E AC 43341 GRE 65 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1967 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1967 CONTENTS Page Health Committee 3 Welfare Committee 5 Staff 6 Introductory 9 Section I—General Statistics and Social Conditions 14 II—Vital Statistics 32 III—Prevalence of, and Control Over, Infectious and Other Diseases 53 IV—Personal Health and Related Services 80 V—Community Care 124 VI—Environmental Health 182 VII—Miscellaneous 264 VIII—School Health 279 Index 299 Appendix—Statistical Tables 3 HEALTH COMMITTEE (as at 31st December, 1967) The Mayor: (ex-officio) Alderman W. T. Walden, J.P. Chairman: Alderman A. C. Chrisp Vice-Chairman: Councillor J. P. Hamilton Alderman : D. C. Hubber Councillors: (1)The Committee shall consist of 15 members of the Council (exclusive of the Mayor and the Leaders of the Council and Opposition). (2) The Council's powers and duties pertaining to the general health services (personal and environmental) and sanitation of the borough, including the school health service and nurseries. (3) The powers and duties of the Council under the Clean Air Act, 1956, the Shops Acts, the Offices, Shops and Railway Premises Act, 1963, Food & Drugs Acts, Acts relating to consumer protection and public control, Gaming Acts and related legislation, and matters relating to markets and street trading and the control and welfare of animals. (4) The powers and duties of the Council under the Mental Health Acts and related legislation. T. G. Blann Mrs. J. E. Chrisp G. S. Dean Mrs. W. H. M. Hulbert Mrs. A. D. A. Kennedy W. J. Manners P. G. Mornington G. E. Offord, J.P. H. F. Reilly I. N. Smith L. Squirrell Mrs. H. Stroud Terms of Reference 4 (5) The powers and duties of the Council relating to houses in multiple occupation, individual unfit houses, the declaration of improvement areas, the reception of representations as to Clearance areas and the issue of certificates of disrepair under the Rent Acts. (6) Home Safety. 5 WELFARE COMMITTEE (as at 31st December, 1967) The Mayor: (ex-officio) Alderman W. T. Walden, J.P. Chairman : Councillor T. A. J. Malone Vice-Chairman: Councillor Mrs. K. P. Bullard, J.P. Aldermen : A. C. Chrisp E. McCarthy Councillors : N. G. Burbridge Mrs. M. E. Polley Mrs. J. E. Chrisp H. F. Reilly Mrs. W. H. M. Hulbert A. M. Selves Mrs. C. B. Jeffery (from 6.12.67) Mrs. E. R. M. Middleton N. R. J. Sims G. E. Offord, J.P. Mrs. H. Stroud Terms of Reference : (1) The Committee shall consist of 15 members of the Council (exclusive of the Mayor and the Leaders of the Council and Opposition). (2) The Council's powers and duties in relation to the welfare of the aged, the physically handicapped and the homeless. (3) The provision and management of homes for unmarried mothers. (4) The burial or cremation of dead persons where this has otherwise not been arranged. 6 STAFF HEALTH AND WELFARE DEPARTMENT (31st December, 1967) 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 Medical Officers: Dr. B. W. Hordern Dr. J. M. Oldfield Dr. G. G. Sherriff Dr. F. I. Winfteld Chief Dental Officer and Principal School Dental Officer: F. Elston Visiting Medical Officers: Dr. R. S. L. Hood Dr. G. F. Horton (,from 11.12.67) Dr. S. L. Price Dr. W. D. H. Troughton Dr. R. G. Taylor 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 Borough Welfare Officer: R. E. Haymes Community Care Co-ordinator of Community Care & Chief Mental Health Officer: B. A. Freeman COMMUNITY CARE TEAMS Area "A"—Supervisor: Miss B. Hatfield Team Leader: D. L. R. Neill Area "B"—Supervisor: J.E.Allen Team Leader: Miss N. E. L. Irwin 7 Area "C"—Supervisor : R. C. Baldock Team Leader: Miss N. A. Fluck Area "D"—Supervisor: Mrs. J. Y. White Team Leader: J. M. Ashton RESIDENTIAL & ANCILLARY SERVICES Matrons of Old People's Mrs. D. M. Bell Homes: Miss M. Campbell Miss K. Mansfield Miss M. Troup Greenwich Hotel Superintendent: Miss W. E. Wilson Homeless Families' Units Supervisor: D. A. Upton Workshop for the Blind Manager: R.J. Nottage Training Centre Supervisors: Miss B. A. Godfrey P. Rickards Mrs. I. A. Robbins Personal Health Chief Nursing Officer: Miss M. Naunton Deputy Chief Nursing Officer: Miss A. Hayward Supervisor of Midwives and Home Nursing Services: Miss J. A. Waugh Chief Chiropodists: K. D. Reeve Miss E. P. Flanagan Home Help Organisers: Miss P. M. Calland (from 20.2.67) Mrs. D. Greeno 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 8 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 Administration Chief Administrative Officer: L. M. Longhurst Deputy Chief Administrative Officers: L. A. Westacott C. A. Webb (Establishment) Section Heads Finance and Supplies: R.E. Sweett Community Care: R. Bruty Residential & Ancillary : J. W. Shorter Personal Health: J. Hannen Environmental Health: K. G. Allum Staff: R. Augustin Planning and Development: R.G. Garratt Health Education and Related Functions: A. H. Wilcox J. E. Kay Transport: W. F. Goodall Typing: Mrs. W. Ellison 9 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 am privileged to present this account of the health and community care services of the London Borough of Greenwich for 1967. The reorganisation of the Department, begun last year, has now been completed with the formation of a Community Care Branch which embraces all the social work undertaken in the Department. Allied to the idea of mixed teams of health and social workers has been the creation of combined occupation centres, day centres and day clubs for the mentally ill, the physically handicapped and the elderly. Professional workers from many disciplines, with varied interests and enthusiasms, can now identify themselves positively with field establishments and can discuss with supervisors at the centres the specific needs of their clients. After several months it is clear that this concept of mutual support and interdependence within a single organisation is sound and now forms a firm foundation on which to expand existing services and to examine new thoughts in the social field. Undoubtedly this Department, providing a wide and diverse range of health and social services on behalf of the Council, will be concerned for a considerable period with meeting community needs which are already clearly identifiable. Nevertheless, the purse is not limitless and the resources which can be made avail able to the Department must therefore be husbanded and deployed to the best advantage, while some objective assessment of value for money must be applied. I am aware that in the social field this can be difficult, but an attempt must be made and the issue cannot be evaded. Vague generalities and verbal obscurities must be avoided and. above all, we must subject our theories and our actions to a rigorous scrutiny and evaluation. There is also much careless talk about prevention in the social field. One can understand preventing an infectious disease by a process of immunisation, because here we are dealing with direct cause and effect, but is there any evidence that so-called preventive measures in the social field, based on no solid criteria, result in fewer pressures on the community services or create a happier and more contented society? Regrettably, the evidence is to the 10 trary. Herein lies the dilemma. In our present ignorance of the underlying causes of social pathology, are these ills (if indeed they are ills) preventable, or would we achieve much the same end by providing adequately in the material sense for those who fall by the wayside, without the necessity for the prolonged professional intervention of officialdom? Is there a danger that in our very enthusiasm to help people, sometimes with rather ill defined problems, social service departments may be stigmatised as professional inquisitors? These philosophical reservations do not rule out the provision of social services of a high and consistent standard, and I trust that the progress recorded in the main body of this report will indicate the concern of this Department to help the needy, the unfortunate and demonstrably inadequate. The Maud and Mallaby reports have been published, and many Boroughs are undergoing the agonising pains of examining their management structures. Unavoidably there are differences of opinion and it is no part of this report to express any views on the validity of many of their recommendations, other than to support the idea of the grouping of related services and to reaffirm my own conviction about the essential indivisibility and unity of health and the social causes and consequences of disease and disability. It is also regrettable that the Seebohm Committee's review of the personal social services was not available at the same time as the reports on local authority staffing and management structures. The Mallaby report emphasises the need for knowledgeable and expert staff, and the Department is aware of the importance of recruiting, training and retaining qualified staff. Great efforts are being made to encourage staff to obtain qualifications appropriate to their jobs. While recognising that in the past there has been chronic shortage of suitable recruits because of other more attractive employment prospects, the position seems to be improving. The Junior Centre now has a fully qualified staff and social workers in all disciplines are being seconded for training, while a regular quota year by year of student health visitors and public health inspectors is accepted in the Department. A higher quality of junior officers is now coming forward and in the Community Care Branch students are engaged in the first instance for clerical and administrative duties, but with a view to eventual qualification as social workers. I must now address myself to the specfiic events of the year. Once again there has been a slight decrease in population, although the number of deaths is down. There has been a marginal increase in the infantile mortality rate and, as expected, the illegitimacy rate is higher. When one examines the main causes of death, there has been a reduction by 4% in heart diseases, although coronary artery disease 11 has slightly increased. On the other hand, there has been an increase of over 20% in lung cancer and in carcinoma of the breast. This reverses the trend noted last year, and it seems clear that the preventive measures against lung cancer must be continued with vigour, particularly to eliminate unnecessary atmospheric pollution and to reduce the consumption of tobacco. Fortunately the high incidence of pneumonia last year has not been repeated and bronchitis shows a reduction. The large increase in the incidence of notifiable infectious diseases is due mainly to measles, although there were significant increases in scarlet fever and whooping cough. Once again the Borough was free from diphtheria and enteric fevers. Although not yet notifiable. 19 cases of infective hepatitis came to our attention. The work of the Environmental Branch continued unobtrusively and progress in respect of atmospheric pollution, housing and food inspection and supervision is worthy of commendation. During the latter part of the year the recruitment position of health visitors improved, due to the Borough's efforts in accepting suitable students for training. Although there have been shortages of staff, the Home Nursing Service has been maintained at a high level. Several family doctor group practices have been selected for the secondment of health visitors and home nurses, and a group practice surgery working alongside and in close partnership with the local authority staff at 101 Shooters Hill Road has been highly successful. There has been further authorised expansion of the Home Help Service, particularly for the elderly, and it has been possible to extend further the availability of child helps. Despite our efforts to stimulate continuing interest in cervical cytology, the number of "well women" coming forward for this simple examination is still declining. A breast examination is now included and other simple screening tests will be added in the future. New arrangements were agreed with the Family Planning Association as a result of the passing of the new Family Planning Act, which places further obligations on the local health authority for providing this service. As part of the new Greenwich District Hospital, a day nursery is being incorporated in the building and the local authority are hoping to share the facilities. The absence of a local authority day nursery in the Borough is a hardship, although emergency needs can be met either by private day nurseries or by the extensive Child Minder Service which is available. 12 The Health Education Section has shown great enthusiasm and diligence. The successful Home Safety exhibition was staged; a colour film entitled "They Have A Future" on the activities of the Junior Centre was produced and has been acclaimed by all who have seen it. The section has also organised a full programme of lectures, demonstrations and film shows. A good deal of the health education material is designed and printed in the Department, and new and interesting methods of presenting health education matter have been devised. The combined centres at Federation Hall and Riverdale will be opening soon and will prove valuable assets. Two additional lunch clubs for the elderly have been provided and the meals on wheels have increased. Indeed, all the domiciliary supporting services for the elderly show appreciable expansion. The total number of elderly in the community continues to rise and the Department is now being asked to help the over 75s in ever greater numbers when, of course, the inevitable concomitants of advancing years are most apparent. Despite the closest ties with the hospital geriatric services, the Department is having to accept ever greater numbers of infirm elderly into Part III accommodation. The building of the new home at Gavestone Crescent with a special care unit for the infirm was started this year and strenuous efforts are being made by the Council to build more 60-bed homes to accommodate in Greenwich all the old folk requiring attention. If the programme is uninterrupted, there is a good prospect that all our old people at Southern Grove Lodge will be accommodated within the Borough by the end of 1970 or early in 1971. This achievement will be dependent on a sympathetic attitude being adopted by the Ministry and on the necessary loan sanction being made available for the homes to be built to a strict time table. The Greater London Council's new estate at Kidbrooke will necessitate the provision of a maternity and child welfare centre together with a dental suite; negotiations have been conducted and agreement reached. The imaginative development at Thamesmead presents an opportunity to build new modern medical and social services. Already a Joint Health Services Advisory Committee has been formed and, although stages 1 and 2 of the development will be in Bexley, a feasibility study is already under way to examine the feasibility of providing comprehensive medical and social services for the people of Thamesmead from a main medical and family centre. Some preliminary investigations have already been undertaken by the General Practice Research Unit at Guy's Hospital, and it is gratifying to report the willingness with which the three branches of the Health Service are co-operating in an attempt to provide a 13 ordinated service. The other social services for which this Department is responsible will be planned with the closest co-ordination and partnership with the health services in mind. Until the feasibility exercise has been completed it would be premature to prejudge the conclusions of the Working Party. Formidable difficulties, not least financial, have to be overcome, but undoubtedly health centres in one form or another will be the basis of medical and family care in this area, and the prospect of the hospital services emerging from their exclusive cloisters to join in partnership with the family doctors and the local authority community services is an event of some moment. The purposes of this preface are to delineate the main streams of development and achievement in the past year. A department of this size is dependent on help from many sources and I am mindful of my indebtedness to friends and colleagues. I have received much kindness and consideration from Alderman Chrisp and Councillor Malone, Chairmen of the Health and Welfare Committees respectively. I must also thank the members of these Committees for their support, for in the last analysis it is the elected members who direct the broad policies of a department. I trust that they will feel that their confidence has not been misplaced. In conclusion, I wish to thank all my senior colleagues for their loyalty and their interest, but in this year of reorganisation of the social work of the Department I am under a particular obligation to Mr. B. A. Freeman, the newly appointed co-ordinator of Community Care and Chief Mental Health Officer. His exertions, his shrewd assessment of need and his unwavering allegiance to the interests of the Department and the community have contributed largely to the early success of the new Community Care Branch. As usual, I am most grateful to my Deputy, Dr. M. E. Watts, and Mr. Longhurst, the Chief Administrative Officer, for all their efforts, both in respect of their positive contributions to the advancement of the Department's affairs and for their ready acceptance of a disproportionate share of the burden. Your obedient Servant, J. Kerr Brown, Medical Officer of Health. 14 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 †At Census, 1966 (10% sample)226,980 Estimated, 1967 (mid-year) 231,150 Density of Population (persons per acre) 19.75 Number of Inhabited Dwellings—end 1967 72,348 (according to Rate Books) *Structurally separate dwellings at Census, 1961 70,175 †At Census, 1966 (10% sample)70,140 Number of Uninhabited Dwellings— *At Census, 1961 1,031 †At Census, 1966 (10% sample) 1,710 At end 1967 2,029 Number of Families or Separate Occupiers— *At Census, 1961 75,803 †At Census, 1966 (10% sample) 74,050 Rateable Value, 1967 £12,759,639 Sum Represented by a Id. Rate, 1967 £49,600 *Adjusted to accord with Boundary Changes introduced under the London Government Act, 1963. †Provisional (Subject to eventual statistical evaluation by the Registrar-General) 15 PUBLIC OPEN SPACES Borough Council— A pprox. 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 Manor- way 6.31 Queen's Gardens, Coldharbour Estate 1.50 Queenscroft Recreation Ground 12.50 Rockcliff Gardens 5.21 St. Alfege Recreation and Church Grounds 2.30 St. Mary's Churchyard 3.36 St. Nicholas Gardens, S.E.18 2.80 Sidcup Road Open Space 9.13 Southwood Road Recreation Ground 1.26 Sunbury Street Recreation Ground 0.30 Sutcliffe Park and Harrow Meadow Playing Field 65.00 The Tarn, Court Road 10.45 Villas Road 0.16 Well Hall Pleasaunce 12.17 William Barefoot Gardens 0.79 Other Open Spaces 6.01 199.12 acres 16 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 (representing 12.8% of the total area of the Borough) Mileage of Roads (1st April, 1967) Approx. 250.19 17 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 ¼mile 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 give 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 18 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 particularly 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 19 the area and there was great hardship among the workers. In this respect, the people in the neighbourhood of Woolwich were a little more fortunate in that some compensation was provided by the increasing demand for labour at the 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 20 became imperative in order to resolve the serious housing problems thereby arising and in this respect over 3,000 units of accommodation were so acquired. Following the war, the respective local authorities immediately proceeded to plan and organise housing programmes to meet residents' needs, and, as first priority, arranged for the erection in the Borough of 1,801 Emergency Factory Made Bungalows (later to become known as "pre-fabs"). Meanwhile, traditional building began and continued apace and work on the completion of 2 pre-war estates was commenced in December, 1945, in accordance with modernised plans. By the end of 1947, 112 flats and 48 houses had been erected and occupied at Cherry Orchard arid 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 pubiic 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, 21 many being of the old-fashioned "shop on the corner" type selling a wide range of goods. However, this situation is changing, possibly contrary to the interests of many sections of the public. Town planning is demanding the concentration of traders into "shopping centres" 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 southeast 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 Community Care 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 promoted by tuition, training and the introduction of pastime activities. Blind people are offered a service of Braille and "talking" books obtained from the National Library for the Blind and allied organisations, and sheltered employment is provided at the Greenwich Workshops for the Blind where mattresses, baskets and 22 "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. 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, which are responsible for dispensing almost 175,000 meals a year, 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 original prints by contemporary British artists have been made available to residents over the age of 18 years. "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 23 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, 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 has taken 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 24 Community Council in conjunction with the I.L.E.A. and, in this connection, it can be stated that there are upwards of 178 clubs and societies affiliated to this Community Council. Besides Associations for rowing and barge sailing, the local sports clubs include the famous Blackheath Football Club (the oldest of all rugby football clubs) and the newer professional Charlton Athletic Football Club. It is hard to believe that the area supports 2 golf clubs, one of which is the Royal Blackheath, the oldest golf club in the world. With royal sanction it was formed nearly 360 years ago as the "Society of Blackheath Goffers" at a time when James 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 delightful attributes, Avery Hill grounds and nurseries serve as the headquarters of the Education Authority's Nature Study Scheme supplying "botany boxes" to the local schools. West of the Royal Military Academy is Woolwich Common which has been the site for military displays since the latter half of the 18th century, a practice which is continued today with the Royal Regiment of Artillery's Annual Tattoo. Greenwich can boast of modern public baths. There are four such establishments within the Borough, each of which has two swimming pools. Moreover, at Eltham, the Council has provided a hydrotherapy pool, and on the Abbey Estate, has introduced a 25 ette. Warm baths for men and women are to be bad at Greenwich, Plumstead and Woolwich and, at the former two premises, in addition to Turkish and Vapour Baths, public laundries still operate. In winter, the large pools at Eltham, Greenwich and Woolwich are covered and utilised for a wide range of recreational pursuits such as roller skating, badminton, table tennis, etc., and facilities are made available for indoor bowling and the use of indoor cricket practice nets. The Council has control of the five cemeteries located within the Borough and, on behalf of the Woolwich, Greenwich and North West Kent Crematorium Board, is responsible for the modern crematorium at Eltham. The unique position held by Greenwich in Britain's history has its counterpart in the nation's industrial story. From earliest years its residents have been closely linked with the sea and ships and Britain's ascendency in respect of them for over 1,000 years. This association, manifest since before the advent of the ancient "wooden walls" until after the birth of the "ironclad" has, to a very large extent, determined the pattern of industry in the Borough. Early in its history, local industry was influenced by the area's close association with royalty and the demands which it and its retinues made on the neighbourhood. For instance, the siting close to Greenwich Palace of the Royal Armoury in the reign of Henry VIII gave rise to the production of russet steel suits of armour which became renowned and modern metal products from Greenwich continue this distinction. Connections with shipbuilding and armaments, forged in the days of Britain's peril, are perpetuated in existing industries. Indeed, throughout its annals, the country has never demanded armaments and accoutrements from Greenwich industry in vain. Even records covering the last war will clearly reveal the great contributions made by these industries with special reference to PLUTO, FIDO and the famous Mulberry harbour. In the main, industries and sources of employment of the Borough are to be found in the vicinity of the River Thames which forms the northern boundary, Chief among the concerns employing large numbers of workers are:— Cablemakers, telecommunications and shipbuilding and repair works; automobile, construction, electrical and mechanical engineers; manufacturers of fire engines; manufacturers of tools, gauges, scientific instruments, tin boxes and containers, paints and lacquers, glass bottles, ropes, ships' propellers, cement and road surface materials; works for the recovery of metal and for the production of castings and for extruded non-ferrous metals and alloys and for the manufacture of oxygen and rare gases; printers, both letterpress 26 and newspapers; furniture makers, joiners and shopfitters; electric welders and galvanisers and sheet metal workers; producers of water softening and conditioning chemicals and horticultural products; works for the manufacture of wireless, aero, vehicle and typewriter accessories. Besides the usual electricity generating stations and gas works, there are cement and stone works, cold meat stores, coal wharves and the inevitable lighterage companies. The numbers actually employed vary from a few hundred to several thousands at the larger factories. Recent efforts by the Government to encourage rationalisation of industry and manufacturing processes throughout the country have met with varying degrees of success. Locally, however, considerable anxiety has grown and great concern expressed in the Borough at the probable economic and social consequences of severe staff reductions in, or the closure of, a number of large industrial premises in the area. Elimination or contraction of firms such as A.E.I., U.G B., Johnson & Phillips, S.E.G.B. (gas processing), Stone-Wallwork, General Steam Navigation, etc., make long term planning of industry and the establishment Of viable residential areas in the Borough (as in the case of "Thamesmead") hazardous undertakings. SUPERFICIAL GEOLOGY Geological formations occurring in the London Borough of Greenwich are of two groups, namely, the "superficial deposits" and the "solid formations". These are given below, seriatim, in descending order and while this holds good for the area as a whole, the complete sequence is not always met with for superficial deposits may be non-existent, local arching of strata and subsequent denudation of the higher parts may have brought to the surface lower members of the succession and, in other cases, a stratum of the sequence may be entirely absent. Where maximum and minimum depths are stated, this implies a true variation of the thickness of the beds in question and, with the exception of the superficial deposits, is not to be ascribed to thinning due to erosion. Superficial deposits in the Borough are distributed over the surface of the "solid formations" and may be considered as being of (a) "made" ground, (b) alluvium, and (c) gravel, the latter deposit being of the Pleistocene or "drift"' series. At some places these deposits fill deep hollows in the surface of the "solid" attaining a maximum thickness of about 70 feet and at others are arranged as banks. More usually they form spreads of comparatively uniform thickness, or remain caps to the higher ground. Situated below these 27 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 alterations of mud or silt, clay, shell marl, peat, sand and gravel, any or all of which may be present, the deposits may lie directly on "solid formations" or on banks of "river terrace gravel". Alluvium components are subject to rapid changes in thicknesses and often arranged in "lens-shaped" masses. Gravels—Although four types of gravel deposits have been distinguished, the most important are the River Gravels which form part of the ancient alluvial deposits of the Thames and its tributaries. These deposits, up to 40 feet in thickness, extend up the sides of the valley from the bed of the Thames and lie on the gentle slopes or series of 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 Claygate Beds—A group of evenly-bedded alternations of fine sands and clays with thicknesses in the range of 50 to 100 feet. At the top of the sequence, seams of clay lie between the thicker beds of sand while at the base, fine laminae of white sand alternate with beds of clay. Within the Borough, a syncline fold running from Mitcham through Crystal Palace to Shooter's Hill brings a vestige of the Claygate Beds to the surface at the latter locality. London Clay—This is a formation of stiff dark grey or bluishgrey clay which when exposed at the surface or underlying "drift" becomes brown in colour due to weathering. The weathering may 28 29 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 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 Woodwich 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 30 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. 31 METEOROLOGICAL OBSERVATIONS—1967 I am indebted to the Director of the National Maritime Museum and, in particular, to Lieutenant-Commander D. W. Waters, R.N., Curator of Navigation and Astronomy, for the following meteorological data for the year ended December, 1967: — Temperature Highest screen temperature 83° on 17th July Lowest screen temperature 19° on 9th December Maximum in January 57° on 29th „ February 56° on 2nd „ November 61° on 11th „ December 57° on 23rd Sunshine TOTAL FOR YEAR 1428.3 hours Sunniest Day 14.1 hours on 9th July Number of Days without sun, 67, distributed as follows :— January 13 July Nil February 7 August 2 March 2 September 5 April 7 October 4 May 3 November 11 June Nil December 13 Rainfall TOTAL 25.36 ins. Highest Fall in 24 hours 1.02 ins. on 25th June Driest Month 1.08 ins. July Wettest Month 3.64 ins. October 32 SECTION II VITAL STATISTICS SUMMARY* Population (mid-year 1967) Total Home Population 231,150 Child Population (under 15 years) 49,900 Elderly Population (over 65 years) 30,090 Density (persons per acre) 19.75 Area Comparability Factors: Births—1.04; Deaths—1.06 Marriages Total 2,066 Greenwich District 719 Woolwich District 1,347 Marriage Rate (persons marrying) 17.94 Births Live Total: 3,600 M F Total Legitimate 1,661 1,573 3,234 Illegitimate 195 171 366 Rate (Crude): 15.62 (Comparable Rate): 16.25 1,856 1,744 3,600 Illegitimate Live Births = 10.1% of all live births Stillbirths Total: 54 M F Total Legitimate 24 24 48 Rate (per Illegitimate 3 3 6 1000 total 27 27 54 births): 14.77 Total of all Live and Stillbirths 3,654 Deaths Total: 2,479 Males 1,267 Rate (Crude): 10.76 Females 1,212 (Comparable Rate): 11.40 Natural Increase (excess of births over deaths) 1,121 Infantile Mortality (deaths of infants under 1 year) Total: 73 Infant Deaths Age Leg. illeg. Total M F M F Under 1 year 35 29 2 7 73 Under 4 wks. 23 19 2 6 50 Under 1 wk. 18 17 2 5 42 Infant Mortality Rates All Infant Deaths (per 1,000 total live births) 20.27 Legitimate Deaths (per 1,000 legitimate live births) 19.78 Illegitimate Deaths (per 1,000 illegitimate live births) 24.59 Neo-Natal Mortality Rate (per 1,000 total live births) 13.88 Early Neo-Natal Mortality Rate (per 1,000 total live births) 11.66 Peri-Natal Mortality Rate (per 1,000 total births) 26.27 Reproductive Wastage (per 1,000 total births) 34.75 Maternal Mortality Total 2 Maternal Mortality Rate (per 1,000 total births) 0.54 Death Rates—Special Causes (per 1,000 population) No. Rate Heart Disease (all forms) 784 3.40 Coronary Disease, Angina 627 2.72 Vascular Lesions of Nervous System 280 1.21 Cancer (all forms excl. Leukaemia) 574 2.49 Lung, Bronchus 190 0.82 Uterus 14 0.06 Cervix 8 0.03 Leukaemia, Aleukaemia 18 0.07 Tuberculosis (all forms) 12 0.05 Pneumonia 178 0.77 Bronchitis 135 0.58 Congenital Malformations 27 0.11 Accidents—Motor Vehicles 32 0.13 Home 10 0.04 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 33 34 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.