CHI 27 CHISLEHURST AND SIDCUP URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE URBAN DISTRICT 1955 H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. CHISLEHURST AND SIDCUP URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE URBAN DISTRICT 1955 H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. 3 CONTENTS. Page Members of the Urban District Council 5 Staff 5 Prefatory Letter 6 Section A. Vital and Other Statistics and Social Conditions of the Area. Vital Statistics 10 Population 11 Births 12 Deaths 12 Morbidity Statistics 13 Medical Examinations 14 Unemployment 14 Open Air Recreational Amenities 14 Section B. General Provision of Health Services for the Area. Ambulance Service 22 British Red Cross Society 25 Disinfections 20 Domestic Help Service 22 Domiciliary Midwifery 22 Health Visiting 22 Home Nursing Service 23 Hospitals 21 Laboratory Service 19 Laundry for the Aged Sick 21 Local Clinic Services 23 National Assistance Act, 1948 18 Nursing Homes 18 Old People's Welfare Committee 27 Public Conveniences 19 Public Mortuary 18 The St. John Ambulance Brigade 26 T.B. Care Committee 26 Women's Welfare Clinics 23 Women's Voluntary Services 26 Section C. Sanitary and Environmental Circumstances of the Area. Cesspools 33 Drainage and Sewerage 33 Factories Acts, 1937 and 1948 35 Game Act, 1831 41 Heating Appliances (Fireguards) Act, 1954 38 Pet Animals Act, 1951 39 Petroleum (Regulation) Acts, 1928 and 1936 41 Public Cleansing, Refuse Collection and Disposal 38 Rag Flock and Other Filling Materials Act, 1951 39 4 Page Section C. Sanitary and Environmental Circumstances—continued. Riding Establishments Act, 1939 41 Rivers and Streams 33 Rodent Control 39 Sanitary Inspection of the Area 34 Shops Act, 1950 38 Smoke Abatement 36 Swimming Baths 34 Verminous Conditions and Uncleanliness 38 Water Supply 30 Section D. Housing. Housing Repairs and Rents Act, 1954 44 Housing Act, 1949 45 Moveable Dwellings 46 Re-housing 45 Section E. Inspection and Supervision of Foods. Bacteriological Examinations, Milk and Ice Cream 54 Food Complaints 52 Food & Drugs Act, 1938. Food Sampling 50 Food & Drugs Act, 1938. Section 14 53 Food Premises 53 Meat Inspection 54 Piggeries 54 Registrations for the Sale of Milk 54 Unsound Food 52 Section F. Prevalence of, and Control Over Infectious and Other Diseases Acute Anterior Poliomyelitis 56 Diphtheria and Immunisation 57 Dysentery 57 Food Poisoning 58 General Remarks 56 Measles 58 Other Infectious Diseases 63 Pneumonia 58 Smallpox and Vaccination 59 Tuberculosis, Chest Clinic and Mass X-Ray 59 Typhoid and Para-Typhoid Fever 62 Whooping Cough 63 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 67 II.—Causes of Death 68 III.—Infant Mortality 69 IV.- Notifiable Infectious Diseases—Sex and Age Distribution 70 V.—Notifiable Infectious Diseases—Seasonal Incidence 71 VI.—Sanitary Inspection of the Area 72 5 MEMBERS OF THE URBAN DISTRICT COUNCIL (as at 31.12.55) Chairman : F. C. MANSFIELD, Esq., J.P. Vice-Chairman : J. R. CAMPBELL CARTER, Esq. Councillors : P. Andrews. *G. H. Kirby-Smith. G. F. Barr. *H. A. Miller. Mrs. E. G. Beecher Bryant. E. V. Mills. J. A. Cantello. *Mrs. R. Moss. D. W. Child. R. Pope. H. P. B. Cox. *E. J. Reader. F. G. Emmerson. *Miss E. E. Rhodes. F. H. Farmer. R. D. Rowland-Hill. J. R. Fitzgerald. R. A. Sanderson. E. N. Foinette. *J. W. Schuch. W. G. Fuller. *W. J. Skinner. *W. H. Grimmer. D. R. Trunks. *Mrs. S. M. Gunn. G. Udall. *Miss B. H. James, J.P *Mrs. E. V. Wallace. (Chairman of P.H. Committee) A. C. Weedon. *F. E. Skone James. *R. E. Woods. (* denotes members of the Public Health Committee.) STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health : H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. (Also Medical Officer of Health for the Borough of Bromley, and Orpington Urban District Council.) (Appointed 13.1.55) Deputy Medical Officer of Health : A. J. I. KELYNACK, m.b., b.s., d.p.h. (Also Deputy Medical Officer of Health for the Borough of Bromley, and Orpington Urban District Council.) (Appointed 23.2.55) Chief Sanitary Inspector. Chief Food & Drugs Act Inspector. Inspector under the Petroleum Acts, Shops Act. Rag Flock & Other Filling Materials Act, Pet Animals Act, and Heating Appliances (Fireguards) Act : J. C. KERMODE, c.r.s.h., m.s.i.a. Deputy Chief Sanitary Inspector, and Inspector under the Food & Drugs Act, Shops Act, Rag Flock & Other Filling Materials Act, Pet Animals Act, and Heating Appliances (Fireguards) Act : E. C. BERWICK, c.r.s.h., m.s.i.a. District Sanitary Inspectors, and Inspectors under the Food & Drugs Act, Shops Act, Rag Flock & Other Filling Materials Act. Pet Animals Act, and Heating Appliances (Fireguards) Act : G. F. DOWNING, c.r.s.h., m.s.i.a. K. W. FINCH, c.r.s.h., a.r.s.h. J. W. P. HARRIS, c.r.s.h., m.s.i.a. CLERICAL STAFF. A. F. OUGHTON. Miss C. DEVONSHIRE. OUTDOOR STAFF. T. BACK (Disinfector, Mortuary Keeper, Drain Clearer and General Handyman.) J. DAVIS (Assistant to Disinfector.) E. ELLIS (Rodent Operative.) 6 To the Chairman and Members of the Chislehurst and Sidcup Urban District Council. Mr. Chairman, Ladies and Gentlemen, My opening remarks will, no doubt, occasion some surprise to my readers as I intend to try to hammer home the need for cleanliness. There may even be those who think that such a suggestion is insulting in this modern age, or, at the very least, such an old-fashioned idea that it is not worth consideration to-day. I must, therefore, explain that reference is being made to the urgent necessity for training everybody to the idea that it is not so much the visible dirt that has now to be dealt with, but the invisible variety. The menace of visible filth is so obvious that the ordinary person is forewarned and therefore forearmed, but when one comes to bacterial contamination of the hands, a very different problem is set, though its conquest is really a very easy matter. The answer lies in those two very simple commodities—soap and water. Perhaps a few examples of illnesses which are much to the forefront at present, and could be so easily controlled by a knowledgeable public, would not be out of place. It is fairly widely known that much trouble and sickness are caused by food poisoning, but if only everyone would take that little bit of extra care in handwashing before touching food, the incidence of the condition could undoubtedly be cut enormously. The same thing could be said of dysentery which, if it once gets into a household, nearly always affects everybody living there, due almost entirely to hand contamination with the bowel borne germs of the disease. It is also a scientific fact that the virus of anterior poliomyelitis can be recovered from the excreta of patients, and often from close contacts in the home, and surely this is a good enough excuse alone for raising the question of cleanliness and for appealing to all to ponder this question and honestly ask themselves if they could not improve their standard of hand washing. Reference has just been made to the virus of anterior poliomyelitis, and it would seem the opportune time to refer to the comparatively new science of virology which may well hold the key to some of the outstanding problems of medical science. There are still a number of incidents taking place in our midst which appear to be of an infectious nature, but for which no obvious cause can be found, and it may well be that the eventual answer will come from the ever increasing study of the viruses. Even as this is being written, preparations are going well ahead for the first batch of vaccinations against anterior poliomyelitis, and one hopes that satisfactory results will accrue from this campaign although it is inevitable that some considerable time will have to elapse before the results can be assessed properly. 7 As will be known, a number of cases of anterior poliomyelitis occurred in the district during the course of the year, and as a full account of them can be found in the infectious diseases section, further reference to this disease will not be made here. Another problem which has been very much to the forefront during the past year has been that of cancer of the lung, and its possible association with tobacco smoking. Statistically speaking, there would certainly appear to be a correlation between the incidence of the disease and the amount of tobacco smoked, but it would also appear that smoking can only be a contributory factor and not the sole cause, as the disease also affects those who have never smoked. Statistics also show that cancer of the lung is much more prevalent in urban communities than it is in rural ones, which might indicate that atmospheric pollution also plays a part in the aetiology of this disease, but of course there are other great differences between the way of life in town and country which may play a part. When considering this very difficult question, it is well to remember that the facilities for diagnosis of chest conditions improve year by year, and it could well be that the apparent increase is greater than the actual increase owing to improved diagnosis. Summing up, I should say that all the available evidence pointed strongly to some association between cancer of the lung and smoking, and in the present state of our knowledge, I would counsel moderation in smoking pending further factual evidence being brought to light, but with the facts before him or her, it is up to every smoker to come to their own conclusions in the light of present knowledge. This letter would be incomplete without reference to the recurring problems of the elderly person for whom difficulty is experienced in finding suitable accommodation. The statutory bodies are doing everything within their power and are receiving wonderful support from the voluntary organisations which flourish greatly in this district, but the time comes when only a bed and constant care and attention can solve the problem, and this with an ever ageing population, is where the real difficulties start for with long waiting lists for institutional accommodation really difficult situations inevitably arise from time to time. One wonders what preventive measures can be taken to alleviate the position, and it does appear that it is very necessary for each of us to prepare ourselves for a possibly very long life by acquiring interests and hobbies in middle age, and indeed even in youth, which will stand us in good stead in our later years. By always having an interest it is undoubtedly possible to stave off many of the more tiresome effects of advancing years, and thus remain useful, happy and contented to the end of our days. 8 Turning from soliloquy to hard facts, the vital statistics show no dramatic changes from the previous year. A further small rise in the population is recorded, the death and infant mortality rates both show a small increase, but the stillbirth rate is well down compared with the previous year. Generally speaking, the alterations do not seem to be of any special significance but those who are interested will be able to find detailed facts and figures in the section devoted to vital statistics. I must now refer to the staff changes which have occurred during the past year. Following my promotion from your Deputy Medical Officer of Health to your Medical Officer of Health, a new deputy was appointed in the person of Dr. A. J. I. Kelynack, who has delighted everyone with his charm of manner and the quality of his work. In addition, we welcomed Mr. Downing who has ably filled a vacancy in the ranks of the sanitary inspectors. I should especially like to thank Mr. Kermode for all the hard work he has performed during this his first full year as your Chief Sanitary Inspector and under whose guidance the whole staff have worked so well—a fact which I acknowledge with grateful thanks. This is also my opportunity for expressing my gratitude to my colleagues in the Hospital and General Practitioner services who have co-operated so graciously during the year, and thus lightened my task materially. There are many other individuals and organisations to whom I am indebted and to all I say " thank you very much." Finally, I should like to thank the members of the Public Health Committee for their continued interest and support, and trust they will like the " new look " which has been given to this year's report both as regards cover and contents. I am. Your obedient Servant, H. B. C. CARTER-LOCKE, Medical Officer of Health. May, 1956. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 10 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area of the Urban District (in acres) 8,957 Registrar General's estimate of total population (mid-year) 1955 86,870 Rateable Value at 31st March, 1955 £739,293 Rateable Value at 31st March, 1956 (estimated) £750,270 Rateable Value at 1st April, 1956 (estimated) £1,249,746 Product of a Penny Rate for year ended 31st March, 1956 £3,040 Number of Valuation assessments as at 31st March, 1955: — Houses and Flats, including Flats over shops 24,826 Farmhouses 93 Public Houses and Beer Houses 28 Business Premises 1,589 26,536 Mileage of Roads as at 31st March, 1955: — County Roads, Class 1 (including Trunk Roads) 21.42 County Roads, Class 2 4.30 County Roads, Class 3 6.12 District Roads 75.75 Unadopted Roads 8.50 116.09 Vital Statistics. Live Births. Total. Male. Female. Legitimate 1,325 660 665 Birth Rate 15.8 (crude) per 1,000 total population. (Adjusted rate lor comparison with other areas 15.3.) Illegitimate 45 25 20 1,370 685 685 The area comparability factor supplied by the Registrar General for the purpose of determining rates for comparison with other areas is 0.97. Stillbirths. Total. Male. Female. Legitimate 17 11 6 Stillbirth Rate 0.19 per 1,000 total population, and 12.2 per 1,000 (live and still) births. Illegitimate — — — 17 11 6 Deaths. Total. Male. Female. 747 399 348 Death Rate 8.6 per 1,000 total population. (Adjusted rate for comparison with other areas 10.5.) The area comparability factor calculated by the Registrar General for comparison of death rates is 1.22. 11 Deaths from Puerperal Causes. Puerperal sepsis 1 Maternal Mortality Rate 0.72 per 1,000 (live and still) births. Deaths of Infants under 1 year of age. Total. Male. Female. Legitimate 32 16 16 Infant Mortality Rate 24.8 per 1,000 live births. Illegitimate 2 1 1 34 17 17 All Infants per 1,000 live births 24.8 Legitimate Infants per 1,000 live legitimate births 24.2 Illegitimate Infants per 1,000 live illegitimate births 44.4 Vital Statistics of the Urban District for the past ten years. Year Population No. of Births (live) No. of Deaths No. of Infant Deaths No. of Maternal Deaths Birth Rate Death Rate Infant Mortality Rate Maternal Mortality Rate 1946 67,870 1,412 638 35 1 20.8 9.4 24.0 0.6 1947 70,580 1,481 632 44 1 20.9 8.9 29.0 0.6 1948 72,750 1,197 659 20 3 16.4 9.1 16.7 2.5 1949 73,850 1,159 582 22 3 15.8 7.9 19.0 2.6 1950 80,040 1,201 682 28 — 15.0 8.5 23.3 — 1951 85,150 1,372 757 32 4 16.1 8.9 23.3 2.9 1952 85,130 1,282 739 25 2 15.1 8.7 19.5 1.5 1953 85,290 1,291 732 31 — 15.1 8.6 24.0 — 1954 85,830 1,317 678 24 — 15.3 7.9 18.2 — 1955 86,870 1,370 747 34 1 15.8 8.6 24.8 0.72 Statistics for England and Wales, 1955. Birth Rate per 1,000 total population 15.0 Death Rate per 1,000 total population 11.7 Infant Mortality Rate, per 1,000 live births 24.9 (Lowest ever recorded for whole country.) POPULATION. The Registrar General's estimate of the total population of the Urban District mid-year 1955, was 86,870, which is an increase of 1,040 over the figure for the previous year. This figure gives a density of 9.7 persons to the acre. The natural increase of population, measured by excess of births over deaths, for 1955, was 623. The steady increase in population in the postwar years continues and it is interesting to note that as recently as 1946. the number resident in the district was only 67,870. It is not anticipated that the rate of increase during the past ten years will continue during the next ten years and it is more likely that in the not too distant future this figure will tend to become a fairly static one. 12 BIRTHS. At 15.8 per 1,000 total population, the birth rate exceeded that of England and Wales which was 15.0, it was also slightly in excess of the local figure of 15.3 during the previous year. A total of 1,370 live births were registered as against 1,317 during 1954. It is perhaps surprising that this figure of 1,370, is made up of exactly the same number, i.e. 685 of males and females. The birth rate, adjusted for comparison with other areas, is 15.3. Having considered the over all birth rate, I must now refer to the illegitimate birth rate which is 32.4 per 1,000 live and still births and represents a total of 45 illegitimate births of which 25 were males and 20 females. Finally, reference must be made to the still births of which 17 were registered and of those 11 were males and 6 females, giving a rate of 12.3 per 1,000 live and still births. DEATHS. 747 deaths appertaining to the Urban District were registered during 1955, giving a Death Rate of 8.6 per 1,000 total population. The adjusted rate for comparison is 10.5. The rate for England and Wales as a whole is 11.7. Of the 747 deaths registered, 399 were males and 348 females. An analysis of the ages at death shows that:— 34 were under 1 year of age. 4 were 1 and under 5 years of age. 3 were 5 and under 15 years of age. 5 were 15 and under 25 years of age. 30 were 25 and under 45 years of age. 228 were 45 and under 65 years of age. 166 were 65 and under 75 years of age. 277 were 75 and over. 747 Total. The death rate at 8.6, shows an increase when compared with a figure of 7.9 for the previous year, but this small increase is largely accounted for by an increase in the infant mortality rate which has risen from 18.2 in 1954, to 24.8 in 1955. Even now this compares favourably with the whole of England and Wales for which the infant mortality rate is 24.9, which figure itself is the lowest ever recorded for the country as a whole. The infant mortality rate represents 34 deaths, of which 25 occurred during the first month of life, and as many as 10 were due to congenital malformations. 13 After two consecutive years with no maternal mortality, I have to record, regretfully, that one maternal death occurred during 1955. Full details of the causes of death will be found in Table II in the appendix, but the following information with regard to certain causes of death in the Urban District during the past five years may be of interest:— 1951 1952 1953 1954 1955 Cancer (all sites) 132 127 154 149 157 Cancer of Lung, Bronchus 22 21 38 36 44 Respiratory Diseases (not Tuberculosis) 89 72 80 73 87 Heart and Circulatory Diseases 361 377 325 320 353 Tuberculosis 30 22 20 14 7 Infectious Diseases 4 4 3 2 2 Road Traffic Accidents 6 4 9 5 5 Other Violent Causes 12 10 7 9 10 Suicide 9 8 13 6 10 Digestive Diseases 18 11 17 14 14 The most encouraging feature of these figures is the continued fall in the number of deaths from tuberculosis, which were only 7 compared with 14 in the previous year and 30 as recently as 1951. It cannot of course be expected that the number of deaths attributable to this disease can fall much further until the disease has been eliminated from the community entirely. There were 25 deaths from violence, including 5 road traffic accidents, 10 other accidents, and 10 suicides. This compares unfavourably with a total of 20 during 1954 and represents a tragic and unnecessary loss of life. The number of deaths from cancer rose by 8 in comparison with 1954. and this rise was accounted for by the increase in the deaths from cancer of the lung, which subject has been dealt with more fully elsewhere in this report. MORBIDITY STATISTICS. A weekly return is received from the Regional Office of the Ministry of National Insurance, giving details of the number of certificates for sickness benefit received at the local office. These figures give some indication of the seasonal trend of illness in the area, and it will be seen that the year 1955 followed the expected trend, i.e.. that the highest incidence of illness occurred during January and February and then declined to its lowest level in August, and then gradually rose again towards the end of the year. 14 Four weeks ending. Number of certificates of incapacity. First. Intermediate. Final. 25th January 1,444 4,146 1,009 22nd February 1,405 4,342 1,362 22nd March 1,170 4,163 1,158 19th April 854 3,891 1,007 17th May 735 3,753 718 14th June 584 3,646 568 12th July 565 3,543 613 9th August 506 3,306 516 6th September 567 3,215 503 4th October 712 3,391 555 1st November 882 3,638 763 29th November 842 3,577 826 1956 3rd January, (5 weeks) 1,065 4,016 854 MEDICAL EXAMINATIONS. During the year 26 members, or potential members of the staff, were medically examined for superannuation purposes, etc. UNEMPLOYMENT. I am indebted to the Manager of the Local Employment Exchange for the following information. 1955 has been a peak year for unemployment. Local concerns have all been working to capacity, while there is a constant demand for workers in Central and South Eastern London. Unemployment has accordingly been its lowest for many years. Women have been able to obtain a fair amount on a part-time basis, and the older man and woman has found it a little easier. As before, with only a few exceptions, the able-bodied not too old, and not too disabled, man and woman has been able to find employment. OPEN AIR RECREATIONAL AMENITIES. Commons. The Chislehurst and St. Paul's Cray Commons have an area of approximately 165 acres and are administered by a Board of Conservators. Public Recreation Grounds, Gardens, etc. Some 392.42 acres of land have been secured or reserved for public recreational purposes within the Urban District. 15 Location. Acreage. Description. Abbeyhill Park 6.84 Part allotments. Belmont Lane Open Space 5.59 Temporary 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 and children's playground. Church Lane Recreation Ground 2.25 Open space. Footscray Common .70 Open space. Footscray Recreation Ground 6.80 Open space and part allotments. Hoblingwell Wood 87.00 Open space. 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 and children's playground. 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. Marlborough Park 6.32 Open space with 1 football pitch and 1 netball pitch. Mottingham Lane 1.00 Children's playground. Mottingham Sports Ground 30.00 Open space with 2 tennis courts, 8 football pitches, 6 cricket pitches, 1 hockey pitch and 3 concrete cricket practice pitches (mobile canteen, summer). Mottingham Recreation Ground 5.89 Open space — children's playground. Old Farm Park 11.78 Open space and part allotments. Parish Wood 6.73 Open space. Penhill Park 17.10 Open space with 3 football pitches, 3 grass cricket pitches, 1 concrete cricket pitch and children's playground. River Cray Reservation: — (1) North Cray Place Farm 29.60 Used for agricultural purposes. (2) Footscray Meadows 49.32 Open space and agricultural purposes. 