I BRO 17 LONDON BOROUGH OF BROMLEY Library Annual Report OF THE MEDICAL OFFICER OF HEALTH 1965 L. R. L. EDWARDS, M.D. (Lond.). M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health CIVIC OFFICES, THE WALNUTS, HIGH STREET, ORPINGTON, KENT Telephone: Orpington 27666 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH 1965 L. R. L. EDWARDS, M.D. (Lond.). M.B., B.S., M.R.C.S., L.R.C.P.. D.P.H. Medical Officer of Health CIVIC OFFICES, THE WALNUTS, HIGH STREET, ORPINGTON, KENT Telephone: Orpington 27666 3 INDEX Page A Animal Boarding Establishments 122 B Bacteriological Examinations— Sundry 95 Burial or Cremation of Deceased Persons 82 C Care of Mothers and Young Children 22 Care of Unmarried Mother and Her Child 23 Cervical Cytology 26 Child Minders 25 Chiropody 32 Clean Air Act 109 Common Lodging Houses 105 D Day Nurseries 25 Dental Services—M. & C.W. 33 Diphtheria 40 Diseases of Animals 121 Disinfection 109 Disinfestation 109 Drainage and Sewerage 107 Dysentery 40 E Environmental Health Services 84 Erysipelas 40 F Factories Act 116 Food and Drugs Act—Sampling 86 Food Complaints 96 Food Hygiene Regulations 100 Page Food Poisoning 40 Food Premises 99 Food Premises—for Preparation 99 G Geriatric Community Services 63 H Health and Welfare Committee 7 Health Education 35 Health Visiting 28 Home Help Service 33 Home Nursing 31 Home Safety 36 Housing and Slum Clearance 100 Housing—Improvement Areas 103 Housing—Improvement Grants 103 Housing Inspections 104 Housing—Public Health Acts 102 I Ice Cream—Sampling 95 Immigrants — Medical Arrangements 32 Infectious and Other Diseases 40 Insect Infestation 109 Inspection and Supervision of Foods 86 Introductory Review 11 M Marie Curie Foundation Fund 31 Maternity and Child Welfare 22 Meals and Recreation 64 Measles 42 Meat Inspection 96 Meningococcal Infections 42 5 IN DEX—(continued) Page Mental Health Services 45 Mental Illness 50 Mental Subnormality 47 Midwifery 27 Milk—Sampling 95 Milk—Special Designations Regulations 99 Mortuaries 117 Moveable Dwellings 106 N National Assistance Acts 32, 54 Nursing Homes 26 O Offices, Shops and Railway Premises Act 113 Ophthalmia Neonatorum 43 Outwork 117 P Paratyphoid Fever 43 Pet Animals 122 Pigeon Destruction 112 Play Therapy and Clinic Play Groups 23 Pneumonia 42 Poliomyelitis 40 Protection of Property 81 Puerperal Pyrexia 43 R Recuperative Care 31 Registration—Disabled and Old People's Homes 81 Page Rehousing 102 Residential Care 54 Riding Establishments 122 Rodent Control 111 S Scarlet Fever 42 Smallpox 42 Special Housing of the Elderly 64 Staff 7 Statistics—Environmental 122,125 Statistics—Vital 16 Statutory Notices 105 Swimming Baths 121 T Temporary Accommodation 62 Training Centres 48 Tuberculosis 42 Typhoid Fever 43 U Unsound Food 94 V Vaccination and Immunisation 23 Vital Statistics 16 W Water Supply 118 Welfare — Blind and Partially Sighted 71 Welfare Foods 23 Welfare — Handicapped Persons 65 Welfare Services 54 Whooping Cough 43 7 HEALTH AND WELFARE COMMITTEE (as at 31st December, 1965) Chairman: Councillor Miss B. James, J.P. Vice-Chairman: Councillor Mrs. S. M. Stead. The Mayor: Alderman H. T. Parkin, J.P. Councillors: Mrs. N. V. Carter D. J. W. Eves H. W. Haden Mrs. M. J. Higgins A. T. Johnson, J.P. M. J. Neubert, M.A. Miss B. G. Oldham Mrs. C. A. Parker Mrs. M. M. Read L. Selwyn J. P. Sheridan, A.M.I.E.I. C. E. Stickings, B.Sc., Ph.D. Mrs. D. E. L. West, M.B.E. Co-opted Members: H. J. Lester, O.B.E., J.P., F.C.A. Dr. P. D. MacLellan, M.A., M.B., B.Chir., M.R.C.S., L.R.C.P. Miss D. J. Owens, S.R.N., S.C.M., M.T.D. STAFF OF THE HEALTH AND WELFARE DEPARTMENT 0as at 31st December, 1965) MEDICAL AND DENTAL STAFF: Medical Officer of Health and Principal School Medical Officer: L. R. L. EDWARDS, m.d. (Lond.), m b., b.s., m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health and Deputy Principal School Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer (Schools): H. B. Carter-Locke, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Senior Medical Officer (Maternity and Child Welfare): P. A. Currie, m.r.c.s., l.r.c.p. Senior Medical Officer (Mental Health): Sara Syrop, m.d. (Warsaw), d.p.h., d.c.h., d.t.m. & h. 8 Assistant Medical Officers: *(Mrs.) V. M. Collins, m.b., b.s., d.r.c.o.g. *(Mrs.) A. Gall, m.a., m.b., b.ch. (Mrs.) G. L. Hobbs, m.r.c.s., l.r.c.p. E. Gaynor Lewis, m.b., b.ch., d.t.m. & h. (Mrs.) A. J. Jones, m.b., ch.b. (Mrs.) J. C. Lister, m.b., b.s. (Lond.). (Mrs.) B. R. Luscombe, m.r.c.s., l.r.c.p. (Mrs.) C. M. Maxwell, m.a., m.b., b.chir. (Mrs.) J. C. Van Essen, m.b., ch.b. *Part-time. 10 General Practitioners attend clinics on a sessional basis. Principal Dental Officer: Mrs. C. M. Lindsay, L.D.S., r.f.P.S. (Glasgow). Dental Officers: R. G. Cooper, b.d.s., l.d.s., r.c.s. (Eng.). (Mrs.) I. T. Creed, l.d.s., r.c.s. (Eng.). (Mrs.) T. Farmer, b.d.s. (Mrs.) A. R. Leach, b.d.s. (Mrs.) A. P. O'Reilly, l.d.s., r.c.s. (Eng.). (Mrs.) M. I. Kininmonth, l.d.s. (Part-time). 4 Dental Officers Sessional, 2 Anaesthetists Sessional, 1 Orthodontist Sessional, 1 Dental Hygienist, 9 Dental Attendants. Orthopaedic Surgeon: K. F. Hulbert, f.R.C.S. Physiotherapist: Mrs. v. Norman, m.c.S.p. Senior Speech Therapist: Mrs. M. M. Evans, l.C.S.t. Orthoptist: Miss D. A. Driskell, d.b.o. Chest Physicians (in conjunction with Regional Hospital Board): D. G. Madigan, b.a., m.b., b.ch., b.a.o., n.u.i. E. W. Street, m.r.c.s., l.r.c.p. NURSING AND ALLIED STAFFS: Superintendent Home Nursing Service: Mrs. J. Symington, s.r.n., s.c.m., d.d.n. Deputy Superintendent Home Nursing Service: Mrs. M. O. Tierney, s.r.n., q.n. 38 Home Nurses. Superintendent Health Visitor: Miss B. N. Chandler, s.r.n., s.c.m., h.v. cert.,Dip. soc. studies (Lond.). Deputy Superintendent Health Visitor: Mrs. M. M. Connolly, s.r.n., s.c.m., q.n., h.v. Cert. 39 Health Visitors, 1 Supernumerary Student Health Visitor. Non-Medical Supervisor of Midwives: Mrs. B. Adcock, s.r.n., s.c.m., h.v. cert. Deputy Supervisor of Midwives: Miss G. I. Simmons, s.r.n., s.c.m. 28 District Midwives (including 1 part-time). Senior Home Help Organiser: Miss j. Woodrow, m.i.o.h.h.o. 5 Area Home Help Organisers. 9 PUBLIC HEALTH INSPECTORS' STAFF: Chief Public Health Inspector: J. C. Kermode, m.a.p.h.i., m.R.S.h. Deputy Chief Public Health Inspector: W. T. Weedy, m.a.p.h.i., m.R.s.h. Divisional Public Health Inspectors: A. I. Bell, m.a.p.h.i. P. R. Light, m.a.p.h.i., a.r.s.h. E. U. Williams, m.a.p.h.i. 15 Public Health Inspectors, 4 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 6 Rodent Operators, 2 Disinfector/ Handymen, 2 Mortuary Keepers, 1 Diseases of Animals Inspector. WELFARE SERVICES' STAFF: Chief Welfare Officer: J. Hanson, d.m.a., f.i.s.w. Deputy Chief Welfare Officer: J. R. Gill, d.m.a., a.i.s.w. Casework Supervisor: Mrs. E. K. Lemare-Long, a.m.i., m.s.w. 6 Social Welfare Officers, 2 Domiciliary Craft Instructors, 3 Home Teachers of Blind, 1 Occupational Therapist, 2 Trainee Welfare Assistants, 6 Residential Homes each with Superintendents, Matrons, Chaplains and other Staff. Chief Chiropodist: A. J. Jones, s.r.c., m.c.l.s. 3 Chiropodists (Sessional). MENTAL HEALTH STAFF: Senior Mental Welfare Officer: H. J. Vagg, a.r.s.h., a.i.s.w. 6 Mental Welfare Officers, 1 Supernumerary Mental Welfare Officer. Training Centre: 1 Senior Assistant Supervisor, 7 Assistant Supervisors, 1 Trainee Assistant Supervisor. ADMINISTRATIVE STAFF: Chief Administrative Officer: N. H. Collins, a.c.c.s., a.r.s.h. Senior Administrative Officer: S. F. Judd, a.r.s.h. Central Administration Senior Administrative Assistant: R. D. Billings, a.c.c.s. 1 Secretary, 3 Clerks, 2 Shorthand-Typists, 3 Supernumerary Junior Clerks, 2 Telephonists, 1 Driver/Storekeeper. Environmental Health Senior Administrative Assistant: B. Adams. 1 Administrative Assistant, 4 Clerical Assistants, 3 Clerks, 2 Shorthand-Typists, 1 Supernumerary Junior Clerk. Maternity and Child Welfare Senior Administrative Assistant: G. R. L. Smith. 3 Clerical Assistants, 2 Clerks, 1 Shorthand-Typist. Mental Health 1 Administrative Assistant, 1 Clerical Assistant, 1 ShorthandTypist. 10 Welfare 3 Administrative Assistants. 4 Clerical Assistants, 2 Clerks, 2 Shorthand-Typists, 4 Clerks (Residential Homes). Area Offices and Clinics 8 Clerical Assistants (1 part-time), 5 Clerks, 2 Clerk-Typists, 20 part-time Clinic Clerks. Health Education and Home Safety Officer: J. Bretton. 11 To the Chairman and Members of the Health and Welfare Committee. Ladies and Gentlemen, I have the honour to present the first annual report on the services administered by the Health and Welfare Department of the London Borough of Bromley. The report is set out in accordance with the requirements of Ministry of Health Circular 1/66. In addition, the senior officers of each section reveal in their contributions how the problems of setting up new services and of integrating old services throughout the large area of this new authority have been achieved. This success stems first from the services inherited from the former authorities of Kent County Council, the Boroughs of Bromley and Beckenham, and the Urban Districts of Orpington, Penge, and Chislehurst and Sidcup, and second from the team spirit and blending of experience of members and officers. In this prefatory letter, I should like to comment on reports in the various sections which are particularly noteworthy. National Health Service Act, 1946 Health Visitors The Health Visitor has always needed to be up to date with advances in current knowledge but never more so than at the present time. Valuable links with former colleagues in Kent were maintained. Residential courses have been attended and monthly staff meetings have been addressed by special speakers. Several health visitors have attended short courses during their leisure time and all are equipping themselves for the wider functions of their work. These functions now include health education, cooperation with other social workers, advice to mothers, organising play groups for under fives, and above all, closer links with general practitioners, as shown in the report. Midwifery Owing to shortage of staff, it has not been possible to consider attachment of midwives to group practices. Recruitment is hampered by difficulty in finding suitable single or married accommodation for midwives. The high cost of building in the greater part of the borough is particularly relevant. It is difficult to assess the ultimate ratio of hospital confinements to domiciliary after-care. The report indicates the increase in 48 hour discharges from hospital. Over half the domiciliary midwife's work is directed to post-hospital care. New arrangements for holiday, night and weekend emergency calls were made as former arrangements through the Ambulance telephone network had to be discontinued, and after initial 12 "teething" troubles, a satisfactory system is now in operation and has been of considerable help to the authority. Post-graduate refresher courses for nurses are only statutory for midwives and satisfactory cover was arranged to enable a third of the nurses to attend. Home Nursing A satisfactory feature has been the recruitment of nurses to a full complement. This has enabled the Superintendent to replan the districts so that a designated relief nurse is available to each. The importance of such relief is shown in the heavy nursing care. 65% of the patients attended were over 65 years of age. Effective liaison with the Welfare Section has enabled full use to be made of nursing aids. A recent research by the Queen's Institute entitled "Feeling the Pulse" has suggested the need for a reappraisal of the work of Home Nurses with special reference to increasing opportunities for the additional employment of State enrolled nurses. Such reappraisal is now taking place in the Borough as is also consideration of the possibilities of attachment schemes. Home Help Service The report sets out fully the types of households where domiciliary help is needed. A Family Welfare Help is provided where a careful assessment of the needs of a "problem family" calls for such assistance. A Family Care Help is provided where the mother has been admitted to hospital. Night and evening service is needed for the elderly and frail living alone. Reference is made to recruitment difficulties. The nature of the work makes it necessary to employ mainly part-time workers but it is intended to build up the nucleus of whole-time workers so that more assistance can be given in Family Care and Family Welfare. Health Education The policy of the Council has been to appoint to the Health and Welfare Department, an officer to develop and co-ordinate all work concerning Health Education and to encourage voluntary effort to set up Home Safety Committees in the Borough. In this way, the Health and Welfare Committee has considered groups of people, young and old, and special places where health education is of paramount importance and can be effectively implemented, and from which it can then be gradually extended. Though health education is an honest presentation of the factors promoting good health as shown in the report, it can only 13 have its greatest success when habits have not already been established. Grateful acknowledgment is made to the Education and Hospital Authorities and organisations mentioned in this report for their valuable assistance. Mental Health Act, 1959 Every opportunity has been taken to develop a comprehensive Mental Health Service and to establish the precise extent of community care needed. Details are shown in the report and include an account of the valuable work carried out at the present combined Training Centre at Scads Hill, Orpington. National Assistance Acts, 1948/62 The report of the Chief Welfare Officer on the development of Welfare Services in the new Borough contains not only a factual account of the work of the social workers and occupation officers based at the three area offices but also in numerous places, a valuable evaluation of old and new services. Special attention is drawn to the research in the reports on age in relation to admission or discharge in residential homes, to the value of day care in residential homes, to the development of Family Units for those needing temporary accommodation, and to the work of the social worker in relation to the elderly. Public Health Services The Chief Public Health Inspector reports in detail the setting up of three divisions, the welding together of the services formerly provided by five authorities, and the establishment of a 10 year plan for the development of smoke control areas throughout the Borough. Work on the Offices, Shops and Railway Premises Act, 1963, commenced by the former authorities was continued but hampered by the work of re-organisation and staff shortage. Arrangements for implementing the Riding Establishments Act, 1964, which came into force on the 1st April, 1965, are described. Other new work in the Borough included inspections, licences and issue of movement control orders under the Diseases of Animals Act, 1951. A most valuable part of this report is the support it gives to the investigation of food complaints. Infectious and Other Diseases Apart from a high incidence of measles, there was no unusual incidence of infectious diseases. It is satisfactory to note that the number of cases of tuberculosis on the register declined substantially during the year. 14 Cervical Cytology In spite of the work involved in setting up sections of the new department, it was possible to introduce a pilot scheme for the early detection of cervical cancer through the co-operative efforts of the local authority medical officers and the pathologists of two hospitals in the Borough where schemes were already in progress. Considerable success has been achieved. The year has been a momentous one for the new London Borough of Bromley, and for the Health and Welfare Department the task has been formidable. The change was accomplished with a meritorious smoothness in spite of difficulties in resolving inherited problems. This involved working in cramped conditions, badly sited in relation to the centre of the Borough and in regard to proximity to other departments. I thank my staff, especially the Chief Administrative Officer and Heads of Sections, for their enthusiasm and work during the year. The interest shown by the Mayor and other members of the Council in the welfare of the staff was greatly appreciated. The help given by other Chief Officers and departments is gratefully acknowledged. Finally, I wish to thank the Chairman and members of the Health and Welfare Committee for their support and encouragement throughout the year to me and to every member of my staff. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 16 VITAL STATISTICS Population (Mid-year 1965) 301,450 Area 39,266 acres. Inhabited domestic properties (1.4.65) 95,907 Rateable value as at 1.4.65 £15,373,666 Product of 1d. Rate £63,400 Live Births 4,913 Live Birth Rate (Crude) 16.3 per 1,000 population. Live Birth Rate (Corrected) 16.5 per 1,000 population. Illegitimate Live Births per cent of total Live Births 6.4% Stillbirths 68 Stillbirth Rate 13.7 per 1,000 total live and still births. Total Live and Still Births 4,981 Infant Deaths (deaths under 1 year) 80 Infant Mortality Rate— Total 16.3 per 1,000 total live births. Legitimate only 16.9 per 1,000 legitimate live births Illegitimate only 6.3 per 1,000 illegitimate live births. Neo-natal Mortality Rate 13.4 per 1,000 total live births. Early Neo-natal Mortality Rate 12.2 per 1,000 total live births. Perinatal Mortality Rate 25.7 per 1,000 total live and still births. Maternal Deaths (including abortion) 2 Maternal Mortality Rate 0.4 per 1,000 live and still births. Deaths 3,111 Death Rate (Crude) 10.3 per 1,000 population. Death Rate (Corrected) 10.0 per 1,000 population. Tuberculosis Death Rates— All forms 0.05 per 1,000 population. Pulmonary 0.05 per 1,000 population. Non-pulmonary NIL Cancer Death Rates— All forms 2.2 per 1,000 population. Lung and Bronchus 0.7 per 1,000 population. Other forms 1.5 per 1,000 population. 17 Population The population of the Borough, as estimated by the Registrar General, mid-year, 1965, was 301,450. Births There were 4,913 live births appertaining to the Borough after adjustment for inward and outward transfers, giving a crude birth rate of 16.3 per 1,000 population. The adjusted rate for use when comparing one area with another was 16.5 per 1,000 population. The birth rate for the Borough was lower than the rate of 18.1 for England and Wales as a whole. In addition, there were 65 still births, representing a rate of 13.7 per 1,000 total live and still births, which is also lower than the rate of 15.8 for the country as a whole. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Male 2,410 154 2,564 37 3 40 Female 2,187 162 2,349 28 - 28 Totals 4,597 316 4,913 65 3 68 Deaths 3,111 deaths appertaining to the Borough were registered during 1965, equivalent to a crude death rate of 10.3 per 1,000 population. The adjusted rate for comparison purposes was 10.0. The death rate for the Borough was lower than the rate of 11.5 for England and Wales as a whole. Infantile Mortality 80 infants died before completing the first year of life, representing a rate of 163 per 1,000 live births. This rate is well below that of 19.0 for England and Wales as a whole. Of the 80 infant deaths, 66 occurred before attaining the age of one month, giving a neo-natal mortality rate of 13.4 as compared with the England and Wales rate of 13.0. Maternal Mortality There were 2 maternal deaths in the area in 1965, giving a maternal mortality rate of 0.4 per 1,000 live and still births. The rate for England and Wales was 0.25 per 1,000 live and still births. 18 Tuberculosis There were 14 deaths from pulmonary tuberculosis during the year, giving a death rate of 0.05. The provisional national rate for all forms of tuberculosis is 0.48 per 1,000 population. Street Accidents 1,878 street accidents occurred in the Borough during 1965. 2,619 persons were injured and 26 died. These totals include 391 children under 15 years of age who were injured, and 5 who died. Water Supply Details relating to the Borough's water supply are shown in the Chief Public Health Inspector's section of this report. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1965 (Registrar General's Return) Causes of Death Sex All ages Under four weeks Four weeks and under 1 year Age in Years 1 5 15 25 35 45 55 65 75 and over 1. Tuberculosis, respiratory M 8 - - - - - - - - 1 5 2 F 6 — — — — — — 1 — — 2 3 2. Tuberculosis, other forms M - - - - - - - - - - - - F — — — — — — — — — — — — 3. Syphilitic disease M 3 - - - - - - - - - 2 1 F 2 — — — — — — — — 2 — — 4. Diphtheria M - - - - — — - — — — — - F — - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - — — - F — — ~ — — — — — — ~ — — 6. Meningococcal infections M 1 - - - - - - - - - 1 - F — — — — — — — — — - — — 7. Acute poliomyelitis M - - - - - - - - - - - - F — — — — — — — — — ~ — — 8. Measles M - - - - - - - - - - - - F — — — — — — — — — — — — 9. Other Infective & parasitic diseases M - - - - - - - - - - - - F 2 — — — — — — — 1 1 — — 10. Malignant neoplasm, Stomach M 35 - - - - - 1 - 4 11 9 10 F 26 - — — — - - - 4 7 15 11. Malignant neoplasm, lung bronchus M 154 - - - - - - - 12 57 52 33 F 36 - - - - - - - 4 10 9 13 19 Causes of Death at different periods of life for 1965— Causes of Death Sex All ages Under four weeks Four weeks and under 1 year Age in Years 1 5 15 25 35 45 55 65 75 and over 12. Malignant neoplasm, breast M _ _ _ — — — — — — — — — F 70 — — — — - - - 10 17 13 21 13. Malignant neoplasm, uterus F 15 — — — — — — — 2 5 6 2 14. Other malignant and lymphatic neoplasms M 149 - - - - 1 2 4 9 31 42 60 F 169 - - - 1 - 4 7 18 28 4/ 64 15. Leukaemia, aleukaemia M 12 - - - 1 - 1 - 2 2 2 4 F 15 — — - - 1 2 3 1 4 1 3 16. Diabetes M 13 - - - - - 1 - - 1 4 7 F 14 — — — — 1 - — 1 1 4 7 17. Vascularlesions nervous system M 121 - - - - 1 - - 8 18 25 69 F 231 — — - — — — 3 12 17 48 151 18. Coronary disease, angina M 346 - - - - - - 10 35 100 92 109 F 278 — — — — — 1 — 5 26 72 174 19. Hypertension with heart disease M 14 - - - - - - - - 3 3 8 F 28 - — - - - - - - 1 10 17 20. Other heart disease M 106 - - - - 1 - 4 8 10 24 59 F 213 — — - — - — 1 5 10 35 162 21. Other circulatory disease M 76 - - - - - - 4 2 14 18 38 F 103 — — — — — — — 6 7 20 70 22. Influenza M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 23. Pneumonia M 117 - 1 - - - 1 - 3 4 ?4 84 F 174 — 2 2 — - - — 2 8 18 142 24. Bronchitis M 97 - - - - - - - 4 20 40 33 F 29 — 2 1 - - - - - 2 5 19 25. Other diseases of respiratory system M 21 - - 1 - 1 1 - - 6 5 7 F 7 — — 1 - - - - - - 2 4 26. Ulcer of stomach and duodenum M 14 - - - - - - - 3 - 5 6 F 8 — — - - - - - - 1 — 7 27. Gastritis, enteritis & diarrhoea M 5 - 1 - - - - - - 1 2 1 F 8 — - 2 - - - - - - - 6 28. Nephritis & nephrosis M 10 - - - - — 1 — 5 3 — 1 F 2 — — — — — — - 1 - — 1 29. Hyperplasia of prostate M 9 — — - - - - - - - 2 7 30. Pregnancy, childbirth, abortion F 2 — - - — 1 1 — - - - - 31. Congenital malformations M 16 9 4 1 - 1 - - 1 - — - F 12 6 3 1 — — — — — 2 — - 32. Othe defined & Ill-defined diseases M 87 31 - - 1 2 1 1 4 11 19 17 F 126 20 — 1 - - 3 2 10 13 18 59 33. Motor vehicle accidents M 32 - 1 - 1 9 3 5 4 3 4 2 F 11 — - — 1 3 - 2 — 1 3 1 34. All other accidents M 16 - - - - 2 - 4 3 3 1 3 F 14 — — 2 — — 1 — — 2 2 7 35. Suicide M 21 - - - - 1 5 ? 4 4 2 3 F 24 — — — — - - 4 6 3 9 2 36. Homicide & operations of war M 1 - - - - - 1 - - - - F - - - - - - - - - - - - All causes M 1,484 40 7 ? 3 19 17 35 111 303 383 564 F 1,627 26 7 10 2 6 12 32 84 165 331 952 NATIONAL HEALTH SERVICE ACT 1946 Section 22 Care of Mothers and Young Children Section 23 Midwifery Section 24 Health Visiting Section 25 Home Nursing Section 26 Vaccination and Immunisation Section 27 Ambulance Service (Provided by Greater London Council) Section 28 Prevention of Illness, Care and After-Care Section 29 Domestic Help Section 51 Mental Health Services 22 MATERNITY AND CHILD WELFARE Peter A. Currie, m.r.c.s., l.r.c.p., Senior Medical Officer. The various sub-divisions of this section have settled down and are learning their interdependence on each other for the furtherance of the welfare of the mother and her child. The Borough has inherited a very high level of protective immunisation which will not be allowed to fall. There have been many babies thought to be "at risk" for various reasons. It is difficult to assess what is "at risk", as there is often very little information available at first as to the condition of the baby at birth. During the year there have been sixty children notified within the area as suffering from congenital malformations recognisable at birth. Particular attention is being concentrated on the early recognition of deafness, and Stycar sets have been made available to all Medical Officers at the Infant Welfare Clinics. The appointment of a peripatetic teacher of the deaf is eagerly awaited, so that active treatment can be instituted, for example, by the provision of auditory trainers with which the mother can help her child at home, under supervision. The Health Visitor reports any suspected defect, however slight, which might possibly handicap a child, and this information is passed to the School Health and Mental Health sections, so that some indication of future requirements, both educational and social, may be obtained. Following discussions, a pilot scheme for the early detection of Cervical Cancer was introduced at the latter end of the year, with the very active and unstinted help of the Pathologists and their staffs at two local hospitals. CARE OF MOTHERS AND YOUNG CHILDREN Under Section 22 of the National Health Service Act, 1946, it is the duty of every Local Health Authority to make arrangements for the care, including, in particular, dental care of expectant and nursing mothers and of children who have not attained the age of five years and are not attending primary schools maintained by a Local Education Authority. Care of Unmarried Mother and her child During the year financial liability for residential care at voluntary homes was accepted for 53 unmarried mothers. The average length of stay for each mother was thirteen weeks. 