AC 4412(3) CHSLEAURST CHISLEHURST AND SIDCUP URBAN DISTRICT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the Health of the Urban District and the Work of the Health Department for the Year 1951 Printed by Bromley Office Supplies & Printing Co. Ltd. East Street, Bromley 1 CONTENTS. Page Members of the Health Committee 3 Staff 3 Prefatory Letter 4 Section A. Vital and Other Statistics and Social Conditions of the Area. Vital Statistics 8 Population 9 Births 10 Illegitimate Births 10 Stillbirths 10 Deaths 11 Maternal Mortality 11 Infantile Mortality 11 Unemployment 11 Open Air Recreational Amenities 12 Section B. General Provision of Health Services for the Area. Hospitals 14 Home Nursing Service 15 Health Visiting 15 Domiciliary Midwifery 15 Child Welfare Centres 15 Clinics 15 Day Nurseries 16 Domestic Help Service 16 Ambulance Facilities 16 Laboratory Service 17 Medical Loan Depots 17 St. John Ambulance Brigade 17 Old People's Welfare Committee 17 Old People's Clubs 17 British Red Cross Society 18 Section C. Sanitary and Environmental Circumstances. Water Supply 20 Rivers and Streams 21 Drainage and Sewerage 21 Cesspools 21 Swimming Baths 21 Section D. Factories, Outworkers, Etc. Factories 24 Smoke Abatement 24 Shops Act 24 Rodent Control 25 Verminous Conditions and Uncleanliness 25 Section E. Housing. Rehousing 28 Moveable Dwellings 28 2 Page Section F. Inspection and Supervision of Food. Food Sampling 32 Food Preparing Places 33 Unsound Food 34 Slaughterhouses 34 Piggeries 35 Inspection of Food Premises 35 Milk 35 Ice Cream 35 Section G. Infectious Diseases. Smallpox 38 Vaccination 38 Anterior Poliomyelitis 39 Scarlet Fever 39 Diphtheria 39 Diphtheria Immunisation 39 Paratyphoid 40 Measles 41 Whooping Cough 41 Tuberculosis 41 Food Poisoning 42 Dysentery 42 General 43 Section H. Other Services. Nursing Homes 46 Health Education 46 Public Mortuary 47 Parks and Open Spaces 47 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 51 „ II.—Causes of Death 52 „ III.—Sanitary Inspection of the Area 53 „ IV.—Factories Acts 54 „ V.—Water Supply — Analysis 56 „ VI.—Tuberculosis Rates 58 „ VII.—Tuberculosis—Summary of Quarterly Returns, 1951 59 „ VIII.—Tuberculosis — Age Groups, 1951 60 „ IX.—Commons, Parks and Open Spaces 61 3 PUBLIC HEALTH COMMITTEE Chairman : G. C. ODLING, Esq. Vice-Chairman: P. V. NASH, Esq. Chairman of the Council. Vice-Chairman of the Council. P. Andrews, Esq. T. Ramsbottom, Esq. Miss M. H. Bird. P. A. Shaw, Esq. F. C. Carter, Esq. Mrs. E. V. Wallace. K. E. Carter, Esq. W. Williams, Esq. C. Clark, Esq. Mrs. F. J. Daubney. STAFF OF THE HEALTH DEPARTMENT as at 31st December, 1951. Medical Officer of Health: K. E TAPPER, o.b.e., g.m., m.b., ch.b., d.p.h. Deputy Medical Officer of Health: H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Chief Sanitary and Shops Act Inspector: A. V. B. ALLEN, m.r.s.i., m.r.i.p.h.h., m.s.i.a. Deputy Chief Sanitary and Shops Act Inspector: J. C. KERMODE, c.r.s.i., m.s.i.a. District Sanitary Inspectors: E. C. BERWICK, c.r.s.i., m.s.i.a. J. W. P. HARRIS, c.r.s.i., m.s.i.a. D. M. SKINNER, m.s.i.a. CLERICAL STAFF. W. J. WATLING. MISS C. DEVONSHIRE. OUTDOOR STAFF. T. BACK (Disinfector, Mortuary Keeper, Drain Clearer and General Handyman). J. DAVIS (Assistant to Mr. Back) E. ELLIS (Rodent Operative). 4 To the Chairman and Members of the Chislehurst and Sidcup Urban District Council. Mr. Chairman, Ladies and Gentlemen, This is my fourth Annual Report to you and the eighteenth report since Chislehurst and Sidcup became an Urban District in 1934. The report for 1951 is in the form of previous years and is again divided into the following sections:— Section A.—Vital and Other Statistics and Social Conditions of the Area. Section B.—General Provision of Health Services for the Area. Section C.—Sanitary and Environmental Circumstances. Section D.—Factories, Outworkers, etc. Section E— Housing. Section F.—Inspection and Supervision of Food. Section G.—Infectious Diseases. Section H.—Other Services. I could not have completed this report without the able assistance of Mr. Allen, the Chief Sanitary Inspector, and of Mr. Watling. the Chief Clerk, and without the careful recording of the work by each of the District Sanitary Inspectors. There are few new factors which call for special mention. The year as a whole has been an uneventful one so far as the health of the district is concerned. The publication of the Preliminary Report on the census taken in April, 1951, gave the population as 83,837, but we must await the full report before any conclusive findings can be discussed. The London County Council estate at St. Paul's Cray was, for all practical purposes, completed during the year and it is mainly due to this that the increase in population, since the census of 1931, has been so marked. It will be of interest to watch the development of the health of the people of this estate and the effect of this influx upon the general static population of your Urban District. It must not, however, be overlooked that where one takes a large population from bad and cheap housing conditions to new houses at increased rents and travelling costs for the wage earner, and also where priority is given to tuberculous families, there may result temporary detriment rather than improvement in the health of the transferred families. It is for this reason that the development of the health services, known to-day as the Part III Services of the National 5 Health Service Act, should not lag behind the development of the estate but, in fact, should have been established to meet the foreseeable need. To-day the trend of medicine is developing towards treatment, hospitalisation and specialisation, less attention being given to true prevention. It is cheaper to prevent than it is to cure. The time, too, has arrived when a re-orientation of thought should be given to the type of services that should be rendered under health services. We continue to exercise a model of a service set up some thirty years ago. What was needed and good in those early years is not necessarily good for the present age. Centralisation of government tends to operate to a pattern and not to take into consideration local need and local circumstances. The functions of a Local District Council Health Department require to be extended, for example, to bring under the notification of diseases, all diseases that are communicable to man or transmittable to man. We tend to overlook diseases such as, canicola fever, "Q" fever, Bornholm's disease, Weils disease, glandular fever, etc., while we continue to exercise our activities in the control of diseases which have been common to the country for many years. To exercise this control and to exercise prevention one must have a complete knowledge and early notification. When staff, such as nursing staff or health visiting staff are not under the Department's control, it is difficult to maintain all those operations that we would wish to put into force. There is need, too, to bring the General Practitioner more actively into the preventive service. It may well be necessary in the near future to appoint an infectious disease nurse, especially if the common diseases such as measles and whooping cough become more virulent than they have been in the past few years. There is a growing tendency for the public to treat these diseases as of little importance but there is no guarantee that their virulence may not increase in the near future. Scarlet Fever and its allied diseases have, fortunately, remained mild in character. Diphtheria has disappeared from our returns but it is still possible that in spite of intensive diphtheria immunisation it may again raise its ugly head. It is of vital importance that every Health Department should be on the alert and so organised that immediate action can be taken in the event of an outbreak of acute infectious disease, such as smallpox, arising in the district. The visit of the mass x-ray unit to Chislehurst and Sidcup in the early part of the year received welcome support from the public. This is a service which needs extension and is one that is, in fact, truly preventive because it "picks up" the early stages of the disease and allows such cases to receive early and effective treatment before the disease can develop into a crippling catastrophe. There is far too great a tendency to-day to judge the 6 effectiveness of a service on its statistical basis and on form filling, whereas the real value of all work in public health lies in the personal approach between staff and members of the public. The effectiveness of this personal approach is demonstrated so well in the improvement that has taken place in the care in handling and preparation of foodstuffs, which has been the main success of the Department during recent months. Propaganda talks to the workers and the personal visitation by the Sanitary Inspectors are building up a hygienic food practice throughout the district. If one judges the health of a district by its vital statistics, then Chislehurst and Sidcup is, with a death rate of 8.9, birth rate 16.1, infant mortality rate 23.3, and a population of eight persons per acre, a healthy residential district, but we know that the hospitals are full to capacity and the doctor's surgeries arc overcrowded, and there are factors such as overcrowded trains in "rush hours" that make for tiredness of body and mind in the adult workers. We have not yet reached the state of one house one family, and until we do there can be no security in family health. I cannot end this prefatory letter without an acknowledgment of the help that I have received from other Chief Officers and the Chairman and Members of the Health Committee. I have the honour to be, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. JUNE, 1952. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 8 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The area of the Urban District is 8,957 acres. Registrar General's estimate of total population (mid-year) 1951 85,150 Number of valuation assessments of habitable premises at the 31st March, 1952 23,804 Number of valuation assessments of habitable premises at the close of the year 1951, in respect of: — (a) Houses 21,730 (b) Flats 1,300 (c) Farmhouses 17 (d) Public Houses (including Beerhouses) 27 Rateable Value (estimated) at 31st March, 1952 £693,912 Product of a Penny Rate for the year ending 31st March, 1952 £2,825 Vital Statistics. Live Births. Total Male Female Legitimate 1,320 686 634 Birth Rate 16.1 per 1,000 Illegitimate 52 30 22 total population. 1,372 716 656 Stillbirths. Total Male Female Legitimate 29 16 13 Stillbirth Rate 0.38 per 1,000 Illegitimate 4 2 2 total population. 33 18 15 Deaths. Total Male Female Death Rate 8.9 per 1,000 757 379 378 total population. Deaths from Puerperal Causes. Pregnancy, childbirth and abortion 4 Deaths of Infants under I year of age. Total Male Female Legitimate 32 18 14 Infant Mortality Rate 23.32 Illegitimate per 1,000 live births. 32 18 14 9 Death Rates of Infants under 1 year of age. All Infants per 1,000 live births 23.32 Legitimate Infants per 1,000 live legitimate birth 23.32 Illegitimate Infants per 1,000 live illegitimate births POPULATION. In April, 1951, the National Census was taken and the preliminary figures showed the population of the Urban District of Chislehurst and Sidcup, on the night of the 8th April, 1951, to be 83,837-a figure which indicated a 208.7% increase over the census taken twenty years ago. This large increase was, in the main, due to the overflow population of London being rehoused at St. Paul's Cray and other London County Council housing estates in the district. Details of the census are not yet available and are awaited with interest because it is only from these details that one can judge the need for and scope of the social services in an area that is mainly residential. It is, for example, important to know the age grouping of the population, the proportion of child to adult population and the proportion of the over sixties. The 1951 return shows that the excess of births over deaths was equivalent to 7.22 persons per 1,000 population. The following information which is based on a 1% sample has been extracted from the preliminary report:— Housing conditions. Bromley. Chislehurst & Sidcup. Orpington Total Households 20,500 24,100 18,500 Households sharing accommodation 3,400 2,000 1,300 Persons living more than 2 persons per room - 1.12% 1.33% Average number of persons per household 3.09 3.34 3.25 Average number of persons per room .66 .75 .70 Households living density— 1½-2 persons per room 700 700 300 1-l½ persons per room 2,000 2,700 1,400 Less than 1 17,800 20,600 16,700 Households without exclusive use of— Water closet 2,100 1,700 1,000 Fixed bath 5,100 3,600 2,700 Stove and sink 1,700 1,300 900 Age distribution. 1. Persons of over 65 years of age: Bromley 12% Chislehurst and Sidcup 9% Orpington 11% 2. Child population (0-15 years): Bromley 20% Chislehurst and Sidcup 23% Orpington 25% 10 3. Excess females over males (all ages): Bromley 6,000 Chislehurst and Sidcup 4,200 Orpington 4,500 4. Single females (all ages): Bromley 13,800 Chislehurst and Sidcup 19,100 Orpington 14,600 BIRTHS. The Birth Rate for 1951 is 16.1 per 1,000 total population. Comparative rates during the past ten years are as follow:— Year. Chislehurst & Sidcup. England & Wales. 1942 18.1 15.8 1943 17.8 16.5 1944 20.0 17.6 1945 17.5 16.1 1946 20.8 19.1 1947 20.9 20.5 1948 16.4 17.9 1949 15.8 16.7 1950 15.0 15.8 1951 16.1 15.5 The average yearly Birth Rate during the past ten years was Chislehurst and Sidcup 17.84, England and Wales 17.15. The Registrar General's returns for the year showed the following registered births, after transferable adjustments had been made:— Live Births 1,372, Stillbirths 33, Total 1,405. Illegitimate Births. The illegitimate birth rate (per 1,000 total population) for 1951, is 0.61. Stillbirths. The number of stillbirths registered for the area during 1951 is 33. The stillbirth rate per 1,000 (live and still) births for the year is 23.48. The following tabulation gives the number of stillbirths and rates per 1,000 (live and still) births for the past ten years:— Year. No. of stillbirths. Rate per 1,000 (live & still) births. 1942 31 27.5 1943 27 24.5 1944 22 18.7 1945 28 26.2 1946 35 24.1 1947 35 22.8 1948 28 23.4 1949 21 17.8 1950 25 20.4 1951 33 23.5 11 DEATHS. The Death Rate for the year 1951 is 8.9 per 1,000 total population. Of the 757 deaths occurring, 379 were males and 378 females. The following table shows the main causes of death:— 1950 1951 Cancer 131 132 Respiratory Diseases including Influenza (not Tuberculosis) 59 89 Heart and Circulatory Diseases 330 361 Tuberculosis 30 30 Infectious Diseases 8 4 Road Traffic Accidents 5 6 Other Violent Causes 12 12 Suicide 7 9 Digestive Diseases 18 18 Other Causes 82 96 682 757 Maternal Mortality. There were four maternal deaths in the Urban District during the year. During the last ten years, maternal deaths have been as follows:— Year. Number of Maternal Deaths. 1942 5 1943 — 1944 1 1945 2 1946 1 1947 1 1948 3 1949 3 1950 — 1951 4 Infantile Mortality. The Infant Mortality rate for the year is 23.3 per 1,000 live births. 32 infants died during 1951 before reaching their first birthday, and the following relates to these cases:— Died in first four weeks of life 19 Died within first week and twelfth month 32 The infantile mortality rate for 1951 is exactly the same as that for 1950. UNEMPLOYMENT. I am indebted to the Manager of the Local Employment Exchange for the following information:— "At the beginning of the year there was the usual seasonal increase, followed by very low registers during the summer. This was despite the increase of population due to the building of Council Estates in or near this neighbourhood. 12 The registers rose in the autumn, as is customary, but still remained low, except towards the end of the year, when they began to rise. The majority of women registrants are able to work restricted hours only, and the demand for this type of labour is negligible. Clerical workers are not usually prepared to work on Saturdays." OPEN AIR RECREATION AMENITIES. Chislehurst and Sidcup have happily retained much of the natural beauty of the countryside by the preservation of large open spaces and attractive parks and sports grounds. The quiet seclusion that can be obtained from this wise administration is a refreshing tonic after the rush and turmoil of present day life. The encroachment upon many of these beauty spots by the development of large housing undertakings in the neighbourhood of London may, at some future date, be seriously regretted. The Town Planning Act gives some protection. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 14 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. I have again sub-divided the services into services rendered by the Council, services rendered by the Hospital Boards, services rendered by the County Council under Part III of the National Health Service Act, 1946. and Voluntary Services. 1. Public Health services rendered by the Council. The major work of the Health Department is carried out at the offices in Elm Road, Sidcup, under the day to day administration of the Chief Sanitary Inspector. The transfer of the offices to Manor House which will shortly take place, is a move which will result in a closer link with the main Council Offices in Sidcup Place. During the year 1,099 complaints which necessitated action by the Inspectors were received at the offices and this extensive work pays tribute to the trust that the public place in the work of their Sanitary Inspectors. The major services of the Department to which detailed reference is made under Sections C, D, E, F, G and H, are as follows :— Infectious Diseases (Prevention and Notification). Inspection of Food and Food Premises. Inspection and Examination of Water and Milk Supplies. Inspection of Factories and Shops. Housing. Inspection of Nursing Homes. Rodent Control. Atmospheric Pollution. Health Education. Public Mortuary. All matters covered by the general heading of Sanitary and Environmental services. In the Appendices III-VI is a summary of the work of the Sanitary Inspectors. 