PEN 18 PENGE URBAN DISTRICT COUNCIL. ANNUAL REPORTS of THE MEDICAL OFFICER of HEALTH and the CHIEF SANITARY INSPECTOR for 1940. Chairman:- Mr.A,Emery, J.P. Vice-Chairman:- Mr.J.Smith. PUBLIC HEALTH COMMITTEE. Chairman: Mr.O.E.Prince. Mr.H.Allder. Mr.R.C.S.Barnett. Mr.G.R.Deal. Mr.A.Emery, J.P. Mr . F. W. Foreman. Mr.J.B.Geale, J.P. Mr.H.E.George. Mr.F.P.Hodes, J.P. Mr.J.Smith. Mr.F.Theobald. Co-opted Members of Maternity and Child Welfare Section: Mrs.M,Barson, Mrs.F.Dixon, Miss Fannie Moore and Mrs.A.Theobald. Representatives on the Joint Maternity Horne Committee Mr.R.C.S.Barnett, Mr.J.B.Geale, J.P., Mr.F.P.Hodes, J.P., Dr.S.Pope, Mr.F.Theobald and Mrs.A.Theobald. PUBLIC HEALTH DEPARTMENT. STAFF. X 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.). (on sick leave from June, 194 0). X Temporary Medical Officer of Health: W. P. Starforth, M.B. ,Ch.B. (Edin.). (From 25.6.40 to 30.11.40). B.E.Hawkins, M.R.C.S.(Eng.), L.R.C.P.(Lond.). (From 30.12.40) . 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 Act Inspector: E.G.Thomas, Cert.R.S.I. Cert.Insp. of Food, R.S.I. Health Visitor: Miss V.M.Evans, S.R.N., S.C.M., H.V's Cert. Clerks. R.W.Rixson, Cert.S.I.B., Cert.Insp. of Food, R.S.I. (In Army from 19.7.40). X Miss A.G.Mitchell. Miss J.M.Garrett. (Temporary from 22.7.40). X Part-time Officer. 1. \ Town Hall, Anerley, S.E.20. July, 1941. To the Chairman and Members of the Urban District Council of Penge. Mr.Chairman and Gentlemen, I beg to present an abridged Annual Report on the health of the district for the year ending the 31st December, 1940, It is compiled in accordance with Circular 2314 (1941) of the Ministry of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 770 Population (Census, 1931) 27,771 Population (Estimated 1940, R.G.) 21,820 Rateable value £211,369 Sum represented by 1d. rate £750 The Manager of the Employment Exchange informs me that there were 4 3 men, 104 women and 19 juveniles unemployed in the Penge Urban District at the end of the year, compared with 777 men and 123 women in 1939. The Out-door relief given during the year amounted to £15,481 of which £936 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 £16,927 of which £1,628 was to ablebodied unemployed and their families in the year 1939. VITAL STATISTICS. Total Male Female Live- Births Legitimate 385 194 191 Illegitimate 16 4 12 Birth rate per 1,000 of estimated population, 18.3 StillBirths Legitimate 8 5 3 Illegitimate 1 1 — Still-birth rate per 1,000 total (live and still) births, 21.9 Deaths 389 176 213 Crude Death Rate per 1,000 of the estimated population, 17.8 Adjusted Death Rate per 1,000 of the estimated population, 16.0 Deaths from puerperal causes: Nil. Deaths of Infants under one year of age: Legitimate 24. Illegitimate 1. Total 25. Death Rate of Infants under one year of age: All infants, per 1,000 live births 62.1 Legitimate infants, per 1,000 legitimate live births 62.1 Illegitimate infants, per 1,000 illegitimate live births 62.5 2. Deaths from Cancer (all ages) 41 " " Measles (all ages) - " " Whooping Cough (all ages) - " " Diarrhoea (under two years of age) 5 Births. The live births registered during the year numbered 401, of which 198 were males and 203 females. This gives a birth rate of 18.3 per 1,000 compared with 15.1 for 1939. Still-Births. The number of still-births was 9, of which 6 were males and 3 females. Notification of Births. Of the live births occurring in the district, 17 were notified by Medical Practitioners and 167 by Midwives. Pour notifications of still-births were received, 1 being from a Modical Practitioner and 3 from Midwives. Deaths. The corrected number of deaths was 389 equal to a crude death rate of 17.8 per 1,000. The factor for adjusting the Death Rate for the district, given by the Registrar-General, is 0.90. This areal comparability factor makes the Adjusted Death Rate 16.0 per 1,000 compared with a rate of 11.6 per 1,000 for 