions, etc., outside the District were transferred to Penge. The corrected number of Deaths was therefore 332, equal to a crude death rate of 12.9 per 1,000. The factor for adjusting the Death Rate for the district, given by the Registrar-General, is 0.92. This areal comparability factor makes the Adjusted Death Rate 11.9 per 1,000, compared with a rate of 10.9 per 1,000 for 1936. Of the 332 deaths during the year, 180, or 54.2 per cent, were of persons over 65 years of age. Seventy-four were of persons between the ages of 75 and 85 years, and 30 (including two centenarians) were of persons over 85 years of age. Misadventure and accidents accounted for 5 deaths, compared with 12 the previous year, and 12 in 1935. 9 Maternal Mortality. One woman died of a cause other than puerperal sepsis (post-partum haemorrhage). The following shows a comparison of the maternal mortality rates for the year :— Puerperal Other Sepsis. Causes. Total. England and Wales :— per 1,000 total births 0.97 2.26 3.23 Penge ,, ,, Nil 2.41 2.41 England and Wales :— per 1,000 live births 0.94 2.17 3.11 Penge ,, ,, ,, Nil 2.32 2.32 The average maternal mortality rates per 1,000 live births for the last ten years (1928 to 1937 inclusive), are as follows :— England and Wales 4.14 Penge 3.42 Infantile Mortality. The number of deaths under one year of age was 24, corresponding to a rate of 57.9 per 1,000 births, compared with the rates of 48.4 for 1936, and 69.4 for 1935. Six infants died under the age of one week from unavoidable causes. 10 Of the 24 deaths, 4 were from Premature Birth, 2 from Congenital Malformations, 6 from Enteritis and 6 from Pneumonia. Eleven deaths occurred amongst infants who had attended the Child Welfare Centre. Comparative Vital Statistics. The following table shows the comparative figures for 1937 :— Rate per 1,000 Population Death rate per 1,000 population Deaths under one year per 1,000 births Livebirths Stillbirths Penge 16.1 06.6 11.9 57 England and Wales 14.9 06.0 12.4 58 125 County Boroughs and Great Towns including London 14.9 0.67 12.5 62 148 Smaller Towns (resident populations, 25,000 to 50,000 at Census, 1931) 15.3 0.64 11.9 55 London 13.3 054 12.3 60 11 Public Mortuary. Four inquests were held in Penge during the year 1937, as follows :— Verdict. Males. Females. Total. Suicide 2 1 3 Accidental Death 1 - 1 In addition, 11 post-mortem examinations were made, the Coroner certifying the cause of death in these cases without holding an Inquest. Causes of Sickness. There have been no specially noteworthy causes of sickness or invalidity during the year. Unemployment of parents is a definite contributing, though indirect, factor in malnutrition and consequent sickness, 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. 12 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 712 calls ; 368 for private removals and 344 for accidents. There is a co-ordination scheme between the ambulance services of Penge, Beckenham and Bromley, which works satisfactorily. Nursing in the Home. There are no changes or developments to report under this heading. Clinics and Treatment Centres. 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. In addition, a special Ante-Natal Clinic, attended by the Medical Officer of Health, is held fortnightly, on alternate Wednesday mornings. A monthly clinic for post-natal patients and for women in the neighbourhood of 40 years of age was established in December. 13 Medical Officer's Consultations. Infants 2,298 Nursing Mothers 388 Ante-Natal 731 3,417 Total attendance of children at the Centre 6,675 Individual children who attended 750 Average weekly attendance of children 133.5 Total attendance of nursing mothers 1,351 Individual nursing mothers who attended 247 Average weekly attendance of nursing mothers 27.0 Total attendance of expectant mothers 763 Individual expectan t mothers who attended 206 Average weekly attendance of expectant mothers 14.9 During the year 398 urinary analyses were made. The Health Visitor, assisted by ladies who very kindly volunteer their services, a private nurse and a nurse from the Maternity Home managed 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 44 expectant mothers and 164 nursing mothers and infants during the year :— Dried Milk, £333 17s. Id.; Fresh Milk, £9 10s. 4d. 14 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 £285 16s. 8d There is do doubt whatever that the provision of free milk, etc., to necessitous mothers and infants continues to be the main cause in keeping down the rate of Infantile Mortality. Where necessary, expectant mothers and infants are referrred to the Dental Surgeon for treatment, and during the year this was done in 52 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 the Croydon General Hospital, 15 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 Typhoid Fever, Cerebro-spinal Fever, Puerperal Pyrexia and Encephalitis Lethargica. Smallpox. Negotiations are still 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 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. 16 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 496, compared with 320 during 1936. 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, and the Croydon General Hospital. Midwifery and Maternity Services. During the year, notifications of births occurring in the District were received from 16 Midwives. Up to the 31st August, District Midwives were employed by theBeckenham and Penge Joint Maternity Home to attend patients in their own homes. From that date a domiciliary service of midwives was provided for this district by the Kent County Council under the provisions of the Midwives Act, 1936. These midwives work in co-operation with the Maternity and Child Welfare Centre. 17 A consulting obstetrician is available for complicated maternity cases occurring in the District and in the Joint Maternity Home. Maternity Home. The Penge and Beckenham Joint Maternity Home, Croydon Road, Beckenham, with accommodation for fourteen beds, is managed by a Joint Committee appointed annually by the Penge Urban District Council and the Beckenham Borough Council, 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. Necessitous cases, after due enquiry by the Committee, are 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[/## 1933 324 97 227 1934 347 93 254 1935 323 97 226 1936 339 98 241 1937 319 81 238 18 The average period spent in the Home during the year by each patient was 14.57 days. Patients can be attended at the Home by their own Doctors if they wish. Prior to the establishment by the Kent County Council of a domiciliary service of midwives, those who desired it could be attended in their own homes by a qualified midwife from the Maternity Home. She was assisted by a probationer nurse. During the eight months ended 31st August, 48 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 have arranged for the erection of a new Joint Maternity Home containing 38 beds and building operations in connection therewith commenced at the beginning of 1938. 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. Health Visiting. One Health Visitor and a part-time nurse are employed, and the following shows the number of visits paid :— 19 First visits to infants under one year 369 Subsequent visits to infants under one year 1,289 Visits to children between the ages of one and live years 2,203 First visits to expectant mothers 109 Subsequent visits to expectant mothers 62 Visits to tuberculosis cases 225 Visits to foster-children 39 Miscellaneous visits 51 4,347 Child Life Protection. The Health Visitor is the Child Protection Visitor, and she paid 39 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. Number of foster-parents on the Register:— (a) at the beginning of the year 10 (b) at the end of the year 6 Number of foster-children on the register:— (a) at the beginning of the year 10 (b) at the end of the year 8 (c) who died during the year - No legal proceedings were taken. 20 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 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. 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 water being examined bacteriologically daily by them. The majority of the premises are directly connected with the rising main. Seven drinking water cisterns were cleansed and covered, and at four houses water was supplied direct from the rising main. 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. 