CRAY FORD AC 411-12(3) CRAY FORD CRA 9 RENT Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1944 BY C. M. OCKWELL M.D. (Lond.), F.R.C.S. (Eng.), D.P.H. (Camb.) The Sparta Press, Crayford, 68032 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 twenty-fourth Annual Report. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres 2,698.71 Population (Census 1931) 15,896 Population estimated 21,910 Number of inhabited houses 6,982 Rateable Value £156,598 Sum represented by a penny rate £610 Total M. F. Live Births—Legitimate 483 253 230 Illegitimate 24 6 18 507 259 248 Birth rate per 1,000 of the estimated resident population 23.1. General birth rate for England and Wales 17.6. Total M. F. Stillbirths—Legitimate 11 3 8 Illegitimate — — — Rate per 1,000 total (live and still) births 21.2. Total M. F. Deaths 243 114 129 Death rate per 1,000 of the estimated resident population 11.1. General death rate for England and Wales 11.6. Deaths from puerperal causes. Puerperal Sepsis — Other puerperal causes — Other Maternal Causes — Death rate of infants under one year of age:— All infants per 1,000 live births 41.4 Legitimate infants per 1,000 legitimate live births 37.3 2 Illegitimate infants per 1,000 illegitimate live births 125.0 General death rate of infants under 1 year of age for England and Wales 46 Death from Cancer (all ages) 35 Death from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 2 Table showing Summary of Causes of Death registered during the year ended 31st December, 1944. CAUSES OF DEATH. Male Female 1. Typhoid and Paratyphoid Fevers — — 2. Cerebrospinal fever — — 3. Scarlet fever — — 4. Whooping cough — 1 5. Diphtheria — — 6. Tuberculosis of respiratory system 6 8 7. Other form of tuberculosis 1 1 8. Syphlitic diseases 2 — 9. Influenza — 2 10. Measles — — 11. Acute Poliomyelitis and Polioencephalitis — — 12. Acute Infantile encaphalitis — — 13. Cancer of buccal cavity and oesophagus (M) Uterus (F) — 3 14. Cancer of stomach and duodenum 4 5 15. Cancer of breast — 2 16. Cancer of all other sites 9 12 17. Diabetes — 1 18. Intracranial vascular lesions 11 11 19. Heart disease 23 29 20. Other diseases of circularity system 1 5 21. Bronchitis 7 1 22. Pneumonia 3 4 23. Other respiratory diseases 2 1 24. Ulcer of stomach or duodenum 7 — 25. Diarrhoea under 2 years 2 — 26. Appendicitis — — 27. Other digestive diseases 1 2 28. Nephritis 1 1 29. Puerperal and post-aboTtive sepsis — — 30. Other maternal causes — — 31. Premature birth 2 3 32. Congenital malformation, birth injuries, infant disease 3 5 33. Suicide — 1 34. Road traffic accident 2 — 35. Other violent causes 18 23 36. All other causes 9 8 All causes Total 114 129 3 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. (Cambs.) 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. Health Visitors (whole time) Miss E. B. Kiddell. Miss I. E. Smith, S.R.N., S.C.M. Health Visitors' Cert. Laboratory Facilities. The following specimens were sent to the County Laboratory from the District:— Swabs 27 Sputa 69 Others 10 School Milk Tubercle Bacilli 1 Infant Welfare Clinics. Attendances are considered very satisfactory in view of the number of children under 5 years of age evacuated. The average attendances are as follows:— No. of Clinics. Attendances. Average Toddlers Clinics Crayford 24 838 34.9 Slade Green 23 469 20.4 Barnehurst 23 797 34.7 Infants Clinics. Crayford 47 2491 53.0 Slade Green 23 1031 44.8 Barnehurst 47 2946 62.7 Totals at both Clinics 187 8572 45.8 4 Milk. 14 pounds (dry milk) of milk were granted to Clinic mothers and children during the year either free or at less than cost price. Wartime Nurseries. Attendances: "Shenstone," Crayford 5,781. 35 Children on the Register at the end of the year. Attendances: Slade Green 4,684. 31 Children on the Register at the end of the year. Four Students were successful in passing the examination for the Diploma of the National Society of Children's Nurseries. Government Evacuation Scheme. Number of expectant mothers evacuated 49 Number of children under 5 evacuated 532 Total number of children evacuated 3187 Home Helps. Home helps have carried out their duties satisfactorily to 12 families during the year. Maternity Services. 