ORP 22 AC 4412(3) ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE URBAN DISTRICT 1958 H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health MUNICIPAL BUILDINGS, BROMLEY, KENT Telephone: RAVensbourne 4623 ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE URBAN DISTRICT 1958 H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health MUNICIPAL BUILDINGS, BROMLEY, KENT Telephone: RAVensbourne 4623 3 CONTENTS Pagb 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 14 Medical Examinations 14 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 District Nursing Service 21 Domestic Help Service 21 Domiciliary Midwifery 20 Health Visiting 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 Service 22 Section C. Sanitary and Environmental Circumstances of the Area Agriculture (Safety, Health and Welfare Provisions) Act, 1956 26 Atmospheric Pollution—Clean Air Act, 1956 26 Cesspools 27 Complaints 27 Diseases of Animals (Waste Foods) Order, 1957 28 Drainage and Sewerage 28 Factories Acts, 1937 and 1948 28 Heating Appliances (Fireguards) Act, 1952 29 Pet Animals Act, 1951 29 Prevention of Damage by Pests Act, 1949 30 Rag Flock and Other Filling Materials Act, 1951 30 Rivers, Streams and Lakes 30 Sanitary Inspection of the Area 30 Shops Act, 1950 30 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 36 Moveable Dwellings 37 Re-Housing 37 Section E. Inspection and Supervision of Foods. Bakehouses 47 Butchers' Shops 47 Food Complaints 43 Food Hygiene Regulations, 1955 43 Food Premises 44 Food and Drugs Act, 1955—Food Sampling 40 Food and Drugs Act, 1955—Section 16 45 Game Act, 1831 47 General 40 Ice Cream 44 Meat Inspection 46 Merchandise Marks Act 47 Milk and Dairies Regulation 46 Restaurants, Hotels and Canteens 47 Special Samples—Milk, Ice Cream, Water and Egg Products 44 Unsound Food 45 Section F. Prevalence of, and Control Over Infectious and Other Diseases. Acute Anterior Poliomyelitis 50 Poliomyelitis Vaccination 50 Diphtheria and Diphtheria Immunisation 51 Dysentery 51 Food Poisoning 51 General Remarks 50 Measles 52 Meningococcal Infections 52 Other Infectious Diseases 56 Pneumonia 52 Scarlet Fever 52 Smallpox and Vaccination 53 Tuberculosis, Chest Clinic and Mass X-ray 53 Tuberculosis Care Committee 54 Typhoid and Para-Typhoid Fever 55 Whooping Cough & Whooping Cough Immunisation 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 71 5 MEMBERS OF THE URBAN DISTRICT COUNCIL (as at 31st December, 1958) * Chairman of the Council : Councillor C. H. E. PRATT, J.P. * Vice-Chairman of the Council : Councillor F. G. GARDNER (Mrs.) Councillors R. W. AYLIFFE, F.R.I.C.S. W. W. BALDING *Mrs. J. G. BANKS (Vice-Chairman of Public Health Committee) *G. E. BLABER, A.M.I.C.W. *H. L. BLAKE H. T. COX J. DAVIES, C.C. A. L. FERRIS *J. W. HARRADINE *E. A. P. HART, J.P. W. D. HAYNE, T.D. F. S. HOCKEY *W. D. KNIGHT. *F. W. LANE E. LLOYD-WARD, M.C. *F H LUCAS *Mrs. C. M. MEDLYCOTT *T. S. MILLO-PATTLE R. L. MUMFORD Lt.-Col. T. H. NEWEY, E.D., C.C. J. F. NUNN Mrs. P. L. ROBERTSON G. G. ROMA1N C. S. SAFFERY L. G. SIGGS, M.I.O.B., F.I.C.E. *G. A. SMITH (Chairman of Public Health Committee) M. J. A. STEVENS W. C. SWEATMAN, J.P. Mrs. J. V. WEBB *S W WFI I S *B. D.' WOODMANSEE (* denotes members of the Public Health Committee.) STAFF OF THE PUBLIC HEALTH DEPARTMENT (as at 31st December, 1958) 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. Council Offices, Orpington, Kent. Telephone: Orpington 27661. 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. J. COPPIN, C.R.S.H., M.A.P.H.I. A. E. ROBINSON, C.R.S.H., M.A.P.H.I. 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. MURRAY. 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, Comparisons have the unfortunate reputation of being odious, but this happens to be the twenty-fifth annual report of the Medical Officer of Health since the Urban District was constituted in its present form, and it therefore seems to be an opportunity to pause a while and look back over the last quarter of a century, comparing one or two of the problems of 1934 with those of to-day. In 1934 there were 31 deaths due to cancer in a population of 33,420, but by 1958, the cancer deaths were 158 in a population of 73,640 and of this latter number, 38 were due to cancer of the lung. Owing to the fact that deaths from lung cancer were a comparative rarity in 1934, no separate figures for its mortality are available for that year, but the fact that in 1958 the deaths from lung cancer outnumbered the total deaths from all forms of this disease in 1934, is a point of considerable significance. Although its critics say that figures can be made to prove anything, accumulated statistical evidence has shown a clear association between tobacco smoking, especially in the form of cigarettes and lung cancer, and it would appear that there is no other reasonable interpretation of the statistics which have been produced. Despite the publicity and consequent widespread knowledge of these facts, public apathy continues and indeed the consumption of tobacco is still on the increase. There are certainly very deep psychological factors involved in the odd situation in which vast numbers of our people are prepared to run the apparently severe risk of smoking rather than abandon the habit. At one stage I was of the opinion that if the youth of the country could be discouraged from smoking, the problem would eventually solve itself, but further thought has forced me to the conclusion that so long as their elders smoke, so will our youth follow suit, for it is one of the natural characteristics of adolescents that they want to appear mature and therefore tend to copy their elders' habits. Having given a very sombre warning in the previous paragraph, I should now like to turn to a feature which shows a very satisfactory alteration for the better over the years. In 1934 there were no less than 46 cases of diphtheria with two deaths, but it is now nine years since the last case occurred in Orpington—surely a great triumph for preventive medicine in the form of immunisation. If on the other hand this freedom from diphtheria is to be maintained, it is essential that all possible children should continue to be immunised. The subject of prevention leads almost instinctively to the question of vaccination against acute anterior poliomyelitis which 7 has loomed so large in the public eye in recent years. Sufficient experience of this form of treatment has now been acquired to indicate that it is safe and gives a high degree of immunity against the paralytic form of the disease, and it is therefore to be hoped that all who are at present eligible for this treatment will take advantage of it as soon as possible. It is also hoped that it will not be long before all who wish to be vaccinated against this disease, irrespective of age, will be able to have this done. During the year the Council have had under active consideration their policy with regard to the question of accidents in the home, and although at the time of writing no decisions have been made, it would seem an appropriate stage at which to refer to this big problem. There is a very well-known expression, " an Englishman's home is his castle," the obvious interpretation of which is that his home is a haven of refuge in which the family grows up in privacy, security and safety. But unfortunately the security and safety are often jeopardised in too many cases by the lack of the most elementary precautions against home accidents. The toll of such accidents now exceeds those occurring on the roads, though the latter receive much more publicity on the whole. It is a terrible thing to suffer the remorse of those who, for instance, have caused injury to a child through failure to provide a suitable fireguard, but one cannot help wondering how often such thoughtlessness is perpetuated until the tragedy suddenly and quite unexpectedly occurs. Elderly persons are also peculiarly susceptible to home accidents as their mobility gets reduced and their eyesight less effective. Fire and falls are their special risks and in connection with the latter, bad lighting, loose mats and polished floors all make their contribution to the total of accidents in the home. I have mentioned only a very few of the hazards likely to occur in any home, but having drawn the reader's attention to such dangers one hopes that these and other risks will be eliminated as much as possible before it is too late. The Royal Commission on Local Government in Greater London invited this local authority to make a statement during 1958, and in view of the importance to the Health Committee of this summary of views, it would not be right to let this matter pass without comment. It will probably be some considerable time before the views of the Royal Commission become known, but I feel that should their recommendations lead to an increase in the responsibilities of the Health Committee, the latter would welcome them enthusiastically. The time has now come to comment on the vital statistics which generally speaking are very satisfactory. There has been a further rise in population, the birth rate remains above that for England 8 and Wales as a whole, the infant mortality rate and the death rate are both less than that for the whole country and there were no maternal deaths. Infectious disease notifications were exceptionally small, only totalling 498 as against 2,284 in the previous year when there was a very big epidemic of measles. I will not particularise on this subject, as the individual infectious diseases are dealt with in detail in their own section of the report. My final remarks must be of thanks to my very able deputy, Dr. Kelynack, and all the members of the staff of the Public Health Department. It gives me particular pleasure to praise the work of Mr. Crowe, who is so conscientious in his dual role as Chief Public Health Inspector and Cleansing Superintendent. My thanks are also due to many of my colleagues outside the local government service who have been so helpful and co-operative in many matters of mutual concern. Lastly, I should like to express my gratitude to the Chairman and Members of the Public Health Committee who have taken such a keen interest in the problems affecting the Public Health Department. 