Ac. 4412 (3) ??? Library ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S ANNUAL REPORT on the Health of the Urban District 1963 H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health. Telephone: RAVensbourno 4623. Offices: COUNCIL OFFICES, ORPINGTON, KENT. Telephone: Orpington 27661. ORPINGTON URBAN DISTRICT COUNCIL MEDICAL OFFICER OF HEALTH'S ANNUAL REPORT on the Health of the Urban District 1963 H. B. C. CARTER-LOCKE, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health. Telephone: RAVensbourne 4623. Offices: Council Offices, Orpington, Kent. Telephone: Orpington 27661. 3 CONTENTS page Members of the Urban District Council 5 Staff 5 Prefatory Letter 7 Section A. Vital and other Statistics and Social Conditions of the Area. General Statistics 12 Vital Statistics 12 Population 14 Births 14 Deaths 16 Morbidity Statistics 17 Medical Examinations 17 Unemployment 18 Open-Air Recreational Amenities 18 Section B. General Provision of Health Services for the Area. Ambulance Service 24 British Red Cross Society—Medical Loan Depot 25 Chiropody Service 24 Day Nurseries 24 Diseases of Animals Acts 24 Disinfection 22 District Nursing Service 24 Domestic Help Service 24 Domiciliary Midwifery 24 Handicapped Persons 24 Health Visiting 25 Hospitals 23 Laboratory Service 23 Local Clinic Services 26 National Assistance Act, 1948 23 Nursing Homes 23 Public Mortuary 23 Women's Voluntary Services 25 Section C. Sanitary and Environmental Circumstances of the Area. Agriculture (Safety, Health and Welfare Provisions) Act, 1956 30 Atmospheric Pollution—Clean Air Act, 1956 30 Cesspools 31 Complaints 31 Diseases of Animals (Waste Foods) Order, 1957 31 Drainage and Sewerage 31 Factories Act, 1961 32 Heating Appliances (Fireguards) Act, 1952 33 Pet Animals Act, 1951 33 Prevention of Damage by Pests Act, 1949 33 Public Conveniences 33 Rag Flock and Other Filling Materials Act, 1951 34 Rivers, Streams and Lakes 34 Sanitary Inspection of the Area 34 Shops Act, 1950 34 Swimming Baths and Pools 34 Verminous Conditions and Uncleanliness 35 Water Supply 35 4 Section D. Housing. page Clearance Areas 40 Rent Act, 1957 40 Common Lodging Houses 42 Housing Act, 1961 40 Housing Statistics 41 Movable Dwellings 41 Overcrowding 42 Re-Housing 41 Section E. Inspection and Supervision of Foods. Bakehouses 50 Butchers' Shops 50 Food Complaints 47 Food Hygiene Regulations, 1955 47 Food Premises 48 Food and Drugs Act, 1955—Food Sampling 44 Food and Drugs Act, 1955—Section 16 49 Game Act, 1831 50 General 44 Ice Cream 48 Merchandise Marks Act 50 Milk and Dairies Regulations 49 Restaurants, Hotels and Canteens 50 Slaughterhouses and Slaughtermen 49 Special Samples—Milk, Ice Cream, Water and Egg Products 48 Unsound Food 49 Section F. Prevalence of, and Control over Infectious and other Diseases. Acute Anterior Poliomyelitis and Vaccination 52 Diphtheria and Diphtheria Immunisation 52 Biggin Hill Airport 52 Dysentery 52 Food Poisoning 53 General Remarks 52 Measles 53 Meningococcal Infections 53 Other Infectious Diseases 56 Pneumonia 53 Scarlet Fever 54 Smallpox and Vaccination 54 Tuberculosis, Chest Clinic and Mass X-Ray 54 Typhoid and Paratyphoid Fever 55 Whooping Cough and Immunisation 56 Section G. Refuse Collection and Disposal. 58 APPENDIX—STATISTICAL TABLES Table I. Summary of Statistics 64 „ II. Causes of Death 65 ,, III. Notifiable Infectious Diseases—Sex and Age Distribution 66 „ IV. Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 67 ,, V. Notifiable Infectious Diseases— Seasonal Incidence 68 „ VI. Summary of the work of the Public Health Inspectors 69 „ VII. Nuisances, Defects and Contraventions Abated 71 5 MEMBERS OF THE URBAN DISTRICT COUNCIL (as at 31st December, 1963). Chairman of the Council: *Councillor A. B. HOWARD, C.C., J.P. Vice-Chairman of the Council: *Councillor Mrs. C. A. PARKER. Councillors C. ANDERSON, B.Sc., A.M.l.C.A. P. McNALLY *W. J. ASHWORTH *P. K. MINTON *J. W. BRAY E. J. NORMAN R. B. BUDGEN *A. A. PARFITT W. J. CAIN (Chairman of P.H. Committee) J. DAVIES, C.C. C. H. E. PRATT *J. H. DAWSON, A.R.I.C. *Mrs* P. L. ROBERTSON G T DAY G. G. ROMAlN, J.P. *M. EDWARDES-EVANS, *D. E. SAUNDERS, A.M.B.I.M. B.A. (Cantab.) *D. A. SCOLLICK, A.F.I.C.D. *A. L. FERRIS *Mrs. S. M. STEAD *T. J. FLAWN (Vice-Chairman of P.H. Committee) R W FOX Mrs. J. TATHAM P. A. GOLDING, A.R.I.B.A. Mrs- J. V. WEBB E. C. H. JONES, C.B.E., B.Sc. *Mrs- L. WIGGINS *F. W. LANE, J.P WOODMANSEE E. J. LOVELL (*denotes members of the Public Health Committee). STAFF OF THE PUBLIC HEALTH DEPARTMENT (as at 31st December, 1963). 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). 6 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, M.R.S.H., M.A.P.H.I. District Public Health Inspectors T E. W. OSBORNE, C.R.S.H., R.I.P.H. K. J. COPPIN, C.R.S.H., M.A.P.H.I. B. E. MARTIN, M.R.S.H., M.A.P.H.I. 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. Pupil Public Health Inspector R. PYMAN. Clerical Staff Secretary: Miss C. COOPER. Shorthand-Typist: Mrs. G. BOONE. Clerk: Mrs. S. KNIGHT. Outdoor Staff Disinfector: E. J. PEPPER. Rodent Operative: W. S. MILLS. Assistant Rodent Operative: C. V. POTTER. General Foreman (Refuse): F. HONESS. Foreman and Mobile Cleaner (Public Conveniences) A. E. TURNER. 7 To the Chairman and Members of the Orpington Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for 1963, and it must inevitably be a matter of regret that this is the last such document likely to be received by the Orpington Urban District Council, for it must be assumed that the London Borough of Bromley will be the local health authority before the 1964 report is ready for circulation. Although the changes in local government must be received with very mixed feelings by many people, yet it must not be forgotten that the new local authority will have far greater powers with regard to the Health and Welfare services than was ever the case with the individual constituent authorities. Perhaps I may be forgiven for reminding Members of some of the future responsibilities of the Health Committee, e.g. Health Education, Midwives, Health Visitors, Immunisation and Vaccination, Domestic Helps, Welfare and Mental Health. That the future holds wonderful opportunities both for members and officers is incontestable, and so far no mention has even been made of the School Health Service which will, of course, be the responsibility of the Education Committee. In the field of welfare, the Council and officers are also assured of a vast amount of goodwill from the many voluntary agencies which prosper so greatly in this area. That the problems associated with ageing will not lessen with the passing years, is almost a foregone conclusion, and any additional assistance that can be given over and above that provided by the Local Authority, will be greatly welcomed. That much has been achieved in the past is undeniable, but at this stage in the history of local government in the Greater London Area, it is the future to which we must look, for there are certain diseases and conditions which, unlike most of the infectious diseases most of the time, have certainly not been conquered. It will therefore be desirable through the medium of Health Education to make an attack on these conditions which, although to a large extent preventable, are in fact not being prevented. First and foremost in this category must come lung cancer and its main cause—the smoking of cigarettes. This fact is now so well known that to stress it seems superfluous, yet the fear of abandoning smoking still surpasses the fear of the possibility of becoming a victim of lung cancer at some future date. That the whole attitude to smoking will have to be altered seems a near certainty, and one of the big tasks of the future will be to bring about such a change. Not only is smoking responsible for lung cancer, but it also makes a very material contribution to the incidence of bronchitis 8 and emphysema, which are two of the most crippling diseases known to afflict mankind. Abnormal conditions of the heart and circulatory system also make a great contribution to ill-health and death, and here one feels that greater attention to suitable diet and a sufficiency of exercise are important factors in preventing vascular disorders. Reference has already been made to lung cancer and its prevention, but it must be remembered that most other cases of cancer are curable if treatment is undertaken at an early enough stage and it therefore behoves us to do all in our power to persuade people to seek advice at the earliest signs of any abnormality. Although a large number of cases of measles was notified during the year, it was a period during which we were free from all the more serious infections. The continued absence of both diphtheria and anterior poliomyelitis in our district was a matter for congratulation, but our freedom in this direction will only be kept up if a high degree of immunity is maintained in the population. Tuberculosis continues its trend to attack the older age-groups, and the four deaths attributed to this disease were all in persons middle-aged or over. During the course of the year, over 7,000 people took advantage of the Mass X-Ray service, and although the number of cases of tuberculosis thus discovered was small, yet the importance of such discoveries to both patient and contacts cannot be over-estimated if this disease is to be finally defeated. A glance at the vital statistics will show that there is not a lot of deviation from the figures of the previous year, though there is a small drop in the birth rate which is below that for the country as a whole. There is also a small reduction in the infant mortality rate which represents a lessening of four in the number of infants dying. There was no maternal mortality, and the death rate showed little or no variation compared with 1962. The time has now come to pay tribute to all who have helped the department during the past years. There are many doctors in Hospitals and General Practice included under this heading, and to all I should like to say a most sincere ''thank you". When it comes to the staff of the Public Health Department, there is little that I can add to my previously expressed appreciation. Mr. Crowe has again been the mainstay of the department, and I should like to thank him, the Inspectors, Miss Cooper and the clerical staff, for their unfailing reliability. My deputy, Dr. Kelynack has as usual earned my warmest 9 thanks, and in conclusion I should like to thank the Chairman and Members of the Public Health Committee for their constant interest, geniality and courtesy. 