—Experts have estimated the world's population at the beginning of the Christian era as no more than 2/300 million. It took 16 centuries, i.e. until the Renaissance, to double in size but by 1850 it had reached 1,000 million and by the early 1930s this had risen to 2,000 million. As natural factors such as famine, disease and tribal wars which, in previous times, controlled populations are largely eliminated or substantially reduced it becomes increasingly clear that man is fast developing into the sole arbiter of population densities. As a result, world population is rising rapidly, the yearly increase being in the order of some 65 million (approximately equivalent to the whole population of the United Kingdom) and by the year 2000 it is expected to total some 7,000 million, double the present figure. Between 1967 and 1981, the present population of England and Wales is expected to rise by millions (9%) to almost 53 millions. This accretion is accounted for mainly by increases of 2 millions (17%) in those under 15 years of age and 1 million (15%) in those 35 over retirement age (65 for men and 60 for women). In the working population, however, the rise is anticipated to be no more than 1½ millions (5%). Given the present national rate of growth, there will be at the end of this century some 15 millions (approx. 30%) 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. Moreover, arising from the implementation of the "Thamesmead" scheme, future large-scale immigration may well distort or even reverse national trends in this area for the greater proportion of the prospective residents will be those seconded from the G.L.C.'s Housing List which consists predominantly of younger married couples and their children. Inevitably, long-term planning of general practitioner, maternity and dental services, hospitals, schools and the welfare of infants, the handicapped, elderly people, etc., will be affected. Boundary changes consequent upon the inauguration of the London Borough of Greenwich meant that, for comparative purposes, some adjustment to the combined populations of the old Metropolitan Boroughs of Greenwich and Woolwich had to be made 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, which showed 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 1967, upon which the statistics of this Report have been based. The figure returned is 231,150, indicating a decrease in the population of 440 from that of the previous year but a rise of 900 since the 1961 Census. Natural Increase.—The natural increase for the year, i.e. excess of births over deaths, was 1,121 compared with the figure of 1,155 for the previous year. Emigration! Immigration.—Taking into account a recorded natural increase of 1,121, there is a presumptive emigration from the Borough of 1,561 persons. 36 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. ESTIMATED AGE COMPOSITION OF THE POPULATION As estimated by the RegistrarGeneral : Age No. Approx. % of Total Population {Under 1 year 3,520 1.5 {1 to 4 years (inclusive) 14,380 6.2 {5 to 14 years (inclusive) 32,000 13.8 {Total Child Population under 15 years 49,900 21.5 Estimated locally: {15 to 64 years (inclusive) 150,508 65.2 {65 years and over 30,742 13.3 {Total Population 231,150 100.0 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 112,100 males and 119,050 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 1,050 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. Of the Borough's male residents, almost 10% are over the age of 65 years and women in the same age group form 15.6% of the female population; together they account for 13.3% of the total population. If to these figures are added those women over 60 years of age, then the proportion of retirement persons rises to 16.3%. 37 From details given in the accompanying table it will be seen that the "working" population of Greenwich, i.e. those between 15 and 65 years amounts to approximately 65.2% and that of "dependent" groups collectively, to 34.8%. In effect, this means that for every two persons of "working age" there is one dependent person outside this group. 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. 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 1967. The total of 2,006 gives a marriage rate (i.e. persons marrying) of 17.94, an increase of 1.25 over that of the previous year and is 2.04 in advance of the figure of 15.9 for England and Wales. Greater London returned a rate of 18.43. The following table shows particulars given by the Registrars for the past 3 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 Cireenwich 280 78 23 284 Woolwich 570 114 91 487 1,927 231,590 16.69 1967 Greenwich 291 71 69 288 Woolwich 597 127 79 544 2,066 231,150 17.94 38 In England and Wales during the past 30 years marriages have tended to be contracted earlier, especially among females under the age of 20 years and, although the increase in popularity for young marriages is losing momentum, nevertheless, from 1951 to 1967 the number of wives in this group has risen from 44 to 77 per 1,000. Furthermore, in the age group 15-24 years, the number of married males per 1,000 has risen from 132 in 1961 to 170 in 1967 and married females from 267 to 326. To a large extent these increases may be ascribed to the bulge of population around the age of 20 years arising from the post-war boom in births. For the year 1966 (the latest available), the mean age at marriage for bachelor bridegrooms was 24.88 and for spinster brides 22.54, both exemplifying this tendency for earlier marriage. Marriages in which both bride and bridegroom were under 20 numbered 27,000, 12% more than in 1965 and 50% more than in 1956. Births Fertility is a measure of the rate at which a specific community adds to itself by births. This is usually assessed by relating the number of births to the population of the particular group concerned. i.e. the birth rate, but clearly this is not an accurate calculation of "fertility" since the population figure used contains males and also females outside child-bearing age. However, 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 are of vital importance to governments for the framing of policies in connection with family and other allowances, to hospitals for the provision of adequate and suitable facilities, to local authorities who may wish to plan maternity services, nurseries, schools, housing, etc., and to the Medical Officer of Health who needs to know and to gauge the effect of these variables upon the health of the public, generally. 39 Live births registered in the Borough during the year totalled 4,611 and of this number 3,921 occurred in hospitals and 690 in private dwellings. In 1,733 cases the parents resided outside the Borough and these births were subsequently transferred to their appropriate districts leaving a figure of 2,878. To this must be added 722 births belonging to this Borough which took place in institutions outside the Borough, thus making a final total for Greenwich of 3,600, a decrease of 115 from that calculated for the previous year. Of the total, 1,856 were males and 1,744 females, a proportion of 1,064 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 Registrar's Returns :— 1,065 1,813 2,878 Inward Transfers: — 1st Qtr. 35 136 171 2nd Qtr. 31 144 175 3rd Qtr. 34 157 191 4th Qtr. 39 146 185 TOTALS 1,204 2,396 3,600 The Birth Rate for the year, calculated on the figure of 3,600 live births, is 15.62 per 1,000 of the population, 0.48 lower than that computed for 1966. With an area comparability factor of 1.04, an adjusted rate of 16.25 is returned compared with 17.2, the figure for England and Wales and 15.8 for the Greater London area. Inner London returned an unadjusted rate of 17.7. Illegitimate Births The degree of illegitimacy is usually evaluated by calculating illegitimate births as a percentage of total live births. This is satisfactory for the short term assessment but if the legitimate rate is declining and the illegitimate remains constant, there will be an apparent but not necessarily a real increase in illegitimacy. It would appear generally to be the case that illegitimacy is greatest when social standards, cultural and material, are low and. collectively, factors such as an insecure family life, poor and overcrowded homes, lack of direction and personal drive in life, etc., seem to be implicated. In London, rates tend to be higher than that for the country as a whole possibly by reason of a higher proportion of single females 40 but very probably because of its compelling attraction to pregnant women who find not only anonymity but better facilities in the antenatal, maternity, social and welfare fields. Illegitimate births in Greenwich during the current year numbered 366, equivalent to 10.1% of all live births registered, an increase of I.5% over that for the previous year. In effect, this means that one baby in every ten born of Greenwich residents was illegitimate. Even so, this situation was the most favourable of all the Inner London Boroughs whose average illegitimacy was 15.3%. Figures for the Greater London area and for England and Wales were 11.4% and 8.4% respectively. In each case, the percentage quoted shows an increase over the previous year's figure. 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 14.8. Recent studies instituted by the Medical Research Council, et al, 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 54 (27 males—27 females) which is equivalent to a rate of 14.77 per 1,000 total births, a decrease of 0.86 from that for 1966. Greater London returned a rate of 13.3 and that for Inner London was 13.5. All stillbirths must be registered in accordance with the Registration Service Act of 1953 as amended by the Population (Statistics) Act, 1960, and must be accompanied by a statement as to cause. An investigation of stillbirths occurring to Greenwich residents during 1967 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: — Anoxia 1 Asphyxia 1 Asphyxia placental 1 Congenital malformation 11 Dystocia 1 Haemorrhage—accidental 4 ante partum 2 retro-placenta 1 1 Hydrocephalus 1 Hypertension—acute 1 essential 1 Macerated foetus 5 Placental insufficiency 9 Postmaturity 3 Prolapsed cord 2 Rhesus incompatability 4 Toxaemia—pre-eclamptic 3 Unknown 2 Uterine infection 1 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 Under 4 Wks 4 wks and under 1 year All Causes M 1267 25 12 7 7 13 16 39 98 267 383 400 F 1212 25 11 6 1 6 8 22 64 144 300 625 1 Tuberculosis, Respiratory M 7 — — — — — — 1 1 3 2 F 4 — — — — — — — 1 — — 3 2 Tuberculosis, Other M 1 — — — — — — — — — 1 F — — — — — — — — — — — — 3 Syphilitic Disease M 4 — — — — — — — — — 2 2 F 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 M 2 — — — — — — — 1 1 Diseases F — — — — — — — — — — — — 10 Malignant Neoplasm, Stomach M 41 — — — — — — — 3 11 14 13 F 28 — — — — — — — 2 4 8 14 11 Malignant Neoplasm, Lung, M 139 — — — — — 1 2 15 39 55 27 Bronchus l 51 — — — — — — 3 4 16 21 7 12 Malignant Neoplasm, Breast M — — — — — — — — — — — — F 58 — — — — — — 4 7 18 16 13 13 Malignant Neoplasm, Uterus F 14 — — — — — — — 2 3 3 6 14 Other Malignant and Lymphatic M 124 — — — — — 3 5 12 33 39 32 Neoplasms F 119 — — 1 — 1 1 4 14 20 37 41 15 Leukaemia, Aleukaemia M 8 — — 2 — 1 — — 1 1 1 2 F 10 — — 1 — 1 3 — 1 2 2 16 Diabetes M 5 — — — — — — — — — 4 1 F 10 — — — — — — 1 — — 4 5 17 Vascular Lesions of Nervous M 112 — — — — 1 — 4 6 17 30 54 System F 168 — — — — — — 3 3 17 31 114 18 Coronary Disease, Angina M 362 — — — — — — 15 33 91 111 112 F 265 — — — — — — — 4 30 73 158 19 Hypertension with Heart Disease M 20 — — — — 1 — — 2 3 6 8 F 19 — — — — — — — — 2 8 9 20 Other Heart Diseases M 48 — 1 — — 1 1 2 1 5 16 21 F 70 — — — — — 1 1 5 3 15 45 21 Other Circulatory Disease M 45 — 1 — — — — 2 5 10 13 14 F 60 — — — — — — — 1 8 16 35 22 Influenza M — — — — — — — — — — — — F — — — — — — — — — — — — 23 Pneumonia M 75 1 2 — — 2 2 5 18 45 F 103 — 3 — — — 1 — 1 3 21 74 24 Bronchitis M 92 — 2 — — — — — 5 19 35 31 F 43 1 3 — — — — — 1 3 12 23 25 Other Diseases of Respiratory M 8 — — — — — — — — 3 1 4 System F 8 — 2 — — 1 — — — — 1 4 26 Ulcer of Stomach and Duodenum M 12 — — — — — 1 — — 2 6 3 F 10 — — — — — — — 1 3 6 27 Gastritis, Enteritis and Diarrhoea M 4 — — 1 — — — — — 1 2 F 9 — 1 — — — — — 2 — 1 5 28 Nephritis and Nephrosis M 7 — 1 — — — — — 1 2 3 — F 7 — — — — — — — 2 3 2 29 Hyperplasia of Prostate M 11 — — — — — — — — — 3 8 30 Pregnancy, Childbirth, abortion F 2 — — — — 1 1 — — — — — 31 Congenital Malformations M 15 6 3 2 1 — — — — — 3 — F 12 8 1 1 — — 1 — 1 32 Other defined and ill-defined M 69 18 1 2 3 6 13 10 16 Diseases F 109 16 1 2 4 8 8 18 52 33 Motor Vehicle Accidents M 20 — 2 3 4 1 3 1 2 1 3 F 12 1 1 1 1 3 5 34 All other Accidents M 23 1 1 4 4 2 5 4 2 F 14 — — — — — — 1 3 2 4 4 35 Suicide M 11 — 1 3 2 4 1 — F 6 — 2 1 2 1 — — 36 Homicide and Operations of War M 2 1 1 F — — — — — — — — — — — — 41 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. 1.06, 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 1967 was 2,479, of which 1,267 were males and 1,212 females, compared with last year's total of 2,560. This gives a crude Death Rate for the Borough of 10.76 per 1,000 of the population, representing a decrease of 0.33 from that calculated for the previous year. When the area comparability factor is taken into account the rate is increased to 11.4 for comparative purposes. The comparable Death Rates for Greater London and for England and Wales are 10.9 and 11.2 respectively. Inner London returned a crude Death Rate of 11.0. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of. and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. Age Mortality The age mortality and the distribution of the deaths between the different quarters of the year are shown by the following table: — 42 Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 23 19 18 13 73 Between 1 and 2 years — 2 2 1 5 Between 2 and 5 years 1 2 4 1 8 Between 5 and 15 years 2 3 1 2 8 Between 15 and 25 years 9 5 1 4 19 Between 25 and 35 years 7 8 4 5 24 Between 35 and 45 years 18 18 12 13 61 Between 45 and 55 years 42 39 36 45 162 Between 55 and 65 years 104 101 92 114 411 Between 65 and 75 years 188 178 146 171 683 75 years and upwards 255 240 228 302 1,025 TOTALS 649 615 544 671 2,479 Of the four quarters, the fourth registered the highest proportion of the year's total deaths and the third the lowest, viz. 27.0% and 21.9% respectively. It will be observed from the following table that, during 1967 the deaths in the age group 0-5 years accounted for 3.4% and that of the "over 65's" 68.9% of the year's total. Figures for the previous two years are given for comparative purposes. Age Group 1965 1966 1967 Under 1 year of age 80 68 73 Between 1 and 5 years 5 10 13 Between 5 and 15 years 8 16 8 Between 15 and 25 years 24 24 19 Between 25 and 65 years 719 676 658 65 years and over 1,708 1,766 1,708 Totals 2,544 2,560 2,479 Deaths in Institutions The following table gives the number of deaths of Greenwich residents in Public Institutions during the last three years: — 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 1967 2,479 1,844 74.3 43 Maternal Mortality Statistically, maternal deaths should be related to all those women who are pregnant during the period of the review. However, as this is impractical (for miscarriages are not registerable and many pregnancies are terminated unbeknown to the authorities), the extent of maternal mortality is measured against the total of live and stillbirths which gives a reasonably accurate basis for enumerating pregnancies during the interval of assessment. Maternal mortality is 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 infection. Two maternal deaths were recorded during the current year giving a maternal death rate of 0.54 per 1,000 total births compared with a figure of 0.26 for 1966. Of the two deaths recorded, one, aged 20 years, was the result of "sub-arachnoid haemorrhage—toxaemia of pregnancy" and the other, aged 26 years, was attributed to "acute cardiac failure—prolonged labour (54 hours)—dystocia". The rates returned for England and Wales and Greater London were 0.20 and 0.33 respectively, while Inner London registered a rate of 0.45. 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 fluctuations in the rate and only a long term appraisal is likely to reflect the true position. 44 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 20.27 and 73. 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. During the current year, 68.5% of all infant deaths occurred during the neonatal period, indicating a somewhat disconcerting proportional increase of 1.6% since 1948. Early neonatal deaths, i.e. those taking place during the first week of birth, when similarly calculated, are equally disturbing, the percentage rising from 54.2 to 57.5. My previous Reports have indicated the relationship existing between age, social class, parity, bad obstetric history, previous abortions, premature and still births, postmaturity, etc., and perinatal mortality and the effects which institutional and domiciliary maternity and midwifery services have had on its reduction. However, it is becoming increasingly obvious that methods which brought about such spectacular successes in reducing infant mortality in previous years will not suffice to subjugate the seemingly intractable problems of perinatal deaths. Whilst not discarding former effective procedures we must be alive to the fact that these early deaths arise mainly from prematurity, congenital malformation, inherited metabolic disease and the possible teratogenic effects in early pregnancy of virus infections, 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 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 45 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. Moreover, familial patterns can be traced and the giving of advice and the suggestion as to suitable action to be followed have now become practicable propositions. It is conceivable that one of the future roles of local authorities' health departments could be the establishment of "genetic clinics" where investigations would be instigated and prospective parents counselled accordingly. Actual infant deaths recorded during the year were 73 (5 more than last year) comprising 37 males and 36 females of which 69 occurred in hospital and 4 at home. The following table shows the causes of and ages at death : INFANTILE MORTALITY DURING THE YEAR 1967 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 Accidental (restriction of neck during resuscitation) - - - - - - 1 - - 1 Asphyxia neonatorum 1 1 1 Atelectasis 1 — — — 1 — — — — 1 Birth trauma 2 1 — — 3 — — — — 3 Bronchiolitis — — — — — — 1 — — 1 Bronchitis - acute — — — — — — 1 — — 1 - acute tracheo — 1 — — 1 1 2 — — 4 Bronchopneumonia — — — — — 2 3 — — 5 Congenital abnormalities 7 2 1 — 10 1 — — 1 12 Edwards Syndrome — 1 — — 1 — — — — 1 Gastro-enteritis — — — — — 1 — — — 1 Haemolytic Disease of Newborn (Rh incompatability) 1 — — — 1 — — — — 1 Hydrocephalus — — — — — 1 — 1 — 2 Intra-pulmonary haemorrhage 1 — — — 1 — — — — 1 Myocarditis - operation — — — — — — — — 1 1 Patent ductus arteriosus — — — — — 1 — — — 1 Pneumonia — 1 — — 1 1 — — — 2 Prematurity 23 — — — 23 1 — — — 24 Renal failure — — — — — 1 — — — 1 Respiratory Distress Syndrome 4 — — — 4 — — — — 4 Rhabdomyoma 1 — — — 1 — — — — 1 Sugar imbalance - intestinal — — — — — 1 — — — 1 Superior v. caval congestion — — — — — — 1 — — | Supra-renal haematoma 1 — — — 1 — — — — 1 Volvulus — 1 — — 1 — — — — 1 TOTALS 42 7 1 50 11 9 1 2 73 Males 37 Females 36 46 Respiratory complaints and pneumonia cause approximately 20% of all deaths occurring in children under 12 months of age. To a large extent this is due to the fact that isolation of a causal organism can take anything up to 30 days. A new diagnostic technique, based on fluoroscopic analysis, enabling the detection and diagnosis of respiratory syncytial virus within a few hours has been perfected recently in Newcastle. Such a breakthrough is likely to save countless infant lives and may well prove to be a major success in the fight to reduce infantile mortality. Clearly, substantial reductions in present infant death rates will come only by the practical application of modern scientific knowledge, 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. The present infant mortality rate for the Borough, viz., 20.27, is an increase of 1.97 over that for the previous year with rates of 18.3 and 18.4 being returned for England and Wales and Greater London respectively. Inner London recorded a rate of 19.8. 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 50 deaths, equivalent to 68.5% of all infant deaths and giving a Neonatal Mortality Rate of 13.88 per 1,000 live births. This rate is 2.28 more than that calculated for the previous year and is slightly less favourable than the figure of 12.9 for Greater London and that returned for England and Wales, namely, 12.5. Inner London registered a rate of 13.5. Early Neonatal Mortality.—Forty-two infant deaths occurring during the first week of birth gives an Early Neonatal Mortality Rate of 11.66 per 1,000 live births compared with rates of 11.1 for Greater London and 10.7 for England and Wales. The comparable figure for Inner London was 11.5. 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 54 stillbirths and 42 deaths of infants under 1 week, was 26.27 per 1,000 total births, showing a rise of 0.57 over that for 1966. The equivalent rate for England and Wales is 25.4 and that for Greater London, 24.2. Inner London recorded a rate of 24.9. Reproductive Wastage.—A sum total of 127 stillbirths and infantile deaths gives a Reproductive Wastage Rate of 34.75 per 1,000 total births, an increase of 1.15 over that calculated for the previous year. Figures for England and Wales and Greater London are 32.9 and 31.6 respectively. 47 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, 1965, 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 pause of death is taken from one or more causes as stated on the medical certificate in accordance with the rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying practitioner. This enables his department to modify the original classification— hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar-General. General Following the general trend throughout the country, there was a slight decrease of 3.1% in the total number of deaths of Borough residents during 1967. Decreases in Greater London and England and Wales were 3.1% and 3.7% respectively. Little change was manifest when comparing the total number of deaths in 1967 with those of the previous year but there were a number of changes in cause distribution. Mainly as a result of an increase in deaths from congenital malformations, infant mortality showed a rise of over 7%. There was an advance of 14% in motor vehicle accidents but suicides showed a decline of almost 30%. Statistically the variations seem substantial but, in these instances, actual numbers are small leading to wide and probably only temporary fluctuations. Decreases were recorded in respect of Vascular Lesions of the Nervous System (11%), Heart Disease (4%), Pneumonia (almost 25%) and Bronchitis (over 9%) but, contrarywise. Cancer (all forms) experienced a rise of over 7% mainly as the result of an increase of 21.8% in Lung Cancer and an advance of the order of 20% in Carcinoma of the Breast. Leukaemia sustained an 48 increase of 80% but as the actual number of deaths was small the change is probably of no significance although the trend will need to be watched. Heart Disease Cardiovascular and atherosclerotic diseases as a group constitute the greatest possible challenge to preventive medicine. Each week, on an average, over 2,200 people in England and Wales die from coronary disease and the incidence is increasing, particularly in the case of the middle-aged male. In fact, in males between the ages of 25 and 45 years, the rate of heart attack has more than doubled during the past decade. Curiously, coronary disease in a woman before the age of 45 years is uncommon and it would seem that, during her child-bearing epoch, her hormones give her a "built-in" protection. Recognised as the principal "killer" complaint of modern times, this classification, covering as it does, (a) coronary disease, angina, (b) hypertension with heart disease and (c) other heart disease, was responsible for 784 deaths (430 males and 354 females) during the current year. This total, which was a decrease of 34 from that of the previous year, formed 31.6% of the total of deaths from all causes and gives a rate of 3.40 per 1,000 of the population. The rate for 1966 was 3.54. Deaths in the Borough from coronary disease alone accounted for 627 (362 males and 265 females), a rise of 1.6%. The increase was mainly evident in females over 75 years. Compared with figures of 2.38 and 2.30 for England and Wales and Greater London respectively, the Borough rate was slightly less favourable at 2.72. Vascular Lesions of Nervous System Under this classification, which includes cerebral haemorrhage, embolism and thrombosis, some 280 deaths were recorded during 1967, a decrease of over 11% from the previous year which had been an increase of 7.1% over the 1966 figure. Of the present total, 168 were females and, apart from coronary disease, this constituted the main cause of deaths in females during the year although 114 (68%) occurred in women over the age of 75 years and only 6 in females under 55 (3.5%). Cancer Second only to heart disease as the principal cause of death in the community, this disease, which has so many psychological connotations not met with in other diseases, claimed 592 victims during the year under review, an advance of 47 over those recorded during 1966. 49 With the exception of Cancer of the Uterus, deaths from which remained unaltered, and those for Other Forms of Cancer which showed a reduction of 2.4%, figures for cancer of other sites registered increases. Indeed, a total of 190 deaths indicated a rise of 34 (almost 22%) in Lung Cancer, mainly as a result of the doubling of the incidence in females to an aggregate of 51, while an almost similar increase was witnessed in Cancer of the Breast, viz. 21% to 58 and Leukaemia deaths jumped from 10 to 18 to record a disturbing advance of 80%. The total of 592 cancer deaths was equivalent to 23.9% 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 41 28 69 0.29 „ „ lung, bronchus 139 51 190 0.82 „ „ breast 58 58 0.25 „ „ uterus 14† 14 0.06 „ „ other forms 124 119 243 1.05 Leukaemia 8 10 18 0.07 Totals 312 280 592 2.54 * 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. 28,250 indicates that not only has the annual rise of 2% been more than maintained (the 1967 figure is 4.5%) but that the total, which shows an increase of 60% over the last decade, gives a national rate of 0.58. Figures for Greater London, which has consistently returned a high rate from this cause, follow the national pattern and a current rate of 0.73 is returned compared with the Borough rate of 0.82. A reduction of 15% in lung cancer deaths of residents during 1966 defies explanation but the current year's figure is even less favourable than that returned for 1965. Although death rates throughout the country 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. In Greenwich, however, the rate in women rose from 0.20 per 1,000 in 1966 to 0.42 in 1967 and the ratio of male to female deaths from this cause is less than 3 to 1. This rapid increase was confined to women over 55 years of age. 50 Lung Cancer.—In recent years there has been a marked rise in the incidence of cancer of the lung and the following table has been included in order that the trend in this Borough may be studied:— DEATHS FROM CANCER OF LUNG (including Bronchogenic Carcinoma) Year AGE GROUPS Totals Grand Total Rate per 1,000 Pop. 25 and under 35 yrs. 35 and under 45 yrs. 45 and under 55 yrs. 55 and under 65 yrs. 65 and under 75 yrs. 75 yrs. and upwards M F M F M F M F M F M F M F 1965 — — 2 3 16 7 47 10 59 9 23 8 147 37 184 0.79 1966 — — 6 3 17 6 44 5 46 4 19 6 132 24 156 0.68 1967 1 — 2 3 15 4 39 16 55 21 27 7 139 51 190 0.82 Pneumonia There were six children under one year of age and 158 persons over 65 years in a total of 178 deaths from pneumonia registered during 1967. The total, which consisted of 75 males and 103 females, showed a decrease of 59 from that of the previous year indicating a fall of 25%. Compared with rates of 0.68 and 0.78 for England and Wales and Greater London respectively, the Borough returned a rate of 0.77 which was 0.26 less than that for 1966. In each case the rate was somewhat lower than formerly. Bronchitis During the current year, Greenwich had a total of 135 bronchitis deaths, 92 males and 43 females, giving a rate of 0.58 compared with that of 0.59 both for Greater London and for England and Wales. The Greenwich total indicated a decrease of over 9% but there were 6 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 12, producing a rate of 0.05 per 1,000 population. Of the deaths registered, 8 were males and 4 females, one of the former being of the non-pulmonary type. The comparable rate for England and Wales was 0.04 and that returned for Greater London, 0.05. 51 Violent Deaths As a classification, the term "violent death" includes those deaths arising from motor vehicle accidents, suicide, homicide and "other forms" of accident. During 1967 there were 88 deaths from violence in the Borough, giving a rate of 0.38 per 1,000 population compared with a rate of 0.49 for England and Wales and 0.43 for Greater London. Motor Vehicle Accidents.—Road accidents, which are now the commonest cause of death in adolescents and young adults, were responsible for 7,160 deaths in England and Wales during the year. This represents a 4% improvement over the previous year when the total was 7,454. Justifiably, much has been made of the serious nature of the increase in deaths from cancer and heart disease but it must be recognised that, from a national and economic standpoint, a child who is killed in a road accident is a greater potential loss to the community than a person over 65 years who dies from either of the other causes. Thirty-two persons in the Borough died from motor vehicle accidents during 1967, an increase of 4 over those recorded for the previous year. The calculated rate of 0.13 compares with 0.15 and 0.12, the rates 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 1967 amounted to the formidable figure of 4,712, giving a rate of 0.10 per 1,000 population. Moreover, of this total, more than one fifth, viz. 962, were recorded in London, giving a rate of 0.12 compared with 17 deaths and a rate of 0.07 for Greenwich. 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 equal to the total deaths from road accidents. Homicide.—Two deaths were recorded during the year, both as a result of stab wounds. One, a youth of 19, died after being stabbed in the chest and the other, a man of 32 years, who suffered abdominal injuries. A conviction for murder was subsequently obtained in the latter case. All Other Accidents.—The remaining deaths from violence in the Borough, viz. 37, give a rate of 0.16 per 1,000 population which 52 compares favourably with the rate of 0.24 for England and Wales and that of 0.19 for Greater London. Home accidents were responsible for 10 deaths, a reduction of 44% from the previous year, giving a Borough rate of 0.04 per 1,000 population. Among these were 2 deaths from carbon monoxide poisoning, 4 from falls, 2 from burns, 1 from poisoning and 1 arising from constriction of neck during attempted resuscitation of a child of 3 months. 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. However, the death in hospital of a female child under one year, was recorded as gastro-enteritis, the organisms implicated being E.Coli and Ps. pyocyanea septicaemia. 