PRO Regm 5 C4412(3)CRAYFORD CRA 18 Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1953 BY JOHN LANDON M.R.C.S., L.R.C.P., D.P.H. Printed by Perry Son a Lack Ltd. (t.u.) Lowfield Works, Dartpord Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1953 BY JOHN LAND0N M.R.C.S., L.R.C.P., D.P.H. Printed by Perry Son & Lack Ltd. (t.u.) Lowfield Works, Dartford MEMBERS OF THE HEALTH COMMITTEE. Chairman : Councillor J. Kerr. Members: Councillors : Councillors : J. P. Briggs. H. E. Clark. F. A. Gerrard. L. Riches. Miss L. M. Rodgers. Mrs. E. White, J.P. J. W. Taylor. S J. Woolley. Co-opted Members : Mrs. V. Clarke. Mrs. I. Walker. Mrs. L. Woolley. Public Health Staff. Medical Officer of Health : John Landon, M.R.C.S., L.R.C.P., D.P.H. (Joint appointment with Boroughs of Bexley and Erith). Senior Sanitary Inspector : *†‡R Milligan, Cert.R.San.I., M.S.I.A. District Sanitary Inspector. *†A. W. Kent, M.R.S.I., M.S.I.A, Chief Clerk : Mrs. G. Mitchell (Retired 31.5.53). E. T. Shutte (Appointed 1.6.53). Shorthand Typist/Clerk : Mrs. M. Travis. Rodent Operator : W. McCulla. * Certificate for Inspection of Meat and other Foods. † Shops Acts Inspector. ‡ Rodent Officer. [ 2 ] Crayford Urban District Council To the Chairman and Members of the Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1953. The vital statistics of the Urban District indicate once again that, according to this limited yardstick, the health of the Urban District can be considered satisfactory. The customary warning must however be given that these figures should be accepted with guarded optimism as they give only a part, albeit an important one, of the total health situation of the population. The birth rate for 1953 was 14.6 per 1,000 of the population compared with 14.4 in 1952. It would be premature to suppose that this slight increase can represent a reversal of the downward trend which has been noticeable for over 40 years and it is impossible to forecast what the future rates may be. The birth rate for 1953, after correction by the comparability factor supplied by the Registrar General (.95) was 13.8. The uncorrected birth rate for England and Wales was 15.5, so it will be seen that, once again, the birth rate for the District was well below that of the Country as a whole. The death rate for 1953, at 9.8 per 1,000 of the whole population was slightly lower than the rate for 1952 which was 9.11 per 1,000. After correction by the comparability factor for deaths (1.20) the rate was 11.7, and the uncorrected death rate for England and Wales for 1953 was 11.4. Cancer was again second, after diseases of the heart and blood vessels, among the chief causes of death. The infant mortality rate for 1953 at 24.5 per 1,000 live births showed a slight decrease on 1952, namely 25.0 per 1,000 live births. The rate for the Country as a whole was 26.8 per 1,000 related births so that the relatively favourable position of the Urban District in this respect will be appreciated. Of the 10 infantile deaths in the District only one was due to causes which are at present preventable, namely, a death from gastroenteritis. Infectious diseases when judged by the standards of 25 years ago, were very low. Measles headed the list with 174 cases; with whooping cough 41, and scarlet fever 36, the [ 3 ] latter disease being, generally speaking, of low virulence. There is more and more evidence that the great problem of the future will be the control of the virus infections. Fortunately there were no cases of poliomyelitis during the year in the Urban District but it may now be regarded as an annual visitant and is, in fact, endemic in this country. There is, however, at the present time, a somewhat greater hope of controlling this disease by immunisation although vaccination against poliomyelitis is still very much in the experimental stage. It may be some years yet before a vaccine can be produced in such a reliable form that it can be depended upon to produce resistance to the virus of this disease. The welfare of old people continues to take up a considerable amount of the time of the department. The notification of an old person living alone, often in very bad conditions, may present itself as an emergency requiring immediate attention. It is often a serious problem to decide what is the best action to be taken. Admission to hospital sometimes provides a temporary respite to the difficulties of the old person, but still leaves the problem of what is going to happen when he or she is ready for discharge. A tribute is due to those volunteers, from many sources, who are prepared to clean up the home and receive the old person on return from hospital. Recognition must also be given to the Woolwich Group Hospital Management Committee who are very co-operative in this matter. Often, however, in spite of all the contra-indications it is in the interests of the old person to be kept at home, however deplorable this may be and to apply, to the fullest extent, the social remedies which are available. In this connection, the Home Help Service is invaluable. Many old people ask for no more than to be allowed to keep their independence and their old homes and, whereever possible, this must be respected. The work of the Old People's Welfare Committee and the "good neighbours" of