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 GENERAL STATISTICS Area of the Urban District (in acres) 20,842 Area of Parks, Open Spaces, etc. (in acres) 283.6 Registrar-General's estimate of total population mid-year 1958 73,640 Rateable value at 31st March, 1959 £1,149,864 Estimated net product of a penny rate, 1958/9 £4,700 Total number of valuation assessments at 31st March, 1959 23,463 iMileage of Roads as at 1st April, 1958. County Roads, Class I, 11 and III 41.35 miles District Roads 97.876 miles Unadopted Roads 37.90 miles Total 177.126 miles VITAL STATISTICS Live Births. Male Female Total Legitimate 667 616 1,283 Illegitimate 19 17 36 686 633 1,319 Crude birth rate per 1,000 estimated total population 17.9 Adjusted birth rate for comparison with other areas 17.7 (The area comparability factor for births is 0.99.) Birth rate for England and Wales 16.4 Stillbirths. Male Female Total Legitimate 7 14 21 Illegitimate — 3 3 7 17 24 Stillbirth rate per 1,000 estimated total population 0.33 Stillbirth rate per 1,000 live and still births Total Births (Live and Still) 17.87 Male Female Total Legitimate 674 630 1,304 Illegitimate 19 20 39 693 650 1,343 11. Infant Mortality. Male Female Total Legitimate 12 14 26 Illegitimate 1 — 1 13 14 27 Infant Mortality rate per 1,000 live births 20.5 Legitimate infants per 1,000 live legitimate births 20.3 Illegitimate infants per 1,000 live illegitimate births 27.8 Infant mortality rate for England and Wales 22.5 Male infants per 1,000 male live births 19.0 Female infants per 1,000 female live births 22.1 Neonatal deaths (under 4 weeks of age) per 1,000 live births 15.2 Illegitimate live births per cent of total live births 2.7 Maternal Mortality. Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and still births Nil Maternal mortality rate for England and Wales 0.43 Deaths. Male Female Total 388 359 747 Crude death rate per 1,000 estimated total population 10.1 Adjusted death rate for comparison purposes (The area comparability factor for deaths is 1.12.) 11.3 Death rate for England and Wales 11.7 Population. The Registrar General's estimate of the total population of the Urban District, mid-year 1958, was 73,640, which is an increase of 1,470 over the figure for 1957, and is equivalent to a density of 3.53 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 572. This increase continues the healthy trend noted in previous years, which is illustrated in the figures below showing the growth of the population during the last decade. Year Population 1949 59,500 1950 62,420 1951 62,850 1952 63,670 1953 64,480 1954 66,380 1955 68,450 1956 70,410 1957 72,170 1958 73,640 12 Births. The birth rate for the year 1958 was 17.9 per 1,000 total population. The adjusted rate for comparison with other areas being 17.7. The rate of 17.9 is .1 lower than that for 1957, but is well above the figure of 16.4 for England and Wales as a whole. 1,319 live births were registered in the Urban District during the year, as against 1,302 in 1957. The illegitimate birth rate was 29.0 per 1,000 live and still births. There were 36 illegitimate live births, 19 being males and 17 females. Twenty-four stillbirths were registered, giving a rate of 0.33 per 1,000 total population and 17.87 per 1,000 live and still births. Seven of the stillbirths were males and seventeen females. Deaths. 747 deaths appertaining to the Urban District were registered during 1958, giving a Death Rate of 10.1 per 1,000 total population. The adjusted rate for use when comparing one area with another is 11.3. The rate for England and Wales as a whole is 11.7. Of the Orpington deaths registered, 388 were males and 359 females. Death rates for Orpington for the past ten years are as under: Year Rate (Crude) 1949 10.7 1950 10.6 1951 10.4 1952 8.9 1953 9.8 1954 7.8 1955 9.1 1956 9.2 1957 8.7 1958 10.1 The following is an analysis of the ages at death: Under 1 year of age 27 1 and under 5 years of age 3 5 and under 15 years of age 7 15 and under 25 years of age 7 25 and under 35 years of age 7 35 and under 45 years of age 20 45 and under 55 years of age 56 55 and under 65 years of age 102 65 and under 75 years of age 176 75 years and over 342 747 13 Full details of the causes of death will be found in Table II in the appendix, but the following table, which gives details of certain causes of death in the Urban District during the past ten years, may be of interest: 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Cancer (all sites) 99 114 120 85 108 108 134 131 131 158 Cancer of the lung and bronchus * 20 19 9 19 25 23 34 33 38 Heart and Circulatory Diseases 310 342 293 293 285 320 262 264 284 328 Respiratory Diseases (exclud. Tuberculosis) 63 66 76 77 81 44 79 135 88 119 Tuberculosis 18 11 19 11 10 5 6 7 4 4 Infectious Diseases 10 1 — 2 4 1 2 1 1 3 Road Accidents 7 9 10 4 5 8 6 6 5 10 Other accidents 10 9 14 6 3 2 8 10 8 10 *no figures available. Perhaps the most striking feature of these figures is the relatively insignificant place now occupied by the infectious diseases including tuberculosis, which together were responsible during the year for less than 1% of the total deaths. This was, for example, fewer than those attributable to either road or home accidents, and the very low figure of 4 deaths from tuberculosis attained last year was again reached. This is a tribute to preventive measures in their widest sense, from specific immunising procedures to an improved standard of living, together with environmental factors that are often taken for granted such as housing, the safe disposal of sewage and refuse, and purity of the water supply. While advancing knowledge of the causes of other diseases brings new hope of, and new scope for, prevention in other fields, it is becoming clear that unless advances in knowledge are followed by corresponding advances in public opinion, little benefit will be derived. In this connection reference is made in my introductory letter to the growing problem of cancer of the lung, and as will be seen from the table, the number of deaths due to this condition rose to 38 compared with 33 last year. The significance of this lies not in the magnitude of the increase, which is small, but rather in the fact that it continues an almost unbroken trend. Compared with last year, there were also similar small increases in deaths from cancer (all sites), respiratory and circulatory diseases. The overall death rate remained satisfactory, the level being below that for England and Wales as a whole, though the factors mentioned above led to a small increase compared with the previous year. 14 Local Sickness. The following is a summary of the weekly details received from the Ministry of National Insurance during 1958: Four weeks ending Number of First certificates of incapacity received 28th January 1,417 22nd February 1,044 25th March 909 22nd April 672 20th May 609 17th June 446 15th July 518 12th August 416 9th September 389 7th October 617 4th November 816 2nd December 760 30th December 670 The above figures followed the expected trend, namely, the highest incidence of illness occurred during January and February, the lowest level was reached in August, after which it began to rise again. Medical Examinations. One hundred and forty-one examinations of members or potential members of the staff were carried out during the year. Unemployment. 