CHI 20 CHISLEHURST AND SIDCUP URBAN DISTRICT COUNCIL REPORT OF THE MEDICAL OFFICER OF HEALTH 1948 TONBRIDGE FREE PRESS. LTD 129 High Street. Tel 2318 CHISLEHURST AND SIDCUP URBAN DISTRICT COUNCIL REPORT OF THE MEDICAL OFFICER OF HEALTH 1948 TONBRIDGE FREE PRESS. LTD 129 High Street Tel 2318 Urban District Council of Chislehurst and Sidcup PUBLIC HEALTH COMMITTEE. Chairman E. O'SULLIVAN, Esq. Vice-Chairman - - P. A. SHAW, Esq. CHAIRMAN OF THE COUNCIL. Mrs. I. BROOK. H. N. BEECHER BRYANT, Esq. J. BUTCHER, Esq. P. C. CARTER, Esq. E. J. GRANT, Esq. VICE-CHAIRMAN OF THE COUNCIL. Miss B. H. JAMES. G. T. JONES, Esq. J. C. ROBSON, Esq. Mrs. E. V. WALLACE. W. WILLIAMS, Esq. STAFF of the HEALTH DEPARTMENT as at 31/12/48. MEDICAL OFFICER OF HEALTH: K. E. TAPPER, O.B.E., G.M., M.B., Ch.B., D.P.H. SANITARY INSPECTORS: A. V. B. ALLEN, M.R.S.I., M.R.I.P.H.H., M.S.I.A. Chief Sanitary and Shops Inspector. J. C. KERMODE, C.R.S.I., M.S.I.A., Deputy Chief Sanitary and Shops Inspector. E. C. BERWICK, C.R.S.I., M.S.I.A., District Sanitary Inspector. D. W. FOSTER, M.R.S.I., M.S.I.A., District Sanitary Inspector. J. W. P. HARRIS, C.R.S.I., M.S.I.A., District Sanitary Inspector. CLERICAL STAFF: W. J. WATLING. Miss C. DEVONSHIRE. 2 Urban District Council of Chislehurst and Sidcup PREFATORY LETTER TO THE CHAIRMAN AND MEMBERS OF THE COUNCIL. Ladies and Gentlemen, I have pleasure in submitting to you my Annual Report for the year 1948, this being the first submitted by me since taking up my duties as your Medical Officer of Health on the 1st August, 1948, subsequent upon the retirement of Dr. P. N. Cave, who for so long served you so loyally with such notable skill and ability. By virtue of the National Health Act, 1946, much of the work brought to fruition by Dr. Cave was transferred to the administration of the County Council on 5th July last, and this has made more difficult my task of reporting to you on the work of the Health Department during the year 1948. Under the scheme of divisional administration, your Authority has lost functions previously administered by it, but it should be realised that there is still a vast field of work !to be explored in Public Health, so long as one has not too narrow a conception of the definition of Public Health, which includes investigation of, and care for, the general social conditions of the populace, with the accent always on prevention. I lay great stress on the previous paragraph in the hope of allaying, to some extent at least, the fear that local enthusiasm and incentive are being entirely stifled by recent changes. Elsewhere in the report will be found a resume of the services rendered by the County scheme through their divisional administration as they concern the inhabitants of Chislehurst and Sidcup. There is a further matter of Public Health importance on which attention has been focussed during the last year, and to which further detailed consideration will have to be given in the near future. I refer to the question of the hygiene of food preparation and handling. Mr. Allen and the District Sanitary Inspectors have commenced a thorough investigation of the local cafes, restaurants, canteens and kitchens, where food is prepared for communal feeding, and I hope to be in a position to give a full account of their findings in my next Annual Report. 3 The importance of the above investigation cannot be overestimated, as with the ever-increasing tendency for people to have their main meal away from home, there is a grave and ever-present danger of a big outbreak of food poisoning should the standard of hygiene of the persons and premises dealing with the preparation and handling of food fall below the highest attainable. As has already been stated, this investigation is being undertaken by Mr. Allen and the Inspectors, and I should like to take this opportunity of expressing my deep appreciation of the unfailing efficiency and loyalty of Mr. Allen, upon whose shoulders devolves the main responsibility for the routine running of the Public Health Department. At this point in my report, I should like to draw your attention to an outbreak of acute poliomyelitis (infantile paralysis), which occurred in August in a residential training school for children's nurses, affecting four students and one baby. This training school had some 56 student nurses in residence, 30 resident children, and a 40-unit day nursery. Although the infection was severe, one of the student nurses dying from poliomyelitis, it was actively controlled in spite of the many difficulties associated with a residential establishment with close and daily contact. The fact that the first case recorded occurred while the patient was on holiday in another part of the country, and that some eight days elapsed before the information was received, raised a problem at the time as to whether the infection originated in the school. The usual precautions, however, were taken, and the school placed " in isolation." Sixteen days after the first case had left the school, a second—and ultimately fatal—case was notified with unreported illness of two days previously. The parents of all children and students were advised of the infection in the school, and, if they so wished, to take their children home after advising their own doctors and the local Medical Officer of Health. With few exceptions parents so decided. Ten days later a third case arose. The fourth case, a student nurse, occurred five days later and was admitted to hospital. This proved to be an abortive attack. Nine days later the fifth case, a baby of eight months who had left the nursery seven days before, was notified as a mild case. This was the end of the infection, and all investigations carried out failed to prove the cause of the origin of the infection. The school was re-opened a month later. 4 Coincident with the above infection, three cases of poliomyelitis were notified in the Urban District, none of which had any relationship with the infection in the school. I have endeavoured in this Annual Report to dispense with a mere tabulation of statistics, and to make the report more discoursive in character. In the interests of clarity, it is divided into the following sub-sections— A. Social Conditions of the Area, including Vital Statistics. B. Summary of Health Services. C. Sanitary and Environmental Circumstances. D. Housing. E. Food Protection. F. Infectious Diseases. G. Other Services of the Health Department. Finally, may I be permitted to put on record my profound appreciation of the assistance rendered by Dr. P. N. Cave at the time of my taking over his duties, and also of the help at all times so willingly given by the Clerk, Officers and Committee, without which my task would have been so much more difficult. I have the honour to be, Your obedient servant, K. E. TAPPER, Medical Officer of Health. SECTION A. SOCIAL CONDITIONS OF THE AREA. The Urban District of Chislehurst and Sidcup, comprising 8,957 acres, was formed in 1934, and now has a total population of 72,750. The reconstituted districts of the Authority were: Part of Chislehurst Urban District, Sidcup Urban District, Parish of Mottingham, Parish of North Cray, part of the Parish of St. Paul's Cray, part of the Parish of Orpington, part of the Parish of St. Mary Cray, part of the Bromley Municipal Borough, and part of the Urban District of Bexley. The area is mainly residential in character, 5 SUMMARY OF VITAL AND OTHER STATISTICS. Area in acres 8,957 Registrar-General's estimate of population (mid-year 1948) 72,750 Number of valuation assessments of habitable premises at the close of the year (approx.) 