Stare PEN 16 PENGE URBAN DISTRICT. Annual Report of the Medical Officer of health Robert Wilkinson (M.D.Brux.). together with THE ANNUAL REPORT of the Chief Sanitarg .Inspector Richard T. Pearce (M.S.I.A.). 1938 Urban District Council of Penge. With the Compliments of the Medical Officer of Health TOWN HALL, ANERLEY, S.E. 20. Urban District Council of Penge. Chairman: Mr. F. Theobald, J.P. Vice-chairman: Capt. F. W. R. Young. PUBLIC HEALTH COMMITTEE. Chairman : Mr. R. C. S. Barnett. Mr. H. Allder. Mr. F. P. Hodes, J.P. „ G. R. Deal. „ O. E. Prince. ,, A. Emery. ,, F. A. Smith. „ F. W. Foreman. „ J. Smith. „ J. B. Geale, J.P. „ F. Theobald, J.P. Mr. A. R. Thompson. Co-opted Members of Maternity and Child Welfare Section: Mrs. M. Barson, Mrs. F. Dixon, Mrs. E. Jones, 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., Dr. S. Pope, Mr. J. Smith and Mrs. A. Theobald. 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. (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 Medical Officer of Health for the Penge Urban District in the COUNTY OF KENT for the Year ending December 31st, 1938 Town Hall, Anerley, S.E. 20. May, 1939. To the Chairman and Members of the Urban District Council of Penge. Mr. Chairman and Gentlemen, I beg to present my Thirtieth Annual Report 011 the health of the District for the year ending the 31st December, 1938. It is compiled in accordance with Circular 1,728 (1938) of the Ministry of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 770 Population (Census 1931) 27,771 Population (Estimated middle of 1938, R.G.) 25,520 Number of separately rated inhabited dwellings (end of 1938) according to rate books (approximate) 6,817 Rateable Value £206,516 Sum represented by Id. rate £778 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 greater part of the grounds, occupying approximately 127 acres, are within the district, and provide a much needed “ lung” 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 778 men and 123 women unemployed in the Penge Urban District at the end of the year, compared with 828 and 70 respectively in 1937. The Out-door relief given during the year amounted to £19,370 8s. 10d., of which £2,931 18s. 9d. 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 £19,253 16s. 9d., of which £4,512 11s. 0d., was to able-bodied unemployed and their families, in the year 1937. VITAL STATISTICS. Total Male Female Live- Legitimate 389 - 212 - 177 Births Illegitimate 26 - 16 - 10 Birth rate per 1,000 of estimated resident population, 16-2 7 Still-) Legitimate 15 - 10 - 5 Births I Illegitimate 3 - 2 - 1 Still-birth rate, per 1,000 total (live and still) births 41-5 Deaths 318 - 162 - 156 Crude Death Rate per 1,000 of the estimated resident population, 12.4. Adjusted Death Rate per 1,000 of the estimated resident population, 11.4. Deaths from puerperal causes: Nil. Deaths of Infants under one year of age: Legitimate, 28 Illegitimate, Nil. Total, 28. Death Rate of Infants under one year of age: All infants per 1,000 live births 67.4 Legitimate infants per 1,000 legitimate live births 71 -9 Illegitimate infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 50 „ „ Measles (all ages) 1 ,, ,, Whooping Cough (all ages) - „ „ Diarrhoea (under two years of age) 4 Births. The live births registered during the year numbered 415, of which 228 were males and 187 females. This gives a birth rate of 16-2 per 1,000 compared with 16-1 for 1937. 8 Still-Births. The number of still-births registered was 18, of which 12 were males and 6 females. Notification of Births. Of the live births occurring in the district, 43 were notified by Medical Practitioners and 195 by Midwives. Seven notifications of still-births were received, one from a Medical Practitioner and 6 from Midwives. Eleven births were not notified. Deaths. The number of deaths registered in the Urban District of Penge during the year was 166. Twenty-eight of these were transferable to other districts; but 180 deaths of Penge parishioners occurring in Public Institutions, etc., outside the District were transferred to Penge. The corrected number of deaths was therefore 318, equal to a crude death rate of 12-4 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 