PENGE URBAN DISTRICT COUNCIL. ANNUAL REPORTS of THE MEDICAL OFFICER OF HEALTH and the CHIEF SANITARY INSPECTOR for 1945. Chairman:- Councillor A.Emery, J, P. Vice-Chairman:- Councillor G.J.Gully, J.P. PUBLIC HEALTH COMMITTEE. Chairman:- Councillor 0,E,Prince, Councillor H.Allder. Councillor F.\7. Foreman. Councillor R.C,S.Barnett, J.P. Councillor J.B.Geale, J,P. Councillor G.R.Deal. Councillor H.E.George. Councillor J.F.D.Dixon, Councillor F.P.Hodes, J,P. Councillor A.Emery, J,P. Councillor R.H.Jarvis. Councillor F.Theobald, Co-opted Members of Maternity and Child Welfare Section:- Mrs,M.Barson, Mrs.E,Jarvis, Miss Fannie Moore and Mrs,A,Theobald, Representatives on the Joint Maternity Hospital Committee:- Councillors R.C. S .Barnett, J.P., J.B.Geale, J,P., F.P.Hodes, J.P., O.E. Princej and Dr.YJ.M. Penny and Mrs .A.Theobald (Co-opted Members). BAR-TIME NURSERY COMMITTEE. Councillor A.Emery, J.P. (Chairman), Councillors R.C.S.Barnett,J,P. J.B.Geale, J.P., G.J.Gully, J. P., F. P. Hodes, J,P.* and Mrs, E. Jarvis (Co-opted Member). PUBLIC HEALTH DEPARTMENT. STAFF. * Temporary Medical Officer of Health:B. E.Hawkins, M. R.C.S. (Eng. ) , L.R. C. P. (Lond.). Chief Sanitary Inspector:R.T.Pearce, Cert.3.I.E.B. (Lond.), Cert.Insp. of Food, G.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 Visitors:- Miss D.Nicholson, S.R.N. , S.C.M., H.V's Cert,, T.A.Cert, Miss E.P.Eldridge, S.R.N., S.C.M., H.V's Cert, Clerks. * Miss A.G.Mitchell. Mrs,J.M.Maundrell. (Temporary). * Part-time Officer. « * » Town Hall, Anerley, S.E.20. July, 1944, 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, 1943, It is compiled in accordance with Circular 10 (1944) of the Ministry of Health and does not include matters connected with the Civil Defence Services. On the grounds of National Security, the population of the district estimated by the Registrar-General is not to be published in this report and in consequence, the number of births, deaths, etc. are not given, the information being restricted to the publication of birth and other rates. STATISTICS AND SOCIAL CONDITIONS OP THE AREA. Area (acres) 770 Population (Census, 1931) 27,771 Rateab1e value £206,142 Sum represented by 1d. rate £695 The Manager of the Employment Exchange informed me that there were 4 men and 7 women unemployed in the Penge Urban District at the end of the year, compared with 21 men and 6 women in 1942. The Cut-door relief given during the year amounted to £11,691 of which £374 was to able-bodied unemployed and their families and the balances to the unemployable from age or other causes. This compares with an amount of £9,405, of which £500 was to able-bodied unemployed and their families in the year 1942. VITAL STATISTICS. Birth rate per* 1,000 of estimated Civilian population, 19.3 Still-birth rate per 1,000 total (Live and still) births, 26.8 Crude death rate per 1,000 of the estimated Civilian population,15.3 Deaths from Puerperal causes:- Rate per 1,000 total (live and still) births. Puerperal sepsis Nil Other maternal causes Nil Death rate of Infants under one year of age: - All infants, per 1,000 1ive births 41.3 Legitimate infants, per 1,000 legitimate live births 35.8 Illegitimate infants, per 1,000 illegitimate live births 107.1 Births. The live birth rate per 1,000 civilian population was 19.3, compared with 20.4 for 1,942, Still-births. The rate per 1,000 total births was 26.8, compared with 13.3 for 1943. 1. Deaths. The crude death rate for the year equalled 15,3 per 1,000 civilian population, compared with 14.5 for 1942, Of the total deaths, 58.4% were of persons 65 years of age and over, compared with 58.7% the previous year. Cancer. The Cancer death rate per 1,000 civilian population was 2.60, compared with 2.42 in 1942. Maternal Mortality. There were no maternal deaths during the year. Infantile Mortality. The death rate of infants under one year of age was 41.3 per 1,000 births compared with a rate of 53.9 for 1942, Nine deaths occurred amongst infants who had attended the Child Welfare Centre. Comparative Vital Statistics. The following table shows the comparative figures for 1943. Rate per 1,000 