C . 43341 II GRE 64 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER I966 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1966 CONTENTS Page Health Committee 3 Welfare Committee 6 Staff 8 Introductory 11 Section I—General Statistics and Social Conditions 17 „ II—Vital Statistics 34 „ III—Prevalence of, and Control Over, Infectious and Other Diseases 54 „ IV—Personal Health and Related Social Services 89 „ V—Welfare Services 125 „ VI—Mental Health Services 172 „ VII—Environmental Health Services 193 „ VIII—Miscellaneous 266 „ IX—School Health Services 281 Census 1966 300 Index 305 Appendix—Statistical Tables 3 HEALTH COMMITTEE (as at 31st December, 1966) The Mayor: (ex-officio) Councillor R. T. Coombs, J.P. Chairman: Councillor Mrs. H. Stroud Vice-Chairman: Alderman A. C. Chrisp Aldermen: W. S. Manners, M.B.E. (Died 26.9.66) D. C. Hubber (2.11.66) Councillors: Mrs. M. J. M. Bradley W. J. Manners, Mrs. J. E. Chrisp G. E. Offord, J.P. J. P. Hamilton H. A. Read L. A. Heath N. R. J. Sims Mrs. W. H. M. Hulbert I. N. Smith Mrs. A. D. A. Kennedy 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. 4 (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. (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, 1946, 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. 5 (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 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. 6 WELFARE COMMITTEE (as at 31st December, 1966) The Mayor: (ex-officio) Councillor R. T. Coombs, J.P. Chairman: Councillor G. E. Offord, J.P. Vice-Chairman: Councillor T. A. J. Malone Aldermen: Mrs. E. Brooks A. C. Chrisp E. McCarthy Councillors: Mrs. K. P. Bullard, J.P. W. J. Manners N. G. Burbridge Mrs. E. Pennington Mrs. J. E. Chrisp Mrs. M. E. Polley G. S. Dean H. F. Reilly Mrs. W. H. M. Hulbert Mrs. N. A. E. Woods 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; 7 (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. 8 STAFF HEALTH AND WELFARE DEPARTMENT (31st December, 1966) 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 Chief Dental Officer and Principal School Dental Officer: F. Elston Visiting Medical Officers: Dr. R. S. L. Hood Dr. A. G. Marus Dr. S. L. Price (commenced 12.12.66) 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 Public Analyst: Dr. H. A. Williams Welfare Borough Welfare Officer: R. E. Haymes 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 9 Matrons of Old People's Homes: Mrs. D. M. Bell (from 8.8.66) Miss M. Campbell Miss K. Mansfield (from 19.12.66) Miss M. Troup (from 1.9.66) Greenwich Hotels' Superintendent: Miss W. E. Wilson Homeless Families' Units Super— visor: 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 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: Miss P. M. Calland (from 20.2.67) Mrs. D. Greeno (from 15.8.66) 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 10 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 L. A. Westacott Officers: C. A. Webb (Establishment) Section Heads Finance and Supplies: R. E. Sweett Welfare: R. Bruty J. W. Shorter 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 11 Health and Welfare Department, Municipal Offices, Royal Hill, S.E.10. To the Mayor, Aldermen and Councillors, London Borough of Greenwich. Ladies and Gentlemen, I have the honour to present this record of the health, social and environmental circumstances of the London Borough of Greenwich for 1966. Last year the report chronicled at some length the difficulties of establishing a department which would provide a continuity of service. Moreover, it was important that the interim methods adopted at that time and the disposition of staff and resources should be such that reorganisation and redeployment to meet our future needs would be possible without serious disruption. Apart from the substantial increase in the local social services provision, which will be outlined in these prefatory remarks and described in more detail in the main report, the Department is now in the process of being organised on more rational lines and in accordance with sound principles. All the administration has been centralised. Duplication of effort has been minimised and all the professional branches have been allocated supporting administrative and clerical help in their everyday work. Next year will see the completion of this task with the integration of all community care being provided by the Department, and this action will unify the services for the physically handicapped, the mentally ill and handicapped, the elderly and families found to be socially inadequate and who require help. This is a bold concept and one which, as far as I am aware, as yet has no parallel in the country. Success in this planning for the future depends upon the stability of a well organised health and welfare department, which in turn relies entirely upon competent and trained professional and administrative staff. Throughout the country, community health and welfare services at the moment suffer from organisational deficiencies, inconsistencies and contradictions which are in part the product of historical accidents, past neglect and unawareness. It is as well to remind ourselves that the environmental health services are barely 100 years old and it is only since 1948 that any attempt has been made to 12 provide comprehensive health and welfare services on a community basis. Administration and organisation in these fields still tend to be fragmentary and disorderly because no studies in depth have been undertaken to examine the inter-relationship and interdependence of health and wellbeing in the broadest sense with the social milieu. The tendency has been for curative medicine to proceed in isolation of prevention and in ignorance of injurious aetiological factors, mostly of social origin. The result has been the growth of organisations and departments as separate entities with their own vested interests, viewing each other with suspicion and at times with hostility. This thesis on the merits of integration and interdependence does not imply that any one profession has the prescriptive right to domination or to leadership, but it does mean a recognition and an acceptance by all related disciplines of the fact that the relationship of the human family one to another and their reaction to their environment is multi-factorial. It is thus only now that boroughs with wide health and welfare powers and proper resources can look objectively at the whole spectrum and decide in the light of modern thought the practice which will best serve the community needs, and at the same time will make full use of skilled staff who are in short supply. The whole basis of local government organisation and staffing is now under review by several committees and it is probable that, valuable as these investigations may be, their individual recommendations may conflict. The Maud, Mallaby and Seebohm reports are all awaited with interest, but in the meantime it is important that attitudes are not frozen and that every effort is made to provide a balanced service with due regard to economy, with a strict assessment of priorities at a time when resources are not limitless. I must now turn to some consideration of the year under review. There has been a slight reduction in population, births having declined and deaths having risen slightly. The infant mortality rate including early neonatal and perinatal is down, but it is significant that the only rise is in the category of illegitimate infants. This is as expected and in the future we must try to do more for the unsupported mother, both in relation to encouraging early and consistent pre-natal care and in the provision of adequate hostel accommodation for those in need. A detailed analysis of causes of death will be found in the main report. Cardiovascular disease has increased considerably but it is pleasing to note a decrease in cancer of the lung although it would be premature to ascribe this to a substantial decline in cigarette m oking. Nevertheless, I have the feeling that more people are being 13 persuaded of the noxious consequences of a habit which has little to commend it. There has been a surprising increase in deaths from pneumonia. This may be a coincidence and the trend will have to be watched over a period of years. Undoubtedly, however, the indiscriminate and irresponsible use of antibiotics could lead to resistant strains of organisms of high virulence causing great damage to a susceptible population. On the question of infectious diseases notification, there has been an overall decrease of 1,390, largely due to the biennual fluctuation of measles incidence, but I would note in passing a slight increase in the notification of tuberculosis. This reverses the trend for the first time for many years. Two cases of paratyphoid, both non-residents, were notified from hospital and the one typhoid case notified was an Indian child whose father was found to be a carrier. Dysentery and food poisoning showed increases, but at this stage are not considered to be of community significance. The outbreaks were sporadic and well controlled. It is the aim of the Council to have the whole Borough covered by smoke control orders by 1970 and further progress towards this end was achieved. Our various atmospheric pollution measuring stations, strategically placed throughout the Borough, clearly show a reduction in the smoke content of the atmosphere. Slum clearance has also proceeded and individual unfit houses have been closed in considerable numbers. In this connection tribute should be paid to the Housing Committee, which has had the difficult job of rehousing tenants displaced from sub-standard property. This is in addition to the obligation which it has faced in respect of the needs of homeless families. The personal health services also made some progress despite the loss of several health visitors who have not been replaced. The number of student health visitors under training will not cover our losses and the position is serious. This shortage of health visitors has hampered our plans for attachments to family doctor group practices, although we hope that in Abbey Wood, Plumstead and Blackheath it may be possible next year to attach health visitors and home nurses to selected practices. Premises are being adapted at Shooters Hill Road for a group practice to be housed alongside domiciliary midwifery, home nursing and home help offices, a school dental surgery, a chiropody surgery, the central stores and a clinic with a full range of personal health services. This unit, which will be in all but name a health centre, will be in operation next year. Since 1965 the home help service has been extended by about 30% and although all reasonable demands can be met, there is no 14 margin of reserve. The child help service being provided as a specialised part of the home help service has proved to be of value in cases of parental misfortune or inadequacy and to the Children's Department in keeping children out of care and within their own homes. The arrangements for the examination of well women at the cervical cytology clinics have continued and our teams are available to go into any factory employing female labour where adequate clinic facilities exist. There has been a slackening of demand for this service and efforts must be pursued to encourage women regularly to seek this simple examination as a precautionary measure. Next year a breast examination will also be undertaken at these clinics. A report on the chiropody services is included and it is commendable that the Council's Chief Chiropodist manages to keep a good service going despite his staffing difficulties. A section of this report is also devoted to the activities of the health education section, which has shown great initiative and enthusiasm. Dr. Boyd, Consultant Geriatrician at the Greenwich District Hospital, has joined the staff on a part-time basis and his advice and guidance, as well as his hospital resources, are proving of great value. There is now a free exchange of patients between hospital and old people's homes, which is of great benefit to the old people who are now receiving care more appropriate to their needs. This year geriatric advisory clinics were established where any old person not apparently suffering from any recognisable illness can seek a medical interview to discuss health and social problems with a doctor in a more leisurely atmosphere than would be possible in a busy general surgery. Plans for the expansion of the community mental health services have almost reached fruition, but have been hampered a little by credit restrictions. Federation Hall in Abbey Wood will serve as a combined day centre meeting the needs of the mentally ill, the physically handicapped and elderly, some of whom may be showing the mental and physical frailties of ageing. The hostel for the mentally ill at St. John's Park awaits loan sanction for adaptation and equipping but in the meantime is being used as an occupation centre and for diversional therapy. Building work on the hostel for mentally handicapped children at Ashburnham Grove has started and this will be ready for occupation next year. The provision of a child guidance clinic continues to prove an almost intractable problem, due entirely to the impossibility of recruiting a child psychiatrist. The development of the junior centre at Maze Hill has been a source of great pride and I hope it will be possible for the Council to duplicate this educational facility in the eastern part of the Borough. 15 The geriatric services have been well established for years in the former Metropolitan Boroughs of Greenwich and Woolwich, and it is only a question of building on existing solid foundations. The adaptations at the Greenwich Hotel to take numbers of the severely disabled are nearing completion and the hotel will have a capacity of about 90 guests. The laundry, bathing and chiropody services have all expanded. There are now 13 luncheon clubs open, with more to come which will eventually provide a full geographical cover for the Borough. Meals on wheels are now on a five day per week basis throughout the Borough with emergency weekend cover for those in need. All the meals are now being supplied either by the Department or the Borough's catering service. The Borough is making the most strenuous efforts to build small homes as quickly as possible to enable our old people to be brought back from Southern Grove Lodge in Tower Hamlets. During the year the detailed design of one in Gavestone Crescent was completed and preliminary consideration given to the home planned for the Glyndon development. If loan sanction is available it is possible that four new 60 bed homes with special care units for frail and infirm may be in occupation by the end of 1970. Adaptations at 158a Plumstead High Street were partly completed to give more privacy and better amenities to individual families, and further improvements are in hand. The new training unit at Charlton Road was opened and is already proving useful for the rehabilitation of families before moving to permanent accommodation. Some progress has been made towards examining the future medical, social and welfare needs of the comprehensive development at Thamesmead. A plan in embryonic form has been provided by the Guy's General Practice Research Unit for an integrated medical service for that area, embracing the work of the hospitals, the general practitioners and the local authorities. These ideas have immense implications for our Borough and will be discussed at greater length next year, when the suggestions have been examined and analysed in more detail. This glossary of the Council's achievements during the year does not purport to be exhaustive. These are the matters which have come immediately to mind in writing this introduction. Undoubtedly, two factors govern further advances. The first is the availability of staff of proven ability or potentiality. The shortages in all the professional grades are almost critical, and on the residential side where the immediate comfort and living conditions of vulnerable groups of people are affected this constant threat of a breakdown of standards is of perpetual concern. 16 The second factor relates to finance. It is perhaps of relevance to note that in the last two years this Council has authorised expenditure on the social services for local residents which is greater in extent than in the previous eight or nine years. This is no reflection on the former health and welfare authorities, but it is a measure of the Council's achievement and of the direct interest which local elected members take in trying to meet the various needs and known deficiencies. Herein lies the dilemma. Social services are expensive in terms of labour and resources and it is a simple matter for officers to draw up grandiose plans for expansion without due regard to future capital and revenue implications. I am convinced, however, that in providing social services where the needs to be met have no immediate practical or foreseeable limits, all available resources must be husbanded and used in a strict priority to be determined by the Council. From these grisly realities it is pleasant to acknowledge the help and support which I have received from so many sides. I must thank Councillor Mrs. Stroud and Councillor Offord, the Chairman of the Health and Welfare Committees respectively, for their support and encouragement. The Committees have had many difficult decisions to take and the Department has received from them nothing but kindness and consideration. This Department, having such a multiplicity of diverse services, must rely on innumerable voluntary helpers and I acknowledge gladly the indebtedness of the staff and myself to all of them. I am privileged to lead a large team and I am grateful to the staff for their loyalty and their industry. I hope that these pages, which contain the contributions and efforts of many, will reflect faithfully my obligation to them. I must also express my deep gratitude to those senior members of the staff with whom I am in daily contact and in particular I must mention my deputy, Dr. M. E. Watts, and the Chief Administrative Officer, Mr. L. Longhurst, who have not only shouldered a heavy and continuous burden, but have almost entirely relieved me of the wearisome irritations and frustrations of a busy department. Last year I expressed the hope that the Council's exertions during that year and its future plans which were outlined would bring credit to the Borough. I trust that this further account of advances will be found pleasing and acceptable. Your obedient Servant, J. Kerr Brown, Medical Officer of Health 17 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, 1966 (mid-year) 231,590 Density of Population (persons per acre) 19.75 Number of Inhabited Dwellings—end 1966 70,303 (according to Rate Books) *Structurally separate dwellings at Census, 1961 70,175 Number of Uninhabited Dwellings— *At Census, 1961 1,031 At end 1966 1,707 Number of Families or Separate Occupiers— *At Census, 1961 75,803 Rateable Value, 1966 £12,847,820 Sum Represented by a 1d. Rate, 1966 £50,900 *Adjusted to accord with Boundary Changes introduced under the London Government Act, 1963. 18 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 way 6.31 Queen's Gardens, Coldharbour Estate 1.50 Queenscroft Recreation Ground 12.50 Rockcliff Gardens 5.21 St. Alfege Recreation and Church Ground 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 19 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 1,500.12 acres (jrepresenting 12.8% of the total area 1,500.12 acres of the Borough) Mileage of Roads (1st April, 1966) Approx. 249.94 20 GENERAL INFORMATION AND SOCIAL CONDITIONS Re-organisation of local government in London was effected by the London Government Act, 1963, and 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 (with the exclusion of North Woolwich) 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 ¼ 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 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. It is a steady climb at every point from the 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. 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 Greenwich an air and a fascination difficult to resist. 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 and all evidence points to the 21 fact that the present Royal Naval College stands on a site where once stood handsome Roman villas and courts. 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 continuous 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. Although early English kings had no settled domicile, in 1012 A.D., Ethelred II had a residence at Greenwich and Eltham, was prominent in royal affairs for some 200 years during the Plantagenet period. Later, when Henry IV (the first of the Lancastrians) was king, Greenwich was regarded as one of the seats of government and, from then on, the court at the Palace of Placentia became world famous. Especially was this so during the Tudor period and partic ularly during the reigns of Henry VIII and his daughter Queen Elizabeth when the palace was frequented by the most eminent people of the time. The founding of the Navy Office and Trinity House and the establishment of the Deptford and Woolwich Dockyards by Henry VIII merely confirmed the Borough's long standing affinity with the sea and shipbuilding. Present basic industries of the area owe their origins to these latter occupations with their associated trades and skills and also to the fact that, somewhat later, manufacture and testing of the country's arms and equipment became located at Woolwich Arsenal. At the opening of the present century the Greenwich and Woolwich areas, which were still 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. Sail-makers 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 22 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 government's armaments depot at Woolwich 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. 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, 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 23 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 flats 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 being actively pursued by the Greater London Council for the accommodation of 60,000 persons over a period of 15 years), new housing can come only from clearance of sub-standard houses and redevelopment in areas similar to those at St. Mary's, Glyndon, Lewisham Road, Maryon Road, etc. Housing in the Borough is provided not only by the Council, the G.L.C. and private enterprise 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 24 wide range of goods. However, this situation is changing, possibly contrary to the interests of many sections of the public. Town planning is demanding the concentration of traders into 'shopping centres'1 which tend to become dominated by big combines and which often lead to burdensome and sometimes costly journeys for the elderly and women with large families. 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 week-end 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, this forward looking attitude persists and all aspects of health and welfare, both personal and environmental, continue to be 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 clinics to the special maternity, paediatric, geriatric, thoracic and neuro-surgical units based at local hospitals of which there are twelve. Comprehensive Borough welfare services include 4 modern, purpose-built 'Old People's Homes' and future plans provide for further 'small home' accommodation. To overcome urgent and unexpected crises, a Reception Centre gives shelter to homeless families and a Main Unit caters for the more intractable cases. At 2 Centres and several voluntarily supported clubs, social rehabilitation of persons with differing physical handicaps is pro— moted by tuition, training and the introduction of pastime activities. Sheltered employment for blind people is provided at the Greenwich Workshops for the Blind where mattresses, baskets and 'fend-offs' are manufactured. Substantial assistance is given to the severely mentally handicapped child by the Borough's modern, specially designed 'Junior Centre' and older persons in this category are encouraged to become self-supporting at the Council's 2 Industrial Training Centres. 25 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 thirteen 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 625 homebound persons and the number of meals provided is at the rate of 162,500 annually. A Day Club for the home-bound 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. 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. By appointing a Geriatric Advisor, the Council has demonstrated its fervent support of'preventive medicine' and, furthermore, has recently introduced Geriatric Clinics for the early detection of disorders to which the elderly become prone. Serving the Borough are 13 libraries, 9 main and 4 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 and reproductions of famous paintings have been made available to 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. 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, 26 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. The name Rachel McMillan is internationally famous, for the McMillan sisters were the pioneers of nursery schools in the British Isles and their avant garde methods met with world wide acclaim. To cater for an increasing demand for this type of education, expansion and extensive adaptation is now taking place at the College of Education based upon the original Rachel McMillan Training College at the Deptford end of the Borough. 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. Within the Borough, the 'Arts' are well patronised and the Rangers House on Blackheath is becoming noted for its art displays, poetry reading sessions, etc. Recently, the building of a theatre on the site of the old Parthenon Music Hall has been given the Council's blessing and financial support. Municipal entertainment, especially for the very young and the elderly, is a prominent feature in the Council's policies. 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 27 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 I 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. 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 delight— ful attributes, Avery Hill grounds and nurseries serve as the head— quarters 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. 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 hydro— therapy 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 addi— tion 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 roller skating, badminton, table tennis, etc., and facilities are made 28 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, deter— mined 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 Green— wich 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:— Cablemakers, telecommunications and shipbuilding and repair works; automobile, construction, electrical and mechanical engin— eers; 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 oxygen 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. 29 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 descend— ing 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 denuda— tion 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. 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. 30 31 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 platform 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 Claygale 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 bluish-grey 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. At regular 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 32 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 thickness 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 greencoated 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. 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. 33 METEOROLOGICAL OBSERVATIONS—1966 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 meteoro— logical data for the year ended December, 1966:— Temperature Highest screen temperature 80° on 20th August Lowest screen temperature 20° on 19th January Maximum in January 56° on 29th „ „ February 56° on 1 st and 8th „ „ November 62° on 7th „ „ December 56° on 29th and 31st Sunshine TOTAL FOR YEAR 1231.0 hours. Sunniest Day 14.7 hours on 30th May. Number of Days without sun, 101, distributed as follows:— January 21 July 2 February 15 August 1 March 2 September 2 April 16 October 10 May Nil November 14 June Nil December 18 Rainfall TOTAL 28.80 ins. Highest Fall in 24 hours 1.12 ins. on 22nd June. Driest Month 0.39 ins. March Wettest Month 4.10 ins. December. 34 SECTION II VITAL STATISTICS SUMMARY* Population (mid-year 1966) Total Home Population 231,590 Child Population (under 15 years) 49,300 Elderly Population (over 65 years) 29,440 Density (persons per acre) 19.75 Area Comparability Factors: Births—1.04; Deaths—1.07 Marriages Total 1,927 Greenwich District 665 Woolwich District 1,262 Marriage Rate (persons marrying) 16.69 Births Live Total: 3,715 M F Total Legitimate 1,769 1,626 3,395 Rate (Crude): 16.10 Illegitimate 159 161 320 (Comparable Rate): 16.74 1,928 1,787 3,715 Illegitimate Live Births =8.6% of all live births Stillbirths Total: 59 M F Total Legitimate 25 27 52 Rate (per Illegitimate 3 4 7 1.000 total births): 15.63 28 31 59 Total of all Live and Stillbirths 3,774 Deaths Total: 2,560 Males 1,332 Rate (Crude): 11.09 Females 1,228 (Comparable Rate):! 1.87 Natural Increase (excess of births over deaths) 1,155 35 Infantile Mortality (deaths of infants under 1 year) Total: 68 Infant Deaths Leg. Illeg. Total M F M F Under 1 year 34 27 4 3 68 Under 4 wks. 20 17 4 2 43 Under 1 wk. 18 14 4 2 38 Infant Mortality Rates All Infant Deaths (per 1,000 total live births) 18.30 Legitimate Deaths (per 1,000 legitimate live births) 17.96 Illegitimate Deaths (per 1,000 illegitimate live births) 21.87 Neo-Natal Mortality Rate (per 1,000 total live births) 11.6 Early Neo-Natal Mortality Rate (per 1,000 total live births) 10.2 Peri-Natal Mortality Rate (per 1,000 total births) 25.7 Reproductive Wastage (per 1,000 total births) 33.6 Maternal Mortality Total: 1 Maternal Mortality Rate (per 1,000 total births) 0.26 Death Rates—Special Causes (per 1,000 population) No. Rate Heart Disease (all forms) 818 3.54 Coronary Disease, Angina 617 2.67 Vascular Lesions of Nervous System 316 1.37 Cancer (all forms excl. Leukaemia) 535 2.32 Lung, Bronchus 156 0.68 Uterus 14 0.06 Cervix 8 0.03 Leukaemia, Aleukaemia 10 0.04 Tuberculosis (all forms) 13 0.06 Pneumonia 237 1.03 Bronchitis 149 0.64 Congenital Malformations 18 0.08 Accidents—Motor Vehicles 28 0.12 Home 18 0.08 * These figure s, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 36 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. An essential preliminary to any statistical appraisal is the 'counting of heads' and this is achieved by the decennial Census. 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. Population General.—Natural factors such as famine, disease and tribal wars which, in previous times, controlled populations have been largely eliminated or substantially reduced and man is fast becoming the sole arbiter of population densities. As a result, world population is rising rapidly, the yearly increase being in the order of some 65 millions, approximately equivalent to the whole population of the United Kingdom. Given the present national rate of growth, there will be at the end of this century some 17 millions more people in England and Wales for which accommodation must be found. Population in Greater London, however, is not expected to grow much beyond the eight million mark by 1981, primarily because new housing, which can be built within this period, will be sufficient only to satisfy the needs of the existing residents. Whilst these observations may be true for Greater London as a whole, Greenwich in particular will prove to be an exception because development by the Greater London Council of the Plumstead Marshes area to accommodate 60,000 or more persons will initiate a gradual but persistent rise in the population of this Borough, for the majority of these people will be Greenwich residents. 37 Although it is common knowledge that our population structure is an ageing one and that the proportion of elderly in the population is rising, this, per se, is not to be construed as evidence indicating improved vitality of the older groups nor that the longevity of individuals is increasing. (Indeed, the expectation of life of a man of 65 years has increased only from 10.8 years at the beginning of the century to the current figure of 12.0). The explanation lies in the fact that a total of 9,298,000 live births in England and Wales during the decade 1900/10 (the survivors of which are now forming the '65 years and over' group) proved to be a 'high-water' mark. Subsequent decades failed to provide comparable births and the resulting 'bulge', which gave a youthful structure to the population earlier in the century, is responsible for the present ageing one. This temporary ageing of population structure, due mainly to changes in fertility, will have almost ceased to have effect by 1985 but improved mortality rates, especially evident in the younger divisions during the last 20 years, have begun a gradual but permanent ageing structure which will not be fully reflected until the middle of the next century. However, a surge in live births since 1955 (which has already begun to recede) will, during the next decade, give a higher proportion of younger age groups and, with the increase in retired people, will mean a substantial decline in the proportion of our 'working' population. In the future, some of these national trends are likely to be distorted or even reversed in Greenwich for the relatively large-scale immigration into the Borough during the next few years resulting from the development of the Plumstead Marshes area is almost certain to contain a predominance of young married couples and their children seconded from the G.L.C.'s housing list. This in turn will affect long term planning of general practitioner, maternity and dental services, hospitals, schools and the welfare of infants, the handicapped and elderly people, etc. Boundary changes consequent upon the inauguration of the London Borough of Greenwich meant that, for comparative pur— poses, some adjustment to the combined populations of the old Metropolitan Boroughs of Greenwich and Woolwich 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. The Registrar General has submitted his estimate of the Home population of the London Borough of Greenwich, computed at mid-year 1966, upon which the statistics of this Report have been based. The figure returned is 231,590, indicating a decrease in the population of 180 from that of the previous year but a rise of 1,340 since the 1961 Census. 38 Natural Increase.—The natural increase for the year, i.e., excess of births over deaths, was 1,155 compared with the figure of 1,178 for the previous year. Emigration/Immigration.—Taking into account a recorded natural increase of 1,155, there is a presumptive emigration from the Borough of 1,335 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 68.3 years for males and 74.4 for females. Composition of Population: (a) Sex Ratio—Taking the 1961 Census as a basis, it is estimated that the total population of Greenwich is made up of 112,314 males and 119,276 females, giving a sex ratio of 1,062 females per 1,000 males. Ratios for Greater London and England and Wales are 1,094 and 1,055 respectively. (b) Age Composition—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. 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 65.5% and that of "dependent" groups collectively, to 34.5%. 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 As estimated by the Registrar General: Age No. Approx. % of Total Population Under 1 year 3,620 1.6 1 to 4 years (inclusive) 14,080 6.1 5 to 14 years (inclusive) 31,600 13.6 Total Child Population under 15 years 49,300 21.3 Estimated locally: 15 to 64 years (inclusive) 151,675 65.5 65 years and over 30,615 13.2 Total Population 231,590 100.0 39 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. In England and Wales earlier marriage during the last 30 years, especially among females under the age of 20, has tended to increase; from 1951 to 1965 the number of wives in this group has risen from 44 to 71 per 1,000. Moreover, for the year 1965, the mean age at marriage for bachelor bridegrooms was 25.04 and for spinster brides 22.64, 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 1966. The total of 1,927 gives a marriage rate (i.e. persons marrying) of 16.69, a decrease of 0.55 from that of the previous year and is 0.69 in advance of the figure of 16.0 for England and Wales. Greater London returned a rate of 18.54. The following table shows particulars given by the Registrars for the past 2 years: Year Area Church of England Chapels and R.C. Churches Non Conforming Churches and Chapels Register Office Total Reg. General's Estimate of Population Marriage Rate (persons marrying) 1965 Greenwich 285 84 60 256 Woolwich 604 115 104 484 1,992 231,770 17.24 1966 Greenwich 280 78 23 284 Woolwich 570 114 91 487 1,927 231,590 16.69 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, 40 i.e. the birth rate. Clearly this is not an accurate calculation of "fertility" since the population figure used contains males and also females outside child-bearing age, but the birth rate does give, in a convenient way, 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 variations is made by the Registrar-General 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. However, determinations of fertility and therefore of future population arc 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 and to gauge the effect of these variables upon the health of the public, generally. Live births registered in the Borough during the year totalled 4,963 and of this number 4,111 occurred in hospitals and 852 in private dwellings. In 1,915 cases the parents resided outside the Borough and these births were subsequently transferred to their appropriate districts leaving a figure of 3,048. To this must be added 687 births belonging to this Borough which took place in institutions outside the Borough, thus making a final total for Greenwich of 3,715, a decrease of 7 from that calculated for the previous year. Of the total, 1,928 were males and 1,787 females, a proportion of 1,078 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:— 1,094 1,934 3.028 Inward Transfers:— 1st Qtr. 55 139 194 2nd Qtr. 37 136 173 3rd Qlr. 36 137 173 4th Qtr. 33 114 147 TOTALS 1,255 2,460 3,715 41 The Birth Rate for the year, calculated on the figure of 3,715 live births, is 16.10 per 1,000 of the population, 0.01 lower than that computed for 1965. With an area comparability factor of 1.04, an adjusted rate of 16.74 is returned compared with 17.7, the figure for England and Wales and for the Greater London area also. Illegitimate Births The degree of illegitimacy is usually evaluated by calculating illegitimate births as a percentage of total live births. This is satis— factory 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. 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 over— crowded 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 number— ed 320, equivalent to 8.6% of all live births registered, an increase of 0.2% over that for the previous year. In effect this means that one baby in every twelve born of Greenwich residents was illegitimate. Even so, this situation was the most favourable of all the Inner London Boroughs whose average illegitimacy was 14.5%. Figures for the Greater London area and for England and Wales were 10.9% and 7.9 % respectively. Stillbirths There has been a steady reduction of the stillbirth rate in England and Wales from the 1930 figure of 41 to the present rate of 15.4. Recent studies instituted by the Medical Research Council, et a/, have confirmed that the mother's age, parity and social class were found to be significant factors affecting stillbirths. Furthermore, improvements in this field were most marked in the higher social classes. Registered Greenwich stillbirths numbered 59 (28 males— 31 females) which is equivalent to a rate of 15.63 per 1,000 total births, a decrease of 5.92 from that for 1965. Greater London returned a rate of 14.2 and that for England and Wales was 15.4. All stillbirths must be registered in accordance with the Registra— tion Service Act of 1953 as amended by the Population (Statistics) Act, 1960, and must be accompanied by a statement as to cause. 42 An investigation of stillbirths occurring to Greenwich residents during 1966 reveals that the majority of stillbirths resulted from placental insufficiency, congenital malformations and accidental haemorrhage. A full analysis of causes of stillbirths is given in the following table:— Abruptio placentae 2 Hypertension 1 Accidental haemorrhage 7 Maceratcd foetus (hydramnios) 5 „ „ (essential hypertension) 1 Placental infarction 2 Placental insufficiency 10 Ante partum haemorrhage 1 „ „ (maternal hypertension) 3 Asphyxia 1 „ (by umbilical cord) 2 Postmaturity 1 Congenital malformation 9 Precipitate labour 1 „ „ (maternal age) 1 Pre-eclampsia 4 Early rupture of membranes 1 Rhesus incompatability 2 Fulminating termination of pregnancy 1 Vasa praevia 1 Unknown 2 Hydrocephalus 1 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 area comparability factor and is based on the last census population figure. The factor for Greenwich, viz. 1.07, may be regarded as the population handicap to be applied which, when multiplied 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 1966 was 2,560, of which 1,332 were males and 1,228 females, compared with last year's total of 2,544. This gives a crude Death Rate for the Borough of 11.09 per 1,000 of the population, representing an increase of 0.08 over that calculated for the previous year. When the area comparability factor is taken into account the rate is increased to 11.87 for comparative purposes. The Death Rates for Greater London and for England and Wales are 11.1 and 11.7 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. No. in Short List Causes of Death Sex Deaths at subjoined Ages of "Residents," whether occurring within or without the District. 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 Un— der 4 Wks 4 wks and un— der 1 year All Causes M 1332 24 14 9 11 16 12 45 110 267 376 448 F 1228 19 11 1 5 8 6 27 77 132 300 642 1 Tuberculosis, Respiratory M 9 — — — — — — 1 2 4 — 2 F 3 — — — — — — — 1 — 2 — 2 Tuberculosis, Other M - — — — — — — — — — — — F 1 — — — — — — 1 — — — — 3 Syphilitic Disease M 8 — — — — — — — — 3 4 1 F 3 — — — — — — — — 1 1 1 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 3 — — — 1 — 1 — — — — 1 F 3 — — — — — — — 1 — 1 1 10 Malignant Neoplasm, Stomach M 37 — — — — — — 2 4 10 15 6 F 31 — — — — — — — 3 3 11 14 11 Malignant Neoplasm, Lung, Bronchus M 132 — — — — — — 6 17 44 46 19 F 24 — — — — — — 3 6 5 4 6 12 Malignant Neoplasm, Breast M — — — — — — — — — — — — F 48 — — — — — 1 1 10 9 16 11 13 Malignant Neoplasm, Uterus F 14 — — — — — — 1 — 3 8 2 14 Other Malignant and Lymphatic Neoplasms M 122 — — 1 3 1 1 5 13 30 24 44 F 127 — — — 2 1 1 6 12 28 36 41 15 Leukaemia, Aleukaemia M 7 — — 1 — 1 — 1 1 1 — 2 F 3 — — — — — — 1 — 1 1 — 16 Diabetes M 3 — — — — — — — — 1 — 2 F 11 — — — — — — — — 1 6 4 17 Vascular Lesions of Nervous System M 126 — — — — — — 2 5 14 46 59 F 190 — — — — — 1 — 6 14 44 125 18 Coronary Disease, Angina M 363 — — — — — 2 12 39 85 110 115 F 254 — — — — — — 3 8 23 75 145 19 Hypertension with Heart Disease M 15 — — — — — — — 1 — 9 5 F 28 — — — — — — — 1 2 5 20 20 Other Heart Diseases M 61 — — — — — 1 3 3 9 11 34 F 97 — — — 1 — 2 3 5 9 15 62 21 Other Circulatory Disease M 48 — — — — — 1 2 4 11 13 17 F 48 — — — — — — 1 1 6 13 27 22 Influenza M 2 — — — — 1 — — — — — 1 F — — — — — — —__ — 23 Pneumonia M 105 — 7 3 — 1 — 1 2 8 21 62 F 132 1 3 — — — — 1 6 5 21 95 24 Bronchitis M 106 — — — — — — — 6 22 44 34 F 43 — — 1 1 — — — 1 6 10 24 25 Other Diseases of Respiratory System M 9 — 1 — — — — — — 1 4 3 F 7 — 1 — — — — 1 1 1 1 2 26 Ulcer of Stomach and Duodenum M 20 — — — — — — 2 1 6 6 5 F 9 — — — — — — — 1 1 2 5 27 Gastritis, Enteritis and Diarrhoea M 4 — — — — — — — — 2 2 — F 12 — 2 — — — — — 1 1 1 7 28 Nephritis and Nephrosis M 8 — 1 — — — — — — 2 1 4 F 3 — — — — — — — — 1 — 2 29 Hyperplasia of Prostate M 9 — — — — — — — — 1 1 7 30 Pregnancy, Childbirth, abortion F 1 — — — — 1 — — — — — — 31 Congenital Malformations M 9 3 3 — 2 — — 1 — — — F 9 3 3 — 1 — — 1 — 1 — 32 Other defined and ill-defined Diseases M 69 21 2 1 4 1 — 2 1 8 13 16 F 93 14 1 — — 2 1 3 7 9 20 36 33 Motor Vehicle Accidents M 18 — — 1 1 8 1 1 1 3 2 F 10 — — — — 1 — 2 2 5 34 All other Accidents M 25 — — 2 — 3 1 4 7 2 1 5 F 13 1 1 — — — — 1 1 _ 1 6 35 Suicide M 14 — — — — — 4 1 3 2 2 2 F 10 — — — — 1 — — 2 3 3 1 Homicide and Operations of War M — — — — — — — — — — — — F 1 — — — — — — 1 — — — — 43 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 22 12 12 22 68 Between 1 and 2 years 2 — 2 3 7 Between 2 and 5 years 1 1 — 1 3 Between 5 and 15 years 2 3 4 7 16 Between 15 and 25 years 8 3 6 7 24 Between 25 and 35 years 6 5 3 4 18 Between 35 and 45 years 24 20 11 17 72 Between 45 and 55 years 54 47 45 41 187 Between 55 and 65 years 119 100 95 85 399 Between 65 and 75 years 208 175 128 165 676 75 years and upwards 333 238 215 304 1,090 TOTALS 779 604 521 656 2,560 Of the four quarters, the first registered the highest proportion of the year's total deaths and the third the lowest, viz. 30.4% and 20.3 % respectively. It will be observed from the following table that, during 1966 the deaths in the age group 0-5 years accounted for 3.0% and that of the "over 65's" 69 % of the year's total. Figures for 1965 are given for comparative purposes. Age Group 1965 1966 Under 1 year of age 80 68 Between 1 and 5 years 5 10 Between 5 and 15 years 8 16 Between 15 and 25 years 24 24 Between 25 and 65 years 719 676 65 years and over 1,708 1,766 Totals 2,544 2,560 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 1966 2.560 1,854 72.4 44 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 enumera— ting pregnancies during the interval of assessment. Maternal mortality is conveniently 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 infec— tion. One maternal death was recorded during the current year giving a maternal death rate of 0.26 per 1,000 total births compared with a figure of 0.52 for 1965. The death, concerning a woman of 24 years, was certified as being due to 'self-induced' abortion. The rates returned for England and Wales and Greater London were 0.26 and 0.33 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, 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 fluctua— tions in the rate and only a long term appraisal is likely to reflect the true position. It is generally agreed that there is a direct relationship between foetal loss and the amount of ante natal care received. Some 60 years or so ago in the early 1900's there were no cyetic examinations at all and even when examinations were introduced at about 1909 they were carried out for ascertainment of presentation and detection of 45 albumin only. Undoubtedly the introduction of regular ante natal examination and subsequent treatment will rank as one of the greater achievements of preventive medicine of this century. Nevertheless, despite the introduction of these services and the great advances in chemotherapeutics and diagnostic techniques and notwithstanding the amount of research directed towards elucidating the causes of infant mortality, there still remains the refractory core of perinatal deaths for, in this brief period of life, there are as many deaths as will occur during the next 40 years among the survivors. This is not to say, however, that substantial improvements have not been achieved. On the contrary; in 1901 the infant mortality rate in the area now known as the London Borough of Greenwich was 130 per 1,000 live births, the actual number of children dying before reaching the age of 1 year being 818. Comparable figures for the current year are 18.30 and 68. But although there has been a real reduction in the total number of infant deaths the neonatal deaths in recent years have not decreased pro-rata. For example, in 1948 (the year in which the transfer of all M. & C.W. services to the L.C.C. took place) the sum total of all infant deaths amounted to 118. During the current year, a figure of 68 was returned showing a reduction of over 42% during the period. Neonatal deaths however, which, in 1948, represented 66.9% of all infant deaths, now form 63.2% of the total, indicating only a very slight improvement. Early neonatal deaths, similarly calculated, are even less impressive, the percentage actually rising from 54.2 to 56.0 respectively. In my Report for last year, I intimated the various agencies which were influencing perinatal mortality as disclosed by the survey of perinatal mortality instituted by the National Baby Trust Fund. In general, these covered the relationship of age, social class, parity, bad obstetric histories, previous abortions, number of premature and stillbirths, postmaturity, etc., and the varying effects that the institutional and domiciliary maternity and midwifery services had on the perinatal deaths. It is becoming clear that methods which brought about the spectacular successes of recent years in reducing the sum total of all infant deaths under 1 year will not prove so effective in achieving a lowering of the neonatal and perinatal deaths. Indeed, investigations reveal that hazards to infant life no longer arise as a result of mal— nutrition or infectious diseases but mainly from prematurity, congenital malformations, inherited metabolic disease and the possible teratogenic effects in early pregnancy of radiation and certain modern drugs. Minimal use of certain drugs and X-rays during the first trimester of pregnancy is one obvious step towards reducing infant mortality and closer medical supervision of the mother prior to 46 confinement is another but, congenital malformations, however, present us with much more substantial obstacles as do the inherited metabolic diseases. It seems evident that until human cytogenetics has advanced sufficiently to resolve more of the hidden problems of chromosomal abnormality, the infant mortality rate is unlikely to be materially altered. Nevertheless, some progress has been made within the last decade, for genetically determined deviations arising from chromosomal excesses or deficiencies are becoming comparatively easy for the expert to recognise as also are those involving the sex chromosomes. Familiar patterns can be traced and the giving of advice and the suggestion as to suitable action to be followed have now become practicable propositions. Although a great many genetically inherited abnormal conditions arising from autosomal translocations, perhaps involving the com— plete transfer of one chromosome to another or the exchange of similar amounts of material between differentiated chromosomes, cannot be detected by visual examination, fortunately, in some cases, observation over a number of years has established their modes of inheritance and accurate risk figures can be provided. It has been estimated that approximately eight per cent of all pregnancies are at risk from an Rh incompatibility of which one baby in twenty would be affected. Experiments on a new antibody recently carried out at Liverpool University have indicated that complete protection may shortly be possible and that haemolytic disease of the newborn from this cause could well be eliminated. Clearly, substantial reductions in present infant death rates will come only by the practical application of modern scientific know— ledge, a corollary to which will be a change from natural to planned parenthood and from natural to artificial selection. Eventually, society will have to face the complicated medical, social, educational and religious problems inherent in such a policy. It is conceivable that one of the future roles of local authority's health departments could be the establishment of 'genetic clinics' where investigations would be instigated and prospective parents counselled accordingly. The present infant mortality rate for the Borough, viz., 18.30, is a decrease of 3.2 from that for the previous year with rates of 19.0 and 17.8 being returned for England and Wales and Greater London respectively. Actual infant deaths recorded during the year were 68 (12 fewer than last year) comprising 38 males and 30 females of which 59 occurred in hospital and 9 at home. The following table shows the causes of and ages at death: 47 INFANTILE MORTALITY DURING THE YEAR 1966 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 Anoxia 1 1 — — — 1 Cerebral 1 1 — — — 1 Ante Partum Haemorrhage (Caesarian Section) — — — — — — — 1 — — — 1 — — — — 1 Asphyxia — — — 1 1 — — — — 1 „ neonatorum 1 1 — — — — 1 „ white 1 1 — — — — 1 Asthma—acute bronchial — — — — — 1 — — 1 Atelectasis 2 2 — — — — 2 Bronchitis—acute capillary — — — — — 1 1 — — 2 Bronchopneumonia — — 1 — 1 3 — 1 — 5 Congenital Abnormalities 1 — — — 1 1 — — — 2 „ Heart Disease 3 — — — 3 1 — 1 — 5 Diaphragmatic Hernia 1 — — — 1 — — — — 1 Displacement—abdominal viscera 1 — — — 1 — — — — 1 Epiglottitis—acute — — — — — — — 1 — 1 Fibro-elastosis of Heart — — — — — 1 1 — — — Gastro enteritis — — — — — 1 — — — 1 „ „ acute necrotising — — — — — — — 1 — 1 Haemolytic Disease of Newborn 2 — — — 2 — — — — — Labour—2nd Stage Delay 1 — — 1 — — — — 1 Laryngeal Stridor — — — — — 1 — — — 1 Malnutrition (manslaughter) — — — — — — 1 — — 1 Meningitis—pneumococcal — — — — — — — — — 1 Meningomyelocele — 1 — — 1 — — — — 1 Multiple Pregnancy 1 — — — 1 — — — — 1 Pneumonia—interstitial — — — — — 1 1 — 1 — —congenital cerebral abscess — — — — — — — — 1 1 Prematurity 16 — — — 16 — — — — 16 Pre-viable infant 2 — — — 2 — — — — — Renal Failure — — — — — 1 — — — 1 Respiratory Distress Syndrome 1 — — — 1 — — — — 1 Septicaemia — — 1 — 1 — — — — 1 Strangulation—umbilical cord 1 — — — 1 — — — — 1 Subdural Hygroma — — — — — — — — — 1 Tentorial Tear 1 — — — 1 — — — — 1 Unascertainable 1 — — — 1 — — — — 1 TOTALS 38 1 3 1 43 13 5 5 2 68 Males 38 Females 30 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 43 deaths, equivalent to 63.2% of all infant deaths and giving a Neonatal Mortality Rate of 11.6 per I,000 live births. This rate is 1.3 less than that calculated for the previous year and is slightly more favourable than the figure of 12.4 for Greater London and that returned for England and Wales, namely, 12.9. Early Neonatal Mortality.—Thirty-eight infant deaths occurring during the first week of birth gives an Early Neonatal Mortality Rate of 10.2 per 1,000 live births compared with rates of 11.0 and II.1 for Greater London and for England and Wales respectively. 48 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 97 stillbirths and deaths of infants under 1 week, was 25.7 per 1,000 total births, showing a fall of 6.9 from 1965. The equivalent rate for England and Wales is 26.3 and that for Greater London, 25.1. Reproductive Wastage.—A sum total of 127 stillbirths and infantile deaths gives a Reproductive Wastage Rate of 33.6 per 1,000 total births, a decrease of 9.0 from 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 practi— tioner. This enables his department to modify the original classifica— tion—hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the RegistrarGeneral. General. Following the general trend throughout the country, there was a very slight increase of 0.6% in the total number of deaths of Bor— ough residents during 1966. Increases in Greater London and Eng— land and Wales were 0.5% and 2.6% respectively. Little change was manifest when comparing the total number of deaths in 1966 with those of the previous year but there was a noticeable change in cause distribution. Mainly as a result of a decrease in deaths from congenital malformations, infant mortality showed a reduction of some 15% and there was a decline in motor vehicle accidents and suicide. 49 However, deaths from vascular lesions of the nervous system con— tinued to rise as did those from coronary disease and although pneumonia claimed substantially more deaths, an improvement in the bronchitis figures provided almost full compensation. Overall cancer deaths remained static but a decrease of 15% in lung cancer afforded a welcome relief to the persistent rise in recent years. Heart Disease Cardiovascular and atherosclerotic diseases as a group consti— tute 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 818 deaths (439 males and 379 females) during the current year. This total, which was an increase of 33 over that of the previous year, formed 31.9 % of the total of deaths from all causes and gives a rate of 3.54 per 1,000 of the population. The rate for 1965 was 3.39. Deaths in the Borough from coronary disease alone accounted for 617 (363 males and 254 females), a rise of some 11%. The increase was mainly evident in males over 45 years and in females over 65 years. Compared with figures of 2.39 and 2.28 for England and Wales and Greater London respectively (both of which showed slight advances over the previous year), the Borough rate was slightly less favourable at 2.67. Vascular Lesions of Nervous System Under this classification, which includes cerebral haemorrhage, embolism and thrombosis, some 316 deaths were recorded during 1966, a rise of 7.1% over the figure for the previous year which itself had been an increase of 22 % over 1964. Of the present total, 190 were females and, apart from coronary disease, this constituted the main cause of deaths in females during the year although 125 (66%) occurred in women over the age of 75 years and only 7 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 50 connotations not met with in other diseases, claimed 545 victims during the year under review. With the exception of leukaemia and lung cancer, which showed a reduction of 15%, all other forms of cancer registered increases. Indeed, stomach cancer deaths rose by 15 as a result of an increase of 72% in women, mainly over the age of 65 years. Comparatively, deaths from cancer of the uterus and cervix were much more prevalent but, as the actual figures were small, these may well be chance fluctuations. The total of 545 cancer deaths was equivalent to 21.5% 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:— Site Male Female Total Rate* Cancer of stomach 37 31 68 0.29 „ „ lung, bronchus 132 24 156 0.68 „ „ breast — 48 48 0.21 „ „ uterus — 14† 14 0.06 „ ,, other forms 122 127 249 1.08 Leukaemia 7 3 10 0.04 Totals 298 247 545 2.36 * Per 1,000 population † cancer of the cervix—8 (rate 0.03) 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. 27,025, indicates that not only has the annual rise of 2% been more than maintained but that the total, which shows an increase of almost 60% over the last decade, gives a national rate of 0.56. Figures for Greater London, which has consistently returned a high rate from this cause, follow the national pattern and a current rate of 0.72 is returned compared with the more favourable Borough rate of 0.68. A reduction of 15% in lung cancer deaths of residents during 1966 defies explanation but it is conceivable that this occurrence reflects an improvement due to the efforts of the health educationalists or it may presage a 'levelling out' of fatalities from this pernicious disease as forecast by some experts. Although death rates for women who die from cancer of the lung continue to increase, there are still five times as many men as women dying from this cause. 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;— 51 DEATHS FROM CANCERNOF LUNG (INCLUDING BRONCHOGENIC CARCINOMA) Year AGE GROUPS 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 Totals 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 1966 — — 6 3 17 6 44 5 46 4 19 6 132 24 156 0.68 Pneumonia There were eleven children under one year of age in a total of 237 deaths from pneumonia registered during 1966. The total, which consisted of 105 males and 132 females, showed an increase of 54 over that for the previous year indicating a 30% rise. Com— pared with rates of 0.75 and 0.85 for England and Wales and Greater London respectively, the Borough returned a rate of 1.03 which was 0.24 greater than that for 1965. In each case the rate was substantially higher than formerly. Bronchitis During the current year, Greenwich had a total of 149 bronchitis deaths, 106 males and 43 females, giving a rate of 0.64 compared with that of 0.63 for Greater London and 0.66 for England and Wales. Contrary to the London and England figures, both of which showed increases over the previous year, the Greenwich total indicated a decrease of almost 11 % and there were no deaths of children under the age of one year. 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 all forms of tuberculosis numbered 13, producing a rate similar to that for 1965, viz., 0.06 per 1,000 population. Of the deaths registered, 9 were males and 4 females, one of the latter being of the non-pulmonary type. The comparable rate for England and Wales was 0.05, a similar figure to that returned for Greater London, both figures being identical with those for the previous year. Violent Deaths As a classification, the term 'violent death' includes those deaths arising from motor vehicle accidents, suicide, homicide and 'other forms' of accident. 52 During 1966 there were 91 deaths from violence in the Borough, giving a rate of 0.39 per 1,000 population compared with a rate of 0.51 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 7,454 deaths in England and Wales during the year. This represents a slight improvement from the previous year when the total was 7,515. 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. Twenty-eight persons in the Borough died from this cause during 1966, a reduction of 7 from the previous year. The calculated rate of 0.12 compares favourably with the rates of 0.15 and 0.12 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 1966 amounted to the formidable figure of 4,994, giving a rate of 0.10 per 1,000 population. Moreover, of this total, approximately one fifth, viz. 992 were recorded in London, giving a rate of 0.13 compared with 24 deaths and a rate of 0.10 for Green— wich. Figures for London in particular throw into relief a psychiatric problem which is becoming very familiar in the cities of countries which sustain high living standards, for deaths from suicide in the Metropolis were more than twice those for tuberculosis and greater than the total deaths from road accidents. Homicide.—One death was recorded during the year in respect of a woman of 39 years who died from manual strangulation, the perpetrator being convicted of murder. Parents of a 3 months old female child who died from malnu— trition were convicted of manslaughter but the death was considered to be accidental. All Other Accidents.—The remaining deaths from violence in the Borough, viz. 38, give a rate of 0.16 per 1,000 population which compares favourably with the rate of 0.23 for England and Wales and that of 0.19 for Greater London. Home accidents were responsible for 18 deaths giving a Borough rate of 0.08 per 1,000 population. Among these were 4 deaths from carbon monoxide poisoning, 5 from falls, 5 from asphyxia resulting 53 from the inhalation of fire fumes, 2 from burns (1 chemical) and 1 arising from injuries sustained when jumping from a window to escape from fire. Common Infectious Diseases There were no deaths registered during the current year from diseases such as measles, scarlet fever, whooping cough, diphtheria and diarrhoea which are covered by this classification. There were, however, 2 female deaths of children under one year from gastro— enteritis, both of which occurred in hospital. 