LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1970 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 Be021 I LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1970 L. R. L. EDWARDS. M.D. (Load.). 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 122 for Index to School Health Service Report. Page A Accidents—Street 22 Ambulance Service 40 Animal Boarding Establishments 114 Animal Keepers 114 Animals—Miscellaneous 113 Animals—Performing 113 Animals—Pets 114 Atmospheric Pollution 103 B Bacteriological Examinations 88 Births 17, 19 C Cervical Cytology 29 Child Minders 28 Chiropody 30 Clean Air Act—see under Atmospheric Pollution Common Lodging Houses 100 Cytology—see under Cervical Cytology D Day Nurseries 28 Deaf Children 29 Deaths 18-22 Dental Services 43 Diptheria 50 Diseases of Animals 112 Disinfections 103 Disinfestation 103 Drainage and Sewerage 101 Dysentery 50 Page E Environmental Health Services 67 F Factories Act 110 Family Planning 29 Food and Drugs Act 92 Food and Drugs Act—Sampling 74 Food Complaints 90 Food Poisoning 50 Food Hygiene Regulations 92 Fowl Pest 112 Fox Control 107 H Health and Welfare Committee 7 Health Education 37 Health Visiting 33 Home Help Service 36 Home Nursing 32 Home Safety 39 Housing and Slum Clearance 93 Housing Inspections 99 Housing—Public Health Acts 97 I Ice Cream Sampling 87 Immigrants— Medical Arrangements 34 Infant Mortality 18,22 Infections and Other Diseases 47 Infective Jaundice 51 Introduction 11 L Leptospirosis 51 5 IN DEX—(continued) Page M Maternal and Child Health 27 Maternal Mortality 18 Measles 51 Meat Inspection 89 Meningitis 51 Mental Health Services 55 Meteorological Observations 23 Midwifery 31 Milk Sampling 87 Milk (Special Designation) Regulations 93 Mortuaries Ill Moveable Dwellings 100 N National Assistance Acts 34 Nursing Homes 28 O Offices, Shops and Railway Premises Act 107 Ophthalmia Neonatorium 51 Outwork Ill P Paratyphoid Fever 53 Personal Health Services 25 Pigeon Destruction 107 Poliomyelitis 51 Population 19 R Rabies 113 Rag Flock 93 Recuperative Care 29 Rehousing 97 Page Rent Act 1957 98 Riding Establishments 113 Rodent Control 106 S Scarlet Fever 51 Smallpox 52 Smoke Control—see under Atmospheric Pollution Staff 8 Staff—Medical Examinations 35 Statistics—Environmental 115 Statistics—Vital 17 Statutory Notices 117 Swimming Baths Ill Swine—Movement of 112 T Tetanus 52 Tuberculosis 52 Typhoid Fever 53 U Unmarried Mother—Care of 27 Unsound Food 86 V Vaccination and Immunisation 30 Venereal Diseases 36 Vital Statistics 17 W Wasps 103 Water Supply 118 Welfare Foods 27 Welfare Services 63 Whooping Cough 53 ' 7 HEALTH, WELFARE AND CHILDREN COMMITTEE (as at 31st December, 1970) Chairman: M. B. Kenward, B.D.S., L.D.S., R.C.S. Vice-Chairman: Mrs. S. M. Stead The Mayor: Alderman Miss Bertha H. James, J.P. Councillors: B. D. F. Bennett M. I. Blazey D. J. W. Eves M. E. Forster C. R. E. Kember S. J. C. Randall J. P. Sheridan, A.M.I.E.I. E. C. H. Smith J. F. Spellar R. W. Spon-Smith W. H. Stephenson J. E. Swatton A. M. Wilkinson 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. Stillwell, 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, 1970) 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.) J. C. Van Essen, m.b., ch.b. D. J. Thornton, m.b., ch.b. (Mrs.) J. B. Howitt, m.b., b.s., m.r.c.s., l.r.c.p. 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), 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 (one part-time). Orthoptist: Mrs. D. A. Ivil, d.b.o. (Part-time). Ophthalmologists: 4 (Sessional). 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. M. W. Teare, s.r.n. 41 Home Nurses. Superintendent Health Visitor: Miss B. N. Chandler, s.r.n., s.C.m., h.v.cert., Dip. Soc. Studies(Lond). Deputy Superintendent Health Visitor: Mrs. L. A. Hamilton, s.r.n., C.m.b. part 1, H.v.cert. Group Adviser: Miss C. A. Paxton, s.r.n., s.c.m., H.v.cert. 42 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: Mrs. E. F. Thompson. Deputy Senior Home Help Organiser: Miss A Paul. 5 Area Home Help Organisers. 1 Cytology Nurse (Sessional). 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. 16 Public Health Inspectors. 3 Technical Assistants. 5 Trainee Public Health Inspectors, 1 Senior Rodent Operator. 8 Rodent Operators, 3 Disinfector/Handymen, 2 Mortuary Keepers. WELFARE SERVICES STAFF: Acting Chief Welfare Officer: J. R. Gill, d.m.a., a.i.s.w. Principal Social Welfare Officer: Mrs. P. A. Angel. 3 Senior Social Welfare Officers. 1 Senior Social Welfare Officer for the Blind, 1 Mobility Instructor for the Blind, 1 Special Social Welfare Officer for the Deaf, 15 Social Welfare Officers (4 Part-time), 5 Occupations Officers, 1 Industrial Work Organiser, 1 Fieldwork Teacher for work with the Deaf, 1 Work Centre Supervisor, 1 Family Case Worker, 3 Welfare Assistants, 5 Trainee Welfare Assistants. Staff at 9 Residential Homes: 8 Matrons. 17 Assistant Matrons, 2 Relief Assistant Matrons, 1 Warden, 7 Clerks. Chief Chiropodist: A. S. Jones, s.r.ch., m.ch.s., m.r.s.h. 1 Senior Chiropodist. 9 Chiropodists (Sessional). 10 MENTAL HEALTH STAFF: Principal Mental Welfare Officer: H. J. Vagg, m.r.s.h., m.j.s.w., m.b.a.s.w. Deputy Principal Mental Welfare Officer: A. G. Ball, s.r.n., n.c.b.t.a.. c.s.w. 3 Senior Mental Welfare Officers, 14 Mental Welfare Officers, 3 Trainee Mental Wefare Assistants. Senior Training Centre: 1 Manager, 1 Deputy Manager, 4 Instructors, 1 Clerk (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, 1 Trainee, 1 Clerk (part-time), 1 Physiotherapist (parttime). 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 A dministration: Senior Administrative Assistant: W. Hancock. 2 Administrative Assistants, 1 Secretary, 2 Clerical Assistants, 3 Clerks, 3 Shorthand Typists, 2 Enquiry Clerks/Receptionists. 1 Driver /Storekeeper. Environmental Health: Senior Administrative Officer: B. Adams. 2 Administrative Assistants, 3 Clerical Assistants, 3 Clerks, 2 Shorthand Typists. Maternal and Child Health : Senior Administrative Assistant: G. R. L. Smith. 2 Administrative Assistants, 4 Clerical Assistants, 3 Clerks. School Health: Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant, 3 Clerical Assistants, 7 Clerks, 1 Shorthand Typist. Mental Health: Senior Administrative Assistant: C. J. Moore. 2 Clerical Assistants, 1 Clerk, 2 Shorthand Typists. Welfare: Senior Administrative Assistant: J. W. Meeks. 4 Administrative Assistants, 4 Clerical Assistants, 5 Clerks. I Shorthand Typist, 3 Clerks (Residential Homes). A rea Offices and Clinics: 7 Clerical Assistants, 6 Clerks (2 part-time), 3 Clerk/Typists. 26 Clinic Clerks (24 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 1970 on the services administered by the Health and Welfare Department of the London Borough of Bromley. The Local Authority Social Services Act, 1970, will lead to the creation on the 1st April, 1971, of a Social Services Department, and as a consequence a separate Health Department. The new Department will deal in the main with the activities of the former Children's Services, Welfare Services, Mental Health Services, Home Help Service, Recuperative Care Service and T.B. After-Care Service, previously provided by the Health and Welfare and Children's Departments. As one of the outstanding achievements of the Health and Welfare Department has been the development of the Mental Health Services of the Borough, it is appropriate that the final complete Report of this Department should include a review of the expansion of this service from 1st April, 1965, to 31st December, 1970. The Report speaks for itself. I would only make two comments; first, that when in April 1971 the two year old purpose built training centre, Woodbrook, passes to the control of the Education Committee and the other establishments and services to the control of the Social Services Committee, the leeway in these services inevitably inherited from former Authorities will have been made up and a firm base established for a more sophisticated and broader front advance of these services in the future; second, in the further reorganisation already appearing on the horizon, and in the interim period, the Health Department will try to maintain the essentially twin character of Health and Social Services which had developed primarily as a consequence of the wise inauguration in 1965 of a combined Department. This now becomes even more necessary for the practical implementation of such statutory measures as the Chronically Sick and Disabled Persons Act, 1970, and similar measures must depend on proper communications and collaboration between your Health Department and the new Social Services Department. Statistics Though the birth rate was 0.1 higher than the previous year it is still below that for Greater London and England and Wales and the number of live births again fell. There was a disturbing rise in the number of still births and equally disturbing to note that two of these were associated with domiciliary confinements. The table setting out Deaths from Cancer over a five year 12 period indicates a continuing reduction in males of deaths from cancer of the lung not matched by the increase in deaths in females for the same cause; overall in the past 3 years there has been a decrease in total deaths from this disease. Over the same five year period there are no significant increases or decreases in deaths from other causes of cancer for either sex. Centres for regional research and treatment of all forms of cancer have been recommended at various national Conferences and these are likely to provide a significant advance in national efforts to eradicate cancer by co ordinating all research into earlier diagnosis and more effective surgery. Environmental Health As 1970 is European Conservation Year and has been marked by the setting up of a Department of Environment, it is of interest to look at those services in the Borough provided by the Health Department most obviously concerned with the control of pollution. The relevant Report shows that some 7,320 of the 37,583 acres of the Borough and approximately 38,750 of its premises are covered by Smoke Control Orders, representing 20% of the total area and approximately 35% of the premises. The Authority has a "rolling" programme of smoke control and, in addition, the Health Department monitors closely the concentration in the atmosphere of sulphur dioxide, collaborating with the Ministry of Technology in this research. Less spectacular is the control of industrial chimney height and alteration of existing plants such as oil fired boilers, and the advice given where practicable for diminishing nuisance from offensive fumes or dust. The storage and use of radioactive materials is licensed by the Ministry of Housing and Local Government. Previous reports have indicated the limitations of action under the Noise Abatement Act and the recommendations that have been made to improve this Act. However, until the research which is proceeding to establish acceptable noise levels for different neighbourhoods has been completed, all Health Departments are restricted in the practical advice that can be tendered to the public. Gross cases of infringement are speedily investigated and most industrial users are co-operative. Maternal and Child Health The Report indicates the increasing number of registered private day nurseries, child minders and play groups, and the volume of supervision that is needed. This service will be transferred to the new Social Services Department. While the response to "open" cervical cytology clinics has been 13 disappointing, more women returned for routine re-examination and the results for positive tests and minor infections related to the total number of tests show the value of this screening. Two measures designed to prevent a congenital disability were introduced in 1970—the Guthrie test of 10 day old babies to detect phenylketonuria, and the Rubella Vaccination Scheme. Integration of the service with general practices and hospitals continued in the midwifery and home nursing sections to supplement the progress already achieved in the Health Visiting Section. With the exception of Biggin Hill, an attachment scheme for all midwives has been completed and a similar scheme for home nurses will be developed next year. Infectious and Other Diseases Though whooping cough continues as a milder disease possibly from the effects of immunisation, its incidence continues to fluctuate. Measles on the other hand has lost its biannual epidemicity and now has a periodicity similar to scarlet fever. The beneficial effects of measles immunisation are now being confirmed. In conclusion, I wish to thank the Heads of Sections and my staff for their continued support throughout the year. In particular and in advance I should like to pay tribute to the efficiency and loyalty of staff who following appointment will be working in 1971 in the Social Services Department in the Sections where since 1965 they have given such valuable service to the Borough. Throughout 1970, co-operation with Health Services outside the Authority through liaison with Hospital Management Officers, Medical and Dental Practitioners and Administrative Officers of the Regional Hospital Board, Executive Council and Local Medical Committee has been greatly appreciated. The professional staff at all times have welcomed the valuable help of members of Voluntary Organisations, in particular the assistance of the staff of the Council of Social Service. Finally, I would like to thank for their advice and support the Members of the Council and the Chairman and Members of the Health Welfare and Children Committee, particularly those Members who have known the Department since its formal inauguration in April 1965, and to promise them the same loyal support of the staff in the new Departments to be set up. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 17 VITAL AND OTHER STATISTICS Population (mid year 1970) 301,820 Area (acres) 37,583 Density of population (persons per acre) 8.03 Rateable Value as at 1.4.70 £17,235,000 Product of Id. Rate £70,000 Rate in pound 1970/1971 (Domestic) 12/6 Births: Live 4,368 Males Females Total Legitimate 2,053 2,028 4,081 Illegitimate 153 134 287 Crude birth rate per 1,000 estimated total population 14.5 Adjusted birth rate for comparison with other areas 14.6 (Area comparability factor for births = 1.01) Illegitimate live births = 7% of all live births Crude birth rate for Greater London 15.2 Birth rate for England and Wales 16.0 Stillbirths: Stillbirths 53 Males Females T otal Legitimate 22 23 45 Illegitimate 7 18 Stillbirth rate per 1,000 live and still births 12.0 Stillbirth rate for Greater London 12.0 Stillbirth rate for England and Wales 13.0 Total births (live and still) 4,421 Males Females T otal Legitimate 2,075 2,051 4,126 Illegitimate 160 135 295 Total of all live and stillbirths 2,235 2,186 4,421 18 Infant Mortality : Males Females T otal Legitimate 37 13 50 Illegitimate 2 3 5 Infant mortality rate per 1,000 total live births 13 Legitimate infant deaths per 1,000 legitimate live births 12 Illegitimate infant deaths per 1,000 illegitimate live births 17 Infant mortality rate for Greater London per 1,000 live births 17.8 Infant mortality rate for England and Wales 18 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 8 Neonatal mortality rate for Greater London 12.3 Neonatal mortality rate for England and Wales 12 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 6 Early neonatal mortality rate for Greater London 10.7 Early neonatal mortality rate for England and Wales 11 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 18 Perinatal mortality rate for Greater London 22.6 Perinatal mortality rate for England and Wales 23 Maternal Mortality: Maternal deaths (including abortions) Nil Maternal mortality rate for Greater London per 1,000 live and stillbirths 0.17 Deaths : Males Females T otal 1,544 1,638 3,182 Crude death rate per 1,000 estimated total population 10.5 Adjusted rate for comparison with other areas (Area comparability factor for deaths = .97) 10.2 Crude death rate for Greater London per 1,000 population 11.3 Death rate for England and Wales 11.7 Tuberculosis Death Rates: All forms (per 1,000 population) 0.03 Pulmonary (per 1,000 population) 0.023 Non-Pulmonary (per 1,000 population) 0.007 19 Cancer Death Rates: All forms (per 1,000 population) 2.2 Lung and Bronchus (per 1,000 population) 0.65 Other forms (per 1,000 population) 1.55 Population The Registrar-General's estimate of the population of the Borough, mid year 1970, was 301,820. This figure gives a density of 8.03 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 1,186. The figure for 1969 was 1,126. Births There were 4,368 live births allocated to the Borough during 1970, after adjustments for inward and outward transfers, this being a decrease of 16 on the figure for the previous year. Of the 4,368 live births, 2,206 were males and 2,162 were females. The crude birth rate for the Borough was 14.5 per 1,000 population, and the adjusted birth rate, for use when comparing with other areas was 14.6. The birth rate for 1970 was 0.1 higher than that recorded for 1969, but it is below the figures of 15.2 and 16.0 for Greater London and England and Wales respectively. In addition to the live births there were 53 stillbirths, representing a rate of 12 per thousand total births. This rate is comparable with that of 12 for Greater London and 13 for the country as a whole. The figure for the Borough for 1969 was 8 per 1,000 total births. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Males 2,053 153 2,206 22 7 29 Females 2,028 134 2,162 23 1 24 Totals 4,081 287 4,368 45 8 53 Birth Notifications A total of 4,457 births were notified as having occurred in the Borough. Of this number 3,987 were institutional and 470 domiciliary births. 53 stillbirths actually occurred in the area. 2 of these were from domiciliary confinements. Deaths 3,182 deaths were registered in 1970, giving a crude death rate of 10.5 per 1,000 population. This rate, when standardised by the comparability factor, gives a figure of 10.2 for comparison purposes. The rates for Greater London and England and Wales were 11.3 and 11.7 respectively. The following table shows cause of death as given in the Registrar-General's statistics. 20 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1970 (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 3 - 1 2 - - - - - - - - F 1 - 1 - - - - - - - - - 2. Tuberculosis of Respiratory System M 2 - - - - - - - - - 1 1 F 2 - - - - - - - 1 1 - - 3. Late Effects of Respiratory Tuberculosis M 3 — — — — — — — — 2 — 1 F - - - - - - - - - - - - 4. Other Tuberculosis M - - - - - - — - - - - - F 2 - - - - - - - - 1 - 1 5. Meningococcal Infection M 1 - - - - - - - - 1 - — F - - - - - - - - - - - - 6. Other Infective and Parasitic Diseases M 1 1 - - - - - - - - - - F 5 1 — 1 - - - - - 1 - 2 7. Malignant Neoplasm, Buccal Cavity Etc. M 2 - - - - - - - 1 - 1 - F 2 - - - - - - - - - 1 1 8. Malignant Neoplasm Oesophagus M 8 - - - - - - 1 1 2 1 3 F 12 - - - - - - - - - 3 9 9. Malignant Neoplasm, Stomach M 33 - - - - - - - 4 7 10 12 F 37 - - - - - - 1 2 5 7 22 10. Malignant Neoplasm, Intestine M 24 - - - - - - 3 7 6 8 F 63 — — - - - 1 2 5 9 19 27 11. Malignant Neoplasm, Larynx M 3 - - - - - - - 1 1 1 - F 1 - - - - - - - 1 - - - 12. Malignant Neoplasm, Lung, Bronchus M 151 - - - - - - 2 18 47 56 28 F 46 - - - - - - 1 6 16 10 13 13. Malignant Neoplasm, Breast M - - - - - - - - - - - - F 56 — — — — — 1 3 12 17 14 9 14. Malignant Neoplasm, Uterus F 22 - — — — - - 1 3 8 4 6 15. Malignant Neoplasm, Prostate M 23 — - — — — — — — 4 3 16 16. Leukaemia M F 10 3 — — — — — — 2 1 2 3 2 2 1 17. Other Malignant Neoplasms M 71 - - - 1 2 3 4 8 18 20 15 F 101 — — — — — 3 2 11 27 24 34 18. Benign and Unspecified Neoplasms M 5 - - - - — - - 1 1 2 1 F 4 - - - - 1 - - - - 1 2 19. Diabetes Mellltus M 8 - - - - - - - 1 3 1 3 F 11 — — — — — — 1 — — 4 6 20. Avitamlnoses, etc. M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - 21. Other Endocrine etc. Diseases M 3 - - - - - - - 1 - 2 - F 5 - - - - 1 - - - 1 — 3 22. Anaemias 5 - - - - - - - - - 1 4 F 6 - - — — — — — — - 1 5 23. Other Diseases of Blood, etc. M 1 - - - - - - - - - 1 — F — — — — — — — — — — — — 24. Mental Disorders M 7 - - - - - - - - - 1 5 F 2 — — - - - - - - - - 2 25. Meningitis M 1 - - - - - - - - - 1 - F - - - - - - - - - - - - 26. Multiple Sclerosis M 3 - - - - - - - - 3 - - F 3 - - — - - - - 1 — 2 - 21 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. Other Diseases of Nervous System M 9 - 1 - 1 1 1 - 1 - 1 3 F 12 — - — - - 2 — 3 1 3 3 28. Active Rheumatic Fever M 1 - - - - - - - - - 1 - F — — — — — — — — — — — — 29. Chronic Rheumatic Heart Disease M 14 - - - - - - 1 - 4 3 6 F 24 — — - - - - - 1 4 8 11 30. Hypertensive Disease M 20 - - - - - - - 3 4 10 3 F 21 — — — — — — — - 4 5 12 31. Ischaemic Heart Disease M 446 - - - - - - 9 44 108 133 152 F 336 - — — — — — 1 2 17 71 245 32. Other Forms of Heart Disease M 59 - - - - - - 1 1 9 14 34 F 85 - — — — — — — 1 2 8 74 33. Cerebrovascular Disease M 132 - - - - - - 2 7 22 36 65 F 238 — — — — — - 1 6 13 42 176 34. Other Diseases of Circulatory System M 74 - - - - 1 - - 4 11 24 34 F 102 — — — — — — 1 — 3 22 76 35. Influenza M 4 - - - - - - - - - 1 3 F 11 - - - - 1 - - - - 2 8 36. Pneumonia M 143 - 2 - - - 1 - - 3 31 106 F 208 — - ~ — — 1 — - 6 23 178 37. Bronchitis and Emphysema M 110 - - - - - - 1 1 20 33 55 F 51 1 - - - - - - 1 2 11 36 38. Asthma M 2 - - - - - - 1 - 1 - - F 10 — — — — — — 1 1 2 4 2 39. Other Diseases of Respiratory System M 27 1 6 - - - - 2 - 5 8 5 F 21 - 2 3 - - - - 1 2 5 8 40. Peptic Ulcer M 6 - - - - - - - - - 3 3 F 6 — — — — — - — 1 1 1 3 41. Appendicitis M 1 - - - - - - - 1 - - - F 2 — — — — — — — - — 2 — 42. Intestinal Obstruction and Hernia M 7 1 1 - - - - - - - 1 4 F 5 — - - - - - - - - 4 1 43. Cirrhosis of Liver M 4 - - - - - - - - 1 1 2 F 1 - - - - - 1 - - - - - 44. Other Diseases of Digestive System M 14 - - - - - - - 1 3 5 5 F 21 — 1 — 1 — — — 3 3 5 8 45. Nephritis and Nephrosis M 4 - - - - - - 1 - 1 1 1 F 6 — — — — — 1 — 1 3 — 1 46. Hyperplasia of Prostate M 5 — — — — — — — — — 2 3 47. Other Diseases, Genito-Urinary System 8 - - - - - - - 2 2 1 3 F 13 — — - - - — - - - 3 10 48. Diseases of Musculo-Skeletal System M 3 - - - - - - - - - 1 2 F 13 - — — — — - - 1 - 1 11 49. Congenital Anomalies M 10 5 2 — 1 — 1 — 1 — — — F 10 3 3 - - - - - - 2 1 1 50. Birth Injury, Difficult Labour, etc. M 12 12 - - - - - - - - - - F 2 2 — - - - - - - - - - 51. Other Causes of Perinatal Mortality M 5 5 - - - - - - - - - - F 3 3 — - - - - - - - - - 52. Symptoms and III defined Conditions M 2 - - - - - - - - - 1 1 F 4 - - - - - - - - - - 4 53. Motor Vehicle Accidents - - - 1 8 3 2 - 3 5 5 F 13 - — - 3 1 1 - 1 2 1 4 54. All Other Accidents M 15 _ — 1 — 5 2 — — 3 2 2 F 22 — — 1 — — - 1 1 2 1 16 55. Suicide and Selfinflicted Injuries M 8 - - - - - - 2 3 1 - 2 F 11 — — — — — 1 1 1 5 3 — 56. All Other External Causes M 2 — 1 - - - - 1 - - - - F 3 — - - -—- - - 1 - 2 - - TOTAL ALL CAUSES M 1,543 25 14 3 4 18 11 32 109 299 429 599 F 1.638 10 7 5 4 4 12 18 67 162 318 1,031 22 Accidental Deaths During the year 78 residents died from accidents of all kinds, including 40 in motor vehicle accidents. DEATHS FROM CANCER Male Female Total 1970 1969 1968 1967 1966 1970 1969 1968 1967 1966 1970 1969 1968 1967 1966 Malignant neoplasm, stomach 33 35 53 28 39 37 34 39 33 32 70 69 92 61 71 Malignant neoplasm, lung, bronchus 151 168 221 148 136 46 36 54 41 32 197 204 275 189 168 Malignant neoplasm, breast - - 2 - - 56 83 114 76 64 56 83 116 76 64 Malignant neoplasm, uterus - - - - - 22 20 39 18 22 22 20 39 18 22 Other malignant and lymphatic neoplasms 146 220 221 191 151 186 191 256 161 187 332 411 477 352 338 Totals 330 423 497 367 326 347 364 502 329 337 677 787 999 696 663 Rates per 1,000 population All forms 2.2 Lung and bronchus 0.65 Other forms 1.55 Maternal Mortality No maternal deaths occurred in the Borough during the year. The maternal mortality rate for Greater London for 1970 was 0.17 per 1,000 total births (excluding deaths due to abortion). T uberculosis There were 7 deaths attributed to pulmonary tuberculosis and 2 to non-respiratory tuberculosis, giving a death rate of 0.03 per 1,000 population. Street Accidents 1,683 street accidents occurred in the Borough during 1970. 2,349 persons were injured and 33 died. These totals include 418 children under 15 years of age who were injured, and 4 who died. Infant Mortality There were 55 deaths of infants under 1 year of age during 1970. 50 of these were of legitimate and 5 of illegitimate births, giving a rate of 13 per 1,000 total births. The rates for Greater 23 London and England and Wales were 17.8 and 18.0 respectively. Of the 55 infants deaths, 35 were under four weeks old, giving a neonatal mortality rate of 8.0 per 1,000 total live births. The neonatal mortality rate for Greater London was 12.3 and for England and Wales 12.0. There were 28 deaths of infants under one week of age, giving an early neonatal mortality rate of 6.0 per 1,000 total live births. The rates for Greater London and England and Wales were 10.7 and 11. The perinatal mortality rate for the Borough (stillbirths and deaths under one week combined, per 1,000 total live and stillbirths) was 18 and those for Greater London and England and Wales were 22.6 and 23 respectively. METEOROLOGICAL OBSERVATIONS—1970 Total Rainfall The average total rainfall taken over the Borough as a whole was 25.58 inches. Temperatures Due to damage to equipment, the Director of Parks has been unable to supply the figure for the highest maximum temperature in 1970. The lowest minimum temperature recorded in 1970 was 17 degrees Fahrenheit on 5th and 7th January. The mean minimum daily temperature for 1970 was 42.69 degrees Fahrenheit. PERSONAL HEALTH SERVICES 27 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 Child Health Clinics The number of premises used for Child Health Clinics remains at 36. The number of sessions held at these Clinics totalled 2,437, an average of 48.5 per week. The number of attendances by children at these Clinics totalled 81,315 thus reversing the downward trend of the last few years by an increase of 6.3 per cent over 1969. Of this total, 63.3 per cent were children under one year of age, 19.2 per cent children of one to two years, and 17.5 per cent children from two to five years of age. The average number of attendances per child remained at 6.2 over the year. Welfare Foods Sales of these foods were:— National Dried Milk 5,061 Cod Liver Oil 4,030 Vitamin A & D Tablets 5,944 Orange Juice 129,475 These figures represent a decrease of 2½ per cent on 1969. The issue of free commodities totalled 1,701 and, together with 1,112 issues of cheap milk, represented 1.9 per cent of sales. Care of the Unmarried Mother and her Child The claims for capitation grants to the Canterbury and Rochester Diocesan Council for Social Work, and the Southwark Catholic Children's Society were in respect of approximately 109 and 6 cases respectively. These represent all types of cases involving the unsupported mother dealt with by these organisations. The Council assisted financially towards the cost of placing 17 unsupported mothers in Mother and Baby Homes, at a cost of £1,439, an average of £85 a case. This number is similar to that for 1969. 28 Day Nurseries and Child Minders 1969 1970 Difference Registered Premises: Number 101 120 + 19 Children Permitted 3,255 3,638 + 383 Average Permitted 32.2 30.3 -1.9 All day care was given at 12 premises where the number of children permitted averaged 23. 1969 1970 Difference Child Minders: Number 204 289 + 85 Number of Child Permitted 840 908 +68 Average Permitted 4.1 3.1 -1 A total of 256 Child Minders were permitted to give all-day care to 538 children. Approximately 140 playgroups were organised, providing, on a sessional basis, group play activities for children over two years, and sometimes over five years of age. Introductory courses for Play Group Leaders continued. Scheme of Assistance for Day Care A scheme was introduced whereby arrangements were made for the day care of children in priority groups including the materially deprived, mentally or physically handicapped, emotionally or socially deprived children, where the parents were unable, for any reason, to meet the full cost of such a service. At the end of the year assistance was given for 11 children. Nursing Homes 1969 1970 Number of Homes at year end 16 15 Homes closed 3 2 Homes Registered 1 1 Number of beds provided at year end 369 353 Mother and Baby Homes 1 1 included above Number of Beds provided 14 14 Number of Cots provided 6 6 29 Deaf Children From infant screening at the Child Health Clinics, 55 children were thought to have some impairment and were referred to the Audiology Clinic for further investigation. The work of referral continued to expand. Cervical Cytology A publicity leaflet was distributed to each household in the Borough showing the place, time and dates of the clinics. These Clinics are "open", no appointment being needed. The response to this publicity was disappointingly low but more women, as expected, returned for their routine three yearly re-examination. 1969 1970 Difference Total number of Tests 2,557 2,635 +78 Primary 1,540 1,111 -429 Routine Re-Examinations 905 1,455 +550 Specific Re-Examinations 112 68 —44 Results: Positive 4 1 —3 Doubtful 8 5 —3 Minor Infections 376 386 +10 195 Clinic sessions were held, an average of 16 per month. Recuperative Care Convalescent holidays were arranged, on medical grounds, for those unable to meet the cost of such a holiday. The number of applications received was 102, of which 71 were able to be placed, at a cost of £1,330 representing an increase of £1.25 on the average cost per patient over that of last year. Of these applications, 22 were for babies and children, 4 for young mothers, 22 for those aged between 35 and 60 years, and 54 for those over 60 years. Family Planning Family Planning facilities were provided on behalf of the Council by the Family Planning Association. Clinics are held at seven Centres in the Borough. Free facilities were available to medical cases in the following categories:— (a) Any woman who suffered from a specific condition, gynaecological or otherwise, which would render pregnancy injurious. (b) Any woman whose general health would suffer by reason of an increased mental, physical or social burden placed on her by pregnancy. 30 Vaccination and Immunisation The scheme for vaccination against Rubella was introduced in 1970, and a vigorous programme was being carried out in the schools during the Winter and Spring terms of 1970/71. Vaccination against influenza was available to all nursing staffs employed by the Council. 1,295 children under 2 years of age were vaccinated against Smallpox together with 913 up to 15 years of age. A total of 638 children were re-vaccinated. Completed primary courses: Year of Birth Others Under Total 1970 1969 1968 1967 1963-6 16 Measles 7 1,031 1,075 356 295 118 2,882 Diphtheria 216 2,690 751 54 125 23 3,859 Whooping Cough 215 2,683 736 50 78 8 3,770 Tetanus 216 2,691 753 58 140 174 4,032 Poliomyelitis 188 2,701 479 65 111 44 3,588 Re-inforcing Doses given: Diphtheria 4 120 883 306 3,279 323 4,915 Whooping Cough 3 97 809 253 1,158 104 2,424 Tetanus 5 120 885 309 3,296 438 5,053 Poliomyelitis 2 55 231 96 3,223 340 3,947 Comparative Statistics Percentage of children born in 1968 and vaccinated by 31.12.1970. Whooping Cough Diphtheria Poliomyelitis Smallpox (children under 2) England & Wales 79 81 79 35 Bromley 90 91 82 30 CHIROPODY In 1970 4,791 patients received 25,181 treatments under the London Borough of Bromley's scheme. They included 14,999 surgery attendances and 10,182 domiciliary treatments. Despite the increase in cost to the Borough in providing this service, no increase in the charge of 7s. 6d. to patients was made. There was an increase in the number of sessional staff employed by the Borough and this brought the number up to 10, but the number of contractual chiropodists employed was reduced by 3. 31 MIDWIFERY Miss M. C. Martin, s.r.n., s.c.m. Non-medical Supervisor of Midwives Group Attachment of Domiciliary Midwives A one year pilot scheme for the attachment of a domiciliary midwife to a group of general practitioners was completed in August 1970. The reactions of both midwives and general practitioners were favourable and the scheme was extended to the whole Borough, except for the Biggin Hill area. A further pilot scheme for domiciliary midwives to deliver a few of their cases in hospital, followed by the early discharge of the patients, was completed in October 1970. The hospital concerned was Queen Mary's Maternity Unit at Sidcup. Again, reactions to the scheme were favourable and similar arrangements were therefore extended to the Beckenham Maternity Hospital, Mason's Hill and Widmore Road Maternity Units. The Guthrie test for detecting phenylketonuria was introduced during the year. Every baby about 10 days old was tested either in hospital or by the domiciliary midwife. Deliveries attended by Midwives Number of Domiciliary confinements attended by Midwives:— Doctor not booked 1 Doctor booked 458 Total 459 Number of cases delivered in hospital but discharged and attended by Midwives before the tenth day was 1,176. The figure of 459 Domiciliary Confinements represent 9% of the total number of births (adjusted), compared with 29% in 1965. Over this six year period the number of discharges before the tenth day has remained a constant proportion (±2½%) of the number of hospital deliveries. The number of all visits by Midwives during 1970 was 26,027, a decrease of 5% over 1969. Ante-natal and Post-natal Clinics The number of women attending Local Authority Clinics (the last to be held) was 184. Most women used General Practitioner Clinics where Council nursing staff are attached to the Practices. Relaxation and Mothercraft Classes 414 women attended these classes, maintaining an increase over previous years. Each attended an average of 6 classes. 32 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1970 who were born:— (i) at home or in a Nursing Home 13 (ii) in hospital 266 (2) The number of those born at home or in a Nursing Home:— who were nursed entirely there 12 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 12 (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 247 (4) The number of premature stillbirths who were born:— (i) at home or in a Nursing Home — (ii) in hospital 15 Congenital Malformations 80 notifications were received, of which 66 were in respect of live births and 14 in respect of stillbirths. The total number of malformations was 99 and the number of children with multiple malformations was 18. Notification of Intention to Practise During the year 132 midwives notified their intention to practise within the Borough. HOME NURSING Mrs. M. O. Tierney, s.r.n., q.n. Superintendent, Home Nursing Service Co-operation with the other medical and nursing services continued to develop and a scheme for the attachment of District Nurses to groups of General Practitioners is proposed for early 1971. There was a definite expansion of the scheme in which 33 Student Nurses, Pupil Nurses and Pupil Midwives accompany District Nurses on their domiciliary visits. The District Nursing Service was helped considerably by the generous help of the staff of St. Christopher's Hospice, and the staff of the local branches of the British Red Cross Association. Statistics During the year 2,827 persons were nursed, representing a continuing decrease over the previous year (3,192). The total number of visits to patients was 99,624, an increase in average attendance over the previous year of 0.5 to 31.2. HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert. Dip.Soc.Studies (Lond.) Establishment The establishment of Health Visitors has been increased by five this year, although at no time has it been up to strength. One Health Visitor left for further training in church work, one to take another post, and three for domestic reasons. Four sponsored Student Health Visitors gained their certificates, but one did not take up her position due to domestic problems. Two full-time staff have been appointed and one retired but returned to work part-time. At the end of the year the staff in post were 41 fulltime equivalent. It is hoped that by increasing the number of students the staff situation will be improved in the coming year. Training Four sponsored Students commenced training in September and the five Fieldwork Instructors are assisting in the practical training of seven students from other areas. 149 Nurses from the local hospitals, 42 Pupil Midwives, and 14 Students, including Post-Graduate visitors from overseas, have been given an insight into the work of the Community Health Services in the Borough. Health Visitors once more had the opportunity of participating in In-Service Training with the Kent County Council Health Visitors. Four went on a fortnight's Refresher Course and two more Fieldwork Instructors were trained. Home Visits 27,000 effective home visits were paid of which 22,400 were to mothers with children under five years, and 600 were to persons over 65 years of age. 97 home visits were paid to households where one of the 34 members was a patient at the Chest Clinic. 9,940 visits were paid where no reply was obtained. 3,972 miscellaneous visits were paid, these visits taking more time than is usually spent in visiting as their purpose was assistance and support in problem situations. Clinics 4,336 Clinic Sessions have been held by Health Visitors, of which 3,717 were Child Health Sessions. Screening Tests During 1970 the routine screening tests on babies between six months and one year have highlighted babies with some degree of hearing loss and the early follow-up treatment instigated by these investigations has been invaluable in helping these children to develop speech normally in spite of this handicap. Conclusion In spite of under-staffing the essential work has been covered, but a better service to all members of the public in the preventive field could be given if recruitment is successful in bringing the Establishment up to strength. 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 182 persons were notified to the department and 113 were 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 35 year it was not found necessary in any instance to apply for a removal order as, with the assistance of other interested bodies, it was possible 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 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 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 admission to Teacher Training Colleges, and also from the requirements 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 1,356 Number of recommendations without medical examinations 1,137 Number of medical examinations carried out:— (a) For admission to Superannuation Scheme 219 (b) Training College Candidates 384 (c) Teachers' First Appointments 167 (d) Premature retirement or prolonged sick leave 20 (e) For other Authorities 14 (f) For West Kent Main Sewerage Board 17 821 Candidates examined for this Borough by other Authorities 10 36 HOME HELP SERVICE The following is a summary of the cases in which assistance was given between 1st January and 31st December, 1970, under Section 13 of the Health Service and Public Health Act of 1968. Aged 65 or over on 1st visit 2,218 Chronic Sick and Tuberculosis 213 Mentally disordered 22 Maternity 241 Illness 296 Hours of service involved 229,303 Family Care Service 17 cases received assistance involving 2,270 hours of service and preventing 46 children from being taken into care. Family Welfare Service 1 case received assistance involving 192 hours of service. Evening and Night Service 6 cases received assistance involving 601 hours of service. It will be seen that home help was supplied in 3,014 homes involving 232,366 hours of service. 7,445 visits were made to households. VENEREAL DISEASE Under the National Health 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. 37 I am indebted to the physicians at the undermentioned treatment centres for the following statistics for 1970:— New Cases of Residents Treated During 1970 Treatment Centre Syphitis Primary and Secondary Other Gonorrhoea Other Conditions Total Croydon General — 1 26 103 130 Dreadnought Seamen's Hospital, Greenwich - 7 36 43 Greenwich District Hospital - - 8 27 35 St. Giles's Hospital — — 19 50 69 St. John's Hospital — 3 31 169 203 St. Thomas's Hospital 1 — 4 60 65 Westminster Hospital - — 1 19 20 The London Hospital Whitechapel Clinic - — 4 31 35 1 4 100 495 600 HEALTH EDUCATION AND HOME SAFETY Health Education and the Adult—The Parent as Partner When one considers some features of modern society, the burden of ill-health, much of it the result of ignorance of basic principles of healthy living, the misuse of the National Health Service—over-use by some and the suffering which goes unrelieved because many others fail to consult their doctors or dentists or disregard or misinterpret their advice, the gullibility of many who when subjected to social pressures or to the subtle persuasive influences which have been called "admass" make the unwise decisions to over-eat to smoke or drink heavily, or to experiment with drugs, one must conclude pessimistically that our education system sorely needs buttressing. There is much to set against such a gloomy view, however; more books are read and purchased than ever before; more informative articles—often on health topics—appear in the popular press; health programmes produced by the BBC and the Independent Television have a large following. Critical assessment of advertisements and products—including many which make claims in the field of health—is finding a considerable following, and further education in various forms is available on a vastly increased scale for adults. Health education for adults comes in many guises. Books, magazines, newspapers, films, sound or television broadcasting and 38 various forms of advertisements all help to reach many who could not have been reached in any other way. The doctor in general practice has an important role in health education when he can spare the time for this important role with his patients. Some practices organise special education sessions for those of their patients who wish to attend. The doctors organisations, too, provide a highly valued service through their publications which are widely available at booksellers and in chemists shops. Health education must do more than provide information. It must also seek to influence people to act on the advice and information given, and must seek to counteract pressures which are inimical to health. High priority should continue to be given to the health education of mothers. It is necessary to educate the public on a truer understanding of cancer, on dental care, about suitable kinds of footwear, on mental health and the emotional needs of parents and children. The special needs of immigrants are important, also the promotion of the habit of exercise and the healthy use of leisure at all ages; special attention should be paid to middle-aged men. It is against this background that the health services concerned with parents and young children are so particularly rewarding. At no other time is the adult so open to suggestions and help, since the parents have undertaken a formidable commitment and are likely to be glad of all the help that can be given. It is thanks in great measure to the doctor, health visitor and midwife, to clinic and maternity ward and to all sources of help available during the child's infancy that parents today can hope to build up their family without losing sight of each other in the process, and that the mother, in particular, can hope to perform her heavy task without any longer becoming worn out before her time. Nor is there any real risk that the new agencies provided to help the parents may between them reduce the sense of parental responsibility. Some parents take their duties too lightly, just as others make a burden of them; both kinds will be known to welfare workers and teachers. But most parents take their responsibilities seriously, though not to the point of priggishness. Those people who have themselves wrestled with the day-to-day task of bringing up children are seldom under any illusion that outside agencies can take the parents place. As for the experts, the whole trend of current thinking is in any case to emphasise and build up the family unit within the larger framework of society, not to replace it. Where a family is not functioning properly, it needs to be helped to do better and rehabilitation is often possible; institutions may be 39 needed in cases of complete breakdown, but they cannot take the family's place. Perhaps more could be done through organisations like Parent Teachers Associations to educate parents and give them counsel when necessary. Their active participation is needed, of course, and their importance is universally recognised but there are times when they sorely need advice and they should know where to find it, when they need it. The place of the school in the community is changing, and a changing pattern which is tending to strengthen the partnership of parent, teacher and school health service, will give the school a central role which should strengthen family and community life. Home Safety From January to December, 1970, a total of 8,820 home accident cases were treated at the hospitals of Beckenham, Farnborough, Orpington and Bromley. Of these, 5,093 were adults and 3,727 children. In the previous year, the overall total from these hospitals was 9,509, and of these 5,484 were adults and 4,025 children. This shows a reduction of 689 casualties in 1970, as compared with the previous year. Of these, 391 were adults and 298 children. This reduction is most encouraging but once again all Home Safety Committees and other Organisations engaged in Accident Prevention must realise that continued education of the public is the foremost remedy. As was mentioned in previous reports, it is useless educating the child without educating the mother. It is also useless educating the elderly without educating those who might have to look after them. Once again the three most prominent causes of these accidents, with serious complications, according to the statistics supplied by the Hospital Authorities, were given as follows:— (1) FALLS being the chief danger to old people. (2) BURNS/SCALDS affect both the young and old people. (3) POISONING/SUFFOCATION being the danger to adults, especially in relation to gas, medicinal substances, through overdoses, mistakes, etc. Also to the very young persons who find drugs, tablets, medicines, detergents, etc., loose in cupboards, drawers, and finally to the small babies without adequate net screens on prams and cots against domestic pets, and the dangerous use of soft pillows and plastic bibs, etc. 40 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 43 DENTAL SERVICES Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(glasgow) Principal Dental Officer In 1970 the number of Maternal and Child Health patients treated was less than in recent years. The primary causes of the reduction was a delay of some five months in the replacement of a dental officer who had left the area, and the prolonged sick leave of another dental surgeon. The treatment of school children however was maintained at the usual high levels previously reached, but the talks to mothers at Baby and Toddlers Clinics had to be curtailed. School Health Dental Service The total number of deciduous and permanent fillings in 1970 is slightly less than that of 1969. This is not due to any great improvement in the dental health of the children but to some staffing problems. Two Dental Surgeons had lengthy illnesses and there was some hiatus to time due to the obligation to advertise two vacancies on the staff and wait for the successful applicants to take up their posts. The standard and productivity of the Dentists in general has well exceeded the national average and there were no difficulties in securing suitable operators to occupy the vacant positions. With a currently fully operative staff it is expected that all sections of the Dental Department will produce increased output in 1971. It continues to be a source of regret that there is still a considerable amount of caries in the children's teeth in the Borough. Areas within the Borough differ and talks on Dental Health are concentrated in the worst areas as it is not possible to cover the entire Borough. One of the Dental Surgeons and the Hygienist, with the consent of the parents, have been treating some children with a topical application of Fluorise. It is hoped to report satisfactory results in due course. Our thanks are due to Dr. Morris and Dr. Miller for their co-operation and excellent anaesthetics performed during the year. Sessions Sessions devoted to treatment 3,120 Sessions devoted to inspection 228 Sessions devoted to Dental Health Education 60 44 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS (as at December 1970) A. Attendances and Treatment: Number of Visits for Treatment During Year: Children 0-4 (incl.) Expectant & Nursing Mothers First Visit 360 22 Subsequent Visits 366 57 Total Visits 726 79 Number of Additional Courses of Treatment other than the First Course commenced during year 26 - Treatment provided during the year: Number of Fillings 543 29 Teeth Filled .... 460 22 Teeth Extracted 39 12 General Anaesthetics given 16 2 Emergency Visits by Patients 11 4 Patients X-Rayed 1 3 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 85 28 Teeth Otherwise Conserved 40 — Teeth Root Filled — 5 Inlays — 3 Crowns — 2 Number of Courses of Treatment completed during the year 218 30 B. Prosthetics: Patients supplied with F.U. or F.L. (First Time) 1 Patients supplied with Other Dentures 2 Number of Dentures supplied 3 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. 154 D. 2 Number of Patients in A and D above who required Treatment B. 66 E. 2 Number of Patients in B and E above who were offered Treatment C. 64 F. 2 E. Sessions: Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment G. 82.1 For Health Education H. 8.0 45 ATTENDANCES AND TREATMENT—SCHOOL CHILDREN Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 13367 2457 360 6184 Subsequent Visits 6434 8029 1070 15533 Total Visits 9801 10486 1430 21717 commenced 309 216 52 577 Fillings in permanent teeth 2376 5956 1623 9955 Fillings in deciduous teeth 8669 1066 — 9735 Permanent teeth extracted 67 216 58 341 Deciduous teeth extracted 1063 342 — 1405 General anaesthetics 440 183 7 630 Emergencies 193 59 18 270 Number of Pupils X-rayed 241 Prophylaxis 3,091 Teeth otherwise conserved 365 Number of teeth root filled 7 Inlays — Crowns 26 Courses of treatment completed 6,279 ORTHODONTICS New cases commenced during year 219 Cases completed during year 164 Cases discontinued during year 2 Number of removable appliances fitted 210 Number of fixed appliances fitted — Pupils referred to Hospital Consultant 1 PROSTHETICS 5 to 9 10 to 14 15 and over Total Pupils supplied with F.U. or F.L. (first time) - - - - Pupils supplied with other dentures (first time) - - - - Number of dentures supplied 2 — 1 3 ANAESTHETICS General Anaesthetics administered by Dental Officers — INSPECTIONS (a) First inspection at school, number of pupils 34,422 (b) First inspection at clinic, number of pupils 3,262 Number of (a) + (b) found to require treatment 13,017 Number of (a) + (b) offered treatment 9,336 (c) Pupils re-inspected at school or clinic 646 Number of (c) found to require treatment 301 SESSIONS Sessions devoted to treatment 2,978 Sessions devoted to inspection 228 Sessions devoted to Dental Health Education 60 INFECTIOUS AND OTHER DISEASES 49 INFECTIOUS AND OTHER DISEASES General The total number of notified cases of infectious disease showed a decrease compared with the previous year, 1,002 cases being reported compared with 1,349 during 1969. This reduction was mainly due to a fall in the number of cases of measles. With the introduction of measles vaccination in the Borough in 1968, the bi-annual epidemics of this illness have ceased to occur, but the effect on the endemic level of the infection has been less pronounced and it seems likely that this will not be greatly reduced until a higher proportion of the children at risk are protected. Nearly all the 668 cases reported during the year affected children under the age of 15 years. Reductions in the numbers of cases of Scarlet Fever, Dysentery and Tuberculosis, also contributed to the improved picture. It is pleasing once again to be able to report the absence of Diptheria and Poliomyelitis from the Borough, something that now tends to be taken for granted but which, nevertheless, represents a considerable preventive achievement on the part of all those who have successfully laboured to maintain the high level of protection by immunisation now prevailing in the Community. Compared with the previous year there was an increase in the cases of Whooping Cough reported, continuing a tendency for this infection to fluctuate considerably in prevalence from year to year. The cases notified were, however, generally of a mild character. A single case of Typhoid Fever was notified, the infection having been contracted during a holiday outside Europe, an incident that leads me to draw attention to the recommendation of the Department of Health that vaccination against this condition should be considered by travellers going outside Europe or North America. An unusual occurrence was the involvement of the Department during the year in three instances where Rabies was suspected. Two of these followed abnormal illnesses in domestic pets that had been reported to the veterinary officers of the Ministry of Agriculture, Fisheries and Food. The other instance concerned a child who was bitten by a St. Bernard dog while on holiday on the Continent; the Authorities of the country concerned were most co-operative and it was possible to establish that the dog had not been suffering from the disease. I am pleased to be able to report that the other two domestic pets were also cleared from suspicion. Generally speaking, it may, therefore, be said that the level of notifiable infectious disease during the year maintained the good record in this respect enjoyed by the Borough in previous years. Statistical details of the various infectious diseases are given 50 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 Only 7 cases of this infection were reported during the year, a very gratifying decrease compared with the previous year when 79 cases were notified. Food Poisoning 30 cases of Food Poisoning were notified compared with 17 during the previous year and a number of additional cases came to light as a result of the investigations carried out. Details are shown in the table below and it can be seen that in the majority of instances the illness was caused by organisms of the Salmonella group. There was one death during the year associated with Salmonella infection. FOOD POISONING Incidents and Cases Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases cols. (1+3 + 5) TOTAL No. of cases columns (2 + 4 + 5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S. typhimurium 1 2 2 5 11 14 18 2. Other Salmoneilae (a) 1 11 1 2 8 10 21 3. CI. welchii — — 1 2 — 1 2 4. Staph, aureus — — — — 1 1 1 5. Other causes (b) — — — — — — — 6. Cause unknown — — — — 2 2 2 7. TOTAL 2 13 4 9 22 28 44 DETAILS OF FOOD POISONING DUE TO SALMONELLAE Type of OTHER THAN S. TYPHIMURIUM Salmoneilae Group D — - - - 1 1 1 Panama 1 11 - - 3 4 14 Stanley - - — - 1 1 1 Stanleyville - - - — 1 1 1 Livingstone - - - — 1 1 1 Enteritidis — — 1 2 - 1 2 Ohio — — — — 1 1 1 51 Infective Jaundice A total of 44 notifications of Infective Jaundice were received during the year, a similar figure to that of 39 reported during the the previous year. The general pattern of the infection was again of sporadic cases. There was one death reported from this cause. Leptospirosis No case was notified during the year. Measles A total of 668 cases were notified during the year compared with 1,041 during 1969. Most of the notifications related to children under the age of 15 years and cases now tend to occur throughout the year in contrast with the traditional tendency of the infection to be more or less confined to the winter months. The Meningitis 11 cases were notified during the year compared with 7 in the preceding year. Ophthalmia Neonatorum No notifications were received during the year. Poliomyelitis No case of this disease was notified during the year. Scarlet Fever This infection continued to occur in a mild form and no deaths were recorded. 56 cases were notified compared with 99 during the previous year. 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 1970 668 52 Smallpox No cases occurred during 1970, but in accordance with the usual arrangements it was necessary for a number of travellers from overseas who had been possible contacts of the infection to be kept under surveillance. Information regarding these contacts was received from the Port Health Authorities. The Department was called upon to authenticate the signature of the Doctor on 7,342 International Certificates of Vaccination during the year, the figure for 1969 being 6,813. Tetanus There was no case of Tetanus notified during the year. Tuberculosis The decline in new cases which has been such a feature of recent years continued and the number of notifications received was 44 compared with 50 during the previous year. Special preventive measures are sometimes necessary when cases of the illness occur in schools or similar communities and I am greatly indebted to the Consultant Chest Physician, Dr. E. W. Street, and his colleagues for their very helpful expert advice in connection with these problems. The mass x-ray units, under the auspices of the S.E. Metropolitan Regional Hospital Board, paid regular visits to different sites in the Borough and continued to play an important part in combatting the infection. The total number of cases on the Register showed a further decline during the year from 2,823 to 2,728. There were 9 deaths attributed to the disease compared with 6 in 1969. The following are details of the recordings in the Register for the year ended 31st December, 1970:— Respiratory Other forms Total No. of Cases M F M F No. on Register at 1.1.70 1,408 1,099 148 168 2,823 No. of cases notified during 1970 22 21 — 1 44 No. of cases coming to knowledge after death 1 4 — — 5 Restored to Register - 1 - - 1 Inward Transfers 15 7 - 1 23 1,446 1,132 148 170 2,896 Deletions - deaths, removals recoveries, etc., 96 68 1 3 168 Number of cases on Register at 31.12.70. 1,350 1,064 147 167 2,728 53 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 — — — — — — — - 5-14 years - 1 — 1 — - - - 15-24 years 5 3 — — — — — - 25-44 years 1 5 — — — — — — 45-64 years 14 6 — — 2 2 — 1 65 years and over 2 6 — — 3 — — 1 Age Unknown — — — — — — — Inward Transfers 22 21 — 1 5 2 — 2 15 7 — 1 Totals 37 28 — 2 Typhoid Fever A single case of Typhoid Fever was reported. The patient recovered and there were no secondary cases. Paratyphoid Fever 2 cases of Paratyphoid fever occurred in a family, apparently following a holiday abroad. Both patients recovered from the illness. Whooping Cough 138 notifications were received compared with 14 in 1969. There were no deaths from this cause. The following table shows the variations in the incidence of this infection in the Borough since 1965. Year Number of Cases Notified 1965 26 1966 113 1967 218 1968 120 1969 14 1970 138 INFECTIOUS DISEASES 1970 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 M F M F M F M F M F M F M F M F M F M F Scarlet Fever 1 16 8 17 11 1 1 1 34 22 Whooping Cough 5 5 21 30 27 39 1 2 2 1 1 1 3 57 81 Measles 15 18 180 171 120 136 4 9 3 3 9 322 346 Food Poisoning 3 4 3 2 3 4 2 1 1 1 1 1 2 1 1 17 13 Paratyphoid 1 1 2 Dysentery 1 1 1 1 2 1 5 2 Infective Jaundice 10 4 8 3 6 1 2 2 1 4 1 1 1 29 15 Tuberculosis (Pul.) 1 5 3 2 1 3 14 6 2 6 22 21 Tuberculosis (N.Pul.) 1 1 Meningitis 1 3 2 2 1 2 6 5 Typhoid Fever 1 1 Encephalitis 1 1 Totals 24 28 221 211 181 194 25 23 8 12 7 6 17 14 4 9 6 12 493 509 1,002 54 SERVICES UNDER THE MENTAL HEALTH ACT, 1959 57 MENTAL HEALTH SERVICES As a result of the passing of the Local Authority Social Services Act, 1970, the responsibility for the borough's mental health services will pass from the Health, Welfare and Children Committee to the new Social Services Committee and so it would seem fitting that this Report should be in the form of a review of the development of the mental health services in Bromley since the creation of the borough on the 1st April, 1965, at the same time giving some indication of the work which still lies ahead. Mental Health Social Work By April, 1965, the Mental Health Act, 1959, had been in operation for almost 4½ years and few of the previous Authority's plans for the development of the mental health service had advanced sufficiently to be put into effect. Six of the stalf of the former Kent County Council district offices transferred to Bromley and were appointed Mental Welfare Officers and paired off to three area offices to cover the areas of Beckenham and Penge, Bromley and Chislehurst, Orpington and the Crays, respectively. Previously these officers, because of the wide range of their former duties, had carried out very little more than statutory duties with regard to the care of the mentally disordered. Right from the start, the concept of the mental welfare officer as a case worker with statutory duties, was introduced and an intensive In-service training programme was initiated. In addition to regular lectures, discussions and visits to various mental health establishments locally, one large psychiatric hospital generously arranged for each mental welfare officer to spend a week there and provided a most informative and instructive programme of activities. Consonant with the needs of the service, full advantage was taken of the facilities offered by the newly formed London Borough's Training Committee and in that first year the Council seconded one mental welfare officer to a full time training course leading to the Certificate in Social Work. Every effort was made to establish and foster a close liaison with the two other partners in the health service, the family doctors and the hospitals, who were very ready to respond to the improved facilities offered. It was quickly apparent that if the service was to fulfil its expected role, qualified senior staff would be required to give direction and leadership to the field officers and in the first eighteen months, three such appointments were made, one to each of the three areas. As the work has increased and the service has developed, it has been necessary from time to time to increase the number of mental welfare officers in the area teams until at the time of writing there 58 are 15 full time equivalent mental welfare officers in addition to one shared with Child Guidance Service. There are three officers at present working with the hospital serving this area and this ensures a continuity of social work when a patient passes from community to hospital or vice versa. Furthermore such secondments facilitate an easy flow of information between the hospital and local authority staff. A pilot scheme of attachment of a mental welfare officer to certain group general practices was initiated in 1967. This proved very successful in that not only is there a close consultation on the social needs of the patient but also the doctor, through the social worker, is kept in constant touch with the progress of the patient so that in many cases a crisis situation can be avoided. There are now four such attachments. As the service has developed the more intensive case work has shown the necessity for selectivity in matching the available resources to the need and within the last year two additional posts of senior mental welfare officers have been established, one to deal with residential care and the social work flowing from it and the second will have special responsibility for the co-ordination of work carried out outside the area offices, particular attention being paid to vulnerable and "at risk" groups. Residential Accommodation From the earliest days it was quite apparent that there would be an increasing need for the Council to provide residential accommodation for those who while not requiring hospital care would, for a longer or shorter period, need a degree of supervision and care not available to them in their own homes or private accommodation. Several people had already been placed by the previous Authority in residential establishments provided by outside agencies such as the Mental after Care Association and the Guardianship Society and the Council still makes considerable use of such facilities. However, there are obvious advantages in having such establishments within the borough and under the direct control and management of the council. In July, 1965, the attention of the department was drawn to Rydal Mount, a large house in Beckenham in the ownership of the Council, which it was expected would be vacated in the near future. On inspection, it was found that the property would be very suitable with some adaptations for use as a small hostel for short stay ex-mentally ill patients. The proposal was accepted by the Council and the hostel opened in March, 1968. It provides accommodation for 15 men and women who are either in full-time employment or capable of such employment, but who need a "Bridging period" 59 between the sheltered environment of hospital and the full stresses and responsibilities of life in the open community. The majority of those who have been admitted have, in due course, taken up their place again as fully independent members of the community within a reasonably short time. One or two have regressed and have had to return to hospital care and in one case it was found that care and support would be needed indefinitely and arrangements were made for a transfer to a long stay establishment. Group Homes In September, 1969, a "group home" for five women was opened in Anerley. In such a home, the residents live together in a community and maintain themselves with the support of a social worker who visits regularly and advises and sorts out problems. Each resident pays an agreed charge which covers rent, repairs, heating and lighting. This scheme has enabled several persons in hostel care who still need some degree of support, to move on one step further towards complete rehabilitation and independence. Following the success of this scheme, a second "group home" was opened in Bromley in October of this year, which provides similar facilities for 10 residents and at the time of writing, nine places are occupied. An important aspect of these two establishments is that they are self financing. The fact that all residents are seen to be financially independent is a key element in their rehabilitation. Boarding Out Scheme During the current year a further step in providing accommodation has been the implementation of a boarding out scheme. The scheme comprises the provision of suitable lodgings in appropriate cases at an agreed weekly charge. The resident will meet this charge if he is able to do so, but if not, his contribution is determined in accordance with the Council's assessment scales and the Council accepts responsibility for the difference. A social worker maintains contact with both the resident and the landlady and is available to deal with any problem or crisis which may arise. At present two persons are boarded out under this scheme. It will be seen that a successful start has been made in tackling the problem of providing residential care but much still remains to to be done. At the time of writing, negotiations are in hand for the acquisition of a site for a hostel to accommodate approximately 60 25 mentally handicapped children and a hostel for a similar number of mentally handicapped adults and a long stay hostel for exmentally ill patients are included in the programme of capital projects for the year 1971/72. Training Centre for the Mentally Subnormal The London Borough of Bromley inherited from the Kent County Council only one training centre for the mentally subnormal. This was an all age centre providing around 80 places and was housed in an old building, which, by present day standards, was unsuitable and inadequate to the need. It was immediately apparent that an improvement and expansion of day training facilities for the mentally subnormal must be an urgent priority. Within a few weeks, two positive steps had been taken to this end, firstly a suitable site for a new junior training centre in Beckenham had been allocated by the Council. Secondly a decision had been made to provide an additional prefabricated classroom at the Orpington Training Centre. This latter was taken into use at the beginning of the summer term, 1967, and so enabled the number of places available at the centre to be increased to 100 and the waiting list was reduced to "special care" children only. Owing to several factors outside the Council's control, the new purpose-built junior training centre, Woodbrook, was not opened until September, 1969. It is a single storey building providing 5 classrooms, a manual instruction room and a domestic subjects room, together with a kindergarten and special care unit. In the design, the special needs of the handicapped child have been borne in mind and the Borough Architect and his staff are to be congratulated on providing a building which is both extremely functional and at the same time presents an attractive appearance. Although it was designed to accommodate 80 children there are at the moment just 100 on the register, some of whom are attending on a part-time basis. In April, 1971, Woodbrook will pass to the control of the Education Committee and it can take a proud place in Bromley's education system. With the opening of Woodbrook, the Orpington Training Centre was devoted entirely to adults. Although the nature of the premises limits activities, much more can be done than formerly in training and developing the potential of the adult trainee. Suitable light industrial work is undertaken and social and independence training form an important part of the curriculum. The centre accommodates approximately 80 and the work done there will prepare the trainees to take full advantage of the up-to-date and extended facilities which will be provided at the 61 purpose-built centre, Astley, now under construction at Magpie Hall Lane, Bromley. It is anticipated that this new centre which will provide 120 places, will be ready for use by September, 1971. As well as providing for those at present attending the Orpington centre, it will accommodate those Bromley residents who are at present attending the Kent County Council Adult Training Centre at Swanley and still allow some places for natural growth. As there is no upper age limit for attendance at an adult training centre, it will be seen that considerably more places will ultimately be required than can be provided at Astley. Provision has, therefore, been made in the capital building programme for a further adult training centre of 120 places for the year 1973/74. Day Centre Facilities—Stembridge Hall Stembridge Hall Day Centre situated in Stembridge Road, S.E.20., was opened in September, 1967, in a small Council owned property. It provides rehabilitation for approximately 20 adults of either sex who are or have been suffering from some form of mental disorder and who need to spend a period working in sheltered and supervised conditions before returning to open employment. Attendance is from 9.30 a.m. to 4.00 p.m. Mondays to Fridays and the importance of punctual and regular attendance is stressed as a pre-requisite for open employment. The work done in the centre consists mainly of light assembly and packaging which is done under contract with commercial firms, but limited facilities are provided for clerical work and typing where these are more appropriate. Recently, a weekly class in household management has been started. Periods are also devoted to social rehabilitation and discussion of matters of current interest. In addition to its primary function of rehabilitation for open employment it has been found that attendance at the centre is most useful in assessing the work potential of a person and this is valuable in planning his or her continuing care. The experience of Stembridge Hall has confirmed the need for some provision for those, who while able to work in a sheltered and supportive environment, will continue to need this for an indefinite period or even for the rest of their working lives. For these people, a 100 place "sheltered workshop" is also planned for the year 1973/74. Preliminary work is in progress to site the sheltered workshop in an industrial redevelopment area of the borough on a large site shared with other departments and thought has been given to the 62 possibility of including in the centre some of those suffering from other types of disability. For those whose mental health does not permit them to maintain a level of work performance required in a sheltered workshop, a day centre is planned which will provide occupational and social facilities for about 50 persons. Conclusion The mental health service report is but an outline account of what has been accomplished in the past five years and there are plans for further development. Lack of space precludes reporting on "fringe" services, such as the drug problem and work with problems of the adolescent, but the department sees the mental health services in the broadest context. While there is much to do in the more clearly defined areas of mental health, still more developments will take place in the "fringe" areas which present so many community and personal problems. Finally, a tribute must be paid to the sterling work of the various voluntary organisations in the Borough, who make a vital contribution in the field of mental health and welfare. WELFARE SERVICES 65 REPORT OF THE CHIEF WELFARE OFFICER Services for the Disabled The year under review was eventful in the field of services for the disabled mainly because of the introduction of the Chronically Sick and Disabled Persons Act, 1970. This Act, introduced into Parliament as a Private Members Bill, places a greater responsibility on Local Authorities to recognise and provide adequate services for the disabled. The full implications of the Act will not be felt until the appropriate Statutory Instruments are issued. However, it is expected that a greater demand will be made on the services provided by Local Authorities due to the publicity generated by the introduction of the legislation. (a) Physically Handicapped The number of persons on the registers have varied since last year as follows:— Blind Partially Sighted Physically Handicapped Deaf Hard of Hearing 1969 512 242 1,303 65 59 1970 494 268 1,600 64 60 Holidays—During 1970, 225 (113 physically handicapped, 112 blind persons) enjoyed holidays under the Local Authority Scheme. Instead of an assessed service these holidays are now provided at a fixed charge of £3.50 a week to each client. Aids and Appliances—The Local Authority continued to provide aids and appliances to the disabled. These can vary from simple pick-up sticks costing 25p to a hydraulic hoist costing £90. This year £2,300 was spent on new stocks of these appliances. Adaptations—Under this Authority's adaption scheme £5,800 was spent during 1970. In two cases substantial costs were involved in the adaptation of client's homes in order that renal dialysis equipment could be installed. It is expected that in future years the commitment on adaptations relating to dialysis equipment will increase in number as hospitals attempt to discharge patients to their homes for treatment. Transport—The demands on the special vehicles for the disabled continue to increase. The Department are looking 66 ward to the provision of four new vehicles early next year. In the field of transport the Local Authority receives tremendous support from Local Voluntary Organisations who often make their own special vehicles available to the Authority in the event of breakdowns etc. Craft and Work Centres—The Penge Work Centre still provides work centre facilities each day for 25 disabled. Work is at present going ahead to adapt the ex Civil Defence Centre at Coney Hall in order to create an Activities Centre for all handicapped groups. (b) Deaf and Hard of Hearing The advisory sessions organised by the Social Welfare Officer for the Deaf continue to develop. There are now five such sessions held each month at establishments throughout the Borough. In the sphere of deaf welfare a close link exists with the School Health Service, the Welfare Services and the Education Department, through which efforts are made to offer a parent guidance service to parents of deaf children. (c) Blind The services for the blind continue to develop especially in the field of mobility. The appointment of a Mobility Instructor for the Blind has led to a number of registered blind benefiting from instruction in the long cane technique. There continues to exist a very close liaison on blind welfare between officers of this Authority and officers of the Kent Association for the Blind. Services for the Elderly—Community Care There is a close link between the Council and the voluntary services in the field of Community Care for the Elderly. No less than 160,000 meals were provided during the year to the elderly at luncheon clubs, day centres and through the meals on wheels service. These meals being prepared and served by the W.R.V.S., the British Red Cross Society and the Old People's Welfare Committees. Work began this year on the Mason's Hill Day Centre which will provide 150 places each day for the elderly as well as providing 60 meals daily for the meals on wheels service. The Old People's Welfare Joint Committee who are grant aided by this Authority co-ordinate the activities of services for the elderly. ENVIRONMENTAL HEALTH 69 ENVIRONMENTAL HEALTH Following the transfer of the Department's Offices from Orpington to Bromley, in 1969, the staff settled down and all concerned found administration more convenient from a location central to the Borough. The infinitely better layout of the offices led to improved functioning and it was possible to fill vacancies in the professional staff which had existed since 1965. This was helped by the appointment of students in the Department who had completed their 4 year course of training and passed the Diploma Examination. The addition of these younger inspectors to the staff helps all to keep abreast of modern developments. In no field of environmental health work has there been more advancement than that relating to food. New foods are constantly coming to the market. Transport by air has immeasurably widened the markets. Preparations of West Indian, Pakistanian and Chinese origin are becoming commonplace. Altered techniques in cooking, packaging and retailing are being developed to keep pace with present day needs. Legislation flows from the Ministries to control the situation. Many shopkeepers have neither the training nor the background to appreciate the implications which follow these advances. The Inspector, therefore, must keep his knowledge up to date so as to be able to advise those who are affected. Storage of Food under Cold Conditions One example of this is refrigeration which has become a science in itself. It has travelled a long way since the days when only the fortunate were able to build ice houses on their estates in an attempt to keep food fresh. Now, no home is complete without a refrigerator which allows the housewife to "lay in" a small supply of items such as milk, dairy produce, soft fruit, etc. and store at a temperature around 40°F. Temperature control has enabled a whole range of sophisticated foodstuffs to be made available but each has its own requirements for storage. If it is necessary to prepare meat dishes the day before use they can be cooled rapidly and kept at a low temperature until consumed. This not only lengthens the life of food stuffs but, generally, they can be served in a safer and more palatable condition. In addition many shops and some homes are provided with "freezers" which enable food stuffs to be stored for periods greatly in excess of their life under ambient temperatures. It is essential that those so equipped should be well aware of the limitations of these cold cabinets and acquainted with the rules to be observed in their use. Open display cabinets in shops are often seen to be loaded above the safe line and goods stored on 70 shelves above them are found to be at a temperature greatly in excess of that recommended by the manufacturers. The Inspectors spend much time in explaining to shopkeepers the reasons behind the strict code of control which it is essential to observe if these most useful adjuncts to modern living are not to give rise to complacency or a false sense of security. For example, it is essential that deep frozen poultry should be kept at a very low temperature from the time they are prepared at the factory farms. They must be transported in refrigerated vehicles and on delivery to the shop immediately transferred to a proper cold store. If displayed in the shop under ordinary temperatures, and not shortly sold, birds should not be returned to the cold store. The purchasers of any defrosted poultry should be informed that they are for early consumption. Stricter control than appears to be exercised in some shops is necessary. Lengthy "power cuts" affecting the operation of refrigerators and leading to premature thawing of frozen food are another cause for concern. An additional hazard which may arise from the mishandling of this economic and nutritious food source arises from insufficient cooking of frozen poultry in the home. If the bird is sold in a frozen state and is not completely thawed out before inserting in the oven, it is likely that the temperature reached at the centre of the flesh will be insufficient to kill pathogenic organisms which may be present in the raw carcase. It is believed that a number of cases of food poisoning investigated during the year and traced to the consumption of poultry, have arisen in this manner. As an indication of the time factor involved it takes an "oven-ready" turkey weighing 10 lbs., at ordinary room temperature, 36 hours to thaw out properly. The carcase would still require approximately 4 hours cooking at 350°F. The normal 3 lb. chicken would ordinarily thaw out overnight but with larger birds it would be wise for shopkeepers to include specific intructions with each frozen carcase sold. The enforcement of the Food Hygiene (General) Regulations 1970 and their sister Regulations the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 is very largely the task of educating food handlers on the verse of the legislation and why the various precautions are necessary. When this fails to achieve improvement and other informal requests are ignored it is necessary to resort to proceedings in order to protect the public. In this respect the control of stalls from which open food is sold is particularly difficult. Little trouble is experienced with the Borough's covered Market in Bromley. The street market at 71 Penge presents some problems but the itinerant sellers who open seasonal stalls in Bromley High Street and elsewhere, call for persistent attention. The Regulations are inadequate to control such traders. If approached, they may give false names and leave the site only to commence operations elsewhere. Nevertheless, it is not always understood that the District Public Health Inspector can only concern himself with the enforcement of food hygiene requirements and cannot deal with any obstruction of the pavement or with the grievances of other traders. During the year the following prosecutions have been taken:— Prosecutions Fine Costs Stall £1 £1 Is. 0d. Stall £16 £10 10s. 0d. Greengrocers Shop £6 £4 4s. 0d. Bakers Shop £42 £8 8s. 0d. Restaurant £57 £15 15s. 0d. Butcher's Shop £80 £15 15s. 0d. It may be mentioned that in the course of an inspection of the greengrocer shop mentioned above the Inspector was physically obstructed by the owner who was subsequently fined £5 for this offence together with £1 in respect of smoking whilst handling food. The spate of legislation in the form of Regulations governing the constituents in manufactured foodstuffs continues to add to the complexities of control. The following Regulations have been issued in the current year and became operative immediately or early in 1971:— Made To come into operation Cheese Regulations 1970 23rd Jan. 1970 31st Jan. 1970 Labelling of Food Regulations 1970 12th Mar. 1970 31st Mar. 1970 Cream Regulations 1970 13th May 1970 1st June 1970 Emulsifiers & Stabilisers in Food (Amendment) Regulations 1970 24th July 1970 1st Sept. 1970 Colouring matter in Food (Amendment) Regulations 1970 24th July 1970 1st Jan. 1971 Food Hygiene (General) Regulations 1970 3rd Aug. 1970 1st Mar. 1971 Soft Drinks (Amendment) Regulations 1970 26th Oct. 1970 3rd Nov. 1970 72 The Wider Spectrum of Housing The supervision of food supplies is only one of the Department's many duties, albeit of great importance. To the environmentalist the provision of "shelter" in accord with modern requirements is another fundamental necessity for healthy living. Here, again, the Public Health Inspector is the official primarily concerned. There are many ways open to the Inspector for dealing with such privately owned housing stock of the Borough as may fall short of certain requirements. If a group of houses become unfit for human habitation and it is thought that the best way of dealing with them is by the clearance of the whole area there are procedures, with suitable safeguards for owners, whereby this can be brought about. This is the process known as Slum Clearance. Like all other housing work it commences with a detailed survey and assessment of the property. Subsequently it may involve the holding of an enquiry by an Inspector from the Department of the Environment. A year or two may elapse before the site is cleared. The Health Department has a Four Year Slum Clearance Programme and the appropriate houses were dealt with in 1970 details of which are given in the body of the report. Some houses which are unfit for human occupation do not lie in groups. These are dealt with as "individual unfit houses". Again, after inspection and legal procedures the owner may be required to close or demolish the properties. A similar process is open to the Council to close only a part of a dwelling when the rest of the house is not unfit. This system is frequently used to bring about the vacation of damp basement rooms. In all these cases the Council's policy is to rehouse the displaced tenants. Not all unfit houses are so defective that suitable repairs cannot raise them to a reasonable standard. Such properties can be dealt with as defective houses under the Housing Acts, in which case the owner is required to remedy the defects. Alternatively, they may be found to constitute a "nuisance" when remedy lies in the Public Health Acts. In practice this latter system is especially useful for relatively minor defects and is much used. In both cases, failure by an owner to carry out the necessary works can ultimately lead to legal proceedings and as a final resort the Council may step in and carry out the work at the owner's expense. It is, in fact, very rarely necessary to proceed so far, but whichever method is selected a lengthy period may elapse before the defect is remedied especially if the owner is unwilling. A new weapon has been added to the Inspectors' armoury in his endeavour to raise property to a reasonable standard of amenity and repair, having regard to the age, character and 73 location of the dwelling concerned. Briefly, in controlled tenancies, the owner may apply for a Certificate of Qualification which will not be granted unless the missing amenities are provided and the house brought up to a proper standard of repair. Ultimately, possession of a Certificate will enable him to increase the rent. The Inspectors have been able to obtain a very large volume of work by means of this procedure. It would be undesirable to demolish old houses which are in sound condition and which still have a substantial "life" but lack of modern amenities, such as a bath and an inside toilet. Improvement Grants are available to owners of such houses and many who occupy their own properties have taken advantage of the scheme. Compulsory improvement (i.e. in the absence of a request from the owner) can be enforced only where the tenant requests it or if the premises are contained within a "Compulsory Improvement Area" such as that established by the Council on part of Bromley Common. Improvement has been affected in a considerable number of old properties of sound structure by the use of these methods but new legislation will remove the powers to establish Compulsory Improvement Areas. One of the greatest problems facing the Department in its fight for better housing conditions is that posed by houses let in "multiple occupation." This type of letting may vary from virtually self-contained flats to old houses let room by room with toilet, cooking, and other facilities shared between 2 or more families. The conditions to be found vary from the objectionable to squalor in an extreme degree. The Council has approved standards relating to abatement of overcrowding, provision of amenities and for securing precautions against the spread of fire in these multioccupied premises. However, there are a large number of such properties and although a start has been made on a systematic programme progress with available staff has been slow. These are the principal methods which the Department has to remove the worst of our housing blots and to improve and preserve the remainder. Some details of the progress made are included in the body of this report. 74 FOOD AND DRUGS ACT, 1955 FOOD SAMPLING 1970 Letters in parenthesis are referred to on page 76. Article No. Examined No. Formal Unsatisfactory Informal Formal Informal Baby Foods - 17 - - Beer finings — I — — (j) Biscuits - 5 - 4 Blancmange Powder — 1 — — Brandy 3 — — — (f) Bread and Bread Rolls - 19 - 18 Buns — 1 — — (e) Butter - 9 - 4 Buttered Rolls — 1 — — (g) Cakes - 23 - 4 Cake Decorations - 3 - — Cake Improver — 1 — — (k) Cereal and Cereal Products — 10 - 2 Cheese — 32 - — Cheese Spread — 4 - — (r) Chocolate and Chocolate Confectionery - 15 - 2 Cidrax — 1 - — Coffee Products — 10 - — Coffee, pure — 9 - — Colouring matters — 11 - — (m) Cream — 18 - 1 Desiccated Coconut — 3 - — Dessert Powders — 1 - — Drugs — 25 - — Emulsifiers — 1 - — (c) Fish and Fish Products 12 - 4 Flour — 12 - — Fruit and Fruit Products (including tinned fruit) — 28 - — Fruit, Dried - 11 - — Gin 2 — - — Gravy Salt — 1 - — Ground Almonds — 2 - — Ice Cream — 27 - — Jam and Preserves — 6 - — Jelly — 4 - — Liqueur Chocolates — 2 - — Low Fat Spread — 1 - — Margarine — 4 - — Marzipan — 2 - — (a) Meat and Meat Products (including tinned meat) - 51 - 8 Meat tenderiser — 1 - — 75 Article No. Ex Formal amined Informal No. Formal Unsatis factory Informal d) Milk arid Milk Bottles I 87 - 14 Milk (Dried) — 4 — — Milk Drink — 1 — — Milk Puddings — 1 — — Milk (tinned) — 2 — — Mousse — 2 — — Nuts — 1 - — Oils and Fats — 4 — — Pastes — 49 — — n) Peanut Butter — 1 — 1 i) Poultry and Poultry Products — 10 - 3 Raising Agent — 1 — — Rum Flavour Butter — 2 — — Salads — 2 - — Salad Cream and Dressing — 8 — — [h) Sauces and Pickles — 7 — 1 b) Sausages and Sausage Meat 3 61 - 6 Sausage Rolls — 1 — — Savoury Filling — 1 — — Shandy — 1 — — Slimming Foods — 5 — — q) Soft Drinks - 24 - 1 Soft Drink Crystals — 1 - — Soup (canned) — 3 - — Soup (dehydrated) — 2 - — Spaghetti in Tomato and Cheese Sauce - 1 - - Spices and Flavourings — 13 - — Sugar and Sugar Products — 4 - — Sweeteners — 1 — — o) Sweets - 11 - 1 Synthetic Cream — 1 — — (1) Tea - 16 - 2 Vegetables (dehydrated) — 3 - — Vegetables (fresh) — 7 - — Vegetables (tinned) — 6 - — Vegetable products — 10 - — Vending Machines: — Cocoa — 1 - — Coffee — 1 - — Vinegar — 19 - — Whisky 3 — - — Yeast — 2 - — p) Yoghourt — 10 - 2 For Pesticide Residues: — Fish — 3 - - Meat — 4 - — TOTALS 12 779 - 78 76 Nature of Unsatisfactory Sample Remarks Serial No. 3449 (a) Cooked rashers of Bacon Composition: Contained three rodent droppings. The absence of phosphatase enzymes indicated that they had been heated. Legal proceedings. Cafe proprietor fined £25 with £9 19s. 6d. costs. Serial No. 3493 (b) Pork Sausages Composition: Contained 180 p.p.m. sulphite without declaration, contrary to the requirements of the Preservatives in Food Regulations. These sausages normally made without preservative. Discrepancy arose through use of a borrowed rusk which contained preservative. Now satisfactory. Serial No. 3450 (c) Fish Finger Composition : Contained a nail i in. long and of a type known as a panel pin. Adherent to it were softwood fragments together with small amounts of a starchy matter suggesting that it had been cooked in the fish finger. Matter investigated. Warning letter to producer. Serial No. 3407 (d) Channel Island Milk Composition : Free in the milk was a skin of denatured milk in which mould had grown. Legal proceedings. Bottler fined £25 with £5 5s. costs. Serial No. 3560 (e) Butter Composition : The foreign body associated with the butter was a bent piece of iron wire 0.9 in. in length and 0.035 in. in diameter. The butter itself was contaminated by a few specks of rust where the wire was in contact. Matter investigated. Warning letter to packers. Serial No. 3406 (f) Bread Composition: A house fly was embedded in the crumb and the absence of phosphatase enzymes indicated that insect had been heated. Matter investigated. Warning letter to bakers. Serial No. 3559 (f) Bread Composition: There was a house fly embedded in the crumb and the absence of phosphatase enzymes indicated that the insect had been heated. Matter investigated. Strong warning letter to bakers. 77 Nature of Unsatisfactory Sample Remarks Serial No. 3440 (f) Bread Composition: Embedded in the crumb of the loaf were small pieces of wrapping paper. Matter investigated. Warning letter to baker. Serial No. 3543 (f) Bread Composition: Contained fragments of newsprint. Six small pieces were isolated, the largest being 1J in. x } in. Legal proceedings. Baker fined £15 with £8 18s. Od. costs. Serial No. 3527 (f) Bread Roll Composition: Embedded in the crumb of the roll were parts of the limb of a rodent. Its condition, close adherence to the crumb and the absence of phosphatase enzymes indicated that it had been cooked in the roll. Legal proceedings. Baker fined £15 with £9 16s. 6d. costs. Serial No. 3467 (g) Cake Composition: Contained a softwood splinter li in. long which had crumb adherent to it. Sugar had penetrated the outer layers of the wood confirming that the splinter had been baked in the cake. Matter investigated. Warning letter to baker. Serial No. 3544 (g) Battenberg Cake Composition: a wood fragment 1 in. long and i in. wide, as well as a number of small splinters, were present. It was a hardwood of the mahogany class and varnish was present on some surfaces, suggesting it derived from a piece of furniture. Matter investigated. Warning letter to baker. Serial No. 3482 (h) Sweet Pickle Composition: Contained a piece of wood resembling oak, the surface layers of which had to some extent become permeated by the ingredients of the pickle. Matter investigated. Warning letter to manufacturer. Serial No. 3645 (a) Beef Curry Composition: The foreign matter was not a metal spring as was suspected but part of a plant. It had the characters of a leguminous seed pod. Matter drawn to attention of importers. Serial No. 3712 (b) Pork Sausages Composition: The meat content was 54 per cent as opposed to the required standard of not less than 65 per cent. Correspondence with manufacturers. Repeat formal sample—satisfactory. 78 Nature of Unsatisfactory Sample Remarks Serial No. 3676 (i) Canned Chicken in Sauce Composition: The meat content was 58 per cent. The Canned Meat Products Regulations call for not less than 60 per cent. Correspondence with manufacturers. Satisfacfactory. Serial No. 3709 (c) Fish Fingers Composition: The soiling of the coating of the fish fingers was due to the presence of iron particles. Warning letter to packers. Serial No. 3678 (d) Milk Bottle Composition: The soiling on the inner surface of the bottle consisted of a set cement and sand mixture. A few particles were free in the milk. Matter investigated. Not proceeded with owing to legal difficulties. Serial No. 3596 (d) Milk Bottle Composition: Adhering to the inner surface of the empty pint milk bottle was an irregularly shaped film of denatured milk in which mould had grown. Matter investigated. Warning letter to bottlers. Serial No. 3707 (d) Pasteurised Milk Composition: The foreign matter which was free in the milk consisted of small particles of tea leaves. Matter investigated. No further action Serial No. 3598 (f) Bread Composition: The foreign matter complained of consisted of fragments, about 2.5 mm. in diameter, of flour, soiled by oil and iron particles. Matter investigated. Warning letter to baker. Serial No. 3708 (f) Bread Roll Composition: The foreign matter embedded in the dough was approximately 2.5 mm. in diameter and consisted of soiled dough, iron particles being detected. Matter investigated. Warning letter to baker. Serial No. 3660 (f) French Roll Composition : Contained a glass fragment having the characters of common glass. It was 20 mm. in length and 5 mm. in width and had the shape of the rim of a glass vessel. Fragments of dough were adherent to its surface. Matter investigated. No further action. 79 Nature of Unsatisfactory Sample Remarks Serial No. 3677 (j) Biscuits Composition: The discolouration on the base of the biscuit measured 5 x 1.5 mm. It consisted of soiled dough, iron particles being present. Matter investigated. Warning letter to manufacturer. Serial No. 3659 (g) Cake Composition: The foreign body associated with the cake consisted of a 25 mm. length of match stick showing charring of the wood at the head end. Adherent to the wood were fragments of dough and tests showed that sugars had penetrated the wood structure. Complainant refused to give evidence. Warning letter to baker. Serial No. 3597 (k) Cereal Composition: The larva associated with the cereal was identified as that of Hofmannophila pseudospretella, the brown house moth. No evidence of infestation could be found, however, in the carton, wrapper or remaining contents of the packet. Matter investigated. No further action. Serial No. 3599 (1) Tea Composition: the "object" associated with the tea was not a rodent dropping as was suspected but consisted of small fragments of tea leaves matted together with hairs off the leaves to form a coherent mass. Matter drawn to attention of packers. Serial No. 3629 (1) Tea Powder Composition: the glass splinter associated with the sample was 4 cm. long and had the same specific gravity, 2.47, as the glass of the jar in which the sample was contained, as well as having a compatible shape to that of the rim of the jar. Matter investigated. Warning letter to packers and manufacturers. Serial No. 3842 (a) Fat (removed from the outside of a rolled topside joint). Composition: the fat was pork fat. Correspondence with vendor / manufacturer. This practice now discontinued. Serial No. 3927 (a) Roast Beef Dinner Composition: A calcareous stone weighing 2 g. was present in the meal. Matter investigated. Warning letter to packers. 80 Nature of Unsatisfactory Sample Remarks Serial No. 3909 (a) Pork Luncheon Meat Composition: The discolouration on the meat surface was due to rusting of the inner surface of the can. Matter investigated. Warning letter to importers Serial No. 3743 (a) Chopped Pork Roll Composition: The foreign matter was of animal origin and consisted of fragments of gristle and hairs. Matter drawn to attention of manufacturer. Serial No. 3776 (b) Pork Chipolatas Composition: Meat 56 per cent. Correspondence with manufacturer. Repeat formal sample — satisfactory. Serial No. 3762 (b) Sausage Composition: Contained a copper coated iron staple half an inch in length Matter investigated. Warning letter to manufacturer. Serial No. 3911 (b) Skinless Sausages Composition: The surfaces of the sausages were affected by mould growths. Matter investigated. Circumstance of sale not substantiated. Serial No. 3810 (a) Steak and Kidney Pudding Composition: Contained eight portions of a dressing made from cotton gauze and adhesive plaster. The fact that the dressing was fragmented indicated that it had been through a chopping process. There was no evidence of the dressing having been used. Matter investigated. Warning letter to manufacturer. Serial No. 3819 (i) Spray Dried Whole Egg Composition: The sample consisted of dried egg white. Repeat samples (3) satisfactory. Serial No. 3759 (c) Canned Pink Salmon Composition : The rubber object found in the tinned salmon was a finger stall. Matter investigated and drawn to attention of importers. Serial No. 3844 (d) Milk Bottle Composition: The bottle was soiled internally by dried milk residues and chalk deposits. Matter investigated. Warning letter to bottlers. 81 Nature of Unsatisfactory Sample Remarks Serial No. 3845 (d) Milk Bottle Composition: Mould growths were adherent to the inner surface of the bottle. Matter investigated. Warning letter to bottlers. Serial No. 3910 (d) Milk Bottle Composition: The inner surface of the base of the bottle was soiled round the periphery by deposits of a set sand and cement mixture. Matter investigated. Warning letter to bottlers. Serial No. 3945 (d) Milk Bottle Composition: The soiling of the internal surface of the bottle consisted of denatured milk containing a few fragments of plant debris. Matter investigated. Warning letter to bottlers. Serial No. 3946 (d) Milk Bottle Composition: Adhering to the inner surface of the unopened bottle was a small fragment of plant material resembling fruit skin. Matter investigated. Warning letter to bottlers. Serial No. 3959 (d) Milk Bottle Composition: The unopened pint bottle of milk contained loose in the milk a triangular piece of glass weighing 3.1 g. The curvature of the fragment of glass coincided with that of the container bottle. Matter investigated. Warning letter to farmer. Serial No. 3761 (m) Cream Composition: The cream contained a one inch length of human hair of a light brown colour. Matter investigated. Strong warning letter to packers. Serial No. 3826 (e) Butter Composition: The moisture content was 16.8 per cent as opposed to the maximum of 16 per cent permitted under the Butter Regulations. Correspondence with importers. Satisfactory. Serial No. 3978 (e) Butter Composition: The surface of the butter was affected by growths of the mould Penicillium and the fat showed evidence of rancidity. Matter investigated. Strong warning letter to packers. 82 Nature of Unsatisfactory Sample Remarks Serial No. 3843 (n) Peanut Butter Composition: The piece of glass submitted with the jar of peanut butter had the same specific gravity as the glass of which the jar was made. The sample jar was intact. Matter investigated. Strong warning letter to packers. Serial No. 3760 (f) Buttered Bread Composition: The dark coloured material embedded in the crumb consisted of dough soiled with iron and mineral oil. Matter investigated. Warning letter to baker. Serial No. 3763 (f) Bread Composition: The crumb was soiled locally by charred dough fragments. Matter investigated and drawn to attention of baker. Serial No. 3841 (f) Bread Composition: The soiling of the dough was due to mineral oil and particles of iron. The contamination was probably from the bakehouse machinery. Matter investigated. Warning letter to baker. Serial No. 3928 (f) Bread Composition: A cockroach was present in a depression in the basal crust of the loaf. The absence of phosphatase endymes indicated that it had been baked with the loaf. Legal proceedings. Baker fined £30 with £15 4s. Od costs. Serial No. 3977 (f) Bread Composition: The slices of bread showed an indentation on their basal surface: this indentation was soiled in similar manner to the two portions of cigarette filter tip associated with the sample and small portions of the filter tip were adherent to this depression. Legal proceedings. Baker fined £40 with £15 4s. Od. costs. Serial No. 3979 (f) Bread Composition: The foreign matter in the crumb of the bread consisted of rust flakes. Matter investigated. Warning letter to baker. Serial No. 3874 (j) Biscuits Composition: The amounts of calcium and phosphorus were both below the declared values, 100 as opposed to 120 and 55 as opposed to 85 mg. per oz. respectively. Correspondence with manufacturers. Satisfactory. 83 Nature of Unsatisfactory Sample Remarks Serial No. 3960 (o) Sweets Composition: Of the fifteen sweets submitted, thirteen showed evidence of infestation in that excreta and webbing were present. Three live larvae of the Cocoamoth — Ephestia elutella — were found. Legal proceedings [lending. Serial No. 4055 (b) Beef Sausages Composition: Contained 240 p.p.m. sulphite without declaration, contrary to the requirement of the Preservatives in Food Regulations. Correspondence with vendor. Now exhibiting, appropriate notice. Satisfactory. Serial No. 4016 (a) Pork Pie Composition: The object which had been removed from the pie was a bone fragment. Complaint investigated and result brought to the attention of producer. Serial No. 3980 (i) Chicken Pie Composition: Embedded in the filling of the pie was a wasp which had been heated. Matter investigated. Warning letter to producer. Serial No. 4113 (c) Tinned Pilchards Composition: Contained the isopod crustacean Nerocilia orbignyi, parasitic on the bodies of fish. Investigation. Matter drawn to the attention of importer. Serial No. 4050 (d) Pasteurised Milk—unopened bottle Composition: Attached to the inner surface of the bottle was a fruit fly (Drosophila). Legal proceedings. Bottler fined £50 with £10 14s. 6d. costs. Serial No. 4083 (d) Empty Milk Bottle Composition: Contained a piece of set sand and cement mixture which was 25 mm. long and approximately 10 mm. in width. Matter investigated. Warning letter to bottlers. Serial No. 4114 (d) Empty Milk Bottle Composition: Internally, the base and the lower part of the sides of the bottle were soiled by fragments of a set sand and cement mixture. Legal proceedings. Bottler fined £25 with £25 costs. 84 Nature of Unsatisfactory Sample Remarks Serial No. 4167 (d) Pasteurised Milk—unopened bottle Composition: Floating free in the milk was a denatured milk film in which mould had grown. Legal proceedings pending. Serial No. 4162 (p) Apricot Yoghourt Composition: Contained parts of an ant. As most of the appendages were missing it was not possible to identify the ant but nevertheless it was not a British species and may have been associated with the apricot. Examination indicated that the ant had been heated. Matter investigated. Warning letter to manufacturer. Serial No. 4163 (p) Bilberry Yoghourt Composition: Contained a Carabid beetle. Examination indicated that it had been processed in the Yoghourt. Matter investigated. Warning letter to manufacturer. Serial No. 4129 (e) Butter Composition: Embedded in the block of butter was a fragment of grey coloured cardboard. Matter investigated. Warning letter to packers. Serial No. 3997 (f) Sliced Bread Composition: Embedded in each of the five slices of the cut loaf were fragments of a plastic covered fabric. Examination indicated that the fabric was in the loaf at baking and that it was cut with the cutting of the loaf. Matter investigated. Warning letter to baker. Serial No. 4051 (f) Bread Composition: The foreign matter embedded in the crumb of one crust and the adjacent slice consisted of jute fibres which had probably derived from sacking. Matter investigated. Warning letter to baker. Serial No. 4130 (f) Bread Composition: The foreign matter consisted of a small fragment of dough (4 mm. by 1 mm.) soiled with iron and mineral oil. Matter investigated. Warning letter to baker. Serial No. 4161 (f) Bread Rolls Composition: The outer surfaces of the rolls had become soiled with particles of charred dough together with sacking fibres (jute). Matter under investigation. 85 Nature of Unsatisfactory Sample Remarks Serial No. 4160 (j) Biscuits Composition: The top biscuit in the pack had embedded in it a ferrous metal turning 13 mm. long. Legal proceedings pending. Serial No. 4166 (j) Biscuits Composition: The unusual appearance of these biscuits was not due to mould but may have been due to the surface having become damp and on subsequent drying sugar has partly crystallised. Stock withdrawn from sale. Serial No. 4004 (g) Two Cream Doughnuts Composition: The fat in the "cream" filling of the doughnuts was not butter fat. Contact with vendors. Satisfactory notice now exhibited. Serial No. 4082 (k) Breakfast Cereal Composition: The foreign object in the packet was a lump of wax weighing 5.6 g. and was similar to the wax on the inner wrapper. Matter investigated. Warning letter to packers. Serial No. 4057 (q) Super Concentrated Orange Squash Composition: The description, "super concentrated", and the claim that an eight-fold dilution was appropriate implied that the squash was stronger than a normal squash, but this did not appear justified as the juice content was 32 per cent as opposed to 40 per cent implied by the claim. Complies with Soft Drink Regulations. Referred to Weights and Measures Department for action on labelling under the Trades Description Act. They have contacted the manufacturers. Serial No 4080 (r) Chocolate Chewing Nuts Composition: The chocolate showed evidence of attack by larvae of the Cocoa Moth. Under investigation. Serial No. 3998 (r) Chocolate Composition: There was evidence of attack by larvae of Ephestia elutella, the cocoa moth. Matter investigated. Warning letter to vendor. 86 Unsound Food Some comment is necessary to explain the large quantity of frozen foods dealt with during the year. Almost all of this arises from the breakdown or malfunction of refrigerated display cabinets and cold stores in shops and stores (some of this food went bad as a result of electricity power cuts during the "industrial action" in the early part of the year). Frozen food which has thawed out must be used immediately. Many items are rendered unsaleable and once thawing has occurred the food should not be re-frozen. The closing of the refuse tip at St. Mary Cray and the cessation of destruction of refuse by incineration within the Borough has given rise to difficulties in the safe disposal of unsound food. However, with the co-operation of the Greater London Council these have been overcome although facilities are not so satisfactory as heretofore. A total of 18 tons 12 cwts. 53 lbs. of food unfit for human consumption was surrendered to Public Health Inspectors during the year. Details of the various items are given below: — Tons Cwts. lbs. Meat and Offal at slaughterhouse — 3 20 Meat and Offal at wholesale and retail premises 1 18 76 Cooked meat and meat products — — 87 Canned meat — 17 95 Fish (fresh and tinned) — 10 27 Frozen Foods 11 9 57 Other Foods 3 12 27 87 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken and submitted for examination with the following results— Satisfied Failed Phosphatase Test 158 — Methylene Blue Test 172 6 Ring Test 60 — 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 — 70 Grade II — 18 Grade III — 6 Grade IV — 1 Further samples were obtained from the suppliers whose products had given Grade III and IV results. These further samples were found to be satisfactory and were classified as Grade I. 88 OTHER SAMPLES AND SPECIMENS SUBMITTED TO PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION 60 empty milk bottles were submitted at intervals during the year for bacteriological examination directly following their treatment by the bottle washing machine at a local milk bottling plant, all were found to be satisfactory. Samples of the under-mentioned foodstuffs were also examined for bacteriological condition, all proved to be satisfactory:— No. of samples Article 2 Noodles 1 Reconstituted Dried Eggs (whole egg) 1 Frozen whole Eggs 1 Frozen albumen 1 Pistachio Galantine 1 Sliced spam 1 Desiccated coconut 1 Chopped Pork with Stuffing Samples of foodstuffs as under were examined in connection with Food Poisoning enquiries and were found to be free of pathogenic organisms. Remains of meal from Chinese Take Away Foods Neg. Potato Salad in Mayonnaise Neg. Savoury Mixed Beef with Vegetables Neg. Cold Turkey, Aspic Jelly and Chopped Tongue Neg. Cooked Whole Chicken Neg. Veal Cutlets with Mushroom Neg. Green Giant Whole Kernel Corn Neg. Baked Beans in Tomato Sauce Neg. 387 specimens of faeces were examined from persons suspected to be suffering from infectious disease or food poisoning, or who were contacts of persons so suffering. The results were:— Faeces Specimens Positive Negative Suspected Dysentery 62 12 50 Suspected Food Poisoning 296 67 229 Suspected Paratyphoid, etc 29 7 22 Blood Positive Negative Suspected Food Poisoning — 1 Urine Positive Negative Suspected Typhoid — 6 89 MEAT INSPECTION The carcases of all animals slaughtered within the Borough were inspected and regular routine visits and inspection 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 39 6 4 413 103 — Number not inspected NIL NIL NIL NIL NIL NIL A11 diseases except Tuberculosis and Cysticerci Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned 10 4 1 42 18 - Tuberculosis only Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - - Cysticerci Carcases of which some part or organ was condemned 1 1 - - - - Carcases submitted to refrigeration 1 1 — — — — Generalised and totally condemned — — — — — — The approved charges totalling £22 were made for the inspection by the Public Health Inspectors of the carcases shown in the above table. Approximate weight of meat condemned 356 lbs. 90 FOOD COMPLAINTS The number of complaints received relating to food which after sale has been found to contain foreign bodies or is out of condition continues to give rise to concern. During the year 130 were received, being 29 in excess of the figure for 1969 and amounting to one complaint for every other day the office was open. Twenty-four of these related to mouldy conditions found on bread, flour, confectionery, pies, sausages, yoghurt, etc. This shows an increase on the previous year and is most disappointing. In June a letter was addressed to all retail outlets for these perishable foodstuffs setting out in great detail the conditions to be observed in their control. The presence of mould on meat products may not, in itself, be harmful to the consumer. It will give rise to unpleasant flavour but the the conditions which favour mould growth are often identical with those which allow the multiplication of food poisoning organisms to a dangerous level. The Department's principle aim in dealing with food complaints is the removal of conditions which have given rise to them. After full investigation a warning may be given to a manufacturer or a vendor. If advice is rejected or ignored legal proceedings under the Food and Drugs Act are considered. The complaints came within the following categories:— Alleged condition Foreign Bodies, Dirty, etc. Mouldy Other Conditions Bread and flour confectionery 25 7 1 Tinned foodstuffs 10 — 3 Perishable articles (pies, sausages, etc.) 10 8 4 Milk and Milk Bottles 15 — 2 Chocolate and sugar confectionery 4 — — Cereals 3 — — Preserves 1 — — Miscellaneous 15 5 9 Butter 2 1 — Cheese 2 3 — Foreign bodies identified in the specimens were:— Bread and flour confectionery: Pieces of "fur", paper, wood, glass, wire, matchsticks, plastic, string, bakehouse char, machine 91 grease, and insects, nails, part of a cigarette, mouse excreta, and part of a rodent. Tinned foodstuffs: Small metal spring, broom bristle, rubber finger stall, small stone, an insect, and staining from the internal surfaces of tins. Pies, sausages, etc.: Small pieces of metal in sausages, bandage in meat pie, insects, and animal tooth in meat pie. Milk and milk bottles : Internal stains, cement, fly larvae, glass. Chocolate and sugar confectionery: Maggots. Preserves: Glass in jam. Cereals: Insects. Butter : Wire and string. Cheese: A nail and a fly. Miscellaneous: Glass in peanut butter, piece of metal in a steak, maggots in sliced ham and bacon, matchstick in fish cake. Other conditions consisted of : foul odour in frozen beans, decomposition of bacon, sour sausages, taste and smell of disinfectant in milk, abnormal taste in baby food, rusted interior of can of evaporated milk, and sour milk from a vending machine. Not all complaints were justified, there were some instances where the smell, taste or appearance of articles complained of proved to be natural to the foodstuffs in question. During 1970 it was found necessary to issue 84 warning letters and to institute proceedings as shown below:— Fined Costs FC 561 Chicken and ham pie affected with mould Retailer £25 £5 FC 515 Pork pie affected with mould Retailer £15 £8 FC 468 Bread contained part of a mouse Manufacturer £20 £5 5s. Od. FC 469 Bread contained piece of paper Manufacturer £15 £8 18s. Od. FC 530 Bread contained insect Manufacturer £30 £15 4s. Od. FC 543 Bread contained part of cigarette Manufacturer £40 £15 4s. Od. FC 557 Fly in bottle of milk Dairyman £50 £10 14s. 6d. FC 568 Dirty milk bottle Dairyman £25 £25 FC 539 Wrapped sweets contained maggots Retailer £25 £8 92 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 698 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 245 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 1970 approximately 5,000 birds were slaughtered, the premises were visited on 16 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 The following premises in the Borough are subject to the requirements of the above-mentioned Regulations:— Bakers and Bakehouses 104 Butchers 168 Confectioners 226 Milk Dealers 123 Clubs and Hotels 135 Chemists 75 Fishmongers (wet, dried and fried) 61 Greengrocers 143 Grocers 275 Hospitals, Nursing Homes and Old People's Homes 76 Canteens 105 Public Houses 161 School Canteens and Services 116 Cafes and Restaurants 178 93 MILK (SPECIAL DESIGNATION) REGULATIONS Licences to deal in specially designated milks were currently held as under:— Dealers (Pasteurisers) 1 Pasteurised 106 Sterilised 86 Ultra Heat Treated 82 Untreated 30 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Regulations made under this Act prescribe standards of cleanliness for specified materials used in filling upholstery, soft furnishings, bedding, soft toys, etc. No infringements were found during the year. There were no new licences issued to manufacture specified materials, nor any new registrations made in connection with their storage. HOUSING AND SLUM CLEARANCE Early in the year the Council approved a 4 year programme for the clearance of unfit houses totalling nearly 200 properties. The programme for 1970 was completed although it was found on detailed inspection that some of the properties could not be dealt with on the grounds of unfitness or bad arrangement. Four Clearance Areas were declared in respect of 24 properties in Jasmine Grove, Penge, Oakfield Road, Penge, and Churchill Road, Beckenham. One property was demolished as the result of a previous Demolition Order and 43 properties were demolished following Clearance Area and Compulsory Purchase procedure. Closing and Demolition Orders were represented and made on 16 properties or parts of premises which were found to be unfit and not capable of repair at reasonable expense. There were 60 known cases of statutory overcrowding of which 11 came to the notice of the department during 1970. 23 families were rehoused, 5 families themselves found suitable alternative accommodation and 2 families moved out of the district. As mentioned in the preamble to this section of the report the Housing Act, 1969, brought an initial flood of applications for Qualification Certificates. Part III of the Act introduced a new 94 system enabling the rents of private dwellings, which were subject to control, to be increased provided the dwellings met certain standards with regard to repair, amenity and fitness. If satisfied that these conditions are met the Local Authority on application by the owner may issue a Qualification Certificate which entitles him to apply to the Rent Officer for a Certificate of Fair Rent. The qualifying conditions are:— (a) that all the standard amenities are provided for the exclusive use of the occupants of the dwelling; (b) that the dwelling is in good repair having regard to its age, character and locality and disregarding internal decorative repair; and (c) that the dwelling is in all other respects fit for human habitation. The standard amenities referred to are:— (a) a fixed bath or shower which must be in a bathroom; (b) a wash-hand basin; (c) a sink; (d) a water closet which must be in, and accessible from within the dwelling; and (e) a hot and cold water supply at the fixed bath or shower, the wash-hand basin and the sink. The procedures, following the receipt of an application for Qualification Certificate by an owner who feels that his house satisfies these conditions, are laid down and are quite complex. Each application may involve several inspections of the property, a great deal of correspondence and other negotiations with landlords. Considerable time is often expended by the staff in explaining to owners and tenants the procedures and legal rights involved. During 1969, 224 applications were received and by the end of 1970 this total had risen to 819. 322 Certificates had been issued, and 142 refused, the remainder were awaiting the completion of items of repair before being given further consideration. In 134 instances works of repair and renovation were 95 requested and carried out before the issue of Certificates were approved and the following table gives an indication of the extent and variety of the items involved. Baths 1 Brickwork and Pointing 13 Ceilings 11 Doors 36 Electric Wiring 19 Fireplaces and Boilers 19 Fences and Gates 18 Gutters and Downpipes 30 Floors, damp and defective 11 Paintwork—External 36 Plaster—Wall 18 Putties—Windows 35 Paving 9 Roofs 21 Rendering 7 Sink Wastes 7 Sinks 5 Stairs 13 Steps 5 Windows—frames 35 cills 13 ill-fitting 82 glazing 38 sashcords 12 Walls—damp 25 Water Heaters 3 Water Taps 11 Washbasins 10 W.C.'s—pans 9 cisterns 4 96 Application for Qualification Certificate may also be made by an owner in respect of property which does not satisfy the qualifying conditions but in these cases the application must be accompanied by a specification of the works which will, in the opinion of the owner, bring the house to the required standard. If the Local Authority are satisfied, a Provisional Qualification Certificate may be issued to enable an application to be made for the Fair Rent Certificate and the rent assessed. When the work has been completed to the Department's satisfaction a Qualification Certificate may be issued and the new rent can be registered. The increase has to be phased over five equal annual stages. During 1969/70 5 applications were received and 5 Provisional Qualification Certificates were issued. It has seldom been found necessary to refuse any application outright except where it is stated that the house satisfies the qualifying conditions but is found on inspection to lack one or more standard amenities. In most other cases the applicants have been notified of the works required to bring the houses to the required standard and this has enabled considerable improvements to be made informally. There is little doubt that this part of the Housing Act has achieved its aim in producing fair rents at the same time as halting the further deterioration of the older properties. Slow but steady progress was made in the inspection of Houses in Multiple Occupation resulting in improved amenities and the provision of means of escape in case of fire. The appended tables give a detailed account of the work of Housing and Slum Clearance carried out during 1970:— CLEARANCE AREAS REPRESENTED Churchfields Road, Clearance Area, 1970: Nos. 57/87 (odd) Churchfields Road, Beckenham. Bromley—Jasmine Grove/Oakfield Road (Penge) Clearance Area, 1970: No. 1 Jasmine Grove. Nos. 6, 8, 10, 12, 16, 20 and 22 Oakfield Road. 97 RE-HOUSING The following information has been supplied by the Housing Managerpr/or to 1970 During 1970 Houses Houses Permanent dwellings built (of the grand total of 11,681, 102 of these properties have been sold) 11,221 460 Prefabricated dwellings built by Local Authority 294 Nil (23 still occupied) During 1970, 567 families were housed from the waiting list in permanent accommodation. The total number of facilities on the waiting list as at 31st December, 1970, was 4,283. HOUSING (A) Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices : — Informal Formal By owner 351 58 (B) Beyond repair—Housing Act, 1957 1. No. of undertakings accepted (Section 16) 2 2. No. of closing orders made (Section 17) 1 3. No. of demolition orders made (Section 17) 2 4. No. of closing orders made (Section 18) 4 5. No. of closing orders determined (Section 27) Nil 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 2 2. Houses unfit for human habitation 24 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 69 (b) Families 27 98 (2) Action taken during the year : 1. Houses demolished by Local Authorities or Owners : (a) Unfit 36 (b) Others 3 2. Number of people displaced from houses to be demolished or closed: (a) Individuals 776 (b) Families 243 COMPULSORY IMPROVEMENT OF DWELLINGS Preliminary Notices served 3 Immediate Improvement Notices served 3 Formal undertakings given by owners to execute improvement work 3 Houses where works of improvement were completed during the year 10 RENT ACT, 1957 Certificates of Disrepair and other documents specified in the Act have been issued as follows:— Applications for Certificates of Disrepair 1 Number of decisions not to issue certificates — Number of certificates issued 1 Number of undertakings given by landlords under Paragraph 5, First Schedule — Number of undertakings refused by L/A — Applications for Cancellation of Certificate By Landlords to L/A for cancellation — Objections by tenants to cancellation — Certificates cancelled by L/A — A pplications for Certificates as to remedying defects which landlord has undertaken to remedy Number of applications 2 Number of certificates issued 2 99 HOUSING INSPECTIONS Defects Remedied, Nuisances Abated by Informal Action Drainage Drains: Constructed or Reconstructed 75 Repaired 139 Cleansed 882 Cesspools: Provided — Overflowing 36 Abolished 2 Sanitary Appliances Sinks, etc., provided 13 Sinks, etc., repaired 37 W.C.s provided 8 W.C.s repaired 55 Dampness Roofs and rainwater fittings 349 Walls and stacks 229 Damp-proof courses and floors 88 Water Supply Provided 6 Installations repaired 24 General Items Wallplaster 27 Ceiling plaster 113 Floors 120 Rooms cleansed or redecorated 66 Windows and doors 218 Lighting 13 Ventilation 18 Staircases 16 Fireplaces, etc. (ex. Clean Air) 12 Yard paving and drainage 53 Dustbins 77 Food storage and preparation 32 Nuisances from animals abated 23 Accumulations removed 110 Premises disinfested 41 Premises disinfected 2 100 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. 793 Informal Notices were issued of which 377 had been compiled with by the end of the year. 107 Statutory Notices were served. During the year 93 Statutory Notices were fully complied with. COMMON LODGING HOUSES The one remaining Common Lodging House namely the premises at Poverest Road, St. Mary Cray, closed down early in 1970. There are now no premises used as Common Lodging Houses in the Borough. 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 six licences in force. Particulars of the licensed sites are as follows:— No. of Vans Location of Licensed Sites Permitted The Paddock, Downe Road, Keston 12 Lower Hockenden Farm, Hockenden, Swanley 1 Crittenden Caravan Park, Pond Lane, High Street, West Wickham 30 Chalk Pit Caravan Site, St. Paul's Cray 25 11 Heathfield Road, Keston 23 Restavon, Berry's Green Road, Cudham, Nr. Biggin 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. 101 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 1,852 instances of choked drains dealt with, 1,022 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 1970 as under:— PRIVATE ESTATE DEVELOPMENT Foul Sewers Yards 6 in. diameter 2,651 9 in. diameter 1,843 Surface Water Sewers 6 in. diameter 1,530 9 in. diameter 1,875 12 in. diameter 304 15 in. diameter 162 24 in. diameter 81 PRIVATE STREET WORKS Foul Sewers 4 in. diameter 10 9 in. diameter 771 Surface Water Sewers 6 in. diameter 293 9 in. diameter 322 12 in. diameter 265 15 in. diameter 141 42 in. diameter 279 102 SEWERAGE AUTHORITY (a) New Sewers 1. Foul Sewers 6 in. diameter 88 9 in. diameter 175 12 in. diameter 214 15 in. diameter 447 15 in. diameter in 36 in. diameter 43 2. Surface Water Sewers 9 in. diameter 22 12 in. diameter 129 15. in. diameter 267 36 in. diameter 219 42 in. diameter 157 48 in. diameter 456 60 in. tunnel 400 (b) Replacement Sewers 1. Foul Sewers 6 in. diameter 2 9 in. diameter 88 12 in. diameter 60 18 in. diameter 20 2. Surface Water Sewers 9 in. diameter 20 12 in. diameter 75 21 in. diameter 18 (c) By Declaration under Sections 17 and 18, Public Health Act, 1936 1. Foul Sewers 6 in. diameter 398 9 in. diameter 442 2. Surface Water Sewers 9 in. diameter 41 (d) Sewage Pumping Station Station Plus Rising Main 1£ in. diameter 119 103 DISINFECTION Articles of clothing, bedding, etc., were dealt with at the steam disinfecting plant at Crofton Road 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 127 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 Weather conditions this year were again suitable for wasps to produce large numbers of colonies and 588 nests were destroyed. The charge for this service was kept to £1 per nest clearance. From the nature of the complaints received it is evident that the presence of wasp nests in or adjacent to dwellings causes considerable anxiety to the occupants and, whilst a percentage of complaints express the view that this service should be provided free of cost, the large majority are satisfied to be rid of a wasp nest for the charge made. ATMOSPHERIC POLLUTION At the beginning of the year some 7,320 acres of the borough and approximately 38,750 of its premises were covered by smoke control orders. These figures represent approximately 20 per cent of the total area of the borough and approximately 35 per cent of the premises. During the year Smoke Control Orders Nos. 10, 11 and 12, namely parts of Plaistow, Sundridge, Bickley and Famborough 104 wards, and Copers Cope ward, were confirmed by the Minister of Housing and Local Government but the operative date was postponed by the Minister from 1st December, 1970, to 1st July, 1971, because no assurance could be given by the fuel suppliers that adequate supplies of smokeless fuel would be available during the 1970/71 winter. Two local residents lodged objections to the confirmation of Smoke Control Order No. 12 which covers Copers Cope ward, with the result that the Minister caused a local hearing to be held at Bromley Town Hall. The Minister, however, over-ruled the objection and as stated the Order was confirmed. When these Orders become operative on 1st July, 1971, a further 8,970 premises and 2,634 acres will have been brought under smoke control. Towards the end of 1970 the Minister of Housing and Local Government requested all authorities in the London area to suspend the operation of some of their smoke control orders in order to ease the position concerning the non-availability of solid smokeless fuel. The Council decided to suspend nine of its smoke control orders in order to permit the burning of coal when supplies of smokeless fuel were exhausted. Approximately 37 per cent of the premises under smoke control are affected by the suspension orders which operate until 31st March, 1971. At the time of writing the daily measurement of smoke and sulphur dioxide which are made within the borough have not indicated any marked increases in pollution as a result of the suspension orders permitting the use of coal nor have there been complaints about fuel not being available. The preliminary survey of three further smoke control areas which will be established in due course in Bickley ward, Manor House ward and the remaining part of Famborough were completed with a view to orders being made by the Council for submission to the Minister. Under the provisions of the Clean Air Act, 1969, applications were received for the approval of the proposed height of chimneys to be erected in connection with new plants, or the alteration of existing plants. The applications related mainly to the chimneys of oil fired boiler plants at schools, institutional premises and industrial premises. Following some requested modifications all the proposals were approved. The instruments for determining the concentration in the atmosphere of the two main pollutants, i.e. smoke and sulphur dioxide continue to be maintained by the Public Health Inspectorate and the recorded measurements are forwarded monthly to the Ministry of Technology (Warren Springs Laboratory). 