I BRO 18 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH 1966 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 and Principal School Medical Officer CIVIC OFFICES, THE WALNUTS, HIGH STREET, ORPINGTON, KENT Telephone: Orpington 27666 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH 1966 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 and Principal School Medical Officer CIVIC OFFICES, THE WALNUTS, HIGH STREET, ORPINGTON, KENT Telephone: Orpington 27666 3 INDEX See Page 138 for Index to School Health Service Report. Page A Ambulance Service 37 Animal Boarding Establishments 110 Accidents (Street) 22 B Bacteriological Examinations— Sundry 82 Births 19 Burial or Cremation of Deceased Persons 33 C Care of Mothers and Young Children 25 Care of Unmarried Mother and Her Child 25 Cervical Cytology 28 Child Minders 27 Chiropody 33 Clean Air Act 96 Common Lodging Houses 93 D Day Nurseries 27 Deaths 19 Dental Services, M. & C. W. 34 Diphtheria 44 Diseases of Animals 109 Disinfection 96 Disinfestation 96 Drainage and Sewerage 95 Dysentery 45 E Environmental Health Services 66 Erysipelas 45 Page F Factories Act 103 Food and Drugs Act—Sampling 69 Food Complaints 84 Food Hygiene Regulations 87 Food Poisoning 45 Food Premises 86 G Geriatric Community Services 118 H Health and Welfare Committee 3 Health Education 38 Health Visiting 30 Home Help Service 36 Home Nursing 32 Home Safety 39 Housing and Slum Clearance 88 Housing—Improvement Areas 90 Housing—Improvement Grants 91 Housing Inspections 92 Housing—Public Health Acts 90 I Ice Cream Sampling 82 Immigrants — Medical Arrangements 33 Infant Mortality 22 Infectious and Other Diseases 44 Insect Infestation 96 Inspection and Supervision of Foods 69 Introductory Review 11 5 INDEX—(continued) Page M Marie Curie Foundation Fund 32 Maternal Mortality 22 Maternity and Child Welfare 24 Meals and Recreation 125 Measles 46 Meat Inspection 83 Meningococcal Infections 46 Mental Health Services 50 Mental Subnormality 54 Meteorological Observations 18 Midwifery 28 Milk Sampling 82 Milk—Special Designations Regulations 86 Mortuaries 104 Moveable Dwellings 94 N National Assistance Acts 33 Nursing Homes 27 O Offices, Shops and Railway Premises Act 101 Ophthalmia Neonatorum 48 Outwork 104 P Paratyphoid Fever 47 Pet Animals 110 Pigeon Destruction 100 Pneumonia 46 Poliomyelitis 44 Population 18 Protection of Property 135 Puerperal Pyrexia 48 Page R Recuperative Care 32 Registration—Disabled and Old People's Homes 124 Rehousing 89 Rent Act, 1957 92 Residential Care 118 Riding Establishments 110 Rodent Control 99 S Scarlet Fever 46 Smallpox 46 Staff 7 Statistics—Environmental 111 Statistics—Vital 16 Statutory Notices 115 Swimming Baths 109 T Temporary Accommodation 126 Training Centres 58 Tuberculosis 46 Typhoid Fever 47 U Unsound Food 81 V Vaccination and Immunisation 26 Venereal Diseases 36 Vital Statistics 16 W Water Supply 105 Welfare—Blind and Partially Sighted 130 Welfare Foods 25 Welfare—Handicapped Persons 127 Welfare Services 116 Whooping Cough 48 7 HEALTH AND WELFARE COMMITTEE (as at 31st December, 1966) Chairman: Councillor Miss B. James, J. P. Vice-Chairman : Councillor Mrs. S. M. Stead. The Mayor: Councillor F. G. V. Lovell, J. P. Councillors: Mrs. N. V. Carter D. J. W. Eves A. L. Ferris H. W. Haden Mrs. M. J. Higgins A. T. Johnson, J.P. J. A. Mansi, M.R.C.S.(Eng.), L.R.C.P.(Lond.) K. A. Pawsey Mrs. M. M. Read J. P. Sheridan, A.M.I.E.I. C. E. Stickings, B.Sc., Ph.D. B. H. Taylor, L.D.S., R.C.S.(Eng.) Mrs. D. E. L. West, M.B.E. Co-opted Members : Miss A. Denholm, S.R.N. Miss M. E. Lambert, S.R.N., S.C.M., M.T.D. H. J. Lester, O.B.E., J.P., F.C.A. G. D. Stilwell, M.R.C.S.(Eng.), L.R.C.P.(Lond.) STAFF OF THE HEALTH AND WELFARE DEPARTMENT (as at 31st December, 1966) 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 Medical Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer (School Health): 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.o. *(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.) I. F. Maclean, m.b., ch.b. (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). 3 Dental Officers (Sessional), 2 Anaesthetists (Sessional), 1 Orthodontist (Sessional), 1 Dental Hygienist, 9 Dental Attendants. Orthopaedic Surgeon (in conjunction with Regional Hospital Board): 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. 3 Speech Therapists (1 Part-time). Ophthalmologists: 6 (Sessional). Orthoptist: Mrs. D. A. Ivil, d.b.o. (Part-time). 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. Psychiatrist: 1 (in conjunction with Regional Hospital Board) (Part-time). 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. 40 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. Group Adviser: Mrs. L. A. Hamilton, s.r.n., s.c.m., h.v. cert. 39 Health Visitors, 5 Student Health Visitors. Non-Medical Supervisor of Midwives: Miss G. I. Simmons, s.R.N., s.c.m. Deputy Supervisor of Midwives: Miss M. C. Martin, 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. Deputy Senior Home Help Organiser: Mrs. E. F. Thompson, 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.rs.h. E. U. Williams, m.a.p.h.i. 14 Public Health Inspectors, 5 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 7 Rodent Operators, 2 Disinfector/ Handymen, 2 Mortuary Keepers. WELFARE SERVICES' STAFF: Chief Welfare Officer: J. Hanson, O.b.e., 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. 4 Senior Social Welfare Officers, 8 Social Welfare Officers, 2 Occupations' Officers, 6 Trainee Welfare Assistants. Staff at 8 Residential Homes: 8 Matrons, 10 Assistant Matrons, 1 Warden, Chaplains and other staff. Chief Chiropodist: A. S. Jones, s.r.c., m.c.i.s. 3 Chiropodists (Sessional). MENTAL HEALTH STAFF: Principal Mental Welfare Officer: H. J. Vagg, a.r.s.h., a.i.s.w. 1 Senior Mental Welfare Officer, 10 Mental Welfare Officers, 2 Trainee Mental Welfare Assistants. Training Centre: 1 Supervisor, 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. 2 Administrative Assistants, 1 Secretary, 1 Co-ordinating Secretary, 2 Clerical Assistants, 4 Clerks, 2 Shorthand-Typists, 1 Supernumerary Junior Clerk, 3 Telephonists (2 Part-time), 1 Driver/ Storekeeper. Environmental Health Senior Administrative Assistant: B. Adams. 2 Administrative Assistants, 3 Clerical Assistants, 4 Clerks, 2 Shorthand-Typists, 1 Supernumerary Junior Clerk. Maternity and Child Welfare Senior Administrative Assistant: G. R. L. Smith. 2 Administrative Assistants, 3 Clerical Assistants, 2 Clerks, 1 Supernumerary Junior Clerk. Mental Health 1 Administrative Assistant, 1 Clerical Assistant, 1 ShorthandTypist. 10 School Health Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant, 3 Clerical Assistants, 6 Clerks (1 Parttime), 1 Supernumerary Junior Clerk, 1 Shorthand-Typist (Part-time). Welfare Senior Administrative Assistant: J. W. Meeks. 3 Administrative Assistants, 1 Secretary, 4 Clerical Assistants, 4 Clerks, 2 Shorthand-Typists, 4 Clerks (Residential Homes). Area Offices and Clinics 6 Clerical Assistants (1 Part-time), 6 Clerks, 3 Clerk-Typists, 20 Part-time Clinic Clerks. Health Education and Home Safety Officer: J. Bretton. 11 To: THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF BROMLEY. Mr. Mayor, Ladies and Gentlemen, I present my report on the health and welfare of the Borough for the year 1966. This is my second annual report for the Borough and is set out according to the requirements of the Ministry of Health Circular No. 1/66. The various sections of the report show in detail the multiplicity of services that have been provided first to evaluate the health of the population at all ages, second to advise the Authority on measures for prevention and promotion of health, and third to carry out to this end the general policy and directions of the Council. Community Care Services A first priority for the establishment of adequate community care services has been to recruit highly skilled officers. In spite of a national shortage, this has been accomplished in a difficult economic climate and with gradually increasing restrictions of financial stringency. A comprehensive personal advisory service to match that already provided by health visitors in the Maternity and Child Welfare Section has now been developed by the Mental Health and Social Welfare Sections. A second priority has been to co-ordinate the statutory services with the role of voluntary organisations and with the roles of the Hospital and General Medical Practitioner services. This has been accomplished by frequent consultation and by sharing knowledge of plans, and by the attachment of staff to general medical practices and to hospital staff wherever this has been both appropriate and practicable. The appointment of a Co-ordinating Secretary for Social Services by the Authority has been of great value to the co-ordination of visits by Social Workers, the arranging of Case Conferences, of meetings of an Officers Liaison Committee and of records. A third priority has been to acquire sites and obtain finance for additional Training Centres, Day Centres, Hostels and Residential Homes as set out in the Ten Year programme. At first sight, progress in this direction has been very disappointing since the difficulty of obtaining sites for new projects has been overtaken towards the end of the year by a deterioration in our national economic affairs and a strict rationing of financial resources. Nevertheless the prudent financial actions that have been taken 12 and the plans for development that are proceeding should greatly assist the Authority to provide in the not too distant future many of these essential adjuncts of community care. Environmental Health Services Phased programmes are being carried out under the Housing Act, 1957 and Clean Air Act, 1956. The Slum Clearance programme, in spite of staff shortage, is up to schedule; and the Clean Air programme, if assisted by the appointment of three Technical Assistants, is phased to ensure that by 1976 a smokeless zoned Borough of Bromley will adjoin the smokeless zones of its neighbouring boroughs. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations. 1966, added to the list of mandatory visits of inspection by officers of this section of the department. As legislation adds to mandatory duties, the alacrity with which these can be carried out varies directly with the number of skilled Inspectors who can be recruited to the permanent staff and with the skill shown in the organisation of their manifold duties. The increasing involvement of the Inspectors through their work in Development Areas in housing matters is a contribution of great value to the integration of all the social services in the department. Personal Health Services The increasing work load of midwives and district nurses, coupled with the 20% establishment deficiency of the former, has precluded attachments to medical practices. Nevertheless, assistance has been given to some medical practitioner ante-natal clinics and to a general medical practice research project. Ten Health Visitors have been working with groups of medical practitioners in attachment or liaison schemes but without considerably more grouping of medical practices, further progress in this direction will be negligible. The national trend of increasing private Day Nurseries has been evident in Bromley. Also, following a national pattern, the demand for cervical cytology examinations at Local Authority clinics has fallen in spite of full availability of this service. Assistance to the Family Planning Association was given by the provision of free Clinic facilities where these could not be adequately provided by the Association's clinics sited in Hospital buildings or other premises. Health Education with especial reference to Home Safety and including participation in the national "Medicines with Care" publicity campaign was an important part of the work of this department. 13 Research and In-Service Training This essential part of the work of any local authority department is being fully implemented in the Health and Welfare Department and reference will be found later in the report of the work of nearly all the sections. Officers have contributed to the work of Committees and Working Parties of the Association of Municipal Corporations and London Boroughs Association. I wish to express my appreciation to the Chairman and members of the Health and Welfare Committee, as well as to other members of the Council, for the consideration and courtesy they have shown me during the year. My thanks are also due to all members of the staff of my department for the loyal and efficient manner in which they have carried out their duties and to my colleagues in other departments for their ready help and co-operation. Finally, my thanks are due to colleagues in the medical practitioner and hospital services and to all the valuable workers of voluntary organisations in the Borough. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 16 VITAL AND OTHER STATISTICS Population (mid-year 1966) 301,680 Area (acres) 39,293 Density of population (persons per acre) 7.7 Inhabited domestic properties (1.4.66) 97,092 Rateable value as at 1.4.66 £15,651,527 Product of Id. Rate £69,960 Rate in the pound 12/- Births: Live (Total) 4,775 Males Females Total Legitimate 2,324 2,106 4,430 Illegitimate 180 165 345 2,504 2,271 4,775 Crude birth rate per 1.000 estimated total population 15.8 Adjusted birth rate for comparison with other areas 16.0 (Area comparability factor for Births=1.01) Illegitimate live births=7.2% of all live births Birth rate for Greater London 17.7 Birth rate for England and Wales 17.7 Stillbirths (Total) 73 Males Females Total Legitimate 34 31 65 Illegitimate 6 2 8 40 33 73 Stillbirth rate for 1,000 live and still births 15.0 Stillbirth rate per 1,000 estimated total population 0.24 Stillbirth rate for Greater London 14.2 Stillbirth rate for England and Wales 15.4 Total births (live and still) 4,848 Males Females Total Legitimate 2,358 2,137 4,495 Illegitimate 186 167 353 Total of all live and still births 2,544 2,304 4,848 17 Infant Mortality: Males Females Total Legitimate 43 20 63 Illegitimate 4 1 5 47 21 68 Infant mortality rate per 1,000 total live births 14.2 Legitimate infant deaths per 1,000 live legitimate births 14.2 Illegitimate infant deaths per 1,000 live illegitimate births 14.4 Infant mortality rate for Greater London per 1,000 live births 17.8 Infant mortality rate for England and Wales 19.0 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 9.6 Neonatal mortality rate for Greater London 12.4 Neonatal mortality rate for England and Wales 12.9 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 8.4 Early neonatal mortality rate for Greater London 11.0 Early neonatal mortality rate for England and Wales 11.1 Perinatal mortality rate (stillbirths and deaths under one week combined, per 1,000 total live and still births) 23.3 Perinatal mortality rate for Greater London 25.1 Perinatal mortality rate for England and Wales 26.3 Maternal Mortality: Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 total live and still births Nil Maternal mortality rate for Greater London per 1,000 live and still births 0.33 Maternal mortality rate for England and Wales per 1,000 total births 0,26 18 Deaths: Males Females Total 1,457 1,662 3,119 Crude death rate per 1,000 estimated total population 10.3 Adjusted rate for comparison with other areas 10.0 (Area comparability factor for deaths = 0.97) Death rate for Greater London per 1,000 population 11.1 Death rate for England and Wales 11.7 Tuberculosis death rates: All forms (per 1,000 population) 0.03 Pulmonary (per 1,000 population) 0.026 Non-Pulmonary (per 1,000 population) 0.003 Cancer death rates: All forms (per 1,000 population) 2.2 Lung and Bronchus (per 1,000 population) 0.56 Other forms (per 1,000 population) 1.64 Staff Medical Examinations 409 members or potential members of the staff were given a medical examination during 1966. Meteorological Observations The Director of Parks has kindly furnished the following information from the records at the Climatological Station, Church House Gardens: Total rainfall 31.32 inches Mean maximum daily temperature 57.5°F. Mean minimum daily temperature 45.3°F. Highest maximum temperature 80°F. (on 15.9.66) Lowest minimum temperature 17°F. (on 19.1.66) Lowest grass minimum 15°F. (on 15.1.66) Population The Registrar-General's estimate of the population of the Borough, mid-year, 1966, was 301,680, an increase of 230 over the figure for the previous year. This figure gives a density of 7.7 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 1,656. The figure for 1965 was 1,802. 19 Births There were 4,775 live births allocated to the Borough during 1966, after adjustments for inward and outward transfers, this being a decrease of 138 over the figure for the previous year. Of the 4,775 live births, 3,685 occurred in hospitals and 1,090 in private dwellings. Of the total live births, 2,504 were males and 2,271 females. The crude birth rate for the area was 15.8 per 1,000 population, and the adjusted rate, for use when comparing one area with another was 16.0. The figures for 1965 were 16.3 and 16.5 respectively. The birth rate for the Borough is well below that of 17.7 for Greater London and England and Wales as a whole. In addition to the live births, there were 73 still births, representee a rate of 15.0 per 1.000 total live and still births. This rate is also below that of 15.4 for the country as a whole, but above that of 14.2 for Greater London and 1.3 above the figure for the Borough for the previous year. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Male Female 2,324 2,106 180 165 2,504 2,271 34 31 6 2 40 33 Totals 4,430 345 4,775 65 8 73 Deaths Deaths registered in 1966 numbered 3,119 giving a crude death rate of 10.3 per 1,000 population. This rate, when standardized by the comparability factor gives a figure of 10.0 for comparison purposes. The rates for Greater London and for England and Wales were 11.1 and 11.7 respectively. The total number of deaths shown in the following Table includes persons who, though normally resident in the Borough, died elsewhere in England and Wales, but excludes persons who, though they died in the area were ordinarily resident in other parts of England and Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the figures if they occurred in the Borough, as also are those of members of H.M. Forces who were stationed in the area. Accidental Deaths During the year 82 residents died from accidents of all kinds, including 41 in motor vehicle accidents. 20 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1966 (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 5 - - - - - - - 2 - 3 - F 3 — — — — — — — — 2 1 — 2. Tuberculosis, other forms M 1 - - - - - - - - - - 1 F — — — — — — — — — — — — 3. Syphilitic disease M 3 - - - - - - - - 2 1 - F 4 - - - - - - - - - 1 3 4. Diphtheria M - - - - - - - - - - - - F — — — — — — — — — — — — 5. Whooping Cough M - - - - - - - - - - - - F — — — — — — — — — - — — 6. Meningococcal Infections M 1 F — — — — - — — — — — — — 7. Acute poliomyelitis M - - - - - - - - - - - - F — — — — — — — — — — — — 8. Measles M - - - - - - - - - - - - F — — — — — — — — — — — _ 0. Other Infective & parasitic M - - - - - - - - - - - - F — - - - - - - - - - - - 10. Malignant neoplasm, Stomach M 39 - - - - - - - 1 13 11 14 F 32 - - - - - - - 1 4 9 18 11. Malignant neoplasm, lung bronchus M 136 - - - - - 2 1 12 45 54 22 F 32 - - - - - - - 6 11 6 9 12. Malignant neoplasm, breast M - - - - - - - - - - - - F 64 — — - — — - 3 10 20 15 16 13. Malignant neoplasm,uterus F 22 — — — — — — 2 2 8 6 4 14. Other malignant and lymphatic neoplasms M 151 - - - 2 3 - 7 14 33 42 50 F 187 — 1 - 2 1 3 6 15 31 41 87 15. Leukaemia, aleukaemia M 9 - - - - 1 - 1 - 1 4 2 F 14 — — 1 — — 1 1 3 3 1 4 16. Diabetes M 3 - - - - - - - - 1 2 - F 17 — — - - - - - - 3 5 9 17. Vascular lesions nervous system M F 114 245 — — — — — — 1 1 4 9 16 16 39 58 54 161 18. Coronary disease. angina M 360 - - - - - - 4 53 87 108 108 F 283 — — — — — — 3 4 32 70 174 19. Hypertension with heart disease M 16 - - - - - - - 3 1 9 3 F 30 — - - - — — — — 1 5 24 20. Other heart disease M 95 - - - - - - 2 2 13 18 60 F 186 — — — — - 1 6 3 11 20 145 21. Other circulatory disease M 65 - - - - - - 3 2 13 13 34 F 93 — — — — - — 3 1 5 22 62 22. Influenza M 2 - - - - - - - - 1 - 1 F 8 — — — — — — — 1 1 6 23. Pneumonia M 134 2 3 - - - 1 1 2 3 38 84 F 178 - 2 - — 1 3 10 21 141 24. Bronchitis M 103 - - - - - - - 1 25 37 33 F 46 — 7 - - - - - - 2 12 32 21 Causes of Death at different periods of life for 1966— 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 25. Other diseases of respiratory system M 16 - - 1 - - - - 1 3 8 3 F 10 — — - - - — - — 1 2 7 26. Ulcer of stomach and duodenum M 14 - - - - - - - 4 1 2 7 F 8 — — — — — — — — 1 1 6 27. Gastritis, enteritis & diarrhoea M 3 - 1 - - - - - - 1 - 1 F 12 - 1 1 - - - - - 1 - 9 28. Nephritis & nephrosis M 5 - - - - 1 1 - 1 2 - - F 8 — — — - - - 1 1 - 3 3 29. Hyperplasia of prostate M 8 — — — — — - — - — 2 6 30. Pregnancy, childbirth, abortion F - - - - - - - - - - - - 31. Congenital malformations M 15 10 - 3 - - - - - - - 2 F 5 2 2 — 1 - - - - - - - 32. Other defined & III — defined diseases M 102 19 3 2 1 3 1 4 3 17 14 35 F 128 13 — 3 1 4 4 5 18 15 65 33. Motor vehicle accidents M 29 - 1 1 3 7 3 1 4 4 3 2 F 12 — — - - 1 1 — 2 1 3 4 34. All other accidents M 23 - 1 2 4 1 4 1 2 1 2 F 18 — — 1 2 — — — 2 2 3 8 35. Suicide M 6 - - - - 1 1 - 1 2 1 - F 17 — — — — 1 - 3 6 5 1 1 36. Homicide & operations of war M - - - - - - - - - - - - F — — — — — _ _ — — — Total all causes M 1,457 31 16 9 10 21 10 29 111 286 410 524 F 1,662 15 6 3 8 5 10 33 73 189 322 998 Infant Mortality Deaths of infants under one year totalled 68 (63 legitimate and 5 illegitimate), giving a rate of 14.2 per 1,000 live births. The rate for England and Wales was 19.0 and for Greater London 17.8. Details showing causes of death, according to age group and sex, are given in the following table. Of the 68 infant deaths, 49 were under four weeks old, giving a neo-natal mortality rate of 9.6 per 1,000 total live births. The neonatal mortality rate for England and Wales was 12.9, and for Greater London 12.4. The early neo-natal mortality rate (deaths under 1 week per 1,000 total live births) was 8.4 (England and Wales 11.1; Greater London 11.0) and the peri-natal mortality rate (still births and deaths under one week combined per 1,000 total live and still births) was 23.3 (England and Wales 26.3; Greater London 25.1). 22 INFANT MORTALITY According to Cause, Age-Group and Sex CAUSE OF DEATH Under week 1 and under 2 weeks 2 and under 4 weeks 1 and under 3 mths 3 and under 6 mths 6 and under 9 mths 9 and under 12 mths Total M F M F M F M F M F M F M F M F Atelectasis 5 1 - - - - - - - - - - - - 5 3 Acute Bronchitis - - - - - - 3 - 2 - - - - 1 5 1 Congenital Heart Disease 4 - 1 1 1 - 1 1 - - - - - - 7 2 Gastro enteritis - — - — — — 1 — 1 — — — - - 2 - Prematurity 8 7 - - - - - - - - - - - - 8 7 Broncho-Pneumonia 1 — — — 1 — 2 - 1 — — — — - 5 - Respiratory Failure 1 1 1 - - - - - - - - - - - 2 1 Cardiac failure 1 1 - - - - - - - - - - - - 1 1 Cerebral Haemorrhage 1 1 - - - - - - - - - - - - 1 1 Pyelonephritis - - - - - - - - - - - - - - - 1 Meningitis - - - - - - - - - - - - 1 - 1 - Haemolytic Disease 1 - - - - - - - - - - - - - 1 - Infra-uterine Foetal Asphyxia - - - - - - - 1 - - - - - - - 1 Pneumothorax 1 - - - - - - - - - - - - - 1 — Nephroblastoma - - - - - - - - - - - - - 1 - 1 Anencephaly 1 1 1 - - - - - - - - - - - 2 1 Pneumonia - - - - - - - - - - 1 - - - 1 - Intussusception - - - - - - - - - 1 - - - - 1 Acute Pericarditis - - - - - - - - 1 - - - - - 1 — Accidental — - - — - — 1 — 1 - - - — - 2 — Adrenal Haemorrhage 1 - - - - - - - - - - - - - 1 - Haemorrhagic Disease 1 - - - - - - - - - - - - - 1 - Totals 26 14 3 1 2 - 8 3 6 1 1 - 1 2 47 21 Maternal Mortality There were no maternal deaths in the Borough in 1966. The maternal mortality rate for Greater London was 0.33 per thousand live and still births and the rate for England and Wales was 0.26 per 1.000 total births. Tuberculosis There were eight deaths from pulmonary tuberculosis and one from non-respiratory tuberculosis, giving a death rate of 0.03. Street Accidents 1,831 street accidents involving people in personal injury occurred in the Borough during 1966. 2,577 persons were injured and 27 died. These totals include 409 children under 15 years of age who were injured and 13 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. 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 24 MATERNITY AND CHILD WELFARE Peter A. Currie, m.r.c.s., l.r.c.p., Senior Medical Officer. Following the re-organisation of the London Boroughs and its associated upheaval we should, as a section, be particularly well qualified to deal with "teething troubles". However, it would be remiss to suggest that these have been overcome single-handedly and our gratitude is extended to the staff of the County Medical Officer of Health for their help. I remarked in my first report that every endeavour would be made to continue the high level of immunity from the undermentioned infectious diseases, and I am pleased to submit the following figures issued by the Ministry of Health which are selfexplanatory. Children Born in 1965 Whooping Cough Diphtheria Poliomyelitis Smallpox (Children under 2) England and Wales 72% 73% 68% 38% Local Authority 83% 84% 80% 62% It must be pointed out that these figures will be hard to improve upon, but it remains our ambition to achieve protection of 100% of our children. The pilot scheme for the early detection of cervical carcinoma has been fully developed. The initial response was encouraging but has declined and the number of women still at risk remains disappointingly very great. However, local organisations are co-operating most enthusiastically in helping to staff the clinics, providing a newly designed poster and seizing every opportunity of encouraging women to attend for examination. Following the receipt of Circular 7/66 of the Ministry of Health, discussions have taken place with the local Hospital Management Committee to appoint the Assistant Medical Officers as medical officers in a liaison capacity for the continuing care of handicapped children and in that capacity to attend clinics where children are seen in the hospitals of the group and to visit patients on the ward by arrangement with the Paediatrician or other Consultants. Consistent with this policy the Health and Welfare Committee is considering the appointment of an Assistant Medical Officer to act in a liaison capacity with particular responsibility for the deaf child. Active consideration is being given to the formulation of a comprehensive "at risk" register, and subsequent progress will be reported. 25 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 At the beginning of the year there were two Homes for Unmarried Mothers within the Borough, one maintained by a Trust Fund, the other by the Rochester Diocesan Council for Social Work. The former was closed and the property disposed of during the year. The other Home has accommodation for up to fourteen expectant and nursing mothers, and is used by several local authorities. Recent major structural alterations caused a substantial rise in the weekly maintenance rate, and it is understood that consequently some authorities cancelled bookings, and by so doing were instrumental in creating a situation leading to a further increase. Few residents of the Borough were admitted to the Home, in view of the considered desirability for these young women to be able to leave the immediate neighbourhood of their own homes. Generally, despite the efforts of the managing bodies, maintenance costs at Mother and Baby Homes throughout London and South East England continue to rise, though a somewhat artificial situation has arisen whereby there is a heavy demand for accommodation at the lower priced establishments, while there are empty beds at those Homes where a more realistic economic charge obtains. The Council accepted financial liability for the maintenance of 62 unmarried mothers at various Mother and Baby Homes during the year under review. Births Of the 4,869 births notified, 3,776 occurred in hospitals and 1,093 were domiciliary births. Welfare Foods All Child Welfare Clinics sell Welfare Foods in addition to a range of Proprietary Baby Foods. Sales for the year were:— 14,838 tins of National Dried Milk 4,935 bottles of Cod Liver Oil 7,074 packets of Vitamin Tablets 136,470 bottles of Orange Juice Proprietary foods to the value of £15,118 4s. 7d. were sold during the same period. 26 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. VACCINATION AGAINST SMALLPOX A total of 3,378 children, mostly between one and two years of age, received primary vaccination and 52 children were re-vaccinated during the year. DIPHTHERIA IMMUNISATION Primary Courses—Number of persons under age 16 Type of Vaccine or dose YEAR OF BIRTH Others under 16 Total 1966 1965 1964 1963 59-62 1. Quadruple 1 7 - - 10 - 18 2. Triple 1,897 2,100 127 46 74 15 4,259 3. Diphtheria/Pertussis - 1 - - 5 - 6 4. Diphtheria/Tetanus 11 18 2 5 17 3 56 5. Diphtheria - - - - - - - Totals 1,909 2,126 129 51 106 18 4,339 Re-inforcing Doses—Number of persons under age 16 Type of Vaccine or dose 1966 1965 1964 1963 59-62 Others under 16 Total 1. Quadruple - - 1 - 7 - 8 2. Triple 11 371 1,706 449 1,744 116 4,197 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 3 18 115 56 1,174 164 1,530 5. Diphtheria - - - - 2 - 2 Totals 14 389 1,822 505 2,927 280 5,937 Primary Oral Poliomyelitis Vaccination Completed Primary Course Under Five School Children Adults Total M. & C.W. Clinics 2,609 136 114 2,859 G.P's. Surgeries 1,624 195 — 1,819 Total 4,233 331 114 4,678 Completed Oral Poliomyelitis Vaccination M. & C.W. Clinics 29 1,418 10 1,457 G.P's. Surgeries 56 1,227 — 1,283 Total 85 2,645 10 2,740 (Salk—Nil) 27 Under 16 Protected Against Diphtheria, Pertussis and Tetanus Primary Immunisations Diphtheria Diphtheria and Pertussis Diphtheria Pertussis and Tetanus Diphtheria and Tetanus Tetanus Total Diphtheria Total Whooping Cough Total Tetanus NIL 6 4,259 56 9 4,339 4,284 4,342 Re-Immunisations Diphtheria Diphtheria and Pertussis Diphtheria Pertussis and Tetanus Diphtheria and Tetanus Tetanus Total Diphtheria Total Whooping Cough Total Tetanus 2 4,397 1,530 21 5,937 4,405 5,956 DAY NURSERIES Every effort is made by my domiciliary staff to ensure that day nurseries registered with the local authority maintain suitable standards. Consistent with the national trend the number of day nursery places continues to increase. Number of Registered Day Nurseries 54 (44) Number of Places provided 1,645 (1,398) (Figures in parenthesis represent 1965) There are no day nurseries maintained by the Council. CHILD MINDERS The number of child minders registered at the end of the year was: — Number of Registered Child Minders 49 (51) Number of Places provided 623 (629) (Figures in parenthesis represent 1965) NURSING HOMES Details of the homes at present on the Register are as under:— Number of Nursing Homes 31.12.65 19 Number of Nursing Homes 31.12.66 17 Nursing Homes Closed during 1966 2 Nursing Homes Registered during 1966 0 28 Number of Beds provided at 31.12.65 335 Number of Beds provided at 31.12.66 317 Unmarried Mothers' Homes at 31.12.66 1 (Registered under Nursing Homes Act) Number of Beds 14 Number of Cots 7 CERVICAL CYTOLOGY Many of the clinics within the Borough are equipped for the collection of Cervical Smears. This service which was introduced in the latter part of 1965 reached a peak in demand during the early months of 1966 and for some time nine regular weekly clinics were required to meet the demand. Of the 6,212 women who attended the council's clinics, 17 were found to have an invasive carcinoma in situ and in a further 6 women a gynaecological opinion was considered necessary. The demand for the service towards the end of the year declined rapidly and it was only necessary to maintain two regular weekly clinics. MIDWIFERY Miss G. Simmons, s.r.n., s.c.m. 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. There are at present 24 full-time and one part-time midwives employed in the Borough, ten of whom are approved teaching midwives. At present there are vacancies for six full-time midwives, i.e. 20% of the staff establishment is unfilled and individual case loads have become proportionately heavier. The availability of suitable living accommodation to offer prospective employees would, it is felt, do much to improve the situation. During the year the municipal midwives attended 1,093 domiciliary confinements and attended 862 mothers discharged from hospitals within 48 hours of delivery. Training for childbirth and parentcraft classes has been established at two centres and the attendances there have been very good. The present shortage of midwives precludes their attachment to general medical practitioner practices as has been done with health visitors, but in some areas midwives are assisting at antenatal clinics held by local doctors. Training of Pupil Midwives Ten members of the staff are approved teaching midwives and they undertook the training of 34 pupil midwives from Beckenham 29 Maternity and Farnborough Hospitals during the year. Pupils are accommodated in private lodgings while undergoing district training. Refresher Courses Seven midwives attended approved post-graduate courses to comply with statutory requirements and five attended a weekend seminar in "training for childbirth". 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. (4) Doctor not booked (1) Doctor booked (2) Total (3) 67 1,026 1,093 862 Total number of home visits made by midwives — 43,764 Ante-Natal Clinics and Post-Natal Clinics Number of women in attendance 1,407 Ante-Natal Mothercrajt and Relaxation Classes Number of women who attended during the year 1,755 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1966 who were born: — (i) At home or in a Nursing Home 23 (ii) In hospital 207 (2) The number of those born at home or in a Nursing Home:— who were nursed entirely there 23 who were transferred to hospital on or before the 28th day 0 who died during the first 24 hours 0 who died in one and under 7 days 1 who died in 7 and under 28 days 0 who survived at the end of one month 22 (3) Number of those born in hospital:— who died during the first 24 hours 7 who died in one and under 7 days 4 who died in 7 and under 28 days 3 who survived at the end of one month 193 (4) Number of premature still births who were born:— (i) At home or in a Nursing Home 4 (ii) In hospital 32 30 Notifications of intention to practise In accordance with the rules of the Central Midwives Board, 148 midwives notified their intention to practise within the Borough during the year 1966. HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., dip. soc. studies (lond.) Superintendent Health Visitor. The health visiting establishment has remained at 40 but approval has been obtained to increase the number to 45 when the financial position allows. During the year 4 full-time Health Visitors and one part-time Health Visitor were appointed and 7 Health Visitors left the service. One student Health Visitor was successful in her examination and was appointed in July. One Health Visitor had maternity leave. In spite of staff changes, the essential work of the service has been adequately covered, but of necessity routine visiting to normal babies has had to be restricted. In addition the Health Visitors have had to undertake extra sessions for preparation of and attendances at medical inspection in the Independent Schools who responded so enthusiastically to the invitation to take advantage of the School Health Service. A Family Planning Clinic has been started in Penge Clinic on Thursday mornings. Student Health Visitors Five student Health Visitors were sponsored by the Borough and all were fortunate enough to be accepted for training by the University of Surrey. The course commenced in September. In-Service Training The newly appointed Group Adviser was sent on a special administrative training course which she found to be of invaluable assistance. One Field Work Instructor was trained during the year. Once again Kent County Council invited the Health Visitors to attend one week's refresher course of lectures. This was very much appreciated by all concerned, and twelve Health Visitors were able to attend each afternoon's session. 