21,000 Rateable Value (31st December, 1948) £563,076 Product of a Penny Rate for the year ending 31st March, 1949) £2,063 Live Births: Total. Male. Female. Legitimate 1,156 581 575 Birth Rate 16.4 per Illegitimate 41 19 22 1,000 population. 1,197 600 597 Stillbirths: Total. Male. Female. Legitimate 26 14 12 Stillbirth Rate 23.4 Illegitimate 2 1 1 per 1,000 births. 28 15 13 Deaths: Total. Male. Female. Death Rate 9.1 per 659 327 332 1,000 population. Deaths from Puerperal Causes: Puerperal Sepsis 2 Maternal Mortality Other Maternal Causes 1 Rate 2.5 per 1,00C live births. Deaths of Infants under one year of age: Total. Male. Female. Legitimate 20 15 5 Infant Mortality Illegitimate Rate 16.7 per 1,000 live births. 20 15 5 Death Kates of Infants under one year of age: All infants per 1,000 live births 16.7 Legitimate infants per 1,000 legitimate live births 16.7 Illegitimate infants per 1,000 iliegitimate live births Nil 6 POPULATION. The Registrar-General's figures shew the population at mid-year 1948 to be 72,750, which equals approximately eight persons per acre. The population continues to increase at a steady rate, having been 70,580 in 1947 and 67,870 in 1946. As it is now some eighteen years since the last Census was taken, it is impossible to give the details which a Census provides and which are of such importance in practising preventive medicine. The vital statistics of a comparatively small area may appear to give too small a sample to be of much value, but it is only by the comparison of the figures for comparative populations that one can separate the "good" areas from the "bad" ones, and thereby give the Medical Officer of Health and his staff the information necessary to them before they can conduct any research into the needs of the "bad" areas. A problem which has arisen in recent years, and one which is likely to become greater with the passage of time, is that of the increasing numbers of elderly people in the community. Here again one must have a knowledge of the appropriate vital statistics before geriatrics can come into its own and assist in the care and treatment of the elderly. BIRTHS. The rate of 16.4 per 1,000 population is given by the Registrar-General, which shows a fall compared with recent years. The average yearly birth rate since 1934 is 17.7 per 1,000 population, so this year's rate compares unfavourably with previous years. In the years following a war it is usual for the birth rate to rise steeply, but the summit has probably been reached now, and a steady fall is to be expected. The excess of births over deaths was 538. There were 149 births in Nursing Homes in the district, but the figures for home confinements are not available, as they are not kept separately for the Chislehurst and Sidcup area at Maidstone, but as a total figure for the whole of No. 7 Area, comprising Penge, Beckenham, Bromley, Chislehurst and Sidcup, and Orpington. Illegitimate Births. The illegitimate birth rate for 1,000 births for 1948 was 3.5. This figure is a variable quantity from year to year, but reached its highest level of the past 14 years in the later years of the war. Stillbirths. The stillbirth rate for the year was 23.4 per 1,000 births, which shews a decline from the average over the previous 14 years. But this again is a figure which varies considerably from year to year. 7 DEATHS. There were 659 deaths in 1948, giving a death rate of 9.1 per 1,000 population. This compares unfavourably, but not significantly so, with the previous year's figures of 8.9, and is below the average for the past 14 years, namely, 9.5. There follows a table of the main causes of death. The ages at death shew that 60% were 65 years and over. Causes. Cancer Heart and Circulatory Diseases 313 Respiratory Diseases (not Tuberculosis) 54 Tuberculosis 45 Infectious Diseases 9 Accident 22 Suicide 12 Digestive Diseases 23 Other Causes 65 Perhaps the most significant fact emerging from the above table is the number of deaths from digestive diseases. This would tend to confirm the commonly expressed opinion that gastric and duodenal diseases are on the increase. The fact that there were 23 deaths from digestive diseases, which are not particularly mortal complaints, suggests that the number of sufferers must be legion. INFANT DEATHS. There were 20 deaths of infants under one year of age, giving a very low Infant Mortality Rate of 16.7 per 1,000 live births. It is perhaps unfortunate that it is impossible to investigate the reasons for this low rate, as the Maternity and Child Welfare services do not come within the province of your Council, and your Medical Officer of Health is therefore not armed with sufficient information about the family and environmental circumstances or with adequate medical details. The Infant Mortality Rate for Chislehurst and Sidcup compares very favourably with the average rate of the past 14 years of 37 per 1,000 live births. MATERNAL MORTALITY. The maternal mortality rate has risen, being 2.5, and thus compares with a rate of .6 for the previous year. At first sight this might appear to be an alarming increase, but it actually represents three maternal deaths, whereas there was only one in the previous year. Even a small increase in the number of maternal deaths gives a comparatively inflated Maternal Mortality Rate. 8 SECTION B. SUMMARY OF HEALTH SERVICES. General social conditions and environment are the main considerations of a Public Health service, while the chief function of a Health service is the treatment of disease. The science of therapautics is not so advanced that we can afford to scorn the old adage that "prevention is better than cure," hence the importance of such factors as adequate housing, street cleansing, removal of house refuse, efficient drainage, a wholesome water supply, and safe food supply, most of which functions are the responsibility of your Council. There follows a short statement of services and facilities available in your district for treatment of diseases and for the promotion of positive health. I. HEALTH SERVICES RENDERED BY THE COUNCIL. With effect from 5th July, 1948, such services as diphtheria immunisation, home visiting of infectious diseases, tuberculosis, etc., by Health Visitors, passed from the control of your Council to that of the County Council. Sanitary and Environmental Services. These, which are the main services of your Health Department, have been reported upon in Sections C, D, E, F and G. A summary of the year's work is in the Appendix. Inspection of Nursing Homes. This service has been delegated to your Council by the County Council. The six Nursing Homes in the area provide the following accommodation:— Number of maternity beds 19 Number of other beds 26 Number of patients received during the year 223 Eight inspections were carried out at these Homes during the course of the year, and there were no serious infringements of the Local Bye-Laws. II. SERVICES RENDERED BY HOSPITAL BOARDS. There are three hospitals in Chislehurst and Sidcup— Queen Mary's Hospital with 510 beds, Cray Valley Hospital with 31 beds, and Sidcup Cottage Hospital with 14 beds, giving a total of 555 hospital beds available in the district. They form part of the Sidcup and Swanley Hospital Group of the S.E. London Region. 