67753 ORP 14 AC 4412(3) ORPINGTON ORPINGTON URBAN DISTRICT COUNCIL ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH of the URBAN DISTRICT 1950 Printed by Bromley Office Supplies & Printing Co. Ltd. East Street, Bromley CONTENTS. Page Members of the Health Committee 3 Staff 3 Prefatory Letter 4 Section A. Vital and Other Statistics and Social Conditions. Vital Statistics 8 Population 9 Births 9 Illegitimate Births 9 Stillbirths 9 Deaths 10 Infant Deaths 10 Maternal Mortality 10 Unemployment 10 Open Air Recreational Facilities 11 Section B. Summary of Health Services. Public Health Services Rendered by the Council 14 Hospitals 15 Health Visiting 15 Domiciliary Midwifery 15 Home Nursing Service 15 Domestic Help Service 15 Child Welfare Centres16 Clinics 16 Ambulance Service 17 Laboratory Service 17 Day Nurseries 17 Diseases of Animals Acts 17 Medical Loan Depots 17 Meals on Wheels 17 Tuberculosis Care Committee 18 St. John Ambulance Brigade 18 Old People's Welfare Committee 18 Old People's Clubs 18 Section C. Sanitary and Environmental Circumstances. Water Supply 22 Drainage and Sewerage 23 Cesspools 23 Rivers and Streams 24 Swimming Baths 24 Section D. Factories, Workplaces, Etc. Factories, Workplaces and Outworkers 26 Smoke Abatement 26 Shops Act 27 Verminous Conditions and Uncleanliness 27 Rodent Control 28 Section E. Housing. Housing Inspections 30 Rehousing 30 Moveable Dwellings 31 2 Page Section F. Inspection and Supervision of Foods. Food Sampling 34 Inspection of Food Premises 36 Slaughterhouses 36 Meat Inspection 36 Butcher's Shops 36 Bakehouses 37 Milk 37 Ice Cream 37 Restaurants, Hotels, Canteens, etc 38 Unsound Food 38 Section G. Infectious Diseases. Anterior Poliomyelitis 40 Smallpox 41 Vaccination 42 Scarlet Fever 42 Diphtheria 42 Diphtheria Immunisation 43 Measles 43 Whooping Cough 43 Tuberculosis 44 Food Poisoning 44 Dysentery 44 Section H. Refuse Collection and Disposal. Refuse Collection and Disposal 46 Section J. Other Services. Registries for Female Domestic Servants 50 Nursing Homes 50 Health Education 50 APPENDIX—STATISTICAL TABLES. 1.—Sanitary Inspection of the Area 55 2.—Housing Inspection—Defects Remedied 57 3.—Infectious Diseases—Notifications and Age Groups 58 4 —Factories Acts 59 5.—Food and Drugs Sampling 61 6.—Water Supply—Analysis 63 7.—Schedule of Parks and Open Spaces 64 3 PUBLIC HEALTH COMMITTEE, as at 31st December 1950. Chairman : H. C. VICKERS, Esq. Vice-Chairman : S. J. L. MURRAY-WHITE, Esq. CHAIRMAN OF THE COUNCIL. Mrs. B. D. BARHAM. F. W. BUCK, Esq. Mrs. F. G. GARDNER J. W. HARRADINE, Esq. W E. HAWKEN, Esq. J. R. HENDERSON, Esq. VICE-CHAIRMAN OF THE COUNCIL. E. W. LANE, Esq. Lt.-Col. T. H. NEWEY, e.d. P. H. POWELL, Esq. R. F SMITH, Esq. F. W. SMURTHWAITE, Esq. STAFF OF THE HEALTH DEPARTMENT. as at 31st December, 1950. Medical Officer of Health. K. E. TAPPER, O.B.E, G.M., M.B., Ch.B., D.P.H. Deputy Medical Officer of Health. H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P , D.P.H. Chief Sanitary Inspector, Cleansing Superintendent and Food and Drugs Inspector. F. C. CROWE, M.R S.I., M.S.I.A. Deputy Chief Sanitary Inspector, Deputy Cleansing Superintendent and Food and Drugs Inspector. W. T. WEEDY, C.R.S.I. District Sanitary Inspectors. K. AUTY, M.S.I.A. C. W. BEDDIS, M.S.I A., F.R.Met.S. T. E. W. OSBORNE, C.R.S.I., R.I P.H. Note—All Sanitary Inspectors have been appointed Inspectors under the Shops Act. Temporary Cesspool Survey Officer. J. A. G. WHITE. Clerical Staff. Senior Clerk/Shorthand-Typist : Miss C. COOPER. Clerk/Shorthand-Typist: Miss G. SMITH. Junior Clerk : Miss L. CLEE. Outdoor Staff. Disinfector: W. O. PRINCE. Rodent Operative: W. S. MILLS. Assistant Rodent Operative: C. V. POTTER. 4 To the CHAIRMAN and MEMBERS of the ORPINGTON URBAN DISTRICT COUNCIL. Ladies and Gentlemen, This report covers the year 1950 and is my Third Annual Report to you and the seventeenth since Orpington became an Urban District in 1934. The. report follows closely the form adopted for previous years and I am indebted to the staff of the Orpington Health Department for the collation of facts and statistics. The Department can look back upon a year of successful and progressive work. The vital statistics continue to show improvement, an improvement which began many years ago with the upgrading of the social conditions of the population. It has been more than once authoritatively stated that improvement of vital statistics occurs when there is continuous full employment in the country, when the family purse is full, and when the food supply to the family is adequate. It is also beyond doubt that the Public Health and Medical Services are necessary to maintain this improvement and, by exercising control of infectious diseases and epidemics, to prevent any retrogression. There has been no widespread illness during 1950 sufficiently severe to leave behind a lowered standard of health. There are no available measurements to indicate whether there has been any permanent raising or lowering of morale of the people, but there does appear to be an increase in the number of cases referred to psychological consultation clinics. An increasing number of houses in Orpington are becoming structurally outworn, requiring urgent care and attention ; many, built fifty years ago, were built without the provision of modern facilities; many are shared by two or more families, thus affecting the happiness of real home life. New houses are barely meeting the needs of the natural increase of population, i.e.. excess of births over deaths. With every new housing policy must go a policy for the maintenance of fitness of existing houses. It is incumbent upon Local Authorities, as far as they are permitted, so see that each and every family has a house of its own, free of defects, with all the services that make a home, and that the younger generation are not scarred physically or mentally as a result of bad environment. It is not good government to allow, without protest, young children to be brought up in homes where cold and dampness are evident, 5 With an ageing population there is a need to give consideration as to whether the Public Health Services planned so many years ago are meeting the present day requirements. Some of the attention given to child welfare, with such marked success over the past twenty-five years, should now be diverted to the older population. Investigation should be made into all causes of morbidity of the middle-aged, but until such morbidity is notified to the Health Departments, we are hampered in our investigations. The services of the Health Department of Orpington are worthy of extension, and because Orpington is a rapidly developing and progressive town, there is a greater need than ever that the Council should have functional executive powers of the day to day health services and so be master of its own fate. A full report on infectious diseases appears in the body of the report. Scarlet Fever, whilst maintaining a high incidence, is falling in severity and it is to-day rare indeed to have a death from this disease and rarely do we see an acute case or one causing any anxiety. Diphtheria in recent years shows :i remarkably low incidence and there were no cases notified in 1950. Coincident with the fall in incidence and the absence of deaths has been the increase in immunity as a result of preventive innoculation, which has been an active service in Orpington since 1928. It is, perhaps, too early to state categorically that this is cause and effect. The increase in the virus diseases such as poliomyelitis, a disease which appears to affect principally the fit and well and a disease upon which the usual preventive measures seem to have little effect, creates a new field of research in the Public Health Department, and is also one that must continue to give us anxiety. At the end of the year the cesspool survey neared its completion and I make reference to this in the text of the report. The matter of cesspool drainage received the active attention of the Health Committee throughout the year. The increase of the caravan population in Orpington has now become largely a matter to be dealt with under the Town and Country Planning Act of 1947, but there must be tactful and strict control to prevent nuisances as defined in the Public Health Act. There was one change of staff during the year—the resignation of Mr. Taylor on his appointment as Surveyor and Sanitary Inspector to the Borough of Buckingham, and the appointment of Mr. Beddis to fill the vacancy. 6 In the body of the report is Mr; Crowe's report on House Refuse Collection and Disposal. The help that I have, at all times, received from Mr. Crowe and all members of the Health Department has made my task an easy and happy one. I am also indebted to Mr. King and all Chief Officers for their help and advice and to the Health Committee for their progressive policy to improve the health of Orpington. I have the honour to be, Your obedient Servant, June, 1951. K. E. TAPPER, Medical Officer of Health. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 8 SECTION A. VITAL STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Orpington was made an Urban District of 20,842 acres in 1934, and since that date has developed rapidly from a 33,000 population to a 62,420 population in 1950. The northern part of the district is urban in character ; the southern largely rural. Light industries have developed in the St. Mary Cray Ward. There are now some 179 factories of various characters within the district. Its proximity to London and the ready means of transport by rail and bus make Orpingon one of the dormitory towns of London. The " spread over " of London housing into Orpington, and the extension of housing by the Local Authority must, unfortunately, encroach on the beauty of the country-side of North West Kent. During the year extensive alterations and decorations were completed to the Civic Hall and it was officially opened on the 9th December, 1950, so adding greatly to the amenities of the Civic Services. Summary of Vital and Other Statistics. Area (in acres) 20,842 Registrar General's estimate of total population (midyear), 1950 62,420 No. of Inhabited Houses and Flats, according to the rate books, at the close of the year 18,567 No. of valuation assessments of habitable premises at the close of the year 19,477 Rateable Value (31st March, 1951) £551,456 Product of a Penny Rate for the year ending 31st March, 1951 £2,240 Live Births. Total Male Female Legitimate 893 454 439 Birth Rate, 14.8 per 1,000 Illegitimate 32 14 18 Population. 