ERI 31 LIBRARY BOROUGH OF ERITH ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1951 BY JOHN LANDON M.R.C.S.. L.R.C.P.. D.P.H. BOROUGH OF ERITH . With the compliments of the Medical Officer of Health. Health Department, Town Hall, Erith, Kent. BOROUGH OF ERITH ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1951 BY JOHN LANDON M.R.G.S., L.R.C.P., D.P.H. Printed by Freame, Manning & Co., Ltd. Lewi sham, S.EA3 Arrangement of Report Section Page A Statistics and Social Conditions of the Area 1. Physical Situation and Amenities 10 2. Comparative Rainfall 10 3. Unemployment Figures and Comments 11 4. Statistics 11 (a) General 11 (b) Births, Birth Rate, Still Births, Still Birth Rates 12 (c) Deaths, Death Rate, Maternal Mortality Rate 12 (d) Infant Mortality 13 (e) Summary of Vital Statistics for year 1951 14 (f) Vital Statistics of whole District during 1951 and previous years 15 (g) Table Showing Summary of Causes of Death during 1951 16 (h) Comparison of Maternal Mortality Rate 17 (i) Infant Mortality—Causes of death and table of comparison 17 B Prevalence of and Control over Infectious and other Diseases 1. Notifications 19 (a) Age Distribution 25 (b) Ward Distribution 26 2. Tuberculosis 27 (a) New cases notified during 1951 27 (b) Deaths 27 (c) Quarterly statements for year 1951 28 3. Diphtheria Immunisation 29 4. Scabies 30 5. Smallpox 30 (a) Vaccination 31 6. Public Health (Leprosy) Regulations, 1951 31 7. Research on Poliomyelitis 31 C General Provision of Health Services for the Area 1. General Hospital Facilities 32 2. Infectious Disease Hospitals 32 3. Tuberculosis Treatment and Hospital Accommodation 32 4. Venereal Diseases 32 5. Ambulance Service 32 i Section Page 6. School Clinics 32 7. Maternity and Child Welfare Centres 33 8. Maternity Home 33 9. Private Nursing Homes 33 10. Day Nursery 33 11. Laboratory Facilities 33 12. Mortuary 34 13. Disinfection Services 34 14. Old People's Welfare 34 15. National Assistance Act, 1948, (Burials) Section 50 35 D Sanitary Circumstances of the Area 1. Refuse Collection and Disposal 36 (a) Costs 36 (b) Details of Refuse Collection Vehicles and Staff 36 (c) Details of Tonnage 37 2. Trade Refuse 37 3. Salvage 37 4. Public Conveniences 37 5. Sanitary Inspection of the Area 38 (a) Visits by Sanitary Inspectors 38 (b) Premises visited and results of such visits 38 (c) Summary of Nuisances and defects remedied during the year 38 (d) Closet accommodation and cesspools 39 (e) Smoke Abatement 39 (f) Swimming Baths and Pools 39 (g) Camping Sites 40 (h) Hop Pickers 40 (i) Rag Flock Act 40 (j) Eradication of Bed Bugs 40 (k) Mosquito Control 41 (1) Rodent Control 41 (m) Pest Control 41 (n) Offensive Trades 42 6. Factories 42 (i) Inspections 42 (ii) Defects Found 42 7. Shops Acts 1950 43 8. Sanitary Accommodation at Offices 43 9. Effluvia from River Thames 43 10. Atmospheric Pollution 45 ii Section Page 11. Housing 45 (a) Inspection of Dwelling Houses during the year 45 (b) Remedy of Defects during the year 45 (c) Housing Progress from 1st April 1945 to 31st March, 1951 46 12. Rent and Mortgage Interest (Restrictions) Act, 1939 47 13. Legal Proceedings 48 E Water Supply — Milk and Food and Drugs 1. Water Supply 48 2. (a) Dairies and Milk Stores 48 (b) Bacteriological examination of Milk 48 (c) Biological testing of Milk 48 (d) Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, etc. 50 (e) Designated Milk 50 (f) Ice Cream 51 3. Food and Drugs Act, 1938, Sections 3 and 68, Routine Sampling 52 4. Meat and Food Inspection 53 5. Slaughter of Animals Act, 1933 53 6. Food Hygiene—Food Traders' Guild 54 7. Health Education 54 F General 1. Members of Committee 2 2. Staff of Public Health Department 3 3. Introductory remarks of Medical Officer of Health 4 4. National Assistance Act, 1948, Sec. 47 54 5. Legislation in force 55 iii 2 F (1) BOROUGH OF ERITH Mayor :—Councillor E. J. Clarke, J.P., (1950-1951) Mayor :—Alderman C. F. Morling, J.P., (1951-1952) Deputy Mayor:—Councillor J. N.Powrie, J.P.,C.C. (1950-1951) Deputy Mayor :—Alderman Mrs. L. F. Christian (1951-1952) Health Committee Chairman :—Alderman Mrs. L. F. Christian, J.P. (Ex-officio) Members of Committee May 1950—May 1951 May 1951—May 1952 Alderman C. F. Morling Councillors W. F. Alford W. F. Alford F. W. E. Gilder A. H. Cross E. Handy J. F. L. Gates Mrs. H. A. Jerome Mrs. H. A. Jerome E. Taylor Miss M. E. Odell T. G. Tuffee C. Schofield E. Taylor T. G. Tuffee Ex-Officio Members Ex-Officio Members Aldermen G. W. H. Luck C. F. Morling, J.P. G. W. H. Luck Councillors E. J. N. Clarke, J.P. J. N. Powrie, J.P., C.C. 3 F (2) PUBLIC HEALTH DEPARTMENT STAFF Medical Officer of Health John Landon, M.R.C.S., L.R.C.P., D.P.H. (Acts also as Medical Officer of Health for the Borough of Bexley and the Urban District of Crayford). Senior Sanitary Inspector L. E. King, M.R.San.I., Cert.S.I.E.B., D.S.A.A. Meat Inspectors Certificate. Sanitary Inspectors J. Hacker, M.R.San.I., Cert.S.I.E.B., Meat Inspectors Certificate. N. E. Broom. Cert.S.I.E.B. P. R. Hickson, Cert.S.I.E.B. Chief Clerk J. M. Roberts (Resigned 31.8.51) J. A. Sutherland (Appointed 8.10.51) Clerks Shorthand-typist :— Mrs. G. Green (Appointed 26.2.51) General Clerk :— E. A. Howard (Resigned 28.4.51) Junior Clerk :— J. W. Tiptaft 4 To the Mayor, Aldermen and Councillors of the Borough of Erith Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1951. The vital statistics of the Borough are, broadly, satisfactory and present a number of interesting features. The birth rate during 1951 was 15.00 per thousand of the home population compared with 14.96 per thousand in 1950, 17.00 in 1949, 18.96 in 1948, 22.6 in 1947, 22.30 in 1946, 19.13 in 1945 and 24.3 in 1944. It will be seen that the increase in the birth rate towards the end of the war has not been maintained and the birth rate in fact shows a continued rate of decline which, in general, follows the trend in the birth rate for the country as a whole, although the birth rate for Erith is not appreciably lower than the national rate (15.5). There is a number of possible explanations. Firstly, the housing position is a major deterrent to young married people to start a family. Added to this there is the high cost of living, including the high cost of setting up a home. The birth rate for the Borough corrected by the use of the Registrar General's comparability factor (0.95) was 14.25. Bearing in mind the low death rate which we enjoy nowadays and the fact that the level of the population is being maintained only by the fertility of the past, two things are obvious ; firstly that the number of old people must increase and secondly (since we are all mortal) the death rate must be expected to rise and the population stabilised at a lower level based on present day fertility factors. The death rate for the Borough, during 1951 was 11.6 compared with 10.2 for 1950, or, after correction by means of the comparability factor for deaths (1.07), 12.4 compared with a corrected death rate of 11.0 for 1950. The death rate for the country as a whole was 12.5. The infant mortality rate for 1951, at 34.8 per thousand live births, was considerably higher than the record low rate for 1950, namely, 20.0. The number of babies who died in the first year of life per thousand live births during 1951 was 24 compared with 14 in 1950. The percentage of children dying during the first month of life (neo-natal deaths) was 5 considerably greater than in 1950 and as these causes relate in the main to prematurity and congenital defects, they are, to a great extent outside public health control for the time being. The number of deaths from preventable conditions such as broncho pneumonia and other lung infections was roughly the same as in 1950, so that there does not appear to have been any obvious worsening of the position in regard to environmental conditions or maternal care. It is necessary to point out that the trend of infant mortality in a district such as this, based as it is on a relatively small number of deaths, must not be judged by small annual fluctuations which may be due to fortuitous circumstances, but over a period of years and by this criterion our figures are satisfactory. There was 1 maternal death resulting from childbirth. There were 690 live births during the year, in addition to 15 still births. The incidence of infectious disease within the Borough continued to be very low. No case of poliomyelitis was confirmed in the Borough during 1951 and no case of diphtheria was notified for the second year in succession. Although this is eminently satisfactory, there is an implied danger in the freedom from this disease in that the young mothers of today have never seen a child with diphtheria or heard of a child recently dying from this cause. There is a noticeable tendency for diphtheria immunisation to be neglected in many cases. It cannot be too strongly stressed, however, that our present freedom from this disease is dependent on a continued high level of immunisation of young children as a group and parents should realise that they have both a public and private duty to perform in this matter. Although there were 1,007 cases of measles there was only one death from this cause. 