23 Births Of the 4,981 births notified, 3,633 occurred in hospitals, and 1,348 were domiciliary births. Play Therapy and Clinic Play Groups Play groups, meeting once or twice a week and supervised by the mothers of children attending, have been established at some centres, and have proved a great success. Additionally, a group for physically handicapped children has been formed at the St. Paul's Cray centre, meeting once weekly. The response has been good, and the facilities are greatly appreciated. Welfare Foods All Child Welfare Clinics sell welfare foods (National Dried Milk, Orange Juice, Cod Liver Oil and Vitamin Tablets) as well as a range of proprietary foods. During the nine months ended 31st December the total sales of welfare foods were: — 13,588 tins of National Dried Milk. 3,659 bottles of Cod Liver Oil. 6,076 packets of Vitamin Tablets. 101,016 bottles of Orange Juice. In addition, proprietary foods to the value of £13,989 13s. 6d. were sold during the same period. VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act, 1946, every Local Health Authority is required to make arrangements with Medical Practitioners for the vaccination of persons in the area of the Authority, against smallpox and the immunisation of such persons against diphtheria. The Minister of Health has also approved proposals for immunisation against whooping cough, poliomyelitis and tetanus. In addition to vaccination and immunisation by General Medical Practitioners, facilities are also available at Welfare Centres and other clinics by the Council's own medical staff. Following receipt of the Ministry of Health circular 19/65, proposals for the protection against anthrax for those at special risk have been submitted to the appropriate committee. 24 VACCINATION AGAINST SMALLPOX A total of 2,427 children received primary vaccination and 33 re-vaccination during the year. DIPHTHERIA IMMUNISATION Primary Courses—Number of persons under age 16 Type of Vaccine or dose YEAR OF BIRTH Others under Total 1965 1964 1963 1962 58-61 16 1. Quadruple 6 7 - - 4 - 17 2. Triple 1,948 1,154 114 34 66 10 3,326 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 7 14 10 6 16 6 59 5. Diphtheria 1 — - - 1 - 2 Totals 1,962 1,175 124 40 87 16 3,404 Re-inforcing Doses—Number of persons under age 16 Type of Vaccine or dose 1965 1964 1963 1962 58-61 Others under 16 Total 1. Quadruple - - - - 3 - 3 2. Triple 9 263 1,084 281 1,130 90 2,857 3. Diphtheria/Pertussis - - 2 - - 1 3 4. Diphtheria/Tetanus 4 17 107 33 779 77 1,017 5. Diphtheria — - - - - - - Totals 13 280 1,193 314 1,912 168 3,880 Number of children under 16 years protected against Diphtheria, Whooping Cough and Tetanus, are as follows:— PRIMARY IMMUNISATIONS Diphtheria Diphtheria and Pertussis Diphtheria Pertussis and Tetanus Diphtheria and Tetanus Tetanus Total Diphtheria Total Whooping Cough Total Tetanus 2 NIL 3,326 59 27 3,404 3,343 3,430 RE-IMMUNISATIONS Diphtheria Dipthheria and Pertussis Diphtheria Pertussis and Tetanus Diphtheria and Tetanus Tetanus Total Diphtheria Total Whooping Cough Total Tetanus NIL 3 2,857 1,017 24 3,880 2,863 3,901 25 ORAL POLIOMYELITIS VACCINATION Individuals who received primary course (3 doses) and fourth doses in 1965. Completed Primary Course Under Five School Children Adults Total M. & C.W. Clinics 1,995 153 77 2,225 G.P's. Surgeries 1,367 147 75 1,589 Total 3,362 300 152 3,814 Completed Fourth Doses M. & C.W. Clinics 19 1,333 19 1,371 G.P's. Surgeries 51 1,207 34 1,292 Total 70 2,540 53 2,663 In addition to Oral Poliomyelitis vaccinations a total of 2 individuals received Booster Salk injections. DAY NURSERIES The Registration required under the Nurseries and Child Minders Regulation Act, 1948, is the responsibility of the Council and full details of those already so registered were received from Kent County Council. A booklet outlining the requirements and including advice and recommendations has been prepared and is issued to all applicants. The booklet also provides a list of infectious diseases and exclusion periods. Initial visits are made by the Health Visitor, Senior Medical Officer, Fire Officer and Public Health Inspector (the latter when inspection under the Food Hygiene Regulations is required). Subsequent formal quarterly visits are made by the Health Visitor and reports submitted. Two applications were refused and five have not been proceeded with. Playgroups—i.e. those organized by voluntary organisations— are not formally registered but are regularly visited. Number of Registered Day Nurseries 44 Number of places provided 1,398 CHILD MINDERS At the end of 1965 there were 51 registered child minders (frequently with additional staff to assist them) responsible for a total of 629 children. More parents seem to feel that their children 26 need companionship in their pre-school years and because of the lack of nursery schools, mothers with small children of their own, and voluntary organisations, are setting up small play groups. These, although not formally registered, are regularly visited. NURSING HOMES Under part 6 of the Public Health Act, 1936, the Nursing Homes Act, 1963, and regulations made thereunder, it is the duty of the Local Health Authorities to register and inspect nursing homes. These premises have been inspected six monthly by the Senior Medical Officer and following his visit, by the Fire Officer. The different requirements of the constituent authorities are being unified so that a complete standard pattern of requirements will operate. Details of the homes at present on the register are as under:— Number of Nursing Homes, 1.4.65 18 Number of Nursing Homes, 31.12.65 19 Nursing Homes closed in 1965 0 Nursing Homes registered in 1965 1 Number of Beds provided at 1.4.65 310 Number of Beds provided at 31.12.65 335 Unmarried Mothers' Homes (Registered as Nursing Homes) 2 Number of Beds 23 Number of Cots 11 CYTOLOGY On the recommendation of the Ministry of Health, the Council, in co-operation with general medical practitioners and the hospitals, is providing publicity and clinics for exfoliative cytology for the detection of cervical carcinoma. A pilot scheme was introduced at the end of the year to provide this service, by appointment, for women between the ages of 25 years and 55 years, who are resident in the Borough. Three clinics have been opened and others will be commenced as the demand increases. Co-ordinated arrangements exist for notifying the result to the patient, the family doctor and the local health authority. Where necessary, routine follow-up tests will be arranged. By the end of the year 535 applications for the service had been received. 27 MIDWIFERY (Mrs.) B. Adcock, s.r.n., s.c.m., h.v.cert. Non-Medical Supervisor of Midwives. Under Section 23 of the National Health Service Act, 1946, it is the duty of every Local Health Authority to provide a domiciliary midwifery service.. The Midwifery establishment is 30 and the number of staff at the end of December was 27 full-time and 1 part-time. During the year there were 3 resignations and 2 appointments. Early Discharges During the past year there has been a steady increase in the number of 48 hours discharges. 912 patients were so discharged, and necessitated some 7,296 visits. Each home was visited to assess the amount of help required and to assist where necessary in making arrangements for home care. Training of Pupil Midwives 10 members of the staff are approved teaching midwives and they undertook the training of 28 pupil midwives from the Beckenham Maternity, and Farnborough Hospitals during the year. Pupils are accommodated in private lodgings while undergoing district training and suitable accommodation has often been difficult to find. Instruction for Mothers Classes for mothercraft and psychoprophylactic training for childbirth were run in most areas. These are proving to be progressively popular, particularly the film "Birthday" to which the mothers who have attended the classes bring their husbands. Refresher Courses Nine midwives attended approved residential post-graduate courses to comply with statutory requirements. These were arranged by the Royal College of Midwives. Kent County Council invited the Bromley Borough midwives to their annual refresher course at Bearstead and most of them attended at some time during the week. SUMMARY OF DOMICILIARY MIDWIVES' WORK Number of domiciliary confinements attended by midwives under N.H.S. arrangements. Number of cases delivered in hospitals and other institutions but discharged and attended by domiciliary midwives before 10th day. Doctor not booked Doctor booked Total (1) (2) (3) (4) 23 1,325 1,348 912 Total number of Home Visits made by midwives—40,901 28 Ante-Natal Clinics Attended by Midwife—Total attendances 4,205 Relaxation Classes Attendances—Midwife in charge 1,525 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1965 who were born:— (i) at home or in a nursing home 27 (ii) in hospital 192 (2) The number of those born at home or in a nursing home:— who were nursed entirely there 19 who were transferred to hospital on or before the 28th day 8 who died during the first 24 hours 2 who died in 1 and under 7 days 1 who died in 7 and under 28 days — who survived at the end of one month 24 (3) Number of those born in hospital: — who died during the first 24 hours 16 who died in 1 and under 7 days 8 who died in 7 and under 28 days 3 who survived at the end of one month 165 (4) Number of premature still births who were born: — (i) at home or in a nursing home 2 (ii) in hospital 31 Notifications of intention to practise In accordance with the rules of the Central Midwives Board, 168 midwives notified their intention to practise within the Borough during the year 1965. HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., dip. soc. studies (lond.) Superintendent Health Visitor. Under Section 24 of the National Health Service Act, 1946, it is the duty of every Local Health Authority to make provision in their area for the visiting of persons in their homes by Health Visitors for the purpose of giving advice as to the care of young children, persons suffering from illness and expectant and nursing mothers and as to the measures necessary to prevent the spread of infection. The Health Visiting establishment is 40. At the beginning of the year there were three vacancies which were filled by the end 29 of December. Three members of the staff have each had the misfortune to need three months' sick leave and one had maternity leave, but their colleagues have ensured that the essential services have been maintained during their absence. One student Health Visitor was successful in her examination. The work of the Health Visitors as advisers on all aspects of maternal and child care has proceeded smoothly during the year. The field of work covered by the Health Visitor has broadened over the last few years to embrace the whole family in the advice she gives on all matters related to health. As her wider function is becoming known her services are being increasingly sought. The broad aspect of her work has been facilitated by closer links with general practitioners and hospital staff so that a fully integrated service is developing. Special attention has been paid to various groups according to need. Advice on psychoprophylaxis methods of preparation for childbirth is available at clinics, children at risk of handicap are kept under close surveillance and children with mental and physical and social handicaps are visited more frequently than others. Health education to senior girls has begun in a few secondary modern schools and a session for senior citizens at St. Paul's Cray informing them of the various services available has been well received. Playgroups for children under five years of age have been started at clinic premises and are organised by the mothers. A special playgroup for the under fives has been organised by the local branch of the parents of mentally handicapped children. A Health Visitor is available at these sessions for guidance and consultation. In Service Training Four Health Visitors attended a two week residential Refresher Course and one an Administrative Course. Two Fieldwork Instructors have been trained in order to train Student Health Visitors in their practical work. Several of the staff have attended short courses on matters relevant to their work bearing the cost themselves and doing the courses in their leisure time. All the Health Visitors were invited to lectures arranged by the Kent County Council every afternoon for one week in May, and most were able to attend. Staff meetings have been held at monthly intervals when a speaker on a special subject has been invited, or a film on some branch of the work has been shown. Training provided by the Health Visitors Student Nurses have been out with the Health Visitors as required by their Training Body, from Orpington, Farnborough, 30 Bromley and Beckenham Hospitals. Four student Health Visitors did their practical work training under the guidance of the Fieldwork Instructors. Lectures to the student nurses have been given by the senior staff and discussion groups attended by them after their visits on the area. A few students from other disciplines and medical graduates have been given an insight into the work. General Practitioner/Health Visitor Liaison Six Health Visitors are attached to general practices and carry out their work entirely within the practice, except for their school work. Three Health Visitors work in close liaison with general practitioners but are geographically based. Surveys The Health Visitors have taken part in two national surveys on child development and one on childhood cancers involving approximately 200 special interviews each lasting an hour or more. They have also visited in connection with a survey on children of low intelligence and undertaken a few follow-up visits in connection with special surveys. Visits Home visits paid by the Health Visitors were as follow :— To Expectant Mothers 993 To Children under 1 year 23,027 To Children between 1 and 2 years 12,079 To Children between 2 and 5 years 17,150 To Patients with Tuberculosis 3,151 Other visits, hospital care, care of old people, etc 6,239 Total 62,639 Child Welfare Centres Attendances by children under 1 year 41,594 Attendances by children aged 1-2 years 10,632 Attendances by children aged 2-5 years 14,211 Total 66,437 Number of children under 1 year attending Child Welfare Centres for first time 2,702 Total number of children attending 15,021 31 Ante-Natal Clinics Attended by doctor— First attendances 237 Subsequent 763 Relaxation Classes Attendances (Health Visitor in charge) 953 HOME NURSING Mrs. J. Symington, s.r.n., s.c.m., d.d.n. Superintendent Home Nursing Service. Under Section 25 of the National Health Service Act, 1946, it is the duty of every Local Health Authority to make provision in their area for securing the attendance of nurses on persons who require nursing in their own homes. The Home Nursing establishment is 40 whole time nurses. No difficulty was experienced in recruitment in the latter half of the year, and all districts now have their full complement of nurses. The number of patients attended during the year was 2,985, of which 1,897 were over 65 years of age. A total of 107,150 visits was made during 1965. Disposable syringes and incontinence pads came into full use from April; although disposal of the latter is at times a problem in premises in smokeless zones, they are of great assistance to the well being of the patients. The provision of a scheme for the collection and disposal of soiled pads is at present under consideration. Marie Curie Foundation Fund The Authority has recently joined the trust, and this we hope will make a valuable contribution to a group of patients who need every care and assistance that can possibly be given. Training Courses for District Nurses Nine District Nurses are attending a recognised training course and this should prove of great benefit to both the patients and the nurses. Close liaison with voluntary organisations and hospitals has been achieved, thus giving a better service to the patients, and it is hoped to expand this still further in the coming year. RECUPERATIVE CARE The Council accepts financial responsibility for convalescence recommended by general practitioners and hospital doctors. Each patient recommended must have had a definite illness or accident 32 and must go to a recognised Convalescent Home. The Council recovers part or all the cost according to the income of the patient and in accordance with a definite assessment scale. Certain patients may receive convalescent treatment free, these include Old Age Pensioners. Every effort is made to suit the patient to the particular Home, as different Homes cater for different age groups and different kinds of medical or surgical condition. During the year 78 cases were dealt with; they comprised 21 men, 51 women and 6 children. CHIROPODY From April to December, 1965, 15,376 treatments were given by the Chiropody Service of this authority. Of this number, 4,554 were domiciliary and 10,822 were surgery cases. One full-time and three sessional Chiropodists were employed, and the services of 20 Contractual Chiropodists were also used. Four clinics were in use throughout the Borough covering the area concerned quite extensively. Proposals for a further Chiropody Clinic at Orpington were also considered and this has since been opened. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS Arrangements to cover the special problems which arise in connection with the health and treatment of long-stay immigrants to this country have been laid down by the Ministry of Health. Instructions have also been issued by the Ministry detailing specific arrangements for the detection and prevention of tuberculosis in long-stay immigrants. During the year 138 families were notified to the department and 97 were successfully visited. This not infrequently involved more than one visit per family. Some families were not known at the addresses given and others, despite repeated visits, had not been contacted by the end of the year. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 Under this section of the Act (as amended by the National Assistance (Amendment) Act, 1951) powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year it was not necessary to apply to the court for an order for compulsory removal. 33 HOME HELP SERVICE Under Section 29 of the National Health Service Act, 1946, the Local Health Authority may make arrangements for providing domiciliary help for households where such help is required owing to the presence of any person who is ill, lying in, an expectant mother, aged or a child not over compulsory school age within the meaning of the Education Act, 1944. The following is a summary of the cases in which assistance was given between January 1st and December 31st, 1965:— Aged 65 or over on first visit in 1965 1,799 Under 65— Chronic Sick and Tuberculosis 240 Mentally Disordered 14 Maternity 503 Illness 370 Family Care Service 26 cases received assistance under this scheme in the same period. Family Welfare Service 4 cases received assistance in 1965. Night and Evening Service 9 cases received assistance during the year. It will be seen that Home Help has been supplied in 2,965 homes during the year 1965. Demand steadily increases, particularly in regard to aged people, maternity cases, and the care of children in the absence of the mother. In spite of recruitment difficulties, no applicants eligible for Home Help because of advanced age, ill-health, or maternity were refused service. DENTAL SERVICE FOR NURSING AND EXPECTANT MOTHERS AND CHILDREN UNDER SCHOOL AGE Mrs. C. M. Lindsay, l.d.s., r.f.p.s. (Glasgow) Principal Dental Officer A fully comprehensive maternity and child welfare dental service is provided in the borough for all expectant and nursing mothers, also children under five who are not yet eligible for treatment within the School Dental Service. All types of treatment as in, private practice are available, including treatment of orthodontic cases and the service is operated from all the school dental clinics. Details of work carried out during the year: — Number of persons examined during the year. Number of persons who commenced treatment during the year. Number of courses of treatment completed during the year. 1. Expectant and Nursing Mothers 61 53 46 2. Children aged under 5 years and not eligible for school dental service 304 293 275 DENTAL TREATMENT PROVIDED Scalings and Gum Treatment Fillings Silver Nitrate Treatment Crown and Inlays Extractions General Anaesthetics Dentures Provided Radiographs Full upper or lower Partial upper or lower 1. Expectant and nursing mothers 27 79 — — 8 — 5 2 — 2. Children under 5 years and not eligible for school dental service 10 567 174 — 42 12 — — 6 34 35 The clinics are staffed by five full time and four part-time dental officers. The success of this service is mainly dependent on the cooperation of the Medical Officers and Health Visitors. The progressive overall increase in attendances at the clinics of the under five year group is in no small measure due to this co-operation and also to the patience and understanding of the Dental Officers. HEALTH EDUCATION Venereal Diseases Syphilis and gonorrhoea are still among the most important preventable diseases in the world. Although preventable and curable, they still continue to damage the health of the nation. It is, therefore, important that we should all know what these diseases are, how they can be prevented and cured. Publicity material on this subject, in the form of posters and leaflets, have been acquired and circulated to many senior schools, Youth Clubs, etc., within the Borough and where schools are concerned, selected teachers have given talks on the preventive measures, and other topics of Health Education. The Health Department have circulated over 300 posters on V.D., overprinted showing the Treatment Clinics within and around the London Borough of Bromley, and of these 153 have been exhibited in all Public Conveniences, with orders that should these posters be defaced replacements are immediately available. Lectures by the Health Education Officer on Venereal Diseases have been given to various Youth Clubs, Ranger Groups and many Parent/Teacher Associations. Smoking The decision to smoke or not is the prerogative of the individual for, in Britain, everyone over the age of 16 has the legal right to smoke. Expense is the most common reason for reducing or stopping smoking, closely followed by ILL HEALTH. As regards the younger element, the common reasons given by children for starting to smoke, are curiosity, the wish to demonstrate maturity, the desire to be like others or the obligation to accept a proffered cigarette. Every adult admired by children could set a good example by not smoking in their presence—the importance of example cannot be over-emphasised. With these problems in mind, the Health Department arranged for many talks to be given at schools, by films, the publication of posters, the issue of many types of leaflets to Libraries, Youth Clubs, 36 Parent/Teacher Assemblies, etc., with the object of getting an influence on the dangers of smoking to everyone, but in particular to school children over the age of 10 years. Local cinemas within the Borough of Bromley have assisted in this project in showing the Ministry of Health film "Smoking Machine" whilst national publicity by radio and television has also been extensively given. The mounting evidence of association between smoking and lung cancer is of national importance. Therefore, every effort, both locally and nationally, must be made to bring these alarming facts to the notice of all concerned, with the result that publicity on this subject must always be available, and used as often as possible. HOME SAFETY Every year there are more than 8,000 fatal home accidents in Great Britain. Four-fifths of these fatalities occur in children under 5 years and elderly people over 65 years of age. Non-fatal Accidents There is no precise information on this point, but it is estimated that each year, between one and two million cases occur, which are sufficiently serious as to require hospital treatment. This needless loss of life and health is caused