54 SECTION III PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Public health, as we know it today, had its origins in the middle 1800's when Chad wick confirmed a connection between material environment and health and, moreover, was successful in getting this fact officially accepted. Principles then established are still tenable. But, whereas, for very practical reasons Chadwick had to concentrate upon material and physical aspects, nowadays, as advances in scientific fields bring more profound knowledge and fuller comprehension, both health and environment are now being seen as a mosaic of physical, mental and social problems. Until recently, epidemiology, being a basic constituent of Chadwick's 'sanitary idea', suffered from a similar 'narrowness' of concept but, today, it is moving from its former artificial confines to broader realms covering the occurrence and distribution of all diseases. Without in any way minimising the rightful importance of infectious disease and its control in the health of the community, it is clearly evident that non-communicable diseases such as bron— chitis, diabetes, arthritis and rheumatic complaints are assuming relatively greater prominence in the sphere of public health and that heart conditions, non-bacterial pneumonias and cancers are pro— viding, in this modern age, a challenge as great or even greater than plague and smallpox in the earlier years. Although, fundamentally, the health of a nation is centred around the physician, the efficiency of a country's health services is also dependent upon many supporting personnel. Days of the single-handed doctor providing complete medical care for his patients are gone and those of the research worker attempting to solve, in isolation, complicated biochemical problems are numbered, for the emphasis is now on 'team' effort. As the community, the family and the individual all suffer the consequences of disease, 'teams' are not limited merely to members of the health professions but include educators, economists, engineers, etc., all of whom contribute to prosperity and welfare and stimulate a demand for 'positive' health in its widest sense. A pre-requisite for the successful planning of prevention, treatment and control of disease is reliable epidemiological know— ledge. A perceptive Chinese proverb which runs 'If you are planning for a year ahead, sow rice; for ten years, plant trees; for a hundred years, educate the people' not only gives in precise form the very 55 essence of the aims of the Health and Welfare Department but also the 'raison d'être' for the presentation in this Report of data calculated to achieve these ends. As already outlined in my previous Report, many diseases and malformations are genetically determined and, short of artificial selection, these are, as yet, beyond our control. Efforts for the moment, therefore, are limited to those directed towards influencing those environments which are disease precipitating. Such factors will include maternal and child care, housing, education, factory processes and working conditions, atmospheric pollution, food and food premises, diet, etc. Unfortunately, because not all diseases, infectious or otherwise, are notifiable to the Medical Officer of Health, local morbidity in certain instances may be difficult to assess and, of necessity, reference must be made to national trends. In other instances where aetiological uncertainty persists, some attempt has been made to give current authoritative views and hypotheses. Rising anxiety about drug addiction, coupled with its topicality, persuades me that the interests of the public would best be served by an exposition of the problem. Because, in general, local authori— ties are moving towards the establishment of all-embracing health and welfare services on which the results of drug addiction are certain to impinge, opportunity has been taken to summarise the present situation. Drug Addiction and Alcoholism Most problems in this connection arise as the result of the misuse or abuse of substances which, when employed sensibly, are generally of benefit to the public at large. As stated in my previous Report, neither drug addiction nor alcoholism appears to be of real moment in this Borough at present but, unquestionably, the problem of drug addiction is becoming increasingly more serious nationally and, as a health authority, we must be on our guard. Drug Addiction There is no doubt but that the misuse of drugs is a sickness and should be treated as such. It is important, therefore, that the underlying causes, social, psychological or environmental should be discovered and remedied or rectified. From 1959 to 1966, drug addicts known to the Home Office increased from 454 to 1,349, the latter figure included 899 heroin addicts of whom almost 400 also used cocaine. The numbers, although relatively small in comparison with total population, have doubled since 1947 but what is most disturbing is that they are now 56 rising steeply. Those on 'hard' drugs were located mainly in the London area although within the past year or two there has been a noticeable movement of some of these to large provincial cities such as Birmingham. Previously, addiction was to be found almost exclusively among the middle and older age groups, the majority of whom became dependent as a result of drug therapy, but recent additions to the 'addicted' list, however, were mainly those in their teens and early twenties. Official statistics obviously do not reflect the true position for they cannot cover the illicit use of drugs which appears to be on the increase especially among the young people. According to Lord Brain's Interdepartmental Committee Report, this rapid increase in illicit addiction in the young was largely due to over-prescribing by some doctors resulting in the excess supply finding its way to a black market. In conforming to a normal pattern, today's youth in its advance to maturity, seeks 'non-conformity' in order to assert its right to independent thought and action. Because the use of drugs, other than for the treatment and prevention of illness or disease, is prohibited by the 'establishment', this is considered by the younger generation to be a natural and legitimate field for rebellion. Hence its support, often irresponsible, of the free use of 'soft' drugs and cannabis in the mistaken belief that they are harmless. There is reliable evidence that people who have become addicted to 'hard' drugs have usually passed through the stage of experimenting with amphetamine barbiturate mixtures obtained illegally under such pseudonyms as 'Purple Hearts', 'Blues', 'French Blues', 'Black Bombers', etc. This transition from simple sedatives and stimulants to the compulsive slavery of heroin and cocaine is all too easy. It is suspected that such progression is aided and abetted by the 'pushers' of amphetamines and other 'soft' drugs who are predominantly heroin addicts relying on the profits from these transactions to buy supplies of their own drugs. Paradoxically, efforts by the adolescent to display his independence by the indiscriminate use of drugs are likely to end in the loss of those very qualities which he is so earnestly trying to establish. To justify support for legitimising the use of 'soft' drugs and cannabis, serious attempts are made to equate the use of modern stimulant and tranquilliser drugs with that of tobacco and alcohol (both of which are known 'killers') in the sense that if there is unlimited freedom in the use of tobacco and alcohol, why not the 'soft' drugs and cannabis? This is rather like saying that as there are already two man-eating tigers loose in the community, the introduction of further potential killers is not to be resisted. Indeed, 57 would we not have certain reservations about the introduction of tobacco and alcohol if we were starting from scratch ? Today, it can be confidently anticipated that the addicted smoker is not oblivious of the association between cigarette smoking and lung cancer and that, therefore, it must be assumed that the continued use of tobacco is his decision to take a calculated risk with his health and life span, an action which contains a pious hope that he will prove to be the exceptional individual who escapes the dire consequences of his addiction. Such an attitude merely emphasises a heavy dependence upon tobacco which in no circumstances can be condoned but, what is much more important, it can scarcely be presented as the archetype for unrestricted excursions into the world of drugs, 'soft' or otherwise. Alcohol is somewhat akin to cannabis in that both affect a person's judgement and lead to a false sense of security but, whereas the excessive drinker of alcohol becomes confused and realises the fact, a person under the influence of cannabis, although similarly confused, is dangerously unaware of it. Moreover, alcohol is a depressant which, if taken to excess, either induces sleep or precipitates vomiting before any serious harm occurs. No such safety regulator exists with cannabis which must be considered potentially dangerous if for no other reason than the variability of its pharmacology. It is true that many persons accustomed to the use of cannabis are left with apparently little or no residual damage but it is generally conceded that effects greatly depend upon a number of factors of which the psychological condition of the subject is perhaps the most important. Indeed, in 1963 the Commission of Narcotic Drugs stated that "cannabis users in industrial countries often have a psychopathic personality and consumption of cannabis is frequently the first step towards later addiction to heroin and morphine". In a number of instances, amphetamine is known to produce paranoic psychosis and it is particularly dangerous in that a person already inclined to feel persecuted may be stimulated from aggressive defensiveness to something more violent—even to murder. It would appear that petty crimes such as shoplifting, thieving, breaking and entering, false pretences, etc., are common in case histories of addicts to stimulants, possibly due to the need for obtaining further supplies or an inability or reluctance to obtain gainful employment. An investigation into delinquent adolescent boys admitted to London remand homes revealed the presence of amphetamine-like substance in the urine of almost 20% of whom only one fifth had conceded its use. Out of 60 murder cases in Japan during May and June of 1954, 31 convicted murderers had a connection with abuse of amphetamine. A drug squad recently established by Newcastle's Chief 58 Constable, with the support of a Medical Officer of Health's working party, found within a few months 50 young persons (some between the ages of 12 and 13 years) who were takers of amphetamine or L.S.D. This increasing use of L.S.D. is causing even greater concern to members of the W.H.O's Regional Committee for Europe who were presented with evidence indicating chromosome damage resulting from the use of this hallucinogen. Broadly it would seem that there are two types of young 'soft' drug takers—those coming into town for the weekend who are prepared to indulge in a little 'experimenting' and the 'hard core' of shallow, homeless drifters rejected by family and society who seek escape from their misery and hopelessness. It is in the latter group that those who progress to the 'hard' drugs of heroin and cocaine are most likely to be found. Personality disorders considered predisposing to drug taking such as emotional instability, immaturity, impulsiveness, etc., are common among addicts but they are not unknown among nonaddicts. Moreover, it is evident that some addicts have previously been normal, stable and well-adjusted individuals, a fact which shows quite clearly the unmistakable harm which addiction has upon inter-personal and social relationships. Perhaps an addict can be described as a person with certain personality traits who has chosen drug taking as a solution to his problems, the reasons for which he is unaware but which often include his association and movement within a social group which eulogises the practice of drug taking. In other words, it would appear that the extreme case with a defective personality is probably already set on a course of selfdestruction and the drug addiction has been found to be a con— venient mode of transport. A London Consulting Psychiatrist has summarised the social, psychological and environmental circumstances of drug dependence in the following terms:— 1. Drug dependence is the result of the interplay of two factors, viz., the kind of drug and a susceptible personality. 2. Drugs are taken by different people for different reasons— it is misleading to assume that all people classified as 'addicts' are similar. 3. The more a drug is socially acceptable the more normal the group who take it. The more foreign to society is a drug, the more deviant personalities will be found who take it. 4. Drug users range from normal personalities to those who already have such a defective personality that drug taking is only one symptom among many and that their social mal— functioning has been the cause rather than the result of taking drugs. 59 Narcotic addiction is not, nor has it ever been, an offence. Moreover, medical practitioners are permitted to supply or prescribe such narcotic drugs as they consider necessary for the treatment of patients. Legislation, however, makes the illicit possession of opium derivatives and scheduled drugs such as amphetamine or barbiturate criminal offences but penalties exacted as a result of its application cover a wide range and are related to the nature of the offence. Unfortunately, because not enough is known by magistrates and jurists about dangerous drugs, the variation in penalties is wider than seems logical and the law is brought into disrepute. Courts need reliable guidance and this is not possible until research has indicated what legal status drugs are to have and until doctors, hospitals, chemists, health authorities and police are given an opportunity to implement the findings in a firm but compassionate manner. For some, the prospect of drug taking is like a new fashion— fascinating, exciting and usually a nine-day wonder but for others, probably the majority of those with inadequate personalities who eventually become addicts, it appears to offer an escape from reality and a solution to their inability to cope with the ordinary vicissitudes of life in a world too complex for them to master even the simplest of their personal problems. What is not apparent to them is the fact that habitual drug taking cannot transform their environment but that it can certainly have serious effects upon their health and personality, all for the worse. It is the duty of every Medical Officer of Health to make himself fully acquainted with the state of public health in the district for which he is responsible. Drug addiction and its recent increase is one such aspect. Unfortunately, little information is available and, consequently, the collation of reliable epidemiological data is difficult. It has been very aptly said that 'the best treatment for drug addiction is never to let it happen' but, in present circumstances, actions by health departments are limited mainly to the educational field in offering guidance to the potential drug taker and actively discouraging the taking of tablets for every trivial complaint. In this way, risks of progression to serious addiction can be avoided. For local authorities to take practical action in the future, there needs to be a method whereby addicts are notified to the Medical Officer of Health who could then assess the gravity of the problem in his own area and perhaps bring his health and welfare community care team to bear on the problem. Maybe following an announcement of the Ministry's support of a research centre at the Maudsley Hospital, its agreement to the establishment of in-patient and out-patient treatment and the development of special centres for drug addiction will enable a much more positive line to be taken. 60 Alcoholism Alcohol aids digestion, is in many ways a food, is usually pleasant to take and is accepted as a social beverage leading to convivial association. Within this construction its use is harmless but the regular employment of alcohol for the relief of tensions and anxieties must be considered an abuse which may well result in addiction. Alcoholism is given as the fourth major cause of premature death in the community and the cost to the nation generally and to industry in particular, is stupendous. As a pre-requisite to prevention planning and control, epidemio— logical knowledge is again essential. The problem must be clearly defined, its size in relation to population at risk computed and its prevalence accurately assessed. It must be admitted that with the exception of the Parr survey in 1956, very little study has been undertaken in this country as to the prevalence of alcoholism and there is a great need for research on the problem. Our services are therefore constrained to utilise data from other countries in order to have any basis upon which to organise preventive work. Accurate statistics in respect of alcoholism are difficult to come by for these persons are not registrable by any agency although general practitioners may well keep a list of people whom they consider to be alcoholics. Undoubtedly cases come to light as a result of police proceedings, recourse to hospital or G.P. treatment, or applications to voluntary organisations or local authorities for help, but no arrangements exist for this information to be collated and consolidated. However, for several reasons such figures would not necessarily be a reliable indication of the actual number of alcoholics in the community. Statistically, the problem is complicated by the fact that no officially recognised definition of an alcoholic exists which would enable standardised registration to be effective. Moreover, although the male in settled employment is compelled to seek a medical certificate from his doctor if his addiction leads to absence, this does not apply as effectively to the unemployed or casual worker. Furthermore, women in particular are reticent about this type of problem not only in connection with themselves but also with regard to any member of their family. To the doctor, an alcoholic is not a 'drunkard' but an individual suffering from compulsive, obsessive drinking beyond his control, a condition which calls for medical, psychiatric and social help. Whilst few would quarrel with this general description, for statistical purposes, the term 'alcoholic' needs to be more clearly defined. The definition of an alcoholic varies but that offered by the W.H.O. appears to be the most acceptable and is twofold. It defines 61 excessive drinking as that which goes beyond the ordinary compliance with social drinking customs of the whole community concerned and an alcoholic as that excessive drinker whose dependence on alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with his bodily or mental health, his inter-personal relations and his smooth social and economic functioning or who shows signs of such development. According to the Jellinek formula, it has been estimated that there are about 300,000 alcoholics in England and Wales of which some 70,000 are chronic cases but these figures could be gross underestimations for excessive drinking is considered a social stigma to be hidden at all costs. Alcoholism appears to affect all socio-economic classes although more patients from the higher social groups seek treatment, and males are more prone to it than females, the ratio being in the order of 2:1. These generalisations indicate the paucity of our knowledge in this sphere and merely serve to emphasise the need for more research to ensure that errors of theory and practice are not perpetuated. What can be said is that restrictive legislation of the kind introduced in America failed and that concentration upon the 'medical' aspects of the problem is more likely to be successful, Meanwhile education will continue to be the first line of defence. Heart Disease Following the national trend, diseases of the heart were respon— sible for almost 32% of all deaths in the Borough during 1966 and, when taken in conjunction with circulatory disease, the percentage rises to over 35. Besides being the reason for a prodigious loss of man-working capacity in the United Kingdom amounting, it is estimated, to some 12 million week days per year, cardiovascular and atherosclerotic diseases, as a group, account for more deaths than any other single cause and, therefore, constitute the greatest possible challenge to preventive medicine. In particular, the middle-aged man is enjoying unprecedented prosperity and affluence but, today, his health falls short of pre-war standards, primarily as a result of persistently rising death and disability rates of his heart conditions with special emphasis on coronary disease. Conclusions from the M.R.C's social medicine unit's investi— gation into middle-aged men and their jobs supports the view that physically active men have a lower incidence of coronaries than those less actively employed but, a further study indicated that it was not just simply a question of the job. There was evidence suggesting that there may be a common genetic factor which could have a 62 bearing on the differing incidences of coronary disease. Thousands of post-mortems carried out in the original survey demonstrated, however, that scarring of the heart was most prevalent in those with light occupations and least in those with heavy jobs. This shows that exercise opens up collateral branches of the coronary arteries which are of inestimable value when a main branch becomes occluded. Epidemiologically, heart disease is proving to be modern society's greatest menace for it ranges over the whole span of life, from genotypic conditions, through those acquired as residual results of rheumatic and other diseases, to types concomitant with old age. Surgery is gaining a considerable measure of success in con— nection with congenital heart disease (which causes a large number of infantile deaths) and also in respect of the acquired disabilities but preventive action is having little or no demonstrable effect. This may be due, in part, to the fact that preventive measures lack the glamour of the curative procedures and perhaps to the dearth of suitable educative material being dynamically presented. In the light of present day knowledge, there are a number of aetiological factors which are thought to have a bearing on the increase in heart conditions, especially within the middle-aged groups. These are, excess animal fat in the diet, producing a rise in serum cholesterol—dietary imbalance—lack of physical exercise with a consequent rise in body weight—smoking—the connection of coronary disease with 'stress and strain' and with diabetes—genetic tendencies. Several of these predisposing factors have their origins in self-indulgence and the remedies are obvious. However, until our knowledge of cause and effect is complete, it would be unwise to delay introduction of preventive measures such as the adoption of a balanced diet and the restriction of the intake of animal fat, weight reduction, control of smoking, introduction of regular exercise and, most important, the dissemination of reliable information by health education officers. In a recent investigation in the U.S.A. into the effect upon osteoporosis of fluorides in the water supply it was found, quite fortuitously, that there was a striking difference between the high and low fluoride areas and the number of calcified aortas—the difference being in the order of 40% less in the high fluoride area. Confirmation of such a discovery would emphasise the significant role which fluoride consumption could play not only in the treatment of osteoporosis and dental caries but also in preventing calcification of the cardiac vessels. Cancer Serious though the problem of malignant disease is, some effort should be made to maintain a proper perspective. As Dr. Doll 63 has recently stated, if all male deaths from cancer could be prevented, then man's expectation of life would rise by only 2½ years and, in the case of females, by 11½. But because cancer is now one of the principal causes of child mortality, preventive measures should have greater public appeal both socially and psychologically. Bearing in mind the possible dangers of producing a few hypo— chondriacs I feel that, if any progress is to be made in the field of cancer prevention, it is incumbent upon all health authorities to present the public with up-to-date information in order that it may have the opportunity to avoid the 'cause and effect' associations with regard to cancer risks encountered in the daily round. Cancer education is a 'must', not only to stimulate the seeking of early treatment but also to promote the preventive aspects. Since carcinogens abound in our environment and even natural radioactivity in this country delivers to humans a dosage of the order of 100 units per annum, and although these are generally harmless, it would seem reasonable not to exacerbate the problem. We find, however, that the traces of arsenic which occur naturally in our food are being added to by the use of modern insecticides; the well-known tobacco carcinogen, '3.4 benzpyrene', is found in a number of uncooked, cooked and smoked foods; drinks made by pulverizing whole citrus fruits could be a hazard, for citrus oils are capable of producing skin cancers in mice. Alcohol, although not in itself a carcinogen, is associated with buccal and oesophageal carcinomas presumably by allowing the absorption of carcinogens. Of all the cancers, that of the lungs has shown the greatest increase, the rate being equivalent to 2,188 per cent, higher than 40 years previously. However enjoyable smoking may seem to be, evidence that it is the prime cause of lung cancer is overwhelming and that advice to heavy smokers to change to cigars or pipe in order to avoid the serious consequences of cigarette smoking seems a little too optimistic. The Ministry's Chief Medical Officer, at a world conference on 'smoking and health' has stated quite cate— gorically that the aim was not to limit cigarette smoking but to stop it. As proof of the efficacy of ceasing to smoke he said that, nowa— days, only one in three doctors smoked and their death rate from lung cancer had fallen by 30 % while the general male rate in Britain from this cause had risen by 25%. Hardened smokers, seeking to mitigate and divert attention from their unreasonable addiction, are inclined to indict atmospheric pollution as the major cause of lung cancer. Investigations by the Medical Research Council into this question failed to produce a decisive answer but there are indications that some factor in urban life acts synergistically with cigarette smoking which gives rise to lung cancer. This could be atmospheric pollution but there are suggestions that density of population is significant. It is true that urban lung cancer rates are 64 some three times greater than those in rural areas but the rate for smokers anywhere is still up to ten times that of non-smokers. Bronchial exfoliative cytology for adult males could possibly be the next step in the campaign against lung cancer. Present emphasis on cervical cytology, besides being a sound preventive measure, tends to counter what could well be a serious worry to the middle-aged woman, namely, cervical cancer. Carcinoma of the cervix, which is almost unknown in nuns, is rarer in single women than in married and it is unusual in Jewish women, perhaps because of the cult of circumcision in their males. There is, moreover, statistical evidence that cervical cancer is less prevalent where an obstructive contraceptive is habitually used. However, despite the concentration on cervical cytology, logically there is more reason for screening appropriate groups of women for the detection of breast cancer, for deaths from this cause are more than four times those for carcinoma of the cervix. Mammography, a method of soft tissue X-ray, is by no means a new diagnostic aid but it is still the commonly accepted technique for the examination of the breast for cancer. Although not infallible, if used in combination with a thorough clinical examination it gives a high degree of accuracy, for each method tends to compensate for the false findings of the other. Radiological risks have already been recognised but these must be intelligently equated with the many benefits accruing from the information gained such as more accurate diagnoses, effective treatment, relief of anxiety and the prolongation of life. Uncertainty about cancer and its causes prompted the outlining at length in my previous report of the various schools of thought concerning the causation of cancer and the avenues now being explored by modern researchers. Still more recent research suggests that the vital lead which is proving to be so elusive could possibly be found in the more effective use and better interpretation of existing epidemiological data. Investigations into 'graft' rejections have focused attention on the relationship between 'cellular' and 'humoral' immunity. 'Cellular' immunity, which is the body's method of immediately localizing antigens (analagous to graft rejection), is a preliminary to the development of 'humoral' immunity, the synthesis of antibody which renders bacteria more susceptible to phagocytosis. These two processes have always been considered complementary. It is now postulated that all attempts at immunizing patients against cancer have proved to be abortive because, far from being complementary, there is increasing evidence that these defence mechanisms may well be antagonistic. The hypothesis is that cellular immunity causes graft rejection but that antibodies against 65 the graft coat its cells and protect them against cellular immunity. There follows the possibility that if cellular immunity controls malignant disease in a similar way and if this is followed by the development of antibodies against cancer, such control is corres— pondingly diminished. It is known that if cancer cells are used to immunize an animal and the lymphocytes thereby activated are introduced into the donor of the tumour, they react immunologically against the original tumour. If this 'delayed allergic response' is the basic defence against cancer, then species in which it is well developed would be expected to have a low cancer incidence rate. This has been found to be so. Only in man, the primates and guinea pigs is this 'delayed allergic response' fully developed and it appears to be linked with cortisoneresistant qualities, these being high in man, monkeys and guinea pigs but low in rats, mice, rabbits and ferrets, etc.; natural incidence of cancer is related, inversely, to these qualities. Following this hypothesis through, it provides an explanation for the high incidence of cancer in childhood when one would expect immunological inadequacy and the accelerating rise after middle age associated with progressive inability of this group to initiate new immunological reactions with advancing age. Some evidence has been accumulated to the effect that cellular immunity in people with cancer is low but whether this is the cause or result of the disease has not yet been established. Anabolism of protein in guinea pigs increases their capacity to produce a delayed allergic response and catabolism diminishes it. If man reacts in the same way, the wasting arising from malignant disease would reduce immunological cellular resistance but this cachexia may well be superimposed on a natural immunological incompetency which permitted the establishment of the original cancer. Paradoxically, perhaps, research work in Chicago has shown that restriction of certain essential amino acids in the diet (in this instance phenylalanine) has a decided reducing effect upon advanced malignancies. Although a moderate body weight loss was evident, the absence of toxic side effects and the maintenance of haemoglobin and serum protein levels was an encouragement to pursue this line of investigation. Childhood Cancers—Survey—During the current year co— operation continued with Dr. Alice Stewart of the Department of Social Medicine, Oxford University. Notifications are received of all childhood deaths due to cancer in Greenwich during the previous year and after suitable preparation, if the parents are willing, they are visited by a Medical Officer who completes a penetrating history of the child and his or her family background. A control child is selected and the procedure is repeated. During 1965, as in 1964, 66 there were two such deaths in the area of the London Borough of Greenwich. Already certain common factors have been demonstrated in the backgrounds of some children who develop malignant diseases. It is hoped that analysis of the information obtained from these families will ultimately reveal the manner in which such tragedies may be prevented. Respiratory Infections A surge of pneumonia deaths in the Borough during 1966 focuses attention upon the increasingly serious nature of respiratory infections. Nationally, deaths from pneumonia and bronchitis have increased by 70% and 11 % respectively during the past decade and they are still rising. Furthermore, on an average, bronchitis causes the loss of over 30 million working days per year and is the commonest reason for consulting practitioners, there being over 26 consultations per 1,000 patients per year. Respiratory disease places a substantial burden on the hospital services. For every million of the population there are 213.3 and 122.5 beds for males and females respectively which are utilised annually for the treatment of chronic chest infections and these totals comprise 5.5% of male beds and 2.5% of female beds available for all causes. With the introduction of sulphonamides in the middle 1930s and, later, penicillin and other antibiotics, it is true that the severe symptoms generally associated with the old 'classic' type of pneu— monia have become comparatively rare and the course of the disease has considerably shortened. Nevertheless, despite improved en— vironmental conditions, an ageing population is much more sus— ceptible to chest infections particularly in those instances where there is financial hardship leading to enforced dietary deficiencies and restricted home heating. Moreover, diabetes, stroke or cancer, often the concomitants of old age, also pave the way for pneumonia and, in other conditions where cytotoxic drugs or cortisone are the selected forms of treatment, pneumonia can advance insidiously because of absence of prodromal symptoms. Infections of the respiratory system, variously diagnosed as bronchitis, pneumonia, influenza, colds and so on, which constitute the commonest form of illness in the community, are responsible for over one-third of all working days and two-thirds of all school days lost through sickness. In a great many instances, however, the precise causal organism is never established. While this may be of little significance in the treatment of the majority of adults, it could well be of vital importance in the case of young children for, in Greenwich, some 16 % of our infant deaths arise as a result of respira— tory infections. 67 Between the two World Wars it was recognised that some pneumonias differed clinically from the ordinary bacterial kinds such as the pneumococcal and streptococcal types and were, as such, referred to as primary atypical pneumonia. Subsequently, as a direct result of progress in microbiology and virology, various rickettsiae and viruses were revealed as causal organisms. For example, it was discovered that the respiratory syncytial virus which merely produces a common cold in adults gives rise to serious conditions of acute bronchiolitis and bronchopneumonia in infants. However, many other respiratory infections defy identification but, today, some of these are known to be caused by a pleuropneumonialike organism now officially designated as a 'mycoplasma'. Such organisms, which stand somewhere between the bacteria and the viruses, possess some characteristics of each and it is perhaps within this sphere that our hopes for real improvement in the control of chest infections lie. Discovery of man's hypersensitivity to antigens from some fungi (giving rise to such disabilities as Farmer's Lung) and from avian excreta (the suggested name for which is Bird Breeder's (Fancier's) Lung), shows that intensive research is gradually reveal ing causes, hitherto unknown, of a number of respiratory complaints. But when, despite thorough investigation, many chest infections remain unidentified, preventive measures inevitably become circum— scribed. All available evidence points to the fact that cigarette smoking is a major aetiological factor in chest diseases. It would seem that smoking habits are developed early in life at school or elsewhere and it is a matter of some urgency that the underlying motives be ascertained and for the health educators to act. Atmospheric pollution is an undeniable environmental hazard in the production of respiratory disease and this was amply demon— strated in the 'smogs' of 1952 and 1958/9 and which the Clean Air Act seeks to remedy. Prevention lies in the acceleration of nation— wide smoke control including a sustained effort to reduce harmful products of combustion emitted from motor vehicles. In cold weather, sufferers from respiratory complaints are advised to use warm rooms and to avoid sudden changes in tempera— ture when passing from one room to another. At times of 'smog' it is advisable to keep all windows closed to prevent exacerbation of an existing respiratory condition. Unattended chest infection at the beginning of adult life often leads to impaired lung function later on and it behoves everyone to seek medical advice in the early stages. Prevention is all important since once structural changes in the lungs and bronchi have taken place treatment tends to be merely palliative and the disease pro— gresses if not to a premature death then often to permanent disability. 68 Mental Illness Public attitudes towards mental illness and disorder are changing. No longer is it considered right or desirable that unfortunate sufferers should be incarcerated in asylums to be subjected to what is virtual torture. A more humane approach has led to the abolition of judicial certification by the Mental Health Act, 1959 and mental illness is now afforded the same status as other illnesses. Of what magnitude, in the community, is the problem of mental illness and what of prevention ? Effective preventive action is based upon profound knowledge and understanding backed by accurate information. Regrettably, in the case of mental illness, much of the data in use at present is empirical although, with recently awakened public interest and the establishment of several research study groups, this is being remedied. Ascertainment of reliable statistics is difficult but, nationally, of those persons known officially, some 100,000 (equivalent to about 0.2% of the population) are mentally subnormal and severely sub— normal. Of these, 65,000 are in psychiatric hospitals for mentally subnormal persons, some 1,000 are at home and, of the 34,000 in training centres, one half are under the age of 16 years. Of those in hospital, only 7,000 are under 15 years and these are probably severely subnormal. It is conceded, however, that the number of officially known mentally subnormal and severely subnormal may well be only two-thirds of the true total. Furthermore, it has been suggested that the total of other mentally ill persons is likely to equal or even exceed those who are subnormal or severely subnormal. In the local authority's care at Greenwich, there are almost 500 persons in the subnormal and severely subnormal category and approximately 600 people who are otherwise 'mentally ill'. It is known that genetics figure largely in mental illness but, with knowledge in this field at present being very limited, prevention in these instances can lie only in the application of eugenics with the local authority playing a supportive role. Such a role would include efforts enabling all individuals to realise their full potential capacity with a view to ultimate social adaptation and integration within the family and community. Elimination of brain damage in the newborn—perinatal as well as congenital—would be a great step towards prevention of mental illness and, in time, the 'at risk' registers should provide some of the answers. This would, of course, depend upon fully recording neonatal illness and the maintaining of thorough clinical examinations of selected children at regular intervals up to about the age of three months. Lack of self-discipline, exemplified by recourse to drugs to obtain solace and refuge rather than face difficulties or stand on 69 one's own feet, is a growing modern attitude towards life, and this drug addiction is posing further problems in the field of mental health. In speaking about drug dependence recently, a Professor of Forensic Medicine stated that soft drugs like L.S.D. are the most dangerous because 'they turn people into psychotics and schizo— phrenics'. Prevention in relation to psychoses, especially with regard to schizophrenia, is very limited although gradually ways are being found whereby the psychoneurotic and personality disorders may be avoided. Assistance in the development of stable personalities, avoidance of emotional trauma in the formative years and support in life's more important crises are some methods now employed and, today, it would be right to talk of social psychiatry and community mental health. In Britain, just over one-tenth of all hospital beds are occupied by schizophrenics and it would appear that this disease has attracted little finance and lesser research time. There are four main classifications of schizophrenia, briefly:— 1. Simple—exemplified by blunting of feelings and an indif— ference in personal relationships usually arising in puberty and sometimes mistaken for 'bone idleness' or weakness of character. 2. Hebephrenic—patient subject to moods of deep depression —quite likely to fly into rages over trifles or to laugh uproarious— ly over serious matters—thoughts appear to be 'under pressure' giving rise to delusions. 3. Catatonic—patient refuses to speak, eat or talk—their stupor often presents in bizarre forms such as a frozen stance with one knee raised stork-like off the ground. 4. Paranoic—most common among the middle-aged and elderly—patient is subject to hallucinations and delusions such as hearing voices from heating systems, refrigerators, etc. Adolescents in working class families appear to be more susceptible than those from the middle classes and their I.Qs. tend to be average although a number are extremely clever and talented. Even their delusive conversation can be logically based. Many schizophrenics can entertain delusions and yet still have normal relationships with friends and neighbours and the condition need not necessarily affect day-to-day social life. However, some schizoid symptoms can lead to violence. Indeed, the M'Naughten 'Rules' which formed the basis for judicial consideration of insanity pleas in the courts were formulated as a result of the murder of Sir Robert Peel's secretary by the schizophrenic Daniel M'Naughten in 1843. By means of paper chromatography, a Liverpool University research team established a link with the non-paranoic schizophren— ics and the presence in the urine of a chemical substance similar to 70 the hallucinogen mescaline, a close chemical relative of adrenaline. It is suggested that a genetic defect prevents the breaking down of this substance (D.M.P.E.) which then circulates in the body and is finally eliminated. This poses an interesting but extremely complex biochemical problem, the solving of which can only be to the ad— vantage of the schizophrenic. In other instances, some dramatic successes have been obtained by the use of phenothiazine derivatives but, inexplicably, there have been many failures and much more research into the reasons is needed. Some neuroses are precipitated by modern environmental conditions found in some satellite towns and at some new housing estates. In the quest for higher density housing, wholesale destruction of older and more mellow houses occurs which breaks up thriving communities and isolates the displaced families in unfamiliar areas among complete strangers. As completion of clearance areas often takes up to six or seven years, the community has little chance of regaining the balance and cohesion of former years. Moreover, multi-storey dwellings are producing family isolation and a neurosis in mothers who are cooped up in small self-contained flats, insulated from normal sights and sounds of everyday life, deprived of the daily neighbourly 'chat' and cut off from easy contact with friends and relations. With children constantly under their feet and full of apprehension as to whether these children will fall from the balcony or down the stairs or get trapped in the lift—worried in case the break-down in the lift will deter the milkman, baker or other tradesman from delivering—anxious as to whether, before closing time, she will get to the shopping centre which has been planned some half-a-mile or so away—it is no wonder that mothers with these worries and frustrations exhibit signs of neurosis. Children of the multi-storey flat family, starved of play space to expend energies in a harmless way, are eventually constrained to look away from the home for hobbies and pastimes. Sometimes these pursuits are not provided in the 'space' saved by high-rise housing which tends to combine the defects of congestion with none of the merits of 'neigh— bourliness'. All too often vandalism, destruction and other anti— social behaviour are the outward and visible signs of a community's subconscious protest against the limitations of skyscraper accom— modation, which are giving rise to unstable personalities. It is conceivable that such instability in young adults could form part of the 'battered baby' syndrome which has been the subject of much publicity recently. Legislation During the current year the following new legislation concerning infectious disease was enacted. 71 The Public Health (Leprosy) Regulations, 1966 These Regulations provide, inter alia, for the notification of leprosy by medical practitioners to the Medical Officer of Health in whose district the patient is resident at the time of diagnosis. On receipt of such a notification, a copy shall be sent forthwith to the Chief Medical Officer of the Ministry of Health and similarly, if the patient is ordinarily resident in another district, to the Medical Officer of Health of that other district. The Regulations came into operation on 1st March, 1966, and revoked those made in 1951, which required leprosy to be notified by medical practitioners direct to the Ministry's Chief Medical Officer. The Chief Medical Officer has requested Medical Officers of Health to maintain strictly confidential records and to inform him at the end of February each year, of changes as they occur and the names and addresses of leprosy cases domiciled in their respective districts including hospital in-patients. The Public Health (Aircraft) Regulations, 1966 and The Public Health (Ships) Regulations, 1966 These Regulations came into operation on 1st April, 1966 and consolidate The Public Health (Aircraft) Regulations 1952 to 1963 and The Public Health (Ships) Regulations 1952 to 1963 respectively, which provided for public health control of aircraft and ships arriving in or leaving England and Wales. They also make minor amendments which ensure conformity with the current International Sanitary Regulations of the World Health Assembly and, in respect of the Aircraft Regulations, continue public health control at aerodromes transferred by the Airports Authority Act, 1965, from the Minister of Aviation to the British Airports Authority. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936 and associated Regulations was 1,614. Under the Public Health (Tuberculosis) Regulations, 1952, there were 76 notifications giving a consolidated total of 1,690 cases notified during the year. However, 1 case was not confirmed thus giving a corrected figure of 1,689 compared with 3,079 for the year 1965. This decrease of 1,390 is largely accounted for by the biennial fluctuation 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'. 72 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 pro— duction 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 authenti— cation 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 vac— cination against Cholera and Smallpox and, to be valid, the certifi— cate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 8,453 certificates of persons proceeding abroad were so authenticated, of these 8,005 were in respect of Smallpox, 315 Cholera, and 133 for Typhoid. This total represents a rise of 5,807 over that of the previous year and consisted almost entirely of Smallpox vaccination certificates. Outbreaks of Smallpox (variola minor) in the West Midlands, Pontypool and Salford probably contributed to this increase. Smallpox No cases were notified during the year, but a number of con— tacts 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. 73 Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 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 1966 was 2,650, 2,404 under Council arrangements and 246 by general practitioners; figures for re-vaccination were 213 and 40 respectively. Occasionally a smallpox scare in the country results in a steep rise in the number of vaccinations effected, as witnessed during 1962, but generally the trend is downwards. During the current year, outbreaks of variola minor occurred in the West Midlands, Pontypool and Salford which again resulted in an expected resurgence of demand for vaccination. Some residents about to travel abroad were unable to obtain treatment from their respective doctors in time. Accordingly, arrangements were made for special evening smallpox vaccination clinics to be held at two of the Council's welfare centres, namely, Market Street and Shooters Hill Road. A total of eight sessions were held at which 50 primary vaccinations and 707 revaccinations were carried out. These were in addition to those effected at the Council's normal prophylaxis clinics. It was reported that, of the 50 West Midlands smallpox cases, 32 had never been vaccinated and a chance comparison of vaccina— tion techniques revealed that multi-puncture produced a reaction some 1^ days before that of the scratch method. It is also interesting to record that use was made of the electron microscope to identify smallpox virus and to differentiate them from those of chicken pox. Moreover, while identificati on by the old method was calculated in hours and even days, an unequivocal diagnosis was reached in a matter of minutes by the new approach. 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 vac— cinations this fortunate state of affairs cannot continue indefinitely. Measles The normal biennial fluctuation was evident in the number of cases notified during the year which fell from a total of 2,608 in 1965 to 1,250, the figure for the current year. 74 Only 15 cases, 4 of whom were non-resident, were removed to hospital. There were no deaths recorded. Prior to 1954, no vaccine against measles was available for the virus causing the disease had not been isolated. However, protection could be afforded by the antibodies contained in gamma globulin prepared from the blood of persons who had already had an attack of measles. This kind of protection had a very limited life and, moreover, it was very expensive. Since then, much research has been carried out and new vaccines, free of the undesirable reactions of the earlier types, have been developed. Under the control of the Medical Research Council, a limited scheme for vaccination with a new vaccine was introduced during 1964. Up to the end of 1965 some 620 Greenwich babies were so vaccinated and, during the current year, information concerning notified cases born between 1st November, 1962, and 31st December, 1963, continued to be furnished monthly to the M.R.C. Scarlet Fever There were 43 notified cases in 1966, a total which shows a fall of 68 from the previous year when Greenwich recorded 111. One of three cases removed to hospital was resident outside the Borough and no fatality was recorded. Whooping Cough Altogether 96 notifications were received in 1966, an increase of 26 over those of the previous year. Fourteen cases were removed to hospital, of whom three were non-residents, and there were no deaths. With regard to prophylaxis, eight children received a combined antigen (whooping cough and diphtheria) and a further 3,378 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 3,386 whooping cough immunisations carried out during the current year. Diphtheria During the year under review the sole notification received was not confirmed and there were no notifications registered during 1965. During the year, 3,768 primary immunisations were completed in the Borough of which 298 were effected by general practitioners. Most diphtheria immunisations which are given form part of a combined antigen therapy and, in addition to these primary treat— ments, some 7,537 reinforcing doses were given, 374 of which were carried out by local doctors. 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. 75 Acute Primary and Acute Influenzal Pneumonia The 30 notified cases registered in 1966 show a decrease of 10 from the total of 40 for 1965. Nine cases received hospital treatment, but no deaths were recorded. Typhoid One case of typhoid and two of paratyphoid fever were notified during the year compared with a nil return for 1965. The case of typhoid fever occurred in a child of 1½ years who had been to India with her parents for 5 months in 1965. Examination of faecal specimens revealed that the father, an Indian who had typhoid when aged 8 years, was a 'carrier' of this disease. The family were kept under hospital observation and treatment until several negative results had been obtained. The Department then arranged for further specimens to be taken over a period of time to try to exclude the possibility of a chronic carrier state developing. Both cases of paratyphoid fever, admitted to hospitals within Greenwich, were not Borough residents. One case was that of a seaman flown specially to this country for medical treatment and the other was a member of H.M. Forces recently returned from abroad. Erysipelas During the year there were six notified cases, the same total as for 1965 when Greenwich recorded 1 and Woolwich 5. Sonne Dysentery This disease is usually characterised by diarrhoea, fever and, to a lesser extent, vomiting. Although modern methods of treat— ment are effective and usually rapid, nevertheless the disease has become a serious nuisance and difficult to control. It is 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. Ninety-two notifications were received in 1966, a total which shows a considerable increase over the consolidated figure of 26 for the previous year. Five of the 16 cases who received hospital treatment were resident outside the Borough. No fatality was recorded. Puerperal Pyrexia Of the 83 notified cases, 24 were in respect of hospital patients whose residences were outside the Borough. In 1965, there was a total of 130 cases registered which included 32 non-residents in hospitals within the Borough. 76 Eighty-two cases were nursed in hospital and the remaining case at home. There were no fatalities. Meningococcal Infection Two notifications were received in 1966 compared with a nil return for the previous year. Both cases were removed to hospital and there were no deaths. Acute Encephalitis {Infective or Post Infectious) Compared with a nil return for 1965, there were two cases of the post infectious type notified during the current year, one following Mumps and the other after vaccination against Smallpox. Both patients, one of whom was a member of H.M. Forces and resident outside the Borough, were removed to hospital. There were no deaths. Ophthalmia Neonotorum There were 5 notifications received in 1966 compared with a total of 7 for the previous year. Poliomyelitis As in the previous year, no notification was received during 1966. Completed primary poliomyelitis inoculations carried out during the current year numbered 3,794, 265 of which were by general practitioners. Reinforcing doses totalled 3,061 again with 123 being given by general practitioners. Tetanus (prophylaxis) During the year, 3,734 persons were protected against tetanus and 6,446 reinforcing doses were given, both being part of combined antigen therapy. Of these treatments, 298 and 374 respectively were effected by general practitioners. Malaria One notification was received in 1966 in respect of this disease which was contracted abroad, compared with a nil return for the previous year. The patient was a member of H.M. Forces admitted to a hospital within Greenwich but whose residence was outside the Borough. Tuberculosis Undoubtedly, as a result of the efforts of the medical profession and of public health staffs generally, tuberculosis is a declining disease. Nevertheless, although notifications to local authorities again decreased during the current year, deaths both in England and Wales and Greater London showed slight increases. Whether this 77 rise in mortality will continue and, if so, whether it is evidence of increasing bacterial resistance to modern drugs or the results of recently introduced foci of infection has yet to be determined. Fundamentally, tuberculosis has retained its nature but patterns of treatment have changed. Chemotherapy, although more complex than hitherto involving as it does various combinations of P.A.S., izoniazid and streptomycin, is the modern procedure whereby infectivity is quickly eliminated irrespective of adverse environmental conditions and relapse risks are minimised. Obviously the effective— ness of such techniques depends ultimately upon the maintenance of regular treatment. Preventive measures, however, lie mainly in the sphere of the family where an active case is, or has been revealed. B.C.G. vaccina— tion has become standard preventive practice during school life or in instances where there are special risks and other steps include the tracing and supervision of contacts and investigations into social and environmental circumstances. However, 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. It may be that vagrancy is perhaps too strong a word for the people who wander the countryside and have no fixed abode but the practice is growing especially among the younger age groups. Control of infectious cases under these conditions is virtually impossible and the infected immigrant and the grossly infected mobile patient, in close contact with susceptible groups, could lead to latent pools of infection throughout the community. The situation presents grave difficulties to health departments in general and to chest clinics in particular. That elderly people may suffer from tuberculosis which remains undiagnosed until they are admitted to hospital for other reasons or until a post mortem is undertaken is revealed in a recent examination of 1,713 post mortems carried out in a South East London hospital between 1950/64, on patients over 70 years. Thirty-one cases of tuberculosis were discovered and in only 4 cases was there a previous tuberculosis history. Fifteen of these were found during the terminal illness and 12 at post mortem. In these instances there is a potential risk to other patients in the hospital and there must be a certain number of inaccuracies in clinical diagnoses and death certificates if a post mortem is not performed, if this situation is common throughout the country then there would appear to be a need for routine necropsy and examination of all sputum specimens for acid-fast bacilli. It seems that although a great deal has been achieved, there still remains much to be accomplished. There were 76 notifications received during the year and of these 67 were of the pulmonary type and 9 non-pulmonary, i.e. tuberculosis 78 of parts of the body other than the lungs. From sources other than formal notification, a case of pulmonary and another of nonpulmonary were posthumously notified. In 1965, some 56 pulmonary and 13 non-pulmonary cases were notified giving a consolidated total of 69. During 1966, some 2,542 Greenwich school children and, students 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 24 rooms. An additional 31 premises involving 178 rooms were disinfected as a result of Council housing transfers. The number of notified cases of tuberculosis remaining on the Register at 31st December, 1966, was as follows:— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 502 332 5 12 851 34 31 2 2 69 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 1,723 pulmonary and 105 non-pulmonary for Greenwich and Woolwich at the end of 1965. 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-five new cases of pulmonary tuberculosis were notified during the year. These included 17 males, of whom 13 were over the age of 40, 7 females and one girl. The girl aged 11 and 1 female were discovered as a result of our scheme for having X-rays of all contacts. Three cases of non-pulmonary tuberculosis were notified, a boy of 7 with tuberculous infection of the knee and two females with tuberculous glands. One hundred and three ante-natal patients have been X-rayed but none was found to have active tuberculosis. One hundred and 79 sixty two contacts of persons with tuberculosis were X-rayed and two were found to have active tuberculosis, as mentioned earlier. Seventy two children and young adults were given B.C.G. inocula— tion because they were contacts of cases with tuberculosis. Thirty three positive Mantoux children were referred to us from school but none was found to have active disease. Many patients with other chest conditions, including neoplasm of the lung, bronchitis and asthma are referred to the Chest Clinic and the examination and investigation of these patients continues to play a large part of the work carried on at the clinic." 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 "During the year 1966 there were 44 new cases of pulmonary tuberculosis notified in the Woolwich area. This was an increase of 13 on the previous year. Of these 28 were male and 16 female. Age Group Females Males 0—20 3 2 20—40 5 5 Over 40 8 21 Eight cases of non-pulmonary tuberculosis were notified; three male and five female. The total number of notified cases of tuber— culosis now on the Register is 687; pulmonary 650 and surgical 37. Figures for 1965 were 1,074. The reduction in the number since last year is due to the fact that patients who were unlikely to relapse were removed from the register which now contains only those who are infectious or potentially infectious. The total number of atten— dances at the Woolwich Clinics for the year was 6,097 (new patients 1,093) as compared with 5,633 in 1965. B.C.G. vaccination was given to 183 patients. Seventy Mantoux positive schoolchildren were referred to the clinic but none of these was found to have a tuber— culous lesion. The number of Indians attending the clinic for the first time was 60. Of these 3 Indian women had tuberculous cervical adenitis. Two relapses with miliary dissemination occurred in old cured tuberculosis cases who had been discharged from the clinic which emphasises the need for indefinite annual check-up examina— tion. Chest diseases other than tuberculosis, especially bronchitis, neoplasm, asthma and industrial diseases are now demanding ever more time and investigation. All modern lines of investigation and treatment are carried out. I am indebted to Dr. P. Forgacs and Dr. D. Wraith for performing pulmonary function tests. Obesity and iron deficiency anaemia are two disorders frequently detected on routine examination of our old cases of tuberculosis and 80 bronchitis. Advice regarding diet is an important part of clinic work. Several cases of sarcoidosis and atypical mycobacteriosis are now being treated at this clinic. An X-ray only service for general practitioners has always been well catered for by the Woolwich Group Hospitals. There is, there— fore, no need for this service to be provided by the Chest Clinic. Patients with abnormalities in their X-rays are referred to the clinic for further assessment. Ten regular sessions are held weekly at the Woolwich Clinics, at four of which two physicians are in attendance. An evening clinic is held on a Monday at the Out-Patient Department of the Eltham & Mottingham Hospital by arrangement as required. Patients who require hospital treatment are admitted to Grove Park Hospital. Student health visitors and other nurses attend clinics for observation and instruction. Many domiciliary visits are made at the request of the general practitioners." 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. Although no major surveys were undertaken, in addition to attendances at regular sites, short visits covering 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, 1966 PART I —GENERAL ANALYSIS Men Women Total (a) Total X-rayed 9,166 4,167 13,333 (b) Total previously X-rayed (within 5 years) 6,609 1,986 8,595 (c) Total number reviewed 339 97 436 (d) Number considered abnormal after review 234 64 298 81 PART II.