AC 43341 London Borough of GRE 63 GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1965 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1965 CONTENTS Page Health Committee 3 Welfare Committee 5 Staff 7 Introductory 10 Section I—General Statistics and Social Conditions 15 ,, II—Vital Statistics 41 ,, III—Prevalence of, and Control Over, Infectious and Other Diseases 61 ,, IV—Personal Health and Related Social Services 80 ,, V—Welfare Services 115 „ VI—Mental Health Services 166 „ VII—Environmental Health Services 188 „ VIII—Miscellaneous 263 ,, IX—School Health Services 277 Appendix—statistical Tables 3 HEALTH COMMITTEE (as at 31st December, 1965) The Mayor: (ex-officio) Councillor W. A. G. Brooks, J.P. Chairman: Councillor Mrs. H. Stroud Vice-Chairman: Alderman A. C. Chrisp Alderman: W. S. Manners, M.B.E. councillors: Mrs. M. J. M. Bradley Mrs. A. D. A. Kennedy Mrs. S. M. Bradley G. E. Offord, J.P. Mrs. J. E. Chrisp H.A. Read J. P. Hamilton N. R. J. Sims L. A. Heath I. N. Smith Mrs. W. H. M. Hulbert L. Squirrell Terms of Reference: (1) The Committee shall consist of 15 members of the Council. (2) All matters concerning the general health and sanitation of the borough. (3) The notification and prevention of infectious and contagious diseases. (4) Matters relating to water supply in the Borough. (5) The powers and duties of the Council under the Clean Air Act, 1956. (6) The preparation of schemes under the London Government Act, 1963, for the co-ordination of the Council's health service and the school health service. (7) The powers and duties of the Council under the Housing Acts relating to individual unfit houses. (8) Receive representations as to clearance areas and submit recommendations thereon. 4 (9) The powers and duties of the Council relating to houses in multiple occupation, including the making of control orders under the Housing Act, 1964. (10) The declaration of improvement areas relating to the compulsory improvement of dwellings to provide standard amenities in accordance with the powers contained in Part II of the Housing Act, 1964. (11) The provision and management under the National Health Service Act, 1958, Part III, of clinics and health centres and vaccination and immunisation services. (12) The provision and management of maternity, midwifery and child welfare services. (13) The provision and management, under the National Health Service Act, 1946, and the Mental Health Act, 1959, of welfare clinics for handicapped children, junior and adult training centres, day centres, social clubs and other facilities for the mentally sub-normal and the mentally ill. (14) The supervision of the mentally sub-normal and the mentally ill in their homes, in lodgings, hostels, etc., and home training. (15) The provision and management of residential accommodation for the sub-normal and the mentally ill and placing such persons in voluntary hostels and private homes. (16) (a) The removal of persons in need of care and attention: (b) home nursing and health visiting of the sick and aged; (c) domestic help services for the aged and sick; (d) the provision and management of chiropody, disinfestation, incontinent laundry, and personal ablution services for the aged and necessitous. (17) Environmental health services and hygiene, including investigation and abatement of nuisances from defects in buildings, drainage, noise, offensive and other trades, provision of dustbins, sanitary accommodation in factories, shops, offices, places of public refreshment and entertainment, enforcement of regulations for out-workers, sampling to check the cleanliness of rag flock and other fillings, inspection under Animal Boarding Act, inspection of canal boats, hairdressers' premises, common lodging houses and amusement fairs. (18) Inspections under the Offices, Shops and Railway Premises Act, 1963. (19) Food hygiene and drugs control, including inspection of premises for manufacture, storage and sale of ice cream, dairies and milk retailing, poison and pharmacy, manufacture 5 and storage of sausage and preserved foods, slaughterhouses, knackers' yards and inspection of meat, sampling and analysis of samples, chemical and bacteriological. (20) Disinfection and pest control. (21) The provision of mortuaries or arrangements for the joint use of sharing mortuary accommodation. (22) Consumer protection as regards the composition, labelling, advertisement, and description of food, drugs and medicines, and prevention of adulteration. (23) Health education and home safety. (24) Inspection of riding establishments. (25) the administration of the Council's powers relating to certificates of disrepair under the Rent Act, 1957, and related legislation. WELFARE COMMITTEE (as at 31 st December, 1965) The Mayor: (ex-officio) Councillor W. A. G. Brooks, J.P. Chairman: Councillor G. E. Offord, J.P. Vice-Chairman: Councillor R. T. Coombs Aldermen : Mrs. E. Brooks A. C. Chrisp E. McCarthy Councillors: Mrs. K. P. Bullard, J.P. W. J. Manners N. G. Burbridc.e Mrs. E. Pennington Mrs. J. E. Chrisp Mrs. M. E. Polley Mrs. W. H. M. Hulbert H. F. Reilly t. a. j. Malone Mrs. n. a. E. Woods 6 Terms of Reference: (1) The Committee shall consist of 15 members of the Council. (2) The administration of the powers and duties of the Council under the National Health Service Act, 1946, the National Assistance Acts, 1948, 1951 and 1962, and related legislation as follows:— (a) the welfare of the aged, the blind, the deaf, the dumb, the crippled and the handicapped, including the employment of, and grants to, voluntary organisations for aged or disabled persons' welfare; (b) the provision of residential and temporary accommodation for the aged and the sick, including accommodation in premises maintained by voluntary organisations; (c) the registration and inspection of disabled and aged persons' homes; (d) social visiting of the sick and aged; (e) the burial and cremation of dead persons where no suitable alternative arrangements are being made. (f) temporary protection for property of persons admitted to hospitals; (g) the provision and management of workshops and other occupational centres for the disabled and aged. (h) arrangements in connection with luncheon clubs and mobile and other meals services for the sick and aged; (i) the provision of, and assistance with, social, entertainment, recreation and other amenities for the sick and the aged, including the disabled and physically handicapped, together with facilities (whether within or outside the Borough) for the provision of holiday accommodation either directly by the Council or through other agencies; (j) the provision and management of homes for unmarried mothers; (k) the provision, regulation and management of such accommodation for the homeless as may be allocated for the accommodation of persons or families who might be received or accommodated on a temporary or transfer basis in the exercise of the Council's statutory responsibilities under the National Assistance and associated Acts. 7 STAFF HEALTH AND WELFARE DEPARTMENT (31st December, 1965) SENIOR OFFICERS Medical Officer of Health and Principal School Medical Officer: Dr. J. Kerr Brown Deputy Medical Officer of Health: Dr. M. E. Watts Associate Medical Officer of Health: Dr. T. Standring Principal Medical Officer: Dr. C. C. A. Jansz (commenced 20.5.66) Medical Officers: Dr. B. W. Hordern Dr. J. M. Oldfield Dr. G. G. Sherriff Dr. F. I. Winfield Visiting Medical Officers: Dr. R. S. L. Hood Dr. A. G. Marus Dr. D. Ricketts Dr. W. D. H. Troughton Dr. R. G. Taylor (commenced 19.9.66) Dr. P. D. Warren Dr. J. R. Wood Consultant Chest Physicians: Dr. P. Forgacs Dr. A. MacManus Dr. D. G. Wraith Consultant Geriatrician: Dr. R. V. Boyd (commenced 1.1.66) Public Analyst: Dr. H. A. Williams Welfare Borough Welfare Officer: R. E. Haymes Deputy Borough Welfare Officer: A. Healey Senior Social Worker: R. C. Baldock Deputy Senior Social Worker: Miss N. E. L. Irwin Senior Woman Public Health Officer: Miss B. Hatfield Deputy Woman Public Health Officer: Miss N. A. Fluck 8 Matrons of Old People's Homes: Mrs. M. C. Aspinall. Miss M. Campbell Mrs. J. Henville Mrs. J. B. Lanham Greenwich Hotels' Superintendent: Miss W. E. Wilson Homeless Families' Units Supervisor: D. A. Upton Workshop for the Blind Manager: R. J. Nottage Personal Health Chief Nursing Officer: Miss M. Naunton Deputy Chief Nursing Officer: Miss A. Hayward Supervisor of Midwives and Home Nursing Services: Miss J. A. Waugh Chief Dental Officer: F. Elston Principal Social Worker: Mrs. J. Y. White Deputy Principal Social Worker: Mrs. M. J. Hassett Chief Chiropodists: K. D. Reeve Miss E. P. Flanagan Home Help Organisers: Mrs. D. E. Hayward Mrs. J. A. McTavish Miss D. E. White Environmental Health Chief Public Health Inspector: F. A. Andrew Deputy Chief Public Health Inspector: G. B. Allen Principal Food Inspectors: F. J. Hoines C. W. Spore Principal Housing Inspector: W. F. Wheal Senior District Public Health Inspector and Hygiene Officer: W. F. N. TrougHton Senior Clean Air Inspector: W. E. McLelland Disinfection and Disinfestation Inspector: J. G. Lyons Rodent Control Inspector: J. W. Dennard 9 Mental Health Principal Mental Health Officer: B. Freeman Deputy Principal Mental Health Officer: J. E. Allen Training Centre Supervisors: Miss B. A. Godfrey P. Rickards Mrs. I. A. Robbins Administration Chief Administrative Officer: L. M. Longhurst Deputy Chief Administrative Officers: L. A. Westacott C. A. Webb (Establishment) Section Heads Finance and Supplies: R. E. Sweett Welfare: R. Bruty (Meals, Handicapped and Elderly) J. W. Shorter (Residential and Ancillary) Personal Health: J. Hannen Environmental Health: K. G. Allum Staff: R. Augustin Planning and Development: R. G. Garratt Statistics and Health Education: A. H. Wilcox J. E. Kay Transport: W. F. Goodall Typing: Mrs. W. Ellison 10 Health and Welfare Department, Municipal Offices, Royal Hill, S.E.10. To the Mayor, Aldermen and Councillors, London Borough of Greenwich. Ladies and Gentlemen, It is my great privilege to submit this first report on the health, welfare and environmental circumstances of the new London Borough of Greenwich. The Borough was formed by the union of the former Metropolitan Boroughs of Greenwich and Woolwich and, in creating the new Health and Welfare Department, the services being provided by a number of authorities had to be integrated. Some idea of the complexity of this exercise can be gained by a detailed study of the multifarious services now being provided by the new Department, which are described in the report. In those early days the Council had in mind certain priorities. It was concerned with preserving the continuity and quality of service so that the public would suffer no inconvenience. It was anxious to absorb staff without disruption and to create a Department which would work effectively and harmoniously. Furthermore, it wished to adapt and to shape the services and administrative patterns to meet local requirements and, lastly, the Council was concerned to recognize as early as possible present deficiencies in the local services and, as a result of those enquiries, to prepare an orderly plan of expansion relevant to the Borough's needs. By and large these tasks have been accomplished and the process of consolidation can begin. In such an upheaval it is understandable that some Boroughs were more fortunate than others in the allocation of facilities and premises, but it must be said that in general Greenwich inherited a reasonably well balanced service. The advances which have already begun are along several fronts and full details are recorded in the body of the report, but some are worthy of brief mention in these prefatory remarks. The Department is already identified as an important element in the life of the community and the links which have been forged with hospitals, doctors, societies and voluntary bodies in the health and welfare field have never been closer. More local family 11 doctors than ever before are now being employed by the Borough either as sessional medical officers at the clinics or as visiting medical officers to the various establishments. Our social workers are being welcomed into the hospitals and, in view of the shortage of hospital medical social workers, they are undertaking duties on behalf of the various hospital consultants. This is the sort of co-operation that one finds most gratifying. Cervical cytology clinics are screening each week a higher proportion of women per population than any other borough in the country, and the clinics are staffed exclusively by general practitioner obstetricians. In the field of mental health, the Maze Hill Junior Centre, which opened towards the end of the year, is already earning a high reputation as a pioneer in the field of education and training of the severely mentally handicapped child. Day centre and hostel provision for the mentally ill and handicapped now await Ministry sanction, and the industrial centre has been expanded along more ambitious lines. In the welfare services, much preparatory work has been undertaken for rapid advances in the services for the family and for the handicapped and in relation to residential accommodation for the aged. The local community geriatric services are already most comprehensive and are meeting ever increasing needs. All aspects of old people's welfare have been expanded and the holiday hotel, after extensive adaptations which are at present under way, will shortly be able to accommodate between 90 and 95 citizens per fortnight, including a substantial proportion of severely handicapped. Welfare provision for the adolescent and adult handicapped and the young chronic sick will require to be given higher degrees of priority and efforts must be directed towards obtaining a more accurate assessment of local needs. The one rehabilitation centre which is in use is manifestly inadequate and further facilities will be provided. Turning to personal health, a new clinic at Abbey Wood has been opened and the services brought closer to the general practitioners. It is hoped that group practices in this area will grow and flourish and this will give the Department the opportunity of further participation on the community side of the work of the family doctors. A Health Education section has been created and an account of the year's activities is included. Midwifery and home nursing have been unified under the one control and are now geared to a Borough requirement, and the general practitioner obstetricians and hospitals are now much more closely involved in the local services. 12 In connection with the requirements of the midwifery, mental health and homelessness services, a 24 hour weekend and holiday cover has been created and has proved to be of great benefit. Other health and welfare emergencies are, of course, handled by this control centre. In these days a great deal of attention must properly be directed to the personal health and welfare of the individual and family, but it must not be forgotten that traditional public health is still of vital significance and the unflagging energies of the public health inspectors must be given prominence. The Environmental Section has continued to advance the slum clearance programme, many individual unfit houses, basements and parts of houses have been closed, smoke control areas have been extended and all the routine and important work of the public health and food inspectors has proceeded without interruption. The reorganisation of London government resulted in certain minor changes in procedure regarding the notification of certain infectious diseases, which are detailed elsewhere, and the repeal of the Public Health (London) Act and the various London County Council (General Powers) Acts has necessitated extensive reorganisation of informal and statutory procedures. The most important infectious diseases notified last year were measles, scarlet fever, puerperal pyrexia and acute primary and influenzal pneumonia. There were only 26 notifications of sonne dysentery and the Borough was free from typhoid, smallpox and diphtheria. Tuberculosis continues to decline and 69 notifications were received, compared with 94 the previous year. The contributions which the chest physicians have made to this report indicate that other chest and heart diseases have superseded tuberculosis in community importance. In connection with causes of death, once again heart and circulatory diseases and malignancy constituted together about 52% of all deaths in the Borough. This high figure underlines the increasing importance of the "stress" diseases and the vital part which the increasingly heavy consumption of tobacco is playing in the incidence of circulatory disturbances and respiratory malignancy. Such preventable aetiological factors are a continual challenge to the efficacy, the persuasiveness and the ingenuity of our health educationists. With the agreement of the Inner London Education Authority the opportunity has been taken to include the report submitted to that Authority on the local School Health Service. The Chief Dental Officer in his report has indicated deficiencies in the local authority dental services which must be rectified, but the main difficulty is the recruitment of qualified dental officers and no early 13 solution is apparent. In the meantime, premises and equipment are being improved where possible. In this first year of operation the advantages of a combined health and welfare department are becoming increasingly apparent. The whole area of health and welfare is being encompassed within the same headquarters and each of the many specialists can consult and co-operate as equal colleagues with one another in the same department. The concept of a unified domiciliary team providing a comprehensive integrated health and welfare family service is being evolved, and once the necessary administrative and professional adjustments have been made to the new circumstances, the prospect of a balanced co-ordinated service being available to all citizens, with no arbitrary line of demarcation between health and welfare and with an absence of professional or departmental misunderstandings, are bright and promising. This co-operative team effort is being actively encouraged in the Department and the early results are heartening. What of the future of this newly created comprehensive social services structure in the Department? It is perhaps too early to be dogmatic but, experience gained during the first year, is tending to emphasize the fact that full integration of the health and welfare services is not only rational but that any division between medical and social necessity is illusory and that social breakdown and conditions of health are inalienable. It has been made abundantly clear that family social work is an integral part of public health and, as now undertaken by the department, represents the most economical and advantageous deployment of available personnel for a comprehensive, all-embracing community social service while largely avoiding the former duplication of effort. Furthermore, despite the benefits already apparent, it is clear that we have yet to witness the full advantages accruing from an integrated service. It may well be that, in the future, complete exploitation of our existing services will be hampered by limited resources and a paucity of trained personnel but there is no doubt that the co-ordination now being achieved is the way to success. This has been an arduous year for both members and staff and I am deeply sensible of the help and encouragement which I have received from the Chairmen and Vice-Chairmen of the Health and Welfare Committees. The members of these Committees have also had many difficult problems to solve and policy to determine, and I trust that this account of the work which they have authorised will provide a measure of satisfaction. In paying tribute to all who serve in the Department I am conscious of a sense of inadequacy. The selfless devotion to duty of many of the staff. 14 particularly those looking after the frail, the handicapped and the deprived, is beyond praise, and I must also express my deep gratitude to those who, by the nature of things, have been closest to me in the direction of the affairs of the Department. This report records the efforts and contributions of many and it has been my happy task to act as the compiler, co-ordinator and editor. Any merits which the report may have are due to the quality of the many contributions which have been harvested from diverse sources. I acknowledge gladly my indebtedness to all of them. I trust that this year of endeavour by the Council will have provided the citizens of Greenwich with the foundations of a structure of service for the community which will bring credit to this historic Borough. Your obedient Servant, J. Kerr Brown, Medical Officer of Health. 15 SECTION I GENERAL STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 416 feet above sea level. *Area of the Borough and Districts (land and Inland Water)— Greenwich 3,863 acres Woolwich 7,861 acres 11,724 acres Population— *At Census, 1961 230,250 Estimated, 1965 (mid-year) 231,770 Density of Population (persons per acre) 19.76 Number of Inhabited Dwellings—end 1965 (according to Rate Books) 69,916 *Structurally separate dwellings at Census, 1961 70,175 Number of Uninhabited Dwellings— *At Census, 1961 1,031 At end 1965 2,094 Number of Families or Separate Occupiers— *At Census, 1961 75,803 Rateable Value, 1965 £12,439,895 Sum Represented by a 1d. Rate, 1965 £50,350 * Adjusted to accord with Boundary Changes introduced under the London Government Act, 1963. 16 PUBLIC OPEN SPACES Borough Council— Approx. Acreage Altash Gardens 1.90 Batley Park 0.97 Bellott Memorial Gardens 0.19 Bostall Gardens, McLeod Road 2.75 Briset Road Recreation Ground 3.79 Charlton House and Gardens 9.25 Coldharbour Open Space 7.90 Dallin Road Open Space 0.50 East Greenwich Pleasaunce 5.93 Eltham Green 6.00 Horn Park Open Space 8.55 Hughes Fields Recreation Ground 0.74 Middle Park Children's Playing Field 8.00 Pippinhall Farm, Bexley Road 3.40 Plumstead Gardens, Church Manorway 6.31 Queen's Gardens, Coldharbour Estate 1.50 Queenscroft Recreation Ground 12.50 Rockcliff Gardens 5.21 St. Alfege Recreation and Church Grounds 2.30 St. Mary"s Churchyard 3.36 St. Nicholas Gardens, S.E.18 2.80 Sidcup Road Open Space 9.13 Southwood Road Recreation Ground 1.26 Sunbury Street Recreation Ground 0.30 Sutcliffe Park and Harrow Meadow Playing Field 65.00 The Tarn, Court Road 10.45 Villas Road 0.16 Well Hall Pleasaunce 12.17 William Barefoot Gardens 0.79 Other Open Spaces 6.01 199.12 acres 17 Greater London Council— Avery Hill, Eltham (with Nurseries) 83.00 Blackheath (part of) 89.00 Blackheath—Rangers House and Gardens 2.50 Bostall Heath 71.50 Bostall Woods 62.00 Castlewood, Shooter's Hill 22.50 Charlotte Turner Gardens 1.75 Charlton Park 42.75 Eaglesfield, Shooter's Hill 9.00 Eltham Common, Shooter's Hill 32.00 Eltham Park, South 41.50 Eltham Park, North 14.00 Fairy Hill 11.50 Hornfair (formerly Charlton Playing Field) 26.00 Jackwood, Shooter's Hill 45.00 King George's Field 4.75 Maryon and Maryon Wilson Parks 51.50 Oxleas and Shepherdleas Woods 212.50 Plumstead Common 103.50 Sayes Court Recreation Grounds 3.25 Shrewsbury Park 27.50 957.00 acres H.M. Office of Works Greenwich Park 185.00 acres War Office Department Woolwich Common 159.00 acres Total Public Open Spaces in Borough (representing 12.8% of the total area of the Borough) 1,500.12 acres Mileage of Roads (1st April, 1965) Approx. 249.81 18 GENERAL INFORMATION AND SOCIAL CONDITIONS In any society, the establishment and implementation of a public health and welfare policy must have due regard to the social circumstances of the particular section of the community to which it is directed. Present social circumstances are the result of the impact of history, both political and economic, on the lives and environment of its inhabitants. It is the aim of these introductory pages to supply, in abbreviated form, such background information as will enable a more objective view to be taken of the Borough and its problems. Since the beginning of the 19th century, accelerating increases in population have created a variety of problems in the London area, not the least important of which has been that of local government. Clearly, with such rapid changes in recent years and the intensification of difficulties associated with housing, social conditions, public health, etc., an investigation into London Government became desirable. Accordingly, in December, 1957, a Commission was set up "to examine the present system and working of local government in the Greater London area" and, if considered necessary, to recommend changes which would secure better and more efficient administration. Resulting from the Commission's Report presented to Parliament in October, 1960, it was concluded that, in the light of modern requirements, some adjustment to London Government was imperative and that in a number of instances, new local authorities needed to be created. Subsequently, re-organisation of local government in London was effected by the London Government Act, 1963. Greater London now consists of 32 London Boroughs with the City and the Temples. Twelve of these are designated Inner London Boroughs, of which Greenwich is one, and on 1st April, 1965, under the title of the London Borough of Greenwich, the previous Metropolitan Boroughs of Greenwich and Woolwich were united. Amalgamation of these two areas has resulted in the formation of a Borough which is second to none in historical background and diverse interests. As a riparian authority, the Council now has jurisdiction over a river frontage of almost nine miles extending eastwards from just short of the Surrey Commercial Docks and Limehouse Reach, through the Greenwich, Blackwall, Bugsby, Woolwich and Gallion's Reaches almost to Crossness on the Erith Marshes in Barking Reach. Averaging approximately 1/4 mile in width, the River Thames forms the northern boundary of the new Borough which ranges southwards for about 5 miles from this base line in a 19 triangular shape closely resembling that of a map of India. The resultant area is 18.32 square miles. With the exception of the Kidbrooke/Shooters Hill region which is mainly clay, the sub-soil of the greater portion of the Borough consists of gravel and sand and, throughout the whole of the area, the altitude varies from a few feet below high-water mark on the Marshes up to 416 feet above sea level on Shooters Hill. In the days of Caesar, Greenwich, which in Latin was described as Grenovicum viridis sinus a viridariis and in Saxon, Grenawic, i.e., the flourishing village in the pleasant green hollow, was in the Roman province of Britannia Primo. All evidence points to the fact that the present Royal Naval College stands on a site where once stood handsome Roman villas and courts. It is a steady climb at every point from the narrow strip of low lying land adjacent to the Thames to the raised plateau of Blackheath where extensive views of London and the river obtainable from this escarpment are incomparable. This strip of land, invaluable for defensive purposes, was the future site of Greenwich and, undoubtedly, the significance of this topography was not lost upon the Romans. When they cut and paved the Dover Road through the forests of south-east England in a dead straight line to London via Canterbury, the strategic importance of Greenwich became more obvious, for here the two main arteries from the Continent, viz., the road and the river, through which trade or trouble could reach the capital, all but met at this point. Moreover, the peculiar horse-shoe bend in the river gave shelter to the unloading of the early primitive shipping. Few residential districts near the City of London are so full of historical associations as Greenwich, whose streets are among the most interesting of any in the capital and whose wealth of surviving buildings is unrivalled. History has played a large part in determining the types of industries located within its boundary with their consequent effects upon the social conditions of its community. Its particularly favourable siting on the banks of the Thames, its unique place in English history and its close connection with Royalty through the ages gives it an air and a fascination difficult to resist. Notwithstanding that documented history of Greenwich appears to begin only during King Alfred's reign when he was Lord of the Manor, circa 900, there is evidence that Greenwich has been inhabited for over 2,000 years—certainly Crooms Hill is pre-Celtic whilst Maidenstone Hill and Shooters Hill along with many other place names, are clearly of Celtic origin. Charlton is a corruption of Ceorl-tun, the Romano-Celtic 'freeman's village'. Recovered coins and fragments of pottery show an almost 20 tinuous Roman settlement from 41 B.C. to 423 A.D. and Saxon burial mounds and barrows dating from the 6th century are still to be seen in Greenwich Park. As far as can be ascertained, the first mention of the name Greenwich occurred in September. 918, when the Manor, which included Lewisham, Woolwich, Mottingham and Combe, was granted by Elstrudis, daughter of King Alfred, to the Abbey of St. Peter at Ghent 'for the safety of her soul', a grant which was confirmed by King Edgar in 964 and again by Edward the Confessor in 1040. At the time of the Doomsday survey, Greenwich proper (as distinguished from the Hundred of Greenwich) was 2 sulings, a measurement of land peculiar to Kent, being about 400 acres in extent, one third of which was domain land, the remainder being held by 24 villeins. The area had a sufficiency of beech and oak trees to support 10 pigs and there were 4 water mills worked by the Thames or the Ravensbourne. Under the title of HULVIZ (hill-reach), Doomsday Book records, inter alia, 'a wretched tract of country' occupied by eleven bordars or cottagers who, altogether paid 41 pence annually. This area, subsequently to become known as Woolwich, was, in Edward the Confessor's time, held by one William Falconer 'to be hawked' and it may well be that Harold, portrayed on the Bayeux tapestry with a hawk on his wrist, diverted himself in such a fashion on occasions in this neighbourhood since he held one of the two Manors of Greenwich. At the time of the Doomsday survey these two Manors had been welded into one and were under the control of Odo, Bishop of Bayeux, half brother to William the Conqueror. Village life, which survived the Romans' departure and the coming of the Jutes in the mid 5th century, was predominantly that of men whose business was with the sea and ships with the profession of waterman as its most important occupation. Indeed, it is hard to visualize that, even up to one hundred years ago, the river rang with the shipbuilders' hammers and fishing fleets were sail ng regularly from Greenwich, a busy little attractive Thames-side town, to the North Sea, Iceland and Greenland, thus emphasising the economic as well as the historical influences which its excellent roadstead has had on the life of the inhabitants in the area. Such was the importance of this portion of the river that during the reign of King Ethelred (1011 A.D.) the whole Danish Fleet lay off Greenwich for three or four years whilst the army was for the most part encamped on Blackheath. This army ravaged the whole country and sacked the City of Canterbury, from whence they brought Archbishop Alfege to his martyrdom on 19th April, 1012. 21 Although efforts to obtain a Royal Charter have proved unsuccessful, Greenwich is unquestionably royal by association. Early English kings normally had no settled domicile. They travelled the country with their retinues and resided at various castles and palaces within their kingdom, dispensing justice and entertaining lavishly until they had exhausted the vicinity of its food and victuals. It seems clear, however, that the early Norman kings preferred Winchester but, at the time of St. Alfege's martyrdom, the English king was resident and had a Royal Treasury at Greenwich. Subsequently, Eltham became prominent in royal affairs for a period of 200 years and, as early as 1270, it is recorded that Henry III, a somewhat reckless monarch, spent Christmas here. It is interesting to note that Geoffrey Chaucer, author of "Canterbury Tales" and a frequenter of Bella Court at Greenwich, was Clerk of Works at Eltham between 1389 and 1391 and contributed to the construction of the Palace. Prince John, son of Edward II, was born at Eltham in 1316, a palace where Edward III, father of the Black Prince and founder of the English textile industry, was wont to hold tournaments and where, in 1347, he is reputed to have instituted the "Order of the Garter". Eltham was the favourite residence of Richard II who held parliaments at the palace and whose appointment of a host of tax gatherers to collect his iniquitous poll-tax led to the revolution of 1381. Headed by Wat Tyler, a motley assembly of ill-armed ragged peasants camped on Blackheath after pillaging the countryside of Kent on their way to London to meet Richard II who undertook to redress their wrongs but failed to keep his promise. Blackheath Common, from which the Park was taken by Humphrey, Duke of Gloucester, in 1433, was the scene of many other interesting and important events. It would seem that, at this particular time in English history, the Heath was the place where distinguished persons from the Continent were usually received in order to be conducted with proper state and ceremony to London. In 1400. the Emperor of Constantinople was met by Henry IV in great splendour and, in 1415, the Lord Mayor and Aldermen of London attired in 'orient grained scarlet with rich collars and great chains rode caparisoned horses' and 'accompanied by 400 commoners clad in beautiful murrie, all well mounted' greeted, in triumph, Henry V on his victorious return from Agincourt. The following year, Emperor Sigismund, King of the Romans, seeking a peace between France and England, was met by the Duke of Gloucester and conducted to the king at Lambeth. Thirty-four years later, Blackheath witnessed another insurrection—that of Jack Cade and, in 1497, 4,000 Cornishmen under Lord Audley 22 were routed by Henry VII on this very Heath. In 1540, Anne of Cleves was met here by her 'unwieldy lover', Henry VIII, and escorted to Greenwich Palace. However, not until Henry IV, the first of the Lancastrians, was Greenwich regarded as one of the seats of government at which time he was building himself a house in the south-east corner of Blackheath, probably on the site of the present Morden College. His will dated "Greenwich, 22nd January, 1408" bears testimony to his residence here. Meanwhile, royalty continued to utilise Eltham Palace to which was added a magnificent banqueting hall with hammer-beam roof by Edward IV who was also responsible for enlarging the Palace at Greenwich and stocking its park with deer. On the death of Henry V, 'Good Duke Humphrey' became Regent during the minority of his nephew Henry VI who granted to his uncle the right to enclose 200 acres of Blackheath to make a park and to build a castle, on the site of which now stands the Royal Observatory, and a palace, a fine red-bricked building which he named Bella Court. Humphrey, at heart a studious man, settled down in his palace to enjoy the life he loved surrounded by scholars and artists. At his death, he bequeathed to Oxford University his library, where it formed the nucleus of the now world famous Bodleian. Later, Bella Court was re-named Palace of Placentia by Margaret of Anjou, the wife of Henry VI, who spent large sums of money on beautifying it, tiling the floors and filling the windows with glass. At this splendid palace lived Henry Tudor (Henry VII) the victor of the Battle of Bosworth Field (1485) who began the Tudors' long association with Greenwich. He was the true founder of English maritime power and he it was who linked the history of Greenwich indissolubly with that of England's sea services. It was here that Henry VIII, his daughter Mary and her half sister Elizabeth were born and spent much of their time and where Edward VI, son of Henry VIII, died at the early age of 16 years. At this palace, the ill-fated Anne Boleyn, second wife of Henry VIII and mother of Queen Elizabeth I, was arrested and taken by barge to the Tower of London to be beheaded and, within the precincts of this noble residence, the marriage of Henry VIII to Anne of Cleves was celebrated. It was during this period that the connection of Eltham Palace with royalty began to wane and the Palace of Placentia became more important in royal and state affairs. Henry VIII, who was the first king to put the Royal Navy on a national basis, founded the Navy Office. He established the Deptford and Woolwich Dockyards and at the latter, in 1515, 23 built the 'Henri Grace a Dieu', the greatest warship of her day. He christened the ship and appointed her captain as the first Master of Trinity House, the corporation which still controls the lighthouses and pilotage of the coasts of England. At that time, Trinity House was located beside St. Nicholas, the 'seafarers'' church, in an area famous for its association with Peter the Great, Admiral Benbow. John Evelyn, Christopher Marlowe, Grinling Gibbons, Samuel Pepys and others. For his shipbuilding needs, premises and property were acquired by Henry VIII, especially in the vicinity of Woolwich Dockyard, and some of these could be regarded as ordnance depots which eventually were to lead to the establishment of the Royal Arsenal. Unquestionably Henry VIII loved Greenwich. Here within easy water distance of London, he could hawk and hunt, watch his merchant shipping bring valuable merchandise from abroad, visit his ships of war anchored close by, and where he and his great minister Cardinal Wolsey could welcome with grandest pageantry the many illustrious visitors to his sumptuous palace. Wolsey was the organiser of the historic ceremony at Greenwich when a legate of Pope Leo X conferred upon Henry VIII the title of 'Defender of the Faith' which was soon to acquire an entirely different connotation. In his dealings with Emperor Charles V, usually at Greenwich Palace, Henry VIII laid the foundations of England's foreign policy which remain to this day, viz. to oppose the military domination of the Continent by any one state. Following the failure of Cardinals Wolsey and Campeggio to resolve Henry's marriage difficulties with the church, Wolsey was replaced by Sir Thomas More, author of 'Utopia', as Lord Chancellor. He was beheaded in 1533 for refusing to take the Oath of Supremacy. His beautiful and talented daughter, Margaret, subject of a portraiture by the painter Holbein, married William Roper who is reputed to have been responsible for the building of Well Hall Manor house. Before he died, Henry VIII had made great additions to the Palace of Placentia. He completed the gardens and made them the finest in England. He built the Armoury and staffed it with the best of foreign craftsmen, mostly Germans, whose work in this field made the name of Greenwich world famous. He added the Tilt Yard which became renowned throughout Europe as did his Banqueting Hall, the work of the architect William Vertue who was responsible for the Bath Chapel at Westminster. It is difficult to conceive the magnificence and splendour of the Palace of Placentia during this period for, set amidst gardens 24 laid out with flower beds, sparkling fountains, ornamental summer houses and surrounded by a superb park, it contained everything that money could buy or thought could devise to add to its grandeur. Floors were heavily carpeted; rooms, furnished from the dis-established monasteries and churches, were richly decorated, and the genius of the world's greatest painters was expended on its walls and ceilings which were hung with fine Arras cloth and tapestries, with silk and crimson velvet from Montpelier in Gascony and with ermine, sable and fox from Ireland; cloth of gold, blue cloth of silver broached upon satin ground, white damask, each richly emblazoned with Royal emblems, were lavishly used; servants' liveries of blue murrey and horses with "hobby harnesss" of green velvet and aglets of silver, all were here assembled to receive distinguished personages from the world of arts, crafts, trades and professions. From the beginning of the 15th century when Westminster had again become the centre of government, the Palace of Placentia, the favourite royal resort up to the time of James II (1685), became the scene of countless tournaments, pageants and lavish spectacles. Greenwich in its hey-day and during one of the most colourful periods in English history, was the haunt of most eminent people of the time and the great Elizabethan admirals, statesmen, philosophers, writers, musicians and courtiers thronged the riverside and splendid palace nestling at the foot of Greenwich Hill in some 200 acres of beautiful sward and delightful woodlands. Among these could be numbered the painters Holbein, Rubens and Vandyke—men of letters such as Shakespeare, Bacon, More, Johnson, Milton, Sidney, Spencer, Evelyn and Pepys— seamen and explorers such as Drake, Hawkins, Raleigh, Blake, Cabot, Lord Howard, Davis, Frobisher, etc.—Tallis and Bull the composers—Newton the celebrated philosopher-mathematician and friend of Flamsteed, the Astronomer Royal—Harvey, the physiologist—Gresham, the astute merchant and financier and "money-finder" for the Royal Households—the list seems endless but, with such habitues, it was no wonder that the Court of Greenwich was the most popular in Europe. A sign of its popularity was the fact that in 1586, due to the concourse of visitors to the Palace, local bakers were constrained to apply for a warrant to obtain corn from various markets in Kent. It was towards the end of this "golden age" in 1675, on a Warrant of Charles II, that the Royal Observatory was founded and, to the design of Christopher Wren, Flamsteed House was built on the site of Duke Humphrey's tower. Almost as if to create a surfeit of grand edifices, an exquisite building designed by Inigo Jones with ceilings by Gentileschi and 25 originally intended by James I as a palace for his Queen, Anne of Denmark, was commenced in 1616 and marked the introduction for the first time in England of the Palladian style of domestic architecture. The Queen's House, as it is now called, was finally completed for Charles I and occupied by Queen Henrietta Maria in 1635. This beautiful house set the fashion for the big country seats which subsequently sprang up all over England. Following the execution of Charles I, the Palace of Placentia fell into disrepair and, during the Cromwellian period, valuable furnishings and pictures were sold. It was the same story with Eltham Palace to which, unfortunately, full reparations were not made until the middle 1930's. However, at Greenwich, on the restoration of Charles II in 1660, the older buildings were demolished for an intended new palace but only one of the four blocks forming the present Royal Naval College was begun. The remaining three blocks were completed by Queen Ann and William and Mary, respectively, with the laudable aim of providing a Royal Hospital for Naval Seamen. For this purpose, a commission had been set up with John Evelyn, the diarist, as its treasurer but it was some years before the Hospital was eventually completed by Vanbrugh, Hawksmoor and later architects in accordance with the overall plans of Christopher Wren. This group of imposing and stately buildings, now the Navy's University, were themselves to become equally famous as the original palace for they now house the nation's Maritime Museum. Meanwhile, at Woolwich, the foundations of a Royal Arsenal were laid with the erection of a Rope Yard in 1573 to serve the nearby dockyards. Some 50 years later, the Warren was being used for gun testing and by the end of the 17th century the Lieutenant General of Ordnance was resident at the Warren and the manufacture of other war materials was proceeding. Previous to 1716, the government's guns were cast at Moorfields but, following a serious accident there, the Royal Brass Foundry at Woolwich was completed a year later to the designs of Sir John Vanbrugh to undertake these duties. Many of the buildings erected at that time were completed by convict labour which was accommodated in hulks moored offshore in the Thames. Resulting from a visit by George III in 1805, the establishment became known as the Royal Arsenal. As a centre for research, design, manufacture and testing of military stores and equipment, the Royal Arsenal was unsurpassed. Modern requirements have demanded a curtailment and concentration of these particular skills and now plans are for much of the land to be utilised by the Greater London Council for housing purposes. 26 The year 1716 also saw the establishment of the Royal Regiment of Artillery with permanent headquarters at Woolwich. Originally housed at the Warren, the regiment became too large for its quarters and a move to new barracks on Woolwich Common was completed by 1781. It is perhaps not unnatural that a soldier as famous as General Gordon of Khartoum should have been born at Woolwich Common in 1833. He was later christened at St. Alfege's Church, near the Royal Naval College. The commanding position held by Greenwich in the 17th century, began to wane during the following century partly due to the conversion of the Palace into a hospital which induced many of the fashionable people to leave the area. Moreover, it was in an atmosphere of violence and unscrupulous intrigue that George I, who began the Hanoverian dynasty, landed at Greenwich in 1714 and held his first reception at the Queen's House. Nevertheless, although the Court was no longer in permanent residence and Blackheath was still plagued with highwaymen and footpads, its position continued to appeal to influential people of the times who still frequented Greenwich or lived in the fine buildings in its environs. Lord Chesterfield, friend of Voltaire and Pope, lived and wrote many of his celebrated "Letters" to his son at the Rangers House. McCartney House adjoining was the home of General Wolfe—Angerstein, father of "Lloyds" of London, whose paintings became the foundation of the National Portrait Gallery, resided at the "Woodlands". Sir John Morden, the founder of Morden College, a delightful Wren masterpiece, lived locally in a handsome mansion at Wricklemarsh. Dr. Johnson, the lexicographer and poet, who lodged locally, composed in and often strolled the park with his biographer, James Boswell. Notable occupants of other stately homes such as Charlton House (one of the country's finest examples of Jacobean architecture), of Vanbrugh Castle and Mince Pie House, (both erected by the designer of Blenheim Palace and the Mansion House), and of the Manor Houses at Crooms Hill and East and West Combe (the latter being the home of the Dowager Duchess of Bolton—the "Polly Peachum" of the "Beggar's Opera", and East-Combe, the residence of the Duchess of Athol), gave evidence of the continued popularity of Greenwich. Within its boundaries Greenwich had two traditional fairs. Granted to Charlton by Henry III at the same time as sanction for its market received Royal Assent, Horn Fair was held on St. Luke's Day, October 18th, when horn trinkets of all kinds were sold and where a carnival of the most restrained kind was included. However, over the years the procession became more ribald 27 and the crowds so disorderly that it was ended by an Order in Council dated March, 1872. That Greenwich Fair held on 12th-14th May and 11th-13th October was one of London's brightest attractions is emphasised by the numerous clever skits and drawings which emanated from the various journals and papers of the day. It came into prominence at the beginning of the 18th century originally as a cattle fair but gradually became a place noted not only for the sale of eatables and for its variety of amusement but also for its riotous and disreputable character. Despite its doubtful reputation Charles Dickens thoroughly enjoyed the fair and gives an amusing account of it in his "Sketches by Boz". In addition to theatrical and waxwork shows, there were menageries, prize fighters, thimble-riggers, equestrians, rope performers, quack doctors, dancing booths, and the inevitable quota of pickpockets. Through telescopes on the Observatory and One Tree Hills, gibbets with skeletons attached could be viewed on the river banks for a few pence. The fair drew enormous crowds and thousands of persons, many of whom came by water in every conceivable craft, congregated in the park for rough merrymaking. There were swings and roundabouts, and it is reliably reported that the latter was first introduced to the British public at Greenwich from France in 1835. Stalls were arranged by the roadside from St. Mary's Gate to Blackheath and refreshments included shell fish of all kinds, effervescing drinks, eels in all its stages of cooking (pickled, stewed and in pies), plum pudding, gingerbread, cold fried fish all liberally peppered with dust but being rapidly disposed of by their vendors. In the evenings, the taverns were filled to overflowing and the merrymaking continued well into the night. As a direct result of the increase in the riotous nature of the entertainment, the fair was relegated to the road from Deptford Creek via St. Alfege's Church to the Park Gates and, finally, the local inhabitants succeeded in having it closed down in about 1860. One suspects that Nathaniel Hawthorne, the celebrated American writer who resided in Pond Road for a time, although somewhat critical of the fair, was one of many who regretted its passing. Nevertheless, the fair, a mere shadow of its former glory, is still held on Blackheath at time of Public Holidays. In more recent time, before the quality of the river deteriorated as a result of the population explosion of London in the latter half of the nineteenth century, Greenwich was renowned for its whitebait dinners and suppers. Gladstone, Prime Minister and member of parliament for this constituency in 1868, with his ministers, regularly dined here on whitebait caught in the Thames, off Greenwich, and the "Ship", "Trafalgar" and "Crown and 28 Sceptre" Hotels were famous not only for these occasions but for the literary luncheons which were frequented by such celebrities as Thomas Hood, Captain Marryat, George Cruickshank, Douglas Jerrold and Charles Dickens. Lately, with a resurgence of events of interest in Greenwich and its history, there has been some move to revive these admirable riverside gatherings. At the opening of the present century the Greenwich and Woolwich areas, which were predominantly shipbuilding and engineering centres, were already feeling the effects of the changeover from sail to steam. Acceptance of the steamship had led to the building of bigger ships and, as a consequence, this trade passed to other and more suitable areas of the country with the result that many local industries were seriously affected. Sailmakers and repairers were no longer required; men engaged in the refitting, etc., of the sailing vessels lost their employment and concerns which catered for the revictualling of such vessels saw their trade wither away. Firms were compelled to close down owing to competition and the heavy rates and taxes imposed and such movements of industry only tended to aggravate the unemployment problem in the area and there was great hardship among the workers. In this respect, the people in the neighbourhood of Woolwich were a little more fortunate in that some compensation was provided by the increasing demand for labour at the Royal Arsenal and the expansion of electrical engineering at a riverside factory. During the 1914-18 war, a number of industries returned to the area although the post-war period saw the closing of the Foreign Animals' wharf (locally known as the Deptford Cattle Market), the site being acquired by the Government for a Supply Reserve Depot. Still later a further compensating movement began and some of the larger buildings and dwellings were utilised as new factories and commercial undertakings. As a result of the recent War, housing problems have been accentuated, but in certain instances some benefits have been derived from the fact that many properties which have been demolished by enemy action would, by now, have been unsightly and particularly difficult problems for the Health Department. With the advance of time many old buildings and houses were demolished and improvements effected. The breaking up of large estates, especially in the Westcombe Park area, has led, in the case of the houses concerned, to many new units of accommodation in the shape of flats and, in the case of the extensive grounds, to spacious areas for the erection of houses of the villa type. 29 Very early in the 18th century Daniel Defoe described Greenwich as "the most delightful spot of ground in Great Britain" and in 1738, in a road book of the British Isles this description was given : "Greenwich on the Thames, 4 miles east of London Bridge, a very delightful place". It can still lay claim to that title. Considering that the Borough is a constituent part of the country's greatest conurbation, it is well served with parks and open spaces. These are evenly distributed throughout its area and form 12.8% of its total acreage, equivalent to 6½ acres per 1,000 of its population. Shooters Hill, which encompasses Oxleas and Shepherdleas Woods, Castlewood, Jackwood and Eltham Common in total amounting to some 312 acres, gives a continuous expanse of woodland as attractive and extensive as Hampstead Heath. Greenwich Park, designed by Le Notre of Versailles fame, with its historical associations and surroundings, covers an area of 185 acres of rich fauna and flora. On its southern boundary is Blackheath, one of London's most famous open spaces, 89 acres of which are within the Borough providing unsurpassed facilities for games, sports and amusements. Excellent recreation grounds serve the Charlton area for, as well as the Maryon and Charlton Parks, there is the Greater London Council's Play Centre and Lido with its well-equipped open-air swimming bath, tennis courts and bowling greens. In addition to 65 acres at Sutcliffe Park allocated for a variety of sports, and a beautiful natural lake at the Tarn, Eltham, the Council has control of attractive formal gardens and grounds at Well Hall Pleasaunce. Among other delightful attributes, Avery Hill grounds and nurseries serve as the headquarters of the Education Authority's Nature Study Scheme supplying "botany boxes" to the local schools. West of the Royal Military Academy is Woolwich Common which has been the site for military displays since the latter half of the 18th century, a practice which is continued today with the Royal Regiment of Artillery's annual Tattoo. Areas in close proximity to the River Thames are, generally speaking, industrial but, as the result of a pattern of living inherited from the Industrial Revolution era, these districts tend to be more densely populated than other parts of the Borough. However, the scene has been changing and, in recent years, there has been a movement of people away from the riverside to Eltham and Kidbrooke, regions which earlier in the century had been considered 'rural'. These areas are now almost entirely built over. Prior to 1919, housing was considered hardly a local government responsibility and, in 1915, 1,000 houses and a large number of timber bungalows were erected in the Borough by the Government for its munitions and other workers. Subsequent to this, 30 however, housing has always been given a high degree of priority, a policy which started with the conversion into flats of a number of large houses in Blackheath acquired under the Housing and Town Planning Act in 1919. This was followed by the purchase for housing of Page's Estate (previously known as Eltham Estate) and an area in Charlton known as 'Hanging Wood Lane'. Gradually other sites such as Charlton Park, Middle Park, Horn Park, Cherry Orchard, Victoria Way, Timbercroft Lane and Woodlands Estate, etc., were acquired and development proceeded until halted by the second World War in 1939. By this time, 14,474 dwellings had been erected in the Borough since the year 1919, 9,648 in the Woolwich area and 4,826 in Greenwich and, of this total, the local authority had been responsible for 5,891. Of the remainder, the majority were built in accordance with private enterprise plans although from 1934 the London County Council had also been operating housing schemes within the Borough boundaries. During the second World War, when new building had necessarily ceased, the Borough suffered heavily from bomb damage and destruction of its residential areas. Requisitioning of property became imperative in order to resolve the serious housing problems thereby arising and in this respect over 3,000 units of accommodation were so acquired. Following the war, the respective local authorities immediately proceeded to plan and organise housing programmes to meet residents' needs, and, as first priority, arranged for the erection in the Borough of 1,801 Emergency Factory Made Bungalows (later to become known as 'pre-fabs'). Meanwhile, traditional building began and continued apace and work on the completion of 2 pre-war estates was commenced in December, 1945, in accordance with modernised plans. By the end of 1947, 112 flats and 48 houses had been erected and occupied at Cherry Orchard and the construction of a further 24 houses at Marlborough Lane and 24 old people's flat at East Mascalls was well under way. Other schemes, including the Coldharbour Estate which was begun in the same year, were advancing rapidly and Borough residents were reaping the rewards of the foresight shown by the authorities. Substantial support to these efforts was forthcoming from the London County Council which was developing estates in this area. In April, 1965, at the inauguration of the new Borough, nearly 15,500 dwellings of all types came into the control of the Council. Supplies of building land which, until recently, had been fairly readily available especially in the Woolwich area, became exhausted and, with the exception of the Plumstead Marshes Scheme (a project actively pursued by the Greater London Council for the accommodation of 60,000 persons over a period of 15 years), new 31 housing can come only from clearance of sub-standard houses and redevelopment in areas such as St. Mary's, Glyndon, Lewisham Road, Maryon Road, etc. Housing in the Borough is not only provided by the Council, the G.L.C. and private enterprises but also by a number of other agencies which serve special classes of citizens, i.e. the aged, widows, elderly spinsters, and widowers, etc. Organisations such as the Greenwich Housing Society provide assistance in the housing of elderly people not likely to qualify for such help from the local authority and over 200 units of accommodation for aged persons are furnished by ten groups of almshouses one of which was founded as early as 1558, being the first public charity to be established after the reformation. Although the future housing problem is monumental there is no doubt that it will be tackled by the Council in a manner as firm and resolute as has been demonstrated in previous years. Providing for the needs of Borough residents there are, at the present time, more than 2,000 shops, generally of the smaller kind, many being of the old-fashioned 'shop on the corner' type selling a wide range of goods. However, this situation is changing. Possibly contrary to the interests of many sections of the public, town planning is demanding concentration of traders into 'shopping centres' which tend to be dominated by big combines. Of the existing shops, a large percentage are food establishments to which supplies of meat and poultry come mainly from Smithfield Market and sometimes directly from Kent and Surrey. Fruit and vegetables, for the most part, arrive from Kent or from the Covent Garden, Borough, Greenwich or Spitalfields Markets. The rights of a flourishing daily open-air market in Beresford Square mainly for the sale of meat, fish and poultry, are vested in the Council and date from the reign of James I. A 'new market', under cover, in Plumstead Road, is also a popular centre for the daily and weekend shoppers of south-east London. Full time supervision is afforded by the Borough's Food Inspectors to the private slaughterhouse at Woodlands Farm, Garland Road, one of the most up-to-date and busiest abattoirs in the Metropolitan area. Both the previous local councils, now united in the London Borough of Greenwich, had always been in the forefront of progressive health authorities and within the new area all aspects of health and welfare, both personal and environmental, are amply covered. These range from the normal maternity, child welfare and school health services, to the usual general practitioner and hospital services, and from the useful municipally-run chiropody 32 clinics to the special maternity, paedriatric, geriatric, thoracic and neuro-surgical units based at local hospitals of which there are twelve. With such a close connection as Woolwich has with the army it is almost inevitable that one of these establishments, the Royal Herbert, should be a military hospital. This latter hospital, opened in 1866, owes its existence to the efforts of Florence Nightingale and her friend Lord Herbert (Secretary of War) following the Crimean War. Virtually first class educational facilities are at the disposal of residents, encompassing as they do the nursery and handicapped children's establishments as well as the normal primary, secondary, grammar, technical and comprehensive schools. Abundant opportunities are also provided for further education whether vocational or cultural or merely for enabling persons to indulge in a particular hobby. A women's residential training college, the first to be established by the London County Council, is located at Avery Hill and provides for upwards of 360 students and is a constituent college of the University of London. Woolwich Polytechnic, now catering for nearly 700 full time students and over 2,000 part-timers released by industrial concerns, is unique in that it is the only polytechnic in the London area which may be aided by the local Council. Eltham College, originally founded in 1842 as a 'Home and School for the Sons of Missionaries' lies just beyond the Borough boundary in Bromley and is recognised as a Public School. Of the nursery schools, that of Rachel McMillan is internationally famous, for the McMillan sisters were the pioneers of nursery schools in the British Isles; and in the Roan Schools, founded in 1643 by John Roan the son of a member of the Royal household when it was at the Palace of Placentia, Greenwich has one of the oldest teaching foundations in London. Most educational services are now under the control of the I.L.E.A. or church organisations but there are still some private schools in the area which are conducted independently of the Education Authority and which cater for fee-paying pupils. Serving the Borough are 12 libraries, 9 main and 3 part-time, supplemented by a mobile library intended to cater for the more 'remote' parts of the area. The main branches are admirably adapted to enable private study to be undertaken in close proximity to comprehensive reference sections and they afford access to daily newspapers as well as weekly and monthly periodicals. Special facilities are provided for children, hospital patients, homebound invalids and elderly persons and, furthermore, opportunities for the borrowing of gramophone records have been made available to 33 residents over the age of 18 years. Blind people are offered a service of Braille and 'talking books' obtained from the National Library for the Blind and allied organisations, and 'large print' books are stocked for the particular use of the elderly and partially sighted. A museum at Plumstead, an Art Gallery at the Tudor Barn and a Local History Section are all the responsibility of the Borough Librarian and Curator. Social centres providing for all shades of cultural and educational tastes have been established at Charlton House, Kidbrooke House, and West Greenwich House under the auspices of the Greenwich Community Council in conjunction with the I.L.E.A. and, in this connection, it can be stated that there are upwards of 178 clubs and societies affiliated to this Community Council. Besides Associations for rowing and barge sailing, the local sports clubs include the famous Blackheath Football Club (the oldest of all rugby football clubs) and the newer professional Charlton Athletic Football Club. It is hard to believe that the area supports 2 golf clubs, one of which is the Royal Blackheath, the oldest golf club in the world. With royal sanction it was formed nearly 360 years ago as the 'Society of Blackheath Goffers' at a time when James 1 was wont to play with his friends when holding court at Greenwich. It is reputed that the army title of 'Field Marshal' which dates from 1736 was copied from the appellation used by the Blackheath Club a century earlier. Andrew Lang, that Scottish scholar and versatile writer of the late 1890s commented 'Blackheath was the mother of Bombay, Westward Ho, Wimbledon, Hoylake. Thence sprang golf all over England'. Fifty-five 'Old People's Clubs', each of which receives a little financial assistance from the Council, cater for the elderly residents of the Borough and, in seven instances. Council premises are made available free of charge. In addition to the twelve luncheon clubs and the supplying of meals to three other establishments, viz. two for handicapped and one for elderly homebound, there is an effective 'Meals-on-Wheels' service. Daily deliveries are made to over 400 homebound persons and the number of meals provided is at the rate of almost 90,000 annually. A Day Club for the homebound and 4 Day Rooms have been founded to ameliorate still further the lot of the retired person. More recently, realizing the substantial benefits accruing to the aged from a satisfying holiday, the Council purchased two first class hotels at Westgate-on-Sea for the exclusive use of its elderly residents and holidays have now been made available to them throughout the year at nominal cost. 34 In suitable cases, arrangements are made for the elderly to be bathed either in their own homes or at the Council's Bathing Centres and a special "incontinent laundry" service has been introduced for the cleansing of soiled bed linen and clothing of the bedridden. Greenwich can boast of modern public baths. There are four such establishments within the Borough, each of which has two swimming pools. Moreover, at Eltham, the Council has provided a hydrotherapy pool and, on the Abbey Estate, has introduced a launderette. Warm baths for men and women are to be had at Greenwich, Plumstead and Woolwich and, at the former two premises, in addition to Turkish and Vapour Baths, public laundries still operate. In winter, the large pools at Eltham, Greenwich and Woolwich are covered and utilised for a wide range of recreational pursuits such as ro.ler skating, badminton, table tennis, etc., and facilities are made available for indoor bowling and the use of indoor cricket practice nets. The Council has control of the five cemeteries located within the Borough and, on behalf of the Woolwich, Greenwich and North West Kent Crematorium Board, is responsible for the modern crematorium at Eltham. The unique position held by Greenwich in Britain's history has its counterpart in the nation's industrial story. From earliest years its residents have been closely linked with the sea and ships and Britain's ascendency in respect of them for over 1,000 years. This association, manifest since before the advent of the ancient "wooden walls" until after the birth of the "ironclad" has, to a very large extent, determined the pattern of industry in the Borough. Early in its history, local industry was influenced by the area's close association with royalty and the demands which it and its retinues made on the neighbourhood. For instance, the siting close to Greenwich Palace of the Royal Armoury in the reign of Henry VIII gave rise to the production of russet steel suits of armour which became renowned and modern metal products from Greenwich continue this distinction. Connections with shipbuilding and armaments, forged in the days of Britain's peril, are perpetuated in existing industries. Indeed, throughout its annals, the country has never demanded armaments and accoutrements from Greenwich industry in vain. Even records covering the last war will clearly reveal the great contributions made by these industries with special reference to PLUTO, FIDO and the famous Mulberry harbour. In the main, industries and sources of employment of the Borough are to be found in the vicinity of the River Thames which forms the northern boundary. Chief among the concerns employing large numbers of workers are:— 35 Cablemakers, telecommunications and shipbuilding and repair works; automobile, construction, electrical and mechanical engineers; manufacturers of fire engines; manufacturers of tools, gauges, scientific instruments, tin boxes and containers, paints and lacquers, glass bottles, ropes, ships' propellers, cement and road surface materials; works for the recovery of metal and for the production of castings and for extruded non-ferrous metals and alloys and for the manufacture of oxgyen and rare gases; printers, both letterpress and newspapers; furniture makers, joiners and shopfitters; electric welders and galvanisers and sheet metal workers; producers of water softening and conditioning chemicals and horticultural products; works for the manufacture of wireless, aero, vehicle and typewriter accessories. Besides the usual electricity generating stations and gas works, there are cement and stone works, cold meat stores, coal wharves and the inevitable lighterage companies. The numbers actually employed vary from a few hundred to several thousands at the larger factories. SUPERFICIAL GEOLOGY Geological formations occurring in the London Borough of Greenwich are of two groups, namely, the "superficial deposits" and the "solid formations". These are given below, seriatim, in descending order and while this holds good for the area as a whole, the complete sequence is not always met with for superficial deposits may be non-existent, local arching of strata and subsequent denudation of the higher parts may have brought to the surface lower members of the succession and, in other cases, a stratum of the sequence may be entirely absent. Where maximum and minimum depths are stated, this implies a true variation of the thickness of the beds in question and, with the exception of the superficial deposits, is not to be ascribed to thinning due to erosion. Superficial deposits in the Borough are distributed over the surface of the "solid formations" and may be considered as being of (a) "made" ground, (b) alluvium, and (c) gravel, the latter deposit being of the Pleistocene or "drift" series. At some places these deposits fill deep hollows in the surface of the "solid" attaining a maximum thickness of about 70 feet and at others are arranged as banks. More usually they form spreads of comparatively uniform thickness, or remain caps to the higher ground. Situated below these are the "solid" Eocene formations of Claygate, London, Blackheath and Woolwich & Reading beds followed by that of Thanet Sand. Underlying the whole Eocene strata is the Chalk or Cretaceous formation. 36 Superficial Deposits Made—Made ground, consisting of artificial accumulations of debris and dumped materials from excavations have been spread over a number of areas of the district especially where the material has been used to raise the surface level of alluvial areas to reduce flooding in times of exceptionally high tides and heavy rainfall. Alluvium—Such a term is applied to the deposits up to 30 feet in depth forming the low-lying areas bordering the Thames and its tributaries. Originally marshland, these areas are still liable to flood should the river overflow its banks except where artificial means of protection have been adopted. Consisting of alternations of mud or silt, clay, shell marl, peat, sand and gravel, any or all of which may be present, the deposits may lie directly on "solid formations" or on banks of "river terrace gravel". Alluvium components are subject to rapid changes in thicknesses and often arranged in "lens-shaped" masses. Gravels—Although four types of gravel deposits have been distinguished, the most important are the River Gravels which form part of the ancient alluvial deposits of the Thames and its tributaries. These deposits, up to 40 feet in thickness, extend up the sides of the valley from the bed of the Thames and lie on the gentle slopes or series of platforms or terraces of "solid formations". The gravel is largely composed of subangular and well-rounded flints, together with quartz and quartzite pebbles. Sand is frequently interbedded with the gravel and, in places, constitutes the bulk of the deposit while occasional seams of peat are to be found. Solid Formations Claygate Beds—A group of evenly-bedded alternations of fine sands and clays with thicknesses in the range of 50 to 100 feet. At the top of the sequence, seams of clay lie between the thicker beds of sand while at the base, fine laminae of white sand alternate with beds of clay. Within the Borough, a syncline fold running from Mitcham through Crystal Palace to Shooter's Hill brings a vestige of the Claygate Beds to the surface at the latter locality. London Clay—This is a formation of stiff dark grey or bluishgrey clay which when exposed at the surface or underlying "drift" becomes brown in colour due to weathering. The weathering may penetrate a few inches or reach a depth of 10 feet beyond which the brown-grey mottling indicates incomplete oxidization. When water has stood on the clay for a long period the zone of decomposition may extend to a depth of 40 feet. 37 At irregular intervals, layers of septarian nodules (argillaceous limestone often with calcium sulphate veins) are met with throughout the clay and crystals of selenite and pyrites are common. The lower part of the formation is frequently composed of fossiliferous sand with black flint pebbles and occasional layers of sandstone and is known as the Basement Bed. The full thickness of London Clay is from 300 to 430 feet but, in the Borough, this is only realised at Shooter's Hill. In the Deptford, Greenwich and Woolwich areas the whole of the clay has been removed by denudation exposing older formations. Blackheath Beds—Very irregular in thickness, ranging up to 45 feet, these beds lying to the East of a line joining Sydenham and Deptford often fill hollows eroded in the Woolwich & Reading beds. They are composed of pebble-beds with a sandy matrix and beds of fine, sharp, light-coloured quartzose sand in which are thin layers of clay. The pebbles are well-rounded and consist mainly of black flints with white spotted surfaces and occasional quartzites. Locally the pebble beds are cemented into conglomerate and the sand hardened to a sandstone. Fossils occur throughout the division and, in places, the calcareous matter from shells forms the cement of the conglomerate. In other places the cement is ferruginous or siliceous. Woolwich & Reading Beds.