by ignorance, carelessness and to some extent by existing conditions of physical disability, particularly among the elderly, and can be remedied only by a nation wide campaign to make the public aware of the risk, and willing to accept responsibility for safety in the home. Home Safety Sub-Committees During the past year, the Sub-Committees of Orpington and Beckenham / Penge have supported the National Campaign on general home safety aspects, but particularly on the theme "DO IT YOURSELF WITH SAFETY", which was in operation from April to September. The do-it-yourself movement becomes more and more important every year. This is due partly to economic necessity and partly to the pleasure and satisfaction which the creative activity gives. It can however, give rise to unsuspected hazards, particularly as the tendency is for everyone to tackle more and more ambitious jobs. Attention to ordinary commonsense precautions avoids most of these hazards. From October to December, emphasis was on the National Fire Prevention Campaign, and the Home Office, in conjunction 37 with Ro.S.P.A. and the Fire Protection Associations arranged for full national publicity on this very costly and important subject. The human aspect of home accidents is related to age and physical and psychological conditions, and one of the main functions of these Committees is to inform the public of these causes, and suggest measures for prevention. This is done mainly by lectures, displays of posters, distribution of leaflets, film shows, newspaper articles on accidents and statistics, etc., and carried out through clinics, schools, voluntary organisations of all kinds and through the local press. Various Quiz Units and portable displays were shown at many Summer Fetes and Shows, whilst large and small exhibitions were held at clinics and schools. A considerable quantity of publicity material was displayed throughout the Borough during the year, particularly on local authority and school premises, with the valued assistance of Head Teachers and their staff, and members of the Junior Accident Prevention Councils. As a result of these displays and exhibitions, many requests have been received for lectures on home accident problems to be given to Youth Clubs, Parent/Teacher Associations, Teachers' Training Colleges, Old People's Clubs, Scouts and Guides, etc., in the latter cases, many of these training lectures being required as part of the syllabus for the Duke of Edinburgh Award Scheme. All these lectures and tests were given by Health Visitors and the Health Education Officer. Hospital Statistics From April to December, Beckenham Hospital recorded a total of 1,198 home accident cases admitted for treatment, of which 374 were children, whilst the figures for Farnborough Hospital from May to December were 1,003 of which 458 were children. Records from Orpington Hospital from September to December were 1,312; of these 489 were children. This makes a total of 3,513 people admitted to three of the local hospitals within the Borough, during the past nine months. It is noted, however, that cuts, fractures, burns /scalds still predominate as the chief causes of home accidents, but there is great concern at the increasing numbers of young children who are admitted to hospital, having taken by mistake, tablets and drugs, which have been left within reach of these youngsters. Every effort is being made to give full publicity to this type of accident, and arrangements are being made for the Pharmaceutical Mobile Display Unit on this subject, to hold an exhibition within the Borough during 1966. INFECTIOUS AND OTHER DISEASES 40 INFECTIOUS AND OTHER DISEASES General Following the now familiar pattern of alternating epidemic "measles years", it was not surprising after the low incidence of this infection, in 1964, to find that measles accounted for no fewer than 5,119 of the total of 5,563 notifications of infectious disease received during 1965. As has been the case in other recent years, the illness remained on the whole mild in character and no deaths from this cause occurred. Nevertheless, it is hoped that the time is not far distant when, with the development of effective and reliable measles vaccines, it will be possible to make this biennial burden of acute childhood illness a thing of the past. Apart from measles, the number of other notifications received was very small in relation to the population of the area and in this respect the new Borough may be said to have made a decidedly encouraging start. Whether this early promise is maintained, depends a great deal on the continued co-operation of parents, and on the unremitting efforts of those concerned with health education; both are essential in maintaining the levels of immunisation which have made it possible to record that no cases of poliomyelitis, diphtheria or smallpox, and only 26 cases of whooping cough, were reported in the Borough during 1965. Personally, I am confident that this good record can be maintained. Statistical details of the various infectious diseases are given below under separate headings and unless otherwise stated, no deaths from these infections occurred. Poliomyelitis No cases of this disease were notified during the year. Diphtheria No cases were notified during the year. Erysipelas Fourteen cases were notified during the year. Dysentery 28 cases were notified, all of them being of the mild sonnei type. These were all isolated cases and the infection did not occur in epidemic form. Full investigations were carried out in each instance. Food Poisoning 17 cases were notified during the year. All these proved to be of the salmonella type and in the majority of incidents affected single families or individuals. One institutional outbreak occurred but it was considered that the infection in this case was not food borne. 41 FOOD POISONING Incidents and Cases Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases cols. (1+3 + 5) TOTAL No. of cases columns (2+4 + 5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S. typhi murium — — 4 9 2 6 11 2. Other Salmonellae (a) - — 2 10 - 2 10 3. CI. welchii — — — — — — — 4. Staph. aureus — — — — — — — 5. Other causes (b) — — — — — — — 6. Cause unknown — — — — — — — 7. TOTAL — — 6 19 2 8 21 GENERAL INFORMATION on food poisoning Salmonella Infections (not food borne). Details in the above table relate to an outbreak at Orpington Hospital. DETAILS OF FOOD POISONING DUE TO SALMONE Type of OTHER THAN S. TYPHIMURIUM Salmonellae LLAE BRANDENBURG — — 1 5 — 1 5 NEWPORT - — 1 5 - 1 5 — - — — - — — — — — — - — - - 2 10 - 2 10 SALMONELLA INFECTIONS (not food borne) Incidents and Cases Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases cols. (1+3 + 5) TOTAL No. of cases columns (2+4 + 5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1. S. typhimurium 1 14 — — — 1 14 2. Other Salmonellae (a) — - - - — — — 3. TOTAL 1 14 - - - 1 14 42 Measles The expected high incidence of this disease occurred during 1965, a total of 5,119 cases coming to our knowledge. Meningococcal Infections 6 notifications were received. One death of a male in the age group 65-74 years was recorded. Pneumonia 51 notifications in respect of cases of pneumonia were received in 1965. 290 deaths were attributed to this disease. This figure includes people who are normally resident in the area, but who died in premises outside the Borough boundaries. Scarlet Fever 178 cases were notified during the year. This is another infection which now generally occurs in a mild form. Smallpox No cases occurred during 1965, but it was necessary for a number of suspected contacts to be kept under surveillance at various times during the year. The department was called upon to authenticate the signature of the doctor on 3,690 International Certificates of Vaccination. Tuberculosis 90 notifications were received, and 14 deaths attributed to this disease during 1965. It is difficult to appraise the progress made in this field during the year as there are no corresponding figures available for direct comparison but it is encouraging to note that the number of cases on register declined quite substantially during the year. Of the 14 deaths, all but 2 occurred in the age group over 65. The following are details of the recordings in the register for the year ended 31st December, 1965: — Respiratory Other forms Total No. of Cases M F M F On Register at 1.1.65 1,747 1,360 143 178 3,428 New cases notified during 1965 44 34 5 7 90 Number of cases coming to knowledge after death — — — — — Restored to Register — 2 — — 2 Inward Transfers 39 38 2 1 80 1,830 1,434 150 186 3,600 Deletions - deaths, removals recoveries, etc., 171 139 3 10 323 Number of cases on Register at 31.12.65. 1,659 1,295 147 176 3,277 43 TUBERCULOSIS New cases and Mortality:— Age groups New cases notified or otherwise revealed (Not including Inward Trans.) Deaths Pulmonary Non-pulmonary Pulmonary Non-pulmonary M F M F M F M F Under 5 3 3 — — - — — - 5-14 1 1 1 - - - - - 15-24 6 7 1 - - - - - 25-44 12 10 1 3 - 1 — — 45-64 14 9 2 1 1 — — — 65 and over 8 5 — 3 7 5 — - Age not known - 1 - - - - - - 44 36 5 7 8 6 - - Inward Trans. 39 38 2 1 Totals 83 74 7 8 TUBERCULOSIS Public Health Prevention of Tuberculosis Regulations 1925 Section 172. Public Health Act, 1936 No action was taken by the Local Authority under these regulations during 1965. Typhoid and Paratyphoid Fever No notifications were received. Whooping Cough 26 cases were notified to the Department in 1965. Ophthalmia Neonatorum Only one notification was received. Puerperal Pyrexia 33 cases were notified during the year. 44 INFECTIOUS DISEASES, 1965 Notifiable Disease Number of Cases Notified in Age Groups. Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 65 65 and upwards Age unknown Total All ages Scarlet Fever M F M F M F M F M F M F M F M F M F 1 1 27 32 64 47 2 2 1 1 178 Whooping Cough 6 8 2 10 26 Measles 81 55 1,367 1,335 1,070 1,148 10 10 7 6 16 14 5,119 Pneumonia 1 3 2 2 3 3 3 1 1 7 9 7 7 2 51 Dysentery 1 8 8 5 1 2 3 28 Erysipelas 4 4 1 3 2 14 Puerperal Pyrexia 1 7 20 5 33 Food Poisoning 3 2 5 6 1 17 Meningococcal Infection 1 2 2 1 6 Ophthalmia Neonatorum 1 1 Tuberculosis (Pul.) 1 3 2 1 1 6 7 7 5 5 5 14 7 8 5 1 78 Tuberculosis (N.Pul.) 1 1 1 2 1 2 1 3 12 Totals 85 59 1,409 1,387 1,151 1,217 23 30 23 46 6 12 27 18 18 18 19 15 5,563 45 MENTAL HEALTH SERVICE Sara Syrop, med. dip. univ. of warsaw, d.t.m. & h., d.c.h., d.p.h. Senior Medical Officer. H. J. Vagg, a.r.s.h., a.i.s.w., Principal Mental Health Officer. Introduction The revolutionary advances in the treatment of mental illness in the past twenty years together with the changing public attitudes towards the mentally disordered brought about the Mental Health Act, 1959. Since the Bill was passed, on the one hand this change in public attitudes towards the mentally ill gathered momentum, and on the other the method of applying the principles of public health and treating mental illness on a par with physical illness became accepted. As in physical illness the problems of mental ill health can be broadly divided into those of: Effective prevention. Early recognition. Suitable treatment. Adequate after care. Three of these four problems lie outside the scope of hospital service and two, namely prevention and after care, are the statutory responsibility of the Local Health Authority. The First Quarter of 1965 The Mental Health Service administered from County Hall, Maidstone, was based on three District Offices, each manned by a District Officer and his Assistant. The District Officer was an all-purpose Social Worker vested in addition with statutory duties under the Mental Health Act. He was thus neither able nor expected to develop social case work. He was further hampered by the lack of Mental Health establishments, e.g. Hostels, Work Centres, etc. Situation on 1st April, 1965 In its difficulties, the Mental Health Service of the Borough was not alone. Every new London Borough has its own problems. The Inner Boroughs took over the existing L.C.C. Service and worked out their own pattern. The Outer Boroughs often had to "start from scratch". The Mental Health Section set out from the beginning to lay down the policy of a comprehensive Mental Health Service. 46 Staff Six District Officers transferred from Kent County Council were designated Mental Welfare Officers and paired off to be based at the three District Offices: 77, Tweedy Road, Bromley, now 17, Palace Grove. 12, Beckenham Road, Beckenham, now 69, Croydon Road, Penge, S.E.20. County Offices, The Walnuts, High Street, Orpington. Each M.W.O. has to cater for a population of approximately 50,000. M.W.O. as Specialised Case Worker The concept of M.W.O. as Case Worker with statutory duties was introduced and an intense in-service training programme formulated. In addition to regular lectures, discussions and visits to places of interest locally, it was arranged for each Mental Welfare Officer to gain experience by spending a week in a large Mental Hospital. In conjunction with the London Boroughs Training Committee, two Mental Welfare Officers attended weekly Seminars, whilst one Mental Welfare Officer is away on a "Younghusband Course". The Council has also been generous in allowing the officers of the Section to attend National Conferences and Meetings relative to mental health. Liaison with Hospital and Family Doctors Very close liaison at all levels both within and outside the Health Department is inherent in the concept of social work, and in no other field is this close co-operation as important as in the field of mental health. Frequent informal consultations were soon established with the hospital service and the General Practitioners. To publicise the changing role of the Mental Welfare Officer, a Meeting for Family Doctors, under the title "Mental Health in the New Borough, The Present, The Future and The Priorities", was held in December, 1965, and it was generally acclaimed as a most successful function. Links with Other Services Since the majority of school leavers from Special Schools come under voluntary supervision by the Mental Welfare Officers, the Mental Health Section works in close liaison with Special Schools and the Youth Employment Service. The Youth Employment Service has been most helpful in work placement for the more able youngsters from the Training Centres. The voluntary agencies have always supplemented in cash and kind where the statutory services are not empowered to provide. 47 Staff Structure Present and Future Administration problems of the Section are dealt with by its small headquarters staff at the Health and Welfare Department. The experience of the first months of the service made clear the need for qualified senior field staff, and three such appointments will be made in the middle of 1966. The appointment of senior field staff will greatly enhance the quality of the service in addition to providing training and promotion within the service. Facts and Figures The Mental Health Service is concerned with two distinct broad categories of mental disorder, namely, mental illness and mental subnormality. The "case load" for the whole Borough is given below: Cases Under Community Care Mental Illness Psychopathic Disorder Subnormality Severe Subnormality Totals New Referrals 152 2 58 53 265 Total Cases 31.12.65 170 2 241 185* 598 * Children under five are supervised by health visitors. MENTAL SUBNORMALITY The Very Young It is now widely accepted that every attempt should be made to recognise mental handicap as early in life as possible, thus giving the child an optimum chance of improvement. With this end in view, a Register of all children suspected of being backward was started early in April, 1965, the Health Visitors being asked to report any such child born after 31.12.1959. On 31.12.1965, the Register stood at 86, showing the following grouping by diagnosis: Cause as yet unspecified or unknown 26 children Mongol 24 Cerebral palsy 13 Hydrocephalic 9 Multiple (including sensory) defect 6 Microcephalic 5 Birth accident 2 Rare conditions 1 child Since it was previously estimated that the Borough would have 100 severely subnormal children under the age of 5, and that it is unavoidable that some of these children will not be known to the Local Health Authority, the nearness of the number of cases known 48 to the number of cases expected, calls for a favourable comment on the efficiency of the Maternity and Child Welfare Section. It must be pointed out however, that out of this group there will be a few children not falling into the severely subnormal category, but being on the borderline between subnormality and severe subnormality. The purpose of the Register is twofold—by assessing the young child at home as early as practicable, the parents are given a chance to discuss the child's future with the Senior Medical Officer and be informed of the facilities available locally. The other social services both voluntary or statutory are brought in to relieve the strain on the family. Secondly, the Local Authority has the advantage of planning for future development with the full knowledge of the size of the problem. LONDON BOROUGH OF BROMLEY RESIDENTS ATTENDING TRAINING CENTRES Juniors and Adults Name of Centre and Responsible Authority. AGE 5 years - 16 years - TOTALS M F M F Scads Hill (Bromley) 22 23 21 18 84 Swanley (Kent C.C.) — — 26 19 45 Sidcup (L.B. Bexley) 5 1 1 — 7 Lewisham (L.B. Lewisham) 1 — — — 1 Thanet* (Kent C.C.) 2 1 - - 3 Slough* (N.S.M.H.C.) — — - — 1 TOTALS 30 25 49 37 141 * These trainees are resident in the hostel attached to the Centre. SCADS HILL TRAINING CENTRE Supervisor—Mrs. Dorothy Hodgman. Senior Asst. Supervisor—Mrs. S. I. Walton. The Centre accommodates both Juniors and Adults, the premises being unsuitable for either. The high quality of training given at Scads Hill is a tribute to the skill and devotion of the Supervisor and her staff. The Centre holds a regular "Social" for senior boys and girls as well as informal coffee meetings for parents, so that a close contact between the Centre and the home is maintained throughout. The 1965 Christmas festivities included two Christmas parties and a very well attended visit to the Pantomime. The Bromley Society for Mentally Handicapped Children presented the Centre with a Film Projector which has been in constant use and greatly appreciated by everybody. The standard of light industrial work undertaken by the older trainees is very high and the Centre hopes for more work to be forthcoming. 49 On 1st April, 1965, the waiting list for Training Centre places stood at 28 and vacancies were made by transferring older trainees to Swanley Training Centre. On 31.12.65 there were 12 children under 16 years and one over 16 awaiting Training Centre placement. All the trainees have a routine annual medical examination and those found to have physical defects are referred either to the School Health Service Clinic or to the family Doctor for treatment. In addition five children were fully reassessed and found to be suitably placed at Scads Hill. Changes in 1965 An additional post of Assistant Supervisor was created and filled. This has in some measure lightened the burden of managing the children with multiple handicaps attending the Centre. Development in Progress A new classroom will be added shortly to provide alternative accommodation for older boys who are at present working in conditions unsuitable from every point of view. It is envisaged that this new accommodation will form the nucleus of the purpose-built Adult Centre scheduled to replace the present premises. The Borough and the Subnormality Hospital The Table below shows the number of patients admitted for short term care to a subnormality hospital. This service follows the Ministry's Circular 5/52 and is designed to provide temporary relief to the family either in an emergency or to give the family a well deserved break and/or holiday. Cases Provided with Short-Term Care Under 16 Over 16 Mentally Subnormal 4 3 Severely Subnormal 4 10 Total 8 13 In addition 4 severely subnormal children were admitted to the Kent County Council Hostel at Broadstairs for three weeks' short term care during the summer holidays. Developments in 1965 A Nursery Play Group for the young mentally handicapped child was started by the Bromley Society for Mentally Handicapped Children, the Council providing the premises at the Mickleham Road Clinic, St. Paul's Cray. 50 St. Mary's Centre, a Play Centre for similar children managed by the Hayes Parish Church School Trust started in September, 1965, and has been a most successful venture. A Social Club for mentally handicapped adolescents, "Gateway", was set up in Penge by the Mental Welfare Officer responsible for the area. The Club met a great need and by offering a wide range of activities is proving to be most popular with the youngsters and parents alike. Development Anticipated Shortly It is hoped to open a new Junior Training Centre in the Beckenham area early in 1967. The Centre will have special features essential for the comprehensive care of the mentally handicapped child. The parents of very young children will be offered a place in the Kindergarten. An Intense Care Unit with an indoor sand pit and paddling pool will accommodate children with multiple handicaps. MENTAL ILLNESS The first Table has given some idea of the volume of work carried out by the Mental Welfare Officers. The monthly returns from which the data on the Table were compiled showed an upward trend in new referrals and the increasing awareness of the public and various agencies that effective help can be given to a mentally disordered person without admitting him/her to hospital. In this aspect of his work, the M.W.O. is handicapped by the lack of supportive establishments like Hospitals, Sheltered Workshops and Work Centres, but a modest boarding out scheme has been operating successfully from the beginning. A Hostel in Beckenham for rehabilitation of the mentally ill should be ready for occupation before the end of 1966. Admissions to Hospitals HOSPITAL ADMISSIONS (BOROUGH RESIDENTS 1.1.65—31.12.65) EFFECTED BY M.W.Os. Mentally Ill and Psychopaths Mentally Subnormal and Severely Subnormal Section 25 13 — Section 26 9 1 Section 29 108 — Section 60 2 1 Informal 28 4 Total 160 6 The ratio between informal and statutory admissions and the relative frequency of the sections used by the M.W.Os. is comparable 51 to the figures available from other parts of the country. It is irrelevant to point out that these admissions constitute only a fraction of the total hospital admissions. The Borough has now a well established psychiatric follow-up service and many informal admissions take place either after or in lieu of an attendance at Psychiatric Outpatients. Short-Term Plans Following the concept that a full range of Mental Health establishments is necessary for the service to function well, the immediate priorities include a Sheltered Workshop and/or Work Centre, a purpose-built Adult Training Centre and a long term Hostel for the mentally ill. Every effort will be made for the full range of establishments to be operational within the Council's 10 Year Plan. Long-Term Policy Since prevention (see paragraph 2) would always be the keynote in mental as in physical health problems, it is hoped that eventually the service will concentrate most of its efforts to this end. Secondary Prevention Recognition of early signs of mental break down with appropriate referral for treatment is already carried out by the Section with the help of other agencies. Tertiary Prevention Lessening the effect of mental disorder on the patient and his family is an important part of the Mental Welfare Officers' day to day work. Primary Prevention Promoting good mental health and lowering the incidence of mental disorder is as yet a vast largely unchartered ground. While the theoretical principles are being worked out the techniques are still in the experimental stage. The Service looks forward to the time when a fully comprehensive local health authority programme has been formulated and implemented. REPORT OF THE CHIEF WELFARE OFFICER 54 REPORT OF THE CHIEF WELFARE OFFICER UPON THE WELFARE SERVICES COVERING THE PERIOD 1.4.65 to 31.3.66 J. Hanson, d.m.a., f.i.s.w., Chief Welfare Officer. 1. The duties and powers of the local welfare authority are contained in the National Assistance Acts, 1948/62. In the discharge of its responsibilities under these Acts the local authority provides, inter alia, residential care for people who are elderly or infirm; temporary accommodation for the homeless; and welfare services for the deaf, the blind and the physically handicapped. Residential Care 2. When the London Borough of Bromley came into existence on 1st April, 1965, 6 residential homes were transferred from the Kent County Council. In addition, a purpose-built home (Isard House, Hayes) in its final stages of completion, and another new home (Manor Fields, Orpington) in the early construction stage, were transferred to the new authority. Residential accommodation for 45 elderly persons at Orpington Hospital was also available under a joint user agreement with the Regional Hospital Board. 3. On the 1st April. 