ORP 7 library ORPINGTON URBAN DISTRICT COUNCIL REPORT For the Year 1943 on the Sanitary Conditions and Vital Statistics of the Urban District of Orpington by the Medical Officer of Health. Bromley: kentish district times co., ltd., 22, north street. 1 URBAN DISTRICT COUNCIL OF ORPINGTON. Health Report for 1943. Madam and Gentlemen, I have pleasure in presenting my Annual Health Report for the year 1943, this being the twenty-first one submitted by me as your Medical Officer of Health. This Report is again curtailed and contains only such essential features as it is necessary to record. The population of the District as estimated by the Registrar-General at mid-year 1943 was 48,520, as compared with 47,990 last year. There was a slight increase in the Birth Rate, viz., 21.0 per thousand of population, as against 20.6 last year. The Death Rate was equal to 11.2 per thousand of population, as compared with 11.1 last year. The Infantile Mortality Rate remained low, this being 29 per thousand registered births, as compared with 28 last year. The year has been a satisfactory one from the point of view of incidence of Infectious Disease, the number of cases notified being 980 as against 1,027 last year. This is mainly due to a much lower number of cases of "Whooping Cough being notified. In submitting this Report I desire to express my thanks for the help and assistance I have received from the Council and its Officers. I particularly desire to record my appreciation of the loyal service rendered by all members of the Public Health Department. I am, Madam and Gentlemen, Your obedient Servant, P. N. CAVE, Medical Officer of Health. 2 URBAN DISTRICT COUNCIL OF ORPINGTON, Public Health Committee. Chairman: W. E. Hawken, Esq. Vice-Chairman: F. W. Buck, Esq. Mrs. E. E. Phillips. F. J. Hyam, Esq., c.c. Lt.-Col. K. M. Kirkhope, H. J. Lester, Esq., c.i.e. j.p., f.s.a.av G. E. Barrett, Esq. G. T. May, Esq. F. J. Bell, Esq. P. H. Powell, Esq. C. L. Bruce, Esq. A. L. Priest, Esq., j.p. C. F. Bulpitt, Esq. G. R. Rickard, Esq. J. Davies, Esq. S. Rawlings Smith, Esq. G. E. Davis, Esq., W. C. Sweatman, Esq. m.c., ll.b. W. J. Tarry, Esq. P. W. Dewberry, Esq. T. Temple, Esq. J. P. Earnshaw, Esq. E. J. Walker, Esq. A. H. A. Grenger, Esq. E. Whiddon, Esq. R. Hamilton, Esq. S. R. Woodcock, Esq. Representatives on the West Kent Joint Hospital Board. C. L. Bruce, Esq. A. L. Priest, Esq., j.p. Representatives on the West Kent Main Sewerage Board. C. L. Bruce, Esq. A. L. Priest, Esq., j.p. STAFF. Medical Officer of Health: P. N. Cave, m.a., m.d., m.r.c.s., l.r.c.p., d.p.h. Sanitary Inspectors: J. A. Capon, c.r.s.i., m.s.i.a. (Chief Sanitary Inspector and Cleansing Superintendent). F. C. Crowe, m.r.s.i., m.s.i.a. (Deputy Chief Sanitary Inspector, Housing Inspector, Inspector under the Shop Acts, and Food and Drugs Inspector). W. T. Weedy, c.r.s.i., m.s.i.a. (Senior District Sanitary Inspector, and Inspector under the Shops Act). D. H. Livesey, m.r.s.i., m.s.i.a. (District Sanitary Inspector). With H.M. Forces. R. Taylor, c.r.s.i., m.s.i.a. (District Sanitary Inspector). D. Grantley Smith (Pupil Assistant). Salvage Officer: Health Visitor: H. T. Cartmel Mrs. L. Russell. Clerk and Shorthand Typist: Miss I. Chamberlain. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 20,842 Registrar-General's estimate of population, mid-1943 48,520 Number of occupied houses, December, 1943 16,224 Rateable Value of District, December, 1943 £483,101 Sum represented by a penny rate, December, 1943 £1,810 VITAL STATISTICS. Total. M. F. Birth Rate per 1,000 estimated population Live births Legitimate 975 498 477 21.0 Illegitimate 47 18 29 Total Births 1022 516 506 Rate per 1,000 (live and still) birth Still-births 20 13 7 19.1 Rate per 1,000 of estimated population. Deaths 545 255 290 11.2 Rate per 1,000 total (live and still) births. Deaths from Puerperal causes: Deaths. Puerperal Sepsis 1 0.95 Other puerperal causes - - Infant deaths: Number. Rate per 1000. All Infants 30 29 Legitimate Infants 29 29 Illegitimate Infants 1 21 Deaths from Cancer (all ages) 93 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) 3 4 HEALTH REPORT FOR 1943. Births.— During the year 1,022 were registered as belonging to the District, of which number 516 were males and 506 were females. This gives a Birth Rate of 21.0 per thousand of population, as compared with 20.6 last year. The Birth Rate for England and Wales was 16.5. Deaths.— The number of Deaths registered during the year was 545 (255 males and 290 females). This is equal to a Death Rate of 11.2 per thousand of population, as against 11.1 last year. The Death Rate for England and Wales was 12.1. Infantile Mortality Rate.— During the year 30 Deaths were registered of infants under one year of age (29 legitimate and 1 illegitimate. The Infantile Mortality Rate was equal to 29 per thousand registered Births. Orpington Urban England & District. Wales. Birth Rate 21.0 16.5 Death Rate 11.8 12.1 Infantile Mortality Rate 29 49 INFECTIOUS DISEASE. From the point of view of the incidence of Infectious Disease the year 1943 was a satisfactory one. The number of Notification Certificates received was 980. The following Table shows the number of cases notified, together with the number removed to Hospital, and the total deaths:— 5 Disease. Number notified. Removed to Hospital. Total Deaths. Scarlet Fever 200 142 — Diphtheria 24 22 3 Typhoid Fever 2 2 — Erysipelas 6 — — Pneumonia 31 — 23* Cerebro-spinal Fever 1 1 — Acute Poliomyelitis 1 — — Puerperal Pyrexia 66 — 1 Ophthalmia Neonatorum 2 — — Dysentery 14 — — Whooping Cough 37 — — Measles 596 — — TOTALS 980 167 27 * All forms of Pneumonia. IMMUNISATION CLINIC. During the year the following amount of work has been carried out at the Diptheria Immunisation Clinic:— Number of sessions held 189 Number of new cases 1,292 Number of attendances 5,948 OPHTHALMIA NEONATORUM. During the year 2 cases of Ophthalmia Neonatorum were notified, of which:— Number treated at home Nil Number treated in Hospital 2 Number in which vision was: Impaired Nil Unimpaired 2 Number of deaths Nil 6 Birth Rates, Civilian Death Rates, Analysis of Mortality, Maternal Mortality and Case Rates for certain infectious diseases in the Year 1943. England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident populations 25,000 to 50,000 at 1931 census) London Administrative County. Orpington Urban District Rates per 1,000 Civilian Population. Births: Live 16.5 18.6 19.4 15.8 21.0 Still 0.51 0.63 0.61 0.45 0.41 Deaths: All Causes 12.1 14.2 12.7 15.0 11.2 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.03 0.03 0.03 0.03 — Diphtheria 0.03 0.04 0.04 0.02 0.06 Influenza 0.37 0.36 0.37 0.27 0.30 Smallpox — — — — — Measles 0.02 0.02 0.02 0.02 — Rates per 1,000 Live Births. Deaths under 1 year of age 49 58 46 58 29.0 Deaths from Diarrhœa and Enteritis under 2 years of age 5.3 7.9 4.4 10.4 2.9 Notifications: Rates per 1,000 Civilian Population. Typhoid Fever 0.01 0.01 0.02 0.01 0.04 Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro-Spinal Fever 0.08 0.10 0.06 0.09 0.02 Scarlet Fever 3.01 3.29 3.54 3.80 4.01 Whooping Cough 2.54 2.82 2.25 2.68 0.96 Diphtheria 0.88 1.12 0.77 0.74 0.49 Erysipelas 0.31 0.35 0.27 0.42 0.12 Smallpox — — — — — Measles 9.88 9.23 9.77 9.17 6.22 Pneumonia 1.34 1.62 1.16 1.27 0.63 Rates per 1,000 Total Births (i.e., Live and Still). Notifications: Puerperal Fever 11.68 15.11 9.26 3.05 63.33 Puerperal Pyrexia 15.23§ § Including puerperal fever. 