— ANALYSIS OF ABNORMAL FILMS (1) Cases considered tuberculous and referred for further investigation:— Men Women Total (a) No further action required — — — 06) Occasional Supervision 5 6 11 (c) Requiring close supervision or treat— ment *6 5 *11 (d) Still under investigation — — — (e) Refused further investigation — — — (2) Previously known tuberculous cases 8 — 8 (3) Non-tuberculous cases: (a) Investigated 35 18 53 (b) Still under investigation 5 — 5 (c) Refused investigation 1 1 (4) Cardio-vascular lesions 32 18 50 (5) Abnormalities requiring no action 142 16 158 *One of these cases was also diagnosed as carcinoma of bronchus. ANALYSIS OF SURVEYS a) Public Surveys (Small) Numbers Examined Cases of Tuberculosis requiring treatment or close supervision NOT Previously Examined (iincluded in first column) Numbers Cases Men Women Total Men Women Total Men Women Total Men Women Total 344 730 1,074 1 1 2 246 541 787 1 1 2 (B) Public Surveys— Examination of Special Groups 283 130 413 — — — 88 60 148 — — — Firms Full-scale visits 2,079 1,371 3,450 3 3 625 589 1,214 — 1 1 Firms Examination of Special groups 3,396 22 3,418 4 — 4 86 10 96 — — — Colleges, Schools, Hospitals, etc. 808 656 1,464 — — — 552 217 769 — — — Regular Site (Woolwich) 2,216 1,188 3,404 *1 1 2 923 700 1,623 1 1 2 fames, Lodging Houses, etc. 40 70 110 — — — 37 64 101 — — — TOTAL 9,166 4,167 13,333 6 5 11 2,557 2,181 4,738 2 3 5 * This case was also diagnosed as carcinoma of bronchus. 82 Non-Tuberculous Cases Men Carcinoma of bronchus 6 Carcinoma of bronchus (previously known) 1 Suspect Carcinoma of bronchus—refused investigation 1 Secondary deposits from Hypernephroma 1 Bronchiectasis 1 Pneumonitis 13 Ch. Bronchitis and Emphysema 4 Pleural thickening 3 Cystic disease of lung 1 Eventration of diaphragm 1 Kyphosis 1 Abnormal rib 2 Total 35 Women Carcinoma of bronchus 1 Neurofibroma 2 Sarcoidosis 2 Bronchiectasis 1 Pneumonitis 3 Ch. Bronchitis I Pleural thickening 1 Diaphragmatic hernia 3 L.L.L. collapse—cause unknown 1 Funnel chest 1 Sub-sternal goitre 2 Total 18 Notes: Incidence of significant tuberculous cases remains at slightly over one per 1,000 in those NOT previously X-rayed and at 0.7 per 1,000 among those X-rayed within the last 5 years. There is thus a substantial gain to be effected by examining as many as possible of the population not previously X-rayed. Venereal Diseases The term 'venereal' is given to a group of diseases acquired during sexual intercourse of which, in England, syphilis and gonor— rhoea are the most common. Other complaints, usually acquired sexually, such as non-gonococcal urethritis and trichomonal infec— tion have recently been taking progressively more of the venereo— logist's time but, fortunately, although in some instances these can produce serious complications, in the main, they do not present the difficulties associated with syphilis and gonorrhoea. 83 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. Syphilis affects the circulatory system and the elastic tissue of the aorta may be damaged giving rise to an aneurysm which, at best, may impair the functioning of the aortic valves or precipitate heart failure and, at worst, by its rupture lead to sudden death. When the treponema damages the nervous system (tabes dorsalis) there follows a history of progressive destruction of nerve fibres in the spine and periphery and, in cases where the brain cells are affected, there arises a condition known as 'general paralysis of the insane'. In tabes, there may also be crippling joint destruction while involvement of the eyes could result in blindness. Unborn children of syphilitic women can be infected via the mother's blood and, moreover, the earlier pregnancies of an affected woman often end in abortion and later ones in stillbirth. Many children who survived these hazards suffered from congenital syphilis which gave rise to mental deficiency, blindness and deafness. Although it can be the source of serious complications gonorrhoea, a disease more localised than syphilis, is seldom lethal but is one of the causes of sterility in men and women. Before effective prophylaxis was introduced, ophthalmia neonatorum, previously the most common cause of blindness, was often acquired by children at birth as a result of the mother's infection. Venereal disease can have catastrophic effects on health, happiness and family life. Indeed, the Matrimonial Causes Act of 1950 gives undisclosed communicable venereal disease at time of marriage as grounds for rendering such a marriage invalid. In the sphere of venereal disease, promiscuity and an 'infector' pool are the two factors determining the size of the problem. Promiscuity is a reflector of personal behaviour and morals and, naturally, the higher these standards the less prevalent are the venereal diseases. Pools of infection are increased and enlarged by promiscuity and reduced after the contagious period is over or a person is cured. No reliable means exist of estimating the extent of promiscuity in a community although the number of persons attending the special clinics may provide a pointer to the numbers exposing 84 themselves to the risk of infection. There has always been a correlation between illegitimate births and numbers seeking advice at the venereal disease clinics but with the changing attitudes to pre-marital intercourse and the availability of contraceptive knowledge and measures, in future, this association will tend to be misleading. Previously, because of the element of 'guilt and shame' in venereal infections there has always been a reluctance to seek advice and treatment although this was partially offset by the introduction of penicillin. Unfortunately, the very success of this antibiotic has tended to minimise the seriousness of these diseases especially among the young persons where there is a measure of sexual freedom undreamt of a decade ago. Although the Wassermann Reaction had been used since 1906, it is hard to realise that not until 1948, was syphilis specifically identifiable. Treatment in the earlier days was prolonged and painful and patients frequently defaulted before treatment had been completed. Today, the number of defaulters is considered to bear some relationship to under-staffing of centres. Over the years, chemotherapy has been and still is successful in treating venereal disease although some growing resistance against penicillin has been recorded. Nevertheless, it is recognised that drug therapy can never be the complete answer and the problem remains primarily one of public health. Despite improvements in methods of diagnosis and treatment and in epidemiological techniques, anxiety was expressed by the Ministry's C.M.O. about the increase in national figures for venereal disease, especially syphilis, during 1965. That his concern was somewhat too pessimistic has been revealed by the figures for 1966 which show a decline of 14% in syphilis but a slight increase of 2% in the case of gonorrhoea. In both diseases, however, there was an increase in female cases but this may well have been the result of better 'case finding' particularly as in many women gonorrhoea gives rise to no symptoms. Prompt tracing of contacts is one of the most important aspects of control and the Ministry is shortly to produce a circular giving recommendations intended to strengthen and extend procedures of contact tracing and to clarify the legal issues involved. Health education and instruction is another link in the chain of prevention and control which has the active support of the Ministry of Health and the Department of Education and Science. 85 Speed of modern travel makes local control of infectious diseases difficult if not well nigh impossible on occasions, a fact 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. It is 50 years now since the Venereal Disease Service in this country was established and venereology has begun to emerge from the furtive and prejudiced period of the late 19th century to an era of enlightened attitudes where it is attracting due recognition for its valuable contribution to the nation's wellbeing. 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 1966:— 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 5 123 57 367 213 495 275 Dreadnought Seamen s Hospital: 37 - 166 - 898 - 1101 - New Cases of Residents Treated During 1966 (as given in returns from the undermentioned Centres) Treatment Centre Syphilis Gonorrhoea Other Conditions TOTALS Greenwich District Hospital Miller Wing: 6 52 212 270 Dreadnought Seamen's Hospital: 1 28 158 187 St. John's Hospital: — 11 22 33 London Hospital: — 5 16 21 Middlesex Hospital: 1 6 39 46 TOTALS 8 102 447 557 86 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. On an individual basis, oral hygiene, regular dental supervision, restriction of fermentable carbohydrates and provision of extra 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. In the U.S.A., laboratory evidence has shown that fluoride leads to the perfection of crystals of dental enamel and the fluoridation of water supplies is a rational and practical method of combating dental decay. This could be achieved at relatively little cost compared with the present excessive expenditure on dental services, generally, which will continue to increase if effective preventive measures are not introduced. Fluoride tablets, as suggested by the opponents of water fluoridation, fail as an effective alternative because, in general, they tend not to be taken regularly. As far as this Borough is concerned, the Metropolitan Water Board is persisting in its policy of not introducing fluoridation until there is unanimity among the local health authorities. In the meantime, a great deal of preventable dental caries will continue to afflict the young, the conservative treatment of which will prove to be extremely expensive in money, manpower and personal inconvenience. 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. Fifty-four cases were notified and one case was otherwise ascertained during the year. 87 All the cases were investigated with the following results:— No. of Cases Organism (if known) No. of Hospital Cases Remarks 9 Salmonella typhimurium 3 One family suspected custard and one case chicken pie. Two of the cases admitted to hospital were resident outside the Borough. Otherwise no particular food suspected. 2 Clostridium welchii — Sausage meat suspected but it was not possible to verify. 2 Salmonella braenderup 2 Mother and new born baby diagnosed whilst in maternity ward. Both were symptomless. 1 Salmonella panama — No particular food suspected. 1 Salmonella new-haw — Soup consumed whilst abroad on holiday was suspected. 40 No organisms detected 1 Thirteen cases occurred in five families and 26 in separate households. The remaining case was one reported by a neighbouring Borough where 12 others occurred and the food suspected was consumed in a factory canteen within that Borough. One family suspected minced beef and another beefburgers and examination of the latter revealed the presence of staphylococci faecalis. In the other cases no particular food was suspected. 55 6 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 1966. 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 88 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. New Claims to Sickness and Industrial Injury Benefit Year Ended 29th November, 1966 Sickness Benefit Injury Benefit Quarter ended 1.3.66 Deptford 6,604 304 Eltham 7,891 281 Woolwich 8,196 344 Quarter ended 31.5.66 Deptford 6,231 410 Eltham 6,454 336 Woolwich 6,647 404 Quarter ended 30.8.66 Deptford 4,927 379 Eltham 4,528 326 Woolwich 4,958 403 Quarter ended 29.11.66 Deptford 6,028 401 Eltham 6,092 320 Woolwich 6,842 372 Totals: 75,398 4,280 89 SECTION IV PERSONAL HEALTH AND RELATED SOCIAL SERVICES Although Health Visitors were first appointed in Liverpool in 1897 and in Birmingham some two years later, some voluntary health visiting had taken place in Salford as early as 1862. However, the Maternity and Child Welfare Services as we now know them had their origins in the 'milk depots' set up in a number of towns at the turn of the century for the express purpose of supplying clean cow's milk to necessitous mothers who were unable to breast-feed their infants. By 1907, some welfare clinics and schools for mothers were already operating to provide free medical consultations for infants on an ever increasing scale. Government support in the guise of the Maternity and Child Welfare Act of 1918 gave added strength to local authorities' powers to introduce schemes and today the care of expectant and nursing mothers and their babies is an integral part of these authorities' advisory and preventive services. Lives of infants are at danger from exogenous or environmental hazards and endogenous or congenital handicap or damage. To a very large extent, the environmental aspects have been mastered and, although many congenital conditions and malformations which allowed no hope of cure in previous times are responding to surgery and treatment, success is still limited. Possibly as a consequence, the past few years have seen a reorientation of the function and purpose of the child welfare clinic, which today, broadly seeks to provide a diagnostic service for the early detection of mental and physical handicap and endeavours to develop a child's ability to the full. Furthermore, with the increasing use made of hospitals for confinements coupled with early discharge schemes, local authority Maternity Services are being inexorably pressured into a 'supportive' role and the domiciliary midwife constrained to become a socio-nursing health educator of the expectant and parturient mother. 90 However, repercussions from the implementation of the National Health Service and the upheavals inherent in the recent reorganisation of local government are still being felt. One of the more important effects of recent developments which is having a decided impact on the health services in general is the loss each year to overseas countries of doctors equivalent to between 30 % and 50 % of the total of newly qualified practitioners. Inevitably, during this period of seemingly endless change, pressure on the country's medical resources has been mounting and there is a growing clamour for more and more integration and rationalisation. Greater efforts are now being made to establish purpose-built family health centres and, with the reorganisation of general practice now being undertaken and with the 'attachment' of health visitors and other local health authority professional workers being so strongly advocated, realignment of the personal health services as we know them today is presaged. Likewise the introduction of a comprehensive family doctor service will undoubtedly have its effect upon local authority services. In particular, the increasing role already played by the general practitioner in the local authority's personal health services leads one to the conclusion that, over the next few years, there will be a progressive reduction in the number of council medical officers engaged in child welfare clinical work. Moreover, to conserve experienced medical administrators, to save administrative time and to contain the galloping costs of services and premises, amalgamation of the child welfare and school medical services seems a logical development. In this present state of transition, of reorganisation and reshaping of old systems and ideas, it must not be forgotten for whom these personal health services were devised. It would indeed be tragic if, during these revolutionary processes, the basic purposes were ignored. General Despite staff shortages the maternity and child welfare work has continued satisfactorily but expansion has been necessarily limited. During the year a considerable amount of health education has been provided in mothercraft and parentcraft groups, in talks given to various clubs and groups run by voluntary organisations and in a number of sessions held in schools. • 91 Psychoprophylaxis classes are being used increasingly by expectant mothers and several local maternity hospitals are now referring mothers to our sessions. Cytology clinics continue to operate throughout the Borough and sessions have been held in factories and offices for the benefit of factory, shop and clerical workers. Many women have availed themselves of this service but numbers still choose to ignore it. However, in many ways the work could and should progress and increase but until there is considerable improvement in the staff situation, the implementation of changes must be deferred. 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 in the table below indicate the use made by residents of these clinics. Total attendances for the current year show some reduction from those of 1965 which are given in brackets :- No. of Women in Attendance: Ante Natal 1,313 Post Natal 508 -1,821 Total No. of Attendances made 7,052 (7,645) No. of Sessions held by: Medical Officers 68 Midwives G.P.s on Sessional Basis 244 Hospital Medical Staff 281 - 593 General Practitioner Obstetricians - No. of Sessions held 647 No. of Attendances: Ante Natal , 9,566 Post Natal 792 - 10,358 (11,716) 92 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 1966. Live Births by Age and Parity of Mother and by Place of Occurrence Parity of Mother Place of Deliv'y 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) 1,123 212 515 281 86 23 6 — (b) 119 33 64 19 3 — — — (c) 36 10 19 6 1 — — — (d) 4 2 — 1 — 1 — — 1 (a) 581 31 214 184 100 43 8 1 (b) 86 2 38 33 9 4 — — (c) 325 10 132 119 52 12 — — (d) 8 1 4 2 — — 1 — 2 (a) 288 4 51 91 72 51 18 1 (b) 33 2 10 10 10 1 — — (c) 275 4 61 109 70 24 7 — (d) 3 1 1 1 — — — — 3 (a) 141 20 44 42 26 9 (b) 12 — 1 6 1 2 1 I (c) 99 — 12 41 27 15 4 — (d) 1 — — 1 — — — — 4 (a) (b) 104 9 29 35 23 7 1 8 — — 3 3 1 1 — (c) 33 2 9 13 7 2 — (d) — — — — — — — 5—9 (a) 101 3 11 35 31 19 2 (b) 11 — 1 2 7 1 — — (c) 13 — — 5 1 5 1 1 (d) — — — — — — — — 10—14 (a) 3 — — — — 2 1 — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 15 & over (a) — — — — — — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — lllegit. (a) 241 93 86 35 14 9 3 1 (b) 23 7 6 7 2 1 — (c) 54 5 14 14 13 7 1 — (d) 13 4 7 1 1 — — — TOTAL (a) 2,582 340 898 675 384 208 71 6 (b) 292 44 120 80 35 9 3 1 (c) 835 29 240 303 177 70 15 1 (d) 29 8 12 6 1 1 1 (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. 93 Stillbirths by Age and Parity of Mother and by Place of Occurrence Parity of Mother Place of Deliv'y ALL AGES AGE OF MOTHER Under 20 yr». 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) 23 2 12 5 1 2 1 — (b) 1 — — 1 — — — — (c) - — — — — — — — (d) — — — — — — — 1 (a) 8 - 2 4 2 - - - (b) 3 — 1 1 - 1 — - (c) 2 — — 2 — — — — (d) — — — — — — — — 2 (a) 6 - 1 3 - 1 1 (b) — — — — — — — — (c) 1 -_ 1 (d) — — — — — — — — 3 (a) 2 — 1 - 1 - - (b) — — — — — — — — (c) — — — — — — — (d) — — — — -- — — — 4 (a) 3 — - 2 - 1 (b) — — — — — — — (c) — — — — — — — _ (d) — — — — — — — — 5—9 (a) 2 - - - 2 (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 10—14 (a) 1 - - - 1 (b) - - - - (c) — — — - - - (d) — — — — — — — — 15 and over (a) - - - - (b) — — — — — — — — (c) (d) — — — — — — — Illegit. (a) 6 — 2 1 2 1 (b) 1 — — — 1 — — — (c) — — — — — — — — (d) — — — — — — — — TOTAL (a) 51 2 18 15 6 5 5 (b) 5 1 2 1 1 (c) 3 — 1 2 — (d) — — — — — — — — (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home (d) Other. Preparation for Childbirth A further four health visitors were trained to teach the psychoprophylaxis method of preparation for childbirth and, classes in this and other methods of relaxation were continued during the current year following each of which a talk and discussion were held, together with appropriate demonstrations. Some 236 such sessions were held during 1966 with 3,302 attendances. A total of 94 3,869 attendances were attracted to the 434 Mothercraft sessions at which talks were given by health visitors to advise and instruct mothers in infant care. Several centres persevered with their Parentcraft classes to which fathers were invited and, at the 51 sessions held, there were attendances of 1,075. Midwifery Throughout 1966, our mutually helpful liaison with hospitals was again actively pursued and, despite a shortage of personnel, it was still made possible for health visitors to attend each week at one of the antenatal Consultant Clinics at St. Alfege's Hospital. Regular monthly meetings, which are very well attended by health visitors, midwives, local authority doctors and by hospital medical and nursing staff, continue to be held at the British Hospital where interesting obstetric cases are discussed and explained by the hospital's own medical staff. Every fourth month organisation of the meeting is undertaken by local authority staff who are able to talk about the Health Services in general and their own work in particular. It has been found that the hospital staff are particularly appreciative of accounts of the work of all sections of the Health and Welfare department, much of which has previously been unknown to them. Clinic services were maintained for 32 general practitioner obstetricians to examine their domiciliary cases with midwives in attendance. Appointment systems were in operation and every mother who booked at a clinic had a full physical examination and blood investigation. Facilities are provided by the Devonport Laboratory at Dreadnought Seamen's Hospital for the blood specimens to be examined. Postnatal examinations were offered to all mothers six weeks after delivery but the response remains very disappointing. Some mothers did attend their own doctor's surgery for the examination but only 508 were recorded as having attended local authority postnatal clinics during 1966. Practising Midwives Notifications of intention to practise as midwife in the London Borough of Greenwich during 1966 were received from 140 persons in accordance with the Midwives Act, 1951. Of these, 115 were in respect of hospital midwives and the remainder, viz. 25, were from those engaged in the Council's service and included the supervisory staff. Domiciliary Services The Borough is divided into 13 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 95 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 to a total of 874. Domiciliary Confinements Attended and Hospital Deliveries Nursed at Home Doctor Present Doctor Not Present Doctor Not Booked - 9 Doctor Booked 92 773 Totals 92 782 No. of Hospital Deliveries attended by Midwives on discharge before 10th Day. 323 NOTE: Because of complications, 134 cases booked for home confinements, were admitted to hospital in the ante-natal period or during labour. Deliveries for the year averaged 67 for each midwife, but as 134 cases booked for home confinement were admitted to hospital either in the ante-natal period or during labour because of complications, the figure of 67 does not give a true picture of work accomplished and visits made. Many mothers admitted during labour are discharged home early to the care of the midwife and during 1966 some 323 mothers were so discharged. 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 during 1966 Age Total confine ments Parity 0 1 2 3 4 5 and over Not known Under 20 No. % 34 13 18 3 39 1.5 2.1 0.3 — — — — 20-29 No. % 588 18 253 191 103 14 9 67.3 2.1 28.9 21.8 11.8 1.6 1.0 — 30-39 No. % 229 1 59 90 38 28 11 2 26.2 0.1 6.7 10.3 4. 4 3.2 1.3 0.2 40 and over No. % 14 1 6 5 1 1 1.6 — 0.1 0.7 0.6 0.1 0.1 — Not known No. % 9 3 4 1 1 10 — 0.3 0.5 0.1 — 0.1 — Total No. % 874 32 334 294 147 43 22 2 100.0 3.7 38.2 33.6 16.9 4.9 2.5 0.2 96 Subsequent to postnatal examination all mothers were invited to attend for a cervical cytology test. In future, it is intended that such facilities shall be made available at the postnatal clinics in order to avoid the necessity for two separate visits. Early Discharges—Again planned early discharges took place from various 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 323 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 called upon 25 times during 1966. 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 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 5.7 — — 2 5.7 31b 5oz to 41b 6oz 4 11.4 — — 3 8.6 41b 7oz to 41b 15oz 4 11.4 — — 4 11.4 51b to 51b 8oz 25 71.5 1 2.9 24 68.6 All cases 35 100 1 2.9 33 94.3 97 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 necessary to transfer ten babies to the care of these units. Twenty-five babies born prematurely in the district were able to be nursed at home. Conditions for which Midwives summoned Medical Aid during 1966 During pregnancy— During labour- Threatened miscarriage 4 Premature labour 9 Toxaemia 16 Malpresentation 9 Anaemia (Hb under 10 mgms.) 10 Allergic to Pethidine 1 Ante partum haemorrhage 17 Foetal distress 7 Post-maturity 3 Delayed labour(2nd stage) 9 Rash on face and body 1 Retained placenta 11 Epigastric pain 1 Post-partum haemorrhage Secondary hemorrhage 1 Ruptured Perineum 58 During puerperium For mother— For infant— Hypertension 3 Still born 3 Phlebitis 2 Asphyxia—Blue 4 Puerperal psychosis 1 „ —White 2 Engorged breast 1 Premature 35 Puerperal pyrexia 3 Rash 2 Sub-normal temperature 2 Haemorrhage from cord 1 Imperforate anus 1 Convulsions 1 Jaundiced 3 Blood in stools 3 Raised temperature 4 Colds and coughing 3 Thrush 1 Vomiting, loss of weight 2 Sticky eyes7 In only three cases were claims for fees received from medical practitioners called in by midwives in an emergency (Midwives Act, 1951, Section 14). Maternity Outfits—In all cases of confinements, other than in hospital, maternity outfits are made available and during the current year some 900 packs were distributed. Midwifery Training—Part II— 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 31/12/66 6 98 Refresher Courses—In accordance with the rules of the Central Midwives Board, two midwives attended Statutory Refresher Courses during the year, each of one week's duration. In addition, midwives were released for courses as under:— 11 for 1 day courses 6 for ½ day courses 1 for 1 week (International Congress of Midwives—Berlin) Observation Visits—During the year, 16 Student Nurses taking an obstetric course were given the opportunity to observe the working of the department's midwifery service. Cervical Cytology With the co-operation of Dr. Thomas, Consultant Pathologist at Greenwich District Hospital, the five clinics established for cervical cytology and staffed by general practitioner obstetricians and nurses from the department were continued at various centres during the year. At these clinics, "well women' over the age of 25 years and postnatal mothers had cervical smears taken and examined for the detection of pre-malignant changes. Unfortunately, despite the publicity given to this service, the impetus of attendance evident during the early months of 1966 was not maintained throughout the rest of the year. Further letters were sent to managers of local factories and stores inviting them to enable their eligible employees to participate in the scheme. In some cases where medical facilities were available at the business premises, the 'cytology team' of doctor and nurse with the necessary equipment carried out sessions at the places of employment. Dr. Thomas was able to accept 100 (and later 120) specimens weekly for examination and by the end of the year, 65 women were undergoing examination each week. Statistics are still too meagre for full comparisons to be made but there were 8 deaths in the Borough from carcinoma of the cervix uteri during 1966 giving a rate of 0.03 per 1,000 of the population which compares very favourably with that for England and Wales generally, viz. 0.10. Of the 3,387 specimens examined by 31st December, 1966, 15 were found to require further investigation and 52 women were referred for treatment of various gynaecological conditions followed by re-examination of a cervical smear. The following statistics indicate the volume and type of work undertaken at the various clinics during the year:— Clinics No. of Attendances Rustall Lodge 897 Shooters Hill Road 786 Burney Street 366 Plumstead High Street 420 99 Market Street 682 Local Firms 236 Total @ 31/12/66 3,387 Age Groups No. of Attendances Under 25 years 94 25—35 years 955 35—45 years 1,361 45—55 years 772 over 55 years 205 Total 3,387 Parity No. with no Children 381 No. with 1 Child 718 No. with 2 Children 1,324 No. with 3 Children 602 No. with 4 Children 232 No. with over 4 children 130 Total 3,387 Family Planning It is generally accepted that perinatal and maternal mortality rise after the third child and experience has shown that children of spaced and limited families tend to be healthier. Moreover, the qualities of tranquil love and calm affection which, in the normal home, enable the very young to develop stable personalities, are threatened by the advent of the unexpected and unplanned pregnancy. A law recently enacted in Denmark makes it obligatory for a woman who has just had a baby to be offered contraceptive advice by her doctor. Family planning affords relief from the economic consequences of a family too large for parents effectively to handle and amelioration of the tensions, ill-temper, neuroses and mental disability born of fatigue, frustration, anxiety and depression all too frequently met with in the prolific household. Furthermore, recourse to the 'backstreet' abortionist as a solution is rendered less inviting. Other practical advantages accruing from the adoption of family planning are, less 'problem' families and a corresponding reduction in demands made on the local health and welfare services. Regular family planning clinics held at six welfare centres in the Borough and staffed by members of the Family Planning Association, offer advice not only on contraception but on other marital 100 problems including infertility and sub-fertility, etc. In appropriate cases, facilities are also provided for the taking of cervical smears for examination. The new clinic, opened in January at Abbey Wood, although well supported, has not yet fulfilled expectations. I am indebted to Harold Pring, Organising Secretary of the South East London Branch of the Family Planning Association for the following account of his association's activities in this Borough during 1966. In addition to the report, the Secretary, on behalf of his Branch, has expressed appreciation of the Council's generous support and the ready co-operation of its officers in his organisation's work. "During 1966 the Family Planning Association has been reorganised nationally with 51 geographical Branches. The South East London Branch (No. 7) includes the London Borough of Greenwich and thus what was originally the Greenwich Branch is now part of the No. 7 Branch. The day-to-day management of the family planning clinics is entrusted to local clinic committees. Additional premises were made available to the Association at the Abbey Wood Welfare Centre and a family planning clinic was opened there on 7th January, 1966. Following the issue of the Ministry of Health Circular No. 5/66 on 17th February, 1966, further meetings were held between the Medical Officer of Health and officers of the S.E. London Branch of the Family Planning Association and a mutually acceptable formula was established whereby help and advice would be readily available for all women to whom further pregnancy would be detrimental to health. The local authority agreed to continue to meet the cost of treatment to such patients referred to family planning clinics by its own medical officers during 1966 and 19 were aided in this way. For the following year the local authority agreed to make a block grant to the Association who, for their part, agreed to treat all such patients referred to them by any medical practitioners, whether or not the grant covered the cost of such treatment. It is believed that by such simplified administration many more women will avail themselves of the facilities and without doubt it will be appreciated by the general medical practitioners. The clinic established at the Homeless Families Unit at 158a Plumstead High Street has continued to give useful service. As the number of families therein has been reduced the facilities have been increasingly offered to those previously resident there and to those who, because of their circumstances, were at risk of becoming homeless. No charges are made to the patients living there or to those referred on social grounds by health visitors or other social workers. 101 The following table lists the various Welfare Centres at which family planning sessions are held (no charge being made to the Association for the use of the premises) and also summarises the work effected during 1966":— Centre Total Attendances L/A or Hospital referrals Cytology Smears Premarital advice Abbey Wood 362 10 67 26 Charlton Lane 1,776 59 366 21 Garland Road 850 61 88 3 Lionel Road 2,076 32 252 75 Creek Road 745 30 117 13 158a Plumstead High St. 315 19† 12 — *Lewisham Hospital 574 20 248 — † All the patients are regarded as "referred" whether on medical or social grounds. * This is a clinic for the fitting of intra uterine devices. Although it is a subsidiary of the Greenwich Clinic Committee, patients are drawn from beyond the area of Greenwich. It is anticipated that the long-awaited National Health Service (Family Planning) Act, now before Parliament, will already have received the royal assent and be operative by the end of 1967. The Minister of Health has re-emphasized that an adequate family planning service is an essential part of family welfare which, in many instances, will help to relieve the burden on other services occasioned by physical ill-health and mental distress arising from lack of knowledge and advice. Existing powers of local health authorities enabling them to provide (or arrange for other bodies to provide) advice on contraception, etc., are extended by the Act which now permits the advice and supplies, previously only available to medical cases, to be offered to persons on social grounds. The Act empowers the local health authority, if it so desires, to recover such charges for advice, prescriptions, substances or appliances as it considers reasonable, having regard to the means of the recipient. Congenital Malformations Congenital malformations probably constitute today's greatest challenge to paediatrics and most advanced countries are seeking to discover the aetiologies, the first step to which is the recording of the various conditions. Two serious methodological difficulties face the research worker or statistician. Firstly, clear definitions of malformations and defects which are to be the subjects of registration and with which doctors, nurses and midwives must be fully conversant and, secondly, duration of observation, for prolonged observation will 102 inevitably result in the discovery of further registrable conditions. Congenital malformations are notified to the department and summaries are forwarded to the Ministry of Health in accordance with the scheme introduced on 1st January, 1964. Obviously the success of the scheme is dependent upon the support given by the doctors, hospital staffs and midwives and also upon the accuracy with which they solve the difficulties of diagnosis of malformations presenting proximal to parturition. Because only those malformations detected at birth are reported under the scheme, constant vigilance must be maintained in subsequent examinations in order that those congenital conditions which produce signs and symptoms only after the early weeks of life are duly recorded. The following tables give information regarding malformations notified to the department during 1966 compared with those returned for England and Wales in 1965. Congenital Malformations Numbers Notified According to Site Site No. Notified Rates per 1,000 Total Notified Births Greenwich 1966 England & Wales 1965 ALL SITES 100 26.57 18.91 Central Nervous System 18 4.78 4.66 Eye, ear 2 0.53 0.53 Alimentary system 17 4.52 1 .99 Heart and great vessels 1 0.27 0.80 Respiratory system _ — 0.22 Uro-genital system 14 3.72 1.34 Limbs 30 7.97 6.50 Other skeletal 7 1. 86 0.41 Other systems 7 1 .86 1 .33 Other malformations 4 1.06 1. 13 NOTE:—This table indicates the number of malformations NOT the number of children. Congenital malformations notified during 1966. Babies with Live GREENWICH % E & W 1965 Still Total % 8 66 82.5 86.3 One malformation 58 Two malformations 7 3 10 12.5 10.3 Three malformations 1 2 3 3.75 2.4 Four malformations — — — — 0.6 Five or more malformations - - - - - 1 — 1 1.25 0.5 Total babies 67 13 80 100.0 100.0 103 Compared with the previous year, more notifications were received during 1966 relating to malformations of the alimentary and urogenital systems while there were fewer central nervous system defects. The number of other malformations indicated no considerable variation on the 1965 figures, Anencephaly—Of all the malformations recorded, most research has been carried out in respect of anencephaly perhaps because this is a condition which is easily and reliably identified. Statistics with regard to this defect, therefore, tend to reflect the true position. In Greenwich, the rate per 1,000 total notified births was 1.59 compared with a figure of 1.66 for England and Wales and 1.09 for the South East Region. Mongolism—This is another reasonably easily identified defect with a local rate of 1.06. Rates for England and Wales and the South East Region are 0.67 and 0.61 respectively. 'At Risk' Register Certain familiar or acquired factors in pre-natal, perinatal or post-natal life are now established as giving rise to greater than average risks of a baby having or developing mental or physical abnormalities. The earlier such abnormalities are detected, the sooner may treatment or remedial action be initiated, usually with a greater degree of success than if diagnosis is delayed. In order to ensure such early detection, all notifications of discharge of a mother from a maternity unit or the care of a midwife are perused to select those whose infants are liable to develop such a handicap. These infants are reviewed regularly on the 'At Risk' register with the gleaning of information from various sources. After a variable period the name of a child who is found to be developing normally is removed from the register and that of a child who is found to have an abnormality is transferred to the Handicapped Register. During 1966, as in 1965, approximately one third of the children born to residents in the Borough were "at risk", although happily the majority developed normally. At the end of 1966 there were 1,486 children listed in the register compared with 933 at 31st December, 1965. The 'At Risk' register cannot, of course, guarantee to find every case of hidden handicap, but it does encourage careful observation in all those who are working with infants. It is also important that parents should not be made unduly anxious when their baby is on the register and that risks are not exaggerated, particularly in the occasional case where a baby is to be placed for adoption. 104 Handicapped Register At 31st December, 1966 there were 372 children under the age of five years listed in this register. Some idea of their difficulties can be seen from the following table:— Physically handicapped 277 Mentally handicapped 109 Spina Bifida 16 Limb deformities 5 Sight defects 12 Hearing defects 16 Dual handicaps 53 Since several children have more than one defect, the total number of handicaps is greater than the number of registered children. This register is subject to regular review by a Medical Officer and an Assistant Nursing Officer to ensure that a child and its family are receiving all necessary support and guidance in their daily problems and that plans may be made for future educational and recreational needs. In the case of children who are so severely handicapped that they will obviously require community services after school leaving age, the appropriate welfare/mental health workers are introduced to the family, although day to day support is given by health visitors during infancy and by social workers (Personal Health Services) during school days. On school entry, all records of handicapped children are available to School Medical Officers. Some handicapped children cannot receive the necessary care at home and in such cases residential care is arranged making sure that the child is kept in touch with his family. Great importance is attached to the consideration of these families as complete units containing a handicapped member rather than as a group which has an isolated "patient" attached to it. The Council's arrangements for the co-ordination of services for the handicapped, a report on which was requested by the Ministry of Health and the Department of Education and Science in their respective Circulars 7/66 and 9/66, are to be found on pages 149 to 154 in the Section dealing with the Welfare Services. Deaf Register (Including Partially Hearing) The comprehensive register containing the names of all children known to be deaf or with partial hearing was maintained by the department throughout the year. At the end of 1966, the register contained the names of 192 deaf or partially hearing children, 179 of whom were of school age, the majority having been diagnosed following the "sweep" hearing test which all children undergo on entering school. 105 Some of the children under five years of age had lost their hearing through illness during infancy but the majority were suffering from deafness of congenital origin. It is the children with acquired deafness who continue to present the greatest difficulty because this department must rely upon notification from hospitals when patients are discharged. Information is usually received from local hospitals about such children but, from those outside the Borough it is less complete although the health visitors may be able to rectify omissions if the patient is under five years of age or if there is a pre-school child in the same family. Children on the register who are under five years of age are assessed to determine whether special schooling will be required. A final decision is made only after discussion between parents, social and other workers and particularly the otologist. It can be seen from the following table that only 48 children attended special schools due to their disability. Fortunately the majority were able to attend ordinary schools, some requiring special assistance but others need only regular supervision to ensure that (1) they are attending hospital or clinic as required, (2) they are wearing their prescribed hearing aids and (3) they are sitting in the recommended places in the classroom and that school progress is satisfactory. Deaf Register—31st December, 1966 Under Over 5 yrs. 5 yrs. Total No. of Children on register 13 179 192 No. of Children with hearing aids 12 53 65 No. of Children attending Deaf Schools or Partially Hearing Units 2 29 31 No. of Children attending other Special Schools 1 16 17 Depending on the degree of deafness, the Welfare Section is informed about certain of the children on the Deaf Register when they leave school. Social workers make themselves known to these young people and their families so that any needs arising from their handicap may be met. The vast majority of deaf and partially hearing school-leavers compete for jobs on the open market and obtain and keep their employment without difficulty. Home Nursing Success attending the unification of the previous three nursing organisations is reflected in the statistics for the current year. In contrast to the trend noted in recent years, new cases increased by 875 to a total of 3,505 and visits by 44,825 to 171,181. Closer identification of the nursing service with other branches of the department 106 has brought benefits not only to the nursing staff but also to their patients and, in particular, links with general practitioners, hospitals, chest clinics, geriatric visitors, etc., have been substantially strengthened. Each of the 40 districts into which the Borough is divided for nursing purposes carries an average case load of 30 and the District Nursing Sister maintains a monthly mean of 360 visits. There has been little change in the kind of services demanded although the actual number of patients visited rose by approximately 53% to 4,022, the increase being mainly in the 'over 65 years' group. This group, which comprised 63.1% of the total of all patients visited during 1966, was responsible for more than 80% of all visits made by the nursing staff. Cases of terminal carcinoma often necessitated up to four visits daily and many had the benefit of the Madame Curie Night Nursing Service. An analysis of the 3,505 new cases who received attention during the year is given hereunder:— Sources from which New Cases were Referred General Practitioners 2,280 Hospitals 883 Clinics (Chest, Ante Natal and Diabetic) 100 Geriatric Visitors 77 District Nursing Service 165 3,505 Classification of New Cases No. Cases % Medical 2,919 83.3 Surgical 389 11.1 Maternal Complications 149 4.2 Early Maternity Discharges 15 0.4 Tuberculosis 27 0.8 Mental Ill-health 6 0.2 Total 3,505 100.0 Patients and Visits Total number of Patients 4,022 Total number of Visits 174,181 Average number of Visits to each Patient 43 I Long Term Cases Patients Nursed for 3 months or more 415 (equivalent to 10% of all cases nursed) 107 Type of Treatment and where effected Treatment At Patients' Homes Elsewhere (e.g. Nurses' Homes) Total % Injections only 42,697 493 43,190 25 Injections plus other Treatment 8,612 29 8,641 5 Other Treatment only 122,214 136 122,350 70 TOTALS 173,523 658 174,181 100 Age Distribution of Patients Age Group No. of Patients % 0 to 4 years 46 1.1 5 to 64 years 1,440 35.8 65 years and over 2,536 63.1 Total 4,022 100.0 District Nurses—Full time equivalent (including 2 Reliefs and 7 Students) 54 Marie Curie Day and Night Nursing Service—Duties undertaken in the Borough by this organisation involved 334 night's nursing of 15 cases and a further 21 patients were assisted by the provision of extra nourishment, clothing, fuel, etc. Training—During 1966, 12 State Registered Nurses successfully undertook the District Nursing Certificate and at the end of the year 8 S.R.N.s were still in training. Refresher Courses—Arrangements for 6 District Nursing Sisters to attend refresher courses of one week, organised by the Queen's Institute of District Nursing had to be abandoned owing to staff shortages. Nevertheless, 2 nurses were enabled to attend refresher courses of ½ day's duration per week for 4 weeks and a further 5 for courses of 1 day. Integrated Students—Two students from Hammersmith Hospital worked for 6 weeks under the supervision of a District Nursing Sister. Eight 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. 108 Observation Visits—Facilities for the purposes of observation were afforded by the department to the following:— 2 Ward Sisters 1 Health Visitor Student 36 Female Hospital Students 12 Male Hospital Students District Nursing—An Appraisal—Improved child health has led to a fall in the proportion of paediatric cases but the operation of the Mental Health Act of 1959, which has resulted in a reorientation of treatment of the mentally ill from hospital to community care, will undoubtedly increase demands on the district nursing service as will the general tendency towards an ageing population. Until a better understanding is developed between district nursing and its allied services, the full potentiality of home nursing cannot be realised and the public, in general, benefit from its use. Good home nursing staff has not been easy to recruit, those resigning, almost always for domestic reasons, have persistently outweighed those commencing. Our staff of district nurses has, therefore, remained below establishment although there are signs that the position is improving. Attachment of nurses to group practices, their employment in groups under a senior district sister, greater use of S.E.Ns., auxiliary nurses and bath attendants, are all subjects being investigated with a view to improving the standards of service. With the introduction of disposable equipment and presterilized dressing packs a more efficient service has been made available to the patient. However, 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 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 Help Service During 1966, as in the preceding year, the aged infirm section of the population were the predominant users of the Home Help Service. The number of those over 65 years receiving help almost trebled during the year and it is without doubt the devoted service of both the District Nurses and the Home Helps which enables many elderly folk to continue living in their own homes for as long as possible. Without such a service, the increase in pressure on the Council's Part III accommodation would be considerable. Unlike previous years, there was no undue difficulty in recruitment of suitable persons for this work, apart from a few months at 109 the end of the year when Home Helps were scarce in one area of the borough. At the end of the year there was the equivalent of 295 full time Home Helps employed and an analysis of the services rendered during 1966 is given below:— Type of Case No. Aged 65 years or over on 1st Visit in 1966 2,928 Aged under 65 years on 1st Visit in 1966 Chronic Sick and Tuberculous 282 Mentally Disordered 23 Maternity 207 Others 254 766 Total Cases 3,694 Family Aids—A pilot scheme was commenced during the year whereby home helps, designated 'family aids' were attached to family caseworkers employed to give intensive help to families who, for various reasons, were unable to benefit from the normal supportive social services. This innovation has been very successful and warrants further extension. Home Help Course—A one week's course of talks, films, discussions and demonstrations was arranged for 15 home helps during May, 1966. This was very much appreciated by home helps and further courses are planned. Child Help Courses—The first course for child helps was held in April, 1966, when eleven selected home helps spent a week at the Health and Welfare Department and attended a course of lectures, films and discussions. A second group of eleven attended a similar course in October. Of these 22 trained child helps, seventeen were still working in the Borough in December, 1966. It is planned that they should have a one day refresher course early in 1967. Besides gaining knowledge these women have come to feel themselves part of the Borough and part of a very important service. They have benefited greatly from meeting and talking to senior members of staff, who call on them for help. The venture as a whole has proved very well worthwhile. Altogether 48 families have been helped and the number of children involved was 171. It seems fair to say that the break-up of these families, with children being received into care, has been prevented. 110 Health Visiting The shortage of health visitors continued unabated during the current year and 9 health visitors resigned and one retired. Resignations were due to a variety of causes, marriage, pregnancy, removal from the area or simply a desire for change; one centre superintendent was appointed to an assistant nursing officer post in another London borough. Only one health visitor was recruited during the year, but in August our four sponsored health visitor students successfully finished their training and became health visitors for the borough. Despite these additions the health visitor staffing situation remains critical. We have continued to recruit good clinic nurses and have been able to promote a number of them to school nursing sister posts. There is a considerable turnover of staff in the clinic and school sister grades, but recruitment is satisfactory. Services were continued on similar lines to those of previous years and the following table summarises the visiting carried out during 1966:— No. of Cases Visited by Health Visitors Children born in 1966 4,165 Children born in 1965 5,054 Children bom in 1961/64 7,616 16,835 Persons aged 65 years and over 97 Persons aged 65 years and over (visited at special request of G.P. or Hospital) 38 Mentally Disordered Persons 68 Mentally Disordered Persons (visited at special request of G.P. or Hospital) 13 Persons Discharged from Hospitals other than Mental (excl. maternity cases) 67 Persons Discharged from Hospitals other than Mental (excl. maternity cases) (visited at special request of G.P. or Hospital) 61 Tuberculous Households Visited 40 Households Visited re Other Infectious Diseases 276 Total Effective Visits and Re-visits 45,933 Unsuccessful Visit 10,166 Health Visitors—full time equivalent 23.1 T.B. Visitors & T.B. Health Visitors—Full time equivalent 6.0 Co-operation with Hospital Departments—During 1966, as in 1965, the shortage of Medical Social Workers in hospitals caused more Consultants to call upon the services of Social Workers from the Health and Welfare Department. 111 This liaison is welcomed by the Department and visits to inpatients were particularly useful in enabling environmental problems to be alleviated before discharge from hospital. Health Visitors continued to attend 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. Such attendances acted as links between the hospital staff and community care workers and enabled the patient to be considered as a sick member of a family rather than as an isolated individual with symptoms and problems. Problem Family Index—There are certain families who need more than the usual amount of support in order to withstand the stresses of life. They are often families with many children, perhaps several under 5 years of age. Such families are indexed on a Problem Families file and are visited frequently by Health Visitors who ensure that they are advised on the best way to feed and clothe the family and provide furniture without undertaking unrealistic hire purchase commitments. Sometimes material assistance is also provided. Other specialist help is called in when necessary and co-operation between members of the Health and Welfare, Children's and Housing Departments enables some of the families to be rehabilitated and achieve normal standards of life. October of the current year saw the establishment of a special unit at 32, Charlton Road, S.E.3, for the training and rehabilitation of 'problem' families. Here, social workers provide intensive help in an endeavour to overcome the various difficulties leading to a family's existing situation. Although it is a little too early fully to assess the value of this unit there are already signs that it will prove a useful addition to the department's community care services. At the end of 1966 there were 166 families in the index including 542 children which compares with figures of 143 and 590 respectively for the previous year. The index is checked completely every year and all families are constantly under review. Surveys— Information regarding those children and 'controls' who were subjects of the Medical Research Council's scheme with regard to measles vaccination is still being submitted to that organisation. In addition, the survey into child deaths from cancer being undertaken by the Department of Social Medicine at Oxford University continues to demand from health visitors, careful and delicate preparation of parents for the subsequent visiting of a Medical Officer to obtain comprehensive histories of the various cases. 112 At the close of the year, a survey into children with spina bifida was launched with a view to ascertaining:— (1) All known cases of this congenital malformation living at 30th September, 1966, with information regarding site of lesion, associated malformations and handicaps, operation treatment, extent of locomotion and continence, living conditions and education. (2) The number of cases during the 12 months ended 30th September, 1967, with additional details of birth weight, birth order, mother's age and obstetric history, cause of death, etc. Formerly, the mortality rate in spina bifida cases was high but, today, modern surgical treatment is saving many such children. This survey is linked with future planning for the needs of such children who are left with varying degrees of disability. Health Visitor 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 and conditions of entry to training courses and examinations. Field Work Instructor Courses—Because of the heavy commitments of Health Visitor Training it was necessary to train five more Instructors. Two Health Visitors attended full-time courses instead of the usual Health Visitor Refresher Course and three attended a Day Release Course arranged by the London Borough's Training Committee. This meant that, at the end of 1966, the Borough had seven trained Field Work Instructors. Psychoprophylaxis Course—Members of the health visiting staff attended a weekend course arranged by the National Childbirth Trust enabling them to teach psychoprophylaxis to expectant mothers. Student Health Visitors—During 1966 the Borough has been responsible for the practical work training of students taking the Integrated Course of Nurse, Health Visitor Training at Kings College Hospital and Royal College of Nursing. These students have their first contact with the Borough at the beginning of their training and continue to visit their Field Work Instructors from time to time. During their second year they spend six weeks with the District Nurses and during their third year they make scheduled visits to establishments in the Borough. After taking their State Examination to become a Registered Nurse they return to the Royal College of 113 Nursing to complete their Health Visitors Training. During this period they work more closely and for longer periods with their Field Work Instructors. This continued training places a heavy burden on the Field Work Instructors and during 1966 there were 27 students taking practical training in the Borough. Of the seven students who took their Health Visitors Examination in 1966, five were successful. The London Borough of Greenwich sponsored six student health visitors for 1965-1966. Two students withdrew early in the course and the remaining four completed their training and were successful in the Health Visitors Examination, starting work in the Borough in July, 1966. Four student Health Visitors are being sponsored by the Borough for the year 1966-1967. Starting their training in October, two are at The University of Surrey, one at South-East Essex College of Technology and one at North-West Polytechnical College. "In-Service" Training—In 1966, 4 newly appointed school nurses attended a four-day course sponsored by the London Boroughs Training Committee and 8 Clinic nurses attended a one-day Induction course organised by the Chief Nursing Officer. Refresher Courses—Three Health Visitors attended refresher courses arranged by the Royal College of Nursing or The Health Visitors' Association. Student Nurses—The Borough continued to provide facilities for student and pupil nurses as required by the General Nursing Council. Throughout the year 751 student nurses and 56 pupil nurses each spent half a day in the Borough. The Chief Nursing Officer and her staff gave 41 lectures to student nurses training in hospitals in the Area. Observation and Other Visits—The Chief Nursing Officer arranged programmes of visits for various interested people during the year including a Chief Public Health Nursing Officer from Denmark and a District Midwife from Germany. 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. Mothercraft classes have continued to be given at the larger schools in the area including three comprehensive schools. 114 Informal talks on personal hygiene, good grooming and other similar subjects were given in most of the schools during regular hygiene surveys. Posters and leaflets have been displayed in the Treatment Centres and in the schools where there are Medical rooms. 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 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 1966 relating to Child Welfare Clinics are given in the following table:— Attendances No. of Children born in 1966 3,581 No. of Children born in 1965 3,478 No. of Children born 1961/64 4,535 11,594 Sessions held by:— Medical Officers 315 Health Visitors 209 G.P.s on Sessional basis 1,972 Hospital Medical Staff — 2,496 No. of Children Referred elsewhere 361 No. of Children on 'At Risk' Register 31.12.66 1,486 Day Nursery Admissions—During 1966, further difficulties were encountered due to the absence of a Day Nursery in Greenwich. The allocated ten places in a Lewisham Nursery were continually over-subscribed and these could only be allocated to unsupported mothers and lone parents. Local Play Groups and Nursery Schools assisted as much as possible by accepting an occasional medically or socially handicapped child who urgently needed such care. However, these establishments had their own staffing difficulties and could not offer as many places as they would wish. 115 Co-operation between a local Vicar and the management of a nearby factory (with generous financial support from the latter organization) enabled a private Day Nursery/Play Group to be opened in a Church Hall. This has proved to be a most successful venture; it is hoped that arrangements can be made for a small number of children who urgently need to attend a Nursery for medical or social reasons to be sponsored by the Council for acceptance by this Group. Council Places in Day Nursery Unsupported Mothers In Waiting 6 3 Lone parent 4 4 Deaf children 1 — Occasional Creche Service Each week a creche is held at two Welfare Centres at which children under five years of age are cared for while their mothers undertake various duties such as visits to hospital or attend activities in the same Centre. One of these creches is consistently well attended but, so far, the use of the other session has proved disappointing. A nominal charge is made for the use of these facilities which is abated when necessary. No charge is made to any mother who is using the service to enable her to attend hospital. 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 pregressively 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 records are of considerable value to the Medical Officer when his observations are sought by the various agencies concerned with adoption. 116 Foster Parents—In accordance with the Boarding Out 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 by the Children's Officer in the course of his duties. 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 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 during the antenatal period. Following confinement, most mothers returned to the Mother and Baby Homes, some rejoined their families while others preferred to find lodgings. Occasionally, mothers requested the Children's Department to arrange for the adoption of their babies. However, where the mother wished to rear her child, every assistance was given by the health visitors with priority admission to a Day Nursery or recommendation to known child minders. During 1966, 169 women contacted the undermentioned Moral Welfare Organisations in Greenwich:— Southwark Catholic Children's Society 26 Southwark Diocesan Association 143 Compiled from information supplied by the Registrar General and the G.L.C., the following table gives the total number of illegitimate births in the Borough during the current year and indicates the numbers and ages of mothers seeking advice and assistance:— Illegitimate Ages of Mothers Number Seeking Births Help 1 Under 15 years 108 15—19 years 82 113 20—24 years 69 57 25—29 years 11 30 30—34 years 3 22 35 years and over 3 — Not known 1 331 Totals 169 Of the total of 169 women seeking help, some 21 or 12.4% were already pregnant on their arrival in London. 