whom there are so many, often makes it possible for this solution to be applied. I have many times reported to the Health Committee that, although the death rate from tuberculosis has been falling rapidly during recent years due to great improvement in medical treatment, the notification rate has not shown a similar reduction. This may be due, in part, to better means of ascertainment, notably by means of Miniature Mass Radiography, but I have from time to time, suggested that an attack of the problem of tuberculosis from all possible angles, [ 4 ] preventive and curative, is necessary if the disease is to be finally conquered. The Minister of Health has now prepared a memorandum which accompanied Circular No. 8/54 in which he "indicates a need for intensifying various preventive measures and reviews the value of existing measures to bring the disease under control". Among the suggested remedies are greater efforts to discover the source of a new case, the supervision of contacts, the extension of the use of B.C.G. Vaccine, and the more selective use of Mass Miniature Radiography. It will be seen, therefore, that the implementation of this scheme requires the closest co-operation between Chest Clinics, the Local Health Authority, the General Practitioners and the Local Authorities, the latter being concerned, mainly, as housing authorities and as the authorities responsible, in an important measure, for the local control of infectious disease. The task is one of the most arduous thrown on the health services for many years, but it is the only sure way of getting rid of tuberculosis in the foreseeable future. The need for the collaboration of a large number of medical and social workers is called for and the effect on our own health department would be considerable. It is to be hoped that, in the coming years, this joint action will be taken. Another impending development is the new housing legislation which is at present embodied in the Housing Repairs and Rents Bill now before Parliament. While the provision of new housing has proceeded apace, the older houses have tended to deteriorate during the war and since, and the new Bill is in part concerned with slum clearance, the patching up of sub-standard houses and the improvement and conversion of older properties with a view to extending their life while further new houses are provided. There are no slums in the Urban District in the accepted sense of the word, but there is a manageable number of obsolescent houses which are ripe for demolition and could be tackled within the next few years. These could be demolished as individual unfit houses or as small clearance schemes and, particularly in the former case, the problem of rehousing the occupants is one of great difficulty. Often they are occupied by old persons living on their old age pension and the transfer to a more hygienic new house or flat is overshadowed by the fear of higher rents and the possible reduction of expenditure on food and other essentials. The Food and Drugs (Amendment) Bill at present before Parliament may also place further responsibilities on the [ 5 ] Health Department in that it foreshadows the extension of registration to classes of premises not covered, at present, by Section 14 of the Food and Drugs Act, 1938. The Bexley, Erith and Crayford Clean Food Guild has continued its work during the year and at present 112 plaques have been awarded. The co-operation of many of the multiple firms has been obtained and this long term essay in health education, stimulated perhaps by the Food & Drugs (Amendment) Act, when it reaches the Statute Book, will help to provide that higher standard of food hygiene which we all desire. During the year a Clean Food Week was held which culminated in an address and demonstration by the Deputy Medical Director of the Central Council for Health Education, and was followed by a film show and discussion. The newly-formed Bexley, Erith and Crayford Home Safety Committee promises to become an active instrument for the reduction of accidents in the home and is, in fact, complementary in its function to the Bexley, Erith and Crayford Road Safety Committee. The Minister of Housing and Local Government has given his approval to the making of a grant by each of the constituent authorities so that the Committee has, financially speaking, got off to a flying start. The collection of reliable statistics of home accidents is proceeding well, and in the near future, activities will be undertaken to draw the attention of the public, by propaganda methods, to the preventable nature of home accidents which, as is now well known, greatly exceed the number of accidents on the road. In conclusion, I wish to thank the Members of the Health Committee for their support and encouragement, and the Senior Sanitary Inspector, the Chief Clerk and all members of the Health Department for their devotion to duty at all times during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,698.71 Population (Registrar General's estimate mid-year 1953) 27,820 Number of inhabited houses 8,475 [ 6 ] Rateable Value £187,622 Sum represented by a penny rate £752 Live Births. Total M. F. Legitimate 396 207 189 Illegitimate 11 7 4 407 214 193 Birth rate per 1,000 of the estimated