21 Rivers and Streams. There are no rivers in the District. There is a stream forming part of the boundary between Penge and Beckenham, the greater part of which is culverted. It was necessary for rubbish to be cleared from the open portion periodically. The culverting of the remaining open portion of the stream has been agreed to by the Penge and Beckenham Councils, and the work will be put in hand during 1938. Closet Accommodation. The whole of the premises—approximately 5,795—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 £6,335. There are no cesspools or privies within the District. Sanitary Inspection of the Area ; and Shops. These subjects are dealt with in the Report of the Chief Sanitary Inspector. 22 Smoke Abatement. Smoke nuisances were found at four factories and abated after informal action. Swimming Baths and Pools. There are none in the area. Eradication of Bed Bugs. Bed bugs were found in two Council houses and 65 other houses, all of which were disinfected. The methods employed for freeing houses of bed bugs are to require the stripping of paper from the walls and the loosening of woodwork in the rooms. The Council's workman then sprays the room with an insecticide and burns sulphur candles therein, the openings in the rooms being sealed. When considered necessary, the bedding is removed and steam disinfected. 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 schools. Attendance from infected houses is prohibited for certain periods. HOUSING. Number of new houses erected during the year 3 Number of new self-contained flats erected during the year 118 (3 blocks) 23 In addition, 17 houses were converted into 42 self-contained flats, and 7 houses containing 14 self-contained maisonettes were erected. 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) 645 (b) Number of inspections made for the purpose 710 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 73 (b) Number of inspections made for the purpose 73 (2a) Number of dwelling-houses inspected in connection with dustbin accommodation only 16 (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 592 (4a) Number of dwelling-houses found with defective dustbins only 16 24 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 562 Number of dwelling-houses provided with newdustbins only in consequence of informal action by the Local Authority or their officers 14 3.—Action under Statutory Powers. A.—Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 — B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 30 (2) Number of dwelling-houses in which defects were remedied after the service of formal notices: (a) By Owners 22 (b) By Local Authority in default of Owners 8 (2a) Number of dwelling-houses supplied with dustbins after service of formal notices: (a) By Owners 2 (b) By Local Authority in default of owners - 25 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936 — D.—Proceedings under Section 12 of the Housing Act, 1936 — 4.—Housing Act, 1936—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 70 (ii) Number of families dwelling therein 70 (iii) Number of persons dwelling therein:— Over 10 years 323 Under 10 years 130 (b) Number of new cases of overcrowding reported during the year 52 (c) (i) Number of cases of overcrowding relieved during the year 65 (ii) Number of persons concerned in such cases:— Over 10 years 285 Under 10 years 85 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding. In one house a further case of overcrowding occurred during the year, and after a notice had been served upon the owner-occupier, the overcrowding was abated. 26 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report:— It is to be noted in respect of 69 of the present number of cases of overcrowding (70) that insomuch as alternative accommodation has not yet been provided, that the occupiers have not infringed the provisions of the Act. INSPECTION AND SUPERVISION OF FOOD. These subjects are dealt with in the Chief Sanitary Inspector's Report. 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. No action has been taken regarding the use of measles serum for prophylaxis or attenuation. Diphtheria. Twenty-three cases were notified (compared with 18 the previous year), two of them being nasal. Four cases occurred in one family. 27 Hospital treatment was provided in 22 cases and there were no "return" cases. There were no deaths from diphtheria during the year. Supply of Antitoxin. Anti-diphtheritic serum was used for the treatment of only one case, 4,000 units being supplied. 