4412 (3) II CRA 28 Urban District of Crayford ANNUAL REPORT of the Medical Officer of Health for the year 1963 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 1963 JOHN L A N D 0 N, M. R. C. S. , L.R. C.P. , D.P.H. MEMBERS OF THE HEALTH COMMITTEE Chairman: Councillor J. Kerr Members: Councillors: Mrs. H.E. Gleed Mrs. P.M. Pilbrow E. A. A. Kerridge Mrs. M. E. Syms Councillors: R. H. A. Saunders H. E. Sutton. A. Turner Mrs. E. M. White Co-opted Members: Mrs. E. Fatharley Mr. P. Hayward Mrs. K. Hill 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 Miss P.I. Fewkes (resigned 3.5.63) *M. D. McSweeney, M. A. P. H.I. Mrs. V. F. Kennedy ( appointed 10.6. 63) General Assistant: P.J. O'Brien *Certificate for Inspector of Meat and other foods #Shops Act Inspector iRodent 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 1963, my fifteenth and probably the last to be submitted to the Authority as at present constituted in view of the creation of the London Borough of Bexley under the London Government Act, 1963. I have worked in the area for eighteen years, having been appointed to Bexley in 1946. Eighteen years is not a long time in the life of a local authority (although it does represent a substantial slice of the working life of an individual) but it is long enough to warrant a comparison of the health circumstances of the area at the beginning and end of this period. The year 1946 witnessed the beginning of the transition from war to peace. The strain of bombardment of the civilian population was lifted and the reintegration of family life was assisted by the return of evacuated children and by an acceleration of the rate of demobilisation of the Armed Forces. Housing circumstances had been seriously affected by bombing and the suspension of new building, and represented the most serious of the problems facing the Urban District at that time. Difficulties in the process of resettlement in civilian life inevitably occurred as a result of the enforced separation, over a number of years, of husbands and wives, children and parents; food shortages remained and in many ways the discipline of the wartime years continued. Strangely enough, in spite of these vicissitudes the general health of the community, as evidenced by the vital statistics of the area remained good. The infant mortality rate (i.e. the number of children dying in the first year of life per 1,000 live births), a very sensitive index of social conditions, was 37 per 1,000 live births in 1946, a favourable rate compared with previous years. In 1941 the rate was 59.7 per 1,000. This rate has continued to fall and, in 1963, was 14.73 per 1,000 and, even allowing for the inevitable fluctuations which are expected when dealing with small numbers, it may be said with some justification that there has been a downward trend since the end of the war which is statistically significant. This has, undoubtedly, been due to improved environmental conditions including housing, an advance in child health services including health education and the discovery of the chamotherapeutic drugs as well as penicillin and the other antibiotics which have greatly simplified the control of the childhood infections. The maternal mortality rate (the number of deaths of mothers in childbirth per 1,000 total births) had been consistently low and it is pleasant to report that there have been no maternal deaths due to childbirth, in the Urban District for the past three years. This improvement can be related to improved obstetric 2 services, better housing conditions and, again, better chemical and antibiotic control of the puerperal infections. The birth rate in 1946 was 22 per 1,000 of the population (18.8 and 23.1 in the previous two years) and fell steadily until about 1956 when an upward trend became noticeable. The rate for 1963 was 18.73 compared with 13.9 per 1,000 in 1951. The Department for Education and Science's, 'Statistics of Education', 1963 (H.M.S.O.) show that the post-war 'bulge' now passing out of the secondary schools is but the forerunner of bigger bulges to come which are bound to have important social, industrial and educational implications for the future. The death rate, on the other hand, has remained almost unchanged over the past 18 years and more. The fall in the death rate in the country as a whole began around 1875 and was due to improvements in the adverse environmental conditions which the process of urbanisation had brought to bear on the community not merely in regard to sanitation but housing, overcrowding, nutrition, hours of work and factory conditions. The tuberculosis death rate also began to fall about the same time and has continued unabated to the present day. Improved standards of living and medical discoveries have combined to bring this about and to raise the general expectation of life of the population. Why then has the death rate not continued to fall? The answer is twofold. Firstly with an ageing