173 cases of whooping cough were notified, there was 1 death. These two diseases, with the exception of tuberculosis, are the two most important infectious diseases experienced at the present time, leaving out for the moment the unpredictable incidence of poliomyelitis. Constant vigilance has to be exercised in regard to the prevention of smallpox. As a result of the Brighton epidemic in 1950/51, 22 contacts were traced to this area and vaccination was carried out by the Health Department in most cases and intensive supervision exercised during the danger period. On two other occasions ships arrived in nearby ports carrying a case of smallpox and contacts were traced to this area. 6 Vaccination was carried out wherever necessary and the appropriate surveillance exercised. During 1951, 37 cases of paratyphoid fever occurred in an area covering adjacent London boroughs and districts in Kent and Sussex. The cause of the outbreak was judged to be synthetic cream supplied from a food establishment in the Borough. Some of the cases occurred in the Borough of Erith, an extensive investigation developed and it is likely that the control measures which were instituted prevented a more widespread epidemic. Reference is made to the full report on this outbreak in the body of the report. In addition to these cases, 3 cases of food poisoning were notified during the year. Generally speaking the infectious diseases which took such a heavy toll of life and health in the past have diminished in importance but continued vigilance is needed as some change in the natural history of the organisms or some lowering of individual resistance in peace or in war may precipitate a return to former conditions. Tuberculosis remains the most important of the infectious diseases which are encountered. It is a tragedy that this disease which is preventable is not being prevented. It presents a medico-social problem of great complexity, a description of which is outside the scope of this foreword. I would emphasise one aspect, however, which demands immediate attention, namely, the discharge from sanatorium to their own homes of open, i.e., infectious, cases when their continued stay in hospital can no longer be of benefit to them. These frequently chronic cases are responsible for a good deal of mischief and our powers under the Public Health Act, 1936, to control this source of infection are inadequate in that such patients may onlybe compulsorily removed to hospital provided suitable accommodation is available for them. The report of the Central Health Services Council for the year ended December 31st, 1950, recognises that "this is a potent source of infection" and recommends "that for chronic infectious patients who are ambulant it is desirable to provide hostels affording domiciliary care and medical supervision." In my view an anomalous position has arisen in regard to the domiciliary tuberculous patient. The presence of a tuberculous person in a household is often regarded by the 7 Housing Committee, and rightly so, as grounds for the rehousing of the patient or of a second family, especially if it includes young children, who are occupying the same premises. It would, perhaps, be more efficacious to remove the source of infection to suitable hospital or other accommodation. The care of old people living alone is becoming more and more the responsibility of the Health Department. Under Section 47 of the National Assistance Act, 1948, as amended by the National Assistance (Amendment) Act, 1951 it is the responsibility of the local authority to take appropriate action in the case of persons "who are suffering from grave chronic disease or being aged and infirm or physically handicapped are living in insanitary conditions and are unable to devote to themselves, and are not receiving from other persons, proper care and attention." The effects of the ageing of the population are now being felt in the increase of such cases. Old people are often discovered to be living in conditions grotesque from the point of view of loneliness and the absence of even the lowest standards of comfort, care and cleanliness. These old people are nearly always infirm to a greater or lesser extent and I would like to express my appreciation of the help which is so readily forthcoming from the officers of the Woolwich Group Hospital Management Committee who do their best under difficult circumstances to find accommodation for these urgent cases. The affiliation of the local Elderly People's Welfare Committee to the North West Kent Old People's Welfare Committee operating under the North West Kent Council of Social Service, has now taken place, and the experiment is being tried of appointing district liaison officers somewhat on the lines of the Tuberculosis Care and After-Care Committee. The work of the new Committee will be, firstly, to ascertain on a Ward basis the old people needing additional care, to coordinate the work of all agencies providing for the care of old people and to afford to the latter a wide range of good neighbourly services. One of the added functions will be the raising of funds from various charitable sources and the assistance of old people, in suitable cases, by small monetary grants or their equivalent in food and other requirements needed for their comfort. Although the State is now responsible for a wide range of statutory services for old people, it is considered essential that each local community should interest itself in the deprived old people who are living in their midst. 8 The joint Clean Food Campaign with Bexley and Crayford goes forward slowly but steadily and good progress has been made in what is essentially a long term health education project. In April, 1951 a clean food exhibition was held and was reasonably well supported by the general public. Organised parties of school children from the three areas visited the exhibition and lectures and film shows were given. Codes of Practice have now been formulated for all the main food trades and applications for membership have been received from 98 food traders of which 19 have been approved to date. There is still a great deal of work to be done in this sphere during the next few years to bring into membership the majority of the food traders in the area. An attractive plaque has now been prepared which, we hope, will become more and more familiar to the public as it appears in increasing numbers in the windows and on the premises of the food establishments of the Borough. Effluvia from the river Thames continued to be a cause of discomfort and exasperation to the people of the Borough during the year. The remedy, however, does not lie with the Borough Council, who have given this matter considerable attention, but with the London County Council, whose £10,000,000 scheme to improve the sewage effluents from their Barking and Crossness outfalls has been approved by the Ministry of Health and is now in the early stages of implementation. There appears to be no method of bringing this nuisance to an early end and the remedy is, unfortunately, a long term one. The prevention of accidents in the home is being recognised more and more as coming within the realm of preventive medicine and therefore a legitimate field of endeavour for the public health authorities. This matter can best be dealt with by a partnership of local health authority, local authority and the local Road Safety Committees, whose functions could be enlarged to cover by means of a sub-committee this important part of the work of accident prevention in general. Preliminary steps to achieve this end have been taken locally and it is hoped that further developments will take place during 1952. During 1951 the Bexley public mortuary was enlarged and equipped with refrigeration for six bodies. It will be used by Erith by arrangement with the Bexley Borough Council. I wish to thank the members of the Health Committee for 9 their support and encouragement and the Senior Sanitary Inspector, the Chief Clerk and all members of the Health Department for their devotion to duty at all times during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. 10 Annual Report 1951 SECTION A :-STATISTICS AND SOCIAL CONDITIONS OF THE AREA A (1) Physical Situation and Amenities Erith is situated in the north west corner of Kent, and bounded on the North-East by the River Thames, to which it has a frontage of about 4 miles; on the West by the Metropolitan Borough of Woolwich and the Borough of Bexley, and on the South by the Borough of Bexley and the Urban District of Crayford. The residential parts of the Borough consist of areas in Abbey Wood, Belvedere, Northumberland Heath and the southern portion of the Town, all of which are well wooded and excellently situated. The main arterial road connects the Town with London, 10 miles distant, good rail transport facilities being provided by British Railways. The chief industries are light and heavy engineering; edible oil refining; chemical works; coal shipping and lighterage, and production of building materials, i.e., stoneware, plaster boards, asbestos, etc. A (2) Comparative Rainfall 1950 Inches 1951 Inches January 1.00 2.03 February 3.43 5.92 March 0.69 2.49 April 2.16 2.68 May 1.40 2.27 June 1.43 1.27 July 3.23 2.51 August 1.29 2.64 September 2.50 2.25 October 0.30 0.80 November 4.80 3.66 December 1.52 2.01 Total 23.75 Total 30.53 11 A (3) Unemployment Figures and Comments With the co-operation of the Manager of Erith Employment Exchange, to whom I am indebted for the necessary information, it is once again possible to give definite figures with regard to the state of unemployment in the district, as shown in the following table. Erith and District Unemployment Figures 1939—1951 Month and year Males Females Total 18 and over Under 18 18 and over Under 18 December, 1939 373 31 299 48 751 December, 1940 75 3 255 37 370 December, 1941 39 17 44 17 117 December, 1942 38 1 39 5 83 December, 1943 27 1 6 5 39 December, 1944 31 — 6 3 40 December, 1945 91 1 133 1 226 December, 1946 177 12 58 13 260 December, 1947 131 4 94 5 234 December, 1948 208 7 129 2 346 December, 1949 111 8 153 3 275 December, 1950 114 3 122 1 240 December, 1951 82 1 103 3 189 Unemployment in Erith for the first six months of 1951 continued to decrease. Towards the Autumn the register rose slightly and gradually until the end of the year, The total number of unemployed in December, 1951, however, still did not reach the corresponding figure for December, 1950, and a satisfactory position was maintained. A (4) STATISTICS A (4)a General Area (i) Including River :—4,607 acres. Area (ii) Excluding River :—3,859 acres Population figure supplied by Registrar General :— Estimated mid-year Home Population—46,010 Density of population i.e. No. of persons per acre (Based on (ii) above) :—11.9 No. of inhabited houses at 31st December, 1951 :— (Excluding houses with shops and houses with Public Houses assessed as single heraditaments) 12,385 Rateable value at 31st December, 1951 :—£351,727 Sum produced by a penny rate, 1951 :— (Estimated product for 1951/52) £1,420. 