1939. Of the 389 deaths during the year, 221 or 56.8 per cent, were of persons over 65 years of age. Maternal Mortality. There were no maternal deaths during the year. The average maternal mortality rates per 1,OOOtotal births for the last ten years (1931 to 1940 inclusive) are as follows: England and Wales 3.53 Penge 3.21 Infantile Mortality. The number of deaths under one year of age was 25, corresponding to a rate of 62,1 per 1,000 births compared with rates of 48.8 for 1939 and 67.4 for 1938. Nine deaths occurred amongst infants who had attended the Child Welfare Centre, 3. Comparative Vital Statistics, The following table shows the comparative figures for 1940: Rate per 1,000 Civilian Population. Death rate per 1,000 civilian population. • Deaths under one year per 1,000 births. LiveBirths. StillBirth. Penge 18.3 0.41 16.0 62 England and Wales 14.6 0.55 14.3 55 126 County Boroughs and Great Towns including London 16.0 0.64 15.8 61 148 Smaller Towns (resident populations, 25,000 to 50,000 at Census, 1931) 15.7 0.55 ! 12.8 54 London 13.7 0.44 17.8 50 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA.. Ambulance Facilities. During the year the Council's motor ambulance responded to 620 calls; 307 for private removals and 313 for accidents and sudden illness. There is a co-ordination scheme between the ambulance services of Penge, Beckenham and Bromley, which works satisfactorily. Maternity and Child Welfare Centre._ The Maternity and Child Welfare Centre was held, as before, at the Council's School Clinic, 17, Oakfield Road, on Tuesday, Wednesday and Friday afternoons, and the Ante-Natal and PostNatal Clinic on Y/ednesday mornings. Medical Officer's Consultations. Infants 995 Nursing Mothers 342 Ante—Natal 363 Post—Natal 3 1,703 Total attendance of children at the Centre 6,154 Individual children who attended 774 Average weekly attendance of children 120.6 Total attendance of nursing mothers 1,286 Individual nursing mothers who attended 257 Average weekly attendance of nursing mothers 25.2 Total attendance of expectant mothers 375 Individual expectant mothers who attendeded 257 Average weekly attendance of expectant mothers 10.4 The following amounts were expended in supplying milk gratis to 28 expectant mothers and 118 nursing mothers and infants up to the 21st August. Dried Milk, £165.17.4. Fresh Milk, £9.3.5. 4. HOSPITALS. There are no changes to report in connection with the hospital services. Cases admitted to the County Hospital, Parnborough, Kent, from this district numbered 456 compared with 549 during the year 1939. Maternity Home. During the year, 102 Penge cases were admitted to the new Penge and Beckenham Joint Maternity Home, Stone Park Avenue, Beckenham. The following table gives the numbers of mothers admitted annually for the last five years: Year. Total cases admitted. Penge Cases. Beckenham Cases. 1936 339 98 241 1937 319 31 238 1938 333 91 242 1939 246 48 198 1940 405 102 303 The average period spent in the home during the year by each patient was 14 days. 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 390 Subsequent visits to infants under one year 946 Visits to children between the ages of one and five years 2,476 First visits to expectant mothers 193 Subsequent visits to expectant mothers 60 Visits to tuberculosis cases 221 Visits to foster children 60 Miscellaneous visits 98 4,444 Child Life Protection. Number of foster parents on the Register: (a) at the beginning of the year 9 (b) at the end of the year 6 Number of foster children on the Register: (a) at the beginning of the year 13 (b) at the end of the year 6 (c) who died during the year — No legal proceedings were taken. Dental Treatment. Where necessary, expectant and nursing mothers and children are referred to the Dental Surgeon for treatment, and during the year this was done in 60 cases. 