—These beds, with a normal ness of from 25 to 80 feet, have been denuded from a tract which follows the Thames from South Bermondsey to East Woolwich and outcrops only at intervals at Plumstead and Eltham. They comprise a variable group of white, grey or crimson sands, sometimes hardened; red, green, grey or brown clays, frequently mottled; pebbles formed of flint or occasionally quartz, locally cemented into conglomerate; shell beds, concretions of carbonate of lime, selenite, iron pyrites and lignite. Although considered as one division, the Woolwich & Reading beds are distinct; the Reading Beds are characterised by mottled plastic clays, sands and pebbles and the Woolwich Beds consisting of laminated sands and clays with abundant shells. The base of the Woolwich & Reading Beds is relatively constant, being composed of a green or greyish-green sand, somewhat clayey, with flint pebbles and, at intervals, oyster shells. Thanet Sand—Essentially of fine, buff or pale greenish-grey sand, often silt, with a bed of green loam and generally unworn green-coated flints at the base (known as the Bull Head Bed), these beds are exposed around Woolwich, Charlton, Greenwich and north of Lewisham, while at Plumstead Marshes the eroded beds are overlain by superficial deposits. 38 39 Normally up to 55 feet thick, the beds reach a maximum thickness in the south east of the area. Chalk—This formation, almost entirely composed of soft, white limestone with flints, is present everywhere in the area underlying the Eocene strata except when it comes to the surface at Woolwich and at the Greenwich Fault on both sides of the River Ravensbourne in the vicinity of the Blackheath Hill, Brookmill Road and Loampit Vale areas. Its thickness, which can be from 550 to 740 feet, is subject to considerable variation due to pre-Eocene erosion, but the formation is usually divided into Upper, Middle and Lower chalk beds, and these are often sub-divided in accordance with the types and species of fossils found therein. The accompanying sketch map gives a clearer picture of the various geological formations found within the Borough. 40 METEOROLOGICAL OBSERVATIONS—1965 I am indebted to the Director of the National Maritime Museum and, in particular, to Lieutenant-Commander D. W. Waters, R.N., Curator of Navigation and Astronomy, for the following meteorological data for the year ended December, 1965:— Temperature Highest screen temperature 82° on 14th May. Lowest screen temperature 20° on 3rd March. Maximum in January 54° on 16th. ,, „ February 52° on 12th. „ „ November 59° on 1st, 7th and 8th ,, „ December 56° on 17th, 18th and 19th. Sunshine TOTAL FOR YEAR 1267.4 hours. Sunniest Day 13.5 hours on 12th May, 26th and 28th June. Number of Days without sun, 70, distributed as follows:— January 12 July 3 February 13 August 1 March 5 September 3 April 0 October 4 May 2 November 9 June 2 December 16 Rainfall TOTAL 25.04 ins. Highest Fall in 24 hours 1.53 ins. on 3rd September. Driest Month 0.34 ins. October. Wettest Month 3.55 ins. December. 41 SECTION II VITAL STATISTICS SUMMARY* Population (mid-year 1965) Total Home Population 231,770 Child Population (under 15 years) 48,000 Elderly Population (over 65 years) 29,890 Density (persons per acre) 19.76 Area Comparability Factors: Births—1.04; Deaths —1.06. Marriages Total 1,992 Greenwich District 685 Woolwich District 1,307 Marriage Rate (persons marrying) 17.24 Births Live Total: 3,722 M F Total Legitimate 1.742 1,665 3,407 Rate (Crude): 16.11 Illegitimate 171 144 315 (Comparable Rate): 16.75 1,913 1,809 3,722 Illegitimate Live Births = 8.4% of all live births. Stillbirths Total: 82 M F Total Legitimate 41 36 77 Rate (per 1,000 total births): 21.55 Illegitimate 2 3 5 43 39 82 Total of all Live and Stillbirths 3,804 Deaths Total: 2,544 Males 1,334 Females 1,210 Rate (Crude): 11.01 (Comparable Rate): 11.67 Natural Increase (excess of births over deaths) 1,178 42 Infantile Mortality (deaths of infants under 1 year) Infant Deaths Total #] Leg. Illeg. Total M F M F Under 1 year 50 27 2 1 80 Under 4 wks. 29 16 2 1 48 Under 1 wk. 25 14 2 1 42 Infant Mortality Rates All Infant Deaths (per 1,000 total live births) 21.5 Legitimate Deaths (per 1,000 legitimate live births) 22.6 Illegitimate Deaths (per 1,000 illegitimate live births) 9.5 Neo-Natal Mortality Rate (per 1,000 total live births) 12.9 Early neo-Natal Mortality Rate (per 1,000 total live births) 11.2 Peri-Natal Mortality Rate (per 1,000 total births) 32.6 Reproductive Wastage (per 1,000 total births) 42.5 Maternal Mortality Total 2 Maternal Mortality Rate (per 1,000 total births) 0.52 Death Rates—Special Causes (per 1,000 population) No. Rate Heart Disease (all forms) 785 3.39 Coronary Disease, Angina 552 2.38 Vascular Lesions of Nervous System 295 1.28 Cancer (all forms excl. Leukaemia) 540 2.33 Lung, Bronchus 184 0.79 Uterus 9 0.04 Cervix 5 0.02 Leukaemia, Aleukaemia 14 0.06 Tuberculosis (all forms) 14 0.06 Pneumonia 183 0.79 Bronchitis 167 0.72 Congenital Malformations 24 0.10 Accidents—Motor Vehicles 35 0.15 Home 12 0.05 *These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 43 General The term 'statistics' covers all types of numerical descriptions of social, economic and biological phenomena and, as a method of comparing, differentiating and classifying material and data, brings intelligent coherence to an otherwise incomprehensible mass of minutiae. It is conventional to consider vital statistics' as the continuous numerical recording, in a large number of lives, of marriages, births, sickness and deaths as a means whereby the health and growth of a community may be measured. Inevitably, of course, this leads to the observation of other aspects of society which influence life, its reproductivity and its vitality. This whole field is, nowadays, referred to as the science of demography. Early in the sixteenth century, it became evident that, for legal and other purposes, there should be some permanent and formal recording of baptisms, marriages and deaths in order not only to provide proof of age but to deter bigamy and guard against infanticide. In 1538, in the reign of Henry VIII, clergy were required to keep weekly records of these events but, except for a brief period from 1653 to the Restoration, this recording was not statutory and did not become so until the Births and Deaths Registration Act, of 1836. This Act established the General Register Office and divided the country into registration districts for the specific purpose of the registration of births and deaths. Penalties for non-registration were not imposed until the Act of 1874. Legislation is now consolidated in the Births and Deaths Registration Act, 1953, the Marriage Act, 1949, and the Registration Service Act, 1953. An essential preliminary to any statistical appraisal is the 'counting of heads' and this is achieved by the decennial Census. Gregory King (1648-1712), working from tax returns of houses, made the earliest attempt to enumerate the population. However, it was not until 1801 that a national Census was initiated and, with the exception of 1941, has been repeated every 10 years since. At first, the Census merely covered the recording of sexes with a rough classification of occupation. Not until the Census of 1851, after the establishment of the General Register Office in 1839, was appropriate detailed data sought and correct analyses made of Census figures. Since then, the Census form has become progressively more comprehensive and consequently more valuable as a statistical instrument. 44 Population General.—Boundary changes consequent upon the inauguration of the London Borough of Greenwich has meant that, for comparative purposes, some adjustment to the combined populations of the old Metropolitan Boroughs of Greenwich and Woolwich has had to be made by the Registrar General in respect of the 1961 Census. According to the Registrar General, the 1961 Census population for the new Borough is to be regarded as 230,250, showing a transfer of 1,899 persons from North Woolwich to the London Borough of Newham. Actual population is known only by Census enumeration although it is customary for the Registrar General to estimate for the inter-censal years. Population growth results from the excess of births over deaths (natural increase) with the addition of the excess of immigrants over emigrants. The Registrar General has submitted his estimate of the Home population of the London Borough of Greenwich, computed at mid-year 1965, upon which the statistics of this Report have been based. The figure returned is 231,770, indicating an increase in the population of 230 over the previous year and a rise of 1,520 since the 1961 Census. Natural Increase.—The natural increase for the year, i.e., excess of births over deaths, was 1,178 compared with the calculated figure of 1,443 for the previous year. Emigration/Immigration.—Taking into account a recorded natural increase of 1,178, there is a presumptive emigration from the Borough of 948 persons. Expectation of Life.—From 1841, when the expectation of life at birth was 40 years for males and 42 for females, there was a gradual but persistent rise in both these figures until 1954, but since that year the expectation of life at birth has scarcely changed and now stands at 68.1 years for males and 74.2 for females. Age Composition of Population.—It has been expedient from time to time to make analyses of the population figures with particular regard to age distribution in relation to whooping cough, diphtheria, poliomyelitis and B.C.G. prophylaxis and, more recently, the problem of the aged. In line with the general trend throughout the country, Greenwich has an ageing population and the number of persons outside the normal working range is still increasing. Although since the end of World War II there has been a sharp rise in births compared with those of the immediate pre-war years, a fact which naturally tends to advance the proportion of "under 15s" of the population, the relative size of the 45 "over 65s" group also continues to increase. These two factors together have augmented the pressure of dependency on the working portion of the population, viz., those between 15 and 65 years —a section of the community whose relative size has correspondingly diminished. From details given in the following table it will be seen that the "working" population of Greenwich, i.e. those between 15 and 65 years amounts to approximately 66.4% and that of "dependent" groups collectively, to 33.6%. In effect, this means that for every two persons of "working age" there is one dependent person outside this group. ESTIMATED AGE COMPOSITION OF THE POPULATION Age No. Approx. % of Total Population As estimated by the Registrar General: Under 1 year 3,770 1.6 1 to 4 years (inclusive) 13,730 5.9 5 to 14 years (inclusive) 30,500 13.2 Total Child Population under 15 years 48,000 20.7 Estimated locally: 15 to 64 years (inclusive) 153,880 66.4 65 years and over 29,890 12.9 Total Population 231,770 100.0 Marriages The Marriage Rate is calculated on a "total population" basis and, as such, is not strictly comparable with other areas by reason of discrepancies in age constitution. A more accurate ascertainment would be to return a rate based upon the marriage of unmarried persons over the age of 16 years (legal marriage is prohibited where either party is under 16 years). As over 90% of all births are legitimate it follows that the extent to which people marry exerts a powerful influence on the fertility rate. Although during the past few years the marriage rate in England and Wales has remained reasonably stable, earlier marriage, especially among females under the age of 20, has tended to increase; from 1955 to 1964 the number of wives in this group 46 has risen from 68 to 116 per 1,000. Moreover, for the year 1964. the mean age at marriage for bachelor bridegrooms was 25.24 and for spinster brides 22.78, both exemplifying this tendency for earlier marriage. Mrs. V. M. Gilham and Mr. H. E. Turner, Superintendent Registrars for the Districts of Greenwich and Woolwich respectively, have kindly furnished me with particulars relating to the number of marriages solemnised or registered in the London Borough of Greenwich during 1965. The total of 1,992 gives a marriage rate (i.e. persons marrying) of 17.24, an increase of 1.48 over that calculated for the previous year and is 1.74 in advance of the figure of 15.5 for England and Wales. Greater London returned a rate of 18.13. The following table shows particulars given by the Registrars: Greenwich Woolwich TOTAL Church of England 285 604 889 Chapels and R.C. Churches 84 115 199 Register Office 256 484 740 Non-Conforming Churches and Chapels by Authorised Persons 60 104 164 685 1,307 1,992 Births Fertility is a measure of the rate at which a specific community adds to itself by births and this is usually assessed by relating the number of births to the population of the particular group concerned, i.e. the birth rate. Clearly this is not an accurate calculation of "fertility" since the population used contains males and also females outside child-bearing age, but the birth rate does give the gross rate of increase of the population by births. Fertility varies not only with age, marriage and its duration but also with occupation and social class, with area of residence (urban or rural) and with religion and several other factors. Some attempt at correction for such variations is made by the RegistrarGeneral with his "area comparability factor". Nevertheless, although future fertility depends upon past fertility, this official "correction" is unable to take account of human volition and, nowadays, the position is further complicated by the fact that contraception is becoming widespread throughout all classes. Long-term forecasts of population changes inevitably become unreliable. 47 However, determinations of fertility and therefore of future population are of vital importance to governments for the framing of policies in connection with family and other allowances, to hospitals for the provision of adequate and suitable facilities, to local authorities who may wish to plan maternity services, nurseries, schools, housing, etc., and to the Medical Officer of Health who needs to know the effect of these variables upon the health of the public, generally. Live births registered in the Borough during the year totalled 4,911 and of this number 4,091 occurred in hospitals and 820 in private dwellings. In 1,844 cases the parents resided outside the Borough and these births were subsequently transferred to their appropriate districts leaving a figure of 3,067. To this must be added 655 births belonging to this Borough which took place in institutions outside the Borough, thus making a final total for Greenwich of 3,722, a decrease of 191 from that calculated for the previous year. of the total, 1,913 were males and 1,809 females, a proportion of 1,057 males to 1,000 females. The following table gives by districts the number of registrations of Greenwich Births during the current year:— Source of Information DISTRICT Total Borough Births Greenwich Woolwich Registrars' Returns:— 792 2,275 3,067 Inward Transfers:— 1st Qtr. 108 35 143 2nd Qtr. 52 143 195 3rd Qtr. 37 129 166 4th Qtr. 32 119 151 TOTALS 1,021 2,701 3,722 The Birth Rate for the year, calculated on the figure of 3,722 live births, is 16.11 per 1,000 of the population, 0.79 lower than that computed for 1964. With an area comparability factor of 1.04, an adjusted rate of 16.75 is returned compared with 18.1 and 17.9 for England and Wales and Greater London respectively. Illegitimate Births The degree of illegitimacy is usually evaluated by calculating illegitimate births as a percentage of total live births. This is satisfactory for the short term assessment but if the legitimate rate is declining and the illegitimate remains constant, there will be an apparent but not necessarily a real increase in illegitimacy. 48 It would appear generally to be the case that illegitimacy is greatest when social standards, cultural and material, are low and, collectively, factors such as an insecure family life, poor and overcrowded homes, lack of direction and personal drive in life, etc., seem to be implicated. In London, rates tend to be higher than that for the country as a whole possibly by reason of a higher proportion of single females but very probably because of its compelling attraction to pregnant women who find not only anonymity but better facilities in the ante-natal, maternity, social and welfare fields. Illegitimate births in Greenwich during the current year numbered 315 (8.4% of all live births) giving an illegitimate rate of 84 per 1,000 live births compared with a figure of 77 for England and Wales. Put more prosaically, one baby in every twelve born of Greenwich residents was illegitimate. Stillbirths in recent studies, instituted by the Medical Research Council and others, the mother's age, parity and social class were found to be significant factors affecting stillbirths. Furthermore, although recent years have shown reductions in stillbirths throughout the country, the improvement was most marked in the higher social classes. Registered Greenwich stillbirths numbered 82 (43 males— 39 females) which is equivalent to a rate of 21.55 per 1,000 total births, an increase of 4.72 over that calculated for 1964. Greater London returned a rate of 14.7 and that for England and Wales was 15.8. Deaths Populations are not similarly constituted and their crude Death Rates therefore fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution. For instance, a town with a population consisting of aged persons would register more deaths than one composed entirely of young and vigorous adults. Again a town containing a larger number of males than females records more deaths with a consequent higher Death Rate than one in which females preponderate. To overcome this difficulty the Registrar-General has worked out for each area in the country an adjusting factor which is termed the "Comparability Factor" and is based on the last census population figure. The Factor for Greenwich, viz. 1.06, may be regarded as the population handicap to be applied which, when multiplied Deaths at subjoined Ages of "Residents," whether occurring within or without the District. No. in Short List. Causes of Death Sex All Ages. 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 55. 55 and under 65. 65 and under 75. 75 and over Under 4 Wks 4 wks and under 1 year All Causes M 1334 31 21 4 4 17 13 50 112 297 361 424 F 1210 17 11 1 4 7 9 31 66 141 288 635 1 Tuberculosis, Respiratory M 10 - - - - - - - 1 4 3 2 F 4 - - - - - - - - 2 1 1 2 Tuberculosis, Other M - - - - - - - - - - - - F - - - - - - - - - - - - 3 Syphilitic Disease M 2 - - - - - - - - - 1 1 F 3 - - - - - - - - - - 3 4 Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5 Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6 Meningococcal Infections M - - - - - - - - - - - - F - - - - - - - - - - - - 7 Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8 Measles M - - - - - - - - - - - - F - - - - - - - - - - - - 9 Other Infective and Parasitic Diseases M 1 - - - - - 1 - - - - - F 1 - - - - - - - - - - 1 10 Malignant Neoplasm, Stomach M 35 - - - - - - 3 2 8 13 9 F 18 - - - - - - - - 4 6 8 11 Malignant Neoplasm, Lung, Bronchus M 147 - - - - - - 2 16 47 59 23 F 37 - - - - - - 3 7 10 9 8 12 Malignant Neoplasm, Breast M - - - - - - - - - - - - F 47 - - - - - - 5 10 13 7 12 13 Malignant Neoplasm, Uterus F 9 - - - - - - - 1 4 2 2 14 Other Malignant and Lymphatic Neoplasms M 138 - - - - 1 3 6 21 34 38 35 F 109 - - - 1 - 3 4 7 19 31 44 15 Leukaemia, Aleukaemia M 7 - - - 1 1 - - - 2 2 1 F 7 - - - 1 1 - - 1 2 1 1 16 Diabetes M 6 - - - - - - - - 2 1 3 F 10 - - - - - - - 1 - 4 5 17 Vascular Lesions of Nervous System M 112 - - - - - - 1 6 19 29 57 F 183 - - - - 1 - 4 5 19 41 113 18 Coronary Disease, Angina M 320 - - - - - 1 12 28 87 89 103 F 232 - - - - - - - 6 20 68 138 19 Hypertension with Heart Disease M 18 - - - - 1 - 1 - 8 4 4 F 40 - - - - 1 - - - 3 8 28 20 Other Heart Diseases M 74 - - 1 - 1 1 3 6 13 18 31 F 101 - - - - - - 5 7 9 20 60 21 Other Circulatory Disease M 51 - - - - - 1 4 2 9 16 19 F 62 - - - - - 2 1 4 5 9 41 22 Influenza M - - - - - - - - - - - - F 2 - - - - - - - - - 1 1 23 Pneumonia M 85 1 3 2 - - - 2 2 7 17 51 F 98 - 1 - - - - 1 1 4 26 65 24 Bronchitis M 118 - 4 - - - - - 6 22 41 45 F 49 - 2 - - 1 - - 1 2 15 28 25 Other Diseases of Respiratory System M 13 - - - - - - 1 2 2 4 4 F 8 - - - - - - 1 - 1 1 5 26 Ulcer of Stomach and Duodenum M 12 - - - - - - - 1 4 4 3 F 9 - - - - - - - 2 1 - 6 27 Gastritis, Enteritis and Diarrhoea M 6 - 2 - - - - 1 - - 2 1 F 8 - - - - - - - - - 4 4 28 Nephritis and Nephrosis M 9 - - - - 1 - - 5 - 1 2 F 4 - - - - - - - - 1 - 3 29 Hyperplasia of Prostate M 5 - - - - - - - - - - 5 30 Pregnancy, Childbirth, abortion F 2 - - - - - 1 1 - - - - 31 Congenital Malformations M 14 6 7 - - - - 1 - - - - F 14 4 5 1 - - - - 2 1 1 - 32 Other defined and ill-defined Diseases M 87 24 4 - - 3 - 1 4 21 14 16 F 109 13 3 - - 2 2 3 6 12 26 42 33 Motor Vehicle Accidents M 22 - - - 3 4 2 3 2 2 2 4 F 13 - - - 2 - - 1 - 3 2 5 34 All other Accidents M 25 - - - - 5 2 4 5 3 3 3 F 14 - - - - - - - 1 - 3 10 35 Suicide M 15 - - - - - 2 5 3 3 - 2 F 17 - - - - 1 1 2 4 6 2 1 36 Homicide and Operations of War M 2 - 1 1 - - - - - - - F - - - - - - - - - - - - 49 by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The net number of Greenwich deaths "registered during 1965 was 2,544, of which 1,334 were males and 1,210 females, compared with last year's estimated total of 2,464. This gives a crude Death Rate for the Borough of 11.01 per 1,000 of the population, representing an increase of 0.37 over that calculated for the previous year. When the area comparability factor is taken into account the rate is increased to 11.67 for comparative purposes. The Death Rates for Greater London and for England and Wales are 11.0 and 11.5 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. Age Mortality The age mortality and the distribution of the deaths between the different quarters of the year are shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 21 22 21 16 80 Between 1 and 2 years 1 1 1 1 4 Between 2 and 5 years - - - 1 1 Between 5 and 15 years 2 2 1 3 8 Between 15 and 25 years 5 4 5 10 24 Between 25 and 35 years 6 7 3 6 22 Between 35 and 45 years 22 23 16 20 81 Between 45 and 55 years 48 46 37 47 178 Between 55 and 65 years 121 111 102 104 438 Between 65 and 75 years 188 144 137 180 649 75 years and upwards 325 267 196 271 1,059 Totals 739 627 519 659 2,544 Of the four quarters, the first registered the highest proportion of the year's total deaths and the third the lowest, viz. 29% and 20.4% respectively. It will be observed from the following table that, during 1965, the deaths in the age group 0-5 years accounted for 3.3% and that of the "over 65's" 67.1% of the year's total. Figures for 1964, calculated locally, are given for comparative purposes. 50 Age Group 1964 1965 Under 1 year of age 70 80 Between 1 and 5 years 11 5 Between 5 and 15 years 10 8 Between 15 and 25 years 21 24 Between 25 and 65 years 697 719 65 years and over 1,655 1,708 Totals 2,464 2,544 Deaths in Institutions The following table gives the number of deaths of Greenwich residents in Public Institutions during the year:— Deaths of Greenwich Residents Year Total In Public Institutions No. % of Total Deaths 1965 2,544 1,825 71.7 Maternal Mortality Statistically, maternal deaths should be related to all those women who are pregnant during the period of the review. However, as this is impractical (for miscarriages are not registerable and many pregnancies are terminated unbeknown to the authorities), the extent of maternal mortality is measured against the total of live and stillbirths which gives a reasonably accurate basis for enumerating pregnancies during the interval of assessment. Maternal mortality is conventionally defined as the number of women dying from complications of pregnancy, childbirth or puerperium during the year. This is then related to the number of live and stillbirths during the same period to give the maternal death rate. Abortion, because of the possible criminal element, is often excluded but, when included, the fact should be stated. Studies have shown that expectant mothers on a poor pre-natal diet become greater obstetric risks and the incidence of miscarriages, stillbirths and premature births increases. Moreover, subsequently the offspring of the mothers appear more prone to illness and infection. There were 2 maternal deaths recorded during the current year, both occurring in hospital. This gives a maternal death rate of 0.52 per 1,000 total births, the causes being certified as 'caesarian 51 section for foetal distress' and 'obstetric shock during labour'. One maternal death was registered during 1964 giving a rate of 0.26. The rates returned for England and Wales and Greater London were 0.25 and 0.38 respectively. Infantile Mortality Infant Mortality of any given locality is measured by relating the number of deaths of children under one year of age recorded during the year to the number of live births registered for that particular area during the same period. Bad housing, overcrowding, poor sanitation, low standards of education, illegitimacy, all tend to produce higher infant mortality rates. It follows therefore that the infant mortality rate should provide a reasonably accurate indication of the social circumstances of any particular area. However, because approximately one third of all infants dying in one year will be found to have been born in the previous year, great care must be exercised when drawing conclusions from any rise or fall in infant mortality rates, for such rates are not comparable year by year unless the birth rates remain more or less constant. Further, it must be borne in mind that as infant mortality has now reached relatively small proportions, any slight deviation in the number of deaths tends to misleading fluctuations in the rate and only a long term appraisal is likely to reflect the true position. A recent valuable survey, instituted by the National Baby Trust Fund, showed that the risk of perinatal deaths in England and Wales varied geographically from North and West to South and East, as much as 40 per cent. and confirmed, what is common knowledge in health departments generally, that poor physique and standards of health, increasing maternal age, multiparity and social class, all exert influences on perinatal mortality. Having elicited the main causes will this data enable authorities to introduce effective remedies? Not necessarily, for a number of unexpected complications in the situation have been revealed. For instance, despite the fact that identical social and welfare services are available to all social groups (as defined by the Registrar-General) there is the equivalent of a 30-year gap between infant mortality rates of unskilled workers and the professional groups—latest figures show a ratio of 4:1 to the detriment of the lower group. Again, use made of available welfare and medical services by Social Group II was twice that of Group V. It is likely that long term remedies such as 'housing' and 'education' have greater effects upon infant mortality than is at present visualised. 52 Ideas on aristocracy, hereditary rights and good breeding have not found favour in the modern world but, nevertheless, it remains true that the difference between one person and another is due as much, if not more, to breeding as to environment. Today, it can be said that we are able, or have the knowledge to control the environmental factors. For instance, advanced surgical techniques have brought considerable reductions in infant deaths from spina bifida, hydrocephalus and cardiac abnormalities and amelioration in disabilities such as cleft lip or palate and talipes. Moreover, better antenatal and obstetric care, coupled with improved management of the premature infant, have likewise produced more favourable prognoses for cerebral palsy, subdural haematoma, neonatal jaundice, infantile convulsions and meningitis. However, it is generally conceded that, apart from the teratogenic effect in early pregnancy of certain modern drugs, infectious diseases and radiation, congenital malformations have a relationship with chromosomal abnormality and that our future success in reducing infant mortality is likely to depend upon the use made of the recent advances in human cytogenetics. Notwithstanding the fact that the subject of human heredity is extremely complex, it has already been established that disabilities such as achondroplasia, familial polyposis and Huntington's chorea are due to dominant mutant genes and that recessive mutant genes are responsible for fibrocystic disease of the pancreas, phenylketonuria and galactosaemia. Moreover, it has been shown that haemophilia, diabetes insipidus and a type of muscular dystrophy arise from sex-linked recessive genes. Since 1956, cytologists have been able to identify the syndromes of Klinefelter and Turner as resulting from an extra chromosome (trisomy) and a deficiency of one chromosome (monosomy) respectively. Extensions of these investigations have indicated that there is a connection between mongolism, another example of trisomy, and a form of leukaemia. Clarification of intra-embryonic mortality and congenital deformity may well be the outcome of further chromosomal studies. It follows that, from knowledge already gained and as a result of the newer treatments evolved to save children from the full effects of genetically determined disabilities, there will be an increase in the frequency of these disorders and, in such circumstances, some method of artificial selection seems inevitable. The present infant mortality rate for the Borough, viz., 21.5, is an increase of 3.6 over that estimated for the previous year with rates of 19.0 and 18.4 being returned for England and Wales and Greater London respectively. Actual infant deaths recorded during the year were 80 (10 more than last year) comprising 52 males and 28 females of which 53 73 occurred in hospital and 7 at home. The following table shows the causes of and ages at death: INFANTILE MORTALITY DURING THE YEAR 1965 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Congenital Malformation 5 2 1 2 10 6 5 2 23 Premature Birth 18 _ _ _ 18 - - - - 18 „ „ (placenta praevia) 2 - - - 2 - - - - 2 ,, „ (post mortem caesarian section) 1 - - - 1 - - - - 1 „ „ (circumvallate placenta) 1 - - - 1 - - - - 1 Acute tracheo-bronchitis - - - - - 2 4 - - 6 Bronchopneumonia - - - 1 1 - 1 - 2 4 „ (intra-uterine) 1 - - - 1 - - - - 1 „ (manslaughter) - - - - - - - 1 - 1 Cerebral haemorrhage 4 - - - 4 - - - - 4 Breech presentation (results of) 3 - - - 3 - - - - 3 Acute gastro-enteritis - - - - - - - 1 1 2 Encephalitis - - - - - - 1 1 - 2 Respiratory distress syndrome 2 - - - 2 - - - - 2 Bronchiolitis - - - - - - 1 - - 1 Pyoderma gangrenosum - - - - - - - - 1 1 Asphyxia 1 - - - 1 - - - - 1 „ (intra-uterine) 1 - - - 1 - - - - 1 Meningitis (B.coli) 1 - - - 1 - - - - 1 Pyelonephritis - - - - - 1 - - - 1 Birth Injury 1 - - - 1 - - - - 1 Rupture of Intestinal Tract (intra-uterine) 1 - - - 1 - - - - 1 Cirrhosis of liver - - - - - 1 - - - 1 Otitis media - - - - - - - - 1 1 TOTALS 42 2 1 3 48 10 12 5 5 80 Males 52 Females 28 Neonatal Mortality.—From the accompanying table it can be seen that neonatal mortality, i.e. infants dying before attaining the age of one month, accounted for 48 deaths, equivalent to 60% of all infant deaths and giving a neonatal mortality rate of 12.9 per 1,000 live births. This rate is 0.3 less than that calculated for the previous year and is slightly more favourable than that returned for England and Wales, namely, 13.0. Early Neonatal Mortality.—Forty-two infant deaths occurring during the first week of birth gives an early neonatal mortality rate of 11.2 per 1,000 live births compared with a rate of 11.3 for England and Wales. The foregoing table indicates that these early deaths were due, in the main, to prematurity and congenital malformations. Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 124 stillbirths and deaths of infants under 1 week, 54 was 32.6 per 1,000 total births. The equivalent rate for England and Wales is 26.9. Reproductive Wastage.—A sum total of 162 stillbirths and infantile deaths gives a reproductive wastage rate of 42.6 per 1,000 total births, an increase of 7.6 over that calculated for the previous year. REMARKS ON OTHER VARIOUS DEATH CAUSES Recognising the importance of ensuring as far as possible the uniformity and comparability of statistics in relation to diseases and causes of death, the Registrar-General has, from 1st January, 1950, implemented the Nomenclature Regulations, 1948, as suggested by the World Health Organisation. Although these regulations are not binding on Medical Officers of Health, it is essential that the International Statistical Classification of Diseases, Injuries and Causes of Death, 1955, should be adopted in order that local statistics can be compared with national figures and national with international. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying practitioner. This enables his department to modify the original classification—hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar-General. General A slight increase in the total number of deaths of Borough residents during 1965 (and a consequent rise in the rate) followed the general trend throughout the country. Such increases as have occurred are to be found mainly under the headings of 'vascular diseases of the nervous system' and 'respiratory complaints' which registered rises of 22% and 10% respectively. The overall picture of cancer was a little more reassuring but carcinoma of the lung continued its unrelenting progression. Deaths from heart disabilities showed some small 55 improvement while infant deaths (q.v.) registered a somewhat less favourable fluctuation. Heart Disease Cardiovascular and atherosclerotic diseases as a group constitute the greatest possible challenge to preventive medicine. Each week, on an average, over 2,200 people in England and Wales die from coronary disease and the incidence is increasing, particularly in the case of the middle-aged male. In fact, in males between the ages of 25 and 45 years, the rate of heart attack has more than doubled during the past decade. Curiously, coronary disease in a woman before the age of 45 years is uncommon and it would seem that, during her child-bearing epoch, her hormones give her a 'built-in' protection. Recognised as the principal 'killer' complaint of modern times, this classification, covering as it does, (a) coronary disease, angina, (b) hypertension with heart disease and (c) other heart disease, was responsible for 785 deaths (412 males and 373 females) during the current year. This is equivalent to approximately 31% of the total of deaths from all causes and gives a rate of 3.39 per 1,000 of the population. Deaths in the Borough from coronary disease alone accounted for 552 (320 males and 232 females) producing a rate similar to that returned for England and Wales, viz. 2.38 compared with a figure of 2.27 for Greater London. Vascular Lesions of Nervous System Under this classification, which includes cerebral haemorrhage, embolism and thrombosis, some 295 deaths were recorded during 1965, a rise of approximately 22% over the figure for the previous year. Of these, 183 were females and, apart from coronary disease, this constituted the main cause of deaths in females during the year although 113 (61.7%) occurred in women over the age of 75 years and only 10 in females under 55. Cancer Second only to heart disease as the principal cause of death in the community, this disease, which has so many psychological connotations not met with in other diseases, claimed fewer victims during the year under review. With the exception of lung cancer, which registered a 15% increase, all forms of cancer, including leukaemia, showed some reduction. The total of 554 cancer deaths was equivalent to 21.8% of deaths from all causes, indicating that approximately one death in every five resulted from some form of cancer. The following table shows the various sites affected:— 56 Site Male Female Total Rate* Cancer of stomach 35 18 53 0.23 „ „ lung, bronchus 147 37 184 0.79 „ „ breast - 47 47 0.20 „ „ uterus 9† 9 0.04 „ „ other forms 138 109 247 1.07 Leukaemia 7 7 14 0.06 Totals 327 227 554 2.39 * Per 1,000 population †cancer of the cervix—5 (rate 0.02) Nationally, the number of cancer deaths is rising mainly due to the increase in cancer of the lung, deaths from which have been advancing at a rate of over 1,000 per year since 1960. Indeed, the present total for England and Wales, viz. 26,399, shows an increase of more than 58% over the past ten years and gives a national rate of 0.55 per 1,000 population. Although London has consistently returned a high rate from this cause, its figure for 1965, namely, 0.70 is, nevertheless, slightly more favourable than the Borough rate of 0.79. Death rates for women who die from cancer of the lung continue to increase but there are still five times as many men as women dying from this cause. Many causes of cancer are still not known with any certainty, although in the last decade there have been remarkable advances in the recognition and understanding of the disease. It is generally considered to be a disease of middle and old age, although in more recent times cases have begun to appear in younger age groups and, as such, it is a disease which is rapidly becoming a serious impediment to a healthy nation. Modern research suggests that in some cases there may be a relationship between inherited chromosomal abnormality and myeloid leukaemia, and in others that climatic conditions may be indirectly responsible for the appearance of some strains of antigenically similar viruses which have been recovered from the bone marrow of patients suffering from various leukaemias, the connection between which, so far, has only been postulated. There is also abundant evidence that cancer of the womb is linked with poor hygiene and clearly this must constitute a challenge to health staffs generally and to health visitors in particular, both of whom are pledged to regard health education as top priority. In this connection, it would not come amiss to mention the Family Planning Association and its invaluable work in the use, among a number of its patients, of diagnostic cytology. 57 It is undeniable that fear is a very potent influence in discouraging people from seeking medical advice but if there is one thing which has been proved to the expert's satisfaction it is that, given certain conditions, cancer is a curable disease. Another important circumstance which militates against early diagnosis is the absence of pain or serious symptom until the disease has reached a stage at which the benefit of treatment becomes problematical. The World Health Organisation has estimated that three-quarters of all cancer deaths could be prevented if diagnosed early enough. Time is the most important factor and public education in this field would appear to be well within the province of local authorities. Childhood Cancers—Survey—Co-operation with Dr. Alice Stewart of the Department of Social Medicine, Oxford University, who is undertaking investigations into deaths from cancer in childhood, was continued during the current year. Notifications are received of all such deaths in the Greenwich area and, after suitable approach and preparation, the parents—if they are willing—are visited by a Medical Officer who completes a comprehensive history of the case which includes a penetrating enquiry into the family background. A similar procedure is followed in respect of an appropriately selected control child. Gradually facts are being amassed from these anamneses which, we hope, will eventually indicate methods of prevention. Although the picture is far from complete, there is some evidence that certain children are more likely than others to develop one of the malignant diseases and it has been established that abdominal X-ray of the pregnant woman should be avoided wherever possible. Lung Cancer.—Throughout the country in recent years there has been a marked rise in the incidence of cancer of the lung and the following table has been included in order that the trend in this Borough may be studied:— DEATHS FROM CANCER OF LUNG (including Bronchogenic Carcinoma) Year AGE GROUPS Totals Grand Total Rate per 1,000 Pop. 25 and under 35 yrs. 35 and under 45 yrs. 45 and under 55 yrs. 55 and under 65 yrs. 65 and under 75 yrs. 75 yrs. and upwards M F M F M F M F M F M F M F 1965 - - 2 3 16 7 47 10 59 9 23 8 147 37 184 0.79 58 In the three years from 1963 to 1965, the daily average of deaths from lung cancer in England and Wales rose from 66.9 to 72.3, an increase of 5.4%. Furthermore, a recent report of the Registrar General states that, because of incorrect diagnoses, the steadily increasing numbers of deaths from lung cancer is Higher than that shown in the official statistics. As a result of post mortem examinations carried out by pathologists, it was found that in only 45.3% did the results agree with doctors' diagnoses and that some conditions, such as lung cancer, were significantly more common than the national figures indicate. According to the Ministry of Health, the recent national 'red ashtray' poster campaign has effected a small but statistically significant shift in attitudes against cigarette smoking, mainly among adolescents. In recent statistics there is evidence that, at long last, health education is having some success for between 1961 and 1965, although the population in Great Britain over the age of 16 years rose by more than 1 1/4 million, the number of smokers fell by almost 1/2 million. Non smokers (including ex-smokers) rose from 43% in 1961 to 46% in 1965. Had cigarette smoking in 1965 been at the same rate at each age as in 1961, there would have been between 1 and 1¼ million more smokers than was the case. The increase in non-smokers between 1961 and 1965 was substantial in men of all ages whereas in women, apart from the 16-19 age group, there was no significant change. During this particular period, persons in the 16-19 age group increased by over 1/2 million but the number smoking rose by less than 10,000 and the proportion of non-smokers in the group increased from 38% to 49% among young men and from 55% to 61% in young women. Pneumonia There were five children under one year of age in a total of 183 deaths from pneumonia registered during 1965. The total, which consisted of 85 males and 98 females, was little changed from that of the previous year and a rate of 0.79 was returned in comparison with 0.66 and 0.78, the rates for England and Wales and Greater London respectively. Bronchitis During the current year, Greenwich had a total of 167 bronchitis deaths (118 males and 49 females) with a rate of 0.72. The comparable rate for Greater London was 0.61 and for England and Wales 0.62. There was an increase of almost 20% in the Borough total over that for 1964 and there were 6 deaths of children under the age of one year. 59 Tuberculosis Despite the great improvement witnessed in recent times in respect of the control of tuberculosis, it is clear that the preventive services have still a vital part to play during the coming years for, with the exception of pneumonia, tuberculosis continues to cause more deaths than any other notifiable infectious disease. Deaths in the Borough from tuberculosis numbered 14, all of the respiratory type, producing a rate of 0.06 per 1,000 population. This indicates a slightly less favourable situation than that for the previous year. Of the 14 deaths registered, 10 were males, 9 of whom were over the age of 55 years. The comparable rate for England and Wales was 0.05, a similar figure to that returned for Greater London. Violent Deaths As a classification, the term 'violent death' includes those deaths arising from motor vehicle accidents, suicide, homicide and 'other forms' of accident. During 1965 there were 108 deaths from violence in the Borough, giving a rate of 0.47 per 1,000 population compared with a rate of 0.50 for England and Wales and 0.45 for Greater London. Motor Vehicle Accidents.—Road accidents, which are now the commonest cause of death in adolescents' and young adults, were responsible for 7,515 deaths in England and Wales during the year and the total is mounting. Justifiably, much has been made of the serious nature of the increase in deaths from cancer and heart disease but it must be recognised that, from a national and economic standpoint, a child who is killed in a road accident is a greater potential loss to the community than a person over 65 years who dies from either of the other causes. Thirty-five persons in the Borough died from this cause during the current year, a reduction of 5 from the previous year, with a rate of 0.15 compared with the rates of 0.16 and 0.14 for England and Wales and Greater London respectively. Suicide.—Contrary to general belief, suicide continues to claim a substantial number of victims. In England and Wales, the number of suicides during 1965 amounted to the formidable figure of 5,161, giving a rate of 0.11 per 1,000 population. Moreover, of this total, over one fifth, viz. 1,103 were recorded in London, giving a rate of 0.14 compared with 32 deaths and a rate of 0.13 for Greenwich. Figures for London in particular throw into relief a psychiatric problem which is becoming very familiar in the cities of countries 60 which sustain high living standards, for they were nearly three times those arising from tuberculosis and almost 100 more than the total deaths from road accidents. Homicide.—Two deaths were recorded during the year in respect of male children of 7 and 13 months respectively. Both resulted from maltreatment and the perpetrators, one a parent and the other a one-time nurse of the child, were convicted of manslaughter. All Other Accidents.—The remaining deaths from violence, viz. 39, give a rate of 0.17 per 1,000 population which compares favourably with the rate of 0.21 for England and Wales and that of 0.18 for Greater London. Home accidents were responsible for 12 deaths giving a Borough rate of 0.05 per 1,000 population. Among these were 5 deaths from carbon monoxide poisoning and 5 from falls. Common Infectious Diseases During the current year no deaths from these diseases were registered. This classification comprises measles, scarlet fever, diphtheria, whooping cough and diarrhoea. 61 SECTION III PREVALENCE OF, AND CONTROL-OVER. INFECTIOUS AND OTHER DISEASES By definition, epidemiology is concerned with the occurrence and distribution of all diseases but, until recently, it had acquired a narrower concept linking it, fortuitously, with infectious disease. But, now that recent advances in pharmacology, chemotherapy and immunology have rendered the conquest of infectious disease all but complete, other non-communicable diseases are assuming relatively greater prominence and are providing a new challenge. This will need to be resolved by the re-orientation of the preventive services, changes in clinical and laboratory techniques and greater emphasis on health education. However, we must not blind ourselves to the fact that inherent in the speed of modern travel is the danger of the importation from abroad of the more serious infectious diseases such as tuberculosis, smallpox, leprosy, enteric infections and perhaps other unfamiliar complaints which, conceivably, could threaten our standards of public health so painstakingly built up over a number of years. Such a situation brooks of no relaxation on the part of health authorities, for the price of public health is constant local and national vigilance. Moreover, complacency with our efforts in preventive medicine so far must not lead us to forget that, in infections of viral origin, measles can still cause significant and serious illness in young children and influenza is notorious in its ability, on occasions, to disrupt the life of the community. Rubella, so often dismissed as a trivial complaint, continues to threaten the unborn child, while mumps persists in producing its infrequent but grave effects on the nervous system or gonads of adults. Furthermore, viral hepatitis, for which there are no specific laboratory tests nor vaccines available, is becoming increasingly recognised as a serious menace in European countries. It is reasonable to assume that all diseases are the outcome of interactions of environmental and genetic factors. If this view is sustained and it is accepted that, as yet, the genetic aspects are beyond our control, then present prevention or alleviation must lie in influencing environments which are disease precipitating. In this respect, diseases (other than those of the infectious type) such as cancers of the lung and bladder, respiratory disabilities such as silicosis, pneumoconiosis, etc., saturnism, salmonellosis, all with their own particular associations, immediately spring to mind 62 although, on reflection, the field is even wider. There is great scope in this field for preventive measures and health education. Other influences, namely, research into effects of the thymus gland upon the 'immune processes' may well lead to effective control of some forms of cancer. In a similar context, haemolytic disease of the newborn has provoked some comment in a report by a W.H.O. Scientific Group which has made observations on the fact that in normal pregnancy, although the foetus is essentially a heterologous transplant, it is rarely rejected by its mother. It must therefore be subject during the gestation period to some protective mechanism as yet unknown. It has been postulated that isoantigens from the amniotic membrane and fluid are implicated. Again, the solving of a problem of this nature has even wider applications in the field of preventive medicine and 'spare-part' surgery. Epidemiologically, heart disease is proving to be the greatest menace of modern society. It ranges from congenital heart conditions such as patent ductus arteriosus, co-arctation of the aorta, septal defects, Fallot's tetralogy, etc., to those acquired disabilities of the rheumatic heart involving the mitral, aortic and tricuspid valves and of coronary artery disease. However, early surgery is proving very effective in the field of congenital heart disease where present mortality is some 60% before the age of one year. Furthermore, a considerable measure of success is to be seen in surgery concerned with the acquired heart disabilities. Improved cardiopulmonary by-pass techniques and the development of profound hypothermia in open heart surgery are enabling more extensive repairs and prosthesis to be entertained. Again, impaired coronary circulation is being compensated by the implantation of the internal mammary and splenic arteries or by the even more revolutionary method of cardiac acupuncture. Whether those methods will stand the test of time remains to be seen but the prospects are exciting and bright. Mental diseases have, in more recent times, attracted attention and have been investigated with varying degrees of success. Schizophrenia, frequently triggered by environmental influences, has been the subject of considerable research. It is now generally believed that susceptibility is genetically determined but, as head injuries and addiction to certain drugs can produce similar symptoms in members of families with no 'schizophrenic' histories, it might well be that the onset arises from a functional breakdown involving biochemical pathways. A significant advance which could be invaluable in the field of mental disease is the use, in bloodless brain surgery, of the 'laser' 63 beam enabling incisions of hitherto inaccessible nerve centres to be effected without recourse to craniotomy. Far from being effete, preventive medicine is due for a revitalisation during the latter half of the twentieth century albeit on lines somewhat different from today. Legislation During the current year, no national legislation concerning infectious diseases was enacted. In respect of the Inner London Boroughs, however, uniformity with the rest of the country in the allocation of notifications of infectious disease was effected by the substitution of the Public Health (London) Act, 1936, with the provincial Act of the same year and the introduction of the London Authorities (Miscellaneous Health Provisions) Order, 1965. All notifications (with the exception of those in respect of tuberculosis which shall continue to be forwarded to the Medical Officer of Health of the area in which the patient normally resides) must be sent to and retained by the Medical Officer of Health of the district in which the patient is resident at the time of diagnosis. On representation by the Medical Officer and with the approval of the Minister of Health, Orders requiring the notification in the Borough of Zymotic Enteritis and Acute Rheumatism were revoked on 1st October, 1965. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936, Section 192 of the Public Health (London) Act, 1936 (from 1.1.65 to 31.3.65) and associated Orders and Regulations was 3,036. Under the Public Health (Tuberculosis) Regulations, 1952, there were 69 notifications, giving a consolidated total of 3,105 cases notified during the year. However, 23 cases were not confirmed and 3 were rediagnosed as food poisoning, thus giving a corrected figure of 3,079 compared with the combined total of 1,302 in respect of the previous Metropolitan Boroughs of Greenwich and Woolwich for the year 1964. This increase of 1,777 is largely accounted for by the biennial increase in measles notifications. Particulars of age groups, by sex and districts, are shown in the table given in the Appendix. National Insurance Act, 1946 From time to time it is necessary for the Medical Officer of Health to insist that a suspected 'carrier* of, or a person in contact with, an infectious disease should be precluded from working in order that the risk of transmission of the disease is minimised. This is especially necessary when the person concerned is a 'food handler'. 64 Regulation 3(b) of the National Insurance (Unemployment and Sickness Benefit) Regulations, 1948, made under the above Act, enables any person so excluded to claim sickness benefit on production of a certificate issued by the Medical Officer of Health. In the Ministry of Health Circular 115/48 it has been suggested that the Medical Officer of Health should be prepared to furnish such a certificate if, in his opinion, circumstances are such that this action becomes necessary. It is likely that action of this nature could result in hardship for National Health benefits are considerably less than a person's normal earnings. However, Section 41 of the Public Health Act, 1961, provides that where, with a view to preventing the spread of a notifiable infectious disease or a disease to which Section 23(1) of the Food and Drugs Act, 1955, applies, a Medical Officer of Health by written notice requests a person to discontinue his work, then the local authority shall compensate such person for the loss occasioned in compliance thereof. No action was necessary during the year under review. International Certificates Ministry of Health Circular 20/52.—The question of authentication of International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October, 1952. The Regulations prescribe inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 2,646 certificates of persons proceeding abroad were so authenticated, of these 2,252 were in respect of Smallpox, 275 Cholera, and 119 for Typhoid. Smallpox No cases were notified during the year, but a number of contacts were reported arriving in the Borough from abroad and these were kept under surveillance for the requisite period. Public Health (Smallpox Prevention) Regulations, 1917.— These Regulations give a Medical Officer of Health power to vaccinate or re-vaccinate without charge, any contacts of Smallpox cases willing to submit themselves for treatment. Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 65 1853, nine-tenths of smallpox victims were children under 5 years of age. Subsequent to this period, children, by and large, escaped. However, since 1898, when the 'conscientious objection' clause made its appearance, vaccinations have declined steeply and the position deteriorated still further from 1948 when vaccination became optional. Glycerinated calf lymph is the standard vaccine used in this country and the number of primary vaccinations carried out in the Borough during 1965 was 2,565, 2,336 under Council arrangements and 229 by general practitioners; figures for re-vaccination were 176 and 39 respectively. Occasionally a smallpox scare in the country results in a jump in the number of vaccinations effected, as witnessed at the beginning of 1962, but generally the trend is downwards. Today, although every precaution is taken at seaports and airports, infected persons do occasionally slip through but the comparative immunity of the country has hitherto been due mainly to its high vaccination state. With the fall in the number of vaccinations this fortunate state of affairs cannot be expected to continue. Measles The normal biennial fluctuation was evident in the number of cases notified during the year which increased from a total of 696 for Greenwich and Woolwich in 1964, to 2,608 for the current year. Only ten cases were removed to hospital and there were no deaths recorded. Much research has been carried out in recent years with regard to the control of measles. New vaccines, free of the undesirable reactions of the earlier types, have been developed and under the control of the Medical Research Council, a limited scheme for vaccination with a new vaccine was introduced during 1964. Some 620 babies up to the end of 1965 were vaccinated and during the year information concerning notified cases born between 1st November, 1962, and 31st December, 1963, were returned monthly to the M.R.C. Scarlet Fever There were 111 notified cases in 1965, a total which shows a fall of 12 from the consolidated figure of 123 for the previous year when Greenwich recorded 52 and Woolwich 71. Three cases were removed to hospital and no fatality was recorded. 66 Whooping Cough Seventy notifications were received during the current year compared with a total of 113 in 1964 which comprised Greenwich 33 and Woolwich 80. Four cases were removed to hospital and there were no deaths. Diphtheria As in 1964, no notification was received for the year under review. During the year there were 3,950 primary immunisations completed in the Borough of which 315 were effected by general practitioners. Most diphtheria immunisations given form part of a combined antigen therapy and, in addition to these primary treatments, some 7,657 reinforcing doses were given, 423 of which were carried out by general practitioners. Antitoxin.—Since January, 1949, arrangements have been made for a small stock of diphtheria antitoxin to be held at St. Alfege's Hospital for use by general practitioners in emergencies. Acute Primary Pneumonia and Acute Influenzal Pneumonia Altogether 40 notified cases were registered in 1965, an increase of five over the combined total of 35 for 1964. Thirteen cases received hospital treatment but there were no fatalities. Typhoid No notification was received for the current year, a result similar to that in 1964. Zymotic Enteritis Eleven cases were recorded as confirmed as against Greenwich 11 and Woolwich 6, giving a consolidated total of 17 for the previous year. However, as already stated this disease ceased to be notifiable in the Borough on 1st October, 1965. No case received hospital treatment and there were no deaths. Erysipelas During the year there were 6 confirmed cases. In 1964, there were 8 cases returned for the Woolwich area. Sonne Dysentery This disease is usually characterised by diarrhoea, fever and, to a lesser extent, vomiting. Although modern methods of treatment are effective and usually fairly rapid, nevertheless the disease has become a serious nuisance and difficult to control. It is 67 normally mild but in infants and young children it can produce serious illness and debility, especially if the patients are already slightly below normal health. In adults it is an irksome inconvenience and, if they work in the food trade, it can cause economic hardship. There were 26 confirmed cases in 1965, a total which shows a considerable decrease from the consolidated figure of 100 for the previous year when Greenwich recorded 82 and Woolwich 18. No cases were admitted to hospital and there were no deaths. Scabies Only 1 notification was received compared with 2 from Greenwich and 1 from Woolwich during 1964. However, as previously stated this disease ceased to be notifiable on 1st April, 1965. Treatment of all cases of Scabies continues to be available at the Tunnel Avenue and Plumstead High Street Centres. Puerperal Pyrexia Of the 130 notified cases, 32 were in respect of hospital patients whose residences were outside the Borough. In 1964, totals of 3 and 96 were recorded for Greenwich and Woolwich respectively, but the latter total included 43 hospital patients resident outside Woolwich. Ten of the cases were nursed at home and the remainder in hospital. There were no fatalities. Meningococcal Infection No confirmed cases were recorded in 1965 compared with three for the previous year in Woolwich. Acute Encephalitis (Infective or Post Infectious) Similar to the previous year, there were no notifications received. Ophthalmia Neonatorum Seven notifications were received for this year, the same figure as recorded by Woolwich in 1964. Poliomyelitis As in the previous year, no notification was received during 1965. Completed primary poliomyelitis inoculations carried out during the current year numbered 4,061, 418 of which were by 68 general practitioners. Reinforcing doses totalled 3,096 again with 179 being given by general practitioners. Malaria Compared with a nil return for this year, one notification was recorded by Woolwich in 1964 in respect of the disease which was contracted abroad. Tuberculosis One of the most important tasks ever falling to the medical profession and to public health staffs generally throughout the country, is the control and ultimate conquest of tuberculosis. This they have proceeded to do with remarkable effectiveness considering the inherent difficulties. However, notwithstanding the successes gained especially in recent years with the newer forms of chemotherapy, it must be remembered that, pneumonia apart, tuberculosis is still responsible for more deaths than any other infectious disease. Moreover, there is more than a suspicion that this disease is being imported by present immigrants not subject to a medical examination or to one that is a little too perfunctory. Vagrancy, which curiously enough is becoming more common in the younger age groups, perpetuates pools of infection which defy present casefinding procedures. Again, some elderly people admitted to hospital for various reasons have been found to be latent cases. It seems that although a great deal has been achieved, there still remains much to be accomplished. There were 69 notifications received during the year and of these 56 were of the pulmonary type and 13 non-pulmonary, i.e., tuberculosis of parts of the body other than the lungs. From sources other than formal notification, an inward transferable death return gave information on one person having suffered from pulmonary tuberculosis. In 1964 Greenwich and Woolwich respectively registered 30 and 47 pulmonary and 11 and 6 nonpulmonary cases, giving a consolidated total of 94. During 1965, some 2,204 Greenwich school children received B.C.G. vaccination under the direction of School Medical Officers. Although not always essential, disinfection was offered and carried out in 14 cases including 27 rooms. An additional 10 premises involving 43 rooms were disinfected as a result of Council housing transfers. 69 The number of notified cases of tuberculosis remaining on the Register at 31st December, 1965, was as follows: — PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 950 720 32 21 1,723 45 49 4 7 105 During the current year in co-operation with the Greenwich and Woolwich Chest Clinics, the comprehensive checking of each case on the respective registers was continued. Many cases about which nothing has been heard for at least five years and who were found to have removed from the district and many more considered by the Chest Physicians to have recovered, were extracted from the registers. The result can be seen by a comparison of the above table with the combined totals of 2,110 pulmonary and 142 non-pulmonary for Greenwich and Woolwich at the end of 1964. CHEST CLINIC REPORTS Greenwich Chest Clinic I am indebted to Drs. P. Forgacs and D. G. Wraith, Consultant Physicians at the Greenwich Chest Clinic, for the following Report: — "Twenty-three new cases of pulmonary tuberculosis were notified during the year. This includes 15 males of whom 10 were over the age of 40 and 5 between 20 and 40. There were 8 females all of whom, except one, were below the age of 40. Two of these were aged 12 and 14 but there were no other children found to have tuberculosis. Three cases of non-pulmonary tuberculosis were notified, all males, two with tuberculous glands and one with meningitis. During the year all the patients on our Pulmonary Tuberculosis Register have been reclassified into one of the following three groups: — 1. Patients known to be infectious. 2. Potentially infectious patients, i.e., those who might relapse and become infectious. 3. Patients unlikely to relapse, i.e., healed tuberculosis. The new register will now only consist of the patients in the first two categories. 70 Ninety-six ante-natal patients have been X-rayed of whom one was found to have active tuberculosis. One hundred and seventy-nine contacts were X-rayed but no evidence of tuberculous disease was found in them. Eighty-eight children and young adults were given B.C.G. inoculation because they were contacts of cases with tuberculosis. Thirty positive Mantoux children were referred to us from school but none was found to have active disease. Many patients have attended the Chest Clinic for investigation of other chest diseases including neoplasm of the lung, bronchitis and asthma, etc. Twenty-eight patients were found to have carcinoma of the lung as compared with 40 last year. They were referred to the Brook Hospital for surgical treatment or radiotherapy. The total number of attendances for all patients was 8,256 which is approximately the same as last year. The total number of chest X-rays was 6,028 which is also similar to the number for last year. A proportion of these X-rays were taken as part of a routine service provided for local General Practitioners; patients for whom their General Practitioner does not consider it necessary to attend for full examination at the Clinic, can have X-ray only and are recalled for further investigation only if some abnormality is found. Continued interest has been taken in bronchitis and asthma with a view to investigating and treating these conditions at an early stage where possible in an attempt to prevent more permanent disability. Specialised investigations have included tests for the presence of underlying allergy which may be prevented or treated with vaccine; respiratory function tests and investigation of the patients' blood for antibodies against certain organic dusts and foreign protein which have been found to cause certain types of lung disease. As a result of these special tests it has been discovered that lung disease of a severe and progressive nature, which is distinct from asthma, may be caused in some cases by J exposure to birds, especially budgerigars and pigeons. We have continued to keep under supervision a large number of patients who have unfortunately become already disabled as a result of various kinds of chest disease and in whom a number of social problems are found. Difficulty in finding suitable employment results in poor morale and probably aggravates one's ill health and it is hoped that some form of sheltered work might become available for these disabled persons. Unsuitable housing appears to play a large part in aggravating some of these patients' chest symptoms due to dampness and excessive dust and crowding. 71 A survey of the patients' food is being carried out which shows that some of these disabled persons are not having sufficient of certain food stuffs although this could be improved in most cases with suitable advice." Woolwich and Brook Chest Clinics I am also indebted to Dr. A. MacManus, Consultant Physician at the Woolwich and Brook Chest Clinics for the following Report: — No. of Pulmonary Tuberculosis Cases notified during 1965: Males Age Group Females 1 1 - 10 1 2 11 - 20 3 3 21 - 30 1 1 31 - 40 - 4 41 - 50 1 4 51 - 60 — 6 61 - 70 — 3 71 - 80 — 1 81 - 90 — TOTAL — 31 No. of Non-Pulmonary Tuberculosis Cases notified during 1965: Site Males Females Inguinal Glands 1 — Renal 3 3 Endometrium — 1 G.U. Tract — 1 Cervical Lymph Glands — 1 Mesenteric nodes — 1 TOTAL — 11 No. of Pulmonary Tuberculosis Cases in 1964 52 B.C.G. Vaccination (Children and Young Adults) Given at Woolwich Chest Clinic 122 Given at Brook Chest Clinic 63 Total No. of Patients attending: Woolwich Chest Clinic in 1965 3,488 (New Cases—826) Brook Chest Clinic in 1965 2,145 (New Cases—222) TOTALS BOTH CLINICS: Attendances—5,633 New Patients—1,048 72 Total No. of notified, recovered and observation cases Woolwich and Brook Chest Clinics at 31.12.65:— Male Female Children Total Pulmonary 874 670 61 1,605 Non-pulmonary 25 32 4 61 1,666 "Although there has been a reduction of new notified cases of pulmonary tuberculosis it cannot be emphasised too much that the disease is not yet conquered. There are still a few resistant cases and in 1965 there were two relapses (1 male, 1 female) of tuberculous infection who were treated in the pre-chemotherapy days. As there appears to be still a considerable reservoir of infection it is important that case finding technique be intensified rather than relaxed. All old notified cases of pulmonary tuberculosis are reviewed annually with X-rays and sputum tests. The specialised services of the chest clinics now embrace and are eminently suitable for dealing with patients with other chest diseases. Carcinoma of the lung is now the hidden menace for which we must ever be on the alert as the numbers are increasing. These are treated by surgery, radiotherapy and cytotoxic drug therapy as indicated. Grants were obtained from the National Society for Cancer Relief where needed. Patients with bronchitis are treated with antibiotics, physiotherapy and anti-smoking advice given. Rehousing in suitable areas, recuperative holidays and sheltered employment have been arranged in many cases. Allergy testing, desensitisation and relaxation therapy is now an important feature of chest clinic work". Mass Radiography In London, Mass Radiography was originally carried out under the direction of the London County Council, but since January, 1948, the responsibility for this service has rested with the South East Metropolitan Regional Hospital Board. Introduced primarily for the early detection of Tuberculosis, the Mass Radiography service is responsible for revealing many other chest malformations and disabilities which would doubtless have remained undetected perhaps for years. As a direct consequence of the diagnosis of these ailments treatment is made possible at a very early age, thereby enabling a much more favourable prognosis to be entertained. 73 Although no major surveys were undertaken, in addition to attendances at regular sites, short visits cpvering public and factory surveys (with attention to special groups in each category) were carried out in the Borough during the year by the South East London Mass Radiography Unit and I am indebted to Dr. J. M. Morgan, the Director, for the following analysis of the results received so far:— Summary of Surveys Carried Out in the Borough from 1st January to 31st December, 1965. PART I.—General Analysis Men W omen Total (a) Total X-rayed 10,497 4,039 14,536 (b) Total previously X-rayed (within 5 years) 8,215 1,688 9,903 (c) Total number reviewed 421 90 511 (d) Number considered abnormal after review 323 54 377 (e) Not yet attended after review 2 1 3 PART II.