4412 (3) CRA 25 Urban District of Crayford ANNUAL REPORT of the Medical Officer of Health for the year 1960 JOHN L A N D 0 N 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 1960 JOHN L A N D 0 N M.R.C.S., L.R.C.P.,D.P.H. MEMBERS OP THE HEALTH COMMITTEE Chairman Councillor J. Kerr Members Councillors; Mrs. H. E_ Gleed JR. Nokes Mrs. F.M Pilbrow T. E. Sanders Councillors. G Co Smith J.W. Taylor Mrs. E. M. White B. H. Youngman Co-opted Members Mrs. E. Patharley Mr. P Hayward Miss 0. 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) Telephone Number. Bexleyheath 2244 Chief Public Health Inspector Chief Clerk *#I A. W. Kent. M R S H . M A P H I. E. T. Shutte District Public Health Inspectors Shorthand Typist/Clerk H.G. Avril Mrs. E. M. Tibbies * J H. Grimston (Resigned 29.2.60) Student Public Health Inspector: General Assistant: A. Game P. J. 0' Brien * Certificate for Inspector of Meat and other foods. # Shops Act Inspector. I Rodent Officer. 1 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 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 1960 which has been prepared on the lines set out in Circular 1/61 of the Ministry of Health. The Registrar General' s estimate of the mid year population is 30,920 (30,600 in 1959). The vital statistics supplied, annually, by the General Register Office, and dealt with below indicate that, broadly speaking, the health of the Urban District was well maintained The standardised death rate for 1960 was 11 01 per thousand of the home population (9 87 in 1959) compared with 11 5 per thousand for England and Wales The standardised birth rate was 16. 16 per thousand estimated home population (15.39 in 1959) compared with a rate of 17 1 per thousand for the country as a whole,. Fourteen infants died during the first year of life, giving an infant mortality rate of 26,6 per thousand live births (30,24 in 1959) compared with 21 9 per thousand in England and Wales. All but six of the infantile deaths were due to congenital abnormalities and prematurity over which there is little control at present There was one maternal death associated with childbirth, the first for three years. Bearing in mind that, during this period, there were 1,583 total births in the area it may be said that the result, overall,, reflects the efficiency of the antenatal and obstetrical services as well as the greater degree of control over puerperal infections made possible by the use of the antibiotics and chemo-therapeutic substances. In regard to the infectious diseases, it is pleasing to report that for the eleventh year in succession, there has been no case of diphtheria in the Urban District It is, nevertheless, a duty that the public should be. constantly reminded of the possible return of this disease should the level of immunisation fall to a sufficiently low level. Already there have been signs of a recrudescence of the disease in various parts of the country and, while there were no deaths from this cause in England and Wales during 1959, there were two deaths in 1960 and seven deaths in the first seven months of 1961 Parents would be well advised to heed this warning and ensure that their children are kept fully immunised. For the third year in succession, no case of poliomyelitis occurred in the District. There can be little doubt that this satisfactory result is, substantially, due to the intensive poliomyelitis vaccination of children and young adults in recent years. A further interesting development which may have 2 far-reaching consequences is the introduction of a new type of vaccine which is given by the mouth (oral vaccine). It is evident from extensive trials carried out in various parts of the world that it is both safe and effective In the meantime it behoves all parents and all adults within the approved age limit (at present 40 years) to avail themselves to the fullest extent, both for their children and for themselves, of the fully-tried procedure at present in use which is known to be at least 90 per cent effective for those persons receiving three or more doses During 1960, there were 15 deaths from cancer of the lung. The annual figures for the previous nine years were 17, 13, 15, 12, 10, 16, 7, 12 and 7. The increased incidence and associated mortality are, of course, a national problem. It is now ten years since the first publication of evidence in this country, of the close association between cancer of the lung and heavy cigarette smoking and there must be few people from the age of 15 years and upwards who are not aware of the danger, and yet the consumption of cigarettes goes up and up. The report of the Commissioners of H. M. Customs and Excise, for the year ended 31st March, 1960, indicates that a big increase in tobacco smoking in Britain sent the Customs and Excise revenue up, during that year, by £52 million to £788 million- the department