home population 14.6. General birth rate for England and Wales 15.5. Stillbirths. Total M. F. Legitimate 10 7 3 Illegitimate — — — 10 7 3 Rate per 1,000 total (live and still) births 23.9. Total M. F. Deaths 273 142 131 Death rate per 1,000 of the estimated resident population 9.8. General death rate for England and Wales 11.4. The Birth Rate and Death Rate for Crayford compares favourably with that for other parts of the Country. The Registrar General has supplied comparability factors for 1953. The standardised Birth Rate which allows for comparison with other parts of the Country is 13.8 and the standardised Death Rate is 11.7. Maternal Deaths :— There were no Maternal Deaths in 1953. Deaths of Infants under one year of age:— Total M. F. Legitimate 9 4 5 Illegitimate 1 1 — 10 5 5 Rate per 1,000 live births (Crayford) 24.5. Rate per 1,000 legitimate live births 22.7. General death rate of infants under 1 year of age for England and Wales 26.8. Deaths from Various Causes. Malignant Neoplasm (all ages) 34 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) 1 [ 7 ] [ 8 ] Vital Statistics during 1953 and previous years. Year Population LIVE BIRTHS DEATHS INFANT DEATHS No. RATE No. RATE No RATE C.U.D.C. C.U.D.C Eng. & W. C.U.D.C. C.U.D.C. Eng. & W. C.U.D.C. C.U.D.C. Eng. & W. 1939* 25,200 458 18.26 15 194 9.4 12.1 16 35.4 50 1940* 23,770 428 18 14.6 256 13.8 14.3 16 38.9 55 1941* 22,380 347 15.5 14.2 227 10.1 12.9 20 59.7 59 1942 22,840 441 19.3 15.8 193 8.5 11.6 20 45.3 49 1943 22,850 431 18.9 16.5 223 9.8 12.1 18 41.8 49 1944 21,190 507 23.1 17.6 243 11.1 11.6 21 41.4 46 1945 23,030 432 18.8 16.1 170 7.4 11.4 10 23.1 46 1946 25,780 566 22 19.1 249 9.7 11.5 21 37 43 1947 26,610 583 22 20.5 271 10.2 12 21 36 41 1948 27,190 501 18.4 17.9 205 7.5 10.8 10 19.9 34 1949 27,520 492 17.9 16.7 221 8.03 11.7 13 26.4 32 1950 27,750 434 15.6 15.8 219 7.89 11.6 12 27.6 29.8 1951 27,820 387 13.9 15.5 266 9.56 12.5 8 20.7 29.6 1952 27,760 400 14.4 15.3 253 9.11 11.3 10 25 27.6 1953 27,820 407 14.6 15.5 273 9.8 11.4 10 24.5 26.8 * Instructions were issued by the Registrar General for these particular years, giving certain alternative figures for calculation of these statistics. SUMMARY OF VITAL STATISTICS 1953. England and Wales 160 County Boro's and Great Towns (including London) 160 Smaller Towns (Resident Population) 25,000—50.000 at 1951 Census London Administrative County Urban District of Crayford Rates per 1,000 Home Population BIRTHS. Live Births 15.5 17.0 15.7 17.5 14.6 Still Births 0.35 0.43 0.34 0.38 0.36 22.4(a) 24.8(a) 21.4(a) 21.0(a) 23.9(a) DEATHS. All Causes 11.4 12.2 11.3 12.5 9.8 Typhoid and paratyphoid 0.00 0.00 - - - Whooping Cough 0.01 0.01 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 - - Tuberculosis 0.20 0.24 0.19 0.24 0.39 Influenza 0.16 0.15 0.17 0.15 0.18 Smallpox 0.00 0.00 0.00 — — Acute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.01 0.01 - Pneumonia 0.55 0.59 0.52 0.64 0.46 NOTIFICATIONS. (Corrected). Typhoid Fever 0.00 0.00 0.01 0.01 — Paratyphoid Fever 0.01 0.01 0.01 0.01 — Meningococcal Infection 0.03 0.04 0.03 0.03 0.04 Scarlet Fever 1.39 1.50 1.44 1.02 1.29 Whooping Cough 3.58 3.72 3.38 3.30 1.47 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.07 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 6.29 Pneumonia ... 0.84 0.92 0.76 0.73 0.50 Acute Poliomyelitis (Including Polioencephalitis Paralytic 0.07 0.06 0.06 0.07 — Non-paralytic 0.04 0.03 0.04 0.03 — Food Poisoning 0.24 0.25 0.24 0.38 — Puerperal Pyrexia 18.23(a) 24.33(a) 12.46(a) 28.61(a) 7.19(a) Rates per 1,000 live births deaths. All causes under 1 year of age 26.8(b) 30.8 24.3 24.8 24.6 Enteritis and diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 2.5 (a) Per 1,000 total (live and still) Births. (b) Per 1,000 related live births. [ 9 ] Maternal Mortality in England and Wales. Intermediate List of No. and Cause No of. deaths Rates per 1,000 Total (Live & Still) Births Rates per Million Women aged 15-44 A115. Sepsis of pregnancy, childbirth and the puerperium 68 0.10 A116. Abortion with toxaemia 7 0.01 1 Other toxaemias of pregnancy and the puerperium 166 0.24 A117. Haemorrhage of pregnancy and childbirth 90 0.13 A118. Abortion without mention of sepsis or toxaemia 30 0.04 3 A119. Abortion with sepsis 39 0.06 4 A120. Other complications of pregnancy, childbirth and the puerperium 125 0.18 [ 10 ] Table showing Summary of Causes of Death Registered during the year ended 31st December, 1953. CAUSE OF DEATH Male Female 1. Tuberculosis, respiratory 9 2 2. Tuberculosis, other — — 3. Syphilitic disease — — 4. Diphtheria — — 5. Whooping Cough — — 6. Meningococcal Infections — — 7. Acute Poliomyelitis — — 8. Measles — — 9. Other infective and parasitic diseases — 1 10. Malignant neoplasm, stomach 3 2 11. Malignant neoplasm, lung bronchus 6 1 12. Malignant neoplasm, breast — 3 13. Malignant neoplasm uterus — 2 14. Other malignant and lymphatic neoplasm 8 9 15. Leukaemia, aleukaemia — — 16. Diabetes 1 2 17. Vascular lesions of nervous system 19 14 18. Coronary disease, angina 28 17 19. Hypertension with heart disease 1 1 20. Other heart disease 15 28 21. Other circulatory disease 6 8 22. Influenza 5 — 23. Pneumonia 7 6 24. Bronchitis 13 9 25. Other diseases of respiratory system 1 3 26. Ulcer of stomach