AC4412(3) CRA 20 Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1955 BY JOHN LANDON M.R.C.S., L.R.C.P., D.P.H. Printed by Perry Son & Lack Ltd (t.u.) Lowfleld Works, Dartford Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1955 BY JOHN LANDON M.R.C.S., L.R.C.P., D.P.H. Printed by Perry Son a Lack Ltd (t.u.) Lowfleld Works, Dartford MEMBERS OF THE HEALTH COMMITTEE. Chairman: Councillor J. Kerr. Members: Councillors: Councillors : Miss M. Barrand. J. W. Taylor. H. E. Clark. Mrs. I. Walker. J. Nokes. Mrs. E. White. L. Riches. Co-opted Members: Mrs. E. Fatharley. Mrs. A. E. Coston. Mr. H. Spaull. 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. (Retired 30.6.55). *†‡A. W. Kent, M.R.S.I., M.S.I.A., (Promoted 1.1.55), (Redesignated Chief Sanitary Inspector). District Sanitary Inspector: *R. E. Richards, Cert.R.S.I., S.I.J.B„ M.S.I.A. Chief Clerk: E. T Shutte. Shorthand Typist/Clerk: Mrs. M. H. Travis (Resigned l9.3.55). Mrs. E. M. Tibbies (Appointed 9.5.55). Rodent Operator: W. McCulla. *Certificate for Inspection of Meat and other foods, †Shops Acts Inspector, ‡Rodent Officer. [ 2 ] Crayford Urban District Council Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1955. The widening of our conception of health in recent years to include mental, as well as physical aspects imposes special difficulties on anyone who attempts an objective assessment of the health of a community. The Medical Officer of Health of the Urban District Council of Crayford in the year 1921, on the other hand, could have suffered from no such inhibitions faced, as he was, with a heavy load of infectious disease, an infant mortality rate of 88.8 per thousand live births, and a wide variety of environmental problems which survive only as a faint echo in the present day health administration of the Urban District. It should be borne in mind that the population of the district at that time was barely 12,000 but, even so, there were 111 cases of diphtheria with 12 deaths, and 93 cases of Scarlet Fever with one death. A comparison with the vital statistics for 1955 will, therefore, show the extent of the progress which has taken place in the intervening 35 years as a result of improvements in environmental hygiene, in standards of living generally, in the techniques of health education, and through the introduction of a wide range of personal health services. Yet in spite of all this, it would be to take a superficial view to say that the present day health of the community can be regarded as entirely satisfactory. Considerable emphasis is, nowadays, being placed on mental health and there is a widespread feeling that neurosis and anxiety states are on the increase. It is, certainly, true that a very high proportion of hospital beds in the country as a whole is devoted to the treatment of mental disease. There are no statistics on which to base a realistic assessment of the mental health of our community and general impressions, even when they are the result of careful enquiry, may not be altogether reliable. The mental health of schoolchildren is nowadays receiving greater attention than it did a decade ago but this may be [3] the result, not of an actual increase in maladjustment and behaviour problems, but of a reorientation of medical outlook and an increase in the ascertainment of such children. In other words, higher levels of health are now being sought than in days gone by. One significant development is the widespread and growing use of the class of drugs known as the "chemical tranquillizers" of which phenobarbitone is, perhaps, the best known and which are used to reduce anxiety and tension with a view to making life more tolerable in an age in which it is not, always, easy to achieve that inward peace of mind which is, undoubtedly, a pre-requisite of the health of the individual. On a more optimistic note, an important criterion of the health of a community, as of an individual, is the degree of activity which it undertakes. Judged by this standard, the Urban District acquits itself well. The official list of organisations operating in the Urban District shows that a very wide range of activities is covered with the cultural, social and charitable organisations much in evidence. The cumulative work of these organisations represents a very considerable force working for the good of the community. Many instances could, also, be quoted in which neighbourly help and solicitude by individuals have made it possible for the old and infirm to remain in their own homes in conditions of relative peace and contentment. It would not be an exaggeration to say that never in the history of the