6 Student Health Visitors, 2 Human Biology Students, and 1 Integrated Course Student have been helped in their practical experience by the Field Work Instructors. 31 Student nurses in training at Orpington. Farnborough and Bromley Hospitals have received lectures from senior staff on the work of the Health Visiting Service. Observation visits on the work of the Personal Health Services have been arranged for 119 student nurses and for 8 social work students. GENERAL MEDICAL PRACTITIONER ATTACHMENT There are now seven Health Visitors working in attachment schemes and three in liaison schemes with groups of General Medical Practitioners. The climate of opinion seems to be one of enthusiasm for these arrangements, as the work of the General Medical Practitioners and the Health Visitors is better co-ordinated to the benefit of the patient. Co-operation with Hospital Staff A closer liaison between the hospitals and the Health Visiting staff has resulted in improved communications and better use of each other's roles for the benefit of the community. We hope to continue to develop this co-operation. Surveys The Health Visitors have continued to take part in essential research projects. These have included the Dr. Alice Stewart Survey into Childhood Cancers, and a new project concerned with children suffering from Spina Bifida which has been started by Dr. Bernard Benjamin of the Greater London Council Research and Intelligence Unit. This is very time-consuming work for the Health Visitors, but they do it willingly because of its obvious importance. Visits Cases visited by Health Visitors No. of cases Children born in 1966 5,014 Children born in 1965 4,065 Children born in 1961-64 9,978 Total number of children in lines 1 - 3 19,057 Persons aged 65 or over 336 Number included in line 5 who were visited at the special request of a G.P. or hospital 157 Mentally disordered persons 150 Number included in line 7 who were visited at the special request of a G.P. or hospital 52 Persons, excluding Maternity cases, discharged from hospital (other than mental hospitals) 48 32 Number included in line 9 who were visited at the special request of a G.P. or hospital 41 Number of tuberculosis households visited 49 Number of households visited on account of other infectious diseases 37 Number of tuberculous households visited by tuberculosis visitor 669 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 number of district nurses employed by the Borough is 40, and in the past year they paid 108,604 visits to 3,184 patients. The prolonged periods of nursing care required by aged persons, and terminal cases, make heavy demands on the service, and it is gratifying to record the extremely valuable assistance afforded by local Red Cross detachments. Their work is carried out under the supervision of the district nursing staff. The Marie Curie Memorial Foundation has been of great assistance in the nursing of terminal cancer patients, by providing additional nursing care, to lighten the burden falling on relatives and the district nurses, and so enable patients to remain at home. A group of general medical practitioners, engaged in a survey of the aged and their care, has been helped by the secondment of a district nurse on one half day each week to assist them in the collection of pathological specimens. Twelve nurses attended a course arranged by the Ministry of Health, and all were successful in obtaining certificates for district nursing. RECUPERATIVE CARE The demand for short recuperative holidays for persons who have had an illness, or operative treatment, continues and advantage has been taken to obtain accommodation at various Nursing and Convalescent Homes in Kent and Sussex for periods usually of two weeks. These holidays can be extended on medical recommendation. In most cases there has been a considerable improvement in the patient's condition and the service is appreciated. 33 The majority of persons for whom the service was provided were aged, and apart from the choice of suitable homes to meet the individual needs, the problems of conveyance which have arisen have in the main been solved with the willing assistance of the W.R.V.S. There is evidence that, particularly with the aged group, the need for holidays for social rather than medical needs is increasing. During the year the Council accepted financial responsibility for fifty cases. CHIROPODY The demand for this service continued to increase during 1966. During the year 21,461 treatments were provided in the five clinics used for this service, and twenty-eight contractual chiropodists were also employed. This represents a 3% increase. Of particular note is the 13% increase in domiciliary treatments, 6,223 being given in 1965 and 7,088 in 1966. No new clinics were opened during the year, but three additional sessional chiropodists were employed. 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 88 families were notified to the department and 71 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 34 capped 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 thoroughly investigated during the year it was not necessary to obtain an order for compulsory removal. 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. There was a considerable increase in the number of Maternal and Child Welfare cases during the past year especially in the under five age group. The Dental Department records thanks to the Medical Officers and Health Visitors for their co-operation in advising the mothers to bring their children to the dental clinics for examination and treatment. The increase referred to above is encouraging as these children are potential patients of the future in the school service. There is also a wide scope in this field for preventive dentistry. The Dental Officer from the Department of Education and Science has visited the Borough again and commended the Authority on its industrious and well organised service, inter alia, its Maternal and Child Welfare Section. 35 Number of Visits for Treatment During Year: Children 0-4 (incl.) Expectant & Nursing Mothers First Visit 467 51 Subsequent Visits 514 110 Total Visits 981 161 Number of Additional Courses of Treatment other than the First Course commenced during year 60 110 Treatment provided during the year: Number of Fillings 858 145 Teeth Filled — 100 Teeth Extracted 45 19 General Anaesthetics given 17 7 Emergency Visits by Patients 8 67 Patients X-Rayed 7 9 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 63 36 Teeth Otherwise Conserved 75 — Teeth Root Filled — 5 Inlays — 6 Crowns — 2 Number of Courses of Treatment completed during the year 280 33 Prosthetics: Patients supplied with F.U. or F.L. (First Time) 7 Patients supplied with Other Dentures 4 Number of Dentures supplied 5 Anaesthetics: General Anaesthetics Administered by Dental Officers 3 Inspections: Children 0-4 (incl.) Expectant & Nursing Mothers Number of Patients given First Inspections during year A. 366 D. 23 Number of Patients in A and D above who required Treatment B. 106 E. 7 Number of Patients in B and E above who were offered Treatment C. 96 F. 6 Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment G. 170 For Health Education H. 4 36 HOME HELP SERVICE The following is a summary of the cases in which assistance was given between January 1st and December 31st, 1966:— Aged 65 or over on first visit in 1966 1,940 Under 65— Chronic Sick and Tuberculosis 225 Mentally Disordered 18 Maternity 474 Illness 382 3,039 Family Care Service 41 cases received assistance under this scheme in the same period. Family Welfare Service 1 case received assistance during the year. Night and Evening Service 8 cases received assistance in 1966. During the year 1966, help was supplied in 3,089 homes, reflecting the steadily increasing demand for the service. Family care cases almost doubled in number, and by this means 146 children were able to stay in their own homes in the temporary absence of the mothers. Recruitment has become slightly easier, although most new Home Helps can spare only a few hours daily, and in parts of the Borough poorly served by public transport it is difficult to provide frequent visits by the workers. VENEREAL DISEASES Under the National Health Service Act of 1946, diagnosis and treatment of venereal diseases became a responsibility of the Regional Hospital Boards and the functions of the local health authorities were limited to those of prevention. This involves the tracing of contacts wherever possible, and health education. There are no treatment centres for these diseases within the Borough. I am indebted to the Physicians at the undermentioned treatment centres for the following statistics for 1966. 37 New cases of residents treated during 1966. Treatment Centre Syphilis Gonorrhcea Other Conditions Total Croydon General Hospital 1 10 44 55 Dreadnought Seamen's Hospital, Greenwich — 5 16 21 Miller Wing, Greenwich District Hospital — 5 26 31 St. John's Hospital, Lewisham 1 18 80 99 The Middlesex Hospital (James Pringle House) — 1 22 23 The London Hospital (Whitechapel Clinic) — 2 12 14 Totals 2 41 200 243 AMBULANCE SERVICE The provision of the Ambulance Service within this Borough is the responsibility of the Greater London Council, and I am indebted to the Chief Ambulance Officer for the following report: — "Set out below are figures showing the number of patients carried and mileage run in respect of the three ambulance stations serving the London Borough of Bromley for the year ended 31st December, 1966. These figures also include some work arising outside of the Borough of Bromley as the Sidcup ambulance station is just inside the boundary of the Borough of Bexley and serves both boroughs. In addition, the Bromley Borough is served by ambulances based in the Borough of Croydon but separate figures of patients so carried in the Bromley area are not available". ACCIDENT AND EMERGENCY Ambulance Station Patients Others Patients Mileage Patients Mileage Bromley 3,928 30,895 99,916 504,991 Penge 2,056 10,824 20,704 51,627 Sidcup 1,801 12,259 31,329 86,530 7,785 53,978 151,949 643,148 38 HEALTH EDUCATION & HOME SAFETY Health Habits Basic health habits should become second nature. They are far more likely to be acquired and followed when there is a full understanding for the need for them. A knowledge of the broad facts about the structure of the human body and its working machinery—and everyone should know something about it—is the foundation upon which health instruction should be built, as an example, First Aid training gives a splendid background. During the last century when sanitary reform came into being, it was the lack of education and the apathy which went with it, that were the greatest obstacles to better health. This lack of interest—there was often great opposition—was widespread: not unexpectedly, it was greatest in that section of the populace which, being under the worst possible conditions, suffered most for want of it. The health of a nation is the history of that nation: better education precedes social reform, which in turn raises the standard of health and brings prosperity. The main principle underlying the activities of those whose concern is the public health, is HEALTH EDUCATION. They have a duty to keep the public informed, and to engage in health propaganda, but as will be seen, their task does not end there. The public health service is designed for this purpose, but it is by no means the only service that should engage in this work. All members of the Health and Social Services participate, and so do the Churches, Schools, Youth Organisations and Community Centres. The National and Local Press can be great allies, together with radio and television, with their nation-wide audiences. The close contact which the members of the staff of the Local Health Authority have with the public gives them many opportunities for health teaching and propaganda. It provides the public with a ready source of information and guidance. The Doctors, Health Visitors, Health Inspectors and Home Helps attached to the local Health and Welfare Department are well qualified to perform this service, and so are the Welfare, Children and Housing Officers, together with other Social Workers. A feature of their work is the practical assistance they can give, and the fact that they work as a team. Education of the Young At no age is health teaching more rewarding and necessary than in childhood and youth. It is then that the description of life must be learned together with an understanding of personal responsibility, and the need for care of the body and the maintenance of physical fitness. 39 Whilst the set lecture on a health topic has its place, it is as well to remember that fit young people, and grown-ups for that matter, are not interested in health for health's sake. They are interested in the improvement of physique and personal appearance, as exemplified by famous people in sports, films, the Services and other walks of life—the heroes of yesterday and to-day. THIS SHOULD AND MUST BE AN EXCELLENT GUIDE TO THE HEALTH TEACHER. The Health Educator realises also that the old fashioned lecture of an hour's duration is not very acceptable to people of any age, unless the audience is of a special character, therefore he or she has to rely on more than the spoken word, and techniques, now known as "Visual Aids" are utilised to the fullest. These consist of models and exhibits in great variety, playlets, films and filmstrips, posters, pamphlets, flannelgraphs and other models of this type. These new ideas of education have been used regularly during the past year by all members of the trained staff of this Department in an effort to give fuller and better publicity to the many facets of Health Education. Schools have been visited, lectures and film shows given, whilst many talks, discussion groups, film strips and large or small displays and exhibitions given to Youth Clubs, Scouts and Guides, Ranger Group, Old People's Clubs and various other organisations. Home Safety From January to December 1966, a total of 6,440 home accident cases were treated at Farnborough, Orpington and Beckenham Hospitals; of these 3,703 were adults and 2.737 were children. Facts about home accidents 1. Every year there are about 8,500 fatal home accidents in Great Britain 2. It is estimated that something like 100,000 home accident cases are admitted to hospital. 3. At least 1½ million home accident cases are treated in outpatient departments, and many, many more than that are cared for by general practitioners, etc. 4. Four-fifths of these fatalities occur to elderly people (aged 65 years and over) and to children under 5 years of age. 5. About the same number of children under 15 years of age, die in home accidents, as die from all accidental causes elsewhere, including road accidents. 40 6. More children under 15 years of age die from accidents at home, than from any single infectious disease. 7. In children between 1 to 5 years, home accidents are the third main cause of death. 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 topics, but particularly with regard to the theme "STOP ACCIDENTS IN THE HOME", which was in operation from April to September. Great emphasis in this campaign was devoted to the physical and mental condition of the injured person, and the material factor of the home environment, with regard to tidyness, etc. From October to December the project was again concentrated on the National Fire Protection Campaign, in conjunction with the Home Office, R.o.S.P.A., and the Fire Protection Associations, and full publicity given locally to this most important accident causation, with particular emphasis on oil heaters and oil containers. The members of these Home Safety Committees are fully aware of all home accident problems, and they in their turn do everything possible to inform the members of the public of these, and suggest measures for prevention and other safe and sound procedures. Many lectures, displays of material, film shows, are carried out through clinics, schools, voluntary organisations, whilst small and large exhibitions were on view at various summer fetes, etc. Complete accident statistics are forwarded to Local Press offices for publication. Publicity material covering all age groups and their problems was displayed throughout the Borough during the year, particularly on local authority and school premises, with the valued assistance and co-operation of Head Teachers and their staff, and members of the Junior Accident Prevention Council. From the 24th to the 29th October, 1966, the "Medicines with Care" exhibition, promoted by the Pharmaceutical Society of Great Britain, was on view within the Borough. Between 4,000 and 5,000 people attended during the week. During this exhibition the local press had given valued assistance to this project in asking the public to return to chemists' shops all unwanted drugs and tablets for subsequent disposal. During the year many requests have been received for talks/ lectures to be given to Youth Clubs, Parent/Teacher Associations, Teachers Training Colleges, Old People's Clubs, Scouts and Guides and many Junior and Senior Schools within the Borough. Many 41 of these training lectures, particularly with regard to senior schools and Scouts and Guides, were required as part of the syllabus for the Duke of Edinburgh's Award Scheme. Hospital Statistics From January to December, 1966, Beckenham Hospital received a total of 1,357 home accident cases admitted for treatment; of these 451 were children. The figures for Farnborough Hospital for the same period were 1,879 cases, of which 867 were children, while Orpington Hospital recorded 3,204 cases, of these 1,419 being children. This makes a total of 6,440 home accident cases having been admitted to these three local hospitals, during the whole of 1966. It is worthy of note, that in the annual report of 1965, the total of home accidents recorded by the above three hospitals was 3,513 cases, but it must be mentioned that this figure represented the following periods: BECKENHAM—April to December, FARNBOROUGH—May to December, ORPINGTON—September to December. The three most prominent causes of these accidents, according to the hospital's records are as follow :— 1. FALLS are the chief danger to the older people. 2. BURNS/SCALDS are chiefly applicable to the very young and very old people. 3. POISONING is the danger to adults, especially in relation to gas, medicinal substances, through overdoses, mistakes, etc. Also a considerable number of young children were admitted, having taken by mistake tablets and drugs which had been left within reach of these youngsters. INFECTIOUS AND OTHER DISEASES 44 INFECTIOUS AND OTHER DISEASES General During the year the Borough remained free from any serious outbreak of infectious disease. The total number of notifications received, 1,652, was considerably fewer than the preceding year's figure of 5,563 notifications, the difference being mainly accounted for by the fact that measles did not occur in epidemic form during the year under review. Once again there were no cases of diphtheria or poliomyelitis reported, reflecting the high level of protective immunisation which has been maintained in the Borough; this good record should not, however, blind us to the fact that any lapse in this immunity would leave the way clear for a recurrence of these dangerous and distressing illnesses, and should encourage parents to make quite certain that their children receive the benefit of the various immunising procedures that are available. There was a single case of typhoid fever reported, the infection in this instance having been contracted outside the United Kingdom. Another feature worthy of comment was the very small number of cases of food poisoning notified, only seven being confirmed during the year. These were all isolated cases, and there were no generalised outbreaks of the type associated with failures of food hygiene in canteens and other catering establishments. Even when allowance is made for the incomplete reporting of the milder forms of this illness, and no doubt also for an element of good fortune, the achievement still seems a considerable one, in a Borough of this size, especially when the vast number of meals served annually in catering establishments throughout the Borough is borne in mind —over six million by the school meafs service alone. A good deal of patient educational work has been carried out by the staff of the department in the field of food hygiene, and this was also a practice of the health departments of the constituent authorities prior to amalgamation. It is important that this work should continue without interruption. Finally, it is pleasing to note a considerable reduction in the number of new cases of tuberculosis, sixty notifications being received compared with ninety in the previous year. There were also fewer fatalities from this cause, and a small decrease in the number of cases on the register. 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. 45 Erysipelas Eight cases were notified during 1966 compared with fourteen notifications in the previous year. Dysentery Forty-three 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. The corresponding number of notifications received in 1965 was 28. Food Poisoning Seven cases were notified during the year compared with 17 in 1965. All of these affected single families or individuals and proved to be of the salmonella type. 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. typhimurium — — — — 4 4 4 2. Other Salmonellae (a) - - - - 3 3 3 3. CI. welchii — — — — — — — 4. Staph, aureus — — — — — — — 5. Other causes(b) — — — — — — — 6. Cause unknown — — — — — — — 7. TOTAL — — - - 7 7 7 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of Salmonellae STANLEY - - — 2 2 2 SANTIAGO - - - - 1 1 1 - - - - - - - - - - - - — - - - - - - - - Salmonella Infections — Nil. 46 Measles 1,236 notifications were received compared with 5,119 in 1965. The illness remained on the whole mild in character and no deaths from this cause occurred. Meningococcal Infections Two notifications were received in 1966. One case was in respect of a female under one year and the other in the case of a male between 1-5 years of age. Six notifications were received in 1965. Pneumonia Forty-six notifications in respect of cases of pneumonia were received in 1966. 312 deaths were attributed to this disease. This figure includes the people who are normally resident in the area but who died in premises outside the Borough boundaries. Scarlet Fever 111 cases were notified during the year, compared with 178 in 1965. The infection continued to occur in a generally mild form. Smallpox No cases occurred during 1966 but once again 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 20,991 International Certificates of Vaccination, compared with 3,690 in the previous year. This large increase was due to the restriction imposed by other countries in view of the cases of smallpox existing in the United Kingdom during the year. Tuberculosis 60 notifications were received and 9 deaths attributed to this disease during 1966. These figures compare favourably with those of the previous year, namely 90 notifications and 14 deaths. Of the 9 deaths, two occurred in the 45/54 age group, 2 in the 55/64 age group, 4 in the 65/74 age group and 1 was over 75 years of age. The following are details of the recordings in the register for the year ended 31st December, 1966. 47  Respiratory Other forms Total No. of Cases M F M F On Register at 1.1.66 1,659 1,295 147 176 3,277 New cases notified during 1965 33 17 6 4 60 Number of cases coming to knowledge after death — — — — — Restored to Register 1 2 - - 3 Inward Transfers 24 25 - 1 50 1,717 1,339 153 181 3,390 Deletions - deaths, removals recoveries, etc., 120 78 5 6 209 Number of cases on Register at 31.12.66. 1,597 1,261 148 175 3,181 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 2 - 1 - - - - - 5-14 1 - - - — — — — 15-24 4 3 2 - - - - - 25-44 4 7 - 3 - - — — 45-64 14 3 2 1 2 2 — — 65 and over 8 4 1 - 3 1 — Age not known - - — — - — — — 33 17 6 4 5 3 1 - Inward Trans. 24 25 — 1 - - - - Totals 57 42 6 5 - - - - 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 1966. Typhoid and Paratyphoid Fever One case of Typhoid Fever in a female in the age group 15/25 years was notified during the year. It was concluded that the infection had been acquired during a holiday outside the United Kingdom. 48 Whooping Cough 113 cases were notified to the Department during 1966 as compared with 26 cases during the previous year. Ophthalmia Neonatorum Only 1 notification was received. Puerperal Pyrexia 24 cases were notified during the year 1966. SERVICES UNDER THE MENTAL HEALTH ACT 1959 50 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. When considering the development of the local authority Mental Health Service in 1966, the reader must bear in mind that the service started nine months previously almost from scratch. Therefore, a parallel can be drawn with a spurt of growth occurring in a human being during the second year of life. Such an expansion was envisaged by the senior staff of the service and every effort made to make adequate provisions from the staff, "bricks and mortar" and financial angles. On the first point we faced the national problem of professional staff being in short supply; suitable "bricks and mortar" are very scarce in the Borough, while free land is practically non-existent. The financial provisions already approved by the Council had to be severely cut back in accordance with the Governmental policy of summer 1966. One measure of the work of the Mental Health Section is given in the table below: Cases in community care supervised by the Mental Health Section in 196~6 (corresponding numbers for 1965 in brackets). TABLE I. Mental Illness Psychopathic Disorder Subnormality Severe Subnormality Totals New Referrals 288 (152) 1 (2) 114 (58) 18 (53) 421 (265) Total Cases 31.12.66 353 (170) 1 (2) 292 (241) 183 (185) 829 (598) One notes that the main increase in total cases is due to the doubling of new referrals in mental illness from last year. The figures for subnormality are discussed further on in the report. MENTAL HEALTH SECTION STAFF General Comments The Department's policy of appointing academically qualified staff has been adhered to and in spite of the national shortage of such workers, we appointed one trainee, three Mental Welfare Officers and one Senior Mental Welfare Officer. Two out of the three Mental Welfare Officers appointed and the Senior Mental Welfare Officer have social work qualifications. Thus on 31.12.1966, the total strength of the Section was 2 trainees, 10 Mental Welfare 51 Officers (one away on Younghusband course), 1 Senior Mental Welfare Officer, all under the general direction of the Principal Mental Welfare Officer. The division into three areas each with the office situated at: The former County Offices, The Walnuts, Orpington; 17, Palace Grove, Bromley; 69, Croydon Road, Penge, S.E.20, has been maintained, while the Borough has a round-the-clock service, weekends and public holidays included, with all the M.W.O.s taking their turn on the duty roster. The division into three areas remains necessary for geographical reasons and we are frequently reminded of the fact that Bromley, the largest of the London Boroughs in area, covers more than 60 square miles and that many parts are inaccessible by public transport. Statutory Functions The statutory duties of the M.W.O. are often forgotten, especially by the lay people who are under the impression that since the Mental Health Act, 1959, the patient must give his/her consent before he/she is admitted to hospital. The table below gives the number of admissions where the M.W.O. was involved: TABLE II. HOSPITAL ADMISSIONS EFFECTED BY M.W.O.s IN 1966 (Corresponding numbers for 1965 in backets) Mentally Ill and Psychopaths Mentally Subnormal and Severely Subnormal Section 25 33 (13) - (-) Section 26 11 (9) - (1) Section 29 115 (108) — (-) Section 60 4 (2) (1) Informally 73 (28) 2 (4) Total 236 (160) 2 (6) It would be noted that there is an increase of Section 25 admissions, doubtless due to more psychiatrists' time available and used for this purpose. The two-and-a-half-fold increase in informal admissions reflects the general effect of mental health education. M.W.O. as a Specialised Social Worker The concept of the specialised social worker carrying out statutory duties is a fairly new one, but has been accepted in other fields, e.g. child care. However, not all local health authorities have adopted such policy and several comparable London Boroughs engage two distinct categories of staff, i.e. P.S.W.s for intense case work and M.W.O.s for statutory duties and general support only. 52 The Department felt that such policy would not be in the interest of the service. Leaving, if one only could, the national shortage of P.S.W.s on one side, the difficulties in recruiting and retaining staff of suitable calibre, would be much increased. Furthermore, the achieving of the generally accepted aim, "one client—one social worker", would recede further into the future. It followed therefore that efforts must concentrate towards in-service training and staff development. The first term applies to secondment on courses leading to a professional qualification, the second to day or week release courses and lectures. The London Boroughs' Training Committee proved to be a most valuable body to provide such training and the Council most generous in approving attendances at seminars, courses and conferences for our staff at all levels. The figures given below apply only to lectures given by professional staffs other than officers of the Health Department. Altogether the officers of the section attended 92 such sessions in 1966, making an average of 8.5 sessions per officer. (These figures do not include the in-service training for the staff of the Training Centre, which will be considered separately.) On the point of the in-service training proper, one Mental Welfare Officer was away on the Younghusband course and one trainee was accepted as a student for a similar course to start in September, 1967. Training future Social Workers from outside the Borough One of the signs of the recognition of the quality of the service provided has been the application from the London School of Economics to place their students for the P.S.W. qualification with the Authority's Mental Health Service. In addition, the senior officers of the section are involved in helping the Education Department to organise the further education courses, e.g. the Principal Mental Welfare Officer gave lectures during the autumn course, on "Family Stresses". Towards a Comprehensive Mental Health Service The proof that the Department has been successful in building up a corps of field staff capable of case work came from hospital psychiatrists as a request for attachment of two M.W.O.s to two Consultants working in the Borough, and this request was readily met. The attachment takes the form of attendances at the clinic and carrying out the support of the patient and his family on the lines hitherto reserved for the hospital P.S.W. (Both M.W.O.s are academically qualified, one a P.S.W., the other a C.S.W.) A third M.W.O. was seconded to the Director of the Child Guidance Clinic where she works most of the time. All three M.W.O.s retain 53 "their own" case load, carry out full statutory duties and take their turn on the duty roster. Although such attachments in a situation when the volume of work is growing rapidly and the manpower remains limited, make the Section fully stretched, the officers look forward to further integration and dovetailing between the hospital and the local health authority services. New Developments in the Hospital Services for the Borough 1966 saw considerable expansion of psychiatric out-patient services and the position at the end of the year is summarised on the table below:— TABLE III. NUMBER OF OUT PATIENT CONSULTANT SESSIONS IN THE BOROUGH PER WEEK Name of Hospital Adull Psychiatry Child Psychiatry/ Guidance Bromley (Stepping Stones) 6 3 Beckenham 2 0 Farnborough 3 2* Orpington 1 0 Queen Mary's** 2 0 Sydenham** 0 2 The Willows, Chislehurst*** 0 4 TOTAL 14 11 * referrals through Paediatricians only. ** hospital situated just outside Borough boundaries. *** local authority clinic. The Borough has no Mental Health Centre. "Stepping Stones", contrary to popular belief, is not a "walk-in clinic", but the building owned by the hospital authority is used for the dual purpose of providing rooms for psychiatric out-patient and club facilities. If at some later date, a Mental Health Centre is contemplated, it would have to be sited in the Beckenham/Penge area where the population is dense, with social and mental health problems in abundance. The Borough is served by three large psychiatric hospitals, Cane Hill (Coulsdon), Oakwood (Barming, near Maidstone) and Bexley. Farnborough Hospital, which prior to the Mental Health Act, 1959, was a designated hospital with two observation wards (one male, one female), has been rapidly developing as the acute 54 psychiatric hospital provision for the area. The three Consultant Psychiatrists in charge of treatment at Farnborough Hospital also work at Cane Hill and cover out-patient sessions in other parts of the Borough. The opening of a large and modern Day Unit at Farnborough Hospital (stage one of their plan for an up-to-date Day Hospital), which took place early in 1967, may well provide a focal point of contact between hospital and community services. Child Psychiatry/Guidance The appointment of a Consultant Child Psychiatrist to cover all the sessions in the Borough took place in November, 1966, and was heartily welcomed by all involved. With this appointment, child psychiatry and child guidance have rightly merged into one specialism, and attendance at a particular clinic or hospital is governed by geographical considerations only. Farnborough Hospital, where only internal referrals are accepted (see table III), is the exception to the rule, necessitated by the scarcity of consultation time available. SUBNORMALITY Size of the Problem It would have been seen from table I that the number of new referrals for subnormality has doubled since last year. This increase is due to several factors: the more ready acceptance by parents of the Special School leaver to have the youngster supervised by the M.W.O., the very efficient case finding service with the Health Visitor referring all young children who are retarded in their development. Very often the Paediatricians as well report these children to the Medical Officer of Health so that advance arrangements can be made for their schooling or training and the family given social support. The new referrals on the severe subnormality side have dropped from 53 last year to 18 this year. This drop is understandable since we expected that all the severely subnormals were already known to the Department and indeed practically all the 18 cases newly referred were those of the severely subnormal children born in the Borough in 1966. The Young Mentally Handicapped Child Our figures come very closely to the national statistics of severe subnormality, the incidence rate being 3.7 per 1,000 births. As there are close on 5,000 births per year in the Borough we can expect 18.5 severely subnormal children born during such period. 