Civilian Population. Death rate per 1,000 Civilian Population. Deaths under 1 year per 1,000 live births. LiveBirths. StillBirths. Penge Urban District 19.3 0.53 15.3 41 England and Wales 16.5 0.51 12.1 49 126 County Boroughs and Great Towns including = London 18.6 0.63 14.2 58 148 Smaller Towns (resident populations, 25,000 to 50,000 at Census, 1931) 19.4 0.61 12.7 46 London Administrative County 15.8 0.45 15.0 58 GENERAL FROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities. During the year the Council's motor ambulance responded to 801 calls; 444 for private removals and 357 for accidents and sudden illness. 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 Post-Natal Clinic on Wednesday mornings and one Monday afternoon in every four weeks. In order to cope with the increased attendances, an additional session of the Ante-Natal and Post-Natal clinic was held once in four weeks on Monday afternoons. This additional clinic commenced on the 22nd February, 1943. There was again a marked increase in the attendances at the Centre during the year, and the figures for 1942 and 1943 are as follows: - 2. Medical Officer's Consultations. 1942 1943 Infants 1,379 2,579 1,558 2,909 Nursing Mothers 361 335 Ante—Natal 750 889 Post-Natal 109 127 Health Visitors' Consultations. Children 6,394 8,106 Weighing of Children 5,708 7,280 Nursing Mothers 1,616 2,301 Expectant Mothers 441 470 Test feeds 116 160 Scabies 133 158 Miscellaneous - 60 Total attendance of children at the Centre 6 ,394 8,106 Individua1 children who at tended. 738 869 Average weekly attendance or children 122.9 155.8 Total attendance of Nursing Mothers 1,616 2,301 Individual Nursing Mothers who attended 256 288 Average weekly attendance of Nursing Mothers 31.0 44.2 Total attendance of Expectant Mothers 730 889 Individual Expectant Mothers who attended 255 280 Average weekly attendance of Expectant Mothers 14.0 17.1 Total attendance of Post-Natal Mothers. 109 127 Individual Post-Natal Mothers who attended 99 106 Average weekly attendance of Post-Natal Mothers 2.1 2.4 Dried Milk and otter foods for mothers and children are sold at cost price and during 1943, the receipts totalled £892. WAR-TIME NURSERY. An addition to the existing Nursery at 218, Anerley Road, was opened at 214, Anerley Road on the 10th May, 1943, the increased accommodation allowing for the reception during the day of 100 children between the ages of 0-5 years instead of 50 children as hereto fore. As from the 17th May, 1943, 218, Anerley Road was also used as a Night Nursery for the- reception of 8 children. This accommodation was increased to 12 children on the 3rd July, 1943. The attendances during the year were as follows;- Day Nursery (6 days per week). 0-2 years 2-5 years Total attendances. Average daily at tendances. Prom 1st January, 1943 to 9th May. 1943, (103 days) 1528 3018 4546 42.09 Prom 10th May, 194Z to 31st December, 1943 (198 days) 5788 8759 14,547 73.46 The highest daily attendance was 102 and the lowest 13. The Saturday attendances were well below the average for the other days of the week. 3. Night Nursery (6 nights per week). 0-2 years 2-5 years Total at tendances. Average nightly attendances From 17th May, 1943 to 31st December, 1943. (193 nights) 949 456 1405 7.28 Fortnightly sessions for the routine medical inspections of the children were commenced on the 18th May, 1943, Maternity Hospital. During the year 113 Penge cases were admitted to the Penge and Beckenham Joint Maternity Hospital, Stone Park Avenue, Beckenham. The following table gives the number of mothers admitted annually for the last five years:- Year Total cases admitted. penge cases. Beckenham cases. Other cases. 1939 246 48 198 - 1940 405 102 303 - 1941 310 79 228 3 1942 570 119 447 4 1943 571 118 453 - The average period spent in the home during the year by each patient was 13.6 days. Maternity cases sent to the County Hospital, Farnborough, Kent, through' the Council's Ante-Natal Clinic totalled 39 and 12 patients were evacuated under the London County Council's scheme for Expectant Mothers. Health Visiting. Two Health Visitors were employed and the following shows the number of visits paid:- First visits to infants under one year 360 Subsequent visits to infants under one year 1,657 Visits to children between the ages of 1 and 5 years 1,851 Visits to expectant mothers 403 Visits to post-natal mothers 187 Visits to Tuberculosis cases 315 Visits to foster children. 