—Analysis of Abnormal Films (1) Cases considered tuberculous and referred for further investigation : Men Women Total (a) No further action required — — — (b) Occasional Supervision 10 4 14 (c) Requiring close supervision or treatment 12 4 16 (d) Still under investigation — — — (e) Refused further investigation — — — (2) Previously known tuberculous cases 20 5 25 (3) Non-tuberculous cases: (a) Investigated 48 13 61 (b) Still under investigation 4 — 4 (4) Cardio-vascular lesions 30 8 38 (5) Abnormalities requiring no action 196 19 215 74 ANALYSIS OF SURVEYS Numbers Examined Cases of Tubercu/osis requiring treatment or dose Not Previously Examined (included in first column) Numbers Cases Men Women Total Men Women Total Men Women Total Men Women Total A) Public Surveys 58 14 72 - - - 50 10 60 - - - B) Public SurveysExamination of Special Groups 702 145 847 1 - 1 77 79 156 - - - C) Firms— Full-scale visits 3,262 1,290 4,552 3 2 5 1,107 526 1,633 3 1 4 D) Firms- Examination of Special groups 3,813 33 3,846 2* - 2 62 12 74 1 - 1 E) Colleges, Schools, Hospitals, etc. 310 1,352 1,662 — - - 135 1,080 1,215 - - - F) Regular Sites 2,352 1,205 3,557 6 2 8 851 644 1,495 5 2 7 TOTAL 10,497 4,039 14,536 12 4 16 2,282 2,351 4,633 9 3 12 * One of these cases also carcinoma of bronchus. Venereal Diseases Under the National Health Service Act of 1946, diagnosis and treatment of venereal diseases became a responsibility of the Regional Hospital Boards and the functions of the local health authorities were limited to those of prevention. In practical terms, this means the tracing of contacts, a difficult and often unrewarding part of the preventive service. On various occasions, the Minister of Health has stated that although complete control is still an unfulfilled and perhaps distant objective, our free facilities for diagnosis and treatment has at least contained the spread of these diseases to a degree which compares favourably with other countries. Maybe there are newer 75 methods of treatment and control which, with advantage, could be introduced but there is no doubt of the need to stir the public conscience and make it more aware of venereal diseases and their dangers. Experts differ as to how this might be achieved, ranging from an outright and sustained national publicity campaign to more discrete local advertisement concerning treatment clinics and times. Unfortunately, at a time of stringency when finance is severely restricted (a situation which seems to have been with the preventive services ab initio), venereal disease clinics come very low in the order of priorities for establishments, improvements, etc. As reported earlier in this section, speed of modern travel makes local control of infectious diseases difficult if not well nigh impossible on occasions, which serves to emphasise the urgent need for a more vigorously and internationally applied preventive policy. This is particularly so in respect of the venereal diseases. I am indebted to Drs. A.A. M. Reekie and D. Erskine, Physicians i/c at the Miller and Dreadnought (Seamen's Hospital) Treatment Centres respectively for the following statistics for 1965: — New Cases Treated at Centres Within the Borough Treatment Centre Syphilis Gonorrhoea Other Conditions TOTALS M F M F M F M F Greenwich District Hospital Miller Wing: 5 8 121 48 416 170 542 226 Dreadnought Seamen's Hospital: 36 - 182 - 948 - 1,166 - New Cases of Residents Treated During 1965 (as given in returns from the undermentioned Centres) Treatment Centre Syphilis Gonorrhoea Other Conditions TOTALS Greenwich District Hospital Miller Wing: 4 36 182 222 Dreadnought Seamen's Hospital: 5 25 167 197 St. John's Hospital: 1 12 38 51 TOTALS 10 73 387 470 76 Alcoholism and Drug Addiction So far, there is no evidence that alcholism or drug addiction is of any real moment in this Borough at present. However, unquestionably, the problem is becoming increasingly serious nationally and, as health authorities, we must be on our guard locally. Accurate statistics in respect of alcoholism and drug addiction are difficult to come by but whatever figures are available they indicate only the tip of the 'iceberg' because for every addict there are at least two other persons implicated. New-found social freedom has brought a startling increase in drug addiction among the younger age groups (under the excuse of 'I can do what I like with myself) ranging from addiction to ordinary tranquillisers and stimulants to the 'harder' drugs of heroin and cocaine, etc. With regard to alcoholism perhaps the most difficult task is to convince the public that it is a disease requiring medical treatment and not a self-inflicted condition. Alcoholism is given as the fourth major cause of premature death in the community and the cost to the nation in general and to industry in particular, is stupendous. By and large, it can be said that restrictive legislation of the kind introduced in America has failed and that concentration upon the 'medical' aspects are likely to be more successful. The problem bristles with difficulties but it is clear that further research on the problem is essential, meanwhile education will have to serve as the first line of defence. Dental Caries—Fluoridation Although perhaps not considered by the public as a serious complaint, dental caries is, one might say, a disease of civilisation in that modern diets have, to a large extent, contributed to the disgraceful condition of our children's teeth. Accumulated evidence suggests that of all teeth likely to suffer from dental caries, 75% are attacked before the age of 15 years and there is no need to labour the point that the addition of only 1 p.p.m. fluoride in the water supply would eliminate most of the trouble. As has been well said by Lord Cohen in respect of health services generally, 'simply to ask for more money and so duplicate existing staffs and facilities is not progress'. On an individual basis, oral hygiene, regular dental supervision, restriction of fermentable carbohydrates and provision of extra 77 vitamins and minerals have met with varying degrees of success, but their application as public health measures to the population at large has been disappointing. Fluoridation is a rational and practical method of combating dental decay and this could be achieved at relatively little cost in comparison with the present excessive expenditure on dental services, generally, which will continue to increase if effective preventive measures are not introduced. Most of the objections other than 'ethical' arise from the mistaken idea, fostered by eccentrics, that artificially introduced fluoride into water supply is 'poisonous, gives rise to various diseases, spoils beer, boosts the profits of aluminium companies, etc., etc.', accusations which have never been substantiated under strict examination. Indeed investigations carried out on behalf of the Arthritis and Rheumatism Council for Research seem to show that it has some preventive action in rheumatic diseases. Furthermore, other experiments in Britain and the U.S.A. into substantial and sustained doses of fluoride salts have shown that there is no chance of any toxic effect from fluoridation of water supplies. Investigations have indicated that with a fluoride intake many times greater than the levels proposed for drinking water, the fluoride content of the body cell fluids never rises above an early peak of 2 p.p.m. The new research shows not that a few parts per million of fluoride can be beneficial (this has already been proved) but that it is virtually impossible to produce damaging concentrations of fluoride by oral methods. Moreover, it has been demonstrated that fluoride has beneficial effects in forms of skeletal decay and that regeneration of bone occurs under treatment without adverse effects on the mineral balances of the body. Bone porosity is reduced and a decrease in the incidence of fractures has been observed as has the fact that high levels of fluoride tend to prevent bone calcium loss associated with inactivity. This is of great importance in geriatrics and treatment of long-term immobile patients. Far from being the menace as some would have us suppose, it seems that uses of fluoride in preventive medicine are grossly underrated. Food Poisoning Under the provisions of Section 26 of the Food and Drugs Act, 1955, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that any person is suffering from food poisoning, forthwith notify such case to the Medical Officer of Health. Twenty-two of such cases were registered including rediagnosis of one paratyphoid and two dysentery notified cases. All the cases, which were of the sporadic type, were investigated with the following results: — No. of Cases Organism (if known) No. of Hospital Cases Remarks 7 Salmonella typhimurium - One family suspected sliced luncheon meat bought whilst on holiday. Otherwise no particular food suspected. 15 No organisms detected - Eight cases occurred in 3 families and the remaining 7 occurred in separate households. One family suspected roast pork and another veal and ham pasties, but in neither instance was it possible to verify the cause. In the other cases no particular food was suspected. 22 — Local Morbidity I am indebted to Mr. L. W. Mole, The Manager, Ministry of Social Security, Concert Hall, Lee Road, S.E.3., for the following statistics relating to claims for sickness and industrial injury benefits during 1965. Local offices of the Ministry of Social Security concerned mainly with the London Borough of Greenwich are those located at Deptford, Eltham and Woolwich. Regions covered by these offices are, unfortunately, based upon postal districts and not upon local authority areas but, nevertheless, for most practical purposes the figures quoted are reasonably representative of the Borough's morbidity, subject to the following considerations: — (a) Figures refer to new claims only—they do not indicate the current 'live load' which includes a good deal of long term sickness. (b) Figures relate only to persons insured for sickness benefit. Sickness, therefore, in children, the aged, the non-employed and 'exempt' married women is not included. (c) Injury benefit figures relate to all employed persons. 78 79 Claims to Sickness and Industrial Injury Benefit Year Ended 30th November, 1965. Sickness Benefit Injury Benefit Quarter ended 23.2.65 Deptford 5,532 406 Eltham 6,563 335 Woolwich 6,768 389 Quarter ended 25.5.65 Deptford 5,415 319 Eltham 6,968 303 Woolwich 6,921 324 Quarter ended 31.8.65 Deptford 3,588 275 Eltham 4,463 309 Woolwich 4,465 345 Quarter ended 30.11.65 Deptford 4,922 327 Eltham 6,022 329 Woolwich 6,089 370 Totals: 67,716 4,031 80 SECTION IV PERSONAL HEALTH AND RELATED SOCIAL SERVICES The operation of the maternity and child welfare clinics is largely on the same lines as applied by the London County Council, who in turn had inherited well established services from the old metropolitan boroughs. A development which is being encouraged is the employment to a greater extent of local family doctors at the various local authority clinics. This brings them into closer contact with the preventive services and promotes greater understanding. The possibility, and at the moment it is no more than a possibility, of attaching health visitors and home nurses to selected group practices is being explored and, in any future clinic building, accommodation for group practices will be provided if acceptable to the general practitioners. At the same time, peripheral office accommodation will be found for a variety of specialist officers in the department, such as old people's visitors, mental health officers and social welfare officers, so that a full domiciliary team will be available in the field to serve the area community needs in partnership with the family doctors. Similarly, in organizing the local domiciliary midwifery services, effort has been directed towards obtaining closer associa.ion with the general practitioner obstetricians and the maternity hospitals. Some thought has been given to the proper role of the local authority clinics and the relationship which should exist between the midwife and the other branches of the midwifery service. A good maternity service is obviously begun with good ante-natal care and regular supervision of expectant mothers from the earliest months. The Council has therefore encouraged and extended the practice inherited from its predecessors of making clinic premises available to the local general practitioner obstetricians who wish to use the facilities. These arrangements, together with local Maternity Liaison Committees, have gone a long way to bringing the midwife from a position of isolation and re-establishing her in her true position as a professional person, qualified after rigorous training and searching examination. The modern trend is now undoubtedly towards hospital in preference to home confinement. If this trend continues, and present evidence on the social habits of the community suggest that it will, a complete reappraisal of the role of the local authority midwifery service will be necessary. To some extent this is already being done. The early discharge system from maternity hospitals is working admirably and the midwife is now undertaking social as well as 81 nursing duties. The midwife must, of course, retain her function as an education instructor to the expectant mother. She must also concentrate to a greater extent on post-natal domiciliary work for a high proportion of parous women sutler from gynaecological disorders directly attributable to neglect in the immediate postnatal period. On the practical side, the home midwife must in some way be brought into the hospital as well as the home and encouraged to take her full share in the delivery in hospital of the normal case. Similarly, general practitioner obstetricians should be encouraged to use the local maternity hospital as a place where they can deal with their own cases and work in close association with the consultants. I am aware that this is happening to some extent locally, but the practice should be more universal. As regards our own local authority clinics and domiciliary services, I am confident that if we move with the times and foster even closer links with the general practitioner obstetricians and the hospitals, apart from the mechanics of home midwifery, there are important duties to perform in the field of education and in relation to medico-social needs. These matters are already being given the close attention of the Central Midwives Board. It is with hope and confidence that this first report on the local authority midwifery services is presented. Despite the tripartite administration of midwifery imposed by statute, I believe that it is possible, and indeed it is already happening, that all three branches can co-operate in harmony, with hospital care for priority groups and perhaps eventually hospital general practitioner/midwife beds for the normal cases preferring hospital delivery, while at the same time home confinement can be made easily available for those whose homes are suitable and who are eager and willing to have their babies at home. It must never be forgotten, however, that whatever the arrangements, the pre-eminent consideration must be the safety and the health of future mothers and children. General All sessions have continued and attendances have remained fairly steady throughout the year. A great deal of individual health education goes on at these sessions and demonstration cabinets and posters which are always on display are noticed and frequently discussed by the mothers and by the children. In addition to the two creches in the Borough, both of which open one half day weekly, a number of mothers have been enrolled in accordance with the voluntary child-minders' registration scheme. In the absence of a Borough day nursery, these mothers are fulfilling a very necessary function. During the year, a new purpose-built centre was opened at Abbey Wood, taking the place of the previously very inadequate 82 accommodation in Grovebury Road. Now there is room for some expansion of the services and, in fact, some increase has already taken place. An Old People's Visitor is now based at the centre, a school health vision clinic is held fortnightly and the Family Planning Association holds weekly sessions. A general practitioner obstetrician clinic has been established at Creek Road Centre for the convenience of mothers in that area. Psychoprophylactic training for childbirth has gone forward. More classes have been introduced and these are now held at seven centres in the Borough. Relaxation sessions for expectant mothers are held in most of the other centres and these are well attended. There is close co-operation between health visitors and the staff of the Children's Department over the welfare of families facing problems which are often difficult and even unsurmountable to the family itself. Contact is also maintained between health visitors, the staff of other Borough departments and voluntary organisations. Ante and Post Natal Clinics These clinics, provided by the Council at its Welfare Centres, are under the supervision of the Council's Medical Officers or general practitioner obstetricians and they serve as centres where midwives can book and examine their patients and where facilities are offered for certain routine investigations. Figures given below indicate the use made by residents of these clinics: — No. of Women in Attendance: Ante Natal 1,516 Post Natal 518 2,034 Total No. of Attendances made 7,645 No. of Sessions held by: Medical Officers 142 Midwives - G.P.s on Sessional Basis 278 Hospital Medical Staff 236 656 General Practitioner Obstetricians No. of Sessions held 606 No. of Attendances : Ante Natal 11,019 Post Natal 697 11,716 83 Selection of Women for Hospital Confinement It is obvious that the number of emergency hospital admissions can be reduced by the correct booking of place of confinement in accordance with certain criteria. The following tables are included to indicate the degree of success of the selections made in the Greenwich area during 1965. Live Births by Age and Parity of Mother and by Place of Occurrence Parity of Mother Place of Delivery ALL AGES AGE OF MOTHER Under 20 yrs. 20 to 24 yrs. 25 to 29 yrs. 30 to 34 yrs. 35 to 39 yrs. 40 to 44 yrs. 45 and over 0 (a) 1,086 199 511 232 109 26 8 1 (b) 86 13 47 24 1 1 — — (c) 46 7 22 13 3 1 — — (d) 2 — 2 — — — — — 1 (a) 588 34 194 214 91 39 16 — (b) 68 3 38 16 8 3 — — (c) 366 16 130 156 54 10 — — (d) 11 2 6 3 — — — — 2 (a) 263 5 57 84 54 43 20 — (b) 38 — 8 23 2 4 1 — (c) 283 2 67 115 80 16 3 — (d) 1 — 1 — — — — — 3 (a) 144 19 42 41 25 13 4 (b) 23 — 4 11 5 3 — — (c) 119 — 13 48 36 18 4 — (d) 1 — 1 — — — — — 4 (a) 93 7 23 27 26 10 (b) 9 — — 3 4 — 2 — (c) 39 — 3 12 14 8 2 — (d) — — — — — — — — 5-9 (a) 96 — 4 19 31 24 16 2 (b) 7 - - 2 4 - 1 - (c) 16 — 1 2 8 3 2 — (d) — — — — — — — — 10-14 (a) 3 1 2 (b) — — — — — — — — (c) 3 — — — 1 1 1 — (d) — — — — — — — — 15 & over (a) (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — Illegit. (a) 226 80 72 41 15 10 8 (b) 17 6 8 2 1 — — — (c) 53 4 17 15 13 4 — — (d) 7 2 5 — — — — — TOTAL (a) 2,499 318 864 655 369 195 91 7 (b) 248 22 105 81 25 11 4 — (c) 925 29 253 361 209 61 12 — (d) 22 4 15 3 - - - - (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. 84 Stillbirths by Age and Parity of Mother and by Place of Occurrence Parity of Mother Place of Delivery ALL AGES Under 20 yrs. 20 to 24 yrs. AGE OF MOTHER 40 to 44 yrs. 45 and over. 25 to 29 yrs. 30 to 34 yrs. 35 to 39 yrs. 0 (a) 33 9 15 4 4 1 (b) 1 — 1 — — (c) — — — — — — — — (d) — — — — — — — — 1 (a) 11 1 3 2 1 4 - - (b) 3 - 2 1 - - - - (c) 2 - ] 1 - - - - (d) - — — — — — 2 (a) 9 — 3 3 2 — 1 — (b) — — — — — — — (c) 2 — 1 — — 1 (d) — — — — — — — — ] (a) 6 — 1 3 1 1 (b) — — — — — — — (c) 1 - - - - 1 - - (d) — — — — — — — — 4 (a) 6 1 3 1 1 (b) — — — — — — — — (O 1 — — — — — 1 — (d) — — — — — — — — 5-9 (a) 1 — — — 1 — — — (b) (c) 1 — — — — — 1 — (d) — — — — — — — — 10-14 (a) — — — — — — — -[ (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 15 and over (a) (b) — — — — — — (c) — — — — — — — — (d) — — — — — — — — Illegit. (a) 3 1 1 1 (b) — — — —- — — — — (c) 1 — — 1 — (d) 1 — — 1 — — — — TOTAL (a) 69 10 22 12 15 6 4 — (b) 4 — 2 2 — — — — (c) - - — - - — (d) 1 - - 1 - - - - (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. Preparation for Childbirth Twelve relaxation classes were held each week in Child Welfare Centres throughout the Borough, five of which taught the psychoprophylaxis method. Following all classes, talks were given by a health visitor preparing the mother for the birth of her baby. 85 Once every six weeks, four of the centres held an evening parenteral class to which fathers were invited. In all, 19 evening sessions were held with 333 attendances and the following table shows the total attendances made during the year at the various classes: — Ante Natal, Mothercraft and Relaxation Classes No. of Women Attending: — Hospital Booked 805 Domiciliary Booked 102 907 Total No. of Attendances 4,463 Midwifery Practising Midwives Notifications of intention to practise as midwife in the London Borough of Greenwich during 1965 were received from 108 persons in accordance with the Midwives Act, 1951. Of these, 86 were in respect of hospital midwives and the remainder, viz. 22, were from those engaged in the Council's service and included the supervisory staff. Domiciliary Services The Borough is divided into 16 midwifery areas, each with a full time midwife. There have been some changes in the Council's midwifery staff during the year but, by and large, the numbers are well up to establishment and are tending to remain so. As a result of patients taking advantage of the '48 hour discharge' scheme and also of the fact that every encouragement to enter hospital is given to all primiparas and to those mothers having any baby after the fourth, the number of home deliveries decreased during the current year. Domiciliary Confinements Attended and Hospital Deliveries Nursed at Home Doctor Present Doctor Not Present Doctor Not Booked _ 9 Doctor Booked 97 804 Totals 97 813 No. of Hospital Deliveries' attended by Midwives on discharge before 10th Day. 378 NOTE: Because of complications, 154 cases booked for home confinements, were admitted to hospital in the ante-natal period or during labour. 86 Deliveries for the year averaged 57 for each midwife, but as 154 cases booked for home confinement were admitted to hospital either in the ante-natal period or during labour because of complications, the figure of 57 does not give a true picture of work done and visits made. Many mothers admitted during labour are discharged home early to the care of the midwife. For the early discharge scheme and for nursing mothers who are discharged, one part-time midwife does all home assessments until the 10th day. Domiciliary Confinements by Age and Parity (1.4.65 to 31.12.65) Age Total confine ments Parity 0 1 2 3 4 5 and over Not known Under 20 No. % 22 3 14 4 1 — — 3.3 0.4 2.1 0.6 0.1 — — — 20-29 No. % 458 17 215 149 58 15 4 — 69.4 2.6 32.6 22.6 8.8 2.3 0.6 — 30-39 No. % 172 47 52 46 16 11 260 — 71 80 70 2.4 1.6 — 40 and over No. % 5 - - 1 1 1 2 - 0.8 — — 0.1 0.1 0.1 0.3 — Not known No. % 3 1 2 - - - - - 0.5 0.1 0.3 - - - - - Total No. % 660 21 278 206 106 32 17 100 .0 3.2 42.1 31.3 16.0 4.8 2.6 - All ante-natal clinics have general practitioner obstetricians in attendance and all patients are encouraged to book these for their confinement. In fact opportunities were provided at clinics for 33 general practitioner obstetricians to examine, with midwives, their domiciliary cases. Appointment systems were in operation at these centres. Every mother booked at a clinic had a full physical and blood examination, facilities for the latter being provided by the Devonport Laboratory at Dreadnought Seamen's Hospital. Post natal examinations were offered to all mothers six weeks after delivery but the response was not encouraging. Some mothers did, of course, attend their own doctor's surgery for the 87 examination, but a disappointing number were recorded as having attended local authority clinics in 1965. After post natal examination, all mothers were invited to attend for a cervical cytology test and 436 attended for this examination between October (when cytology clinics were opened) and December, 1965. Liaison with hospital staff has continued throughout the year, and a health visitor attends each week at one of the ante-natal consultant clinics at St. Alfege's Hospital. Regular monthly meetings are held at the British Hospital which are very well attended by health visitors, midwives and local authority doctors and by the hospital medical and nursing staff. Interesting obstetric cases are discussed and explained by the medical staff. Every four months the meeting is taken by the department's staff who are able to talk about their work and the health services in general. Several lunch-time meetings have been held at which films were shown and discussions took place and to which practitioners and general practitioner obstetricians were invited, with a good response. These meetings have been useful to all medical and nursing personnel and more have been requested. Early Discharges—Planned early discharges took place from St. Alfege's and Hainault Hospitals. In the case of mothers who could spend or needed to spend only 48 hours in hospital but who, for medical reasons required hospital confinements, domiciliary visits were made before delivery so that the suitability of home conditions for the nursing of a post-partum mother could be assessed. A few unplanned early discharges took place when mothers decided to leave hospital soon after delivery (often because they could not relax away from their other young children) or when an emergency arose and the hospital bed was required for another mother. In such cases, it is always desirable that a report on home conditions should be sought from the Department before the mother leaves hospital. Some 378 mothers were attended by midwives on discharge before the 10th day. Emergency Obstetric Units—These units are based at the British Hospital for Mothers and Babies, St. Alfege's, Lewisham and Dartford Hospitals, and are manned by hospital staff. They are available to any medical practitioner or midwife who is in need of additional assistance at a domiciliary confinement, either before a delivery at home or before unplanned removal to hospital. These units were used 16 times during 1965. 88 Premature Baby Units—Premature babies who require special nursing are transferred to units at the British Hospital for Mothers and Babies or to the Lewisham Hospital. When hospital nursing is found to be necessary for premature babies born in the district and if transport under normal conditions in an ambulance is considered to be undesirable, then a doctor and nurse may be sent from hospital with a mobile incubator to transfer the child. During the current year it was unnecessary to call upon the services of these units. Domiciliary Births — Prematurity and Mortality by Birth Weight Weight Number Proportion per 100 live premature infants Deaths in 24 hours Survivors at 28 days Number Per 100 live premature infants Number Per 100 live premature infants 21b 3oz or less — — — — — — 31b 4oz or less 2 6.7 — — 1 3 .3 31b 5oz to 41b 6oz 2 6.7 — — 2 6.7 41b 7oz to 41b 15oz 5 16. 6 — — 5 16.6 51b to 51b 8oz 21 700 — — 18 60.0 All cases 30 100 — — 26 86.6 Maternity Outfits—In all cases of confinements, other than in hospital, maternity outfits are made availiable and during the current year some 1,250 packs were distributed. Part II Midwifery Training—A scheme for the training of midwives is undertaken in co-operation with the British Hospital for Mothers and Babies, with each pupil spending 3 months on the district. No. of Pupils completing Course during year 16 No. of Pupils in Training at 31/12/65 4 Refresher Courses—In accordance with the rules of the Central Midwives Board one midwife attended a Statutory Refresher Course during the year. 89 Observation Visits—With the object of observing the working of the service, 2 Ghanaian midwives were received during 1965. Conditions for which Midwives summoned Medical Aid During 1965 During Pregnancy Ante partum haemorrhage 15 Raised Blood Pressure 12 Post maturity 8 Haemorrhage per vaginam 6 Malpresentation 6 Premature Ruptured Membranes 2 Threatened premature labour 2 Threatened abortion 2 Threatened miscarriage 2 Anaemia 3 Albuminuria 3 Toxaemia 2 Rh antibodies (late booking) 1 Meconium stained liquor 2 Placenta praevia 1 Low haemoglobin 1 Miscarriage 1 Abortion 1 Twin pregnancy? 1 Pains (abdominal, head and chest) 3 Oedema (abnormal sensitivity to uterine contractions) 1 Absence of foetal movement for 24 hours 1 High Head at term 1 False labour 1 During Labour Episiotomy 5 Ruptured perineum 48 Post partum haemorrhage 9 Delay—1st Stage 1 2 2nd Stage 6 Malpresentation: Breech 5 Face 2 Cord 1 Hand 1 Foot 1 Doubtful 2 Foetal distress 8 Retained placenta 7 Ante partum haemorrhage 4 Hypertension 6 Uterine Inertia 4 Premature Labour 10 Asphyxiated baby 2 Hydramnios 1 Obstetric Shock (Pethidine reaction) 1 Prolonged Labour 2 Syncope 2 Inhibiting lactation 2 Rigid perineum 1 Irregular foetal heart (1st Stage) 1 Epilepsy 1 Raised pulse rate 1 Intra-uterine death 1 Obstructed Labour 1 Maternal distress 1 Pain ? 1 Ruptured Membranes over 24 hours 2 90 During puerperium For mother:— Pyrexia 16 Raised pulse rate 4 Phlebitis 3 Excessive Haemorrhage 2 Oedema of lower limb 1 Breasts secreting (after stillbirth) 1 Frequent micturition with back pain 1 Breathlessness 1 Pain in lower leg 1 Early Discharge (against advice) 1 For baby:— Inflammation of eyes 15 Oral Thrush 6 Vomiting 4 Small baby 2 Cyanosis 2 Jaundice 2 Septic rash 2 Spasms 1 Cord haemorrhage 1 Talipes 1 Infected umbilicus 1 Poor respiration 1 Subnormal temperature 1 Melaena stools? 1 Asphyxia pallida 2 Haematemesis 1 Fits 1 No attempts to breathe 1 Inhaled meconium stained liquor 1 Extensive Port Wine staining 1 Lack of response (due to tight cord round neck) 1 In only 4 cases were claims for fees received from medical practitioners called in by midwives in an emergency (Midwives Act, 1951, Section 14). Cervical Cytology With the co-operation of Dr. Thomas, Consultant Pathologist at Greenwich District Hospital, five clinics for cervical cytology, staffed by general practitioner obstetricians and nurses from the department, were opened in October, 1965, at various centres in the Borough. At these sessions, 'well women' over the age of 35 years (a limit which was later lowered to 25 years) and post natal mothers were able to have cervical smears taken and examined for the detection of pre-cancerous changes. Initially the response was slow but, following more extensive publicity, an increasing number of women took advantage of this service. Invitations sent to managers of local factories and stores enabled their eligible employees to take part in the scheme. In some cases, where medical facilities on the business premises were suitable, sessions were to be arranged at the place of employment. In others, certain managers agreed to allow their employees to attend the Council's clinics during working hours. 91 Each week Dr. Thomas was able to accept 100 specimens and, by the end of the current year, 100 women per week were undergoing examination under the scheme. Naturally statistics at this early stage are too meagre for comparisons and analyses will have to be made over a period of years. However, it can be stated that there were 5 deaths from cancer of the cervix uteri in the Borough during 1965, giving a rate of 0.02 per 1,000 population which compares very favourably with the rate of 0.1 for England & Wales. By 31st December, 1965, 436 specimens had been examined and one positive result obtained. This patient, a 49 year old mother of 4 children, has since undergone an operation. Progress made in the sphere of cervical cytology by the end of the year can be gauged by the following statistics:— Clinics No. of Attendances Rustall Lodge 125 Shooters Hill Road 139 Burney Street 56 Plumstead High Street 40 Market Street 76 Total @ 31/12/65 436 Age Groups No. of Attendances 25 — 35 years 45 35 — 45 years 255 45 — 55 years 107 over 55 years 29 Total 436 Parity No. with no Children 23 No. with 1 Child 90 No. with 2 children 183 No. with 3 Children 92 No. with 4 Children 29 No. with over 4 Children 19 Total 436 Family Planning In May and November of 1964, further premises were made available to the Family Planning Association who opened sessions at the Homeless Families Unit at 158a, Plumstead High Street 92 and at Creek Road Welfare Centre respectively—the former at the special request of the London County Council. These sessions were well attended and were obviously in areas where many, who needed advice on planning their families, were unaware of the help which could be given by the Family Planning Association. Again advice on other marital problems, such as infertility, was also offered and cervical smears for diagnostic cytology were taken from a number of patients. Where pregnancy is considered to be detrimental to a woman's health or when, for other medical reasons, advice on contraception becomes necessary, payment of the Family Planning fees may be undertaken by the local authority. During 1965, 77 such patients were aided in this way. Several meetings took place between the Medical Officer of Health and Officers of the Family Planning Association where matters of policy and financial help to the organisation were discussed and the friendly relationship between the Association and the Local Authority was reinforced. The following table not only lists the various Welfare Centres at which Family Planning sessions are held but also summarises the work effected during 1965:— Centre Attendances Cytology Smears *Charlton Lane 1,563 283 Creek Road 502 107 Garland Road 404 51 Lionel Road 1,772 180 †l58a Plumstead High Street 422 31 *A subfertility clinic saw 28 new patients during the year and there were 49 repeat attendances. † This clinic was established to cater for the particular circumstances of families accommodated at this Reception Centre. Since 1st April, 1965, it has been the Council's policy to reduce the number of families to a minimum and accordingly, the scope of this clinic has become correspondingly more limited. However, as a result of consultations, it has been agreed that families, which although not homeless are nevertheless living in similar circumstances, would in future be referred to the clinic by health visitors and other social workers in the area. NOTE : An Intra Uterine Contraceptive Device sub-clinic of the Greenwich Branch, based at Lewisham Hospital, was established in July and some 140 patients had been seen by March 1966. 93 Home Nursing This service provided within the area of the new Borough was shared between three voluntary organisations undertaking the work as agents of the former local health authority. A high standard of service was maintained but inevitably, with three separate organisations operating within the Borough, confusion could arise and although no patient ever suffered, there was, perhaps, a lack of uniformity of standards. The new Borough decided, therefore, to accept direct responsibility for home nursing and the staff were invited to transfer. This unification has been a great success and has benefited not only the patients but, I believe, the staff also. General practitioners have established close working links with the Supervisor and Area Superintendents and a high standard of professional work is being provided. The new arrangements have also tended to identify the nursing sisters more closely with the other branches of the department and a previous feeling of isolation has been eliminated. There have also been benefits to other officers in the department and mutual consultation has been much closer and more personal than ever before. Each of the 24 districts into which the Borough has been divided carries an average load of 40 cases. The rate of visiting is high and each full time District Nursing Sister maintains a monthly mean of approximately 300-350 visits. The general work performed on the district during the year has not changed a great deal and although the number of new patients has fallen slightly, actual visits have increased. In the main, this is due to the higher proportion of visits made not only to the 'over 65's' (82% of the total) in connection with general care and rehabilitation but also to cases of terminal carcinoma, many of whom receive four visits daily. Many of the latter cases also have the benefit of the Marie Curie Night Nursing Service. Clearly the District Nursing Service could be used a great deal more by the Hospital Service. In the latter, there is a lack of knowledge of the potential of the District Nursing Service and steps are being taken to bring to the notice of hospital consultants and medical workers the purposes of the home nursing service. Possibilities of earlier discharge of patients from hospital, particularly surgical patients, should be examined and it would seem to be useful for the District Nursing Service to be invited into the hospital to discuss with the hospital staffs the nursing problems which may have to be faced when the patient is discharged. 94 An analysis of the 2,630 new cases who received attention between 1st April and 31st December, 1965, is given hereunder: — Sources from which Cases were Referred General Practitioners 1,764 Hospitals 603 Clinics (Chest and Ante Natal) 57 District Nursing Service 206 Patients and Visits Total number of Patients 2,630 Total number of Visits 129,356 Average number of Visits to each Patient 49 Classification of Cases New Cases % Medical 2,131 81.0 Surgical 286 10.9 Maternal Complications 149 5.7 Early Maternity Discharges 43 1.6 Tuberculosis 19 0.7 Mental Ill-health 2 0.1 Total 2,630 100.0 Type of Treatment and where effected Treatment At Patients' Homes Elsewhere (e.g. Nurses' Homes) Total % Injections only 30,429 266 30,695 24 Injections plus other Treatment 6,031 41 6,072 5 Other Treatment only 92,560 29 92,589 71 TOTALS 129,020 336 129,356 100 Long Term Cases Patients Nursed for 3 months or more 243 (equivalent to 9% of all cases nursed) Age Distribution of Patients Age Group No. of Patients % 0 to 4 years 44 1.6 5 to 64 years 1,041 39.6 65 years and over 1,545 58.8 TOTALS 2,630 100.0 District Nurses—Full time equivalent (including 2 Reliefs and 4 Students) 53.9 95 Training—During 1965, 10 State Registered Nurses successfully undertook the District Nursing Certificate, two of whom gained distinctions. At the end of the year 5 S.R.N.s were still in training. Refresher Courses—Six District Nursing Sisters attended refresher courses of one week arranged by the Queen's Institute of District Nursing. Integrated Students—Two students from Hammersmith Hospital worked for 6 weeks under the supervision of a District Nursing Sister and a further 3 students from the same hospital were taken for 2 days while undergoing their preliminary training. Five students from King's College Hospital, again under the supervision of a District Nursing Sister, spent 5 weeks gaining district experience. Although these students do not take the District Nursing Certificate it is obligatory for them to have district nursing experience. Observation Visits—Facilities for the purposes of observation were afforded by the department to the following: — 5 Ward Sisters 3 Health Visitor Students 31 Female Hospital Students 11 Male Hospital Students District Nursing—Future Plans—District Nursing is not a static service and its constant expansion and development involves a high proportion of trained staff. A better understanding of its functions and greater co-operation from allied services would undoubtedly lead to its more effective use. Methods by which the service could be made more effective have been the subject of investigations during the year and these have included discussions on attachment of district nursing sisters to group practices enabling more information about patients to be gained resulting in more accurate assessments. It is thought that district nurses working in groups under a senior district nurse, would not only assist internal administration but would also enable greater use to be made of ancillaries such as State Enrolled Nurses, Auxiliary Nurses and bath attendants to the benefit of the service as a whole. Use of disposal equipment during the year has helped towards a more efficient service and the introduction of sterilized dressing packs would continue this trend. From 1st July these will be obtainable on an E.C.10 prescription form and it is hoped that the general practitioner will make full use of the new equipment. Advantages gained by the nursing services on the introduction of disposable equipment are being offset by the growing problems arising from its disposal. Elimination of the coal fires and stoves 96 in new, high density dwellings and smoke control areas, intensifies the difficulties encountered in the disposal of soiled dressings, incontinent pads, etc., the solution to which may mean an expensive ad hoc collecting service. Home Nursing Equipment—Loans This service, concerning loans of nursing and sick room aids for persons being nursed at home, previously administered by the L.C.C., was continued by the Health and Welfare department during the current year. Such equipment is supplied free of charge on indefinite loan at the request of the family doctor, district nurse, hospital almoner, health visitor, old people's visitor, etc. Since the inception of the scheme under the National Health Service Act, the demand for the service has grown and, despite the recent reorganisation, this growth has persisted. Although the need for larger or more expensive items was not so acute during 1965, it can clearly be seen in the following table that the total demand was approximately 33% higher than that for the previous year. Items Number Loaned 1964 1965 Air Rings 26 46 Armchair Commodes 264 307 Back Rest 53 80 Beds (cot type) 4 7 Beds (hospital type) 16 18 Bed Cradles 31 64 Bed Pans 28 40 Easicarri Hoists 14 13 Egerton electrically operated bed — 1 Fracture Boards 14 16 Mackintosh Sheets 45 76 Mattresses 17 23 P.C.P. Nursing Mattress — 1 Penryn Hoist 17 10 Ripple Beds 11 1 Sorbo Rings 1 21 Urinals 12 27 Walking Aids 57 67 Wheelchairs (indoor use only) 36 41 Total Issues 646 859 97 As new items of nursing equipment become available, they are tested and, if found suitable, are introduced into the service. In this category came Sorbo Rings which were brought into use as aids complementary to the Inflatable Air Rings. In addition, the new P.C.P. Nursing Mattress was introduced later in the year and, although there has been insufficient time finally to judge the suitability of this item of equipment, all signs point to its being a most useful addition to the range of articles available. It is difficult to estimate future expansion but there is no doubt that there exists an increasing demand for the service and at the end of the year there were over 600 Borough residents with one or more items on loan. Home Help Service When such a service was introduced in the Borough prior to the last war it was intended primarily for assistance in domiciliary maternity cases. However, due to the fact that, for various reasons, the bulk of confinements now take place in hospitals or maternity homes, the main emphasis of the domestic help service is directed towards the aged infirm and chronic sick. In recent years, great difficulty has been experienced in enrolling suitable persons for this important kind of community service, the nature of which is predominantly part-time. At the end of the year there was the equivalent of 266 full time Home Helps employed and an analysis of the services rendered during 1965 is given below:— Type of Case No. Aged 65 years or over on 1st Visit in 1965 1,082 Aged under 65 years on 1st Visit in 1965: Chronic Sick and Tuberculous 143 Mentally Disordered 22 Maternity 185 Others 215 565 Total Cases 1,647 Home Help Course—In May, 1965, twelve home helps attended a one week course of lectures, films and demonstrations at the Health and Welfare department. This course, arranged by the Chief Nursing Officer, was designed to fit home helps to cope with difficult and problem families. Subsequent courses will be held to prepare carefully selected home helps to act as 'child helps'. 98 Congenital Malformations Congenital malformations continued to be notified to the department by all midwives with summaries forwarded to the Ministry of Health in accordance with the scheme introduced on 1st January, 1964. Notification of malformations in new born babies has as its object the early detection of trends which may arise from the use of drugs or exposure to environmental factors during the mother's pregnancy. As information is required as early as possible, in practice, this means that only those malformations observable at birth tend to be reported. Obviously the success of the scheme is dependent not only upon the support given by the doctors, hospital staffs and midwives, but also upon the types of malformations presenting and the difficulty of diagnosis of some of these proximal to parturition. The following table gives information regarding malformations notified to the department during 1965 compared with those returned for England and Wales during 1964. Congenital Malformations Notified Site No. Notified Rates per 1,000 Total Births Greenwich 1965 England & Wales 1964 ALL SITES 117 30.75 20.03 Central Nervous System 36 9.46 4.67 Eye, ear 8 2.10 0.62 Alimentary system 4 1.05 2.15 Heart and great vessels 2 0.52 0.93 Respiratory system 4 1.05 0.24 Uro-genital system 5 1.31 1.52 Limbs 39 10.51 6.71 Other skeletal 3 0.78 0.54 Other systems 12 3.15 1.46 Other malformations 4 1.05 1.16 NOTE :—This table indicates the number of malformations NOT the number of children. 9 children presented 2 malformations 4 children presented 3 malformations 2 children presented 4 malformations 99 'At Risk' Register It has now been firmly established that certain factors in pre-natal, perinatal and post natal periods give rise to greater than average risks of a baby having or developing abnormalities. All notifications of discharge of a mother from hospital or midwifery care indicate whether an abnormal pregnancy, delivery or puerperium have led to or are likely to render a child liable to a developing handicap and, with the object of instituting early preventive or modifying treatment, these circumstances are recorded in the department's 'at risk' register. General progress of any child in this register is regularly reviewed by a Medical Officer who obtains reports from various sources to assist in an accurate up-todate assessment. After a variable period of time the name of the child who is subsequently found to be normal is removed from the register and that of the child where an abnormality does develop is transferred to the 'Handicapped' Register. Although it is found that approximately one third of all children born to residents in the Borough are 'at risk', the majority develop normally. At the end of the current year there were 933 children listed in the 'at risk' register. Handicapped Register At 31st December, 1965, there were 351 children listed in this register with the following defects: — Retarded 100 Physically Handicapped 236 Limb Deformities 9 Spina bifida or meningocele 22 Double or treble handicap 52 By reason of the fact that several children have more than one defect the total of handicaps is greater than the number of registered children. This register is also subject to regular review by a Medical Officer and an Assistant Nursing Officer with a view not only to ensuring that a child and its family receives all the necessary guidance and support to help in the day-to-day problems in caring for a handicapped child but that measures to meet a child's special needs for education and recreation are planned well in advance. Through the department's Health Visiting service a child is 'followed-up' so that any necessary treatment is given at sui:able times. All records accumulated in respect of such a child are made available to the School Medical Officer when schooling commences. In the case where a child is unable to attend school and where the family is unable to provide continuous attention at home, community or residential care, as appropriate, is arranged. Great 100 efforts are made to ensure that a child is not treated in isolation but is considered as a member of a group, all of whom are involved in some way with the handicap. One of the main uses of the 'Handicapped Register' is to extend the consideration afforded the handicapped child to the family as a whole. Deaf Register (Including Partially Hearing) A comprehensive register inherited from the London County Council on 1st April, 1965, and containing the names of all children known to be deaf or with partial hearing was maintained by the department. At the end of the year the register consisted of 219 deaf or partially hearing children (209 of school age) the majority of whom were diagnosed as a result of the 'sweep' hearing test which all children undergo on entering school. Under 5 years of age the children are mainly congenitally deaf although some had lost their hearing through illness during infancy. It is these latter children who present the greatest difficulty as, for the most part, the department is constrained to rely upon notification from hospitals when patients are discharged. Co-operation, in this respect, with hospitals in the Borough is good but with those outside it is less efficient. Certain omissions may be rectified by the Health Visitor who often has knowledge of illness in any particular family. In order to determine whether special schooling is required, children under 5 years of age are assessed before entry and only after discussions have taken place between parents, social and other workers and particularly the otologist, is a final decision made. From the accompanying table it can be seen that only 39 children attend special schools due to their disability. Happily the majority can take their places with contemporaries in the ordinary school system, some with special assistance, others with no help other than regular supervision. Deaf Register—31st December 1965 Under 5 yrs. Over 5 yrs. Total No. of Children on Register 10 209 219 No of Children with Hearing Aids 7 42 49 No. of Children at Deaf Schools or partially Hearing Units 3 25 28 No. of Deaf Children attending other Special Schools 7 14 21 101 Health Visiting The shortage of health visitors continued unabated during the current year and 5 health visitors left the service. Vacancies are difficult to fill and replacement was possible on only two occasions with one part-time visitor engaged for the latter part of the year only. In the Ten Year Development Plan it has been indicated that there will be a need throughout the country for an increase in health visitors of the order of 50% and the Council for the Training of Health Visitors has ascertained that, at the present time, there are more than 2,000 practising health visitors in the 50 to 60 years range. It is clear that, even if training facilities are expanded to meet the demand, the shortage of tutor health visitors, already acute, will be further accentuated and may well prejudice the success of the plan. Nevertheless, despite the inevitable disruptive influences of re-organisation and the shortage of staff, services were continued on similar lines to those in previous years and the following table summarises the visiting carried out during 1965:— No. of Cases VISITED by Health Visitors Children born in 1965 3,737 Children born in 1964 3,522 Children born 1960/63 6,825 14,084 Persons aged 65 years and over 74 Persons aged 65 years and over (visited at special request of G.P. or Hospital) 41 Mentally Disordered Persons 41 Mentally Disordered Persons (visited at special request of G.P. or Hospital) 3 Persons Discharged from Hospitals other than Mental (excl. maternity cases) 62 Persons Discharged from Hospitals other than Mental (excl. maternity cases) (visited at special request of G.P. or Hospital) 54 Tuberculous Households Visited 26 Households Visited re Other Infectious Diseases 428 Total Effective Visits and Re-visits 54,037 Unsuccessful Visits 11,597 Health Visitors—full time equivalent 32.7 T.B. Visitors & T.B. Health Visitors—Full time equivalent 7.0 102 Co-operation with Hospital Departments—This relationship increased during the year under review. As in the case of the School Health Service, shortage of Medical Social Workers in hospitals led to more requests from Consultants for help with the social problems met with or suspected in their patients. When requested, visits to in-patients took place in order to prepare for environmental adjustments, where possible, before their discharge from hospital. Health Visitors attended the Diabetic Clinic at Greenwich District Hospital, the Paediatric Clinic at the Memorial and Miller Hospitals and one Ante-natal Clinic at St. Alfege's Hospital. These visits serve to increase liaison between the Hospital Services and those of the Local Authority. Problem Family Index—Problem families are those families which, for various reasons, are unable to cope with the difficulties and stresses of life and who need a great deal of support and some material help. Often they are large families and, usually, the mother has a number of children under five years of aee to manage. Lack of money and the need to clothe and feed the family and provide furniture, etc., encourage the parents to undertake hire purchase commitments bevond their means so that debts tend to accumulate. Health Visitors make freauent visits to these families in the course of which they give help and advice and, if necessary, material assistance. They also call in other specialist help when this is needed and co-operate with other social workers to provide the best available means to rehabilitate these families. There were 143 families on the index at the end of the year with a total of 590 children. This index, which is checked completely each year, is under constant review. Surveys—A considerable amount of time and effort was demanded of health visitors in "follow-up" visits to children and young persons not only in connection with the National Survey of Health Development of those born in 1948 but also to those children and "controls" who were subjects of the Medical Research Council's scheme with regard to measles vaccination. In addition, a survey into child deaths from cancer being undertaken by the Department of Social Medicine at Oxford University, necessitated careful and delicate preparation of parents by some health visitors for the subsequent visiting of a Medical Officer to obtain comprehensive histories of the various cases. 103 Health VisfroR Training In accordance with Section 2 of the Health Visiting and Social Work (Training) Act, 1962, the Council for the Training of Health Visitors submitted to the Minister of Health revised rules for the training of health visitors and these were approved in December 1965. The revised rules replace those of 1964 and give in more detail the content of and conditions of entry to training courses and examinations. Field Work Instructor Courses—In 1965, the first year of the new health visitor training syllabus, it became compulsory to attach health visitor students to Field Work Instructors for their practical training. Accordingly, two health visitors were selected and attended an appropriate course to fit them for this post. Ultimately, the Borough will need at least six training field work instructors. Psychoprophylaxis Course—Two health visitors attended a weekend course arranged by the National Childbirth Trust enabling them to teach the Psychoprophylactic Method of preparation for childbirth. They, in turn, have instructed other members of the staff. Student Health Visitors—This Borough is a practical training area for students from the University of London Institute of Education and for those taking the Integrated Course of Nurse and Health Visitor Training arranged by Kings College Hospital and the Royal College of Nursing. In July, 1965, seven students from the Institute and two from the Integrated Course were successful in the Health Visitor examination having taken all or part of their practical training in the Borough. In October, 1965, eight students started their integrated course of training with us subsequently going on to Kings College Hospital in January, 1966. A further three students from the Institute of Education came to the Borough in October for their practical training. The London Borough of Greenwich sponsored six students for health visitor training, two at the Battersea College of Technology, three at the Institute of Education and one at the South East Essex College of Technology. These students who commenced their training in October, 1965, should complete their course in July, 1966? In-Service" Training—Three newly appointed school nurses attended daily for 4 days a course sponsored by The London Boroughs Training Committee. 104 Thirteen Clinic Nurses attended a one-day course organised by the Chief Nursing Officer. Twenty-three of the Nursing Staff attended a half-day course in use of visual aids, the session having been arranged by the Health Education Section. Refresher Courses—During the year, 10 of the Nursing Staff were directed to refresher courses of 5 days or more duration and this number included health visitors, district nurses, midwives, school nurses and chest clinic visitors. Staff were also invited to join a number of study days arranged by local hospitals and by the South East Metropolitan Regional Hospital Board. Observation and Other Visits—Programmes of visits were prepared for 36 visitors to the Borough which total included 3 doctors studying for their Diploma in Child Health each of whom was obliged to make 20 separate visits. Student Nurses—The General Nursing Council which requires student nurses to take lectures on preventive medicine and the social services also stipulates that they should visit and observe facilities provided by voluntary and statutory bodies. In all, 505 student and pupil nurses spent a day in the Boroush visiting clinics, schools and other establishments. The Chief Nursing Officer and her staff gave 38 lectures to student nurses training in hospitals in the area. Health Education During the year, a health education committee consisting of health visitors and school nurses met every month and, with the help of the Health Education Officer, made out a programme of topics for the year. Posters and leaflets were selected to support the topic chosen for the month and, if no suitable material was available, the Health Education Section with ideas from this committee, were able to fill the gap. This committee also reviewed new films, leaflets and posters and assessed their suitability for use in the health visiting and school health fields. Child Welfare Clinics From the early part of the century when 'child welfare' was the field of the voluntary bodies and the problems were mainly those of malnutrition and insanitary conditions, to the present day highly organised local authority services, there has been a gradual change in emphasis of functions and purposes. Today, close liaison with paediatricians and general practitioners is a feature of the 105 modern approach with the aim of detecting, at the earliest possible moment, physical and mental handicaps in order that suitable action may be taken and, where necessary, for special arrangements involving medical and education problems to be planned. Statistics for 1965 relating to Child Welfare Clinics are given in the following table: — Attendances No. of Children born 1965 3,575 No. of Children bom 1964 3,498 No. of Children born 1960/63 4,173 11,246 Sessions held by:— Medical Officers 323 Health Visitors 219 G.P.s on Sessional basis 1,822 Hospital Medical Staff — 2,364 No. of Children Referred elsewhere 502 No. of Children on 'At Risk' Register 31.12.65 933 Day Nursery Admissions—On 1st April, 1965, the Borough, unfortunately, did not inherit a day nursery but was allocated ten places in such an establishment under the control of the London Borough of Lewisham. These places were usually over-subscribed and priority had to be given to unmarried mothers and widows who needed to work. Such rationing of places necessarily involved much hardship to handicapped and deprived children who needed to be in the company of others in their age group. Local play groups and head teachers of normal schools helped as much as possible but, due to staff shortages and the relatively large amount of individual attention needed by such children, it was difficult for them to accept more than one handicapped child in each group. It is to be hoped that this great need will soon be filled. Council Places in Day Nursery In Waiting Unsupported Mothers 5 2 Lone parent 5 4 Mother ill health - 1 Deaf children — 1 * Recommended by hospital — 5 * These children were unable to enter the nursery due to restricted numbers or lived too far from nursery. 106 The absence of a Day Nursery under the direct control of the Department is proving a most serious difficulty. Most Health Visitors are in contact with familes who should rank high in priority for admission and a Day Nursery would also assist the Children's Department in keeping children out of care. Occasional Creche Service At two of the Council's Welfare Centres occasional creches are provided for the minding of children under 5 years of age while their mothers visit hospital, attend to shopping and other domestic duties or take part in activities at the centre at which the creches are held. A nominal charge per session is made and this is abateable in necessitous cases. Adoption, Foster Parents and Boarding Out Adoption—One of the most serious social problems of the country today (although happily of no great moment in this Borough at present) is the difficulty experienced in the assimilation into society of coloured immigrants in order that hostility and discrimination may be avoided. A corollary to this situation, which is becoming progressively more important, is that of the settlement of children of differing racial origins who, for various reasons, are deprived of a family life. Responsibility, generally, for the placement of these children rests with Adoption Societies and with Children's Departments and. for most adopters, there is an obligation, under Section 3 of the Adoption Act, 1958, to notify the local authority of their intention to adopt. Health visitors are often in close contact with such children and in some instances their tecords are of considerable value to the Medical Officer when his observations are sought by the various agencies concerned with adoption. Foster Parents—In accordance with the Boarding Cut of Children Regulations, 1955, the department's observations are also sought with regard to foster homes listed by the Children's Department into which children have been placed privately by their parents. Boarding Out—On the recommendation of the Chest Physician, arrangements can be made for the boarding-out of children exposed to infection in their own homes or whose parent or parents are receiving residential treatment for tuberculosis and cannot arrange 107 for the care of their children. Similar arrangements can be made to enable segregation to be achieved during immunisation with B.C.G. Unsupported Mothers Unsupported mothers were put in touch with Moral Welfare Workers who, in most cases, arranged for admission to a Mother and Baby Home prior to hospital confinement. After the birth of their babies, some of the mothers returned to the Mother and Baby Homes while others went back to their families or into lodgings. Some of the mothers approached the Children's Department, either before or after confinement, asking that their babies should be considered for adoption. Where the mother decided to bring up her own child, every assistance was given by the health visitors and, whenever possible, priority admission of the child to a day nursery was arranged when the mother returned to work. During 1965, 161 unmarried mothers contacted the undermentioned Moral Welfare Organisations in Greenwich: — Southwark Catholic Children's Society 18 Southwark Diocesan Association 143 Rehabilitation of Mothers On occasions mothers become anxious about breast feeding difficulties or are confronted with infant dietetic troubles. In suitable cases arrangements can be made for mothers of young children to be sent (with or without their children) to a recuperative centre for a residential course in mothercraft. For these purposes the Council makes use of the Violet Melchett Mothercraft Unit and the normal period of training ranges from four to six weeks. A weekly charge is made according to the financial circumstances of the parents. Mothers' Clubs Two Child Welfare Centres provided facilities for mothers to meet and, with help from the health visitors, arrangements were made for speakers to attend and films to be shown on health topics. Four other clubs are organised by the Greenwich Council of Social Service, two of these also being held in Borough Council Welfare Centres. Co-ordinating Committee This Committee was established to initiate a policy of ensuring that full use is made of the the preventive and other services, both statutory and voluntary, to avoid the break-up of families and to prevent the neglect or ill-treatment of children. It consists of representatives from the appropriate branches of the Council's Health 108 and Welfare, Housing and Children's Departments, the I.L.E.A. and the Housing Department of the G.L.C. When necessary, representatives of other statutory or voluntary bodies are invited to attend. Included among matters discussed at its meetings during 1965 were those concerning difficult housing estates, prevention of homelessness in its widest sense, shel ered accommodation and the likely effects on problem families of the impending Administration of Justice Act which was to deal with debtors and outstanding hire purchase commitments. A summary of the work undertaken during the current year is given in the following table: — No. of Intermediate Case Conferences held 15 ♦No. of New Cases discussed 18 No. of Old Cases discussed 14 No. of Housing Case Conferences held 11 ♦No. of New Cases discussed 49 No. of Old Cases discussed 62 *New Cases: Referred by: — Greenwich Housing Department 16 Greenwich Health and Welfare Department 15 Greenwich Children's Department 2 G.L.C. Housing Department 28 I.L.E.A. Department 4 N.S.P.C.C 2 67 Welfare Foods Resulting from the closure in 1954 of the local offices of the Ministry of Food, distribution of National Welfare Foods was undertaken by the London County Council. This responsibility has now passed to the new London Borough of Greenwich and under the Ministry of Health Scheme the following foods and nutrients are sold at regulated prices from all the Council's Welfare Centres: National Dried Milk Cod Liver Oil Vitamin 'A' and 'D' Tablets Concentrated Orange Juice In addition to these, a number of proprietary foods are sold at special prices and manufacturers co-operate in providing 'welfare' packs. This service has continued to expand and, as new products become available and are felt to be valuable dietary 109 additions for young children, they have been included for sale. A list of products at present available is set out hereunder. Allergilac Farleys Milk Baby Rice Fru-vita Bemax Glucose D Carella Groats Carnation Milk (ready cooked fortified) Casilan Groats (Triple Pack) Cod Liver Oil & Malt Marmite Complan Ostermilk Cow & Gate—Full Cream Rose Hip Syrup Cow & Gate—Half Cream Ribena Cow & Gate—Cereal Food Scott's Baby Crl. Farex S.M.A. Powder Farlene Trufood (Humanised) Virol Recuperative Holidays On medical recommendation, recuperative holidays for mothers and young children and for the prevention of illness and for care and after care are provided in accordance with Sections 22 and 28 respectively of the National Health Service Act. Similar holiday arrangements are made for school children under the School Health Services scheme. In all such cases the emphasis is on rest, fresh air and good food and the holidays are provided where regular medical and nursing attention are not needed. A summary of the use made of these facilities during 1965 is given in the following table: — Type of Case No. Adults : Psychiatric 8 Tuberculous 11 Other Adults 82 Expectant and Nursing Mothers 4 Other Mothers 8 Infants : Accompanied 17 Unaccompanied : Aged 0-1 year — Aged 1 - 2 years 3 Aged 2-5 years 10 School Children: — 30 Accompanied 8 Unaccompanied 88 — 96 Total Holidays 239 110 Child-Minders and Private Day Nurseries Voluntary Under the National Health Service Act, the Council provides a service of approved child-minders who, in return for their willingness to submit to supervision and the Council's requirements, receive a registration fee of 6s. 0d. per week whilst minding a child. Children under the age of 5 years who do not attend school can be accepted into a minder's home for daily care, the charges for which are matters for agreement between the minder and the child's parents. Under existing arrangements no child-minder is permitted to care for more than two children at any one time and those who desire to take more than this number are required to register as statutory child minders under the Nurseries and ChildMinders Regulation Act, 1948, and are not eligible for registration fee. Statutory Any person who intends to undertake, for payment, the care in her own home of more than two children under 5 years of age from more than one household and to whom she is not closely related, or to open a private day nursery must apply beforehand to the local health authority for registration under the Nurseries and ChildMinders Regulation Act, 1948. The following table indicates the position at the end of 1965 National Health Service Act, 1946 No. of Child-Minders Registered 63 No. of Places or Children Minded 88 Nurseries and Child-Minders Regulation Act, 1948 No. of Premises Registered: Factories — Places — Other 7 Places 140 No. of Child-Minders Registered: 28 Places 187 Registration of Nursing Homes In accordance with Part VI of the Public Health Act, 1936, Part III of the Mental Health Act, 1959, and the Nursing Homes Act, 1963, registration and inspection of nursing homes is a responsibility of the local health authority. For some time authorities have been critical of the weakness of the legislation in the Public Health Act, the lack of preciseness of which has led to varying standards in different areas. 