2. Services rendered by the 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 South East London Region. There are ten maternity beds in the Cray Valley Hospital. In addition to these hospitals, six blocks of Grove Park Hospital lie within the Chislehurst and Sidcup Urban District. One of these blocks is given over to Mass Radiography. In the 15 remaining five blocks there are 291 beds given over to cases of tuberculosis. They form part of the Woolwich Hospital Group. 3. Services rendered by the County Council. Home Nursing Service. There are nine Home Nurses operating in the Urban District. Home Nursing is provided on medical certification only, and is free. This is a very valuable service, especially when there are long waiting lists for hospital admission. Health Visiting. The County Council employ nine Health Visitors, two School Nurses and one Tuberculosis Health Visitor to work in the area. Among the duties of the Health Visitors are included attendances at Welfare Centres, and the follow up and arrangement of immunisation against diphtheria and vaccination against smallpox. Their domiciliary visiting and advice has been the keystone upon which the Maternity and Child Welfare Services have been successfully built since 1918. Midwifery (Domiciliary). Nine midwives are engaged whole time in domiciliary midwifery in the area. The services of the midwives are engaged direct by the patient or through the patient's private doctor and the midwives act either as midwives or maternity nurses. Child Welfare Centres. CHISLEHURST: The Willows, Red Tuesdays & Thursdays p.m. HillTest Feeds, Tuesdays a.m. FOOTSCRAY: W. Smith Memorial Hall Tuesdays p.m. MOTTINGHAM: Kimmeridge Road Mondays & Wednesdays p.m. Tues. (non-doctor's session) p.m. SIDCUP: The Oval, Sherwood Park AvenueTues Wed. & Fri p.m. Congregational Church Hall Mondays & Wednesdays p.m. NORTH CRAY: Social Club, North- Cray Road 1st, 3rd & 5th Fridays p.m. Ante-Natal Clinics. CHISLEHURST: The Willows, Red Hill Wednesdays p.m. MOTTINGHAM: Kimmeridge Road 1st Thursdays 1.30 p.m. SIDCUP: The Oval, Sherwood Park Avenue 3rd Thursdays p.m. Congregational Church Hall 1st & 3rd Thursdays a.m. Women's Welfare Clinics. CHISLEHURST: The Willows, Red Hill Tuesdays a.m. MOTTINGHAM: Kimmeridge Road 1st Thursdays 1.30 p.m. SIDCUP: The Oval, Sherwood Park 1st Thursdays a.m. Avenue 3rd Thursdays p.m. Congregational Church Hall 3rd Thursdays a.m. 16 Minor Ailment Clinics (Schools). CHISLEHURST: The Willows, Red Hill Mon., Wed., Fri. & Sat a.m. MOTTINGHAM: Kimmeridge Road 2nd & 4th Saturdays a.m. SIDCUP: 10, Station Road Thursdays a.m. Dental Clinics. CHISLEHURST: The Willows, Red Hill Thursdays & Fridays all day MOTTINGHAM: Kimmeridge Road Mondays & Wednesdays. .. all day SIDCUP: Baptist Church Hall Mondays & Tuesdays all day Post Natal Exercises. MOTTINGHAM: Kimmeridge Road Fridays 8.0 p.m. SIDCUP: The Oval, Sherwood Park Avenue Wednesdays 8.0 p.m. Ante-Natal Exercises (Relaxation). MOTTINGHAM: Kimmeridge Road Thursdays 8.0 p.m. SIDCUP: The Oval, Sherwood Park Thurs. (except 2nd Thurs.) p.m. Avenue 2nd Thursdays 10.30 a.m. Immunisation and Vaccination. These services are carried out at Child Welfare Centres and at 10, Station Road, Sidcup on Thursday mornings. Day Nurseries. During 1951 the Day Nursery provision in the Chislehurst and Sidcup area was reduced from three to one, Sidcup Hill Day Nursery being retained and transport being provided for children of necessitous cases. At the time of writing, it is the intention of the County Council to cease to provide a Day Nursery Service. Domestic Help Service. Applications for this service are made to the District Organiser at 30, Elm Road, Sidcup. Demands for assistance continue to increase, especially for cases of illness in the home and for old people. Provision is also made for domestic help during a home confinement. Details of the service which was provided during the year are given below:— Maternity 101 Tuberculosis 25 Aged 136 Others 128 There were 116 part-time workers employed in the area as at the 31st December, 1951. Ambulance Facilities. There is an ambulance depot at the Council Offices, Main Road, Sidcup, where there are seven ambulances and three sitting-case cars. Sitting case cars are provided for out-patients on medical certification. 17 Laboratory Service. Food and drug samples and bacteriological medical samples are examined by the Public Health Laboratory at Maidstone, and details appear later in the report. 4. Services rendered by Voluntary Associations. Medical Loan Depots. A full range of nursing requisites is available at the Medical Loan Depots. Application for loan of such equipment for Chislehurst and Sidcup inhabitants should be made to:— The Manor House Hall, Sidcup Green Tuesdays 3—4 p.m. Thursdays 7—8 p.m. 56, Woodside Avenue, Chislehurst Mondays 3—4 p.m. Thursdays 6.30—8 p.m. 51, Framlingham Crescent, Mottingham Wednesdays 6—7 p.m. Chislehurst and Sidcup Tuberculosis Care Committee. This is a very active and representative Committee which is doing very valuable work in the care and after-care of tuberculous patients and their families. During the past year 107 families came under the supervision of the Committee, 37 of them being new cases. It is very pleasing to note that this voluntary Committee is receiving financial support from so many varied sections of the community. The close liaison that exists between this body and the clinics and hospitals and other official bodies is to be commended. The St. John Ambulance Brigade. The objects of the Brigade are to afford holders of first aid certificates from the St. John Ambulance Association opportunities of meeting together for ambulance and nursing practice, with the object of combining individual efforts for the public advantage ; to render first aid to the sick and injured on public occasions, with the sanction of the police and other authorities, and to maintain in readiness for such duty a body of trained men and women. Chislehurst and Sidcup Old People's Welfare Committee Abstract from Secretary's Annual Report:— "One of the original objects of the Old People's Welfare Committee was to establish as many Clubs as possible in the district so that the old people in each Ward could avail themselves of a friendly meeting place. The year has seen the opening of the 'Rest a While' Club in the Foots Cray area and there are now thirteen Clubs in the Urban District, which means that there is now a Club within reach of every part of the Urban District. 18 The average attendance of members at Clubs is as follows:— The Blackfen O.A.P 170 The Blackfen W.V.S. Club 160 The Cosy Club 80 The Friendly Club 40 The Good Companions Club 100 The Home from Home Club 45 The Jolly Rogers Club (Davenport Road) 40 The Jolly Rogers Club (Wren Road) 60 The Merry and Bright Club 50 The Mottingham W.V.S. Club 30 The Rest a While Club 50 The Rodney Club (L.C.C. Estate) (Open daily) 100 The Sunshine Club 45 The total average attendance is approximately 970." British Bed Cross Society. The Chislehurst and Sidcup division of the British Red Cross Society has detachments at Chislehurst, Sidcup (2), Mottingham, and also at Petts Wood and Orpington (serving the St. Paul's Cray L.C.C. Estate), with cadet units and associate groups. The Divisional Office is at Hornbrook House, High Street, Chislehurst. The objects of this Society are the care of the sick and wounded in peace and war, the improvement of health, the prevention of disease and the mitigation of suffering. In addition to first aid duties and regular auxiliary nursing in the hospitals of the neighbourhood, the men and women of the Society's detachments are engaged in a number of local welfare activities which include the Hospital Library Service, diversional therapy for the home-bound, home visiting of the sick, hospital needlework and hop-field dispensaries. A first aid hut is open at Ruxley Corner, Footscray, on Sundays and public holidays during the summer, and four depots are operated at all times for the loan of invalid and sick room equipment. Personnel assist in staffing at local clinics and at the periodical blood transfusion sessions. The division is responsible for the recruitment and initial instruction of untrained volunteers for the National Hospital Service Reserve, and undertake the basic first aid training of volunteers for the Civil Defence Corps. Membership of the adult detachments is open to men and women between the ages of sixteen and sixty-five. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 20 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. Water Supply. I am indebted to the Director of Water Examination Metropolitan Water Board for the following statement and also for the details of analysis of water supplies, which are set out in Appendix VI. "The supply to the district of Chislehurst and Sidcup has been adequate at all times in 1951 and is derived from the following seven wells: Orpington, North Orpington, Shortlands. Eynsford, Bexley, Wilmington and Darenth, together with Thames-derived filtered water via Shortlands pumping station. Bacteriological analyses of samples of water at the various stages of purification of these sources of supply are made at least five times a week and consistently satisfactory results have been obtained. Chemical analyses of the samples are also made at frequent 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, Orpington, Bexley and Wilmington to ensure an adequate period of contact of chlorine with the water; tanks at other well stations are planned or are 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 each of the abovementioned sources. All the houses are supplied directly and not by means of stand-pipes." The following information has been supplied by the Clerk to the Metropolitan Water Board:— "No new source of public water supply has been instituted in the Council's area during 1951. There have been no extensions of trunk mains. Various lengths of service mains have been laid within the Council's Urban District. The water supply has been satisfactory as regards quantity." 