Urban District has greater voluntary effort been expended in the care of the elderly and the handicapped than is the case today. Turning to those aspects of health in which definite information is available, the vital statistics were, once again, satisfactory. The birth rate at 15.4 per thousand showed an increase over the rate of 13.9 in 1954, which was the lowest birth rate ever recorded in the Urban District, but it is too early to say whether there is any discernible upward trend. The standardised birth rate, which allows for comparison with other parts of the country was 14.6 and was, therefore, below that for England and Wales which was 15.0 per thousand. The still-birth rate at 13.5 per thousand total births showed a decrease over 1954 (15.03) and the rate was considerably lower than that for England and Wales (23.1). The death rate for the Urban District fell slightly to 7.7 per thousand of the estimated whole population (8.06 in 1954) and the standardised death rate of 9.24 was below [4] the death rate for England and Wales for 1955 which was 11.7 per thousand. Cancer of the lung was responsible for 10 deaths and showed a decrease of 6 as compared with 1954. There has been much controversy over the part played by smoking in the causation of lung cancer, and it is safe to say that while statistical evidence does not provide definite proof that cigarette smoking directly causes cancer of the lung, the accumulated evidence is such as to denote a cause and effect relationship. In the circumstances it seems reasonable to advise young people not to take up smoking and, in the case of heavy smokers of middle age, to say that published data indicate that there may be some diminution in risk to those who give up smoking even after many years of addiction. The infant mortality rate for 1955. that is the number of children dying in the first year of life for every thousand live births, was 18.3 compared with 10.15 per thousand in 1954. The rate compares favourable with that for England and Wales, which was 24.9. The was one maternal death during the year, giving a maternal mortality rate of 2.25 per thousand live and stillbirths. In regard to infectious diseases, measles reached epidemic proportions in 1955, 816 cases being notified. There were no deaths and, indeed, there has been no death in the Urban District from this cause for 4 years. There were 3 cases of poliomyelitis during the year, 2 paralytic and 1 non-paralytic, but with no deaths. At the time of writing, vaccination against this disease has, recently, commenced under arrangements made by the Local Health Authority, and it is hoped that the development of this technique will bring this disease under some measure of control. During the year 23 new cases of tuberculosis were notified compared with 37 in 1954 and 45 in 1953. The number of deaths from this disease was 2 compared with 4 in 1954 and 11 in 1953. For the fifth year in succession no case of diphtheria occurred in the District. A warning that diphtheria could return as a killing disease is contained in the fact that in certain parts of the country outbreaks of diphtheria have occurred, recently, resulting in death of a number of children. Parents should take heed of this and should not fail to have their children immunised, as the continued freedom from this disease depends on the maintenance of a high level of immunisation among the child population. [5] Standards of food hygiene, while greatly improved in recent years, still leave much to be desired in many cases. The protection of food exposed for sale from dust and flies, and from the hazards inherent in its preparation and handling, will call for increased efforts by the Health Department, as well as the food traders and housewives, too, have a twofold duty, firstly, to insist on adequate standards of cleanliness in food shops and in their own homes and, also, to exercise forebearance in the unnecessary handling of food in shops prior to purchase. The new Food Hygiene Regulations strengthen the hand of the Local Authorities but their successful operation will demand a staff of sanitary inspectors adequate to the task. The present shortage of these officers is, therefore, a very serious problem. Cleanliness depends, ultimately, on an attitude of mind and the development of a sense of social responsibility and one of the results of the failure to develop the latter is the widespread litter in our streets, parks and open spaces. It may be considered that this is not primarily a health matter, but its implications in regard to hygiene in general, and the mental distress which it causes to large numbers of