CRA 3 Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1938 BY C. M. OCKWELL M.D. (Loud.), F.R.C.S. (Eng.), D.P.H. Camb) Printed by Thos W. Jenkins (5-day week, T.U. all depts.). Bexleyheath Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1938 BY C. M. OCKWELL M.D. (Lond.), F.R.C.S. (Eng.), D.P.H. Camb) 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 eighteenth Annual Report. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,698.71 Population (Census 1931) 15,896 Resident population 24,590 Number of inhabited houses 7,063 Rateable Value £148,769 Sum represented by a penny rate £590 Total M. F. Live Births—Legitimate 421 206 215 Illegitimate 12 5 7 433 211 222 Birth rate per 1,000 of the estimated resident population 17.6. General birth rate for England and Wales 15.1. Total M. F. Stillbirths—Legitimate15 8 7 Illegitimate — — — Rate per 1,000 total (live and still) births 33.4. 3 Total M. F. Deaths 183 100 83 Death rate per 1,000 of the estimated resident population 7.4. General death rate for England and Wales 11.6. Deaths from puerperal causes. Puerperal Sepsis 1 Other puerperal causes 1 Total 2 Bate per 1,000 total (live and still) births 4.4 Death rate of infants under one year of age: — All infants per 1,000 live births 39.3 Legitimate infants per 1,000 legitimate live births 40.3 Illegitimate infants per 1,000 illegitimate live births — General death rate of infants under 1 year of age for England and Wales 53 Deaths from Cancer (all ages) 24 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) — GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 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, A.R.S.I., Cert.S.I.B., Sanitary Inspector's Pupil. Health Visitors (whole time) Miss E. B. Kiddell. Miss M. E. George. 4 No further developments have occurred in the Health Services under the following headings: — Treatment Centres. Hospitals. Nursing in the Home. Ambulance Facilites are adequate. Laboratory Facilities. The following specimens were sent to the County Laboratory from this district: — Swabs 82 Sputa 83 Others 6 Bacteriological examination of School Milk 38 Child Welfare Clinics. A start was made with a Toddlers' Clinic at Barnehurst in May, 1938. This proved so successful that similar Clinics were started at Crayford and Slade Green in October, 1938. As a full year has not run with these new Clinics the figures below are the total attendances for infants and toddlers. The average attendance at the Toddlers' Clinics since their inception is as follows: — Crayford 18 Slade Green 24 Barnehurst 25 Total Attendances at the Clinics. Clinic. Total Attendance. Average. Crayford 3,490 69.8 Slade Green 1,302 43.4 Barnehurst 3,897 59.9 Milk. 2,968 pints and 1,681 pounds (dry milk) of milk were granted to Clinic mothers and children during the year either free or at less than cost price. 5 Maternal Mortality. 121 women attended the Council's Ante-Natal Clinic which is held at the Crayford Russell-Stoneham Memorial Hospital. The total number of attendances during the year was 485. Seven cases were referred to the Obstetric Consultant. One case was treated at Guy's Hospital under his supervision and one local visit was made for an operation. Maternity and Nursing Homes. Of the 433 births 260 occurred at Institutions and 147 of these at The Crayford Russell-Stoneham Memorial Hospital. Health Visiting. During the year the Health Visitors paid 10,623 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 eight foster children and the Health Visitor paid 47 visits to them. SANITARY CIRCUMSTANCES OF THE AREA. Water. Extensions of Water Mains have been made as follows : Spring Vale, Hazel Drive, Old Barn Way, and Old Road. Drainage and Sewerage. Surface Water Drainage has been completed as follows : London Road, High Street, Park Grove, and Hazel Drive. Foul. Sewers were completed as follows: Hazel Drive and Iron Mill Lane. 6 Rivers and Streams. No complaints were received and no action taken under the above heading. Closet Accommodation. Approximate number of premises containing each type of sanitary convenience in