9 In addition to these, six blocks of Grove Park Hospital lie within the Chislehurst and Sidcup U.D. These blocks, which are, of course, not entirely used for patients coming from Chislehurst and Sidcup, have approximately 240 beds, all of which are used for cases of tuberculosis. They form part of the Woolwich Hospital Group. III. SERVICES RENDERED BY THE COUNTY COUNCIL. It is impossible to give statistical details of these services, as the figures are kept at Maidstone, and those for Chislehurst and Sidcup are included in the figures for Area 7 as a whole. Chislehurst and Sidcup has three representatives on the Area 7 Health Services Sub-Committee, which supervises the services provided by the County Council. Health Visiting. The County Council employ eight Health Visitors to work in Chislehurst and Sidcup. Their functions include advising expectant and nursing mothers; also advising on the care of young children. In addition they have duties in connection with the School Health Service, immunisation, vaccination, etc. Midwifery (Domiciliary). There are seven midwives engaged whole-time on domiciliary midwifery. They are engaged either by the patient directly, or through the latter's doctor, and act either as midwives or maternity nurses. Home Nursing Service. This service provides trained nurses for patients requiring nursing in their own homes, and became free with effect from 5th July, 1948. A medical certificate has to be submitted before a nurse can attend, and at the moment there is no night service. There are six Home Nurses in the Chislehurst and Sidcup area. Domestic Help Service. Number of helpers employed at 31/12/47 26 (part-time, at 30/ 6/48 43 at 31/12/48 59 Number of cases assisted during 1948 265 10 This service undoubtedly satisfies a long-felt want, and is expanding steadily. In cases where the housewife is unable to carry on owing to illness, the provision of a domestic help may make all the difference to a family which might otherwise be harassed and worried almost beyond human endurance. This service also provides domestic help during a home confinement—a service which is invaluable. Child Welfare Centres. Chislehurst: The Willows, Red Hill Tues. & Thurs. p.m. Test Feeds Tues. a.m. Footscray: W. Smith Memorial Hall Tues. p.m. Mottingham: St. Edward's Hall, Mon. & Wed. p.m. St. Keverne Road Sidcup: The Oval, Sherwood Park Ave. Tues., Wed. & Fri. p.m. Congregational Church Hall Mon. & Wed. p.m. Ante-Natal Clinics. Chislehurst: The Willows, Red Hill Wed. p.m. Mottingham: St. Edward's Hall, Mon. & Wed. a.m. St. Keverne Road Sidcup: The Oval, Sherwood Park Ave. Tues. & Fri. a.m. Congregational Church Hall Wed. a.m. Thurs. p.m. Women's Welfare Clinics. Chislehurst: The Willows, Red Hill Tues. a.m. Mottingham: St. Edward's Hall, 1st Thur3 p.m. St. Keverne Road Sidcup: The Oval, Sherwood Park Ave. 3rd Thurs. p.m. 1st Thurs. a.m. Congregational Church Hall 3rd Thurs. a.m. Post-Natal Physiotherapy. Classes for post-natal exercises are held each week on a Thursday evening at Day's Lane Primary School, Sidcup. These classes, which are in charge of a physiotherapist, are very well attended. Minor Ailment Clinics (Schools). Chislehurst: The Willows Sat. mornings. Mottingham: St. Edward's Hall, 2nd & 4th Sat. a.m. St. Keverne Road Sidcup: Longlands School, 1st Sat. a.m. Woodside Road Congregational Church Hall Thurs. a.m. 11 Dental Clinics. The Willows, Red Hill Wed. & Thurs. (all day). 218, Court Farm Road, Mottingham Mon. & Fri. (all day). Baptist Church Hall, Sidcup Every day. Immunisation and Vaccination. These services are conducted at Child Welfare Centres, and at "Charmouth," Eim Road, Sidcup, on Tuesday afternoons. Ambulance Service. There is an ambulance depot at the Council Offices, Main Road, Sidcup, where there are three ambulances and one sitting-case car. It is locally administered through the District Officer stationed at 2, Alma Road, Sidcup. Laboratory Service. Routine medical specimens, and samples of food and milk, are examined at Maidstone Laboratory. Day Nurseries. There are three day nurseries, situated at Day's Lane, Sidcup; 67-69, Sidcup Hill; and Beaconsfield Road, Mottingham, accommodating a total of 180 children daily. Specialist Clinics. The Willows, Red Hill Child Guidance. Queen Mary's Hospital, Sidcup Ear, Nose and Throat. The Willows, Red Hill Ophthalmic. Queen Mary's Hospital, Sidcup Orthopaedic. The Willows, Red Hill Speech Defects. Medical Loan Depot. Arrangements have been made with the British Red Cross Society for the continuation of the Medical Loan Depots. The full range of nursing requisites is available at these depots, which are additional to the loan cupboards kept by Home Nurses. Applications for loans of such equipment for Chislehurst and Sidcup inhabitants should be made to: The Manor House Hall, Tuesday 3—4 p.m. Sidcup Green, Sidcup Thursday 7 -8 p.m. 56, Woodside Avenue, Chislehurst Monday 3—4 p.m. Thursday 6.30—8 p.m. 12 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. WATER. The Director of Water Examination of the Metropolitan Water Board has kindly supplied the following information: (1) No new source of public water supply has been instituted in the Council's area during 1948. (2) There have been no extensions of trunk mains. (3) Considerable lengths of service mains have been laid on the London County Council's St. Paul's Cray Estate. (4) The water supply has been satisfactory as regards quantity at all times in 1948, and is derived from the following seven wells: Orpington, North Orpington, Shortlards, Eynesford, Bexley, Wilmington and Darenth, together with Thames-derived filtered water via Shortlands. Bacteriological analyses of these sources of supply are made at least five times a week and consistently satisfactory results have been obtained. Chemical analyses of the supplies are also made at regular intervals. All supplies are treated with chlorine on the works, but any excess remaining after a period of contact is removed completely or reduced to an amount that will not be perceptible to consumers. Tanks have been installed at North Orpington and Bexley to ensure an adequate contact of chlorine with the water; tank3 at other well stations are planned or in the course of construction. All new and repaired mains are disinfected with