925 468 457 Stillbirths. Total Male Female Legitimate 19 11 8 Stillbirth Rate 22.2, per 1,000 Illegitimate 2 2 0 (Live and Still) Births. 21 13 8 9 Deaths. Total Male Female 661 354 307 Death Rate 10.6 per 1,000 Population. Deaths from Puerperal Causes. Puerperal Sepsis — Maternal Mortality Rate, 1.1 Other Maternal Causes 1 per 1,000 (Live and Still) Births. Deaths of Infants Under 1 Year of Age. Total Male Female Legitimate 23 19 4 Infant Mortality Rate 24.9 Illegitimate — — — per 1,000 Live Births. 23 19 4 Death Rates of Infants Under 1 Year of Age. All infants per 1,000 live births 24.9 Legitimate infants per 1,000 legitimate live births 24.9 Illegitimate Infants per 1,000 illegitimate live births — Population. The Registrar General's estimate of the population of the Urban District (Civilian and Non-Civilian), mid-year, 1950, is 62,420, which is an increase of 2,920 on the corresponding figure for 1949, and is equivalent to a density of 3.0 persons per acre. The excess of births over deaths during the year was equal to a figure of 264, and is included in the figure of increase previously stated. Births. The Birth Rate for 1950, is 14.8 per 1,000 population, and shows a slight reduction against the figure of 16.5 for 1949. There were 925 births registered, of which 468 were males and 457 females. Of this number 32 were illegitimate. Illegitimate Births. The illegitimate birth rate per 1,000 live births for 1950, was 34.6, as against 48 for the year 1949, and is considerably lower than the average of 45 for the years 1934-1949. Stillbirths. The Registrar General's returns for the year show that the number of stillbirths registered for the area was 21 (after adjustment for inward and outward transfers), which represents a stillbirth rate of 22.2 per 1,000 (live and still) births. 10 Deaths. 661 deaths were recorded during 1950, giving a Death Rate of 10.6 per 1,000 population, compared with 10.7 for previous year. Of this figure, 354 were males and 307 females. The following are details of the main causes of death in the Urban District :— Cancer 114 Heart and Circulatory Diseases 342 Respiratory Diseases (not Tuberculosis) 66 Tuberculosis 11 Infectious Diseases 1 Influenza 5 Road Accidents 9 Other Accidents 9 Suicide 3 Digestive Diseases 5 Other Causes 96 It is pleasing to notice the fall in the number of deaths from Tuberculosis from eighteen in each of the last two years to eleven in 1950. The only death from Infectious Diseases was due to a case of Infantile Paralysis. Infantile Mortality. The Infant Mortality Rate for the year is 24.9 per 1,000 live births. Twenty-three infants died during 1950 before reaching their first birthday. Sixteen of these deaths occurred when the infant was under four weeks of age. Maternal Mortality. There was one maternal death in the district during 1950, giving a mortality rate of 1.1 per 1,000 (live and still) births. Unemployment. I am indebted to the Manager of the Local Labour Exchange for the following information :— " The position of unemployment throughout the year was relatively steady. Towards the end of the period, however, the position worsened slightly owing to the seasonal slackness for painters and also due to the easing of demands for other building trade workers locally. 11 On the women's side the position was also fairly steady with the exception of a rise towards the end of the year due to a general shortage of vacancies for factory work locally and to the requirements of married women who were seeking employment of a part-time nature to meet their domestic commitments. A few women also came on to the register due to seasonal slackness in Agriculture and Market Gardening." Open Air Recreational Amenities. Orpington is very fortunate in the number of its open air recreational facilities, for there are few things more refreshing both for the body and mind than the ability to be able to get away, even if only for an hour or so, from the turmoil and stress of modern city life. The Council, by its wise provision of these amenities, has given everybody a chance of enjoying the peace and quiet of the open spaces and thereby made a great if unspectacular, contribution to the health of the populace. There is, however, the extraordinary anomaly that on fine Saturday mornings one sees children queueing for admission to cinemas. In Appendix 7 will be found a schedule of Parks and Open Spaces. SECTION B. SUMMARY OF HEALTH SERVICES. 14 SECTION B. SUMMARY OF HEALTH SERVICES. I have sub-divided the services into those rendered by the Council, services rendered by the Hospital Boards, and services rendered by the County Council under Part III of the National Health Service Act, and Voluntary Services. I. Public Health Services Rendered by the Council. One of the major services of the Health Department and, one might add, one for which Sanitary Inspectors were first appointed, is to deal with complaints and the abatement of nuisances. A number of these are discovered by routine inspection of the district but the great majority are brought to our notice by members of the public. It is pleasing to note that of the two hundred and ninety-eight complaints received during the year, it was necessary only in six cases to take recourse to legal action to secure an abatement of the nuisance. These figures undoubtedly pay a tribute to the tact and discretion of the Inspectors and, to my mind, are an indication of good liaison with the public generally. One of the essentials in the provision of this service is for the officers of the department to be situated where they are easily accessible to any member of the public and it is gratifying to know that this essential will be achieved next year when the Health Department will be accommodated in the main offices of the Council at Crofton Pound Hill. The other major services of the Public Health Department, to which detailed reference is made under Sections C, D, E. F. G. H. and J. of this report, are as follows :— Infectious Diseases (Prevention and Notification). Inspection of Food and Food Premises. Inspection and Examination of Water and Milk Supplies. Inspection of Factories and Shops. Refuse Collection and Disposal. Housing. Inspection of Nursing Homes. Rodent Control. Atmospheric Pollution. Health Education and all matters covered by the general heading of Sanitary and Environmental Services. In the Appendices (Nos. 1 to 5), is a summary of the work of the Health Department. 15 2. Services Rendered by Hospital Boards. There are two hospitals situated in the district ; Farnborough Hospital with 802 beds, which is within the Bromley Group, and Orpington Hospital with 983 beds, which is within the Orpington and Sevenoaks Group. 3. Services Rendered by the County Council. Health Visiting. The County Council employ ten Health Visitors within the district. Their main function is to give domiciliary advice on the care of mother and child, to attend welfare centres and school clinics and school medical inspections. They follow up and advise on immunisation against diphtheria and vaccination against smallpox. Midwifery (Domiciliary). Three full-time midwives, and five others who combine midwifery and home nursing, are responsible for this area. Home Nursing Service. In addition to the nurses mentioned above, there are seven Home Nurses, plus one part-time nurse. Their services are provided on Medical Practitioners' certification and the service is free. Domestic Help Service. The following is a summary of the cases assisted in Orpington during the year :— Types of cases Jan. Feb. Mar. A pi. May June July Aug. Spt. Oct. Nov. Dec. Total Lying-in 11 7 8 4 10 9 9 9 3 11 9 11 101 Expectant Mothers. Ambulant 12 2 3 3 2 — 1 1 1 — 3 1 29 Bedridden 3 1 2 2 2 — — — 1 1 — 1 13 Aged Ambulant 25 3 6 1 7 1 3 3 1 3 3 4 60 Bedridden 10 3 4 — — 1 1 1 3 4 1 2 30 Tuberculosis. Ambulant 7 — 2 2 2 1 — 1 1 — — 1 17 Bedridden 4 — — 1 1 — 2 1 — 1 — — 10 Other cases. Ambulant 54 17 19 19 10 15 21 11 15 10 13 19 223 Bedridden 22 4 10 15 4 5 7 1 2 5 10 8 93 Totals 148 37 54 47 38 32 44 28 27 35 39 47 576 Number of Part-time Domestic Helpers 112 Number of Full-time Domestic Helpers 3 115 16 Child Welfare Centres. CHELSFIELD Reading Room 1st, 3rd and 5th Tuesday in month—afternoon. CUDHAM and BIGGIN HILL Sports Pavilion, Biggin Hill Thursday—morning and afternoon. DOWNE Gospel Hall 1st and 3rd Wednesday in month—afternoon. FARNBOROUGH Methodist Hall Friday—afternoon. GREEN ST. GREEN Baptist Schoolroom Friday—afternoon. KNOCKHOLT The Institute 2nd and 4th Tuesday in month—afternoon. ORPINGTON Methodist Church Hall Monday and Tuesday —afternoon. CROFTON St. Paul's Church Hall Monday—afternoon. PETTS WOOD Sports Pavilion, Recreation Ground Monday and Thursday —afternoon. ST. MARY CRAY Sports Pavilion, Recreation Ground Monday and Wednesday —afternoon. Ante-Natal Clinics. CUDHAM and BIGGIN HILL Sports Pavilion, Biggin Hill 2nd and 4th Wednesday in month—morning. GREEN ST. GREEN Baptist Schoolroom 4th Thursday in month— morning. ORPINGTON Methodist Church Hall Tuesday and Friday— morning. PETTS