12 EXTRACTS FROM VITAL STATISTICS FOR YEAR 1951. A(4)b Births Male Female Total Live Births Legitimate 359 305 664 Illegitimate 13 13 26 372 318 690 Live Birth rate per 1,000 Home Population (Registrar General's Figure) :—15.00 Birth rate corrected for comparison with other areas :— 14.25 Comparability factor supplied by Registrar General :— 0.95. Live birth rate, England and Wales :—15.5 Corresponding rate for the Borough of Erith for year 1950 :—14.96 Male Female Total Still Births Legitimate 9 6 15 Illegitimate — — — 9 6 15 Still Birth rate per 1,000 total births :—21.28 Still Birth rate per 1,000 Home population :—0.33 Still Birth rate per 1,000 Home population, England and Wales 0.36 A (4)c Deaths Male :—301 Female :—232 Total :—533 Death rate per 1,000 Home population :—11.6 Death rate corrected for comparison with other areas :— 12.4. (Comparability Factor supplied by Registrar General) :— 1.07. Corresponding rate for 1950 :—10.2. Death rate per 1,000 Home population, England and Wales (1951) 12.5 Number of women dying in, or in consequence of, childbirth :—1. Maternal Mortality Rate per 1,000 total births :—1.42. Comparative figure for England and Wales :—0.79 13 A (4)d Infant Mortality Deaths of infants under 1 year of age :— Male Female Total Legitimate 16 8 24 Illegitimate — — — 16 8 24 Death rate of infants under 1 year of age per 1,000 live births :—34.8 Death rate of infants under 1 year of age per 1,000 live births, England and Wales :—29.6 Deaths of infants under 4 weeks of age :— Male Female Total Legitimate 11 6 17 Illegitimate — — — 11 6 17 Death rate of infants under 4 weeks of age per 1,000 live births :—24.64 Total number of deaths from :— 1950 1951 Measles (All ages) 1 1 Whooping Cough — 1 14 A (4)e Summary of Vital Statistics for the Year 1951 England and Wales 126 County Boro's & Great towns including London 148 smaller towns (Resident population 25,000. 50,000 at 1931 census) London Administrative County Borough of Erith Births :— Rates per 1,000 Home Population Live births 15.5 17.3 16.7 17.8 14.25 Still births 0.36 0.45 0.38 0.37 0.33 Deaths :— All causes 12.5 13.4 12.5 13.1 12.4 Typhoid and Para.Typhoid 0.00 0.00 0.00 0.00 0 00 Whooping Cough 0.01 0.01 0.01 0.01 0.02 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.31 0.37 0.31 0.38 0.30 Influenza 0.38 0.36 0.38 0.23 0.41 Smallpox 0.00 0.00 0.00 0 00 0.00 Acute Poliomyelitis (including Polioencephalitis) 0 00 0.01 0.01 0 00 0 00 Pneumonia 0.61 0.65 0.63 0.61 0.74 Deaths :— Rates per 1,000 Live Births All causes under 1 year of age 29 .6(a) 33.9 27 .6 26 .4 34.8 Notifications :— 1 Rates per 1,000 Home Population. (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Para-Typhoid Fever 0.02 0.03 0.02 0.01 0.07 Meningococcal Infection 0.03 0.04 0.03 0.03 0.04 Scarlet Fever 1.11 1.20 1.20 1.10 0.98 Whooping Cough 3.87 3.62 4.00 3.11 3.76 Diphtheria 0.02 0.02 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.15 0.11 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 14.07 13.93 14.82 14.64 21.89 Pneumonia 0.99 1.04 0.96 0.72 0.87 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.00 Non.Paralytic 0 02 0.02 0.03 0.02 0.00 Food Poisoning 0.13 0 15 0.08 0.23 0.07 Notifications:— (corrected) Rates per 1,000 Total (Live & Still) Births. Puerperal Fever and Pyrexia 10.66 13.77 8.08 14.90 1.42 (a) Per 1,000 Related Live Births. 15 Year Population Figure according to Registrar General No. of Live Births according to Registrar General Live Birth Rate per 1,000 population No. of Deaths according to Registrar General Death rate per 1,000 Population No. of Deaths of infants under 1 year of age Infant Mortality Rate per 1,000 live births A (4)f Vital Statistics of Whole District daring 1951 and previous years 1938 39,800 634 15.87 390 9.8 34 53.62 1939 41,870 721 17.22 452 10.98 31 44.28 1940 40,210 721 17.8 486 12.08 24 37.17 1941 36,520 606 16.8 473 17.00 23 37.95 1942 37,340 734 19.6 415 11.1 26 45.4 1943 37,890 822 21.6 439 11.58 35 42.57 1944 36,780 895 24.3 463 12.5 44 49.16 1945 38,270 732 19.13 451 11.78 29 39.61 1946 42,900 958 22.3 446 10.4 31 32.3 1947 44,350 1,006 22.6 493 11.1 34 33.7 1948 46,250 877 18.96 458 9.9 20 22.8 1949 46,730 (Civilian) 46,770 (Total) 795 17.00* 465 9.95* (Corrected) 10.75 19 23.9 1950 46,850 (Home Population) 701 14.96 (Corrected) 14.21 478 10.2 (Corrected) 11.0 14 20.0 1951 46,010 (Home Population) 690 15.00 (Corrected) 14.25 533 11.6 (Corrected) 12.4 24 34.8 *Per 1,000 Home Population. 16 A (4)g Table showing Summary of Causes of Death during the year ended 31st December, 1951 Cause of Death Males Females Total 1 Tuberculosis, Respiratory 9 3 12 2 Tuberculosis, Other forms 1 1 2 3 S>philitic diseases 2 1 3 4 Diphtheria — — — 5 Whooping Cough — 1 1 6 Meningococcal Infections — — — 7 Acute Poliomyelitis — — — 8 Measles — 1 1 9 Other infective and parasitic diseases 1 — 1 10 Malignant neoplasm, stomach 10 7 17 11 Malignant neoplasm, lung, bronchus 17 3 20 12 Malignant neoplasm, breast — 7 7 13 Malignant neoplasm, uterus — 2 2 14 Other forms malignant neoplasm and lymphatic neoplasms 25 20 45 15 Leukaemia, Aleukaemia 2 1 3 16 Diabetes 1 3 4 17 Vascular lesions of nervous system 35 23 58 18 Coronary disease, angina 44 18 62 19 Hypertension with heart disease 8 5 13 20 Other heart diseases 48 60 108 21 Other circulatory diseases 5 3 8 22 Influenza 10 9 19 23 Pneumonia 19 15 34 24 Bronchitis 17 15 32 25 Other diseases of respiratory system 4 4 8 26 Ulcer of stomach and duodenum 6 1 7 27 Gastritis, enteritis and diarrhoea 1 3 4 28 Nephritis and Nephrosis 5 1 6 29 Hyperplasia of prostate 4 — 4 30 Pregnancy, Childbirth and abortion — 1 1 31 Congenital Malformations 4 1 5 32 Other defined and ill-defined diseases 19 20 39 33 Motor vehicle accidents — — — 34 All other accidents 1 2 3 35 Suicide 3 1 4 36 Homicide and operations of war — — — Total all causes 301 232 533 17 A (4)h Comparison of Maternal Mortality Rate Yearly Maternal Mortality rates are given Year Maternal Deaths Live Births Still Births Maternal Mortality Rate per 1,000 total Births 1921 3 735 11 4.0 1922 3 644 22 4.5 1923 1 623 14 1.57 1924 1 558 13 1.75 1925 — 602 9 — 1926 3 546 9 5.4 1927 1 532 — 1.88 1928 3 513 — 5.84 1929 1 547 11 1.82 1930 2 488 17 3.96 1931 — 492 7 — 1932 2 475 13 4.2 1933 1 492 10 2.03 1934 1 481 17 1.96 1935 2 525 19 3.67 1936 1 510 . 18 1.96 1937 1 605 20 1.52 1938 3 634 22 4.57 1939 3 721 24 4.28 1940 1 721 24 1.38 1941 1 606 23 1.65 1942 2 734 28 2.6 1943 3 822 21 3.65 1944 2 895 18 2.2 1945 — 732 17 — 1946 — 958 23 — 1947 1 1,006 27 0.9 1948 2 877 12 2.25 1949 1 795 13 1.24 1950 — 701 15 — 1951 1 690 15 1.42 A (4) i. Infant Mortality 24 infants died before reaching one year of age giving an infant mortality rate of 34.8 per 1,000 live births. The comparable figure for the whole of the country is 29.6. Of the 24 children who died, 17 died before reaching the age of one month, giving a neo-natal mortality rate of 24.64 per 1,000 live births. 19 died in hospital and the remaining 5 in their own homes. Coroner's Postmortem examinations, without inquests, were carried out in Ave cases. Analysis of the causes of death and of the age at death reveals the following figures:— 18 Cause of death as certified under 1 day 1 day 2 days 3 days 4 days 5 days 6 days 7-14 days 14-21 days 21-28 days 28 days - 2 months 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11-12 months Total deaths under 1 year Broncho Pneumonia 1 1 1 1 1 1 6 Capillary Bronchitis 1 1 Inanition 1 1 2 Congenital Heart Disease 1 1 Atelectasis 1 1 2 Icternes Neonatorum 1 1 Prematurity 4 1 5 Acute Pulmonary Congestion 1 1 Pulmonary Atelectasis 1 1 Kernicterus 1 1 Pulmonary Oedema 1 1 Pyloric Stenosis 1 1 Shock (Inanition after Breech delivery) 1 1 Totals 5 3 1 1 2 1 — 1 1 2 3 — 1 — 1 1 — — — — 1 24 19 Below is given a table showing the Infant Mortality rates and actual number of infant deaths for Erith at five yearly intervals 1920.1945 and for the years 1946, 1947, 1948, 1949, 1950 and 1951. Year Erith England and Wales (Infant Mortality Rate) No. of Inf. Deaths Infant Mortality Rate 1920 50 60.5 83 1925 34 56.48 75 1930 32 65.6 60 1935 21 40 00 39 1940 24 37.17 55 1945 29 39.61 46 1946 31 32.3 43 1947 34 33.7 41 1948 20 22.8 34 1949 19 23.9 32 1950 14 20.0 29.8 1951 24 34.8 29.6 SECTION B.—PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES B (1) Notifications. Disease Total No. of cases notified Cases admitted to infectious disease hospital Total No. of Deaths among notified cases Scarlet Fever 45 22 - Whooping Cough 173 2 - Measles 1,007 6 1 Acute Pneumonia 40 14 1 Acute Encephalitis - Infective 1 1 - Post Infectious 2 2 - Paratyphoid Fever 3 3 - Erysipelas 5 1 — Meningococcal infection 2 2 — Food Poisoning 3 — — Puerperal Pyiexia 1 1 — Ophthalmia Neonatorum 1 1 — Gastro Enteritis 2 2 — Total 1,285 57 2 One case notified as Scarlet Fever was rediagnosed on admission to hospital as Glandular Fever. One case admitted to hospital as queried Poliomyelitis proved not to be so. One case notified as Poliomyelitis was subsequently rediagnosed on admission to hospital, as Synovitis of the right knee. 20 Paratyphoid Fever It will be noted from the figures that 3 cases of paratyphoid fever were notified during the year and a report is set out below on the outbreak of which these cases were a part. Report on Outbreak of Paratyphoid 'B ' Fever. The outbreak of Paratyphoid 'B' to be described affected the Boroughs of Erith and Bexley, the Urban District of Crayford, the Borough of Dartford and the Dartford Rural District, the Urban District of Swanscombe, the Urban Districts of Orpington and Chislehurst and Sidcup, the Metropolitan Boroughs of Deptford, Lewisham and Fulham and the County Borough of Brighton. In all 38 cases occurred and 13 carriers were discovered, and there was, to the best of my knowledge, one death from this disease. The point of particular interest is that the cause of the outbreak appeared to be due to the