53 SECTION III PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Over the years, preventive medicine has made a considerable contribution towards improving the expectation of life at birth. Indeed, during the last 150 years, prodigious efforts have doubled this figure to almost 70 years for males and 75 for females. But what of the life-span itself which, in developed countries, averages 75 years for men and 80 for women? Surprisingly, these figures do not differ substantially from those set in the Bible some 2,000 years ago, viz. three score years and ten. If longevity has not been materially altered then advantages accruing from medical and scientific progress ought to be reflected in living conditions for, altruistically, it should be the aim of every generation to add quality to the life which is inherited. Medically speaking, however, we still live in a community where one man in every four is a bronchitic, one in every four dies from neoplastic disease (over one third of these from lung cancer), more than one in four from coronary occlusion and where one woman in every four is attending a medical practitioner. This can hardly be the Utopia for which men strive. However, if extension of man's life-span is to be strictly limited then, in the not-too-distant future, by reducing all mortality factors it should be possible to defer the onset of old age and to increase not only the period but the vigour of adulthood. In this respect, much will depend upon even closer co-operation between Medical Officers of Health and the Director of the Public Health Laboratory Service in the epidemiological control of communicable diseases and between these departments and the research and hospital services for diseases other than infectious. Particularly with regard to infectious disease, previous successes of preventive medicine in which chemotherapy has played a not inconsiderable part, have been gained largely with those "environmentally determined" and, former "killer" diseases such as smallpox, diphtheria, tuberculosis, diarrhoea, etc., are no longer the menaces of yesteryear. Even so, not enough is yet known about infection-producing bacteria and viruses and their versatility for mutation when under attack but immunology, as a practical science, is daily growing in stature. Our potential future ability to synthesize antibodies free 54 from the reactions and allergies so prevalent today amply justifies a prediction that the next two decades will see the virtual disappearance of communicable diseases as we now know them. During this period, we will come to understand more fully the principle by which our immune system works and thereby we shall be able to use it to the benefit of individuals in ways which, at present, we can only conjecture. Whilst maintaining prevention of the environmental diseases, our future efforts towards reducing morbidity are likely to be directed not only to those overt "genetically determined" diseases and the abiotrophies such as Huntington's chorea, familial polyposis, acholuric jaundice, etc., but also to a number of the more common complaints which now appear to be involved with genetic factors. If diagnosis is made early enough, there is scope for treatment in those diseases where gene mutation is implicated and a reduction in the number of children born with such conditions is possible if genetic counselling is encouraged. By applying special prophylactic measures, prevention is possible in cases where there is a genetic predisposition, i.e., diseases of mixed genetic and environmental origin such as diabetes, duodenal ulcer, rheumatic fever and schizophrenia which depend upon the cumulative effects of many genes interacting with an environmental "trigger". It is unfortunate but incontrovertible that health, be it individual or communal, is seldom appreciated until it is lost. Only then is the individual or community prepared to put some credence in the truism that "prevention is better than cure". However, in the euphoria engendered by the restoration of normal conditions, such belief appears to vanish overnight and preventive medicine is again afforded its usual unspectacular and unglamourised role. This established role of local authority health departments, so vital and so carefully nurtured and shaped over many years by painstaking dedication, education and sheer application, could be threatened by present incipient reorganisations both real and rumoured. It would be a tragedy if such "expertise" and accumulated knowledge were to be dissipated merely for transient administrative convenience or change introduced for "change's sake". 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. 55 Although W.H.O. regards alcoholism as the fourth most important problem in the world today, this country can scarcely consider itself in the "van" with regard to its approach to the treatment and eradication of alcoholism. Hitherto, by leaving alcoholism mainly in the hands of reformers and moralists, the medical profession as a whole has forfeited an opportunity to clarify the aetiology and render the problem less intractable. In a survey report "Alcoholism in Industry" issued by a consortium of charities connected with rehabilitation of alcoholics, it was estimated that working time lost by people whose drinking problems were known to their employers costs the country £24 million per year. Investigations covered by the report revealed that, on an average, the alcoholic lost 86 days per year because of drinking and only 1.5% had not lost time during the previous year because of their problem. Some 40% admitted missing a Monday morning's work once or twice a month and 38% of the cases interviewed had been dismissed during the previous year because of their drinking habits. A substantial number (76%) considered that promotion had been denied them because of their drinking and 11% thought that this was the cause of an accident sometime during the previous year. Locally, a survey among 247 firms in a neighbouring borough revealed that 3.45 men per 1,000 and 0.19 women per 1,000 were alcoholics known to their employers. If this were repeated nationally it would mean a total of 57,750 men and 900 women with known drinking problems in industry. However, because alcoholics, generally, are particularly adept at hiding their problems, these figures must substantially understate the position. Apart from all the medical and social implications, such evidence suggests that alcoholism is a serious industrial disease warranting immediate attention. Meanwhile, voluntary endeavour would seem to be worthy of greater central and local government support. Cancer We have moved some way from the concept that cancer is a single disease. Over recent years our laboratory, clinical and epidemiological researchers have demonstrated that there are numerous and varied cancers among which only the industrial types are, at the moment, subject to primary prevention. Nevertheless, the ultimate control of cancer must be based on prevention. If preventive action is to be effective, it must take account of all the accumulated knowledge concerning neoplastic disease and the causative factors, where known, and apply them in such practical ways as will produce the maximum impact on the public. 56 Our main approach to cancer prevention is limited, at present, to educating the public into recognising, at an early stage, signs and symptoms and, in the case of cervical and breast cancers, into using the established screening clinics. In this context, exfoliative cytology would appear to be the next logical step in the detection of bronchial carcinoma. Some doubt has been cast upon the practica bility of specific regular medical examinations and the fact that these tend to reveal previously undetected disease, but, under present circumstances, such methods must be considered to have a place in the sphere of prevention. Greater attention needs to be given to ensuring that people not only receive the most up-to-date information about various cancers but also the best methods of avoiding exposure to such hazards. Environmentally, these risks are to be found in nutrition, foods, cosmetics, pharmaceutical products, trauma, viruses, tobacco smoking, atmospheric pollution, etc., many of which are obviously avoidable now, thus indicating that man already has some control over whether he does or does not develop certain cancers. Knowledge concerning genetic and hormonal influences in the generation of cancers is being constantly expanded but there may well be difficulties in applying it in a practical preventive way. In my 1966 Report, I summarised the current authoritative views and hypotheses regarding the causes of cancer upon which preventive measures must depend for their orientation and these do not need reiteration. However, it is interesting to record that, more recently, new evidence has been accumulated suggesting that at least some of the human cancers are induced by viruses. A herpes-type virus cultivated from a Burkitt's lymphoma has induced infectious mononucleosis in a human being with an increase in antiviral antibody compared with normal levels. It is postulated that, although this type of viral infection was common, resulting disease was rare; moreover, the fact that higher than normal levels of antibody have been found in patients with Burkitt's lymphoma, Hodgkin's disease, lymphosarcoma, leukaemia and selected solid tumours merely strengthens this contention and brings the prospective use of anticancer vaccines a little nearer. It would seem that causes of many cancers are likely to be revealed during the next two decades and that preventive measures will thereby become much more effective. Childhood Cancers—Survey—During the current year cooperation 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 57 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 1967 there were four 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. 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. 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. It has been estimated that, to relieve the existing staggering and exorbitant burden of dental disease, this country needs one dentist to every 2,000 people. At present, the population/dentist ratio is 3,200:1 but if, as is anticipated, our population rises to 75 millions by 2000 A.D. and the number of dentists increases at the same rate as during the last 30 years, then the ratio will deteriorate to 3,750:1. A population increase of the scale mentioned will have serious consequences on our dental health services for it is certain that, despite every effort, the desired population/dentist ratio is unlikely to be achieved in the foreseeable future. It seems that fluoridation is the one factor which can help to ameliorate the situation and because this takes a number of years for its full benefits to become apparent in the community this becomes not only a social but an extremely urgent necessity. 58 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. Drug Addiction 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. By 31st March, 1968, the number of drug addicts reported to the Central Authority under the procedure of the Dangerous Drugs Act, 1967, was 1,608 but the number known by the Home Secretary to be dependent upon narcotics was 1,729, an increase of more than 28% over the previous year. These numbers, although relatively small in comparison with total population, have almost trebled since 1947 but what is most disturbing is that they are now rising steeply. Those on "hard" drugs are located mainly in the London area although within the past two or three years there has been a noticeable movement of some of these to large provincial cities. 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. 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. Under the Dangerous Drugs (Notification of Addicts) Regulations, 1968, operative from 22nd February, medical practitioners are charged with the duty of forwarding to the Chief Medical Officer at the Home Office, certain particulars relating to persons on whom they attend and consider to be addicted. There is no statutory obligation on the part of a doctor to notify nor to take any action in connection with a known or suspected case of drug addiction which has been reported to him by someone else. So far, there are no arrangements for the Medical Officer of Health to be notified of cases living within his area of control. 59 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, medical, social or environmental should be discovered and remedied or rectified. A drug addict may be defined as a person regularly using centrally-acting drugs to which he has become tolerant and of which he requires increasing amounts and without which he exhibits an uncontrollable desire. In most cases there seems to be a progression from cannabis through the "soft" drugs such as amphetamines to the "hard" drugs like heroin and cocaine. Socially, this progression is paralleled by a corresponding movement away from regular employment through casual jobs on to unemployment, from a peaceful home life to increasing family friction and a move into "peer" group living eventually descending to a state of vagrancy. It is conceded that the aetiology of drug addiction is based on either individual or social pathology and these can be divided roughly into two groups. Those with middle-class backgrounds who have intellectual and artistic ambitions but who are essentially "drop-outs" and those from "twilight" areas where social amenities are poor or non-existent and where the inhabitants have suffered deprivation in the past. To these, one can add those whose parents have been re-housed en bloc to new towns or sites on the outskirts of London. Following recommendations made by the Brain Committee and in an effort to contain the spread of addiction, in London, facilities have been made available at 11 hospitals eventually for about 1,000 addicts to receive either "in-patient" or "out-patient" treatment. This scheme is in its early infancy but it would seem that the majority of those seeking treatment have been convicted or expect to be charged with a minor offence and their attendance at clinics is usually a defensive effort designed to mitigate police action. Management of the addicts aims at (a) emergency treatment— which tends to be mainly medical rather than social and arises from complications such as serum hepatitis or septic conditions resulting from the use of dirty syringes and needles, (b) regular normal treatment, (c) maintenance treatment and finally, (d) rehabilitation. With regard to rehabilitation and after-care of addicts the Minister has been advised by the Committee on Drug Dependence that, so far as London is concerned, there is a need for 4 hostels (3 male and 1 female) for patients who have completed "in-patient" treatment and 2 further hostels (one for each sex) for homeless addicts attending "out-patient" clinics. It is suggested that each hostel should accommodate up to 12 persons. 60 As stated in previous Reports, 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 against its appearance locally. Heart Disease Again following the national trend, diseases of the heart were responsible for nearly 32% of all deaths in the Borough during 1967 and, when taken in conjunction with circulatory disease, the percentage rises to almost 36. 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. Nearly three quarters of all deaths in the Borough from heart disease resulted from coronary insufficiency and, of these, 60% occurred in males of whom nearly two fifths died before reaching the age of 65 years. Coronary occlusion is responsible not only for physical damage but also for the psychological chaos which often accompanies the victim's attack; personally, because he is anxious and afraid that a second attack would be fatal and, family wise, because his spouse, who considers herself the custodian of the family's health, feels in some way responsible and therefore harbours a guilty complex. 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 connection 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. One of these concerns the intake of saturated fats which, with excess carbohydrates, is being reliably linked with ischaemic heart disease. Chances of angina were doubled in people who were 61 30% overweight while the risk of myocardial infarction was trebled in those who were 20% over average. Other aspects which have a bearing on heart disability are 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, ft 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. Fluoridation of water supplies would appear to have no relationship with heart disability but 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. Infective Hepatitis Infective hepatitis, which is transmitted mostly by person to person contact but which may also be passed on parenterally like serum hepatitis, has an incubation period of, usually, from 15 to 40 days. A common source of spread is via communities of children who may infect susceptible adults in their households. Water and food outbreaks are rare. Cases of both serum and infective hepatitis have been reported in connection with intermittent haemodialysis for the treatment of chronic renal failure. It was suggested in my 1965 Report that viral hepatitis should be made the subject of official notification throughout the country in order that more precise information could be obtained concerning its epidemiological background thus enabling the introduction of effective measures to prevent its dissipation. An increase in drug addiction has tended to focus attention on the transmission of infective hepatitis by contaminated syringes and needles and, conversely, drug addiction has been revealed by the occurrence of infective hepatitis. 62 The following table gives information concerning the 19 cases of infective hepatitis which were brought to the notice of this department during the current year :— 9 cases (one non-resident) removed into hospital. 2 cases notified by Army Authorities (Royal Herbert hospital). 2 cases (one family) removed to hospital but sent home for nursing. 6 cases traced via School Reports. There is every reason for believing that this disease will be made compulsorily notifiable during 1968. 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 introduction of the Mental Health Act, 1959, and mental illness is now afforded the same status as other illnesses. There appears to be some inconsistency in the fact that although various agencies have stated that one person in nine spends some time in a mental hospital and that one in three patients seen by general practitioners had a neurotic illness, mental illness itself defies accurate definition. Furthermore, could it be that with the changing role of workhouses into hospitals following the introduction in 1946 of the National Health Service Act with the consequent redistribution of their inmates has resulted in a statistical distortion? 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 subnormal. 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. Such a high incidence presents us with a problem of some magnitude and urgency which demands appropriate efforts to reduce it. Clearly prevention, if made possible, would bring in its train enormous advantages not the least of which would be the release 63 of the great physical and financial burden now being shouldered by the hospital and local authority services. 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. However, the establishment of "genetic clinics" would seem to be one logical step which could quickly reduce the numbers requiring supportive services. Elimination of brain damage in the newborn—perinatal as well as congenital—would be a further 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. Causes of mental retardation were often difficult to isolate except in cases resulting from infection such as encephalitis which, in theory at least, should be preventable. Prompt relief of hypoxia and modern methods of resuscitation in respiratory distress in the maternity unit, the regular monitoring of bilirubin in the newborn, routine screening (preferably by blood testing) for phenylketonuria and galactosaemia were all avenues open particularly to the paediatrician in the quest for prevention. A comparatively novel aspect of mental disability is to be found in drug addiction which, unless controlled, is certain to add its quota of psychotics and schizophrenics to the ever-growing number of smokers, insomniacs and neurotics, etc., whose illnesses are considered to be psychiatric. Human evolution itself, which is the adaptation of an individual to its environment, may also be implicated in the production of neuroses found in families which, having for several generations adapted themselves to a particular society, are compulsorily removed to an entirely different area and environment. Mental impairment which is frequently met with in elderly people could, to a large extent, be prevented by regular surveillance. In geriatric cases a great deal of dementia arises from isolation and loneliness following loss of relatives or friends, from "unreported" illness, from compulsory retirement or financial difficulties and very often from malnutrition resulting from the "tea, bread and butter" diet. 64 Some mental instability is precipitated by institutional care which many old people view with trepidation. In their minds it represents their last move, it robs them of their independence, it makes all decisions for them and usurps their responsibility and they have nothing to live for and so lapse into apathy. Fortunately, this attitude and type of welfare home is rapidly changing. Co-ordinated local authority services have a vital part to play in relieving mental illness which has so many facets and which demands so much from so many professions and skills in its prevention. Respiratory Infections Very naturally, the "glamour" of heart, kidney and liver transplants have taken the "limelight" in medicine but this must not blind us to the more mundane but equally important problems such as respiratory disease. Patients who may benefit from such radical surgery are limited and the number small in comparison with those who would obtain a fuller life if respiratory disease could be substantially reduced. Examples of national mortality arising from chest diseases during the current year are, Lung Cancer 28,252 deaths Pneumonia 32,657 „ Bronchitis 27,811 „ Respiratory Tuberculosis 1,798 Other Respiratory Diseases 5,016 and the total shows that almost one in every five deaths (18%) throughout the country resulted from respiratory trouble. The comparable figure for Greenwich, viz. 21.4% is even less favourable. Moreover, mortality figures in themselves are less than half the picture for they give not the slightest indication of the disability occasioned by these respiratory diseases. The tragedy of the situation is that the bulk of these deaths and the permanent disability so often preceding them are the direct or indirect results of cigarette smoking, the elimination of which could reduce the enormous physical and financial burden being carried by the country's medical and welfare services. Assimilation into the circulatory system of oxygen, that indispensable commodity without which life is impossible, can be effected only by means of the lungs and yet the defiling of these organs on such a large scale merely demonstrates a human capacity for self-immolation. Bronchitis, an almost inevitable concomitant of tobacco smoking, alone is responsible for the loss of over 30 million working days per year and is the commonest reason for seeking medical advice, there 65 being over 26 consultations per 1,000 patients per year. Progress of this disease is insidious with a gradual loss of respiratory efficiency and by the time a patient is compelled to seek medical assistance, the lung damage is often severe and irreversible. Lung cancer and bronchitis are more frequent in towns and cities than in rural areas and this suggests that some additional factor is present in the conurbations. Atmospheric pollution is an undeniable environmental hazard in the production of respiratory disease and this was amply demonstrated 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. Asthma, hitherto not considered a respiratory disease, is one of the disorders about which we know very little and which has not had the attention it warrants, although the introduction of the new steroid drugs into its treatment has saved many lives. Previously, we had considered that relief of spasm, sufficient to re-establish normal lung ventilation, was all that was needed but we are now learning that the removal of airway obstruction does not automatically enable more oxygen to be taken up by the blood. It has been found that it takes a matter of days for blood oxygenation to become normal. Without reducing "allergy" research it seems that we must get to know more about "lung functions" and its complex blood supply before we can control this disabling malady which creates so much misery and disablement. Many other respiratory infections defy identification but, today, some of these are known to be caused by a pleuropneumonia-like 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. But when, despite thorough investigation, many chest infections remain unidentified, preventive measures inevitably become circumscribed. Venereal Diseases The term "venereal" is given to a group of diseases acquired during sexual intercourse of which, in England, syphilis and gonorrhoea are the most common. Other complaints, usually acquired sexually, such as non-gonococcal urethritis and trichomonal infection have recently been taking progressively more of the venereologist'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. 66 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. In bygone days many children who survived these hazards suffered from congenital syphilis which gave rise to mental deficiency, blindness and deafness but, with modern preventive methods, this problem is minimal in England today. 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. 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 anti-biotic 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. 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 67 ally applied preventive policy. This is particularly so in respect of the venereal diseases. In Sweden, an acknowledged advanced country medically, there was recently instituted under control conditions, an investigation into venereal disease in its capital Stockholm. Among those patients with venereal disease some 15/20% had been previously infected and 70% of boys aged 16 to 17 years along with 43% of girls of a similar age had had seven or more sexual partners by the age of 17. Moreover, 85% of the boys and 72% of the girls had had their first sexual experience at the age of 15 years or under. At a recent meeting in London of the Medical Society for the Study of Venereal Diseases, Dr. Gustaven said he regarded these persons as the "rule breakers" and this contention was supported by the fact that significantly more of those who had had many partners had been involved in burglary, petty thefts, fights or had had brushes with the police. Another significant fact revealed by this social pathology exercise was that twice as many of those with venereal disease had taken drugs as in the control group. New cases of primary and secondary syphilis during 1967 in England and Wales at 1,321 (1,075 males and 246 females) showed a slight reduction from those of the previous year, viz. 1,374 (1,132 males and 242 females), the improvement being mainly in males. Current figures for the Inner London Boroughs were 679 males and 105 females compared with the 1966 totals of 749 and 148 respectively. Such reductions, though small, are an indication that even in today's permissive society where many consider extramarital sexual activity normal, control is possible but it requires constant vigilance. Conversely, gonorrhoea cases reported during the year in England and Wales rose by 11.6% to 41,829, the highest total since 1946. Cases of vulvo-vaginitis in children (77) which showed an increase of 7 over the previous year and gonococcal ophthalmia which rose by 6 to a total of 41 are admittedly small in numbers but they are disturbing. Since 1951, non-gonococcal urethritis in males has increased each year and the 1967 figure of 32,318 cases is an advance of 6% over the 1966 total. This persistent increase reveals an intractable problem which, on occasions, produces serious complications to joints and eyes. Modern methods of contraception, being non-mechanical, provide no barrier to the spread of this infection the cause of which has, so far, eluded us. 68 Health education is of the utmost importance in prevention but such a great deal depends upon family and group environment and the subject's susceptibility to example. I am indebted to Drs. A. Grimble and D. Erskine, Physicians i/c at the Miller and Dreadnought (Seamen's Hospital) Treatment Centres respectively for the following statistics for 1967 :— 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: 9 7 116 53 380 179 505 239 Dreadnought Seamen's Hospital: 38 — 205 — 915 1 1158 1 New Cases of Residents Treated During 1967 (as given in returns from the undermentioned Centres) Treatment Centre Syphilis Gonorrhoea Other Conditions TOTALS Greenwich District Hospital Miller Wing: 3 47 177 227 Dreadnought Seamen's Hospital: 1 48 204 253 St. John's Hospital: 1 8 30 39 London Hospital: 1 5 31 37 Middlesex Hospital: 3 6 23 32 St. Bartholomew's Hospital: — 3 17 20 King's College Hospital: — 3 10 13 St. Thomas's Hospital: — 5 23 28 Oldchurch Hospital: — — 1 1 TOTALS 9 125 516 650 Legislation During the current year no national legislation concerning infectious disease was enacted. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936, and associated Regulations was 2,837. Under the Public Health (Tuberculosis) Regulations, 1952, there were 56 notifications giving a consolidated total of 2,893 cases notified during the year. However, three cases were not confirmed and two were rediagnosed as food poisoning thus giving a corrected figure of 2,888 compared with 1,689 for the year 1966. This 69 increase of 1,199 is almost entirely 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". Regulation 3(b) of the National Insurance (Unemployment and Sickness Benefit) Regulations, 1948, made under the above Act, enables any person so excluded to claim sickness benefit on production of a certificate issued by the Medical Officer of Health. In the Ministry of Health Circular 115/48 it has been suggested that the Medical Officer of Health should be prepared to furnish such a certificate if, in his opinion, circumstances are such that this action becomes necessary. It is likely that action of this nature could result in hardship for National Health benefits are considerably less than a person's normal earnings. However, Section 41 of the Public Health Act, 1961, provides that where, with a view to preventing the spread of a notifiable infectious disease or a disease to which Section 23(1) of the Food and Drugs Act, 1955, applies, a Medical Officer of Health by written notice requests a person to discontinue his work, then the local authority shall compensate such person for the loss occasioned in compliance thereof. Under this Section 41, such action was taken in respect of three food handlers during the current year. International Certificates Ministry of Health Circular 20/52.—The question of authentication of International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October, 1952. The Regulations prescribe inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 3,603 certificates of persons proceeding abroad were so authenticated, of these 3,008 were in respect of Smallpox, 355 Cholera, and 240 for Typhoid. 70 Smallpox No cases were notified during the year, but a number of contacts were reported arriving in the Borough from abroad and these were kept under surveillance for the requisite period. Public Health (Smallpox Prevention) Regulations, 1917.—These Regulations give a Medical Officer of Health power to vaccinate or re-vaccinate without charge, any contacts of Smallpox cases willing to submit themselves for treatment. Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 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 1967 was 2,350, 2,106 under Council arrangements and 244 by general practitioners, the total indicating a fall of 300 from the previous year. Figures for re-vaccination were 46 and 79 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. Today, although every precaution is taken at seaports and airports, infected persons do occasionally slip through but the comparative immunity of the country has hitherto been due mainly to its high vaccination state. With the fall in the number of vaccinations this fortunate state of affairs cannot continue indefinitely. Measles The normal biennial fluctuation was evident in the number of cases notified during the year which increased from a total of 1,250 in 1966 to 2,345, the figure for the current year. Only 62 cases, 18 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 71 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 and up to the end of 1966 some 620 Greenwich babies had been so vaccinated. 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. and current opinion is that universal measles vaccination is imminent. During 1963, an enquiry into measles conducted by the Public Health Laboratory Service had shown that out of 1,000 cases 38 developed bronchitis or pneumonia and 25 otitis media. Neurological disturbance, mostly transitory but some serious, occurred in 4 cases per 1,000. From 1962 to 1966, there were no fewer than 434 deaths attributed to measles, a hundred more than those from diphtheria, whooping cough, poliomyelitis and smallpox during the same period. The evolution of a safe, effective measles vaccine and its acceptance universally for treatment of vulnerable groups promises results similar to those obtained with regard to smallpox and diphtheria which have virtually eliminated them from the community. Suffering and family distress will be relieved and the practical and financial advantages to the country's hospital, nursing and pharmaceutical services will be incalculable. Scarlet Fever There were 76 notified cases in 1967, one of which was not confirmed. The total of 75 shows an increase of 32 over that of the previous year. Three cases were admitted to hospital but there were no deaths. Whooping Cough The 163 notified cases registered in 1967 show an increase of 67 over those of the previous year. Six cases were removed to hospital, of whom three were nonresidents, and no fatality was recorded. With regard to prophylaxis, one child received a combined antigen (whooping cough and diphtheria) and a further 3,101 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 3,102 whooping cough immunisations carried out during the current year. Of these, 395 were effected by local general practitioners who were also responsible for giving 332 reinforcing doses out of a total of 2,505. 