and duodenum 2 — 27. Gastritis, enteritis and diarrhoea 1 — 28. Nephritis and nephrosis 1 — 29. Hyperplasia of prostate — — 30. Pregnancy, childbirth, abortion — — 31. Congenital malformations — 2 32. Other defined and ill-defined diseases 10 16 33. Motor vehicle accidents 3 — 34. All other accidents 1 2 35. Suicide 2 3 36. Homicide and operations of war — — ALL CAUSES TOTAL 142 131 [ 11 ] Births. The 407 live births notified showed an increase of 7 compared with last year's figure. The birth rate per 1,000 of the population is 14.6 against 14.4 last year. The birth rate for England and Wales was 15.5. Deaths. This year we recorded 273 deaths out of a population of 27,820 representing a death rate of 9.8 against 9.11 in 1952. The death rate for England and Wales was 11.4. Infant Deaths. During the year 10 infants died before reaching the age of one year. There were 10 in 1952. Rate of Infant Deaths under one year per 1,000 live births was 24.5 as against 25 last year. That of England and Wales was 26.8. [ 12 ] [ 13 ] Analysis of the causes of Death of Infants at various ages under one year. Cause of Death as Certified DAYS MONTHS Total under 1 year 0 — 1 — 2 — 3 — 4 — 5 — 6 — 7 — 14 — 21 - 28 — 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 — 10 — 11 — Meningocele 1 1 Acute Necrosis of Suprarenals I 1 Atelactasis 1 1 2 Prematurity 3 1 1 5 Gastro-enteritis' 1 1 TOTAL 4 1 1 1 1 2 10 During 1953, 10 infants died before reaching the age of one year, of these 8, that is 80% occurred in the neonatal period (within one month of birth), the corresponding figure for 1952 was 90%. DISINFECTION SERVICE. A Joint Scheme is in existance with the Bexley Borough Council for the disinfection of bedding following cases of infectious diseases, tuberculosis and cancer, and for the disinfestation of bedding of verminous persons. In the case of tuberculosis, the service is carried out free of cost. MORTUARY. The Mortuary at Bexley is being jointly used by the Boroughs of Bexley and Erith and the Urban District of Crayford. In 1953, 158 cases were dealt with, out of which 156 post mortems and 31 inquests were conducted. 32 were from Crayford and from this latter figure 31 post mortems and 8 inquests were conducted. LABORATORY FACILITIES. The following specimens were sent to the County Laboratory from the District during 1953. Swabs 27 Sputa 93 Faeces 11 Bacteriological Examinations of Milk 28 Ice Creams 34 Waters (drinking) 43 Swimming Bath Waters 20 Miscellaneous examinations 320 576 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES AND OTHER DISEASES. Scarlet Fever. During the year 36 cases were notified. Of these 12 cases were isolated in hospital. The number of cases notified in 1952 was 99. [ 14 ] Diphtheria. There were no cases notified in 1953. Paratyphoid or Typhoid Fever. No cases were notified during the year. Puerperal Pyrexia. Three cases were notified during the year. Two less than the previous year's figure. All the cases were from the Russell Stoneham Hospital. One case was removed to the Brook Hospital. Meningococcal Infection. One case was notified during the year. the same as in 1952. Food Poisoning. No cases were notified during the year. Measles. The number of cases notified in 1953 was 174. One case was removed to Joyce Green Hospital. The number of cases notified in 1952 was 357. Whooping Cough. 41 cases were notified during the year. The number of cases notified in 1952 was 92. Acute Poliomyelitis. There were no cases notified in 1953. Ophthalmia Neonatorum. No cases were notified during the year. Dysentery. One case was notified during the year. Two cases were notified in 1952. [ 15 ] Notifiable Diseases (other than Tuberculosis) during the year. Dieases Total cases notified Cases admitted to hospital Deaths Small Pox - -— - Scarlet Fever 36 12 - Diphtheria - - - Enteric or Typhoid Fever - - - Paratyphoid Fever - - - Puerperal Pyrexia 3 1 - Pneumonia 14 3 1 Erysipelas 2 - - Meningococcal Infection 1 1 - Measles 174 1 - Whooping Cough 41 - - Ophthalmia Neonatorum - - - Dysentery 1 - - Scabies - - - Poliomyelitis (Paralytic) - - - Encephalitis - - - Food Poisoning - - - TOTALS 272 18 1 [ 16 ] [17] Age Groups. Scarlet Fever Diphtheria Whooping Cough Measles (excluding rubella) Ac. Poliomyelitis Paralytic Non Paralytic M F M F M F M F M F M ] Under One Year — — — — 1 2 1 4 — — — — 1 — 1 — — 4 5 18 15 — — — — 5 7 3 — — 7 5 28 24 — — — — 3 7 14 — — 14 3 50 31 — — — — 10 — 3 — — — — — 1 — — — — 15 1 — — — — — 1 1 — — — — 25* and over — — — — — — — — — — — — Age unknown — — — — — — — — — — — — Total (All Ages) 15 21 — — 26 15 98 76 — — — — Enteric or Typhoid Fevers Paratyphoid Fever Ac. Pneumonia Dysentery Meningococcal Infection Ac. encephalitis lethargica M F M F M F M F M F M F Under 5 Years — — — — 1 1 — — — — — — 5 — — — — 1 1 — — — — — — 15 — — — — 1 — 1 — — 1 — — 45 — — — — 2 2 — — — — — — 65 and over — — — — 3 2 — — — — — — Age unknown — — — — — — — — — — — — Total (All Ages) — — — — 8 6 1 — — 1 — — [ 81 ] Age Groups—continued Erysipelas Smallpox Food Poisoning M F M F M F M F Puerperal pyrexia — 3 Ophthalmia neonatorum — — 0 — — — — — — Scabies — — 5 1 — — — — — 15 — — — — — — 45 — — — — — — 65 and over — 1 — — — — Age unknown — — — — — — Total (All Ages) 1 1 [ 19 ] Immunisation