7 TUBERCULOSIS. The following Table shows the number of new cases of Tuberculosis notified, together with the number of deaths registered:— Notified. Deaths. Males. Females. Total. Males. Females. Total. Pulmonary 24 13 37 15 7 22 Non-Pulmonary 17 8 25 1 1 2 Total 41 21 62 16 8 24 The Kent County Council undertakes the treatment for cases of Tuberculosis, and the following number of patients have received treatment during the year:— Number receiving sanatorium treatment 27 Number receiving Dispensary treatment 14 Dispensary supervision only 145 PUBLIC HEALTH ACT, 1936 (SECTION 176). PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action under the above during the year. ISOLATION HOSPITAL. This District is served by the West Kent Joint Isolation Hospital, and the following number of patients have been admitted there during the year:— Scarlet Fever 142 Diphtheria 18 Typhoid Fever 2 Cerebro-spinal Fever 1 In addition, 4 patients were admitted to London Countv Council's Hospitals suffering from Diphtheria. 8 LABORATORY WORK. The County Laboratory, Maidstone, carries out the bacteriological work in connection with this District, and during the year the following number of specimens have been examined there:— Positive. Negative. TOTAL. Swabs for Diphtheria 11 8 19 Swabs for Haemolytic Streptococci 10 21 31 Sputa for Tubercle 22 - 22 Faeces for Dysentery 13 19 32 TOTALS 56 48 104 In addition, the following number of emergency examinations have been made at the West Kent Joint Hospital Board's Laboratory, by Dr. J. Byers:— Positive. Negative. TOTAL. Swabs for Diphtheria 15 108 123 DRAINAGE. The houses in the main portion of the District are on the water carriage system, and most of the houses are connected to the public sewer. No extensions to the sewers were carried out during the year. 9 SANITARY STATISTICS. Number of houses connected to the sewers. No. of houses not connected to sewers. No. of houses not provided with a piped water supply. No. of wells still in use for purpose of domestic supply. 12814 3017 393 6 Sanitary Conveniences. W.C.'s Pan or Pail Closets. Midden Privies. Ashpits separate from Midden Privies. Cesspools. No. of No. of houses into. 15492 294 13 — 2285 2700 WATER SUPPLY. The mains of the Metropolitan Water Board supply the greater portion of the District. In some outlying parts, however, water is. obtained from deep wells and from rain water collected from the roofs of houses and stored in tanks. There were no extensions to the mains during the year. During the year 48 bacteriological and 33 chemical examinations of the water were made. All the bacteriological specimens proved to be good waters, and the chemical specimens were as follows:— Fair quality 18 Good quality 2 Excellent quality 1 Unsatisfactory 1 Poor Quality 4 Bad quality 4 Inferior quality 3 PUBLIC CLEANSING. The collection of house refuse throughout the District is carried out by direct labour. Owing to the shortage of labour, the removal of refuse during the year has presented considerable difficulty, but although collections have not been carried out at pre-war frequency, the service throughout the District has been maintained. 10 CESSPOOL EMPTYING. No special action was taken with regard to the emptying of cesspools during the year. The Council undertake the emptying of cesspools as circumstances permit. HOUSING. 