s highest single revenue rise. Tobacco clearances for consumption rose by more than 17 million lbs. to 262 million lbs. and the report makes it clear that the increase was due, in the main, to an increased consumer demand. It may be of some use to re-state the facts. The consumption of tobacco rose from 11½ million lbs. in 1900 to over 225 million lbs. in 1958. In 1900 deaths from lung cancer were eight per million of the population - in 1958, 440 per million In the past eight years 125,000 deaths have occurred from lung cancer in England and Wales alone - many more than all accidental deaths on the roads, in the home and in industry. Publicity has failed In any case it has been quite inadequate when compared with the skilful and sustained propaganda for smoking conducted by the tobacco industry - much of it directed at the adolescent boy and girl to whom smoking is presented as something fine and glamorous and a sign of maturity. It would be wrong, in spite of public apathy to drop this subject and accept the consequences It is hoped that the wise person will, progressively, cut down his cigarettes or, better still: give them up altogether, or change over to a pipe which is considered to be less dangerous During 1960 a concentrated mass x ray survey was carried out in Cray ford, Bexley and Erith (total population 166,800) in conjunction with the South-East Metropolitan Regional Hospital Board. The results of this survey are given in the body of the report. It will be seen that 35,250 people were x-rayed (Crayford 5,950) but it should be stated that an additional seven thousand were x rayed in factories just prior to the campaign in order to free the units 3 from some of their routine work Further the fact that a high proportion of local residents work in London ensures that many are x rayed by units operating in different parts of the Metropolis A diagnosis of pulmonary tuberculosis was made in 169 cases (Crayford 26) of which 57 (Crayford 10) required close supervision or treatment - an incidence of 1 6 per thousand x-rayed The total number x rayed, however, includes 16,040 persons who had not previously been x rayed and these show an incidence for tuberculosis of 2 7 per thousand x rayed One can agree therefore with the statement made in the Survey report by Dr. J. M. Morgan Director of the South East London Mass X Ray Service that "an important step has been made in reducing the number of unrecognised cases in the area surveyed" He continues, It seems unlikely however that more than 60 per cent of adult residents in the areas have been examined in the last five years, including those who have been x-rayed elsewhere, and in an effort to reach the remaining 40 per cent a mass radiography unit is visiting Bexleyheath weekly and it is hoped that it will prove possible to persuade a substantial number of this unexamined group to attend Persons attending this weekly session are, in the main referred by their private doctors and these attendances are therefore, more selective than is the case in ordinary mass radiography sessions I should like to take this opportunity of thanking the Council for their encouragement and assistance in carrying out this survey and the innumerable people who worked so hard on the organisation of the campaign For a fuller account of the latter, reference is made to the report issued by the Director of the South East London Mass X Ray Service from the New Cross General Hospital; S. E. 14 The work of the Bexley, Erith and Crayford Home Safety Committee continued during the year and with the grant now being received from the Local Health Authority, has increased in scope. However, this is time consuming work and must, at present be fitted into the general work of the Health Department This makes a really sustained effort a matter of some difficulty It may be that the appointment of a part time Home Safety Organiser for the three areas covered by the Committee would be one way of solving the difficulty 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 the good work which has been done during the year I am, Your obedient Servant JOHN LANDON Medical Officer of Health 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 2,698,71 Population (Registrar General's estimate mid-year 1960) 30,920 Number of inhabited houses 9,555 Rateable Value £479,968 Sum represented by a penny rate £1,950 Live Births Total M F Legitimate 511 256 255 Illegitimate 15 11 4 526 267 259 Birth rate per 1,000 of the estimated home population - 17.01 Illegitimate live births per cent of total live births - 2.85% General birth rate for England and Wales - 17.1 Stillbirths Total M F Legitimate 3 2 1 Illegitimate 1 1 - 4 3 1 Rate per 1,000 total (live and still) births - 7.55 Total M F Deaths 258 152 106 Death rate per 1.000 of the estimated resident population - 8.34 General death rate for England