chlorine before being restored to supply, and samples of water from them are analysed to establish that it is up to the normal standard of quality expected in the distribution system. None of the supplies is plumbo-solvent. We have no information with regard to the proportion of the total number of dwelling-houses and population in Chislehurst and Sidcup which are supplied from the above-mentioned sources. All the houses are supplied directly and not by means of stand-pipes. Appended are the results of chemical and bacteriological analyses of the various supplies to Chislehurst and Sidcup during 1948. DRAINAGE. The West Kent Sewerage Board are the responsible authority for the main drainage of Chislehurst and Sidcup. There have been no important additions or improvements to the drainage, sewerage or sewage disposal facilities during the past year. As far as is known, there are 479 premises in the district not drained to sewers. Ten have chemical closets, seven have earth closets, and the rest cesspools. Owners or occupiers make private arrangements with a Maidstone firm for emptying cesspools. The charge is 23/- for the first 1,000 gallons, and 20/- for each subsequent 1,000 gallons of sewage emptied. RIVERS AND STREAMS. The main watercourses are the rivers Quaggy, Cray and Shuttle, and a total number of 82 inspections were carried out on them during the year. In addition, the watercourse from Corbylands Road to Wincham Stream has been piped with 18in. concrete tubes. FACTORIES AND WORKSHOPS. There are 134 factories with mechanical power, and 15 without, in the district, and 394 visits were paid to them during the year. A close liaison is maintained between the Sanitary Inspectors and the Factories Act Inspector. OUTWORKERS. 97 visits were paid in connection with outworkers in the district during the year. They were all employed by firms outside the district. No firms in the district employ any outworkers. SMOKE ABATEMENT. During the year 19 inspections and observations were made in connection with the emission of smoke from industrial premises, and no cases needed enforcement of local bye-laws in respect of smoke emission. PIGGERIES. There are 9 piggeries in the district, to which 77 visits were made during the year. 12 defects were found and remedied. 14 SHOPS ACTS. 489 inspections of shops were made during the course of the year, and 25 informal notices were served in connection with the Shops Acts. The total number of shops in the district is 634, and the following defects were remedied:— Ventilation at two shops was improved. Temperature at four shops was made equable. Sanitary accommodation or additional sanitary accommodation was provided at 10 shops. Better lighting was provided at one shop. Proper washing facilities were provided at six shop premises. In one cafe proper facilities for taking meals were provided. Action had to be taken in three cases over the question of working hours. In 24 instances, shopkeepers were not keeping, exhibiting or providing the necessary notices or records. CLEANSING OF PERSONS. A unit is established at Chislehurst Caves for the treatment of scabies and cleansing of verminous persons. Number of persons cleansed in 1948 28 Number of persons treated for scabies 60 BED BUGS. During the year 39 complaints were received of infestation of premises by bed bugs. The number of houses and/or their contents found to be infested was 29 (including 7 in the Council's possession). In suitable cases, and on the request of tenant and owner, the disinfestation of the premises and contents were simultaneously carried out by the Health Department. In all other cases the premises were disinfested by the owners, and the contents by the tenants. In all necessary cases, bedding was steam disinfected by the Department. SANITARY INSPECTION OF AREA. The whole area comes under the supervision of the Sanitary Inspectors, both by routine visiting and by the following-up of complaints. NOTICES. 658 Informal Notices were served drawing the attention of owners to the existence of nuisances and requesting abatement. Difficulty continues to be experienced in getting repairs done, owing to the heavy cost of labour and the restriction on rents. 15 It was found necessary to serve 47 Statutory Notices affecting premises under the Public Health Acts to secure the abatement of nuisances where Informal Notices had not received compliance, after which the matters were remedied. Appended is a resume of the work done in the year. HOUSING. Number of inspections 8,023 Number of premises in which defects were found 1,693 INFECTIOUS DISEASES. Number of inspections 415 FOOD PREMISES. Number of inspections 798 Number of premises in which defects were found (approx.) 500 FACTORIES AND WORKSHOPS. Number of inspections 394 Number of factories in which defects were found 36 SAMPLING. Total number of samples taken 334 As follows:— Food and Drugs Act 180 Designated Milks 23 Ice-cream 52 Water 79 TRADE PREMISES. Number of inspections 489 Number of premises in which defects were found (approx.) 300 RODENT CONTROL. This work was carried on actively during the year. A whole-time rodent control operative is employed. Not only does he operate on private property, but also on Council property, including sewers. During 1948 he made 3,094 visits in connection with the task of eliminating rats and mice. In addition the Sanitary Inspectors made 792 calls to premises infested with rats. There were 210 complaints, and at 227 premises rat and mice infestation was remedied. Two l-in-10 tests of sewer manholes for rats gave very satisfactory results as follows:— 1st.—Number of manholes tested 171 Number found "no takes" by rats 145 2nd.—Number of manholes tested 194 Number found "no takes" by rats 178 16 SECTION D. HOUSING. During the war years when housing repairs were at a standstill, there naturally accumulated a vast amount of maintenance work. The local authority's task is not only that of re-housing but also of seeing that private properties are kept in a reasonable state of repair. The latter task devolves upon the Public Health Department, and is a complex one, owing to the shortage of labour and materials in the post-war era. When necessary the local authority has to enforce statutory action where nuisances and defects exist. The Council has adopted a rent rebate scheme by means of which, where necessary, rebates from the normal rents are allowed to Council tenants to ensure that the amount paid by them for rent and rates does not exceed 25% of the tenants' gross weekly income (excluding family allowances) provided that the foregoing sum shall be— (1) reduced, by 2/- per week for each child entitled to a family allowance and/or (2) increased by 2/6d. per week for each child in ment up to 18 years of age and 5/- per week for each child above 18 years old and for each adult (other than the tenants) living in the house. The effect of this progressive piece of legislation is to help to ensure that there is sufficient residual income, after paying rent and rates, to keep the family adequately