54 Visits re Diphtheria Immunisation 323 Visits re Scabies 87 Measles 47 Whooping Cough 37 Miscellaneous visits 264 5,585 Child Life Protection. Number of foster parents on the Register: (a) at the beginning of the year 5 (b) at the end of the year Number of foster children on the Register: (a) at the beginning of the year 6 (b) at the end of the year 5 (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 7 0 cases. HOUSING. There were no houses or flats erected during the..year. One house was converted into two flats. 1. Inspection of dwellinghouses dearing the year: (1) (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 590 (b) Number of inspections made for the purpose 650 (2) (a) Number of dwe11inghouses (included under subhead (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932. 9 (3) Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwe11inghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 550 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 534 3. Action under Statutory Powers: (a) Proceedings under Section 9 of Housing Act, 1936. Nil (b) Proceedings under Public Health Acts. (l) 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 15 (b) by Local Authority in default of Owners 1 5. 4• Housing Act, 3-956 " Overcrowding: Number of cases of overcrowding relieved during the year 1 PREVALENCE OF, and CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Diphtheria. For the first time since Ponge became an Urban District, no cases were notified. Diphtheria Immunisation. The following table gives the attendances, etc. during the year 1943. Under 5 years. Over 5 years. Totals. First Inoculations 239 69 308 Second Inoculations 218 134 352 Schick Tests 243 181 424 Children who received complete course of Immunisation 218 134 352 Scarlet Fever. There were 39 cases of Scarlet Fever notified (as against 28 in 194 2) and 35 of these were removed to Hospital. The disease generally was of a mild type, and there were no deaths. One "return" case was notifed. Scabies and Verminous Heads. There was an increase in the number of cases of scabies. Patients (other than school children) who attended at the Maternity and Child Welfare Centre for treatment numbered 377 and they received 963 treatments. Between the 1st November, 1943 and 31st December, 1943, 87 school children received 377 treatments. Persons affected with head lice totalled 48 (of whom 18 were school children) and they received 230 treatments. Information regarding school children treated prior to the 1st November, 1943, will be found in the School Medical Officer's report. Disinfection. Rooms fumigated 122 Mattresses disinfected 251 Blankets disinfected. 627 Pillows disinfected 319 Miscellaneous articles disinfected 411 6. Bacteriological Work. Bacillus found Bacillus not found. Diphtheria, County Laboratory. - ? Diphtheria. Clinical Research Association. - 6 Tuberculosis. County Laboratory. 6 ? On the grounds of economy, copies of the reports on specimens sent to the County Laboratory which prove to be negative are not forwarded to local medical officers of health. Pour samples of water from dwellinghouses in the district were analysed during the year and in each case the water was satisfactory. NOTIFIABLE DISEASES (other than Tuberculosis) during the year 1943. Disease Total cases notified. Cases admitted to Hospitals. Total deaths. Scarlet Fever 39 35 — Diphtheria - — — Puerperal Pyrexia 1 — — Pneumonia 21 6 17 (all forms) Erysipelas 2 — Dysentery (Sonne) 1 1 — Measles 108 2 1 Whooping Cough 72 4 1 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 ) 10 8 10 '' (Females) 11 11 2 Totals 21 19 12 Non-Pulmonary (Males) 1 2 1 '' (Females) 3 2 1 Totals 4 4 2 Pour of the deaths from tuberculosis wore of cases not notified, three of whom died in hospitals outside the district. 