117 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. Recently, because of demand, one of these centres has started a sewing class. At the 33 sessions held during the year there was a total attendance of 505 at these two clubs. Four other such clubs called 'Home Advice Groups' are organised by the Greenwich Council of Social Service, two of these also being held at Borough Welfare Centres. Co-ordinating Committee This Committee was established to initiate a policy of ensuring that full use is made of 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 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 1966 were those of the Social Aid Scheme of the G.L.C. Housing Department; problems arising on certain estates; the proposed development of Thamesmead; and gas and electricity debts. Family Caseworkers and Family Aids—The year 1966 saw a pilot scheme started whereby a new type of home help designated a 'Family Aid' was employed. The family aid is attached to the family caseworkers who are employed to give intensive help to families who, for various reasons, are unable to benefit from the normal supporting social services. The family aid is supported by the caseworkers and helps to relieve them of some of their simpler tasks such as floor scrubbing, child minding and teaching mothers simple household skills. This innovation has been very successful especially 118 in cases where there were no specific grounds for asking for domestic help on health grounds but where, due to the overall situation at home, the mothers became so depressed that the situation at home overwhelmed them. In one case a mother notorious for slovenliness and cruelty and neglect of her children, has become clean and tidy and more able to cope with the demands of growing children. In another family of three children under a supervision order the two youngest have been able to stay at home because of the improved standard that the mother has been able to maintain with the assistance of the family aid. Number of Intermediate Case Conferences 18 Number of new cases discussed 28 Number of old cases discussed 14 Number of Housing Case Conferences held 24 Number of new cases discussed 85 Number of old cases discussed52 New Cases were referred by:— Greenwich Borough Council Housing Dept. 39 Greenwich Health and Welfare Dept. 5 Greenwich Children's Dept. 14 G.L.C. Housing Dept. 45 I.L.E.A 7 N.S.P.C.C 1 Family Service Unit 1 Hospital 1 113 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 additions for young children, they have been included for sale. A list of products at present available is set out hereunder. Allergilac Farleys Milk 119 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 Under Sections 22 and 28 of the National Health Service Act, recuperative holidays are provided for mothers and young children, for the prevention of illness and for care and after care. Similar holidays are provided under a School Health Services scheme for children attending school. These holidays are intended to furnish rest, fresh air and good food but not medical or nursing attention. There was a considerable increase in the number of holidays provided during the current year, more unaccompanied school children and adults (mainly elderly people requiring convalescence) being accommodated. A summary of the use made of these facilities during 1966 is given in the following table:— Type of Case No. Adults: Psychiatric 8 Tuberculous 11 Other Adults 122 Expectant and Nursing Mothers 5 Other Mothers 9 Infants: Accompanied 20 Unaccompanied: Aged 0-1 year Aged 1-2 years 1 Aged 2-5 years 8 — 29 School Children: Accompanied. 3 Unaccompanied 148 151 Total Holidays 335 120 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. Od. 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 Child-Minders 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. Registration is only necessary when payment is made for these services. Such applicants are visited in their own homes by a Medical Officer and Nursing Officer in order that the suitability of the minder and the premises may be assessed before any recommendation for registration is made to the Council. At the end of 1966 the following child-minders and premises were registered for these purposes:— National Health Service Act, 1946 No. of Child-Minders Registered 72 No. of Places or Children Minded 93 Nurseries and Child-Minders Regulation Act, 1948 No. of Premises Registered: Factories — Places — Other 8 Places 180 No. of Child Minders Registered: 23 Places 113 Compared with 1965, there were more places with voluntary minders during 1966 and in private day nurseries but fewer places were available with registered child minders. 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. 121 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. 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 Borough has seen the attendance figure of 38,678 for 1965 rise to 41,628 and the number of new cases from 1,336 to 1,488. The expansion of 105 Shooters Hill Road, into a multi-staffed establishment necessitated by the recent re-organisation has been overshadowed by the impending enforced move to 103 Shooters Hill Road. This is expected to be completed by the autumn of 1967. Despite all difficulties, this year can be considered as one of reasonable success and of quiet satisfaction. Bathing Centre—Tunnel Avenue—A chiropody clinic established at Tunnel Avenue Bathing Centre in September, 1963, for the treatment of cases (mainly geriatric) brought to the Centre for bathing services, was continued during the current year. At the 52 sessions held there were some 335 treatments carried out. Chiropody Treatment during 1966 No. of Chiropodist Sessions 5,339 Attendances: Children 0- 4 years 11 5-14 years 226 237 Males 15-64 years 2,925 65 years and over 5,216 8,141 Females 15-59 years .. 11,952 60 y ears and over 21,298 33,250 Total Attendances 41,628 No. of New Patients 1,488 Domiciliary Chiropody—All requests for domiciliary chiropody are referred to the Greenwich Council of Social Service which makes all the necessary arrangements. Most of these cases tend to be geriatric types and close liaison is maintained by this organisation not only with the Senior Public Health Officer but also with the Chief Chiropodist. During 1966, some 1,862 domiciliary treatments were effected. 122 DENTAL TREATMENT (Maternity and Child Welfare) F. ELSTON, L.D.S., R.C.S.Eng., the Chief Dental Officer, reports:— "Whilst all other branches of the Maternity and Child Welfare Services transferred from the London County Council in 1965 are now firmly and autonomously under the control of the Borough Council, the appropriate dental services are very closely linked with those of the School Health Services. Issues raised in the School Dental Services report, therefore, apply equally to the Maternity and Child Welfare Dental Services. The problems of 1966 were mainly those of organisation and consolidation and, although the Inner London Education Authority's re-equipment and modernisation of its clinics has, of course, been of great benefit to the Maternity and Child Welfare dental services, there is still an acute shortage of dental surgeons. However, in the future, the Maternity and Child Welfare Dental Services are destined to play an increasingly important role, for dental disease is understood and preventable and efforts, every bit as arduous as direct treatment of established lesions, will have to be made in the direction of prevention. It is the aim, therefore, not only that every expectant and nursing mother shall be reached with a thorough explanation of the origin of dental disease and the simple preventive measures but also to afford treatment facilities to as many of the 'under 5s' as can be accommodated at the clinics. Recognition by the Royal College of Surgeons of the importance of the dental aspects of public health is evident in the establishment in 1966 of the Diploma in Dental Public Health, a qualification analagous to the D.P.H. required of Medical Officers of Health. In all medical and surgical conditions, assessment is essential and, in a similar way, this is necessary with regard to a service. Realistically, it must be reported that this service remained stationary during 1966 but, nevertheless, it must also be stated that explosive expansion outstripping treatment facilities would inevitably lead to chaos and while the execution of important work is emminently desirable, shortage of qualified staff precludes its implementation. Although all clinics dealt with the sporadic Maternity and Child Welfare patient, only one centre was able to devote itself to regular sessions. Consequently the service was constrained to concentrate on dental health education and locally prepared publications entitled 'Dental Facts' and its supplement for the 'Care of Small Children's Teeth' were distributed during 1966 at the various clinics in order to reach mothers who were deprived of personal tuition by reason of the shortage of dental surgeons. 123 Dental services for the Maternity and Child Welfare population were referred to in the 1965 Report as a 'minimal token service'. It is distressing, therefore, knowing of the tremendous need of the small child for optimal introduction to preventive knowledge and treatment by means of a specialised service, to have to explain away its practical non-existence by the irrefutable argument of lack of suitable qualified staff. We know what has to be done and we are most eager to do it. We know what direction to take and we know that with increasing operational efficiency of the School Dental Service we will also reach the aim of an effective and vigorous service for the priority classes. As stressed repeatedly, prevention is every bit as important as the treatment of established lesions. In dealing with preventive measures there must be a division between those which can be carried out by the patient or mother to minimise damage to existing teeth, and those which the community can take to strengthen resistance of teeth to dental decay. It is established beyond any doubt that the addition of one part per million of sodium fluoride to water ingested by a child during its period of tooth development, is a systemically completely harmless measure but which increases the resistance of the tooth to dental decay by anything up to 40% or more. Such a step, however, must not result in less vigilance towards dental caries and the introduction of other preventive measures. Although this Council is dedicated towards fluoridation of its water supply, it is sad to record that, of the 34 local health authorities supplied by the Metropolitan Water Board, 26 are in favour and 8 against fluoridation. Notwithstanding Ministry approval and its support in the event of legal proceedings, the Metropolitan Water Board has publicly stated that, on such a public issue, it requires unanimity before it will act. It is, perhaps, superfluous to say that most responsible bodies in the medical world support fluoridation and the London Boroughs' Association is aware of and actively interested in the problem. The present position in Greenwich may be summarised as follows. Despite the great and indisputable need of the community for Maternity and Child Welfare dental services, they remain deplorably rudimentary in character. Although modernisation of the clinics has rendered them more effective and conducive to the recruitment of dental surgeons, the chain of efficient service cannot be completed without the missing link of suitable dental officers. Dental health education, in print, is the only field where tangible improvement has been achieved and this will persist until, with the advent of an adequate team of dental surgeons, the Council's wider plans can be realised. Fluoridation, if it could be made available, is the one sure measure calculated in the long run to reduce the need for professional assistance." 124 Treatment During 1966 ATTENDANCES New Patients: No. of Appointments 324 No. and percentage of Appointments Taken Up 220 68% On-treatment Patients: No. of Appointments 612 No. and percentage of Appointments Taken Up 435 71% Emergency Patients Treated 50 total attendances 705 TREATMENTS No. of Treatment Sessions 90 Total No. of Teeth Treated 614 (a) Mothers: No. and percentage Filled 63 98.4% No. and percentage Extracted 1 1.6% (b) Children: No. and percentage Filled 468 99.3 % No. and percentage Extracted 3 0.7% Prophylactic Treatment 141 X-rays 11 Dentures — General Anaesthetics All Other Operations 224 125 SECTION V WELFARE SERVICES State welfare has evolved from piecemeal philanthropy built up over generations and originally the prerogative of the churches and other charitable bodies. By the very nature of the previous organisations, gaps in services were bound to occur but, since the community undertook to shoulder the burden of providing a welfare structure, an assumption that no longer would there be breaks in the services has proved erronous. It has always been a function of voluntary and charitable organisations to show the need for a certain welfare service or facility and for the government or a local authority finally to accept responsibility if public expenditure was considered justified. Many aspects of welfare which enabled people to express generosity of spirit in a very practical way have been adopted by the state and, although this action was inevitable, a great deal of goodwill was thereby lost. However, much of this natural generosity remains pent-up waiting to be 'tapped' by some enterprising public ventures. Such a harnessing of benevolence, unfortunately, is not without its drawbacks. Moves to establish associations for special causes such as spasticity, multiple sclerosis, diabetes, epilepsy, etc., were in the 'van' of a flood of appeals most of which, by reason of novelty, met with such resounding success and public support that they became nationally viable organisations with highly trained staffs. Later arrivals on the scene tend to be less fortunate. With so many charities already founded they discover that even if sufficient funds are raised for initial establishment of a project, heavy costs of providing for continuous operation prove too onerous and supporters quickly lose heart. The dilemma is that it is easier to find support for a new scheme than for maintaining one already in existence. For example, recent advances in medicine and surgery have stimulated enthusiasm in the lay world and trusts and charities are often persuaded to grant funds to provide special hospital units. Such units are rightly the responsibility of the hospital authorities which would doubtless have been happy to have these facilities under their jurisdiction but the money has just not been available. Moreover, running costs of such units tend to be high and hospital resources are bespoken for years ahead. Gifts of such a nature, although well intentioned, become an embarrassment to donors and recipients alike and the charity or trust may be induced to over-extend itself financially for a number of years or to abandon the project completely. Often hospitals are constrained, seemingly ungraciously, to reject a scheme which, at 126 first sight, would appear to be to its advantage or, with its acceptance, risk interference with future plans and so invite public opprobrium. Because of its universality, central control of policy and finance has often proved to be an inappropriate and unsuitable form of administration to deal with circumscribed and neighbourhood problems. It is conceivable that local autonomy would generate a more 'personal' feeling of involvement and it is likely that the public, in general, could more easily be persuaded to take interest in 'their' establishments and the solving of problems peculiar to their own locality. It may well be asked what this has to do with the local welfare services. Since, on a number of occasions the Minister has advocated closer links between voluntary organisations and local authorities and the present trend is for greater liaison of local health authorities with hospitals, problems of 'charitable' gifts, grants and assistance become common ground. All successful welfare planning is based upon reliable economic, statistical and social information with an assessment of resources and availability of the various skills required. Unpalatable though it may be, it is a fact that finance is the ultimate resource from which all other resources flow. Therefore, with present increasing national and local financial stringency and the possibility of its persistence for some time to come, offers of voluntary help are likely to increase and may perhaps have to be solicited if existing facilities are to be improved or even maintained. Health and welfare are spheres in which voluntary and statutory agencies can work amicably in close association, each complementing the other, for the ultimate benefit of the community. Fortunately, in Greenwich, a fruitful partnership, born of long-standing respect, is already in existence. Nevertheless, there is a growing need for coordination of voluntary effort if only to avoid duplication and to channel the largely untapped reservoir of goodwill into the right directions. A great deal of information, formal and informal, is gathered by the officers of the department in the course of their duties and it would be logical for the local authority, which has an overall picture of the health and welfare needs of its residents, to undertake such co-ordination. Legislation Beyond the integration of the National Insurance and National Assistance organisations into the Ministry of Social Security, the present year brought no alteration in the existing law with regard to welfare. However, a number of changes in welfare legislation are presaged in a new Bill to be placed before Parliament during the coming year. 127 As a method of establishing a fully efficient, preventive health service and with the aim of reducing demands for places in welfare homes and even in hospitals, it is proposed that every local health authority shall provide domestic help sufficient for the needs of its area and, furthermore, that recipients of such help shall also be eligible for laundry facilities, charges for which will be according to means. Up until the present time most welfare work, other than voluntary, has been carried out under Section 29 of the 1948 National Assistance Act which is really geared to the needs of the handicapped. A radical alteration is suggested, namely, that welfare authorities be made responsible (subject to Ministry approval) for all arrangements for promoting the welfare of old people. Moreover, it is further suggested that power be given to local authorities to make payment for suitable accommodation in private homes registered in accordance with Section 37 of the Act of 1948, in addition to that provided by voluntary organisations for those in need of care and attention. Perhaps this latter piece of legislation will tend to stimulate registration under Section 37 and make available to welfare authorities more accommodation for their elderly and disabled, the lack of which has been a serious and continuing problem. Unfortunately, enactment itself will not produce the improvements sought. Limited resources and shortages of skills will present the Council with the dilemma of balancing short term 'necessity' with that of long term planning in an atmosphere of rigid financial restriction. General In accordance with the request from the Ministry of Health, a ten-year plan in respect of local welfare services was, after special consideration, prepared and forwarded. Preparation of the plan paid due regard, inter alia, to the growth in population arising from the 'Thamesmead' project and the expected increasing proportion of elderly residents over the next decade. Emphasis was given to the supportive services to enable more aged to live their remaining years at home which, incidentally, will have the added advantage of relieving pressure on the Council's own homes. It is intended that a further 4 small residential homes, each of 60 places and including special units, shall be provided and more sheltered housing for the aged is anticipated. Again for the elderly, additional Day Centres will be provided and progressive extensions of Meals-on-Wheels and Luncheon Club facilities are envisaged. Included in the plan are schemes for further social rehabilitation centres and sheltered workshops for the blind and other handicapped persons and an enlargement of the special transport pool. Under the plan it is the Council's aim that homeless families shall have early priority and a hostel for unsupported mothers and 128 their babies is expected to be in operation by the end of 1968. Naturally, success in implementing the plan fully is dependent upon the availability of sufficient resources. At the moment, future finances seem very uncertain and the plan will need to be regularly reviewed and adjusted accordingly. During the year under review, few changes took place in the Borough's welfare services. Planning of new Old People's Homes in the Gavestone and Glyndon Developments continued but real progress was delayed by national economic factors. Loan sanction for both projects is promised for 1967/68 and it is anticipated that the building of these Homes will commence in the second half of 1967. Homes for Old People There are four modern purpose-built Old People's Homes situated in the Borough, namely:— Perrygrove, Rectory Field Crescent, S.E.7. Plumstead Lodge, Plumstead Common Road, S.E.I8. Sunbury Lodge, Sunbury Street, S.E.I8. Weybourne, I Finchale Road, S.E.2. In addition, as a temporary expedient until sufficient accommodation is made available locally, some 259 beds in Southern Grove Lodge, Mile End Road, E.l, form part of this Council's Part III facilities. The standard of physical fitness of the old people admitted to the Council's Homes continues to decline, a natural and anticipated result of our policy. We consider that it is generally of greater social benefit that every effort be made to maintain people in their own homes and normal surroundings and to admit to a Home only in the last resort. In fact, because of the shortage of beds within the Borough, it is only in almost crisis conditions when every form of domiciliary help is being given but is found to be insufficient, that admission to a Home can be contemplated. In these circumstances it is not surprising that more and more of the residents in the Homes require a degree of care and attention previously unknown both to the staff and the former administration. Anxious as we are to see the end of the large institutional Homes such as Southern Grove Lodge, it cannot be discounted that a great many people with severe and varied infirmities were cared for within their wards and existing trends would seem to indicate that the burden of this care will continue to fall on the Welfare Services. Special units catering for several needs such as mild psychiatric and physically handicapped cases are planned for the new Homes, but it will also be necessary to examine both the physical and staffing structure of all our Homes to seek ways to ease the burden of this additional care which must fall on the various staffs. 129 There would appear to be a conflict in planning for the care of old people with perhaps too great an emphasis on the provision of hotel-like Homes admirable for the shelter of the healthy aged and the moderately infirm person, but hardly suitable, even at this point in time, for the average candidate for admission. Few would quarrel with the principle that only people in need of hospital skills should be maintained in hospital beds, but a line drawn at this point ignores a tremendous and growing number of old people who need hours of personal attention if they and their surroundings are to be kept wholesome and attractive and who exert even greater demands on staff in the last days or weeks of their lives. Alternative geriatric facilities are not being developed in sufficient quantity or with sufficient speed to fill the gap and, strangely, in this Borough the number of such beds is being reduced. In the absence of an adequate number of beds in purpose-built geriatric wards a "Hospital Case Exchange System" is always in danger of functioning without due regard to the personal feelings and happiness of the individual. 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. The procedure for the consideration and assessment by a professional panel of all applications or referrals for admission to Homes has been further developed. The Deputy Medical Officer of Health aided by the Senior Woman Public Health Officer and the Senior Social Worker comprise an informed panel particularly able to decide between degrees of medical and social priority when dealing with the waiting list. As and when necessary, the Consultant Geriatrician is invited to join the panel in its deliberations. 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 No. Personal Applications (self or relative) 88 Referred by Council Members 3 Referred by Women Public Health Officers 62 Referred by other Council Officers 35 Referred by Hospitals 198 Referred by General Practitioners 43 Miscellaneous 41 470* * Of these applications, 188 were withdrawn or not proceeded with before inclusion in the waiting list for admission to a Home. 130 It will be noted from the figures given in the Table of Accommodation Statistics that the number of Greenwich residents maintained in Southern Grove Lodge continues to decline. This only serves to prove, if proof were needed, that this remote accommodation is almost completely unacceptable both to the prospective resident and his, or her, relatives. Because of this feeling and the fact that a number of the beds included in the Southern Grove Lodge allocation were suitable only for healthy, aged residents for which there is no demand, negotiations are taking place to reduce the accepted number from 259 to 199 beds with effect from 1st April, 1967. Staff—The recruitment of staff for the Homes continues to give rise to some anxiety, particularly in supervisory grades. Whilst the turnover in numbers of lower grade staff is higher than desirable, there is no acute shortage, but much greater difficulty has been experienced in filling the positions of Assistant Matron. Recreation—The Matrons and staffs of the Homes maintained their efforts to provide varied recreational and occupational interests additional to the normal care and attention. Sightseeing outings, shopping expeditions, trips to the country or the coast in one form or another are a weekly occurrence. Concert parties and other forms of entertainment, including the cinema, provide a frequent change from radio and television. Combined parties for staff, residents and friends have been held. Transfer of Residents—Requests continue to be received for residents to be moved from one Home to another generally to facilitate visiting by their friends and relatives. During the year, 23 such transfers were arranged. Part III Accommodation—Statistics Old People's Homes 1st Jan., 1966 Nos. in Residence 31st Dec., 1966 Nos. in Residence Males Females Total Admitted Died Discharged or transferred Males Females Total Perrygrove 28 33 61 58 6 56 26 31 57 Plumstead Lodge 21 70 91 114 4 113 21 67 88 Sunbury Lodge 14 45 59 51 5 46 15 44 59 Weybourne 20 38 58 65 7 63 18 35 53 * Southern Grove Lodge 148 60 208 121 28 126 117 58 175 Totals 231 246 477 409 50 404 197 235 432 * London Borough of Tower Hamlets 131 ui Voluntary Homes—Visits to Greenwich residents maintained in voluntary homes continue to be made, and the Officers making these visits have taken particular note of the facilities available in the specialist accommodation provided by the various voluntary societies. Voluntary Establishments 1st Jan., 1966 Admitted Discharged 31st Dec., 1966 No. of No. of Homes Residents No. of Homes No. of Residents Aged 22 27 8 8 21 27 Blind 9 10 - 1 8 9 Epileptics 2 5 1 1 3 5 Physically Handicapped 15 24 10 13 15 21 Deaf and Dumb 2 3 - - 2 3 Totals 50 69 19 23* 49 65 * Including 12 Deaths Homeless Families The incidence of homelessness showed no sign of reduction. As will be seen from the statistics, large numbers of applications continue to be made and the numbers admitted to temporary accommodation are quite high. It was found possible to improve the S.E. Block at 158a, Plumstead High Street, which now offers private, although not selfcontained accommodation for 22 families. In addition to their sleeping accommodation, each family now enjoys a private kitchen and a private bathroom containing W.C., wash basin and bath as distinct from the communal arrangements in the Main Block. It is planned to improve the "Annexe" in a similar manner to provide nine family units and work will commence early in 1967. During October, a special unit for the training and rehabilitation of "problem" families was opened at 32 Charlton Road. The property is rented from the Housing Department and consists of four self-contained flats/maisonettes on three floors with semibasement. Some success has already been achieved and it is expected that, with the additional Social Worker support which is provided, more families will be aided to overcome the social problems which have contributed to their homelessness. Homeless Families Accommodation—Statistics Applications for Admission (1st January—31jf December, 1966) Number of Applications* 358 Number accepted into Residence 124 * Excludes numerous preliminary enquiries not amounting to applications. 132 Homes—Admissions and Discharges Resident at 1st Jan., 1966 Admissions Discharges Resident at 31st December, 1966 | Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons 'Summercourt' 4 14 9 14 127 84 129 295 508 158a Plumstead High Street 128 83 130 292 505 3 2 3 12 17 62 47 62 190 299 93 73 94 233 400 32 Charlton Road* 88 69 89 220 378 67 51 67 203 321 2 2 2 11 15 3 3 3 10 16 1 2 1 8 11 4 3 4 13 20 * Opened in October Families Rehoused By Greater London Council Families Men Women Children Persons 27 19 28 80 127 By London Borough of Greenwich 51 36 52 117 205 By other Local Authorities — — — — Found own accommodation 37 17 37 65 119 Left for other reasons 10 19 11 53 83 125 91 128 315 534 Unsupported Mothers and Babies Because of financial and planning difficulties, no progress was made toward the provision of a mother and baby hostel, but this project will materialise when other more urgent plans have been fulfilled. Meanwhile the Department gave financial help to 36 young, unmarried mothers at the request of the local Moral Welfare Workers who in their turn placed the girls in various mother and baby homes. (See also page 116). DOMICILIARY AND COMMUNITY SERVICES FOR THE HANDICAPPED Prior to the 1939/45 war, welfare work depended largely upon voluntary agencies but, on the cessation of hostilities, there was an almost universal demand for public accountability in this field. Since the introduction of legislation in the 1946 and 1948 Acts which gave powers to local authorities to make arrangements for promoting the welfare of the elderly and those physically handicapped including the blind and deaf, there has been full or almost full employment for all but very small sections of the community. Young people are healthier, they are given better educational 133 ties than ever before and their prospects of 'job-finding' after leaving school have never been brighter. Medical science has advanced at a startling rate and general science and technology have enabled many hitherto 'unemployables' to become gainfully employed. Unfortunately, there are signs that present material prosperity is being threatened. Paradoxically, this period has been one of social uneasiness on the part of the nation and there has been a persistent demand for more and more welfare facilities—in fact for a fully comprehensive social welfare service. However, we would do well to remember, in planning for the future, that community services are intended to serve the needs of the community and we should beware of subordinating these to administrative convenience and procedures. Underlying all the welfare services is the aim of helping persons towards independent living and self support including rehabilitation and training for regaining capacity for work. Where this is found to be impracticable, a solution is sought by the department which endeavours to give the handicapped the greatest of physical and mental freedom compatible with his/her underlying condition. Attainment of these objects means a personal social service to individuals or families and, ipso facto, more social workers for the local authority services. A more comprehensive service will require even more trained personnel and existing training facilities are already inadequate; furthermore, recruitment of suitable trainees has also proved to be a substantial obstacle. A new organisation, the Social Work Advisory Service was established during the year to promote recruitment and form a link between all agencies concerned with social service training. Existing training has been expanded and recommendations for future training of social workers have been circulated to local authorities by the Council for Training in Social Work. Until a sufficiency of trained social workers becomes available it is inevitable that some of the social work will have to be sustained by persons qualified by practical experience and limited training and to whom we already owe a great deal for the maintenance of standards of the present services. General The nationwide scarcity of Social Workers was reflected in this Borough's situation during 1966 and the total establishment of 19 was never complete at any one time. At the end of the year, 17 Social Workers were in post, there having been 9 resignations which included 2 Home Teachers of the blind. Although 7 new appointments were made during the current year, it was not possible to obtain replacements for the Home Teachers and at the close of the period under review only one member of the staff was so qualified. 134 Nevertheless, despite all the staffing difficulties, the Social Work Services were largely maintained. Not including the Senior Social Worker and his Deputy (both of whom, because of the shortage of supervisory staff, undertook direct supervision of the social work service in addition to visiting) the average working week of the 15 Social Workers may be analysed as follows:— Office Work (case reports and interviews) 33 % Attendance at Clubs and Centres 25% Homeless Family Units13% Domiciliary Visiting 29 % Departmental registers cover not only the blind and partially sighted but the deaf and dumb and those persons severely or permanently handicapped by illness, injury or congenital deformity and, during 1966, efforts were continued to make these registers more comprehensive. Although registration is normally a pre-requisite to the provision of services, no call for assistance goes unheeded by the department. Visits to the handicapped during the year totalled 6,394 compared with a figure of 3,185 for the previous nine-month's period. This is equivalent to an increase of almost 50% over the 1965 figure as estimated from the 9-month total. The following table indicates the number of visits made to the various classes of physically handicapped persons during the current year:— Type of Visit Category of Handicapped Blind Partially Sighted Physically Handicapped New Cases 66 57 323 Routine/Subsequent 784 424 3,496 Teaching 45 43 Non-effective 184 104 868 Totals 1,079 628 4,687 Visits carried out by Social Workers during the year in connection with applications for admission to Old People's Homes amounted to 805. These were in addition to those also undertaken by the Women Public Health Officers. Furthermore, Social Workers dealt with 423 applications (almost 2 cases every working day) in respect of the Council's Homeless Families' temporary accommodation which resulted in the admission of 120 families. With regard to many of the cases not admitted, advice was given on obtaining alternative accommodation 135 or on how to maintain residence at their existing addresses. During the year, a scheme was commenced whereby families rehoused from the Council's Homeless Families Accommodation at 158a, Plumstead High Street, or 32, Charlton Road, were "followedup' by a Social Worker. In most instances only two visits were made and these proved considerably worthwhile in that the attention of appropriate officers and other agencies i.e. Health Visitors, Housing Welfare Officers, Ministry of Social Security representatives, etc., were quickly drawn to any problems developing early after return to the community. Six parties were arranged for the handicapped at Christmas and in the New Year and the Mayor, who allocated £40 towards them from the Christmas Fund, attended all but one when he was represented by his Deputy. In all, some 314 guests were entertained. Students—There were 5 student placements with Welfare Social Workers during 1966. Welfare of the Blind In contrast with a deaf or dumb handicap, blindness has always had public support and sympathy and its difficulties have been more readily understood possibly because it is easier to envisage a world without sight than a life without speech or sound. Following the national trend, the most usual site for blindness is the retina which accounts for almost one third of all persons locally registered as blind. The major cause is congenital defect, and glaucoma, cataract and interstitial keratitis are common conditions. A high proportion of lesions causing blindness are preventable or remediable if detected sufficiently early. Nevertheless, despite all recent progress in the medical fields there will always be a certain number of blind persons in any community and even with the adoption of new techniques arising from the rapid advances in science and technology, blindness will remain a major social problem. Congenital blindness needs the deep understanding of loving parents but, above all, it demands constant application towards the practical aspects of ameliorating the handicap. In this respect the parents need skilled guidance and encouragement to ensure that a child's full potential is realised. A blind child's progress towards adulthood must be closely followed and necessary adjustments made for the changes in practical and emotional conflicts especially at the stage when a decision has to be made with regard to vocational training and again when the time comes for placement in sheltered or open employment. Particularly difficult problems arise with those who, for various reasons, become blind in middle age. These people, usually with 136 family commitments, need rehabilitation and resettlement in appropriate employment and, during this interim period of shock and helplessness, the individual and family need the fullest support from our services in order to face the future and adjust to the changed circumstances. Onset of blindness in old age tends to be insidious and perhaps for this reason is less subject to emotional stress. Unfortunately it is often accompanied by the loss of other faculties which merely intensifies the need for the supportive services. As in other spheres, social workers in this field are in great demand especially those designated 'teachers', the paucity of which is lamentable. Progress has been made in training social workers in the special 'teaching' skills but a sufficiency to meet all demands is unlikely within the next few years. Investigations into some modern innovations such as 'ultra sonic' aids and the 'long cane' hold out hopes that eventually the mobility of many blind persons will be substantially improved. 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 (now the Ministry of Social Security), 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. In connection with the blind, of the 41 new cases added to the register during the year, 30 (73 %) were over the age of 65 years and only one under one year. With regard to the partially sighted, of the 40 cases newly registered, 26 (65 %) were over 65 years of age and there was none under the age of 15 years. 137 BLIND PERSONS Register (as at 31st December, 1966) New Cases in Brackets AGE GROUP Number Registered Age at Onset of Blindness M F Total M F Total 0-1 year _ _ _ 24 26(1) 50(1) 1 year _ _ _ 1 1 2 years - - - 7 3 10 3 years _ _ _ 1 1 2 4 years 1 - 1 2 - 2 5-10 years 1 - 1 8 8 16 11-15 years 5 1 6 3 3 6 16-20 years 6 - 6 4 3 7 21-29 years 6 9 15 11 8 19 30-39 years 10 7(1) 17(1) 18(1) 18 36 (1) 40-49 years 11 11 22 15 21 (1) 36(1) 50-59 years 28(1) 20(1) 48 (2) 24(2) 24 (3) 48(5) 60-64 years 17(2) 21 (1) 38 (3) 6(2) 21 (1) 27 (3) 65-69 years 12(1) 24 (5) 36 (6) 8 (1) 21 (4) 29(5) 70-79 years 48(5) 61 (8) 109 (13) 32(5) 58 (10) 90(15) 80-84 years 22(2) 52 (4) 74(6) 13 (2) 26(3) 39(5) 85-89 years 13(3) 38 (6) 51 (9) 9(1) 15(2) 24(3) 90 and over 8 19(1) 27 (1) 1 1 2 Unknown - - - 1 6(2) 7(2) Totals 188 (14) 263 (27) 451 (41) 188 (14) 263 (27) 451 (41) Bund 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) 2 1 Not at School (no other defects) 1 — Unsuitable for Education at School: At Hospital for Mentally Subnormal (no other defects) 2 — At Home or elsewhere (with multiple defects) 1 — 7 1 138 Blind Persons 16 Years and Over Education, Training and Employment (i) EMPLOYED AND AT SCHOOL AGE GROUPS At School EMPLOYED Total Employ ed Under Sheltered Conditions Ordinary Conditions Special WorkShops Home Worker Schemes M F M F M F M F 16-20 years 1 _ _ _ 21-39 years - - - 1 1 — 8 4 14 40-49 years _ _ 4 _ _ 2 3 4 13 50-59 years - - 6 - 3 1 8 4 22 60-64 years - - 4 - — - 4 — 8 65 and over - - 1 - - - - - 1 TOTALS 1 15 1 4 3 23 12 58 (ii) TRAINING AND NOT EMPLOYED Male Female Undergoing Training: Professional or University 1 1 Not Employed: Subject to Training— Suitable for Sheltered Employment 3 — Suitable for Open Employment — 1 Without Training— Suitable for Sheltered Employment 1 — Suitable for Open Employment .. 3 2 (iii) 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 1 8 4 7 20 Not capable of Work 19 19 4 14 _ 56 Not Working - - - - 102 194 296 TOTALS 20 27 8 21 102 194 372 139 (iv) OCCUPATIONS OF EMPLOYED BLIND PERSONS Occupations Sheltered Conditions Ordinary Conditions Totals Special Workshops Home Worker Schemes Physiotherapists _ _ 1 1 Lecturers, Teachers and Instructors 1 1 2 Other Professional Workers - 1 1 2 Typists and Secretaries - 10 10 Braille Copyists and Proof Readers 1 1 Clerical Workers _ _ 1 1 Telephone Operators - - 3 3 Shop Managers and Proprietors 1 2 3 Machine Tool Operators - - 2 2 Fitters and Assemblers - - 2 2 Viewers, Inspectors and Testers 2 2 Boxers, Fillers and Packers - - 1 1 Knitters and Weavers 1 2 - 3 Upholsterers and Machinists 1 - - 1 Basket Makers 10 2 — 12 Mat Makers 1 — — 1 Fend-off Makers 2 - - 2 Labourers _ _ 3 3 Domestics, Porters, etc. - - 1 1 Launderers, Dry Cleaners _ _ 1 1 Miscellaneous Service Workers - - 4 4 TOTALS 16 7 35 58 (v) BLIND PERSONS—IN-RES1 DENTS (16 YEARS AND OVER) Residential Accommodation (1948 Act, Pari III (21)) Male Female Homes for Blind 2 6 Others 3 3 Other Residential Homes — 1 Hospitals for Mentally I11 1 5 Hospitals for Mentally Sub-normal 3 3 Other Hospitals 1 7 TOTAL 10 25 140 partially sighted persons Register (as at 31st December, 1966) AGE GROUP Number Registered 31.12.66 Newly Removals from Register during year Registered Admitted to Blind Register De-cert ified- Improved Visual Acuity M F Total M F Total M F M f 2-4 years 5-15 years 2 2 4 _ _ _ _ _ _ 16-20 years 1 3 4 1 _ 1 _ _ _ _ 21-49 years 21 19 40 2 3 5 - _ 1 _ 50-64 years 9 12 21 4 4 8 - - - - 65 and over 37 115 152 8 18 26 2 6 - - TOTALS 70 151 221 15 25 40 2 6 1 Training and Employment (16 Years and Over) AGE GROUPS Employed Unemployed and not under Training Training TOTAL Available andcapableof Trg or Work Not Available for Work m f m f m f m (i) Persons near or Prospectively Blind 1 2 1 21-49 years 3 1 _ _ _ 4 8 50-64 years 2 3 1 _ i 2 _ 9 65 and over 1 - - - 21 73 - 95 TOTALS 7 4 1 - 22 79 1 114 (ii) Persons mainly Industrially Handicapped 16-20 years _ 2 1 1 4 21-49 years 14 1 2 2 9 _ 28 50-64 years 1 2 1 - 3 5 - 12 65 and over - — - - 12 34 - 46 TOTALS 15 5 3 2 16 49 90 141 Sheltered Employment—The Department continued to administer the Greenwich Workshops for the Blind, which are situated at Greenwich High Road and Eastney Street. The total number of registered blind employees fell to 26 during the year. This fact, together with the inherent unprofitability of the traditional trades practised in the Workshops (i.e., the manufacture of baskets, mattresses and ships' fend-offs) tended to aggravate the difficulty of restricting costs. In an effort to reverse this trend, light engineering was introduced on an experimental basis. A sub-contract was obtained from a large electrical firm for the drilling and deburring of plastic components. All the blind workers, who so wished, were given the opportunity of a trial run on the two drilling machines. The results were very encouraging and indicated that, with a little practice, the majority of men taking part in the experiment were capable of achieving worthwhile rates of production. Unfortunately, the national economic difficulties in the latter part of the year seem likely to jeopardise the development of the scheme. 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 Greenwich blind homeworkers continued to participate in the scheme which is supervised, on behalf of the Council, by the Royal National Institute for the Blind. 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 Social Security benefits. (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. 142 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. (f) Additional Income Tax relief may be claimed from H.M. Inspector of Taxes. Welfare of the Physically Handicapped The following table gives a breakdown of the main conditions registered with the department. It will be seen that, in accounting for 32 % of the total registrations, the rheumatic group continues to take pride of place with 'organic nervous diseases' comprising some 31 %. Of this latter figure, almost one half were hemi or paraplegics and one third spastics and polio victims. Much can be done to minimise handicaps arising from neurological lesions; consultations with specialists in the clinical field and with experts in physical medicine and orthopaedics are essential if modern advances in therapeutics and rehabilitation are to be allowed to play their full part. 143 Physically Handicapped Register at 31.12.66 Primary Disabilities DISABILITY AGE GROUPS (in years) TOTALS SEX 0-10 11-20 21-30 31-40 41-50 51-60 61-64 65-70 71-80 81-90 90 & over Males Females GRAND TOTALS Amputation M - - 1 2 5 12 - 8 10 4 - 45 29 74 F — — 1 1 2 4 - 3 12 3 — - - Rheumatism M - 1 - 2 2 10 8 12 7 6 1 49 - 320 F — 1 1 8 6 27 40 43 85 53 7 - 271 - Deformities, etc. M - 1 - 1 - - - 2 - - - 4 25 F — 2 1 1 1 2 - 2 9 2 - - 21 25 Systemic Diseases M - 1 - 4 5 10 6 10 2 - 41 46 87 F - — 1 2 1 3 5 4 18 12 — - Injuries and diseases M - 4 3 1 1 5 3 2 6 1 - 26 - 84 F - 1 | 2 1 5 6 14 23 2 1 - 58 - Organic Nervous diseases M 1 10 10 16 24 38 14 12 13 9 1 148 167 315 F 1 21 9 15 18 30 9 17 38 7 2 - - Neurosis M - 1 1 - - 1 — 1 1 - - 5 11 F — 1 1 — — 3 - - - - - 6 Tuberculosis M _ - 1 _ 3 1 - - — - 6 6 F - 6 Other M _ 1 1 1 1 6 3 - 5 1 1 20 - 71 F - 3 2 3 8 12 - 12 - 3 1 51 6 Totals M 1 19 17 27 41 83 3! 43 52 23 3 344 F 1 29 19 32 37 86 72 95 185 82 11 - 649 Grand Totals 2 48 36 59 78 169 107 138 237 105 14 993 (i) Analysis of "Rheumatism" group DISABILITY AGE GROUPS (in years) TOTALS SEX 0-10 11-20 | 21-30 | 31-40 1 **-*> 1 | 51-60 | 61-64 | 65-70 | 71-80 | 81-90 | 90 & over Males Females GRAND TOTALS Arthritis M _ 1 _ 1 1 2 2 3 2 5 1 18 F - — 1 2 2 8 21 20 49 29 4 137 ( 135 Rheumatoid M - - - 1 1 6 2 4 3 1 - 18 Arthritis F - 1 - 5 J 1 J 13 15 24 7 2 83 Osteo-Arthritis M 2 4 5 1 - — 13 F - - 1 1 6 3 8 12 17 1 31 1 04 Totals M _ 1 _ 2 2 10 8 12 7 6 1 49 F - 1 1 8 6 27 40 43 85 53 7 271 Grand Totals - 2 1 10 8 37 48 55 92 59 8 320 144 (ii) Analysis of "Diseases of Systems" 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 _ _ _ _ 2 2 _ - 1 1 - 6 14 F - - - - - 1 - 1 3 3 - 8 Heart Diseases M - - - 2 1 2 1 4 7 1 - 18 31 F - - - - 1 - 1 1 6 4 - 13 Sclerosis M - 1 - 2 1 5 2 2 1 - - 14 38 F - - 1 2 - 2 4 2 8 5 - 24 Others M - - - - 1 1 - - 1 - - 3 4 F - - - - - - - - 1 - - 1 Totals M - 1 - 4 5 10 3 6 10 2 - 41 F - - 1 2 1 3 5 4 18 12 - 46 Grand Totals - 1 1 6 6 13 8 10 28 14 - 87 (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 7 2 - 1 - - 22 66 F 1 10 2 4 4 4 1 5 5 7 1 44 Hemi and Para-plegia M - 2 6 1 5 16 5 7 10 7 1 60 128 F - 6 - 4 5 16 6 7 24 - - 68 Epilepsy M - - 1 4 2 6 1 2 - - - 16 37 F - 1 3 2 6 4 1 1 3 - - 21 Poliomyelitis M 1 4 - 2 7 6 4 3 - - - 27 40 F - 2 2 3 - 2 - 2 1 - 1 13 Encephalitis M - 1 - - - 2 - - 2 - - 5 10 F - - - - - 2 1 - 2 - - 5 Parkinson's Disease M - - 1 2 6 - - - - - - 9 17 F - - - - 2 2 - 1 3 - - 8 Friedreich's Ataxia M - - - - 2 - 1 - - 1 - 4 6 F - 1 - - 1 - - - - - - 2 Other M - - - 1 1 1 1 - - 1 - 5 11 F - 1 2 2 - - - 1 - - - 6 Totals M 1 10 10 16 24 38 14 12 13 9 1 148 F 1 21 9 15 18 30 9 17 38 7 2 167 Grand Totals 2 31 19 31 42 68 23 29 51 16 3 315 145 (iv) Additions & Removals from Register DISABILITY GROUPS Sex Number at 31.12.65 Additions to Register Deletions from Register Number at 31.12.66 Amputation M 42 16 13 45 F 21 8 — 29 Rheumatism M 43 12 6 49 F 247 58 34 271 Deformities M 7 3 4 F 13 10 2 21 Systemic Diseases M 20 23 2 41 F 29 22 5 46 Injuries and Diseases M 26 4 4 26 F 45 15 2 58 Organic Nervous Diseases M 142 27 21 148 F 170 13 16 167 Neurosis M 5 — — 5 F 9 — 3 6 Tuberculosis M 4 2 — 6 Other F - - - - M 26 6 20 F 50 3 2 51 Totals M 315 84 55 344 F 584 129 64 649 Grand Totals 899 213 119 993 Reference to table (iv) shows that although the number of registrations viz. 993 is an increase of 94 over the figure for the previous year, there were actually 213 new registrations during the current year with 119 deletions. A rise of new registrations of this order gives evidence of the drive to make our registers more comprehensive than hitherto. It is true 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. 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. 146 Social Rehabilitation Centre, Ormiston Road—This centreproviding 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. An art class, held twice weekly and supervised by instructresses from the I.L.E. A., was introduced during the year with marked success. Each full session, morning and afternoon, provides accommodation for 14 persons and regrettably a handicapped person can attend for one half day per week only. There is a waiting list for members. St. Saviour's Centre for Handicapped Young People—On an average, 11 severely handicapped young people attended weekly 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 20. Minor Hall, Greenwich—Opened on 29th April, 1965, this club is for persons who are blind or deaf and meetings are held every Thursday afternoon. The average attendance during the year was 19 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. Loan of Equipment Home Nursing Equipment—The service for the loan of nursing and sick room aids continued during the 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. 147 Since the inception of the scheme under the National Health Service Act, the demand for the service has grown steadily and this growth is persisting. Portable Aids for Handicapped Persons—Prior to January 1966 certain portable aids (for example bath seats, bath boards and raised lavatory seats) were provided to registered physically handicapped people under the Council's scheme for the welfare of such persons. It was felt these aids could also be of great benefit to many people, particularly infirm elderly persons, who would not necessarily be eligible for registration as being permanently and substantially handicapped. In January 1966 the Council, therefore, decided to extend the scope of the home nursing equipment scheme to make a wide range of portable aids available for free loan to all necessitous people. Moreover, as new items of nursing equipment become available, they are tested and, if found suitable are introduced into the service. The table below shows the items of equipment loaned during 1966 and, where appropriate, the comparable figures for the preceding year. Equipment Number Loaned 1966 1965 Bathing Aids *Bath Boards 23 *Bath Mats 36 *Bath Rails 21 *Bath Seats 43 Bed Aids Air Ripple Bed 3 — Air Rings 41 46 Back Rests 103 80 Bed Blocks 8 — Bed Cradles 83 64 Bed Pans 54 40 Sorbo Rings 32 21 Fracture Boards 23 16 Mackintosh Sheeting 101 76 Urinals 43 27 Stoke Mandeville Slings 2 — Beds Adult Cot 6 7 Egerton Bed 1 1 Hospital Bed 16 18 Commodes Armchair 348 307 Others 1 — 148 Equipment Number Loaned 1966 1965 Domestic Aids *Combs (Long-Handled) 1 *Fireguards 34 33 *Pick-Up Sticks 11 *Shoehorn (Long-Handled) 3 *Stocking Aids 6 *Tap Turners 3 *Tin Openers (Wall Type) 2 *Trolleys 4 Eating Aids *Food Guards 1 Hoists Easi-Carri 2 13 Penryn 15 10 Mattresses Dunlopillo 14 Hair 9 P.C.P. 1 1 Easi-Nurse 1 - Premature Baby Scales 14 3 Toilet Aids *Air Rings (Toilet) 5 * Raised Toilet Seats 11 Toilet Aids 6 Walking Aids Elbow Crutches 2 Walking Frames 109 67 Tripod Aids 19 Walking Sticks 18 Wheelchairs (Indoor Type) 57 41 Total issues 1,336 894 * Equipment newly available on loan. Excluding the 176 issues of newly available equipment in 1966. a total of 1,160 items were loaned during the year compared with 894 during 1965. This represents an increase of very nearly 30% and it is anticipated that the demand will continue to increase. 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. 149 During the year, some 246 applications were dealt with regarding holidays for handicapped persons. For various reasons 65 of these were subsequently cancelled and the actual number proceeding on holiday was 181. 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 of which 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 it is anticipated that, in the near future, the opening of 3 combined centres will provide urgently needed facilities for handicapped persons. HANDICAPPED CHILDREN AND YOUNG PEOPLE Co-ordination of the Education and the Health and Welfare Services During the past 20 years, school population has increased by about 2,500,000 pupils and, although accurate statistics covering all handicaps are unobtainable, it is estimated that this has resulted in some 250,000 being added to those requiring special educational treatment. Moreover, by reason of better care of the premature infant, advances in surgery and its techniques which is saving many spina bifida and hydrocephalic babies and new discoveries in the field of chemotherapeutics, the actual numbers of handicapped are increasing and the accompanying problems correspondingly more complex. Early identification of disability and subsequent assessment is essential if the potential of a child is to be completely or substantially realised. Full assessment of any child who is handicapped may well involve one of a number of sciences such as paediatrics, orthopaedics, audiometry, speech therapy, ophthalmology, psychology, psychiatry, the expert in physical medicine and occasionally, perhaps, the geneticist. With such diverse skills and disciplines involved, no longer is it within the compass of any single individual to make a full assessment and the necessity of complete co-ordination is self evident. 150 Apprehension by the Minister of Health regarding co-ordination of various services prompted the issue, during the year, of his Circular 7/66 jointly with that of 9/66 from the Department of Education and Science requesting information concerning the coordination of the Borough's health and welfare services for the handicapped with those of the I.L.E.A. Following a review of the Council's services and of the several specially convened meetings at which all relevant bodies were represented, a procedure for the co-ordination of services for handicapped children in Greenwich was drawn up and copies forwarded to the Minister and to the Secretary of State for Education and Science respectively. Details of the operation of the procedure are given below:— A. The Risk Register (1) From information provided by the birth notifications received in the Department, an indication is obtained of children at risk of developing a handicapping condition. These children are placed on a Risk Register. (2) Hospital and other medical and social information is regularly sought about these children and their progress is reviewed by a Senior Medical Officer and Assistant Nursing Officer. (3) Children are not removed from this Register until there is no doubt that their development is normal. B. The Handicapped Register (1) Children known to be handicapped at birth and those diagnosed later as handicapped following observation on the Risk Register and/or information received from hospitals are placed on the Handicapped Register. (2) Information is regularly obtained and recorded. The children's medical and social progress is reviewed by a Senior Medical Assistant, Assistant Nursing Officer and field staff. (3) Health Visitors attend the local paediatric out-patient clinics and add to the source of information regarding these children, as well as providing hospital staff with information about the social background of all local children attending the Paediatric Department. *(4) The Divisional Education Officer is notified of those children sufficiently handicapped that potentially they require special education. It is hoped that this will enable future planning of educational services to be met on a reasonably reliable estimate. (5) Regular consultations take place between a Senior Medical Officer, Assistant Nursing Officer and the Principal Mental Health Officer in appropriate cases. The Principal Mental Health Officer is brought into the picture as soon as a diagnosis of potential mental handicap has been made. 151 (6) An examination of all children sufficiently handicapped that potentially they require special education takes place after the age of 4 years. Recommendations are made regarding schooling and attendance at Nursery Schools is advised when necessary and when vacancies can be obtained. Unfortunately, insufficient vacancies are available both for physically handicapped and socially handicapped children. *(7) A copy of recommendations regarding special education of handicapped children is sent to the Welfare Section. Visits to these children and young people by various interested Social Workers are arranged to avoid overlap and over-visiting, but information is provided for all Social Workers involved with the case, including the Children's Officer when appropriate. (8) Parents of children who are suspected of being mentally retarded are invited to a Special Clinic staffed by a Medical Officer particularly experienced in mental subnormality. Here regular observation of the child's progress takes place and parents receive advice on training and management of the child at home. This Clinic also affords the opportunity for the Mental Health Officer and parents to become acquainted in an early period of the child's life. A recommendation may be made that the child should attend a Nursery Class of an ordinary school or of the Junior Training Centre. When the child is approaching the age of 5 years, he is examined, often by the Medical Officer who knew him at the Special Clinic, to ascertain whether he should enter an ordinary school for a trial period, whether he should attend a school for educationally subnormal children or attend the Training Centre. (9) Blind children are invariably on the Risk Register or the Handicapped Register from birth. They are visited by the Social Worker who is a home teacher of the blind and is able to advise parents on management and services available. Close co-operation takes place between this Social Worker and the Health Visitor who has a statutory duty to visit all children under the age of 5 years. Care is again taken to ensure that the home is not overwhelmed by a multiplicity of visitors. These children are reviewed again at the age of two years, medical reports are obtained and information is sent to the Medical Adviser who has an Ophthalmologist appointed to his staff. A recommendation may be made for residential nursery placement. If the child ultimately attends a Day School for the partially sighted, co-ordination of services is effected by the School Care Committee. At the time of school leaving, the Welfare Social Worker who has known the child from an early age and has kept in touch with the family assumes the community care which is necessary both if the young person is able to work and also if he is unemployable. 152 (10) Children who are found to be deaf may have been on the Risk Register or may have an acquired deafness. Most of these children will be notified to the Department by the Hospital Consultant. They are reviewed regularly by a Medical Officer and Social Worker to ensure that they are obtaining the necessary aids, keeping hospital appointments and receiving training. At the age of two years a complete medical and social history is provided for the Medical Adviser whose Otologist makes a recommendation regarding future schooling. Again during school years, co-ordination takes place between the School Care Committee and the Social Worker staff from the Department. C. School Children in Special Schools (1) These children are examined by a School Medical Officer every term, also by a Consultant employed by the Inner London Education Authority in the case of deaf, blind and physically handicapped school children. At these examinations, consultation takes place between the Medical Officer, Head Teacher, parent and Care Committee Worker to ensure that education and all necessary services are obtained by the child and his family. (2) An annual rota examination takes place in all children attending E.S.N, schools at "upper" and "lower" limits of this designation, otherwise rota examinations take place on recommendations by the Head Teacher. (3) The Borough Deaf Register contains the names of all deaf children of any age. This ensures regular review of these children by a Medical Officer and Social Worker. In every case medical and school progress reports are obtained and appropriate action is taken. In the case of children attending schools for the deaf and partially hearing, the children are also regularly reviewed by an Otologist employed by the I.L.E.A. (4) The welfare of children in Boarding Schools is followed up by the School Care Committee or a Social Worker of the Invalid Children's Aid Association. The Principal Social Worker (Health Services) is kept informed of the progress of these children. *(5) The I.L.E.A. Working Party has suggested that a Social Worker from the School Health Service should be appointed to all Special Schools. There is good liaison between the local Paediatric Departments and the Borough concerning the progress of children who attend these schools and the hospital Out-Patient Department and Local Authority Social Workers already work within the hospitals to co-ordinate services for all school children, not only the handicapped. No firm attachment is possible at present to Special Schools or hospital departments due to staffing difficulties, but whenever a Consultant requests such a visit, the appropriate Social Worker goes into the hospital—not only the Social Worker (School 153 Health Service), but also Health Visitors and Mental Health Officers perform these duties when required. Routine reports are received from the Consultants whenever a school child is seen at the hospital. (6) There is constant consultation between the Divisional Education Officer and the staff of the School Health Service. This consultation does not always take the form of formal conferences, but individual children are frequently discussed by Medical Officers and Social Workers. Formal conferences at field level are constantly held to discuss families with social problems and the l.L.E.A. Working Party suggested that such meetings could also take place to discuss all handicapped children. This suggestion raises the problems of time and staffing difficulties. D. School Leavers (1) From E.S.N, school—discussions already take place between Head Teachers, Youth Employment Officers, the Mental Health Officer and parents of the school leaver. Community care is arranged when this is thought to be necessary, desirable and acceptable to the family concerned. It is hoped to extend this arrangement to all handicapped school leavers, some of whom will not require or desire follow-up and community care. *(2) Medical records and case files for all physically handicapped school leavers are passed to the Welfare Section. *(3) The names and addresses of severely deaf school leavers are passed to the Welfare Section, together with the children's records. Recommendations are made to the Youth Employment Officer by School Medical Officers and the l.L.E.A. Otologist concerning future employment. (4) Handicapped children attending ordinary schools are known if their names have appeared on the Handicapped Register, but many are older children who passed into school before the existence of the Handicapped Register. Attempts will be made to notify School Medical Officers about these children so that their progress can be followed at regular intervals. However, such reviews must be carried out with circumspection since if these children are managing life within the normal educational system without special help and are rightly encouraged by their doctors to regard themselves as capable of living normal lives, it would be wrong to give any indication such as by too frequent observation or questioning of the child and his parents that one anticipates that complications in life may arise as a result of the handicap. In any case, at the school leavers' examination, the School Medical Officer, parent and sometimes teachers discuss contra-indications to certain forms of employment and the Youth Employment Officer is notified of this recommendation. 