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subsequent months. Some of the factors being considered during this period prior to the final
approval of the plans were the restrictions of the site, the separate nature of the participating
practices, and the changing pattern of the health and social services' administration, including the
possibility that there might be separate area offices for social workers. The proximity of the Erith
and District Hospital made it unnecessary to include hospital services, but in respect of the main
community health services the plans were comprehensive.
CANCER
The environmental causes of cancer deserve more attention. The Pfizer International
Symposium Monograph No.2 on Racial and Geographical Factors in Tumour Incidence, and the
International Agency for Cancer Research Reports are recent expressions of this viewpoint.
Globally it is easier to see such causes than in a comparatively small area like a London Borough.
Statistical methods were used initially in directing attention to the hazards of cigarette smoking
and it is possible that such methods used in conjunction with local epidemiological intelligence on
this subject might be productive of useful information in the future.
In the meantime the national anti-smoking campaign pursued its long slow progress which
included the local use of publicity material and the giving of talks to groups in schools or other
places in Bexley. The adverse effects of smoking by expectant mothers on their unborn children
were emphasised in the appropriate settings.
CERVICAL CYTOLOGY
The cervical cytology scheme in Bexley continued as described in the previous Annual
Report. When the demand for tests went up or down the number of clinics was adjusted accordingly,
but at no time was the service under the serious pressure which applied to it in 1966-67 nor
was the waiting period for it above the unavoidable minimum. All three branches of the National
Health Service and the Family Planning Association undertake cervical cytology tests. The local
health authority scheme for Bexley can be described in the following three respects
BEXLEY LONDON BOROUGH CYTOLOGY SCHEME
(1) General publicity and provision of cervical cytology clinics for all women aged 25 years and
upwards.
(2) Specific publicity and specially arranged clinics for groups of women in co-operation with
industrial firms employing women and with voluntary organisations of primary interest to
women.
(3) Deliberate extension of the scheme to selected women thought to be at greater than average
risk, for example those approaching middle age. This part of the scheme operated with the
full participation of general practitioners who selected from amongst their patients those
women of any age for whom the examination might be desirable on clinical grounds, also
some women between 25 and 65 years on socio-economic grounds and all their female
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