population more people may be expected to die for there is a limit to which life can be prolonged and, secondly, deaths from certain causes have increased over the past quarter of a century, notably, cancer of the lung, cardio-vascular disease, including coronary disease and accidents both on the roads and in the home. The causes of these epidemics, for this is what they really are, are so complex and interwoven in the fabric of our Society that there can be no easy way to their prevention. The highly competitive nature of life today, the pursuit of ever-increasing standards of living, automation, and the advances of science and technology, good in many respects, unfortunately bring with them new hazards to human health and happiness e.g. radio-active contamination, atmospheric pollution, noise, sophistication of our food supplies, speed and a materialistic outlook which is not conducive to the mental health of the population. In 1950, the first year in which separate figures became available for cancer of the lung, the number of deaths from this cause was 3 compared with 12 in 1962 and 16 in 1963. The number of deaths ascribed to coronary disease similarly rose from 6 in 1950 to 51 in 1962 and 51 in 1963. During the period 28th October to 1st November, 1963, a Smoking and Health Campaign was held in conjunction with Bexley and Erith. The spearhead of this was a five day visit to the area of the Central Council for Health Education mobile unit which visited a number of secondary schools and a Youth organisation. Films were shown at those schools not actually visited by the Unit. Ten thousand copies of a personal letter addressed to parents by the Medical Officer of Health were distributed throughout the schools and a large number of leaflets and posters were made available in the area. 3 The Campaign made a good impact on the public at the time but I fear that it will take much more than this to shake the public generally out of their apathy in regard to this problem, bearing in mind the vast amount of money spect annually by the tobacco industry in advertising their products. Section 32 of the children and Young Persons Act, 1963, substantially increases the penalty for the sale of tobacco to persons under 16 years of age but it would appear that the problem of enforcement will remain. The picture is much brighter in regard to the older epidemics. In 1942 eight cases of diphtheria were notified in the Urban District with one death (6 cases with no deaths in 1941, 32 cases with 3 deaths in 1930). There has not been a single notified case of diphtheria in the Urban District for the past 14 years. In the late summer of 1947, suddenly and unaccountably, poliomyelitis struck the country after many years of relative quiescence. Four cases occurred in the Urban District. Immunisation against this disease began in 1956 and it is significant that, since that time, there has been a remarkable decline in poliomyelitis. There were no cases in the Crayford Urban District in the five year period 1959 to 1963 as against 13 in the previous five years. Pew would deny that this decrease is closely related to the immunisation of children and young adults in the Urban District first by the Salk vaccine and now by the oral vaccine which has almost replaced the former. Over the relatively short period under review there has been a marked improvement in food hygiene in the District as a result of the implementation of the Pood Hygiene Regulations and of internal developments in the Catering trades as a whole. Refrigeration of foodstuffs is, now, almost universal and the wrapping of foodstuffs has gone to considerable lengths. The opportunities for the occurrence of food poisoning are certainly fewer nowadays (although there were two notified cases in 1963) but constant vigilance is still necessary as human sources of error can still defeat the most elaborate equipment. A further hazard arises from the growing tendency for people to take their holidays abroad and the importation of typhoid fever appears to be a growing risk. In regard to housing the Council have pursued a steady slum clearance programme both by clearance orders and by the demolition of individual unfit houses. Among their achievements during this period have been the clearance of Arthur Street and Boundary Street areas and the redevelopment of the site to include three 'tower' (13-storey) blocks of flats, 76 living units in each block, with a further block of 76 units a short distance away in Northend Road, the latter also being served with special facilities for Old People' s recreation. Other development has taken place in the Hazel Road area where 98 living units have been provided; in Lincoln Road where fifty prefabricated type houses have been removed leaving a sizeable site ready for development, and in Maxim Road, Crayford, quite close to the Town Centre where it is proposed to erect more tower blocks. Altogether the Council have provided