BOROUGH OF ERITH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the year 1964 JOHN LANDON, M.R.C.S., L.R.C.P., D.P.H. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH To the Chairman and Councillors of the Urban District of Erith. MR CHAIRMAN, LADIES AND GENTLEMEN, I have the honour to present the Annual Report for 1964. Owing to the coming into operation of the London Government Act, 1963 and the creation of the London Borough of Bexley on April 1st, 19&5, usual form of presentation has had to be modified, the contents being largely statistical and intended to preserve continuity with previous reports. My thanks are due to the Members of the Authority and Staff of the Department for their unfailing help and encouragement over the years. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. STATISTICS 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- 45,970. Density of population, i.e. No. of persons per acre (Based on (ii) above):- 11.95. No. of inhabited houses at 31st December, 1964. (Excluding houses with shops and houses with Public Houses assessed as single hereditaments):- 14,045# Rateable value at 31st December, 1964:- £2,688,717 Sum produced by a penny rate, 1964 (Product for 1964/65):- £12,000. Rate in the £ at 31st December, 1964:- 9/3d. EXTRACTS FROM VITAL STATISTICS FOR YEAR 1964 Births Male Female Total Live Births Legitimate 385 358 743 Illegitimate 28 20 48 413 378 791 Live Birth rate per 1,000 Home Population (Registrar General!s Figure):- 17.21. Birth rate corrected for comparison with other areas:18.07. Comparability factor supplied by Registrar General:- 1.05. Live Birth Rate, England and Wales:- 18,4 Corresponding rate for the Borough of Erith for year 1963:- 17.91. Male Female Total Still Births Legitimate 11 8 19 Illegitimate - - - 11 8 19 Still Birth Rate per 1,000 total births:- 25.46. Still Birth Rate per 1,000 total births, England and Wales:- 16.4. Still Birth Rate per 1,000 Home Population:- 0.41. Still Birth Rate per 1,000 Home Population, England, and Vales:- 0.31. Male Female Total Total Live and Still Births 424 386 810 Infant Mortality Deaths of infants under 1 year of age:- Male Female Total Legitimate 6 9 15 Illegitimate 1 l 2 7 10 17 Death rate of Infants under one year of age, per 1,000 live births:- 21.49- Hate per 1,000 live births, England and Wales:- 19.95. Rate per 1,000 legitimate live births:- 22.88. Rate per 1,000 illegitimate live births:- 28.24. Deaths of infants under 4 weeks of age:- Male Female Total Legitimate 4 6 10 Illegitimate 1 1 2 5 7 12 Neo-natal Mortality Rate:- Death rate of infants under 4 weeks of age per 1,000 live births:- 15.04. Death rate of infants under 4 weeks of age per 1,000 live births England and Wales:- 15.8. Early Neo-natal Mortality Rate:- Death Rate of infants under 1 week of age per 1,000 live births:- 15.04. Perinatal Mortality Rate:- Still births and deaths of infants under 1 week of age combined per 1,000 total live and still births:- 38.27. Illegitimate live births per cent of total live births:- 6.07. Deaths Maternal Deaths. Number of women dying in, or in consequence of, childbirth:- Nil. Maternal Mortality Rate per 1,000 total births:- Nil. Comparative figure for England and Wales:- 0.25. Deaths all Causes. Male, 252. Female, 202. Total, 454. Death rate per 1,000 Home Population:- 9-88. Death rate corrected for comparison with other areas:10.07. Comparability Factor supplied by Registrar General:- 1.12. Corresponding rate, 1963:- 11.53. Death rate per 1,000 Home population, England and Wales:- 11.3 1964 1963 Total number of deaths from:Measles (All ages) - Whooping Cough - SUMMARY OF VITAL STATISTICS FOR THE YEAR 1964 England and Wales Borough of Erith BIRTHS:- Rates per 1,000 Home Population Live births 18.4 17.21 Still births 0.31 0.41 16.4(a) 23.46(a) DEATHS:- All causes 11.3 9.88 Typhoid and Paratyphoid 0.00 - Whooping Cough 0.00 - Diphtheria - - Tuberculosis 0.05 0.07 Influenza 0.02 - Smallpox - — Acute Poliomyelitis (including Polio-encephalitis) - - Pneumonia 0.63 0.72 NOTIFICATIONS:- (Corrected) Typhoid Fever 0.00 Paratyphoid Fever 0.00 - Meningococcal Infection 0.01 - Scarlet Fever 0.42 0.50 Whooping Cough 0.67 0.26 Diphtheria 0.00 - Erysipelas 0.04 0.09 Smallpox - - Measles 6.47 4.18 Pneumonia 0.19 0.02 Acute Poliomyelitis (including Polio-encephalitis) Paralytic 0.00 - Non-Paralytic 0.00 - Food Poisoning 0.11 0.04 Puerperal Pyrexia 6.67(a) 6.17(a) DEATHS:- Rates per 1,000 live births All causes under 1 year of age 20.00 21.49 Enteritis and diarrhoea