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 12 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) 292.28 Registrar General's estimate of total population, mid-year 1963 81,570 Rateable value at 31st December, 1963 £3,823,738 Estimated net product of a Penny Rate, 1963/4 £15,910 Rate in the Pound, 1963/4 9/1 Total number of valuation assessments at 31st December, 1963 25,331 Mileage of Roads as at 31st December, 1963. County Roads (Class I, II and III) 42.40 miles District Roads 116.85 miles Unadopted Roads 22.18 miles Total 181.43 miles VITAL STATISTICS Live Births. Males Females Total Legitimate 624 666 1290 Illegitimate 26 26 52 650 692 1342 Crude birth rate per 1,000 estimated total population 16.5 Adjusted birth rate for comparison with other areas 16.0 (The area comparability factor for births is 0.97) Illegitimate live births (per cent of total live births)3.9 Birth rate for England and Wales 18.2 Stillbirths. Males Females Total Legitimate 12 8 20 Illegitimate — — — 12 8 20 Stillbirth rate per 1,000 live and stillbirths 14.7 Stillbirth rate per 1,000 estimated total population 0.2 Stillbirth rate for England and Wales 17.3 Total Births (live and still). Males Females Total Legitimate 636 674 1310 Illegitimate 26 26 52 662 700 1362 13 Infant Mortality. Males Females Total Legitimate 11 4 15 Illegitimate — 1 1 11 5 16 Infant mortality rate per 1,000 total live births 11.9 Legitimate infant deaths per 1,000 live legitimate births 11.6 Illegitimate infant deaths per 1,000 live illegitimate births 19.2 Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 8.2 Early neo-natal mortality rate (deaths under 1 week per 1,000 total live births) 6.7 Perinatal mortality rate (stillbirths and deaths under 1 week combined, per 1,000 total live and stillbirths) 21.3 Infant mortality rate for England and Wales 20.9 Maternal Mortality. Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and stillbirths Nil Maternal mortality rate for England and Wales 0.28 Deaths. Males Females Total 423 364 787 Crude death rate per 1,000 estimated total population 9.6 Adjusted death rate for comparison with other areas 10.8 (The area comparability factor for deaths is 1.13) Death rate for England and Wales 12.2 Population, Birth, Death, Infant and Maternal Mortality Rates, 1934—1963. Year Estimated Population. Birth rate per 1,000 Death rate population. Infant Mortality rate per live births. Maternal Mortality 1,000 total births. 1934 33,420 17.1 8.6 32 4.41 1935 36,620 18.2 9.5 47 1.46 1936 39,900 19.1 10.3 64 1.25 1937 43,610 18.0 8.6 52 1.27 1938 46,320 19.3 8.3 28 3.25 1939 49,570 19.4 9.0 43 4.00 1940 48,760 17.5 10.9 35 Nil 1941 46,270 16.4 12.3 51 Nil 1942 47,990 20.6 11.1 28 1.9 1943 48,520 21.0 11.2 29 0.95 1944 46,980 22.7 11.4 28 1.84 1945 49,610 17.8 10.1 28 1.09 1946 56,640 20.0 9.3 34 1.6 1947 58,080 19.0 8.6 29 2.64 1948 58,320 16.3 8.4 19.9 1.0 1949 59,500 16.5 10.7 21.5 1.01 1950 62,420 14.8 10.6 24.9 1.1 1951 62,850 14.9 10.4 19.2 Nil 1952 63,670 14.7 8.9 18.2 Nil 1953 64,480 14.4 9.8 17.2 2.1 1954 66,380 15.8 7.8 14.3 Nil 1955 68,450 15.8 9.1 17.5 Nil 1956 70,410 17.3 9.2 20.5 Nil 1957 72,170 18.0 8.7 19.2 0.76 1958 73,640 17.9 10.1 20.5 Nil 1959 74,620 18.6 10.1 14.4 Nil 1960 76,020 18.9 9.4 18.8 Nil 1961 80,080 16.3 9.5 12.2 Nil 1962 80,950 17.4 9.5 14.2 Nil 1963 81,570 16.5 9.6 11.9 Nil 14 Population. The Registrar General's estimate of the total population of the Urban District, mid-year 1963, was 81,570, which is an increase of 620 over the figure for the previous year. This population figure gives a density of 3.9 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 555. Births. 1,342 live births appertaining to the area were registered during 1963, of which 650 were males and 692 females. 1,290 of these births were legitimate and 52 illegitimate. The crude birth rate for the Urban District was 16.5 per 1,000 total population, which is a decrease of 0.9 over the rate for the previous year and is below the rate for England and Wales as a whole (18.2). The illegitimate birth rate was 38.2 per 1,000 live and still births, or 3.9 per cent of the total live births. There were 52 illegitimate live births, of which 26 were males and 26 females. There was 1 more illegitimate live birth in 1963 than in 1962. 20 stillbirths were registered, giving a rate of 14.7 per 1,000 live and still births, and 0.2 per 1,000 total population. 12 of the stillbirths were males and 8 females. The stillbirth rate of England and Wales as a whole was 17.3 per 1,000 total births. Infant Mortality. There were 16 deaths of infants under one year of age in 1963, which is four less than the figure for the previous year. The infant mortality rate for the year was 11.9 per 1,000 total live births, which is well below the figure of 20.9 for the country as a whole. The table which follows gives the Orpington mortality rate for legitimate and illegitimate infants, as well as for all infants, and also shows the comparison between the infant mortality rate in the Urban District and that for England and Wales during the past ten years. 15 Year. Legitimate Infants. Rate per 1,000 live legitimate births. Illegitimate Infants. Rate per 1,000 live illegitimate births. All Infants Rate per 1,000 live births. Orpington. England & Wales. 1954 13.6 47.6 14.3 25.5 1955 16.99 41.7 17.5 24.9 1956 21.3 Nil 20.5 23.8 1957 19.5 Nil 19.2 23.0 1958 20.3 27.8 20.5 22.5 1959 13.4 41.7 14.4 22.0 1960 18.0 40.8 18.8 21.7 1961 12.6 Nil 12.2 21.4 1962 14.7 Nil 14.2 21.4 1963 11.6 19.2 11.9 20.9 Causes of Infant Deaths, 1963. 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 2 - - - 2 - - - - 2 Bronchopneumonia - - - - - 1 - - - 1 Congenital Heart Disease - 1 1 - 2 1 - - - 3 Malformation 2 — — — 2 — 1 — — 3 Prematurity 3 — — — 3 — — — — 3 Cerebral Haemorrhage 1 - - - 1 - - - - 1 Other causes 1 - - — 1 2 — — — 3 Total 9 1 1 — 11 4 1 — — 16 16 Analysis of Couses of Infant Deaths. 1954-1963. 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 Total Number of Births Give) 1047 1083 1219 1302 1319 1388 1437 1308 1407 1342 12,852 Infant Mortality Rate (per 1,000 live births) 14.3 17.5 20.5 19.2 20.5 14.4 18.8 12.2 14.2 11.9 16.3 Atelectasis 1 3 6 9 3 2 2 1 2 2 31 Malformation 2 - - - - - - - 1 3 6 Gastro-enteritis — — — — — 1 1 — — — 2 Prematurity 7 4 8 7 6 4 10 7 1 3 57 Respiratory Diseases 3 6 6 3 8 3 3 3 5 1 41 Cerebral Haemorrhage - - - - 5 1 3 2 3 1 15 Meningitis — — — 1 — 1 1 1 1 — 5 Congenital Heart Disease - 1 - 1 3 4 2 - 3 3 17 Other causes 2 5 5 4 2 4 5 2 4 3 36 Totals 15 19 25 25 27 20 27 16 20 16 210 Maternal Mortality. I am pleased to report that there were no maternal deaths in the area during 1963. Deaths. 787 deaths appertaining to the Urban District were registered during the year, giving a death rate of 9.6 per 1,000 total population. The adjusted rate for use when comparing one area with another is 10.8. The rate for England and Wales as a whole was 12.2. Of the Orpington deaths registered, 423 were males and 364 females. The average death rate for the area during the past ten years was 9.3. The following is an analysis of the ages at death for the year 1963: — Males Females. 16 were under 1 year of age 11 5 4 were one and under 5 years of age 3 1 5 were 5 and under 15 years of age 5 — 8 were 15 and under 25 years of age 5 3 22 were 25 and under 45 years of age 13 9 191 were 45 and under 65 years of age 119 72 187 were 65 and under 75 years of age 111 76 354 were 75 years of age and over 156 198 423 364 17 Full details of the causes of death will be found in Table II in the appendix to this report, but the following table, giving details of certain causes of death in the Urban District during the past ten years, may prove of interest:— Disease. 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 Canccr (all sites) 108 134 131 131 158 172 159 169 155 167 Cancer of the lung, bronchus 25 23 34 33 38 48 33 43 47 40 Heart and Circulatory Diseases 320 262 264 284 328 348 321 382 384 388 Respiratory Diseases (exeluding Tuberculosis 44 79 135 88 119 107 110 90 104 111 Tuberculosis 5 6 7 4 4 4 3 3 7 4 Infectious Diseases 1 2 1 1 3 3 1 3 3 1 Road Accidents 8 6 6 5 10 12 13 12 9 8 Other Accidents 2 8 10 8 10 6 8 6 9 10 Morbidity Statistics. The following is a summary of the weekly details received from the Ministry of Pensions and National Insurance during 1963:— Four weeks ending. Number of first certificates of incapacity received. 