LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1969 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 SHERMAN HOUSE, SHERMAN ROAD, BROMLEY, BR1 3TF Telephone: 01-464 3333 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1969 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 SHERMAN HOUSE, SHERMAN ROAD, BROMLEY, BR1 3TF Telephone: 01-464 3333 3 INDEX See Page 156 for Index to School Health Service Report. Page A Ambulance Service 46 Animal Boarding Establishments 146 Accidents 25 B Bacteriological Examinations— Sundry 121 Births 22 C Care of Mothers and Young Children 31 Care of Unmarried Mother and Her Child 31 Cervical Cytology 32 Child Minders 32 Chiropody 33 Clean Air Act 135 Common Lodging Houses 132 D Day Nurseries 31 Deaf Children 32 Deaths 21 Dental Services, M. & C.W. and School Health 47 Diphtheria 55 Diseases of Animals 145 Disinfection 134 Disinfestation 135 Drainage and Sewerage 133 Dysentery 55 Page E Environmental Health Services 99 F Factories Act 143 Family Planning 33 Food and Drugs Act—Sampling 106 Food Complaints 123 Food Poisoning 56 Food Hygiene Regulations 125 H Health and Welfare Committee 7 Health Education 43 Health Visiting 36 Home Help Service 40 Home Nursing 38 Home Safety 44 Housing and Slum Clearance 126 Housing Inspections 131 Housing—Public Health Acts 129 I Ice Cream Sampling 120 Immigrants — Medical Arrangements 39 Infant Mortality 20 Infectious and Other Diseases 53 Infective Jaundice 56 Introductory Review 11 L Leptospirosis 57 5 INDEX—(continued) Page M Maternal Mortality 20 Maternal and Child Health 31 Measles 57 Meat Inspection 122 Meningococcal Infections 57 Mental Health Services 61 Midwifery 34 Milk Sampling 120 Milk—Special Designations Regulations 126 Mortuaries 105 Moveable Dwellings 132 N National Assistance Acts 39 Nursing Homes 32 O Offices, Shops and Railway Premises Act 140 Ophthalmia Neonatorum 57 Outwork 144 P Paratyphoid Fever 59 Pet Animals Act 147 Pigeon Destruction 140 Poliomyelitis 57 Population 21 R Rag Flock 126 Recuperative Care 33 Page Rehousing 128 Rent Act, 1957 130 Riding Establishments 147 Rodent Control 139 S Scarlet Fever 57 Smallpox 57 Staff 8 Staff—Medical Examinations 39 Statistic—Environmental 148 Statistics—Vital 19 Statutory Notices 150 Swimming Baths 145 T Tetanus 58 Tuberculosis 58 Typhoid Fever 59 U Unsound Food 119 V Vaccination and Immunisation 33 Venereal Diseases 42 Vital Statistics 19 W Wasps 135 Water Supply 151 Welfare Foods 31 Welfare Services 91 Whooping Cough 59 7 HEALTH, WELFARE AND CHILDREN COMMITTEE (as at 31st December, 1969) Chairman: Alderman Miss Bertha H. James, J.P. Vice-Chairman: Councillor P. J. J. Higgins The Mayor: Alderman C. H. E. Pratt Councillors: B. D. F. Bennett M. I. Blazey D. J. W. Eves M. E. Forster H. W. Haden Mrs. M. J. Higgins C. R. E. Kember M. B. Kenward, B.D.S., L.D.S., R.C.S. A. A. Parfitt S. J. C. Randall J. P. Sheridan, A.M.I.E.I. R. W. Spon-Smith Mrs. S. M. Stead W. H. Stephenson Co-opted Members : Mrs. C. Attlee Mrs. V. J. Harris, J.P. H. J. Lester, O.B.E., J.P., F.C.A. K. Scott, M.B., B.S., D.Obst., R.C.O.G. G. D. Stilwell, M.R.C.S., L.R.C.P. Miss M. Thompson. S.R.N., R.S.C.N., C.M.B. 8 STAFF OF THE HEALTH AND WELFARE DEPARTMENT (as at 31st December, 1969) 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): P. A. Currie, m.r.c.s., l.r.c.p. Senior Medical Officer (Maternal and Child Health): (Mrs.) A. J. Jones, m.b., ch.b. Senior Medical Officer (Mental Health): (Mrs.) Sara Syrop, m.d.(Warsaw), d.p.h., d.c.h., d.t.m. & h. Medical Officers in Department: (Mrs.) E. M. Davis, m.b., b.s.(Lond.), m.r.c.S., l.r.c.p., d.c.h. (Mrs.) G. L. Hobbs, m.r.c.S., l.r.c.p. E. Gaynor Lewis, m.b., b.ch., d.t.m.&h. (Miss) M. E. Lyttle, m.b., b.ch., b.a.o. (Mrs.) B. R. Luscombe, m.r.c.S., l.r.c.p. (Mrs.) V. N. Menon, m.b., b.s., d.c.h. (Mrs.) I. F. Maclean, m.b., ch.b. (Mrs.) M. Parkinson, m.b., b.s. (Mrs.) Z. W. Swistak, m.r.c.S., l.r.c.p., d.p.h. (Mrs.) J. C. Van Essen, m.b., ch.b. 10 General Practitioners attend clinics on a sessional basis. Principal Dental Officer: Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(Glasgow). Denial 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.) M. M. Alford, l.d.s., r.c.s.i. (Mrs.) M. I. Kininmonth, l.d.s. (Part-time) (Mrs.) A. R. Leach, b.d.s. (Mrs.) A. P. O'Reilly, l.d.s., r.c.s.(Eng.). 4 Dental Officers (Sessional), 2 Anaesthetists (Sessional), 1 Orthodontist (Sessional), 1 Dental Hygienist, 10 Dental Surgery Assistants. Orthopaedic Surgeon (in conjunction with Regional Hospital Board): K. F. Hulbert, f.r.C.s. Physiotherapist: Mrs. V. Norman, m.c.s.p. (Sessional). Senior Speech Therapist: Miss V. M. Connery, l.C.S.t. 3 Speech Therapists (1 Part-time). Ophthalmologists: 4 (Sessional). Orthoptist: Mrs. D. A. Ivil, d.b.o. (Part-time). Chest Physician (in conjunction with Regional Hospital Board): E. W. Street, m.r.c.S., l.r.c.p. Psychiatrist : 1 (in conjunction with Regional Hospital Board). (Part-time). 9 NURSING AND ALLIED STAFFS: Superintendent Home Nursing Service: Mrs. M. O. Tierney, s.r.n., q.n. Deputy Superintendent Home Nursing Service: Mrs. J. W. M. Teare, s.r.n. 42 Home Nurses (1 Part-time). 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. L. A. Hamilton, s.r.n., h.v.cert. Group Adviser: Miss C. A. Paxton, s.r.n., s.c.m., H.v.cert. 39 Health Visitors, 4 Student Health Visitors. Non-Medical Supervisor of Midwives: Miss M. C. Martin, s.r.n., s.c.m. Deputy Supervisor of Midwives: Miss J. S. Brown, s.r.n., s.c.m. 26 District Midwives. 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. 1 Cytology Nurse. 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: D. K. Evans, m.a.p.h.i. P. R. Light, m.a.p.h.i., a.r.s.h. E. U. Williams, m.a.p.h.i. 15 Public Health Inspectors, 3 Technical Assistants, 6 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 7 Rodent Operators, 3 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. 4 Senior Social Welfare Officers, 1 Spec. S.W.O. (Deaf), 1 Mobility Instructor for Blind, 17 Social Welfare Officers (5 Part-time), 3 Occupations Officers, 1 Field Work Teacher, 1 Industrial Work Organiser, 1 Work Centre Supervisor, 8 Trainee Welfare Assistants. Staff at 9 Residential Homes: 9 Matrons, 12 Assistant Matrons, 1 Warden, Chaplains and other staff. Chief Chiropodist: A. S. Jones, s.r.c., m.c.l.s. I Senior Chiropodist, 3 Chiropodists (Sessional). 10 MENTAL HEALTH STAFF: Principal Mental Welfare Officer: H. J. Vagg, m.r.s.h., m.i.s.w., m.b.a.s.w. Deputy Principal Mental Welfare Officer: A. F. Puckett, m.s.m.w.d., a.a.p.s.w. 3 Senior Mental Welfare Officers, 15 Mental Welfare Officers, 4 Trainee Mental Welfare Assistants. Senior Training Centre: 1 Deputy Manager, 4 Instructors, 1 Clerk (Part-time), 1 Pianist (Part-time). Junior Training Centre: 1 Head Teacher, 1 Deputy Head Teacher. 1 Senr. Sup/Teacher, 1 Sup/Teacher, 5 Teachers, 2 Assistant Supervisors, 3 General Assistants, 2 Trainees, 1 Clerk (Part-time), 1 Pianist (Part-time), 1 Physiotherapist (Part-time). Hostel: 1 Warden, 1 Deputy Warden, 1 Housekeeper. Day Centre: 1 Supervisor, 1 Deputy 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, 3 Shorthand Typists, 1 Supernumerary Junior Clerk, 2 Enquiry Clerks/Receptionists, 1 Driver/ Storekeeper. Environmental Health: Senior Administrative Assistant: B. Adams. 2 Administrative Assistants, 3 Clerical Assistants, 3 Clerks, 2 Shorthand-Typists, I Supernumerary Junior Clerk. Maternal and Child Health: Senior Administrative Assistant: G. R. L. Smith. 2 Administrative Assistants, 4 Clerical Assistants, 2 Clerks, 1 Supernumerary Junior Clerk. Mental Health: Senior Administrative Assistant: C. J. Moore. 2 Clerical Assistants, 1 Clerk, 1 Shorthand Typist. School Health: Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant, 4 Clerical Assistants, 7 Clerks, 1 Supernumerary Junior Clerk, 1 Shorthand Typist (Part-time). Welfare: Senior Administrative Assistant: J. W. Meeks. 4 Administrative Assistants, 1 Secretary, 4 Clerical Assistants, 4 Clerks, 1 Shorthand Typist, 3 Clerks (Residential Homes), 1 Supernumerary Junior Clerk. A rea Offices and Clinics: 6 Clerical Assistants. 12 Clerks (4 Part-time), 4 Clerk/Typists, 25 Clinic Clerks (Part-time). 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 have the honour to present a report for the year 1969 on the services administered by the Health and Welfare Department of the London Borough of Bromley. The report is set out to the requirements of Department of Health and Social Security Circular 1/69. The acceptance of the Seebohm Report means that when the necessary legislation has been passed even Local Health Authorities such as Bromley with combined Health and Welfare Departments will need to set up separate departments of Health and Social Services. This annual report is likely to be the last but one of similar reports bringing together for one whole year the Health, the general Social Services and the School Health Services of this Local Health Authority and presented by the Medical Officer of Health. In many ways, the combination of health and welfare had paved the way to the setting up of a Social Services Department in that greater co-ordination was possible than had health and welfare always been separate. However, new problems of medical confidentiality and overlap of services will inevitably be met in the new divisions and more than goodwill may be needed to resolve these difficulties. There will be tremendous opportunities for the new department to experiment on lines not possible or appropriate for traditional health departments; and it is likely that both departments in the long run will benefit from a separation that will enable them to develop their individual styles of administration and services to the public. Early in the year, the staff of the Health and Welfare Department moved from their Orpington offices to Sherman House, Bromley, a building shared with the Borough Treasurer, and providing more central and satisfactory accommodation. Statistics Owing to boundary adjustments, there was a decrease in area from 39,266 acres to 37,583 acres. It was necessary to use a weighted average population figure to determine the rates of Birth and Death for valid comparison with other areas. Differences with last year's rates are minimal and insignificant. Three maternal deaths were reported to the Department of Health and Social Security which completed the necessary investigations and no adverse report was received. The death rate of pulmonary tuberculosis showed a continuing 12 and expected significant fall but surprisingly there was also a fall in cancer death rates including those for cancers of lung and bronchus. Reference to the more detailed table of causes of death show that this decrease was significantly of males in the 65-74 age group, followed by males in the 45-54 age group; 32 and 11 less deaths respectively. Environmental Health and Infectious Diseases There was an increase from 300 to 528 notified cases of venereal disease; an increase of 5 cases of Syphilis, 51 cases of Gonorrhoea and 182 cases of other venereal conditions. The treatment centres for these conditions are outside the Borough. The responsibility of the Authority lies in the tracing of contacts and in general preventative health education. There are general comments in the report of the Health Education Officer on health education and youth which in the long term are equally relevant to prevention of this rising tide of venereal disease as they are to the prevention of drug addiction and smoking addiction. Happily on the other side of the picture, the prevalence of other infectious diseases with the exception of measles and the alimentary diseases was less. Even with measles, the increase was less than might be expected. With an illness so infectious as measles, a very high immunisation rate of over 80% must be maintained before eradication on the lines of the poliomyelitis results can be achieved. My Deputy deals in more detail with this later in the Report. In the first year of notification, there was no recorded epidemic of infectious hepatitis though in my experience in another large Authority and at another time, an epidemic in primary schools dragged on for many months. For many viral diseases, effective vaccines are unlikely ever to be manufactured and consequently the skills and expertise of Public Health Inspectors in containing the spread of epidemics with the advice of medical practitioners and medical officers experienced in epidemiology will ever be necessary. The work of the Public Health Inspectors of the Borough and of the Veterinary Officers of the City of London undertaking certain duties in connection with diseases of animals indicates later in the Report the valuable epidemiological enquiries that are necessary. Prevention of the spread of Anthrax from a local farm, control of an outbreak of fowl pest and the investigation of the disposal of asbestos waste in commercial premises where this could be present and might cause cancer were examples during the year of such control. The report on environmental health refers in great detail to food hygiene and to the advantages of self-service stores, to 13 the problems of container traffic which is very relevant to our entry into the Common Market and to the problems of turnover and coding of foodstuffs. Under Smoke Control, the continuing work of survey has been kept up in spite of financial stringencies which of recent years has delayed the final date of completion for the Borough so that the year now is 1977. However, the highest priority has been given to this work in the capital programme and now enough is being accomplished to increase visibly the winter sunshine and to benefit more and more the houses and gardens of the Borough. The increasing involvement of the environmental section in Housing Act Improvement work and the start that has been made in survey of houses in multi-occupation are factors which must later be taken into account in reviewing the manpower requirements of this important section of the Department. Care of Mothers and Young Children As a measure of economy, the sale of proprietary foods from Child Health Clinics was discontinued. The Report indicates the downward trend of attendances at these clinics over the last three years—a drop from 87,379 to 76, 172. It is hoped that this reflects increasing establishment of child health sessions at general practice premises. The considerable increase in child minding and establishment of play groups in numbers is well shown and the average places per person and per premises has decreased. The marginal ups and downs of the cervical cytology campaign continue; this year it will be noted there was an increase. This situation must prevail while controversy on the value of this screening method for well women in reducing cervical cancer continues. Nevertheless, there is no controversy on its value in reducing a great deal of ill-health. The Authority introduced, through the Family Planning Association, a scheme of financial assistance but it is too early to assess how effective this service has been. There can be no doubt of the value of screening for phenylketonuria and a new test—the Guthrie test was introduced during the year. A pilot scheme for the attachment of a midwife to a group of medical practitioners was commenced, and it is the Authority's intention, if this scheme is successful, to attach all domiciliary midwives to group practices or groups of practitioners throughout the Borough. Similarly, the Authority has favoured the more efficient use of domiciliary midwives by encouraging schemes whereby they can deliver selected cases in hospital and attend these "earlier discharged" cases in their homes. This is part of unifying maternity 14 services with the provision of greater job satisfaction and training experience for hospital and domiciliary midwives resulting in greater comfort, safety and efficiency for mother and baby. It is clear that a different set of circumstances exists with regard to the attachment of district nurses and the Authority has been cautious in its approach. The effective work of the home nurse must remain in the home, and the immobility of the patients, the frequency and length of their treatment, needs careful planning of district nursing rounds. In a very compact general practice, some attachment may be possible, and a pilot scheme is to be tried out next year. Wherever possible, the services of auxiliary nurses are used to assist in the general district work of the Authority. The training of student nurses from hospital in community care and the field training of students from other disciplines has developed considerably in this section and this is particularly brought out by the report on health visiting. At the same time, in-service training of health visitors themselves is a continuing task to fit them for their increased involvement in attachment schemes. A total of thirteen Health Visitors are in various general practitioner attachment schemes. As the policy of the Authority is to attach the health visitor only to those practices where there are full facilities and where the health visitor can play a fully effective role, it is unlikely that this number will be greatly exceeded in the future. It will be noted that 50% of the Health Visitors' work is in the School Health Service, and in order to show the great variety of her work over a year, there is a detailed breakdown of these visits at the end of the report of the Health Visitor section. It is clear that these visits are attended by a great deal of incidental health education. Health Education in a wider field is dealt with in a separate section of the Report. Mental and Social Welfare Both these sections of the Department have contributed very full reports of continuing progress; and it is intended to comment in greater detail next year on progress since the inception of the new Borough. However, I must comment on two contributions of the Mental Health Section. Firstly, the account of the purpose and work of Rydal Mount Hostel is clearly set out. It presents most lucidly the way in which the Local Authority can assist most effectively the recovery from their illnesses of the mentally ill. Secondly, the report refers to the investigation on drug abuse. The booklet "Drugs in your Town" was the result of a single-handed investigation by a member of the Health and Welfare Committee. It stimulated national and international 15 cussion on press and radio/television and prompted the Committee to set up a Panel which over many hours reviewed evidence, and made important recommendations to abate a problem, no greater in Bromley than elsewhere, which time alone may heal. In conclusion, I wish to thank the Heads of Sections and all my loyal staff for their zealous and enthusiastic services throughout the year. My thanks are also due to the Town Clerk and other Chief Officers. The Department has enjoyed the co-operation of the numerous voluntary organisations of the Borough and is grateful for their assistance and understanding. The advice of Adminstrative Officers of the Hospitals, Executive Council and Local Medical Committee have been readily available and welcomed. The general medical practitioners of the Borough have had the friendliest relations with the staff of the Health and Welfare Department and there has been mutual understanding of problems and objectives for the future. The Press services of the Borough have contributed in no small measure by interesting articles and by informed comment to the work of the Health Services. Finally, I would like to thank the members of the Council and in particular the Chairman and Members of the Health, Welfare and Children Committee for their help and understanding of the priorities and needs of the Health Services of the Borough. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 19 VITAL AND OTHER STATISTICS Population (mid-year 1969) 303,550 Area (acres) 37,583 Density of population (persons per acre) 8.1 Rateable value as at 1.4.1970 £17,235,000 Product of ld. Rate £70,000 Rate in pound 1970/71 (Domestic) 12/6 Births: Live 4,384 Males Females Total Legitimate 2,130 1,964 4,094 Illegitimate 137 153 290 Crude birth rate per 1,000 estimated total population 14.4 Adjusted birth rate for comparison with other areas 14.5 (Area comparability factor for Births = 1.01) Illegitimate live births = 7% of all live births Crude birth rate for Greater London 15.7 Adjusted birth rate for Greater London 14.6 Birth rate for England and Wales 16.3 Stillbirths: Stillbirths 35 Males Females Total Legitimate 21 10 31 Illegitimate 2 2 4 Stillbirth rate for 1,000 live and still births 8 Stillbirth rate for Greater London 12.7 Stillbirth rate for England and Wales 13 Total births (live and still) 4,419 Males Females Total Legitimate 2,151 1,974 4,125 Illegitimate 139 155 294 Total of all live and still births 2,290 2,129 4,419 20 Infant Mortality: Males Females Total Legitimate 23 31 54 Illegitimate 1 3 4 Infant mortality rate per 1,000 total live births 13 Legitimate infant deaths per 1,000 legitimate live births 13 Illegitimate infant deaths per 1,000 illegitimate live births 14 Infant mortality rate for Greater London per 1,000 live births 17.9 Infant mortality rate for England and Wales 18 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 9 Neonatal mortality rate for Greater London 11.7 Neonatal mortality rate for England and Wales 12 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 8 Early neonatal mortality rate for Greater London 10.2 Early neonatal mortality rate for England and Wales 10 Perinatal mortality rate (stillbirths and deaths under one week combined, per 1,000 total live and stillbirths) 16 Perinatal mortality rate for Greater London 22.8 Perinatal mortality rate for England and Wales 23 Maternal Mortality: Maternal deaths (including abortion) 3 Maternal mortality rate per 1,000 total live and still births 0.07 Maternal mortality rate for Greater London per 1,000 live and still births 0.20 Maternal mortality rate for England and Wales per 1,000 total births 0.19 21 Deaths : Males Females Total 1,552 1,706 3,258 Crude death rate per 1,000 estimated total population 10.7 Adjusted rate for comparison with other areas 9.5 (Area comparability factor for deaths = 0.89) Crude death rate for Greater London per 1.000 population 11.5 Adjusted death rate for Greater London per 1,000 population 11.6 Death rate for England and Wales 11.9 Tuberculosis death rates: All forms (per 1,000 population) 0.02 Pulmonary (per 1,000 population) 0.007 Non-Pulmonary (per 1,000 population) 0.014 Cancer death rates: All forms (per 1.000 population) 2.6 Lung and Bronchus (per 1,000 population) 0.7 Other forms (per 1,000 population) 1.9 NOTE: As there has been a change of boundary during the year, the statistics represent the events assigned to the area within the boundaries as they existed at the date of registration of each event. To allow calculation of valid Birth and Death rates the population figure used, i.e. 303,890, is a weighted average of the mid-year population of the areas as constituted before and after the change. This population figure is calculated only for the purpose described above and will not agree with the official population figure of 303,550 published in the Registrar General's "Annual Estimates of the Population of England and Wales and of Local Authority Areas, 1969". Population The Registrar-General's estimate of the population of the Borough, mid-year 1969, was 303,550. This figure gives a density of 8.1 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 1,126. The figure for 1968 was 650. 22 Births There were 4,384 live births allocated to the Borough during 1969, after adjustments for inward and outward transfers, this being an increase of 25 over the figure for the previous year. Of the 4,384 live births, 2,267 were males and 2,117 females. The crude birth rate for the Borough was 14.4 per 1,000 population, and the adjusted rate, for use when comparing one area with another was 14.5. The birth rate for 1969 was 0.1 higher than that recorded for the previous year, and is below the figures of 15.7 and 16.3 for Greater London and England and Wales respectively. In addition to the live births, there were 35 still births, representing a rate of 8 per thousand total births. This rate is well below that of 12.7 for Greater London and 13 for the country as a whole. The figure for the Borough for 1968 was 12 per 1,000 total births. Birth Notification A total of 3,886 births was notified as having occurred in the area. Of this number, 3,258 were institutional and 628 domiciliary births. 31 still births actually occurred in the area. 4 of these were from domiciliary confinements. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Males 2,130 137 2,267 21 2 23 Females 1,964 153 2,117 10 2 12 Totals 4,094 290 4,384 31 4 35 Deaths 3,258 deaths were registered in 1969, giving a crude death rate of 10.7 per 1,000 population. This rate, when standardised by the comparability factor, gives a figure of 9.5 for comparison purposes. The rates for Greater London, and England and Wales were 11.6 and 11.9 respectively. The following table shows causes of death as given in the Registrar-General's statistics. 23 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1969 (Registrar-General's Return) Cause of Death Sex Total all ages Under four weeks Four weeks and under 1 year Age In Years 1 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74 75 and over 1. Enteritis and other Diarrhoeal Diseases M 2 - - 1 - - - - - - 1 - F 1 — - - - - - - - 1 - — 2. Tuberculosis of Respiratory System M 1 - - - - - - - - 1 - - F 1 - - - - - - 1 - - - - 3. Other Tuberculoosis Incl. Late Effects M 2 - - - - - - 1 - - 1 - F 2 - - - - - - - 1 - 1 - 4. Syphilis and Its Sequelae M 1 - - - - - - - - 1 - - F - — — — — — - — — - - - 5. Other Infective and Parasitic Diseases M 2 - - - - - - - - - 1 1 F 3 — — 1 - - - - - 1 - 1 6. Malignant Neoplasm, Buccal Cavity Etc. M 3 - - - - - - - - 1 1 1 F 3 - - - - - - - - - 1 - 7. Malignant Neoplasm Oesophagus M 11 - - - - - - - 1 1 5 4 F 14 - - - - - - - 2 2 2 8 8. Malignant Neoplasm, Stomach M 35 - - - - - - 2 3 10 12 8 F 34 — — — — — — - - 7 8 19 9. Malignant Neoplasm, Intestine M 52 - - — - - — 1 4 18 11 18 F 57 - - - - - - 3 7 8 18 21 10. Malignant Neoplasm, Larynx M 5 - - - - - - - - 1 2 2 F 1 - - - - - - - - - - 1 11. Malignant Neoplasm, Lung, Bronchus M 168 - - — - - - 1 14 62 58 33 F 36 - - - - - - - 5 8 14 9 12. Malignant Neoplasm, Breast M - - - - - - - - - - - - F 83 — - — — 1 1 4 17 24 22 14 13. Malignant Neoplasm, Uterus F 20 - - — — — — 2 4 4 7 3 14. Malignant Neoplasm, Prostate M 23 — — — — — — — 1 3 8 11 15. Leukaemia M 11 - - - 1 - 1 - 2 3 2 2 F 8 — — — — - — 1 2 4 1 16. Other Malignant Neoplasms M 115 - - 1 - 1 5 5 16 32 34 21 F 108 - - 1 — 1 1 6 8 24 32 35 17. Benign and Unspecified Neoplasms M 1 - - - - - - - - - - 1 F 8 — — - - - 1 - 1 2 2 2 18. Diabetes Mellitus M 5 - - - 1 - - - - - 2 2 F 5 — — — — — — — — 1 — 4 19. Avitaminoses, etc. M 1 - - - - - - - - - - 1 F 2 — — - - - - - - 1 1 — 20. Other Endocrine etc. Diseases M 8 - - - 2 - - - 2 - 2 2 F 4 — — — — — — 1 — — 1 2 21. Anaemias M 1 - - - - - - - - - - 1 F 5 — — - - - - - - - 1 4 22. Other Diseases of Blood, etc. M 2 - - - - - - - 1 - - 1 F — - - - - - - - - - - - 23. Mental Disorders M 1 - - - - - 1 - - - - - F 3 - — - - - - - - - 1 2 24 Meningitis M - - - - - - - - - - — - F 1 — 1 - - - - - - - - - 25. Other Diseases of Nervous System, etc. M 10 - - - 1 1 - 1 - 3 3 1 F 14 - - 1 — — — 1 2 4 6 26. Chronic Rheumatic Heart Disease M 18 - - - - - - - 1 8 7 2 F 27 — — - - - - 1 1 10 2 13 24 Cause of Death Sex Total all ages Under four weeks Four weeks and under 1 year Age In Years 1 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74 75 and over 27. Hypertensive Disease M 17 - - - - - - - 2 2 9 4 F 37 — — - - - - - - 2 11 24 28. Ischaemic Heart Disease M 419 - - - - - 5 34 125 122 133 F 334 — — — — — — 4 11 27 70 222 29. Other Forms of Heart Disease M 49 - - - 1 - - - 2 7 13 26 F 91 — — — — 1 — 1 1 1 8 79 30. Cerebrovascular Disease M 112 - - - - - - 1 9 8 26 68 F 250 — — — — — — 4 6 11 53 176 31. Other Diseases of Circulatory System M 69 - - - - - - - - - 21 34 F 83 — — — — — — - - 5 9 69 32. Influenza M 9 - - - - - - 1 - 1 3 4 F 6 — — — — — — 1 — 1 1 3 33. Pneumonia M 133 1 1 - - - - - 3 11 23 94 F 226 1 2 — — — — 2 1 16 27 177 34. Bronchitis and Emphysema M 114 - - - - - - - 1 24 53 36 F 46 — — — — — - - 1 4 14 27 35. Asthma M 2 — - — — - - - - 1 - 1 F 6 - - - - 1 1 1 1 1 1 - 36. Other Diseases of Respiratory System M 24 - 7 2 - - - - - 3 8 4 F 17 — 2 - - - - 1 - 1 5 8 37. Peptic Ulcer M - - - - - - - - - - - - F 9 — — - - - - - - - 1 8 38. Appendicitis M - - - - - - - - - - - - F 1 — — - — — — — — — 1 — 39. Intestinal Obstruction and Hernia M 2 - - - - 1 - - - - - 1 F 12 1 — - - - - - - 1 3 7 40. Cirrhosis of Liver M 3 - - - - - - 1 1 - 1 - F 3 — — — — — — — — 2 1 — 41. Other Diseases of Digestive System M 9 - - - - - - - 1 3 3 2 F 18 — — — — — — 1 1 1 3 12 42. Nephritis and Nephrosis M 5 - - - - - - - - 3 - 2 F 2 — — — — — — — — 1 1 — 43. Hyperplasia of Prostate M 7 — - - - - - - - - 4 3 44. Other Diseases, Genito-Urinary System M 9 - - - - - - - - - 2 6 F 20 — — - — - 1 — 1 1 6 11 45. Abortion F 1 - - - - - - 1 - - - - 46. Other Complications of Pregnancy, etc. F 2 - — — — 1 1 — — — — - 47. Diseases of Skin, Subcutaneous Tissue M 1 1 - - - - - - - - - - F 1 - - - - - - 1 - - - - 48. Diseases of Musculo-Skeletal System M 1 - - - - - - - - - 1 - F 11 - - - - - 1 - 1 1 2 6 49. Congenital Anomalies M 17 4 2 - 4 - 1 1 2 2 1 - F 11 6 1 2 - - - - - - 1 1 50. Birth Injury, Difficult Labour, etc. M 4 4 - - - - - - - - - - F 8 8 — - - - - - - - - - 51. Other Causes of Perinatal Mortality M 4 4 - - - - - - - - - - F 10 10 — - - - - - - - - - 52. Symptoms and III defined Conditions M 2 - - - - - - - 1 — - 1 F 5 - - - - - - 1 - - - 4 53. Motor Vehicle Accidents M 14 - - - 2 2 - 5 1 2 2 - F 19 — - — 2 2 2 - 3 2 3 5 54. All Other Accidents M 19 - - - - 3 1 4 - 2 5 4 F 21 1 — - - - - - - 2 1 17 55. Suicide and Selfinflicted Injuries M 8 - - - - 1 1 1 2 1 2 - F 13 — — — — 1 2 3 4 1 2 — 56. All Other External Causes M 8 - - - - - 2 1 2 3 - - F 3 — 1 - - - - 1 1 - — — TOTAL ALL CAUSES M 1,553 14 10 4 12 10 12 32 111 352 456 539 F 1,706 27 7 5 2 9 11 40 81 178 345 1,001 25 Accidental Deaths During the year 73 residents died from accidents of all kinds, including 33 in motor vehicle accidents. DEATHS FROM CANCER Male Female Total 1969 1968 1967 1966 1965 1969 1968 1967 1966 1965 1969 1968 1967 1966 1965 Malignant neoplasm, stomach 35 53 28 39 35 34 39 33 32 26 69 92 61 71 61 Malignant neoplasm, lung, bronchus 168 221 148 136 154 36 54 41 32 36 204 275 189 168 190 Malignant neoplasm, breast - 2 - - - 83 114 76 64 70 83 116 76 64 70 Malignant neoplasm, uterus - - - - - 20 39 18 22 15 20 39 18 22 15 Other malignant and lymphatic neoplasms 220 221 191 151 149 191 256 161 187 169 411 477 352 338 318 Totals 423 497 367 326 338 364 502 329 337 316 787 999 696 663 654 Rates per 1,000 population:- All forms 2.6 Lung and bronchus 0.7 Other forms 1.9 Maternal Mortality Three maternal deaths occurred in the Borough during the year, giving a rate of 0.07 per thousand total births. The maternal mortality rate for Greater London for 1969 was 0.20 per 1,000 total births, and 0.19 for England and Wales. Tuberculosis There were two deaths attributed to pulmonary tuberculosis and four to non-respiratory tuberculosis, giving a death rate of 0.02 per 1,000 population. Street Accidents 1,719 street accidents occurred in the Borough during 1969. 2,317 persons were injured and 30 died. These totals include 397 children under 15 years of age who were injured, and 5 who died. Infant Mortality There were 58 deaths of infants under one year of age during 1969. 54 of these were legitimate and 4 illegitimate, giving a rate of 26 13 per 1,000 total births. The rates for Greater London and England and Wales were 17.9 and 18.0 respectively. Of the 58 infant deaths, 41 were under four weeks old, giving a neonatal mortality rate of 9.0 per 1,000 total live births. The neonatal mortality rate for Greater London was 11.7 and for England and Wales 12.0. There were 36 deaths of infants under one week of age, giving an early neonatal mortality rate of 8.0 per 1,000 total live births. The rates for Greater London and England and Wales were 10.2 and 10.0. The perinatal mortality rate for the Borough (still births and deaths under one week combined, per 1,000 total live and still births) was 16 and those for Greater London and England and Wales 22.8 and 23 respectively. 27 DEATHS OF INFANTS UNDER 4 WEEKS OF AGE Cause of Death AGE TOTAL 24 hours 1-7 days 8-28 days Prematurity 5 6 - 11 Congenital Heart Disease 1 3 1 5 Rhesus Incompatibility - 1 - 1 Anencephaly 1 - - 1 Congenital Pulmonary Atresia - - 1 1 Intra-Cranial Haemorrhage - 1 - 1 Heart Failure - - 2 2 Cerebral Haemorrhage 1 1 - 2 Respiratory Failure 2 1 - 3 Respiratory Distress Syndrome 4 2 - 6 Broncho-Pneumonia - - 2 2 Pneumonia 1 1 - 2 Tracheo-Bronchitis - - 1 1 Atelectasis 2 - - 2 Anoxia 1 - - 1 18 16 7 41 Meteorological Observations Due to damage to equipment, the Director of Parks has been unable to supply full information in respect of the year 1969. The average total rainfall taken over the Borough as a whole was 22.526 inches. PERSONAL HEALTH SERVICES 31 PERSONAL HEALTH SERVICES These services are provided under Part III of the National Health Service Act of 1946. MATERNAL AND CHILD HEALTH Audrey Jones, M.B.ch.B., Senior Medical Officer. CARE OF MOTHERS AND YOUNG CHILDREN Care of the Unmarried Mother and her Child Financial liability was accepted for 13 cases, at a total cost of £1,170, an average of £90 per case. The majority were referred by the Canterbury Rochester Diocesan Council for Social Work. Others were referred by the Southwark Catholic Children's Society, and the Welfare Section. Child Health Clinics The total number of premises used for clinics is 35, of which 6 are purpose-built, 3 are adapted, and the remainder occupied on a sessional basis. The Elmers End Clinic was re-established in improved premises at St. James's Hall. Doctor sessions per week averaged 41. Attendances totalling 76,172 were made by children of up to 5 years of age, continuing the downward trend of the last 3 years (1968—83,721, 1967—87,379). 62.2% of attendances were by children under 1 year of age, 17.5% by those 1 to 2 years, and 20.3% by those between 2 and 5 years. 4,285 children attended a clinic for the first time. Welfare Foods Whilst the sale of proprietary foods was discontinued, the sale of welfare foods increased slightly to the value of £11,011 from National Dried Milk, Cod Liver Oil, Vitamin A & D Tablets and Orange Juice. Day Nurseries and Child Minders The number of registrations increased considerably under the new regulations. 1969 1968 Difference Number of premises 101 74 +27 (12% providing all-day care) Number of places provided 3,255 2,585 +670 Average places provided 32.2 34.9 -2.7 No day nurseries were provided by the Council and financial assistance was not given towards placements in private nurseries. 32 Child Minders 1969 1968 Difference Number of persons 204 59 +145 (85% providing all-day care) Number of places provided 840 786 +54 Average places provided 4.1 13.3 -9.2 Approximately 120 Play Groups were organised, these being defined as "Premises or persons registered under the Nursery and Child Minders Regulations and the Health Service and Public Health Act 1936, providing, on a sessional basis, group play activity for 2 - 5 or older children". Introductory courses for play group leaders commenced during the year at the Bromley and Beckenham/Penge Adult Education Centres. Nursing Homes Number of homes at 31.12.1968 17 Number of homes at 31.12.1969 16 Homes closed during 1969 2 Homes registered during 1969 1 Number of beds provided: at 31.12.1968 380 at 31.12.1969 369 Mother and Baby Homes 1 Number of beds provided 14 Included above Number of cots provided 6 Deaf Children The scheme continued to work well. 57 children were referred from the child health clinics for further examination at the Audiology Clinic or by home visits. Cervical Cytology Tests made numbered 2,557, of which 1,540 were primary, 905 were routine re-examinations after three years, and 112 were specific re-examinations. The yearly total compares with a total of 2,343 tests during 1968. Limited press coverage was given to this service in the early part of the year bringing a substantial response. An extensive publicity campaign was planned for 1970, based on leaflet distribution to each household. A further evening Clinic was established, monthly at Bromley Hospital, and has had considerable success, and thereby making a total of 15 regular clinics per month. 33 Recuperative Care Arrangements were made, on medical grounds certified by the General Practitioner, for 54 persons to spend a period, generally of 2 weeks, at various Homes. Many of these were elderly, and, indeed, it is apparent that there is a need for holidays on social as well as medical grounds, particularly for this age group. The total cost was £950, an average of £17 10s. per person, and charges were made on the basis of assessed income. Family Planning Since the scheme of Family Planning Clinics was implemented during the year, 69 patients have been seen at 6 clinics held throughout the Borough, 3 of these at Local Authority premises. Included in this number of patients are 46 seen for their general health, 22 for specific non-gynaecological conditions, and the rest for specific gynaecological conditions. Vaccination and Immunisation Smallpox Vaccinations The number of children vaccinated was 2,452 and 524 were revaccinated, making a total of 2,976 children. Completed Primary Courses (Persons Under 16) Year of Birth Others Under 16 Total 1969 1968 1967 1966 1962/5 Diphtheria 334 1,641 118 42 89 17 2,241 Whooping Cough 327 1,614 114 35 69 11 2,170 Tetanus 335 1,631 121 42 87 117 2,333 Poliomyelitis 219 2,274 217 79 154 21 2,964 Reinforcing Doses : Diphtheria 1 964 1,907 405 3,447 301 7,025 Whooping Cough 1 913 1,824 357 1,465 100 4,660 Tetanus 1 964 1,909 409 3,474 450 7,215 Poliomyelitis 5 115 4 86 3,335 357 3,902 CHIROPODY During the year 1969, the demand for chiropody continued to increase. Fortunately, the Authority was able to secure the services of three more sessional chiropodists to work in the Borough's Clinics. These were in addition to those already employed, i.e. two full time, twenty-seven contractual and seven sessional chiropodists. The total number of treatments given under the Authority's scheme was 24,121 out of which 9,191 were domiciliary and 14,930 surgery. Plans were made for a Chiropodial Clinic to be opened in West Wickham, Hawes Down School Clinic. 34 MIDWIFERY Miss M. C. Martin, S.R.N., S.C.M Non-Medical Supervisor of Midwives Group Attachment of Domiciliary Midwives A pilot scheme for the attachment of a Domiciliary Midwife to a group of General Practitioners was commenced in August, 1969, for one year. Patients say they have felt the benefit of more complete Doctor/Midwife liaison. The doctors and midwives concerned felt they were working more efficiently and with more job satisfaction. A further review of the scheme will be made in August, 1970, and it is hoped, as a result, to extend attachment of midwives to group practitioners. Integrated Cases A further pilot scheme for domiciliary midwives to deliver selected cases in hospital, followed by early discharge, was commenced in conjunction with Queen Mary's Maternity Unit, Sidcup. So far the scheme has run smoothly with good co-operation between domiciliary and hospital staffs. Preliminary discussions have taken place at Beckenham Maternity Hospital between the Consultant Obstetrician, Senior Medical Officer, Senior Nursing Officer and Supervisor of Midwives, with a view to starting a similar scheme in that area. Guthrie Test Preparations were made to commence the Guthrie test on all babies born in 1970. Midwives were instructed in the technique of making the Guthrie test where necessary. Accommodation for Midwives Two new midwives have been accommodated through the Housing and Estates Departments. Community Care Programme for Student Midwives A greatly extended community care programme was arranged for student midwives receiving their domiciliary training in the Borough. Excellent co-operation has been achieved with other departments including Moral Welfare, Children's Department, Geriatric Unit and old people's homes. Further improvement in the programme is envisaged. 35 Courses Two domiciliary midwives attended a seven-day course on ante-natal teaching at the Royal College of Midwives, two attended a course on practical teaching and management, and two attended Psychoprophylaxis Seminars. Six midwives attended statutory refresher courses. Deliveries attended by Midwives A total of 631 domiciliary confinements were attended by Midwives, and in 538 of these cases a doctor was not present at the delivery. The number of institutional deliveries discharged and attended by Midwives before the 10th day was 1,060. 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) 4(7) 627 (742) 631 (749) 1,060(965) (Figures in parenthesis relate to 1968) Total number of home visits made by midwives—27,398 Ante-Natal and Post-Natal Climes Number of women in attendance 945 Ante-Natal Mothercraft and Relaxation Classes Number of women who attended during the year 2,495 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1968 who were born:— (i) at home or in a Nursing Home 12 (ii) in hospital 266 (2) The number of those born at home or in a Nursing Home:— who were nursed entirely there 1ll who were transferred to hospital on or before the 28th day 1 who died during the first 24 hours — who died in 1 and under 7 days 1 who died in 7 days and under 28 days — who survived at the end of one month 11 36 (3) The number of those born in hospital:— who died during the first 24 hours 13 who died in 1 and under 7 days 4 who died in 7 and under 28 days 2 who survived at the end of one month 147 (4) The number of premature stillbirths who were born:— (i) at home or in a Nursing Home (ii) in hospital 15 Congenital Malformations The presence of a congenital malformation noted at birth is reported on the card notifying the birth to this Authority. Following completion of the standard enquiry form by the midwife or of the appropriate hospital form information is passed to the Registrar-General. All children so notified are kept under constant surveillance. 65 notifications were received during 1969 of which 58 were in respect of live births and 7 still births. The total number of malformations was 78 and the number of children with multiple malformations was 5. Notifications of Intention to Practise In accordance with the rules of the Central Midwives Board 127 midwives notified their intention to practise within the Borough during the year 1969. HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., Dip.Soc.Studies (Lond.) Staffing The Health Visiting Establishment was 47, and the equivalent of 38 staff were in post at the end of the year. 4 Sponsored Student Health Visitors were in post, and 5 who were sponsored in 1968/69 completed their training and were successful in passing their examinations (one with distinction) and were taken on the staff. In-Service Training 4 Health Visitors attended a 2-week Refresher Course, and 2 attended a Day Release Course to qualify them as Field Work Instructors. 9 Student Health Visitors were trained in the area under the Field Work Instructors' guidance. The Kent County 37 Council invited the staff to participate in their In-Service Refresher Course and 50 attendances were made during the last week of April. In addition, discussions, seminars and short courses on various aspects of the work have been attended by various members of staff. Training from the Bromley Group of Hospitals and Orpington Hospital 104 Student Nurses have been given an insight into Community Care. 43 nurses taking special courses in obstetrics and paediatrics have been on visits with the health visitors. 9 students from other disciplines have accompanied the health visitors for observation and instruction. General Practitioner/Health Visitor Co-ordination of Work Schemes 7 Health Visitors are on Attachment Schemes. 4 Health Visitors are in Attachment Schemes plus geographical area. 2 Health Visitors are in Liaison Schemes. Surveys 10 Health Visitors participated in an exacting survey of the Health Visitor's work, organised throughout Greater London by the G.L.C. Research and Intelligence Unit, over a two-week period in the autumn and which added considerably to their clerical work. The results of the survey are still awaited. 72 questionnaires were completed for the National Child Development Study, and 2 surveys were undertaken on children born with spina bifida and allied conditions. Daily Minder Registrations Over 300 persons and premises have now been visited after applications for child minding have been received, and follow-up visits and reports have added to the work load of senior staff and Health Visitors. Statistics The statistical breakdown of the Health Visitors' work excluding 50% of their time spent on the School Health Service is as follows:— Children visited for the first time in the current year:— Children born in 1969 4,739 Children born in 1968 3,207 Children born between 1964/67 6,887 38 Persons aged 65 or over visited for the first time 296 Mentally disordered persons 131 First visits not included in above 239 Total number of T.B. patients visited 521 Total number of patients other than T.B. attending the Chest Clinic 139 Subsequent visits to children under 5 years 23,311 Visits to ante-natal mothers 430 Total number of visits to the elderly 556 Total number of miscellaneous visits 3,395 Total number of maternity and child health sessions attended 3,541 Total number of other clinic sessions attended 708 Ineffective visits 8,658 HOME NURSING Mrs. P. Tierney, s.r.n., q.n. Superintendent, Home Nursing Service General Hospitals Arrangements have been made, and are now in progress, for Student and Pupil Nurses to accompany District Nurses for one day, to obtain knowledge of the work to be undertaken. Geriatric Hospitals District Nurses are now invited into the hospitals to see patients before they are discharged into their care, and to discuss with hospital staff treatment and capabilities of the patients. Family Doctors Nurses are appointed to geographical areas and are responsible to family doctors for patients who are registered in their particular area. Co-operation between doctors and nurses continues to be satisfactory. No liaison or attachment schemes are in operation. Statistics A total of 3,192 persons were nursed during the year, 11 of whom were under 5 years of age, and 1,425 were over 65 years of age. This represents a total decrease over 1968 but is the same as for 1967, with the number of aged remaining stable. The number of visits made was 98,153, an average of 30.75 visits per patient during the year. 39 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. During the year 202 persons were notified to the department and 112 successfully visited. This not infrequently involved more than one visit. Some persons were not known at the addresses given and others, despite repeated visits, had not been contacted by the end of the year. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 Under this section of the Act as amended by the National Assistance (Amendment) Act, 1951, powers -are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year it was not found necessary in any instance to apply for a removal order as, with the assistance of other interested bodies, we were able to effect improvement in the conditions found to exist. MEDICAL EXAMINATION OF STAFF Staff who are eligible for admission to the Council's Superannuation Scheme are required to complete a medical questionnaire. From the information given it is decided whether the candidate can be regarded as fit, or if it is necessary for a medical examination to be carried out before a decision is made. Other examinations are arranged following prolonged sick leave and in cases of retirement on health grounds; candidates may also be examined at the request of the Chief Officer to assess their fitness for employment. In addition to these examinations of the Council's staff a similar procedure is carried out for the West Kent Main Sewerage Board and for the Stockwell Teachers' Training College. A considerable number of medical examinations take place as a result of applications by residents in the Borough for 40 admission to Teacher Training Colleges, and also from the requirement of the Department of Education and Science that teachers taking up their first teaching appointment should be medically examined. The statistical details for the year are given below: Total number of Health Declaration Forms received 1,275 No. of recommendations without medical examination 1,024 No. of medical examinations carried out (a) For admission to Superannuation Scheme 251 (b) Training College Candidates 398 (c) Teachers' first appointments 78 (d) Premature retirement or prolonged sick leave 50 (e) For other Authorities 8 (f) For West Kent Main Sewerage Board 16 801 Candidates examined for this Borough by other Authorities 2 HOME HELP SERVICE The Health Services and Public Health Act, 1968, now makes the provision of Home Help mandatory. Part 1, Section 13, states: "It shall be the duty of every local Health Authority to provide on such a scale as is adequate for the needs of their area, or to arrange for the provision on such a scale as is so adequate, of home help for households where such help is required owing to the presence of a person who is suffering from illness, lying-in, and expectant mother, aged, handicapped as a result of having suffered from an illness or by congenital deformity, or a child who has not attained the age which, for the purposes of the Education Act, 1944, is, in his case, the upper limit of the compulsory school age, and every such Authority shall have power to provide or arrange for the provision of laundry facilities for households for which the Home Help is being, or can be provided under this sub-section. A local Health Authority may, with the approval of the Minister, recover from persons 41 availing themselves of help or facilities provided under this section, such charges (if any) as the Authority consider reasonable, having regard to the means of those persons". The following is a summary of the cases in which assistance was given in 1969 :— Aged 65 or over on first visit in 1969 2,122 Under 65— Chronic Sick and T.B 215 Mentally disordered 27 Maternity 285 Illness 319 Hours of Service given Home Help Service 230,740 Family Care Service 2,391 Family Welfare Service 295 Evening Service 607 Total 234,033 Family Care Service 26 cases involving 77 children, received assistance. Family Welfare Service 4 cases received assistance in 1969. Night and Evening Service 5 cases received assistance during the year. It will be seen that Home Help was supplied in 3,003 homes during the year 1969. In-Service Training Two Area Organisers attended a Seminar for Home Help Organisers in London arranged by the London Boroughs Training Committee. The Area Organisers have taken students from other sections of the Health and Welfare Department out visiting, in order to show them the work of the Home Helps, and their own responsibilities, in the domiciliary care of the aged and sick, and in the homes of young families with health or social problems. Lectures have been given at intervals to groups of students by the Senior Organisers, who also take part in Case Conferences held to consider the problems of families whose standards of living have deteriorated. 42 Home Visits Home visits to clients by Organisers during 1969 totalled 8,830. This figure does not include visits to the Home Helps or calls made but no admittance gained. Essential day-to-day help in homes where there is real need continues to be supplied. Recruiting is spasmodic, but by advertisement, personal effort, and recommendation, gaps caused by retirement and ill health are filled. Since there are increasing numbers of elderly and sick people who must remain in their own homes, it is evident that Home Helps must always be found, in spite of local difficulties in obtaining staff. There is, however, increasing need for selectivity in assessing individual needs, and co-operation with other statutory and voluntary organisations which is so valuable to both sides. 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 1969: — New Cases of Residents Treated During 1969 Treatment Centre Syphilis Gonorrhoea Other Conditions Total Primary and Secondary Other Croydon General — — 21 65 86 Dreadnought Seamen's Hospital, Greenwich 2 - 11 39 52 Greenwich District Hospital - 1 13 36 50 St. Bartholomew's Hospital, E.C.l 1 - 2 34 37 St. John's Hospital, Lewisham 4 1 33 175 213 St. Thomas's Hospital — — 10 44 54 Westminster Hospital, S.W.l - - 3 22 22 The London Hospital Whitechapel Clinic — — 3 11 14 7 2 93 426 528 43 HEALTH EDUCATION AND HOME SAFETY Health Education and Youth Adolescence is a mixed state, in which childhood and adult life overlap, not always with ease. Many of the problems remain the same whether a boy or girl has left school or not and, in many respects, the wage-earning adolescent is just like the schoolboy or schoolgirl of like age; the needs of mind and spirit are the same, and the processes of learning are not essentially different. But, for the young wage-earner, school is over for ever. He is earning his living in a wider and insecure world, and this tends to give him an air of apparent maturity which his friends at school have still to achieve. He is also understandably suspicious of anything that smacks too obviously of his own childish past, however happy this may have been. Two of the symptoms of growing up met by every youth leader are the desire to smoke and the desire to have a drink in imitation of those who are already grown up. Young people must be helped to realise the dangers inherent in these desires, and the example of youth leaders and in fact of all adults is of the greatest importance, particularly so with regard to the misuse of drugs. Some of these young people take drugs in an attempt to solve their problems, to give themselves self-confidence, or to help them to face the realities of life. Others do so because they need to revolt against teachers and parents and the established order of society. It might be said that all these people have emotional problems and that, with drugs, they can create a new, more tolerable, but false world. The opportunities for health education among young people seem to fall into three main groups, according to their sources. First comes everything which a young worker learns in the course of employment that may have a bearing on general education in matters of health. Under the Factory Acts, careful provision is made for welfare and many firms supplement the legal minimum in their own way; the actual job and the training needed for it may also be of real value from the point of view of accident prevention, hygiene or general physical development. But the knowledge and practice which are disseminated in this way are in practice very unevenly distributed; many of those who need help most, do not get it. Next comes all that can be provided to the young workers through further education; the last seven years have seen a remarkable increase in the numbers of young workers released part-time for further education. Admittedly, the vocational 44 element predominates in most courses. In many, however, time is found for general studies in which young workers have the opportunity to discuss with their tutors problems of very immediate concern to them, including those of health, morals and conduct. The Youth Clubs and similar groups organised by Local Authorities and Voluntary Associations provide the third group of activities in this field. All regard social training as a main aim and the increasing stream of volunteers to train for this work is a welcome feature of recent years. As boys and girls become older and more interested in each other, they often become conscious of needing more information and advice on questions of etiquette, ethics and general behaviour, particularly towards members of the other sex, on general fitness, personal poise, sexual problems and the problems involved in becoming a parent. One needs only to read the weekly column of advice in any journal much read by young women to see how greatly these questions agitate and often confuse the next generation. Boys are perhaps more reticent, but both sexes turn eagerly to all apparently reasonable sources of help. Some turn to their parents, some to a minister or priest, some to a doctor. Often the circumstances of the moment may provide a potential counsellor. Yet many find it difficult to confide in older people. Young people have always tended to react against the good intentions of an older generation and sometimes natural independence drives them to very dubious sources of advice. They are fortunate who know an older and more experienced friend, still young enough to speak the same language, does not offer too much advice, and is none the less there when needed. Sometimes, a young lecturer or tutor, sometimes a friend of the family, or a senior member of a Youth Group or similar society, is in a position to give this kind of help. The contribution made by the best youth leaders is outstanding, and the authorities are wisely providing them with training in individual and group counselling. Their training should give them the knowledge of outside agencies to whom they can turn for expert help when they feel the need. Contributions from outsiders to Club programmes designed to help members with problems of personal relationships are a growing feature of their activities. Home Safety From January to December, 1969, a total of 9,509 home accident cases were treated at the hospitals of Beckenham, Farnborough, Orpington and Bromley. Of these, 5,484 were adults and 4,025 children. In 1968, the overall total from these hospitals was 8,130 and, of these, 4,569 were adults and 3,561 children. 45 This shows an increase of 1,379 casualties in 1969, as compared with the previous year. Of these 915 were adults and 464 children. This increase is most disappointing, although enquiries reveal that the majority of these accidents, both to adults and children, were of a minor nature. The message, however, is clear—more and more effort must be made to make the public more conscious of Accident Prevention. Therefore, education of the public must be the foremost priority, and must consist of example, teaching, exhortation and publicity together on all fronts. To ignore any sector is wasted effort. It is useless to educate the child without educating the parents. It is useless to educate the elderly, without educating those who may have to look after them. Once again, the three most prominent causes of home accidents, and with possibly serious complications, according to the statistics supplied by the hospital authorities were given as follows: (1) FALLS are of chief danger to old people. (2) BURNS/SCALDS affect both young and old. (3) POISONING is a general danger to adults, especially in relation to gas and medicinal substances, through overdose, etc., and also to the very young who may find drugs, tablets, medicines, detergents, etc., lying loose in cupboards, drawers, etc. Accidents at Home The average individual has not only to learn how to prevent accidents in his home, but must first be convinced that the various dangers exist. It is seldom realised that more deaths are caused by accidents in the home than by accidents on the roads. Between 1960 and 1965, the ratio was roughly six to five. Most of the victims of accidents at home are children and old people; about an eighth are under 15, and almost two-thirds over 65. Both these groups are at greater risk than are children of more responsible ages or adults in their prime of life. By far the greatest number of accidental deaths in the home are caused by falls (53% in 1964), followed by coal gas poisoning (12%), burns and scalds (10%) and suffocation (10%). Neary 90% of falls, over two-thirds of coal gas poisonings, and well over half of burns and scalds involve people over 65. Nearly 75% of accidents of suffocation (often due to babies turning over on a down pillow) and 15% of burns and scalds, happen to children under five years of age. 46 The commonest causes of death through accidents at home to children under 15 are suffocation, burning and scalding, and falls. In a recent investigation of 1,639 burn accidents, 70% of the victims were children under 15 and more than 80% of the deaths were due to injuries caused by ignited clothing. Most of the non-fatal cases required long periods of hospital treatment. CAREFULNESS begins at home—it is for a parent to make quite sure that his home and all its equipment is properly kept and used. This involves proper regard for individual items of equipment and proper carefulness on the part of the user. Local Campaigns 1970 In continued effort to reduce the appalling number of home accidents, the Home Safety Committees of the Borough have co-operated with the Royal Society for the Prevention of Accidents in their National Campaigns for the year as follows:— JANUARY—MARCH. "Face the Facts". APRIL—JUNE. Babies—the first three years. JULY—SEPTEMBER. Care of medicines—Ro.S.P.A. Leaflets and Posters. OCTOBER—DECEMBER. Winter Hazards. LONDON AMBULANCE SERVICE The Ambulance Service for the whole of Greater London is provided by the G.L.C. Ambulance stations within the Borough are sited in Hayes Lane, Bromley, and Croydon Road, Penge, but service is provided in addition from other stations sited outside of the Borough. There is a main Control in Bromley which covers the whole of South East London for non-emergency work. All emergency calls are routed directly to a Central Emergency Control at Ambulance Headquarters which directs ambulances by radio and by direct telephone lines to ambulance stations. DENTAL SERVICES 49 DENTAL SERVICES Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(glasgow) Principal Dental Officer Dental Service for Nursing and Expectant Mothers and Children under School Age Maternity and Child Welfare Dental Treatment has been continued in the normal pattern. There has, however, been a small decrease in the number of cases treated, 299 children as compared with 360, 23 mothers as compared with 37 in the previous year, probably by reason of the fact that the talks to the mothers on Dental Health have had to be curtailed owing to increased incidences of sick leave in the staff. The hygienist who delivers such talks, has had to assist with more essential duties. I welcome this opportunity to place on record my thanks to the entire dental staff for their unstinted co-operation and support during 1969. All types of treatment as in private practice are available, including treatment of orthodontic cases and the service is operated from all the school dental clinics. Details of the work carried out during 1969 are given on page 50. School Health Dental Service The complement of dental staff comprising five full-time and five part-time Dental Officers, has been fully maintained although there has been a change in the part-time dental staff. Despite an increase in the incidence of sick leave of both dental and nursing staff, the output of work has not decreased. There has in fact been an increase in some branches of the conservative work and almost all the maintained schools in the Borough have received dental inspections within the year. There is always a minimum of 500 orthodontic cases undergoing treatment. This year 160 new cases were undertaken and 132 cases successfully completed. This eminently satisfying branch of the dental department is much appreciated by the parents of the children treated. There is still a large incidence of caries in the infant schools especially in the new entrants and a great need for increased Dental Health Education is desirable. The Chief Dental Officer thanks all the Head Teachers for their help and co-operation to the Dental department. The Dental staff gratefully acknowledge the excellent work done by Dr. Morris and Dr. Miller in adminstering dental anaesthetics at the Clinics. 50 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS (as at December 1969) A. Attendances and Treatment: Children 0-4 (incl.) Expectant & Nursing Mothers Number of Visits for Treatment During Year: First Visit 299 23 Subsequent Visits 417 93 Total Visits 716 116 Number of Additional Courses of Treatment other than the First Course commenced during year 27 1 Treatment provided during the year: Number of Fillings 546 44 Teeth Filled 455 39 Teeth Extracted 46 26 General Anaesthetics given 22 2 Emergency Visits by Patients 12 14 Patients X-Rayed 1 3 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 102 35 Teeth Otherwise Conserved 40 — Teeth Root Filled — — Inlays — 10 Crowns — — Number of Courses of Treatment completed during the year 213 26 B. Prosthetics: Patients supplied with F.U. or F.L. (First Time) 6 Patients supplied with Other Dentures 6 Number of Dentures supplied 12 C. Anaesthetics: General Anaesthetics Administered by Dental Officers - D. Inspections: Children 0-4 (incl.) Expectant & Nursing Mothers Number of Patients given First Inspections during year A. 221 D. 13 Number of Patients in A and D above who required Treatment B. 111 E. 13 Number of Patients in B and E above who were offered Treatment C. 105 F. 13 E. Sessions: Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment G. 119.4 For Health Education H. 8.0 51 ATTENDANCES AND TREATMENT—SCHOOL CHILDREN Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 3174 2131 360 5665 Subsequent Visits 6757 8194 1242 16193 Total Visits 9931 10325 1602 21858 Additional courses of treatment commenced 380 281 96 757 Fillings in permanent teeth 2511 6322 1625 10458 Fillings in deciduous teeth 9005 2125 — 11130 Permanent teeth filled 2018 5202 1291 8511 Deciduous teeth filled 7767 895 — 8662 Permanent teeth extracted 62 238 53 353 Deciduous teeth extracted 1103 332 — 1435 General anaesthetics 424 236 9 669 Emergencies 126 49 11 186 Number of Pupils X-rayed 179 Prophylaxis 3,718 Teeth otherwise conserved 367 Number of teeth root filled 15 Inlays 3 Crowns 37 Courses of treatment completed 5,479 ORTHODONTICS Cases remaining from previous year 343 New cases commenced during year 163 Cases completed during year 132 Cases discontinued during year 3 No. of removable appliances fitted 191 No. of fixed appliances fitted 8 Pupils referred to Hospital Consultant 1 PROSTHETICS 5 to 9 10 to l4 15 and over Total Pupils supplied with F.U. or F.L. (first time) - - - - Pupils supplied with other dentures (first time) - l l 2 Number of dentures supplied l 1 l 3 ANAESTHETICS General Anaesthetics administered by Dental OfficersINSPECTIONS (a) First inspection at school. Number of pupils 34,295 (b) First inspection at clinic. Number of pupils 2,638 Number of (a) + (b) found to require treatment 12,052 Number of (a) + (b) offered treatment 8,693 (c) Pupils re-inspected at school or clinic 1,243 Number of (c) found to require treatment 578 SESSIONS Sessions devoted to treatment 2,978 Sessions devoted to inspection 293 Sessions devoted to Dental Health Education 55 INFECTIOUS AND OTHER DISEASES 55 INFECTIOUS AND OTHER DISEASES General The total number of notified cases of infectious disease showed a moderate increase compared with the previous year, 1,349 cases being reported compared with 780 during 1968. The principal reason for this was an increase in the number of cases of Measles, although a full scale epidemic of this infection, which could have been anticipated during the year, did not occur. The avoidance of a major outbreak can almost certainly be attributed to the success of the recently introduced immunising procedure, but further progress depends upon increasing the number of children who are protected. This, in turn, depends upon parents ensuring that their children are able to take advantage of this protective measure, if they have not already received it, and have not acquired immunity as a result of an attack of the disease. A very gratifying feature of the year was a considerable fall in the number of cases of Whooping Cough reported, and once again I am pleased to say that there were no cases of Diphtheria and Poliomyelitis in the Borough. The incidence of the other notifiable infectious diseases also remained at a low level throughout the year, although figures for gastro-intestinal infections in general showed a continued need for vigilance in respect of food hygiene and personal hygiene in the kitchen if the number of these infections is to be kept at a low level. A single case of Typhoid Fever was reported, and attention should be drawn to the recommendation of the Department of Health that vaccination against this condition should be considered before taking a holiday abroad. As a whole, the figures of notifiable disease throughout the year remained at a very satisfactory level, thus continuing the good record the Borough has enjoyed in this respect during previous years. Statistical details of the various infectious diseases are given below under separate headings, and unless otherwise stated, no deaths from these infections occurred. Diphtheria Once again no case of Diphtheria was notified in the Borough during the year. Dysentery 79 cases were notified, an increase compared with the previous year when only 17 cases were reported. The majority of cases occurring in the present year were recorded in the Spring and early Summer, and affected pupils attending a Primary School in the Borough. All the reported cases were of the mild sonne type. 56 Food Poisoning 17 cases were notified compared with 10 in 1968. In all except one instance the illnesses were due to organisms of the Salmonella group. In the remaining case the causative organism was not isolated. Full details are given in the tables below, from which it can be seen that there were no general outbreaks of food poisoning, all the cases being isolated ones except for a single instance in which two members of the same household were affected. 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. typhimunum — — 1 2 5 6 7 2. Other Salmonellae (a) - - — — 9 9 9 3. CI. welchii — — — — — — — 4. Staph. aureus — — — — — — — 5. Other causes (b) — — — — — — — 6. Cause unknown — — — — I 1 1 7. TOTAL — — 1 2 15 16 17 DETAILS OF FOOD POISONING DUE TO SALMONELLAE Type Of OTHER THAN S. TYPHIMURIUM Salmonellae brandenburg — — - - 1 1 1 enteritidis — — — - 3 3 3 stanley — — - — 1 1 1 group b - - - - 1 1 1 group d — - - - 3 3 3 Infective Jaundice This was the first full year during which Infective Jaundice has been notifiable. 39 notifications were received, there being no deaths from this cause. The general pattern of the infection has been of sporadic cases. 57 Leptospirosis No cases were notified during the year. Measles A total of 1,041 cases were notified during the year. This compares with 398 in 1968. The incidence of this infection during the year was nevertheless much below that which might have been expected to occur as, if the usual sequence of events had taken place, a full scale Measles epidemic could have been anticipated. The following table shows the incidence of the infection in the Borough since 1965. Year Number of cases notified 1965 5,119 1966 1,236 1967 4,299 1968 398 1969 1,041 It would appear that the campaign for protection of children against the disease by means of Measles vaccine has been successful in reducing the impact of the infection this year. If a greater proportion of the child population was to receive immunisation it is probable that this unpleasant and debilitating illness could be brought under complete control. I would therefore urge parents, if their children have not already had an attack of the disease or been immunised against it, to see that they receive the benefit of this safe and effective protective measure. Meningococcal Infections 7 cases were notified during the year and there was one death from this cause. Ophthalmia Neonatorum No notifications were received during the year. Poliomyelitis No case of this disease was notified during the year. Scarlet Fever Once again this infection continued to occur in a mild form and no deaths were recorded. 99 cases were notified compared with 73 during the previous year. Smallpox No cases occurred during 1969, but in accordance with the usual arrangements it was necessary for a number of suspected contacts from overseas to be kept under surveillance at various 58 times during the year. Information regarding these contacts was received from the Port Health Authorities. The department was called upon to authenticate the signature of the doctor on 6,813 International Certificates of Vaccination during the year, the figure for 1968 being 6,893. Tetanus One case of Tenanus was notified during the year. The patient, who recovered, was an adult employed in an outdoor occupation and had not previously been inoculated against the disease. Tuberculosis 50 new cases were notified during 1969 compared with 54 during 1968, continuing the decline in new cases which has been a feature of recent years. If the infection is to be eliminated, however, there is a continuing need for vigilance and the continuance of preventative measures to achieve this result. Assistance in tracing contacts of new cases is given by members of the Health Visiting staff attached to work with the local Chest Physicians. Also, BCG vaccination, which gives protection against the disease, is offered to all school children during their 13th year. It might seem, too, that it could be premature at this stage to reduce the services provided by the Mass X-Ray Units which, under the auspices of the S.E. Metropolitan Regional Hospital Board, pay regular visits to different sites in the Borough. The total number of cases on the register showed a further decline during the year from 2,922 to 2,823. There were 6 deaths attributed to the disease compared with 9 in 1968. In both these respects it is pleasing to report that the general improvement is continued. TUBERCULOSIS The following are details of the recordings in the register for the year ended 31st December, 1969: Respiratory Other forms Total No. of Cases M F M F No. on Register at 1.1.69 1,462 1,142 146 172 2,922 No. of cases notified during 1969 28 17 4 1 50 No. of cases coming to knowledge after death 1 — — — 1 Restored to Register - - — — - Inward Transfers 15 9 1 - 25 1,506 1,168 151 173 2,998 Deletions - deaths, removals recoveries, etc., 98 69 3 5 175 Number of cases on Register at 31.12.69. 1,408 1,099 148 168 2,823 59 New cases and Mortality: Age Groups New cases notified or otherwise revealed. (Not including Inward Transfers). Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 5 1 — — — — — — 5-14 years 2 4 — - - — — - 15-24 years 3 2 — - — — - - 25-44 years 4 2 - - — 1 1 — 45-64 years 16 6 2 1 1 — 1 — 65 years and over 2 3 — — — — 1 1 Age Unknown - — — - — — — — 28 17 4 1 1 1 3 1 Inward Transfers 15 9 1 — Totals 43 26 5 1 Typhoid Fever One case of Typhoid Fever was reported. The infection appeared to have been contracted during the course of a holiday abroad. Paratyphoid Fever One case of paratyphoid fever was notified. Whooping Cough There were only 14 notifications received compared with 120 in 1968, a very gratifying reduction. INFECTIOUS DISEASES 1969 Notifiable Disease Number of Cases Notified in Age Groups Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 65 65 and Upwards Age unknown Total All ages Dysentery M F M F M F M F M F M F M F M F M F M F 3 5 6 16 22 3 1 1 4 7 7 2 2 34 45 Food Poisoning 1 1 1 1 4 1 3 1 1 3 9 8 Infective Jaundice 1 7 6 6 4 2 3 6 1 1 1 1 24 15 Measles 15 13 302 264 206 202 3 9 1 2 1 17 6 544 497 Meningitis 3 1 1 1 1 5 2 Scarlet Fever 26 19 24 27 3 53 46 Tetanus 1 1 Tuberculosis (Pul.) 1 2 4 3 2 2 2 2 16 6 2 3 28 17 Tuberculosis (N.Pul.) 1 1 2 1 4 1 Typhoid & Paratyphoid 1 1 1 1 Whooping Cough 4 1 6 1 1 1 3 11 Totals 15 21 339 296 257 264 20 18 8 11 20 10 25 n 4 6 18 6 706 643 1,349 60 SERVICES UNDER THE MENTAL HEALTH ACT, 1959 63 SERVICES UNDER THE MENTAL HEALTH ACT, 1959 Sara Syrop, m.d.(warsaw), d.p.h., d.c.h., d.t.m. and h. Senior Medical Officer H. J. Vagg, m.r.s.h., m.i.s.w., m.b.a.s.w. Principal Mental Welfare Officer The pattern of presentation and lay-out follows closely the Reports for previous years, the new developments receiving due emphasis. TABLE I CASES IN COMMUNITY CARE SUPERVISED BY THE MENTAL HEALTH SECTION IN 1969 (Corresponding numbers for 1968 in brackets) Mental Illness Elderly Mentally Infirm Psychopathic Disorder Subnormality Severe Subnormality Totals New Referrals 437(366) 63(32) 17 (30) 66 (62) 26(10) 609(500) Total Cases at 31.12.69 432 (458) 34 (28) 11 (23) 329 (309) 181 (186) 987(1,004) The upward trend in new referrals continues to be evident and this year the increase amounts to over 20%. At the same time the total sum of cases receiving community care remains constant. These two facts point to good "turnover". The appreciable size of the turnover reflects two simultaneous trends. Firstly the enhanced rate of discharge from community care is due to accelerated rate of cure—in this acceleration the community services play an important role. Secondly, the acceleration of upward trend in referrals reflects the quality of the service and the demand for it. Taking both factors together one can justifiably assume that increasingly the patients with mental problems of less florid and overt nature are now coming to our notice. The Service's contribution to prevention is increasing all the time. 64 TABLE II HOSPITAL ADMISSIONS EFFECTED BY M.W.O.s in 1969 (Corresponding numbers for 1968 in brackets) Mental Health Act 1959 Mentally 111 and Psychopaths Mentally Subnormal & Severely Subnormal Section 25 43 (30) (-) Section 26 27 (10) 1 (1) Section 29 101 (100) 1 (-) Section 60 2 (3) — (1) Total Compulsory Admissions 173 (143) 2 (2) Informal Admissions 107 (80) 4 (5) Total all Admissions 280 (223) 6 (7) In previous reports reference was made to the upward trend in hospital admissions—the year 1968 being the notable exception. Several comments could usefully be made on the tables for 1969. The number of admissions on the subnormality side has remained constant and marginal since the inception of the Service. This point is commented on more extensively in the chapter on Subnormality. If the subnormality is disregarded, the increase of all admissions amounts to 26%. The figures for compulsory and informal admissions are 21% and 34% respectively. In other words the informal admissions rose proportionately by over half as much as the compulsory admissions. Last year we saw the downward trend in compulsory admissions with a marginal rise in informal admissions. This year's upward surge of informal admissions can be explained by a more ready acceptance by parents and their families to enter hospitals and the increasing involvement by the M.W.O.s in the mechanics of admissions. The sizeable rise of compulsory admissions however remains unexplained but it is gratifying to note that this increase is taken up wholly by Section 25 (observation) and Section 26 (treatment) leaving the figures for Section 29 (emergency) constant. This must reflect better use of Consultant facilities by the family doctor. 65 STAFF OF THE MENTAL HEALTH SECTION During the year the following staff movements took place : Appointments 1—Senior Mental Welfare Officer—to replace the previous post holder who took up another appointment. 5—Mental Welfare Officers. Resignations 1—Mental Welfare Officer. Staff P.M.W.0. 1 D.P.M.W.O. 1 S.M.W.0. 3 M.W.O. **16 Trainee *4 Qualifications P.S.W. 4 C.S.W. 4 Dip. Soc. Studies 3 Declaration of Recognition 1 Undergoing Training 3 Others 10 **2 Mental Welfare Officers seconded to 2 year Certificate in Social Work Course. *1 Trainee seconded to 2 year Certificate in Social Work Course. 1 Mental Welfare Officer returned to the section having successfully completed a one year P.S.W. Course at Leeds University. Student Placements During the year the following establishments placed students with the Service for observation and case work experience:— University of London—2 students Bromley College of Technology—2 students University College of South Wales—1 student In-service training and staff development This continues to run at a satisfactory rate. The Mental Welfare Officers attended 110 seminars and conferences during the year. This figure excludes local case conferences and seminar discussions held at Area Office and section meetings, which are held monthly. The Mental Welfare Officers are based in 3 Area Offices at 69 Croydon Road, Penge, S.E.20, Sherman House, Sherman Road, Bromley and 11 Homefield Rise, Orpington. There is a Senior Mental Welfare Officer heading a team of Mental Welfare Officers at each of these offices. He acts as a team leader, co-ordinating the work at area level, giving support and consultation to his team as well as encouraging close liaison with 66 all the other agencies, both statutory and voluntary. He also deals with problems of special difficulty and carries a small specialised case load. Mental Welfare Officers and Community Care The family is taken as the unit and Mental Welfare Officers give help, not only in the interest of the primary client but also with regard to the family relationship as a whole. The client is the focus of the programme. All treatment, services and institutions are viewed as interlocking parts of a programme which is designed to meet the needs of the client. The aim is not to provide institutional or community care but a whole range of possible social environments either in or out of hospital which are the most suitable for a particular client at any particular time. We thus aim to provide continuity of relationships from the beginning to the end of treatment and if possible in successive treatments. As the patient moves from community to hospital and back again through a continuam of treatment an attempt is made to provide the client with a figure with whom he can build up a relationship. This may be with a psychiatrist or a social worker in the hospital or the Mental Welfare Officer, or all of these. In providing a comprehensive Mental Health Service, prevention is as important as treatment. To this end we have continued our policy of attachment of Mental Welfare Officers to General Medical Practices. As well as the original pilot scheme in the Penge area, we now have a further attachment to a Group Practice in the Orpington area. From both the doctors' point of view and that of the Mental Welfare Officers, this scheme is well worthwhile. There is little doubt that the anxiety experienced by the patient/ client has been relieved and the doctors are becoming aware of the Mental Welfare Officer's capacity in helping the General Practitioner in his daily work. In justifying this scheme there seems to be several points worthy of note. There is the problem of referral both from the doctor and patient's point of view. Most General Practitioner's are well aware of the strain under which all social work agencies function. This tends to make him less ready to refer cases which are not severe but with an attached Mental Welfare Officer this is a vital point at which to pick up a case if prevention is to be achieved. On the patient's side there is often a great reluctance to meet and share the problem with strangers, especially in the community setting, as this is not such a recognised form of contact as, for instance, going to the hospital out-patient's department. However, most patients find it more acceptable to see a Mental Welfare Officer within the surgery setting. As well as the attachment to the General Practitioner, 2 Mental Welfare Officers attend regular local hospital out-patient clinics giving social work help to the consultant psychiatrist and 67 again bringing closer together the local authority service with that of the hospital, with benefit to both and not least to the client. Another Mental Welfare Officer is seconded to Cane Hill, Coulsdon, 3 days each week. By being within the hospital setting this social worker can deal with all the Borough patients admitted to the hospital keeping in close contact with them during their hospitalisation, acting as a link between the local authority social worker and the hospital staff. This is yet another link in the total treatment plan and prevents isolation when the client is moved from the home environment. A further experienced social worker interested in child psychiatry is working 4 days a week at the Child Guidance Clinic and one day within the area team. This again provides continuity of care and brings within the Mental Health section a specialised section in the psychiatric field. There has been no alteration in the number of Out-patient Consultant facilities. These are listed below. TABLE III NUMBER OF OUT-PATIENT CONSULTANT SESSIONS IN THE BOROUGH PER WEEK Name of Hospital Adult Psychiatry Child Psychiatry / Guidance Bromley (Stepping Stones) 8 3 Beckenham 3 0 Farnborough 3 2* Orpington 1 0 Queen Mary's** 2 0 Sydenham** 0 2 The Willows, Chislehurst*** 0 4 TOTAL 17 11 * referrals through Paediatricians only. ** hospitals situated just outside Borough boundaries. *** Local Authority Clinics. 68 YOUNG MENTALLY RETARDED CHILD-PLAY GROUPS Play Groups form one of the most important parts in the service for the mentally handicapped. The young child receives stimulation, extends his social experience and undergoes early training. For the mother it may well be the only period of relief from strain and stress inherent in caring for the child. It may also be the first contact with mothers in a similar situation and with the teaching profession. The support she receives from such contact is invaluable; the Play Group attracts the immediate community and thus contributes to the community's education and acceptance of mental handicap. All three special Play Groups are registered with the Council under the Child Minders' Regulations, 1968, and all accept multi/ handicapped children. All provide transport to and from the Centre. The Play Groups receive ongoing support from the Senior Medical Officer, Mental Health who is responsible for putting forward the names of children suitable for admission. The St. Mary's Centre, Hayes, run by the Hayes Church Trustees, operates every morning and has children from the whole of the Borough. The Council gives generous financial support on a per capita basis. The remaining two Groups receive modest annual grants from the Council and confine their catchment area to a radius of a few miles. Beckenham Red Cross Centre held at Beckenham Red Cross Headquarters, functions twice a week but will soon extend to a third day. Petts Wood Centre held at the Methodist Church Hall operates three mornings a week. 69 TABLE IV CHILDREN IN COMMUNITY THOUGHT TO BE MENTALLY HANDICAPPED, BORN AFTER 31.12.1963 (Corresponding number for 1968, children born after 31.12.1962, in brackets) Subnormality (various causes) 34 (36) Mongolism 29 (23) Severe Subnormality (non-specific defects) 16 (21) Cerebral Palsy 15 (9) Spina bifida (with hydrocephaly) 7 (9) Hydrocephaly 7 (6) Microcephaly 7 (6) Microcephaly with cerebral palsy 3 (2) Deaf 2 (3) Spina bifida 1 (1) Autism 1 (-) Rubella syndrome 1 (2) Patau's syndrome 1 (2) Lowe's syndrome 1 (1) Rubinstein Taybi syndrome 1 (-) Total: 126 (121) The above Table does not include: 2 children who died in 1969. 2 children who moved out of the area. 2 children who were admitted to Leybourne Grange on long-term basis. TABLE V LONDON BOROUGH OF BROMLEY RESIDENTS ATTENDING TRAINING CENTRES AS AT 31.12.1969 IUNIORS AND ADULTS Name or Centre and responsible Authority AGE GROUP TOTALS 0-16 16 + M F M F Orpington (Bromley) - (34) - (23) 31 (21) 32 (24) 63 (102) Woodbrook (Bromley) 60 (-) 29 (-) 89 Swanley (Kent) 11 (24) 9 (18) 20 (42) Sidcup (Bexley) - (2) - (2) - (-) - (-) - (4) Perry Rise (Lewisham) - (2) - (-) - (-) - (-) - (2) Thanet (Kent) - (1) - (1) - (-) - (-) - (2) Total 60 (39) 29 (26) 42 (45) 41 (42) 172 (152) 70 In previous reports reference was made to the saturation point having been reached. The year 1969 saw the opening of Woodbrook (see also special chapter on Woodbrook) resulting in the transfer of all "Juniors" from Orpington Training Centre to Woodbrook. At the same time the Orpington Training Centre absorbed half of our Adults from Swanley (see also special chapter on Orpington Training Centre). The very clear sex differential in favour of the males—2 : 1 ratio— is demonstrated in the 0-16 age group. The distribution among the adults is equal. The predominance of males among those in Training Centres and subnormality hospitals has been observed for many years and the differential was thought not to be true prevalence but a phenomenon dependent on several factors. For example, the mentally handicapped boy is more likely to be picked out by the educationalist and his presence at home when adolescent and clearly not capable of open employment is less easily tolerated than that of a girl. The incidence of behaviour difficulties notoriously higher among boys would also play a considerable part when the family wished their child to be "sent away". Recently, however, further thought and research into the causes of subnormality has brought forward the concept of increased vulnerability of the male foetus to adverse agents whether operating in the uterus or in the perinatal period. The researchers point out that the same factors operating the sex differential for still births must equally apply to the babies surviving either because the adversities are not strong enough to kill or because the latest medical and surgical techniques are successfully applied. Either way there would be an excess of boys among those who survive. Once more we come back to the crucial issue of primary prevention, i.e. preventing damage taking place through optimum ante-natal obstetric and paediatric care, based on sound health education of the community. 71 WOODBROOK JUNIOR TRAINING SCHOOL Head Teacher: Mrs. S. I. Walton Deputy Head Teacher: Mrs. W. A. Harvey 6 Teachers 1 Welfare Assistant Pianist (Sessional) SPECIAL CARE UNIT 1 Senior Teacher 2 Teachers 2 Welfare Assistants 1 Physiotherapist (half-time) When the building was formally handed over to the Department in July, 1969, everything was ready for the beginning of the September Term. 3 Teachers and 2 Trainee Teachers were appointed—the main body of Teachers as mentioned above transferred from Orpington Training Centre. In addition, the Welfare Assistants, the Caretaker and the Kitchen staff were recruited. The acquisition of a Physiotherapist came in view of the national shortage as a morale booster to all concerned. The Pianist too proved to be an unqualified success. The children and the staff settled down very quickly and in a few days there was little to show that the School had not been there for years. The Special Care Unit children were divided between the two classrooms in the Unit. The aggressive and hyperactive in one and the totally helpless in the other. Even those children who had never left the confines of their own homes before settled well in the happy and harmonious setting. The staff feel that the pleasant surroundings, the effect of light and air in the School, the functional lay-out, together with generous 72 provision of cupboards and circulation space, play a large part in contributing to the high morale of children and teachers alike. Two difficulties were encountered, the pressure on places and the transport of totally helpless children. The first difficulty was foreseen. It is generally accepted that provision increases demand. Long before Woodbrook was ready it was noted that many more oases were being brought forward for admission than in previous years. Teachers in special schools were prepared to "hold on to a child until Woodbrook is ready", especially if parents were vocal against such a transfer. Furthermore, parents of children under 5 pressed for their children to start at "the new school in Beckenham as soon as possible". The pressure for places had to be considered against the knowledge that there would be a delay of two years before sufficient vacancies were available at the Adult Training Centre to take on the Woodbrook school leavers. In spite of these difficulties every child reported to the Section by July, 1969, was found a place at Woodbrook and soon the total number of children reached 100 against 80 places. The excess was divided equally between the school proper and the Special Care Unit where 10 children had to attend part-time to enable as fair a distribution of this provision as possible. The second difficulty was not foreseen. The Council had agreed a special vehicle to transport the totally helpless children, numbering 13, who cannot travel by coach. The estimated period between placing the order and delivery of the "ambulance" was in reality doubled. Fortunately, the Bromley Society for Mentally Handicapped Children stepped into the breach and organised a fleet of voluntary cars to bring these children to Woodbrook. The school became part of the local community with other care-giving bodies, including the churches, taking a keen interest. The parents, delighted with the new premises, attend open days and monthly meetings to discuss subjects of common interest. The mental health social workers provide family support and keep in close touch with the head teacher and her staff. The 73 London Borough of Bromley is paying more than lip service to the concept of comprehensive care of the mentally handicapped child. Training and Staff Development Every effort is made to implement the Council's policy to employ trained staff. One of our trainees returned qualified from the two-year Bristol course and was re-appointed as a teacher. Two new trainees are in post with the same end in view. In addition, semi formal activities continue: 1. Inter-disciplinary professional meetings to cover one subject of common interest. 2. Monthly case conferences at Woodbrook. 3. Release of staff for seminars and short courses usually arranged by the London Boroughs' Training Committee or National Association for Mental Health. 4. Combined in-service training with Bexley L.B. consisting of two one-day conferences per year. In 1969, these took place in Orpington Training Centre and Goldie Leigh Hospital respectively. The quality and stability of the staff is but one pointer to the high standards of Woodbrook. 74 ORPINGTON ADULT TRAINING CENTRE Manager: Mr. G. Langton (Head Teacher: Mrs. S. I. Walton, until July, 1969) Deputy Manager: Mr. H. E. Freeman 4 Instructors 2 Trainee Instructors Until the end of summer term the centre continued to function as an all-age centre. By September only those trainees who were 16 or over by the end of 1968, remained. These numbered 43 and the figure was augmented by the transfer of 20 adults from Swanley. (For breakdown of these figures see Table V.) The change over presented additional difficulties through the existing premises being inadequate and unsuitable all round. Minor adaptations and essential repairs only could be carried out since the life of the building is very limited. Light machinery was installed in the main hall, the bathroom was converted into an office for the clerk and the scene was set to make the best use of what was available. Only two members of the teaching staff wished to stay and work with adults—the rest accompanied the juniors to Woodbrook. We were indeed fortunate in our recruitment; 2 instructors and 2 trainee instructors were appointed before the centre re-opened in its new guise in September. There was a delay with the appointment of the Manager, our sights being set high. In this appointment too we were fortunate. The new manager took up his post in March, 1970, and from that date activities at Orpington Training Centre once again gathered momentum. The atmosphere of work-centred purposefulness coupled with social training activities and an ambitious ongoing assessment programme, all carried out on the old premises, once again proved that "people not buildings matter". 2 instructors were fortunate in obtaining placements on a full-time diploma course at Bournemouth College to start in September, 1970. The Council gave approval for secondment on full pay. The staff join the Woodbrook staff for other types of inservice training (see special chapter). 75 Organised Holidays As foreshadowed in last year's report, 17 trainees took part in the two weeks' holiday organised by the Inner London Boroughs. 4 members of our staff (2 each week) accompanied the "children". This time the weather was excellent and the holidays greatly appreciated by the trainees. Their families were also most appreciative, since for many of them, this afforded the only opportunity to relax from the constant care given to their handicapped member. NEW ADULT INDUSTRIAL/TRAINING CENTRE "ASTLEY". BROMLEY COMMON (120 places) The senior officers of the section continued to work towards the above project. The usual frequent discussions and consultations have taken place with the Borough Architect to ensure the most economical use of land and financial resources while at the same time providing for every need of the service. It has been our experience, shared by other authorities, that particularly for special projects time spent on preparation and planning is more than justified by results. According to schedule, the centre will open in September, 1971. DAY CENTRE STEMBRIDGE HALL, 9a STEMBR1DGE ROAD, PENGE, S.E.20 Supervisor: Mr. S. J. Hall Deputy Supervisor: Mr. R. J. Harris 1969 was the second full year of this Day Centre. Many of the developments envisaged in 1968 were implemented. (a) Financial Incentive for Members. The incentive payment system mentioned in last year's report has proved to be a great success. This method of calculating payment is liked by the members and gives an accurate assessment of progress. (b) The Provision of a Van and Driver. This new facility has taken the pressure of collecting and delivering work away from the staff. Subsequently, more time has been given to the staff in which to organise and present a more varied work programme. 76 Facts and Figures In its second year, Stembridge Hall was used by 47 members (an increase of 4 on the first year). The average stay in the centre was 6½ months although those who stayed between 3 and 6 months benefited most. The average number of members using the centre at any one time was 17 and the attendance for the year was 85%. Referrals (by diagnosis): Schizophrenic 16 Subnormal 6 Inadequate 11 Manic Depressed 1 Brain Damaged 2 Epileptic 1 Senile Dementia 2 Psychopath 1 Drug Addict 1 Physically Handicapped 2 Maladjusted due to Other Causes 4 47 Referrals (by source): Mental Welfare Officers 29 Social Welfare Officers 1 Disabled Resettlement Officers 2 Hospitals 13 General Practitioners 2 47 Movement of members during the year: Remained at Stembridge Hall 9 Moved on to Work 16 I.R.U 2 Remploy 3 Training Centre 2 Hospital 4 Moved from Area 2 Discharged Themselves 2 Left for Other Reasons 7 47 77 Stembridge Hall has proved a suitable environment for all types of mental disorder. However, no significant success rate can be linked with any one illness. During 1969 two ex-members returned to the centre from work. This points to the possibility of an increasing number of ex-members returning to the centre for short-term support. Every three months we arrange for ex-members to meet and exchange ideas concerning work or other topics. Unfortunately, these meetings are not well attended and it is thought that once a member believes he can support himself he prefers to sever his links with the centre. During the year the Centre has become more widely known and respected by community agencies. This can be attributed to visits made to the centre by staff of referring agencies. The result of this is greater understanding on both sides. In the industrial work field Stembridge Hall has established good contacts, and the centre's work is highly respected. Contact with sympathetic firms has made for continuity of work. Future Developments It is proposed to extend the Social group activities within the centre. With the help of a qualified social worker, more emphasis will be placed on the importance of building up and maintaining the work habit. Personal appearance will be discussed and special help will be given to female members to ensure that they are conversant with the basic skills in the domestic field. Preparatory work will also be given to briefing members prior to interviews for employment. To assist members in outside employment, it is planned whenever possible to support them in the difficult first few weeks of employment. This will need co-operation from the firms involved who already show many signs of becoming more tolerant and understanding of the need for a slow rehabilitation of those who have been mentally ill. HOSTEL CARE RYDAL MOUNT, 20 HAYNE ROAD, BECKENHAM Warden: Mr. B. Morris Matron: Mrs. M. Morris Deputy Warden: Mrs. J. Ball Purpose People in our society who are mentally ill are normally, or ideally, given care, support and protection by their families and occasionally by their friends. However, this is the ideal situation 78 and should there not be a family or home available to provide the care needed for a particular person then it is reasonable to suppose that there is lacking a good home and residential care may be necessary. This may not mean that the home is unsuitable in the normal sense but that it is unable to provide the care necessary for a particular individual. Mentally disordered persons who lack a suitable home may require residential care for a variety of reasons. There may be no family available because of death, disappearance or refusal to take any further responsibility for their family member. There may be a family but it could still be unsuitable for the person because although willing to have their family member they are totally unable to provide the type of care and environment for the person's needs. This is particularly so where emotional relationship between a mentally disordered person and his family may be disturbed and living in close proximity seems to make the illness worse. There are also situations where the family is willing to have its member but is already over-burdened and this extra problem leads to inter familial stress. People are, therefore, admitted to hostel care for a variety of reasons and are, likewise, discharged for a similar variety of reasons. Many different things happen to them and their families whilst they are in hostel care. It is, therefore, the aim of hostel care to provide a stable and helpful environment for mentally ill persons who need this and who, for the reasons already stated, cannot find this within their own social circles. Therefore, each person is seen as an individual needing his own particular kind of training, assistance and support, directed towards whatever goals seem appropriate for him as an individual. Selection of Residents It may well be that the patients that would benefit most from transitional care are not referred as they prefer either to return to their home environment or to seek accommodation directly within the community although neither of these might be most suitable. When selecting residents referred for hostel care we look for people who seem already motivated towards work and getting back to the community. Patients who are motivated and who are already working from hospital or who attend regularly at an industrial unit and will be ready to seek employment at an early date are offered hostel placement as soon as possible. It is difficult to assess how well a patient might improve and move on and one can only look at past records of achievement and how they seem in the "here and now". Unfortunately, some residents are unable to sustain their level of functioning and lose their jobs or are only able to function at Day Centre level. This then presents more problems of management and movement within the hostel as patients tend to become more long-stay. 79 Hostel at Work One of the aims of a hostel is the provision of a "home" but this must be seen by staff and residents as a starting point to complete community involvement as the hostel is part of the total community care service. Residents are neither encouraged nor allowed to spend all their time in the hostel. If they are not working for any reason other than sickness, they are encouraged to attend our Stembridge Hall Day Rehabilitation Centre on a daily basis, with a view to establishing a daily work pattern enabling them to progress from the Centre back into open employment or to proceed to an industrial rehabilitation unit for further assessment and training or to employment at Remploy factories. Residents are also encouraged to participate in leisure activities outside the hostel. Social care as part of total community care is an important aim of hostel provision. Although medical treatment is important it is not an essential part of the hostel service. Medical care is provided in the same way that it is for any person discharged from hospital, i.e. from General Practitioners and Out-patient departments. The two main aims of hostel care are therefore, firstly, the establishment of a temporary substitute to the home environment, which is geared to individual needs. Secondly, to reduce the disadvantages of a substitute home to a minimum. This can best be achieved by integrating the hostel and its residents into the local community. It is only when we have total community caring that the concept of community care will have been achieved. Obviously social work is very relevant to these two aims, bringing together residential social work, case work and community work. It is, therefore, essential that social work knowledge, values and skills be available, not as an extra, but as a rightful part of the service to facilitate the aims of hostel care. In this respect there must be close liaison between the mental health social workers, the social worker with special responsibility for the hostel and the hostel staff and residents, to preserve close lines of communication and for each to be aware of every step in the residents' treatment plan. Apart from regular individual discussions with residents regarding their future and the difficulties they experience, fortnightly group meetings in the hostel have a sound therapeutic value. Conclusion It has now become evident that although Rydal Mount short stay hostel is fulfilling a most useful function, there is a need for a variety of care, long term as well as short term, together with Group Homes and Boarding Out facilities. The latter two schemes have been commenced and it is hoped that they will be substantially developed. Attached below is a statistical breakdown of 80 admissions and discharges from Rydal Mount Hostel for the period January—December, 1969. ADMISSIONS TO RYDAL MOUNT JANUARY 1969 — DECEMBER 1969 Admission Men Women Total One admission only 5 6 11 Reason for Admission No Home — 3 3 Halfway house from Hospital 2 — 2 Short Term Care 3 — 3 Domestic Tension — 3 3 Diagnosis Functional Psychosis 1 3 4 High Grade Subnormal 1 — 1 Psycho-Neurosis 2 2 4 Personality Disorders 1 1 2 Age Groups 15-20 — 2 20-25 3 2 26-35 2 2 DISCHARGES FROM RYDAL MOUNT JANUARY 1969 — DECEMBER 1969 Men Women Total One Discharge only 7 5 12 Duration of Stay 1 month or less 1 — 1 1-3 months — — — 3-6 months 2 1 3 6-9 months — — — 9-12 months 3 1 4 12-18 months 1 3 4 Outcome Satisfactory Left by agreement — 1 1 Placement at Home 1 — 1 Placement in Lodgings 3 2 5 Transferred to other Hostel 2 — 2 Group Homes — 2 2 Unsatisfactory Deteriorated and returned to Hospital 1 - 1 81 RESIDENTIAL ACCOMMODATION WITHIN THE BOROUGH OTHER THAN HOSTELS Group Home A large, five-bedroomed detached house was made available in the Anerley area. The Housing Department undertook a complete interior redecoration, also making good electrical wiring and plumbing systems. Despite the eventual short notice of commencement of tenancy, the house was equipped to a minimum stage for occupancy. One of the main difficulties in a venture of this nature is getting all the items of furniture and equipment together in a short space of time, especially as there are no facilities for storing furniture, offered from time to time, until a venture of this kind is mooted. Help in obtaining some items of furniture, carpets and a cooker was given by the Council for Social Service. Other items and equipment were obtained from various sources by members of the local social work team. Much time and effort was given by a few members of the local social work team in collecting items, humping them and arranging the lay-out of the house. Cleaning, scrubbing and polishing was also a very essential task undertaken by a few of the social workers—much of it in their own time. The three clients, who it was felt could take up residence at this home, two schizophrenic women who had good work records since hospital discharge and a more middle-aged, depressed woman, helped with the sewing of curtains, sorting of linen, etc. Because of the non-availability of any money for this venture, there were initial problems in respect of curtain rails and fittings and adequate floor and stair covering. To some extent, the former problem resolved itself by various means, but only in a temporary fashion. Despite these difficulties, the three clients were eager and willing to move into their new home during the last weekend in September. These three women seem to have settled down quite well. They each buy their own food for weekdays, mainly because they go out in the morning and return in the evening at different times. At weekends they come together rather like a family and decide on what meals they will have and then share the cost. They each pay the same weekly rental to the visiting social worker, which covers rent, rates, lighting and heating. As might be expected, there had been some apprehension on the part of the residents, but with careful and fairly regular support from the social workers, these women are gradually settling in their new environment. TABLE VI PERSONS PROVIDED WITH LONG TERM RESIDENTIAL ACCOMMODATION OUTSIDE THE BOROUGH DURING 1969 Mentally ill Subnormal In residence on 1.1.69 10 (12) 14 (12) Admitted during year 7 (1) 9 (8) Discharged during year 3 (3) 2 (6) In residence on 31.12.69 14 (10) 21 (14) 82 The garden surrounding this house has been allowed to get into a neglected state, but it is hopefully anticipated that a group of young volunteers will deal with this and thus enable the residents to keep it under control in the future. TABLE VII CASES PROVIDED WITH SHORT-TERM CARE IN 1969 Hospital Placements Other Placements Category Under 16 Over 16 Total Hospital Placements Under 16 Over 16 Total Other Placements Total all Placements Subnormal 1 (1) 3 (3) 4 (4) 2 (2) 2 (2) 4 (4) 8 (8) Severely Subnormal 8 (11) 4 (7) 12 (18) 4 (-) 1 (1) 5 (1) 17 (19) TOTALS: 9 (12) 7 (10) 16 (22) 6 (2) 3 (3) 9 (5) 25 (27) STEPPING STONES CLUB Since 1969 was the first year of very close involvement of the Service with the Stepping Stones Club, a fairly full account of its activities has been incorporated in the report. Stepping Stones is a club for the rehabilitation of mentally ill and emotionally disturbed persons who live in Bromley and the surrounding districts. It has been named "Stepping Stones" because it is an intermediary between the patient in a phase of personal social isolation and an ultimate participation in the ordinary social institutions in the community. The object of the club is to enable persons suffering from mental ill health to resume full activity within the community. The club provides occupational, social and recreational activities as a form of additional treatment to promote social rehabilitation. The club is housed together with the Psychiatric Out-patient (Adults and Child Guidance Clinic) of Bromley Hospital and is affiliated to the Friends of Bromley Hospital. 83 The history of the club goes back to 1946 when Dr. G. D. Morgan pioneered a way of integrating the mentally ill with the community. Changes in public opinion towards the mentally ill and the new methods of treatment had decreased the number of patients receiving treatment on an out-patient basis. It was felt that the very nature of the illness created an isolating effect, which was heightened by public attitudes through ignorance, fear and prejudice, and this not only hindered recovery, but often reinforced the sense of social isolation. But as these patients live in the community, Dr. Morgan and his colleagues made the necessary efforts to involve the community in the social rehabilitation of these patients. They gave a series of lectures and talks to various voluntary and statutory agencies and associates in the Bromley area. Fortunately there was a good response from the community of Bromley, due partly to the interest which it had always taken in the hospital, which was originally a Cottage Hospital, and partly to the fact that the citizens of Bromley have a strong civic sense. Between 1945 and 1954, a great deal of work was done by Dr. Morgan and Dr. Tylden and their Psychiatric Social Workers in recruiting ordinary members of the community, who together with the patients, all of whom are known as "club members", were made responsible for the running of the club. The members elected an Executive Committee which was to be responsible for the administration of the club. In 1954, a grant was received from the King Edward Fund and in 1957 Stepping Stones Club was opened. The Bromley Group Hospital Management Committee covers all overheads and maintenance connected with the day to day running of Stepping Stones House and the club is responsible for its own materials and equipment. The club raises funds by an annual subscription of a minimum of 2/6d. and by other fund-raising activities organised by the Appeals and Social Committee, and these include Annual Bazaars, Jumble Sales and Garden Parties. Every 2 years the club endeavours to hold Open Day. The Executive Committee is made up annually of elected members and is fully responsible for the policy and for the running of the club. The clinical staff, together with the hospital secretary and delegates from the Hospital Management Committee often attend the monthly meetings as observer/advisers, and without any voting power, as the club is autonomous. Apart from the Executive Committee, the club has 5 other committees, i.e. Appeals and Social which is responsible for fund raising and formal social activities; the Finance Committee, responsible for allocation of funds and expenses; Premises Committee which looks after the security of the building; the Liaison Committee which is responsible for visitors, new members, and 84 also for looking after the building between 5.00 and 8.00 p.m.; and the Group Organisation Standing Committee which is made up of all group leaders, and whose function it is to evaluate and support the group activities. The membership has now reached well over 250 and the members meet weekly in 22 groups. We are hoping to have more new groups as we progress. All the groups are led by club members who may or may not have been patients. An exception is the Woodwork Group which is looked after by a paid leader. The Groups are divided in the following activities:— Social (games and social groups, teenage group). Recreational (woodwork, fancy work and drama). Occupational (dressmaking, handicraft, toy-making, woodwork and art). Therapeutics (woodwork and discussion groups). In addition there are child-minding groups (part day) which look after the under school-age children whilst their mothers attend the groups. Some of our younger members attend in their own right, and have been referred from the Child Guidance Clinic. These children often benefit from a consistently firm but not restrictive handling. The club is open between 10.00 a.m. and 10.00 p.m., and thus gives opportunities to working and nonworking members to attend. The members are referred to the club by our own Consultant Psychiatrists working in the O.P. Clinics, by G.P.s, by Psychiatrists and Social Workers from other hospitals, and by Social Workers working with the local authorities and other voluntary and statutory agencies. Various types of members are referred to us, and a breakdown of attendances during the period April 1969 - March 1970 shows that out of 250 members who attend the club at least once a month, there are 106 members who have no psychiatric history whatsoever. The remaining members are divided into the following categories:— 26 suffering from neuroses. 27 suffering from schizophrenic and schizo-affective states. 66 suffering from depression and/or anxiety. 9 suffering from personality disorders. 6 E.S.N. 10 others. There is a predominance of women over men (ratio 196—54), 47% over the age of 40, 32% in age group 25-40, and 14% under 25 years old. Depression seems to be more common in the over 40 years age group. Male neurosis is prevalent in the 25 - 40 age group. There is no big difference in the male marital 85 status, married 50%, single 47%, other 3%. There are also 30 under school age children who come to the club weekly. The club attendances vary from day to day, averaging 60 on Tuesdays and Thursdays, 30 on Mondays and Fridays, and 15 on Wednesdays. As it is the policy of the club to provide facilities on the group-work basis and as the objective is to give experiences in social intercourse, it is not surprising to see from the above table that there is a higher percentage of depressive and neurotic patients. These two conditions respond best to treatment and because their manifestations are not as "frightening" to the community as some psychotic types of illness, they are able to show some degree of communication and are therefore more readily acceptable. There are two other factors which also contributed, namely that (1) Bromley is a suburban area with a high percentage of middle-class and semi-professional society in which there is normally a prevalence of the "milder" types of mental illness, and (2) Stepping Stones had tended to recruit those people who would "function" in a group work setting, and as this required communication and participation, we have tended to favour those suffering from neuroses and depression. The members may come to as many groups as they wish, and may change from one group to another after consultation with the social workers. Initially, after referral, the potential member is interviewed with a view to placement in a group. The previous and present medical and social backgrounds are taken into consideration, as well as personality, interests and other specific instruction on referral, before they are placed in a particular group. Every effort is made to ensure that both the member and the group will gain mutual help in their struggle towards integration within the community at large. To ensure this, there is regular consultation between individual members and the social workers, as well as between the social workers and the group leaders. This allows the professional staff to keep in close touch with the members and the club. At present there are 3 Consultant Psychiatrists, 1 Consultant Child Psychiatrist, 1 Mental Welfare Officer (who has been seconded by the Bromley Mental Health Department, and who acts as Senior Psychiatric Social Worker), 2 part-time Social Workers, 1 part-time Child Guidance Social Worker and 4 secretaries on the clinical staff. While some members of the clinical staff are members of the Stepping Stones Club, the only group where the staff attend is the Discussion Group. One member of the secretarial staff is a member of 3 committees and is also hon. treasurer of the club. The social workers attend all the committees in an advisory capacity only, and have no voting power. 86 Stepping Stones Club's history of success has been heavily dependent on the unselfish contribution and interests of its "voluntary" members. This has been further helped by the Hospital Service taking a keen interest in the form of referral and giving unlimited support to the club. A further step forward in the club's aim to provide facilities was when the Local Authority Mental Health Service was invited to give its support to the club. This development brought about the unification of all resources to provide a better service for the mentally disordered in the Bromley District. Stepping Stones Club has been running for over 13 years, and is now playing -a prominent role in the overall treatment of some psychiatric patients. It is a bridge between the traditional institution and the community, a bridge which allows the patient to move progressively from the shattering effects of "illness' to a normal life in the community. The club not only facilitates a movement towards normal life, but it also gives unlimited support to those who become afflicted, thus decreasing a deterioration trend towards further mental breakdown. This is made possible because members are sufficiently interested in each other to give a helping hand or to seek professional help when they feel that their "friends" do not seem well. 250 MEMBERS WHO ATTENDED THE CLUB AT LEAST ONCE A MONTH DURING THE PERIOD APRIL 1969—March 1970 Classification of Illness 1. Schizophrenic States: Acute 15 Chronic 9 Paranoid 3 — 27 2. Affective States: Mania - Depression 35 Manic/Depressive 4 Affective disorder 27 — 66 3. Neuroses: — 26 87 4. Personality Disorder: No specific classification 7 Drug Addict - Alcoholic - Anti-social - Sexual deviation 2 — 9 5. Paranoia — 6. Senility — 7. Others: Poison - Organic - Brain tumour 1 Epilepsy 7 Arteriosclerosis 2 — 10 8. E.S.N 6 9. No previous or past history 106 250 Age Groups (M) (F) (a) under 25 years 15 19 (b) 25 - 40 years 14 63 (c) 40+ years 16 101 (d) No information 8 14 53 197 250 Marital Status Married Single Divorced/ Sep. / Widow (M) (F) (M) (F) (M) (F) (a) 3 3 12 16 - - (b) 8 37 6 26 — - (c) 9 53 7 39 - 9 20 93 25 81 - 9 Total 228 No information 22 — 250 88 RESEARCH It is our experience that about once a year we receive a new request to help with a Survey or Research project. In spite of the fact that our resources remain fully stretched, every such request receives sympathetic consideration. At the end of 1969, the Paediatric Research Unit of Guy's Hospital approached the Medical Officer of Health for help with their Survey on the role of radiation in damage to the foetus. The details of work involved, the findings and conclusions of the Survey will be covered in the Annual Report for 1970. DRUG ABUSE On publication of Councillor Simon Randall's booklet, "Drugs in Your Town", Bromley found itself spot-lighted by the national Press and other mass media. This was matched by wide publicity, interest and discussion evoked locally. Until then the Section's involvement with the problem had been limited to individual cases and attachment of a Mental Health Social Worker to one Youth Club where the problem persisted. In the autumn of 1969, the Health, Welfare and Children Committee had set up a Panel to look into Councillor Randall's findings and conclusions and at the time of writing this Report, the Panel had presented its recommendations to the Health, Welfare and Children Committee. These were unanimously accepted. The recommendations of the Panel were, briefly, that drug taking should be looked at in conjunction with other problems of adolescence and should best be dealt with by a "non-authority figure" such as a detached youth worker. The Mental Health Section, hitherto involved on an informal basis only, will from now on, be available to give specialist help to the detached youth workers. On the size of the problem the most controversial point of "Drugs in your Town"—the Panel found that Bromley has a problem au par with other London Boroughs, and thus supported the Medical Officer of Health's statement quoted in the booklet on page 16, "Our problems are not unlike those encountered by my colleagues in other Outer Boroughs and I feel the general trend follows the national picture". However, only time will tell whether as some authorities feel the contagion of drug abuse has reached its peak. 89 VOLUNTARY ORGANISATIONS For our service to function efficiently it is essential to have community support. The voluntary bodies give this support in a very constructive way and at every level work closely with our officers. Orpington Mental Health Association made great strides in 1969 by the opening in March of Anchor House. Serving as headquarters for the Association, Anchor House runs day and evening activities and accepts people from a wide area. Education is provided through meetings and lectures on mental health and allied subjects and these are very popular. The success of Anchor House is evidenced by a steadily increasing membership, its excellent attendances at all social events, and by its successful fund raising activities. Beckenham Association for Mental Health continues to provide club activities and practical support to the mentally ill and their relatives. Bromley Society for Mentally Handicapped Children became a member of Bromley Association for the Handicapped, wishing to ally themselves with physically handicapped rather than with the mentally disordered. The Society launched widely ranging activities and proposed a joint project with the authority to provide a hostel for mentally handicapped children. Clubs. In the previous Annual Report, reference was made to various Clubs. This year a comprehensive table has been prepared to provide all information "at a glance". Traditionally the role of voluntary organisations is to complement and/or supplement the services provided by central or local government. This role, however, often extends far beyond these limits. With the blurring of division between those who help and those who are helped, the problem of "they" and "us" does not arise and every person makes his contribution to the involvement of the community. As an officer of the Section informally comes in on most of the voluntary societies' activities, he is seen in his true role— as a professional from another helping agency. The concept of a caring community is further strengthened. CONCLUSION 1969 has been an exciting year for many reasons. Our first major project (Woodbrook) became operational. The Service expanded in width and depth, and policy and procedures are being noticed by other local health authorities. Never flagging efforts to maintain steady growth of the Service will continue. MENTAL HEALTH CLUBS WITHIN THE LONDON BOROUGH OF BROMLEY Name of Club Organisation Responsible Place/Address of Meeting Day of the Week & Time Type of Person Catered for Activities Wednesday Club Beckenham & District Mental Health Association Adult Education Centre, 244 Croydon Road, Beckenham Wednesday 2-4 p.m. Mentally I11 (Mainly Women) Knitting, sewing, etc., flower arranging, slide shows. 135 Club Beckenham & District Mental Health Association Emmanuel Church Hall, The Grove, West Wickham Monday 8 p.m. Mentally I11 Social Club—Games, etc. Beckenham & Penge Gateway Club Own Committee Melvin Hall, Penge Thursday 7.30-9.30 p.m. All Handicapped over 14 Social Club—Dancing and Games. Orpington Gateway Club Own Committee Small Civic Hall. Orpington Friday 7.30-9.30 p.m. Mentally Handicapped over 14 Social activities. Conquest Swimming Club Own Committee Beckenham Baths Saturday 3-4 p.m. All Handicapped Swimming—Instruction given. Anchor Club Orpington Mental Health Association Anchor House. 5 Station Road. Orpington Apply for details Anchor House on Monday 2-4 p.m. Mentally I11 Art, Handicraft, Dressmaking. Play-reading, Cooking, Beauty Counselling, Discussion and Social activities, Play-groups for members' children. Peter Pan Social Club National Society for Mentally Handicapped Children Parish School, College Road, Bromley Monday 7-9 p.m. Mentally Handicapped over 14 Dancing, singing, organised games. Stepping Stones Club Attached to Bromley Hospital Stepping Stones House. 38 Masons Hill, Bromley Monday-Friday 8-10 p.m. Mentally I11 Various activities. Bromley & District Cruse Club Cruse Clubs The Crypt, Bromley Parish Church, Church Road, Bromley 2nd and last Wednesday 8 p.m. Widows and families Social contact and expert advice for widows. 90 WELFARE SERVICES 93 REPORT OF THE CHIEF WELFARE OFFICER This is the fifth report on the work of the Welfare Service in the London Borough of Bromley. Residential Care Throughout the year work continued on the construction of the new residential home, Belle Grove, Mickleham Road, St. Paul's Cray. It was hoped that it would have been completed and handed over during the year under review, but due to a delay with the Contractors, it is now expected to open early in 1970. The acommodation available for permanent residents in the eight homes remained, therefore, at 394. Throughout the year the waiting list for residential accommodation has remained at approximately 140, and the number awaiting admission from hospital has not been less than 30 at any one time. The total number of long-term admissions during 1969 was 105, of whom 42 or 40% were admitted direct from hospital. The number of residents in voluntary homes throughout the country at the 31st December, 1969, for whom the Council has accepted financial responsibility was 242. Short-Term Care 136 people were provided with short-term care in the Homes during the year and of this number, 43 were people who lived alone. Community Care Meals-on-Wheels—152,000 meals were provided by the Women's Royal Voluntary Service, the British Red Cross and the Old People's Welfare Committees. The Council supports the meals service by providing a subsidy of 1/- (l/2d. as from December, 1969) for each meal provided. Day Centres—During the year, work commenced on the purposebuilt day centre at Masons Hill, Bromley, which will provide facilities for up to 150 clients as well as supplying 60 meals per day for the Meals-on-Wheels service. The centre will be completed in 1971. This centre will supplement the day centre facilities now provided at Beckenham, West Wickham, Orpington, Bromley and Mottingham by the Old People's Welfare Committees. The booklet jointly produced by the department and the Old People's Welfare Joint Committee "Services for the Elderly" was reprinted and widely distributed throughout the Borough. It contains information of all services available in the Borough provided by the statutory and voluntary organisations. 94 Welfare of the Elderly—The members of the social work teams based at area offices in Orpington, Bromley and Penge arrange for the admission of elderly people to the residential homes for both long- and short-term care, as well as arranging attendances at the homes for day care. Eleven beds are reserved for the short-term care provision and, as stated, this year 136 clients used the facilities. This sort of care often prevents the need for an elderly person to be admitted on a permanent basis as well as in some cases allowing for relatives supporting an elderly person at home to have a holiday. During the year there has been over 2,000 attendances for day care at the homes. Clients using this service are provided with a mid-day meal and often tea, as well as being able to use the facilities of the home, i.e. bathing, hairdressing and chiropody. Welfare Services for the Blind, Deaf and Physically Handicapped The number of persons on the registers have increased during the year as follows: Blind Partially Sighted Physically Handicapped Deaf with Speech Deaf without Speech Hard of Hearing 1968 502 213 1,132 32 27 60 1969 512 242 1,303 34 31 59 Holidays—Holidays were arranged for the blind and physically handicapped either in groups or individually. 96 blind or partially sighted persons and their guides went on holidays arranged by the Council, and 103 physically handicapped and seven escorts availed themselves of the Council's holiday scheme. Included in these figures were parties of physically handicapped persons whose holiday we organised in conjunction with the British Red Cross Society. A high proportion of blind and partially sighted persons took their holiday at the Kent Association for the Blind home at Cliftonville. The choice of holiday accommodation for seriously disabled persons is very limited due to the special facilities that they require. The distance to be travelled is also an important factor. Aids and Adaptations—Many aids to daily living are supplied by the Council. The total amount spent during the year was £1,515. After extensive research had been carried out, a new type of tableware came on the market which assists severely handicapped persons to overcome their eating and drinking problems. This tableware is being supplied where it will meet the disabled person's need. In May, the general public were given an opportunity of viewing the wide range of aids available when the Geoffrey Peto 95 travelling exhibition of aids for the disabled held an exhibition at the old Public Library, Bromley. Adaptations of property have been completed at the homes of 83 handicapped persons at a cost of £2,226. An unusual request came from a disabled man who is fond of gardening. He is confined to a wheelchair, having had both legs amputated. Arrangements were made for a special track and lifting hoist to be fitted to his house so that he could enter and leave his sunken garden. Special Transport—The service has continued to expand with the purchase of two more specially adapted vehicles. The Council now has 5 vehicles which are used to transport handicapped people. More work has been taken on including transporting severely disabled persons to the Conquest Swimming Club, Beckenham, and the Orpington Young Handicapped Club. Without the aid of the special tail-lifts on the vehicles, it would be impossible to transport persons in wheelchairs to the various activities which are available for handicapped persons. Difficulties have been experienced in maintaining the transport services due to the prolonged ill-health of two drivers, and for two months one vehicle was off the road as a result of an accident. Thanks to the co-operation of the British Red Cross Society, the Beckenham, Bromley and Orpington Old People's Welfare and St. Cecilia's Home, in permitting the Council to use their vehicles, the transport services did not have to be curtailed. Bromley Association for the Handicapped—The Association had a busy year and continued to flourish. Close liaison has been established between the Association and the Health and Welfare Department, and this is illustrated by the joint publication of a very informative leaflet outlining the services for handicapped persons. The highlight of the Association's work was organising a one-day conference on the "Young Handicapped and the Future". This was attended by a cross-section of the general public and professional welfare workers. The Association played its part making the annual "Help the Disabled Week" a success. The B.A.T.H. Newsletter is of great value in circulating information to members. Penge Work Centre—In April, 1969, a full-time Supervisor was appointed to take charge of the Centre. Renovations including fluorescent lighting and power points have been carried out in the main work room which has enabled machinery such as drilling machines to be brought into use. Handrails have been fitted in the toilets to assist the more seriously disabled, and benches have been made for persons working from a wheelchair. The average attendance is 75 persons per week. The dining-room can seat 20 96 persons comfortably and lunches are provided through the School Meals Service. Arising from their working together in the workshop, the handicapped workers have formed a Social Club called the "Penge Work Centre Social Club". The club meets monthly and is organised by the handicapped members with the assistance of voluntary workers. The aim of the club is to provide a social outlet and friendship for those who attend the work centre. A variety of entertainment is provided and stemming from the club have been day outings to places as far apart as Woburn Abbey and Hastings. Outwork—With the purchase by the department of a 15 cwt. Bedford van it was possible at the end of September to commence a collection and delivery service of outwork. The work is collected in bulk from local factories and distributed to both Penge Work Centre and Stembridge Hall and also to individual clients in their own homes. A variety of work has been obtained from local firms ranging from electrical assembly through to simple packing and sorting work. Apart from its therapeutic value the work enables handicapped persons to supplement their income. Long Cane Technique—The Long Cane technique and methods of mobility and orientation were introduced to the Borough on the appointment of a qualified Long Cane Instructor in April, 1969. The Long Cane technique is a systematic approach to mobility for a blind person which includes orientation, that is making full use of blind person's hearing, tactile senses, and power to memorise. The Borough is a pioneer in the provision of mobility training for the blind. Co-operation has been received from the Education, Planning and Parks Departments, and full support was also received from the Kent Association for the Blind. In particular, heads of local schools and technical colleges have been most helpful in making their premises available for indoor training. Without such support, the problems associated with the training programme could not have been overcome. The Long Cane will soon become a common sight in the streets and roads of the Borough. Services for the Deaf and Hard of Hearing The registers have remained fairly static during the year, but the number of people using the advisory sessions and the information service for the hard of hearing has risen substantially. There are now four monthly advisory sessions for the hard of hearing at the Old People's Day Centres at Beckenham, Penge, William Morris Hall. Bromley, and Oxford House, Mottingham. 97 Hard of hearing clubs have been opened at Orpington and Beckenham. The clubs have formed branches of a London Borough of Bromley Social Club for the Hard of Hearing and, although the membership is small compared to the number of people with hearing losses in the borough, their activities are varied and expanding. During the year, through co-operation with the School Health Section and the Education Department, efforts have been made to offer a parent guidance service to parents of deaf children. Advice is also offered to the families of potential school leavers during the period of change from school to employment and adulthood. Temporary Accommodation The provision of units of accommodation for temporary use by homeless families was increased by two during the year, to bring the total available units to twenty-two. Special provision is made for families made homeless by fire or flood emergency. In all thirty-six families have been assisted during the year. Burials The Council has a responsibility under Section 50, National Assistance Act, 1948, to arrange for the burial or cremation of the body of any person found dead in the Borough area, where it appears that no suitable arrangements are being made. The Council cannot, however, assist financially any individual who has arranged a burial. There have been six cases dealt with during the year. Receivership The Chief Welfare Officer was appointed by the Council to act as Receiver in cases where the individual client was not able to look after his or her own affairs. This appointment necessitates an application being submitted to the Court of Protection if and when the occasion arises. During the year, it has been necessary to seek appointments as Receiver of five clients. In addition, the finances of a further two clients have been "budgeted" by the Receiver on instructions through short-term orders from the Court. Chiropody At its meeting on the 22nd January, 1969, the Health Welfare and Children Committee considered a comprehensive report of the Chief Welfare Officer on the chiropody service. At this meeting the Committee resolved to increase the cost of treatment from 5/- to 7/6 as from 1st April, 1969. In the resolution provision was made for remission of the charge on hardship grounds. 26,060 treatments were given under the Council Scheme. 102 patients requested a remission of fees and after careful consideration remission was granted in 15 cases. ENVIRONMENTAL HEALTH 101 ENVIRONMENTAL HEALTH In March of the year, together with all staff of the Health and Welfare Department, the Environmental Health Section moved from the Orpington Offices, on the periphery of the Borough, to much more satisfactory accomm0dation at Sherman House, Bromley. Inspectors operating in the Penge area have no longer to face a 40 minute traffic-ridden journey before they can commence their work. The use of offices centrally situated in the Borough has facilitated the co-ordination of work whilst ratepayers living in the Orpington district have lost little in that they can meet the Inspectors by appointment at an office established there to complement that already in use in Penge. Inevitably some disorganisation accompanied the move but the Department soon settled down and this, together with some numerical improvement in the staff position, has made possible a more determined attack on the day to day work of routine inspections. Fo0d Frequent visiting is of vital importance, especially in such matters as fo0d hygiene. By and large, all premises where fo0d is prepared, stored, eaten or sold, now comply with the structural requirements of the Regulations. Only by frequent visiting can it be determined that the facilities provided are in effective working order, that premises are kept in a scrupulous state of cleanliness and that the ever changing staffs in cafes and supermarkets are versed in the important details of personal hygiene. More time, too, has been made available to keep check on newly opened fo0d businesses. All proposals for the institution of new businesses involving planning consent are forwarded by the Borough Planning Officer to the Department and the Inspectors are able to peruse the plans. Possible contraventions are pointed out to the prospective user of a building and, if necessary, conferences are arranged with his architect or builder. By this means amendments can be made to plans which obviate the need to carry out structural alterations after the building is completed and the business established. Unfortunately, there is no legal requirement to notify the Department of intention to occupy premises for the purpose of a fo0d business and it is not always clear, from perusal of plans of a particular building, that it is to be so used. Again, there is no obligation to notify a change of occupancy nor in many cases the conversion of a building to fo0d business use. This last mentioned situation has, on a number of occasions, given rise to the opening of cafes, especially by imigrants, under the most unsuitable of conditions. Economics demand that the business be started 102 immediately after the conclusion of purchase and the problem of communication with such proprietors who are often unaware of requirements in this country, offers considerable difficulty. In some cases it has been possible, by means of persuasion, to secure the closing of the business pending the execution of important works. In the event of non-co-operation, proceedings are instituted under the Fo0d Hygiene General Regulations but this legislation was not designed to deal with urgent situations. The establishment of self-service stores has given rise to a situation where most go0ds for sale are pre-packed, generally before leaving the factory but with some items, particularly fresh meat, this takes place on the premises before being placed on display. This is all to the go0d as neither shop assistant, nor customer, are able to touch fo0dstuffs directly. It is preferable that cutting, packing, etc. should take place either in a well-ordered factory or the properly equipped preparaton room of a store, where handling is by specially trained staff and conditions are more readily controlled. There is an increasing number of perishable fo0dstuffs arriving on the market, some being imported by aeroplanes from continental countries. Many of these derive from milk and some contain meat and are usually in sealed containers of various types. If they are to reach the consumer in go0d condition it is most important that conditions relating to conveyance, storage and display be laid down and adhered to strictly. The Inspectors have frequently found items of this nature exhibited on the shelves of a shop when they should be kept in a refrigerated display cabinet. The shop-keeper has only a vague idea of its "shelf life" and may not even have recorded the date on which it was delivered to his shop. Most of these items bear a c0de indicating in some way this time factor. A few of these are readily decipherable or can be so read if the manufacturer's key is available. Too often the shopkeeper is not able to interpret the c0de and in far too many instances the mechanically applied marks are indistinct or even absent. For this reason all persons selling perishable comm0dities, whether in a shop or in a catering establishment, are urged to apply their own c0de on receipt of each consignment. Some of the larger manufacturers have an arrangement whereby their van salesman control the display of items supplied to a shop. During his frequent visits he "tops up" the amount of each item on display having first removed the go0ds which are "out of c0de". This system works in most cases. Nevertheless, it is open to error and abuse. The presence of "up-lifted" go0ds amongst the fresh fo0d in the delivery van is a source of concern. Further, the legal responsibility for the sale of unsound fo0d lies not with the person delivering it but with the owner of the shop. It is, 103 therefore, preferable that the latter should attend to its control and rotation. The entire system of fo0d technology is changing. Of less moment is the inspection of carcass meat at the slaughter house and the taking of routine samples for chemical analyses. This is not to say that controls are unnecessary. Indeed all carcass pr0duced in the Borough, some 492 were inspected and parts of 55 were condemned as unfit for fo0d. No fewer than 1,121 samples were taken although greater emphasis is now being placed on bacteriological examinations. Nevertheless, the Inspector is constantly reviewing his systems to ensure that all fo0d including the newer and more sophisticated varieties, is pure and wholesome when sold. Common L0dging Houses It is not only in the field of fo0d inspection that the Inspector's work is changing. In the latter part of the nineteenth century, in order to provide accomm0dation for itinerant labourers, "common l0dging houses" were established by municipalities, charitable b0dies and by private persons for gain. Squalid conditions, particularly in the last mentioned classification, became the rule rather than the exception and legislation was intr0duced to register and control this type of accomm0dation. It was one of the less pleasant duties of the Public Health Inspector to visit these unsavoury establishments by night to ensure that some measure of hygiene was being maintained and that overcrowding in communal sleeping rooms was not practiced. M0dern ideas and higher wages have led to the discontinuation of most of these premises. Nevertheless, two very long established common l0dging houses, one for 33 men and the other for 24 men continued to be registered in the Borough. One of these was incorporated in a large Clearance Area and ceased to function before the end of the year and it is anticipated that the registration issued for the other in respect of 1970 will be the last. Housing The District Public Inspector plays a key part in "housing" under the Public Health and Housing Acts. He is responsible for the repair of houses in the private sector, and for initiating closure or demolition of houses no longer fit for human habitation. He is concerned in the abatement of overcrowding in accomm0dation generally and the control of houses in which parts are let to individual families. These houses used in multi-occupation, of which there are several thousand in the Borough, vary from flats which are virtually self contained to individual rooms in basements where facilities, such as exist, are shared by a number of families. 104 It is in some of these premises that the most squalid living conditions in the Borough are to be found, although very few of them are structurally unfit for habitation. The Council has adopted standards for houses let in multioccupation and a start has been made in surveying, recording and requesting owners to effect improvements, to provide a better standard of facilities and to attend to possible fire hazards. The Housing Act, 1969, is likely to change the direction of future housing work. Although a four year programme of slum clearance for the years 1970-1973 was prepared, it contained only 192 properties and although other properties progress into this category, as the years pass, it cannot be said that there is a real slum clearance problem in Bromley. The new Act, in the part dealing with General Improvement Areas, envisages the declaration for special attention of suitable parts of the district in which houses are structurally sound but lack important amenities. A concerted effort will have to be made not only to bring individual houses up to the standard but to improve the immediate environment. It is hoped not only to make the areas more desirable to those who live there but to save properties falling into the "slum clearance" category. By and large, this work is a continuation of that carried out by the Inspectorate in the Compulsory Improvement Area established at Bromley Common. The Housing Act, 1969, also provided for the issue of Qualification Certificates, in respect of certain controlled tenancies, whereby "fair rents" will be fixed and charged providing the houses possess the standard amenities and are in go0d state of repair. A large number of applications for these Certificates were received in the latter part of the year and more are expected. The resulting inspections and elaborate documentation threw a considerable burden on the Department. Nevertheless, a volume of useful housing work was accomplished. The important part played by the Department in the control of housing conditions generally is indicated by the pages of the report which are devoted to the subject in its many facets. Smoke Control A "m0dern miracle" is the term used to describe the extraordinary improvement in atmospheric conditions in London since the commencement of the Clean Air programme. Although financial stringency resulted in no new Smoke Control Orders being made in the Borough for 1969, the work of survey has continued. Three further areas will be created in 1970 and it is hoped that all parts of Bromley will be brought under control by 1977. 105 Mortuaries In cases of sudden death it is necessary to conduct a postmortem examination of the b0dy so that the Coroner can consider whether the holding of an inquest is necessary. It is the Council's duty to provide mortuaries where such b0dies can be kept under the proper conditions and where the Home Office Pathologist may perform his autopsy. Except for those who are unfortunate enough to come into direct contact with this service, little is known of it, yet no fewer than 625 b0dies were handled at the two mortuaries in 1968. The work of the mortuary attendants is demanding and not always pleasant. The tactful handling of bereaved relatives is a very necessary quality. Considerable improvement has recently been made to the Beckenham mortuary, especially the refurbishing of the viewing room, to enable what is so often a distressing experience to take place in seemly surroundings. Similar improvements will be effected at the Chislehurst mortuary in the coming year. 106 FO0d AND DRUGS ACT, 1955 FO0d SAMPLING Letters in parenthesis are referred to on page 108. Article Mo. Examined No. Unsatisfactory Formal Informal Formal Informal (y) Baby Fo0ds - 5 - 1 Biscuits - 2 - — Brandy 2 — - — (o) Bread and Bread Rolls — 21 - 11 Bread Crumbs — 1 - — (e) Butter — 7 — 2 Buttered Rolls — 2 - — (h) Cake — 18 — 7 Cake Decorations — 3 - — (i) Cereal and Cereal Pr0ducts - 5 — 1 Cheese — 5 - — Chicken Curry with Rice — 2 - — (n) Chocolate and Chocolate Confectionery - 4 - 2 Coffee Extract — 4 — — (*) Colouring Matters — 9 - 1 Cream — 21 - — Custard Powder — 1 - — Cyclamate & Saccharin Cube — 1 - — Desiccated Coconut — 3 — — Dessert Powders — 5 - — Diabetic Chocolate — 1 - — (g) Dried Fruit — 10 - 1 Drinking Chocolate — 3 - — Drugs — 18 - — (c) Fish and Fish Pr0ducts — 13 — 2 (x) Flour — 8 - 1 (f) Fruit and Fruit Pr0ducts (including tinned fruit) - 26 - 5 Gin 2 — — - Ground Almonds — 6 - - Honey — 1 - — Ice Cream — 12 - - Jam and Preserves — 7 - - Jelly — 10 - - (z) Light Ale — 1 — 1 Liqueur Chocolates — 2 - - (r) Margarine- — 8 - 1 Marzipan — 1 - - (a) Meat and Meat Pr0ducts (including tinned meat) — 63 — 5 107 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal (d) Milk and Milk Bottles - 72 - 15 Milk Fo0d Beverage - 1 — — Milk Powder - 6 — — Milk Puddings - 5 — — Milk (Tinned) - 3 — Mousse - 1 — — Nuts - 6 — — (m) Oils and Fats - 27 — 1 Paste - 36 — — Poultry and Poultry Pr0ducts - 5 — — Prawn Curry with Rice - 1 — — Puddings - 5 — — (P) Pudding and Cake Mixtures - 4 — 1 Rum Flavour Butter - 1 — — (v) Rum Punch - 1 — 1 Salads - 11 — — Salad Cream and Dressing - 4 — — Sauces and Pickles - 14 — (b) Sausages and Sausage Meat 1 104 — 9 Seasoning - 7 — — Slimming Fo0ds - 6 — — (u) Soft Drinks - 27 — 3 Soup (canned) - 9 — — Soup (dehydrated) - 4 — — Spices and Flavourings - 36 — — Spreads - 12 — — (k) Stout - 1 — 1 (t) Sugar and Sugar Pr0ducts — 6 — 1 (j) Sweets - 18 — 1 Synthetic Cream - 1 — — Tea - 4 — - Vegetable Curry with Rice - 1 — - Vegetables (dehydrated) - 2 — - Vegetables (fresh) - 9 — - (s) Vegetables (tinned) - 8 — 1 (w) Vegetable pr0ducts - 4 — 1 Vending Machines:— Chocolate - 3 — - Coffee - 3 — - Soup - 2 — - Tea - 2 — - (1) Vinegar - 19 — 1 Vitamin Fo0ds - 4 — - Whisky 3 — — - Yeast — 1 — - (q) Yoghourt — 9 — 2 TOTALS 8 814 — 79 108 Nature of Unsatisfactory Sample Remarks Serial No. 2682 (a) Lamb Tongues Composition: Meat 80%. This article would have been better described as Tongues in Jelly. Correspondence with Manufacturer. Agreed to re-label "Lambs Tongues in Jelly". Serial No. 2715 (b) Pork Sausages Composition: Meat 63% as opposed to the acceptable minimum of 65%. Correspondence with Manufacturer. Repeat sample satisfactory. Serial No. 2569 (b) Pork Sausagemeat Composition: Contained 160 p.p.m. sulphite. Preservative had not been declared. Preservative notice displayed. No further action. Serial No. 2727 (a) Pork Pie Composition: Dark particles lying between the meat and pastry consisted of charred dough. Matter drawn to attention of Manufacturer. Serial No. 2742 (c) Plaice Fillets Composition: Ammonia 100 p.p.m. The presence of ammonia rendered the fish unfit for consumption. Result of refrigerator breakdown at wholesalers. All stocks withdrawn from sale. Serial No. 2743 (c) Plaice Fillets Composition: Ammonia 1100 p.p.m. The presence of ammonia rendered the fish unfit for consumption. Result of refrigerator breakdown at wholesalers. All stocks with drawn from sale. Serial No. 2617 (d) Milk Bottle Composition: The bottle contained growths of green algae. Warning letter to Bottlers, after investigation. Serial No. 2632 (d) Milk Bottle Composition: There were two small masses of cement mixture (2 mm. in diam.) adhering to the inner surface of the bottle and a third such mass, about 1 mm. in diam., was free in the milk. Warning letter to Bottlers, after investigation. Serial No. 2618 (e) Butter Composition: Contained part of a knot from a piece of wo0d. Warning letter to packers, after investigation. 109 Nature of Unsatisfactory Sample Remarks Serial No. 2619 (e) Butter Composition: Contained a piece of paper 2" x 1 1/4" which was part of a roll of brown paper treated on one surface with a material which rendered it waterproof. Warning letter to packers, after investigation. Serial No. 2568 (f) Pineapple Chunks Composition: The interior of the can showed etching and discoloration. Matter drawn to the attention of Importers and the South African Trade Department. Serial No. 2598 (f) Pineapple Juice Composition: The top and bottom portion of the can were coated externally with aluminium paint. This material had to some extent become detached in opening the can and 3.5 mg. of aluminium was found in the juice. The interior of the can showed extensive attack of the tin coating but in view of the can having been opened some time before examination the significance of this could not be assessed. Warning letter to Importers and South African Embassy notified. Serial No. 2728 (g) Mixed Dried Fruit Composition: Contained insect fragments which were those of a wasp, Vespa Germanica, a very widespread species. Warning letter to packers, after investigation. Serial No. 2756 (h) Eccles Cake Composition: These cakes were more in the nature of Banbury rather than Eccles cakes in that they contained a spiced mince meat filling as opposed to the generally accepted currant and brown sugar filling of Eccles cakes. It is, however, interesting to note that Laws Grocers Manual refers to Eccles cake as being "very like Banbury Cakes" so the line of demarcation may in practice be somewhat arbitrary. Correspondence with Manufacturer and Analyst. Analyst advises no further action. Serial No. 2694 (i) Breakfast Oats Composition: Associated with the sample was a ferrous metal strand, 1.1" long, which had the appearance of a metal turning. Manufacturer warned after full investigation. 110 Nature of Unsatisfactory Sample Remarks Serial No. 2599 (h) Battenburg Cake Composition: The foreign b0dy from the coating of the cake was an aluminium fragment weighing 0.32g and approximately 8 mm. in diameter. Matter investigated. Warning letter to Baker. Serial No. 2616 (j) Rock Composition: Embedded in the rock was a length of iron wire approximately 3" in length. This wire was coated with plastic in part and formed into a loop, part of which was embedded in the rock in such a way as to indicate that it gained access during manufacture. The wire was 0.017" in diameter. Legal proceedings. Manufacturers fined £15 with £7 12s. 3d. costs. Serial No. 2740 (k) Stout Composition: The composition stopper of the bottle and rubber washer were the source of contamination. Phenolic b0dies which were present suggested the prior use of the stopper in a bottle containing a disinfectant fluid. Warning letter to Bottlers after investigation. Serial No. 2710 (1) Vinegar Composition: The sample which declared the addition of salt contained only a very insignificant trace. Correspondence with Manufacturers. Re-labelling to omit the word "salt". Serial No. 2738 (m) Cooking Fat Composition: Antioxidants were not detected although Butylated Hydroxyanisole was declared. Correspondence with Manufacturers. Re-labelling to omit antioxidants. Serial No. 2634 (n) Chocolate Christmas Decorations Composition: One of the decorations was described as milk chocolate but lacked butter fat although it contained milk solids and should not, therefore, have been described as milk chocolate. Correspondence with Manufacturers. Serial No. 2633 (n) Chocolate Christmas Decorations Composition: Insufficient milk fat present to warrant the description milk chocolate. The ratio between the butter fat and nonfatty milk solids indicated that the chocolate was pr0duced with a mixture of fullcream milk and non-fat milk. Correspondence with Manufacturers. 111 Nature of Unsatisfactory Sample Remarks Serial No. 2822 (a) Corned Beef Composition: The can appeared to be a faulty one in that a leak was found in the seam and this would account for the deterioration of the contents. Matter investigated. Warning letter to importers. Serial No. 2843 (a) Steak and Kidney Pie Composition: Contained foreign b0dy. The object removed from the pie had the structure and composition of a urinary calculus. It consisted of calcium and magnesium, phosphates and carbonates associated with uric acid. Matter investigated. Warning letter to manufacturers. Serial No. 2907 (d) Milk Bottle Composition: The bottle contained fragments of a card on which there appeared both printing and writing with a ball pen. The card gave positive reactions for a cationic detergent and was readily broken up suggesting it had undergone a washing process. Matter investigated. Warning letter to bottlers. Serial No. 2840 (f) Stoned Dates Composition: In the macerated fragment of date there were strands of tobacco leaf and fragments of paper indicating the presence of part of a cigarette. Matter investigated. Warning letter to importers. Serial No. 2839 (f) Canned Rhubarb Composition: The material present in the canned rhubarb was a cylindrical mass of gelatinised flour, 1" long by 1/8" in diameter, dyed with Ponceau 4R. Matter investigated and drawn to the attention of canners. Serial No. F.C.365 (o) Bread Composition: In the crumb of the loaf was an unaerated dough fragment on which were a series of black dots in serried lines. The fragment was divided between two slices in one of which it was embedded in the crumb and in the other it was locally attached to the crumb. The black areas contained iron, mineral oil and mould and their form and arrangement suggested that they derived from a perforated baking surface or similar article with perforations. Matter investigated. Warning letter to baker. 112 Nature of Unsatisfactory Sample Remarks Serial No. 2874 (o) Sliced Bread Composition: Contained glass. The fragments from the bread consisted of glass having a specific gravity of 2.48 which corresponds with common glass used for bottles, windows, etc. No corroboration that glass was baked in loaf. Warning letter to bakers. Serial No. 2767 (P) Sponge Mixture Composition: Sugar 51%. Available CO2 0.63%. Sugar was second on the list of ingredients and therefore should not be 51%. Correspondence with manufacturer. Satisfactory. Serial No. 3088 (b) Pork Sausages Composition: Meat 61%. Slightly below standard. Correspondence with manufacturer. Repeat formal samples—satisfactory. Serial No. 3001 (b) Pork Sausages Composition: Contained glass fragments. The specific gravity of the fragements indicated that they were of heat resisting glass. Legal proceedings. Case dismissed. Serial No. 3148 (d) Milk, Pasteurised Composition: On the inner surface of the glass were numerous small yellow mould colonies and a denatured milk film of approximate overall dimensions of 1/2" x 1/4" also contaminated by mould was attached to the inner surface of the bottle near the base. Matter investigated. Foreign matter relatively small. Warning letter to bottlers. Serial No. 3050 (d) Milk, Pasteurised Composition: The half filled pint bottle of milk contained 0.17 g. of black pepper free in the milk. Matter investigated. No further action. Serial No. 3017 (d) Milk Bottle Composition: The deposit on the inner surface of the base of the bottle consists of a hardened sand cement mixture. Matter investigated. Warning letter to bottlers. 113 Nature of Unsatisfactory Sample Remarks Serial No. 3114 (d) Milk Bottle Composition: The foreign matter consisted of a small brown leaf. The brown colour was due either to decay or to treatment with caustic s0da but it is not possible to prove which. If the leaf had been in contact with caustic s0da this would indicate that it had been through the bottle washing process. Matter investigated. Warning letter to bottlers. Serial No. 3066 (d) Milk Bottle Composition: Adhering to the inner surface of the base and lower portion of the bottle were pieces of film of denatured milk in which mould hyphae were detected. Legal proceedings under Fo0d and Drugs Act. Case dismissed with £5 5s. 0d. costs against Council. (No foreign matter free in milk.) Serial No. 3128 (d) Milk Bottle Composition: The interior of the bottle showed local staining by iron particles which were firmly adherent to the glass. Matter investigated. Staining not extensive. Warning letter to bottlers. Serial No. 2924 (q) Yoghourt Composition: The yoghourt contained a four inch length of sisal string. Matter investigated. Warning letter to manufacturer. Serial No. 3147 (q) Yoghourt Composition: The yoghourt was fermenting. Yeast cells and alcohol were detected. Matter investigated. Sold after c0ded date. Warning letter to vendor. Serial No. 3057 (r) Margarine Composition: The moisture content at 16.2% was slightly in excess of the maximum permitted (viz. 16.0%). Correspondence with manufacturer. Satisfactory. Serial No. 3049 (f) Canned Loganberries Composition: The insect associated with the canned loganberries was one of the Hemiptera type of bug and had been subjected to heat. Matter investigated. Importers warned and Embassy of exporting country notified. 114 Nature of Unsatisfactory Sample Remarks Serial No. 3098 (s) Canned Peas Composition: The snail associated with the peas was discovered after the peas had been cooked and it was not possible to establish if the snail had been canned with the peas. Matter investigated. Warning letter to canners. Serial No. 3130 (o) Bread Composition: The crumb of the loaf and of the accompanying fragments were stained with iron and mineral oil. Matter investigated. Foreign matter relatively small. Warning letter to bakers. Serial No. 3149 (o) Bread Composition: The foreign matter in the slice of bread was part of a blue paper label. A small fragment of similar material was detected in an adjacent slice. Matter investigated. Foreign matter relatively small. Warning letter to bakers. Serial No. 3131 (o) Bread Composition: The soiled area of the dough gave positive reactions for iron and mineral oil. Matter investigated. Foreign matter relatively small. Warning letter to bakers. Serial No. 3099 (o) Bread Composition: The dark matter consisted of charred dough together with mineral oil and particles of iron which had probably derived from the bakehouse machinery. Matter investigated. Warning letter to baker. Serial No. 2990 (°) Bread Composition: Examination of the discoloured fragments found in the loaf indicated that they had derived from the slicing of the loaf, being charred crust. Matter investigated. No further action. Serial No. 2908 (o) Bread Composition: The larva is that of the mealworm beetle (Tenebrio Molitor) and it has been heated. Legal proceedings. Baker fined £40 with £5 5s. 0d. costs. Serial No. 3046 (o) Bread Composition: Embedded in the crumb of the loaf was a folded waterproof dressing. Examination indicated that the dressing had been baked in the loaf. Difficulty over evidence precluded proceeding. Warning letter to bakers. 115 Nature of Unsatisfactory Sample Remarks Serial No. 3100 (o) Bread Composition: A small amount of crumb was adhering to the ends of the wo0d splinters but it was not possible to prove that the splinters had been embedded in the loaf. Apart from one very small fragment of wo0d visible through a hand lens no other pieces of wo0d or pencil lead were found. Matter investigated. Warning letter to bakers. Serial No. 3179 (h) Cherry Sultana Cake Composition: The coin is a Greek 50 Lepta coin, i.e. half a drachma, of 1962 showing King Paul. The faces of the coin are undamaged but the rim has been severely hammered all round the circumference. When received the coin had adherent crumb on both sides but no other foreign matter was detected in the cake. Matter investigated. Warning letter to packers of fruit. Serial No. 2956 (h) Fruit Buns Composition: The spider which was alleged to have fallen out of the bun had a few crumb particles adherent to it but from its condition appeared not to have been subjected to a mixing process. Matter investigated. Source of spider uncertain. No further action. Serial No. 3180 (h) Doughnut Composition: Cigarette filter tip with fragments of doughnut adhering. The filter tip was from a cigarette which had been smoked and the material adhering to it consisted of cooked wheat flour. Legal proceedings. Baker fined £25 with £24 16s. 0d. costs. Serial No. 2918 (t) Cinnamon Sugar Composition: Microscopic examination indicated that the spice was cassia rather than cinnamon. In Canada, the country of origin, it appears that the terms cinnamon and cassia are interchangeable and that what in Britain is called cinnamon is there known as Ceylon Cinnamon. Correspondence with manufacturer. Analyst agreed no further action. Serial No. 3051 (u) Blackcurrant Lemon Drink Composition: The list of ingredients mentioned liquid glucose B.P.C. but this comm0dity is not now a B.P.C. article. Correspondence with manufacturer. Labels being amended satisfactorily. 116 Nature of Unsatisfactory Sample Remarks Serial No. 3009 (u) Blackcurrant Health Drink Composition: Contained sulphite 390 p.p.m. which exceeds the maximum of 350 permitted by the Preservatives Regulations. Correspondence with manufacturer. Satisfactory. Serial No. 3308 (b) Pork Sausages Composition: Contained 230 p.p.m. sulphite without declaration, contrary to the requirements of the Preservatives in Fo0d Regulations. Correspondence with manufacturer / vendor. Permanent notice now exhibited. Serial No. 3353 (b) Pork Sausages Composition: Contained 130 p.p.m. sulphite without declaration. Correspondence with manufacturer / vendor. Permanent notice now exhibited. Serial No. 3314 (b) Pork Sausages Composition: The meat content at 60% was below the minimum of 65% laid down in the Sausage and Other Meat Pr0ducts Regulations. Repeat formal sample. Result satisfactory. Serial No. 3256 (b) Beef Sausages Composition: Contained 390 p.p.m. sulphite without declaration, contrary to the requirements of the Preservatives in Fo0d Regulations. Permanent notice exhibited—satisfactory. Serial No. F.C.439 (b) Sausage Composition: Contained a copper coated iron stample 49 mm. long and 1.5 mm. in width. Matterinvestigated. Warning letter to butcher/ manufacturer. Serial No. 3322 (a) Steak and Kidney Pudding Composition: The strip of iron associated with the pudding was in the form of a rough hook and measured overall 35 mm.: it was 2 mm. wide and 0.5 mm. thick. Its surface was rusty and dough was adherent to it. Matter investigated. Warning letter to packers of can. Serial No. 3305 (d) Milk Composition: Fat 4.35, Solids not fat 8.05%. Extraneous water 2.5%. Repeat formal sample— satisfactory. Pr0ducer ceased business in December 1969. 117 Nature of Unsatisfactory Sample Remarks Serial No. 3217 (d) Milk Composition: The material adhering to the inner surface of the bottle consisted of dried milk solids and dust. Matter investigated. Warning letter to bottlers. Serial No. 3230 (d) Milk Composition: The material adhering to the inner surface of the bottle consisted of dried milk solids and dust. Matter investigated. Warning letter to Dairy, Serial No. 3242 (d) Milk Composition: The foreign matter consisted of light brown particles of milk solids on which mould had grown. Legal proceedings. Bottlers fined £25 with £5 5s. 0d. costs. Serial No. 3292 (d) Milk Composition: The bottle was soiled on the base and on the sides adjacent to the base by a residue of paint. In the paint, which contained lead and iron, was embedded grit and adventitious debris. Legal proceedings. Bottlers fined £25 with £5 5s. 0d. costs. Serial No. 3277 (d) Milk Composition: Contained a number of dark specks up to 1 mm. in diameter in which mould had grown. Matterinvestigated. Warning letter to bottlers. Serial No. 3284 (v) Rum Punch Composition: This pr0duct is basically a yoghourt sweetened with agar and flavoured with fruit and rum. The description is therefore not appropriate. Correspondence with manufacturer. Label redesigned—satisfactory. Serial No. 3373 (w) Part of a Fried Potato Composition: Embedded in the fried potato was a stone measuring overall 9x7x5 mm. and weighing 0.34 g. Matter investigated. Warning letter to caterer. Serial No. 3198 (x) Flour Composition: The flour was infested by Psocoptera, small primitive insects popularly known as book lice. Matter investigated. Warning letter to millers. 118 Nature of Unsatisfactory Sample Remarks Serial No. 3243 (o) Bread Composition: Contained a piece of copper wire 1" in length. Legal proceedings. Baker fined £20 with £8 18s. 0d. costs. Serial No. 3285 (h) Cream Slice Composition: The fat in the "cream" contained no significant amount of butter fat. Slice mistakently placed in the fresh cream display cabinet. Price (6d.) indicated no wilful deception. Now satisfactory. Serial No. 3389 (h) Cake Composition: A housefly was almost completely embedded in the crumb of the cake, indicating that it had been baked therein as did the absence of phosphatase enzymes. Matter investigated. Warning letter to baker. Serial No. 3216 (y) Protein Cereal Baby Fo0d Composition: There was evidence of attack by the Confused Flour Beetle— Tribolium Confusum. Matter investigated and drawn to attention of manufacturer. Serial No. 3306 (u) Straight Drink Composition: The complaint of a faint 0dour of petrol or paraffin was confirmed. Matter investigated. Warning letter to bottlers. Serial No. 3323 (z) Light Ale Composition: Contained matted fragments of mould growths. Matter investigated. Warning letters to bottlers and vendor. Serial No. 3371 C) Pea Green Colour Composition: Contained Blue VBS which is no longer a permitted colour. School Meals—old stock. Withdrawn and destroyed. 119 Unsound Food A total of 23 tons 16 cwts. 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. lb. Meat and Offal at slaughterhouse — 2 56 Meat and Offal at wholesale and retail premises 2 2 64 Cooked meat and meat pr0ducts — — 32 Canned meat — 8 50 Fish (fresh and tinned) — 4 65 Fruit and Vegetables (fresh and tinned) 5 4 75 Frozen Foods 13 17 106 Other Foods 1 15 — 120 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken and submitted for examination with the following results:— Satisfied Failed Phosphatase Test 96 — Methylene Blue Test 175 8 Ring Test 88 — The tests shown in the above table were applied for the following purposes:— Phosphatase Tests—Applied to "Pasteurised" Milk to determine that the milk was satisfactorily pasteurised. Methylene Blue Tests—Applied to "Untreated" and "Pasteurised" milks to indicate that the bacterial content was within the prescribed standard. Ring Test—Applied to untreated milk to determine the presence of "Brucellus abortus". Where samples failed to satisfy the prescribed tests investigations were undertaken and further samples obtained, the tests of which proved to be satisfactory. BACTERIOLOGICAL SAMPLES OF ICE CREAM 102 samples were taken during the year with the following results:— Grade I 85 Grade II 15 Grade III 2 Grade IV - Further samples were obtained from the suppliers whose pr0ducts had given Grade III results. These further samples were found to be satisfactory and were classified as Grade I. 121 OTHER SAMPLES AND SPECIMENS SUBMITTED TO PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION 40 empty milk bottles were submitted at intervals during the year for bacteriological examination directly following their treatment by the bottle washing machine for a local milk bottling plant; all were found to be satisfactory. 4 samples of Frozen Egg and 5 samples of Egg Noodles were examined and were found satisfactory, no pathogenic organisms being isolated. The following 13 samples of foodstuffs were examined in connection with suspected cases of Fo0d Poisoning and were found to be free of pathogenic organisms:— Sweet and Sour Pork Cooked Yellow Rice Raw Sausagemeat Cooked White Rice Raw Marrow Savoury Minced Steak Cooked Marrow and Bean Sprouts Sausagemeat Residue of prepacked Chinese Reshni Kebads Food Cooked Chicken Pork Brawn Cooked Chopped Beef The culture from a composite Chinese Meal showed the following result:—"A heamolytic strain of clostzidium welchii was isolated". 2 samples of chicken manure, foliage and soil were examined during an investigation into an alleged hazard to health—no pathogeus were isolated. 976 specimens of faeces were examined from persons suspected to be suffering from infectious disease or fo0d poisoning, or who were contacts of persons so suffering. The results were: Faeces Specimens Positive Negative Suspected Dysentery 702 113 589 Suspected Food Poisoning 167 18 149 Suspected Paratyphoid, etc. 107 — 107 122 MEAT INSPECTION 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 Goats Number killed 42 8 10 392 40 — Number not inspected NIL NIL NIL NIL NIL NIL All diseases except Tuberculosis and Cysticerci Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned 16 1 - 32 6 - Tuberculosis only Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - - Cysticerci Carcases of which some part or organ was condemned - - - - - - Carcases submitted to refrigeration - - - - - - Generalised and totally condemned — — — — — — The approved charges totalling £18 13s. 0d. were made for the inspection by Public Health Inspectors of the carcases shown in the above table. 123 Food COMPLAINTS 101 complaints were received alleging foodstuffs to be unsound or to contain foreign matter. These complaints came within the following categories:— Alleged condition Foreign B0dies, Dirty, etc. Mouldy Other Conditions Bread and flour confectionery 22 8 — Tinned foodstuffs 6 — 3 Perishable articles (pies, sausages, etc.) 5 9 1 Milk and Milk Bottles 16 — — Chocolate and sugar confectionery — — 1 Cereals 1 — — Preserves — 1 — Miscellaneous 14 2 12 Foreign bodies identified in the specimens were as follows:— Bread and flour confectionery. Grease from machinery, piece of wood, dead insects, a piece of bandage, brush bristle, a small foreign coin, cigarette end, piece of wire. Tinned fo0dstuffs. A piece of plastic, dead beetles, a snail, solder, and staining from the internal surface of the tins. Pies, sausages, etc. Small stones, a piece of glass, a nail, a metal staple, a small piece of broken metal. Milk and milk bottles. Pieces of paper, paint, cement. Other conditions comprised unusual taste and appearance of various articles, decomposition, rancidity, live mites in flour, and one instance of mouse droppings on bacon. Some complaints were found to be due to misconceptions, for instance the pieces of glass alleged to be in a packet of salt proved to be salt crystals, and "plastic" in fish fingers was in fact fish bone, whilst the smell, taste and appearance of articles sometimes proved to be natural to the foodstuffs complained of. 124 During 1969 it was found necessary to issue 62 warning letters and to institute proceedings as shown below:— Fined Costs FC 376 Bread containing meal worm larva Manufacturer £40 £5 5s. 0d FC 377 Fruit pie affected with mould Retailer £25 £5 5s. 0d. FC 382 Meat pies affected with mould Retailer £25 £5 5s. 0d. FC 400 Bread containing pieces of wood Manufacturer £35 £11 l1s. 0d. FC 408 Chicken and ham pie affected with mould Retailer £20 £3 3s. 0d. FC 411 Sausages affected with mould Retailer £10 £6 6s. 0d. FC 419 Doughnut contained cigarette end Manufacturer £25 £24 16s. 0d. FC 429 Dirty milk bottle Dairyman £25 £15 15s. 0d. FC 433 Bread containing piece of wire Manufacturer £20 £8 18s. 0d. FC 434 Dirty milk bottle Dairyman £25 £15 15s. 0d. FC 442 Sausage rolls affected with mould Retailer £25 £21 0s. 0d. FC 448 Beef steak pie affected with mould Retailer's Manager £25 £10 10s. 0d. FC 456 Dirty milk bottle Dairyman £25 £15 15s. 0d. FC 460 Bacon, eggs and chips served as a meal contained mice droppings Vendor £25 £5 5s. 0d. FOOD AND DRUGS ACT. SECTION 16 Number of Food Premises registered under the abovementioned Act for:— (a) Sale or manufacture for purposes of sale of ice-cream or the storage of ice-cream intended for sale 863 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 276 125 SLAUGHTER OF POULTRY ACT, 1967 There is one registered premises in the Borough at which the slaughter of poultry is carried out. The premises consist of a turkey farm on which 4-5,000 turkeys are raised annually. These birds are all slaughtered at the Christmas period, the main bulk between 12th to 20th December. Slaughter is carried out at two specially equipped units within the curtilage of the premises, both units are equipped with 85 volt stunning devices. The birds are dry plucked after slaughter and placed in chilled storage. No evisceration is carried out on the premises. In 1969 5,000 birds were slaughtered, the premises were visited on 15 occasions. No birds were rejected as unfit for human consumption. The standard of hygiene maintained during the rearing and subsequent slaughter of the birds is very satisfactory. The flock was carefully "culled" during the rearing period to ensure that only healthy birds in good condition were slaughtered. FOOD HYGIENE (GENERAL) REGULATIONS, 1960 There are some 2,106 food premises in the area, made up as follows:— Bakers and Bakehouses 103 Butchers 171 Confectioners 231 Milk Dealers 280 Clubs and Hotels 137 Chemists 73 Fishmongers (wet, dried and fried) 59 Greengrocers 140 Grocers 286 Hospitals, Nursing Homes and Old People's Homes 74 Canteens 102 Public Houses 161 School Canteens and Serveries 116 Cafes and Restaurants 173 126 MILK (SPECIAL DESIGNATIONS) REGULATIONS Licences to deal in specially designated milks were currently held as under:— Dealers (Pasteurisers) Licences 1 Pasteurised 170 Sterilised 113 Ultra Heat Treated 61 Untreated 72 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act and Regulations made thereunder which prescribe standards of cleanliness for the various filling material apply to the upholstery, soft furnishing, bedding and soft toy trades. Thirteen samples were taken during the year and submitted to the prescribed analyst who carried out the routine tests under the Regulations for cleanliness. Eleven of the samples proved to be satisfactory and two failed to comply with the required standard. Appropriate follow up action was taken. No new licences were issued or registrations made during the year in connection with these trades. Foam crumb, a synthetic material for which no standard of cleanliness has yet been prescribed, continues to be used on an increasing scale as a filling material for soft toys and other articles. HOUSING AND SLUM CLEARANCE The year 1969 represents a milestone in Housing legislation. It was the year which saw the implementation in the Housing Act, 1969, of many of the recommendations and policies outlined by the Government's White Paper "New Homes for Older Houses". The Act of 1969 proposed alterations and increases in the payment of Improvement Grants and authorised the establishment of General Improvement Areas. It also legislated for conversion of controlled tenancies in dwellings which have, or are to be provided with, all the standard amenities, a fixed bath, a wash hand basin, and sink and a hot and cold water supply to these fittings and a water closet accessible from within the dwelling. The Act also improved and simplified the legislation relating to Houses in Multiple Occupation. The Act came into operation 127 on 25th August, 1969, and immediately many applications were received from owners of controlled dwellings who thought that their properties satisfied the qualifying requirements to enable them to apply for registered rents on the appropriate day. This created a considerable amount of work during 1969, particularly in the administrative sphere as the operation of the Housing Act in this respect is quite complex. During the early months of 1969 three Public Enquiries were held as a result of objections received to Compulsory Purchase Orders. These Compulsory Purchase Orders included properties declared as Unfit in Clearance Areas made previously. The Minister of Housing and Local Government finally confirmed in 1969 all the Compulsory Purchase Orders which will enable the Council to proceed with the rehousing and demolition for redevelopment all the properties with the Blenheim/Arpley Redevelopment Area and the St. Hugh's Redevelopment Area schemes. During the course of the year the properties outstanding on the 1965 - 1969 five year slum clearance programme were dealt with and inspections made with a view to compiling the succeeding four year programme upon which information was sought by the Minister in December. The last two houses were demolished in the Hadlow Place Clearance Area and 9 houses or basements were closed by Closing Orders. 1 Closing Order on a Basement was determined as a result of the owner carrying out such work as was necessary to make it fit for human habitation. During 1969 as a result of 17 inspections made for overcrowding, 8 families were rehoused. The appended tables give a detailed account of the work of Housing and Slum Clearance carried out during 1969. CLEARANCE AREAS REPRESENTED Mill Place, Chislehurst (No. 1) Clearance Area. Nos. 36, 37, 38, 39, 40 and 41 Mill Place, Chislehurst. Clearance and Cumpulsory Purchase Orders Confirmed. Victoria Place, St. Paul's Cray Clearance Area. Nos. 5 and 6 Victoria Place. Bromley (Evelina Road/Clarino Road) Clearance Area. Nos. 1-15 Evelina Road. Nos. 8, 10, 11, 12 and 14 Clarino Road. 128 Penge Lane, Penge Clearance Area. 1-6 (consecutive) Penge Lane. Heath and Clifford Groves, Penge, Clearance Area. Nos. 4, 6, 7, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 Heath Grove. Nos. 1, 2, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 16, 17 and 18 Clifford Grove. Bromley (Evelina Road/Pawleyne Road) Compulsory Purchase Order, including: Evelina Road, Penge, Clearance Area. Nos. 19, 20 and 21 Evelina Road. Croydon Road, Penge, Clearance Area. Nos. 12 and 14 Croydon Road. Pawleyne Road, Penge, Clearance Area. Nos. 100, 102 and 104 Pawleyne Road. OVERCROWDING There were 51 known cases of statutory overcrowding of which 20 came to the notice of the department during 1969. RE-HOUSING The following information has been supplied by the Housing Manager:— Prior to 1969 Houses During 1969 Houses Permanent dwellings built 10,536 685 Prefabricated dwellings built by Local Authority 294 nil (60 still occupied) During 1969, 772 families were housed from the waiting list in permanent accommodation. The total number of families on the waiting list as at 31st December 1969, was 4,199. 129 HOUSING (A) Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices:— Informal Formal By owner 368 178 (B) Beyond repair—Housing Act, 1957 1. No. of undertakings accepted (Section 16 2 2. No. of closing orders made (Section 17) 3 3. No. of demolition orders made (Section 17) 2 4. No. of closing orders made (Section 18) 5 5. No. of closing orders determined (Section 27) 1 6. No. of closing orders revoked and demolition orders substituted (Section 28) nil 7. No. of houses demolished following demolition orders nil (C) Clearance Areas (1) Represented during Year: 1. Number of areas 1 2. Houses unfit for human habitation 6 3. Houses included by reason of bad arrangement, etc. nil 4. Houses on land acquired under 43(2) nil 5. Number of people to be displaced: (a) Individuals 7 (b) Families 4 (2) Action taken during the year: 1. Houses demolished by Local Authorities or Owners: (a) Unfit 3 (b) Others nil 2. Number of people displaced from houses to be demolished or closed; (a) Individuals 379 (b) Families 95 130 COMPULSORY IMPROVEMENT OF DWELLINGS The following table is a summary of the formal action taken under the Housing Act, 1964, in connection with the compulsory improvement of dwellings: Preliminary Notices served 2 Formal undertakings given by owners to execute improvement work 5 Purchase Notices served by owners 1 Houses where works of improvement were completed during the year 10 No further action was taken in connection with new compulsory improvement areas because of new legislation which was forecast on this subject and which culminated in the passing of the Housing Act, 1969. The Act took away a local authority's power to require the compulsory improvement of all tenanted dwellings in a declared improvement area, and substituted a power to declare "General Improvement Areas" where improvement of the dwelling is to be on a voluntary basis, the incentive for which it is hoped will be the bigger improvement grants that are now available to owners and the higher rents which the owner will be able to ask the Rent Officer to fix once the house possesses the standard amenities and is in a proper state of repair. The right of individual tenants to request the Council to exercise their power to compel an owner to improve a dwelling is preserved. First impressions are that many tenants will prefer to forego an internal water closet and bathroom rather than pay a considerable increase in rent. RENT ACT, 1957 Certificates of Disrepair and other documents specified in the Act have been issued as follows:— Applications for Certificates of Disrepair 4 Number of decisions not to issue certificates — Number of certificates issued — Number of undertakings given by landlords under Paragraph 5, First Schedule 4 Number of undertakings refused by L/A — A pplications for Cancellation of Certificates By Landlords to L/A for cancellation — Objections by tenants to cancellation — Certificates cancelled by L/A — Applications for Certificates as to remedying defects which landlord has undertaken to remedy Number of applications 2 Number of certificates issued 2 131 HOUSING INSPECTIONS Defects Remedied, Nuisances Abated by Informal Action Drainage Drains: Constructed or Reconstructed 137 Repaired 220 Cleansed 987 Cesspools: Provided — Overflowing 1 Leaking 1 Abolished 27 Sanitary Appliances Sinks, etc., provided 22 Sinks, etc., repaired 25 W.C.s provided 33 W.C.s repaired 130 Dampness Roofs and rainwater fittings 652 Walls and stacks 489 Damp-proof courses and floors 191 Water Supply Provided 4 Installations repaired 65 General Items Wallplaster 408 Ceiling plaster 173 Floors 159 Rooms cleansed or redecorated 79 Windows and doors 175 Lighting 9 Ventilation 40 Staircases 21 Fireplaces, etc. (ex. Clean Air) 22 Yard paving and drainage 29 Dustbins 51 Food storage and preparation 35 Nuisances from animals abated 7 Accumulations removed 139 Premises disinfested 40 Premises disinfected 127 132 NOTICES Infringements found, 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 Statutory Notices are served. 628 Informal Notices were issued of which 424 had been complied with by the end of the year. 112 Statutory Notices were served. During the year 76 Statutory Notices were fully complied with. COMMON LODGING HOUSES Of the two Common Lodging Houses whose keepers were registered under Section 238, Public Health Act, 1936, one, situated at Arpley Road, Penge, ceased to be used for this purpose at the end of the year and the premises were vacated. The premises at Poverest Road, St. Mary Cray continued in use throughout the year, but it is anticipated that these will also close down sometime in 1970. Both premises were regularly inspected and no infringements of the byelaws were found. MOVEABLE DWELLINGS The Caravan Sites and Control of Development Act, 1960, prohibits the use of land as a caravan site without a site licence. Licences are issued by Local Authorities who may attach conditions to them to enforce a satisfactory standard of environment for the caravan dwellers. At the end of the year there were five licences in force. In addition one licence was being considered for renewal. Particulars of the licensed sites are as follows Location of Licensed Sites No. of Vans Permitted The paddock, Downe Road, Keston 12 Lower Hockenden Farm, Hockenden. Swanley 1 Crittenden Caravan Park, Pond Lane, High Street West Wickham 30 Restavon, Berry's Green Road, Cudham, Nr. Biggin Hill 23 Hill 60 The Council has provided a site for twelve gipsy families at Star Lane, St. Mary Cray which is managed by the Housing Department. 133 DRAINAGE AND SEWAGE 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 1,574 instances of choked drains dealt with, 1,192 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 1969 as under:— PRIVATE ESTATE DEVELOPMENTS Foul Sewers Yards 6 in. diameter 717 9 in. diameter 1,285 Surface Water Sewers 6 in. diameter 412 9 in. diameter 1,542 12 in. diameter 259 24 in. diameter 169 PRIVATE STREET WORKS Foul Sewers 6 in. diameter 189 9 in. diameter 1,295 Surface Water Sewers 9 in. diameter 100 134 SEWERAGE AUTHORITY (a) New Sewers 1. Surface Water Sewers 6 in. diameter 78 9 in. diameter 420 12 in. diameter 130 15 in. diameter 186 21 in. diameter 102 36 in. diameter 210 48 in. diameter 233 (b) Replacement Sewers 1. Foul Sewers 6 in. diameter 2 9 in. diameter 23 12 in. diameter 74 2. Surface Water Sewers 9 in. diameter 60 15 in. diameter 23 (c) By Declaration under Section 17/18, Public Health Act, 1936 1. Foul Sewers 6 in. diameter 37 9 in. diameter 30 DISINFECTION During the year a re-organisation in the Greater London Council's method of refuse disposal resulted in the supply of steam (previously produced as a bye-product) being no longer available for the operation of the Disinfecting Plant at Waldo Road Depot. Alternative methods of providing steam being uneconomic the use of the plant was discontinued. 135 The steam disinfecting plant at Croften Road Depot is fortunately provided with an independent boiler and articles of clothing, bedding, etc., were adequately dealt with at that Depot to which they were transported in specially constructed vehicles. Articles unsuitable for treatment by steam disinfection were dealt with by chemical methods. The disinfection of premises was undertaken by spraying with liquid disinfectants or by the use of chemical fumigants. Disinfection following notifiable infectious disease was carried out free of charge, a few requests were received for the use of the disinfecting service when notifiable disease was not involved and in such cases an approved nominal charge was made. DISINFESTATION 111 requests were received for the treatment of premises and articles infested by vermin and insects and were dealt with by the use of insecticides in either liquid or powder form. This type of work was undertaken on payment of approved charges. WASP NEST DESTRUCTION Compared with last year the climatic conditions this season were more favourable for the development of wasp colonies and 370 nests were destroyed. The charge per clearance remained at £1. CLEAN AIR ACT, 1956/68 Smoke Control Areas Because of the Council's decision in 1968 to suspend action in regard to the establishment of smoke control areas, no new areas were brought under control during 1969. The total area covered by Smoke Control Orders therefore remains as it was in 1968 at 7,320 acres and the number of premises affected is 38,750. The following table shows the parts of the Borough which are affected by Smoke Control Orders:— Smoke Control Order No. Wards Operative Date Acres Premises Borough of Bromley No. 1 Bromley Common (part) 1.10.60 11 284 Borough of Bromley No. 2 Hayes & Keston (part) 1.10.60 70 443 Borough of Bromley No. 3 Hayes & Keston (part) 1.12.61 175 1,118 Borough of Bromley No. 4 Hayes & Keston (part) 1.12.62 130 896 Borough of Bromley No. 5 Hayes & Keston (part) 1.12.63 411 1,161 Borough of Bromley No. 6 Hayes, Keston (part), Martins Hill and Town (part) 1.7.65 654 1,175 Chislehurst & Sidcup U.D.C. No. 1 Mottingham South 1.7.64 225 2,417 Chislehurst & Sidcup U.D.C. No. 2 Mottingham North 1.7.65 425 1,731 Borough of Beckenham No. 1 Manor House Ward (part), Eden Park Ward (part), West Wickham South (part) 1.11.61 307 2,667 Borough of Beckenham No. 2 West Wickham South (part) 1.10.63 534 2,870 Borough of Beckenham No. 3 West Wickham North 1.11.65 1,016 2,260 Penge U.D.C. No. 1 Penge (part) 1. 9.62 67 691 Penge U.D.C. No. 2 Penge (part) 1.10.63 48 738 London Borough of Bromley No. 1 Penge (part) 1.11.66 68 1,193 London Borough of Bromley No. 2 West Wickham North (part) 1.11.66 359 2,003 London Borough of Bromley No. 3 Martins Hill and Town Ward (part) 1.11.66 278 1,954 London Borough of Bromley No. 4 Petts Wood (part) 1.12.67 685 3,423 London Borough of Bromley No. 5 Martins Hill, Town Ward (part), Plaistow and Sundridge (part) 1.12.67 268 3,164 London Borough of Bromley No. 6 Anerley 1.12.67 346 2,436 London Borough of Bromley No. 7 Plaistow and Sundridge (part) 1.12.68 620 3,247 London Borough of Bromley No. 8 Petts Wood (part) 1.12.68 420 1,936 London Borough of Bromley No. 9 Petts Wood (part) 1.12.68 210 950 136 137 The survey of three proposed smoke control areas (Nos. 10; 11 and 12) which was discontinued in 1968 because of Council policy was resumed and completed during 1969. Smoke Control Orders in respect of these areas were made by the Council and submitted to the Minister of Housing and Local Government for confirmation at the turn of the year. Particulars of the three areas are as follows:— Area No. Area Acreage Premises 10 Part Plaistow and Sundridge Ward Part Bickley Ward 923 2,361 11 Part Farnborough Ward 921 3,176 12 Copers Cope Ward 790 3,433 A survey of three further areas (No. 13, part Bickley Ward; No. 14, part Farnborough Ward and part Hayes and Keston Ward; and No. 15, part Manor House Ward) which it is hoped to bring under smoke control in 1971 was commenced. No contravention of the requirements of the various Smoke Control Orders was reported or detected during the year. Section 9 of the Clean Air Act, 1968, which came into operation on 1st April, 1969, now makes the acquisition and sale of unauthorised fuel in a smoke control area an offence under the Act. A tmospheric Pollution Although the Borough does not suffer very much from industrial pollution a few complaints were received of smoke and grit from industrial sources and these were fully investigated and appropriate measures taken. A number of applications for approval to the height of chimney stacks were received and dealt with under the provisions of the Clean Air Act, 1968, during the year. The applications related mainly to the chimneys of oil fired central heating boiler plants at schools and similar institutional buildings. The instruments for determining the concentration in the atmosphere of the two main pollutants, i.e. smoke and sulphur dioxide continue to be maintained at four sites by the Public Health Inspectorate and the recorded measurements are forwarded each month to the Minstry of Technology (Warren Spring Laboratory). Eleven premises within the Borough are licensed by the Ministry of Housing and Local Government for the storage and use of radio-active materials. 138 Disposal of Asbestos Waste A survey of commercial and industrial premises where it was thought that asbestos might be a waste product was carried out after a Circular had been received from the Ministry of Housing and Local Government indicating that there was evidence of an association between the inhalation of asbestos fibres and the development of a rare form of cancer. The result of the survey indicated that there was no danger to public health from the disposal of this waste material within the Borough. Investigation of a complaint concerning nuisance from smoke and fumes caused by the burning of waste material from a factory did reveal that asbestos fibre was one of the constituents of the material being disposed of. The smoke was caused by the burning of rubber, another of the constituent substances. The amount of asbestos fibre in a sample of the material sent to the Public Analyst for examination was reported to be insignificant. The burning of the waste material appeared to be due to the spontaneous combustion of the refuse tip used by the factory, but nevertheless it was felt necessary to send a warning letter to the owner of the factory. Bonfires There is public misunderstanding on the question of lighting garden bonfires. Considerable discomfort can be caused to persons in their gardens or even within their homes by unthinking neighbours who may light fires too frequently or when wind and weather are unfavourable. The making of a Smoke Control Order, which relates to a specific area, does not alter the legal position as to the lighting of bonfires in that area. However, a section of the Clean Air Act, 1956, does deal with these fires, wherever they may be lit. Action can be taken if smoke from such sources gives rise to conditions which come within the legal definition of a "nuisance". There is no legislation which specifies where or when fires may or may not be lighted. Representations have been made to the Department that powers should be sought to limit them to stated times on specific days. This would be undesirable as it might well give rise to an unfortunate concentration of smoke for limited periods. The Inspectors will always investigate alleged nuisances from smoke. Usually the situation will be met by advice given to offenders. In fact, during the year, 18 such complaints were received and investigated. The need for this action would not have arisen if the persons responsible had been more thoughtful to their neighbours comfort. If, due to limited space or other cause, garden refuse cannot be disposed of by fire the Council's Borough Engineer and Surveyor will on demand, arrange for its collection at a reasonable set charge. 139 PREVENTION OF DAMAGE BY PESTS ACT, 1949 RODENT CONTROL The level of rat infestation, both on the surface and in sewers, has been very much the same for the past few years. Undoubtedly many thousands of rats are killed each year but these are quickly replaced by the quick breeding habits of the survivors. In some areas of the United Kingdom rats (and mice) have become resistant to Warfarin, which is the poison in general use, but so far no cases of resistance have been detected in the Borough. Research is being undertaken by the appropriate Ministry and commercial undertakings in an endeavour to find a suitable substitute for warfarin but so far little success has been achieved. If resistance is encountered recourse is had to one of the acute poisons such as zinc phosphide which was in general use before the discovery of warfarin. The importance of rodent control work should not be underestimated, especially where food stores are concerned because of the risk of contamination but the task could be made lighter in urban areas if householders would remove sources of harbourage and food supply. The annual figures relating to surface infestation are shown below:— Properties other than sewers Type of Property NonAgricultural Agricultural 1. Number of properties in district 115,080 374 2. (a) Total number of properties (including nearby premises) inspected following notification 6,248 22 (b) Number infested by (i) Rats 2,133 7 (ii) Mice 257 1 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 83 36 (b) Number infested by (i) Rats 2 2 (ii) Mice — 1 140 PIGEON DESTRUCTION Complaints were received during the year and, as a result of these and daily routine visits to the numerous sites of congregation 3,897 pigeons were destroyed. OFFICES, SHOPS & RAILWAY PREMISES ACT, 1963 Work under this Act to provide improved and well maintained working conditions in shops and offices has made very good progress. One thousand nine hundred and sixty-four detailed primary inspections were made and, where necessary, employers were requested to deal with the contraventions found. These numbered 747 and were mostly of a varied character. The most common types of contraventions found were failure to provide first-aid equipment and thermometers to register room temperatures, unsatisfactory condition of and obstruction to floors, passages and stairs, and inadequate washing facilities. The total number of visits made for all purposes was 2,404 and it was found generally that employers showed a willingness to comply with the requirements of the Act. In no case was it found necessary to resort to legal action. 141 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 42 752 429 Retail shops 90 1,545 1,306 Wholesale shops, warehouses 5 53 53 Catering establishments open to the public, canteens 6 172 172 Fuel storage depots - 12 4 Totals 143 2,534 1,964 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 2,404 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 50 15 Eating facilities 1 5 Overcrowding — 16 Floors, passage and stairs 70 6 Temperature 125 17 Fencing exposed machinery 23 7 Ventilation 43 8 Lighting 13 18 Protection of young persons from dangerous machinery - 9 Sanitary Conveniences 38 10 Washing facilities 73 19 Training of young persons working at dangerous machinery - 11 Supply of drinking water 11 12 Clothing accommodation 16 23 Prohibition of heavy work - 13 Sitting facilities 2 24 First Aid General Provisions 121 14 Seats (Sedentary Workers) — 50 Exhibition of abstract of Act 161 Total 747 142 (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 10 4 — — 4 6 Retail Shops 37 14 — — 14 23 Wholesale Shops, Warehouses 11 3 - 1 2 8 Catering Establishments open to the public 3 1 - - 1 2 Canteens 2 1 — — 1 1 Fuel Storage Depots 1 — - — — 1 TOTALS 64 23 — 1 22 41 Analysis of Reported Accidents Offices Retail Shop Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery — — 1 — - Transport - - 1 — — Falls of persons 6 12 3 2 1 Stepping on or striking against object or person — 2 1 — — Handling goods 2 7 5 2 — Struck by falling object 1 3 - 1 - Fires and Explosions - - - - — Electricity - - — - — Use of hand tools - 10 - — — Not otherwise specified 1 3 — — - 143 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 53 63 - Nil (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 659 288 9 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 40 119 — Nil Total 752 470 9 Nil 2. Cases in which DEFECTS were found. Particulars (1) Number of cases in which defects were found r of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Refe rred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) — — — 7 — (a) Insufficient 1 1 — — — (b) Unsuitable or defective 8 8 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — - - - Total 9 9 - 7 - 144 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. 110 Household linen 2 Lace, lace curtains and nets 1 Upholstery 11 Making of paper bags 2 Making of boxes or other recptacles or parts thereof made wholly or partially of paper 4 Stuffed Toys 2 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, Chislehurst. During 1969, 625 bodies were brought to the mortuaries where post-mortem examinations were conducted by Home Office Pathologists as shown below:— Mortuary Address No. of bodies brought to the Mortuary and post-mortem examinations conducted (1) Town Hall, Beckenham 473 (2) Beaverwood Road, Chislehurst 152 145 SWIMMING BATHS All swimming baths in the Borough to which the public has access are the responsibility of the Department in respect of conditions which might give rise to health hazards. They are subjected to periodic inspections and samples of the bath waters are regularly taken for bacterial and chemical examination in order to confirm that the measures taken to purify the waters are effectively maintained. The Baths Manager and Engineer provides day to day oversight of the Public Baths owned by the Council and of baths situated at schools under the Council's control. The three pools at the Crystal Palace Sports Centre are controlled by the Greater London Council whose Scientific Branch submits monthly reports on the samples taken. Of the 80 samples taken during the year by the Public Health Inspectors, 75 proved to be satisfactory. Appropriate action was taken on the five cases where the bacteriological quality of the water did not reach the required standards. There are the undermentioned swimming baths and pools in the Borough:— Private Schools 8 Council Schools 14 Clubs, Instructions, etc. 6 Muncipally owned 4 Greater London Council 3 THE DISEASES OF ANIMALS ACT, 1951 The City of London's Veterinary Department operates a service to undertake certain duties under the above mentioned Act on behalf of Local Authorities. This service has continued in operation during 1969 in the London Borough of Bromley and I am indebted to the Veterinary Officer, Mr. G. S. Wiggins, m.r.c.v.s., for the co-operation of his Department and for much of the following information. REGULATION MOVEMENT OF SWINE ORDER, 1959 189 movement licences were verified under the terms of this order. No irregularities were found. 146 ANTHRAX ORDER, 1938 A sow which died at a local farm was suspected to be suffering from Anthrax. The carcase was destroyed by burning and the farm was disinfected and cleansed. The examination of specimens taken from the carcase subsequently proved that the animal was not affected with Anthrax and a notice defining the farm as an infected place was consequently withdrawn. FOWL PEST ORDER, 1938 An outbreak of fowl pest occurred in February, affecting nine local farms and involving some 138,500 head of poultry. During this outbreak the Department worked in close liaison with the Ministry of Agriculture, Fisheries and Food to keep it under control. All farms in the area were visited and advice given to owners regarding the vaccination of birds and the precautions to be taken to prevent the disease spreading. The Department was consulted concerning the disposal of dead birds and at one farm alone arrangements were made for some 33,000 birds to be buried. By the end of April the outbreak was over and all restrictions on the infected farms were lifted. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 RIDING ESTABLISHMENTS ACT, 1964 Veterinary reports were submitted on all premises in the Borough which were licensed under the above Acts. All were recommended for re-licensing. One application to establish an Animal Boarding Establishment was received, the premises were inspected and were recommended for licensing. ORDERS—MINISTRY OF AGRICULTURE, FISHERIES AND FOOD From time to time Orders which require advertisement are received from the Ministry. The following were therefore inserted in the National Press:— The Equine Animals (Importation) Order, 1969. Foot and Mouth Disease (Amendment) Order, 1969. Foot and Mouth Disease (Infected Areas Restrictions) (Amendment) Order, 1969. Foot and Mouth Disease (Controlled Areas Restrictions) (Amendment) Order, 1969. Exotic Animals (Importation) Order, 1969. Export of Horses (Excepted Cases) Order, 1969. Export of Horses (Protection) Order, 1969. 147 GENERAL The attention of the Department was drawn to a farm the owner of which had taken in unwanted animals. On inspection several sick animals were found to be present. The owner was instructed regarding the spread of disease and the premises will receive periodic visits of inspection. There were several instances of pigs, and on one occasion a calf being found dead near public highways. These are cases of "dumping" and in each instance post mortem examinations were made by Veterinary Officers. No evidence of infectious or contagious diseases were found. The carcases were disposed of by burial in lime. It was not possible to ascertain the origin or owners of these dead animals. ANIMAL KEEPERS, ETC. The following premises are situated within the Borough and were regularly visited and inspected. No irregularities were found. Stock Keepers 30 Farms (more than one type of animal) 43 Pig Keepers 48 Horses only 3 Poultry Keepers 26 Slaughterhouses 1 Riding Establishments 14 Animal Boarding Establishments 16 RIDING ESTABLISHMENTS ACT, 1964 Fourteen 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. PET ANIMALS ACT, 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to 28 applicants. The majority of the businesses were on a small scale selling fish, tortoises, birds and small animals. A total of 43 visits were made to the premises, 4 contraventions of the terms of the licences being found and remedied. 