under 2 years of age 0.57 - (a) Per 1,000 Total (Live and. Still) Births TABLE SHOVING SUMMARY OF CAUSES OP DEATH DURING THE YEAR ENDED 31st DECEMBER, 1964 Cause of Death Males Females Total 1 Tuberculosis, Respiratory 2 - 2 2 Tuberculosis, Other forms - 1 1 3 Syphilitic diseases 1 - 1 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal Infection - - - 7 Acute Poliomyelitis - - - 8 Measles - - - 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 6 4 10 11 Malignant neoplasm, lung, bronchus 24 7 31 12 Malignant neoplasm, breast 1 9 10 13 Malignant neoplasm, uterus - 7 7 14 Other malignant and lymphatic neoplasms 31 15 46 15 Leukaemia, Aleukaemia - 1 1 1 16 Diabetes - 1 1 17 Vascular lesions of nervous system 26 35 61 18 Coronary disease, angina 52 35 87 19 Hypertension with heart disease 2 7 9 20 Other heart diseases 23 25 48 21 Other circulatory diseases 10 10 20 22 Influenza - - - 23 Pneumonia 21 12 33 24 Bronchitis 23 3 26 25 Other diseases of respiratory system 5 — 5 26 Ulcer of stomach and duodenum 3 2 5 27 Gastritis, enteritis and diarrhoea - 2 2 28 Nephritis and Nephrosis 3 1 4 29 Hyperplasia of prostate 2 - 2 30 Pregnancy, Childbirth and abortion - - - 31 Congenital Malformations 3 3 6 32 Other defined and ill-defined diseases 8 17 25 33 Motor vehicle accidents 3 - 3 34 All other accidents 1 4 5 35 Suicide 2 1 3 36 Homicide and operations of war - - - TOTAL ALL CAUSES 252 202 454 INFANT MORTALITY - CAUSES OP DEATH AND TABLE OP COMPARISON 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 day-2 months 2 months 3 months 4 months -5 months 6 months 7 monras 8 months 9 months 10 months 11-12 months. Total deaths under 1 year Prematurity 4 - - 1 - - - - - - - - - - - - - - - - - 5 Acute Lymphoblastic leukaemia - - - - - - - - - - - - - - 1 - - - - - - 1 Pulmonary congestion - - - - - - - - - - - - - - - - - - - - 1 1 Broncho pneumonia - - - - - - - - - - - - - - - 1 - 1 - - - 2 Anencephaly - 1 - - - - - - - - - - - - - - - - - - - 1 Ventricular haemorrhage 1 - - - - - - - - - - - - - - - - - - - - 1 Congestive pulmonary failure - - 1 - - - - - - - - - - - - - - - - - - 1 Acute cardiac failure - - - - - - - - - - - - - - - - - - - - - 1 Congestive cardiac failure 1 - - - - - - - - 1 - - - - - - - - - - - 2 Multiple congenital deformities 1 - - - - - - - - - - - - - - - - - - - - 1 Internal hydrocephalus - - 1 - - - - - - - - - - - - - - - - - - 1 Totals 7 1 2 1 - - - - - 1 - - - - 1 1 1 1 - - 1 17 SECTION B. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFICATION AND AGE DISTRIBUTION The following table shows the age distribution of confirmed cases of Infectious Disease (other than Tuberculosis) notified during the year. Disease Age Groups Under 1 year 1 2 3 4 5-9 10-14 15-24 25 & over Age not known Totals M F M F M F M F M F M F M F M F M F M F Acute Pneumonia - - - - - - - - - - - - - - - - - - - - 1 Dysentery - - - - - - - - - - - - - - - - - - - - 2 Measles 4 7 9 10 12 17 14 17 16 13 44 28 - 1 - - - - - - 192 Whooping Cough - 1 1 1 1 3 1 1 - - 3 - - - - - - - - - 12 Puerperal Pyrexia - - - - - - - - - - - - - - - 4 - 1 - - 5 Scarlet Fever - - - - - - 1 1 1 3 7 8 - - 2 - - - - - 23 Food Poisoning - - - - - - - - - - - - - - - - 1 1 - - 2 Totals 4 8 10 11 13 21 16 19 17 16 55 36 - 1 2 4 2 2 - - 237 TUBERCULOSIS B (2)a New Cases notified for the first time during 1964 Age Respiratory Non-Respiratory Total M F M F Under 5 years - - 1 - 1 5-14 " - 1 - - 1 15-24 " 1 2 - - 3 25-44 " 2 - 1 3 6 45-64 " 5 3 - - 6 65 & over 3 2 - - 5 Age unknown - - - - - Totals 9 8 2 3 22 In addition to the above cases eight males and seven females suffering from respiratory tuberculosis, and one male suffering from non-respiratory tuberculosis were transferred into the district from other areas. 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 M F Total M F Total M F Total 2 - 2 - 1 1 2 1 3 IMMUNISATION AGAINST DIPHTHERIA AND WHOOPING COUGH, 1964 The following table shows the diphtheria immunisation and. whooping cough immunisation figures for 1964 based on the returns submitted to the Ministry of Health by the Local Health Authority. Year of Birth Diphtheria Immunisation (Singly or in combination) Whoopihg Cough Immunisation (Singly or in combination) Primary Reinforcing Primary 1964 264 - 263 1965 557 11 335 1962 21 227 21 1961 10 125 9 1960 8 42 8 1955-1959 3 245 2 1950-1954 1 - - Totals 644 650 638 SMALLPOX VACCINATION, 1964 The following table shows the smallpox vaccination figures for 19&4 based on the return submitted to the Ministry of Health by