consumption of synthetic cream supplied by a food establishment in the Borough of Erith, and I set out below details of the epidemic and an account of the measures taken to control it in the Borough and in the area as a whole. On the 9th July, 1951, I was first notified of a case of Paratyphoid 'B' in the Borough of Bexley. The patient had been sent to hospital where the diagnosis had been established following the customary investigations. In quick succession cases were reported from Erith, Crayford, Orpington, Chislehurst and Sidcup, Dartford and the Dartford Rural District and steps were taken to ensure that all patients were admitted to hospital as early as possible for treatment and confirmation of the diagnosis. In all these districts the Medical Officers of Health and Sanitary Inspectors made the usual investigations and before long it became clear that there was a common factor in the outbreak, namely the consumption of synthetic cream. This was noticed independently in the separate districts and I was accordingly notified as the firm was in a district for which I act as Medical Officer of Health. An interesting point was the occurrence of 9 cases and 3 carriers in the County Borough of Brighton, and the Medical Officer of Health got in touch with me by telephone as he also had noticed the association with the firm in question. It was obvious that control measures were necessary and this was greatly facilitated by the close link which was established between ourselves and the Health Departments of 21 the other districts concerned, and we kept each other informed of the day to day position in regard to the paratyphoid fever in our respective districts. This enabled me to keep a central register of cases and contacts occurring over the whole area, a fact appreciated by the Ministry of Health who were, of course, informed and who kept in close touch with us during the outbreak. The following measures were taken in Erith, Bexley and Crayford. 1. All Doctors were warned of the prevalence of Paratyphoid fever and an offer made for me to see suspected cases with them. 2. All suspected cases and carriers were quickly admitted to hospital. 3. A search for contacts was made and specimens of stools, and in a few cases, of blood, were submitted to the Public Health Laboratory at Maidstone for examination. 4. The Sanitary Inspectors visited all shops supplied by the firm in question and withdrew any cream products which were still exposed for sale. The major part of the investigation was, of course, in connection with the firm in question which I visited with the Senior Sanitary Inspector and made a full investigation as follows. 1. A list was obtained of all cream products supplied by the firm. 2. The source and composition of the synthetic cream used was ascertained. 3. The method of manufacture, handling and packing of the cream products was fully gone into. 4. A full list of handlers, fillers and packers of these cream products was obtained together with a detailed account of their duties. 5. I interviewed personally every member of the staff in this section of the firm with particular reference to past illnesses of themselves and their families. A number was away for various reasons and these persons were visited at home, or if away on holiday, interviewed later. 6. The plant in general was inspected. 22 7. Arrangements were made for specimens of stools to be taken from the 21 employees concerned and submitted for bacteriological investigation. 8. Samples of synthetic cream of three different kinds and actual products on sale were taken away for investigation. 9. I assembled all the staff in the section and explained the nature of our investigation and the need for particular care in cleanliness of the hands, especially after visits to the lavatory. 10. Arrangements were made with the Management for the immediate discontinuance of the manufacture and issue of cream products of any kind until further notice, the staff to be found other work not concerned with food handling in the meantime. 11. After a suitable interval second specimens of stools of the staff were submitted for examination. 12. Specimens were also taken from certain members of the staff concerned with the handling and distribution of other manufactured products as, in a number of cases, these seemed to be the article of diet at fault, but the possibility of contamination in transit had to be considered. 13. A daily inspection of the personnel and machinery was carried out. One of the girls working on the cream side of the firm was away ill with a diagnosis of German Measles. I visited her at home and, as there appeared to have been a history of abdominal upset, the question of a mistaken diagnosis had to be considered, and I had her admitted to hospital for investigation. Subsequent examinations proved to be negative. The possibility that the outbreak may have been caused either by ice lollies, ice cream or milk had also to be investigated, but it was decided that these were not implicated in the present outbreak. It was ascertained that cases of Paratyphoid fever had also occurred in various other parts of the country including St. Helen's, Lancs., and Barnsley, Yorks., and liaison was established through the Ministry of Health to ascertain if there was some common factor, especially as it was known that the synthetic cream concerned was also distributed to those areas. In all, 12 different strains of the Paratyphoid 'B' germ are known to the Central Enteric Reference Laboratory of the Medical Research Council, and the Hospital authorities sent 23 a germ culture from each patient admitted to ascertain the particular Type of organism which had caused the infection. This "typing" of organisms, as it is called, is as individual as the examination of fingerprints in criminology, and is a valuable aid in tracing the origin of an epidemic. The extraordinary thing was that the germs isolated from the epidemic cases did not fall into any known category, and the result from the Laboratory showed that we were dealing with an un. typeable strain which had not been met before in this country. The information, however, that all the cases were due to the same strain was, in itself, very valuable and showed that, not only our cases, but certain cases occurring in other parts of the country were due to the same source. This type has now officially been recognised as the Kent strain of Paratyphoid 'B' by the Central Enteric Reference Laboratory. Meanwhile the search for contacts and cases was continued and any fresh cases or carriers were immediately sent to hospital. Doctors called me out to see many suspected cases and 2 of these were admitted to hospital, although the rest proved to be innocent as far as this disease was concerned. The results of the stool examination submitted from the employees of the firm were all negative as were also the blood samples which were taken, but this does not exclude the possibility that one of the workers may have been the source of the outbreak. The problem of the "intermittent carrier" has always to be faced and it is often necessary to take 6 or 7 specimens before a positive result is obtained. There were limits, however, to the extent to which the firm and the employees could be inconvenienced and we had to be satisfied with the results obtained. The possibility had also to be considered that the cream may have already been infected on arrival at the premises and this might also explain the fact that cases in other parts of the country were due to the same strain or organism. The Ministry of Health undertook to make such investigations as were possible at the places of origin of the synthetic creams and this has presumably been done. The fact remains, however, that by the 6th August, 1951, it was decided that the outbreak was over and it is possible that a dangerous situation which might have resulted in a more serious outbreak was averted by the control measures which were adopted. I should like to acknowledge the ready co.operation of the Management and Staff of the firm concerned who immediately 24 agreed to accept such restrictions and measures as appeared to be necessary, and to give us every facility to carry out our investigation. I am also greatly indebted to my colleagues, both Medical Officers of Health and Sanitary Inspectors in the affected areas who did so much to bring the epidemic to an end in the shortest possible time. Every assistance was also received from the Hospital authorities, the Public Health Laboratories and from the Ministry of Health for which we are also grateful. 