fed and clothed. Another fact worth recording is that the Council gives priority points for housing in cases where there are patients suffering from active tuberculosis in the home. The following is a resume of the work carried out in 1948:— Number of premises inspected 1,823 Number of visits in connection therewith 8,028 Number of premises where defects were found 1,693 Number of premises rendered fit as result of informal action 1,427 Number of premises rendered fit as result of formal action 47 No clearance areas, demolition orders, or individually unfit houses were declared during the year. 17 OVERCROWDING. Chislehurst and Sidcup does not differ from the rest of the country in the general housing shortage, making the abatement of overcrowding a very difficult problem. In consequence of this there are far too many people sharing homes, with the inevitable result of domestic strife which is always so prevalent where cooking and washing facilities have to be shared. New houses are, of course, the biggest single factor in the abatement of overcrowding, and the following statement indicates the progress made during 1948:— 53 Permanent houses built on behalf of the Council. 16 Permanent houses built by private enterprise. 30 Permanent houses built on L.C.C. estate, St. Paul's Cray. 160 Houses rebuilt. 75 Prefabricated aluminium houses erected on Chalk Pit Estate. Overcrowding: Housing Act, 1936. Ward No. of Cases at 31st December 31 Dec. 1948 Number or Cases July, 1936 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 | No. of Cases found during year ,, ,, remedied ,, Cases at end of year No. of persons concerned No. of Cases Aged over 10 Aged under 10 Lamorbey E. 19 13 6 6 4 2 4 6 7 9 6 7 11 4 6 9 49 9 w. Longlands 2 1 ... 1 ... ... ... 1 ... 1 1 1 ... ... ... ... ... ... Birchwood ... ... ... ... ... ... ... ... 1 ... ... 1 1 3 4 ... ... ... Frognal 5 5 5 ... ... ... ... 1 1 ... ... 1 1 1 1 1 2 1 North Cray 2 3 1 1 1 1 1 1 1 1 1 1 3 ... 2 1 4 2 St. Paul's Cray 4 8 3 ... 1 1 1 2 4 5 6 4 5 2 4 3 25 7 Chistehurst Common 11 13 4 2 1 1 1 ... ... ... 1 3 6 1 4 3 18 3 Mottingbam 8 9 4 2 3 2 2 2 4 5 15 6 15 30 19 26 165 48 Totals 44 51 23 12 10 7 9 13 18 21 30 24 42 41 40 43 263 70 18 RE-HOUSING. Considerable progress has been made in the past year, as will be seen from the following table, for which I am indebted to the Housing Manager:— Prior to 1948 During 1948 l. (a) Number of "permanent" dwellings built by L.A. 112 53 (b) Number of prefabricated dwellings built by L.A. 200 75 (c) Number of dwellings requisitioned by L.A. 283 2* 2. (a) Number of families occupying 1 (a) 412 53 (b) „ „ „ „ 1 (b) 200 75 (c) „ „ „ „ 1 (c) 445 less 12* * 14 requisitioned properties were released. 3. Total number of families re-housed during 1943 in (a), (b) and (c) 266 as follows: Requisitioned properties 138 Permanent houses 53 Prefabricated bungalows 75 4. Number of families on waiting list at 31st December, 1948, in various points categories:— 19 families requiring 4 bedroomed houses. 518 „ „ 3 „ „ 1200 „ „ 2 „ „ 634 couples and single persons. As a result of the Ministry of Health's enquiry into the number of housing applications, and the completion of individual forms, the number of applicants for houses on Chislehurst and Sidcup Council's list is likely to be reduced materially. MOVABLE DWELLINGS, ETC 1. Pickers' Huts. There are two camps of pickers' huts in the district, both of which were in use during the course of the year. These were subject to 20 inspections. 2. Movable Dwellings. Visits to these premises totalled 144. The present position with regard to movable dwellings is as follows:— At Chalk Pit, Ruxley, there are 18 families, of whom 11 were granted licences for the year 1948. This is a decrease of five in the total number of families as compared with the previous year. It has been found that the terms of the licences have not been strictly complied with in all respects, and where irregularities have been discovered they have been taken up with the persons concerned. Speaking generally, it is a most undesirable site for these structures. At Twysdens Meadow, Cray Road, only two families occupy the site and they were both granted licences in the year 1948. 19 "Corkes Meadow," Leesons Hill, is a field containing approximately 100 structures used for dwelling purposes, as well as a number of store sheds, including stables. The field has been used for this purpose for many years and the structures are unlicensed. Conditions are very unsatisfactory and from time to time give cause for complaint. Very many attempts hsve been made to have the conditions improved, including the provision of a piped water supply and brick-built W.C.s, but, owing to the type of occupants and the constant change of occupants, etc., no real and sustained improvement has ensued. It is likely that the L.C.C. will purchase the site shortly and use it in connection with the St. Paul's Cray housing estate. SECTION E. INSPECTION AND SUPERVISION OF FOOD. The success or failure of this service depends enormously on the assistance and co-operation given us by the traders and retailers, and their unfailing helpfulness has been greatly appreciated. In view of the fact that the quantity of food is limited, it is doubly important that the quality and purity should be the highest attainable; also, with the increasing tendency towards communal feeding, which has in all probability come to stay, the importance of proper protection of foodstuffs from all types of contamination cannot be overestimated. Failing careful supervision of cafes, restaurants, canteens, etc., there is a great risk of frequent widespread outbreaks of food poisoning, owing to the number of people using these premises. However, I am glad to be able to report that there have been no outbreaks of food poisoning during the year 1948, and that there has been very little food and drug adulteration. It is, however, necessary to continue vigilence both for the sake of the customer and of the distributor. FOOD AND DRUGS ACT, 1938. 128 formal and 52 informal samples were taken under this Act. Of these, 15 were found to be unsatisfactory, and appropriate action was taken in each case. A comprehensive list of the samples taken will be found tabulated in the appendix, together with a sumary of legal action taken. 20 INSPECTION OF FOOD PREMISES. During the year these premises were subject to routine inspection, and a total of 798 visits was made to the following types of shops as detailed:— Bakers 98 Butchers 177 Ice-cream premises 113 Caf6s, etc. 201 Greengrocers 70 Fishmongers 103 Other food-preparing premises 30 MEAT INSPECTION. Slaughterhouses. There are two licensed slaughterhouses in the district, and three applications for licences to slaughter under the Slaughter of Animals Act, 1933, were granted during the year, but no slaughtering took place under the above Act. Under the food control regulations, the slaughter of pigs only is allowed in the district. Butchers' Shops. 