the Local Health Authority. Primary Vaccination Re-Vaccination 1 Year School Age but under 8 years 310 Nil POLIOMYELITIS VACCINATION, 1964 The following table shows the poliomyelitis vaccination figures for 1964 based on the return submitted to the Ministry of Health by the Local Health Authority. Year 3rd and 4th Dose (Salk and Oral) 3 Orals (Complete Course) 1964 - 85 1965 7 469 1962 3 71 1961 - 30 1949-1960 348 54 1933-1948 - 11 Others - 3 NATIONAL ASSISTANCE ACT, 1948 SECTION 47 Sanitary circumstances and associated home conditions of the many aged persons have been kept under review, and where indicated, the necessary improvements have been effected. SECTION C - SANITARY CIRCUMSTANCES OF THE AREA I am indebted to the Chief Public Health Inspector for the following information. Sanitary Inspection of the Area Visits by Public Health Inspectors, The total number of visits was 4635 Notices served: 26 Formal 120 Informal 146 Complaints received and investigated 1041 Summary of Nuisances abated and defects remedied during the year. Dampness remedied 52 Roofs repaired 44 Floors repaired 25 Eaves gutters repairod 28 New W.C. pans 11 New sinks 6 Sink wastes renewed 5 Drains repaired 20 New vent pipes 8 Doors repaired 5 Plasters renewed 46 Repairs to windows 42 Water supply restored 6 Dustbins renewed 12 W.C. cisterns repaired 10 Offensive accumulations removed 24 Walls re-pointed 12 Keeping of animals 5 Miscellaneous 82 Drainage, Closet accommodation and Cesspools Almost all premises in the Borough are connected to the main sewerage system and are provided with properly functioning water closets. Sewage is disposed of at the outfall works of the West Kent Main Sewerage Board situated in the area of a neighbouring Local Authority. Some drainage difficulties occur in premises situated on the Belvedere Marshes and consideration is being given to improving the situation there. Fourteen domestic cesspools are known to exist and these are emptied when required by a special vehicle and the contents emptied into the Council's sewer. CLEAN AIR ACT, 1956 BOROUGH OF ERITH (NO.l) SMOKE CONTROL ORDER, 1961 The above Order, which covers approximately 390 acres in which there are about 3,234 dwellings, was confirmed on the 18th April, 1962. During 1964 a further 516 approvals were given to householders for the carrying out of works to comply with the Order. As it appeared that by the operative date the total number of applications received would fall considerably short of the number expected (i.e. only about half) the operative date was postponed to the 1st April, 1965, in order that further conversions could be achieved. OFFENSIVE TRADES Fish frying was declared to be an offensive trade in the Borough in March 1939 and bye-laws were made accordingly. There are no other scheduled offensive trades under Section 107 of the Public Health Act, 1936, operating within the Borough. Renewals of the consent to establish offensive trades were granted in the case of 11 fish frying premises, all of which are well conducted with frying apparatus of a modern and approved pattern. RAG, FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Act is designed to secure that clean filling materials are manufactured and used. There are two registered premises in the borough in which filling materials, as defined in the Act, are used in the upholstery trade. During the year the premises have been regularly inspected and one sample of white cotton felt and one sample of coir fibre were obtained and submitted to the prescribed Analyst for the purpose of testing, both the samples were satisfactory. CARAVAN SITES Under Section 3 of the Caravan Sites and Control of Development Act, 1960, there is only one conditionally licensed site existing in the Borough. The site in question consists of approximately one half acre of land in which three caravans are stationed. During the year it was found necessary to give attention to various sites in order that unauthorised caravanners did not become established. RODENT CONTROL Two trained Operators are employed to deal with rodent infestations at commercial, private and corporation premises. 