the district: — W.C.'s into drainage system 7,750 W.C.'s into Cesspools 12 Earth Closets or privvy middens 4 Pail Closets 9 Number of premises not connected to public water supplies 2 Public Cleansing. In order to enable the cricket nuisance on the Howbury Lane Tip to be dealt with, refuse was sent away by barge from July 25th onwards. Sanitary Inspection of the Area. No. in District No. of visits in 1938 No. of faults & defects found No. of faults & defects remedied Bakehouses 4 23 2 2 Dairies 14 36 1 1 Slaughterhouses: Registered 1 585 1 1 Licensed 1 — — Other food-preparing places which are. as such, subject to inspection 78 314 7 7 Offensive Trades — — — — Common lodging houses — — — — Houses let in lodgings 2 4 — — Facories with mechanical power 26 66 8 8 Factories without mechanical power 20 52 6 6 7 Nuisances and defects remedied during the year (other than those enumerated in the previous tabulation). Overcrowding 27 Keeping of Animals 1 Hop-Pickers' Camp — Sanitary Accommodation: (i) Insufficient 1 (ii) Defective 77 Drainage: (i) Re-constructed 5 (ii) Repaired 11 (iii) Cleansed 89 Cesspools: (i) Abolished 1 (ii) Repaired — Offensive accumulations 1 Buildings requiring Re- pointing 18 Miscellaneous 136 Refuse Receptacles 109 Tents, Vans and Sheds 2 Smoke Nuisances 12 Yard Paving 5 Dampness 84 Roofs and Rain Water Pipes 62 Floors 22 Walls and Ceilings 1,294 Windows and Ventilation 157 Baths, Lavatory Basins and Sinks 99 Water Supplies 9 Total number of visits of all kinds paid by Inspectors during the year 8,398 Approximate number of separate premises in area 7,573 Notices served— Statutory 7 Informal 844 Number of houses, etc., disinfected 77 Batches of clothing 85 Shops Act, 1934. 611 visits were paid during the year. Five cases exceeding the Closing Hours were discovered, and occupiers warned. 37 notices were served. The Closing Hours for Tobacconists were extended by request to coincide with those of Sweetshops. Smoke Abatement. Alterations have been made in one case by the provision of smoke consumers and readjusting dampers in the factory. A set of mechanical stokers will soon be installed, which should prevent excessive smoke emission. 8 Swimming Baths or Pools. The reconstruction of the Swiming Fool at Marten's Grove and the installation of filtration and ozone sterilisation plant was commenced in September. Eradication of the Bed Bug. Particulars of the action taken in 1938 for the eradication of the Bed Bug are as follows: — Number of Infested. Disinfested. Council Houses 23 22 Other Houses 13 13 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. HOUSING STATISTICS. (1). Inspection of dwelling-houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 844 Number of inspections made for that purpose 4,330 (2) Number of dwelling-houses (included under sub head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 355 Number of inspections made for that purpose 3,529 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 9 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 844 (2). Remedy of defects during the year without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 837 (3). Action under Statutory Powers during the year. 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 7 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 7 (b) By Local Authority in default of owners Nil B. Proceedings under Public Health Act: — (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 3 10 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 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 Total number of houses owned by the Local Authority 947 Number of new houses built during 1938 (a) By the Local Authority 91 (b) By other bodies or persons 295 (4). Housing Act, 1936, Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 24 (ii) Number of families dwelling therein 25 (iii) Number of persons dwelling therein 172 (b) Number of new cases of overcrowding reported during the year 7 (c) (i) Number of cases of overcrowding relieved during the year 43 (ii) Number of persons concerned in such cases 302 (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 11 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Periodical inspections of Dairies, Cowsheds and harms 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 66 0 113 1207 2434 Number Inspected 66 0 113 1207 2434 Ail Diseases except Tuberculosis Whole carcases condemned . 