154 E. Children with Dual Handicaps Between the ages of 2-5 years, these children are usually examined by a member of the staff from the Department of the Medical Adviser or, by agreement, by a member of the staff of the Principal School Medical Officer. Placement is usually difficult and these children often require Boarding School education. Support is given to these children and their families by the Social Workers who act with the Medical Officer or Principal Medical Officer and these workers ensure that home aids, transport and all other necessary help is available. The welfare of these children when they have entered Boarding Schools is followed up by the School Care Committee or Social Worker of the Invalid Children's Aid Association. F. Ineducable Children and Young People (1) After ascertainment under Section 57 of the Education Act and Committee approval, the Mental Health Officer from the Department visits the child's home to explain the significance of the decision and the local Health and Welfare Services that are available. (2) Arrangements are made for attendance at the Junior or Senior Training Centre in the Borough where basic skills are taught and the child or young person is prepared for life in the community. (3) Mental Health Officers are continually in contact with the staff at the Training Centres, the child and his family so that all needs are met and training initiated at the Centres is promoted at home. * Indicates an item which has been or will be introduced as a result of the receipt of the Circular. 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. 155 Action was taken by the Council in 4 instances to mitigate damage to, or loss of movable property belonging to patients admitted to hospital. In two of these cases, property was moved into store for safe keeping. 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 26 deaths. The Council's expenses totalled £256, of which approximately £243 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, 1966, only one establishment was registered and this was in respect of an Old People's Home providing accommodation for eight people. COMMUNITY GERIATRIC SERVICES Geriatrics is the branch of medicine which has re-introduced 'independence' to the vocabulary and life of elderly persons. During the past 20 years, it has progressed from an era characterised by the reception of old people in the final stages of dissolution to the present age of preventive medicine which assesses, rehabilitates and, where possible, returns persons to their own homes or to those of the now more enlightened welfare authorities. Differing views are held on the extent to which the community should accept or assume responsibilities for the problems of the individual and these are often coloured or influenced by various political philosophies. Nevertheless, most people would agree that those at risk or unable to look after themselves should be protected and that essential items and services should be made available as soon as and as fairly as possible. However, the use of the word 'protected' should not be construed as meaning that the deprived or disabled should be compelled to take up a purely 'passive' role. On the contrary, rehabilitation or restoration of independence, wherever possible, should be the primary aim. Old people were the least well provided for under the National Health Service Act and, until comparatively recent times, legislation covering their needs was notoriously scanty. However, this legal 156 limitation proved of little consequence in Greenwich for, over a number of years, its comprehensive geriatric services evolved on empirical lines, viz. ascertainment of needs and the production of practical solutions, all with a view to creating for our residents, an old age of which we ourselves would be unashamed. It has always been, and still is, our endeavour to understand the problems and state of mind of the aged and/or the solitary person for whom these services exist, to impress upon them that they are not forgotten, to lend assurance in their fears and to help them realise some of the few hopes still remaining to them. Naturally everyone is different but as people grow older, generally their bodily alertness wanes, their emotions cool and they begin to accustom themselves to life on a lower key at a slower rate. Impetus may be given to this decline by illness, 'stroke' or perhaps the loss of a close relative. As a result of poorer muscular co-ordination old people, generally, are subject to a certain amount of unsteadiness which, on occasions, is inclined to precipitate falls involving fracture of thighbones which could spell disaster. Accidents of this nature are likely to occur on rising quickly in the morning before the circulation has a chance to adjust or after a hot bath or a heavy meal when the heart is undertaking a little extra work. Nutritional problems among the aged are common and, due perhaps to a reluctance to take exercise or sheer forgetfulness, costiveness or incontinence may become established to prove a continuing difficulty. Loneliness, which often impels an elderly person to a bedridden existence long before this really becomes a necessity, is sometimes responsible for mental deterioration. This may present as a serious arteriosclerotic dementia or merely as insomnia, irrascibility, forgetfulness, wandering, mislaying personal possessions and an inability to dress properly, etc. In a recent survey at Newcastle, it was found that about 12% of a random sample of old people of 65 years and over suffered from psychiatric disturbance of at least moderate severity and, of these, only a small proportion were in hospitals or residential homes. It has been suggested by the Minister of Health that an allocation of 10 hospital beds per 1,000 persons over the age of 65 years could be considered reasonable but that this figure was only for guidance and would vary when regard was had to the local population structure. However, on a national level there would certainly appear to be a general shortage of geriatric beds. This has been supported by recent investigations which have revealed that numbers of acute hospital beds are 'blocked' by geriatric patients who do not require nursing skills and who, rightly, should be at home with supportive services or in local authority welfare homes. Predicaments of this nature could largely be avoided by careful assessments prior and subsequent to admission aided by full co-ordination of hospital 157 and local authority services. In relation to this Department's services, such problems have been minimised by its insistence on an accurate initial assessment by a skilled geriatric visitor and by the appointment of Dr. Boyd, the Consultant Geriatrician to St. Alfege's Hospital, as the Council's Geriatric Adviser. Our relationships with the local hospitals' geriatric services, already close and cordial, have thereby been further improved and we are more nearly at the point when we can say we have 'the right patient in the right bed'. Our experience, locally, convinces us that the majority of the elderly wish to remain independent in the familiar surroundings of their own homes and our supportive services, therefore, are organised and directed towards that end. Admissions of the aged to hospitals or residential homes can often be avoided, with consequent economic advantages, by better nutrition. Indeed, a case could doubtless be made out for the appointment to the department of a dietitian whose duties, inter alia, would include nutritional advice to the elderly. Response to a proper diet is often dramatic in elderly people and many an old person with mental infirmity has made a remarkable recovery when regular, balanced meals have been forthcoming. Support of this principle is evident in the Department's 13 luncheon clubs and a 5-day per week 'meals-on-wheels' service with emergency arrangements for weekends. Recipients of meals-on-wheels are carefully selected for it is recognised that attendance at luncheon clubs has not only a nutritional but a therapeutic value. The clubs entice the elderly from their homes and, in doing so, maximum benefit is derived from the effort of dressing and titivating and the energy, both physical and mental, involved in mixing with others. In addition, encouragement is given to our elderly citizens to make use of the 55 old people's clubs and so avoid the devastating effects of loneliness. As yet, notification to the department by general practitioners of elderly persons at risk is not obligatory but there is extremely good liaison and regular contact with local doctors, officers of the Ministry of Social Security, clergymen and other voluntary bodies which enables our services to be brought to bear on many of the day-to-day problems of elderly people. Our present combined health and welfare department ensures the closest co-operation of geriatric visitors with the district nurses and home helps which, with appropriate use of the department's supportive services, not only makes domestic life for the homebound a feasible proposition, but reduces demand on the Council's residential accommodation. The proportion in the population of residents over the age of 65 years is rising and with this increase comes the additional need and demand for domiciliary services. Future planning and develop- 158 ment will need to take account of these and other changes especially those following implementation of the G.L.C's housing scheme on the Plumstead Marshes. At present there are some 9,000 elderly persons in the Borough subject to geriatric visiting or in receipt of other departmental services, a figure which represents 25% of the estimated total of all male residents over the age of 65 years and females over 60 years. The size of this register indicates the large majority of our pensionable people are reasonably fit and well and, with our emphasis on the preventive aspects and with judicious use of the domiciliary services, it is our earnest endeavour to maintain or even improve on the present position. A 'mobile body is a healthy body' is a truism which moves the geriatric services to ensure that the elderly are encouraged to make the maximum use of their facilities, to remain active, to have a proper diet, to have regular social contacts, to have a high standard of personal hygiene and not to lapse into apathy or despair. 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. Visits made during 1966 amounted to 24,549, a fall of almost one third from those of the previous year. This is wholly accounted for by the considerable shortage of qualified staff for, although an establishment exists for 11 public health officers, the actual visiting strength was only 7. In consequence, average case loads for the geriatric visitors rose, in most instances, from the usual 800/900 to over 1,000. Therefore, during the year, in order to husband the department's visiting strength, further decentralisation of staff became a necessity. Travelling time was saved and opportunities to foster even closer relationships with cases were increased by placing some public health officers in accommodation located within their own particular areas. At the end of the current year, offices for geriatric visitors were in use at the Abbey M. & C.W. Centre, Lionel Road Bathing Centre and at Eltham Library. Plans for the use of appropriate accommodation at Plumstead Baths are nearly complete. To cater for any sudden emergencies, daily contact is maintained with headquarters. Because of staff shortages, priority had to be afforded to the homebound and those considered to be at risk. Elderly People in Receipt of Visits and Other Services Number in Register at 1st January, 1966 8,120 Number in Register at 31st December, 1966 9,006 159 Elderly Handicapped Persons included in the above Register: (i) Blind 318 (ii) Partially Sighted 155 (iii) Physically Handicapped 566 1,039 Visits by Women Public Health Officers Total Visits by Officers during year 24,549 1st Visits 1,268 Unsuccessful Visits 3,459 Cases referred to:— A. British Red Cross Society 42 B. Chest Clinics 20 C. Church or Club 109 D. District Nurses 83 F. Chiropody Clinic Domiciliary Service 204 G. General Medical Practitioners 205 H. Borough Dept.—Housing 304 J. Borough Dept. Public Health Inspectors.. 78 K. Borough Dept.—Home Help 581 L. Borough Dept.—Blind Welfare 19 M. Borough Dept.—Mental Welfare 38 N. Borough Dept.—Physically Handicapped Welfare 80 O. Borough Dept.—Old People's Holidays 666 P. Hospital Service 54 Q. National Assistance Board 99 R. Mobile Meals 406 S. Radio (Wireless for the Blind) 5 U. Radio—Others 5 V. Women's Royal Voluntary Service 20 W. Ophthalmic Domiciliary 45 X. Dental Domiciliary 15 Y. Friendly Visitor 41 Z. T. V. (Wireless for the Blind) 77 A.A. T.V. Anon, donor 8 B.B. T.V. Others 42 CC. Transport—British Red Cross Society 14 DD. Referred for Pt. Ill Accommodation 90 Bathing Service This very personal service which is much appreciated by the elderly who view it also as a social occasion to have a chat and a cup of tea in a congenial atmosphere, expanded still further during 1966. Another unit was opened at Lionel Road to add to those already 160 functioning at Tunnel Avenue and Plumstead Baths. The Bathing Service Staff now consists of:— 11 Full time Bath Attendants 1 Part Time Bath Attendant 3 Male Bath Attendants 1 Driver (combined post) 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 Lionel Road Total Number bathed at home 2,187 3,364 1,015 6,566* Number bathed at centre 1,884 1,450 483 3,817† Pedicure 315 39 30 384 Hair-washing 10 — — 10 * Mates 2,677 Females 3,889 t Males 888 Females 2,929 Miscellaneous—Treatment of scabies and the cleansing of verminous persons are also duties falling to the staff of the bathing centres. 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 161 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. 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, one at the Tunnel Avenue Centre and the other at the White Hart Road Centre. How effective and valuable this service is proving to be is shown by the following statistics:— Tunnel White Hart Avenue Road Number of articles laundered 82,690 99,438 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 37 From Tunnel Avenue Bathing Centre 5 From Lionel Road Bathing Centre 2 C hiropody Services Weekly chiropody sessions, under the control of the Council's Chief Chiropodist, are held at Tunnel Avenue Bathing Centre for patients who, unable to walk, need the Centre's services and are conveyed there by minibus. In addition, a domiciliary chiropody scheme for Borough residents is operated by the Greenwich Council of Social Service and full consultation with the department's geriatric branch ensures the treatment of priority cases. Tunnel Avenue—Sessions: 52; Persons Treated: 335. Council of Social Service—Treatments: 1,862. Mobile Meals There has been a continued growth in the demand for mobile meals for necessitous old people. To meet this need, 3 new minibuses were purchased which increased the number of meals vehicles to 15, each vehicle being capable of delivering some 36 lunches. The total 162 number of meals delivered during the current year, viz. 113,290, shows an advance of over 27% compared with 1965. Actual persons receiving 'meals-on-wheels' numbered 606 at the end of the year, a figure equivalent to more than 2% of the total of all residents over the age of 65 years. The charge to the recipient for each meal remained at 1s. 1d., the balance of the cost being subvented by the Council. In cases of need, a restricted service was provided during Bank Holidays and, over the Christmas period, 84 meals were delivered on Christmas Day, 88 on Boxing Day and a further 121 on December 27th. Emergency food packs for the use of old people were again distributed during the winter months to cover the eventuality of 'non-delivery' of a meal during severe weather. Provision of Mobile Meals (during 1966) 1966 1965 Mobile Meals served during year 113,290 88,988 Persons on Mobile Meals Register 606 453 (315/ December, 1966) Luncheon Clubs 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, the Council's policy in relation to its Luncheon Club Service is one of expansion. During the year, the number of meals served was 148,786, an increase of over 24% compared with the figure of 119,945 for 1965. New clubs were opened at St. Luke's Church Hall, Charlton Village, S.E.7, and at St. James' Church Hall, Burrage Road, S.E.I8, in June, both of which have proved to be very successful and the present daily attendances of over 70 at each club indicates their popularity. All clubs provide opportunities for social activities and organisers invariably arrange outings and Christmas treats for their members. An increasing number of elderly homebound persons are being conveyed to luncheon clubs and, in some cases where there is an established Old People's Club held on the premises during the afternoon, they stay to enjoy the social activities. There are some 6 luncheon clubs which are able to offer this dual service for the benefit of the homebound. As with the mobile meal, that served at lunch clubs is subvented by the Council and the cost to the member remained at 1s. 1d. By the end of the year, negotiations were well advanced for the opening of a new club at the Methodist Hall, McLeod Road, S.E.2, and plans for a further 3 clubs were being formulated, 163 Geriatric Clinics During the previous year, consideration had been 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 establishing geriatric clinics, it was the Council's intention to offer old people, who were in apparent good health, a routine medical examination and to give them an opportunity to discuss their problems with a doctor in a relaxed atmosphere. In no circumstances was it envisaged that treatment should be given but that if any unsuspected lesion was found the patient would be referred to his/her general practitioner for attention. In June, 1966, a clinic was opened at Charlton Lane Centre and, by the close of the year, 5 other such clinics were in operation, namely, at Market Street Centre, Abbey Centre, Avery Hill Centre, Garland Road Centre and, on occasions, at the department's Headquarters' Medical Room. Problems revealed by patients varied from the absence of bathing facilities in their living accommodation to the cost of replacement of spectacles or dentures. At the physical examination, the patient's height and weight were measured. Their distant and near vision was tested and, if they wore a hearing aid, this was checked. Blood pressure was recorded and urine tested for sugar, albumen and blood. Diet was discussed in detail and a close watch was kept for signs of any mental disorder. Publicity was achieved by geriatric visitors talking about these clinics at Old People's Clubs and a large number of requests for examination came from patients whose friends had already been to a clinic. During the year under review, 117 appointments were made in response to requests which resulted in 94 attendances. Of these, 28 were referred to their general practitioner, the commonest reasons being hypertension, deafness and depression. Some of the hearing defects were so severe that these patients were gradually withdrawing from contact with people because they were embarrassed at not being able to follow any normal conversation. Naturally, the slow pace of these clinics, although very pleasing to the patients because it gave them time to air their worries and fears, was very time consuming and numbers were relatively small. Assessment of the value of the clinics will be needed but this will only be possible after they have been in operation for a longer period. 164 GERIATRIC ADVISORY CLINICS Disposal of Patients Found to be Fit 35 Referred to General Practitioner 28 Referred to Dentist 7 Referred to Optician 4 Referred to Chiropodist 3 Total Attendances 94 Referrals to General Practitioners Raised Blood Pressure 12 Hearing Defects 7 Depression 7 Varicose Veins (elastic stockings) 3 Sugar in Urine 3 Rodent Ulcer 1 Melanoma 1 New Surgical Belt 1 Geriatric Adviser to the Council In his Circular 10/65, the Minister of Health 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. There are indications that, despite every effort made to the contrary, much undiagnosed illness and undisclosed disability in the elderly exists. 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 hospitals' geriatric services was satisfied by the 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 has led to a situation where each elderly person now receives appropriate care from the appropriate authority. Geriatric Units 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. Holiday Relief for Relatives Many families who are caring for seriously infirm elderly relatives have great difficulty in taking an annual holiday. In many such cases the Council was again able to help by providing accom- 165 modation for the elderly relatives for the period of the holiday. In the main, these old people were temporarily admitted to Old People's Homes but, as the result of a combined effort of trained staff and voluntary help, some 65 old people who had considerable disability were enabled to enjoy a holiday under the Council's Avery Hill Holiday Scheme, and their relatives afforded a much needed break. In accordance with these arrangements, use was made of the College students' ground floor single rooms to provide some 65 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. Nutritional Supplements A scheme is in operation throughout the Borough for the sale to bona fide retirement pensioners, at preferential rates, of various nutritional commodities. Distribution is mainly via Old People's Clubs which make 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 £7,500. 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. Physical Aids A number of conditions arising as a result of old age are assisted by the use of simple aids and arrangements have been made for Women Public Health Officers to authorise issue of such articles in a similar manner as loans of medical equipment. 166 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 issued a comprehensive guide to the Health and Welfare Services to all local general practitioners, hospitals, statutory and voluntary organisations and to all workers in the health, welfare and social fields. 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 and the successful functioning of the scheme owes much to the devoted attention given by the W.R.V.S. and the B.R.C.S. Each week about 50 homebound persons are able to take advantage of these facilities and this club is so successful that the Council's Welfare Committee is anxious to establish similar services elsewhere in the Borough. Unfortunately suitable premises with a high standard of comfort are difficult to come by and the Committee were constrained to introduce a 'pilot' scheme at one of the Old People's Homes. This has not been quite the successful venture as had been hoped but it is abundantly clear that much of the success of these clubs depends upon the close relationships built up between the voluntary helpers and club members. Nevertheless, although expansion in this field is being eagerly sought, present financial stringency will prove to be a substantial obstacle. 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 available at West Greenwich House, 141 Greenwich High Road, S.E.10, Charlton House, S.E.7, Ogilby Club, Calderwood Street, S.E.18, 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. It is with regret that the closure of the club at Calderwood Street at the end of the year has to be reported but, fortunately, in a rebuilding scheme in the vicinity, provisions are being made for another such club to be established. AVERY HILL HOLIDAY SCHEME FOR HOMEBOUND ELDERLY (for the relief of Relatives) The 'Venue' 'Setting Out' 'Case Conference' 'Sunday Symphony' 'Olde Tyme' Entertainment—The 'Strong Man' 167 Old People's Clubs—To assist newly established clubs to equip themselves, it is the policy of the Welfare Committee initially to make a grant of £10 and to continue this support on an annual basis in order that clubs may be enabled to expand and improve their recreational facilities. During the current year, 4 initial and 47 annual grants of £10 were so made. Old People's Clubs in the Borough, almost all of which regularly meet on a weekly basis, 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. Holiday Hotel—To meet an ever increasing demand by elderly residents for holidays, the Council operates its own hotel for the exclusive use of Greenwich residents at Westgate-on-Sea. The present hotel, which is managed by a Resident Superintendent and Assistant with appropriate staff, is an annexation of the previous Greenwich and Sea Grange Hotels and it caters for almost 2,000 guests annually. Existing accommodation at the combined hotels 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. It is the Council's intention to provide a cheerful holiday and recreational facilities for guests and, although the holiday-makers are generally expected to be active, provision is made for frail and handicapped old persons to be accommodated on the ground floor. 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. The new combined hotel remains open to enable 'out of season' holidays to be taken. Charges are very reasonable and, when 168 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. By reason of the extensive works of adaptation being carried out during the current year, the total number of guests accommodated was reduced to 418. In her Report for 1966, Miss W. E. Wilson, the Resident Superintendent, stated that "the Hotel was closed from 1st January to 13th May to permit extensive alterations to the kitchen and stores. The builders were in occupation of the old "Sea Grange" building, where they carried out adaptations and decorations to the whole building. This work continued until December. Meanwhile, 28 guests per fortnight were accommodated in the original Greenwich Hotel, parties changing on alternate Fridays, from 13th May to 9th December. The Hotel was closed from 9th December for two weeks, to enable new carpets to be laid, and new furniture to be arranged. The whole building was re-opened on 23rd December, with a Christmas party of 50 guests." Visitors Whit Sunday Mayor and Mayoress of Greenwich Burgomaster of Reinickendorf Sixty Councillors Friday 30.12.66 Mayor and Mayoress of Greenwich Chairman of Welfare Committee Medical Officer of Health Concerts and Outings, etc.—Restricted mobility renders elderly people unsuitable for whole day outings. Selection for half day breaks is therefore based upon up-to-date visiting data. During the year, 40 trips were arranged whereby 306 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. With the department's 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. 169 Through the generosity of a private donor, other television sets were made available, without charge, to 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. A number of elderly homebound people in the Kidbrooke area are visited every fortnight by volunteers who distribute and exchange books chosen from the Kidbrooke Branch library. Civic Entertainment—I am indebted to Mr. T. W. Dobinson, the Council's Entertainments Manager, for the statistics given hereunder:— "For your information the following figures were recorded on the entertainments provided for O.A.Ps. in the calendar year of 1966: No. of Shows No. of Type of Show During year Venues O.A.P. Club Shows 420 48 *O.P. Homes Film Shows 52 4 *Avery Hill Shows 10 1 *In conjunction with the Health & Welfare Department The afternoon shows in the Clubs lasted for one hour and the entertainment provided by three artistes per show. Films booked for the Homes throughout the months January-March and OctoberDecember were full-length features, half of which were in colour. The shows at the Avery Hill Home were presented between August 7th-19th and included 6 film shows, 2 variety and 2 programmes of light music." Carol Services—Carol services for the elderly were held at Christ Church, Greenwich, St. Nicholas, Plumstead and Eltham Congregational churches on 12th, 13th and 15th December, respectively. In all, some 215 persons attended these services after which refreshments were provided by voluntary organisations. Handicraft Exhibition—At a Garden Party held at Charlton House on 25th June, a handicraft exhibition attracted 172 entries from our elder citizens. Mayor's Fund—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. Christmas Parcels—Distribution on Christmas Eve of over 5,500 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 170 'needy' 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 operation 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. Observers Services provided in this Borough for the elderly are attracting observers from many sources, Representatives of interested organisations from Australia, America and Czechoslovakia have been welcomed and given every opportunity to study our services for the elderly. In particular, following a request from the Ministry, arrangements were made to give a conducted tour of our geriatric services to a group of 25 Italian doctors, some of whom returned in 1967 with other colleagues. Advantage is also taken of our services by Health Visitors and Hospital Students in accordance with their various curricula. Voluntary Help There are a number of voluntary organisations and 'solo' volunteers giving to our elderly citizens regular services such as grasscutting and gardening, painting and interior decorating, driving and escorting, radio and T.V. repairs, sewing and mending, sick visiting and shopping, provision of firewood and fuel, hairdressing and changing of library books, etc. 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. 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. Many Christmas Parties were arranged in the Borough for elderly and handicapped people by local organisations and local Rotary Clubs again arranged outings and entertainment for many old people recommended by the Department. 171 Friendly Visiting, etc. Some 350 friendly visits were made by voluntary visitors, reporting directly to the department. In addition, a number of school and church groups and 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. 172 SECTION VI MENTAL HEALTH SERVICES Introduction If it were necessary, the aims of the mental health services could perhaps be epitomised as 'the helping of each individual with a mental disability, in a confident and suitable manner, to make as good an adjustment to life as his own particular potentialities and circumstances will allow'. Undoubtedly the degree to which these aims are achieved depends upon the accuracy of the assessment or measurement of 'potentiality' and 'circumstances' and herein lies one of the more important difficulties. Circumstances, in this context, is a broad term to be construed as society in general, the control of which is impossible even if it were desirable and it is only the immediate environment which can be subject to a modicum of amelioration. To say that there is a 'genetic' or a 'social environment' connection with mental illness is to state the obvious but, at the present time, it is unlikely, if not impossible, for a definition of mental health to be given which would be universally acceptable. Nevertheless, in a negative way, it can be said that mental health is absence of disease and also that it is possible to assess mental ill-health in terms of behaviour and the social problems it engenders. In the preventive field, there is very little epidemiological data available and, indeed, our scanty knowledge of mental health is fnainly empirical. Naturally, therefore, our services are concerned with care and after-care of persons suffering from various mental disorders and that this is rehabilitation rather than prevention. So far, there is little indication that the incidence of serious mental illness is reduced by preventive measures. It is true that circumstantial evidence points to the fact that hormonal changes in adolescence, pregnancy and in old age may predispose an individual to emotional instability but there is a desperate need for a reliable method of measuring mental health in order that real progress towards prevention can become a practicable proposition. To date, attention has been mainly confined to the measurement of'performance' which is the psychologist's general approach. It is more probable, however, that prevention, if at all feasible, will be better served and many of the anomalies of human behaviour explained by the modern studies now taking place in neurophysiology. It has been suggested that mental illness is a combination of three disorders, namely, inadequate personality, unresolved depression and unrelieved anxiety. With the use of modern drugs, the latter two disabilities can be controlled but inadequate personality, 173 the inability to make the appropriate response to a social challenge, requires an understanding of the brain's capacity to handle 'incoming' messages and its accurate control and direction of the resultant motor circuit impulses which subserve the functions of behaviour. Mechanical brain damage can have startling effects on behaviour and modes of thought, and we are becoming increasingly aware that certain chemicals have similar effects. Such results indicate the dependence which behaviour and thought have upon the structure and function of the higher levels of the nervous system and it is here that neuro-physiology may well reveal the basic biological processes leading to social adjustment. Notwithstanding that there is evidence to support the theory that some people have a genetically inherited low anxiety-neurosis threshold, it is known that anxiety is basic to all human behaviour and that it is the natural driving force which persuades the body to take constructive and useful action. Often anxiety causes internal tension which may present as actual physical illness but if it results in ineffective behaviour and a defective personality, it is then considered to be mental illness. Yet it must be recognised that there never has been, or ever will be, a time when social and emotional environments could be regarded as ideal. Indeed, even if it were possible, it would be little short of disaster if all anxieties were to be removed from life for it is a fact that all bodily structures mature and improve their performances when provided with constant challenge. This is the process which develops personality. Recently it has been postulated that neurotic behaviour is learned. If this is substantiated then everybody, but parents in particular, must be made to realise the impact of their own behaviour patterns on a child's development for, as with physical education, personality development begins early in life. Discrimination and judgement are shaped by challenges graduated according to age, ability and aptitude and to entice children into the habit of thought and response to social situations is to introduce them to human relations' training and enables the foundations of a stable personality to be laid. Essentially, this is fitting the individual to the environment and it is society's responsibility to see that this environment is physically suitable and emotionally acceptable. Adulthood or maturity is exemplified by an individual's ability to balance his instinctive urges against demands of society and re-directing them into socially constructive channels. Although during the past few years new methods of care and treatment have evolved, officially the needs of the mentally ill can be met only by three agencies, viz. the hospital, the general practitioner and the local authority, and conflict of intent between any or all of these exposes the patient to great risk. With regard to these 174 needs it should be our earnest endeavour to see that our services are not found wanting. 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. General The current year has been one of consolidation. We have been fortunate in keeping our establishment of staff and, other than admissions to Day Centres and Hostels, we have been able to meet all demands made upon us for community and statutory services. Our immediate response to all requests made by general practitioners and psychiatrists for admissions to hospital has, on many occasions, been complimented. Support which we can offer to clients and their families in their own homes is extensive but, in itself, it is insufficient. Day Centres and a Hostel for the mentally ill, had they been available, would not only have avoided many frustrations but would have provided the staff with greater opportunities for producing satisfactory solutions. The lack of these amenities has been due, largely, to financial restrictions imposed by the Government. However, it was decided that premises at St. John's Park purchased for conversion to a Hostel 175 could be used temporarily as a Day Centre and, since February, 1967, it has been successful in accommodating an average of 25 persons for 5 days a week. Although the building is rather drab, the improvement in the mental state of persons attending has to be seen to be believed and this undoubtedly follows from the excellent atmosphere generated by the staff and leaves no doubt as to the value of such facilities. Satisfactory integration with the mentally ill by the few physically handicapped attending this centre justifies the department's decision for future Centres to be combined. Next year should see the opening of two combined Day Centres which are now well on the way to completion. One of the mental health Social Workers continues to attend Dr. Leiberman's Clinic at the Miller Wing of the Greenwich District Hospital on Wednesday afternoons. This arrangement has proved satisfactory and could, with advantage to all concerned, be extended to other out-patient clinics in the Borough if and when the Consultants at these clinics are prepared to accept them. At the Castlewood Day Hospital, a mental health Social Worker employed by this authority attends for three or four sessions per week. In addition, the salary of the Occupational Therapist and the fees of the Art Therapist for two sessions per week are the responsibility of this Council. Moreover, charges for patients attending the swimming baths are also met by this authority. Numerous visits, in addition to those normally solicited by general practitioners, were made by psychiatrists from Bexley Hospital at the request of the mental health staff to give advice and make recommendations. The advantage of such a procedure is that, if considered necessary, a bed at Bexley Hospital can be made available by the Consultant whereas, not having the means to admit a patient to hospital, a Council psychiatrist would be able only to advise on policy. Held at the Albany Institute on Wednesday evenings for the mentally ill of both Greenwich and Lewisham, the Tideway Club has proved to be somewhat disappointing, in so far as Greenwich is concerned, for only about 6 residents attend. Doubtless this is due, in part, to the fact that the premises are located at the extreme edge of the Borough and that the building itself is old and forbidding and does not readily lend itself to this type of activity. Co-operation with other departments of the Council has been maintained on a satisfactory basis, and relationships with statutory and voluntary agencies have been fostered and strengthened during the current year. Community Services for the Mentally 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. & C.W, clinics, doctors and 176 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 This clinic continues to be under the direction of Dr. J. Dunkley, Visiting Medical Officer from the Greater London Council and a Social Worker from the Mental Health Section also attends. Children Seen Greenwich Lewisham No. of new referrals 45 — No. of old cases seen 17 3 Disposal of Cases—Since investigation, 15 Greenwich children have been admitted to Maze Hill Junior centre, 7 to the Greenwich Society for Mentally Handicapped Children (Eltham Creche) and 28 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 cooperation 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. 177 Training Centres Maze Hill Junior Centre This centre, which was purpose-designed on a difficult site, was inherited 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, 1965. 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. 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 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 who suffer from specific problems such as walking, speech, self-feeding, 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. (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. 178 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 hygiene 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'. Discipline is maintained throughout the centre at such a level as will promote obedience and enable the child to exercise a measure of self-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 eventually for undertaking employment but also to encourage the use of leisure hours to advantage. (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 179 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. Comments At the Centre's opening in December, 1965, some 56 children were transferred from the previous accommodation at Cecil Rooms and, within a few months, the Nursery, Training and Special Care Units were fully occupied. Unfortunately, it had not been appreciated that, upon the establishment of this Centre, the I.L.E.A. would refer for further medical examination children from the lower streams of E.S.N. schools with a view to excluding them. This not only precipitated a situation whereby 33 children had to be accommodated at Maze Hill but also the establishment of a waiting list for all children found unsuitable for education at school. Furthermore, it also prevented the transfer of children from the Nursery or the Special Care Unit where places were taken up almost immediately. By dividing the Special Care Unit and altering a Nursery store it will be possible in 1967 to accommodate an additional 4 or 5 children in the Nursery and 3 more in the Special Care Unit. Much of the year has been spent in consolidating ideas and plans laid during the first few months of the Centre's existence. The senior class has become a transition group where less supervision is given and, in preparation for the future, the boys and girls are encouraged to adopt a more adult approach to work. Near-adult occupations have been introduced whereby boys are taught gardening, very simple carpentry and a variety of other suitable tasks. All girls' activities have been withdrawn from the boys' timetable, a step which would seem to have been very important. In addition to being taught to shampoo and set their own hair, the girls are learning plain needlework, first by hand and then by machine, and the group spends some time in 'self-help' activities such as care of clothes, nails, teeth, etc. All these pursuits are designed to help the boys and girls to integrate happily and unobtrusively into the community. Perhaps the most important aspect of the year's work is that the Centre has become much more of a place to work from than merely a building to work in. With the exception of the Nursery its occupants have moved out into the community. Infants are using the playground in the local park and are mixing with normal children. Juniors undertake nature walks and the intermediates make local visits of educational interest. By using public transport including the 180 'underground', the transition class ventures further afield to London and calls at a local cafe for refreshments are encouraged. Without doubt, social awareness in these children is increasing, and with the Centre's growth more and more points of interest are introduced. For example, animals suitable to various sections have been obtained and the children are gradually becoming responsible for their wellbeing. Need for teachers with specific qualities was realised and great care has been taken in selecting the extra staff required for the increasing numbers. In recruiting staff of excellent calibre, we have blended younger staff with older and, within the Centre we now have teachers possessing a whole range of abilities, all being employed to the children's advantage. It would be fair comment to say that, during this year, the Centre has drawn closer to educational methods of the primary schools and that the gap between education in its fullest sense and 'training' is gradually being narrowed. Six students have undergone periods of training at Maze Hill and a large number of visitors, both from home and overseas, have been accommodated. Park Vista Training Centre Held on lease, this Centre comprises the ground and first floors of the premises of a private undertaking and provides facilities for 60 adult girls, 42 of whom are Greenwich residents, 13 from Lewisham with 5 vacancies. 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. This centre has not made the progress one would have wished and, although the girls are quite happy with the present situation whereby they earn a little pocket money which makes them feel more 181 adult, I am confident that they are capable of accomplishing more difficult tasks. By transferring the boys at present attending the Lewisham Centre at Knoyle Street, it is hoped to make our establishment at Park Vista a mixed centre and, furthermore, by employing another male staff member, the undertaking of more useful and complex out-work can be entertained. In addition to laundering and plain cooking, the girls are being taught to shampoo and set their own hair and a few are being introduced to reading, writing and very simple arithmetic. On the occasions when they are taken out to places of interest the trainees travel by public transport. Some of the girls who previously reached the Centre by coach now make the journey by themselves but so far, during the current year, only one girl has been found suitable for transfer to the Blackwall Lane Industrial Centre. It is hoped to transfer more during 1967. As soon as is practicable, the whole scope and purpose of this Centre will be reviewed. Blackwall Industrial Training Centre This building, which has a total capacity for 35 trainees, is bright, airy, has good central heating and a well equipped canteen and accommodates 24 trainees from this Borough and a further 9 from Lewisham. It is the aim of the Centre where possible to bring the standard of ability of trainees to such a level that they can compete in the open market. When 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. Work at this Centre during 1965 was mostly the carding of simple items of stationery and printing on plastic. During the current year, efforts have been made with some success to obtain work of a light assembly nature from local concerns. More power tools such as bench drills and a lathe have been introduced with the result that 4 trainees have been placed in open industry and have managed to hold the jobs found for them. Others have been given trials in industrial firms but have failed to make the grade and have had to return to the Centre. Three trainees are capable of working in industry but their parents will not allow them to do so. With this Centre, however, there are 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. In consequence, a purpose-built Centre has been proposed and it is hoped that this will be included in the 1967/8 building programme. 182 Meanwhile, in order to overcome this difficulty, 12 of the trainees are working temporarily at 6, St. John's Park. This has enabled them to work at simple carpentry, an activity which was not possible at the Blackwall Lane Centre. They have been able to repair wooden furniture for the Council, make wooden bases for basketwork, etc., used by the physically handicapped at Ormiston Road and fashion coffee tables from materials obtained from old wardrobes. It is hoped that orders for such articles as table tennis bats, etc., will be obtained from the Greater London Council Supplies Department. Aided by voluntary helpers ,the staff of this centre continue to be 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. Average attendances at this club range from 25 to 30 each evening. Recently, parties of these boys and girls have been taken into the country for weekend camps under canvas. This has proved to be not only worthwhile but very popular. 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 and, 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 paid guides. 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. Holidays A scheme to provide an organised holiday at St. Mary's Bay Holiday Camp, Dymchurch, for trainees from centres had the support of other London Boroughs and during May, 38 trainees from the Maze Hill, Park Vista and Blackwall Training Centres attended. By such a scheme it is intended to cater for those trainees who 183 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. Training Centre Statistics Centre Park Vista (Adult Girls) Blackwall Industrial (Adult Girls and Boys) Maze Hill (Junior) Knoyle Street, S.E.14 (Adult Boys) Brighton Guardianship Number of Places 60 35 112 65 Not known Number of Greenwich Cases attending 38 24 89 17 3 Eltham Creche 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. Now, under the control of the Greenwich Society for Mentally Handicapped Children, this nursery provides accommodation for some 15 mentally handicapped young children of whom 10 are sponsored by this Council. 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 unrestricted. Undoubtedly, however, there is a great deficiency of beds in the area for mentally subnormal children but, with 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 needs, 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 184 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. 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 Greenwich Society for Mentally Handicapped Children. Attendances vary between 18 and 20. Hostels or Homes (for Subnormal Patients) 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. Subnormal Patients Placed in Homes or Hostels Roman Catholic Convents 5 Guardianship Society—Private Homes 8 Approved Private Homes 2 Halliwick School 1 National Society for Mentally Handicapped Children— Slough Project 1 Spastics Society—Meldreth 1 185 Mentally III Persons Placed in Homes or Hostels Mental After-Care Association Hostels 7 Jewish Welfare Board Hostel 1 Private Approved Home 1 S.O.S. Society Hostel 1 Y.M.C.A. Farm Training Hostel 1 National Association for Mental Health Hostel 2 Richmond Fellowship Hostel 1 Honor Lea (London Borough of Lewisham Hostel) 8 Castlewood 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 186 mise 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 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 'Tideway Club', Albany Institute, Creek Road, S.E.8. 'Castlewood', Shooter's Hill, S.E.18. 'The Links' Castlewood, Shooter's Hill, S.E.18. 'Vanbrugh', Kidbrooke House, Shooter's Hill Road, S.E.3. Day Wednesday evening (Shared with neighbouring Borough of Lewisham) Tuesday evening (Day patients only) Friday evening (For ex Bexley Hospital patients) Monday evening (For ex Bexley Hospital patients) Staff Mental Health Officers from both Boroughs Bexley Hospital Appointees Bexley Social Worker Bexley Hospital Occupational Therapist Attendances Between 25 and 30 Between 20 and 30 Between 12 and 18 Between 8 and 16 187 A therapeutic group for alcoholics supervised by a Bexley Hospital consultant psychiatrist meets at Castlewood on Wednesday evenings. Community Services for the Mentally Ill. As with an iceberg our thoughts, emotions, fears and desires lie largely hidden but they can be the origin of severe mental illness. Life's catastrophies can vary from the death of a loved one, sudden severe illness or accident, financial or social disgrace any one of which is capable of precipitating a neurosis. Moreover, disaster can descend without ceremony or warning on any one in the community. Depending upon personality, this is met by some with fortitude and resolution, by others with placidity and, in a minority, with a degree of despair or even complete collapse. Personality is the sum total of heredity and environmental influences including parents' views, those of contemporaries, working and leisure conditions, etc., all of which are subject at times to religious teaching, faith or other ideological pressures. During the Victorian era, it was taught that even under great stress to show one's feelings was just 'not done'. All emotions had to be under strict control and there was to be no 'elation' at success nor 'collapse' at disaster—the aim was imperturbability. In adversity, such an ideal was extremely valuable for it added to one's self-respect, enhanced one's social status and the satisfaction of 'bearing' oneself well often compensated for the actual disaster. Unfortunately, such stoicism was difficult to maintain and slow to achieve and, on occasions, it undoubtedly produced much personal misery, mental and physical ill-health and social injustice. Today, although it is considered psychologically sound to express feelings and emotions fully, it may well be that the readjustment has gone too far. Uncontrolled feelings are expressed without consideration for others which not only leave an individual without a steadying influence and bereft of support in adverse circumstances but society itself is threatened with instability. In such an atmosphere an increase in the development of psychoneurosis should not occasion surprise. Because the psychological needs of a patient depend so much on family relationships and those with his friends, associates, superiors, etc., a local authority's endeavours should include not only care for the mentally ill in their own homes and within their own community but, on a broader basis, schemes for the education of the public to accept them should be given a high degree of priority. Our community services, therefore, are geared to support the mentally ill, to restore confidence to those who have lost the ability to face life's difficulties and with the aim ultimately of so 188 ing such persons that a return to a normal existence and gainful employment is achieved. Within such a concept, the provision of Day Centres and Clubs is essential as is the utilisation of the resources both statutory and voluntary in order that all benefits to which a patient is entitled are in fact provided. For those persons who have no home of their own or where accommodation is denied by relatives, hostel residence for a period of 9 to 12 months is indicated. This time should be used profitably by placing occupants into employment or arranging for their attendance at day centres with a view to rehabilitating them to such an extent that eventually a return home or into lodgings can be effected. (Without doubt a case can be made out for the provision of flatlets for such persons.) Subsequent supervision from the mental health officer could then be minimal. Psychiatric Services Clinics, etc. Out-patient clinics for psychiatrics are held as follows:— Greenwich District Hospital (a) Miller Wing Monday a.m. Wednesday a.m. and p.m. Thursday p.m. (b) St. Alfege's Wing Monday evening Tuesday a.m. (Children's Diagnostic Clinic) Thursday p.m. St. Nicholas Hospital Monday p.m. Wednesday p.m. Friday p.m. Seamen's Hospital Tuesday p.m. Woolwich Memorial Hospital Monday p.m. Wednesday p.m. Thursday Friday a.m. and p.m. Domiciliary visiting is carried out in most cases, for the Bexley 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. 189 Accommodation Although the number of beds available to our psychiatric patients is unspecified, little trouble is experienced in obtaining admission of adults to Bexley Hospital within whose catchment area 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. Limited treatment is afforded at the Castlewood Day Hospital. 190 NUMBER OF PERSONS UNDER LOCAL HEALTH AUTHORITY CARE AT 31st DECEMBER 1966 Mentally ill Elderly mentally infirm 65 yrs. & over Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over i Under age 16 16 and over M F M F M F M F M F M F M F M F M F 1 Total number 4 1 198 349 25 93 — — — — 6 6 82 81 73 58 72 76 1124 2 Attending training centre — — 11 17 — — — — — — — — 2 9 47 42 30 45 203 3 Awaiting entry to training centre — — — — — — — — — — — — — — 5 2 — — 7 4 Receiving home training — — — — 1 — — — — — — — — — — — — — 1 5 Awaiting home training — — — — — — — — — — — — — — — — — — — 6 Resident in L.A. home/hostel — — 4 4 — — — — — — — — — — — — — — 8 7 Awaiting residence in L.A. home/hostel — — — — — — — — — — — — — — — — — — — 8 Resident at L.A. expense in other homes/hostels — — 5 7 — — — — — — — 1 _ 3 5 21 9 Resident at L.A. expense by boarding out in private household — — — — — — — — — — — — — — 1 2 — 4 7 10 Attending day hospitals — — 2 10 2 1 — — — — — — — — — — — — 15 11 Receiving (a) suitable home visits to attend and not a training included in centre lines 2-10 — — — — — — — — — — — — — — — — — — — (b) others 4 1 176 311 22 92 — — — — 6 6 80 71 20 9 42 22 862 12 Number of children under age 16 attending training centres who have not been included in item 2 because they do not come within the categories covered. Male 9 Female 7 191 NUMBER OF PATIENTS AWAITING ENTRY TO HOSPITAL, OR ADMITTED FOR TEMPORARY RESIDENTIAL CARE DURING 1966 Mentally ill Elderly mentally infirm Psychopathic Subnormal Severely subnormal 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 M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1. Number of persons in L.H.A. area on waiting list for admission to hospital at end of year (a) In urgent need of hospital care – – – – – – – – – – – – – 4 5 – – 9 (b) Not in urgent need of hospital care – – – – – – – – – – – – – – – 1 — 1 2 (c) Total – – – – – – – – – – – – – – 4 6 — 1 11 2. Number of admissions for temporary resi dential care (e.g. to relieve the family) (a) To N.H.S. hospitals – – – – – – – – – – – – – – 29 9 4 — 42 (b) To L.A. residential accommodation – – – – – – – – – – – – – – – – – – – (c) Elsewhere – – – – 1 – – – – – – – – – 1 1 8 7 18 (d) Total – – – – – – – – – – – – – – 30 10 12 7 60 192 NUMBER OF PERSONS REFERRED TO LOCAL HEALTH AUTHORITY DURING YEAR ENDED 31st DECEMBER 1966 Referred by Mentally ill Psychopathic Subnormal Severely subnormal 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 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (a) General practitioners 1 – 84 135 – – – – 6 2 1 – 1 – – – 230 (b) Hospitals, on discharge from inpatient treatment — — 87 147 — — — — — 1 4 4 — 1 2 — 246 (c) Hospitals, after or during outpatient or day treatment — — 39 27 — — — — — 1 1 1 — 2 — — 71 (d) Local education authorities 3 – – 1 — – – — 2 4 21 15 12 12 – – 70 (e) Police and courts – – 15 9 – – – – – — – – – – 1 – 25 (f) Other sources 1 1 81 142 – – – – – 1 10 4 4 2 2 2 250 (g) Total 5 1 306 461 – – – – 8 9 37 24 17 17 5 2 892 193 SECTION VII ENVIRONMENTAL HEALTH SERVICES Transitional difficulties presented by the application to the Borough of the previously provincial Public Health Acts of 1936 and 1961, were successfully overcome during 1966, the first complete year of the new London Borough of Greenwich. Some deficiencies in these Acts, such as procedures for the abatement of urgent nuisances in defective premises and the reinstatement of interrupted water supplies, are already receiving attention and legislation is being promoted by the Greater London Council with a view to restoring the previous position. New Legislation The Construction (Health and Welfare) Regulations, 1966 These Regulations, made by the Minister of Labour, became operative on 1st May, 1966 and impose requirements for the health and welfare of persons employed at places where building operations and works of engineering construction are carried on. The Regulations contain provisions as to first-aid and ambulance arrangements, shelter from the weather, accommodation for clothing and for taking meals, protective clothing, washing facilities and sanitary conveniences. However, only the undermentioned Regulations which relate to sanitary conveniences are enforceable by district councils:— Regulation 13 (1) Subject to paragraph (2) of this Regulation, a contractor shall provide at least one suitable sanitary convenience (not being a convenience suitable only as a urinal) for every 25 persons in his employment on a site. (2) Where a contractor has more than 100 persons in his employment on a site, and sufficient urinal accommodation is also provided, it shall be sufficient if there is one such convenience as aforesaid for every 25 persons in his employment on the site up to the first 100 and one for every 35 persons thereafter. (3) In calculating the number of conveniences required by this Regulation any number of persons less than 25 or 35, or in excess of a multiple of 25 or 35, as the case may be, shall be reckoned as 25 or 35. Regulation 14 (1) Every sanitary convenience shall be sufficiently ventilated, and shall not communicate with any workroom or messroom except through the open air or through an intervening ventilated space. 194 (2) Every sanitary convenience (other than a convenience suitable merely as a urinal) shall be under cover and so partitioned off as to secure privacy, and shall have a proper door and fastening. Urinals shall be so placed or so screened as not to be visible from other places, whether on or off the site. (3) The sanitary conveniences shall be so arranged as to be conveniently accessible to the persons employed at all times while they are at the site. (4) This Regulation is without prejudice to the requirements in section 7(1) of the principal Act that the conveniences shall be maintained and kept clean, that effective provision shall be made for lighting the conveniences and that where persons of both sexes are or are intended to be employed the conveniences shall afford proper separate accommodation for persons of each sex. The Alkali, &c. Works Order, 1966 The discharge of certain noxious or offensive gases from certain types of work is subject to control under the Alkali, &c. Works Regulations Act, 1906. This Order, which came into operation on 1st December, 1966, applies to England and Wales and makes two minor alterations both in the list of gases and the schedule of works. The original list of gases and schedule of works subject to control have been extended by seven previous Orders made between 1928 and 1963, and control under the Act of 1906 was extended to smoke, grit and dust by Section 17 of the Clean Air Act, 1956. These previous Orders have been revoked and the alterations they introduced have been consolidated in this Order. The Smoke Control Areas (Exempted Fireplaces) Order, 1966 This Order came into operation on 10th March, 1966 and exempted the fireplace known as the Hounsell Sawdust Burning Stove, manufactured by John Hounsell (Engineers) Limited, from the provisions of Section 11 of the Clean Air Act, 1956, subject to the following conditions:— “The fireplace shall be so installed, maintained and operated as to minimise the emission of smoke, and in any case in accordance with the manufacturers' instructions. No fuel shall be used other than wood waste in clean condition". Sanitary Circumstances of the Area The tables on pages 224 to 225 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 37,203 houses and premises have been inspected or reinspected during the year; 1,383 Preliminary and 408 Statutory or Abatement Notices were served. Registered complaints numbered 5,483. 