90 infestations in dwelling houses and 21 infestations in other premises were dealt with, this shows a slight increase over the previous year but the majority of infestations were very small. Test baiting of the Corporation's sewers confirmed that very little infestation exists nowadays and this situation exists because of the treatments based on Ministry techniques which have been carried out for a number of years. FACTORIES ACT 1961 PART 1 OF THE ACT (1) Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections l,2,3,4 6 are to be enforced by Local Authorities - - - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority - - - - (iii)Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) - - - - (2) Cases in which defects were found Particulars Number of cases in which defects were found Referred Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By.H.M. Inspectoi (1) (2) (3) (4) (5) (6) Want of cleanliness (s.1.) - - - - - Overcrowding (S.2.) Unreasonable temperature ( s. 3. )... - - - - - Inadequate ventilation (S.4.) - - - - - Ineffective drainage of floors (S.6.) 1 1 - - - Sanitary conveniences (S.7.) (a) Insufficient 3 3 - - - (b) Unsuitable or defective 2 2 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 6 6 - - - PART 8 OP THE ACT. OUTWORK. SECTIONS 135 AND 134. Section 133 Section 134 Nature of Work No. of outworkers in August list required by Section 133 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 43 - - - - - Lampshades 2 - - - - - Total 45 - - - - - SECTION D HOUSING HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE. RESULTS OF ACTION. In Clearance areas declared under Sec. 42 H.A.1957 NIL HOUSES DEMOLISHED DURING THE YEAR No. of houses demolished As a result of pro- Formal 2 cedure under Sec. Informal 16 or 17 HA 1957. Local Authority owned houses certified unfit by MOH. 2 0 Not in Clearance areas Persons displaced during year. From houses demolished as a result of formal or informal procedure under sees. 16 or 17 HA 1957 From Local Authority houses certified unfit By MOH. 10 0 Families displaced during year From houses demolished as a result of formal or informal procedure under sees. 16 or 17 HA 1957 5 From Local Authority houses certified unfit by MOH. 0 UNFIT HOUSES CLOSED DURING YEAR No. of Houses Under sees. Housing Act Housing Act Under sees. Act 1957. 16(4), 17(1) and 35(1) 1957 and sec.26 1961. 2 17(3) and 26 Housing 0 Persons displaced during year From houses closed:- Under sees. 16(4), 17(l) and 35(1) Housing Act 1957 and sec. 26 Housing Act 1961 Under sees 17(5) and 26 Housing Act 1957. 13 Families displaced during year. From houses closed:- Under sees. l6(4), 17(l) and 35(l) Housing Act 1957 and sec.26 Housing Act 1961. Under sees 17(3) and 26 Housing Act 1957. 4 0 UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED After informal action byLocal Authority. By owner After formal notice under (a) By owner Public Health Acts (b) By L.A. After formal notice under (a) By owner sees. 9 and 16 Housing (b) By L.A. Act 1957. Under sec. 24 Housing Act 1957. By owner 102 26 0 0 0 0 Parts of Buildings closed under Section 18, Housing Act, 1957 Number of houses Nil Number of persons displaced Nil Number of families displaced Nil Housing Statistics Number of permanent houses constructed in the Borough during 1964- Houses Flats & Maisonettes By the Council 0 0 By private enterprise 95 39 Total number of permanent houses in the Borough which have been built and are owned by the Council 1,395 Total number of flats which have been built and are owned by the Council 650 Total number of pre-fabricated temporary houses in the Borough 182 Discretionary Grants These are available for a wide range of improvements which enable houses built before 1945 to be thoroughly modernised. Number granted during the year: 32 1 Standard Grants These grants are available for the improvement of dwellings built before 1945 by the provision of certain amenities. Number granted during the year: 44 The Rent Act 1957 Action under the Act is enumerated below (1) Number of Applications for Certificates of disrepair 2 (2) Number of Certificates issued 2 (3) Number of Revocations applied for - (4) Number of Revocations granted - SECTION E - WATER SUPPLY - MILK - POOD AND DRUGS ACT - FOOD INSPECTION Water supply The Borough is served throughout by the Metropolitan Water Board, the water containing some 30.8 degrees of hardness. Without known exception, the supply is led direct into the premises served. Sixteen samples drawn from various points in the district have "been forwarded to the Public Health Laboratory for bacteriological examination, with satisfactory results. Milk (Special Designation) Regulations. I960. (a) The designations applicable to milk sold in the Borough are •Pasteurised', 'Sterilised' and 'Tuberculin Tested'. Pasteurised milk must be bottled at the premises at which it is heat treated. There are no