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. Scarlet Fever. There were 74 cases of Scarlet Fever notified as against 29 in 1936, and 67 of these were removed to hospital. Five of the cases occurred whilst inmates of London Hospitals. Eight families had two or more cases. The disease generally was of a mild type and there were no deaths. There were two "return" cases. When adequate isolation and nursing can be obtained, cases are nursed at home. This was done in seven instances. 28 Puerperal Pyrexia. Two cases were notified whilst inmates of London hospitals, and made satisfactory recoveries. An arrangement exists with a local nurse for the home nursing of cases when required. Non-Notifiable Diseases. The following cases were notified to me from the local Elementary Schools:—Mumps, 9; Whooping Cough, 20; Chicken-pox, 35; and Adenitis, 1. 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 32 premises after cases of Tuberculosis and 15 of Cancer. Where vermin are discovered, disinfection of rooms and if necessary, bedding and clothing is carried out. This was done in 67 cases. The following list shows the number of rooms fumigated and of beds and other articles steam disinfected during the year Rooms fumigated 288 Mattresses disinfected 213 Blankets disinfected 391 Pillows disinfected 519 Miscellaneous articles disinfected 1,509 Library books fumigated 87 29 Bacteriological Work. Bacillus found. Bacillus not found. Total. Diphtheria. County Laboratory 4 52 56 Diphtheria. Clinical Research Association 10 42 52 Tuberculosis. County Labora tory 23 105 128 Dysentery. County Laboratory — 3 3 Hemolytic streptococcus. County Laboratory . 2 1 3 39 203 242 32/187 Notifiable Diseases (other than Tuberculosis) during the Year, 1937. Disease Total Cases notified Cases admitted to Hospital. Total Deaths Scarlet Fever 74 67 — Diphtheria 23 22 — Puerperal Pyrexia 2 2 — Pneumonia 7 2 19 (all forms) Erysipelas 6 2 — Poliomyelitis 1 1 — 30 Cancer. The Cancer death rate per 1,000 population was 1.52, compared with 1.43 in 1936. The rate for England and Wales was 1.63. Prevention of Blindness. No action was taken under Section 66, Public Health Act, 1925, or under Section 176, Public Health Act, 1936. Tuberculosis. No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925; Section 62, Public Health Act, 1925; or Section 172, Public Health Act, 1936. Total Primary Cases notified Total Cases admitted to Sanatoria and Hospitals Total Deaths Pulmonary (Males) 16 20 5 ,, (Females) 12 18 5 Totals 28 38 10 Non-Pulmonary (Males) 1 1 1 „ „ (Females) 3 3 6 Totals 4 4 7 31 Eight of the 10 deaths from pulmonary tuberculosis were of cases notified in this district. Both of the non-notified cases who died were patients in hospitals outside the district. Two of the seven cases of other forms of tuberculosis who died during the year had been notified. The five cases not notified died of tuberculous meningitis (3) and tuberculous peritonitis (2), and with the exception of one case all died in hospitals outside the area. During the year 128 specimens of sputum were sent to the Kent County Laboratory, Maidstone, to be examined for tubercle bacillus ; 23 of these were positive. New Tuberculosis Cases and Mortality during 1937. Age Periods. *New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0—1 — — — — — — — — 1— 5 — — 1 3 — — 1 1 5—15 — 2 — 4 — 1 — 4 15—25 6 10 1 2 1 — — — 25—35 6 4 — 1 1 1 — 1 35—45 1 1 — — — 1 — — 45—55 2 1 1 — 2 2 — — 55—65 4 — — — 1 — — — 65 and upwards 1 — — — — — — — Totals 20 18 3 10 5 5 1 6 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 to other districts and transferred to Penge, and patients who died from tuberculosis and were not notified previous to death. There were 170 cases of tuberculosis on the register at the end of the year as follows:— Male. Female. Total. Pulmonary 60 66 126 Non-Pulmonary 24 20 44 84 86 170 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 much 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, 1937. Registrar-General's Figures. Causes of Death. Males Females All Causes 141 191 1 Typhoid and paratyphoid fevers ... ... 2 Measles ... ... 3 Scarlet fever ... ... 4 Whooping cough 1 ... 5 Diphtheria ... ... 6 Influenza 5 4 7 Encephalitis lethargica ... ... 8 Cerebro-spinal fever ... ... 9 Respiratory tuberculosis 5 5 10 Other tuberculosis 1 7 11 Syphilis ... 3 12 General paralysis of the insane, etc. 2 ... 