1ll However, under existing legislation there is only one nursing home registered within the Borough and this provides accommodation for 21 elderly persons. Number of Beds Nursing Home Mental Maternity Others Manna Mead Nursing Home, 17. West Grove, S.E. 10 — — 21 Chiropody Services During the year, clinical chiropody in the new Borough has seen an attendance figure of 38,678, including 1,336 new patients, this despite the fact that the service had to be re-arranged to accommodate the Chief Chiropodist within the new boundaries, following the loss of Amersham Road Clinic from the old L.C.C. Division to the neighbouring Borough of Lewisham. The move meant the expansion of 105 Shooter's Hill Road into a multistaffed establishment and, after some adjustments, a four-chair clinic was set up. The impending demolition of this building has prevented future planning in this direction, but plans have been made for the best disposition of rooms in the proposed new location. Lionel Road Foot Clinic—This three-chair clinic continued to function without full-time staff. The scheme to offer transport to this clinic for those patients listed by a chiropodist over the boundary as desirous of continuing at that practice, if this Council paid, was abandoned— all preferred to continue privately at the said practice. Domiciliary Chiropody—The attempt to reduce the domiciliary list of the Council of Social Service by transferring a number of patients to a minibus service to Chevening Road, as recommended at a meeting during the year, was not successful— almost all had to be returned to the list and this special session has had to be filled by new referrals and ambulant cases. The result indicates that virtually all those persons receiving domiciliary treatment were in need of this service. Future arrangements will be made for all domiciliary service to come under the auspices of the Greenwich Council of Social Service, the Chief Chiropodist to maintain liaison with this organization. All roads in the Borough are within two and a quarter miles of a multi-staffed clinic: concentration of available staff into main clinics with clerical assistance means that more patients can receive treatment at more frequent intervals, and, to this end, it is considered that dilution of staff into single-handed clinics should be kept to a minimum. The spreading of available staff throughout 112 the Borough does not constitute expansion, and centralisation of a specialist service is more in accord with modern practice. Intervals between appointments average eight weeks, and it is considered that ambulant patients, most of whom travel daily or weekly into shopping centres, would not find it difficult or costly to journey to a clinic at these intervals. Bathing Centre—Tunnel Avenue—A report on the working of this clinic is included in the section on the Community Geriatric Services. Chiropody Treatment during 1965 No. of Chiropodist Sessions 5,135 Attendances: Children 0-4 years 9 5 - 14 years 130 139 Males 15-64 years 2,818 65 years and over 4,657 7,475 Females 15-59 years 11,659 60 years and over 19,405 31,064 Total Attendances 38,678 No. of New Patients 1,336 DENTAL TREATMENT (Maternity and Child Welfare) F. ELSTON, L.D.S., R.C.S. Eng., the Chief Dental Officer, reports: — "As in the case of the rest of the Dental Services in the Borough, the pattern necessarily pursued in 1965 was the one taken over from the L.C.C. on the 1st April, 1965. One Dental Officer, at the rate of two half-days per week, was charged with the task of looking after nursing and expectant mothers, and children below school age. As can be seen from the appended statistical data, this one clinic did all it could to deal with the considerable demand for treatment. All patients received explanatory and preventive instructions, and the total of only 13 extractions in one year out of 840 items of treatment shows the trend, and is gratifying. Nevertheless, the service in 1965 must be viewed as a minimum token service, which did not go any way towards meeting the potential demand. This criticism is based on the fact that dental service for mothers and young children should not just consist of treatment 113 facilities for established lesions. As a branch of preventive medicine, it should primarily concentrate on the basic essential that every mother should receive instruction on the origin of oral disease and its prevention and that she should be guided and encouraged to apply this knowledge to herself and to her child. It should further be the clinic's responsibility to explain the scope of modern and preventive dentistry, to foster the understanding that extractions and dentures are not synonymous with dental treatment and to create and maintain the correct public image in contra-distinction to the concept of the 'dentist' who inflicts pain in alarming surroundings. As to treatment, it is very easy to criticise the present facilities as inadequate and unrealistic. It is much more difficult, however, to state exactly what optimum treatment facilities ought to be provided. We can estimate that there are 7,500 nursing and expectant mothers and 17,500 children under 5 years in the Borough, and that we ought to be able to undertake the treatment of a certain percentage of this number to help the existing and overworked dental Health Service. Nursing and expectant mothers as well as children are entitled to free treatment by dental practitioners participating in the National Health Service. As far as the mothers are concerned this arrangement works fairly well as, from a treatment point of view, there is little difference between them and the rest of the adult public. As far as the young child is concerned, however, we are up against an enormous problem. The needs of the young child in its formative period are not only for treatment but particularly for a favourable introduction towards laying down its attitude to dental health and a friendly dentistpatient relationship for the rest of its future life. For this reason it is most desirable for it to receive its initiation to dentistry in an establishment provided exclusively for the specialised requirements of the very young. No one conversant with the workings of the National Health Service can or will doubt the excellence of treatment given to the pre-school child. Smaller are the numbers of those, however, who realise how difficult it is to afford adequate treatment to a small child in a practice primarily and necessarily geared to the treatment of older members of the community. As regards the local authority dental services, rather than competing with something already provided, it is much more desirable that the Borough should supplement the general dental services by providing one specially focused on the needs and requirements of the small child. As to the nursing and expectant mothers, they should receive guidance in the understanding and prevention of dental disease, explanation of the effects of motherhood on the oral tissues, and treatment for the relief of acute conditions. As the 114 Borough dental services will have to be expanded to fulfil the urgent need, and as machinery for routine treatment for mothers already exists within the general dental services, it would be wisest at this stage to concentrate on the small children and on dental health education and to defer ambitious expansion of routine treatment for mothers until these aims have been achieved. The writer deeply regrets having to dwell on inadequacies rather than on achievements in his report. The obvious question to ask him is why no active steps were taken in 1965 to remedy the known crisis. The greatest problem facing the Borough dental services at the time of writing is that of inadequate staffing. The acute difficulty of recruiting dental surgeons is the obstacle to expansion and improvement. Although this is beyond the powers of the Borough to remedy actively, all possible steps are being taken to try to find a solution. As the Borough dental services are closely linked with the School Dental Service of the Inner London Education Authority, expansion and re-organization will have to proceed parallel with the progress of the School Dental Service. If the difficulties of recruitment can be overcome, however, there is every reason to hope for a report of success and progress in Annual Reports to come." Treatment During 1965 A ttendances New Patients: No. of Appointments 396 No. and percentage of Appointments Taken Up 184 46.5% On-treatment Patients: No. of Appointments 609 No. and percentage of Appointments Taken Up 488 80.1% Emergency Patients Treated 40 Total Attendances 712 Treatments No. of Treatment Sessions 91 Total No. of Teeth Treated 583 (a) Mothers : No. and percentage Filled 82 92.1% No. and percentage Extracted 7 7.9% (b) Children : No. and percentage Filled 479 98.8% No. and percentage Extracted 6 1.2% Silver Nitrate Treatment 9 Gum Treatment 15 X-rays 52 Dentures 5 General Anaesthetics — All Other Operations 184 115 SECTION V WELFARE SERVICES Residential Before discussing in detail the statutory obligations of the Council in the provision of residential accommodation and our methods of assessment and selection, it may be helpful to indicate the basic thinking of the Department and to describe our aims. Local citizens are admitted to residential accommodation because there has been a breakdown or an inadequacy of one sort or another, either material or psychological. The reasons for this breakdown may be medical or social. On the social side, the whole range of supportive services in the Department can be and are being brought into action rapidly and on the medical side the family doctor or the geriatric adviser is consulted on therapy and further action. The geriatric advisory clinics are becoming increasingly important in this connection. As far as possible, people should be encouraged to remain in their own homes leading an independent life, and when applications are received for admission to residential homes great efforts are made to keep old people with their families or in familiar surroundings. However comfortable residential accommodation is made, it is never home in the true sense, and change is disruptive and can have damaging effects on the elderly. It is for these sound reasons that each applicant is examined carefully and all the circumstances explored in an endeavour to meet individual needs in the way best suited to the particular case. By means of this approach many elderly people can remain quite happily at home in their declining years, and admission to hospital or to residential accommodation should be considered as a final expedient or because no other action is possible. These means can only be successful if each member of the team recognizes the contribution which their professional colleagues, either within or outside the Department, can make. Already the efforts being made in this direction are showing results, and a great deal of remediable social and medical malaise is being relieved by the co-operative efforts of the various officers in the Department who have knowledge and a contribution to make. National Assistance Act, 1948—Part III. Provision of Accommodation This Act placed a duty upon local authorities to provide :— (a) Residential accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them. 116 (b) Temporary accommodation for persons who are in urgent need thereof, being need arising in circumstances which could not reasonably have been foreseen or in such other circumstances as the authority may in any particular case determine. The National Assistance Act, in contradistinction to the previous Poor Law Legislation, states that in the exercise of their duties a local authority shall have regard to the welfare of all persons for whom accommodation is provided. Homes for Old People The newly constituted London Borough of Greenwich took over this duty from the London County Council on 1st April, 1965, and assumed responsibility for the 271 persons resident in the four modern purpose-built Old People's Homes situated in the Borough, namely :— Perry Grove, Rectory Field Crescent, S.E.7. Plumstead Lodge, Plumstead Common Road, S.E.I8. Sunbury Lodge, Sunbury Street, S.E.I8. Weybourne, 1, Finchdale Road, S.E.2. In addition, as a temporary expedient until sufficient accommodation became available in small homes, joint use of the large Homes formerly managed by the County Council was agreed upon. Greenwich was allocated 259 beds in Southern Grove Lodge, Mile End Road, E.I., situated in the London Borough of Tower Hamlets and administered by that authority. This allocation, against which Greenwich protested, has proved quite as inconvenient as had been expected. When Greenwich residents are admitted, subsequent visiting by relatives and friends becomes difficult, costly and time consuming and the remoteness of the accommodation has prompted some old people into delaying or refusing admission to Part III accommodation when otherwise it would have been in their interests to enter a residential home. Admissions—It is the intention that old people shall be supported by domiciliary services so that, for as long as possible, they remain part of the general community. Ultimately, admission to a residential Home, when and if necessary, is then merely a continuation of care. Old people living in the Borough who make enquiries about admission to a Home or who, for other reasons come to our knowledge, are visited in their own homes where their future is discussed with them and they are assessed and advised as to the course most likely to prove to be in their 117 best interests. This assessment is normally undertaken by the Deputy Medical Officer of Health, the Senior Health Officer and the Senior Social Welfare Officer. The system ensures that the medical, nursing and social aspects of each person are thoroughly investigated. Moreover, those who are placed on the waiting lists are revisited, their cases reviewed from time to time and active measures are taken to ameliorate their circumstances, e.g., mealson-wheels, home help, domiciliary bathing, home nursing service, etc. The sources of referral of those ultimately placed on the waiting list are given in the following table :— Applications for Accommodation in Old People's Homes Sources of Referral Personal Applications (self or relative) 61 Referred by Council Members 1 Referred by Women Public Health Officers 64 Referred by other Council Officers 14 Referred by Hospitals 128 Referred by General Practitioners 19 Miscellaneous 10 297 Visiting Medical Officers—Residents in Old People's Homes are, of course, entitled to remain on the list of a General Practitioner of their own choice but in almost all cases they prefer to avail themselves of the services of the Visiting Medical Officer appointed to the Home. This officer is a local general practitiorier. Welfare and Recreation—Apart from normal attention to well-being, matrons and staffs in Old People's Homes endeavour to take an active interest in each of the residents and it is the policy of the Council to provide recreational and occupational facilities. Residents who wish to and are able to do so may undertake regular light tasks in return for which small monetary payments are made. A handicraft instructress attends each Home on one day a week and knitting, embroidery and other hand-work completed by residents is sold in aid of the Comforts Fund which is used to provide additional amenities. During winter months film shows are provided fortniahtly and, in addition, voluntary concert parties and other entertainers give performances. An 'Olde Tyme' dancing group have arranged occasional dances at the Homes. Voluntary visiting at all reasonable hours is encouraged as is every contact with the local 118 munity. Christmas gifts were received from several sources and school girls made Christmas decorations and hung them in one of the Homes. By means of the Department's own transport, regular short outings for shopping and visits to local beauty spots were arranged for old folk fit enough to benefit from them. During summer, longer outings were organised. Residents who were able so to do, were encouraged to take summer holidays with relatives or friends but for those who could not make their own arrangements, the Council provided a holiday. Newspapers and periodicals were provided for residents' use and arrangements made with the Borough Librarian for the loan of books, including large print books. Regular religious services are held in the Homes for those who wish to participate and are unable to venture out for worship. Day Club—An innovation is the setting-up of a small Day Club within a Home. Groups of lonely, less active old people in the vicinity are taken to have a midday meal and join the residents in the amenities of the Home for a few hours. The scheme is appreciated both by visitors and residents alike. Transfer of Residents—Requests for transfer to other districts are not infrequent from residents who wish to be moved nearer to relatives and friends. This is no easy matter but, by means of mutual exchanges with residents in other areas and the use of Voluntary Homes, it has been possible to assist in some 20 cases. Future Development—It is the intention to replace the accommodation now being used at Southern Grove Lodge as soon as possible with six small purpose-built Homes within this Borough to give a total of 300 beds. This will be all the more necessary for not only is there a waiting list of over 100 but the number of elderly persons in the Borough is increasing; more people are living to retiring age and beyond and those now seeking admission to Homes are often older and more infirm than was previously the case. The first of these projects to be erected is to be on the development site at Gavestone Crescent. It will accommodate 60 elderly and infirm persons, has provision for a day centre and lunch club and hopes are that it will be completed during 1968. Voluntary Homes—In addition to Part III accommodation, 69 Greenwich residents who are aged, blind or physically handicapped were maintained in voluntary Homes or Hostels of various types throughout the country. Some of these establishments cater for special handicaps, e.g., Chalfont Colony for epileptics, Kyre Park for spastics, etc., and others provide for particular classes such as war veterans, merchant seamen, members of religious 119 denominations, etc. Arrangements exist for the department to keep in touch with these Greenwich residents accommodated outside the Borough. Part III Accommodation—Statistics 1st April, 1965 Nos. in Residence 31st December, 1965 Nos. in Residence Old People's Homes Males Females Total Admitted Died Discharged or transferred Males Females Total Perry grove 31 29 60 13 4 7 28 34 62 Plumstead Lodge 23 66 89 59 12 42 22 72 94 Sunbury Lodge 17 46 63 20 10 11 14 48 62 Weybourne 20 39 59 20 9 12 20 38 58 'Southern Grove 180 54 234 74 32 68 148 60 208 Lodge Totals 271 234 505 186 67 140 232 252 484 * London Borough of Tower Hamlets Voluntary Establishments 1st April, 1965 Admitted Discharged 31 st December, 1965 No. of Homes No. of Residents No. of Homes No. of Residents Aged 24 26 7 6 22 27 Blind 9 10 _ _ 9 10 Epileptics 2 5 - - 2 5 Physically Handicapped 16 26 3 5 15 24 Deaf and Dumb I 2 1 - 2 3 Totals 52 69 11 11 50 69 Homeless Families—Accommodation The first priority of the Department in dealing with the problem of homelessness is the provision of shelter to overcome the immediate crisis. Our present resources have proved sufficient to meet these needs. Acting on the instructions of the Council, the Department's policy for dealing with homelessness is an enlightened one. We are not prepared to see families breaking up, with fathers separated from wives and children, which makes the ultimate re-establishment or rehabilitation of the family unit difficult if not impossible. This is not to say that families are encouraged passively to accept everything that the Council is prepared to provide. The most strenuous efforts are made by the Department's officers to induce families to 120 overcome their own problems, but a carefully judged balance has to be preserved between a Draconian severity and an easy going tolerance. Considering the number of families who have been accommodated, a study of the figures will show that great progress has been made this year and a lot has been learned. Present accommodation is being improved and further amenities installed to ensure that families can live as families with reasonable independence. In this way standards will be rising, and apart from a small minority there is evidence that families do respond to encouragement and example. After a full year of working, great adjustments in our attitude to this intractable problem have had to be made, and it will be interesting to analyse the results of the Council's policy over a period of years. Reception Centre—The Council has its own reception centre with accommodation for 9 families and to which, when necessary, immediate admission can be authorised. If, within a period of 2 or 3 weeks a family is unable to make suitable arrangements for itself, it is transferred to a larger establishment at 158a Plumstead High Street, S.E.18. Main Unit—On 1st April, 1965, there were 80 families in occupation at 158a Plumstead High Street, the majority of whom had little or no previous residence in the Borough. A very difficult problem was therefore inherited by the Council and at the time of the re-organisation, 4 social workers were employed to deal with families and help them with their problems. In some cases this is no small task and assistance is afforded at a homemaking class for mothers which meets weekly. For residents, the services of a visiting Medical Officer are available when required and under the auspices of the Inner London Education Authority a nursery class has been organised. Staffed by voluntary workers from "Save the Children Fund" a nursery play-group operates during the school holidays. Moreover during the evenings, a Youth Club for school children and 'teenagers' is organised by members of the Y.M.C.A. At the invitation of country branches of the Mothers' Union, 3 summer outings for mothers and children were arranged and, assisted by voluntary workers and aided by voluntary funds, the Welfare Staff organised a day at the seaside for the children. There are many problem families resident in this accommodation. Those with marked defects but offering some prospect of improvement are to be removed to a large house which will open shortly as a training unit. Families there will be given intensive help by social workers with the object of rendering them suitable for normal re-housing. 121 Maintenance of premises, oversight of families, welfare of women and children, collection of payments due and assessments for re-housing, constitute a substantial volume of work for the Council's Staff which demands a high degree of patience, perseverance, understanding and firmness so necessary in such matters. During the year it has been possible to reduce occupancy to 62 families and the number of social workers to 3. Homeless Families Accommodation—Statistics Applications for Admission (1st April—31st December, 1965) Number of Applications* 203 Number accepted into Residence 59 * Excludes numerous preliminary enquiries not amounting to applications. Homes—Admissions and Discharges Resident at 1st April, 1965 Admissions Discharges Resident at 31st December, 1965 Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons 'Summercourt' 106 206 56 41 56 99 196 4 1 4 9 14 111 2 4 59 41 59 158a, Plumstead High Street 80 48 80 242 370 45 47 45 113 205 63 48 63 165 276 62 47 62 190 299 Families Rehoused: Families Men Women Children Persons By Greater London Council 31 13 31 97 141 By London Borough of Greenwich 23 21 23 39 83 By other Local Authorities 1 - 1 2 3 Found own accommodation 16 15 16 24 55 Left for other reasons 4 3 4 17 24 75 52 75 179 306 Unsupported Mothers and Babies—Financial assistance in respect of accommodation in 'Mother and Baby' Homes has been granted in 45 cases. Social aspects during this phase are dealt with by the Moral Welfare Workers for the district, with whom liaison is maintained. There is, however, the problem of long term accommodation for unmarried or deserted mothers who wish to keep their children with them and preliminary consideration is being given to the acquisition of premises for conversion to a Hostel. 122 DOMICILIARY AND COMMUNITY SERVICES FOR THE HANDICAPPED When one examines health and welfare functions, and particularly the implications of the welfare services for the various categories of handicapped persons, one is constantly finding that the problems are neither simple nor static, for example, in the services for the blind, the deaf, the dumb and the physically handicapped one should be conscious that welfare in its broadest sense embraces not only the actual welfare aspect, but cannot be divorced' from rehabilitation, treatment or regular assessments and reassessments of the degrees of disability. This approach, therefore, requires the closest collaboration between all the many workers in the medico-social and welfare field. There have been and are great advances taking place not only in sociology but in the realms of somatic and psychological medicine and it seems important that officers responsible for implementing welfare policy should be aware of the - enlarging field of therapeutics and rehabilitation. Professional links must be maintained and fostered with other specialists and other authorities, particularly with hospital consultants and specialised hospital departments. In addition, the recognition of the contribution which a united and integrated departmental domiciliary team can make avoids waste and duplication of effort. The number of domiciliary visits recorded and the services now being provided are a great credit to the officers concerned, but I am sure that they are conscious of deficiencies and gaps which the Council is anxious to overcome. Mention is made in the report of the Workshop for the Blind, which must be replaced and re-orientated to bring it into line with modern industrial practice. Further social rehabilitation and employment centres for the handicapped are also an urgent necessity and their eventual provision will give the social welfare officers an opportunity to enlarge their own contribution. Efforts are also being made to make the register of physically handicapped persons more comprehensive and the orthopaedic and physical medicine departments of the local hospitals are being invited to take a closer interest in our work. It is known that there are many handicapped persons who for one reason or another are not on the register of the Department and, as in the case of the elderly where there has been great expansion over the years, handicapped people and their families will be seeking assistance as the Department's services become more widely known and appreciated That is why it is important to encourage all outside agencies to look to the Department as the local focal point for meeting the domiciliary and community needs of the handicapped. 123 Registers, which are maintained by the department, cover not only the blind and partially sighted but the deaf and dumb and also those persons who are severely or permanently handicapped by illness, injury or congenital deformity. New cases, referred to the department by various agencies such as hospitals, Ministry of Health Appliance Centre, housing department, etc., are visited by a Social Worker who prepares a comprehensive report. It is found that the majority of referrals are eligible for registration. Once a person has been registered, arrangements are made for the handicapped person to be visited as frequently as necessary by a Social Worker who will advise and assist in all the practical dayto-day matters which may be affected by the particular handicap. These matters cover a wide field, e.g. housing, National Insurance, dressing, feeding, cooking, mobility, etc., and much detailed casework may be necessary particularly in the early stages. On occasions, casework involves homeless families and the investigation of applications for admission to residential accommodation. Help with specific problems can often be obtained from voluntary and statutory organisations. During the 9 months ended 31st December, 1965, social workers, in respect of this aspect of their duties, made a total of 4,612 domiciliary visits as under: — Type of Visit Category of Handicapped Blind Partially Sighted Physically Handicapped New Cases 41 37 198 Routine 821 169 2,447 Teaching 137 16 5 Non-effective 134 72 535 Totals 1,133 294 3,185 Welfare of the Blind A study of the local figures of the main causes of blindness or serious defective vision indicates the following most common conditions: ophthalmia neonatorum, interstitial keratitis, glaucoma, cataract and certain retinal lesions. A high proportion of these lesions are preventable or remediable if detected sufficiently early. In infancy the common conditions are congenital abnormalities which present the same difficulties or the same difficult problems of prevention as other congenital lesions. Similarly, in old age degenerative processes, arteriosclerosis and cateract are the most common presenting causes of blindness or gross deterioration of vision. 124 In any welfare service purporting to be comprehensive or with any aspiration to prevention, it is essential that skilled social workers engaged in providing support for the blind should forge the closest association with the family doctor and with the specialist ophthalmological services. The care of the eyes must begin at birth and methods of testing sight and detecting defects must be so organized that deviations from normal can be recognized and treated at the earliest possible moment. This inevitably brings in the midwifery service, the infant welfare clinics and the school health service and, at the other end of the age structure, the domiciliary services for the elderly. A department organized merely to provide help and support for the already established blind is only providing half a service and efforts must be made to bring the local ophthalmologists more closely into consultation when decisions are taken as to the best ways of dealing with particular cases. The possibilities and advantages to be gained from vision screening on a community basis must be explored. Results from such services to date have been somewhat disappointing and have been incommensurate with the effort and expense involved. It is much more important for the ophthalmological services, whether provided by the family doctor, the local authority or the hospital, to be working in harmony and for a free exchange of information to flow between them. Undoubtedly a substantial amount of blindness could be reduced by ensuring the detection of potentially serious conditions before irreversible deterioration has occurred. That is why it is so important that workers engaged in welfare for the blind become part of the whole organization and why they should be welcomed as specialists in their own right. These are the future aims of the department. Registers—Registers of blind and partially sighted persons are maintained. New cases which come into notice are referred from many sources including the National Assistance Board, general practitioners and hospitals. Subject to the consent of the person concerned, an examination by a Consultant Ophthalmologist is arranged. For this purpose the Council employs a part-time ophthalmologist and examinations are arranged either by a domiciliary visit or by transporting the patient to the departmental Medical Examination Room. At appropriate intervals, similar arrangements are made for re-examination of persons already on the partially sighted register. Registration marks the point at which case work service begins. 125 BLIND PERSONS Register (as at 31st December, 1965) New Cases in Brackets AGE GROUP Number Registered Age at Onset of Blindness M F TOTAL M F TOTAL 0-1 year _ - -- 18 19 37 1 year ~ — — 1 1 2 2 years — _ _ 4(1) 2 6(1) 3 years 1 (1) _ 1(1) 2 1 3 4 years - _ - 3 3 5-10 years 2 - 2 11 9(1) 20(1) 11-15 years 6 1 7 2 3 5 16-20 years 3 - 3 6 3 9 21-29 years 7 9 16 11 9 20 30-39 years 8 7 15 14 17 31 40-49 years 12(1) 13 (2) 25(3) 17(1) 19(1) 36 (2) 50-59 years 28(1) 23 (3) 51 (4) 21 (1) 23 (4) 44(5) 60-64 years 12 16 (2) 28 (2) 7 (1) 21 (4) 28 (5) 65-69 years 14 18(2) 32(2) 9(1) 23 (1) 32(2) 70-79 years 51 (6) 65 (7) 116 (13) 34 (4) 62 (6) 96 (10) 80-84 years 22 (2) 59 (6) 81 (8) 12(2) 29 (6) 41 (8) 85-89 years 12(3) 39 (5) 51 (8) 9(3) 14 (4) 23 (7) 90 and over 5 10(1) 15 (1) 2(1) 2 (1) Unknown - - - 2 3 5 TOTALS 183 (14) 260 (28) 443 (42) 183 (14) 260 (28) 443 (42) Blind Persons under 16 Years Male Female Aged 2 to 4 years Unsuitable for Education at School: At Home or Elsewhere 1 - Aged 5 to 15 years Suitable for Education at School: At Special Schools for Blind (no other defects) 3 1 Not at School (no other defects) Unsuitable for Education at School: Blind 1 3 - With Multiple Defects 1 — 9 1 126 Blind Persons—Education, Training and Employment (16 years and over) (i) Employed and at School AGE GROUPS At School EMPLOYED Total Employed Under Sheltered Conditions Ordinary Conditions Special WorkShops Home Worker Schemes M F M F M F M F 16-20 years 2 _ _ _ _ _ 21-39 years _ - _ 1 1 - 7 4 13 40—49 years - - 5 - - 3 5 3 16 50-59 years - - 7 — 4 1 9 5 26 60-64 years . _ 2 _ _ 2 _ 4 65 and over - - 1 - - - - - 1 TOTALS 2 - 15 1 5 4 23 12 60 (ii) Training and Not Employed Male Female Undergoing Training : Professional or University — 1 Not Employed: Subject to Training—Open Employment — 1 Without Training—Open Employment 4 Not Available for Work Category 16-59 yrs 60-64 yrs 65 yrs and Over total m f m f m f Not Available for Work _ 14 3 3 _ _ 20 Not capable of Work 15 19 4 12 - - 50 Not Working - - - - 103 190 293 totals 15 33 7 15 103 190 363 127 iii) Occupations of Employed Blind Persons Occupations Sheltered Conditions Special Wkshops Home Worker Schemes Ordinary Conditions TOTAL Physiotherapists - _ 1 1 Lecturers, Teacher 1 - 1 2 Instructors Clergy & Members _ - - - of Religious Orders Typists & - - 11 11 Secretaries Braille Copyists - 1 1 2 & Proof readers Telephone Ops. - - 3 3 Working Proprietors - 1 2 3 Shop Managers Machine Tool Ops. — 1 2 3 Fitters & Assemblers - — 3 3 Viewers & Testers - - 2 2 Boxers & Packers — — 1 1 Knitters & Weavers 1 3 - 4 Upholsterers & 1 - - 1 Mattress Makers Basket Makers 10 2 - 12 Mat Makers 1 - — 1 Fend-off Makers 2 - - 2 Labourers _ — 2 2 Domestic Porters, etc. — - 1 1 Launderers _ - 1 1 Miscellaneous - 1 4 5 TOTAL 16 9 35 60 Blind Persons—In-Residents (16 Years and Over) Male Female Residential Accommodation (1948 Act Part III (21)) Homes for Blind 2 7 Others 4 5 Hospitals for Mentally 111 — 3 Hospitals for Mentally Sub-normal 5 4 Other Hospitals 1 8 TOTAL 12 27 128 PARTIALLY SIGHTED PERSONS Register (as at 31st December, 1965) AGE GROUP Number Registered 31.12.65 Newly Registered Removals from Register during year Admitted to Blind Register Decertified- Improved Visual Acuity M F Total M F Total M F M F 2-4 years 1 1 2 _ _ _ _ _ _ 5-15 years 1 1 2 _ _ _ _ _ _ _ 16-20 years 2 4 6 1 _ 1 - - - - 21-49 years 17 17 34 7 3 5 _ 1 — — 50-64 years 9 14 23 3 1 4 - 1 - i 65 and over 34 112 146 6 16 22 1 7 - - TOTALS 64 149 213 12 20 32 1 9 - 1 Training and Employment AGE GROUPS Employed Unemployed and not under Training TOTAL Available and capable of Trg or Work Not available for Work m f m f m f (i) Persons near or Prospectively Blind (16 years and over) 16-20 years 1 _ _ _ _ _ 1 21-49 years 1 2 - - - 4 7 50-64 years 1 - - - 3 8 12 65 and over - - - - 23 80 103 TOTALS 3 2 " - 26 92 123 (ii) Persons mainly Industrially Handicapped (16 years and over) 16-20 years 1 _ 1 1 2 5 21-49 years 14 5 2 - - 4 25 50-64 years 2 1 - - 3 5 11 65 and over - - - - 6 25 31 TOTALS 16 7 2 1 10 36 72 129 Major Causes of Blindness Comparison between the figures for the London Borough of Greenwich and those for England and Wales Site Clinical Entity LBG Cases % for LBG % for England & Wales 1 Eyeball in General Congenital Defects 25 5.7 1.0 Acquired Affections: Glaucoma 39 8.8 12.6 Trauma Military 5 1.0 0.03 „ Other 6 1.4 0.2 Diabetes 1 0.2 1.4 Other affections - - 0.17 TOTAL FOR SITE 76 17.1% 15.4% 2 Conjunctiva Opthalmia Neonatorum 6 1.4 0.1 Other Infections 1 0.2 0.1 TOTAL FOR SITE 7 1.6% 0.2% 3 Cornea Interstitial Keratitis 10 2.3 0.5 Trauma Military 2 0.4 0.6 „ Other 2 0.4 0.01 Other affections 6 1.5 1.29 TOTAL FOR SITE 20 4.6% 2.4% 4 Lens Cataract: Senile 48 10.9 21.7 General 8 1.8 0.1 Pre-Natal Influences 18 4.0 1.0 Dislocated Lens 1 0.2 0.1 Other affections 5 1.1 0.4 TOTAL FOR SITE 80 18.0% 23.3% 5 Uveal Tract Congenital abnormalities 1 0.2 0.01 Choroiditis 8 1.8 0.8 Iritis & Iridocyclitis 9 2.0 2.2 Myopic Chorioretinal Atrophy 35 8.0 8.3 Other Affections - - 0.39 TOTAL FOR SITE 53 12.0% 11.7% 6 Retina Retinitis Pigmentosa 11 2.5 1.9 Macular Lesions & Dystrophies 81 18.4 27.5 Detached Retina 22 5.0 1.2 Other affections 21 4.7 10.1 TOTAL FOR SITE 135 30.6% 40.7% 7 Optic Nerve Optic Atrophy Infection 4 0.9 0.3 Trauma-Military 3 0.8 0.01 „ Other 4 0.9 0.9 Congenital Syphilis 14 3.2 0.1 Other Congenital 27 5.8 1.9 General Diseases 3 0.7 1.5 Other affections - - 0.69 TOTAL FOR SITE 55 12.3% 5.4% Vitreous Haemorrhage 1 0.2 0.1 TOTAL FOR SITE 1 0.2% 0.1% Other Whole Globe 111 defined lesions Unknown 16 3.6% 0.8% TOTAL 443 100% 100% 130 Concessions—A registered blind person may be eligible for the following concessions and action is taken by the department to ensure that they are received: — (a) An increase in National Assistance Allowance. (b) An exemption pass on London Transport buses which allows the blind person and an escort to travel at the cost of one fare. (c) A certificate for the exemption of payment of a fee for a wireless receiving licence. (d) Provision of a free white stick by the Metropolitan Society for the Blind. (e) Free loan of a wireless set by the Society for the Blind. (f) Free loan of a spark guard. Many other concessionary facilities are also available for Registered Blind Persons who are given any necessary help and advice in taking advantage of them, for example: — (a) Specialised apparatus such as braille watches, clocks, playing cards, etc., may be obtained at special discount terms from the Royal National Institute for the Blind. Such purchases are often grant-aided by voluntary societies. (b) The Guide Dog for the Blind Association will both supply the dog and train the blind person how to use it. Registered blind persons are exempt from paying dog licences when the dog is used for guide purposes. (c) The Nuffield Talking Book Library provides talking books at a cost of £2 Os. Od. a year. (The Council makes a capitation grant of 10/- a year in respect of each person participating in the scheme.) (d) The National Library for the Blind provides a library service for Braille and Moon readers. There are also special magazines for the blind and Braille and Moon copies of letter-press magazines which are published by voluntary societies are circulated by the department to groups of blind readers. (e) Special facilities are available to enable blind persons to vote at elections. (0 Additional Income Tax relief may be claimed from H.M. Inspector of Taxes. 131 Sheltered Employment—In conjunction with the Ministry of Labour, the Council provides this service to a small extent by sponsoring and aiding 5 blind persons employed at workshops conducted by voluntary societies but principally through the Greenwich Workshops for the Blind. These workshops, situated in two separate buildings—one in Greenwich High Road housing the mattress and fend-off departments and one in Eastney Street housing the basket department, are administered by the Department and provide sheltered employment and training facilities for some 30 registered blind persons resident in London. There is a retail shop for the manufactured articles but the main outlet is through the United London Workshops for the Blind (Sales) Ltd., a nonprofit making company on the directorate of which the Council is represented by its Welfare Officer. Sales in 1965 totalled over £26,000. Manufacture of ships' fend-offs is a traditional riverside skill of particular interest and our workshop, which was engaging in this trade as far back as 1880, is one of the three remaining workshops still practising this craft. Fend-offs are made entirely by hand and range in size from 24 ft. bow fend-offs, through those measuring 5 ft. by 4 ft. (supplied to Trinity House) down to others 9 ins. by 5 ins. for use on small cabin cruisers. Our existing workshop buildings are antiquated and unsuited to present day manufacturing requirements and there are plans to replace these with modern purpose-built premises. However, action is held in abeyance pending the report of a Ministry of Labour working party set up to consider the blind workshop needs for the south-east area of London as a whole. Blind Homeworkers—There is a scheme for the employment of the blind in their own homes for which the department is responsible and these homeworkers pursue a variety of trades, e.g. basket making, machine knitting and even a retail grocery shop. Six such homeworkers are directly supervised by the Royal National Institute for the Blind. Welfare of the Physically Handicapped The following table gives a breakdown of the main conditions registered with the department. It will be seen that rheumatism and the disabilities associated with the rheumatic process, namely rheumatoid arthritis and carditis, account for approximately 32% of the total and it is also of significance that organic nervous diseases constitute 35% of the total. The disabilities connected with neurological lesions can be most crippling, but with skilled assessments much can be done to minimise the handicaps. 132 Physically Handicapped — Primary Disabilities DISABILITY SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 1 0-10 1 11-20 21-30 31-40 41-50 | 51-60 61-64 65-70 71-80 81-90 90 & over | Males Females Amputation M _ 1 _ _ 6 7 8 7 10 2 J 42 _ 63 F - - — 1 2 4 3 4 5 2 — - 21 Rheumatism M - 1 1 1 2 6 8 5 12 6 1 43 - 290 F 1 1 1 4 6 26 41 29 82 53 3 — 247 Deformities, etc. M - 2 1 - — _ I 3 — _ - 7 20 F - 5 2 1 1 2 1 - 1 - - - 13 Systemic Diseases M - 1 - - - 5 4 3 6 1 - 20 49 F - - 1 3 4 3 4 1 8 5 - 29 Injuries and Diseases M 1 3 - 1 2 7 2 5 5 - - 26 71 F — 3 3 _ 3 6 6 4 18 1 1 45 Organic Nervous Diseases M 1 8 10 15 24 31 6 19 18 9 1 142 312 F 2 15 9 18 23 26 7 32 30 6 2 - 170 Neurosis M 1 _ _ _ _ 2 1 _ 1 _ _ 5 14 F _ 2 1 1 - 3 1 1 - _ _ — 9 Tuberculosis M - - - - 4 - - - - - - 4 4 F — - — - - — — — — - - - - Other M 1 - 2 - 2 3 7 1 2 7 1 26 76 F - - 1 3 5 13 8 6 7 4 3 50 Totals M 4 16 14 17 40 61 37 43 54 25 4 315 F 3 26 18 31 44 83 71 77 151 71 9 584 Grand Totals 7 42 32 48 84 144 108 120 205 96 13 899 (i) Analysis of 'Rheumatism' Group DISABILITY sex AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 | 11-20 | 21-30 | 31-40 41-50 | 51-60 61-64 65-70 71-80 81-90 90 & over Males Females Arthritis M _ 1 _ 1 ] 1 3 2 3 5 1 18 145 F _ _ 1 1 2 8 23 14 47 79 2 127 Rheumatoid Arthritis M _ _ 1 - - 4 3 1 3 1 - 14 84 F 1 _ 2 3 17 13 8 73 7 1 70 Osteo- Arthritis M - - _ - - - 2 2 6 - _ 11 61 F - 1 ~ 1 1 6 5 7 12 17 - 50 Totals M _ 1 1 1 2 6 8 5 12 6 1 43 F 1 1 1 4 6 26 41 29 82 53 3 247 Grand Totals 1 2 2 5 8 32 49 34 94 59 4 290 133 (II) Analysis of 'Systemic Diseases' Group DISABILITY SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 11-20 | 21-30 | 31—40 41-50 51-60 61-64 65-70 71-80 81-90 90 & over Males Females Bronchitis M _ _ _ _ _ 1 1 _ 1 1 _ 4 9 F _ _ _ _ _ 1 _ _ 2 2 — 5 Diseases of the heart M - - - - - - 1 2 5 _ — 8 16 F _ _ _ _ 3 _ _ 2 3 _ 8 Sclerosis M _ 1 — _ _ 4 2 1 _ _ — 8 22 F _ _ 1 2 1 2 4 1 3 _ _ 14 Other M - - - - - - - - - - - 2 F - 1 - " - - 1 - - 2 Totals M _ 1 _ _ _ 5 4 3 6 1 _ 20 F - - 1 3 4 3 4 1 8 5 - 29 Grand Totals - 1 1 3 4 8 8 4 14 6 - 49 (iii) Analysis of 'Organic Nervous Diseases' Group DISABILITY SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 11-20 21-30 31-40 41-50 51-60 61-64 | 65-70 71-80 | 81-90 | 90 & over | Males Females Spastics M _ 3 2 6 1 6 - _ 1 _ _ 19 57 F 1 8 2 5 5 2 1 10 J — 1 38 Hemi and Paraplegia M _ 1 6 _ 5 13 4 10 15 7 1 62 138 F - 4 - 6 8 15 4 12 21 6 - 76 Epilepsy M — — 1 4 2 5 — J - — — 15 38 F _ 1 i 2 6 4 1 4 2 — - 23 Poliomyelitis M 1 3 - 2 7 6 2 5 - - - 26 37 F — 1 2 3 — 1 — 2 1 — 1 11 Encephalitis M - 1 - - - 1 - - 1 - - 3 7 F — — — — — 2 1 — 1 — — 4 Parkinson's Disease M _ _ 1 2 6 - - 1 - - - 10 20 F — - — — 3 2 — J 2 — — 10 Friedreich's Ataxia M - - - - 2 - - - - 1 - 3 5 F _ 1 - - 1 - - - - - - 2 Other M — — — 1 1 — — - 1 1 - 4 10 F 1 - 2 2 - ~ - I - - " 6 Totals M 1 8 10 15 24 31 6 19 18 9 1 142 F 2 15 9 18 23 26 7 32 30 6 2 170 Grand Totals 3 23 19 33 47 57 13 51 48 15 3 312 134 It is of obvious importance that the closest consultation must be maintained by the department with specialists in the clinical field and with experts in physical medicine and orthopaedics, in order that the most modern advances in therapeutics and rehabilitation can be given due weight. Decisions as to aids, adaptations, general community welfare and possible employment cannot be taken in a vacuum and everyone who has a contribution to make should be invited to participate. It is hoped that arrangements can be made in the future for social welfare officers to have access to the local hospital departments of physical medicine, orthopaedics neurology and cardiology, so that the needs of patients about to be discharged into the community may be discussed with the hospital authorities. In this way preparations can be made in advance of a patient's discharge from hospital, thus enabling much to be done locally to make the handicap more acceptable. Of course, it is appreciated that, at the moment, the majority of cases coming to the notice of the department and those already on our register of handicapped persons have well established handicaps, many of which are either static or becoming progressively more severe. However, this should not deter us from taking a preventive attitude wherever possible and a patient being discharged from hospital with a residual disability gives the department an opportunity of being involved at an early and formative stage, so that even the patient's attitude towards his own disability can be influenced to his benefit. In certain circumstances this could very well involve the department's mental health team. The welfare services for the handicapped can be seen to have great possibilities if they are organized on dynamic and cooperative lines and not on static departmental introspection. Such an attitude requires the participation and ready good will of all engaged in this work and this we hope to achieve in the coming years. Clubs and Centres Two centres and a number of clubs are organised for the blind and other handicapped persons with the object of ensuring, as far as is practicable, the intermingling of persons with differing handicaps. These establishments provide members with facilities not only for training and adjustment but also for pastime activities, handicrafts, etc., and with opportunities for social contact with others of similar disability and with similar interests. In this way, the clubs make an invaluable contribution towards the social rehabilitation of members. Tuition and help in diversionary occupation is provided for those unable to enjoy these benefits. 135 Social Rehabilitation Centre, Ormiston Road—This centre, providing club facilities for general classes of physically handicapped persons, is open for this purpose on Monday, Wednesday, Thursday and Friday, while on Tuesday, partially sighted persons attend. In addition to the services of a handicraft instructress, the centre also has special facilities for rehabilitation activities, e.g. instruction and practice in carrying out domestic tasks. Originally, members attended the centre from mid-morning to afternoon but the availability of more coaches enabled double the number of persons to share its benefits. Each full session, morning and afternoon, provides accommodation for 14 persons and a handicapped person attends for one half day per week only. There is a waiting list for members. St. Saviour's Centre for Handicapped Young People—Twelve severely handicapped young people attend at this centre which was opened in October, 1965. It meets each Monday, Thursday and Friday in the Youth Club at St. Saviour's Church Hall, Eltham. Lunches are served at midday and, at this and other times, the Social Workers are assisted by church volunteers. A handicraft instructress is in attendance and in addition to taking part in a variety of pastimes, including basket making and cane work, the teenagers enjoy recreational pursuits. Eltham Club—Primarily for registered blind persons, this club meets each Monday afternoon in the Sherard Hall at Eltham. During the year, the average attendance was approximately 19. Minor Hall, Greenwich—Opened on 29th April of the current year, this club is for persons who are blind or deaf and meetings are held every Thursday afternoon. The average attendance during the year was approximately 10 but this is increasing. Works of Access and Adaptation The cost of the works of access and adaptation to enable a disabled person to overcome the effects of his disability may be met by the Council. Such works include ramping steps, widening doorways, adaptation of toilets, provision of handrails in bathroom and on stairs, etc. Persons requiring these alterations are assessed as to their ability to contribute towards the cost. During the year, works of access or adaptation were arranged for 38 persons. Portable Aids for Handicapped Persons During the year, in addition to many items of home nursing equipment more generally available to those needing them, the following aids were issued to handicapped persons, free or on assessed charge: — 136 Bathing Equipment Bath seats, boards, mats, safety rails 75 Home Equipment Long-handled brush and pan, can openers, fire guards 15 Dressing Aids Long-handled combs, long-handled shoe horns, stocking aids, elastic shoe laces 13 Special cutlery Nelson knives, long-handled knives and forks 16 Pick Up sticks and 'Lazy' tongs 32 Toilet Aids Raised toilet seats, safety rails 24 Trolleys, Ramps, etc 19 Holidays Summer holidays are arranged for all categories of handicapped persons, either directly or in conjunction with voluntary organisations or by assisting with holidays privately arranged by the persons concerned. A party of 63 handicapped people was taken for two weeks to the Century Camp, Shepperton, where the Social Workers were assisted by helpers from the International Voluntary Services. In addition, a further 59 holidays were arranged, largely in cooperation with voluntary societies. Persons receiving holidays are assessed to contribute towards the cost according to their means. Transport In addition to a fleet of minibuses, there are four coaches specially designed for the conveyance of handicapped persons. Each is equipped with a tail-lift and can accommodate up to three wheelchair patients as well as the seated passengers. The primary use of these vehicles is to convey those who are unable to use normal transport, to the centres and clubs organised by the Council and voluntary agencies. Use is also made of them for outings and holiday journeys. Future Development Considerable scope for the improvement and expansion of services for the handicapped exists and, in the long term, a new purpose-designed Social Rehabilitation Centre is visualised to provide those urgently needed facilities which the registered handicapped, at present, lack. There are hopes that, in the near future, a work centre for the physically handicapped will be opened. 137 MISCELLANEOUS SERVICES Receivership The Borough Welfare Officer has been appointed Receiver by the Court of Protection to administer the estates of 6 patients, previously resident in the Borough, who are incapable by reason of mental disorder of managing their own affairs. Day to day administration of a patient's financial affairs is the responsibility of the Receiver who has to account to the Court of Protection for his actions on behalf of the patient. Apart from the management of a patient's estate, the Receiver takes an interest in his welfare and, if necessary, seeks a medical opinion and submits to the Court any proposals within the patient's means which are likely to ameliorate his condition or add to his comfort. Protection of Property Where it appears that there is danger of loss or damage and where no other suitable arrangements can be made, it is the duty of the Council to arrange for the temporary protection of property of persons who are admitted to hospital or welfare home. On 1st April, 1965, responsibility was assumed for 5 lots of property which were moved into a store allocated for this purpose. During the year, protection action was taken in respect of a further 5 cases, in two of which, the property was moved into store. Burial or Cremation of Deceased Persons The Council's powers under Section 50 of the National Assistance Act to arrange for the burial or cremation of any person where no other suitable arrangements were being made, were exercised in respect of 13 deaths and two stillbirths. Fourteen burials were arranged and one cremation. The Council's expenses totalled £165, of which £147 was recovered from the estates of the deceased persons. Registration of Disabled and Old Persons' Homes Action has been taken in pursuance of the duty of the authority within whose area a disabled persons' or old people's home is situated, to visit the premises and grant a Certificate of Registration under Part IV of the National Assistance Act where the authority is satisfied as to the management, construction and conduct of the establishment. At 31st December, 1965, only one establishment was registered and this was in respect of an Old People's Home providing accommodation for eight people. 138 COMMUNITY GERIATRIC SERVICES On 1st April, 1965, the new London Borough Council constituted a Welfare Committee on the assumption by the Council of the new powers and duties relating to the welfare services which were formerly administered by the London County Council and the Metropolitan Boroughs of Greenwich and Woolwich. This Committee is responsible for all aspects of old people's welfare work, including the visiting service for the elderly, the provision of meals at luncheon clubs and by meals-on-wheels, the Council's holiday hotel for the elderly, recreational services for the elderly and other domiciliary geriatric services. It is assisted by an Old People's Welfare Sub-Committee, which comprises twelve members of the Council and eleven representatives of voluntary organisations. The Sub-Committee has special responsibilities for the day-to-day operation of the old people's welfare services and liaison with voluntary workers, subject to the determination of matters of principle by the Welfare Committee. Comprehensive services for the elderly were inherited by the department from the previous authorities and a detailed account is included of the many activities undertaken both by the Council and by local voluntary organizations. Although these services may appear to have evolved in a somewhat haphazard fashion over many years inasmuch as they were designed to meet needs as they arose and were recognized at the time, nevertheless there is a pattern of consistency which may not be immediately obvious. All efforts have been and are directed towards assisting the elderly in preventing deterioration in their health or welfare and to reduce illness and accidents. This means that the closest association and co-operation must be established with doctors, nurses, social workers, hospitals and voluntary workers who have an interest in home care. It means also encouraging the elderly to make the maximum use of their facilities, particularly to remain active, to have regular social contacts, to have a proper diet, to maintain a high standard of personal hygiene and appearance and not to sink into apathy and despondency. Our services should be seen in the light of these broad criteria. 139 Undoubtedly the question of hospital admission or removal to residential accommodation has to be considered on occasions, but experience shows that the vast majority of the elderly wish to remain independent in their own familiar surroundings for as long as possible. That is why community care should be comprehensive and should have a strong preventive emphasis. The theme running through the descriptions of these various services is the interdependence of all engaged in this work. No section or facet can be considered in complete isolation and no elderly citizen should be denied the advice and support of any individual or organization which might have a contribution to make. The department is confident that the services being provided are well balanced and are meeting the immediate needs. The future will undoubtedly see a high proportion of citizens in the higher age groups and understandably therefore, in spite of the progress of science and medicine, more elderly will develop the infirmities of great age. This will require an extension of our services along certain lines relevant to the circumstances. This planned development is already under way and reasonably accurate estimates of our future needs can be made for the next ten years. In recent years, with the growth of modern standards of living, the need for community care has increased considerably. There are some 30,000 residents in the Borough aged 65 years and over and it is anticipated that in 10 years' time this number will have risen to well over 36,000. Furthermore, the proportion of very old is increasing rather more rapidly than the actual numbers of aged as a whole and it is estimated that by 1976 there will be more than 12,000 people aged 75 years and over resident in the Borough. As has been mentioned, all signs point to the need to expand our services to meet the challenge of the 1970's. Accordingly, during 1965, the Council formulated its plans for the orderly expansion of the health and welfare services over the next ten years in anticipation of the expected demand. Fortunately, only about one quarter of our elderly residents are in need of immediate local authority health and welfare assistance. However, through loneliness resulting from the loss of a relative or close friend, a larger number would most benefit from companionship and recreation. Some of the health and welfare services are differing ways of meeting the same need and the Council's aim is to improve still 140 further the area of choice available to an individual so that, when the time comes, the elderly will be given as wide a choice as is possible between alternative welfare provisions. Further measures taken during the year by the Council and directed towards a more preventive service for the elderly included an increase in the number of geriatric visitors to eleven. These officers are now regularly visiting over 9,000 elderly persons known to be at risk, particular attention being directed to the ill, the infirm, the home-bound and the isolated. Unfortunately, we cannot yet claim to know all elderly people in the Borough coming within these categories although many more old people in need came to our notice during the current year. Other measures designed to supplement this preventive work were contained in the proposals agreed by the Council for the establishment of 2 geriatric clinics, initially on an experimental basis, at which apparently healthy elderly people would be medically examined and any obvious abnormalities followed up with the patient's own doctor. Another important step taken was the appointment by the Council of a geriatric adviser who is the hospital geriatric consultant in the Greenwich area. These matters are discussed more fully later in the report. Organised regular visiting for the aged now provided by the Council is supported by well-developed domiciliary services which are available to thousands of old people many of whom would otherwise be needing residential care. Old people's welfare is a field in which voluntary and statutory agencies can work very efficiently in close association and this is exemplified in Greenwich where the Council make full use of the services of many enthusiastic voluntary workers. It is true to say that without their support much that we are able to do for the old people would be extremely difficult if not impossible to achieve. It is appropriate to mention here that assistance afforded elderly persons by relatives is often far greater than is realised and in a great many instances relatives and friends carry enormous burdens in caring for aged people over prolonged periods. Undoubtedly, the task of the social services is to supplement, where necessary, the family system of care and during the last few years attention has been directed towards alleviating the lot of the single daughter who, in addition to caring for an aged parent, has to earn 141 her own living. Such cases deserve all the help which can be given locally and should attract the maximum financial assistance available from state sources. Throughout the year, women public health officers, who are all qualified health visitors and nurses, maintained a comprehensive visiting service to the elderly, the frequency of which depended upon individual circumstances. In each case the person was made aware of the help and services available to him/her. In 1965, the number of visits made specifically by these officers to the elderly was over 36,000, which total does not include those made by welfare social workers to the elderly, blind and physically handicapped nor the visits made by other health visitors, district nurses, mental health officers, home help organisers or public health inspectors. Local workers known to be active in old people's welfare work are supplied with pre-paid reply post-cards to enable them to notify the department of any elderly person likely to require a visit. Receipt of such a card produces an immediate visit from the geriatric visitor who leaves a visiting card of her own in order that the department may be notified if and when assistance is required. Although notification to the department by general practitioners of elderly people at risk is still not obligatory, nevertheless, regular contact with local doctors, clergymen, National Assistance Board officers, home help organisers and others enables the department to maintain a confidential register which has proved of inestimable value in indicating day-to-day needs of any elderly person. Moreover, the register is not only an indication of the size of the problem but also a reliable guide to the planning of services. As the majority of our 30,000 or so persons of pensionable age are reasonably tit and well there is no necessity, indeed it would be impractical, to list them all and our register, therefore, relates only to those elderly persons being regularly visited and in receipt of health and welfare services. Visiting All services relevant to those elderly with diminished physical and/or mental activity germinate from skilled and diligent visiting. Great emphasis is therefore placed on visiting by highly qualified officers. The relationships established by the visitors with the old people influence the attitude which the elderly adopt to our efforts made to help and assist them and the first visits or contacts can make the difference between success and failure. 142 At present, all public health officers use the Health and Welfare department as their headquarters but, to save travelling time and foster even closer contact with each area, it is proposed to decentralise as and when possible. Elderly People in Receipt of Visits and Other Services Number in Register at 1st April, 1965 7,989 Number in Register at 31st December, 1965 8,120 Elderly Handicapped Persons included in the above Register: (i) Blind 327 (ii) Partially Sighted 151 (iii) Physically Handicapped 440 918 Visits by Women Public Health Officers Total Visits by Officers during year 36,804 Visits re:— New Cases 1,849 Office interviews 376 Home bathing 220 Bathing—Bathing Centre 258 Hospital 245 Distribution of furniture and clothing 185 Medical loans 554 Cleansing of house 93 Hospitality Scheme 38 Incontinent Laundry arranged 242 Admissions to L.A. Home 127 Admissions to Private Home 13 Admissions to hospital in Borough 446 Admissions to hospital outside Borough 99 Discharges from hospital 137 Moved from Borough 175 Miscellaneous visits 2,188 143 Tunnel Avenue Bathing Centre—Exterior 144 Bathing Centre—Laundry Bathing Centre—Bathroom 145 Westgate Bay Dining Room 146 Bedroom Bar Lounge 147 PLUMSTEAD LODGE 82 PLUMSTEAD COMMON ROAD, WOOLWICH, S.E. 18 The frontage along the Plumstead Conunon Road (Photo: Fox Photos Ltd.) Part of the spacious and sunny dining room (Photo: Mann Bros.) 149 WEYBOURNE 1 Finchale Road. Woolwich, S.E.2 The home with neighbouring block of flats in the midst of the Abbey Wood estate A twin-bedded room with curtained wash handbasin (Photo: Pox Photos Ltd.) 4 Res lents enjoying the sunshine in the interior courtyard (Photo: Fox Photos Ltd.) 150 SUNBURY LODGE I Sunbury Street. Woolwich, S.E. 18 A new resident at the home has a friendly chat while exploring the pal o The entrance courtyard with its specially commissioned sculpture (Photo: Fox Photos Ltd.) 151 Cases referred to :— A. British Red Cross-Society 52 B. Chest Clinics 9 C. Church or Club 224 D. District Nurses 120 E. Chiropody Clinic 166 F. Chiropody Clinic Domiciliary Service 283 G. General Medical Practitioners 225 H. Borough Dept.—Housing 437 J. Borough Dept.—Public Health Inspectors 98 K. Borough Dept.—Home Help 824 L. Borough Dept.—Blind Welfare 32 M. Borough Dept.—Mental Welfare 62 N. Borough Dept.—Physically Handicapped Welfare 135 O. Borough Dept.—Old People's Holidays 999 P. Hospital Service 57 Q. National Assistance Board 121 R. Mobile Meals 513 S. Radio (Wireless for the Blind) 71 T. Radio—Borough 16 U. Radio—Others 10 V. Women's Royal Voluntary Service 21 W. Ophthalmic Domiciliary 70 X. Dental Domiciliary 26 Y. Friendly Visitor 45 Z. T.V. (Wireless for the Blind) 107 AA. T.V. Anon, donor 21 BB. T.V. Others 96 CC. Transport—British Red Cross Society 21 DD. Referred for Pt. Ill Accommodation 140 BATHING SERVICE Figures prior to merger:— Greenwich Woolwich At home 593 At home 74 At centre 449 Pedicure 36 Hairwashing 4 This very personal service has expanded greatly since April 1st, 1965, and is very much appreciated by the elderly, who view it as a social occasion to have a chat and a cup of tea in a congenial atmosphere. 152 Centres used for bathing are Tunnel Avenue Bathing Centre and Plumstead Baths Bathing Centre, with an increased staff of one male and one female bath attendant. To relieve the pressure of work it is proposed in the near future to establish a small unit adjoining the foot clinic at Lionel Road to deal with a growing need in the Eltham Area. The functions of this service, which are two-fold, are carried out as originally envisaged in accordance with Section 43 of the London County Council (General Powers) Act, 1953. Home Bathing—Such a service was introduced for elderly persons not ill enough to need a District Nurse but, owing to varying disabilities, require assistance; these include a small number of all age groups, who due to some crippling deformity are unable to cope either on their own or with help from relatives. Bathing at Bathing Centres—Elderly people who are concerned with this service are conveyed to the centres by minibus and they consist of those persons who have inadequate bathing facilities at home coupled with blindness, failing sight or suffer with other physical disabilities. Hair-washing and pedicure have become indispensable off-shoots of the bathing service for although many old people are able to bath themselves they lack the range of movement and dexterity to perform these very necessary personal functions. Tunnel Avenue Plumstead Number bathed at home 1,504 1,226 Number bathed at centre 1,534 1,255 Pedicure 146 Hair-washing 12 Incontinent Laundry Service This service has been established to: — (i) relieve the pressure on families who are managing under extreme difficulties with seriously ill patients; (ii) assist many old persons who, although not seriously ill, have a stress incontinence or kidney condition Although dealing mainly with laundry from the homes of the elderly, this service is extended to all like cases of all ages at home or in residential care. Collections are usually daily but they can vary from twice to three times per week. There is no doubt but that this service is frequently the means whereby elderly persons are enabled to pass their remaining days among their own surroundings when otherwise they would be hospital patients. 153 Ancillary to this service is the loan of mackintoshes and a limited number of sheets and draw sheets are also available for urgent needs. Both this and the Bathing Service are worked in closest co-operation with the District Nurses. There are two laundry centres. At the Tunnel Avenue Centre the staff combine the duties of bathing with treatment of incontinent laundry whereas the White Hart Road Centre is in operation for the laundry service only. Tunnel White Hart Avenue Road Number of articles laundered 52,253 65,333 Home Cleansing Service Not infrequently the rooms of elderly people deteriorate into a muddled dirty state and the task of cleaning up becomes too complex for the relations or home helps. In such cases, having first gained the consent of relations or persons concerned, a team consisting of two bath attendants with transport, supervised by a Public Health Officer and equipped with the necessary protective clothing and apparatus, deal with the offending conditions and remove the accumulated rubbish. After such operations the home help can then carry out her normal duties. Cleansing Services Effected From Plumstead Bathing Centre 24 From Tunnel Avenue Bathing Centre 9 Miscellaneous—Treatment of scabies and the cleansing of verminous persons are also duties falling to the staff of the bathing centres. Chiropody Service—In January, 1965, domiciliary chiropody for the Woolwich area was the responsibility of the Woolwich Council of Social Service but in Greenwich it was a function falling within the purview of Old People's Welfare. A weekly session was held at Tunnel Avenue Bathing Centre for this purpose and those patients unable to walk were conveyed by minibus. In addition, a weekly session was allocated for domiciliary treatment. Subsequent to 1st April, 1965, however, all domiciliary chiropody became the responsibility of the Greenwich Council of Social Service and the session at Tunnel Avenue is now operating as part of the normal statutory services. Tunnel Avenue—Sessions: 36; Persons Treated: 237. Council of Social Service—Treatments: 1,534. 154 Recreational Facilities for the Elderly Day Clubs for the Homebound—Since 1957 a Day Club for homebound elderly has operated at Kidbrooke House, Shooters Hill Road, S.E.3, and it provides much appreciated recreational facilities and companionship. Members of the club are transported by the Council's coach on five days of the week, meals being prepared and served by the W.R.V.S. Each week about 50 homebound persons are able to take advantage of a service which is so successful that the Council's Welfare Committee is anxious to establish similar clubs elsewhere in the Borough. However, as suitable premises with a high standard of comfort are difficult to obtain, the Committee decided, as an experiment, to use Old People's Homes for this purpose and a pilot scheme at Sunbury Lodge was authorised. Up to eight elderly persons are conveyed on three days of the week to this centre where they enjoy a hot midday meal and the recreational facilities of the Home. Every effort has been made to welcome these visitors to the Home and care is taken to see that the domestic character of the premises, which is 'home' to the residents, is retained. Voluntary workers assist in escort and other duties and there are hopes that, in the near future, similar arrangements will be made in respect of other Old People's Homes. Day Clubs for the Elderly—A number of elderly persons, whilst fit and active, are of a 'retiring' nature and are either unwilling or find difficulty in joining a large club. Therefore, in an endeavour to encourage them to mix, Day Rooms are made availab.e at West Greenwich House, 141 Greenwich High Road, S.E.10. Charlton House, S.E.7, Ogilby Club, Calderwood Street, S.E.I8, and Victorians Club, Sherard Road, S.E.9. At these clubs, which are open to any elderly person from approximately 10 a.m. to 4 p.m., Monday to Friday, they will find warmth, comfort and companionship over a cup of tea or during lunch. Outings and parties are also arranged for club members. Old People's Clubs—It had been the policy of the former Metropolitan Borough of Greenwich to make a newly established club an initial grant of £10 to assist it to equip itself and to continue this grant annually to enable it to improve its recreational facilities. This policy was continued and extended by the Welfare Committee to cover the whole of the new Borough. There are approximately 50 Old People's Clubs in the Borough almost all of which regularly meet on a weekly basis and arrange their own programmes, annual outings, Christmas festivities, etc. Although the majority of their members are active, clubs are catering increasingly for the more isolated old person but, so far, it has not been possible for the department to provide special transport to assist the older, less active members to attend club meetings. 155 Concerts and Outings, etc.—During the year, over 250 elderly persons attended a successful evening's entertainment at the A.E.I. Sports Stadium, Cemetery Lane, given by the firm's own concert party. A further 257 elderly homebound enjoyed afternoon outings to the Kent countryside and to local parks and open spaces arranged for two afternoons each week during the months from May to September. In addition, the department provided transport for regular outings to Lewisham Clubs and Day Centres. In hundreds of cases, restricted mobility renders elderly people unsuitable for whole day outings. Selection for half day breaks is therefore based upon up-to-date visiting data. As a direct result of the delivery to the department of 2 new 'handicapped' coaches equipped with hydraulic tail-lifts, the number of regular weekly and monthly outings to clubs and other social activities was substantially increased. Furthermore, the ability of the department to arrange special journeys for elderly people going on holiday or to visit relations in hospital was greatly enhanced. Television and Radio Sets—A number of television sets donated to the Council were repaired and put on loan to needy old people. Through the generosity of a private donor, other television sets were made available, without charge, to some 45 elderly residents of the Borough. The department makes arrangements for the repair and loan of its own sets and also acts as agent for a number of voluntary organisations such as 'Wireless for the Bedridden Society'. Library Service—The Council's Library Service to Old People's Homes was further extended and collections of books were changed regularly. Some 20 people in the Kidbrooke area are visited every fortnight by volunteers who distribute and exchange books chosen from the Kidbrooke Branch library. The Borough Librarian reports that issues of books during 1965 to Hospitals, Old People's Homes and housebound readers totalled over 10,000. Civic Entertainment—Film Shows, arranged by the Recrational Services Committee, were held fortnightly during the winter season at each of the 4 Old People's Homes and a further 200 'live' shows were given to old people's clubs to audiences amounting to almost 15,500. Holiday Hotel—To meet an ever increasing demand by elderly residents for holidays, the former Metropolitan Borough of Greenwich decided, in 1963, to operate its own hotel for the exclusive use of Greenwich residents and to this end, after a prolonged search, an hotel was purchased at Westgate-on-Sea. It was clearly the Council's intention to provide a cheerful holiday and recreational facilities for guests and, although the holiday-makers were generally 156 expected to be active, provision was made for frail and handicapped old persons to be accommodated on the ground floor. At the time of the transfer of these premises and other old people's we.fare services to the new London Borough on 1st April, 1965, the hotel had already accommodated 716 elderly persons, the majority of whom were away on holiday for the first time under such a scheme. During the autumn of 1964, the Sea Grange Hotel, situated adjacent to the Greenwich Hotel on the sea front, came on to the market. Accordingly, the former Metropolitan Borough of Woolwich decided to buy this hotel in order that it could be operated in conjunction with Greenwich Hotel and thus provide much more accommodation for the benefit of residents of the new London Borough. Purchase was completed immediately prior to 1st April, 1965, and the two hotels were annexed by means of a heated, covered way. Subsequently they were operated as a combined establishment providing accommodation for some 70 old people and, during the current year 1,140 elderly persons spent a fortnight's holiday at Westgate-on-Sea. Existing accommodation at the combined hotels now includes a kitchen serving the whole establishment, several lounges with sea views, a bar lounge and three dining rooms all on the ground floor. Inclement weather is countered by enclosed balconies and there are ample facilities for indoor entertainment and pastimes, including television and radio. Managed by a Resident Superintendent and Assistant with appropriate staff, the new combined hotel remained open until 31st December, 1965, thus enabling 'out of season' holidays to be taken. Charges are very reasonable and, when possible, applicants who accept an 'off-season' for their initial holiday are offered a summer booking when the opportunity for a second holiday arises. Accommodation for the Christmas period is reserved for persons living alone. These excellent holidays provided by the Council for retirement pensioners resident in the Borough, i.e. men aged 65 years and over and women of 60 years or more and not in full time employment, are comparable with the best. Holidays commence on Friday and bookings are for a fortnight. Parties are conveyed by escorted coaches from various 'picking-up' points in the Borough to and from Westgate. Less active guests are further transported by minibus to and from their own homes and the 'picking-up" points. Every fortnight, during the period from May to September, eight of our elderly citizens, who for medical reasons require ground floor accommodation, go to the Greenwich Hotel. Each case, which is submitted to very careful consideration, is visited to ensure that the term 'holiday hotel' (not convalescent home) is preserved. 