177 inspections were made during the year, and 15 cwt. 2 qtrs. 8 lbs. of unsound meat were condemned. There were a few cases of sausages or sausage meat being deficient in meat content, each case being dealt with in the appropriate manner. (See Appendix.) BAKEHOUSES. 98 visits were paid to the 11 bakers' premises in the district during the year, and 39 defects were found and remedied. The general standard of the bakehouses is good. FISHMONGERS. There were 63 inspections of fishmongers' premises, and 40 inspections of premises where fish frying is conducted. Eight defects were found and remedied at 14 different shops where fish frying is done. DAIRIES AND COWSHEDS. The district contains 20 dairies and cowsheds, which necessitated 52 visits during the year. A total of 11 defects were brought to light and remedied. There are six producers, one producer-retailer, and nine retailers of milk in the area. No farms are licensed to produce accredited milk, but three have licences to produce Tuberculin Tested milk. MILK SAMPLING. Number of samples. Number passed. Number failed. Accredited - - - Non-designated - - - T.T. 23 20 3 Where unsatisfactory samples are obtained, the tests are repeated until such time as the cause of the trouble has been eradicated. Finally, the tests for cleanliness and 21 adequate heat-treatment gave the following eminently satisfactory results:— Number of samples. Number unsatisfactory. Methylene Blue test 27 - Phosphatase 27 - ICE-CREAM. During the year 113 visits were made to ice-cream premises, and 52 samples were taken for bacteriological examination. I am glad to be able to report that no diseaseproducing organisms were found in any of the samples. The methylene blue test for cleanliness gives the following fairly satisfactory results:— Grade I 17 II 13 III 12 IV 10 In all cases where the results were unsatisfactory, the matter was taken up with both the wholesaler and retailer concerned. The question of the purity of ice-cream has been tackled vigorously during the past year, with encouraging results with regard to its safety. From the point of view of its nutrient value, which is almost as important as its purity, the present world shortage of fats has made it impossible to make a legal minimum fat content, but it is hoped that regulations will be made in the not too distant future to cover this very important point. There are 71 premises registered for the sale of ice-cream in the district, but of these nearly half are not actually selling it at the moment, and of the others, many only have a monthly allocation which is very rapidly expended. This accounts for the fact that the number of visits paid to ice-cream vendors is not as great as would be expected with 71 registrations. Four of these registered dealers are, in addition, manufacturers of ice-cream. RESTAURANTS, HOTELS, CANTEENS, ETC. 201 visits were made to these premises in the year, and a special survey of all food handling and preparing places was begun at the end of the year with the object of raising the standard of hygiene and minimising the dangers of food contamination and poisoning. UNSOUND FOOD. A total quantity of 6 tons 4 cwt. 2 qtrs. 26 lbs. of unsound food was condemned in the course of the year. The traders co-operated well and the food was surrendered voluntarily, thus avoiding the necessity of prosecution. Where possible, the condemned food, after suitable treatment, was used as animal food, and the rest had to be destroyed. There will be found in the Appendix a table of the foods found unfit for human consumption. 22 SECTION F. INFECTIOUS DISEASES. A table of the notified Infectious Diseases will be found in the Appendix. The only serious epidemic was a small outbreak of infantile paralysis, to which I have referred more fully elsewhere in my report. 415 visits were made to notified cases of infectious disease (diphtheria, scarlet fever, tuberculosis, etc.). On the removal of a case to the Isolation Hospital, the release from quarantine (home cases) or in other necessary cases, disinfection was immediately carried out by spraying rooms and their contents with formalin, and the clothing and bedding were steam disinfected at the disinfecting station. Public Library books found in any premises in which infectious or contagious disease occurred were also disinfected by formalin vapour in a special metal chamber. The disinfections carried out during the year were as follows:— Sprayed. Fumigated. Steam Disinfected. Destroyed. Rooms 214 34 - - Mattresses - - 265 7 Pillows - - 560 8 Bedclothes, batches of - - 175 - Blankets - - 649 - Library Books - 109 - - Clothing - - - 1 Furniture, lots - - - 1 SCARLET FEVER. 143 cases were notified during the year, and of these 88 were transferred to hospital, the remainder being nursed at home. As for a good number of years now, the infection proved to be of a very mild type, though he would be a bold man to guarantee that it will remain so. The great disadvantage of the mild type of scarlet fever is that there must be many cases in which people have the disease without realising it, and consequently spread it about among others owing to lack of the precautions normally adopted in cases of this illness. DIPHTHERIA. There were no cases of diphtheria notified during the year, which is probably a tribute to the efficacy of immunisation, but there are so many other factors to be considered in the prevention of this disease that it would be intellectually unpardonable to be so unwise as to rush to the conclusion that immunisation is the only relevant factor— an error into which the unstatistically minded are all too 23 prone to fall. There are no statistics available of the immunisation state of Chislehurst and Sidcup children, as since the 5th July last the records have been transferred to Maidstone and combined with Area 7 as a whole. MEASLES. There were 601 cases of measles notified during the year, of which only 6 were nursed in hospital. Like scarlet fever, the prevalent form of measles is of an exceptionally mild type, which is very fortunate, as severe measles epidemics hit the young child so badly and produce in many cases a debilitated, delicate child. The control of measles is still in its infancy, and good nursing and proper isolation are the most important factors. A certain amount of work has been done using immunising sera, but the results up to date are somewhat indeterminate and cannot by any means be called really satisfactory. WHOOPING COUGH. 