11-4 per 1,000, compared with a rate of 11-9 per 1,000 for 1937. Of the 318 deaths during the year, 164 or 51-5 per cent, were of persons over 65 years of age. Seventy-five were of persons between the ages of 75 and 85 years and 22 were of persons over 85 years of age. 9 Misadventure and accidents accounted for 10 deaths, compared with 5 the previous year and 12 in 1936. Maternal Mortality. There were no maternal deaths during the year. The average maternal mortality rales per 1,000 live births for the last ten years (1929 to 1938 inclusive), are as follow:— England and Wales 4.01 Penge 3.21 Infantile Mortality. The number of deaths under one year of age was 28, corresponding to a rate of 67-4 per 1,000 births, compared with the rate of 57-9 for 1937. Twelve infants died under the age of one week from unavoidable causes. Two sets of twins died from prematurity and one set of twins from pneumonia. Of the 28 deaths, 10 were from Premature Birth, 2 from Injury at Birth, 2 from Enteritis and 9 from Pneumonia. Eight deaths occurred amongst infants who had attended the Child Welfare Centre. Comparative Vital Statistics. The following table shows the comparative figures for 1938 10 Rate per 1,000 Population Death rate per 1,000 population Deaths under one year per 1,000 births Livebirths Stillbirths Penge 16-2 0-70 11-4 . 67 England and Wales 15-1 0-60 11-6 53 126 County Boroughs and Great Towns including London 15-0 0-65 11-7 57 148 Smaller Towns (resident populations, 25,000 to 50,000 at Census, 1931) 154 0-60 110 51 London 13-4 0-48 11-4 57 Public Mortuary. Four inquests were held in Penge during the year 1938 as follows:— Verdict. Males. Females. Total. Suicide 1 - 1 Accidental Death 1 - 1 Misadventure - 1 1 Open 1 - 1 11 In addition, 12 post-mortem examinations were made, the Coroner certifying the cause of death in these cases without holding an Inquest. Causes of Sickness. Measles and Chicken-pox were prevalent during the Spring of the year. Cases of Scarlet Fever showed a marked increase during the latter half of 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 development 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. 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 699 calls; 373 for private removals and 326 for accidents. 12 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. 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, 1937. Medical Officer's Consultations. Infants 2,059 Nursing Mothers 422 Post-Natal 51 Ante-Natal 777 3,309 13 Total attendance of children at the Centre 6,360 Individual children who attended 754 Average weekly attendance of children 127.2 Total attendance of nursing mothers 1,181 Individual nursing mothers who attended 213 Average weekly attendance of nursing mothers 23.6 Total attendance of expectant mothers 822 Individual expectant mothers who attended 214 Average weekly attendance of expectant mothers 16.4 The Health Visitor, assisted by ladies who very kindly volunteer their services, and private nurses 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 milks are provided free. The following amounts were expended in supplying milk gratis to 70 expectant mothers and 171 nursing mothers and infants during the year:— Dried Milk, £322 5s. lid.; Fresh Milk, £13 6s. 9d. Milk 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 £344 10s. 4d. There is no 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. 14 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 are 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. 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. 15 Smallpox. New arrangements for the hospital treatment of smallpox in their hospital at Orpington have been made with the West Kent Joint Hospital Board as from the 1st April, 1939. 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. 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. 16 Cases admitted to the County Hospital, Farnborough, Kent, from this District, numbered 486, compared with 496, during 1937. 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. A domiciliary service of midwives is 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. 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. 