29th January 1,541 26th February 1,946 26th March 1,310 23rd April 788 21st May 762 18th June 635 16th July 630 13th August 493 10th September 573 8 th October 753 5 th November 899 3rd December 904 31st December 795 The sickness rate continued to follow the normal trend, namely, the highest incidence of illness occurred during the early and late parts of the year, with the lowest figures being recorded in August. Staff Medical Examinations. 124 members or potential members of the staff were given a medical examination during the year. 114 were examined in the previous year. 18 Unemployment. I am indebted to the Manager of the Local Employment Exchange for the following information with regard to unemployment in the area during 1963: — "Due to prolonged bad weather the number of persons unemployed during the first three months of 1963 was the highest for many years. The peak figure was reached in January, with a total of 485 men and 27 women unemployed. Included in this total were 178 men who were out of work solely because of bad weather. "Since this period the numbers of unemployed have declined and • in December the figures showed a reduction of 62 on last year. "Since March there have been steady demands for skilled and unskilled men and a constant unsatisfied demand for women in the factories in the area. "The percentage of unemployed persons has been consistently below both the figure for London and South East Region and the National figure." Open-Air Recreational Amenities. Approximately 292.28 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 Biggin Hill Valley Biggin Hill 0.54 Chelsfield Chelsfield 0.50 Cudham Village Cudham 10.39 Cudham Lane Green-Street-Green 6.5 Downe Downe 3.0 Farnborough Farnborough 10.0 Farnborough (Opp. New Inn P.H.) Farnborough 0.134 Glentrammon Green-Street-Green 13.5 Goddington Goddington South 63.95 Grassmeade Goddington North 9.6 Knockholt Knockholt 0.75 Leamington Avenue Crofton South 4.0 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 Tubbendcn Lane Crofton South 4.14 Willett Petts Wood 6.1 Public Gardens. Ward. Acreage 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 19 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 In addition, there are 213 acres of woodlands at High Elms Estate, situated between Farnborough, Green Street Green and Downe. The value of Orpington's open spaces cannot be over estimated, for they provide rest and relaxation for the older members of the population and facilities for recreational activities for the younger generation, thus making a notable contribution to the general wellbeing of the community. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 22 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). Public Conveniences. Rodent Control. Refuse Collection and Disposal. Disinfection. The disinfecting station is situate at the Council Offices and details of the work carried out during 1963 are as under: — Disinfections. Premises visited 2 Rooms disinfected 7 Articles disinfected 35 Disinfestations. Premises visited 10 Rooms disinfested 27 Articles disinfested 245 Beds Mattresses Pillows Bolsters Bedclothes (batches) Clothing (batches) Cushions Hangings Carpets, etc Library Books Articles treated 24 69 34 2 23 16 32 23 32 25 280 Articles destroyed 1 1 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. 23 Laboratory Service. Routine medical and Food and Drugs samples are forwarded to the Public Health Laboratory at Barming or to the County Analyst's Laboratory at Maidstone, and the following is a summary of the work carried out on behalf of the Council during 1963: — Faeces 65 Food Samples 255 Water Samples 48 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. It was not necessary for the Council to deal with any bodies during the year. 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 mortuaries attached to Farnborough and Orpington Hospitals. SERVICES RENDERED BY THE HOSPITAL BOARDS. (a) Farnborough Hospital—Provides a general hospital service with 709 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 550 (staffed) beds, plus 51 beds 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. The main depot for the area is situate at 12, Hayes Lane, Bromley. At the present time there are 24 ambulances and 27 silting case cars available for use at this depot, and the majority of these are radio controlled. 24 Chiropody Service. This is provided by means of domiciliary visits, for Old Age Pensioners, Handicapped Persons and Expectant Mothers. Applications for this service should be made to the District Officer, County Offices, "The Walnuts", High Street, Orpington, Kent. Telephone: Orpington 21123. Day Nurseries. There are no Day Nurseries in the area. Diseases of Animals Act. There is an officer stationed at Bexley who carries out the functions of this service. Domiciliary Midwifery. Seven full-time Midwives and five Home Nurse Midwives are employed in the Urban District. 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 "The Walnuts", High Street, Orpington. The following is a summary of the cases assisted during 1963: Aged 65 or over 280 Under 65 Chronic Sick 10 Tuberculosis 3 Expectant Mothers 26 Nursing Mothers 151 Illness 168 638 Night and Evening Service. Ten cases received assistance under this scheme during 1963. Family Care Service. Assistance was given in twenty-five cases during the year. Family Welfare Service. Two cases were assisted in 1963. District Nursing Service. There are five District Nurses and four District Nurse Midwives employed in the district. No night service is provided. The services of a District Nurse may be obtained on medical certification. Applications should be made to the District Officer, County Offices, "The Walnuts", High Street, Orpington. Handicapped Persons. The Kent County Council Scheme for the welfare of the handicapped continues to assist handicapped persons to overcome the effects of their disabilities. Advice and guidance is given on personal 25 problems, and the provision of special appliances and aids as necessary. A Craft Instructor is available to visit handicapped persons in their homes. Health Visiting. Ten Health Visitors/School Nurses, one full-time School Nurse and one Tuberculosis Health Visitor are employed in the Urban 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, etc. SERVICES RENDERED BY VOLUNTARY AGENCIES. The St. John Ambulance Brigade. Over 60's Clubs. These agencies continue to carry out their good work in the area. Women's Voluntary Service. The County Organiser has kindly furnished the following information:— Meals on Wheels. During the severe winter at the beginning of 1963, the Meals-on-Wheels service had to be carried out as an emergency operation. During the worst of the period W.V.S. members cooked meals in their own homes and delivered them to recipients in their own area, but it was not long before the service was running as usual. 8,158 meals were served to 88 old people during the year. A free Christmas dinner was served to all recipients, with additional presents of fruit, sweets and tea and a table decoration for every household, made by one W.V.S. member. No application for meals has ever been refused. Darby and Joan Clubs. These did not meet during the most severe weather. The Farnborough Club, unfortunately, lost eight members during the year—one in a fatal accident, but the numbers are increasing again and now average 55 members, of whom about 20 have to be fetched by car. The Rookery Club has a membershop of 54, all of whom are mobile. Both Clubs had half-day outings and full days by the sea and local organisations have been very generous with their entertainment. There is a constant demand for the loan of wheel-chairs and medical equipment. Old people are visited in hospital and in their own homes. The Centre receives many requests for this service from the Geriatric Almoner of Orpington Hospital. The Centre undertakes a regular service two days a week for bringing old people to visit their relatives in both Orpington and Farnborough Hospitals. Old people are also taken to shop, to visit Opticians, Chiropodists, etc., and several regular clients have to be taken to the Chest Clinic in Bromley. In all, 380 car escorts have been undertaken during the year, which include visits to London Specialists, Convalescent Homes in Essex and Sussex, to the Kent coast, and to New Cross Hospital for 26 hearing aids. Old people have also been taken to various Homes for holidays and these include long-stay handicapped patients of Orpington Hospital who would be unable to have a holiday unless taken by car. British Red Cross—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 opened by appointment. Application should be made to Mrs. Jones at that address—Telephone: Orpington 22083. LOCAL CLINIC SERVICES. Child Welfare Centres. Chelsfield Village Hall 1st, 3rd and 5th Tuesday in month, p.m. Biggin Hill Sports Pavilion, Thursday—p.m. and 1st, Biggin Hill 3rd and 5th Monday— p.m. Downe Village Hall 1st and 3rd Friday in month—p.m. Farnborough Methodist Hall Friday—p.m. Green-Street-Green Baptist School Room Friday—p.m. Knockholt The Institute 2nd and 4th Tuesday in month—p.m. Orpington Methodist Church Hall Monday, Tuesday and Friday—p.m. Orpington St. Giles Church Hall, Wednesday—p.m. Leamington Avenue Crofton St. Paul's Church Hall Monday—p.m. Petts Wood Methodist Church Hall, Monday and Thursday— Lakeswood Road p.m. St. Mary Cray Temple Congregational Tuesday and Wednesday Church Hall —p.m. Pratts Bottom Village Hall 2nd and 4th Thursday in month—p.m. Poverest Coronation Hall, Each Thursday—p.m. Bridge Road, St. Mary Cray Cudham Eldon Hall, Downe 1st and 3rd Wednesday Avenue in month—p.m. Ante-Natal Clinics. Orpington Methodist Church Hall Sevenoaks Road Tuesday—a.m. Petts Wood Methodist Church Hall Lakeswood Road Relaxation Class, 10 a.m. 12 noon—Wednesday. 