1965, the number of persons who could be provided with residential accommodation was: No. of places Durham House, Bromley 56 Elmbank, Bromley 34 Kingswood House, Shortlands, Bromley 58 Lubbock House, Orpington 41 Selwood, Chislehurst 36 Willett House, Chislehurst 50 Orpington Hospital 45 Total 320 4. At the end of the first year of the new Borough, the two purpose-built homes had been completed and it was planned to transfer the female residents of Orpington Hospital to Manor Fields in May, 1966. The additional accommodation of 61 places at Isard House, 60 beds at Manor Fields, less the 22 beds to be relinquished at Orpington Hospital, enables a total of 419 persons to be provided with residential care (excluding those accommodated by other local authorities and voluntary organisations on behalf of this authority). The standard maintenance charge in the local authority homes was £9 3s. 2d. and 47 residents were paying this charge. 5. Four of the 8 residential homes are adapted houses, although two have purpose-built extensions. The other four (Kingswood 55 TABLE I RESIDENTIAL HOMES (LONDON BOROUGH OF BROMLEY) RECORD OF ADMISSIONS — 1.4.65 to 31.3.66 Home Relatives Lodgings Living Alone Hospital Transfer Others No fixed abode Total Average Age M F M F M F M F M F M F M F M F Both Durham House 7 9 — 6 — 4 3 9 — 1 — — - — 39 82 83 82 Elmbank 2 3 - 2 1 3 2 - - - - - - - 13 80 83 82 Isard House 5 18 - 2 4 13 9 18 3 9 — — — 1 82 79 83 81 Kingswood House 5 12 1 2 7 13 5 7 — 1 — — — — 53 81 81 81 Lubbock House — 12 1 1 3 3 2 3 - - - - - - 25 75 81 78 Selwood 2 7 — — 1 4 2 3 1 1 — — — — 21 82 85 83 Willett House 5 17 1 — 4 7 4 6 1 6 — — — — 51 81 85 83 Orpington Hospital 5 5 1 — — 1 10 6 - - - - - - 28 77 81 79 Total 31 83 4 13 20 48 37 52 5 18 — — — 1 312 80 83 81 56 House, Willett House, Isard House and Manor Fields) are purposebuilt homes. Isard House and Manor Fields are single storey buildings accommodating 61 and 60 residents respectively. These two homes provide a number of single rooms and incorporate such modern features as several small lounges providing a more homely atmosphere and an electronic emergency call system. While Isard House was already being furnished when taken over, the furnishing of Manor Fields was one of the main tasks of the Welfare Services during the year and provided the opportunity to include several new features. These included easy chairs of varying styles and sizes to meet the needs of individual residents. The Welfare Service Sub-Committee decided to allow persons occupying single rooms to bring furniture into the home. An evaluation of these arrangements may result in a further application of this principle as far as future homes are concerned. There is an overall shortage of single rooms which, experience shows, are preferred by the majority of residents. Of the 419 places in the 8 local authority homes, only 85 (or 20%) are in single rooms. This imbalance in the kind of places available when related to the wishes of residents has prompted the Welfare Services Sub-Committee to provide 80% of the accommodation in single rooms in the next residential home, which will be sited in St. Pauls Cray. Loan sanction for this project is anticipated in 1967/68. 6. In "Health & Welfare: The Development of Community Care" (revision to 1975/76) published in June, 1966, by the Ministry of Health, the number of places in homes for persons age 65 or over throughout England and Wales is given as 15.6 per 1,000 population of that age group at 31st March, 1965. The figure increases to 20.2 on 31st March, 1971, and 21.7 by 31st March, 1976. The comparative figures for the London Borough of Bromley were 14.3 per 1,000 at 31st March, 1965; 17.8 per 1,000 at 31st March, 1971; and 19.3 per 1,000 by 31st March, 1976. Admission and Discharge Rates 7. 312 admissions to the local authority accommodation were arranged during the year (see Table I). This is relatively high owing to the occupation of the new home at Isard House during the year under review. Of this total, 89 (or 28%) were from hospital. This is rather lower than one expects but is likely to show an increase in the ensuing year as a result of the closer collaboration which has developed between the department and the two geriatricians in the area. Far too many old people are admitted to residential accommodation because more convenient housing is not available. It will also be interesting to see whether, in future years, there is a diminution in the number admitted who were formerly residing with relatives. This is a trend which might be expected as a result of improved social work services, although this can be off-set by a more ready acceptance of residential care. 57 TABLE II RESIDENTIAL HOMES (LONDON BOROUGH OF BROMLEY) RECORD OF DISCHARGES — 1.4.65 to 31.3.66 Home Home Hospital Transfer Death Total Average Age M F M F M F M F M F Both Durham House - 4 7 14 — 2 — 5 32 85 81 83 Elmbank 1 1 2 6 — 2 1 — 13 80 86 83 Isard House 4 7 3 1 - 1 1 6 23 81 84 83 Kingswood House 2 6 10 18 5 7 3 8 59 88 82 82 Lubbock House - 4 3 9 1 - - 3 20 84 83 83 Selwood 3 5 4 3 2 4 — 3 24 82 85 83 Willett House 5 14 8 16 1 1 5 5 55 83 84 83 Orpington Hospital - — 9 4 - - 6 3 22 80 85 82 Total 15 41 46 71 9 17 16 33 248 83 84 83 58 TABLE III RESIDENTIAL HOMES (LONDON BOROUGH OF BROMLEY) LENGTH OF STAY OF RESIDENTS AT 31st MARCH, 1966 Home Average Age YEARS M F 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 Over 10 Durham House 83 83 24 8 7 3 3 1 1 1 1 1 — Elmbank 80 84 5 12 8 2 1 1 1 1 — - - Isard House 79 83 58 - - - - - - - - - - Kingswood House 83 80 27 10 16 — — — — — — — — Lubbock House 80 84 18 4 5 5 1 3 3 1 — 1 — Selwood 83 84 7 7 10 5 1 1 — 1 1 - 1 Willett House 79 84 28 4 7 2 4 — — - — — — Orpington Hospital 79 80 15 8 5 3 2 3 5 1 2 — 2 Total 83 84 182 53 58 20 12 9 10 5 4 2 4 59 8. The average age (81 years) of new residents is significant. It demonstrates that the elderly are coming into residential homes at a later stage in their lives, and it has important implications in regard to staffing ratios as well as the attitudes to be fostered to enable these elderly residents to live effectively. 9. A higher proportion of the 248 discharges (see Table II) than one would expect were in respect of a return home (56 or 22%). The majority of these were those brought into a home for short term care although a few returned when they discovered that they could not adjust to life in a communal home. The social workers employed in the Department do their utmost to ensure that no premature steps are taken to terminate tenancies or dispose of owner-occupied properties until the resident reaches a decision about permanent residence. 10. 117 residents were discharged to hospital but a proportion of these returned and are included in the statistics in Table I. An indication of the extent to which residents are cared for during terminal illnesses can be gauged from the 49 deaths which occurred in the residential homes. 11. With such a high average age group in residential homes, it might be expected that the average length of stay is relatively short. Yet there have been suggestions to the contrary. It is of interest, therefore, to find that 293 residents (or 81% of the total) at 31st March, 1966, had a stay not exceeding 3 years (see Table III). Only 34 (or 9% of the total) had been resident for 5 years or more. When read in conjunction with the other tables, these statistics suggest that the purpose of the residential home is to support a minority of the over 80 age group during the last 3 years of their lives. TABLE IV RESIDENTIAL HOMES (LONDON BOROUGH OF BROMLEY) — AGE DISTRIBUTION OF RESIDENTS AT 31st MARCH, 1966 Home Under 65 65 - 74 75 - 84 85 - 99 100 & over M F M F M F M F M F Durham House — — 1 5 2 16 6 19 - 1 Elmbank — — — 2 3 8 1 16 — — Isard House — — 3 4 4 23 4 21 — — Kingswood House - 1 2 6 4 19 9 13 — — Lubbock House — — 1 1 6 13 4 17 - — Selwood - — — 2 7 12 5 8 — — Willett House 1 - 1 3 7 16 3 18 — — Orpington Hospital 2 2 6 3 7 10 8 6 — — Total 3 3 14 26 40 117 40 118 — 1 60 12. The main significance of Table IV is that, increasingly, the residential home is concerned with those in what is sometimes described as the "very old" group. This table and those which precede it take into account, of course, only the local authority homes. But the same pattern is apparent in those voluntary homes whose main or sole purpose is the care of the elderly. Short-Term and Day Care 13. As well as providing permanent residential care, the authority has allocated a number of beds in the homes for the short term care of elderly people normally residing in their own homes or in relatives' homes. This is a policy encouraged by the memorandum issued by the Ministry of Health in September, 1965, on "Care of the Elderly in Hospitals and Residential Homes". Short-Term Care Admissions No. Total Average Age M F M F Both 14 48 62 83 84 84 14. Further assistance is given to the elderly persons living in the community by the provision of day care facilities at some of the homes. The elderly are brought to the home, in relatives' cars, by voluntary drivers or in the department's own special vehicle, to spend the day with the residents of the home. A mid-day meal and, often, tea, is provided and all the facilities of the home are available, including bathing and hairdressing, before the return to their own homes. A few express a desire to become permanent residents after attending homes under these day care arrangements, but the majority continue to remain in their own homes longer with this kind of support. Voluntary Services in the Residential Homes 15. It is a pleasurable duty to take this opportunity of recording appreciation to those individuals and members of voluntary organisations who do so much to brighten the lives of residents by bringing some of the outside world to them. Trolley shops run by members of the British Red Cross Society and the Women's Royal Voluntary Service; morning coffee and afternoon tea served by members of the local Women's Institutes; entertainments and fetes organised by Friends of the Homes; the innumerable kindnesses shown by thoughtful neighbours and relatives; and the enthusiastic help given by school children and others too numerous to specify. All these are welcome aids in the care of the elderly. Accommodation Provided by Other Authorities 16. Some Bromley residents choose to apply for admission to a home run by another local authority, or were accommodated by the former authority, Kent County Council, in homes which were 61 not transferred to the new Borough under the London Reorganisation arrangements. The Welfare Services Sub-Committee has accepted financial responsibility for the cost of maintenance of 48 Bromley residents who were accommodated by other authorities at 31st March, 1966. Similarly, 10 men and 36 women were provided with residential care by this authority on behalf of other authorities. 17. Accommodation for various needs is provided throughout the country by voluntary organisations. Some of this accommodation is for the elderly and complements that provided by local authorities. It is often preferred because of religious or other affiliations. Other accommodation, however, provides for the special needs of those with various disabilities, e.g. epilepsy, spasticity, blindness, deafness. For these varying reasons, financial responsibility has been accepted for 190 residents in voluntary homes of many kinds and dispersed widely throughout the country. Ten-Year Programme—Residential Care 18. One of the tasks to be faced in the first year was the production of a Ten Year Plan for the development of the Welfare Services. For local authorities outside the London area the information supplied to the Ministry of Health was a review of plans submitted in 1963 but for the London Boroughs this was a new exercise. 19. The plan approved by the Committee envisages an increase in the number of places available for residential care to 629 by 1976. It is anticipated that a further 188 residents will be accommodated in voluntary homes in the Borough. This figure, which can be adjusted as further reviews take place and as more experience is gained of the needs in the Borough, is made up by the provision of new homes in the areas of St. Pauls Cray, Penge, Bromley, Beckenham and Chislehurst which, together, will provide an additional 205 places, but 45 places at Orpington Hospital will be vacated in this period. It is anticipated that voluntary and private homes in the area will serve local needs of an estimated 248 places. The Development Programme 20. Year of Commencement of Scheme Proposed Home No. of Places 1966/67 Mickleham Road, St. Pauls Cray (site available) 45 1969/70 Penge (no site as yet) 40 1971/72 Bromley (no site as yet) 40 to Beckenham (no site as yet) 40 1975/76 Chislehurst (no site as yet) 40 205 62 Note: These schemes have now been deferred due to restrictions on capital expenditure imposed by the Government. The St. Pauls Cray scheme, for example, is now due for loan sanction in 1967/68 and is unlikely to be ready for occupation before 1970. PROVISION OF TEMPORARY ACCOMMODATION Responsibility of the "Welfare Authority" 21. Section 21(lXb) of the National Assistance Act, 1948, makes it a duty to provide temporary accommodation for persons who are in urgent need thereof, being need arising in circumstances which could not reasonably have been foreseen, or in such other circumstances as the authority may in any particular case determine. There are thus two aspects of temporary accommodation in which the Welfare Services have a responsibility: (a) the statutory obligation to provide accommodation in cases where the need could not have been foreseen and (b) the responsibility placed on the local authority to care for families rendered homeless in foreseeable circumstances, e.g. eviction following non-payment of rent. 22. In 1963 the Kent County Council prepared a scheme to provide temporary accommodation for persons rendered homeless by fire, flood or other peace-time emergency, for each district in the County area. The scheme provided, inter alia, for dealing with homelessness arising as a result of a large scale disaster in the areas of Orpington, Beckenham, Bromley, Chislehurst and Penge. Within the area now covered by the London Borough of Bromley the plans provided for the accommodation of up to 700 persons. It is intended to bring this scheme up to date and sources of supply of food, blankets and other essential supplies are being checked. It has not been necessary to implement this scheme since its preparation in 1963. 23. The main concern of the "Welfare Authority" has been the prevention of homelessness with individual families. Despite the preventive work undertaken, however, the department experienced many difficulties in providing satisfactory temporary accommodation when all other avenues had been explored. The Family 24. The majority of Welfare Authorities admit families to temporary accommodation without discrimination against the husband. This is the policy adopted by the London Borough of Bromley although it could not be applied until suitable properties were obtained. Accommodation at West Mailing, available by agreement with the Kent County Council until 31st March, 1967, had to be used and husbands were excluded. 25. On 1st April, 1965, 4 families (involving 11 children) were the responsibility of this authority at West Mailing, and 1 family 63 (involving 4 children) at Newington Lodge, Lambeth. Between 1st April, 1965, and 31st March, 1966, a further 27 families (70 children) were taken into temporary accommodation. Of these 27 families, 24 were admitted to West Mailing and 3 direct to family units within the Borough. The families admitted direct to family units were rendered homeless as a result of fire. They were able to return to their own accommodation after a short time. During the same period, 24 families were discharged from West Mailing. 5 were accommodated by the Housing Department of this Authority; 15 made their own arrangements; and 4 were transferred to family units. At 31st March, 1966, there were 3 families remaining at West Mailing. Family Units 26. The first family unit was brought into operation on 18th October, 1965. At 31st March, 1966, there were 7 of these units in various parts of the Borough, and 7 families had been accommodated in them—4 transferred from West Mailing, 3 admitted direct. Of the 4 discharged from family units, 1 family was provided with permanent housing accommodation by the Housing Department and the remaining 3 families made their own alternative arrangements. Prevention 27. Between 1st April, 1965, and 31st March, 1966, the social welfare officers dealt with 134 families. As indicated in the preceding paragraph, 27 of these were admitted to temporary accommodation. In the majority of cases, therefore, other measures were taken to avoid the necessity for admission. Closer liaison has been developed between departments of the local authority, other agencies, and the voluntary organisations in a determined effort to reduce the incidence of homelessness. At the end of the period under review, however, the situation remained of great concern. WORK OF THE SOCIAL WORKER IN RELATION TO THE ELDERLY 28. Although the Council provides residential care for a number of old people, the majority of the elderly remain in their own homes, or with relatives. The social welfare officers are concerned in helping these people to lead a full and independent life, in a place of their own where they can enjoy privacy and comfort in familiar surroundings. A great deal of effort, thought, and imagination is required on the part of the worker, in order to help an old person achieve this. In the first instance, a professional relationship with the client must be built up, which should be one of mutual trust and confidence, and in which the person's wishes must always be respected, and the dignity of old age preserved. The building 64 up of such a relationship takes a long time and involves regular visiting over a long period. During this time the social worker helps the individual with the emotional problems of ageing, and the practical difficulties which accompany it. The worker knows where help is available, and can easily call upon the domiciliary services (e.g. home helps, meals on wheels, etc.) and voluntary bodies to support the elderly in their own homes. 29. There may, however, come a time when it is neither practical nor desirable for an old person to continue to live in the community, and the greatest adjustment has to be made when the time comes for an old person to be admitted to residential care. The social worker may have been helping the client over a long period to come to this decision, and should be able to ease the transfer from home to residential accommodation. This is usually a time of emotional crisis for the elderly, and a field worker with skill and ability can make it a much less traumatic experience. It must be remembered that the job is not finished when an elderly person is admitted to residential care; follow-up visits and continued contact are maintained between the worker and the resident. Thus the old person has the security of a continuing relationship with someone outside the residential home. It will be seen, therefore, that the field worker is usually in touch with the elderly for a long period, which should begin some time before residential care is necessary, and continue through and after the time of admission. The social welfare officers made a total of 3,118 visits to elderly persons during the year. MEALS AND RECREATION 30. The Borough makes an annual grant to voluntary organisations whose activities include the provision of meals and/or recreation for old people. The Bromley Old People's Welfare Joint Committee co-ordinates the work of the local Old People's Welfare Committees. During 1965/66 a grant of £11,260 was made by the Borough to the Old People's Welfare Joint Committee in respect of services provided by Old People's Clubs and also for Meals-onWheels, Holidays for Old People, and the Boarding Out scheme. During the year 86,000 meals were served by the Women's Royal Voluntary Service, the British Red Cross Society, and the voluntary Old People's Welfare Committees through the Meals-on-Wheels services, at luncheon clubs and day centres. SPECIAL HOUSING OF THE ELDERLY 31. The Borough makes a grant in respect of the welfare services provided in connection with the housing of old people. These services include the employment of wardens to provide assistance to the elderly tenants. During 1965/66 grants totalling £9,280 were made in respect of 348 special housing units provided by the 65 Housing Committee and voluntary Housing Associations in the Borough. WELFARE OF HANDICAPPED PERSONS 32. Section 29 of the National Assistance Act, 1948, provides for local welfare authorities to promote the welfare of persons who are blind, deaf or dumb, and other persons who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed by the Minister. Welfare services in respect of blind persons have been mandatory since 1948. On the advice of the Minister of Health schemes for the deaf and other handicapped persons have been operated by local authorities since 1951 and in 1960 these were made mandatory. 33. A Committee of Inquiry on the Rehabilitation, Training and Resettlement of Disabled Persons (the Piercy Committee) reported in 1957 on the need for the development of services to disabled persons. The Committee emphasised that more services were required to provide occupational home work; personal aids; carrying out structural alterations in disabled persons' homes; and stressed the need for day clubs or centres for the handicapped. The Committee focused on the disabled person as a human being and a social unit and pointed out that there was a need for co-operation between all agencies, particularly between voluntary and statutory bodies. It is in the spirit of the recommendations of the Piercy Committee that the services for the disabled are being developed in the Borough. The Register 34. A register of handicapped persons who apply for, or on whose behalf application is made for assistance, is kept in accordance with the requirements of the Minister of Health. There were 562 persons registered at 31st March, 1966. The grouping of disabilities is in accordance with the Medical Research Council code of diseases and disabilities as used by the Ministry of Labour. Relevant statistics are produced in Table V. Social Welfare 35. In order to assist handicapped persons to overcome the effects of their disabilities, the social workers from the three Area Offices situated in Orpington, Bromley and Penge. visit the disabled on the Register regularly. They give advice and guidance on personal problems and in connection with any services which may be of benefit whether they be provided by voluntary or statutory agencies. In pursuance of this policy the social welfare officers made 1,191 visits during the year. Many of these were of an introductory nature as a first step in ascertaining needs. 66 TABLE V LONDON BOROUGH OF BROMLEY — REGISTER OF HANDICAPPED PERSONS 0-15 16-25 26-35 36-45 46-55 56-64 65 and over Total M F M F M F M F M F M F M F A/E — 1 - — — — 4 — 5 3 6 3 15 11 48 F 1 - - - - - 1 1 4 7 7 20 18 97 156 G — - 3 1 2 — 1 3 2 — — 1 1 1 15 H/L 1 - - - - 1 2 1 5 4 16 5 20 18 73 Q/T — - 1 1 1 1 7 2 4 4 8 8 9 11 57 V 2 2 15 8 5 7 4 15 21 32 14 23 14 42 204 U/W - - - - - - 1 1 - - - - - - 2 X - - - - - - - - - - 1 - - - 1 Y - - 1 - - - - - - - - - - 1 2 Z — — — - - - - — - 1 1 — 2 — 4 Totals 4 3 20 10 8 9 20 23 41 51 53 60 79 181 562 Key: A/E Amputation F Arthritis and rheumatism G Congenital malformations and deformities. H/L Diseases of the digestive and genito-urinary systems; of the heart or circulatory system; of the respiratory system (other than tuberculosis) and of the skin. X Tuberculosis (respiratory). Y Tuberculosis (non-respiratory). Q/T Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine. V Organic nervous diseases - epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica, etc. U/W Neuroses, psychoses and other nervous and mental disorders not included in V. Z Diseases and injuries not specified above. 