157 Immediately on the closure of the hotel at 31st December, 1965, arrangements were made to carry out extensive works of adaptation which included the installation of a lift, central heating in part of the hotel, the formation of a main entrance to serve the whole hotel and the provision of a special unit for up to 18 physically handicapped and infirm guests. On the completion of the work in the Autumn of 1966, the accommodation will then all be of a very high standard and will cater for almost 2,000 guests annually including not only the active but also the infirm and the physically handicapped. Holiday Relief for Relatives A scheme for the holiday relief of relatives has the complete support of the Welfare Committee and arrangements were made for a number of aged persons to be cared for during their relatives' holiday period. In fact, this care also resolved itself into a holiday for the elderly themselves for, under arrangements made by the Council, they were accommodated at Avery Hill College, Eltham. during the summer recess. Under these arrangements, use was made of students' ground floor single rooms to provide some 75 homebound old people with very comfortable quarters and full nursing assistance and care. The holiday stay included a full recreational programme and the department's special transport conveyed the elderly to and from their homes and to the social outings arranged during the fortnight. All were thoroughly appreciated by the old people enjoying their 'holiday break' among the semi-rural surroundings of the college. A major feature of the scheme was the invaluable assistance given by voluntary helpers, many of whom were senior members of schools in the vicinity. Mobile Meals During 1965, the effectiveness of the Mobile Meals Service was extended still further and at the end of the year a 5-days-perweek' service was planned for all elderly people in the Borough in need of it. Implementation was dependent upon the delivery of two new vans ordered for this purpose. Intensive visiting revealed a marked rise in the demand for this service among the increasing elderly population of the new Borough and, to meet this need, the Welfare Committee decided to purchase two new minibuses and three 6 cwts. vans. Because of the acute shortage of voluntary help during the midday period it became necessary to increase the part-time staff employed on this service. 158 The total number of meals delivered during 1965 was 88,988 compared with a figure of 70,325 provided jointly by the Metropolitan Boroughs of Greenwich and Woolwich in 1964. For the year as a whole, the average number of persons receiving meals daily was 342 but, during the last quarter, this figure rose to 416, an indication of the increasing use made of the service. Meals are provided from three sources, viz., the Council's kitchens at Woolwich and Eltham, a private caterer in Greenwich and the Council's Luncheon Clubs which prepare frozen foods. Subvented by the Council, the meal costs the recipient Is. Id. The service was continued during the Bank Holiday periods and on Christmas Day meals were delivered to 129 old people unable to make other arrangements for a hot meal. Similarly, 150 persons received this service on Boxing Day. Furthermore, tins of rice and soup were delivered to 118 persons on Christmas Day for consumption on Sunday, 26th December. Emergency food packs for the use of old people were distributed during the winter months to cover the eventuality of 'non-delivery' of a meal during severe weather. I should like to take this opportunity of extending my sincere appreciation to the drivers, heloers and other voluntary workers, particularly members of the W.R.V.S. and the British Red Cross Society, who so willingly gave assistance in this service throughout the year. Provision of Mobile Meals (during 1965) (1) Greenwich 1.1.65-31.3.65 10,649 1.4.65-31.12.65 31,992 42,641 (2) Woolwich 1.1.65 -31.3.65 9,585 1.4.65 - 31.12.65 33,575 43,160 Meals supplied by Luncheon Clubs from frozen foods 3.187 3,187 88.988 Luncheon Clubs The Council's policy is an expansion of its Luncheon Club Service with the object of enabling as many elderly residents as possible to have at least one hot meal a day and to encourage them out of their homes to enjoy companionship and recreation with others. Each Luncheon Club which provides a hot main meal and sweet for Is. Id., is open from 11.30 a.m. to 1.30 p.m. 159 although some members arrive well before the opening time. A number of meals served at the club are prepared from frozen foods and these have proved extremely popular with our old folk. These clubs provide opportunities for social activities and organisers invariably arrange outings and Christmas treats for their members. Some clubs are closely associated with local churches and voluntary helpers play an important part in their undoubted success. Assistants is also given by senior girls during school holidays. A notable feature of the Council's Luncheon Club Service is the increasing number of elderly homebound persons now being conveyed at least once a week to clubs for a mid-day meal. Reciprocal arrangements are made with neighbouring Boroughs for persons residing just outside Borough boundaries to attend the Luncheon Club most convenient for them. In June of the current year the luncheon club at 'Oaklands', Shooter's Hill Road, was closed prior to demolition but a transfer to St. James Hall, Kidbrooke Park Road, was effected without interruption of the meals service, and attendances at the new club have been more than maintained. An entirely new luncheon club which was opened in May at the Slade Community Centre, Pendrell Street, S.E.I 8, was immediately successful and continued to gain such popularity that the attendances were soon in excess of 80 persons per day. Plans were made and by the end of the year negotiations were begun for the provision of four new luncheon clubs at St. Luke's Church Hall, Charlton Village, S.E.7, St. James' Church Hall, Burrage Road, S.E.I8, Abbey Wood Methodist Church Hall, McLeod Road, S.E.2, and the Charlton Liberal Club's new premises at 59, Charlton Church Lane, S.E.7. In 1964, the combined total of luncheon club meals consumed in the Metropolitan Borough of Greenwich and Woolwich was 95,118 but the year 1965 saw an increase in this figure to 119,945. Provision of Luncheon Club Meals (during 1965) (1) Greenwich 1.1.65 - 31.3.65 10,715 1.4.65 - 31.12.65 28,756 39,471 (2) Woolwich 1.1.65 -31.3.65 16,086 1.4.65-31.12.65 64,388 80,474 119,945 160 Geriatric Clinics During 1965, consideration was given to ways of improving the local geriatric services, not only with a view to providing relief for the family doctor but also to introducing further preventive health services for old people. In deciding to establish two experimental geriatric clinics, one in the Greenwich area and one in the Woolwich area, the Council noted that the emphasis of the work of these clinics would be along the same preventive lines as in the present infant welfare centres. Elderly persons would be invited and encouraged to attend the clinics where they would undergo a simple basic examination to detect disorders of hearing, vision, anaemia, blood pressure and urinary abnormalities. An assessment of the hygiene, nutritional and mental condition of the patient would be made and advice given on any adjustment in mode of living found to be necessary. Results of investigations would then be sent to the respective family doctor for his records and any necessary referrals for medical treatment to be undertaken by the general practitioner himself. In no circumstances and indeed it will be no part of the scheme, for treatment to be given at the clinics where only apparently healthy persons are to be seen. Clinics are to be staffed on a sessional basis by doctors particularly interested in the problem of ageing and, initially, the sessions will be held once a fortnight. Full approval of this project has been obtained from the Minister of Health. Geriatric Adviser to the Council In his Circular 10/65, the Minister of Health has pointed out that, although the various Health and Welfare Services for the elderly are not under one authority, their purpose is to provide what is essentially a single service for each individual who needs it. Reports to the Welfare Committee indicated that, despite every effort made to the contrary, there is much undiagnosed illness and undisclosed disability in the elderly. Although locally the position is improving there were still a number of elderly found to be in welfare accommodation who ought to be in receipt of hospital care and, conversely, there were hospital patients fit for admission to an old people's home. It was clear that early recognition of changes in the physical or mental condition of our old folk in the Council's homes would be most satisfactorily achieved by a doctor responsible both to the hospital and to the local authority. This desire for a closer association between the Health and Welfare department and the 161 hospitals' geriatric services was satified by a decision of the Council to appoint the Consultant Geriatrician at St. Alfege's Hospital as its geriatric adviser on its own services for the elderly. This appointment will lead to a situation where each elderly person will receive appropriate care from the appropriate authority. Geriatric Unit Since 1st April, 1965, close links with the Geriatric Units in the Borough have been further strengthened and regular discussions at the St. Alfege's Hospital Staff Meetings give rise to greater understanding of common problems. Nutritional Supplements Prior to the recent merger, both Greenwich and Woolwich Council had centres for the sale, at preferential rates, of various nutritional commodities, to bona fide retirement pensioners. Since April, additional centres for distribution have been established and the variety of foods extended in order that an ever widening section of the elderly community will be reached with a greater choice of supplements. The Council's present scheme is very popular and forty-six Old People's Clubs covering over 400 participating members are making regular purchases of foods such as Ovaltine, Marmite, Horlicks, Bovril, Ribena and Complan for re-sale to their members at reduced costs. Non-Club members can purchase these foods from the W.R.V.S. offices at Woolwich, the Citizens Advice Bureau at Eltham, and from the Health and Welfare Department at Greenwich. Relatives and friends may obtain supplies from these Centres for homebound elderly people on production of a registration card. Sales are restricted to persons of pensionable age and only in sufficient quantities considered reasonable for that person's own consumption. During the year sales exceeded £5,500. Housing Regular consultation takes place between the Public Health Officers and representatives of the Housing Departments of this and the Greater London Councils. Furthermore, active participation in the selection of elderly persons for residence in local almshouses and Housing Society properties is also undertaken by the department's officers. A new Council flatlet scheme at Plumstead Common Road which, in addition to the usual housing amenities also provides a warden service and communal recreation rooms, was completed by the end of the year and the accommodation fully occupied. 162 In view of the close proximity of the flats to the Council's Plumstead Lodge Old People's Home, arrangements were made for the staff at the Home to give support as necessary, particularly on the warden's day off. The facilities at the Home are also being made available to the Council's new flatlet tenants. Physical Aids A number of conditions arising as a result of old age are assisted by the use of simple aids. It is therefore proposed to have a small selection available to the Public Health Officers in the same manner as a medical loan. Publicity It has been found that many old people have little or no knowledge of the local services available to them. To help remedy this situation the Council distributed 10,000 copies of a booklet specially prepared as a guide to the services available to elderly people. Early in 1966, the Department also plans to issue a comprehensive guide to the Health and Welfare Services. Observers Services provided in this Borough for the elderly are attracting observers from many sources, Representatives of interested organisations from Australia, Holland and Germany have been welcomed and given every opportunity to study our services for the elderly. Advantage is also taken of our services by Health Visitors and Hospital Students in accordance with their various curricula. Voluntary Help In order to attract more voluntary help for our elderly folk, particularly from senior schools, church and youth organisations during the year, talks, films and lectures were used to disseminate information about the general activities and responsibilities of the Health and Welfare department within which there is great scope for the volunteer. Particular emphasis was given to explaining the growing problems of an increased elderly population and to the needs of those younger persons with physical and mental handicaps. Discussions took place with the Dean of Greenwich (the Rev. N. Stacey) and the Sub-Rector (Rev. R. Garrard) of St. Mark's Church, Woolwich, and a special meeting of local interested clergymen was arranged. The Sub-Rector of Woolwich also contacted several churches in the new deanery of Greenwich with a view to encouraging their interest and that of their parishioners 163 in undertaking voluntary work in the various health and welfare services. In the Kidbrooke area, four churches of different denominations were co-operating to establish a joint scheme for emergency and other help for the elderly in that area. Moreover, the Council's voluntary welfare liaison officer approached several youth organisations and local headmasters with encouraging results and several groups gave practical assistance to old people during the year. Twenty-three persons received assistance from eight voluntary gardeners, three school groups, thirteen church groups and one adult group and practical work was carried out at the homes of old persons by three church and three other organisations. In addition, funds were raised by four different voluntary organisations to assist four other old persons, in respect of the cost of materials. Further expansion of this kind of voluntary work was planned for 1966. Assistance was also provided by thirty-nine active "solo" volunteers for ninety-eight old persons, with escorting, hairdressing, domestic repairs, radio and T.V. repairs, sick visiting, household chores, shopping, sewing and mending, transportation and the provision of firewood and fuel. Following requests from schools in the Borough, that their Harvest Festival gifts should go to local old people, the department supplied appropriate names and addresses and assisted with distribution and transport, where required. Local Rotary Clubs again arranged outings and entertainment for many old people recommended by the Department. MAYOR'S 'FESTIVAL OF CHRISTMAS' APPEAL Once again a feature of the Christmas period was the most successful 'Festival of Christmas' Appeal organised under the active leadership of Councillor W. A. Brooks, J.P., Mayor of Greenwich. The Council decided that there should be a 'Festival of Christmas' covering the whole of the new London Borough and a sum of money was made available to provide parcels and to allow for decorations, entertainments and festivities to be organised at Christmas time. A 'Festival of Christmas' SubCommittee was set up on which the various local organisations, churches and schools were represented. Distribution on Christmas Eve of over 4,500 parcels, the contents of which were determined on department advice, was effected by a rota of volunteers organised in consultation with the Health and Welfare department. Generally speaking, all 'needy' 164 elderly people known to the department received a parcel although, inevitably, a few persons in this category and not on the Council's lists were missed. However, information supplied by the volunteer distributors in respect of the latter persons has proved extremely useful and they were subsequently visited by Public Health Officers. The success of the scheme was due in no small measure to the help given by the voluntary distributors of the food parcels and they were all thanked personally by the Mayor for their efforts. In addition to the Mayor's scheme, names of many other suitable recipients were given on request to various factory groups, schools and voluntary organisations who themselves arranged for the distribution of their own Christmas gifts. Carol Services for elderly people were held at St. Luke's Church, Charlton, and at St. Alfege Church, Greenwich, on afternoons preceding Christmas, refreshments after each service being provided by voluntary organisations. Many Christmas Parties were arranged in the Borough for elderly and handicapped people by local organisations. With the aid of a grant from the Mayor's Fund, a large supply of bagged fuel was purchased for issue to elderly persons who, during bad weather, had no heating resulting from the non-delivery of a fuel order. In addition to the aforementioned work which was coordinated by the Council's voluntary welfare liaison officer, much other voluntary work came to the notice of the Department which had been carried out independently of this scheme. Friendly Visiting, etc. Some 290 old people were receiving calls from voluntary visitors, reporting directly to the department. In addition, seven school groups, fourteen church groups and five other voluntary bodies were also co-operating in this visiting scheme. Such visitors often spend considerable time with the elderly people and are able to report immediately to the department Should something be amiss. During 1964 a visiting group of the National Old People's Welfare Council carried out a survey in selected areas of the country, including the Woolwich area. The object of the survey was to find out what were the ingredients of a good visiting service for the elderly. The report noted that in this area the Council were sponsoring a number of services, making use of voluntary personnel and aiming to bring most of the services for the elderly under one umbrella. Inter-change of voluntary helpers between all the services was particularly noted, as was the fact that voluntary 165 visitors were also taking part in lunch club work and helping with the mobile meals service. The value of periodic written or verbal reports to the organisers by the voluntary visitors received favourable comment as did the Council's efforts to keep in touch with isolated old people. During March, 1965, a large number of volunteers attended at the Town Hall, Woolwich, for a get-together in acknowledgement of all the work done for the old people of Woolwich. Also in March a special meeting of the Greenwich Old People's Welfare Association was held for the winding up of the Association and to thank voluntary workers for their valuable support in this work. Both local Old People's Committees expressed the sincere hope that everyone then working for the aged citizens in the area would continue to take an active interest in the work for the elderly and assist the new Borough Council in maintaining and extending the first class services for the old people . During the Summer months a meeting of voluntary workers was held to explain the latest developments in the local work for old people and to hear at first hand the views of the volunteers, together with any suggestions for improving the service. The meeting was attended by some 130 voluntary visitors, mobile meals drivers and helpers, lunch club voluntary workers and other volunteers, including car drivers, escorts, hairdressers and leaders of local old people's clubs, working directly with the Council. The New Eltham Townswomen's Guild again ran a stall at the Mayor's Michaelmas Market during October, the proceeds being donated to the Mayor's Christmas appeal for old people. 166 SECTION VI MENTAL HEALTH SERVICES Introduction. In the following pages detailed descriptions are given of the aims and purposes of the mental health services which are being developed in the Borough. Reasonably accurate estimates can be given regarding the incidence of mental subnormality, but the degree of mental illness in the community requiring the attention of the local authority is difficult to estimate correctly. According to the most recent figures available, if Greenwich is typical of the national average we can expect somewhere in the region of 700 of the population to be mentally subnormal, of which total perhaps 180 at any one time will be under the age of 16. Because of the care taken by midwives and health visitors in compiling the "At Risk" and "Handicapped" registers, it is doubtful if many mentally handicapped children do not come to the notice of the department. Nevertheless, even with all precautions some can escape ascertainment, especially children under the age of five. The numbers of mentally ill in Greenwich who may require community services may be about 600, but this figure can be nothing more than an intelligent guess. In any case these numbers are not static. Population is a dynamic agglomeration. The birth rate fluctuates. The differential age structure is changing perceptibly. The expectation of life of the mentally disordered and handicapped is increasing with new methods and treatment. All these factors, complicated in themselves, have an influence at any one time on the numbers who may require community support. The services have therefore to be geared to a reasonable expectation of possible requirements and, apart from the broad and obvious purpose of helping the disordered and handicapped to live as useful and purposeful a life as the limits of their disability will allow, a great deal of public education and enlightenment on these important questions is desirable and it seems that this can only be done by the local authority. Great stress is now being laid on the fact that these patients are part of a family and members of the community, and both families and the community have to be educated to accept them and to play their part in this new field. It may be asked where prevention comes into these endeavours. Prevention embraces genetics, heredity and sociology as well as neurology and psychiatry, and it is difficult to see, in the present organization of society, great and spectacular advances on a wide front. Nevertheless, certain types of mental illness can be prevented 167 by timely intervention. Such things as endocrinal disturbance and metabolic disorders are amenable to medical diagnosis. The possible place of eugenics in these intractable problems has yet to be developed and considered. Heredity and sociological factors are more difficult and a great deal of research into social pathology is required before any tentative conclusions can be advanced. The hospital and local authority services might be deemed to be secondary prevention inasmuch as treatment, support and rehabilitation prevent a recurrence of the illness, and it is in this light that the local authority services have been organized and should be judged. All the services described below are to some extent based on an empiricism, and the approach and results will have to be assessed over a period of years. Mental Health Officers In respect of persons suffering from mental disorder and where the appropriate relatives are unwilling or unable to make application for the admission of such persons into hospital or into guardianship then, in accordance with the provisions of the Mental Health Act, 1959, the Mental Health Officer (statutorily entitled Mental Welfare Officer) is required so to do. Before undertaking this procedure, which he does entirely on his own responsibility, the mental welfare officer must satisfy himself not only that such an application ought to be made but that, having due regard to the wishes of relatives and taking other relevant circumstances into account, it is necessary or proper for the application to be made by him. It is his duty to escort and convey mentally disordered persons to hospital and, subject to the provisions of the Act, any person absconding from hospital or guardianship may be taken into custody and subsequently returned thereto by the mental welfare officer. Moreover, where an officer has knowledge that a person suffering from mental disorder is living alone, or is being cruelly treated or neglected, he has a duty to apply to the Court for a warrant to enter such premises with a view to ascertaining the situation. Apart from emergency applications where only the medical recommendation of the patient's own doctor is required, it is necessary to obtain a further medical recommendation from a doctor approved by the local authority as being experienced in the diagnosis and treatment of mental disorder. Arranging for the visits and co-ordination on the part of doctors often proves difficult and time consuming, most cases taking a minimum of half a day but often considerably longer. Greater emphasis is given to prevention than to 'aftercare' but before, during and after necessary hospitalisation when advising. 168 assisting and counselling the patient and his family, the mental welfare officer, acting as a social worker needs infinite patience, tact and understanding. Often this entails greater work with the family than with the patient. Arrangements are made for attendances at out-patient clinics, day centres, clubs, etc., and for admissions to hostels and homes. With subnormality, the officer arranges for attendances at clinics, training centres, clubs and. in addition, for long and short term care to relieve family stress. Again support for relatives is imperative. Mental health officers are in constant day-to-day communication and contact with hospital consultants and social workers and a general case conference is held at Bexley Hospital on the first Friday of each month. One officer is in attendance at the Miller Hospital clinic on Wednesday afternoons and another attends Castlewood Day Hospital for three or four sessions per week. At this latter hospital the Council employs an art therapist for two sessions per week as well as a full time occupational therapist. Furthermore, a mental health officer is in attendance at all training centre medical examinations and at the Special Clinic, held on Thursday of each week at 105, Shooter's Hill Road. While the Principal Mental Health Officer is present at the weekly Wednesday afternoon clinic conference at Goldie Leigh Hospital, his deputy attends the educationally subnormal schools for the maladjusted with a view to discussing with the respective head teachers suitable 'after-care' for school leavers. As required, mental health officers attend case conferences and liaise with statutory and voluntary agencies. Good relationships with local general practitioners have been established and, in order to enable these relationships to become more personal and therefore more effective, the area of the Borough has been divided into twelve districts each with its own officer, thus enabling a doctor in any particular area to get to know its respective mental welfare officer more closely. For the most part, it is the object of the mental health officer to liaise between doctor, patient and hospital and to relieve general practitioners of duties other than those of a purely medical nature. Whenever he feels it necessary, the officer contacts the doctor or the hospital reporting either satisfactory progress or deterioration in a patient's condition. Mental health officers need to have a complete knowledge of the Acts relating to mental disorder, a comprehensive knowledge of statutory social legislation and of other statutory and social agencies concerned with their work. 169 COMMUNITY SERVICES FOR THE MEDICALLY SUBNORMAL Referrals are received mainly from the Nursing Service which is responsible for the 'At Risk' register and whose information is obtained from hospitals, midwives, M. & CW. clinics, doctors and health visitors. Others originate from the Education Authority. If a child is, or appears to be mentally retarded, arrangements are made for him/her to be seen at a Special Clinic to which the parents are invited, transport to and from the clinic being provided where necessary. A child found to be retarded is seen at three monthly intervals but, if conditions other than mental are revealed, then the child is referred to the general practitioner or appropriate hospital department. It is not usual for children to be seen before the age of two years but at the age of five years they are subject to statutory examinations in accordance with Section 57 of the Education Act, 1944, and if found necessary they are either recommended for attendance at Special Schools or referred to the Local Health Authority for admission to training centres. At the request of a parent, but in any event at approximately yearly intervals, a child is re-examined. In a case where education at a special school is found to be unsuitable, the child is referred to the local health authority for admission to a training centre and, conversely, if a child attending a training centre is found to be educationally suitable, transfer to an appropriate school is arranged. SPECIAL INVESTIGATION CLINIC Children Seen Greenwich Lewisham No. of new referrals 19 7 No. of old cases seen 16 10 Disposal of Cases—Since investigation, 9 Greenwich children have been admitted to Maze Hill Junior Centre, 6 to the Eltham Creche and 5 not to re-attend. Prior to attaining the age of 16 years, mentally handicapped school-leavers are brought to the notice of the mental health service and, as previously indicated, the question of 'after-care' is settled by discussions between the deputy principal mental health officer and the school head. Similar steps are taken with regard to maladjusted school-leavers at the age of 15 years since these children are classified as mentally ill. There is the closest co-operation between the Mental Health Service and that of the Divisional School Care Organiser. It is the policy for community care to cease at the age of 18 years provided employment is well tolerated and no adverse reports are received. 170 Eltham Nursery This nursery was established by the Woolwich and Greenwich Society for Mentally Handicapped Children and received grants from the former London County Council to cover a substantial portion of the running costs. This policy has been continued by the new Authority. Contact with the nursery is maintained by the mental health officer for the Eltham area who visits it two or three times a month and also attends the medical examinations at present undertaken by a Medical Officer on the department's staff. Admissions are regulated by the Medical Officer and every effort is made to transfer nursery children to the Maze Hill Training Centre when they reach years of age. Of the places at the nursery, this Council has assumed responsibility for 10, the Borough of Bexley for 3 and the London Borough of Lewisham for 2. The Deputy Principal Mental Health Officer serves on the Nursery Committee and also attends the Society's general meetings. In the past, the Society has provided amenities such as record players for the department's centres and always makes generous contributions towards Christmas parties of the junior and senior centres. Such kind interest is greatly appreciated. Darenth Park and Goldie Leigh Hospitals Both formal and informal links have been established by the department with these two important hospitals and consultation and exchange of information is much closer since 1st April of the current year. Undoubtedly, however, there is a great deficiency of beds in the area for mentally subnormal children but, due to improvements and expansion in the local community care services, a freer exchange of patients will be possible in the future and perhaps larger numbers of these children will be able eventually to be accepted into the community. The hospital authorities realise that there are patients who by the nature and severity of their disabilities must be admitted to or remain in hospital care. Boarding Out A few adult subnormals are boarded out with local landladies and where the patient is unable to earn sufficient for his keep or where statutory benefits fall short of need, facilities exist for the Council to subvent. Long and short term care schemes are successfully introduced and advantage is taken of hospital facilities, approved voluntary homes and of private accommodation supervised by the Brighton Guardianship Society. Financial responsibility is assumed by the Council and no charge accrues to the parents but the Council's assessment scale is applied to adults entitled to National Assistance. 171 Holidays A scheme to provide an organised holiday during the first two weeks in May at St. Mary's Bay Holiday Camp, Dymchurch, for trainees from centres has the support of all London Boroughs. It is intended to cater for those trainees who would otherwise have no holiday. A charge of approximately £4 per week is levied but this is subject to abatement under the Council's assessment scale and some trainees pay only a few shillings. Other holidays are dealt with under the short term care schemes. Clubs Club facilities for the 'over 16's' are provided on Thursday evenings at the Park Vista Centre and attendances usually range between 25 and 30. Managed mainly by members of the Blackwall Centre staff, the club is visited on occasions by the Principal Mental Health Officer. At the Albany Institute, Creek Road, a club organised by the Blackfriars Settlement caters for the needs of boys and girls from the Greenwich and Lewisham boroughs and this Council meets half the cost of the social worker's salary. The Court Youth Club held at the Congregational Church Rooms, Court Road, Eltham, on Monday evenings encourages the mixing of normal 'teenagers' with the mentally handicapped but this attempt at integration has not been too successful. This venture is entirely voluntary and no financial responsibility devolves on the Council. Support is provided by the Council in the shape of a minibus to convey children on Wednesday evenings to a club at Griffin Manor School which is organised for the 'under 16's' by the Woolwich and Greenwich Society for Mentally Handicapped Children. Attendances vary between 18 and 20. Hostels At present there is no Borough Hostel. Such a situation will persist until the completion of the one envisaged at Ashburnham Grove where the intention is to provide emergency long and short term care for 25 subnormal girls and boys between the ages of 3 and 16 years. While in occupation at this Hostel, the children will attend the Maze Hill Training Centre. Suitably placing the '16years-old' who cannot be accommodated in private lodgings will constitute a serious problem but consideration may be given in the future to a scheme involving co-operation with an adjacent authority to provide adult hostel accommodation on a shared basis. 172 Eight Greenwich patients hold places at Honor Lea Hostel, Lewisham, and a further 11 are accommodated as follows:— One each at Hill House, Elstree, and the Susheila Community, Dorset, and the remainder at Mental After Care or National Society for Mental Health Homes at Margate, Westgate, Esher, Cliftonville, South Croydon, Northampton, Hastings and Ipswich. Ministry of Labour There is normal co-operation with the local Disablement Resettlement and Youth Employment Officers who, unfortunately with little success, endeavour to place into employment subnormals who, perforce, must therefore remain in the care of the Mental Health Service. It would appear that more favourable results are obtained by the direct approach to employers for as problems arise they can be brought immediately to our notice. Park Vista Training Centre Held on lease (18 years unexpired), this Centre comprises the ground and first floors of the premises of a private undertaking and provides facilities for 60 adult girls, 38 of whom are Greenwich residents. Its ground floor accommodation consists of, (a) a large room used as the supervisor's office and for medical examinations, (b) a further large room, capable of being divided into two rooms by a movable partition, which is used for the work and training of the most severely subnormal girls and, (c) a dining room and kitchen adapted from its previous use as a Hall. Although meals for the centre are supplied by the School Meals Service, the latter rooms are used for the teaching of plain cooking and laundering. Outwork and training are carried out in the main hall on the upper floor which is also utilized on Thursday evenings by the Park Vista Club. Outwork is simple and consists mainly of carding stationery display cards while other occupational work carried out includes needlework, knitting, rugmaking, etc. Trainees are conveyed to the centre by coach. The possibility of keeping the centre open during school holidays must be explored although it is evident that serious practical difficulties exist. One obvious advantage of such a scheme would be that industry might more easily be persuaded to provide the centre with work. Moreover, boredom of the trainees resulting from inactivity could be avoided and, as an added benefit, relatives would enjoy greater relief from responsibility. If Lewisham were able to accommodate its own 15 girls who use the centre then a conversion should be possible enabling it to 173 deal with mixed trainees. Transfer of the 17 Greenwich boys from Knoyle Street could be entertained although this would necessitate male staff being recruited. Knoyle Street Centre There are 17 Greenwich boys attending this Centre which is held in a Church Hall and is under the control of the London Borough of Lewisham. Woodwork, basket making, etc., are the main activities but more recently, work involved in dismantling telephones has been obtained from the Post Office. Boys are conveyed to and from the centre by public transport under the supervision of 6 paid guides. Blackwall Industrial Training Centre This building, which can accommodate 36 trainees, is bright, airy, has good central heating and a well equipped canteen. There are, however, a number of drawbacks in its design, e.g. work and storage spaces are generally inadequate, work in progress has to be stored on wall shelving in the workshops which are already too small for their purposes and all completed work has to be stored in the entrance hall to await collection. Types of productive labour which can be undertaken are limited by the size of the workshops and supervision is restricted by the building's lay-out. For example, the outside workshop where 3 printing presses are located requires the constant presence of an assistant supervisor and yet the workshop will accommodate only 7 trainees. Of the remaining 29 trainees in the 2 workshops in the main building, one group is under the control of the supervisor and the other under that of the assistant supervisor. Due to clerical and general administrative duties and the operation of the 'leave' rota the assistant in the main building is frequently found supervising both workshops. Where possible it Is the aim of the Centre to bring the standard of ability of trainees to such a level that they can compete in the open market. Where this object proves unattainable, the policy is to teach them to be emotionally stable and socially acceptable in order that they may live harmoniously within the community. During the year efforts have been directed to diversifying the industrial activity in order that work of a more complicated type could, with advantage, be accepted. The trainees have shown great versatility in adapting themselves to simple light industrial processes and further advances are possible. Contract work undertaken by the Centre is mainly on behalf of a firm of stationers suppliers and concerns the making of 'counter displays' and the carding of general stationery products. Although outwardly simple, such work has inestimable value in 174 training for it involves co-ordination, manual dexterity, colour recognition, collating, pattern following, simple reading and finally counting of finished articles. All operations are performed by the trainees. Three platen heat printing presses which stamp calibrations on to plastic geometric instruments such as protractors, set squares and rules have been provided by this same firm which also furnished two heat sealing machines and one pillar drill. More recently, the Centre has been engaged in contract work for a large local electrical and telecommunications firm and the trainees are now engaged in assembling telephone components. An attempt was made to repair wooden park benches for the Greater London Council but the size of our premises was found to be inadequate for this enterprise. Apart from the industrial aspects of the centre, a weekly swimming session is held at Greenwich Baths and November of the current year saw the first and, so far only proficiency certificate gained. In addition, at St. Mary's Bay Holiday Camp, Dymchurch, an annual fortnight's holiday is organised for the trainees. Aided by voluntary helpers, the staff are responsible for the Evening Social Club held weekly at the Park Vista Training Centre which caters not only for trainees from the Park Vista and Blackwall Centres but also for other resident subnormal adults. As well as table tennis, ten-pin bowling, rounders, hockey and dancing the activities include football, cricket, badminton and physical education. Maze Hill Junior Centre General This centre, which was purpose-designed on a difficult site, was well on the way to completion when the Borough inherited it from the London County Council. After certain modifications were made in respect of internal design and equipment, and some safety factors given urgent attention, the Centre was taken over on 14th December of the current year. A detailed description of the organization and methods employed is included below and it will be seen, and this should be emphasised, that the centre is run on strict educational lines. An attempt is being made to create a school atmosphere, and the dichotomy which could develop between the education authority and the local health authority because of differences of emphasis or purpose in the Mental Health and Education Acts has been effectively eliminated. No arbitrary limit is placed on educability or ineducability on the basis of an intelligence quotient estimation. Each child is considered as an individual and his or her aptitudes carefully ascertained. Any skills or functions, however modest, which have a potential for development are encouraged and exploited. 175 Maze Hill Training Centre for the Mentally Handicapped 176 Use of Corridor for Safety First Training Group Activities—Over 5 Years 177 Speech Therapy Nursery Group—Under 5 Years 178 This centre is also to be seen as a part of the whole range of supportive services which are available or will soon become available for the mentally handicapped child. It will take its natural place with the hostel which is being built at Ashburnham Grove as well as with the Adult Centre, the Industrial Centre and the domiciliary services provided by the mental health team. The response of the children to this environment has been heartening. The improvements in behaviour and aptitudes have been remarkable and, almost of equal importance, the parents and relatives of these handicapped children have been made to feel at long last that education and training is a matter of degree and not of segregation and priorities. Parents have regained confidence and feel encouraged to face a future which now holds some promise. Society is taking an interest in these handicaps and it is being demonstrated in the most practical way that even with the most serious incapacities some meaning and purpose can be infused into the lives of these children and their parents. Staff The staff consists of the following:— Head Teacher Deputy Head Teacher Seven Teachers (one with special responsibility) A School Sister Four Guide Attendants A ccommodation The centre provides accommodation for 112 children in 3 main groups, as under: — (1) Nursing Unit Notwithstanding that the unit is intended mainly to serve the needs of 20 children between the age of 3½ and 5 years in the severely subnormal range, a few selected subnormal children w o suffer from specific problems such as walking, speech, self-feedi; g, or behaviour, are accepted in order that they may, with appropriate assistance, subsequently gain entrance to a special school. This nursery is designed to make the change from home and mother to school and teacher as painless and happy a transition as possible and, in a purposefully maintained informal atmosphere, the little isolated entrant is encouraged to become a real member of a group and to participate in its activities. In this respect, a wide variety of pleasant, easy-to-han !le equipment is necessary to provide the stimulating environment so essential for developing the potential of the incoming child. 179 Perhaps for the parents of this group of children, the most difficult problems are those of toilet training and feeding. However, contrary to the stress and anxiety so often encountered in these cases, in the pleasant environment of this well designed unit these difficulties are handled with the minimum of fuss by an efficient staff. (2) Education and Training Centre Catering for a total of 80 children between the ages of 5 and 16 years, the centre is organised into four classes each of 20 children including a transition class for boys and girls aged 14 to 16 years. Ideally, classes should be limited to 10 children but the teaching staff have coped admirably with the difficulties arising from classes of 20. This has been achieved largely by subdividing the classes into several small groups and introducing children into a group most suitable to their aptitude and ability. The scheme has been made possible by utilizing the wide corridors which make excellent additional areas for project teaching. Each child is regarded as an individual and considerable thought is given not only to the development of his/her full potential within a group situation but also to the means whereby a child can be assisted to overcome, as far as possible, its lack of ability. Activity Methods, which are applied throughout the centre, enable each child to learn and progress at its own level of ability and the problems of the brighter child being held back by the less able or the slower child, through constant failure, being frustrated and intractable, are therefore eliminated. Instruction is designed to enable a child to take its place in the community and, to this end, lessons are planned dealing with 'real life situations'. In addition to the basic skills necessary for employment in senior or industrial centres, the elements of personal h> iene and the simple social graces are also inculcated. Simple reading, writing and arithmetic are taught with special reference to word and number recognition so necessary to 'safe-living'. Di cipline is maintained throughout the centre at such a level as wil promote obedience and enable the child to exercise a measure of elf-control and become more emotionally stable. It is the intention of centre training to have regard to the whole personality of a child and not only to prepare him/her eve Uually for undertaking employment but also to encourage the use of leisure hours to advantage. 180 (3) Special Care Unit With the object of accommodating 12 very severely retarded children suffering from other handicaps, this unit, at first sight, would appear to meet the needs of the parent rather than the child. However, while the value of the unit to the parent should not be underrated, the service is not to be considered as merely one of child-minding. On the contrary, it must be, and indeed it is, a training unit in as much as the children are being helped towards greater independence. On admission at the age of 5 or 6 years, some children are still bottle-fed and much skilled and patient teaching is required to assist them to surmount the physical handicaps which make self-help so difficult. A great sense of achievement is felt when a previously helpless child begins to spoon-feed itself. Of all the groups this one, perhaps more than any other, needs to be taught leisure-hour activities in order that the many hours spent by its members in wheel chairs at home may, in fact, be those of leisure and not of boring and deleterious idleness. It may well be that many children in this unit will never be able to undertake employment even under sheltered conditions but their lives can be made less irksome if as a result of training, they can occupy themselves and are able to engage in a modicum of selfhelp. It is fundamental to the success of the centre that every effort be made to create a stimulating and happy atmosphere, an environment within which children are given the best of opportunities to assimilate and adjust. TRAINING CENTRE STATISTICS Centre Number of Places Number of Greenwich Cases attending Park Vista (Adult Girls) 60 38 Blackwall Industrial (Adult Girls and Boys) 35 22 Maze Hill (Junior) 112 *56 Deptford Boys Knoyle Street, S.E.14 (Adult Boys) 65 17 Perry Rise, S.E.23 120 1 (Junior) Brighton Guardianship Not known 5 * In process of expansion to capacity. 181 COMMUNITY SERVICES FOR THE MENTALLY ILL Interpretations of 'community care' are many and varied but in the Mental Health Act of 1959 the aim was twofold, firstly to care for the mentally ill in the community at large and to educate the public to accept them and secondly to care for the mentally ill in their home environment and within the community of their own relatives and friends. It has been truly said that, provided tolerance and understanding on the part of relatives and friends were readily forthcoming and immediate and constant support to the patient and family was given by the mental health officer, then most persons suffering from mental illness could be treated in their own homes. Apart from the support, assistance and understanding required by the mentally ill, a real need exists for their protection against situations calculated to aggravate and precipitate a relapse. Constant reminders to take prescribed medication, physical and mental occupation to prevent boredom and self-pity and regular excursions from the house to give relatives valuable respite, are all m tters indispensable to a patient's eventual recovery and to which the mental health officer must address himself. In this respect, besides the services provided by his own authority, he should utilize the resources of both statutory and voluntary agencies to such effect that all benefits to which a patient is entitled are in fa t provided and the aim to rehabilitate such a person is realized to such an extent that a return to gainful employment is achieved. Within such a concept, the provision of Day Centres and Clubs is ssential but the vital link is the complete trust and confidence bu It up by the close personal relationships established between a mi itally ill person and the mental health officer. For those persons who have no home of their own or where accommodation is denied by relatives, hostel residence for a period of 'to 12 months is indicated. This time should be used profitably by placing occupants into employment or arranging for their atti 'idance at day centres with a view to rehabilitating them to sutri an extent that eventually a return home or into lodgings can be effected. (Without doubt a case can be made out for the provison of flatlets for such persons.) Subsequent supervision from the mental health officer could then be minimal. 182 Psychiatric Services Clinics, etc. Out-patient clinics for psychiatrics are held as follows: — Greenwich District Hospital (a) Miller Wing Monday morning Wednesday morning and afternoon Thursday afternoon (b) St. Alfege's Wing Monday evening Tuesday morning (Children's Diagnostic Clinic) Thursday afternoon St. Nicholas Hospital Monday afternoon Wednesday afternoon Friday afternoon Seamen's Hospital Tuesday afternoon Woolwich Memorial Monday afternoon Hospital Wednesday afternoon Thursday friday } All day Domiciliary visiting is carried out in most cases, for the Bexlcy Hospital policy is not to admit unless patient has been seen by one of their consultants. Mental Hospitals apart, there are only 3 doctors in the Borough approved in accordance with the Mental Health Act and the situation would be eased considerably if more local general practitioners could be so authorised. A ccommodation Although the number of beds available to our psychiat ic patients is unspecified, little trouble is experienced in obtaining i dmission of adults to Bexley Hospital within whose catchment ar a this Borough falls. Our difficulties arise with the children for, other than at the Maudsley Hospital which caters for the country as a whole and is therefore very selective, no such accommodation is available to them. A few psychotics from the old Metropolitan Borough of Greenwich are admitted to Mabledon Park Hospital, Dartford, and restricted use is made of the emergency accommodation at St. Francis Hospital, Dulwich. Limited treatment is afforded at the Castlewood Day Hospital. 183 Cast lew ood Day Hospital Formerly a small hospital annexe, these premises consist of treatment, consulting and day rooms with office and dining accommodation. With the exception of the social worker, all staff are hospital appointments and the present establishment is as follows: 2 Psychiatrists—registrars or senior registrars (one full time— one 2 days per week) 1 Nursing Sister 1 Staff Nurse—Female 1 Staff Nurse—Male * 1 Occupational Therapist * 1 Art Therapist (2 sessions per week) * 1 Social Worker (3 or 4 sessions per week according to need) 1 Secretary (part time) Kitchen Staff * Council responsible for salary The number of patients varies between 25 and 45 but, for the reasons of comfort, is usually in the 30's range. Treatment is physically orientated but discussion groups are held and some counselling is undertaken by the psychiatrists. In this unit the majority of patients are neurotics or depressives and supervision of treatment is assumed by the Bexley Hospital consultant psychiatrists who remain the sole sources of referral which is effected almost exclusively through the out-patient clinics. This day hospital is pleasant and reasonably accessible. As a unit, it might be more effective if detailed consideration could be given to its precise local function and significance in the light of the developing community mental health services. There are also staff deficiencies with frequent changes and it seems that advantage would flow from the appointment of a consultant psychiatrist, either full time or part time, with exclusive responsibility for the day-to-day management and control of the day hospital. Divided responsibility disrupts continuity and brings confusion. Consideration should also be given to broadening the field of referral. Despite these criticisms, however, it would be wrong to minimise the usefulness of this facility, and the day hospital has great local potentiality. Day Centres Chevening Road Catering for adult mentally-ill of both sexes, this clinic is held on Thursday from 10 a.m. until 4 p.m. Arrangements are made for a mid-day meal which the members themselves help to prepare 184 on the premises. Occupational therapy is supervised by a Council's social worker and attendances are normally in the range of 15 persons. Federation Hall (Proposed) When adapted as a Day Centre and in full use, this building, held by the Council on an unexpired lease of 20 years, will provide places for 60 persons. At present the intention is to commence at a level of 25 to 30 persons with a controlled expansion to the higher figure. Initially, there will be 3 supervisory staff and 1 cleaner. It will be the object of the Centre to rehabilitate persons who are suffering, or have suffered, from mental illness to a position whereby they may return to gainful employment. Inevitably some chronic cases will not respond but beneficial effects will be felt by relatives who, from time to time, will be relieved of their responsibilities when these cases attend the centre. Suitable outwork can be obtained from local industry which will result in minimal payments being made to patients in addition to their statutory allowances. Fares to and from the Centre will be paid and patients will be provided with a midday meal. Provision for medical supervision is contemplated and a room at the rear of the premises is to be suitably furnished and equipped to accommodate up to 20 senile persons for similar purposes. Opportunity can be taken to utilize the Centre for evening club and group activities. Therapeutic Clubs Club Day Staff A ttendances 'Tideway Club', Albany Institute, Creek Road, S.E.8. Wednesday evening (Shared with neighbouring Borough of Lewisham) Mental Health Officers from both Boroughs Between 25 and 30 'Castlewood', Shooter's Hill, S.E.I 8. Tuesday evening (Day patients only) Bexiey Hospital Appointees Between 20 and 30 'The Links' Castlewood, Shooter's Hill, S.E.I 8. Friday evening (For ex Bexiey Hospital patients) Bexiey Social Worker Between 12 and 18 'Vanbrugh', Kidbrooke House, Shooter's Hill Road, S.E.3. Monday evening (For ex Bexiey Hospital patients) Bexiey Hospital Occupational Therapist Between 8 and 16 A therapeutic group for alcoholics supervised by a bexiey Hospital consultant psychiatrist meets at Castlewood on Wednesday evenings. 185 NUMBER OF PATIENTS UNDER L.H.A. CARE AT 31.12.65 Mentally 111 Psychopathic Subnormal normal and severely subnormal Grand Total Under a ere 16 le and over Under age 16 16 and over Under age 16 16 and over Under agre 16 16 and over M F M F M F M F M P M P M P M F Under age 16 16 and over (a) Total number 5 3 211 391 - - - - 20 14 91 95 58 50 78 81 142 345 1097 (b) (i) Attending: day training centre - - 7 23 - - - - - 1 2 7 36 22 29 41 59 79 168 (11) Awaiting entry thereto - - - - - - - - - - - - 6 7 2 - 13 2 15 (c) (1) Resident in residential - - - - - - - - - - - - - - - - - - - (ii) Awaiting residence therein - - - - - - - - - - - - - - - - - - - (d) (1) Receiving home training - - - - - - - - - - - - - - - - - - - (11) Awaiting home training - - - - - - - - - - - - - - - - - - - (e) (1) Resident in L.A. home/hostel (11) Awaiting residence in L.A. home/hostel (111) Resident at L.A. expense in other residential homes/hostels (lv) Resident at L.A. expense by boarding out in private household - - 1 8 - - - - - - - - - - - - - - 9 - - - - - - - - - - - - - - - - - - 1 - - 5 6 - - - - - - - - 1 4 - 2 5 2 18 - - - - - - - - - - - - 1 1 - 3 2 3 5 (0 Receiving home visits and not included under (b) to (e):— (1) suitable to attend a training centre - - - - - - - - - - - - - - - - - - - (11) others 6 2 197 354 - - - - 20 13 89 88 14 16 47 35 63 259 880 3. Number of children under age 16 attending day or residential training centres who have not been included In above table because they do not come within the categories covered Male - Female - 186 NUMBER OF PATIENTS AWAITING ENTRY TO HOSPITAL. OR ADMITTED FOR TEMPORARY RESIDENTIAL CARE DURING 1965 Mentally ill Psychopathic Subnormal Severely subnormal Total subnormal and severely subnormal Grand Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over ! Under age 16 16 and over M F M F M F M F M F M F M F M F Under age 16 16 and over 1. Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.65 (a) In urgent need of hospital care - - - - - - - - - - - - 7 5 - - 12 - 12 (b) Not in urgent need of hospital care - - - - - - - - - - - - - - - 1 - 1 1 (c) Total - - - - - - - - - - - - 7 5 - 1 12 1 13 2. Number of admissions for temporary residential care (e.g. to relieve the family) (ft) To N.H.S. hospitals - - - - - - - - - - - - 23 13 1 2 36 3 39 (b) To L.A. residential accommodation - - - - - - - - - - - - - 1 - - 1 - 1 (c) Elsewhere - - - - - - - - - - - - 7 11 2 5 18 7 25 (d) Total - - - - - - - - - - - - 30 25 3 7 55 10 65 187 NUMBER OF PATIENTS REFERRED TO LOCAL HEALTH AUTHORITY DURING YEAR ENDED 31st DECEMBER 1965 Referred by Mentally 111 Psychopathic Subnormal Severely subnormal Total subnormal and severely subnormal Grand Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F Under age 16 16 and over (a) General practitioners 3 - 52 88 - - - - - - - - - - - - - - 143 (b) Hospitals, on discharge from in-patient treatment 1 - 73 132 - - - - 1 - 6 8 2 - - - 3 14 223 (c) Hospitals, after or during out-patient or day treatment - 1 20 34 - - - - 1 - - - - 2 - - 3 - 58 (d) Local education authorities - - - - - - - - 6 1 26 14 6 3 1 - 16 41 57 (e) Police and courts - - 12 11 - - - - - - 2 1 - - - - - 3 26 (0 Other sources 3 - 88 105 - - - - 2 3 2 7 1 4 - 1 10 10 216 (g) Total 7 1 245 370 - - - - 10 4 36 30 9 9 1 1 32 68 723 188 SECTION VII ENVIRONMENTAL HEALTH SERVICES As from 1st April, 1965, the London Government Act, 1963, affected health legislation relative to the former Metropolitan Boroughs in that the Public Health (London) Act, 1936, and various provisions in the London County Council (General Powers) Acts were repealed. With effect from this date the Public Health Acts, 1936 and 1961, previously and predominantly applicable to the provinces, became operative in Metropolitan London. For the newly established Inner London Boroughs these Acts involved amendments to, or replacements of, existing notices and different methods of administrative procedure in relation thereto. New Legislation Shops (Early Closing Days) Act, 1965—The principal provisions of this Act, which consequentially amend the Shops Act, 1950, provide for a shop's early closing day to be selected by its occupier and they abolish the local authority's power to change the closing time on early closing days and that of extending early closing day requirements to exempted shops. The Act is effective from 5th August, 1965, except in relation to any proposed alteration in the early closing day and, in this respect, a three months' notice must be conspicuously displayed in the shop specifying the different day, provided an Order fixing an early closing day was not in force immediately prior to the date of the commencement of this Act. In this event, the Order would continue in force for three months from that date unless revoked during that period. Rent Act, 1965—With the exception of Part II (Registration of Rents) which is to become operative on such dates as may by Orders be appointed, this Act came into force on 8th December, 1965. It is now a criminal offence for anyone to evict a tenant of whatever type of accommodation without a Court Order, or to drive them out by threats, violence or any other interference. Existing "controlled" tenants already have security of tenure under earlier Rent Acts, i.e. their removal can only be by Court Order within the strict conditions laid down in those Acts. The 189 1965 Act keeps all these rights unchanged and gives similar securiiy to tenants previously outside control prior to its enforcement and who rent private unfurnished accommodation of a rateable value not exceeding £400 in the Greater London Area and £200 elsewhere. A new system is introduced regulating rents of the aforementioned accommodation and rateable values. Rent Officers will be appointed to assist landlords and tenants to agree on "fair" rents and any case of disagreement will be referred to a Rent Assessment Committee which will adjudicate after hearing both sides. Any rent agreed by either method will be registered and will not be varied except by new registration which will not be given within three years unless there is some special reason. The Borough Rent Officer's address is:— 23/25, Woolwich New Road, S.E.18. (Telephone number WOOlwich 7010). Furnished lettings remain under the Rent Tribunals, but there are two important changes. First, the rateable value of such lettings whereby the Tribunals can fix reasonable rents is raised from £40 to not exceeding £400 in the Greater London Area and £200 elsewhere. Second, they can give tenants up to six months' security instead of the original three. The Rent Book (Forms of Notice) Regulations, 1965—These Regulations made under Section 2(1) of the Landlord and Tenant Act, 1962, became operative on 8th December, 1965. They are consequential on the provisions of the Rent Act, 1965, and, (i) revise the forms of notice which have to be inserted in rent books and other similar documents which, under Section 1 of the Landlord and Tenant Act, 1962, are required to be provided for use where the rent is payable weekly in connection with:— (a) premises let on tenancies to which the Rent Acts, 1920 to 1939, apply immediately before the coming into operation of the Rent Act, 1965; and (b) premises occupied under contracts to which the Furnished Houses (Rent Control) Act, 1946, applied immediately before that date, and under contracts to which the Act of 1946 applies by virtue of the Rent Act, 1965; (ii) prescribe a new form of notice which has to be inserted in rent books and other similar documents which, under Section 1 of the Act of 1962, are required to be provided for use where the rent is payable weekly in connection with premises let on tenancies which are regulated under the Rent Act, 1965. 190 The Rag Flock and Other Filling Materials Regulations, 1965—Made under the Act of 1951, these Regulations, operative from 2nd August, 1965, amend those of 1961. They effect a technical alteration in the process of testing for cleanliness, woollen flock and other woollen filling materials. The proportion of animal fibre in such materials which has hitherto been the subject of a requirement under such tests, will now become a standard for grading materials and determining what tests and requirements are applicable. An additional fee for the analyst is preccribed for making such determination by the 'animal fibre' test. There is also a revision in the list of analysts prescribed for testing purposes under the Act. Smoke Control Areas (Authorised Fuels) (No. 2) Regulations, 1965—These Regulations, made under the Clean Air Act, 1956, came into operation on 13th December, 1965, and add to the list of 'authorised' fuels the name 'Multiheat' a commodity previously known as 'Phurnacine'. With regard to Smoke Control Areas, the following Circulars have been issued by the Ministry of Housing and Local Government for the guidance of local authorities. Circular 13/65—Supplies of Smoke'ess Fuels—This Circular refers to a previous Ministry Circular 69/63 which outlined measures advocated for compensating an expected deficiency by 1970 of 2 million tons of gas coke occasioned by the use of liquid methane. Brieflv, Circular 13/65 summarises prospects of additional sunnlies of some reactive fuels, together with the oocsibi'itv of further development of capacity in later years if needed, and indicates that sunpHes of open-grate fuels should be adeouate to meet expected demand although consumers may sometimes have to buy more expensive varieties of reactive fuels when their first preference would be cheaper gas cokes. This expectation of fuel availability is, however, sub'ect to the continuance of the present freedom of choice between fuels and appliances for the purposes of grant under the Act. Circular 51165—Grant Arrangements—Again reference was made to the previous Circular 69/63 which modified princip1es to be observed in determining what adaptations should be trea'ed as 'reasonably necessary' under the Clean Air Act, with particular reference to new solid fuel, gas, electricity or oil appliances and their cost in relation to those provided by local authorities. 191 However, some local authorities have not installed appliances of types in respect of which applications for grant are made and others are installing appliances which the Department would not normally regard as 'reasonably necessary' replacements for existing appliances in smoke control areas. To resolve these difficulties, which this Council has not experienced, the Circular sets out cost limits for various types of appliances and, the principles to be observed by the local authorities in determining what works of adaptation should be treated as 'reasonably necessary', have been consolidated and amended. These principles are in the form of a further revision of Paragraph 26 of the Ministry's Memorandum on Smoke Control Areas. It is for the local authority to decide within the appropriate cost limit, what costs are reasonable and the Minister will, for his part, accept as qualifying for exchequer contribution, expenditure which is acceptable to the local authority and which falls within the limits set out, but he will not normally accept any portion of the cost, excluding that of installation, which exceeds the appropriate limit. The cost limits set out in the Circular were adopted by the Council. Circular 69/65—Tall Buildings and Industrial Emissions— This Circular draws attention to the need for local authorities to give especially careful consideration to proposals for the erection of very tall new buildings where they might be affected by the emissions from existing chimney stacks which serve large industrial installations burning solid or liquid fuels. In such situations, the upper parts of the building may be subjected to undesirable high peak concentrations of sulphur dioxide and the bui'ding, by reason of the down-draughts it creates, might interfere with the normal dispersal of the plume from the stack. It is suggested that both eventualities should be considered whenever the proposed building would be more than two-thirds the height of the existing stack. In respect of distance between either, much depends on the volume and temperature of the emissions, the amount of sulphur dioxide involved, the size and shape of the building and local topographical conditions. Circular 77/65—Estimates and Final Costs—In order to simplify the handling of smoke control orders, arrangements for submission of information about the cost of fireplace adaptations are revised in this Circular with the main changes concerning local authority dwellings. Hitherto, detailed information was required 192 regarding replacements, adaptations or new appliances to be installed and costs of installation. Only the number of dwellings involved and the total costs of work eligible for grant will be required in future. During the current year, the Poisons Order, 1965, added certain substances to Parts I and II of the Poisons List and the Poisons Rules, 1965, were amended to accommodate these additions and also to take into account other amendments insofar as they applied to Part II of the Poisons List. Sanitary Circumstances of the Area The tables on pages 222 to 223 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 29,788 houses and premises have been inspected or re-inspected during the year; 174 Intimation, 800 Preliminary and 358 Statutory or Abatement Notices were served. Registered complaints numbered 5,629. Factories Act, 1961.—During the year 101 inspections were made by the Council's Inspectors in relation to the 749 registered factories. The latter figure includes 93 premises where mechanical power is not used. Defects were found in 4 instances, all of which were remedied. FACTORIES ACT, 1961 Inspections for purposes of provisions as to health. Number on Register Number of Premises Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 93 9 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 645 85 4 - (iii) Other Premises in which Sec tion 7 is enforced by the Local Authority (excluding out workers' premises) 11 7 - - Total 749 101 4 — 193 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 Want of cleanliness (S.l) - _ Overcrowding (S.2) - - — — — Unreasonable temperature (S.3) - - — — — Inadequate ventilation (S.4) - - — — — Ineffective drainage of floors (S.6) - - — — — Sanitary Conveniences (S.7): (a)insufficient , - - — - (b) unsuitable or defective 4 4 — 4 — (c) not separate for sexes — — - — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 4 4 - 4 - Outwork—(Sections 133 and 134) Section 133 Section 134 Nature of Work No. of out-workers in August list required by Sect. 133 (l)(c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing! Making, etc. 74 — — — — — Linen 1 — - - - Lampshades 44 - — - - Colour Cards 2 - — - - Leather Goods 1 — - — - - Total 122 — — — — - 194 Outworkers.—Twice yearly, February and August, the Factories Act requires all employers of outworkers to forward to the Local Authority a list giving the names and addresses of all employed in homework during the previous six months. Notifications received from Greenwich firms of:— (a) Outworkers resident in the Borough 77 (b) Outworkers resident outside the Borough 135 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 60 Total number of Greenwich residents employed as outworkers (as given in August list) 122 Premises where homework is carried on were visited on 92 occasions by the District Public Health Inspectors. In no instance was it necessary to take action because of infectious disease. The Offices, Shops and Railway Premises Act, 1963.— The broad purpose of this Act which, for the purpose of registration came into force on 1st August, 1964, is to give office and shop workers standards of working conditions and safety as favourable as those which apply to factory workers under the Factories Act, 1961. A statistical summary of the Annual Report, as forwarded to the Ministry of Labour in respect of the work carried out during 1965, is given in the following tables:— Registration and General Inspections Class of Premises No. of Premises Registered during year Total No. of Premises Registered at end of year No. of Premises receiving General Inspection during the year Offices 33 318 198 Retail Shops 69 1,110 479 Wholesale Shops, Warehouses 3 43 33 Catering Establishments, Canteens 9 170 53 Fuel Storage Depots 2 5 3 TOTALS 116 1,646 766 195 Analysis by Workplace of Persons Employed in Registered Premises Class of Workplace No. of persons employed Offices 5,208 Retail shops 6,667 Wholesale departments, warehouses 860 Catering establishments open to the public 1,015 Canteens 117 Fuel storage depots 46 TOTAL *13,913 ♦Males: 5,958 Females: 7,955 A total of 1,863 visits including 766 general inspections were made to premises during the year. The principal matters requiring attention were as follows :— Abstract of the Act not exhibited 9 Absence of thermometers 11 „ hot or cold water supply 3 „ first aid equipment 7 „ satisfactory floor covering 2 Lighting Standards—In Circular 9 (Supplement No. 1) dated 8th August, 1965, the Ministry of Labour requested that a special report in narrative form in respect of lighting standards, both natural and artificial, related to inspections carried out in the last quarter of the current year should accompany his 1965 Report. In addition, to setting out points which the report should cover, information was requested to be incorporated about premises inspected during the month of November on :— (i) the number of office premises inspected to check lighting standards, either natural or artificial, at the working place or plane, e.g., desk, filing cabinet, etc.; (ii) standards of lighting in the working areas of shops, etc., stockrooms, packing departments, preparation rooms, etc., compared with those in the selling areas. As a result of the inspections made during the three months period, the lighting standards, both natural and artificial, were on the whole found to be reasonably satisfactory. In shop selling areas the light provided ranged between 30 lumens per square foot in the older shops to 180 lumens per square foot in the modern supermarkets. No problems of excessive glare were encountered. 