well over 3,000 living units throughout the district and it is of interest to note that the Arthur Street project was the first of its kind in Kent. Included in this figure are five blocks of flats totalling 31 dwellings in two-storey accommodation for old persons (including a residential flat for a Warden) at the Homestead, High Street, Crayford, and three two-storey 4 blocks of flats totalling 28 dwellings, also with flat for resident Warden at Lingwood, Three Corners, Barnehurst. The standard of amenity of these old people's dwellings is extremely high and provides a pattern for future developments in the welfare of old people. The district now has no slums in the accepted sense of the word but there are still quite a number of individual houses which will need to be dealt with in the next five years. The obsolescence factor is, indeed, low and, with the increase in the number of owner-occupiers, the provision of new houses by the Council and private enterprise and the improvement of some of the older houses by improvement grant procedure this favourable position could be maintained. The housing needs of the elderly and of young femilies living in cramped conditions either in furnished accommodation or with 'in-laws' present an urgent problem throughout the country and are recognised by the Council as a major obstacle to health and happiness which should be removed as soon as possible. Atmospheric pollution is nowadays the most important hazard to the health of the community. It is comparable in its magnitude to the pollution of public water supplies in the 19th century before the provision of water-carriage sewerage schemes and the problems involved in its abolition are probably even more complex. The atmosphere is becoming, more and more, a new kind of public sewer into which every kind of gaseous filth is discharged - from the domestic fire, the factory chimney and, of course, from the evergrowing number of motor vehicles, both diesel and petrol, which threaten to bring chaos to our roads. The Clean Air Act of 1956 has enabled local authorities to take the first steps to control black smoke emissions from the domestic hearth and factory and much has already been achieved in some of the worst 'black areas' of the country. Despite its many shortcomings the Act remains one of the most important and far-reaching pieces of legislation on the Statute Book and the many frustrations arising from its operation should be seen as teething troubles inherent in such a great task as the removal of one of the main causes of chronic respiratory disease, one of the great killing diseases, and of cancer of the lung, of which it is not doubt a contributory cause As a result of the London Government Act, 1963, the new London Borough of Bexley will, on 1st April, 1965, become responsible for the Health and Welfare and Children's services. It is difficult not to feel some regret at the passing of the old order but one cannot but welcome the great opportunities and challenge which face the new Borough and which will, surely, in years to come, bring about a fully integrated Health service, close to the people it is designed to serve and providing opportunities for the prevention of disease and the promotion of health greater than ever before particularly in the field of mental health and the welfare of the elderly and the handicapped. 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 acknowledge also the help and co-operation received from other Departments of the Council. I am. Your obedient Servant, JOHN LANDON Medical Officer of Health 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 2,698.71 Population (Registrar-General's estimate mid-year 1963) 32,620 Number of separate dwellings 10,607 Rateable value £1,473,488 Sum represented by a penny rate £5,900 Live Births Total M F Legitimate 594 305 289 Illegitimate 17 6 11 611 311 300 Birth rate per 1,000 of the estimated home population - 18.73 Illegitimate live births per cent of total live births - 2.86% General birth rate for England and Wales - 18.2 Stillbirths Total M ] Legitimate 13 6 7 Illegitimate - - - 13 6 7 Rate per 1,000 total (live and still) births - 20.83 Total M F Deaths 261 143 118 Death rate per 1,000 of the estimated resident population - 8.00 General death rate for England and Wales - 12.2 The Registrar General has supplied comparability factors for 1963. The standardised Birth Rate which allows for comparison with other parts of the country is 17.23 and the standardised Death Rate is 10.96. Maternal Deaths There were no maternal deaths in 1963. Deaths of Infants under one year of age Total M F Legitimate 9 5 4 Illegitimate - - - 9 5 4 Rate per 1,000 live births (Crayford) - 14.73 Rate per 1,000 legitimate live births - 15.15 Neo Natal mortality rate per 1,000 live births - 13.09 Early Neo-Natal mortality rate per 1,000 live births - 13.09 Perinatal mortality rate per 1,000 total (live and still) births - 33.65 General death rate of infants under 1 year of age for England and Wales - 20.9 Deaths from Various Causes Malignant Neoplasm (all ages) 53 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) - 7 8 Vital Statistics during 1963 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. En g. & 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 1961 31,290 572 18.28 17.4 251 8.02 12 13 22.73 21.6 1962 31,980 538 16.82 18 257 8.04 11.9 11 20. 