7. New Tuberculosis Cases and Mortality during 1S43. Age Period * New Cases Deaths Pulmonary NonPalmonary Pulmonary NonPulmonary M F M F M F M F 0 — 1 - - - - - - - - 1 - 5 - - 1 1 - - l 1 5 — 15 1 2 - 2 - 1 1 - 15-25 2 8 - 2 - - - - 25 - 35 4 3 - - 1 1 - - 35-45 3 2 - - 5 - - - 45-55 4 - - - 2 - - - 55 - 65 - - - - 1 - - - 65 and upwards 2 - - - 1 - - - Totals 16 15 1 5 10 2 1 1 * Cases previously notified in other districts and transferred to Penge and those restored to the Register are included in these figures There were 152 cases of tuberculosis on the Register at the end of the year, compared with 161 in 1942. Male Female Total. Pulmonary 59 68 127 Non-pulmonary 13 12 25 72 80 152 I am, Mr.Chairman and Gentlemen, Your obedient Servant, B.E.HAWKINS. Medical Officer of Health. Notifiable Diseases (other than Tuberculosis) during the year 1945. Gases notified At ages - years. Cages admitted to Isolation Hospitals. At all ages Under 1 1 to 2 2 to 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 39 1 2 4 5 7 14 4 - 2 - - - 35 Puerperal Pyrexia 1 - - - - - - - - 1 - - - Pneumonia 21 - - - 1 1 - - 5 1 6 9 - Erysipelas 2 - _ - - - - - 1 - - 1 - Dysentery (Sonne) 1 - - - - - 1 - - - - - - 1 Measles 108 6 16 17 12 18 29 7 - 3 - - 2 Whooping Cough 7 2 6 11 12 8 15 20 2 - - - — - 4 Totals 244 13 29 33 25 59 65 15 - 10 1 6 10 42 Deaths of notified cases - Pneumonia:- 3, aged 82, 79 and 68 years respectively. Whooping Cough:- 1, aged 16 months. 9. Town Hall, Anerley, S.E. 20, July, 1944. 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 of the work of the Sanitary Inspectors (excluding that in connection with Civil Defence) for the year ending the 31st December, 1943. In addition to verbal intimation of defects found in premises, 414 written intimation notices and 16 statutory notices were served under the Public Health Act, 1936. There hundred and ninet;y - eight intimation notices and 16 statutory notices were complied with. The Council did the work required by 22 notices served under Section 24 of the Public Health Act, 1936, respecting 35 orchises and one notice served under Section 39 of the Publics Health Act, 1936, Legal proceedings were taken for non~comp]iance with notices served regarding statutory nuisances caused by housing defects, with the following results: - 1. Non-compliance with Nuisance Order. Fined £3.0.0. with penalties of 10/- per day for 44 days and £3.3.0. costs, a total of £28.3,0, 2. Orders made to comply with Notices within one month and to pay £3 3.0 costs and Court costs. The drainage systems of 60 houses were partially relaid and 90 cleared. The shortage of labour and materials necessitated attention being given only to the more serious items of disrepair in houses. PREMISES OR OCCUPATIONS WHICH CAN BE CONTROLLED BY BYELAWS OR REGULATIONS. No, in District. No. of visits. Notices served. Notices complied with. Common Lodging Houses 3 30 - - Houses Let-in-Lodgings 50 66 7 7 Dairies 8 30 - - stables 20 85 1 1 Butchers Shops 23 94 3 3 SUMMARY OF INSPECTIONS AND VISITS. The following summary snows the number of visits and inspections made:- Inspections through complaints received 523 Infectious diseases. 86 Transferable deaths 96 Overcrowding and measurement of rooms 51 10. Houses let-in-lodgings and Common Lodging Houses 96 bakehouses 34 Dairies and milkshops 53 Meat shops 94 Milk samp1ing 12 Fish frying shops 12 Other Pood Shops, Stores and Stalls 283 Urinals 48 Stables and piggeries 85 Rats and Mice (Destruction) Act 661 Factories 94 Shops Acts 62 Marine stores 10 Schools 12 Inspections and re-inspections of world in hand 1,515 Miscellaneous visits 143 Dram tests 117 Civil Defence Services 152 SUMMARY OP WORK EXECUTED DURING THE YEAR. Water Supply:- Water supply re-instated to houses 19 Water service pipes repaired 50 Cisterns cleansed, covered or covers repaired 3 Water Closets:- New pans and traps fixed. 38 Flushing apparatus renewed or repaired 32 Foul pans and traps cleansed 8 Connections of flushing pipes to pans made good 15 Seats and doors provided or repaired. 