105 Twelve premises within the Borough are licenced by the Ministry of Housing and Local Government for the storage and use of radio-active materials. 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 London Borough of Bromley No. 10 Plaistow, Sundridge, Bickley (parts) * 923 2,361 London Borough of Bromley No. 11 Famborough (part) * 921 3,176 London Borough of Bromley No. 12 Copers Cope (part) * 790 3,433 'Postponed from 1.12.70 to 1.7.71 106 PREVENTION OF DAMAGE BY PESTS ACT, 1949— RODENT CONTROL Surface Infestations The number of complaints of rat infestation received remains approximately at the same level as the last few years. In the case of complaints of mice, however, this year's figures show an increase of 38 per cent over those for 1969. From consultations with other local authorities in London it has been ascertained that the increase in mice infestations is fairly general and the consensus of opinion is that it is due to the infestation of new buildings of the terrace type, during the course of erection, where no precautions are taken to prevent access to cavity walls and ducts. Sewers The practice of treating the sewerage system with poison bait twice yearly continues, also the test-baiting in the spring which reveals the level of infestation. This level has never been high and for the year under review there was a noticeable reduction in the number of "takes". Properties other than sewers Type of Property NonAgricultural Agricultural 1. Number of properties in district 122,388 323 2. (a) Total number of properties (including nearby premises) inspected following notification 6,202 10 (b) Number infested by (0 Rats 2,059 7 (ii) Mice 363 3 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 28 52 (b) Number infested by (i) Rats 2 2 (ii) Mice — — 107 FOX CONTROL In recent years there have been increasing complaints from residents in Bromley regarding the presence and depredations of foxes. On 1st January, 1970, an officer with considerable experience of Fox Control was appointed to deal with this problem. It was intended that the destruction of foxes should be confined to instances where a nuisance has been caused to residents and this policy has been closely followed. The need to conserve wild life has been fully appreciated and foxes inhabiting woodlands and open spaces and not causing complaints have not been molested. During the year 618 complaints were received and investigated and 346 foxes were traced and killed thus more than justifying the work undertaken. PIGEON DESTRUCTION Complaints were received during the year and, as a result of these and daily routine visits to the numerous sites of congregation. 4,149 pigeons were dealt with. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The working conditions in offices, shops, etc., have continued to be the subject of general inspections made under this Act, 1,820 inspections being carried out and in 293 instances employers were requested in writing to deal with contraventions found. The most common types of contraventions were failure to provide first aid equipment, inadequate washing facilities, insufficient ventilation, absence of therometers to register room temperature, and inadequate cleansing of floors, passages, stairs and sanitary conveniences. The total number of visits made for all purposes was 2,579 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. 108 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 33 780 511 Retail shops 94 1,622 1.064 Wholesale shops, warehouses 5 58 58 Catering establishments open to the public, canteens 9 181 181 Fuel storage depots 12 6 Totals 141 2,653 1,820 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 2,579 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 19 15 Eating facilities 2 5 Overcrowding 1 16 Floors, passage and stairs 13 6 Temperature 31 17 Fencing exposed machinery 8 7 Ventilation 22 8 Lighting 4 18 Protection of young persons from dangerous machinery - 9 Sanitary Conveniences 15 10 Washing facilities 27 19 Training of young persons working at dangerous machinery - 11 Supply of drinking water 6 12 Clothing accommodation 7 23 Prohibition of heavy work — 13 Sitting facilities 1 24 First Aid—General Provisions 31 14 Seats (Sedentary Workers) 2 50 Exhibition of abstract of Act 1 77 Total 293 109  (C) Exemptions Number 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 8 7 — - 1 7 Retail Shops 50 44 — 4 5 41 Wholesale Shops, Warehouses 7 7 — — — 7 Catering Establishments open to the public - - - - - - Canteens - - - - - - Fuel Storage Depots - - - - - - TOTALS 65 58 — 4 6 55 Analysis of Reported Accidents Offices Retail Shop Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery — — 1 — — Transport - 7 - — — Falls of persons 4 15 4 — — Stepping on or striking against object or person — 6 — — — Handling goods — 8 1 — — Struck by falling object 2 — 1 - — Fires and Explosions — — — — - Electricity 1 — — - — Use of hand tools — 13 — — — Not otherwise specified 1 1 — — — 110 Prescribed Particulars on the Administration of the Factories Act, 1961 PART I OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 57 52 Nil (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 705 197 10 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 52 246 - Nil Total 814 495 10 Nil 2. Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 1 1 - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 1 — — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient 2 2 — - - (b) Unsuitable or defective 6 6 — — - (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) - - - - - Total 10 10 — 8 - PART VIII OF THE ACT OUTWORK (Sections 133 and 134) No. of out-workers in August list required by Section 133(l)(c) Wearing Apparel—making, etc. 77 Household linen 2 Lace, lace curtains and nets 1 Upholstery 4 Making of paper bags 1 Making of boxes or other tacles or parts thereof made wholly or partially of paper 2 Stuffed Toys 4 Manufacture of lampshades 2 MORTUARIES In cases of sudden death it is necessary to conduct a postmortem examination of the body 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 bodies 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 658 bodies were handled at the two mortuaries in 1970. The work of the mortuary attendants is demanding and not always pleasant. The tactful handling of bereaved relatives is a very necessary quality. The viewing rooms at both mortuaries have recently been refurbished to enable what is so often a distressing experience to take place in seemly surroundings. SWIMMING BATHS Swimming baths in the Borough to which the public has access are subjected to periodic inspections and samples of the bath waters are periodically submitted for bacterial and chemical 111 112 examination to confirm that measures taken for purification are effective. The Baths Manager and Engineer provides day to day oversight of the Public Baths owned by the Council and also of baths situated at Schools controlled by the Council. At the Crystal Palace Sports Centre there are three baths controlled by the Greater London Council whose Scientific Branch submits monthly reports on the samples taken therefrom. 43 samples were reported upon and all were satisfactory. Of the 52 samples taken by Public Health Health Inspectors, 3 from privately owned swimming baths were not entirely satisfactory and prompt action was taken to rectify the condition of the waters. 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 to operate in the London Borough of Bromley during 1970 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 details. REGULATION OF MOVEMENT OF SWINE ORDER Under the terms of this Order 202 movement licences were received and verified. The restrictions of these licences were fully complied with by the pigkeepers concerned. FOWL PEST ORDER, 1938 Under the terms of this order notices declaring premises to be an infected place (Form A) were served in respect of fifteen farms and inspections were made to ensure that the imposed Rules were properly observed. Movement Restriction Notices (Form B) were also served in respect of seventeen farms which had been exposed to infection, these premises were kept under observation and no infringements were found. At the end of the year all notices had been withdrawn with the exception of four Forms A. 113 RABIES ORDER, 1938 A suspected case of rabies occurring in the Borough in April was reported to the Ministry of Agriculture, Fisheries and Foods, whose officers took the action required by the Order. There was no evidence of biting of other animals or persons. An Isolation Notice (Form Al) was served on 9th April and was subsequently withdrawn on 15th April, it being established that the animal had not in fact been infected with rabies. ANIMALS (MISCELLANEOUS PROVISIONS) ORDER. 1927 The following Order was advertised in the National Press as required under the terms of the Order: The Importation of Dogs and Cats (Amendment) (No. 3) Order, 1970. PERFORMING ANIMALS (REGULATION) ACT, 1925 In October a circus was held on Bromley Common, visits were made to ensure that the conditions of this Order were observed. No infringements were found. RIDING ESTABLISHMENTS ACTS, 1964 AND 1970 Annual inspections were carried out at eleven riding establishments. Ten were recommended for licensing and one for conditional licensing. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Inspections were carried out at fifteen boarding establishments. Fourteen were recommended for licensing and one for conditional licensing. MISCELLANEOUS In December post mortem examinations carried out on four pigs which had been found dead and dumped on the roadside. In cases of this kind there is the possibility that the animals may have died from the effects of an infectious disease. Fortunately, this was not the case, the animals having died of pneumonia and other complications. The carcases were hygienically disposed of. At the request of the Ministry of Agriculture, Fisheries and Foods, a visit was made to a research laboratory in the Borough concerning the movement of animals. There were 34 head of cattle, 200 sheep and 14 goats on the premises. All records of movements of animals were inspected and found to be in order. The premises are visited regularly by Home Office Officials and will also be visited by a Veterinary Officer at regular intervals. 114 ANIMALS, KEEPERS, ETC. The following premises are situated within the Borough and were regularly visited and inspected. No irregularities were found. No. Premises No. Visits Stock Keepers 30 50 Farms 43 91 Pig Keepers 45 139 Poultry Keepers 24 45 Horses only 3 5 Slaughterhouse 1 12 Laboratory 1 1 Riding Establishments 11 11 Animal Boarding Establishments 15 15 RIDING ESTABLISHMENTS ACT, 1964 Twelve applications were received for the grant of licences to keep Riding Establishments. The premises were inspected and were referred to, and reported upon, by a Veterinary Surgeon and a Fire Prevention Officer. All animals available to be hired from the premises were also examined by Veterinary Surgeons. Conditions were satisfactory and the licences were issued. During the year forty-four routine inspections were made and on four occasions minor infringements were found and were remedied by informal action. PET ANIMALS ACT, 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to 29 applicants. The majority of the businesses were on a small scale selling fish, tortoises, birds and small animals. A total of 73 visits were made to the premises, 3 contraventions of the terms of the licences being found and remedied. ANIMAL BOARDING ESTABLISHMENTS Sixteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at these premises for boarding 385 dogs and 296 cats. Forty-four visits were made to these premises during the year —fourteen contraventions of a minor nature being remedied by informal action. 115 SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS General Sanitation Agricultural Welfare 7 Animal Boarding Establishments 44 Caravans 225 Cesspools 165 Common Lodging Houses 66 Drainage 2,061 Filthy Premises 245 Fouling of Footpaths 8 Hairdressers 119 Keeping of Animals 88 Noxious Accumulations 502 Piggeries 34 Public Conveniences 73 Rivers, etc. 66 Schools 76 Swimming Baths—Public 15 Swimming Baths—Private 32 Theatres, etc 7 Verminous Premises 202 Housing Housing Acts (Clearance) 379 Housing Acts (Improvement) 214 Overcrowding 86 Public Health Acts 5,752 Houses in Multiple Occupation 221 Rent Act 860 Factories, etc. Factories with power 197 Factories without power 52 Building Sites 246 Outworkers 25 116 Offices, Shops and Railway Premises General Inspections—Offices 511 Retail Shops 1,064 Wholesale Shops and Warehouses 58 Catering Establishments and Canteens 181 Fuel Storage Depots 6 Visits of all kinds (including above) 2,579 Food Premises—Food Hygiene Regulations Bakers' Shops 358 Bakehouses 138 Butchers 618 Dairies 108 Fishmongers 221 Greengrocers 419 Grocers 1,038 Ice Cream 356 Merchandise Marks 35 Restaurants 758 Slaughterhouses 34 Stalls 225 Food Complaints 131 Inspection of Foodstuffs Meat—Slaughterhouse 68 Meat—Wholesale Depots 115 Meat—Retail Shops 124 Other Foods 384 Rodent Control Agricultural premises 17 Non-agricultural premises 476 Water Supply 102 Noise Abatement 276 Pharmacy and Medicines 16 Rag Flock and Other Fillings Act 8 Riding Establishments Act 44 Pet Animals Act 73 117 Clean Air Act Nuisances 313 Industrial premises 319 Smoke Control Areas 4,872 Pigeons Infestations 45 Infectious Diseases General 371 Food Poisoning 328 Disinfection Supervision 23 Surveillance of Infectious Diseases, Contacts, etc. 151 Nursing Homes and Child Minders 106 Sampling Egg Products 12 Food and Drugs 791 Ice Cream (Bacteriological) 99 Milk (Bacteriological) 570 Water—Drinking 26 Rivers, etc. — Swimming Baths 31 Rag Flock Act 3 Miscellaneous 12 NOTICES SERVED Informal Notices: Public Health and Housing 793 Others 264 Complied with at the end of year: Public Health and Housing 377 Others 215 Statutory Notices: Public Health Act 106 Housing Act 1 Complied with at the end of year: Public Health Act 93 Housing Act — 118 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 1970. (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 the analytical 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, 1970, was 301,643. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being 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 and well water from Merton, Shortlands, West Wickham, Orpington, North Orpington, Sundridge, Lullingstone, Eynsford, Horton Kirby and Jewels Wood 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 shown to be not 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 to lead. 119 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY, 1970 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 KMnO 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 CI Phosphate as P04 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames derived 363 0.026 0.083 4.8 1.02 274 79 5 27.7 5.6 40 2.7 9 70 0.20 0.03 0.1 11 7.9 570 Merton Abbey 3 0.015 0.021 0.8 0.12 244 22 16 0.50 0.3 6 7.3 480 Eynsford 8 0.008 0.015 3.7 0.09 266 39 18 0.10 0.0 2 7.3 480 Horton Kirby 9 0.005 0.016 4.8 0.08 275 57 23 0.10 0.1 2 7.2 480 Jewels Wood 2 0.008 0.010 3.1 0.06 242 22 11 0.15 0.1 1 7.3 450 Lullingstone 8 0.004 0.014 3.8 0.04 264 43 16 0.10 0.2 4 7.3 470 North Orpington 8 0.008 0.013 4.2 0.04 278 38 16 0.10 0.1 2 7.2 500 Orpington 4 0.008 0.023 6.4 0.08 295 53 21 0.10 0.0 2 7.2 540 Shortlands 8 0.007 0.018 4.9 0.05 296 74 23 0.15 0.0 1 7.3 530 Sundridge 14 0.004 0.013 3.6 0.04 226 70 21 0.10 0.1 1 7.3 440 West Wickham 2 0.009 0.026 6.4 0.10 298 56 25 0.10 0.2 4 7.2 510 120 BACTERIOLOGICAL RESULTS—YEARLY AVERAGES, 1970 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. River Thames-Derived 8,259 31.9 - 37.91 17.3 53.58 4.7 3,710 8.0 99.92 99.97 Merton Abbey 8 0.1 3 100.0 — 100.0 — 8 0.0 3 100.0 100.0 Eynsford Well 175 0.0 7 99.43 — 100.0 - 252 0.1 8 100.0 100.0 Eynsford Borehole 195 0.0 1 100.0 — 100.0 - Horton Kirby No. 1 138 0.1 68 97.83 — 100.0 - 253 0.0 5 100.0 100.0 Horton Kirby No. 2 193 0.0 15 99.48 — 99.48 - Jewels Wood 89 0.1 18 98.88 — 100.0 - 90 3.5 14 100.0 100.0 Lullingstone No. 1 135 0.0 2 100.0 — 100.0 - 253 0.0 21 100.0 100.0 Lullingstone No. 2 177 0.0 3 100.0 — 100.0 - North Orpington No. 1 187 1.9 26 10.70 26.5 24.60 7.7 250 1.3 7 99.60 99.60 North Orpington No. 2 194 14.2 23 16.49 13.5 34.54 4.1 Orpington 247 0.1 7 99.19 — 99.60 - 252 0.0 8 100.0 100.0 Shortlands No. 1 188 0.1 12 98.46 — 99.47 - 252 0.0 3 100.0 100.0 Shortlands No. 2 145 0.0 3 99.31 — 100.0 - Shortlands No. 3 142 0.1 110 99.30 — 100.0 - Sundridge No. 1 108 0.0 7 98.15 0.1 100.0 - 252 0.0 91 100.0 100.0 Sundridge No. 2 153 0.0 7 99.35 100.0 - Sundridge No. 3 209 0.0 15 99.04 — 100.0 - Sundridge No. 4 184 0.6 31 98.91 0.4 100.0 - West Wickham 73 0.4 127 97.26 0.1 100.0 - 74 0.0 626 100.0 100.0 SCHOOL HEALTH SERVICE 122 SCHOOL HEALTH SERVICE INDEX Page Audiology Service 145 B.C.G. Vaccination 137 Cheyne Hospital 149 Child Guidance 141 Cleanliness Inspections 131 Clinics 162 Defects—Periodic and Special Medical Examinations 132 Diseases of Ear, Nose and Throat 136 Diseases of Skin 137 Employment of Young Children 157 Follow-up Examinations 131 Handicapped Pupils 147 Health Education and Home Safety 159 Health Visiting 158 Independent Schools 133 Infectious Diseases 138 Page Members of Education Committee 123 Minor Ailments 135 Ophthalmic Clinics 135 Orthopaedic Clinic 137 Orthoptic Clinic 135 Other Inspections 130 Other Medical Examinations 157 Periodic Medical Inspections 130 Phoenix Centre 149 Physiotherapy Clinic 137 Prefatory Letter 125 Rubella 137 School Health Service 128 School Meals and Milk Service 157 School Psychological Service 143 Speech Therapy 139 Special Inspections 131 Special Schools 154 Staff 124 123 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December, 1970) *Councillor F. J. Packer, F.C.I.S. (Chairman) *Councillor J. F. David (Vice-Chairman) Alderman Miss B. H. James, J.P. (Mayor) Alderman C. H. E. Pratt Alderman Mrs. A. L. Gunn, 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. Hevy Miss E. M. Huxstep, C.B.E., B.A. *Mr. W. Marsden (to 12.10.70) 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. 124 STAFF OF THE SCHOOL HEALTH SECTION (as at 31st December, 1970) 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 Principal School Medical Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer: P. A. Currie, m.r.c.s., l.r.c.p. *9 Medical Officers in Department. Principal Dental Officer: Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(Glasgow). *5 Dental Officers. *5 Sessional Dental Officers. *10 Dental Surgery Assistants. * 1 Dental Hygienist. *2 Anaesthetists (sessional). Senior Speech Therapist: *Miss V. M. Connery, l.c.s.t. * 1 Speech Therapist (full time). * 2 Speech Therapists. † 4 Ophthalmologists. † l Orthoptist. + 1 Physiotherapist. † l Orthopaedic Surgeon. † l Consultant Psychiatrist. 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., s.c.m., h.v.Cert. Group Adviser: *Miss C. M. Paxton. s.r.n., s.c.m., h.v.Cert. *37 Health Visitors. Chief Administrative Officer: N. H. Collins, a.c.c.s., a.r.s.h. Senior Administrative Officer: S. F. Judd, a.r.s.h. Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant. 9 Clerical Assistants. 1 Clinic Clerk (full time). †2 Clinic Clerks. †l Shorthand Typist. * Also employed in the Maternal and Child Health Service. † Part time. 125 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the sixth annual report of the School Health Service of the London Borough of Bromley. The health of Bromley school children has been satisfactory and there have been several "firsts" in the School Health Services which are commented on in greater detail later in the report. This has been the first year during which school entrants have been offered a sweep audiometer test of hearing; it has been the first complete academic year in their new premises at St. Paul's Wood Hill for the School Psychological Service; and towards the end of the year Rubella (German Measles) Vaccination was offered for the first time in the School Health immunisation programme. Handicapped Children Service A total of 86 boys and girls were assessed as in need of special education because of handicap. A table sets out details of these handicaps. The need for a new school for physically handicapped remains a top priority, and so it is hoped that financial stringency will not delay this very vital requirement. Primarily for the needs of one section of handicapped children suffering from cerebral palsy, requiring rather close hospital supervision and currently provided at the Phoenix Centre, a new centre at Farnborough Hospital with the support of the voluntary Spastic Society is under construction and will be of great assistance. This report further indicates the detailed interest of the Department of Education and Science nationally in the unmet medical and educational needs of each handicapped child. A report on the situation in the London Borough of Bromley has been forwarded to the Department. School Psychological Service The report emphasises the excellent relationship of this service with all Departments in the Borough. It is particularly important that there should be good personal contacts and communication between Educational Psychologists and the Medical Officers in Department and Health Visitors in the School Health Service. It will be important in the future to establish and maintain in addition equally good contacts with officers in the new Social Service Department of the Authority. The School Psychological Service works in close harmony with the Child Guidance Service. The report of Dr. Rodriguez indicates yet again some lack of treatment facilities. The Establishment now includes an approved post for 126 a psychotherapist but there are so few of these particularly experienced in dealing with children. However it is believed that eventually this appointment will be filled and for the present it is hoped to make greater use of the services of an experienced officer of the new Social Services Department. During the past three years local medical practitioners have more than doubled their use of the Child Guidance Service. Audiology and Speech Therapy There has been reference to the introduction of an audiometer test at each entrant medical examination and already this has proved worthwhile. The report outlines the team work between medical officers, teachers of the deaf, speech therapists and educational psychologists and the liaison that ensues in the work in the Audiology Clinic. The comparatively low number of attendances at this clinic is partly related to the multiplicity of handicaps that are found and the investigations that are needed. Correct and precise assessment is essential to the proper placement and treatment in special units and classes. Miss Connery is now Senior Speech Therapist on the permanent establishment of the Service and is coping in a meritorious manner with the perennial problems of staff changes. In the report which sets out in detail the distribution of speech defects it is of interest that specific retardation of speech and language development is more than four times as common as stammer. On the list of speech defects stammer ranks as only fourth in importance and this is a lower position than one might expect of a defect which has such publicity. Immunisation Service A new immunisation programme offering protection against Rubella (German Measles) was introduced and offered to all girls between their 11th and 14th birthdays. It was organised to allow a necessary immunisation interval from B.C.G. vaccination against Tuberculosis offered to boys and girls in their 13th to 14th years. The introduction of an immunisation scheme to a selected age and sex group presents obvious administrative difficulties but in the case of rubella vaccination this is considered on epidemiological grounds to be a better practice than a more general immunisation scheme. The reduction both in notifications and in the biennial periodicity of Measles, believed to be the result of the measles immunisation programme, is well shown in the table of measles notification since 1965. Immunisation must keep pace with the recruitment of susceptibles and failure from any cause to ensure 127 this will simply increase cases and shift the periodicity to out of season. Measles causes a loss of at least a few weeks school time and the fall in notifications indicates that already a good deal of school time has been saved. Only in the long term can it be estimated how much this will mean medically and educationally to the adult. Future Trends Looking ahead, it is clear that considerable changes in the care of handicapped children are on the way. It is believed that the School Health Service will for very many years continue to play an important part. It has a fund both local and national of irreplaceable advantages of specialised knowledge in the medical care of school children. Throughout the report this is emphasised from time to time by the accounts of surveillance, research, care and treatment of school children by medical, dental, nursing and technical staff under the supervision of senior and experienced officers. In conclusion, I wish to thank the Chairman and Members of the Education Committee for their continued support. During the past year more than ever, Mr. Barraclough, Chief Education Officer, his Staff and Heads of Schools have been able to give valuable advice. The School Health Section has benefited by this consultation and cooperation in many useful directions not least in the more effective application of Health Education in Schools' curricula. I am most grateful to Dr. P. A. Currie, Senior Medical Officer, for his professional dedication to the Service, to the Medical Officers in Department and the Administrative Staff, to the Principal Dental Officer, Mrs. C. M. Lindsay and her Staff, and to the professional and technical officers of all the supporting sections of the School Health Service. L. R. L. EDWARDS, Principal School Medical Officer. 128 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 to 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. There are 34 Secondary Schools (including 2 Direct Grant) and 88 Primary Schools in the Borough; also 3 special day schools for educationally subnormal children. In January there were 46,866 pupils (an increase of 1,315) on the registers of the Maintained Primary Secondary, Special and Nursery Schools. It is the aim to give statutory routine medical inspections to all pupils entering the infants' schools and to repeat these when they reach the age of 10 years and 14 years. In addition at 8 years of age pupils are given routine tests of vision and hearing alone; a full medical examination is undertaken at this age only if, for any reason, it appears necessary. Further, when at any time during a child's school career the head teacher, parent or doctor is concerned about the health of a particular child in relation to school education or activity, arrangements are made for special examinations to be carried out. Private schools may participate in the School Health Service at request. It has not been possible to complete the programme of routine medical inspections envisaged at the beginning of the year. The 10-year-old medicals and autumn term entrant medicals have had to be deferred. It is hoped naturally that these will be picked up next year, but this is dependent on the recruitment of Medical Officers to full establishment. However, priorities in the Service were agreed giving pride of place to the B.C.G. vaccination against tuberculosis and the newly introduced Rubella vaccination. Following the introduction of the special Occluder and the wider range of vision testing charts being made available, it would appear that past difficulties which had occasionally been experienced in obtaining the required standards for accurate vision testing in schools have now been overcome. The total number of children attending both Maintained and Independent Schools who were examined in the routine age groups 129 was 14,368, an increase of 3,324. The physical condition of all the pupils inspected was satisfactory and 2,100 pupils (14.6 per cent) were found to require treatment. A further 4,215 children were given routine tests of vision and hearing, as a result of which 277 pupils (6.7 per cent) were referred for treatment because of visual defects and 33 pupils (0.8 per cent) were referred for treatment because of hearing defects. Follow-up examinations, referrals to General Practitioners, specialist clinics and to Hospital Consultants were arranged as and when necessary. Further details of these examinations will be found later in the report. Reference was made in my report for 1969 that because of the shortage of Medical Officers the year's work could not be completed. Unfortunately as above I have to report that some work was still outstanding at the end of the year under review, due to the fact that the full establishment of Medical Officers could be maintained for only 8 weeks during the year. In spite of this, however, it was possible to arrange attendance at various training courses for some of the Medical Officers—regrettably, however, not all. It is recognised both administratively and at field level that the maintenance of an up-to-date and efficient Service can only be achieved by such an attendance. It will be appreciated that Medical Officers devote about half of their time to the School Health Service. The arrangement of identification of an area based around the Child Health Clinics has worked very satisfactorily, as it enabled a continuity of service to be given to the parents. Financial provision has been made and it is hoped to appoint a Psychotherapist and an Audiometrician in the coming year. It was felt that the time was opportune, following national interest in various education/health matters, to arrange a conference. A four day residential conference was, therefore, organised by the Chief Education Officer and was held at Kingsgate College, Kent. Four senior members of the Health Department were invited to attend as staff taking an active part in what proved to be an outstandingly successful conference. Subsequently, the Department was represented on the Working Party engaged in drawing up proposals for a uniform scheme of of work on Health Education suitable and flexible for use in Secondary Schools, and it is understood that a decision will be made in the near future on the scheme. Meanwhile, some of the Health Visitors assist actively in Health Education teaching in some schools where this subject is already incorporated in various parts of the syllabus. 130 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) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory No. Unsatisfactory No. (1) (2) (3) (4) (5) (6) (7) (8) 1966 and later 39 39 — — 2 3 5 1965 1,376 1,376 — — 58 186 219 1964 3,475 3,475 — — 188 395 514 1963 273 273 — 1* 16 28 41 1962 122 122 — 3,926* 7 16 20 1961 147 147 — 205* 12 13 23 1960 3,437 3,437 — 18* 210 309 494 1959 1,178 1,178 — — 97 114 199 1958 186 186 — — 27 17 44 1957 95 95 — — 10 12 22 1956 3,183 3,183 — — 192 222 377 1955 and earlier 249 249 — — 18 19 31 TOTAL 13,760 13,760 — 4,150* 837 1,334 1,989 The physical condition of all the children inspected was satisfactory. *Tests of Vision and Hearing only at age of eight years. 254 Pupils referred for treatment because of Visual Defect. 33 Pupils referred for treatment because of Hearing Defect. Other Inspections Number of Special Inspections 1,714 Number of Re-inspections 2,295 4,009 131 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 1,714 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 2,295 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 42,395 (b) Total number of individual pupils found to be infested 215 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 73 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 3 132 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 90 73 140 303 11 O 24 52 79 155 2 5 Eyes—a. Vision T 248 210 379 837 267 O 386 279 504 1169 532 b. Squint T 43 2 10 55 3 o 3 1 13 17 2 c. Other T 13 16 19 48 2 o 5 5 20 30 2 6 Ears—a. Hearing T 58 11 36 105 104 O 205 58 132 495 252 b. Otitis T 10 3 4 17 - Media O 18 4 6 28 — c. Other T 2 - 5 7 1 O 1 3 7 11 1 7 Nose and Throat T 88 22 39 149 13 O 120 49 104 273 31 8 Speech T 47 7 17 71 41 O 36 5 14 55 22 9 Lymphatic Glands T 5 1 2 8 1 O 34 7 26 67 4 10 Heart T 13 2 5 20 2 O 17 16 7 40 8 11 Lungs T 50 7 41 98 3 O 48 53 56 157 13 12 Developmental— T 6 4 4 14 2 a. Hernia O 8 4 18 30 4 b. Other T 21 3 28 52 9 O 38 13 46 97 20 13 Orthopaedic— T 8 25 10 43 7 a. Posture O 9 64 98 171 8 b. Feet T 69 20 52 141 14 O 42 60 110 212 5 c. Other T 15 20 24 59 3 o 13 31 24 68 4 14 Nervous System— T 7 2 11 20 2 a. Epilepsy O 4 12 10 26 3 b. Other T 4 3 5 12 2 O 24 13 29 66 7 15 Psychological— T 4 2 8 14 9 a. Development O 21 12 24 57 16 b. Stability T 13 1 16 30 18 O 78 73 225 376 42 16 Abdomen T 13 6 16 35 5 O 8 6 32 46 12 17 Other T 5 10 18 33 11 O 19 54 86 159 32 T = treatment O = observation 133 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. 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 608 children were medically inspected and a further 65 children received tests of vision and hearing only. In addition, a total of 22 special inspections and 22 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) 1966 and later 3 3 — — — — — 1965 36 36 - — 1 2 3 1964 107 107 - — 10 14 24 1963 19 19 — - 5 — 5 1962 42 42 — — 3 2 5 1961 9 9 — 17* 1 1 2 1960 45 45 — 13* 2 5 7 1959 88 88 - 35* 10 6 16 1958 19 19 — — 1 2 3 1957 2 2 - — - — — 1956 213 213 - - 26 16 40 1955 and earlier 25 25 — — 4 2 6 TOTAL 608 608 — 65* 63 50 111 The physical condition of all the children inspected was satisfactory. *Tests of vision and hearing only at age of eight years. 23 pupils referred for treatment because of visual defect. - pupils referred for treatment because of hearing defect. OTHER INSPECTIONS: Number of Special Inspections 22 Number of Re-inspections 22 44 134 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS—INDEPENDENT SCHOOLS Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total (1) (2) 4 Skin T O 3 3 3 9 1 4 — 5 — 5 Eyes—a. Vision T 11 30 22 63 8 O 21 14 20 55 4 b. Squint T 2 1 3 - O - - — - — c. Other T 1 3 - 4 - O — - 1 1 — 6 Ears—a. Hearing T 1 1 - 2 1 O 12 1 8 21 3 b. Otitis T 2 1 1 4 - Media O — — — - — c. Other T - - — - - O — — — — — 7 Nose and Throat T 1 2 3 6 - O 7 4 7 18 — 8 Speech T - 2 - 2 1 O 3 - — 3 - 9 Lymphatic Glands T - - - - - O 5 2 - 8 — 10 Heart T 1 - - 1 - O - — 1 - — 11 Lungs T - 2 - 2 - O 5 3 2 10 — 12 Developmental— T - - 3 3 a. Hernia O 1 — — 1 — b. Other T - - - - - O 1 3 — 4 — 13 T - - - - - a. Posture O — 6 3 9 — b. Feet T 3 1 - 4 - O 6 3 — 9 — c. Other T 1 - 3 4 - O - — 2 2 — 14 T - - - - - a. Epilepsy O — — — — — b. Other T 1 O 1 1 — 2 15 Psychological— T - - 1 1 2 a. Development O 1 1 3 5 - b. Stability T - 1 1 2 - O 9 7 11 27 — 16 Abdomen T - - 1 1 - O 2 — 1 3 — 17 Other T 1 1 - 2 - O — 1 — 1 — T—TREATMENT O—OBSERVATION 135 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 323 pupils was treated. Treatment of Pupils EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with:— External and other, excluding errors of refraction and squint 14 Errors of refraction (including squint) 3,722 Total 3,736 Number of pupils for whom spectacles were prescribed 1,955 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 747 new cases and 2,989 re-examinations was seen at the Clinics. 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. In spite of this it is surprising the wastage that occurs from appointments not being kept. Regrettably, in some cases no message is received either, which leads to difficulties in making up full appointment lists. Orthoptic Clinic Patients seen at this Clinic are always referred by an Ophthalmologist. Two 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. (b) Patients suspected of having a strabismus. (c) Amblyopic patients. (d) Patients with any ocular muscle imbalance. 136 (e) Patients who are complaining of ocular symptoms, the cause of which is not obvious to the Ophthalmologist. Details of treatments and attendances are as follows:— Number of new cases 54 Number of treatment 107 Number of occlusion 94 Number of treatments given 145 Number of cures with operation 7 Number of cures without operation 28 Cases discharged—cured: (a) Functional for binocular single vision 20 (b) Cosmetic 14 Total number of attendances 616 Transferred or left the district 10 Number of sessions 154 Number on waiting list at 31.12.70 6 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 689 (c) for other nose and throat conditions 333 Total 1,022 Total number of pupils in schools who are known to have been provided with hearing aids:— (a) during 1970 17 (b) in previous years 82 Orthopaedic and Postural Defects Number known to have been treated:— (a) Pupils treated at clinics or out-patients 169 (b) Pupils treated at school for postural defects — 169 137 Orphopaedic 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 1,016 attendances was made at the two Clinics and of these 763 were for remedial exercises, etc., and 253 for sunlight. Diseases of the Skin (excluding uncleanliness) Number of pupils known to have been treated:— Ringworm—(a) Scalp 3 (b) Body — Scabies 5 Impetigo 5 Other skin diseases 187 200 B.C.G. Vaccination In the effort to eradicate tuberculosis, B.C.G. vaccination was again undertaken, with parental consent, on children in the 3-14 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 3,506 children received a skin test and the 3,130 negative reactors received B.C.G. vaccination. Of the 184 children who were found to have a positive reaction to the skin test, 52 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 132 children who gave a positive reaction because of previous B.C.G. vaccination. Rubella As has already been mentioned at the beginning of this Report, Rubella vaccination was introduced into the School Health Service Immunisation Programme in September. The Department of Health and Social Security recommended that vaccination against Rubella (German Measles) should be 138 offered to all girls between their 11th and 14th birthdays, with initial priority being given to the older girls in this group. This is to ensure that as many girls as possible are offered protection against Rubella by vaccination, before reaching child-bearing age. Although the disease itself is mild, there are well-established associations between an attack of Rubella during pregnancy and the occurrence of serious abnormalities in the unborn child. Certain difficulties were experienced in linking this with the B.C.G. programme due to the necessity of an interval of at least 4 weeks between these vaccinations. However, during the Autumn Term is was possible to arrange for the vaccination of 417 girls with parental consent—an acceptance rate of 65.6 per cent. Infectious Diseases 389 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as below:— Disease Total No. of Cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Dysentery 1 1 - - — *Food Poisoning 11 — 3 6 2 Inf. Jaundice 15 4 6 2 3 † Measles 259 59 34 44 122 Meningitis 5 1 3 — 1 Scarlet Fever 29 8 12 2 7 Tuberculosis (Pul.) 1 - - 1 - Tuberculosis (Non.Pul.) 1 - - 1 - Whooping Cough 67 4 1 18 44 Totals 389 77 59 74 179 *6 of these cases were not confirmed on investigation. fin 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 Ill 1969 411 1970 259 (as above) 139 Speech Therapy It will be recalled that in the last report Miss Connery acted in the capacity of locum Senior Speech Therapist, a post which she filled most admirably. It is, therefore, very pleasing to report that Miss Connery has accepted this post on a permanent basis. Once again this year we have had some staff changes. One full-time Therapist resigned in September and, so far, has not been replaced. However, we did fill one part-time post, thus the year ended with one full-time post still vacant. As a result of staffing difficulties some areas of the Borough have increased waiting lists, the remaining lists are reducing very satisfactorily. Group therapy for language handicapped children continues to prove itself invaluable for the pre-school children. During the year 3 Students from the Central School of Speech Therapy, and 2 Students from the Oldrey-Fleming School of Speech Therapy attended the Bromley and Chislehurst clinics. We also had visits from the Rose Bruford College of Speech and Drama for observation study. Several girls in their last year at school visited the clinics to observe speech therapy with a view to training as Speech Therapists when they leave school. The figures for 970 are as follows:— Number of children referred by:— 1. Medical Officers in Department 125 2. Head Teachers 52 3. Hospital Consultants 8 4. General Practitioners 14 5. Parents 25 6. Health Visitors 21 7. Educational Psychologist 4 8. Teachers of the Deaf 1 9. Other Districts 9 Total 259 Number of Children seen in Clinic 526 Number of Children seen in Special Schools (including Cheyne Hospital but not including Grovelands School) 94 Number of Children seen at Woodbrook Junior Training Centre 32 652 140 Number of attendances:— 1. Clinics 2,845 *2. Special Schools 581 3. Woodbrook Junior Training Centre 87 *Excludes Grovelands, as no Speech Therapist was available for sessional work. Number of Home Visits 157 Number of School Visits 70 Number of Initial Interviews 227 Distribution of Cases:— Stammer 50 Dyslalia 179 Retarded Speech and Language Development 207 Interdental Speech 72 Lateral Speech 23 Deaf 13 Dysphonia 3 Dysphasia 3 Dysarthria 11 Nasal Speech 7 Hyponasality 3 Cleft Palate—Repaired 19 General Retardation 39 Dyspraxia 2 Total 631 Twenty-one cases seen in the Clinic have not been classified as therapy was either not indicated, or being received elsewhere. Cases closed:— Improved 109 Removed 15 Refused Appointments 4 Non-attendance after First Interview 11 Failed Interview Appointment 6 Therapy not Indicated 20 Having Therapy Elsewhere 1 Transferred 5 Left School 6 Total 177 At the end of the year the waiting list was 97, including 25 priorities. 141 Child Guidance Through various sources, cases of psychological disturbance come to light and are referred, if necessary, to the appropriate Child Care 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 services 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 four sessions per week. During 1970 the demands on the Clinic have remained practically unchanged. The number of children referred was 100 (1969—98). The median length of the waiting list has again been reduced to slightly over three months. (1968—6 months, 1969—4 months); more than 66 per cent of the cases had their diagnostic interview within two months of being referred. Many urgent cases were seen within one to two weeks. As there is still some lack of 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 continues to cause frustration amongst parents and referring agencies. There has been an increased number of children referred because of poor school attendance (school refusal, truancy)—this reflects a national trend. 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. Mrs. Preston and Mr. Bennett have attended the Clinic to carry out psychological assessments and also for regular case discussions. We welcome the appointment of a third Psychologist— Miss A. Galloway—who since September has taken up her duties at this Clinic. Mrs. Cameron, as in the previous year, has continued to work part-time at this Clinic, while still carrying on her duties as Mental Welfare Officer. Let us hope that she will be able eventually to give full time service here. The post of Child Psychotherapist (part-time) was established, but unfortunately there were no suitable applicants and the post is still vacant. Some much needed repairs and rewiring were carried out and some new gas heaters were also installed. Any future increase in the staff will highlight the limitations of the present building. Seventy new children from the borough were investigated 142 and taken on for treatment during the year (1969—67). The number of children referred by local General Practitioners increased (from 11 per cent in 1967 to 29 per cent in 1970). This trend no doubt is the result of efforts made by the Clinic to maintain close contact through letters and telephone calls with them. The total number of Psychiatric interviews was 582. Close co-operation was maintained with other disciplines in the field of education and child care. Efforts were continued to be made to improve communication with Medical Officers in Department, Head Teachers, Education Welfare Officers, Child Care Officers, Probation Officers and Health Visitors. Many interdisciplinary Case conferences were held in the Clinic. The Staff also had quarterly meetings with the tutorial teachers at St. Paul's Wood Hill Unit. 18 Students attended the Clinic:— 1 School Counsellor Student 2 Mental Health Students 1 Dental Student 1 Medical Student 1 Mental Welfare Trainee 1 Health Visitor Student 11 Social Work Students The Clinic is collaborating in a project, sponsored by the World Health Organisation, on standardisation of the classification of childhood psychiatric disorders. Details of referrals and attendances during the year are as follows:— Waiting List: (a) Awaiting first interview 28 (b) Interviews and awaiting treatment Nil In attendance: (a) Active 95 (b) Periodic Review (holiday cases) 10 Number of cases closed 92 Number of applications withdrawn. (Failed repeatedly to attend for diagnostic interview) 12 Sources of referral: Probation Officers 7 Court 2 Head Teachers 9 Medical Officers in Department 22 General Practitioners 29 Parents 6 Child Care Officers 1 Hospitals (Paediatricians and Psychiatrists) 13 Chief Education Officer 2 School Psychological Service 4 Others 5 100 143 Number of new patients taken on for treatment during each month :— January 4; February 8; March 8; April 4; May 8; June 9; July 3; August 2; September 8; October 5; November 4; December 6. Number of Psychiatric Interviews: Quarter to 31st March, 1970 149 Quarter to 30th June, 1970 140 Quarter to 30th September, 1970 143 Quarter to 31st December, 1970 150 Number of Social Workers Interviews: Quarter to 31st March, 1970 202 Quarter to 30th June, 1970 218 Quarter to 30th September, 1970 187 Quarter to 31st December, 1970 199 Number of Home Visits: Psychiatric Social Worker 103 Number of School Visits: Psychiatric Social Worker 18 Educational Psychologists No figures available The Social Worker made nine visits to different outside agencies. School Psychological Service I am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following report on the School Psychological Service:— This has been the first complete academic year spent at the new premises at St. Paul's Wood Hill. This hutted accommodation has proved spacious and has enabled the Service to organise its administration more satisfactorily. As usual, the work of the School Psychological Service falls into three broad categories, thus : (a) Investigation of individual children in schools or hospital clinics. (b) Investigation into the problems presented by groups of children, e.g. slow learners. (c) General educational advisory duties including organising and conducting lectures, discussions, etc. The School Psychological Service spans the whole of the educational range from the pre-school to the school leaver, but 144 the greatest call on the Service seems to come from the Primary sector and special education. 1. In the Primary Sector (i) Screening of slow learners at top infant level for selection into special education is an annual feature. (ii) The Educational Psychologists have attended regularly meetings of the Audiology Ascertainment Team. (iii) The Educational Psychologists have visited the Opportunity Classes regularly and held annual meetings at each of the Opportunity Classes for the placement of their leavers. (iv) The Service has organised two educational film shows for the staff of the Opportunity Classes, Cheyne Hospital and the Phoenix Centre as well as film shows for the Darrick Wood Partially Hearing Unit and the staff of the Darrick Wood Schools and Teachers of the Deaf. These have proved very popular. (v) Two educational visits were organised for the staff of the Opportunity Classes during the year. The School Psychological Service has continued to be consulted in an advisory capacity in general matters and, more specifically, concerning special education. 2. In the Secondary Sector (i) The School Psychological Service has continued to follow up remedial provisions within the non-selective schools. (ii) The School Psychological Service has also been consulted in matters regarding 11 + Selection procedure. 3. In the Special Education Sector (i) Regular meetings have taken place with the remedial teachers and the teachers of tutorial maladjusted classes. (ii) Regular visits were undertaken to special day E.S.N, schools. (iii) The Educational Psychologists have also seen children at the Cheyne Hospital School for the physically handicapped. Children attending the Phoenix Centre (Cerebral Palsy Unit) were seen, but only as out-patients at Farnborough Hospital rather than at the Phoenix Centre itself. 4. In the Local A uthority and Hospital Clinics Sector Each Educational Psychologist has continued to work regularly at the Local Authority Child Guidance Clinic at the Willows, at the Bromley Hospital Child Psychiatric Clinic and at the Paediatric Department at Farnborough Hospital. During the year, the School Psychological Service enjoyed excellent relationships with all Departments in the Borough, especially School Health, where a free and easy personal contact 145 was maintained between the Educational Psychologists and the Medical Officers in Department. A third Educational Psychologist has been appointed and is warmly welcomed to the Service. Audiology Service Two Medical Officers have particular responsibilities in this field and I am happy to submit this report which can be considered as follows:— This is the first year in which an attempt has been made to otter all entrants a sweep audiometer test at their routine medical examination and this introduction to earlier sweep testing has been accepted enthusiastically by all concerned, including the children only a few of whom have been unable to co-operate. A number of cases of catarrhal deafness was confirmed in this age group, and there was one child found to have monaural deafness with a complete and irreversible deafness in one ear of which neither parents nor the child was aware. Cases of catarrhal deafness are followed up and those which are followed up and those which fail to resolve spontaneously, which in our experience constitute the minority, are referred through their General Practitioners to our local consultants or to consultants in the London teaching hospitals with all of whom a good liaison is maintained. Routine testing of vision and hearing continues to be carried out at the eight year level and in certain schools sweep tests of hearing are included routinely at the intermediate and leavers examinations also. The Youth Employment Service is notified of any permanent handicap on form Y9 which is completed at the leavers examination. At the Audiology Clinic we continue to hold weekly sessions run jointly by medical officers and teachers of the deaf. Infants are referred from clinics for failure of their hearing tests. Children from school may also be referred and those school children with established hearing losses are regularly followed up. Details of attendances at the Audiology Clinic are as follows:— Number of sessions held 38 No. of children No. of seen attendances Over 2 years of age 87 109 Under 2 years of age 42 49 129 158 On the principle that handicaps rarely occur singly, and where it is felt, necessary, a comprehensive assessment is made of infants and children visiting the Audiology Clinic, and this search for 146 additional problems has frequently been rewarding in that coexisting but undefined handicaps have been discovered. These complicate the basic hearing handicap and call for special medical and educational treatment. Speech disorders, emotional disorders, social problems, mental retardation and brain damage have all been found at comprehensive assessment to co-exist with deafness, and the subsequent overall approach to treatment helps to minimise the child's overall handicap. The Ascertainment Team now meets at least once a term. This year we have had meetings in May, July, November and December at which a total of twenty-eight children was discussed. These meetings are useful in providing a medium for discussion of children with problems in addition to their hearing ones, for medical officers, teachers of the deaf, educational psychologists and speech therapists all attend as and when necessary to consider each child as a whole child and how best to provide for him educationally. 