44 21.6 1963 32,620 611 18.73 18.2 261 8 12.2 9 14.73 20.9 * 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 and Crayford Wales U.D.C. Rates per 1,000 Home Population Births Live Births 18.2 18.73 Stillbirths 0.32 17.2 (a) .34 20 . 83 (a) Deaths All Causes 12.2 8.00 Typhoid and Paratyphoid .. 0.00 - Whooping Cough 0.00 - Diphtheria 0.00 - Tuberculosis 0.06 0.03 Influenza 0.06 - Smallpox - - Acute Poliomyelitis (including Polioencephalitis 0.00 - Pneumonia 0.99 0. 46 Notifications (Corrected) Typhoid Fever 0.00 - Paratyphoid Fever 0.00 - Meningococcal Infection 0.01 - Scarlet Fever 0.37 0. 25 Whooping Cough 0.74 0. 25 Diphtheria 0.00 - Erysipelas 0.04 - Smallpox - - Measles 12. 78 17.01 Pneumonia 0. 30 0.03 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.00 - Non-Paralytic 0.00 - Food Poisoning 0.12 0.06 Puerperal Pyrexia 7.44 (a) 22.44 (a) 9 England and Crayford Wales U.D.C. Rates per 1,000 Total Live and Still Births Maternal Mortality Maternal causes excluding abortion 0. 22 - Due to abortion 0.06 - Total maternal mortality 0.28 - 10 11 Deaths Registered (in Age Groups) 1963 CAUSE OP DEATH Under 4 Wks. 4 Wks. and under 1 Year 1 - 5 - 15 - 25 - 35 - 45 - 55 - 65 - 75 & over TOTAL ALL AGES M F M F M F M F M F M F M F M F M F M F M F Male Female l. Tuberculosis, respiratory 1 1 2. Tuberculosis, other _ _ 3. Syphilitic disease .. _ 4. Diphtheri a _ _ 5. Whooping Cough .. _ _ 6. Meningococcal infections _ _ 7. Acute Poliomyelitis .. _ _ 8. Measles — _ 9. Other infective and parasitic diseases 1 1 10. Malignant neoplasm, stomach 1 1 _ 11. Malignant neoplasm, lung and bronchus. 1 1 2 1 5 3 2 1 14 2 12. Malignant neoplasm, breast 1 3 2 _ 6 13. Malignant neoplasm, uterus 1 1 2 _ 4 14. Other malignant and lymphatic neoplasm 1 2 4 1 4 4 3 1 4 2 18 8 15. Leukaemia, aleukaemia 1 1 1 2 1 16. Diabetes 2 1 2 1 17. Vascular lesions of nervous system 3 4 5 7 6 11 14 18. Coronary disease, angina 1 8 1 12 6 12 11 33 18 19. Hypertension with heart disease .. 1 3 1 1 1 5 2 20. Other heart disease 1 1 1 1 1 1 3 7 14 10 20 21. Other circulatory disease 1 1 5 3 5 5 10 22. Influenza _ _ 23. Pneumonia 4 2 3 4 7 6 24. Bronchitis 7 1 1 1 3 9 4 25. Other diseases of respiratory system.. 1 1 1 1 26. Ulcer of stomach and duodenum 1 — 1 27. Gastritis, enteritis and diarrhoea .. 1 1 _ 28. Nephritis and nephrosis .. .. .. . 1 — 1 29. Hyperplasia of prostate 1 1 - 30. Pregnancy, childbirth, abortion .. - _ 31. Congenital malformations 1 1 1 1 2 2 32. Other defined and ill-defined diseases 5 3 1 1 1 3 4 2 3 1 3 14 13 33. Motor vehicle accidents 1 1 2 _ 34. All other accidents 1 1 1 1 2 2 35. Suicide ., 1 1 1 2 1 36. Homicide and operations of war - - ALL CAUSES . . TOTAL . . 5 3 1 _ — — — 5 — 1 — 6 3 12 7 33 17 38 33 43 54 143 118 12 Analysis of the Causes of Death of Infants at Various Ages under One Year Causes of Death DAYS MONTHS Total Under One Year as Certi fied 0 1 2 3 4 5 6 7 14 21 28 2 3 4 5 6 7 8 9 10 11 Prematurity 3 1 4 Asphyxia 1 1 Cerebral Haemorrhage 2 2 Haemolytic Disease of Newborn 1 1 Broncho-Pneumonia 1 1 Totals 6 1 1 1 9 Disinfection Service The joint scheme 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 has been discontinued on account of the need to replace the vertical boiler at Bexley, and the fact that the Bexley Council had plans for the demolition of the Cleansing Station. A joint application by Crayford, Bexley and Erith Councils was successfully made to the Woolwich Borough Council for the use of their disinfe3tion facilities until further notice. Mortuary The Mortuary at Bexley is jointly used by the Boroughs of Bexley and Erith and the Urban District of Crayford. During 1963, 236 bodies were admitted to the Mortuary, post mortems being conducted in 234 cases, and inquests in 24 cases. Crayford' s figures were 33 bodies, 33 post mortems and 4 inquests. 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 8 cases were notified. The number of cases notified in 1962 was 22. Diphtheria. No case was notified in 1963. Paratyphoid or Typhoid Fever, No case was notified during the year. Puerperal Pyrexia. 14 cases were notified during the year. Meningococcal infections. No case was notified during the year. Food Poisoning. 2 cases were notified during the year. Measles. The number of cases notified in 1963 was 555. The number of cases notified in 1962 was 18. 13 Whooping Cough. 