302 cases were notified during the year, and of these only 8 were admitted to hospital. What has been said of measles with regard to its mildness and control may well be repeated in regard to whooping cough. Experiments are constantly being conducted with different prophylactic vaccines, but as yet none has been discovered which will altogether satisfy the stringent tests applied by the medical statisticians. TUBERCULOSIS. The following table shows the incidence of tuberculosis during the year from the notifications received:— Males. Females. Primary notifications (Pulmonary) 62 52 Transfer cases (Pulmonary) 24 27 Primary notifications (Non-Pulmonary) 4 1 Transfer cases (Non-Pulmonary) 1 1 These figures may appear high, but one must take into consideration the greatly increased facilities available for diagnosis with the development of X-rays. This has enabled the clinician to get his cases on the average at a much earlier stage in the disease, with a correspondingly increased chance of ultimate complete recovery. The table which follows in the Appendix shews that although the number of notified cases of tuberculosis in Chislehurst and Sidcup has risen sharply over the last 11 years, yet the death rate has shewn no significant alteration, a fact which tends to prove the benefit of early diagnosis. 24 Two types of tuberculosis are recognised: (1) the human form occurring amongst adults and the infection acquired from an "open" case of tuberculosis, and (2) the bovine form mostly affecting children and acquired as a result of drinking infected milk. On the face of it, it would seem easy to investigate the milk supply and, if infected, cut off that supply at its source, but unfortunately milk is ingested at so many places and in so many forms at different times, that this line of investigation rarely gives any clue to the source of infection. PUBLIC HEALTH (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, Section 172. There were no occasions during 1948 to take action under the above provisions. SECTION G. OTHER SERVICES. PETROLEUM ACTS. Number of licences granted for storage of petroleum spirit/mixture 46 Number of gallons of petroleum spirit concerned 48,230 Number of gallons of petroleum mixtures concerned 4,922 Number of visits 81 Number of contraventions: premises concerned 40 Number of contraventions: items concerned 148 DISEASES OF ANIMALS ACTS. This service is carried out by the County Council. APPENDICES. 1. Sanitary Inspectors—Inspections and Complaints. 2. Factories Acts, 1937-48. Part I. Part II. 3. Food and Drugs: Samples taken during 1948. 4. Unsound Food: Food Condemned. 5. Water Supply: Results of Bacteriological Examination. 6. Tabulation of Tuberculosis 1937-1948—Rates. 7. Tabulation of Tuberculosis 1948—Quarterly Returns. 8. Tabulation of Tuberculosis 1948—Age Groups. 25 Appendix 1. sanitary inspectors—inspections and Complaints. INSPECTIONS—General. A total of 12,626 inspections were made during the year as follows:— 7,775 to dwelling-houses (Public Health Acts) 253 „ dwelling-houses (Housing Acts) 98 „ bakers 177 „ butchers 201 „ cafés and restaurants 52 „ farms, dairies and cowsheds 103 „ fishmongers 76 „ greengrocers 120 „ grocers 77 „ piggeries 113 „ ice-cream 30 „ other food preparing premises 170 „ factories with mechanical power 224 „ factories without mechanical power 97 „ outworkers' premises 792 „ premises for rats and mice 238 ,, cases of infectious disease—general 177 „ cases of infectious disease—tuberculosis 144 „ movable dwellings 20 „ pickers' huts 19 „ smoke abatement 489 „ shops 425 „ unsound food 82 „ rivers and streams 674 „ miscellaneous 12,626 COMPLAINTS. 1,752 complaints were received and investigated. Where necessary appropriate remedial action was taken. The complaints were as follows:— 623 re general sanitary defects 28 „ keeping of animals 78 „ offensive accumulations 39 „ verminous premises 369 „ drainage 19 „ water supply 210 „ rats and mice 102 „ overcrowding 117 „ food 2 ,, rivers 97 „ dustbins 12 „ smoke 56 „ miscellaneous 1,752 26 APPENDIX 2. FACTORIES ACTS, 1937 and 1948. Part I of the Act. 1. Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 15 224 40 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 134 170 19 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) - - - - TOTAL 149 394 59 - * i.e. Electrical Stations (Section 103 (3)), Institutions (Section 104), and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 2. Cases in which defects were found. (If defects are discovered at the premises on two, three, or more separate occasions, they should be reckoned as two. three or more "cases.") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 15 14 _ — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 2 1 — 1 — Inadequate ventilation (S.4) 1 1 — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) (a) Insufficient 10 9 — — — (b) Unsuitable or defective 7 7 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — 32 2 — TOTAL 36 33 32 3 — 27 APPENDIX 3. FOOD & DRUGS: Samples Taken During 1948. Formal. Informal. Aspirin tablets 1 — Baking powder 3 — Baking soda 1 — Beef, spiced 1 — Bun flour 1 — Butter scotch 2 — Bread — 3 Bronchial tablets 2 — Cake, cherry 1 — Cake mixture 2 — Cocoa 1 — Coffee 1 — Coffee and Chicory 1 — Cough mixture 1 — Curry powder 1 — Faggot 1 — Fish paste 1 — Fruit sauce — 1 Gravy powder 1 — Ginger, ground 1 — Herbs, mixed, dried — 1 Horseradish 1 — Jam 1 — Junket powder 1 — Lemonade crystals 1 — Lemonade powder 1 — Lemonade tablets 1 — Licorice rolls 1 — Macaroni 1 — Marmalade — 1 Meat pastes 4 — Meat pies 5 — Meat roll 1 — Meat soups 1 1 Milk 8 30 Milk, dried — 3 Mint and vinegar 1 — Mint sauce — 1 Mussels, marinated — 1 Mustard — 1 Pate de foie — 1 Pepper 1 — Pickles, mixed — 1 Pickles, sweet 1 — Pickled walnuts — 1 Pork pies 2 — Pudding mixture 1 — Quinine tonic water 1 — Raising powder 1 — Raising powder, golden 1 1 Salad cream 3 _ Salad dressing 2 — Sausages 2 — Sausages, beef 21 — Sausages, beef and mutton 1 — Sausage, breakfast 2 — Sausage, liver 1 — Sausage, luncheon 2 — Sausage, pork 2 — 28  Formal. Informal. Sausage, savoury - 1 Sausage, vegetable 1 - Sausage meat 1 - Sausage meat, beef 12 - Sausage meat, pork 1 - Sausage, rolls 1 - Savoury, meat - Savoury, spiced 1 - Semolina 1 - Scone flour 1 - Soft drink powder 1 - Soya flour 1 - Spice, mixed 1 - Sponge flour 1 - Sponge mixture 1 - Stomach powder 1 - Syrup of figs 1 - Teaseed oil 1 - Tomato juice cocktail 1 1 Tomato ketchup - 1 Vinegar 1 - Vinegar, malt 2 2 128 52 The examination of the samples showed them to be of genuine quality with the exception of the following:— Bread: contained foreign matter, probably stale dough.—Warning given to baker. Bronchial tablets: arsenic 350 parts per million.—Warning given to manufacturers. Further samples satisfactory. Beef sausages: deficiency of 26% of meat.—Butcher prosecuted and fined, with an order for costs. Beef sausage meat: deficiency of 22% of meat.—Butcher prosecuted and fined, with an order for costs. Beef sausages deficient 40% minimum amount meat.—Butcher prosecuted and fined, with an order for costs. Beef sausages: deficient 18% minimum amount meat.—Butcher prosecuted and fined, with an order for costs. Beef sausages: deficient 36 % minimum amount meat.—Butcher prosecuted and fined. Tomato ketchup: fermented and unfit for food.—Warning given and stock withdrawn from sale. " Savoury " sausage: contained no meat.—No further action. Vegetable sausage: contained no meat and therefore did not comply with the definition of sausage in the Meat Products and Canned Meat (Control and Maximum Prices) Order, 1947.—Reported to Ministry of Food. No further action. Beef sausages: deficient 18% minimum amount meat.