55 Assessment and Parent Counselling Parent counselling and support for the family with a young mentally handicapped child has until now been carried out by the Health Visitor. This policy was adopted because in the majority of cases the problems encountered were not unlike those in a family with "normal" children, and with these the Health Visitor deals in the day-to-day course of her work. Moreover, a number of these children belong to either established or "borderline" problem families and the Health Visitor is already deeply involved, especially when co-ordination with other statutory (Children's Dept., Probation Service) or voluntary (N.S.P.C.C.) agency is called for. Where there is an overt mental illness or a clear mental health problem, the M.W.O. takes over the supervision of the case before the usual date, i.e. the child's 5th birthday. The clinical assessment is carried out by the Senior Medical Officer at the child's home as soon as practicable and often as a matter of some urgency. A home visit has many advantages with the child and the family being examined in the natural setting. Much thought has been given to establishing an Assessment Centre, but no concrete steps have as yet been taken in this direction. The geographical problems mentioned before may be the overriding difficulty. The scarcity of clinical accommodation available would also have to be overcome. Link with Hospital Paediatrician Service The Borough is well served by the paediatric in-patient and out-patient facilities. In practice, every mentally handicapped child has been seen by the paediatrician at some stage of his development. The proximity of London teaching hospitals resulted in many children being referred to such hospital for a "second opinion" and the newly established Assessment Centre (Newcomen) at Guy's, which is easily accessible by rail, is being increasingly used by the local paediatricians. A two-way exchange of information, clinical and social, between the local and London hospitals and the Medical Officer of Health is now well established. Clinical Types of Subnormality The table below gives grouping by diagnosis of young subnormal children:— TABLE IV. CHILDREN IN COMMUNITY THOUGHT TO BE MENTALLY HANDICAPPED —BORN AFTER 31.12.1960 GROUPING BY DIAGNOSIS Subnormality (various causes) 32 children Mongolism 28 „ Severe subnormality (non specific defects) 18 „ Cerebral palsy 18 „ 56 Spina bifida with hydrocephaly 6 „ Hydrocephaly 6 „ Microcephaly 5 „ Spina bifida 3 „ Microcephaly with cerebral palsy 3 „ Hypercalcaemia 1 „ Total 120 children The first group consists of a "mixed bag" of conditions, e.g. prematurity, birth trauma and toxaemia as possible or probable causes of damage. Mongolism comes a close second, being universally accepted as the largest single cause of mental defect. It is interesting to note that in every case where a mongol was born to a young mother, genetic advice including chromosomal studies was carried out at a London teaching hospital. Children taken off the Register With the prevalence rates of severe subnormality remaining static for the past 60 years or so, it was interesting to know the reasons for the mentally handicapped child to leave the local authority register. These are summarised in the table below: — TABLE V. CHILDREN BORN AFTER 31.12.1960 REMOVED FROM THE MENTALLY HANDICAPPED REGISTER DURING 1966 Left district (5 mongols. 5 subnormals, 4 severely subnormal) 14 children Found on assessment to be "dull average" 5 „ Found on assessment to have deafness as main handicap 4 „ Admitted to subnormality hospital (one mongol, one severely subnormal) 2 „ Died 6 „ Total 31 children Five children found to be dull average on assessment reflect the difficulty encountered by parents and even by professional workers in estimating a young child's intelligence and potential. Understandably, in every one of the five cases the mother expressed 57 gratitude and relief for the expert help available and for the assurance that the child will not be barred from entering the Infants' School at the normal age of 5. The 4 children where deafness is thought to be the major handicap became the responsibility of the School Health Service. The fact that only 2 children were admitted to subnormality hospital for long-term care reflects the modern trend towards home care and also the scarcity of hospital accommodation. The number of deaths—6 in a group of 150 children—is not excessive if one considers the very severe defect present and remembers that not long ago some of these children would not have survived the neo-natal period. There was no case of mongolism among the deaths. Play Groups Two well established Play Groups have continued successfully during 1966. ST. PAULS CRAY, MICKLEHAM ROAD CLINIC, run by the Bromley Society for Mentally Handicapped Children, operates once a week on the Clinic premises which the Council provides free of charge. A Health Visitor is available for advice if required. ST. MARY'S CENTRE, HAYES, run by the Trustees of the Hayes Parish Church on the Kindergarten lines three times a week, employs qualified staff. This Play Group has assimilated children with varying degrees of mental handicap and its activities proved beneficial to every child without exception. The fees are met by the parents and in necessitous cases by the Bromley Society for Mentally Handicapped Children. The Council reimburse the deficit incurred in the running of the Centre by a per capita grant to the Trustees (60% from the Education Committee, 40% from the Health and Welfare Committee). A third Play Group in Beckenham, organised by the British Red Cross Society, will start early in 1967. Research into Subnormality On the clinical side research has always been and likely to remain the prerogative of hospital service. The need for such research is very great indeed. Early in 1966, the Medical Officer of Health was approached by Professor Elek, Head of the Department of Bacteriology at St. George's Hospital Medical School, with a request for co-operation in the project he was working on, in conjunction with his Senior Lecturer in Virology, Dr. Harold Stern. The project set out to test the hypothesis that infections other than rubella and toxoplasmosis occurring in utero or early infancy play a part in producing subnormality. Professor Elek 58 asked for facilities to be given to examine as many retarded young children in the community as possible, and his request was granted. All the examinations were carried out successfully, full co-operation having been obtained from nearly every parent. Expressing his appreciation for the help received. Professor Elek indicated that Bromley has contributed a major share for his survey, namely 50 cases out of the total of 300, the rest coming from the remaining 31 London Boroughs. The St. George's Hospital research project also includes 300 controls, and at the time of this report going to press, the results were being analysed. A very detailed two-phased survey of the social and emotional problems facing families with a mentally handicapped member is planned by the Mental Health Section. The first phase will cover children under 16 and the second will include the rest of all the cases in the community. The aim of this survey is twofold. Firstly it will enable the Medical Officer of Health to advise the Council in detail on the needs and usage of the local authority's services and secondly it would test certain assumptions and predictions recently made in the scientific publications. SCADS HILL TRAINING CENTRE Supervisor: Mrs. Dorothy Hodgman Senior Asst. Supervisor: Mrs. S. I. Walton The high standard of work at the Centre which accommodates Juniors and Adults continued throughout the year. Three new staff were appointed, one qualified Assistant Supervisor, one with relevant nursing experience, and one Assistant Trainee Supervisor. The general health and vigour of the trainees remained good throughout and the annual medical inspections carried out for all the age groups in the summer revealed lower incidence of defect than usually found in schools. The numbers on the roll are given in table VI under the heading "Problems of Training Centre Placements". A new classroom provided by the Council will be opened early in 1967. This will relieve the congestion and enable the urgent cases from the waiting list to be admitted. There are six Special Care children at the Centre, i.e. children with multiple handicaps and five adolescents functioning at such a low level that only a limited social training can be attempted. These "children" are still in the community because on one hand their parents wish to care for them and on the other, the staff accept them at the Centre. If it was not for the devotion and hard work on the part of the staff most of these "children" would have long since been in a subnormality hospital. 59 The social activities have continued on the traditional pattern, e.g. excursion to the Zoo, Christmas time visits to the Circus and the Pantomime and shopping expeditions in small groups. The summer Garden Fete was a new and a very successful venture when a most enjoyable afternoon was spent by grown-ups and children alike. Apart from increasing the Amenities Fund of the Centre by over £120, it brought into Scads Hill many visitors not directly connected with it, thus the atmosphere of good neighbourliness and social acceptance of the mentally subnormals by the community was further reinforced. In-Service Training The departmental policy regarding the training of Mental Welfare Officers discussed before, applies equally to the teaching staff at the Centre. Every attempt was made to fill the new vacancies with qualified staff, but the difficulties obtaining nationally are not lessened by the unattractive and unsuitable premises at Scads Hill. The appointment of one qualified teacher was already mentioned. One Trainee Assistant Supervisor was successful in her application for a place at the Two Year Course leading to the Diploma for Teachers of the mentally handicapped, at Bristol, starting in September, 1967, and the Council approved her secondment. Every opportunity was given for all the staff to attend relevant National Conferences, Day release Courses and Lectures within the Borough by professional workers. The total number of such attendances in 1966 was 57, giving an average of 5.7 sessions per teacher. Combined In-Service Training Programme with Bexley The figures above include a Two-Day Conference held at Crayford Training Centre in the autumn of 1966. A second will take place at Orpington Training Centre in the spring, 1967, as part of the combined in-service training programme between the Borough of Bexley and this Authority. This conference was acclaimed an unqualified success. The sub-normality hospitals working with both Boroughs expressed great interest in this form of training and one of them (Darenth Park) has now offered to return the hospitality by organising a further conference in the autumn of 1967. Problems of Training Centre Placements The shortage of Training Centre places, especially on the adult side, was one of the major problems facing the Borough from its inception and we wish to place on record the unfailing co-operation afforded to us by the contiguous authorities, especially the Borough of Bexley and the Kent County Council. Themselves short of Adult 60 Training Centre places, the Kent County Medical Officer of Health agreed to us using their Adult Centre at Swanley for more than half of our total number of "placed" adults. Details of Training Centre placements are given in the table below:— TABLE VI. LONDON BOROUGH OF BROMLEY RESIDENTS ATTENDING TRAINING CENTRES (Corresponding numbers for 1965 in brackets) Juniors and Adults Name of Centre and Responsible Authority. AGE TOTALS 5 years - 16 years - M F M F Scads Hill (Bromley) 28 (22) 22 (23) 16 (21) 21 (18) 87 (84) Swanley (Kent C.C.) — (—) — (—) 27 (26) 16 (19) 43 (45) Sidcup (L.B. Bexley) 3 (5) 2 (1) 1 (1) -(-) 6 (7) Lewisham (L.B. Lewisham) 1 (1) — (-) - (-) — (—) 1 (1) Thanet* (Kent C.C.) 1 (2) 1 (1) — (—) -(-) 2 (3) Slough* (N.S.M.H.C.) — (—) — (—) 1 (1) — (—) 1 (1) TOTALS 33 (30) 25 (25) 45 (49) 37 (37) 140 (141) * These trainees are resident in the hostel attached to the Centre. Marginal variations only in the situation in 1965 and 1966 would be noticed. This is due to the fact that all the Centres listed are working to capacity with no room for expansion. Proposed developments in this and other fields are discussed in the past part of the report. Club Activities for the Mentally Handicapped The "Gateway" Club in the Penge area has continued successfully throughout the year. The Club has the services of the M.W.O. who was instrumental in bringing it into being. The Council meets the rental of the premises. A second "Gateway" Club in the Borough will open early in 1967 in Orpington and the local authority's involvement with it follows on the same lines. Clubs for the Mentally III These have so far remained in the hands of local Mental Health Associations. The well established Orpington Mental Health Association has been very active in this field. The official launching of the Beckenham and District Mental Health Association in December, 1966, has stepped up the work in yet another part of the Borough. 61 The nationally known "Stepping Stones" have had a most successful year and the future may well see a closer involvement with the club on the part of the community mental health service. Headquarters of the Mental Health Section This is based in the Health and Welfare Department at The Walnuts, Orpington, and consists of Senior Medical Officer, Principal Mental Welfare Office, Administrative Assistant, with a very small secretarial and clerical staff. It is at the headquarters that admissions to subnormality hospitals (short or long term) are arranged. The long term admissions are not very numerous and the Borough shares with the rest of the country the shortage of subnormality beds. A very close and friendly working relationship was soon established with Leybourne Grange Hospital which includes the Borough in its catchment area. The degree of bed shortage at Leybourne Grange Hospital is such that hardly ever can an indication be given as to when the patient is likely to be admitted. The Physician Superintendent however is always most helpful in cases of social emergency, e.g. death or a serious illness of the parent and gives special consideration to cases showing severe deterioration. The number of admissions for short term care (Ministry of Health Circular 5/52) are given below: — TABLE VII. NUMBER OF CASES PROVIDED WITH SHORT-TERM HOSPITAL CARE IN 1966 (Corresponding numbers for 1965 in brackets) Category Under 16 Over 16 TOTAL Mentally Subnormal 4 (4) 3 (3) 7 (7) Severely Subnormal 13 (4) 14 (10) 27 (14) Total 17 (8) 17 (13) 34 (21) There has been no increase in the numbers of subnormals provided with such care, but while the number of severely subnormal children under 16 has doubled in the last 12 months, the number of severely subnormal over 16 has increased by one third. This is in line with the well-known fact that the amount of services asked for rises with the degree of handicap. The severely subnormal population now surviving to an increasingly higher age must make the authorities look towards gearing more and more of their services towards the very severely handicapped. 62 Residential Placement under the Mental Health Act, 1959 The Council is empowered to provide residential accommodation other than hospital accommodation for every category of mental disorder. The Borough has as yet no Hostel of its own either for the subnormals or for the mentally ill. The last table gives figures for 1966 where we placed the mentally subnormal and mentally ill in Hostels run by other local authorities or voluntary bodies. TABLE VIII. NUMBER OF PERSONS PROVIDED WITH RESIDENTIAL ACCOMMODATION (OTHER THAN HOSPITAL ACCOMMODATION) DURING THE YEAR 1966 Mentally Ill Mentally Subnormal In residence on 1.1.66 9 5 Admitted during the year 7 5 Discharged during the year 3 1 In residence on 31.12.66 13 9 It will be seen that the numbers of persons so maintained has more than doubled in 1966. Prior to recommending for Council to meet the cost of maintaining a Borough resident at such a Hostel, the Medical Officer of Health must be satisfied that such placement is both necessary and suitable. The task of collecting, checking and collating all the information required is the responsibility of the headquarters staff. The headquarters further deal with all staff matters, administering the Training Centre and individual problems on which the field staff need help and guidance. Last but not least, it answers enquiries from within and outside the Borough and represents the Medical Officer of Health in dealing with relevant voluntary agencies and central Government departments. The Immediate Future The senior staff of the Mental Health Section were from the beginning only too acutely aware that for the service to function effectively we must provide a full range of services. No effort was spared in an attempt to acquire the supportive mental health establishments, e.g. Hostels, Training and Work Centres. At the time of going to press the following projects were in the varying degrees of completion. These are listed in the order we started to work on them. 63 Junior Training Centre, "Woodbrook", Beckenham. This property is Council owned. We indicated in May, 1965, that we considered it suitable as a Junior Training Centre. Unfortunately, having been advised that the property was suitable for adaptation, we heard eighteen months later that the Ministry would not agree to loan sanction for such adaptation. Work started immediately on planning a purpose-built Junior Training Centre with Kindergarten and Special Care Unit on the site and it is hoped the Centre would open at the end of 1968. Short-Stay Hostel for ex Mentally III, "Rydal Mount", Beckenham. This property is also Borough owned. It was brought to our attention in July, 1965, and appeared to be eminently suitable for use as a small Hostel. Although the property was vacated by the tenant (a Central Government Department) early in 1966. progress, again owing to circumstances beyond our control, was slow, and at the time of writing this report, loan sanction is awaited prior to placing the contract with the buliders. The Hostel should open in the autumn of 1967. Day Centre for ex Menially III, "Stembridge Hall", Penge. This Hall came to our notice in November, 1965, when the Council was considering terminating the tenancy of the Hall by a voluntary body. The Centre will provide work and social rehabilitation for 24 ex mentally ill patients and is due to open in August, 1967. Adult Industrial Rehabilitation I Training Centre, Bromley Work is in progress in establishing such a Centre in the Bromley area which would provide 120 places and the whole range of work/occupation for the subnormal adult at present incapable of open employment. Closing Comments The Annual Report by its very nature must deal with the situation factually and objectively, leaving out the human side. Since it is basically on personal relationships that a community psychiatric service stands or falls, we feel it important to place on record the harmonious working together by the officers of the Section, and the full confidence and courtesy we unfailingly encounter from our colleagues within and outside the Department. 64 Moreover the facts and figures in the Report refer to people and a difference of 1 in the last digit of a figure means that a particular service was either provided or denied. When personal suffering or family hardship is involved, the problem cannot be expressed in terms of arithmetic or statistics. We would therefore like to stress that in spile of the difficulties touched upon at the beginning of the Report, there has been no case where we did not offer community care. On the other hand we were only too aware of the fact that very often what we had to offer was not acceptable and it will be, of necessity, some time before the Mental Health Service is truly adequate. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 66 WORK OF THE PUBLIC HEALTH INSPECTORS J. C. Kermode, m.a.p.h.i., m.r.s.h. Chief Public Health Inspector By January, 1966, the delays and frustrations, inseparable from the early days of the Borough, were largely forgotten. Every effort was made to catch up on arrears of work, to tackle the problems of the present and to prepare for tasks which will have to be undertaken in the future. It is too often forgotten that the work of the section is mandatory. If some new duty is imposed by legislation, or a fresh development arises from a change in Council policy, the existing work cannot be discarded. For instance, no matter how urgent inspections in connection with a particular slum clearance area may appear, they have to take second place to the investigations of an outbreak of food poisoning or a complaint by a ratepayer about a serious public health nuisance. Such matters, and there are many of them, cannot be ignored nor in some cases, left until another day. For a time, some of the routine tasks may receive less attention but this can be only a short-term expedient. If fewer visits are paid to offices, swimming baths or food premises, it becomes only too obvious in a lowering of standards, laboriously built up over the course of years. These standards are designed to protect the health of the public or for the welfare of employees. They are one of the indices by which a Borough may be judged. Even if there is no serious consequence, any significant deterioration is a reflection on the staff and ultimately on the Council. As in 1965 the great problem has been to accomplish the work in the face of staff shortages. At no time was it possible to raise the inspectorate within three of the established number. During the year one of our Student Public Health Inspectors qualified but, unfortunately left the Authority to take up an appointment elsewhere. The establishment of pupils was raised by one making a total of five. Offices, Shops and Railway Premises During the year better progress was made in the initial inspection of offices, shops and railway premises under the Act which came into operation in 1964. At the end of the year 2,278 premises were registered of which 1,245 had been visited. It is known that the owners of a considerable number of businesses have so far failed to apply for registration but systematic inspecting will reveal these. One of the duties placed upon the staff is the investigation of accidents occurring in these premises. Sixty-four 67 were notified during the year. Many of these were of a trivial nature and commonsense advice was given to employers and employees. A more serious type of accident can arise from the failure to install guards on machines such as those used for meat slicing and where necessary these have been required. Food and Food Hygiene The protection of the Borough's food supply has continued to form an important part of the Inspectors work. The district has the widest range of food premises possible. In the Southern part are farms where pigs and poultry are bred and where milk is produced. In this connection frequent samples were taken to exercise proper control and particularly to detect the presence of Brucellosis in dairy herds. In fact, none was confirmed. In the second stage of food protection the Borough has a milk bottling establishment and a slaughterhouse. Although the latter is small, slaughter goes on for six days a week and an inspector has to be constantly available as all meat must be inspected and stamped before it can be released for human consumption. This involved the inspection of 8,697 carcases during the year. Further down the scale the district has its quota of food factories, some of national importance, depots, shops, cafes and canteens. These premises, some 2,038 in all must be inspected and the staff there guided along the recognised practices of food hygiene. A failure at any stage in the progression from farm to home could have serious consequences. That such possibilities exist is indicated by the increased number of complaints concerning food which is out of condition or which was found to contain abnormalities. Most of these are indications that a fault has occurred somewhere along the line. There were 86 complaints and these resulted in proceedings being instituted in 27 cases, all but two being successful. In other instances 42 warning letters were sent to those responsible. Of the prosecutions instituted 13 referred to bread and flour confectionery some of which were mouldy. Foreign bodies varied from oily residues from bakehouse machinery (usually thought to be rodent droppings) to parasite worms in fish. Three related to the sale of milk from dirty bottles and three to mouldy meat pies. The latter are particularly reprehensible as they may indicate a dangerous condition in the meat filling. Almost invariably they result from negligence on the part of the vendor. Articles which should have been sold within two days of receipt are still on sale two weeks after. This situation arises from the inefficiency of staff generally and in particular to the failure to rotate stock which, under modern vending methods, calls for meticulous supervision.. 68 It should not be thought that the examination of particular items of food takes place only when complaints are made. Some 1,109 routine samples have been taken of which 46 were found to be in some degree unsatisfactory. In these cases deficiences were taken up with manufacturers and agreement reached. Amongst the food samples obtained some were examined for the residues of pest control chemicals. If these pesticides should be present beyond a certain minimum they can be dangerous to health. This work was carried out as part of a survey undertaken by other London Boroughs, and no undue concentrations were detected. Chaffinch Brook By a considerable number of ratepayers 1966 will be remembered as the year during which the appalling nuisance arising from the malfunctioning of the Sewage Works of an adjacent authority was largely abated. Since the last war this antiquated and dilapidated installation had given rise to an increasing number of justified complaints from persons living in the vicinity of the plant and along the banks of the Chaffinch Brook into which it discharged a heavily polluted effluent. Not only was the smell intolerable but the frequent flooding of the stream into gardens and even houses left a layer of diluted sewage when the water subsided. Constructional works leading to the virtual cessation of sewage treatment at South Norwood were completed and a massive project by the Greater London Council will deal with the River Ravensbourne and obviate flooding. As to the future, the section is likely to be involved more and more in the all important question of housing. The redevelopment of Penge and North-west Beckenham is likely to proceed with quickening pace. We are involved in three important aspects of this venture. Firstly, Public Health Inspectors will be in the spearhead, as the first stage must be clearance of existing slums. Secondly, the establishment of proper standards in houses let in multiple occupation for it is in these large old buildings that the lowest standards of all are to be found. Although such houses are scattered throughout the Borough, and a departmental estimate puts the total figure at over 5,000, there is a particularly bad concentration of such houses in Penge. The abatement of overcrowding and the provision of a sufficiency of essential facilities is urgent. The third, and by no means the least important feature of housing, is the improvement, with the aid of a grant, of those dwellings which, although lacking certain amenities, are, nevertheless, structurally sound and will constitute an important part of the 69 Borough's stock of dwellings for at least two or three decades. Again, it is estimated that they total over 5,000 and Penge has its share. Before closing I must record my sincerest thanks to my deputy, my Divisional Officers, the District Inspectors and the administrative staff. Without their unqualified assistance the limited progress made could not have been accomplished. I would also place on record the unfailing advice and support I have received from the Medical Officer of Health, his Deputy and the Chief Administrative Officer. INSPECTION AND SUPERVISION OF FOODS Routine sampling of food is a constant process, with the object of obtaining a representative cross section of the foods on sale to the public. All such samples were submitted to a Public Analyst for examination. Some technical infringements were found and were drawn to the attention of manufacturers. There were, however, no instances of adulteration. Specimens of liquid frozen egg used in the bakery trade were tested for the presence of food poisoning organisms and raw milk was examined for the presence of the bacillus giving rise to the disease Brucellosis. All these specimens gave satisfactory results. As part of a survey in collaboration with other London Boroughs, samples of foodstuffs were examined for the presence of residual pesticides. Details of these samples are shown separately on page 71. FOOD AND DRUGS ACT, 1955 FOOD SAMPLING Letters in parentheses are referred to on page 72. Article No. Examined No. Unsatisfactory Formal Informal Formal Informal (h) Baby Food - 8 - 4 Beer — 6 — — (x) Biscuits — 4 - 1 (i) Bread and Bread Rolls — 15 — 13 Bread Sauce Mix — 1 - - (w) Butter — 9 — 1 (q) Butter (Cumberland Brandy) — 1 — 1 (p) Butter (Rum Flavoured) — 1 — 1 (n) Cake — 15 — 4 Cake Decorations — 2 — — (o) Cereal and Cereal Products — 16 — 2 70 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal Cheese and Cheese Products - 11 - - Chocolate Confectionery — 4 - 1 Christmas Pudding — 1 - — Chutney — 1 - — Coffee and Chicory Essence — 2 - — Coffee Extract — 2 - — Colouring Matters — 2 - — Cream — 19 - — Cream Spread — 1 - — Curds — 3 - — (j) Currant Bun — 1 - 1 Custard Powder — 3 - — (z) Custard Tart — 1 - 1 Dehydrated Vegetables — 5 - — Dessicated Coconut — 3 - — Dried Fruit — 15 - — (1) Drugs — 18 - 2 Eggs — 1 - — (v) Fish and Fish Products (including tinned fish) — 14 - 1 Flavouring Essence — 3 - — Flour (including self-raising) — 6 - — (f) Fruit and Fruit Products (including tinned fruit) - 51 - 4 Fruit Lolly — 1 - — Fruit Topping — 2 - — Gelatine — 2 - — Gravy Salt — 1 - — Ground Almonds — 5 - — Honey — 3 - — Ice Cream — 11 - — Ice Cream Powder — 3 - — (e) Jam — 6 - 1 Jelly — 11 - — Lard — 2 - — Lemon Pie Filling — 1 - — Lolly Mix — 1 - — Margarine — 8 - — Marzipan — 2 - — (a) Meat Products (including tinned meat) - 76 - 5 (d) Milk and Milk Bottles — 81 - 13 Milk Drink — 1 - - Milk Pudding - 7 - — Oils and Fats - 8 - - (m) Pastes - 35 - 2 Pease Pudding - 1 - — Pickles and Sauces — 24 - — (c) Poultry and Poultry Products - 14 - 4 (t) Pudding and Cake Mixtures - 6 - 1 Puff Pastry - 1 - — Raw Vegetables - 4 - — Rennet Essence — 1 - — Rose Hip Syrup — 1 - — Saccharin Tablets — 1 - — Sage and Onion Stuffing — 2 - — Salad Cream — 2 - — 71 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal (b) Sausages and Sausage Meat 3 58 3 10 (*) Soft Drinks — 28 — — Soft Drink Powder — 2 — - Soups — 5 — — (k) Spices — 24 — 4 Suet — 3 - - Sugar and Sugar Products — 5 - — (y) Sweets — 15 - 1 Tea — 7 - — Tomato Puree — 4 - — (g) Vegetables (Tinned) — 18 - 4 Vegetable Shortening — 1 - — Vinegar — 5 - — Yeast — 1 - — Yoghourt - 5 - — TOTALS 3 750 3 83 The undermentioned food stuffs were examined for the presence of residual pesticides:— Article No. Examined No. Unsatisfactory Formal Informal Formal Informal[/##] Apples - 1 - - Baby Foods — 7 — — Braising Steak — 1 — — (s) Bread — 5 — 1 Canned pilchards — 1 — — Canned Vegetables — 6 — — Custard Powder — 1 — — Dehydrated Vegetables — 1 — — (r) Dried Fruit — 4 — 1 Eggs — 1 — — Flour — 2 — — Horseradish Relish — 1 — — Lambs Liver — 1 — — Margarine — 1 — — Pickled Beetroot — 1 — — Tapioca — 1 — — Vegetables (Raw) — 3 — — TOTALS — 38 — 2 72 Nature of Unsatisfactory Sample. Remarks Serial No. 0334. Ham Sandwich. (a) Composition: Associated with but separate from the portion of ham sandwich were portions of two small adhesive dressings. The two dressings were one on top of the other and adhering to each other. In each case the protective layer had been removed and the condition suggested in each case that the dressing had been used and been in contact with the ham Reported to Committee. Vendors warned. Serial No. 0323. Polony. (b) Composition: Meat content 51%. The proposed sausage regulations call for not less than 65% meat for this product. Formal sample being taken. Serial No. 0324. Chicken Croquette. (c) Composition: Meat 31%. A reasonable standard for a croquette is not less than 35% meat. Correspondence with Manufacturers. Serial No. 0169. Milk containing foreign matter. (d) Composition: The inner surface of the pint bottle was soiled on the base and side by patches of a hardened sand cement mixture. Matter investigated and reported to Committee. No further action. Serial No. 0249. Milk containing foreign matter. (d) Composition: The inner surface of the glass of the pint milk bottle was soiled down one side by a brownish discolouration. This discolouration consisted of a film of denatured milk containing a small amount of vegetable debris. Legal proceedings. Vendor fined £15 with £5 19s. Od. costs. Serial No. 1193. Milk containing foreign matter. (d) Composition: Small fungal growths on the inner surface of the base of the pint bottle. Insufficient evidence for legal proceedings. Serial No. 0216. Instant Low Fat Milk (Skimmed). (d) Composition: The moisture figure (6.6%) is higher than desirable, 5% being a reasonable minimum. Correspondence with Manufacturers. Serial No. 0382. Instant Low Fat Milk (Skimmed). (d) Composition: Moisture 5.8%, Lactic Acid 1.3%, Solubility 99.8%, Fat 1.0%. The moisture content exceeds the maximum (5%) permitted by the Dried Milk Regulations. The declaration although containing the information required by the regulations is not in the form required as to type and exclusion of other matter. Correspondence with Manufacturers. 73 Nature of Unsatisfactory Sample. Remarks Serial No. 0363. Gooseberry Jam. (e) Composition: The fruit is Cape Gooseberry and not Gooseberry as known in this country. The description is therefore misleading. Serial No. 969. Canned Peaches. Correspondence with Manufacturers. (f) Composition: Adhering to the inner surface of the can was the thorax, wings and parts of the legs of a hymenopterous insect, possibly a bee. Tests indicated that the insect had undergone heat treatment. Serial No. 1050. Remains of tinned Cherries. Reported to Committee. Matter drawn to the attention of exporting country (S. Africa). (f) Composition: The lepidopterous larva was found to be dyed with Erythrosine, the same permitted dye as had been used for the Cherries. Serial No. 1192. Tin of Carrots. Reported to Committee. Matter drawn to the attention of exporting country (Italy). (g) Composition: Floating on the surface of the liquid in the can was a patch of mould growths approximately 2 in. in diameter, mould spores having gained access through pin holes in the lid. These holes had developed due to local rusting on the can exterior. Serial No. 0182. Tin of beans. Reported to Committee. Proceedings instituted. Producers fined £10 with 10 gns. costs. (g) Composition: Associated with the open can of beans was an earthworm. Examination showed that the worm had undergone a heating process and bean structures were found adhering to its body. Serial No. 0356. Mixed Cereals for Babies. Proceedings instituted. Manufacturer fined £10 plus £25 5s. Od. costs (See also 1965 Report.) (h) Composition: Rice—Aldrin 0.02 p.p.m. Groats and Mixed Cereal Pesticides not detected It is desirable that baby foods should be completely free of pesticide residues. Serial No. 0290. Bread. Correspondence with Manufacturers. (i) Composition: the foreign body in the crumb of the slice was a fragment of charred dough. Serial No. 0205. Bread. Investigated and reported to Committee. Bakers warned. (i) Composition: The crumb of the loaf shows a streak of discolouration extending approximately half the length of the loaf. The soiled area contains iron and mineral oil. Proceedings instituted. Manufacturers fined £5 5s. 0d. with £6 19s. 0d. costs. 