against Diphtheria and Vaccination against Smallpox, 1953. The following is a return received from the County Medical Officer of Health of (a) the number of children resident in the Crayford area who were immunised again Diphtheria and (b) the number of persons who were vaccinated against Smallpox during the year ended 31st December, 1953. (A) DIPHTHERIA IMMUNISATION Year of Birth 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 Total Primary Inoculations 39 196 17 6 4 7 6 1 2 1 — — 1 — — 280 Re-inforcing Inoculations - - - - 79 221 38 10 31 20 18 9 - - - 426 (B) VACCINATION. before Year of Birth 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1939 Total Primary Vaccination 134 97 - 2 - 1 - 1 2 - - - - - 2 14 253 Re-Vaccination — — — 1 1 1 2 2 1 1 — — — 1 — 26 36 The following is a return of the number of children resident in the Crayford area under the age of 15 years on the 31st December, 1953, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1939). Year of Birth 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 Total Last complete course of injections whether primary or Booster 1949—1953 269 324 192 287 180 260 328 335 417 409 401 321 260 234 39 4,256 1948 or earlier — 47 50 — 91 47 73 65 — — — — — — — 373 Tuberculosis. Age periods N^w Cases Deaths Respiratory NonRetpiratorv Respiratory Non» Respiratory M F M F M F M F 0 — — - - - - - - 1 2 3 - - - - - - 5 1 3 — 1 — — — — 15 4 6 — 1 — — — — 25 2 4 — — 1 1 — — 35 3 2 — — — — — — 45 4 2 1 — 2 — — — 55 2 1 — — 5 1 — — 65 and uowards 2 1 — — 1 — — — Totals 20 22 1 2 9 2 — — Chest Clinics. At West Hill Hospital, Dartford, and 65, Bexley Road, Erith. Housing Applicants. Special consideration is given to cases put forward by the Medical Officer of Health involving tuberculosis or other physical disability in the applicants' families and such cases are considered outside the normal points scheme. Cases investigated during the year—24. Applicants recommended for rehousing—3. No. of families granted houses on account of Tuberculosis—9. CRAYFORD TUBERCULOSIS CARE COMMITTEE. The Crayford Tuberculosis Care Committee in association with the Kent Council of Social Service has continued to function during the year. It is perhaps significant to note that the same number of cases have been assisted as in 1952. i.e. 39, although 19 of these were new cases. Clothing, coal supplies and fares to visit relatives in Sanatoria had once again formed the bulk of the assistance given by the Committee. Other cases involved arrears of rent, mortgages and the like. Many people have approached the Committee for advice, and indeed it has often been brought home to the [ 20 ] Committee that there is much scope in this direction in the future. Occupational Therapy continues to progress satisfactorily, and it was felt that this aspect of the Committee's work was well worthwhile. The results of the Christmas Seals Sale was again gratifying, showing, after deduction of administrative expenses, the sum of £114 16s. Od. The County Organiser, Health Visitor, Chest Physician and District Officer have given invaluable service to the Committee. WELFARE OF OLD PEOPLE. This has provided an increasing demand on the services of the Health Department and the Crayford Old Peoples Welfare Committee during the year. Many cases brought to the notice of the Department by the Committe Visitors and otherwise discovered, have been visited by the Medical Officer of Health and Sanitary Inspectors. Arrangements have been made for entry into Old Peoples Homes where this has been possible. Nevertheless the problem of the care of aged people is becoming increasingly difficult. The Visiting Service carried out by the Crayford Old Peoples Welfare Committee has continued to flourish. Help has been given to the old folk with clothing and small home comforts, gifts of tea and sugar. During the year a wheelchair for use on loan to old people was purchased by the Committee, and has been in constant use ever since. Many services have been rendered to elderly people and in this connection much assistance had been given by other Voluntary Organisations to the Old Peoples Welfare Committee. Last offices have been carried out by Visitors. A Wireless Set donated to the Committee was loaned out to an old lady and the licence paid for her by the donor. On representation from the Crayford Branch of the Old Age Pensions Association and from individual sources the need for a foot clinic in the area was investigated by the Committee. It was felt that a need existed and the services of a Chiropodist were obtained and a foot clinic for old people was set up operating at three different points within the district. Finally members of the Committee felt that the question of holidays for old folk might be discussed with a view to setting up such a scheme in the area. It was, therefore, [ 21 ] ed that the Committee should operate a Holiday Scheme for Old Folk in conjunction with the schemes at present operating in many coastal resorts. Close co-operation was maintained with the Kent County Council's District Officer, the National Assistance Board, the Women's Voluntary Service, the St. John Ambulance Brigade and Nursing Division and the Red Cross. The Committee is affiliated to the North West Kent Old Peoples Welfare