15 Ventilation provided or improved 4 Flooring or paving repaired 5 Drainage:- Drains tested with smoke, water or colour 117 Drains cleared 90 Houses with drains partially relaid 60 Inspection chambers constructed or improved 12 Soil and ventilation pipes fixed or repaired 6 Sinks, lavatory basins and baths provided 4 Waste pipes renewed or provided 5 Waste pipes repaired or trapped 22 Waste pipes cleared 11 Fresh-air-inlets provided or repaired 5 Rainwater pipes disconnected from drain 1 Dampness:- Houses with - Walls re-pointed or rendered 10 Dampness in ground floor rooms remedied 21 Roofs repaired 108 Gutters repaired or renewed 27 Rainwater pipes repaired or renewed 24 Ventilation under floors provided or improved 3 Water service pipes repaired 50 Window sills repaired 4 Cleanliness:- Dirty rooms, etc. cleansed 271 Verminous rooms fumigated 60 Miscellaneous: - Houses with defective floors, joists, etc. repaired 55 Houses with defective plaster repaired 105 Houses with new sash lines provided to windows 19 Houses with window frames, etc. repaired 24 Houses with yards or forecourts paved or repaired 4 11. Miscellaneous (continued):- Houses with scullery paving repaired 3 Houses with air bricks renewed 15 Houses with stairs repaired 8 Houses with fireplace jambs and mantels repaired 4 Kitchen stoves repaired or renewed 11 Scullery coppers repaired or renewed 5 Other stoves repaired or renewed 19 Doors repaired or renewed 15 Ventilation and lighting of rooms improved 13 Chimney stacks repaired, 7 New dustbins provided 27 Premises with miscellaneous defects repaired, etc. 32 Overcrowding abated 1 Animals removed 5 Manure receptacles provided 1 Wasps nests destroyed 4 Accumulations removed 22 INSPECTION AND SUPERVISION OF FOOD. The analysis of 12 informal samples of milk obtained during the year, all of which were genuine, show the following satisfactory average:- Fat 3.92% Solids, not fat 3.86% The following licences were issued under the Milk (Special Designations) Orders Dealers' Licences:- Tuberculin tested milk 1 Pasteurised milk 3 Supplementary Licences 'tuberculin tested milk 4 Pasteurised milk 4 The following shows the amount of food surrendered and condemned from shops and stalls:- Bacon 72 lbs. Custard powder 7 pkts. Mutton 36 lbs. Pudding mixture 4 pkts. Beef 199 lbs. Oranges 20 lbs. Fish 231 lbs. Eggs 43 Sausages 7 lbs. Sauces 5 bots. Liver Meat 3 lbs. Salad cream 3 bots. Tinned Meat 452 tins. Pickles 2 bots . Tinned meat & vegetable 534 tins. Bread 7 lbs. Tinned Milk 53 tins. Cereals 60 lbs. Tinned Vegetables 51 tins. Biscuits 4 lbs. Tinned Fruits, 43 tins. Dried fruit 40 lbs. Tinned Soup 2 tins. Mincemeat 1 lb. Jam 113 lbs. Flour 65 lbs. Cheese 21 lbs. Coffee essence 2 bots. Rabbits 461 lbs. Cocoa ½ lb. Chickens 150 lbs. Cake 10 lbs. Meat & fish paste 6 jars. Split peas 4 lbs. Tinned Fish 43 tins. Approximate weight of food condemned:1 ton, 4 cwts. 0 qtrs. 13 lbs. 12. Periodical 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. Defects found at 11 food premises were remedied. Adulteration, etc. The Kent County Council's Inspector took 96 samples of various foods in this district during the year and all were found to be genuine. Your Inspectors obtained 12 informal samples of milk, all being genuine. Factories Act, 1957. Visits paid to factories total 94 and in addition to verbal intimations regarding small defects, 7 written notices were served and complied with. Rats and Mice (Destruction) Act, 1919 and Infestation Order S.R.0. 1945. Complaints were received from various parts of the district and investigated, 661 visits being made in this connection. When considered necessary, the drains of premises were tested with smoke and any defects found made good. During December, pre-bait and poisoned baits were laid in the manholes and side entrances of the foul water sewers in the district, and it is estimated that at least 2,760 rats were killed in consequence of this first complete treatment .of the foul sewers. The number of rats killed in other premises during the year is estimated to be at least 2,000. I am, Mr.Chairman and Gentlemen, Your obedient Servant, R.T.PEARCE. Chief Sanitary Inspector* 13.