16 Location. Acreage. Description. St. Paul's Cray Recreation Ground 6.20 Open space with children's playground. Sidcup Place 25.31 Open space with 1 football pitch, 1 cricket pitch, 1 putting green, 4 tennis courts, walled garden, children's playground and cafe. Stable Meadow Sports Ground 17.45 Open space with 2 football pitches and 1 cricket pitch. The Oval 1.66 Open space. Walden Recreation Ground 4.60 Open space with 1 football pitch. Waring Park 13.06 Open space with 4 tennis courts, 2 cricket pitches, 1 putting green, 2 netball pitches and 1 concrete practice pitch and children's playground. Willersley Park 5.59 Open space with 4 tennis courts and children's playground. 480.33 The contribution which the open spaces can make towards the health of a place is of course incalculable, and by its provision of a large number of open air recreational facilities the Council has made arrangements for both young and old alike. The younger generation are given the opportunity to enjoy their sports and pastimes, and for those who enjoy less active pursuits, every chance is given to take full advantage of the restfulness of a summer evening or week-end. Such amenities for both recreation and relaxation can only have beneficial effects on the population in general. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 18 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. NURSING HOMES. (Public Health Act. 1936. Sections 187-194.) There are six Nursing Homes on the register at the present time, providing for a total of 77 beds. Three of these beds are for maternity cases and the remainder for medical or surgical cases. Aged sick or aged infirm patients occupy the majority of these beds. The homes were inspected at frequent intervals during the year, and at no time were any contraventions found which required action on the part of the local authority. Details of the Homes are as under :— Number of Beds. Maternity. Other. Total. "Fallowfield," Ashfield Lane, Chislehurst — 38 38 "Hadlow," Hadlow Road, Sidcup 3 4 7 "Hatherley," Hatherley Road, Sidcup — 9 9 "Glenthorne," Lower Camden, Chislehurst — 12 12 "The Retreat," Lower Camden, Chislehurst — 4 4 "Redhill House," Redhill, Chislehurst — 7 7 3 74 77 PUBLIC MORTUARY. The public mortuary is situate at Beaverwood Road. Chislehurst, and during the year 144 bodies were taken there. Seventytwo of these were received from hospitals. Inquests were held in 27 cases. NATIONAL ASSISTANCE ACT, 1948. Section 47. Under this section of the Act (as amended by the National Assistance (Amendment) Act. 1951), powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year, it was not necessary to apply to the court for an order for compulsory removal. 19 Section 50. This section of the Act places a duty on the local authority to arrange for the burial or cremation of the body of any person who has died or been found dead in their area if it appears that no suitable arrangements for the disposal of the body have or are being made. Expenses incurred by the local authority may be recovered from the estate of the deceased person or from any person liable to maintain the deceased person immediately prior to his death. During the year the Council arranged for the burial of one person under this section of the Act. LABORATORY SERVICE. Routine Food and Drugs samples and medical specimens, are sent to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council towards the end of 1955. and was taken over by the Public Health Laboratory Service (Directed by the Medical Research Council for the Ministry of Health). In cases of urgency specimens are examined by courtesy of Dr. Keall at Bromley Hospital. During the course of the year the following specimens have been reported upon. Food Faeces Vomit Others No. sent No. Positive No. sent No. Positive No. sent No. Positive No. sent No. Positive Bromley Hospital 7 2 23 3 — — 1 nasal Swab 1 throat Swab 1 Maidstone Public Health Laboratory 9 — 100 6 1 — 1 blood 1 Totals 16 2 123 9 1 — 3 2 PUBLIC CONVENIENCES. The Public Health Department is responsible for the cleaning of the undermentioned conveniences used by the public:— Public Lavatories (Male & Female sections): — Westwood Lane, Blackfen. St. Johns Road, Sidcup. Queens Head P.H., Chislehurst. Adj. Tigers Head P.H., Chislehurst. 20 Public Conveniences in Parks (Female sections only):— Willersley Park, Blackfen. Penhill Park, Blackfen. The Glade, Lamorbey. Waring Park, Sidcup. King George's Field, Sidcup. Longlands Recreation Ground, Sidcup. Recreation Ground, St. Paul's Cray. West Chislehurst Sports Ground, Chislehurst. Recreation Ground, Mottingham. A staff of three whole-time and one part-time cleaners is employed for this work. Plans have been approved for the construction of new conveniences on the L.C.C. Estate at St. Paul's Cray, and in the village of Mottingham. Particular attention has been paid to the use of sturdy fitments in order to reduce to a minimum malicious damage which is caused to these buildings and fixtures. This damage has reached serious proportions during the year and in one case it became necessary to close a convenience pending the erection of fencing and the reinstatement of the building. DISINFECTION. DISINFECTIONS. Premises visited 348 Rooms disinfected 55 Articles disinfected 490 DISINFESTATIONS. Premises visited 21 Rooms disinfested 8 Articles disinfested — DISINFECTIONS. Fumigation Sprayed Steam Disinfected Destroyed Rooms 8 55 — — Mattresses — — 75 10 Pillows — — 258 6 Blankets — — 139 8 Clothing, bundles of — — 1 4 Library Books — 17 — — 8 72 473 28 Disinfections. In appropriate cases disinfection is carried out by the Department after the removal of a person with an infectious complaint from a house or subsequent to the patient being declared free from infection. 21 Rooms, fixtures and furnishings are sprayed with formalin and in suitable cases bedding and clothing are treated in the Council's steam disinfector. Public Library books which have been exposed to infection are rendered safe and returned to the Libraries. Disinfestation. The Department also carries out work to eradicate vermin in premises. Rooms infected with bed bugs are treated with a solution containing a quick acting insecticide together with D.D.T. Bedding is subjected to steam under pressure, in order to destroy eggs. etc. Advice is given to householders to assist them in dealing with various other insect infestations. Laundry for the Aged Sick. In conjunction with the Old Peoples Welfare Committee and the Sidcup and Swanley Hospital Management Committee, a service is provided for the laundering of soiled bed linen from incontinent persons, in cases where it is not suitable for cleaning at a commercial laundry and where it cannot be dealt with in the patient's home. Although the facility has been available since 1954. surprisingly little use has been made of it. However, towards the end of the year it was possible to assist two suitable cases and there is evidence that the scheme is becoming better known, amongst General Practitioners and social workers. HOSPITAL SERVICES. Cray Valley Hospital.—Provides a Hospital Service with the following beds:— 10 Maternity 10 Medical 10 Surgical 2 " Section 5 " 3 " Section 4 " Queen Mary's Hospital.—A general Hospital Service with the following beds :— Male. Female. Children. General Medicine 29 21 — Paediatrics — — 16 Diseases of the Chest 30 30 — (These beds are for pleural effusion patients and post-operative thoracic surgery convalescence only.) Chronic Sick 24 24 — General Surgery 30 30 8 Tonsils and Adenoids — — 10 Traumatic and Orthopaedic Surgery 15 15 — Opthalmology — — 2 Gynaecology — 20 — Totals 128 140 36 22 Sidcup Cottage Hospital.—A General Practitioner Hospital with the following beds :— 11 Medical 1 " Section 5 " 1 " Section 4 " The above Hospitals all come within the area of the Sidcup and Swanley Group Hospital Management Committee of the South East London Region. Grove Park Hospital.— Six blocks of this hospital come within the area of the Urban District. All beds are reserved for the use of tuberculous patients. Venereal Diseases.— Patients are referred to the various hospitals with specialist clinics for dealing with these diseases. None of these are situated within the Urban District. COUNTY COUNCIL SERVICES. Ambulance Service. The ambulance depot is situate at Main Road, Sidcup, where 2 ambulances and 4 sitting-case cars are available. These vehicles are radio controlled. Domestic Help Service. The District Organiser's office is at 69. Sidcup Hill, Sidcup. The following is a summary of the cases assisted during 1955:— Maternity (Expectant Mothers) 128 Tuberculosis 26 Aged 279 Others 203 636 Domiciliary Midwifery. Eight full-time midwives are engaged in the area. Patients may obtain the services of a midwife on direct application, or through the patient's private doctor. Health Visiting. Twelve Health Visitors and School Nurses, and three Tuberculosis Health Visitors are employed in the Urban District. In addition to their school work, the Health Visitors are responsible for the Maternity and Child Welfare Centres, Immunisation and Vaccination Clinics. Home Visiting. After Care, and give advice on the care of young children, and advice to expectant and nursing mothers. 23 Home Nursing Service. Twelve Home Nurses are working in the area. This service is provided on medical certification only, and is free. No night service is given at the present time. Women's Welfare Clinics. These clinics are held in various parts of the district. Patients must be referred on medical grounds, and are seen by appointment. HEALTH SERVICES. Ante-Natal Clinics and Child Welfare Centres. CHISLEHURST: The Willows, Red Hill Child Welfare Ante-Natal Women's Welfare FOOTSCRAY: W. Smith Memorial Hall, Church Road Child Welfare MOTTINGHAM: K.C.C. Clinic, Kimmeridge Road Child Welfare Ante-Natal NORTH CRAY: Men's Social Club Child Welfare SIDCUP: Congregational Church Hall, Station Road Child Welfare Ante-Natal First Aid Post, The Oval, Sherwood Park Avenue Child Welfare Ante-Natal Women's Welfare ST. PAUL'S CRAY: Health Clinic, Mickleham Road Child Welfare Ante-Natal Tuesday & Thursday p.m. Test Feeds—Tuesday a.m. Wednesday p.m. 2nd Tuesday a.m. Tuesday p.m. Monday & Wednesday p.m. Monday & Wednesday a.m. 1st, 3rd & 5th Friday p.m. Monday & Wednesday p.m. Wednesday a.m. Thursday p.m. Tues., Wed. & Fri p.m. Tuesday & Friday a.m. 1st & 3rd Thursday a.m. Mon., Wed. & Thur p.m. Wednesday a.m. Ante-Natal Exercises, Relaxation and Mothercraft. MOTTINGHAM: Kimmeridge Road ST. PAUL'S CRAY: Mickleham Rd. SIDCUP: The Oval, Sherwood Park Avenue. Congregational Church Hall, Station Road CHISLEHURST: The Willows, Red Hill Thursday 2.30 p.m. Tuesday p.m. Thursday 2.30 p.m. Thursday 1.30—4 p.m. Wednesday 1.30—4 p.m. 24 Asthma Clinic. CHISLEHURST: The Willows, Red Hill Dental Clinics. (all Dental Clinics by appointment.) CHISLEHURST: The Willows, Red Hill MOTTINGHAM: Kimmeridge Road ST. PAUL'S CRAY: Mickleham Rd. SIDCUP: 10, Station Road Thursday (by appointment) a.m. Mon., Wed. & Thurs (all day) Tuesday & Friday (all day) Mon., Tues, Thurs. & Fri. (all day) Mon., Tues., Wed., Thurs. & Fri (all day) Domestic Help, Family Help and Old People's Service. District Organiser: Miss J. SMITH, 69, Sidcup Hill, Sidcup. Tel. FOOtscray 5521/2. Diphtheria Immunisation and Vaccination. CHISLEHURST: The Willows, Red Hill Immunisation Vaccination FOOTSCRAY: W. Smith Memorial Hall, Church Road Immunisation Vaccination MOTTINGHAM: Kimmeridge Road Immunisation Vaccination NORTH CRAY: Men's Social Club Immunisation ST. PAUL'S CRAY: Mickleham Rd. Immunisation Vaccination SIDCUP: First Aid Post, The Oval, Sherwood Park Avenue Immunisation Vaccination Tuesday & Thursday 2—4 p.m. Tuesday & Thursday 2—4 p.m. Tuesday 2—4 p.m. 1st Tuesday in month 2—4 p.m. Monday & Wednesday 2—4 p.m. Wednesday 2—4 p.m. 1st Friday in month 2—4 p.m. Mon, Wed. & Thurs 2—4 p.m. Mon., Wed. & Thurs 2—4 p.m. Tues, Wed. & Fri 2—4 p.m. Wednesday & Friday 2—4 p.m. All the above sessions are in conjunction with the normal child welfare sessions. SIDCUP: 10, Station Road Immunisation Thursday II a.m.—12 noon Vaccination Thursday 11a.m.—12 noon These sessions are for diphtheria immunisation and vaccination only. Midwives Clinic. ST. PAUL'S CRAY: Mickleham Rd. Minor Ailment Clinics (Schools). CHISLEHURST: The Willows, Red Hill ST. PAUL'S CRAY: Mickleham Rd. SIDCUP: 10, Station Road Friday p.m. Thursday 9—10 a.m. Saturday 9—12 noon Mon., Tues., Wed., Fri., & Sat 9—10 a.m. Thursday a.m. 25 Ophthalmic Clinic. (By appointment) CHISLEHURST: The Willows, Red Hill ST. PAUL'S CRAY: Mickleham Rd. Monday a.m. Thursday a.m. Post-Natal—Women's Welfare Clinics. CHISLEHURST: The Willows, Red Hill SIDCUP: The Oval, Sherwood Park Avenue 2nd Tuesday a.m. 1st & 3rd Thursday a.m. District Officer and Assistant District Officer. (Also Duly Authorised Officers under the Lunacy and Mental Treatment Acts.) District Officer: B. C. WICKENDEN, Office: 69, Sidcup Hill, Sidcup. Tel. FOOtscray 5521/2. Assistant District Officer: J. N. TIBBALS, Office: 69, Sidcup Hill, Sidcup. Tel. FOOtscray 5521/2. Home Teacher of the Blind. Miss S. M. NOBLE, c/o 69, Sidcup Hill, Sidcup. SERVICES RENDERED BY VOLUNTARY AGENCIES. British Red Cross Society. The Chislehurst and Sidcup Division has six Detachments which operate wholly or partly within the District. The Divisional Office is at Hornbrook House, High Street, Chislehurst. Four medical loan depots are operated in the area, to provide invalid and sick room equipment for local residents. A small charge is normally made for each article. " Beltoft," Hadlow Road, Sidcup By appointment. Kent County Council, District Office, Sidcup Hill, Sidcup During office hours. 56, Woodside Avenue, Chislehurst By appointment. 51, Framlingham Crescent, Mottingham Wednesdays 6—7 p.m. or by appointment. A club for disabled men and women known as " The Good Samaritan Club "meets at the British Legion Headquarters, Chislehurst, on the second and fourth Friday in each month, at 2.30 p.m. 26 In addition to first aid duties and regular auxiliary nursing in the hospitals of the neighbourhood, invaluable assistance is rendered in home visiting of the sick and aged, diversional therapy for the home bound, auxiliary hospital services, and escort duties. A road hut at Ruxley is manned on Sundays and Bank Holidays, to render first aid in case of road accidents. The St. John Ambulance Brigade. The Sidcup Brigade continues to offer personnel trained in first aid for attendances at public gatherings, to accompany children and aged persons and to escort patients undertaking long journeys. During 1955 members of the local Division have put in 2,500 nursing hours. Chislehurst and Sidcup Voluntary Tuberculosis Care Committee. I am indebted to the Liaison Officer of this Committee for the following information on its work during 1955 :— The Committee has been very active and help has been extended whenever possible to many families ; in most cases the help has followed the usual pattern—help with fuel during the winter months, assistance with fares to visit patients, hire purchase debts, clothing, bedding, furniture, etc. Financial help has also been obtained from other organisations, such as S.S.A.F.A., W.V.S., British Legion, and British Red Cross Society, and the closest co-operation has been maintained between all statutory bodies. Many home visits were paid, and an office is open on Tuesdays, Wednesdays and Thursdays, between 2 p.m. and 4 p.m. at the United Services Club. 108, Main Road, Sidcup, for all patients or their representatives to call and see the Liaison Officer to discuss their many problems and to obtain whatever help is necessary. Employment presents a problem, as most patients are considered fit for light work only, but in this respect we have the closest co-operation with many local firms and whenever possible they will help when a suitable vacancy occurs. Toys are distributed at Christmas time via the Chairman of the Council, and help is often given by various sources in the form of grocery parcels for distribution to patients. Women's Voluntary Services. The work of the Women's Voluntary Service continues throughout the district and emphasis has again been laid on the welfare of old people. Wheel chairs are loaned and escorts are provided to assist those attending hospital. Assistance is given in the Outpatients' 27 ment of Queen Mary's Hospital, and a trolley shop is operated at Cray Valley Hospital. Help has been given to the staff of the Mass X-Ray Unit, whilst operating in the district. Domestic help is arranged in suitable cases and personal shopping undertaken. Clothing is supplied to tuberculous patients and other needy persons at the request of the National Assistance Board's Officers. The distribution of welfare food is undertaken. CHISLEHURST AND SIDCUP OLD PEOPLE'S WELFARE COMMITTEE. The following is a resume of the work carried out by the Committee :— During the year 1,000 elderly people have enjoyed the club life provided. " Redlac," 49, Station Road, Sidcup. This house which has been converted into ten single-room flats, was opened during the year. The old people residing there have the assistance of a resident house-mother. Boarding Out Scheme. A scheme whereby accommodation is found for old people in suitable private homes has been inaugurated. Education. With the aid of the King George VI Memorial Fund, it has been possible to send two members of the Committee to a Leaders' Course and to arrange courses for local leaders, one of which was held in Sidcup. In conjunction with the Kent Education Committee, lectures suitable for the old people were arranged and much appreciated. Holidays and Entertainment. Over 150 old people were enabled to enjoy seaside holidays, the inclusive charge for the week being most reasonable. Various excursions have been arranged and handicraft, bulb growing and choir contests have been particularly successful. Entertainment has been provided by numerous local organisations. Visiting. Visits are arranged to the homes of lonely persons and to those in hospital. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. 30 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. WATER SUPPLY. A number of samples of water from the mains of the Metropolitan Water Board were taken by the Department. Five were submitted for bacteriological test and two were analysed to ascertain the chemical constitution. All were found to be satisfactory for drinking purposes. At the end of the year there were two dwelling houses in the District not connected with the public supply. Water is obtained from one private well. I am indebted to the Director of Water Examination of the Metropolitan Water Board for the following information on the supply of water to the Urban District during the year 1955 :— "The supply to the district of Chislehurst and Sidcup in 1955 was derived from the following wells: Orpington, North Orpington, Shortlands, Eynsford, Horton Kirby, Wilmington and Darenth, together with Thames-derived filtered water via Shortlands Pumping Station. There were no extensions of trunk mains in the area during 1955, but there were a number of 4-inch mains laid in various estate roads. Bacteriological analyses of samples of water at these various sources of supply are made at least five times a week and consistently satisfactory results have been obtained from samples of water passing into supply. Chemical analyses of the samples are also made at frequent intervals. All supplies are treated with chlorine at 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 all the above well stations to ensure an adequate period of contact of chlorine with the water. 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 plumbosolvent. Appended are the results of chemical and bacteriological analyses of the various supplies to Chislehurst and Sidcup during 1955 before and after treatment." 31 Average Results of the Chemical and Bacteriological Examination of the water supplied to the Chislehurst and Sidcup Urban District Council during 1955. Parts per Million (unless otherwise stated). Horton Kirby Well Orpington Well North Orpington Well Shortlands Well Eynsford Well Wilmington Well Darenth Well Thames derived filtered water Number of samples 2 4 4 10 5 7 8 1663 Ammoniacal Nitrogen Nil Nil 0.003 0.002 0.001 0.006 Nil 0.014 Albuminoid Nitrogen 0.015 0.019 0.019 0.020 0.019 0.024 0.018 0.085 Oxidised Nitrogen—Nitrite — — — — — — — — Oxidised Nitrogen—Nitrate 5.0 7.5 5.4 4.5 4.1 7.1 5.5 3.8 Chlorides as Cl 16.0 15.0 13.0 17.0 16.0 21.0 16.0 26.0 Oxygen abs. from Permanganate 4 hrs. at 27°C. 0.08 0.08 0.07 0.08 0.10 0.12 0.06 1.04 Turbidity in terms of Silica 0.4 0.3 Nil Nil 0.1 0.1 Nil 0.2 Colour, m.m. brown 2 ft. tube, Burgess's Tintometer Nil 3 Nil Nil Nil Nil Nil 12 Hardness (Total) 254 282 265 272 254 286 270 258 Hardness Non-Carbonate 39 50 35 70 34 56 40 65 pH Value 7.3 7.2 7.2 7.1 7.3 7.2 7.2 7.8 Phosphate as P.O4 0.10 0.06 0.06 0.05 0.06 0.04 0.05 0.50 Sulphates as S04 18 13 8 41 11 15 13 49 Dissolved Oxygen — — — — — — — — Oxygen Saturation % — — — — — — — — B.O.D. 5 days at 65°F. — — — — — — — — Conductivity 425 425 425 450 400 450 450 450 32 BACTERIOLOGICAL RESULTS Horton Kirby Well Orpington Well N. Orpington Well Shortlands Well Eynsford Well Wilmington Well Darenth Well Thames derived filtered water Before Chlorination Number of samples 140 249 226 499 311 470 398 7040 Plate Count (Average per millilitre) Colonies counted on Agar: 37°C. (20-24 hours) Bact. coli test: 0.2 5.0 5.3 0.04 0.5 3.0 0.2 — Percentage samples negative in 100 ml. 98.6 100.0 25.2 100.0 99.1 99.4 99.3 60.4 Average number per 100 ml 0.01 — 6.80 — 0.01 0.01 0.01 3.73 After Chlorination (Water passing into Supply) Number of samples Plate Count (Average per millilitre) Colonies counted on Agar: 143 255 230 256 316 255 251 3561 37°C. (20-24 hours) Bact. coli test: — — — — — — — 7.8 Percentage samples negative in 100 ml. 100.0 100.0 99.6 100.0 100.0 100.0 100.0 99.9 Average number per 100 ml — — 0.004 — — — — 0.002 33 DRAINAGE AND SEWERAGE. The Engineer and Surveyor has kindly furnished the following details of work carried out:— Extensions to Public Sewers carried out during the year :— Foul Sewers. Leesons Hill, St. Paul's Cray 1,075 yards. Sidcup By-pass 113 yards. Storm Water Sewers. Leesons Hill, St. Paul's Cray 1,071 yards. In addition, 91 yards of foul sewers and 166 yards of storm water sewers have been laid in connection with private housing estates. RIVERS AND STREAMS. It has not been necessary to carry out any constructional work to the streams in the district for which the Council is responsible. Day to day maintenance has received attention. CESSPOOLS. Two new buildings with cesspool drainage were erected in 1955. Twenty-five cesspools are known to have been abolished, mainly in consequence of the construction of the sewer at Leesons Hill. The desirability of connecting premises to the sewer, when available, has been brought to the notice of owners concerned. There are now 455 premises not connected to main drainage. Lamorbey and Blackfen 8 Sidcup and Footscray 21 North Cray 241 St. Paul's Cray 102 Chislehurst and Mottingham 83 455 In a number of cases two or more properties are drained to the same cesspool. The total number of cesspools in use in the district is believed to be 359. The Cesspool Emptying Service instituted by the Council in 1954 has functioned satisfactorily. A charge of 7/6 is made for the removal of 600 gallons from private houses and 15/- per 600 gallons for other premises. Continuous efforts have been made to bring to the notice of property owners the advantage of emptying their cesspools 34 quently. The service is now better known and has received fair usage. A total of 998,400 gallons of sewage were dealt with. 1954 April-Dec. 1955 Individual cesspools emptied 208 239 Total number of emptyings 447 748 Total number of loads removed 1,023 1,664 SWIMMING BATHS. There are two small open air swimming pools in the area. One is privately owned, but the public are admitted during the summer. The other is attached to a factory and used by employees. Two samples from each of these pools were taken and proved to be satisfactory. SANITARY INSPECTION OF THE AREA. Table VI in the Appendix gives full details of the work carried out by the Sanitary Inspectors during 1955. The following is a summary of the totals under the respective headings :— Total number of Inspections and Visits. Housing 4,832 Infectious Diseases 430 Food Premises, Sampling, Visits, etc 2,045 Factories, Outworkers, etc. 333 Moveable Dwellings 606 Smoke Abatement and Shops Act 316 Rodent Control 1,725 Miscellaneous 429 10,716 In addition to the above, there were many interviews with owners, agents, etc., on site and at the office, in this connection. Notices issued :— Preliminary: General Sanitary Defects 137 Food Premises 49 Shop Premises 4 Factories, etc 14 Rodent Control 9 213 Statutory: Public Health Act 17 Housing 0 Total 230 Food Condemnation Certificates issued 491 35 FACTORIES ACTS, 1937 AND 1948. A total of 333 inspections and re-inspections were made during the year and 40 nuisances and defects were found. Forty nuisances and defects were remedied during 1955. The following is a copy of the return for the year 1955, which has been made to the Minister of Labour and National Service :— 1. Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by the Local Authorities 28 29 2 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 156 198 9 — (c) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 46 106 3 — Totals 230 333 14 0 Number of cases in which defects were Number of cases in which prosecutions were Instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 1 1 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): — (a) Insufficient 15 14 — 1 — (b) Unsuitable or defective 17 16 — 9 — (c) Not separate for sexes 3 2 — — — Other offences against the Act (not including offences relating to Outwork) 4 1 3 — — Totals 40 34 3 11 0 36 SMOKE ABATEMENT. During the year the Thames-side Advisory Committee for the Abatement of Atmospheric Pollution adopted a new constitution and was renamed the Thames-side Joint Committee for the Abatement of Atmospheric Pollution. This Council continues to be represented and, in conjunction with other affected Authorities, an active part has been played in observing the effects of pollution caused by cement works flue dust. The deposit gauge installed at North Cray is read at regular intervals and serves to indicate the level of the solid matter present in the atmosphere. Detailed analysis of the matter deposited is given herewith. The level of total solids per square mile amounts to 14.97 tons each month during the year compared with 12.835 tons in 1954. It should be realised, however, that the readings obtained from an individual gauge are subject to considerable variation due to meteorological factors. It is hoped to instal further deposit and sulphur dioxide gauges in the Lamorbey area in 1956. In July, the first sulphur dioxide gauge was provided at North Cray and the readings so far obtained do not record a high degree of pollution from this substance within the district. The emission of industrial black smoke has not been the source of complaint during the year but the Clean Air Bill laid before Parliament, toward the end of the year, will, if passed, give further powers in this direction and secure some control over smoke from domestic premises. 37 Monthly deposit in tons per square mile during 1955. Water (in rain in inches) 2.36 1.31 0.94 0.67 3.30 1.81 0.036 0.77 2.38 3.43 0.26 1.72 pH Value 5.64 5.7 6.42 6.60 6.96 7.5 — 7.78 6.45 5.00 — 5.96 Total water in soluble matter 8.09 6.41 8.21 6.34 8.56 8.31 9.14 8.95 5.04 6.82 5.01 4.85 Soluble in CS, 0.08 0.10 0.13 0.17 0.11 0.25 0.03 0.08 0.14 0.11 0.06 0.11 Ash 5.89 4.74 6.51 4.75 6.32 6.26 6.84 6.77 3.42 4.92 3.68 3.75 Other combustible matter 2.12 1.57 1.56 1.42 2.13 1.80 2.27 2.11 1.48 1.79 1.27 0.99 Total water soluble matter 10.20 7.97 7.97 5.17 10.07 11.07 6.54 9.03 5.44 10.47 3.89 6.11 Ca + + 1.34 1.28 1.17 0.94 1.68 1.88 1.31 1.54 0.47 0.81 0.57 0.94 CI 1.44 1.02 1.17 0.54 0.97 0.84 0.49 0.70 0.64 1.41 0.70 1.07 so; 4.01 3.32 2.49 1.77 4.36 3.32 2.39 3.75 1.88 3.43 1.78 2.32 Total solids 18.30 14.38 16.18 11.50 18.63 19.38 15.69 17.98 10.48 17.29 8.91 10.95 Sulphur dioxide (milligrams of sulphur trioxide collected per day by 100 sq. cms. of Batch A lead peroxide) 0.76 0.68 0.85 1.35 1.75 1.38 38 VERMINOUS CONDITIONS AND UNCLEANLINESS. Fifteen complaints were received in connection with premises alleged to be verminous or unclean and 21 inspections were made. Insect infestations were found in 21 houses (11 controlled by the Council and 10 privately owned). The main causes were the bed bug and the common flea. Where necessary works of disinfestation were carried out by the staff of the Department. Complaints concerning dirty premises are sometimes found to be in houses occupied by the aged infirm or by persons of weak intellect. It is usually possible to effect some improvement in these cases but frequent visiting may be necessary if clean conditions are to be maintained. PUBLIC CLEANSING, REFUSE COLLECTION AND DISPOSAL. I am indebted to the Cleansing, Transport and Salvage Officer for the following information :— The volume of refuse has increased during the year, although the weight carried has not increased to any large extent. A lighter type of refuse is very much in evidence. The number of loads increased from 8,900 to 9,300. The tonnage was estimated to be in the region of 24,000 tons. The amount of kitchen waste collected is estimated to be over 720 tons, a slight increase over last year. The system of collecting kitchen waste by means of individual containers first introduced into the Lamorbey area in 1953 was extended to the Mottingham area in 1955. There were about 3,500 containers in use. HEATING APPLIANCES (FIREGUARDS) ACT, 1954. Observations have been kept on premises from which gas, electric and oil fires are sold, in connection with which 16 visits have been made. No contraventions of the Act were discovered. SHOPS ACT, 1950. The number of shops in the Urban District continues to increase, there now being 826 situated as follows :— Lamorbey and Blackfen 254 Sidcup and Footscray 266 North Cray and St. Paul's Cray 95 Chislehurst and Mottingham 211 39 Visits and observations under the Act have totalled 245, and four informal notices have been served on shopkeepers. In addition a number of minor infringements have been dealt with, without the service of notices. Offences. Found. Remedied. Notices and records 6 6 Sanitary accommodation 3 5 Washing facilities 2 3 No Closing Orders have been made. General Closing days vary throughout the district as follow:— Wednesday—St. Paul's Cray Estate (.except Leith Hill), All Chislehurst, The Oval, Lamorbey and Lewis Road, Sidcup. Thursday—Other areas. It is noted that a number of individual shopkeepers have exercised their right to remain open on the usual early closing day and to close on Saturday afternoons. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. There are no premises in the district licensed under the Rag, Flock Act. PET ANIMALS ACT, 1951. Licences to sell pet animals were issued in respect of 7 premises. Supervision of these shops has entailed 32 visits. Unsatisfactory conditions developed at one of these premises, but it was closed by the owner before any formal action became necessary. Allegations concerning the sale of pets by an unauthorised person were investigated, but no contravention of the Act was revealed. RODENT CONTROL. In common with other districts similarly situated, the usual increase in the activity of rats in the Spring of the year reached considerably higher proportions than is usual. This was dealt with by the Inspectors and the Rodent Operative, as a result of which, the level of infestations was reduced to normal by the Autumn. 40 The following is a summary of the work carried out during the year:— TYPE OF PROPERTY Non-Agricultural Local Authority Dwellings (including Council Houses) Others Business (inc. L.A. Business) Agricultural Number of properties inspected as a result of:— (a) Notification (Complaints, etc.) 20 428 52 — (b) Survey under Act (Visits as a result of (a), etc.) 29 553 50 — (c) Otherwise (e.g., visits primarily for other purpose) — 57 32 — Total inspections carried out 110 3,915 194 2 Number of properties inspected found infested: (a) Rats (Major) — — — — (Minor) 31 725 65 — (b) Mice (Major) 1 — — — (Minor) 1 39 15 — Number of infested properties treated by L.A. 26 721 66 1 Total treatments—including re-treatments and those carried out privately to properties 34 769 87 1 Number of notices (verbal or written): (a) Treatment — 30 11 — (b) Structural (e.g., Proofing) — 31 9 — Number of "Block" control schemes carried out — 5 — — SEWER INFESTATION. A "test bait" of all the Council's sewers was carried out in Mav to determine the extent of infestation by rats therein. The result of this test was favourable when compared with some other areas, but maintenance treatments were instituted during the months of June and November. Number Manholes treated No. manholes in which " Complete takes " " Partial takes " "No takes " Test Bait (10% manholes treated) 205 9 5 191 1st Maintenance treatment (June) 111 29 9 73 2nd Maintenance treatment (Nov.) 112 16 9 87 41 PETROLEUM (REGULATION) ACTS, 1928 AND 1936. Mr. J. C. Kermode is the Inspector appointed under these Acts. The storage facilities for petroleum spirit continues to expand due to additional tanks being installed at existing filling stations. Safety regulations are strictly enforced at the 56 premises which were licensed during the year. There are three riding stables in the district from which horses and ponies are hired out. The animals (consisting of 30 horses, 1 foal and 27 ponies) together with the premises, have been inspected by a veterinary surgeon, appointed by the Council, on two occasions during the year and found to be satisfactory. Certain improvements were effected to the stables. Two Licences were issued to dealers in Game in respect of the year. The total storage capacity is as follows:— Petroleum Spirit in tanks 120,035 gallons. in cans 100 gallons. Petroleum Mixtures in approved stores 7,615 gallons. Calcium Carbide 100 pounds. RIDING ESTABLISHMENTS ACT, 1939. GAME ACT, 1831 SECTION D. HOUSING. 44 SECTION D. HOUSING. HOUSING REPAIRS AND RENTS ACT, 1954. (i) Routine Inspections: Five hundred and five visits were made to premises in connection with the Housing Acts. The Survey under the Housing Repairs and Rents Act, 1954, commenced in the preceding year involved a review of some 824 premises. Having regard to Section 9 of the Act, 30 properties were considered ripe for demolition or closure and the Minister was notified accordingly. In due course, the programme received approval and it is intended to deal with these premises in the course of the next three years. This will entail the rehousing of displaced persons. (ii) Clearance Areas: No Clearance Areas were declared during the year. (iii) Individually Unfit Houses: No houses were closed during the year. (iv) Demolition Orders: No orders were made. (v) Overcrowding: The position at the 31st December, with regard to statutory overcrowding, as defined in the Housing Act, 1936, is as shown in the following table:— Number of cases—31st December 31st Dec., 1955 Area 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 No. of cases found during the year No. of cases remedied during year Cases at end of year No. of cases No. of persons concerned Aged over 10 Aged under 10 Lamorbey 4 6 7 9 6 7 11 9 5 2 2 2 4 3 1 — 4 22 5 Longlands — 1 — 1 1 1 — — — — — — — — — — — — — Birchwood — — 1 — — — 1 — — — — — — — — — — — — Frognal — 1 1 — — 1 1 1 — — — — — 1 — — 1 8 6 North Cray 1 1 1 1 1 1 3 1 1 — — — — — — — — — — St. Paul's Cray 1 2 4 5 6 4 5 3 3 2 2 4 4 3 1 1 3 18 9 Chislehurst Common 1 — — — 1 3 6 3 1 1 1 1 — — — — — — — Mottingham 2 2 4 5 15 6 15 26 17 13 10 10 11 5 1 1 5 41 5 Totals 9 13 18 21 30 24 42 43 27 18 15 17 19 12 3 2 13 89 25 45 HOUSING ACT, 1949. During the year 65 applications for improvement grants under the Housing Act 1949 were received. Thirty-one of these have been approved, involving a total cost of works of £8,849 one half of which will be paid by way of grant. Twenty-five applications are still under consideration. The majority of applications are in respect of the provision of bathrooms and hot water systems where none exist. CERTIFICATES OF DISREPAIR. Applications for Certificates of Disrepair under the Housing Repairs and Rents Act 1954, were few, only eleven being issued during the year. One of these was revoked, together with one of the Certificates issued in 1954. New Houses. During the course of the year 329 houses and 42 new flats were erected. (vi) Defects: Number of houses inspected for housing defects (Public Health and Housing Acts) 771 Number of houses found not in all respects fit 387 Number of houses made fit without service of formal notices 291 Council Houses. The following information has been supplied by the Housing Manager:— Prior to 1955. During 1955. Houses. Families in occup. Houses. Families in occup. 1. Permanent dwellings built by Local Authority 1,225 1,225 130 1,355 2. Prefabricated dwellings built by Local Authority 275 275 0 275 3. Premises requisitioned by Local Authority 196 326 161 253 4. Halfway Houses 6 35 6 31 5. Temporary Hutments 11 11 0 0 During 1955 there were 226 lettings as follow:— (a) Permanent dwellings 84 families from waiting list. (b) Prefabricated dwellings 10 families from waiting list. (c) Requisitioned premises 37 families from waiting list 131 46 The figure of 226 lettings includes 95 transfers which have been effected from various types of Council controlled property. During the year 14 families have been admitted to the Halfway Houses. 6. The total number of families on the waiting list at 1st November, 1955:— Couples 629 Families requiring two bedrooms 792 Families requiring three bedrooms 509 Families requiring four or more bedrooms 48 Old Age Pensioners and single persons 156 Cases not pointed and those passed for accommodation 228 Families in requisitioned premises 270 2,632 With reference to Item 3, it will be noted that a number of properties have been released from requisition during the year. MOVEABLE DWELLINGS. The presence of moveable dwellings in the area is governed by the Public Health Act, 1936, and by Town Planning requirements. Licences are required under the Public Health Act, and each application is considered on its own merits having regard to health considerations only. No new permissions are granted on Town Planning grounds unless satisfactory reasons are given in each individual case. The Department maintains a close liaison with the Engineer and Surveyor who is consulted in all appropriate cases. Careful watch is kept and the legal position is explained to unauthorised persons stationing vehicles either on new sites or adding to dwellings on sites already used for the purpose. The following table indicates the position at the end of 1955:— Average number of families Approx. number of persons Whether licensed Chalk Pit, Ruxley 47 196 (31 licensed) (16 not licensed) Smallgains Farm, Maidstone Road, Ruxley 2 4 Yes Ruxley Manor Farm, „ „ „ 1 2 Yes Birchwood (adj. Bull Hotel) 3 6 Yes Lower Hockenden Farm, Lower Hockenden 1 2 Yes Mundays Piggery, Trunks Alley, Hockenden 2 5 No 168, Blackfen Road, Sidcup 1 3 Yes Sports Ground (Kemnal), Sidcup By-pass 1 1 Yes Old Brickfield, Baugh Estate, Footscray 3 11 Yes Twysdens Meadow, Cray Road, Footscray 3 9 Yes Conservative Club, Oxford Road, Sidcup 2 6 Yes Corke's Meadow, St. Paul's Cray 115 460 No Old London Road, Ruxley (opp. Z.B. Yard) 1 3 No Steps are being taken to deal with the vehicles stationed at Trunks Alley and Old London Road, Ruxley. 47 Chalk Pit, Ruxley. This site is used by families of the gipsy type, many of whom leave in the summer to engage in fruit picking, but return in due course. There was a considerable increase in the number of families in residence during the Autumn of 1955 and the Committee decided to issue licences to 31 families only, in order to prevent overcrowding on the site. The owner has been required to remove unlicensed dwellings from the Pit. Corke's Meadow, St. Paul's Cray. The conditions at this site are very similar to those reported previously. Consultations with the London County Council, the Kent County Council, and the Ministry of Housing and Local Government, regarding the establishment of a Council controlled site at Highlands Wood, St. Paul's Cray, have continued. It is intended that the occupants of Corke's Meadow should be moved to Highlands Wood, where proper amenities could be provided. There is considerable local opposition to the proposed new site. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 50 SECTION E. INSPECTION AND SUPERVISION OF FOODS. INSPECTIONS. A total of 2,288 visits were made to places where food is stored and prepared or from which it is sold. One hundred and seventythree defects were drawn to the attention of persons concerned and at the end of the year 163 of these had been remedied. FOOD SAMPLING—FOOD & DRUGS ACT, 1938. Samples Taken Result ARTICLE Formal Informal Genuine Inferior Adulterated Remarks See below Bread — 3 1 2 — See (a) & (b) Butter 5 — 5 — — Buttered Rolls and Buns 3 — 2 — 1 See (c) Cake and Pudding Mixture 9 — 8 1 — See (d) Cereals 3 — 3 — — Cheese 6 — 6 — — Cockles 1 — 1 — — Coffee and Chicory 2 — 2 — — Confectionery — 1 — 1 — See (e) Cream 5 — 5 — — Creamed Rice 1 — 1 — — Drugs 3 — 3 — — Fish Cakes 3 — 3 — — Flour 2 — 2 — — Fruit (Canned) 1 — 1 — — Fruit (Dried) 8 — 8 — — Fruit Juice 2 — 2 — — Gelatine 5 — 4 1 — See (f) Glace Cherries 3 — 3 — — Glucose Tablets 1 — 1 — — Ground Nut Oil 1 — 1 — — Ice Cream — 14 13 1 — See (g) Ice Lollies — 2 2 — — Jelly 3 — 3 — — Lard and Cooking Fat 3 — 3 — — Lemonade Powder 5 — 5 — — Margarine 9 — 9 — — Marzipan 1 — 1 — — Meat and Fish Paste 3 — 3 — — Meat Pie 2 — 2 — — Milk 19 36 54 1 — See (h) Milk Drink (Flavoured) 3 — 3 — — Milk (Hot) 3 — 2 — 1 See (i) Milk (Condensed) 2 — 2 — — 51 Milk Chocolate 1 — 1 — — Nuts (Ground) 9 — 9 — — Olive Oil 2 — 2 — — Peel (Mixed) 3 — 3 — — Pickle 1 — 1 — — Preserves 15 — 14 1 — See (j) Rennet Essence 1 — 1 — — Sauces 2 — 2 — — Sausages and Sausage Meat 19 1 16 4 — See (k), (1) & (m) Soft Drink 4 — 3 1 — See (n) Soups 2 — 2 — — Spices 5 — 5 — — Suet (Shredded) 1 — 1 — — Sugar (Icing) 1 — 1 — — Sugar Confectionery 5 1 6 — — Tea 7 — 7 — — Vinegar 1 — 1 — — 196 58 239 13 2 (a) Stained portion contained oil and copper. Baker warned. (b) Contained minute amount of matter resembling coke. No action. (c) Roll spread with margarine not butter. Vendor successfully prosecuted. (d) Cake flour labelled "with egg" contained (1.3% dried egg) insufficient to justify claim. Manufacturers undertook to increase amount of egg in product. (e) Bakewell Tart contained spots of dirt in pastry and on icing. Baker warned. (f) Lead very slightly in excess of limit. Manufactured in Australia. Importers informed. (g) Piece of glass in wrapped ice cream. Manufacturer notified. (h) Small mould particles in cream layer of South Devon Milk. Matter taken up with bottlers. (i) Contained 9% added water. Vendor successfully prosecuted. (j) Fruit content of Strawberry and Apple Jam (31%) low. Manufacturers notified. (k) Pork sausagemeat. Meat content of two samples slightly below former standard. Further samples satisfactory. (l) Pork Sausages. Meat content slightly below old standard. Further samples satisfactory. (m) Pork Sausages contained an excessive amount of fat (36% to 34% lean). Manufacturers notified. (n) Orange drink contained only 3% whole orange. Ministry have matter under consideration. 52 FOOD COMPLAINTS. A total of 31 complaints regarding the condition of food, or impurities contained in it. were received. All of these were fully investigated and the food stuff concerned was traced back to its source. In some instances the complaint arose from a misconception on the part of the purchaser, but in others warnings were issued to the shopkeepers or manufacturers. In appropriate cases improved methods of dealing with the food were suggested by the Inspectors and adopted by the tradesmen. Evidence of gross carelessness led the Committee to institute legal proceedings in three cases, entailing:— Cigarette end in loaf. Tobacco in sugar confectionery. Mould growth in meat pies. All of these prosecutions were successful. UNSOUND FOOD. A total of 3 tons 1 qr. 8 lb. of varied articles of food were condemned during the year, and 491 Food Condemnation Certificates issued. The main items were:— cwts. qtrs. lbs. Bananas 6 3 9 Cake 1 3 6 Cheese 2 2 18 Fish 4 2 3 Fruit (Canned) 7 3 18 Meat (Canned) 14 2 22 Meat (Fresh) 6 1 19 Milk (Canned) 4 0 21 Sweets 1 0 18 Vegetables (Canned) 7 2 19 53 FOOD AND DRUGS ACT, 1938. SECTION 14. The food premises in the area registered under the above Act are:— No. of Premises Registered. IceCream. Mfr. of Sausages. Cooked Ham. Bakers' shops 2 — — Butchers' shops — 44 — Dairies 1 — — Fishmongers (wet and dried) 2 — — Greengrocers' shops 4 — — Grocers 45 — 7 Restaurants and Cafes (for consumption off the premises) 20 — — Others, including confectioners, etc. 79 — — 153 44 7 Total 204 FOOD PREMISES. There are some 503 food premises in the area, made up as under:— (1) Bakers 13 (2) Bakers and Bakehouses 13 (3) Butchers 56 (4) Dairies 1 (5) Fishmongers (wet and dried) 11 (6) Fishmongers (wet, dried and fried) 10 (7) Fishmongers (fried) 4 (8) Greengrocers' shops and stalls 56 (9) Grocers 133 (10) Ice Cream premises, other than those included in (1), (2), (4), (8), (9) and (13), but including confectioners 70 (11) Public Houses and Hotels with catering facilities 10 (12) Public Houses without catering facilities 18 (13) Restaurants, Cafes 37 (14) Works Canteens 12 (15) School Canteens, etc 35 (16) Private Canteens 9 (17) Confectioners (not included in 10) 15 503 54 REGISTRATIONS FOR THE SALE OF MILK. Sixteen Dairies and sixteen Distributors of Milk have been registered. The following are details of the licences issued by the Local Authority in respect of the year 1955:— Pasteurised Dealer's Licences 18 Pasteurised Supplementary Licences 12 Sterilised Dealer's Licences 26 Sterilised Supplementary Licences 12 Tuberculin Tested Dealer's Licences 18 Tuberculin Tested Supplementary Licences 11 BACTERIOLOGICAL EXAMINATIONS. Milk (Pasteurised). No. of samples taken. Result. Satisfactory. Unsatisfactory. 53 49 4 Ice Cream. No. of samples taken. Methylene Blue Group. I. II. III. IV. 16 10 4 1 1 Fifty-eight samples of milk were submitted for chemical examination, the lowest fat content being 3.2% and the highest 4.8%. MEAT INSPECTION. An annual licence was issued to one slaughterman during the year. One small slaughterhouse within the area was licensed, but no slaughtering took place there. Routine inspection of meat has been carried out in butchers' shops. PIGGERIES. There are 18 piggeries in the district, one of which is of considerable size. Eighty-nine visits of inspection were made and four informal notices were served. Eleven defects were remedied. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 56 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. General. A total of 1,896 cases of notifiable infectious diseases (excluding tuberculosis), were notified as against 660 during 1954, and this state of affairs was largely brought about by the considerable increase in the incidence of measles during the year under discussion. Although the number of cases of this disease was large, the vast majority of them were uncomplicated and did not give rise to any undue alarm. Compared with some other places in the country, we must be considered fortunate to have had only thirteen confirmed cases of acute anterior poliomyelitis, all but one of which were paralytic, including one fatal case. In addition, seven further cases were notified but on investigation none of these could be confirmed. There was therefore a total of twenty cases under supervision during the course of the year. Two hundred and sixty cases of whooping cough, 67 of pneumonia, 44 of scarlet fever, 18 of dysentery, and 13 of food poisoning came to light during the year and these, in conjunction with the cases of measles and infantile paralysis, accounted for most of the infectious disease notifications received during 1955, but statistical details of notifiable infectious diseases will be found in Tables IV and V in the Appendix. Acute Anterior Poliomyelitis. The first case of this disease to occur was in January, followed by two in March and one in both April and May. Two more cases were notified in July, and from then on until just before Christmas the remaining ones came in at fairly regular intervals. Further analysing these cases, we find that five of the paralytic ones were of the Bulbar type, which is an unusually high percentage, but from what I can glean from various sources, this seems to have been a fairly general experience throughout the country during the recent outbreak. 57 Exclusion of contacts, except in the case of school children, is not a routine automatic procedure and a number of rather difficult decisions on the necessity or otherwise for this action had to be made during the year, especially in view of the number of cases arising which were often the subject of quite considerable delay before a definite diagnosis of acute poliomyelitis could be confirmed. One further feature to which attention should be drawn, is that of the thirteen cases confirmed, eleven referred to children of school age, and only two to persons of over 18 years of age. This is rather contrary to national experience where the tendency is for the disease to attack the adult to a greater extent, thus making the designation of "infantile paralysis " somewhat of a misnomer. Diphtheria. No notifications of this disease were received during the year. The present position with regard to immunisation against diphtheria is summarised in the following figures which have been supplied by the County Medical Officer. Of the children resident in the area who were born since 1941, a total of 1,053 received primary inoculations and 1,310 received reinforcing inoculations during 1955. A total of 15,051 children under the age of 15 years have completed a course of immunisation at some time prior to 31st December, 1955. Dysentery. This disease continues to be endemic and although generally of a mild type, two cases out of the eighteen notified were sufficiently bad to necessitate admission to hospital. A number of unconfirmed cases were also investigated and pathological specimens were submitted by the department in addition to those taken by the patient's own doctor. The cases were mainly sporadic and for the most part not inter-connected. 58 Food Poisoning. Thirteen single cases were notified during the year and in nine of them the causative organism was discovered. A number of unconfirmed cases were also investigated and pathological specimens taken by the department. It is inevitable that a considerable number of such cases will never come to the notice of a medical practitioner and it is therefore necessary to state that the actual number of cases occurring probably bears little relation to the number notified. It appears very desirable to draw attention to this point in order to encourage the highest possible standard of kitchen hygiene in all walks of life, otherwise, with so few " official" cases to report, there might be a tendency to minimise the importance of those very vital operations. Measles. The year produced a large epidemic of measles and 1,466 cases were notified in the Urban District, but it is a commentary on the mildness of the condition that only eleven of these cases necessitated hospital admission. In the previous year 229 cases were notified but most of these occurred at the end of the year and were part of the same epidemic. It is highly probable that the number of actual cases was greater than this, but as always occurs when an infection is mild, a certain number of cases never receive any medical attention and so miss being notified. There were no deaths from this disease in the area. Pneumonia (all forms). During the year 67 cases were notified, as compared with 62 for the previous year. There were 37 deaths from pneumonia. This figure includes people who died in other areas, but who are normally resident in the Urban District. Scarlet Fever. Scarlet fever continues to be a mild infection with the occasional 59 severe case cropping up for no apparent reason. There is little doubt that, generally speaking, the disease has so lost its terrors, that there must be quite a number of missed cases. Every year there must people who get sore throats with rashes so slight and trivial that the latter are not even noticed, and it is well to remember that an attack of tonsillitis without a rash can often be a much more serious illness than the modern type of scarlet fever. During the year 44 cases were notified, of which only four had to be removed to hospital. In the previous year 96 cases were notified. There were no " return cases," and no deaths notified. Smallpox. No cases occurred in the area during 1955. The continued absence of this disease is a cause for congratulation and thankfulness, but we have to be constantly on our guard against its importation with the ever increasing speed of travel between different parts of the world. There is a steady call on the department to stamp and sign International Certificates of Vaccination, which are not valid until so countersigned. During the year 273 such certificates were authenticated. Every year re-vaccination is offered to all members of the staff of the Health Department. I am indebted to the County Medical Officer for the following information showing the current position with regard to vaccination in the Urban District. A total of 1,022 residents received primary vaccination, and 151 re-vaccination during 1955. Tuberculosis. The following table shows the position with regard to tuberculosis, with comparative figures since 1942 (as corrected by Inward and Outward Transfers). 60 Year Ended Population 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 1952 85,130 72 6 635 629 59 62 1,385 78 16.3 1953 85,290 75 3 664 663 61 61 1,449 78 15.8 1954 85,830 77 9 702 673 67 65 1,507 58 17.6 1955 86,870 74 1 744 714 65 65 1,588 81 18.3 61 This table shows that the number of notifications has remained fairly static during the past four years and has not decreased with the much diminished death rate from this disease, to which reference has been made elsewhere. It is, however, encouraging to note that, compared with 1942 when the population was much smaller, the incidence has declined despite the greatly improved facilities for diagnosis available in recent years. There is still a steady yearly increase in the numbers on the register, but this is only to be expected with a condition involving such a lengthy period of treatment, and many who are still on the register are now only receiving very occasional supervision. Mass X-Ray. A very close and satisfactory liaison exists between this department and Dr. J. M. Morgan, the Director of the Mass X-Ray Unit of the South Eastern Regional Hospital Board, which operates from time to time in this area, and I am very grateful to him and his staff especially for supplying me with the statistics upon which the following information is based. During the year, 7,115 people were X-rayed, of whom 4,189 were women and 2,926 men. Of the grand total 2,559 had previously taken advantage of this service. Of the 130 abnormalities discovered, 79 required no action, and 21 were considered tuberculous. Of this latter group, 9 required treatment, 7 needed occasional supervision only, 4 required no further action, and one is still under investigation. The remainder of the 130 consisted of non-tuberculous chest conditions, cardiac abnormalities and a few previously known tuberculous cases. Whilst these figures show that there would appear to be some 2,559 persons who have recognised the value of regular examination of this type, there were only 4,556 new converts, and it is safe to say that a much higher percentage of people will have to be encouraged to co-operate with this service if we are to succeed in our aim of the eventual elimination of the scourge of tuberculosis from our midst, Chest Clinic. I am indebted to Dr. M. Price, Physician in charge, for the following information:— Male. Female. Children. Total. Number of new patients referred to the Clinic 218 226 338 782 Number of new patients diagnosed as tuberculous 35 18 3 56 Number of patients included in above who attended as Contacts 68 91 253 412 Number of Contacts diagnosed as tuberculous Number of persons vaccinated with B.C.G. 41 219 adults, children. Number of refills given during the year 4,905 The evening refill clinic continues to be held on Tuesday evenings in addition to the day-time diagnostic and refill sessions. Typhoid and Para-Typhoid Fever. One case of typhoid fever was notified during the year and removed to hospital. The patient, a child of pre-school age. had been away from home during the three weeks preceding his illness, and had returned from this holiday only a few days before the onset of the symptoms. During this period he accompanied relatives who were engaged in fruit picking, and had been living in rather primitive conditions, sharing accommodation with an older member of the family. Although it appeared certain from the time factor that the disease had been contracted during the holiday, preliminary enquiries revealed no obvious source of infection. None of the contacts had, to their knowledge, suffered from the disease, and there had been no other cases in the vicinity. No suspicion could be attached to any of the foodstuffs consumed ; the milk supply was satisfactory, and the main water supply had been used. The only suspicious feature was that the patient had bathed in a nearby stream, which was known to be heavily polluted, and in the absence of a known carrier, this, at first, appeared to be the most likely source of infection. Arrangements were made for all contacts to be visited, and speciments of faeces requested for bacteriological examination, the assistance of a neighbouring health department being obtained in the case of contacts living outside the district. Some suspicion was aroused when it was learned as a result of these visits that the parent of two other children present on the holiday had suffered with typhoid many years previously. Although she 63 had not been present herself, this suggested a possible indirect source of infection, but all investigations proved in this case negative. Results of the examination of the other contacts however, showed that the elderly relative, with whom the patient had been in closest contact, was, unknown to herself, a carrier of the typhoid bacillus, and this was confirmed by the Widal reaction. Further proof was obtained when typing of the organisms had been carried out, when it was found that both were of the same type. It was concluded that the person concerned, who in subsequent examinations proved to be an intermittent carrier, had infected the child in the less than ideal conditions prevailing during the holiday. It is of interest that under normal home conditions there had been no cross infection, this indicating once again the invaluable role of normal cleanliness in preventing the dissemination of such infections. There were no further cases of this disease, and the patient made a full recovery. The carrier, a retired person, is not engaged in food handling, but it was necessary to exclude one of the contacts from her occupation as a food handler for a period while investigations were taking place. Two cases of para-typhoid fever were notified during the year. Both were removed to hospital, but one case was not confirmed. In the other case, the disease was apparently contracted outside the district. In tracing these cases and dealing with contacts, eighty pathological specimens were taken by the department and submitted for examination. Whooping Cough. This is another of those diseases which at least temporarily, and one hopes permanently, has lost a great deal of its former virulence. Of 260 cases notified, only 6 had to be treated in hospital. There was a slight increase in the number of cases notified when compared with the figure of 223 during the year 1954. No deaths were recorded in the area from this disease during 1955. Other Infectious Diseases. In addition to those previously mentioned, notifications were received, as under:— Erysipelas 4 Ophthalmia Neonatorum 3 (No impairment of vision in any case.) Puerperal Pyrexia 5 APPENDIX. STATISTICAL TABLES. 66 STATISTICAL TABLES, 1955. TABLE I.—Summary of Statistics. TABLE II.—Causes of Death. TABLE III.—Infant Mortality. TABLE IV.—Notifiable Infectious Diseases—Sex and Age Distribution. TABLE V.—Notifiable Infectious Diseases—Seasonal Incidence. TABLE VI.—Sanitary Inspection of the Area. 67 TABLE I. SUMMARY OF STATISTICS, 1955. Population (mid-year 1955, per Registrar General) 86,870 Birth Rate (crude) 15.8 Death Rate (crude) 8.6 Maternal Mortality Rate 0.72 Infant Mortality Rate 24.8 Number of Births (live) 1,370 Number of Stillbirths 17 Number of Deaths 747 Number of Maternal Deaths 1 Number of Infant Deaths (under 1 year) 34 Death Rates: — Respiratory Diseases (excluding Tuberculosis) 1.00 Tuberculosis 0.09 Cancer (all forms) 1.80 Cancer of the Lung, Bronchus 0.50 Zymotic Diseases 0.02 Notification of Infectious Diseases: — Diphtheria Nil Dysentery 18 Erysipelas 4 Food Poisoning 13 Measles 1,466 Pneumonia (all forms) 67 Poliomyelitis (paralytic) 12 Poliomyelitis (non-paralytic) 1 Puerperal Pyrexia 5 Scarlet Fever 44 Tuberculosis (new cases and including Inward Transfers) 153 Typhoid and Para-Typhoid Fever 3 Whooping Cough 260 Number of Deaths from Infectious Diseases 2 Number of visits made by Sanitary Inspectors 10,716 68 TABLE II. CAUSES OF DEATH. 1951 1952 1953 1954 1958 Male Female Total l. Tuberculosis—Respiratory 29 17 18 12 6 1 7 2. Tuberculosis—Other 1 5 2 2 — — 3. Syphilitic Diseases 3 5 2 1 — — — 4. Diphtheria — — — — — — — 5. Whooping Cough 1 — — — — — — 6. Meningococcal Infection — 2 1 — — — — 7. Acute Poliomyelitis 1 1 1 — — 1 1 8. Measles — — — — — — — 9. Other infective and parasitic diseases 2 1 1 2 1 1 10. Malignant neoplasm, stomach 20 22 23 15 13 7 20 11. Malignant neoplasm, lung bronchus 22 21 38 36 40 4 44 12. Malignant neoplasm, breast 13 14 13 19 — 13 13 13. Malignant neoplasm, uterus 7 5 5 9 — 8 8 14. Other malignant and lymphatic neoplasms 70 65 75 70 44 28 72 15. Leukaemia, aleukaemia 2 8 8 5 2 4 6 16. Diabetes 6 7 5 1 1 3 4 17. Vascular lesions of nervous system 90 103 66 79 41 57 98 18. Coronary disease, angina 92 101 99 107 78 35 113 19. Hypertension with heart disease 35 16 13 22 9 11 20 20. Other heart disease 118 117 96 87 31 49 80 21. Other circulatory disease 26 40 51 25 19 23 42 22. Influenza 9 2 11 1 2 1 3 23. Pneumonia 28 27 32 28 18 19 37 24. Bronchitis 50 38 44 39 33 9 42 25. Other diseases of respiratory system 2 7 4 6 2 6 8 26. Ulcer of stomach or duodenum 14 8 10 10 4 2 6 27. Gastritis, enteritis and diarrhoea 4 3 7 4 4 4 8 28. Nephritis and nephrosis 5 7 8 5 6 2 8 29. Hyperplasia of prostate 4 4 6 6 2 — . 2 30. Pregnancy, childbirth, abortion 4 2 — — — 1 1 31. Congenital malformation 14 10 8 8 3 7 10 32. Other defined and ill-defined diseases 58 59 56 59 29 39 68 33. Motor vehicle accidents 6 4 9 5 4 1 5 34. All other accidents 12 10 7 9 3 7 10 35. Suicide 9 8 13 6 5 5 10 36. Homicide and operations of war All causes 757 739 732 678 399 348 747 69 TABLE III. INFANT MORTALITY, 1955. (Compiled locally from Registrar's Death Returns.) CAUSES OF DEATH Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 4 weeks 1 month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Malformation 1 1 — 2 — — — — 2 Prematurity 14 1 — — 15 — — — 15 Respiratory Diseases — 1 — — 1 1 — — 1 3 Gastro-enteritis — — — — — — — 2 1 3 Atelectasis 2 1 — — 3 — — — 3 Congenital Heart Disease 1 — — — 1 — 1 1 — 3 Other causes 2 1 — — 3 1 — — 1 5 TOTALS 19 5 1 — 25 2 1 3 3 34 70 TABLE IV. NOTIFIABLE INFECTIOUS DISEASES, 1955. Sex and Age Distribution. Disease Totals Under 1 1—2 3—4 5—9 10—14 15—24 25 and over Age unknown M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 23 21 — — — 1 3 1 15 14 4 3 1 — — 2 — — Whooping Cough 125 135 4 9 31 16 23 36 63 69 3 2 — — 1 3 — — Poliomyelitis (Paralytic) 6 6 — — — 1 — — 2 3 3 1 — — 1 — — — Poliomyelitis (Non-Paralytic) — 1 — — — — — — — — — 1 — — — — — — Measles 744 722 16 23 145 125 187 155 371 396 23 16 — 2 2 5 — — 898 885 20 32 176 143 213 192 451 482 33 23 1 3 4 10 — — Under 5 5—14 15—44 45—64 65 & over Age unknown M. F. M. F. M. F. M. F. M. F. M. F. Acute Pneumonia 39 28 11 6 6 8 9 6 9 5 4 3 - - Dysentery 8 10 4 3 2 2 1 3 1 2 — — — — Erysipelas 3 1 — — — — — — 3 1 — — — — Food Poisoning 6 7 1 2 1 1 — 2 4 2 — — — — Ophthalmia Neonatorum 3 3 — — — — — — — — — Puerperal Pyrexia — 5 — — — — — 5 — — — — — — Typhoid Fever and Para-Tvphoid Fever 1 2 1 — — 1 — 1 — — — — — — Tuberculosis (Pulmonary) 51 24 1 1 3 — 27 18 17 2 3 3 — — Tuberculosis (Non-Pulmonary) — 1 — — — — — — — 1 — — — — 108 81 18 15 12 12 37 35 34 13 7 6 — — 1,006 966 71 TABLE V. NOTIFIABLE INFECTIOUS DISEASES, 1955. Seasonal Incidence. Disease Jan. Feb Mar. April May June July Aug. Sep. Oct. Nov. Dec. Totals Dysentery 7 — — 1 — — 2 2 4 — 1 1 18 Erysipelas - - 1 - - - — — 1 1 1 — 4 Food Poisoning 1 - — 1 — 2 1 2 1 3 1 1 13 Measles 114 400 526 263 58 57 18 5 a — — 23 1,466 Ophthalmia Neonatorum 1 — - — — — — — I - - 1 3 Acute Pneumonia 7 17 9 14 2 3 — 2 3 1 1 8 67 Paratyphoid Fever 1 - — — — — — — 1 — — — 2 Poliomyelitis (Paralytic) 1 — 1 1 — — 2 1 5 — 1 — 12 Poliomyelitis (Non-Paralytic) — — — — - — — — 1 — — — 1 Puerperal Pyrexia — — 2 1 1 — — — — — — 1 5 Scarlet Fever 5 5 2 2 2 5 2 1 1 2 6 11 44 Typhoid Fever — — — — — — — 1 — — — — 1 Whooping Cough 32 58 56 24 22 12 22 20 7 — 1 6 260 Totals 169 480 597 307 85 79 47 34 27 7 12 52 1,896 72 TABLE VI. SANITARY INSPECTION OF THE AREA. 1. Inspections—General. Dwelling Houses (Public Health Act) 4,327 Dwelling Houses (Housing Act) 505 Bakers 98 Bakehouses 77 Butchers 117 Butchers and registered sausage manufacturers 126 Works Canteens 32 Restaurants and Cafes 207 Dairies 83 Fishmongers 143 Greengrocers 196 Grocers 483 Ice Cream Shops 188 Public Houses 10 Confectioners Shops 31 Other food preparing premises 11 Piggeries 89 Slaughterhouses 8 Factories (Sections 1, 2, 3, 4 and 6, Factories Acts) 36 Factories (Section 7) 210 Factories (Section 7—other premises) 87 Smoke Abatement 71 Premises—for rats and mice 1,725 Infectious diseases 348 Food Poisoning 82 Moveable Dwellings 606 Rivers and Streams 53 Shops Act 245 Schools 65 Swimming Pools 6 Public Conveniences 161 Unsound Food 146 Stables 30 Petroleum Acts 66 Pet Animals Act 32 Fireguards Act 16 10,716 73 2. Complaints. General Sanitary Defects 220 Drainage 310 Keeping of Animals 7 Offensive accumulations 66 Verminous premises 15 Water Supply 11 Rats 523 Mice 54 Overcrowding 21 Foods 41 Dustbins 26 Smoke 41 Moveable Dwellings 2 Miscellaneous 26 1,363 3. Notices. Two hundred and thirteen Informal Notices were served, drawing the attention of the owners to the existence of nuisances at their properties and requesting abatement.