Committee. BURIAL—NATIONAL ASSISTANCE ACT, 1948, SECTION 50. In one case arrangements were made for the burial of a person under Section 50 of the above Act. The cost of the burial being recovered from the Ministry of National Insurance. INSPECTION AND SUPERVISION OF FOOD. The inspection of food plays an important part in the activities of the Health Department, and regular visits are paid to all food premises, particular attention being paid to those premises where food is prepared for sale. In this connection a total of 822 inspections were carried out, 378 of which were to premises registered under Section 14 of the Food & Drugs Act, 1938. The use of a temporary structure as a Cafe was discontinued, and the building demolished by the Owners. The number of food premises in the area is as follows:— Bakers 4; Grocers 50; Butchers 18; Fish Shops 9; Confectioners 19; Cafes and Canteens 27; Public Houses serving meals 5. Under Section 14 of the Food & Drugs Act, 1938, 58 premises are registered for the storage and sale of Ice Cream and 38 for the manufacture or preparation of preserved food intended for sale. From time to time complaints are received concerning the condition of foodstuffs purchased in the Crayford area, and the following list of foodstuffs indicate the kind of problems that have to be dealt with :— Canned Cherries. Complaint was received from a Shopkeeper regarding the presence of foreign matter in a tin of dessert cherries in syrup. A warning letter was sent to the Suppliers. Bread. Following a complaint regarding foreign matter in a loaf of bread, a warning letter was sent to the Suppliers. [ 22 ] A subsequent complaint of this nature resulted in legal proceedings being instituted, the Suppliers being fined £10 with £2 2s. Od. costs. Toffee Cigarette. Complaint was received regarding the unpleasant taste of a quantity of toffee cigarettes. Samples were submitted to the County Analyst, who reported that the cigarettes contained much starch. Contact was made with the Manufacturers who explained that an employee had made an error in mixing the ingredients and doubled the quantities of the flavouring materials which being highly concentrated had caused the unpleasant taste. Fortunately only a small quantity of the sweets had got on to the market and these were called back for destruction with the remainder of the stock in hand. Tinned Peas. Complaint was received regarding the condition of a tin of peas. A sample was obtained from the consignment and submitted to the Public Analyst for his observations. The contents were found to be genuine and free from foreign matter. Butter. Complaint was received concerning a J-lb. package of butter in which was embedded what appeared to be an old butter wrapper. The consignment was examined and another i-lb. package was found to contain a splinter of wood. Contact was made with the Wholesaler and the Ministry of Food, and letters of explanation received were accepted. Rice. A quantity of rice found to be slightly unpalatable was withdrawn from sale and returned to the Wholesaler. Chocolate. Complaint was received regarding a quantity of nut milk chocolate, which although fit for human consumption, was unsaleable because of its appearance. The chocolate was made from palm kernel and being hand blocked, pocketing of the surface had taken place, giving rise to the belief that the chocolate was affected by some form of larval infestation. Representation was made to the Manufacturers who withdrew the chocolate from sale. In such cases the services of the County Laboratory and the County Analyst is readily available, and is of invaluable assistance to the Local Authority's Officers. [ 23 ] Meat and Other Foods. The following articles were found during the year to be unfit for human consumption :— Beef 683½ lbs. "Frizets" 25 ½ lbs. Pork 107 ¼ lbs. Flour Mixture 30 lbs. Mutton 7 lbs. Tinned Peas 29 lbs. Lamb 14 lbs. Tinned Beans 5 lbs. Offal 972 lbs. Jam and Marmalade 34¼ lbs. Eggs 115 Bacon 160 lbs. Fruit and Fruit Juices 78¼ lbs. Cheese 6 lbs. Cooked Fat 28 lbs Tinned Stewed Steak 3 lbs. Fish 154 lbs Tinned Fish 30 lbs. Corned Beef 10½ lbs. Cooked Ham 43 lbs. Tinned Soup 61 lbs. Tinned Milk 19 tins Malted Food 48 tins Tinned Luncheon Meat 84 lbs Pickles 12 jars Confectionary 48 Rice 14 lbs. Miscellaneous Articles 18 Sponge Mixture 14½ lbs. Ihe bulk of the food condemned was unfit for salvage and had to be destroyed, but where possible, it is the practice to use condemned food for animal feeding. Slaughterhouses. There are no Government slaughterhouses in the area, but one existing slaughterhouse was used for cottagers pigs slaughtered under licence. 17 pigs were examined and all found to be fit for human consumption. Milk. Licences granted by the Council under the Milk (Special Designation) Regulations, 1949/1953. Supplementary :— Tuberculin Tested 8 Pasteurised 9 Sterilised 9 Dealers :— Tuberculin Tested 4 Pasteurised 4 Sterilised 27 [ 24 ] 29 samples of milk were submitted to the County Laboratory as follows :— Tuberculin Tested Pasteurised 10 Pasteurised 11 Sterilised 8 Of these, 1 pasteurised and 2 tuberculin tested pasteurised failed to satisfy the Methylene Blue Test. The Dairies concerned were contacted and their attention drawn to the unsatisfactory results. Although these samples were procurred during the morning delivery, it was thought that the time lag between pasteurisation and delivery may have had some bearing on the result, and the suppliers were asked to investigate the matter from this angle. Since then all samples from the same source have satisfied the tests. ICE CREAM (HEAT TREATMENT) REGULATIONS, 1947—1952. There is only one manufacturer of ice cream in the area, and as a complete cold mix is used, heat treatment is not necessary. 