8 cases were notified during the year. The number of cases notified in 1962 was 1. Acute Poliomyelitis. No case was notified in 1963. Ophthalmia Neonatorum. Two cases were notified during the year. Dysentery. No cases were notified during the year. Notifiable Diseases (other than Tuberculosis) during the year Diseases Total Cases notified Cases admitted to hospital Deaths Smallpox — — — Scarlet Fever 8 — — Diphtheria — — — Enteric or Typhoid Fever — — — Paratyphoid Fever — — -— Puerperal Pyrexia 14 — — Pneumonia 1 1 — Erysipelas — — — Meningococcal Infection — — — Measles 555 — — Whooping Cough 8 — — Ophthalmia Neonatorum .. 2 — — Dysentery — — — Poliomyelitis (Paralytic) — — — Poliomyelitis (Non—Paralytic) — — — Encephalitis 1 — — Food Poisoning 2 — — Totals 591 1 — 14 15 Age Groups Scarlet Fever Diphtheri a Whooping Cough Measles (excluding rubel1a) Acute Poliomyelitis Paralytic Non-Paralytic M F M F M F M F M F M F Under 1 Year — — — — — 1 8 10 — — — — 1 — — — — 2 _ 21 41 — — — — 2 — 1 — — — 2 36 31 — — — — 3 — 1 — — — — 34 33 — — — — 4 1 — — _ — _ 32 42 — — — _ 5—9 2 3 — — 2 1 139 125 — — — — 10 — 14 — — — — — 1 — — — — — — 15 — 24 — — — — — — — — — — — — 25 and over — — — — — — 2 1 — — — — Total (all ages) 3 5 — — 4 4 272 283 _ — — — Enteric or Typhoid Fevers Paratyphoid Fever Acute Pneumonia Dysentery Meningococcal Infection Acute Encephalitis Lethargica M F M F M F M F M F M F Under 5 Years 5 — — — — — — — — — — 1 — 15 — — — — — 1 — — — — — — 45 — — — — — — — — — — — — 65 and over — — — — — — — — — — — — Total (all ages) — — — — — 1 — — — — 1 — 16 Age Groups (contd.)  Erysipelas Smal1pox Food Poisoning M F M F M F Under 5 Years – – – – – 1 5–14 – – – – – – 15 – 44 – – – – – 1 45 – 64 – – – – – – 65 and over – – – – – – Total (all ages) – – – – – 2 M F Puerperal Pyrexia – 14 Ophthalmia Neonatorum – 2 Immunisation Crayford Urban District The following table shows the diphtheria immunisation and whooping cough immunisation figures for 1963 based on the returns submitted to the Ministry of Health. Year of Birth Diphtheria Immunisation (Singly or in combination) Whooping Cough Immunisation (Singly or in combination) Primary Reinforcing Primary 1963 221 Nil 221 1962 212 3 208 1961 13 245 13 1960 4 97 4 1959 7 45 3 1954-1958 29 247 22 1949-1954 3 6 Nil Total 489 643 471 Poliomyelitis Vaccination The following are the poliomyelitis vaccination figures for 1963 based on the return submitted to the Ministry of Health. Year 2 Injections (SALK) 3rd Dose (SALK & ORAL) 4th Dose (SALK & ORAL) 3 Oral s (Complete Course) – 391 1963 – 2 – 73 1962 – 4 – 365 1961 – 18 – 53 1957–1960 – 3 – 34 1943–1956 – 3 – 13 1933–1942 – 1 – 19 Others – 6 – 17 17 Smallpox Vaccination Crayford Urban District In view of the amendment to the County Council's proposals approved as from the 1st January, 1963, the following is the only information now available. Primary Vaccination 1 Year Re-Vaccination School Age but under 8 Years 101 5 Tuberculosis Age Periods New Cases Deaths Resp i ratory Non-Resp i ratory Resp i ratory Non-Resp i ratory M F M F M F M F Under 5 Years 1 – – – – – – – 5-14 1 – – – – – – – 15 - 24 1 2 1 – – – – – 25 - 44 4 3 – – – – – – 45 - 64 1 – – – 1 – – – 65 and over 1 – – – – – – – Total 9 5 1 – 1 – – – Chest Clinics. At West Hill Hospital, Dartford, and Erith Hospital, Park Crescent, 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 - 19 Applicants recommended for rehousing - 6 Number of families granted houses on account of tuberculosis - 1 Other reasons - 8 18 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 13, 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 result of the local Christmas Seals Sale, including the mail sale, as reported by the Organiser to the Annual General Meeting, amounted to £90 19s. l0d. 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 not necessary to arrange burial under this Section during the year. _LQ_ 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 1963, which gives a general summary of the work carried out by the Public Health Inspectors during the year. Inspection and Supervision of Food In this connection, no fewer than 134 visits were made, 67 being to premises registered under Section 16 of the Pood and Drugs Act. 50 informal notices were served under the Pood Hygiene Regulations and in 52 cases repairs or improvements were carried out. Time and effort figured largely in the field of Pood Hygiene and rigid attention by your Inspectors was focused in this direction. Co-operation continued between the various tradespeople and ourselves and a genuine attempt was made to understand the difficulties of shop managements and the necessary standards and need for constant vigilance. The number of food premises in the area is as follows:- Bakers 4; Butchers 18; Grocers 56; Greengrocers 20; Confectioners 25; Fishmongers 8; Cafes, Canteens, etc. 37; Public Houses 19; Off Licences 3; Clubs 12; Other Premises 30. Under Section 16 of the Pood and Drugs Act, 1955, 71 premises are registered for the storage and sale of Ice Cream and 35 for the manufacture or preparation of preserved food intended for sale. Complaints The following complaints were received and dealt with during the year:- Cheese Finger. No further action was taken regarding a cheese finger alleged to contain foreign matter. This matter consisted of soiled, charred dough. The case was, however, taken up with the manufacturers and a representative of the firm concerned attended a meeting of the Health Committee and outlined his company's proposals for improvements in production methods. 