196 Of the 17 office premises inspected, in only one, viz., that of the Manager of a Funeral Furnishers, was the number of lumens per square foot found to fall below 25. He preferred to maintain a subdued standard of lighting by reason of the nature of his business. During inspections carried out in November, retail shops and stockrooms, etc., were found generally to have satisfactory standards of lighting although, with the exception of newly erected self-service stores, the lighting of each stockroom was below that of the respective shop. However, in only 3 instances was it considered necessary to serve notices. Defective Dwellings.—Repairs—With regard to houses found not to be in a reasonable state of repair, the following procedure, classified under two headings is generally adopted :— (1) Complaints from or on behalf of the occupier.—The District Public Health Inspector makes inspection and a preliminary Notice is sent to the owner specifying the work necessary to abate the nuisance. Where necessary, the circumstances are reported to the Health Committee for authority to serve a Notice to enforce abatement of the nuisance. The premises are reinspected and, if work required is not executed within a reasonable period, an Abatement Notice is served. In cases of noncompliance the Town Clerk is instructed to institute proceedings. Hitherto, under the Public Health (London) Act, 1936, it was obligatory to serve an Intimation Notice but only to specify the nature of the nuisance. (2) Housing Defects.—These are cases where the conditions are such that they cannot be remedied under the procedure of the Public Health Act, 1936, and are dealt with under the Housing Act, 1957, as being houses unfit for human habitation. Representations are made to the Health Committee to consider as to whether such houses can be repaired at a reasonable cost having regard to the value of the premises, or whether Closing and Demolition Orders should be made. Pigeon Nuisance.—A local authority is enabled by Section 74 of the Public Health Act, 1961, to deal with nuisance arising from the congregation of pigeons believed to be ownerless. During the year, 44 complaints were received and, where justified, arrangements were made to reduce the pigeons to a reasonable number by members of the Rodent Control staff or a pigeon catcher engaged by the Council. 197 River Pollution.—In the London area, sewage and its disposal, amounting to a daily dry flow of approximately 300 million gallons, is under the control of the Greater London Council and after treatment at the northern and southern outfalls at Beckton and Crossness respectively, the resultant sewage effluent is discharged into the Thames. It is then considered by various authorities to be a pollutant and the predominating cause of complaint. Although no complaints regarding pollution were made to this department during the current year, a small number in respect of smells emanating from the Greater London Council's Southern Outfall at Crossness were received from residents in the Abbey Wood area. The matter was raised with that Authority and a reply indicated that investigations were proceeding to elucidate the cause. Having been aware of the shortcomings of its sewage disposal system for some considerable time, the Greater London Council (previously as the L.C.C.), in recent years, has sought to improve the position by instituting new processes and improvements. During 1965, decisions were taken by the G.L.C. to introduce, at a cost of approximately £500,000, further aeration plant at the Southern Outfall Works. A solution to the problem complained of by the Abbey Wood residents may well lie in the implementation of these decisions. Storm Flooding.—There were no instances of damage to property due to unusually heavy rainfall recorded during the current year. River Ravensbourne—Improvement and Jurisdiction.— Although no complaints of flooding were received during the year under review, nevertheless, for over a century now at times of heavy rainfall the Ravensbourne has overflowed its banks to inundate the proximal areas, some as many as five times a year. It was for this reason that the River Ravensbourne, etc. (Improvement and Flood Prevention) Act, 1961, was introduced to confer like powers on the London and Kent County Councils for "the improvement and protection of and the prevention of flooding from the River Ravensbourne and its tributaries and for purposes connected therewith". In London it applies not only to the rivers Ravensbourne, Pool, and Quaggy, the Kid Brook, Kyd Brook and the Lower Kid Brook but also to the parts of all tributaries, brooks and watercourses (whether open or covered) that flow into these rivers or streams. 198 Powers were given to both these County Councils to make bylaws and, in the prevention of pollution, (a) to dredge, cleanse and scour the stream, (b) to reduce or remove any shoals, shelves, banks or other accumulation in the stream, (c) to abate or remove, or cause to be abated or removed, all or any impediments, obstructions or nuisances whatsoever in the stream or on the banks thereof. Such powers included the purchase of any necessary land by agreement or compulsorily and the prohibition of the deposition of any articles, matter, etc., in the stream or on the banks. Dredging of streams covered by the Act was also prohibited except with the express permission of the respective County Council. The County Council's consent was also required in connection with the erection of any buildings, etc., in or over the said streams. By virtue of the London Government Act, 1963, the functions of the Kent County Council under the Act became the responsibility of the G.L.C. from 1st April, 1965. ATMOSPHERIC POLLUTION At the time of amalgamation, the Boroughs of Greenwich and Woolwich were actively dealing with applications for works of conversion or adaptation in respect of previously confirmed Smoke Control Areas. Slight differences of policy in the manner each Borough had previously carried out its Smoke Control Programme were resolved, chief of which was in regard to publicity. In this connection the following procedure is now effected by which means residents of an Area, approved in principle, are given information and advice appropriate to the various stages which ensue. (1) Letters are sent:— (a) some 6 months preceding the anticipated date of making the Smoke Control Order enclosing an explanatory booklet; (b) following the making of the Order by the Council and coincident with an advertisement to that effect in the local press; (c) following the confirmation of the Order by the Minister of Housing and Local Government; (d) some 3 months prior to the operative date, to residents from whom applications have not been received. 199 (2) Where an Area is predominantly private property, the holding of a Public Meeting shortly after the date of confirmation by the Minister. In this event, requisite information is incorporated in the letter sent under (1) (c). During the year 2,468 grants amounting to £57,670 13s. 2d. were reported to and approved by the Council. These grants were in respect of applications for works of conversion or adaptation carried out which had previously been proposed by the applicants and approved by the Council within the appropriate cost limits. However, Section 95 of the Housing Act, 1964, gives a local authority, inter alia, discretion on the payment of grant in respect of such works effected without prior approval. One hundred and twenty-two discretionary grants amounting to £2,508 4s. 7d. were so reported and approved, giving a consolidated figure of 2,590 grants totalling £60,178 17s. 9d. In cases of financial hardship, a local authority also has discretion under Section 12(1) of the Clean Air Act, to pay more than the 7/10ths grant. The Council decided to pay the full cost of reasonable and necessary works of conversion or adaptation in the case of application from owner/occupiers who are retirement pensioners and in receipt of National Assistance. Twelve such payments were approved in the year. A further seven payments were approved in respect of retirement pensioners who, although not in receipt of National Assistance, would have been so entitled had they chosen to apply. These additional costs are now borne jointly by the local authority and the Government as provided in Section 95 (7) of the Housing Act, 1964, and the Government contribution in these cases is 4/7ths of the grant paid. The Council, in respect of 271 late applications, authorised the service of statutory notices under Section 12 (2) of the Clean Air Act, 1956, thereby enabling the payment of grant. Section 3 of the Clean Air Act requires that new furnaces not used mainly for domestic purposes and exceeding a capacity of 55,000 B.T.U's. shall, as far as practicable, be smokeless. Any person installing such a furnace must give prior notice to the Council and may submit detailed plans and specifications for the Council's approval before the works of installation commence. Two approvals were given in 1965. In the Summer, preliminary arrangements for the formation of two further Smoke Control Areas were completed and the Council declared both Areas on 14th July, 1965. Details of these Areas are as follows :— 200 Brook This is an Area of some 290 acres comprising 1,885 permanent dwellings, of which total 62 are Borough Council, 950 Greater London Council and the remainder privately owned. In addition there are 34 commercial premises and 7 other premises. Plumstead This is an Area of predominantly private property comprising some 324 acres and 3,733 dwellings. Of this total 180 are Borough Council, 25 Greater London Council, 3,513 privately owned and the remaining 15 Borough Council temporary dwellings. Included in this Area are 226 commercial premises and 23 other premises. In respect of both Areas it is estimated that 75 per cent, of the dwellings require some form of conversion or adaptation and their operative date is 1st December, 1966. Following their confirmation by the Minister, Public Meetings were held in each Area whereby residents were able to make enquiries to members and officers of the Council. In addition, local fuel suppliers and representatives of the London Electricity Board and South-Eastern Gas Board attended, to reply to questions relative to their particular organisations and to provide displays of appliances. Both meetings were very well supported. On the same date as the Brook and Plumstead Smoke Control Areas were declared, the Council approved in principle the Blackheath Park Smoke Control Area with a view to it being declared in the Summer of 1966. This Area comprises approximately 626 acres and 3,450 properties. At the end of the year there were 6,051 acres and 39,945 dwellings within operative Smoke Control Areas, and a further 1,028 acres and 7,204 dwellings within Areas being brought into operation. Details in respect of these Areas are set out in the table on page 201 and their respective coverage of the Borough shown on the accompanying map. Within the Borough a Senior Clean Air Inspector and a team of two Clean Air Inspectors and three Technical Assistants are employed full-time on duties in connection with atmospheric pollution and with the surveying and inspections of properties in Smoke Control Areas. Such duties involved a total of 9,021 inspections and visits. The Council's date for the whole Borough to be smokeless is 1970. 201 Pollution Recording—Nine atmospheric pollution measuring stations are maintained by the Council and the daily mean concentration of smoke and sulphur dioxide are calculated on readings taken at these stations. No heavy atmospheric pollution was recorded during the year. Rent Act, 1957.—The following table gives details regarding applications received, certificates issued and action taken during the current year in accordance with the Rent Act, 1957 :— PART I—Applications for Certificates of Disrepair Number of applications for certificates13 Number of decisions not to issue certificates — Number of decisions to issue certificates: (a) in respect of some but not all defects 7 (b) in respect of all defects 4 — 11 Number of undertakings given by landlords 4 (under para. 5 of 1st Schedule) Number of undertakings refused by Council — (under proviso to para. 5 of 1st Schedule) Number of certificates issued 10 Name of Area Operative Date Approximate Acreage No. of Dwellings No. of Industrial Premises No. of Commercial Premises No. of Other Premises St. Mary's 1.10.58 26 595 Nil Nil 2 Abbey Wood (Abbey Estate) 1.11.58 202 2,515 1 17 9 Abbey Wood 1.10.59 157 1.251 Nil 13 3 Middle Park (North East) 1.10.60 163 1,122 Nil 16 6 Middle Park (South West) 1.10.60 100 722 Nil Abbey Wood No. 2 1.10.60 78 1,150 Nil 24 4 Clothworkers Wood 1.10.60 260 1,868 Nil 12 4 Greenwich No. 1 1.10.60 76 985 6 40 10 Coldharbour 1.10.61 350 2,806 Nil 33 4 Abbey Wood No. 3 1.10.61 380 1,973 2 59 2 St. Mary's No. 2 1.10.61 26 596 Nil 14 Nil St. Mary's No. 3 1.11.61 12 Incourse of Nil Nil Nil construction Greenwich No. 2 1.7.62 63 1,587 2 70 14 New Eltham 1.10.62 380 1,916 Nil 68 18 Greenwich No. 3 1.10.62 49 891 6 49 7 Garrison North 1.10.62 260 350 1 3 17 Glyndon 1.10.62 6 250 Nil Nil Nil Horn Park 1.12.62 454 2,359 Nil 26 3 Eltham 1.10.63 1,550 5,325 6 370 7 St. Mary's No. 4 1.10.63 8 191 Nil 2 Nil Glyndon No. 2 1.10.63 26 390 Nil 12 1 Rockmount 1.10.63 5 253 Nil 1 1 Greenwich No. 4 1.10.63 262 1,212 Nil Nil 3 Greenwich No. 5 1.10.63 132 1,022 Nil 6 1 Well Hall 1.10.64 540 4,136 Nil 93 11 Glyndon No. 3 1.10.65 6 220 Nil 1 Nil Shooters Hill 1.12.65 480 4,360 1 75 12 Greenwich No. 6 1.7.66 414 1,586 Nil 29 8 Brook 1.12.66 290 1,885 Nil 34 7 Plumstead 1.12.66 32 43,733 Nil 226 23 202 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 6 Objections by tenants to cancellation of certificates upheld — Decisions by Council to cancel notwithstanding tenants' objection — Certificates cancelled 8 In addition to the foregoing, 3 applications (Form "O") were received, 2 from landlords and 1 from a tenant, each for a certificate as to the remedying of defects which the landlords has undertaken to remedy. These resulted in the issue of Certificates (Form "P") as follows :— Form 'P' Certificates By issued in respect of:— Applications whom made Defects Defects not/not Remedied wholly Remedied In respect of Tenant — 1 Form 'H' undertaking Landlord — — In respect of Tenant — Form 'K' undertaking Landlord 2 Noise Abatement Act, 1960.—Local authorities have been empowered to deal with noise or vibration as statutory nuisances under this Act and, during the current year, 34 relatively minor complaints were received. In no instance was it found necessary to resort to statutory action to secure abatement. Pharmacy and Poisons Act, 1933.—During the year 5 applications for entry of name in the Council's List of Persons entitled to sell Poisons included in Part II of the Poisons List were received and 162 vendors applied for retention in the Council's List. All were duly considered and approved and, in accordance with the Act, the premises concerned were kept under supervision by the Senior District Public Health Inspector. Poisons Information Service—Circular 16/63 received from the Ministry of Health drew attention to a Poisons Information Service which has been set up at Guys Hospital and which came 203 into operation on the 2nd September, 1963. The functions of the service are :— (i) to maintain an index of substances in common use— medicinal, veterinary, industrial, agricultural, horticultural, household, etc.—showing their composition and, wherever possible, their toxicity and corrective measures in cases of poisoning; (ii) to provide information to medical practitioners so as to facilitate treatment of cases of acute poisoning. The service is primarily intended to deal with enquiries related to specific cases of poisoning or suspected poisoning. It will not serve as a repository of toxicological information of a general nature, nor will it be able to advise on miscellaneous toxic hazards. Consumer Protection Act, 1961— Powers and duties of the Council under this Act have now been transferred to the Public Control Section of the Town Clerk's Department. Shops Acts, 1950/65.—Under these Acts, which became effective from 1st October, 1950, the Council was responsible for ensuring that, in every part of a shop in which persons are employed about the business of that shop : (a) suitable and sufficient ventilation is provided and maintained, (b) suitable and sufficient temperature is provided and maintained, and (c) suitable and sufficient sanitary conveniences are provided and maintained. In the event of satisfactory sanitary arrangements not being available at the premises the Council was empowered under Section 38 of the Act to grant exemption from this provision if it was satisfied that suitable facilities were readily accessible elsewhere. At the end of the year 32 exemption certificates were in operation. Routine inspections were carried out under the abovementioned Acts on 82 occasions. The Council's main functions under these Acts are now covered by the Offices, Shops and Railway Premises Act, 1963. Rag Flock and Other Filling Materials Act, 1951.—Six premises, at which filling and upholstering with new materials is carried out, remained on the register at the end of the year. One annual licence was renewed in respect of the manufacture of Rag Flock. 204 Under the Rag Flock and Other Filling Materials Regulations, 1961 and 1965, four samples, two of Rag Flock and one each of Coir Fibre and New Cotton Felt were obtained and submitted for examination. All proved satisfactory. Licensing Act, 1961.—During the year, 34 applications for renewal of registration as licensed premises were made involving inspections by District Public Health Inspectors. All were considered satisfactory for their particular purposes. Betting, Gaming and Lotteries Acts, 1963/64.—In accordance with the provisions of these Acts, the Council issues permits in respect of amusements with prizes. Applications received from proprietors of cafes, restaurants and public houses for permits, are referred to this Department for reports as to the general suitability of their premises. During the course of the year, 61 inspections were made and reports submitted to the Town Clerk. Pet Animals Act, 1951.—This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. At the end of the year 11 licences were in operation and 45 inspections were carried out by the Senior District Public Health Inspector. Animal Boarding Establishments Act, 1963.— In accordance with this Act, introduced to regulate the keeping of boarding establishments for animals and for purposes therein, no person after 1st January, 1964, shall keep such a boarding establishment except under the authority of a licence granted by the local authority. In granting a licence the local authority must have regard to the fact that the accommodation shall be suitable in respect of temperature, lighting, ventilation and cleanliness and that it shall be large enough for the number of occupants and, further, that there shall be sufficient exercising facilities. The Act insists that the animals shall be adequately supplied with food, drink and bedding material and that they shall be exercised and visited at suitable intervals. Precautions must be taken to control the spread of infectious or contagious diseases and there must be adequate isolation facilities. In addition there must be appropriate measures available to ensure the protection of the animals in case of fire or other emergency. Registers must be kept giving 205 all relevant information about the animals and their owners and such registers must be available for inspection at all times by authorised officers. At the end of the year one licence was in operation. Riding Establishments Act, 1964.—Operative from 1st April, 1965, this Act repeals the previous Act of 1939 and requires any person keeping a riding establishment, not being disqualified under certain specified legislation, to be licensed in accordance with its provisions. It empowers local authorities to inspect such premises and to issue licences on payment of ten shillings only after considering a report submitted by a veterinary officer. Land Charges Act, 1925.—Under this Act, enquiries in respect of properties in the Borough are received from time to time by the Town Cleric concerning outstanding Notices served under any Health legislation and whether such properties are within existent or proposed Clearance, Development or Smoke Control Areas. During the year 3,756 reports on such enquiries were forwarded to the Town Clerk's department. Drainage and Sewerage One of the principal changes effected by the application of the Public Health Act, 1936, to Inner London Boroughs was that an existing combined drain became classified as a public sewer which it is the Council's duty to maintain, cleanse and empty. "Maintenance" includes repair, renewal and improvement but, in the case of improvement includes only that which may be necessary to make the length of sewer adequate for draining the premises served by it immediately before the improvement was undertaken. A local authority is entitled to recover the expenses reasonably incurred in carrying out such works. During the year, 89 public sewers were tested and maintained, cleansed or emptied. Eleven cesspools remain in use in the Borough and under the Borough Engineer and Planning Officer's direction, these are emptied on request. Plans received in respect of proposed drainage work to be carried out to existing buildings are examined by the Public Health Inspectors prior to their submission by the Borough Engineer and Planning Officer to the Council for approval. 206 Radioactive Substances Act, 1960.—The Act is concerned with the control of the accumulation and disposal of radioactive wastes and, as from 1st December, 1963, persons keeping or using radioactive material will, unless exempted, be required to register with the Minister of Housing and Local Government and obtain authorisation from him for the accumulation or disposal of radioactive waste. During the year, the Minister has forwarded copies of two certificates of registration under this Act. Water Supply.—The whole of the Borough is supplied with water by the Metropolitan Water Board, a Statutory undertaking, which, as a result of the Metropolis Water Act, 1902, was formed in 1903 when it took over the 8 undertakings which were then supplying London's water. As a Board it is committed to supply a population of some 6i million people within an area of 540 square miles extending from Ware in the north to Sevenoaks in the South and which has an average daily consumption of about 400 million gallons. One of this Borough's two wells which supply drinking water is a most prolific contributor to the Board's supplies, having a normal output of 5 million gallons per day. The Board is responsible for the purity of its water and the supplies are regularly tested—chemically and physically for an estimation of its clarity, colour and taste, and bacteriologically for assessment of coliform colonies with confirmatory examinations for Escherichia coli. There are 69,916 inhabited dwellings in the Borough with direct connections to the Board's mains. Although the requirement to issue water supply certificates no longer applies to Inner London Boroughs, on request and subject to satisfactory report, a letter is sent confirming that a property has a suitable and sufficient supply of water. One, hundred and twenty-one properties were so dealt with during the nine months ended 31st December, 1965. During the three months prior to this period. Greenwich and Woolwich Councils issued a combined total of 268 water supply certificates. Underground Water Supplies (Wells).—In August, 1947, at the request of the Ministry of Health, a survey of underground water supplies was made. The accompanying table gives details insofar as they are known to the department at the present time. In all, 55 wells are listed, of which only two are used for the supply of water for drinking purposes. Of the remaining 53 wells, 19 are used for commercial purposes and 34 disused. 207 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position Use. Condition of Water Remarks. Greenwich Area 1 British Oxygen Co. Ltd , Tunnel Avenue. S.E.10. 200 ft. deep 400 yds. from river. Water drawn at 190 ft. Drinking. Bacteriologically a good water; chemically no significant change in composition since March '42; affords no evidence of recent organic pollution and may be considered safe for drinking, but is very hard. Well completely enclosed and protected from pollution. Samples to be taken quarterly. 3 Metropolitan Water Board Pumping Station, Brookmill Rd., S.E.8. 1500yds. from river. Do. Water from combination of wells is tested dally. This well is in circuit by adit to main pump supply. 3 Delta Metal Co. Ltd., Delta Works Tunnel Avenue, S.E.10. 500 ft. deep 50 yds. from river. Water drawn at 490 ft. Industrial. Chemically satisfactory. There is a brace of iron and considerable temporary hardness and salt; no evidence of pollution. Water used for cooling purposes; there are no drinking points. Well is completely enclosed and protected. 4 Christie's Wharf Ltd. Riverside (Lombard Wall) Charlton S.E.7. 250 ft. deep 300 yds. from river. Water drawn at 30 ft. Do. Chemically satisfactory. There is a trace of Iron, the water is very hard, with a high degree of salt. Bacteriologically good; no evidence of recent pollution. The water is used only for industrial purposes, with no drinking points. The well la in good condition and protected from surface water pollution. 5 United Glass Bottle Manufacturers Ltd. Anchor & Hope Lane. Charlton, S.E.7. No. 2 Well— 300 ft. deep 200 yds. from river. Water drawn at 300 ft. Do. Extremely hard water, with a high salt content and traces of iron. Used for industrial purposes only. Enclosed type, protected from pollution. There are no drinking points. 6 Do. No. 4 Well— 300 ft. deep 150 yds. from river. Water drawn at 300 ft. Do. Excessively hard water, very high salt content and heavy in iron. Bacteriologically good. Used for industrial purposes only. Enclosed type, protected from pollution. There are no drinking points. Only used in emergency as water is too hard. 7 Do. No. 5 Well— 300 ft. deep 250 yds. from river. Water drawn at 300 ft. Do. Satisfactory, but hard and a little salt. In regular use for Industrial purposes only. Enclosed type, protected from pollution. 8 S. P. Mumford & Co. Ltd., Greenwich Flour Mills, Deptford Bridge, S.E.10. 165 ft. deep Very near to Deptford Creek. Water drawn at 36 ft. Do. Bacteriologically and chemically there is definite evidence of pollution. The water has a high bacteriological count with B. Coli in 1 cc. This water is used for commercial purposes and is subject to chlorlnatlon. 9 St. Alfege's Hospital, Vanbrugh Hill, S.E.10. No. 1 Well— 200 ft. deep 400 yds. from river, outside Laundry. Do. A hard water, with no evidence of pollution. This well is used as a reserve supply for the Laundry only. Open type, protected from surface water. 10 St. Alfege's Hospital, Vanbrugh Hill, S.E.10. No. 2 Well— 250 ft. deep 400 yds. from river, under Administrative wing of hospital. Do. A hard water, but showing no evidence of recent pollution. The well is used as a reserve supply to the boiler feed. Protected from surface water. 208 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position Use. Condition of Water Remarks. 11 Thos. Borthwick «fe Sons, Ltd.. Borthwick's Wharf. Butcher Row, S.E.8. 300 ft. deep 40 yds. from river. Water drawn at 300 ft. Industrial. Extremely hard water and very salt. Chemically: no evidence of recent pollution. Bacteriologically: evidence of a slight degree of pollution, but sample taken from pump discharge tank. Completely enclosed well, protected from pollution. Used only for industrial purposes. 12 J. Lovibond & Sons, Ltd.. Greenwich Brewery, Greenwich High Road, S.E.10. Shallow well, 36 ft. deep 300 yds. from river. Water drawn at 30 ft. Do. Very hard water with high salt content. No evidence of recent pollution. Enclosed type, adequately protected from pollution. 13 Tunnel Glucose Refineries Ltd., Thames Bank House. Tunnel Avenue, S.E.10. No. 1 Well— 50 ft. deep 100 yds. from river. Water drawn at 25 ft. Do. These three samples of water are extremely hard and contain excessive amounts of dissolved solids and chlorides. They also contain a good deal of iron which is gradually precipitated on exposure to the atmosphere, forming heavy rust-coloured deposits. Quite unfit for domestic purposes, but no evidence of recent pollution. Open type well, is covered by shed and protected from surface water. Water used for cooling purposes only. Heavy iron deposit. 14 Do. No. 2 Well— 30 ft. deep 100 yds. from river. Water drawn at 26 ft. Do. Closed type well, protected from surface pollution. Water used for cooling purposes only. Heavy iron deposit. 15 Do. No. 3 Well— 25 ft. deep 15C yds. from river. Do. Do. 16 R.A.P., No. 1 M.U., Kldbrooke, S.E.3. 30 ft. deep 2,000yds. from river. Water drawn at 25 ft. Do. Chemically: very hard and heavy in iron Bacteriologically: heavy contamination (B.Coll in 1 cc.). This is probably from nearby disused and open well (See No. 21). Used only for reserve fire-fighting supply Metal shaft capped with iron cover screwed down. 17 Delta Metal Co. Ltd., Grelgs Wharf Tunnel Avenue S.E.10. Greigs Well 20 yds. l com river. Disused. Sample taken from resting water alongside pump bore. Bacteriologically: evidence of a slight degree of pollution. Disused for a long period; may be brought back into commission. meanwhile well is protected by manhole cover. 16 South Eastern Gas Board Ordnance Wharf, Tunnel Avenue, S.E.10. No. 1 Well— 322 ft. deep 90 yds. from river. Do. Heavily contaminated by tar seepage. Bacteriologically: evidence of pollution, with B. Coli in 1 cc. Well disused; is situated about 4 yds. from large tar pit. 19 Ministry of Works, Kidbrooke S.E.3. (Formerly R.A.P. Camp.) No. 1 Well— 30 ft. deep. Do. Both enclosed type sealed with screwed on metal cap. 20 Do. Nc. 2 Well— 30 ft. deep Do. 21 R.A.P., No 1 M.U., Kldbrooke, S.E.3. 30 ft. deep Boring unsuccessful and abandoned, shaft left exposed to surface water contamination. To be sealed up. 209 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position Use. Condition of Water Remarks. 22 South Eastern Gas Board, Ordnance Wharf, Tunnel Avenue, S.E.10. No. 2 Well— 180 ft. deep 120 yds. from river. Disused. — Closed type well, sealed up. Disused since 1936 because of high salt content. 23 London Transport Executive, Old Woolwich Road, S.E.10. Do. — Enclosed type, pump left sealed. Protected from pollution. 24 London Electricity Board, Power House, S.E.10. 2 Wells 300 ft. deep. Sealed. Yielded brackish and polluted water In 1935. Not used since March 1947. Wells plugged with concrete and back filled. 25 26 London Electricity Board, Stowage Wharf, Deptford, S.E.8. No. 1 Well— 500 ft. deep. Do. Concreted over. 27 Do. No. 2 Well— 500 ft. deep. Do. — Concreted over. 28 Do. No. 3 Well— 100 ft. deep. Do. — Capped iron and concrete. 29 Do. No. 4 Well— 186 ft. deep. Do. — Concreted over. 30 Carbide Stores Ltd.. 1 & 2, Kirkland Place, S.E.10. 2 Wells 184 ft. deep. Do. (Water said to have been salt). Both concreted over. 31 32 Molasslne Co., Riverway, S.E.10. 170 ft. deep. Do. — Concreted over. 33 Formerly Beehive Brewery. Church Street, S.E.10. 276 ft. deep. Abandoned. — Site not traced. 34 Flams'eed's Well, Royal Observatory. S.E.10. In garden of Astronomer- Royal. Do. — Do. 35 Formerly Mr. Hills, Eastney Street, S.E.10. 159 ft. deep. Do. — Do. 36 House adjoining, "Sun-in-the-Sands", Shooter's Hill Road, S.E.3. 139 ft. deep. Do. Do. 37 J. B. Orr. Ltd., Riverside, 8.E.10. Four borings. Do. Water extremely hard, brackish when last analysed. Do. 38 39 40 41 Formery Royal Hospital Brewery. King William Walk. 8.E.10. 305 ft. deep. Do. Exact site not traced, but concreted in under roadway. 210 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position Use. Condition of Water Remarks. Woolwich Area 42 A.E.I., Ltd., Bowater Road, S.E.18. 14 Borings. Disused. — — 43 Woolwich Royal Dockyard, East Pumping Station, S.E.18. 70 ft. deep Industrial. – Water used for Are precaution purposes. 44 Formerly A. W. Mellish, Ltd., Nile Street, S.E.18. 4 Borings from 200 ft to 608 ft. Disused. — — 45 Royal Arsenal, Beresford Square, S.E.18. 52 ft. deep Do. — — 46 Formerly M.W.B., Plumstead Pumping Station, Park Road, S.E.18. 5 Borings 136 ft. deep Not in current use. – – 47 Formerly Workhouse, 158a, Plumstead High Street, S.E.18. — Disused. — — 48 Plumstead Baths, Plumstead High Street, S.E.18. Deep Well. Industrial. – Water used for swimming pools, warm baths and laundry. 49 Woolwich Baths, S.E.18. Deep Well. Do. – Water used for swimming pools and warm baths. 50 Formerly W.B.C. Electric Works. White Hart Road, S.E.18. 5 Borings from 55 ft. to 637 ft. Not in current use. – Water originally used for boilers. 51 Holdsworth Ltd., White Hart Road, S.E.18. 60 ft. deep. Industrial. — Used In rag flock processing. 53 do. 2 Borings 64} ft. and 120 ft. Do. – 53 Chas Beasley's Brewery, fJrewery Road, S.E.18. Deep Well. Disused. — Water originally used in brewing and lor cooling purposes. 54 Well Hall, Sherard Road, S.E.9. — Do. 55 Formerly Dr. King's garden, Eltham Hill. s.E.9. 2 Borings 46J ft. and 105 ft. Do. – – 211 Fluoridation of Water Supplies.—In recent years dental decay has increased especially among the younger age groups and it has been found that a minute quantity of fluorine assists the formation of healthy teeth and reduces the incidence of decay. In Circular 15/65, issued by the Ministry of Health on 3rd August, 1965, recounts inter alia, the substance of previous circulars on the fluoridation of water supplies as a preventive measure in dental caries. In this latest Circular, the Minister has stated that he considers fluoridation is now an established and well proven public health measure conferring benefits to dental and, in consequence, general health, greatly exceeding the cost of its introduction. Moreover, he is convinced that it is completely safe and he hopes therefore that all local authorities will now take steps to make arrangements for the addition of fluoride to public water supplies. Notwithstanding the overwhelming evidence to the contrary, the Minister is aware that a minority continues to maintain that fluoridation may have some harmful effects. He has also stated that, in the event of legal proceedings either on lack of powers or on damage to health, he is prepared to give any local health authority or statutory water undertaking in England or Wales an indemnity as set out in an appended statement to the Circular. Water undertakings were informed in the Ministry of Housing and Local Government Circular 37/63 that the full cost of fluoridation would be reimbursed by the local health authorities. The Minister of Health considers such authorities will no doubt agree to meet such costs other than those covered by his direct indemnity, but including, if requested, the cost of insurance cover taken out by the water undertaking against liability arising from the negligence of the water undertaking or its employees or agents in the course of fluoridating the water supplies. Prior to the amalgamation of Greenwich and Woolwich, both Councils supported this measure. The present Council passed a resolution and so informed the London Boroughs' Committee that it supported the fluoridation of water supplies as a dental caries preventive measure, and asked that consideration be given for an approach to be made to the Metropolitan Water Board on behalf of all the London Boroughs with a view to its introduction at an early date. 212 Public Baths and Washhouses.—There are 4 Borough Council Public Baths and 2 Public Washhouses. A summary of Bacteriological Samples taken during the year with the results of the examinations is given in the following table:— Sample Date & Time Nature & Temperature No. of Bathers Plate Count per ml. yeastral Agar 2 days 37°C. Probable No. of Coliform bacilli per 100 ml. MacConkey 2 days 37°C Faecal Coli per 100 ml. Result 1 2.2.65 10.50 a.m. *Greenwich (Large) 76° F. 50 — — — Satisfactory 2 20.4.65 10.20 a.m. *Eltham (Large) 82°F 50 730,000 3 3 Satisfactory 3 20.4.65 10.25 a.m. *Eltham (Small) 75°F. 35 — 5 5 Satisfactory 4 20.4.65 11.00 a.m. *Woolwich (Large) 80°F. 60 283 — — Satisfactory 5 20.4.65 11.15 a.m. *Woolwich (Small) 80°F. 60 — — — Satisfactory 6 20.4.65 11.40 a.m. *Plumstead (Large) 80°F. 70 51 — — Satisfactory 7 20.4.65 11.55 a.m. *Plumstead (Small) 80°F. 50 3 — — Satisfactory 8 28.4.65 11.00 a.m. *Eltham (Spastics) 90° F. 2 90 — — Satisfactory 9 28.4.65 11.30 a.m. *Eltham (Small) 80° F. 60 950 — — Satisfactory 10 28.4.65 12 noon *Eltham (Large) 82°F. 50 650 — — Satisfactory 11 4.8.65 11.00 a.m. *Greenwich (Small) 80°F. 98 1 — — Satisfactory 12 4.8.65 11.15 a.m. *Greenwich (Large) 80°F. 110 10 3 — Satisfactory * Mixed Bathing. I am indebted to Mr. D. F. Wallis, Baths Manager, for the following information and statistics in respect of the current year :— "The Council has four Bathing Establishments and a Launderette. There are two Swimming Baths at each of the four Establishments and in addition there is a Hydrotherapy Pool at the Eltham Baths. Warm baths for men and women are available at Plumstead, Woolwich and Greenwich. Turkish and Russian Baths are provided at Plumstead and Greenwich. There are public laundries at Plumstead and Greenwich, and the Council opened a new Launderette on the Abbey Estate on the 27th March, 1965. 213 During the winter season the large pools at Eltham, Greenwich and Woolwich were converted into halls and a wide range of recreational activities was made available, including an indoor bowling green, indoor cricket nets, roller skating, badminton and table tennis. The hall at Eltham was let for many functions ranging from wrestling, dancing and even a one-day Youth Conference. Swimming instruction is available at each Establishment and the Council introduced a new scheme this year for 3-5 year old children. These are called "Fledglings" and the scheme operates in the Hydrotherapy Pool at Eltham. There were already "Duckling" classes held at Plumstead, Eltham and Greenwich Baths for 5-9 year old children. The London Borough of Greenwich became effective on the 1st April and the attendances for the year ended 31st December covers nine months of the new Borough and three months of the old Boroughs for the above Establishments. In addition there are the attendances for the Warm Baths at North Woolwich which, on the 1st April, was transferred to the London Borough of Newham." The attendances for each Establishment are as follows :— Eltham Greenwich Plumstead Woolwich North Woolwich & Abbey Estate Launderette TOTALS Public Swimming 210,698 87,630 143,031 121,572 562,931 Spectators 14,919 5,371 7,829 2,634 — 30,753 Swimming Tuition 9,200 5,269 4,274 1,381 — 20,124 School Swimming 60,847 52,640 114,239 51,060 — 278,786 Swimming Clubs 14,149 11,533 19.569 11,007 — 56,258 Private Baths — 47,720 25,299 54,171 2,638 129,828 Free Baths to O.A.P. etc. — 3,491 3,710 4,248 139 11,588 Turkish Baths — 18,103 10,741 — — 28,844 Public Laundries — 4,678 16,678 — 21,356 Abbey Estate Launderette — — — — 25,326 25,326 309,813 236,435 345,370 246,073 28,103 1,165,794 RODENT CONTROL General.—During the year the Rodent Control Scheme, as approved by the Ministry of Agriculture, Fisheries and Food, has continued, although with the introduction in 1959 of "block" grants to local authorities, direct financial assistance by the Government to this service ceased. Of a total of 2,798 recorded complaints (1,491 of rats and 1,307 of mice), 1,986 were notifications, 459 re-notifications from occupiers or other sources and 353 were found during survey. The monthly average of complaints from all sources was 233. 214 In addition to the investigations of recorded complaints, 2,142 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 4,940. During investigations, infestation was found to exist on 53 occasions in local authority's premises, 1,940 in dwelling houses and 324 in miscellaneous properties and places of business. Of these, one major infestation was disclosed in a pig farm. In all, some 2,513 treatments were effected by the local authority and 15 by occupiers or other services. Notwithstanding the fact that large industrial firms are inclined to make contracts with servicing companies, periodical treatments were carried out at 6 industrial premises, 2 wharves and storage places, 6 miscellaneous properties and at one hospital in the Borough. Following the policy of tracing the source of each infestation, 18 defective drainage systems were discovered. In these instances Notices were served under the Public Health Act, 1936, and the defects remedied. Calls were made as and when necessary on the services of the Borough Engineer and Planning Officer's staff to enter sewers during colour-tests or in the tracing of disused drains and also to the lifting of paving to locate sources of infestation; these services were readily available. Occupiers of business premises and also householders readily report any known or suspected infestation, and the value of routine investigation made in these properties is emphasised by the fact that it is rare to find occupiers tolerating infestation after being made aware of the service available under the Rodent Control scheme. Prevention of Damage by Pests Act, 1949.—Rats and mice are notorious not only for the wholesale destruction and fouling of foodstuffs and for the structural damage they cause to buildings, but also for their part in the spread of disease. Leptospirosis (Weil's disease) is primarily a disease of rats and is one which can be fatal to man. The disease is transmitted by means of food, dust, mud, slime and water which has been contaminated by urine or faeces from infected rats. Efficient rodent control is the first and most important defence against this type of disease. The Prevention of Damage by Pests Act, 1949, has placed the onus for the destruction of these pests on Local Authorities and makes obligatory the notification to these authorities by occupiers of any rodent infestation. It has not been found necessary during the year to take legal action to enforce the provisions of the Act. The following report was submitted to the Ministry of Agriculture, Fisheries and Food, for the year ended 31st December, 1965:—  TYPE OP PROPERTY Non-Agricultural (5) Agricultural (I) Local Authority (2) Dwelling Houses (Inc. Council Houses) (3) All Other (Including Business Premises) (4) Total of Cols. (1), (2) & (3) 1. Number of properties in Authority's District 330 70,823 13.326 84,479 1 2. Total number of properties inspected as a result of notification 22 1.662 223 1,907 — Number of such properties found to be infested by:— Common rat Major — — — — — Minor 9 656 89 754 — Ship rat Major — — — — — Minor — — 1 1 House mouse Major — — — — — Minor 11 706 93 810 — 3. Total number of properties inspected in the course of survey under the Act 32 1,917 374 2,323 — Number of such properties found to be infested by:— Common rat Major — — 1 1 — Minor 6 129 43 178 — Ship rat Major — — — — — Minor — — — — — House mouse Major — — — — — Minor — 72 8 80 — 4. Total number of properties otherwise inspected (e.g. when visited primarily for some other purpose) — 37 1 38 — Number of such properties found to be infested by:— Common rat Major — — — — — Minor — 11 — 11 — Ship rat Major — — — — — Minor — — — — — House mouse Major — — — — — Minor — 20 1 21 — 5 Total inspections carried out—including re-inspeotlons (To be completed only if figures are readily available) 81 4.090 707 4.878 — 6. Number of infested prop- erties (in Sections 2, 3 & 4 treated by the L.A. 27 1.607 230 1.864 — 7. Total treatments carried out—including re-treatments 54 2,124 350 2.528 — 8. Number of notices served under Section 4 of the Act: (a) Treatment — — — — — (b) Structural Work (i.e. Proofing) — — — — — 9. Number of cases in which default action was taken following the issue of a notice under Sect. 4 of the Act — — — — — 10. Legal Proceedings — — — — — 11. Number of "Block" control schemes carried out — — 12. Where legal proceedings have been instituted by the Local Authority brief Particulars should be given here:— — — — — — 13. Any other points of interest — — — — — 215 216 Baiting of Sewers.—Under the control of the Rodent Officer directing 5 teams, each of 1 Rodent Operative as supervisor and two workmen drawn from the Borough Engineer and Planning Officer's Area Depots as assistants, baiting of sewers was carried out to 1,386 sewer manholes out of a total of 3,920. The prebaiting and poisoning method was employed and the bait used was fluoracetamide (1081). Fouling of Pavements, Etc., by Dogs.—Warning notices are fixed to lamp-posts in areas where complaints have been received. When it is considered that the warning has been fully noted they are then transferred to another site. Scavenging and Refuse Disposal.—The collection of refuse in the Borough is under the control of the Borough Engineer and Planning Officer who has kindly supplied me with the following information: — "Street Cleansing. There are 250 miles of roads to be cleansed in the Borough, of which 13% are swept at least once daily; 15% 3-6 times weekly; and 72% twice weekly. One hundred and three street sweepers are employed on the work and, in addition, a mechanical sweeper and sprinkler is used to sweep the main traffic routes in the Borough and roads in the shopping areas. Approximately 18,060 street gulleys are cleansed quarterly by mechanical gulley cleansing machines. House and Trade Refuse. During the year under review, 56,733 tons of refuse were collected by the Council's vehicles and carted to tip. The Council's service for removing household lumber and old furniture without charge continues to be widely used and 3 lorries are engaged full time on this work in the Borough. Public Conveniences. There are 29 conveniences for men and a similar number for women within the Borough and, in all conveniences, the water closets are available without charge. In addition, the Council provides free washing facilities at the main public conveniences, including the provision of paper towels and this service continues to be used to an increasing extent and is much appreciated by the public. Paid washing facilities, which include the supply of a linen towel, are also available." Flies and Mosquitoes.—During the year, 21 complaints of flies were received, resulting in treatments being carried out to 21 rooms and 7 external areas. 217 On request from the Borough and Greater London Council Housing Departments, dust chutes and containers in the multistorey flats are treated with Gammexane. (Sprinkling of Gammexane powder into dustbins subsequent to their being emptied has been discontinued—Health Committee decision 2nd June, 1965.) Disinfestation of Verminous Premises.—D.D.T. in kerosene continues to give good results in dealing with verminous premises when alternated with other vermicides such as Dieldrin Concentrate or Lindane to counteract the development of organismal resistance. During the year the department dealt with 102 cases of dirty and verminous premises, and the disinfestation staff sprayed 99 rooms and contents. In 2 cases the bedding and effects were removed to the Council's disinfecting station for treatment by steam or formaldehyde. Of other pests which necessitated the treatment of 182 rooms and 39 external areas, the following initiated the greater number of complaints. Ants. Ants carry no disease but their presence in human foodstuffs is objectionable. Foods of a relatively high sugar content are particularly attractive to ants and the insects are prepared to go to great lengths in order to obtain a sufficiency for their community. In the main, the 70 complaints received concerned either the black garden ant (Lasius niger) or the yellow meadow ant (L. flavis), the workers of which will gain access to houses through cracks in the walls or floors, over sills or through window frames in search of food. Sixty-six treatments involving 54 rooms and 59 external areas were carried out to combat the reported nuisances. One of the commonest of ants, the very small red House or Pharaoh's ant (Monomorium pharaonis) was also the cause of a number of complaints. This species, being of tropical origin, is incapable of breeding in England without artificial heat. A temperature of approximately 80°F is considered to be ideal for its propagation and ipso facto it is found infesting bakehouses, restaurants, hospitals and houses, especially in larders and kitchens and nests may be found behind wall plasters, behind pipes or ovens, in heating ducts and under floor coverings and foundations. As in previous years this pest was encountered at two of the large hospitals in the Borough where, despite intensive investigation the sources of infestation were not located. The total number of treatments carried out in respect of this ant was 18. 218 Although the treatments which involved 58 rooms effected a reasonable measure of success, it must be stated that complete control can be achieved only by the destruction of the colonies, for once ants become established in a building, complete elimination is extremely difficult. Locating each individual nest, especially in old buildings, is not only extremely difficult but commercially impractical. As usual, prevention offers the best solution to the problem namely, (a) to block or obstruct the entry of the ant, (b) to keep premises clear and free from crumbs and scraps of food, (c) to seal holes and cracks through which ants could enter and (d) to use an effective insecticide, preferably of a residual nature. Cockroaches. The cockroach (Blatta orientalis) and its smaller relative (Blattella germanica) are well known for their destructiveness, especially in relation to stored organic matter, ranging from foodstuffs to book bindings. Food is rendered repulsive from contamination not only with their faeces but also with the secretion from their scent glands, and the cockroach is strongly suspected of transmitting to man a number of pathogenic organisms especially those of an enteric nature. Cockroaches shun the light and are most active during the night. Warmth, moisture, darkness and close proximity to food supplies constitute favourable conditions for breeding. As was to be expected most of the 77 complaints received concerning this pest came from three large hospitals in the Borough; very few originated from occupiers of dwelling houses. The construction of such premises offers ideal breeding sites in concealed and almost inaccessible places. Thorough investigation and treatment with D.D.T. or Dieldrin Concentrate resulted in the infestations being considerably reduced. In all, 77 treatments were effected involving 325 rooms. Clover Mite. Three complaints were received, mainly from tenants in blocks of flats in various parts of the Borough, concerning small red or dark brown insects (Bryobia praetiosa) found moving over walls and windows. On each occasion spraying of exterior surfaces with vermicene and D.D.T. produced satisfactory results. Wasps. Complaints received implicated three types, the Common, the German and the Tree wasp. (Vespula vulgaris, V. germanica and V. sylvestris). Fear of the wasp is often misplaced for they rarely sting unless they are roused or frightened and, contrary to popular belief, wasps 219 are not entirely harmful for in Spring and early Summer they feed mainly on insects, many of which are themselves injurious. However, after mid-summer their diet becomes more vegetarian and the workers feed on ripening fruit and other sweet substances, thus effecting serious damage in orchards, sugar warehouses, grain factories, etc., where they cause considerable wastage of goods. In houses they become a nuisance during cooking and at meal times and it is conceivable that they are instrumental in the spread of food poisoning. The queen wasp, the only survivor from the previous year's colony, emerges from hibernation in the Spring to choose a site for nesting, usually in cavity walls, lofts, under roof tiles and other sites which evoke a certain ingenuity on the part of the disinfestors in order satisfactorily to deal with the nuisance. Two hundred and forty-four complaints regarding this pest were received and during the year some 227 nests were destroyed, mainly by means of Gammexane powder or Dieldrin Concentrate. Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith Complaints Treatment Rooms External Areas Beetles: Black 10 10 13 — Carpet 5 5 16 — Leather 1 1 6 — Earwigs 2 2 2 1 Silver Fish 12 12 20 2 Red Mite of Birds & Poultry 5 5 43 Slugs 5 4 7 2 Spiders 1 1 3 1 Wood Lice 3 3 1 2 Woodworm 21 18 24 — Wild Bees 36 28 4 27 Misc. Insects 24 15 43 4 Forty-seven requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by treatments to 88 rooms and 8 external areas. 220 Precautionary Spraying. During the year, 196 premises were entered for the purpose of spraying unwanted bedding, furniture and miscellaneous household effects as a precautionary measure prior to removal by the Borough Engineer and Planning Officer's staff. Treatment was effected in 216 rooms and 65 external areas. Verminous Conditions.—The procedure adopted to combat infestation by lice and general verminous conditions is essentially the same. Treatment for all cases and contacts is carried out at the Tunnel Avenue and Plumstead High Street Cleansing Stations and the following Return summarises the work carried out during the year:— Attendances Vermin Scabies Adults 30 58 Children under school age 32 20 ♦School children 348 101 Totals 410 179 * In addition to these figures 4 attendances were made in respect of Impetigo. Disinfection.—The disinfection of rooms is effected by the formaldehyde spray. This is carried out on removal of the infectious case or termination of the illness, and, on request, for conditions other than notifiable. In cases of request a charge may be made depending on the circumstances of the case. Bedding and wearing apparel can be removed to the Disinfecting Station, White Hart Road., where they can be submitted to steam disinfection. Books may be treated with formalin. The accompanying table shows in detail the work carried out during the year. Eltham Crematorium.—The Crematorium, situated in the grounds adjoining Eltham Cemetery, is administered by the Eltham Joint Crematorium Committee which comprises the London Boroughs of Greenwich and Bexley and the Boroughs of Dartford and Gravesend. The number of cremations which took place during 1965 totalled 2,914, being 61 more than the previous year. Of this total, 1,038 were from within this Borough compared with 216 and 839 from Greenwich and Woolwich respectively in 1964. Exhumations.—Two exhumations were carried out during the current year and a Public Health Inspector was present to see that all the usual precautions were observed. 221 Rooms and Articles Disinfected, Year ended 31st December, 1965 Diseases, etc. Premises Entered Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns j Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 10 12 2 3 3 2 3 7 — _ 1 4 3 2 — 30 Diphtheria - - - - - - - - — - - - - - - - Tuberculosis 24 70 4 6 6 13 10 15 — - 2 14 - 1 - 71 Cancer 2 2 - 2 2 6 6 7 — - 2 2 — 4 — 31 Meningococcal Infection 17 21 2 15 9 20 18 25 — — 7 13 — — — 109 Puerperal Pyrexia — — — — — — — — — - — — — — — — Typhoid Fever — - - — - - - - — — — - ~~ — — Polio-Myelitis — — — — — — — — — — — — — — — — Erysipelas 1 1 1 1 1 - - 3 - - 1 4 1 1 13 Acute Encephalitis — — — — — — — — — — — — — — — — Measles - - - - - - - - — — — — — — — — Scabies — — — — — — — — _ — — — — — — — Other Diseases 26 39 7 45 8 91 18 23 - 4 1 208 4 9 — 418 Verminous Premises — — 1 — — — 1 3 — — — — — — 1 6 Total 80 145 17 72 29 132 56 83 — 4 14 245 8 17 1 678 Library Books Disinfected 12 222 Mortuary Accommodation.—Arrangements exist between Greenwich Council and the Council of Lewisham for bodies to be accommodated at the latter's two mortuaries prior to inquests and post mortems or while awaiting burial. During the current year some 991 bodies were so accommodated at a cost to the Council of £2,000 5s. Od. Summary of Work Performed by the Public Health Inspectors during the Year 1965 Inspections— Houses inspected (Complaints, nuisances) 2,622 „ „ (Infectious Disease) 1,500 „ „ (Overcrowding and other Housing Applicants) 216 Inspections of Factories 101 „ „ Shops 82 „ „ Licensed Victuallers and Clubs 120 „ „ Underground Rooms 167 „ „ Pet Shops 45 „ „ Stables and Yards 9 „ „ Urinals 63 „ „ Houses in Multiple Occupation 67 „ Outworkers premises 92 „ Under Clean Air Act 7,735 „ Miscellaneous 2,930 Inspection of Premises (Clearance Areas) 295 „ „ „ (Rent Acts) 62 Inspections of Offices, Shops and Railway premises 1,863 Investigations (Rats and Mice) 712 Investigations (Insect Pests) 347 Re-inspections, calls made, etc 10,760 29,788 Drains— Drains tested—by smoke 24 „ „ —by water 65 Opened, cleansed and repaired 92 Yards and forecourts drained 18 W.C. Compartments erected or repaired 91 W.C. fittings repaired or renewed 68 W.C. pedestals installed or renewed 145 Sanitary conveniences or improvements effected to Factories and Workplaces 4 Urinals cleansed or repaired 13 Dustbins— Provided 55 Pavings— Yards and Forecourts 42 General Water Supply— Water Fittings amended 22 Water supply restored 53 Extra water supply to tenement houses — 223 Other Improvements— Rooms cleansed and repaired 189 Rooms and staircases lighted and ventilated 411 Verminous rooms cleansed 99 Roofs, gutters and rainwater pipes repaired 375 Dampness abated 162 Underground Rooms (enforcement of Regulations) — Sinks, baths and lavatory basins provided 150 Sink, lavatory and bath waste pipes trapped or amended 113 Stoves and fireplaces 29 Floors repaired 102 Miscellaneous repairs 89 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Animals kept in unfit places discontinued or removed — Foul Accumulations removed 21 Rat infestation abated 944 Smoke Nuisances— Observations 245 Statutory Notices served Notices, &c.— Intimations served under Public Health (London) Act. 1936 174 Preliminary Notices served under Public Health Act, 1936 800 Statutory or Abatement Notices served 358 Houses rendered fit by informal action 695 Legal Proceedings Premises Offence Results of Proceedings 13, Marlton Street Non-Compliance of Abatement Notice Fined £1. Council awarded £4 4s. 0d. costs. Work completed. 65, Floyd Road do. Fined £2. Council awarded £4 4s. 0d. costs. Work completed. 43, Ordnance Road do. Work completed — summons withdrawn. 23 Benares Road do. Fined £1. Council awarded £4 4s. 0d. costs. Work completed. 21, Tewson Road do. Order for work to be executed within 6 weeks. 29, Glenside Road do. Order for work to be executed within 28 days. Council awarded £2 2s. Od. costs. 59, Waverley Road do. Order for work to be executed within 28 days. Fined £5. Council awarded £10 10s. 0d. costs. 16, Kirkside Road do. do. 18, Kirkside Road do. do. 224 HOUSING To say that the housing problem is involved and complicated is to be banal. It is probable that, collectively, unsuitable housing conditions form the greatest single cause of unhappiness within the community. Furthermore, it is indisputable that much mental illness stems from very close and uncongenial living conditions, but it is also true that enforced loneliness resulting from the operation of clearance schemes is conducive to similar effects. In these days of extreme housing shortage, it is perhaps unavoidable that the psychological aspects of the situation become overshadowed by the demands for new housing and slum clearance but public health authorities will ignore these aspects at their peril. Public Health is inextricably involved in housing problems, for the provision of houses of good standard is a prerequisite for the elimination of disease, mental and physical, and a basis for the maintenance of a happy and contented existence. Since the last war, the insistent demand for more and better housing has, in urban areas, been met largely by multi-storey dwellings on the assumption that it was cheaper and more conservative of the limited space available. Much of the supposed advantages of high density housing achieved by building upwards have proved to be illusory. Experience has shown that flats are rarely cheaper than houses. Indeed, with the necessity of providing fire-proof stairs and other insulation and with the introduction of lifts and perhaps a building frame, multi-storey dwellings often become the most expensive form of housing. Moreover, site costs per dwelling are not materially reduced by building upwards to achieve the planners' desired densities for, under present regulations, it is obligatory for tall blocks of flats to have considerable open space around them. Again, maintenance of flats tends to be more costly in labour and equipment and the provision of social and cultural amenities, usually unnecessary in traditional housing, becomes essential. To add further to the disadvantages of multistorey building it seems almost discourteous to urban local authorities to reiterate that, traditionally, the British are house and not flat dwellers and they have an abiding love for a garden however small. Where people are constrained to take up "flat life", difficulties in attaining a successful environment often arise, for the pursuit of hobbies and pastimes has mainly to be made away from the home and its influences. In newly built areas, where few social or cultural amenities exist and there is no community background, the effect, especially upon the young, is most marked. 225 Unfortunately, despite government efforts, building costs are still rising. Prices of materials are not expected to fall, labour costs remain high and the coming selective employment tax will not ease the situation. Large building contractors have already indicated that even system-built local authority houses will be costing £40 more per unit. In attempting to keep costs within reasonable limits and, at the same time, to increase the rate of production, it has been necessary to make greater use of prefabrication. Inevitably, this has meant limited ranges of standard type plans, the repetition of which could lead to monotony on a scale that would be frightening and, so far, industrialised house building has failed to produce the richness and variety of the traditional dwelling. Beset with such problems, it may be difficult for present authorities to avoid criticism in future years of the kind which is now levelled at the builders and planners of the 19th century who were subject to similar pressures arising from the industrial revolution. On an average, Britain loses about 100,000 houses each year as a result of clearance schemes, road improvements, etc., and it has been estimated that she needs to build approximately 150,000 extra houses annually to keep pace with the increasing population and the rising number of households. Although the South East Study Report has proved to be a little too pessimistic in that it overstates the population difficulties in S.E. England, nevertheless, the problems, especially in the urban areas, remain substantial. For Greenwich in particular, implementation by the Greater London Council of the Plumstead Marshes and Kidbrooke Housing Schemes is awaited with not disinterested anticipation. New Legislation The Housing (Prescribed Forms) (Amendment) Regulations, 1965.—These Regulations became operative from 18th February, 1965, and amended certain existing forms consequential upon the amendment of Part II of the Housing Act, 1961, (carrying out of works and abatement of overcrowding of houses in multiple occupation) by Part IV of the Housing Act, 1964, and prescribe new forms. During the current year the following Circulars were issued by the Ministry of Housing and Local Government for the guidance of local authorities: — Circular 21/65.—In this Circular of 1st April, 1965, the Minister requested from Housing Authorities submission of housebuilding programmes for the next four years, which period was to include the current year. 226 Local authorities were also advised to make increasing use of industrialised methods of building and the Circular drew attention to the National Building Agency and its services in this respect. Circular 41/65—House Improvement—Administrative Procedures.—The principal effect of this Circular dated 5th May, 1965, is that in future the Exchequer contribution will be paid in respect of discretionary and standard improvement grants in which local authorities are satisfied that the statutory requirements are fulfilled and that it would be right to pay grant. Hitherto requirements of earlier Circulars included additionally those of a purely administrative nature to be observed in order to recover Exchequer contribution. Housing Act, 1957 Part II.—The following procedures were carried out during 1965 :— (i) Premises Unfit for Human Habitation—Sections 16 and 17.—The undermentioned premises were considered unfit for human habitation and not capable at reasonable expense of being rendered fit and Closing or Demolition Orders were made as follows: — (a) Closing Orders 47 Jackson Street, S.E.18. 36 Hillreach, S.E.18. 61 Sandy Hill Road, S.E.18. 2 Calderwood Street, S.E.18. 4 Pellipar Road, S.E.18. 5 Pellipar Road, S.E.18. 11 Reidhaven Road, S.E.18. 14 Richmond Place, S.E.18. 67A Reidhaven Road, S.E.18. 73 Earl Rise, S.E.18. 29 Coupland Terrace, S.E.18. 52 Richmond Place, S.E.18. 49 The Village, S.E.7. 54 Woodrow, S.E.18. 51 Burrage Road, S.E.18. 127 John Wilson Street, S.E.18. 17A Plumstead High Street, S.E.18. 20 Mabyn Road. S.E.18. (b) Demolition Orders 18 Parry Place, S.E.18. 7 Salutation Alley, S.E.18. 8 Salutation Alley, S.E.18. 227 (ii) Underground Room and Part of a Building—Section 18. The Council's powers to close part of a building or an underground room are provided by this Section and in respect of the latter as qualified by the Housing (Underground Rooms) Act, 1959. New regulations for securing the proper ventilation, lighting and the protection against dampness and effluvia or exhalation of underground rooms received the Minister's approval and became operative on 28th August, 1961. The undermentioned part of a building and rooms of properties, being rooms, the surface of the floors of which were more than 3 feet below adjoining ground level and not complying with the Local Authority's Regulations, were considered unfit for human habitation and Closing Orders were made: — 49 Raglan Road, S.E.I8.—Basement front and back rooms and scullery. 11 Frances Street, S.E.I8.—Basement front and back rooms, ground floor kitchen, first floor front, back and back addition rooms. (iii) Determination of Closing Orders—Section 27.—Closing Orders of premises and parts of premises as undermentioned were determined :— 210 Maxey Road, S.E.I8.—Lower ground floor front room. 56 Vicarage Road, S.E.I8. 20 Willenhall Road, S.E.I8.—Basement rooms. 27 Caradoc Street, S.E. 10.—Ground and first floor annexe rooms. 34 Griffin Road, S.E. 18.—Ground floor rooms. 41 Hudson Road, S.E. 18. 39 The Village, S.E.7. Part III—Clearance Areas.—The following Clearance Areas were represented during the year :— Eglinton Road Clearance Area: 1-19 (odd) Eglinton Road, and 3-5 (consec.) Ordnance Road. 228 Glyndon Road Clearance Areas Nos. 1 to 9: No. 1 Area— 73-91 (odd) Robert Street; 62-66 (even) and 51-65 (odd) Earl Rise; 34a, 36, 38, 44, 48, 52 - 66 (even) Glyndon Road. No. 2 Area— 58-70 (even), 61, 65 and 67 Elmley Street; 64 and 65 Southport Road. No. 3 Area— 74-94 (even), 77-85 (odd), 91 and 93 Elmley Street; 84-90 (even) and 71-83 (odd) Southport Road. No. 4 Area— 98, 87 and 89 Southport Road. No. 5 Area— 101-115 (odd) Elmley Street; 104, 108, 110, 120 and 97, 99, 103, and 105 Southport Road. No. 6 Area— 119-123 (odd) Elmley Street; 19-23 (odd) Brewery Road; 124 Southport Road. No. 7 Area— 104-118 (even) Earl Rise. No. 8 Area— 95-109 (odd) Robert Street; 76-100 (even), 95 and 97 Earl Rise. No. 9 Area— 68-72 (even) Earl Rise. House Purchase and Housing Acts, 1958 and 1959 — Improvement Grants.—Section 20 of the Housing Act, 1949, as modified by Section 16 of the Housing Repairs and Rents Act, 1954, empowering local authorities to make grants to private owners for improvements and conversions of sums up to £400 or half the cost, whichever is the less, where the dwellings would provide satisfactory accommodation for more than 15 years, has now been replaced by Section 30 of the Housing (Financial Provisions) Act, 1958. These grants are now known as discretionary grants. Section 4 of the House Purchase and Housing Act, 1959, introduced a system of grants known as standard grants which, if certain conditions are fulfilled, can be claimed as a right. This 229 grant, generally of a maximum of £155, provides for the installation of five basic amenities, viz. :— (1) a fixed bath or shower in a bathroom £25; (2) a wash-hand basin £5; (3) a water closet in or contiguous to the dwelling £40; (4) a hot water supply £75; and, (5) facilities for storing food £10. However, subject to certain circumstances a higher maximum of £350 can be allowed. Applications submitted to the Borough Treasurer are referred to this Department to ascertain that the proposed works satisfy the specified requirements. In this connection the Housing Inspectors carried out 231 and 27 inspections for 'discretionary' and 'standard' grant applications respectively, and advice was given on 149 occasions in respect of such grants. On completion of 'standard' grant works, a further 24 inspections were made. Housing Act 1961.—Houses in Multiple Occupation.—In connection with these types of properties, the general powers given to the Council under the previous legislation, viz.: — Natural Lighting Ventilation Water Supply Drainage and Sanitary Conveniences Facilities for storage, preparation and cooking of food and for the disposal of waste water Prevention of overcrowding of sleeping rooms were retained under Sections 36 and 90 of the 1957 Act. However, powers enabling the Council to enforce standards under Section 36 proved to be inadequate and were repealed by Part II of the Housing Act, 1961. Regulations were made subsequently by the Minister under Section 13 of the new Act providing a management code for Councils to apply to Houses in Multiple Occupation. Further, for the purpose of implementing the provisions of Section 15 of the Housing Act, 1961, the Council, on the 14th November, 1962, adopted the standards of provision of amenities, as suggested in the joint report of the Advisory Bodies of Town Clerks and Medical Officers of Health of Metropolitan Borough Councils. During the year 67 visits were made by the Housing Inspectors. In no instance was it found necessary to serve notices requiring the execution of works under this Act. 230 Re-housing (a) Borough Council.—The number of families housed and re-housed including transfers, casual voids, etc., amounted to 1,181. Of this number 29 were in respect of families re-housed from outside the Borough. (b) Greater London Council.—During the year ended 31st December, 1965, the Greater London Council had provided alternative accommodation for a total of 676 Greenwich families. Of this figure 212 were housed on Greater London Council housing estates outside the Borough. Six families from outside Greenwich were re-housed in the Borough under the Greater London Council scheme. Overcrowding.—During 1965 there were 216 visits carried out in respect of complaints of overcrowding and applications for rehousing, as a result of which 11 families were found to be statutorily overcrowded. Council Housing Schemes.—(Information supplied by the Borough Engineer and Planning Officer). (a) Dwellings in the course of construction at the 31st December, 1965—1118. (b) The Council's building programme for rehousing envisaged for 1966, et seq—1665 dwellings. It is expected that this figure will be maintained for the next two years. Housing Survey.—Through the courtesy of Mr. J. R. Cooper, the Chief Housing Officer, the following extracts are quoted from his observations on the housing position in 1965: — "This year can be best described as one where it has been necessary to balance the books, take a look into the future and plan ahead, whilst at the same time meeting immediate requirements. The two boroughs while continuing along their pre-determined channels during the first three months of the year of housing families as vacancies occurred, were simultaneously building up a pool of approved applicants to be used to bridge the gap during the first few months of amalgamation. At the first of April, 1965, it was necessary to compile a new housing register comprising the waiting lists from the two boroughs and those cases that were transferred from the Greater London Council. In order that all of these could be fairly assessed, a new points scheme was devised and introduced. At the end of December, 1965, the total number of families on the new waiting list was 5,947 and 434 applicants had been housed during the year. 231 It was now possible to have a wider field of view when allocating accommodation in vacancies which occurred in the 15,618 dwellings under the Council's control and the large number of building sites throughout the Borough where dwellings were in course of construction. These sites, as shown below, when completed, will have provided 1,265 homes. Scheme Dwellings Glyndon Area Stage II 179 Glyndon Area Stage III 204 St. Mary's area 120 Bowling Green Row, Stage I 125 "The Oaks", Burrage Road 109 "The Vicarage", Eltham 109 Shrewsbury Lane 14 Brent Road 11 Marmadon Road 16 Hylton Street 18 Woodhurst Road 54 Blithdale Road 51 Prince John Road 80 Cantwell Road 9 Shooters Hill Road 27 Hervey Road 4 Coleraine Road 41 Rochester Way 42 Wendover Road 8 Mayerne Road 8 Admaston Road 36 1,265 A total of 457 new dwellings were built during 1965. The first fully Industrialised Building Scheme undertaken by the Council was nearing completion by the end of the year. This pilot scheme, comprising 88 fiats, was commenced on the 23rd November, 1964, and it is envisaged that this will be the forerunner of many such schemes to be carried out by this modern method of construction. The third stage of the Glyndon Area Redevelopment got under way with the commencement of 204 dwellings in April. 