72 Diphtheria As in 1966, the sole notification received this year was not confirmed. During the year, 3,522 primary immunisations were completed in the Borough of which 437 were effected by general practitioners. Most diphtheria immunisations which are given form part of a combined antigen therapy and. in addition to these primary treatments, some 7,096 reinforcing doses were given, 537 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. Acute Primary and Acute Influenzal Pneumonia Altogether 32 notifications were received in 1967 compared with 30 for 1966. Three cases received hospital treatment, but no deaths were recorded. Typhoid No notification was received this year. In 1966, one case of typhoid and two of paratyphoid were recorded. Erysipelas Eight cases were notified during the year compared with 6 in 1966. Sonne Dysentery This disease is usually characterised by diarrhoea, fever and, to a lesser extent, vomiting. Although modern methods of treatment are effective and usually 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. There were 88 confirmed cases in 1967, a total which shows a slight decrease from the figure of 92 from the previous year. Eight of the 18 cases who received hospital treatment were resident outside the Borough. No fatality was recorded. Puerperal Pyrexia Of the 102 notified cases, 25 were in respect of hospital patients whose residences were outside the Borough. In 1966, there was a 73 total of 83 cases registered which included 24 non-residents in hospitals within the Borough. Ninety-nine cases were nursed in hospital and the remaining 3 cases at home. There were no fatalities. Meningococcal Infection Four cases were notified during the year but one was not confirmed. In 1966, two cases were recorded. Acute Encephalitis (Infective or Post Infectious) As in the previous year, two cases of the post-infectious type were notified during 1967. One case followed Measles and the other followed Chicken Pox. Both patients were admitted to hospital and there were no deaths. Ophthalmia Neonatorum There were 13 notified cases during the year, one of whom was a non-resident. In 1966, five cases were recorded. Poliomyelitis No notification was received during 1967, a similar return to that of the previous year. Completed primary poliomyelitis inoculations carried out during the current year numbered 3,522, 371 of which were by general practitioners. Reinforcing doses totalled 3,804, again with 307 being given by general practitioners. Tetanus (prophylaxis) During the year, 3,536 persons were protected against tetanus and 6,727 reinforcing doses were given, both being part of combined antigen therapy. Of these treatments, 453 and 542 respectively were effected by general practitioners. Malaria Compared with a Nil return for this year, one notification was recorded for 1966 in respect of this disease which was contracted abroad. Leprosy One case of tuberculoid leprosy, in respect of which there is no danger of infection, was notified this year compared with a Nil return for 1966. Tuberculosis There were 56 notifications during the year and, of these, 46 were of the pulmonary type and 10 non-pulmonary, i..e tuberculosis of 74 parts of the body other than the lungs. From sources other than formal notification there were six cases, five of the pulmonary type and one non-pulmonary. Of the pulmonary cases, one was posthumously notified and four were derived from the death returns whilst the non-pulmonary case came from information on an inward transferable death return. In 1966, some 67 pulmonary and 9 nonpulmonary cases were notified giving a consolidated figure of 76. Although not always essential, disinfection was offered and carried out in 16 cases including 24 rooms. An additional 6 premises involving 36 rooms were disinfected as a result of Council housing transfers. During 1967, some 2,365 Greenwich school children and students received B.C.G. vaccination under the direction of School Medical Officers. A further 387 contacts were also vaccinated. The number of notified cases of tuberculosis remaining on the Register at 31st December, 1967, was as follows PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 513 338 5 9 865 36 34 2 3 75 CHEST CLINIC REPORTS Greenwich Chest Clinic I am indebted to Drs. P. Forgacs and D. G. Wraith, Consultant Physicians at the Greenwich Chest Clinics, for the following Report: "Seventeen new cases of pulmonary tuberculosis were notified during the year. This includes 9 males, of whom 5 were over the age of 40, and 8 females, of whom 2 were over the age of 40 and 6 under. Three cases of non-pulmonary tuberculosis were notified, 1 female aged 22 with lymph glands in neck and two males, one aged 20 with tuberculous rib and one aged 46 with renal tuberculosis. Twenty-three ante-natal patients have been X-rayed but none was found to have active tuberculosis. Thirty-four children with positive tuberculin tests were referred to us from school but none was found to have active disease. Some 119 contacts of persons with tuberculosis or children and their parents with positive Mantoux tests were X-rayed, none of these was found to have active tuberculosis except two, the husband of a tuberculous patient and their daughter aged 18 who were found to have active tuberculous 75 disease. Ninety-two children and young adults were given B.C.G. inoculation because their tuberculin tests were negative. Many patients with other chest conditions including neoplasm of the lung, bronchitis and asthma, have also been referred to the Chest 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: "There was very little change in 1967 in the pattern of chest clinic work a resume of which was given in my last report. Woolwich area is served by the Woolwich Chest Clinic, Maxey Road, and Brook Hospital Chest Clinic which provides a diagnostic, treatment and welfare service for patients suffering from Pulmonary Diseases. In 1967 there was a total attendance of 6,449, of these 1,237 were new patients. Twenty-eight new cases of pulmonary tuberculosis were notified, 21 male and 7 female. Six cases relapsed and were re-notified. There were 7 non-pulmonary cases of tuberculosis. Two posthumous notifications were received this year. B.C.G. vaccination was given to 311 contacts. Eighty-seven immigrants were examined as contacts but no cases of pulmonary tuberculosis were detected. Only 26 notified cases transferred into this area during the year. The total number of notified, recovered and observation cases at the Woolwich and Brook Chest Clinics on 31.12.67 :— Male Female Children T otals Pulmonary 855 671 50 1,576 Non-pulmonary 26 32 2 60 Grand Total 1,636 Although, as these figures indicate, the disease is less of a problem than in previous years it is still a public health hazard. Close liaison exists between the staff of the chest clinic and the Health and Welfare Department who supply health visitors, a social worker and an occupational therapist. The Medical Social Worker provides advice and assistance with a wide range of personal, domestic and occupational problems. Special housing preference is sought in urgent cases. Many recuperative holidays have been arranged. Extra supplementary nourishment was provided where necessary. At Christmas £80 was distributed by the Care Committee to 91 deserving patients according to custom". 76 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 stage, 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, 1967 PART I.—GENERAL ANALYSIS Men Women Total (a) Total X-rayed 11,519 4,248 15,767 (b) Total previously X-rayed (within 5 years) 8,187 2,068 10,255 (c) Total number reviewed 376 81 457 (d) Number considered abnormal after review 256 61 317 PART 11—ANALYSIS OF ABNORMAL FILMS (1) Cases considered tuberculous and referred for further investigation: — Men Women Total (a) No further action required — — — (b) Occasional Supervision 7 2 9 (c) Requiring close supervision or treatment 9 3 12 (d) Still under investigation — — — (e) Refused further investigation — — — (2) Previously known tuberculous cases 7 3 10 (3) Non-tuberculous cases: (a) Investigated 46 19 65 (b) Still under investigation 3 — 3 (c) Refused investigation — 1 1 (4) Cardio-vascular lesions 28 11 39 (5) Abnormalities requiring no action 156 22 178 77 ANALYSIS OF SURVEYS Numbers Examined Cases of Tuberculosis requiring treatment or close supervision NOT Previously Examined (included in first column) Numbers Cases Men Women Total Men Women Total Men Women Total Men Women Total Public Surveys { Small) 946 966 1,912 — 1 1 529 581 1,110 — — 1 Public Surveys— Examination of Special Groups 275 70 345 — — — 71 37 108 — — — Regular Site (Woolwich) 2,102 1,239 3,341 4 1 5 882 777 1,659 3 1 4 Firms— Routine 4,374 1,264 5,638 2 1 3 1,482 589 2,071 1 1 2 Firms— S.S. Visits 3,334 27 3,361 2 — 2 157 7 164 — — — Colleges, Schools Hospitals, etc. 457 617 1,074 1 — 1 187 134 321 — — — Homes, Lodging Houses, etc. 31 65 96 — — — 24 55 79 — — — TOTAL 11,519 4,248 15,767 9 3 12 3,332 2,180 5,512 4 3 7 Non-Tuberculous Cases Men Carcinoma of bronchus 6 Suspect Carcinoma of bronchus 1 Hamartoma 1 Sarcoidosis 2 Pneumoconiosis 1 Pneumoconiosis (previously known) 2 Bronchiectasis 1 Pneumonitis 15 Bronchitis 1 Pleural effusion 1 Spontaneous pneumothorax 1 Pleural thickening 9 Pericardial cyst 1 Azygos lobe 1 Pad of fat 1 Abnormal ribs 2 Gunshot wound 1 Still under investigation 2 49 78 Women Sarcoidosis 2 Hamartoma 1 Congenital cyst of lung 1 Bronchiectasis 1 Pneumonitis 8 Retrosternal thyroid 1 Hiatus hernia 2 Anterior R.diaphragmatic interposition of colon 1 Abnormal rib 1 Eventration of diaphragm 1 Refused investigation 1 20 Food Poisoning All the cases were investigated with the following results :— No. of Cases Organism (if known) No. of Hospital Cases Remarks 14 Salmonella typhimurium 2 In two cases turkey sandwiches were suspected. One hospital case was a non-resident. Otherwise no particular food suspected. 5 Salmonella enteritidis — Pilchards were suspected in one case and a family of four suspected sausage meat but in neither instance was it possible to verify. 3 Salmonella Stanley — No particular food suspected. 1 Salmonella jena — Recently returned from holiday abroad but no particular food suspected. 1 Salmonella panama 1 Resident outside the Borough. No particular food suspected. 1 Clostridium welchii — No particular food suspected. 80 No organisms detected 4 Thirty-five cases occurred in eleven families and 45 in separate households. Two of the cases admitted to hospital were resident outside the Borough. Various foods were suspected but in no instance was it possible to verify. 105 TOTALS 7 Under the provisions of Section 26 of the Food and Drugs Act, 1955, every registered medical practitioner attending on any person 79 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. During the year, 102 cases were notified of which one was not confirmed. In addition, two cases were otherwise ascertained and two dysentery notified cases were rediagnosed thus giving a total of 105. Local Morbidity I am indebted to the Regional Controller of the Department of Health and Social Security (London South Region) for the following statistics relating to claims for sickness and industrial injury benefits during 1967. Local offices of the Ministry of Social Security concerned mainly with the London Borough of Greenwich are those located at Deptford, Eltham and Woolwich. Regions covered by these offices are, unfortunately, based upon postal districts and not upon local authority areas but, nevertheless, for most practical purposes the figures quoted are reasonably representative of the Borough's morbidity, subject to the following considerations :— (a) Figures refer to new claims only—they do not indicate the current "live load" which includes a good deal of long term sickness. (b) Figures relate only to persons insured for sickness benefit. Sickness, therefore, in children, the aged, the non-employed and "exempt" married women is not included. (c) Injury benefit figures relate to all employed persons. New Claims to Sickness and Industrial Injury Benefit Year Ended 31st December, 1967 Sickness Benefit Injury Benefit Quarter ended 31.3.67 Deptford 5,522 303 Eltham 6,490 306 Woolwich 6,685 443 Quarter ended 30.6.67 Deptford 4,739 356 Eltham 5,632 343 Woolwich 5,617 405 Quarter ended 30.9.67 Deptford 4,417 456 Eltham 5,129 334 Woolwich 4,665 393 Quarter ended 31.12.67 Deptford 5,157 354 Eltham 6,499 365 Woolwich 6,113 423 Totals: 66,666 4,481 80 SECTION IV PERSONAL HEALTH AND RELATED SERVICES Since the Maternity and Child Welfare Act of 1918, local authorities have had the power to introduce schemes for the care of expectant and nursing mothers and their babies and these, together with the midwifery, home nursing and home help facilities form an integral part of local authorities' advisory and preventive services. During the past few years, however, paediatrics has gained a more prominent position and doctors are now tending to favour group practices which enable them to provide most of the services which were, at one time, mainly those available at local welfare clinics. As a consequence, local authority personal health services are being inexorably pressured into a "supportive" role and the domiciliary midwife and health visitor into socio-nursing health educators of the expectant and parturient mother. As malnutrition and communicable disease have become of relatively minor importance, so a great deal more attention is being paid to the "at risk" and mentally disabled children. Indeed, following a report on child welfare centres, prepared by a subcommittee of the Standing Medical Advisory Committee under the Chairmanship of Sir Wilfred Sheldon and published in November of the current year, a number of changes are presaged. The undoubted value of existing preventive services in safeguarding the health of children was acknowledged and affirmed by the sub-committee which, however, considered the term "Child Health Services" to be more appropriate than the previous title. Although the process will be gradual, it was envisaged by the sub-committee that this child health service, in the long run, will form part of a family health service provided by family doctors working in groups from purpose-built health centres. Nevertheless, it was conceded that the special "expertise" gained over many years by the local authority staffs will be needed for some years to come. Briefly, some of the future functions expected of the child health service by the sub-committee, are :— (a) Routine medical examinations aimed at ascertaining a child's physical, mental and emotional development with the referral of affected children through the family doctor to the appropriate hospital for full assessment, diagnosis or treatment. 81 (b) Advice on infant nutrition and hygiene. (c) Counselling of parents. (d) Health Education. (e) Height and weight measurements. (f) Immunisation and vaccination. (g) Attachment of H.V.s to group practices of family doctors. There would appear to be no great dissimilarity between the services listed and those already being provided. Whilst maternal mortality has generally declined, its causes have changed in importance. During the immediate post-war years, toxaemia was the main cause of maternal death but this has now been superseded by abortion; pulmonary embolism takes second place with haemorrhage third and toxaemia fourth. Some anxiety exists with regard to pulmonary embolism and its possible relationship with lactation suppression by diethylstilboestrol and a similar apprehension is discernible with the modern birth control pill. Both problems are still being subjected to intense investigation. Illegitimate births continue to increase throughout the country. In the middle 1930s, on an average, only 4.5% of all live births were illegitimate but the figure for 1967 was 8.4%, almost double the pre-war rate. Increased concern is being expressed not only regarding the fact that one-third of these occurred to girls under the age of 20 years but also about the accompanying health and social problems which illegitimacy brings. Although low birth weight infants form only 7% of all births in England and Wales, they account for approximately 60% of the perinatal mortality and, moreover, it is in the surviving low birth weight infants that most of the physical and mental handicaps are to be found. At present it is difficult to establish whether the problems peculiar to low birth weight infants are due actually to true prematurity or to reasons connected with retarded foetal growth over the full gestation period. It is regrettable that the present method of deciding prematurity, i.e. by birth weight (internationally agreed at 2,500 grms. or less) is unsatisfactory in determining true prematurity, viz. those infants who have had a shortened gestation period. Naturally paediatricians are concerned with both types but it is necessary to distinguish between these two categories because their needs and, indeed, their problems are different. Settling the enigma of prematurity may well open the door to a solution of the respiratory distress syndrome and the susceptibility to infection of the true premature infant and, perhaps, lead to some method of countering hypoglycaemia and the neurological consequences in the infants with impaired foetal progress. 82 It was the intention of the National Health Service Act to develop co-ordination of all medical services, i.e. the hospitals, the general medical and pharmaceutical services and those provided by local authorities. This was to be achieved by means of the "health centre" which was to become the focal point but, due to a number of factors such as financial stringency, insufficient building capacity in a time of intensive housing activity and a large body of "doubtful" general practitioners, the first purpose-designed health centre was not established until 1952. Progress is still very limited and this tardiness was unexpectedly condoned in 1956 by the Guillebaud Committee's comment to the effect that equivalent benefits could be gained by co-ordinating group practices with local authority clinics and more extensive use of the latter's premises for such purposes. With the present demand for combined community care, the role of the local authority in health matters is rapidly changing and instead of providing "laid down" stereotyped services there is this move towards the more flexible, interdependent and specialised kinds. However, difficulties inherent in forecasting future local authority functions are not eased by the apprehension with which the Seebohm Committee's Report is awaited for it is expected that a great deal of re-organisation and reshaping of systems and ideas will be recommended. If this proves to be the case and the recommendations are implemented, then it is to be hoped that the previous failure to anticipate increased expenditure commensurate with the growth of the National Health Service will not be repeated to condemn the new organisation to a "hand-to-mouth" existence and so reduce its potential effectiveness to the community. New Legislation Two major pieces of legislation were enacted during the current year which are certain to have some repercussions on a local authority's personal health and welfare services and some indication of their purport follows. National Health Service (Family Planning) Act, 1967 Receiving the Royal Assent and becoming operative on 28th June of the current year, this Act seeks, with Ministry approval, to extend local authority powers to make arrangements for the giving of advice on contraception to include social cases, to provide for the medical examination of persons for the purpose of determining what advice shall be proffered and to supply contraceptive substances and appliances. Although no charge is to be made in medical cases, nor for advice or examination only in non-medical 83 cases, the Act empowers the local authority to recover other charges having due regard to the means of the recipient. No distinction is drawn between the married and the unmarried. The Abortion Act, 1967 Passed on 27th October, 1967, this Act becomes operative on 27th April, 1968. Briefly, in accordance with this Act, no offence under the law will be committed if a termination of pregnancy is carried out by a registered medical practitioner in a National Health Service hospital or other approved place and provided that two registered medical practitioners, in good faith, are of the opinion that such termination is justifiable on one or other of the following grounds, viz., (a) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, or of injury to the physical or mental health of the pregnant woman or any existing children of her family greater than if the pregnancy were terminated, or (b) that there is a substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped. In forming any opinion under (a), account may be taken of the woman's actual or reasonably foreseeable environment. Except in the case of an emergency, an abortion must be carried out in a N.H.S. hospital, in an approved Services hospital or in a place for the time being approved by the Minister for the purposes of the Act. In the case of nursing homes registered by local authorities under the Public Health Act, 1936, forms, seeking approval for the premises to be used for abortions, are sent to the authority concerned in each case asking them to check the facts and to advise if there is any reason why the Minister should not give his approval. The Act requires the Minister to make Regulations governing the issue of a certificate of opinion and the giving notice of a termination of pregnancy. Although Section 4 of the Act frees a person from the duty to participate in treatment to which he or she has a conscientious objection, it puts the burden of proof on the person claiming it and, furthermore, such conscientious objection cannot relieve a person from the duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to physical or mental health of the pregnant woman. 84 Informed opinion considers that 10% of all conceptions end in abortion, although there are no reliable statistics to support this contention. Estimated discharges from N.H.S. hospitals after abortions in England and Wales have risen from 74,580 in 1961 to 77,570 in 1966, both figures include septic and therapeutic abortions. As those abortions which are treated at home, in nursing homes and in non-N.H.S. hospitals are unknown, what cumulative effect this Act will have is difficult to assess. There are hopes that with the full implementation of the Family Planning Act and improved methods of contraception, the number of women receiving treatment resulting from criminal abortion will decrease. General During the past year the maternity and child welfare work has been carried on satisfactorily. Clinic attendance figures have been maintained and in some instances increased, in spite of continued staff shortages. Mothercraft and parentcraft sessions have continued throughout the year and have been very well attended; talks have been given to outside groups and clubs run by voluntary organisations, and the parentcraft teaching in schools throughout the Borough has continued. Psychoprophylaxis classes have increased in number by two sessions and the number of expectant mothers joining the classes has also increased. A weekly creche session has started at Market Street Health Centre and is proving very successful. It is hoped that another session will be available shortly. During the year the first Health Visitor and District Nurse attachment Scheme to be started in the Borough got under way. A Health Visitor and District Nurse are attached to a group practice of three general practitioners, visiting their patients and in the case of the district nurse, nursing them in their homes. The health visitor works from the surgery, having her office and keeping all her records there. She attends at Infant Welfare Clinics run by the doctors and at their Ante-Natal Clinics. The district nurse is in frequent consultation with the doctors, does some treatment at the surgery and visits all their patients requiring home nursing. It is still too early to say exactly how successful this pilot scheme is, but it does appear to be working very satisfactorily. Several general practitioners and groups of doctors have made enquiries concerning the possibilities of a district nurse working in close liaison with them. In two instances this has been arranged, 85 the nurse working entirely with patients of one doctor or group and being in very close liaison with the doctor. More of these liaison schemes are likely to be arranged in the future. As a whole the work has progressed and there have been signs of useful increase. There is room for much more progress and it is hoped that a better staffing situation in the next years will bring this about. Staff Staff losses in the health visiting service have been severe, resulting in the unprecedented step of closing two centres during August. Eight health visitors resigned for various good reasons, and one, unfortunately, died. To some extent these losses were offset by the recruitment of three full-time and two part-time health visitors and also by the qualifying in September of our four sponsored health visitor students who then commenced work as health visitors for the Borough. Seven health visitor students commenced a year's training in September, sponsored by the Borough. When they are qualified the staffing position for health visiting staff should be considerably easier. The home nursing service has been much better off for staff during the past year. Fewer nurses have resigned and any losses have been made good fairly quickly. Nurses coming forward to work and to train as district nurses have been of a good standard, assets to the service. A steady flow has been maintained of capable well qualified women wishing to work as clinic nurses with the possibility of promotion to school health service work. There is a considerable turnover of staff in this field as many of them are young married women who want to start their own families or whose husbands' work takes them away from the area but there are always others wishing to join the staff and recruitment presents no difficulties. 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 following indicate the use made by residents of these clinics. Total attendances for the current year continue to show some reduction from those of 1966 which are given in brackets:— 86 Preparation for Childbirth A further three health visitors and one midwife 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 class there was a talk and discussion with appropriate demonstrations. Some 292 such sessions were held during 1967 with 2,700 attendances at Relaxation Classes. A total of 3,047 attendances were attracted to the 322 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 56 sessions held, there were 1,155 attendances. 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 1967. They serve also as a reminder of the need for persistent effort to ensure hospital delivery for women in the high risk groups. No. of Women in Attendance : Ante Natal 1,431 Post Natal 584 2,015 Total No. of Attendances made 6,889 (7,052) No. of Sessions held by : Medical Officers 53 Midwives — G.P.s on Sessional Basis 290 Hospital Medical Staff 304 647 General Practitioner Obstetricians No. of Sessions held 653 No. of Attendances : Ante Natal 8,641 Post Natal 725 9,366 (10,358) 87 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) 1,128 197 518 290 86 27 10 — (b) 100 22 54 17 6 1 — — (c) 45 5 18 16 4 2 (d) 1 —- 1 — — — — — (a) 568 30 201 174 114 38 10 1 (b) 99 7 38 36 14 2 2 (c) 260 7 117 96 34 4 2 (d) 7 1 3 2 1 — — — 2 (a) 288 4 67 92 81 34 7 3 (b) 48 — 11 19 10 8 — (c) 216 1 57 103 40 14 1 — (d) 4 — 2 2 — — — — 3 (a) 141 1 22 37 47 20 14 — (b) 10 — 1 3 5 1 (c) 90 — 12 29 36 11 2 (d) 1 — — — — 1 — — 4 (a) 102 10 21 30 28 13 (b) 5 — 1 — 2 2 (O 21 — — 5 8 7 — 1 (d) — — — — — — — — 5—9 (a) 85 1 7 32 32 12 1 (b) 5 1 1 1 2 — (c) 8 — 3 2 2 1 (d) — — — — — — — — 10—14 (a) 2 1 1 (b) (c) (d) — — — — — — — — 15 & over (a) — (b) — — — (c) — — — — — — — — (d) — — — — — — — — Illegit. (a) 297 110 86 49 25 19 8 (b) 25 4 12 6 3 (c) 38 2 15 11 5 5 — — (d) 6 3 1 — 1 1 — — TOTAL (a) 2.611 342 905 670 415 199 75 5 (b) 292 33 117 82 41 14 5 — (O 678 15 219 260 130 45 7 2 (d) 19 4 7 4 2 2 — — (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. 88 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 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) 18 3 11 3 1 (b) 4 — 3 1 — — — — (c) 1 — 1 — — — — — (d) — — — — — — — — 1 (a) 11 — 4 6 — 1 (b) — — — — — — (c) — — — — — — — — (d) — — — — — — — — 2 (a) 3 — — 2 — 1 — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 3 (a) 5 — — 2 — 3 — — (b) 1 — — — 1 — — — (c) — — — — — — — — (d) — — — — — — — — 4 (a) 2 1 1 — — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 5—9 (a) 3 — — — 1 — 2 — (b) — — — — — — — — (c) — — — — — — — (d) — — — — — — — — 10—14 (a) — — — — — — — — (b) — — — — — — — — (O — — — — — — — — (d) — — — — — — — — I5 and over (a) — — — — — — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — Illegit. (a) 6 1 3 1 1 — — — (b) — — — — — — — — (O — — — — — — — — (d) — — — — — — — — TOTAL (a) 48 4 19 15 3 4 2 1 (b) 5 — 3 1 1 — — — (c) 1 — 1 — — — — — (d) — — — — — — (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. Elderly Primaparae Forty mothers over the age of 35 years gave birth to their first viable child of which 38 (95%) were delivered in properly equipped units or hospitals. This total represents 1.1% of all live births to Borough residents during the current year. 89 Multiple Pregnancies Multiple pregnancies in the Borough during 1967 numbered 45 (some 1.25% of all pregnancies resulting in live births) of which 95.5% were delivered in hospital or maternity home. Multiple 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) 9 2 5 2 (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 1 (a) 9 — 2 3 3 1 — — (b) 1 — 1 — — — — — (c) 1 — 1 (d) — — — — — — — — 2 (a) 10 4 1 5 — — — (b) 3 — — 1 1 1 — — (c) — — — — — — —- — (d) — — — — — — — — 3 (a) 2 — — 1 — — 1 — (b) 1 — — — 1 — — — (c) — — — — — — — — (d) — — — — — — — — 4 (a) 4 — 1 — 1 2 — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 5—9 (a) 1 — — — 1 — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — 10—14 (a) — — — — — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — IS and over (a) — — — — — — — (b) — — — — — — — — (c) — — — — — — — — (d) — — — — — — — — Illegit. (a) 3 1 1 1 — — — (b) — — — — — — — — (c) 1 — _— 1 — — — (d) — — — — — — — — TOTAL (a) 38 2 13 8 11 3 1 — (b) 5 — 1 1 2 1 — — (c) 2 — 1 1 — — — — (d) — — — — — — — — (a) N.H.S. Hospitals. (b) Non N.H.S. Hospitals (Mainly Maternity Homes). (c) At Home. (d) Other. 