people in the Urban District, justifies a reference to it in an annual report. Adults are the worst offenders and it is not surprising, therefore, that children should follow their example. There is no doubt that much more could be done in the home and in the schools to inculcate a desire to preserve local amenities which play such a large part in promoting the health of the community. Among the environmental problems which remain, the most important is, undoubtedly, the lack of adequate housing, particularly for young married couples and for the aged, and this in spite of great strides which have been made in recent years by the housing authority. Problems of atmospheric pollution are coming more and more into the foreground and, although in this Urban District the problem may not be so acute as it is in more industrial areas, smoke emissions from the domestic grate add considerably to the impurities which are discharged into the atmosphere. Now that the Clean Air Bill has finally reached the Statute Book, the powers of local authorities are, to some extent, strengthened and, no doubt, the development of smokeless zones will have to be considered in the years to come. [6] The work of the Bexley, Erith and Crayford Home Safety Committee continued to make progress. In an attempt to prevent accidents from poisoning in the home, display cards were sent to all doctors and chemists in the Urban District for use in their waiting rooms and shops, urging parents to keep drugs and medicines in places where children would not have access to them. A brains trust and film show were also held, which was well attended particularly by senior schoolchildren. It is hoped to intensify this propaganda by giving regular talks and demonstrations to the latter and one is driven more and more to the conclusion, in these days when television and other distractions tend to keep people tied to their homes, that in the senior schoolchildren lies the main hope of any future development in regard to health education in general. It is pleasing, once again, to record that the Crayford Old People's Welfare Committee has continued to do excellent work in alleviating the lot of many old people by friendly help, by assistance in kind when necessary, by making arrangements for inexpensive holidays and in other ways. Their work, to some extent, co-ordinates and is complementary to, that of the many Old People's organisations in the Urban District providing clubs and other recreational facilities. The work of this voluntary organisation is of immense value to the old people in the District. The domestic help service and, more recently, the night attendance and family help services provided by the Local Health Authority, also play a vital part in relieving the lot of many old people who would otherwise have to be admitted to institutions. During the year, Mr. R. Milligan, the Senior Sanitary Inspector, retired after a quarter of century of service with the Crayford Council. Our best wishes are extended to him in his retirement. In conclusion I wish to thank the Chairman and Members of the Health Committee for their support and encouragement, and the Chief Sanitary Inspector, Chief Clerk and all members of the Health Department for their excellent service during the year. I am, Your obedient Servant, JOHN LANDON, Medical Officer of Health. [7] STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,698.71 Population (Registrar General's estimate mid-year 1955) 28,460 Number of inhabited houses 9,045 Rateable Value £204,499 Sum represented by a penny rate £754 Live Births. Legitimate Illegitimate Total M. F. 418 223 195 19 9 10 437 232 205 Birth rate per 1,000 of the estimated home population 15.4. General birth rate for England and Wales 15.0. Stillbirths. Total M. F. Legitimate 6 4 2 Illegitimate — — — 6 4 2 Rate per 1,000 total (live and still) births 13.5. Total M. F. Deaths 220 114 106 Death late per 1.000 of the estimated resident population 7.7. General death rate for England and Wales 11.7. 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 1955. The standardised Birth Rate which allows for comparison with other parts of the Country is 14.6 and the standardised Death Rate is 9.24. [8] Maternal Deaths:— There was one Maternal Death in 1955. Deaths of Infants under one year of age:— Total M. F. Legitimate 7 4 3 Illegitimate 1 1 — 8 5 3 Rate per 1,000 live births (Crayford) 18.3. Rate per 1,000 legitimate live births 16.7. General death rate of infants under 1 year of age for England and Wales 24.9. Deaths from Various Causes. Malignant Neoplasm (all ages) 52 Measles (all ages) — Whooping Cough (all ages) — Diarrhoea (under 2 years of age) — [9] [10] Vital Statistics during 1955 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 1954 28,150 394 13.9 15.2 227 8.06 11.3 4 10.1 25.5 1955 28,460 437 15.4 15. 