74 Nature of Unsatisfactory Sample. Remarks Serial No. 0228. Bread. (i) Composition: Embedded in the crumb of the slice of white bread is the somewhat mutilated body of a winged insect. Its position in the crumb indicated that it had been baked in the loaf. Serial No. 0227. Bread. (i) Composition: Contained a dark fragment measuring approximately 0.3 by 0.2 in. It consisted of dough soiled by iron and mineral oil, doubtless derived from the bakehouse machinery. Serial No. 0354. Bread Roll. (i) Composition: Partly embedded in the edge of the lower half of the bread roll was a two-inch length of cotton material. The upper half of the roll showed a cavity from which the material had been withdrawn and both the cavity and fibres were soiled by discoloured dough containing mineral oil and iron. Investigated and reported to Committee. Bakers warned. Investigated and reported to Committee. Bakers warned. Proceedings instituted. Manufacturer fined £30 with £5 19s. 6d. costs. Serial No. 0226. Currant Bun. (j) Composition: Associated with but separate from the parts of the bun were two intertwined iron wires 2.7 in. long to which crumb was adherent. Also present were two small "twists" of a plastic film approximately 1/1 Oth in. in diameter and again crumb was adherent. investigated and reported to Committee. Packers warned. Serial No. 0246. Ground Cloves. (k) Composition: Volatile oil 7.0 v/w. The B.P.C. calls for not less than 12. Correspondence with Manufacturers. Serial No. 1041. Strained Egg Custard with Rice. (h) Composition: The contents of the can had soured causing a separation of the milk proteins. Examination of the can failed to disclose any fault but the opening may have masked previously existing faults. Bacteriological examination did not show heavy growths but the can may have as directed been placed in boiling water before opening, rendering it sterile. Matter investigated and reported to Committee. Manufacturers warned. Serial No. 0306. Soluble Aspirin Tablets B.P. (1) Composition: Aspirin 310/mg./tabl. free salicylic acid is in excess of that allowed by the B.P. Correspondence with Manufacturers. 75 Nature of Unsatisfactory Sample. Remarks Serial No. 0307. Calcium Drink with Vitamin C. (1) Composition: Calcium 607 mg./oz. Vit. C. 175 mg./oz. Cyclamic Acid 220 mg./ oz. The use of cyclamates in foods other than soft drinks is not permitted. No action. Serial No. 0635. Metal found in Corned Beef. (a) Composition: The metallic fragment from the can of corned beef consisted of ferrous metal turning. Warning letter to Importers. Serial No. 0398. Pork Chipolatas. (b) Composition: Meat 63% including 28% fat. Total meat slightly below the acceptable minimum of 65%. Repeat sample satisfactory. Serial No. 0593. Pork Chipolatas. (b) Composition: Meat 61% including 24% fat. Total meat slightly below the acceptable minimum of 65%. Repeat sample satisfactory. Serial No. 0415. Pork Chipolatas. (b) Composition: Meat 61% including 28% fat. Total meat slightly below the acceptable minimum of 65%. Correspondence with Manufacturer. Satisfactory. Serial No. 0556. Beef Sausage Meat. (b) Composition: Meat 45% including 18% fat. Meat content slightly below acceptable minimuirt of 50%. Repeat formal sample. Serial No. 0513. Polony. (b) Composition: Meat 47% including 23% fat. Proposed Regulations call for not less than 65% meat. Analyst advises against statutory action. Serial No. 0514. Frankfurters. (b) Composition: Meat 71% including 11% fat. Proposed Regulations call for not less than 80% meat. Analyst advises against statutory action. Serial No. 427. Frankfurters. (b) Composition: Meat 70% including 9% fat. Proposed Regulations call for not less than 80% meat. Repeat formal sample. Serial No. 0618. Boned Chicken. (c) Composition: Chicken 80%. Label gives impression that the product is Boned Chicken rather than Boned Chicken in Chicken Jelly which carries a lower meat content. Correspondence with Manufacturers satisfactory. 76 Nature of Unsatisfactory Sample. Remarks Serial No. 0599. Crab Spread with Butter. (m) Composition: Crab 83%, butter fat 4.5%. The proposed Fish and Meat Paste Regulations call for not less than 6% butter fat in this product. Correspondence with Manufacturers. Will comply with proposed Regulations when promulgated. Serial No. 0610. Pasteurised Milk. (d) Composition: Failed the Methylene Blue Test. 2heck with suppliers — Satisfactory. Serial No. 0471. Milk (Dirty Bottle). (d) Composition: Contained mould growth on inner surface. Warning letter to Dairy Company. Serial No. F.C.98. Milk (Dirty Bottle). (d) Composition: Contained three foreign bodies—(a) a seed of one of the compositae, (b) a small tea leaf fragment, and (c) a dark irregularly shaped object about 1 mm. in diameter which contained mould hyphae and plant fragments. Warning letter to Bottlers. Serial No. F.C.108. Milk (Dirty Bottle). (d) Composition: Contained mould growths on inner surface. No action. Unable positively to ascertain origin of bottle. Serial No. 0534. Foreign matter in tin of Gooseberries. (f) Composition: The foreign matter consisted of 2 dry peas, 1 dry haricot bean and 1 small fragment of porous stone. The peas gave negative reactions for phosphatase enzyme, would not grow but did not contain an unusual amount of sugar. The bean, like the peas, was not viable. The porous stone which measured 0.3 by 0.4 in. was saturated with sugar. The overall picture was inconclusive in that some findings suggested immersion of the foreign bodies in the can during processing whereas others did not. Warning letter to Canners. Serial No. 0473. Canned Whole Beans. Composition: The can was blown due to hydrogen swell, the internal lacquering having deteriorated. Stock withdrawn from sale. Serial No. 0533. Bread. (i) Composition: Areas of the crumb soiled by mineral oil containing iron. Prosecution. Vendor fined £30 with 10 gns. costs. 77 Nature of Unsatisfactory Sample. Remarks Serial No. 0657. Bread. (i) Composition: Areas of the crumb soiled by mineral oil containing iron. Prosecution. Vendor fined £30 with 10 gns. costs. Serial No. F.C.107. Bread. (i) Composition: The foreign body in the crumb of the loaf consisted of a dried currant. Manufacturers notified. Serial No. 0636. Swiss Roll—Chocolate Sponge. (n) Composition: Contained mould growths. Warning letter to Retailer. Serial No. 0492. Sugar Puffs. (o) Composition: Contained a live moth larva and a fragment of intertwined vegetable fibre measuring approximately 0.4 by 0.2 in. This latter was covered with a layer of charred organic matter. Warning letter to Manufacturers. Serial No. 0429. Rum Flavoured Butter. (p) Composition 1.3% proof spirit. In view of description "rum flavoured" an alcoholic strength of between 1.5 and 2.0 proof would be reasonable. Correspondence with Manufacturers. Satisfactory. Serial No. 0629. Cumberland Brandy Butter. (q) Composition: 0.9% proof spirit. An acceptable alcohol content for this product is between 1.5 and 2.0 per cent. proof spirit. Correspondence with Manufacturers. Satisfactory. Serial No. 0721. Pork Luncheon Meat. (a) Composition: It was confirmed that the contents had an abnormal smell—tainl rather than decomposition. A screw fragment found in the can was of ferrous metal galvanised. Matter raised with embassy of country of origin. Serial No. 0786. Fly Eggs in Streaky Bacon. (a) Composition: Infested by numerous blow fly eggs. Warning letter. Serial No. 0723. Sausage. (b) Composition: The maggot associated with the sample was the maggot of a dipterous fly and probably not more than 24 hours old. Attention of manufacturers and retailer drawn to occurrence. 78 Nature of Unsatisfactory Sample. Remarks Serial No. 0659. Sausage. (b) Composition: Contained a piece of cloth 2} in. by 1¼ in. Proceedings. Manufacturer fined £25 with £7 7s. 0d. costs. Serial No. 0707. Steak and Kidney Pudding. Composition: Meat 23%. Acceptable minimum 25%. Correspondence with Manufacturer. Satisfactory. Serial No. 0663. Chicken Croquette. (c) Composition: Meat 39%. Contained beef as well as chicken. Would more appropriately be described as Chicken and Beef Croquette. Correspondence with Manufacturers. Satisfactory. Serial No. 0734. Apricots. (r) Composition: Pesticides: Dieldrin 0.01, TDE 0.01, DDT 0.3 p.p.m. The DDT content higher than desirable. Correspondence with Wholesaler. Serial No. 0733. Small Wholemeal Brown Loaf. (s) Composition: Pesticides: BHC 0.01, DDD 0.01, DDT 0.15 p.p.m. DDT content higher than desirable. Correspondence with Manufacturers. Serial No. 0700. Bread. (i) Composition: Contained a cylindrical piece of foam rubber, approximately 2 in. long and ½ in. in diameter. Proceedings. Bakers fined £35 with £11 14s. 6d. costs. Serial No. F.C.I21. Bread. (i) Composition: Soiling of the crumb due to the presence of iron and mineral oil. Proceedings. Bakers fined £20 with £5 19s. 6d. costs. Serial No. 0722. Bread. (i) Composition: Contained a rust flake. Warning letter to Baker. Serial No. 0687. Chocolate Sponge Mix. (t) Composition: Sugar 51%. This was the major ingredient and should be first in the list of ingredients. Correspondence with Manufacturer. Label corrected. Serial No. F.C.I28. Hazelnut Milk Chocolate. (u) Composition: Associated with the portion of the chocolate fat were two shed larval skins of dermested beetles. Warning letter to Manufacturers, Wholesaler and Retailers. Serial No. 0673. Ground Cinnamon. (k) Composition: Volatile Oil 0.6%. B.P. requires 0.7%. Correspondence with Manufacturers. 79 Nature of Unsatisfactory Sample. Remarks Serial No. 0936. Pate de Foie. (m) Composition: Meat 85%. List of ingredients are given only in foreign languages. Correspondence with Wholesalers. Withdrawn from sale. Serial No. 0802. Pork Chipolatas. (b) Composition: Lean meat 26%, fat 39%. Fat reckoned as meat only up to 50% of the total meat content by weight. On this basis the meat content of the sample is 52% which is below the required standard of 65% for pork sausages. Correspondence with Manufacturers. No further action. Serial No. 0856. Pork Chipolatas. (b) Composition: Lean meat 26%, fat 39% Fat reckoned as meat only up to 50% of the total meat content by weight. On this basis the meat content of the sample is 52% which is below the required standard of 65% for pork sausages. Correspondence with Manufacturers. No further action. Serial No. F.C.I44. Pork Sausages. (b) Composition: Contained a flake of paint 5 mm. by 4 mm. by 0.5 mm. Warning letter to Manufacturers. Serial No. 0801. Chicken Croquette. (c) Composition: Meat 36% included beef therefore should be described as Chicken and Beef Croquette. Correspondence with Manufacturers in progress. Serial No. 0831. Fish Sticks. (v) Composition: Contained two worms of the Nematode group. Matter investigated. No further action. Serial No. F.C.146A. Bottle of Milk. (d) Composition: Mould growths present. No further action. Serial No. F.C. 146B. Bottle of Milk. (d) Composition : Contained 15 pupa cases of a dipterous fly, possibly of a species of Drosophila. Proceedings. Vendor fined £10 with 10 gns. costs. Serial No. 0896. Bottle of Milk. (d) Composition: Mould growths present. Warning letter to Bottlers. Serial No. 0913. Bottle of Milk. (d) Composition: Contained 17 pupal cases of a dipterous fly. They had undergone heat treatment. Proceedings. Vendor fined £40 with £6 14s. 6d. costs. 80 Nature of Unsatisfactory Sample. Remarks Serial No. 0901. Butter. (w) Composition: Moisture 17.1%, should not exceed 16.0%. Serial No. 0799. Fruit Salad in Syrup. (f) Composition: List of ingredients not in correct order. Correspondence with Manufacturers. Satisfactory. Correspondence with Manufacturers. Satisfactory. Serial No. 0897. Tin of Peeled Tomatoes containing Worm. (g) Composition: Contained a small earthworm. It had not been heat treated. No action. Serial No. 0895. Bread. (i) Composition: Contained mould hyphae. Warning letter to Bakers. Serial No. 0940. Farmhouse Loaf. (i) Composition: Foreign matter consisted of "bakehouse char". Warning letter to Bakers. Serial No. 0830. Chocolate Biscuits. (x) Composition: Contained bread beetles and the biscuits were also heavily infested with the larvae of these beetles. Warning letter to Retailer. Serial No. 0938. Cake. (n) Composition: Mould growths present. Warning letter to firm concerned. Serial No. 0797. Fondant Dips. (y) Composition: Mould colonies present. Warning letter to firm concerned. Serial No. 0845. Chocolate Sponge Sandwich Cake. (n) Composition: Contained a piece of open weave cotton fabric 2 in. by 5/8 in. Particles of marzipan firmly adherent to the fabric indicated that it was in the marzipan layer of the cake. Proceedings instituted. Baker fined £20 with 5 gns. costs. Serial No. 0939. Bath Bun. (n) Composition: Contained a tangled length of string or course yarn, partly embedded in the cooked dough. Proceedings instituted. Baker fined £20 with 10 gns. costs. Serial No. F.C.I50. Remains of Custard Tart. (z) Composition: Contained a match stick. The food adherent to it is pastry rather than custard. Proceedings instituted. Baker fined £25 with 5 gns. costs. 81 Nature of Unsatisfactory Sample. Remarks Serial No. 0829. Mixed Cereal for Babies. (h) Composition: Mould growth of the penicillium type. Warning letter to Retailers. Serial No. 0828. Fruesli. (o) Composition: Contained "webbing" associated with infestation by insect larvae but no actual larvae were found. The packet appeared to be undamaged and it is possible that infestation occurred in one of the ingredients and that the insects had left before the material was mixed and packed. Warning letter to Manufacturers. Serial No. 0832. Orange Squash. (*) Composition: Contained a mass of mould hyphae. Bottlers fined £20 with 12 gns. costs. Serial No. 0814. Ground Cloves. (k) Composition: Volatile Oil 4.3%; should contain not less than 12% v/w. Correspondence with Manufacturers. Satisfactory. Serial No. F.C.I48. Pickling Spice. (k) Composition: Infested by bread or drug store beetle. Warning letter to Importers and Packers. Serial No. F.C.I55. Heinz Junior Fruit Dessert. (h) Composition: Mould growths present. Warning letter to Manufacturers. Unsound Food A total of 16 tons 4 cwt. 38 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 15 86 Meat at wholesale premises 2 12 — Meat at retail shops — 8 17 Cooked meat and meat products - 1 20 Canned meat - 15 74 Fish 1 6 90 Fruit and vegetables 4 14 88 Other foods 1 9 111 714 Certificates were issued. 82 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken with the following results :— Satisfied Failed Phosphatase Test 125 2 Methylene Blue Test 138 8 Turbidity Test 3 - Ring Test 45 - The tests were applied for the following purposes:— Phosphatase Tests 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 55 samples were taken during the year with the following results :— Grade 1 46 Grade II 7 Grade III 2 Grade IV - Further samples were obtained from the suppliers whose products had given Grade III results. These further samples were found to be satisfactory and were classified as Grade I. SUNDRY BACTERIOLOGICAL EXAMINATIONS 60 Empty milk bottles were sub- All were found satisfactory, mitted at intervals during the year to bacteriological examination directly following their treatment by the bottle washing machine of a local milk bottling plant. 6 Samples of Frozen Egg (3 of All were found satisfactory—no whole frozen eggs and 3 of pathogenic organisms being frozen egg white) were exam- isolated, ined. 83 372 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 Organisms isolated Shigella Sonne organisms isolated 22 44 MEAT INSPECTION Annual licences were granted to six 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 66 35 2427 4554 1615 Number not inspected NIL NIL NIL NIL NIL All diseases except Tuberculosis and Cysticerci Whole carcases condemned 2 - 9 32 12 Carcases of which some part or organ was condemned 11 12 40 972 224 Tuberculosis only Whole carcases condemned - — — - - Carcases of which some part or organ was condemned - - - - 10 Cysticerci Carcases of which some part or organ was condemned - - - - - Carcases submitted to refrigeration - - - - — Generalised and totally condemned — — — — — Approved charges totalling £278 8s. Od. were made for the inspection by Public Health Inspectors of the carcases shown in the above table. 84 FOOD COMPLAINTS Eighty-six complaints were received concerning the sale of food which was alleged to contain extraneous matter, or to be in a decomposed or mouldy condition. All complaints of this nature are very fully investigated by the Public Health Inspectors and detailed reports are submitted to the Environmental Health Sub-Committee whose members give careful consideration to each case in order to determine the appropriate action which should be taken. In order to present fair and accurate reports complainants are closely questioned, it being found that they are sometimes genuinely mistaken in their original statements. Shopkeepers and food manufacturers are interviewed and their premises and stocks inspected to ascertain the point at which the trouble may have arisen. Specimens are submitted to the Public Analyst to determine the nature of extraneous matter. Where necessary the assistance of Inspectors is called upon in areas, outside that of the London Borough of Bromley, where the food was prepared or stored. The complaints may be classified as under:— Alleged condition Foreign Bodies, Dirty, etc. Mouldy Other Condition Bread and flour confectionery 11 15 - Tinned foodstuffs 7 2 3 Perishable articles (pies, sausages, etc.) 5 7 2 Milk and milk bottles 10 — — Chocolate confectionery 2 — — Cereals 11 1 — Miscellaneous 7 2 1 Not all of these complaints were justified, some articles being kept overlong by the complainants, whilst there were other instances where complaints regarding the smell, appearance or taste of articles arose from the complainants being unfamiliar with the natural condition of the foodstuffs in question. One complaint concerned the alleged presence of an insect in tinned tomatoes; investigation proved the insect had not been subjected to any form of heat treatment and must therefore have gained access to the tomatoes after the tin had been opened. As shown in the above table the majority of complaints concerned bread and flour confectionery. The articles found in loaves, 85 etc., being metal screws, pieces of metal, grease from machinery, a piece of string and portions of burnt crust. The presence of mould was mainly found in sliced loaves. Complaints regarding milk were all concerned with the internal staining of the bottles from various causes. The presence of mould and decomposition in perishable articles such as meat pies and sausages usually indicates prolonged and possibly unsuitable storage. The Inspectors therefore lose no opportunities of impressing upon shopkeepers the need to dispose of such goods rapidly and to maintain a strict system of inspection and turnover. During 1966 it was found necessary to institute proceedings as shown below:— Prosecutions Fined Costs Bath Bun (Foreign matter) Manufacturer £20 £10 10s. 0d. Bread (Foreign matter) Manufacturer 5 gns. £6 19s. 6d. Bread (Foreign matter) Manufacturer £30 £5 19s. 6d. Bread (Foreign matter) Manufacturer £10 £10 10s. 0d. Bread (Foreign matter) Manufacturer £30 £10 10s. 0d. Bread (Foreign matter) Manufacturer £30 £10 10s. 0d. Bread (Foreign matter) Manufacturer £20 £5 5s. 0d. Bread (Foreign matter) Manufacturer £35 £11 14s. 6d. Cake (Foreign matter) Manufacturer £20 £5 5s. 0d. Custard Tart (Foreign matter) Manufacturer £25 £5 5s. 0d. Chocolate covered cakes (Mould) Vendor £10 £10 10s. 0d. Crumpets (Mould) Shopkeeper £10 £5 5s. 0d. Fruit Pie (Mould) Manufacturer £15 £7 7s. 0d. Milk (Foreign matter) Dairy £15 £5 19s. 6d. Milk (Foreign matter) Dairy £10 £10 10s. 0d. Milk (Foreign matter) Dairy £40 £6 14s. 6d. Orange Squash (Mould) Manufacturer £20 £12 12s. 0d. Pork Pies (Mould) Manufacturer £8 £5 5s. 0d. Sausage (Foreign matter) Manufacturer £25 £7 7s. 0d. Steak & Kidney Pie (Foreign matter) Manufacturer £20 £15 15s. 0d. Steak & Kidney Pie (Mould) Shopkeeper £5 £3 3s. 0d. Steak & Kidney Pie (Mould) Shopkeeper £10 £5 5s. 0d. Tinned Carrots (Foreign matter) Manufacturer £10 £10 10s. 0d. Tinned Vegetables & Bacon (Decomposition) Manufacturer 5 gns. £3 3s. 0d. Yoghourt (Mould) Shopkeeper £20 £15 15s. 0d. Sausages (Mould) Shopkeeper Case dismissed Party Pie (Mould) Shopkeeper Case dismissed 86 FOOD PREMISES There are some 2,038 food premises in the area, made up as follows :— Premises Total Bakers and Bakehouses 123 Butchers 196 Confectioners 308 Dairies/Grocers 132 Clubs and Hotels 48 Chemists 78 Fishmongers (Wet, Dried and Fried) 85 Greengrocers 203 Grocers 311 Hospitals, Nursing Homes and Old People's Homes 104 Industrial Canteens 117 Off Licences 61 Public Houses 143 School Canteens and Serveries 104 Stalls 25 FOOD AND DRUGS ACT, SECTION 16 Number of Food Premises registered under the above- mentioned Act for:— (a) Sale or manufacture for purposes of sale of ice-cream or the storage of ice-cream intended for sale 844 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 264 MILK (SPECIAL DESIGNATIONS) REGULATIONS Licences to deal in specially designated milks were currently held as under :— Dealers (Pasteurisers) Licences 1 Pasteurised 132 Sterilised 93 Ultra Heat treated 23 Untreated 53 87 FOOD HYGIENE The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations became operative during the year. By and large they bring food stalls and mobile shops into line with factories and food shops. They require, for instance, the provision of wash basin with hot water on stalls and vehicles from which "open food" is sold; control of temperatures at which food containing meat, etc. may be kept; the manner in which meat may be transported and the precautions to be taken against contamination of food whilst on sale from stalls. These Regulations also give some control over food vending machines. There are two markets in the area as well as a number of other scattered food stalls, itinerant food selling vehicles and numerous delivery vans, some firms owning large fleets. A start has been made on inspecting and checking these stalls and vans and, so far as the staff position has allowed, the established food premises have also been kept under observation. Over 3,000 visits were made, 333 infringements being found. Informal written notices were served as necessary. Food traders generally have been co-operative and have complied with verbal requests for modifications and improvements. It has not been necessary to institute any legal proceedings. It is becoming obvious that the critical factor in food hygiene is not the premises but the personnel. The large labour force required and the quality of that available, the level of intelligence, skills and efficiency, and the diversity of foods now being served are all factors which determine the standards of food hygiene. Present trends may, in time, produce higher standards, merely by reducing the number of workers. Developments in food technology are taking the preparation of food out of the kitchen to the factory production lines: operations on a large scale make possible efficient management and supervision. Big reductions in the numbers employed should make a better selection of workers possible and ensure that much of the on-the-job training is not wasted, as it is at present with the enormous labour turnover. Pre-portioned meats, peeled vegetables, prepared meals and frozen foods, all make food service relatively simple and obviate spillage, fat splashing, greasy equipment, floors, etc. RAG FLOCK ACT AND OTHER FILLING MATERIALS ACT, 1951 This Act provides standards of cleanliness in respect of specified filling materials used in connection with upholstery, soft furnishings, pillows, etc. Premises where such materials are manufactured, or used or stored, are required to be licensed by the Local Authority, and provision is made for samples of filling 88 materials to be taken either from stocks of such materials or by opening up any finished article containing filling materials. Samples of the undermentioned filling materials were taken and submitted for analysis and were all found to be of a satisfactory standard :— Algerian Fibre. Rag Flock—layered. Feathers—contents of pillows. Cotton flock—contents of pillows. HOUSING AND SLUM CLEARANCE Of the 1965 programme, the 36 houses in Woodbine Grove were inspected at the end of 1965, and as a result the following Clearance Areas were represented in 1966 :— Woodbine Grove (1966) Clearance Area No. 1.—Nos. 8 & 10. Woodbine Grove (1966) Clearance Area No. 2.— Nos. 37, 39, 41 & 43. Woodbine Grove (1966) Clearance Area No. 3.—Nos. 49 & 51. Woodbine Grove (1966) Clearance Area No. 4.—Nos. 55 & 57. A compulsory Purchase Order was made in relation to these houses, and objections being received, a Public Enquiry was held in January, 1967, the result of which has not yet been received. Numbers 2 & 17 Woodbine Grove were represented as Individual Unfit Houses, but Demolition Orders were not made. Compulsory Purchase Orders were made in respect of:— Laurel Grove—Nos. 14-20, 26-48, 52-64 (even inclusive). Woodbine Grove—Nos. 5-19, 23-35 (odd inclusive), 45, 47, 53; 2, 4 & 6. Oakfield Road—Nos. 48-84, 92-100 (even inclusive). Hawthorne Grove—No. 1. Woodbine Terrace—Nos. 1 & 3. These Compulsory Purchase Orders take in the houses in Woodbine Grove not represented as unfit. Objections being made, a Public Local Enquiry is to be held in August, 1968. The 1966 programme of Slum Clearance inspection was adhered to and the following Clearance Areas were represented :— Thicket Grove, Anerley, Clearance Area 1966—Nos. 2-10 (even inclusive); 1-9 (odd inclusive). Arpley Road, Penge, Clearance Area 1966—Nos. 16-62 (even inclusive); 31, 33, 51-57 (odd inclusive). The remaining houses in Arpley Road and Thicket Wood Chambers are owned by the Council. 89 Since the end of the year the occupants of Thicket Wood Chambers have been rehoused, and demolition is in progress. Objections to the Compulsory Purchase Order on Thicket Grove have been made and a Public Local Enquiry is to be held in August, 1968. The Slum Clearance programme of the former Penge Urban District Council further progressed and additional houses in Hawthorne Grove—Nos. 2-26 (even inclusive) were demolished. Demolition Orders were made in respect of :— Nos. 20, 22 and 24 Cherry Orchard Road, Bromley, which were dealt with although not in the programme for the year. A Demolition Order was made in 1965 in respect of :— No. 47 Jasmine Grove, Penge, S.E.20—this property was demolished during 1966. Closing Orders were made in respect of basements at:— 17 and 19 Derwent Road, Anerley, S.E.20. The following basements were represented during the year for Closing Orders :— 61 Selby Road, Penge, S.E.20. 67 Anerley Road, Anerley, S.E.I9. 90 Belvedere Road, Upper Norwood, S.E.19. 17 Mosslea Road, Penge, S.E.20. A Closing Order made by the former Penge Urban District Council in respect of 69A Church Road, Upper Norwood, S.E.19, was determined, work having been satisfactorily carried out and the premises rendered fit. RE-HOUSING The following information has been supplied by the Housing Manager:— Prior to 1966 During 1966 Houses Families in occup. Houses Families in occup. Permanent dwellings built by Local Authority 9,144 9,144 192 192 Prefabricated dwellings built by Local Authority 875 875 Nil Nil During 1966 there were 309 vacancies. During 1966, 326 families were housed from the waiting list in permanent accommodation. The total number of families on the waiting list as at 31st December, 1966, was 3,872. During the same period 129 temporary bungalows were demolished and the tenants were transferred to permanent accommodation. 90 HOUSING (A) Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices :— Sections 9,10 and 16, Public Health and Housing Act 1957 similar Local Acts Totals Informal Formal Informal Formal Informal Formal By owner 517 20 204 24 721 44 (B) Beyond repair—Housing Act, 1957 1. No. of undertakings accepted (section 16) Nil 2. „ closing orders made (section 17) Nil 3. „ demolition orders made (section 17) Nil 4. „ closing orders made (section 18) 2 5. „ closing orders determined (section 27) Nil 6. „ closing orders revoked and demolition orders substituted (section 28) Nil 7. „ houses demolished following demolition orders Nil (C) Clearance Areas (1) Represented during Year: 1. Number of Areas 6 2. Houses unfit for human habitation 50 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 190 (b) Families 78 (2) Action taken during Year: 1. Houses demolished by Local Authorities or Owners: (a) Unfit 13 (b) Others — 2. Numbers of people displaced: (a) Individuals 101 (b) Families 21 Improvement Areas—Housing Act, 1964 Areas surveyed - Areas declared - Dwellings outside improvement areas Number of representations made by tenants 8 91 Improvement Grants (I) Standard Owner I occupier Tenanted Number of Applications Received 66 21 Number of Applications Approved 61 19 Number of Applications Refused 3 1 Amount paid in grants £8,743 10s. Od. Amenities provided (a) fixed bath 53 (b) shower — (c) wash hand basin 62 (d) hot water supply (to any fittings) 70 (e) water closet (1) within dwelling 62 (f) food store 52 (2) Discretionary Owner / occupier Tenanted Number of Applications Received 90 30 Number of Applications Approved 65 29 Number of Applications Refused 8 2 Amount paid in grants .... £25,259 5s. 8d. Compulsory Improvement A start was made during the year to secure the improvement of the tenanted dwellings situated in the Bromley No. 1 Compulsory Improvement Area. The area in question had been declared an Improvement Area by the former Bromley Borough Council under Part II of the Housing Act, 1964, which gives power to local authorities to require the provision of an internal water closet, bath, wash hand-basin and sink with hot and cold water supply, and a ventilated food store, in tenanted dwellings which lack these facilities. The area comprised the following roads :— Walpole Road (part), Addison Road, Bloomfield Road, Cowper Road, Cowper Close, Chantry Lane, Chatterton Road (part), Southlands Road (part) and Bromley Common (part). There are approximately 325 houses in the area, 148 of which were tenanted, and it was estimated that approximately 96 lacked the standard amenities. Although a preliminary inspection of the houses had been carried out as part of a survey of a much larger area undertaken by the Health Department of the Bromley Borough, it was necessary to re-inspect all the tenanted houses in order to confirm the conditions and to prepare a specification of works of the proposed improvement. At the same time the tenants were informed of the Council's proposals and the tenants' views were obtained. It was apparent from a first study of the Act that the compulsory improvement legislation would be difficult to operate and this, indeed, proved to be the case. The result was that only very slow 92 progress was made and it was not found possible to deal with the whole area within the statutory two-year period following the declaration of the area by the Bromley Council. By the end of the year 44 Preliminary Notices, 11 Immediate Improvement Notices and 11 Suspended Improvement Notices had been served. Twenty statutory undertakings by owners to carry out the improvement work were accepted by the Council. The Suspended Notices were in respect of dwellings where the tenants, mainly because of their age or infirmity, did not want the improvement work carried out. One of the major problems which had to be overcome was the disagreement between landlord and tenant concerning the method of carrying out the improvement. So far as the owner was concerned, there was also the difficulty of finding builders who were prepared to carry out the work within the maximum cost limit laid down in the Housing Act for standard and discretionary grants. RENT ACT 1957 Applications under the Rent Act have reached a very low level. Certificates of Disrepair and other documents specified in the Act have been issued as follows:— Application for Certificate of Disrepair 14 Number of decisions not to issue certificate 1 Number of certificates issued 5 Number of undertakings given by landlords under Paragraph 5, First Schedule 8 Number of undertakings refused by L/A Applications for Cancellation of Certificate By Landlords to L/A for cancellation 1 Objections by tenants to cancellation — Certificates cancelled by L/A 1 Housing Inspections—Defects Remedied, Nuisances Abated by Informal Action Drainage Drains: constructed or reconstructed 67 repaired 168 cleansed 482 Cesspools: provided — overflowing 10 leaking — abolished — 93 Sanitary Appliances Sinks, etc., provided 2 Sinks, etc., repaired 16 W.C.s provided 17 W.C.s repaired 70 Dampness Roofs and rainwater fittings 231 Walls and stacks 274 Damp-proof courses and floors 30 Water Supply Provided 3 Installations repaired 64 General Items Wall plaster 154 Ceiling plaster 90 Floors 75 Rooms cleansed or redecorated 10 Windows and doors 160 Lighting 4 Ventilation 4 Staircases 23 Fireplaces, etc. (ex Clean Air) 9 Yard paving and drainage 12 Dustbins 28 Food storage and preparation 40 Nuisances from animals abated 14 Accumulations removed 75 Premises disinfested 20 Premises disinfected 5 STATUTORY NOTICES Nuisances found in dwelling houses, either as a result of routine inspections, or following the investigations of complaints, are dealt with by informally requesting the owners or agents to apply a suitable remedy. If these requests are not acceded to after an appropriate interval, Committee sanction is sought for the service of Statutory Notices. Eighty such Statutory Notices were served, and in seven instances Court Orders were obtained. By the end of the year 70 of these Notices had been fully complied with. COMMON LODGING HOUSES There were two registered Common Lodging Houses in the area, these being situated at :— 36 Arply Road, Penge—where provision is made for 33 men, and at 1/3 Poverest Road, St. Mary Cray—where provision is made for 24 men. 94 The property at 36 Arpley Road, Penge, is included in a Clearance Area and the Keeper was informed that it would be unlikely that his registration would be renewed after the end of 1967. MOVEABLE DWELLINGS The control of caravan sites is obtained through The Caravan Sites and Control of Development Act 1960. There are seven licensed sites and in each case the "conditions" attached to the licences enable the Council to enforce a high standard of environment for the caravan dwellers. The difficulty of dealing with itinerants camping on grass verges and Council owned land was referred to in my last year's report and ultimately the Council found it necessary to apply to the Bromley Magistrates Court for Orders, under the Orpington Urban District Council Act 1954, requiring the removal of the caravans and prohibiting the use of the land for this purpose. At the same time, it was decided to provide a permanent site for 12 gipsy families at Star Lane, St. Mary Cray. There is no doubt that the congregation of itinerant families on unauthorised land can constitute a serious public health problem due to the lack of proper sanitary facilities, a situation which is aggravated when they settle near to residential property. The only permanent solution is to provide a sufficient number of properly controlled and equipped sites throughout the country, to absorb the itinerant population. It would then be possible to prohibit the use by this population of any unauthorised land. A long-term measure to be recommended is the gradual absorption of families into society by rehousing from these sites, after a period of rehabilitation. Licensed Sites No. of Vans Address permitted The Paddock, Downe Road, Keston 12 Chalk Pit, Maidstone Road, Ruxley 25 "Cherry Tree Nursery", Foxbury, Chislehurst 1 "Lower Hockenden Farm", Hockenden, Swanley 1 "Crittenden Caravan Park", Pond Lane, High Street, West Wickham 30 11 Heathfield Road, Keston 23 "Restavon", Berrys Green Road 60 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, and which will be discontinued after the end of 1967. 95 DRAINAGE AND SEWERAGE The Council accepts as a legal responsibility the clearance of certain types of public sewers and the work is undertaken by Disinfector/Handymen employed by the Department. In addition, private drains are cleared, but a charge is made in these cases. Of the 1,359 instances of choked drains dealt with, 787 related to private drainage. 