5 HOUSING. Number of new houses erected during the year - Number of new self-contained flats erected during the year (2 blocks) 34 No houses were converted into flats during the year. 1. Inspection of dwellinghouses during the year; (1) (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 370 (b) Number of inspections made for the purpose 410 (2) (a) Number of dwellinghouses (Included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 340 2. Remedy of Defects without service of formal notices: Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 324 3. Action under Statutory Powers: (a) Proceedings under Housing Act, 1936 Nil (b) Proceedings under Public Health Acts. (1) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 16 (2) Number of dwellinghouses in which defects were remedied after service of formal notices: (a) By Owners 16 (b) By Local Authority in default of Owners - 4. Housing Act, 1936 - Overcrowding: Number of cases of overcrowding relieved during the year 13 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Diphtheria. Seven cases were notified (compared with 20 the previous year), this being the lowest number recorded in one year since Penge became an Urban District. 6. Hospital treatment was provided in all cases and there wereno "return" cases. There were no deaths from diphtheria during the year. Anti-diphtheritic serum was used for the treatment of 2 cases, 24,000 unit3 being supplied. Scarlet Fever. There were 13 cases of Scarlet Fever notified as against 56 in 1939 and 10 of these were removed to hospital. This was also the lowest number of cases recorded in one year. The disease generally was of a mild type and there were no deaths. There were no "return" cases. Disinfection. Rooms fumigated 138 Mattresses disinfected 165 Blankets disinfected 1,599 Pillows disinfected 456 Miscellaneous articles disinfected 1,241 Bacteriological Work. Bacillus found. Bacillus not found. Total. Diphtheria. County Laboratory. 1 20 21 Diphtheria. Clinical Research Association. 3 3 Tuberculosis. County Laboratory. 14 83 97 Typhoid Fever. County Laboratory. - 1 1 Haemolytic streptococcus. County Laboratory. - 5 5 15 112 127 NOTIFIABLE DISEASES (other than Tuberculosis) during the year, 1940. Disease. Total cases notified. Cases admitted to Hospital. Total deaths. Scarlet Fever 13 10 — Diphtheria 7 7 - Puerperal Pyrexia 2 2 - Pneumonia 7 1 23 (all forms) Erysipelas 4 2 - Cerebro-spinal fever 6 6 — Measles 125 101 - Whooping Cough 5 4 -— Cancer. The Cancer death rate per 1,000 civilian population was 1.87 compared with 1.84 in 1939. Prevention of Blindness. Wo action was taken under Section 176, Public Health Act, 1935. 7. 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) 26 23 7 " (Females) 14 14 3 Totals 40 37 10 Non-Pulmonary (Males) Nil 3 1 " "(Females) Nil 1 1 Totals Nil 4 2 All the deaths from tuberculosis were of cases notified in this district. New Tuberculosis Cases and Mortality during 1940. Age Period, X New Cases. Deaths. Respiratory Non- respiratory. Respiratory Nonrespira tory. M F M F j; M F M F 0-1 1 - - - - - - - 1 - 5 2 2 - 3 - — - - 5-15 3 3 2 - •* - - — 15 — 25 6 9 1 1 — - 1 M 25-35 11 2 1 1 2 1 - — 35-45 6 1 — 4 1 - - 45 - 55 2 2 - — - - - 1 55-65 1 2 1 - - - 65 and upwards - - - - 1 - - Totals 32 21 4 • 5 7 3 1 1 X Cases previously notified in other districts and transferred to Penge are included in these figures. There were 175 cases of tuberculosis on the register at the end of the year as follows Male Female Total Pulmonary 71 67 138 Non-Pulmonary 22 15 37 93 82 175 X am, Mr.Chairman and Gentlemen, Your obedient Servant, B.E.HAWKINS. Temporary Medical Officer of Health. 