0 0 0 0 2 Carcases of which some part or organ was condemned 15 0 1 6 30 Percentage of the number inspected affected with disease other than tuberculosis 22.7% 0% 9% .5% 1.3% Tuberculosis only Whole carcases condemned. 0 0 0 0 9 Carcases of which some part or organ was condemned 4 0 0 0 191 Percentage of the number inspected affected with Tuberculosis 6.1% 0% 1% 0% 8.2% During the year 1 ton 15 cwt. 0 qrs. 15 lbs. of food was condemned, comprising 1 ton 10 cwt. 3 qrs. 18 lbs. of meat, 55 lbs. smoked bacon, 3 cwt. of vegetables, 24 rabbits, 1 box kippers, and 1 gallon of cockles. Nutrition and General Health Education. 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. 12 There is nothing further to note under the following headings:— Adulteration. Chemical and Bacteriological Examination of Food. Shell Fish (Molluscan). CONTROL OVER INFECTIOUS DISEASE. Diphtheria Immunisation. During the year 203 children presented themselves either for immunisation or for Schick Test, as follows: Name of School or Clinic Pre-School Age School Age For Immunization For Schick Test For Immunization For Schick Test Crayford C.E. Boys' School – – 4 – Crayford C.E. Girls' School – — 7 — Crayford R.C. School – — 8 — Slade Green Council School – — 10 — Northend Council School – — 12 — Barnehurst Junior and Infants' School – – 79 1 Mayplace Road Junior and Infants' School – – 30 – Crayford Child Welfare Clinic 2 2 3 5 Barnehurst Child Welfare Clinic 23 4 10 3 Totals 25 6 163 9 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. 13 Notifiable Diseases (other than Tuberculosis) during the year. Disease Total cases notified Cases admitted to Hospital Deaths Smallpox — — — Scarlet Fever 49 25 1 Diphtheria 7 7 1 Enteric Fever (including Paratyphoid 1 1 — Puerperal Pyrexia 5 3 1 Pneumonia 10 1 — Erysipelas 8 2 — Totals 80 39 3 Age Croups. Disease Under 1 1 2 3 4 5 10 15 20 35 45 65 upwards Total Smallpox – – – – – – – – – – – — 0 Scarlet Fever — 3 1 2 3 30 7 2 1 — — — 49 Diphtheria — — 1 1 — 3 — — — — 2 — 7 Enteric Fever (including Paratyphoid – – – – – – – – – – – – 1 Puerperal Pyrexia – – – – – — — — 3 2 — — 5 Pneumonia 1 1 — – 1 1 — 1 — 1 3 1 10 Erysipelas – – – – – – – – 1 3 3 1 0 Totals 1 4 2 3 4 34 7 3 6 6 8 2 80 It will be seen that of the 49 cases of Scarlet Fever notified, only 25 were admitted to Isolation Hospital. 14 Public Health Act, 1936, Section 176. No action was taken. Ophthalmia Neonatorum. CASES Vision unimpaired Vision impaired Total Blindness Deaths Notified Treated At Home In Hospital — — — — — — — Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken. Public Health Act, 1936, Section 172. No action was taken. Tuberculosis. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 – – – – – – – – 1 – – 1 – – – – – 5 2 – 1 2 – – – – 15 4 4 3 2 1 – – 1 25 7 3 1 – 2 2 1 – 35 5 – – – 3 – – 1 45 2 1 – – 4 – – – 55 2 – – – – – – – 65 and upwards – – – – – – – – Totals 22 8 6 4 10 2 1 2 All Tuberculosis deaths had been previously notified. 15 1. Inspection of Factories, Workshops and Workplaces. Including inspections made by Sanitary Inspectors. Premises Inspections Number of Written Notices Occupiers Prosecuted Factories (with mechanical power) 66 6 — Workshops (without mechanical power) 52 7 — Other premises under the Act (including works of building and engineering construction, but not including Outworkers' premises) – – – Total 118 13 — 2. Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 5 5 – – Overcrowding – – – – Unreasonable Temperature — — — – Inadequate Ventilation – – – – Ineffective drainage of floors — — — — Sanitary Conveniences— Insufficient 2 2 — — Unsuitable or defective 6 6 — — Not separate for sexes — — — — Other Offences 1 1 — — Total 14 14 — — I am, Your obedient servant, C. M. OCKWELL, Medical Officer of Health. 18