27 St. Mary Cray Temple Congregational Church Hall 1st, 3rd and 5th Friday— p.m. Doctor in attendance. St. Mary Cray Temple Congregational Church Hall 2nd and 4th Friday—p.m (Midwives only in attendance). Ophthalmic Clinic. The School House, Every Monday, all day, Chislehurst Road, appointments only. Orpington Minor Ailment Clinics (Schools). The School House, Every Wednesday—p.m. Chislehurst Road, 1.45 p.m.—3 p.m. Orpington Dental Clinics. The School House, Monday, Tuesday, Chislehurst Road, Wednesday, Thursday, Orpington Friday all day. Dental Clinics are also held in the Country areas, Farnborough, Cudham, Westerham, Biggin Hill, Downe, Green-Street-Green and Knockholt, etc. Immunisation and Vaccination. This is carried out at the Child Welfare Centres listed above. District Officer. There is a District Officer stationed at County Offices, "The Walnuts", High Street, Orpington. Telephone: Orpington 21123. SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. 30 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. Agriculture (Safety, Health and Welfare Provisions) Act, 1956. The responsibility of the Health Department under this Act is to ensure that farm workers have suitable and sufficient sanitary accommodation and adequate washing facilities. Atmospheric Pollution. Eighty-eight observations and visits were made by the Public Health Inspectors under the Clean Air Act 1956, during the year. The Public Health Department continues to receive every cooperation from the factory managements and consequently any infringements detected are dealt with on an informal basis. The Ministry of Housing and Local Government prepared a map of the Greater London area and this district is not shown thereon as a black area. The district, with an acreage of some 20,000, is one of the largest Urban Districts in the country and is fortunate in having many open spaces, parks and recreation grounds. With many factories and dwellinghouses using smokeless fuels, the atmosphere is comparatively free from smoke pollution. The Council co-operates with the Fuel Research Station acting under the Department of Scientific and Industrial Research in the measurement of atmospheric pollution. There are two sites in the district, at one of which a deposit gauge is positioned for the measurement of solid matter suspended in the atmosphere and at the other a Lead Peroxide Cylinder for the measurement of sulphur dioxide. At monthly intervals, samples are forwarded to the Council's Analyst and reports thereon are submitted to the Fuel Research Station. 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 Society for Clean Air and the Standing Conference of Local Authorities which co-operate with the Department of Scientific and Industrial Research. 31 Cesspools. During the year, 76 cesspools were abolished. Nine of these were on the line of sewers which were constructed before 1961, and the remainder on the line of recently constructed sewers at Leaves Green, The Hillside, Craven Road, and Knockholt. The following summary shows the position at the end of 1963: — (1) on line of sewers constructed before 1st January, 1962 8 (2) not on line of sewers 2,158 Number of cesspools abolished and main drainage provided during the year 76 Number of houses with pail closets converted to cesspool drainage Nil Number of new houses erected with cesspool drainage 9 Number of loads removed from cesspools: On private property (subsidised) 5,181 On private property (non-subsidised) 616 On Council property 673 Complaints. During the year, 367 complaints were received from residents, but in no case was it necessary to take formal action to secure abatement of the nuisance. Diseases of Animals (Waste Foods) Order, 1957. 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 animals or poultry, the foods must first be boiled for one hour in a plant licensed by the Local Authority. Three further Boiling Plants were licensed during 1963, making a total of 55 licences issued since this Order came into force. 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: — (a) Private Estate Development: Foul water 6in. 3,745 yards 9in. 304 „ Surface Water 6in. 814 „ 9in. 393 „ „ „ 12in. 553 „ ,, ,, 15in. 161 ,, 18in. 459 „ „ „ 24in. 70 „ 32 Factories Act, 1961. There are 145 factories on the Council's register at the present time. Thirty-three visits of inspection were made by the Public Health Inspectors and the two defects found were remedied. The following gives particulars of the work carried out during 1963: — 1. Inspection for purposes of provisions as to health: Premises. Number on Register Inspections Number Written Notices of Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by the Local Authority 9 1 — — (b) Factories not included in (1) in which Section 7 is enforced by the Local Authority 123 18 1 — (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises)* . 13 14 1 — 145 33 2 — * Building sites on Estate development. 2. Cases in which defects were found: Found Remedied Number of cases in which defects were referred Number of cases in which prosecutions were instituted 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 2 2 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 2 2 — — — 33 Outworkers. Sixteen 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 67 Cardboard boxes 1 68 Section 134. No instances of work in unwholesome premises were found, no notices were served, nor were any prosecutions undertaken. Heating Appliances (Fireguards) Act, 1952. No contraventions were found during the course of the year. Pet Animals Act, 1951. Licences in respect of six premises were granted or renewed during 1963 and twenty 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 were as follow: —» Total number Number of of inspections. Infestations cleared. Local Authority's property 16 8 Dwelling houses (including Council houses) 5,238 578 Business premises 167 29 In addition, the Council's sewers were test-baited early in the year to ascertain the areas of infestation and this was followed up by treatment with poison bait in September. The degree of infestation was found to be negligible. Public Conveniences. The Local Authority's eight public conveniences are situated in Orpington Town (3), Petts Wood (1), St. Mary Cray (1), Green Street Green (1), Farnborough (1) and Biggin Hill (1). Wilful damage and misuse continues to be a problem but the system of inspection and cleansing undertaken during the hours of opening by a mobile cleaner appears to be working well as no complaints from members of the public were received. 34 The opening and initial cleaning in the morning and closing at night is undertaken by ten part-time employees. Maintenance and repair work is carried out by the Housing and Estates Department. 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 1963. Rivers, Streams and Lakes. Since 1950, the Kent Rivers Board has 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 2,068 105 Infectious Diseases 515 — Food Premises 1,160 48 Factories (including Smoke Observations, Outworkers) 121 2 Rodent Control (Public Health Inspectors only) 270 — Trade Premises 375 18 Public Conveniences 402 — Miscellaneous 566 1 Shops Acts, 1950. During the year, one hundred and ninety-two inspections of shops were made and the following contraventions were found and subsequently remedied by the shop-keepers:— Neglect in displaying Statutory Forms 10 Inadequate heating 4 Inadequate sanitary accommodation 2 Swimming Baths and Pools. There is only one swimming bath in the district to which the public are admitted, and this is situated at Darrick Wood, Lovibonds Avenue, Orpington. It is owned by the Kent Education Committee, but is operated by Orpington Urban District Council in conjunction with the Committee under a financial arrangement during the summer months, whereby, although it is normally reserved for the use of school children, the general public are admitted at certain times. The charge for admission 35 is Is. 6d. for adults, 9d. for children, and 3d. for spectators. It is an indoor swimming bath covered with white glazed tiles. The water, supplied by the Metropolitan Water Board, is heated, chlorinated and then filtered continuously, this cycle taking eight hours. Five visits of inspection were made during the year by the District Public Health Inspector and two samples of the water taken for analysis proved to be satisfactory. Verminous Conditions and Uncleanliness. There were no cases of verminous persons needing attention during the year but a small number of verminous premises were dealt with by the Department's disinfector. No case of filthy or unwholesome premises as described in Section 83 of the