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 Darrick Wood Unit for Deaf Children The numbers of children at the end of 1970 were as follows:— Junior Class 8 (including 2 from Bexley) Infant Class 6 Nursery Group 6 (including 2 from Bexley) Total 20 The majority of these children are severely or profoundly deaf, who would probably be in residential schools if the Unit had not been established. They are all integrated as much as is practicable with hearing classes in the Infant and Junior Schools, thanks to the continuing interest and co-operation of Mrs. Jordan and Mr. Langley. The Peripatetic Service The numbers of children covered by the Peripatetic Teachers of the Deaf at the end of 1970 were as follows:— Pre-school children 6 Children in normal schools with hearing aids 50 Other children with hearing defects in normal schools 83 Children in residential placement 15 Children in day replacement outside the Borough 12 166 147 Total number of hearing impaired children in December, 1970: 186. This total figure represents an increase since December, 1969, the most significant change occurring in the group of children in ordinary schools with a hearing defect but no hearing aid. This is occasioned not by an increase in the incidence of minor hearing losses, but by wider reporting of such cases. The Medical Officers in the Department now hold weekly clinics for assessing new cases and reviewing old ones, and this is welcomed for keeping all concerned in the Health and Education Departments in close touch with each other and with urgent cases or problems. Two of the nine school leavers at the end of the Summer Term were accepted at the Brixton College of Further Education, which has a Teacher of the Deaf on the Staff and facilities for the further education or training of hearing impaired school leavers. Such arrangements are practically non-existent elsewhere and these boys are fortunate in being able to take advantage of the Brixton scheme. A girl has been offered a place at Dartford College of Education for September, 1971, and a boy of 12 was accepted at the Mary Hare Grammar School for the Deaf, Newbury, where competition for places is keen. Two Russaid radio-microphones have now been purchased for severely deaf children in hearing schools. Teachers, parents and children are very conscious of the help given by this method of amplified communication the potential of which has not yet been fully developed. Twenty-three children are having a weekly session with a Peripatetic Teacher either at home, in school or at the Audiology Clinic, Beckenham. Some of these children would benefit from more attention from a Teacher of the Deaf or in a partially hearing unit, but it would be imposing too great a strain on the resources at Darrick Wood to include them alongside the severely deaf children. All the Teachers of the Deaf owe grateful thanks to many in the Health and Education Departments without whose interest, co-operation and help the effectiveness of their work would be much reduced. 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, 148 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 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 59 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 detailed discussions that have taken place with the Education and Architect Departments, convinces one that the new School for Physically Handicapped at Coopers will soon appear in a concrete form. 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. Some confusion often exists in what is meant by a handicapped child. It is often thought that if a child has any defect it could be termed a handicap, but the briefest consideration will make one realise that many people have achieved incredible success in overcoming obstacles in adapting themselves to the difficulties presented by their disabilities, whether they are physical, social or possibly emotional. However, under the Act a handicapped pupil is defined as one for whom special educational provision must be made. It will, therefore, be appreciated that there are many children in ordinary schools with certain deformities or disabilities which do not prevent their taking part in the full life of the school or require special facilities for their instruction. During the year it was, therefore, interesting to carry out an investigation into the number, location and type of physical disability of children attending ordinary schools. This was carried out at the request of the Department of Education and Science, the previous investigation having been done about eighteen years ago. Two very detailed 149 questionnaires were completed from the educational and medical angles, in respect of each child examined. Looking to the future the implementation of a new Act, which will remove a bar to a child receiving education, gives one renewed enthusiasm to work for their needs. The recognition that the education of a child does not consist merely of the "three R's" has developed over the years, and the earlier recognition of a child's handicap—which cannot be too frequently stressed—is what should constantly be striven for, will enable earlier education to be provided and thus help these handicapped little ones and their parents to achieve what one believes will be a fuller, and one hopes, a happier life. Cheyne Hospital, West Wickham I am grateful to Dr. S. R. Lewis, Locum Consultant Paediatrician, Farnborough Hospital, for the following report:— The school at Cheyne has continued to give the children as full and interesting experience as possible. Young children have been admitted to the nursery class as day pupils. I think this could be an increasingly valuable asset. The number of admissions during 1970 were 15, and the number of discharges 19, with one death. Under the direction of the regional board we are shortly to accept some children from Leybourne Grange. 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 has continued to function as described in the previous report. The hospital educational staff have been fully occupied with thirty-one children attending the Centre' during term time. There are twelve children aged five years who attend daily and younger childrens' attendances vary between two and four days each week. All the previous Consultant visits have continued. The Spastic Society have most generously given £60,000 for the building of a new Phoenix Centre, and work has already begun on this. The Centre should be completed in the Spring of next year and after completion it is intended that the attendances of the children attending the Centre will be increased. 151 RETURN OF HANDICAPPED CHILDREN PART I New assessments and placements During the calendar year ended 31st December, 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 handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? boys 1 - 3 - 4 - 21 29 - 1 59 girls — — — — 3 2 2 19 1 — 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 - - 3 - 3 - 8 14 - - 28 girls — — — — 1 2 2 9 i — 15 (ii) of those assessed prior to January, 1970 boys - - - - - 3 3 24 - - 30 girls - - - - - - - - - - 7 (iii) TOTAL newly placed—B (i) and (ii) boys - - 3 - 3 3 11 38 - - 58 girls — — - — 1 2 2 16 1 — 22 PART II Children found unsuitable for education at school During the calendar year ended 31st December, 1970:— (i) How many children were the subject of new decisions recorded under Section 57 of the Education Act, 1944? 26 (ii) How many reviews were carried out under the provisions of Section 57A of the Education Act, 1944? 3 (iii) How many decisions were cancelled under Section 57A(2) of the Education Act 1944? — 152 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 21st January, 1971:— Blind (1) P.S. (2) Deaf (3) Ft. 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? (i) waiting before 1st January, 1970:— (a) day places boys - - - - 1 - - - - - 1 girls - - - - - - - - - - - (1) Under 5 years of (b) boarding places boys - - - - - - - - - - - glris - - - - - - - - - - - (ii) newly assessed since 1st January, 1970:— (a) day places boys - - - - - - - - - - - girls - - - - 1 - - - - - 1 (b) boarding places boys 1 - - - - - - - - - 1 girls - - - - - - - - - - - (i) waiting before 1st January, 1970:— (a) whose parents had refused consent to their admission to a special school (a) day places boys — — — — — 1 — 1 — — 2 girls - - - - - - - 1 - - 1 (b) boarding places boys - - - - - - - - - - - girls - - - - - - - - - - - (2) Aged 5 (b) others years and over (a) day places boys - - - - - - - 9 - - 9 girls - - - - - - - 1 - - 1 (b) boarding places boys — — — — 1 — — 1 — — 2 girls - - - - - - - 1 - - 1 (ii) newly assessed since 1st January, 1970:— (a) whose parents had refused consent to their admission to a special school (a) day places boys - - - - - - - - - - - girls - - - - - - - 2 - - 2 (b) boarding places boys - - - - - - 2 - - - 2 girls - - - - - - - - - - - (b) others (a) day places boys - - - - - - - 14 - - 14 girls - - - - - - - 7 - - 7 (b) boarding places boys — — — — 1 — 5 — — 1 7 girls - - - - - - - - - - - (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 — — — — 1 1 — 24 — — 26 girls — — — — 1 — — 11 — — 12 (b) boarding places boys 1 — — — 2 — 7 1 — 1 12 girls - - - - - - - 1 - - 1 153 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 21st January, 1971:— Blind (1) P.S. (2) Def (3) Pt.Hg. (4) P.H. (5) Del. (6) Mal. (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 4 5 12 7 1 181 - - 214 girls - 1 1 2 4 4 — 122 - - 134 boarding boys 1 — 1 - 4 4 3 10 - — 23 girls - - 1 — 6 5 - 1 - — 13 How many pupils from the Authority's area were on the registers of:— (ii) Non-maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) wherever situated day boys - - - - 4 - - - - - 4 girls 1 - - - 3 - - - - - 4 boarding boys — 1 7 - 2 3 7 7 1 - 28 girls 2 — 1 - 3 1 1 2 2 — 12 (iii) Independent schools under arrangements made by the authority day boys - — - 1 — - 2 1 — — 4 girls - - 1 — 1 — — — — — 2 boarding boys — — 3 — 2 — 33 4 — - 42 girls — — 3 - 1 — 4 4 — — 12 (iv) Special classes and units not forming part of a special school. boys - - - 5 - - - - - - 5 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 - - - - 13 - - - - - 13 girls - - - - 7 - - - - - 7 (iii) at home boys - - - - - 1 1 - — — 2 girls — — - - 1 3 — 1 — — 5 E 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 2 5 15 11 40 16 54 228 1 1 373 girls 3 1 7 11 27 13 5 142 2 — 211 154 SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington Mr. Anderson, who had been Head Teacher of Goddington School for sixteen years left in April and was succeeded by Mrs. Rackham. Mrs. D. Ogden, S.R.N., R.S.C.N., Welfare Assistant, attended the Health Education Conference held at Kingsgate College, Broadstairs, in October. She now takes four senior groups (two groups of boys and two groups of girls) for counselling in health and personal relationships. It has proved to be very successful. Work of a similar nature is also included in the general curriculum for the entire school; and it is implemented by Mrs. E. Perkins, who is the teacher for home economics. She is also in charge of the senior girls. The learner swimming pool was opened and is jointly used by Blenheim Junior School and Goddington. The extensive physical education programme of the school, run by physical education specialist, Mrs. J. Oliver, and also by Mr. Moyse, who does weight training, boys games and athletics, led to the splendid performance at the combined sports day held at Goddington in July. The three Bromley Special Schools and Woodside (Bexley) were participants. Goddington won with 103 points with Grovelands as runner up with 75 points. A pony club was begun in the summer by Miss Davies, who has since left the school; it is now run by Mrs. Mehmet. The activities of the club take place once a week at Bradbourne Stables at Sevenoaks. It is very popular and acts in a remedial therapeutic capacity in many cases. The numbers are limited to nine. There are extensive careers programmes in the two last senior years of the school, namely visiting likely places of employment, social integration and general environmental knowledge. There were eleven school leavers during the year of which nine are employed. There was one de-ascertainment. Special defects in children of the school:— Pupils Speech 11 Personality disorders 22 Deafness 6 Epileptic 12 Down's Syndrome 1 Visual defect 15 Incontinent 3 Sturge Weber 2 155 Physical handicap:— Asthma 3 9 Heart 1 Hydrocephalus 1 Rheumatism 1 Atonia 1 Cerebal Palsy 1 Fragilitas osseum 1 Severely sub-normal 6 St. Nicholas School, West Wickham Number of children on roll:— Boys 63 Girls 47 Total 110 Staff includes Headmaster, Deputy Head, 9 full-time teachers. 1 full-time teacher for House Craft and 3 Housemothers, 1 fulltime, 2 part-time. Everyone on the Staff, children and parents were upset by the illness of Mr. Spencer the Headmaster who was absent during the whole summer and autumn terms. Mr. Brian Maunder joined the staff as Acting Headmaster in September and his enthusiasm, energy and ideas were felt and incorporated from the first day he came. The annual medical examinations including vision and hearing tests for every child in the school were carried out during the summer term, and B.C.G. tests and vaccinations were done on 13 boys and girls of the 13 year old age group. At least one third of the children have vision defects and wear glasses and about a third have regular speech therapy and language development. During the year there were 12 school leavers who obtained a variety of jobs under supervision, mostly of a routine nature and suited to their limited capabilities. Every child in the school has the chance of learning to swim in summer or winter, as the cover for the heated swimming pool has been completed and looks like a miniature Crystal Palace. Outings to London have been great highlights and the 156 imaginative drawings and paintings of places of interest seen during the trips were often outstanding. An innovation with the legal backing of the Education Department has been the shopping expeditions in pairs to West Wickham High Street to buy ingredients for cookery or materials for woodwork. Both boys and girls enjoy cookery and proudly take the finished products home for their family to sample. The entire staff work to help each individual child develop to his or her utmost potential, and their outlook is broadened and the social side is encouraged by many projects within the school and by visits to places of interest outside it. Grovelands School, St. Pauls Cray Twenty-two children have been admitted during the past year including seven from other special schools and five from Special Opportunity Classes. Of the eleven pupils who left, one transferred to an ordinary school, four moved to another special school and six entered employment including work as a hospital orderly and pet shop assistant. Staff changes have been minimal which is always a help with regard to familiarity and continuity. One member is attending a full time course which necessitates temporary replacement and one has changed from part time to full time work. Speech therapy has been more regular and an Amplivox ring amplifier has been fitted for the benefit of a child with a severe hearing loss. The usual medicals and dental inspections have taken place which have often provided useful contact with parents to discuss problems and give advice. The provision of a pet rabbit and a guinea pig for the admission class has given much pleasure as has the practical room for the senior girls. Here once a week a meal is provided for themselves and an invited guest which gives practise in budgeting, shopping, cooking, etc. which is of great use after they leave school. The usual trips to places of interest and as suggestions for future employment, have been made in addition to swimming, sports and social activities. As much touch as possible has been maintained with the ex-pupils many of whom return for regular visits. Considerable effort is put in by everyone concerned to enable each pupil to fit into the community as well as possible. 157 Employment of Young Children 392 children were examined by the Medical Officers in the Department during the year. Certificates were issued in 390 cases, and in only two cases were the certificates not issued. Boys Girls Delivery of newspapers 200 71 Delivery of milk 2 — Delivery of bread 1 — Delivery of eggs 1 — Shop Assistant 19 60 Shelf Filler 6 4 Waitress — 3 Cash Desk — 1 Hairdresser's Assistant — 7 Library Assistant — 4 Entertainment 2 6 Cleaning 2 — Clerk 1 - 234 156 Other Medical Examinations The following examinations were carried out by Medical Officers during the year:— Training College candidates 384 Teachers (including two for other Authorities) 167 Total 551 School Meals and Milk Services The average daily number of meals served during 1970 was 35,400 which represents an increase of less than 1 per cent over last year's figures. A return for a day in October 1970, showed that the number of pupils taking a ⅓ pint of milk was 24,172 (Maintained) and 2,105 (non-maintained) equal to 1,097½ galls, daily. The total gallonage for the same period in 1969 was 1.040 daily. The demand in 1970 was therefore up by 5 per cent. During 1970 the School Meals Service were asked to provide daily to Stembridge Hall and the Beckenham Work Centre 20 meals and 18 meals respectively, and were also able to help 158 Oxford House with prepared meals, when they encountered some difficulty in the Autumn Term. The experiment at Kent Wood School with convenience foods is being continued following the 12 months trial and it will be interesting to see how the operation compares with that of the first year's performance. Canteens which came fully into use during 1970 were (1) St. James R.C. in Petts Wood, Orpington—opened Summer Term— and currently producing 170 meals daily, and (2) Footbury Hill Infants' Orpington—opened Autumn Term—and serving approximately 160 meals per day. The Health Visitor in the School Health Service The Health Visiting Staff has prepared and/or assisted in the full medical examination of 14,368 school children and in addition tested the vision of 4,215 eight year old children. 1,483 treatments have been given for minor ailments to 323 children in clinics of which 187 children were treated for conditions of the skin. It is not always appreciated that the Health Visitors give a great deal of advice to parents on the care of school children either in the course of their family visiting or because of matters arising from school medical and hygiene inspections. The Health Visitors are also frequently contacted by parents at their offices for advice and assistance with their school children on all aspects of health and behaviour. Rubella Vaccination for school girls between eleven years and fourteen years has been offered: this programme started in November, 1970, and is continuing. This should be a great safeguard for the health of future generations in preventing children being born with defects due to injury from Rubella Virus during the mother's pregnancy. 159 HEALTH EDUCATION AND HOME SAFETY HEALTH EDUCATION Education of the Young At no age is health teaching more rewarding and necessary than in childhood and youth. It is then that the disciplines of life must be learned together with an understanding of personal responsibilities, and the need for care of the body and the maintenance of physical fitness. To learn to spend leisure time wisely is important. The home, with its love and security, is the place where these foundations are laid. Child neglect with its serious consequences is often due to the parents lack of knowledge; and over-indulgence, for the same reason, may have no less unfortunate repercussions in later life. Some of the ways in which parents can obtain guidance in these matters are manifold. Those who instruct the young at school or elsewhere should not forget that perhaps the most useful health lessons, particularly for younger children, are those taught indirectly during instruction in other subjects. Geography and history lessons and religious instruction provide many opportunities; chemistry, physics, biology and domestic science just as many. Games and physical training—now more appropriately called physical education—are specific aspects of health education. Whilst the set lecture on a health topic has its place, it is as well to remember that fit young people, and grownups for that matter, are not interested in health for health's sake. Those who are blessed with it are indifferent to the possibility of a departure from it. They are interested in the improvement of physique and personal appearance, as exemplified by famous personalities in sport, films, the Services and other walks of life— the heroes of yesterday and today. Camping is another healthy activity, which among other things, directs attention to good sanitation and food hygiene. Lastly, young people who have learned good health habits elsewhere do not forget them at home, where they may be copied by the other members of the family. The Aims of Health Education Basic health habits should become second nature. They are far more likely to be acquired and followed when there is full understanding of the need for them. A knowledge of the broad facts about the structure of the human body and its working machinery—and everyone should 160 know something about it—is the foundation upon which health education should be built. It has been learned that one of the objects of health education is to inform people, to give them facts so that they may better understand the reasons behind health principles and precepts. The three aims of health education as defined by an Expert Committee of the World Health Organisation are:— (1) To ensure that the community regards health as an asset. (2) To equip the individual with skills, knowledge and attitudes to help solve his own health problems. (3) To promote the development of the health services. But, more important still, is the application of this knowledge: no easy task, when ingrained habits and customs have sometimes to be broken down, and personal likes and dislikes, as well as prejudices and emotions, counteracted. Success depends not only on expert teaching, but on sympathy, patience and the correct approach appropriate to the age, sex, personality and the social and educational background of those to whom it is directed. Advice, guidance and practical help go shoulder to shoulder with teaching. The maximum effort must be directed towards children and young people so that good habits may be formed early. As has been said there is an important place for indirect instruction. The foundations are laid at home, wise parents take every opportunity of improving their health knowledge, so do sensible young people preparing for marriage. Children who practice at home what they have learned at school or youth centres may stimulate indifferent parents to follow suit. Home Safety From January to December, 1970, a total of 8,820 home accident cases were treated at the hospitals of Beckenham, Farnborough, Orpington and Bromley. Of these, 5,093 were adults and 3,727 children. In the previous year, the overall totals from these hospitals was 9,509 and of these 5,484 were adults and 4,025 children. This shows a reduction of 689 casualties in 1970, as compared with the previous year. Of these, 391 were adults and 298 children. This reduction is most encouraging but once again all Home Safety Committees and other Organisations engaged in Accident 161 Prevention must realise that continued education of the public is the foremost remedy. As was mentioned in previous reports, it is useless educating the child without educating the mother. It is also useless educating the elderly without educating those who might have to look after them. Once again the three most prominent causes of these accidents, with serious complications, according to the statistics supplied by the Hospital Authorities, were given as follows:— 1. Falls: Being the chief danger to old people. 2. Burns/Scalds: Affect both the young and old people. 3. Poisoning/Suffocation: Being the danger to adults, especially in relation to gas, medicinal substances, through overdoses, mistakes, etc. Also to the very young persons who find drugs, tablets, medicines, detergents, etc., loose in cupboards, drawers, and finally to the small babies without adequate net screens on prams and cots against domestic pets, and the dangerous use of soft pillows and plastic bibs, etc. Local Campaigns 1971 In an effort to try and reduce these appalling numbers of home accidents, it is hoped that the Home Safety Committees within the Borough will co-operate with the Royal Society for the Prevention of Accidents in their National Campaign for the year, which is as follows:— January—March: Burns/Scalds. April—June: Household Poisons, Drugs, Medicines. July—September Plan a Competition. October—December: Fire Stafety, Fireworks, Christmas hazards. 162 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. 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. 163 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 „ Friday ,, Tuesday—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—All day 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 ,, 164 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. Monday—All day Thursday „ Tuesday—a.m. only Wednesday—a.m. only Friday—a.m. only Hawes Down Clinic, Hawes Lane, West Wickham. Tuesday—p.m. Wednesday—All day Thursday ,, School Clinic, Oakfield Road, Penge. Tuesday—All day Thursday „ Monday—a.m. only Wednesday—a.m. only Friday—a.m. only *SPECIAL EXAMINATION CLINICS: School Clinic, Oakfield Road, Penge. Thursday— 9.30 - 11.0 a.m. The Willows, Red Hill, Chislehurst. 2nd and 4th Thursday in month 4.15-5 p.m. Mickleham Road Clinic, St. Paul's Cray. 2nd and 4th Thursday in month 4.15-5 p.m. School House, 55 Chislehurst Road, Orpington. 2nd Friday in month 9.30-12 noon *In addition to these fixed times, appointments are arranged as and when necessary at other clinics for the purpose of carrying out special examinations, etc.