and Wales - 11.5 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 1960. The standardised Birth Rate which allows for comparison with other parts of the country is 16 16 and the standardised Death Rate is 11.01. Maternal Deaths There was one maternal death in 1960. Deaths of Infants under one year of age Total M F Legitimate 14 8 6 Illegitimate - - - 14 8 6 Rate per 1,000 live births (Crayford) - 26.6 Rate per 1,000 legitimate live births - 27.4 Neo Natal mortality rate per 1 000 live births - 15.2 Early Neo Natal mortality rate per 1,000 live births - 15.2 Perinatal mortality rate per 1,000 total (live and still) births - 22.6 General death rate of infants under 1 year of age for England and Wales - 21.9 Deaths from Various Causes Malignant Neoplasm (all ages) 61 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) - 6 7 Vital Statistics during 1960 and Previous Years YEAR POPULATION LIVE BIRTHS DEATHS INFANT DEATHS No RATE No RATE No. RATE C.U.D.C. C.D.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 1958 30.280 543 17.93 16.4 265 8.75 11.7 8 14.7 15.2 1959 30.600 496 16.2 16.5 229 7.48 11.6 15 30.2 22.2 1960 30.920 526 17.01 17.1 258 8.34 11.5 14 26.6 21.7 * 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 and Wales ord U.D. C. Rates per 1 000 Home Population Births Live Births 17.1 17.01 Stillbirths 0.35 .13 19.8 (a) 7.54 (a) Deaths All causes 11.5 8.34 Typhoid and Paratyphoid 0.00 - Whooping Cough 0.00 - Diphtheria 0.00 - Tuberculosis 0.07 0.09 Influenza 0.02 - Smallpox - - Acute Poliomyelitis (including Polioencephalitis) 0.00 - Pneumonia 0.56 .19 Notifications (Corrected) Typhoid Fever 0.00 Paratyphoid Fever 0.00 - Meningococcal Infection 0.01 - Scarlet Fever 0.70 0.59 Whooping Cough 1.27 0.96 Diphtheria 0.00 - Erysipelas 0.06 0.09 Smallpox 0.00 Measles 3.48 l.36 Pneumonia 0.32 0.06 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.01 - Non-paralytic 0.00 - Food Poisoning 0.17 - Puerperal Pyrexia 11.03 (a) 24.5 (a) 8 England and Crayford Wales U.D.C. Rates per 1,000 Live Births Deaths All causes under 1 year of age 21.9 (b) 26.6 (b) Enteritis and diarrhoea under 2 years of age 0.5 — (a) Per 1,000 total (live and still) births (b) Per 1.000 live births Maternal Mortality England and Wales Crayford U.D.C. Rates per 1,000 Total Live and Still Births Maternal Mortality Maternal causes excluding abortion. 0.31 l,89 Due to abortion 0.08 — Total maternal mortality 0.39 l.89 9 Table showing Summary of Causes of Death Registered during the year ended 31st December, 1960 Cause of Death Male Female 1. Tuberculosis, respiratory 3 - 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 2 - 10. Malignant neoplasm, stomach 6 - ll. Malignant neoplasm lung and bronchus 14 1 12. Malignant neoplasm, breast - 6 13. Malignant neoplasm, uterus - - 14. Other malignant and lymphatic neoplasm 17 17 15. Leukaemia, aleukaemia 1 1 16. Diabetes - - 17. Vascular lesions of nervous system 9 10 18. Coronary disease, angina 34 16 19. Hypertension with heart disease 2 5 20. Other heart disease 12 14 21. Other circulatory disease 5 6 22. Influenza - - 23. Pneumonia 5 1 24. Bronchitis 10 3 25. Other diseases of respiratory system 1 1 26. Ulcer of stomach and duodenum 2 1 27. Gastritis, enteritis and diarrhoea = 1 28. Nephritis and nephrosis 3 1 29. Hyperplasia of prostate 1 - 30. Pregnancy , childbirth abortion - 1 31. Congenital malformations 3 3 32. Other defined and ill defined diseases 14 13 33. Motor vehicle accidents 2 2 34. All other accidents 3 2 35. SUlClde 3 1 36. Homicide and operations of war ° - All Causes Total 152 106 10 11 Analysis of the Causes of Death of Infants at Various Ages under One Year Causes of Death as Certified DAYS MONTHS Total Under One Year 0 1 2 3 4 5 6 7 14 21 28 2 3 4 5 6 7 8 9 10 11 Prematurity 1 1 Hyaline Membrane 1 1 Atelectasis 1 2 3 Congenital Heart Disease 1 1 Meningitis 1 1 Hydrocephalus Meningocele 1 1 Anencephaly 1 1 Acute Tracheobronchitis 1 1 2 Intercranial Haemorrhage 1 1 1 3 Totals 3 1 3 1 2 2 1 1 14 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 jointly used by the Boroughs of Bexley and Erith and the Urban District of Crayford Owing to the non availability of technical assistance for the Pathologist it was decided by H. M. Coroner to direct bodies early in April, 1960, to West Hill Hospital and the arrangement continued until 1st July, 1961 when the Bexley Mortuary reverted to normal operation During the period 1st January to 4th April, 1960, 52 cases were dealt with, out of which 52 post mortems and 12 inquests were conducted, 10 were from Crayford and from this latter figure 10 post mortems and 2 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 18 cases were notified. The number of cases notified in 1959 was 12 Diphtheria There was no case notified in 1960. Paratyphoid or Typhoid Fever No case was notified during the year. Puerperal Pyrexia 