40 samples of ice cream submitted for examination during the year were graded as follows:— Grade 1 32 Grade II 4 Grade III 3 Grade IV 1 In the case of the Grade IV sample, which concerned ice cream manufactured from a complete cold mix, a visit was paid to the premises and the method of manufacture and storage checked. Advice was given to the manufacturer and as a result subsequent samples showed considerable improvement, the bulk of them being Grade I. [ 25 ] FOOD AND DRUGS ACT, 1938—1950. Details of Samples taken by the County Sampling Officer within the Urban District of Crayford during the year ended 31st December, 1953. Article. No. Article. No. A.P.C. Tablets 1 B/fd 33 Beef Sausage 3 Iodine B.P. 1 Bemax 1 Jam, Strawberry 1 Blackcurrants 1 Lard 1 Black Pepper 1 Liver Sausage 1 Boneless Rabbit in Jelly 1 Meat Pies Borax 1 Milk 26 Butter 1 Parrish's Food 1 Cheese Spread Pork Chipolates 1 Chico 1 Pork Pie 1 Children's Tonic 1 Pork Sausages Cocoa 1 Pork Sausage Meat (Irish) 1 Crain and Traycle 1 Dairy Butters 1 Robrex 1 Dried Milk 1 Sage and Onion Stuffing 1 Fancy Biscuits 1 Sausage Rolls G Brand Milk Food 1 Sponge Pudding Mixture 1 Gin Steak and Kidney Pie 1 Glucose 1 Strained Broth 1 Glycerine. Lemon and Aniseed Mixture 1 Suenut 1 Sugar Sweetened Egg Goddard's White Oils 1 Self-raising Flour 1 Green Pea Soup 1 Three Noughts Cough Syrup 1 Gripe Water 1 Ground Rice 1 Vaseline 1 Ground White Pepper 1 Vick Cetamium Cough Syrup 1 Halibut Oil Capsules 1 Honey, Glycerine and Blackcurrant 1 Whisky 1 Zinc and Castor Oil 1 Ice Lollies 2 Zinc, Starch and Boric 1 C/fd. 33 Total 89 [ 26 ] SUMMARY. Milk 26 Drugs 14 Spirits 3 Other Samples 46 89 All the above samples were genuine with the exception of the following :— Analysis. Action Taken. Sample of Meat 60%. Further sample Pork Chipolatas Inferior. to be obtained. BYELAWS UNDER SECTION 15 OF THE FOOD AND DRUGS ACT, 1938. Under this Section two traders were warned for contravening the Byelaws, but it was not found necessary to take statutory action. CLEAN FOOD CAMPAIGN. The work of the Bexley, Erith and Crayford Clean Food Traders Guild still goes on, and while increasing membership may appear to be slow, it is distinctly progressive, and there are indications that it will shortly improve considerably. One must realise that so far as multiple firms and Cooperative Societies are concerned, membership of various clean food campaigns can mean quite a large financial outlay, but it is pleasing to note that almost without exception, such firms in this area have signified their willingness to become members. As there may be a need for structural alterations in the case of smaller businesses, there will inevitably be a delay in the admission of such premises to membership of the Guild, especially where they are leasehold. ATMOSPHERIC POLLUTION. As a member of the Thames-side Advisory Committee for the Abatement of Atmospheric Pollution, the Council are submitting for analysis monthly samples from a deposit gauge situated within the area. The results of these samples provide interesting data on the amount of pollution, and its variations due both to atmospheric conditions and the standard of efficiency of the precipitators in use at the various works. [ 27 ] A factor of extreme importance in connection with this Committee is the increase in membership both of Local Authorities and Manufacturers. The more Local Authorities and Manufacturers representatives can mutually discuss and endeavour to solve their problems, the greater the chance and hope of success. The Control of Rodents and other Pests. During the year the following infestations were dealt with :— Rats 152, Mice 38, Wasps 3, Woodworm 13, Ants 3, Miscellaneous 7. HOUSING STATISTICS. (1) Inspection of Dwelling Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) Number of inspections made for that purpose 237 1759 (2) Number of dwelling-houses (included under sub-heading (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 5 Number of inspections made for that purpose 17 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 174 (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 Local Authority or their Officers 166 The use of an old ammunition storage hut for human habitation was discontinued. (3) Action under Statutory Powers during the year. Statutory Notices under Housing or Public Health Acts 8 [ 28 ] Number of dwelling houses in respect of which demolition orders were made Number of dwelling-houses demolished in pursuance of demolition orders 12 By agreement with Owner 3 (4) Action under Local Government (Miscellaneous Provisions) Act, 1953. Number of houses closed 2 (5) Housing Act, 1936, Part IV—Overcrowding. Whilst it is known from the particulars supplied by housing applicants that overcrowding