—Butcher prosecuted and fined. Beef sausage meat: deficient 32% minimum amount meat.—Warning given. Milk: 4.4% added water.—Warning given. Salad cream: fat, 9.2%; egg yolk solids, none.—Did not comply with the Salad Cream and Mayonnaise Order. Prosecuted but summons dismissed, with an order against defendant for payment of costs. Marmalade: contained large numbers of jute hairs, presumably derived from sacking. Unfit for food. Ministry of Food investigating manufacture abroad. 29 APPENDIX 4. UNSOUND FOOD—CONDEMNED. Item. Tons. cwts. qrs lbs. Beef (unsound bone taint) - 15 2 8 Canned bacon (containers blown, punctured Canned fish do. do - 2 1 24 perforated) - - 1 16 „ fruit do. do. - 3 1 7 „ fruit juice do. do. - 1 1 25 „ meat do. do. - 12 2 15 ,, meat and vegetables do. do - - - 1 „ milk do. do. - 5 - 3 „ . preserves do. do. - 1 3 4 „ soup do. do. - 1 - 24 „ vegetables do. do. 1 11 1 19 „ jam do. do. - 2 2 6 „ fish paste do. do. - - - 19 „ spaghetti do. do. - - - 1 ,, beetroot do. do. - - - 2 „ meat paste do. do. - - - 21 „ peas do. do. - - - 11 „ pudding do. do. - - 2 3 „ tomatoes do. do. - - 3 5 „ beans do. do. - - - 23 „ chocolate spread do. do. - - - 2 „ marmalade do. do. - - - 13 „ sweet phat do. do. - - - 2 Cheese (mouldy) - - 2 18 Fish (decomposed) 1 10 2 27 Mutton (unsound) - 1 1 24 Pickles (decomposed) - - 2 1 Rabbits (decomposed) - - 3 26 Butter (rancid) - - - 2 Barley (unsound) - - - 26 Pastry Mixture (unsound) - - - 1 Lentils (unsound) - - 2 11 Soyagetti (glass contamination) - - - 12 Dried Eggs (contaminated) - - - 1 Cooking Fat (contaminated) - - - 1 Margarine (contaminated) - - - 1 Prawns (decomposed) - - 2 21 Semolina (mites) - - - 1 Sugar (contaminated) - 4 - 2 Breakfast cereals (mouldy) - - - 20 Sugar confectionery (contaminated) - - - 9 Dates (unsound) - - - 20 Jam (mouldy) - - 1 8 Peaches (mouldy) - - - 3 Poultry (unsound) - - - 5 Prunes (mouldy) - - 2 4 Tomato ketchup (fermented) - - 2 11 Cheese (unsound) - - - 7 Bacon (contaminated) - - - 1 Chickens (unsound) - - - 10 Ducks (unsound) - 1 - 7 Prunes (decomposed) - - - 7 Cereals (unsound) - - - 6 Liver (cirrhosis) - - - 13 Cocoa (mouldy) - - 2 15 Dried egg (unsound) - - - 26 Orange Juice (unsound) - - - 25 Prunes (unsound) - - - 10 Chocolate (contaminated) - - - 1 Dates (mites) - - - 5 6 4 2 26 30 31 APPENDIX 5. Average Results of the Chemical and Bacteriological Examination of the Water Supply to Chislehurst and Sidcup U.D. January-December, 1948. Parts per million (unless otherwise stated.) (a) Oxygen abs. from Permanganate at 80° F. (b) Colour m.m. brown 2 ft. tube. Burgess's Tintometer. Description of the Sample . No. of Samples acal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. (a) Turbidity. in terms of Silica (b) Hardness (Total) Hardness (Perm) pH Value Conductivity Orpington Well 3 0.010 0.017 5.2 16.0 0.16 0 324 81 7.1 475 North Orpington 4 0.001 0.019 4.2 14.5 0.12 — 3 299 100 7.1 450 Shortlands Well 3 0.000 0.024 4 5 19.0 0.15 — 0 315 129 7.2 475 Eynesford Well 3 0.010 0.019 3.1 160 0.13 — 0 313 78 7.2 450 Bexley Well 3 0.003 0 015 4.2 16 7 0.14 — 0 310 80 7.1 475 Wilmington Well 8 0.007 0.018 6.0 204 0.14 — 0 312 79 7.1 475 Darenth Well 5 0. 001 0.012 3.5 16.4 0.15 — 0 301 96 7 1 450 Thames-derived 1930 0.083 0.086 3.7 27.9 1.00 0.3 16 242 71 7.7 450 filtered water BACTERIOLOGICAL RESULTS. Description of the Sample No. of Samples Percentage of Samples negative 100 ml. Bact. coli. per 100 ml Orpington Well 255 100.0 NIL North Orpington 255 100.0 NIL Shortlands 255 100.0 NIL Bexley Well 377 100.0 NIL Wilmington Well 253 100.0 NIL Wilmington Well 404 100.0 NIL Darenth Well 257 100.0 NIL Thames-derived filtered water 3827 99.7 0.006 32 APPENDIX 6. TUBERCULOSIS IN CHISLEHURST AND SIDCUP (as corrected by Inward and Outward Transfers) Year ending Population Chislehurst and Sideup U.D. Notifications Number of Cases on Register Deaths Pulm. NonPulm. Pulmonary Non-Pulmonary Total Number of yearly increase No. of 1000 pop. Number of Death Rate-C.S.U.D, per 1000 population Death Rate- England & Wales per 1000 pop. M F M F Pulm. NonPulm. Pulmonary NonPulmonary Pulmonary NonPulmonary Dec. 1937 58,678 54 6 109 96 43 25 273 33 4.6 29 1 .49 .01 .508 .135 8 61,750 32 8 114 104 50 28 296 25 4.8 32 7 .51 .11 .463 .128 9 63,160 48 18 135 106 57 35 333 37 5.2 29 8 .46 .13 .463 .120 1940 63,650 58 10 153 106 56 40 355 22 5 5 32 3 .60 .05 .538 .135 1 60,610 64 15 169 122 65 41 397 42 6.5 35 15 .57 .24 .002 .128 2 60,400 73 12 191 128 54 43 416 19 6.8 37 4 .61 .06 .542 .115 3 60,130 77 15 200 140 51 45 436 20 7.1 34 2 .56 .03 .557 .111 4 57,470 81 6 194 177 51 42 464 28 8.9 39 5 .68 .08 .524 .103 5 59,170 58 13 201 194 56 47 498 34 8.4 34 5 .57 .08 .515 .099 6 67,870 78 15 231 217 61 51 560 62 8.2 23 5 .33 .07 .467 .083 7 70,580 81 3 253 241 58 51 603 43 8.5 33 6 .46 .08 .473 .077 8 72,750 114 5 308 301 60 51 720 117 9.8 50 5 .68 .60 33 APPENDIX 7. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Quarterly Statement of cases on Notification Register 1948. Quarter Ended 31st March, 1948 30th June, 1948 30th September, 1948 31st December, 1948 Pul. N. Pul Total Cases Pul. N. Pul Total Cases Pul N. Pul Total Cases Pul. N. Pul. Total Cases (a) No. of cases of Tuberculosis on the Register at the commencement of the Quarter M F M F 603 M F M 640 M F M F 677 M F M F 703 253 241 58 51 277 252 60 51 290 276 60 51 300 292 7 60 51 (b) No. of cases notified under the Public Health (Tuberculosis) Regulations for the first time during the Quarter 19 9 2 _ 30 15 22 1 - 38 19 14 1 1 35 9 - - 16 (c) No. of cases restored to the Register during the Quarter - - — - Nil - - — — Nil - - - - Nil - - - - Nil (d) Other additions to Register during the Quarter 10 7 — - 17 6 8 1 1 16 3 9 - - 12 5 3 - - 8 (e) No. of cases removed from the Register during the Quarter 5 5 - 10 8 6 2 1 17 12 7 1 1 21 6 1 - - 7 (f) No. of cases remaining on the Register at the end of the Quarter 277 252 60 51 640 290 276 60 51 677 300 292 60 51 703 308 301 60 51 720 34 APPENDIX 8. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Number of Cases Notified under the Public Health (Tuberculosis) Regulation, 1930, for the First Time during Year ended December 31st, 1948, according to Age-Groups. Group Qtr. ended 31.3.48 Qtr- ended 30.6.48 Qtr- ended 30.9.48 Qtr- ended 31.12.48 Totals for year 1948 Totals Pulm. Non-Pulm. Pulm. Non-Pulm. Pulm. Non-Pulm. Pulm. Non-Pulm. Pulm. Male Non-Pulm; Pulm. Female Non-Pulm. 0—Yrs. M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... 1—Yrs. M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... 3—Yrs. M 1 ... 1 ... ... ... ... ... 2 ... 1 ... 3 F ... ... 1 ... ... ... ... ... 5—Yrs. M 2 ... ... 1 2 ... 1 ... 5 1 6 ... 12 F ... ... 3 ... 2 ... 1 ... 10—Yrs. M 1 ... 1 ... ... ... ... ... 2 ... 1 ... 3 F ... ... ... ... ... ... 1 ... 15—Yrs. M ... 2 7 ... 6 1 2 ... 21 3 18 1 43 F 1 ... 9 ... 6 1 2 ... 25—Yrs. M 6 ... 4 ... 9 ... 5 ... 24 ... 22 ... 46 F 6 ... 8 ... 6 ... 2 ... 45—Yrs. M 3 ... 2 ... 2 ... 1 ... 8 ... 4 ... 12 F 2 ... 1 ... ... ... 1 ... Totals 28 2 37 1 33 2 16 ... 62 4 52 1 119