67 Aids, Gadgets and Adaptations 36. Arising from the visits of the social worker, recommendations for the supply of personal aids or adaptations to property have been made. An analysis of aids supplied shows that an amount of £1,481 3s. 3d. was spent on the provision of 240 aids, viz: 6 Amesbury chairs 26 Bath safety mats 33 Bath safety rails 56 Bath safety seats & boards 2 Bath safety toilet aids 1 Bed cradle 1 Bookrest 1 Combined knife & fork 3 Prs. Crutches 1 Food guard 9 Lifting aids—Penryn 2 Lifting aids—Winchester hoist 1 Patient helper 4 Pick-up sticks 1 Ripple bed 4 Stocking pullers-on 15 Toilet seats 1 Trolley (standard) 10 Walking aids—Tripods 8 „ Quadrupeds 11 „ Rollators 3 „ Walkamatic 40 „ Zimmer 37. In addition to the aids supplied directly by the Welfare Services, the Borough makes an annual grant of £50 to each of the three divisions of the British Red Cross Society operating in the area. This contribution assisted the British Red Cross Society in its supply of a range of nursing aids which complements those supplied by the Local Authority. Aids supplied by The Local Authority All types of walking aids Hoists—e.g., Easicarri, Winchester and Penryn Lifters Bath seats & safety rails Raised & adjustable toilet seats Amesbury chairs Ripple beds Pick-up sticks Stocking pullers-on Feeding & other small aids The British Red Cross Society Air beds Kidney bowls Bed mattresses Mackintosh sheets Bed rests Commodes Air cushions Wheelchairs Urinals Feeding cups Air rings Bed pans Fracture boards Air blocks Bed cradles 38. Very often simple adaptations such as the installation of hand rails will be sufficient to make mobility in the home less arduous and much more safe. There are other occasions where it is necessary to make adaptations to improve access to bathroom and toilet facilities. It may be that a person confined to a wheelchair requires doorways to be widened or ramps to be put in the place of steps. Whatever the requirement may be the social worker is available to advise on the most suitable method of adapting the home environment to meet the needs of the individual so that a more independent life is possible. Where adaptations appear impracticable, efforts are made to obtain more suitable housing accommodation. Early indications are that there is a need for more specially designed houses or flats for the seriously disabled in the Borough. 39. When an individual is provided with a motorised invalid vehicle the Ministry of Health require that suitable garaging 68 facilities be available. Where none exists the Ministry provides a storage shed and bears the expense involved in providing a base for it. In co-operation with the Ministry, the local authority usually arranges for the work to be done. Where the shed is erected in the client's garden, work in providing concrete paths, pavement cross-overs, etc., is carried out at the same time. Analysis of Adaptations Grab rails 10 Toilet adaptations 2 Access ways, etc., to Invalid Tricycle Sheds 2 Wooden ramps 3 Interior adaptations for wheelchair access 1 Heating 2 20 Occupation in the Home 40. Handicapped persons who are capable and desirous of engaging in any handicraft or skilled activity may be assisted by the local authority through the three occupations officers employed. Each officer is a member of the team attached to one of the Area Offices at Orpington, Bromley and Penge. In the first half of the year 1965/66 only one officer was employed but, on the appointment of the other two in August, 1965, the service has expanded rapidly. In addition to giving instruction in basketry, rug work, sea-grass work, knitting, crochet, toy making, etc.. the occupation officers have been successful in introducing outwork to several disabled clients. Outwork obtained from local firms involves simple assembly operations which, though repetitive and possibly boring in themselves, do provide a means whereby the individual can earn a small amount of money for the labour involved. Although money rewards are small, the persons concerned derive satisfaction from the knowledge that they are contributing something worthwhile to the community. 41. The occupations officers made 2,249 visits to clients in the course of the year and also visited the residential homes to give instruction to interested residents. At 31st March, 1966, there were 151 persons engaged in occupational work: Occupation Remunerative Diversionary Outwork Total 33 4 9 46 22 2 10 34 42 10 19 71 97 16 38 151 69 Holidays 42. The local authority introduced a scheme for holidays for the disabled, and the social workers were responsible for making the necessary arrangements for individuals to have holidays at centres where the particular needs of handicapped persons were catered for. During 1965/66, 74 seriously disabled people were assisted with holiday arrangements at a cost to the authority of £745 12s. 10d., towards which the persons concerned contributed £144 11s. 6d. A number of holiday centres were used including: California Lakeside Holiday Camp, Wokingham. Dovercourt, Essex. Grange Farm, Chigwell, Essex. Lulworth Court, Westcliff-on-Sea. A holiday is much more difficult to arrange for a disabled person than for an able-bodied person, but with the assistance provided by the British Red Cross Society, many other disabled were able to take a holiday. This service is thus a very important part of the welfare provisions and may be expected to expand if financial limitations permit. Transport 43. Authority was given by the Welfare Services Sub-Committee in November, 1965, for the acquisition of a specially adapted vehicle fitted with a tail lift for the purpose of conveying severely handicapped people. It is anticipated that the vehicle will be brought into use during the next financial year. Club Activities 44. The British Red Cross Society has three divisions working in the Borough and for many years the welfare of disabled persons has been a major activity. Each of the three divisions has social clubs for the disabled operating as follows: District Day held Place Average Attendance Beckenham 2nd & 4th Tuesday 45 Beckenham Road 18 Beckenham 1st & 3rd Thursday Church Hall, Elm Road 38 W. Wickham 2nd & 4th Friday Emmanuel Church 50 Hall, The Grove Bromley 2nd & 4th Wednesday Freelands Road 55 Chislehurst 2nd & 4th Friday Hornbrook House, 46 Chislehurst Chislehurst Tuesday mornings Hornbrook House, 14 Chislehurst 45. In addition to club activities, other events are run by the British Red Cross Society. One of the most notable is the Christmas shopping expedition specially organised with the co-operation of the Manager and staff of F. W. Woolworth & Co., High Street. Bromley. 70 46. The West Kent Spastic Society has a Work Centre for spastics at 17 Park Road, Bromley, where industrial training is given with a view to progression to sheltered workshops for severely handicapped persons or into open industry. 47. The Good Companions Club is a new voluntary association in the Borough, which aims to provide social activities for the severely handicapped. The club holds its meetings at Melvin Hall, Penge, and its disabled members provide the driving force themselves by playing a leading role in the organisation of events and activities. Meetings are held fortnightly on Monday evenings. 48. In March, 1966, a branch of the Multiple Sclerosis Society was formed in the Borough to cater for the needs of persons with this disability and also to raise funds for research. The Borough has given every support to the Bromley branch of the society, and one of the senior social workers is a member of the Committee. 49. Whilst a good beginning has been made in furthering the welfare of the severely disabled in the Borough, it is recognised that it is only a beginning. In a Borough with a population of over 300,000 there must be more severely handicapped persons of working age than the 295 so far registered. It is clear that as the welfare services of the Borough become more widely known, and as the activities of voluntary groups broaden, more disabled people will seek the support and material assistance available. The extension of group activities is as dependent on the availability of suitable premises and means of transport as it is on the enthusiasm of the social workers, voluntary workers, and the disabled themselves. To create the demand for facilities, to enable the disabled to lead as full a life in the social and industrial spheres as possible, the trained and experienced field workers will be looked to for encouraging the will to overcome their disabilities. This is especially so with the homebound. If such casework is successful a rise in the amount spent on adaptations to property and various aids is to be expected. 50. To meet the expected demand for facilities the Borough has included in the development plan for the period to 1975 a social and occupational centre to cater for the needs of the disabled. The further provision of vehicles, specially adapted to carry persons confined to wheelchairs, is envisaged. 51. As severely disabled people become more articulate members of society and more aware that they can play an important part in the life of the community, close co-operation between all agencies in this field is essential to meet the challenge. 71 WELFARE OF THE BLIND AND PARTIALLY-SIGHTED Certification 52. An initial visit is made by the social welfare officer to a person suffering from defective vision and the person is invited to be examined with a view to registration as blind or partially-sighted. Certification is carried out by an ophthalmologist of consultant status who examines the person's eyes, usually at his consulting rooms, and completes a Form B.D.8. As a result of the certification a person is registered as either blind or partially-sighted. Copies of the B.D.8 are supplied to the appropriate family doctor. The definition of a blind person in this country is "a person who is so blind as to be unable to perform any work for which eyesight is essential". A partially-sighted person is a person who is substantially and permanently handicapped by congenital defective vision or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character. In the case of a person under the age of 65 being registered, a copy of the B.D.8 is sent to Professor Sorsby, M.D., F.R.C.S., Research Professor in Ophthalmology, Royal College of Surgeons, for research purposes. 53. 96 persons were examined for the first time by consultant ophthalmologists during the 12 months ended 31st March, 1966; 26 re-examinations took place. The total fees paid amounted to £497 3s. 0d. First examinations accounted for £413 3s. 0d. of this amount and the remainder, £84, was for re-examinations. The following table shows the action taken concerning the examination of persons alleged to be blind during the year ended 31st March, 1966:— No. of Examination Certified Blind Certified PartiallySighted Observation Cases Male Female Male Female Male Female New Cases 96 19 31 9 29 1 7 Re-examinations: Previously Blind— now Partially-Sighted 1 — — — 1 - - Previously PartiallySighted—now Blind 11 4 7 - - - - Previously PartiallySighted—still Partially-Sighted 13 4 9 - - - - Previously Observation—now Partially-Sighted 1 — — — 1 — — Totals 122 27 47 9 31 1 7 72 54. The causes of blindess and partial-sight of the 88 new cases registered are analysed as follows:— Cataract (Opaque Lens) Glaucoma (Increase in intraocular tension) Senile Macula Degeneration (Disorganisation of the Macula) Myopia (Short Sight) Others Blindness 7 12 13 4 14 Partial Sight 10 6 5 6 12 In 1 case there were two causes of partial-sight. 8 persons were considered not certifiable as blind or partially-sighted and their names were placed on the Observation List. Follow-up visits are made to these people by the social welfare officers and, if appropriate, re-examinations arranged subsequently. If it is considered that a partially-sighted person or an observation case will be better served by being on the Physically Handicapped Register, they are invited to be so registered. Registrations—Blind 55. The following changes have taken place in the Blind Register during the 12 months' period ended 31st March, 1966:— London Borough of Bromley as at 31.3.1965 Male Female Total 165 311 476 Less: Changes during 12 months ended 31.3.1966: Deaths 20 30 50 Transfers to other areas 8 12 20 De-certifications 1 1 2 136 268 404 Add: Changes during 12 months ended 31.3.1966: Transfers in from other areas 10 11 21 New Registrations 14 23 37 Transfers from Partially-Sighted Register 4 5 9 164 307 471 Distribution in Age Groups (Blind Persons) 56. Male Female Total % of Total Registrations Male Female Total Ages - 1 1 1.06 0.85 1.91 5-10 2 1 3 11-15 3 2 5 16-20 4 4 8 17.20 20.59 37.79 21-49 34 21 55 50-69 43 72 115 70 and over 78 206 284 16.56 43.74 60.30 164 307 471 34.81 65.18 100.00 73 Blind Registrations as a Percentage of Total Population 57 Registrations Population Male Female Total 164 307 471 305,000 .054% .100% .154% Number of Blind Persons per 10,000 Population = 15.4 (compared with 20.6 for England and Wales). Classification of Blind Persons 58 Male Female Total % of Total Registrations Male Female Total Children under 2 — 1 1 1.06 0.85 1.91 Children 2—4 suitable for education at school - - - Children 2—4 unsuitable for education at school - - - Children 5—15 suitable for education at school: at Special Schools 2 - 2 at Other Schools - — - not at School - — — Children 5-15 unsuitable for education at school: in Hospitals for Mentally Ill - - - in Hospitals for Mentally Subnormal 3 3 6 at home or elsewhere — — - Children 16-20 still at school 1 2 3 0.21 0.42 0.63 Employed: in Special Workshops — 1 1 8.71 3.61 12.32 as Home Workers 3 1 4 elsewhere 38 15 53 Unemployed 117 284 401 24.84 60.30 85.14 164 307 471 34.82 65.18 100.00 Children at School 59. Of the children at school, two boys are at Worcester College for the Blind and one girl is at Chorley Wood College for girls with little or no sight. These schools provide secondary grammar school education for pupils aged 11-19 years who are prepared for the General Certificate of Education and University entrance. The remaining two children receive secondary modem education up to the age of 16, one at Linden Lodge School, Wimbledon, and the other at Dorton House, Seal, near Sevenoaks, Kent. 74 Employed Blind Persons 60. The following table shows the occupations of blind persons who were in employment on 31st March, 1966:— In Special Workshops Home Workers Elsewhere Male Female Male Female Male Female Knitters — 1 - 1 - - Piano Tuners — — 3 — 3 — Masseurs & Physiotherapists — — — — 3 1 Musicians — — — — 1 — Social Welfare Placement Officer - - - - 1 - Company Director (Printers) — — — — 1 — Office Executive — — — — 1 — Typists & Secretaries — — — — 6 5 Telephone Operators — — — — 6 1 Gardeners — — — — 1 — Machine Tool Operators — — — — 9 — Fitters & Assemblers — — — — 2 Boxers, Fillers, Packers - - - - - 3 Labourers — — - - 2 - Porters (Railway) — — — — 1 — Lecturers, Teachers — — — — 1 1 Miscellaneous - - - - - 3 — 1 3 1 38 15 Unemployed 61. The majority (328) of the 401 unemployed blind persons are over the age of 65. Of the remaining 73, 40 are housewives, 12 mentally ill, 11 physically disabled, 6 employable with or without training, 2 retired, 1 in hospital, and 1 man shown as employable with training was undergoing a course of industrial rehabilitation at Torquay. Registrations—Partially-Sighted 62. The following changes have taken place in the Partially-Sighted Register during the 12 months ended 31st March, 1966:— London Borough of Bromley as at 31.3.65 Male Female Total 59 110 169 Less: Changes during 12 months ended 31.3.66: Deaths 5 11 16 Transfers to other areas 3 6 9 Transfers to Blind Register 4 6 10 Untraced - 1 1 47 86 133 Add: Changes during 12 months ended 31.3.66: New Registrations 9 25 34 Transfers from other areas 2 1 3 Transfers from Blind Register 1 1 2 59 113 172 75 Distribution in Age Groups (Partially-Sighted) 63. Male Female Total % of Total Registrations Male Female Total Ages 1—4 - 1 1 2.33 4.07 6.40 5-15 4 6 10 16-20 7 2 9 15.12 13.95 29.07 21-49 10 13 23 50-64 9 9 18 65 and over 29 82 111 16.86 47.67 64.53 59 113 172 34.31 65.69 100.00 Partially-Sighted Registrations as Percentage of Total Population 63. Registrations Population Male Female Total 59 113 172 305,000 .02% .04% .06% Number of Partially-Sighted persons per 10,000 population = 6.01 (compared with 6.01 for England and Wales) Classification of Partially-Sighted Persons 64. Male Female Total % of Total Registrations Mate Female Total Babies Children 5-15 suitable for education at school: - 1 1 2.33 4.07 6.40 at Special Schools 2 4 6 at other Schools 1 — 1 not at School 1 1 2 Children 5-15 unsuitable for education at school - 1 1 Children 16-20 still at school 3 1 4 1.74 0.58 2.32 Employed 17 8 25 9.88 4.66 14.54 Unemployed: undergoing training 1 — 1 13.37 40.70 54.07 available for and capable of work 2 3 5 not available for work 20 67 87 Requiring observation only 12 27 39 6.97 15.70 22.67 59 113 172 34.29 65.71 100.00 Visitation by Social Welfare Officers 65. A total of 898 visits was made by social welfare officers for the blind during the 12 months ended 31st March, 1966. Home Teaching of Crafts and Embossed Types 66. During the 12 months ended 31st March, 1966, lessons were given by social welfare officers in a person's own home, viz.: (a) Braille—7; (b) Moon—10; and (c) Handicrafts—11. 76 Deaf/Blind 67. Included in the duties of the social welfare officer is the visiting of registered blind persons who are not only blind but deaf. Fortunately these doubly handicapped persons form a small percentage of the blind register and in the London Borough of Bromley area there is only one person, a lady of 102 years, who is totally deaf and blind. The main means of communication with a deaf/blind person is by using the deaf/blind manual or block letter printing on the hand. It is the responsibility of the social welfare officer to encourage deaf/blind persons to retain their speech by communicating with them by using one or other of these methods and to teach them braille, moon or handicrafts as appropriate. A Social Club for deaf/blind persons living locally is held at Hombrook House, Chislehurst, on the fourth Saturday in every month. All deaf/blind persons are invited to become members of the National Deaf/Blind Helpers League which is centred at Peterborough. This organisation exists to improve the social conditions of the deaf/blind and to provide information and advice on problems relating to deaf/blind people. A monthly Social Club for the deaf/blind organised by the League is held at Tooley Street, S.E.l, and deaf/blind persons living within a reasonable distance are invited to attend. An annual rally of deaf/blind persons arranged by the League is held in Peterborough in July. Handicraft Classes 68. Regular Handicraft Classes are held at the following Centres: Venue Day held Average Attendance Beckenham Handicraft Class. Fortnightly 12 Azelia Hall, Croydon Road. Beckenham. Fridays Bromley Club, Fornightly 18 New Methodist Church, High Street, Bromley. Mondays Chislehurst Blind Friends. Weekly 10 Hombrook House, High Street, Chislehurst. Thursdays Orpington & District Handicraft Class, Weekly 15 Methodist Church Hall, Sevenoaks Road, Orpington. Wednesdays Instruction is given by the social welfare officers at these classes in such crafts as sea grass work, basketry, knitting, crochet, leatherwork, rug-making, mosaic and lampshade making. Sheltered Employment 69. As at 31st March, 1966, 1 female blind worker was employed in sheltered employment in the London Workshops for the Blind as a flat machine knitter. The total augmentation, supplementation, and travelling expenses, paid in respect of this worker during the 77 period under review was £304 19s. 2d. The Ministry of Labour meets 75% of this expenditure under the approved arrangements for capitation payments. The upper limit of capitation payments was increased to £300 on 1st August, 1965. Home Workers Scheme 70. The Home Workers Scheme is organised by the Home Industries Department of the Royal National Institute for the Blind at Reigate, Surrey. Blind home workers are employed in a variety of occupations such as poultry-keepers, carpenters, basket, brush and mat-makers, machine knitters and piano tuners. Supervision of the home workers is carried out by visiting officers from the Home Industries Department. Materials are supplied to the workers and their goods collected for sale at the Reigate retail shop. Other sales are carried out through a mail order business which has been built up over many years. 3 blind male piano tuners and 1 female blind machine knitter were employed under the Home Workers Scheme during the 12 months ended 31st March, 1966, the total augmentation for these employees being £949 7s. 3d. The local authority also paid a fee of £50 per worker towards administrative costs. The Ministry of Labour meets 75% of this expenditure. The upper limit of capitation fee payable by the Ministry is £40. Residential Accommodation 71. The number of registered blind and partially-sighted persons resident in homes as at 31st March, 1966, was as follows:— In Homes for the Blind—9 women, 1 man In other Homes—34 women, 4 men National Library for the Blind 72. The National Library for the Blind provides a free service, apart from the appropriate charge made to the local authority, of Braille and Moon books to blind persons of all ages. There is a comprehensive range of fiction and non-fiction books available. Provided sufficient demand exists any particular book will be transcribed. A special transcription service is available for students. The Braille and Moon books are sent to and from the library by post and there is no postage charge. An annual Braille reading competition is held by the Library to encourage new readers and maintain the standard of reading of older members of the Library. The number of blind persons who were members of the Library at 31st March, 1966, was 34 and the cost to the London Borough of Bromley for such membership was £3 per person. 78 Talking Books 73. The Nuffield Talking Book Library provides Talking Book Machines on loan to registered blind persons over the age of 21, or to persons who have defective vision and can prove by an ophthalmologist's report that their eyesight is so poor that they cannot read. A comprehensive list of books on tape is available from the Library. 106 residents of the London Borough of Bromley were in possession of Talking Book Machines at 31st March, 1966. The cost of renting a Talking Book Machine is £3 per annum, plus 57- if headphones are used. 90 blind persons pay the rental for a Talking Book Machine themselves; the remaining 16 have the rental paid by the Kent County Association for the Blind. Social Rehabilitation 74. The main centres for Social Rehabilitation are situated at Oldbury Grange, Bridgnorth; Manor House, Torquay; and America Lodge, Torquay. These Centres are administered by the Royal National Institute for the Blind. It may be found that after a short period of social rehabilitation at Torquay a blind or partially-sighted person is suitable for transfer to the Industrial Rehabilitation Course also run at Torquay on behalf of the Ministry of Labour. The charge for the Course, £7 10s. 0d. per week, then becomes the responsibility of the ministry of Labour. Oldbury Grange only caters for Social Rehabilitation, mainly housewives and men in an upper age group. When a blind person, due to domestic circumstances, is unable to undertake a period of residential rehabilitation, facilities for attendance at the Warwick Row Centre have been afforded by the City of Westminster. Services Provided by the Kent County Association for the Blind 75. The blind and partially-sighted persons of Kent have the support of a strong voluntary organisation, the Kent County Association for the Blind, in addition to the services provided by the local authorities, central government and national agencies. This Association, which is centred at Maidstone, supplements the statutory services and provides the extras which might not be available otherwise. A list of the various services is shown below and it will be seen that most of the social outlet for blind and partially-sighted persons is provided by Kent County Association for the Blind. The London Borough of Bromley makes a nominal grant of £10 per annum to the Association. Services Provided 76. 1. Financial help in cases of special need. 2. Recreational facilities: (a) Social Clubs, where necessary providing transport; 79 (b) Inter-Club activities—Dominoes, Cribbage and Quiz contests; (c) Summer outings; (d) Concerts and Parties. 3. Sales service for disposal of goods made by blind people. 4. Holidays arranged at Holiday Homes for the Blind, Margate. 5. Help with provision of special Talking Books and Lending Library of records for blind persons. 6. Membership of National Library—provision of Braille and Moon magazines. 7. Loan, maintenance and insurance of wireless sets, the sets being provided by the British Wireless for the Blind Fund. 8. Arrangements for provision of Guide Dogs in certain cases. 9. Free legal advice when necessary. 10. Rental of premises for Handicraft Classes. 11. Residential Accommodation—at Ogden Home for the Blind, Ramsgate, which has accommodation for 35 residents, male or female. Accommodation is also available at two Homes at Tunbridge Wells—1 Home provides accommodation for 10 males and the other for 4 females. 