8. Causes of Death in Penge Urban District, 1940. REGISTRAR-GENERAL'S FIGURES. Causes of Death. Males Females All Causes 176 213 1 Typhoid and paratyphoid fevers - - 2 Cerebro-spinal fever. - - 3 Scarlet Fever - - 4 Whooping Cough. - - 5 Diphtheria - - 6 Respiratory tuberculosis 7 3 7 Other forms of tuberculosis 1 1 8 Syphilitic diseases - - 9 Influenza - - 10 Measles - - 11 Acute Poliomyelitis and Polioencephalitis - - 12 Acute infective Encephalitis - - 13 Cancer of buccal cavity and Oesophagus (m) Uterus (f) - 2 14 Cancer of Stomach and Duodenum 5 6 15 Cancer of Breast - 3 16 Cancer of all other sites 15 10 17 Diabetes. - 5 18 Intra-cranial' vascular lesions 9 16 19 Heart disease 40 54 20 Diseases of circulatory system(other) 7 11 21 Bronchitis 10 7 22 Pneumonia (all forms) 13 10 23 Other respiratory diseases. 2 3 24 Ulcer of stomach or duodenum 1 2 25 Diarrhoea (under 2 years) 3 2 26 Appendicitis 1 1 27 Other digestive diseases 4 8 28 Nephritis 6 3 29 Puerperal and post-abortion sepsis - - 30 Other maternal causes - - 31 Premature birth 5 2 32 Congenital causes, etc. 2 3 33 Suicide 2 - 34 Road traffic accidents 3 1 35 Other violent causes 23 26 36 All other causes 17 34 Deaths of Infants under 1 year Total 13 12 Legitimate 12 12 Illegitimate 1 - Live Births Total 198 203 Legitimate 194 191 Illegitimate 4 12 Still Births Total 6 3 Legitimate 5 3 Illegitimate 1 - Civilian Population (estimated 1940 Registrar General) 21,820. 9. Notifiable Diseases (other than Tuberculosis) during the year 1940. Cases notified. At ages - Years. Cases admitted to Isolation 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 and upwards Scarlet Fever 13 - - 1 2 1 3 1 3 2 - - - 10 Diphtheria 7 - - 2 - - 1 2 1 - - 1 - 7 Puerperal Pyrexia 2 - - - - - - - - 2 - - - 2 Pneumonia 7 - - - - - - 1 1 - 1 3 1 - Erysipelas 4 - ~ - - - - - - - 1 1 2 2 Carebro-spinal Pever 6 1 - - — 1 - - 1 2 1 - - 6 Measles 125 12 25 24 17 10 19 6 5 5 2 - - 101 Whooping Cough 5 1 1 2 - 1 - - - - - - - 4 Totals 169 14 26 29 19 13 23 10 11 11 5 5 3 132 Deaths of notified cases - Cerebro-spinal fever, 1 aged 28 years. Diphtheria, 1 aged 3 years. 10. f Town Hall, Anerley, S.E.20. July, 1941, 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 (excluding that in connection with A.R.P.) for the year ending the 31st December, 1940. Two hundred and sixty written intimation notioes and 16 Statutory Notices were served under the Public Health Act, 1936. Two hundred and forty four Intimation Notices and 16 Statutory Notices were complied with. The Council did the work required by 18 notices served under Section 24 of the Public Health Act, 1936, Legal proceedings were taken for non-compliance with notices served regarding nuisances caused by general housing defects, v/ith the following results 1. Order made to comply with Notice within 14 days. Defendant ordered to pay £1.11.6. costs. 2. Order made to comply with Notice within 14 days. Defendant ordered to pay £2.2.0. costs. The drainage systems of 32 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. Slaughter Houses 1 16 - - Common Lodging Houses. 3 16 1 1 Houses Let in Lodgings 50 49 3 3 Dairies 9 32 1 1 Stables 22 25 1 1 Pried Pish Shops 7 15 - - Butchers' Shops 25 235 2 2 SUMMARY OP INSPECTIONS AND VISITS. The following summary shows the number of visits and inspections made:- Inspections through complaints received 335 Visits re cases of infectious diseases 73 Visits re transferable deaths 70 Visits re overcrowding and measurement of rooms 58 Houses let-in-lodgings and Common Lodging Houses 65 S1aughterhouses 16 Bakehouses 31 Dairies 32 Milkshops 22 Meat Shops 235 11. [&&&]Fish Shops 15 Ice Cream Shops 20 Other Pood Shops, Stores and Stalls 254 Urinals 25 Stables 25 Visits under Hats and Mice (Destruction) Act 123 Factories 70 Visits under Shops Acts 75 Smoke observations 16 Inspections and re-inspections of work in hand and various visits 1,320 Drain tests 52 SUMMARY OP WORK EXECUTED DURING THE YEAR. Water Supply:- Water supply re-instated to houses 21 Water service pipes repaired. 