21 The Sanitary Inspectors took 53 samples of water for chemical and bacteriological examination during the year and the results were as follow :— Bacteriological Examination. Chemical Examination. Satisfied Test. Did not satisfy Test. Satisfied Test. Did not satisfy Test. Raw Water 6 5 17 5 Treated Water 20 — — — 26 5 17 5 The ten samples that did not satisfy the tests were not from main supplies. Connections to the main water supply have since been made. There are three dwelling houses in the district which receive their water supply from two private wells. Rivers and Streams. Sixty-eight inspections have been carried out by the inspectors. The improvements to the Cray River were carried out by the Kent River Board during the year. Drainage and Sewerage. The Urban District is represented on the West Kent Main Sewerage Board which is the responsible Board in North West Kent. During the year surface water sewers and soil sewers were constructed on the Edgebury Estate, Royal Park Estate and the L.C.C. Estate, St. Paul's Cray and certain major works were required to replace defective glazed stone-ware pipes by iron pipes. Cesspools. So far as we have been able to ascertain, there are 484 premises in the district not drained to sewers. Ten have chemical closets and seven earth closets and the remainder have cesspools. The Local Authority make no direct arrangements for the emptying of cesspools. This task is undertaken by private arrangement with a Maidstone firm. The charge is twenty-three shillings for the first 4,000 gallons and twenty shillings for each additional 1,000 gallons. The Local Authority have formulated a scheme for main drainage at Leesons Hill when restrictions on capital expenditure are lifted. Swimming Baths. The public are admitted to one small private swimming pool in the district. Samples of the water are taken regularly and remedial action taken where necessary. SECTION D. FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL AND VERMINOUS CONDITIONS AND UNCLEANLINESS. 24 SECTION D. FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL AND VERMINOUS CONDITIONS AND UNCLEANLINESS. Factories, Workshops and Workplaces. A wide variety of goods is manufactured in the urban district, including machine tools, bearings, machine packings, paints, mineral waters, electric blankets, painters' equipment, office equipment, scientific and medical glass apparatus and instruments, mirrors and glassware, valves, radio parts and paper. A close liaison is kept with the factory inspector and there is interchange of action especially where it falls within the province of the Local Authority. Three hundred and fifty-seven visits were made by the Sanitary Inspectors and in Appendix IV is a copy of the return made to the Home Office of Inspections made under the Factories Acts, 1937 and 1948. Smoke Abatement. No offences occurred during the year under review. Thirtytwo inspections and observations were made for the emission of harmful smoke or grit. Shops Act. During the year one hundred and twenty-three inspections and observations of shops were made and seven Informal Notices were served in connection with the Act. There are six hundred and fifty-seven shops in the district. As a result of action taken by the inspectors, additional sanitary conveniences were provided in eleven shops. This matter is difficult of application in view of existing conditions, particularly as there is contined fluctuation in the number and sex of staffs. It was necessary in one case to cause facilities to be provided to ensure that a suitable and sufficient temperature could be maintained. Proper washing facilities were provided in fourteen shops. In two cases shopkeepers were required to provide seats for female assistants. No Closing Orders were made for shops in the district. The days of Early Closing generally observed are:— Wednesdays—Chislehurst and the Oval, Sidcup. Thursdays—Remainder of the district. It was found that twelve shopkeepers were not keeping, exhibiting or providing the necessary Notices or Records and in each case an appropriate letter was sent. 25 Rodent Control. The following is a summary of the work carried out during the year:— Local Authority Premises Dwelling Houses Agricultural Property Business Property and others Inspection— As a result of notification 12 217 4 31 As a result of other evidence 5 203 1 24 No. of major infestations found — — — — No. of minor infestations found 17 473 5 55 No. of premises at which serious infestation by mice found — — — — It was not necessary to serve any formal notices. A whole time rodent operative has been engaged since 1941. In addition to work carried out at owner's or occupier's expense in dealing with rodents on private property, he has also undertaken similar duties on the properties in possession of the Council, including sewers. During the year he has made four thousand, four hundred and twenty-seven visits in connection with the work of eradicating rodents. One "1 in 10" test was made of sewer manholes. Of the three hundred tested, two hundred and sixty-two were found "no takes." Two maintenance treatments were carried out and out of a total of two hundred and fifty-seven manholes baited, there were one hundred and eighty-six " no takes." These results show the sewers to be comparatively free from rat infestation. Verminous Conditions and Uncleanliness. One of the indications of improved social conditions is the great reduction in the incidence of verminous conditions and bed bugs and personal uncleanliness. The exception to this is, of course, where the aged infirm or aged sick have reached the unhappy state of being unable to care for themselves. Bed Bugs. During the year twenty-four complaints were received of infestation of premises by bed bugs. This shows a continued low number of complaints and it appears that bed bug infestation is well under control. There were nine houses and/or their contents found to be infested (including four 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 Department. In all other cases the premises were disinfested by the owners and the 26 contents by the tenants. In all necessary cases bedding was steam disinfected by the Department. The usual method of disinfestation is to spray with D.D.T. fluid. Close supervision was made of premises which had been disinfested and the tenants were given suitable advice and instructions on methods of prevention and destruction of vermin. SECTION E. HOUSING. 28 SECTION E. HOUSING. New Houses. There were twenty-seven new private houses erected in the area during the year and two war-destroyed houses rebuilt. The following information has been supplied by the Housing Manager:— Prior to 1951 During 1951 I. (a) No. of "permanent" dwellings built by Local Authority 661 141 (b) No. of prefabricated dwellings built by Local Authority 275 (c) No. of dwellings requisitioned by Local Authority 251 — (d) No. of emergency hutments 46 — (e) Halfway Houses 6 — II. (a) No. of families occupying I (a) 661 141 (b) No. of families occupying I (b) 275 275 (c) No. of families occupying I (c) 405 387 (d) No. of families occupying I (d) 44 44 (e) No. of families occupying I (e) 24 28 III. Total number of families rehoused (a), (b) and (c)— (a) 165 (including transfers) 64 (b) 17 (including transfers) 6 (c) 67 (including transfers) 14 IV. No. of families on waiting list at December, 1951:— Families requiring 1 bedroom 521 Families requiring 2 bedrooms 592 Families requiring 3 bedrooms 591 Families requiring 4 bedrooms 55 Old Age Pensioners 65 Applicants not yet married 35 Applicants not yet pointed 231 Applicants passed but not yet housed 54 Applicants on selection list for January meeting 31 2,175 This number of 2,175 does not include families in Requisitioned property and Emergency Hutments. Moveable Dwellings. Four hundred and fifty-two visits were made to the moveable dwellings in the district. There are four sites as given below:— Approximate Number of Number of families. persons. (i) Old Brickfield, Church Road, Footscray 9 28 (ii) Twydens Meadow, Cray Road, Footscray 1 7 (iii) Chalk Pit, Ruxley 28 114 (iv) Corke's Meadow, Leesons Hill, St. Paul's Cray 80 400-500 29 The site of (i) has been acquired by the Council for other purposes. No action is being taken for the time being to evict the persons occupying the vans—one of which is unlicensed. At site (ii) the vans are licensed annually and this does have some (if limited) control over them. Nearly all the occupants go away fruit picking during the summer months. The owner of the site wishes it to be vacated. The water supply