77. The following Clubs for the Blind are affiliated to the Kent County Association for the Blind:— Beckenham Social Club, Azalia Hall, 90 Croydon Road, Beckenham. Bromley Club, New Methodist Church Hall, High Street, Bromley. Chislehurst Blind Friends Social Club, St. Mary's Hall, High Street, Chislehurst. Orpington and District Club, Baptist Church Hall, High Street, Orpington. Penge and Anerley Social Club, Melvin Hall. Melvin Road, S.E.20. Held Fortnightly on Wednesdays Held Fortnightly on Mondays Held Weekly on Tuesdays Held Fortnightly on Saturdays Held Weekly on Tuesdays General Services 78. The local services provided by the London Borough of Bromley and Kent County Association for the Blind are supplemented by the work of other agencies as follows:— Ministry of Labour 79. The Blind Persons Resettlement Officers and the Disabled Resettlement Officer employed by the Ministry of Labour have the responsibility of arranging for employable persons to be sent for industrial rehabilitation and retraining where necessary, and 80 ultimately for placement in open industry or sheltered employment. The Ministry also makes grants to local authorities towards the cost of providing employment for blind persons in Workshops for the Blind and in Home Workers' Schemes. St. Dunstans 80. Is responsible for the training, settlement and after care of men and women blinded on war service. Many trades and occupations are taught to St. Dunstaners, including typewriting and shorthand, physiotherapy, telephony, machine operating, shopkeeping, poultry farming, joinery, basket-making, netting, rugmaking and weaving. St. Dunstans have a Training Centre and Holiday Home at Ovingdean, Brighton, and a Convalescent Home at Portland Place, Brighton. They also own many houses and bungalows which are rented by St. Dunstaners, and employ welfare officers to visit the war blinded. There are 15 St. Dunstaners in this area. Wireless for the Blind Fund 81. Wireless sets, both battery and mains, are supplied on loan to registered blind persons who do not have a set of their own. The British Wireless for the Blind Fund provides the sets and the distribution is carried out through the Kent County Association for the Blind. An annual appeal for funds for the British Wireless for the Blind Fund is made on the radio on Christmas Day. Guide Dogs for the Blind Association 82. The Association has set up training centres at Bolton, Exeter, Leamington Spa and Forfar. A person must be registered as blind before he or she can apply for a dog. The Association is prepared to supply a fully-trained guide dog to any suitable registered blind person, provided the person qualifies at one of the training centres, no matter what it has cost the Association to train both dog and blind person. It is stipulated that before a dog is handed over the blind person makes a token payment, which may be as little as 5/-. 3 blind men and 2 women who live in the London Borough of Bromley have Guide Dogs. One of the women owners is employed as a Lecturer by the Association. The Royal National Institute for the Blind 83. Very few blind persons can go through fife without sooner or later requiring the services provide by the Royal National Institute for the Blind. The activities of this voluntary organisation include: 1. Publication of books and periodicals in Braille and Moon types; 2. Recording of Talking Books; 81 3. Provision of apparatus such as White Sticks, Watches and Games; 4. Rehabilitation of the newly blind; 5. Care and education of blind children up to the age of 7; 6. Higher education of the blind; 7. Provision of Homes and Hostels. 84. Sunshine Homes Nursery Schools are found in Middlesex, Warwickshire, Shropshire, Lancashire and Glamorgan. These schools look after blind babies and children up to the age of 7 or, if a child has other handicaps, to the age of 9. Schools for blind children with other handicaps are situated at Condover, near Shrewsbury (12-16), and Rushton, near Kettering (7-12 years). Secondary Grammar School education is provided for girls at Chorley Wood College and for boys at Worcester College for the Blind. 85. Heathersett Vocational Assessment Centre for Blind Adolescents at Reigate, Surrey, is an establishment for the further education of handicapped persons. The Centre endeavours to assess the interests and abilities of students with a view to future training and employment. The Rehabilitation Centres at Torquay and Bridgnorth are run by the Royal National Institute for the Blind. The Institute has 11 Homes for the Blind providing residential and holiday accommodation in various parts of the country and 3 hostels in London, 2 for workers and the other for students. REGISTRATION AND INSPECTION OF OLD PERSONS' HOMES 86. Section 37 of the National Assistance Act, 1948, imposes a duty on Local Welfare Authorities to register and inspect any establishment, the sole or main object of which is the provision of accommodation, whether for reward or not, for disabled persons or for the aged or for both. There were 23 such registered establishments in the London Borough of Bromley at 31st March, 1966. Regular visits have been made to all these establishments to ensure that proper standards of care are maintained. PROTECTION OF PROPERTY 87. Section 48 of the National Assistance Act, 1948, provides for the protection by the local authority of property of persons admitted to hospital or residential accommodation where it appears that there is a danger of loss or damage and where no arrangements are made, and it is often necessary to place movable property in store. In addition, the department sometimes needs to store effects of deceased persons. Action had to be taken in 5 cases during the year. 82 BURIALS 88. The local authority has a duty under Section 50 of the National Assistance Act, 1948, to arrange the burial, or cremation, of the body of any person who has died or been found dead in the Borough, in any case where it appears that no suitable arrangements for the disposal of the body have been or are being made. Since 1st April, 1965, 8 burials and 2 cremations have been arranged. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 84 WORK OF THE PUBLIC HEALTH INSPECTORS J. C. Kermode, m.a.p.h.i., m.r.s.h. Chief Public Health Inspector. This report covers the work of the Public Health Inspectorate in the Borough during the first 9 months of its existence, together with that performed by the staff of constituent authorities for the 3 months ended on 31st March, 1965. It has not been easy to weld together the various systems used by the five authorities. These were of a diverse nature consisting of 2 boroughs, an Urban District with a vast rural acreage, a very small Urban District with a character resembling an inner London Borough and half of a further Urban District. From the outset it was decided to provide a uniform service for all parts of the new Borough. Amongst other preliminary considerations it was necessary to abrogate certain local Bye Laws and to formulate new ones applicable to the whole area. On account of both its acreage and the sheer weight of population the Borough was too unwieldy to be dealt with as a whole. The situation was aggravated by the administrative headquarters being far from centrally situated. It was thus thought desirable to divide the district into three Divisions as follows:— 1. Orpington and St. Paul's Cray. 2. Bromley, Chislehurst and Mottingham. 3. Beckenham and Penge. In drawing the boundaries of these Divisions it was expedient not to split previous authorities' districts but this was not done in a slavish fashion and minor adjustments were made. Similarly, although inspectors, rodent operators and disinfecting staff have been allocated to each Division, the staffs are readily able to assist in any part of the Borough where their services may be required at any particular time. Although this reorganisation has not proceeded without teething troubles, the new system is now firmly established and, looking back on the past 9 months, the main problems which have faced the Section have arisen not from administrative problems but from the shortage of Public Health Inspectors. The Borough started with a deficiency of eight, although by the end of the year it had been reduced to three. Until a full staff has been recruited it cannot be hoped entirely to overcome the disturbance of reorganisation nor to cope with additional duties which new legislation continues to pose. 85 The Administrative side of the Section has been faced with parallel problems. Reorganisation of office techniques has been carried through and when shortage of clerical staff has been resolved three "teams" will be charged with providing the necessary clerical assistance for the three geographical Divisions. In the early days of the Borough the office accommodation at the Walnuts was extremely unsatisfactory but improvements and adaptations have now rendered conditions more tolerable. One of the most important duties which falls upon the Inspectorate is the supervision of all matters relating to the production and sale of food. The Orpington area, particularly, has a number of large food factories and depots and there is one slaughterhouse and one milk bottling plant in the Borough. Much of the meat and food produced at these premises is sold outside the administrative area. If food is to be wholesome and free from dangers to consumers, constant vigilance is needed to ensure that conditions, enforceable under the Food Hygiene (General) Regulations and other legislation, are entirely satisfactory. For the most part the structure of premises where food is prepared, where it is stored, and from which it is sold are reasonably good which is a testimony to the work of the constituent authorities. Nevertheless, some action will always be necessary to maintain standards and in this connection it was necessary to take proceedings against the owner of one factory canteen in which it was thought that washing facilities for kitchen staff were not conveniently placed. The magistrates agreed with this contention and inflicted a penalty. The owner then installed a wash basin in a position approved by the Department. This was one of the first recorded instances of the legal enforcement of this Section. There are known to be 2,133 "food premises" in the area and a total of 4,241 visits were made by Inspectors. Although 300 defects were remedied after the service of 54 written notices, this rate of inspection cannot be considered to be sufficient but it was the best that could be achieved under the circumstances. A lowering of standards will inevitably result from any decrease in the attention paid to these cafes, bakeries, food shops, etc. Some indication of the failure of standards attained by management of food factories, etc., can be gained by the number of complaints received from the public concerning the sale of food containing foreign bodies or being otherwise out of condition. The investigation of food complaints serves a very useful purpose in that manufacturers and others concerned are able (and usually very willing) to institute improvements and more methodic control of stock. For example a defect in the metal of a can of corned beef led to the packers introducing a stronger can. 86 INSPECTION AND SUPERVISION OF FOODS Routine sampling of food and drugs is a constant process and several technical infringements were drawn to the attention of manufacturers. In addition to the more usual foodstuffs and drugs examined, specimens of dried and liquid eggs are tested for the presence of food poisoning organisms and raw milk, sold in the District, for the presence of the bacillus giving rise to the disease Brucellosis. More unusual incidents included the examination of imported "coolers" to see if the liquid contained was sterile; the examination of fluorescent toys, included in packets of breakfast cereal, for radiation and the supervision of a consignment of ground nuts which came into the District and which contained aflatoxin. This is a dangerous product which may form naturally in ground nuts and the foodstuff in this case was eventually manufactured for use as animal feed stuff. FOOD AND DRUGS ACT, 1955 FOOD SAMPLING Letters in parenthesis are referred to on page 88 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal Baby Food — 3 — — Baking Powder — 1 — — Beetroot — 1 — — Blancmange Powder — 1 — — Brandy 1 — — — (h) Bread and Bread Rolls — 12 — 8 Butter — 3 — — (r) Cake — 3 — 2 Celery Salt — 1 — — (l) Cereal and Cereal Products — 30 — 1 (o) Cheese Products — 4 — 1 Cheese Spread — 5 — — (i) Chocolate Confectionery — 9 — 1 Chocolate Flavoured Drink — 1 — — Chutney — 1 — — Cocktail Cherries — 1 — — Coffee — 2 — — Coffee and Chicory Essence — 2 — — Coffee Extract — 3 — — Colouring Matters — 5 — — (d) Corned Beef — 6 — 1 (n) Cream — 13 — 1 (q) Crumpets — 1 — 1 Dehydrated Vegetables — 2 — — Dessicated Coconut — 2 — — (f) Dried Fruit— — 28 — 2 Dried Vegetables — 3 — — Drugs — 29 — — Fish Products (including tinned fish) — 22 — — 87 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal Flavouring Essence — 1 — — Flour—Self Raising — 1 — — French Dressing — 1 — — (c) Fruit and Fruit Products — 33 — 2 (j) Fruit Nut Roll — 1 — 1 Gin 2 — — — Gravy Salt — 1 — — Ground Almonds — 4 — — Ice Cream Powder — 1 — — Jam — 18 — — Jelly — 13 — — Lard — 3 — — Lemon Cheese — 1 — — (k) Lemon Pie Filling — 1 — 1 Margarine — 3 — — Marmalade — 8 — — Marzipan — 3 — — (a) Meat Products — 50 — 8 (e) Milk and Milk Bottles — 42 — 9 Milk (Antibiotics) — 3 — — Milk Pudding — 13 — — Mincemeat — 3 — — Mint Sauce — 2 — — Nut Block — 1 — — Oils and Fats — 7 — — Olive Oil — 3 — — Pastes — 17 — — Pate de Foie Truffle — 1 — — (u) Peanuts — 6 — 4 Peanut Butter — 3 — — Pickles — 2 — — Poultry and Poultry Products — 9 — — Pudding Mixture — 1 — — (P) Raw Vegetables — 1 — 1 Salad Cream — 2 — — Sauces — 18 — — (b) Sausages — 19 — 2 (t) Soft Drinks — 27 — 1 Soups — 7 — — Spices and Flavours — 17 — — Sugar Products — 11 — — (s) Sweets — 13 — 2 Tea — 3 — — Tomato Puree (tinned) — 1 — — (g) Vegetables (tinned) — 4 — 2 Vegetable Juices (tinned) — 1 — — Vegetable Products (tinned) — 12 — — (m) Vegetable Salad (tinned) — 1 — 1 Vegetarian Food — 1 — — Vinegar — 6 — — Whisky 5 — — — Yeast — 1 — — Yoghourt — 1 — — TOTALS 8 596 — 52 88 Nature of Unsatisfactory Sample. Remarks Serial No. 621. Minced Beef and Gravy. (a) Composition: Meat content 66%. The proposed regulations require 70% meat content. Unsatisfactory. Satisfactory correspondence with Manufacturer. Serial No. 683. Pork Chipolatas. (b) Composition: Meat content 63%. Minimum proposed standard 65% meat content. Unsatisfactory. Repeat samples satisfactory. Serial No. 686. Stuffed Pork Roll. (a) Composition: Meat content 48%. Recommended minimum 50% meat content. Unsatisfactory. Satisfactory correspondence with Manufacturer. Serial No. 697. Pears in Water. (c) Composition: Label gives wrong impression of contents. Unsatisfactory. Satisfactory correspondence with Manufacturer. Serial No. 711. Pork Luncheon Meat. (a) Composition: Meat content 73%. Proposed regulations minimum 80% meat content. Unsatisfactory. Satisfactory correspondence with Manufacturer. Serial No. 718. Ham and Beef Roll. (a) Composition: Meat content 56%. Proposed regulations meat content 65%. Unsatisfactory. Satisfactory correspondence with Manufacturer. Serial No. 891. Corned Beef. (d) Composition: Meat content 138% in terms of fresh uncooked meat. The paraffin like taste is confirmed organoleptically but not by chemical means. Withdrawn from sale after correspondence with vendor and Manufacturer. Serial No. 876. Fruit Nut Roll. (j) Composition: Sugar 28, Fat 15, including 1% butter fat. This amount of butter is not in accord, with the position of butter in the list of ingredients. Correspondence with Manufacturer—Satisfactory. Serial No. 44. Lemon Pie Filling. (k) Composition: On the surface of the capsule of oil was a dried moth larva belonging to the genus Elphestia or related genus. Examination of the remainder of the contents disclosed no evidence of moth infestation. Manufacturer warned. 89 Nature of Unsatisfactory Sample. Remarks Serial No. 43. Semolina. (i) Composition: The contents of the packet were contaminated by the webbing produced by the lavae of a food infesting moth. No larvae were found but the exoskeleton of a larval head was isolated. Manufacturer warned. Serial No. 829. Vegetable Salad. (m) Composition: The declared composition does not accord with the composition of the product. An edible oil acetic acid possibly derived from vinegar and allspice are all present as well as the declared ingredients. Correspondence with Manufacturer—Satisfactory. Serial No. 56. Minced Beef Loaf. (a) Composition: Embedded in the meat was a piece of skin bearing hairs. Examination suggests that it is animal hide present due to faulty preparation of the carcase. Manufacturers warned. Cannery in Australia already discontinued. Serial No. 990. 1 pint Bottle of Milk. (e) Composition: Inner surface of bottle soiled by adherent patches of cement. Proceedings under Milk and Dairies Regulations. Firm fined £50 with costs of £5 5s. 0d. Serial No. 913. Stewed Steak and Gravy. (a) Composition: Meat content 64% includ11 % fat. The proposed canned meat regulations call for a minimum of 70% in such a product. Correspondence with Manufacturer. Now satisfactory. Serial No. 909. Hamburger with Gravy. (a) Composition: Meat content 59%. The revised proposed Canned Meat Regulations call for a minimum of 70% meat. Correspondence with Manufacturer. Will comply with regulations when they become operative. Serial No. 904. Ham and Beef Roll with Egg Centre. (a) Composition: Meat content 60%. The revised proposed regulations call for a minimum meat content of 65%. Correspondence with Manufacturer. Now satisfactory. Serial No. 950. Pork Sausage. (b) Composition: The portion of sausage contained a lead air gun pellet in a mutilated condition possibly due to having passed through a mincing machine. The two whole sausages were free from foreign bodies. Warning letter to Manufacturer. 90 Nature of Unsatisfactory Sample. Remarks Serial No. 954. 1 pint Unopened Milk Bottle (e) Composition: The milk which passed the Methylene Blue Test for bacteriological quality was free from matter in suspension. On the internal surface of the base of the bottle were small patches of firmly adherent sand and cement mixture. Referred to Maidstone M.B.C., under Milk and Dairies Regulations. Serial No. 931. 1 pint Bottle of Milk. (e) Composition: The pint bottle No. 931 contained a single foreign body; this measured approximately 1 x 2 mm., and had the properties of rubber. The other four samples 932-5 showed no evidence of foreign matter. Warning letter to Dairy Company. Serial No. 827. Part of Sliced Loaf of Bread. (h) Composition: The sample consisted of part of a small sliced white loaf. Embedded in the crumb in one slice was part of the body of an insect. The characteristics of the foreign matter were consistent with its being part of a cockroach. Chemical tests confirmed that the foreign matter had been subjected to a baking process. Proceedings. Fine of £20 with £5 5s. 0d. costs imposed. Serial No. 930. Part of Farmhouse Loaf with dark particles in the crumb. (h) Composition: The dark coloured fragments in the crumb are pieces of charred dough. Matter drawn to attention of baker. Serial No. 953. Portion of Bread. (h) Composition: The foreign body embedded in the bread crumb is a vegetable bristle possibly derived from a brush. Warning letter to baker. Serial No. 839. Cut Loaf of Bread containing foreign matter. (h) Composition: The eight slices of white cut bread all showed dark streaks in the crumb due to the presence of soiled mineral oil presumably derived from the bakehouse machinery. Prosecution instituted. Manufacturer fined £20 with costs of £11 11s. 0d. Serial No. 4. Dark matter in Brown Loaf. (h) Composition: The foreign matter in each of the three fragments of bread consisted of crumb soiled by mineral oil and iron doubtless derived from the bakehouse machinery. Proceedings. Baker fined £20 with £5 5s. 0d. costs. 91 Nature of Unsatisfactory Sample. Remarks Serial No. 855. Portion of Corn Crisp with separate part of cigarette. (i) Composition: The foreign body is the filter tip of a cigarette. It has the appearance of having been incorporated in the confection but there was no evidence of its having been smoked. Tobacco shreds were not found nor was there any evidence of burning of the paper. Strong warning letter to Manufacturer. Serial No. 853. 1 pint Bottle of Pasteurised Milk. (e) Composition: On the receipt at the Laboratory several types of mould were growing on the surface of the milk bottle but it was confirmed that fibrous material, the subject of the complaint, was a matted layer of mould hyphae. Warning letter to Dairy. Serial No. 31. Bottle of Milk containing foreign matter. (e) Composition: In the cream layer of the milk there were present a number of irregularly shaped pieces of paper. This paper was free from print but certain pices were soiled and discoloured. Also present in the cream layer was a small chip of glass, about 0.2 in. diameter. Prosecution instituted. Dairy fined £15 with costs of £6 6s. 0d. Serial No. 929. 1 pint Bottle of Channel Island Milk—Pasteurised. (e) Composition: On the internal surface of the bottle towards the base was a brown stain approximately 1 inch by 0.6 inches due to the presence of mould hyphae. A small greenish discolouration near the neck was due to the presence of algal filaments. No foreign matter was found free in the milk. Prosecution instituted. Dairy fined £15 with costs of £1 14s. 6d. Serial No. 880. Evaporated Fruit Salad. (f) Composition: Prunes 47, Peaches 15, Pears 20, Apricots 12, Apple rings 6%. The presence of pears in excess of peaches is not in accord with the declared composition. The discrepancy is a minor one though and may be peculiar to this packet. Correspondence with Manufacturers. Satisfactory. 92 Nature of Unsatisfactory Sample. Remarks Serial No. 882. Mixed Fruit. (f) Composition: Sultanas 39, Currants 43. Raisins 11, Peel 7%. Clean sample. Proportion of currants exceeds that of sultanas: this is not in accord with the declaration of ingredients. The discrepancy is not great and may be peculiar to this packet. Correspondence with Manufacturer. Satisfactory. Serial No. 852. Canned Tomatoes containing foreign matter. (g) Composition: The material from the car of tomatoes may well be a piece of ar organic polymer used as an aid on seal ing on the ends of the cans in manufacture. Imported from Spain. Matter still under ininvestigation. Serial No. 0092. Milk Bottle. (e) Composition: The specks on the inside of the base of the bottle consisted substantially of iron and may well have derived from the use of the bottle as firework support. Warning letter to Dairy. Serial No. 0093. 1 pint Bottle of Milk. (e) Composition: Thin film of greyish discolouration on inner surface of bottle —indeterminate debris. Proceedings under Milk and Dairies Regulations instituted. Dairy fined £15 with costs of £5 5s. 0d. Serial No. 0015 1 pint Bottle of Channel Island Milk. (e) Composition: Adhering to the inner surface of the bottle were six small pupae. They are those of one of the dipherous flies, possibly a species of Drosophila. Proceeding under Milk and Dairies Regulations. Firm fined £10 plus £6 19s. 6d. costs. Series No. 969. Pure Cream. (n) Composition: Fat 22.3%—all butter fat. Slight deficiency. Correspondence with manufacturer. Satisfactory. Serial No. 0156. Concentrated Cheese Sauce. "Swiss Cheese, Milk, Flour and Spices". (o) Composition: Cheese 8, Flour 9, Skim Milk 77%. These ingredients do not conform with the declared ingredients. Correspondence with manufacturers—stock withdrawn from sale. Serial No. 971. Fruit Salad in Syrup. (c) Composition: Of the drained fruit, pears constituted 16.2 and pineapple 21.0. The Code of Practice for home canned fruit calls for 19-38 pears and 8-16 pineapples. Correspondence with manufacturers. Satisfactory. 93 Nature of Unsatisfactory Sample. Remarks Serial No. 0089. Swedes. (p) Composition: Aldrin 0.3 p.p.m. Higher than might be expected. Investigation proceeding. Serial No. 0073. Mixed Vegetables. "Carrots, Potatoes, Peas, Swedes, Water and Salt". (g) Composition: Drained weight of vegetables 206g. (Carrots 27.6, potatoes 32.0, peas 29.6, swedes 8.9%). Liquor 102g. The placing of the ingredient water between swedes and salt does not give a correct picture of the cans contents in that it is the major single ingredient. Correspondence with Manufacturer. Satisfactory. Serial No. 0016. Bread. (h) Composition: Contained wooden fragments. Parts of a wooden stick such as are used in ice lollies. Proceedings instituted. Shopkeeper fined £10 with £4 17s. 6d. costs. Serial No. 0067. Bread. (h) Composition: Aldrin 0.1, D.D.T. 0.1 p.p.m. Higher than might reasonably be expected. Investigation proceeding. Serial No. 0091. Bread. (h) Composition: Contained a piece of synthetic yarn. Proceedings instituted. Manufacturers fined £20 with costs of £12 4s. 0d. Serial No. 0167. Crumpet. (q) Composition: Contained a small spring about ½ in. long. Investigated— no further action. — Serial No. 0054. Madeira Cake. (r) Composition: Contained two strips of polythene film approx. 3/8 in. wide and ½ in. and 3/8 in. long respectively. Examination indicated that the film had been baked in the crumb. Proceedings instituted. Manufacturer fined £5 with costs of £6 19s. 6d. Serial No. 46. Swiss Rolls. (r) Composition: Mould growths. Warning letter to baker. Serial No. 0053. Wrapped Sweet. (s) Composition: Contained metallic particles consisting of iron. Warning letter to Manufacturers. 94 Nature of Unsatisfactory Sample. Remarks Serial No. 0130. (s) Rock. Embedded in the rock was a small fragment of metal foil approx. 