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 within the Borough during 1966, as under :— PRIVATE ESTATE DEVELOPMENT Foul Sewers: Yards 6" diameter 886 9" diameter 1,608 Surface Water Sewers: 6" diameter 490 9" diameter 2,170 12" diameter 404 15" diameter 160 18" diameter 54 PRIVATE STREET WORKS Foul Sewers: 6" diameter 286 Surface Water Sewers: 6" diameter 176 9" diameter 324 SEWERAGE AUTHORITY Foul Sewers: 9" diameter 52 Surface Water Sewers : 9" diameter 67 18" diameter 311 During the year ten new houses were connected to cesspools and 27 cesspools were abolished, the properties being connected to main drainage. There are now 2,209 cesspools in use in the Borough. 96 DISINFECTION 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. Steam disinfecting plants are situated at the Council's Depots at Waldo Road, Bromley and Crofton Road, Orpington. Articles unsuitable for treatment by steam disinfection are disinfected by chemical means. In appropriate cases premises where infectious diseases have occurred are disinfected by suitable chemical sprays and fumigants. Disinfection of bedding is carried out on request for hospitals in the area. Where notifiable infectious diseases are involved, these services are free of charge. Similar provisions are made for disinfection on request where non-notifiable illness has occurred. In such cases an approved nominal charge may be made. DISINFESTATION Premises and articles infested by vermin and insects are also treated by the disinfecting operators. Approved charges are made for this service. Thirty-eight requests were received for this service. WASP NEST DESTRUCTION A service to destroy wasp nests was put into effect during 1966. Suitable protective clothing and equipment was provided for three Disinfector/Handymen, and a charge of £1 per clearance was approved. As had been anticipated the scheme proved to meet a definite need and some 370 nests were destroyed. Experience during this first season of operation has shown that the scheme could be improved if more of the outside staff were equipped to undertake this work, and consequently two rodent operatives are being provided with the required protective clothing and materials. CLEAN AIR ACT 1956 There was virtually no smoke fog during the winter of 1966-67. This may not be entirely attributable to the progress of smoke control in London, but these procedures have played a dominant part. The Chief Medical Officer to the Ministry of Health, in his Annual Report for 1966, now states :— "The clear association of pollution with bronchitis alone should make it imperative that authorities should do their utmost to reduce what is almost certainly one of the greatest 97 environmental hazards in this country at the present time. It is unfortunate that many of the backward authorities are those with the highest rates of bronchitis". A programme designed to create Smoke Control Areas to cover the whole of the Borough by 1975 was approved by the Council in 1965. Thirteen Smoke Control Areas were in operation at the beginning of 1966. These covered an area of 4,073 acres and contained approximately 18,451 premises. Three further Smoke Control Orders, surveyed in 1965, were confirmed by the Minister of Housing and Local Government and came into operation on 1st November, 1966 as follows :— Ward Penge (part) West Wickham North (part) Martins Hill & Town (part) Acreage 68 359 278 Premises 1,193 2,003 1,954 Of the 4,370 private dwellings in these three Smoke Control Areas, it was estimated that 2,913 houses (67%) required works of adaptation, ranking for grant aid, to enable the occupiers to comply with the Smoke Control Order. It is interesting to note that of the 2,913 entitled to financial assistance, only 57 per cent. made applications and availed themselves of the grant. The total cost of the approved work carried out amounted to approximately £43,086, and the actual cost to the Council after deduction of the Exchequer grant and the owner/occupier contribution amounted to £12,925. The average approved cost per dwelling where work was carried out was £26 0s. Od. and the average amount of grant paid was £18 4s. Od. Those who cannot afford to pay the three-tenths of the cost of adaptations, not covered by grant, may apply for a hardship grant. During the year 33 persons applied for this assistance and grants were approved in 24 cases. No difficulty was experienced during the year in connection with the availability of smokeless fuel or with the sale of unauthorised fuels in Smoke Control Areas. A survey of the undermentioned areas was carried out and it was recommended that Smoke Control Orders should be made and submitted to the Minister for confirmation so that they could be established in 1967 :— Ward Petts Wood (part) Martins Hill & Town (part) Plaistow & Sundridge (part) Anerley Acreage 685 268 346 Premises 3,423 3,164 2,436 98 Unfortunately, staff and the financial situation at the end of the year necessitated the curtailment of this programme and only one area was surveyed in the winter of 1966-67 for establishment in 1968. It is hoped that the original programme will be resumed as soon as possible. Industrial Smoke and Furnaces Twelve notifications under the Clean Air Act were received during the year from persons proposing to install furnaces. In all cases the plans submitted satisfied requirements and indicated that the furnace could be installed and operated without emitting smoke. In consequence no objection was raised to the proposals. In some instances the Department was not satisfied that the height of proposed chimney flues and stacks was sufficient to affect proper dispersal of the flue gases. After consultation with the architects agreements were reached concerning an increase of height but in some cases a compromise had to be accepted. The reluctance of architects and designers possibly on aesthetic grounds to construct chimneys to the full height necessary for the effective dispersion of the products of combustion is an obstacle in the fight for clean air. It was not found necessary during the year to take any formal action under the Clean Air Act in connection with the emission of dark smoke, or grit from chimneys, although several cases were noted and detailed observations made. MEASUREMENT OF ATMOSPHERIC POLLUTION Bromley is one of the selected towns which for the past four years have been co-operating with the Ministry of Technology in carrying out a national survey of atmospheric pollution. Apparatus for the determination of smoke and sulphur dioxide in the air has been set up at four selected sites. These sites are visited daily and measurements are taken, from which the actual concentration of smoke and sulphur dioxide present in the atmosphere can be calculated. The results are forwarded to the Warren Spring Laboratory of the Ministry of Technology where the data for the whole country is collated and evaluated. It would be unwise because of the comparatively short period during which observations have been made to attempt to draw any conclusions from the results obtained locally. Consequently, the following figures, which show the concentration of smoke and sulphur dioxide in Bromley during 1966, are given purely for record purposes. 99 Microgrammes Smoke per cubic metre SO2 January 60 121 February 24 74 March 41 129 April 29 100 May 21 63 June 17 54 July 16 52 August 15 57 September 30 81 October 37 86 November 63 158 December 63 105 Yearly average for 1966 : Smoke = 35 MG/Cu.M. SO2 = 90 MG/Cu.M. The Warren Spring Laboratory has reported that in recent years in the London area, as a result of clean air policy, there has been a marked reduction in the concentration of smoke and a decrease in the sulphur dioxide concentration. PREVENTION OF DAMAGE BY PESTS ACT, 1949 RODENT CONTROL Thousands of tons of the nation's food supply are lost or have to be condemned annually due to the consumption and contamination by rats and mice. The risk of undetected contamination of food is also involved and may result in the infection of human beings. For these reasons, although there are powers in the Act to require the destruction of rats or mice by the occupier or the owner of the land which they infest, most Local Authorities operate a free rodent destruction service in private premises and charge only an economic fee for disinfesting business premises. The Council's sewerage system is "tested" in the spring with unpoisoned bait and the "take" of this bait indicates where it is necessary to lay poison. A further poisoning treatment, based on the results of the earlier one, is carried out in the autumn. The results obtained from the treatments this year indicate a comparatively slight infestation of the sewers. With regard to surface infestations 3,097 premises were visited and treated as a result of complaints, 111 of these being for mice. 100 All Local Authorities submit a statistical report to the Ministry of Agriculture, Fisheries and Food each year so that an assessment can be made of the general situation respecting infestations of rats and mice in England and Wales. This year the form of report required has been very much simplified. The figures relating to surface infestations are shown below. PROPERTIES OTHER THAN SEWERS Properties other than sewers Type of Property Non-Agricultural Agricultural 1. Number of properties in district 112,934 371 2. (a) Total number of properties (including nearby premises) inspected following notification 7,789 — (b) Number infested by (i) Rats 2,986 — (ii) Mice 111 — 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 75 50 (b) Number infested by (i) Rats 12 15 (ii) Mice — — PIGEON DESTRUCTION As indicated in my report under this heading last year approval was given to the employment of a pigeon catcher and the service came into operation on the 1st April, 1966. It is often impracticable and rarely an easy matter to exterminate congregations of pigeons due to their habit of roosting in inaccessible places. Nevertheless, all complaints are investigated promptly. Trappings and shooting are the methods usually employed. During the year 108 complaints were received and 4,756 pigeons were destroyed. 101 OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 The provisions of this Act aim to raise standards of working conditions in shops, offices and railway premises. In the majority of the premises covered by the Act the Local Authority is responsible for enforcing the general requirements which relate to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, working facilities, drinking water, seats, safety of machinery, first aid and fire precautions. As in previous years inspections have had to be somewhat restricted owing to shortage of staff. It was, however, possible to make 1,245 general inspections and 616 contraventions were found, these being mostly of a minor character. The absence of wall thermometers and first aid equipment was predominant. With few exceptions employers have shown a readiness to comply with the requirements of the Act and in no case was it necessary to resort to legal action. Accidents reported numbered 64, the injuries sustained were not serious and were mostly due to falls and minor accidents incurred whilst handling goods. In seven cases advice was given respecting measures to be taken to prevent a recurrence. 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 35 644 145 Retail shops 72 1,432 1,041 Wholesale shops, warehouses 3 42 19 Catering establishments open to the public, canteens 8 148 38 Fuel storage depots - 12 2 Totals 118 2,278 1,245 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 1,455 102 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 66 15 Eating facilities 5 5 Overcrowding 1 16 Floors, passage and stairs 26 6 Temperature 141 7 Ventilation 34 17 Fencing exposed machinery 24 8 Lighting 23 18 Protection of young persons from dangerous machinery - 9 Sanitary Conveniences 45 10 Washing facilities 79 11 Supply of Drinking Water 6 19 Training of young persons working at dangerous machinery - 12 Clothing Accommodation 23 23 Prohibition of heavy work — 13 Sitting facilities 1 14 Seats (Sedentary Workers) 3 24 First Aid General Provisions 139 Total 616 (C) Exemptions No. of applications received Nil (D) Prosecutions Number instituted Nil Number of complaints (or summary applications made under Section 22) Nil Number of interim orders granted Nil (E) Reported Accidents Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advice Offices 6 1 — — 1 5 Retail Shops 54 6 — — 6 48 Wholesale Shops, Warehouses 1 1 - - 1 - Catering Establishments open to public, canteens 2 - - - - 2 Fuel Storage Depots 1 — — — — 1 TOTALS 64 8 — — 8 56 103 Analysis of reported accidents Offices Retail Shop Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery - — — - — Transport 1 4 — — — Falls of persons 2 14 — 1 — Stepping on or striking against object or person 1 4 — — — Handling goods 1 20 - — 1 Struck by falling object 1 2 1 — — Fires and Explosions — - - — - Electricity — - - - — Use of hand tools — 3 - — — Not otherwise specified - 7 - 1 - Prescribed Particulars on the Administration of the Factories Act, 1961 PART 1 OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises (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 90 5 2 Nil (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 754 171 12 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 67 20 1 Nil Total 911 196 15 Nil 104 2. Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 1 1 - - Nil Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) - - - - Nil Sanitary Conveniences (S.7) - — — 2 — (a) Insufficient 5 5 — — Nil (b) Unsuitable or defective 6 6 — - Nil (c) Not separate for sexes 2 2 — - Nil Other offences against the Act (not including offences relating to Outwork) — — — — — Total 15 15 — 2 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. 68 Manufacture of brass articles 1 Making paper bags 1 Making cardboard boxes 4 Making Christmas crackers 3 Making stuffed toys 14 Manufacture of lamp shades 1 MORTUARIES There are two mortuaries operated by the London Borough of Bromley, one in the Town Hall grounds at Beckenham and the other at Beaverwood Road Depot, Chislehurst. Reorganisation of the Coroners' Districts in the London Area has thrown a greater burden on the Beckenham Mortuary and increase of the facilities to allow for the reception of 9 bodies in place of the present facilities for 3 bodies, and also improvements to the existing equipment will shortly be commenced. During 1966, 546 bodies were brought to the Mortuaries where post-mortem examinations were conducted by a Home Office Pathologist as shown on following page:— 105 (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 399 41 (2) Beaverwood Road, Chislehurst 147 25 WATER SUPPLY The water supply in the Borough is provided by the Metropolitan Water Board, and I am indebted to the Director of Water Examination of that Authority for the following information:— " (a) The supply was satisfactory both as to quality and quantity throughout 1966. (b) (i) The supply was derived from the following works and pumping stations:— River Thames (Southern group) and via Kempton Park. Also Shortlands. West Wickham, Orpington, North Orpington, Sundridge, Lullingstone, Eynsford, Horton Kirby and Jewels Wood Wells. No new sources of supply were instituted. (ii) The numbers of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. No fluoride was added, and where the fluoride content is indicated, it represents the naturally occurring fluoride in the water. (c) The supply being hard in character is not liable to be plumbo-solvent. (d) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or well stations, from the 106 distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (e) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1966, was 301,504. (ii) No houses were permanently supplied by standpipe. Other observations (f) There were no changes to the general scheme of supply in your area. (g) There were additions of 13,536 yards of mains in your area." 107 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1966 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply Number of samples BEFORE TREATMENT Escherichia coli count AFTER TREATMENT Agar plate count per ml. Coliform count Number of samples Agar plate count per ml. Coliform count E. coli 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. Thames derived, South of River* 1,825 10.8 99.18 99.95 Kempton Park 763 19.4 99.61 100.0 (a) Shortlands No. 1 157 0.0 2 100.0 - 100.0 - 243 0.4 6 100.0 100.0 (b) Shortlands No. 2 176 0.0 1 99.43 — 99.43 - (c) Shortlands No. 3 137 0.1 34 99.27 — 100.0 - West Wickham 240 0.0 35 99.17 — 99.58 — 244 0.1 14 100.0 100.0 Orpington 244 0.1 88 99.18 — 99.59 - 248 0.3 10 100.0 100.0 (a) North Orpington No. 1 98 1.5 17 35.71 5.6 52.04 2.1 245 0.9 12 100.0 100.0 (b) North Orpington No. 2 131 5.0 103 27.48 10.1 45.80 4.7 (a) Sundridge No. 1 61 0.1 56 100.0 — 100.0 — 252 0.0 7 100.0 100.0 (b) Sundridge No. 2 50 0.0 1 100.0 - 100.0 - (c) Sundridge No. 3 116 0.0 1 98.28 - 99.14 - (d) Sundridge No. 4 107 0.0 0 98.13 - 99.07 - (a) Lullingstone No. 1 136 0.0 1 100.0 - 100.0 - 254 0.1 11 100.0 100.0 (b) Lullingstone No. 2 122 0.0 0 100.0 - 100.0 - (a) Eynsford No. 1 204 0.2 14 88.73 0.7 100.0 - 261 0.3 23 99.62 100.0 (b) Eynsford No. 2 87 0.0 7 98.85 0.1 100.0 - (a) Horton Kirby No. 1 233 0.3 64 94.85 0.2 96.14 0.1 253 2.6 55 100.0 100.0 (b) Horton Kirby No. 2 246 0.1 2 97.97 0.2 99.59 0.1 Jewels Wood 42 4.4 22 100.0 — 100.0 — 42 3.5 19 100.0 100.0 * Hampton, Surbiton and Walton 10 8 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY, 1966 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 KMn O4 4 hrs. at 27°C. B.O.D. 5 days at 20°C Hardness (total) CaCO3 Hardness (non-carbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as C1 Phosphate as P04 Silicate as SiO2 Sulphate as S04 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) (20) (21) (22) (23) Thames derived. 156 0.029 0.090 4.4 1.27 279 77 5 24.2 5.0 32 1.8 9 62 0.20 0.01 0.1 15 7.8 560 South of River* Kempton Park 52 0.017 0.085 3.8 1.24 293 83 31 1.5 7 0.1 14 7.9 570 Shortlands 12 0.012 0.034 4.7 0.12 295 73 2 20 16 44 0.0 1 7.1 530 West Wickham 6 0.004 0.027 4.5 0.11 273 34 2 13 15 14 0.1 1 7.2 490 Orpington 4 0.011 0.025 6.2 0.10 289 45 2 16 13 22 0.0 1 7.1 530 North Orpington 7 0.035 0.029 4.4 0.13 274 29 2 15 12 12 0.0 2 7.2 490 Sundridge 19 0.004 0.026 2.9 0.07 220 49 2 19 18 35 0.1 1 7.4 420 Lullingstone 8 0.012 0.023 3.2 0.16 258 31 3 14 12 12 0.1 1 7.2 470 Eynsford 8 0.010 0.018 3.9 0.13 268 40 2 17 13 16 0.2 1 7.2 470 Horton Kirby 8 0.004 0.031 4.3 0.11 270 46 3 17 13 24 0.1 2 7.1 470 Jewels Wood 4 0.004 0.030 2.1 0.13 240 26 1 12 11 8 0.2 1 7.3 420 * Hampton, Surbiton and Walton 109 SWIMMING BATHS 23 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 chemical and bacteriological 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 9 unsatisfactory samples involving 4 private baths and immediate steps were taken to iectify the conditions. The Crystal Palace Sports Centre racing, divers' and learners' baths were inspected and sampled regularly by the Scientific Branch of the Greater London Council. 41 samples were reported upon, all of which proved satisfactory. THE DISEASES OF ANIMALS ACT, 1951 The duties required under the above-mentioned Act were carried out, under the direction of the Chief Public Health Inspector, by a "Diseases of Animals Inspector" who acted jointly for the London Borough of Bromley and the London Borough of Bexley. During the year the Diseases of Animals Inspector suffered a severe illness from which he died in September. Instead of appointing a successor to him, the London Borough of Bromley contracted to use services offered in this connection to Local Authorities by the City of London's Veterinary Department. This service commenced operating in December. The following premises are situated within the London Borough of Bromley:— Stock Keepers 40 Farms (keeping more than one type of animal) 57 Pig Keepers 96 Poultry Keepers 26 Horses only (not a riding establishment) 1 Riding Establishments 26 Slaughterhouse 1 247 A total of 524 visits was made to these premises during the year for the following various reasons: routine checks on records of movement of animals, supervision of conditions imposed by movement licences; the issue of movement licences; control of the use of swill boiling plants; the quarantine of animals infected by, or suspected to be infected by, infectious diseases. The Borough was free from infectious diseases notifiable under the Act. 110 ANTHRAX ORDER, 1938 There were two suspected cases of Anthrax which were subsequently proved to be negative. The carcases were burnt. SWINE FEVER ORDER, 1963 There were four suspected cases of Swine Fever, all of which were subsequently proved to be negative. A report was received that three dead pigs had been found in a coppice. The carcases were treated as suspected cases of swine fever but were subsequently found to be negative. They were destroyed by burning. All attempts made by the Police and the Diseases of Animals Inspector to trace the ownership of the animals were unsuccessful. RIDING ESTABLISHMENTS ACT, 1964 Twelve applications were received for the grant of licences to keep Riding Establishments. The premises were inspected and were referred to, and reported upon, by a Veterinary Surgeon and a Fire Prevention Officer. All animals available to be hired from the premises were also examined by Veterinary Surgeons. Conditions were satisfactory and the licences were issued. ANIMAL BOARDING ESTABLISHMENTS Fifteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at the premises for boarding 282 dogs and 72 cats. 39 visits were made to these premises during the year—no contraventions of the terms of the licences being found. PET ANIMALS ACT, 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to 25 applicants. The majority of the businesses were on a small scale selling fish, tortoises, birds and small animals. A total of 35 visits were made to the premises, no contraventions of the terms of the licences being found. 1ll SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS General Sanitation Animal Boarding Establishments 39 Caravans 285 Cesspools 70 Common Lodging Houses 35 Drainage 2,303 Filthy Premises 13 Fouling of Footpaths 84 Hairdressers 51 Keeping of Animals 71 Noxious Accumulations 491 Piggeries 17 Public Conveniences 94 Rivers, etc 314 Schools 34 Swimming Baths—Public 4 Swimming Baths—Private 19 Theatres, etc 5 Verminous Premises 105 Housing Housing Acts (Clearance) 470 Housing Acts (Improvement) 378 Overcrowding 92 Public Health Acts 4,648 Rent Act 114 Factories, etc. Factories with power 171 Factories without power 5 Building Sites 20 Outworkers 97 Offices, Shops and Railway Premises General Inspections—Offices 145 Retail Shops 1,041 Wholesale Shops and Warehouses 19 Catering Establishments and Canteens 38 Fuel Storage Depots 2 Visits of all kinds (including above) 1,455 112 Food Premises—Food Hygiene Regulations Bakers' Shops 251 Bakehouses 107 Butchers 384 Dairies 182 Fishmongers 190 Greengrocers 204 Grocers 523 Ice Cream 181 Restaurants 398 Slaughterhouses 119 Stalls 442 Food Complaints 103 Inspection of Foodstuffs Meat—Slaughterhouse 464 Meat—Wholesale Depots 131 Meat—Retail Shops 44 Other foods 760 Merchandise Marks Act—Food only 10 Rodent Control Agricultural premises 13 Non-agricultural premises 291 Water Supply 58 Noise Abatement 173 Pharmacy and Medicines 18 Rag Flock and other Fillings Act 20 Riding Establishments Act 16 Pet Animals Act 35 Clean Air Act Nuisances 242 Industrial premises 345 Smoke Control Areas 10,884 113 Pigeons Infestations 19 Infectious Diseases General 576 Food Poisoning 117 Disinfection supervision 29 Surveillance of Infectious Diseases Contacts, etc. 84 Nursing Homes and Child Minders 5 Sampling Egg Products 19 Fertilisers and Feeding Stuffs 7 Food and Drugs 468 Ice Cream 55 Milk 207 Water—Drinking 8 Rivers, etc. 55 Swimming Baths 36 Rag Flock Act 10 Miscellaneous 315 Total 31,327 NUMBER OF DEFECTS OR CONTRAVENTIONS FOUND Housing: Defects and Nuisances 1,371 Filthy and verminous conditions 40 Water supply 28 Cesspools 6 Drainage 764 Overcrowding 5 Rent Act 7 Infectious Diseases and Food Poisoning 89 114 Food Premises : Bakers and Bakehouses 37 Meat Depots and Stalls 9 Butchers 41 Fishmongers and Poulterers 8 Grocers 56 Greengrocers 28 Dairies and Milk Shops 2 Ice Cream Premises 10 Food Preparing and Manufacturing Premises 20 Restaurants, Hotels, Canteens, etc. 43 Street Vendors, Hawkers' Carts and Markets 29 Trade Premises: Caravan Sites 1 Theatres, etc., Places of entertainment 1 Common Lodging Houses 3 Factories 47 Hairdressers 3 Offices, Shops and Railway Premises Act 323 Miscellaneous : Rodent Control—Agricultural Property 4 Non-Agricultural Property 90 Keeping of Animals 16 Noxious Accumulations 113 Smoke and Clean Air Act 131 Noise Abatement Act 40 Rivers, streams, etc. 3 NOTICES SERVED Informal Notices : Public Health and Housing 414 Others 324 Complied with at end of year: Public Health and Housing 208 Others 106 Statutory Notices: Public Health Act 81 Orpington Urban District Council Act 9 Complied with at end of year: Public Health Act 58 REPORT OF THE CHIEF WELFARE OFFICER 116 REPORT OF THE CHIEF WELFARE OFFICER on the Welfare Services covering the period 1.4.66 to 31.3.67. WELFARE SERVICES STAFF Chief Welfare Officer: J. Hanson, o.b.e., d.m.a., f.i.s.w. Deputy Chief Welfare Officer: J. Gill, d.m.a., a.i.S.w. Casework Supervisor: Mrs. E. K. Lemare-Long, a.i.m.s.w. Senior Social Welfare Officers: R. H. Rogers, c.s.w., a.i.s.w. R. P. Messer, C.s.w. Miss J. Turner, c.s.w. Senior Social Welfare Officer for the Blind: A. A. R. Clay. Introduction 1. This is the Second Report upon the Welfare Services since the formation of the London Borough, and covers the financial year 1966/67. Not all the statistical tables which featured in the first Report are reproduced but the information is available from the department for those who desire it. These unpublished tables are used for comparative purposes in order to highlight interesting trends. 2. The organisation of the Welfare Services continued to be based upon three area offices at Bromley, Orpington and Penge respectively. A senior social worker heads a team consisting of social welfare officers, an occupations officer and welfare assistants. They are working alongside colleagues in the mental health services with shared clerical support at area office level. A professional consultant service is available from the casework supervisor based centrally; and administrative support parallels the professional service under the general direction of the Chief Welfare Officer and his Deputy. 3. The social work staff have been subjected to considerable pressure during the year. This has been evidenced, particularly, by the gradual build-up of demand for residential home places which were not available in sufficient numbers, and by the extensive preventive and rehabilitative work carried out with families likely to become homeless or who were occupying temporary accommodation. Attempts to recruit experienced staff to deal with the situation often prove abortive with the result that the social work services to the physically handicapped suffered considerably. It was not possible to recruit a specialist welfare officer for the deaf so that as in the previous year, little help was available for the adult deaf in the community. 4. Despite acute staffing problems, however, there has been an expansion in some sectors of the Welfare Services. This is especially noticeable in the extended provision of day care for the elderly in the eight residential homes managed by the local authority. Nor 117 has the staffing situation prevented interesting experimental schemes, foremost of which was the arrangement for a proportion of new residents at Manor Fields, Orpington, to bring their own furniture into the residential home. 5. A most encouraging feature of the year's progress has been the further development of co-operation with the voluntary societies which was so evident from the references made in the previous Annual Report: the area of partnership is much broader than is often recognised. In caring for the elderly, the department's relationships with the voluntary organisations providing residential care and the agencies (such as the Bromley Joint Old People's Welfare Committee and the Women's Royal Voluntary Service) engaged primarily in supplying supporting services in the homes of individuals and at clubs or centres, have been excellent. A similar pattern of partnership has emerged with the voluntary agencies concerned primarily with the welfare of the disabled. Particularly close working relationships have been established between the local authority and the British Red Cross Society, the Shaftesbury Society, the Kent Association for the Disabled, the West Kent Spastics Society, the Bromley Branch of the Multiple Sclerosis Society, and the Kent Association for the Blind. 6. The first Annual Report made scant reference to training but the foundations for a sound staffing structure were laid soon after the new authority was formed. In 1966/67 the in-service training arrangements for welfare assistants were continued and improved. It is most encouraging that two trainees were selected for a fulltime two-year course of training for the Certificate in Social Work commencing in September, 1966, and four more had been notified of their success in obtaining places for the courses starting in 1967. 7. Concurrently, the Welfare Services of the London Borough of Bromley were used as a placement agency by the North Western Polytechnic for both first-year and second-year students. The extension of these arrangements made increasing teaching demands upon the casework supervisor and steps were taken to involve the senior social workers (each of whom holds the Certificate in Social Work) in student training. Induction courses have been arranged for those social welfare officers recruited to the service and every opportunity has been taken for staff at all levels (including those in residential homes) to participate in refresher courses arranged by various training organisations and professional groups. 8. It was feared that the stringent position dictated by Government policy would prevent any expansion in the Welfare Services during 1966/67. There is no doubt that the revision of capital programmes will be felt, in terms of inability to meet individual needs, for many years to come. Nevertheless, it was encouraging that the Finance Committee found it possible to allocate an additional sum of money for (health and) welfare purposes. Proposals for a limited 118 sion were approved but their realisation will be more dependent upon the ability to recruit experienced personnel than upon the provision of expenditure for material help. Ascertainment of need is a prerequisite to the use of whatever financial resources are available. 9. The range of welfare services is generally interpreted as embracing residential care for the elderly, temporary accommodation for the homeless, and services for the deaf, the blind, and the physically handicapped. But these groups are not contained in watertight compartments and the emphasis throughout this second year of operation has been upon the provision of social work support irrespective of the legalistic boundaries which are often created by too narrow an interpretation of the relevant legislation. The succeeding sections of this Report attempt to chart the main lines of development. RESIDENTIAL CARE A ccommodation 10. On the 1st April, 1966, 381 places in residential accommodation were available in 7 homes managed by the local authority and in 2 wards at Orpington Hospital under a joint user agreement with the South East Metropolitan Regional Hospital Board. An additional 60 places were provided with the opening of Manor Fields, Orpington, in May, 1966, but it was decided to vacate the female ward (22 places) at Orpington Hospital. Thus, at the 31st March, 1967, the local authority provided 419 places although steps were being taken to "run down" the remaining 23 places in the male ward at the Hospital. Until the new home at Mickleham Road, St. Paul's Cray, is built, therefore, the local authority will have accommodation for a total of 394 places. The discrepancy of 2 beds is accounted for by a reduction at Elmbank following a revision of space standards. 11. The decisions to close down the two remaining wards at Orpington Hospital were taken in accordance with the national policy to vacate all joint-user accommodation in former institutions as soon as possible. The transfer of residents to modern residential homes was effected smoothly and was assisted by the excellent cooperation of the staff at Orpington Hospital. In the light of increasing demands for residential accommodation, the decision to vacate these two wards may be regarded as premature. But the time is rarely opportune to embark upon policies of this nature and the Welfare Services Sub-Committee now has the satisfaction of knowing that the residential accommodation provided is in modern homes, 4 of them purpose-built. 12. The severe restrictions imposed on capital expenditure by the Central Government have affected the building programme for 119 further residential homes. The next home at St. Paul's Cray is unlikely to be ready for occupation until 1970. Present evidence suggests that provision is falling well behind demand. On the 31st March, 1967, the social workers were in contact with 68 elderly people who required residential accommodation urgently. Of these, 24 were in hospital. Even with an extension of supporting community services, some drastic revision of the capital programme seems inevitable. But even if the Ministry of Health could be pressed into additional loan sanctions over the next few years, there is an acute problem of acquiring suitable sites. 13. Reference was made in the Report for 1965/66 to the decision of the Welfare Services Sub-Committee to allow persons occupying 27 single bedrooms and one double bedroom at Manor Fields, Orpington, to bring in their own furniture. An evaluation of this experiment was made in March, 1967, and the results featured prominently in the national professional journals. Where residents brought some of their own furniture they appeared to derive a great deal of benefit and pleasure from being able to maintain a corner of their own. They have been delighted to show their rooms to those who have visited the home as a result of the interest generated by this pilot scheme. These have included the former Chairman of the National Old People's Welfare Council, several Chief Welfare Officers from other authorities, and visitors from France, Canada, Egypt and Portugal. This principle of enabling residents to bring in their own furniture will be applied in the case of the new home to be built at St. Paul's Cray. This Home will also incorporate additional provision for day care services. Staffing in Residential Homes 14. The staff of the residential homes are to be congratulated upon the standards of care provided. Equally important is the awareness of matrons and their assistants of the need to preserve as much individual independence as possible in what tends to be, by its very nature, a dependent environment. Many ideas involving residents in decision-making processes about matters affecting their home have been put into effect. Acute staffing problems, especially the shortage of assistant matrons, has not deterred those responsible from ensuring that residents are enabled to live as effectively as their disabilities permit. 15. A review of the staffing of the residential homes was completed in August. 1966. In an attempt to relieve supervisory staff of the necessity of working excessive hours, additional assistant matrons on a non-resident basis were approved at the larger homes. Authority was also obtained for the engagement of one relief assistant matron. The establishment of attendant, clerical, cooking and domestic staff was also revised. Difficulty continued to be experienced, however, in recruitment. 120 16. The Ministry of Health Report for 1966 draws attention to the problem of the staffing of residential homes, statistics concerning which were collected for the first time in 1966. The statistics indicate that in order to staff the Homes, local authorities have had to employ a high percentage of part-time staff—almost one-third of all staff employed are part-time employees. In the eight residential Homes for the elderly in Bromley 36% are part-time staff. 