was cut off and notices to quit were issued in the spring—since when no rents have been paid. The occupants paid for a new supply and a stand pipe was erected on land adjacent to the site. Site (iv)—Corke's Meadow, Leesons Hill, is an old established site, to be compulsorily acquired by the London County Council. The owner of the site had the sanitary conveniences closed and the water supply cut off during the year but they have since been re-opened and the fencing round the site which was damaged during the war has been repaired. The site is unsatisfactory and unkempt as are a number of the dwellers therein who damage and foul the conveniences considerably. SECTION F. INSPECTION AND SUPERVISION OF FOOD. 32 SECTION F. INSPECTION AND SUPERVISION OF FOOD. Food Sampling. During the year a total of one hundred and forty-seven samples of food and drugs were taken as follows:— Samples taken Result Remarks Formal Informal Genuine Adulterated Baking Powder 1 — 1 — Bread — 1 — 1 See (a) Butter Scotch 5 — 4 1 See (b) Buttered Chocolate 2 — 1 1 See (c) Buttered Crisps 2 — 1 1 See (d) Caramels, Egg Nog 1 — 1 — Coffee 1 — 1 — Cough Mixture 1 — 1 — Custard Powder — 1 1 — Doughnuts 3 — 3 — Fish Cakes 2 — 2 — Flour — 1 — 1 See (e) Flour, Self-Raising — 2 1 1 See (f) Golden Raising Powder — 1 1 — Ice Cream — 21 20 1 See (g) Jam Tarts 1 — 1 — Lemon Curd 1 — 1 — Meat Pie 1 — 1 — Milk 1 16 17 — Milk Powder, Skimmed — 1 1 — Pepper, White 1 — 1 — Rabbit, Tinned — 1 — 1 See (h) Rhubarb, Tinned — 1 1 — Saccharin Tablets 1 1 — 2 See (i) Sausages — 1 1 — Sausages, Beef 32 — 27 5 See (j) Sausages, Pork 14 3 9 8 See (k) Sausage Meat, Beef 16 1 13 4 See (1) Soft Drink 2 1 3 — Sugar — 1 — 1 See (m) Sunny Spread 1 — 1 — Throat Tablets 1 — 1 — Vinegar 2 1 3 — 92 55 119 28 Result. Action Taken (a) "Fruity odour." Probably due to incipient " rope." Not injurious Manufacturers warned. (b) Fat 5% of which approximately 2.5% was butter fat Manufacturers informed. (c) Butter 3.1%. Total fat 11% Matter taken up with turer. (d) Butter 2.8%. Total fat 9.45% Matter taken up with turer. (e) Excess sodium bicarbonate accounted for taste in pastry Manufacturer informed. (f) Contained a few spots consisting of dirty discoloured flour. Not injurious Warning given. 33 RESULTS ACTION TAKEN (g) Deficient in milk solids, not fat Manufacturer informed. (h) Incipient putrefaction. Unsafe for food Withdrawn from sale. (i) 1. Saccharin 0.145% Sodium bonate 0.775% Maize starch, etc., 0.08% grains per tablet. Deficient 19.4% of minimum amount of saccharin Further sample taken. 2. Result as above Prosecution. Fined £3 and two guineas costs. (j) 1. Deficient 20% minimum amount of meat Warning. Further sample taken. 2. Deficient 14% minimum Further sample taken (U.19). (See amount of meat below) Adulterated. 3. 48% meat, inferior Makers informed. Further sample satisfactory. 4. 47% meat, inferior Makers informed. Further sample satisfactory. 5. 47% meat, inferior Makers informed. Further sample satisfactory. (k) 1. Deficient 12.3% minimum amount of meat Warning given. 2. Deficient 4.6% minimum amount of meat Warning given. 3. Deficient 10.8% minimum amount of meat Warning given. 4. Fat had developed a high degree of lipolytic rancidity. Oleic acid—28.7% of fat. Cause of soapy taste Manufacturers informed. 5. Oleic acid—28.2% Manufacturers informed. 6. Deficient 6.1% minimum amount of meat Warning given. 7. Deficient 18.4% minimum Prosecution. Fined £5 and two amount of meat guineas costs. 8. Meat 61% inferior Makers informed. Further sample satisfactory. (1) 1. Deficient 27.7% minimum amount of meat Prosecution. Fined £10, 2. Deficient 36% minimum amount of meat Prosecution. Fined £10. 3. Deficient 10% minimum Further sample taken (U.59). amount of meat Genuine. 4. Deficient 18% minimum Prosecution. Fines £5 and one amount of meat guinea costs. Cm) Blue colour derived from bag which showed signs of having been wetted and dried Manufacturer warned. Food Preparing Places. Five hundred and fifty-one inspections were made to cafes, restaurants and canteens in the district, and 104 to other food preparing premises. There are approximately 256 premises in the area issued with a catering licence by the Ministry of Food, and these include 95 restaurants, cafes, public houses, fish friers, etc., 2 hotels, etc., 30 staff canteens, 73 clubs, 35 day schools and nurseries, and 21 institutions (including hostels, residential schools and colleges, hospitals, nursing homes, orphanages, etc.). 34 Unsound Food. Five tons, fourteen cwts., nine lbs. of unsound food were surrendered as unfit for human consumption during the year, as shown in the following table. Where possible this was used as animal food after suitable treatment. Item. Condition. tons. cwts. . QRS. lbs. Beef Bone taint, etc 4 2 25 Biscuits Unsound 2 Cake Rancid 1 26 Canned Beans Containers blown, perforated or punctured, etc. 1 9 Canned Coconut „ „ „ 1 Canned Fish „ „ „ 4 13 Canned Fruit „ „ „ 1 2 1 25 Canned Jam „ „ „ 1 1 29 Canned Marmalade „ „ „ 20 Canned Meat „ „ „ 1 7 2 17 Canned Milk „ „ „ 1 9 — 27 Canned Mincemeat „ „ „ 1 Canned Paste „ „ „ 2 Canned Peas „ „ „ 1 21 Canned Pudding „ „ „ 2 Canned Sausage „ „ „ 1 17 Canned Soup „ „ „ 2 22 Canned Spaghetti „ „ „ 12 Canned Syrup „ „ „ 2 Canned Tomatoes „ „ „ 2 7 Canned Vegetables „ „ „ 6 — 17 Cereals Verminous 1 1 Cheese Decomposed 1 — — Cheese Spread Unsound 2 23 Coconut Decomposed 20 Custard Powder „ 1 Dates Verminous 2 14 Fish Decomposed 3 1 27 Fruit „ 1 2 25 Fruit Drinks Fermented 11 Marmalade Unsound 8 Meat Paste 1 Milk, Dried „ 6 3 7 Mutton Decomposed 2 — Pickles „ 20 Poultry „ 3 — Rabbits „ 1 3 Sugar Unsound 14 Sweets Decomposed 1 — 3 Tea Unsound 10 5 14 — 9 Slaughterhouses. There were no applications received during the year for licences to slaughter animals under the Slaughter of Animals Act, 1933, and no animals were slaughtered at the one licenced slaughterhouse in the district. 35 Piggeries. There are twenty-two piggeries in the district, to which one hundred and forty-four visits were made. Eighteen defects were found and remedied. INSPECTION OF FOOD PREMISES. Butchers' Shops. There are forty-nine butchers' shops in the district of which forty-four are registered for the making of sausages. Three hundred and thirty-four visits of inspection were made during the year. Six cwt. one qtr. of meat was condemned in butchers' shops. Bakehouses and Bakers' Shops. There are twelve bakehouses in the district. There were two hundred and forty-four visits made to these premises and to bakers' shops. Forty-five defects were found and remedied during the year. Fishmongers and Fish Frying Premises. There are fourteen premises in the district where fish frying is carried out. Out of a total of two hundred and forty inspections made of fish premises, seventy-two were to fish frying shops. Eight defects were found and remedied. Milk. A total of eighty-six Licences were granted under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, and the Milk (Special Designation) (Raw Milk) Regulations, 1949. They were as follow:— Pasteurised Dealers' Licences 16 Pasteurised Supplementary Licences 12 Sterilised Dealers' Licences 19 Sterilised Supplementary Licences 11 Tuberculin Tested Dealers' Licences 17 Tuberculin Tested Supplementary Licences 11 Sixteen samples of pasteurised milk were taken, all of which were satisfactory. There are sixteen dairies in the district to which forty-six visits were made. Seven defects were found and remedied. Ice Cream. There are one hundred and fifty-five premises registered for the storage and sale of ice cream in the district. Fifty-three samples were taken for bacteriological examination. No pathogenic organisms were found to be present. The methylene blue tests resulted as follows and show a definite improvement in the results as compared with those of 36 1950. The method of sampling was varied and always carefully carried out, no apparent reason is readily seen for the improvement in the results. I am, however, of the opinion that the age of the ice cream at time of sampling has something to do with the methylene blue results. Grade I 41 Grade II 9 Grade III 2 Grade IV 1 53 SECTION G. INFECTIOUS DISEASES. 