1 mm. in diameter and also a piece of paper with adherent metal foil label coloured gold with red and blue printing. It was approximately 12 mm. square. Proceedings instituted. Manufacturer fined £10 with £6 19s. 6d. costs. Serial No. 0168. (t) Lemonade. The lemonade had a phenolic odour, and on examination was found to contain 4 p.p.m. of phenols expressed as mixed cresols. Proceedings instituted. Manufacturer given absolute discharge on payment of costs of £16 19s. 6d. Serial Nos. 797/800. (u) Peanuts. Four samples of sliced peanuts were examined for the presence of Aflatoxins. In each case a positive result was obtained and although the amount found did not exceed 0.05 parts per million it was recommended that this toxin should be absent from nuts for human consumption. Aflatoxins are highly poisonous compounds formed by the growth of certain strains of the mould Aspergillus flavus on the nuts. They were first isolated a few years back from poultry food containing Brazilian Ground Nuts; their presence resulted in a high incidence of liver tumours and death of the birds. The stocks were withdrawn from sale. Unsound Food A total of 12 tons 4 cwt. 95 lbs. of food unfit for human consumption was surrendered to Public Health Inspectors during the year. Details of the various items are given below:— Tons Cwts Lbs. Meat at slaughterhouses 4 10 0 Meat at wholesale premises 1 2 0 Meat at retail shops 7 108 Cooked meat and meat products 1 38 Canned meats 12 48 Fish (including fresh & canned) 1 2 85 Fruit and vegetables (including fresh & canned) 2 7 75 Other foods (including fresh & canned) 2 — 77 Total 12 4 95 504 Certificates were issued. 95 BACTERIOLOGICAL SAMPLES OF MILK 88 samples of designated milks were taken with the following results:— Satisfied Failed Phosphatase Test 59 Nil Methylene Blue Test 71 5 Turbidity Test 2 Nil Ring Test 5 1 The tests were applied for the following purposes:— Phosphatase Test applied to "Pasteurised Milk" to determine that the milk was satisfactorily pasteurised. Methylene Blue Test applied to "Untreated" and "Pasteurised" milks to indicate that the bacterial content was within the prescribed standard. Turbidity Test applied to "Sterilised Milk" to determine that the milk was satisfactorily sterilised. Ring Test applied to untreated milk to determine the presence of "Brucellus abortus". Where samples failed to satisfy the prescribed tests, investigations were made and further samples taken, the results of which proved satisfactory. Bacteriological Samples of Ice Cream 45 samples were taken during the year with the following results:— Grade I 20 Grade II 10 Grade III 12 Grade IV 3 Further samples were obtained from the suppliers whose products had given Grades III and IV samples. The results were classified in Grades I and II. SUNDRY BACTERIOLOGICAL EXAMINATIONS 1 Specimen Chinese Egg Noodle containing 25% fresh egg Nil pathogenic organisms isolated 3 Specimens Liquid Pasteurised Egg Nil pathogenic organisms isolated 1 Specimen "Pink Elephants" Beverage coolers Nil pathogenic organisms isolated 236 Specimens of Faeces were taken from persons suspected to be suffering from infectious disease or food poisoning, or to be contacts of persons suffering from infectious disease. Salmonella Typhi murium organisms isolated 30 Shigella Sonne organisms isolated 32 96 MEAT INSPECTION Annual licences were granted to 8 slaughtermen and the licence for one private slaughterhouse was also renewed during the year. The carcases of all animals slaughtered within the Borough were inspected and regular routine visits and inspections were made to distributing depots and retail butchers' shops. CARCASES INSPECTED AND CONDEMNED Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 71 110 2754 3609 3577 Number not inspected NIL NIL NIL NIL NIL All diseases except Tuberculosis and Cysticerci Whole carcases condemned - - 3 91 10 Carcases of which some part or organ was condemned 10 32 24 896 473 Tuberculosis only Whole carcase condemned - - - - - Carcase of which some part or organ was condemned - - - - 14 Cysticerci Carcases of which some part or organ was condemned 2 - - - - Carcases submitted to refrigeration 2 - - - - Generalised and totally condemned - - - - - Approved charges totalling £314 12s. 0d. were made for the inspection by Public Health Inspectors of the carcases shown in the above table. FOOD COMPLAINTS 103 complaints were received concerning the sale of food containing extraneous matter or in a decomposed or mouldy condition. 97 A considerable portion of the Committee's time is taken in considering these complaints and the detailed investigations required to present a fair and complete report occupy the Public Health Inspectors in a similar manner. Complainants must be questioned in detail as they may be genuinely mistaken in their statements. Shopkeepers and food manufacturers must be interviewed and their premises inspected to ascertain the point at which the trouble arose. Where necessary the assistance of Inspectors in areas where the food was prepared or stored must be called upon. The further task of preparing evidence is involved when prosecution is decided upon. The complaints may be classified as under:— Alleged condition Foreign Bodies, Dirty, etc. Mouldy Other Condition Bread and flour confectionery 24 8 1 Tinned foodstuffs 11 3 3 Perishable articles (pies, sausages, etc.) 2 9 1 Milk and milk bottles 15 1 — Foreign articles (other than above) 4 1 — Miscellaneous 11 2 7 Not all of these complaints were justified. For instance, glass in a jar of jam was found to have gained entry in the complainant's home; some cases of mould on various foodstuffs were due to overlong keeping by complainants; alleged foreign particles in a tin of fruit were found on investigation to be pieces of fruit; some complaints regarding the smell or appearance of foodstuffs were due to the complainants being unfamiliar with the products which were found, on examination, to be normal and wholesome, etc. The majority of complaints concerned bread. The articles found in loaves, etc., varied from pieces of metal to dirt. Complaints regarding milk were largely concerned with internal staining of the bottles from various causes. The presence in foodstuffs of mould growths, decomposition, and the like, in such highly perishable articles as meat pies and sausages is usually indicative of prolonged storage, possibly under unsatisfactory conditions. The Inspectors lose no opportunity in stressing to shopkeepers the need to dispose of such goods rapidly and to maintain a strict system of inspection and "turn-over". 98 During 1965 it was found necessary to institute proceedings as shown below:— Prosecutions Fined Costs Bread (Foreign matter) Manufacturer £40 £10 0s. 0d. Bread (Foreign matter) Manufacturer £40 £10 0s. 0d. Cake (Foreign matter) Manufacturer £10 £5 5s. 0d. Steak & Kidney Pie (Mouldy) Manufacturer £15 £5 5s. 0d. Cornish Pasty (Mouldy) Shopkeeper £10 £5 5s. 0d. Bacon (Fly blown) Shopkeeper £20 £5 5s. 0d. Bread (Foreign matter) Manufacturer £20 £5 5s. 0d. Bread (Foreign matter) Manufacturer £20 £5 5s. 0d. Bread (Foreign matter) Manufacturer £20 £11 lis. 0d. Cake (Mouldy) Manufacturer £15 £10 10s. 0d. Cooked Pork (Mouldy) Shopkeeper £10 £5 5s. 0d. Cake (Foreign matter) Manufacturer £5 £6 6s. 0d. Bread (Foreign matter) Manufacturer £20 £5 5s. 0d. Milk (Foreign matter) Dairy £15 £6 6s. 0d. Milk (Foreign matter) Dairy £15 £1 14s. 6d. Sausage Roll (Mouldy) Shopkeeper £10 £5 5s. 0d. Jam (Foreign matter) Manufacturer £25 £5 5s. 0d. Milk (Foreign matter) Dairy £50 £5 5s. 0d. Milk (Foreign matter) Dairy £10 £6 19s. 6d. Sausages (Mouldy) Shopkeeper £20 £5 5s. 0d. Sausages (Mouldy) Shopkeeper £20 £5 5s. 0d. Bread (Foreign matter) Shopkeeper £10 £4 17s. 6d. Bread (Foreign matter) Manufacturer £20 £12 4s. 0d. Cake (Foreign matter) Manufacturer £5 £6 19s. 6d. Milk (Foreign matter) Dairy £15 £5 5s. 0d. Sweets (Foreign matter) Manufacturer £10 £6 19s. 6d. Mineral Water (Foreign matter) Manufacturer given absolute discharge on payment of costs. £16 19s. 6d. Tinned Beans (Foreign matter) Manufacturer £10 £26 5s. 0d. In other instances, where necesssary, warning letters were issued. 99 FOOD PREMISES There are some 2,133 food premises in the area, made up as under:— Premises Total Bakers and Bakehouses 119 Butchers 194 Confectioners 310 Dairies/Grocers 58 Chemists 79 Fishmongers (Wet, Dried and Fried) 84 Grocers 307 Greengrocers 197 Restaurants, Cafes, etc. 177 School Canteens 128 Industrial Canteens 100 Hospitals, Nursing Homes and Old Peoples' Homes 102 Public Houses 143 Off Licences 61 Clubs and Hotels 51 Stalls 23 2,133 FOOD AND DRUGS ACT, SEC. 16 Number of Food Premises registered under the abovementioned Act for:— (a) Sale or manufacture for purposes of sale of ice-cream or the storage of ice-cream intended for sale 835 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 257 MILK (SPECIAL DESIGNATIONS) REGULATIONS Licences to deal in specially designated milks were currently held as under:— Dealers (Pasteurisers) Licences 1 Dealers Licences: Pasteurised 118 Sterilised 87 Ultra Heat treated 21 Untreated 36 100 FOOD HYGIENE (GENERAL) REGULATIONS There was one prosecution under these regulations, this being in respect of an offence against Regulation 16(1) and concerned failure to provide a wash hand basin conveniently accessible for the use of persons handling food in a factory canteen kitchen. A fine of £10 0s. 0d. was imposed with costs of £31 10s. 0d. HOUSING AND SLUM CLEARANCE Consideration was given to the programme for the clearance of unfit houses over the next five years and the Environmental Health Sub-Committee recommended a provisional programme as set out below:— Houses 1965 1-57 (odd) Woodbine Grove, Penge 2-10 (even) Woodbine Grove, Penge 36 7-13 (odd) St. Hughs Road, Penge 4 40 1966 16-72 (even) Arpley Road, Penge 1 31-39 (odd) Arpley Road, Penge 1 1-10 Thicket Grove, Penge 10 1-28 Thicket Wood Chambers, Penge 28 83 1967 1-7, 12, 13 and 22-26 Penge Lane, Penge 14 8-14 Clarina Road, Penge 7 2-11 Lancaster Place, St. Pauls Cray 10 1-6 Victoria Place, St. Pauls Cray 6 1 & 2 Bellfield Road, Fordcroft, St. Mary Cray 2 4-28 (even) Fordcroft Road, St. Mary Cray 13 52 1968 1-21 Heath Grove, Penge 22 1-20 Clifford Grove, Penge 20 42 1969 2-10 (even) Beverley Road, Penge 15-21 (odd) Beverley Road, Penge 9 1&2 Bull Cottages, Chislehurst 2 1-6 Home Farm Cottages, Sandy Lane, St. Pauls Cray 6 1-3 Cacketts Lane, Cudham 3 "Transvaal". Westerham Road, Biggin Hill 1 15 Sunningvale Avenue, Biggin Hill 1 "Primrose Cottage", Jail Lane, Biggin Hill 1 112 Westerham Road, Leaves Green 1 8&9 Willow Walk, Farnborough2 26 Total 243 101 One Clearance Area, comprising Nos. 1,9, 11 and 13 St. Hugh's Road, Penge, was represented in 1965, and inspections were made of the houses in Woodbine Grove at the end of the year, but representations were not made until 1966. The considerable Slum Clearance programme of the former Penge Urban District Council further progressed, 71 houses being demolished during the year as under:— Hawthorne Grove—Nos. 28, 32, 34, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 64a, 66, 68, 74, 74a, 76. Oakfield Road—Nos. 89, 91. Lime Tree Avenue—Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Hamilton Place—Nos. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Jasmine Grove—Nos. 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45. Hartfield Grove—Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, Compulsory Purchase Orders were made, following Clearance Area representation by the former Penge Urban District Council in 1964, relating to:— Hadlow Place, Upper Norwood, Clearance Area, 1964 Nos. 1-9 (consecutive) Hadlow Place (9 houses) Aneriey Vale, Upper Norwood, No. 1 Clearance Area, 1964 Nos. 5, 1,9, 11 and 13 Anerley Vale, S.E.19 (5 houses) Anerley Vale, Upper Norwood, No. 2 Clearance Area, 1964 Nos. 17, 19 and 21 Aneriey Vale, S.E.19 (3 houses) Aneriey Vale, Upper Norwood, No. 3 Clearance Area, 1964 Nos. 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, and Nos. 25, 27, 29, 31, 33, 35, 37, 39, 41, 43 and 45 (23 houses) St. Hugh's Road Clearance Area, 1964 Nos. 15, 17, 19, 21, 23 and 25 (6 houses). Objections being made, a Public Local Enquiry was held at Beckenham Town Hall in December, 1965, in respect of the first four areas cited, the objections to the Compulsory Purchase Order relating to Nos. 15 to 25 St. Hugh's Road having been withdrawn. The Compulsory Purchase Orders made on all five Areas have since been confirmed by the Ministry. Demolition Orders were made on the following individual unfit houses:— No. 10 Versailles Road, Aneriey, S.E.20. No. 47 Jasmine Grove, Penge, S.E.20. Nos. 1 & 2 Tapsells Cottages, St. Mary Cray (demolished during year). Nos. 5 & 7 Lower Road, St. Mary Cray. Closing Orders were made in respect of basement rooms at:— No. 8 Mosslea Road, Penge, S.E.20. No. 2 Palace Square, Upper Norwood, S.E.19. 102 A Closing Order, made by the Penge Urban District Council in respect of the basement rooms at No. 38 Palace Square, Upper Norwood, S.E.19, was determined, work having been satisfactorily carried out to render the premises fit. RE-HOUSING The following information has been supplied by the Housing Manager:— Prior to 1965 During 1965 Houses Families in occup. Houses Families in occup. Permanent dwellings built by Local Authority 8,991 8,991 153 153 Prefabricated dwellings built by Local Authority 891 891 Nil Nil During 1965 there were 185 vacancies. During 1965, 322 families were housed from the waiting list in permanent accommodation. 7 families were housed in Halfway House accommodation. The total number of families on the waiting list as at the 31st December, 1965, was 3,273. During the same period 16 temporary bungalows were demolished and the tenants were transferred to permanent accommodation. HOUSING (A) Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices: Sections 9, 10 and 16, Housing Act 1957 Public Health and similar Local Acts T otals Informal Formal Informal Formal Informal Formal By owner 1 1 351 26 352 27 (B) Beyond Repair—Housing Act, 1957 1. No. of undertakings accepted (section 16) 1 2. „ closing orders made (section 17) — 3. „ demolition orders made (section 17) 6 4. „ closing orders made (section 18) 2 5. „ closing orders determined (section 27) 1 6. „ closing orders revoked and demolition orders substituted (section 28) — 7. „ houses demolished following demolition orders — 103 (C) Clearance Areas (1) Represented during Year: 1. Number of Areas 1 2. Houses unfit for human habitation 4 3. Houses included by reason of bad arrangement, etc. — 4. Houses on land acquired under 43(2) — 5. Numbers of people to be displaced: (a) Individuals 24 (b) Families 5 (2) Action taken during the Year: 1. Houses demolished by Local Authorities or Owners: (a) Unfit 34 (b) Others — 2. Numbers of people displaced: (a) Individuals 57 (b) Families 23 HOUSING Improvement Areas—Housing Act 1964 Areas surveyed 1 Areas declared 1 Houses to be improved to full standard 169 Houses to be improved to reduced standard — Dwellings outside improvement areas Number of representations made by tenants 5 HOUSING Improvement Grants (1) Standard Owner/occupier Tenanted Number of Applications Received 87 — — Number of Applications Approved 59 18 Number of Applications Refused 5 2 Amount paid in grants £8,791 13s. 3d. Amenities provided (a) fixed bath 57 (b) shower — (c) wash hand basin 57 (d) hot water supply (to any fittings) 62 (e) water closet (1) within dwelling 58 (f) food store 39 (2) Discretionary Owner/occupier Tenanted Number of Applications Received 83 — — Number of Applications Approved 59 21 Number of Applications Refused 6 — Amount paid in grants £31,804 0s. 0d. 104 RENT ACT 1957 Certificates of Disrepair and other documents specified in the Act have been issued as follows:— Applications for Certificate of Disrepair Number of applications 9 Number of decisions not to issue certificate — Number of certificates issued 3 Number of undertakings given by landlords under Paragraph 5, First Schedule 6 Number of undertakings refused by L/A Applications for Cancellation of Certificate — By Landlords to L/A for cancellation — Objections by tenants to cancellation — Certificates cancelled by L/A — Housing Inspections—Defects Remedied, Nuisances Abated by Informal Action Drainage Drains: constructed or reconstructed 52 repaired 108 cleansed 795 Inspection Chambers repaired and renewed 35 Inspection Chamber Covers provided 34 ventilation improved or repaired 6 Cesspools: provided 12 overflowing—emptied 6 leaking—repaired or reconstructed — abolished 1 Kitchen sinks New sinks provided 16 Sink waste pipes, trapped, renewed or repaired 47 Water closets Cleansed 12 Repaired or reconstructed 31 Provided 13 Wash basins provided 12 Wash basins renewed 15 W.C. seats repaired or renewed 19 Lighting improved 2 Ventilation improved 7 Flushing cisterns repaired or renewed 30 Water supply provided 1 Dampness Roofs made watertight 83 Walls made waterproof 93 Damp-proof courses provided 9 Damp-proof courses repaired or renewed 2 Rainwater gutters repaired or renewed 27 Rainwater downpipes repaired or renewed 41 Flashings repaired or renewed 6 Chimney stacks made watertight 6 105 Water Supply Provided 4 Pipes repaired or renewed 15 Storage tanks repaired or renewed 4 Ball valves repaired or renewed 9 Domestic boilers repaired 2 General Items Wallplaster repaired 96 Ceiling plaster repaired 64 Floors repaired 42 Rooms cleansed or decorated 18 Windows and doors repaired 47 Glazing repaired 13 Staircase repaired 7 Fire surrounds and grates repaired or renewed 5 Chimney flues cleansed 4 Yard paving and drainage repaired 4 Dustbins provided 33 Nuisances from animals abated 8 Noxious accumulations removed 41 Overcrowding abated 3 Miscellaneous items 63 STATUTORY NOTICES When nuisances or other defects are found in dwelling houses, either as a result of routine inspection or following a complaint, the owner or agent is requested informally to apply a remedy. It is only after an appropriate interval and when this request is not acceded to, that it is necessary to obtain Committee sanction to the service of Statutory Notices. It was necessary to issue 474 informal notices and failure to achieve results made it necessary for 23 to be reported to the Committee for further action. This is a higher proportion than that experienced by most of the constituent authorities and arises to a considerable extent from the type of letting found in the Penge Area. COMMON LODGING HOUSES There are two registered Common Lodging Houses in the area, situated at:— 36 Arpley Road, Penge, where provision is made for the accommodation of 33 men, and at 19 Lower Road, St. Mary Cray, Orpington, where provision is made for the accommodation of 24 men. The premises provide sufficient accommodation in so far as there are usually a few vacant beds. The premises are regularly visited and during the year 32 inspections were made. There were no infringements of the conditions of registration. 106 MOVEABLE DWELLINGS There are a number of sites for caravans mainly in the rural part of the Borough. Most of these are licensed under the Caravan Sites and Control of Development Act, 1960, and vary from individual caravans on agricultural land to large well regulated residential sites. There are in addition, a small number of sites which for technical reasons, usually connected with planning control, have not previously been licensed. Attention is being given to these with a view to issuing licences with suitable conditions designed to achieve a high standard. One of the licensed sites for 25 caravans situated at Ruxley is of particular interest. It was established some years ago to accommodate families of the gipsy type superseding an unsatisfactory encampment on the same land. It has functioned very well due to the supervision exercised by the owner. During the past Autumn a considerable number of caravans, also occupied by gipsy families, were drawn into the District and sited on grass verges of main roads and on a site earmarked for council housing development. The users of these dwellings gave rise to serious nuisance particularly to occupiers of nearby houses. The Council formed a special committee to deal with this serious problem and consideration was given to the establishment of a suitable site for a limited number of such caravans. Licensed Sites No. of Vans Address permitted The Paddock, Downe Road, Keston 12 The Barbecue, Cudham Lane 12 Chalk Pit, Maidstone Road, Ruxley 25 "Brockenhurst", Sheepcote Lane, Orpington 6 "Cherry Tree Nursery", Foxbury, Chislehurst 1 "Lower Hockenden Farm", Hockenden, Swanley 1 "Critten Dene Caravan Park", Pond Lane, High Street, West Wickham 30 11 Heathfield Road, Keston 23 Hayesford Farm, Hayes Lane, Bromley 2 In addition to the above there is a large site at Crystal Palace organised by the Caravan Club of Great Britain, which is exempted from the licensing provisions. 107 Unlicensed Sites Address The Boundary and Beechwood, Hangrave Hill, Downe. (54 caravans) "Restavon", Berrys Green Road, Berrys Green. (60 caravans) "Oak Farm", Farnborough Hill, Green Street Green. (25 caravans) Remarks The Council has the future of these two camps under consideration with a view to their discontinuance. Planning approval has been granted for the use of the existing site and the conditions to be attached to the licence are under discussion. This site enjoys established user rights extending over a period of many years. It was originally used by travelling showmen and exempted from the licensing provisions of the Act, but is now occupied by persons not so employed. The licensing of this site was under consideration at the end of the year. DRAINAGE AND SEWERAGE The Council accepts as a legal responsibility the clearance of certain types of public sewers and the work is undertaken without any charge being made to the owners or occupiers of the properties. An emergency drain clearing service is operated, the necessary work being carried out by Disinfector/Handymen employed by the Department. Of the 405 instances of choked drains dealt with, however, 370 related to single private drainage and, in these cases, a charge was made for the work undertaken. The trunk soil sewerage system is under the control of the West Kent Main Sewerage Board and the Greater London Council. The Borough Engineer states that foul sewers and surface water sewers have been provided during the year by the Constituent Authorities and the London Borough of Bromley as under:— PRIVATE ESTATE DEVELOPMENT AND PRIVATE STREET WORKS Foul Sewers Yards 6" diameter 1,430 9" diameter 974 Surface Water Sewers 6" diameter 430 9" diameter 3,792 12" diameter 1,696 15" diameter 402 18" diameter 688 21" diameter 151 108 24" diameter 50 27" diameter 161 30" diameter 85 The Sewerage Authorities also provided the following:— Surface Water Sewers 6" diameter 321 9" diameter 674 12" diameter 287 15" diameter 66 30" diameter 367 36" diameter 72 During the year 12 new houses were connected to cesspools and 6 cesspools were abolished, the properties being connected to main drainage. There are now 2,226 cesspools in use in the Borough. CHAFFINCH BROOK The Chaffinch Brook is a tributary of the River Ravensbourne which it eventually joins in the London Borough of Lewisham. In dry weather the main content of the Brook is effluent from the South Norwood Sewage Works of the London Borough of Croydon. Flow from this out-dated and overloaded works has, for several years, given rise to severe nuisance from smell experienced by persons dwelling in houses along the banks. The situation was greatly aggravated by the stream tending to overflow its banks after periods of heavy rain. Nuisance from smell, especially in the Clockhouse area of Beckenham reached a peak during the summer months. This arose from the already inadequate works being temporarily impaired due to constructional work designed to facilitate the connection to the main sewer. Numerous complaints were received and all of the many samples taken from effluent entering the stream were substandard. Representations were made to the London Borough of Croydon and the Greater London Council, the latter being the official authority for the administration of the Rivers (Prevention of Pollution) Acts. Long term measures are being taken to deal with these nuisances. The Borough of Croydon is awaiting the completion of extension to the sewerage system of the West Kent Sewerage Board so that the South Norwood Sewage Works may be discontinued in stages. The Greater London Council has an extensive scheme to improve the capacity of the Ravensbourne which should eliminate flooding. It is stated that the connection to the West Kent Main Sewer will be made in 1966. 