148 ANIMAL BOARDING ESTABLISHMENTS Sixteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at these premises for boarding 376 dogs and 184 cats. Thirty-two visits were made to these premises during the year —no contraventions of the terms of the licences being found. SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS General Sanitation Agricultural Welfare 26 Animal Boarding Establishments 32 Caravans 135 Cesspools 64 Common Lodging Houses 27 Drainage 1,776 Filthy Premises 35 Fouling of Footpaths 4 Hairdressers 135 Keeping of Animals 83 Noxious Accumulations 573 Piggeries 15 Public Conveniences 57 Rivers, etc. 91 Schools 43 Swimming Baths—Public 12 Swimming Baths—Private 35 Theatres, etc. 3 Verminous Premises 291 Housing Housing Acts (Clearance) 536 Housing Acts (Improvement) 156 Overcrowding 88 Public Health Acts 5,604 Rent Act 119 Factories, etc. Factories with power 288 Factories without power 63 Building Sites 119 Outworkers 13 149 Offices Shops and Railway Premises General Inspections—Offices 429 Retail Shops 1,306 Wholesale Shops and Warehouses 53 Catering Establishments and Canteens 172 Fuel Storage Depots 4 Visits of all kinds (including above) 2,404 Food Premises—Food Hygiene Regulations Bakers' Shops 357 Bakehouses 189 Butchers 886 Dairies 228 Fishmongers 291 Greengrocers 422 Grocers 954 Ice Cream 206 Merchandise Marks 124 Restaurants 628 Slaughterhouses 101 Stalls 218 Food Complaints 153 Inspection of Foodstuffs Meat—Slaughterhouse 181 Meat—Wholesale Depots 127 Meat—Retail Shops 116 Other Foods 518 Rodent Control Agricultural premises 16 Non-agricultural premises 282 Water Supply 144 Noise Abatement 383 Pharmacy and Medicines 8 Rag Flock and Other Fillings Act 23 Riding Establishments Act 33 150 Pet Animals Act 94 Clean Air Act Nuisances 414 Industrial premises 193 Smoke Control Areas 10,457 Pigeons Infestations 54 Infectious Diseases General 1,340 Food Poisoning 204 Disinfection supervision 28 Surveillance of Infectious Diseases Contacts, etc. 147 Nursing Homes and Child Minders 135 Sampling Egg Products 9 Food and Drugs 822 Ice Cream (Bacteriological) 102 Milk (Bacteriological) 359 Water—Drinking 15 Rivers, etc. 17 Swimming Baths 80 Rag Flock Act 13 Miscellaneous 47 NOTICES SERVED Informal Notices: Public Health and Housing 628 Others 519 Complied with at the end of year : Public Health and Housing 424 Others 396 Statutory Notices: Public Health Act 112 Complied with at the end of year: Public Health Act 76 151 WATER SUPPLY The main 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 :— 1. (a) The supply was satisfactory both as to (i) quality and (ii) quantity throughout 1969. (b) 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, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (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, 1969, was 303,372. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— River Thames—derived, also well water from Eynsford, Horton Kirby, Jewels Wood, Lullingstone, North Orpington, Orpington, Merton, Shortlands, Sundridge and West Wickham Pumping Stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. 152 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY, 1969 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. 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) All Thames derived 371 0.024 0.083 4.4 1.05 282 79 5 24.0 5.4 32 2.1 9 58 0.25 0.02 0.1 11 7.9 550 Merton 4 0.005 0.017 0.2 0.08 252 38 13 0.50 0.4 4 7.4 430 Eynsford 8 0.008 0.018 4.7 0.08 272 51 16 0.10 0.1 0 7.2 480 Horton Kirby 8 0.019 0.025 4.7 0.12 277 58 20 0.15 0.0 2 7.3 500 Jewels Wood 4 0.003 0.021 3.0 0.03 253 37 9 0.10 0.0 2 7.4 430 Lullingstone 8 0.008 0.020 4.5 0.04 265 43 15 0.10 0.0 1 7.2 470 North Orpington 8 0.010 0.022 4.9 0.06 291 54 14 0.10 0.1 2 7.1 490 Orpington 4 0.007 0.031 8.1 0.14 317 73 22 0.10 0.0 3 7.1 570 Shortlands 12 0.011 0.019 4.8 0.08 292 76 20 0.15 0.0 1 7.3 530 Sundridge 16 0.008 0.021 3.3 0.08 222 57 18 0.15 0.0 2 7.5 420 West Wickham 4 0.005 0.015 5.6 0.14 299 73 16 0.10 0.0 1 7.2 540 153 BACTERIOLOGICAL RESULTS—YEARLY AVERAGES, 1969 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply Number of samples BEFORE TREATMENT Number of samples AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count 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. River Thames-Derived 8,196 66.5 - 39.79 19.0 53.97 7.0 3,698 12.9 — 99.89 100.0 Merton 19 2.3 10 100.0 — 100.0 — 19 0.2 2 100.0 100.0 (a) Eynsford Well 169 0.2 30 99.41 — 100.0 - 252 0.0 9 99.60 99.60 (b) Eynsford Borehole 174 0.1 4 99.43 — 99.43 — (a) Horton Kirby No. 1 196 0.2 73 91 .84 0.4 94.90 0.3 249 0.1 8 100.0 100.0 (b) Horton Kirby No. 2 199 0.1 15 94.47 0.2 96.48 0.1 Jewels Wood 104 0.1 3 99.04 — 100.0 - 105 4.6 11 100.0 100.0 (a) Lullingstone No. 1 166 0.1 2 99.40 — 99.40 - 248 0.1 11 100.0 100.0 (b) Lullingstone No. 2 138 0.1 1 99.28 — 100.0 — (a) North Orpington No. 1 191 1.4 13 40.31 5.5 61.8 2.3 251 0.6 53 100.0 100.0 (b) North Orpington No. 2 186 2.8 31 43.01 4.2 62.4 1.6 Orpington 226 0.1 7 98.23 — 99.56 - 230 0.1 7 100.0 100.0 (a) Shortlands No. 1 177 0.1 31 98.31 — 99.44 - 250 0.2 3 100.0 100.0 (b) Shortlands No. 2 171 0.1 5 100.0 — 100.0 - (c) Shortlands No. 3 139 0.3 51 100.0 — 100.0 — (a) Sundridge No. 1 108 0.0 1 99.07 — 99.07 - 252 0.2 185 100.0 100.0 (b) Sundridge No. 2 138 0.1 8 99.28 — 100.0 - (c) Sundridge No. 3 179 0.1 17 100.0 — 100.0 - (d) Sundridge No. 4 171 0.2 7 99.42 — 100.0 —J West Wickham 123 0.8 67 97.56 0.1 100.0 - 118 0.1 24 100.0 100.0 SCHOOL HEALTH SERVICE 156 SCHOOL HEALTH SERVICE INDEX Page Audiology Service 177 B.C.G. Vaccination 170 Cheyne Hospital 184 Child Guidance 174 Cleanliness Inspections 164 Clinics 192 Defects—Periodic and Special Medical Examinations 165 Diseases of Ear, Nose and Throat 169 Diseases of Skin 170 Employment of Young Children 188 Followup Examinations 164 Handicapped Pupils 179 Health Visiting 190 Independent Schools 166 Infectious Diseases 171 Page Members of Education Committee 157 Minor Ailments 168 Ophthalmic Clinics 168 Orthopaedic Clinic 170 Orthoptic Clinic 168 Other Inspections 163 Other Medical Examinations 189 Periodic Medical Inspections 166 Phoenix Centre 184 Physical Education 189 Physiotherapy Clinic 170 Prefatory Letter 158 ReInspections 164 School Health Service 161 School Meals and Milk Service 190 School Psychological Service 176 Speech Therapy 171 Special Inspections 164 Special Schools 185 157 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December, 1969) *Councillor F. J. Packer, F.C.I.S. (Chairman) *Councillor J. F. David (Vice-Chairman) Alderman C. H. E. Pratt (Mayor) Alderman Mrs A. L. Gunn, J.P. Alderman Miss B. H. James, J.P. Alderman A. W. Waller *Councillor Mrs. M. M. Blackburn *Councillor R. A. Davies Councillor A. J. Day *Councillor R. G. Foster Councillor K. J. Harding *Councillor D. A. Heron Councillor R. W. Huzzard Councillor M. G. Law *Councillor Mrs. M. C. McClure, B.Sc. *Councillor P. McNally Councillor Miss K. A. Moore Councillor H. J. Palmer Councillor K. A. Pawsey *Councillor R. A. Sanderson, J.P. Councillor R. W. Spon-Smith *Councillor W. H. Stephenson *Councillor J. E. Swatton Councillor Mrs. J. Tatham Councillor R. A. Upton *Councillor Mrs. A. M. White Co-opted Members: Mr. J. H. Atkins, J.P. Mr. K. Coleborn Mr. J. Davies Miss M. C. Grobel, M.A. The Rev. Canon S. H. Hoffman, M.A. *Mr. N. L. Hevey Miss E M. Huxstep, C.B.E., B.A. *Mr. W. Marsden Mrs. K. G. Wheeler Mr. C. E. Wiltshire, J.P. *Denotes members of Primary Education and Welfare Sub-Committee CHIEF EDUCATION OFFICER—D. R. Barraclough, M.A., Dip.Ed. 158 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the fifth annual report of the School Health Service of the London Borough of Bromley. A considerable part of the report again deals with arrangements for special assistance to either physically or educationally handicapped children. Included for the first time are reports on activities for the physically handicapped children at the special school at Cheyne Hospital, West Wickham, and at the Phoenix Centre, Farnborough Hospital; both are hospitals situated within the administrative boundaries of the London Borough of Bromley. Health of School Children The health of Bromley school children is satisfactory with two exceptions. The Principal School Dental Officer indicates a need for increased dental health education to reduce the incidence of caries in infant school children. The Health Education and Home Safety Officer reports a disappointing increase in home accident figures. On the credit side, despite a notified increase of 309 cases of infectious illness, mainly due to measles, the beneficial effects of measles preventive vaccinations can already be appreciated. In 1969, when a biennial epidemic should have been experienced, the number of measles notified was limited to 411. For previous epidemic years, the figures were 1,730 (1967) and 2,218 (1965). There is a reduction of the waiting list for speech therapy from 133 (17 priority) to 64 (10 priority). This has been achieved in spite of a shortage of staff by an increase in attendances at clinics and at home and school visits. Audiology Service A further six medical officers attended short courses at the Nuffield Hearing and Speech Centre of the National Ear, Nose and Throat Hospital, on the "Diagnosis and Treatment of the Deaf Child"; and it has now become possible to include as part of each routine school medical examination, a sweep frequency hearing test. Children who fail are re-examined by an audiometric threshold hearing test. The School Health Service and the Welfare Section have combined in providing vocational guidance for hearing handicapped school children. A three classroom unit for partially hearing children has been opened in purpose built premises with facilities for speech 159 training to enable the children to attend the Nursery, Infant and Junior classes of an adjacent school. The majority of the 22 children are severely deaf, and this Unit is participating in a wider Research Study on the education of severely deaf children in ordinary schools. In addition, 13 partially deaf children attend out-borough units and 7 deaf children attend residential schools for the deaf. Peripatetic teachers of the deaf assist 84 children at home, school and clinics. Thus a very comprehensive service for the deaf school child has been developed in the first five years of the Borough. School Psychological Service This service has now acquired new premises and full-time clerical assistance. A fourth special class for learning or behaviour problems has been established and increased liaison of the service with teachers of a maladjusted children and teachers of remedial reading has been developed in a tutorial unit. The Child Guidance Service is developing closer links with the General Medical Practitioner service and this is shown by the increased percentage referrals to the Clinic over the past three years: 11% (1967), 15% (1968), and 21% (1969). This service now has, by the nature of its organisation, a complete integration with the child psychiatric hospital and general medical practitioner services of the Borough. School Ophthalmic Service The provision of occluders and alternative vision testing charts has improved standards of accurate vision testing in schools. The Stycar testing of under 5 year olds at the Child Health Clinics provides an earlier screening. Routine eye tests are carried out at 5 years, 8 years, 10 years and 14 years examinations and at special examinations when indicated. There is no delay in follow up and re-examinations, but clearly the ideal service should provide annual tests. Squint and amblyopia due to binocular vision or suppression of visual images can develop quickly after many childhood illnesses and for other reasons and produce permanent defects of sight. A great responsibility rests on those officers who carry out these tests but a further safeguard lies in the fact that the services of four consultant ophthalmologists are available under the supplementary ophthalmic service to examine all referrals from school or clinic. Orthopaedic Service The number of children at school medical examinations noted as needing or receiving treatment for defects of posture or minor deformities of feet decreased by 53. The number of attendances for remedial exercises decreased by 103. This improvement 160 is an extension of that noted in previous reports and has raised the question of whether this service might more efficiently be provided entirely from hospital out-patients. To some extent this already happens when the hospital orthopaedic clinics receive patients referred directly from the general medical practitioner service. Diagnostic facilities are more easily available in hospital but treatment services at clinics may save valuable school time for the children and are often more convenient and acceptable to parents. Health Education The comprehensive report shows that we can never become complacent on this important subject. After rejoicing for several years on the progressive reduction in home accident figures, this year an increase of 1,379 casualties, shared between 915 adults and 464 children, has come as a shock. The local campaigns for 1970 are all directed towards the various identifiable causes but clearly the continuing and main effort must come from the home. Last year the new Health Education Council took over the functions of the Central Council for Health Education. It has set up a Working Party to consider in particular problems of sex health education, and in due course Authorities will receive recommendations. This difficult problem is mentioned later in this report under the heading of "The School and the Future Parent". In concluding this report, I wish to refer to the resignations of three Medical Officers, Dr. Maxwell in March, Dr. Hilton in July and Dr. Swistak in December. Dr. Maxwell had served the former Borough of Bromley for eleven years before transfer to the London Borough of Bromley and was an efficient and very popular Medical Officer. At the same time, we welcomed Dr. Menon in April, Dr. Lyttle in November and Dr. Parkinson in December, to the School Health Service. Finally, may I sincerely thank the Chairman and Members of the Committee for their sympathetic support throughout the year. Mr. Barraclough, the Chief Education Officer, his staff with special responsibilities, and the Heads of Schools, have continued to receive the advice and recommendations of the medical staff with extreme courtesy, and to encourage wholeheartedly the development of any worthwhile support service. My own staff, and in particular Dr. Currie, Senior Medical Officer, have worked diligently to introduce new ideas to improve the service for the handicapped child, and to work in unison with the Hospital and General Medical Services, and I am grateful to them for their efforts throughout the year. L. R. L. Edwards, Principal School Medical Officer. 161 SCHOOL HEALTH SERVICE The Borough has a duty to provide for the medical inspection at appropriate intervals, and to make arrangements for securing the provision of free medical and dental treatment of pupils in attendance at maintained schools. The School Health Service, under the direction of the Principal School Medical Officer, administers these services on behalf of the Borough. It is the aim of the School Health Service, in collaboration with the Education Department, to be satisfied by means of these medical examinations that every child is able to receive the type of education best suited to his age, aptitude and ability. On his appointment as Senior Medical Officer, Dr. P. A. Currie pursued the policy of close liaison with the Head Teachers and was able, during the course of the year, to visit at least once, all maintained schools in the Borough. These are 34 secondary (including 2 direct grants) and 86 primary schools in the Borough; also 3 special day schools for educationally subnormal children. In January there were 45,551 pupils (an increase of 777) on the registers of the maintained primary, secondary, special and nursery schools. Routine Medical Inspections have continued to be given to all pupils entering the Infants' Schools, and are repeated when they reach the age of ten years and fourteen years. In addition, at eight years of age pupils are given routine tests of vision and hearing only; a full medical examination is only undertaken at this age if, for any reason, it appears necessary. It will be recalled that some difficulty had occasionally been experienced in obtaining the required standards for accurate vision testing in Schools. However, following the provision to all Health Visitors of an Occluder and 2 (different) Vision Testing Charts, these examinations have been facilitated. If at any time during a child's school career, the Head Teacher, Parent or Doctor is concerned about the health of a particular child, arrangements are made for a special examination to be carried out. Independent Schools may also participate in the School Health Service. Unfortunately, it was not possible to complete the programme of Routine Medical Inspections envisaged at the beginning of the year. This was due to the fact that the complement of Medical Officers was only at total strength for approximately one month during the year. In spite of the shortage of Medical Officers, however, the very important preventive health measure of B.C.G. Vaccination against Tuberculosis was given priority in order to complete the programme during the spring and autumn terms. 162 The total number of children attending both maintained and independent schools, who were examined in the routine age groups was 11,044. The physical condition of all the pupils inspected was satisfactory, and 1,970 pupils (17.8%) were found to require treatment. A further 4,005 children were given routine tests of vision and hearing, as a result of which 185 pupils (4.6%) were referred for treatment because of visual defects, and 28 pupils (.7%) were referred for treatment because of hearing defects. Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. Further details of these examinations will be found later in the Report. A stall of ten Medical Officers devote approximately 50% of their lime to work within the School Health Service. Each Medical Officer is responsible for a particular group of schools, so that regular contact between the Head Teachers and their own School Medical Officer is possible. The schools allocated to each Medical Officer are grouped, as far as possible, around the Child Welfare Clinics which the particular Medical Officer also attends. This enables the Medical Officer to see both the child and its parent at the Child Welfare Clinic until the child becomes eligible for school, and then to continue seeing them both at school. This continuing care is valuable as it helps to build up a good relationship between the parent, child and doctor. The Borough co-operated in a National Child Development Study in the second follow-up of every child born in one week in 1958. The total number of children involved is approximately 16..000 and seventy of these children, who Live in the Borough, were each medically examined and a very comprehensive form completed. Considerable help was given in doing this by the provision from the Sponsors of the Study, of a special vision testing chart, a detailed booklet of instruction and a half-hour tape recording with projector slides. As these may be retained they will be very useful for demonstrations to newly joined Medical Officers and Health Visitors. The aims of the study are to gather information about the educational progress, health, physical development and home background of these particular children. As information is collected at each stage it is possible to learn a great deal about children's abilities, behaviour, health and development at particular ages, and about the services which are provided. Finally, it was not possible to appoint either an Audiometrician or Psychotherapist, but it is hoped that approval will be given for these appointments to be made during the next financial year 163 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) TABLE A.—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) Satisfactory No. Unsatisfactory No. for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils (1) (2) (3) (4) (5) (6) (7) (8) 1965 and later 2 2 — — — 1 1 1964 1,145 1,145 - - 53 180 205 1961 2,703 2,703 - - 156 387 497 1962 159 159 - 5* 6 15 21 1961 191 191 - 3,652* 9 19 28 1960 75 75 - 176* 10 16 24 1959 2,540 2,540 - 23* 179 257 405 1958 240 240 - 3* 29 23 52 1957 150 150 - 24 33 53 1956 70 70 - 18 18 34 1955 2,919 2,919 - 263 265 514 1954 and earlier 213 213 — — 35 19 52 TOTAL 10,407 10,407 - 3,859* 782 1,233 1,886 The physical condition of all the children inspected was satisfactory. *Tests of Vision and Hearing only at age of eight years. 182 Pupils referred for treatment because of Visual Defect. 28 Pupils referred for treatment because of Hearing Defect. Other Inspections Number of Special Inspections 1,249 Number of Re-inspections 1,949 3,198 164 Special Inspections Special inspections are carried out at any time during a child's school career if the head teacher, family doctor, parent or health visitor is concerned about the health of a particular child. A total of 1,249 special inspections was carried out during the year. Re-Inspections A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. A total of 1,949 re-inspections was carried out during the year. 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 30,490 (b) Total number of individual pupils found to be infested 112 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 36 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 165 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS—MAINTAINED SCHOOLS Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total (1) (2) 4 Skin T 92 93 82 267 13 O 20 37 34 91 23 5 Eyes—a. Vision T 209 298 275 782 213 O 547 160 720 1427 204 b. Squint T 27 7 12 46 2 O 4 3 3 10 — c. Other T 9 2 13 24 1 O 8 2 5 15 — 6 Ears—a. Hearing T 30 8 20 58 39 O 122 28 180 330 68 b. Otitis T 35 - 8 43 2 Media O 20 1 6 27 1 c. Other T 1 1 2 1 O 3 — 6 9 — 7 Nose and Throat T 119 22 47 188 13 O 98 19 60 177 12 8 Speech T 37 3 22 62 27 O 55 3 10 68 13 9 Lymphatic Glands T 2 1 1 4 1 O 58 3 19 80 4 10 Heart T 12 2 8 22 1 O 24 9 13 46 4 11 Lungs T 56 14 16 86 10 O 34 15 35 84 4 12 Developmental— T 8 3 7 18 10 2 a. Hernia O 6 1 3 6 b. Other T 12 7 31 50 10 O 46 33 40 119 19 13 Orthopaedic— T 11 21 1 33 4 a. Posture O 27 55 58 140 1 b. Feet T 43 34 47 124 21 O 54 44 41 139 3 c. Other T 17 28 19 64 2 O 25 16 19 60 5 14 Nervous System— T 5 4 9 18 5 a. Epilepsy O 8 2 2 12 2 b. Other T 6 5 8 19 4 O 19 13 24 56 7 15 Psychological— T 4 4 6 14 7 a. Developme ntO 18 8 45 71 10 b. Stability T 13 8 12 33 15 O 83 55 143 281 12 16 Abdomen T 19 13 4 36 7 O 5 14 12 31 5 17 Other T 10 4 8 22 6 O 9 25 42 76 10 T — TREATMENT O = OBSERVATION 166 INDEPENDENT SCHOOLS Independent Schools, which so desire, have continued to participate in the School Health Service. At present 16 such schools take advantage of the facilities provided by the Service. Two schools closed during the year. A request was received from one school to join the Scheme and was subsequently visited. The accommodation was inspected and found to be satisfactory; it is hoped to commence routine medical inspections early next year. Subject to their parents' consent pupils attending these schools receive routine medical inspections (at the same ages as children attending maintained schools), 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 637 children were medically inspected and a further 146 children received tests of vision and hearing only. In addition, a total of 11 special inspections and 48 re-inspections was carried out. Further details, with a summary of the various defects found at these examinations are as follows:— 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 Unsatisfactory (1) (2) (3) (4) (5) (6) (7) (8) 1965 and later — — — — — — — 1964 71 71 - — 5 10 15 1963 72 72 - — - 7 7 1962 9 9 — — 1 2 3 1961 11 11 - 139* — — — 1960 2 2 — 2* 1 — 1 1959 39 39 — 5* 1 4 5 1958 25 25 — - 3 3 6 1957 26 26 - - 3 1 4 1956 34 34 - — - — — 1955 281 281 - — 21 19 38 1954 and earlier 67 67 — — 3 2 5 TOTAL 637 637 — 146* 38 48 84 The physical condition of all the children inspected was satisfactory. *Tests of vision and hearing only at age of eight years. 3 pupils referred for treatment because of visual defect. - pupils referred for treatment because of hearing defect. OTHER INSPECTIONS: Number of Special Inspections 11 Number of Re-inspections 48 59 167 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS — INDEPENDENT SCHOOLS Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspection (1) (2) Entrants Leavers Others Total 4 Skin T 4 5 1 10 - O 2 2 — 4 — 5 Eyes—a. Vision T 5 24 9 38 5 O 25 5 6 36 2 b. Squint T - 1 1 2 - O - — — — — c. Other T - - 2 2 - O 1 — — 1 — 6 Ears—a. Hearing T 2 — — 2 2 O 3 — — 3 1 b. Otitis T - — — — — Media O 2 — — 2 — c. Other T - - 1 1 - O - — — — — 7 Nose and Throat T 3 8 1 12 - O 10 1 2 13 — 8 Speech T 3 - - 3 - O - — — — — 9 Lymphatic Glands T 1 - - 1 - O 1 — — 1 — 10 Heart T - - — — — O 5 — 1 6 — 11 Lungs T 1 2 1 4 - O — 1 1 2 — 12 Developmental— T 1 — — 1 — a. Hernia O — — — — — b. Other T - - 1 1 — O 1 7 5 13 — 13 Orthopaedic- T - - - - — a. Posture O — — 1 1 — b. Feet T 1 1 1 3 - O 3 2 1 6 — c. Other T 1 1 - 2 - O 4 2 — 6 — 14 Nervous System— T - — — — — a. Epilepsy O — — — — — b. Other T - 1 - 1 - O — 1 — 1 — 15 Psychological T - - - - 4 a. Development O — - — — 1 b. Stability T - 2 1 3 — O 8 4 3 15 — 16 Abdomen T - - — — — O — — 1 1 — 17 Other T - - - - - O — 2 1 3 2 T—TREATMENT O—OBSERVATION 168 Minor Ailments Minor ailments are treated by the Health Visitors at the Clinics, or at 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 308 pupils were 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 39 Errors of refraction (including squint) 4,018 Total 4,057 Number of pupils for whom spectacles were prescribed 1,737 Ophthalmic Clinics These clinics are situated at Beckenham, Bromley, Chislehurst, Orpington, Penge and St. Paul's Cray. A total of 9 weekly sessions is held at these centres. In addition a session is held every other week at Bromley. A total of 711 new cases and 3,346 re-examinations was seen at the Clinics. The attendance at these Clinics continued to be very good on the whole, and it was again possible for both new cases and re-examinations to be seen without any undue delay. It would seem unnecessary to stress how vital it is that children's vision should be checked. It is not universally appreciated how defects of vision are often accepted by a child, and the parents are, therefore, not alerted to their existence. Orthoptic Clinic Patients seen at this Clinic are always referred by an Ophthalmologist. Three weekly sessions are held at the Bromley North Clinic, and one session per week at The Willows Clinic, Chislehurst. Patients not living in the areas served by these two clinics are seen at the nearest local hospital. The following types of cases are referred:— (a) Cases of obvious strabismus or squint. 169 (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 a follows:— Number of new cases 59 Number on treatment 113 Number on occlusion 103 Number of treatments given 175 Number of cures with operation 11 Number of cures without operation 19 Cases discharged—cured— (a) Functional for binocular single vision 11 (b) Cosmetic 16 Total number of attendances 713 Transferred or left the district 12 Number of sessions 184 Number on waiting list at 31.12.69 4 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 609 (c) for other nose and throat conditions 156 Received other forms of treatment Total 765 Total number of pupils in schools who are known to have been provided with hearing aids:— (a) during 1968 9 (b) in previous years 60 170 Orthopaedic and Postural Defects Number known to have been treated:— (a) Pupils treated at clinics or out-patients 153 (b) Pupils treated at school for postural defects — Total 153 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 attendances continued to be 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 803 attendances was made at the two Clinics and of these 570 were for remedial exercises, etc., and 233 for sunlight. Diseases of the Skin (excluding uhcleanliness) Number of pupils known to have been treated: Ringworm- (a) Scalp - (b) Body - Scabies 23 Impetigo 2 Other skin diseases 135 Total 160 B.C.G. Vaccination In the effort to eradicate tuberculosis, B.C.G. vaccination was again 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, with the approval of the family doctor, to the appropriate Chest Clinic. During the year 3,774 children received a skin test and the 3,352 negative reactors received B.C.G. vaccination. Of the 237 171 children who were found to have a positive reaction to the skin test, 86 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 151 children who gave a positive reaction because of previous B.C.G. vaccination. It will be noted that fewer children were referred to the Chest Clinic on account of positive reactions. This is due to the new interpretation of the skin test. Infectious Diseases 527 notifications of infectious diseases in children of school age were received during the year. Details of the notification received are as below:— Disease Total No. of Cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Dysentery 38 7 24 3 4 Food Poisoning 2 - 2 — — Inf. Jaundice 16 7 1 2 6 *Measles 411 176 167 61 7 Meningitis 1 1 — — — Scarlet Fever 51 30 12 4 5 Tuberculosis (Pul.) 6 3 1 2 Whooping Cough 2 - - 2 - Totals 527 224 207 74 22 *In view of the introduction of measles vaccination the following figures would appear to be significant: — Year No. of notifications received 1965 2,218 1966 440 1967 1,730 1968 111 1969 411 (as above) Speech Therapy In the absence of Mrs. M. M. Evans from May, the duties of Senior Speech Therapist were most ably carried out by her locum, Miss V. M. Connery, who has rapidly won the affection of the children and the appreciation of parents and teachers alike. 172 This year has shown a considerable number of staff changes. The year started with the full complement of staff allowed at present; three part-time therapists resigned, two were appointed and the year ended with one part-time post vacant. Some areas of the Borough are satisfactorily staffed, with children being assessed soon after referral, but in other areas the Waiting List is still a cause for concern. Group therapy for language handicapped children has continued at the Masons Hill Clinic, Bromley, and has proved to be of great value. During the year four students from the Central School of Speech Therapy attended the Bromley and Beckenham Clinics, and several students from the Rose Bruford College of Speech and Drama attended the Clinics for observation study. The figures for 1969 are as follows;— Number of children referred by:- 1. Medical Officers in Department 121 2. Head Teachers 60 3. Hospital Consultants 5 4. General Practitioners 9 5. Parents 5 6. Health Visitors 9 7. Educational Psychologists 3 8. Teachers of the Deaf 3 9. Other Districts 6 Total 221 Number of children seen in Clinic 437 Number of children seen in Special Schools (including Cheyne Hospital) 80 Total 517 Sessions were also held at Woodbrook Junior Training Centre in co-operation with the Senior Medical Officer Mental Health. Number of attendances;— 1. Clinics 2,845 2. Special Schools (including Cheyne Hospital) 530 The numbers for Special Schools above do not include Grove- lands. as again, owing to resignations the figures are incomplete. 173 Number of Home Visits 202 Number of School Visits 41 Number of Initial Interviews 197 Distribution of Cases:- Stammer 44 Dyslalia 159 Retarded Speech and language development 157 Interdental Speech 52 Lateral Speech 25 Deaf 12 Dysphonia 1 Dysphasia 5 Dysarthria 8 Nasal speech 11 Hyponasality 2 Cleft palate—repaired 16 General retardation 6 Dyspraxia 2 Total 500 Seventeen cases seen in the clinic have not been classified as therapy was either not indicated or being received elsewhere. Cases closed:— Improved 63 Reported improved 3 Removed 26 Refused appointments 12 Non-attendance after first interview 15 Failed interview appointment 11 Therapy not indicated 14 Having therapy elsewhere 5 Transferred 4 Total 153 At the end of the year the Waiting List was 64 including 10 priorities. 174 Child Guidance Through various sources, cases of psychological disturbance come to light and are referred, if necessary, to the appropriate Child Guidance Clinic. These Clinics, which are spaced throughout the district, are held in Hospital premises except at "The Willows", Red Hill, Chislehurst, which is the Council's own premises. The remaining Child Guidance Clinic sessions are held at Farnborough Hospital, "Stepping Stones", Bromley Hospital and at Sydenham Hospital, which serves the Borough of Bromley although it is outside the geographical limits. One Consultant Psychiatrist is now responsible for the Child Guidance work at local hospitals and at our own Clinic at Chislehurst. I am grateful to Dr. Rodriguez, Consultant Psychiatrist for the following report in respect of the Chislehurst Child Guidance Clinic, where he attends for 4 sessions per week. During 1969 the demands on the Clinic have remained practically unchanged. The number of referrals was 98 (1968—97). The median length of the waiting list was 4 months (1968— 6 months) ranging from 1 day to 84 weeks!