CRA 2 Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1937 BY C. M. OCKWELL M.D. (Lond.), F.R.C.S. (Eng.), D.P.H. (Camb.) The Sparta Press Printers Crayford Kent Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1937 BY C. M. OCKWELL M.D. (Lond.), F.R.C.S. (Eng.), D.P.H. (Camb.) The Sparta Press Printers Crayford . Kent Crayford Urban District Council. To the Chairman and Members of the Urban District Council and Health Committee. Ladies and Gentlemen, I have the honour to submit my seventeenth Annual Report. STATISTICS. Area (in acres) 2,698.71 Population (Census 1931) 15,896 Resident population 23,710 Number of inhabited houses 6,832 Rateable Value £142,174 Sum represented by a penny rate £550 Total M. F. Live Births- —Legitimate 362 184 178 Illegitimate 10 6 4 372 190 182 Birth rate per 1,000 of the estimated resident population 15.64. General birth rate for England and Wales 14.9. Total M. F. Still births— Legitimate 12 8 4 Illegitimate Rate per 1,000 total (live and still) births 31.25. 2 Total M. F. Deaths 223 126 97 Death rate per 1,000 of the estimated resident population 9.4. General death rate for England and Wales 12.4. Deaths from puerperal causes. Puerperal Sepsis — Other puerperal causes 1 Total 1 Rate per 1,000 total (live and still) births 2.6 Death rate of infants under one year of age: — All infants per 1,000 live births 45.6 Legitimate infants per 1,000 legitimate live births 41.4 Illegitimate infants per 1,000 illegitimate live births 200 General death rate of infants under 1 year of age for England and Wales 58 Deaths from Cancer (all ages) 36 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) ... Deaths from Diarrhoea (under two years of age) 1 Public Health Officers. Medical Officer of Health (part time) C. M. Ockwell, M.D.(Lond.), F.R.C.S.(Eng.), D.P.H. (Camb.). Sanitary Inspectors (whole time) R. Milligan, Cert.R.San.I., M.S.I.A. F. C. Weston, A.R.S.I., M.S.I.A., Cert.S.I.B. F. H. Shaw, Sanitary Inspector's pupil. Health Visitors (whole time) Miss E. B. Kiddell. Miss M. E. George from April 1st, 1937, , 3 No further developments have occurred in the Health Services under the following headings: — Treatment Centres. Hospitals. Nursing in the Home. Ambulance Facilities Laboratory Facilities. The following specimens were sent to the County Laboratory from this district:— Swabs 61 Sputa 46 Others 3 Bacteriological examination of School Milk 42 Child Welfare Clinics. The attendances were as follows :— Clinic Total Attendances. Average Crayford 3,253 72.2 Slade Green 1,101 47.8 Barnehurst 3,288 69.9 2,060 pints and 2,115 pounds (dry milk) of milk were granted to Clinic mothers and children during the year either free or at less than cost price. Maternal Mortality. Arising from the Ministry of Health Circular 1622 arrangements have been made for the services of an Obstetric Consultant, Mr. J. B. Blaikley, F.R.C.S., Obstetric Assistant, Guy's Hospital; Gynaecological Surgeon, St. John's Hospital, Lewisham. By arrangement with The Crayford Russell Stoneham Memorial Hospital a weekly Ante-Natal Clinic for midwives' cases was started on October 5 th. During the last three months of the year there were 82 attendances. A Dental Scheme has been adopted whereby necessitous expectant and nursing mothers can obtain dental benefits. 4 Maternity and Nursing Homes. Of the 384 births 187 occurred at Institutions and 105 of these at The Crayford Russell-Stoneham Memorial Hospital. Health Visiting. , An additional Health Visitor, Miss George, was appointed on April 1st. During the year the Health Visitors paid 9,581 visits. Infant Life Protection. At the end of the year there were seven persons receiving children for reward under the Children Act, 1908, and Children and Young Persons Act, 1932. There are seven foster children and the Health Visitor paid 72 visits to them. SANITARY CIRCUMSTANCES OF THE AREA. Water. Extensions of Water Mains have been made as follows: — Slade Gardens, Mayplace Avenue, Maiden Lane and Watling Street. Drainage and Sewerage. Surface Water Drainage has been completed as follows: — Barnehurst Sewer (Merewood Road to Crayford Creek), Mayplace Avenue, Maiden Lane, Pinnacle Hill, Eversley Avenue and Eversley Cross, Orchard Hill, and Plantation Road. Foul Sewers were completed as follows:—Mayplace Avenue and Slade Gardens. Rivers and Streams. No complaints were received and no action taken under the above heading. n 5 Sanitary Inspection of the Area. No. in District No. of visits in 1937 No. of faults & defects found No. of faults & defects remedied Bakehouses 4 15 2 2 Dairies 14 39 1 1 Slaughterhouses: Registered 21 610 1 1 Licensed 1 J — — Other food - preparing places which are, as such, subject to inspection 78 238 7 7 Offensive Trades — — — — Common lodging houses — — — — Houses let in lodgings 2 3 — — Factories 24 85 15 15 Workshops 14 44 7 7 Workplaces (other than outworker's homes)... 