54 Cisterns cleansed, covered or covers repaired 3 Water Closets:- New pans and traps fixed 20 Flushing apparatus renewed or repaired 25 Foul pans and traps cleansed 10 Connections of flushing pipes to pans made good 11 Seats and doors provided or repaired 8 Ventilation provided or improved 2 Flooring or paving repaired 2 Drainage:- Drains tested with smoke, water or colour 52 Drains cleared 48 Houses with drains partially relaid 32 Inspection chambers constructed or improved 11 Soil and ventilation pipes fixed or repaired 8 Sinks, lavatory basins and baths provided 3 Waste pipes renewed or provided 4 Waste pipes repaired or trapped 12 Waste pipes cleared 7 Fresh-alr-inlets provided or repaired 2 Grids provided to gullies 4 Dampness:-Houses with - Walls re-pointed or rendered 5 Dampness in ground floor rooms remedied 12 Roofs repaired 62 Gutters repaired or renewed 15 Rain water pipes repaired or renewed 12 Ventilation under floors provided or improved 3 Water service pipes repaired 54 Window sills repaired 4 Cleanliness:- Dirty rooms, etc. cleansed 408 Verminous rooms fumigated 81 12. Miscellaneous:- Houses with defective floors, joists, etc. repaired 18 Houses with defective plaster repaired 55 Houses with new sash lines provided to windows 8 Houses with window frames, etc. repaired 9 Houses with yards or forecourts paved or repaired 4 Houses with scullery paving repaired 3 Houses with air bricks renewed 10 Houses with stairs repaired 3 Houses with fireplace jambs and mantels repaired 3 Ventilation and light of rooms provided or improved 2 Kitchen stoves repaired or renewed 10 Scullery coppers repaired or renewed 4 Other stoves repaired or renewed 4 Doors repaired or renewed. 10 New dustbins provided 21 Premises with miscellaneous defects repaired, etc. 12 Overcrowding abated 13 Animals removed 5 Accumulations removed 19 INSPECTION AND SUPERVISION OF FOOD. At the end of the year there were 9 premises registered as dairies. In addition, 37 persons were registered to sell milk in sealed containers only. The analysis of 54 informal samples of milk obtained during the year show the following average:- Fat 3.60 Solids not fats 8.79 The following licenses were issued under the Milk (Special Designations) Orders:- Dealers' Licenses:- Tuberculin tested milk 2 Pasteurised milk 4 Supplementary Licenses:- Tuberculin tested milk 2 Pasteurised milk 2 The following shows the amount of food surrendered and condemned from shops and stalls:- Beef 70 lbs. Pork 10 lbs. Mutton 6 5 lbs. Tinned Beef 6 lbs. Tinned Pork 64 lbs. Tinned Ham 1,021 lbs. Tinned Veal 84 lbs. Bacon 647 lbs. Fish 336 lbs. Lard 56 lbs. Tomatoes 209 lbs. Rabbits 73 lbs. Pork pie 1 lb. Total weight 2,642 lbs. 13. In addition, meat weighing 102 lbs. (of which 66 lbs. was' tuberculous) was condemned at the slaughterhouse and various articles of food'weighing approximately 13 cwts. 3 qtrs. 23 lbs." were condemned as a result of enemy action. The total weight of all food condemned was 1 tonv 18 cwts. 1 qtr. 23 lbs. Animal carcases inspected at the slaughterhouse totalled 74. Periodical visits were made to premises and stalls where foods are prepared, stored or exposed for1 sale and with a few exceptions, these were found to be kept in a satisfactory condition. Adulteration, etc. The Kent County Council administers the Pood and Drugs Act, 1938 in this District. Their Inspector took 92 samples of various foods during the year and, with one exception, all were found to be genuine. Factories Act, 1937. Visits paid to factories total 70 and in addition to verbal intimations regarding small dcfects, 4 written notices were served and complied with. Pvats and Mice (Destruction) Act, 1919. Complaints were received from various parts of the district and investigated, 123 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, and when considered necessary, the drains of premises were tested with smoke and any dcfects found made good. A considerable amount of time was spent by your Inspectors on work in connection with the A.R.P.Services of the district. I am, Mr.Chairman and Gentlemen, Your obedient Servant, R .T. PEARCE. Chief Sanitary Inspector. 14.