220 7.7 11.7 8 18.3 24.9 *Instructions were issued by the Registrar General for these particular years, giving certain alternative figures for calculation of these statistics. SUMMARY OF VITAL STATISTICS.  England & Crayford Wales U.d.C. Rates per 1,000 Home Population BIRTHS. Live Births 15.0 15.4 Stillbirths 0.35 .21 23.1(a) 13.5(a) DEATHS. All Causes 11.7 7.7 Typhoid and paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.15 .07 Influenza 0.07 — Smallpox — — Acute Poliomyelitis (including Polioencephalitis) 0.01 — Pneumonia 0.51 .21 NOTIFICATIONS (Corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.02 — Meningococcal Infection 0.03 — Scarlet Fever 0.73 .98 Whooping Cough 1.78 1.5 Diphtheria 0.00 — Erysipelas 0.1 .14 Smallpox — — Measles 15.61 28.6 Pneumonia 0.63 .7 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.08 .07 Non-paralytic 0.06 .03 Food Poisoning 0.29 — Puerperal Pyrexia 17.79(a) 9.0(a) DEATHS. Rates per 1,000 Live Births All causes under 1 year of age Enteritis and diarrhoea under 2 years of age 24.9(b) 18.3(b) .75 — (a) Per 1,000 total (Live and Still) Births. (b) Per 1,000 related Live Births. [11] MATERNAL MORTALITY.  England & Wales Crayford U.D.C. Rates per 1,000 Total Live and Still Births MATERNAL MORTALITY. Maternal causes excluding abortion 0.54 — Due to abortion 0.10 2.25 Total maternal mortality 0.64 2.25 [12] Table showing Summary of Causes of Death Registered during the year ended 31st December, 1955. CAUSE OF DEATH Male Female 1. Tuberculosis, respiratory 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 — — 10. Malignant neoplasm, stomach 6 4 11. Malignant neoplasm, lung bronchus 9 1 12. Malignant neoplasm, breast — 6 13. Malignant neoplasm uterus — 2 14. Other malignant and lymphatic neoplasm 16 8 15. Leukaemia, aleukaemia 2 — 16. Diabetes 1 — 17. Vascular lesions of nervous system 8 16 18. Coronary disease, angina 19 15 19. Hypertension with heart disease 1 7 20. Other heart disease 17 13 21. Other circulatory disease 6 4 22. Influenza — — 23. Pneumonia 3 3 24. Bronchitis 6 3 25. Other diseases of respiratory system — — 26. Ulcer of stomach and duodenum 4 1 27. Gastritis, enteritis and diarrhoea — 2 28. Nephritis and nephrosis — 2 29. Hyperplasia of prostate 3 — 30. Pregnancy, childbirth, abortion — 1 31. Congenital malformations 1 2 32. Other defined and ill-defined diseases 5 13 33. Motor vehicle accidents — 2 34. All other accidents 4 — 35. Suicide 1 1 36. Homicide and operations of war — — ALL CAUSES TOTAL 114 106 [13] Births. The 437 live births notified showed an increase of 43 compared with last year's figure. The birth rate per 1,000 of the population is 15.4 against 13.9 last year. The birth rate for England and Wales was 15.0. Deaths. This year we recorded 220 deaths out of a population of 28,460 representing a death rate of 7.7 against 8.06 in 1954. The death rate for England and Wales was 11.7. Infant Deaths. During the year 8 infants died before reaching the age of one year. There were 4 in 1954. Rate of Infant Deaths under one year per 1,000 live births was 18.3 as against 10.1 last year. That of England and Wales was 24.9. [14] [15] 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 — Broncho-pneumonia 2 2 Prematurity 3 3 Atelectasis 1 1 Congenital Malformation of the Heart 1 1 Hydrocephalus 1 1 TOTAL 5 1 2 8 DISINFECTION SERVICE. A Joint Scheme is in existence 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 1955, 156 cases were dealt with, out of which 153 post mortems and 18 inquests were conducted. 17 were from Crayford and from this latter figure 17 post mortems and 1 inquest were conducted. LABORATORY FACILITIES. Pathological and bacteriological work for the area was carried out at the County Hall, Maidstone, through the Public Health Laboratory Service. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES AND OTHER DISEASES. Scarlet Fever. During the year 28 cases were notified. Of these 1 case was isolated in hospital. The number of cases notified in 1954 was 19. Diphtheria. There were no cases notified in 1955. Paratyphoid or Typhoid Fever. No cases were notified during the year. Puerperal Pyrexia. Four cases were notified during the year from the Russell Stoneham Hospital. Meningococcal Infection. No case was notified during the year, there was one in 1954 [16] Food Poisoning. No case was notified during the year. Measles. The number of cases notified in 1955 was 816. Two cases were removed to Joyce Green Hospital. The number of cases notified in 1954 was 8. Whooping Cough. 44 cases were notified during the year. The number of cases notified in 1954 was 238. Acute Poliomyelitis. There were three cases notified in 1955. Two of these were Paralytic cases and all were treated in hospital. Ophthalmia Neonatorum. No cases were notified during the year. Dysentery. No case was notified during the year. Notifiable Diseases (other than Tuberculosis) during the year. Diseases Total cases notified Cases admitted to hospital Deaths Small Pox — — — Scarlet Fever 28 1 — Diphtheria — — — Enteric or Typhoid Fever — — — Paratyphoid Fever — — — Puerperal Pyrexia 4 — — Pneumonia 20 12 — Erysipelas 4 — — Meningococcal Infection — — — Measles 816 2 — Whooping Cough 44 1 — Ophthalmia Neonatorum — — — Dysentery — — — Scabies 2 — — Poliomyelitis (Paralytic) 2 2 — Poliomyelitis (Non-paralytic) 1 1 — Encephalitis — — — Food Poisoning — — — TOTALS 921 19 — [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 F Under One Year 1 1 1 2 7 8 _ 1 2 — — — 3 10 61 70 — — — — 3 11 8 — — 2 9 89 83 1 — — — 5 3 2 — — 6 6 244 245 — — — — 10 — — — — 2 — 3 1 — — . — — 15 — — — — — — 1 2 1 — — — 25 and over — — — — 1 2 2 — — — — 1 Age unknown — — — — — — — - — — — — Total (All Ages) 17 11 15 29 407 409 2 1 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 4 2 - - - - - - 5 — — — — 3 1 - - - - - - 15 — — — 6 2 - - - - - - 45 — — — — 2 — — — '— — — — 65 and over - - - - - - - - - - - - Age unknown - - - - - - - - - - - - Total (All Ages) 15 5 [ 18 ] Age Groups—continued Erysipelas Smallpox Food Poisoning M F M F M F M F Puerperal pyrexia _ 4 Ophthalmia neonatorum 0 — — Scabies 1 1 5 - — — — — 15 1 - — — — — 45 2 1 — — 65 and over - — — — — Age unknown — - — — — — Total (All Ages) 3 1 [ 19 ] Immunisation against Diphtheria and Vaccination against Smallpox, 1955. 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 against Diphtheria and (B) the number of persons who were vaccinated against Smallpox during the year ended 31st December, 1955. (A) DIPHTHERIA IMMUNISATION. Year of Birth 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 Total Primary Inoculations 20 210 23 6 5 8 1 2 — — — 2 — — 1 278 Re-inforcing Inoculations — — — — 11 183 11 — 4 6 3 58 — 1 — 277 (B) VACCINATION. Before Year of Birth 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1941 Total Primary Vaccination 172 91 1 4 3 2 — 1 1 1 — — 1 — — 11 288 Re-Vaccination — — — 2 — 2 — 1 12 — — 1 — 241 52 The following is a return of the number of children resident in the Crayford area under the age of 15 years on 31st December, 1955, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1941). Year of Birth 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 Total Last complete course of injections (whether primary or booster) 1951—1955 27 60 106 144 116 328 400 356 339 370 273 258 271 252 20 3,320 1950 or earlier 266 230 129 161 224 21 20 69 126 7 _____ 1,253 N> o Tuberculosis. Age periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 5 years 1 — - — — — — — 5 1 — 1 - - - - - 15 1 2 - - - - - - 25 - 5 — 1 — — — — 45 3 1 - - - - - - 65 and over 1 - - - 2 - - - Totals 13 8 1 1 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—17. Applicants recommended for rehousing—3. No. of families granted houses on account of Tuberculosis—4. 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. The number of cases assisted was 29, including 12 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. This number was, once again lower than last year. Occupational Therapy continues to progress satisfactorily, and it was felt that this aspect of the Committee's work was well worthwhile. [ 21 ] The result of the Christmas Seals Sale, after deduction of administrative expenses, as reported by the Organiser to the Annual General Meeting amounted to £99—1—8d. The County Organiser, Health Visitor, Chest Physician and District Officer have given invaluable service to the Committee. MASS RADIOGRAPHY. A Mass Radiography Survey was carried out by the South East London Mass Radiography Unit in the Crayford Urban District from the 17th to 24th October, 1955. The total number radiographed was 756 men and 880 women. WELFARE OF OLD PEOPLE. This continued to provide an increasing demand on the services of the Health Department and the Crayford Old Peoples Welfare Committee. Many cases brought to the notice of the Department by the Committee 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. The Visiting Service carried out by the Crayford Old Peoples Welfare Committee continues to flourish. Help is given to the old folk with clothing and small home comforts, gifts of tea and sugar. Two wheelchairs, one purchased by the Committee and one donated to the Committee during the past year both for the purpose of loaning out to old people, are used extensively. Many services have been rendered to elderly people and much assistance is given by other Voluntary Organisations to the Old Peoples Welfare Committee. Last offices have been carried out by Visitors. Following the Committee's decision to operate a holiday scheme in conjunction with those at present operating in many coastal resorts, arrangements were made for some 50 persons to spend a week at the seaside. 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 Red Cross. The Committee is affiliated to the North West Kent Old Peoples Welfare Committee. [ 22 ] CHIEF SANIIARY INSPECTOR S REPORT. 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 1955, which gives a general summary of the work carried out by the Sanitary Inspectors during the year. INSPECHON 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 454 inspections were carried out, 423 of which were to premises registered under Section 14 of the Food & Drugs Act, 1938. The number of food premises in the area is as follows :— Bakers 5; Grocers 50; Butchers 17; Fish Shops 9; Confectioners 19; Cafes and Canteens 26; Public Houses serving meals 5. Under Section 14 of the Food & Drugs Act, 1938, 68 premises are registered for the storage and sale of Ice Cream and 42 for the manufacture or preparation of preserved food intended for sale. The following complaints were received and dealt with during the year :— Stewed Steak. A complaint was received concerning foreign matter in a tin of stewed steak. The meat was of Irish origin and accordingly the canners together with the Department of Agriculture Republic of Ireland were contacted. After an investigation by the canners, it was decided to accept their explanation. Bread. A complaint was received of blackish foreign matter in a loaf of bread. On consideration of the Analyst's report that this consisted of charred organic matter containing much rancid fat and flour, it was decided that no further action be taken. It was not possible to identify the foreign matter in another two loaves which were the subject of complaint, and consequently no action could be taken. [ 23 ] A case of mould in a loaf was the subject of proceedings taken against the vendor, who exercised her right in claiming warranty against the manufacturers. The case, however, was dismissed. Cream Cheese. A carton of cream cheese brought into the office for examination was ascertained to have been in the possession of the purchaser for longer than the usual keeping time. The process of natural decomposition was well advanced and no further action possible. Currants. A bag of currants was ascertained to be infested with the larvae of the cocoa moth. The rest of the consignment was examined, found free of infestation and passed as fit for human consumption. Chocolate Watches. Advice was sought by a shopkeeper regarding the alleged unpalatability of a quantity of chocolate watches. Upon examination they were found to be rancid and the stock was subsequently withdrawn from sale. Meat Extract. At the request of a local grocer, two bottles of meat extract were forwarded to the Analyst for examination. The samples were stated to be free from harmful organisms but were very old stock. The grocer was notified accordingly and the whole consignment was withdrawn from sale. Condensed Milk. Submission of cans of condensed, milk to the Analyst after complaints were made elucidated the fact that no harmful organisms were present but that the cans came from very old stock. Apart from other consideration the milk was regarded to be unpalatable and unsaleable, and was consequently withdrawn from sale. Meat and Other Foods. The following articles were found during the year to be unfit for human consumption :— Beef 399 lbs. Cooked Ham 105½ lbs. Pigs liver 28 lbs. Tinned Luncheon Lambs liver 648 lbs. Meat 75 lbs. Fish 80 lbs. Corned Beef 195 lbs. The 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. [ 24 ] In addition to the foregoing, several condemned carcases were brought into the district from outside sources and their disposal, as animal feeding material, was supervised by the department. Slaughterhouses. There are no slaughterhouses in the area, but one existing slaughterhouse building previously in use was the subject of an application for re-registration of the premises. This was refused, the applicant appealing against the Council's decision at a later date but finally withdrawing his appeal just prior to the hearing. Milk. Licences granted by the Council under the Milk (Special Designation) Regulations, 1949/1953. Supplementary :— Tuberculin Tested 8 Pasteurised 8 Sterilised 10 Dealers :— Tuberculin Tested 7 Pasteurised 7 Sterilised 28 28 samples of milk were submitted to the County Laboratory as follows :— Tuberculin Tested Pasteurised 10 Pasteurised 10 Sterilised 8 All satisfied the prescribed 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. 