5 13 2 2 Nuisances and defects remedied during the year (other than those enumerated in the above tabulation). Overcrowdin 12 Keeping of Animals — Hop-Pickers' Camp — Sanitary Accommodation: (i) Insufficient 1 (ii) Defective 61 Drainage: (i) Re-constructed 2 (ii) Repaired 19 (iii) Cleansed 27 Cesspools: (i) Abolished — (ii) Repaired — Offensive accumulations 1 Buildings requiring Re- pointing 10 Miscellaneous 141 Refuse Receptacles 99 Tents, Vans & Sheds 1 Smoke Nuisances — Yard Paving 14 Dampness. 96 Roofs & Rain Water Pipes 110 Floors 67 Walls & Ceilings 807 Windows & Ventilation 271 Baths, Lavatory Basins and Sinks 29 Water Supplies 1 6 Total number of visits of all kinds paid by Inspeetor(s) during the year 7909 Approximate number of separate premises in area 7297 Number of premises containing each type of sanitary convenience in district (approximate) : — W.C.'s into drainage system Notices served— 7,410 Statutory 18 W.C.'s into cesspools 13 Informal 377 Earth closets or privvy middens 4 No. of houses, &c., disinfected 66 Pail closets 9 Batches of clothing 73 Number of premises not connected to public water-supplies 2 Scavenging and Deposition of House Refuse. There was a recrudescence of the Cricket Plague at the Slade Green Dump. A new site for tipping is in contemplation. Legal Proceedings and Results. No legal proceedings were taken during the year. Shops Act, 1934. 172 visits were paid during the year. No action was taken under the above Act. Smoke Abatement. During the year alterations to plant were carried out in one factory where the smoke nuisance was excessive. It is hoped thus to reduce considerably the amount of smoke emission. Swimming Baths or Pools. The Bathing Pool at Marten's Grove has been closed. Proposals for the substitution of a more up-to-date Bath are being considered. Eradication of the Bed Bug. During the year the Second Sanitary Inspector attended a fortnight's course on disinfestation held by The Royal Sanitary Institute. 7 Particulars of the action taken in 1937 for the eradication of the Bed Bug are as follows: — Number of Infested. Disinfected. Council Houses 28 28 Other Houses 9 9 The method employed for freeing infested houses is by (a) Spray— "Ris" liquid Insecticide, "Lethane" liquid Concentrate, (b) Fumigation— "Sanitas" Roll Sulphur Trays. A preliminary inspection is made of all prospective Council tenants. The work of disinfestation is carried out by the Local Authority. The Royal Sanitary Institute's Exhibit on the Bed Bug was borrowed and lectures were given at the Health Week during November. Tenants are told by the Inspectors what to do to prevent infestation and methods to employ for disinfestation. HOUSING STATISTICS. (1). Inspection of dwelling-houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 383 Number of inspections made for that purpose 3,644 (2) Number of dwelling-houses (included under sub head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925) 258 Number of inspections made for that purpose 3,376 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 377 8 (2). Remedy of defects without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 658 (3). Action under Statutory Powers. A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 20 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 4 (b) By Local Authority in default of owners Nil B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Nil (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners Nil (b) By Local Authority in default of owners Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 9 D. Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 9 Total number of houses owned by the Local Authority 856 Number of new houses built during 1937 (a) By the Local Authority 114 (b) By other bodies or persons 396 Shortage of Housing accommodation for working classes: — Houses required to (a) replace unsatisfactory property — (b) provide additional accommodation See Sanitary Inspector's remarks on pages 10 and 11. (4). Housing Act, 1936, Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 59 (ii) Number of families dwelling therein 59 (iii) Number of persons dwelling therein 484 (b) Number of new cases of overcrowding reported during the year 13 (c) (i) Number of cases of overcrowding relieved during the year 21 (ii) Number of persons concerned in such cases 201 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil Owing to local industrial activity there is an increasing demand for houses in Crayford. There are very few houses to let and the number of applications for Council Houses keeps increasing out of all proportion to the number of houses available. The majority of these applications are from people who are dissatisfied with their present accommodation either on account of the high rents, unsuitable type of house, or owing to the fact that they live outside the area and work in Crayford. 