195 Factories Act, 1961 During the year 245 inspections were made by the Council's Inspectors in relation to the 532 registered factories. The latter figure includes 18 premises where mechanical power is not used. Defects were found in 47 instances, all of which were remedied. FACTORIES ACT, 1961 Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 18 25 2 – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 499 218 10 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 15 2 – – Total 532 245 12 – 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.1) 16 16 1 – – 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 31 31 – 9 – (c) not separate for sexes – – – – – Other offences against the Act (not including offences relating to Outwork) – – – – – Total 47 47 1 9 – 196 Outwork—(Sections 133 and 134) Nature of Work Section 133 Section 134 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 apparel Making etc. 68 — — — — — Linen 2 — — — — — Lampshades 40 — — — — — Colour Cards 2 — — — — — Christmas Crackers 1 — — — — — Leather Goods 3 — — — — — Total 116 — — — — — 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 84 (b) Outworkers resident outside the Borough 150 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 80 Total number of Greenwich residents employed as outworkers (as given in August list) 116 Premises where homework is carried on were visited on 150 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 1966, is given in the following tables:— 197 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 13 328 66 Retail Shops 48 1,143 179 Wholesale Shops, Warehouses 2 45 3 Catering Establishments, Canteens 17 182 32 Fuel Storage Depots — 5 1 TOTALS 80 1,703 281 Analysis by Workplace of Persons Employed in Registered Premises Class of Workplace No. of persons employed Offices 5,512 Retail shops 6,762 Wholesale departments, warehouses 896 Catering establishments open to the public 1,114 Canteens 121 Fuel storage depots 46 Total *14,451 * Males 6,192 Females 8,259 A total of 1,517 visits including 281 general inspections were made to premises during the year. As a result of the service of 106 informal notices, the following contraventions of the Act were remedied:— No. of thermometers provided 67 Abstract of the Act provided 76 First Aid Kits provided 58 Defective floors repaired 12 Washing facilities provided 16 Overcrowding abated 1 Defective stairs or handrails repaired 9 Electric lighting provided or improved 24 Insufficient seating accommodation remedied 5 Inadequate heating remedied 7 Eating facilities provided 1 Additional locker accommodation provided 11 Inadequate ventilation remedied 12 Defective sanitary accommodation remedied 8 Dirty conditions remedied 32 198 Drinking water provided 1 Floors properly drained 1 Wall surfaces repaired or renewed 12 Hot water supply provided 2 Other contraventions of the Act remedied 17 Exemptions No. of applications received Nil No. of applications granted Nil (i) Running water Nil (ii) Sanitary conveniences Nil (iii) Space Nil (iv) Temperature Nil Notification of Accidents Notice of an accident in the prescribed form is required to be sent to the appropriate enforcing authority if it occurs in any premises to which the Act applies and causes loss of life or disables an employee for more than three days from doing his usual work. Each quarter a return is made to the Ministry of Labour. The 61 notifications received during the year all related to non fatal injuries and were mostly of a minor nature. Each case was investigated by the District Public Health Inspectors and advice was given where necessary. In only two cases was it considered necessary to write to the firms concerned and the measures suggested to prevent the recurrence of similar accidents were readily implemented. The reported accidents and their analysis for the year under review are summarised in the following tables:— Reported Accidents Workplace No. Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advice Offices 3 3 — — — 3 Retail Shops 45 45 — — 2 43 Wholesale Shops, Warehouses 5 5 — — — 5 Catering Establishments open to public, canteens 7 7 — — — 7 Railway Buildings 1 1 — — — 1 Totals 61 61 — — 2 59 199 Analysis of reported accidents Offices Retail Shops Wholesale Warehouses Catering establishments open to public, canteens Railway Buildings Machinery — 4 — — — Transport — 2 1 — — Falls of persons 2 14 1 4 1 Stepping on or striking against object or person — 2 — — — Handling goods — 14 2 1 — Struck by falling object — 2 — — — Fires and explosions — — — — — Electricity — — — — — Use of hand tools — — — 1 — Not otherwise specified 1 7 1 1 — 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 non-compliance 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. 200 During the year, 61 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 up to the time of his resignation in July. 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. No complaints regarding pollution were made to this department during the current year. However, having been aware of the shortcomings of its sewage disposal system for some considerable time, in recent years, the Greater London Council (previously as the L.C.C.), has sought to improve the position by instituting new processes and improvements. As a result, a remarkable improvement in the condition of the river water has been recorded during the last two or three years and the Water Pollution Research Laboratory even holds out hopes that salmon may once more gain the upper reaches of the Thames as they did in the 19th century. Storm Flooding There were no instances of damage to property recorded due to unusually heavy rainfall 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 therewit". 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. 201 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, 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. To carry out their duties in accordance with the Act, during the current year the Greater London Council found it necessary to make certain alterations to Elverson Road bridge and, in doing so, they were obliged to acquire compulsorily the properties numbered 54 and 63 Elverson Road, S.E.8, the latter being within this Borough's boundary. atmospheric pollution Conversion of energy from one form to another is a character-650 istic of all life. With man, who has learned how to release stored energy to modify his local environment, this is accompanied by certain material by-products and it is the discharge of these into the air which constitutes air pollution. Air pollution, which is derived mainly from the combustion of fossil fuels, consists of five major pollutants—carbon monoxide, sulphur dioxide, oxides of nitrogen, hydrocarbons and particulate matter. Toxic effects of carbon monoxide are well known and, in the presence of air and water, sulphur dioxide is an intensely irritating substance at very low levels of concentration. With the hydrocarbons, the oxides of nitrogen are the prime factors in the production of the irritating and damaging 'smog' and, undoubtedly, the emission of particulate matter such as soot, dust, ash and grit is in part responsible in urban areas for respiratory ailments including bronchitis, emphysema, bronchial asthma and lung cancer. Reduction of available sunshine at ground level, resulting from a smokey atmosphere inhibits the manufacture in the skin of vitamin 'D' and has a stunting effect on vegetation. 202 Inevitably, the greater quantities of dust and grit are emitted from industrial furnaces but, because of its low burning temperature, the domestic fire is responsible for a smoke much higher in hydrocarbon or tar content. However, industrial pollutants are usually dispersed at high levels resulting in greater dilution by the time the street is reached. Domestic smoke, on the other hand, is discharged at low level from short flues with the result that it lingers and eddies and thus constitutes a greater hazard to the local inhabitants. Since the introduction of the Clean Air Act in 1956, atmospheric smoke and grit have been substantially reduced and although the degree of air pollution is influenced by such factors as season and weather, it is evident that the improvement in the London atmosphere in recent years has been due to the increasing use of clean fuels and efficient heating appliances. Today, there is growing concern about another source of poll ution, viz. that from motor vehicle exhausts. Properly maintained diesel engines would seem to be blameless but, for the heavy pollution of air near ground level, the petrol-engined vehicle is being indicted. In an effort to control not only this problem but a number of others, a Bill was brought before Parliament in November of the current year which seeks to control the emissions from motor vehicles, to ban the sale of unauthorised fuels in smoke control areas and to make the control of smoke emissions more effective. Clean Air Act, 1956 Fully operative from 1st June, 1958, this Act contains provisions relating to the installation of new furnaces, smoke control areas, height of chimneys, research and publicity, etc., and has, as its aim, four main purposes:— (1) To limit smoke from existing sources. (2) To prevent new sources of industrial smoke. (3) To minimise dust and grit emission. (4) For the first time in nationally applied legislation—to bring about the progressive elimination of domestic smoke. Pollution problems concerning the emission of fumes and noxious gases from industrial premises such as iron and steel works, cement works, chemical plants, gas works and power stations, etc., come under the jurisdiction of the Alkali Inspectorate. In accordance with the Alkali, etc. Works Order, 1958, the Minister of Housing and Local Government indicated the works located in the Borough which are subject to the control of the Alkali Inspector under the Alkali, etc. Works Regulation Act; the works include such industries as metal smelting and synthesis, gas works, electricity generation, etc. In these instances, however, it is understood that the Alkali Act deals only with the particular 203 ses which are registered under the Act, any other works, processes or plant carried on or operated at the premises—e.g. ordinary power plant fired by coal or oil—do not come under the Alkali Act but are subject to the relevant provisions of the Clean Air Act, 1956. Smoke Control Areas Blackheath Park In the Summer, preliminary arrangements for the formation of the Blackheath Park Smoke Control Area were completed and the Council declared the Area on 3rd August, 1966. Details of the Area are as follows:— This is an Area of predominantly private property comprising some 620 acres and 3,390 dwellings of which it is estimated 80 per cent, will require some form of conversion or adaptation. Of this total 294 are Borough Council, 495 Greater London Council and 2,601 privately owned and in addition there are 92 non-domestic premises. The operative date of the Order is 1st December, 1967. Following the confirmation of the Area Order by the Minister, a Public Meeting was held whereby residents were able to make enquiries of members and officers of the Council. In addition, local fuel suppliers and representatives of the London Electricity Board and South-Eastern Gas Board were present to reply to questions relative to their particular organisations and to provide displays of appliances. The meeting was attended by some 120 residents. The questions were fewer than usual, which would appear to indicate that the Council's Clean Air Information service is resolving most difficulties beforehand. Charlton On the same date as the Blackheath Park Smoke Control Area Order was declared, the Council approved in principle the Charlton Smoke Control Area with a view to the making of the Order in the Summer of 1967. This Area comprises approximately 485 acres and 5,516 properties. At the end of the year there were 7,079 acres and 47,249 dwellings within operative Smoke Control Areas. Details in respect of these Areas and that of Blackheath Park are set out in the table on page 204 and their respective coverage of the Borough shown on the accompanying map. With regard to Smoke Control Areas the following Circular and Letter have been issued by the Ministry of Housing and Local Government for the guidance of local authorities:— Circular 25/66.—This Circular dated 3rd June, 1966, sets out details of revised grant arrangements and a revised version of "Smoke Control Areas: Some Questions Answered" which is intended as a guide to local authorities wishing to produce 204 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 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. 1.10.60 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 In course of construction Nil Nil Nil 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 47 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 1.12.66 324 3,733 Nil 226 23 Blackheath Park 1.12.67 620 3,390 5 61 26 tory booklets for householders in proposed smoke control areas. In the latter connection, the Council's own booklet has been kept upto-date and incorporates the answers to the questions listed. The revised grant arrangements are stated to be necessary, mainly to take account of new appliances, increases in cost and developments in the testing of electric storage heaters. The new cost limits of appliances, requested to be used for financial estimates accompanying submissions of smoke control orders made subsequent to the date of the Circular, were adopted by the Council. In addition, the Circular gives advice on the assessment of grant for the installation of oil-fired central heating and oil-burning appliances and "package deals" in which the supply and installation of two or more appliances are offered for an all-in price by some Electricity and Gas Boards. Letter dated 28th July, 1966—Grant Provisions—Gas Coke Supplies This letter states the Department has been advised that Gas Boards producing gas coke for Greater London are no longer able to give local authorities assurances of supplies of this fuel for future smoke control orders, although those given for Orders already made will continue to be honoured. Smoke control orders, therefore, should no longer be based on the assumption that the demand for open fire solid fuel can be met wholly by gas coke. 205 Whilst gas coke may be available for some future areas, but in quantities unlikely to be sufficient to meet the demand, supplies of other open fire fuels are expected to be satisfactory. In these circumstances, and because gas coke may not be available for all who may want to burn it in future smoke control areas, it would be justifiable for London Borough Councils to pay grant for the replacement of an improved open grate by an appliance capable of burning hard coke (an open fire with fan assisted draught, an underfloor draught fire or solid fuel room heater) or by an electric storage heater, gas room heater or fixed oil burning appliance. However, it would be equally justifiable to continue payment of grant in respect of the replacement of a coal fire by an improved open grate because reactive open fire fuels are likely to be available for persons who may wish to burn them. For future smoke control orders, therefore, grant is now payable on the following works, the last two of which incorporate the new provisions, at the option of the owner or occupier:— (a) adapting an improved open grate to burn gas coke; (b) replacing a coal burning grate by an improved open grate; (c) replacing a coal burning grate by an underfloor draught fire, fan assisted open fire, electric storage heater or a solid fuel, gas or oil room heater; (d) replacing an improved open grate by any of the appliances in (c) above; (e) adapting an improved open grate to burn hard coke by installing a forced draught fan. These grant provisions were adopted by the Council. Grants During the year 2,509 grants amounting to £65,724 0s. 6d. were 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 nine discretionary grants amounting to £2,181 18s. Od. were so approved, giving a consolidated figure of 2,618 grants totalling £67,905 18s. 6d. In cases of financial hardship, a local authority also has discretion under Section 12(1) of the Clean Air Act, to pay more than 7/10ths grant. The Council continued its previous policy and paid the full cost of reasonable and necessary works of conversion or adaptation in the case of application from occupier/owners who are retirement pensioners and in receipt of Supplementary Pension. Twenty-six such payments were approved in the year. A further 206 14 payments were approved in respect of retirement pensioners who, although not in receipt of Supplementary Pension, would have been so entitled had they chosen to apply. These additional costs are 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 302 late applications, authorised the service of statutory notices under Section 12(2) of the Clean Air Act, 1956. Installations 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.Us. 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. Eight notifications were received and one approval was given in 1966. Pollution Recording Nine atmospheric pollution measuring stations are maintained by the Council and the daily mean concentrations of smoke and sulphur dioxide are calculated on readings taken at these stations. No heavy atmospheric pollution was recorded during the year. Staff 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 10,334 inspections and visits. 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 certificates 11 Number of decisions not to issue certificates 1 Number of decisions to issue certificates: (a) in respect of some but not all defects 6 (b) in respect of all defects 4 — 10 Number of undertakings given by landlords 9 (under para. 5 of 1st Schedule) Number of undertakings refused by Council (under proviso to para. 5 of 1st Schedule) Number of certificates issued 2 207 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 3 In addition to the foregoing, 4 applications (Form "O") were received, 3 from landlords and 1 from a tenant, each for a certificate as to the remedying of defects which the landlords had undertaken to remedy. These resulted in the issue of Certificates (Form "P") as follows:— Applications By whom made Form 'P' Certificates issued in respect of:— Defects Remedied Defects not/not wholly Remedied In respect of Form 'H' undertaking Tenant — — Landlord — — In respect of Form 'K' undertaking Tenant — 1 Landlord I 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 year 57 complaints were received of which all but two were of a relatively minor nature. The two more serious complaints were in respect of large industrial premises and mainly related to noise at night. With the co-operation of the Scientific Branch of the Greater London Council, noise readings were taken during the day and night, as a result of which, observations were sought from the managements of the firms concerned. At the end of the year, proposals were in hand with a view to reducing the noise levels at both these premises and, in respect of the majority of the other complaints, satisfactory improvements were effected. In all a total of 347 visits were carried out during the course of the year by the Public Health Inspectors in connection with noise complaints. Pharmacy and Poisons Act, 1933 During the year the Town Clerk received 39 applications for entry of name in the Council's List of Persons entitled to sell Poisons 208 included in Part II of the Poisons List and 153 applications from vendors for retention in the Council's List. All were duly considered and approved. 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 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. 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. Under the Rag Flock and Other Filling Materials Regulations, 1961 and 1965, two samples, one of Woollen Mixture Felt and one of Rag Flock, were submitted for examination and both proved satisfactory. Licensing Act, 1961 During the year, 21 applications, 4 for registration and 17 for renewal of registration as licensed premises, were made to the Town Clerk 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, 105 inspections were made and reports submitted to the Town Clerk. 209 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 39 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 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 repealed 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. No licences were issued during 1966. Land Charges Act, 1925 Under this Act, enquiries in respect of properties in the Borough are received from time to time by the Town Clerk concerning outstanding Notices served under any Health legislation and whether such properties are within existent or proposed Clearance, Development or Smoke Control Areas. 210 During the year 3,534 reports on such enquiries were forwarded to the Town Clerk's department. Drainage and Sewerage Under the Public Health Act, 1936, an existing combined drain is 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, 391 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. 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 one copy of a certificate of registration and copies of three revised certificates 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 6¼ 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 211 estimation of its clarity, colour and taste, and bacteriologically for assessment of coliform colonies with confirmatory examination for Escherichia coli. There are 70,303 inhabited dwellings in the Borough with direct connections to the Board's mains. On request and following satisfactory reports, 59 letters were sent during the year in respect of properties confirmed as having a suitable and sufficient supply of water. I am indebted to Dr. E. Windle Taylor, Director of Water Examination for the Metropolitan Water Board, for the following information given in accordance with the Ministry's Circular 1/67, regarding the water supplies in the Greenwich area:— "You will understand that this information does not relate to private supplies and supplies from other Water Undertakings (if any). (a) The supply was satisfactory both as to quality and quantity throughout 1966. (b) (i) The supply was derived from the following works and pumping stations:— River Thames via Hampton and Surbiton; and Deptford, Wilmington, Darenth, Bexley, Wansunt and Crayford Wells. No new sources of supply were instituted. (ii) The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. No fluoride was added, and where the fluoride content is indicated it represents the naturally occurring fluoride in the water. (c) The supply being hard in character is not liable to be plumbo-solvent. (d) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. Water Supply to the London Borough of Greenwich METROPOLITAN WATER BOARD—Water Examination Department Bacteriological Results—Yearly Average 1966 Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Hampton 1,136 11.4 99.82 100.00 Surbiton 432 3.8 99.54 99.77 Deptford 248 2.6 28 91.53 1.8 96.77 0.1 254 3.1 216 100.00 100.00 Wilmington 248 1.4 29 96.77 0.1 98.79 — 255 0.2 3 100.00 100.00 Darenth 248 0.3 67 97.18 0.1 98.79 — 254 0.0 1 100.00 100.00 Bexley 248 0.0 2 99.60 — 100.00 — 255 0.0 19 100.00 100.00 (a) Wansunt No. 1 178 0.0 108 100.00 — 100.00 — (b) „ No. 2 175 0.0 81 99.43 — 100.00 — 184 0.0 127 100.00 100.00 (a) Crayford No. 1 87 0.0 16 100.00 — 100.00 — (b) „ No. 2 138 0.0 12 100.00 — 100.00 — 255 0.1 1 100.00 100.00 (c) „ No. 3 110 0.0 10 100.00 — 100.00 — 212 213 (e) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1966, was 231,590. (ii) No houses were permanently supplied by standpipe. Other observations (/) There were no changes to the general scheme of supply in your area. (g) There were additions of 3,769 yards of mains in your area". Underground Water Supplies (Wells).—In August, 1947, at the request of the Ministry of Health, a survey of underground water supplies was made and the table accompanying my Report for 1965 gave details insofar as they were known to the department at that 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. As far as this Borough is concerned the two wells providing drinking water are properly supervised and have shown no sign of deterioration. Fluoridation of Water Supplies.—In recent years dental decay has increased especially among the younger age groups. On an average, a five-year old child has at least 5 decayed teeth and, in fact, at the age of eleven only one child in every hundred has perfect teeth. Modern research has discovered that a minute quantity of fluorine assists the formation of healthy teeth and reduces the incidence of decay. In Circular 15/65, the Minister stated that he considers fluoridation 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 take steps to make arrangements for the addition of fluoride to public water supplies. This Council is one of 26 local health authorities served by the Metropolitan Water Board who support the fluoridation of water supplies as a dental caries preventive measure. Unfortunately, a METROPOLITAN WATER BOARD—WATER EXAMINATION DEPARTMENT Average Results of the Chemical Examination of the Water Supply to the London Borough of Greenwich—Year 1966 Milligrames per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27° C. Hardness (total) CaC03 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as Cl Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) Hampton 52 0 .029 0.088 4.1 1.27 286 76 5 24.2 5.0 32 1.8 8 62 0.20 0.01 0.1 15 7.8 570 Surbiton 52 0.020 0.087 4.3 1.14 272 76 5 24.2 5.0 34 1.9 8 62 0.20 0.01 0.0 12 7.8 560 Deptford 4 0.013 0.040 5.9 0.20 389 126 9 43 16 122 0.1 3 7.0 740 Wilmington 4 0.008 0.049 7.5 0.35 303 67 2 25 16 30 0.1 2 7.1 570 Darenth 4 0.012 0.041 4.6 0.11 273 42 2 18 14 24 0.2 1 7.1 510 Bexley 4 0.005 0.038 4.9 0.13 323 69 4 19 17 58 0.0 1 7.1 580 Wansunt 6 0.024 0.036 6.3 0.16 340 96 4 26 16 74 0..2 2 7.1 650 (a) Crayford No. 1 2 0.011 0.051 9.0 0.58 448 173 6 37 18 184 0.5 3 6.9 830 (b) „ No. 2 4 0.013 0.028 6.8 0.34 347 96 5 28 20 68 0.4 3 7.1 660 (c) „ No. 3 3 0.015 0.034 6.6 0.43 368 131 2 29 17 134 0.0 2 7.0 700 214 215 minority of 8 authorities have consistently opposed such action and the Metropolitan Water Board is persisting in its policy of not introducing fluoridation until there is unanimity among the authorities supplied. 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. Public Baths and Washhouses There are 4 Borough Council Public Baths, 2 Public Washhouses and a Council Launderette A summary of Bacteriological Samples taken during the year with the results of the examinations is given in the following table:— 216 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. 10.5.66. 11.00. a.m. Greenwich (Small) Entry end 80°F. 134 20 Nil Nil Satisfactory 2. 10.5.66. 11.10 a.m. Greenwich (Small) Exit end 80°F. 134 Nil Nil Nil " 3. 10.5.66. 11.20 a.m. Greenwich (Large) Entry end 80°F. 155 Nil Nil Nil ,, 4. 10.5.66. 11.30 a.m. Greenwich (Large) Exit end 80°F. 155 Nil Nil Nil ,, 5. 5.7.66. 10.00 a.m. Greenwich (Large) 82°F. 6 Nil Nil Nil ,, 6. 5.7.66. 10.30 a.m. Woolwich (Large) 82°F. 85 1,400 Nil Nil ,, 7. 5.7.66. 11.00 a.m. Plumstead (Large) 81°F. 28 Nil Nil Nil ,, 8. 5.7.66. 11.30 a.m. Eltham (Large) 85°F. 20 Nill Nil Nil ,, I am indebted to Mr. D. F. Wallis, Baths Manager, for the following information and statistics in respect of the financial year 1966/67:— "The Council has four Baths 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 has a Launderette on the Abbey Estate. 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, roller skating, badminton and table tennis. The hall at Eltham was let for many functions ranging from wrestling, boxing, dancing, Netball, Indoor Cricket, Badminton, and even a one-day Youth Conference. During the year under review 20,572 swimming lessons were 217 provided through the various schemes operating in the Department, in addition to instruction given to school children attending in organised classes." The following table gives the attendances at each Establishment for the year ended 31st March, 1967:— Service Eltham Greenwich Plumstead Woolwich Abbey Estate Totals Swimming Public 222,125 80,762 139,025 130,583 — 572,495 Schools 66,403 58,173 101,324 57,147 — 283,047 Clubs 14,498 15,295 18,883 12,380 — 61,056 Tuition 9,115 4,498 4,906 2,053 — 20,572 Spectators 13,385 5,314 7,362 2,837 — 28,898 Baths Private — 40,487 29,447 53,826 — 123,760 Free(O.A.P. etc.) — 3,601 3,914 4,607 — 12,122 Turkish — 14,630 8,212 — — 22,842 Laundries — 4,491 14,389 — — 18,880 Launderette — — — — 43,794 43,794 Totals 325,526 227,251 327,462 263,433 43,794 1,187,466 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 2,831 recorded complaints (1,514 of rats and 1,317 of mice), 2,121 were notifications, 440 re-notifications from occupiers or other sources and 270 were found during survey. The monthly average of complaints from all sources was 235. In addition to the investigations of recorded complaints, 6,175 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 9,006. During investigations, infestation was found to exist on 19 occasions in local authority's premises, 2,477 in dwelling houses and 335 in miscellaneous properties and places of business. In all, some 2,627 treatments were effected by the Council and 17 by occupiers or other services. Periodical treatments were carried out at 8 industrial premises, 4 wharves and storage places, 5 miscellaneous properties and at one hospital in the Borough. Following the policy of tracing the source of each infestation, 15 defective drainage systems were discovered. In these instances 218 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, the form of which has now been con siderably reduced, was submitted to the Ministry of Agriculture, Fisheries and Food, for the year ended 31st December, 1966:— Prevention of Damage by Pests Act 1949 Year ended 31st December, 1966. TYPE OF PROPERTY Properties Other than Sewers NonAgricultural Agricultural 1. Number of properties in district 88,205 1 2. (a) Total number of properties (including nearby premises) inspected following notification 2,830 1 (b) Number infested by (i) Rats 1,513 1 (ii) Mice 1,317 — 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 6,503 — (b) Number infested by (i) Rats 177 — (ii) Mice 90 — Sewers 4. Were any sewers infested by rats during the year?—Yes—One Surface Properties and Sewers 5. Any other points of interest? None 219 Baiting of Sewers Under the control of the Rodent Officer directing five teams, each of 1 Rodent Operative as supervisor and 2 workmen drawn from the Borough Engineer and Planning Officer's Area Depots as assistants, baiting of sewers was carried out in May to 1,438 sewer manholes out of a total of 3,920. The pre-baiting and poisoning method was employed and the bait used was zinc phosphide. A repeat treatment of direct poisoning with fluoracetamide (1081) was carried out in November. 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, etc. The collection of refuse and the conduct of Public Conveniences in Greenwich are 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 in the Borough which were cleansed at the following frequencies:— at least once daily 9 % three times weekly 21 % twice weekly 70 % One hundred and one street sweepers were employed and, in addition, a mechanical sweeper and sprinkler was used to sweep the main traffic roads and shopping streets. There are 15,100 street gullies which were each cleansed entirely by mechanical means at four-monthly intervals. Refuse Collection Some 61,850 tons of refuse were collected from 76,560 dustbins and 2,830 bulk containers. Collection was generally weekly, but was more frequent at certain blocks of flats and other premises. A service increasingly used by residents in the Borough was the collection and disposal, without charge, of unwanted household effects. More than 6,000 special collections were made. A new service is the disposal of unwanted private cars. During the year the service, operating from the Council depots at Tunnel Avenue and White Hart Road, received and disposed of 1,500 of these vehicles which resulted in a recovery of 560 tons of scrap metal. 220 Public Conveniences There are 29 conveniences for men and a similar number for women. In all conveniences water closets are available without charge and, wherever practicable, free washing facilities are provided, with paper towels." Flies and Mosquitoes During the year 27 complaints of flies were received, resulting in treatments being carried out to 65 rooms and 13 external areas. On request from the Borough and Greater London Council Housing Departments, dust chutes and containers in the multistorey flats are treated with Gammexane. Disinfestation of Verminous Premises Dieldrin Concentrate continues to give good results in dealing with verminous premises. During the year the department dealt with 104 cases of dirty and verminous premises, and the disinfestation staff sprayed 384 rooms and contents. In 3 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 rooms and 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 101 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. Ninety-four treatments involving 211 rooms and 66 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. 221 Four treatments involving 9 rooms and one external area were carried out in respect of this ant. 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. Forty-five complaints were received concerning this pest and thorough investigation and treatment with Dieldrin Concentrate resulted in the infestations being considerably reduced. In all, 45 treatments were effected involving 179 rooms. Clover Mite. Six 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 Dieldrin Concentrate 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 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. One hundred and sixty-one complaints regarding this pest were received and during the year some 123 nests were destroyed, mainly by means of Gammexane powder or Dieldrin Concentrate. 222 Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith. Complaints Treatments Rooms External Areas Beetles: Black 16 15 61 2 Carpet 5 5 11 — Leather 2 2 5 — Spider 2 2 10 — Earwigs 9 9 13 7 Fleas 55 49 252 — Red Mite of Birds & Poultry 1 1 2 — Silver Fish 12 12 48 — Slugs 3 3 6 — Spiders 3 2 6 — Wild Bees 13 11 — 11 Wood Lice 1 1 1 — Woodworm 14 12 12 — Misc. Insects 37 30 60 4 Sixty-one requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by treatments to 216 rooms and 2 external areas. Precautionary Spraying. During the year, at 22 premises unwanted bedding, furniture and miscellaneous household effects were sprayed as a precautionary measure prior to removal by the Borough Engineer and Planning Officer's staff. Treatment was effected in 36 rooms and 2 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 60 92 Children under school age 35 27 *School children 287 116 Totals 382 235 *In addition to these figures one attendance was made in respect of Impetigo. 223 Rooms and Articles Disinfected, Year ended 31st December, 1966 Diseases, etc. Premises Entered Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 2 2 - - - - - - - - - - - — - - Diphtheria — — — — — — — — — — — — — — — — Tuberculosis 45 202 3 24 10 43 21 55 — 4 8 62 97 — — 327 Cancer 2 3 — 7 2 48 2 5 — — 1 8 — — — 73 Meningococcal Infection 4 8 3 6 2 13 10 17 — — 4 30 4 — - 89 Puerperal Pyrexia — — — — — — — — — — — — — — - — Thyphoid Fever - - - - - - - - - - - - - - - - Polio-Myelitis - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Acute Encephalitis - - - - - - - - - - - - - - - - Measles 2 2 — 1 — 3 4 5 — — 1 6 3 - 23 Scabies 5 8 — 2 — 4 20 24 — — 3 80 1 - 134 Other Diseases 19 56 1 28 — 226 8 8 — 2 2 35 30 — — 340 Verminous Premises 3 8 - 6 - 4 — 3 — 2 - 20 25 - — 60 Total 82 289 7 74 14 341 65 117 — 8 19 241 160 — - 1046 Library Books Disinfected 20 224 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 1966 totalled 3,079 ,being 165 more than the previous year. Of this total, 1,107 were from within this Borough compared with 1,038 in 1965. Exhumations Nineteen exhumations were carried out during the current year and a Public Health Inspector was present to see that all the usual precautions were observed. 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 948 bodies were so accommodated at a cost to the Council of £1.990 16s. Od. Summary of Work Performed by the Public Health Inspectors during the Year 1966 Inspections— Houses inspected (Complaints, nuisances) 3,266 „ „ (Infectious Disease) 1,155 „ „ (Overcrowding and other Housing Applicants) 369 Inspections of Factories 245 „ „ Licensed Victuallers and Clubs 159 „ „ Underground Rooms 90 „ „ Pet Shops 39 „ „ Stables and Yards 2 „ „ Urinals 46 „ „ Houses in Multiple Occupation 41 „ „ Outworkers premises 150 „ Under Clean Air Act 10,334 „ Miscellaneous 13,681 Inspection of Premises (Clearance Areas) 860 „ „ „ (Rent Acts) 44 Inspections of Offices, Shops and Railway premises 1,517 Investigations (Rats and Mice) 1,004 Investigations (Insect Pests) 437 Re-inspections, calls made, etc 3,764 37,203 225 Drains— Drains tested—by smoke 52 „ „ —by water 7 Opened, cleansed and repaired 332 Yards and forecourts drained 10 W.C. Compartments erected or repaired 17 W.C. fittings repaired or renewed 32 W.C. pedestals installed or renewed 108 Sanitary conveniences or improvements effected to Factories and Workplaces 31 Urinals cleansed or repaired 9 Dustbins— Provided 34 Pavings— Yards and Forecourts 10 General Water Supply— Water Fittings amended 17 Water supply restored 83 Extra water supply to tenement houses — Other Improvements— Rooms cleansed and repaired 17 Rooms and staircases lighted and ventilated 282 Verminous rooms cleansed 384 Roofs, gutters and rainwater pipes repaired 560 Dampness abated 544 Underground Rooms (enforcement of Regulations) — Sinks, baths and lavatory basins provided 15 Sink, lavatory and bath waste pipes trapped or amended 48 Stoves and fireplaces 27 Floors repaired 154 Miscellaneous repairs 859 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Animals kept in unfit places discontinued or removed — Foul Accumulations removed 34 Rat infestation abated 2,225 Smoke Nuisances— Observations 135 Statutory Notices served — Notices, &c.— Preliminary Notices served 1,383 Statutory or Abatement Notices served 408 Houses rendered fit by informal action 879 226 Legal Proceedings Premises Offence Results of Proceedings 29 Dinsdale Road Non-compliance with Abatement Notice Summons withdrawn— work completed. 19 Tewson Road do. Fined £2 and £3 3s. 0d. costs. 15 Abbey Grove do. Summons withdrawn— 33 Hartville Road do. work completed, do. 4 Hough Street do. Nuisance Order for work to be executed within 28 days. 16 Helen Street do. Summons withdrawn— work completed. 21 Tewson Road do. Adjourned sine die. 29 Glenside Road Non-compliance with Nuisance Order Fined £5 and £3 3s. 0d. costs. 5 Conway Road Non-compliance with Abatement Notice Summons withdrawn— work completed. 3 Burrage Road do. do. 37 Plumstead Road do. do. 89 Robert Street do. do. 165 Plumstead High St. do. do. 91 Robert Street do. do. 54 Ordnance Road do. £5 5s. 0d. costs. 37 Glenside Road do. Nuisance Order for work to be executed within 28 days. £5 5s. 0d. costs. 5 Conway Road do. Summons withdrawn— work completed. 11 Ordnance Road do. do. 36 Marlton Street do. Nuisance Order for work to be executed within 28 days. £3 3s. 0d. costs. 171 Plumstead High St. do. Nuisance Order for work to be executed within 42 days. £3 3s. 0d. costs. 20 Marlton Street do. Summons withdrawn— work completed. 27 Marlton Street do. do. 29 Glenside Road Non-compliance with Nuisance Order do. 171 Plumstead High st. Non-compliance with Abatement Notice do. 50 Bannockburn Road do. do. 12 Bloomfield Road do. do. 20 Brookhill Road do. do. 227 Housing Intrinsically, housing is a constant cycle of regeneration and the idea that its problems can be 'solved' by a once-and-for-all rebuilding effort is fallacious. At the end of 1966, the country's stock of 17¾ million dwellings included 400,000 more than the potential number of households and, despite the fact that these surplus homes were mal-distributed, the present situation does indicate that although the question of numbers of dwellings may be very serious locally, nationally, it is no longer of paramount importance. However, it is accepted that even today's model house will be obsolete in 70 years time and cottage estates in 40, but what is the period to be for the modern skyscraper and what is the policy to be for future housing replacement? It seems reasonable to suppose that today's housing will have no more permanence than that of yesteryear. It has, in fact, been mooted in some quarters that we are moving into an era where the life of most manufactures, including houses, will be deliberately limited not only to stimulate new ideas in their replacement but also to conform to an 'employment' policy. But assuming that in the next 40 to 50 years it will become necessary to replace or extend the life of the then existing dwellings, there would be much more flexibility with houses than with blocks of flats if recent experience in large cities is to be any guide. In urban districts especially, density is the chief problem of the housing authorities and, in their schemes now under construction, flats comprise more than half of the total. Paradoxically, a recent survey showed that although only one person in every 100 wanted to live in high blocks of flats, one in six of the homes being built by local authorities are flats in tall blocks of 10 or more storeys. Indeed, not only were high flats unpopular, but fewer than one person in seven wished to live in a flat at all. Although this survey showed that the overwhelming majority of people wanted a house, it also revealed that few expected this desire to be satisfied. Such a result demonstrates the degree to which the present housing programmes may be ignoring people's aspirations and perhaps thereby influencing future psychological patterns. However, it is perfectly clear that if the clamour for new houses were to be sated the country would be engulfed in suburban sprawl. Another interesting fact disclosed by the survey was that at a time when the official cost rents of 'semis' ranged between £5 and £7 and even up to £10 in the London area, nearly 70% thought that an appropriate rent for a three-bedroomed semi-detached house should be between £1 and £4 per week. It is natural for a mother to be solicitous for her young child and a small private garden would prove a great boon and give her a serenity and peace of mind which is unattainable in high rise housing 228 with its stairs, balconies, lifts, etc., those ever-present hazards to an adventurous child. Moreover, in a house with a garden, older children would be less restricted with hobbies and fathers would be disinclined to seek diversion away from the house. In short, such a dwelling is most likely to become a 'home' in the fullest sense of the word giving social and emotional stability to the family. Nevertheless, at the moment, due to extremely expensive land values in town areas and the rising costs of labour and materials, financial stringency is largely dictating housing policy and high rise, high density schemes are fostered mainly on 'costs' lines rather than on the needs of the people—quality often being sacrificed for quantity. How then are these aspirations of the people and modern expediency to be reconciled ? Understandably, in recent years, we have been pre-occupied with increasing our stock of houses at the expense of other and perhaps more human aspects. Some areas have been acquired by authorities and many houses which were basically sound have been demolished principally because the site could be redeveloped at a higher density. Furthermore, with comprehensive clearances and developments, many authorities tie down their resources by laying waste sections of their district and leaving wide areas to decay. Slum clearance and new building are extremely costly not only financially but in terms of human suffering and misery. With little prospect of financial easement within the next few years it is urgently necessary for local authorities to explore other ways to deal with their housing problems. Revival rather than renewal of some urban areas would seem to be the most fruitful field for investigation and the Greater London Council are already planning to bring some of their 1920 cottage estates such as Becontree, St. Helier and Downham, up to modern standards. But more important than this is the utilisation, before deterioration goes too far, of the better quality Georgian and Victorian property which possesses a grace and charm which many modern architects have failed to achieve. Because of their large rooms, restoration of such properties is often effective in increasing accommodation, it reduces those inevitable delays in clearance, demolition and rebuilding schemes which sometimes last for as long as 7 years and it reduces the cost per unit by reason of the fact that modernisation can be applied to small areas and its speed of completion tends to offset the interminable rise in building prices inevitable during long-term planning. In addition to these 'time and financial' advantages and contrary to that with clearance areas, such action, preserves the existing social and community structure and eliminates the psychological 229 strain which arises in people who are compelled to re-orientate themselves in a 'strange' neighbourhood. It is possible that the antisocial behaviour, which the Greater London Council acknowledges is becoming a serious problem on their larger estates, is a direct consequence of this enforced re-orientation. Despite the fact that during the last decade a great deal of statistical data on housing has been accumulated, very little is known about the public's attitudes towards housing and what effects, if any, they have had or are likely to have upon planning. Fundamentally, housing should not be just an exercise in building construction. Ideally ,it should be the practical application of social planning which gives full regard to the specific needs of the inhabitants, their attitudes and environment; but attainment of such a Utopia is extremely unlikely. Nevertheless, most of the practical problems are known. If, to this, we can ally more soundly based demographical information a more psychologically satisfactory solution could be achieved. New Legislation The Housing (Prescribed Forms) Regulations 1966—These Regulations, which apply to England and Wales, became operative from 23rd March, 1966 and revoked The Housing (Prescribed Forms) Regulations, 1957 to 1965. The Regulations prescribe the forms of orders, notices and advertisements required to be used for the purposes of the Housing Acts 1957 to 1965 and for the most part consolidate the previous Housing (Prescribed Forms) Regulations with minor and drafting amendments. In particular, certain of the forms have been amended to take account of the recent transfer of housing functions in Wales to the Secretary of State. There are, however, the following substantive alterations of existing prescribed forms:— (a) Form No. 3 is a form prescribed for the first time by Regulations for a Closing Order in respect of a house in a Building Preservation Order etc. (b) Forms Nos. 6, 15, 16, 26 and 33 (and the notes to Form No. 26) have been revised to avoid difficulties experienced in the use of the existing forms. (c) On all forms dealing with the purchase, clearance, closing or demolition of unfit property, the notes on compensation now take account of the amending provisions of the Housing (Slum Clearance Compensation) Act, 1965. Housing Act, 1957 Part II—The following procedures were carried out during 1966:— (i) Unfit Premises Capable of Repair—Section 9—A notice was 230 served in respect of the undermentioned premises which was considered unfit for human habitation but capable at reasonable expense of being rendered so fit:— 109 Alabama Street, S.E.18. (ii) 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. In one instance an Undertaking was accepted to render premises so fit within a specified period and Closing or Demolition Orders were made in respect of the remainder as follows:— (a) Undertaking 58 Eglinton Road, S.E.18. (b) Closing Orders 113 Brewery Road, S.E.18 28 Burrage Road, S.E.18 15 Castile Road, S.E.18 8 Dawson Street, S.E.18 21 Dawson Street, S.E.18 13 Delvan Street, S.E.18 6a Elizabeth Terrace, S.E.9 20 Fenwick Street, S.E.18 11 Gavin Street, S.E.18 107 John Wilson Street, S.E.18 1 King George Street, S.E.10 8 Luton Place, S.E.10 54 Marlton Street, S.E.10 18 Ordnance Road, S.E.18 27 Ordnance Road, S.E.18 38 Pattison Road, S.E.18 64 Pattison Road, S.E.18 17 Plumstead High Street, S.E.18 25 Raglan Road, S.E.18 13 Richmond Place, S.E.18 15 Richmond Place, S.E.18 22 Richmond Place, S.E.18 36 Richmond Place, S.E.18 46 Richmond Place, S.E.18 47 Richmond Place, S.E.18 4 Salutation Alley, S.E.18 27 Tamar Street, S.E.7 66 Tyler Street, S.E.10 3 Warspite Road, S.E.18 7 Warspite Road, S.E.18 2 Woolwich Common, S.E.18 231 (c) Demolition Orders 2 Gaitskell Road, S.E.9 45 Jackson Street, S.E.18 12 Sandyhill Avenue, S.E.18 The Cottage, Tunnel Refineries Ltd., Tunnel Avenue, S.E.10 (iii) Underground Room(s) 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 parts of buildings 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:— 76a Beaconsfield Road, S.E.3—Basement front, back left and back right rooms and kitchen. 45 Blackheath Road, S.E.10—Basement front, back and back- addition rooms. 160 Brewery Road, S.E.18—Ground floor left room, ground floor scullery, first floor left and centre rooms and first floor right room above shop premises, No. 158 Brewery Road. 7 Brookdene Road, S.E.18—Ground floor front, back and back-addition rooms and scullery. 14 Burgos Grove, S.E.10—Basement front room. 143 Footscray Road, S.E.9—Rear ground floor flat comprising living room, bedroom and kitchen. 133 Plumstead Road, S.E.18—Ground floor back and backaddition rooms and scullery; first floor front, back and back-addition rooms. 43 The Village, S.E.7—Basement front and back rooms. 1 1a Woolwich Common, S.E.18—Attic front and back rooms. 106 Woolwich High Street, S.E.18—First floor front and back rooms and second floor front and back rooms. 256 Woolwich Road, S.E.7—Basement front and back rooms. (iv) Determination of Closing Orders—Section 27—Closing Orders of premises and parts of premises as undermentioned were determined:— 114 Red Lion Lane, S.E.18 61 Sandy Hill Road, S.E.18 52b Vanbrugh Park, S.E.3—Basement front, back left and back right rooms. 232 Part III—Clearance Areas—The following Clearance Areas were represented during the year:— Woolwich Common Redevelopment Area—2nd Stage Kempt Street Clearance Areas Nos. 1 to 9: No. 1 Area— 16-19 (consecutive) Engineer Road 8 Jackson Street. No. 2 Area— 1a, 1, 5, 9-15 (odd) and 14 Kempt Street 7-15 (odd), 23, 16 and 20-26 (even) Ritter Street 1 and 2 Keemor Street. No. 3 Area— 19, 20 and 21 Kempt Street. No. 4 Area— 31 and 33 Kempt Street 30-34 (even) and 31-39 (odd) Ritter Street 56-62 (even) Fenwick Street. No. 5 Area— 38 and 41 Kempt Street. No. 6 Area— 2-6 (even) Spearman Street 42 Kempt Street. No. 7 Area— 53, 57 and 59 Jackson Street 5, 7, 13-17 (odd) and 10-16 (even) Spearman Street. No. 8 Area— 21-25 (odd) and 24 Spearman Street. No. 9 Area— 47 and 49 Jackson Street. Escreet Grove Clearance Areas Nos. 1 to 6: No. 1 Area— 6-14 (even) Escreet Grove. No. 2 Area— 18-36 (even) and 19, 23, 33 and 37 Escreet Grove. No. 3 Area— 61, 63, 62 and 64 Escreet Grove. No. 4 Area— 44 Escreet Grove. No. 5 Area 50 Escreet Grove. No. 6 Area— 61 Rectory Place. Delvan Street Clearance Area 1-9 (odd), 2-8 (even), 12 and 14 Delvan Street. King George Street Clearance Area 31-45 (odd) and 38-54 (even) King George Street. 233 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 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 230 and 14 inspections for discretionary and standard grant applications respectively, and advice was given on 135 occasions in respect of such grants. On completion of standard grant works, a further 8 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 Section 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 234 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. The Health and Welfare Department has always given advice concerning houses in multiple occupation to anyone requesting information. Leaflets in printed form giving details of the minimum requirements for such premises have now been supplied to local estate agents and are available through various Departments of the Council for potential house purchasers. During the year, 41 visits were made by the Housing Inspectors. In one instance it was found necessary to serve an informal notice requiring the execution of works under this Act. Means of Escape from Fire—Section 16—Arising from representations made in April 1965 to the London Boroughs' Committee by a constituent member, a Working Party of representatives of that Committee and Officers of the Greater London Council was set up to review the existing procedure and code of practice in the Greater London Area. The Working Party prepared a revised code of practice containing some alterations of a technical nature. Briefly these concern modifications to the requirements in respect of pass doors on top floors of three-storey houses, staircase lobbies and self-closing doors to staircases and the protection of gas meters. On the recommendation of the London Boroughs' Committee to constituent Councils, this Council agreed to the adoption of the undermentioned proposals of the Working Party's Report:— (a) the amendments to the code of practice referred to in the preceding paragraph; (b) that where a code of practice is to be applied, consultation with the Greater London Council would be deemed to have been carried out and only in the few cases where the code is not to be applied should consultation be necessary; (c) the revised code of practice be placed on sale to the public; (d) a footnote on the Notice to a landlord that should there be difficulty in obtaining a builder, application should be made to the Public Health Inspector for the names of suitable builders. Re-housing (a) Borough Council—The number of families housed and rehoused including transfers, casual voids, etc., amounted to 1,594. Of this number 55 were in respect of families re-housed from outside the Borough. 235 (b) Greater London Council—During the year ended 31st December, 1966, the Greater London Council had provided alternative accommodation for a total of 771 Greenwich families. Of this figure 229 were housed on Greater London Council housing estates outside the Borough. Five families from outside Greenwich were re-housed in the Borough under the Greater London Council scheme. Overcrowding—During 1966 there were 369 visits carried out in respect of complaints of overcrowding and applications for re-housing, as a result of which 14 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 1,118 (b) Dwellings completed during 1966 653 (c) Dwellings in the course of construction at 31st December, 1966 830 Housing Survey Through the courtesy of Mr. A. J. Gray, the Housing Manager, the following extracts are quoted from his observations on the housing position in 1966:— "The initial problem caused by the amalgamation of the Metropolitan Boroughs had been largely overcome in the previous year, the position having been reached whereby the new housing waiting list had been compiled and applications assessed under the new points scheme. During the year 547 families on the waiting list had been housed, but registrations continued to increase and by the end of the year 6,976 families had registered for rehousing. Industrialised building methods continued to be used and the first scheme of 88 dwellings on the John Wilson Street site was completed, and it became obvious that the experience gained in this field would not be wasted. It was envisaged that this new method would play a large part in the provision of new homes in the years to come. Meanwhile, all possible improvements with particular regard to design and appearance are being investigated. Overall there were 625 completed dwellings in 1966 which brought the number of properties owned and managed by the Council as at 31st December 1966 to 16,085. Pre-war properties 5,900 Post-war properties 8,671 Temporary Dwellings 308 Miscellaneous properties 1,206 16,085 236 The number of temporary dwellings was reduced by 103 and plans are being prepared for redevelopment of the land which has become available. Of the major sites in the Borough, considerable progress was made within the Glyndon redevelopment area, where the whole of Stage II and nearly half of Stage III were completed, and all 109 dwellings on the Eltham Vicarage site were ready for letting before the end of the year. Altogether, 1,573 dwellings were under construction during 1966 in various sites throughout the Borough as shown below: Schemes in progress No. of dwellings Glyndon Area Stage II 179 „ „ „ III 204 St. Mary's Area—Bowling Green Row Stage I 125 „ „ „ John Wilson Street Stage I 32 „ „ „ John Wilson Street/Castile Road 88 The Oaks, Burrage Road 109 Plumstead Temporary Dwelling Sites 139 Coleraine Road (East) 41 Rochester Way 42 Admaston Road 36 Gavestone Crescent 172 Kidbrooke Park Close 74 Herbert Road/Whitworth Road 12 South wood Road 21 Shrewsbury Lane (2 sites) 30 Old Dover Road 13 The Vicarage Site, Eltham 109 Brent Road 11 Shooters Hill Road 27 Cantwell Road 9 Wendover Road 8 Mayerne Road 8 Prince John Road 80 Hervey Road 4 1,573 The possibility of purchasing properties from elderly occupiers and providing these persons with Council accommodation more appropriate to their needs was re-investigated during the year. Although many of the properties offered for sale to the Council under this scheme require some repairs and adaptations 22 purchases are being made. This is to the advantage of both the vendor and the Council, and enables the dwellings to be better used by the housing of a larger family unit." 237 INSPECTION OF FOOD AND SUPERVISION OF FOOD PREMISES New Legislation The Meat Inspection (Amendment) Regulations, 1966—With the exception of the under-mentioned provision (b), these Regulations came into operation on 30th September, 1966, and further amended the Meat Inspection Regulations 1963. The main provisions are:— (a) to empower local authorities (after consultation with the occupiers and users of private slaughterhouses and subject to a right of appeal by those users to the Minister) to fix the times at which slaughtering may take place in any private slaughterhouse; (b) to end, on 31st October, 1966, the present provision enabling any meat to be removed from a slaughterhouse if it has not been inspected within a specified period of slaughter; (c) to prohibit the use of green ink for inspection marking stamps; and (d) to make changes of detail in the inspection procedure laid down in the principal Regulations. The changes effected by these amending Regulations are designed to bring about 100% inspection of all home killed meat before it leaves the slaughterhouse. This standard, however, has always been maintained at the Slaughterhouse within the Borough. Weekly slaughtering is carried out Monday to Friday between 7.00 a.m. and 5.00 p.m. each day and Saturday 7.00 a.m. to 1.00 p.m., with provision for one or two additional weekend sessions in special circumstance such as to meet the exceptional demands made on the slaughtering trade immediately before Christmas. This provision accords with paragraph 5 of the accompanying Circular FSH 30/66 to these Regulations in which the Minister looks to local authorities for times of slaughter to be sufficiently flexible. Consultations were made with the Slaughterhouse Manager and as there was complete agreement that the existing arrangements had operated in a most satisfactory manner, the Council agreed to their continuation and the owners were notified accordingly. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, and(Amendment) Regulations, 1966—The principal Regulations lay down requirements as to food hygiene in respect of markets, stalls and delivery vehicles. Markets and stalls are so defined that the Regulations apply to any handling of or trading in food which is undertaken either in any market or market premises or away from fixed premises. Delivery vehicles are defined as any vehicles used for the delivery of food; if they are used for the sale of food, they come within the definition of stall and become subject to the appropriate requirements for stalls. 238 The Regulations revoke or supersede corresponding requirements contained in the Food Hygiene (General) Regulations, 1960, which will henceforward continue to apply to food businesses in fixed premises and ships. Their operative date, together with the (Amendment) Regulations is 1st January, 1967. The main requirements of the principal Regulations relate to:— (i) the cleanliness of stalls and delivery vehicles used in any food business and the equipment used therein; (ii) the hygienic handling of food; (iii) the cleanliness of persons engaged in the handling of food and of their clothing, and the action to be taken where they suffer from or are the carriers of certain infections liable to cause food poisoning; (iv) the temperatures at which certain foods particularly liable to transmit disease are to be kept at markets and stalls; (v) the provision of water supply and washing facilities; (vi) the proper disposal of waste material; (vii) the granting by local authorities of certificates of exempion from certain of the requirements with a right of appeal to a magistrates' court against the refusal or withdrawal of a certificate. The main changes from the requirements of the 1960 Regulations as hitherto applicable to markets, stalls and delivery vehicles are:— (a) before food is offered for sale it must be separated from any food which is unfit for human consumption; (b) any person handling any open food (i.e. food not adequately protected by wrappings etc.) must wear clean and washable overclothing, except in specified cases; (c) delivery vehicles as well as stalls must bear the owner's name and address, and both must identify the place where they are kept or garaged; (d) requirements as to the provision of water supply and washing facilities are extended to all businesses; (e) the requirements that certain stalls shall be effectively covered and screened is extended to all stalls selling open food other than raw vegetables, unless the stall is designed, constructed and operated so as to protect the food until it is sold; (f) the requirements as to disposal of waste are extended. The (Amendment) Regulations chiefly affect Regulations 15 to 18 of the principal Regulations, as far as they require washing and other facilities to be provided on food vehicles. Regulation 24 239 exempts certain vehicles operating from premises where similar facilities are provided under other food hygiene regulations; these Regulations enlarge the scope of the exemption so as to exclude, subject to conditions, all food vehicles operating between such premises and certain other premises. Minor amendments are also made in the principal Regulations (i) in Regulation 2(1), the definition of "container" is slightly amended. Also, the definition of "food business", when read with certain provisions, including some repeated from the Food Hygiene (General) Regulations, 1960, limited them to food delivery vehicles operating from a market or stall; the definition as now amended applies these provisions to all food delivery vehicles; (ii) the requirement in Regulation 13(1) to display the address at which a stall or delivery vehicle is kept is slightly amended; (iii) Schedule 1 is amended to make it clear that meat totally wrapped in paper or film is not to be regarded as open food for the purposes of the principal Regulations. The Council in its role as Market Undertaker has to meet certain requirements itself. Consultation is taking place with traders so that problems arising from the introduction of these Regulations can be resolved to the satisfaction of all concerned. The Slaughterhouses (Hygiene) (Amendment) Regulations, 1966 These Regulations come into operation on 1st February, 1967, and amend the Slaughterhouses (Hygiene) Regulations, 1958. The principal changes are:— (a) regulation 19(2) and 19(3) and regulation 20 of the Slaughterhouses (Hygiene) Regulations have been extended to prohibit any person permitting the retention in a slaughterhouse of any carcase of an animal slaughtered elsewhere, unless specified conditions are complied with; (b) the period which any animal intended for slaughter may be kept in a slaughterhouse is limited to 72 hours except where an authorised officer gives his consent, and subject to certain conditions; (c) an obligation to keep any lairage clean is imposed upon the occupier of a slaughterhouse; (d) the use of wiping cloths in the dressing of carcases is prohibited but until 1st November, 1968, a wiping cloth may be used on any carcase or offal, if it is sterilised before use, and used on only one carcase and its associated offal before re-sterilisation, 240 Other Food Legislation In addition to the foregoing legislation, the undermentioned food Regulations were enacted during the current year:— The Skimmed Milk with Non-Milk Fat (Amendment) Regulations, 1966—Extended Schedule 2 to the Skimmed Milk with Non-Milk Fat Regulations with effect from 22nd July, 1966, to exempt the food S.M.A. in liquid as well as in powder form from the requirement to bear on the label the declaration "Unfit for Babies" (or the permitted alternatives). The Mineral Hydrocarbons in Food Regulations, 1966—Reenacted with amendments the Mineral Hydrocarbons in Food Regulations, 1964, and came into operation on 27th August, 1966. The Salad Cream Regulations, 1966—Superseded the Food Standards (Salad Cream and Mayonnaise) Order, 1945, and came into operation on 19th September, 1966. The Antioxidant in Food Regulations, 1966—Superseded the Antioxidant in Food Regulations, 1958, and came into operation on 9th December, 1966, except that those Regulations continue in force for a transitional period ending on 8th September, 1967. The Cheese (Amendment) Regulations, 1966—Amend the Cheese Regulations, 1965, ("the principal Regulations") and come into operation at the same time as those Regulations on 1st February, 1967. The Colouring Matter in Food Regulations, 1966—Superseded the Colouring Matter in Food Regulations, 1957, and come into operation on 26th June, 1967, with the exception that the labelling provisions of those Regulations continue in force for a transitional period ending on 31st December, 1967. The Butter Regulations, 1966—Supersede the Food Standards (Butter and Margarine) Regulations, 1955, insofar as those Regulations apply to butter and come into operation on 1st September 1967. Ministry of Agriculture, Fisheries and Food Circulars 20/66 and 69/66 approve the use of specified chemicals as alternatives to steam or boiling water in the cleansing of vessels used for the 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 Countries: Algeria, Argentine Republic, Australia, Belgium, Botswana, Canada, Denmark, Federal Republic of Germany, Finland, France, French West Africa, Hungary, Kenya, Kingdom of the Netherlands, Luxembourg, Madagascar, Malta, New Zealand, Nigeria, Norway, Poland, Portugal, Romania, South Africa, Spain, Switzerland, Syria, Uganda, United States of America, Uruguay and Yugoslavia. 