232 Another development completed towards the end of 1965 was the 35 old people's flatlets in the Plumstead Common Road. This building not only provides its occupants with pleasant and comfortable accommodation, but offers them many extras to help them in their advancing years. Whilst the flats are entirely self-contained, there is a communal lounge, a television room and, in addition, a room where visitors may stay overnight when necessary. There is a resident warden with whom contact may be made at any time in the case of emergency. Together with schemes where work has already commenced, there are further plans in the course of preparation and more than 1,800 dwellings will become available in the foreseeable future. In conjunction with the housing of applicants, the rehousing of families from temporary dwellings has continued in order to provide land for redevelopment upon which permanent homes may be built. There are 411 temporary dwellings remaining of the 1,214 that were erected after the war. Rehousing will continue until all of these sites have been cleared. The dwellings under Council control at 31st December, 1965, were: Dwellings Pre-war properties 5,900 Post-war properties 8,027 Temporary Dwellings 411 Miscellaneous properties 1,280 15,618 During the year, the following dwellings were erected in the Borough by Local Authorities as shown below: Type of Dwelling L.B.G G.L.C. Total Houses, flats and maisonettes 457 848 1,305 Mobile Homes — 3 3 Total number of dwellings 457 851 1,308 It has been necessary to look carefully at the clearance areas within the the new Borough in order to determine some degree of priority for rehousing, in an attempt to avoid creating a situation where a few occupied dwellings remained on each site and thereby making it impossible to clear any one site in order that it could be passed to the Borough Engineer as building land. Two hundred and twenty-two families were rehoused from these areas and it was possible to demolish 231 dwellings." 233 Inspection of Food and Supervision of Food Premises New Legislation The Dried Milk Regulations, 1965.—These Regulations reenact with amendments those of 1923/48 and although they came into force on 11th March, 1965, the previous Regulations continued to operate until 10th September, 1965, in relation to any dried milk sold in compliance with those Regulations. Further, the new Regulations revoke The Dried Milk Regulations, 1964, which never became operative. The principal changes are :— (a) minimum and maximum percentages are prescribed for the milk fat content of dried milk; (b) the upper limit for the milk fat content of dried skimmed milk has been reduced and the description "dried lowfat skimmed milk" is permitted as an alternative description; (c) a maximum moisture content is prescribed for all descriptions of dried milk; (d) containers bearing the description "dried low-fat skimmed milk" are required, and those bearing the description "dried skimmed milk" are permitted, to carry a declaration as to the maximum milk fat content of the dried milk in the container: and containers of any other dried milk are permitted to carry a declaration as to the actual milk fat content; (e) the regulations do not apply to dried milk intended for export or for consumption by H.M. Forces or by a visiting force, to any sale of dried milk to a caterer or manufacturer, and the labelling provisions therein do not apply to any sale of dried milk for immediate consumption. The Meat Inspection (Amendment) Regulations, 1965.—These Regulations made under Sections 13 and 123 of the Food and Drugs Act, 1955, amend The Meat Inspection Regulations, 1963. They extend by one year, ending on 30th September, 1966, the operation of those Regulations which permit the carcases of animals slaughtered for sale for human consumption to be removed from the place of slaughter without an inspection in certain circumstances. The amendment also continues for a year the requirements that a local authority shall notify the Ministry of Agriculture, Fisheries and Food if there is reason to believe that meat cannot be inspected within six hours of slaughter. 234 The Milk (Special Designation) (Amendment) Regulations, 1965.—These Regulations made under the Food and Drugs Act, 1955, became operative on 1st October, 1965. They amend the Milk (Special Designation) Regulations, 1963, and (a) prescribe a new special designation "Ultra Heat Treated", in relation to milk treated by the ultra high temperature method, i.e. heated to not less than 270°F. for not less than one second; (b) prescribed special conditions subject to which licences to use the new special designation are granted, a test which must be satisfied and forms of licence to authorise use of the new special designation; (c) require the cap of any bottle, or any container other than a bottle, containing milk in relation to which the special designation "Untreated" is used, to be conspicuously and legibly so marked with the words "Untreated Milk". The Egg (Marking and Storage) Regulations, 1965.—These Regulations, which apply to England and Wales only, came into operation on 1st June, 1965, and revoked and superseded the previously amended Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1936. The Regulations re-enact, with amendments, some provisions of those revoked dealing with such matters as the manner of marking eggs which have been preserved or which are placed in cold or chemical storage and the manner of registering premises which are to be used for such storage. The Regulations also prescribe for certain other matters which include the particulars of the notices to be given on placing or removing eggs in or from such storage, the records required to be kept by the occupiers of registered premises and by persons who place eggs in cold or chemical storage on such premises and the manner of marking containers of eggs which are stored and not intended for sale by retail. The provisions of the 1936 Regulations relating to grade designations and grade designation marks for eggs are revoked without replacement. Ministry of Agriculture, Fisheries and Food Circulars 14/65, 29/65 and 46/65, approve the use of specified chemicals as alternatives to steam or boiling water in the cleansing of vessels used 235 for storage or conveyance of milk and, for the purpose of the Public Health (Imported Food) Regulations 1937/48, certificates were officially recognised in respect of the following:—Argentina, Australia, Bechuanaland Protectorate, Brazil, Bulgaria, Canada, Chile, China, Czechoslavakia, Denmark, Finland, Gibraltar, Greece, Guatemala City, Hungary, Japan, Lebanon, New Zealand, Norway, Paraguay, Poland, Roumania, South Africa, South West Africa, Southern Rhodesia, Spain, Sweden, Tanzania, The Netherlands, The Sudan, Uruguay, Yugoslavia and Zambia. MILK Milk and Dairies (General) Regulations, 1959.—Under the provisions of these Regulations each person retailing milk in the Borough must be registered as a Distributor. The number of persons so registered at the end of the year was 188. On 289 occasions the premises of distributors and dairies were visited other than for sampling purposes, and any defects found were remedied. The Milk (Special Designation) Regulations, 1963 and 1965.—There is one milk processing plant in the Borough in respect of which a Dealer's Steriliser's Licence and a Dealer's Pasteuriser's Licence were in force on 31st December, 1965, as were the following licences in relation to milk obtained in pre-packed form for sale to the general public :— In Operation 31.12.65 Distribution of Sterilised Milk 175 .. Pasteurised Milk 133 „ Untreated Milk 69 Sampling.—Under provisions of the aforementioned Regulations, Methylene Blue and Phosphatase tests are prescribed, the former for assessing the "keeping" qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised Milk. Two hundred and sixty-one samples of Pasteurised and Tuberculin Tested Pasteurised milks were submitted for the 236 Methylene Blue test, of which 6 failed and 7 were void. "Followup" samples taken in respect of the 6 which failed all proved satisfactory. The samples declared void were not subjected to the Test as the atmospheric shade temperature exceeded 70°F. Satisfactory reports were received in respect of 261 samples of Pasteurised and T.T. Pasteurised milks submitted for the Phosphatase test and 43 samples of Sterilised milk for the Turbidity test. Analytical Examination of Milk.—A total of 173 samples of designated milks, 170 formal and 3 informal, were submitted for chemical analysis. Three samples were adversely reported upon by the Public Analyst, details of which and action taken are to be found in the list of "non-genuine" samples appended at the end of this Section. Eleven samples of cream were taken and found to be genuine. Preserved Food and Ice Cream Premises.—In accordance with the provisions of the Food and Drugs Act, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used: — (a) for the sale, or manufacture for the purpose of sale, of ice cream, or storage of ice cream intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; are required to be registered by the owner or occupier with the Local Authority. Preserved Food Premises (meat, fish, etc.).—The total number of premises on the register at 31st December, 1965, was 219. Four hundred and eighty-five visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which a number of sanitary defects were remedied. Ice Cream Premises.—By the end of the year the total number of registered Ice Cream premises stood at 547. Visits to these premises were made on 225 occasions and ten improvements were effected. Manufacture and Sale of Ice Cream Ice Cream Sampling. (Bacteriological Examination).—Use was made of the Public Health Laboratory Service as provided for under the National Health Act and 96 samples were submitted for examination and the ice-cream graded according to the Ministry's 237 provisional grading scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below: — Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 69 4½ hours or more 1 Satisfactory 18 2½ to 4 hours 2 Sub-standard 6 ½ to 2 hours 3 Unsatisfactory 3 0 hours 4 Most Unsatisfactory On receipt of a Grade 3 or 4 report it is the practice in this Borough to obtain further samples from a vendor before admin:strative action is taken. It was not necessary during the year to have recourse to "administrative action". Of the 96 samples taken during the current year, 15 were of the "soft" variety, 6 of which were reported upon as being unsatisfactory. Quantitative Analysis.—Standards for the composition of ice cream are contained in the Food Standards (Ice-Cream) Regulations, 1959. Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale or exposure for sale of imported foodstuffs unless bearing an indication of the country of origin. Duties originally undertaken by this department in this connection have now been transferred to the Public Control Section of the Town Clerk's department. Blackheath Fair.—At Easter, Whitsun and the August Bank Holiday, many thousands of Londoners from this and adjacent Boroughs once again availed themselves of the opportuniiy of making a visit to this source of entertainment. In all, inspectors made 14 visits to the fair during these holiday periods but in no instance was action required. Street Traders.—During the year 47 applications were made and licences granted to street traders engaged in the retailing of articles of food. No contraventions of Regulations 26 to 28 of the Food Hygiene (General) Regulations, 1960, were observed. Premises used for the purpose of storing articles of food intended for sale by street traders, were kept under regular supervision by the Food Inspectors. 238 Supervision of Premises Including Factories where Food is Prepared.—To these establishments the Public Health Inspectors made 3,814 visits, as a result of which 127 improvements were effected. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year:— premises Inspected or visit Made No. of Visits No of Premises at which ments were Effected Caterers, Restaurants, etc. 567 24 Grocers, Greengrocers 148 13 Butchers' Shops 108 18 Dairies and Milk Distributors 289 5 Wharves and Factories 780 — Bakehouses and Bakers' Shops 36 8 Ice-Cream Premises, Confectioners, etc. 225 10 Fried Fish Shops 50 7 Other Non-Registered Food Premises 75 18 Cooked Meats and Preserved Foods 327 24 Visits Re. Infestations 75 — „ „ Markets 312 — „ „ Food Poisoning 5 — Sampling Visits 492 — Fair Visits 14 — School Visits 103 — Interviews 156 — Complaints Investigated 52 — Totals 3,814 127 Food Hygiene (General) Regulations, I960.—In compliance with Regulations 16 and 19, which deal with the provision of washhand basins and the provision of facilities for washing food and equipment respectively, the following table gives details of the fitments introduced into food premises as grouped in trade categories:— Type of Premises No. of Premises No. provided with wash-hand basins No. with facilities for washing food and equipment Cafes, Restaurants, etc. 445 445 445 Grocers 339 337 339 Greengrocers 164 159 not applicable Butchers 140 140 140 Bakers 69 68 69 Confectioners 292 289 not applicable Fish Shops 69 69 69 Public Houses 241 241 241 Off Licences 53 53 not applicable 239 Bakehouses—At the end of the year, 12 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 36 occasions and, as a result of the inspections, 8 sanitary defects were remedied. Catering Establishments.—As a result of 567 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 24 occasions. Seven improvements were carried out at public houses as a result of informal action. Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year: — Shops, Stalls, etc.:—  Beef 4,561 lbs. Pork 1,561 „ Lamb 614 „ Veal 73 „ Ox Kidneys 101 „ Pigs' Kidneys 142 „ Sheep Kidneys 20 „ Lambs' Hearts 15 „ Lambs' Livers 16 „ Chicken 10 „ Sausages 120 „ 7,233 lbs. Canned and Other Foods— Foods, Various (Canned) 13,935 lbs. Cooked Meats (Canned) 2,343 „ Fruit 1,196 „ Fruit (Canned) 1,462 „ Fruit Juice (Canned) 117 .. Tomatoes 12,076 „ Fish 43 „ Fish (Canned) 274 „ Vegetables 8,581 „ Foods, Various (Frozen) 8.732 ,. Steak and Kidney Pies and Puddings 8 „ 48,767 lbs. 56,000 lbs. The Meat Inspection Regulations, 1963, and The Meat (Amendment) Regulations, 1965 Butchers' Shops and Stalls.—These are under constant Supervision and 108 visits of inspection were made. Insanitary defects were remedied in 18 instances. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was it necessary to resort to this procedure. 240 Licensing of Slaughterhouses, Slaughtermen and Tripe Boiler Premises.—There is one Slaughterhouse and One Tripe Boiler in the Borough, the licences of which were duly renewed during the year. Twelve licences to slaughtermen were renewed and one new slaughterman's licence granted. Meat Inspection.—Although a thousand fewer cattle were slaughtered than in 1964, the total kill of 78,366 was higher by over 14,000, mainly due to a substantial increase in the number of pigs slaughtered. Details are as follow: — Carcases and Offal Inspected and Condemned in Whole or in Part, 1965 Cattle excluding Cows Cows Calves Sheep and Lambs Pigs NUMBER KILLED AND INSPECTED 9,627 1 10,711 58,027 ALL DISEASES (except Tuberculosis and Cysticerci)— Whole carcases condemned 1 – – – 45 Carcases of which some part or organ was condemned 2,767 – – 825 11,746 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 28.7 – – 7.7 20.2 TUBERCULOSIS ONLY— Whole carcases condemned – – – – – Carcases of which some part or organ was condemned 11 – 298 Percentage of the number inspected affected with Tuberculosis 0.1 – – – 0.5 CYSTICERCOSIS— Carcases of which some part or organ was condemned and treated by refrigeration 50 – – – – 241 The significant increase in the number of Freisian cattle being reared for beef has perhaps been the most striking change in farming over the last ten years. The Freisian cow is already well known for its exceptionally high milk yield, producing, as it does, more than half the nation's milk requirements. Judging from the number of Freisian steers presented for slaughter at Plumstead during the year, it seems that this breed is to become the most popular dual-purpose breed of cattle, if not already so, both in the traditional and intensive fields of beef production. The general improvement in animal health, mainly brought about through the completion of the tuberculosis eradication scheme in 1960, has been satisfactorily maintained during the year. Tuberculosis in cattle is becoming extremely rare—only 11 localised lesions being recorded following the post mortem examination of the 9,627 cattle which were slaughtered. During a similar examination of more than 58,000 pigs, 298 localised lesions resembling tuberculosis were found, mainly in the heads of pigs. One bovine carcase was condemned because of a gangrenous condition in the iliac region complicated by acute nephritis. There were 45 whole pigs rejected for a variety of reasons. Of this number, 17 were found to be dead on arrival at the slaughterhouse or otherwise died in the lairage. The remainder were rejected mainly because of some pathological change representing a hazard to human health. The reasons for rejection were as follows: — Multiple Abscesses 15 Multiple Bruising 2 Fevered 7 Pathological Emaciation 4 Observers in different parts of the country have drawn attention to the marked increase in tail injury among pigs, probably due to biting and the growing incidence of multiple abscesses in the pigs so affected, particularly so in the spinal processes. The observations and experience at this slaughterhouse in this matter support and confirm the observations made elsewhere. Distomatosis (liver fluke) was the most prevalent condition met with in cattle, whilst in pigs pneumonia and, to a lesser extent, ascaridae (worm) infestation were the conditions most frequently encountered. The conditions mentioned accounted for most of the 30 tons of offal rejected during the year. Arthritis in the knee and hock joints of pigs is still very common and shows no decline in the frequence, it is observed. 242 About 20 per cent, of all bovine livers examined were found to be affected with distomatosis (liver fluke). Multiple abscesses are still prevalent in cattle, particularly in 'barley fed'. This condition appears to need investigating as the intensively reared animal is only young when slaughtered. The pig offal condemned is mainly pig lungs which present varying degrees of damage due to pneumonia. Damage to pig livers caused by the larva of the ascaris worm renders the livers so affected quite unsuitable for human food and, consequently, have to be rejected. Most of the liver rejected as unsuitable for human consumption because of parasitic infestation is salvaged and utilised in the manufacture of pharmaceutical products. The slaughterhouse continues to be used as the main training centre in meat inspection for student public health inspectors in training with various London borough councils, and those attending the South East London Technical College. It is estimated that about 600 student public health inspectors have received their basic training in meat inspection at this establishment over the last 20 years. Public Health (Imported Food) Regulations, 1937 and 1948.—The London Borough of Greenwich with a river frontage of some 9 miles with more than 40 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Imported Food Rejected.—Unsound or diseased imported meat when surrendered is passed for non-edible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, processed for stock feeding. The following foods were rejected at the wharves: — Meal— Mutton and Lamb 21,981 lbs. Beef 1,081 Pork 50 „ Rabbits (Skinned) 30 „ Lambs' Hearts 59 „ Lambs' Liver 10 „ Sheep Tongues 52 „ Ox Tails 37 „ Ox Kidneys 3% „ Ox Liver 50 „ Pigs' Kidneys 19 „ Pigs' Hearts 59 „ Sausages 252 „ 24,076 lbs. 243 Canned and Other Foods— Foods, Various (Canned) 27,117 lbs. Cooked Meats (Canned) 1.735 „ Tomatoes, Tomato Juice and Paste 6,654 „ Fish (Canned) 846 „ Black Cherry Jam and Pulp 1,750 „ Rice 900 „ Margarine 280 „ Ravioli 5 „ 39,287 lbs. 63,363 lbs. Caseous Lymphadenitis. This disease, sometimes called " pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. Results of examinations for caseous lymphadenitis are given below Landed Examined Rejected Weight New Zealand Sheep 54,231 523 — — Groundnuts—Presence of Aflatoxin.—In Britain, during I960, a large number of turkeys died from an unknown cause. Investigations revealed that they had been fed on a groundnut meal which contained a toxic factor arising from a mould Aspergillus flavus and this has been named Aflatoxin. Young animals were also found to be susceptible to the toxin. The presence of Aflatoxin appears to develop after the nuts have been lifted and seems to be proportional to the discolouration, amount of damage to the shell and speed of drying. Aflatoxin also shows itself in cases where storage and transport have occurred in conditions of high temperature and humidity. Peanuts in shell arrive in this country mainly from Ethiopia, Eritrea, Libya and India but most eastern Mediterranean countries are known to trade in this commodity. During the year, 30 samples were taken, four of which were reported upon as containing Aflatoxin. Details of these samples are to be found in the list of "non-genuine" samples appended at the end of this section. The Eggs (Marking and Storage) Regulations, 1965.—One application for the cold storage of eggs was received and registered during the year. 244 Dried Egg Albumen and Other Imported Egg Products.— (Conditional Releases).—Importations of Dried Egg Albumen and other Egg Products continued during the year with the following results:— Country of Origin Quantity Imported Containers Sampled Unsatisfactory Bact. Chem. Dried Egg Albumen America 2,13150 lbs. cartons 107 110x44 1bs. cartons 11 Dried Whole Egg America 39x50 1bs. cartons 4 — — „ 2,461x55 lbs. cartons 66 — „ 20x175 lbs. cartons 4 — — Australia 1,428x160 lbs. drums 195 25 — Canada 2,511x44 lbs. cartons 84 5 — China 3,710x110 lbs. tins 217 — — Denmark 600x56 lbs. cartons 30 1 — Poland 10,668x44 lbs. cartons 155 — — Frozen Whole Egg Australia 154,527x28 lbs. tins 630 — 16 China 1,935x44 lbs. tins 31 — 2 Frozen Egg While China 500x44 lbs. tins 26 — — Dried Egg Yolk America 10x175 lbs. drums 2 — — China 240x110 lbs. drums 32 — — Sweden 10x175 lbs. drums 2 — - Incidence of Salmonella Organism Found Samples Dried Egg Albumen Dried Whole Egg Frozen Whole Egg Salmonella anatum 24 - „ chicago — 1 — „ oranienburg — 5 — „ typhimurium — 1 — Dried Hen Egg Albumen.—All landings of this product are submitted to the heat treatment process recommended by the National Albumen Advisory Committee set up by the Ministry of Health. This process is undertaken at the premises of Cory Associated Wharves Ltd., Palmers Wharf, Prince Street, S.E.8. No salmonella organisms were found during the current year. English Frozen Whole Egg Plant.—On the 25th April, 1960, a Frozen Whole Egg production plant became operational at Payne's Wharf, Borthwick Street, S.E.8. The construction of this plant over a period of approximately one year had been supervised 245 by the Food Inspectors and every effort has been made to ensure a high standard of hygiene. In producing English Frozen Whole Egg for the Egg Marketing Board the manufacturers anticipated that the plant would eventually break 360,000 eggs (1,000 cases) per day. In 1965, pasteurisation of liquid egg was only carried out on eighteen days during the period January to March, the production of which amounted to 6,540x28 lbs. tins. The Liquid Egg (Pasteurisation) Regulations, 1963, were implemented without difficulty and to the complete satisfaction of this Department. The product was sampled for chemical examination on five occasions and in each instance was satisfactory. Export Certificates.—Many consignments of meat are exported from the Cold Stores located within the Borough and each has to be accompanied by an appropriate "Certificate" to the effect that such consignments have been examined and are considered fit for export for human consumption. During the year 47 certificates were so issued and the following table indicates the country of origin of the samples, their destinations and the amounts involved: — Country of Origin Certificates Issued Total Weight of Meat Exported Country No. Argentina Ascension Islands * 53,906 lbs. Belgium ** Saudi Arabia 11 Australia Ascension Islands 1 111,981 lbs. Belgium 10 Curacao 3 Cyprus 6 Holland 1 West Africa 1 New Zealand Ascension Islands 2 114,316 lbs. Belgium 5 Denmark 1 Finland 1 Holland 4 Lebanon 1 * Consignment of meat destined for the Ascension Islands from Argentina, Australia and New Zealand entered on same certificate. ** Consignment of meat destined for Belgium from Argentina and Australia entered on same certificate. 246 Food and Drugs Act, 1955.—Eleven hundred and twentythree samples were submitted for examination to the Public Analyst, of which one formal and 147 informal samples were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 186 formal and 789 informal were obtained in the normal course of sampling. Of all the samples obtained, 45 were considered by the Public Analyst to be non-genuine and of this total 11 were in respect of imported foods not on sale to the general public and, in these instances, the importers were notified accordingly. Of the remaining 34 non-genuine samples, 9 were offences in respect of permitted ingredients not disclosed on the labels and these have therefore been e×cluded from the calculated adulteration figure of 2.56%. Milk was one of the main foods sampled, the total being 173 samples of which 136 were in respect of milk other than Channel Islands. Of this latter figure, the average percentage of milk fat was 3.65% and solids-not-fat 8.65%, the standard being 3.00% and 8.50% respectively. However in accordance with the Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, milks in these categories must contain a minimum of 4% milk fat and 8.50% solids-not-fat. Thirty-seven Channel Islands milks sampled in the Borough during the year proved to have an average content of 4.41% and 8.96% respectively. Bread and Flour Regulations, 1963.—There is one flour mill within the Borough. No samples were taken during the current year. Pharmacy and Medicines Act, 1941.—No samples were taken during the year. Dried Milk Regulations, 1965.—The one sample of dried milk taken during the year proved satisfactory. The Condensed Milk Regulations, 1959.—In addition to minimum percentages of milk-fat and milk-solids of condensed milk, the standards of labelling of receptacles are covered under the provisions of these Regulations. There were si× samples e×amined during the current year, all of which proved satisfactory. Other Food E×aminations.—In addition to those obtained under the Food and Drugs Act, other specimens not procured in the normal course of sampling were e×amined either by the Public Analyst or at the Public Health Service Laboratory. These e×aminations were the outcome of complaints from members of the public or as a result of special investigations into certain foods or as the "follow-up" to reported food poisoning cases. 247 Information concerning the analyses of these samples is given in the following table: — Article How Obtained Examination Action Taken Bact. or Chem. Result Mains Water Supply From kitchen tap following complaint from tenant that several families in block of flats suffered from sore throats. Bact. and Chem. Bacteriological examination satisfactory. The chemical examination found that in most respects the water was of similar composition to that normally supplied by the Metropolitan Water Board in the area. The proportion of albuminoid nitrogen and the oxygen absorption were, however, higher than usual and although the results did not indicate sewage pollution, they showed a rather high organic content and suggested bacterial development. Apart from this possibility nothing was found to account for the incidence of sore throats. Cold water storage tanks adequately covered to prevent contamination from bird droppings. Complainant notified. Black Cherry Pulp, Canned Taken from consignment stored in local Warehouse for a considerable time to ascertain its fitness for human consumption. Chem. Satisfactory condition. Firm notified. Concentrated Orange Juice (2) Taken from casks to ascertain fitness for human consumption having been dropped in river water. Bact. Satisfactory. Firm notified. 248 Article How Obtained Examination Action Taken Bact. or Chem. Result Concentrated Orange Juice (2) Taken from casks to ascertain fitness for human consumption having been dropped in river water. Chem. No contamination by river water could be detected in either of the samples. They both contained a very high proportion of sulphur dioxide, 2,380 parts per million, which would be calculated to sterilise any bacterial contamination. The maximum limit for sulphur dioxide is 350 parts per million unless the juice is intended for manufacturing purposes and the maximum content is specified. Firm notified. No further action as requirements specified by the Public Analyst were satisfied. Concentrated Tomato Juice, Canned Taken from local Warehouse to ascertain fitness for human consumption. Chem. The can was rusty on the outside but the interior was in good condition and the contents were sound and free from excessive metallic contamination. Firm notified. Confectionery, Toffee Complaint from member of the public that toffee contained foreign body. Chem. The foreign body consisted of part of a small decayed molar tooth. Manufacturer informed. No further action as it could not be satisfactorily established that the tooth was in the toffee after manuuufacture. Complainant notified. Orange Squash Complaint from member of the public that bottle of orange squash contained foreign body. Chem. Contained, floating at the top, a small dead brown fly. Manufacturer informed. Premises inspected and precautions taken to obviate complaints of this nature appeared satisfactory. Complainant notified. 249 Article How Obtained Examination Action Taken Bact. or Chem. Result Disprin Complaint from member of the public that Disprin was suspected as a cause of sickness and diarrhoea. Chem. The composition of the tablets was found to accord with the formula on the labels and complied with the tests for purity of the B.P., for Soluble Aspirin Tablets. A sample of disprin was purchased from the same shop and submitted as a check sample with those subject to complaint. This sample was similarly reported upon. Complainant notified. No further action. Corned Beef, Canned Complaint from member of the public that corned beef was tainted. Chem. No abnormal taint was observed and the corned beef was judged to be of normal edible quality. Complainant notified. Pineapple Cubes, Canned Complaint from member of the public that pineapple cubes had an oily taste. Chem. The specimen had a slight oily taint suggesting paraffin and was unpalatable. Contamination may have been effected in complainant's home as on investigation of complaint there was a very noticeable oily smell in and around the house as a result of motor car repairs being carried out. Further samples taken from same retailer proved genuine. Complainant notified. No further action. Corned Beef, Canned Corned beef surrendered by retailer to Food Inspector to check complaint by consumer that it had peculiar taste. Chem. The specimen had an objectionable smell and was considered unfit for consumption. No evidence of decomposition was observed at the time of surrender. Complainant notified. No further action. Grapefruit Juice, Canned Some tins in consignment were perforated and lining of can of this sample suspected to have deteriorated sincetime of packing. Chem. Contained tin. 300 parts per million, an excessive proportion. Public Analyst's report confirmed Inspector's opinion. Suspect tins surrendered. 250 Article How Obtained Examination Action Taken Bact. or Chem. Result Pork Sample taken from leg of pork at Meat Wholesalers to ascertain its fitness for consumption. Chem. The meat was stale and unfit for consumption. Public Analyst's report confirmed Inspector's opinion. Pork surrendered and condemned. Cola Complaint from member of public that cola drink had a peculiar taste. Chem. The specimen was contaminated by petrol and unfit to drink. The petrol appeared to have been introduced by the use of washered cap that had previously been in contact with petrol. Manufacturer informed of Public Analyst's report. Crown cork stoppers to be introduced as soon as possible to prevent repetition. Complainant notified, No further action. Corned Beef. Canned Complaint from member of public that corned beef contained foreign matter. Chem. The specimen contained a greyish discoloured area due to the presence of fine particles of carbon, resembling coal dust. Investigations could not establish how carbon particles contaminated Corned Beef. Complainant notified. Cherryade Complaint from member of public that Cherryade had unpleasant taste. Chem. The specimen had an objectionable taste which was found to be due to the presence of 2 parts per million of phenols, and was unfit to drink. The contamination appeared to have been introduced through the use of a plastic bottle cap that had previously been in contact with a disinfectant. The manufacturers on being informed, outlined the precautions taken to prevent complaints of this nature and the explanation was accepted. Complainant notified. 251 Article How Obtained Examination Action Taken Bact. or Chem. Result Pasteurised Milk Complaint from member of public that milk contained foreign body. Chem. Consisted of a full one-pint milk bottle containing, adhering to the glass on the inside, the pupa of a small fly. Company informed and the explanation in regard to the precautions taken to obviate such complaints was accepted. Complainant notified. The fly referred to, constitutes a particular hazard to the dairy trade at a certain time of the year. Sterilised Milk Complaint from member of public that milk contained foreign matter. Chem. Consisted of a full one pint bottle of sterilised milk containing, partly adhering to the glass and partly floating in the milk, a quantity of dirty black sediment consisting of general dust and including the remains of mites and various micro-organisms. The bottle of milk together with a copy of Public Analyst's report sent to local authority in whose area milk was bottled. Complainant notified. Potato Chips Complaint from member of public that potato chips contained a small piece of tile. Chem. Consisted of fried potato chips and included a piece of broken tile. No evidence was found to indicate the stage at which the foreign matter found its way into the potato chips. Subsequent inspection of newlyerected fish and chip establishment failed to provide evidence that the piece of tile originated from the premises in which there are no tiles resembling the subject of the complaint. Complainant informed. No further action. 252 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1965 (including samples taken under the Public Health [Imported Food] Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Agar — 1 1 — — — Ale and Lager — 2 2 — — Almonds — 2 2 — — — Almonds, Ground — 3 3 — — — Angelica — 1 1 — — — Arrowroot — 2 2 — — — Baby food — 2 2 — — — Baby food, canned — 3 3 — — Barley, Pearl — 1 1 — — — Beer — 1 1 — — — Beverage — 1 1 — — — Biscuits — 33 33 — — — Blancmange powder — 3 3 — — — Brandy 2 — 2 — — — Breadcrumbs — 1 1 — — — Butter — 7 7 — — — Butter substitute, canned — 1 1 — 1 1 Cake Mixture — 4 4 — — — Cake and Pudding Mixture — 4 4 — — — Caraway Seeds — 1 1 — — — Caviar, canned — 1 1 — —- Cereal with fruit and nuts — 1 1 — — — Cheese and Cheese Spread — 16 16 — 1 1 Cheese, Grated — 1 1 — — Cider — 3 3 — 2 2 Cockles, Pickled — 1 1 — — Cocoa — 3 3 — — Coconut, compressed — 1 1 — — Coconut, dessicated — 7 7 — — Coffee — 3 3 — — Coffee and chicory — 2 2 — — Coffee extracts (dry) — 7 7 — — Coffee extracts (liquid) — 7 7 — — Colouring matter — 3 3 — — — Confectionery, Chocolate — 2 2 — — — Confectionery, Flour — 14 14 — — — 253 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Confectionery, Sugar — 13 13 — 1 1 Cooking Fat — 3 3 — — — Cornflour — 3 3 — — — Cough Mixture — 2 2 — — — Cream — 11 11 — — — Cream (imitation) Powder — 2 2 — — — Cream of Tartar — 3 3 — — — Curry Powder — 5 5 — — — Curry, Prawn, canned — 1 1 — — — Custard Powder — 4 4 — — — Dessert Powder — 10 10 — — — Dessert preparations — 4 4 — — — Drinks, Soft — 25 25 — — — Drinks, Soft, powder — 3 3 — — — Dripping — 1 1 — — — Egg Noodles — 1 1 — — — Epsom Salts — 1 1 — — — Fish Cakes — 1 1 — — — Fish, canned — 29 29 — 2 2 Fish, frozen — 1 1 — — — Fish Paste — 8 8 — — — Flavouring compounds — 5 5 — — Flavouring Essence — 2 2 — — — Flour — 4 4 — — — Flour, Self-raising — 1 1 — — — Fruit, bottled — 5 5 — — — Fruit, canned — 37 37 — 2 2 Fruit, dried — 23 23 — — — Fruit, glacé — 2 2 — — — Fruit Juice, canned — 5 5 — — — Fruit Pie — 3 3 — — — Fruit Pie Filling — 1 1 — — — Fruit and Nuts — 1 1 — — — Gari — 1 1 — — — Gelatine — 3 3 — — — Gin 3 — 3 — — — Gravy preparation — 8 8 — — — Groundnuts 1 10 11 1 2 3 Herbs — 5 5 — — — Honey — 5 5 — — — Ice Cream 2 2 4 — — — Ice Cream powder — 1 1 — — — Ice Lolly Syrup — 1 1 — — — Jam — 8 8 — — — Jelly and Fruit preparation — 3 3 — — — 254 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Jelly tablet — 3 3 — — — Jelly tablets and compound — 11 11 — — — Jelly with Fruit, prepared — 2 2 — — — Junket preparation — 5 5 — — — Lard — 3 3 — 1 1 Lollymix — 1 1 — — — Macaroni — 4 4 — — — Macaroni Cheese, canned — 2 2 — — — Margarine — 9 9 — — — Marmalade — 2 2 — — — Marzipan — 1 1 — — — Mayonnaise — 2 2 — — — Meal preparation — 2 2 — 1 1 Meal, prepared — 1 1 — — — Meat — 2 2 — — . — Meat, minced 1 6 7 1 — 1 Meat Paste — 5 5 — — — Meat, potted — 1 1 — — — Meat products — 21 21 — 2 2 Meat products, bottled — 1 1 — — — Meat products, canned — 50 50 — 2 2 Meat tenderizer — 3 3 — — — Meringue preparation — 1 1 — — Milk (including Channel Islands) 170 3 173 3 — 3 Milk, condensed — 6 6 — — — Milk, dried — 1 1 — — — Milk, evaporated — 6 6 — 5 5 Mussels, bottled — 1 1 — — — Mustard — 1 1 — — — Mustard preparation — 8 8 — 2 2 Mustard, prepared — 4 4 — — — Nut Roll, canned — 1 1 — — — Nuts — 2 2 — — Oatcakes — 1 1 — — Oats, Breakfast — 1 1 — — — Oil, Cooking 1 1 2 — — — Olive Oil — 2 2 — — — Olives, stuffed — 1 1 — — — Passiflora tablets — 1 1 — — — Pastry Mixture — 1 1 — — — Pastry, uncooked — 1 1 — — — Pea Flour — 4 4 — — — 255 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Peanut Butter — 3 3 — — — Peanut Flakes — 11 11 — — — Peanuts — 6 6 — — — Peanuts, Salted — 1 1 — — — Peanut Shaves — 2 2 — 1 1 Peel, Candied — 5 5 — 1 1 Pease Pudding, canned — 1 1 — — — Pepper — 3 3 — — — Pepper flakes — 1 1 — 1 1 Pickles — 23 23 — 1 1 Pie Filling, canned — 1 1 — — — Potato Chips — 1 1 — — — Potato Crisps — 4 4 — — — Proprietary Foods — 5 5 — — — Proprietary Medicines — 12 12 — — — Pudding — 2 2 — — — Pudding, canned — 1 1 — — — Pudding, Christmas — — 3 — — — Pudding Mixture — 1 1 — — — Rice — 5 — — — Rice, canned — 1 1 — — — Rice, flaked — 1 1 — — — Rum 2 — 2 — — — Saccharin tablets — 1 1 — — — Sago — 1 1 — — — Salad Cream — 2 2 — — — Salt — 4 4 — 1 1 Sauce — 24 24 — — — Sauce (Meat), canned — 2 2 — — — Sauce preparation — 12 12 — — — Sausages and Sausage Meat — 10 10 — 1 1 Savouries — 1 1 — 1 1 Seasoning — 1 1 — — — Shrimps — 1 1 — — — Soda. Bicarbonate of — 3 3 — — — Soup, canned — 6 6 — — — Soup preparation — 14 14 — 3 3 Soya Meal — 1 1 — — — Spice — 11 11 — — — Spreads — 6 6 — — — Stuffing Mixture — 1 1 — — — Suet, Shredded — 4 4 — 1 1 Sugar — 9 9 — — — Tapioca — 1 1 — — — Tea — 53 53 — 3 3 Tea preparation — 1 1 — — — Tenderising salt — 1 1 — — — Tomatoes, canned — 7 7 — — — 256 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Tomato Juice, canned — 2 2 — — — Tomato Juice Cocktail — 1 1 — — — Tomato Paste, canned — 2 2 — — — Trifle Mixture — 1 1 — — — Vegetable Juice, canned — 1 1 — 1 1 Vegetables, bottled — 1 1 — — — Vege'ables, canned — 28 28 — 1 i Vegetables, dehydrated — 9 9 — — — Vegetables, dried — 6 6 — — — Vegetable Salads in Mayonnaise — 3 3 — — — Vinegar — 5 5 — — — Vitamin capsules — 6 6 — — — Vodka 1 — 1 — — — Whisky 4 — 4 — — — Wine, alcoholic — 1 1 — — — Yoghourt — 3 3 — — — TOTALS 187 935 1,122 5 40 45 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of Adulteration and/or irregularity Action Taken (a) In respect of normal sampling. 80 Preserved Pork Sausages Contained meat 56%. Pork sauages ordinarily contain at least 65% of meat. Manufacturer informed of Public Analyst's report. 720 Minced Beef Contained sulphur dioxide, 50 parts per million by weight, an added preservative, the presence of which in this article is not permitted by the Preservatives in Food Regulations, 1962. Legal proceedings taken. Fined £10 with 3 guineas costs. 730 Pasteurised Milk Contained fat 3.45% and solids-not-fat 8.25% corresponding to the presence of 2% of added water. The freezing point of — 0.525'C. confirmed the presumption of added water. Warning letter to Dealer. Further samples taken proved satisfactory. 257 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 750 Mixed Peel Contained no statement as required by the Labelling of Food Order, 1953. Retailer packing own mixed peel advised as to labelling requirements. 786 Vintage Cider Contained sulphur dioxide, 270 parts per million. Cider may contain sulphur dioxide in a proportion not exceeding 200 parts per million. Producer informed of Public Analyst's report. Further sample and action taken see sample number 1480. 1106 Pepper Flakes Contained sulphur dioxide, 500 parts per million, the presence of which was not disclosed on the label. Manufacturers informed of Public Analyst's report and requested to amend wording on label to comply with Labelling of Food Order, 1953. 1286 Turkey Croquettes The croquettes were stale and several growths of green mould were visible on the surfaces. Retailer informed of Public Analyst's report. The remainder of the stock was found stale but unaffected by mould and was withdrawn from sale. 1411 Prepared Dijon Mustard with White Wine Contained acetic acid 3%, but no alcohol and the label was consequently considered misleading. Importers, Distributors, and Retailers advised of Public Analyst's report. Imoorters stated that samples may have been taken from very old stock. Small remaining stocks withdrawn from sale by both retailers. 1425 1426 Milk Contained fat 2.50% and solids-not-fat 8.62% corresponding to the abstraction of 16% of the milk-fat. Deficiency due to plant breakdown of which Processors were aware but were under the impression that all milk of breakdown period had been withdrawn. No further action. 1464 Aniseed Balls Contained lead. 15 parts per million, an excessive proportion. All stocks withdrawn from sale. 258 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 1480 Vintage Cider (Sweet) Contained sulphur dioxide 350 parts per million. Cider may contain sulphur dioxide in a proportion not exceeding 200 parts per million. Excessive sulphur dioxide due to residual sulphur in final rinsing of bottles immediately before filling with cider. All stocks withdrawn from retailers. 1525 Channel Islands Milk Contained fat 3.94% and solids-not-fat 8.92% corresponding to the deficiency of 1% of the milk-fat. Channel Islands milk should contain at least 4% of milk-fat. When Processors were informed of the deficiency they stated their part of the sample was found to be genuine. Further samples taken proved satisfactory. 1564 Lancashire Rarebit The sample had dried up and spoiled owing to an imperfect seal on the plastic carton. Isolated failure. Retailer advised with regard to rotation of stock. 1585 Pork Luncheon Meat canned Contained flour 5%, the presence of whidh was not disclosed on the label. Packer of meat informed of Public Analyst's report, who took up this matter with the Manufacturers. 1595 Shredded Suet Contained fat 78%, flour 22%. Shredded suet should contain not less than 83% of fat. Manufacturer informed of Public Analyst's report. Further samples taken proved satisfactory. 1639 Evaporated Milk The samples were semi-solid due to protein coagulation and unsuitable for ordinary use. Remainder of stocks of this milk withdrawn from sale. 1640 1641 1642 1664 Tea Consisted of the dried, milled leaf of the Aspalathus Contaminatus, a shrub known in South Africa as Rooibos or Rooibosch (The Red Bush). The description of the packet, "LOWTON Rooibosch TEA", in pseudo Chinese lettering was considered likely to be misleading since the Afrikaans name, Rooibos, is virtually unknown in this country and the product is not a species or brand of tea. Despite exhaustive enquiries it was not possible to trace the whereabouts of the distributing Company and it was presumed the Company had ceased business. 259 Sample No. Article Nature of Adulteration and /or irregularity Action Taken 1677 Ham and Tongue Consisted of a paste containing 74% of meat. A product described as "HAM AND TONGUE" should contain at least 95% of meat. No legal standard has yet been adopted for this commodity. 1757 Raspberries in Syrup, canned Contained artificial colouring matter. Ponceau 4R, the presence of which was not disclosed on the label. Importers took up infringement with Suppliers to conform to the Regulations. 1772 Concentrated Chicken Stock Tablets Consisted largely of salt 43% and did not appear to contain chicken stock. Although capable of producing a chicken flavoured broth, the description "Concentrated Chicken Stock" appeared to be inappropriate. Manufacturer informed of Public Analyst's report. Formula being revised so that label of tablets conforms to current legislation. 1819 1778 Green Chilly Pickle Contained sulphur dioxide matter consistent with Orange II. not permitted by the Colouring Matter in Food Regulations and not disclosed on the label. Sample represented stock, the manufacture of which had been discontinued for some considerable time. 1824 Chow Mein with Noodles Contained sulphur dioxide 210 parts per million, the presence of which was not disclosed on the label. Manufacturer requested this infringement be left in abeyance in view of the Food Standards Committee Report and impending new legislation on labelling of food. 1855 Seasoning Salt Contained celery seed as the predominant ingredient but its presence was not disclosed in the statement of ingredients Manufacturer agreed to redraft the label to comply with the requirements of the Labelling of Food Order. 1953. 1870 Tea— Home Farm Tips The sample did not consist of tea tips but of ordinary blended tea. The term "Tip" as applied to tea denotes the tip or bud of a growing tea shoot and the description "Tea Tips" for an ordinary blend containing only a minute proportion of tips is incorrect. Tea Packers informed of Public Analyst's report Following considerable correspondence over a lcuig period. Tea Packers agreed to discontinue the use of the word "Tips". 260 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 1891 Button Mushrooms, canned Consisted of button mushrooms in brine. The presence of brine was not disclosed on the label. Packers have agreed that the presence of brine will be declared on the label, in future. 1899 Dried Vegetable Soup Contained cornflour and potato starch, the presence of which was not disclosed on the label. Manufacturer agreed to jnclude both these ingredients on the labels in the future. 1955 Chopped Ham and Pork, canned Contained meat 89%. This article should contain at least 95% of meat. No legal standard has yet been adopted for this commodity. 2047 Carrot Juice, canned The product did not consist of carrot juice but of a diluted carrot puree containing: water 3 parts, carrot 1 part, with a little sugar and salt. Packer informed of Public Analyst's report. Manufacturer not at address stated on label. No further action. 2051 Cheese Flavoured Puffs Contained butylated hydroxyanisole, 30 parts per million, the presence of which was not disclosed on the label. Manufacturer, informed of Public Analyst's report is seeking the opinof the Food Manufacturers' Federation. (b) In respect of samples taken under Imported Food Regulations. TT.2 Sprats, canned Contained benzoic acid, 1,050 parts per million, an added preservative not permitted in this article. Arrangements were made for the return of the stock already distributed which together with the remainder of the consignment subject to Detention Notice, was subsequently exported to Holland. TT. 2 Decorticated Groundnuts Contained aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being medium. Consignment detained. "Followup" formal sample taken, see TT.15. 261 ]###]Sample No. Article Nature of Adulteration and/or irregularity Action Taken TT. 15 Decorticated Groundnuts Contained aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being high. Consignment exported to Supplier. TT. 19 Lard Contained butylated hydroxytoluene, 100 parts per million. The compound named is an antioxidant permitted in lard, but its presence was not disclosed on the label as required by the Labelling of Food Order, 1953. Importers agreed to amend subsequent labelling. TT. 29 Decorticated Groundnuts Contained aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being low. No further action on this consignment in accordance with Ministry of Health instructions as toxicity was in the low range below 0.05. TT. 38 Red Cherries in Heavy Syrup, canned Contained artificial colouring matters. Ponceau 4R and Erythrosine, the presence of which was not disclosed on the label. Importers requested Suppliers to conform to the Regulations in respect of future shipments. TT. 40 Peanut Shaves Contained Aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being low. Borough to which consignment was moved before result received was informed for "follow-up" samples to be taken. TT. 43 Evaporated Milk Contained milk-fat 8.0%, milk solids including fat 26%. Evaporated milk should contain not less than 9.0% of milk-fat and not less than 31% of milk solids including fat. The label of the container did not include the declaration prescribed by the Condensed Milk Regulations. Importers stated the consignment was intended for "Ships' stores" only. No further action possible. TT. 50 Butter Substitute, canned The label did not include a statement of ingredients in English. Importers advised of labelling infringement. 262 Sample No. Article Nature of Adulteration and/or irregularity Action Taken TT. 59 Tea The sample contained a bird dropping and was considered unfit for consumption. Information passed to Borough in which consignment had been moved prior to receipt of Public Analyst's report. IT. 89 Herring Fillets in Paprika Sauce, canned The sample was contained in a can which was packed in a cardboard carton, but the statement of ingredients which was printed on the carton did not also appear on the label of the can as required by the Labelling of Food Order, 1953. Importers notified and requested to contact Suppliers with regard to compliance with requirements of Labelling of Food Order, 1953. Legal Proceedings Premises Offence Result of Proceedings J. R. Wright Ltd., 112 Westmount Road, S.E.9. Formal sample of minced beef contained sulphur dioxide (including sulphites calculated as sulphur dioxide) 50 parts per million by weight, an added preservative the presence of which in this article is not permitted by the Preservatives in Food Regulations, 1962. Fined £10 with 3 guineas costs. Tip Top Bakeries Ltd., IB Herbert Road,, S.E.18. Loaf of bread contained piece of wire (complaint from member of public). Fined £10 with 3 guineas costs. 263 SECTION VIII MISCELLANEOUS HEALTH EDUCATION On 1st April, 1965, in accordance with the London Government Act, 1963, the Metropolitan Boroughs of Greenwich and Woolwich became one. Health department staffs of the two Boroughs and the majority of the London County Council's Division 6 Office, along with other Welfare personnel and District Nursing organisations were amalgamated to form the Health and Welfare Department of the new London Borough of Greenwich. In order to obtain an accurate and balanced picture of health education during the current year, this first report must include the activities carried out in the first quarter of 1965 by the previously separated authorities. Prior to 1st April, 1965. Current activities of the Greenwich and Woolwich Metropolitan Boroughs:— 1. Film Shows and/or talks to local organisations. 2. Displays to local organisations. 3. Production of display material. 4. Production of notices. 5. Local Campaigns (including exhibitions) on Home Safety, Environmental Health, Old People's Welfare. 6. Participation in national campaigns. 7. Lecture courses to shops and local youth organisations. 8. Distribution of leaflets and posters. 9. Distribution of "Better Health" to local general practitioners, dentists and factories. Current activities of L.C.C. Health Department, Division 6:— 1. Yearly programmes of monthly health education topics. 2. Regular shop window display. 3. Distribution of posters and leaflets to Welfare Centres. 4. Provision of, and assistance with equipment, films, filmstrips and related media. 5. Lecture courses (e.g., "Mothercraft"). 6. In-service training (e.g., Home Helps; students). 7. Film Shows to invited audiences. 8. School health education campaigns and courses. Subsequent to 1st April, 1965. Following the amalgamation the services outlined above continued to operate in parallel within the new combined Health and 264 Welfare Department. After inital settling down, reorganisation within the Department resulted in the establishment of a Health Education Section, under the Health Education Officer to provide specific services as noted below:— 1. To act as the main channel for publicity, public relations and information for the Department and to maintain a constant pressure of activity in this respect. 2. To provide a service to all other sections of the Department. 3. To initiate, co-ordinate, participate in, or give assistance on, Health and Welfare projects, national and local, such as campaigns, courses, conferences and exhibitions. 4. To provide a service of film shows, talks and other educational projects to local organisations, schools and youth organisations, shops, factories and workplaces. 5. To have particular responsibility toward the promotion of Home Safety, in all its aspects. 6. To conduct surveys on the effectiveness of health education projects and the current need for campaigns on pecific aspects. 7. To collect and collate statistical material related to health education activities of the Department. Although health education, mainly of an informational nature, has existed since the inception of public health measures during the 19th century, it is only in recent years that emphasis has shifted to those areas in which legislation has little or no effect upon the promotion of positive health. Notwithstanding that a large proportion of the work still involves the promotion of understanding and co-operation in health developments, there are many aspects of modern health thinking which depend upon individual decisions. These include a person refraining from harming his or her own health or influencing in a derogatory manner those with whom he or she comes into contact particularly with regard to children and young people. Problems of smoking, dental caries, obesity, lack of exercise, casual promiscuity or the more dramatic forms of self injury such as drug taking are current examples. In these and other matters, including home accident prevention, the aim of health education is to achieve a climate of opinion where indulgence in anti-health activities is viewed with the same distaste as infrequent bathing, spitting, etc., are regarded to-day. This change in emphasis has been channelled and focused by the Cohen Report on Health Education which makes farreaching recommendations for the future development of the service. 265 SUMMARY OF ACTIVITIES A.—Circular Letter to Local Organisations During the summer months a circular letter offering the services of the Health Education Section was prepared and distributed to all local organisations in the Borough. The letter offered to any meeting in the area film shows, talks, or a combination of both on the work of professional staff in the Department or on specific health education topics. In addition, the letter offered displays at any bazaar or fete organised in the Borough with supplies of leaflets and instruction in home safety. Film Shows and Talks—Response to the letter was very satisfactory and a total of 142 visits were made to organisations. Average attendances were just under 40 per meeting although this varied tremendously from organisation to organisation. Pensioners audiences were highest in percentage. Programmes were weil received and several letters of appreciation were gained. Thanks are due to the staff of the Department who ably and willingly gave of their time to speak on their work or aspects of it. The popularity of talks or talks with films bears silent tribute to this service. The following tables give an indication of the subjects covered, audience attendance and types of groups. TABLE I Subject Films Talks Films & Talks Total D. O. D. O. D. O. Home Safety 10 3 9 8 10 9 49 Food Hygiene 6 4 5 6 4 — 25 Infectious Disease & Housing 2 2 1 1 1 7 Nutrition 4 — — — — — 4 Dental Hygiene 3 1 — — — — 4 Maternity & Child Welfare 2 1 2 — — — 5 Old People's Welfare 1 — 4 — 3 1 9 Welfare Services — — 1 1 — — 2 Health Services 5 1 2 4 1 — 13 Miscellaneous 3 19 — — 2 — 24 36 31 24 20 21 10 142 266 TABLE II Organisation D. O. Total Audience Religious 16 12 28 583 Political 19 8 27 647 Old People 17 — 17 1,182 Youth 5 11 16 822 Miscellaneous 24 30 54 2,364 81 61 142 5,598 D—In duty hours. O—Out of duty hours. Displays—Four requests for displays were received, all on the subject of Home Safety. Response was good and many leaflets distributed. Home Safety Training Courses—Two courses were given, both in connection with the Duke of Edinburgh's Award Scheme. At the conclusion of the courses, examinations were held and all candidates reached pass standards. Requests for Leaflets—A number of requests for leaflets on a variety of subjects were received. B.—Other Activities Artificial Respiration—There is a need for more informed knowledge of the expired air method of resuscitation. As accidents increase, on holiday, in the home, on the road, there is bound to be an increase in the number of occasions in which a victim's life may be saved by one of the by-standers having a knowledge of this simple method of resuscitation. Public Lectures/Demonstrations—A series of public lectures and demonstrations were held at 8 centres in the Borough during the month of July. A qualified lecturer gave a talk on the factors involved in cessation of breathing and illustrated common incidents where this was likely to happen. This was followed by demonstrations of the Holger-Neilsen method of resuscitation and the expired air method using a "resusci-anne" demonstration model. Public participation followed. The series was reasonably well attended and thanks are due to the Baths Department for provision of demonstrators and the "resusci-anne" model. 267 Public Functions—The opportunity was taken at 6 other functions attended by the public to arrange for the showing of a film on mouth to mouth resuscitation with accompanying demonstrations by Bath's Department staff on the "resusci-anne" model. These demonstrations attracted great interest and stimulated personal participation. Shop Window Displays—In October, the use of a shop window adjacent to the main shopping thoroughfare in Woolwich was placed at the disposal of the Department. The opportunity was taken to mount a display illustrating the safe use of fireworks. This attracted considerable attention and is undoubtedly a valuable method of publicity. Festival of Christmas activities of the Council prohibited the use of a window again for the remainder of the year, but formal arrangements were made for the use of the window whenever possible. In addition a small display window at the entrance to one of the Council Offices is to be allocated for one month to each of the Departments. This Department's tenure commences in January, 1966, and the proposed display is to be devoted to the role of the Health Visitor. Holiday Film Shows—Film shows were arranged at 4 centres during the summer months to which children were invited. The films shown illustrated health education topics and included films of general interest. At three showings audience expectations were not fully realised, possibly due to the timing of the events which occurred at the peak of the holiday season. It is planned to hold a further series in the Easter holidays when greater participation is anticipated. The fourth showing, held at a different time in a housing estate elicited an overwhelming response showing that, with calculated timing, this can be a very effective method of bringing home the health education message to young people. Old People's Homes—Pending arrangements being made by the Entertainments Officer, the Section undertook the provision of regular autumn and winter entertainment programmes at the four residential homes for the elderly in the Borough. In all, 17 programmes were arranged at fortnightly intervals for each home. These programmes were enthusiastically received and were welcomed as a high spot in the life of the residents. Welfare Centres and Schools—Assistance was provided in the shape of equipment, films, film strips and other visual media as requested by Health Visitors in Centres and Schools. A continuous programme of health education is given to expectant and nursing mothers and fully developed instruction in child care is 268 provided. This is dealt with more fully elsewhere in this Report. The Section co-operates by providing extra assistance where required. In all, 57 calls were made upon the facilities of the Section. The Section also undertook the provision of posters and leaflets in conjunction with the monthly programme of topics and other issues of health education material. Other Services within the Department—The Section cooperated with many other Sections of the Department in the provision of assistance, notices, posters, and the showing of films of professional interest. Catalogues of posters, leaflets, films and filmstrips available are being prepared. A series of in-service lectures on successful instruction and demonstration of visual aids is planned for all interested staff. In December, assistance was given in the organisation of the showing of the film "Examination of the Newborn" not only to professional staff within the Department, but also to G.P.'s and G.P.O.'s practising in the Borough. Careers Exhibition—A one-day Careers Exhibition arranged in the Borough was participated in by the Department. A continuous slide projector was hired and slides produced of members of the staff at work in the Borough. This combination of local evidence and information on the various professions within the Department available to school leavers proved to be effective and resulted in a number of enquiries. British Red Cross—A request was received from the local division of the British Red Cross Society for the provision of a course of lectures on Hygiene and Public Health. This proved to be an interesting assignment as the syllabus was extremely comprehensive. It was covered by a series of 12 lectures enlisting the support of a large range of professional staff of the Department. Thanks are due to all those who helped to make this venture a success. Fouling by Dogs—Warning Notices—This scheme originally in operation in Woolwich was extended to cover the new area. Fouling of pavements by dogs is an endemic nuisance and the Ipractice of displaying warning notices drawing attention to the Council's Bye-law prohibiting this does result in a lessening of the problem in the most affected areas. Smoking and Health—National publicity campaigns in this problem have received active participation locally by display of posters at Council establishments and on boards on hire round the Borough. Leaflets have been distributed on request to youth clubs on several occasions and two film programmes have been shown. 269 Venereal Disease—Laminated plastic notices resistant to vandalism were produced and erected in all conveniences in the Borough. The notices give details of where confidential treatment may be obtained and urge early consultation. Leaflets are in course of production along similar lines with additional information to be available on request. Requests have been received from youth leaders for leaflets on a number of occasions and films on the subject have been shown in some schools in the area. Safety in the Home. It is little realised, mainly due to lack of "news" value, that accidents in the home account for more accidental deaths than any other cause, even on the roads. Since accidents are primarily caused through individual carelessness, it remains a problem of education to ensure that everybody is made aware of the hazards that await in every home. This problem received special consideration in the education activities of the Council. A Home Safety Sub-Committee of the Health Committee was formed and had its inaugural meeting in June. The Sub-Committee meets quarterly and its terms of reference are as follows:— (a) To carry on a continual propaganda campaign locally to inform the public of the extent and gravity of the Home Accident problem. (b) To enlist the support of all interested municipal and social organisations for this campaign. (c) To investigate local Home Accident cases and their causes. (d) To investigate possible remedies. (e) To effect any necessary liaison with the National and Area Home Safety Committees set up by the Royal Society for the Prevention of Accidents and, in particular, to participate if considered desirable in any home safety campaigns conducted by these Committees. The Sub-Committee is also empowed to partake in the National Water Safety Campaign. The Sub-Committee considered various matters during the remainder of the year, an early decision resulting in the appointment of a Home Safety Officer and the initiation of several campaigns and ventures, the more notable of which are listed below :— 1. Artificial Respiration Demonstrations (detailed above). 2. Production of a Home Safety Leaflet for broadcast distribution. 270 3. Distribution of reply-paid cards to local hospitals for issue to out-patients attending as the result of a home accident. The card offers help and advice in reducing the possibility of a recurrence. 4. Arrangements made for the occasional use of public baths and libraries for home safety displays. The Sub-Committee also participated in giving local support to national campaigns organised by the Royal Society and the Home Office :— National Fire Prevention Campaign :— Local activities — 1. Insertion of advertisement in local press. 2. Poster publicity on sites available to the Council. 3. Posters advocating the use of fireguards to local ironmongers and fuel merchants for display. 4. Posters and leaflets giving advice on the safe handling of fireworks to all local retailers. (In conjunction with shop window display mentioned above). 5. Provision of displays and publicity material to local stations of the London Fire Brigade. Buy Safe—This Christmas :— Local activities — 1. Requesting local shop-keepers to assist in the distribution of "buy for safety" leaflets. 2. Advertisements in local press. National Water Safety Campaign—A review was made of natural hazards along water ways in the area as recommended in Circular 52/65 of the Ministry of Housing and Local Government. Sets of the campaign pack issued by the Royal Society were purchased and distributed to baths establishments in the Borough. The instruction in mouth to mouth resuscitation recommended by the Ministry is already receiving attention in this Borough. 271 MEDICAL EXAMINATIONS A summary is given below of medical examinations carried out by the Department's Medical Officers from 1st April, 1965, mainly in respect of superannuation and sickness schemes :— Superannuation. Staff No. of Examinees founl to be fit 344 No. of Examinees found to be unfit 3 No. of Examinees deferred 17 One examination was carried out in accordance with Section 106 of the L.C.C. (General Powers) Act, 1937, as amended by Section 28 of the 1951 Act (Widows Pensions). Employees No. of Examinees found to be fit 160 No. of Examinees found to be unfit 7 No. of Examinees deferred 1 Sickness. No. Examined after prolonged sickness 25 No. found to be permanently unfit 10 Accidents (on duty). No. Examined after accidents 6 Other Examinations. Carried out by the Council's M.Os:— On behalf of Inner London O. & M. Committee 6 On behalf of the London Boroughs Joint Computer Committee 14 On behalf of other Local Authorities 9 Carried out by other Local Authorities :— On behalf of London Borough of Greenwich 9 Medical Assessments—Housing. Under the Council's Rehousing Scheme, if an applicant's case is supported on medical or sociological grounds, a certain degree of priority is afforded. During the current year, some 1,013 cases for re-housing or transfer were reviewed and medically assessed by the Associate Medical Officer of Health. A high proportion of these applications were subject to up-to-date reports from the Public Health Inspectors and Social Workers in order that the degree of priority should be fairly allocated. In eight instances it was necessary for the Medical Officer to make a domiciliary visit to enable the appropriate assessment to be made. 272 TRAINING COURSES This year a variety of courses were attended by staff both administrative and professional from all services. Whilst some of these courses are statutory requirements, noticeably in the case of the nursing services, the offer of a wide range of other noncompulsory courses reflects the department's awareness of the need for fully trained staff, and the necessity for staff already trained, to keep abreast of the latest developments. There is no doubt of the value of these courses in ensuring that the services given to the public are of the highest standard. The duration of the courses varied from 1 day to 1 or 2 years and the method of study from day or "block" release to full time release. Members of the staff were seconded on full salary with full course fees paid. The following is a list under each of the services of the various courses attended by staff during 1965 :— Administrative. Catford College of Commerce Local Government courses (day release) Professional. Medical and Dental British Postgraduate Medical Federation Refresher Courses in Paediatrics „ „ The Handicapped Child— Course on Psychiatry London Local Dental Committee Evening classes for training of Dental Surgery Assistants Nursing Services British Postgraduate Medical Federation Hearing Testing Techniques Chest and Heart Association Study day of the Chesty Child Health Visitors Association Fieldwork Instructors courses London Boroughs Training Committee Introductory courses for School Nurses London University Fieldwork Instructors courses „ „ Evening extension course on 'Towards better Medical Care' 273 Queens Institute of District Nursing Mental Health Problems in the community „ „ 'On the road to Independence — The Younger Handicapped' Royal College of Nursing Fieldwork Instructors courses „ „ Study day for Nursing Staff National Society for Children's Nurseries Study day The Committee of King Edward's Hospital Fund for London Residential Courses in Public Health Nursing Administration Compulsory Refresher Courses Health Visitors Association Refresher courses for Nursing Staff Queens Institute of District Nursing Refresher courses for District Nurses Royal College of Nursing Refresher courses for Nursing Staff Social Workers—Health. Council for Training in Social Work Study course on In-service Training for Fieldwork Officers Hull University Applied Social Studies— 1 year London University Extension Courses Lectures on Society for Autistic Children Social Workers—Welfare. Croydon Technical College Course of training in Social Work—Two years Industrial Advisors to the Blind, Ltd. Management Training Courses Society of Teachers of the Deaf Peripatetic Teaching and Assessment of Services for Hearing Impaired Children South East Regional Association for the Blind Course for Home Teachers of the Blind (1 day release) The London County Council Courses on Care of the Handicapped Child 274 Mental Health Services. Chiswick Polytechnic Study group for Teachers (Mentally Handicapped) Council for Training in Social Work Study courses on In-service Training for Fieldwork Officers London University Introduction to Psychology National Association for Mental Health Diploma Course for Teachers (Mentally handicapped)—1 year The Tavistock Institute Prevention of Mental 111 Health by Public Health Environmental Health. College for the Distributive Trade Poultry Refresher Courses „ „ Meat Inspection Refresher Course Royal Society of Health Preservation of Foodstuffs „ „ Examination for Smoke Inspectors Standing conference of Cooperative Bodies Investigation of Atmospheric Pollution Health Education. Central Council for Health Education Summer School Royal Society of Health Advanced Techniques in Health Education Other Services. Home Help Institute of Home Help Organisers Week-end School Miscellaneous—In addition to the courses listed above, the Department was responsible for training six Public Health Institute students, six student Health Visitors, 18 nurses for District Nursing training, and a number of pupil midwives. The Department also accepted a number of students from various colleges for practical placements in its various establishments. 