1 ??? 2 ??? C 4412 (3) DRPINGTON ORP 19 ORPINGTON URBAN DISTRICT COUNCIL ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the r Health of the Urban District 1955 ORPINGTON URBAN DISTRICT COUNCIL ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the Health of the Urban District 1955 H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s.. l.r.c.p., d.p.h. Medical Officer of Health, 3 CONTENTS. Page. Members of the Urban District Council 5 Staff 5 Prefatory Letter 7 Section A. Vital and Other Statistics and Social Conditions of the Area. Vital Statistics 12 Population 14 Births 14 Deaths 14 Morbidity Statistics 16 Medical Examinations 16 Unemployment 17 Open Air Recreational Amenities 18 Section B. General Provision of Health Services for the Area. Ambulance Service 22 British Red Cross Society—Medical Loan Depot 24 Day Nurseries 22 Diseases of Animals Acts 22 Disinfection 21 Domestic Help Service 23 Domiciliary Midwifery 22 Health Visiting 23 Home Nursing Service 23 Hospitals 22 Laboratory Service 21 Local Clinic Services 25 National Assistance Act, 1948 20 Nursing Homes 20 Old People's Welfare Committee 24 Public Mortuary 20 Women's Welfare Clinics 25 Women's Voluntary Services 23 Section C. Sanitary and Environmental Circumstances of the Area. Cesspools 31 Complaints 35 Drainage and Sewerage 31 Factories Acts, 1937 and 1948 32 Heating Appliances (Fireguards) Act, 1951 35 Pet Animals Act, 1951 35 Prevention of Damage by Pests Act, 1949 35 Rag, Flock and Other Filling Materials Act, 1951 35 Registries for Female Domestic Servants 35 Rivers, Streams and Lakes 32 Sanitary Inspection of the Area 35 Shops Act, 1950 34 Smoke Abatement 33 Swimming Baths and Pools 31 Verminous Conditions and Uncleanliness 34 Water Supply 28 4 page Section D. Housing. Clearance Areas 38 Housing Repairs and Rents Acts, 1954 38 Housing Statistics for 1955 39 Moveable Dwellings 38 Re-housing 38 Section E. Inspection and Supervision of Foods. Bakehouses 47 Butchers' Shops 47 Clean Food Bye-laws 44 Food Complaints 44 Food Premises 46 Food and Drugs Act, 1938—Food Sampling 42 Food and Drugs Act, 1938—Section 14 45 Game Act, 1831 47 General 42 Ice Cream 45 Meat Inspection 46 Merchandise Marks Act 47 Milk and Dairies Regulations 46 Restaurants, Hotels and Canteens 47 Special Samples—Milk, Ice Cream and Water 45 Unsound Food 46 Section F. Prevalence of, and Control over Infectious and other Diseases. Acute Anterior Poliomyelitis 50 Diphtheria and Immunisation 51 Dysentery 51 Food Poisoning 51 General Remarks 50 Other Infectious Diseases 57 Measles 52 Pneumonia 52 Smallpox and Vaccination 53 Tuberculosis, Chest Clinic and Mass X-Ray 53 T.B. Care Committee 55 Typhoid Fever 55 Whooping Cough 56 Section G. Refuse Collection and Disposal. Refuse Collection and Disposal 60 Appendix. Statistical Tables. Table I.—Summary of Statistics 63 „ II.—Causes of Death 64 „ III.—Infant Mortality 65 „ IV.—Notifiable Infectious Diseases—Sex and Age Distribution 66 „ V.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 67 „ VI.—Notifiable Infectious Diseases—Seasonal Incidence 68 „ VII.—Summary of the Work of the Sanitary Inspectors 69 „ VIII.—Nuisances, Defects and Contraventions Abated 71 5 MEMBERS OF THE URBAN DISTRICT COUNCIL (As at 31st December, 1955). *Chairman of the Council: Councillor W. C. Sweatman, j.p. *Vice-Chairman of the Council: Councillor Lt.-Col. T. H. Newey, e.d., c.c. Councillors: R. W. Ayliffe, f.r.i.c.s. E. Hart. *Mrs. B. D. Barham, j.p. (Chair- W. D. Hayne, t.d. man of Public Health Com- *p 5 Hockey. mittee). .17 T *E. W. Lane. *Mrs. J. G. Banks. E. Lloyd-Ward, m.c. *H. L. Blake. S. T. Millo-Pattle. L. J. Bowker. *J. F. Nunn. H. T. Cox. *P. H. Powell. J. Davies, c.c. C. H. E. Pratt. L. E. B. Dunkerley, G. C. Romain. m.a. (Cantab.). q 5 Saffery. *W. Frank, f.i.c.s. G. A. Smith. *A. E. Fuller. , J. E. Sutty. *Mrs. F. G. Gardner. W. J. Tarry. V. P. Gray. Mrs. J. V. Webb. B. P. Hancock, d.d. . *S. W. Wells. *J. W. Harradine. B. D. Woodmansee. * denotes members of the Public Health Committee. STAFF OF THE PUBLIC HEALTH DEPARTMENT. (As at 31st December, 1955). Medical Officer of Health: H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. (Also Medical Officer of Health for the Borough of Bromley, and the Chislehurst and Sidcup Urban District). (Appointed 13.1.55). Deputy Medical Officer of Health: A. J. i. KELYNACK, m.b., b.s., d.p.h. (Also Deputy Medical Officer of Health for the Borough of Bromley, and the Chislehurst and Sidcup Urban District). (Appointed 21.2.55). 6 Chief Sanitary Inspector and Cleansing Superintendent: F. C. CROWE, m.r.s.h., m.s.i.a. Deputy Chief Sanitary Inspector and Deputy Cleansing Superintendent: W. T. WEEDY, c.r.s.h., m.s.i.a. District Sanitary Inspectors: K. AUTY, c.r.s.h., m.s.i.a. C. W. BEDDIS, m.s.i.a. T. E. W. OSBORNE, c.r.s.h., r.i.p.h. Note.—All Sanitary Inspectors are Inspectors under the Food and Drugs Acts, Shops Act, Rag Flock and Other Filling Materials Act, Pet Animals Act, and Heating Appliances (Fireguards) Act. CLERICAL STAFF: Secretary Miss C. Cooper Shorthand-Typist Miss G. Smith Clerk Miss S. McGowan Temporary Clerk Miss M. Hughes OUTDOOR STAFF: Disinfector: J. J. HUGHES. Rodent Operative: W. S. MILLS. Assistant Rodent Operative: C. V. POTTER. 7 To the Chairman and Members of the Orpington Urban District Council. Mr. Chairman, Ladies and Gentlemen, Few of us, when suffering from that comparatively benign, but none the less exasperating affliction, the common cold, are in any mood to devote much thought to the ultimate cause of our discomfort. If we pursued the matter, however, we should find that our illness was due to infection with a virus, one of a group of parasites in size much smaller even than the bacteria, but nevertheless responsible for a great deal of human disease. Many common infections are known to be caused by viruses, among these being influenza, measles, and chicken-pox, but none would dispute that one of the most distressing of the virus diseases is poliomyelitis, also known as infantile paralysis. The development of a new weapon for use against this latter disease is therefore a major advance in preventive medicine, and for this reason, although the plans for poliomyelitis vaccination did not mature during the year covered by my report, this would be incomplete without some mention of the new vaccine. Extensive use of a similar vaccine in Canada and the United States has produced convincing evidence as to the effectiveness and safety of this immunising agent, and it would seem that the principal unknown quantity is the duration of the immunity that will be conferred, and whether or not periodic "booster" doses will be advisable to maintain this immunity at a safe level. The answers to these and other questions will become apparent in due course, and will be awaited with considerable interest. In the meantime, however, those concerned with research will not be content to rest on their laurels, for there is still much to be learned about the natural history of the virus, and the prevention and treatment of the disease. Indeed, it is not being unduly pessimistic to predict that, unless some unforeseen discovery transforms the situation, this research will need to continue for many years yet before the final conquest of the disease can be assured. A full account of the occurrence of poliomyelitis, and of the other notifiable infectious diseases will be found in the body of this report, and it is not. my intention to dwell on these in detail here. It may, however, not be inappropriate in this connection to sound a note of warning, lest in a justifiable preoccupation with a new problem, there should be a tendency to relax our efforts in those fields where substantial progress has already been made. To mention but one example, if a high level of immunity against diphtheria is not maintained by immunisation, it is more than likely that this once rampant, but now rare infection would return to tyrannise the community. The business of keeping fit is becoming very much a personal affair and much of the success achieved in the prevention of disease 8 depends on the interest taken by private individuals in health matters. There is one simple way in which not only the man-in-the-street, but also the housewife in the home, can play a vital part in preventing illness in their family, and that is by practising in the home the same high standards of personal hygiene that we expect from those handling our food in shops and restaurants. The germs responsible for food poisoning, dysentery, and many other infections, including the virus of poliomyelitis, can all be introduced into our food while it is being prepared, if they happen to be present on our hands. When this contaminated food is consumed, it is often the means of infecting other members of the family ; as it is possible for an individual to carry many of these organisms in the body, without being ill, the importance of absolute cleanliness of the hands at all times, and particularly after using the toilet, becomes obvious. In fact, it is not too much to say, that care in this simple matter of washing the hands could prevent much serious, as well as minor, illness. In particular, children are liable to be affected by these infections, and it is at this age that habits of cleanliness can best be instilled that will stand them in good stead in later life. It has long been established that two basic essentials for a healthy community are a safe and adequate water supply, and a satisfactory system of sewage disposal, and these requirements are very closely inter-linked. Our present immunity from the large epidemics of water-borne disease prevalent up to the end of the last century, is mainly due to the progress made in these branches of sanitary engineering. These matters are still an active concern of the department, and during the year, no fewer than 82 cesspools were abolished and main drainage substituted. In addition, the department was instrumental in securing the connection of twelve premises to the main water supply. Of the outstanding problems in the field of preventive medicine, few have aroused so much discussion as the apparent relationship between smoking and cancer of the lung. It is particularly difficult for both smoker and non-smoker alike to suppress their prejudices and view the problem dispassionately, and as, in addition, few have the knowledge of statistical techniques which would enable them to follow the arguments originally put forward, it becomes difficult to form a clear picture of the situation. As the facts appear to me, an association between cancer of the lung and heavy smoking has been established, though this does not necessarily mean that tobacco is itself a cause, and certainly not that it is the sole cause of the disease. At the same time, the disease is found to affect more frequently those dwelling in towns rather than those residing in rural districts, and there are many who believe that atmospheric pollution is a relevant factor although there are, of course, a host of other differences between town and country life, which might be involved. The question is really one on which every smoker 9 must make his own decision, but at least it would seem to be prudent to practise moderation in this habit. Those interested in the vital statistics for the year, will find these recorded in the body and appendix of this report, and my only comment here will be that they continue to give grounds for satisfaction. This introductory letter would be incomplete without mention of the many services provided by voluntary agencies, which cover a wide field of health and welfare, and as few are in a better position to see the full measure of their work, I am glad to have this opportunity of expressing my appreciation of the most valuable services they are rendering. This has also been a year of pleasant relationship with my colleagues in the hospital and general practitioner services, and I would like to express my gratitude to them for their friendly collaboration, despite the many other calls on their time. I must now mention my own staff, who have all worked so well under the supervision of Mr. Crowe, who has continued to devote his time and energy so unsparingly to the work of the department. I am greatly indebted to him for the smooth running of the Public Health Service in Orpington, and am glad of this opportunity of expressing my grateful thanks. One other staff matter to which I must refer was the arrival early in the year of a new Deputy Medical Officer of Health, Dr. A. J. I. Kelynack, who by his keenness and enthusiasm rapidly established himself as a very valuable member of the staff, and to him also I am glad to express my most sincere thanks. There finally remains for me the very pleasant task of thanking the Committee for their support and encouragement, which has been such a great help to me during my first year as your Medical Officer of Health. I am, Your obedient Servant, H. B. C. CARTER-LOCKE, Medical Officer of Health. May, 1956. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 12 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area of the Urban District 20,842 acres Registrar General's estimate of total population (mid-year) 1955 68,450 Rateable Value at 31st December, 1955 £641,530 Rateable Value at 1st April, 1956 £1,072,620 Estimated product of a Penny Rate for year beginning 1st April, 1956 £4,470 Total number of Valuation assessments at 31st March, 1955 22,027 (a) Houses and flats:— Not exceeding £10 Rateable Value 2,026 Exceeding £10 but not exceeding £20 Rateable Value 5,249 Exceeding £20 but not exceeding £30 Rateable Value 8,968 Exceeding £30 but not exceeding £40 Rateable Value 2,605 Exceeding £40 but not exceeding £50 Rateable Value 1,119 Exceeding £50 but not exceeding £75 Rateable Value 562 Exceeding £75 but not exceeding £100 Rateable Value 65 Exceeding £100 35 20,629 (b) Commercial 994 (c) Licensed Premises 52 (d) Entertainment and Recreational 66 (e) Public Utility 4 (f) Educational and Cultural 24 (g) Industrial 49 (h) Miscellaneous 209 22,027 Mileage of Roads as at 3\st March, 1955:— County Roads, Class 1 13.79 „ „ Class II 3.13 „ Class III 24.43 District Roads 82.134 Unadopted Roads 40.00 (approx. 163.484 VITAL STATISTICS. Live Births. Total Male Female Legitimate 1059 529 530 Birth Rate 15.8 {crude) per 1,000 total population. (Adjusted rate for comparison with other areas 16.3. Illegitimate 24 1083 14 543 10 540 The area comparability factor supplied by the Registrar General for the purpose of determining rates for comparison with other areas is 1.03. 13 Stillbirths. Total Male Female Legitimate 18 10 8 Stillbirth rate 0.28 per 1,000 total population, and 17.24 per 1,000 (live and still) births. . Illegitimate 1 1 - 19 11 8 Deaths. Total Male Female 624 323 301 Death Rate 9.1 per 1,000 total population (adjusted rate for comparison with other areas 9.1). The area comparability factor calculated by the Registrar General for comparison of death rates is 1.00. Deaths from Puerperal Causes. Puerperal Sepsis Nil Other Puerperal Causes Nil Maternal Mortality Rate, Nil per 1,000 (live and still) births. Deaths of Infants under 1 year of age. Total Male Female Legitimate 18 14 4 Infant Mortality Rate 17.5 per 1,000 live births. Illegitimate 1 — 1 19 14 5 All Infants per 1,000 live births 17.5 Legitimate Infants per 1,000 live legitimate births 16.99 Illegitimate Infants per 1,000 live, illegitimate births 41.7 Vita! Statistics of the Urban District for the past Ten Years. Year. Population. No. of births (live) No. of deaths. No. of Infant deaths. No. of Maternal deaths. Birth Rate. Death Rate. Infant Mortality Rate. Maternal Mortality Rate. 1946 56,640 1137 531 39 2 20.0 9.3 34.0 1.6 1947 58,080 1107 505 33 3 19.0 8.6 29.0 2.64 1948 58,320 954 493 19 1 16.3 8.4 19.9 1.0 1949 59,500 975 636 21 1 16.5 10.7 21.5 1.01 1950 62,420 925 661 23 1 14.8 10.6 24.9 1.1 1951 62,850 939 654 18 Nil 14.9 10.4 19.2 Nil 1952 63,670 934 565 17 Nil 14.7 8.9 18.2 Nil 1953 64,480 927 634 16 2 14.4 9.8 17.2 2.1 1954 66,380 1047 516 15 Nil 15.8 7.8 14.3 Nil 1955 68,450 1083 624 19 Nil 15.8 9.1 17.5 Nil Statistics for England and Wales, 1955. Birth Rate (per 1,00 total population 15.0 Death Rate (per 1,000 total population) 11.7 Infant Mortality (per 1,000 live births) 24.9 (lowest ever recorded for the country). 14 POPULATION. The Registrar General's estimate of the total population of the Urban District, mid-year 1955, was 68,450, which is an increase of 2,070 over the figure for the previous year. This population gives a density of 3.3 persons to the acre. The natural increase of population, measured by excess of births over deaths was 459. This means that the greater part of the increase in population that occurred during the year, was due to the movement of new residents into the district. Some idea of this upward trend can be obtained from the following figures of the population during the past five years:— 1951 62,850 1952 63,670 1953 64.480 1954 66,380 1955 68,450 BIRTHS. One thousand and eighty-three live births were registered during the year, giving a birth-rate of 15.8 per 1,000 total population. Of the births registered, 543 were males, and 540 females. The adjusted rate for comparison with other areas is 16.3 The birth rate remained unchanged, a figure of 15.8 being also recorded during the preceding year. This is slightly greater than the rate for England and Wales as a whole. If the illegitimate births are considered separately, an illegitimate birth rate of 22.7 per 1,000 live and still births is obtained. Altogether there were 24 illegitimate births registered during the year, and of these 14 were males and 10 females. There were 19 stillbirths registered during the year, of which 11 were males and 8 females. This gives a stillbirth rate for the district of 17.24 per 1,000 live and still births, and 0.28 per 1,000 total population. DEATHS. There were 624 deaths appertaining to the Urban District and registered during 1955, giving a Death Rate of 9.1 per 1,000 total population. The adjusted rate for comparison purposes is also 9.1. The rate for 1955 is higher than that for the previous year, but is still below that of 11.7 for England and Wales. Of the deaths registered, 323 were males and 301 females. 15 An analysis of the ages at death shows that of those registered:— 19 were under 1 year of age. 2 were 1 and under 5 years of age. 5 were 5 and under 15 years of age. 5 were 15 and under 25 years of age. 25 were 25 and under 45 years of age. 142 were 45 and under 65 years of age. 154 were 65 and under 75 years of age. 272 were 75 and over. 624 The following tabulation, which gives details of certain causes of death in the Urban District for the past five years, may be of interest:— Disease. 1951 1952 Year. 1953 1954 1955 Cancer (all sites) 120 85 108 108 134 Cancer of the Lung, Bronchus 19 9 19 25 23 Heart and Circulatory Diseases 293 285 320 262 276 Respiratory Diseases (excluding Tuberculosis) 76 77 81 44 79 Tuberculosis 19 11 10 5 6 Infectious Diseases — 2 4 1 2 Influenza 10 3 11 1 1 Road Accidents 10 4 5 8 6 Other Accidents 14 6 3 2 8 Full details of the causes of death will be found in Table II in the Appendix. Perhaps the most striking feature of these figures is the very small number of deaths clue to the infectious diseases. This says much for the success of our preventive measures, but there is also no doubt that modern advances in treatment have saved many lives, and the fact that many of the common infections now seem to be passing through a phase of diminished virulence, must have played a further part in bringing about this gratifying state of affairs. Another favourable trend has been the gradual decline in the number of deaths from tuberculosis, though the fact that this figure did not show a further fall in 1955, suggests that it may now have reached as low a level as will be attained while a hard core of unrecognised cases of the disease exists within the community. A far less satisfactory feature is that of the deaths caused by road and other accidents. Although the number of deaths from this cause in any one year is not great, it must be remembered that for every fatal accident, there are many others less serious, but involving injuries which often lead to permanent disability and disfigurement. Even if fatalities alone are considered, it will be seen that in this district in the past two years, the numbers of accidental deaths have exceeded those caused by all the infectious diseases, including tuberculosis. There is little doubt that much, if not all, of this yearly toll of accidental injuries and deaths could be prevented, if the most elementary 16 precautions were taken, and this is particularly true of accidents in the home. Reference has already been made in this report to the national problem of deaths from cancer of the lung. The figures for this district, taken in isolation, are too small to form a basis for any firm opinions, and the fact that the last two years have shown a slightly greater number of deaths from this cause would not, statistically, be considered significant. The deaths from cancer, taking all sites together, have shown an increase during this year, but again this may well be due to the normal year to year fluctuation of this figure. It is again pleasing to be able to report that no maternal deaths occurred during the year. Although it has risen slightly above the exceptionally low rate of 14.3 recorded last year, the infant mortality rate of 17.5 is still well below the national figure of 24.9, which is itself the lowest ever recorded for the country as a whole. MORBIDITY STATISTICS. A weekly return is received from the Regional Office of the Ministry of National Insurance giving details of the number of certificates of sickness benefit received at the Local Office. These figures give some indication of the seasonal trend of illness in the area, and it will be seen that the year 1955 followed the expected trend, i.e., that the highest incidence of illness occurred during January and February and then declined to its lowest level in August, and then gradually rose again towards the end of the year. Four weeks ending Number First. of certificates of Intermediate. incapacity. Final. 25th January 992 2753 705 22nd February 896 2887 873 22nd March 894 2761 843 19th April 669 2566 688 17th May 505 2489 516 14th June 408 2441 402 12th July 347 2318 365 9th August 373 2237 349 6th September 405 2303 323 4th October 450 2373 441 1st November 628 2306 472 29th November 676 2354 596 3rd January, 1956 (5 weeks) 804 2428 663 MEDICAL EXAMINATIONS. During the year, 70 members or potential members of the staff were medically examined for superannuation purposes, etc. This number is greater than that for previous years, largely because council employees are now medically examined prior to their admission to the Sickness Benefit Scheme. 17 unemployment. I am indebted to the Manager of the Orpington Employment Exchange for the following information with regard to unemployment in the area during 1955:— "The early days of the year found us with a smaller than normal winter register of unemployed men, due to less severe weather than usual and registrants were mainly in the upper age groups or limited in their usefulness owing to disability. The women's register was the lowest for many months, and less than half that of January, 1954, due to the steady improvement in the demands of local factories. Women unemployed included some who were available only for restricted hours owing to domestic circumstances and others who lacked special qualifications or whose capabilities were limited by age. The second quarter saw a large increase in the men's register, due to the Printing Trades Dispute, but apart from this the normal register continued to decrease and reached the lowest total for several months, whilst the women's register remained low and steady. The third quarter's story is really a continuation of plentiful employment opportunities and small unemployment registers, and this position was maintained for the rest of the year, with only a very slight increase in December due to seasonal slackness. Summing up the year, the gradual improvement in the unemployment registers which began in early 1953 has continued except for isolated disturbances due to trade disputes. This improvement coincides with the national position and is due to the ever-growing demands of local industry and firms in surrownding districts." 18 OPEN AIR RECREATIONAL AMENITIES. Approximately 273.5 acres of land have been secured for public recreational purposes within the Urban District, as under:— Parks and Recreation Grounds. Ward. Acreage. Biggin Hill Biggin Hill 10.7 Chelsfield Chelsfield 2.10 Cudham Village Cudham 10.39 Cudham Lane Green-Street-Green 6.5 Downe Downe 0.5 Farnborough Farnborough 10.0 Glentrammon Green-Street-Green 13.5 Goddington Goddington South 63.95 Grassmeade Goddington North 9.6 Knockholt Knockholt 0.75 Petts Wood Crofton North 12.27 Poverest Knoll 17.5 Prattsbottom Playground Green-Street-Green 0.055 St. Mary Cray St. Mary Cray 19.0 Willett Petts Wood 6.1 Farnborough (Opp. New Inn P.H.) Farnborough 0.134 Public Gardens. Broxbourne Gardens Knoll 0.82 Riverside Gardens St. Mary Cray 5.8 The Priory Gardens Goddington North 14.03 Open Spaces. Okemore Gardens St. Mary Cray 3.75 Wotton Green St. Mary Cray 2.25 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-Street-Green Green-Street-Green 15.6 Prattsbottom Green-Street-Green 0.52 Leaves Green Common Leaves Green 19.55 Tugmutton Green Farnborough 4.39 Old Hill Green-Street-Green 1.8 The contribution which the open spaces can make towards the health of the place is, of course, incalculable, and by its provision of a large number of open-air recreational facilities, the Council has made arrangements for both young and old alike. The younger generation are given the opportunity to enjoy their sports and pastimes, and for those who enjoy less active pursuits, every chance is given to take full advantage of the restfulness of a summer evening or week-end. Such amenities for both recreation and relaxation can only have beneficial effects on the population in general. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA 20 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH SERVICES RENDERED BY THE COUNCIL. The major services of the Public Health Department, to which reference is made in later sections of this report are:— Atmospheric Pollution. Enquiries into complaints, and abatements of nuisances. Health Education and all matters covered by the headings of Sanitary and Environmental services. Housing. Inspection of Food and Food Premises. Inspection and Examination of water and milk supplies. Inspection of Factories and Shops. Infectious Diseases (prevention and notification). Rodent Control. Refuse Collection and Disposal. NURSING HOMES. (Public Health Act, 1936. Sections 187/194). There are no registered nursing homes within the area. PUBLIC MORTUARY. There is no public mortuary in use in the district. Facilities have been given for the use of the mortuary attached to Farnborough Hospital. NATIONAL ASSISTANCE ACT, 1948. Section 47. Under this section of the Act (as amended by the National Assistance (Amendment) Act, 1951, powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year, it was not necessary to apply to the Court for an order for compulsory removal. Section 50. This section of the Act places a duty on the local authority to 21 arrange for the burial or cremation of the body of any person who has died or been found dead in their area, if it appears that no suitable arrangements for the disposal of the body have or are being made. Expenses incurred by the local authority may be recovered from the estate of the deceased person or from any person liable to maintain the deceased person immediately prior to his death. During the year 1955, the Council arranged for the burial of 2 persons under this section of the Act. LABORATORY SERVICE. All routine medical and Food and Drugs samples are forwarded to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council towards the end of 1955, and was taken over by the Public Health Laboratory Service which is directed by the Medical Research Council on behalf of the Ministry of Health. DISINFECTION. The disinfecting station is situate at the Council Offices and details of the work carried out during 1955 are as under:— Disinfections. Premises visited 97 Rooms disinfected 131 Articles disinfected 1,531 Disinfestations. Premises visited 5 Rooms disinfested 17 Articles disinfested 33 Articles treated. Articles destroyed. Beds 143 — Mattresses 170 9 Bolsters 152 — Pillows 315 — Cushions 68 — Blankets 154 — Sheets Eiderdowns Bedspreads Carpets 148 - Hangings 242 - Clothing (batches) 142 - Library Books 30 - 1564 9 22 In the case of disinfections, rooms and furniture are treated with Formalin vapour, and if necessary, liquid spray. Some articles are steam treated with a pressure of 20 lbs. per square inch. Bedding is steam treated with a similar pressure. For disinfestation purposes, rooms and furniture are sprayed with a proprietary brand of insecticide containing 5 per cent D.D.T. Services rendered by the Hospital Boards. (a) Farnborough Hospital. Provides a general hospital service with 800 beds. (b) Chest Clinic. There is no chest clinic in the area, all patients being referred to the Clinic at Tiger Lane, Bromley. The above come under the control of the Bromley Group Hospital Management Committee, whose offices are at Farnborough Hospital. (c) Orpington Hospital. General Hospital with provision for 810 beds, including Part III residential accommodation for County use. This hospital is controlled by the Orpington and Sevenoaks Group Hospital Management Committee, whose offices are at Orpington Hospital. (d) Venereal Diseases. Patients are referred to the various hospitals with specialist clinics for dealing with such diseases. Services rendered by the Kent County Council. Ambulance Service. The main depot for this area is at 12, Hayes Lane, Bromley. At the present time there are 29 ambulances and 20 sitting-case cars based at this depot, the majority of which are radio controlled. Day Nurseries. There are no Day Nurseries in the area. Diseases of Animals Acts. There is an officer stationed in Orpington who carries out the functions of this service. Domiciliary Midwifery. Five full-time midwives are employed in the Urban District. Patients may obtain the services of a midwife on direct application, or through the patient's private doctor. 23 Domestic Help Service. Applications for this service continue to be heavy, especially for old people and cases of illness in the home. The following cases received assistance during 1955:— Tuberculosis 92 Maternity (expectant mothers) 23 Aged 199 Others 204 Total 518 Home Nursing Service. Five Home Nurses and 4 Home Nurse/Midwives are engaged in the area. A day service only is provided at the present time, and may be obtained on medical certification. Health Visiting. There are 8 Health Visitors/School Nurses, one full-time school nurse, and one Tuberculosis Health Visitor employed in the area. In addition to their school work, Health Visitors are responsible for Maternity and Child Welfare Centres, Immunisation and Vaccination Clinics, Home Visiting, After Care, and give advice on the care of young children, and advice to expectant and nursing mothers. Women's Welfare Clinics. See "Local Clinic Services," for details. Services rendered by Voluntary Agencies. The St. John Ambulance Brigade. Over 60's Clubs. These have been fully reported upon in previous years, and have continued their most valuable work during 1955. Women's Voluntary Services. The following information has been supplied by the County Organiser:— Escorts. At the request of Almoners of Orpington and Farnborough Hospitals, also the Hospital Transport Officer, 41 old people were escorted by car. A request was also received to take an elderly woman, on three occasions, to visit her husband who was in a London Hospital. Some of this work is in the nature of psychiatric treatment, some to visit sick relatives, as well as conveying old people for special treatment. In every case the hospital or the passenger pays for petrol only—the members never charge a mileage rate. 24 At the request of the hospital Almoners, visits have also been paid to old people who have returned home from hospital and needed settling in. Members also visit some old people regularly and do shopping, etc. A trolley shop is operated at Farnborough Hospital, and the members make a point of talking with the old, chronic sick, patients, who look forward to this weekly visit. Once a week members visit the psychiatric ward at Farnborough Hospital and help the elderly patients with Occupational Therapy. Meals on Wheels. During the year, 4,765 meals were cooked at the Centre and taken out to old people in Orpington, St. Mary Cray, Chelsfield, Green-Street-Green, Cudham, Knockholt and Petts Wood. The old people pay 1s. per meal. Two Darby and Joan Clubs are run, one at Farnborough and the other at St. Mary Cray, and the average attendances are 36 and 50 respectively. No weekly subscription is charged, but the members pay 6d. when they attend. They receive tea, scones and cake. Outings are arranged from time to time, also entertainments, but members are encouraged to make their own amusements. They all understand that if they are worried or need help, we are ready to listen and do what we can to assist them. Orpington and District Old People's Welfare Committee. I am indebted to the Honorary Secretary for the following brief report:— ''The activities of the Committee during 1955 included 393 visits to old people in hospital, plus a number of home calls, and in many cases money and necessities were provided. The Orpington Over 60 Club, which is sponsored by the Committee, opens two whole days a week, and averages 100 hot lunches and teas per week. Coach outings to the coast and London are organised as well as stage shows in the club room. Cheap holiday schemes are also taken advantage of. Other Old People's Clubs are helped financially, especially for their Christmas parties." British Red Cross Society—Medical Loan Depot. One medical loan depot is in operation in the district, where a full range of nursing requisites is held and articles are available to local residents. A small charge is normally made, but, in necessitous cases, articles are loaned free. 25 LOCAL CLINIC SERVICES. Child Welfare Centres. Chelsfield Village Hall 1st, 3rd and 5th Tuesday in month—afternoon. Cudham and Biggin Sports Pavilion, Biggin Hill Hill Thursday—afternoon. Downe Post Office Cafe 1st and 3rd Friday in month—afternoon. Farnborough Methodist Hall Friday—afternoon. Green-Street-Green Baptist School Room Friday—afternoon. Knockholt The Institute 2nd and 4 th Tuesday in month—afternoon. Orpington Methodist Church Hall Monday, Tuesday and Friday—afternoon. Crofton St. Paul's Church Hall Monday—afternoon. Petts Wood G.e.A. Hall, Woodhurst Monday and Thursday— Avenue afternoon. St. Mary Cray Temple Congregational Tuesday and Wednesday Church Hall —afternoon. Pratts Bottom Village Hall 2nd and 4th Thursday in month—afternoon. Ante-Natal Clinics. Cudham and Biggin Sports Pavilion, Biggin Every Wednesday in Hill Hill month—morning. Green-Street-Green Baptist School Room Friday—morning. Orpington Methodist Church Hall Tuesday and Friday— morning. Petts Wood G.E.A. Hall, WoodhurstTuesday—afternoon. Avenue St. Mary Cray Temple Congregational Friday—afternoon. Church Hall Women's Welfare Clinics. Green-Street-Green Baptist School Room 4th Thursday—morning. Minor Ailment Clinics (Schools). The School House. Orpington Every Saturday— Chislehurst Road morning. Dental Clinics. The School House, Orpington Monday, Tuesday, ThursChislehurst Road day and Friday—all day. Saturday-morning. Dental Clinics are also held in the country areas—Farnborough, Cudham, Westerham, Biggin Hill, Downe, Green-Street-Green, Knockholt, etc. Immunisation and Vaccination. This is carried out at the Child Welfare Centres as listed above, and, in addition, at the Temple Congregational Church Hall, St. Mary Cray, every second Thursday in the month, and by special appointment at Chislehurst Road School, Orpington, on Tuesday afternoons. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 28 SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. Water Supply. There are 45 premises within the area where a main piped water supply is not available. Twelve premises were connected to the water main in Biggin Hill during the year, but there are still 74 not yet connected, although the supply is available. This total of 119 premises still dependent upon underground tanks or well supply is made up as under:— Number of premises with: Ward. Stored Rainwater. Wells. Biggin Hill 87 — Cudham 14 — Knockholt 1 — Chelsfield 8 — Green-Street-Green 2 — Downe 3 — Farnborough 1 1 Poverest — 2 116 3 The Council decided in December that Statutory Notices should be served on thirty-one owners in the Biggin Hill area requiring them to connect their premises to the main supply within a period of six months. I am indebted to the Director of Water Examination, Metropolitan Water Board, for the following information on the supply of water to the Urban District during the year 1955:— "The supply to the district of Orpington during 1955 was derived from nine local wells, namely, Orpington, North Orpington, Jewels Wood, Sundridge, Eynsford, Shortlands, Westerham, Lullingstone, and Horton Kirby. In addition there was a certain amount of Thamesderived filtered water supplied to the area. Bacteriological analyses of these wells are made five times a week and consistently satisfactory results have been obtained from samples of water passing into supply. Chemical analyses of well 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 consumer. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are analysed 29 to establish that the water in them is up to the normal standard of water in the distribution system. None of the supplies is plumbo-solvent. The following table gives the results of chemical and bacteriological analyses of the various supplies to Orpington during 1955, including analyses of water before treatment." 30 Average Results of the Chemical and Bacteriological Examination of the Water Supplied to Orpington during the year 1955. (Parts per million, unless otherwise stated). Description of Sample. No. of Samples. Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Nitrate Chlorides as Cl. Oxygen abs. from Permanganate 4 hrs. at 27°C. Turbidity in terms of Silica Colour m.m. brown 2ft. tube Burgess's Tintometer. Hardness (Total) Hardness Non-Carbonate pH Value Phosphate a III P.O. 4 Sulphates as SO4 Silica as SiO2 Conductivity Orpington Well 4 Nil 0.019 7.5 15 0.08 0.3 3 282 50 7.2 0.06 13 — 425 N. Orpington Well 4 0.003 0.019 5.4 13 0.07 Nil Nil 265 35 7.2 0.06 8 — 425 Jewels Wood Well 3 0.005 0.020 3.6 10 0.03 Nil Nil 241 25 7.2 0.04 5 — 375 Sundridge Well 4 0.002 0.013 2.9 18 0.06 Nil Nil 210 45 7.5 0.13 27 — 325 Eynsford Well 5 0.001 0.019 4.2 16 0.10 0.1 Nil 254 34 7.3 0.06 9 — 400 Shortlands Well 10 0.002 0 020 4.5 17 0.08 Nil Nil 272 70 7.1 0.05 41 — 450 Westerham Well 4 Nil 0.021 4.8 13 0.08 Nil Nil 270 46 7.2 0.05 11 — 425 Lullingstone Well 3 Nil 0.025 3.8 14 0.08 0.1 Nil 249 33 7.2 0.05 9 — 400 Horton Kirby Well 2 Nil 0.015 5.0 16 0.08 0.4 Nil 254 39 7.3 0.10 18 — 425 Thames-derived filtered Water 1663 0.014 0 085 3.8 26 1.04 0.2 12 258 65 7.8 0.50 49 10 450 Bacteriological Results. Before Chlorination After Chlorination (Water passing into Supply). Plate count (average per millilitre) Colonies counted on Agar Bact. coli test Number of samples. Plate count (Av. per ml.) Colonies counted on Agar 37 °C. (20-24 hrs.) Bact. coli test Percentage samples neg. 100 ml. Average No. per 100 ml. Percentage samples neg. 100 ml. Average No. per 100 ml. 37 C. (20-24 hrs.) Orpington Well 249 5.0 100.0 — 255 — 100.0 — N. Orpington Well 226 5.3 25.2 6 80 230 — 99.6 0.004 Jewels Wood Well 132 0.5 98.5 0.04 134 — 100.0 — Sundridge Well 302 0.1 100.0 — 256 — 100.0 — Eynsford Well 311 0.5 99.7 0.01 316 — 100.0 — Shortlands Well 499 0.04 100.0 — 256 — 100.0 — Westerham Well 251 0.2 98.8 0.03 257 — 100.0 — Lullingstone Well 227 0.1 100.0 — 232 — 100.0 — Horton Kirby We 140 0.2 98.6 0.01 143 — 100.0 — Thames-derived Filtered water 7040 — 60.4 3.73 7.8 99.9 0.002 31 Cesspools. Number of cesspools at 31st December, 1955: — (1) on line of sewer 205 (2) not on line of sewer 2327 2532 Number of cesspools abolished and main drainage provided during the year 82 Number of houses with pail closets converted to cesspool drainage 2 Number of new houses erected with cesspool drainage 20 Number of loads removed from cesspools on private, requisitioned, and Council properties 4750 Section 23 of the Orpington Urban District Council Act, 1954. enables the Council to require owners to drain their premises to the public sewer in certain cases and a resolution by the Public Health Committee to invoke these powers was ratified by the Council in the early part of the year. The owners of approximately 140 premises were contacted in this matter and in 50 cases Statutory Notices were served. The value of this new local legislation is reflected in the greatly increased number of connections as compared with the previous two years, the figures for 1953 and 1954 being 23 and 24 respectively. It is stressed, however, that every effort is made to secure the execution of the necessary works before recourse to legal action, and every assistance possible is given to the owners concerned, including the availability of a loan scheme. Swimming Baths and Pools. Twenty-five visits of inspection were made by the Sanitary Inspectors to the one swimming bath in the district to which the public are admitted. Two samples of water were taken for examination, both of which were satisfactory. Drainage and Sewerage. The trunk soil sewerage system is under the control of the West Kent Main Sewerage Board. Branch main soil sewers and main surface water sewers have been provided during the year by the Local Authority, as under:— 32 (a) Private Estate Development. 1004 lineal yards 6in. Foul Water Sewer. 632 lineal yards 9in. Foul Water Sewer. 57 lineal yards 6in. Surface Water Sewer. 270 lineal yards 9in. Surface Water Sewer. (b) Council Estate Development. Main Surface Water outfall scheme. 391 lineal yards 12in. Foul Water Sewer. 296 lineal yards 54in. Surface Water Culvert. 461 lineal yards 57in. Surface Water Culvert. 325 lineal yards Box Culvert. Rivers, Streams and Lakes. There are two rivers, the Cray and the Kydbrook. Since 1950, the Kent Rivers Board have been responsible for their supervision in respect of pollution, etc. Factories Acts, 1937 and 1948. There are 155 factories on the Council's register at the present time. Eighty-five visits of inspection were made by the Sanitary Inspectors during the year. Seven defects or contraventions were found and 6 abated. The following is a copy of the return relating to the year 1955, which has been supplied to the Minister of Labour and National Service:— 1. Inspections for purposes of provisions as to health. Premises No. on Register No. of Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4 & 6 are to be enforced by the Local Authorities 12 4 1 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 129 73 4 — (c) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 14* 8 — — TOTAL 155 85 5 — *Building sites on Estate development. 33 2. Cases in which defects were found. No. of cases in which defects were No. of cases in which prosecutions were instituted Found Remedied Referred ToH.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 3 2 — 3 — Overcrowding (S.2) — — — — — Unreasonable temp. (S.3) — — — — — Inadequate ventilation, (S.4) — — — Ineffective drainage of floors (S.6) ... — — Sanitary Conveniences (S.7): (a) Insufficient 1 2 — 1 — (b) Unsuitable or defective 3 2 3 (c) Not separate for sexes Other offences against the Act (not including offences relating to Outwork) — — — — — TOTAL ... 7 6 — 7 — Outworkers. Thirty lists of Outworkers were received during the year, and the following are details of the trades involved, together with the number of persons employed. Trade. Number of Outworkers, employed. Clothing 81 Leather Goods 2 Surgical Appliances 2 Sack Makers 1 Cardboard Boxes and Carton Making 9 95 Sanitary Inspection of the Area. Full details of the work carried out by the Sanitary Inspectors will be found in the Appendix. 34 The following are the aggregate totals under the respective headings: — Total no. of Inspections and Visits. No. of premises at which defects or contraventions were found. Housing 1792 116 Infectious Diseases 378 — Food Premises 2123 31 Factories, Outworkers, etc. 202 8 Trade Premises (various) 239 20 Miscellaneous 710 11 5444 186 Verminous Conditions and Unckanliness. No cases of filthy premises were brought to light during the year, and only five premises were found to be in a verminous condition. These were dealt with by the Council's Disinfector. Smoke Abatement. Many complaints were received from residents regarding a nuisance from dense smoke emitted from the chimney of a laundry. The owners of the laundry were very co-operative and in due course, by the installation of automatic stoking apparatus and induced draught flues, the nuisance was abated. In other less severe cases, improvements were obtained with the co-operation of the factory managers. One hundred and seventeen observations were made by the Sanitary Inspectors during the year. The extent of pollution by deposited matter (grit, etc.) in the small area of light industry at St. Mary Cray is determined by exposing a standard deposit gauge (as designed by the Department of Scientific and Industrial Research) for a period of one month, and then examining the solid and liquid fractions of the sample collected. There has been little variation in the average annual amount of deposited matter during the past seven years and compared with similar areas in other parts of the country, it is not excessive. A Lead Peroxide Instrument, sited in the centre of Orpington, is used for determining the average distribution of sulphur dioxide in the district. In this method, a small cylinder, or "candle," coated with lead peroxide and protected by a louvred box is exposed to the air each month and then analysed for sulphates, since the sulphur dioxide taken up from the air is oxidised by the lead peroxide to sulphate. Statistics published by the Department of Scientific and Industrial Research show that Orpington air compares favourably with towns of similar size and distance from London. 35 The Council is represented on the London and Home Counties Smoke Abatement Advisory Council and the Standing Conference of Local Authorities which co-operate with the Department of Scientific and Industrial Research. Heating Appliances (Fireguards) Act, 1951. No contraventions were found during the course of the year. Shops Act, 1950. The department continues to receive the full co-operation of the shopkeepers in regard to the various matters dealt with under the above Act. A summary of the work carried out in 1955 is given below: — Inspections 119 Neglect in displaying Statutory Forms 16 Inadequate Sanitary Accommodation 1 Rag, Flock and Other Filling Materials Act, 1951. No contraventions were detected under this Act. Pet Animals Act, 1951. Licences in respect of five premises were granted or renewed during 1955, and forty-one visits were made by the Sanitary Inspectors. No nuisances or defects were found. The pets sold from these shops consist mainly of tropical fish, birds and tortoises. Prevention of Damage by Pests Act, 1949. The number of inspections and treatments carried out was maintained at approximately the same level as last year. Total number of Number of Infestations Inspections. cleared. Local Authority's property 87 9 Dwelling-houses (including Council Houses) 5840 494 Business Premises 188 27 In addition, the Council's sewers were test-baited early in the year to ascertain the areas of infestation, and this was followed up by treatment with poison bait in February and September. Complaints. During the year, 197 complaints were received from residents, and in only 3 cases was it necessary to take formal action to secure abatement of the nuisance. Registries for Female Domestic Servants. There are no Registries within the area. SECTION D. HOUSING. 38 SECTION D. HOUSING. Housing Repairs and Rents Act, 1954. If the number of applications from tenants for Certificates of Disrepair is any indication, it would appear that landlords generally are not claiming a repairs increase on the rent of their properties as provided in the above Act. The total number of certificates applied for since this Act came into force is fourteen. The number of certificates dealt with in the year under review was as follows:— No. of applications for certificates received 5 No. of applications for certificates granted 3 No. of applications for certificates refused 2 No. of certificates revoked 1 Clearance Areas. Housing Acts, 1936-1949. In November, representation was made to the Council for the clearance of three areas comprising a total of forty-one properties. Moveable Dwellings. During the year, three licences were renewed embracing a total of eighty-six caravans and forty tents. For the winter months, three licences, covering a total of fifty-three caravans, were also issued. In all, seventy-three visits of inspection to the various sites were made by the Sanitary Inspectors. The matter is now largely dealt with by Town Planning. Re-Housing. I am indebted to the Housing Manager for the following statistics of re-housing carried out by the Local Authority: — Prior to 1955. During 1955. Total as at December 1955. I. (a) Number of permanent dwellings built by Local Authority 1880 72 1952 (b) Number of prefabricated dwellings built by Local Authority 319 — 319 (c) Number of dwellings requisitioned by Local Authority 80 — 29 II. (a) Number of families occupying 1 (a) — — 1952 (b) Number of families occupying 1 (b) — — 319 (c) Number of families occupying 1 (c) — — 50 III. Total number of families re-housed during 1955:— (a) 72. (b) Nil. (c) Nil. 39 IV. Number of families with a residential claim on this Authority on waiting list at 31st December, 1955, in various categories:— (a) Families in urgent need of other accommodation 228 (b) Families whose applications require early consideration 520 (c) Families whose applications are less urgent 1033 (d) Families with varying degrees of housing need but with no residential claim on this Authority 362 It is not possible to give any accurate idea of the number of families on the waiting list living in overcrowded conditions, as no figures are kept as to the extent of statutory overcrowding, but approximately 508 families included in 4 above are living in crowded conditions. Housing Statistics for the Year 1955. Total number of valuation assessments, houses and flats, at 31st December, 1955 21,623 1. Inspection of dwelling houses during the year: — (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) ... 255 (b) Number of inspections made for the purpose 830 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 41 (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 188 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 157 Number of dwelling houses demolished during the year — SECTION E. INSPECTION AND SUPERVISION OF FOODS. 42 SECTION E. INSPECTION AND SUPERVISION OF FOODS. General. A few days before Christmas, notice was given by the Ministry of Agriculture, Fisheries and Food, that the Food and Drugs Amendment Act, 1954, the operation of which had been pending for approximately twelve months, would be brought into operation on the 1st January, 1956. Notice was also given, however, that the Food and Drugs Act, 1955, would be brought into operation on the same day and would repeal the 1954 Act. The 1955 Act is a consolidation measure. Besides repealing the 1954 Act, it consolidates it with the Food and Drugs Act 1938, the Food and Drugs (Milk, Dairies and Artificial Cream) Act 1950, and other legislation while amending Part V of the 1938 Act in connection with Slaughterhouses and Knackers' Yards. The Food Hygiene Regulations 1955 made under the new Food and Drugs Act, were also brought into force on the 1st January, 1956, and at the time this report was being compiled, all food shops had been given preliminary notice of the main changes in the law and a full-scale inspection of food shops had been commenced. The object of these new regulations is to reduce to a minimum the risk of food poisoning by the stricter use of hygienic practices. It is hoped in my next report to give a detailed picture of the improvements that have been effected, but it can be said already that the co-operation of shopkeepers, even where improvements have involved considerable cost, has been highly encouraging. FOOD AND DRUGS ACT, 1938. Food Sampling. 195 informal samples of food and drugs were taken for analysis. Article. Samples taken Formal. Informal. Result Remarks Genuine Inferior. Adulterated Almond Oil — 1 1 — — See (a) Bacon — 2 2 — — Baking Powder — 2 2 — — Boracic Ointment — 1 1 — — Bridge Rolls — 1 — — 1 Butter — 4 4 — — See (b) Butter Sweet Confectionery — 17 16 — 1 Cake Confectionery — 5 4 1 — See (c) Cough Linctus — 1 1 — — Cough Pastilles — 1 1 — — Cheese Spread — 1 1 — — Coffee and Chicory — 1 1 — — Cooking Fat — 1 1 — — Crab, dressed — 1 1 — — Cream, sterilised — 2 2 — — Flavouring, Essence — 2 2 — — 43 Article. Samples taken Formal. Informal. Result Remarks Genuine Inferior. Adulterated Flour, Self- Raising — 2 2 — — See (d) Ground Nut Oil — 1 1 — — Horseradish — 2 2 — — Jam, Strawberry — 1 — 1 — Margarine — 5 5 — — See (e) Milk — 68 68 — — Milk, Evaporated — 1 1 — — Olive Oil — 2 2 — — Orange Drink — 1 1 — — Orange Squash — 1 1 — — Paste, Fish — 13 13 — — Paste, Meat — 14 14 — — Quinine — 2 2 — — Raising Powder — 1 1 — — Salad Cream — 2 2 — — Sauce ,. — 5 5 — — Sausages, Pork — 10 10 — — Sausages, Beef — 9 8 1 — Sausage Meat, Beef — 2 2 — — Soup — 3 3 — — Suet, Beef — 1 1 — — Tomatoes, tinned — 1 1 — — Vinegar — 5 5 — — — 195 190 3 2 — — — — Details of unsatisfactory samples: Sample. Analyst's Report. Action Taken. (a) Bridge Roll Adulterated. Contained A full investigation was fragments of a smoked made. Smoking is strictly cigarette. prohibited in bakery cerned, and the manner in which the fragments came to be in the roll was doubtful. A strict warning was issued. (b) Buttered Brazils. Adulterated. In coating- After consultation by the Fat 6.45% (including Council's Analyst and the 1.9% butter fat). Butter manufacturers, it was fat should be 4%. ascertained that recipe was mathematically correct, but an uneven distribution of fat in total mix was caused by wrong method of adding fats. 44 (c) Cake. (d) Strawberry Jam. (e) Beef Sausages. Inferior. Contained piece of oily dirt,—not a rodent dropping. Inferior. Contained fibrous material consisting of jute. Inferior. Fat 34%, Lean 28%. Total Meat, 62% Sulphite absent. Fat excessive—exceeds Lean. This sample was submitted as rodent contamination was suspected. The oily dirt presumably came from part of the bakery machinery. Contacted jam manufacturers who suggested that jute was part of sack in which supply of sugar was received. Immediate steps were taken to overhaul the system of checking in order to prevent a recurrence of adulteration. After consultation with butcher concerned recipe was altered to give a larger proportion of lean meat. Further sample showed a higher lean meat content. Food Complaints. Twenty-two complaints of unsound condition and/or contamination of foodstuff were received from the public during the year as under: — Bread 4 Bread Roll 2 Bridge Roll 1 Ham 2 Ice Cream 1 Jam 1 Lamb 1 Macaroni Cheese (tinned) 1 Milk 5 Orange Juice 1 Pork Sausages 1 Tomatoes, tinned 1 Tongue 1 22 Clean Food Byelaws. Thirty inspections were made, but it was not found necessary to take formal action under these bye-laws, which were adopted under Section 15 of the Food and Drugs Act, 1938. In 1956, they will be replaced by the new Food Hygiene Regulations, 45 Special Samples of Milk, Ice Cream and Water. In addition to the samples previously mentioned, a further 199 samples were taken for bacteriological and pathological examination and other special tests, as under:— Milk (Tuberculin Tested) 2 Milk (Pasteurised) Phosphatase Test ... 38 Milk (Sterilised) Turbidity Test 28 Ice Cream—Bacteriological and Pathological Examination 24 Water—Bacteriological Examination 75 Water—Chemical Examination 32 199 Ice Cream. At the end of the year, there were 148 premises registered for the of ice cream, but none for the manufacture of this commodity. Forty-three inspections were made and conditions were found to be satisfactory. Twenty-four samples were sent for bacteriological and pathological examinations. No pathogenic organisms were isolated, and the fading of the samples under the Methylene Blue test for cleanliness showed that a high standard is being maintained. FOOD AND DRUGS ACT, 1938. SECTION 14. One hundred and ninety-three shops and food premises have been registered under the above Act as shown: — Ice Cream Stores 148 Fish Shops (Fried) 7 Butchers' Shops 37 Fish and Meat Paste Factory 1 193 The following is an analysis of the results obtained during the Past three years. Result. year. No. of samples taken. Grade I. Grade 11. Grade III. Grade IV. 1953 36 31 5 — — 1954 35 31 4 — — 1955 24 23 1 — — 46 Food Premises. There are some 460 food premises in the area, as under: — Bakers and Confectioners 23 Butchers 40 Chemists 20 Clubs and Hotels 8 Confectionery 55 Dairies 12 Fishmongers (Wet, Dried and Fried) 22 Greengrocery 46 Grocery 92 Hospitals 2 Industrial Canteens 11 Public Houses 46 Restaurants, etc. 55 School Canteens 14 Slaughterhouses 6 Street Vendors 8 460 Unsound Food. During the year, a total of 3 tons, 18 cwts. of varied articles of food were condemned, and 764 Food Condemnation certificates issued. There was no consignment of food especially examined during the year. Milk and Dairies Regulations. Thirteen dairies have been registered under the above Regulations. Details of the licences issued during 1955 are: — Tuberculin Tested Dealer's Licences 11 Supplementary Licences 2 Pasteurised Dealer's Licences 11 Supplementary Licences 2 Sterilised Dealer's Licences 27 Supplementary Licences 2 Fifty-six visits were made to the Dairies in the district. Meat Inspection. Four hundred and seventeen visits were made by the Sanitary Inspectors to the six registered slaughterhouses. Licences were issued to eighteen slaughtermen under the Slaughter of Animals Act, 1933. Total weight of meat condemned was approximately eighteen cwts. The following table gives details of the ante- and post-mortem inspection of animals during 1955:— 47 Carcases Inspected and Condemned:— Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 21 16 49 6 1978 Number inspected 21 16 49 6 1978 AH diseases except tuberculosis : Whole carcases condemned — — — — 19 Carcases of which some part or organ was condemned .. 2 2 — 47 Percentage of the number inspected affected with disease other than tuberculosis 9.7 12.5 — — 3.3 Tuberculosis only : Whole carcases condemned .. — — — — — Carcases of which some part or organ was condemned — 3 — — 18 Percentage of the number inspected affected with tuberculosis — 19 — — 0.9 Restaurants, Hotels and Canteens. One hundred and thirty-seven visits were made to these premises during the year. In eight cases defects requiring the attention of the owner were dealt with by informal action. Butchers' Shops. One hundred and sixty-six detailed inspections were made of the forty retail butchers' shops in the area. In no case was there any evidence of unsound meat being exposed for sale. Bakehouses. Sixty-seven inspections were made of the twenty-one premises during the year, and notices issued for cleaning and repair in respect of fourteen premises. Merchandise Marks Act. Thirty-six visits were paid to premises during the year in connection with this Act. No contraventions were detected. Game Act, 1831. Two licences were granted during the year and four were renewed. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 50 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. GENERAL. Altogether 1,640 cases of infectious disease were notified during the year, as against 1,170 during 1954. This increase in the number of notifications was largely due to an epidemic of measles, which commenced in the latter part of 1954, and continued until the early summer of the year under discussion. Despite the large numbers of cases of the disease, most were mild in character, and remained free from complications. The other feature demanding general comment was the incidence of poliomyelitis, of which there were 16 confirmed cases, ten of these being paralytic. In addition, a further five cases were notified, but on further investigation were not confirmed as poliomyelitis. Although this number of cases was not great, compared with that experienced in some other parts of the country, there were, unfortunately, two deaths from the disease. A discussion of the individual infections follows in this report, and full statistical details of the notifiable infections will be found in Tables IV, V and VI of the Appendix. Acute Anterior Poliomyelitis. The seasonal incidence of this disease followed the now familiar pattern and the great majority of the cases occurred in the late summer, and autumn of the year. Indeed, there was only one exception to this, a paralytic case, which was reported during February. There were then no further notifications until the end of August, following which cases continued to occur until the end of November. Altogether, 21 notifications of the disease were received, but of these 5 proved on subsequent investigation to be suffering from other illnesses. Of the 16 confirmed cases, 6 were non-paralytic, and 10 paralytic, but of the latter 2 were normally resident in other districts. In 2 instances the paralysis was of the bulbar type, and one of these bulbar cases and one other paralytic case, proved fatal. Of the 16 confirmed cases, 3 were children under school age, 7 were children of school age, and 6, including the two fatal cases, were adults. These figures illustrate the tendency in recent years for the disease to affect the older child and the adult, which now makes the name "infantile paralysis" something of a misnomer. 51 In no instances could any connection be established between individual cases. Child contacts of school age were excluded from school, and in the case of adult contacts, a decision was made according to the particular circumstances involved, in general those excluded from their employment being food-handlers and persons working among young children. This decision is often a difficult one to make, particularly as there is frequently a considerable delay before the diagnosis of poliomyelitis can be definitely confirmed in the non-paralytic cases. Diphtheria. For the sixth year in succession, no case of diphtheria was notified in the Urban District, and the continued very low incidence of this disease in the country as a whole, is one of the major triumphs of preventive medicine. The present position with regard to immunisation against this disease is summarised in the following figures which have been supplied by the County Medical Officer. Of the children resident in the area who were born since 1941, a total of 924 received primary inoculations and 1,007 received reinforcing inoculations during 1955. A total of 11,138 children under the age of 15 years have completed a course of immunisation at some time prior to 31st December, 1955. Dysentery. This has now become an endemic disease, and 42 cases were notified during the year. Although these were generally very mild in character, three of the cases required admission to hospital. There were no deaths recorded in the area. The mild nature of the disease is such that in many instances the symptoms are very slight, or indeed absent altogether, and these cases consequently never come to the notice of a medical practitioner. As these unrecognised cases are fully capable of disseminating the infection, control of the disease is made extremely difficult. Food Poisoning. Six single cases were notified during the year. In three cases it was possible to identify the agent as being Salmonella organisms, but the cause of the remaining three cases was unknown. There were no deaths. 52 The following is a copy of the annual return of food poisoning notifications (corrected) furnished to the Ministry of Health: — (1) First Quarter — Second Quarter 2 Third Quarter 4 Fourth Quarter — — (2) Outbreaks due to identified agents :— 6 Total outbreaks Nil. Total cases Nil. (3) Outbreaks of undiscovered cause :— Total outbreaks Nil. Total cases Nil. (4) Single cases:— Agent identified 3 (Salmonella organisms). Unknown cause 3 Although the number of cases notified is small, it is probable that many other individual cases of a minor nature occur, but medical advice is not sought, and so these never come to notice. This is less likely to happen, however, where an outbreak is concerned, and so this seems to indicate that most of the cases now occurring are isolated ones. The absence of outbreaks of this disease is perhaps evidence that the patient educational work already carried out among foodhandlers is now bearing fruit, and that a satisfactory standard of hygiene is being gradually obtained. The continued occurrence of individual cases, however, suggests that the same standards have not yet penetrated into every home, where the cleanest food can be contaminated during preparation, causing the isolated case, or small family outbreak, of food poisoning. Measles. The year 1955 produced a large epidemic of measles, and a total of 1,048 cases was notified in the Urban District, but it is a commentary on the mildness of the condition that only eight of these cases necessitated hospital admission. In the previous year 515 cases were notified, but most of these occurred at the end of the year and were part of the same epidemic. It is highly probable that the number of actual cases was greater than this, but as always occurs when an infection is mild, a certain number of cases never receive any medical attention and so miss being notified. No deaths from the disease were notified in the area. Pneumonia (All Forms). Altogether there were 106 cases of pneumonia notified during the year, and 43 deaths from this cause. These figures were greater than those for the preceding year, when 56 cases were reported. The increased incidence of the disease occurred during the early months of the year, and was almost certainly associated with the prevalence of influenza-like illnesses at that time. 53 Scarlet Fever. Fifty-eight cases were notified during the year, 22 of which were removed to hospital, and the remainder home nursed. One hundred and eleven cases were notified in 1954. There were no " return cases," and no deaths from this disease. Scarlet Fever continues to be a mild infection with the occasional severe case cropping up for no apparent reason. There is little doubt that, generally speaking, the disease has so lost its terrors, that there must be quite a number of missed cases. Every year there must be people who get sore throats with rashes so slight and trivial that the latter are not even noticed, and it is well to remember that an attack of tonsillitis without a rash can often be a much more serious illness than the modern type of scarlet fever. Smallpox. The continued absence of this disease is a cause for congratulation and thankfulness, but we have to be constantly on our guard against its importation with the ever-increasing speed of travel between different parts of the world. During the course of the year, three suspected contacts of cases in other countries came under the supervision of the department, but in no instance did anything develop. There is also a steady call on the department to stamp and sign International Certificates of Vaccination, which are not valid until so countersigned. Every year re-vaccination is offered to all members of the staff of the Health Department. I am indebted to the County Medical Officer for the following figures showing the current position with regard to vaccination in the Urban District. A total of 889 residents received Primary vaccination and 170 Re-vaccination during 1955. Tuberculosis. The following is a copy of the recordings in the register as at 31st December, 1955: — Respiratory. Other Forms. Total No. of Cases. M. F. M. F. On Register at 1st January, 1955 417 340 70 71 898 New cases notified during 1955 31 25 1 2 59 Number of cases coming to knowledge after death 1 — — — 1 Restored to Register 2 — — — 2 Inward Transfers 22 18 — 1 41 473 383 71 74 1001 Deletions—deaths, removals, recoveries, etc 33 28 1 2 64 Number of cases on Register at 31st December, 1955 440 355 70 72 937 54 New cases and mortality, 1955:— Age Groups. New cases revealed. notified or otherwise (Not including Inward Transfers)*. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 5 2 — — — — — — — 5—14 1 — — — — — — — 15—44 13 19 — 1 1 2 — — 45—64 11 4 1 — 2 1 — — 65 and over 4 2 — 1 3 — — — 31 25 1 2 6 3 — — *Inward Transfers 22 18 — 1 Totals 53 43 1 3 Mass X-ray. A very close and satisfactory liaison exists between this department and Dr. J. M. Morgan, the Director of the Mass X-ray Unit of the South-East Metropolitan Regional Hospital Board, which operates from time to time in the area, and I am very grateful to him and his staff, especially for supplying me with the statistics upon which the following information is based. During the year, 4,513 people were x-rayed, of whom 2,687 were women and 1,826 men. Of the grand total, as many as 2,127 had previously taken advantage of this service. Of the 95 abnormalities discovered, 29 were considered tuberculous, 18 required treatment and 11 occasional supervision only. The rest of the 95 consisted of non-tuberculous chest conditions, cardiac abnormalities and a few previously known tuberculous cases. Whilst these figures show that there would appear to be some 2,127 persons who have recognised the value of regular examination of this type, there were only 2,386 new converts, and it is safe to say that a much higher percentage of people will have to be encouraged to co-operate with this service if we are to succeed in our aim of the eventual elimination of the scourge of tuberculosis from our midst. For information, the number of people x-rayed at previous visits of the unit were:—- Year. Number. 1953 4,318 1951 1,954 55 Chest Clinic. I am indebted to Dr. D. G. Madigan, Physician in Charge, for the following information: — New cases attending the Chest Clinic for the first time during 1955: — Adults. Children. M. F. M. F. Pulmonary Tuberculosis 43 27 3 — Non-Pulmonary Tuberculosis — 1 — — Non-Tuberculous 59 51 9 10 New contacts examined during 1955: — Negative. Positive. M. F. M. F. 119 145 1 3 These contact figures are additional to those given in the first part of this table. B.C.G. Vaccination of Contacts 97. Number of patients who completed a course of sanatorium or hospital treatment during 1955: 56. T.B. Care Committee. I am indebted to the Secretary, Orpington and District Tuberculosis Care Committee, for the following information: — During the year the Committee gave assistance to 48 cases, by means of help with the rent, lighting bills, fare for visiting, coal, furniture, clothing, groceries, holidays, removals, etc. At Christmas, arrangements were made for 50 parcels of food and toys to be distributed, and 11 patients in hospital received parcels. Typhoid Fever. A single case of typhoid fever occurred during the year, and as this was of particular interest, showing as it does the importance of the carrier in this infection, a full report of the case is given. The patient, one of the younger members of a large family, attended a day school in an adjoining district. She had been sent home from school at the onset of symptoms, was admitted to hospital in the early stages of the illness, and made a complete recovery. During the period preceding her illness, the patient's movements had been confined to the immediate vicinity of her home and school, and extensive enquiries were therefore made in these two districts to discover the source of the infection. At the school the water and milk supplies were sampled and found to be satisfactory. Although the patient had not consumed school meals, the canteen arrangements were investigated, and could not be 56 implicated. Enquiries were made concerning other absentees, and in one case bacteriological investigations were carried out, but in every instance the disease could be excluded. Daily contact was maintained with the school during the period of quarantine, but no further cases of the disease occurred. At the same time, exhaustive investigations were carried out at the patient's home, specimens of faeces for bacteriological examination being obtained from all other members of the household. The domestic water supply was sampled and found to be satisfactory, and other water supplies in the district, which the child might have consumed, were sampled and found to be free from contamination. The milk and other food supplies, were investigated with negative results. Other contacts in the neighbourhood, including relatives of the patient, were also visited. Although there had been no recent similar illness in the child's family, one member of the household had suffered with the disease many years previously, and seemed at first likely to prove to be a carrier, but careful and repeated investigations proved that this was not the case. The source of the infection was discovered to be an elderly member of the household who, although she could not recall having suffered with the disease, proved to be a carrier of the typhoid organism, and this was subsequently found to be of the same type as that affecting the patient. This person had been in particularly close contact with the child; she was admitted to hospital for treatment, which successfully eradicated the infection, and no further cases of the disease occurred. It will be seen that the amount of work devoted to this one case was considerable, but when it is considered that a possible epidemic of typhoid fever was avoided, all the investigations would appear to have been fully justified. Whooping Cough. This is another of those diseases which at least temporarily, and one hopes, permanently, has lost a great deal of its former virulence. Of the 205 cases notified, only five had to be treated in hospital. There was a large drop in the incidence of this disease compared with the previous year when 316 cases were notified, but, once again, this is a condition in which one does not expect to get one hundred per cent notification as it is often so mild that it is either missed altogether, or else diagnosis is so difficult that a firm decision is never reached. There were no deaths in the area from this disease during 1955. 57 Other Infectious Diseases. In addition to those previously mentioned, notifications were received as under: — Erysipelas 8 cases (4 were removed to hospital). Puerperal Pyrexia 90 cases (89 were institutionally treated and one home nursed). No cases of the following diseases were brought to the notice of the department and no deaths were registered: — Anthrax. Cholera. Encephalitis. Glandular Fever. Malaria. Meningococcal Infection. Ophthalmia Neonatorum. Typhus Fever. Undulant Fever. SECTION G. REFUSE COLLECTION AND DISPOSAL. 60 SECTION G. REFUSE COLLECTION AND DISPOSAL. Mr. Crowe reports: — I am pleased to be able to report that the regular weekly collection of household refuse was maintained throughout the year with only slight disturbances at Bank Holidays. The fortnightly service was maintained for the rural parts of the district. The foreman has given most loyal service and the collecting teams have been enthusiastic in their work and by the working of overtime following Bank Holidays, the normal rounds were quickly restored. It is essential, to my mind, to collect in each road on the same day each week, and at about the same time, and every endeavour is made to do this. The Council own a fleet of 12 side-loading refuse collecting vehicles and 42 workmen are engaged on the service (including the foreman). The method of operating the collections is the relay system. A team of collectors works with two vehicles and drivers and change from one vehicle to the other when a load is taken to the refuse tip, thus ensuring that the collectors' time is not wasted. Approximately 17,000 tons of refuse were collected from the 21,000 premises in the district. All the refuse is disposed of by means of controlled tipping on low-lying land at Budgin's Hill, Pratts Bottom, which was obtained by compulsory purchase following a Ministry of Housing and Local Government public inquiry. Tipping was commenced at this site on the 22nd August. The amount of refuse to be disposed of has increased each year since the war, and particularly since building restrictions were lifted. It became essential to employ mechanical aid at the tip, and a Fordson Major Tractor Muledozer was purchased in May. This machine has proved to be invaluable in maintaining the tip in accordance with the principles of controlled tipping and has also saved manpower. The Ministry of Housing and Local Government Public Cleansing Returns for 1954/55 showed that of the Authorities making a return, 301 were disposing of refuse by controlled tipping and 60 by mechanical means (Destructor). APPENDIX. STATISTICAL TABLES. 62 STATISTICAL TABLES, 1955. TABLE I.—Summary of Statistics. TABLE II.—Causes of Death. TABLE III.—Infant Mortality. TABLE IV.—-Notifiable Infectious Diseases—Sex and Age Distribution. TABLE V.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates. TABLE VI.—Notifiable Infectious Diseases—Seasonal Incidence. TABLE VII.—Summary of the work of the Sanitary Inspectors. TABLE VIII.—Nuisances, Defects and Contraventions Abated. 63 TABLE L SUMMARY OF STATISTICS, 1955. Population (mid-year 1955, per Registrar General) 68,450 Birth Rate (crude) 15.8 Death Rate (crude) 9.1 Maternal Mortality Rate Nil Infant Mortality Rate 17.5 Number of Births (live) 1,083 Number of Stillbirths 19 Number of Deaths 624 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 19 Death Rates—Respiratory Diseases 1.15 Tuberculosis 0.09 Cancer (all forms) 1.96 Cancer of the Lung 0.34 Zymotic Diseases 0.03 Notifications of Infectious Diseases:— Diphtheria — Dysentery 42 Erysipelas 8 Food Poisoning 6 Measles 1,048 Poliomyelitis (paralytic) 10 Poliomyelitis (non-paralytic) 6 Puerperal Pyrexia 90 Pneumonia (all forms) 106 Scarlet Fever 58 Typhoid and Para-typhoid Fever 1 Tuberculosis (new cases and including Inward Transfers) 100 Whooping Cough 205 Number of Deaths from Infectious Diseases 2 Number of Deaths from Diarrhoea (under 2 years) Nil Number of Visits made by Sanitary Inspectors 5,444 TABLE II. CAUSES OF DEATH. 1955. 1951. 1952. 1953. 1954 M. F. Total 1. Tuberculosis—Respiratory 16 10 9 5 3 3 6 2. Tuberculosis—Other 3 1 1 — — — — 3. Syphilitic diseases 1 3 1 1 — — — 4. Diphtheria — — — — — — — 5. Whooping Cough — — — — — — — 6. Meningococcal infections — — — — — — — 7. Acute Poliomyelitis — — 1 — 1 1 2 8. Measles • — — 1 — — — — 9. Other infective and parasitic diseases — 2 2 1 — — — 10. Malignant neoplasm, stomach 27 17 15 16 3 8 11 11. Malignant neoplasm, lung, bronchus 19 9 19 25 17 6 23 12. Malignant neoplasm, breast 13 10 12 14 — 15 15 13. Malignant neoplasm, uterus 7 2 3 2 — 5 5 14. Other malignant and lymphatic neoplasms 54 47 59 51 43 37 80 15. Leukaemia, Aleukaemia 4 4 6 3 4 3 7 16. Diabetes 6 5 4 — — 3 3 17. Vascular lesions of nervous system 66 66 78 72 26 48 74 18. Coronary disease, angina 89 85 108 105 63 43 106 19. Hypertension with heart disease 20 16 19 8 4 6 10 20. Other heart disease 94 91 78 53 20 40 60 21. Other circulatory disease 25 27 37 24 14 12 26 22. Influenza 10 3 11 1 1 — 1 23. Pneumonia 41 32 36 15 27 16 43 24. Bronchitis 35 35 36 26 23 8 31 25. Other diseases of respiratory system 11 10 9 3 1 4 5 26. Ulcer of stomach or duodenum 7 6 7 6 12 3 15 27. Gastritis, enteritis and diarrhoea — 1 2 1 1 1 2 28. Nephritis and nephrosis 5 5 2 9 2 6 8 29. Hyperplasia of prostate 7 4 2 5 9 — 9 30. Pregnancy, childbirth, abortion — — 2 — — — — 31. Congenital malformations 5 7 7 6 2 1 3 32. Other defined and ill-defined diseases 59 54 54 47 32 27 59 33. Motor vehicle accidents 10 4 5 8 6 — 6 34. All other accidents 14 6 3 2 6 2 8 35. Suicide 6 2 5 7 2 3 5 36. Homicide and operations of war — 1 — — 1 — 1 All causes 654 565 634 516 323 301 624 65 TABLE HI. INFANT MORTALITY, 1955. (Compiled locally from Registrar's Death Returns). CAUSES OF DEATH. Under 1 Week- 1 and under 2 Weeks. 2 and under 8 Weeks. 3 and under 4 Weeks. Total under 4 Weeks. 1 month and under 3 Months 3 months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months. Total Deaths under 1 year. Atelectasis 3 • • • • • • 3 • • • • • • • • 3 Congenital Heart Disease • • • • • • 1 1 • • • • • • • • 1 Malformation • • • • • • • • • • • • • • • • • • • • Prematurity 4 • • •• 4 •• • • • • • • 4 Respiratory Diseases 3 • • • • 3 1 • • 2 • • 6 Other Causes 5 • • • • • • 5 • • • • • • • • 5 Totals 15 • • • • 1 16 1 • • 2 •• 19 66 TABLE. IV. NOTIFIABLE INFECTIOUS DISEASES, 1955. Sex and Age Distribution. Disease. Totals. Under 1 1—2 3—4 5-9 10—14 15—24 25 and over. Age unknown M. F. M. F. M. F. M. F, M. F. M, F. . M. F. M. F. M. F. Measles 563 485 9 11 133 110 127 130 263 219 14 5 2 — 5 2 10 8 Whooping Cough 93 112 9 5 20 25 21 27 37 43 3 2 — — 1 7 2 3 Scarlet Fever 26 32 — — 1 6 9 10 14 12 1 2 1 — — 2 — — Poliomyelitis (Paralytic) 6 4 — — — — 1 1 3 — — 1 1 — 1 2 — — ,, (Non-paralytic) 4 2 — — 1 — — — 2 1 — — — 1 1 — — — Diphtheria — — — — — — — — — — — — — — — — — — 692 635 18 16 155 141 158 168 319 275 18 10 4 1 8 13 12 11 Under 5 5—14 15—24 25—44 45—64 65 and over •. Age unknown. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Acute Pneumonia 56 50 3 3 11 7 — — 17 16 14 17 8 7 3 — Dysentery 20 22 12 11 3 7 — — 4 4 — — 1 — — — Erysipelas 2 6 — — — — — — — 2 2 4 — — — — Typhoid and Para- Typhoid Fever — 1 — — — 1 — — — — — — — — — — Food Poisoning 5 1 2 — — — — — —3 1 — — — — — — Puerperal Pyrexia — 90 — — — — — 36 — 52 — — — — — 2 Tuberculosis (Pulm.) 32 25 2 — 1 — 1 12 13 7 11 4 4 2 — — Tuberculosis (Non- Pulmonary) 1 2 — — — — — — — — 1 1 — 1 — — 116 197 19 14 15 15 1 48 37 82 28 26 13 10 3 2 808 832 67 TABLE V. NOTIFIABLE INFECTIOUS DISEASES, 1955. Ward Distribution. Attack and Mortality Rates. Diseases. WARDS Cases removed to hospital. Attack rate per 1,000 population. No. of Deaths. Death rate per 1,000 population. Total Biggin Hill Chelsfield Crofton North Crofton South Cudham Downe Farnborough Goddington North Goddington South Green-Street-Green Knockholt Knoll Leaves Green Petts Wood Poverest St. Mary Cray Measles 1048 42 6 29 91 32 8 17 104 71 89 2 150 8 32 152 215 8 15.31 — — Whooping Cough 205 5 4 21 18 4 — 11 14 18 16 7 11 — 9 22 45 5 2.99 — — Scarlet Fever 58 3 — 1 13 1 1 — 4 10 6 1 1 — — 2 15 22 0.85 — — Pneumonia 106 6 — 9 17 — 1 3 11 7 6 2 15 — 6 9 14 7 1.55† — — Dysentery 42 — — — — — — 3 3 — — — 1 1 1 8 25 3 0.61 — — Erysipelas 8 — 1 — — 1 — 1 1 1 1 — — — — 2 — 4 0.12 — — Food Poisoning 6 1 — — — — — 2 — — — — 1 — 2 — — 6 0.09 — — Acute Poliomyelitis (non-paralytic) 6 — — — — — — — — — — — — — — 3 1 6 0.09 — — Acute Poliomyelitis (paralytic) 10 — 1 1 1 — — 2 — — 1 — 2 — 1 1 — 10 0.15 2 0.03 Puerperal Pyrexia 90 1 — — 3 1 — 77 1 2 — — — — 1 2 2 89 1.31* — — Typhoid Fever 1 1 — — — — — — — — — — — — — — — 1 0.01 — — Diphtheria — — — — — — — — — — — — — — — — — — — — — Tuberculosis (Non-Pulmonary) 3 — — — — — — — — — — 1 — — 1 — 1 3 0.04 — —_ Tuberculosis (Pulmonary) 57 2 — 6 8 — — 3 4 6 1 — 7 2 3 9 6 17 0.83 6 0.09 TOTALS 1640 61 12 67 151 39 10 120 142 116 120 13 188 11 56 210 324 181 23.96 8 0.12 •Based on 1,000 total births and not population, tlncludes all forms of Pneumonia 68 TABLE VI. NOTIFIABLE INFECTIOUS DISEASES, 1955. Seasonal Incidence. Disease. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total . Measles 231 135 193 174 137 127 34 9 6 — 2 — 1048 Whooping Cough 29 20 24 30 15 12 9 18 10 7 20 11 205 Scarlet Fever 2 5 9 1 8 10 1 3 2 4 9 4 58 Pneumonia 37 19 21 8 2 5 3 2 — 3 2 4 106 Dysentery 18 8 4 2 1 1 2 5 — 1 — — 42 Erysipelas — — 1 1 — 3 1 — 1 — 1 — 8 Food Poisoning — — — — 1 1 3 1 — — — — 6 Acute Anterior Poliomyelitis — 1 — — — — — 2 6 5 2 — 16 Puerperal Pyrexia 5 2 11 9 5 9 7 9 14 8 6 5 90 Paratyphoid — — — — — 1 — — — — — — 1 TOTALS .. 322 190 263 225 169 169 60 49 39 28 42 24 1580 69 TABLE VII. SUMMARY OF THE WORK OF THE SANITARY INSPECTORS. No. of Inspections. No. of premises at which defects or contraventions were found. Housing Inspection. For defects and nuisances 814 61 Verminous conditions 16 5 Water supply 178 2 Cesspools 26 3 Common Lodging Houses 12 — Drainage 746 45 (1792) (116) Infectious Diseases. Inquiry visits 356 — Disinfection 22 — (378) Food Premises. Bakehouses 67 14 Butchers 160 3 Dairies and Milkshops 56 — Fishmongers and Poulteres 42 1 Fish Fryers 13 — Food preparing or manufacturing premises 63 — Greengrocers 49 — Grocers 390 5 Ice Cream Premises 43 — Restaurants, hoters, canteens, etc. 137 8 Slaughterhouses 417 — Street Vendor Stalls, Hawkers' carts 60 — Visits in connection with sampling 189 — Re Clean Food Byelaws 30 401 — Miscellaneous (2123) (31) Factories. Factories with machanical power 73 7 Factories without mechanical power 4 — Other premises classified as factories 8 — Emission of smoke and fumes 117 l (202 (8) Trade Premises. 119 17 Shops (for Shops Act) 47 3 Paggeries 73 — Caravan sites (239) (20) 70 No. of Inspections. No. of premises at which defects or contraventions were found. Miscellaneous. Swimming Baths 25 — Suspected Food Poisoning 19 — Keeping of Animals 25 2 Noxious accumulations 15 5 Schools 3 — Public Conveniences 25 — Rivers, streams, etc 40 — (152) (7) Unclassified 558 4 (558) (4) 5444 186 71 TABLE VIII. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1955. Drainage. Drains constructed or structed 5 Water closets repaired or reconstructed 4 Drains repaired 12 W.C. seats repaired or Drains cleansed 34 newed 3 Inspection chambers repaired or renewed 1 Flushing systems repaired or renewed 6 Inspection chamber covers Provided 1 Cesspools emptied 5 Cesspools abolished and connections made to sewer 82 Dampness. Roofs made wateright 16 Rainwater gutters repaired or renewed 5 Walls made waterproof 10 Damp-proof course provided 3 Flashings repaired or renewed 2 Damp-proof course renewed or repaired 3 Chimney stacks made waterproof 2 Water Supply. Supply provided 12 Ball valves repaired or renewed 2 Pipes Paired or renewed 12 Storage tanks repaired or re- newed 8 Taps repaired or renewed ... 2 Water wastage remedied 2 General Items. Wall Plaster repaired 2 Fire surrounds and grates repaired or renewed 6 Ceiling plaster repaired 2 Floors repaired 18 Dustbins provided 7 Windows and doors repaired 17 Nuisances from animals abated 3 Glazing repaired 1 Noxious accumulations removed 12 Ventilation improved 1 Yard paving and drainage re- paired 1 Noise nuisance abated 1