90 Midwifery Throughout 1967 the mutually helpful liaison with local hospitals continued. Regular monthly meetings attended by health visitors, midwives, local authority doctors, and hospital medical and nursing staff, continued at the British Hospital where interesting cases were discussed and explained by the hospital's medical staff. Local authority staff undertake the organisation of this meeting every fourth month, when they talk about the work of all sections of the Health and Welfare Department and give progress reports on handicapped and potentially handicapped children who are born in the British Hospital. This type of meeting is particulary appreciated by hospital staff who must sometimes feel frustrated at the various forms they are asked to complete and may query the value of this additional paper-work. It is rewarding for them to understand the reason for the local authority seeking an increasing amount of information and they are able to see this in the context of the individual child and family who require more than the usual observation and care. Clinic services were maintained for 34 General Practitioner Obstetricians to examine their domiciliary cases with midwives in attendance. Appointment systems were in operation and every mother booking 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. An additional service was offered to ante-natal mothers during the year in the arrangements made for the microscopical and special chemical examination of urine specimens from every woman attending Ante-natal Clinics. This test is a further preventive measure in the detection of symptomless urinary infection which is much more prevalent than has been realised and which, without treatment, may progress to chronic renal disease in later life. Post-natal examinations were offered to all mothers six weeks after delivery but, as in previous years, the response remains very disappointing. Some mothers did attend their own doctor's surgery for the examination, but only 584 were recorded as having attended local authority post-natal clinics during 1967. Practising Midwives Notifications of intention to practise as midwives in the London Borough of Greenwich during 1967 were received from 141 persons, in accordance with the Midwives Act, 1951. Of these 120 were in respect of hospital midwives, 1 was in private practice and the 91 remainder, i.e. 20, were from those engaged in the Council's service and included the supervisory staff. Domiciliary Services The Borough is divided into 9 midwifery areas, each with a fulltime midwife, while a further two areas have a combined midwife/ district nurse. During 1967 there were 682 home confinements. As in previous years the trend continued towards hospital confinement under the "early discharge" scheme. There were 377 such discharges, comDared with 323 durine 1966. Domiciliary Confinements Attended and Hospital Deliveries Nursed at Home Doctor Present Doctor not Present Doctor Not Booked 4 Doctor Booked 60 618 Totals 60 622 No. of Hospital Deliveries attended by Midwives on discharge before 10th Day 377 Although total domiciliary confinements during the current year declined by 192 to 682, the average for each midwife rose slightly to 68. A rise of 54 in the number of mothers discharged home early from hospital also to the care of midwives indicated increased pressure on the service. Domiciliary Confinements by Age and Parity during 1967 Age Total confine ments Parity 0 1 2 3 4 5 and over Not known Under 20 No. 19 6 12 1 — — — — % 2.8 0.9 1.8 0.1 — — — — 20-29 No. 477 11 229 174 53 7 3 — % 70.0 1.6 33.6 25.6 7.8 1.0 0.4 — 30-39 No. 170 — 36 53 54 16 11 — % 24.9 — 5.3 7.8 7.9 2.3 1.6 — 40 and over No. 9 — 2 — 4 2 1 — % 1.3 — 0.3 — 0.6 0.3 0.1 — Not known No. 7 5 1 1 — % 1.0 — 0.8 0.1 0.1 — — — Total No. 682 17 284 229 112 25 15 — % 100.0 2.5 41.6 33.6 16.4 3.7 2.2 — 92 Emergency Obstetric Units These units, manned by hospital staff, are based at the British Hospital for Mothers and Babies, St. Alfege's, Lewisham and Dartford Hospitals. They were called upon 20 times during 1967 to aid medical practitioners or midwives who were in need of additional assistance at domiciliary confinements. Premature Baby Units Premature babies who require special nursing are transferred to units at the British Hospital for Mothers and Babies or to the Lewisham Hospital. When hospital nursing is found to be necessary for premature babies born in the district and if transport under normal conditions in an ambulance is considered to be undesirable, then a doctor and nurse may be sent from hospital with a mobile incubator to transfer the child. During the current year it was necessary to transfer five babies to the care of these units. Nineteen other babies bom prematurely in the district were able to be nursed at home. 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 2lb 3oz or less — — — — — — 3lb 4oz or less 1 5.3 — — I 5.3 3lb 5oz to 41b 6oz 4 21.1 — — 3 15.8 4lb 7oz to 41b 15oz — — 5lb to 5 lb 8oz 14 73.6 — — 14 73.6 All cases 19 100 18 94.7 Maternity Outfits In all cases of confinements, other than in hospital, maternity outfits are made available and during the current year some 658 packs were distributed. Conditions for which Midwives summoned Medical Aid during 1967 (Figures for 1966 in brackets) During pregnancy— During labour Toxaemia 10(16) Premature labour 9(9) Severe Anaemia 1(10) Delayed 1st stage 4(0) Postmaturity 4 (3) (over 10 days) Breech presentation 8(0) Ante-partum haemorrhage 7(0) Fall downstairs 1 (0) Delayed 2nd stage 4(9) Ante-partum haemorrhage 1 (17) Retained placenta 6(9) Post-partum haemorrhage 4(3) Ruptured perineum 45 (58) 93 No emergency calls for professional medical assistance were made by midwives during the current year. No claims, therefore, for fees were received from medical practitioners under Section 14 of the Midwives Act, 1951. From 1st August, 1967, Regulations made by the Minister under Section 14 direct that payment in respect of these emergency professional services shall now be settled by the Executive Council in accordance with the normal maternity medical services procedure as laid down in Part IV of the National Health Services Act, 1946. Only in the case of private patients and under certain circumstances will payment now be made by the local authority. 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 21 No. of Pupils in Training at 31/12/67 4 Refresher Courses In accordance with the rules of the Central Midwives Board, four midwives attended Statutory Refresher Courses during the year, each of one week's duration. In addition, midwives were released for courses as under :— 8 for 1 day courses 1 for Management Course—1 week 1 for Psychoprophylaxis Course During puerperium For mother— For infant— Hypertension 2(3) (a) Before delivery Phlebitis 3(2) Foetal distress 6 Post-partum haemorrhage 1(0) Intra-uterine death 1 Puerperal pyrexia 11(3) (b) After delivery Abdominal pain 1 (0) Retention of urine 1 Oedema of ankles 1(0) Sticky eyes 7(7) Engorged breasts 2(1) Jaundice 3(3) Puerperal psychosis 0(1) Bilateral Talipes 1(0) Sub-normal temperature 2(2) Respiratory distress 7 Rash 1(2) Vomiting 1(2) Convulsive twitching 1 (1) Haemorrhage from cord 1 (1) Melaena 1 (3) Haemorrhagic disease (admitted to hospital on 4th day) 1 94 Cervical Cytology The five clinics established during 1965, staffed by General Practitioner Obstetricians and nurses from the Department, continued at various centres throughout the year. At these clinics facilities were available for "well women" over the age of 25 years and post natal mothers to have cervical smears taken and examined for the detection of pre-malignant conditions. The smears were examined by Dr. Thomas and his staff at Greenwich District Hospital, who were able to check 120 specimens each week. Unfortunately despite widespread publicity by the dissemination of posters and personal approaches by Doctors, Health Visitors, Midwives and District Nurses, the attendance at these clinics has been disappointing throughout the year. Certainly more General Practitioners are undertaking this service in their own surgeries, but there are still many women "at risk" (i.e. married women with children) who are not availing themselves of the opportunity to ensure that they do not develop advanced cancer of the cervix. Statistics have not been collected for a sufficient time to make any final accurate judgement on the preventive nature of this service as far as Greenwich is concerned. Of the 1,791 specimens examined by the 31st December, 1967, 4 were found to require further investigation, and 76 women were referred for treatment of various gynaecological conditions followed by re-examination of a cervical smear. During 1967, cytology teams carried out sessions at local hospitals for the benefit of nursing, administrative and domestic staff; 271 women accepted this opportunity for examination at their place of employment. The scheme of preventive medical examination was extended during the year by offering an examination of the breasts to every woman attending the cytology clinics. Following examination by the doctor, the women were instructed by a nurse in selfexamination of the breasts. They were also shown a film strip and given a pamphlet to remind them of the proper sequence for such examinations. Almost every woman attending the clinics took advantage of this additional preventive care. Since deaths from carcinoma of the breast are more than four times those for carcinoma of the cervix, this examination is perhaps even more valuable from a life saving point of view than cytological screening. Unfortunately carcinoma of the breast is more prevalent amongst unmarried and nulliparous women—those who are seldom seen at the cytology clinics. When 95 problems of availability of space at clinics and shortage of medical staff can be overcome, it may be possible to arrange more facilities for this additional group of women "at risk". The following statistics indicate the volume and type of work undertaken at the various clinics during the year :— Clinics No. of Attendances Rustall Lodge 496 Shooters Hill Road 263 Burney Street 150 Plumstead High Street 227 Market Street 249 Local Firms 485 Total @ 31/12/67 1.870 Age Groups No. of Attendances Under 25 years 86 25—35 years 603 35—45 years 657 45—55 years 451 Over 55 years 73 Total 1,870 Parity No. with no Children 252 No. with 1 Child 386 No. with 2 Children 658 No. with 3 Children 372 No. with 4 Children 139 No. with over 4 Children 63 Total 1,870 Breast Examinations No. examined 197 No. requiring further examination 2 With regard to carcinoma of the cervix uteri, there were 8 deaths recorded in the Borough during 1967 which gives a rate of 0.03 per 1,000 population. This is similar to the rate for 1966 and it again compares very favourably with that for England and Wales, viz. 0.10. 96 During the same period, breast cancer deaths in Greenwich numbered 58 giving a rate of 0.25 compared with 0.41, the rate for England and Wales. Family Planning There is no doubt but that family planning is now considered an essential ingredient of modern living. However, with all the controversy stimulated by the introduction of the Family Planning Act perhaps we ought to ask ourselves—Why Family Planning? On the practical side we must remember that by the turn of the century it has been estimated that the then existing population, living and eating on this planet, will equal the numbers of all who had lived and died throughout recorded history. World population is rising by 2% per annum and adds 65 millions (more than equal to the whole population of the British Isles) to its total every year. Better sanitation and medical care, advances in law and order and education, have all militated to reduce mortality to such effect that for every two people born only one person dies. Some nations, however, have a growth-rate of 3½% or more which, although it may not seem extraordinary, means that their population will double in 20 years. With a country growing as fast as this, approximately one half of its people will be under the age of 15 years and their upbringing will be such a burden on the working section that economic or educational advancement or, indeed, progress of any kind becomes impossible. Unfortunately there are immense areas of the world which are under-developed and over-populated and where the chances of improved output are remote, if not impossible. In this respect even our own country, which has the highest productivity rate per acre in the world, is not self-supporting agriculturally. Moreover, although it can be argued that there are untapped world resources sufficient to support the expected population growth, it is a fact that there is always a "time lag" between the possible and the practical and the geometrical progression of increasing population is unlikely to allow these two to coincide. As with food so with housing, medical, social and other personal and public services. There is no such thing as equality when the problem of women and babies is being considered. It is a fact that the efficiency of the uterus declines with practice and that the chances of abortion grow with each pregnancy. Indeed, abortion is common in women who have had five pregnancies or more by the age of 25 years. Perinatal and maternal mortality also rise after the third child. 97 Since 1955, the teenagers of our country have doubled the illegitimacy rate. Of the year's total of 67,056 registered illegitimate live births, some 20,582 were to girls under the age of 20 years. Furthermore, it is certain that the quarter million unwanted pregnancies per annum was a potent factor in the framing of the Abortion Act introduced during the current year. In giving rise to such problems it is useless to pretend that our present high rate of unplanned pregnancies is of benefit to society. At the beginning of this century, the hazard to infant life of infections like diarrhoea, tuberculosis, diphtheria, etc., was considerable and gave rational grounds for State and religious objections to birth control. Since then we have been extremely successful in reducing infant mortality to the position where 96 out of every 100 children now born will reach maturity. Until recently, however, no comparable steps had been taken to control births. Poverty, another potent social disadvantage, is usually a concomitant of the large family, the children of which so often find themselves handicapped either physically or mentally or even educationally compared with those from the smaller family. Most people do not consult their own doctor about sexual problems, much preferring outside bodies for advice of this nature. For this very reason, successful family planning is more likely to be achieved by local authority clinics where the staff are in constant touch with mothers before and after the birth of their children. Planned parenthood tends to strengthen family life, prevents marital disharmony, ill-health and social breakdown and its aim is the enrichment of all human life. There should be no lack of support for a measure the objective of which is to prevent the mental, physical and social disasters revealed in the overburdened homeless families units, reception centres, foster homes, hospitals, remand homes and prisons. It is a sobering thought that many of these problems could be avoided if the community were prepared to spend on prevention only a fraction of what it now employs for their palliation. 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 1967. "The South East London Branch of the Family Planning Association acknowledges with deep gratitude the help it has received from the London Borough of Greenwich during the year 1967, whereby they have together been able to make a real contribution 98 to the health and happiness of the local community. The Block grant made by the local authority in respect of advice and supplies to women, where further pregnancy would be harmful to health, was particularly appreciated. Determination of such condition was made by local authority doctors, general practitioners, family planning clinic doctors, and hospital doctors, and 212 such cases were seen and treated without charge at clinics (not necessarily within the borough). The Association continued to give advice and supplies freely in socially necessitous cases, and were considerably helped in this respect by the grant. The clinic at the Homeless Families Unit at 158A Plumstead High Street continues to give useful service. With the kind permission of the Management Committee, a subsidiary clinic was established in St. Nicholas Hospital, where intra-uterine devices are fitted, this method being particularly useful with patients who are unable to follow the necessary regime of oral contraceptives, or find themselves unable effectively to use the conventional barrier methods. Both the ordinary clinic and I.U.D. clinic are available to patients referred on social grounds by health visitors or other social workers and no charges are made. The Association felt that, with the support of the local authority so readily forthcoming, comprehensive family planning services should be available within the Borough. Previously women requiring the I.U.D. method had to be referred to clinics elsewhere, including that run by the Greenwich Clinic Committee at the Lewisham Hospital. Arrangements were therefore made for establishing an I.U.D. clinic at the Miller General Wing of the Greenwich and District Hospital, and this was opened on 27th May, 1967, with the team previously working at Lewisham. The Association is grateful to the Management Committee for their permission, and to the Secretary and staff of the hospital for the welcome and help they have given. Because of increased demand, the clinic at Charlton Lane was extended to three sessions and that at Garland Road is open one extra session each month. Apart from the help already mentioned, it must be remembered that the local authority have continued to allow the free use of their premises and, within the limits of availability, have readily granted additional session time. The following table lists the various Welfare Centres and hospitals at which family planning sessions are held, and summarises the work effected during 1967 :— 99 Centre Total Attendances L/A & Hospital referrals Cytology Smears Premarital advice Abbey Wood 702 17 45 7 Charlton Lane 2.952(a) 55 233 23 Garland Road 897 54 58 12 Lionel Road 3,754 36 223 88 Creek Road 1,123 32 58 7 158a Plumstead High 383 12 10 — Street (b) Miller Hospital (c) 281 6 43 1 Lewisham Hospital (d) 378 17 79 — (a) Includes 21 couples advised on sub-fertility. (b) Includes St. Nicholas Hospital. (c) From 26.5.67 for Greenwich patients. (d) Until 26.5.67 but these figures include patients drawn from other areas. In June, 1967, the National Health Service (Family Planning) Act, 1967, received the Royal Assent. This permits local authorities with the approval of the Minister of Health, to make arrangements for the giving of advice on contraception, the medical examination of persons seeking such advice, and the supply of contraceptive substances and appliances. It further empowers the local authority to recover certain of the charges having regard to the means of the recipient. The Act does not differentiate between the married and the unmarried. The Association have had very amicable negotiations with representatives of the Borough and, as a result, have agreed upon a formula which will result in the association acting as the agents of the local authority in providing family planning services in accordance with the Act. At all times the Association has been conscious that, in due course, the provision of family planning services will be the function of the Local Health Authority and, in consequence, have approached the various problems with that in mind. So far as Greenwich is concerned they feel sure that, when the time comes, they will be able to hand over the responsibility to the local authority, confident that it will continue the high standard of service that the Association has set for itself. Coincident with the passing of the new legislation, the Association resolved that its clinics should be free to offer advice to all who needed it, regardless of their marital status. It was known that this decision would be received with misgiving by some individuals and accepted that some professional and lay staff at their clinics might not wish to be associated with it. In the event, it has been generally 100 accepted and there has been no significant increase in the number of young unmarried people seeking advice. Nevertheless the Branch Excutive Committee are aware of the needs of young people, and as soon as possible it is intended to establish a centre where they can be given advice (not necessarily contraceptive) by medical staff specially trained to cope with the emotional and sexual problems of the adolescent." 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. 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 1967 compared with those returned for England and Wales in 1966. Congenital Malformations (Numbers Notified According to Site) Site No. Notified Rates per 1,000 Total Notified Births Greenwich 1967 England & Wales 1966 All SITES 99 27.17 19.00 Central Nervous System 17 4.66 4.54 Eye, ear 3 0.82 0.49 Alimentary system 15 4.11 2.10 Heart and great vessels 2 0.54 0.82 Respiratory system 1 0.27 0.19 Uro-genital system 3 0.82 1.46 Limbs 41 11.25 6.36 Other skeletal — — 0.42 Other systems 5 1.37 1.38 Other malformations 12 3.29 1.19 NOTE:—This table indicates the number of malformations NOT the number of children. 101 Congenital Malformations Notified During 1967 greenwich % e & w 1966 Live Still Total % Babies with One malformation 55 7 62 79.5 86.1 Two malformations 8 4 12 15.4 10.2 Three malformations 2 1 3 3.8 2.5 Four malformations — 1 1 1.3 0.7 Five or more mal- formations — — — — 0.5 Total babies 65 13 78 100.0 100.0 Compared with the previous year, fewer notifications were received during 1967 relating to malformations of the urogenital system and more in respect of limb defects. Other malformations showed no significant variation on the 1966 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 for 1,000 total notified births was 3.01 compared with a figure of 1.43 for England and Wales and 1.05 for the South East Region. Mongolism—This is another reasonably easily identified defect with a local rate of 2.18 per 1,000 total births. Rates for England and Wales and the South East Region are 0.71 and 0.77 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. In pursuance of the well established scheme to ensure early detection of mental or physical abnormalities, infants liable to develop such handicaps were reviewed regularly on the "At Risk" Register. Such infants were identified from the notifications of discharge of a mother from a maternity unit or the care of a midwife. After a variable time a child who was developing normally was removed from the Register and any child who was found to have an abnormality was transferred to the Handicapped Register. During 1967 approximately one-third of the children born to 102 dents in Greenwich were "at risk", although fortunately the majority developed normally. At the end of 1967 there were 1,869 children listed in the register compared with 1,486 at 31st December, 1966. Handicapped Register At 31st December, 1967, there were 507 children under the age of five years listed in the register. Some idea of their conditions can be seen from the following table :— Physically handicapped 316 Mentally handicapped 100 Spina Bifida 13 Limb deformities 2 Sight defects 10 Hearing defects 13 Dual handicaps 46 Battered babies? 7 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. With regard to these latter points, this department is assisting the Research and Intelligence Unit of the G.L.C. in its survey into the occurrence of spina bifida (q.v.) which was initiated at the end of 1966 and is still continuing. In the case of children who are so severely handicapped that they will obviously require community services after school leaving age, the appropriate social workers are introduced to the family, although day to day support is given by health visitors during infancy and social workers (Personal Health Services) during school days. Visits by a few parents of mongol babies to Maze Hill Centre soon after the births of their infants proved to be one encouraging development established during the year. This innovation which was welcomed by the Head Teacher of the Centre, the Mental Health Workers and Health Visitors, gave great encouragement to parents, who were able to see at first hand and early in the lives of their infants, the opportunities for training and education that are now available for mentally handicapped children. A disturbing feature of the register for 1967 is the inclusion of 7 infants who may be suffering from the "battered baby" syndrome". It has now been realised that some of the infants who appear in hospital casualty departments suffering from fractures, 103 bruises and abrasions reputed to be caused by inexplicable "falls" have, in fact, been assaulted by their parents. These parents are often very young, immature and mentally disturbed, unable to budget adequately or provide themselves with proper housing in which to rear a family. If evidence of illtreatment is sufficiently strong and it is thought that the child's life is in danger, legal proceedings are undertaken by the Children's Officer to receive the child into Care. The child may be removed from its parents or may remain at home while the family is supervised and guided by frequent visits from a Child Care Officer and Health Visitor. However, usually it is impossible to obtain such definite evidence so an attempt is made to protect these children by encouraging local paediatricians to notify this department when it is suspected that their young patients' injuries are inadequately explained by the parent. Thereafter, the family is kept under strict observation. These children are thought to be free from serious danger after the age of three years, when most toddlers would not be the silent recipients of ill-treatment. (Elsewhere in Britain where death has occurred in such circumstances, the child has been under the age of two years.) If the mental health of the parents of these children is in doubt, an attempt is made to persuade them to seek treatment, but they will rarely agree to this. 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 its 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, were given in toto in the 1966 Report. 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 1967, the register contained the names of 171 deaf or partially hearing children, 159 of whom were of school age, the majority having been diagnosed following the "sweep" hearing test which all children undergo on entering school. 104 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 47 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, 1967 Under Over 5 yrs. 5 yrs. Total No. of Children on register 12 159 171 No. of Children with hearing aids 6 62 68 No. of Children attending Deaf Schools or Partially Hearing Units 4 27 31 No. of Children attending other Special Schools — 16 16 Depending on the degree of deafness, Social Workers make themselves known to these young people and their families when they leave school so that any needs arising from their handicap may be met. However, 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 The overall number of visits made by District Nurses during 1967 increased by 11,089, although the number of new cases decreased by 36. 105 Increased visiting was due to the fact that more patients are now needing two nurses at each visit; more are on twice daily care and some require even three and four visits daily. Many of the visits could be undertaken by less highly qualified staff although the greatest possible use is made of the services of S.E.N.s and bath attendants. Each of the 40 districts into which the Borough is divided for nursing purposes, carries an average case load of 30 and monthly visits remain at 350-380. Recruitment of suitable home nurses was slow initially but improved later until at December, 1967, there were 67 District Nurses on the establishment (full-time equivalent 55). An analysis of the 3,469 new cases who received attention during the year is given hereunder:— Sources from which New Cases were Referred General Practitioners 2,119 Hospitals 790 Clinics (Chest, Ante Natal and Diabetic) 48 Geriatric Visitors 104 District Nursing Service 408 3,469 Classification of New Cases No. Cases % Medical 2,945 84.9 Surgical 385 11.1 Maternal Complications 98 2.8 Early Maternity Discharges 11 0.3 Tuberculosis 25 0.7 Mental Ill-health 5 0.2 Total 3,469 100.0 Type of Treatment and where effected Treatment At Patients' Homes Elsewhere (e.g. Nurses' Homes) Total % Injections only 41,265 451 41,716 23 Injections plus other treatment 8,964 11 8,975 4 Other Treatment only 134,451 128 134,579 73 TOTALS 184,680 590 185,270 100 106 Patients and Visits Total number of Patients 4,065 Total number of Visits 185,270 Average number of Visits to each Patient 45 Long Term Cases Patients Nursed for 3 months or more 284 (equivalent to 7% of all cases nursed) Age Distribution of Patients Age Group No. of Patients % 0 to 4 years 31 0.8 5 to 64 years 1,319 32.4 65 years and over 2,715 66.8 Total 4,065 100.0 District Nurses—Full time equivalent 54 (including 2 Reliefs and 7 Students) Marie Curie Day and Night Nursing Service Duties undertaken in the Borough by this organisation involved the services of a night nurse for 29 patients, while a further 59 patients received help in other ways, such as the provision of fuel, clothing and extra nourishment. Training During 1967, nine State Registered Nurses successfully undertook the District Nursing Certificate. Three S.R.N.s were trained for other counties; two S.E.N.s undertook 10 weeks "in-service" training and, at the end of the year, five S.R.N.s were still in training. Refresher Courses Arrangements were made for six District Nursing Sisters to attend a refresher course of one week. Two District Nursing Sisters attended a one-day release course and two a 1½-day release course. Integrated Students Six students from King's College Hospital spent five weeks in the Department obtaining District Nursing experience. Observation Visits These were made by three Matrons of Old People's Homes, one student from the National Old People's Welfare Council, 29 female and 11 male hospital students. 107 In October, the District Nursing Headquarters moved to newly adapted premises at Shooter's Hill Road. This new arrangement has placed all the District Nursing professional administration under one roof and adjacent to a group practice of four family doctors, a Welfare Centre, Home Help Office, Chiropody Clinic and the Central Stores, all of whom benefit from this proximity. One G.P. attachment scheme commenced in June to the mutual advantage of patients, doctors and District Nurses. A further three more attachments are being planned. Home Help Service Difficulties in recruitment continued, at times, in the Eltham and Greenwich areas but in Woolwich there was no undue difficulty in obtaining suitable persons for this work. At the end of the year there was the equivalent of 317 full-time home helps employed and an analysis of the services rendered during 1967 is given below:— Type of Case No. Aged 65 years or over on first Visit in 1967 3,130 Aged under 65 years on first Visit in 1967: Chronic Sick and Tuberculous 340 Mentally Disordered 21 Maternity 122 Others 321 804 Total Cases 3,934 Family Aids The pilot scheme introduced during 1966 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, proved very successful and was continued during the current year. Home Help Course A one week's "in-service" training course of talks, films, discussions and demonstrations was arranged for 14 home helps during April, 1967. Child Help Courses Eleven child helps attended a "one-day" refresher course in March and, in May, 11 selected home helps spent a week in the Health and Welfare Department attending a course of lectures, films and discussions to prepare them for child help duties. 108 Of the 33 home helps who had been trained here as child helps, 32 were still working in the Borough in 1967. By attending these courses of "in-service" training, home helps not only gain useful knowledge but are able to realise that they form part of an important service. It was mutually beneficial for them to meet senior members of staff who seek their help. Altogether 75 families were helped in this way, 26 still receiving assistance at 31st December, 1967. The reception into care of many children has undoubtedly been prevented by this service. Health Visiting Our shortage of Health Visitors, severe in 1966, became more acute during the current year. Eight Health Visitors resigned for various good reasons and one, unfortunately, died. These losses were not made good for only three full-time and two part-time replacements were recruited although, later in the year, four sponsored Health Visitors qualified and commenced duties in the area. 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 1967:— No. of Cases Visited by Health Visitors Children born in 1967 3,994 Children born in 1966 3,529 Children born in 1962/65 7,100 14,623 Persons aged 65 years and over 36 Persons aged 65 years and over (visited at special request of G.P. or Hospital) 18 Mentally Disordered Persons 45 Mentally Disordered Persons (visited at special request oj G.P. or Hospital) 12 Persons Discharged from Hospitals other than Mental (excl. maternity cases) 91 Persons Discharged from Hospitals other than Mental (excl. maternity cases) (visited at special request of G.P. or Hospital) 67 Tuberculous Households Visited 42 Households Visited re Other Infectious Diseases 209 Total Effective Visits and Re-visits 45,445 109 Unsuccessful Visits 10,910 Health Visitors—Full time equivalent 23.1 T.B. Visitors and T.B. Health Visitors—Full time equivalent 6.0 Co-operation with Hospital Departments The shortage of Medical Social Workers in local hospitals was partly alleviated in 1967 but the liaison, which was established during 1965 and 1966, continued although less actual hospital visiting was required of the social workers. Health Visitors continued to attend the Diabetic Clinics at Greenwich District Hospital and the Paediatric Clinic at the Memorial Hospital but, owing to staff shortages, attendance by Health Visitors at one Ante Natal Clinic at St. Alfege's and the Paediatric Clinics at the Miller Hospital were discontinued. It is hoped to re-establish this link as soon as possible. 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 five 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. During October, 1966, a special unit at 32 Charlton Road, S.E.3, for the training and rehabilitation of "problem" families was established. Here, social workers provide intensive help in an endeavour to overcome the various difficulties leading to a family's existing situation. There were 176 families on the index at the end of the year with a total of 236 children under five years. This index is under constant review and is checked completely each year. Health Visitors do a great deal of work with these families to whom much material and sympathetic help is given. Surveys Measles—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. 