1. Inspection of Dwelling Houses during the year:— (1) (a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 889 (b) Number of inspections made for the purpose 2485 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 240 2. Remedy of Defects during the year without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 173 3. Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs — (2) Number of dwelling houses which were dered fit after service of formal notices: — (a) By owners — (b) By Local Authority in default of owners — (b) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 7 11 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 7 (b) By Local Authority in default of owners — (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made — (S) Number of dwelling houses demolished in pursuance of Demolition Orders — (d) Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 4. Housing Act, 1936.—Part IV.— Overcrowding. (a) (i) Number of dwelling houses overcrowded at end of year 57 (ii) Number of families dwelling therein 70 (iii) Number of persons dwelling therein 385 (b) Number of new cases of overcrowding reported during the year 12 (c) (i) Number of cases of overcrowding relieved during year 5 (ii) Number of persons concerned in such cases 20 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to ing conditions upon which you may consider it desirable to report — Number of new houses erected during the year:— By the Local Authority — By other persons †20 † These 20 premises had all been left in various stages of non-completion but have been completed during the year and have not been included in any previous return. 12 HEALTH VISITOR. One full-time Health Visitor is employed by the Council, and works under the supervision of the Medical Officer of Health. During* the year she has paid the following number of visits:— To cases of Tuberculosis 283 ,, ,, ,, Whooping Cough 24 „ ,, ,, Chicken Pox 65 ,, ,, „ Measles 364 ,, ,, Mumps 43 ,, ,, ,, Scarlet Fever 224 „ „ „ Impetigo 11 ,, ,, ,, Scabies 108 ,, ,, ,, Diabetes 4 Visits in connection with the Diphtheria Immunisation Clinic 99 Visits in connection with Child Welfare 98 Visits for taking swabs 48 Visits to Diphtheria contacts 9 Visits re Nursing Homes 4 Post-natal visits 8 TOTAL 1392 13 MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare work in this area is under the control of the Kent County Council, and the follow Clinics and Centres have been established for this District:— ANTE-NATAL CLINICS. Cudham, Biggin Hill— 2nd and 4th Wednesdays. (A First Aid Post Post-natal Clinic is also held here every 5th Wednesday). Green Street Green— The Baptist Hall Each Friday. Orpington—Methodist Hall Each Tuesday, Thursday and Friday. (Post-natal Clinic 2nd and 4th Thursday). Petts Wood— First Aid Post Each Tuesday and Wednesday. St. Mary Cray—First Aid Post in Recreation Ground Each Wednesday. CHILD WELFARE CENTRES. Chelsfield—Reading Room 1st and 3rd Tuesday. Cudham—Village Hall 2nd and 4th Tuesday. Cudham, Biggin Hill— First Aid Post Each Thursday. Downe—Gospel Hall 1st and 3rd Wednesdays. Farnborough— Methodist Cliurch Hall Each Tuesday. Grekn Street Green— Baptist Schoolroom Each Friday. Orpington— Methodist Church Hall Each Monday and Tuesday. Petts Wood—Rays Hall, Southborough Road, Each Thursday. Bromley. Petts Wood— St. Francis Hall Each Monday. St. Mary Cray—First Aid Post, Recreation Ground Each Tuesday and Thursday. 