159 women attended the Council's Ante-Natal Clinic. The total number of attendances was 540. X-Ray. Six expectant mothers were referred to the County Hospital for X-Ray examination. 5 Obstetric Consultant. Two cases were referred for examination to the Council's Obstetric Consultant at St. John's Hospital, Lewisham. Priority. As from the 3rd November, 1944, Priority Dockets for sheets have been available for expectant mothers being confined in their own homes. This has proved a welcome addition to the special facilities available to expectant mothers and is greatly appreciated. To the end of December 19 Dockets have been issued. Care of Premature Infants. Two sets of equipment including draught proof cots are available for loan in the District. Daily visits are made by the Heailth Visitors until the infants reach 7 lbs. in weight. The total number of premature babies notified who were born:— (a) At Home 4. (b) In Hospital 21. (i) The number of those born at home:— (a) Who were nursed entirely at home 4. (b) Who died during the first 24 hours 1. (c) Who survived at the end of one month 3. (ii) The number of those born in Hospital:— (a) Who died during the first 24 hours 1. (b) Who survived at the end of one month 9 residing in Crayford area, other areas not known Total from 1st January, 1944, to the 31st December, 1944, 25. Care of Illegitimate Children. The Council have agreed with Oakhurst Diocesan Home, Erith, to make contributions towards the maintenance of unmarried mothers admitted to the home from this area. Four such cases were admitted during the year. 6 Maternity and Nursing Homes. Of the 518 births, 376 occurred at institutions, of these 146 at the Russell-Stoneham Memorial Hospital and 147 at the Dartford County Hospital. Health Visiting. During the year the Health Visitors paid 13,520 visits. The Health Visitors co-operating with the School Nurse pay special visits to the homes of children notified as verminous and excluded from school. 16 children received attention. Infant Life Protection. The Senior Health Visitor is responsible for the, Infant Life Protection work which includes care of adopted children and foster children. Adoption. Seven cases for adoption were investigated and recommended bringing the total to ten children under supervision, involving 33 visits by the Child Protection Visitor who is satisfied with the conditions found. Foster Children. Number of persons receiving children for reward at the end of the year 11. Number of foster children on the register at the end of the year 11. 93 visits were paid to these children, the home conditions were found to be satisfactory. Orthopaedic Treatment. Facilities are available for Orthopaedic treatment at the Dartford County Hospital, and eleven Crayford patients made 83 attendances. One case attended the Speech Clinic at the same hospital. 7 AMBULANCE FACILITIES. Infectious Disease. Cases of Infectious Disease are removed to the Bow Arrow Hospital by the Ambulance in connection with that institution., Non-infectious Disease. The Council have an arrangement with the Crayford Division of the St. John Ambulance Brigade for the use of their Ambulance for removal of cases to hospital. SANITARY CIRCUMSTANCES OF THE AREA. Water. The Metropolitan Water Board is the supplying authority. Water under constant pressure, is satisfactory both in quality and in quantity. No stand-pipes in the area. No analytical evidence of plumbo solvency. The water is "hard" and, therefore, self protective. Samples generally are only taken on complaint as the M.W.B. normally undertake sampling and testing. Closet Accommodation. Approximate number of premises containing each type of sanitary convenience in the district:— W.C's. into drainage system 7894 W.C's. into Cesspools 9 Earth Closets or privy middens 4 Pail Closets 9 Number of premises not connected to public water supplies 1 General. Repair of bomb damaged houses has included in first stage repairs, water closets and water systems, a very large number of which have sustained damage. Public Cleansing. Fortnightly collections of refuse and salvage has been maintained by Surveyor's Department. Receipts of salvage well maintained and included a successful Book Drive. 