17 Necessitous cases, after due enquiry by the Committee, are granted free admission to the Home. The following table gives the number of mothers admitted annually for the last five years :— Year Total cases admitted Penge Cases Beckenham Cases 1934 347 93 254 1935 323 97 226 1936 339 98 241 1937 319 81 238 1938 333 91 242 The average period spent in the Home during the year by each patient was 14.69 days. Patients can be attended at the Home by their own Doctors if they wish. I continue to get 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. It is expected that the new Joint Maternity Home, containing 38 beds, will be ready for use during 1939. 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. 18 Health Visiting. One Health Visitor and a part-time Nurse are employed, and the following shows the number of visits paid:— First visits to infants under one year 428 Subsequent visits to infants under one year 1,026 Visits to children between the ages of one and five years 2,105 First visits to expectant mothers 111 Subsequent visits to expectant mothers 47 Visits to tuberculosis cases 248 Visits to foster children 57 Miscellaneous visits 70 4,092 Child Life Protection. The Health Visitor is the Child Protection Visitor, and she paid 57 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 6 (b) at the end of the year 8 19 Number of foster children on the register:— (a) at the beginning of the year 8 (b) at the end of the year 9 (c) who died during the year 1 No legal proceedings were taken. Arrangements for Dental, Orthopaedic, etc., Cases. Where necessary, expectant and nursing mothers and children are referred to the Dental Surgeon for treatment, and during the year this was done in 45 cases. Dentures are not provided. Orthopaedic cases are seen at the Infant Welfare Centre, 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 provided with a constant service of water by the Metropolitan Water Board, the water being examined bacteriologically daily by the Board. In addition, the County Pathologist reports that the samples of water submitted to him quarterly were good, Bacillus coli being absent in 100 c.c.'s. The majority of the premises are directly connected with the rising main. 20 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. Rivers and Streams. There are no rivers in the district. There is a stream forming part of the boundary between Penge and Beckenham, the whole of which is now culverted, the work being completed during the year. Closet Accommodation. The whole of the premises—approximately 6,085—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 £5,975. There are no cesspools within the District. 21 Sanitary Inspection of the Area; and Shops. These subjects are dealt with in the Report of the Chief Sanitary Inspector. Camping Sites. There are none in the district. Smoke Abatement. Smoke nuisances were found at 4 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 three Council houses and 63 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 rooms with an insecticide (Solution "D") and burns sulphur candles therein, the openings in the rooms being sealed. When considered necessary, the bedding is removed and steam disinfected. Schools. The sanitary condition and water supply of the schools are satisfactory. 22 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 flats over shops erected during the year 10 Number of new self-contained flats erected during the year 206 (7 blocks) In addition, 27 houses were converted into 89 self-contained flats, and 12 houses containing 24 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) 583 (b) Number of inspections made for the purpose 630 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 90 (b) Number of inspections made for the purpose 90 23 (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 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 507 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 32 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (a) By Owners 30 (6) By Local Authority in default of Owners 2 24 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 37 (ii) Number of families dwelling therein 40 (iii) Number of persons dwelling therein:— Over 10 years 193 Under 10 years 67 (b) Number of new cases of overcrowding reported during the year 17 (c) (i) Number of cases of overcrowding relieved during the year 47 (ii) Number of persons concerned in such cases: Over 10 years 203 Under 10 years 81 (d) Particulars of any cases in which dwelling- houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 25 (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 38 of the present number of cases of overcrowding (40) that insomuch as alternative accommodation has not yet been provided, 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. 