Public Health Act 1936 came to light. Water Supply. During the year, one property was connected to the main water supply, having previously been dependent upon stored rainwater. Of approximately 25,000 dwellings, only 24 are not provided with a main piped water supply, and of these 19 are situated where a water main is not available in the roads fronting their premises. These are in isolated parts of the district and generally dependent upon rainwater collected from roofs and stored in underground jtanks, but three premises obtain their source of supply from a private well. The remaining five premises are not connected to a main water supply although it is available in the roads on to which they front. Two of these are a considerable distance from the road, but three premises are within 80 feet of the Metropolitan Water Board Main. Fourteen week-end bungalows are not connected to a main water supply. The total number of premises still dependent upon stored rainwater or well supply is made up as follows:— Ward. Number of premises with Stored rainwater. Well Supply Biggin Hill 11 — Chelsfield 2 — Cudham 2 — Downe 2 — Farnborough — 3 Green Street Green 3 — Knockholt 1 — 21 3 The Metropolitan Water Board supplies the mains water for the whole of the district. The Public Health Department obtains samples of this water at monthly intervals from various dwelling houses throughout the district. Forty-eight samples were taken and the Analyst's reports show that they were all satisfactory. 36 The Director of Water Examination, Metropolitan Water Board, has kindly reported on the water supply to the Urban District during the year 1963:— "The water supply to the Orpington Urban District Council was satisfactory in quantity and quality during 1963. The supply to the district of Orpington was derived from Sundridge, Lullingstone, Eynsford, Horton Kirby, Orpington and North Orpington Wells. There were no new sources of supply instituted by the Board in this area during 1963 and there were no new important extensions of trunk mains, but a total length of 4,121 yards of local supply mains were laid in the area during the year. The following tables give the results of the chemical and bacteriological analyses of the various supplies to Orpington during 1963. 37 Average Results of the Chemical Examination of the Water supplied to Orpington during the Year 1963. Milligrammes per litre (unless otherwise stated). Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as CI. Oxygen abs. from KMn04 4 hrs. at 27°C. Turbidity units Sundridge 10 0013 0019 2.4 19 0 04 Nil Lullingstone 6 0 021 0 022 3.4 15 006 0.4 Eynsford 7 0 003 0 021 3.7 15 002 Nil Horton Kirby 8 0 007 0018 4.4 19 0 06 Nil Orpington 4 0014 0022 5.8 16 004 Nil North Orpington 8 0 008 0019 4.3 14 0 02 0.3 Description of the Sample Colour (Burgess) Scale Hardness (Total) Hardness (non. carbonate) pH Value Sodium as Na Potassium as K Electrical Conductivity (microhms) Sundridge Nil 214 44 7.3 9.5 2.0 410 Lullingstone 1 258 26 7.2 8.5 1.2 480 Eynsford Nil 260 30 7.2 90 1.2 470 Horton Kirby Nil 264 40 7.2 10.0 1.8 490 Orpington Nil 282 34 7.1 10.0 1.7 510 North Orpington Nil 270 26 7.1 8.5 1.8 480 38 Result of the Bacteriological Examination of the Water supplied to Orpington during the Year 1963 BACTERIOLOGICAL RESULTS Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20.24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. 20.24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. Sundridge No. 1 61 0.0 8 100.0 — 100.0 — 242 0.0 10 100.0 100.0 Sundridge No. 2 96 0.1 2 100.0 — 100.0 — Sundridge No. 3 99 0.1 11 100.0 — 100.0 — Sundridge No. 4 87 0.0 11 98.85 — 100.0 — Lullingstone No. 1 157 9.4 57 100.0 — 100.0 — 252 0.1 11 100.0 100.0 Lullingstone No. 2 102 0.3 9 99.02 — 100.0 — Eynsford No. 1 235 1.7 37 83.40 0.9 99.57 — 247 0.1 4 1000 100.0 Eynsford No. 2 122 0.5 15 91.80 0.3 99.18 — Horton Kirby No. 1 177 0.0 79 96.61 0.1 98.31 0.1 255 0.0 15 99.22 100.0 Horton Kirby No. 2 196 0.0 5 97.96 0.1 98.47 0.1 Orpington 232 0.0 14 98.71 — 100.0 237 1.7 97 99.58 99.58 North Orpington No. 1 159 2.6 46 18.24 11.5 32.70 5.0 254 1.2 5 100.0 100.0 North Orpington No. 2 141 1.1 57 34 .04 6.3 50.35 3.6 SECTION D. HOUSING. 40 SECTION D. HOUSING. Clearance Areas and Individual Unfit Dwellings. During the year the last remaining clearance area was dealt with by way of two Closing and four Demolition Orders. There are approximately 15 individual houses which, subject to a detailed inspection, will need to be dealt with in a similar manner to complete our programme. 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". Only one application for a Certificate of Disrepair was received during the year. Housing Act, 1961. This Act extends and amends the principal Act of 1957. Forty applications for Improvement Grants were approved during the year, thirty-two of these being from owner/occupiers. Housing Statistics for the Year 1963. Total number of valuation assessments, houses and flats, at 31st December, 1963 25,300 (1) (a) Total number of dwelling houses inspected for defects (under the Public Health or Housing Acts) 333 (b) Number of inspections made for the purpose 1,237 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 Nil 41 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 107 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 97 (5) (a) Unfit houses demolished 4 (b) Unfit houses closed 1 Moveable Dwellings. Fifty-four visits were made to the six caravan sites. Two of the sites have been issued with a Licence and the remaining four are still under consideration. At the end of the year, the Council agreed to set up a site for twelve gipsy caravans at St. Paul's Cray Hill Park, near Star Lane, as part of the country-wide scheme instigated by the Ministry of Housing and Local Government for establishing properly equipped sites for gipsies. A possibility of the scheme is the gradual absorption of families into society by re-housing from the site. 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 1963 During 1963 Total as at December, 1963 1. (a) No. of "permanent" dwellings built by Local Authority 2,476 56 2,532 (b) No. of pre-fabricated dwellings built by Local Authority 308 308 2. (a) No. of families occupying 1 (a) 2,532 plus lodgers. (b) No. of families occupying 1 (b) 308 plus lodgers 3. Total number of families re-housed during 1963 in (a)—103—56 new houses (b) 7 re-lets, 40 re-lets 4. No. of families on waiting list at 31st December, 1963, in various categories (" live " applications) 668 (a) Families in urgent need of other accommodation 60 (b) Families whose applications require early consideration 52 (c) Families whose applications are less urgent 271 (d) Families with varying degrees of housing need 285 42 Overcrowding. The position at the 31st December, 1963, with regard to overcrowding is as follows:— (a) number of dwellings overcrowded at the end of the year 112 (b) number of new cases of overcrowding reported during 1963 Nil (c) number of cases of overcrowding relieved 66 (d) particulars of any case in which dwelling houses in respect of which local authority have taken steps for the abatement of overcrowding have again become overcrowded Nil (e) any other particulars with respect to conditions in relation to overcrowding Nil Common Lodging Houses. There is only one registered common lodging house within the area. This is situated at the junction of Poverest Road and Cray Avenue and its life is probably limited by proposals for re-development in the area. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 44 SECTION E. INSPECTION AND SUPERVISION OF FOODS. General. Over 900 inspections of food shops were made during the year and the general standard of cleanliness was found to be satisfactory. There were no outbreaks of food poisoning and of the twenty-five single cases notified by doctors, only seven were confirmed. Since the introduction of the Food Hygiene (General) Regulations Act, 1955, there has been a gradually increasing awareness among food handlers of the importance of cleanliness and the proper storage of food in relation to the illness known as Food Poisoning and, with indications that the public are becoming more fastidious over what it is expected to eat, we may expect to find that more and more shopkeepers are finding that good food hygiene is good business. The year's sampling revealed no adulteration and investigations into the Analyst's reports on the few inferior samples were resolved satisfactorily. Food and Drugs Act, 1955. Food Sampling. Details of the two hundred and twenty-three informal samples of food and drugs taken for analysis are as follow:— Samples taken. Result Inferior Adulterated. Remarks Description. Formal. Informal. Genuine Bacon — 2 2 — — Baking Powder — 3 3 — — Blood Purifier — 1 1 — — Boned Chicken — 2 2 — — Brown Bread Mix — 1 1 — — Butter — 6 6 — — Buttered Carrots — 1 1 — — Butter Sweet Confectionery — 1 1 — — Cake Confectionery — 1 1 — — California Syrup of Figs — 1 1 — — Castor Oil — 1 1 — — Catarrh Pastilles — 1 1 — — Chicken Continental — 1 1 — — Cocoa — 1 1 — — Codeine Tablets — 1 1 — — Coffee and Chicory Mixture — 2 2 — — Cold Discs — 1 1 — — Cooking Fat — 1 1 — — Corned Beef — 3 2 1 — see (a). Cornflour — 1 1 — — Cough Tablets — 3 3 — — Cream — 4 4 — — Creamed Rice Pudding — 1 1 — — Currants — 1 1 — — Curry Powder — 1 1 — — Dehydrated Kibbled Onion — 1 