241 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 192. On 16 occasions the premises of distributors and dairies were visited other than for sampling purposes, and 7 defects found were subsequently remedied by informal action. 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 was in force until August, 1966, when processing ceased. A Dealer's Pasteuriser's Licence in respect of this plant was in force on 31st December, 1966, as were the following licences in relation to milk obtained in pre-packed form for sale to the general public:— In Operation 31.12.66 Distribution of Sterilised Milk 178 „ „ Pasteurised Milk 136 „ „ Untreated Milk 69 „ „ Ultra Heat Treated Milk 11 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 thirty-one samples were submitted for the Methylene Blue test, of which 8 failed. "Follow-up" samples taken in respect of the 8 which failed all proved satisfactory. Satisfactory reports were received in respect of 231 milk samples submitted for the Phosphatase test. Forty-two samples of Sterilised milk were submitted for the Turbidity test, of which six failed. "Follow-up" samples taken in respect of the six which failed all proved satisfactory. Analytical Examination of Milk—A total of 182 samples of designated milks, 174 formal and 8 informal, were submitted for chemical analysis and all proved to be genuine. Seven 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:— 242 (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, 1966, was 221. Two hundred and fifty-one 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 558. Visits to these premises were made on 212 occasions and 14 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 110 samples were submitted for examination and the ice-cream graded according to the Ministry's 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 58 4½ hours or more 1 Satisfactory 23 2½ to 4 hours 2 Sub-standard 14 ½ to 2 hours 3 Unsatisfactory 15 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 administrative action is taken. It was not necessary during the year to have recourse to "administrative action". Of the 110 samples taken during the current year, 17 were of the "soft" variety, 7 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. Four samples were taken, all of which proved satisfactory. 243 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 opportunity 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 28 applications were made to the Town Clerk from street traders engaged in the retailing of articles of food. The applications were approved and licences granted. No formal action was necessary in respect of contraventions of Regulations 26 to 28 of the Food Hygiene (General) Regulations, I960. 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. Supervision of Premises Including Factories where Food is prepared To these establishments, the Public Health Inspectors made 3,402 visits, as a result of which 332 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 Visits Made No. of Visits No. of Premises at which Improvements were effected No. of Improvements effected Caterers, Restaurants, etc. 459 54 134 Grocers, Greengrocers 209 11 32 Butchers' Shops 92 8 22 Dairies and Milk Distributors 16 3 7 Wharves and Factories 760 — — Bakehouses and Bakers' Shops 16 2 4 Ice Cream Premises, Confectioners, etc. 212 14 14 Fried Fish Shops 43 5 27 Other Non-Registered Food Premises 135 18 39 Cooked Meats and Preserved Foods 95 27 53 Visits Re. Infestations 116 — — „ „ Markets 311 — — „ „ Food Poisoning 1 — — Sampling Visits 564 — — Fair Visits 14 — — School Visits 79 — — Interviews 210 — — Complaints Investigated 70 — — Totals 3,402 142 332 244 Food Hygiene (General) Regulations, 1960 In compliance with Regulations 16 and 19, which deal with the provision of wash-hand 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 washhand basins No. with facilities for washing food and equipment Cafes, Restaurants, etc. 443 443 443 Grocers 338 338 338 Greengrocers 166 162 Not applicable Butchers 138 138 138 Bakers 71 70 70 Confectioners 289 288 Not applicable Fish Shops 69 69 69 Public Houses 240 240 240 Off Licences 52 52 Not applicable 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 16 occasions and, as a result of the inspections, 4 sanitary defects were remedied. Catering Establishments As a result of 459 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 96 occasions. Thirty-eight 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:— 245 Shops, Stalls, etc.:— Meat— Pork 491 lbs. Beef 3,131 „ Lamb 387 „ Rabbits (skinned) 67 „ Pigs' Kidneys 27 „ Lambs' Livers 4 „ Tripe 7 „ Pigs' Livers 14 „ Mincemeat 5 „ Ox Liver 12 „ Lambs' Hearts 1½ „ Turkeys 75 „ Offal, Cattle 86½ „ Offal, Pigs 57 „ Veal 2 „ Chicken 112 „ 4,479 lbs. Canned and Other Foods— Foods, Various (Canned) 1,868 lbs. Cooked Meats (Canned) 2,738 „ Fruit 250 „ Fruit (Canned) 1,359 „ Fruit Juice (Canned) 86 „ Fish 224 „ Fish (Canned) 38 „ Foods, Various (Frozen) 6,193 „ Meat Pies 30 „ Foods, Various (Packets) 268 „ Butter, Margarine, Lard 354 „ Liver (Canned) 120 „ Cheese 38 „ Coconut 100 „ Mixed Grill 10 „ 13,676 lbs. 18,155 lbs. The Meat Inspection Regulations, 1963, and The Meat (Amendment) Regulations, 1965 Butchers' Shops and Stalls—These are under constant supervision and 92 visits of inspection were made. Insanitary defects were remedied in 22 instances. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was this necessary. 246 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. Ten licences to slaughtermen were also renewed. Meat Inspection—The total number of animals presented for slaughter during the year was 60,725 a reduction of more than 17,000 on the figure for 1965. There were 20,000 less pigs slaughtered than in the previous year, but 3,000 more sheep and lambs. The incidence of disease, parasitic infestation and other con ditions rendering carcase meat and/or offal unsuitable for human consumption followed closely the pattern of 1965. One sheep was condemned because of septic mammitis. Sixty pig carcases were rejected for a variety of reasons, namely:— Pigs found dead on arrival at slaughterhouse 13 Pigs that died in lairage after arrival 6 Pig carcases affected with multiple abscesses 29 Pig carcases condemned for other reas 12 In connection with arthritis in pigs, it is significant to report that more than 7,500 hocks and trotters were condemned because of the swollen nature of the joints. One bovine carcase was condemned as a result of generalised tuberculosis. The condition of livestock being presented for slaughter calls for some comment on the matter of their state of cleanliness on arrival at the slaughterhouse. This varies considerably, but a much greater effort is required from all the parties concerned, i.e. producer, livestock conveyors, and slaughterhouse managements to see that livestock is presented for slaughter in a cleanly state. Quite a number of cattle arrive very dirty and defy any sort of cleaning with the limited facilities available. Some move should be made to encourage those concerned to improve the present position, especially as so much is being done under current Regulations to create new standards of hygiene in the slaughterhouse. So far as slaughterhouses are concerned, the Slaughterhouses (Hygiene) Regulations have been amended to include a specific clause requiring any lairage to be kept thoroughly clean. This new Regulation comes into forcc in February 1967. The bulk of condemnations at the slaughterhouse apart from the sixty pig carcases, one beef carcase and four sheep carcases, was made up of bovine livers and pig offal. The total weight rejected amounted to 38½ tons. 247 Carcases and Offal Inspected and Condemned in Whole or in Part,1966 Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed and Inspected 9,363 50 — 13,847 37,584 All Diseases (except Tuberculosis and Cysticerci)— Whole carcases condemned — — — 4 60 Carcases of which some part or organ was condemned 3,065 — — 974 11,079 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 32.0 — — 14.0 33.0 Tuberculosis only— Whole carcases condemned 1 — — — — Carcases of which some part or organ was condemned 11 — — — 447 Percentage of the number inspected affected with Tuberculosis 0.1 — — — 1.4 Cysticercosis— Carcases of which some part or organ was condemned and treated by refrigeration 29 — — — — 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. 248 The following foods were rejected at the wharves:— Meat— Lamb 5,712 lbs. Lambs' Livers 70 „ Ox Briskets 40 „ Ox Crops 560 „ Ox Shins 80 „ Pigs' Hearts 30 „ 6,492 lbs Canned and Other Foods Fruits, Various (Canned) 52,485½ lbs. Cooked Meats (Canned) 1,182 „ Tomatoes, Tomato Puree and Paste (Canned) 3,613½ „ Fish (Canned) 475 „ Ravioli (Canned) 22 „ Butter Beans 1,344 „ Sweet Corn 23,760 „ Cucumbers 16,500 „ Rice 448 „ Passion Fruit Juice 42 „ Margarine 56 „ Cherries 4 „ Gherkins 30 „ 99,962 lbs 106,454 lbs Caseous Lymphadenitis. This disease, sometimes called "pseudotuberculosis" 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 21,018 209 — — Groundnuts—Presence of Aflatoxin—During the year, 9 samples were taken, one of which was reported upon as containing Aflatoxin. Details of this sample are to be found in the list of "non-genuine" samples appended at the end of this section. 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:— 249 Country of Origin Quantity Imported Containers Sampled Unsatisfactory Bact. Chem. Dried Egg A Ibumen America 1,078 x 50 lb. Cartons 103 — — „ 15 x 150 lb. „ 6 — — „ 307 x 44 lb. „ 41 — — „ 120 x 56 lb. „ 20 — — Dried Whole Egg Australia 917 x 160 lb. Drums 127 1 — „ 280 x 150 lb. „ 36 — — China 4,490 x 110 lb. Tins 310 — — „ 30 x 50 lb. „ 5 — — Denmark 600 x 56 lb. Cartons 50 1 — „ 555 x 441b. „ 39 — — Dried Egg Yolk America 10 x 50 lb. Cartons 2 — — China 100 x 110 lb. Tins 10 — — Frozen Whole Egg Australia 155,341 x 28 lb. Drums 617 — 35 China 14,599 x 44 lb. Tins 255 — 2 „ 1,800 x 22 1b. „ 6 — — Frozen Egg White China 1,000 x 44 1b. Tins 50 — — Incidence of Salmonella Organism Found Samples Dried Egg Albumen Dried Whole Egg Frozen Whole Egg Salmonella anatum — 1 — „ seftenberg — 1 — Dried Hen Egg Albumen—All landings of this product, if found positive on bacteriological examination, 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 of sampling carried out in the Borough but one heat treatment was effected on positive albumen received from another local authority. English Frozen Whole Egg Plant—In 1966, pasteurisation of liquid egg was carried out on 40 days, the production of which amounted to 153 tons. In addition 174 tons of non-pasteurised liquid 250 egg were produced on 83 days. The Liquid Egg (Pasteurisation) Regulations, 1963 were implemented without difficulty and to the complete satisfaction of this Department. The product was sampled and submitted to the Amylase Test on six 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 39 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. Argentine Saudia Arabia 12 27, 193 lbs. Australia Ascension Isles 1 „ „ Belgium 9 „ „ Curacao 1 162,033 lbs. „ „ Cyprus 6 „ „ Germany 2 England Belgium 1 560 lbs. New Zealand Ascension Isles 1 „ „ Belgium * „ „ Curacao ** „ „ Cyprus 1 105,559 lbs. „ „ Germany 1 „ „ Holland 2 „ „ Norway 1 „ „ Sweden 1 * Consignment of meat destined for Belgium from Australia and New Zealand entered on same certificate. ** Consignment of meat destined for Curacao from Australia and New Zealand entered on same certificate. Food and Drugs Act, 1955 Twelve hundred and eleven samples were submitted for examination to the Public Analyst, of which 100 informal samples were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 206 formal and 905 informal were obtained in the normal course of sampling. 251 Of all the samples obtained, 37 were considered by the Public Analyst to be non-genuine and of this total 8 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 29 non-genuine samples, 15 were offences in respect of permitted ingredients not being disclosed on the labels and these have therefore been excluded from the calculated adulteration figure of 1.26%. Milk was one of the main foods sampled, the total being 182 samples of which 144 were in respect of milk other than Channel Islands. Of this latter figure, the average percentage of milk fat was 3.62% and solids-not-fat 8.63%, 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-eight Channel Islands milks sampled in the Borough during the year proved to have an average content of 4.34% and 8.91 % 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 Two samples of Chloral and Potassium Bromide Mixture for Infants were taken for analysis during 1966. One of these samples was found to consist of Chloral Mixture and the stock was completely withdrawn. The manufacturers introduced more stringent measures to eliminate any further errors of labelling. Dried Milk Regulations, 1965 The four samples of dried milk taken during the year proved satisfactory. The Condensed Milk Regulations, 1959 No samples were taken during 1966. Other Food Examinations Information concerning the analyses of these samples is given in the following table:— 252 Examination Article How Obtained Bact. or Chem. Result Action Taken Bitter Lemon Drink Complaint from member of the public that bottle of bitter lemon drink contained foreign matter. Chem. Contained several growths of fungus and a dead Phorid fly. The unopened bottle, prior to analysis, was shown to Manufacturer who stated that following the seasonal demand for soft drinks at Christmas, the bottles on return are washed and stored. Many of the bottles may not be used again until the following Christmas. An isolated incident considered unlikely to recur. Complainant notified. No further action. Dried Apricots Complaint from member of the public that fruit was mouldy. Chem. The apricots had been heavily ininfested by mites and were unfit for consumption. Two further packets, the remainder of the stock of that brand of apricots, surrendered by shop keeper. Further sample No. 2296 submitted to Public Analyst. Other brands of dried apricots when sampled were found to be genuine. Complainant notified. No further action. Raspberry Ice Lolly Complaint from member of public that ice lolly had bitter taste. Chem. Contained salts of calcium (chloride and other calcium salts) 1%. The specimen had an unpleasant, saline taste. Manufacturer stated specimen may have become contaminated through a faulty mould. Sample taken and satisfactory report received. Apparently an isolated complaint and generally unlikely to recur. Complainant notified. No further action. 253 Examination Article How Obtained Bact. or Chem. Result Action Taken Malt Vinegar Complaint from member of the public that bottle of malt vinegar contained foreign matter. Chem. Comprising a full 1-pint bottle of vinegar and contained suspended in the vinegar six flat, cylindrical, jellylike bodies consisting of the zoogloea of bacteria. Contained acetic acid 3.2% instead of 4%, the deficiency probably being due to decomposition. No explanation for this vinegar being on sale as it was known to be relatively old. All other vinegar in retailers inspected and found satisfactory. Rotation in store found to be quite satisfactory. Complainant notified. No further action. Potato Crisps Complaint from member of the public that packet of potato crisps contained foreign body. Chem. Consisted of a thin slice of a hard, translucent, straw coloured material comprising gelatinised potato, consistent with a potato crisp that had been heated but not fried. Complainant notified. No further action. Blackberries Complaint from member of the public of a beetle in blackberries. Chem. The beetle was stained by purple juice and yielded no reaction for phosphatase, indicating that the insect had been heated to a temperature of 150°F or over. Suppliers requested to inform Importers of Public Analyst's Report. Dates Complaint from member of the public that dates smell of petrol. Chem. No foreign taint could be detected even on boiling when the sample was examined and the dates appeared to be in good edible condition. Sample taken and satisfactory report received. Complainant informed. No further action. Cockles Complaint from member of the public that cockles had a peculiar taste. Chem. The specimen satisfied the test applito it. No abnormal taste or smell was observed in the specimen. The salt content 0.7% and the pH 7.5, were normal and no foreign ingredient was detected. Complainant notified. No further action. In addition to the foregoing complaints, there were 62 others from members of the public. One complaint of a razor blade in a bread roll was the subject of legal proceedings and the defendant was fined £15 with 5 guineas costs. The remainder were fully investigated by the Food Inspectors and, where justified, appropriate action was taken. 254 FOOD AND DRUGS ACT, 1955 Number and Description of Sample Submitted fri Analysis under the above Act duing the Year 1966 (including samples taken under the Public Health -Imported Food- Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Almonds, Ground — 1 1 — — — Angelica — 1 1 — — — Baby foods — 10 10 — 1 1 Baking Powder — 1 1 — — — Barley, Pearl — 2 2 — — Beef powder — 2 2 — — — Beer — 1 1 — — — Beverage — 3 3 — — — Biscuits — 36 36 — Blancmange powder — 4 4 — — — Brandy 2 — 2 — — — Bread — 1 1 1 1 Bread (rolls), Buttered 2 — 2 — — — Breadcrumbs — 3 3 Breadsticks — 1 1 Butter — 6 6 Cake and pudding mixtures 10 10 — — — Cake decoration — 1 1 - Calf's foot jelly — 1 1 — — - Camphorated Oil — 1 1 — — - Cheese and biscuits — 1 1 — — - Cheese and cheese spread — 19 19 — 2 2 Cheese, Cream — 1 1 — — — Cheese flaps. Canned — 1 1 — — — Cheese, grated — 1 1 — — — Chestnut flour — 1 1 — — — Chocolate, Drinking — 3 3 — — — Coconut, Creamed — 1 1 — Coconut, Desiccated — 6 6 — Coffee 1 1 — Coffee and chicory — 2 2 — — — Coffee extracts, Dry — 11 11 — — — Coffee extract. Decaffeinated — 1 1 — — — Coffee, Liquid — 3 3 — — — Colouring matter — 3 3 — — — Confectionery, chocolate — 4 4 — — — Confectionery, Flour — 13 13 — — — Confectionery, Sugar — 21 21 — — — 255 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Cooking fat — 1 1 — — — Cornflour — 3 3 — — — Cough mixtures — 2 2 — — — Cough syrup — 1 1 — — — Cream — 4 4 — — — Cream of Tartar — 1 1 — — — Cream, Sterilized 3 3 — — — Curry powder — 4 4 — — — Custard powder — 4 4 — — — Dessert powders — 13 13 — — — Dessert preparation — 1 1 — — — Drinks, Soft — 30 30 — — — Drinks, Soft, Powder — 4 4 — — — Dripping — 1 1 - — — Egg rusks — 1 1 - — — Epsom Salts — 1 1 — — — Fish — 4 4 — — — Fish, Bottled — 3 3 — — — Fish, Canned — 32 32 — 2 2 Fish paste — 9 9 — — — Flavouring compounds — 10 10 — 2 2 Flavouring essence — 2 2 — — — Flour, Plain — 3 3 — 1 1 Flour, Self-raising — 1 1 — — — Fruit, Bottled — 1 1 — — — Fruit, Canned — 47 47 — 2 2 Fruit, Dried — 32 32 — 4 4 Fruit, Fresh — 6 6 — — — Fruit juice — 14 14 — 2 2 Fruit pie — 1 1 — — — Fruit pie filling, Canned — 1 1 — — — Gelatine — 4 4 — — — Gram flour — 1 1 — — — Gravy preparation — 8 8 — — — Groundnuts — 9 9 — 1 1 Herbs, Dried — 8 8 — — — Honey — 8 8 — — — Ice Cream — 4 4 — — — Ice cream powder — I 1 — — — Ice cream preparation — 1 1 — — — Ice lolly — 1 1 — — — Icing compound — 1 1 — — — Jam — 18 18 — — — Jelly tablets and compounds — 24 24 — 1 1 Jelly with fruit, prepared — 5 5 — — _ Junket preparation — 2 2 — — — 256 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Lard 4 4 — — — Lentils — 2 2 — — — Lolly mixture — 2 2 Macaroni cheese, Canned 2 2 — — — Margarine — 5 5 — — — Marmalade 4 4 — — — Marzipan — 2 2 — — — Meal, Prepared — 1 1 — 1 1 Meat, minced 20 — 20 1 — 1 Meat paste — 2 2 — — — Meat products — 19 19 — — — Meat products, Bottled — 1 1 — — — Meat products, Canned — 56 56 — 4 4 Medicines — 2 2 — _ Medicines, Proprietary — 4 4 — — — Meringue powder — 1 1 — —— —— Milk 174 8 182 — — — Milk, Dried — 4 4 — — Milk, Evaporated — 2 2 — — — Milk pudding, Canned — 6 6 — 1 1 Millet, Savoury — 1 1 — — Mincemeat — 3 3 — Mushroom tablets 1 1 1 1 Mustard, Prepared — 11 11 — I 1 Noodle shells in cheese sauce, Canned — 1 1 — — — Nuts — 3 3 — — — Oil and vinegar dressing — 1 1 — — — Oil, Cooking — 7 7 — — —— Olive Oil — 4 4 — — Olives — 1 1 — Omelet mixture — 1 1 — Pasta — 2 2 — — — Pasta in cheese sauce, Canned — 1 1 — — — Pastry mixture — 1 1 — —— — Pastry, Uncooked 1 1 Pea flour — 1 1 Peanut butter — 3 3 — Peanuts 1 1 Pease pudding, Canned — 5 5 — — — Pectin 1 1 Peel, Candied 9 9 Pepper — 7 7 — — — 257 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Pickles — 30 30 Poppy seeds — 1 1 — — — Potato crisps — 3 3 — — — Potato flour — 1 1 — — — Proprietary foods — 5 5 — — — Puddings — 8 8 — — — Rice — 12 12 — 1 1 Rum 2 — 2 — — — Rusks — 1 1 — — — Rye Bread — 1 1 — — — Saccharin tablets — 1 1 — — — Sago — 2 2 — — — Salad cream — 2 2 — — — Salad cream and mayonnaise — 1 1 — Salt — 6 6 — — — Sauce — 35 35 — — — Sauce preparation — 3 3 — — — Sausages — 2 2 — — — Seasoning mixture — 2 2 — —- — Semolina — 4 4 — — — Soda, Bicarbonate of — 4 4 Soup, Canned — 8 8 — — — Soup preparation — 24 24 — 5 5 Spice — 18 18 — — — Spread, Sandwich — 2 2 — — — Suet, Shredded — 5 5 — — — Sugar — 13 13 — — — Sweetener — 1 1 — — — Sweetener, Artificial — 1 1 Sweetening compound — 1 1 — Syrup, Blackcurrant — 2 — — — Syrup, Cherry — 1 1 — — — Syrup, Raspberry — 1 1 — — — Syrup, Rose Hip — 2 — — — Tapioca — 1 1 — — — Tarragon in vinegar — 1 1 23 1 1 Tea — 23 — — — Tomatoes, Canned — 3 3 — — — Tomato juice, Canned — 2 2 — Tomato juice cocktail, Canned — 1 1 — Tomato paste — 3 3 — — — Tomato puree — 3 3 — — — Treacle — 1 1 — — — Trifle Mixture 1 1 — — — Vegetables —• 1 1 — — — 258 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Vegetables, Canned — 14 14 — 2 2 Vegetables, Dehydrated — 21 21 — — — Vinegar (malt) — 10 10 — — — Vinegar, imitation — 1 1 — — — Vinegar, Tarragon — 1 I — — — Vinegar, Wine — 1 1 — — Vitamin health drink — 2 2 — — — Whisky 5 — 5 — — Wine, Alcoholic 1 4 5 — Yoghurt — 2 2 — — — Totals 206 1,005 1,211 1 36 37 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 18 Table Jelly Tablet Contained sulphur dioxide, 100 parts per million, the presence of which was not disclosed in the statement of ingredients on the label. Manufacturer requested to amend label. 24 Beef Mince, Canned Contained meat 52%. Canned Beef Mince should contain at least 90% of meat. The label was considered unsatisfactory because the words "with onion and gravy" were printed in much smaller type below "Lean Cut Beef Mince". No legal standard has yet been adopted for this commodity. Manufacturer rejected Public Analyst's opinion that the label was unsatisfactory. 83 Apricot Custard Contained Vitamin C, 9 milligrams per ounce. The product was claimed on the label to contain "Vitamin C (minimum 12 mg. per oz.)". Manufacturer advised of Vitamin C deficiency which has been corrected. 259 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 196 Red Currant Juice Contained red currant juice, sweetened, 60% and added water 40%. The Distributor of the fruit juice which is imported from Germany was informed that the product contained added water and therefore the declaration on the label required amendment. Pure Red Currant Juice is now being imported and conforms with the Food and Drugs Act. 315 Beef Noodle Soup No significant proportion of beef was found and the analysis indicated only 2J% of meat extract, equivalent to 0.15% when made up. The label, which bore an illustration of a large piece of fresh beef, was considered misleading. Manufacturer advised of Public Analyst's comments. Product appears to have been withdrawn. 346 Blackcurrant Juice (sugar added) Contained blackcurrant juice 50%, sugar 8% and added water 42 %. The Distributor of the fruit juice which is imported from Germany was informed that the product contained added water and therefore the declaration on the label required amendment. Pure blackcurrant juice is now being imported and conforms with the Food and Drugs Act. 379 Plain Flour Contained iron, 1.35 milligrams per 100 grams. According to the Bread and Flour Regulations, flour should contain not less than 1.65 milligrams of iron per 100 grams. Further sample proved satisfactory. 260 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 417 Sliced Peaches in Heavy Syrup, Canned The can was under internal pressure and the peaches, which had a bitter, metallic taste due to corrosion of the tin plate, contained tin 100 parts per million and iron 150 parts per million. The sample was considered unfit for consumption owing to excessive metallic contamination. Remainder of stock surrendered and destroyed. 420 Spring Vegetable Soup Preparation Contained sulphur dioxide 130 parts per million, the presence of which was not disclosed on the label. The manufacturing company state that no sulphur dioxide is added to the ingredients of the soup during the process of preparation by them. The dehydrated vegetables used in the preparation and obtained from a variety of sources may however contain varying amounts of sulphur dioxide within the limits prescribed by the Preservatives in Food Regulations. Manufacturer asked to amend the list of ingredients on the label to include sulphur dioxide. 443 Minced Beef Contained sulphur dioxide 160 parts per million an added preservative not permitted in fresh meat. Warning letter sent to Butcher. 475 Minced Beef, Canned Contained meat 48%. Canned minced beef should contain at least 90% of meat. The label was considered unsatisfactory because the words "with onion and gravy" were printed in smaller type after "Minced Beef". No legal standard has yet been adopted for this commodity. Manufacturer rejected the Public Analyst's opinion that the label was unsatisfactory. 261 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 516 Lancashire Rarebit Contained sorbic acid 220 parts per million, the presence of which was not disclosed on the label. Manufacturer requested to amend the label to include the presence of sorbic acid. 523 Butterkase The label of the product, which consisted of cheese spread, did not bear an English name or statement of ingredients. Distributor of this product requested to inform the Exporters of the necessity to label the product in English. 576 Rice The rice had been glazed by treatment with talc 0.7% and hydrolised starch 0.5%, the presence of which were not disclosed on the label. Manufacturer requested to amend label. 623 Spring Vegetable Soup Preparation Contained sulphur dioxide 90 parts per million by weight, the presence of which was not disclosed on the label. The manufacturing company state that no sulphur dioxide is added to the ingredients of the soup during the process of preparation by them. The dehydrated vegetables used in the preparation and obtained from a variety of sources may however contain varying amounts of sulphur dioxide within the limits prescribed by the Preservatives in Food Regulations. Manufacturer asked to amend the list of ingredients on the label to in clude sulphur dioxide. 626 Mushroom Tablets The sample did not consist of mushroom, but of a compressed mixture of cornflour, salt, rusk and flavourings with not more than 10% of dehydrated mushroom powder. Manufacturer re quested to amend label. 262 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 631 Dietary Loaf Contained calcium 20 milligrams per ounce. According to the statement on the label the loaf should have contained calcium 34.1 mg./oz. Further sample proved satisfactory. 666 CurrantsReady to Use Contained sand and grit 0.11 %. Currants that are described as "Ready to Use" should not contain sand or grit. Further sample proved satisfactory. 667 Spring Vegetable Soup Preparation Contained sulphur dioxide 150 parts per million, the presence of which was not disclosed on the label. The manufacturing company state that no sulphur dioxide is added to the ingredients of the soup during the process of preparation by them. The dehydrated vegetables used in the preparation and obtained from a variety of sources may however contain varying amounts of sulphur dioxide within the limits prescribed by the Preservatives in Food Regulations. Manufacturer asked to amend the list of ingredients on the label to include sulphur dioxide. 770 Prunes. Canned The can was "blown" due to attack on the tinplate and the prunes contained iron 520 parts per million and tin 100 parts per million. The prunes had an unpleasant inky taste and were unfit for consumption. Remainder of stock surrendered and destroyed. 2161 Beef Noodle Soup Preparation No significant amount of beef was found and the analysis indicated only 2J% of meat extract, equivalent to 0.15% in the soup when made up. The label, which bore an illustration of a large piece of fresh beef, was considered misleading. No legal or recognised standard for meat in pack soups. Manufacturer invited to revise illustration on label. 263 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 2233 Instant Chow Mien Dinner Contained suplhur dioxide 80 parts per million, the presence of which was not disclosed, and the carton containing the constituent parts of the dinner did not bear a statement of ingredients as required by the Labelling of Food Order. Manufacturer informed of Public Analyst's report and agreed to rectify labelling infringements. 2275 Raisins (Stoned, Processed, Ready for Use) Contained sand and grit 0.20%. Raisins described as "Ready for Use" should not contain sand or grit. Packer informed of Public Analyst's report. Further sample proved satisfactory. 2296 Dried Apricots The Apricots had been heavily infested by mites and were unfit for consumption. See "action taken" on similar sample submitted for examination following complaint from member of the public. 2302 Creamed Rice Milk Pudding, Canned Contained fat 2.30%. Creamed Rice Milk Puddings are made from milk, rice and sugar, and contain at least 2.6% of fat. "Follow-up" samples as suggested by Public Analyst proved satisfactory. 2366 Vanilla Flavouring Contained vanilla 0.8% and coumarin 0.1%. Coumarin is regarded as a toxic substance, being a cumulative anticoagulent, and should not be used in food. Manufacturer states that Coumarin is now being eliminated from all flavourings of their manufacture. 2373 Chunky, Pork. Canned Contained meat 92%. This article should contain at least 95 % of meat. The Manufacturer disputes the Public Analyst's contention and refers to revised proposals for canned meats in which a minimum of 90% meat is proposed for Chopped Meat which is presumed includes Chopped Pork. 2392 Evaporated Fruit Salad Contained sulphur dioxide 300 parts per million, the presence of which was not disclosed on the label. Packer agreed to include sulphur dioxide in the list of ingredients on the label. 264 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 2364 Milk Shake Syrup The label bore an illustration of five kinds of fruit. Since neither fruit nor fruit juice could be found in the sample the label was considered inappropriate. Manufacturer informed of Public Analyst's report and in reply stated that the label had been redesigned. (b) In respect of samples taken under Imported Food Regulations TT.2 Flaked Peanuts Contained aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being medium. London Borough, to which consignment had been moved, agreed to take further samples. TT.8 Code Roe Pate Contained benzoic acid 100 parts per million, an added preservative. Consignment returned by Importer to Country of origin. TT.14 Prawns, Canned The prawns had an objectionable taint, resembling iodoform, which rendered them unsuitable for consumption. Importer informed of Public Analyst's report. Three "follow-up" samples proved satisfactory. TT.21 Button Mushrooms, Canned Consisted of Button Mushrooms in brine. The presence of brine or salt was not disclosed on the label as required by the Labelling of Food Order. Letter to Importer and reply received that future consignments would comply with labelling requirements. TT.28 Quenelles de Veau, Canned The label was mainly in French and bore no statement of ingredients in English. Letter to Importer and reply received that future consignments would comply with labelling requirements. TT.56 Tarragon in Vinegar The label of the food did not bear an English name or statement of ingredients. Letter to Importer and reply received that French Suppliers would comply with labelling requirements. TT.68 Mushrooms, Canned Consisted of mushrooms in brine. The presence of brine or salt was not disclosed on the label as required by the Labelling of Food Order. Letter to Importer and reply received that labels showing ingredients to be printed to conform with Labelling of Food Order. 265 Sample No. Article Nature of Adulteration and/or irregularity Action Taken TT.69 French Mustard, Canned Consisted of prepared mustard, containing mustard flour, water, salt and acetic acid. The ingredients were not declared on the label as required by the Labelling of Food Order. Letter to Importer. Reply from Manufacturers in France claimed that label was for identification purposes only. Further letter to Importer pointing out his obligation to furnish to the purchaser within 14 days an invoice or document containing statement of particulars enabling the retailer to comply with Labelling of Food Order. Legal Proceedings Premises Offence Result of Proceedings A. Robbins, 93 Blackheath Road, S.E.10. Razor blade in bread roll. Fined £15 with 5 guineas costs. 266 SECTION VIII MISCELLANEOUS HEALTH EDUCATION SERVICE Health Education has two main functions, namely, the provision of information on health and welfare services and the modification of attitudes inimical to community and personal health. In this, therefore, health education is almost totally a preventive medicine measure for, were it fully effective, many more people would live longer, more contented and active lives and the onset of serious disease would be subject to early diagnosis and treatment with a consequent improvement in prognosis. Furthermore, costs of the National Health Service, generally, would be considerably reduced. To be effective, health education should embrace the whole field of communication ranging from person to person contact to the broad field of mass media. The Health Education Service has the responsibility to utilise all factors of the communication process by, (a) providing services to professionals in the field and others having day to day contact with members of the public; (b) contacting other bodies and groups not covered by (a); (c) using mass media techniques, and (d) continually surveying and appraising the communications field, techniques and equipment. A monthly meeting is held to survey recent developments and to review material. Topics are selected for emphasis in each month of the year and 'in-service' courses on communications techniques are arranged. The following paragraphs give a review of the principal activities undertaken during 1966. Health Education Programme to Local Organisations Circular letters sent to local organisations in 1965 offering the facilities of the Health Education Service continued to produce many requests for visits and this offer was renewed during the summer months of 1966. To any meeting in the area of the Borough, the letter offered film shows, talks or a combination of both which are devoted to various aspects of health education or provide information on departmental services. In all, the 178 visits made to local organisations ensured that contact was made with all age groups and shades of opinions. Frequently, these meetings act as a 'feedback' to the department indicating whether information or services are reaching the public. Often, the meetings become an open forum, clearing away many misconceptions and outmoded ideas. 267 As usual audience figures varied widely from organisation to organisation, the highest numbers being recorded in pensioners' clubs. Whilst the film show is still the most popular form of visit (104 compared with 74 where speakers were requested), the high proportion of requests for a talk or demonstration shows not only a demand for more than visual exercise but also a desire for local knowledge and a wish to express ideas. Due credit must be paid to those members of the staff willing to give their time for these talks and the numbers requested indicate the able manner in which they communicate. The following tables give a breakdown of subject matter and types of organisation visited. TABLE I ANALYSIS BY SUBJECT Subject Films Talks Films & Talks Total D O D O D O Home Safety and Artificial Resuscitation 27 8 4 6 7 12 64 Food Hygiene 8 5 — 1 4 4 22 Infectious Disease and Pest Control 4 3 1 — 1 — 9 Other Environmental Health 3 2 — 1 3 1 10 Nutrition 1 2 3 Personal Hygiene 9 2 — — — — 11 Smoking — 4 — — — — 4 Maternity and Child Welfare 2 3 1 — 1 — 7 Old People's Welfare 3 1 2 — 6 2 14 Welfare Services 1 1 2 4 Mental Health 2 2 Health Services 6 4 3 2 3 1 19 Miscellaneous 5 1 1 — 2 — 9 69 35 13 10 29 22 178 TABLE II ANALYSIS BY ORGANISATION Organisation Films Talks Films & Talks Total Attendance D O D O D O Religious 11 11 1 2 9 11 45 1,589 Political 12 4 2 — 9 1 28 815 Old People 13 1 2 — 1 1 18 1,648 Youth Organisations 2 5 — 1 4 6 18 1,063 Others 31 14 8 7 6 3 69 2,529 69 35 13 10 29 22 178 7,644 D—Duty Hours O—Out of Duty Hours 268 In addition to film shows, talks etc., the circular letter also offered the provision of free displays on health education topics at any local event such as a bazaar or fete. This offer was accepted on four occasions. The resultant displays were well received and large numbers of leaflets distributed. As part of the home safety activities of the department, offers are made in the circular letter to give courses on home safety, particularly to youth organisations. Four courses were arranged, all in connection with the Duke of Edinburgh's Award Scheme. Subsequently all but two candidates passed their examinations and the latter succeeded after a further period of training. Artificial Resuscitation As part of the continuing programme of making the simple method of expired air resuscitation more widely known, a further series of public demonstrations was arranged during the last two weeks of June, prior to the holiday season. Eleven demonstrations were arranged at centres widely distributed over the Borough. The programme included the showing of the film "Emergency Resuscitation" followed by demonstration and public participation in the use of the 'resusci-anne' model. The series was reasonably well attended and it was interesting to note the apathy in some areas compared with the interest shown in others. Those members of the public attending, however, felt that the series performed a useful function. Throughout the year, a number of organisations and schools also requested demonstrations on this subject. Thanks are due to the Baths Department for provision of demonstrators and model. Vision Screening A pilot scheme of vision testing was carried out during the third week of June. A vision screening appliance was hired, designed to indicate sharpness of vision, presence of far or short sightedness, co-ordination of eye muscles, depth perception, one eye vision and fusion of images. Tests were carried out in four old people's clubs, at a garden party, and a session was held to which staff of the department were invited. Results of the tests were on a positive/negative basis, those receiving a negative result being asked to seek professional advice. The three types of screening were intended as an indication of visual acuity in elderly people, the general population, and the working population. 269 Table III below gives a brief analysis of the results:— TABLE III visual screening Sample Age Group Total Screened Passed Failed Old People's Clubs 5 86 8 78 Garden Party 1 7 6 1 2 2 2 — 3 4 4 — 4 13 7 6 5 7 2 5 Staff 3 34 25 9 4 26 9 17 179 63 116 AGE GROUP No. I—Under 15 years No. 2—15-18 years No. 3—19-44 years No. 4—45-64 years No. 5—65 years and over Publicity The Service has occasional use of shop windows adjacent to the main shopping thoroughfare in Woolwich. Displays mounted in these windows included: The Role of the Health Visitor. Rail and Water Safety. Only Mugs take Drugs. Venereal Disease. Mental Health. Artificial Resuscitation. Kill that Fly—Food Hygiene. Eye Care. Immunisation. Home Accident Prevention. The Work of the Public Health Inspector. Fireworks Safety. Such windows provide effective publicity since animation and lighting effects can be introduced to attract attention. In addition, the Service has the use of 14 poster sites at railway stations in the Borough and posters are displayed on these at monthly intervals. In larger campaigns the many sites under the control of the Entertainments Officer are used through the courtesy of the Amenities Committee. The 25 Welfare Centres in the Borough participate in the monthly topic and mount their own supporting displays where possible. 270 Holiday Film Shows Further holiday film shows were arranged for schoolchildren during the Easter and Summer periods and the programmes included films on health education and subjects of general interest. These sessions proved extremely popular, showing that timing is as effective as any other means in attracting audiences. Welfare Centres, Schools and other Sections of the Department. Facilities of the Service such as the provision of visual aid material and equipment, speakers and expertise were heavily utilised by other sectors of the health and welfare services, both directly to the public and in 'in-service' training. Table IV below gives an indication of this use:— TABLE IV DEPARTMENTAL USE OF HEALTH EDUCATION SERVICE Talks Films Talks & Films Total In Duty Hours 16 78 12 106 Out of Duty Hours 1 45 1 47 17 123 13 153 The facilities of the Service were also frequently called upon for display work, notice production and printing. Comprehensive catalogues were produced and distributed by the Service giving details of leaflets, posters and films available from national sources and stocks held by the Department. Successful Instruction and use of Visual Aids An 'in-service' course for professionals actively or likely to be engaged in practical health education was held by the Service early in March. The programme took the form of a film on the correct methods and preparation in carrying out instruction, followed by discussion on application to the particular disciplines involved. The second half of the programme was devoted to the demonstration and use of audio-visual aids, projected and non-projected. Leaflets, Posters, General Publicity Many leaflets are distributed annually through public enquiry points, welfare centres, displays, campaigns and following visits by the film unit to local meetings. In June, distribution of the monthly magazine "Better Health" was commenced to local general practitioner and dentist's waiting rooms. Leaflets on topical matters are frequently included in this distribution. 271 Posters for display are distributed to welfare centres and notice boards as mentioned earlier as well as to other Council premises. Local shopping areas are often asked to display material during campaigns where the subject has an apposite application. Table V below gives details of material distribution for the year. TABLE V DISTRIBUTION OF PUBLICITY MATERIAL Subject Leaflets Posters Fireworks 2,500 450 Water Safety 3,400 75 Infectious Disease 2,700 540 Home Safety—General 4,600 200 „ —Falls 2,300 90 „ —Burns & Scalds 2,540 180 Artificial Resuscitation 3,000 500 Personal Hygiene 1,700 150 Nutrition 750 50 Sex Education 400 7 Welfare of Elderly 2,000 — Immunisation 2,500 400 Maternal & Child Welfare 2,300 200 Smoking 2,300 200 Dental Health 1,500 150 Cancer 1,500 — Food Hygiene 1,600 250 Mental Health 2,000 150 Mental Health Week—5th to 11th June As this was the first of a triennial series of "weeks" devoted to awakening public interest in the problems of mental health, publicity was confined to displays in the foyers of the Council's public buildings, shop windows and poster advertisements throughout the Borough. Next year it is hoped to extend publicity activities and to open selected centres for public viewing. Immunisation Publicity Campaign. 19th to 30th September. Due to the late arrival of campaign material it was difficult to mount an extensive campaign locally in conjunction with the national one. However, shop window displays were constructed and emphasis made on this subject in all welfare centres together with distribution of leaflets and display of posters. Tour of Geriatric Services—7th December, 1966 The Department was honoured to receive a party of 14 Geriatricians from Italy who wished to make a study of local authority services for the elderly. 272 With courier assistance, a one day programme was arranged covering lunch club and mobile meals facilities, sheltered housing accommodation, incontinent laundry, bathing and cleansing facilities, day clubs and residential accommodation. Although an official interpreter travelled with the party most of the visitors could comprehend English. Information booklets and folders were prepared and both guests and hosts had an interesting day. Venereal Disease Laminated plastic notices put up in public convienences in 1965 appear to be reasonably proof against vandalism. During the year a leaflet was devised to support the notices which gave reasons why there should be no delay in seeking advice and a list of addresses where this advice could be sought. Several talks were requested by local youth organisations on the subject and demands were also received for leaflets. On a number of occasions a film on this subject was shown at local schools. Smoking and Health Apart from poster and leaflet publicity, 4 film shows were given to local youth organisations on this particular theme. Verrucae In response to a growing demand for information on the prevention and treatment of verrucae, two leaflets were devised, one in question and answer form and one in factual form directed mainly at parents and guardians. These received wide circulation. Safety in the Home The year was again successful. There was a rise in the number of request from various organisations for home safety talks and film shows. Guides, Brownies, schools and other youth organisations increased their demand for these and many took advantage of them to enter for the Duke of Edinburgh's Award Scheme 1st and 2nd level. Displays were held at various local functions including the Greenwich Show, the Welfare Branch Garden Party at Charlton House, and the Mayor's Michaelmas Market. A darts sideshow was introduced with remarkable success at the Garden Party and again at the Greenwich Show. A revolving target was used marked with home safety questions at which contestants were encouraged to fire suction darts. Upon registering a hit upon a question, the participant was requested to provide the appropriate answer. All correct answers were awarded a home safety pencil. Such a novel approach made a great appeal to children and parents alike and, on the two afternoons, over 1,000 pencils were distributed to successful marksmen, 273 In order to obtain more local knowledge of non-fatal accidents, a distribution of reply-paid forms was made to hopitals in the district. There was a good public response and, as most forms indicated individual carelessness, they served to demonstrate the ease with which accidents can be sustained by lack of forethought. Our support to the London Fire Brigade for their Open Day in September was demonstrated by the provision of display equipment, posters and leaflets. Home Safety posters were introduced into clinics and other 'outlets' in the form of programmes. A 'fireworks' campaign was mounted during October when all firework retailers were asked to display a poster showing the safe use of fireworks and were further requested to assist with the distribution of advisory leaflets. National Home Safety Conference—The Council were invited to provide a display at the National Home Safety Conference in October. Since it was felt that the danger from falls receives very little dramatic presentation in home safety publicity the Service devised a working model of a girl tripping down a staircase. This created great interest from many parts of the country and 5 requests were received for copy plans. The model itself was loaned to the City of Norwich for inclusion in an exhibition held there. Throughout the country, home accidents were responsible for 24 deaths per day compared with 22 on the roads and it is, therefore, encouraging to note that the public conscience is slowly awakening to the continuing scandal of accidental deaths and injuries in the home. This is being evidenced in the increasing use of the home safety service provided by the Council and the interest of so many "new" organisations. MEDICAL EXAMINATIONS A summary is given below of medical examinations carried out by the Department's Medical Officers during 1966, mainly in respect of superannuation and sickness schemes:— Superannuation. Staff No. of Examinees found to be fit 367 No. of Examinees found to be unfit 7 No. of Examinees deferred 11 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 303 No. of Examinees found to be unfit 3 No. of Examinees deferred 16 274 Sickness. No. Examined after prolonged sickness 40 No. found to be permanently unfit 39 Accidents (on duty). No. Examined after accidents 10 Other Examinations. Carried out by the Council's M.Os:— On behalf of Inner London O. & M. Committee .. On behalf of the London Boroughs Joint Computer Committee 29 On behalf of other Local Authorities 14 Carried out by other Local Authorities:— On behalf of London Borough of Greenwich 6 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 1,364 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 five instances it was necessary for the Medical Officer to make a domiciliary visit to enable the appropriate assessment to be made. DEPARTMENTAL TRANSPORT During 1966 the Department took delivery of ten new vehicles to augment the fleet, bringing the total vehicle strength to forty-four. Three of these were needed to replace the vehicles loaned by the Women's Royal Voluntary Service for the Meals-on-Wheels Service, as in joint consultation it had been decided that the Department was now able to fulfil its own requirements for this service. The volume of transport commitments continued to rise during the year, and several adjustments were made in the disposition of vehicles between sections to ensure that the correct type of vehicle was used to its fullest advantage. The most significant changes in the Department's transport fleet during the year were as follows:— Health Health Education Section—A specially adapted 10/12 cwt. van was purchased for the Health Education Section for the transporting of displays and film projection equipment, etc. 275 Welfare Handicapped Section—It was decided in April at a joint transport meeting between the London Borough of Lewisham, Southwark and ourselves that the pooling of tail lift coaches should be discontinued, but with the proviso that the three Boroughs would in an emergency still solicit help from each other as this type of vehicle could not be obtained from outside sources. This 'knock for knock' basis worked very well, especially in the Recuperative Holidays for the Elderly commitments, where it was found that the same venues had been arranged. Meals-on-Wheels—The number of vehicles used in this service was increased by two, bringing the total number of meals rounds undertaken daily to fifteen, one of these rounds still being undertaken by the British Red Cross Society as in the previous year. TRAINING COURSES During 1966 there was a noticeable increase in the number and variety of courses available to members of the Health and Welfare Department staff. The scope of the courses reflected an awareness of the increasing need for professional staff not only to be trained, but to be familiar with modern developments and problems. The London Boroughs Training Committee broadened its activities this year and offered courses and study days on several topics which, in addition to supplying information and instruction, provided opportunities for officers from different London Boroughs to exchange views and ideas. COURSES. 1966 Administrative Catford College of Commerce Professional Dental British Dental Association Postgraduate Medical Federation Nursing Services Health Visitors Association Royal College of Nursing Local Government day-release Courses Postgraduate Course on Dental Treatment for the Handicapped Child Course on Paedodontia and Orthodontia Course for Superintendent Health Visitors Special Course for Fieldwork Instructors 276 Royal College of Nursing Health Visitors Association Health Visitors Association London Boroughs Training Committee/University of London Royal College of Midwives Inner London Education Authority/Royal College of Nursing Inner London Education Authority/Health Visitors Association National Childbirth Trust Royal College of Midwives Inner London Education Authority Health Visitors Association South East Metropolitan Regional Hospital Board Queen's Institute of District Nursing Royal College of Midwives London Boroughs Training Committee London Boroughs Training Committee London Boroughs Training Committee Refresher Course for Health Visitors Summer School for Health Visitors, School Nurses and T.B. Visitors Refresher Course for Health Visitors Health Visitor Fieldwork Instructors Course Refresher Course for Midwives Refresher Course on Priorities in Health Visiting Refresher Courses for Health Visitors and School Nurses Seminar on Psychoprophylaxis Post-Certificate Course in Midwifery Training for School Nurses in making Earpieces for Hearing Aids Course for Fieldwork Instructors Refresher Course for Ward Sisters, Charge Nurses and StafT Nurses Study Day for Superintendents Study Days on Methods of Preparation for Childbirth Study Days for District Nurses and Domiciliary Midwives Introductory Course for School Nurses Follow-up Study Days for Superintendent Health Visitors, District Nurses and Midwives 277 Chiswick Polytechnic Health Visitors Association Health Visitors Association London Boroughs Training Committee Royal Institute of Public Administration South East Metropolitan Regional Hospital Board Chiswick Polytechnic London Boroughs Training Committee Institute of Laryngology and Otology Social Work London Boroughs Training Committee/National Institute for Social Work Training London Boroughs Training Committee/North Western Polytechnic Council for Training in Social Work University of London Chiswick Polytechnic Council for Training in Social Work Practical Work Instructors Course Health Visitors Refresher Course Course for Fieldwork Instructors Study Days for Domiciliary Midwives, District Nurses and School Nurses Meetings on the Social Services Refresher Course for Newly Appointed and Potential Ward Sisters and Charge Nurses Course for Practical Work Instructors in District Nursing Health Visitor Fieldwork Instructors Course Short Course for Health Visitors on Hearing Testing Techniques Seminars given by the Gulbenkian Fellows Seminars on Social Casework Study Course on In-Service Training and Staff Development Course on Problems of Children and Parents Study Conference for Health Visitors and Social Workers on Trends in the Health and Social Services Course on Social Change and Social Work 278 British Epilepsy Association University of London Welfare National Old People's Welfare Council National Institute for Social Work Training Southern Regional Association for the Blind Kent Education Committee Severalls Hospital, Colchester Royal Eye Hospital London Council of Social Service Southern Regional Association for the Blind Mental Health Services University of Bristol National Association for Mental Health National Association for Mental Health National Society for Mentally Handicapped Children Tavistock Institute of Human Relations London School of Economics One-day Course for Social Workers Social Casework Seminars Advanced Course for Experienced Wardens and Matrons of Old People's Homes Course for Chief or Deputy Chief Welfare Officers Refresher Course for Home Teachers Refresher Course for Wardens and Matrons of Old People's Homes Study Symposium on Tackling Senility Course on the Nature and Prevention of Blindness Day Release Course for Matrons and Assistant Matrons of Old People's Homes Week-end Course on the Mobility of Blind Persons Refresher Course for Mental Health Workers Course for Assistant Staff of Adult and Junior Training Centres for the Mentally Subnormal Day-release Course for Staffs of Special Care Units Course on Educational Rhythmics Seminar on Public Health Psychiatry and Preventive Intervention One-Year Course in Mental Health Social Work 279 London Boroughs Training Committee Environmental Health Association of Public Health Inspectors College for the Distributive Trades Royal Society of Health Royal Society of Health Coal Utilisation Council London Boroughs Management Services Unit Health Education Royal Society of Health London Boroughs Training Committee/Central Council for Health Education Central Council for Health Education Central Council for Health Education Other Services Home Help Institute of Home Help Organisers Day-release Course on Caring for the Mentally Disordered: The Implications for the Family Weekend School Refresher Courses in Meat and Poultry Inspection Smoke Inspectors Course London Meetings on Health and Hygiene Course for Technical Assistants Critical Path Analysis Course in Housing Health Education Meetings Course on Progress in Health Education Summer School in Health Education Health Education Officers Study Day Weekend School conference organisers, 1966 Association of Public Health Inspectors British Dental Association Central Council for Health Education Food Education Society General Dental Council Health Visitors Association Inner London Education Authority King Edward's Hospital Fund for London London Boroughs Training Committee London Co-operative Society Ltd. London Hospital Dental School London Hospital Medical College 280 National Association for Maternal and Child Welfare National Association for Mental Health National Council of Home Help Services National Council for the Unmarried Mother and Her Child National Old People's Welfare Council National Society for Clean Air National Society of Children's Nurseries National Water Safety Council Queen's Institute of District Nursing Royal Institute of Public Health and Hygiene Royal National Institute for the Deaf Royal Society of Health Society of Medical Officers of Health South East Metropolitan Regional Hospital Board Third Conference on London Government and Welfare Services Special Departmental Conference A successful One Day Conference of interest to all members of staff was held in the Council Chamber of the Health and Welfare Department on Friday, 11th November. The audience were confined to members of the Department with the exception of a few professional members who were interested in the chosen subjects. Morning—Trevor Gibbens, M.D., M.R.C.P., D.P.M., Reader in Forensic Psychiatry, Institute of Psychiatry spoke on "Drugs and Drug Addiction in Teenagers". Afternoon—John Pearson, M.D., M.R.C.P., D.I.H., Deputy Director and Reader, Medical Care Research Unit, University of Manchester, spoke on "Who are my Patients? Can I do better for them ?". In all about 150 took part at each session. It was undoubtedly a success and a conference is likely to become an annual event. 281 SECTION IX SCHOOL HEALTH SERVICES REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER Introduction In presenting the School Health Report for 1966, it is pleasing to record that in general the health of our school-children remains satisfactory. Mention was made last year of a scheme for the proposed joint use of staff and premises by the Boroughs and the Inner London Education Authority. These discussions have resulted in a close partnership being established and the new arrangements would seem to be mutually acceptable and to everyone's advantage. It was hoped that child guidance facilities would have been expanded, but long and tortuous negotiations with the Regional Hospital Board for the engagement of a child psychiatrist proved abortive and the Authority decided to attempt to recruit the necessary consultant help under educational as opposed to health powers. It is disappointing to relate that, due to no fault of the Authority, this post remains unfilled and the local child guidance service continues to be inadequate. The Borough still depends on St. Alfege's Hospital for referrals, the numbers continue at a high level and with a waiting time of three months it is to be hoped that next year will see some progress. In the meantime, the Authority continues to seek suitable premises, apart from the Chevening Road clinic, for even further expansion if a full time consultant psychiatrist can be engaged. It must also be said that in respect of E.S.N. pupils there are continuing delays in the placement of these children at day or boarding schools. Similarly, delays are growing with maladjusted pupils, especially for boarding schools. Although Greenwich is relatively more fortunate than most other boroughs in respect of speech therapists, there is a waiting list for pupils with speech defects. An effort is being made to improve recruitment and the joint employment of speech therapists in Borough services such as junior and adult training centres and the School Health Service is being examined. Apart from the continuing difficulty also of recruiting suitably qualified and experienced full time school medical officers, particularly to undertake the more specialised functions, the general standard of service has been high. 282 General In this year, School Medical Officers in Greenwich examined 16,225 children. This number formed 43.3% of the school roll and was the highest proportion of children examined in the Inner London Boroughs. Among those examined 1.10% were found to be in an unsatisfactory condition. This was the highest figure for the Inner London Boroughs. It may have been due to School Medical Officers in Greenwich imposing higher standards as the number of children referred for treatment or requiring further special examinations was about average in comparison with the other areas served by the Inner London Education Authority. Verrucae Trials continue with a fungicidal preparation which has residual activity and is being applied to polished floors in an attempt to reduce the number of verrucae in schoolchildren. At the school in which the pilot scheme is in progress, there were 54 reported cases of verrucae in September to December 1965, while in the corresponding period of 1966 there were 19 cases. While this improvement is most heartening, it must be remembered that the overall incidence of verrucae among schoolchildren in Greenwich decreased during 1966. Special Investigations A 'Heights and Weights' survey of schoolchildren was carried out at 13 selected schools in the Borough. This survey, organised in connection with the study of growth of London schoolchildren, was supported by the Institute of Child Health. Immunisation Greenwich continues to hold the best record for immunisation in the Inner London Boroughs. It has the highest figures for immunisation against smallpox, diphtheria (91.9) and whooping cough. The figures for polio immunisation are the second highest. It will be noted that there were 498 cases of measles among schoolchildren. In this year under review the measles incidence is high but there is no indication that the disease has caused any serious complications, which is a tribute to the high general health standards of the school population. Undoubtedly the introduction of routine measles immunisation could reduce this incidence, but in view of the comparative mildness of measles it is not considered necessary or at the moment worthwhile to launch a full scale Borough immunisation programme. As the figures indicate, our major efforts are being directed, and not without success, at the more serious infectious diseases. Measles immunisation can, of course, be given selectively to schoolchildren who by reason of poor general health or physique may be considered liable to develop serious complications. 