1 am indebted to the Manager of the Orpington Employment Exchange for the following information with regard to unemployment in the area during 1958: "The position in early January, 1958, showed a continuation of a steady increase in the numbers unemployed which began in August, 1957, and the January figures were the highest for nearly two years. As the year advanced so the numbers increased until April, and then a slight improvement occurred which was maintained well into September, and mainly due to the demands of the Building Industry. The last quarter began with a substantial increase again equal to the April figures and a steady increase continued into early December, when the demands of the Christmas trade and the extra Post Office work provided a welcome if short respite, and the year closed with the total 22% higher than that with which it opened. The year over-all was one of fewer opportunities in local industries and a consequent decrease in the turnover of labour." Open Air Recreational Amenities. Approximately 283*6 acres of land have been secured for public recreational purposes within the Urban District, as under: — 15 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 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 1958 are as under: — Disinfections— Premises visited 27 Rooms disinfected 38 Articles disinfected 204 Disinfestations— Premises visited 28 Rooms disinfested 34 Articles disinfested . 144 Articles treated. Articles destroyed. Beds 52 — Mattresses 48 4 Bolsters 16 — Pillows 50 — Cushions 9 — Bed Clothes (batches) 25 — Carpets 23 — Hangings 55 — Clothes (batches) 19 — Library Books 6 — Other Books 45 — Easy Chairs — 2 348 6 19 In the case of disinfection, rooms and furniture are treated with Formaline 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 1958: — Faeces 106 Food Samples, etc. 216 Throat and Nose Swabs (H.S.) - Water Samples 57 Fertilizer Samples — Miscellaneous — 379 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, two 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. 21 Domestic Help Service. The District Organiser's office is at 102a, High Street, Orpington. The following is a summary of the cases assisted during 1958:— Maternity (Expectant Mothers) 151 Tuberculosis 10 Aged 249 Others 201 Total 611 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. Twenty-two cases were assisted during 1958. Evening and 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. Fourteen cases received assistance during the year. Child Help Service. Assistance under this service was given to two (problem) families in the area during 1958. District Nursing Service. There are six District Nurses and four District Nurse Midwives employed in the area. No night service is provided. The services of a District 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 district. In addition to their school work, Health Visitors are responsible for the Maternity and Child Welfare Clinics, Home Visiting, Mental Health Visiting, Immunisation and Vaccination Clinics, etc. 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. 22 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. Women's Voluntary Service. The County Organiser has kindly furnished the following information:— " .Meals on Wheels." Orpington served 6,400 meals during the year 1958, an average of 123 per week. The old people pay 1/- per meal and no subsidy is taken from any source whatsoever towards the cost of the meal. A free dinner for 78 was served at Christmas. They received a donation from Alexandra Rose Day which has been used to maintain their van. The service covers Orpington, Farnborough, Petts Wood, Chelsfield, St. Mary Cray, Cudham and Knockholt. During the year they have had three very sick women to care for, which has entailed delivering meals five days a week in special containers. Darby and Joan Clubs. The two clubs continue to flourish, one has a membership of approximately 45 and the other 75. Both are run on the same lines —various forms of entertainment parties and outings are arranged for them. A local resident generously gave a free outing and free lunch to the members of the Farnborough Club. General Welfare Work. Many visits are paid to local old people. The Hospital Almoners frequently call upon W.V.S. members to visit lonely old people in hospital. The Trolley Shop is greatly appreciated by the old people in the geriatric units. The Orpington W.V.S. members also assist with the Occupation Therapy in the psychiatric ward, which is very beneficial to some of the old people; this is done by specially chosen members. 243 escorts by car have been carried out during the year. Wheel chairs and other medical equipment are loaned free of charge. 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 23 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. The close working arrangements with the Health Visitors of the district established last year through the good offices of the County Medical Officer of Health have continued, and the two Health Visitors who joined the Committee have given valuable service." 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, and for most old age pensioners 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 Hill Thursday—afternoon. Downe Village Hall 1st & 3rd Friday in month —afternoon. Farnborough Methodist Hall Friday— afternoon. Green-Street-Green Baptist School Room Friday—morning. 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 Avenue Monday & Thursday— afternoon. St. Mary Cray Temple Congregational Church Hall Tuesday & Wednesday —afternoon. Pratts Bottom Village Hall 2nd & 4th Thursday in month—afternoon. Poverest Coronation Hall, Bridge Road, St. Mary Cray Each Thursday afternoon. 24 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 1st, 3rd and 5th Tuesday Avenue afternoon, 1-2.30 p.m. Wednesday afternoon, Relaxation Class. St. Mary Cray Temple Congregational Friday—afternoon. Church Hall Minor Ailment Clinics (Schools). The School House, Orpington Every Saturday—morning Chislehurst Road Dental Clinics. The School House, Orpington Monday, Tuesday, Wed- Chislehurst Road nesday, Thursday and Friday—all day. Saturday—morning. Dentist attends full time each day. 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. The main object of this Act is to make provision for securing the safety, health and welfare of farm workers and avoiding accidents to children arising out of the use of agricultural equipment. No contraventions were found during the course of the year. Atmospheric Pollution—Clean Air Act, 1956. On the 1st June, 1958, the remaining provisions of the Clean Air Act, 1956, came into force and after that date industrial and commercial premises were required to operate their plants with a minimum emission of dark smoke. There are many light industries in the northern part of the district, particularly in a small area at St. Mary Cray, and during the year 174 observations and visits were made by the Public Health Inspectors to these industrial premises but in only nine cases was it necessary to call attention to infringements. The district, with its many open spaces, parks and recreation grounds, is not subject to heavy smoke pollution, particularly in the southern part of the area which is rural in character. The measurement of atmospheric pollution is carried out in co-operation with the Fuel Research Station. There are two sites in the district at which instruments are installed, one being a Deposit Gauge for the measurement of solid matter suspended in the atmosphere and the other a Lead Peroxide Cylinder for the measurement of sulphur dioxide. 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 a copy of the reports forwarded to them. Many districts throughout the country are undertaking this work and the information thus gathered has proved most valuable to the Department of Scientific and Industrial Research. 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. 27 Cesspools. The work of abolishing cesspools where premises served by this type of drainage are within 100 feet of a public sewer has proceeded steadily throughout the year. Seventy-five cesspools have been abolished and approximately forty of these were on the line of recently constructed sewers. There is close liaison with the Engineer and Surveyor's Department, where private street works include the installation of a sewer so that owners of properties fronting the proposed sewer can be notified and given ample time to prepare plans, etc. in order to make a connection to the sewer at the time of its construction or in any case before the road is finally made up. Owners taking full advantage of this prior notification can, of course, effect an appreciable saving in cost. Sixteen formal notices under Section 23 of the Orpington Urban District Council Act 1954 were served upon owners during the year. This notice requires the owner of premises to abolish the existing system of drainage and to make a connection to the public sewer. Number of cesspools at 31st December, 1958. (1) On line of sewer 123 (2) Not on line of sewer 2,342 Number of cesspools abolished and main drainage provided during the year 75 Number of houses with pail closets converted to cesspool drainage — Number of new houses erected with cesspool drainage 32 Number of loads removed from cesspools: — On private properties 4,899 On requisitioned properties 100 On Council properties 675 5,674 Complaints. During the year, 58 complaints were received from residents and in only one case was it necessary to take formal action to secure abatement of the nuisance. In the case mentioned, the owner failed to comply with the Statutory Notice requiring the abatement of a nuisance caused by disrepair. Proceedings were instituted and the Court made a nuisance order requiring the defendant to comply with the abatement notice. The defendant was also ordered to pay £3 3s. costs. 