10 The following analysis of the applications for Council Houses from applicants living in rooms provides food for thought:— Number living and working in Crayford 67 Number living in Crayford and working elsewhere 44 Number working in Crayford and living elsewhere 92 Number living and working in other districts 31 Ignoring the last figure of 31 we are still left with a total of 203 applicants who are living in rooms. As 75 per cent. of these applicants are newcomers to the district the Council are placed in the difficult position of knowing just how many houses to provide for the reasonable needs of the district. I am of the opinion that Local Authorities should be allowed to make a small margin of profit on their housing schemes, such profit to be utilised for further housing improvements in their district. Milk Supply. Periodical inspections of Dairies, Cowsheds and Farms are made and all Retailers' premises. There has been no cause for complaint during the year. Meat and Other Foods. Carcases Inspected and Condemned. Cattle excluding cows Cows Calves Sheep and Lambs Pigs Number Killed 47 0 100 615 2484 Number Inspected 47 0 100 615 2484 All Diseases except Tuberculosis "Whole carcases condemned 0 0 0 0 0 Carcases of which some part or organ was condemned 11 0 1 3 101 Percentage of the number inspected affected with disease other than tuberculosis 23% 0% 1% 5% 4% Tuberculosis only. Whole carcases condemned 1 0 0 0 21 Carcases of which some part or organ was condemned 3 0 0 0 150 Percentage of the number inspected affected with Tuberculosis 8.5% 0% 0% 0% 7% 11 Nutrition and General Health Education. In connection with The National Health Campaign a very successful Health Week was held from November 1st to 5th. It is estimated that about 6,000 people visited the Exhibition and attended the lectures, film displays, school displays and public meetings. Supplies of Posters and Leaflets on Health matters have been received from The Central Council for Health Education. The Posters have been displayed on the Council's hoardings and leaflets distributed at the Clinics. There is nothing further to note under the following headings:— Adulteration. Chemical and Bacteriological Examination of Food. Shell Fish (Molluscan). Notifiable Diseases (other than Tuberculosis) during the year. Disease Total cases notified Cases admitted to Hospital Deaths Smallpox — — — Scarlet Fever 43 18 — Diphtheria 5 4 — Enteric Fever (including Paratyphoid) — — — Puerperal Fever 1 1 — Puerperal Pyrexia — — — Pneumonia 16 2 — Erysipelas 7 2 1 Totals 72 27 1 12 Age Groups. Disease Un der 1 1 2 3 4 5 10 15 20 35 45 65 upwards Total Smallpox Scarlet Fever — — 1 1 6 17 12 3 4 — — — 43 Diphtheria — — — — — 2 — 1 1 1 — — 5 Enteric Fever (including Paratyphoid — — — — — — — — — — — — — Puerperal Fever — — — — — — — — 1 — — — 1 Puerperal Pyrexia — — — — — — — — — — — — — Pneumonia — — — 1 — 1 1 — 5 2 1 5 16 Erysipelas — — — — — — — — 3 1 2 1 7 Totals — — 1 2 6 20 13 4 14 4 3 6 72 It will be seen that of the 43 cases of Scarlet Fever notified, only 18 were admitted to Isolation Hospital. Of the 25 cases nursed at home only in one instance was there a "return case." Diphtheria Immunization. During the year 174 children presented themselves either for Schick Test or Immunization. The numbers for schools were as follows: — Name of School. For Immunization. Crayford C/E. Boys' School 12 Crayford C/E. Girls' School 18 Crayford R.C. School 8 Slade Green Council School 4 Northend Council School 29 Barnehurst Junior and Infants — Mayplace Rd. Junior and Infants 46 Central Girls' School — 117 The numbers for the Clinics were as follows: — Crayford Child Welfare Clinic 31 Barnehurst Child Welfare Clinic 26 57 13 Alum Precipitated Toxoid in two doses (0.1 cc and 0.5 cc.) is now used as a routine. No special pressure is put upon parents to have the Schick Test done subsequently. They are told that to provide full assurance it ought to be done and facilities are offered. Ophthalmia Neonatorum. CASES Vision unimpaired Vision impaired Total Blindness Deaths Notified Treated At Home In Hospital - - - - - - - Tuberculosis. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 - - - - - - - 1 - 1 - _ - - 1 2 5 2 3 1 - - - 2 15 3 1 - - 1 - - 25 2 1 - - 3 1 - - 35 4 - - - 4 - - 45 5 - - - 5 - - 55 1 - - 1 - - 65 and upwards - - - - - - - - Totals 16 4 3 1 12 3 1 4 Ratio of non-notified Deaths to total Tuberculosis Deaths = 8 : 20 The doctors attending these non-notified cases were written to in each case. 14 1. Inspection of Factories, Workshops and Workplaces. Including inspections made by Sanitary Inspectors or Inspectors of Nuisances Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 85 13 — Workshops (including Workshop Laundries) 44 4 — Workplaces (other than Outworkers' premises) 13 2 — Total 142 19 — 2. Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions fo Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 3 3 — — ,, Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — —r — Other Nuisances 3 3 — — Sanitary Accommodation— Insufficient 6 6 — — Unsuitable or defective 12 12 — — Not separate for sexes — — — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouses — — — — Other Offences — — — — Total 24 24 — — 15 Public Health Act, 1925, Section 66, and Public Health Act, 1936, Section 176. No action was taken. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken. Public Health Act, 1925, Section 62, and Public Health Act, 1936, Section 172. No action was taken. I am, Your obedient servant, C. M. OCKWELL, Medical Officer of Health. 16