WOOD Sports Pavilion, Recreation Ground Tuesday afternoon and Wednesday morning. ST. MARY CRAY Sports Pavilion, Recreation Ground Friday — morning and afternoon. Women's Welfare Clinics. CUDHAM and BIGGIN HILL Sports Pavilion, Biggin Hill 3rd and 5th Wednesday in month—morning. ORPINGTON Methodist Church Hall Every Thursday in month—morning. ST. MARY CRAY Sports Pavilion, Recreation Ground 3rd Thursday in month— afternoon. Minor Ailment Clinics (Schools). The School House Chislehurst Road, Orpington—Saturday morning. Dental Clinics. The School House, Chislehurst Road, Orpington—Monday to Friday (all day) and Saturday (morning). Dental Clinics are also held in the country areas—Farnborough, Cudham, Westerham. Biggin Hill. Downe, Green Street Green, Knockbolt, etc. 17 Immunisation and Vaccination. This is carried out at the Child Welfare Centres as listed above, and in addition, by special appointment at Chislehurst Road School, Orpington, on Tuesday afternoons. Ambulance Service. There is an ambulance depot at Farnborough Hospital, where there are eight ambulances and three sitting-case cars. Laboratory Service. Farnborough Hospital, with whom there is close co-operation in matters of urgency, provides a full laboratory service. Routine medical specimens, Food and Drugs samples, etc., are dealt with by the Kent County Council at their Laboratory at Maidstone. This Laboratory service is provided for the county as a whole. Day Nurseries. There is a Day Nursery at Scad's Hill House, Orpington, with accommodation for approximately 75 children under five years of age. Diseases of Animals Acts. The County Council have an Officer stationed in Orpington, who carries out the functions of this service. 4. Services Rendered by Voluntary Agencies. Medical Loan Depots. Arrangements have been made with the British Red Cross Society for the continuation of the Medical Loan Depots. A full range of nursing requisites is available at these depots, which are additional to the loan cupboards kept by Home Nurses. Applications for loan of such equipment for Orpington inhabitants should be made to either of the following :— Mrs. M. M. Jones, 39, Willett Way, Petts Wood. (Orp. 2083). Mrs. M. Brown, 31, Willett Way, Petts Wood. (Orp. 1847). Meals on Wheels Service. This W.V.S. service commenced in Orpington in October, 1950, and in the two months to the end of the year 155 meals were supplied and delivered to elderly and sick people. A charge of one shilling per meal is made. 18 Orpington and District Tuberculosis Care Committee. The aim of the Committee is to relieve the want, distress and anxiety that tuberculosis may bring to a home. Visits are made to the homes and assistance is given towards special nourishment, fares to visit relatives in sanatoria, clothing, and in exceptional cases, towards the cost of bed and bedding. The question of employment and rehabilitation is also dealt with. Anything affecting a family suffering with tuberculosis is the concern of the Committee, and all cases should be referred to the Hon. Secretary. The St. John Ambulance Brigade. The St. John Ambulance Brigade is part of the Ambulance Department of the Grand Priory in the British Realm of the Venerable Order of the Hospital of St. John of Jerusalem. The objects of the Brigade are to afford holders of first aid certificates from the St. John Ambulance Association opportunities of meeting together for ambulance and nursing practice, with the object of combining individual efforts for the public advantage. To render first aid to the sick and injured on public occasions, with the sanction of the police and other authorities, and to maintain in readiness for such duty a body of trained men and women. Orpington Old People's Welfare Committee. The work of the Old People's Welfare Committee, which covers the whole of Orpington and District area, consists of visiting the lonely old people and helping with their various problems, such as accommodation, pensions, and shopping, obtaining Home Helps under the Home Help Scheme, helping to find vacancies in Homes for the Aged, and friendly visits to old people in hospital. Financial help can be arranged in some cases where the need is not covered by statutory bodies. The Hon. Secretary of the Committee is Mr. L. C. Pearce, "Wyvis,'' Farthing Street, Downe. Old People's Clubs. There are eight Old People's Clubs in the Orpington area with an approximate total membership of 800. These clubs do much to dispel the boredom and loneliness which might otherwise hasten the deterioration of the mental and physical health of the elderly people. They have proved their value in giving old people opportunities to meet their own contemporaries at a place where they can be sure of a warm welcome and friendship. It may well be that, in the case of a good many elderly people, the days of the Club's meeting are red letter days in what is otherwise a monotonous and lonely life. 19 Particulars of the Clubs in Orpington area are given below :— ORPINGTON: Over Sixty Club.—Run by Old People's Welfare Association. Meets at old Civic Restaurant, Council Offices, Orpington. Membership 200. Open every Wednesday and Friday from 11 a.m. to 5 p.m. Dinners and teas served Old Age Pensioners Club.—Run by National Federation of Old Age Pensioners Association. Meets at the Church Hall, Orpington, every Thursday from 2.30 p.m. to 4.30 p.m. Membership approximately 250. ST. MARY CRAY: Old Age Pensioners Club.—Run by National Federation of Old Age Pensioners Association. Meets every Thursday from 2.30 p.m. to 4 30 p.m. at the Co-operative Hall, St. Mary Cray. Membership approximately 65. Rookery Club.—Run by W.V.S. Meets every Tuesday at the Rookery Club Room from 1 p.m. to 5 p.m. Membership 45. FARNBOROUGH: Darby and Joan Club.—Run by W.V.S. Meets at Farnborough every Wednesday from 2.30 p.m. to 4 30 p.m. Membership approximately 50. KNOCKHOLT: The Evergreen Club.—Run by residents of Knockholt. Meets every other Thursday from 2.30 p.m. to 5 p.m. at Harrow Cottage Tea Rooms. PETTS WOOD: Garden Estates Association Old People's Club.—Meets at Woodhurst Avenue every Tuesday afternoon from 2 p.m. to 4.30 p.m Membership 60. Garden Estates Association Old People's Club.—Meets every Tuesday afternoon at Daylight Inn. Membership 70. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 22 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. Water Supply. I am indebted to the Director of Water Examination of the Metropolitan Water Board, for the following statement and for the details of analysis of water supplies which are set out in Appendix 6. "The supply to the district of Orpington is derived from seven well stations, namely, Orpington, North Orpington, Jewels Wood, Sundridge, Eynsford, Shortlands and Bexley. Bacteriological analyses of these wells are made at least five times a week and satisfactory results have been obtained throughout the year. Chemical analyses of the wells supplies are also made at regular intervals. All supplies are treated with chlorine on the works, but any excess remaining after a period of contact is removed completely or reduced to an amount that will not be perceptible to the consumers. 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 the water is up to the standard of quality normally supplied. None of the supplies is plumbo-solvent and we have no information with regard to the proportion of the total number of dwelling houses and population in Orpington which are supplied from the above mentioned sources. All the houses are, however, supplied directly and not by means of standpipes. There are certain residential areas within the district that are without main piped water supply, no less than 180 houses being dependent upon underground tank or well supply. During the year 33 houses previously devoid of main supply were connected to water mains." The following information has been supplied by the Clerk of the Metropolitan Water Board :— "The supply to the Orpington district during the year 1950 was satisfactory as regards quantity. There have been no extensions of trunk mains in the Council's area during 1950 and no new source of public water supply has been instituted. Lengths of service mains have been laid in various areas of the Orpington district." 23 Drainage and Sewerage. Main drainage is under the control of the West Kent Main Sewerage Board. During the year a surface water sewer was constructed between a ditch at Farnborough By-Pass and Farnborough Pond. Improvements were made to surface water drainage in Shire Lane near Beechlands Estate. Cesspools. This continues to be the most serious Public Health problem in the district, and until the whole area is properly sewered, which is an expensive matter involving large capital expenditure, and all houses with cesspools are connected to main drainage, the sanitary state of the district cannot be considered at all satisfactory, especially in those areas with chalk sub-soil. Number of cesspools converted to main drainage during year 55 Number of houses with Pail Closets converted to cesspool drainage 7 Number of new houses erected with cesspool drainage 17 Number of loads removed from cesspools on private properties 2,705 Number of loads removed from cesspools on requisitioned properties 440 Number of loads removed from cesspools on Council properties 506 It will be seen from the above that during the year only 55 cesspools were converted to main drainage, and at this rate of progress it will take years to abolish cesspools, even where there are existing sewers available. In spite of the magnitude of this problem, 17 houses were erected with cesspool drainage. The survey of cesspools, which began on the 17th October, 1949, and terminated on the 30th March, 1951, is complete except for 30 premises not yet visited and 490 premises on which details are not complete at the time of writing. These outstanding details will be taken into the routine work of the District Sanitary Inspectors. For the first time, the Department will have a complete and detailed record of the condition of all cesspools. There is now evidence, where previously there existed only surmise, that there is gross pollution of the sub-soil which is a potential danger to public health, not only to this district, but also to other districts. In the course of this survey it was found that 282 houses had no sanitary provision other than a pail closet, 174 of these premises having cesspools for sink waste, etc. The following statistical facts apply to the 1,901 cesspools where the survey has been completed :— 425 or 22.35% of cesspools are in a sewered area. 1,476 or 77.64% of Cesspools are in non-sewered areas. 