110 Childhood Cancers—A 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. Eight families were visited by a Medical Officer during the year in connection with this survey. Spina Bifida—At the close of the year 1966, a survey into children with spina bifida was launched by the G.L.C.'s Research and Intelligence Unit 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. I am happy to include some interim comments by Miss B. Spain, M.A., Dip. Psych., the Research Officer in charge of the project: "The study of the prevalence of spina bifida is now nearing completion. Approximately 600 children suffering from this condition have been located within G.L.C. and their medical records examined to give details of their handicaps. The results of this analysis should be complete in 1969. A study of the incidence of this condition reveals that at the present time about 200 children are born each year with spina bifida within G.L.C. Only about half of these children survive to their first birthday, the rest being either stillborn or dying as babies. This suggests that the incidence for London is somewhat lower than has been found elsewhere in the country. We are making a special investigation of children born between April 1967 and March 1969. All of these children are to be seen annually until they reach school age, to examine their handicaps and development and the kinds of problems arising for their families as a result of their having a handicapped child. We hope in this way to gather information which will help in the planning of school facilities and other local authority services." Health Visitor Training Health Visitor training continues under the agreed revised rules submitted by the Council for the training of Health Visitors to the Minister in 1965 in accordance with Section 2 of the Health Visiting and Social Work (Training) Act, 1962. 111 Field Work Instructor Courses Two Health Visitors attended a Day Release Course arranged by the London Borough's Training Committee. This brings the total number of Field Work Instructors in the Borough to eight. Psychoprophylaxis Course Three Health Visitors and one Midwife attended a weekend course arranged by the National Childbirth Trust enabling them to teach psychoprophylaxis to expectant mothers. Student Health Visitors During 1967, the Borough has continued to be responsible for practical work training of students taking the Integrated Course of Nurse Health Visitor Training at King's College Hospital and the Royal College of Nursing. Five of these students successfully completed their training in 1967. In October, 1967, four practical work placements were taken up by the University of Surrey, two by the Royal College of Nursing and one by Medway and Maidstone College of Technology. These seven students, together with three Integrated Course Students, will complete their Health Visitor Training in September, 1968. Refresher Courses Health Visitors and a Senior Nursing Officer were able to attend refresher courses during the year. These courses included the normal Health Visitor refresher courses and those of a more specialised nature such as that arranged by the National Society of Autistic Children. Student Nurses The Borough continued to provide facilities for student and pupil nurses to see something of the community services provided by the Local Authority. Throughout the year 648 student nurses and 16 pupil nurses each spent a half-day in the Borough. The Chief Nursing Officer and her staff gave lectures and led discussions with student nurses training in the area. Observation and Other Visits The Chief Nursing Officer arranged programmes of visits for various interested people during the year under review. Health Education During the year, a health education committee consisting of health visitors and school nurses continued to meet every month and, with the help of the Health Education Officer, made out a programme of topics for the year. Posters and leaflets were 112 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 by Health Visitors and School Nurses in a variety of schools including three Comprehensive schools, a school for educationally sub-normal girls and a school for maladjusted children. Informal talks on personal hygiene, good grooming and other similar subjects were given to children of all age groups during regular hygiene surveys. Posters and leaflets have been displayed in all Treatment Centres and in schools where there are Medical rooms. Nursing staff discuss with women members of the school staff the importance of Cervical Cytology and examination of breasts whilst also advising them of the facilities available. 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 1967 relating to Child Welfare Clinics are given in the following table:— Attendances No. of Children born in 1967 3,306 No. of Children born in 1966 3,874 No. of Children born 1962/65 4,867 12,047 Sessions held by:- Medical Officers 269 Health Visitors 264 G.P.s on Sessional basis 1,926 Hospital Medical Staff — 2,459 No. of Children Referred elsewhere 368 No. of Children on "At Risk" Register 31.12.67 1,869 113 Day Nurseries Admissions Difficulties encountered during 1966 due to the absence of a Day Nursery in Greenwich, continued during the current year. The allocated ten places in a Lewisham Nursery were continually oversubscribed 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. Council Places in Lewisham Day Nursery In Waiting Unsupported Mothers 6 3 Lone parent 4 4 Deaf children 1 — The private Day Nursery/Play Group, which was opened in a Church Hall during 1966 by a local Vicar with the co-operation of the Management of a nearby factory, has flourished and arrangements were made this year for vacancies to be offered to children who were medically or socially handicapped and would benefit from attendance at the establishment. The Council was responsible for the payment of these places. Under this scheme three children were admitted on social grounds (two were still in attendance at 31st December)—one for three hours daily and one full-time. One physically handicapped child was also admitted for three hours daily. All these children derived considerable benefit from the service and one was enabled to remain at home with his father and school age siblings after the death of the mother. In this case a child help cared for all the children until the father returned from his work each night. Occasional Creche Service Each week a creche is held at three 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 was newly opened during the year. Two of them are 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. 114 Adoption, Foster Parents and Boarding Out Adoption One of the most serious social problems of the country today (although happily of no great moment in this Borough at present) is the difficulty experienced in the assimilation into society of coloured immigrants in order that hostility and discrimination may be avoided. A corollary to this situation, which is becoming progressively more important, is that of the settlement of children of differing racial origins who, for various reasons, are deprived of a family life. Responsibility, generally, for the placement of these children rests with Adoption Societies and with Children's Departments and, for most adopters, there is an obligation, under Section 3 of the Adoption Act, 1958, to notify the local authority of their intention to adopt. Health Visitiors 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. 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 ante natal 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 115 given by the health visitors with priority admission to a Day Nursery or recommendation to known child minders. During 1967, 160 women contacted the undermentioned Moral Welfare Organisations in Greenwich:— Southwark Catholic Children's Society 10 Southwark Diocesan Association 150 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 — 118 15—19 years 79 114 20—24 years 58 66 25—29 years 13 34 30—34 years 6 33 35 years and over 4 Not known — 366 Totals 160 Of the total of 160 women seeking help some 23 or 14.4% were already pregnant on their arrival in London. 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. At the 102 sessions held during the year there was a total attendance of 1,004 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. 116 Co-ordinating Committee This Committee was established to ensure 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 Health and Welfare, Children's and Housing Departments, the Inner London Education Authority and the Housing Department of the Greater London Council. When necessary representatives from other statutory and voluntary bodies are invited to attend. During 1967 the following subjects were discussed:— Problems arising from a certain housing estate, rehabilitation units for homeless families, and Co-ordination of the Education, Health and Welfare Services for Handicapped Children and their families, the Ministry of Social Security Act, 1966, and eviction for non-payment of Mortgage. At field level and Housing Case Conferences the majority of the cases discussed concerned families in difficulties over arrears of rent. During 1967, an additional Committee was set up to discuss families residing in the Homeless Families Units. Statistics Number of Co-ordinating Committees 2 Number of Intermediate Case Conferences 29 New Cases 28 Old Cases 22 Number of Housing Case Conferences 36 New Cases 117 Old Cases 72 Total new Cases discussed 146 Referred by:— Borough Council Children's Department 2 Health and Welfare Department 14 Housing Department 59 Other Agencies I.L.E.A 2 G.L.C. Housing Department 65 Ministry of Social Security 1 Hospital 1 N.S.P.C.C 1 Others 1 146 117 Family Caseworkers and Family Aid During 1967 one of the family caseworkers returned from the Mental Health Course having qualified as a Psychiatric Social Worker. Towards the end of the year she made a survey of the families in the Homeless Family Unit with the result that the above-mentioned Committee on homeless families was set up and certain changes in policy effected. These changes led to a decision to allocate more trained staff to help these families so that more intensive work could be carried out. This new arrangement was facilitated by the re-organisation of the whole Department in September, 1967. What is now apparent is that many of the homeless are families needing a great deal of social work help for long periods, even after rehousing. In order to work effectively the caseworker must restrict her casework and it is, therefore, essential for staffing needs to be kept under review. The use of a Family Aid continues to be a worthwhile experiment and it is hoped that when the economic situation eases, more Family Aids can be employed. 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 Cow & Gate—Cereal Food Baby Rice Decrose Bemax Farex Carella Farex Fingers Carnation Milk Farlene Cod Liver Oil & Malt Farleys Milk Complan Farleys Rice Cow & Gate—Full Cream Farleys Rusks Cow & Gate—Half Cream Groats (Triple Pack) 118 Groats Ribena (ready cooked fortified) Rose Hip Syrup Horlicks S.M.A. Powder & Liquid Marmite Supro Ostermilk Trufood (Humanised) Renbard Virol (Blackcurrant Syrup) 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 decrease in the number of holidays provided during the current year but, although fewer adults had holidays during this time, there was an increasing use of the recuperative holiday scheme by G.P.s for their elderly sick patients suffering from conditions such as chronic bronchitis. Many of these patients have regular winter exacerbations of acute respiratory infection. A summary of the use made of these facilities during 1967 is given in the following table :— Type of Case No. Adults: Psychiatric ..... 5 Tuberculous ..... 9 Other Adults ..... 104 Expectant and Nursing Mothers ..... 2 Other Mothers ..... 8 Infants: Accompanied 11 Unaccompanied : Aged 0-1 year 1 Aged 1-2 years 2 Aged 2-5 years 12 — 26 School Children: Accompanied 12 Unaccompanied 102 114 Total Holidays 268 119 Child-Minders and Private Day Nurseries Voluntary Under the National Health Service Act, the Council provides a service of approved child-minders who, in return for their willingness to submit to supervision and the Council's requirements. receive a registration fee of 6s. 0d. per week whilst minding a child. Children under the age of 5 years who do not attend school can be accepted into a minder's home for daily care, the charges for which are matters for agreement between the minder and the child's parents. Under existing arrangements no child-minder is permitted to care for more than two children at any one time and those who desire to take more than this number are required to register as statutory child-minders under the Nurseries and 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 1967 the following child-minders and premises were registered for these purposes :— National Health Service Act, 1946 No. of Child-Minders Registered 85 No. of Places or Children Minded 116 Nurseries and Child-Minders Regulation Act, 1948 No. of Premises Registered : Factories — Places — Other 8 Places 180 No. of Child-Minders Registered : 27 Places 150 Compared with 1966, there were more places with voluntary and registered child-minders during 1967 and more places in private day nurseries. Altogether, 446 places were available throughout the Borough for children who needed day care for various reasons (excluding the 10 places allocated to this Council at a Lewisham Day Nursery). 120 Registration of Nursing Homes In accordance with Part VI of the Public Health Act, 1936, Part III of the Mental Health Act, 1959, and the Nursing Homes Act, 1963, registration and inspection of nursing homes is a responsibility of the local health authority. For some time authorities have been critical of the weakness of the legislation in the Public Health Act, the lack of preciseness of which has led to varying standards in different areas. However, under existing legislation there is only one nursing home registered within the Borough and this provides accommodation for 19 persons. Number of Beds Nursing Home Mental Maternity Others Lady Edith Marsh Nursing Home, 14 St. German's Place, S.E.3 — — 19 During the year, one nursing home closed and another was registered. Chiropody Services During the year, clinical chiropody in the Borough has seen the attendance figure of 41,628 for 1966 rise to 42,916 and the number of new cases from 1,488 to 1,559. Extracts from the 1967 Report of the Council's Chief Chiropodist (Mr. K. Reeve) are given below :— "Staff increases to bring the chiropodists' sessions up to 5,604 augured well for the future, but at the end of the year it was apparent that losses due to natural wastage would outstrip any intake and, to obtain maximum benefit from the work force, concentration of remaining staff into main centres must continue. The present service depends to a large extent on the sessional chiropodist (a variable factor) and the ideal situation of a full-time staff, supplemented by sessional staff when necessary, is unlikely to obtain with present restricted salary scales. Indeed, the service is often used only as a useful standby when building up private practice or marking time between graduation and the commencement of a partnership or industrial appointment—the very limited number of grades in the Whitley Council structure offers little future for a fulltime career in municipal chiropody. The enforced move of the Blackheath clinic to 103, Shooters Hill Road has not been entirely painless; clinics and building still await finishing touches, and the present environment is not conducive to 121 peace of mind, as the noise and dust arising from large-scale roadworks involved in the new Blackwall Tunnel Approach, together with road closures and diversions of traffic, are constantly with us and likely to be so for some time to come." 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 48 sessions held there were some 337 treatments carried out. Chiropody Treatment during 1967 No. of Chiropodist Sessions 5,604 Attendances: Children 0- 4 years 6 5-14 years 255 —— 261 Males 15-64 years 3,095 65 years and over 5,348 —— 8,443 Females 15-59 years 11,695 60 years and over 22,517 —— 34,212 Total Attendances —— 42,916 No. of New Patients 1,559 Domiciliary Chiropody 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 1967, some 2,065 domiciliary treatments were effected. DENTAL TREATMENT (Maternity and Child Welfare) F. ELSTON, L.D.S., R.C.S.Eng., the Chief Dental Officer, reports :— "At some length, the previous two annual reports outlined the background and emphasised the urgent necessity of an effective Maternity and Child Welfare Dental Service. They particularly stressed the importance of early introduction to dentistry by means 122 of a specialised service designed for the treatment of the small child and for the dental health education of mothers. Whilst satisfactorily maintaining what in the previous reports was referred to as a "token service", the year 1967 gave us the opportunity of a clinical analysis of the state of dental health of the young child. This year's report is therefore deliberately brief in order to let the facts speak for themselves. A sample survey in this Borough of new school entrants in the five-year age group shows the enormous void which must be filled. Almost 75% of the children surveyed are shown to have past or present results of dental disease. These were our findings :— Number of children examined 893 Requiring treatment 553 = 61.93% Not requiring treatment 340 = 38.07% Sum total of findings:— Carious teeth 1,955 = 53.13% Unsavable teeth 47 = 1.27% Teeth missing for reasons other than natural shedding 638 = 17.33% Teeth with satisfactory fillings 1,040 = 28.26% Average findings per child:— Carious teeth 2.19 Unsavable teeth 0.053 Teeth missing for reasons other than natural shedding 0.71 Teeth with satisfactory fillings 1.16 Average dental health per child:— Sum total of diseased + missing + filled teeth 4.12 Number of children with perfect dentitions and no treatment required 234 = 26.20% Pattern of previous dental treatment:— No previous treatment 467 = 52.30% Extractions only 112 = 12.54% Fillings only 187 = 20.94% Extractions and fillings 127 = 14.22% Issues raised in the School Dental Service (q.v.) apply with equal force to our Maternity and Child Welfare Dental Service for their 123 treatment facilities are shared. A need to develop the M. & C.W. Dental Service in which Dental Auxiliaries have an important part to play is rightly stressed by the Ministry which also recommends that 9% of the total treatment sessions should be devoted to this service. Unfortunately, with our present establishment, this recommended figure amounts only to approximately one-third of the full time equivalent of one dental officer. If one dental surgeon were to set up in practice with the express purpose of dealing adequately with the dental problems of preschool children and mothers of the Borough in one-third of his time, his prospects of impact on the community would be open to grave doubts. Yet. in present circumstances, this is all the potential which we ourselves can hope to apply to the problem. It is therefore self-evident that, in close alliance with the necessary expansion of the School Dental Service, the facilities of the Maternity and Child Welfare Dental Service will have to be greatly increased if we are to establish the effective service our community needs." Treatment During 1967 ATTENDANCES New Patients: No. of Appointments 249 No. and percentage of Appointments Taken Up 172 = 69.10% On-treatment Patients: No. of Appointments 616 No. and percentage of Appointments Taken Up 466 = 75.68% Emergency Patients Treated 26 Total attendances 664 TREATMENTS No. of Treatment Sessions 84 Total No. of Teeth Treated 489 (a) Mothers: No. and percentage— Filled 37 = 86.00% Extracted 6 = 14.00% (b) Children : No. and percentage— Filled 397 =100.00% Extracted Nil Prophylactic Treatment 179 X-rays 36 Dentures 2 General Anaesthetics — All Other Operations 45 124 SECTION V COMMUNITY CARE Re-organisation At the inauguration of the new Borough in 1965, it was recognised that considerable difficulties were likely to be encountered in establishing a Health and Welfare Department which would not only provide continuity of the then existing social services but would itself move towards integration of the various branches. This proved to be the case. Arising as they did from organisational deficiencies, inconsistencies, and contradictions mainly connected with historical growth, such problems were largely overcome. However, as foreshadowed in my Report for 1965, complete co-ordination of the various branches and full exploitation of the Department's professional skill and administrative experience have been hampered by limited resources and a paucity of trained personnel. It was no surprise, therefore, to find that co-operation within the new service and integration of the four types of social work groups, viz. the mentally ill and mentally subnormal, the school children and problem families, the various categories of handicapped persons and the elderly and the infirm, all of which had been developed by separate authorities to meet the varying needs of differing groups of the population, was less than had been hoped for in a combined Health and Welfare department and that it would be necessary to make a determined effort to remedy the situation. With continuing financial stringency and a persistent lack of trained workers, it was decided that, in order to avoid duplication of effort and economically to utilise the limited qualified personnel to the greatest possible advantage, a Community Care Branch should be established. Within its framework, the four existing independent social worker groups would be physically integrated and made responsible for all aspects of community care, social work and supporting services. Accordingly, in September of the current year, the Borough was divided into four "all purpose" areas each having a team comprising representatives from each social worker group headed by a leader accountable to an Area Community Care Supervisor. Each Supervisor, a specialist in a particular field of social work in respect of which he/she acts as Consultant to community 125 care workers of all areas, is answerable to the "Co-ordinator of Community Care" who, in turn, is responsible directly to the Medical Officer of Health. Such an establishment, whilst allowing individual officers to practise their own particular specialities will not only secure their participation in the settlement of the more common problems of community care and ensure closer co-operation and consultation with their colleagues, but will also lead to greater flexibility of the service as a whole. Appropriate consultative machinery has been devised to enable "policy" to be sensitive to and shaped by peripheral problems and pressures. A further innovation is to be the establishment of Combined Centres which, under one roof, will cater for the needs of several categories such as the handicapped, the mentally ill and the elderly. In addition to meeting the present financial restrictions which are severely handicapping schemes for purpose-built centres, the advantages of combined centres not only include maximum integration of all types of cases thereby stimulating greater social awareness and a sense of "belonging" to the community but also the economical use of staff, supplies and equipment. Moreover, the effects of erratic attendance, which could bring a separated establishment to a standstill, has very little impact on a combined centre which can make suitable adjustments. Furthermore, when limited funds are finally made available, expansion of this kind of service will bring benefits to a wider range of individuals in all groups needing community care. With the introduction of this new Community Care Service, procedures regarding the placement of individuals into centres, into Part III accommodation, into hostels for the mentally ill and mentally subnormal and of the homeless into emergency accommodation, have been reappraised and, where necessary, improved. Although area staffs will be located at departmental headquarters, when possible, neighbourhood offices readily accessible to the public in the vicinity will be made available for local interviews. Under this scheme, an enlarged administrative section has been organised not only to provide direct support to social workers and other professional colleagues but also to manage the day to day problems arising with regard to the ancillary services such as combined centres, day clubs, luncheon clubs, meals-on-wheels, bathing, incontinent laundry, etc. By the formulation and implementation of these new ideas which constitute a substantial advance on previously held doctrines, the Borough demonstrates its understanding of modern social 126 problems and its progressive attitude over the whole field of community care. Even so, a note of caution needs to be sounded. It would be unwise to expect such a relatively revolutionary step to be immediately successful. Social worker groups have been subjected to varying periods of training under differing disciplines and, over the years, this has led to the development of professional barriers which will not lightly be abandoned. However, the scheme must be seen as a rational extension of community care and, with goodwill on all sides, it will evolve into a powerful instrument for social good. Since the compilation of this Report and at the time of its going to press, various official bodies in their reports are reflecting much of the "thinking" which lay behind this Council's re-organisation of its community services which was initiated in 1966 and completed during the current year. Homes for Old People During the year, no additions were made to the four modern purpose-built Old People's Homes already situated in the Borough and which form part of the Council's Part III accommodation, viz: Perrygrove, Rectory Field Crescent, S.E.7. Plumstead Lodge, Plumstead Common Road, S.E.18. Sunbury Lodge, Sunbury Street, S.E.18. Weybourne, 1 Finchale Road, S.E.2. However, beds allocated for the Council's use in Southern Grove Lodge, Mile End Road, E.I., were, by arrangement with the Council of the London Borough of Tower Hamlets which manages the home, progressively reduced from 259 to 199 on 1st April of the current year and to 179 on 1st January, 1968. In 1967, pressure on the available accommodation continued and admissions rose from 409 to 538. During May, a start was made on the construction of "Tegel" the first of our new homes for old people but our hopes for its completion in the third quarter of 1968 will not be fulfilled and its occupation is not now expected until March, 1969. The planning of "Elmgrove", the second of our new homes, is well advanced and it will, we hope, be in use at the latter end of 1969. It is expected that, before the end of 1969, permission will have been obtained and work will be almost complete on our third home in the Maryon Park area. These homes will eventually provide some 180 desperately needed beds. Admissions Full utilisation of our expanding community care services in order to provide home support for as many old people as possible, 127 for as long as possible, remained the operative policy and despite all pressures, our standards of care were maintained. As a result, the physical condition of residents finally admitted to a Home probably declined in comparison with those of earlier years. The "admissions panel", consisting of the Deputy Medical Officer of Health aided by the Senior Woman Public Health Officer and the Senior Social Worker, continued to prove its worth in assessing and judging the degrees of medical and social priority when dealing with the waiting list and our Consultant Geriatrician, Dr. Boyd, played his usual helpful and sympathetic role when requested. 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) 60 Referred by Council Members — Referred by Women Public Health Officers 98 Referred by other Council Officers 30 Referred by Hospitals 152 Referred by General Practitioners 48 Miscellaneous 24 412* * Of these applications, 169 were withdrawn or not proceeded with before inclusion in the waiting list for admission to a Home. Temporary Admissions—Holiday Relief for People Caring for Aged Relatives Much greater emphasis was placed on providing this service than hitherto. Included in the figure of 538 admissions during the current year as quoted above, there were 35 temporary admissions, 29 to small homes and six to Southern Grove Lodge. Additional arrangements were made for the temporary care of a further 20 people, 11 at the Red Cross Edith Priday Home in Blackheath, eight at the St. Alfege's Hospital and one at the Council's Holiday Home at Westgate. Recreation As in the previous years the Matrons and staffs of the Homes maintained their efforts to provide varied recreational and occupational interests additional to the normal care and attention. 128 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. Facilities available to the residents were improved by the installation of coin-operated telephones in all the Homes after an initial trial operation at "Weybourne". 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. Staff Again, recruitment of staff for the Homes continues to give rise to some anxiety, particularly in supervisory grades and there were some minor crises. Part III Accommodation—Statistics 1st Jan., 1967 Nos. in Residence 31st Dec., 1967 Nos. in Residence Old People's Homes Males Females Total Admitted Died Discharged or Transferred Males Females Total Perrvgrove 26 31 57 81 10 68 23 37 60 Plumstead Lodge 21 67 88 125 5 117 20 71 91 Sunbury Lodge 15 44 59 76 5 72 13 45 58 Weybourne 18 35 53 59 1 53 20 38 58 *Southern Grove Lodge 117 58 175 197 21 188 95 68 163 Totals 197 235 432 538 42 498 171 259 430 * London Borough of Tower Hamlets Voluntary Homes Visits to Greenwich residents maintained in the following voluntary homes continue to be made by Officers of the department. 129 Voluntary Establishments 1st Jan., 1967 Admitted Discharged 31st Dec., 1967 No. of Homes No. of Residents No. of Homes No. of Residents Aged 21 27 6 4* 21 29 Blind 8 9 — — 8 9 Epileptics 3 5 2 1 3 6 Physically Handicapped 15 21 3 3 16 21 Deaf and Dumb 2 3 — — 2 3 Totals 49 65 11 8 50 68 * Including 1 Death Other Local Authority Homes The following residents are being maintained in the Homes of other local authorities: 1st Jan., 1967 Nos.in Residence 31st Dec., 1967 Nos. in Residence Males Females Total Admitted Died Dischaiged or transferred Males Females Total 5 13 18 14 3 4 7 18 25 Homeless Families Compared with the previous year, the number of families seeking help from the department on account of hopelessness showed little reduction. Families provided with shelter during 1967 was 113, a decrease of 11. Alterations, similar to those carried out in the S.E. Block during 1966, were completed to the Annexe at 158A Plumstead High Street during the year thus providing private (although not selfcontained) accommodation for a further nine families making a total of 31 in all now able to enjoy their own private kitchens and toilet facilities. Our special unit at 32 Charlton Road, opened in October, 1966, for the training and rehabilitation of "problem" families is proving to be an extremely useful and highly successful social instrument. At these four self-contained flats/maisonettes, with the assistance of social workers, these families who need more than the usual amount of support are enabled to overcome the social problems which contributed to their hopelessness. 130 Homeless Families Accommodation—Statistics Applications for Admission (Ist January—31st December, 1967) Number of Applications* 386 Number accepted into Residence 113 * Excludes numerous preliminary enquiries not amounting to applications. Homes—Admissions and Discharges Resident at 1st Jan., 1967 Admissions Discharges Resident at 31st December, 1967 Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons 'Summercourt' 3 2 3 12 17 117 69 118 233 420 111 67 112 232 411 9 4 9 13 26 158a Plumstead High Street 67 51 67 203 321 8O 67 80 202 349 82 65 82 215 362 65 53 65 190 308 32 Charlton Road 4 3 4 13 20 2 3 4 12 19 2 1 3 5 9 4 5 5 20 30 Families Rehoused By Greater London Council Families 11 Men 9 Women 11 Children 29 Persons 49 By London Borough of Greenwich 57 35 57 141 233 By other Local Authorities 3 1 3 9 13 Found own accommodation 24 10 25 55 90 Left for other reasons 16 6 16 22 44 111 61 112* 256 429 * Including 1 grandmother Unsupported Mothers and Babies Whilst the department was unable to make any progress towards its own "mother and baby" hostel, the Greenlow Society continued to improve its service for the unsupported mother. In conjunction with the Borough Treasurer, the department was able to help by fixing a maintenance rate payable with effect from 1st April, 1967, by this and other local authorities maintaining women in this hostel. Financial benefits accruing to the Society as a result of this step were more promising than concrete during the early months but good management should ensure greater benefits in the future. 