does exist, it is impossible to state the extent of such overcrowding. Total number of houses owned by local authority 2,024 Number of houses built during year:— (a) by the Local Authority 286 (b) by other bodies or persons 53 PUBLIC HEALTH ACT, 1936. Section 154. Two Iprcoaufens- against Rag and Bone Dealers operating in the area were successful, fines being imposed in both instances. SANITARY CIRCUMSTANCES OF THE AREA. Water. The Metropolitan Water Board is the supplying authority. The supply to the Crayford district is a mixture of water from Crayford, Dartford, Darenth, Wansunt and Wilmington wells. All the water is chlorinated cn the works, but, any excess remaining after a period of contact is removed completely before the water is passed into supply. Bacteriological analyses are carried out at least five times per week for all supplies both before and after chlorination. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested to see that the quality conforms with that normally supplied before the main is passed for service. None of the supplies is plumbo-solvent.. [ 29 ] Water Sampling. The following samples were sent to the County Laboratory by the Council's Sanitary Inspectors. Samples of water taken by the Department and forwarded to the County Laboratory for examination have all been reported satisfactory. (a) Wells (drinking water). Bacteriological 14. (b) Swimming Pool, Bacteriological 20. (c) Domestic Supplies— (i) Bacteriological 32. (ii) Chemical 1. REPORT OF KENT RIVER BOARD. Rivers and Streams. River Cray : Weed growth in the bed of the river and on the banks has been removed along the whole length of this river, together with the removal of considerable amount of refuse and debris from the river course. River Wansunt: Weed growth and debris removed. Middle River: Weed growth in bed and on banks removed. Stanham River : No work has been carried out on this river due primarily to some shortage of labour and the heavy burden of construction of the new river wall. Main Marsh Dykes. Certain amount of de-silting works have been carried out following flooding of 1st, February, 1953. River Thames—Dartford Creek, Crayford Creek.—New River Walls. From the Council's westerly boundary down to the Kent River Board's depot near Jolly Farmers at Crayford, the river wall has been improved from an original top width of 4ft. and height of 16ft. A.O.D.N, to a top width of 15ft. and a height of 20ft, A.O.D.N. to a point approximately \ mile from the mouth of Dartford Creek, where the improved section of wall has a top width of 12ft. and a height of 19ft. A.O.D.N. (This should be considered in relationship to the surge level of 31st January/lst February, 1953, which was approximately 16.2ft. A.O.D.N. in this area). This work has also involved the construction of a new delph ditch between the Council's westerly boundary and Thames Ammunition Works. [ 30 ] Closet Accommodation. Approximately number of premises containing each type of sanitary convenience in the district:— W.C's. into drainage system, approximately 10,450 W.C's. into Cesspools 16 Number of premises not connected to public water supplies 0 Refuse Collection. A seven day collection of refuse was maintained under the same system as previously. Nuisances and defects remedied during the year. Overcrowding 11 Walls and Ceilings 118 Sanitary Accommodation : Baths, Lavatory Basins and Sinks 20 Defective 16 Drainage: Water Supplies 69 (i) Repaired 74 Doors and other woodwork 7 (ii) Cleansed 197 Refuse Receptacles 16 Windows and Ventilation 26 Dampness 108 Roofs and Rain Water Pipes 82 Accumulation of Refuse 7 Smoke Nuisances 2 Other works 49 Floors 79 Total number of visits of all kinds paid by Inspectors during the year 7932 Approximate number of rated premises in the area 8800 Notices served :— Statutory 8 Informal 229 Number of houses, etc., disinfected 49 Swimming Pool. Period open from the 9th May, to the 13th September. Number of bathers 33,042. This figure does not include School Parties and Clubs. Shop Acts. Visits made during the year 262. Smoke Abatement No action taken. [ 31 ] Eradication of the Bed Bug. Particulars of the action taken in 1953 for the eradication of the Bed Bug are as follows :— Number of Infested Disinfested Council Houses 11 11 Other Houses 4 4 Prescribed particulars on the administration of die Factories Act, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises (i) Number on Register (2) Number of Inspections (3) Written notices (4) Occupieis prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 14 35 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 59 123 1 - (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding outworkers' premises) ?4 88 1 — TOTAL 97 246 2 — [ 32 ] 2. Cases in which Defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H .M Inspector By H M. Inspector (1) (2) (3) (4) (5) (6) 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 6 6 — 1 — (b) Unsuitable or defective 2 2 (c) Not separate for sexes — — — — — Other offences (not including offences relating to Outwork) — — — — — TOTAL 8 8 — 1 — [ 33 ] (Sections 110 and 111). OUTWORK. Part VIII of the Act Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices served. Prosecutions. Wearing Apparel, Making, etc. 15 — — — — — [ 34 ]