24 In Sewered Areas. 199 or 46.82% of the cesspools are emptied :— 16 — 8.04% are emptied monthly 42 — 21.10% are emptied quarterly 141 — 70.84% are emptied yearly 226 or 53.17% are not emptied. In Non-Sewered Areas. 556 or 37.66% of the cesspools are emptied :— 83 — 14.92% are emptied monthly 163 — 29.31% are emptied quarterly 310 — 55.75% are emptied yearly 920 or 62.33% are not emptied. Rivers and Streams. As from the 1st April, 1950, the Local Authority ceased to exercise statutory functions in relation to the prevention of pollution in the rivers Cray and Kidbrook as these duties now fall on the newly constituted Kent Rivers Board with offices at County Hall, Maidstone. Swimming Baths The public are admitted to one swimming bath in the district, and samples of water taken from time to time during the year were satisfactory. SECTION D. FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL, AND VERMINOUS CONDITIONS AND UNCLEANLINESS. 26 SECTION D. FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL, AND VERMINOUS CONDITIONS AND UNCLEANLINESS. Factories, Workplaces and Outworkers. The supervision of factories is partly in the hands of the Factory Inspectors of the Ministry of Labour and National Service, and partly in the hands of Local Authorities. Factories having mechanical power are largely the responsibility of the former, and factories without mechanical power the latter. In both cases the adequacy and efficiency of the sanitary accommodation is dealt with by the Local Authority. Owing to the all embracing interpretation of the term "factory," there are 179 premises on the department's register. The definition includes such premises as boot and shoe repairers, cycle and radio repair shops and all premises, however small, where articles are made, repaired, altered or adapted for sale (to quote just a small part of a very long definition). Comparatively few of this number are of any size and these are mainly situated in the Cray Valley. The supervision of workplaces is carried out by the Local Authority under the provisions of the Public Health Act, 1936. The name "outworker" is applied to persons carrying out certain classes of work at their houses and the employer, i.e., the occupier of the factory, is required to supply to the District Council, every six months, lists containing the names and addresses of such persons. None of the local factories employ outworkers, but a certain number of our residents are employed by factories in other areas. When a case of infectious disease is notified at an outworker's home, steps are taken to ensure that there is no risk of infection being conveyed by the articles made thereat. Smoke Abatement. The figures obtained by the analysis of the contents of the deposit gauge at St. Mary Cray fluctuate considerably from month to month due mainly to variations in climatic conditions, viz., wind direction and rain, but the average monthly deposit for the years 1949 and 1950 corresponds very closely, that for 1949 being the equivalent of 14.78 tons per square mile, and for 1950 15.88 tons per square mile. As stated in previous reports, 27 however, observations over a number of years will be necessary before we can reach any useful conclusions. 166 observations were made by the Sanitary Inspectors during the year. The London and Home Counties Smoke Abatement Advisory Council which is a voluntary association representing all local authorities in London and the Home Counties, was constituted in 1939 under the authority of the Ministry of Health. Its main function is to deal with the problem of reducing smoke in the area and I am pleased to say that the Chairman of the Public Health Committee and the Chief Sanitary Inspector are both members of this Council and also occupy two of the three seats allocated to Kent on the Executive Committee. Councillor S. J. L. Murray-White and the Chief Sanitary Inspector also represent the Council on the Standing Conference of Local Authorities which co-operates with the Department of Scientific and Industrial Research. This Department deals, on a national and inter-national basis, with the investigation of atmospheric pollution. Shops Act. The survey referred to in my last report continued throughout the year. The fullest co-operation of the shop-keepers has been received, making it quite unnecessary to institute statutory action with regard to the various requirements of the Act. A summary of the work in 1950 shows : Inspections 282 Absence of Statutory Forms 65 Inadequate Sanitary Accommodation 4 Inadequate Heating Arrangements 2 The Shops Act, 1950, came into force on the 1st October, 1950, and consolidates all previous enactments. Verminous Conditions and Uncieanliness. The continued low incidence of verminous conditions and uncieanliness is a source of gratification, particularly taking into consideration the housing shortage and the consequent overcrowded conditions in which so many families are living. It is surely a measure of our success in educating the public in the principles of cleanliness, that conditions fostered by dirt have declined to such an extent as to be almost negligible. It would probably be true to say that in the majority of cases of uncieanliness, the condition has arisen as a result of old age or illness and not to neglect of the elementary principles of hygiene in 28 healthy, able-bodied people. Having attained such an excellent general standard of cleanliness, it is now our duty to see that it is maintained, and with modern methods and ideas, there seems to be no adequate reason why this should not be done. Rodent Control. On the 31st March, 1950, the Rats and Mice (Destruction) Act, 1919, was repealed, and its place taken by the Prevention of Damage by Pests Act, 1949. This Act is designed to make permanent provision for preventing loss of food by infestation and one of its most notable modifications is that a local authority may now, if they consider it is expedient, after a seven-day notice, carry out rat destruction work on premises which are suitably grouped for "block control," recovery of expenses reasonably incurred being made at a later date. The delay occasioned by consulting the various interested parties and the time and trouble taken to persuade the invariable back-slider is thus avoided and further damage to valuable foodstuffs stopped. Owing to their quick rate of breeding, one of the most important factors in keeping down the rat population is the early notification of infestation to the Health Department and prevention by the occupier is best secured by denying access to food and not providing suitable harbourage for breeding. The year's figures shew a further increase in the number of occupiers who have availed themselves of the rodent control service provided by the Local Authority. The following statistics are of work carried out by the rodent operatives and District Sanitary Inspectors following complaints and by routine investigations. Total No. of Inspections. No. of Infestations. Local Authority's property 168 18 Dwelling houses (including Council houses) 6,881 185 Business premises 317 35 In addition, the Council's sewers are treated with poison bait twice a year, a test baiting being carried out early in the year to indicate the points at which the sewers are infested. SECTION E. HOUSING. 30 SECTION E. HOUSING. The following is a summary of the work of the Inspectors during the year : Premises inspected 202 Number of visits 1,963 Premises with defects 182 Premises rendered fit by informal action 165 Premises rendered fit by formal action 6 Re-Housing. I am indebted to the Housing Manager for the following statistics of re-housing so effectively carried out by the Local Authority : Prior to 1950 During 1950 Total as at Dec. 1950 1 (a) No. of " Permanent" dwellings built by Local Authority 881 96 977 (b) No. of prefabricated dwellings erected by Local Authority 319 — 319 (c) No. of dwellings requisitioned by Local Authority as at 31/12/49 252 — 234 2. (a) No. of families occupying 1 (a) — — 977* (b) No. of families occupying 1 (b) — — 319 (c) No. of families occupying 1 (c) — — 320 * Plus lodgers. 3. Total No. of families rehoused during 1950: (a) 96. (b) Nil. (c) As before. 