17. The Ministry Report also indicates the national shortage of assistant matrons and wardens—there being no fewer than 333 vacancies for such staff throughout the country. The Williams Report on the Staffing of Residential Homes was not published until after the end of the year under review but one must hope for tangible results from the deliberations of this committee. The future of residential care depends on a solution to the staffing problem. 18. Meetings of staff of residential homes and the administrative staff have been held on a regular basis throughout the year. The meetings have taken place at the homes and very valuable and interesting discussions on many topics have been held. Speakers from outside agencies have attended some of these meetings and interest in the problems associated with advancing years has been stimulated. This is particularly so in respect of the deaf and hardof-hearing, occasioned by talks from the Deaf Welfare Officer of the Royal National Institute for the Deaf and the Officer in Charge of Regional Hearing Aid Centre. Admissions and Discharges 19. There were 174 new admissions to homes for permanent care during the year and 35 admissions by transfer from other homes. Of the latter, the majority were the result of the decision to close down the accommodation available to the local authority at Orpington Hospital. In the few remaining instances, a transfer was arranged because ground floor accommodation was essential or to meet the wishes of individual residents who preferred to be in a home in another area of the Borough. The reduction of new admissions from 312 in 1965/66 to 174 in 1966/67 was accounted for in the occupancy of two new homes in the first year. 20. In 1966/67, 64 of the new admissions on a permanent basis were from hospital—36.8% and an increase of 8.8% over the previous year. People admitted to residential homes from hospital are invariably so frail as to require ground floor accommodation and, because of this, vacancies in the adapted homes which do not have lifts cannot be used. Residents transferred from hospitals, therefore, accounted for a much higher proportion of the vacancies which arose in homes where accommodation was available on the ground floor or where other floors were served by lifts. 121 21. Of the 174 new admissions, only 22% were in respect of elderly people residing with relatives compared with 40% the previous year. This may be due to the increased support available from social workers and domiciliary services as well as expanding day care arrangements referred to in paragraph 27. 22. The average age of new residents has risen to 82 years and is in accordance with the national trend. The Annual Report of the Ministry of Health for 1966 indicates that 31.5% of accommodation provided by local authorities, directly or through voluntary organisations, was for people aged 85 or over. In the Bromley local authority homes 47% of residents at 31st March, 1967, were in this age group. Of the 398 elderly people accommodated, at the end of the year under review. 320 (80%) had a stay not exceeding 3 years. This conformed to the pattern observed in 1965/66. 23. There were 186 discharges from permanent residential care during the year, 96 (51%) of which were admitted to hospital and 36 were transfers, again accounted for mainly by the vacation of accommodation at Orpington Hospital. Where residents are admitted to hospital, the policy is for their accommodation to be reserved until an indication is given by the hospital authorities that they are not likely to return. This is essential if residents are to feel that the home is to offer security. It is also one of the strongest arguments for resisting pressure to adopt exchange systems which can result in a bed being filled promptly but then prevents a person going into hospital from returning to a home and a bedroom with which they are familiar and which they regard as theirs. The resultant wastage in bed occupancy is a small price to pay for the application of this policy. 24. The number of deaths in residential homes numbered 48 (25% of the total discharge rate or 32% if transfers to other homes are excluded). This is an indication that the staff of residential homes make an important contribution in terminal care. Only 6 residents returned to the care of relatives or to their own homes. These statistics exclude the short term care arrangements which, for the first time, are dealt with separately. Short-Term Care 25. As indicated in the previous year's Report, a number of places in residential homes are reserved for the short term care of elderly people residing in their own homes or with relatives. This service is becoming more widely known and is now used throughout the year. The number of admissions for short term care was 123, representing a 100% increase when compared with the first year of operation in the new borough. Of these, 31% were men and this is the same percentage of men who were admitted for permanent care. It is significant that 100 (or 81%) of those admitted for short term care were elderly people residing with relatives. This is an indication of the value of such a scheme in providing support 122 for families accepting responsibility for their elderly relatives. The average age of those admitted was 81 years. 26. The discharge pattern requires no comment, except that of those taken into residential homes for short periods 2 were admitted to hospital and 2 died in the Home. There is little evidence that residents' relatives use the short term facilities to press for permanent care. Day Care 27. The acquisition of the special vehicle for the handicapped has enabled the day care arrangements to be extended. Matrons of homes where people attend for day care report that the permanent residents welcome the contacts with their "daily guests" and the days spent at the homes are an important part of the life of those who attend regularly. Throughout the year, there were 1,136 attendances on a day care basis compared with 132 in 1965/66. This represents a tremendous expansion and illustrates how effective day care can be in keeping the elderly in their own homes. Close co-operation between matrons, social workers, residents and relatives have made these arrangements possible and the care taken on an individual basis has ensured the smooth operation of the arrangements. In 1965, a charge of 1s. 6d. per attendance was fixed but this is likely to be reviewed next year in view of the extended facilities provided. Accommodation provided by, or on behalf of, other local authorities 28. There were 45 residents from Bromley accommodated in other local authority homes on 31st March, 1967, whilst 35 elderly people from other authority areas were in care in homes in Bromley. Accommodation provided by Voluntary Organisations 29. A number of voluntary organisations provide residential accommodation for residents of Bromley under arrangements whereby the local authority accepts the financial responsibility for maintenance. At the 31st March, 1967, 185 elderly and 28 physically handicapped persons were accommodated in this way. 30. During the year, there were 60 new admissions to homes managed by voluntary bodies, of which 30% were men. This is the same pattern as in the local authority sector but the average age of the total admitted was slightly less—79 years compared with 82 years. 31. Of the 185 elderly accommodated by voluntary agencies on behalf of the London Borough of Bromley, 58% had a stay not exceeding 3 years compared with 80% in local authority homes. On the other hand, the average age of discharge of Bromley residents in voluntary homes was slightly higher (84 years) than in the local authority establishments (82 years). About the same 123 percentage of deaths (23%) were included in the total of 53 discharges and 3 residents were transferred to local authority homes as needing facilities which the voluntary agency could not provide. 32. Conclusions from a relatively small sample comparison are difficult. Do the voluntary homes admit people earlier than the local authority? Are the new residents less frail? Does the care provided at an earlier stage in their lives result in a longer expectancy of life as evidenced by the higher average age on discharge? If so. would local authorities achieve similar results if more residential places were available to meet the urgent demands as shown by lengthy waiting lists? A number of elderly people, having reached a decision to enter a local authority home, may be kept waiting so long that their situation deteriorates and rehabilitation becomes more difficult. 33. No facilities have been provided by voluntary agencies on behalf of the local authority for short term care. Nor have voluntary homes in the Borough yet experimented with day care arrangements. The department would be pleased to co-operate with the introduction of limited day care schemes where a voluntary agency in the area considers this feasible. 34. The local authority made arrangements with voluntary homes providing special facilities for the disabled for 9 new admissions. The average age was 39 years. The length of stay of the total of 28 physically handicapped accommodated at the 31st March, 1967, varied between under 1 year and over 10 years, as would be expected. 35. Many of the physically handicapped referred to in paragraph 33 were accommodated some distance from their home area and their relatives. It was not found possible, however, to discover how many would prefer to be in their home area if suitable facilities were available. This question, together with that of ascertaining the need for residential accommodation for the physically handicapped in their own homes, has yet to be investigated fully. Charges for Accommodation 36. The Ministry of Social Security Act, 1966, changed the basis on which local authorities assessed ability to pay the standard charge for residential accommodation. A simpler and in some respects a more generous basis for calculating resources came into operation on the 28th November, 1966. 37. The standard maintenance charge in the local authority homes of £9 3s. 2d. which applied on the 1st April, 1966, was increased to £10 0s. 1d. on the 6th February, 1967. At the 31st March, 1967, 34 residents were meeting the full charge whereas 47 residents were doing so at the 31st March, 1966. It was estimated that the basis for calculating resources introduced by the Ministry of Social Security Act, 1966, would involve Bromley in a loss of income in 124 a full year amounting to £2,865 in local authority homes and £632 in voluntary homes. In the latter establishments the standard charge varies and is fixed after consultation with the officers of the local authority in whose area the home is situated. 38. The net expenditure for 1966/67 on residential homes per 1,000 population was £672 1s. 0d., compared with an average of £806 0s. 0d. for London Boroughs. The corresponding averages for counties and county boroughs in England and Wales were £551 8s. 0d. and £720 3s. 0d. respectively. 39. In respect of residential homes provided by the London Borough of Bromley, the average cost per resident week was £11 17s. 3d. compared with an average of £10 13s. 5d. for London Boroughs. The corresponding averages for counties and county boroughs in England and Wales were £9 13s. 2d. and £9 5s. 9d. respectively. Voluntary Services in the Residential Homes 40. Reference was made in last year's Report to those individuals and members of voluntary organisations who made such a valuable contribution to life in residential homes. This form of support continued during 1966/67 and is most appreciated. Particularly encouraging was the help forthcoming from young people, including groups of school children. Registration and Inspection of Homes 41. A duty placed on the local authority by Section 37 of the National Assistance Act, 1948, 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, has involved the staff in considerable work. There were 23 registered homes in the London Borough of Bromley in March, 1966. This number increased to 26 by March, 1967, and in this area where there are suitable properties for setting up voluntary and private homes of this nature, the number is likely to continue to increase. Considerable difficulty has been experienced in requiring proprietors to register in accordance with the Act. 42. During the year, 41 specific visits have been made to the registered homes to ensure that satisfactory standards have been maintained. In addition, senior officers of the department have taken the opportunity of meeting proprietors and matrons of the homes to discuss a wide variety of matters. The role of the local authority is seen as a supportive one, especially as voluntary and private homes are caring for people who might otherwise be seeking local authority residential accommodation. 43. Those who are considering the establishment of homes are advised to contact the department before firm commitments are entered into. Advice can then be provided about registration, 125 including fire prevention requirements, matters affecting hygiene, and standards of accommodation. The voluntary associations take these steps at an early stage. Private owners are encouraged to do likewise. Special Housing for the Elderly 44. The term "special" or "sheltered" housing is used to describe flatlets designed on labour-saving lines and with a resident warden who is on call in emergency, looks after the communal facilities and often gives additional help, for example with bathing, and, during temporary illness, with meals. The warden can also call in other forms of assistance when required. In January, 1966, the Health and Welfare Committee resolved that for an experimental period of one year from 1st April, 1966, grants be made to housing associations, subject to a maximum of £50 per unit of accommodation, in respect of welfare services provided in group housing schemes. The grant was confined to accommodation occupied by persons from the Borough. There were 6 voluntary housing associations in the Borough who received grants on this basis in respect of 95 elderly people. The total contribution by the local authority was £4,500 for the year. 45. The Housing Department managed 301 units of special accommodation where a warden's service was available. The total expenditure incurred in the provision of wardens' services and other communal facilities amounted to £9,800 and was met by the Welfare Services Sub-Committee. The allocation of tenancies was undertaken by the Housing Department. Many authorities consider that the most effective use of sheltered housing is achieved when the social service departments participate in the appointment of wardens and the allocation of tenancies. Meals and Recreation for the Elderly 46. The annual grant paid to the Bromley Old People's Welfare Joint Committee includes a meals subsidy of 1/- per meal provided either at old people's luncheon clubs or delivered to individual homes by the meals-on-wheels service; payment is also made for the acquisition and upkeep of the vehicles used for delivering meals. In 1966/67, 3 new vans were purchased to enable new services to be provided to elderly people living in the Biggin Hill and St. Paul's Cray areas and to augment the existing services in Bromley and Chislehurst. There are now 12 vehicles operating the mealson-wheels service in the Borough. In 1966/67, 95,426 meals were provided at luncheon clubs or by the meals-on-wheels service. The Old People's Welfare Committees in the Borough work in close relationship with the Women's Royal Voluntary Service and the British Red Cross Society in carrying on the meals service. The grant to the Old People's Welfare Committee provides for assistance in the running costs of day centres as well as the boarding-out scheme, and holidays for the elderly. 126 PROVISION FOR THE HOMELESS Temporary Accommodation 47. The policy of the Council in providing separate units of accommodation for homeless families was continued during the year. The special arrangement with Kent County Council whereby families from the London Borough of Bromley were accommodated at King Hill Hostel, West Mailing, came to an end on 31st March, 1967. There were 3 families at King Hill Hostel on 1st April, 1966, and a further 7 families were admitted during the year. Of these 10 families, 1 family found their own accommodation and the remaining 9 families were transferred into family units in the Borough. 48. Family unit accommodation in the Borough increased from 7 properties at 1st April, 1966, to 11 properties at 31st March, 1967. At the beginning of the year there were 3 families in units in the Borough and a further 8 families were admitted into family units during the course of the year, in addition to the 9 families transferred from King Hill Hostel. The Housing Department provided permanent housing accommodation for 8 families and 1 family were able to make their own arrangements. Thus, at 31st March, 1967, there were 11 families in temporary accommodation and all these were accommodated in family units within the Borough. STATISTICS King Hill Hostel Admissions Discharges Families accommodated at 1.4.66 3 Making their own arrangements 1 Families admitted during the year 7 Transferred to family units 9 10 10 Family Unit Accommodation Admissions Discharges Families accommodated at 1.4.66 3 Families rehoused by Housing Dept. 8 Families transferred from King Hill Hostel 9 Making own arrangements 1 New admissions during year 8 20 9 Families remaining in accommodation at 31st March, 1967 11 49. In the year 1965/66, 27 families had been provided with temporary accommodation, whereas in 1966/67, 12 fewer families —a drop of 45%—were accommodated. 127 Prevention 50. Just as the number of families provided with temporary accommodation was less in 1966/67 than in 1965/66, so also was the number of families dealt with by social welfare officers. In 1965/66, 134 families applied for temporary accommodation compared with 78 families in 1966/67. The percentage of applicants admitted to temporary accommodation in the two years, however, did not vary greatly—20% in 1965/66; 19% in 1966/67. 51. The reduction in the number of families rendered homeless in the Borough can probably be attributed to the greater security given to tenants by the Rent Act. 1965, and the close liaison between the social services departments in preventing homelessness arising. It is difficult to assess the number of family units required without relating this to the general shortage of housing accommodation and eliminating the elements of deterrence or rationing which are inescapable when demand exceeds the supply. 52. The policy of the Borough was re-examined in January, 1967, by a Joint Committee of the Housing and Welfare Committee. It was agreed that families would not be rehoused by the Housing Department following eviction from non-local-authority properties, except in exceptional circumstances. They would first be the concern of the Chief Welfare Officer whose responsibility it would be to determine whether temporary accommodation was to be provided. Those families who were evicted by the Housing Committee would also be the concern of this department. However, evictions for non-payment of rent are often avoided by a rent guarantee made by the Children's Committee under the Children's Act, 1963. Arrangements for early notification of families at risk, introduced when the Secretary to the Social Services Liaison Committee was appointed, also gave greater opportunities to officers in the social service departments to prevent homelessness arising. WELFARE SERVICES FOR THE PHYSICALLY HANDICAPPED (GENERAL CLASSES) The Register 53. The Register is kept in accordance with the requirements of the Ministry of Health. The grouping of disabilities is in accordance with the Medical Research Council code of diseases and disabilities as used by the Ministry of Labour. A further 102 persons were assisted under the scheme during the year—the majority of the new registrations were 34 in category F (arthritis and rheumatism) and 38 in Category V (organic nervous diseases). Social Welfare 54. Visits by social welfare officers to the homes of handicapped 128 persons in order to give advice and guidance on services available to them or with personal problems totalled 1,829 during the year This represents an increase of 65% over the previous year. Transport 55. Special transport facilities, in the form of vehicles fitted with hydraulic lifts to take wheelchairs, were made available during the year by the local authority and by voluntary agencies. The Welfare Services Sub-Committee provided a vehicle capable of carrying 12 persons or 6 persons and 3 in wheelchairs. The Bromley Old People's Welfare Committee was presented with a mini-bus fitted with a tail lift by the Council of Youth in May, 1966. The Multiple Sclerosis Society acquired a converted bus, and the Beckenham Old People's Welfare Committee purchased a van adapted for the same purpose. In addition to this, loan sanction was given by the Ministry of Health for a second vehicle to be acquired by the Welfare Services Sub-Committee. The British Red Cross Society and also the Orpington Old People's Welfare Committee were planning to purchase similar vehicles. Co-operation between voluntary organisations in the Borough and the local authority was aimed at ensuring the maximum use of all these vehicles. The department's vehicle travelled 15,918 miles throughthe year and carried 6,083 passengers. Adaptations 56. Adaptations to the homes of handicapped persons were made in 50 cases during the year at a total cost of £1,285. Assistance was given by the provision of access runways for invalid tricycles and adapted cars, the conversion of steps into ramps for wheelchairs, adaptations to toilets and the provision of grab-rails and pulleys. 57. In co-operation with the Housing Department, one severely disabled war pensioner was assisted to move into a specailly adapted bungalow. Certain works were carried out to enable the man to live effectively in his new home and the cost of the welfare element of the work was borne by the Welfare Services SubCommittee. In another case a man confined to living his daily life in a wheelchair was provided with a Remploy Bath Aid which he can operate unaided. 58. Persons who receive assistance under this scheme are assessed to ascertain whether any or all of the cost of the work involved can be recovered. Some opposition to the imposition of a "means test" has been met and the social welfare officers have experienced some difficulty in maintaining satisfactory relationships because of the necessity for detailed assessments. Personal Aids 59. A total of 291 personal aids, including walking frames, pick-up sticks, bath mats and various toilet aids have been supplied as well 129 as the more expensive aids such as Easi Carri hoists, Amesbury Chairs for spastic children, and geriatric chairs for the elderly disabled. The total expenditure on these aids was £1,200. 60. In contrast to adaptations to property, no charge is made for the supply of personal aids. These are issued on permanent loan and are recovered by the department when the client has ceased to use them. 61. Aids were also supplied by the British Red Cross Society— these are essentially nursing aids and wheelchairs. Liaison between the Society and the department prevented any overlapping in providing these services. In order to assist the British Red Cross Society in this work a grant of £150 was made by the Council. Occupation in the Home 62. The three occupation officers of the department maintained a continuing service to 185 handicapped persons in their homes, an increase of 34 over the previous year. Outwork was collected from local firms and distributed to a greater extent. The repetitive nature of the simple assembly jobs does not appeal to everyone and the cash rewards are minimal—but 38 clients were provided with outwork during the year. A wide range of handicraft activities was undertaken by 147 clients, 22 of whom were not able to produce saleable articles. The disposal of products was assisted by the Annual Autumn Fair organised by the Bromley Council of Social Service and held at the Congregational Church Hall in Widmore Road, Bromley. Holidays 63. A change of environment for a brief period is beneficial for everyone, but when physical handicaps prevent people from enjoying the ordinary facilities of travel, accommodation and entertainment, special arrangements need to be made in order to enable them to have a holiday. The department increased its service to registered disabled people during the summer months of 1966/67 but the problem of locating suitable premises remained. A total of 65 people including one family had a week's holiday at a hotel in Ramsgate. Volunteers from the British Red Cross Society and welfare assistants from the department's staff went to give personal assistance. A further 7 disabled persons were sent individually to other centres. The total amount spent on this service in 1966/67 was £657 6s. 3d. including £52 on the provision of transport. The co-operation of the officers of the local divisions of the British Red Cross Society was valued highly and much appreciated. Club Activities 64. The British Red Cross Society continued its valuable work in running clubs for disabled persons. Details of these were given in last year's Report. 65. The Good Companions Club at Penge celebrated its first 130 birthday in 1966, and the members of the club were congratulated in building a firm foundation for the future. The Welfare Services Sub-Committee pays the rental of the room at the Melvin Hall, Penge, where the club holds its meetings at fortnightly intervals. In addition, a grant of £25 is made annually to help club activities. 66. The Bromley branch of the Multiple Sclerosis Society which was formed in March, 1966, has developed its activities during the year. With the support of the national body, ambitious plans are being made for the benefit of persons with multiple sclerosis. A senior social welfare officer serves on the Executive Committee of the local branch. WELFARE SERVICES FOR THE BLIND AND PARTIALLY SIGHTED Certification 67. 100 persons were examined for the first time by consultant ophthalmologists during the 12 months ended 31st March, 1967, and a further 30 re-examinations were made. The total fees paid amounted to £528 10s. 3d. First examinations accounted for £435 10s. 3d. of this amount, and the remainder, £93, was for re-examinations. Eight persons were considered not to be certifiable as blind or partially sighted and their names placed on the Observation List. Register of the Blind 68. After adjustments for new registrations, transfers and deletions from the register, there were 474 persons on the register on the 31st March, 1967—a net increase of three on the previous year. The number of registered blind males fell from 164 at 31st March, 1966, to 157 on 31st March. 1967, whilst the number of registered blind females rose from 307 to 317 during the same period. If the number of registered blind persons per head of population in the London Borough of Bromley was to conform to the pattern of the national register, there would be an increase of 154. Distribution in Age Groups (Blind Persons) 69. There was no change in the group 0-5 ((1), but there were increases in the age groups 6-15 (8-9), 16-20 (8-9), 50 and over (399-405) and a decrease of 5 persons in the group 21-49 (55-50). Over the 12-month period there was no significant increase or decrease in any group. The national statistics indicate that the registration of persons over 70 will continue to increase due to more people enjoying a longer span of life. At the other end of the scale the trend is for the number of children under 10 registered as blind to rise; regrettably some of these children will have handicaps additional to defective vision. As medical knowledge increases the survival rate of multiple-handicapped children will be higher. 131 Classification of Blind Persons Children at School 70. Fortunately in the London Borough of Bromley there are few children requiring education at a school for the blind. Of the children at school one boy was at Worcester College for the Blind which is a Secondary Grammar School; the other boy was receiving secondary modern education at Linden Lodge School, Wimbledon, and a girl at Dorton House, Seal, Nr. Sevenoaks, Kent. During the year ended 31st March, 1967, three children left school for further training or employment; eight children, being mentally retarded, were unsuitable for education at school. Of these children, five were patients in hospitals for the mentally subnormal and the remaining two lived at home. Employed 71. Where possible blind persons are trained for and ultimately placed in open industry. Traditionally, blind persons gain employment either in special workshops or as home workers. In the London Borough of Bromley at 31st March, 1967, one blind female was employed as a machine knitter in a workshop, one female was similarly employed as a home worker and three male home workers were piano tuners. The male home workers are approaching retiring age and it is not anticipated that they will be replaced. 72. At 31st March, 1967, 41 males and 14 females were employed in open industry in a variety of jobs. These cover a cross section of industry and range from an unskilled labourer to machine operatives and office workers through to professional workers. A detailed analysis of occupations for blind persons was given in the previous annual report. Unemployed 73. The majority (333) of the 403 unemployed blind persons were over the age of 65. Of the remaining 70, 37 were housewives, 12 mentally ill, 12 physically disabled, 4 employable with or without training, and 5 not available for employment. Register of the Partially Sighted 74. After adjustments for new registrations, transfers and deletions from the register, there were 184 persons on the register as at 31st March, 1967—a net increase of 12 on the previous year. The number of registered partially sighted males increased from 59 at 31st March, 1966, to 63 at 31st March, 1967, and in the same period the number of partially sighted females also increased from 113 to 121. Potentially an increase in the partially sighted register is reflected in an increase in the blind register as the residual vision of a partially sighted person often deteriorates. It is interesting to note that at 31st March, 1967, the local register was exactly in line with the national register of partially sighted persons. 132 Distribution of Age Groups (Partially Sighted) 75. There were increases in the age groups 1-4 (1-2), 21-49 (23-29), 65 and over (111-120), no change in the group 5-15 (10) and decreases in the groups 16-20 (9-7) and 50-64 (18-16). The most significant change was in the group 65 and over, a trend which was not unexpected and is likely to continue. Classification of Partially Sighted Persons 76. Of the 12 children under 15, two were babies living with their parents, seven attended special schools for the partially sighted, one was able to benefit from education in an ordinary school, and two (being mentally retarded) were unsuitable for education at school. Employed 77. At 31st March, 1967, 29 partially sighted persons were in gainful employment. A partially sighted person can compete on equal terms with his fully-sighted colleagues in industry providing certain precautions are taken. An example of this is where a partially sighted person with a fair margin of sight can be employed as a clerk in a well-lit office providing he is given guidance on mobility which can be particularly difficult after dark. Unemployed 78. Of the total of 109 unemployed, 27 males and 78 females were over age 65, and three males and one female were available for and capable of work. 31 persons were classified as requiring observation only. Visitation by Social Welfare Officers 79. A total of 1,639 visits was made by social welfare officers for the blind during the 12 months ended 31st March, 1967. Home Teaching Craft and Embossed Types 80. During the 12 months ended 31st March, 1967, 189 lessons were given by social welfare officers in a person's own home, viz.: (a) Braille 114 (b) Moon 47; (c) Handicrafts 28. Of the persons receiving instruction in Braille and Moon, one person achieved Grade 2 standard in Braille and two persons completed Grade 1 Moon. One partially-sighted man, in conjunction with his Braille lessons, received instruction in typing. Deaf /Blind 81. One registered blind woman who is also deaf attended the annual rally of Deaf/Blind Persons at Peterborough. This event is organised by the National Deaf/Blind Helpers League. She also was a guest at the Deaf/Blind Christmas luncheon held at Maidstone and organised by the Kent Association for the Blind. 133 Handicraft Classes 82. Handicraft Classes continued to be held regularly at the Centres listed in the previous Annual Report. Traditional crafts such as basketry, knitting, seagrass seating, continue to be taught at the handicraft classes. Attempts were made to stimulate interest in handwork by introducing new ideas, e.g. making Christmas Crackers and Link Mats. Sheltered Employment 83. One female blind worker was employed 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 period was £313 9s. 1d. Home Workers Scheme 84. At 31st March, 1967, there were three blind male piano tuners and one blind female machine knitter employed under the Home Workers Scheme. The total augmentation for these workers amounted to £955 8s. 1d. The Borough also paid a fee of £60 per worker towards administrative costs. 75% of expenditure of administrative costs of Homeworkers Schemes is payable by the Ministry of Labour up to a maximum of £40. Residential Accommodation 85. The number of registered blind and partially-sighted persons resident in home as at 31st March, 1967, was as follows:— In Homes for the Blind 1 Male 9 Females In other Homes: Blind 3 Males 25 Females Partially sighted 2 Males 20 Females National Library for the Blind 86. The number of blind persons who were members of the Library at 31st March, 1967, was 28, and the cost to the London Borough of Bromley for such membership was £3 per person per annum. Nuffield Talking Book Library 87. 136 residents of the London Borough of Bromley were in possession of talking book machines at 31st March, 1967. The cost of renting a talking book machine is £3 per annum plus 5s. Od. if headphones are used. 93 persons pay the rental themselves or have it paid by a relative; 27 who have limited means have all or part of their rental paid by Kent Association for the Blind; 8 are St. Dunstaners and therefore are not asked to pay the rental and 8 are not yet on a rental basis but using the disc machines. Social Rehabilitation 88. During the period under review, it was not considered necessary to send anyone for social rehabilitation. One blind 134 wife with young children continued to attend the Warwick Row Rehabilitation Centre in the City of Westminster. The charge for attendance is 3s. Od. per day plus the cost of travelling expenses, the cost to the London Borough of Bromley being £63 for the year. Kent Association for the Blind 89. This Association, through its many services, continued to give excellent support to the blind and partially sighted. Their all-yearround sales service of goods made by blind and partially sighted persons is of particular value. A number of blind and partially sighted persons, either individually or in groups, took their annual holiday at Merrell House Holiday Home for the Blind at Cliftonville. A nominal grant of £10 per annum was made to the Association by the London Borough of Bromley. A list of Clubs for the Blind affiliated to the Kent Association for the Blind was given in last year's Annual Report. Social Activities 90. During Easter week a party of blind persons enjoyed a group holiday at Merrell House, the Holiday Home for the Blind at Cliftonville, although the weather was appalling. A social welfare officer, assisted by a trainee welfare officer, accompanied the group. In the summer of 1966 the individual Clubs for the Blind organised day outings to the seaside for their members. Other social outlets through the clubs included participating in the Annual Church Service for the blind of Kent at Margate and the dominoes, cribbage and quiz competitions. The church service and the competitions are arranged by the Kent Association for the Blind. 91. In September an experimental course in pottery for blind persons was commenced. Weekly classes were held at the Raglan Road School for Boys, Bromley, on Wednesday evenings. The course proved to be very popular and was extended to cover the winter months. 92. On the 12th October parties of blind and partially sighted people from Bromley, Chislehurst, Beckenham, Penge and Orpington attended Kent Association for the Blind's Annual Exhibition and Sale of Work. For the first time, blind and partially sighted persons in the London Borough of Bromley combined with the physically handicapped in providing articles for sale at the Combined Charities Fair held at the Congregational Church, Bromley, on the 22nd October. At the end of November another joint enterprise was a Sale of Work held for the Council's staff in the Staff Room at Bromley Town Hall. During December most of the elderly blind and partially sighted had an opportunity of attending one or more of the Christmas parties held. 93. On the 18th January members of the local clubs for the blind were the guests of Kent Association for the Blind at the New Year 135 Party held at Maidstone. This annual event is very much appreciated as the entertainment is provided by professional artists well known on television and radio. 94. On the 2nd March a sale of goods made by the blind organised by the Royal National Institute for the Blind Home Industries Department was held at Beckenham. Ministry of Labour 95. The staff of the department work closely with the blind persons resettlement officer and the local disablement resettlement officers employed by the Ministry of Labour. In the period under review arrangements were made for three newly-registered blind persons to attend a course of industrial rehabilitation at Torquay. One of these has been reinstated with his former employers following the course, a second terminated his course at the end of March, 1967, and has not yet been placed in suitable employment, and the third person concerned commenced his three months' course at Torquay on 30th March, 1967. St. Dunstaners 96. The number of St. Dunstaners registered in the Borough is 15, 11 of whom are in employment and 4 over 65 years of age. British Wireless for the Blind Fund 97. During the year many wireless sets were distributed by the Kent Association for the Blind to blind persons without a set of their own. A free repair service is provided by the Association. Any blind person issued with a battery set is entitled to receive two free batteries per annum from Kent Association for the Blind. Guide Dogs for the Blind Association 98. During the 12 months ended 31st March. 1967, one application was made for a Guide Dog but was rejected by the Association on health grounds. Two men and three women in the Borough already have Guide Dogs. Protection of Property 99. 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. It has been necessary to place movable property in store in respect of 5 clients. Burials 100. In carrying out its duty under Section 50 of the National Assistance Act, 1948, the local authority has arranged 4 burials and 2 cremations since 1st April, 1966. SCHOOL HEALTH SERVICE 138 SCHOOL HEALTH SERVICE INDEX Page B.C.G. Vaccination 152 Child Guidance 154 Cleanliness Inspections 146 Clinics 173 Defects—Periodic and Special Medical Examinations 147 Dental Services 165 Diseases of Ear, Nose and Throat 151 Diseases of Skin 152 Employment of Young Children 165 Follow-up Examinations 146 Handicapped Pupils 160 Health Education and Home Safety 170 Health Visiting 144 Independent Schools 148 Infectious Diseases in Schools 152 Intelligence Quotient Tests 165 Page Members of Education Committee 139 Minor Ailments 149 Ophthalmic Clinics 149 Orthopaedic Clinic 151 Orthoptic Clinic 150 Other Inspections 145 Other Medical Examinations 165 Periodic Medical Inspections 145 Physical Education 168 Physiotherapy Clinic 151 Prefatory Letter 140 School Health 143 School Meals and Milk Service 130 School Psychological Service 156 Speech Therapy 153 Special Inspections 145 Special Schools 162 139 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December, 1966) *Alderman C. H. E. Pratt (Chairman) *Councillor Mrs. D. E. L. West, M.B.E. (Vice-Chairman) The Mayor (Councillor F. G. V. Lovell, J.P.) Alderman Mrs. A. L. Gunn, J.P. Alderman E. C. H. Jones, C.B.E., B.Sc. Alderman R. A. Sanderson, J.P. Alderman A. W. Waller *Councillor P. A. R. Allwood *Councillor R. R. Baker Councillor J. F. David *Councillor R. G. Foster Councillor Miss B. James, J.P. Councillor E. J. Lovell *Councillor Mrs. M. C. McClure, B.Sc. *Councillor P. McNally Councillor Miss K. A. Moore *Councillor Miss B. G. Oldham Councillor F. J. Packer, F.C.I.S. *Councillor E. P. Peter Councillor Mrs. L. M. Prince *Councillor A. E. Read *Councillor Mrs. M. Read *Councillor Mrs. O. L. Roberts, J.P. Councillor J. P. Sheridan, A.M.I.E.I. Councillor J. D. Vergette, F.I.M.I. Councillor A. W. Wright Co-opted Members: H. Anderson, M.A., A.Inst.P. J. H. Atkins, J.P. N. K. H. Bailey, B.A., B.Sc. J. Da vies The Rev. Canon T. C. Hammond, M.A. LL.B. A. M. James, B.Sc.(Econ.) *G. R. Lloyd *W. Marsden F. White, M.A. C. E. Wiltshire, J.P. *Denotes members of Primary Education and Welfare Sub-Committee CHIEF EDUCATION OFFICER—G. V. Welbourne, M.A. 140 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the Second Annual Report on the School Health Service of the London Borough of Bromley. Health of School Children It is again reassuring to be able to report to the Committee that the physical condition of school children in the Borough is satisfactory. The contribution of Physical Education to this excellent situation is due in a large measure to the comprehensive system introduced by the Advisers on Physical Education, and I am glad to be able to include for the first time a report from this section of the Education Department. The report speaks for itself and I note with pleasure that the national pre-eminence in swimming of the Borough is now being slowly followed by gymnastics and trampolining. All these activities are positive contributions to the promotion of good health in our school children. Infectious Diseases There was a considerable reduction in the number of cases in all these diseases with the exception of whooping cough, in which there was a slight increase. There was no evidence that the present vaccine against whooping cough is not effective. An investigation of school children and staff who had been in contact with a case of tuberculosis at a school was carried out. No further cases were revealed. Independent Schools Under Section 78 (2) of the Education Act 1944, School Health Service arrangements can be extended to independent schools. Such arrangements have always existed in one part of the Borough but now sufficient independent schools are participating throughout the Borough to enable me to present to the Committee a comprehensive tabular report on defects found on medical inspections at schools in the Borough. A similar preponderance of defects affecting vision, and defects of the ear, nose and throat in these schools was found. Child Guidance The service suffered a great loss by the death of Dr. Judith Waterlow, a dedicated member of the staff who conducted the Child Guidance Clinic in Chislehurst and took an active and popular part in the community work of Voluntary Associations in the Borough. She will be greatly missed. 141 I am glad to welcome Dr. Rodriguez, who as a Consultant Psychiatrist is associated with the child psychiatry work in all the hospitals in the Borough and is now developing the work of this clinic. It is possible to include this year, a more detailed report not only on the work in the clinic but on the home and school visits of the social worker and educational psychologists in relation to cases attending the Centre. Accommodation is difficult and the building is unsuitable for extensive alteration. At the moment no other suitable centre is available in the Borough. School Psychological Service The report refers to the introduction by the Senior Educational Psychologist of a scheme for screening the slow learners of the 4,000 top infant population, and to the success of this scheme the School Psychological Service has greatly contributed. Though the examination of reports by the panels attached to three special schools for educationally subnormal children has led to greatly increased clerical work, the success of the scheme is undoubted and it should now be added to our routine screening procedures. The Committee have authorised the establishment at St. Nicholas of an Assessment Unit for less severely autistic children. More severely autistic children who need assessment and teaching, should receive this within a hospital environment. The report notes the increase in Tutorial Classes and the extension of these to secondary schools. These classes supplement existing provisions in special schools for the educationally subnormal. The need to provide as long a period as possible for assessment, is being met by an increase in the number of special opportunity classes and diagnostic units. The mental health of adolescents is greatly influenced by the adequacy of educational provisions early in their school life. The frequency at this age, of delinquency, truancy, drug taking and other abnormal behaviour is to a large extent controlled by detection and appropriate educational treatment at an early age and throughout school life. The policy of the Committee is to increase local facilities for assessment and treatment of maladjustment and behaviour disorders. The report refers to the difficulty of providing either day or residential treatment, especially for the older child when such establishments are owned by other authorities or voluntary associations. For their economical provision, catchment areas have to be large. Dental Health For the second year a Dental Officer from the Department of Education and Science has visited the dental clinics in the Borough and has commented on various aspects of the developing service. 142 Particular satisfaction was expressed that the pupils of all maintained schools have this year received a dental inspection. These inspections are a statutory requirement and though many children also visit their own dental practitioners for inspection and treatment and are encouraged to make these attendances, they do so at varying intervals often too infrequently. The welfare, equipment and working conditions of the dental surgeons has been the constant concern of the Principal School Dental Officer and as a result, high standards of quality have been maintained. This year the promotion of dental hygiene by personal visits to Welfare Clinics and to Headmasters and Headmistresses of schools has been developed and has supplemented the excellent work of our dental hygienist. The very long-term policy must be to eliminate even the need for a dental conservation service. Health Education Talks on Health Education and Home Safety have been given at schools, meetings of Parent Teachers' Associations, Teachers' Training Colleges, Youth Clubs and other Centres. This work is organised by the Health Education and Home Safety Officer and the Superintendent Health Visitor under the general direction of the Senior Medical Officer. Handicapped Children The appointment of two teachers for the Deaf has enabled a practical start to be made in the comprehensive assessment and educational treatment of deaf children. Arrangements are being made for rooms at a conveniently central clinic to be adapted by sound-proofing to enable examinations and interviews to take place and eventually for a Unit to be established. Hearing aids and auditory trainers are being provided. Special classes are being established in schools to replace those no longer available in schools now sited in other Boroughs, who are also expanding their own services. The Committee are following a policy in line with modern thought, by providing special educational treatment, as far as possible, in normal schools, for those educationally normal but otherwise handicapped. Assistant School Medical Officers and Health Visitors are learning new specialist skills in the earlier ascertainment of defects, especially of sight and hearing and of those arising from developmental defects and are keeping abreast of current research and knowledge. 143 This report has been compiled by many contributors to whom I wish to express my appreciation and thanks. The collation of this report, as well as the detailed day to day administration of the School Health Service, has been carried out by Dr. Carter-Locke, Senior Medical Officer, with the help of the senior administrative staff, to them again I express my appreciation and thanks. In conclusion, I wish to thank the Chairman and members of the Committee for supporting throughout the year various schemes for the consolidation and improvement of the service, the Chief Education Officer, his staff and the Heads of Schools for their valuable advice and assistance in the execution of these schemes, and my staff generally for their diligence and industry throughout the year. L. R. L. EDWARDS, Principal School Medical Officer SCHOOL HEALTH There are 35 secondary (including 2 direct grant) and 81 primary schools in the Borough; also 3 special schools catering for the educationally subnormal children. In January, 1967, there were 41,917 pupils on the registers of the maintained primary, secondary and special schools. The year 1966 was the first in which the consolidated scheme for undertaking Routine Medical Inspections at schools was operative throughout the twelve months. It would be unrealistic not to admit teething troubles, but there can be no doubt that the difficulties experienced were much less formidable than feared. That such a satisfactory state of affairs now exists is due not only to the efforts of the staff of the Health and Welfare Department, but also to the happy relations which exist between the School Health Section, the Education Department and the Head Teachers of the Schools in the Borough. Many combined operations have taken place, particularly fruitful having been the first discussions on the whole field of "Handicaps" in children. Routine Medical Inspections are now carried out on all pupils in the following age groups:— Entrants to Infants' Schools; at 10 years of age and at 14 years old. In addition, at 8 years of age pupils are given routine tests of vision and hearing only. A full medical examination is however, undertaken at this stage if for any reason it appears necessary. If at any time during a child's school career the Head Teacher. Parent or Doctor is concerned about the health of a particular 144 child, arrangements are made for a special examination to be carried out. The number of children examined during the year in the routine age groups was 12,798. As a result of these examinations the physical condition of only two pupils (.02%) was found to be unsatisfactory, and 2,674 pupils (20.9%) were found to require treatment. The Health Visitor in the School Health Service In 1966 the Health Visitors have assisted at 1,117 School Medical Inspections. An increase in the number of School Medical Inspections has occurred as 11 additional Independent Schools have taken advantage of the service, and the organisation of these sessions in the schools has been carried out by the Health Visitors. Vision testing for all children due for Medical Inspection, and all children in their 8th year has also been the Health Visitors' responsibility. 29,767 children have been examined at routine Hygiene Inspections and parents have been advised in dealing with 178 infested heads and 581 treatments for veruccae have been given at the parents' request. Liaison has been improved this year with the Education Welfare Officers and the Children's Officers, but owing to increase of other work the Health Visitors have not been able to extend the Health Education programme as was planned. 145 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (Including Nursery and Special Schools) PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of Pupils who have received a full medical examination Physical Condition of Pupils Inspected No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory No. Unsatisfactory No. (1) (2) (3) (4) (5) (6) (7) (8) 1962 and later 90 90 — — 2 11 12 1961 2,645 2,645 — — 83 321 388 1960 2,210 2,208 2 — 141 349 466 1959 247 247 — 168* 23 43 64 1958 57 57 — 3,752* 16 7 23 1957 22 22 — 12* 2 3 4 1956 3,021 3,021 — — 290 332 618 1955 99 99 — — 5 4 8 1954 77 77 — — 6 8 14 1953 58 58 — — 8 8 14 1952 2,964 2,964 — — 384 367 720 1951 and earlier 1,308 1,308 — — 207 160 343 TOTAL 12,798 12,796 2 3,932* 1,167 1,613 2,674 Col. (3) total as a percentage of Col. (2) total .99*98% Col. (4) total as a percentage of Col. (2) total .02% *Test of vision and Hearing only at the age of eight years. 105 pupils referred for treatment because of visual defects. 12 pupils referred for treatment because of hearing defects. OTHER INSPECTIONS Number of Special Inspections 416 Number of Re-inspections 2,308 Total 2,724 Special Inspections Special examinations are arranged at any time during a child's school career if the Head Teacher, parent, family doctor, or health visitor is concerned about the health of a particular child. A total of 416 special inspections were carried out during the year and the principal defects discovered concerned vision and hearing. 146 Follow-up Examinations Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. Cleanliness Inspections These inspections are carried out by the Health Visitors. Children in the Infants Departments are inspected during the first six weeks of each term. Inspections in the junior and secondary schools are also carried out each term unless clear inspections are reported for three consecutive terms. In addition to the above, inspections are carried out at any time if and when necessary. (a) Total number of individual examinations of pupils in schools by Health Visitors 29,767 (b) Total number of individual pupils found to be infested 178 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 9 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 147 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total 4 Skin T 107 136 93 336 5 O 37 50 25 112 2 5 Eyes—a. Vision T 249 591 327 1167 31 O 636 236 312 1184 19 b. Squint T 58 31 20 109 1 O 9 8 4 21 — c. Other T 18 2 12 32 — O 8 17 13 38 1 6 Ears—a. Hearing T 42 18 19 79 4 O 128 24 82 234 13 b. Otitis Media T 22 1 1 24 — O 43 6 5 54 1 c. Other T 6 2 4 12 — O 15 4 6 25 2 7 Nose and Throat T 145 42 37 224 4 O 234 16 30 280 6 8 Speech T 38 8 7 53 2 O 103 10 13 126 1 9 Lymphatic Glands T 4 — 1 5 — O 118 7 18 143 1 10 Heart T 14 10 2 26 2 O 41 11 18 70 2 11 Lungs T 67 17 30 114 3 O 95 27 24 146 4 12 Developmental— T 18 3 6 27 — a. Hernia O 11 5 6 22 1 b. Other T 13 20 23 56 — O 112 27 52 191 3 13 Orthopaedic— T 3 63 7 73 — a. Posture O 14 59 55 128 5 b. Feet T 44 87 53 184 — O 85 68 43 196 2 c. Other T 38 37 41 116 2 O 134 50 38 222 2 14 Nervous System— T 8 3 7 18 1 a. Epilepsy O 6 2 3 11 1 b. Other T 6 12 3 21 — O 33 7 12 52 4 15 Psychological— T 3 1 4 8 2 a. Development O 47 11 30 88 14 b. Stability T 22 9 14 45 3 O 257 30 121 408 21 16 Abdomen T 12 6 10 28 3 O 44 8 14 66 4 17 Other T 7 12 4 23 1 O 30 43 47 120 6 T=TREATMENT O=OBSERVATION 148 Independent Schools It is possible for Independent Schools, which so desire, to participate in the School Health Service. At the present time 18 such schools take advantage of the facilities offered by the Service. Subject to their parents' consent, pupils attending these schools receive periodic medical examinations, and also have the advantage of access, where necessary, to the specialist clinics. Arrangements are also made as and when necessary for the special examination of any child. During the year 523 children in the various age groups were medically examined, and a further 50 children received tests of vision and hearing only. Further details, with a summary of the various defects found at these examinations are as follow:— Number of schools visited 15 Number of medical inspection sessions held 31 Number of children who received a full medical examination 523 Number of children who received tests of vision and hearing only 50 The physical condition of all the children who received a full medical examination was satisfactory. 149 TABLE OF DEFECTS FOUND BY MEDICAL INSPECTION INDEPENDENT SCHOOLS Number of Defects Requiring T reatment Requiring Observation Skin 6 8 Eyes—Vision 55 38 Squint 3 1 Other — 1 Ears—Hearing 1 4 Otitis Media 5 2 Other — — Nose and Throat 10 10 Speech 1 3 Lymphatic Gland — 2 Heart — 1 Lungs 3 2 Developmental—Hernia — — Other 2 4 Orthopaedic—Posture 2 3 Feet 6 6 Other 3 12 Nervous System—Epilepsy 2 — Other — 3 Psychological—Development . — 1 Stability — 6 Abdomen 3 4 Other 1 4 103 115 Minor Ailments Minor ailments are treated by the Health Visitors at the Clinics, or at a school if requested by the Head Teacher. These arrangements are found to avoid loss of school time which would otherwise be inevitable. During the year a total of 646 pupils was treated. Treatment of Pupils EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 23 Errors of refraction (including squint) 4,411 Total 4,434 Number of pupils for whom spectacles were prescribed 1,406 150 Ophthalmic Clinics These Clinics are situated at Beckenham, Bromley, Chislehurst, Orpington, Penge and St. Paul's Cray. A total of 10 weekly sessions is held at these centres. In addition a session is held every other week at Bromley. A total of 589 new cases and 3,845 re-examinations was seen at the Clinics, and spectacles were prescribed for 1,406 pupils. The attendance at these Clinics is on the whole very good and it was again possible for both new cases and re-examinations to be seen without any undue delay. The importance of the Ophthalmic Clinics cannot be over stressed as unchecked defects of vision can have serious effects on a child's scholastic achievements. Orthoptic Clinic Patients seen at this Clinic, which is held at Bromley North, are always sent by an Ophthalmologist. The following types of cases are referred:— (a) Cases of obvious strabismus or squint. (b) Patients suspected of having a strabismus. (c) Amblyopic patients. (d) Patients with any ocular muscle imbalance. (e) Patients who are complaining of ocular symptoms, the cause of which is not obvious to the Ophthalmologist. Details of treatments and attendances are as follow :— Number of new cases 38 Number on treatment 84 Number on occlusion 101 Number of treatments given 148 Number of cures with operation 5 Number of cures without operation 8 Cases discharged—cured (a) Functional for binocular single vision 7 (b) Cosmetic 6 Unsuitable cases 2 Total Number of attendances 711 Number failed to attend 22 Transferred or left the District 7 Number of sessions 187 Number on waiting list at 31.12.66 4 Patients not living in the area served by this clinic are seen at the nearest local hospital. 151 Diseases and Defects of Ear, Nose and Throat Number of cases known to have been dealt with Received operative treatment:— (a) for diseases of the ear — (b) for adenoids and chronic tonsilitis 580 (c) for other nose and throat conditions 19 Received other forms of treatment 8 Total 607 Total number of pupils in schools who are known to have been provided with hearing aids :— (a) in 1966 10 (b) in previous years 61 Orthopaedic Clinic The Clinic is situated at Bromley North and caters for the surrounding population. Other parts of the area are covered by various Hospital Out-patient Departments. The main defects seen at these clinics were minor deformities of the feet with minor back deformities taking second place. The attendances at Bromley North were very good and the clinic is held according to need, which is approximately once a month. Physiotherapy Clinic Cases are treated at the Bromley North and Beckenham Town Hall, Clinics and at Hospital Out-patient Departments. The majority of cases attending for treatment were referred direct from the Orthopaedic Consultant. Cases of general debility were referred to the clinics for a course of sunlight. A total of 848 attendances was made at the two clinics, and of these, 480 were for remedial exercises, etc., and 368 for sunlight. Orthopaedic and Postural Defects Number known to have been treated (a) Pupils treated at Clinics or Out-patients Departments 305 (b) Pupils treated at School for postural defects 6 Total 311 152 Diseases of the Skin (excluding uncleanliness) Number of pupils known to have been treated Ringworm—(a) Scalp — (b) Body — Scabies — Impetigo — Other skin diseases 378 Total 378 B.C.G. Vaccination In the effort to eradicate tuberculosis, B.C.G. vaccination is undertaken with parental consent, on children in the 13-14 year age group, who are found to need this form of protection following upon a skin test. In addition, those who are shown by the skin test to need further investigation are referred to the appropriate Chest Clinic, with the approval of the family doctor. During the year, 4,167 children received a skin test and the 3,488 negative reactors received B.C.G. vaccination. Of the 469 children who were found to have a positive reaction to the skin test, 201 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 268 children who gave a positive reaction because of previous B.C.G. vaccination. Precautionary investigations of school children who may have been in contact with a known case of tuberculosis were carried out. Of the total of 154 children who were given a skin test, 30 were found to be positive and referred for further investigation. Members of the school staff were given the opportunity of having a Chest X-ray. Infectious Diseases in Schools 583 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as below:— Disease Total No. of Cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Scarlet Fever 71 18 19 10 24 Measles 440 44 83 75 238 WhoopingCough 50 1 6 18 25 Dysentery 10 4 1 2 3 Pneumonia 10 7 3 — — Food Poisoning 2 — — 2 — Totals 583 74 112 107 290 153 Speech Therapy During this year in addition to the Senior Speech Therapist there was only one full-time therapist in Bromley until November when a full-time therapist was appointed to Beckenham and another part-time therapist was appointed to Chislehurst leaving only one part-time appointment vacant, the other appointments being "frozen" until 1968. Nevertheless 276 children were treated in the Clinics including three pre-school deaf children. 51 children were seen in the Special Schools and 63 children on the waiting list were interviewed bringing the total of children seen to 390. Of the 276 children treated in the Clinics the case distribution was as follows:— Stammering 49 Dyslalia 129 Retarded speech and language development 34 Cleft palate (repaired) 7 Dysarthria 1 Motor aphasia 2 Dysphonia 2 Deaf 14 Interdental speech 27 Lateral sigmatism 9 Inadequate nasopharyngeal closure 2 Total 276 186 cases were closed for the following reasons:— Improved 100 Reported to be no longer in need of therapy 12 Unlikely to benefit further 5 Family removed from area 20 Ceased attendance 28 Being treated elsewhere 6 Refused appointments 13 Left school 2 Total 186 At the close of the year the waiting list stood at 175 including 37 priority cases. It must be stressed that this service is still under strength and that to cover the Borough adequately not only more therapists but more Clinics are required. The therapists endeavour to work closely with the schools but with the long waiting lists at each Clinic are unable to make more 154 than one or two school visits a month. Similarly home visits are of necessity restricted in number. The relationship between retarded speech and language development and difficulties with reading and spelling has long been appreciated by speech therapists, and discussions have already taken place with the teachers of the Special Tutorial Classes to ensure that the two departments work closely together. Child Guidance Through various sources, principally the schools, cases of psychological disturbances come to light and are referred, if necessary, to the appropriate Child Guidance Clinic. These Clinics which are spaced throughout the District, are staffed by the Regional Hospital Board and are held in Hospital premises except that at "The Willows", Red Hill, Chislehurst, which is held in the Council's own premises. The remaining Child Guidance Clinic sessions are held at Farnborough Hospital, Stepping Stones House, Bromley Hospital, and at Sydenham Hospital, which serves the Borough of Bromley although it is without its geographical limits. A number of psychiatrists have been concerned at the different Clinics, but in December the Regional Hospital Board appointed one Consultant, Dr. R. Rodriguez, who will work at all the Clinics as from March, 1967. The Clinic suffered a great loss with the untimely death of Dr. Judith Waterlow in February. Dr. R. Rodriguez was appointed Locum-tenens for two sessions per week in March and was appointed Consultant Psychiatrist in December. I am grateful to Dr. R. Rodriguez, Consultant Psychiatrist, for the following report in respect of the Chislehurst Child Guidance Clinic:— The turnover of patients during the year has been slightly higher than in 1965. Mrs. Preston and Mrs. O'Kelly, the Educational Psychologists, have continued their work as in previous years. Apart from psychological assessment in the Clinic, visits were paid to schools in respect of children attending the Clinic. In the absence of a trained child play therapist it was fortunate that Mrs. O'Kelly could undertake the therapy of some cases whilst their parents were being seen by me. The Social Worker, Miss Courtney, who had been working at the Clinic since 1964, retired in September, 1966, and was replaced by Mrs. Cameron, who apart from her duties as Mental Welfare Officer was able to give four weekly sessions to this Clinic. 155 Lack of sufficient accommodation has become, if anything, more pressing, due to the increased number of cases, the greater use of the Dental Clinic and the expanding activity of the School Psychological Service. Some of the play material was replaced during the year and the Clinic was provided also with an Enurex Machine. Co-operation with outside agents has continued as in previous years as a regular part of the responsibilities of the Unit. It is thus hoped to enhance co-operative relationships with others who work with children and to promulgate further knowledge of the working of the Child Guidance Clinic. Some Paediatric House Physicians and also students of the Institute of Education and one student of Psychology visited the Clinic. Details of referrals and attendances during the year are as follow:— Sixty-four new patients from the Borough have been investigated and taken on for treatment. A total of 81 referrals was received compared with 60 during the previous year. A higher proportion of the cases was referred by the general practitioners. The total number of new patients taken on for treatment during each month has been as follows:— January 4 July 7 February 3 August 4 March 7 September 2 April 1 October 10 May 4 November 7 June 8 December 7 Waiting List—as at 31.12.66 (i) Awaiting first interview 18 (ii) Interviewed and awaiting treatment Nil Number of cases attending Clinic at end of year:— (i) Active 115 (ii) Periodic review 18 Number of cases closed 44 Number of applications withdrawn 6 (failed repeatedly to attend for diagnostic interview) Number of Home Visits by:— Social Worker 14 Educational Psychologists — Other Staff — Number of School Visits by:— Social Worker 6 Educational Psychologists (for Clinic cases) 12 Other Staff — 156 School Psychological Service I am grateful to Mrs. P. Preston, Senior Educational Psychologist, for the following report:— This year the demands on the School Psychological Service have shown a healthy growth which although desirable, have taxed the two Educational Psychologists very heavily indeed. There has been the usual number of individual investigations carried out. Some 370 children of all ages were examined in the schools and another 300 children were seen at the various Child Guidance and Hospital Clinics. In addition to this normal load the School Psychological Service has contributed extensively to the Borough's experimental procedure for the early detection, examination, and consideration of the slow learners amongst its 4,000 top infant population. This experimental procedure together with the formation of a Panel system has brought the Assistant Medical Officers, the Head Teachers, and the Educational Psychologists in a unique working situation of close co-operation which should prove most rewarding. As a result of the experiment the School Psychological Service has had to investigate individually some 300 seven-year-old children and 200 of those would have been considered by the Panels of Assistant Medical Officers, Head Teachers and Educational Psychologists. The School Psychological Service has appreciated the help of the Assistant Medical Officers in this project. Apart from the undertaking of individual investigations, the School Psychological Service has advisory and counselling responsibilities with respect to the various special units within the Borough, and these too are growing. The Leeson's Infant Opportunity Class was first started by the Head Teacher of the School, Mrs. Welbourne, four years ago. It is now well established and caters for 10 to 12 children from 5-7 years old who have various educational, social and psychological difficulties. Next year another Infant Opportunity Class will become fully operative in the summer term at Ramsden Infant School. Mrs. Peirse the Head Teacher of the School will have 10 children on roll and the School Psychological Service will advise on selection to the class. The Goddington Infant Diagnostic Unit was started three years ago and caters for 10 children of Infant School age who are borderline educable. With three years of experience to back him, Mr. Anderson, the Head of School, now considers that it would prove advantageous to extend the scope of the class so as to include children with a wider range of handicap and to perhaps lower the age of entry. His proposals need consideration. 157 For the past five years Mr. Spencer the Head Teacher of St. Nicholas School, has admitted some autistic children to his Day School for educationally subnormal children and has integrated them within the school with a good degree of success. It is now proposed to establish at St. Nicholas an assessment unit for the somewhat less severely autistic children. The unit would be used as an aid to help the integration of the autistic children within the school. The Tutorial Classes run by Mrs. Waite and Mr. Thomas have 70 children at present on roll, attending on a part-time basis. The classes originally for primary school children with learning difficulties are now extending to secondary school children as well. The establishment has been increased by one additional teacher, Mr. Rogers. The School Psychological Service is responsible for the selection of the children and supervises their progress. The Phoenix Spastic Centre at Farnborough Hospital has 37 children on roll. This number includes some very young babies. The teaching section of the centre under Mrs. Turner has two parttime assistant teachers. They have 21 children on roll, ranging from 3 to 7 years. The children attend on a part-time basis starting with two days a week at the age of 3 years and gradually building up to full-time attendance ot the 5-year level. There are at present 9 children receiving full-time education at the Phoenix Centre. The learning difficulties of spastic children are indeed complex, and careful and lengthy psychological investigations are essential. The Maladjusted Class at Stepping Stones, Bromley Hospital, was a new venture started last year with Miss Johnson, teacher in charge. Children attend on a part-time basis. At present there are 13 children on roll. The class is designed to help children resolve their problems of impaired social and emotional adjustment and aims at rehabilitating them as quickly as possible so that they may resume attendance at their ordinary schools without great difficulties. Here too Psychological monitoring is required, and the Borough envisages further development of such classes. During this year two teachers for the Deaf were appointed for the Borough, and a day unit for the partially-hearing is to become operative very soon. Psychological and Educational assessments of these children are essential. There are three day schools for educationally sub-normal children from 7 to 16 years with a total of 359 children on the rolls. Here too, the Psychological appraisal of the children is of great value to the teachers and the School Psychological Service should not neglect this rather large and important group. Some contact is maintained with the Senior Speech Therapist, Mrs. Evans, and her staff and a closer liaison is envisaged. The 158 problems of speech and reading difficulties are common amongst children and Mrs. Evans and the School Psychological Service hope to be able to work in closer collaboration over this. In the face of such varied and vigorous expansion of special provisions the inadequate staffing of the School Psychological Service becomes only too blatant. It is frustrating to the present Educational Psychologists not to have enough time to be able to extend the necessary advisory and counselling service they know is required, and the Head Teachers must justifiably at times regard the School Psychological Service as of little practical value to them. It is, therefore, very gratifying to know that the Borough proposes to expand the present establishment of 3 Educational Psychologists to 5 in order to permit adequate Psychological service to the schools, to the various Clinics, and to the special classes. I am pleased to report that a third Educational Psychologist, Mr. A. Bennett, is proposing to join the School Psychological Service staff next year. It only remains for the problem of accommodation to be resolved, for the School Psychological Service to be able to look ahead to next year with a little more hope of meeting the basic requirements of the Borough. Handicapped Pupils Handicapped pupils are one of the main concerns of the School Health Service, and every effort is made to ascertain them at as early an age as possible. Many of them come to the attention of the School Health Service through the Health Visitors, but some are introduced by the Chief Education Officer, parents, teachers or some other person or organisation. The officially recognised types of handicaps are:— Blind, partially-sighted, deaf, partially-hearing, physically handicapped, delicate, maladjusted, educationally subnormal, epileptic and speech defects. Arrangements are made for the special examination of any child over the age of two years thought to be in need of special educational facilities because of a specific handicap. Once a child has been ascertained as handicapped it is kept under supervision and any recommendations for special educational treatment are forwarded to the Chief Education Officer for his consideration. Most of these recommendations are made as a result of advice received from various appropriate Hospital Consultants with whom there is very close liaison, and they may include ordinary schooling, day or residential education at a special school, or in suitable cases home tuition. During the year 74 boys and 34 girls were assessed as needing special educational treatment at Special Schools. Details of the various handicaps are included in the following table. 159 It will again be noted that educationally subnormal pupils easily head the list of handicapped children and are followed by the maladjusted and physically handicapped. Vacancies for the delicate pupils are comparatively easy to obtain, but the biggest problem of all is finding suitable placings for the maladjusted child, particularly those in the older age groups. The Borough is fortunate in possessing three schools for educationally subnormal pupils, but these cannot cater for all the children needing help. The special classes have played their part, however, towards providing the necessary help required, for some of these children. The field of handicap is a very wide one; for instance a large range of different conditions is included under the heading of "Physically Handicapped" and similarly "Delicate" can cover a number of different conditions. Obtaining the best possible arrangements for handicapped children often requires time and patience but the effort involved is fully justified by the results. 160 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF THE EDUCATION ACT 1944 OR BOARDING IN BOARDING HOMES During the calendar year ended 31st December, 1966:- Blind (1) Partially Sighted (2) Deaf (3) Partially Hearing (4) Physically Handicapped (5) Delicate (6) Maladjusted (7) Educationally Sub-normal (8) Epileptic (9) Speech Defects (10) TOTAL (Cols. (1) to (10) A How many handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? boys — 1 3 1 8 10 19 31 — 1 74 girls 1 — 2 1 4 3 3 20 — — 34 B How many children were newly placed in special schools (other than hospital special schools) or boarding homes? (i) of those included at A above boys — — — — 1 8 7 5 — — 21 girls 1 — — — 1 2 2 13 — — 19 (ii) of those assessed prior to January, 1966 boys — — 5 — 3 6 6 18 — — 38 girls 1 — 1 — 1 2 — 11 — — 16 (iii) TOTAL newly placed—B (i) and (ii) boys — — 5 — 4 14 13 23 — — 59 girls 2 — 1 — 2 4 2 24 — — 35 On 19th January, 1967 how many children from the Authority's area C (i) were requiring places in special schools other than hospital special schls. (a) day places boys — 1 1 — 4 — — 15 — — 21 girls — — — — — 2 — 12 — — 14 (b) boarding boys — — 1 — 1 — 6 1 — 1 10 girls — — — — 1 — 1 — — — 4 (ii) included at C(i) who had not reached the age of 5 were awaiting (a) day places boys — — 1 — 2 — — — — — 3 girls — — — — — 1 — — — — 1 (b) boarding places boys — — 1 — — — — — — — 1 girls — — 2 — — — — — — — 2 (iii) included at C(i) who had reached the age of 5 but whose parents had refused consent to their admission to a special school were waiting (a) day places boys — — — — — — — 2 — — 2 girls — — — — — — — 2 — — 2 (b) boarding places boys — — — — — — — — — — — girls — — — — — — — — — — — (iv) included at C(i) had been awaiting admission to special schools for more than one year (a) day places boys — — 1 — — — — — — — 1 girls — — — — — — — — — — — (b) boarding places boys — — — — — — — — — — — girls — — — — — — — — — — — 161 On 19th January, 1967 how many children from the authority's area:— —(1) Maintained special schools (other than hospital special schools and special units and classes not forming part of a (i) were on the— special school) regardless by registers — what authority they are D of:— maintained. —(2) Non-maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) wherever situated. (3) Independent schools under arrangements made by the authority. day boys — 3 5 6 24 9 1 139 — — 187 girls — 6 2 3 17 8 — 109 — — 145 boarding boys 1 — 1 — 5 12 3 6 — — 28 girls — — — 1 6 7 — 6 — — 20 day boys — — — — — — — — — — — girls — — — — — — — — — — — boarding boys 2 1 1 — 2 12 10 4 4 — 36 girls 2 — — — 3 — — — — — 5 boys — — 2 7 3 — 41 6 — — 59 girls — — 2 — — — 6 — — — 8 (ii) were boarded in homes and not already included in D(i) above boys — — — — — — — — — — — girls — — — — — — — — — — — Total 'D' boys 3 4 9 13 34 33 55 155 4 — 310 girls 2 6 4 4 26 15 6 115 — — 178 Number of children from the authority's area who are awaiting places or who are receiving special education in special schools or who are boarded in homes:— Total of sections C(i) (a) and (b) and D boys 3 5 11 13 39 33 61 171 4 1 341 girls 2 6 6 4 27 17 7 127 — — 196 On 19th January, 1967:— E How many handicapped pupils (irrespective of the area to which they belong) were being educated under arrangements made by the authority in accordance with Section 56 of the Education Act 1944. (i) in hospitals — — — — 26 — — — — — 26 (ii) in other groups (e.g. units for spastics. convalescent homes etc.). — — — — 21 — — — — — 21 (iii) at home — — — 2 10 — 3 — — — 15 Children found unsuitable for education at school During the calendar year ended 31st December, 1966:— (i) How many children were the subject of new decisions recorded under Section 57 of the Education Act, 1944? 15 (ii) How many reviews were carried out under the provisions of section 57 A of the Education Act, 1944? — (iii) How many decisions were cancelled under Section 57A(2) of the Education Act, 1944? — 162 SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUBNORMAL CHILDREN Goddington School, Orpington The present roll stands at 126. During 1966, 26 children were admitted to the school, 21 children left the school and of these:— 2 left to enter employment. Both continue working happily. 3 left the district. 3 were transferred to ordinary schools. 4 were transferred to residential special schools. 1 was transferred to another day special school. 8 were found to be unsuitable for education at school and entered the Orpington Training Centre. Two members of staff have left during the year, one moved to Bristol for domestic reasons, and one joined the staff of the new special school in Essex as Deputy Headmaster. The medical work at the school continues on well established lines, the School Medical Officer playing her part as a member of the team. The routine medical inspections, B.C.G. vaccinations, etc., are only a part of the work. During 1966 eight children had "special" medical examinations, being put forward by the Headmaster on medical or social grounds. 39 children were fully re-assessed including the complete psychometric examination. The day to day medical care is given by the Welfare Assistant who has years of experience, full nursing qualifications and the informal status of the School Nurse. The School Nurse takes the children to the Ophthalmic and Dental Clinics and often for consultant hospital appointments. The school is operating the full range of activities. The physical side of development has been given full attention and it is pleasing to record that the weekly attendance at Beckenham Baths under the direction of the Deputy Head Teacher, Mrs. Shorrock, has resulted in two-thirds of the senior children now being able to swim. The school is now in its third year of existence and is producing an increasing number of school leavers. Much effort, therefore, has to be directed into preparing the senior boys and girls for entering employment and the complex conditions of the adult world. Many visits to the places of interest were made, e.g. the Science Museum, Kensington; the trip down the Thames to Greenwich; Chessington Zoo and smaller excursions to interesting localities in the area. The visit to the Biggin Hill R.A.F. Station where the children were entertained by the Officers' wives was generally acclaimed as most successful. On the employment side the senior boys and girls have been visiting local factories, large shops, bakeries, etc. The Principal 163 Youth Employment Officer has devoted much thought and time to the problem, and it is felt that his giving informal talks and film shows at the school has consolidated and reinforced the preemployment training. A new venture has been the most successful liaison with the Ramsden Secondary School for Boys. Six senior boys from Ramsden spend a day a week at Goddington and have completed the new School Library which has started off with the gift of 200 books from the "Friends of Goddington School". It is hoped to reach the target of 1,000 books by the end of 1967. The Ramsden boys have made all the bookcases to accommodate the books and the project has been so successful that it is envisaged to extend these activities to the manufacture of the play apparatus for the infant and nursery classes. The school enjoys continuing and increasing support by the community it serves. This support not only has been most encouraging to the staff and beneficial to the children, but has also produced the tangible result of £900 which is earmarked for a school swimming pool. St. Nicholas School, West Wickham Number of children on roll—Boys 56, Girls 44. Staff Headmaster Deputy Head 7 Assistant teachers (full-time) 1 House-Craft Teacher (part-time) 1 House Mother 1 General Assistant The health of the children has been satisfactory. 80 per cent. have taken advantage of the dental service and attended the Hawes Down Clinic. Speech Therapy The therapy scheme whereby the class teacher gives special help under the supervision of the speech therapist to children handicapped with speech defects became more important than ever, because due to staff shortage the monthly visits of the speech therapist were not maintained. During the year 16 pupils left on attaining the age of 16. Eleven gained employment of various kinds; park and gardening assistants, wrappers in supermarkets, assembly work and drycleaning assistants; two went to training centres, and three are still at home having refused facilities under the Mental Health Act. The results of having nine autistic children in the school have been most rewarding as regards their social adjustment and integration into all the school activities. 164 Routine skin tests (Heaf) were carried out on ten children. Of these two were positive having had previous vaccination, six were negative and were vaccinated accordingly, two were positive and were followed up by the Chest Clinic. The Educational Psychologist visited the school weekly for special tests and reassessment of I.Q. examinations. The heated swimming pool was used every day from the beginning of April to the end of October and 20 children learned to swim. Ballroom dancing and the St. Nicholas Club are popular activities whereby the pupils gain their confidence and social graces. Grovelands School, St. Paul's Cray, Orpington There were 121 pupils at Grovelands School at the beginning of the year, with 18 children leaving and 16 being admitted during the following 12 months. Six leavers started work, two as labourers, two in local factories and two to work in shops. Five were transferred to other special schools where possible. Two to residential special schools and three to training centres. One to home tuition and one to a secondary modern school. Thirty-one routine and 13 special medicals were conducted. Eighteen leaving tests were carried out and a further 12 full I.Q. assessments were undertaken. Nine pupils were given B.C.G. tests. Pupils were taken by the welfare assistants for ophthalmic and dental appointments and the Educational Psychologist attended regularly and gave much valuable advice. Many children are dual handicapped, especially with regard to speech. Valiant work is done by the staff and welfare assistants to implement the all too infrequent visits of the speech therapist. The swimming pool was well used, sometimes in spite of the poor weather, and certificates were awarded for suitable progress. There was the usual wide variety of outside activities which included a day at Cliftonville for the whole school. Smaller groups visited London and the Tower, Chislehurst Caves and Crystal Palace Zoo and Park. Visitors this year included members of Bromley Education Committee, mature Student Teachers, Child-Care Officers and the Road Safety Instructor. There were film shows, social evenings, sports and the usual Christmas activities which consisted of carols. Nativity plays and the traditional parties, all of which help to develop the social abilities of pupils whose academic attainments cannot be high. The Open Evening gave parents and teachers an opportunity to meet and discuss progress and problems. 165 Intelligence Quotient Tests During the year, I.Q. tests were carried out on 71 children. The recommendations were :— Day School for E.S.N, pupils 23 Boarding School for Maladjusted pupils 4 Found to be unsuitable for education at school 14 Special Opportunity Class 3 Remedial Class 4 Diagnostic Unit 4 Small class in ordinary school 4 Suitable for ordinary school 2 Referred for further review 10 Informal Supervision 3 Employment of Young Children 543 children were examined by the Assistant Medical Officers during the year. Certificates were issued in 542 cases, and in only one case was the certificate not issued. Boys Girls Delivery of Newspapers and Milk etc 310 99 Errands and light shop duties, etc 58 36 Shop Assistant 14 17 Junior Clerk — 3 Window Cleaner 1 — Waitress — 1 Entertainment 2 1 385 157 Other Medical Examinations The following examinations were carried out by Medical Officers during the year :— Training College Entrants 356 Teachers 103 Total 459 DENTAL SERVICES Mrs. C. M. Lindsay, l.d.s., R.f.p.s.(Glasgow), Principal Dental Officer. We have at present our full complement of Dental Surgeons and Attendants. This satisfactory situation is worthy of comment in the light of the fact that surrounding Boroughs are much understaffed. The Dental Surgeons have maintained their previous high standard of quality and have increased the quantity of some branches of treatment well in excess of last year, and of the National average. 166 There is a gratifying increase in acceptance for treatment in practically all areas due to the diligence of the respective Dental Officers. All maintained schools in the Borough have been dentally inspected within the year, an improvement on last year, when only 85 per cent, were inspected. The orthodontic cases have increased by over 100, and many excellent results have been obtained in those completed. The discontinued cases amount to less than two per cent. Only two orthodontic patients were referred to hospital for treatment and it was found that surgery was necessary. The children's teeth are, on the whole, fairly well preserved, but there continues to be too much conservative work required. Endeavours are being made by the Principal School Dental Officer to reduce such work by approaching the Headmasters and Headmistresses to seek their co-operation in stopping the sale of sweets and confectionery in the school shops, and by the teachers including in the Biological lectures instructions on oral hygiene. Books and posters have been supplied to facilitate these talks. The Dental Officer from the Department of Education and Science has visited the Borough again and inspected the Dental Department. The Authority has been commended on the output of work, on the excellent calibre of the Dental Officers employed, and on the industrious and well organised Dental Service. 1. Number of Pupils on the Register of Maintained Primary and Secondary Schools including Nursery and Special Schools in January, 1967—41,917. 2. Attendances and Treatment Ages Ages Ages Total 5-9 10-14 15 and over First visit 3,719 3,174 573 7,466 Subsequent visits 4,932 6,179 1,678 12,789 Total visits 8,651 9,353 2,251 20,255 Additional courses of treatment commenced 727 554 707 1,388 Fillings in permanent teeth 2,341 6,059 1,635 10,035 Fillings in deciduous teeth 6,102 912 — 7,014 Permanent teeth filled 1,902 4,606 1,250 7,758 Deciduous teeth filled 4,783 656 — 5,439 Permanent teeth extracted 55 311 88 454 Deciduous teeth extracted 1,076 399 — 1,475 General anaesthetics 301 164 11 476 Emergencies 152 88 19 259 167 Number of pupils X-rayed 341 Prophylaxis 2,077 Teeth otherwise conserved 681 Number of teeth root filled 50 Inlays 10 Crowns 14 Courses of treatment completed 4,523 3. Orthodontics Cases remaining from previous year 231 New cases commenced during year 179 Cases completed during year 70 Cases discontinued during year 8 Number of removable appliances fitted 174 Number of fixed appliances fitted 5 Pupils referred to Hospital Consultant 2 4. Prosthetics Ages Ages Ages Total 5-9 10-14 15 and over Pupils supplied with F.U. or F.L. (first time) — — 1 1 Pupils supplied with other dentures (first time) 1 1 — 2 Number of dentures supplied — 1 — 1 5. Anaesthetics General Anaesthetics administered by Dental Officers 15 6. Inspections (a) First inspection at school Number of Pupils 37,236 (b) First inspection at clinic. Number of Pupils 3,954 Number of (a) + (b) found to require treatment 14,400 Number of (a) + (b) offered treatment 9,947 (c) Pupils re-inspected at school or clinic 1,928 Number of (c) found to require treatment 1,020 7. Sessions Sessions devoted to treatment 2,704.6 Sessions devoted to inspection 200 Sessions devoted to Dental Health Education 96 168 PHYSICAL EDUCATION Introduction This is the first report presented to the Medical Officer on the state of physical education in the new London Borough of Bromley, and therefore, it is reasonable to say something of what is meant by the words physical education. Physical education is not one subject, but rather a collection of many separate games and pursuits each requiring the mastery of many skills in order that the player enjoys to the full the participation in that activity. Each game in the end is capable of leading the youngster into a full life in which he or she understands and values friendship, the opposition of an opponent and learns to evaluate the other person's contribution on the field; a little world bounded or dominated by a line where law is seen to exist, a law recognised as absolute by all who take part. Teachers of physical education know that only when young people are reasonably proficient in the basic skills can the rich enjoyment of friendly competition be added to their lives. Achieving a best performance on the track or in the swimming bath, or perfecting the ability to play a game, is no chance happening to be dismissed as some gift of birth. These are the results of hours and years of arduous practice and training in which the whole body, mind and spirit are involved. This training can have the same effect on the person as the development that accrues through the pursuit of knowledge, the effort to master the playing of an instrument, the struggle to paint a picture. Renee Maheu, DirectorGeneral of U.N.E.S.C.O. in a recent speech in London made the following statement:— "Sport is art, is science, is culture and perhaps for the ordinary man in the street is the only way in which he learns to appreciate beauty". This report is presented in the hope that the work done by all those dedicated teachers of physical education shall be given the credit that is their due for seeking to bring through participation in archery, athletics, basketball, badminton, canoeing, climbing, cricket, cross-country running, dancing, diving, fencing, gymnastics, hockey, judo, life saving, lacrosse, mountaineering, netball, orienteering, sailing, ski-ing, soccer, swimming, rugby, table tennis, lawn tennis, trampolining, volleyball, water polo and weight training. It is their hope that, from this wide field, the young novice will find one activity to develop so that, in the mastery of the activity of his choice, he may gain the social understanding and camaraderie that unites players all over the world. Swimming Two separate swimming organisations in the new Borough affiliated to the Kent Schools Swimming Association have now agreed to a joint committee which will, in conjunction with the 169 Education Department, in future deal with policy matters. Since both organisations were eligible to send two representatives in each event to the Schools County Swimming Championships, the new arrangement ensures that as many children as possible will be given the opportunity of swimming in top school competitions. Many schools have taken a greater interest in gaining lifesaving and survival awards. Additional school swimming pools have been added to those already in being, and there are now six learner pools that achieve 90 per cent, success in teaching children to swim before the age of twelve. These pools have been produced largely through the efforts of Parent-Teacher Associations, and the Education Committee is grateful for this help. Teachers have kept abreast of new developments by attending courses in swimming, many of them gaining professional qualifications as a result of passing the Teachers' Examination of the Amateur Swimming Association. The offices of President and Secretary of the Kent Schools Swimming Association are held by Bromley Teachers, as well as the office of Competition Secretary of Division Eleven (Kent and Surrey) of the English Schools Swimming Association. Water polo has been included in the swimming curriculum for the first time and, because of the facilities enjoyed at the Crystal Palace and the excellence of the instruction, great strides have been made in this sport. Residential Courses This year the physical education adviser arranged a residential course at the Crystal Palace for gifted pupils from each of the secondary schools of the Borough. For four days an equal number of boys and girls received instruction in athletics, diving, badminton, gymnastics, judo, squash, swimming and trampolining. This was done to illustrate the type of course that a school might consider for its older pupils in order to give them a taste of working away from home. It was gratifying, therefore, when two schools got together and worked out a joint scheme for 30 boys, 15 from each school, to live at the Crystal Palace for a further residential course later in the year. It is hoped that many more schools will follow suit and benefit from having this wonderful recreation centre within the Borough's boundaries. Games The standard of play in all games continues to be very good. Very many teams turn out each week and their dress and deportment on the field are commendable. The Borough can be proud of its extensive playingfield areas attached to most of its schools. These are maintained to as high a standard as is possible so that instruction of a high order can 170 be given. The schools section of the Parks Department carries out this task and is unstinting in its efforts to produce good playing surfaces. However, in some areas of the Borough with a high water table, months can elapse without any games taking place on a particular pitch. This can mean the cancellation of outdoor physical education for long periods. The solution lies in the production of all-weather surfaces which can be played on whatever the conditions. Many games benefit from being practised on this kind of surface. The production of many of these pitches will in the end be less demanding on land since one pitch can be played on for ten hours a day without damage, whereas a grass pitch is usually used for seven hours a week. Already experience is being gained by schools playing on the Redgra pitch at the Crystal Palace, and there is little doubt that similar all-weather pitches on school playingfields would be invaluable. SCHOOL MILK SERVICE A survey taken for the Department of Education and Science, on a suitable day between September 12th to 23rd, 1966, when school attendance was normal, showed Number of Pupils Present Taking Milk At Maintained Schools 38,656 31,397 Non-maintained Schools 6,412 4,355 SCHOOL MEALS SERVICE The London Borough of Bromley now has 76 school canteens and 30 serveries serving approximately 33,500 meals a day. In the financial year 1966/67 over six million meals will be served. HEALTH EDUCATION AND HOME SAFETY Like all experimental social sciences, the field of health education is constantly developing. Gone are the days during the first half of the 19th century when the population of this country was riddled with disease, but with the advent of ENVIRONMENTAL CONTROL and SPECIFIC IMMUNISATION conditions became better. These two weapons together with, and contributing to, a rising standard of living, itself entailing improved nutrition, account almost entirely for the substantial improvements which have taken place in the health of the population of this country over the past century. However, the solutions of these problems have not brought the task of the Public Health Service to an end, nor has it made its work easier. Today we are faced with a new set of health problems, different from those of the past, problems which stem largely from the changing nature of our society. Prominent among these are 171 lung cancer due to cigarette smoking, accidents in the home and on the roads, the bigger, but largely hidden problem of alcoholism, and the small, but unhappily rising incidence of venereal disease in young people. These are the really serious health problems which confront us in the community today, serious because, unlike the remnants of the diseases of the past, they are increasing every year. None of these, however, admits of solution through the weapons that were so effective in the past. In the face of these problems, the only weapon we have is health education. These are fundamentally problems of behaviour and they will be solved—if they are to be solved at all—through education. Indeed, if health education fails, then we shall fail, for no other solution is possible. Here then is a new challenge to our Public Health Service, and it is the growing realisation of this challenge which is bringing with it the demand for more personnel to undertake this important work. With the object in view, health education sessions given by the Health Education Officer, Health Visitors and Teachers in many schools within the Borough, also Clubs, Parent Teachers' Associations and other organisations have continued during the year, in which greater and fuller publicity was given to the problem of accidents in the home. This section of health education was considered most necessary, due to the appalling number of fatalities and injuries occurring nationally, and also to the accident statistics as supplied monthly by the local hospitals within the Borough area. These in themselves bring this vital problem nearer home. HOME SAFETY Those of us who work for the cause of home safety know very well that accidents are caused and can, therefore, be prevented. For us, study of many cases has proved that "accidents" are not "bolts from the blue" or sudden acts of unkind fate, but a chain of events, starting from a cause and leading to a result, a tragic result, which could have been prevented by action somewhere along the line. The aspirin bottle "could" have been put away after the last use, the mat "could" have had a non-slip backing, the handle of the saucepan "could" have been turned away from the front of the cooker. If these simple acts had been carried out, a small child could have been saved a trip to hospital, an old person could have avoided a fall, and the scalding accident need not have happened. How can we get these simple truths across to those who have not yet absorbed them? The Press, radio and television play 172 their part in reaching the public with help and advice on the causes and prevention of accidents. Home Safety Committees, Health Committees, Health Visitors and Nurses, Teachers and Voluntary Workers all play their part, but the accident rate remains still too high and "I didn't know" or "I never realised" continue to be the cry of a victim of an unnecessary home accident . From January to December, 1966, a total of 6,440 home accident cases were treated at Farnborough, Orpington and Beckenham Hospitals, of these 3,703 were adults and 2,737 children. These unfortunate people, treated at the local hospitals were resident within the Borough. The three most prominent causes according to the statistics supplied by the Hospital Authorities were as follow :— 1. FALLS Being the chief danger to old people. 2. BURNS/SCALDS Affect young children and old people, and in fact all age groups. 3. POISONING Being mainly the danger to adults, ally in relation to gas and medicinal substances, in the latter case being due to such things as overdoses. 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 nationwide campaign to make the public aware of the risk, and willing to accept responsibility for safety in the home. One way of clarifying and driving home this knowledge that accidents can be prevented, is by studying all kinds of home accidents until the chain of cause and effect is crystal clear and irrefutable. To do this, the best possible means is by education. This is done mainly by lectures, displays of publicity material, film shows and newspaper articles on the subject. As a result of these displays and exhibitions, many requests have been received for lectures and talks on home safety to Parent Teachers' Associations, Teachers' Training Colleges, Schools, Youth Clubs, Old People's Clubs, Boy Scout and Girl Guide Associations. In the latter cases, many of these training lectures are required as part of the syllabus for the Duke of Edinburgh's Award Scheme. All these lectures and tests, etc., were given by Health Visitors and the Health Education Officer. The health education of children cannot be effective in isolation, and must be developed with the co-operation and understanding of parents and teachers. Therefore, invitations to give talks to these Association Meetings are always received with pleasure, and are well attended. 173 DETAILS OF CLINICS CLINIC & ADDRESS WEEKLY SESSIONS held as follow: (By appointment only) OPHTHALMIC : School Clinic, The Willows, Monday—a.m. Red Hill, Chislehurst. School House, 55 Chislehurst Monday—All day Road, Orpington. Mickleham Road Clinic, Monday—a.m. St. Paul's Cray. North Clinic, Monday—a.m. Station Road, Bromley. Wednesday—a.m. Friday—p.m. Saturday—a.m. (Alternate) School Clinic, Friday—a.m. Town Hall, Beckenham. School Clinic, Wednesday—a.m. Oakfield Road, Penge. ORTHOPTIC: North Clinic, Monday—p.m. Station Road, Bromley. Tuesday—All day Thursday—a.m. *ORTHOPAEDIC: North Clinic, Friday—p.m. Station Road, Bromley. (Monthly) *Children living in Beckenham and Bromley are referred to this Clinic. Children living in the remainder of the Borough are referred to: Orpington Hospital; Farnborough Hospital; Queen Mary's Hospital, Sidcup; or to The Children's Hospital, Sydenham. SPEECH: School Clinic, The Willows, Monday—All day Red Hill, Chislehurst. Wednesday—a.m. Assemblies of God Church Rooms, Monday—All day Masons Hill, Bromley. Tuesday—p.m. Wednesday—All day Thursday Friday 174 DETAILS OF CLINICS—continued CLINIC & ADDRESS WEEKLY SESSIONS SPEECH —cont. held as follow : (By appointment only) School Clinic, Monday—All day Town Hall, Beckenham. Tuesday Wednesday „ Friday †CHILD GUIDANCE: The Willows, Tuesday—All day Red Hill, Chislehurst. Friday „ „ †Cases are also referred to the Child Guidance Clinics at Bromley Hospital, and the Children's Hospital, Sydenham. Cases may also be seen at the Child Guidance Clinic at Farnborough Hospital, having been referred via the Paediatricians. DENTAL : School House, The Willows, Monday—All day Red Hill, Chislehurst. Wednesday „ School House, 55 Chislehurst Monday—All day Road, Orpington, Tuesday Wednesday „ Thursday „ Friday Mickleham Road, Monday—All day St. Paul's Cray. Tuesday Wednesday „ Thursday „ Friday „ „ Kimmeridge Road, Thursday—All day Mottingham. Friday „ „ North Clinic, Monday—All day Station Road, Bromley. Tuesday Wednesday „ Thursday „ Friday South Clinic, Monday—All day Princes Plain, Bromley. Tuesday Wednesday „ Thursday „ The Pavilion, Recreation Ground, Friday—All day Church Road, Biggin Hill. 175 DETAILS OF CLINICS^continued CLINIC & ADDRESS WEEKLY SESSIONS DENTAL—cont. held as follow : (By appointment only) School Clinic, Tuesday—All day Town Hall, Beckenham. Friday Hawes Down Clinic, Wednesday—All day Hawes Lane, West Wickham. Thursday School Clinic, Monday—a.m. Oakfield Road, Penge. Tuesday—All day Thursday „ „ Friday ‡SPECIAL EXAMINATION CLINICS : School Clinic, Thursday— Oakfield Road,Penge. 9.30-11 a.m. The Willows, 2nd and 4th Thursday Red Hill, Chislehurst. in month, 4 - 5 p.m. Mickleham Road Clinic, 1st, 3rd and 5th St. Paul's Cray. Friday in month, 9-10 a.m. ‡In addition to these fixed times, appointments are arranged as and when necessary at other Clinics for the purpose of carrying out special examinations, etc. MINOR AILMENT FACILITIES—see page 149 Bromley office supplies & printing co. Ltd., 39/41 East Street, Bromley, Kent BR1 1QT