28 Diseases of Animals (Waste Foods) Order, 1957. Briefly the object of this Order is to prevent the spread of Foot and Mouth and other diseases of animals. The Order provides, inter alia, that where persons collect waste foods for feeding to other animals or poultry, the foods must first be boiled for one hour in a Plant licensed by the Local Authority. Thirty-eight Boiling Plants were licensed during 1958. 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— 1,728 lineal yards of 6" Foul Water Sewer. 109 lineal yards of 9" Foul Water Sewer. 110 lineal yards of 9" Surface Water Sewer. Council Construction— 547 lineal yards of 6" Foul Water Sewer. 4 lineal yards of 9" Foul Water Sewer. Factories Acts, 1937 and 1948. There are 144 factories on the Council's register at the present time. Eighty-two visits of inspection were made by the Public Health Inspectors during the year. Only one defect or contravention was found and this was abated. The following is a copy of the return relating to the year 1958 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 Section 1, 2, 3, 4 and 6 are to be enforced by the Local Authorities 14 2 — — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 116 70 2 — (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 14* 10 — — 144 82 2 — Building sites on Estate development. 29 2. Cases in which defects were found. Number of cases in which defects were Number of cases in which prosecutions were Instituted Referred Found Remedied to H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): (a) Insufficient — — — — — (b) Unsuitable or defective 1 1 — 1 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — Total 1 1 — 1 — Outworkers. Seventeen 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 83 Cardboard Boxes 7 Jewellery 1 Surgical Appliances 2 93 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 1958, and nineteen 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. 30 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 Number of of inspections. Infestations cleared. Local Authority's property 67 12 Dwelling houses (incl. Council Houses) 5,128 467 Business premises 130 19 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 June. 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 1958. 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 1,988 121 Infectious Diseases 282 — Food Premises 1,925 95 Factories, Outworkers, etc. 256 10 Rodent Control 172 121 Trade Premises 463 45 Miscellaneous 1,044 9 6,130 401 Shops Act, 1950. During the year, 285 inspections of shops were made and the following contraventions were found and remedied by the shopkeepers: Neglect in displaying Statutory Forms 36 Inadequate Heating 1 Inadequate Sanitary Accommodation 2 Inadequate Lighting 2 Inadequate facilities for meals 1 31 Swimming Baths and Pools. One visit of inspection was made by the Public Health Inspectors to the swimming bath in the district to which the public are admitted. A sample of the water was taken and this proved to be entirely satisfactory. Verminous Conditions and Uncleanliness. No cases of unclean premises were found during the year, but 28 verminous premises were dealt with by the Department's Disinfector. Water Supply. During the year, the opportunity was taken of carrying out a survey of premises without mains water in the district and it has been necessary to adjust the figures shown in my 1957 Annual Report. The premises without mains water are situated in the large agricultural area at the southern end of the district, and of approximately 24,000 dwellings only 22 premises are situated where a main piped water supply is not available in the road fronting their premises. These are in isolated parts of the district and are generally dependent upon rainwater collected from roofs and stored in underground tanks. Three premises obtain their source of supply from a private well. Twenty-three premises are not connected to a main water supply although it is available in the roads to which they front. Some of these premises are a considerable distance from the road, but 16 are within 80 feet of the Metropolitan Water Board main, and in respect of six of these the Council have resolved to provide a supply of water in default of action by the owners. Fifteen week-end bungalows are not connected to a main water supply. During the year, it was necessary to serve 11 Statutory Notices, five of which were complied with during the course of the year. The total of 43 premises still dependent upon underground tank or well supply is made up as follows: — Ward Number of premises with Stored Rainwater Wells Biggin Hill 30 — Chelsfield 3 — Cudham 2 — Downe 3 — Farnborough 2 1 Green-Street-G reen 3 — Knockholt 1 — 44 1 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. Fifty-four samples were taken and the Analyst's reports show that they were all satisfactory. The Director of Water Examination, Metropolitan Water Board, has kindly reported on the water supply to the Urban District during the year 1958: — "The supply to the district of Orpington during 1958 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 the area. North Orpington new borehole was not in service during 1958. 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 1958, including analyses of water before treatment." 33 Result of the Bacteriological Examination of the Water Supplied to Orpington during the Year 1958. Parts per million (unless otherwise stated) BACTERIOLOGICAL RESULTS Before Chlorination After Chlorination (Water Passing into Supply) Plate Count (Average per ml.) Colonies counted on agar Conform Test Percentage samples negative in 100 ml. Coliform E. Coli Plate Count (Average per ml.) Colonies counted on agar Coliform Test Percentage samples negative in 100 ml. Coliform E. Coli 37 °C (20-24 hrs.) 22°C. (3 days) 37°C. (20-24 hrs.) 22°C. (3 days) Orpington Well 0.1 16.0 94.78 99.60 0.1 20.4 100.0 100.0 N. Orpington Well 2.9 32.2 1.32 14.54 1.8 23.3 99.57 100.0 Shortlands No. 1 0.1 1.9 97.39 99.13 0.1 5.5 100.0 100.0 Shortlands No. 2 0.1 13.0 96.60 97.96 Shortlands No. 3 0.1 4.0 97.91 99.16 Jewels Wood Well 0.2 4.3 94.34 94.97 0.1 8.7 99.39 100.0 Sundridge No. 4 0.8 24.7 98.56 99.28 0.04 3.0 98.81 100.0 Westerham Well 0.3 15.0 99.20 100.0 0.1 5.5 94.14 100.0 Lullingstone Well 0.1 4.3 100.0 100.0 0.1 6.6 97.09 100.0 Eynsford Well 0.4 65.5 75.00 96.25 01. 40.0 98.86 100.0 Eynsford Bore 0.1 45.7 93.48 99.28 0.03 11.4 100.0 100.0 Horton Kirby Well 0.4 8.3 93.03 96.31 0.3 16.7 99.60 100.0 Thames derived — — — — 9.7 — 99.07 99.88 34 Average Results of the Chemical Examination of the Water supplied to Orpington during the Year 1958. Milligrammes per litre (unless otherwise stated) Description of the Sample Ammonia Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen abs. from Permanganate 4 hrs. at 27°C. Turbidity in terms of Silica Colour, m.m. brown 2 ft. Tube Burgess's Tintometer Nitrite Nitrate Orpington well Nil 0.025 — 6.9 15 0.05 Nil Nil N. Orpington well Nil 0.018 —— 5.2 14 0.07 Nil Nil Shortlands No. 1 Nil 0.017 — 5.1 17 0.03 Nil Nil Shortlands No. 2 Nil 0.025 .— 5.0 16 0.03 Nil Nil Shortlands No. 3 Nil 0.020 — 5.2 18 0.05 Nil Nil Jewels Wood well Nil 0.018 — 3.4 12 0.04 Nil Nil Sundridge No. 4 well 0.002 0.016 — 3.2 17 0.11 Nil Nil Westerham well 0.006 0.018 — 4.9 14 0.10 Nil Nil Lullingstone well 0.002 0. 021 — 3.3 15 0.08 Nil Nil Eynsford well 0.002 0.030 — 4.8 17 0.08 01 Nil Eynsford bore 0.003 0.020 — 3.3 15 0.06 Nil Nil Horton Kirby well 0.002 0.018 — 5.0 17 1.12 Nil Nil Thames derived 0.027 0.077 — 4.2 26 1.26 0.3 12 Description of the Sample Hardness (Total) Hardness (noncarbonate) pH. Value Phosphate as PO4 Silicate as SiO4 Sulphate as so4 Fluoride as F Magnesium as Mg. B.O.D. 5 days at 20°C. Electrical Conductivity (gemmhos) Orpington well 272 36 7.2 — — — 525 N. Orpington well 260 20 7.3 — — — 500 Shortlands No. 1 278 60 7.2 — — — 525 Shortlands No. 2 278 58 7.3 — — — 525 Shortlands No. 3 284 72 7.3 — — — 550 Jewels Wood well 242 16 7.3 — — — 450 Sundridge No. 4 well 210 42 7.4 — — — 425 Westerham well 262 34 7.2 — — — 475 Lullingstone well 242 22 7.3 — — — 450 Eynsford well 268 40 7.3 — — — 475 Eynsford bore 254 32 7.3 — — — 450 Horton Kirby well 262 42 7.3 — _ — 500 Thames derived 270 66 7.9 0.85 9 58 0.15 5 — 550 SECTION D. HOUSING. 