4. No of families on waiting list at 31/12/50 in various categories 2,767 (a) Those families with a high degree of housing need 346 (b) Those families whose housing need is considerable but who are not likely to be dealt with in the near future 1,268 (c) Those families whose housing need is, comparatively speaking, small 1,153 In addition to the above, 50 houses were built by private enterprise, 304 by the London County Council, and five war damaged houses rebuilt during 1950. At some future date, when the present housing shortage is no longer a problem, action will be required for the replacement of sub-standard and outworn houses and for the clearance of those areas that had already been scheduled before 1939. It is hoped that in the near future consideration will be given to these matters, 31 Regulation of the use of Moveable Dwellings. In order to regulate the use of moveable dwellings (caravans and tents, etc.) within their district a Local Authority may, under the Public Health Act, 1936, grant licences, (a) to persons authorising them to allow their land to be used as sites, (b) to persons authorising them to station and use such dwellings. In the first mentioned case the land is commonly known as a camping site. Four licences were issued for the summer months, embracing a total of 56 caravans and 110 tents, and two for the winter period covering a total of ten caravans only. In the second case, five licences were issued for the siting of caravans on individual plots. Under the Public Health Act, 1936, a licence can only be refused on public health or sanitary grounds. Further control is obtained through the Town Planning Acts which, excepting temporary use (28 days), and use by organisations such as Boy Scouts or Girl Guides which are exempted under the Public Health Act, 1936, stipulate that consent of the Planning Authority is required. SECTION F. INSPECTION AND SUPERVISION OF FOOD. 34 SECTION F. INSPECTION AND SUPERVISION OF FOOD. Bye-laws for securing the observance of Sanitary and Cleanly Conditions and Practices in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air were adopted by the Council in May, 1950, and came into force on the 24th July, 1950. Generally speaking, the task of improving the hygiene of food premises has been made relatively easy by the willing co-operation of managers and owners, but in the few cases where standards are low and there is little evidence of willingness to improve, the Food Bye-laws will be of great value, particularly as they enable the Local Authority to deal with the actual offender (i.e., the assistant), instead of the person in charge of the business. Food and Drugs Act, 1938. Two hundred and ten samples of food were taken for analysis under the above Act, 39 samples being formal. A further 115 samples were taken for bacteriological and pathological examination and other special tests. Appendix 5 gives details of these samples submitted for examination. Eleven samples (three formal) were found to be inferior or adulterated and the following table gives a precis of the Analyst's Reports and a brief description of the action taken. Sample Analysts Report Action taken Grape Fruit (Informal) Can affected and part blown. Contents 2.9 grains per lb. Adulterated. This was one can of a doubtful batch reported to the department by a Grocery Store Manager. The remaining 70 cans were destroyed. Baking Powder (Informal) Inferior due to the presence of some living small brown beetles. Later identified as psocid, i.e., paper lice. Factory examined by Infestation Division of Ministry of Agriculture and found to be clean. Remainder of stock at Retailers premises free from infestation 35 Sample Analysts Report Action taken Salad Cream (Informal) Unfit for use. Oil had undergone oxidative rancidity. Adulterated. This was one bottle of a doubtful batch reported to the department by a Stores Manager. The remainder of the stock was destroyed. Salad Mayonnaise (Informal) Inferior—the same but not such an advanced stage as the Salad Cream mentioned above. Ditto. Table Jelly Crystals. (Informal) Deficiency in sugar content of 3%. Full investigation made through the Importers and Manufacturers. The Customs Department had made satisfactory trial tests and the unsatisfactory sample could not be explained Owing to comparatively slight deficiency a warning letter was sent. Cream Ices. (Two Informal and One Formal) Not cream ices—contained not more than 0.3% butter fat. The wrappers and advertisement board described the commodities as " Cream " Ice. Representations were made to the Ministry of Food and it was hoped that a provision would be inserted in the new Ice Cream jStandards Order prohibiting the use of the description " Cream Ice" unless the products contained an appreciable amount of butter fat. Provision has not been made however and as the law stands to-day it is unlikely that legal action would succeed. Beef Sausages (Formal) Adulterated. Deficiency of 16% in minimum amount of meat required. First offence. Strict warning given. Pork Sausages (Formal) Adulterated. Deficiency of 12% in minimum amount of meat required. Ditto. 36 Sample Analysts Report Action taken . Groats. (Informal) Inferior. Contains high proportion of reduced iron. Thought to be due to imperfect mix when in bulk. Follow up sample satisfactory. Inspection of Food Premises. During the year these premises were subject to routine inspection and a total of 1,672 visits were made, as shown in Appendix 1. Slaughterhouses. There are nine slaughterhouses recorded on the register of the Local Authority to which the Sanitary Inspectors made 52 visits. Annual Licences were granted to thirteen slaughtermen under the provisions of the Slaughter of Animals Act, 1933. The following is a summary of the carcases inspected during the year. Under Food Control regulations the slaughtering of animals is carried out centrally and the only slaughtering done locally is on behalf of pig keeping clubs, etc. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — — 1 4 90 Number inspected — — 1 3 66 All Diseases except Tuberculosis— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — 3 Percentage of the number inspected affected with disease other than Tuberculosis — — — — 4.5% Tuberculosis only— Whole Carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — 2 Percentage of the number inspected affected with Tuberculosis — — — — 3% Butchers' Shops. There are 40 retail butchers' shops in the area, and in no case was there unsound meat exposed for sale. 178 inspections were made. 37 Bakehouses. Twenty-one premises came under inspection on 64 occasions. The standard generally is good, although four of the premises required notices for cleansing and repairs. Milk. Following the change of legislation referred to in my last report, whereby the Ministry of Agriculture and Fisheries became responsible for the execution and enforcement of regulations relating to dairy farms, the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, was introduced at the end of the year and came into force on 1st January, 1951. The object of this Act was to consolidate most of the enactments relating to milk, dairies and artificial cream. Fifty-nine visits were made to the twelve registered dairies in the Urban District and the following Licences were issued in respect of the sale of milk having a special designation : Tuberculin Tested—Dealers Licences 12 Supplementary Licences 2 Pasteurised— Dealers Licences 11 SupplementaryLicences 3 Sterilised— Dealers Licences 21 Supplementary Licences 2 Thirty-four samples of these milks were sent to the Pathological Laboratory for examination and all passed the appropriate tests. Ice Cream. At the end of the year, there were 87 premises registered for the sale of, and five for the manufacture of Ice Cream. One hundred and seventy-six visits were paid to these premises and a total of 43 samples were submitted for analysis. On the whole these were satisfactory, but reference is made on Page 35 to alleged "cream" ices which contained a negligible amount of butter fat. Intimation of the introduction of a legal standard for ice cream was given at the end of the year but the Order did not come into operation until 1st March, 1951. Thirty-five samples subjected to the Methylene Blue Test were graded as follows : Grade I 8 Grade II 12 Grade III 12 Grade IV 3 38 Restaurants, Hotels, Canteens, etc. Following the detailed survey made in 1949, 146 routine visits were paid to these premises. Two meetings were arranged with the proprietors of cafes, etc., the second one being of an instructional nature. A report of these meetings is presented on Page 50 (Section J—Other Services). Unsound Food. During 1950, a total of 918 condemnation certificates were issued, affecting in quantity 3 tons 1 cwt. of varied articles of food. No prosecutions were necessary, and the condemned food was utilised either for animal food or, where this was impracticable, destroyed. The co-operation of the traders was in all cases complete. 557 tins Vegetables. 1 „ Baking Powder.' 7 „ Chocolate Spread. 444 „ Fruit. 1 „ Curry Powder . 2 „ Coffee. 127 „ Soup 438 „ Meat. 328 „ Milk. 238 „ Preserves. 460 „ Fish. 1 „ Shredded Coconut. 1 „ Baby Food. 1 „ Apple Dumpling. 38 „ Christmas Pudding. 3½ lbs. Butter. 131 „ Cereal. 3 cwt. 56¾ lbs. Fresh Meat. 93¼ lbs. Cheese. 12½ „ Cheese Trimmings. 15 „ Flour. 3 cwt. 99 lbs. Sausages. 18½ lbs. Margarine. 4 cwt. 25& lbs. Dried Fruit. 103¾ lbs. Bacon. 28 „ Dried Fish. 35 „ Fruit Cake. 2 lbs. Veal and Ham Pie. 1 cwt. 53 lbs. Tinned Ham. 96 lbs. Chocolate. 14 „ Sugar. 15 „ Dutch Jellied Veal. 11 „ Cooked Ham. 9 „ Prawns. 40 „ Herring Roes. 4 „ Lemonade Powder. 7½ „ Marrow Bones. 10 „ Sausage Meat. 8 cwt. 31½ lbs. Wet Fish. 1 cwt. New Potatoes. 2 jars Bovril. 189 packets Cereal. 29 jars Pickles. 11 bottles Sauce. 9 boxes Cheese. 19 jars Sandwich Spread. 33 packets Flour. 3 bottles Coffee Extract 12 jars Salad Cream and Mayonnaise. 1 bottle Fruit Juice 8 packets Dates. 1 Sponge Cake. 256 Christmas Puddings. 6 Rabbits. Complaints. Nineteen complaints of unsound condition and contamination of foodstuff were received during the year and these were dealt with to the ultimate satisfaction of the department and the complainants. SECTION G. INFECTIOUS DISEASES. 40 SECTION G. INFECTIOUS DISEASES. The control of infectious diseases necessitates prompt exchange of information between the authorities concerned and it is a matter for gratitude that during the course of the year the liaison between the Medical Officer of Health and the Hospitals has been built up and strengthened. By virtue of arrangements made during the course of the year, the Hospitals keep me informed of any case of infectious or suspected infectious disease which may occur in institutions under their control. For our part we keep the Hospital authorities apprised of all important developments on the Infectious Disease front, thereby enabling them to be on the look out for the particular infectious diseases which may be rampant at any particular time. These arrangements would be especially valuable should an outbreak of a serious infectious disease, for example, smallpox or enteric fever occur. A routine letter is sent to laundries collecting laundry from households in respect of which notification of an infectious disease has been received, advising the laundry to take precautionary public health measures. Head teachers of schools are also kept informed of school contacts, and also the employer especially in cases associated with food handling. Anterior Poliomyelitis. In view of the large and widespread epidemic of infantile paralysis which occurred in the country in the latter part of the year, we were indeed fortunate in that although we had 70 cases notified, only four were paralytic, including one death. Last year's outbreak was distinctive in that many widely separated districts had a large number of cases leaving extensive intervening areas relatively unaffected. Critical anaylsis of this peculiar distribution would rather lead to the conclusion that, spread out over the country, there are at certain times of the year, quite virulent foci of infection. If we take as an example two neighbouring towns A and B of similar type and of more or less equal population and find that in A, there are a large number of cases, while in B only two cases occur, the reasonable inference appears to be that a large number of people in town A have come into contact with the focus of infection in that town, whereas in town B only those who visited A have exposed themselves to the risk of infection. This theory would do a lot to explain the fact that case to case infection appears to be very rare, for example, the unusualness of more than one case in a 41 household and the fact that hospital staffs are not particularly prone to the disease. Unfortunately we are still floundering in the dark as to possible foci of infection and although many ingenious theories have been advanced, I still adhere, in the present state of our knowledge, to the view that human carriers are the most likely source of infection. Before leaving the subject, a word should be added about immunity. At present we have no test to determine whether or not an individual is susceptible to infantile paralysis. It may well be that the majority of people have a natural immunity to the disease, which could explain why only one person in a household is usually affected, but if this is so, the increased number of cases in the community of recent years can only be explained by the fact that there are more foci of infection now than there were formerly. This might well be the case, with the increased intercontinental travel of modern days, by means of which healthy carriers could import the disease into this country from other countries where it is endemic. From the above remarks it will be clear that, although the problem of anterior poliomyelitis is as yet unsolved, there are lines of approach which it is hoped will bring forth fruit in the not too distant future. Smallpox. This disease is no longer endemic in the British Isles but owing to the speed of modern travel there is always the risk of its being imported into this country. It is perfectly possible for a person to be a contact of smallpox, for example in India, to fly to this country and to develop the first signs of illness after being here for several days. If such a sequence of events happened and the patient has been in addition partially immune to smallpox, he might well be insufficiently ill to consult a doctor. In such circumstances, the disease could be spread to a large number of persons before its presence had been suspected, particularly if the population as a whole were not immune. In view of this it will be clear that constant vigilance is necessary on the part of all concerned, if the importation of smallpox on a big scale is to be avoided, every day's delay in the control of movement of a case increases the danger of an epidemic. As the Council are aware, there were two or three instances of smallpox being brought into this country during the past year, but they must all be considered to have been very well controlled. In view of this ever present potential risk it is the practice of the department to urge the necessity for frequent vaccination of all those members of the staff who would be especially exposed 42 to the risk of contracting smallpox, should an outbreak occur in this district. Owing to the difficulty of differentiating smallpox from chickenpox and other diseases, any weakening of the link between the Medical Officer of Health, General Practitioners and Hospitals, would increase the risk of the spread of smallpox. I am happy to say this link is locally a strong one. All contacts of smallpox cases which occurred in other parts of the country and who became residents in the district were kept under daily surveillance for the necessary period of 16 days No cases developed in these contacts. Vaccination. The following figures, which have been furnished by the County Medical Officer, show the number of persons who were vaccinated against smallpox during the year 1950 : Age at 31st December, 1950 Under 1 1 to 4 5 to 14 15 or Over Total Number Vaccinated 337 279 46 35 697 Number Re-Vaccinated — 6 33 149 188 Scarlet Fever. One hundred and twenty-six cases were notified (245 during 1949) 71 of which were treated in hospital and 55 home nursed. The infection continued to be mild in character and no deaths from this disease were recorded. The continued lack of seriousness in the symptoms of this disease in the majority of cases, gives just cause for gratification, but whether this is a temporary or permanent feature will only be able to be judged with the passage of time. If one studies the incidence and life history of scarlet fever over the years, it is a striking fact that this has been subject to periodical waves of alternating seriousness and mildness and it may well be that we are now in the trough of the wave with the crest to be found at some future date. Whether this present attenuation is due to a building up in the resistance of the population or to a weakening in virulence of the infecting organism is not clear, but whatever the cause, the possible course of this disease will need constant vigilance. Diphtheria. There were no cases of diphtheria notified during the year in Orpington, and the continued absence of this disease gives cause for considerable gratification. The diphtheria immunisation campaign is still being kept up, but despite this, there is still quite a large percentage of children who have never been immunised. It is, therefore, impossible to say that immunisation is the only factor concerned in the control of this disease. 43 Diphtheria Immunisation. This service is the responsibility of the County Council. During the year 1950, a total of 564 children received Primary Inoculations and 319 Reinforcing Inoculations. A total of 10,430 children under the age of 15 years had completed a course of immunisation (since 1st January, 1936), at the 31st December, 1950. This is equivalent to approximately 70% of the population under 15 years of age. Measles. Two hundred and fifty cases occurred in the district during 1950, as against 1,049 cases for 1949, giving an attack rate of 4 per 1,000 population. Four of these cases were admitted to hospital and the remainder were home nursed. The distribution of the cases occurring was fairly even throughout the area. The incidence of this disease almost invariably follows a predictable course, for being so very infectious, the great majority of these not immunised by a previous attack, develop it in a time of epidemic. Thus, after a large outbreak we expect to be relatively free until the next lot of susceptible children become exposed to the risk of infection when they also will contract measles thus providing the next epidemic. The interepidemic cases are made up from the susceptibles who somehow missed being attacked during the epidemic and from those who contract the disease more than once—an uncommon occurrence in the case of measles. The vast majority of cases occurring during 1950 were mild in character and it does seem that, providing there is good home hygiene and that very young children are not infected, most of the terrors of this illness have been overcome. Whooping Cough. Two hundred and ninety-seven cases were notified during 1950, as against 182 for 1949, giving an attack rate of 4.7 per 1,000 population. Thirteen of these cases were admitted to hospital, and there were no deaths. There was a rise in the incidence of this disease compared with the previous year, but it would be incorrect to draw any conclusions from the number of notifications of an illness which has always shown inconsistent variations. It is, however, pleasant to be able to record that like measles and scarlet fever, this disease appears to be of a mild type, generally speaking, at the present time, and what has been said about measles with reference to hygiene and voidance of the disease in very early life, applies very much in this case also. 44 Immunisation against whooping cough is still, unfortunately in the experimental stage, and there is no statistical evidence to prove its efficacy, but one is constantly coming across individuals who are of the opinion that it saved their own children either from having the disease at all or at very least modified the attack considerably. Such "evidence" is, of course, inadmissible and as yet immunisation against whooping cough on a large scale cannot be advocated. Tuberculosis. The following table gives the state of notified cases of Tuberculosis in Orpington. Approximately 18 of every 1,000 of population of Orpington is suffering, or has suffered from tuberculosis. The year saw an increase of 87 cases to the register, 50 of which were new cases, and 37 were transferred from other districts. There were 11 deaths from this disease. Pulmonary Non-Pulmonary Total Cases M F M F (a) No. of cases of Tuberculosis on the register at the commencement of year 261 198 62 64 585 (b) No. of cases notified under the Public Health (Tuberculosis) Regulations for the first time during the year 23 19 2 6 50 (c) No. of cases restored to the register during the year - - - - - (d) Other additions to the register during the year 30 34 2 1 67 (e) No. of cases removed from the register during the year 18 11 1 30 (f) No. of cases remaining on the register at the end of the year 296 240 65 71 672 Food Poisoning. There were no outbreaks of food poisoning during the year but 19 single cases occurred. In two cases the agents identified were salmonella organisms. In 17 cases the cause was unknown. A total of 44 faecal specimens were submitted for examination during 1950. Dysentery. Dysentery notifications in Orpington have increased from two in 1949 to 29 in 1950. These have been of the mild Sonne type, but it has been noticed that there has been a tendency to an increase in the notification of this disease in other districts of which I am Medical Officer of Health. The explanation of this rise in the incidence of this disease is not clear, but it is a condition which, if it gains a foothold in any community, will spread very rapidly despite the most rigid public health control measures, and the future distribution of dysentery will have to be watched very carefully. SECTION H. REFUSE COLLECTION AND DISPOSAL. 46 SECTION H. REFUSE COLLECTION AND DISPOSAL. Some 50 tons of household refuse are collected daily from the 18,535 dwelling houses in the district and this is disposed of by controlled tipping. A weekly collection is made in the district, with the exception of the rural part of the area which receives a fortnightly service. No trade refuse is collected by the Council but shop-keepers can, for a small charge, deliver their refuse at the disposal tip and a number of shop-keepers regularly do this by means of their delivery vans and in this way are able easily to dispose of tins, etc. The method of operating the weekly collection is the relay system, four teams (two vehicles each) operating in the district. The refuse in the rural part of the district is collected fortnightly by one team (hired vehicle and driver). One refuse vehicle is used for the collection from the two large hospitals and the numerous schools, also for bulky refuse such as old water tanks from dwelling houses, which cannot be handled by the normal collecting teams. Old water tanks, etc., too readily find their way to vacant and waste plots of land and I am hoping by this service to see a tidier district. Eleven self-contained all steel and metal lined, side-loading refuse collecting vehicles with sliding covers are owned by the Council, one of which is used solely for the collection of kitchen waste. One vehicle is kept in reserve and brought into use at times of breakdown or servicing of the regular vehicles. The collectors are supplied with skips and in a district where the length of carry from the dustbin position to the vehicle is considerable, this is a great saving in manpower as only one trip to the premises is necessary. The cost of the collection and disposal of the refuse was equivalent to a rate poundage of 7.85d. 534 tons 18 cwts of kitchen waste was collected from the communal street bins and shops and this was sold for £1,788 2s. 4d. The first essential to a satisfactory refuse collecting service is, in my opinion, regularity of collection. Every endeavour is made to keep to the same collecting day each week, as householders like to know the day on which to expect the refuse collector, especially those who are away all day and usually lock their gates. 47 The regular collection is interrupted by three causes : sickness of workmen, inclement weather, Bank Holidays or a combination of these factors. Following the Easter Holiday, the work was greatly disorganised due to there being a considerable number of men on sick leave daily for four weeks. It is when the work is in arrears that a considerable number of complaints are received at the office not only with regard to the delay but also in connection with spilling at the dustbin and the vehicle. When the collection is carried out regularly on the same day each week practically no complaints are received which indicate that the spilling is consequential to the irregular collection. The public can help the Council by keeping the amount of refuse deposited in the bin at a minimum and also by ensuring that the refuse which is placed in the bin is dry. During the year a special report was submitted to the Public Health Committee on the service and full consideration was given to the system in force. It was decided to continue with the relay system, the use of skips, to increase the number of collectors and to provide the foreman with a utility van. ✓ SECTION J. OTHER SERVICES. 50 SECTION J. OTHER SERVICES. Registries for Female Domestic Servants. The only Registry in the district ceased to function during 1950. Nursing Homes. Little use is being made of the one excellent Home registered in the district. At first sight it would appear anomalous that, with the shortage of hospital beds, advantage is not taken of the facilities offered by this Home, but the fact is that those people who most need attention and cannot get it in hospital are, in most cases, the very ones who cannot afford to pay the fees of a private nursing home. The only practical solution seems to be that the Hospital Board should pay the Home for patients admitted there at the request of a hospital, but, in order that the Nursing Home should be able to maintain a permanent staff, a guaranteed minimum payment would have to be instituted. Perhaps this is asking too much in these days of enforced economy. Health Education. During the course of the year it was decided to step up the drive for cleaner handling of food and with this object in view a meeting of proprietors of cafes, etc., in Orpington was called in June, 1950. As a result of the ensuing discussion between the Public Health Department and the caterers, at which the difficulties of both sides were discussed in a very friendly spirit, it was decided • to hold an instructional class for the benefit of both caterers and their staffs. In October the promised meeting took place in the old civic restaurant. It could be accounted a great success as some 130 persons were present, including the Chairman of the Council and the Public Health Committee and several other members of the Council. The large and enthusiastic audience seemed to enjoy thoroughly the film and the lecture and discussion which followed it, and the work involved in organising the show seemed justified to the full. A large number of questions were asked, including a request that the department should undertake some teaching of shop staffs immediately after closing hours. It has not been possible to put this excellent suggestion into operation during 1950, but it is hoped that a beginning will be made next year. 51 It would seem that, in the long run, these special efforts are bound to have a beneficial effect on the handling of food, particularly taking into consideration the daily efforts of the department on a more personal basis. One cannot hope for dramatic or sensational results to our work, but it is wise to remember that ex parvis crescunt magna. APPENDICES STATISTICAL TABLES. 54 APPENDICES. 1. SANITARY INSPECTION—VISITS AND DEFECTS. 2. HOUSING INSPECTION—DEFECTS REMEDIED. 3. INFECTIOUS DISEASES—NOTIFICATION AND AGE GROUPS. 4. FACTORIES ACTS—OFFICIAL RETURN. 5. FOOD AND DRUGS SAMPLING. 6. WATER SUPPLY ANALYSIS. 7. SCHEDULE OF RECREATION GROUNDS, ETC. 55 APPENDIX 1. VISITS PAID TO VARIOUS PREMISES TOGETHER WITH DEFECTS AND CONTRAVENTIONS FOUND. Housing Inspection. No. of Inspections No. of Premises at which Defects or Contraventions were found For defects and nuisances 1,963 182 Verminous conditions 30 1 Water supply 100 16 Cesspools 2,247 1,171 Common Lodging House 20 — Drainage 300 45 (4,660) (1,415) Infectious Diseases. Inquiry Visits 341 ... Food Premises. Dairies 59 1 Bakehouses 64 4 Restaurants, Canteens, etc 146 2 Butchers 178 5 Fishmongers and Poulterers 197 1 Grocers 202 5 Greengrocers and Fruiterers 8 2 Ice-Cream 176 3 Slaughterhouses 52 2 Fried Fish Shops 34 — Hawkers' Carts, Stalls and Street Venders 89 6 Visits in connection with sampling 203 — Miscellaneous 264 — (1,672) (31) Factories. Factories with Mech. Power 32 3 Factories without Mech. Power 16 3 Other premises classified as Factories 6 - Emission of Smoke and Fumes 166 2 (220) (8) Trade Premises. Shops (for Shops Act) 282 71 Registry Office for Female Domestic Servants) 2 - Piggeries 63 — Camp Sites 89 — (436) (71) 56 Miscellaneous. Rodent Control— Local Authority's Property 168 18 Dwelling Houses (including Council Houses) 6,881 185 Business Premises 317 35 Swimming Baths—Public 9 — Private 11 - Suspected Food Poisoning 21 — Keeping of Animals 6 4 Offensive Accumulations 29 5 Schools 17 — Public Conveniences 51 — Theatres and Places of Entertainment 6 — Unclassified 352 — 15,186 1,772 57 APPENDIX 2. HOUSING INSPECTION—DEFECTS, ETC., REMEDIED