25 B (l)a Age Distribution The following table shows the age distribution of cases of Infectious Disease notified during the year Disease Age Groups Totals under 1 year 1.2 3-4 5-9 10-14 15-24 25-44 45-64 65 & over Age not known M F M F M F M F M F M F M F M F M F M F Scarlet Fever - - 2 1 7 4 11 18 - 1 1 - - - - - - - - - 45 Whooping Cough 6 6 25 24 32 30 22 25 - 1 — — — — 1 — — — 1 — 173 Measles 10 18 109 92 186 162 199 203 5 4 2 2 3 1 — — — — 7 4 1,007 Acute Pneumonia - - - 1 1 — 3 3 1 1 — — 3 3 9 5 6 4 — — 40 Acute Encephalitis Infective - - - - 1 - - - - - - - - - - - - - - - 1 Post Infectious - - - - - 1 - - - - - - - 1 - - - - - - 2 Erysipelas - - - - - - - - - - - - 1 - - 2 1 1 — — 5 Ophthalmia Neonatorum - 1 - - - - - - - - - - - - - - - - - - 1 Paratyphoid - - - - - - 1 - - - - 1 - 1 - - - - - - 3 Meningococcal Infection 1 - - - - - - - - - - - - - - 1 - - - - 2 Food Poisoning - - - - - - - - - - - - - 1 1 1 — — — — 3 Puerperal Pyrexia - - - - - - - - - - - - - 1 - - - - - - 1 Gastro Enteritis 1 1 - - - - - - - - - - - - - - - - - - 2 Totals 18 26 136 118 227 197 236 249 6 7 3 3 7 8 11 9 7 5 8 4 1,285 26 B (l)b WARD DISTRIBUTION Number of cases of Infectious Disease notified in each ward in the Borough. Disease Ward Total Town Old Church Belvedere North Heath Abbey Wood Bostall Scarlet Fever 1 3 7 21 6 7 45 Whooping Cough 32 42 24 29 13 33 173 Measles 215 123 139 134 123 273 1,007 Acute Pneumonia 7 15 5 5 4 4 40 Erysipelas 1 1 1 1 1 — 5 Ophthalmia Neonatorum — — 1 — — — 1 Acute Encephalitis Infective 1 — — — — — 1 Post Infectious — 1 — — — 1 2 Paratyphoid — — - — 3 — 3 Meningococcal Infection — — — — 1 1 2 Food Poisoning 1 1 — 1 — — 3 Puerperal Pyrexia 1 — — — — — 1 Gastro Enteritis — — — - 2 - 2 Totals 259 186 177 191 153 319 1,285 27 B (2) Tuberculosis B (2)a New Cases notified for the first time during 1951 Age Respiratory Non.Respiratory Total M F M F 0— — — — — — 1— 3 — — 1 4 5— 3 1 — — 4 10— 2 4 1 — 7 15— 3 2 — — 5 20— 7 3 — — 10 25— 11 12 1 1 25 35— 12 3 1 — 16 45— 4 2 — — 6 55— 2 — — — 2 65 & over 1 1 — — 2 Totals 48 28 3 2 81 In addition to the above cases, five females and nine males suffering from Respiratory Tuberculosis, and 1 male suffering from Non- Respiratory Tuberculosis, were transferred into the district from other areas. B (2)b Deaths According to the figures supplied by the Registrar. General, the following is the number of deaths from Tuberculosis during the year. Tuberculosis of Respiratory system Other forms of Tuberculosis All forms of Tuberculosis Male Female Total Male Female Total Male Female Total 9 3 12 1 1 2 10 4 14 28 B (2)c Quarterly Statements for the Year 1951 Tuberculosis 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter M F Total M F Total M F Total M F Total Respiratory Tuberculosis Number on register at commencement of Quarter 242 179 421 247 182 429 250 187 437 259 188 447 New notifications during Quarter 5 7 12 11 6 17 6 2 8 18 9 27 Cases removed, which have been restored 1 - 1 - - - - - - 1 - 1 Cases added other than by formal notification 2 1 3 1 1 4 3 7 11 4 15 Cases removed from register during Quarter 3 5 8 8 2 10 1 4 5 6 6 12 Cases remaining on register at end of Quarter 247 182 429 250 187 437 259 188 447 283 195 478 Non-Respiratory Tuberculosis Number on register at commencement of Quarter 39 40 79 39 41 80 39 40 79 39 40 79 New notifications during Quarter — 1 1 — — — — — — 2 1 3 Cases removed, which have been restored - - - - - - - - - - - - Cases added other than by formal notification - - - - - - 1 - 1 1 - 1 Cases removed from register during Quarter - - - - 1 1 1 - 1 - 1 1 Cases remaining on register at end of Quarter 39 41 80 39 40 79 39 40 79 42 40 82 Total of Respiratory and NonRespiratory Cases on Register at end of Quarter 286 223 509 289 227 516 298 228 526 325 235 560 Number of cases left on the register at end of 1951 is as follows:- Respiratory: Non-Respiratory: Total 283 males 195 females 42 males 40 females 560 29 B (3) Diphtheria Immunisation This service is administered by the Kent County Council. The latest figures supplied by the County Medical Officer show the position at December 31st, 1951, and are given below. It is interesting to note that no case of Diphtheria occurred in an immunised child. Table A:—Number of children resident in the Borough of Erith who were given immunising injections during 1951 Year of Birth Number Immunised Primary Inoculations Number given Reinforcing Inoculations Year of Birth Number Immunised Primary Inoculations Number given Reinforcing Inoculations 1951 Under 1 year of age 49 — 1946. 1942 5.9 years of age 34 415 1950 1 year of age 384 — 1941. 1937 10.14 years of age 72 407 1949 2 years of age 67 — 1948 3 years of age 17 1 1947 4 years of age 14 52 Total 531 53 106 822 30 Table B:—Number of children resident in the Borough of Erith under the age of 15 years on 31st December 1951, who had completed a course of Immunisation at any time since 1st January, 1937 0.4 years 5.14 years Year of Birth Number considered to be immunised Year of Birth Number considered to be immunised 1951 49 1946 1,068 1950 435 1945 831 1949 536 1944 750 1948 575 1943 709 1947 775 1942 695 1941 633 1940 604 1939 620 1938 379 1937 567 Total 2,370 Total 6,856 B(4) Scabies Although the Scabies Order, 1941, was revoked on the 1st January 1948, the Department continues to treat cases and contacts as soon as it becomes aware of them. During the year no cases were dealt with. B (5) Smallpox S.S. "Strathmorer." During the year a case of suspected Smallpox was removed from the S.S."Strathmore." Five contacts, three passengers and two members of the crew, who arrived in Erith, were kept under supervision. It was discovered that the two members of the crew had recently been vaccinated ; the three passengers were re-vaccinated. All contacts remained well throughout the danger period. Post-mortem diagnosis. The Medical Referee of the local crematorium reported that he had examined the certificates relating to a woman aged 78, who had died in this district. As the cause of death was given as "broncho-pneumonia and chicken pox" and bearing in mind the rarity of the latter condition in a person of that age and the prevalence of Smallpox, he required assurance that this was not a missed case. 31 Specimens of skin were submitted for biological investigation at the Central Public Health Laboratory, Colindale. The results were negative, and cremation was carried out. S.S. "Ranchi." Owing to the dispersal of the passengers and crew of the S.S. "Ranchi" from which vessel a case of Smallpox had been removed, a member of the crew was notified as having proceeded to the Borough of Erith. The necessary action was taken for the daily supervision of this contact and no case of Smallpox developed in the Borough. B (5)a Vaccination Age at 31st December 1951 Under 1 year 1.4 years 5.14 years 15 or over Total Number vaccinated 185 150 30 23 388 Number re-vaccinated — 2 1 70 73 B (6) Public Health (Leprosy) Regulations, 1951 The above Regulations came into operation on the 22nd June, 1951, and made it obligatory on every medical practitioner attending on or called in to visit a patient suffering from leprosy in any building used for human habitation as soon as he became aware that that patient was so suffering, or if he was so aware at the date of the coming into operation of the regulations, to forthwith send to the Chief Medical Officer of the Ministry of Health, a notification set out in a prescribed form. It also made it obligatory for every local Authority to send a copy of these Regulations to each medical practitioner ascertained to be practising within the district. B (7) Research on Poliomyelitis A letter was received from the Medical Research Council to the effect that, with the support of the Ministry of Health, they had decided to carry out intensive research into this disease during 1951. Among other things, the research would deal with those cases of Poliomyelitis apparently associated with recent immunisation against diphtheria and/or whooping cough or removal of tonsils and adenoids. Local Sanitary Authorities were asked to collaborate. In any area where more intensive study had to be made the investigators would plan their enquiry in consultation with the Medical Officer of Health. 32 SECTION C.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA C (1) General Hospital Facilities Erith and District Hospital. This hospital is administered by the Regional Hospital Board. In addition, the services of the large General and Specialist Hospitals in London are readily accessible to residents in this area. C (2) Infectious Disease Cases—Hospital Accommodation Brook Hospital. River Hospitals, Joyce Green Any other Infectious Disease Hospital controlled by the South East Metropolitan Regional Hospital Board. C (3) Tuberculosis Treatment and Hospital Accommodation The South East Metropolitan Regional Hospital Board is responsible for sanatorium treatment and hospital accommodation. A dispensary is held weekly at 65, Bexley Road, Erith, by a whole.time Chest Physician. C (4) Venereal Diseases Venereal Disease Clinics for this area are provided and administered by the South East Metropolitan Regional Hospital Board. C (5) Ambulance Service This is provided by the Kent County Council, an ambulance being obtained through Mr. R. W. Griffin, District Officer, Kent County Council, 148, West Street, Erith, telephone Erith 4747/8 or the Ambulance Station, Council Offices, Erith, telephone Erith 3603. C (6) School Clinics Hainault, Lesney Park Road. Minor Ailments, Refraction, Dental. Bedonwell Hill, Minor Ailments, Dental, Orthopaedic.* Lessness Abbey. Minor Ailments. Erith and District Hospital. Ear, Nose and Throat. *These clinics are administered by the Health Committee of the County Council, or the Regional Hospital Board. 33 C (7) Maternity and Child Welfare Centres Hainault, Lesnev Park Road. Ante-Natal Sessions:— Mondays 9 a.m.—12 noon. Child Welfare Sessions:— Mondays 1.45 p.m.—4 p.m. Thursdays 1.45 p.m.—4 p.m. Belvedere Public Hall. Child Welfare Sessions:— Tuesdays 1.45 p.m.—4 p.m. Thursdays 1.45 p.m.—4 p.m. Lessness Abbey. Ante.Natal Sessions:— Wednesdays 9 a.m.—12 noon. Fridays 9 a.m.—12 noon. Child Welfare Sessions:— Wednesdays 1.45 p.m.—4 p.m. Fridays 1.45 p.m.—4 p.m. Bedonwell Schools. Ante.Natal Sessions:— Thursdays 9 a.m.—12 noon. Child Welfare Sessions:— Tuesdays 1.45 p.m.—4 p.m. Wednesdays 1.45 p.m.—4 p.m. Fridays 1.45 p.m.—4 p.m. C (8) Maternity Home Hainault, Lesney Park Road. The administration of this Home is carried out by the Woolwich Group Hospital Management Committee. C (9) Private Nursing Homes The undermentioned Homes are registered by the Erith Borough Council. The Eaves, 64, Picardy Road, Belvedere. Ormande House, 68, Picardy Road, Belvedere. C (10) Day Nursery This is administered by the Kent County Council and is located at Franks Park. C (11) Laboratory Facilities Examination of pathological specimens and other laboratory work for the district are undertaken by the Public Health Laboratories, County Hall, Maidstone. 