14 SCHOOLS. During the year it was not found necessary to close a School in consequence of the prevalence of Infectious Disease amongst the scholars. The following Certificate was, however, issued to cover low attendance at a School:— Orpington, Cudham, Fairchilds—one week ending 5.2.43 on account of Influenza and sore throats. SUMMARY OF REGULATED TRADES. Total Number. No. of Visits. Defects. No. found. No. Remedied Dairies 82 166 3 2 Cowsheds 4 3 Slaughterhouses— Previously Licensed 17 4 - - Bakehouses 20 18 3 2 Piggeries 28 8 — — Other food preparing places 270 450 — — Factories 172 9 1 1 Workplaces — — Workshops Houses—Let-inLodgings - — — - Common Lodging Houses 1 1 — — TOTALS 590 656 11 8 15 MILK (SPECIAL DESIGNATIONS ORDER), 1936. The following number of licences were granted by the Council during the year:— Pasteurised 10 Tuberculin Tested 6 MILK SUPPLY. During the year the following number of samples of milk were submitted for examination:— Mixed milk 3 Accredited milk 11 Tuberculin Tested 61 The results of the examinations were as follows:— Satisfactory Unsatisfactory. Mixed milk 2 1 Accredited milk 8 3 Tuberculin Tested 43 18 These figures do not include samples taken under the Food and Drugs Act. MEAT—INSPECTION OF CARCASES, ETC. Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed •• •• .. 1 2 Number inspected • • .. • • 1 2 SHOPS ACTS. During the year 59 inspections were made, and on no occasion was it found necessary for any action to be taken. FOOD AND DRUGS ACT, 1938. The powers under the above Act are under the control of the Council, and during the year 221 samples were taken, (31 formal and 190 informal) and submitted to the Public Analyst for examination. Two formal samples were reported as being " Not genuine." The following Table shows the number and description of the samples taken:— 16 FORMAL SAMPLES. Description of Sample. Number of Samples submitted. Number genuine. No. not genuine. New Milk 29 28 1 Tincture of Iodine 1 1 — Whiskey 1 — 1 INFORMAL SAMPLES. Description of Sample. Number of Samples submitted. Number genuine. No. not genuine. Anti-Gas Ointment (No. 2) 1 1 - Aspirin Tablets 4 3 — Bacon 1 1 — Baking Powder 7 7 — Bicarbonate of Soda 1 1 — Boracic Ointment 1 1 — Bun Flour 1 1 — Butter 11 11 — Cake Mixture 2 2 — Cheese 6 6 — Cheese Powder 1 1 — Cocoa 5 5 - Coffee Extract 1 1 - Cooking Fat 11 11 — Curry Powder 1 1 — Custard Powder 3 3 — Egg Self-raising Powder 2 2 — Egg Substitute 8 8 — Essence of Rennet 1 1 - Forcemeat 1 1 - Gravy Powder 4 4 - Gravy Salt 2 2 — Ground Ginger 2 2 - Iodine, Tincture of 1 1 - Lemon Essence 5 5 - Lemon Substitute 1 1 - Margarine (special) 11 11 - Magnesia Tablets 1 1 - Meat and Vegetable Extract 1 1 - Mixed Spice 4 4 - Mushroom Ketchup 1 1 - Mustard 7 7 - Oatflakes 1 1 - Paste (Fish) 9 9 - Paste (Meat) 4 4 - Pea Flour 1 1 - Pepper 9 9 - Pickles 3 3 - Pickling Spice 1 1 - Pudding Powder 8 8 - Raising Powder 2 2 — Salad Dressing Powder 1 1 - Salt 4 4 - Sauce 8 8 — 17 INFORMAL SAMPLES (Contd.) Description of Sample. Number of Samples submitted. Number genuine. No. not genuine. Scons Mixture 1 1 — Semolina 1 1 — Semolina Pudding Powder (sweetened) 1 1 - Self-raising Flour 2 2 — Soup 4 4 — Soup Powder 4 4 — Sponge Mixture 2 2 — Sugar 11 11 — Tea 2 2 — Vanilla Flavouring 2 2 — Zinc Ointment 1 1 — Action taken with regard to samples found to be " Not Genuine." No. of Sample. Description. Nature of Adulteration. Action taken. 755 New milk 7.0% deficient in fat. Legal proceedings. Defendant found guilty, but summons dismissed on payment of costs. 902 Whisky 24.1% of excessive water. Legal proceedings. Defendant fined £5 and ordered to pay £5/5 costs. SWIMMING BATHS AND POOLS. There are no Swimming Baths or Pools in use within this District at the present time. CAMPING SITES. No licences for Camping sites were issued during the year. SMOKE ABATEMENT. It was not found necessary during the year to take action with regard to nuisances arising from the emission of smoke. 