36 SECTION D. HOUSING. Clearance Areas and Individual Unfit Dwellings. It was stated in my report for the year 1957 that there remained 66 unfit dwellings to be dealt with under the Council's five-year post-war programme for Slum Clearance. Thirty-five of these dwellings were contained in proposed Clearance Areas and 31 were individual unfit dwellings. During the year under review, eight individual houses have been dealt with and the detailed inspection of nine houses in three Clearance Areas completed. The number of unfit properties which can be dealt with in one year is limited as the programme is dependent upon the number of Council houses available for re-housing the displaced persons. There is no reason to doubt, however, that the total number of houses can be dealt with within the five years allotted for the task. Rent Act, 1957. Applications for Certificates of Disrepair dropped from an average of ten per month, last year when the Act came into force, to three per month for the year ending December, 1958. If the permitted increases in rents have been applied generally by landlords of "controlled" properties, it can only be assumed that the Act is working as intended and that tenants and landlords are reaching agreement on the question of necessary repairs without recourse to the Local Authority. During the year, 38 applications were received. In 22 cases, undertakings were received from landlords to remedy the defects, but in the remaining 16 cases Certificates of Disrepair were issued to tenants. Housing Statistics for the year 1958. Total number of valuation assessments, houses and flats, at 31st December, 1958 23,463 (1) (a) Total number of dwelling houses inspected for housing defects (under the Public Health or Housing Acts) 181 (b) Number of inspections made for the purpose 676 (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 17 37 (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 126 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 110 Number of dwelling houses demolished during the year 40 Moveable Dwellings. During 1958, three licences were renewed and one new one granted, embracing a total of 111 caravans and ten tents. For the winter months, four licences, covering a total of 111 caravans were also issued. One hundred and fifteen visits were made to the various sites by the Public Health Inspectors. 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 During Total as at 1958 1958 Dec. 1958 1. (a) Number of permanent dwellings built by Local Authority (excluding 402 old type pre-1939 council houses) 2,227 87 2,314 (b) Number of pre-fabricated dwellings built by Local Authority 319 — 319 (c) Number of dwellings requisitioned by Local Authority 2 — 2 2. (a) Number of families occupying 1(a) 2,314 and 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 1958 in (a) 87 (b) Nil (c) Nil 4. Number of families on waiting list at 31st December, 1958, in various categories:— (a) Families in urgent need of other accommodation 55 (b) Families whose applications require early consideration 256 (c) Families whose applications are less urgent 231 542 (d) Families with varying degrees of housing need 300 5. Number of families on waiting list living in overcrowded conditions; it is not possible to give an exact figure in this connection, but approximately 331 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. During the year, food premises were subject to routine and specialised inspection and a total of 1,925 visits were made, as shown in Table VII in the appendix. Five hundred and nineteen of these visits were made in connection with the Food Hygiene Regulations which were brought into force in January, 1956, to assist in reducing to a minimum the risk of food poisoning by the stricter use of hygienic practices. Largely owing to the happy relations we have with the proprietors and managers of the food premises in the district. I think we can safely say that progress has been made in 1958. Food and Drugs Act, 1955. Food Sampling. Details of the 216 Informal Samples of food and drugs taken for analysis are as follow: — Food and Drugs Sampling. Slumber examined Number unsatisfactory Formal Informal Formal Informal Aspirins — 2 — — Ammoniated Tincture of Quinine — 2 — — Bacon — 2 — — Beef Suet — 4 — — Borax — 1 — — Butter — 3 — — Bismuth Lozenges — 1 — — Bronchial Tablets — 1 — — Baking Powder — — — Beef Sausages — 1 — — Buttered Cheese Spread — 1 — — Butter Sweet Confectionery — — — — Compound Codeine Tablets — 1 — — Creamed Rice Milk Pudding — 1 — — Cooking Fat — 1 — — Curry Powder — 1 — — Currants — 1 — — 41  Number Formal examined Informal Number Formal unsatisfactory Informal Devonshire Splits — 1 — — Fish Paste — 14 — — Gin — 1 — — Golden Raising Powder — 1 — — Ground Almonds — 1 — — Glucose D — 1 — — Ham, Beef and Tomato Paste — 1 — — Instant Pudding — 1 — — Iodized Blackcurrant Pastilles — 1 — — Jam — 3 — 1 Lard — 1 — — Lemon Flavouring — — — — Lemon Squash — 1 — — Lime Juice Cordial — 1 — — Lung Syrup — 1 — — Malt Vinegar — 2 — — Margarine — 5 — — Meat Paste — 12 — — Mentholated Balsam — 1 — _ Milk — 72 — — Milk of Magnesia — 1 — — Mint Jelly — 1 — — Minced Turkey — 1 — — Mixed Pickling Spice — 1 — — Mustard — 1 — — Night Cough Pastilles — 1 — 1 Olive Oil — 1 — _ Orange Food Colouring — 1 — — Orange Drink — — — — Pepper — 1 — — Piccalilli — 1 — — Pilchards in Tomato — 1 — — Pheasant Savoury — 1 — — Pork Sausages — 1 — — Processed Bacon and Cheese — 1 — 1 Real Minced Turkey — 1 — 1 Salmon Spread — 1 — — Salad Cream — 4 — — Sauce — 2 — 1 Sardines — 1 — — Self-Raising Flour — 6 — — Soup — 9 — 2 Sponge Mixture — 2 — — Strained Veal — 1 — — Sunny Spread — 1 — — Syrup of Figs — 1 — — Table Jelly — 3 — — Tea — 1 — — Tinned Strawberries — 2 — 1 Tomato Ketchup — 3 Tomato Chutney — 1 — — Whisky — 4 — — — 216 — 6 42 Serial No. Article Formal or Informal Nature of adulteration Observations 663 Real Minced Turkey Informal Inferior— Turkey Meat 55% Deficient in meat. Letter to manufacturers, who agreed to co-operate in maintaining correct standard in subsequent productions. 676 Tinned Strawberries Informal Inferior— Contained grit and calex parts. Letter to Company, who expressed regret and gave reasonable explanation as to source of contamination. 725 Cream of Mushroom Soup Informal Inferior— Fat 11% Not entitled to designation of "Cream." Letter to manufacturers. Label to be changed to omit word "Cream." 760 Processed Bacon and Cheese Informal Inferior— Did not comply with recommendations of Food standards for moisture in processed cheese. Manufacturers agreed to amend label to read "Cheese and Bacon Spread." 778 Cream of Leek Soup Informal Inferior— Fat 11.2% Manufacturers agreed to modify label to omit the word "Cream." 803 Strawberry Jam Informal Inferior— Fermented. Letter to wholesalers, who agreed to report matter to Polish manufacturers. 43 Food Hygiene Regulations, 1955. There were no prosecutions under the above Regulations during 1958. A total of 519 inspections were made by the District Inspectors during the year. As a result of these inspections, 53 informal notices were served on the proprietors, and by the end of the year the following works had been carried out at various food premises: — Walls and ceilings cleansed 5 Structural repairs 1 Food protected from contamination 3 Sanitary accommodation— hand washing notices affixed 2 Additional sinks provided 2 Wash-hand basins provided 6 Hot water supply provided 8 First aid equipment provided 1 Clothing accommodation provided 1 Lighting improved 3 Ventilation improved 1 Refuse storage 2 Transport conditions improved 1 Soap, towels and nailbrush provided 2 Non-absorbent surfaces provided for working tables 1 Miscellaneous 4 Food Complaints. Eighteen complaints of unsound condition and/or contamination of foodstuffs were received from the public during the year as under:— Apricot Pie 1 Bacon 1 Baked Beans 1 Beef Chipolatas 1 Bread 2 Butter 1 Cream 1 Luncheon Meat 1 Meat Pie 3 Milk 3 Spam 1 Strawberry Jam 1 Strawberries (tinned) 1 18 44 Special Samples of Milk, Ice Cream, Water and Egg Products. In addition to the samples previously mentioned, a further 194 samples were taken for bacteriological and pathological examination and other special tests as under:— Milk (Pasteurised) Phosphatase Test 41 Milk (Sterilised) Turbidity Test 31 Ice Cream—Bacteriological and Pathological Examination 33 Water—Bacteriological Examination 54 Water—Chemical Examination 2 Imported Egg Products 33 194 Ice Cream. At the end of the year, 169 premises were registered for the storage and sale of ice cream, but none for the manufacture of this commodity. Eighty-four inspections were made and conditions were found to be satisfactory. Thirty-three samples were sent for bacteriological and pathological examination. The following is an analysis of the results obtained during the past three years: — Year No. of Samples taken Result Grade I Grade II Grade III Grade IV 1956 34 20 12 1 1 1957 30 22 8 — — 1958 33 30 2 1 — No pathogenic organisms were round in any or the 33 samples, and the bacteriological grading was highly satisfactory. Food Premises. Bakers and Confectioners 13 Butchers 49 Chemists 21 Clubs and Hotels 7 Confectionery 61 Cooked Meat Shops 1 Dairies 12 Fishmongers (Wet, Dried and Fried) 20 Greengrocery 51 Grocery 92 Hospitals 2 Industrial Canteens 16 Public Houses 43 Restaurants, etc. 49 School Canteens 15 Slaughterhouses 5 Street Vendors 8 465 45 Food and Drugs Act, 1955—Section 16. Two hundred and fourteen shops and food premises have been registered under the above Act, as under:— Ice Cream Stores 169 Fish Shops 7 Butchers' Shops 37 Fish and Meat Paste Factory 1 214 Unsound Food. During the year a total of 35 tons 5 cwts. 15 lbs. of varied articles of food were condemned and 639 Food Condemnation Certificates were issued. 