34 C (12) Mortuary The Borough Mortuary for the year under review was situated at the rear of Erith Parish Church in West Street, and consisted of a reception room and a viewing room. There was accommodation for four bodies. During 1951, the Erith Mortuary was not used, the majority of the bodies being received in Bexley Mortuary, and the remainder at Crayford. This arrangement was made for the convenience of the Pathologist. Discussions proceeded during 1951 for the provision of an up.to.date mortuary to serve the Boroughs of Erith and Bexley, and the Urban District of Crayford. The new mortuary was finally opened early in 1952. C (13) Disinfection and Disinfestation of Bedding, Clothing, etc. A joint arrangement is in existence with the Bexley Borough Council for the disinfection and disinfestation of bedding, clothing, etc. There is, also, a cleansing station for dealing with verminous persons. In the case of notifiable infectious disease, the service is carried out free of charge. It is also available to those persons who wish to make use of the facilities and in these cases a charge is made towards the cost of the work. C (14) Welfare of Old People During the year the Erith Elderly People's Welfare Committee continued its work of visiting old people in their own homes and providing good neighbourly services. Close co.operation was maintained with the District Officer of the Kent County Council, the voluntary organisations, and the visitors concerned. Discussions took place during the year, on the possible widening of the scope of the activities of the Committee, by affiliation to the North West Kent Old People's Welfare Committee and the consequent provision of something more than good neighbourly services. The extra services visualised were the setting up of more clubs for the elderly, the provision of "meals on wheels," arranging of holidays, outings, 35 tainments and social functions of all kinds, and the provision of financial assistance as well as assistance in kind. Affiliation to the North West Kent Old People's Welfare Committee subsequently took place early in 1952, and the Committee is going ahead vigorously with the above objects. C (15) National Assistance Act, 1948 Section 50 Public Burials During the year 1951 it was not necessary for the Council to arrange any public burials. 36 SECTION D.—SANITARY CIRCUMSTANCES OF THE AREA I am indebted to the Borough Engineer and Surveyor for the following information relating to refuse collection and disposal. D (1) Refuse Collection and Disposal The method of storage is by means of sanitary dustbins, and some 15,000 are emptied weekly. The dustbins are provided and maintained by the owners of the properties concerned, the Council securing this by a local act—the Erith Improvement Act, 1920. Disposal is effected by barging under contract, and these arrangements are still working very satisfactorily. D (l)a Costs £ s. d. Cost per ton of collecting refuse 1 2 10 Cost per ton of disposing of refuse 14 1 Net cost per 1,000 population per annum 349 1 0 The following tables show:— 1. Details of the refuse collection vehicles and staff. 2. Details of the tonnage dealt with during the year. D (l)b Table 1 Vehicle Capacity 2 Dennis lorries 12 cubic yards 6 S. & D. Freighters 7,, ,, 1 S. & D. Freighter 12 „ „ 1 Scammell Lorry 5 ,, ,, 1 Austin Van (Utility van) They are operated by:— 1 Foreman 11 Drivers 6 Loaders and Sorters 37 D (l)c Table 2 Month Tonnage Tons Cwts. January, 1951 1,022 0 February, „ 828 12 March, „ 848 9 April, „ 806 11 May, ,, 775 3 June, „ 588 18 July, „ 538 11 August, „ 540 19 September, „ 553 3 October, „ 728 12 November, „ 795 18 December, „ 763 11 Total 8,790 7 D (2) Trade Refuse Trade Refuse is collected from the shops by arrangements with the shopkeepers, an agreed charge being made. Due to increased costs of collection and disposal, the charges were increased by 33#% from 1st April, 1951. The growth of this section of the Refuse Services continues and in 1951, the amount reached approximately 272 loads, producing a revenue of £383 1s. 0d. D (3) Salvage Tonnage collected Bottles Income T. C. Q. lbs. Gross Dozen £ s. d. 888 10 3 13 15 1 7,372 3 2\ (D4) Public Conveniences Public Conveniences under the control of the Council are as under:— Site Hours of opening Walnut Tree Road, Male and Female 6.30 a.m.—Midnight *West Street, Erith Male and Female 6.30 a.m.—11.30 p.m. Station Road, Belvedere Male and Female 24 hrs.—Day and Night Heron Hill, Male 24 hrs.—Day and Night Woolwich Road, Female 6.30 a.m.—11p.m. *Newly erected Male and Female Conveniences, West Street, Erith, opened to public 15th June, 1951. Male Convenience, West Street, demolished 15th June, 1951. 38 D (5) Sanitary Inspection of the Area D (5)a Visits by Sanitary Inspectors The total number of visits of all kinds was 7,210 Notices served 675 : Formal 54 : Informal 621. Number of dwellings and other premises disinfected 148 Complaints received and investigated 1,720 D(5)b Premises Visited and Results of Such Visits Premises No. in district No. of visits No. of defects found No. of defects remedied Bakehouses 10 39 6 6 Dairies 5 24 3 3 Butchers' shops 33 162 10 10 Fish friers 14 52 6 6 Slaughter houses 4 — — — Factories 172 115 25 25 Outworkers 126 102 — — Food Factories 4 19 1 1 D (5)c Summary of Nuisances and defects remedied during the year Other than those enumerated in the above tabulations:— Drains repaired 60 Drains cleared 91 New W.C. pans 11 New W.C.'s provided 18 Cisterns repaired 33 New sinks 25 Roofs made watertight 115 Damp walls remedied 168 Houses cleansed 6 Floors repaired 52 Eaves, gutters, etc., repaired 100 Cooking stoves renewed, etc. 16 Plasters renewed 190 Windows made to open 51 Dustbins provided 65 Accumulations removed 15 Yard pavings repaired 12 Coppers repaired 6 Repointing walls 28 Water supply provided 7 Demolition Orders made — Houses demolished 3 Miscellaneous 72 Many requests were received from owners and occupiers in respect of clearing drains, eradication of vermin, destructions of ants and wasps nests, etc. In each case the necessary service was provided with much beneficial result to the applicant. 39 The charges made in connection with the above service amounted to £46 14s. 6d. D (5)d. Closet Accommodation and Cesspools The whole of the closet accommodation both in the older parts of the town and the recently developed areas is on the main drainage system, there being only 23 known cesspools existing. Cesspools are emptied once a month free of charge under Council resolution of 10th March, 1942, and sewage contents of cesspools are discharged by Council plant into the nearest sewer. The cesspools requiring the service of the Corporation are scattered throughout the district, and in the majority of cases, necessitate the covering of considerable distances both for pumping out and conveying to the point of discharge. During the year, cesspools were emptied on 8 occasions. D (5)e Smoke Abatement Emission of smoke and grit necessitated action being taken which resulted in the following improvements:— (a) Foundry. Roper spark catcher installed. (b) Coal Wharf. 3 Steam locomotives replaced by Deisels. D (5)f Swimming Baths and Pools (1) The Council's open air bath is situated in Stonewood Road and comprises one pool of some 55,000 gallons capacity which is now exclusively used by the Kent Education Committee during normal school hours, and local youth clubs during evenings and on Saturday mornings. Water in the pool is heated to a temperature of 72 degrees Fahrenheit by low pressure steam heating and is sterilised by the chlorine process. There is a slipper establishment with accommodation for 16 males and 4 females. Adjacent to the public baths is a mechanical laundry which launders on behalf of various undertakings which include the Corporation's catering department, works department, County health and education departments and Hainault Hospital. During the year 126,836 articles were dealt with. Attendances at Public Baths for 1951 Swimming pool Slipper Baths Schools : During term 10,922 15,890 bathers Schools : During holidays 4,042 Youth Clubs 7,212 Total 22,176 40 (2) A children's paddling pool of some 60,000 gallons capacity is situated within the Belvedere recreation ground. This pool is regularly emptied and cleansed, and during the summer months is methodically dosed with chloros. D (5)g Camping Sites There are no summer camping sites within the Borough. There are, however, 4 sites which have been occupied by vans for a number of years. Two licences under Section 269 Public Health Act, 1936 were granted. For using land without a licence an owner was fined 40/.. For keeping a moveable dwelling on land without a licence, the occupier was fined 20/-. The shed in question was subsequently demolished. D (5)h Hop pickers There are no hop fields within the district. D (5)i Rag Flock and other Filling Materials Act, 1951 This Act came into operation on 1st November and provides that:— (a) Rag flock manufacturing premises shall be licenced annually by the Local Authority. (b) Premises where filling materials are used shall be registered by the Local Authority. Whilst there are no manufacturing premises in the Borough, there are, however, 2 premises where filling materials are utilised, and these have accordingly been registered. These premises are satisfactory. D (5)j Eradication of Bed Bugs During the year dwelling houses found to be infested with vermin and subsequently disinfested were as follows:— Privately owned houses 12 Corporation houses 3 Disinfestation of both privately owned and Corporation houses is carried out by an operative under the supervision of Sanitary Inspectors, presence of the vermin being revealed either on complaint or when inspections are being carried out. With a view to keeping good control, occupiers are encouraged to report infestation, when every assistance is given to cope with the menace. For an appropriate charge, the operative 41 carries out the necessary destruction. Close co.operation exists between the Housing Department and the Sanitary Inspectors, in which case successful disinfestation is promptly carried out, and in the case of transfers it is sometimes necessary for the tenant to surrender certain household effects for destruction. D (5)k Mosquito Control During the year, no obvious mosquito was found to exist, nevertheless the usual appropriate precautionary measures were taken which included spraying many of the water.courses within the Borough. The 290 pig food salvage bins in the streets