131 During the year, the department gave financial help to 35 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 114.) Four mothers were maintained by this department in the Greenlow Society Hostel. SERVICES FOR THE HANDICAPPED Although, at present, some categories of handicapped people fall outside the National Health Scheme for pecuniary benefits it is the aim of our community services to help all individuals towards self-support and an independent life, such measures including rehabilitation and training for regaining capacity for work. Where this is found to be impractical, 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, a demand for more social workers in the local authority services. Again it is necessary to state that 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 Whilst it can be said that the staffing situation did not improve during the current year, wastage was less than previously. Unfortunately, we were unable to recruit any Home Teachers of the Blind to supplement the department's one social worker so qualified and the position in this respect, therefore, remains unchanged. Despite the scarcity of qualified staff, integration of workers in the social field, consequent upon the department's reorganisation, enabled all services to be maintained. Some 381 guests participated in the ten Christmas and New Year parties organised for the handicapped of which five were held at the Maze Hill Training Centre where their success was assured by the co-operation of the Head Teacher and her staff. Again, following precedent, £40 was donated by the Mayor from his Christmas Fund towards the cost of gifts for the younger handicapped. An innovation in 1967 was the arrangement made for handicapped persons to undertake their own Christmas shopping. On 132 29th November, six of our handicapped people, accompanied by members of the staff, joined in a "mammoth" shopping expedition in the King Street area of Hammersmith under the auspices of the Hammersmith Council. A further 64 persons participated in a similar shopping excursion in Woolwich on 6th December. This latter event was made possible not only by the ready co-operation of the managements of Messrs. Boots, Marks & Spencer and Woolworths, but also by the assistance of a large number of volunteers which included senior school children. 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 1967, efforts were continued to make these registers more comprehensive. Although registration is normally a prerequisite to the provision of services, no call for assistance goes unheeded by the department. Visits Visits to the handicapped during the year totalled 7,864, compared with a figure of 6,394 for 1966. This is equivalent to an increase of more than 20 per cent. 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 71 46 374 Routine/Subsequent 1,103 444 4.435 Teaching 76 25 16 Non-effective 222 116 936 Totals 1,472 611 5,761 Welfare of the Blind and Partially Sighted 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. 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. 133 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 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 53 new cases added to the register during the year, 39 (74%) were over the age of 65 years and only 2 (4%) under one year. Registered Blind cases at 444 (180 males and 264 females) showed a decrease of seven from the previous year. 134 With regard to the partially sighted, of the 27 cases newly registered, 21 (78%) were over 65 years of age and there was none under the age of 15 years. blind persons Register (as at 31st December, 1967) New Cases in Brackets AGE GROUP Number Registered Age at Onset of Blindness M F Total M F Total 0-1 year 20(1) 20(1) 40(2) 1 year — — — 1 2 3 2 years — — — 5 2 7 3 years — 1 (1) 1 (1) 1 1 2 4 years — — — 3 1 4 5-10 years 2 — 2 9 12(1) 21 (1) 11-15 years 3 1 4 2 3 5 16-20 years 6(2) — 6(2) 5(1) 4 9(1) 21-29 years 7 6(1) 13(1) 9 7(1) 16(1) 30-39 years 11 (1) 11 (1) 22 (2) 20(1) 17 37(1) 40-49 years 10 12(1) 22 (1) 15 19(2) 34 (2) 50-59 years 26 (1) 21 (3) 47(4) 21 (2) 22(4) 43 (6) 60-64 years 16(1) 20(2) 36 (3) 10(2) 27 (3) 37(5) 65-69 years 18(4) 22 (2) 40(6) 11 (3) 22 (3) 33 (6) 70-79 years 42(4) 60(13) 102 (17) 29 (5) 56 (12) 85 (17) 80-84 years 21 (3) 54 (6) 75 (9) 12(2) 31 (5) 43 (7) 85-89 years 10 34 (4) 44 (4) 6 12(3) 18(3) 90 and over 8(1) 22 (2) 30 (3) — 3(1) 3(1) Unknown — — — 1 3 4 Totals 180(17) 264 (36) 444(53) 180(17) 264 (36) 444 (53) Blind Persons under 16 Years Male Female Aged 2 to 4 years Unsuitable for Education at School: At Home — 1 Aged 5 to 15 years Suitable for Education at School: At Special Schools for Blind 2 1 Not at School No other Defects 1 With other Defects 1 — Unsuitable for Education at School: At Home (with other Defects) 1 — 5 2 135 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 2 _ 1 _ _ _ _ _ 1 21-39 years _ _ 2 1 _ 8 4 15 40-49 years _ _ 3 — _ 2 2 4 11 50-59 years _ 6 _ 2 2 8 3 21 60-64 years _ _ 4 _ 1 2 2 9 65 and over - - 1 - - - 2 - 3 totals 2 15 2 4 4 22 13 60 (ii) TRAINING OR NOT EMPLOYED Male Female Undergoing Training: For Open Employment 1 Professional or University 1 1 Not Employed: – – Employable subject to Training: Suitable for Sheltered Employment 2 -– Suitable for Open Employment 1 2 Employable without Training: Suitable for Sheltered Employment 1 – Suitable for Open Employment 3 2 Persons Registered Disabled 35 15 (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 2 13 3 7 — - 25 Not capable of Work 16 16 6 10 — _ 48 Not Working — — — — 96 192 288 TOTALS 18 29 9 17 96 192 361 136 (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 - 1 9 10 Braille Copyists and Proof Readers — 1 — 1 Clerical Workers _ — 1 1 Telephone Operators 1 - 3 4 Shop Managers and Proprietors — — 2 2 Street Vendors — - 1 1 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 3 — 4 Basket Makers 10 2 - 12 Mat Makers 3 — — 3 Brush Makers 1 — — 1 Labourers — — 3 3 Domestics, Porters, etc — - 1 1 Launderers, Dry Cleaners — — 1 1 Miscellaneous Service — — — Workers -— - 4 4 TOTALS 17 8 35 60 (v) BLIND PERSONS—IN-RESIDENTS (16 years and over) Male Female Residential Accommodation (1948 Act, Part III (21)) Homes for Blind 3 5 Others 3 4 Homes (N.H.S.A. 1946—Section 28) — 1 Other Residential Homes — 1 Hospitals for Mentally 111 — 1 Hospitals for Mentally Sub-normal 3 7 Other Hospitals 1 3 TOTAL 10 22 137 partially sighted persons Register (as at 31st December, 1967) age group Number Registered 31.12.67 Newly Registered Removals from Register during year Admitted to Blind Register Improved Visual Acuity M f Total m f Total m f m f 2-4 years _ _ _ _ _ _ _ _ _ _ 5-15 years 3 2 5 _ _ _ _ _ _ _ 16-20 years 1 1 2 _ _ _ _ _ _ _ 21-49 years 21 19 40 2 _ 2 _ 1 _ _ 50-64 years 9 14 23 1 3 4 _ 1 _ _ 65 and over 33 111 144 4 17 21 2 7 _ 1 TOTALS 67 147 214 7 20 27 2 9 _ 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 16-20 years _ _ _ _ _ 1 1 21-49 years 6 1 - - - 4 _ 11 50-64 years 3 3 - - 1 3 _ 10 65 and over 2 - - - 15 68 - 85 TOTALS 11 4 - 16 75 1 107 (ii) Persons mainly Industrially Handicapped 16-20 years _ 1 _ 1 21-49 years 11 3 3 2 1 8 _ 28 50-64 years 1 1 1 1 3 5 _ 12 65 and over - - - - 11 39 - 50 TOTALS 12 5 4 3 15 52 91 138 Sheltered Employment Greenwich Workshops for the Blind which are situated at Greenwich High Road and Feathers Place (formerly Eastney Street), continued to be administered by this department. Long absences due to illness, together with the unprofitability of the traditional trades practised at the workshops combined to produce a further increase in costs per approved blind worker. During 1966, in an effort to reverse this trend, a light engineering sub-contract was obtained which involved the drilling and deburring of plastic components for a large, local electrical firm. With a little practice, most men taking part in the experiment became capable of worthwhile rates of production, sufficient even of producing a little profit. Unfortunately, during the current year, the firm concerned was "taken over" and eventually ceased manufacturing in the area, the natural sequence of which was the collapse of this particular scheme. Nevertheless, in order that more diverse occupations may be offered, further enquiries are being made not only regarding engineering work but also in respect of other alternative trades. Blind Home-workers 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. Seven 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. (0 Free loan of a spark guard. 139 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 0s. 0d. a year (The Council makes a capitation grant of 10s. 0d. 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 letterpress 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 370 (33%) out of a total of 1,124, "organic nervous diseases" form the largest group of which two-fifths were hemi or paraplegics and one-third spastics or polio victims. With a figure of 340 (30%), rheumatic disability constitutes the next largest section and, of these, 36 per cent, were classified as rheumatoid arthritis. 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. 140 Physically Handicapped Register at 31.12.67 Primary Disabilities AGE GROUPS (in years) TOTALS DISABILITY 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 _ _ 3 1 5 17 4 14 13 7 _ 64 26 90 F — — _ _ 3 1 4 7 6 5 — Rheumatism M — — — 3 4 3 10 10 13 9 _ 52 288 340 F _ 2 1 5 7 37 18 39 111 61 7 Deformities, etc. M _ _ 4 _ 1 2 1 6 10 _ _ 24 27 51 F _ 3 4 1 _ 4 1 5 9 _ _ Systemic Diseases M 1 _ 3 1 4 5 5 11 5 6 _ 41 39 80 F — — 5 — 4 10 7 6 2 5 — Injuries and diseases M _ 3 7 2 5 6 4 3 4 2 _ 36 55 91 F _ 1 3 3 7 10 3 7 17 4 _ Organic Nervous Diseases M 2 15 18 19 36 29 24 25 2 3 _ 173 197 370 F 2 14 18 14 19 44 35 22 27 2 _ Neurosis M _ 1 1 _ 1 1 _ _ 3 _ _ 7 8 15 F _ _ 1 _ 2 1 1 _ 3 _ _ Tuberculosis M _ _ 1 _ 2 4 1 1 1 _ _ 10 2 12 F _ _ _ _ _ 1 _ _ 1 _ _ _ Other M _ _ 1 2 1 5 4 1 4 3 _ 21 54 75 F _ 1 4 2 7 12 3 8 8 9 _ Totals M 3 19 38 28 59 72 53 71 55 30 _ 428 696 F 2 21 36 25 49 120 72 94 184 86 7 Grand Totals 5 40 74 53 108 192 125 165 239 116 7 1124 (i) Analysis of "Rheumatism" Group AGE GROUPS (in years) TOTALS DISABILITY 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 Arthritis M _ _ _ 2 1 | 4 3 4 6 _ 21 152 F _ 1 | 2 3 9 8 19 53 31 4 131 Rheumatoid Arthritis M _ _ _ 1 3 2 2 1 6 1 18 123 F _ 1 _ 3 21 8 16 44 7 2 105 Osteo-Arthritis M _ _ _ _ _ _ 4 4 3 2 _ 13 65 F _ _ _ _ 1 7 2 4 14 23 1 52 Totals M _ _ _ 3 4 3 10 10 13 9 52 F _ 2 1 5 7 37 18 39 111 61 7 288 Grand Totals _ 2 1 8 11 40 28 49 124 70 7 340 141 (ii) Analysis of "Disease of Systems" Group 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 Bronchitis M _ _ _ _ 2 J 1 _ 1 1 _ 6 11 F _ _ — _ 1 2 1 _ _ 1 _ 5 Heart Diseases M — _ 1 1 1 2 1 7 1 2 _ 16 30 F — — 1 _ 2 2 4 1 1 3 _ 14 Sclerosis M 1 — 2 — — 2 3 4 2 3 _ 17 36 F — — 4 — 1 5 2 5 1 1 _ 19 Others M _ _ _ _ 1 _ _ _ 1 _ _ 2 3 F _ _ _ _ _ 1 _ _ _ _ _ 1 Totals M J _ 3 1 4 5 5 1 1 5 6 _ 41 F _ _ 5 _ 4 10 7 6 2 5 _ 39 Grand Totals 1 _ 8 1 8 15 12 17 7 11 _ 80 (iii) Analysis of "Organic Nervous Diseases" Group AGE GROUPS (in years) TOTALS DISABILITY 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 Spastics M 1 4 1 8 1 4 3 1 _ _ _ 26 67 F 2 4 4 3 4 6 10 6 _ 2 41 Hemi- and Para-Plegia M _ ? 11 1 1 15 10 16 2 71 150 F _ 2 4 4 6 24 12 10 17 _ 79 Epilepsy M _ _ I 5 4 6 2 3 _ _ _ 21 49 F _ _ _ ? 6 6 5 2 4 28 Poliomyelitis M I 7 _ 2 10 2 7 3 _ _ 32 F _ 5 5 3 _ 2 3 2 1 _ _ 21 53 Encephalitis M _ 2 _ 1 _ _ 4 F _ _ _ _ _ 3 3 _ 2 _ _ 8 19 Parkinson's Disease M F _ _ 1 2 6 2 _ _ 1 1 _ _ 9 10 Friedreich's Ataxia M _ _ _ _ ?, _ _ _ _ _ _ 3 6 F _ 2 _ _ 1 _ _ _ _ _ _ 3 Other M _ _ 2 1 2 1 _ 1 _ _ _ 7 14 F - 1 2 2 _ _ 1 1 _ _ _ _ 7 Totals M 2 15 18 19 36 29 24 25 2 3 173 F 2 14 18 14 19 44 35 22 27 2 _ 197 Grand Totals 4 29 36 33 55 73 59 47 29 5 370 142 (iv) Additions and Removals on Physically Handicapped Register DISABILITY GROUPS Sex Number at 31.12.66 Additions during yr. Deletions during yr. Number at 31.12.67 Amputation M 45 27 8 64 F 29 — 3 26 Rheumatism M 49 8 5 52 F 271 52 35 288 Deformities M 4 20 24 F 21 6 27 Systemic Diseases M 41 13 13 41 F 46 1 8 39 Injuries and Diseases M 26 11 1 36 F 58 2 5 55 Organic Nervous Diseases M 148 41 16 173 F 167 52 22 197 Neurosis M 5 2 — 7 F 6 2 — 8 Tuberculosis M 6 4 — 10 F — 2 — 2 Other M 20 7 6 21 F 51 10 7 54 Total M 344 133 49 428 F 649 127 80 696 Grand Totals 993 260 129 1124 Reference to table (iv) shows that although the number of registrations, viz. 1,124, is an increase of 131 over the figure for the previous year, there were actually 260 new registrations during the current year with 129 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 143 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. Social Rehabilitation Centre, Ormiston Road Club facilities are provided for general classes of physically handicapped persons on Monday, Wednesday, Thursday and Friday of each week. Each person attends for a half-day session, either morning or afternoon once a week. On Tuesday there is a full-day session for partially sighted persons. In addition to normal Centre activities, special classes in handicrafts and art are held with the assistance of Instructresses provided by the Inner London Educational Authority. A maximum of 14 persons are able to attend each session and everyone is provided with a mid-day meal. At present there is a waiting list for admission to the Centre. St. Saviour's Centre for Handicapped Young People On an average, 11 severely handicapped young people attend this centre which meets each Monday, Thursday and Friday in the Youth Club at St. Saviour's Church Hall, Eltham. Lunches are served at midday. This centre also has the services of a handicrafts Instructress supplied by the Inner London Education Authority. 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 18. Minor Hall, Greenwich This club is for persons who are blind or deaf and meetings are held every Thursday afternoon. The average attendance during the year was 23. Works of Access and Adaptation The Council may accept financial responsibility for works of access and adaptation which are necessary to enable a handicapped person to overcome the effects of his disability. During the year a total of 47 persons benefited from a variety of works, including the provision of hand-rails, grab-rails, ramps, etc. 144 Although each person was assessed to contribute towards the cost of the work, according to his means, in the majority of cases little or no charge was made. Adaptation for Kidney Machine In March, 1967, the Renal Unit of the Royal Free Hospital offered to provide one of its patients, a local resident, with a Dialysis Machine for use at home. However, certain works of adaptation had first to be carried out at the patient's home to facilitate the installation and use of the machine. It was necessary to provide an electric power point, a sink unit with hot and cold water services and Waste outlets, together with other minor structural alterations. All the required adaptations were carried out by the Council under powers contained in Section 28 of the National Health Service Act, 1948, and the machine was successfully installed. Loan of Equipment The scheme for the loan of nursing and sick-room aids, including aids and gadgets for handicapped and elderly persons, continued to expand during the year. Such equipment is provided on free loan at the request of the Family Doctor, District Nurse, Medical Social Worker, Health Visitor, Old People's Visitor, etc. Total issues during the year numbered 2,434 as compared with 1,420 during the Drevious vear which represents an increase of over 71 per cent. over 71 per cent. The following table shows particulars of these loans. Equipment Number 1967 Loaned 1966 Bathing Aids Bath Boards 22 23 Bath Mats Ill 36 Bath Rails 62 21 Bath Seats Ill 43 Bed Aids Air Ripple Bed 8 3 Air Rings 79 41 Back Rests 175 103 Bed Blocks 10 8 Bed Cradles 129 83 Bed Pans 132 54 Sorbo Rings 119 32 Fracture Boards 21 23 Mackintosh Sheeting 167 101 145 Equipment Number Loaned 1967 1966 Urinals 100 43 Stoke Mandeville slings — 2 Beds Adult Cot 5 6 Egerton Bed — 1 Hospital Bed 19 16 Zed Bed 3 — Commodes Armchair 437 348 Others 8 1 Domestic Aids Combs/Holders 2 1 Fireguards 41 34 Pick Up Aids 28 11 Shoe Horns 6 3 Shoe Laces 7 — Sparkguards 6 — Stocking Aids 7 6 Tap-Turners — 3 Trolleys 6 4 Wall-can openers 1 2 Eating Aids Cutlery 4 — Food Guards 1 1 Hoists Easi-Carri 9 2 Zimmer Patient Lifter 1 — Lifting Poles, Handles and Chains Handy Spring Pole 2 — Lifter-Penryn 27 15 Mattresses Dunlopillo 17 14 Easi-nurse 1 1 Hair 15 9 P.C.P. 3 1 Premature Baby Scales 7 14 146 Equipment Number Loaned 1967 1966 Toilet Aids Raised Toilet Seats 41 11 Toilet Aid (Easi-fit) 12 6 Toilet Aid (Zimmer) 6 Toilet Air Rings 1 5 Walking Aids Elbow Crutches 10 2 Quadruped Aid 3 — Tripod Aid 31 19 Walking Frames 150 109 Walking Sticks 50 18 Wheelchairs Indoor 59 57 Outdoor 162 84 Total Issues 2,434 1,420 The Council's scheme of temporary loan of outdoor wheelchairs is essentially designed to provide a recreational facility for homebound old people. The period of the loan is restricted to two months at a time. After this, the applicant's name is placed again on the waiting list and he/she is eligible to receive a further loan as soon as a wheelchair becomes available. Persons who are in permanent need of an outdoor wheelchair may be provided with one by the Ministry of Health on the recommendation of a Hospital Consultant. Special Physical Aids for the Handicapped In addition to the range of aids and gadgets which are available under the loan of equipment scheme, a variety of special aids were provided for individual physically handicapped persons to assist them in overcoming particular difficulties. These items included a runabout chair, a kitchen stool, foot stool, overbed table, electric shaver, etc. 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. 147 During the year, some 357 applications were dealt with regarding holidays for handicapped persons. For various reasons 101 of these were subsequently cancelled and the actual number proceeding on holiday was 256, an increase of 75 (41%) over the 1966 figure. Of these, 148 were accommodated at the Council's own hotel at Westgate-on-Sea. Persons receiving holidays are assessed to contribute towards the cost according to their means. Transport For many handicapped people, one of the most distressing features of their disability is a severe impairment of mobility. A suitable means of transport for such people is a prime necessity in fostering interests and activities outside the home. The Council's transport for the disabled comprises a fleet of minibuses and four specially designed coaches equipped with a tail-lift for loading the severely disabled. Each coach can accommodate up to three patients in wheelchairs in addition to those in the passenger seats. These vehicles are used mainly to convey people, who are unable to use normal transport, to clubs and centres organised by the Council and numerous voluntary agencies. Transport is also provided by the department for holiday schemes and occasional outings. Christmas Shopping Expedition Many handicapped people are virtually homebound. Many others have extreme difficulty in shopping, particularly at times of the year when the pavements and shops are exceptionally crowded. For this reason a Christmas Shopping Expedition for about 80 physically handicapped persons was arranged on a Wednesday evening in December. Invaluable assistance was received from a number of large stores in central Woolwich, which closed late especially for this purpose. Transport was provided by the Council to convey the handicapped to and from the shops and a large number of voluntary helpers were recruited to push wheelchairs and generally assist the shoppers. The expedition was very greatly appreciated by the handicapped persons who participated. Future Development Considerable scope for the improvement and expansion of services for the handicapped exists which can only be fully satisfied when finances become readily available. Notwithstanding, it is anticipated that, in the near future, the opening of combined centres will provide urgently needed facilities for handicapped persons. 148 MENTAL HEALTH SERVICES With regard to these services the close of the current year was marked, nationally, by the raising of the question as to which authority (education or health) was better suited to undertake the training and education of the mentally sub-normal child. It would appear that, in present circumstances, parents of some mentally handicapped are concerned that their children may not be receiving the best possible education and training commensurate with their abilities or aptitudes. Briefly, the present position may be summarized thus : — Under Section 57 of the Education Act, 1944, as amended by the Mental Health Act, 1959, a local education authority must ascertain which children in its area are suffering from mental disability such as to make them unsuitable for education at school. Training of children so designated then becomes the responsibility of the local health or hospital authority. Indeed, in accordance with Section 12 of the Mental Health Act of 1959, a local health authority has the power to compel attendance at a training centre of any such child of school age. The provision of training centres and residential accommodation for the mentally handicapped is a duty placed upon local health authorities under Section 28 of the National Health Service Act, 1946, as extended by Section 6 of the previously mentioned Mental Health Act. Inevitably, many cogent arguments will be advanced for and against local health authority control but, in the ultimate analysis, it is not administrative convenience that should determine future patterns but the quality of the service and its ability to benefit the mentally handicapped child. However, it would seem logical that, whichever authority is finally made responsible, the disturbing possibility of transfer and re-transfer from one authority to another should be eliminated. Experience, locally, shows that the majority of these mentally handicapped will need either supervision or social welfare support beyond school age and this will fall to local authorities to supply. Early settlement of such a vital issue is important not only in the best interests of the children themselves but also from a planning aspect which, subject to the eventual decision, may require substantial re-organisation and/or re-orientation. General During 1967, mental health services continued as previously, the introduction of improvements and new facilities being severely curtailed by financial expediency. 149 Staffing difficulties remain despite the re-organisation, in September, of the department's community services. However, all emergency demands upon the mental section were satisfactorily met. 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 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 No. of new referrals 40 No. of old cases seen 23 Disposal of Cases Since investigation, two Greenwich children have been admitted to Maze Hill Junior centre, five to the Greenwich Society for Mentally Handicapped Children (Eltham Creche) and 29 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 150 service and, as previously indicated, the question of "after-care" is settled by discussions between the deputy principal mental health officer and the school head. Similar steps are taken with regard to maladjusted school-leavers at the age of 15 years since these children are classified as mentally ill. There is the closest co-operation between the Mental Health Service and that of the Divisional School Care Organiser. It is the policy for community care to cease at the age of 18 years provided employment is well tolerated and no adverse reports are received. Training Centres Maze Hill Junior Centre Purpose-designed on a difficult site, this centre was half completed when inherited from the previous London County Council. It is organised on educational lines and every attempt is made to create a "school" atmosphere in order to prevent the dichotomy which could so easily arise between the health and education aspects of such an establishment. No arbitrary limit is placed upon educability or ineducability, each child being considered as an individual and, after his/her aptitudes have been carefully assessed, the skills or functions, however modest, which have a potential for development are encouraged and exploited. Behaviour and aptitudes have improved remarkably and the parents and relatives of these handicapped children have been made to feel that, at long last, education and training is a matter of degree and not of segregation and priorities. Parents' confidence has been restored and they feel able to face a future which now holds a measure of promise hitherto denied them. The centre provides for the accommodation of 112 children in three main groups: — 1. Nursery A unit serving the needs of 20 children between the ages of 3½ and 5 years in the severely subnormal range including a few selected subnormal children who suffer from specific problems such as walking, speech, self-feeding or behaviour with a view to their entering, eventually, a special school. 2. Training Centre Catering for a total of 80 children between the ages of 5 and 16 years, this section is organised into four classes each of 20 children including a transition class for boys and girls aged 14 to 16 years. "STILLS" FROM HEALTH EDUCATION COLOUR FILM "THEY HAVE A FUTURE" (E.S.N. Training) Co-ordination—Ear and Eye (Music and Singing) Co-ordination Hand and Eye "Budding Academician" Development of Expression & Touch "Finger Painting" Development of Expression & Touch "Playing with Dough" Learning can be such Fun "T; ,Tie to Go" Hygiene Education Encouragement of Responsibility—"Measuring Water" "Preparing Tea" Encouragement of Responsibility 151 It is the intention of centre training to have regard to the whole personality of a child and eventually to prepare him/her not only 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 must also be considered as a training unit in that children are being helped towards greater independence. On admission at the age of 5 or 6 years, some children are still bottle-fed and a great deal of skilled and patient teaching is required to assist them to surmount the physical handicaps which make self-help so difficult. This group, perhaps above all others, needs to be taught leisurehour activities in order that the many hours spent by its members in wheelchairs at home may, in fact, be those of leisure and not of boring deleterious idleness. Since the inauguration of this training unit, success has crowned the efforts of the staff in creating a stimulating and happy atmosphere and an environment within which children are given the best of opportunities to assimilate and adjust. It is not surprising that, with such an avant garde establishment as this centre undoubtedly is, visitors are attracted not only from this country but from Europe and America and its influence on the design of other authorities' new centres has been significant. Furthermore, it has played an important role in re-orientating attitudes both of lay and professional workers who are associated with such training centres. During the current year, the daily routine and teaching methods employed at this centre became the subject of the Health Education Section's first effort at film making entitled "They Have a Future" Despite certain technical deficiences inevitable in a "first" production, this colour film has been very warmly received and is used by the London Borough's Training Committee for teaching purposes. The Health Education Section are to be commended on the completion of a highly successful educational project. I am pleased to include a report by Miss Godfrey, the Head Teacher, on the year's activities at the centre: — "During the past twelve months several new ventures have been launched. We have been successful in booking a weekly session at the Greenwich Swimming Baths with an instructor to teach our children to swim. 152 In the early days we found the children fearful of the water and unwilling to move from the security of the handrail. It has been encouraging both to the staff of Maze Hill and to the swimming instructor to note that, in a very short period of time, the children have not only overcome their fear of the water but have been successful in obtaining a number of swimming certificates. The children have to reach the same standard of efficiency as any normal child to obtain these awards. In the near future we hope to have our own small teaching pool within the centre, thereby enabling us to introduce our very young children to the water in preparation for more advanced tuition later. Older boys and girls at Maze Hill are now firmly established within a transition class. The aim of the group is to ensure, as far as possible, that our children, moving on at the age of 16, are socially and emotionally prepared for adult life. Work in this group is organised under four headings: — Domestic Science Cookery, shopping, house care and laundry. Needlework Care and repair of clothes and the making of simple garments for themselves, using hand sewing and operating hand and electric machines. Woodwork and Gardening Making and repairing toys and equipment for the younger children, producing vegetables and flowers for use in school. Hygiene and Beauty Culture Instruction of both boys and girls in personal cleanliness and neatness, the washing of hair and, in the case of the girls, to set it into simple but attractive styles. Girls are also taught the discreet use of make-up. Throughout the school the children have developed a selfconfidence not often associated with the Severely Sub-normal child. Moreover, they mix in the local playground with normal children without difficulty. A holiday for 22 children was happily and successfully undertaken, and again, the interesting and encouraging aspect was the near normality of the children's behaviour. Our newest venture is the introduction of a Parent/Teacher Association. It is hoped by forming a common meeting ground for discussion and exchange of ideas we will be able to improve still further the service for our children. 153 Again, over the year, we have welcomed a very large number of visitors to the centre from many different countries and walks of life. In this ever changing field of work it is very valuable to be able to hear of the various experimental projects taking place and to take from them the useful material they offer. The staff situation has remained very stable over the year. One member of staff removing from the district was replaced by a teacher who had already worked within the centre for her period of practical training whilst at college. Physical development of the multiple handicapped child has been greatly assisted by our physiotherapist. As well as working with individual children she has made herself available to all members of staff in an advisory capacity thereby becoming very much a member of the 'Maze Hill' team. Liaison between the centre and other members of the Mental Health team has been strengthened and Mental Welfare Officers and administrative staff, by their support, have greatly assisted and enriched the quality of the service given to the children." Park Vista AdulT 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 adults of both sexes. Unfortunately, restrictions imposed by the terms of the lease tend to limit the exploitation of this establishment to its full potential and the service is correspondingly circumscribed. Despite initial misgivings, the conversion of this centre from a female establishment to one accommodating both sexes was successfully accomplished by exchanging our boys at the Lewisham Knoyle Street centre for the Lewisham girls working at this centre. 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. 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 25 trainees from this Borough and a further 10 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 154 to teach them to be emotionally stable and socially acceptable in order that they may live harmoniously within the community. During 1967, progress continued substantially assisted by the use of premises at 6 St. John's Park. Utilisation of these premises not only enabled 12 trainees to undertake woodwork training, an activity precluded at Blackwall Lane owing to the lack of space, but in releasing accommodation at Blackwall Lane, allowed the introduction of more machinery thus widening the scope of work which could be handled by the centre. Mr. Rickards, the centre Supervisor, reports as follows: — "During 1967, the centre maintained an upward trend in the production of sub-contract work and our takings for the year reached £2,400. We have become more mechanised and now have three printing machines, two lathes, three bench drills, a grinding machine, a sanding machine, a toggle press and three kick presses. Machinery now occupies an important place in the training programme. Operating skills, care and maintenance and respect for the safety rules of a machine workshop, all form part of the curriculum for trainees. Much of the machinery was purchased second-hand and. under instruction the trainees have dismantled, cleaned, repaired, repainted and re-assembled it into working order. During the year, five trainees have left the centre to work in open employment. This is one less than last year but this is due. I feel, to the closing down of the larger factories in our area and the ensuing employment difficulties." Knoyle Street Centre Greenwich boys attending this Centre which is held in a Church Hall and is under the control of the London Borough of Lewisham have been engaged in woodwork, basket making, etc., and, more recently, in dismantling Post Office telephones. A mixed adult training centre was established within our own Borough in November of the current year by transferring the Greenwich boys to this Council's premises at Park Vista in exchange for the Lewisham girls working there. The department's use of the Knoyle Street centre was therefore discontinued from that date. 