1 — — Desiccated Coconut — 1 1 — — 45 Disprin — 1 — 1 -— see (b). Fish Paste — 13 13 — — Flavouring Essence — 3 3 — — Full Cream Evaporated Milk — 1 1 — — Gelatine — 1 1 — — Gravy Browning — 1 1 — — Honey — 2 2 — — Iron Tonic Tablets — 2 2 — — Jam — 2 2 — — Lamb Chops, Vegetable and Gravy 1 1 — — Lard — 1 1 — — Lemon Drink — 2 2 — — Liquid Paraffin — 1 1 — — Lollies — 1 1 — — Marmalade — 1 1 — — Margarine — 5 11 5 — — Meat Paste — 11 — — Milk (Pasteurised) — 33 32 1 — see (c). Milk (Sterilised) — 24 24 — — Milk (Channel Islands) — 3 1 2 — see (d). Milk (Tuberculin Tested) — 6 6 — — Milk of Magnesia — 1 1 — — Minced Beef with Onion — 1 1 — — Mixed Spice — 1 1 — — Mucus Congestion Tablets — 1 1 — — Mustard — 3 3 — — Neuro Phosphates Tonic — 1 1 — — Orange Drink — 3 2 1 — see (e). Orange Pie Filling — 1 1 — — Onion Salt — 1 1 — — Parrish's Food — 1 1 — — Pork Pie — 1 1 — — Pork Luncheon Meat — 2 2 — — Pure Wheat Embryo — 1 1 — — Rose Hip Syrup — 1 1 — — Salad Cream — 1 1 — — Self-Raising Flour — 3 3 — — Soup — 4 4 — — Sponge Mixture — 1 1 — — Steak and Kidney Pie (tinned) — 2 2 — — Steak and Kidney Pudding — 4 1 3 — see (f). Sugar — 2 2 — — Sunny Spread — 1 1 — — Table Jelly — 4 4 — — Tartare Sauce — 1 1 — — Tea — 4 4 — — Throat Drops — 1 1 — — Tomato Ketchup — 4 3 1 — see (g). Tomato Sauce — 1 1 — — Travel Sickness Tablets — 1 1 — — "Turns" for Acid Indigestion — 1 1 — — Turkey and Ham Pie — 1 1 — — Vegetables and Lamb Dinner — 1 1 — — Vinegar — 1 1 — — Vitamin Tablets — 3 3 — — White Pepper — 3 3 — — Worm Syrup — 1 1 — — — 223 213 10 — 46 NATURE OF ADULTERATION REMARKS (a) Serial No. 900. Corned Beef. The meat had an abnormal smell but the Analyst was not able to apply any chemical tests to determine its origin which could have been bacteriological. Examination for metallic contamination was satisfactory showing Lead 1.2, Copper 2, Zinc 50, Iron 80 parts per million. Inferior. A follow-up sample taken from the same batch proved to be satisfactory. (b) Serial No. 842. Disprin. A tablet dissolved in water gave no unusual taste or smell. The cotton wool plug had a slight paraffin odour and on extraction yielded 160 milligrammes paraffin. Inferior. An investigation was carried out but it was impossible to trace the source of the paraffin found in the cotton wool. (c) Serial No. 960. Milk (Pasteurised). The bitter taste alleged by the complainant to be present was confirmed by the Analyst and proved to be of bacterial origin. Inferior. The matter was taken up with the dairy concerned. (d) Serial Nos. 943 and 987. Milk (Channel Islands). The samples showed a fat content of 3.95% and 3.9% respectively against a recommended minimum fat content of 4%. Inferior The farmer ceased to sell this milk under the designation of "Channel Islands" as from 8th December, 1963. (e) Serial No. 791. Orange Juice. The Analyst reported that the sample contained approximately 60% water. Inferior. After investigation, the manufacturers admitted to wrong labelling of the product and all stocks were withdrawn. (f) Serial Nos. 945, 969 and 993. Steak and Kidney Pudding. The samples showed a meat content of 31%, 28% and 33% respectively. Food Standards Committee Report on Canned Meat calls for not less than 35%. Inferior. The attention of the manufacturers was drawn to the deficiency in the meat content. Apologies and an assurance to look into the matter were accepted. (g) Serial No. 794. Tomato Ketchup. The sample showed 5.7% of tomato solids whereas the Standard requires 6% The Manufacturers were advised of the slight deviation from standard. 47 Food Hygiene (General) Regulations, 1960. There were no prosecutions under the above Regulations during 1963. A total of 936 inspections were made by the District Inspectors during the year. As a result of these inspections, 51 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:— Food premises cleansed and redecorated 8 Food premises ratproofed 3 Floors repaired 5 Floors cleansed 1 Floors re-surfaced 3 Floors re-covered 3 Walls and ceilings repaired, cleansed and redecorated 19 Doors repaired 1 Stockroom redecorated 1 Refrigerators repaired and cleansed 4 Wash-hand basins provided 3 Soap, towels and nailbrush provided 3 New chopping block provided 5 Dustbins provided for refuse storage 3 Accumulation of rubbish removed 3 Lockers provided for outdoor clothing 2 Hot water supply provided 3 Ventilation improved 2 Lighting improved 1 New sinks provided 1 Impervious surfaces provided for working tables 1 Sanitary accommodation cleansed and re-decorated 5 Sanitary accommodation repaired 2 Vehicle yard cleansed and tidied 1 Food Complaints. Forty-nine complaints of unsound condition and/or contamination of foodstuffs were received from the public during the year, as under. Where the condition of the food could not be determined by visual examination, the article was sent to the Council's Analyst. In each case it was possible to give a satisfactory explanation to the complainant. Bacon 1 Bread 9 Butter 1 Corned Beef 2 Crumpets 1 Fish Fingers 2 Fish Cakes 1 Kidneys 1 Kippers 1 Meat 3 Meat Pies 4 Meat and Cheese Hamburger 1 Milk 10 Oranges 1 48 Peanut Butter 1 Pearl Barley 1 Pork Pie 1 Potatoes 1 Pudding and Cake Mixture 2 Sausages 3 Strained Baby Broth 1 Tea 1 49 Special Samples of Milk, Ice Cream and Water. In addition to the samples previously mentioned, samples were submitted for bacteriological and pathological examination and other special tests, as under:— Milk (Tuberculin Tested) Bacteriological Examination 6 Milk (Pasteurised) Phosphatase Test 33 Milk (Sterilised) Turbidity Test 24 Milk (Channel Islands) 3 Ice Cream—Bacteriological and Pathological Examination 32 Water—Bacteriological Examination 48 Ice Cream. At the end of the year, two hundred and six premises were registered for the storage of, and sale of ice cream, but none for the manufacture of this commodity. Sixteen inspections were made and conditions were found to be satisfactory. Thirty-two 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. Grade Result. Grade Grade I II III 1961 41 25 14 — 1962 37 27 9 1 1963 32 16 16 — No pathogenic organisms were found in any of the 32 samples and the bacteriological grading was satisfactory. Food Premises. Bakehouses 11 Bakers' Shops 21 Butchers 49 Chemists 20 Clubs and Hotels 7 Confectionery 62 Cooked Meat Shops 2 Dairies 9 49 Fishmongers (wet, dried and fried) 20 Greengrocery 58 Grocery 78 Hospitals 2 Industrial Canteens 18 Public Houses 43 Restaurants 46 School Canteens 15 Street Vendors 12 473 Food and Drugs Act, 1955—Section 16. Two hundred and fifty-six shops and food premises have been registered under the above Act, as follow: — Ice Cream Stores 206 Fish Shops 8 Butchers' Shops 41 Fish and Meat Paste Factory 1 256 Unsound Food. During the year a total of 1 ton 17 cwt. 10 lbs. of varied articles of food were condemned and destroyed, and 311 Food Condemnation Certificates were issued. Bacon 13 lbs. Cereals 246 lbs Cheese 5 lbs. Chickens 26 lbs. Cordials 4 lbs. Cream 4 lbs. Confectionery 8 lbs. Fish 97 lbs. Fish (tinned) 120 lbs. Fruit (tinned) 900 lbs. Kidneys 22 lbs. Liver 34 lbs. Meat (tinned) 1166 lbs. Meat 915 lbs. Meat Pies 26 lbs. Milk (tinned) 27 lbs. Poultry 20 lbs. Preserves 11 lbs. Sausages 153 lbs. Sauces 1 lb. Soups 4 lbs. Vegetables (tinned) 294 lbs. Vegetables 58 lbs. Milk and Dairies Regulations. Five dairies have been registered under the above regulations. No further Dealer's (Pre-Packed Milk) Licences under the Milk (Special Designation) Regulations, 1960, were issued during the year. Five visits were made to the dairies during 1963. 50 New regulations were brought into operation (in part) at the end of September. The principal change with which we are concerned is that as from the 1st October, 1964, "Untreated" will replace "Tuberculin Tested" as the special designation for raw milk. The designations for the heat-treated milk, viz., " Pasteurised " and " Sterilised" remain unchanged. Slaughterhouses and Slaughtermen. No slaughterhouses were licensed during the year, but licences were issued to six slaughtermen under the Slaughter of Animals Act, 1958. Restaurants, Hotels and Canteens. One hundred and three visits were made to these premises during the year. In five cases defects requiring the attention of the owner were dealt with by informal action. Butchers' Shops. One hundred and seventy-five detailed inspections were made of the forty-nine 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 915 lbs. of meat were condemned as being unfit for human consumption. In no case was there any evidence of unsound meat being exposed for sale. Bakehouses. Forty-three inspections were made of the eleven premises during the year, and in six cases defects were found which required the attention of the department. Merchandise Marks Act, 1926. Thirty-six visits were made to premises during the year in connection with this Act. No contraventions were detected. Game Act, 1831. Five licences were renewed during the year. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 52 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. General. One thousand four hundred and twenty-three notifications of infectious diseases were received during the year, compared with 420 during 1962. The difference in the figures for these two years is mainly accounted for by the increase in the number of cases of measles, there being 253 notifications of this disease in 1962 and 1,283 in the year under review. Biggin Hill Civil Airport. The Health Control unit was maintained as usual throughout the year, but no use was made of it. On one occasion only was it necessary for three travellers arriving at the airport to present valid international certificates of vaccination. Acute Anterior Poliomyelitis and Vaccination. There were no cases of poliomyelitis in 1963. The County Medical Officer has kindly supplied the following poliomyelitis vaccination figures for 1963, based on the return submitted to the Ministry of Health: Year. 2 injections (Salk) 3rd Dose. (Salk and Oral) 4th Dose. (Salk and Oral) 3 Orals (Complete Course) 1963 9 3 912 200 1962 2 80 — 844 1961 1 91 — 106 1957-1960 — 25 — 58 1943-1956 — 27 — 33 1933-1942 3 27 — 37 Others 3 83 — 93 Diphtheria and Diphtheria Immunisation. No cases of this disease were notified in the Urban District during 1963. The following table, details of which have been supplied by the County Medical Officer, shows the diphtheria immunisation figures for 1963, based on returns submitted to the Ministry of Health: Year of Birth. Diphtheria Immunisation (Singly or in combination). Primary. Reinforcing. 1963 574 Nil 1962 616 42 1961 30 358 1960 6 114 1959 6 52 1954-1958 8 623 1949-1954 Nil 10 Totals 1240 1199 53 Dysentery. Six cases of dysentery were notified during the year, only one patient being admitted to hospital. No deaths from this disease were recorded. Food Poisoning. A total of twenty-five cases were notified in 1963, three being admitted to hospital. All were single cases. There were no outbreaks of this disease. Salmonella was isolated in seven cases. No deaths from this disease were recorded. The following is a copy of the annual return forwarded to the Ministry of Health: Notifications (corrected). (1) First Quarter 19 Second Quarter 5 Third Quarter 1 Fourth Quarter Nil (2) Cases otherwise ascertained Nil (3) Symptomless Excreters Nil (4) Fatal Cases Nil (5) Particulars of outbreaks: No. of cases notified Nil No. of cases otherwise ascertained Nil Agent identified: Staphylococci Nil CI. Welchii Nil (6) Single cases: Agent identified: Salmonella 7 Unknown 18 (7) Salmonella infections, not foodborne Nil Measles. Notifications of this disease showed an increase, 1,283 cases being notified as against 253 in 1962. Fifteen of these cases were admitted to hospital. No deaths from this disease were recorded. Meningococcal Infections. Two cases occurred in the area during 1963. No deaths from this disease were recorded. Pneumonia. Twenty cases of pneumonia were notified in 1963, as against twenty-nine in the previous year. None of these cases was admitted to hospital, all being home nursed. There were fifty-eight deaths attributed to this disease. This figure includes people who are normally resident in the Urban District, but who died outside the area. 54 Scarlet Fever. Twenty-two cases were notified during the year, two being admitted to hospital and the remainder being home-nursed. No deaths from this disease were recorded and there were no "return" cases. Smallpox and Vaccination. No cases of smallpox occurred in the area, but it was necessary to keep four contacts under surveillance for the requisite period. Eight hundred and twenty-two International Certificates of Vaccination were brought into the Public Health Department for the doctors' signatures to be authenticated during 1963. The County Medical Officer informs me that 312 children in the area received primary vaccination and 8 (school age but under 8 years) re-vaccination during 1963. Tuberculosis. The following is a copy of the recordings in the register at 31st December, 1963:— Respiratory. Other Forms. Total No. of cases. M. F. M. F. On register at 1st January, 1963 365 305 27 33 730 New cases notified during 1963 10 8 3 4 25 No. of cases coming to knowledge after death 3 — — — 3 Restored to Register — — — — — Inward Transfers 12 11 — — 23 390 324 30 37 781 Deletions, deaths, removals, recoveries, etc. 37 26 — — 63 353 298 30 37 718 New Cases and Mortality, 1963. New cases notified or otherwise revealed. (Not including Inward Transfers*). Deaths. Age Groups. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M F. M. F. M. F. Under 5 — — 1 1 — — — — 5-14 1 — — — — — — — 15-24 1 3 — — — — — — 25-44 2 2 2 1 — — — — 45-64 5 2 — 1 1 — — — 65 and over 1 1 — 1 3 — — — Age unknown — — — — — — — — 10 8 3 4 4 — — — *Inward Transfers 12 11 — — 22 19 3 4 55 The number of new cases of tuberculosis notified during the year was 25 and there were 4 deaths from this disease in 1963. Chest Clinic. Dr. D. G. Madigan, Physician in charge, has kindly furnished the following details for the year 1963:— New cases attending the Chest Clinic for the first time during 1963:— Adults. Children under 15. M. F. M. F. Pulmonary Tuberculosis 15 8 — — Non-Pulmonary Tuberculosis — 1 — — Non-Tuberculous 82 69 44 29 New contacts examined during 1963 (not included in the above table):— Negative: 147. Positive: 4 (3 of these were inward transfers). Number of tuberculous patients who completed a course of Hospital treatment during 1963: 32. B.C.G. Vaccination of contacts: 95. Public Health (Prevention of Tuberculosis) Regulations, 1925. Section 172, Public Health Act, 1936. No action was taken by the Local Authority under these regulations in 1963. 56 MASS X-RAY Details of the results of the surveys undertaken in Orpington during 1963. Numbers examined Cases of tuberculosis requiring treatment or close supervision Not previously examined Numbers Cases Men Women Total Men Women Total Men Women Total Men Women Total Public Surveys 2515 3411 5926 2 1 3 1056 1770 2826 1 1 2 Public Surveys — examnation of special groups 489 67 556 1 1 47 28 75 — — — Firms — full scale visits 465 105 570 — — — 191 44 235 — — — Firms — examination of special groups 76 — 76 — — — 2 — 2 — — — TOTAL 3545 3583 7128 3 1 4 1296 1842 3138 1 1 2 57 Typhoid and Paratyphoid Fever. No cases were notified during 1963. Whooping Cough. Thirty-five cases were notified during the year, as against three in the previous year. No deaths from this disease were recorded. The County Medical Officer informs me that 1,189 children received Whooping Cough Immunisation (singly or in combination) during the year. Other Infectious Diseases. In addition to those previously mentioned, notifications were received as under:— Erysipelas 2 Puerperal Pyrexia 1 Meningococcal Infection 2 Encephalitis 2 SECTION G. REFUSE COLLECTION AND DISPOSAL. 60 SECTION G. REFUSE COLLECTION AND DISPOSAL. Mr. Crowe reports:— It was not possible to maintain the regular weekly collection of household refuse on the same day each week during January and February owing to the severe weather conditions which prevailed during that period. The heavy snowfalls which followed immediately after the Christmas holidays could not have come at a worse time. Apart from this and slight disturbance at Easter, the regular weekly collection on the same day each week has been maintained. The method employed in the collection of household refuse is known as the relay system. Each team of collectors works with two vehicles and drivers, and at the commencement of the day's work, they divide into two collecting teams with a vehicle and driver. The divided teams work in close proximity and when one vehicle proceeds to the refuse tip with its load, the collectors join forces and complete the loading of the remaining vehicle. This principle is adopted throughout the whole day's work with the teams working either with one or two vehicles. Thus there is no waste of collector's time as with the single vehicle system. Collections are made weekly throughout the district from some 25,000 premises. A weekly collection of trade refuse is made from 300 shop premises and offices. A vehicle and driver and a collector are engaged on this work for which an annual charge is made. Collections of refuse are made from the numerous schools each week and three times weekly from the two large hospitals. Vehicles and personnel separate from the regular refuse teams are engaged on this work. The Council owns a fleet of 18 refuse collecting vehicles, ten of which are of the dual-tip rear loading type. It is the Council's policy, as replacements take place, to purchase this type of vehicle which enables the work to be carried out in a more cleanly manner than with vehicles which are loaded from the sides. Fifty-one workmen are employed on the work of collection and disposal. All the refuse is disposed of by means of controlled tipping on low-lying land of poor agricultural value at Budgin's Hill, Pratts Bottom. The refuse is deposited in layer formation, consolidated, covered and sealed in accordance with modern principles of controlled tipping as laid down by the Ministry of Housing and Local 61 ment. 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, thus reclaiming the land and enabling it to be used as pasture. Two men are employed at the tip, a Fordson Major Tractor Muledozer being used for the levelling process and approximately 23,500 tons of refuse is deposited annually. The cost of collection and disposal compares favourably with districts of comparable size and characteristics. The costing returns of the Ministry of Housing and Local Government published in 1963 show that the net cost per 1,000 population for collection and disposal of house refuse was £618, and the net cost per 1,000 premises for collection and disposal was £1,984. The Abstract of Accounts prepared by the Council's Treasurer for the year ended 31st March, 1963, showed that on a unit basis, the cost of house refuse collection and disposal was £2 2s. 11d. per dwelling per annum. APPENDIX. STATISTICAL TABLES. 