received attention. D (5)1 Rodent Control Two operatives continue to be employed on rodent destruction in accordance with the terms of Circular N.S. 19. As in previous years, Corporation sewers were effectively treated for sewer rats during the months of March and September when a total of 378 manholes were baited. On 1st October, 1951, the Prevention of damage by Pests (Application to Shipping) Order, came into operation, which provided that the duties of Local Authorities in terms of Part I of the Prevention of Damage by Pests Act, 1949 in relation to rats and mice on land, shall now extend so as to include any vessel or craft in the area which is not a sea.going ship. Statutory requirements under the Order are as follows:— (a) Inspection of vessels to discover presence of rodents. (b) Destruction of rodents on Local Authority's own vessels if any. (c) Enforcement of duties and obligations of owners and persons in charge of vessels and the carrying out of operations authorised by the Order. During the year, the following inspections were made:— Coastwise vessels 16 Barges 20 Tugs 5 41 D (5)m Pest Control Ants, wasps, beetles, silverfish, crickets, etc., are well known to be the cause of much distress amongst occupiers, and 42 to alleviate such condition, a disinfestation service is available. The charge incurred includes the cost of materials used plus apportionment charge on operatives' time devoted to the service. D (5)n Offensive Trades In addition to the ordinary statutory trades which are specified in Section 107 Public Health Act 1936, fish frying was declared to be an offensive trade on 17th March, 1939 and bye.laws were made accordingly. Within the Borough, there are no offensive trades other than those of fish frying, and of these premises, there are 14. D (6) Factories (1) Inspections for the purpose of provisions as to health are detailed below:— Premises Number of Inspections Written Notices Occupiers Prosecuted 170 Factories on Register 115 9 - 2 Other premises under the Act (including building works and engineering construction but not including outworkers) - - - 172 Total 115 9 - (2) Defects found Number of defects Number of defects in respect of which prosecutions were instituted Particulars Found Remedied Referred to H.M. F.I. Want of cleanliness 2 2 - - Sanitary Conveniences: (a) Insufficient 8 8 - - (b) Unsuitable 6 6 — — Other offences against the Act (not including offences relating to outwork). 9 9 - - Total 25 25 — — 43 D (7) Shops Act 1950 With regard to statutory hours of closing it was necessary to issue 4 warnings to shop-keepers respecting closing of shops at the prescribed hour. Infringements of health and comfort provisions were located in the following instances, and the necessary improvements were subsequently effected:— Heating provided 3 New W.C's provided 3 New W.C. Pans 1 New sinks 2 Shops cleansed 1 Floors renewed 2 Water supply provided 1 D (8) Sanitary Accommodation at Offices At one factory office, it was found necessary to implement Section 46, Public Health Act 1936, in consequence of which 2 additional conveniences were provided for male staff and 2 similar conveniences for female staff. Adequate washing facilities were also provided in each case. D (9) River Thames—Effluvia In July, 3 samples of river mud and one of river water were submitted to the Public Analyst who reported that sulphide. sulphur was present in the mud in varying proportions of 536, 1970 and 2280 parts per million, all samples yielding sulphuretted hydrogen, and that the river water was considerably sewage polluted. It may well be that effluvia from the river Thames in 1951 was not so apparent as in the summer of 1949 because of the interim expedient of chlorination which is referred to in the London County Council's Rivers and Drainage Committee's published report on the £10,000,000 five year programme of capital works for improving the sewage effluents at the northern and southern outfalls as follows:— "The Housing Committee reported in January, 1949, on the programme of works for improving the effluents during the quinquennium 1947-1952. The fulfilment of this programme was retarded, but work on the completion of the detritus pits at the northern outfall works, which had been delayed by the war, was restarted in March, 1950, and the 44 construction of sixteen new sedimentation tanks with a total capacity of 20 million gallons at the northern outfall began in September, 1950. In addition to these schemes the programme included diffused air activated sludge plants to treat 30 million gallons of sedimented sewage a day at the northern outfall and the same at the southern. Because of the delay and of the continuing deterioration in the condition of the river water, the Committee have, in consultation with the Ministry of Health (now Ministry of Local Government and Planning) reviewed the situation and propose an expansion of the programme to increase the capacity of the diffused air activated sludge plants at each outfall to 60 million gallons a day instead of 30 million, and in addition to provide for the construction of sludge digesting plant to treat all the sludge produced at both outfalls. The completion of these works would enable all the sewage at both outfalls to receive efficient sedimentation and two-thirds of the effluents to be further purified by the activated sludge process. The new sedimentation tanks at the northern outfall works are due for completion in 1953 and until they are in operation no great improvement in the condition of the river water can be expected. As an interim expedient we propose to install chlorination plant at an estimated cost of £8,000. The estimated cost of the capital works envisaged in the revised programme is as follows:— £ (i) Diffused air plant to treat 60 million gallons of sedimented sewage a day at northern outfall works 3,250,000 (ii) Sludge digestion plant, to treat all the sludge produced at northern outfall works 2,225,000 (iii) Diffused air plant to treat 60 million gallons of sedimented sewage a day at southern outfall works 2,800,000 (iv) Sludge digestion plant to treat all the sludge produced at southern outfall works 1,515,000 These estimates amount to £9,790,000 for the constructional work, including mechanical and electrical works, to which must be added £70,000 for expenditure on designing works (i) and (iii), including site investigations, making a total of £9,860,000. The incidence of the expenditure on these projects is difficult to forecast but it is likely to be £100,000 in 1951-52, 45 £760,000 in 1952-53, £3,500,000 in 1953-54, £5,000,000 in 1954-55 and £500,000 in 1955-56. D (10) Atmospheric Pollution Dust emission—Thameside area No deposits of cement dust from North West Kent industries were discernible during the year. D(11) Housing D(11)a Inspection of Dwelling Houses during the year. 1. (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,422 (b) Number of inspections made for the purpose 1,536 2. (a) Number of houses (included under sub-head (1) above) which were recorded and inspected under the Consolidated Housing Regulations, 1925 and 1932. 0 (b) Number of inspections made for the purpose 0 3. Number of houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 4. Number of houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 912 D(11)b Remedy of defects during the year without service of Formal Notices Number of defective dwelling houses rendered fit in consequence of informal action by the local authority 728 Action under Statutory Powers during the year. (a) Proceedings under Sections 9 and 10 Housing Act, 1936 (1) No. of houses in respect of which Notices were served requiring repairs 0 (2) No. of houses which were rendered fit after service of formal notices (a) By owner 0 (b) By Local Authority 0 46 (b) Proceedings under the Public Health Act. (1) No. of houses (dwelling) in which Notice was served requiring defects to be remedied 54 (2) No. of dwelling houses in which defects were remedied after service of formal Notices (a) By owner 54 (b) By Local Authority 0 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) No. of dwelling houses in respect of which demolition orders were made 0 (2) No. of houses demolished in pursuance of demolition orders 0 (d) Proceedings under Section 12 of the Housing Act, 1936 (1) No. of separate tenements or underground rooms in respect of which closing orders were made 0 (2) No. of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been made fit 0 1, 2, 3, Magazine Cottages, Crabtree Manorway, were demolished by informal action. In accordance with the requirements of Form P.13 (HSG) the following information was submitted to the Ministry of Local Government and Planning:— D(11)c Housing progress from 1st April, 1945 to 31st March, 1951 Clearance Areas—Nil. Unfit houses not included in clearance areas. No. of houses No. of persons displaced (1) Housing Act, 1936. (a) Houses demolished as a result of formal procedure under Section 11 50 151 (b) Houses demolished as a result of informal Notices preliminary to formal procedure under Section 11 Nil Nil (c) Houses closed in pursuance of an undertaking given by owners under Section 11 Nil Nil (d) Parts of buildings closed (Section 12) 5 19 47 (e) Houses made fit:— (1) as a result of formal Notices under Sections 9 to 12 43 Nil (2) as a result of informal Notices preliminary to formal procedure under Sections 9 to 12 Nil Nil (2) Housing Act, 1949 (f) Closing Orders made under Section 3 (1) Nil Nil (g) Demolition Orders determined and Closing Orders substituted under Section 3 (2) Nil Nil (h) Demolition Orders quashed under Section 2 Nil Nil The acute problem of housing continues to give considerable anxiety, and I am indebted to the Borough Surveyor and the Housing Assistant for the following information on the subject:— Number of permanent houses constructed in 1951:— By the Council 58 By private enterprise 45 103 Total number of permanent Council houses in the Borough 1,043 Total number of prefabricated temporary houses in the Borough 250 Total number of requisitioned premises in the Borough 207 Number of premises requisitioned in 1951 Nil Number of premises de-requisitioned in 1951 3 D (12) Rent and Mortgage Interest (Restriction) Act, 1939 The provisions regarding extortionate rents are administered by the Senior Sanitary Inspector, and during the year 154 applications were made for advice and assistance. The maximum rent of houses brought under control by this Act is the rent payable at 2nd September 1939, subject to certain permitted increases. Houses let for the first time after the aforementioned date come within the orbit of the Landlord and Tenant (Rent Control) Act, 1949, which Act provides for application to be made to the Rent Tribunal for the assessing of a reasonable rent. This Act also affords protection of tenants who share accommodation. 