38 SECTION G. INFECTIOUS DISEASES. Except for the incidence of Paratyphoid and the great increase in measles, there has been nothing of note during the year. The close liaison with the Hospital Authorities and with the General Practitioners has continued to assist in the exercise of control over the spread of infectious diseases. It is especially important that this liaison should be as close as possible because so much depends upon the early notification to the Department, especially does this apply to the more acute infections and to cases of food poisoning. As most of the notifications during the year applied to measles and whooping cough, both, fortunately of a mild nature, and owing to the fact that little can be done from the Department's point of view in the following up of these cases without employment of a special infectious diseases nurse, the activities of the Department during the year under review have not been unduly heavy. The absence of diphtheria and the absence of any extension of infantile paralysis have also eased the task. Three hundred and sixty-nine visits were made by the Sanitary Inspectors during the year to notified cases of infectious disease. On the removal of a case to hospital, release from quarantine (home cases) or in other necessary cases, disinfection was immediately carried out by spraying rooms and their contents with formalin, the clothing and bedding being 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. In my introduction to this report I have mentioned the need for the notification to the Local Authority of all forms of disease which by their nature are infectious and not necessarily only those on the statutory list at present. Such diseases as " Q " fever, canicola fever, Weils disease, glandular fever are some of the diseases that could quite well be added to the list of notifiable illnegses. Smallpox. In the early part of the year considerable anxiety in Public Health Departments followed the Brighton epidemic of acute smallpox but, fortunately, the dissemination of the disease was very satisfactorily controlled. However, the importation of smallpox in a severe form is always possible and for this reason a plan of campaign in the event of cases arising in the area has been approved by the Health Committee and the staff kept in a state of preparation to meet any danger that might arise. At the time of writing there has been an outbreak of variola minor 39 (modified smallpox) in other parts of the country but, although this disease is similarly infectious as is smallpox, it is not a disease which need create similar anxiety to the virulent form of smallpox. I am indebted to the County Medical Officer who has given me the following figures of persons vaccinated during the year:— Age at 31st December, 1950 Under 1 1 to 4 5 to 14 15 or Over TOTAL Number Vaccinated 527 475 131 114 1,247 Number Re-Vaccinated — 7 74 272 353 Anterior Poliomyelitis. A few sporadic cases were notified during the year—nine in all, compared with twenty-seven in the previous year. None of these cases had subsequent paralysis. It is hoped that this disease is in the period of waning following the extensive epidemic of a few years ago. Scarlet Fever. This disease continued to be mild in character and there were no deaths. One hundred and sixty-one cases were notified as compared with two hundred and seventy-five in the previous year. Ninety-nine were treated in Hospital and sixty nursed at home. There were, however, seven of these cases which could safely be recorded as "return" cases. The high percentage of cases that are admitted to Hospital by General Practitioners and accepted by the Hospitals is, in my view, not completely warranted, not only from the economic point of view but also as very few of them require hospital treatment. Whilst this disease continues to be of a mild character, I feel that too much importance is being placed upon it. However, the epidemiology of any infectious diseases shows that virulence rises and falls over a period of years and there can be no guarantee that scarlet fever may not once again become a disease of serious import. Diphtheria. Two cases were notified and admitted to Hospital, but neither was confirmed. The absence of this disease from the yearly returns and the falling of the death rate coincided with the immunising campaign commenced in the early thirties. Whether this is post hoc ergo propter hoc only the years ahead can tell. Nevertheless, it is essential from the Public Health angle to promote the immunisation and the re-immunisation of all children under fifteen years of age. I am indebted to the County Medical Officer for the following return of immunisation carried out in the year as immunisation is a County Council service and is not now carried out by the Local Authority:— During the year 1951, a total of 1,543 children received 40 Primary Inoculations and 2,109 Reinforcing Inoculations. (Figures for 1950 were 755 Primary Inoculations and 513 Reinforcing Inoculations.) Paratyphoid " B." Two cases of paratyphoid "B" were notified, one on the 13th July, 1951, and the second on the 17th July, 1951—the date of onset of symptoms in each case being respectively the 7th and 12th July. The delay in notifications was mainly due to the difficulty of diagnosis and to the time taken for bacteriological and serological verification. It is this delay between onset of illness and the confirmation of the diagnosis that makes any investigation into the source of this disease so difficult. In cases of paratyphoid infection, there is also to be considered the period of incubation which, in some cases, may be as much as two weeks. As a general rule, one can accept that paratyphoid "B" is a food infection and not a "case to case" infection. On investigation being made into these two cases, there appeared to be no connection—the one at Sidcup had no relation or contact with the case at St. Paul's Cray. It was only on the occurrence in the same week of a case in the Orpington district that a relationship was found between all three. All these families had purchased cakes from the same baker, and possibly had purchased "iced lollies" which, although obtained from different itinerant dealers, were found to come from a common source. The investigation made into the "iced lolly" source, however, proved negative and we were left with the Baker as the only possible source of infection. It was known that this Bakery covered a very wide area in North West Kent and there was definite evidence in two of the three cases that cream buns had been eaten from this supply. On communicating with the Medical Officer of Health of the area in which this firm is established, it was found that another case had arisen about the same time in his own area—the baker being the same itinerant supplier. Steps were immediately taken by this Medical Officer to investigate and control the source of supply. In the meantime a further case arose in the Orpington district and other cases in Lewisham, Dartford and Dartford Rural District and Crayford. Of the fourteen cases which thus came to notice, eleven had the same baker and there was evidence that cream buns had been eaten. There was, therefore, presumptive evidence that the infection lay with the " cream." As a result of action taken, there were no further cases. The comparatively small number of cases notified bears little relationship to the number of persons who may have been infected, for it is noteworthy that, in epidemics of Paratyphoid "B," cases occur which are not severe enough to call in medical aid and, therefore, escape supervision. 41 Measles. There were one thousand, eight hundred and twenty-four cases of measles notified during the year, giving an attack rate of 21.4 per thousand population—a great increase over 1951 when there were three hundred and thirty-eight cases which gave an attack rate of 4.2 per thousand population. Most of these cases were mild in nature and without complications. Sixty-nine of the cases were admitted to Hospital. The control of the spread of measles is always a difficult task because of the nature of the early symptoms and of the delay in confirmation by the onset of the rash. There is, however, a certain lack of care given to this aspect by a number of parents, a practice which is not to be encouraged. Measles can be and often is, a very serious illness in childhood and the lack of adequate nursing and home care have, during the years when measles has been more acute in nature, led to complications and, in some cases, actually to death. The employment of an infectious disease nurse by the Local District Councils, is a matter which has received consideration by the Health Committee and is a matter that might well be re-considered in the near future. Whooping Cough. The spread over of the whooping cough epidemic from 1950 continued into 1951 and continues at the time of writing. Four hundred and forty-one cases were notified, giving an attack rate of 5.2 per 1,000 population. Eight cases were admitted to hospital. There were no deaths. Like measles, whooping cough has its rise and fall in severity of the symptoms and we appear to be going through a period of mild and non-virulent type. Immunisation against whooping cough has not been promoted as it still remains in an experimental stage. What has been said about measles in the care and home nursing applies equally to the care of whooping cough. Too often does one see children in the active stage of whooping cough being transported in public conveyances or being in congregations of people. Tuberculosis. Statistical statements on the incidence of tuberculosis in Chislehurst and Sidcup are recorded in Appendices VII, VIII and IX. During the year a check up was made in the current register and, for the first time, the total of cases on the register showed a reduction over the previous year. The register had a considerable influx of patients as a result of the completion of the L.C.C. Estate at St. Paul's Cray, priority of tenancy being given to tuberculous families from London. The register now shows a total of one thousand three hundred and seven cases, compared with one thousand, three hundred and nine cases of the previous year. Ninety-eight cases were new notifications and 42 