86 lbs. Bacon. 91 lbs. Biscuits. 20 lbs. Butter 87 lbs. Bread. 274 lbs. Cereals. 78 lbs. Cheese. 60 lbs. Chickens. 2 lbs. Coffee. 24 lbs. Cooking Fats. 8 lbs. Cream. 25 lbs. Cake. 188 lbs. Fish. 36 lbs. Fish (Tinned). 59 lbs. Flour. 26 lbs. Fruit Pies. 549 lbs. Fruit (Tinned). 25,373 lbs. Fruit. 73 lbs. Fruit (Dried). 10 lbs. Kidneys. 735 lbs. Meat (Tinned). 733 lbs. Meat. 29 lbs. Meat Paste. 22 lbs. Meat Pies. 136 lbs. Milk (Tinned). 36 lbs. Nuts. 7 lbs. Pickles. 46 lbs. Preserves. 14 lbs. Salt. 33 lbs. Sausages. 1 lb. Sauce. 116 lbs. Soups. 271 lbs. Sugar. 90 lbs. Sweet Confectionery. 6 lbs. Tea. 339 lbs. Vegetables (Tinned). 49,252 lbs. Vegetables. 46 Milk and Dairies Regulations. Twelve dairies have been registered under the above Regulations. Details of the licences issued during 1958 are:— Tuberculin Tested Dealer's Licences 12 Supplementary Licences 2 Pasteurised Dealer's Licences 12 Supplementary Licences 3 Sterilised Dealers' Licences 29 Supplementary Licences 2 Thirty-two visits were made to the dairies in the district during 1958. Slaughterhouses and Slaughtermen. One hundred and eighty visits were made by the Public Health Inspectors to the five licensed slaughterhouses. Licences were issued to 16 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 1958: — Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep & Lambs Pig Number killed 66 21 16 76 1,000 Number inspected 66 21 16 76 1,000 All diseases except Tuberculosis and Cysticerci— — — — — — Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 3 2 — — 43 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 4.5 9.5 — — 4.3 Tuberculosis only— — — — — — Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — 8 Percentage of the number inspected affected with Tuberculosis — — — — 0.8 The total weight of meat condemned was approximately three cwts. one quarter. 47 Restaurants, Hotels and Canteens. Ninety-six visits were made to these premises during the year. In seven cases defects requiring the attention of the owner were dealt with by informal action. Butchers' Shops. One hundred and thirty detailed inspections were made of the 49 retail butchers' shops in the area. The butchers work in close collaboration with the Public Health Department and during the year called upon the services of the District Inspectors in connection with carcase meat suspected of being unsound, as a result of which 773 lbs. of meat was condemned as being unfit for human consumption. In no case was there any evidence of unsound meat being exposed for sale. Bakehouses. Twenty-one inspections were made of the 13 premises during the year, and in only two cases were defects found which required the attention of this department. Merchandise Marks Act. Twenty-five visits were paid to premises during the year in connection with this Act. No contraventions were detected. Game Act, 1831. Two 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. Only 498 notifications of infectious diseases were received during the year, a total which is exceptionally small, and compares with the figure of 2,284 recorded during 1957. By far the greater part of this big reduction is attributable to the fact that 1958, unlike 1957, was not a " measles year." This fact alone accounts for a difference of 1,800 in the total notifications but is, of course, of no particular significance as a pointer to the District's Health. Smaller, but in fact more significant improvements on the previous year, were the falls in the notifications of Tuberculosis and Whooping Cough, and the fact that no cases of dysentery were reported during the year. The total number of poliomyelitis cases was very small, numbering only four, compared with seven in 1957, and for the second year in succession, no cases of meningoccocal infections occurred. From the above, it will be seen that the overall picture of the infectious diseases during the year was an eminently satisfactory one. Comment on individual diseases will be found in the subsequent paragraphs. Acute Anterior Poliomyelitis. During the year only four cases were notified, as against seven in the previous year. Three cases were confirmed as being paralytic and one nonparalytic, and all were admitted to hospital. One death from acute poliomyelitis was recorded. The following figures, which have been supplied by the County Medical Officer, show the numbers of Orpington residents who were vaccinated against this disease in 1958: — Year of Birth Given two injections Given third injection 1958 142 — 1957 902 55 1956 862 184 1955 827 148 1954 783 141 1953 748 103 1952 677 102 1951 666 103 1950 436 118 1949 410 135 1948 390 120 1947 463 116 51 Year of Birth Given two injections Given third injection 1946 917 11 1945 718 10 1944 701 11 Others 1,392 52 11,034 1,409 Diphtheria and Diphtheria Immunisation. For the ninth consecutive year, I am pleased to be able to report a complete absence of this disease in the Urban District. The County Medical officer has kindly furnished the following information with regard to diphtheria immunisation. Of the children resident in the area who were born since 1943, a total of 1,164 received primary inoculations and 533 received reinforcing inoculations during 1958. A total of 10,980 children under the age of 15 years on 31st December, 1958, have completed a course of immunisation at some time prior to that date. Dysentery. No cases of dysentery were notified during the year. Compared with 33 in 1957, even when allowance is made for the possibility of some undetected cases, the situation can be considered eminently satisfactory, especially in view of the unusual prevalence of this complaint in recent years. Food Poisoning. Sixty-five single cases were notified during the year, 13 being removed to hospital. In six cases, the agent was identified as Salmonella Typhimurium, and in two cases as Staphylococci. The following is a copy of the annual return of Food Poisoning notifications (corrected) forwarded to the Ministry of Health. (1) First Quarter 27 Second Quarter 15 Third Quarter 11 Fourth Quarter 12 65 (2) Cases otherwise ascertained Nil (3) Fatal cases Nil (4) Particulars of Outbreaks Nil (5) Single cases: Agent identified: Salmonella Typhimurium 6 Staphylococci 2 Unknown 57 (6) Salmonella Infections, not food-borne Nil 52 The majority of these notifications were of suspected cases of food poisoning, which were not confirmed by the subsequent investigations. This is not to say, however, that there is any room for relaxation, but rather plenty of room for improvement in the care with which we handle our food. This, of course, is just as important in the home as elsewhere, indeed it seems that the exponents of Mrs. Beeton's art must look to their laurels in this respect, as most of the cases reported this year were within the confines of the family circle. Undoubtedly the answer to this unpleasant and sometimes serious illness, lies in constant awareness of the need for scrupulous cleanliness, particularly of the hands, whenever and wherever food is prepared. Measles. Seventy-four cases were notified during the year, only three being admitted to hospital. This figure is a big decrease on the 1,874 cases which occurred during 1957. No deaths from this disease were recorded in the area in 1958. This big reduction in cases of measles was to be expected following a year in which the incidence was high, and the cases that occurred were generally of a mild character. Meningococcal Infections. No cases occurred in the area during 1958. Pneumonia. Thirty-three cases of pneumonia were notified during 1958, as against 17 cases in 1957, four cases being admitted to hospital. There were 83 deaths from pneumonia. This figure includes people who were normally resident in the Urban District, but who died outside the area. Scarlet Fever. Twenty-nine cases were notified during the year, two of which were removed to hospital, and the remainder home nursed. This is practically the same number of notifications as was received during 1957. There were no " return cases " and no deaths occurred from this disease during 1958. The mild characteristics of this disease in recent years were retained, a change that is illustrated by the fact that the great majority of cases are now successfully nursed at home. This is in marked contrast with the situation in, say, 1934, when of the 86 cases, 73 were admitted to hospital. As the disease is now generally so mild, it is no longer the routine practice to exclude child contacts from school, and this policy seems to have been amply justified by the continued low incidence of this disease. 