pasteurising plants and bottling establishments within the Borough. (b) Details of dealers licences to use a special designation in relation to milk which is obtained and sold pre-packed by the dealer are as follows:- Pasteurised 27 Sterilised 16 Tuberculin tested 24. Total 67 (c) The following samples of designated milk from various sources and retailed in the Borough were obtained and submitted for examination:- Pasteurised 12 Sterilised 3 Tuberculin Tested (Pasteurised) 2 Total 19 All satisfied the prescribed tests. Milk and Dairies (General) Regulations, 1959* Number of registered distributors in Borough 12 Number of dairies 3 Number of milkshops 39 Number of producer/retailers 0 Regular inspections have been made at the above throughout the year. Ice-Cream 130 premises in the Borough are registered for the sale of ice cream. The majority deal in prepared products produced by the large manufacturers. Two premises are used for the manufacture of ice cream by the heat treatment method. Three samples of ice cream and one sample of ice cream mix were submitted to the Public Analyst and reported as satisfactory. Nine samples were forwarded to the Public Health Laboratory for bacteriological examination and graded .satisfactory as follows Grade 1 7 Grade 2 2 Inspection of Other Foods Much time and attention has been devoted to the inspection of food in shops and stores as a result of which a total of 5 tons, 8 cwts., 1 qtr., 8 lbs, was found to be unfit for human consumption and surrendered for removal and destruction. Food and Drugs Act, 1955Sampling A total of 128 informal and 3 formal samples of Food and Drugs were submitted to the Public Analyst for analysis, this total included 11 samples of milk. Eleven samples were reported as unsatisfactory and action was taken as appropriate to each case. Food Hygiene (General) Regulations, 1960 With the exception of a few mobile traders all food trading takes place from premises, there being no roadside stalls or markets. Considerable time has been given to the implementation of the above Regulations and further improvements to premises have been carried out during the year. In the case of the Public Houses situated in the Borough, liaison exists with the Licensing Justices regarding the transfer of licences. Slaughter of Animals Act. 1958 A total of 11 licences were renewed or issued to slaughtermen under the above Act. The Instruments permitted to be used being the captive bolt pistol and the electrolethaler. Meat and Food Inspection: Slaughterhouses- There is one privately owned Slaughterhouse situated in the Borough and slaughtering of animals takes place there every day of the week except Friday. In order to carry out 100% inspection of carcases and offals in accordance with the Meat Inspection Regulations, 1963, it has been necessary to have 2 Public Health Inspectors regularly in attendance. Because of the resulting disruption of other duties, and the fact that during the year a considerable amount of overtime at week-ends and on some evenings was being worked, the Council decided at the end of the year to appoint a further Public Health Inspector. The Meat Inspection Regulations, 1963, give power to the Local Authority to make charges for meat inspection, and the Council have adopted the maximum charges permitted i.e. 2/6 per bovine animal (other than calf); 9d« per calf or pig; 6d. per sheep, lamp or goat. The following table in the prescribed form details the number of carcases and offals inspected and condemned in whole or in part Carcases & Offal inspected and condemned in whole or in part : Cattle excluding Cows: Cows Calves Sheep and Lambs Pigs Horses Number killed: 2062 5386 80 9453 31,998 - Number inspected: 2062 5386 80 9453 31,998 - ALL DISEASES EXCEPT TUBERCULOSIS & CYSTICERCI: Whole carcases condemned 7 1 5 30 - Carcases of which some part or organ was condemned 355 2428 4 216 2410 Percentage of the number inspected affected with disease other than tuberculosis & cysticerc 17.2 45.2 6.25 2.34 7.6 Tuberculosis only: Whole carcases condemned - 1 - - - Carcases of which some part or organ was condemned - 3 - - 72 Percentage of the number inspected affected with tuberculosis - .07 - - .23 Cysticercosis Carcases of which some part or crgan was condemned - - - - - Carcases submitted to treatment by refrigeration - - - - - Generalised and totally condemned - - - - - TOTAL WEIGHT of meat found during routine inspection at the slaughterhouse to be unfit for human consumption: 24 tons 7 cwts. 1 qu. 2 lbs.