20 Milk. The condition of bottles in which milk had been delivered and the question of a separate complaint regarding a chipped bottle were referred to the Local Authority in whose area the bottling plant was situated. Prom there the matter was taken up with the dairy concerned. Bread. Complaints regarding bread were received as follows:- Presence of paper in a loaf of bread-was investigated but due to unreliable witness no proceedings could be taken. String in a loaf resulted in legal proceedings being taken resulting in a fine of £50 with 5 guineas costs. No action was taken after investigation of a case of mould in bread. A small metal rod found in a loaf led to the bakery concerned being prosecuted but in this instance a conditional discharge was granted. Fibre in bread resulted in legal proceedings against the manufacturer with a fine of £30 with 4 guineas costs. Cardboard found in a loaf resulted in subsequent legal proceedings with a fine of £25 with 5 guineas costs. Two cases of flies being found in loaves of bread resulted in fines being imposed of £10 and £5 respectively with 3 guineas costs in each case. Steak and Kidney Pie and Corned Beef. Alleged mould in the former and dark staining in the latter were investigated but after detailed information as to the circumstances of the cases, warning letters were sent to the manufacturers concerned. Canned Tomatoes. The presence of a caterpillar in canned tomatoes was investigated but as the product was of Italian origin the matter was drawn to the attention of the Ministry of Agriculture, Fisheries and Food. Larva in Chocolate Crunch, Mould in Veal and Egg Pie, Larva in Can of Rhubarb, Beetle in Jam. These complaints resulted in legal proceedings with fines of £15 and 5 guineas costs in each case. Chocolate. Examination of one of two bars of chocolate alleged to have caused sickness was sent for examination but nothing abnormal was discovered in the sample. Sausage Roll. A piece of greaseproof paper contained in a sausage roll led to the manufacturers being fined £25 with 5 guineas costs. Frankfurter Roll. This contained yellowish streaks and the explanation given was that a small piece of dried fruit had adhered to the machinery from a previous batch. A warning letter was sent to the manufacturers. Maggot in Cereal. This matter was investigated but having regard to all the circumstances in this case no further action was taken. The matter was, however, taken up with the manufacturers. _21 Mineral Water. No further action was deemed necessary in the case of a bottle of mineral water, which, it was alleged, possessed a peculiar taste. The trouble arose from the cap of the bottle and on being referred to the manufacturers, it was ascertained that a different method of capping had been adopted and therefore no further complaints should arise. Meat and Other Foods. The following articles were found during the year to be unfit for human consumption:- lbs. ozs. lbs. ozs. Ox Livers 9 8 Tinned Pork 67 4 Ox Cheeks 113 0 Tinned Green Beans 1 4 Beef 24 0 Tinned Orange Juice 1 3 Pork 12 4 Tinned Ravioli 1 7½ Pressed Pork 6 0 Tinned Celery 1 4 Pigs Spleens 56 0 Tinned Rice 6 14 Pigs Melts 28 0 Tinned Tapioca 1 0 Pigs Livers 20 0 Tinned Fish 2 6½ Lamb 47 15 Tinned Tomatoes 12 15 Goose 12 0 Tinned Milk 10 Corned Beef 100 15 Jam 1 0 Custard Powder 9 5½ Pie Filling 2 0 Rice 4 0 Marmalade 3 0 Guavas 1 0 Cereals 2 0 Mincemeat 4 10½ Cake Mix 10 Cooked Pore End 13 9 Glace Fruits 3 4 Currants 3 0 Potatoes 224 0 Raisins 3 0 Ground Almonds 12 Chicken Curry 7½ Cream 3 2 Tinned Baked Beans 4 1 Hamburgers 1 14 Tinned creamed Sago 15½ Lentils 10 0 Tinned Fruit 271 8 Suet 8 Tinned Cherries 26 1 Pickled Onions 10 Tinned Steak 4 7 Bolognese 2 5½ Tinned Vegetables 80 13¼ Butter Beans 12 0 Tinned Luncheon Meat 41 14 Lemon Drink 12 Tinned Minced Beef Loaf. 7 Cream Crackers 15 Tinned Soup 4 8 Orange 15 Tinned Ham 64 4 Ginger Sponge 7 Tinned Beetroot 10 1 Sweet Biscuits 8 Tinned Jellied Veal 12 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. 99 Slaughterhouses There is no slaughterhouse in the area. Milk and Dairies (General Regulations)1959 Number of persons registered as distributors during the year 2 ICE CREAM (HEAT TREATMENT) REGULATIONS, 1959-1963 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 17 Grade II 20 Grade III - Grade IV - 23 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, 1963. Article No. Article No. B/Fwd. 37 Aspirin 1 Linctus Codeine B.P.C. 1 Beer 2 Linctus with Chlorodyne B.P.C. 1 Blackcurrant Drink 1 Marzipan 1 Bloater Paste 1 Milk 24 Bread 1 Milk Chocolate 1 Butter Brazils 1 Milk Chocolate Eclairs 1 Butter 2 Milk, Evaporated 1 Cake Fruit Mix 1 Minced Beef 3 Cheese 2 Minced Beef with Onions and Gravy (Canned) 1 Chow Mein 1 Citrus Fruits 2 Mixed Vegetables (Canned) 1 Cochineal 1 Oxtail Soup 1 Cocoa 1 Pepper Sauce 1 Compound Cooking Fat 1 Pineapple Jam 2 Custard Powder 1 Quickset 1 Double Cream 1 Red Meat (Beef) 2 Eye Lotion 1 Salad Frying and Baking Oil 1 Fruit Jellies 1 Salmon Spread with Butter 1 Gin 2 Sausages, Pork 3 Ginger Beer 1 Sausage Rolls 1 Grapefruit (Canned) 1 Semolina 1 Ground Almonds 1 Self Raising Flour 1 Ham 1 Steak and Kidney Pie 1 Horseradish Sauce 1 Sultanas 1 Hydrogen Peroxide 1 Tea 1 Ice Cream 1 Throat Lozenges 2 Ice Lolly 1 Throat Pastilles 3 Instant Coffee 1 Tizer the Appetizer 1 Jam Sandwich 1 Tuna in Oil 1 Jelly Cream 1 Vintage Apple Wine 1 Jolyroll 1 Whisky 2 Junior K.L.N. Suspension 1 10 Hour Flu and Cold Pastilles 1 C/Fwd. 37 Total 101 Summary Milks 24 Drugs 12 Spirits 4 Other Samples 61 101 All the foregoing samples were satisfactory with the exception of the following:- Sample of: Analysis Action taken Pork Sausages with preservatives Fat 21%, Lean 41%, Total meat 62%. Sulphite 128 p.p.m. Recognised minimum meat content 65%. Makers notified. Quickset Fat 37%, Protein 10.9%, Lactose 11.5%, Sugar 33.3%. The article is a cocoa product but as it is not confectionery and is prepacked the ingredients should be declared. Packers agreed to amend labelling. Cake Fruit Mix Sultanas and raisins comprised 62.5%, currants 29.9%, mixed peel 7.6%, cherries nil. Cherries which were declared were absent, while mixed peel, which was not declared was present. Currants which should be the major ingredient were less than the sultanas and raisins. Written Caution issued. CLEAN AIR ACT, 1956 Progress on the establishment of Smoke Control Areas throughout the Urban District has been maintained. No. 1 Area having come into operation on 1st April, 1962, paved the way for the commencement of No. 2 Area and a considerable amount of time and effort was devoted by your Inspectors in order that this could come about. This second area containing over 3,600 properties spread over approximately 463 acres, naturally proved a greater problem than in No. 1 Area but nevertheless progress was so satisfactory that some thought was given to the conversion of the rest of the district, designated Area 3, into a further smoke control area. Indeed at the time of writing plans are well in hand to this end. Team work in a venture of this nature is essential and I have been most fortunate in receiving all possible assistance from other departments of the Council. HOUSING STATISTICS (1) Inspection of Dwel1inghouses (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 804 Number of inspections made for that purpose 1, 598 25 (2) Number of dwellinghouses (included under sub-heading (1) above) which were inspected and recorded under the Housing Consolidated 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 14 (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 277 (2) Remedy of defects during the year without service of formal notice Number of defective dwellinghouses rendered fit in consequence of informal action by Local Authority or their Officers. 48 (3) Action under statutory powers during the year Statutory notices under Housing or Public Health Acts – Number of houses in which defects were remedied after serving of formal notices - (a) by owners – (b) by local authority in default of owners – Proceedings under Housing Act, 1957 - (a) Demolition orders made under Section 17 14 (b) Houses demolished - (i) as a result of formal or informal procedure under Section 17(1) 1 (ii) temporary bungalows (prefabs.) 9 (c) Unfit houses closed under Sections 16(4) and 35(1) 4 (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 3,267 Number of houses built during the year - (a) by the local authority 76 (b) by other bodies or persons 370 26 Rent Act, 1957 During the year, one application was received for a certificate of disrepair. No certificates of disrepair were issued, but three 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. Water Sampl ing The following samples were sent to the County Laboratory by the Council's Public Health Inspector - (a) Wells (drinking water), Bacteriological - 8 (b) Swimming Pool, Bacteriological - 8 (c) Domestic Supplies, Bacteriological - 8 All samples forwarded have been reported satisfactory. Water Supply Normal mains extension to serve new development was carried out. 914 yards of small service mains were laid in the area during the year. Drainage and Sewerage Normal sewerage extension to serve new housing development. Housing PIans Housing Scheme No. 39 - 36 houses to be constructed. The Nursery - 4 shops and 4 maisonettes Details in course of preparation. Hurstwood Avenue - 16 dwellings Lincoln Road - Development under consideration. Maxim Road 27 Report of Kent River Board River Cray. Usual programme of brushing and clearing was carried out. A total of approximately 45 tons of rubbish, mostly timber, bricks and scrap, etc., has also been removed. The diversion of a section of the river at Central and Provincial Properties' site has been completed. This consisted of cutting a new channel to the north of the Factory buildings; diversion of a sewer and the construction of a concrete spillway. The Cray was diverted into this new channel on 1st April, 1963. River Stanham, Middle River and River Wansunt. Normal brushing and weed clearance has been carried out on all these rivers. Crayford Marshes. The usual clearance of weeds, rubbish, etc., has been carried out on the Main Marsh Dykes and the Commissioners of Sewers dykes maintained by the Board. Sea Wal 1 s. 210 square yards of damaged ragstone revetment has been made good and various odd holes repaired on the river and creek walls. The usual programme of mowing was carried out on the sea walls. Closet Accommodation Approximate number of premises containing each type of sanitary convenience in the district - W.C.'s into drainage system, approximately 13,242 W.C.'s into cesspools 16 Number of premises not connected to public water supplies .. Nil 28 Refuse Collection, A seven day collection of refuse was maintained under the same system as previously. Refuse is now being tipped in the area of land southeast of Bridge Road. Nuisances and Defects remedied during the year:- Sanitary accommodation defective 22 Drainage: (i) repaired 17 (ii) unstopped, etc. 106 Refuse receptacles 9 Roofs and rainwater pipes 64 Chimney stacks and pots repaired or renewed 8 Fireplaces, grates and stoves repaired or improved 3 Floors, walls and ceilings repaired or renewed 108 Rooms cleansed 2 Water supplies 30 Doors and other woodwork 33 Refuse and offensive accumulations removed 29 Improper keeping of animals 1 Other defects 183 Control of Rodents and other Pests 173 complaints in respect of rats and mice infestations were received and fully investigated. During the months of April and October the foul water sewers were treated with Warfarin for the destruction of rats and where a manhole was found to be infested, treatment was continued until their extinction. I enjoyed the cooperation and assistance of the Engineer and Surveyor who, once again, placed additional labour, lifting mechanisms plus motor transport readily available. Sewer infestations were again remarkably low, despite development of land and the consequent increase in new lengths of sewers. 29 Other pest infestations dealt with were as follows:Woodworm 5; Bugs 2; Wasps nests 16; Miscellaneous 5. Eradication of the Bed Bug. Particulars of the action taken in 1963 for the eradication of the Bed Bug were as follows:- Infested Disinfested Number of - Council houses 2 2 Other houses – – Total number of visits of all kinds paid by Inspectors during the year 5,324 Approximate number of rated premises in the area 12,095 Notices served - Statutory Informal 353 Number of houses, etc., disinfected 3 Swimming Pool. Period open from 11th May to 15th September. Number of bathers - 34,019. This figure does not include school parties and clubs. Improvement to the swimming pool recently has been the extension of the kitchen and cafe. Shops Act. A total number of 76 visits were made during the year. This figure includes Sunday and evening visits. Requests for information continue to come in relation to Sunday Trading and Closing Hours and more detailed information was requested from the smaller shopkeepers relating to the selling of a variety of goods from one establishment. No serious breach of the Act was noted. 30 Prescribed Particulars on the Administration of the Factories Act, 1961 1. Inspections for purposes of provisions as to Health (including inspections made by Public Health Inspectors). Premi ses Number on Regi ster Number of Inspections Wri tten Notices Occup i ers Prosecuted (1) (2) (3) (D (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 14 14 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 82 47 1 — (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding outworkers premises) 18 18 — — Total 114 79 1 — 31 2. Cases in which defects were found. Parti culars Number of Cases in which defects were found Number of Cases in which prosecutions were inst i tuted. Found Rernedi ed Referred to H.M. Inspector Referred by ji. M. Inspector (1) (2) (3) CO (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 1 1 — — — (c) Not separate for sexes — — — — — Other offences (not including offences relating to outwork) — — — — — Total 1 1 — — — 32 OUTWORK Part VIIIof the Act Nature of Work Section 133 Section 134 No. of out-workers in August list required by Section 133(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. 7 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 — — — — — I am, Your obedient Servant, A. W. KENT Chief Public Health Inspector 33