53 Smallpox and Vaccination. No cases of smallpox occurred in this area, neither were any suspected contacts of this disease brought to the notice of the department. During the year, 377 International Certificates of Vaccination passed through the hands of the department for purposes of authenticating doctors' signatures. The County Medical Officer informs me that a total of 903 residents in the Urban District received primary vaccination and 118 re-vaccination during 1958. Tuberculosis. The following is a copy of the recordings in the register at 31st December, 1958: — Respiratory. Other Forms. Total No. of cases. M. F. M. F. On Register at 1st Jan., 1958 498 429 69 76 1,072 New cases notified during 1958 20 23 2 1 46 Number of cases coming to knowledge after death — 2 1 — 3 Restored to Register 1 1 — — 2 Inward Transfers 20 28 — 2 50 539 483 72 79 1,173 Deletions, deaths, removals, recoveries, etc. 32 31 1 — 64 507 452 71 79 1,109 New Cases and Mortality, 1958. Age Groups New Cases notified or otherwise revealed. (Not including Inward Transfers)* Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 5 2 _ — — — 1 — 5-14 — 3 1 — — — — — 15-24 — 5 — — — — — — 25-44 7 11 1 —_ — — — — 45-64 9 3 — 1 3 2 — — 65 and over 3 — — — 2 1 — — Age unknown — — — — — — — — 21 22 2 1 5 3 1 — •Inward Transfers 20 28 — 2 41 50 2 3 54 The number of new cases of tuberculosis notified during the year was 46. One of the lowest figures for the post-war years, this compares favourably with the total of 57 in 1957, and is an encouraging indication of the progress made in the control of this disease. 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 1958:— Adults. Children. M. F. M. F. Pulmonary Tuberculosis ... 34 39 — — Non-Pulmonary Tuberculosis — 1 — — Non-Tuberculous 47 49 48 39 New contacts examined during 1958: — Non-Tuberculous, 279. Tuberculous, 2. These contact figures are not included in the above table. B.C.G. Vaccination of Contacts, 99. Number of patients who completed a course of hospital or sanatorium treatment during 1958: 48. Orpington and District Tuberculosis Care Committee. The following report has been furnished by the Honorary Secretary:— " During the year 1958, 45 cases have been helped by the Care Committee, 16 of these being new cases. Several patients were helped to meet commitments entered into before they became ill, which enabled treatment to be accepted with a minimum of worry. Two cases were sent away for holidays through the SPERO Holiday Scheme. At Christmas time 49 parcels were distributed to patients whose names are on our books and to those who were in hospital. During the year two Committee members have periodically visited patients in local hospitals, also distributing magazines and cigarettes in needy cases. The financial aspect of the Committee has given rise to a certain amount of uneasiness as money is hard to raise, but the usual activities such as Flag Days, etc., were organised." 55 Public Health (Prevention of Tuberculosis) Regulations, 1925. Section 172, Public Health Act, 1936. No action was taken by the Local Authority under these Regulations during 1958. Typhoid and Para-Typhoid Fever. Six cases of Para-Typhoid Fever occurred during the year, five being from one family. All cases were admitted to hospital for treatment. The source of infection of the family was not discovered. The other case was associated with an outbreak which occurred in another district. There were no deaths from this disease in the Urban District during 1958. Mass X-ray. No Mass X-Ray survey was undertaken in the area during 1958. A new service, now available to Orpington residents, offers a regular X-ray check to men over the age of 45, as a form of insurance against lung cancer. The earlier this disease is discovered, the better are the chances of successful treatment, and a regular chest X-ray examination offers the best chances of early detection. Those taking advantage of these arrangements, which are made by the South East London Mass X-Ray Service, will receive appointments for a chest X-ray every six months at places convenient to them. This service offers such obvious benefits that its popularity ought to be assured, especially at a time when the number of deaths from this disease is tending to increase from year to year. More than 30 Orpington men died from lung cancer during 1958 as compared, for example, with only two from pulmonary tuberculosis; early detection by Mass Radiography has played no mean part in the conquest of the latter disease, and this gives added reason to hope that similar success can be achieved in this additional field. Whooping Cough. One hundred and fifty-two cases were notified during the year, as against 228 cases in 1957. Only two cases were admitted to hospital for treatment. Though generally mild, whooping cough can still be a prolonged and unpleasant illness, sometimes serious, especially in the first year of life. The value of immunisation in preventing or modifying the attacks is now well proven, and this represents 56 another noteworthy advance in protecting the health of the younger generation. No deaths from this disease were recorded in the area during 1958. The County Medical Officer informs me that 1,467 children resident in the Urban District were immunised against Whooping Cough in 1958. Other Infectious Diseases. In addition to those previously mentioned, notifications were received as under: — Erysipelas—1 case which was admitted to hospital. Puerperal pyrexia—87 cases (86 were institutionally treated and 1 home nursed). Ophthalmia Neonatorum—1 case. This was home nursed and made a complete recovery. SECTION G. REFUSE COLLECTION AND DISPOSAL. 58 SECTION G. REFUSE COLLECTION AND DISPOSAL Mr. Crowe reports: — The collection of household refuse is the one service of the Council which brings the Authority into close contact with its residents each week. It is, therefore, important if complaints are to be avoided to provide a satisfactory and efficient service. Every effort is made to achieve this object and I am pleased to report that a regular weekly service was maintained throughout the whole district during the year with only slight disturbances on a few days immediately prior to and following Bank holidays. It is essential, in my view, to collect regularly on the same day each week and the collecting teams are organised with this in view. The contract for the hire of a refuse vehicle to serve the rural part of the area having been terminated on the 31st March, the entire district is now served by the Council's own vehicles. There are six teams of collectors operating in the district, each team working with two vehicles and drivers. A relay system is operated so that there is no waste of collectors time whilst the vehicle is travelling to the tip to dispose of its load. The work of each team is so arranged that when one vehicle is travelling to and from the tip, all the collectors are engaged on loading the remaining vehicle. In a residential area such as this the distance between the dustbin position at the rear of the premises and the refuse vehicle is, in the majority of cases, considerable. Especially is this so in roads which have a width of grass verge in addition to the footpath. It is for this reason that the collectors are supplied with skips, thus saving one visit to each house. In addition to the collection of household refuse from some 24,000 premises, collection of trade refuse is made from approximately 220 shop premises and offices. A vehicle with driver and a collector are engaged on this work and an annual charge is made for this service. Frequent collections are made each week from the two large hospitals and weekly collections from the numerous schools, vehicles and personnel apart from the normal teams are being engaged on this work. The Council owns a fleet of sixteen refuse collecting vehicles, one of which is of the dual-tip rear loading type and as replacements take place, it is hoped that with the addition of more of these vehicles, the loading will be carried out in a more cleanly manner, especially on windy days. 59 Refuse is disposed of by means of controlled tipping on low lying land of poor agricultural value at Budgins Hill, Pratts Bottom. The refuse is deposited in layer formation, consolidated, covered and sealed in accordance with modern principles of controlled tipping, laid down by the Ministry of Housing and Local Government. The layer formations are arranged so that the final layer merges with the contours of the site. Completed sections are covered with soil and then sown with grass seed. In this way, the beauties of the countryside are not marred and valuable pasture land is provided. Two men are employed at the tip, a Major Tractor Muledozer being used for the levelling process and approximately 19,000 tons of refuse is deposited annually. Forty-seven workmen and one foreman are engaged on the work of collection and disposal and they have worked well under the foreman to whom I am indebted for his excellent and loyal service during the year. The cost of collection and disposal compares favourably with districts of comparable size and characteristics. The net cost per 1,000 population for collection and disposal of house refuse was £558 and the net cost per 1,000 premises for collection and disposal was £1,711. The Abstract of Accounts prepared by the Council's Treasurer for the year ended 31st March, 1959, showed that on a unit basis, the cost of house refuse collection and disposal was £1 15s. Id. per dwelling per annum. APPENDIX. STATISTICAL TABLES. 