13 Cancer 18 21 14 Diabetes 2 2 15 Cerebral hæmorrhage 7 12 16 Heart disease 33 58 17 Aneurysm 2 ... 18 Other circulatory diseases 8 17 19 Bronchitis 5 7 20 Pneumonia (all forms) 12 7 21 Other respiratory diseases ... 1 22 Peptic ulcer 3 2 23 Diarrhoea (under 2 years) 4 4 24 Appendicitis ... 1 25 Cirrhosis of liver ... 26 Other liver diseases ... ... 27 Other digestive diseases 2 3 28 Nephritis 3 2 29 Puerperal sepsis ... ... 30 Other puerperal causes ... 1 31 Congenital causes, etc. 4 3 32 Senility 6 18 33 Suicide 3 1 34 Other violence 3 2 35 Other defined diseases 12 10 36 Ill-defined or not known ... ... Special causes (included in No. 35 above) Small-pox ... ... Poliomyelitis ... ... Polioencephalitis ... ... Deaths of Infants under 1 year Total 13 11 Legitimate 12 10 Illegitimate 1 1 Live Births Total 203 211 Legitimate 190 202 Illegitimate 13 9 Still Births Total 6 11 Legitimate 6 9 Illegitimate ... 2 Population (estimated middle of 1937 R.G.) 25,560 Infant Mortality, 1937. 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 6 — 3 1 10 6 4 1 3 24 Uncertified — — — — — — — — — — 1 Small-pox ... ... ... ... ... ... ... ... ... ... 2 Chicken-pox ... ... ... ... ... ... ... ... ... ... 3 Measles ... ... ... ... ... ... ... ... ... ... 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7 Erysipelas ... ... ... ... ... ... ... ... ... ... 8 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 9 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10 Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... 11 Meningitis ... ... ... ... ... ... ... 1 ... 1 12 Convulsions ... ... ... ... ... ... ... ... ... ... 13 Laryngitis ... ... ... ... ... ... ... ... ... ... 14 Bronchitis ... ... ... ... ... 1 ... ... ... 1 15 Pneumonia (all forms) ... ... 2 ... 2 1 1 ... 2 6 16 Influenza ... ... ... ... ... ... ... ... ... ... 17 Diarrhœa ... ... ... ... ... ... ... ... 1 1 18 Enteritis ... ... ... ... ... 3 3 ... ... 6 19 Gastritis ... ... ... ... ... ... ... ... ... ... 20 Syphilis ... ... ... ... ... 1 ... ... ... 1 21 Rickets ... ... ... ... ... ... ... ... ... ... 22 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... 23 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 24 Congenital Malformations 1 ... ... ... 2 ... ... ... ... 2 25 Premature Birth 4 ... ... ... 4 ... ... ... ... 4 26 Atrophy, Debility, Marasmus ... ... ... ... ... ... ... ... ... ... 27 Other causes ... ... 1 ... 1 ... ... ... ... 1 Totals 6 — 3 1 10 | 6 4 1 3 24 Nett live Births registered during the calendar year:— Nett Deaths registered during the calendar year:— Legitimate 392 Illegitimate 22 414 Legitimate infants 22 Illegitimate „ 2 24 BIRTH-RATES, DEATH-RATES, AND ANALYSIS OF MORTALITY IN THE YEAR, 1937. 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 16. 1 0.66 11.9 — — — — 0.03 — 0.35 0.35 19.3 57 England and Wales 14.9 0.60 12.4 0.00 — 0.02 0.01 0.04 0 07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns including London 14.9 0.67 12.5 0.01 — 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (Resident Populations, 25,000 to 50,000 at Census, 1931) 15.3 0.64 11.9 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 — 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 Notifiable Diseases (other than Tuberculosis) during the Year 1937- 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 74 1 ... 6 4 9 41 7 1 4 ... 1 ... 67 Diphtheria 23 1 1 1 3 2 6 6 1 2 ... ... ... 22 Puerperal Pyrexia 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Pneumonia 7 ... ... ... ... ... ... ... ... 1 2 1 3 ... Erysipelas 6 ... ... ... ... ... ... ... ... ... 2 3 1 1 Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... Totals 113 2 1 7 7 12 47 13 2 9 4 5 4 90 Deaths of notified cases—Pneumonia, 3, aged 82, 82 and 84 years. Inspection of Factories, Workshops and Workplaces, 1937 Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. Factories Including Factory Laundries 52 4 ... Workshops Including Workshop Laundries 19 1 ... Workplaces Other than Outworkers' premises 30 3 ... Total 101 8 ... Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Ref'rr'd to H.M. Insp't'r Nuisances under the Public Health Acts:—* Want of cleanliness 5 5 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 16 16 ... ... Sanitary accommodation:— Insufficient ... ... ... ... Unsuitable or defective 6 6 ... ... 