8 Sanitary Inspection of the Area. No. in district No. of visits in 1944 No. of faults and defects found No. of faults and defects remedied Bakehouses 2 28 0 0 Dairies 4 39 0 0 Other food - preparing places, which are, as such, subject to inspection 25 404 0 0 Nuisances and defects remedied during the year (other than those enumerated in the previous tabulation). Overcrowding 0 Roofs and Rain Water Sanitary Accommodation: Pipes 331 Defective 227 Floors 18 Drainage : Walls & Ceilings 368 (i) Repaired 0 Windows & Ventilation 70 (ii) Cleansed 289 Baths, Lavatory Basins Refuse Receptacles 257 and Sinks 101 Dampness 36 Water Supplies 15 Total number of visits of all kinds paid by Inspectors during the year 5,893 Approximate number of separate premises in area 7,500 Notices served:— Statutory 0 Informal 1,142 Number of houses, etc., disinfected 45 9 Shops Acts. Visits made during the year 69. Swimming Bath. Remained popular and appreciated; increased attendances and high quality of water purity was maintained. 9 Eradication of the Bed Bug. Particulars of the action taken in 1944, for the eradication of the Bed Bug are as follows:— Number of Infested Disinfested Council Houses 18 18 Other Houses 6 6 Public Shelters 3 3 HOUSING STATISTICS. (1). Inspection of Dwelling-Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1148 Number of inspections made for that purpose 2262 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1 Number of inspections made for that purpose 6 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1101 (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 1101 (3). Action under Statutory Powers during the year. Statutory Notices under Housing or Public Health Acts 0 10 Total number of houses owned by the Local Authority 783 Number of houses built during 1944:— (a) By the Local Authority Nil (b) By other bodies or persons Nil (4). Housing Act, 1936, Part IV.—Overcrowding. Owing to the extraordinary circumstances prevailing at the present time any attempt to give figures for the above items without a fresh survey would merely be guesswork and not a correct statement. Housing as affected by War Conditions. Houses demolished 184 Houses seriously damaged 568 Houses slightly damaged 6265 Original No. of houses, approximately 7100 Repairs to Ministry of Health "Higher Standard" will be completed by November, 1945. Extensive general repair and decoration work is needed on Council and private houses. Post-War Housing Plans. 50 temporary houses (10 year type) have been completed, and the erection of a further 50 temporary houses will commence August, 1945. The rebuilding of 25 permanent houses is to commence in September, 1945, to be followed by the construction of 40 permanent houses at Heath Road, probably in November/December. Further land at Thames Road for 200/220 permanent houses is in course of acquisition. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. One sample of milk submitted for biological test showed no signs of Tuberculosis. One notice was served for contraventions of Acts 6 (3 and 7) of the Milk and Dairies Order, 1926. As a consequence, the Cowkeeper has since ceased to produce milk for sale. 11 MEAT AND OTHER FOODS. Local slaughterhouses are closed owing to the Centralised Slaughtering Scheme of the Ministry of Food. During the year a total of 4 tons, 7 cwts., 1 qrs., 3 lbs. of food was found to be unfit for human consumption. Classification is shown below:— Tons Cwts. Qrs. Lbs. Meat 8 3 27 Fish 8 1 9 Vegetables and Fruits 8 1 13 Miscellaneous 3 1 2 10 4 7 1 3 The bulk of this foodstuff was diverted to other channels, e.g., Animal feeding. The Control of Rodents and Other Pests. In addition to work under the Rats and Mice (Destruction) Act, 1919, such work as mosquito control and general disinfestations were given careful attention. During the year the following infestations were dealt with:— Rats 153 Crickets 18 * Wasps nests 35 Flies 2 *Ticks 2 Wooly Bear 1 *Ants 1 * Infestations in these cases were Anderson Shelters. Mosquito Control—40 gallon metal drums—treatments 338. 