13 cases were notified during the year Meningococcal Infections No case was notified during the year. Food Poisoning No case was notified during the year 12 Measles The number of cases notified in 1960 was 42. The number of cases notified in 1959 was 228, Whooping Cough 29 cases were notified during the year The number of cases notified in 1959 was 31. Acute Poliomyelitis There was no case notified in 1960. Ophthalmia Neonatorum No case was 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 Smallpox - - - Scarlet Fever 18 - - Diphtheria - - - Enteric or Typhoid Fever - - - Paratyphoid Fever - - - Puerperal Pyrexia 13 - - Pneumonia 2 - - Erysipelas 3 1 - Meningococcal Infection - - - Measles 42 1 - Whooping Cough 29 - - Ophthalmia Neonatorum - - - Dysentery - - - Poliomyelitis (Paralytic) - - - Poliomyelitis (Non Paralytic) - - - Encephalitis - - - Food Poisoning - - - Totals 107 2 - 13 15 Age Groups (contd.) Erysipe1as Smal1 pox Food Poisoning M F M F M F 0 - - - - - - 5 - - - - - 15 1 1 - - - - 45 1 - - - - - 65 and over - - - - - Total (all ages) 2 1 - - - - M F Puerperal Pyrexia - 13 Ophthalmia Neonatorum - - 14 Age Groups Scarlet Fever Diphtheria Whooping Cough Measles (excluding rubella) Acute Poliomyel1ti s Paralytic Non-Paralytic M F M F M F M F M F M F Under 1 Year - - - - 3 - 1 - - - - - 1 - - - - 2 2 2 2 - - - - 2 2 - - - 2 - 2 2 - - - - 3 2 - - - - 1 2 2 - - - - 4 1 - - - 2 2 1 1 - - - - 5-9 6 5 - - 7 8 14 13 - - - - 10 - 14 1 1 - - - - - - - - - - 15 - 24 - - - - - - - - - - - - 25 and over - - - - - - - - - - - - Total (all ages) 12 6 - - 16 13 22 20 - - - -  Enteric or Typhoid Fevers Paratyphoid Fever Acute Pneumonia Dysentery Men Ingococcal Infection Acute Encephalitis Lethargica M F M F M F M F M F M F Under 5 Years - - - - - - - - - - - - 5 - - - - - - - - - - - - 15 - - - - - - - - - - - - 45 - - - - 1 - - - - - - - 65 and over - - - - - 1 - - - - - - Total (all ages) - - - - - 1 - - - - - - 16 Poliomyelitis Vaccination, 1960 The following table gives the numbers of persons resident in the Crayford Urban District who received injections against poliomyelitis during the year ended 31st December, 1960:- Year of Birth 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1933 to 1943 Before 1933 Others Total Given 2nd injections 72 280 31 10 9 8 9 3 4 8 3 1 4 3 5 3 6 6 108 633 57 1263 Given 3rd injections 1 200 187 61 42 48 37 25 38 27 37 21 27 27 22 19 28 27 741 162 148 1925 Immunisation against Diphtheria, 1960 The following is a return of the number of children resident in the Crayford area, under the age of 15 years on 31st December 1960 who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1946):- Year of Birth 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 Total Last complete course of injections (whether primary or booster) 1956 1960 208 158 118 165 239 103 230 228 270 371 336 315 330 327 209 3607 1955 or earlier 329 262 237 366 327 105 86 129 109 8 - - - - - 1958 Immunisation and Vaccination Set out below are the diphtheria immunisation, whooping-cough immunisation and smallpox vaccination figures for 1960 based on record cards received:- Year of Birth Diphtheria Immunisation Smallpox Vaccination Whooping-cough Immunisation Primary Reinforcing Primary Revaccination Primary 1960 207 2 144 — 205 1959 253 1 151 — 200 1958 40 4 1 — 7 1957 17 — 1 — 10 1956 11 42 — — 5 1955 5 176 1 — 3 1954 9 27 1 — 4 1953 2 4 2 — 1 1952 3 6 — — 2 1951 3 7 1 1 — 1950 — 4 — — — 1949 1 4 — — — 1948 — 2 — — — 1947 1 — — — — 1946 — 1 — — — Before 1946 — — 2 3 — Total 552 280 304 4 437 17 Tuberculosis Age Periods New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M F M F M F M F Under 5 years 1 1 - - - - - - 5 1 1 - - - - - - 15 1 2 - 1 - - - - 25 7 4 - 1 - - - - 45 5 1 1 - - - - - 65 and over 2 - 1 - 3 - - - Totals 16 9 2 2 3 - 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 - 9 Applicants recommended for rehousing - 5 No, of families granted houses on account of tuberculosis - 1 Other reasons - 3 18 Bexley, Erith and Crayford Mass X-Ray Campaign May 23rd to 30th June, 1960 The idea of a Mass X-Ray Campaign for the Boroughs of Bexley and Erith and the Urban District of Crayford arose out of a report entitled "No Time for Complacency", issued in May, 1958 by the South East London Mass Radiography Service and which covered the area of South East London and North West Kent. The report indicated that, although great improvements had taken place in recent years in the treatment of tuberculosis, there was little evidence that this progress had yet effected a material decrease in the incidence of new cases of tuberculosis or in the size of the reservoir of long-standing tuberculosis cases within the community. The figure relating to the incidence of tuberculosis per 1,000 x-rayed for the three towns appeared to provide "prima facie" evidence that further action was indicated and the Councils of Bexley, Erith and Crayford readily agreed to co operate with the Mass Radiography Service in planning a comprehensive survey on the lines of the one carried out in Glasgow in 1957. The Area Under Review Bexley, Erith and Crayford are three contiguous towns forming part of Metropolitan Kent, The mid-year populations (as estimated by the RegistrarGeneral) were- Bexley 90,500 Erith 45,700 Crayford 30,600 Total 166,800 These figures are for the total population in the area, but the Mass X-Ray Campaign was only concerned with the ambulant adult population. A full account of the Campaign has been published as a separate report and may be obtained from Dr J.M. Morgan Director, South-East London Mass X Ray Service. New Cross General Hospital, Avonley Road, London, S, E 14 The following statistics relating to the survey are extracted from the main report. Certain observations on these findings are made in the Foreword on Pages 3 and 4. 19 20 SOUTH-EAST LONDON MASS X-RAY SERVICE (BEXLEY, CRAYFORO AND ERITH CAMPAIGN, 23rd May, 1960 - 30th June, I960) TUBERCULOSIS AND NEOPLASMS OF LUNG Borough or District of Residence Totals X-rayed Tuberculous cases requiring close supervision or treatment Tuberculous cases requiring occasional supervi sion Total of tuberculous cases Total Number proved cases of carcinoma of lung Total Number non-malignant neoplasms Cases Incidence per 1,000 Cases Incidence per l,000 Cases Incidence per 1,000 Cases Incidence per 1,000 BEXLEY 16,640 28 50 78 11 9 CRAYFORD 5,950 10 16 26 2 2 ERITH 9,690 18 43 61 1 4 Elsewhere 2,970 1 3 4 2 1 35,250 57 l.6 112 3.2 169 4.8 16 0.5 16 Men and Women BEXLEY Age Groups Total Number Examined Total Number tuberculous cases requirging close supervision Total Number tuberculous cases requiring occasional supervision Total Number proved cases of carcinoma of lung Total Number non-malignant neoplasms M F M F M F M F 15 - 19 1,270 - 1 - - - - - - 20 - 24 1,300 1 1 - - - - - - 25 - 34 3,100 3 4 3 3 - - 1 - 35 - 44 3,820 1 2 4 5 - - 1 - 45 - 54 3,290 4 4 4 7 1 - 1 2 55 - 59 l,370 2 1 3 2 6 - - 1 60 - 64 970 - 1 3 6 1 - 1 2 65 & over 1,520 2 1 9 1 1 2 - - Totals (all ages) 16,640 13 15 26 24 9 2 4 5 28 50 Incidence per 1,000 = 1.7 Incidence per 1,000 = 3.0 4.7 per 1,000 21 Men and Women CRAYF0RD Age Groups Total Number Examined Total Number tuberculous cases requiring close supervision Total Number tuberculous cases requiring occasional supervision Total Number proved cases of carcinoma of lung Total Number non-malignaftt neoplasms M F M F M F M F 15 - 19 540 - 1 - - - - - - 20 - 24 430 - 1 - - - - - - 25 - 34 1,670 2 2 - 1 - - - - 35 - 44 1,180 - 1 - 1 - - - - 45 - 54 1,030 1 1 3 5 - - - - 55 - 59 440 - 1 1 - - - - - 60 - 64 350 - - - 2 - 1 - 1 65 & over 310 - - 2 1 1 - - 1 Totals (all ages) 5,950 3 7 6 10 1 1 - 2 10 16 Incidence per 1,000 = 1.7 Incidence per 1,000 = 2.7 4.4 per 1,000 22 Men and Women ERITH Age Groups Total Number Examined Total Number tuberculous cases requiring close supervision Total Number tuberculous cases requoring occasional supervision Total Number proved cases of carcinoma of lung Total Number non-malignant neoplasms M F M F M F M F 15 - 19 1,040 - 1 - - - - - - 20 - 24 700 - - - - - - - - 25 - 34 1,880 1 2 3 1 - - - - 35 - 44 2,230 - 4 2 6 - - - - 45 - 54 1,810 1 5 4 11 1 - - 1 55 - 59 740 - 1 1 1 - - - - 60 - 64 530 1 - - 4 - - - - 65 & over 760 2 - 4 6 - - - 4 Totals (all ages) 9,690 5 13 14 29 1 - - 5 18 43 Incidence per 1P000 - lo9 \ Incidence per 1,000 - 4.4 6.3 per 1,000 23. Men and Women ELSEWHERE Age Groups Total Number Examined Total number tuberculous cases requiring close supervision Total number tuberculous cases requiring occasional supervision Total number proved cases of carcinoma of lung Total number non-malignant neoplasms M F M F M F M F 15 - 19 380 - - - - - - - - 20 - 24 290 - - 1 - - - - - 25 - 34 780 - - - 1 - - - 1 35 - 44 700 1 - 1 - - - - 45 - 54 500 - - - - - - - - 55 - 59 120 - - - - 1 - - 60 - 64 120 - - - - - 1 - - 65 & over 80 - - - - - - - - Totals (all ages) 2,970 1 - 2 1 - 2 - 1 1 3 Incidence per 1,000 = 0.3 Incidence per 1,000 = 1.0 1.3 per 1,000 24. 25. Incidence of Tuberculous Disease Amongst Those Not Previously X-Rayed Total NOT previously X-Rayed Tuberculous cases requiring close supervision or treatment Tuberculous cases requiring occasional supervision 16 040 44 (incidence of 2.7 per 1,000) 86 (incidence of 5.4 per 1,000) Carcinoma of Bronchus MEN OVER 15 WOMEN OVER 45 Men and Women Total X-rayed Cases Found Total X-rayed Cases Found Cases Found BEXLEY 2 550 9 (3.5 per 1,000) 4,600 2 (0.4 per 1,000) 11 CRAYFORD 760 1 (1.3 per 1,000) 1,370 1 (0.7 per 1,000) 2 ERITH 1,150 1 (0.9 per 1,000) 2,690 - 1 Elsewhere 390 - 430 2 (4.7 per 1,000) 2 4,850 11 (2.3 per 1,000) 9,090 5 (0.6 per 1,000) 16 (1.1 per 1,000) 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 7 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. The total result of the local Christmas Seals Sale, including the mail sale as reported by the Organiser to the Annual General Meeting, amounted to £143 16s 1d. The County Organiser, Health Visitor, Chest Physician and District Officer have given invaluable service to the Committee. Welfare of Old People This continued to place an increasing demand on the services of the Health Department and the Crayford Old People's 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 People's Homes where this has been possible. The Visiting Service carried out by the Crayford Old People's Welfare Committee continues to flourish. Help is given to the old folk with clothing and small home comforts. Many services have been rendered to elderly people and much assistance is given by other Voluntary Organisations to the Old People's Welfare Committee. 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 the 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 the area if it appears that no suitable arrangements for the disposal of the body can otherwise be made. It was necessary to arrange one burial under this Section during the year. 26. CHIEF PUBLIC HEALTH INSPECTOR'S REPORT To The Chairman and Members of the Urban District Council of Crayford. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1960 which gives a general summary of the work carried out by the Public Health Inspectors during the year. Inspection and Supervision of Food Many visits were made by your Public Health Inspectors during the year in relation to food and food premises - a very important branch of Public Health work. I would like to take the opportunity of thanking all local trades people for the courtesy and consideration given to me and my staff in this aspect of Public Health work. In this connection, no fewer than 677 visits were made, 132 being to premises registered under Section 16 of the Pood and Drugs Acto 45 informal notices were served under the Food Hygiene Regulations, and in 38 cases, repairs or improvements were carried out. The introduction of the new Food Hygiene Regulations has at last cleared any doubts regarding smoking whilst handling food. However as I have expressed before, I feel that much can still be done in the field of food hygiene. The Meat (Staining and Sterilisation) Regulations, 1960 also came into force and suitable arrangements have been made regarding certain unfit meat being allowed into Crayford to be used for animal feeding. The number of food premises in the area is as follows Bakers 4; Butchers 18; Grocers 56; Greengrocers 20; Confectioners 26; Fishmongers 8; Cafes, Canteens, etc, 35; Public Houses 19; Off Licences 3; Clubs 12; Other premises 29. Under Section 16 of the Pood and Drugs Act, 1955, 66 premises are registered for the storage and sale of Ice Cream and 32 for the manufacture or preparation of preserved food intended for sale. Complaints The following complaints were received and dealt with during the year: Cooked Cauliflower, A sample of cooked cauliflower was brought into the office, complaint being made as to its peculiar colour with possibility of unsoundness Further investigation, however, suggested that there was nothing harmful contained therein. Bread. Brownish specks in a loaf of bread were ascertained by laboratory examination to be harmless bakery char. 27. In another instance foreign matter in a loaf of bread resulted in legal proceedings being taken against the suppliers who were fined £30 with £2 2s. costs awarded to the Council. Toffees. Information was requested regarding the quality of some wrapped toffees. It appeared that in this case the shopkeeper had been making up his own assortments contrary to the wishes of the manufacturer. No further action was deemed necessary. Fish. Complaint was made regarding the condition of some haddock and cod pieces alleging that they were not fresh when sold. A warning letter was sent to the suppliers. Ple. The presence of mould in a steak and kidney pie formed the basis of another complaint. Investigation, however, revealed that the pie had been kept in an unrefrigerated larder by the purchaser before making the complaint and accordingly, no further action was deemed necessary Cheesecake. The presence of a nail in a cheesecake resulted in legal proceed ings being taken and the supplier being subsequently fined the sum of £5 with £2 2s costs being awarded to the Council. Fireworks and Ice Cream. An unusual complaint was made regarding the sale of fireworks and ice cream from the same travelling van Contact was made with the owners of the vehicle and the practice ceased. Meat and Other Foods. The following articles were found during the year to be unfit for human consumption: lbs. ozs. lbs ozs Beef 95 0 Melts 1 12 Beef loaf 6 Spleens 24 0 Liver 95 0 Ox Cheek 56 0 Pigs Kidneys 20 0 Tinned Fruit 84 9½ Chopped Pork 10 0 Tinned Vegetables 62 3 Ham 333 5 Tinned Soup 2 14 Chicken 38 8 Tinned Ham 57 0 Corned Beef 55 15 Tinned Meat Loaf 7 Luncheon Meat 5 0 Tinned Meat 107 11½ Pressed Pork 36 0 Tinned Pish 6 15¾ Jellied Veal 42 0 Tinned Jam 1 8 Rabbit 54 12 Dripping 1 0 Butter 26 8 Margarine 8 8 Skate 14 0 Mayonnaise 4½ Steak and Kidney Pudding 1 0 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, after sterilisation. 28 Slaughterhouses There is no slaughterhouse in the area. Milk Licences granted by the Council under the Milk (Special Designation) Regulations, 1949/1953: Supplementary - Tuberculin Tested 12 Pasteurised 13 Sterilised 14 Dealers - Tuberculin Tested 8 Pasteurised 13 Sterilised 31 12 samples of milk were submitted to the County Laboratory as follows:- Tuberculin Tested Pasteurised 5 Pasteurised 4 Sterilised 3 All satisfied the prescribed tests. ICE CREAM (HEAT TREATMENT) REGULATIONS 1947-1952 There are 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 29 Grade II 8 Grade III - Grade IV - 29. FOOD AND DRUGS ACT, 1955 Details of samples taken by the County Sampling Officers within the Crayford Urban District during the year ended 31st December, 1960: Article No. Article No Almond Marzipan 1 B/f 46 Apricot Nectar 1 Lard 1 Battenburg Cake 1 Lixen 1 Beans (tinned) 1 Meat Paste 1 Beef Sausages 1 Meat Pie 2 Blackcurrant Vitamin C Drink 1 Milk 24 Brandy Flavour 1 Milk Chocolate Eclairs 1 Bronchial Pastilles 1 Mistol Drops with Ephedrine 1 Bronchial Tablets 1 Mixed Cut Peel 1 Butter 2 Mixed Fruit 1 Buttered Brazils 1 Nite Cup 1 Buttered Kipper Fillets 1 0.K. Sauce 1 Cereal Beverage 1 Orange 1 Cheese 4 Pea Soup with Bacon 1 Chocolate Caramels 1 Peaches 1 Chocolate Pineapple Leaves 1 Pork Sausages 2 Coco Pops 1 Potatoes 6 Cold Relief Aerosol 1 Prunes 1 Cooking Fat 1 Quinine Compound Tablets 1 Cough Syrup with Vitamin C 1 Quip Real Table Cream 1 Crab Spread with Butter 1 Rum 2 Custard Powder 1 Sausage Rolls 2 Cyder 2 Seraflo 1 Dates 1 Shortcake Sweetened 1 Diabetic Chocolate Drink 1 Single Cream 1 Double Cream 1 Sponge Mixture 1 Frador 1 Strawberry Conserve 1 Gees Linctus Pastilles 1 Sugar 1 Gin 1 Sweetened Condensed Machine Skimmed Milk 1 Glycerine Lemon and Honey 1 Grapefrui 1 Tapioca 1 Ground Almonds 1 Tuna Fish 1 Ground White Pepper 1 Tuscana Cocillana Cough Linctus 1 Horseradish 1 Vinegar 1 Ice Cream 5 Whisky 1 Jellied Eels 1 Zinc and Castor Oil Cream 1 Jelly blackcurrant flavour 1 Total 112 C/f 46 Milks 24 Drugs 12 Spiri 4 Others 72 112 All of the above samples were genuine. 30. CLEAN AIR ACT, 1956 During the year 1960 the detailed survey of Smoke Control Area No. 1 at Slade Green was completed and final details prepared ready for submission to the Minister of Housing and Local Government. It is both interesting and heartening to note that many of the residents of Crayford are becoming "Clean Air" conscious and during the year a steady stream of enquiries have been received from residents from all parts of the Urban District regarding smokeless fuel, appliances and clean air in general. Through these enquiries and routine visits by the Inspectors it has been ascertained that in many cases smokeless fuel and appropriate approved appliances are quite often found to be already in use. HOUSING STATISTICS (!) Inspection of Dwelling Houses (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 1,225 Number of inspections made for that purpose 2,589 (2) Number of dwellinghouses (included under sub-heading (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 3 (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 329 (2) Remedy of defects during the year without the service of formal notice Number of defective dwellinghouses rendered fit in consequence of informal action by Local Authority or their Officers 90 (3) Action under statutory powers during the year Statutory Notices under Housingor Public Health Acts 3 Number of houses in which defects were remedied after serving of formal notices- (a) by owners 3 (b) by local authority in default of owners - 31o Proceedings under Housing Act, 1957- (a) Demolition Orders made under Section 17 3 (b) Clearance Area declared - Section 42 31 (c) Houses demolished (i) as a result of formal or informal procedure under Section 17(1) 5 (ii) temporary bungalows (prefabs ) 17 (4) Housing Act, 1957 - 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 2,950 Number of houses built during the year- (a) by the local authority 69 (b) by other bodies or persons 78 Rent Act, 1957 During the year, 4 applications have been received for certificates or disrepair and certificates as to the remedying of defects which landlords have undertaken to remedy, no certificates of disrepair or certificates as to the remedying of defects have been issued. SANITARY CIRCUMSTANCES OF THE AREA Water The Metropolitan Water Board is the supplying authority. The water supply to the Crayford Urban District is derived from the Crayford, Darenth and Wansunt wells. The water has been satisfactory in quality and quantity throughout the year. The wells supplies are examined bacteriologically at least five times a week before and after treatment which consists of chlorination and dechlorination. The waters are not liable to have plumbo solvent action and there has been no evidence of contamination of Crayford or other wells during the year. 32. Water Sampling The following samples were sent to the County Laboratory by the Council's Public Health Inspector: (a) Wells (drinking water), Bacteriological - 10 (b) Swimming Pool, Bacteriological - 10 (c) Domestic Supplies, Bacteriological - 11 All samples forwarded have been reported satisfactory. Water Supply Normal mains extension to serve new development was carried out. Drainage and Sewerage Normal sewerage extension to serve new housing development. Housing Plans The building of houses is in progress at Schemes Nos. 42 and 20; the former to comprise 263 dwellings and the latter 4 dwellings. Report of Kent River Board River Cray Weed clearance has been carried out from Vitbe Mills to Hall Place. Rubbish has been regularly cleared from the river, notably at Maiden Lane and Crayford Way. River Stanham, Middle River, River Wansunt Weeds have been removed from these watercourses and handcasting has been carried out on the R. Stanham below Maiden Lane and R. Wansunt above Crayford High Street. Marsh Dykes On Crayford marsh, annual clearance of the Board's dykes has been carried out and repairs effected to the tidal flap at Crayford Sluice, damaged by hooligans. 33. In spite of the abnormally high rainfall, no flooding has been experienced in the Crayford District from the fore-going watercourses. Closet Accommodation. Approximate number of premises containing each type of sanitary convenience in the district- W.Cs. into drainage system, approximately 12,148 W.Cs. into cesspools 16 Number of premises not connected to public water supplies - 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 21 Drainage (i) repaired 45 (ii) unstopped, etc. 122 Refuse receptacles 36 Damp proof courses inerted 1 Roofs and rain water pipes 40 Chimney stacks and pots repaired or renewed 11 Fireplaces grates and stoves repaired or improved 7 Floors walls and ceilings repaired or renewed 81 Rooms cleansed 4 Water supplies 22 Doors and other woodwork 34 Yard paving provided or renewed 3 Offensive accumulations removed 17 Improper keeping of animals abated 1 Other defects 140 34. Control of Rodents and other Pests 192 complaints in respect of rats and mice infestations were received and fully investigated. 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 28; Bugs 9; Miscellaneous 33. Total number of visits of all kinds paid by Inspectors during the year 6,674 Approximate number of rated premises in the area 10,519 Notices served- Statutory 3 Informal 437 Number of houses etc. disinfected 7 Swimming Pool Period open from 7th May to 11th September. Number of bathers - 38,179 95 season tickets This figure does not include school parties and clubs. Shops Act. A total number of 103 visits were made during the year. This figure includes Sunday and evening visits One notice was served. Shops continue the practice of closing earlier than the statutory closing times but the smaller shopkeepers seem to prefer commencing business much earlier in the morning whilst on the other hand the larger concerns are beginning to carry on business until a later time on specific days. No serious breach of the Act has been noted. Eradication of the Bed Bug 35. Particulars of the action taken in 1960 for the eradication 6f the Bed Bug were as follows: Infested Disinfested Number of- Council houses 6 6 Other houses 3 3 Prescribed Particulars on the Administration of the Factories Act, 1937 to 1959 1. Inspections for purposes of provisions as to Health (including inspections made by Public Health Inspectors). Premsses 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 13 14 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 64 49 3 - (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding outworkers premises) 20 20 1 - Total 97 83 4 - 36. 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 Referred by H. M. 1nspector (1) (2) (3) (4) (5) (6) Want of Cleanliness (S. 1) 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 5 3 - - - (c) Not separate for sexes - - - - - Other offences (not including offences relating to outwork) 2 - - - - Total 8 4 - - - 37. OUTWORK Part VIII of the Act Nature of Work Section 110 Section 111 No. of out workers in August list required by Section 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. 8 - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 1 - - - - - I am Your obedient Servant, A.W. KENT Chief Public Health Inspector 38.