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 27 27 ... ... *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 Inspertnr FOR THE Penge Urban District IN THE COUNTY OF KENT FOR THE Year ending December 31st, 1937 Town Hall, Anerley, S.E. 20. April, 1938. 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, 1937. Five hundred and twenty written intimation notices and 38 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). Four hundred and eighty-two Intimation Notices and 30 Statutory Notices were complied with. The Council did the work required by 8 Notices served under Section 24 of the Public Health Act, 1936. Difficulty was experienced in 11 cases regarding repairs, and the necessary works were effected only after summonses had been served or threatened. Legal proceedings were taken for non-compliance with notices served regarding nuisances caused by general housing defects, with the following results:— 42 1. Non-Compliance with Order of the Court. Defendant fined 7/- per day for 37 days (£12 19s. 0d.) and ordered to pay £2 2s. 0d. costs. 2. Order made to comply with Notice within 21 days. Defendant ordered to pay £2 2s. Od. costs. 3. Order made to comply with Notice within 21 days. Defendant ordered to pay £1 Is. 0d. costs. The drainage systems of 45 houses were partially relaid, and 45 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 2 268 — — Common Lodging Houses 5 33 7 7 Houses Let in Lodgings 53 90 23 23 Dairies 9 43 2 2 Stables 25 69 3 3 F ried F ish Shops 8 19 — — Butchers' Shops 26 62 3 3 Housing Consolidated Regulations, 1925. During the year, 73 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 65 instances. 43 SUMMARY OF INSPECTIONS AND VISITS. The following summary shows the number of visits and inspections made:— Inspections through complaints received 551 Inspections re defective dustbins 14 Inspections under the Housing Consolidated Regulations, 1925 73 Visits re cases of infectious diseases 206 Visits re transferable deaths 98 Visits re overcrowding and measurement of rooms 304 Houses Let-in-Lodgings and Common Lodging Houses 123 Slaughterhouses 268 Bakehouses 39 Dairies 43 Milkshops 35 Meat shops 62 Fish shops 25 Ice cream shops 10 Other food shops, stores and stalls 219 Urinals 42 Stables 69 Visits under Rats and Mice (Destruction) Act 117 Factories, Workshops and Workplaces 101 Visits under Shops Acts 363 Smoke observations 26 Inspections and re-inspections of work in hand and various visits 2,098 Drain tests 166 44 SUMMARY OF WORK EXECUTED DURING THE YEAR. Water Supply: Water supply re-instated to houses 3 Water service pipes repaired 26 Draw-off taps provided on the rising main 4 Cisterns cleansed, covered or covers repaired 7 Water Closets: New pans and traps fixed 51 Flushing apparatus renewed or repaired 43 Foul pans and traps cleansed 19 Connections of flushing pipes to pans made good 13 Seats and doors provided or repaired 28 Ventilation provided or improved 5 Flooring or paving repaired 5 Drainage: Drains tested with smoke, water or colour 166 Drains cleared 45 Houses with drains partially relaid 45 Inspection chambers constructed or improved 17 Interceptors provided 1 Soil and ventilation pipes fixed or repaired 18 Sinks, lavatory basins and baths provided 33 Sinks repaired 2 Waste pipes renewed or provided 33 Waste pipes repaired or trapped 41 45 Drainage: Waste pipes cleared 8 Fresh-air-inlets provided or repaired 7 Grids provided to gullies 3 Dampness: Houses with:— Walls repointed or rendered 21 Dampness in ground floor rooms remedied 62 Roofs repaired 155 Gutters repaired or renewed 49 Rainwater pipes repaired or renewed 33 Ventilation under floors provided or improved 18 Water service pipes repaired 26 Window sills repaired 11 Cleanliness: Dirty rooms, etc., cleansed or whitewashed 791 Verminous rooms fumigated 143 Miscellaneous: Houses with defective floors, joists, etc., repaired 51 Houses with defective plaster repaired 130 Houses with new sash lines provided to windows 50 Houses with window frames, etc., repaired 35 Houses with yards or forecourts paved or repaired 38 Houses with scullery paving repaired 17 Houses with air bricks renewed 12 Houses with stairs repaired 9 Houses with fireplace jambs and mantels repaired 9 46 Miscellaneous: Ventilation and light of rooms provided or improved 10 Kitchen stoves repaired or renewed 24 Scullery coppers repaired or