275 Conferences—Conferences attended during the year by Council and/or Staff representatives are given in the following summary:— CONFERENCE ORGANISERS Association for Special National Association for Education Mental Health British Dental Association National Childbirth Trust British Lighting Council National Institute for Central Council for the Social Work Training Disabled The National Nursery Council for Home Help Examination Board Services National Society for Clean Health Visitors Association Air Holborn College of Law, North Western Polytechnic Languages and Commerce Queens Institute of District Inner London Education Nursing Authority Royal Institute of Public International Union of Health and Hygiene School and University The Royal Society for the Health Prevention of Accidents London Boroughs Commit- South-East Regional tee Association for the Deaf National Association for Society of Medical Officers Maternal and Child Wel- of Health fare World Asthma Association DEPARTMENTAL TRANSPORT On 1st April, 1965, the total strength of the newly formed Health and Welfare Department's transport fleet was 32 vehicles. Thirteen were inherited from the Metropolitan Borough of Greenwich, 12 from Metropolitan Woolwich and 7 from the London County Council. A Transport Organiser was appointed to administer the deployment of men and vehicles and to arrange garaging, repairs and the engagement of drivers. During the year 1965/66, the Department took delivery of 6 more vehicles, for which provision had been made, bringing the total fleet to 38. The main services to which these vehicles were allocated were :— 276 (i) Handicapped Persons 4 Coaches with tail lifts (ii) Mobile Meals 10 6-cwt. vans 4 Minibuses (iii) Day Clubs 1 Minibus 1 10-seater Personnel Carrier (with tail lift) (iv) Blind Workshop 1 3-ton van (v) Lunch Clubs 1 Minibus 1 6-seater Utilibus (vi) Residential Accom1 Utilibus modation (vii) Environmental Health 3 6-cwt. vans 1 10/12-cwt. van (viii) Supplies 2 10/12-cwt. vans (ix) Bathing Centres 3 Minibuses 1 6-cwt. van 2 10/12-cwt. vans (x) Mental Health 1 Morris 1000 car (xi) Nursing Service 1 Morris 1000 car The policy of using minibuses for the 'Meals-on-Wheels' service proved economical in vehicle operation as they could be utilised for other types of work both before and after the 'Meals-on-Wheels' rounds. In addition to the vehicles mentioned above, 3 5-cwt. vans were loaned to the Department by the W.R.V.S. for Mobile Meals operations and the British Red Cross Society also contributed one for this service. The Department had only one tail lift coach at the 1st April, 1965. Two more were delivered in September and, towards the end of the year, the last of the ordered vehicles was delivered making a total of four. A shortage of this type of vehicle had been anticipated and, therefore, in order to provide sufficient suitable transport for handicapped persons, a system of pooling of available vehicles had been devised in conjunction with the London Boroughs of Lewisham and Southwark. This enabled all activities for handicapped persons to proceed without interruption. Such arrangements are to be reviewed at the end of the first year of operation in the light of each Borough's fleet strength so that pooling could be discontinued as soon as their respective vehicle strengths became satisfactory. By the end of the first year of operation, it was found that our fleet of vehicles could meet most of the requirements of all health and welfare activities and, by judicious use of each vehicle, wasted time in 'standing-by' was eliminated and hiring of vehicles was reduced to a minimum. 277 SECTION IX SCHOOL HEALTH SERVICES REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER Introduction This is the first year that the School Health Service has been organised on a Borough basis and it is understandable that this annual report should follow closely the pattern adopted for so long by the former London County Council. While in the Inner London Education Authority area and for Ministry purposes certain basic statistical standardisation will be necessary and indeed desirable, it is hoped that in future years Boroughs will be able to show a certain individuality in the presentation of local reports. The year has seen no major changes and the main aim has been to preserve a continuity and to agree on the limits of local and central responsibilities, particularly in respect of arrangements and recommendations for special education. It is certain that by early next year a scheme for the joint use of staff and premises relating to the School Health Service will be agreed by the Boroughs and the Inner London Education Authority. In this introduction certain matters of local relevance must be emphasised, particularly deficiencies which are known to exist and which it is hoped can be remedied in due course. Child Guidance Facilities Child guidance facilities were seriously lacking in the Borough during 1965. The service formerly provided by special arrangement with the Memorial Hospital was discontinued and the clinic at St. Alfege's Hospital had a waiting list of three months. Children and parents in need of this service required immediate attention locally. It was very occasionally possible to arrange appointments at teaching hospitals, but the journey involved caused difficulties, sometimes insuperable, when frequent and regular psychotherapy was prescribed. The number of referrals in one year in this area has averaged over 190 and four sessions per week at Chevening Road Welfare Centre have been allocated so that an immediate expansion of the facilities will be possible. It is hoped that the Regional Hospital Board can make available a consultant psychiatrist for the sessions and the I.L.E.A. will provide the educational psychologist and psychotherapist. A psychiatric social worker and administrative and clerical support are available. This scheme in full operation 278 will go some way towards meeting local deficiencies and, looking further to the future, plans are advanced for child guidance facilities to be provided at Garland Road, alongside new maternity and child welfare premises. Delays in Placement of Certain Special Categories There was an undesirable delay in the placement of children ascertained as Educationally Subnormal. The delay for those requiring education at a boarding school was worse than that for day pupils. A worse delay was experienced for those who were recommended to schools for the maladjusted. This situation should be remedied as a matter of urgency—these pupils needed help immediately and not two terms hence. It is often regretted by School Medical Officers that boarding open air schools can not be used for children who are not only "delicate" but who also require long term placement for social reasons. Too often such children will enter boarding open air schools where their condition improves with fresh air, adequate rest and a high standard of nutrition and, after two terms or so, they are so much healthier that they are discharged to day schools. Despite great efforts by social workers concentrated on the home environment during the children's absence, it must be accepted that there is a small number of families in which conditions will never be really satisfactory for the nurture of children without serious risks to their future, and it is of no benefit to such children to perambulate between day and boarding open air schools. The placement of psychotic children continued to give concern to the authorities. Occasionally, such children could be contained in ordinary schools, pending admission to suitable special establishments, but sometimes behaviour such as aggression was so serious that the child was a danger to himself, other children and to the teaching staff, so that exclusion from school was imperative. Such cases were treated as a matter of urgency, but parents needed much support in the home during the interval between recommendation for special education and placement. Provision for the education of children with a dual handicap may be difficult and, pending placement, such children may remain in ordinary schools, schools for the physically handicapped or the educationally subnormal, or may even require home tuition. Support for the child and family was provided by the Social Worker or agency most known to the family. There is no school for partially sighted children in the Borough. All such children from Greenwich travel to the Nansen school in Lewisham. There appears to be no delay in admitting these children, 18 of whom were attending the Nansen school during 279 1965. There is a need in Greenwich for a nursery class to help mothers of blind and partially sighted children under the age of five years. These children tend to be over-protected by their parents and could be helped much earlier in life. Perhaps it may be possible at some time to provide combined nursery facilities for partially hearing and deaf, partially sighted and blind pre-school children, which might be linked with an ordinary day nursery. Blind children attend Linden Lodge, S.W.19, or private schools. There is no delay or difficulty in admission of these children. Similarly, there are no delays for admission to day open air schools for delicate children. In the case of epileptic children, however, there were usually long delays and difficulties in arrangements for admission of suitable children to Lingfield. Several epileptic children, insufficiently controlled by drug therapy to attend ordinary schools, attended either the school for the physically handicapped or the day open air school. Speech Therapy There are seven speech therapy clinics within the Borough, but there is a shortage of speech therapists and a long waiting list for nearly all the clinics. As far as possible all children have their hearing tested before attending for speech therapy. Great efforts will have to be made to recruit speech therapists not only in the school service but in the junior centres provided under the Mental Health Act. A greater sharing of facilities must be explored, and these same difficulties apply to physiotherapy. Day Nursery Facilities Although this is not directly related to the School Health Service, this Department is aware of the need for a day nursery in the Borough. This need is experienced not only in the case of children whose mothers need to work for economic reasons, but also handicapped children and children from deprived environments, e.g. the child with normal hearing whose parents are deaf and have little or no speech. Ten places are available to the Borough in a day nursery within the London Borough of Lewisham, but these places are always over-subscribed and a decision on priority admission is essential, leaving many deserving cases without assistance. Head teachers of local nursery schools have been helpful in admitting, occasionally, a handicapped child who is in need of company, but the numbers helped in this way are necessarily very limited, due firstly to the great deal of individual attention required by some of these children, which adversely affects that given to "normal" children, and secondly to the fact that some of the staff feel unable 280 to manage children who, later in their school lives, will definitely require education from specially trained teachers. The provision of a day nursery would relieve pressure on the local nursery schools. Special Techniques in Examination No new special techniques are being explored or used in examinations at present but, as a matter of interest, in the case of colour vision all boys of 11-12 years had their colour vision tested by selected Ishihari charts at their routine examination. If there was any doubt at this test, the child was referred to the County Hall for special testing with the Edridge Green lantern. During the year efforts were continued to increase co-operation between the social workers, local family doctors and hospitals. Due to the increasing shortage of hospital Medical Social Workers, a number of requests were received from consultants, either for reports on home background or for assistance in providing the environment to suit the medical and social needs of particular patients. It is fortunate that no racial or language problems are known in the School Health Service in Greenwich. Although there were no staffing shortages in the School Health Service, there was unfortunately a considerable turnover in school nursing staff. This would appear to be the future pattern in this service. The work of the local Care Committee must be given special mention. In association with social workers in the education and health field who supervise their training and deployment, these voluntary workers undertake the most arduous duties in connection with home visiting and medical after care, and it is a matter of satisfaction that this Committee provides such a good service in connection with the social problems of schoolchildren and their families. I should also express my gratitude to the Divisional Education Officer, Mr. W. A. Pattison, his Deputy, Mr. C. L. Curtis, and their staff for the help they have given and for the forbearance they have shown. It must have been a most trying experience for them to adjust to a new organisation. The head teachers and staff of the local schools have similarly shown great sympathy and friendship, and I trust that their many enquiries and difficulties have always been given a sympathetic ear. In conclusion, I should like to thank my own staff, and in particular my Deputy, Dr. M. E. Watts, on whose shoulders the daily burden of problems has descended, for their loyalty and devotion to the interests of the Service and to the Department. John Kerr Brown, Principal School Medical Officer. 281 SCHOOL HEALTH SERVICE ANNUAL REPORT 1965 Number of pupils (as at 20.1.66) Primary 20,263 Secondary 16,000 Nursery School 562 Special, including Hospital schools 721 37,546 Periodic General Medical Inspections Age Groups Number Percentage 4 years and less 954 6.4 5 years 2,778 18.7 6 years 830 5.3 7 years 724 4.8 8 years 1,994 13.3 9 years 387 2.6 10 years 208 1.4 11 years 1,008 6.7 12 years 1,665 11.1 13 years 564 3.8 14 years 522 3.5 15 years and over 3,338 22.4 14,972 100.0 Pupils found to require treatment at periodic general medical inspections (excluding dental and infestation) Age groups inspected For defective vision (excluding squint) For other conditions Total individual pupils 4 years and less 5 83 85 5 years 35 227 260 6 years 21 106 119 7 years 28 70 90 8 years 132 145 267 9 years 24 39 57 10 years 14 20 33 11 years 129 58 177 12 years 189 90 263 13 years 61 44 101 14 years 70 34 101 15 years and over 586 123 692 1,294 1,039 2,245 282 Percentage of children inspected who were noted for treatment Age and Sex All defects Vision defects Defects other than vision 4 yrs. & Less 475 Boys 9.3 0.604 9.1 479 Girls 8.6 0.417 8.4 5 years 1,414 Boys 11.0 1.4 9.6 1,364 Girls 7.7 1.1 6.6 6 years 452 Boys 16.2 2.9 14.6 378 Girls 10.1 2.1 10.5 7 years 398 Boys 13.6 3.8 10.8 326 Girls 11.0 3.1 8.3 8 years 1,033 Boys 13.9 6.5 7.8 961 Girls 12.7 6.8 6.6 9 years 216 Boys 13.9 6.1 9.7 171 Girls 15.2 6.4 10.5 10 years 108 Boys 17.6 7.4 10.2 100 Girls 14.0 6.0 9.0 11 years 328 Boys 16.2 11.6 5.1 680 Girls 18.2 13.4 6.0 12 years 841 Boys 12.1 8.3 4.8 824 Girls 19.5 14.4 6.1 13 years 308 Boys 14.9 7.8 8.1 256 Girls 21.5 14.5 7.4 14 years 306 Boys 23.2 16.0 7.8 216 Girls 14.0 9.7 4.6 15 yrs. and over 1,403 Boys 20.9 17.3 3.9 1,935 Girls 20.6 17.7 3.5 Total 7,282 Boys *14.9 *7.7 *7.7 7,690 Girls *15.1 *9.6 *6.2 Total both sexes 14,972 14.9 8.6 6.9 * Total average percentage Non-Routine Medical Inspections Re-inspections 6,625 Secondary school reviewals 340 Other non-routine inspections (see next table) 4,552 11,517 Total Inspections 26,489 283 Analysis of non-routine medical inspections Number Inspected 1965 *1964[/##] Bathing Centre inspections—scabies — 9 " " " other — 7 Employment certificates 502 507 Licences for Theatrical employees — — School journeys 2,765 2,495 Recuperative holidays—prior to holiday 15 27 —on return — — Candidates for higher awards 6 10 National school entrants — — Outward Bound and Adventure Courses 13 5 T.B. contacts — — Boarding school for the delicate: pre-departure inspections 5 J on return — — Other handicapped pupils: Statutory examinations 9 5 Periodic special defect examinations 417 294 Research investigations and enquiries 4 28 3,736 3,392 Specials, at request of: Head Teacher—special book 76 97 —other 268 288 School Nurse—after health survey 87 147 „ —other 51 49 Divisional Officer (Education) 25 40 District Care Organiser or Care Committee 34 31 Parent 101 116 642 768 All other non-routine inspections 174 114 TOTAL 4,552 284 Medical Treatment of Schoolchildren Type of Clinic Sessions Cases New Attendance Minor ailments (nurse) 1,840 16,587 62,190 „ „ (doctor) 247 2,560 Special Investigation 198 209 1,425 Dental 1,777 3,914 12,736 Vision 286 2,087 4,718 Ear, nose, throat 43 164 419 Audiology 45 163 365 Defects treated at Minor Ailments Clinics Defect Number Athlete's foot 236 Verrucae 1,867 Ringworm: body 9 Impetigo 136 Other skin diseases 425 Eye diseases 570 Ear diseases 209 Miscellaneous, bruises, lacerations, etc. 17,363 The majority of children suffering from verrucae are attended by their family doctor, but the fact remains that a considerable number attend the Minor Ailments Clinic for treatment of this contagious, painful and preventable ailment. Verrucae in children give concern to parents and teachers as well as School Medical Officers. On page 297 of the report, reference is made to the experimental use of a residual fungicidal preparation for floors which is undergoing trial at one school. Special Clinics—Attendances in 1965 New Total Cases Attendances Audiology 163 365 E.N.T 164 419 Enuresis 85 Special Nutrition 28 Investigation Behaviour Problems 20 1,402 Clinics Rheumatism or Heart Conditions 9 VISION It is significant that the majority of visual defects were found as a result of routine examinations at ages 5 years, 7-8 year, 11-12 years and 15 years. This may signify that selective medical examination, that is, waiting until symptoms manifest themselves 285 Visual acuity standards of children whose eyes were tested Age Group (years) BOYS Number tested—5,763 Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 6/9 6/12 or worse Referred for treatment Under 7 775 41 20 29 9 4 5 7 7 339 16 7 11 7 4 5 4 8 892 50 34 36 15 21 17 31 9 189 5 5 5 5 1 7 8 10 90 6 2 3 5 3 2 5 11 261 16 9 8 19 13 10 30 12 713 39 28 33 24 19 16 37 13 257 11 15 11 18 2 4 13 14 241 11 24 23 11 13 6 26 1 c and over 1,056 50 73 75 114 63 46 168 Total 4,813 245 217 234 227 143 118 329 Age Group (years) GIRLS Number tested—6,266 Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 6/9 6/12 or worse Referred for treatment Under 7 757 34 14 20 4 3 3 5 7 284 16 8 11 3 2 — 2 8 817 58 34 43 21 9 17 22 9 146 8 5 6 3 1 6 5 10 86 6 1 2 4 2 1 4 11 524 36 37 41 39 18 24 50 12 645 41 33 46 55 24 25 73 13 209 6 12 11 12 6 11 26 14 176 12 6 8 10 2 9 13 15 and over 1,438 53 84 84 223 80 63 259 Total 5,082 270 234 272 374 147 159 459 286 so that the child, parent or teacher requests examination, would not play sufficient part in preventive medicine at least insofar as visual defects are concerned, although a similar pattern of detection is noted in the statistics for all defects. Defects treated at Vision Clinics Defect Number Error of refraction and squint 3,796 Other eye defects 39 Spectacles ordered 1,189 Findings at Health Surveys School Roll (20.1.66)—37,502 1. Comprehensive surveys (a) Number examined 28,109 (b) Number (occasions) found verminous 138 (c) Percentage found verminous 0.49 2. Selective surveys (a) Number examined 25,026 (b) Number (occasions) found verminous 399 (c) Percentage found verminous 1.59 3. Verminous cases (a) Total times vermin found 537 (b) Total percentage found verminous 1.0 (c) Number of individual pupils found verminous 268 (d) Percentage of individual pupils found verminous (of School Roll) 0.71 4. Action taken with verminous cases (a) Advice and/or Lorexane 398 (b) Further action 139 (c) Percentage of cases given advice and/or Lorexane requiring further action 34.9 Voluntary attendances at bathing centres: Number of pupils 139 Number of statutory notices issued — 5. Communicable disease surveys: Numbers examined for: Athlete's foot 3,451 Plantar warts 3,097 Dysentery 345 Other communicable diseases 4,370 11,263 287 Prophylaxis School Roll (20.1.66) 37,502 Routine Inspections Number inspected 14,972 Number found not to warrant examination (7 plus 'special scheme') 70 Percentage of Number inspected of Parent present 53.9 Care Committee present 82.5 Number vaccinated against smallpox 86.4 Number immunised against diphtheria 91.9 Number immunised against whooping cough 80.7 Number vaccinated against poliomyelitis 89.8 Physical condition unsatisfactory 1.0 Referred for treatment of defects 15.0 Referred for treatment of defects other than vision 6.9 Non-Routine Inspections (i) Specials 4,892 (ii) Re-inspections 6,625 TOTAL (i) and (ii) 11,517 Number of routine inspections as percentage of school roll 39.9 Number of non-routine inspections as percentage of school roll 30.7 The above table gives a broad indication of the general physical and immunisation state of schoolchildren in the Borough. It is gratifying to note that in respect of immunsation procedures Greenwich has the best record of the Inner London Boroughs. The staff concerned are to be congratulated on a magnificent effort. On the other hand, one per cent. of all children examined at routine inspections were found to have an unsatisfactory physical condition. This figure is marginally the worst in London but it may be a statistical accident, for the number referred eventually for treatment for defects other than visual was about average for London, as was the number of non-routine inspections of the school roll. Examinations for recuperative holidays Fifteen such examinations were carried out in 1965 (27 examinations in 1964). The schoolchildren were examined after recommendation by school medical officers, the Children's Department, the Education Department or various social agencies, as being in need of a holiday which would provide fresh air, nourishing diet and adequate rest. Sometimes these children were accompanied by their siblings, while mother and children under five also enjoyed a holiday elsewhere. 288 B.C.G.—1965 SKIN TESTED NEGATIVE B.C.G. GIVEN Schools Further Education & Training Colleges Schools Further Education &Training Colleges Schools Further Education & Training Colleges 1st Quarter 452 64 405 8 405 8 2nd Quarter 330 — 291 — 291 — 3rd Quarter 687 — 603 — 603 — 4th Quarter 1,064 2 897 — 897 — Total for 1965 2,533 66 2,196 8 2,196 8 Numbers on roll = 1,850 Infectious Diseases in Schools Disease Number Chickenpox 805 Dysentery, diarrhoea or enteritis 92 German measles 58 Impetigo 14 Influenza 11 Jaundice 8 Measles 1,136 Mumps 189 Ophthalmia and conjunctivitis 28 Ringworm (scalp) — Ringworm (body) 5 Scabies 7 Scarlet fever 103 Sore throat and tonsillitis 87 Whooping cough 32 These figures cannot be considered to be comprehensive but are an indication of the incidence and pattern of infectious disease. Measles and chickenpox accounted for the majority of cases of infectious disease in schools during 1965, measles showing its usual biennial peak in this year. There were seven cases of scabies, all 289 of whom were treated by their family doctors. The number of children suffering from ophthalmia and conjunctivitis was small (28 cases from a school roll of 37,502), but since these highly infectious diseases are transmitted by poor personal standards and lack of hygiene, even such a small figure as this must be further reduced. The care of the handicapped child In the introduction some reference has been made to specific difficulties arising in relation to placement. In providing a school health service for handicapped children the responsibility falling on the examining medical officer is a heavy one and decisions and recommendations cannot be taken without knowledge not only of the presenting handicap but of the attendant difficulties, problems and needs of handicapped children in the family group. Every encouragement should therefore be given to school medical officers working in the clinical field to gain experience and satisfaction in the type of work that interests them and in which they are expert. The various tables in the report contain the findings and statistical information relating to examinations under Sections 34, 57 (as amended) and 57A of the Education Act, 1944. With regard to mental subnormality, there is a close link between the education and the mental health side in respect of children deemed unsuitable for education at school and who can be accepted for admission to the Junior Centre. Number of children of all ages noted for treatment or observation expressed as a rate per 1,000 inspected Number Inspected 14,972 Defects Treatment Observation 1965 *1964 1965 *1964 Skin 5.88 5.95 8.95 6.73 Eyes (a) Vision 86.43 27.99 (b) Squint 7.41 3.47 (c) Other 2.47 2.87 Ears (a) Hearing 6.28 3.72 4.61 4.58 (b) Otitis media 3.41 2.61 3.47 4.25 (c) Other 0.53 1.00 Nose and Throat 8.82 26.13 Speech 3.67 3.46 8.28 5.95 Lymphatic Glands — 2.27 Heart 3.07 3.40 10.22 8.24 Lungs 7.08 9.81 8.82 11.31 Developmental (a) Hernia 0.73 1.24 1.87 2.22 (b) Other 1.14 5.28 290 Orthopaedic (a) Posture 0.87 6.08 (b) Feet 2.81 19.77 (c) Others 2.47 9.15 6.15 7.45 35.00 29.29 Nervous System (a) Epilepsy 2.00 1.40 (b) Other 0.40 1.14 2.40 2.48 2.54 2.35 Psychological (a) Development 0.40 3.94 (b) Stability 1.20 10.29 1.60 2.68 14.23 12.88 Abdomen 0.20 0.87 Other 15.43 37.47 Comparative figures for 1964, where known A small increase in the number of children noted for observation in 1965 for psychological disturbances can be seen. A number of these were referred for child guidance, hence the need for such facilities to be developed in Greenwich as soon as possible. Paediatricians report an increasing incidence of catarrhal conditions and asthma in childhood—these statistics should cause concern, since bronchitis, known abroad as "the English disease", is increasing among other age groups and is one of the major causes of chronic ill health among older workers. Frequently there is a familial predisposition to develop bronchitis, a tendency which it is possible to negate by inculcating a healthy mode of life in the young person and advising suitable employment for the school leaver. There was a significant increase in the incidence of orthopaedic defects in 1965, comparable figures for foot defects are not available for 1964, but it is not unlikely that the increase is largely due to "painful feet" caused by present fashions in foot wear and the progressively early age at which such foot wear is adopted. When the statistics for the Inner London Education Authority areas are compared with Greenwich, it is found that the Borough seems to be above average in some instances, substantially in relation to the incidence of skin, visual, speech, heart and lung defects, and the incidence of otitis media and epilepsy is also recorded as above average for London. On the basis of one year it would be unrealistic to draw any definite conclusions from these figures, but we will await the figures for succeeding years with more than casual interest to see if this pattern is repeated. If it is confirmed, a more careful local scrutiny of area and individual school figures will be necessary so that an analysis of possible environmental or sociological factors can be undertaken by the Department. 291 Comparison of Defects Noted at 7-plus Routine and 7-plus 'Special' Medical Examinations in 1965 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected. Number inspected at 7-plus Routine Inspections 3,086 Number inspected at 7-plus Experimental Scheme Inspections—18 Defects A* B† Skin 10.69 — Eyes (a) Vision 98.83 55.56 (b) Squint 8.75 — (c) Other 6.16 — Ears (a) Hearing 15.88 — (b) Otitis media 5.51 — (c) Other 1.94 — Nose and Throat 53.47 111.11 Speech 11.99 111.11 Lymphatic Glands 2.59 55.56 Heart 11.99 — Lungs 16.53 55.56 Developmental (a) Hernia 1.62 55.56 (b) Other 7.78 — Orthopaedic (a) Posture 8.43 — (b) Feet 24.95 — (c) Other 6.80 — Nervous System (a) Epilepsy 3.56 — (b) Other 1.30 — Psychological (a) Development 7.13 — (b) Stability 10.37 111.11 Abdomen 1.30 — Other 53.79 55.56 *Column 'A' refers to 7-plus routine medical inspections †Column 'B' refers to 7-plus experimental scheme inspections With regard to the comparison of defects noted at 7-plus routine and 7-plus 'special' medical inspections, to some extent the general local pattern is repeated in the Inner London Education Authority area in respect of defects specifically recorded in that experimental scheme, although there are some variables. Further local knowledge of areas and social groups more adversely affected than others would be useful. 292 Educationally Subnormal Pupils Number examined: 86 Number recommended: 1. Day E.S.N. School 63 2. Boarding E.S.N. School 3 3. Ordinary school with special help 8 4. Junior Training Centre 12 Children in E.S.N. schools were examined annually as regard their special handicap. Those fit to return to ordinary school were de-ascertained. Regular contact was maintained between head teachers of E.S.N. schools, the Mental Health Officers and Youth Employment Officers, so that those school leavers who might require community care were visited and suitable employment found for them. Such social support enabled these young people to maintain regular attendance at work and helped the family to give guidance during those early years of adult life. During 1965, 57 school leavers were referred to the Department for community care—of these 48 were 16 year old leavers and 9 had left school either at an earlier or later age. Four children were ascertained as maladjusted and in need of education in a special school while three children with dual handicaps were referred to County Hall for special examination. As a result of these examinations one child was recommended for day school for the maladjusted, 1 was recommended for day E.S.N. school and the remaining child was admitted to a tutorial class pending a further decision. Routine Audiometer Testing Pupils given screening tests 7,058 Pupils failing screening tests Pupils given pure tone tests 431 Pupils failing pure tone tests 290 Pupils referred to Otologists Percentage referred to Otologists 4.09 Every child under the educational system is subjected to a screening hearing test. If this test is failed, more detailed investigation is arranged and, when necessary, children are referred to the Otologist for advice and/or treatment; 4.0% of children tested during 1965 were examined by the Otologist. Some of these children regained normal hearing after treatment, but others, for example those suffering from an untreatable congenital hearing defect, were advised to sit in an appropriate position in class. A few more seriously deaf children were fitted with hearing aids (at the expense of the Inner London Education Authority), which enabled some to take their place in ordinary schools, while a few were admitted 293 to special schools or units in ordinary schools for deaf and partially hearing children. A register is kept in the Department of all deaf and partially hearing children in Greenwich. This record is reviewed regularly to confirm that the children's school progress is satisfactory, that hospital appointments are kept when necessary and that hearing aids, if prescribed, are worn regularly. If any of these factors give cause for concern, appropriate action is taken, often starting with a home visit by a Social Worker, so that the concern of the Department for the child is explained and parental co-operation is forthcoming. The total roll at Beverley School for the Deaf is 30, of whom six are Greenwich children. Similarly, at the partially hearing unit of the Meridian School there are 11 Greenwich children out of a total roll of 25. THE SCHOOL DENTAL SERVICE F. Elston, L.D.S., R.C.S. Eng., the Principal School Dental Officer, reports:— "Following the changeover resulting from the London Government Act on 1st April 1965 the School Dental Service formerly administered by the London County Council became administered jointly by the Inner London Education Authority and the London Borough of Greenwich. Owing to the interim period of resettlement following the changeover, however, the scheme for provision of school dental care continued to be based on that of the London County Council for the remainder of the year. The existing five treatment centres in the Borough were greatly affected in their continuity by the advent and departure of Dental Officers. Although one full-time and one part-time Dental Officer were appointed in 1965, resignation of two lady dental surgeons for personal reasons caused the temporary closure of the Dental Clinic at Rusthall Lodge for two months prior to its re-opening on a reduced part-time basis. Demand for treatment greatly exceeded the available treatment facilities. Although it is necessary for every school child to have a dental inspection at least once a year, staffing difficulties rendered this impossible. Not only was it impossible to examine the 37,502 schoolchildren of the Borough, but it was decided to reduce the number of school inspections to a realistic level rather than to cause congestion of the clinics by creating a demand for treatment exceeding the possible treatment facilities. In fact, it is incorrect to say that the original programme for 1965 included inspection of all the schoolchildren if physically possible. In the latter half of 1965 school inspections were guided by a newly introduced policy of the Inner London Education 294 Authority, whereby only the five year old entrants in infants' schools were to be examined whilst the rest of the parents and guardians of the school population were to opt on a form supplied via the school whether they wished their children to be examined and treated by the School Dental Service or by dental surgeons in general practice. In view of the use of a form SHS.59 this option procedure was generally referred to as the SHS.59 scheme. The distribution of forms SHS.59 had again to be limited to a small number of schools, to avoid a demand for treatment by the School Dental Service exceeding treatment facilities. The dental service established by the L.C.C. in the area of this Borough was fully engaged in the actual treatment of existing dental lesions but contained shortcomings in the essentials of dental health education and preventive dentistry. These aspects will have to be considered for expansion in the near future. Whilst two of the clinics provided every child patient with initial dental health explanations and instructions and subsequent strict supervision, the element of fluctuation in dental man-power rendered it impossible in 1965 to introduce dental health instruction of patients into all the clinics. In the latter part of 1965 the Principal School Dental Officer visited all Head Teachers of schools whose children either underwent dental inspections or were considered under the SHS.59 Scheme. The objects of his visits were: (a) to acquaint all Head Teachers and teaching staff with the aetiology and prevention of dental disease; (b) to encourage Head Teachers and teaching staff to give the children simple tuition on preventive measures; (c) to establish oral health education as a part of the school curriculum by constant repetition of the main theme througout school age; (d) to make available preventive procedures, such as water after meals, the abolition of carbohydrates in tuck shops, and the discouragement of in-between-meal snacks. As mentioned above, the limited facilities of the School Dental Service were in 1965 mainly concentrated on supplementing the hard pressed general dental practitioners and on limited school inspections. Whilst this activity was undertaken to the maximum capacity of the slender professional resources available, it is the writer's opinion that the School Dental Service should have a wider field of activity than mere treatment and inspection. Dental Health Education to supply the child with a firm understanding of the causes and prevention of dental disease is the next step in the programme, together with epidemiological surveys and analysis of the data obtained from school examinations. It is anticipated that future annual reports will include progress in this direction and will see the School Dental Officer participating in the team educating the child for its future life and acting in a preventive as well as in a therapeutic capacity." 295 SCHOOL DENTAL SERVICE — Statistical Analysis Sessions Treatment Sessions 1,680 General Anaesthetic Sessions 27 School Inspections 70 Attendance New patients given appointments 9,178 attended 3,914 percentage of attendance 42.6% On-treatment patients given appointments 11,117 attended 8,444 percentage attendance 75.9% Emergency patients treated 378 Total of attendances 12,736 Number of treatment cases started 3,270 completed 2,934 Treatment Total number of teeth treated 12,143 (1) Permanent teeth 5,459 filled 5,131 extracted (including orthodontics) 328 percentage of fillings 94% extractions 6% (2) Deciduous teeth 4,299 filled 3.458 extracted 841 percentage of fillings 81.4% extractions 18.6% Teeth root-filled 64 otherwise conserved 2,321 Prophylactic treatment 1,731 Number of patients x-rayed 235 Number of general anaesthetics 431 Orthodontics New cases undertaken for treatment or referred 26 Completed cases 5 Discontinued cases 1 Appliances fitted—removable 9 fixed 4 296 Inspections Children inspected at schools and clinics 9,128 Found to require treatment—Number 6,094 Percentage 66.7% Acceptance—School Dental Service 4,890 percentage 80.2% General Dental Services 1,204 percentage 19.8% Inspections of local schools by Public Health Inspectors on matters of environmental hygiene At the requests of Head Teachers, the following visits were made to schools during 1965: — PURPOSE NUMBERS REMARKS Food Hygiene 34 23 Visits at request of 11 Head Teachers, and on routine inspections. Food Inspection 12 12 Visits at request of school catering service re unsound food. Infectious Diseases 16 16 Investigations ing medical or school notifications. Nuisances 20 11 Visits on request of 9 Head Teachers or on complaints from parents, and on routine inspections. Eighteen of these nuisance complaints were in respect of minor defective sanitary fittings or unsatisfactory washing facilities or drainage defects, and two in respect of inadequate ventilation. Surveys 1 1 At request of the Education Authority. TOTAL VISITS 83 83 The continued use of four huts as annexed classrooms of a Junior School were the subject of concern to the teaching staff and the advice of the Department was requested. On inspection, considerable dampness was found to be due to various structural defects. These defects were discussed with the Architect of the Maintenance Section of the Inner London Education Authority and his Assistant when it was apparent that the extent of repairs and maintenance work necessary to secure a reasonable standard of fitness was probably prohibitive and uneconomic in view of 297 the length of time that the buildings were expected to remain in use. However, it was necessary to inform the Divisional Officer that further use of the huts as classrooms could be detrimental to children and the teaching staff. Another Junior School was troubled by an increasing evidence of verrucae. The matter was discussed with the Head Teacher and a leaflet was prepared for distribution to parents indicating how these lesions were constructed and how they could be prevented. It was explained to parents and teaching staff that the best safeguard in preventing this condition is the discontinuation of physical training in bare feet and the use of individual shoes and socks. A fungicidal preparation for use on polished floors is now undergoing trial at this school. This is a preparation which is alleged to be absorbed into the floor and, due to its residual activity, leaves it as a disinfecting agent. Examinations regarding fitness for employment (Children and Young Persons Act) Five hundred and two examinations took place in 1965 (507 in 1964). The majority of these examinations took place in school. When special sessions were held for this purpose outside school hours the attendance was usually very low indeed, and repetition of appointments was a waste of medical and clerical man power. Occasionally, the assistance of the Divisional Education Officer was requested to ensure that the child or young person did eventually attend for the examination. Health Education in Schools Mothercraft classes have been given regularly in five of the larger schools, including the Comprehensive. Informal talks on personal hygiene, good grooming and similar subjects were given in most schools at the comprehensive surveys. During the summer holidays, three films were held for the schoolchildren at different Welfare Centres with limited success, but encouraging enough to suggest continuing these in the future. In the schools with medical rooms and in the Treatment Centres, posters and leaflets have been displayed. The Health Education Officer has produced colourful and lively illustrations to suit talks and discussions given by the School Sisters. 298 Student Health Service Avery Hill College is the only Teacher Training College within the Borough boundaries. Medical services are provided in the college by a local general practitioner but the assistance of the Department is given in physical examinations of all college leavers. Two hundred and forty-seven were examined during 1965. Medical inspection services are also provided at Woolwich Polytechnic. In this case students are examined during their training and before completion of the course. B.C.G. vaccination was also offered to all students, but the response in 1965 was disappointing. It was felt that the students were not sufficiently aware of the desirability of this vaccination and it is, therefore, intended that special talks should be provided prior to the vaccination sessions, so that students may be informed of the advantage of vaccination and immunisation in genera!—information which they can pass on to the parents and children whom they will encounter throughout their teaching career. INDEX Page A Abattoir 240 Accidents—Deaths 42, 60 Home 42,60,269 Accommodation— for Elderly 116 for Homeless 119 for Mortuary 222 for Psychiatric Patients 182 Acute Encephalitis 67 Acute Influenzal Pneumonia 66 Acute Poliomyelitis 67 Acute Primary Pneumonia 66 Acute Rheumatism 63 Adoption 106 Adults Cleansed 220 Aflatoxin in Ground Nuts 243 Age Composition of Population 44 Age Mortality 49 Alcoholism and Drug Addiction 76 Aleukaemia 42 Allergy Testing at Chest Clinics 70, 72 Analysis of Non Routine Medical Inspections 283 Analytical Examination of Milk. 236 Animal Boarding Establishments Act 204 Ante and Post Natal Clinics 82 Ante and Post Natal Attendances 82 Antitoxin—Diphtheria 66 Ants, Pharaoh's etc 217 Area of Borough 15 Art Therapist — Day Hospital for Mentally Ill 183 Articles and Rooms Disinfected 221 Articles Destroyed 220 Artificial Respiration— Lectures/Demonstrations 266 Ascaridae in Pigs 241 Asthma 70 Atmospheric Pollution 198 "At Risk" Register 99. 166 Audiometer Testing of Schoolchildren 292 B Bacteriological Examinations 212, 235,236, 244 Baiting of Sewers 216 Bakehouses 239 Bathing—at Centres 152 at Home 152 Bathing Centres 152 Bathing Service 151 Baths—Swimming 212 Page Baths—Turkish & Russian 212 Baths—Vapour 212 Baths—Warm 212 Baths and Wash-houses .... 212 B.C.G. Vaccination 68,70,71, 288, 298 Beetles, etc 219 Betting, Gaming and Lotteries Act 204 Beverley School for Deaf .... 293 Birth Registrations 47 Births 41,46 Births -Age, Parity and Place of Occurrence 83 Blackheath Fair 237 Blackwall Industrial Training Centre 173 Blind—Club at Eltham 135 Blind—Concessions 130 Blind—Education, Training & Employment 126 Blind—Homeworkers 126, 127,131 Blind—"In" Residents 127 Blind Occupations 127 Blind—Registers 125 Blind—Sheltered Employment 126, 131 Blind—Welfare 123 Blindness—Major Causes 129 Boarding Out— Child Contacts etc. 106 Subnormal Adults 170 Bread and Flour Regs. .... 246 British Red Cross Society— H.E. Lectures 268 Bronchitis ... 42,58,70,290 Bronchogenic Carcinoma 57 Brook Chest Clinic 71 Burial or Cremation of Deceased Persons 137 Butchers' Shops and Stalls 239 C Cancer—Cervix 42 Cancer—General 42, 55 Cancer—Childhood, Survey of 57 Cancer—Lung 42, 57,70,72 Cancer—Other Special Sites 42,56 Cancer—Uterus 42 Care and Protection of Property 137 Care Committee 280 Care of the Handicapped Child 289 Careers Exhibition — Health Exhibition Stand 268 INDEX (continued) Page Carcases and Offal Inspected at Slaughterhouse 240 Case Conferences 108 Caseous Lymphadenitis 243 Cases of Infectious Diseases 63 Castlewood Day Hospital— Mentally Ill 183 Catering Establishments 239 Cerebral Embolism 55 Cerebral Haemorrhage 55 Cerebral Thrombosis 55 Certificates—Export 245 Certificates—Disrepair 201 Certificates—International Vaccination 64 Cervical Cytology 90, 92 Cesspools 205 Chest Clinics 69,71 Chest Physicians' Reports 69,71 Chevening Road Day Centre— Mentally Ill 183 Chickenpox 288 Chief Housing Officer's Survey 230 Child Contacts—Boarding Out 106 Child Guidance Facilities 277 Child Helps 97 Child Minders—Statutory 110 Child Minders—Voluntary 110 Child Welfare Clinics 104 Childbirth. Preparation for 84 Children Cleansed 220 Chiropody—Domiciliary 111 Chiropody—General 111 Chiropody—Elderly 112, 153 Chiropody—Services 111 Civic Entertainment for Elderly 153 Classification of Deaths 54 Clean Air Act 199 Cleansing & Bathing Centres 152,220 Cleansing of Children 220 Cleansing of Old People 152 Clearance Areas 227 Clinics—Ante Natal 82 Clinics—Child Welfare 104 Clinics—Family Planning 91 Clinics—Geriatric 160 Clinics—Mental Health 169 Clinics—Minor Ailments 284 Clinics—Post Natal 82 Closing Orders 226 Closing Orders— Determinations 227 Closing Orders—Houses 226 Clover Mite 218 Clubs—Blind 134 Page Clubs—Day 154 Clubs—Deaf 135 Clubs—Elderly 154 Clubs—Luncheon 158 Clubs—Mothers' 107 Clubs—Physically Handicapped 134 Clubs—Subnormal 171 Clubs—Therapeutic, Social 184 Clubs and Centres for Handicapped 134 Cockroaches 218 Common Infectious Diseases 60 Communicable Diseases Survey—Schoolchildren 286 Community Centres 33 Community Council 33 Community Services— Geriatric 138 Handicapped 122 Medically Subnormal 169 Mentally Ill 181 Complaints 192, 196 Concerts and Outings, etc. —Elderly 155 Concessions for Blind 130 Condensed Milk Regs. 246 Conditional Releases (Imported Egg Products) 244 Conference Organisers 275 Confinement—Arrangements 83, 84, 85 Confinement — Medical Aid Fees 90 Congenital Malformations—Notifications 98 Conjunctivitis 288 Conveniences—Public 216 Co-operation with Hospital Depts. 102 Co-ordinating Committee 107 Coronary Disease 42, 55 Consultant Chest Physicians 69,71 Consumer Protection Act 203 Council Dwellings 232 Council Housing Schemes 230,231 Council Rehousing 230 Creches 106 Cremation or Burial of Deceased 137 Cremations 220 Crematorium 220 Cysticercosis 239 Cytology, Cervical 90, 92 D Darenth Park & Goldie Leigh Hospitals 170 INDEX (continued) Page Day Centres—Mentally Ill 184 Day Clubs—Elderly 154 Day Clubs—Homebound 154 Day Hospital—Mentally Ill 183 Day Nurseries—Private 110 Day Nursery 105,279 Day Rooms 154 Day Training normality 172,173,174 Deaf Register (incl. Partially Hearing) 100,293 Death Causes—Remarks 54 Death Rates—Special Causes 42 Death Registrations 48 Deaths 41,48 Deaths—Table Showing Causes of and Ages at Appendix Deaths—Table Showing Causes of and Ages under 1 year 53 Deaths—Violent 59 Deaths in Institutions 50 Defective Dwellings — Repairs 196 Defects of Schoolchildren at Routine and Special Med. Exams. 291 Demolition Orders 226 Density of Population 15,41 Dental Caries 76,211 Dental Health Education 294 Dental Services—M. & C.W. 112 Dental Services—Schools 293 Dental Treatment 112,295 Departmental Transport 275 Determination of Closing Orders 227 Diagnostic Cytology 90, 92 Diphtheria 66 Diphtheria—Antitoxin 66 Diphtheria—Immunisation 66 Disabled and Old People's Home—Registration 137 Disablement Resettlement Officer 172 Diseased Carcases 240 Diseases—Infectious 61 Diseases—Respiratory 57, 58, 66. 68 Disinfecting Stations 220 Disinfection 68,220 Disinfestation 217,220 Disinfestation of Verminous Premises 217 Displays — Health Education 266 Distomatosis at Slaughterhouse 246 Distribution Centres— Nutritional Supplements 161 Welfare Foods 108 Page District Nursing—Future Plans 95 Divisional School Care Organiser 169 Domestic Helps 97 Domiciliary Births — Prematurity & Mortality 88 Domiciliary Confinements 85 Domiciliary Confinements by Age & Parity 86 Domiciliary Midwifery Services 85 Domiciliary Midwives 85 Domiciliary Services— Geriatric 138 Handicapped 122 Midwifery 85 Drainage and Sewerage 205 Dried Egg Products—Imported 244 Dried Hen Egg Albumen 244 Dried Milk Regs 233, 246 Drug Addicts and Alcoholism 76 Ducklings—Swimming Instruction 213 Dwellings—Erected by L.As. 232 Dwellings—Inhabited and Uninhabited 15 Dwellings—Separate Occupiers 15 Dysentery 66, 286, 288 E Early Discharges — Maternity Cases 87 Early Neonatal Mortality 53 Education Act—Examinations 289 Education and Training Centre —E.S.N 179 Education Sessions — Ante Natal 84 Educationally Subnormal Pupils 292 Educationally Subnormal Club 171 Egg Albumen—Imported 244 Egg Marketing Board 245 Egg (Marketing & Storage) Regs. 234,243 Elderly—Clubs for 154 Elderly—Day Rooms for 154 Elderly—Luncheon Clubs for 158 Elderly—Meals-on-Wheels 157 Elevation of Borough 15 Eltham Club for Blind 135 Eltham Crematorium 220 Eltham Nursery for Mentally Handicapped 170 Emergency Obstetric Units 87 Emigration/Immigration 44 Employment of Blind Persons 126 Employment of Partially Sighted 128 INDEX (continued) Page Encephalitis 67 English Frozen Whole Egg Plant 244 Enteric Fever 66 Environmental Health Services 188 Erysipelas 66 Estimates and Final Costs— S.C.As 191 Eviction—Protection from 188 Examinations— Fitness for Employment 297 Mental Illness 168 For Recuperative Holidays 287 Superannuation 271 Exhumations 220 Expectation of Life 44 Export Certificates 245 Extracts from Vital Statistics 41 F Factories Act, 1961 192 Factories Inspection 192 Fair on Blackheath 237 Fair Rents 188 Family Planning Association 91 Family Planning Association Clinics 91 Federation Hall Day Centre— (Proposed) 184 Fertility Clinics 92 Festival of Christmas—Mayor's Appeal 163 Field Work Instructor Courses 103 Film Shows and Talks 265 Findings at Health Survey of Schoolchildren 286 Fledglings—Swimming Instruction 213 Flies and Mosquitoes 216 Flooding of R. Ravensbourne 197 Flour Composition Regs 246 Fluoridation of Water Supplies 76,211 Food and Drugs Act— Sampling 246,252 Food and Drugs Act—Non- Genuine Samples 246,256 Food Examination 246 Food Hygiene Regs 237, 238 Food Inspection 238 Food Poisoning 77 Food — Premises for Preparation of 238 Food Rejected 239/242 Foods—Welfare 108. 161 Foot Clinics 111 Foster Parents 106 Page Fouling of Pavements by Dogs 216,268 Friendly Visiting—Elderly 164 Frozen Whole Egg Plant 244 Furnished Lettings 188 Future Development--Rehabilitation Centre 136 G General Information and Social Conditions 18 General Med. Inspection of Schoolchildren 281 General Practitioner Obstetricians' Clinics 82 General Statistics 15 Geology. Superficial 35 Geriatric Adviser to the Council 160 Geriatric Clinics 160 Geriatric Community Services 138 Geriatric Units 161 German Measles 61,288 G.L.C.—New Housing 232 G.L.C.—Rehousing 230 G.P. Obstetricians' Clinics 82 Grant Arrangements — S.C.As. 190 Greenwich Chest Clinic 69 Greenwich Community Council 33 Greenwich Council of Social Service 111 Greenwich Hotel ... ... 155 Greenwich Workshops for the Blind 122,131 Ground Nuts—Aflatoxin Content 243 H Habitation Certificates (Water Supply) 206 Hairwashing—Elderly 152 Handicapped—Children 99, 289 Handicapped—Holidays 136 Handicapped—Portable Aids 135 Handicapped—Register 99,166 Handicapped—Services 122, 136 Handicapped—Transport 136 Handicapped—Works of Access, etc 135 Handicapped—Young People's Centre 135 Health Committee 3 Health Committee—Terms of Reference 3 Health Education 81,104.263 Health Education Classes 81,260 INDEX (continued) Page Health Education in Schools 267, 297 Health Education at Welfare Centres 267 Health Education Subjects 265 Health Surveys 57,102 Health Visiting 101 Health Visitor Training 103 Health and Welfare Department Staff Heart Disease 42, 55 H.M. Inspector of Factories 193 Holiday Film Shows—Health Education 267 Holiday Hotel for Elderly 155 Holiday Relief for Relatives 157 Holidays—for Elderly 155 Holidays—for Handicapped 136 Holidays—Recuperative 109 Holidays—Subnormal Trainees 171 Home Bathing 152 Home Cleansing Service 153 Home Help Course 97 Home Help Service 97 Home Nursing 93 Home Nursing Equipment — Loans 96 Home Nursing—Training 95 Home Safety 266 Home Safety Sub-Committee 269 Home Safety Training Courses 266 Home Visits—Elderly 141 Homeless Families—Accommodation 119 Homeless Families—Statistics 121 Homelessness 116,119 Homes for Old People— Admissions 116 Council 116 Future Development 118 Provision of 115 Transfers of Residents 118 Visiting M.Os 117 Voluntary 119 Welfare & Recreation 117 Homicide 60 Hospital Confinements Nursed at Home 85 Hospital Confinements — Selection for 83 Hostels for Subnormal 171 Hotel, Holiday for Elderly 155 House Improvement — Adm. Procedures 226 House Purchase & Housing Acts 228 House & Trade Refuse 216 Page Houses—No. in Borough 15 Houses in Multiple Occupation 229 Houses Unfit 226 Housing 161,224 Housing—Accommodation 232 Housing—Conditions 224 Housing—Defects 196 Housing—Elderly 161,232 Housing—Financial Provisions Act , 228 Housing—Homeless Persons 119 Housing—Medical Assessments 271 Housing—Premises Unfit 226 Housing—Prescribed Forms Regs. 225 Housing—Register 230 Housing—Repairs & Rents Act 228 Housing—Schemes, Council 228 Housing—Security of Tenure 188 Housing Survey, Chief Housing Officer's 230 Housing—Underground Rooms Act 227 Housing Act—1949 228 Housing Act—1957 — Procedure under 226 Housing Act—1961 229 Housing Act—1964 225 Hydrotherapy Pool 213 I Ice Cream — Bacteriological Examinations 236 Ice Cream—Premises 236 Ice Cream—Quantitative Analysis 237 Ice Cream—Sampling 236 Illegitimate Births 41,47 Immunisation and Vaccination 64, 65, 66, 67, 68,70,71 Impetigo 220,288 Imported Egg Products 244 Imported Food Regs 242, 260 Imported Food Rejected 242 Incontinent Laundry Service 152 " Industrial Emissions — Tall Buildings 191 Industrial Injury Benefit Claims 79 Industrial Rehabilitation 135 Industrial Training Centres 172, 173 Infantile Mortality 42,51 Infant Welfare Clinics 104 Infectious Diseases 61 Infectious Diseases — Notifications 63 INDEX (continued) Page Infectious Diseases in Schools 288 Infertility Clinics 91 Influenza 61,288 Inhabited Dwellings 15 Inoculations—Poliomyelitis 67 "In" Service Training 103 Inspections of Food & Food Premises 233 Inspections—Food 240 Inspections—Food Premises 238 Inspections—Local Schools by P.H.Is. 296 Inspections—Meat at Slaughterhouse 240 Institution Deaths 50 Integrated Students 95 International Vaccination Certificates 64 Interviews—re Elderly 142 Interviews—Housing 271 Intra Uterine Contraceptive Device—Sub Clinic 92 Introductory Review 10 J Jurisdiction over R. bourne 197 K Knoyle Street Centre — Medically Subnormal 173 L Laboratory Work 212,235 Land Charges Act 205 Launderette 212 Laundries—Public 212 Laundry Service — Incontinent 152 Leaflets—Health Education 266 Legal Proceedings 223,251,262 Legislation—New 63,188,225,233 Legitimate Births 41 Leptospirosis 214 Lettings—Furnished 188 Lettings—Unfurnished 189 Leukaemia 42 Library Facilities—Blind 130 Library Facilities—Elderly 155 Library Facilities—Homebound 155 Library Facilities—Old People's Homes 155 Licences—Milk 235 Licences—Radio for Blind 130 Licensing Act, 1961 204 Licensing of Slaughterhouse & Slaughtermen 240 Page Licensing of Offices, Shops, etc. 195 Licensing of Tripe Boiler 240 Lighting Standards 195 Live Births 41,47 Liver Fluke 241 Loan of Home Nursing Equipment 96 Local Morbidity 78 London Government Act, 1963 18,188 Luncheon Clubs 158 Lung Cancer 57 M Main Unit—Homeless 120 Major Causes of Blindness 129 Malaria 68 Manufacture and Sale of Ice Cream 236 Marie Curie Night Nursing Service 93 Marriages 41,45 Mass Radiography 72 Maternal Mortality 42, 50 Maternity Outfits 88 Maternity Services 80 Mayor's Festival of Christmas Appeal 163 Maze Hill Chest Clinic 69 Maze Hill Training Centre 174 Maze Hill Training Centre— Education & Training 179 Nursing Unit 178 Special Unit 180 Meals-on-Wheels 157 Measles 65,288 Measles—Vaccination 65 Meat Inspection — Slaughterhouse 240 Meat Regs 233,239 Meat Surrendered 239 Medical Aid — Confinement Cases 89 Medical Appliances—Loans 96 Medical Assessments 122,271 Medical Examinations— Accidents 271 Ante and Post Natal 82 Sick Persons 271 Staff Appointments 271 Superannuation 271 Medical Inspections — Schoolchildren 281,283 Medical Officer of Health's Review 10 INDEX (continued) Page Medical Practitioner Obstetricians' Clinics 82 Medical Treatment — Schoolchildren 284 Meningococcal Infection 67 Mental Health—Act 167 Mental Health—Officers 167,292 Mental Health—Services 166 Mental Health—Statistics 185 Mental Illness — Community Services 181 Mental Subnormality — Community Services 169 Merchandise Marks Act 237 Meridian School for Deaf 293 Meteorological Observations 40 Metropolitan Water Board 206 Mice Destruction 213 Midwifery 85 Midwifery Training—Part II 88 Midw^ves 85 Mileage of Roads 17 Milk—Analysis 236, 246 Milk—Dairies 235 Milk—Distributors 235 Milk—Licences 235 Milk—Sampling 235,246 Milk and Dairies Regs 235 Milk (Special Designation) Regs. 234,235 Ministry of Labour—D.R.Os. & Y.E.Os 172 Ministry of Social Security —Statistics 78 Minor Ailments Clinics— Defects Treated 284 Minor Hall Club—Blind and Deaf 135 Miscellaneous Services 137,263 Mobile Meals 157 Mortuary Accommodation 222 Mothercraft Training 85 Mothers' Clubs 107 Mothers—Rehabilitation 107 Motor Vehicle Accidents — Deaths 59 Mumps 61,288 N National Assistance Act 115 N.A.A.—Part III Accommodation—Statistics 119 National Fire Prevention Campaign 270 Page National Insurance Act (Medical Certificates) 63 National Water Safety Campaign 270 National Welfare Foods—Distribution 108 Natural Increase 41,44 Neonatal Mortality 53 New Housing 231,232 New Legislation 63,188,225,233 Noise Abatement Act 202 Nomenclature Regs 54 Non Genuine Samples 246, 256 Non Routine Medical Inspections—Schoolchildren 282 Notices, etc 192,223 Notifications—Food Poisoning 77 Notifications — Infectious Diseases 63 Number of Families 15 Nursing Equipment—Loans 96 Nursing Homes — Registration 110 Nursing Unit—Mentally Handicapped 178 Nutritional Supplements for Elderly 161 O Observers of Council's Services 95,104,162 Occasional Creche Service 106 Occupational Therapist 135, 183 Offensive Trade—Tripe Boiler 240 Offices. Shops & Railway Premises Act 194 Offices. Shops & Railway Premises—Inspections 194 Old People—Visiting 141 Old People's Clubs 154 Old People's Homes 116 Old People's Homes—Registration 137 Open Spaces—Public 16 Ophthalmia 288 Ophthalmia Neonatorum 67, 129 Ophthalmic Services 124 Organic Nervous Diseases Gp Handicapped 133 Ormiston Road Rehabilitation Centre 135 Orthopaedic Defects—Schoolchildren 290 Other Food Examinations 246 Otology - Schoolchildren 292 Outwork 193 INDEX (continued) Page Outworkers 194 Overcrowding 230 P Park Vista Training Centre 172 Part III (N.A.A.) Accommodation Statistics 119 Partially Sighted—Employment and Training 128 Partially Sighted—Register 128 Parts of Buildings—Unfit 227 Pedicure—Elderly 152 Perinatal Mortality 53 Personal Health and Related Services 80 Persons Cleansed 152,220,286 Pet Animals Act 204 Pharaoh's Ants 217 Pharmacy & Medicines Act 246 Pharmacy & Poisons Act 202 P.H. Regs.—Dried Milk 233 P.H. Regs.—Egg (Marketing & Storage) 234 P.H. Regs.—Imported Food 235, 242, 246 P.H. Regs.—Meat 233 P.H. Regs.—Milk & Dairies (Gen.) 235 P.H. Regs. — Milk (Special Designations) 234,235 P.H. Regs.—Smallpox Prevention 64 P.H. Regs.—Tuberculosis 63 Physical Aids 162 Physically Handicapped— Clubs & Centres 135 Organic Nervous Diseases Gp 133 Primary Disabilities 132 Rheumatism Gp 132 Social Rehabilitation Centre 135 Systemic Diseases Gp 133 Welfare 131 Pigeon Nuisance 196 Placement of Certain Special Categories 278 Pneumonia 42,58,66 Poisons Information Service 202 Poliomyelitis 67 Poliomyelitis Inoculations 67 Pollution—Atmospheric 198 Pollution—Recording 201 Pollution—River 197 Population 15,41,44 Population—Age Composition 44 Page Portable Aids for Handicapped 135 Post Natal Clinics 82 Powers & Duties—Health Committee 3 Powers & Duties — Welfare Committee 6 Practising Midwives 85 Precautionary Spraying 220 Premature Baby Units 88 Premises Unfit for Human Habitation 226 Preparation for Childbirth 84 Preserved Food Premises 236 Prevalence of, and Control over, Infectious and Other Diseases 61 Prevention of Damage by Pests Act 214 Principal School Dental Officer's Report 293 Principal School Medical Officer's Report 277 Private Day Nurseries 110 Problem lamilies Index 102 Procedure under Housing Act, 1957 226 Proceedings- Legal 223,251,262 Product of Id. Rate 15 Property Protection 137 Prophylaxis 64, 65, 66,67, 68, 70. 71,287 Protection from Eviction 188 Protection of Property 137 Provision of Accommodation (N.A.A. Part III) 115 Psychiatric Patients — Accommodation 182 Psychiatric Services 182 Psychoprophylaxis in Childbirth 84 Psychoprophylaxis Course 103 Public Baths and Wash-houses 212 Public Conveniences 216 Public Functions—Health Education 267 Public Health Laboratory Service 236,246 Public Lectures / Demonstrations 266 Publicity re Services for Elderly 162 Public Open Spaces 16 Puerperal Pyrexia 67 Q Quantitative Analysis — Ice Cream 237 INDEX (continued) Page R Radio & T.V. Repairs for Elderly 155 Radioactive Substances Act 206 Radiography—Mass 72 Rag Flock Act 203 Rag Flock & Other Filling Materials Regs 190 Rateable Value 15 Rates—Births & Deaths, etc. 41 Rats and Mice Destruction 213 Ravensbourne, River—Flooding 197 Receivership 137 Reception Centre 120 Recreational Facilities for Elderly 154 Recuperative Holidays 109 Recuperative Holidays — Med. Exams. 287 Redevelopment—Housing 231 Refresher Course 88,95,104 Refuse Collection 216 Refuse Disposal 216 Registers—"At Risk" 99 Registers—Blind 125 Registers—Elderly People 142 Registers—Handicapped 99 Registers—Partially Sighted 128 Registration—Births 46 Registration—Child Minders 110 Registration—Deaths 48 Registration—Disabled and Old People's Homes 137 Registration—Ice Cream Premises 236 Registration—Marriages 46 Registration — Nursing Homes 110 Registration—Preserved Food Premises 236 Registration—Residential Homes 137 Rehabilitation Centre 135 Refiabilitation of Mothers 107 Rehousing 230 Rehousing—Council 230 Rehousing—G.L.C 230 Rehousing — Interviews by A.M.O.H. 271 Rehousing—Medical Grounds 271 Rejected Food 239, 242 Relaxation Classes—AnteNatal 85 Remarks on Various Death Causes 54 Rent Act. 1957 201 Rent Act, 1965 188 Rent Book Regs, 1965 189 Rent Officer 189 Rent Registration 189 Rent Tribunals 189 Page Rents, "Fair" 189 Report of Principal School M.O. 277 Reproductive Wastage 54 Residential Homes 119,127 Residential Services 115 Respiratory System — Diseases of 57,58,66,68 Review by M.O.H 10 Rheumatism Gp. Handicapped 132 Riding Establishments Act 205 Ringworm 288 River Pollution 197 River Ravensbourne—Flooding 197 River Ravensbourne—Jurisdiction 197 River Smells 197 Roads, Mileage in Borough 17 Rodent Control 213 Routine Audiometer Testing 292 Rubella 61,288 Russian Vapour Baths 212 S Safety in the Home 269 Salmonellae in Imported Egg Products 244 Samples—Non Genuine 246,256 Samples—Under Food & Drugs Act 252 Sampling—Food & Drugs 246 Sampling—Ice Cream 236 Sampling—Milk 235, 246 Sanitary Circumstances of the Area 192 Sanitary Work—Summaries, etc. 222 Scabies 67,220,288 Scabies & Cleansing Clinics 67,153, 220 Scarlet Fever 65,288 Scavenging & Refuse Disposal 216 Schoolchildren Cleansed 220 School Dental Services 293 School Dental Services— Statistics 295 School Health Services 277 School Health Services— Statistics 295 School Treatment Centres 284 Security of Tenure—Housing 188 Selection of Women for Hospital Confinement 83 Sewerage and Drainage 205 Sewers—Baiting 216 Shop Window Displays—Health Education 267 Shops Acts 203 INDEX (continued) Page Shops (Early Closing) Act, 1965 188 Shops and Offices Inspections 194 Sick Room Equipment—Loans 96 Sickness Claims 79 Sight Testing 124,160 Slaughterhouse — Meat Inspection 240 Slaughterhouse, Slaughtermen —Licensing 240 Smallpox 64 Smallpox Vaccination 64 Smells from River 197 Smoke Control Areas 198,200,201 Smoke Control Areas (Authorised Fuels) Regs 190 Smokeless Fuels—Supplies 190 Smoking and Health—Education 268 Social Clubs—Therapeutic 184 Social Conditions of the Area 18 Social Rehabilitation Centre 135 Social Security, Ministry of— Statistics 78 Solid Formations—Geology 36 Sonne Dysentery 66 South East Population Study 225 Special Care Unit—E.S.N. 180 Special Categories — Placement 278 Special Clinics—V.D. 74 Special Investigation Clinics 169,284 Special Techniques in Examination 280 Speech Therapy .... 177,279 Spectacles—Supply to Schoolchildren 286 Spraying—Precautionary 220 St. Saviour's Centre for Handicapped Young People 135 Staff of Health & Welfare Department Statistics—General 15 Statistics—Tables Appendix Statistics—Vital 41 Stillbirths 41,48 Storm Flooding 197 Street Cleansing 216 Street Traders 237 Streets—Mileage in Borough 17 Structurally Separate Dwellings 15 Student Health Service 298 Student Health Visitors 103 Student Nurses 104 Sub Fertility Clinics 92 Suicide 59 Summary of Activities—Health Education 265 Page Summary of Sanitary Work 222 Superficial Deposits 36 Superficial Geology 35 Supervision of Food Premises 238 Supplies of Smokeless Fuels 190 Supplies of Underground Water (Wells) 206 Surveys 57,102,286 Swimming—Attendances 213 Swimming—Baths 212 Swimming—Instruction 213 Systemic Diseases Gp.—Handicapped 133 T Tall Buildings — Industrial Emissions 191 Television & Radio Sets— Elderly 155 Tenure—Security of 188 Therapeutic Clubs — Mentally Ill 184 Therapists 135, 183 Trade and House Refuse 216 Training Centres — Black wall Industrial 173 Training Centres—Maze Hill 174 Training Centres—Park Vista 172 Training Centres—Statistics 180 Training Courses 95,272 Transfers—Residential Homes 118 Transport for Handicapped 136 Transport—Departmental 275 Transport Organiser 275 Transported Meals for Old People 157 Tripe Boiler—Licensing 240 Tuberculosis 42,59,68 Tuberculosis in Animals 240 Tuberculosis Reports — Chest Physicians' 69,71 Turkish Baths 212 Typhoid Fever 66 U Underground Rooms—Unfit 227 Underground Water Supplies (Wells) 206 Unfit Houses 226 Uninhabited Dwellings 15 Unsound Food 239,242 Unsupported Mothers and Babies 107,121 INDEX (continued) Page V Vaccination 64 Vaccination — International Certificates 64 Various Death Causes— Remarks on 54 Vascular Lesions of Nervous System 42, 55 Venereal Diseases 74 Venereal Diseases—Publicity 269 Verminous Conditions 217,220,286 Verminous Persons 220,286 Verminous Premises 217 Verrucae 284,286,297 Violent Deaths 59 Violet Melchett Mothercraft Unit 107 Vision—Clinics 286 Vision—Schoolchildren 284 Visiting M.Os.—Old People's Homes 117 Visits by Health Visitors 101 Visits by Women P.H. Officers 142 Visual Acuity of Schoolchildren 285 Vital Statistics 41 Vitamin Supplements 108 Vocational Training — Handicapped 135 Voluntary Help—Elderly 162 Voluntary Homes 119 W Wash-houses & Public Baths 212 Wasps 218 Water—Underground Supplies (Weels) 206 Water Supplies—Fluoridation 76,211 Water Supply 206 Page Water Supply Certificates 206 Weil's Disease 214 Welfare—Blind 123 Welfare—Clinics 104 Welfare—Committee 5 Welfare—Committee, Terms of Reference 6 Welfare—Foods, Elderly 161 Welfare—Foods, M. & C.W. 108 Welfare — Physically Handicapped 131 Welfare—Residential 115 Welfare—Services 115 Welfare — Services, Future Development 136 Wells 206 Whooping Cough 66,288 Women Public Health Officers 141 Women Public Health Officers' Visits 142 Women's Royal Voluntary Services 158 Woolwich & Brook Chest Clinics 71 Works of Access and Adaptation for Handicapped 135 Workshops for the Blind 122, 131 X X-Ray Examinations 70,72 X-Ray, Mass 72 Y Youth Employment Officers 172,292 Z Zymotic Enteritis 63,66 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1965. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality Age & Sex Group At all Ages 0 to 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-45 45-65 65 and over Greenwich Woolwich M F M F M F m F M F M F M F M F M F M F M F M F M F M f Malaria — — — — — — — — — — — — _ — _ _ _ _ _ _ _ _ _ _ _ _ _ _ Small-Pox — — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Encephalitis Infectious — — — — — — — — — — — — — — — — — — — — — — — — — — — — Post-Infectious — — — — — — — — — — — — — — — — — — — — — — — — — — — _ Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 14 12 1 1 — — — 1 2 — 1 1 4 2 2 3 — 1 4 3 — — — — 6 9 8 3 Erysipelas 2 4 — — — — — — — — — — — — — — — — — 1 2 2 _ 1 1 _ 1 4 Acute Polio-Myelitis P. — — — — — — — — — — — — — — — — — — — — — — — — — — — — N.P. — — — — — — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever 59 52 — — 1 1 4 1 1 3 1 3 39 32 8 6 4 5 1 1 — — — — 20 15 39 37 Typhoid Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Scabies — 1 — — — — — — — — — — — — — — — — — — — — — — — — — 1 Puerperal Pyrexia — 130* — — — — — — — — — — — — — — — 41 _ 89 _ _ _ _ _ 26 _ 72 Meningococcal Infection _ — — — — — — — — — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Measles 1364 1244 46 46 153 140 161 182 197 175 223 185 551 489 25 18 6 6 2 3 _ _ _ _ 505 427 859 817 Whooping Cough 23 47 — 4 7 6 2 4 2 8 1 8 9 10 2 5 — 2 _ — _ _ _ _ 11 25 12 22 Diarrhoea 4 7 — 3 1 1 _ 1 2 1 _ _ _ _ — _ _ 1 1 _ _ _ _ _ 3 6 1 1 Ophthalmia Neonatorum 3 4 3 4 — — — — — — — — — — — — — — — — — — — — 1 — 2 4 Pneumonia, Acute Primary or Acute Influenzal 16 24 1 2 — 1 — — — 1 — 1 — 1 — — 4 — 2 5 6 4 3 9 — — 16 24 Tuberculosis, Pulmonary 40 16 — — — — — — 1 1 _ _ _ _ 1 3 4 3 8 6 14 3 12 14 8 26 8 „ Non-Pulmonary 7 6 — — — — — — — — — — — — — 1 1 — 4 3 2 2 — — 3 — 4 6 Totals 1532 1547 51 60 162 149 167 189 205 189 226 198 603 535 38 36 19 59 22 111 24 11 15 10 564 516 968 999 *Of this total 32 were hospitalised within Greenwich but came from residences outside the Borough NOTE:—The above table refers to "Corrected Notifications" only, i.e., all cases in which the diagnosis was not confirmed have been ignored TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December, 1965. No. in Short List Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards GREENWICH WOOLWICH St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital St. Nicholas Hospital Memorial Hospital B.H.M.B. E. & M. Hospital Other Institutions Outside Institutions Under 4 wks. 4 wks. and under 1 yr. 1 Tuberculosis, Respiratory 13 ... ... ... ... ... ... ... 6 5 2 5 8 4 ... ... ... ... ... ... ... ... ... 7 2 2 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease 6 ... ... ... ... ... ... ... ... 2 4 1 5 1 ... ... ... ... 1 ... ... ... ... 3 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Acute Poliomyolitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases 3 ... ... ... ... ... ... 1 1 ... 1 3 ... 1 ... ... ... ... ... ... ... ... ... 1 5 10 Malignant Neoplasm, Stomach, 55 ... ... ... ... ... ... 3 16 19 17 16 39 10 ... 1 ... 6 10 5 ... 3 ... 7 57 11 Malignant Neoplasm, Lung, Bronchus 179 ... ... ... ... ... ... 4 76 68 31 72 107 23 4 2 ... 18 16 2 ... 2 1 40 137 12 Malignant Neoplasm, Breast 46 ... ... ... ... ... ... 5 22 8 11 12 34 3 ... 2 ... 6 4 4 ... 4 ... 14 45 13 Malignant Neoplasm, Uterus 9 ... ... ... ... ... ... ... 5 2 2 4 5 ... ... ... ... 2 ... 1 ... ... ... 4 10 14 Other Malignant and Lymphatic Neoplasms 258 ... ... ... ... ... 1 13 80 79 85 88 170 34 3 14 ... 23 48 14 ... 9 1 40 259 15 Leukaemia, Aleukaemia 15 ... ... ... ... ... 2 ... 5 3 3 3 12 1 1 1 ... ... 6 ... ... ... ... 5 18 16 Diabetes 19 ... ... ... ... ... ... ... 5 5 9 3 16 1 1 ... ... 4 2 ... ... ... ... 5 15 17 Vascular Lesions of Nervous System 303 ... ... ... ... ... 1 5 55 74 167 94 209 50 3 9 1 79 68 2 ... 5 5 28 435 18 Coronary Disease, Angina 343 ... ... ... ... ... ... 10 89 113 131 137 206 39 4 17 ... 15 51 14 ... 5 10 38 278 19 Hypertension with Heart Disease 16 ... ... ... ... ... ... ... 6 5 5 9 7 3 ... 1 ... 3 1 ... ... ... ... 1 9 20 Other Heart Disease 414 ... ... 1 ... ... 1 10 68 106 228 157 257 62 9 15 ... 61 68 8 ... 4 5 41 404 21 Other Circulatory Disease 133 ... ... ... ... ... 2 8 25 27 71 57 76 24 ... 2 ... 19 17 4 ... 2 1 21 128 22 Influenza 2 ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... ... ... 2 ... 2 23 Pneumonia 186 1 4 1 ... ... ... 4 10 48 118 77 109 47 3 7 1 45 23 2 ... 1 3 19 233 24 Bronchitis 160 ... 6 ... ... ... 1 ... 32 54 66 58 102 21 4 6 ... 27 31 2 ... 2 4 21 161 25 Other Diseases of Respiratory System 15 ... ... ... ... ... 1 2 3 2 7 3 12 ... ... 2 ... 3 5 ... ... 2 ... ... 19 26 Ulcer of Stomach and Duodenum 20 ... ... ... ... ... ... ... 7 5 8 10 10 4 1 ... ... 1 6 1 ... ... ... 3 26 27 Gastritis, Enteritis and Diarrhoea 14 ... 2 ... ... ... ... ... 1 4 7 4 10 4 2 1 ... 1 3 ... ... ... ... 2 18 28 Nephritis and Nephrosis 17 ... ... ... ... ... 1 1 6 2 7 7 10 1 1 1 ... 5 2 ... ... ... ... 6 15 29 Hyperplasia of Prostate 7 ... ... ... ... ... ... ... ... 2 5 4 3 1 ... 1 ... 1 1 1 ... ... ... 2 9 30 Pregnancy, Childbirth, abortion 2 ... ... ... ... ... ... 2 ... ... ... 2 ... 1 ... ... ... ... ... ... 1 ... ... ... 3 31 Congenital Malformations 27 11 11 1 ... ... ... 1 2 1 ... 8 19 3 ... 1 ... 5 1 1 3 ... ... 11 27 32 Other defined and ill-defined Diseases 170 36 7 ... ... 1 5 9 37 32 43 58 112 25 4 7 ... 26 22 8 18 ... 2 41 220 33 Motor Vehicle Accidents 31 ... ... ... ... 6 2 5 6 4 8 8 23 3 1 ... 1 ... 5 10 ... ... ... 12 44 34 All other Accidents 39 ... ... ... ... 1 4 6 9 5 14 16 23 5 ... ... ... 6 6 2 ... ... 1 12 52 35 Suicide 31 ... ... ... ... ... 3 10 13 2 3 8 23 ... ... 1 1 2 2 2 ... ... ... 2 18 36 Homicide and Operations of War 2 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 1 Totals 2535 49 31 4 1 10 24 99 585 678 1054 925 1610 368 41 91 4 358 400 83 22 39 35 384 2653 Note.—All "Transferable Deaths of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded.