ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S ( Annual Report on the HEALTH OF THE URBAN DISTRICT 1957 H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE URBAN DISTRICT I9S7 H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health 3 CONTENTS Page Members of the Urban District Council 5 Staff 5 Prefatory Letter 6 Section A. Vital and Other Statistics and Social Conditions of the Area. Vital Statistics 10 Population 11 Births 12 Deaths 12 Morbidity Statistics 13 Medical Examinations 13 Unemployment 14 Open Air Recreational Amenities 14 Section B. General Provision of Health Services for the Area. Ambulance Service 20 British Red Cross Society—Medical Loan Depot 23 Day Nurseries 20 Diseases of Animals Acts 20 Disinfection 18 Domestic Help Service 20 Domiciliary Midwifery 20 Health Visiting 21 Home Nursing Service 21 Hospitals 20 Laboratory Service 19 Local Clinic Services 23 National Assistance Act, 1948 19 Nursing Homes 19 Old People's Welfare Committee 22 Public Mortuary 19 Women's Voluntary Services 22 Section C. Sanitary and Environmental Circumstances of the Area Agriculture (Safety, Health and Welfare Provisions) Act, 1956 26 Atmospheric Pollution 29 Cesspools 26 Complaints 27 Drainage and Sewerage 27 Factories Acts, 1937 and 1948 27 Heating Appliances (Fireguards) Act, 1952 28 Pet Animals Act, 1951 28 Prevention of Damage by Pests Act, 1949 28 Rag Flock and Other Filling Materials Act, 1951 29 Rivers, Streams and Lakes 29 Sanitary Inspection of the Area 29 Shops Act, 1950 29 Swimming Baths and Pools 31 Verminous Conditions and Uncleanliness 31 Water Supply 31 4 Page Section D. Housing. Clearance Areas 36 Rent Act, 1957 36 Housing Statistics 37 Moveable Dwellings 37 Re-Housing 38 Section E. Inspection and Supervision of Foods. Bakehouses 48 Butchers' Shops 48 Food Complaints 44 Food Hygiene Regulations, 1955 44 Food Premises 45 Food and Drugs Act, 1955—Food Sampling 40 Food and Drugs Act, 1955—Section 16 46 Game Act, 1831 48 General 40 Ice Cream 45 Meat Inspection 47 Merchandise Marks Act 48 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 Poliomyelitis Vaccination 50 Diphtheria and Immunisation 51 Dysentery 51 Food Poisoning 51 General Remarks 50 Measles 52 Other Infectious Diseases 55 Pneumonia 52 Smallpox and Vaccination 52 Tuberculosis, Chest Clinic and Mass X-ray 53 T.B. Care Committee 54 Typhoid and Para-Typhoid Fever 54 Whooping Cough 55 Section G. Refuse Collection and Disposal. Refuse Collection and Disposal 58 APPENDIX—STATISTICAL TABLES. 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 Public Health Inspectors 69 VIII. Nuisances, Defects and Contraventions abated 70 5 MEMBERS OF THE URBAN DISTRICT COUNCIL as at 31st December, 1957. *Chairman of the Council: Councillor B. D. WOODMANSEE, J.P. * Vice-Chairman oj the Council : Councillor C. H. E. PRATT. Councillors R. W. AYLIFFE, F.R.I.C.S. *W. D. KNIGHT. W. W. BALDING *F. W. LANE ^ Mrs. J. G. BANKS (Vice-Chairman E. LLOYD-WARD, M.C. of Public Health Committee) T. S. MILLO-PATTLE *H. L. BLAKE *Mrs. C. M. MEDLYCOTT L. J. BOWKER Lt.-Col. T. H. NEWEY, E.D., C.C. H. T. COX J. F. NUNN J. DAVIES, C.C. G. G. ROMAIN L. E. B. DUNKERLEY, M.A., C. S. SAFFERY (Cantab.) *G. A. SMITH (Chairman *W. FRANK, F.I.C.S. of Public Health Committee) *A. E. FULLER M. J. A. STEVENS, A.I.B. *Mrs. F. G. GARDNER L. G. SIGGS, M.I.O.B., F.I.B.E. *J. W. HARRADINE J. E. SUTTY *E. A. P. HART W. C. SWEATMAN, J.P. W. D. HAYNE, T.D. Mrs. J. V. WEBB F. S. HOCKEY *S. W. WELLS (* denotes members of the Public Health Committee.) STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1957. 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 Chislehurst and Sidcup Urban District.) 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 Chislehurst and Sidcup Urban District.) Chief Public Health Inspector and Cleansing Superintendent F. C. CROWE, M.R.S.H., M.A.P.H.I. Deputy Chief Public Health Inspector and Deputy Cleansing Superintendent W. T. WEEDY, C.R.S.H., M.A.P.H.I. District Public Health Inspectors K. AUTY, C.R.S.H., M.A.P.H.I C. W. BEDDIS, M.A.P.H.I. (Resigned 31.5.57) (Resigned 31.7.57) A. E. ROBINSON, C.R.S.H., M.A.P.H.I. (Commenced 1.8.57) K. J. COPPIN, C.R.S.H., M.A.P.H.I. (Commenced 1.8.57) T. E. W. OSBORNE, C.R.S.H., R.I.P.H. Note.—All Public Health Inspectors are Inspectors under the Food and Drugs Acts, Shops Act, Rag Flock and Other Filling Materials Act, Pet Animals Act, Heating Appliances (Fireguards) Act, and the Agriculture (Safety, Health and Welfare Provisions) Act, 1956. Clerical Staff Secretary : Miss C. COOPER. Shorthand Typist : Miss G. SMITH. Clerk : Mrs. S. KNIGHT. Outdoor Staff Disinfector : J. J. HUGHES. Rodent Operative : W. S. MILLS. Assistant Rodent Operative : C. V. POTTER. General Foreman (Refuse) : F. HONESS. 6 To the Chairman and Members of the Orpington Urban District Council. Mr. Chairman, Ladies and Gentlemen, The main body of this report, must in the nature of things, consist primarily of hard facts, which of themselves may be of interest to the technically minded, but which undoubtedly provide heavy and uninspired reading matter for the great majority of those likely to study them. It therefore seems desirable that the introductory letter should highlight a few of the outstanding happenings of the year and present them in a form which one hopes, will not be too humdrum and uninteresting. One of the human race's greatest attributes is its ability to forget the less pleasant features of life and it is an undoubted fact that if on any one day a particular individual were asked what his main worry of the previous day was, the chances are heavily in favour of him being quite unable to give the answer, at least without a great deal of thought. However, despite this remark, I imagine that everybody will remember the influenza outbreak which occurred during the later part of last year, and caused so much anxiety at the time, although looked at in retrospect most people would agree " it might have been much worse." Such widespread publicity is given these days to any outbreak of illness that one wonders whether the psychological reaction on those unaffected can be anything but damaging to morale. When proved preventive measures are available to all, it is of course desirable to use all possible methods of disseminating the appropriate information, but when as in the case of influenza, measures for its control are still so much in their infancy, I personally have grave doubts of the wisdom of high powered publicity. Of course the real crux of the matter lies in the fact that bad health is news, while good health is not; this in itself is just as it should be and our aim for the future must be to do away with all news of bad health. The influenza epidemic as such started in September, reached its peak in the week ending 15th October, and thereafter declined more or less rapidly although the sickness rate remained well above average for the rest of the year. This outbreak which originated in the East, spread across the world with some speed and was caused by a mutation of a previously known virus. Fortunately it can be said as a generalisation, that the resultant disease was mild in character and tended to affect predominantly the younger members of the community, who of course were better equipped to withstand its assault, but the problems of its control remained more or less unsolved. Even should a vaccine with one hundred 7 per cent efficiency be produced, there are difficulties of preparation, distribution and injection of virtually the whole population of the country, and getting it immune before the epidemic strikes. In this connection it must be remembered that before a vaccine can be produced, the responsible organism has to be known, and that full immunity could not be attained until some weeks after the first of two spaced injections had been given. It will thus be obvious that there are still many serious obstacles to be overcome before we can hope to control effectively these periodic invasions of the influenza viruses. Whilst on the subject of immunisation procedures, it is gratifying to find that the County Medical Officer is able to report that 3,161 Orpington children were vaccinated against anterior poliomyelitis during the year, a figure which it is anticipated will be exceeded greatly during 1958. As the programme gathers momentum, it is sincerely to be hoped that its beneficial effects will make themselves obvious by a greatly reduced incidence of the disease, although we were fortunate in Orpington in only having seven cases notified during the course of the year. Encouraging facts to which attention should be drawn include the birth and death rates, the former of which is well in excess of that of the country as a whole, and the latter of which is well below the corresponding national figure. The infant mortality rate is also very favourable judged by the same standard, and the steady rise in population noted over past years has been maintained. With the exception of measles, infectious disease was not a prominent feature in Orpington during the year, but numbers of notifications can be very deceptive and the really important feature is whether these illnesses are or are not serious when they strike their victims. It it therefore a matter for thankfulness that most of the infections have been, with the occasional exception, of low virulence, but have nevertheless one hopes, given most of the sufferers life-long immunity to further attacks. There are two matters affecting health which although they are not confined to this local authority's area, cannot go unnoticed. I refer to the problems of cancer of the lung, and accidents in the home. In the case of the former, evidence has been accumulating of a probable association between this condition and tobacco smoking, and at the risk of being repetitive, I would once again warn my readers of this fact. In the case of home accidents, which we are now told exceed even casualties occurring on the roads, a peculiarly tragic state of affairs appears to have arisen. The very existence of the word " homesick " suggests that our homes are a haven and refuge from the more unpleasant buffets of the outside world, but if we have indeed reached the state where an accident in the home is more likely than in the streets, it behoves each and 8 everyone of us to take serious note of all those little things which we all know are potential dangers in the house, and take appropriate preventive measures before it is too late. This warning applies particularly where children or elderly persons are resident, for they are the groups most susceptible to accidents caused by slight deviations from the safest possible domestic arrangements. The time has now come to thank Mr. Crowe, the Chief Public Health Inspector for his customary application to duty, also the district inspectors and clerical staff, all of whom have worked so well together as a team. During the course of the year we said a regretful goodbye to Messrs. Auty and Beddis, two of the inspectors, and welcomed in their places Messrs. Coppin and Robinson. My professional colleagues, including Dr. Kelynack, my deputy, and various local bodies both statutory and voluntary have all been most helpful for which I am truly grateful. As usual my final words of thanks must be to the Chairman and Members of the Public Health Committee who have taken a continuing keen interest in the work of the department and shown a sympathetic understanding of the difficulties sometimes experienced by those whose task it is to implement Committee decisions. I am. Your obedient Servant, H. B. C. CARTER-LOCKE, Medical Officer of Health SECTION A VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA 10 SECTION A VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area. The area of the Urban District is 20,842 acres. Parks, Open Spaces, Recreation Grounds, etc., comprise 283.6 acres. Population. The Registrar General's estimate of total population, mid-year 1957, was 72,170. Rateable Value. Rateable value at 1st April, 1957 £1,112,228 Estimated net product of a penny rate, 1957/58 £4,550 Total number of valuation assessments at 31st March, 1957 22,898 Mileage of Roads as at 1st April, 1957. County Roads, Class I, II, III 41.35 miles District Roads 86.91 miles Unadopted Roads 25.9 miles Total 154.16 miles Live Births. Male. Female. Total. Legitimate 669 616 1,285 Illegitimate 8 9 17 677 625 1,302 Crude birth rate, per 1,000 total population 18.0 Adjusted birth rate for purposes of comparison with other areas 17.8 (Area comparability factor for births is 0.99.) Birth rate for England and Wales 16.1 Stillbirths. Male. Female. Total. Legitimate 9 4 13 Illegitimate — — — 9 4 13 Stillbirth rate 0.18 per 1,000 total population, and 9.9 per 1,000 (live and still) births. Deaths. Male. Female. Total. 333 295 628 Crude death rate 8.7 per 1,000 total population. Adjusted death rate for purposes of comparison with other areas 9.7. (Area comparability factor for deaths is 1.12.) Death rate for England and Wales 11.5. 11 Maternal Deaths. Deaths from Puerperal sepsis 1 Deaths from other causes Nil Maternal mortality rate 0.76 per 1,000 (live and still) births. Deaths of Infants under 1 year of age. Male. Female. Total. Legitimate 12 13 25 Illegitimate — — — 12 13 25 Infant mortality rate 19.2 per 1,000 live births. Legitimate infants per 1,000 legitimate live births 19.5. Illegitimate infants per 1,000 illegitimate live births Nil. Male infants per 1,000 male live births 17.7. Female infants per 1,000 female live births 20.8. Neonatal deaths (under 4 weeks of age) per 1,000 live births 15.4. Infant mortality rate for England and Wales 23.0. Vital Statistics of the Urban District for the Past Ten Years. Year Population No. of Births (live) No. of Deaths No. of Infant Deaths No. of Maternal Deaths Birth Rate Death Rate Infant Mortality Rate Maternal Mortality Rate 1948 58,320 954 493 19 1 16.3 8.4 19.9 10 1949 59,500 975 636 21 1 16.5 10.7 21.5 101 1950 62,420 925 661 23 1 14.8 10.6 24.9 M 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 21 1954 66,380 1,047 516 15 Nil 15.8 7.8 14.3 Nil 1955 68,450 1,083 624 19 Nil 15.8 91 17.5 Nil 1956 70,410 1,219 648 25 Nil 17.3 9.2 20.5 Nil 1957 72,170 1,302 628 25 1 180 8.7 19.2 0.76 STATISTICS FOR ENGLAND AND WALES, 1957. Birth rate (per 1,000 total population) 16.1 Death rate (per 1,000 total population) 11.5 Infant mortality rate (per 1,000 live births) 23.0 Population. The Registrar General's estimate of the total population of the Urban District, mid.year, 1957, was 72,170 which is an increase of 1,760 over the figure for the previous year. This figure gives a density of 3.5 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 674. 12 Births. One thousand, three hundred and two live births were registered during the year, as against one thousand, two hundred and nineteen during 1956. The birth rate for the year is 18-0 per 1,000 total population. The adjusted rate, for comparison with other areas, is 17*8. The adjusted rate is *7 higher than that for 1956, and is well above that for England and Wales as a whole. Of the births registered, 677 were males and 625 females. Thirteen stillbirths occurred in the area, 9 males and 4 females. This gives a stillbirth rate of 9.9 per 1,000 live and still births, and is a considerable decrease from the figure of 161 for the previous year. Deaths. Six hundred and twenty-eight deaths belonging to the Urban District were registered during the year. Of this number 333 were males and 295 females, giving a crude death rate of 8-7 per 1,000 total population. The area comparability factor for deaths is 112 therefore the adjusted rate is 9*7 per 1,000 total population, and this compares favourably with the rate of 11*5 for England and Wales. The following is an analysis of the ages at death :— Under 1 year of age 25 1 and under 5 years of age 5 5 and under 15 years of age 3 15 and under 25 years of age 8 25 and under 35 years of age 3 35 and under 45 years of age 17 45 and under 55 years of age 55 55 and under 65 years of age 90 65 and under 75 years of age 156 75 years and over 266 628 Full details of the causes of death will be found in Table II in the appendix, but the following special causes of death during the past six years may be of interest:— Disease. Year. 1952 1953 1954 1955 1956 1957 Cancer (all sites) 85 108 108 134 131 131 Cancer of the Lung, Bronchus 9 19 25 23 34 33 Heart and Circulatory Diseases 293 285 320 262 264 284 Respiratory Diseases (excluding Tuberculosis) 77 81 44 79 135 .88 Tuberculosis 11 10 5 6 7 4 Infectious Diseases 2 4 1 2 1 1 Influenza 3 11 1 1 2 4 Road Accidents 4 5 8 6 6 5 Other Accidents 6 3 2 8 10 8 13 Analysis of these figures shows one especially satisfying feature, and that is a significant fall in the number of deaths attributable to non-tuberculous respiratory diseases, and this must be considered particularly gratifying in a year in which influenza was so prevalent. It is also worth noting that deaths from tuberculosis reached the very low figure of four, and while this disease still exists in our community, the number of deaths it causes is unlikely to be reduced below its present figure. The remaining figures quoted above show no marked changes from the previous year, and therefore do not appear to call for special comment. Morbidity Statistics. The following is a summary of the weekly details received from the Ministry of National Insurance during 1957 :— Four weeks ending. Number of Certificates of Incapacity. First. Intermediate. Final. 22nd January 795 2,631 672 19th February 697 2,605 605 19th March 759 2,789 665 16th April 601 2,697 587 14th May 510 2,192 463 11th June 486 2,184 486 9th July 441 2,505 427 6th August 376 2,377 385 3rd September 467 2,395 417 1st October 734 2,387 519 30th October 2,380 3,147 1,828 26th November 1,082 2,972 1,271 31st December (5 weeks) 1,356 3,125 1,119 These figures in an average year, follow the same pattern, that is their peak occurs in January and February followed by a gradual fall, reaching rock bottom in August and followed thereafter by a steady climb during the rest of the year. However, during the year under review, the incidence of sickness reached a very high peak during October, the month in which the influenza epidemic was at its height, and although considerably reduced in the remaining two months of the year, still continued at a level considerably above normal. Medical Examinations. One hundred and eleven examinations of members or potential members of the staff were carried out during the year. 14 Unemployment. I am indebted to the Manager of the Orpington Employment Exchange for the following information with regard to unemployment in the area during 1957 :— "Early January found us with a substantial increase in the men's register due mainly to seasonal slackness in the Building and Decorating trades, and the general after-Christmas lull in the retail trades, this position persisted throughout the quarter, but in April business began to improve both outdoors and in the Factories and this improvement continued until July when we reached our lowest figures for the year for both men and women. The midsummer figures however were still well above those of 1956 due to a steadying down of industrial labour requirements attributed to economic causes. The third quarter of the year saw the beginning of steadily increasing registers of men and women, a condition which had not been experienced in recent years, and due probably to the continuing financial restrictions familiarly known as the " credit squeeze." This increase became stabilised during the closing months of the year, tempered partially and temporarily by the seasonal call of Christmas markets. To sum up the year, the level of unemployment has remained generally low, but with smaller differences due to trade fluctuations than in recent years." Open Air Recreational Amenities. Approximately 283*6 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 0.50 Cudham Village Cudham 10.39 Cudham Lane Green-Street-Green 6.5 Downe Downe 3.0 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 15 Public Gardens. Broxbourne Gardens Knoll 0.82 Riverside Gardens St. Mary Cray 10.3 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 Gumping Common Crofton South 4.25 Sparrow Common Petts Wood 0.50 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. 18 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH SERVICES RENDERED BY THE COUNCIL. 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 Abatement 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. Disinfection. The disinfecting station is situate at the Council Offices and details of the work carried out during 1957 are as under :— Disinfections— Premises visited 49 Rooms disinfected 54 Articles disinfected 784 Disinfestations— Premises visited 12 Rooms disinfested 34 Articles disinfested 58 Articles Articles treated. destroyed. Beds 77 — Mattresses 75 2 Sleeping Bags — — Bolsters 65 — Pillows 111 4 Cushions 25 — Blankets 127 — Bed Clothes (batches) 66 — Carpets 76 — Hangings 151 — Clothing (batches) 66 — Library Books 3 — Easy Chair — 1 842 7 19 In the case of disinfection, 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 five per cent D.D.T. Laboratory Service. Routine medical and Food and Drugs samples are forwarded to the Public Health Laboratory at Maidstone, and the following is a summary of the work carried out on behalf of the Council during 1957 :— Faces 8 Food Samples, etc. 226 Rag Flock Samples — Throat and Nose Swabs — Water Samples 50 Miscellaneous 1 Fertilizer Samples 11 296 NATIONAL ASSISTANCE ACT, 1948. Section 47. 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 of any of the persons concerned. Section 50. Under this section of the Act, a duty is placed on the local authority to arrange for the burial or cremation of the body of any person who has died or been found dead in their area, if it appears that no suitable arrangements for the disposal of the body have or are being made. During the year 2 bodies were dealt with by the Council under this section of the Act. Nursing Homes. 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. 20 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 are 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 and their offices are at Orpington Hospital. (d) Venereal Diseases.—Patients are referred to the various hospitals with specialist clinics for dealing with these diseases. SERVICES RENDERED BY THE KENT COUNTY COUNCIL. Ambulance Service. This service is operated from the depot at 12, Hayes Lane, Bromley, and 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 Bexley who carries out the functions of this service. Domiciliary Midwifery. Four full-time midwives and 2 part-time midwives are employed in the Urban District, together with 4 Home Nurse Midwives, The services of a midwife may be obtained on direct application or through the patient's private doctor. Domestic Help Service. The District Organiser's office is at 102a, High Street, Orpington. 21 The following is a summary of the cases assisted during 1957:— Maternity (Expectant Mothers) 162 Tuberculosis 6 Aged 239 Others 198 Total 605 Family Help Service. This service is provided to deal with the care of children in their own homes when they are temporarily deprived of the care of their mother or a female guardian. Nineteen cases were assisted during the year. Night Attendant Service. This service is for old people in their own homes, and arrangements include evening service and preparation for sleep, preparation of meals, attention to fires and night service. Sixteen cases received assistance in 1957. Home Nursing Service. There are 6 Home Nurses and 4 Home Nurse Midwives employed in the area. No night service is provided. The services of a home nurse may be obtained on medical certification. Health Visiting. Eight Health Visitors/School Nurses, one full time School Nurse, and one Tuberculosis Health Visitor are employed in the area. Health Visitors in addition to their school work, are responsible for maternity and child welfare centres, immunisation and vaccination clinics, home visiting, after-care, mental health visiting, etc., and give advice on the care of young children, and advice to expectant and nursing mothers. Women's Welfare Clinics. Details will be found under the heading " Local Clinic Services." All patients are seen by appointment and must be referred on medical grounds. SERVICES RENDERED BY VOLUNTARY AGENCIES. The St. John Ambulance Brigade. Over 60's Clubs. The invaluable work carried out by these voluntary agencies continued during the year. 22 Women's Voluntary Service. The County Organiser has kindly furnished the following information :— " Meals on Wheels." " This service continues to meet a very real need in the district and 552 meals are served each month. The mileage covered each week is 75. The cost of the meal still remains at a 1/- but W.V.S. do not at present, have to pay for gas, or the cleaning of the kitchen. A free dinner of Turkey and Christmas Pudding was sent out over Christmas. The meals are delivered in Orpington, Petts Wood, Chelsfield, St. Mary Cray, Cudham, Knockholt and Farnborough, three days a week. The drivers and mates take a personal interest in the old people, and twice this year an old person's life has been saved by our W.V.S. member calling just in time with a meal—one from being badly burnt, and the other from gas poisoning. General Welfare Work. Members visit lonely old people, do shopping for them, etc. A considerable amount of escort work by car has been done this year, taking old people to visit relatives in hospitals, and—at the request of the Almoners—taking them for treatment or to Convalescent Homes, when an ambulance is not warranted. In all, during the year, 126 escorts by car with old people—the cost of petrol only is charged. Darby and Joan Clubs. Orpington run two Darby and Joan Clubs, one at Farnborough and the other at St. Mary Cray, and the membership of each is just over the fifty mark." Orpington and District Old People's Welfare Committee. The Honorary Secretary has kindly furnished the following report:— " The Orpington and District Old People's Welfare Committee maintained its usual activities throughout the year. In addition to providing a means of liaison between the numerous Old People's Clubs in the district, the Committee, through its visiting representatives, relieves many cases of genuine distress among the aged poor, from funds generously placed at its disposal. Close working arrangements were established, through the good offices of the County Medical Officer of Health, with the Health Visitors of the district, two of whom have accepted permanent membership of the Committee." 23 British Red Cross Society—Medical Loan Depot. One medical loan depot is in operation in the area, 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. The address of this depot is 1, Birchwood Road, Petts Wood, and it is open by appointment. Application should be made to Mrs. Jones of that address—telephone number Orpington 22083. LOCAL CLINIC SERVICES. Child Welfare Centres. Chelsfield Village Hall 1st, 3rd & 5th Tuesday in month—afternoon. Cudham & Biggin Hill Sports Pavilion, Biggin Thursday—afternoon. Hil/ Downe Post Office Cafe 1st & 3rd Friday in month —afternoon. Farnborough Methodist Hall Friday--afternoon. Green-Street-Green Baptist School Room Friday—afternoon. Knockholt The Institute 2nd & 4th Tuesday in month—afternoon. Orpington Methodist Church Hall Monday, Tuesday & Friday—afternoon. Crofton St. Paul's Church Hall Monday—afternoon. Petts Wood G.E.A. Hall, Woodhurst Monday & Thursday— Avenue afternoon. St. Mary Cray Temple Congregational Tuesday & Wednesday Church Hall —afternoon. Pratts Bottom Village Hall 2nd & 4th Thursday in month—afternoon. Poverest Coronation Hall, Bridge Each Thursday afternoon. Road, St. Mary Cray Ante-Natal Clinics. Cudham & Biggin Hill Sports Pavilion, Biggin 1st, 3rd & 5th Wednesday Hill in month—morning. Relaxation, Mothercraft & Post Natal—2nd & 4th Wednesday morning in each month. Green-Street-Green Baptist School Room Friday —morning. (Also Relaxation Class.) Orpington Methodist Church Hall Tuesday & Friday— morning. Petts Wood G.E.A. Hall, Woodhurst Tuesday—afternoon. Avenue 1-2.30 p.m. Wednesday, Relaxation Class. St. Mary Cray Temple Congregational Friday—afternoon. Church Hall 24 Women's Welfare Clinics. Green-Street-Green Baptist School Room 4th Thursday—morning. Minor Ailment Clinics (Schools). The School House, Orpington Every Saturday—morning. Chislehurst Road Dental Clinics. The School House, Orpington Monday, Tuesday, Chislehurst Road day & Friday—all day. Saturday—morning. Dental Clinics are also held in the country areas—Farnborough, Cudham, Westerham, Biggin Hill, Downe, Green-StreetGreen, Knockholt, etc. Immunisation and Vaccination. This is carried out at the Child Welfare Centres as listed above, and, by special appointment at Chislehurst Road School, Orpington, on Tuesday afternoons. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. 26 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. Agriculture (Safety, Health and Welfare Provisions) Act, 1956. No contraventions were found during the course of the year. Cesspools. As a result of a policy, first of persuasion and then of enforcement under the Council's private Act, 427 cesspools have been abolished and the premises drained to a sewer in the nine year period ended 31st December, 1957. At this date there were approximately 132 cesspools remaining where the sewer is available and representation had been already made to the owners in many of these cases. As enforcement under the Council's Act is resorted to in cases only where the owner shows no disposition whatever to deal with the conversion, progress is somewhat slow. Many owners, after acknowledging the necessity for the suggested improvement and indicating a willingness to do something about it, need constantly reminding before the work is actually completed. It is pleasing to report, however, that in spite of the considerable cost in many cases, there has been very little real resentment shown by owners who, generally speaking, accept the inevitability of the improvement with good grace. On the question of cost it should also be recorded that many owners have expressed their appreciation of the Council's loan scheme which enables the cost to be spread over a number of years. Number of cesspools at 31st December, 1957. (1) on line of sewer 132 (2) not on line of sewer 2,376 2,508 Number of cesspools abolished and main drainage provided during the year 24 Number of houses with pail closets converted to cesspool drainage — Number of new houses erected with cesspool drainage 23 Number of loads removed from cesspools:— On private properties 4,513 On requisitioned properties 156 On Council properties 570 — 5,239 27 Complaints. During the year, 114 complaints were received from residents and in only two cases was it necessary to take formal action to secure abatement of the nuisance. 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:— Private Estate Development— 877 lineal yards of 9" Foul Water Sewer. 863 lineal yards of 6" Foul Water Sewer. 504 lineal yards of 6" Surface Water Sewer. 227 lineal yards of 9" Surface Water Sewer. 116 lineal yards of 12" Surface Water Sewer. Council Estate Development— 786 lineal yards of 18" Foul Water Sewer. 340 lineal yards of 15" Foul Water Sewer. Factories Acts 1937 and 1948. There are 146 factories on the Council's register at the present time. Forty visits of inspection were made by the Public Health Inspectors during the year. Five defects or contraventions were found and three abated. The following is a copy of the return relating to the year 1957 which has been supplied to the Minister of Labour and National Service:— 1. Inspection for purposes of provisions as to health: Premises No. on Register Number of Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4 & 6 are to be enforced by the Local Authorities 14 4 – – (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 116 31 2 – (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 16* 5 – – Total 146 40 2 – * Building sites on Estate development. 28 2. Cases in which defects were found. Number of cases in which defects were Referred Number of cases in which prosecutions were Instituted Found Remedied to H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 1 – – 1 – Overcrowding (S.2) – – – – – Unreasonable temperature (S.3) – – – – – Inadequate ventilation (S.4) – – – – – Ineffective drainage of floors (S.6) – – – – – Sanitary Conveniences (S.7): – – – – – (a) Insufficient 1 1 – – – (b) Unsuitable or defective 1 1 – 1 – (c) Not separate for sexes 1 1 – 1 – Other offences against the Act (not including offences relating to Outwork) 1 – – 1 – Total 5 3 – 4 — Outworkers. Twenty-five 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 No: of outworkers employed. Clothing 80 Leather Goods 1 Surgical Appliances 2 Cardboard Boxes and Carton Making 12 95 Heating Appliances (Fireguards) Act, 1952. No contraventions were found during the course of the year. Pet Animals Act, 1951. Licences in respect of five premises were granted or renewed during 1957, and 27 visits were made by the Public Health Inspectors. No nuisances or defects were found. The pets sold from these shops consist mainly of birds, fish 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. 29  Total number of inspections. Number of Infestations cleared. Local Authority's property 27 5 Dwelling-houses (including Council houses; 1 5,514 499 Business premises 226 38 In addition the Council's sewers were test-baited in the year to ascertain the areas of infestation and this was followed up by treatment with poison bait in February and September. Rag Flock and Other Filling Materials Act, 1951. This Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined, or for purposes connected therewith. No contraventions were found under this Act during 1957. Rivers, Streams and Lakes. Since 1950, the Kent Rivers Board have been responsible for the supervision of the two rivers in this area, i.e. the Cray and the Kydbrook. Sanitary Inspection of the Area. Total number of Inspections and visits No of premises at which defects or contraventions were found Housing 2,080 115 Infectious Diseases 121 — Food Premises 1,940 60 Factories, Outworkers, etc, 159 4 Trade Premises (various) 238 24 Miscellaneous 111 15 4,649 218 Shops Act, 1950. During the year one hundred and twenty-three inspections of shops were made and the following contraventions were found, and remedied by the shopkeepers : Neglect in displaying Statutory Forms 18 Inadequate Sanitary Accommodation 5 Inadequate Washing Facilities 1 Atmospheric Pollution. The Clean Air Act 1956 (Appointed Day) Order 1956 brought into operation on the 31st December, 1956, certain provisions of the Clean Air Act, 1956. These provisions include those relating to prior approval of new furnaces and smoke control areas. The 30 Ministry of Housing and Local Government Circular 64/56 advised Local Authorities that the Minister intended at a later date to make an Order fixing a date in the early part of 1958 as the appointed day for the remaining provisions of the Act. A conference was held under the auspices of the Thames-Side Joint Committee for the Abatement of Atmospheric Pollution at which sixteen Councils were represented by their officers when the matter was fully discussed and it was agreed that each Authority proceed on its own with such consultation with neighbouring Authorities as they deemed necessary. A report was submitted to the Public Health Committee and as a result the Town Planning Committee recommended to the Council the implementation of the provisions of the Clean Air Act amending Series 4 of the Building Bye-Laws so as to require the provision in new buildings of such arrangements for heating or cooking as are calculated to prevent so far as practicable the emission of smoke. The district, which is well provided with parks and recreation grounds and has many open spaces, is not subject to heavy smoke pollution, and this applies particularly to the southern part of the area which is rural in character. There are many light industries in the northern part of the district, mainly in a small area at St. Mary Cray, and these industrial premises have been under frequent observation by the Public Health Inspectors during the year. There are two sites in the district at which instruments are sited. At the Police Station, St. Mary Cray, there is a deposit gauge for the measurement of solid matter suspended in the atmosphere and at Barn Hawe, Orpington, there is a Lead Peroxide cylinder, by means of which the average concentration of sulphur dioxide within the district is determined. These instruments are maintained in co-operation with the Fuel Research Station at Greenwich (acting under the Department of Scientific and Industrial Research), and at monthly intervals samples are analysed by the Council's Analyst and forwarded to them. Many districts throughout the country are undertaking this work and the information is most valuable to the Department of Scientific and Industrial Research for research purposes. The Council is represented by the Chairman of the Public Health Committee and the Chief Public Health Inspector on the London and Home Counties Smoke Abatement Advisory Council, The National Smoke Abatement Society and the Standing Conference of Local Authorities which co-operate with the Department of Scientific and Industrial Research. 31 Swimming Baths and Pools. Four visits of inspection were made by the Public Health Inspectors to the one swimming bath in the district to which the public are admitted. Verminous Conditions and Uncleanliness. No cases of unclean premises were found during the year, but twelve of verminous premises were dealt with by the Department's disinfector. Water Supply. The urban district has a large agricultural area in the south and of a total of approximately 24,000 dwellings, only 37 premises are situated where a main piped water supply is not available. The source of water supply to these 37 premises is derived from rainwater collected from roofs and stored in underground tanks constructed of brick and concrete. 50 owners have not connected their premises to the water main although it is available in the roads fronting their premises. Some of these are a considerable distance from the road, but there are 13 within 80 feet of the main. During the year it was necessary to serve one Statutory Notice. The total of 87 premises still dependent upon underground tank or well supply is made up as follows — Ward. Number of premises with Stored Rainwater. . Biggin Hill 63 – Cudham 12 – Knockholt 1 – Chelsfield 3 – Green-Street-Green 2 – Downe 2 – Farnborough 1 1 Poverest – 2 84 3 32 The Metropolitan Water Board supplies the mains water for the whole of the district. The Public Health Department obtain samples of this water at monthly intervals from various dwelling houses throughout the district. 46 samples were taken and the Analyst's reports show that they were all satisfactory. The Metropolitan Water Board obtained many samples, both before chlorination and as the water passed into supply after chlorination, and details regarding these can be seen in the table following. The Director of Water Examination, Metropolitan Water Board, has kindly reported on the water supply to the Urban District during the year 1957:— "The supply to the district of Orpington during 1957 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 Thames-derived filtered water supplied to your area. North Orpington new borehole was not in service during 1957. 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 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 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 1957, including analyses of water before treatment." 33 Result of the Bacteriological Examination of the Water Supplied to Orpington during the Year 1957. Parts per million (unless otherwise stated) BACTERIOLOGICAL RESULTS No. of Samples Before Chlorination After Chlorination (Water Passing into Supply) Plate Count (Average per ml.) Colonies counted on agar Coliform Test Percentage samples negative in 100 ml. No. of Samples Plate Count (Average per ml.) Colonies counted on agar Coliform Test Percentage samples negative in 100 ml. Coliform E. Coli Coliform E. Coli 37°C. (20-24 hrs.) 22°C. (3 days) 37°C. (20-24 hrs.) 22°C. (3 days) Orpington Wells 251 0.04 102.0 94.82 99.0 256 0.03 16.0 100.0 1000 N. Orpington Wells 215 1.2 53.4 3.26 26.51 221 0.7 21.2 99.10 1000 Jewels Wood Well 98 0.04 3.3 97.96 100.0 101 0.1 72.2 100.0 1000 Sundridge Well 265 110.2 101.5 98.49 100.0 256 0.1 30.5 100.0 1000 Westerham Well 249 0.1 3.0 9960 100.0 255 0.1 12.5 96.47 1000 Lullingstone Well 237 0.04 14.0 98.73 99.58 242 0.02 7.7 97.93 100.0 Eynsford Bore 121 0.02 81.0 99.17 99.17 124 0.04 1.2 100.0 1000 Eynsford Wells 231 0.03 15.0 97.40 99.57 234 0.02 11.3 97.44 100.0 Shortlands No. 1 161 0.04 4.9 100.0 100.0 256 0.2 3.6 100.0 100.0 Shortlands No. 2 92 0.1 2.2 100.0 100.0 256 0.2 3.6 100.0 100.0 Horton Kirby Well 241 0.1 27.7 96.27 98.76 246 0.2 27.0 99.59 100.0 Thames derived – – – – – 3,438 6.4 – 99.33 99.91 34 Average Results of the Chemical Examination of the Water supplied to Orpington during the Year 1957. Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Ammonia Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as Cl Oxygen abs. from Permanganate 4 hrs. at 27°C. Turbidity in terms of Silica Nitrite Nitrate Orpington well 5 0 002 0.018 — 5.8 15 0.08 Nil N. Orpington well 4 0 002 0.019 — 4.4 13 0.08 Nil Jewels Wood well 5 0. 005 0.018 — 2.7 12 0.06 Nil Sundridge No. 2 well 4 0.001 0.021 — 2.5 18 0.07 Nil Westerham well 4 Nil 0.014 — 4.3 16 0.10 Nil Lullingstone wel 4 Nil 0.015 — 2.7 17 0.05 Nil Eynsford bore 4 0.001 0.019 — 3.3 16 0.06 Nil Eynsford well 4 0.001 0.020 — 3.2 16 0.10 0.2 Shortlands No. 1 3 0.005 0.026 — 4.3 17 0.03 Nil Shortlands No. 2 2 0.002 0.010 — 4.5 18 0.02 Nil Horton Kirby well 2 0.005 0.023 — 4.5 17 0.05 0.3 Thames derived 1882 0.027 0.074 — 3.9 29 1.16 0.3 Description of the Sample Colour, m.m. brown 2 ft. Tube Burgess's Tintometer Hardness (Total) Hardness (noncarbonate) pH. Value Phosphate as po4 Silicate as SiO2 B.O.D. 5 days at 20°C. Electrical Conductivity (gemmhos) Orpington well Nil 272 30 7.2 — — — 525 N. Orpington well Nil 258 21 7.3 — — — 475 Jewels Wood well Nil 240 16 7.3 — — — 450 Sundridge No. 2 well Nil 205 38 7.4 — — — 425 Westerham well Nil 264 28 7.3 — — — 500 Lullingstone well Nil 241 15 7.2 — — — 450 Eynsford bore Nil 250 24 7.3 — — — 475 Eynsford well Nil 256 24 7.2 — — — 475 Shortlands No. 1 Nil 275 54 7.2 — — — 525 Shortlands No. 2 Nil 278 57 7.3 — — — 525 Horton Kirby well Nil 250 38 7.3 — — – 475 Thames derived 11 260 56 7.9 — — — 550 SECTION D. HOUSING. 36 SECTION D. HOUSING. Clearance Areas and Individual Unfit Dwellings. The Council's post war programme for Slum Clearance, as approved by the Ministry of Housing and Local Government, made provision for dealing with a total of 184 houses within five years ending 1961. Of this number, 67 are already covered by operative clearance or compulsory purchase orders and 6 are in a Clearance Area for which a clearance order has been submitted to the Ministry but has not yet become operative. In the balance of 111 houses, there were included approximately 35 houses which, subject to a detailed inspection, will be dealt with individually by Demolition Orders. Four of these have been dealt with and already demolished, but the bulk of them will be dealt with during the last year or so of the programme. A survey of proposed Clearance Area properties carried out during the year revealed that changes had taken place since the original list was compiled. Many premises had been converted and are now used solely for business purposes, and others had been improved to a degree which precluded their retention on the list. As a consequence of this revision, the number of houses which have yet to be represented in Clearance Areas has been reduced from 76 to 35. Subject to detailed inspections, therefore, there remain 31 houses to be dealt with by Demolition Orders and 35 to be dealt with by Clearance or Compulsory Purchase Orders. Rent Act, 1957. This Act came into force on the 6th July, 1957. The role of the Health Department in the administration of the Act is confined almost entirely to the consideration of applications made by tenants of controlled houses for Certificates of Disrepair. In broad terms, the possession of this Certificate enables a tenant to resist the rent increase permitted by the Act and the granting of a Certificate is justified only where the dwelling is in disrepair by reason of defects which ought reasonably to be remedied "having due regard to the age, character and locality of the dwelling." A local Authority as far as the alleged defects are concerned, is in the position of an arbiter, but both tenant and landlord may appeal to a County Court if dissatisfied with the decision of a Local Authority. 37 The formal procedure prescribed for dealing with applications was observed in every case and the authority of the Public Health Committee sought before implementation. From the date of commencement of the Act until the end of the year, fifty-nine applications were received. In the majority of cases undertakings by the landlords to remedy the defects were received but in twelve cases Certificates were issued. There were no cases of appeal and the administration worked smoothly throughout. Housing Statistics for the Year 1957. Total number of valuation assessments, houses and flats, at 31st December, 1957 22,898 1. Inspection of Dwelling Houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under the Public Health or Housing Acts) 154 (b) Number of inspections made for the purpose 810 (2) 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 — (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 145 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 138 Number of dwelling houses demolished during the year 4 Moveable Dwellings. During 1957, three licences were renewed embracing a total of 94 Caravans and 10 tents. For the winter months, three licences, covering a total of 68 caravans were also issued. Fifty-six visits were made to the various sites by the Public Health Inspectors. 38 Re-Housing. I am indebted to the Housing and Estates Manager for the following statistics on re-housing carried out by the Local Authority:— Prior to 1957 During 1957 Total as at Dec. 1957 1. (a) Number of permanent dwellings built by Local Authority (excluding 402 old type pre-1939 Council houses) 2,214 13 2,227 (b) Number of pre-fabricated dwellings built by Local Authority 319 — 319 (c) Number of dwellings requisitioned by Local Authority as at Dec., 1955 2 — 2 2. (a) Number of families occupying 1(a) 2,227 + lodgers (b) Number of families occupying 1(b) 319 (c) Number of families occupying 1(c) 15 3. Total number of families re-housed during 1957 in: (a) 13 (b) Nil (c) Nil 4. Number of families on waiting list at 31.12.57 in various categories: (a) Families in urgent need of other accommodation 75 (b) Families whose applications require early consideration 234 (c) Families whose applications are less urgent 211 520 (d) Families with varying degrees of housing need 230 5. 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 about 309 of the families included in (4) above are living in crowded conditions. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 40 SECTION E. INSPECTION AND SUPERVISION OF FOODS. General. Administration of the law relating generally to the protection of the nation's food supply has always been a large and important part of the duties of public health department staffs. It is necessary, of course for Local Authorities to employ an adequate number of properly qualified inspectors for this supervisory work but it is equally necessary to obtain the full co-operation of all persons engaged in the food trade and especially those who actually handle the food. Enforcement of the law is not in itself sufficient as there are many occasions when the common sense and understanding of the food handler prevents contamination of food which, if consumed, would result in illness. Part of the inspectors' duty therefore is to explain to food handlers the purpose of the various acts and regulations so that they will see themselves as equal guardians of the health of the general public. There have been great improvements in the hygienic preparation and sale of food in the past few years, but there is still room for improvement in some establishments. Food and Drugs Act, 1955. Food Sampling. 226 Informal Samples of food and drugs were taken for analysis. The Food Hygiene Regulations of 1955 have enabled the department to secure great improvements in the condition of food premises during the past two years, and the opportunity has been taken at all visits of inspection to explain the purpose of the improvements which have for their object the prevention of food poisoning. 41 ARTICLE No. of Informal Samples Taken RESULT Remarks[/ ks Genuine Inferior Adulterated Aspirin 1 1 — — Bacon 2 2 — — Beef Suet 2 2 — — Beef Sausages 2 2 — — Beetroot (strained) 1 1 — — Bicarbonate of Soda 1 1 — — Blancmange 1 i 1 — — Boric Acid Ointment 1 1 — — Bread 5 1 3 1 See (a) (b) (c) (d) Brandy Flavour 1 1 — — Butter 5 5 — — Butter Sweet Confectionery 5 5 — — Cake Mixture 3 3 — — Cake Confectionery 1 1 — — Caviar 1 1 — — Cheese 1 1 — — Coffee and Chicory 2 2 — — Cough Mixture 5 5 — — Cornflour 1 1 — — Cream of Tartar 1 1 — — Curry Powder 3 3 — — Evaporated Milk 1 1 — — Fish Paste 14 14 — — Flour 5 5 — — Gelatine 2 2 — — Glace Cherries 1 1 — — Glucose Confectionery 1 1 — — Grapefruit Squash 1 1 — — Ground Almonds 1 1 — — Halibut Liver Oil Capsules 1 1 — — Horseradish Relish 1 1 — — Instant Icing 1 1 — — Jaffa Juice 1 1 — — Jelly 1 1 — — Lemon Squash 1 1 — — Margarine 3 3 — — Meat Paste 16 16 — — Milk 76 73 1 2 See (e) (f) (g) Milk Jelly Crystals 1 1 — — Mincemeat 2 2 — — Minced Chicken 1 1 — — Mint Jelly 1 1 — — Mustard 1 1 — — Orange Drink 6 1 — See (h) Olive Oil 1 1 — — Passion Fruit Squash 1 1 — — Peel 1 1 — — Pepper 1 1 — — Pork Sausages 5 5 — — Pudding Mixture 9 2 — — 42 article No. of Informal Samples Taken. RESULT Remarks Genuine Inferior Adulterated Quinine 2 — 2 — See (i) (j) Rice 1 1 — — Salad Cream 1 1 — — Sauce 3 3 — — Saccharin Tablets 1 1 — — Semolina 1 1 — — Soup (packets) 2 2 — — Steak and Kidney Pie 1 1 — — Sugar 2 2 — — Tomato Ketchup 3 3 — — Toffees 1 — 1 — See (k) Vienna Steaks 1 1 — — Vinegar 4 4 — — Vitamin Yeast Tablets 2 2 — — Whisky 4 4 — — White Milky Bar 1 1 — — Zinc and Castor Oil Cream 1 1 — — 226 215 8 3 Details of unsatisfactory samples:— Sample. Analyst's Report. Action taken. (a) Bread (Slice) Inferior—Foreign matter consisted of a pellet of yeast. No action taken. (b) Bread Adulterated—Contained near the corner of the slice small pellet of rodent excrement about half the size of a lentil. Reported to Public Health Committee. Strong warning letter sent to Bakery. (c) Bread Inferior—The foreign matter appeared to be due to the presence of a small particle of dough which had become discoloured by contact with oil from the bread making machinery. An investigation was made at the bakery and circumstances of contamination were explained to complainant. (d) Bread Inferior—Foreign matter consisted of dark brown-black matter extending through a fold in the dough; contains mineral matter and iron therefore lubricating oil. No rodent hairs or other fibres or debris. Warning letter to occupier of the bakery concerned. 43 (e) Tuberculin Tested Milk Adulterated— Fat 2.7%. SnF. 8.65%. The deficiency in milk fat in these cases (all from one farmer) was thought almost certainly to be due to poor feeding and an improvement in this direction resulted in satisfactory reports on follow-up samples. (f) Tuberculin Tested Milk Deficient 10% minimum amount of fat. Inferior— Fat 2.75%. SnF. 8.85%. Deficient 8.3% minimum amount of fat. (g) Tuberculin Tested Milk Adulterated— Fat 2.65%. SnF. 8.75%. Deficient 11.7% minimum amount of fat. (h) Orange Drink Inferior—The foreign matter consisted of mould spores. This contamination arose through an improperly washed bottle where mould spores had fed upon the small amount of sediment left in the bottom of the bottle. The mould spores had been killed by the Company's sterilisation process. Nevertheless, a strict warning was issued to the Company concerned. (i) Quinine, Ammoniated Tincture Inferior—Quinine 1.73%; Ammonia 0.70%. A slight deficiency of Ammonia. The Pharmacist was asked to remove the remainder of his stock from sale. (j) Quinine Ammoniated Tincture Inferior—Quinine 1.7%; Ammonia 0.65%. B.P.C. limits 0.85%1.05%. Cork in bottle shrunk; probably old stock. (k) Toffees Inferior—Contained some black particles varying in size from very small down to microscopic. Probably consisted of charred sugar and therefore not harmful. No action taken. 44 Food Hygiene Regulations, 1955. A total of 498 inspections under the above Regulations were made by the District Inspectors during the year. As a result of these inspections, 27 informal notices were served on the proprietors, and by the end of the year the following works had been carried out at food premises and stalls. Food Premises: Walls and ceiling cleansed 20 Structural repairs 19 New equipment provided 7 Food protected from contamination 5 Food storage 2 Staff cleanliness 1 Sanitary accommodation cleansed 12 Sanitary accommodation—hand washing notices affixed 11 Additional sinks provided 5 Wash-hand basins provided 14 Hot water supply provided 38 First-aid equipment provided 22 Clothing accommodation provided 15 Detergent or sterilising agent provided 1 Lighting improved 4 Ventilation improved 2 Refuse storage 8 Transport conditions improved 3 Soap, towels and nailbrush provided 14 Non-absorbent surfaces provided for working tables 10 Miscellaneous 22 Stalls: Name and address displayed 3 Cleansed 1 Food Complaints. Twenty-four complaints of unsound condition and/or contamination of foodstuffs were received from the public during the year as under:— Bacon 1 Beetroot (tinned) 1 Bread 11 Chocolates 1 Egg 1 Meat Pies 1 Milk 3 Orange Juice 1 Pork Sausages 1 Sausage 1 Semolina 1 Toffees 1 24 45 Special Samples of Milk, Ice Cream, Water and Egg Products. In addition to the samples previously mentioned, a further 174 samples were taken for bacteriological and pathological tion and other special tests, as under:— Milk (Tuberculin Tested) 5 Milk (Pasteurised) Phosphatase Test 38 Milk (Sterilised) Turbidity Test 33 Ice cream—Bacteriological and Pathological Examination 30 Water—Bacteriological Examination 46 Water—Chemical Examination 2 Imported Egg Products 20 174 Ice Cream. At the end of the year, 161 premises were registered for the storage and sale of ice-cream, but none for the manufacture of this commodity. Fifty-eight inspections were made and conditions were found to be satisfactory. Thirty samples were sent for bacteriological and pathological examination. Year. No. of samples taken. Grade I Result. Grade II Grade III Grade IV 1955 24 23 1 — — 1956 34 20 12 1 1 1957 30 22 8 — — No pathogenic organisms were found in any of the thirty samples, and the bacteriological grading was highly satisfactory. Food Premises. Bakers and Confectioners 17 Butchers 37 Chemists 20 Clubs and Hotels 7 Confectionery 61 Cooked Meat Shops 1 Dairies 12 Fishmongers (Wet, Dried and Fried) 21 Greengrocery 51 Grocery 91 Hospitals 2 Industrial Canteens 12 Public Houses 46 Restaurants, etc. 55 School Canteens 15 Slaughterhouses 5 Street Vendors 8 461 46 Food and Drugs Act, 1955—Section 16. Two hundred and six shops and food premises have been registered under the above Act, as under:— Ice Cream Stores 161 Fish Shops 7 Butchers' Shops 37 Fish and Meat Paste Factory 1 206 Unsound Food. During the year, a total of 33 tons, 10 cwts. 1 quarter, 3 lbs. of varied articles of food were condemned, and 543 Food Condemnation Certificates were issued. 171½lbs. of Bacon. 7 lbs. of Butter. 52 lbs. of Cakes. 13 lbs. of Cereals. 149 lbs. of Cheese. 51 lbs. of Chickens. ½lb. of Coffee. 5 lbs. of Chocolate (Drinking). 56 lbs. of Fish. 34½ lbs. of Fish (Tinned). 375½lbs. of Fruit (Tinned). 5,148 lbs. of Fruit. 87½ lbs. of Fruit (Dried). 56 lbs. of Kidney. 8½ lbs. of Liver. 575 lbs. of Meat (Tinned). 1,136½ lbs. of Meat. 27 lbs. of Meat Pies. 107 lbs. of Milk (Tinned). 3 lbs. of Pickles. 40 lbs. of Poultry. 25 lbs. of Preserves. 133 lbs. of Sausages. 5 lbs. of Sauces. 42 lbs. of Soups. 304 lbs. of Vegetables (Tinned). 65,685 lbs. of Vegetables. Milk and Dairies Regulations. Twelve dairies have been registered under the above Regulations. Details of the licences issued during 1957 are:— Tuberculin Tested Dealer's Licences 12 Supplementary Licences 2 Pasteurised Dealer's Licences 12 Supplementary Licences 3 Sterilised Dealer's Licences 30 Supplementary Licences 2 47 Forty-six visits were made to the Dairies in the district during 1957. Slaughterhouses and Slaughtermen. One hundred and sixty visits were made by the Public Health Inspectors to the five licensed slaughterhouses. Licences were issued to twenty slaughtermen under the Slaughter of Animals Acts 1933 to 1954. Meat Inspection at Slaughterhouses. The following table gives details of the ante and post-mortem inspection of animals during 1957. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep & Lambs Pigs Number killed 1 – 2 – 587 Number inspected 1 – 2 – 587 All diseases except Tuberculosis and Cysticerci— Whole carcases condemned – – – – 3 Carcases of which some part or organ was condemned – – – – 35 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci – – – – 6.5% Tuberculosis only— Whole carcases condemned – – – – 1 Carcases of which some part or organ was condemned – – – – 6 Percentage of the number inspected affected with Tuberculosis – – – – 1.2% Cysticercosis— Carcases submitted to treatment by refrigeration – – – – – Carcases of which some part or organ was condemned – – – –– – Generalised and totally condemned – – – – – The total weight of meat condemned was approximately four cwts. Restaurants, Hotels and Canteens. Fifty-six visits were made to these premises during the year. In four cases defects requiring the attention of the owner were dealt with by informal action. 48 Butchers' Shops. Ninety-one detailed inspections were made of the 37 retail butchers' shops in the area. The butchers work in close collaboration with the Public Health Department and frequently call upon our services in connection with carcase meat which they suspect is unsound. In no case was there any evidence of unsound meat being exposed for sale. Bakehouses. Twenty-five inspections were made of the thirteen premises during the year, and no defects were found. Merchandise Marks Act. Eighteen visits were paid to premises during the year in connection with this Act. No contraventions were detected. Game Act, 1831. Three licences were renewed during the year. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 50 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. General. Compared with the previous year when only 578 notifications of infectious diseases, excluding Tuberculosis, were received, the figure of 2,284 for 1957 may appear bad on the surface. Actually the picture portrayed by these figures is deceptive for if we exclude measles, only 410 other than for tuberculosis were received. If measles were to be eliminated from the 1956 figures, our total notifications for that year would have been 545, giving an overall result of 135 less notifications in 1957 than in 1956. Other variations which have occurred during the year include a reduction of ten in the number of cases of scarlet fever, and twenty-six in the number of cases of pneumonia. There was also a decrease in the number of cases of dysentery thirty-three being notified as against fifty in 1956. The figures for anterior poliomyelitis also dropped from twelve to seven, and food poisoning from thirty-six to nineteen. Generally speaking the infectious diseases retained their mild characteristics of recent years, and this point is very well illustrated by the fact that only twelve of the 1,874 notified cases of measles were admitted to hospital. Acute Anterior Poliomyelitis. During the past year, seven cases were notified, as against twelve in the previous year. Three cases were confirmed as being paralytic, and were admitted to hospital. The remaining four cases were non-paralytic and of these two were home nursed and two were admitted to hospital. Vaccination against Poliomyelitis. Vaccination against poliomyelitis was carried out in the area by the County Council, and the following table, which has been furnished by the County Medical Officer, gives the number of children resident in the Urban District who received a course of two injections during the year ended 31st December, 1957 :— Year of Birth 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 No. Vaccinated 638 582 572 489 181 158 160 146 105 128 2 Grand Total: 3,161. 51 Diphtheria and Diphtheria Immunisation. For the eighth year in succession, no case of diphtheria was notified. The present position with regard to diphtheria immunisation is summarised in the following figures which have been furnished by the County Medical Officer. Of the children resident in the area who were born since 1943, a total of 1,131 received primary inoculations and 777 received reinforcing inoculations during 1957. A total of 13,323 children under the age of fifteen years on 31st December, 1957, have completed a course of immunisation at some time before that date. Dysentery. Thirty-three cases were notified during the year, only two being admitted to hospital. This figure is a decrease on the fifty cases which occurred during 1956, and was in conformity with the figures for the country as a whole. Food Poisoning. Nineteen single cases were notified during the year, three being removed to hospital. In four cases, the agent was indentified as Salmonella organisms and in six cases as B. Welchii. The following is a copy of the annual return of Food Poisoning notifications (corrected) forwarded to the Ministry of Health :— (1) First Quarter Second Quarter Third Quarter Fourth Quarter 3 11 3 2 19 (2) Outbreaks due to identified agents: — Total outbreaks Total cases Nil Nil (3) Outbreaks of undiscovered cause: — Total outbreaks Total cases Nil Nil (4) Single cases: — Ageni identified: Salmonella B. Welchii Unknown 4 6 9 52 Measles. As was to be expected after a year of few notifications, there was a large increase in the number of measles notified during 1957, a total of one thousand eight hundred and seventy-four cases being brought to our notice, as against only thirty-three cases during 1956. Twelve cases necessitated hospital treatment, and there was one death. This ailment, although so widespread, retained the milder characteristics so noticeable of late, and it would seem that here we are dealing with a condition of lessening importance and that the higher standard of living has dealt a crippling blow to the killing power of this illness. Meningococcal Infections. No cases occurred in the area during 1957. Pneumonia. Altogether seventeen cases of pneumonia were notified during the year, as against forty-three cases in 1956. Three cases were admitted to hospital, and fifty-two deaths were recorded. This latter figure includes people who are normally resident in the Urban District, but who died outside the area. It was expected that a rise in the incidence of pneumonia would have taken place in 1957 as influenza was epidemic on a large scale, but it is more than probable that the explanation is that influenza affected predominantly the younger age groups and tended to miss those age groups which are more likely to be attacked by pneumonia. Scarlet Fever. Thirty cases were notified during the year, seven of which were removed to hospital, and the remainder home nursed. This is a decrease on the figure of forty cases notified during 1956. There were no "return cases," and no deaths occurred from this disease in the area during 1957. Here again one is able to report that most sufferers from this complaint were not seriously affected, and there are very few instances of the complications which used to make this condition so dreaded. Smallpox and Vaccination. Once again no cases of smallpox occurred in this area, but two suspected contacts of cases came under supervision of the department. 53 During the year, 429 International Certificates of Vaccination were stamped by the department and the doctor's signature authenticated. The County Medical Officer informs me that a total of 1,080 residents in the Urban District received primary vaccination and 183 re-vaccination during 1957. Tuberculosis. The following is a copy of the recordings in the register as at 31st December, 1957 :— Respiratory. Other Forms. Total No. of cases. M. F. M. F. On Register at 1st Jan., 1957 467 397 71 72 1,007 New cases notified during 1957 31 24 — 2 57 Number of cases coming to knowledge after death 2 1 - - 3 Restored to Register — — — — — Inv/ard Transfers 35 34 — 2 71 535 456 71 76 1,138 Deletions—deaths, removals, recoveries, etc 37 27 2 — 66 498 429 69 76 1,072 New Cases and Mortality, 1957. Age Groups New Cases notified or otherwise revealed. (Not including Inward Transfers)* Deaths Pulm onary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 5 2 1 - - - - - - 5-14 1 1 — 1 - _ 15-24 6 7 — — _ _ 25-44 12 8 — 1 _ - 45-64 8 5 __ — 2 1 - _ 65 and over 2 2 — — 1 2 - — Age unknown — — — — — — - — 31 24 — 2 3 3 - — * Inward Transfers 35 34 — 2 66 58 — 4 Chest Clinic. Dr. D. G. Madigan, Physician in Charge, has kindly furnished the following details. New cases attending the Chest Clinic for the first time during 1957 :— Adults. Children. M. F. M. F. Pulmonary Tuberculosis 46 37 1 — Non-pulmonary Tuberculosis — — — 1 Non-tuberculous 58 61 41 34 54 New contacts examined during 1957 :— Negative. M. F. 153 178 Positive. M. F. 2 1 (These contact figures are not included in the first table.) B.C.G. Vaccination of Contacts 102. Number of patients who completed a course of sanatorium or hospital treatment during 1957 51. Orpington and District Tuberculosis Care Committee. The following report has been received from the Honorary Secretary :— "During the year 1957, the Committee helped forty-five cases, sixteen of which were new cases referred during the year. A considerable amount of our help took the form of weekly grants for extra nourishment such as milk, groceries and coal. Two holidays were arranged through the N.A.P.T. and paid for out of our funds. At Christmas forty-nine parcels were sent out to patients in the Orpington district and also in Orpington and Farnborough hospitals. Help was extended to patients to cover outstanding commitments so enabling them to accept hospital treatment without undue worry or delay. Two members of the Committee paid weekly visits to patients in Orpington hospital and kept them supplied with magazines which are much appreciated. Funds are becoming harder to raise but, as far as possible, we have not allowed this to curtail our activities." Typhoid and Para-Typhoid Fever. One case of Para Typhoid fever occurred during the year and was admitted to Hospital for treatment. Mass X-ray. I am indebted to Dr. J. M. Morgan, the Director of the Mass X-Ray Unit of the South Eastern Regional Hospital Board and his staff, for supplying me with the statistics upon which the following information is based. During the year 11,252 people were X-rayed, of whom 4,735 were men and 6,517 women. Of the grand total, 5,978 had previously taken advantage of this service. 55 Of the 205 abnormalities discovered, 104 required no action, and 61 were considered tuberculous. Of this latter group, 16 were previously known tuberculous cases, 19 required occasional supervision only, 23 required treatment, 2 are still under investigation, and 1 refused further investigation. The remainder of the 205 consisted of non-tuberculous chest conditions, cardiac abnormalities, etc. Whooping Cough. By a coincidence, practically the same number of notifications were received during the year under review as in the previous year, two hundred and twenty-eight cases being notified during 1957 and two hundred and twenty-seven in 1956. Only one case was admitted to hospital. Mildness is still the characteristic feature of this disease in most instances and as in the case of measles. I suspect that the general standard of living has quite a lot to do with this happy state of affairs. Other Infectious Diseases. In addition to those previously mentioned, notifications were received as under :— Erysipelas—3 cases (1 home nursed and 2 admitted to hospital). Puerperal Pyrexia—72 cases (70 were institutionally treated and 2 home nursed). SECTION G. REFUSE COLLECTION AND DISPOSAL. 58 SECTION G. REFUSE COLLECTION AND DISPOSAL. Mr. Crowe reports :— A weekly collection of household refuse is now undertaken from some 24,000 premises in the district. Previously the southern and rural parts of the area were visited fortnightly, but as from 1st April, they were also visited at weekly intervals. Every effort is made to maintain a regular weekly collection on the same day each week. It was found necessary, owing to the number of new buildings erected, to re-organise the rounds so that each team visited approximately the same number of premises each week. A relay system is operated. A team of collectors work with two collecting vehicles and drivers. The work is so arranged that when one vehicle is travelling to and from the refuse tip, all the collectors are engaged on loading the remaining vehicle. There are five such teams working in the district and each team collects from approximately 3,800 premises each week. The weight of refuse carried by each collector during a week is about 14 tons. The rural parts of the district are served by two single vehicles working entirely separately, one vehicle and driver being hired from a contractor. In addition, frequent collections are made each week from two large hospitals and weekly collections from the numerous schools, vehicles and personnel apart from the normal teams being engaged on this work. A Trade Refuse collecting scheme was commenced on the 1st October, 1957, a vehicle with driver and collector being engaged on this work, and weekly collections are made from some 300 shop premises and offices for which an annual charge is made. The drivers and collecting teams worked well during the year and the rounds were quickly restored to normal after the disturbance caused by Bank Holidays. A particular word in praise of Mr. Honess, the foreman, is due for his excellent support during the year. The Council owns a fleet of fourteen side-loading refuse collecting vehicles, which includes a 10 cubic yard diesel-engined vehicle put into service on the 1st April, making four dieselengined vehicles in all now in use. It is the Council's policy to replace petrol-driven engines as further vehicles are purchased. 59 Refuse is disposed of by means of controlled tipping on low lying land at Budgins Hill, Pratts Bottom. Two men are employed at the tip, a Major Tractor Muledozer being used to level, consolidate and seal refuse and during the year approximately 19,000 tons of refuse were deposited. The Ministry of Housing and Local Government Public Cleansing and Costing Returns for 1956/57 showed that of the Authorities making a return, 368 were disposing of refuse by controlled tipping and 62 by mechanical means. This Costing Return also showed that of 48 Authorities in the population range of 50,000 to 100,000, the average annual net cost per ton of house refuse was 43/2d. for collection and 10/4d. for disposal, a total of 53/6d. for collection and disposal. The figures for Orpington are 33/8d. for collection and 2/- for disposal, making a total of 35/8d. The Abstract of Accounts prepared by the Council's Treasurer for the year ended 31st March, 1957, showed that on a unit basis, the cost of house refuse collection and disposal was £1 l1s. 2d. per dwelling, per annum. APPENDIX. STATISTICAL TABLES. 62 STATISTICAL TABLES, 1957. 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 Public Health Inspectors. TABLE VIII—Nuisances, Defects and Contraventions Abated. 63 TABLE I. SUMMARY OF STATISTICS, 1957. Population (mid-year 1957, per Registrar General) 72,170 Birth Rate (crude) 18.0 Death Rate (crude) 8.7 Maternal Mortality Rate 0.76 Infant Mortality Rate 19.2 Number of Births (live) 1,302 Number of Stillbirths 13 Number of Deaths 628 Number of Maternal Deaths 1 Number of Infant Deaths (under 1 year) 25 Death Rates— Respiratory Diseases 1.22 Tuberculosis 0.06 Cancer (all forms) 1.82 Cancer of the Lung 0.46 Infectious Diseases 0.01 Notifications of Infectious Diseases— Diphtheria Nil Dysentery 33 Erysipelas 3 Food Poisoning 19 Measles 1,874 Poliomyelitis (paralytic) 3 Poliomyelitis (non-paralytic) 4 Puerperal Pyrexia 72 Pneumonia (all forms) 17 Scarlet Fever 30 Tuberculosis (new cases and including Inward Transfers) 128 Typhoid and Para-typhoid Fever 1 Whooping Cough 228 Number of Deaths from Infectious Diseases 1 Number of visits made by Public Health Inspectors 5,257 64 TABLE II. CAUSES OF DEATH. 1953 1954 1955 1956 1957 Male/ Female Total 1. Tuberculosis—Respiratory 9 5 6 3 2 1 3 2. Tuberculosis—Other 1 — — 4 1 — 1 3. Syphilitic Diseases 1 1 — 2 — — — 4. Diphtheria - - - - - - 5. Whooping Cough - - - - - - - 6. Meningococcal Infections - - - - - - - 7. Acute Poliomyelitis 1 — 2 1 — — — 8. Measles 1 — — — — 1 1 9. Other infective and parasitic diseases 2 1 10. Malignant neoplasm, stomach 15 16 11 17 7 5 12 11. Maligant neoplasm, lung bronchus 19 25 23 34 28 5 33 12. Malignant neoplasm, breast 12 14 15 10 — 16 16 13. Malignant neoplasm, uterus 3 2 5 6 — 2 2 14. Other malignant and lymphatic neoplasms 59 51 80 64 36 32 68 15. Leukaemia, Aleukaemia 6 3 7 3 2 2 4 16. Diabetes 4 — 3 3 1 1 2 17. Vascular lesions of nervous system 78 72 74 64 31 42 73 18. Coronary disease, angina 108 105 106 111 62 34 96 19. Hypertension with heart disease 19 8 10 11 9 7 16 20. Other heart disease 78 53 60 50 30 31 61 21. Other circulatory disease 37 24 26 28 21 17 38 22. Influenza 11 1 1 2 2 2 4 23. Pneumonia 36 15 43 70 24 28 52 24. Bronchitis 36 26 31 50 19 12 31 25. Other diseases of respiratory system 9 3 5 15 4 1 5 26. Ulcer of stomach or duodenum 7 6 15 13 5 1 6 27. Gastritis, enteritis and diarrhoea 2 1 2 4 1 2 3 28. Nephritis and nephrosis 2 9 8 4 2 5 7 29. Hyperplasia of prostate 2 5 9 4 9 — 9 30. Pregnancy, childbirth, abortion 2 — — — — 1 1 31. Congenital malformations 7 6 3 4 6 1 7 32. Other defined and ill-defined diseases 54 47 59 48 21 35 56 33. Motor vehicle accidents 5 8 6 6 3 2 5 34. All other accidents 3 2 8 10 5 3 8 35. Suicide 5 7 5 5 2 6 8 36. Homicide and operations of war — — 1 2 — - —— All causes 634 516 624 648 333 295 628 TABLE III. INFANT MORTALITY, 1957. (Compiled locally from Registrar's Death Returns.) CAUSES OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 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 9 — — — 9 — — — — 9 Congenital Heart Disease 1 — — — 1 — — — — 1 Prematurity 7 — — — 7 — — — — 7 Respiratory Diseases — — — — — 2 1 — — 3 Meningitis — — — — — — — 1 — 1 Other Causes 3 — — — 3 — 1 — — 4 Totals 20 — — — 20 2 2 1 — 25 65 TABLE IV. NOTIFIABLE INFECTIOUS DISEASES, 1957. 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 ... 962 912 15 11 199 161 213 213 498 486 19 18 4 6 5 8 9 9 Whooping Cough 115 113 7 9 17 20 36 27 49 53 2 1 — — 3 1 1 2 Scarlet Fever 19 11 — — 1 — 4 — 9 10 5 1 Poliomyelitis (Paralytic) — 3 1 Poliomyelitis (Non-Paralytic) 1 3 Dysentery 16 17 — 2 5 4 2 3 4 2 2 3 1 — 2 3 — — 1113 1059 22 22 222 185 255 243 561 555 28 23 5 6 10 13 10 12 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. Pneumonia 12 5 - 3 3 - - - 1 - 5 2 2 - 1 - Erysipelas — 3 - - - - - - - - - 1 — 2 — — Food Poisoning 4 15 — — 1 4 1 7 — 4 1 — — — 1 — Puerperal Pyrexia — 72 — — - — — 25 — 45 — — — — — 2 Paratyphoid — 1 — — — — — — — — — 1 — — — — Tuberculosis (Pulmonary) 31 24 2 1 1 1 6 7 12 8 8 5 2 2 — — Tuberculosis (Non-Pulmonary) — 2 — — — 1 — — — 1 — — - — — - 47 122 2 4 5 6 7 39 13 58 14 9 4 4 2 2 1160 1181 66 67 table V. Notifiable infectious diseases, 1957. Ward Distribution. Attack and Mortality Rates. Diseases Total WARDS Cases removed to Hospital Attack rate per 1,000 population No. of Deaths Death rate per 1,000 population 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 ... 1874 186 16 103 328 30 20 96 184 348 180 14 100 14 58 118 79 12 26.0 1 001 Whooping Cough 228 33 1 4 10 2 8 12 36 26 26 1 14 7 25 23 1 3.16 - Scarlet Fever 30 1 — 1 4 — — 1 2 4 3 1 4 2 3 4 7 0.41 - Pneumonia 17 2 — 1 — — — — 3 1 1 1 2 — 1 3 2 3 *0.24 0.72 Dysentery 33 2 - - 4 - - - 1 - - - - - 4 16 6 2 0.47 - Erysipelas 3 — — — 1 — — 1 — — — 1 - - - - - 2 0.04 - Food Poisoning 19 — — - 1 — — 2 — — 6 — 1 — 1 7 1 3 0.26 - Poliomyelitis (Paralytic) 3 — — — — — — 2 — — 1 — — — — - - 3 0.04 - Poliomyelitis (Non-Paralytic) 4 — — — — — — 1 — 1 — — — — 1 1 2 0.06 - Puerperal Pyrexia 72 1 — — — — — 70 — — — — — — 1 70 +54.80 - Paratyphoid Tuberculosis (Pulmonary) 1 55 6 1 2 1 — 1 6 6 7 4 — 5 — 2 7 7 1 22. 0.01 0.76 3 0.04 Tuberculosis (Non-Pulmonary) 2 - - - - - - - 1 - - - — — — 1 - 1 0.03 1 0-01 Totals 2341 231 18 111 349 32 29 192 233 387 221 18 126 16 75 180 123 129 32.44 57 0-79 t Based on 1,000 total births and not population. * Includes all forms of Pneumonia. TABLE VI. NOTIFIABLE INFECTIOUS DISEASES, 1957. Seasonal Incidence. Disease Jan. Feb. March Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Measles 74 218 466 536 290 150 82 39 8 1 6 4 1874 Whooping Cough 26 8 15 20 20 28 75 18 9 3 3 3 228 Scarlet Fever 4 4 4 4 2 7 _ - ... 1 2 2 30 Pneumonia 1 4 1 2 1 _ _ - 2 - 6 17 Dysentery 17 4 2 1 4 1 4 - - - 33 Erysipelas — 2 _ — - _ .... - 1 - - 3 Food Poisoning 2 1 — 1 7 3 2 1 1 1 - 19 Poliomyelitis (Non-Paralytic) - - - - - - 2 1 1 ... _ - 4 Poliomyelitis (Paralytic) — - — — — — 2 — 1 ... _ _ 3 Puerperal Pyrexia 2 12 5 4 7 4 1 10 6 8 6 7 72 Paratyphoid " - - - - 1 — _ —- - — — 1 Totals 126 253 493 568 331 194 168 69 26 16 18 22 2284 68 69 TABLE VII. SUMMARY OF THE WORK OF THE PUBLIC HEALTH INSPECTORS. Housing Inspection. No. of Inspections N'o. of premises at which defects or :ontraventions were found For defects and nuisances 785 40 Verminous conditions 25 7 Water supply 113 2 Cesspools 50 10 Common Lodging Houses 10 — Drainage 1,097 56 Infectious Diseases. (2,080) (115) Inquiry visits 119 — Disinfection 2 — Food Premises. (121) (-) Bakehouses 25 — Butchers 91 5 Dairies and Milkshops 46 — Fishmongers and Poulterers 8 2 Fish Fryers 9 — Food Preparing and Manufacturing Premises 22 — Greengrocers 27 4 Grocers 256 13 Ice Cream Premises 58 — Restaurants, Hotels, Canteens 56 4 Slaughterhouses 160 3 Street Vendors, Stalls and Hawkers Carts 47 2 Visits in connection with sampling 192 — Visits under Food Hygiene Regulations 498 27 Miscellaneous 345 — (1,940) (60) Factories. Factories with mechanical power 4 - Factories without mechanical power 31 2 Other premises classified as factories 5 — Emission of smoke, fumes and grit 119 2 Trade Premises. (159) (4) Shops (for Shops Act) 123 24 Piggeries 59 — Caravan Sites 56 — Miscellaneous. (238) (24) Swimming Baths 4 - Suspected Food Poisoning 17 - Keeping of Animals 36 4 Noxious accumulations 23 11 Schools — — Public Conveniences 20 — Rivers, Streams, etc 11 — (111) (15) Unclassified 618 (618) (-) 5,257 218 70 TABLE VIII. NUISANCES, DEFECTS, CONTRAVENTIONS, ETC., ABATED OR REMEDIED IN 1957. Drainage. Drains constructed or reconstructed 3 Drains repaired 17 Drains cleansed 50 Inspection chambers repaired or renewed 5 Inspection chamber covers provided 1 Ventilation improved or repaired 4 Cesspools emptied 4 Cesspools repaired or reconstructed 4 Cesspools abolished and connections made to sewer 24 Dampness. Roofs made watertight 19 Walls made waterproof 5 Damp-proof course provided 1 Damp-proof course repaired or renewed 2 Water Supply. Main supply provided 3 Pipes repaired or renewed 2 Storage tanks repaired or renewed 1 General Items. Wall plaster repaired 4 Ceiling plaster repaired 4 Floors repaired 3 Rooms cleansed or decorated 6 Windows and doors repaired 11 Fire surrounds and grates repaired or renewed 1 New sinks in kitchen provided 1 Sink waste pipes trapped, renewed or repaired 2 Water closets repaired or reconstructed 3 Wash basins provided 1 Water closet seats repaired or renewed 2 Ventilation in water closet improved 1 Flushing cisterns repaired or renewed 3 Rainwater gutters repaired or renewed 3 Rainwater downpipes repaired or renewed 1 Chimney stacks made waterproof 3 Ball valves repaired or renewed 2 Taps repaired or renewed 1 Yard paving and drainage repaired 4 Dustbins provided 3 Ventilated food stores provided 1 Nuisance from animals abated 2 Noxious accumulation removed 5 Chimney pots renewed 1 Intercepter repaired or renewed 3