—in the last case the parents had asked for the case to be deferred. Because of the lack of adequate treatment facilities we are still falling short of the goal of early diagnosis and effective treatment for all the children referred to the Clinic. This results in long waiting lists and causes frustration and even antagonism towards the Child Guidance Clinic amongst parents and referring agencies. The appointment of a Child Psychotherapist is urgently needed, and it is hoped to fill this next year. As in previous years every effort has been made by the members of the staff to co-operate with other care-giving professions, through informal meetings, case conferences and lectures. In March the School Psychological Service moved to its new premises at St. Paul's Wood Hill. Mrs. Preston and Mr. Bennett have attended the Clinic to carry out psychological assessments and also for regular case discussions. During the first half of the year, Mrs. Cameron, Social Worker, attended the Course on Community Care run by the London Boroughs Training Committee. Since 1st December she has increased her number of sessions, while still carrying on her duties as Mental Welfare Officer. No major repairs were carried out during the year. Some furniture and play material were replaced. Any future increase in the staff will highlight the limitations of the present building. Sixty-seven new children from the Borough were investigated and taken on for treatment during the year (1968-67). The number of children referred by local General Practitioners increased (1969 —21% of all the referrals, 1968—15%, 1967—11%). This trend 175 reflects no doubt the increasing awareness of the contribution the Child Guidance Clinic can make to the community. The total number of psychiatric interviews was 558. Close co-operation was maintained with other professionals in the field of education and child care, and efforts were made to improve communication with Head Teachers, Education Welfare Officers, Medical Officers in Department, Children's Officers, Probation Officers and Health Visitors. Thirteen inter-disciplinary case conferences were held in the Clinic. The staff also had quarterly meetings with the tutorial teachers at St. Paul's Wood Hiil Unit. Ten students attended the Clinic: 1 Health Visitor student, 1 Local Authority trainee, 1 Education Welfare Officer trainee, 1 Probation Officer trainee, 4 Social Work students, 1 Child Care Officer student, 1 Education student. Details of referrals and attendances during the year are as follows:— Waiting List: (a) Awaiting first interview 30 (b) Interviewed and awaiting treatment Nil In attendance : (a) Active 92 (b) Periodic Review (holiday cases) 9 Number of cases closed 94 Number of applications withdrawn (Failed repeatedly to attend for diagnostic interview) 25 Sources of referral: Probation Officers 3 Court 4 Head Teachers 13 Medical Officers in Department 22 General Practitioners 21 Parents 2 Children's Officers 3 Hospitals (Paediatricians and Psychiatrists) 13 Chief Education Officer 6 School Psychological Service 9 Others 2 98 176 Number of new patients taken on for treatment during each month: January 5; February 6; March 5; April 7; May 2; June 9; July 8; August 3; September 2; October 11; November 4; December 5. Number of Psychiatric Interviews: Quarter to 31st March, 1969 146 Quarter to 30th June, 1969 125 Quarter to 30th September, 1969 127 Quarter to 31st December, 1969 160 Number of Social Worker's Interviews: Quarter to 31st March, 1969 151 Quarter to 30th June, 1969 134 Quarter to 30th September, 1969 155 Quarter to 31st December, 1969 212 Number of Home Visits: Psychiatric Social Worker 81 Educational Psychologists — Other Staff The Social Worker made 18 visits to different outside agencies. Number of School Visits: Psychiatric Social Worker 6 Educational Psychologists 6 School Psychological Service I am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following report on the School Psychological Services:— This Service, which is part of the Education Department, has been hampered in the past by unsuitable buildings and by the fact that its staff was too small for the demands made upon it. In 1969, however, the School Psychological Service moved to St. Paul's Wood Hill where, for the first time, it had a place of its own and adequate accommodation. Full-time clerical assistance was allocated to the Service and, in the financial year 1970-71, the number of educational psychologists is to be increased from two to three. Children are referred to the educational psychologists by schools, by hospitals, by Child Guidance Clinics, by the Principal School Medical Officer and, of course, by the Chief Education Officer. Problems of learning and under-functioning are by far the main causes of referral by schools. The behaviour problems are more commonly referred through the clinics. The intelligence quotient range is similar for children from all sources with the boys perhaps presenting a wider range of levels than the girls. 177 In general, the children seen are in the lower half of the normal distribution for intellectual development. The educational psychologists have continued to be consulted over the selection procedure for secondary schools and have undertaken a survey of the remedial provision in reading and other basic skills in those schools. The screening of the top infant slow learners has become a well-established practice. In 1969, 122 infants were the subject of further investigation. Thereafter, thirty were discussed at three co-ordinating panel meetings and twenty-three were recommended for placement in special schools. The year brought increased liaison with the teachers of maladjusted children and with the teachers of remedial reading who make up the tutorial unit. The work of this unit has been affected by the prolonged illness of Mrs. Waite, and her untimely death in December, 1969, greatly saddened all those who knew her and the quality of her work. The educational psychologists have also continued to give help at the Borough's four special schools. During 1969, a fourth special opportunity class was opened. These classes, which are valued by parents because they form part of normal schools, now exist at Churchfields Primary, Leesons Infants', Raglan Infants' and Midfield Primary Schools. They provide education for children between the ages of five and seven who have serious learning or behaviour difficulties or who need a substantial diagnostic period in a school situation. The development of these classes, which do not exist elsewhere, is greatly to the credit of Mrs. Preston, the Borough's Senior Educational Psychologist. Audiology Service Further development and satisfactory integration continued in this Service. During the year arrangements were made for a further six Medical Officers to attend the Short Course on "The Diagnosis and Treatment of the Deaf Child" at the Nuffield Hearing and Speech Centre. Two Medical Officers have particular responsibility in this field and I am happy to submit this report which can be considered as follows:— (a) Routine Medical Inspections now include a sweep frequency test and those who fail are followed up with a threshold test. In the 5-6 years age group we wish to identify those children suffering from catarrhal deafness, a condition very common to this age group and a real handicap to the child, particularly if it is unsuspected. Those requiring treatment are then referred to local Ear, Nose and Throat Consultants, with the concurrence of the family doctor. Routine audiometry at the 10 and 14 years inspection would 178 pick up any new cases of defective hearing from whatever cause. Early cases of otosclerosis, the deafness which affects adults and for which treatment has been developed in the postwar years, may be detected at the school leavers inspection, and are indeed sought, if the family history is positive. Audiometry at this stage also provides a base line of adult hearing for each individual, which, in this age of noise induced deafness, could prove a useful reference later. From time to time also, a meeting of the ascertainment team is called at the Audiology Clinic to discuss and make recommendations regarding referrals for wider investigations, school placement and extra educational provision. Children discussed at these meetings are often additionally handicapped either in themselves or in their environment. We also have the assistance of the Welfare Officers for the Deaf and the Special Services Officer for the Handicapped, in providing vocational guidance for the hearing handicapped child, (b) The Unit for Hearing Impaired Children has been included in a study on the extent to which it is practicable to educate severely deaf children in ordinary schools. This is being conducted for the London Institute of Education by Dr. Dale, Senior Lecturer in teaching of the deaf and partially hearing children, and supported by the Ewing Foundation. (Three other Boroughs are included in the survey and also children of a similar degree of deafness already placed in schools for the deaf.) The study provides a consultation service and a six-monthly record of speech and language development, educational and social progress. These tests are conducted by Dr. Dale and his research associates. There are twenty-two children in the Unit—the majority are severely deaf. One who has only moderate hearing loss is now almost full-time in the normally hearing class and returns to the Unit only for speech and language. There is also one partially hearing child in the Infants who has some speech training help from the Unit. Also under the heading "Audiology Service" I am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following report on the service for the hearing impaired child: — The Borough Unit for hearing impaired children was transferred to new, specially equipped premises at the Darrick Wood Schools in September 1969. By December 1969 the number of children there was as follows: — Nursery Group 8 Infant Class 6 Junior Class 8 179 These children are integrated as much as is practicable with hearing classes in the Infant and Junior Schools, and the two heads and their staffs have worked hard for the success of the Unit. No children over the age of 8 attend the Unit as these have previously been placed elsewhere. Thirteen children attend day schools for the deaf or partially hearing units outside the Borough. Seven attend residential schools for the deaf. The Borough's Peripatetic Service arranges for special help for 8 pre-school children, for 40 children with hearing aids at ordinary schools and for 44 children with hearing defects who do not wear hearing aids but who attend ordinary schools. The two Peripatetic Teachers of the Deaf have weekly sessions at home, in schools or at the Audiology Clinic with 20 children. They also attend fortnightly clinics taken by the Medical Officers in the Department with special responsibility for the deaf child for assessing new cases and reviewing old ones. This has been very helpful for co-ordinating the medical and educational aspects of the work. Meetings to consider particular problem cases have continued, attended by Dr. Dale of London University, the Educational Psychologists and other members of the Authority's staff. The Connevans group hearing aids at the Partially Hearing Unit have been taken into use. The Peripatetic Teachers have acquired among other items a Phillips' Russaid radio-microphone for use in the Langley Park Boys' School by a severely deaf 11year-old and his teachers. This new development in communication for hearing impaired school children is proving successful, and it is hoped to acquire more Russaids in the future. The practice of purchasing individual commercial hearing aids on otologists' recommendations has continued, also the arrangements for maintaining these and National Health Service (Modresco) aids. Handicapped Pupils It is the duty of the local authority to ascertain those children in its area who, having attained the age of two years, may require special educational treatment. These children usually come to the attention of the School Health Service through the Health Visitors, the Chief Education Officer, Parents and Hospitals. The officially recognised types of handicaps are: Blind, Partially Sighted, Deaf, Partially Hearing, Physically Handicapped, Delicate, Maladjusted, Educationally Sub-Normal, Epileptic and Speech Defects. Once a child has been ascertained as handicapped surveillance is maintained and recommendations for special educational treatment are forwarded to the Chief Education Officer for his 180 consideration and action. Special appointments are arranged for the Medical Officer to see these children, either at a Clinic or at the child's home, depending usually on the degree or type of handicap. Before a recommendation is made the advice of the various appropriate Hospital Consultants, with whom there is a very close liaison, is sought. During the year 81 boys and 27 girls were assessed as needing special educational treatment at special schools. Details of the various handicaps are included in the following table. The Borough is fortunate in possessing three day schools for educationally sub-normal pupils, and a report on each of these schools will be found later in this Report. 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 quite a number of different conditions. Obtaining the best possible arrangements for the education of the handicapped child requires time and patience, but the effort involved is fully justified by the results obtained. It should be stressed that the assessment of a handicapped child does not consist merely in appraising the defects. The assets—what the child can do, the total environment, etc., must not be forgotten. Further, there is a new approach to this often purely clinical examination, namely an attempt to see the child in the home and school environment because a handicap or defect can have a different meaning to a doctor, a parent, or a child. 181 RETURN OF HANDICAPPED CHILDREN PART I New assessments and placements During the calendar year ended 31st December, 1969:— Blind (1) P.S. (2) Deaf (3) Pt.Hg. (4) P.H. (5) Del. (6) Mal. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) A How many handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? boys - - 1 4 6 10 13 47 - - 81 girls — — — I 1 2 3 20 — — 27 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 — — — — 5 5 8 18 - — 36 girls — — — 1 1 2 1 11 — — 16 (ii) of those assessed prior to January, 1969 boys — 1 1 1 1 2 7 — 13 girls — — — — 2 3 1 5 — — 11 (iii) TOTAL newly placed—B (i) and (ii) boys — - 1 1 6 6 10 25 - — 49 girls — — — 1 3 5 2 16 — — 27 PART II Children found unsuitable for education at school During the calendar year ended 31st December, 1969:— (i) How many children were the subject of new decisions recorded under Section 57 of the Education Act, 1944? 18 (ii) How many reviews were carried out under the provisions of Section 57A of the Education Act, 1944? 2 (iii) How many decisions were cancelled under Section 57A(2) of the Education Act, 1944? — 182 PART III Handicapped pupils awaiting places in special schools or receiving education in special schools : independent schools : in special classes and units : under Section 56 of The Education Act, 1944; and boarded in homes. As at 22nd January, 1970:— Blind (1) P.S. (2) Deaf (3) Pt. Hg. (4) P.H. (5) Del. (6) Mal. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) A How many children from the Authority's area were awaiting places in special schools other than hospital special schools? (1) Under 5 years of age (i) waiting before 1st January, 1969:— (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - - - (ii) newly assessed since 1st January, 1969:— (a) day places boys - — — 3 1 — - — — — 4 girls - - - - - - - - - - - (b) boarding places boys — — 1 — — — — 1 — — 2 girls - - - - - - 1 - - - 1 (i) waiting before 1st January, 1969:- (a) whose parents had refused consent to their admission to a special school (a) day places - - - - - - - - - - - (b) boarding places boys - - - - - 2 - - - - 2 girls - - - - - - - - - - - (a) day places boys - - - - - - - 5 - - 5 (2) Aged 5 years and over (b) others girls - - - - - - - 5 - - 5 (b) boarding places boys - - - - - - - 1 - - 1 girls - - - - - - - - - - - (ii) newly assessed since 1st January, 1969:- (a) whose parents refused consent to their admission to a special school (a) day places - - - - - - - - - - (b) boarding places boys - - - - - 2 - - - - 2 girls - - - - - - - - - - - (a) day places boys - - — — - 1 — 24 — — 25 (b) others girls — - - 1 — - — 8 — — 9 (b) boarding places boys - - — - — 1 4 - — — 5 girls - - - - - - 1 - - - 1 (3) Total number of children awaiting admission to special schools other than hospital special schools—total of (1) and (2) above (a) day places boys — — — 3 1 1 — 29 — - 34 girls — — - 1 - — — 13 — — 14 (b) boarding places boys — — 1 — — 5 4 2 — — 12 girls - - - - - - 2 - - - 2 183 Handicapped pupils awaiting places in special schools or receiving education in special schools : independent schools: in special classes and units: under Section 56 of The Education Act, 1944; and boarded in homes. As at 22nd January, 1970:— Blind (1) P.S. (2) Def (3) Pt. Hg. (4) P.H. (5) Del. (6) Mai. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) B (i) Maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) regardless by what authority they are maintained day boys — 4 5 6 14 7 2 168 - - 206 girls - 4 1 5 8 5 - 128 - - 151 boarding boys 1 - 1 — 6 1 3 10 — — 22 girls - - - — 6 7 — 1 - — 14 (ii) Non-maintained special schools How many pupils (other than hospital special from the schools and special units and Authority's area classes not forming part of a were on the special school) wherever situated registers of:— day boys — - - - 4 - — — — — 4 girls 1 - — - 2 — — — — — 3 boarding boys 2 1 6 — 4 8 6 6 - — 33 girls 4 — 1 — 3 3 1 3 — — 15 (iii) Independent schools under arrangements made by the authority day boys — — — 4 1 — 2 1 1 — 9 girls - - - 1 - - - - - - 1 boarding boys - — 2 — 2 — 28 1 - - 33 girls - - 4 — 1 — 6 4 — — 15 (iv) Special classes and units not forming part of a special school. boys - — . - 8 — - — — — - 8 girls — — — 9 — — — — — — 9 C How many children from the Authority's area were boarded in homes and not already included in B above. boys - - - - - - - - - - - girls - - - - - - - - - - - D 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 boys - - - - - - - - - - - girls - - - - - - - - - - - (ii) in other groups, e.g. units for spastics, etc. boys — — — — 12 — — — — — 12 girls — — — — 7 — - - — — 7 (iii) at home boys — — — — 2 — — 1 - — 3 girls — — — — 2 1 — 2 — — 5 Total number of handicapped children requiring places in special schools; receiving education in special schools; independent schools; special classes and units; under Section 56 of the Education Act 1944; and boarded in Homes. Totals of A(3); B(i) to (iv); C and D(i) to (iii) boys 3 5 15 21 46 22 45 218 1 — 376 girls 5 4 6 16 29 16 9 151 - 236 184 Cheyne Hospital, West Wickham I am grateful to Dr. J. Richings, Paediatrician, Farnborough Hospital, for the following report: — Cheyne Hospital, West Wickham, is a long-stay Children's Hospital of sixty beds. The majority of cases admitted are severely disabled children who require nursing care, intensive physiotherapy and education. Cases of Spina Bifida and Cerebral Palsy make up the majority of children. Children are admitted up to the age of ten years. In the past year four children were discharged home or transferred to suitable residential hospital schools. Miss Miles became the new head of the school in September, 1969: the children have all enjoyed her lively approach to education and have benefited accordingly. Cheyne now has the services of a part-time Medical Social Worker. This has proved very helpful to both parents and staff. The Phoenix Centre for Children with Cerebral Palsy I am grateful to Dr. C. H. Upjohn, Paediatrician, Farnborough Hospital, for the following report:— The Phoenix centre was opened at Farnborough Hospital in April, 1959. Initially it was proposed to take 19 children of school age, but over the years the number has gradually increased and children now attend as soon as it is apparent that they are suffering from cerebral palsy. The youngest begin attending before the age of 1 year (youngest admission was a 5 months) for physiotherapy and advice regarding management at home by the parents. During the past year 9 children of school age have attended daily during the school term and there are 10 children between 3 and 5 years of age who attend the infants' group and who have their own teacher allotted to them. These children also have all the medical treatment required at these attendances. There are 12 children, under 3 years of age, who attend for medical treatment as required, and in this age group there are 5 hemiplegic children. Altogether more than 30 children are attending the unit. The staff includes: one consultant paediatrician, and one clinical assistant, two physiotherapists (one full-time and one parttime), two full-time and one part-time school teachers from the borough, a full-time occupational therapist, a part-time speech therapist, one nursing warden, one nursing auxiliary; cadet nurses are appointed regularly to the unit to help with care of the children and to receive instructions in the care of handicapped children; there are also Norland Nurses who attend during their training period at Farnborough Hospital. In addition consultants from other specialities attend, including the orthopaedic consultant (who pays regular visits), the E.N.T. surgeon and the dental surgeon; all children are seen by Mr. Owen, the ophthalmic specialist. 185 SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington Twenty children left during the year and 21 were admitted— the school roll was maintained at 129. The medical work continued as before with one session a week devoted to "special" medicals and total reassessments of the children. Discussions with the teaching staff and other agencies have continued in the spirit of frankness and mutual confidence. The child and his family derived clear benefit from such multi disciplinary approach. Two teachers having left. Miss Davies and Mr. Hoey filled the resulting vacancies. The advent of the mini-bus described in the closing paragraph of the last Report proved to be a milestone in the School's outside activities. Goddington combined with Grovelands to borrow each other's buses so that two classes could visit places of interest at any one time. Swimming remains a popular activity throughout the year. Many children attend Swanley Baths in the evenings, together with three Goddington teachers who provide lessons and supervision. The joint swimming pool project with Blenheim Junior School is very near completion and it should be in use during the early part of the Summer Term, 1970. The Parents and Friends of Goddington School have raised nearly £2.400 towards the cost of the pool—a truly magnificent effort from a small body of people. The senior boys and the senior girls have extended their activities considerably. Their two classrooms have been adapted and furnished so that the children now regard themselves as young adults. Easy chairs, carpets, record players, etc., have been installed. This was possible through the generosity of the Rotary Club of Orpington and the Round Table Clubs of Orpington and Farnborough. Thirty-two boys and girls have been in employment since the School opened in 1964. The children maintained a close contact with the School and some come to spend a day at their old School. They are all well integrated socially and lead a successful life. Just as an ordinary school prepares a child for adult life, the Special School has this task made more difficult through intellectual retardation, frequently complicated by social and emotional problems of the children. In spite of the difficulties, in 1969 as in the year before, Goddington has achieved its targets and objectives. 186 St. Nicholas School, West Wickham Number of children on roll:— Boys 64 Girls 47 Total 111 Staff: Headmaster Deputy Head 9 Full-time Assistant Teachers 1 Part-time Teacher for Housecraft 3 Housemothers (1 full-time and 2 part-time) with responsibility for welfare and social training of the children. A routine annual inspection of every child in the school is arranged with an appointment system so that parents can be present. There are many secondary disabilities or handicaps. Number of children receiving treatment for: Eye defects 30 Heart murmurs 6 Minor hearing defects 3 Neurological disease 2 Brain damage 5 Mongols 5 Hydrocephalus 1 Autistic 5 Under treatment for psychological, emotional and behaviour problems 10 Controlled epilepsy or petitmal 6 Children from broken homes, problem families, poor homes or socially deprived 13 Immigrant children unable to keep pace in ordinary school 6 Physical deformities 3 Asthma and other chest complaints 3 All the children have learning difficulties but not all because of the above secondary disabilities and they all work at their own level and speed. The aim is for the majority of school leavers to be placed in employment suited to their limited capacity where they can cope with a reasonable degree of success. There were 10 school leavers during the year who obtained jobs in industry, super-markets, commerce and outdoor work under supervision. The Speech Therapist gives all new entrants an initial 187 ing and has weekly sessions with all those who have speech difficulties. Physical education, swimming, woodwork and pottery are popular activities, and the cover for the heated outdoor swimming pool is in the process of being built which will enable swimming to take place all the year round. "Old" boys and girls of the school meet the two senior classes once a month at the St. Nicholas Club held in the school during an evening, and a link is maintained with the school, staff and friends for as long as they would like to belong to the Club. Grovelands School, St. Paul's Cray There are now 121 children on roll including thirty-two who were admitted during the year. Of those who left, nine entered employment, one is unemployed and no information available about one; one child was transferred to a Training Centre and another went to a Residential School. Eight left the area and five went back to normal schools. The 121 children at Grovelands cover a wide range of ability. I.Q.s are between 46 and 80 with ages of 7-16 years. Many children have multiple handicaps including cerebral palsy, epilepsy, poor sight, various physical handicaps and a high proportion have difficulty with speech. The Welfare Assistants have divided their time between helping in Class I, carrying out speech practice as instructed by the Speech Therapists and contributing to the general physical well-being of the children. This included assistance on outings in the minibus. They also arranged hair-dressing sessions for the senior girls. There have been no staff changes this year which has done much to maintain continuity of lessons. Drama has been less practical than usual but there has been considerable interest in Art. Pupils have visited exhibitions and taken part in outings for painting and sketching subjects of their choice. The corridors in school have been enlivened by some of the results. Independence has been encouraged by allowing pupils to find their own way to and from school, and going shopping in Sidcup and Orpington to purchase the ingredients for cookery classes with the purpose of giving some idea of home budgeting. One class combined cookery with geography by preparing and eating a traditional dish from the area being studied. This was a great success. Boys and girls find their way around the district with the aid of maps, time-tables and telephones, training which will be useful to them when they leave school. A clocking in and out scheme has been started for senior 188 pupils and also the cultivation of a small area of the grounds. A local nursery was visited to purchase plants and there has been a good display of bulbs throughout the school. Many of the children come from poor backgrounds with lack of stimulation and interest from their parents, and several are in care. Attempts are made to impress upon parents the extra need for the retarded child to be encouraged to use speech, and to gain confidence and ability by doing as much as possible for themselves. The active P.T.A. have continued their activities by making and helping to equip a library area which is being well used. Newspapers are delivered daily and read and discussed according to the ability of the individual child. The usual visits by minibus included several trips to London, local places of interest and factories, etc., with the purpose of future employment in mind. There have been social evenings, a Concert, Sports Meetings and the usual seasonal activities. The boys continue to produce attractive and useful pieces of woodwork and have also been showing interest in book-binding and basket work. Medical examinations, vision and hearing tests, dental, speech and hospital treatments have taken place as usual. The whole staff combine to see that each child receives as much help as possible, socially as well as academically. Their pupils have a greater difficulty than those in ordinary schools in settling successfully in an increasingly competitive outside world. Employment of Young Children 319 children were examined by the Medical Officers in the Department during the year. Certificates were issued in 317 cases, and in only two cases were the certificates not issued. Boys Girls Delivery of newspapers and milk, etc. 193 52 Shop Assistant 14 30 Waitress — 3 Entertainment 2 4 Clerk — 1 Library Assistant 2 6 Hairdresser's Assistant — 3 Gardener 1 1 Meals on Wheels — 1 Warehouseman's Assistant 1 — Garage help 3 — 216 101 189 Other Medical Examinations The following examinations were carried out by Medical Officers during the year:—- Training College candidates 398 Teachers (including two for other authorities) 78 Total 476 1 am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following reports on Physical Education, and the School Milk Meals Services:— Physical Education During the last five years there has been a steady programme of installing trampolines in all secondary schools. By 1971, all secondary schools will be in possession of this valuable piece of equipment. It is the first piece of apparatus other than the water in a swimming bath which allows a big overweight person to work equally as well as the more athletically built youngster. In the primary schools a similar programme of gradual supply of indoor climbing equipment has resulted in a quarter of the junior schools possessing this apparatus. This equipment enables these schools to carry on with adventurous gymnastic lessons indoors throughout the inclement season. From the point of cost efficiency it is a much better proposition than the outdoor equipment which lies unused because of rain and cold for long periods of the year. Many of the junior schools have considered the ability to swim as so important that they have collected fairly large sums of money to build their own learner swimming pools. About a quarter of the junior schools already possess their own pool and as a result they are successful in teaching almost all school leavers to swim 20 yards or more. Children at schools without learner pools receive ten swimming lessons at the public baths in their final junior year. Consideration is being given to supplying all-weather training surfaces instead of the more traditional grass areas. These fine "granite chippings" surfaces are invaluable for games that are played throughout the two hundred days of a school year. A single grass pitch can be used for seven games a week and even this cannot be allowed in wet weather whereas an all-weather surface can be used twelve hours a day throughout the year without any deterioration. When combined with floodlighting, these future pitches could be a boon to the young adults of Bromley. One such pitch near Kennington Oval has served the community there for over thirty years. 190 A great deal of the physical education programme is related to playing games with other schools outside school hours. This involves the teaching staiT in many hours of after-school duties training the many squads from whom the teams are selected to play at weekends, when the master or mistress again will be involved in refereeing the game. In addition, many other activities are being correlated with physical education. These include the Duke of Edinburgh Award Scheme and such activities as camping, canoeing, rock climbing and orienteering. The detailed preparation for expeditions involving these subjects are onerous. The safety of young people taking part in these activities must always be a care, responsibly borne by the teacher and the authority encouraging this work. Members of the teaching staff have been encouraged to take the Mountain Leadership Certificate, which means that they have prepared themselves in a most thorough fashion, and have been carefully assessed as persons capable of dealing effectively and safely with hazards. Last year four teachers qualified for this award. School Meals and Milk Services The average daily number of meals served during 1969 was 35,300 or 6,700,000 in the year. A return for a day in October, 1969, showed that the daily number of pupils (all of primary school age) drinking one-third of a pint of milk was 23,306 in the maintained schools and 1,665 in non-maintained schools— equal to 1,040 gallons daily. Canteens which came fully into use included Langley Park Boys who are now producing upwards of 600 meals per day, and Kentwood Boys which moved to the former Beckenham and Penge Grammar School premises in the autumn of 1969. Convenience foods were introduced here for the first time at a Borough School, and early impressions would appear to indicate general approval of this type of meal. During 1969 the School Meals Service was asked to provide approximately twenty meals daily to Stembridge Hall, and eighteen daily to the Work Centre at Beckenham. The Health Visitor in the School Health Service 1,698 School Medical Sessions (including B.C.G. sessions) were carried out during 1969. These were prepared, and in the Infant and Junior Schools, attended by Health Visitors. 29,954 individual school children have been examined at hygiene inspections, necessitating home visits to the parents of 112 to advise them of treatment for infested heads, a decline of 65 from 1968. 191 308 children were treated for minor ailments involving 1,397 treatments of which 835 were for conditions of the skin. A series of Health Education talks have been given in five senior schools, and the Health Visitor is often asked to contribute one or two in a series of sessions in Courses for school leavers. Visits to some of the Clinics have also been arranged for school leavers and the services explained. 192 DETAILS OF CLINICS CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) OPHTHALMIC: School Clinic, The Willows, Red Hill, Chislehurst, Monday—a.m. School House, 55 Chislehurst Road, Orpington. Monday—All day Mickleham Road Clinic, St. Paul's Cray. Monday—a.m. North Clinic, Station Road, Bromley. Monday—a.m. Wednesday—a.m. Friday—p.m. Saturday—a.m. (Alternate) School Clinic, Town Hall, Beckenham. Wednesday—p.m. School Clinic, Oakfield Road, Penge. Friday—a.m. ORTHOPTIC: North Clinic, Station Road, Bromley. Monday—p.m. Tuesday—All day School Clinic, The Willows, Red Hill, Chislehurst. Thursday—a.m. *ORTHOPAEDIC: North Clinic, Station Road, Bromley. Friday—p.m. (Monthly) *PHYSIOTHERAPY: School Clinic, Town Hall, Beckenham. Monday—p.m. Thursday—a.m. North Clinic, Station Road, Bromley. Tuesday—a.m. Friday—a.m. *Children living in Beckenham and Bromley are referred to these Clinics. 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. 193 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) SPEECH: Assemblies of God Church Rooms, Masons Hill, Bromley. Monday—All day Wednesday „ „ Thursday „ „ Tuesday—p.m. Friday—p.m. School Clinic, Town Hall, Beckenham. Monday—All day Wednesday „ „ Friday „ „ Tuesday—a.m. The Clinic, Kimmeridge Road, Mottingham, S.E.9. Tuesday—All day Thursday—a.m. Hawes Down School Clinic, Hawes Lane, West Wickham. Tuesday—p.m. Wednesday—p.m. School Clinic, The Willows, Red Hill, Chislehurst. Monday—p.m. Wednesday—a.m. *CHILD GUIDANCE: The Willows, Red Hill, Chislehurst. Tuesday—All day 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 Clinic, The Willows, Red Hill, Chislehurst. Monday—All day Wednesday „ „ School House, 55 Chislehurst Road, Orpington. Monday—All day Tuesday „ „ Wednesday „ „ Thursday „ „ Friday „ „ Mickleham Road, St. Paul's Cray. Monday—All day Tuesday „ „ Wednesday „ „ Thursday „ „ Friday „ „ 194 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) Kimmeridge Road, Mottingham. Tuesday—All day Thursday „ „ Friday „ „ North Clinic, Station Road, Bromley. Monday—All day Tuesday „ „ Wednesday ,, „ Thursday „ „ Friday „ „ South Clinic, Princes Plain, Bromley. Monday—All day Tuesday „ „ Wednesday „ „ Thursday „ „ The Pavilion, Recreation Ground, Church Road, Biggin Hill. Friday—All day School Clinic, Town Hall, Beckenham. Tuesday—All day Wednesday „ „ Thursday „ „ Hawes Down Clinic, Hawes Lane, West Wickham. Tuesday—a.m. Wednesday—All day Thursday „ „ School Clinic, Oakfield Road, Penge. Monday—All day Tuesday „ „ Wednesday—a.m. Thursday—p.m. Friday—a.m.