renewed 23 Other stoves repaired or renewed 52 New dustbins provided 56 Premises with miscellaneous defects repaired, etc. 40 Overcrowding abated 65 Animals removed 2 Manure pits repaired 1 Accumulations removed 16 Smoke nuisances abated 4 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. At the end of the year there were 9 premises registered as dairies. Periodical inspections have been made and in two instances defects were discovered. These were remedied after informal action. In addition, 49 persons were registered to sell milk in sealed containers only. Sixteen 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 3.56% Solids not fat 8.75% 47 The following licenses were issued under the Milk (Special Designations) Order, 1936:— Dealers Licenses :— Tuberculin tested milk . 2 Pasteurised milk 13 Supplementary Licenses:— Tuberculin tested milk 3 Pasteurised milk 2 Meat. Most of the meat sold in the district is obtained from the London Meat Market. Visits are paid to meat purveyors' premises from time to time, and attention drawn to the requirements of the Public Health (Meat) Regulations. Three intimation notices were served requiring defects in butchers' premises to be remedied. The notices were complied with. Slaughterhouses. Registered 2 These have been regularly lime washed and inspected. The total number of visits to the slaughterhouses was 268, 48 Carcases Inspected and Condemned. Cattle, excluding Cows Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 5 6 216 953 82 Number inspected 5 6 216 939 82 All diseases except Tuberculosis: Whole carcases condemned — — — 1 1 Carcases of which some part or organ was condemned 3 1 2 23 4 Percentage of the number inspected affected with disease other th?n tuberculosis 60.0 16.6 0.9 2.5 6.0 Tuberculosis only. Whole carcases condemned — 1 — — Carcases of which some part or organ was condemned — — 2 — 3 Percentage of the number inspected affected with tuberculosis. — 16.6 0.9 — 3.6 49 The total weight of meat surrendered and condemned at the slaughterhouses is as follows :— cwts. qrts. lbs. Tuberculous meat 6 1 26 Diseased non-tuberculous meat 1 3 6 Total 8 1 4 Other Foods. There are 15 bakehouses in the district, one being underground. These have been periodically inspected and cleansed. Two informal notices to remedy defects were served and complied with. In addition to visits to the slaughterhouses, 433 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 :— Beef 117 lbs. Pork 5 lbs. Sausages 1 lb. Mutton 5 lbs. Bacon 9 lbs. Ducks 6 lbs. Milk 8 pints. 50 Tomatoes 48 lbs. Tomatoes (canned; 2 tins. Baked beans 1 tin. Kippers 42 lbs. Halibut 84 lbs. Periwinkles 2 bushels. Total weight: 3 cwts. 2 qrts. 18 lbs. Adulteration, etc. The Kent County Council administers the Food and Drugs (Adulteration) Act in this District. The Clerk to the Kent County Council has kindly furnished the following statement of the 62 samples taken:— 3 Butter 1 Gin 1 Cocoa 1 Ground Ginger 1 Coffee 2 Jam 1 Dried Fruit 2 Lard 1 Flour 2 Margarine 36 Milk 1 Sugar 1 Olive Oil 1 Tapioca 1 Pepper 1 Vinegar 1 Rice 1 Whisky 1 Sausages 1 Pearl Barley 1 Suet 1 Mincemeat Proceedings were taken in respect of the sample of Ground Ginger, with the result that the Vendor was convicted and fined £1 and ordered to pay Five Guineas costs. 51 In addition, 66 informal samples of new milk were purchased by your inspectors and submitted for analysis. All samples proved 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. Factories and Workshops. There are 102 factories and workshops on the register, in the great majority of which very few people are employed. Eight notices were served respecting cleansing, defective sanitary accommodation, etc., and complied with, and in 13 cases defects were remedied after verbal intimations had been given. Rats and Mice (Destruction) Act, 1919. Complaints were received from various parts of the district and investigated, 117 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, and where found to be defective, were remedied. 52 Shops Act. The Shops Act, 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 visits paid in this connection numbered 363. Notices requiring the maintenance of a reasonable temperature in two shops were served and complied with. 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. fAINMURY (PRINTER8) LTD.. ANERLEY.8. E.