18 ERADICATION OF BED BUGS. Number of houses found to be infested:— Council houses 11 Other houses 18 Number of houses disinfested:— Council houses 11 Other houses 18 The following action is taken where premises are found to be infested:— Council Houses.— Strict supervision is exercised where possible infestations exist, and advice given where necessary. In all cases where infestations are found, the necessary action is taken by the Council. Other Houses.— The premises are inspected, and advice and assistance given to the occupiers. Zaldecide insecticide is used in connection with disinfestation. NURSING FACILITIES. No change has been made in the nursing facilities for the District during the year. MATERNITY AND NURSING HOMES. The powers under the Public Health Act, 1936, relating to Nursing and Maternity Homes has been delegated by the County Council to the District Council. There is one registered Home within the District, the number of beds available being six for maternity cases and one for other cases. ADOPTIVE ACTS AND BYE-LAWS. No Acts or Bye-laws were adopted during the year. RIVERS AND STREAMS. All watercourses within the District receive careful supervision. LEGAL PROCEEDINGS. In the following cases it was found necessary to institute legal proceedings:— Particulars. Result. Milk deficient in fat. Summons dismissed on payment of costs. Whisky with excessive water. Defendant fined £5 with £5 5s. costs. Defects at Premises. Defects having been remedied before the hearing of the summons, the case was withdrawn Defendant paying costs amounting to £2 7&. 6d. 19 TABLE 1. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1943. Disease. At all ages. At ages—years. Removed to Hospital. Total Deaths. Under 1 year. 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 25 25 to 45 45 to 65 65 and over. Diphtheria 24 •• 2 2 2 10 1 4 3 .. .. .. 22 3 Puerperal Pyrexia 66 •• .. .. .. .. .. .. 29 37 .. .. .. 1 Pneumonia 31 1 .. 2 2 2 4 2 2 10 2 4 .. 23 Scarlet Fever 200 1 4 12 10 13 110 27 7 15 1 .. 142 .. Measles 596 16 25 45 62 54 306 59 16 10 3 .. .. .. Typhoid 2 .. .. .. .. .. .. .. .. 2 .. .. 2 .. Erysipelas 6 .. .. .. .. 1 .. .. 1 .. 4 .. .. .. Cerebro-spinal Meningitis 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. Poliomyelitis 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. Ophthalmia Neonatorum 2 2 .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 37 5 3 3 7 2 13 1 .. 3 .. .. .. .. Dysentry 14 1 1 .. 1 2 3 .. .. 2 3 1 .. .. TOTALS 980 26 35 64 84 84 438 93 59 79 13 5 167 27 20 TABLE II. DEATHS REGISTERED AS OCCURING DURING THE YEAR 1943. Cause of Death Males. Females. TOTALS. Typhoid Fever - - - Cerebro-spinal Fever - - - Scarlet Fever - - - Whooping Cough - - - Diphtheria 1 2 3 Tuberculosis of respiratory system 15 7 22 Other Tuberculous diseases 1 1 2 Syphilitic diseases - 2 2 Influenza 6 9 15 Measles - - - Poliomyelitis and Polioencephalitis - - - Acute Infantile Encephalitis - - - Cancer of bronchial cavity 3 9 12 Cancer of Stomach and Duodenum 6 8 14 Cancer of the Breast - 12 12 Cancer (all other forms) 30 25 55 Diabetes 2 2 4 Inter cranial vesc. lesions 25 38 63 Heart Disease 65 72 137 Other Diseases of Circulatory System 11 16 27 Bronchitis 12 11 23 Pneumonia 10 13 23 Other respiratory diseases 5 6 11 Ulcer of Stomach and Duodenum 4 1 5 Diarrhoea (under 2 years) 3 - 3 Appendicitis 1 1 2 Other digestive diseases 7 6 13 Nephritis 5 4 9 Post and port-abort. sepsis - 1 1 Other maternal causes — — — Premature birth 5 5 10 Congenital malformation and birth injury 6 3 9 Suicide 1 1 2 Road traffic accidents 4 — 4 Other violent causes 7 11 18 All other causes 20 24 44 TOTALS 255 290 545 ++