109 DISINFECTION There are two steam disinfecting plants in operation in the Borough. These are situated at the Council's depots at Waldo Road, Bromley, and Crofton Road, Orpington. Articles of clothing, bedding, etc., requiring disinfection following cases of infectious disease are collected and delivered in specially constructed metal lined vehicles and are taken to the depots where disinfection is carried out by experienced operators. Articles unsuitable for treatment by steam disinfection are treated by chemical means; in appropriate cases operators also disinfect, by suitable chemical sprays and fumigants, premises where infectious diseases have occurred. Disinfection of bedding is carried out on request for hospitals. Where notifiable infectious disease is involved these services are carried out free of charge. Similar provision is also made for disinfection, on request, where non-notifiable illness is involved. In such cases an approved nominal charge may be made. D1SINFESTATION Premises and articles infested by vermin and insects are also treated by the disinfecting operators. Approved charges are made for this service. It was only necessary for seventeen premises to be treated. Provision is made for the cleansing of persons, affected by scabies or vermin, to be carried out at the Lewisham Cleansing Station. It was only found necessary to refer two such cases for treatment. OTHER INSECT INFESTATION Many requests, over 300, were received for the destruction of wasp nests. These were referred to private contractors who had expressed willingness to undertake this work at the complainant's expense. The number of complaints finally proved greater than the contractors wished to handle and it was felt the Council should consider a scheme to provide a service to destroy wasp nests. Such a service has subsequently been approved and will be operated by members of the department's staff in future wasp seasons. A charge of £1 per clearance will be made. CLEAN AIR ACT The main source of atmospheric pollution is the burning of ordinary "household coal" in the domestic grates. The Government's policy in establishing "Smoke Control Area" is to obviate 110 this serious menace to health by assisting householders to adapt or provide means of heating which does not involve the use of such coal. Every open fireplace which has no means of suitably controlling draught and which is in regular use must be altered or replaced. This objective cannot be achieved rapidly. "Smoke Control Areas" each covering a limited number of properties, are established successively. The constituent authorities had made comparatively little progress when reorganisation took place. The Urban District of Orpington not being scheduled as a "black area" had no "Smoke Control Areas". The following areas, covered by 10 Smoke Control Orders, had been established prior to 1st April, 1965:— District Acreage Premises Hayes & Keston (part) 797 3.902 Bromley Common (part) Manor House (part) Eden Park (part) 841 5,537 West Wickham (part) Mottingham (part) 225 2,417 Penge (part) 115 1,429 The work of survey having been carried out prior to amalgamation the following areas were confirmed by the Minister and became operative during 1965. District Acreage Premises Mottingham (part) 425 1,731 Martin's Hill & Town (part) Hayes & Keston (part) 654 1,175 West Wickham South 1,016 2,260 The Committee considered the problem of the establishment of Smoke Control Areas and decided that the whole of the Borough, including the Orpington area, should be dealt with by 1975. The following programme has been agreed:— Orpington Division Date Ward Premises 1965-1968 Petts Wood 5,900 1968-1970 Farnborough 5,000 1970-1972 St. Pauls Cray 5,300 1972-1974 St. Mary Cray 4,400 1974-1976 Goddington 4,700 Bromley Division Date Ward Premises 1965-1967 *Martin's Hill & Town (part) 3,700 1967-1970 Plaistow & Sundridge 6,000 1969-1971 Bickley 3,300 1970-1972 Chislehurst 3,500 1972-1973 Keston & Hayes (part) 800 1972-1974 Bromley Common (part) 3,500 1974-1975 Darwin 1,200 1975-1976 Chelsfield 2,600 1ll Beckenham Division Date Ward Premises 1965-1966 *West Wickham North 1,850 1966 To be estab. *Penge 1,193 1966-1967 †Anerley 2,500 1967-1968 Lawrie Park & Kent House 3,050 1968-1969 Clock House 2,700 1969-1970 Manor House (part) 2,450 1970-1971 Copers Cope 3,050 1971-1972 Eden Park 1,950 1972-1973 Shortlands 3,250 1973-1974 Biggin Hill 1,700 1974-1975 Penge (part) 2,600 * to become operative in 1966. † to be surveyed in 1966 Duties under the Clean Air Act are not confined to the establishment of Smoke Control Areas. The Act requires owners of property to notify the Department when they are installing furnaces, although these may be of relatively small capacity. The Department has to record such installations, and in certain cases to give specific approval to details of plants and to ensure that flues are of sufficient height, properly to disperse the products of combustion. Control is also exercised over the emission of smoke and grit from factory chimneys and observations have been made during the year to ascertain whether the period during which "black smoke" is produced is in excess of the permitted maximum. Such observations often lead to advice being given to factory owners in the better charging of furnaces and, in some cases, to adjustments to boiler plant. Complaints are received of smoke from bonfires, sometimes due to the burning of garden refuse, but often arising from incineration of paper and other waste from shops. In these instances persons concerned are made aware of their responsibilities and alternative means of disposal of waste material are recommended. PREVENTION OF DAMAGE BY PESTS ACT, 1949 RODENT CONTROL The purposes of a Rat Destruction service are many. Not only are these rodents destructive to the nation's food supply but they are carriers of disease. Historically the black or ship rat (not at present found in this district), is the carrier of bubonic plague. The common or brown rat is not infrequently infected with a form of jaundice called "Wiels' Disease". This is occasionally found in sewermen amongst others, and may be contracted through skin abrasion, by those working in rat infested sewers. For this reason first aid facilities are available to the rodent operatives and those at similar risks. 112 In man the disease is rare but may be fatal. One case came to the knowledge of this department during the year in the person of an adult male. Investigation into the source of the infection showed that he had been cleaning the household drains some days previous to the onset of symptoms. Slight rat infestation was found in the vicinity and immediate steps were taken to repress the rodents. Fortunately the sufferer made a complete recovery. Rodent control work is carried out by a Senior Rodent Officer and 6 Rodent Officers. The extermination of rats at dwelling houses is carried out free of charge, and as large an area as is practical in the vicinity is treated at the same time. A charge based on the cost of time and materials is made for the extermination of mice in dwelling houses, and a similar charge is made for the extermination of both rats and mice at business premises. There were 1,836 premises visited and treated as a result of complaints, 71 of these being for mice. Following these complaints, and also as a result of routine surveys, a further 3,342 premises were visited and 1,026 were found to be infested by rats. Treatment of infested premises involves an initial inspection and baiting and follow-up visits to ascertain either the need for further baiting or to establish that the infestation has been cleared. A maintenance treatment of the sewers was undertaken in October, 1965; this was based on the results obtained at the last treatments carried out by the constituent authorities some of whose programmes had been restricted due to the pressure of the abnormal circumstances existing prior to the amalgamation. One hundred and eighty manholes were baited with Warfarin at which there were 37 complete takes and 146 partial takes. Towards the end of the year preparations were made for a full scale test-baiting in the Spring of 1966 to be followed by a poison treatment. PIGEON DESTRUCTION Section 74 of the Public Health Act, 1961, gives local authorities power to take steps to reduce the numbers of pigeons in built-up areas so as to abate or mitigate the nuisance or damage caused by them. The former constituent authorities of Penge and Beckenham employed a contractor to do the work on a part-time basis. The contracts were carried on after 1st April, 1965, the work still being confined to the area of the two authorities mentioned. 422 premises were visited and an estimated 3,700 pigeons destroyed. Complaints received from other parts of the district indicated the need to extend the service to the whole Borough and 113 mission was sought to employ a Pigeon Catcher/Rodent Officer as from the 1st April, 1966. This was approved and from that date the service will be in operation. PREVENTION OF DAMAGE BY PESTS ACT, 1949 TYPE OF PROPERTY Non-Agricultural (5) Agricultural (1) Local Authority (2) Dwelling Houses (inc. Council Houses) (3) All other (including Business Premises) (4) Total of Cols. (1), (2) & (3) Number of properties in Local Authority's District 110 95,545 15,054 110,709 362 Total number of properties inspected as a result of notification 24 1,704 104 1,832 4 Number of such properties Common rat Major Minor 18 1,681 87 1,786 4 Ship rat Major Minor House mouse Major Minor 5 51 15 71 Total number of properties inspected in the course of survey under the Act 3,187 153 3,340 2 Number of such properties found to be infested by:- Common rat Major Minor 1,008 18 1,026 Number of infested properties treated by the L.A. 23 2,740 120 2,883 4 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The object of this Act is to raise standards of working conditions in shops, offices and railway premises so as to promote the health, welfare and safety of the workers in them. The Act includes provisions relating to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, working facilities, drinking water, seats, safety of machinery, first aid, and fire precautions and in the great majority of premises covered by the Act the Local Authority is responsible for enforcing the general requirements. 114 Employers were required to register particulars of employees on the 1st May, 1964, and most of the provisions of the Act were brought into operation on the 1st August, 1964. General inspections of premises were commenced by the former constituent authorities although in two local authorities' areas the work was hampered by an acute shortage of staff. It was hoped that better progress could be made in the remainder of 1965 but, due partly to the work of reorganisation arising from amalgamation and in particular to a continued shortage of staff, it was not possible to achieve this aim. During the 355 general inspections made, 617 contraventions were detected but these were mostly of a minor character; the absence of wall thermometers and first aid equipment was predominant. For the most part the attitude of occupiers has shown a readiness to comply with the requirements of the Act and in no case has it been necessary to resort to legal action. Sixty-one accidents were reported, 54 of these being in shop premises. Most of the accidents were caused by falls, the handling of goods and hand tools and the injuries sustained were not serious. In sixteen cases advice was given on measures necessary to prevent a recurrence. There were no fatal accidents. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 (A) Registrations and General Inspections Class of premises No. of premises registered during the year No. of registered premises at end of year No. of registered premises receiving a General Inspection Offices 35 609 36 Retail shops 46 1,366 267 Wholesale shops, warehouses 39 Catering establishments open to the public, canteens 6 141 49 Fuel storage depots 1 12 3 Totals 88 2,167 355 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 604 115 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 66 15 Eating facilities 11 5 Overcrowding 3 16 Floors, passage & stairs 63 6 Temperature 102 7 Ventilation 36 17 Fencing exposed part machinery 6 8 Lighting 41 18 Protection of young persons from dangerous machinery — 9 Sanitary Conveniences 24 10 Washing facilities 75 11 Supply of Drinking Water 2 19 Training of young persons working at dangerous machinery — 12 Clothing Accommodation 27 23 Prohibition of heavy work — 13 Sitting facilities 9 14 Seats (Sedentary Workers) — 24 First Aid General Provisions 152 Total 617 (C) Exemptions No. of applications received Nil No. of applications granted Nil (i) Space Nil (ii) Temperature Nil (iii) Sanitary Conveniences Nil (iv) Running Water Nil (D) Prosecutions Number instituted and completed during the year Nil Section of Act or title of Order or Regulation No. of persons or companies prosecuted No. of informations laid No. of informations leading to conviction Nil Nil Nil Nil Number of complaints (or summary applications made under Section 22) Nil Number of interim orders granted Nil 116 (E) Reported Accidents Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advice Offices 2 1 — — 1 1 Retail Shops 54 13 — — 13 41 Wholesale Shops, Warehouses 2 2 2 Catering Establishments open to public, canteens 3 — — — — 3 Fuel Storage Depots — — — — — — TOTALS 61 16 — — 16 45 Analysis of reported accidents Offices Retail Shop Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery — 3 1 — — Transport — 2 — — — Falls of persons 1 17 1 1 — Stepping on or striking against object or person 1 6 — — — Handling goods — ii — 1 — Struck by falling object — 2 — — — Fires and Explosions — — — — — Electricity — — — — — Use of hand tools — 12 — — — Not otherwise specified — 1 — 1 — Prescribed Particulars on the Administration of the Factories Act, 1961 PART I OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 92 14 - Nil (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 762 97 14 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 82 24 1 Nil Total 936 135 15 Nil 117 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions, they should be reckoned at two, three or more "cases") Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Refe rred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.l) 5 5 — — Nil Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — Nil Sanitary Conveniences (S.7) (a) Insufficient 3 3 — — Nil (b) Unsuitable or defective 4 4 — — Nil (c) Not separate for sexes — — — — Nil Other offences against the Act (not including offences relating to Outwork) 1 1 — — — Total 13 13 — — Nil PART VIII OF THE ACT OUTWORK (Sections 133 and 134) No. of out-workers in August list required by Section 133(1) (c) Wearing Apparel—Making, etc. 39 Lace, lace curtains and nets 1 Furniture and upholstery 1 Stuffed toys 11 Total 52 MORTUARIES The Authority has 2 mortuaries, one in the Town Hall grounds at Beckenham and the other at Beaverwood Road Depot, Chislehurst. It was decided that the mortuary at Blenheim Road, Penge, was surplus to requirements. Reorganisation of the Coroners' Districts in the London Area threw a greater burden on the Beckenham Mortuary and plans to increase the facilities to allow for the reception of 9 118 bodies in place of the existing 3 were formulated. In this scheme were also incorporated improvements to existing equipment. During 1965, 498 bodies were brought to the Mortuaries where post-mortem examinations were conducted by a Home Office Pathologist as shown below:— (1) Mortuary address (2) No. of bodies brought to the Mortuary and post-mortem examinations conducted (3) No. of inquests held at Coroners Courts in respect of bodies recorded in Col. (2) (1) Town Hall, Beckenham 303 41 (2) Beaverwood Road, Chislehurst 195 12 WATER SUPPLY The water supply to the whole of the Borough is provided by the Metropolitan Water Board, and I am indebted to the Director of Water Examination to that authority for the following information:— "The water has been satisfactory both in quality and quantity during the year in question. The supply is made up of River Thames derived water together with a number of local wells at Shortlands, West Wickham, Orpington, North Orpington, Sundridge, Lullingstone, Eynsford, Horton Kirby and Jewels Wood. The analysis of these various sources are set out on the attached sheets. The population supplied with water in your borough is estimated to be 301,274. All water supplies are direct to the premises, none being permanently supplied by standpipe. New trunk mains to the extent of 158 yards were laid in the borough during 1965, but otherwise there was no change in the general scheme of supply. The total distance in yards of service mains laid during the same period was 10,097 yards. All this work is thoroughly disinfected with chlorine and samples of water in the mains proved to be of satisfactory quality before these structures were put into service." Fluoridation of public water supply The Council have considered and approved a recommendation by the Health and Welfare Committee in favour of fluoridation of water supplies in the Borough. The present fluoride level is shown in the table of chemical analysis. 119 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1965 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli Number of samples Agar plate count per ml. Coliform count E. coli count count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. All Thames-derived 3,888 7.3 — 99.92 100.0 Eynsford No. 1 191 0.2 10 53.40 3.7 99.48 — 240 0.6 3 99.58 100.0 Eynsford No. 2 123 0.0 1 96.75 0.1 99.19 — HortonKirbyNo. 1 189 0.0 11 93.12 0.2 96.83 — 256 0.0 2 100.0 100.0 HortonKirbyNo.2 237 0.2 3 96.20 0.4 97.89 0.1 Jewels Wood 51 0.0 23 98.04 — 100.0 — 53 0.0 2 98.11 100.0 Lullingstone No. 1 130 0.0 1 100.0 — 100.0 — 255 0.0 9 100.0 100.0 Lullingstone No. 2 120 0.2 3 99.17 — 99.17 — North Orpington No. 1 189 1.8 54 5.82 32. 24.34 7.2 257 0.5 6 100.0 100.0 North Orpington No. 2 164 2.3 49 3.66 40. 31.10 11. Orpington 264 0.0 39 98.37 0.1 98.78 — 252 0.1 40 100.0 100.0 Shortlands No. 1 166 0.2 24 100.0 — 100.0 — 252 0.1 8 Shortlands No. 2 193 0.0 1 99.48 — 100.0 — 100.0 100.0 Shortlands No. 3 109 0.0 3 99.08 — 99.08 — Sundridge No. 1 54 0.0 2 98.15 — 98.15 — 253 0.1 8 99.60 100.0 Sundridge No. 2 51 0.0 1 100.0 — 100.0 — Sundridge No. 3 116 0.1 2 100.0 — 100.0 — Sundridge No. 4 105 0.0 2 100.0 — 100.0 — West Wickham 239 0.0 7 99.58 0.1 99.58 — 242 — 1 100.0 100.0 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. Hardness (total) CaCO3 Hardness (non-carbonate) CaCO3 Magnesium as Mg Chloride as CI Phosphate as P04 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) All Thames-derived 363 0.049 0.091 4.3 1.20 264 68 4 41 19 10 64 0.25 0.10 0.1 15 7.6 560 Eynsford 8 0.003 0.023 3.6 0.12 258 24 17 0.2 Nil Nil 7.2 460 Horton Kirby 8 0.008 0.026 4.5 0.12 272 44 21 0.15 Nil Nil 7.2 480 Jewels Wood 4 0.008 0.022 1.8 0.10 234 12 14 0.1 2 1.2 410 Lullingstone 8 0.007 0.021 3.1 0.08 250 24 15 0.15 Nil Nil 7.2 440 North Orpington 8 0.010 0.029 3.8 0.08 266 22 16 0.1 0.1 Nil 7.1 470 Orpington 4 0.005 0.031 5.6 0.10 280 32 16 0.1 Nil Nil 7.1 500 Shortlands 10 0.025 0.026 4.7 0.10 286 66 19 0.15 Nil 1 7.1 510 Sundridge 12 0.011 0.022 3.0 0.08 216 46 20 0.15 Nil 1 7.4 400 West Wickham 6 0.015 0.023 4.1 0.04 262 24 15 0.1 0.1 1 7.1 460 121 SWIMMING BATHS 79 Routine Visits were made to the Public Swimming Baths and Pool and to swimming baths associated with clubs and schools in the area. 28 samples of water were taken for bacteriological and chemical examination. Frequent tests were made to check the chlorine content and pH value of the waters and to check the efficiency of purification plants. There were seven unsatisfactory samples involving 3 private baths, and immediate steps were taken to rectify the conditions. Further samples were satisfactory. At the Crystal Palace Sports Centre the racing, learners and diving baths were inspected and sampled regularly by the Scientific Branch of the Greater London Council. 33 samples were reported upon, all of which proved satisfactory. DISEASES OF ANIMALS ACT, 1951 On 1st April, 1965, a Diseases of Animals Inspector was appointed to undertake, under the direction of the Chief Public Health Inspector, the duties required by the above-mentioned Act jointly for the London Borough of Bromley and the London Borough of Bexley. A deputy was later appointed to act in the Inspector's absence. The following premises are situated within the London Borough of Bromley:— Stock-keepers (Cattle) 63 Pig-keepers 85 Poultry keepers 29 Sheep graziers 6 A total of 422 visits was made to these premises during the year for the following various purposes: routine checks on records of movement of animals, observance of conditions specified in movement licences, the issue of movement licences, the control of the use of swill boiling plants, and the quarantine of animals infected, or suspected of being infected, with infectious diseases. 38 Movement Licences were issued. ANTHRAX ORDER, 1938 There were five suspected cases of Anthrax of which one was confirmed by Veterinary Officers of the Ministry of Agriculture, Fisheries and Food. The suspected and infected carcases were burnt at the Local Auhorities' expense and the affected premises were cleansed in accordance with the provisions of the Anthrax Order. Apart from the case mentioned above the area was free from notifiable diseases during the year. 122 RIDING ESTABLISHMENTS ACT, 1964 This Act came into operation on 1st April, 1965. Twelve applications were received for licences to keep Riding Establishments. The premises concerned were inspected and were referred to and reported upon by a Veterinary Surgeon and by a Fire Prevention Officer. All animals available to be hired from the premises, namely 221, were also examined by Veterinary Surgeons and found to be fit. Various amendments and improvements to the premises were requested and were carried out. The licences were subsequently issued. PET ANIMALS ACT, 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to 19 applicants. The majority of the businesses were on a small scale selling goldfish, tropical fish, tortoises and small animals. There was a total of 43 visits made to these premises; 11 contraventions were found and were dealt with by written notices, the requirements of which were complied with. ANIMAL BOARDING ESTABLISHMENTS 13 Licences were currently held in respect of persons keeping Animal Boarding Establishments. 32 visits were made to these premises during the year. Provision is made at these premises for boarding a total of approximately 254 dogs and 82 cats. SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS DURING THE YEAR General Sanitation Cesspools 27 Common Lodging Houses 32 Drainage 1,489 Dustbins 105 Keeping of Animals 49 Moveable Dwellings 133 Noxious Accumulations 135 Piggeries 37 Public Conveniences 121 Rivers, Streams, etc. 46 123 General Sanitation—continued Rodent Control 318 Schools 62 Clean Air (Nuisances and Observations) 289 Swimming Baths—Public 34 Swimming Baths—Private 25 Theatres and Places of Entertainment 5 Water Supply 104 Miscellaneous Sanitary Visits 1,255 Camp Sites 30 Housing Under Public Health Acts 3,697 Under Housing Acts 410 Overcrowding 56 Verminous Premises 51 Miscellaneous Housing Visits 426 Infectious Diseases Inquiries into cases of Infectious Diseases 405 Inquiries into cases of suspected Food Poisoning 42 Visits re: Disinfection 34 Miscellaneous Infectious Disease Visits 400 Rent Act, 1957 45 Inspection of Meat At Slaughterhouse 512 At Shops and Stalls 46 At Other Premises 53 Inspection of other food (all premises) 189 Inspection of Food Premises under Food Hygiene Regulations Bakehouses 73 Butchers 329 Dairies and Milkshops 129 Fishmongers and Poulterers 59 Fish Fryers 73 Food Preparing or Manufacturing Premises 89 Greengrocers 139 Grocers 511 Ice Cream Premises 141 Restaurants, Hotels, Canteens, etc. 370 Slaughterhouses 43 Street Vendors and Hawkers' Carts 496 Bakers' Shops 90 Miscellaneous Food Visits 417 124 Visits in connection with Sampling Fertilisers and Feeding Stuffs 2 Food and Drugs 310 Ice Cream 48 Milk 96 Water: Drinking 24 Swimming Bath 22 Rivers, Streams, etc. 2 Factories, Shops, etc. Factories 162 Workplaces 43 Outworkers 63 Shops (Acts) 59 Offices, Shops and Railway Premises: General Inspections 355 Visits of all kinds 604 Miscellaneous Visits Merchandise Marks Act (Food only) 6 Pet Animals 43 Rag Flock Act 5 Clean Air Act (Smoke Control Areas) 5,950 Hairdressers 46 Riding Establishments 21 Animal Boarding Establishments 32 Noise Abatement 12 Exhumations 2 21,528 NUMBER OF PREMISES AT WHICH DEFECTS OR CONTRAVENTIONS WERE FOUND Housing For Defects and Nuisances 646 Verminous Conditions 15 Water Supply 24 Cesspools 3 Drainage 814 Food Premises Slaughterhouse 3 Meat Depots and Stalls 3 Butchers 57 Fishmongers and Poulterers 10 125 Food Premises—continued Grocers 77 Greengrocers and Fruiterers 40 Bakehouses 11 Dairies and Milkshops 3 Ice-cream Premises 13 Food Preparing and Manufacturing Premises 10 Restaurants, Hotels, Canteens, etc. 55 Street Vendors, Hawkers' Carts and Markets 18 Trade Premises Caravan Sites 1 Theatres and Places of Entertainment 4 Miscellaneous Rodent Control: Local Authorities' Property 10 Dwelling Houses 62 Business Premises 17 Agricultural Property 1 Swimming Baths—Private 2 Keeping of Animals 11 Noxious Accumulations 43 Schools 6 Public Conveniences 2 Smoke and Clain Air Act 21 Hairdressers 7 Offices, Shops and Railway Premises 275 NOTICES SERVED Informal Notices Public Health and Housing 474 Others 341 Complied at end of year: Public Health and Housing 328 Others 210 Statutory Notices Public Health Act 23 Complied at end of year 13 Bromley Office Supplies & Printing Co. Ltd., 39-41 East Street, Broomely, Kent