one hundred and twenty were transferred cases. This increase was counteracted by the removal from the register of two hundred and twenty patients, of whom thirty had died. The visit of the mass x-ray unit to Chislehurst and Sidcup for the three weeks in February received good response from the public and is a very valuable service. A total of three thousand five hundred and forty-four persons, one thousand and twentyfive of whom were school children attended. One hundred and seven showed abnormal film signs, fourteen of which were significant new cases of tuberculosis. Notification of the disease is well maintained—there being only one case dying of tuberculosis which had not been previously notified. It will be interesting to watch the effect of re-housing of tuberculous families into the new housing estates. Every endeavour must, of course, continue to be made to lift tuberculous families from bad housing conditions into good housing conditions but any increased cost of living resulting from increased rentage and increased travelling costs to their place of work may have a very serious effect on the living standards of such families. Food Poisoning. During the year there were twenty-one notifications of food poisoning but, after investigation, only nine cases could be substantiated. I was unsuccessful in the investigation of these cases to confirm the bacteriological agent. The fact that we are receiving co-operation from the people concerned tends to inflate the number of notifications, but it is better to err on the side of safety in spite of the increased work entailed. There is no doubt that, as a result of much Public Health Education, the public are responding to the teaching of food hygiene and are now only too willing to call the aid of the Department. I would, however, stress one point in that any delay in notification of an outbreak complicates the investigation and not infrequently leads to negative results. The great help we receive from the superintendents of school canteens is greatly appreciated. There is a tendency to establish central school canteens and to distribute, by container, such cooked food to other schools. This is a practice that although economic in establishment, might well lead to increased danger in the cause and spread of food poisoning. Dysentery- The dysentery incidence which has been increasing during the last three years gave rise to ninety-five notifications, most of these being confirmed cases of Sonne Dysentery—a somewhat mild disease of short duration, but one that tends to spread rapidly throughout a family unless personal hygiene is very 43 strictly exercised. In most cases, Sonne dysentery responds readily to treatment if treatment is sought early. Public Health control measures are not always successful. The disease has been rather widely spread throughout the country and is not limited to Chislehurst and Sidcup. General. The following table gives a summary of infectious diseases notified during the year:— Disease. 1950 1951 No. of cases notified. Scarlet Fever 275 161 Puerperal Pyrexia 4 2 Acute Poliomyelitis 27 9 Respiratory Tuberculosis (Male) 52 47 Respiratory Tuberculosis (Female) 42 41 Tuberculosis (other forms (Male) 2 2 Tuberculosis (other forms) (Female) 3 7 Pneumonia 44 51 Whooping Cough 461 441 Measles 338 1,824 Erysipelas 13 10 Dysentery 21 95 Typhoid Fever 1 — Malaria (contracted abroad) 1 — Paratyphoid Fever — 4 Meningitis — 4 Ophthalmia Neonatorum — 1 Food Poisoning 46 9 The following details relate to cases of infectious disease admitted to hospital during the year:— Disease. Lennard Hospital. Others. Diagnosis not confirmed. Scarlet Fever 94 5 — Acute Poliomyelitis 1 1 — Cerebro-spinal Meningitis 2 — 1 Diphtheria 1 1 2 Whooping Cough 6 2 — Measles 4 5 — Dysentery 1 4 — Paratyphoid Fever — 3 — Pneumonia — 6 — Pneumonia and Measles — 1 — Puerperal Pyrexia — 1 — SECTION H. OTHER SERVICES. 46 SECTION H. OTHER SERVICES. Nursing Homes. There are six fully equipped Nursing Homes in the district, as follows:— Name and Address of Home. Number of Beds. Total. Maternity. Other. The Crays, 98, Sidcup Hill, Sidcup — 2 2 *" Fallowfield," Ashfield Lane, Chislehurst — 34 34 "Glenttiorne," 24, Lower Camden, Chislehurst — 12 12 "Hadlow," 4. Hadlow Road, Sidcup 3 4 7 "Hatherley," 12, Hatherley Road, Sidcup — 9 9 "Redhill House," Redhill, Chislehurst — 7 7 3 68 71 *The beds at "Fallowfield" are used exclusively for patients who have been discharged from hospital as being no longer in need of hospital nursing, but who are not sufficiently fit to return to their homes. The nursing homes were visited regularly throughout the year. No serious infringements of the Byelaws were found and the service offered, in all cases, was up to the required standard. Health Education. In an effort to sustain and measure the interest in food hygiene, a programme of four films was shown to food handlers in November, at Alma Road School. The show, which was attended by one hundred and thirtyseven persons, was opened by the Chairman of the Council with a few well chosen words, and, after the films, the Chairman of the Public Health Committee gave a brief but able summing up of the points brought out by the films. Judged by the large attendance and the wrapt attention of the audience, one felt that the information given by the films did not fall upon stony ground and that at least some of the many lessons to be learned about the correct handling of foodstuffs must have been impressed upon the audience. If everybody who attended the show only remembered one fact that was new to them, the effort put into the organisation can be considered well worth while and must bear fruit in the future. In view of the attraction of films to modern audiences, it is probably one of the best ways of educating food handlers in the importance of their work from the public health point of view, but it is probably wise not to overdo this form of propaganda as opposed to the routine and more humdrum efforts at education made throughout the year by word of mouth. 47 Public Conveniences. The Health Department was responsible for the cleansing of nine Public Conveniences during the year, at St. Johns Road, Sidcup Park Place, Queens Head, Willersley Park, Tigers Head, Waring Park, West Chislehurst Sports Ground, Longlands Recreation Ground, and the Glade, Lamorbey Park. Public Mortuary. There were one hundred and thirteen bodies received in the public mortuary during the year, and twenty-two post mortem examinations Derformed. National Assistance Act, 1948. There was one case of compulsory removal under Section 47(3) of the National Assistance Act, 1948. The case was that of an elderly man " being aged and infirm and living in insanitary conditions and unable to devote to himself or receiving from other persons proper care and attention." An order was made by the Magistrate's Court for a period not exceeding three months. The man in question was removed to Lynton Hospital, Coxheath, near Maidstone, and, as far as we are aware, is still there. APPENDIX. STATISTICAL TABLES. 50 STATISTICAL TABLES, 1951. TABLE I.—Summary of Statistics. TABLE II.—Cause of Death. TABLE III.—Sanitary Inspection of the Area. TABLE IV.—Factories Acts. TABLE V—Water Supply. TABLE VI.—Tuberculosis Rates. TABLE VII.—Tuberculosis—Summary of Quarterly Returns, 1951. TABLE VIII.—Tuberculosis—Age Groups, 1951. TABLE IX.—Schedule of Commons, Parks and Open Spaces. 51 TABLE I. SUMMARY OF STATISTICS, 1951. Population (mid-year 1951, per Registrar General) 85,150 Birth Rate 16.1 Death Rate 8.9 Maternal Mortality Rate (per 1,000 live births) 2.9 Infant Mortality Rate (per 1,000 live births) 23.32 Number of Births (live) 1,372 Number of Stillbirths 33 Number of Deaths 757 Number of Maternal Deaths 4 Number of Infant Deaths (under 1 year) 32 Death Rate of Respiratory Diseases (incl. Influenza but not Tuberculosis) 1.04 Death Rate of Tuberculosis 0.35 Death Rate of Cancer 1.55 Death Rate of Zymotic Diseases 0.05 Notifications of Infectious Diseases:— Scarlet Fever 161 Diphtheria — Poliomyelitis 9 Typhoid Fever — Puerperal Pyrexia 2 Pneumonia 51 Tuberculosis (New Cases) 97 Number of Deaths from Infectious Diseases 4 Number of Deaths from Diarrhoea (under 2 years of age) — Number of Visits by Sanitary Inspectors 11,235 52 TABLE II. CAUSES OF DEATH, 1951. Male. Female. Total 1. Tuberculosis—Respiratory 21 8 29 2. „ —Other — 1 1 3. Syphilitic diseases 2 1 3 4. Diphtheria — — — 5. Whooping Cough 1 — 1 6 Meningococcal Infection — — — 7. Acute Poliomyelitis 1 — 1 8. Measles — — — 9. Other infective and parasitic diseases 1 1 2 10. Malignant neoplasm, stomach 8 12 20 11. Malignant neoplasm, lung bronchus 21 1 22 12 Malignant neoplasm, breast — 13 13 13. Malignant neoplasm, uterus — 7 7 14. Other malignant and lymphatic neoplasms 39 31 70 15. Leukaemia, aleukaemia — 2 2 16. Diabetes 1 5 6 17. Vascular lesions of nervous system 38 52 90 18. Coronary disease, angina 53 39 92 19. Hypertension with heart disease 15 20 35 20. Other heart disease 42 76 118 21. Other circulatory disease 11 15 26 22. Influenza 5 4 9 23. Pneumonia 18 10 28 24. Bronchitis 34 16 50 25. Other diseases of the respiratory system — 2 2 26. Ulcer of stomach or duodenum 9 5 14 27. Gastritis, enteritis