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. Thirty-four cases were notified (compared with 23 the previous year), six of them being nasal. 26 Hospital treatment was provided in 33 cases, and there were no "return" cases. There were four deaths from diphtheria during the year. Supply of Antitoxin. Anti-diphtheritic serum was used for the treatment of 13 cases, 100,000 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 149 cases of Scarlet Fever notified, an unusually high number (as against 74 in 1937) and 133 of these were removed to hospital. Seven cases occurred whilst inmates of London Hospitals. Twenty-two families had two or more cases. There were five " return " cases. The type of the disease was universally mild and spread over the district, and no deaths occurred. When adequate isolation and nursing can be obtained, cases are nursed at home. This was done in 16 instances. Puerperal Pyrexia. Two cases were notified whilst inmates of hospitals outside the district and made satisfactory recoveries. An arrangement exists with a local nurse for the home nursing of cases when required. 27 Non-Notifiable Diseases. The following cases were notified to me from the local Elementary Schools:—Mumps, 21; Measles, 157; Chickenpox, 61. 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 34 premises after cases of Tuberculosis and 13 of Cancer. Where vermin are discovered, disinfection of rooms and, if necessary, bedding and clothing is carried out. This was done in 66 cases. The following list shows the number of rooms fumigated and of beds and other articles steam disinfected during the year Rooms fumigated 401 Mattresses disinfected 324 Blankets disinfected 668 Pillows disinfected 845 Miscellaneous articles disinfected 2,434 Library books fumigated 145 28 Bacteriological Work. Bacillus Bacillus found. not found. Total. Diphtheria. County Laboratory 16 125 141 Diphtheria. Clinical Research Association 16 119 135 Tuberculosis. County Laboratory 29 74 103 Dysentery. County Laboratory 1 — 1 Faeces ,, — 3 3 Hemolytic streptococcus. County Laboratory 3 15 18 65 336 401 Notifiable Diseases (other than Tuberculosis) during the year 1938. Disease Total Cases notified Cases admitted to Hospital. Total Deaths Scarlet Fever 149 133 – Diphtheria 34 33 4 Enteric Fever 1 1 – Puerperal Pyrexia 2 2 – Pneumonia 10 6 23 (all forms) Erysipelas 4 2 – Dysentery 1 1 – 29 Cancer. The Cancer death rate per 1,000 population was 1.95, compared with 1.52 in 1937. The rate for England and Wales was 1.66. Prevention of Blindness. No action was taken under Section 176, Public Health Act, 1936. Tuberculosis. No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925; or Section 172, Public Health Act, 1936. Total Primary Cases notified Total Cases admitted to Sanatoria and Hospitals Total Deaths Pulmonary (Males) 7 10 5 „ (Females) 15 15 7 Totals 22 25 12 Non-Pulmonary (Males) 3 2 4 „ „ (Females) 1 1 1 Totals 4 3 5 30 Ten of the 12 deaths from Pulmonary Tuberculosis were of cases notified in this district. Two of the 5 cases of other forms of Tuberculosis who died during the year had been notified. During the year 103 specimens of sputum were sent to the Kent County Laboratory, Maidstone, to be examined for tubercle bacillus; 29 of these were positive. New Tuberculosis Cases and Mortality during 1938. Age Periods. New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0—1 — — — — — — — — 1— 5 — — 2 — — — 1 — 5—15 — — 1 — — — — — 15—25 1 10 2 1 1 2 1 1 25—35 4 4 — — 1 2 1 — 35—45 2 3 — — — 1 — — 45—55 3 1 — — 1 — — — 55—65 3 — — — 2 — — — 65 and upwards — 1 1 — — 2 1 — Totals 13 19 6 1 5 7 4 1 31 *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 160 cases of tuberculosis on the register at the end of the year as follows:— Male. Female. Total. Pulmonary 56 63 119 Non-Pulmonary 26 15 41 82 78 160 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, 1938. Registrar-General's Figures. Causes of Death. Males Females All Causes 162 156 1 Typhoid and paratyphoid fevers 1 ... 