48 Appended below is a summary of improvements effected under the Rents Restriction Act:— (a) Rent reduced from 18/4d. per week to 15/4d. (b) Rent reduced from £1 2s. 6d. per week to £1. 1s. 6d. (c) Several references were recommended to the Rents Tribunal under the Furnished Houses (Rent control) Act, 1946, and the Landlord and Tenant (Rent control) Act, 1949, with satisfactory results. D (13) Legal Proceedings Statute Offence Penalty Article 2. Labelling of Food Order 1946 (Offence in 1950) Misdescription of drinking chocolate Fined £25 and £10 10s.0d. costs. Section 269 Public Health Act, 1936 (1) Occupying land without licence. Fined 40/- (2) Keeping moveable dwelling on land without licence. Fined 20/- Metropolitan Police prosecution (Evidence by Senior Sanitary Inspector) (1) Larceny of Corporation kitchen waste. Fined 20/- (2) Larceny of Corporation kitchen waste. Fined 20/- Section 95 Public Health Act 1936 Failing to comply with Nuisance Order granted by Magistrates' Court. Fined 60/- and 13/6 costs SECTION E—WATER SUPPLY—MILK AND FOOD AND DRUGS, ETC. E (1) Water Supply The water supply in the district is supplied by the Metropolitan Water Board, and, though possessing a considerable degree of hardness, (30.8°), is palatable and of good quality. The supply is led direct into the premises served, no standpipes being known to exist. Two monthly samples have been regularly obtained and submitted to the Kent County Council's Laboratory for examination, with satisfactory results. Detailed report on a sample submitted for chemical examination is as follows:— 49 54, Cross Street, Erith. Parts per million Total solid residue (Dried at 180 C) 490 Chlorine 24 Free Amonia (as Nitrogen) None Albuminoid Ammonia (as Nitrogen) None Nitrogen as Nitrates 8.0 Nitrogen as Nitrites None Oxygen absorbed ¼ hr. at 26.7 C 0.09 „ „ 4 hrs at 26.7 C 0.23 Toxic metals None detected Free and Combined residual chlorine on receipt None detected pH. 7.15 The water is of satisfactory organic quality and on the above chemical analysis should be fit for drinking. (signed) H. E. Monk, Public Analyst for the 16th July, 1951. County of Kent. E (2)a Dairies and Milk stores The current register of dairies and milk stores records the following registration figures:— No. of registered distributors 8 No. of dairies 5 Regular inspections have been made throughout the year with a view to maintaining the high standard of cleanliness. E (2)b Bacteriological Examination of Milk The following samples of designated milk retailed within the Borough were obtained and submitted to the County Laboratory for examination:— Pasteurised 33 Tuberculin tested (Past) 4 Sterilised 5 Total 42 All were reported upon satisfactorily, such milk satisfying the phosphatase, methylene blue, and turbidity tests. E (2)c Biological Testing of Milk Two samples of milk were submitted to the County Laboratory for biological testing. No evidence of Tuberculosis was found to exist. 50 E (2)d Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 The Milk (Special Designations) (Specified Areas) Order 1951 This Order came into operation on 1st October and made it illegal in specified areas for any person to sell by retail for human consumption, any milk other than that which may be sold as specially designated milk in accordance with the Special Designation Milk Statute of 1949—Milk (Special Designation) Regulations. Under this Order, Erith, together with many other Local Authorities in the London and greater London district, was scheduled a "specified area," and accordingly the necessary action was taken to ensure that only designated milk was retailed in the Borough. For this purpose, it was necessary for 2 retailers correctly to describe pasteurised milk which hitherto had been sold undesignated. The coming into force of this Order has achieved a realisation of 30 years or more effort on the part of Health Committees, Medical Officers and Sanitary Inspectors to remove all undesignated milk from sale, and in lieu thereof to provide either an efficiently heat treated commodity or alternatively approved milk from accredited and attested herds only. E (2)e Designated Milk The following table indicates the number of licences issued by the Local Authority in 1951 under (1) Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949, and (2) Milk (Special Designation) (Raw Milk) Regulations 1949, viz:— Dealers Pasteurised 8 Sterilised 16 Tuberculin tested 5 Tuberculin tested (past) 1 30 Supplementary Pasteurised 6 Sterilised 7 Tuberculin tested 6 19 51 E (2)f Ice-Cream During the year, 18 samples of ice-cream were procured and submitted to the Bacteriologist, examination results being as follows:— Grade 1 16 Grade 3 2 18 23 manufacturers of ice-cream are entered on the Register but only 10 operate (i.e. 2 boil mix and 8 cold mix). 52 E (3) Food and Drugs Act, 1938, Sections 3 and 68 The following samples were procured during the year and submitted to the Public Analyst for analysis. Unsatisfactory Genuine No. of Samples Milk 38 38 Ice Cream *2 10 12 Coffee & Chicory Essence 5 5 Pudding Mixture †1 2 3 Sponge Mixture 4 4 Flour Mixture 3 3 Flour 2 2 Golden Raising Powder 1 1 Mustard 1 1 Mixed Spice 3 3 Ground Cinnamon 2 2 Ground Nutmeg 1 1 Ground Pimento 1 1 Pepper Flavoured Compound 1 1 Curry Powder 2 2 Dried Herbs 1 1 Soup Powder 3 3 Desiccated Soup 3 3 Pate Foie 1 1 Meat Paste 2 2 Fish Paste 3 3 Malt Vinegar 1 1 Non-brewed Condiment 1 1 Sauce 2 2 Salad Cream 2 2 Tomato Ketchup 1 1 Horseradish Cream 1 1 Table Salt 1 1 Gravy Salt 2 2 Gravy Powders 3 3 Yeast Extract 2 2 Meat Extract Cubes 2 2 Onion Powder 1 1 Junket Powder †1 — 1 Essence of Rennet 1 1 Dessert Powder 1 1 Tapioca Dessert 1 1 Tapioca 1 1 Table Jelly 3 3 Melvet 1 1 Custard Powder 5 5 Blanc Mange Powder 2 2 Flavouring Essence 2 2 Shredded Cocoanut in Syrup 1 1 Baby Food 2 2 Potato Crisps 1 1 Orange Squash 1 1 Lime Juice Cordial 1 1 Lemonade 1 1 53 Refreshers ‡1 — 1 Jam 1 1 Sulphur Dioxide 1 1 Milk of Magnesia Tablets 1 1 Headache etc. powders 7 7 Cascara Sagrada Tablets 1 1 Liver Salts 1 1 5 144 149 * Repeat samples satisfactory. † Stocks withdrawn from sale. ‡ No food value. The milk samples averaged a content of 3.52% fat and 8.79 % solids not fat. The ice-cream samples averaged a content of 9.44 % fat. E (4) Meat and Food Inspection (a) Considerable time and attention has been devoted to the inspection of meat and other foods in shops and stores, and the following were confiscated as being unfit for human consumption:— Meat 612 tins Meat 11 cwts. 13 lbs. Fish 182 tins Fish 3 cwts. 1 qr. 2 lbs. Vegetables 303 tins Vegetables 1 qr. 12 lbs. Fruit 3,978 tins Fruit 1 cwt. 1 qr. 18 lbs. Preserves 71 tins Preserves 2 qrs. 1 lb. Cheese 7 boxes Cheese 22 lbs. Cereals 1 cwt. 3 qrs. Fats 11 cwts. 3 qrs. 8 lbs Coffee 7 bottles Tea 1 qr. 15 lbs. Cordials 34 bottles Confectionery 3 tons 10 cwts. 1 qr. 4 lbs. Milk powder 2 cwts. 2 qrs. Total weight 8 tons 15 cwts. 0 qrs. 3 lbs. E (5) Slaughter of Animals Act 1933 The above Act makes the use of mechanically operated instruments a statutory obligation. By resolution of the Council dated 23rd May, 1938, the provisions of Section 1 of the Act apply to sheep which are slaughtered in the district. 54 E (6) Food Hygiene Clean Food Traders' Guild By the end of the year, formulations of Codes of Practice had been completed, having regard to the various food trades, and arrangements were in hand to invite traders to apply for membership to the Clean Food Traders' Guild. The joint Erith, Bexley and Crayford Food Hygiene Exhibition held at Crayford in May, stimulated much interest amongst local food traders, and in foodshops in the Borough it is now noted that in many cases attempts are being made by shopkeepers to bring their premises up to Code standard. E (7) Health Education In co-operation with the Ministry of Agriculture and Fisheries and Central Office of Information, a series of Food Hygiene and Health films were shown to the members of two organisations in the Borough. Appreciative audiences numbered 150. F (4) National Assistance Act, 1948. Sec. 47 The persons covered by the above section are those mentioned in sub-section 1 as follows:— (a) Persons who:— Are suffering from grave chronic disease, or, being aged, infirm or physically incapacitated, are living in insanitary conditions, and (b) Are unable to devote to themselves, and are not receiving from other persons, proper care and attention. Throughout the year, close liaison has been maintained with the Old Age Pensioners' Association and the Kent County Council's Home Help Service, whereby it has been possible to render some assistance to those to whom this Statute applies. 55 F (5) Legislation in Force—Byelaws Tents, vans and sheds 28th Feb. 1928 Houses let in lodgings 27th Jan. 1930 Slaughterhouses 29th Feb. 1932 Libraries and Museums 15th June 1934 Nursing Homes 20th July 1934 Pleasure Grounds 4th Feb. 1936 Dogs fouling footpaths 22nd Feb. 1939 Fish Frying 9th May 1939 Building bye-laws 10th Aug. 1939 House refuse 17th Oct. 1939 Erith Cemetery 25th Oct. 1939 Public Baths 26th Oct. 1939 Prevention of Nuisances 23rd Apr. 1940 Good rule and government 1st Jan. 1941 Offensive trades 9th May, 1939 Deposit of litter 9th Jan. 1950 Clean food 19th July, 1950