283 There were 82 cases of dysentery notified and in relation to the school population this figure can be considered satisfactory. Other infectious diseases notified do not call for any special comment. Dentistry The Principal School Dental Officer, in his own contribution to this report, has mentioned the difficulties in the recruitment of dental officers, but considerable progress has been made in bringing the dental premises up to the highest standards in terms of equipment. It is pleasant to have the opportunity of paying tribute to the valuable work of the local Care Committee and of recording the help and support which we receive from Miss Comber and her staff. I am grateful also to the Divisional Education Officer, Mr. W. A. Pattison, his Deputy, Mr. C. L. Curtis, and all the local head teachers and staff for their kindness and consideration to the Department. The efficient running of the School Health Service is due entirely to the efforts of a skilled and knowledgeable staff and, in expressing my indebtedness to them, I would mention in particular my Deputy, Dr. M. E. Watts, and the Principal Medical Officer, Dr. C. C. A. Jansz, who by their untiring efforts have lightened immeasurably the task of supervising this service. John Kerr Brown, Principal School Medical Officer. (See page 149 for the Council's Scheme for the Co-ordination of the Education and Health and Welfare Services in respect of Handicapped Children and Young People). SCHOOL HEALTH SERVICE STATISTICAL REPORT 1966 Number of Pupils (as at 19.1.67) Primary 20,876 Secondary 16,013 Nursery School 828 Special, including Hospital schools 572 38,289 Periodic General Medical Inspections Age Groups Number Percentage 4 years and less 967 6.0 5 years 2,723 16.8 6 years 847 5.2 7 years 1,118 6.9 8 years 2,197 13.5 9 years 460 2.8 284 10 years 201 1.2 11 years 1,320 8.1 12 years 1,916 11.8 13 years 639 3.9 14 years 420 2.7 15 years and over 3,417 21.1 16,225 100.0 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 3 85 86 5 years 14 262 274 6 years 16 107 120 7 years 62 99 154 8 years 102 173 269 9 years 28 62 85 10 years 10 12 20 11 years 162 93 246 12 years 191 117 295 13 years 61 36 92 14 years 53 25 74 15 years and over 490 146 607 1,192 1,217 2,322 Percentage of children inspected who were noted for treatment Age and Sex All Defects Vision defects Defects other than vision 4 yrs. & Less 476 Boys 9.9 0.21 9.9 491 Girls 7.9 0.41 7.7 5 yrs. 1,355 Boys 10.7 0.59 10.3 1,368 Girls 9.4 0.44 9.0 6 yrs. 437 Boys 16.4 2.8 14.2 410 Girls 11.7 0.98 11.0 7 yrs. 605 Boys 15.5 5.8 10.3 513 Girls 11.7 5.3 7.2 8 yrs. 1,152 Boys 13.4 5.2 8.3 1,045 Girls 11.0 4.0 7.4 285 9 yrs. 248 Boys 18.9 6.0 14.5 212 Girls 17.9 6.1 12.3 10 yrs. 116 Boys 13.8 6.9 8.6 85 Girls 4.7 2.3 2.3 11 yrs. 410 Boys 18.3 12.2 7.1 910 Girls 18.8 12.3 7.0 12 yrs. 1,097 Boys 15.3 9.2 6.9 819 Girls 15.5 11.0 5.0 13 yrs. 400 Boys 11.5 7.8 4.7 239 Girls 19.3 12.5 7.2 14 yrs. 260 Boys 19.2 13.1 7.7 160 Girls 15.0 11.9 3.1 15 yrs. & Over 1,627 Boys 15.0 11.7 4.1 1,790 Girls 20.2 16.8 4.4 Total 8,183 Boys *14.2 *6.7 *8.1 8,042 Girls *14.5 *8.1 *6.9 Total both sexes 16,225 14.3 7.4 7.5 *Total average percentage Non-Routine Medical Inspections Re-inspections 5,565 Secondary school reviewals 377 Other non-routine inspections 4,366 (see next table) 10,308 Total Inspections 26,533 Analvsis of non-routine medical inspections Number Inspected 1966 1965 Bathing Centre inspections—scabies — — —other 9 — Employment certificates 656 502 Licences for Theatrical employees — — School Journeys 2,140 2,765 Recuperative holidays—prior to holiday 47 15 „ „ —on return — — Secondary School Annual Surveys 377 — Candidates for higher awards 6 6 Nautical school entrants — — Outward Bound and Adventure Courses 6 13 286 T.B. contacts - - Boarding school for the delicate: Pre-departure inspections - 5 On return - - Other handicapped pupils Statutory examinations 6 9 Periodic special defect examinations 531 417 Research investigations and enquiries 18 4 3,796 3,736 Specials, at request of: Head Teacher—special book 58 76 „ „—other 355 268 School Nurse—after health survey 81 87 „ „ —other 90 51 Divisional Officer (Education) 46 25 District Care Organiser or Care Committee 28 34 Parent 90 101 School Medical Officer 181 - 929 642 All other non-routine inspections 18 174 Total 4,743 4,552 Medical Treatment of Schoolchildren Type of Clinic Sessions Cases New Attendances Minor ailments (nurse) 1,172 15,421 60,432 „ „ (doctor) 261 2,115 Special Investigation 130 171 1,251 Dental 1,167 2,147 8,315 Vision 290 1,759 4,275 Ear, nose, throat 42 169 442 Audiology 46 164 344 Defects treated at Minor Ailments Clinics Defect Number Athlete's foot 328 Verrucae 1,510 Ringworm: body 11 Impetigo 98 Other skin diseases 404 Eye diseases 364 Ear diseases 170 Miscellaneous, bruises, lacerations, etc. 15,266 287 There has been an overall drop in the numbers of Verrucae, since visits were paid to schools by the Council's Public Health Inspectors for prophylaxis disinfection of floors against Verrucae. The Physical Education staff at some of these schools have showed interest in these preventive measures and have inspected the children's feet as a routine prior to their taking part in swimming or other barefoot activitv. Special Clinics—Attendances in 1966 New Total Cases Attendances Audiology 164 344 E.N.T 169 442 Enuresis Special Nutrition Investigation Behaviour Problems 171 1,251 Clinics Rheumatism or Heart Conditions VISION Visual acuity standards of children whose eyes were tested Age Group (years) BOYS Number tested—6,743 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 7 798 37 9 16 15 1 4 5 7 498 34 26 26 14 2 7 9 8 1,007 53 39 31 20 11 17 29 9 214 12 8 7 5 5 2 8 10 100 4 4 5 3 2 2 3 11 328 14 17 16 30 7 12 34 12 899 35 60 43 58 22 22 58 13 329 12 23 17 18 7 11 14 14 206 5 14 9 20 6 9 25 15 and over 1,255 61 80 67 137 45 48 123 Total 5,634 267 280 237 320 108 134 308 288 Age Group (years) Girls number tested-6,539 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 7 729 38 10 9 7 3 1 3 7 436 35 16 18 4 3 8 9 8 915 62 22 26 23 11 7 16 9 181 12 11 9 5 - - 4 10 78 1 1 - 2 1 2 2 11 719 50 31 34 67 24 17 78 12 675 33 26 31 52 16 17 59 13 187 7 12 10 14 7 12 20 14 135 7 7 10 6 - 5 9 15 and over 1,281 70 65 65 234 68 71 235 Total 5,336 315 201 212 414 133 140 435 Defects treated at Vision Clinics Defect Number Error of refraction and squint 3,669 Other eye defects 23 Spectacles ordered 1,178 Findings At Health Surveys School Roll (19.1.67) 38,289 1. Comprehensive surveys (a) Number examined 24,854 (b) Number (occasions) found verminous 139 (c) Percentage found verminous 0.56 2. Selective surveys (a) Number examined 27,192 (b) Number (occasions) found verminous 366 (c) Percentage found verminous 1.35 3. Verminous cases (a) Total times vermin found 505 (b) Total percentage found verminous 0.97 (c) Number of individual pupils found verminous 347 (d) Percentage of individual pupils found verminous (of School Roll) 0.93 289 4. Action taken with verminous cases (a) Advice and/or Lorexane 401 (b) Further action 104 (c) Percentage of cases given advice and/or Lorexane requiring further action 25.9 Voluntary attendances at bathing centres: Number of pupils 104 Number of statutory notices issued — 5. Communicable disease surveys: Numbers examined for: Athlete's foot 11,122 Plantar warts 10,778 Dysentery 71 Other communicable diseases 1,833 Prophylaxis School Roll (19.1.67) 38,289 Routine Inspections Number inspected 16,225 Number found not to warrant examination 65 (7 plus 'special scheme') Percentage of Number inspected of Parent present 53.8 Care Committee present 82.5 Number vaccinated against smallpox 85.7 Number immunised against diphtheria 91.9 Number immunised against whooping cough 82.1 Number vaccinated against poliomyelitis 90.3 Physical condition unsatisfactory 1.1 Referred for treatment of defects 14.3 Referred for treatment of defects other than vision 7.5 Non-Routine Inspections (i) Specials 4,743 (ii) Re-inspections 5,565 Total (i) and (ii) 10,308 Number of routine inspections as percentage of school roll 43.3 Number of non-routine inspections as percentage of school roll 27.5 290 B.C.G.—1966 SKIN TESTED NEGATIVE B.C.G. GIVEN Schools Further Education & Training Colleges Schools Further Education & Training Colleges Schools Further Education & Training Colleges 1st Quarter 943 23 828 7 828 2 2nd Quarter 906 8 764 8 764 8 3rd Quarter 306 113 257 20 257 20 4th Quarter 741 203 640 23 640 23 Total for 1966 2,896 347 2,489 58 2,489 53 Examinations for recuperative holidays Forty-seven such examinations were carried out in 1966 (15 examinations in 1965). The schoolchildren were examined after recommendations 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. Infectious Diseases in Schools Disease Number Cerebro-Spinal Meningitis 1 Chickenpox 795 Dysentery, diarrhoea or enteritis 82 German Measles 125 Impetigo 16 Influenza 95 Jaundice 29 Measles 498 Mumps 830 Ophthalmia and conjunctivitis 29 Pneumonia 1 Ringworm (scalp) 6 291 Ringworm (body) 6 Scabies 4 Scarlet Fever 42 Sore throat and tonsillitis 122 Whooping cough 26 Number of Children of all ages noted for Treatment or Observation Expressed as a rate per 1,000 Inspected Number Inspected-16,225 Defects Treatment Observation 1966 1965 1966 1965 Skin 8.51 5.88 11.40 8.95 Eyes (a) Vision 73.47 86.43 31.99 27.99 (b) Squint 6.78 7.41 4.62 3.47 (c) Other 2.22 2.47 3.33 2.87 Ears (a) Hearing 5.05 6.28 5.18 4.61 (b) Otitis media 2.53 3.41 4.50 3.47 (c) Other 0.49 0.53 0.92 1.00 Nose and Throat 9.06 8.82 33.90 26.13 Speech 4.56 3.67 9.37 8.28 Lymphatic Glands 0.68 - 6.04 2.27 Heart 3.45 3.07 11.40 10.22 Lungs 6.78 7.08 11.09 8.82 Developmental (a) Hernia 1.42 0.73 4.13 1.87 (b) Other 1.29 1.14 6.84 5.28 2.71 1.87 10.97 7.15 Orthopaedic (a) Posture 1.23 0.87 7.03 6.08 (b) Feet 7.03 2.81 34.88 19.77 (c) Other 2.22 2.47 8.44 9.15 10.48 6.15 50.35 35.00 Nervous System (a) Epilepsy 1.42 2.00 1.23 1.40 (b) Other 0.68 0.40 2.34 1.14 2.10 2.40 3.57 2.54 Psychological (a) Development 1.23 0.40 4.93 3.94 (b) Stability 0.99 1.20 11.03 10.29 2.22 1.60 15.96 14.23 Abdomen 0.37 0.20 1.73 0.87 Other 14.61 15.43 38.64 37.47 292 Comparison of Defects noted at 7-plus routine and 7-plus 'Special' Medical Examinations in 1966 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected Number inspected at 7-plus Routine Inspections 3,749 Number inspected at 7-plus Experimental Scheme Inspections 26 Defects A* B† Skin 21.61 38.46 Eyes (a) Vision 93.36 38.46 (b) Squint 11.74 38.46 (c) Other 4.27 Ears (a) Hearing 14.40 (b) Otitis media 6.40 (c) Other 93 Nose and Throat 52.55 76.92 Speech16.27 38.46 Lymphatic Glands 7.74 — Heart 16.80 76.92 Lungs 17.07 38.46 Developmental (a) Hernia 5.87 — (b) Other 8.00 Orthopaedic (a) Posture 8.54 — (b) Feet 46.14 — (c) Other 8.00 — Nervous System (a) Epilepsy 2.67 — (b) Other 4.27 Psychological (a) Development 8.00 38.46 (b) Stability 14.14 115.38 Abdomen 3.20 Other 45.35 307.69 *Column 'A' refers to 7-plus routine medical inspections †Column 'B' refers to 7-plus experimental scheme inspections Educationally Subnormal Pupils Number examined: 66 Number recommended: 1. Day E.S.N. School 40 2. Boarding E.S.N. School 4 3. Ordinary school with special help 10 4. Junior Training Centre 12 293 Routine Audiometer Testing Pupils given screening tests 6,869 Pupils failing screening tests 359 Pupils given pure tone tests Pupils failing pure tone tests 204 Pupils referred to Otologists Percentage referred to Otologists 2.97 THE SCHOOL DENTAL SERVICE F. Elston, L.D.S., R.C.S.Eng., the Principal School Dental Officer, reports:— "Although the 1965 Report was mainly descriptive of the then extant School Dental Service, nevertheless, we were acutely aware of its not inconsiderable shortcomings. Primarily we were faced with the question of whether, in the light of experience, to modify the existing service with necessary improvements or to make a bold sweep and start afresh. Even at the end of 1965, assessment of what was possible was not easy for there was still some doubt as to the methods by which beneficial alterations would be achieved. In this respect, easement came with the seconding of Mr. Webster to the post of Dental Adviser to the I.L.E.A. and it is greatly to the credit of this authority that, within a short period of his appointment, effective administrative machinery was established. At the first meeting of the Principal School Dental Officers in March, 1966, at the County Hall, it was decided to form, from those officers of the Inner London Boroughs, three sub-committees, viz. 'Preventive Dentistry', 'Premises and Equipment' and 'Orthodontics and Special Services' with the Dental Adviser of the I.L.E.A. as chairman of each committee so formed. The writer was appointed to the 'Preventive Dentistry' Committee which concerns itself with all aspects of active and preventive treatment and school dental examinations. With a firmly established organisation suitable to deal with individual and collective problems, the scene was set for advancement to the next stage, i.e. a searching analysis of the existing facilities. In this Borough the difficulties were twofold. Firstly, the equipment and premises at our disposal were below the standards generally expected and those found in normal dental practice. Secondly, the clinical aspects of the service deviated from those usually associated with a specialised Public Health team. Moreover, with such an extensive organisation as was the previous L.C.C. Dental Service, treatment at individual clinics, of necessity, had to be left entirely to the dental surgeon in charge. Doubtless, with dedicated staff, these clinics gave excellent treatment but less desirable standards were reached with officers of more limited experience and a lack of interest engendered by the prevailing conditions. In such a situation even 294 dedicated and experienced dental officers deplored the professional isolation which prevented them from profiting from a mutual exchange of observations and ideas with their service colleagues. It was clear from this analysis that a continuance of the present 'set-up' was unlikely to lead to an efficient dental service and, until the requisite staff had been obtained, it seemed politic to improve premises and equipment where this could reasonably be achieved and at the same time to attempt to re-shape the existing staff and organisation in order to create a team on the lines of a 'teaching hospital'. Such a radical change became more pressing when it was learned that we were to lose three dental officers in the early part of the year. Subsequently, the policy of concentrating on equipping suitable premises coupled with the maintenance of a minimal service as a temporary measure, proved successful and the opportunity of joining a team of dental surgeons genuinely dedicated to provide a first class dental service in well-equipped, pleasant clinics has attracted the right type of officer. A publication entitled 'Children's Dentistry without Tears' compiled by your own dental officer serves as a clinical guide to the members of the team. Without the understanding and assistance of the I.L.E.A., work on many Borough problems could not have been undertaken and detailed discussions and policy planning continued throughout the Spring. These culminated in an I.L.E.A. Report in June which, together with that authority's sanction of our own new policy, were ratified by the Greenwich Council in October 1966. I.L.E.A. policy embracing the School Dental Service not only in this Borough but in all other Inner London Boroughs, was officially promulgated in a letter from the Medical Adviser in July of this year which may be summarised as follows:— General Policy 1. That annual routine dental inspections in school for all children attending the Authority's schools be introduced as soon as possible, starting in the autumn term 1966. 2. That a further report on the school dental service be submitted by the Medical Adviser and the Education Officer in the summer of 1967. 3. That the Department of Education and Science be informed of the recommendations in the report. Sttfff 4. That the Inner London Borough Councils be asked to review the establishments of dental officers jointly employed by them and the Authority with a view to expansion to the extent needed to permit the full introduction of annual dental inspections in schools and the treatment work resulting from this. 295 5. That the Inner London Borough Councils be informed that, in the Authority's view, a working week of ten sessions could be introduced for full time staff in the school dental service and that they be asked to bring this into effect subject to their views so far as the maternity and child welfare service is concerned. 6. That the Inner London Borough Councils be asked to consider whether it is desirable to add a position of senior dental officer to the establishment of dental officers jointly employed by them and the Authority. 7. That the Inner London Borough Councils be asked to do all they can to encourage recruitment of dental officers, and informed particularly that the Authority hopes (a) that they will take full account of experiences since registration in determining the commencing salaries of new entrants and (b) that they will give sympathetic consideration to any proposal for allowing suitable dental officers to be associated with the work of the dental schools of the London teaching hospitals. 8. That a dental record card (form 11M) be provided for each school child at the time of dental inspections in school and that the Inner London Borough Councils be asked to provide the clerical assistance necessary for this and for any necessary transfer of the records. 9. That the fixed staff of the Medical Department be increased by one position of dental health educator. Accommodation for Dental Surgeries 10. That the standards for new dental clinics submitted as an Appendix to the report be adopted so far as the Authority is concerned for its own future premises and for accommodation provided on behalf of the Authority by Inner London Borough Councils in new combined centres. 11. That the Education Officer do discuss with the Headmasters and Headmistresses of schools where provision was made for the use of a room as a dental surgery the possibility of rearrangements to permit certain of the surgeries to be brought into use and do report on this in association with the Medical Adviser. Equipment 12. That the Director of Mechanical and Electrical Services be authorised, on request by Principal School Medical Officers, to undertake the maintenance of school health service dental equipment in surgeries in premises vested in the Inner London Borough Councils. Equipment and Finance 13. (i) That approval in principle be given to the provision of dental equipment for the school health service during 1966-7 and 1967-8. 296 (ii) That expenditure in the current financial year not exceeding the specified sum by the Inner London Borough Councils on behalf of the Authority for new equipment in school dental surgeries be authorised. (iii) That the Councils be asked to make provision in their estimates for 1967-8 for their respective proportions of the agreed further expenditure at the surgeries on furniture and equipment, high speed drills (or aerotors) and compressors where not already provided and so far as necessary on improved resuscitation apparatus and electric amalgamators, X-ray machines, waiting room furniture and replacement of anaesthetic apparatus. 14. That approval be given to the provision in 1966-7 of two mobile dental clinics and, in principle, to the provision of four more in 1967-8. 15. That the Finance Sub-Committee be asked to approve a drawing on the revenue provisional sum for the year 1966-7 for the purchase of two mobile dental clinics for use in the Authority's school dental service. Affects on the Borough School Dental Services of the implementation of the I.L.E.A. recommendations are given below, seriatim. General Policy 1. School Dental Inspections At the Council's meeting, the P.S.M.O., although enthusiastically in favour of the recommendation, cautiously referred to it as a 'counsel of perfection'. To avoid useless massive school dental inspections, realistically, the extent of inspections undertaken should be strictly proportional to the staff available for dealing with the resultant treatments. Therefore, as a first step, it was decided to concentrate on the '5 year old' school entrants and to examine as many of these as treatment facilities in school clinics permitted. Consequently, as was to be expected, the numbers of school dental inspections carried out in 1966 though relatively small were commensurate with the facilities available. However, a simple streamlined but efficient system of school dental inspections was established enabling immediate advantage to be taken of an anticipated improvement in the staffing situation which would lead, ultimately, to dental supervision of every child throughout school life. This new system in no way affected the management of school children of all ages under the existing 'SHS 59 Scheme' where parents opted for treatment at our clinics. Although as many children as possible were seen in accordance with the 'SHS 59 Scheme', this non-selective approach to dental health proved, on the whole, unsuccessful in that the influx of patients was beyond the Service's control and this led to frustrating bottlenecks, delays and parental disappointment. 297 Staff 4. Review of Establishment of Dental Officers For the institution of a satisfactory school dental service, a survey of the conditions in this Borough suggests a ratio of one dental officer per 3,000 school children and, on this basis, the Borough would require the equivalent of 12 full time dental officers to provide the comprehensive service envisaged. During 1966, the staffing situation was critical and no significant progress in this direction was possible although the early part of 1967 showed a slight improvement. 5. Introduction of'10-Session' Week This recommendation was implemented as from 1st January, 1967. 6. Post of Senior Dental Officer The Council considered that the creation of this position should be deferred until such time as additional dental officers had been appointed. 7. Recruitment of Dental Officers It would appear that recruitment is mainly affected by two practical considerations:— (a) Financial—This is largely governed by Whitley Council Awards. (b) Conditions—Working conditions need to be made as attractive as possible by the provision of modern dental surgeries with opportunities for post-graduate training to ensure the maintenance of a high standard of professional competence. 8. Dental Records Although not maintained by the former L.C.C., separate dental record cards are considered necessary. Insufficient professional staff necessitates the division of the scheme into 'near-future' and 'long-term' policies. Moreover, a collection of 37,000 case cards, containing no relevant dental information would be of little practical value. It was decided, therefore, that in addition to the existing dental record cards of children treated at the clinics, every child examined at school dental inspections should be provided with a record card on which the findings at the inspection are to be noted. This, together with a survey of diseased, unsaveable, missing and filled teeth will furnish us with constant information about the school children's individual and collective state of dental health. Accommodation for Dental Surgeries 10. Standards for New Dental Surgeries Standards suggested for new dental clinics were accepted by the Council which agreed that standards for future improvements should be those contained in the Ministry of Health Building Notes. 298 11. Denial Surgeries in Schools A dental clinic was successfully established at Kidbrooke Comprehensive School during October, 1966. Originally it has been envisaged that this clinic would commence with progressive school dental inspections but pressure for treatment from parents and from cases diagnosed at school medical inspections was such that, by the end of 1966, although not a single school dental examination had been carried out, the 'waiting list' for treatment was still considerable. It was confidently expected that a dental surgery at Eltham Green School would be operating during 1967. These are the first dental clinics in schools to be opened within the jurisdiction of the Inner London Boroughs. Equipment and Finance 13. Expenditure on Furniture and Equipment Most of the equipment necessary for the modernisation of clinics was provided during 1966. All clinics have now been brought up-to-date and compare favourably with standards to be found in any good modern general dental practice. Each clinic is furnished with an X-ray unit, modern operating light, high speed aerotor and an electric amalgamator. All recommendations concerning improvements have been implemented and items not provided during the financial year 1966/67 were included in estimates for 1967/68. 14. Mobile Dental Clinics Maximum use will be made of these mobile units in the treatment of handicapped and disabled children but, naturally, deployment of these caravans will be closely linked with the availability of dental surgeons. Summary The year 1966 was devoted, primarily, to an analysis of the defects of the existing service and to the drafting of schemes for overcoming the deficiencies. It can be reported that plans have been laid for a desirable and effective School Dental Service capable of physical and administrative expansion subject to the nationwide shortage of suitable dental surgeons being satisfactorily resolved. That the Borough School Dental Service is now on the right lines is manifest in its undoubted increase in popularity and the results accruing from an unrelenting drive in the field of dental health education. 299 SCHOOL DENTAL SERVICE—Statistical Analysis Sessions Treatment Sessions 1,076 General Anaesthetic Sessions 5 School Inspections 10 Attendance New patients given appointments 4,446 attended 2,125 percentage of attendance 48% On-treatment patients given appointments 7,567 attended 5,755 percentage attendance 77.4% Emergency patients treated 401 Total of attendances 8,281 Number of treatment cases completed 2,145 Treatment Total number of teeth treated 7,674 (1) Permanent teeth 3,130 filled 3,061 extracted (including orthodontics) 69 percentage of fillings 97.75% „ „ extractions 2.25% (2) Deciduous teeth 3,225 filled 2,895 extracted 330 percentage of fillings 81.7% „ „ extractions 18.3% Teeth root-filled 43 „ otherwise conserved 1,276 Prophylactic treatment 1,906 Number of patients X-rayed 304 Number of general anaesthetics 49 Orthodontics New cases undertaken for treatment or referred 35 Inspections Children inspected at schools and clinics 2,054 „ found to require treatment—number 1,588 —percentage 77.3% Acceptance—School Dental Service—number 1,790 percentage 84.7% —General Dental Services—number 264 —percentage 15.3% CENSUS 1966 300 CENSUS 1966 (Source—General Register Office) Results concerning the 1966 sample Census have recently been published and a brief summary of those relating to the London Borough of Greenwich are given in the following tables. The Census was held on the night 24/25th April, 1966, in accordance with the provisions of the Census Act, 1920. Under the heading of 'enumerated population' all persons included in the Census were assigned to the areas where they were enumerated on Census night irrespective of where they were permanently resident or treated as residents for estimate purposes. As the Census was a 10% sample, all figures appearing in the accompanying tables must be multiplied by 10 to obtain statistics relevant to the total population. Investigations, however, into the completeness of the lists from which the sample frame was selected, coupled with the resultant response, suggest not only that these estimates could be from 2½% to 3% too low but that under-enumeration in the Inner London Boroughs was likely to have been substantially greater than for the outer Boroughs. Consequently, figures published are subject to eventual statistical evaluation by the Registrar General and, for the time being therefore, they must be considered as of a provisional nature. TOTAL POPULATION As enumerated in the Census, the number of persons totalled 22,698 which, when multiplied by 10, gives the estimated population for Greenwich as 226,980. As this figure related to April of the current year, for comparison with the Registrar General's mid-year estimate, some adjustment is necessary by reason of the variation in dates of the two estimates. On the basis of the adjusted Census figure, viz. 231,070, the Registrar General's mid-year estimate of 231,590 is some 0.22% high. AGE Age distribution in Greenwich largely followed the national pattern in that 30.7% of persons were under 20 years of age. Some 7.7% were under 5 years, 14.3% between 5 and 15 years and 12.4% were enumerated as being 65 years or more. BIRTHPLACE Of all the persons enumerated in the sample, 73.2% were actually born within the Greater London area, 22.3% within the remainder of the British Isles and 4.5% overseas (2.7% were born in the Commonwealth and 1.8 % in other foreign countries). Greater London returned a figure of 9% for all persons born abroad. 301 HOUSING AND HOUSEHOLDS According to the sample Census, there were 220,850 persons in 74,050 private households who were living in 71,860 structurally separate dwellings of which 1,710 or 2.4% were vacant on Census night. From these figures it is estimated that only 3% of dwellings were shared by more than one household, although some 9,030 or 12.2% of the total households were sharing a dwelling. One-person households numbered 11,660 of which 7,430 or 63.7% concerned 6,270 females over 60 years of age and 1,160 males over 65 years. TENURE Thirty-six per cent of all private households were owneroccupiers and 61 % were renting accommodation. Of the total of 45,210 households renting accommodation, 58.7% were doing so from Local Authorities, 5.5% were renting furnished and 35.8% unfurnished accommodation from private landlords. MIGRATION Details regarding migration showed that 86.9% of all persons in the Borough had been domiciled in the same residence for at least one year and 57.7 % had occupied the same accommodation for five years or more. Persons now living in the Borough who, a year ago were resident overseas numbered 1,830 (0.8%) and those who were doing so five years ago totalled 4,980 (2.2 %). HOUSEHOLD AMENITIES Of the 71,860 dwellings, some 12,730 or 17.7% had no inside flush toilet. In a total of 74,050 households, 1,450 or almost 2% lacked the exclusive use of a stove and sink, 9,740 (13.1%) were without a hot water tap and 11,640 (15.7%) without a fixed bath. SOCIO-ECONOMIC GROUPS In the Borough there was a total of 114,040 persons 'economically active', (i.e. those having a job at any time in the week ended 23rd April, 1966) of which 42,950 or 37.7% were females. Of all the Greenwich males over 15 years considered to be economically active, 4.7% were classified as professional workers, 8.7% as employers and managers, 31.9% as foremen or skilled manual workers, 16.1% as semi-skilled workers (including personal service and agricultural workers), 23.5% as non-manual workers and 10.2% as unskilled. With regard to the remainder (4.9%), the majority of these were armed forces or people who could not be assigned to any group. In these socio-economic groupings a majority of the 42,950 economically active females, almost 58%, were classified as nonmanual workers, 0.8% were professional workers, 29.3% employers and managers, 4.7% were skilled workers, 22.3% personal service and semi-skilled workers with a further 9% in the unskilled workers' group. 302 CARS AND GARAGING For the first time ever in a Census, information was requested regarding cars and garaging. Out of the 74,050 households enumerated in this Census, 58.1 % had no car, 37% had one car and 4.8% had two or more cars. Of the total of 34,940 cars belonging to these households, 33.7% were garaged overnight at the house, 13.5% were kept overnight in other garages, 11.1% were kept off the road within the curtilage of the house but not in a garage and 39.8% were parked overnight in the road. TABLE I—SUMMARY OF 1966 CENSUS POPULATION—AGE & SEX DISTRIBUTION Children Under 5 years of age: Males 870 Females 885 1,755 5 years and under 15: Males 1,648 Females 1,593 3,241 Working Population Males 15 and under 65 years: 7,410 Females 15 and under 60 years: 6,824 14,234 Elderly Population Males 65 years and over: 1,072 Females 60 years and over: 2,396 3,468 TOTAL POPULATION ENUMERATED 22,698 Persons in Private Households Males 10,727 Females 11,358 22,085 Persons in Non-Private Households Males 273 Females 340 613 TOTAL No. OF PERSONS IN HOUSEHOLDS 22,698 Private Households Total No. of Households 7,405 Total No. of Rooms 37,442 Total No. of Families 6,129 Total No. of Dwellings 7,186 Total No. of Cars 3,494 303 table ii—population of greenwich—age, sex and marital condition Age last Birthday Persons PRIVATE HOUSEHOLDS NON-PRIVATE H'HOLDS Male Female Male Female Total Married Others Total Married Others 0-4 1,755 853 - 853 864 - 864 17 21 5-9 1,616 816 - 816 772 - 772 15 13 10-14 1,625 815 — 815 794 — 794 2 14 15-19 1,977 1,001 16 985 928 70 858 18 30 20-24 1,567 752 231 521 698 401 297 49 68 25-29 1,198 568 399 169 560 470 90 32 38 30-34 1,226 565 475 90 618 544 74 15 28 35-39 1,428 720 623 97 690 622 68 9 9 40-44 1,605 743 651 92 843 739 104 14 5 45-49 1,586 784 706 78 778 666 112 15 9 50-54 1,621 783 705 78 802 672 130 19 17 55-59 1,412 696 611 85 692 528 164 13 11 60-64 1,272 604 519 85 649 422 227 10 9 65-69 1,009 427 345 82 561 311 250 11 10 70-74 760 274 213 61 470 171 299 9 7 75 & over 1,041 326 216 110 639 154 485 25 51 All ages 22,698 10,727 5,710 5,017 11,358 5,770 5,588 273 340 304 TABLE III—AGE AND SEX OF CHILDREN UNDER 16 YEARS Sex Age (in years) Total Under 16 yrs. 0-1 1-2 2-3 3-4 4-5 5-6 5-10 11-15 Males 154 211 156 181 168 180 988 849 2,707 Females 171 168 192 174 180 141 945 809 2,639 Total 325 379 348 355 348 321 1,933 1,658 5,346 TABLE IV—WARD STATISTICS ward Males Females Total Private Households Number of No. Rooms Families Dwellings Cars Abbey Wood 570 640 1,210 411 2,201 336 415 182 Academy 407 387 794 243 1,273 207 232 112 Blackheath 355 416 771 248 1,239 196 258 173 Charlton 327 335 662 226 1,098 186 186 85 Coldharbour 421 420 841 252 1,353 229 252 169 Eastcombe 304 312 616 209 1,081 170 203 82 Eltham 338 385 723 250 1,384 204 249 172 Eynsham 467 508 975 265 1,136 226 269 124 Hornfair 436 449 885 275 1,399 233 273 119 Horn Park 340 355 695 223 1,141 192 225 150 Kidbrooke 498 516 1,014 304 1,482 278 303 186 Marsh 291 336 627 199 1,055 171 179 62 Middle Park 375 415 790 259 1,211 218 249 108 New Eltham 559 610 1,169 395 2,125 347 396 244 Park 324 389 713 268 1,161 194 232 112 St. George's 369 338 707 198 960 178 201 69 St. Margaret's 584 645 1,229 416 2,230 345 369 214 St. Mary's 494 488 982 345 1,570 278 348 124 St. Nicholas 671 674 1,345 432 2,303 358 407 148 Sherard 406 427 833 230 1,237 205 229 91 Shooters Hill 340 390 730 246 1,376 201 237 174 Slade 346 396 742 269 1,409 221 268 124 Trafalgar 293 297 590 208 1,057 159 191 64 Vanbrugh 377 396 773 260 1,183 178 239 140 Well Hall 340 401 741 268 1,432 201 276 103 West 430 425 855 264 1,151 233 248 87 Woolwich 338 348 686 242 1,195 185 252 76 totals 11,000 11,698 22,698 7,405 37,442 6,129 7,186 3,494 INDEX Page A Abattoir 246 Accidents—Deaths 35, 52 —Home 35, 52, 273 —Motor Vehicles 35, 52 Accommodation— for Elderly 128 for Homeless 131 for Mortuary 224 for Psychiatric. 189 Acute Encephalitis 76 Acute Influenzal Pneumonia 75 Acute Poliomyelitis 76 Acute Primary Pneumonia 75 Adoption 115 Adults Cleansed 222 Aflatoxin in Ground Nuts 248 Age and Sex of Children Under 16 years (1966 Census) 304 Age Composition of Population 38, 300 Age Mortality 43 Age, Sex and Marital Condition of Population (1966 Census) 303 Alcoholism & Drug Addiction 55, 60 Aleukaemia 35 Alkali Works Orders 194, 202 Allergy Testing at Chest Clinics 79 Amylase Test—Egg Pasteurisation 250 Analysis of Non Routine Medical Inspections—Schools 285 Analytical Examination of Milk 241 Anencephaly 103 Animal Boarding Establishments Act 209 Ante & Post Natal—Clinics 91 Ante & Post Natal Attendances 91 Antioxidant in Food Regs. 1966 240 Antitoxin—Diphtheria 74 Ants, Pharoah's, etc 220 Area—Borough 17 Area—Comparability Factors 34, 40, 42 Art Therapist—Mentally III 185 Articles and Rooms Disinfected 223 Articles Destroyed 222 Artificial Respiration 268 Asthma 79 Atmospheric Pollution. 63. 67, 201 'At Risk'Register 103,150 Audiometer Testing of School Children 293 B Bacteriological Examinations 216, 241, 242, 249, 252 Baiting of Sewers 219 Bakehouses 244 Bathing—at Centres 160 Page Bathing—at Home 160 Bathing Centres 159 Bathing Service 159 Baths—Swimming 216 Baths—Turkish & Russian 217 Baths—Warm 17 Baths & Wash-houses 15 B.C.G. Vaccination 79, 290 Beetles, etc—Disinfestation 222 Betting, Gaming & Lotteries Act 208 Birth Registrations 40 Birthplace (1966 Census) 300 Births 34, 39 Births—Age, Parity and Place of Occurrence 92 Births—Illegitimate 34,41,116 Births—Legitimate 34, 39 Births—Live 34, 39 Births—Still 34, 41, 93 Blackheath Fair 243 Blackwall Industrial Training Centre 181 Blind—Clubs 146 Blind—Concessions . 141 Blind—Education, Training and Employment 138 Blind—Homeworkers 141 Blind—'In'Residents 139 Blind—Occupations 139 Blind—Registers 136 Blind—Sheltered Employment 41 Blind—Welfare 135 Blindness—Major Causes 135 Boarding Out— Child Contacts, etc 116 Subnormal Adults 183 Bread & Flour Regs 251 Bronchitis. 35,51,66, 79 Bronchogenic Carcinoma 51,63 Brook Chest Clinic 79 Burial or Cremation of Deceased Persons 155 Butchers' Shops and Stalls 245 Butter Regs. 1966 240 C Cancer—Cervix 35, 50 Cancer—General 35, 49, 62 Cancer—Childhood, Survey of 65, 111 Cancer—Lung 35, 50, 51, 63, 79 Cancer—Other Special Sites 35, 50 Cancer—Uterus 35, 50 Care and Protection of Property 154 Care Committee 283 Care of the Handicapped Child 149 Carol Services for Elderly 169 INDEX (continued) Page Carcases & Offal Inspected at Slaughterhouse 247 Cars & Garaging (1966 Census) 302 Case Conferences 118 Caseous Lymphadenitis 248 Cases of Infectious Diseases 71, 290 Castlewood Day Hospital— Mentally 111 185 Catering Establishments 244 Census 1966 300 Cerebral Embolism 49 Cerebral Haemorrhage 49 Cerebral Thrombosis 49 Certificates—Export 250 Certificates—Disrepair 206 Certificates—International Vaccination 72 Cervical Cytology 64, 98 Cesspools 210 Cheese Regs. 1966 240 Chest Clinics 78, 79 Chest Physicians' Reports 78, 79 Chevening Road Day Centr— Mentally 111 186 Chickenpox—School Children 290 Child—Contacts, Boarding Out 116 Child—Guidance Facilities 281 Child—Helps, Courses 109 Child—Minders, Statutory 120 Child—Minders, Voluntary 120 Child—Population 34, 38, 304 Child—Welfare Clinics 114 Childbirth, Preparation for 93 Children—Cleansed 222 Children—Dual Handicaps 154 Children—Ineducable 154 Chiropody—Domiciliary 121, 161 Chiropody—General 121 Chiropody—Elderly 121,161 Chiropody—Services 121, 161 Christmas Parcels for Elderly 169 Civic Entertainment for Elderly 169 Classification of Deaths 48 Clean Air Act 202 Cleansing & Bathing Centres 160, 222 Cleansing of Children 222, 289 Cleansing of Old People 160 Clearance Areas 232 Clinics—Ante Natal 91 Clinics—Child Welfare 114 Clinics—Family Planning 101 Clinics—Geriatric 163 Clinics—Mental Health 176 Clinics—Minor Ailments 286 Clinics—Post Natal 91 Pagt Closing Orders— Demolition Orders 231 Determinations 231 Houses 230 Parts of Houses 231 Underground Rooms 231 Undertakings 230 Clover Mite 221 Clubs—Blind 146 Clubs—Day 166 Clubs—Deaf 146 Clubs—Elderly 166,167 Clubs—Luncheon 162 Clubs—Mothers' 117 Clubs—Physically Handicapped 145 Clubs—Subnormal 184 Clubs—Therapeutic, Social 186 Clubs & Centres for Handicapped 145 Cockroaches 221 Colouring Matter in Food Regs. 240 Common Infectious Diseases 53 , 290 Communicable Diseases Survey— School Children 289 Community Centres 26 Community Council 26 Community Services— Geriatric 155 Handicapped 132 Mentally 111 187 Mentally Subnormal 175 Comparability Factors 34, 40, 4! Complaints 194,199 Concerts & Outings, etc.— Elderly 168 Concessions for Blind 141 Condensed Milk Regs. 251 Conditional Releases—Imported Egg Products 248 Conference Organisers . 278 Confinement—Arrangements 92 Confinement—Medical Aid Fees 97 Congenital Malformations— Deaths 35 Notifications 101 Conjunctivitis—School Children 290 Construction (H & W) Regs., 1966 193 Consultant Chest Physicians 78,79 Conveniences—Public 220 Co-operation with Hospital Dcpts. I Id Co-ordinating Committee 117 Coronary Disease 35, 49,61 Council—Dwellings235 Council—Housing Schemes 235, 236 Council—Rehousing 234 Creches 115,183 Cremation or Burial of Deceased 155 INDEX (continued) Page Cremations 224 Crematorium 224 Cysticercosis 247 Cytology—Bronchial 64 Cytology—Cervical 64, 98 D Darenth Park & Goldie Leigh Hospitals 183 Day Centres—Mentally 111 186 Clubs—Elderly 166 Clubs—Homebound 166 Hospital—Mentally 111 185 Nurseries—Private 120 Nursery 114 Rooms 166 Training normality 177 Deaf Register (incl. Partially Hearing) 104 Death Causes—Remarks 48 Death Rates—Special Causes 35 Death Registrations 42, 48 Deaths—General 34, 42 Deaths—Institutional. 43 Deaths—Table Showing Causes of and Ages at Appendix Deaths—Table Showing Causes of and Ages under 1 yr. 47 Deaths—Violent 51 Defective Dwellings—Repairs 199 Defects of School Children at Routine & Special Med. Exams. 292 Demolition Orders 231 Density of Population 17, 34 Dental Caries 86, 122,213 Dental Health Education 122 Dental Services—M & C.W. 172 Dental Services—Schools 283, 293 Dental Treatment .122, 124, 299 Dentistry 283 Departmental Conference 279 Departmental Transport 274 Determination of Closing Orders 231 Diagnostic Cytology 64, 98, 101 Diphtheria 74 Diphtheria—Antitoxin 74 Diphtheria—Immunisation 74, 289 Disabled & Old People's Homes —Registration. 155 Disablement Resettlement Officer 182 Diseased Carcases 247 Diseases—Infectious 54,71,290 Diseases—Respiratory 50,51,63,66, 75, 76 Disinfecting Stations 222 Page Disinfection. 78, 224 Disinfestation. 220, 289 Disinfestation of Verminous Pre mises 220 Displays—Health Education 271 Distribution Centres— Nutritional Supplements 165 Welfare Foods 118 District Nursing Appraisal 108 District Nursing Service 105 Divisional School Care Organiser 176 Domestic Helps108 Domiciliary Births 95 Domiciliary Births, Prematurity & Mortality 96 Domiciliary Chiropody 121 Domiciliary Confinements 95 Domiciliary Confinements by Age & Parity 95 Domiciliary Midwifery Services 94 Domiciliary Midwives 94 Domiciliary Services— Geriatric 155 Handicapped 132 Midwifery .94 Drainage & Sewerage 210 Dried Egg Products—Imported 248 Dried Hen Egg Albumen 249 Dried Milk Regs 251 Drug Addicts & Alcoholism 55 Dual Handicaps—Children's 154 Dwellings—Erected by L.As. 235 Dwellings—Inhabited 17 Dwellings—Separate Occupiers 17, 301 Dwellings—Shared 301 Dwellings—Uninhabited 17 Dysentery 75,290 E Early Discharges—Maternity Cases 96 Early Neonatal Mortality 35,47 Economically Active Persons (1966 Census) 301 Education Act—Examinations. 154 Education and Training Centre— E.S.N 177 Education Sessions—Ante Natal 90,93 Educationally Subnormal Pupils 292 Educationally Subnormal Clubs 183, 184 Egg Albumen—Imported 248 Elderly—Clubs for 166 Elderly—Day Rooms for 166 Elderly—Luncheon Clubs for 162 Elderly—Meals-on-Wheels 161 Elderly—Population 34, 38, 300, 302 Elderly—Recreational Facilities 166 INDEX (continued) Page Elderly—Visiting 158 Elevation of Borough 17 Eltham—Club for Blind 146 Eltham—Creche 183 Eltham—Crematorium 224 Eltham—Nursery for Mentally Handicapped 183 Emergency Obstetric Units 96 Emigration/Immigration 38 Employment of Blind Persons 138 Employment of Partially Sighted 140 Encephalitis 76 English Frozen Whole Egg Plant 249 Enteric Fever 75 Entertainment for Elderly 169 Environmental Health Services 193 Erysipelas 5 Examinations— Accidents (Staff) 274 Ante and Post Natal 91 Fitness for Employment 273 Mental Illness 176 Recuperative Holidays 290 Sick Persons 274 Staff Appointments 273 Superannuation 273 Exhumations 224 Expectation of Life 38 Export Certificates 250 Extracts from Vital Statistics 34 F Factories Act, 1961 195 Factories Inspections 195 Fair on Blackheath 243 Families, Number of 17,302 Family—Aids 109,117 Family—Caseworkers 117,131 Family—Planning Association 99 Family—Planning Assoc. Clinics 101 Federation Hall Day Centre— Proposed 186 Fertility Clinics 99 Field Work Instructor Courses 112 Film Shows—for Elderly 169 Film Shows and Talks—Health Education 267 Flies and Mosquitoes 220 Flooding of R. Ravensbournc 200 Flour Composition Regs. 51 Fluoridation of Water Supplies 86, 123,213 Food and Drugs Act- Genuine Samples 251, 254 Non-Genuine Samples 251,258 Other Food Samples 251 Food Examination 250 Page Food Hygiene Regs 237, 243, 244 Food Inspection 251 Food Legislation, New . 237 Food Poisoning 86 Food Premises for Preparation of 243 Food Rejected 245, 248 Foods—Welfare 118,165 Foot Clinics 121 Foster Parents 116 Fouling of Pavements by Dogs 219 Friendly Visiting—Elderly 171 Frozen Whole Egg Plant 249 Future Development—Handicapped Services 149 G General Information and Social Conditions 20 General Medical Inspection of School Children 283 General Practitioner Obstetricians' Clinics 91 General Statistics 17 Geology, Superficial 29 Geriatric Adviser to the Council 164 Geriatric—Clinics 163 Geriatric—Community Services 155 Geriatric—Units 164 German Measles 290 G.L.C.—Rehousing 235 G.P. Obstetricians' Clinics 91 Grants—S.C.As. 205 Greenwich Chest Clinic. 78 Greenwich Community Council 26 Greenwich Council of Social Service 121 Greenwich Hotel 167 Greenwich Workshops for the Blind 141 Ground Nuts—Aflatoxin Con- tent . 248 H Hairwashing—Elderly 160 Handicapped- Children 104 Children and Young People —Report on 149 Future Development 149 Holidays 148 Portable Aids 147 Register 104,150 Services 132 Transport 149,275 Works of Access, etc. 146 Young People's Centre. 146 Handicraft Exhibition—Elderly's 169 INDEX (continued) Page Health—Committee 3 Health—Committee—Terms of Reference 3 Health—Education 113,266 Health—Education Classes 90,113 Health—Education in Schools 270 Health—Education at Welfare Centres 270 Health—Education Subjects 267 Health—Surveys 65.111 Health—Visiting 110 Health—Visitor Training 112 Health and Welfare Dept. Staff Heart Disease 35,49,61 H.M. Inspector of Factories 195 Holiday Film Shows—Health Education 270 Holiday Hotel for Elderly 167 Holiday Relief for Relatives 164 Holidays—Elderly 167 Holidays—Handicapped 148 Holidays—Recuperative 119 Holidays—Subnormal Trainees 182 Home Accidents—Deaths 35, 52 Bathing 160 Cleansing Service 161 Help Course 109 Help Service 108 Nursing 105 Nursing Equipment—Loans 146 Nursing—Training 107 Safety 272 Visits—Elderly 158 Homeless Families— Accommodation 131 Statistics 132 Homelessness 131 Homes for Mentally 111 185 Homes for Old People— Admissions 129 Council 128 Future Development 128 Provision of 128 Staff 130 Transfer of Residents 130 Voluntary 131 Welfare and Recreation 130 Homes for Subnormal 184 Homicide 52 Hospital Nursed at Home 95, 96 Selection for 92 Hostels for Subnormal 184 Hotel, Holiday for Elderly 167 House Improvements 234 Page House Purchase and Housing Acts 233 House and Trade Refuse 219 Houses—No. in Borough 17 Houses—Means of Escape from Fire 234 Houses—Multiple Occupation 233 Houses—Unfit .229 Household Amenities (1966 Census) 301 Households—One Persons (1966 Census) .301 Households—Private (1966 Census) 301 Households—Tenure (1966 Census) 301 Housing 165,227 Housing (1966 Census) 301 Housing—Accommodation 235 Housing—Conditions 227 Housing—Defects 199 Housing—Elderly 165 Housing—Financial Provs. Act 233 Housing—Homeless Persons 131 Housing—Medical Assessments 274 Housing—Premises Unfit 229 Housing—Prescribed Forms Regs. 229 Housing—Register 235 Housing—Repairs and Rents Act 233 Housing—Schemes, Council 235 Housing—Survey, Housing Manager's 235 Housing—Underground Rooms Act 231 Housing Act, 1949 233 Housing Act, 1957—Procedure under 229 Housing Act, 1961 233 Hydrotherapy Pool 216 I Ice Cream—Bacteriological Exams 242 Ice Cream—Premises 241 IceCream—Quantitative Analysis 242 Ice Cream—Sampling 242 Illegitimate Births 34,41,116 Immigration/Emigration 38 Immunisation and Vaccination 72, 73, 74, 76, 77, 79, 282 Impetigo 222,290 Imported Egg Products 248 Imported Food Regs. 240,247 Imported Food Rejected 248 Incontinent Laundry Service 160 Industrial Emissions—S.C.As 202 Injury Benefit Claims 88 Rehabilitation 146 INDEX (continued) Page Training Centres 180 Infantile Mortality 35,44 Infant Welfare Clinics 114 Infectious Diseases 54,71,290 Infectious Diseases— Notifications 71 School Children 290 Infertility Clinics 100 Influenza 66, 290 Inhabited Dwellings 17,301 Innoculations—Poliomyelitis 76 In Service'Training 113 Inspections— Food and Food Premises 237 Food 241 Food Premises 243 Meat at Slaughterhouse 246 Institution Deaths 43 Integrated Students 107 International Vaccination Certs. 72 Interviews—re Housing (A.M.O.H.) 274 Intra Uterine Contraceptive Device—Subclinic 101 Introductory Review 11 J Jurisdiction over R. bourne 200 K Knoyle Street Centre—Mentally Subnormal 182 L Laboratory Work 216, 241, 249, 250, 251 Land Charges Act 209 Launderette 217 Laundries—Public 217 Laundry Service—Incontinent 160 Leaflets—Health Education 270 Legal Proceedings 226,265 Legislation, New 70, 126, 193, 229, 237 Legitimate Births 34, 39 Leptospirosis 218 Leukaemia 35 Library Facilities- Blind 142 Elderly 169 Homebound 169 Old People's Homes 169 Licences—Milk 241 Licences—Radio for Blind 141 Licensing Act, 1961 208 Licensing—Slaughterhouse 246 Licensing—Slaughtermen 246 Licensing—Street Traders 243 Licensing—Tripe Boiler 246 Live Births 34,39 Loan of Nursing Equipment 146 Local Morbidity 87 London Government Act, 1963 20 Luncheon Clubs 162 Lung Cancer 35,50,51,63 M Main Unit—Homeless 131 Major Causes of Blindness 135 Malaria 76 Malformations, Deaths 35 Notifications 101 Manufacture and Sale of Ice Cream 242 Marie Curie Night Nursing Service 107 Marriages 34,39 Mass Radiography 80 Maternal Mortality 35,44 Maternity Outfits 97 Maternity Services 90 Mayor's Fund—Coal for Elderly 169 Maxey Road Chest Clinic 79 Maze Hill— Chest Clinic Training Centre 177 Training Centre—Education and Training 177 Nursing Unit 177 Special Unit 177 Meals-on-Wheels 161 Measles 73 , 290 Measles—Vaccination 74 Meat Inspection—Slaughterhouse 246 Meat Regs 237,245 Meat Surrendered 244 Medical Aid—Confinement Cases 97 Medical Appliances—Loans 146 Medical Assessments—Housing 274 Medical Examinations— Accidents (Staff) 274 Ante Natal 91 Mental Health 176 Post Natal 91 Sick Persons 274 Staff Appointments 273 Superannuation 273 Medical Inspections—School Children 283,285 Medical Officer of Health's Review 11 Medical Practitioner Obstetrician Clinics Medical Treatment—Schoolchildren 286 Meningococcal Infection 76 Mental Health— Act 174 Officers 174 Services 172 INDEX (continued) Page Page Statistics 190 National Welfare Week 271 bution 118 Mental Illness— Natural Increase 34,38 Community Services 187 Neonatal Mortality 35,47 Prevention 68 New Housing 235,236 Mental Subnormality—ComNew Legislation 70,193,229,237 munity Services 175 Noise Abatement Act 207 Meteorological Observations 33 Nomenclature Regulations 48 Metropolitan Water Board 86,210 Non-Genuine Samples 251,258 Met. Water Board—Director's Non Routine Med. Inspections— Report 211 Schoolchildren 285 Mice Destruction 218 Notices, etc 194,225 Midwifery 94 Notifications— Midwifery Training—Part II 97 Accidents 198 Midwives 94 Con. Malformations 101 Migration (1966 Census) 301 Food Poisoning 86 Mileage of Roads 19 Infectious Diseases 71 Milk— Number of Families 17,302 Analysis 241,251 Nursing Equipment—Loans 146 Condensed, Regs 251 Homes—Registration 120 Dairies 241 Unit—Mentally Handicapped 177 Distributors 241 Nutritional Supplements 165 Dried, Regs 251 Non Private Households (1966 Licences 241 Census) 302 Sampling 241,251 Milk and Dairies Rags 241 O Milk (special Designation) Regs. 241 Observations of Council's Services Mineral Hydrocarbons in Food Rags. 1966 240 Occasional Creche Services M="?E°<5SUioUr-D-ROS' ,82 8SS?S^¥5KB„i,c,.l46'»6 Ministry of Social Security- ~ Offices Shops and Railway Premises- Statistics .. .. 87 ^ $ MTnr°itedmentSCIiniCS_DefeCtS 286 Notifications of Accidents! 198 Minor Hall Club—Blind and " S°£!frV,Slting " " 158 Deaf 146 °ld PeoPle s- Miscellaneous Services .. i54,266 lis Mobile Meals 161 "omes „ v, ■ •• £8 Mongolism 103 Homes—Registration .. 155 Moral Wdfare " " !! 116 °"e Perfn Households (1966 Mortuary Accommodation .. 224 Mothercraft Training .. ..93,113 °pcnR^fhrniin .. Mothers'Clubs .. .. .. 117 Borough Council .. .. 8 Mothers—Rehabilitation .. 117 u rim™ u/~,V " !o Motor Vehicle Accidents- H M Office of Works .. 9 Deaths 35,52 ri . " " o Mumps—Schoolchildren .. 290 Ophthalmia—Schoolchildren ' 290 N Ophthalmia Neonatorum .. 76 National Assistance Act .. 127 Ophthalmic Services .. .. 135 N.A.A.—Part III Accommoda- Organic Nervous Diseases Gp tion—Statistics .. .. 130 Handicapped .. .. .. 144 National Fire Prevention Cam- Ormiston Road Rehabilitation paign 273 Centre .. 146 National Insurance Act—Med. Orthopaedic Defects—School Certs. .. .. .. .. 71 children .. .. .. 291 INDEX (continued) Page Page Other Food Examinations 251 Population 17,34,36,300 Otology—Schoolchildren 293 Population Outwork 196 Age Composition 38,300,303 p Child .. 34,38,300,302 Paratyphoid Fever 75 Density of 17,34 Part III (N.A.A.) AccommodaElderly 34,38,300,302 tion Statistics 130 Sex Ratio in 38 Partially Sighted— Wards 304 Employment and Training 140 Working 38,301,302 Register 140 Portable Aids for Handicapped 147 Parts of Buildings—Unfit 231 Post Natal Clinics 91 Pedicure—Elderly 160 Powers and Duties- Perinatal Mortality 35,48 Health Committee Personal Health and Related Welfare Committee 6 Services 89 Practising Midwives 94 Persons Cleansed 160,212 Precautionary Spraying 220 Persons— Premature Baby Units 96 Non-Private Households 302 Premises Unfit for Human Private Households 302 tation 230 Pet Animals Act 209 Preparation for Childbirth 93 Pharaoh's Ants 220 Preserved Food Premises 241 Pharmacy and Medicines Act 251 Prevalence and Control over Pharmacy and Poisons Act 207 fectious and Other Diseases 54 P.H. Regs.— Prevention of Damage by Pests Aircraft 71 Act 218 Dried Milk 251 Principal School Dental Officer's Imported Food 240,247,250,254 Report 293 Leprosy 71 Principal School Medical Officer's Meat 245 Report 281 Milk and Dairies (Gen.) 241 Private Day Nurseries 120 Milk (Spec. Designations) 241 Private Households(1966 Census) Ships 71 301,302,303,304 Smallpox Prevention 72 Problem Families Index Ill Tuberculosis 71 Procedure under Housing Act, Physical Aids 147,165 1957 229 Physically Handicapped— Proceedings, Legal 226,253,265 Additions and Removals 145 Product of Id. Rate 17 Clubs and Centres 145 Property Protection 154 Organic Nervous Diseases Prophylaxis 72,73, 74, 76, 77, 79,289 Gp 144 Protection of Property 154 Primary Disabilities 143 Provision of Accommodation Register 143 (N.A.A.) 127 Rheumatism Gp 143 Psychiatric Social Rehabilitation Centre 146 dation 189 Systemic Diseases Gp 144 Psychiatric Services 188 Welfare 142 Psychoprophylaxis in Childbirth 93 Pigeon Nuisance 199 Psychoprophylaxis Course 112 Placement of Schoolchildrcn 281 Public Baths and Wash-houses 215 Pneumonia 35,51,66,75 Public Conveniences 220 Poisons Information Service 208 Public Health Laboratory Service Poliomyelitis 76 215,241,242 Poliomyelitis Inoculations 76 Public Lectures / Demonstrations 267 Pollution— Publicity— Atmospheric 63,67,201 Health Education 269 Recording 206 Immunisation Campaign 271 River 200 Services for Elderly 166 INDEX (continued) Page Page Public Open Spaces 18 G.L.C. 235 Public Open Spaces— Interviews by A.M.O.H. 274 Council 18 Medical Grounds 274 G.L.C. 19 Rejected Food 244,247 H.M. Office of Works 19 Relaxation Classes—Ante Natal 93 War Office Dept 19 Remarks on Various Death Puerperal Pyrexia 75 Causes 48 Rent Act, 1957 206 Q Report of Dental Officer (M. & Quantitative Analysis—Ice Cream 242 C.W.) 122 R Report of Principal S.D.O. 293 Report of Principal S.M.O. 281 Radio and T.V.Repairs for Reproductive Wastage 35,48 Elderly 168 Residential Homes 128,139 Radioactive Substances Act 210 Residential Services 126 Radiography Mass 80 Respiratory Infection 66 Rag Flock Act 208 Respiratory System—Diseases of Rag Flock and Other Filling 50,51,63,66,75,76 Materials Regs 208 Review by M.O.H. 11 Rainfall Annual 33 Rheumatism Gp—Handicapped 143 Rateable Value 17 Riding Establishments Act 209 Rates-Births and Deaths, etc. 34 Ringworm 290 Rats and Mice Destruction 218 Risk Register 103,150 Ravensbourne, River—Flooding 200 River Pollution 200 Receivership 154 River Ravensbourne— Reception Centre—Homeless 131 Flooding 200 Recreational Facilities for Elderly 166 Jurisdiction 200 Recuperative Holidays 119 River Smells 200 Recuperative Holidays Med. Roads, Mileage in Borough 19 Exams 290 Rodent Control 217 Redevelopment- Housing 236 Routine Audiometer Testing 293 Refresher Courses 98,107,113 Rubella 290 Refuse-Collection 219 Rubella 290 Russian Vapour Baths 217 Refuse—Disposal 219 Registers— S At Risk 103 Safety in the Home 272 Blind 136 Salad Cream Regs. 1966 240 Deaf 104 Salmonellae in Egg Imports 249 Elderly People 158 Samples— Handicapped 104 Non Genuine 251,258 Partially Sighted 140 Under Food and Drugs Act Registration— 250,254 Births 39 Sampling- Child Minders 120 Food and Drugs 250 Deaths 42 Ice Cream 242 Disabled and Old People's Milk 241 Homes 155 Sanitary Circumstances of Area 194 Ice Cream Premises 242 Sanitary Work—Summaries, etc. 224 Marriages 39 Scabies 222,291 Nursing Homes 120 Scabies and Cleansing Clinics 222 Preserved Food Premises 242 Scarlet Fever 74,291 Residential Homes 155 Scavenging and Refuse Disposal 219 Rehabilitation Centre 146 Schoolchildren Cleansed 222 Rehabilitation of Mothers 117 School Dental Services 291 Rehousing 234 School Dental Services—Statistics 299 Rehousing— School Health Services 281 Council 234 School Health Services—Statistics 283 INDEX (continued) Page Page School Leavers—Handicapped.. 153 Statistics- School Treatment Centres 286 General 17 Selection of Women for Hospital Tables Appendix Confinement 92 Vital 34 Separate Occupiers 17 Stillbirths 34,41,93 Sewerage and Drainage 210 Storm Flooding 200 Sewers—Baiting 219 Street Cleansing 219 Sex Ratio—Population 38 Street—Traders 243 Shop Window Displays—Health Streets—Mileage in Borough 19 Education 269 Structurally Separate Dwellings 17 Shops and Offices Inspection 197 Structurally Separate Dwellings Sick Room Equipment—Loans 146 (1966 Census) 301 Sickness Claims—Ministry of S.S. 88 Student— Sight Testing 136,163,268 Health Visitors 112 Skimmed Milk Regs. 1966 240 Nurses 107,113 Slaughterhouse—Meat InspecSocial Workers 135 tion 246 Sub Fertility Clinics 100 Slaughterhouse, Slaughtermen— Suicide 52 Licensing 246 Summary of Activities—Health Slaughterhouses Regs. 1966 239 Education 267 Smallpox 72 Summary of Sanitary Work 224 Smallpox Vaccination 73 Sunshine, Annual 33 Smells from River 200 Superficial Deposits 29 Smoke Control— Superficial Geology 29 Areas 203 Supervision of Food Premises 243 Exempted Fireplaces Order 194 Supplies of Smokeless Fuels 204 Grants 205 Supplies of Underground Water Installations 206 (Wells) 213 Pollution Reconding 206 Surveys 65,111 Staff 206 Swimming— Smokeless Fuels—Supplies 204 Attendances 217 Smoking and Health—Health Baths 216 Education 272 Instruction 217 Social Clubs—Therapeutic 186 Systemic Diseases Conditions of the Area 20 capped 144 Rehabilitation Centre 146 T Security, Ministry of Television and Radio Sets- Statistics 87 Elderly 168 Socio-Economic Groups (1966 Census 301 Temperature, Annual-Max. and Min Solid Formations—Geology 31 Tenure— Sonne Dysentery 75 Owner Occupiers(1966 sus) Special Care Unit-E.S.N. 175 Categories-Placement 281 Clinics-V.D. 82 Private Households(1966 Census) DepartmentalConference 279 Renting Households (1966 Investigation—Clinics 176,287 Census) 301 Investigation Schoolchildren 282 Tetanus Prophylaxis 76 Special Schools 152 Therapeutic Clubs—Mentally Ill 186 Sprctacles-Supply to SchoolTherapists 146,185 children Trade and House Refuse 219 Spina Bifida Survey 112 Training Centres- Spraying—Precautionary 222 Blackwall Lane 181 St. Saviour's Centre for HandiKnoyle Street 182 capped Young People 146 Maze Hill 177 Staff—Health and Welfare Dept. 8 Park Vista 180 INDEX (continued) Page Page Statistics 183 Visits by Women Public Health Training Courses 107,275 Officers 159 Transfers Visual Acuity of Schoolchildren 287 Housing 234 236 Vital Statistics—Summary 34 Residential Homes 130 Vitamin Supplements 118 Transport Vocational Departmental 274 ped 135, 138 Handicapped 149 Voluntary Help-Elderly 170 Organiser 274 Voluntary Homes 131 Transported Meals for Old People 161 W Tripe Boiler Licensing 246 Ward Statistics (1966 Census) 304 Tuberculosis 35 51,76 Wash-houses and Public Baths 215 Tuberculosis- Wasps 221 Animals Water—Underground Supplies B.C.G. Vaccination 78 (Wells) 213 Chest Physicians' Reports 78 79 Water Supplies-Fluoridation 86, 213 Turkish Baths 217 Water Supply 210 Typhoid Feve 75 Water Supply- Letters 211 U M.W.B. Report 211 Underground Rooms—Unfit 231 Weil's Disease 218 Underground Water Supplies Welfare— (Wells) 213 Blind 135 Undertakings—Housing 230 Clinics 114 Unfit Premises 229 Committee 6 Uninhabited Dwellings 17 Committee, Terms of Ref. 6 Unsound Food 245,247 Foods, Elderly 165 Unsupported Mothers and Babies Foods, M. & C.W. 118 116,132 Physically Handicapped 142 Residential 128 V Services 125 Vaccination 73,78,289,290 Services, Future Vaccination—International Certs. 72 ment 149 Various Death Causes—Remarks Wells 213 on 48 Whooping Cough 74,291 Vascular Lesions of Nervous Whooping Cough Prophylaxis 74 System 35,49 Women Public Health Officers 158 Venereal Diseases 82 Women Public Health Officers' Venereal Diseases—Publicity 272 Visits 159 Verminous Conditions 222 Woolwich and Brook Chest Verminous Persons 222,288 Clinics Verminous Premises 220 Works of Access and Adaptation Verrucae 272 282 for Handicapped 146 Violent Deaths 51 Workshops for the Blind 141 Violet Melchett Mothercraft X Unit 117 X-Ray— Vision— Examinations 78,80 Clinics 288 Mass 80 Schoolchildren 287 Y Screening 268 Youth Employment Officers 153,182 Visiting- Young People- Friendly 171 Ineducable 154 Geriatric 158 Handicapped—Co-ordination Visits by Health Visitors 110 of Services 149 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1966 Notifiable Disease Cases Notified in Whole District Age & Sex Group Total Cases Notified in each Locality At all Ages Oto 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-45 45-65 65 & 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 Small-Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - Post-lnfectious(a) 2 _ _ _ _ - — - - _ - - - - - - 1 - 1 - - - - - - - 1 - Diphtheria _ — - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery(b) 46 46 2 _ 1 5 6 2 8 2 2 2 12 12 2 1 - 3 9 12 4 2 - 5 20 27 23 17 Erysipelas 3 3 - - - - - - - - - - - - - 1 - - 1 - 2 2 - - - - 3 3 Acute Polio-Myelitis P - - - - - - - - - - - - - - - - - - - - - - - - - - - - N.P. - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever(c) 20 23 - - - - 3 1 - 1 6 2 9 14 1 i 1 1 - 1 - - - - 4 6 15 17 Typhoid Fever — 1 — — — 1 — — — — — — — — — — — — — — — - — — — — — 1 Paratyphoid Fever (d) 1 1 - - - - - - - - - - - - - - 1 1 - - - - - - - — - - Puerperal Pyrexia(e) - 83 - - - - - - - - - - - - - - - 36 - 46 - 1 - - - 13 - 46 Meningococcal Infection - 2 - - - — - 1 - - - - - 1 - - - - - - - - - - — - - 2 Measles(f) 628 622 28 26 78 68 70 94 85 91 99 92 257 237 7 6 4 3 - 5 - - - - 158 166 467 455 Whooping Cough(g) 51 45 5 7 8 6 6 3 7 9 9 6 14 12 1 2 - - 1 - - - - - 23 21 26 23 Malaria (h) 1 — — — — — — — — — — — — — — — — — — — 1 — — — — — — — Ophthalmia Neonatorum 2 3 2 3 - - - - - - - - - - - - - - - - - - - - - - 2 3 Pneumonia, Acute Primary or Acute Influenzal 14 16 3 - 1 1 - - 1 - - - - 1 - - 1 - 2 4 2 3 4 7 4 8 10 8 Tuberculosis, Pulmonary 44 23 - - - - - - - - 1 - - 1 1 1 - 4 16 10 16 5 10 2 17 8 27 15 „ Non-Pulmonary 3 6 - - - - - - - - - - 1 - - - - 1 1 3 1 - - 2 1 2 2 4 Totals 815 874 40 36 88 81 85 101 101 103 117 102 293 278 12 14 8 49 31 81 26 13 14 16 227 251 576 594 NOTE:—The above table refers to “Corrected Notifications” only, i.e., all cases in which the diagnosis was not confirmed have been ignored (a) Of this total 1 hospitalised within Greenwich but resident outside the Borough (b) „„„ 5 ,, „ ,, ,, ,, ,, „ ,, (c) „„„1„„„„„„„„ (d) „„„2„„„„„„„„ (e) „„„24 „„„„„„„„ (f) „„„ 4 ,, ,, „ ,, ,, ,, ,, ,, (g) „„„3 ,, ,, ,, „ ,, ,, ,, ,, (h) „„„1„„„„„„„„