AC 4412(3) CRA 22 Urban District of Crayford ANNUAL REPORT of the Medical Officer of Health For the Year 1957 BY JOHN LANDON M.R.C. S. .L.R.C.P. , D. P. H Urban District of Crayford ANNUAL REPORT of the Medical Officer of Health For the Year 1957 BY JOHN LANDON M.R.C. S. .L.R.C.P. , D. P. H MEMBERS OF THE HEALTH COMMITTEE Chairman: Councillor J. Kerr Members: Councillors: Mrs. F. M Pilbrow N.E. Killick J. Nokes T. E. Sanders Councillors: J.W. Taylor Mrs. I. Walker Mrs E. White P. J. E. Boss Co-opted Members Mrs E. Fatharley Mrs, A, E. Coston Miss O. Perry 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) Chief Public Health Inspector: *†** A. W, Kent, M.R.S.H., M. A.P.H.I. District Public Health Inspectors: * R.E Richards, Cert R.S.I., S.I.J.B., M.A.P.H I., (resigned 3/6/57) * E.J. Day, A.R.S.H., M.APH.I. Chief Clerk: E. T. Shutte Shorthand Typist/Clerk. Mrs. E.M. Tibbies Rodent Operator W. McCulla * Certificate for Inspection of Meat and other foods. † Shops Act Inspector. ** Rodent Officer. 1. To the Chairman and Members of the Urban District Council of Crayford Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1957 As in previous years, in attempting to assess the health of the Urban District it is necessary to consider the vital statistics for the area The infant mortality rate for 1957 was 34 0 per 1,000 live births, compared with 23 1 in 1956 and a rate for England and Wales of 23.1. An analysis of the figures of deaths shows that the increase was due to causes not easily controllable and although the new rate is rather disappointing, there does not appear to be any reason for pessimism There was one maternal death giving a maternal mortality rate of 1.9 per 1,000 total live and stillbirths For the eighth year there has not been a case of diphtheria in the Urban District. The standardised birth rate remained practically stationary at 15 77 per 1,000 of the population compared with a rate of 16 1 per 1,000 for England and Wales, whilst the standardised death rate is 12,45 compared with 11 5 for the country as a whole There is nothing in these figures to warrant either concern or undue complacency. When one observes the great changes wrought in our civilisation by the industrial, social, educational and scientific developments of the past 50 years and their profound influence on our whole way of life, one cannot help feeling that the yardsticks used in the past to measure the health of a community need to be interpreted with great caution Designed as they originally were for conditions of widespread poverty and disease and the absence of medical care they served, in bygone years, not only as a measure of environmental hazards but, also, as a spur to their amelioration Nowadays, however, having overcome the gross hazards of environment we can turn our attention to the more insidious and subtle ones which remain, as well as to the new hazards which are constantly arising as a result of the application of scientific developments as, for example, in the field of nuclear physics. A good example of the subjection of present-day vital statistics to the high power of the microscope is afforded by the study 2 of infant mortality where the emphasis has shifted from the main causes of death during the first year of life (which at one time were gastro-enteritis and bronchopneumonia) to deaths during the neo-natal period (the first four weeks of life, the commonest causes of death being congenital malformations and prematurity) and, latterly, to the perinatal period in which the deaths during the first week of life are studied alongside with stillbirths This highlights the combined effects of toxaemia of pregnancy and prematurity and, in a few cases, obstetrical difficulties and it will be seen on analysis of the figures that the perinatal mortality during 1957 was 43 4 per 1,000 related births It is, indeed, remarkable that of the 17 Crayford babies on whom the infant mortality rate is based, no less than 12 died within the first week of life. It is clear that a closer study needs, now, to be made of the causes of toxaemia and of the significance of maternal infections in early pregnancy (particularly german measles and, possibly, other virus diseases as well) in relation both to prematurity and congenital malformations. The fall in deaths during the perinatal period has not kept pace over the past 25 years with the fall in infant mortality generally and further improvements in the infant mortality rate depend on further research on these lines as well as on the maintenance of satisfactory conditions of living and levels of child care generally The number of deaths from cancer of the lung during 1957 was 15 as against 12 in 1956 and 10 in 1955. The fact that there is an association between smoking and cancer of the lung has received very wide publicity and is now, I think, accepted by most reasonable people There is no evidence, however, that this has had much effect on the smoking habits of people in general although one does meet individuals, here and there, who have given up cigarette smoking as a direct result of this newlygained knowledge. It appears that the general attitude among the majority of smokers is a fatalistic acceptance of the risk, which can only mean that the smoking habit may fulfil a deep physical and psychological need in the stressful world in which we live It is good to learn, therefore, that attempts are being made, by selective cultivation of particular varieties of tobacco leaf and by other means, to reduce the carcinogenic substances in tobacco, and I believe that some progress is being made in this respect I have given a number of talks on this subject to senior 3 schoolchildren in a neighbouring district and have been impressed by the grasp shown by them in regard to the hazard of lung cancer in relation to smoking Nevertheless, although they received the information in a responsible way. one could not help feeling that the remoteness of the risk in point of time tended to reduce its impact for, to a boy or girl of 15, to talk of what may happen in 30 or 40 years time is somewhat akin to a voyage into eternity. However, this particular form of health education must continue, and teachers as well as doctors and health visitors have their responsibilities, particularly when one bears in mind the seductive advertisements on television and in the Press which are designed to inculcate, in the adolescent mind, the impression that smoking is a sign of emancipation and growing up and a stepping-stone to social ease and acceptance In considering lung diseases in general and perhaps chronic bronchitis in particular, one must not forget that the abatement of atmospheric pollution is one of the most important tasks facing both central and local government at the present time In a way this problem is comparable in its complexity with the cleaning up of urban water supplies in the 19th century and just as important The Clean Air Act, 1956 grants, among its many provisions, permissive powers to local authorities to declare smoke control areas in which only smokeless fuels will be burnt in suitable boilers and domestic heating appliances. In Crayford a beginning has been made, the Council having authorised a pilot survey to be carried out in a selected area with a view to obtaining reliable information as to the cost of replacing unsuitable appliances and adapting others to make them capable of burning smokeless fuels It took over 50 years to provide a clean and safe water supply to the great towns thus ridding the population of such diseases as cholera, typhoid and dysentery By sustained and determined action in regard to clean air one may similarly see, in years to come, a reduction in lung diseases which are responsible for so much mortality and illhealth, as well as the removal, from the atmosphere, of pollution which causes much unnecessary work for the harassed housewife and does untold damage to vegetation and the fabric of buildings.. We have, now installed, in the Health Department, a volumetric apparatus for the daily estimation of sulphur dioxide (one of the most lethal constituents of smoke and figures are being collected which will serve as a guide to future action in regard to smoke abatement 4 It is unfortunate, to say the least of it, that the time when the prevention of atmospheric pollution is becoming a matter of major policy should coincide with the introduction of yet another serious hazard this time from nuclear and allied radiations resulting from the peaceful uses of atomic energy in industry including the use of x-rays and of radioactive isotopes and from international efforts to build up the "atomic deterrent". The addition of these radiations to those occurring naturally from certain heavy elements in the earth's crust and from cosmic rays reaching us from outer space may one day, and before long, induce a level of radioactivity in our surroundings harmful to the maintenance of health and, by causing undesirable genetic mutations, constitute a threat to future generations Indeed, one can foresee the time when the Geiger counter will become as important a piece of public health equipment as the sampling bottle or deposit gauge is today During the year steady progress was made in regard to the implementation of the Food Hygiene Regulations, 1955. Much work and constant vigilance is necessary to ensure that satisfactory standards of production and handling of food are not only achieved but, also, maintained Even when cleanliness, repair of food premises, the supply of wash hand basins, hot and cold water and facilities for washing food and equipment are of a satisfactory standard, real cleanliness depends, ultimately, on the acceptance by food handlers, both management and staff, of a personal responsibility to the public, and we cannot say that this is invariably the case During the year 1,105 inspections of food and food preparing premises were carried out by the Public Health Inspectors and improvements were carried out or defects remedied under the Regulations at 78 premises. Eleven premises were dealt with for infestations by rats and mice. During the year the Housing Act, 1957, and the Rent Act, 1957, came into operation The former was largely a consolidating Act, while the latter, in that it aimed, among other things, at the preservation of the structure of existing houses, placed a good deal of extra work on the Chief Public Health Inspector and his colleagues, particularly in connection with certificates of disrepair Steady progress has been made during the year in the clearance of unfit houses within the framework of the 5 year plan submitted 5 to the Ministry of Housing and Local Government in 1955: The work of the Bexley, Erith and Crayford Home Safety Committee continued during the year, with steady propaganda in the interests of the reduction of accidents in the home, chiefly through falls and burns and scalds. Officially this responsibility lies with the Local Health Authority under Section 28 of the National Health Service Act, 1948 In practice, the local voluntary committee, closely linked with district Health Department and the local Council is in a far better strategic position to increase the public awareness of a problem, the magnitude of which, both as regards morbidity and mortality exceeds that of accidents on the roads. During 1957 three cases of paralytic poliomyelitis were notified in the Urban District The number of children resident in the Urban District who received a course of two injections against this disease, under arrangements made by the Local Health Authority, was 787. The extension of vaccination to all children of school age and possibly, in due course, to members of the public generally may, it is hoped, in years to come, considerably reduce the ill effects of this annual visitation. Although, broadly speaking, the incidence of pulmonary tuberculosis is on the wane, there is evidence to show that much still remains to be done in the abolition of this incapacitating and killing disease. The chronic open case in the community and the undiagnosed case, often in middle-aged and elderly people, remain two potent sources of infection The main spearheads in the attack against this disease are the unremitting tracing of sources of infection, the protection of contacts and young children by B C.G. inoculation and a more intensive search for new cases by means of mass miniature radiography During the latter part of the year influenza of the Asian type reached epidemic proportions in the Urban District, this being part of a world epidemic Although widespread, the disease did not reach the severity which had been anticipated and most cases were of a relatively mild type, necessitating a few days in bed followed by a short period of convalescence. Much absenteeism resulted in factories and in schools from this cause in the Urban District. Five deaths were recorded as due to influenza during the year. 6. So much for these objective factors for which figures are available, but this is by no means the whole story. There are no statistics by which we can study the health of the individual and of the community in the sense of happy and successful living as integrated members of society which is the essence of true health. It is, I think, true that, despite the great advances in clinical medicine over the past 40 years and the operation of the National Health Service for 10 years, there has been no reduction in the total incidence of disease although the pattern of disease has changed The old-fashioned epidemics have been largely brought under control but have been largely offset by the increase in the incidence of the so-called psychosomatic diseases such as coronary thrombosis, peptic ulcer, certain forms of cancer, the psychoneuroses and by the new endemics, accidents on the roads and in the home. Most disturbing of all is the great increase in the last few decades, of mental ill-health as shown by the high proportion of hospital beds taken up by the mentally sick., The causes of this social malaise are very complex and have their roots in the rapid changes which our society has undergone in recent years. Prevention and cure of disease is not enough to ensure true health in a modern society. The promotion of health by a consciously-directed policy based, not only on the causes of disease, but on the causes of health remains, as always,the greatest challenge to statesmanship at the present time. In conclusion, I wish to thank the Chairman and Members of the Health Committee for their support and encouragement, and the Chief Public Health Inspector, Chief Clerk and all members of the Health Department for their devoted 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 1957) 29,980 Number of inhabited houses 9,473 Rateable Value £387,378 Sum represented by a penny rate £1,526 Live Births Total M F Legitimate 484 250 234 Illegitimate 15 8 7 499 258 241 Birth rate per 1,000 of the estimated home population - 16.64 General birth rate for England and Wales - 16.1 Stillbirths Total M F Legitimate 8 3 5 Illegitimate 2 2 10 5 5 Rate per 1,000 total (live and still) births - 19.6 Total M F Deaths 285 153 132 Death rate per 1,000 of the estimated resident population -9.5 General death rate for England and Wales - 11.5 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 1957. The standardised 8 Birth Rate which allows for comparison with other parts of the country is 15.77 and the standardised Death Rate is 12,45 Maternal Deaths- There was one Maternal Death in 1957 Deaths of Infants under one year of age:- Total M F Legitimate 17 6 11 Illegitimate - - - 17 6 11 Rate per 1,000 live births (Crayford) - 34 Rate per 1,000 legitimate live births - 35.1 General death rate of infants under 1 year of age for England and Wales - 23.1 Deaths from Various Causes Malignant Neoplasm (all ages) 62 Measles (all ages) — Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) — Vital Statistics during 1957 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 1956 29,530 476 16.1 15.6 247 8.36 11.7 11 23.1 23.8 1957 29,980 499 16.6 16.1 285 9.5 11.5 17 34 23.1 * Instructions were issued by the Registrar General for these particular years, giving certain alternative figures for calculation of these statistics. 10 SUMMARY OF VITAL STATISTICS England & Wales Crayford U D. C. Rates per 1,000 Home Population BIRTHS Live Births 16.1 16.64 Stillbirths 0.37 0.33 22.4 (a) 19.6 (a) DEATHS All causes 11.5 9.5 Typhoid and paratyphoid 0.00 -. Whooping Cough 0.00 - Diphtheria 0.00 - Tuberculosis 0.11 0.03 Influenza 0.16 0.16 Smallpox 0.00 - Acute Poliomyelitis (including Polioencephalitis) 0.01 0.03 Pneumonia 0.56 0.7 NOTIFICATIONS (Corrected) Typhoid Fever 0.00 - Paratyphoid Fever 0.01 - Meningococcal Infection 0.02 - Scarlet Fever 0.66 0.53 Whooping Cough 1.89 4.07 Diphtheria 0.00 - Erysipelas 0.08 - Smallpox 0.00 - Measles 14.11 23.38 Pneumonia 0.73 0.4 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.07 0.1 Non-paralytic 0.04 0.1 Food Poisoning 0.20 - Puerperal Pyrexia 16.00 (a) 7.86 (a) 11  England & Wales Crayford U. D.C. Rates per 1,000 Live Births DEATHS All causes under 1 year of age 23.0 (b) 34.0 (b) Enteritis and diarrhoea under 2 years of age .50 - (a) Per 1,000 total (Live and Still) Births (b) Per 1,000 Live Births MATERNAL MORTALITY England & Wales Crayford U.D.C. Rates per 1,000 Total Live and Still Births MATERNAL MORTALITY Maternal causes excluding abortion 0. 39 1.9 Due to abortion 0.08 - Total maternal mortality 0.47 1.9 12 Table showing Summary of Causes of Death Registered during the year ended 31st December, 1957 CAUSE OF DEATH Male Female 1 Tuberculosis, respiratory 1 — 2. Tuberculosis, other — — 3. Syphilitic disease — — 4. Diphtheria — — 5. Whooping Cough 1 — 6. Meningococcal Infections — — 7. Acute Poliomyelitis 1 — 8 Measles — -— 9 Other infective and parasitic diseases — — 10 Malignant neoplasm, stomach 2 4 11 Malignant neoplasm, lung & bronchus 12 3 12. Malignant neoplasm, breast — 8 13. Malignant neoplasm, uterus — 1 14. Other malignant and lymphatic neoplasm 24 8 15. Leukaemia, aleukaemia — — 16. Diabetes 1 1 17. Vascular lesions of nervous system 12 13 18. Coronary disease, angina 30 12 19. Hypertension with heart disease 1 2 20. Other heart disease 16 20 21. Other circulatory disease 3 8 22, Influenza 3 2 23. Pneumonia 10 11 24. Bronchitis 4 9 25 Other diseases of respiratory system 3 — 26. Ulcer of stomach and duodenum 3 2 27. Gastritis, enteritis and diarrhoea 2 — 28. Nephritis and nephrosis — 3 29. Hyperplasia of prostate 1 — 30. Pregnancy, childbirth, abortion — 1 31. Congenital malformations 1 2 32 Other defined and ill-defined diseases 15 19 33. Motor vehicle accidents 2 — 34. All other accidents 3 2 35. Suicide 2 1 36. Homicide and operations of war — — ALL CAUSES TOTAL 153 132 13 Births The 499 live births notified showed an increase of 23 compared with last years figure The birth rate per 1,000 of the population is 16.64 against 16.1 last year The birth rate for England and Wales was 16.1 Deaths This year we recorded 285 deaths out of a population of 29,980 representing a death rate of 9.5 against 8.36 in 1956, The death rate for England and Wales was 11.5 Infant Deaths During the year 17 infants died before reaching the age of one year. There were 11 in 1956,, Rate of Infant Deaths under one year per 1,000 live births was 34.0 as against 23 1 last year That of England and Wales was 23.0 14 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 1 1 2 Prematurity 2 1 3 Atelectasis 2 2 1 5 Congenital Heart Disease 1 1 Intercranial Haemorrhage 1 1 Fibrocystic disease of pancreas 1 1 Subpericardial Pleural haemorrhage 1 1 Acute TracheoBronchitis 1 2 3 TOTAL 6 2 3 1 1 2 1 1 17 15 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 1957 145 cases were dealt with, out of which 142 post mortems and 19 inquests were conducted 31 were from Crayford and from this latter figure 29 post mortems and 4 inquests were conducted LABORATORY FACILITIES Pathological and bacteriological work for the area was carried out through the Public Health Laboratory Service. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES AND OTHER DISEASES Scarlet Fever During the year 16 cases were notified Of these 1 case was isolated in hospital The number of cases notified in 1956 was 44 Diphtheria There were no cases notified in 1957 Paratyphoid or Typhoid Fever No cases were notified during the year Puerperal Pyrexia Four cases were notified during the year. Meningococcal Infection No case was notified during the year, there were none in 1956 Food Poisoning No cases were notified during the year 16 Measles The number of cases notified in 1957 was 701 The number of cases notified in 1956 was 7 Whooping Cough 122 cases were notified during the year The number of cases notified in 1956 was 25. Acute Poliomyelitis Six cases were notified in 1957 Three were paralytic cases and treated in hospital, three were non-paralytic cases, of which two were treated in hospital. Ophthalmia Neonatorum No cases were notified during the year. Dysentery One case was notified during the year Notifiable diseases (other than Tuberculosis) during the year Diseases Total cases notified Cases admitted to hospital Deaths Smallpox - – - Scarlet Fever 16 1 - Diphtheria - - - Enteric or Typhoid Fever - - - Paratyphoid Fever - - - Puerperal Pyrexia 4 2 - Pneumonia 12 3 - Erysipelas - - - Meningococcal Infection - - - Measles 701 3 - looping Cough 122 2 1 Ophthalmia Neonatorum - - - Dysentery 1 - - Poliomyelitis (Paralytic) 3 3 1 Poliomyelitis (Non-Paralytic) 3 2 - Encephalitis - - - Pood Poisoning - - Totals: 862 16 2 17 18 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 – _ _ — 4 6 6 15 _ _ – – 1 – – – – 5 6 33 31 – – – – 2 – – – – 9 12 49 40 – – – – 3 1 1 – – 7 8 36 35 – 1 – – 4 – – – – 11 6 49 44 – – – – 5-9 3 7 – – 25 18 154 201 2 – 1 1 10 - 14 2 2 – – 1 2 3 4 – – 1 – 15-24 – — – – – 1 1 – – – – – 25 and over – - – – 1 – – – – – – – Total (All ages) 6 10 –- –- 63 59 331 370 2 1 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 P M F Under 5 years – – – – - 3 – – – – – – 5 – – – – 1 – – – – – – – 15 – – – – 2 – – 1 – – – – 45 – – – – 3 1 – – – – – – 65 and over – – – – 1 1 – – – – – – Total (All ages) – – – – 7 5 – 1 – – – – 19. Age Groups (continued) Erysipelas Smallpox Food Poisoning M F M F M F M F 0 _ _ _ _ _ _ Puerperal Pyrexia _ 4 5 _ _ _ _ _ _ Ophthalmia neonatorum _ _ 15 _ _ _ _ _ _ 45 _ _ _ _ _ _ 65 and over _ _ _ _ _ _ Total (All ages) _ _ _ _ _ _ Poliomyelitis Vaccination 1957 The following table gives the numbers of children resident in the Crayford Urban District who received a course of two injections against poliomyelitis during the year ended 31st December, 1957:- Born 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total 184 153 143 151 57 34 25 29 _ _ 1 787 20. Immunisation against Diphtheria and vaccination against Smallpox, 1957 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, 1957 - (A) DIPHTHERIA IMMUNISATION Year of Birth 1943 1944 1945 1946 i 1947 ' 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total Primary Inoculations _ _ _ _ _ 6 3 3 4 8 3 15 30 232 41 345 Re - inforcing Inoculations _ _ 4 2 6 93 87 7 37 168 22 1 2 _ _ 429 (B) VACCINATION Year of Birth 1943 1944 1945 1946 1947 1948 1949 1950 1 951 1 1952 1953 1954 1955 1956 1957 I Before 1943 Total Primary Vaccination _ 2 1 2 2 1 3 3 3 5 4 3 59 138 13 239 Re- vaccination - _ _ _ 1 _ 1 _ _ _ _ _ _ _ _ 32 34 The following is a return of the number of children resident in the Crayford area under the age of 15 years on 31st December, 1957, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1943): Year of Birth 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total Last complete course of injections (whether primary or booster) 1953-1957 76 105 102 236 191 259 387 467 114 276 278 311 298 274 41 3415 1952 or earlier . . 162 201 275 297 225 89 146 91 80 15 _ _ _ _ _ 1581 Tuberculosis Age periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M P M P M F Under 5 years _ _ _ _ _ _ _ _ 5 _ -_ _ 1 _ _ _ _ 15 _ 4 1 _ _ _ _ _ 25 3 3 _ _ _ _ _ _ 45 3 1 _ _ 1 _ _ _ 65 and over 1 _ _ _ _ _ _ _ Totals: 7 8 1 1 1 _ _ _ 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 - 18 Applicants recommended for rehousing - 7 No. of families granted houses on account of Tuberculosis - 4 Other reasons - 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 14, including 8 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, although in terms of expenditure the monetary cost was higher. 21 The result of the local Christmas Seals Sale, after deduction of administrative expenses, as reported by the Organiser to the Annual General Meeting amounted to £86,0s.7d The County Organiser, Health Visitor, Chest Physician and District Officer have given invaluable service to the Committee 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 Chief Public Health Inspector. 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, 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. Close co-operation is 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. NATIONAL ASSISTANCE ACT, 1948 Under Section 50 of the Act, it is the duty of the local authority to arrange for the burial or cremation of any person who has died in its area if it appears that no suitable arrangements for the disposal of the body can otherwise be made. During the year two bodies were dealt with by the Council under these provisions. 22 CHIEF PUBLIC HEALTH 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 1957, which gives a general summary of the work carried out by the Public Health Inspectors during the year INSPECTION AND SUPERVISION OF FOOD The inspection of food continues to play 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 1105 inspections were carried out, 134 of which were to premises registered under Section 16 of the Food and Drugs Act. 1955 The number of food premises in the area is as follows Bakers 4; Butchers 16; Grocers 58: Greengrocers 19; Confectioners 26; Fishmongers 8; Cafes, canteens etc 34 Public Houses 19; Off Licences 3; Clubs 12; Other premises 24 Under Section 16 of the Food & Drugs Act, 1955, 54 premises are registered for the storage and sale of Ice Cream and 21 for the manufacture or preparation of preserved food intended for sale. Food Hygiene Regulations, 1955 Following a comprehensive survey of all food premises, continued efforts were made to maintain contact with all the food traders. The fact that quite a number of shops changed hands during the year brought forth a number of enquiries as to required standards and your Public Health Inspectors continued to advise accordingly, A total of 196 informal notices were served in connection with this work. 23 The following complaints were received and dealt with during the year - Sponge Cake. This was alleged to contain a number of hairs Investigation proved these to be bakehouse brush bristles. Milk Bottles, Two complaints were received regarding foreign matter in the bottles and "dirt" under the cap respectively In the former case this was ascertained to be iron oxide scale and in the latter butter fat mixed with iron rust and iron dust A full investigation involving inspection of milk tankers, churns and other dairy equipment was carried out by the dairy concerned and the results obtained fully justified the action taken. Bread. In three instances bread formed the basis of complaints. In one case mould growth was found to be in existence in a comparatively new loaf. Blackish foreign matter in another loaf was ascertained to be caused by dough becoming impregnated with vegetable oil used for greasing the baking tin. The third loaf was affected with a dark staining which upon investigation was found to be a trace of finely divided iron Toffee. Two bars of toffee were alleged to contain ants. The remainder of the stock in the shop concerned was inspected and found to be free from trouble. Only two bars it appeared, had been affected, and it is not altogether insignificant that the bars in question were the two outer bars from the box. Tinned Rhubarb The purchaser in this case had complained of the bitter taste of the rhubarb The Analyst's report confirmed that the internal lacquer was affected and the remainder of the stock was surrendered Whilst in all the above cases the attention of the suppliers was drawn to the complaints received, the result of subsequent investigations did not warrant any further action. Meat and Other Foods. The following articles were found during the year to be unfit for human consumption - 24 lb oz lb. oz Beef 97 - Tinned Ham 198 - Pork 30 - Luncheon Meat 50 12 Lambs Livers 10 - Sausages 15 8 Pigs Livers 120 - Corned Beef 65 - Tinned Steak 32 8 Jellied Veal 11 - Tinned Pish 1 7 Liver & Bacon Paste . 1 2 Pish 84 - Tinned Fruit 121 6 Bacon 8 Tinned Fruit Juice 1 3 Tinned Pork 249 - Tinned Soup 6 1½ Beef Suet 7 4 Tinned Vegetables 142 - Frozen Rabbits 12 8 Jam 1 - Tinned Chicken 3 3 Chocolate 10 - Chickens 44 - Miscellaneous 2 8½ Cheese 3 12 Tinned Milk equlv 10½ pts. In addition forty four 8 oz cans of tomatoes were surrendered as unsaleable. 7 cwt 1 qr 8 lb 14% oz, of confectionery was surrendered after being damaged by fire in a local shop 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 Slaughterhouses - There are no slaughterhouses in the area. M ilk Licences granted by the Council under the Milk (Special Designation) Regulations, 1949/1953:- Supplementary - Tuberculin Tested 12 Pasteurised 13 Sterilised 14 Dealers - Tuberculin Tested 7 Pasteurised 10 Sterilised 29 29 samples of milk were submitted to the County Laboratory as follows:— Tuberculin Tested Pasteurised 6 Pasteurised 14 Sterilised 9 All satisfied the prescribed tests 25 ICE CREAM (HEAT TREATMENT) REGULATIONS 1947 - 1952 There are now no manufacturers of ice cream in the area 37 samples of ice cream submitted for examination during the year were graded as follows- Grade I 23 Grade II 13 Grade III 1 Grade IV – FOOD AND DRUGS ACT, 1955 Details of samples taken by the County Sampling Officers within the Urban District of Crayford during the year ended 31st December, 1957:- Article No Article NO. B/fwd. 23 Agarol 1 Diuromil 1 Alka Seltzer 1 Fish Cakes, Fresh Salmon 1 Almond Marzipan 2 do. Tomato 1 Anti-Gastric Mixture 1 Flour 4 Aspirin Spirit Liniment 1 Fruit Salad in Syrup 1 Alvosen 1 Full Cream Evaporated Milk 1 Aspirin Tablets 1 Gels 1 Bitter Lemon 1 Ginger Flavoured Beverage, Non-alcoholic 1 Blackcurrant Jam 1 Bread and Butter 1 Horehound and Honey Cough Balsam 1 Breakfast Flakes 1 Chocolate Blancmange Powder 1 Ice Cream 1 Chopped Pork 1 Ice Cream containing fresh dairy cream 1 Christmas Pudding 1 Collosol Iodine 1 Ice Lollies containing ice cream 1 Cornflour 1 Cream Doughnuts 1 Liquid Paraffin 1 Cream Ices 1 Menthol and Extract of Liquorice Globules 1 Cream, Homogenised Sterilised 1 Milk 22 Cream, Pure Sterilised 1 Milk Powder 3 Custard Powder 1 Mushrooms and Savoury Rice 1 Dairy Cream Sponge Sandwich 1 Mustard 1 C/fwd. 23 C/fwd. 67 26. Article No, Article No B/fwd. 67 B/fwd. 77 Neutradonna 1 Sausages, Beef 1 Orange Drink 1 Sausages, Pork 2 Pepper 1 Savlon 1 Piccalilli 1 Shortbread 4 Pickled Onions 1 Shortbread Biscuits 1 Pineapple Juice 1 Shortcake 4 Punch Stout containing Glucose 1 Skip 1 Veal, Ham & Egg Pie 1 Pure Lemon Juice 1 Vermicelli 1 Sauce 1 Vinegar 3 Sausage Rolls 1 Whisky 3 C/fwd, 77 Total: 99 SUMMARY Milks 22 Drugs 14 Spirits 4 Other samples 59 99 All the foregoing samples were genuine with the exception of the following: - Sample of Analysis Action taken Bread and Butter 60% butter and 40% other fatty matter of the nature of margarine. Proceedings Fined £5 Cream Doughnuts Sample consists of flour confectionery (doughnuts) having a filling of imitation cream the fat of which contains no material amount of butterfat. Proceedings. Fined £5 plus £5,5s costs > Christmas Pudding Fat 10 2% total sugars as sucrose 40.1%, egg solids 0.18% Ingredients not stated in correct order Makers notified Label amended 27 Sample of Analysis Action taken Cream Ices Fat 13.2%, solids not Pat 8.17%, sugar 14.4%, total solids 37 4%. Starch absent. Only about l/6th of the fat appears to be butter fat. Under investigation Milk (School) Foreign matter consists of glass fragments (weight 0 26 grams) bottle undamaged Foil cap loose and pierced Evidence available showed that the glass could have come from inside the bottle after it had left the dairy. No action could therefore be taken in the matter Sausages, Pork Fat 35% lean 32% total meat 67%, Fat exceeds lean. Makers warned. Sausages, Pork Fat 42% lean 39% total meat 81%. Fat exceeds lean. Makers warned Skip Probable orange content not more than 15%. Hence on 5-fold dilution to make 1 pint will only yield 3% in liquid for drinking Makers warned. Production discontinued Clean Air Act, 1956 The Council adopted Building Byelaws requiring the provision in new buildings of such arrangements for heating and cooking as were calculated to prevent so far as practicable the emission of smoke. In October a Domestic Heating and Clean Air Exhibition was held at the Town Hall in an effort to acquaint the general public with trends in domestic heating with particular emphasis on Clean Air. The Council in addition to installing modern fuel burning appliances in their older type properties have introduced electric under floor heating in one of their newly erected blocks of flats. Industrial smoke and cement dust would still appear to be persistent but judging by enquiries received, industrialists are fully aware of the problems and their obligations under the Clean Air Act. 28. It was hoped to commence an investigation and formation of a smokeless zone but by reason of staff shortage it was not found possible to commence operations There is no doubt that until smokeless zones are widespread and strictly controlled the problem of atmospheric pollution will remain with us HOUSING STATISTICS (1) Inspection of Dwelling Houses (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 840 Number of inspections made for that purpose. 2,010 (2) Number of dwellinghouses (included wider subheading (1) above) which were inspected and recorded under the Housing Consolidation Regulations – Number of inspections made for that purpose. – (3) Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 16 (4) Number of dwellinghouses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 119 (2) Remedy of defects during the year without Service of formal Notices Number of defective dwellinghouses rendered fit in consequence of informal action by Local Authority or their Officers 130 (3) Action under Statutory Powers during the Year Statutory Notices under Housing or Public Health Acts 4 Number of houses in which defects were remedied after serving of formal notices:- (a) By owners 4 (b) By Local Authority in default of owners. – 29 Proceedings under Housing Acts 1936 or 1957: (a) Demolition Orders made under Section 11 or 17 16 (b) Parts of buildings closed – (c) Houses demolished – (i) in pursuance of Demolition Orders – (ii) by agreement with owner – (iii) after purchase by Council 10 (4) Action under Local Government (Miscellaneous Provisions) Act, 1953 Number of houses closed – (5) Housing Act, 1936/57 - 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 Number of houses built during the year:- 2,600 (a) by the Local Authority 151 (b) by other bodies or persons 75 Rent Act, 1957 Since the Act came into force on 6th July, 1957, a large number of enquiries have been received and negotiations with Owners of property resulted in the acceptance of undertakings with one exception, and in this instance a Certificate of Disrepair was issued. 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 30. 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. Water Sampling The following samples were sent to the County Laboratory by the Council's Public Health 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 one sample taken from a well supply. One complaint of 'cloudy' water upon investigation was found not to be associated with contamination but solely due to aeration caused by supersaturation of the water with air owing to the pressure in the mains. (a) Wells (drinking water), Bacteriological - 11 (b) Swimming Pool, Bacteriological - 7 (c) Domestic Supplies, Bacteriological - 5 Water Supply Approximately 0.25 mile mains extension Drainage and Sewerage Normal sewerage extension to serve new housing development. Housing Plans The building of houses is in progress at Schemes Nos, 40 and 41 and when completed will provide 324 living units., REPORT OF KENT RIVER BOARD Rivers and Streams The following work was carried out within the Crayford Urban District. - River Cray Weeds cut and rubbish cleared to tip from Hall Place to Vitbe Mill. Middle River. Weeds cut and accumulated silt and gravel banks handcast 31. Stanham River Weeds cut and watercourse generally cleansed. River Wansunt Cleared from Crayford Road Bridge to upstream of the Greyhound Stadium Marsh Dykes Some miles of dykes under the Board's jurisdiction have been cleared of weed Immediately North of the Council's Depot at Slade Green, the main dyke has been handcast and slightly deepened down to the culvert under Slade Green Road Closet Accommodation Approximate number of premises containing each type of sanitary convenience in the district:- W C's into drainage system, approximately 11,578 W C's into Cesspools 20 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 37 Floors, walls and ceilings repaired or renewed 52 Drainage 3aths, lavatory basins and sinks 21 (i) examined, exposed etc. 155 Water supplies 18 (ii) repaired 78 Doors and other woodwork 12 (iii) unstopped, etc. 147 Refuse Receptacles 126 Windows, lighting and Dampness 43 ventilation 42 Roofs and rain water pipes 47 Offensive Accumulations removed 9 Fireplaces, grates and stoves repaired or improved 6 Improper keeping of animals abated 5 Other defects 17 32 Control of Rodents and Other Pests 233 complaints in respect of rats and mice infestations were received and fully investigated. In some instances defective drains and sewers could be attributed to such infestations and defects were traced and rectified Twice during the year the foul water system was treated for rats and the results were most satisfactory. Other pest infestations dealt with were as follows:woodworm 11, bugs 10, miscellaneous 16- Total number of visits of all kinds paid by Inspectors during the year 8,715 Approximate number of rated premises in the area 9,755 Notices served:- Statutory 4 Informal 512 Number of houses etc disinfected 6 Swimming Pool Period open from the 11th May to the 15th September. Number of bathers - 36,883 This figure does not include school parties and clubs„ Shops Acts A total of 72 visits were made during the year This figure includes Sunday and evening visits Eradication of the Bed Bug Particulars of the action taken in 1957 for the eradication of the Bed Bug are as follows,- Number of Infested Disinfested Council houses 5 5 Other houses 5 5 33. Prescribed particulars on the administration of the Factories Act, 1937 1. Inspections for purposes of provisions as to Health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which sections 1,2,3,4, and 6 are to be enforced by Local Authorities 12 28 2 – (ii) Factories not included in (i) in which section 7 is enforced by the Local Authority 64 176 15 – (iii) Other Premises in which section 7 is enforced by Local Authority (excluding outworkers' premises) 11 13 – Total 87 217 17 – 34. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H M Inspector Referred By H. M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S 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 19 22 – 2 – (c) Not separate for sexes – – – — — Other offences (not including offences relating to Outwork) – – – – – Total 19 22 – 2 – 35 (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(l)(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 - - - - - I am, Your obedient Servant, A.W. KENT Chief Public Health Inspector 36