64 STATISTICAL TABLES, 1963. TABLE I. Summary of Statistics. TABLE II. Causes of Death. TABLE III. Notifiable Infectious Diseases—Sex and Age Distribution. TABLE IV. Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates. TABLE V. Notifiable Infectious Diseases—Seasonal Incidence. TABLE VI. Summary of the work of the Public Health Inspectors. TABLE VII. Nuisances, Defects and Contraventions Abated. TABLE I. SUMMARY OF STATISTICS, 1963. Population (mid-year 1963) per Registrar General 81,570 Birth Rate (crude) (per 1,000 estimated total population) 16.5 Death Rate (crude) (per 1,000 estimated total population) 9.6 Maternal Mortality Rate (per 1,000 total live and stillbirths) Nil Stillbirth Rate (per 1,000 live and stillbirths) 14.8 Infant Mortality Rate (per 1,000 total live births) 11.9 Number of Births (live) 1,342 Number of Stillbirths 20 Number of Deaths 787 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 16 Number of Deaths from Infectious Diseases 1 Death Rates:— Respiratory Diseases (excluding Tuberculosis) 1.4 Tuberculosis 0.05 Cancer (all forms) 2.0 Cancer of the lung, bronchus 0.5 Infectious Diseases 0.01 Notifications of Infectious Diseases:— Diphtheria Nil Dysentery 6 Erysipelas 2 Food Poisoning 25 Measles 1,283 Ophthalmia Neonatorum Nil Poliomyelitis (paralytic) Nil Poliomyelitis (non-paralytic) Nil Puerperal Pyrexia 1 Pneumonia (all forms) 20 Scarlet Fever 22 Tuberculosis (new cases and including Inward Transfers) 48 Typhoid and Paratyphoid Fever Nil Whooping Cough 35 Number of visits made by Public Health Inspectors 5,477 65 TABLE II. CAUSES OF DEATH. 1959 1960 1961 1962 1963 Male Female Total 1. Tuberculosis—Respiratory 3 2 3 7 4 — 4 2. Tuberculosis—Other 1 1 — — — — — 3. Syphilitic Diseases — 1 3 1 1 — 1 4. Diphtheria — — — — — — — 5. Whooping Cough — — — — — — — 6. Meningococcal Infections — — — 1 — — — 7. Acute Poliomeylitis — — — — — — — 8. Measles 1 — — — — — — 9. Other infective and parasitic diseases 2 1 3 2 — 1 1 10. Malignant neoplasm, stomach 16 29 14 14 12 7 19 11. Malignant neoplasm, lung, bronchus 48 33 43 47 36 4 40 12. Malignant neoplasm, breast 14 13 16 11 — 20 20 13. Malignant neoplasm, uterus 5 6 13 4 — 6 6 14. Other malignant and lymphatic neoplasms 89 78 83 79 49 33 82 15. Leukaemia, Aleukaemia 6 6 5 4 — 3 3 16. Diabetes 3 1 8 4 1 4 5 17. Vascular lesions of nervous system 84 48 78 75 27 42 69 18. Coronary disease, angina 139 132 108 120 86 58 144 19. Hypertension with heart disease 20 11 16 15 5 8 13 20. Other heart disease 73 88 133 112 41 50 91 21. Other circulatory disease 32 42 47 62 36 35 71 22. Influenza 5 — 6 2 4 4 8 23. Pneumonia 65 71 50 57 28 30 58 24. Bronchitis 36 27 33 37 34 13 47 25. Other diseases of respiratory system 6 12 7 10 3 3 6 26. Ulcer of stomach or duodenum 8 7 3 6 7 1 8 27. Gastritis, enteritis & diarrhoea 2 3 3 1 2 2 4 28. Nephritis and Nephrosis 3 2 — 2 2 2 4 29. Hyperplasia of Prostate 3 2 7 3 1 — 1 30. Pregnancy, childbirth, abortion — — — — — — — 31. Congenital malformations 10 7 5 9 3 3 6 32. Other defined and ill-defined diseases 55 58 50 56 29 25 54 33. Motor vehicle accidents 12 13 12 12 5 3 8 34. All other accidents 6 8 6 9 5 5 10 35. Suicide 3 9 6 9 2 2 4 36. Homicide and operations of war 1 1 — — — — — 751 712 761 771 423 364 787 66 TABLE III. NOTIFIABLE INFECTIOUS DISEASES, 1963. 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 650 633 15 12 137 113 179 189 303 299 4 14 4 1 1 1 7 4 Whooping Cough 15 20 1 2 5 3 6 8 3 7 — — — — — — — — Scarlet Fever 16 6 — — 3 1 3 3 7 2 3 — — — — — — — Dysentery 4 2 — 1 1 — — — 2 — — — — — 1 1 — — Poliomyelitis (Paralytic) — — — — — — — — — — — — — — — — — — Poliomyelitis (Non-Paralytic) — — — — — — — — — — — — — — — — — — Meningococcal Infection 2 — — — — — 1 — 1 — — — — — — — — — 687 661 16 15 146 117 189 200 316 308 7 14 4 1 2 2 7 4 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 11 9 1 1 1 — — — 3 1 1 5 4 2 1 — Erysipelas 1 1 — — — — — — — — 1 1 — — — — Food Poisoning 9 16 2 3 2 2 — 1 3 5 1 3 1 2 — — Puerperal Pyrexia — 1 — — — — — — — 1 — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — — — — — Encephalitis 1 1 — — 1 1 — — — — — — — — — — Tuberculosis (Pulmonary) 10 8 — — 1 — 1 3 2 2 5 2 1 1 — — Tuberculosis (Non-Pulmonary) 3 4 1 1 — — — — 2 1 — 1 — 1 — — 35 40 4 5 5 3 1 4 10 10 8 12 6 6 1 — 722 701 67 TABLE IV. NOTIFIABLE INFECTIOUS DISEASES, 1963. 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 G reen-Street-Green Goddington South Goddington North Knockholt Knoll Leaves Green Petts Wood Poverest St. Mary Cray Measles 1283 85 259 72 6 18 18 82 117 170 270 — 48 6 28 27 77 15 15.7 — — Whooping Cough 35 — 5 3 — 1 — 12 2 1 — — 8 — — 2 1 — 0.43 — — Scarlet Fever 22 — 6 5 — — — 1 — 3 1 — — — 1 4 1 2 0.27 — — Pneumonia 20 9 — 6 — — — — — 2 — 1 — — 1 1 — — 0.25 58* 0.71 Dysentery 6 — 1 — — — — — — 3 1 — 1 — — — — 1 0.07 — — Erysipelas 2 — 1 — — — — — — — 1 — — — — — — 1 0.02 — — Food Poisoning 25 — 9 — — — — 1 — 1 3 10 — — — — 1 3 0.30 — — Poliomyelitis (Paralytic) — — — — — — — — — — — — — — — — — — — — — Poliomyelitis (Non-Paralytic) — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 1 — — — — — — — — — 1 — — — — — — — %0.73 — — Tuberculosis (Pulmonary) 18 2 4 — 1 — 1 — 2 1 3 — — — 3 — 1 4 0.22 4 0.05 Tuberculosis (Non-Pulmonary) 7 1 — 1 — — — 2 — 1 — — — — — 1 1 4 0.09 — — Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — — — — — Meningococcal Infection 2 — — — — — — 2 — — — — — — — — — 2 0.02 — — Encephalitis 2 — — — — — — 2 — — — — — — — — — 2 0.02 — — Totals 1423 97 285 87 7 19 19 102 121 182 280 11 57 6 33 35 82 34 17.44 62 0.76 * Based on 1,000 total births and not population. % Includes all forms of Pneumonia. 68 TABLE V. NOTIFIABLE INFECTIOUS DISEASES, 1963. Seasonal Incidence. Disease Jan. Feb. March Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Measles 152 257 110 145 124 115 149 141 17 17 24 32 1283 Whooping Cough — — — 8 1 3 1 — 2 8 4 8 35 Scarlet Fever 1 2 2 2 3 2 1 — 2 2 5 — 22 Pneumonia 4 3 — 3 1 1 1 — 3 2 1 1 20 Dysentery — — 1 — 1 — — — — 3 — 6 Erysipelas — — — — — — 1 — — — 1 — 2 Poliomyelitis (Paralytic) — — — — — — — — — — — — — Poliomyelitis (Non-Paralytic) — — — — — — — — — — — — — Food Poisoning 3 10 6 — 1 4 1 — — — — — 25 Meningococcal Infection — 1 — — — — — — 1 — — — 2 Puerperal Pyrexia — — — — — 1 — — — — — — 1 Encephalitis — 2 — — — — — — — — — — 2 Ophthalmia Neonatorum — — — — — — — — — — — — — Totals 160 275 119 158 131 126 155 141 25 29 38 41 1398 69 TABLE VI. SUMMARY OF THE WORK OF THE PUBLIC HEALTH INSPECTORS. No. of Inspections. No. of premises at which defects or contraventions were found. Housing Inspection. For defects and nuisances 1,206 38 Verminous conditions 5 1 Water Supply 49 5 Cesspools 60 3 Common Lodging Houses 28 1 Drainage 713 56 Under Rent Act, 1957 7 1 (2,068) (105) Infectious Diseases. Inquiry Visits 510 — Disinfection 5 — (515) (—) Food Premises. Bakehouses 43 6 Bakers' Shops 17 — Butchers 175 14 Dairies and Milkshops 5 — Fishmongers and Poulterers .. 21 2 Fish Fryers 10 — Food Preparing or Manufacturing Premises 24 — Greengrocers 47 4 Grocers 260 16 Ice Cream Premises 16 — Restaurants, Hotels and Canteens 103 5 Street Vendors and Hawkers' Carts 24 1 Visits in connection with sampling 105 — Miscellaneous 310 — (1,160) (48) Factories. Factories with mechanical power 18 2 Factories without mechanical power 14 — Other premises classified as factories 1 — Emission of smoke, grit, fumes and noise 88 — (121) (2) Rodent Control. Miscellaneous premises 270 — (270) (—) 92 70  No. of Inspections. No. of premises at which defects or contraventions were found. Trade Premises. Shops (for Shops Act) 192 16 Piggeries 30 2 Caravan Sites 54 — Hairdressers 43 — Merchandise Marks Act 36 — Pet Animals Act 20 — (375) (18) Public Conveniences 402 — (402) (—) Miscellaneous. Swimming Baths 5 _ Suspected Food Poisoning 54 — Keeping of Animals 17 — Noxious Accumulations 4 1 Rivers, Streams, etc. 1 — (81) (1) Unclassified 485 — (485) (—) 5,477 174 68 71 TABLE VII. NUISANCES, DEFECTS, CONTRAVENTIONS, ETC., ABATED OR REMEDIED IN 1963. Drainage. Drains constructed or reconstructed 27 Overflowing cesspools emptied 6 Cesspools abolished 2 Drains repaired 18 Water Closets repaired or reconstructed 1 Drains cleansed 44 Inspection chambers repaired or renewed 20 W.C. Seats repaired or renewed 1 Flushing cisterns repaired or renewed 1 Inspection chamber covers provided 4 New connections to sewer 2 Ventilation improved or repaired 17 Sink Waste pipes trapped, renewed or repaired 3 Dampness. Roofs made watertight 8 Rainwater gutters repaired or renewed 1 Walls made waterproof 5 Damp proof course provided 1 Rainwater down pipes repaired or renewed 1 Flashings repaired or renewed 1 Water Supply. Water supply provided 1 Domestic boilers repaired 1 Pipes repaired or renewed 4 Storage tanks repaired or renewed 2 General Items. Wall plaster repaired 3 Dustbins provided 6 Ceiling plaster repaired 4 Nuisance from animals abated 2 Floors repaired 2 Noxious accumulations removed 7 Windows and doors repaired 8 Miscellaneous items 13 Glazing repaired 2 Ventilation improved 1 135 85