62 STATISTICAL TABLES, 1958 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, 1958 Population (mid-year, 1958) per Registrar General 73,640 Birth Rate (Crude) 17.9 Death Rate (Crude) 10.1 Maternal Mortality Rate Nil Infant Mortality Rate 20.5 Number of Births (live) 1,319 Number of Stillbirths 24 Number of Deaths 747 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 27 Number of Deaths from Infectious Diseases 3 Death Rates: — Respiratory Diseases 1.62 Tuberculosis 0.05 Cancer (all forms) 2.15 Cancer of the lung 0.52 Infectious Diseases 0.04 Notifications of Infectious Diseases: — Diphtheria — Dysentery — Erysipelas 1 Food Poisoning 65 Measles 74 Poliomyelitis (paralytic) 3 Poliomyelitis (non-paralytic) 1 Puerperal Pyrexia 87 Pneumonia (all forms) 33 Scarlet Fever 29 Tuberculosis (new cases and including Inward Transfers) 96 Typhoid and Para-typhoid Fever 6 Whooping Cough 152 Number of Visits made by the Public Health Inspectors 6,130 64 TABLE II. CAUSES OF DEATH. 1958 1. Tuberculosis—Respiratory 1954 1955 1956 1957 Male/Female Total 5 6 3 3 2 1 3 2. Tuberculosis—Other — — 4 1 1 — 1 3. Syphilitic Diseases 1 — 2 — 2 1 3 4. Diphtheria — — — — — — — 5. Whooping Cough — — — — — — — 6. Meningococcal Infections — — — — — — — 7. Acute Poliomyelitis — 2 1 — 1 — 1 8. Measles — — — 1 — — — 9. Other infective and parasitic diseases 1 — — — 1 1 2 10. Malignant neoplasm, stomach 16 11 17 12 15 9 24 11. Maligant neoplasm, lung bronchus 25 23 34 33 31 7 38 12. Malignant neoplasm, breast 14 15 10 16 — 23 23 13. Malignant neoplasm, uterus 2 5 6 2 — 7 7 14. Other malignant and lymphatic neoplasms 51 80 64 68 32 34 66 15. Leukaemia, Aleukaemia 3 7 3 4 3 3 6 16. Diabetes — 3 3 2 1 3 4 17. Vascular lesions of nervous system 72 74 64 73 26 49 75 18. Coronary disease, angina 105 106 111 96 78 55 133 19. Hypertension with heart disease 8 10 11 16 8 9 17 20. Other heart disease 53 60 50 61 33 35 68 21. Other circulatory disease 24 26 28 38 16 19 35 22. Influenza 1 1 2 4 1 1 2 23. Pneumonia 15 43 70 52 45 38 83 24. Bronchitis 26 31 50 31 21 10 31 25. Other diseases of respiratory system 3 5 15 5 4 1 5 26. Ulcer of stomach or duodenum 6 15 13 6 5 2 7 27. Gastritis, enteritis and diarrhoea 1 2 4 3 2 1 3 28. Nephritis and nephrosis 9 8 4 7 4 2 6 29. Hyperplasia of prostate 5 9 4 9 6 — 6 30. Pregnancy, childbirth, abortion — — — 1 — — — 31. Congenital malformations 6 3 4 7 4 5 9 32. Other defined and ill-defined diseases 47 59 48 56 28 32 60 33. Motor vehicle accidents 8 6 6 5 8 2 10 34. All other accidents 2 8 10 8 6 4 10 35. Suicide 7 5 5 8 4 5 9 36. Homicide and operations of war — 1 2 — — — — All causes 516 624 648 628 388 359 747 65 TABLE III. INFANT MORTALITY, 1958. (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 3 — — — 3 — — — — 3 Congenital Heart Disease 2 — — — 2 — — — 1 3 Prematurity 5 — — — 5 1 — — — 6 Respiratory Diseases 3 — — — 3 1 2 1 1 8 Cerebral Haemorrhage 5 — — — 5 — — — — 5 Other Causes 2 — — — 2 — — — — 2 Totals 20 — — — 20 2 2 1 2 27 66 TABLE IV. NOTIFIABLE INFECTIOUS DISEASES, 1958. Sex and Age Distribution. Disease Totals Under 1 1-2 3-4 5-9 10-14 15-24 25 and over Age Unknown Measles M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 37 37 1 3 13 8 10 12 12 12 — 2 — - 1 — — — Whooping Cough 68 84 5 7 10 17 11 24 37 33 1 3 — — 2 — 2 — Scarlet Fever 16 13 — — — 1 1 1 12 10 3 — — 1 — — — — Poliomyelitis (Paralytic) 2 1 — — — — — — — 1 — — — — 2 — — — Poliomyelitis (Non-Paralytic) 1 — — — — — — — — — — — 1 — — — — — 124 135 6 10 23 26 22 37 61 56 4 5 1 1 5 — 2 — 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. Erysipelas -— 1 — — — — — — — — — — — 1 — — Food Poisoning 36 29 14 8 8 5 — 2 5 12 3 — 4 2 2 — Puerperal Pyrexia — 87 — — — — — 27 — 55 — — — — — 5 Paratyphoid 2 4 — — — 1 — 2 1 1 1 — — — — — Ophthalmia Neonatorum — 1 — 1 — — — — — — — — — — — — Pneumonia 18 15 — 3 3 1 — 1 3 4 11 4 1 2 — — Tuberculosis (Pulmonary) 20 23 2 — — 3 — 5 7 10 9 4 2 1 — — Tuberculosis (Non-Pulmonary) 2 1 — — 1 — — — 1 — — 1 — — — — 78 161 16 12 12 10 — 37 17 82 24 9 7 6 2 5 202 296 67 TABLE V. NOTIFIABLE INFECTIOUS DISEASES, 1958. 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 Crofton South Crofton North Chelsfield Cudham Downe Farnborough Green-Street-Green Goddington North J Goddington South Knockholt Knoll Leaves Green Petts Wood Poverest St. Mary Cray Measles 74 4 41 7 — — 1 1 2 5 — 2 — 4 1 6 3 1.00 — — Whooping Cough 152 — 45 8 — — — 13 13 15 7 — 4 2 6 9 30 2 2.06 — — Scarlet Fever 29 11 3 — — — — 1 3 1 1 — 1 3 1 1 1 2 0.39 — — Pneumonia 33 5 — 7 — — — 2 — 4 — — 2 — — 6 7 4 0.45* 78 1.06 Erysipelas 1 — — — — — — — — — — — — — — — — 1 0.01 — — Food Poisoning 65 4 33 1 — 8 — 3 7 — 3 5 — — 1 — — 13 0.88 — — Poliomyelitis (Paralytic) 3 — — — — — — — — — — — — — — — — 3 0.04 1 0.01 Poliomyelitis (Non-Paralytic) 1 — — — — — — — — — — — — — — 1 1 1 001 — — Puerperal Pyrexia 87 1 — — — — — — — — — — — — — 86 64.78t — — Paratyphoid 6 — — — — — — — — — — — — — — — 5 6 0 08 — — Ophthalmia Neonatorum 1 — 1 — — — — — — — — — — — — — — — 001 — — Tuberculosis (Pulmonary) 43 5 3 5 3 — 1 2 3 4 1 5 3 — 2 2 4 11 0.58 3 0 04 Tuberculosis (Non-Pulmonary) 3 ~~ 2 — — — — — — — — — — — — — — 12 0 04 1 001 Totals 498 30 128 28 3 9 2 108 27 28 17 10 14 5 15 20 54 134 616 83 113 t Based on 1,000 total births and not population. * Includes all forms of Pneumonia. 68 TABLE VI. NOTIFIABLE INFECTIOUS DISEASES, 1958. Seasonal Incidence. Disease Jan. Feb. March Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Measles 1 2 2 9 1 5 31 17 1 — 3 2 74 Whooping Cough 4 16 37 7 6 15 18 27 22 — — — 152 Scarlet Fever 1 2 2 2 1 8 5 1 — — 3 4 29 Pneumonia 20 2 3 3 — 1 1 — — 1 — 2 33 Erysipelas — — 1 — — — — — — — — — 1 Food Poisoning 4 9 14 6 5 4 1 1 9 4 4 4 65 Poliomyelitis (Non-Paralytic) — — — — — — — 1 — — —— 1 Poliomyelitis (Paralytic) — — — 12 — — — 1 1 — 1 — 3 Puerperal Pyrexia 14 11 11 5 7 12 3 4 2 3 3 87 Paratyphoid — — — — — — 3 — 1 — — — 6 Ophthalmia Neoratorum — — — — — — — — 1 — — — l Totals 44 42 70 39 18 40 73 51 39 7 14 15 452 69 TABLE VII SUMMARY OF THE WORK OF THE PUBLIC HEALTH INSPECTORS. No. of premises No. of Inspections at which defects or contraventions were found Housing Inspection. For defects and nuisances 664 35 Verminous condition 12 2 Water Supply 242 1 Cesspools 123 4 Common lodging houses 11 — Drainage 779 41 Under Rent Act, 1957 157 38 Infectious Disease. (1.988) (121) Inquiry Visits 269 — Disinfection 13 — (282) (—) Food Premises. Bakehouses 21 2 Butchers 130 10 Dairies and Milkshops 32 — Fishmongers and Poulterers 18 2 Fish Fryers 14 — Food Preparing Places or Manufacturing Premises 27 Greengrocers 63 10 Grocers 241 6 Ice Cream Premises 84 3 Restaurants, Hotels, Canteens 96 7 Slaughterhouses 180 1 Street vendors or Hawkers' Carts 36 1 Visits in connection with sampling 168 — Visits under Food Hygiene Regulations 519 53 Miscellaneous 296 — (1,925) (95) Factories. Factories with mechanical power 70 1 Factories without mechanical power 2 — Other premises classified as factories 10 — Emission of smoke, fumes and grit 174 9 (256) (10) Rodent Control. Miscellaneous premises 172 121 (172) (121) Trade Premises. Shops (for Shops Act) 285 42 Piggeries 63 2 Caravan sites 115 1 (463) (45) 70 Miscellaneous. Swimming Baths 1 — Suspected Food Poisoning 78 — Keeping of Animals 58 1 Noxious accumulations 9 8 Schools 1 — Public Conveniences 30 — Rivers, Streams, etc 11 — (188) (9) Unclassified. 856 — (856) (-) 6,130 401 71 TABLE VIII. NUISANCES, DEFECTS, CONTRAVENTIONS, ETC., ABATED OR REMEDIED IN 1958. Drainage. Drains constructed or reconstructed 20 New sink in kitchens provided Sink waste pipes trapped, 3 Drains repaired 7 renewed or repaired 4 Drains cleansed 56 Water closets repaired or Inspection chamber covers provided 1 reconstructed Water closet seats repaired 1 Inspection chamber covers repaired or renewed 8 or renewed 1 Ventilation improved or repaired 4 Cesspools emptied 11 Cesspools repaired or reconstructed 2 Dampness. Roofs made watertight 11 Rainwater downpipes repaired Walls made waterproof 6 or renewed 2 Rainwater gutters repaired or renewed 4 Chimney stacks made waterproof 1 Water Supply. Main supply provided Pipes repaired or renewed 6 4 Storage tanks repaired or renewed 1 General Items. Wall plaster repaired 4 Yard paving and drainage repaired Ceiling plaster repaired 4 1 Floors repaired 6 Dustbins provided 5 Rooms cleansed or decorated 2 Nuisance from animals abated 1 Windows and doors repaired 3 Noxious accumulations removed 5 Lighting improved 1 Interceptor repaired or renewed 2 Fire surrounds and grates repaired or renewed 2