2 Measles 1 • • • 3 Scarlet fever • • • • • • 4 Whooping cough • • • • • • 5 Diphtheria 1 3 6 Influenza ... 1 7 Encephalitis lethargica ... 1 8 Cerebro-spinal fever ... ... 9 Respiratory tuberculosis 5 7 10 Other tuberculosis 4 1 11 Syphilis 2 ... 12 General paralysis of the insane, etc 2 1 13 Cancer 22 28 14 Diabetes 2 1 15 Cerebral haemorrhage 5 7 16 Heart disease 39 44 17 Aneurysm ... 2 18 Other circulatory diseases 8 8 19 Bronchitis 1 2 20 Pneumonia (all forms) 12 11 21 Other respiratory diseases 3 3 22 Peptic ulcer 1 ... 23 Diarrhoea (under 2 years) 2 2 24 Appendicitis 2 3 25 Cirrhosis of liver ... ... 26 Other liver diseases 1 • • • 27 Other digestive diseases 6 3 28 Nephritis 5 2 29 Puerperal sepsis ... ... 30 Other puerperal causes ... ... 31 Congenital causes, etc 11 2 32 Senility 2 5 33 Suicide 1 1 34 Other violence 6 3 35 Other defined diseases 16 16 36 Ill-defined or not known 1 ... 37 Diarrhoea (2 years and over) ... ... Special causes (included in No. 35 above) Small-pox ... ... Poliomyelitis ... ... Polioencephalitis ... ... Deaths of Infants under 1 year Total 19 9 Legitimate 19 9 Illegitimate ... ... Live Births Total 228 187 Legitimate 212 177 Illegitimate 16 10 Still Births Total 12 6 Legitimate 10 5 Illegitimate 2 1 Population (estimated middle of 1938 R.G.) ... 25,520 Infant Mortality, 1938. 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. 1 1 9 months and under 12 months. Total deaths under 1 year. All Causes Certified 12 – 1 1 14 2 4 4 4 28 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 • • • • • • • • • • • • 1 12 Bronchitis • • • • • • • • • • • • • • • • • • 1 • • • • • • 1 13 Pneumonia (all forms) • • • • • • • • • • • • • • • 1 3 1 4 9 14 Influenza • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 15 Diarrhæa • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 16 Enteritis • • • • • • • • • • • • • • • • • • • • • 2 • • • 2 17 Syphilis • • • • • • • • • • • • • • • • • • • • • • • • • • • ... 18 Rickets • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 19 Suffocation, overlying • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 20 Injury at Birth 2 • • • • • • • • • 2 • • • • • • • • • • • • 2 21 Congenital Malformations 1 • • • • • • • • • 1 • • • • • • • • • • • • 1 22 Premature Birth 9 • • • • • • • • • 10 • • • • • • • • • • • • 10 23 Atrophy, Debility, Marasmus ... • • • • • • • • • ... • • • • • • • • • • • • • • • 24 Other causes ... • • • • • • • • • ... 1 • • • 1 • • • 2 Totals 12 — 1 1 14 2 4 4 4 28 Nett live Births registered during the calendar year:— Legitimate 389 415 Illegitimate 26 Nett Deaths registered during the calendar year:— Legitimate infants 28 28 Illegitimate — BIRTH-RATES, DEATH-RATES, AND ANALYSIS OF MORTALITY IN THE YEAR, 1938. 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. Diarrhoea and Enteritis (under two years). Total Deaths under one year. Penge U.D. 16.2 0.70 11.4 0.03 — 0.03 — — 0.15 0.03 9.6 67 England and Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0 07 0.11 5.5 53 126 County Boroughs and Great Towns including London 15.0 0.65 11.7 0.00 — 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (Resident Populations, 25,000 to 50,000 at Census, 1931) 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London 13.4 0.48 11.4 0.00 — 0.06 0.01 0.03 0.05 0.06 13.1 57 Notifiable Diseases (other than Tuberculosis) during the Year 1938. 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 149 2 6 8 7 15 83 20 3 4 1 ... ... 133 Diphtheria 34 ... 1 2 1 4 19 1 4 ... 1 1 ... 33 Enteric Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 Puerperal Pyrexia 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... Pneumonia 10 ... ... ... ... ... 2 ... ... 3 1 3 1 ... Erysipelas 4 ... ... ... ... ... ... ... ... ... 2 2 ... ... Dysentery 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 Totals 201 2 7 10 8 19 104 21 8 8 6 1 1 168 Deaths of notified cases—Diphtheria, 4, aged 6, 4, 7 and 3 years. Pneumonia, 2, aged 54 and 23 years. Inspection of Factories, 1938. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 46 1 ... Factories without mechanical power 15 ... ... Other Premises under the Act ... ... ... Total 61 1 ... Defects found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Ref'rr'd to H.M. Insp't'r Want of cleanliness ... ... ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate ventilation ... ... ... ... Ineffective drainage of floors ... ... ... ... Sanitary conveniences :— Insufficient ... ... ... ... Unsuitable or defective ... ... ... ... Not separate for sexes ... ... ... ... Other offences 7 7 ... ... Totals 7 7 ... ... ANNUAL REPORT OF THE Chief Sanitary Inspector FOR THE Penge Urban District IN THE COUNTY OF KENT FOR THE Year ending December 31st, 1938 Town Hall, Anerley, S.E. 20. May, 1939. 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, 1938. Five hundred and fifteen 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 Slaughterhouses (quarterly). Four hundred and seventy-seven Intimation Notices and 36 Statutory Notices were complied with. The Council did the work required by 20 notices served under Section 24 of the Public Health Act, 1936. Difficulty was experienced in 10 cases regarding nuisances and the necessary works were effected only after summonses had been served or threatened. 40 Legal proceedings were taken for non-compliance with notices served regarding nuisances caused by general housing defects, with the following results:— 1. Order made to comply with Notice within 3 days. 2. Order made to comply with Notice within 14 days. Defendant ordered to pay £2 2s. 0d. costs. 3. Non-compliance with Order of the Court. Defendant fined £5 0s. 0d., and ordered to pay £2 2s. 0d. costs. 4. Order made to comply with Notice within 7 days. Defendant ordered to pay £2 2s. Od. costs. The drainage systems of 41 houses were partially relaid, and 48 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 2 313 1 1 Common Lodging Houses 5 30 7 7 Houses Let in Lodgings 53 81 21 21 Dairies 9 30 — — Stables 24 54 3 3 Fried Fish Shops 7 16 — — Butchers' Shops 25 52 1 1 41 Housing Consolidated Regulations, 1925 and 1932. During the year, 90 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 86 instances. SUMMARY OF INSPECTIONS AND VISITS. The following summary shows the number of visits and inspections made:— Inspections through complaints received 442 Inspections re defective dustbins 12 Inspections under the Housing Consolidated Regulations 90 Visits re cases of infectious diseases 322 Visits re transferable deaths 51 Visits re overcrowding and measurement of rooms 90 Houses let-in-lodgings and Common Lodging Houses 1ll Slaughterhouses 313 Bakehouses 33 Dairies 30 Milkshops 61 Meat Shops 52 Fish Shops 20 Ice Cream Shops 10 Other Food Shops, Stores and Stalls 245 Urinals 28 42 Stables 54 Visits under Rats and Mice (Destruction) Act 113 Factories 61 Visits under Shops Acts 146 Smoke observations 40 Inspections and re-inspections of work in hand and various visits 1,857 Drain tests 187 SUMMARY OF WORK EXECUTED DURING THE YEAR. Water Supply: Water supply re-instated to houses 13 Water service pipes repaired 29 Draw-off taps provided on the rising main 2 Cisterns cleansed, covered or covers repaired 9 Water Closets: New pans and traps fixed 49 Flushing apparatus renewed or repaired 36 Foul pans and traps cleansed 15 Connections of flushing pipes to pans made good 12 Seats and doors provided or repaired 35 Ventilation provided or improved 5 Flooring or paving repaired 2 43 Drainage: Drains tested with smoke, water or colour 187 Drains cleared 48 Houses re-drained 2 Houses with drains partially relaid 39 Inspection chambers constructed or improved 16 Interceptors provided 3 Soil and ventilation pipes fixed or repaired 23 Sinks, lavatory basins and baths provided 43 Sinks repaired 2 Waste pipes renewed or provided 37 Waste pipes repaired or trapped 40 Waste pipes cleared 14 Fresh-air-inlets provided or repaired 6 Grids provided to gullies 2 Dampness: Houses with: Walls re-pointed or rendered 30 Dampness in ground floor rooms remedied 67 Roofs repaired 116 Gutters repaired or renewed 42 Rain water pipes repaired or renewed 21 Ventilation under floors provided or improved 10 Water service pipes repaired 29 Window sills repaired 10 Cleanliness: Dirty rooms, etc., cleansed or whitewashed 906 Verminous rooms fumigated 149 44 Miscellaneous: Houses with defective floors, joists, etc., repaired 59 Houses with defective plaster repaired 157 Houses with new sash lines provided to windows 66 Houses with window frames, etc., repaired 41 Houses with yards or forecourts paved or repaired 45 Houses with scullery paving repaired 13 Houses with air bricks renewed 12 Houses with stairs repaired 9 Houses with fireplace jambs and mantels repaired 10 Ventilation and light of rooms provided or improved 3 Kitchen stoves repaired or renewed 42 Scullery coppers repaired or renewed 23 Other stoves repaired or renewed 67 Doors repaired or renewed 23 New dustbins provided 47 Premises with miscellaneous defects repaired, etc. 62 Overcrowding abated 47 Animals removed 7 Manure pits repaired 1 Accumulations removed 23 Smoke nuisances abated 4 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. At the end of the year there were 9 premises registered as dairies. In addition, 48 persons were registered to sell milk in sealed containers only. Fifteen dairymen, with dairies outside the district, who sell milk in Penge, are also registered. There are no cowsheds in the district. 45 The analysis of 66 informal samples obtained during the year show the following average:— Fat 3.62% Solids not fats 8.79% The following licenses were issued under the Milk (Special Designations) Order, 1936:— Dealers' Licenses:— Tuberculin tested milk 2 Pasteurised milk 11 Supplementary Licenses:— Tuberculin tested milk 3 Pasteurised milk 3 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. Slaughterhouses. Registered 2 These have been regularly limewashed and inspected. The total number of visits to the slaughterhouses was 313. 46 Carcases Inspected and Condemned. Cattle, excluding Cows Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 9 — 243 1172 226 N umber inspected 9 — 243 1151 226 A11 diseases except Tuberculosis: Whole carcases condemned — — — 2 — Carcases of which some part or organ was condemned 1 — 1 43 11 Percentage of the number inspected affected with disease other than tuberculosis 11.1 _ 0.4 3.9 4.8 Tuberculosis only. Whole carcases condemned - - - 2 - Carcases of which some part or organ was condemned — — 5 — 6 Percentage of the number inspected affected with tuberculosis — — 2.0 — 2.6 47 The total weight of meat surrendered and condemned at the slaughterhouses is as follows:— cwts. qrts. lbs. Tuberculous meat — 1 2 Diseased non-tuberculous meat 2 — 13 Total 2 1 15 Other Foods. There are fifteen bakehouses in the district, one being underground. These have been periodically inspected and cleansed. Defects found at two bakehouses were remedied after informal action. In addition to visits to the slaughterhouses, 451 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:— Mutton 43 lbs. Lambs' livers 163 lbs. Corned beef 6 lbs. Tinned soup 32 tins Grapes 20 lbs. Herrings 49 lbs. Pollock 84 lbs. Total weight: 3 cwts. 1 qtr. 17 lbs. 48 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 58 samples taken:— 1 Almonds, Ground 2 Lard 1 Brandy 3 Margarine 3 Butter 35 Milk 1 Cocoa 1 Olive Oil 1 Coffee 1 Pepper 1 Flour 2 Sausages 1 Fruit, Dried 1 Sugar 1 Ginger, Ground 1 Tapioca 1 Jam 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. One sample was 5.3% deficient in fat, but a further sample taken in this case was 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. 49 Rats and Mice (Destruction) Act, 1919. Complaints were received from various parts of the district and investigated, 113 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 made good. 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 146. Notices requiring the maintenance of a reasonable temperature in three shops were served and complied with. I desire to express thanks to the Chairman and Members of the Public Health Committee for cheir 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. 3T-- ' r J ' V