64 samples of ice cream submitted for examination during the year were graded as follows :— Grade I 47 Grade II 15 Grade III 1 Grade IV 1 FOOD AND DRUGS ACT, 1938—1950. Details of samples taken by the County Sampling Officers within the Urban District of Crayford during the year ended 31st December, 1955. [ 25 ] Article. No. Ammoniated Mercury Ointment 1 Aspirin 1 Beef Sausages 1 Bitter Beer 1 Boracic Powder 1 Bronchia] Mixture 1 Boric Acid Ointment 1 Canadian Ice Cream 2 Capsicum Ointment, B.P.C 1 Cherries with liquid centres 1 Chfest and Lung Mixture 1 Cold and Influenza Mixture 1 Compound .Glycerine of Thymol 1 Corned Beef 2 Cream of Mushroom Soup 3 Danish Butter 1 Devilled Ham 1 Digestive Sweetmeal Biscuits 1 Dressed Crab 1 Dundee Cake 1 Easy Mix 1 Figs 1 Fresh Ground Coffee 1 Garden Peas 1 Glace Cherries 1 C/fd. 29 Article. No. B/fd 29 Ground Almonds 1 Ground Arrowroot 1 Ground Cinnamon 1 Ham and Beef Roll 1 Ice Cream 1 Italian Peeled Tomatoes 1 Junior Aspirin 1 Lemon Curd 1 Lassar's Paste 1 Liquid Paraffin 1 Mandarin Oranges in Syrup 1 Margarine 2 Marzipan 1 Milk 22 Mixed Fruit 1 Mixed Fruit Salad 1 Parmesan Cheese 1 Parrish's Chemical Food 1 Processed Cheese Varieties 1 Pure Dairy Cream 1 Pure Glycerine 1 Pure Lard 1 Raisins 1 Saveloys 1 Stewed Steak 1 Sultanas 1 Tartaric Acid 1 Tea 3 Whisky2 Total 83 SUMMARY. Milks 22 Drugs 16 Spirits 3 Other Samples 42 83 [ 26 ] All the above samples were genuine with the exception of the following :— Sample of Analysis. Remarks. Cream of Mushroom Fat 7.6%, Protein Old stock. Remaind Soup 13.9%, Salt 11.7%. er withdrawn fron Mushroom present sale. when diluted according to instructions only 0.7% fat. Hot Milk Contained 5.3% ad- Cautioned. ded water. Hot Milk Contained 14.3% ad- Legal proceedings ded water. Fined £5, and £2.2.0 costs. Hot Milk Contained 15.8% ad- Legal proceedings ded water. Fined £5, and £2.2.0 costs. Hot Milk Contained 22.9% ad- Legal proceedings ded water. Fined £5, and £2.2.0 costs. Canadian Ice Cream Fat 9.1% (not more than 0.2% butter fat), Total solids 38.55%, Sucrose 16.8%. Milk solid 12.5%. Canadian Ice Cream contains not less than 10% milk Makers will dis- fat- I continue the use Canadian Ice Cream Fat 10.6% includ- description ing no material amount of butter fat. "Canadian". Total solids 38.2%, Sucrose 14.0%, Nonfatty Milk Solids 13.0%. Starch present. Canadian Ice Cream contains 10% butter fat at least. Dundee Cake ... Fat 18.4% contain- Under investigation. ing 5.8% butter fat. Deficient in butter fat. [ 27 ] ATMOSPHERIC POLLUTION. The problem of atmospheric pollution still persists, cement dust and industrial smoke being the chief offenders. Although the Council have carried out schemes to instal modern fuel burning appliances in their older properties, the modern fire still presents a problem by emitting too much smoke and unless householders are prepared to use only smokeless types of fuel, providing of course ample supplies were available, unsatisfactory conditions will no doubt prevail. Complete smokeless zones would naturally play a great part in eliminating the general pollution of the atmosphere. THE CONTROL OF RODENTS AND OTHER PESTS. During the year the following infestations were dealt with :— Rats 97; Mice 52; Woodworm 15; Ants 1; Crickets 8; Beetles 5; Flies 4; Fleas 2. HOUSING STATISTICS. (1) Inspection of Dwelling Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 122 Number of inspections made for that purpose 678 (2) Number of dwelling-houses (included under sub-heading (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Number of inspections made for that purpose (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (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 106 (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 106 (3) Action under Statutory Powers during the year. Statutory Notices under Housing or Public Health Acts Nil [ 28 ] Number of houses in which defects were remedied after serving of formal notices :— (a) By Owners Nil (b) By Local Authority in default of Owners Nil Proceedings under Housing Act, 1936 :— (a) Demolition Orders made under Section 11 Nil (b) Parts of buildings closed under Section 12 Nil (c) Houses