DURING 1950. Drainage. Defective drains re-laid 3 F A J. provided 1 Manhole covers provided 4 constructed 1 New drains provided 5 Choked drains cleared 34 Cesspools emptied 10 W.C. buildings provided 1 Defective W.C. buildings: repaired 2 renewed 3 Soil pipes repaired 1 Cesspools repaired 3 Cesspools constructed 1 Gulleys renewed 2 Flushing cisterns repaired 5 Additional sanitary accommodation provided 4 Waste pipes repaired 8 Sinks provided 2 Rainwater pipes repaired 3 W.C. provided 2 W.C. seats provided 4 W.C. pans renewed 12 Premises connected to sewer 18 Dampness. Roofs repaired 65 New gutters fitted 20 Walls re-rendered 16 New damp courses provided 5 Rainwater downpipes: repaired 1 renewed 1 Defective chimneys repaired 2 Chimney flashings renewed 2 Walls re-pointed 12 re-built 2 Water Supply. Burst water pipes repaired 8 Domestic boiler provided 1 Domestic boiler repaired 2 Defective supply pipes repaired 1 New storage tanks fitted 5 Ball valves repaired 3 Main supply provided 5 General Items. Fire grate repaired 2 New fire grate fixed 5 Defective fireplaces repaired 2 Floors repaired 14 Ceiling plaster repaired 20 Wall plaster repaired 26 Doors repaired 16 Dustbins provided 28 Accumulations removed 7 Defective flue repaired 1 Windows repaired 17 Premises cleaned 5 Sash cords renewed 7 Staircase renewed 1 Defective paving 1 Handrail provided 1 Chimney pot renewed 1 Defective glazing renewed 1 NUISANCES ABATED AND DEFECTS REMEDIED FOLLOWING FORMAL ACTION, 1950. Defective roofs, causing dampness 5 New sink waste pipe 1 New sink waste trap 1 Defective lead flashing 1 Defective window- repaired 1 Drains cleared 1 Lead flats over bay windows repaired 2 Defective fire grate 1 Chimney flashing renewed 1 Complaints. Two hundred and ninety eight general complaints were received during the year and, with the exception of six, these were dealt with by informal action. 58 APPENDIX 3. CASES OF INFECTIOUS DISEASE NOTIFIED DURING 1950. At all ages Under 1 year 1-2 3-4 5-9 10-14 15-24 25-44 45-64 65 and over Age Unknown Removed to Hospital Total Deaths Scarlet Fever 126 2 4 25 67 17 3 4 - - 4 71 - Whooping Cough 297 20 76 90 97 3 1 1 2 2 5 13 - Poliomyelitis 70 — 2 10 14 7 18 14 4 1 — 8 1 Measles 250 8 38 76 118 3 1 3 — — 3 4 — Pneumonia 44 1 4 3 3 3 4 7 9 7 3 9 — Diphtheria - - - - - - - - - - - - - Dysentery 29 1 2 1 1 — 2 7 4 3 8 3 — Smallpox — — — — — — — — — — — — — Puerperal Pyrexia 13 — — — — — 4 9 — — — 13 — Erysipelas 14 — — — — — 1 6 7 — — — _L Malaria 2 — — — — — — 2 — — — 1 — Food Poisoning 19 1 2 2 7 — 1 5 1 — — 2 — Meningococcal Infection 3 1 1 - - - - - 1 - - - - Totals 867 34 129 207 307 33 35 58 28 13 23 124 1 59 APPENDIX 4. FACTORIES ACTS 1937 AND 1948. PART I. OF THE ACT. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 32 16 3 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 139 32 3 — (iii) Other premises in which Section 7 is enforced by the Local Authority *(excluding outworkers' premises) 8 6 — —• Total ... 179 54 6 — *Electrical Stations (Section 103 (1)), Institutions (Section 104), and sites of Building Operations and works of Engineering Construction (Sections 107 and 108). 60 APPENDIX 4 (contd.) 2. CASES IN WHICH DEFECTS WERE FOUND. (If defects are discovered at the premises on two, three or more separate occasions, they should be reckoned as two, three or more "cases"). Particulars Number of Cases in which defects were found Number of cases in which prosecutions were instituted Found Referred Remedied To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) 3 3 — — — Overcrowding (S. 2) — — — — — Unreasonable temperature (S. 3) — — — — — Inadequate ventilation (S. 4) — — — — — Ineffective drainage of floors (S. 6) — — — — — Sanitary Conveniences (S. 7)— (a) Insufficient 1 1 - - - (b) Unsuitable or defective 1 1 — 1 — (c) Not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 6 6 — 1 — 61 APPENDIX 5. FOOD AND DRUGS SAMPLING. Articles Formal Samples Informal Samples Arrowroot — 1 Baking Powder — 7 Butter — 1 Blackberries (Canned) — 1 Blancmange — 2 Cough Pastilles — 2 Cough Syrup Ipecacuanha and B.C. — 1 Coffee and Chicory — 9 Custard Powder — 5 Cherryade — 1 Cake and Pudding Mix — 3 Cream of Tartar — 1 Coffee — 1 Cake and Bun Flour Mix — 1 Cornflour — 1 Doughnuts — 2 Egg, Liquid frozen whole — 1 Frizets — 1 Flour — 3 Figs, Syrup of — 1 Flavouring Essence: Vanilla — 3 Lemon — 4 Pineapple — 1 Grape Fruit — 1 Grape Fruit Cup — 1 Glycerine and Borax — 2 Ground Cinnamon — 1 Gravy Powder — 1 Gelatine — 2 Groats — 1 Gin — 1 Horseradish Cream — 2 Ice Cream (Fat Content) 1 7 Jam: Strawberry — 1 Raspberry — 2 Blackcurrant — 2 Apricot — 1 Lemonade Crystals — 2 Milk: New (Fat Content) 31 — Condensed — 1 Marmalade — 1 Myrrh and Borax — 1 Mustard — 3 Mincemeat — 2 Oysters — 1 Ointment: Itsit - 1 Zinc - 1 Pastries - 2 Paste: Meat - 9 62 Articles Forma Samples Informal Samples Fish — 13 Pastilles, Acid — 1 Peas (Canned) — 1 Pickles: Piccalilli — 1 Sweet — 1 Pudding: Flour Mixture — 1 Christmas — 1 Quinine, Ammoniated Tincture of — 1 Sausage Rolls — 1 Sandwich Spread — 1 Salad Cream — 12 Salad Mayonnaise — 2 Sponge Flour Mix — 8 Sausages: Pork 3 — Beef 3 — Salts — 1 Semolina — 1 Sausage Meat 1 — Shortcakes — 1 Suet, Beef — 2 Soup, Cream of Tomato — 1 Sauce, Tomato Ketchup — . 4 Spice, Mixed — 1 Table Jelly Crystals — 2 Tincture of Iodine — 3 Vinegar — 4 Whisky — 4 Yorkshire Pudding Mixture — 1 39 171 SPECIAL SAMPLES OF MILK, ICE CREAM AND WATER. Milk (Tuberculin Tested)—Bacteriological examination 3 Milk (Pasteurised)—Phosphatase Test 21 Milk (Sterilised)—Turbidity Test 10 Ice Cream—Bacteriological, Pathological and Chemical examination 35 Ice Cream—Chemical Test 8 Water—Bacteriological examination 52 Water—Chemical examination 4 133 GRAND TOTAL 343 63 APPENDIX 6. RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLY TO ORPINGTON FOR THE YEAR 1950. PARTS PER MILLION (unless otherwise stated). Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Nitrite Nitrate Chlorides as CI Oxygen abs. from Permanganate 3 hrs at 80°F. Turbidity in terms of Silica Colour m.m. bro.vn, 2 ft. tube Burgess's Tintometer Hardness (Total) Hardness (Perm) pH Value Conductivity Orpington Well 3 0.007 0.023 — 5.9 15.0 0.09 - 0 276 42 7.4 475 North Orpington 3 0.008 0.030 — 5.5 15.3 0.14 0.3 0 265 41 7.2 425 Jewels Wood 1 0.005 0.015 — 3.0 22.0 0.06 — 0 250 30 7.4 — Sundridge 4 0.051 0.018 — 2.0 17.6 0.05 — 0 218 64 7.4 350 Eynsford 4 0.005 0.020 — 3.3 17.6 0.09 0.2 1 275 56 7.4 450 Shortlands 4 0.004 0.025 — 4.3 18.6 0.13 — 0 298 90 7.2 475 Bexley 5 0.006 0.031 — 5.3 19.3 0.09 — 2 291 69 7.2 450 BACTERIOLOGICAL RESULTS. No. of samples Percentage of samples negative to Bact. coli in 100 ml. Bact. coli Test Bact. coli in 100 ml. Orpington 253 99.6 0.004 North Orpington 241 100.0 Nil Jewels Wood 44 100.0 Nil Sundridge 256 100.0 Nil Eynsford 352 99.7 0.006 Shortlands 256 100.0 Nil Bexley 217 100.0 Nil 64 APPENDIX 7. ORPINGTON URBAN DISTRICT COUNCIL. SCHEDULE OF RECREATION GROUNDS, COMMONS, PARKS, OPEN SPACES AND PUBLIC GARDENS FACILITIES, MARCH, 1951. Parks and Recreation Grounds Ward Acreage Sports Fixtures Children's Playground Football Rugby Hockey Lacrosse Cricket Netball Bowls Hard Courts Grass Courts Concrete Practice Wicket Putting Running Track, etc. Swings Plank Swings Roundabout Ocean Wave See-Saw Giant Stride Sandpit Paddling Pool Hut Storm Shelter Pavilion BIGGIN HILL Biggin Hill 10.7 2 _ 1 _ 1 — _ 2 — 1 — — 9 — — 1 1 — 1 - 1 - Yes CHELSFIELD Chelsfield 2.10 - - - - - - - - - - - - - - - - - - - - - - No CUDHAM VILLAGE Cudham 10.39 1 - - - 1 1 - - 1 1 - - 3 1 - 1 -- - 1 - - - Yes CUDHAM LANE Green St. Green 6.5 - - - - - - - - - - - - - - - - - - - - - - No DOWNE Downe 0.5 — - - - - - - - - - - - 4 - - - 1 - - - - - No FARNBOROUGH Farnborough 10.0 2 -- 1 - 1 1 - - - 1 - - 0 - 1 1 1 1 1 1 - - Yes GLENTRAMMON Green St. Green 13.5 1 — — — 1 2 - - - 1 - - 8 - - 1 1 - 1 - - - Yes GODDINGTON Goddington South 63.95 4 3 1 1 3 2 - 2 - 1 - 1 4 - 1 - 1 - 1 - 1 - Yes GRASSMEADE Goddington North 9.6 - - - - - - - - - - - - 8 - 1 - 1 - - - - 1 Yes KNOCKHOLT Knockholt 0.75 - - - - - - - - - - - - 3 - - 1 1 1 - - - 1 No PETTS WOOD Crofton North 12.27 1 — 1 - 1 - - 2 - - - - 6 - - 1 1 - - - - - Yes POVEREST Knoll 17.5 2 — — — 1 1 1 4 - 1 1 — 6 - 1 - 1 - 1 - - - Yes PRATTSBOTTOM PLAYGROUND Green St. Green 0.055 - - - - - - - - - - - - - - - - - - - - - - No ST. MARY CRAY St. Mary Cray North 19.0 3 — 1 — 1 1 1 2 - 1 - _ 4 1 1 1 1 -- 1 - 1 1 Yes W1LLETT Petts Wood 6.1 — — -- — 1 — 1 6 - 1 - - - - - - - - - - - - Yes FARNBOROUGH (Opp. New Inn P.H.) Farnborough 0.134 - - - - - - - - - - - - - - - - - - - - - - No PUBLIC GARDENS. BROXBOURNE GARDENS Knoll 0.82 - - - - - - - - - - - - - - - - - - - - - - No RIVERSIDE GARDENS St. Mary Cray North 5.8 - - - - - - - 1 - - - - - - - - - - - - - - No THE PRIORY GARDENS Goddington North 14.03 -- - - - - - - - - - - - - - - - - - - - - - No OPEN SPACES. OKEMORE GARDENS St. Mary Cray North 3.75 - - - - - - - - - - - - - - - - - - - - - - No WOTTON GREEN St. Mary Cray North 2.25 - - - - - - - - - - - - 4 - - - 2 - - - - - No COMMON LAND. BIGGIN HILL GREEN Biggin Hill 1.47 - - - - - - - - - - - - - - - - - - - - - - — BROOMHILL COMMON Knoll 1.89 - - - - - - - - - - - - - - - - - - - - - - — DARRICK COMMON Crofton South 1.88 - - - - - - - - - - - - - - - - - - - - - - — FARNBOROUGH COMMON Farnborough 16.72 - - - - - - - - - - - - - - - - - - - - - - — GREEN ST. GREEN COMMON Green St. Green 15.6 - - - - - - - - - - - - - - - - - - - - - - — PRATTSBOTTOM COMMON Green St. Green 0.52 - - - - - - - - - - - - - - - - - - - - - - — LEAVES GREEN COMMON Leaves Green 19.55 - - - - - - - - - - - - - - - - - - - - - - — TUGMUTTON GREEN Farnborough 4.39 - - - - - - - - - - - - - - - - - - - - - - — OLD HILL Green St. Green 1.8 - - - - - - - - - - - - - - - - - - - - - - —