and diarrhoea 2 2 4 28 Nephritis and nephrosis 2 3 5 29. Hyperplasia of prostate 4 — 4 30. Pregnancy, childbirth, abortion — 4 4 31. Congenital malformation 5 9 14 32. Other defined and ill-defined diseases 29 29 58 33. Motor vehicle accidents 5 1 6 34. All other accidents 7 5 12 35. Suicide 5 4 9 36 Homicide and operations of war — — — All causes 379 378 757 53 TABLE III. SANITARY INSPECTION OF THE AREA. 1. Inspections—General. A total of 11,235 inspections were made during the year, as under :— Dwelling houses (Public Health Acts) 5,468 Dwelling houses (Housing Acts) 104 Bakers and bakehouses 224 Butchers 334 Cafes, restaurants and canteens 551 Dairies 46 Fishmongers 240 Greengrocers 257 Grocers 487 Piggeries 144 Ice cream premises 226 Other food preparing premises 104 Factories with mechanical power 67 Factories without mechanical power 290 Premises re rats and mice infestation 1,000 Visits re infectious diseases 362 Visits re infectious diseases (tuberculosis) 7 Moveable dwellings 452 Pickers huts 7 Visits in connection with smoke abatement 32 Shops 123 Visits re unsound food 342 Rivers and Streams 68 Miscellaneous 280 11,235 2 Complaints. A total of 1,099 complaints were received and investigated and, where necessary, appropriate remedial action was taken. Summary of complaints received:— General sanitary defects 390 Keeping of animals 7 Offensive accumulations 49 Verminous premises 28 Drainage 271 Water supply 10 Rats and mice 249 Overcrowding 18 Food 39 Dustbins 23 Smoke 7 Miscellaneous 8 1,099 54 TABLE IV. FACTORIES ACTS, 1937 and 1948. Part I. 1. Inspections for Purposes of Provisions as to Health. Premises. Number on Register. Inspections. Number of Written Notices. Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorites 14 67 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 124 270 - - (iii) Other Premises in which Section 7 is enforced by the Local Authority *(excluding outworkers premises). 5 20 - - Total 143 357 - - * Electrical Stations (Section 103) (i), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 55 TABLE IV. (cont.). 2. Cases in which defects were found. 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.) 8 8 - - - Overcrowding (S.2.) - - - - - Unreasonable temperature (S.3.) — — - — - Inadequate ventilation (S.4.) — — - — - Ineffective drainage to floors (S.6.) — — - — - Sanitary Conveniences (S.7.):— (a) insufficient 3 3 - - - (b) unsuitable or defective 26 25 - 2 - (c) not separate for sexes 1 1 - 1 - Other offences against the Act (not including offences relating to outwork) 18 17 8 4 - Total 56 54 8 7 - 56 TABLE V. WATER SUPPLY. Average Results of the Chemical and Bacteriological Examination of the Water Supply to Chislehurst and Sidcup during 1951. Orpington Well North Orpington Well Shortlands Well Eynsford Well Bexley Well Wilmington Well Darenth Well Thames derived filtered water Number of samples 2 2 6 4 6 6 3 1,749 Ammoniacal Nitrogen 0.000 0.004 0.005 0.014 0.009 0.015 0.007 0.022 Albuminoid Nitrogen 0.016 0.020 0.022 0.032 0.053 0.033 0.023 0.085 Oxidised Nitrogen—Nitrate 8.5 5.3 5.1 4.2 5.8 7.9 5.2 4.0 Chlorides as C1 16.0 13.8 16.3 14.3 17.3 19.8 15.8 22.5 Oxygen abs. from Permanganate 3 hrs. at 80° F. 0.09 0.10 0.05 0.06 0.16 0.12 0.12 1.34 Turbidity in terms of Silica — — — — — - — 0.2 Colour, M.M. brown 2 ft. tube, Burgess's Tintometer 0 0 0 2 0 2 0 14 Hardness (Total) 292 269 295 264 295 291 264 264 Hardness Non-carbonate 52 34 77 35 61 54 32 63 pH Value 7.3 7.4 7.3 7.3 7.3 7.2 7.4 7.8 Phosphate as P.O. 111/4 — — — — — - - 0.33 Silica as SiO2 13 15 17 15 17 19 15 11 Conductivity 475 425 450 425 450 475 400 450 57 TABLE V. (cont.). BACTERIOLOGICAL RESULTS. Orpington Well North Orpington Well Shortlands Well Eynsford Well Bexley Well . Wilmington Well Darenth Well Thames derived filtered water Number of samples 249 250 256 352 247 268 241 3,321 Plate Count (Average per millilitre) Colonies counted on Agar— 22° C. (3 days) 108.7 104.8 7.8 181.6 2.0 32.3 1.6 - 37° C. (20-24 hrs.) 9.7 5.7 0.1 42.0 0.5 1.4 0.3 20.0 Bact. coli test— Percentage of samples negative in 100 ml. 99.6 100.0 100.0 99.2 99.6 99.6 100.0 99.9 Average number of Bact. coli per 100 ml. 0.008 — — 0.017 0.004 0.005 — 0.002 58 TABLE VI. TUBERCULOSIS IN CHISLEHURST AND SIDCUP. (as corrected by Inward and Outward Transfers) Year Ending Population of Chislehurst and Sidcup Urban District Notifications Number of Cases on Register Pulm. Non-Pulm. Pulm. Non-Pulm. Total Number of yearly increase Number per 1,000 pop. M F M F Dec. 1942 60,400 73 12 191 128 54 43 416 19 6.8 1943 60,130 77 15 200 140 51 45 436 20 7.1 1944 57,470 81 6 194 177 51 42 464 28 8.9 1945 59,170 58 13 201 194 56 47 498 34 8.4 1946 67,870 78 15 231 217 61 51 560 62 8.2 1947 70,580 81 3 253 241 58 51 603 43 8.5 1948 72,750 114 5 308 301 60 51 720 117 9.8 1949 73,510 86 9 399 395 64 55 913 193 12.4 1950 80,040 94 5 583 587 73 66 1,309 396 16.3 1951 85,150 89 9 590 602 56 59 1,307 (minus 2) 15.3 TABLE VII. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Quarterly Statement of Cases on Notification Register, 1951. Quarter Ended 31st March, 1951 30th June, 1951 30th September, 1951 31st December, 1951 Pul. N. Pul. Total Pul. N. Pul. Total Pul. N. Pul. Total Pul. N. Pul. Total Cases (a) No. of cases of Tuberculosis on the Register at the commencement of the Quarter M F M F Cases M F M F Cases M F M F Cases M F M F 583 587 73 66 1309 598 617 73 67 1355 579 602 55 59 1295 583 604 54 61 1302 (b) No. of cases notified under the Public Health (Tuberculosis) Regulations for the first time during the Quarter 13 9 - 1 23 12 16 1 3 32 11 9 1 3 24 11 7 - - 18 (c) No. of cases restored to the Register during the Quarter - - - - - - - - - - - - - - - 1 - - - 1 (d) Other additions to the Register during the Quarter 17 27 - - 44 19 14 - 1 34 12 14 1 - 27 8 5 2 - 15 (e) No. of cases removed from the Register during the Quarter 15 6 - - 21 50 45 19 12 126 19 21 3 1 44 13 14 - 2 29 (f) No. of cases remaining on the Register at the end of the Quarter 598 617 73 67 1355 579 602 55 59 1295 583 604 54 61 1302 590 602 56 59 1309 59 60 TABLE VIII. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Number of Cases Notified under the Public Health (Tuberculosis) Regulations, 1930, for the First Time during Year ended 31st December, 1951, according to Age Groups. Age Group Qtr. ended 31.3.51 Qtr. ended 30.6.51 Qtr. ended 30.9.51 Qtr.ended 31.12.51 Totals for Year 1951 Total Pulm. NonPulm. Pulm. NonPulm. Pulm. NonPulin. Pulm. NonPulm. Pulm. Non-Pulm. Male Pulm Non-Pulm. Female 0-Yrs. M - - - - - - - - - - - - 2 F 1 — — 1 — — — — — — 1 1 1-Yr. M - - - - - - - - - - - - 2 F - — 1 - — - 1 — — — 2 — 3-Yrs. M - - - - - - - - - - - - — F - - - - - - - - - - 5-Yrs. M - - - 1 - 1 - - - 2 - - 5 F - — 1 - - 1 1 - — - 2 1 10-Yrs. M - - 1 - 1 - 1 - 3 - - - 6 F 1 — 1 - 1 — — — — — 3 — lo-Yrs. M 5 - 1 - 6 - 5 - 17 - - - 37 F 4 1 7 2 4 - 2 - — — 17 3 25-Yrs. M 5 - 7 - 3 - 4 - 19 - - - 32 F 3 - 4 — 4 — 2 — — — 13 — 45-Yrs. M 3 - 3 - 1 - 1 - 8 - - - 13 F - — 2 — — 2 1 — — — 3 2 Totals 22 1 28 4 20 4 18 — 47 2 41 7 97 61 TABLE IX. SCHEDULE OF COMMONS, PARKS AND OPEN SPACES. Commons. The Chislehurst and St. Paul's Cray Commons have an area of approximately 165 acres and are administered by a Board of Conservators. Location. Acreage. Description. Abbeyhill park 6.84 Part allotments. Belmont Lane Open Space 5.59 Part allotments. Beverley Avenue 1.64 Open space. Chalk Wood and Mount Misery 69.21 Open space. Chislehurst Recreation Ground and Whytes Woodland 15.02 Open space with 4 tennis courts, 1 football pitch and 1 cricket pitch. Church Lane Recreation Ground 2.25 Open space. Footscray Common .70 Open space. Footscray Recreation Ground 6.80 Open space and part allotments. Hollyoak Wood Park 11.61 Open space and part allotments. King George's Field 11.10 Open space with 3 football pitches, 2 cricket pitches and 2 concrete cricket practice pitches. Lamorbey Park:— (1) The Glade 10.63 Open space. (2) Land fronting Burnt Oak Lane 2.00 Open space. (3) Land leased 12.42 Open space. Longlands Recreation Ground 6.00 Open space with 1 football pitch and 1 netball pitch. Marlborough Park 6.32 Open space with 1 football pitch and 1 netball pitch. Mottingham Sports Ground 30.00 Open space with 3 tennis courts, 8 football pitches, 6 cricket pitches, 1 hockey pitch and 3 concrete cricket practice pitches. Mottingham Recreation Ground 5.89 Open space. Old Farm Park 11.78 Open space and part allotments. Parish Wood 6.73 Open space. Penhill Open Space 17.10 Open space with 3 football pitches and 2 cricket pitches. 62 Location. Acreage. Description. River Cray Reservation:— (1) North Cray Place Farm 29.60 Used for agricultural Purposes. (2) Footscray Place Estate 49.32 Open space. St. Paul's Cray Recreation Ground 6.20 Open space with 4 tennis courts, 1 football pitch. Sidcup Place 25.31 Open space with 1 cricket pitch and 1 putting green. Stable Meadow Sports Ground 17.45 Open space with 2 football pitches and 1 cricket pitch. The Oval 1.66 Open space. Walden Manor 4.60 Open space. Waring Park 13.06 Open space with 4 tennis courts, 2 cricket pitches, 1 putting green, 2 netball pitches and 1 concrete cricket practice pitch. Willersley Park 5.59 392.42 Open space with 2 tennis courts.