demolished (i) in pursuance of Demolition Orders 1 (ii) by agreement with Owner (4) Action under Local Government (Miscellaneous Provisions) Act, 1953. Number of houses closed Nil (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 own by local authority 2,363 Number of houses built during year :— (a) by the Local Authority 130 (b) by other bodies or persons 120 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 on 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 with the exception of 7 samples taken from a deep well. The well in question was taken out of use until results from samples showed that contamination was no longer evident. (a) Wells (drinking water), Bacteriological 27. (b) Swimming Pool, Bacteriogolical 13. (c) Domestic Supplies 5. Water Supply. Approximately 0.5 mile mains extension. Drainage and Sewerage. Normal sewerage extension to serve new housing development. Housing Plans. The building of houses is in progress at Scheme No. 38 (Normandy Farm), and when completed the scheme will provide 102 living units. A further 385 dwellings are proposed on other schemes. REPORT OF KENT RIVER BOARD. Rivers and Streams. During the past year, normal annual maintenance work has been carried out on rivers and dykes in the Crayford Urban District. This has comprised the cutting of weed growth, trimming of banks and general clearance of the following :— Crayford Main Marsh Dyke from the outfall into the R. Thames to Slade Green sewerage works and the eastern leg to the Kent River Board's Crayford Depot. R. Cray from Vitbe Mills. R. Stanham and Middle River from the outfall into Crayford Creek to Vickers Crayford. R. Wansunt from Crayford Road. [ 30 ] Closet Accommodation. Approximate number of premises containing each type of sanitary convenience in the district:— W.C's. into drainage system, approximately 11,130 W.C's. into Cesspools 22 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. Sanitary Accommodation Defective 40 Drainage : (i) examined, exposed, etc 139 (ii) repaired 31 (iii) unstopped, etc. 115 Refuse Receptacles 20 Dampness 112 Roofs and Rain Water Pipes 223 Fireplaces, grates and stoves repaired or improved 22 Floors, walls and ceilings repaired or renewed 269 Baths, lavatory basins and sinks 12 Water Supplies 27 Doors and other woodwork 79 Windows, lighting and ventilation 137 Offensive Accumulations removed 6 Connections to sewers 1 Improper keeping of animals abated 2 Other defects 37 Total number of visits of all kinds paid by Inspectors during the year 7751 Approximate number of rated premises in the area 9428 Notices served :— Statutory Informal 125 Number of houses, etc., disinfected 22 Swimming Pool. Period open from the 14th May. to the 18th September. Number of bathers 44,316. This figure does not include School Parties and Clubs. Shops Acts. A total of 347 visits were made during the year. It was found necessary to call upon the owner of one block of shops to provide additional sanitary accommodation and in two [ 31 ] further instances owners were requested to improve heating arrangements or provide additional heating. It was deemed necessary to draw the attention of certain shopkeepers to the provisions appertaining to Sunday trading and to closing times generally. Smoke Abatement. No action taken. Eradication of the Bed Bug. Particulars of the action taken in 1955 for the eradication of the Bed Bug are as follows :— Number of Infested Disinfested Council Houses 2 2 Other Houses 2 2 Prescribed particulars on the administration of the Factories Act, 1937. I. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Number of Premises (i) Number on Register (2) Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 16 19 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 68 184 1 - (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding outworkers' premises) 15 18 1 — TOTAL 99 2?1 2 — 32 2. Cases in which Defects were found. Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) FoundRemedied (2) (3) Referred Particulars (1) To H.M Inspector (1) By H.M. Inspector (5) Want of cleanliness (S.l) 1 1 Overcrowding (S.2) Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient - - - - - (b) Unsuitable or defective (c) Not separate for sexes 10 10 — 4 — Other offences (not including offences relating to Outwork) — — — — — TOTAL 11 11 — 4 — (Sections 110 and 111). OUTWORK. Part V III 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. 12 - - - - - Carding of buttons, etc. 2 - In one instance an outworker was requested to discontinue outwork due to infectious disease. I am, Your obedient Servant, A. W. KENT, Chief Sanitary Inspector. [ 34 ]