300 gallon concrete tanks—treatments 156. On the initial survey 96 per cent, of the metal drums and 67 per cent, of the concrete tanks contained mosquito larvae. 12 CONTROL OVER INFECTIOUS DISEASE. Diphtheria Immunisation. Immunisation is carried out at each of the Infant Welfare Clinics held at Crayford, Barnehurst and Slade Green, and also at the Public Health Department, and all the Schools in the area. Total number of children who completed the full course of immunisation during the year:— Under 5 years of age 404 Over 5 years and under 15 years 68 Total 472 Percentage of Child population considered Immunised at the end of the year:— Under Five years 87.2 per cent. Over Five and under Fifteen years 88 per cent. Alum Precipitated Toxoid in two doses (0.2 cc. and 0.5 cc.) is now used as routine. Notifiable Diseases (other than Tuberculosis) during the year. Disease Total cases notified Cases admitted to hospital Deaths Small Pox — — — Scarlet Fever 36 16 — Diphtheria — — — Enteric Fever (including Paratyphoid) — — — Puerperal Pyrexia 3 2 — Pneumonia 29 3 7 Erysipelas 7 — — Cerebrospinal Meningitis — — — Measles 98 — — Whooping Cough 109 4 1 Ophthalmia Neonatorium 1 — — Dysentry 1 — — Scabies 182 — — Totals 466 25 8 13 Ages, etc. (N.K.-age unknown) Scarlet Fever Diphtheria Whooping Cough Measles (excluding rubella ) Ac Poliomyelitis Ac Polioencephalitis M F M F M F M F M F M F Civilians— 0 — — — — 6 9 4 3 — — — — 1 — — — — 12 18 7 11 — — — — 3 3 6 — — 12 16 7 7 — — — — 5 11 6 — — 15 14 30 17 — — — — 10 3 4 — — — 2 2 5 — — — — 15 — — — — — — 1 3 — — — — 25 and over 1 1 — — — 3 — 1 '— — — — Age unknown — — — — 1 1 — — — — — — Total Civilians 18 17 — — 46 63 51 47 — — — — Non-Civilians— 15 1 — — — — — — — — — — — 25 and over (or N.K.) — — — — — — — — — — — — Total Non-Civilians 1 — — — — — — — — — — — Ages, etc. (N.K.-age unknown) Enteric or Typhoid Fever Paratyphoid Fevers Ac Pneumonia Dysentery Cerebro Spinal Fever Ac encephalitis lethargica M F M F M F M F M F M F Civilians— 0 — — — — 3 4 1 — — — — — 5 — — — — 3 1 — — — — — — 15 — — — — 3 2 — — — — — — 45 — — — — 8 3 — — — — — — 65 and over — — — — 1 1 — — — — — „ — Age unknown — — — — — — — — — — — — Total Civilians — — — — 18 11 1 — — — — — Non-Civilians— 15 (or N.K.) — — — — — — — — — — — — 45 and over — — — — — — — — — — — — Total Non-Civilians — — — — — — — — — — — — 14 Ages, etc. (N.K.-age unknown) Erysipelas Smallpox Civilians M F M F M F Puerperal pyrexia — 3 Civilians— Ophthalmia neonatorum 1 — 0 — — — — Scabies 75 107 5 — 1 — — 15 1 1 — — 45 2 2 — — Non-Civilians M F 65 and over — — — — Age unknown — — — — Total Civilians 3 4 — — Puerperal pyrexia — — Non-Civilians— — — — — 15 (or N.K.) — — — — 45 and over — — — — Total Non-Civilians — — — — 15 Tuberculosis. Age periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M ] 0 — — — — — — 1 — 1 — — — — — 1 — — 5 1 — 15 5 7 1 2 1 — — — 25 7 6 — — 3 4 — — 35 6 4 — — 1 3 — 1 45 4 — — — 1 — — — 55 1 — — — — — — — 65 and upwards — — Totals 24 17 1 2 6 8 1 1 Scabies. This is a notifiable disease in the area. During the war period treatment has been carried out by the personnel of the First Aid Post. Cases notified 182 Cases and contacts treated 252 Batches of clothing disinfested 5 It is worthy of note that there has been a considerable reduction in the number of cases, the number' 'receiving treatment in 1943 being 413. Venereal Diseases. Under the auspices of the Ministry of Health and Central Council for Health Education posters were displayed in the area throughout the year. 28 blood specimens for Wasserman testing were taken at the Ante-natal Clinic, all of which proved negative. Public Health Act, 1936, Sec. 154. One rag merchant was warned for a contravention of the above section. I am, Your obedient servant, C. M. OCKWELL, Medical Officer of Health. 16