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 155 obtained by the direct approach to employers for as problems arise they can be brought immediately to our notice. Holidays Under a scheme intended to cater for those who would otherwise have no holiday, 62 trainees from the various training centres were enabled to spend a happy vacation at St. Mary's Bay Holiday Camp, Dymchurch, during the summer. 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. Training Centre Statistics Centre Number of Places Number of Greenwich Cases attending Park Vista (Adult Girls and Boys) 60 60 Blackwall Industrial (Adult Girls and Boys) 35 25 Maze Hill (Junior) 112 110 Guardianship Society Not known 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. 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 156 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 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 grants from the Ministry of Social Security. Clubs Club facilities for the "over 16's" are provided on Thursday evening at the Park Vista Adult Centre and attendances usually range between 25 and 3D. 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 E.S.N, 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. 157 Subnormal Patients Placed in Homes or Hostels Roman Catholic Convents 5 Guardianship Society—Private Homes 6 Approved Private Homes 4 Halliwick School 1 National Society for Mentally Handicapped Children—Slough Project 3 Spastics Society—Meldreth 1 Services for the Mentally III 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 rehabilitating 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. 158 NUMBER OF PERSONS UNDER LOCAL HEALTH AUTHORITY CARE AT 31st DECEMBER 1967 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 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 6 1 170 296 22 52 — 5 1 3 3 59 69 70 59 63 80 959 2 Attending training centre — — 23 27 — — — — — — 2 2 7 16 59 41 28 43 248 3 Awaiting entry to training centre — — — — — — — — — — — — — — 10 3 — — 14 4 Receiving home training — — — — — — — — — — — — — — — — — — — 5 Awaiting home training — — — — — — — — — — — — — — — — — — — 6 Resident in L.A. home/hostel — — 4 3 — — — — — — 1 — — — — — — — 8 7 Awaiting residence in L.A. home/hostel — — 2 2 — — — — — — — — — — 1 1 — — 6 8 Resident at L.A. expense in other homes/hostels — — 3 3 1 5 — — — — — — — — 1 3 2 8 26 9 Resident at L.A. expense by boarding out in private household — — — — — — — — — — — — — — 2 — — 4 6 10 Attending day hospitals — — 4 11 — — — — — — — — — — — — — — 15 11 Receiving (a) suitable home visits to attend and not a training included in centre lines 2-10 — — — — — — — — — — — — — — — — — — — (b) others 6 1 134 250 21 47 5 1 1 52 53 1 15 34 29 650 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 4 Female 6 159 (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 Monday p.m. Hospital Wednesday 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 three 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. 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. Castlewood Day Hospital Undoubtedly the day hospital has great potentiality locally and this day hospital is pleasant and reasonably accessible. 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. 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 160 NUMBER OF PATIENTS AWAITING ENTRY TO HOSPITAL, OR ADMITTED FOR TEMPORARY RESIDENTIAL CARE DURING 1967 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 Under age 16 16 and over M F M F M F M F M F M F M F M F M F (D (2) (3) (4) (5) (6) (7) (8) (9) (10) 01) (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 (c) Total — — — — — — — — — — — — — 1 4 5 — — 10 2. Number of admissions for temporary residential care (e.g. to relieve the family) (a) To N.H.S. hospitals — — — — — — — — — — — — — — 13 10 — 2 26 (b) To L.A. residential accommodation — — — — — — — — — — — — — — — — — — — (c) Elsewhere — — — — — — — — — — — — 1 1 6 3 2 8 21 (d) Total — — — — — — — — — — — — 1 1 19 13 3 10 47 161 psychiatrists who remain the sole sources of referral which is effected almost exclusively through the out-patients clinics. Day Centres Chevening Road Catering for adult mentally-ill of both sexes, this clinic was held on Thursday from 10 a.m. until 4 p.m. This centre was closed in February of the current year and replaced by that at 6 St. John's Park, a move which proved to be highly successful. St. John's Park Opened in February, this centre has taken the place of that which previously operated at Chevening Road Welfare Centre. Its use may only be temporary for these premises were purchased originally for a hostel but, largely owing to financial restrictions, its conversion has had to be delayed. An average of some 25 persons have been accommodated for five days a week and the excellent atmosphere generated since its inception has led to an almost unbelievable improvement in the mental condition of people participating. Successful integration of physically handicapped with the mentally ill has been achieved and justifies the department's decision to press for combined centres in the future. 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. It is the intention to utilise this establishment not only as a combined centre to rehabilitate persons who are suffering or have suffered from mental illness and physical handicaps but also, eventually, to furnish and equip part of the premises to accommodate up to 20 senile persons for similar purposes. 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 or transport arranged, patients will be provided with a subvented midday meal and some form of medical supervision is being contemplated. Opportunity can be taken to utilize the Centre for evening club and group activities. 162 NUMBER OF PERSONS REFERRED TO LOCAL HEALTH AUTHORITY DURING YEAR ENDED 31st DECEMBER 1967 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 (a) General practitioners 2 1 56 121 — — — - 2 — — — — — 182 (b) Hospitals, on discharge from in-patient treatment — 1 79 144 — — — — — — 1 — — — 1 2 229 (c) Hospitals, after or during out-patients day treatment — — 19 48 — — — — 1 — — — — — — — 68 (d) Local education authorities 2 3 4 1 — — - — 5 2 13 9 8 6 — 3 56 (e) Police and courts - - 8 15 — - — — 1 - 3 — — — — — 27 (f) Other sources 6 1 73 129 — — - — 4 6 10 7 2 2 1 — 241 (g) Total 10 6 239 458 11 8 29 16 11 8 2 5 803 163 Mentally III Persons Placed in Homes or Hostels Mental After-Care Association Hostels 8 Jewish Welfare Board Hostel 1 Private Approved Home 1 S.O.S. Society Hostel 1 National Association for Mental Health Hostel 1 Honor Lea (London Borough of Lewisham Hostel) 7 Therapeutic Clubs Club Day Staff Attendances "Tideway Club", Albany Institute, Creek Road, S.E.8. Wednesday evening (Shared with neighbouring Borough of Lewisham) Mental Health Officers from both Boroughs Between 25 and 30 "Castlewood", Shooter's Hill, S.E.I 8. Tuesday evening (Day patients only) Bexley Hospital Appointees Between 20 and 30 "The Links", Castlewood, Shooter's Hill, S.E.18. Friday evening (For ex Bexley Hospital patients) Bexley Social Worker Between 12 and 18 "Vanbrugh", Kidbrooke House, Mycenae Road, S.E.3. Monday evening (For ex Bexley Hospital patients) Bexley Hospital Occupational Therapist Between 8 and 16 A therapeutic group for alcoholics supervised by a Bexley Hospital consultant psychiatrist meets at Castlewood on Wednesday evenings. GERIATRIC SERVICES Although additional local authority powers and duties are envisaged in a new Bill now before Parliament, present legislation covering the specific needs of elderly people is still scanty and much of the work now being executed in this field is dependent upon the enthusiasm and dedication of the staffs of enlightened local authorities and hospital boards. For years illnesses and disabilities of elderly persons had been considered a natural corollary of old age and, ipso facto, not worthy of special attention. Indeed, until more recent times, lack of positive effort towards alleviating disabilities in old age was often justified by attributing them to degenerative processes and therefore not preventable. Moreover, many consciences were salved by the suggestion that, in any event, treatment of the elderly would merely prolong their misery and that their interests would best be served if they were left alone and undisturbed. 164 It was only after the establishment of the National Health Service in the latter 1940s that serious attention began to be paid to geriatrics and its associated problems by local authorities and, for that matter, by the medical profession as a whole. Fortunately, at long last, stimulation of medical interest has resulted in greater emphasis being placed upon the preventive aspects of illness in old age. Prevention of disease at any age is usually long term but this is especially true regarding many of those disabilities associated with the ageing processes. For instance, health education in the field of dietetics is a necessity if obesity with its accompanying sequelae of arthritis, diabetes and hypertension are to be avoided and, appropriate financial arrangements need to be made to prevent the debility and hypovitaminosis arising from malnutrition born of persistent straitened circumstances so common in elderly households. Patently old age modifies most diseases and, in geriatric cases, the classic symptoms are usually not so pronounced. Because of diminished response in the senium, breakdown in physiological mechanisms controlling blood pressure, temperature and water balance is often insidious and painless. Lack of response of the heat-regulating centre of the brain brought about by cerebrovascular disease, perhaps presenting as "confusion" in the elderly, could lead to ailments such as pneumonia, tuberculosis, genito-urinary and other infections escaping detection and perhaps to cases of irreversible hypothermia. Again, because of the absence of pain, loss of movement in an old person can sometimes be mistakenly attributed to a "stroke" when it may well be due to an undiagnosed fracture and the onset of deafness or defective sight, failings frequently met with in the elderly, are often so imperceptible that only chance examination reveals their existence. Immobility arising from bad feet or arthritis of the knee or hip joint can lead to progressive dependency which, although not in itself lethal, could result in many unhappy years being spent expensively in an institution until a final illness terminates the misery. Despite the fact that in old age multiple pathology is the rule rather than the exception, much of this illness is non-lethal and, far from being degenerative and untreatable, many disabilities such as anaemia, thyroid disease (both hypo and hyper functioning), congestive cardiac failure, urinary tract infection, depression, etc., are manifestly treatable conditions. Leaving aside the humane elements of the problem there are sound economic reasons for even further emphasis on the prevention of disability in old age and, advantages gained by early recognition and treatment of many of these ailments can be 165 stantial. Independence, that essential ingredient of a contented retirement, would be prolonged, local authority residential accommodation would be more suitably filled and many hospital places released for more urgent and less "bed-blocking" cases. Indeed, it has been estimated that today, because of high morbidity rates in the older age groups, two-thirds of all hospital beds (other than those for paediatric, maternity and mental cases) are occupied by persons over the age of 65. With the anticipated increase during the next 10 to 20 years in the elderly population, especially those over 75 the majority of whom will be women, some alleviation of the strain on hospital resources is essential if a breakdown is to be averted. It seems that an effective geriatric service must be based upon the following propositions :— (a) Preventive action—nutritional, prophylactic and educational. (b) Ascertainment of disability. (c) Provision of all necessary supportive services or prompt hospitalisation, as appropriate, to prevent, reverse or decelerate dependency. (d) Adequate and suitable residential accommodation when required. How can such services be organised and how ought they to be implemented? It has been estimated that some 95% of all old people live and die at home. Logically, therefore, the first lines of defence must be established in the home by preventive-orientated medical and nursing agencies. Despite very strong support for a hospital-based geriatric service it is clear that, without a re-orientation of its functions or a substantial increase in nursing and ancillary staff, the existing hospital services would be unable to sustain the imposition of a further heavy and growing burden. Moreover, at present, hospitals can deal only with such cases as are referred to them, namely, those with overt disease or persons in whom doctors have suspected some disability. Even this situation pre-supposes that elderly people, as a whole, regularly attend their own doctors who are aware not only of the medical condition of their patients but also of their social and environmental circumstances. There is ample evidence that this is not so and that more than half of all disabling conditions occurring in elderly persons are unknown to their general practitioners. This probably arises from the fact that it is traditional in this country for medical treatment to be based upon the 166 reporting of illness, a method known to be largely ineffective in the case of old people irrespective of their financial status. It can clearly be seen that hospital links with the bulk of elderly persons in the community, all of whom are potential geriatric patients, is tenuous and through other agencies. General practitioners are only able to deal with those presenting for treatment. In this respect, therefore, although having their own important roles to play, both the hospital and general practitioner services fall seriously short of providing the fundamental conditions necessary for a successful geriatric service, viz. preventive action and ascertainment of disability. Prevention has always been the prerogative of local authority health departments and, without doubt, attention to long term measures is fundamental to eventual overall improvement. However, there still remains the problem of discovering how much disability exists in the elderly population, whether it is curable and, if not, JioW sufficient improvement can be achieved to enable patients to regain independence and become acceptable once more in society. Health departments with their peculiar standing in the community and their accumulated knowledge of social and environmental conditions are in a particularly advantageous position to seek and ascertain the extent and seriousness of the hidden disabilities of our older citizens. Future Prospects It is universally recognised that during the next decade the proportion of old people in the country's population will rise to approximately one-sixth. A problem of such magnitude could be a daunting prospect for the health, welfare and social services which may well be hampered by financial considerations for some time to come. In this connection, there is one aspect of an ageing population which receives all too little attention but which will gain in importance over the coming years. It is the question of leisure. Inextricably bound up with the rapidly growing geriatric problem is that of leisure and its profitable use. In these modern days, if we are to hold our position as one of the most successful industrialised nations of the world, we must learn to utilise our increasingly expensive capital equipment more fully and, therefore, more economically. During the next five to ten years, this will undoubtedly demand round-the-clock working which will result in greater productivity and more leisure being made available at other than normal times, all with the same or even less manpower. The working week will be reduced but, more 167 fically, this, together with work-study, technical advancement, automation and computerisation, will ultimately mean compulsory earlier retirement for many with a consequent intensification of pressure on the health, welfare and social services. Perhaps the most vulnerable of these newly retired will be the less well educated who have never learned to use their leisure fruitfully. It seems that qualities are required for a happy retirement other than those needed during a working life and some method must be found to discover and nurture latent gifts and talents. Failure in this respect will, in some instances, lead to apathy and aimlessness and finally to decrepitude and, in others, to less reputable, ethical or satisfying avenues of escape such as bingo, gambling on dogs and horses or pools, etc. The one will give rise to physical and mental impairment and the other to financial embarrassment to be relieved at public expense. Persons retiring from a more sophisticated milieu will demand more cultural, educational and engrossing diversions. It is clear that the need for allembracing pre-retirement courses is becoming imperative. Unfortunately, with greater mechanisation, the bulk of the country's manpower will be engaged in repetitive, boring and less intricate and interesting tasks and, for youth especially, this will prove a formidable obstacle. However, in this depressing outlook there is one bright spot. Not all young people would wish their leisure to be filled with outdoor pursuits such as mountain climbing, canoeing, hiking, etc., and their enthusiasm could be channelled towards various voluntary services for the older citizen. In fact, their search for adventurous leisure-time activities could, with mutual benefit, be successfully married to the elderly person's need. Of all the social problems likely to face the country within the next two decades, that of the "retired" elderly will be the greatest and not only in numbers. Retirement, especially on the scale already presaged, is a comparatively modern phenomenon and there is no previous experience or "know-how" upon which to rely for guidance. Future geriatric problems will be legion but we must not wait for them to descend haphazardly upon us before attempting to deal with them. If we do, the transition from the active elderly to the incapacitated or disorientated old person will be precipitate, socially costly and personally tragic. The necessity for "vision" was never more clearly demonstrated. Visiting All services relevant to those elderly with diminished physical and/or mental activity germinate from skilled and diligent visiting. 168 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 1967 amounted to 16,207, a fall of one-third from those of the previous year. This is accounted for partly by the shortage of qualified staff and partly by reorganisation teething troubles. 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, 1967 9,006 Number in Register at 31st December, 1967 9,340 Elderly Handicapped Persons included in the above Register: (i) Blind 310 1,063 (ii) Partially Sighted 150 (iii) Physically Handicapped 603 Visits by Women Public Health Officers Total Visits by Officers during year 16,207 1st Visits 971 Subsequent Visits 12,310 Unsuccessful Visits 2,926 Cases referred to : — British Red Cross Society 14 Chest Clinics 13 Church or Club 78 District Nurses 85 Chiropody Clinic 89 Chiropody Clinic Domiciliary Service 180 General Medical Practitioners 160 Borough Department:— Housing 277 Public Health Inspectors 53 Home Help 443 Blind Welfare 14 Mental Welfare 50 Physically Handicapped Welfare 48 Old People's Holidays 541 169 Hospital Service 44 Ministry of Social Security 64 Mobile Meals 485 Radio:—(Wireless for the Blind) 37 Borough 3 Others 8 Women's Royal Voluntary Service 13 Ophthalmic Domiciliary 27 Dental Domiciliary 19 Friendly Visitor 35 T.V.: —(Wireless for the Blind) 56 Anonymous donor 47 Others 114 Transport—British Red Cross Society 8 Referred for Pt. Ill Accommodation 98 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 1967. The additional unit opened at Lionel Road during 1966 to add to those already operating at Tunnel Avenue and Plumstead Baths proved most successful. 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. 170 Tunnel Avenue Plumstead Lionel Road Total Number bathed at home 2.679 3,718 2,654 9,051* Number bathed at centre 1,824 1,045 919 3.788t Pedicure 218 49 108 375 Hair-washing 22 10 2 34 * Males 1,979 Females 7,072 t Males 817 Females 2,971 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 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 which show an increase of 1\% over the previous year. Tunnel White Hart Avenue Road Number of articles laundered 84,669 111,061 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 171 ing 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 15 From Tunnel Avenue Bathing Centre 9 From Lionel Road Bathing Centre 2 Chiropody 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: 48; Persons Treated: 337. Council of Social Service—Treatments: 1,967. Mobile Meals In planning the development of the Mobile Meals Services it is the intention of the Council that the provision of such meals should be restricted to those necessitous Old People who are unable to attend a Lunch Club. Although each application is carefully considered to ensure that there is a genuine need, and existing cases are reviewed from time to time to ascertain that the service is still essential, there has been a continued growth in the demand for mobile meals. To meet this need, two new vehicles were purchased and a total of 17 vehicles are now operating. The total number of meals delivered during the year was 136,486, showing an advance of over 20% compared with the previous year. Persons receiving Mobile Meals at the end of the year totalled 631. The charge for each meal was the same as that made at Lunch Clubs, i.e. 1/ld. A restricted service, for cases of special need, was provided during Bank Holidays. Over the Christmas period, 110 meals were delivered on Christmas Day and 120 on Boxing Day. Emergency food packs were again distributed to old people on the Mobile Meals Register to cover the possibility of the nondelivery of a meal during severe weather. 172 Provision of Mobile Meals (iduring 1967) 1967 1966 Mobile Meals served during year 136,486 113,290 Persons on Mobile Meals Register (3Is? December, 1967) 631 606 Lunch Clubs Lunch Club services continue to expand. Ultimately, it is hoped that a Lunch Club will be available within reasonable travelling distance of almost eveiy elderly resident in the Borough. This will ensure that as many as possible enjoy at least one hot meal a day and benefit from the opportunity for companionship and social contact which are available at Lunch Clubs. During the year the number of meals served increased by over 16% to a total of 172,324. The cost of the meal was subvented by the Council and the charge to members remained at 1/ld. A number of elderly homebound persons are conveyed to Lunch Clubs on days when an established Old People's Club meets on the premises during the afternoon. Thus they can enjoy a hot lunch and then stay to enjoy the social activities in the afternoon. A new Lunch Club which was opened at McLeod Road, Abbey Wood, S.E.2, in March, has proved very successful and the present daily attendance is over 100. By the end of the year, negotiations were well advanced for the opening of new Clubs at Charlton Church Lane, S.E.7, and Anstridge Road, S.E.9. Plans were also being prepared for two further Clubs at Abery Street, S.E.I8, and Southwood Road, S.E.9. The Abery Street premises will provide improved accommodation for the Club which now operates at Plumstead Baths. It is also expected that a Lunch Club will be incorporated in the new Ogilby Club, Calderwood Street, S.E.I8, which is likely to be completed towards the end of 1968. Geriatric Advisory Clinics These Clinics, which were started in June, 1966, continued to operate at the following six centres :— Charlton Lane Centre, Market Street Centre, Avery Hill Centre, Garland Road Centre, Abbey Centre, Headquarters Medical Room. 173 The aim of these clinics remains unchanged, i.e. to offer a routine medical examination to old people who think they are in good health and have not seen their doctor for some time. Attendances at Geriatric Clinics during 1967 Male Female New cases 21 100 Re-attendances 8 26 Total 29 126 A total of 135 old people were seen during the year of which 95 required some treatment or advice. Forty were found to be fit and amongst them was an elderly gentleman who had last seen a doctor 28 years ago, and a 75-year-old lady who had last seen her doctor in 1927! The most frequently found defects requiring referral elsewhere were blood pressure, visual defects, hearing defects and depression. Disposal of Patients Found to be Fit 40 Referred to General Practitioner 51 Referred to Dentist 6 Referred to Optician 11 Referred to Chiropodist 5 Total Attendances 135 During this year the routine examination of patients' height, weight, eyesight, hearing, blood pressure and urine was extended to include a routine test for anaemia. Unfortunately, the method used was not found to give consistent results and had to be abandoned. Referrals to General Practitioners Hypertension 11 Hearing Defects 9 Depression 9 Hernia 2 Sugar in Urine 5 Warts requiring removal 3 Congestive Heart Failure 1 Vit. B deficiency 1 Total 41 174 Dietary advice was frequently necessary. Many old people were eating an excess of carbohydrate foods, partly from habit and partly for economic reasons. The importance of protein foods was stressed and some elderly people were advised to use the Borough's Lunch Club facilities, where a balanced meal was available at a reasonable price. Fifteen old people were found to be overweight and were advised on how to lose weight safely. An unhurried atmosphere still appears to be an important factor in attracting old people to these clinics. This did, however, have the effect of limiting numbers although the 1967 attendances showed an increase of almost 44% over the preceding year. 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 its. 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 provide full time care for seriously infirm elderly relatives and well deserve any possible support in this task. The Council therefore decided to give increased publicity to its scheme for providing temporary accommodation for such old people, in order to enable their relatives to take a holiday. A total of 54 old people were admitted to the Old People's Homes under this scheme, generally for a period of two weeks. 175 As the result of a combined effort of trained staff and voluntary help, some 65 old people who also 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. 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. During the year the total sales of Nutritional Supplements to retirement pensioners totalled £9,605 as compared with £7,500 during the preceding year. Distribution is effected mainly via Old People's Clubs, which make regular purchases of foods such as Ovaltine, Marmite, Horlicks, Bovril, Ribena, Complan and Supro for resale to their members at a discount price. Supplies are also available from the W.R.V.S. Offices at Woolwich, Citizens' Advice Bureau at Eltham, The Burney Street Welfare Centre at Greenwich and certain Lunch Clubs. Supplies are restricted to persons of pensionable age and only in sufficient quantities considered reasonable for that person's own consumption. For this purpose, the old person is issued with a Registration Card. Relatives and friends may purchase supplies on behalf of a homebound elderly person on production of this Registration Card. 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. 176 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. 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 has distributed 13,000 copies of a booklet specially prepared as a guide to the services available to elderly people. In addition, the Department has 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 Kidbrooke House was closed in July for demolition. The Day Club which had successfully operated there since 1957 was transferred to Charlton House. In its new location it continues to function successfully in providing opportunities for recreation and social activity which are much appreciated by the members. Approximately 10 Homebound elderly people are transported into the club each day, Monday to Friday. A lunch is served to them at midday. In view of the success of this type of Day Club, additional Clubs for elderly people were opened at Sunbury Lodge, Perry Grove and Weybourne Old People's Homes. These Clubs operate for a total of four days each week. Approximately 6 old people attend each day and they enjoy the amenities of the Homes, their social activities and a midday meal. Day Clubs for the Elderly Day Clubs for active elderly people are open from approximately 10 a.m. to 4 p.m. Monday to Friday at West Greenwich House, 141 Greenwich High Road, S.E.10, Charlton House, S.E.7, and Victorians Club, Sherard Road, S.E.9. Here elderly people may find warmth, comfort and companionship. Old People's Clubs In order to foster the recreational activities of Old People's Clubs the Welfare Committee makes an annual grant of £10 to each club which provides a satisfactory service for its members. During the year, grants were made to 51 established clubs and two new clubs. 177 Almost all of the clubs meet regularly once a week; they arrange their own programmes, including outings, Christmas Festivities, etc. 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 can cater 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 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. Miss W. E. Wilson, the Resident Superintendent, reports as follows :— "The Hotel re-opened for guests on 17th March, 1967, after being closed for spring cleaning. 178 The official opening ceremony of the newly completed wing was performed on 29th April by the Mayor, Councillor R. T. Coombs, J.P.; the Deputy Mayor of Margate, Councillor H. Anish, and Mrs. Anish were among the guests. A total of 1,400 guests was accommodated during the year, in parties averaging 80. The parties consisted, in the main, of old age pensioners with an average of twelve handicapped persons, some of whom were also old age pensioners and others were middle-aged. There was one experimental party in September consisting of handicapped persons only. The last party of the year, due to return home on the 6th January, 1968, was badly hit by the influenza epidemic, which was severe in Thanet. On the advice of Dr. R. G. Taylor, the visiting Medical Officer, those who were fit to travel, returned home on the 2nd January, 1968, leaving a small party to return when they had recovered at the end of the week." 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, 42 trips were arranged whereby 336 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 August, a garden party, at which 60 old people were entertained, was organised by the local Rotary Club and the girls of Abbey School staged a Christmas Concert for the benefit of a further 50. Transport to all such functions has been made so much easier by the department's 2 newly acquired "handicapped" coaches which are equipped with hydraulic tail-lifts. Television and Radio Sets The Department acts as agent for certain voluntary organisations which provide television and radio sets for lonely homebound old persons of limited means. Furthermore, the Department has also received a number of television sets which were donated by members of the public for use by old people. Although the majority of these sets are nearing the end of their useful life, they have helped very considerably to relieve the boredom and loneliness of the old people to whom they have been loaned. Donations of second-hand television sets, particularly those in reasonable working order, are therefore most welcome. 179 Demand for the loan of television sets, to even the most deserving cases, far outstrips the supply and there is a long waiting list. Library Services The Council's Library Service to Old People's Homes was further extended and collections of books were changed regularly. A mobile library, operating from Monday to Friday, caters for elderly residents who are unable to make the journey to and from branches of the Council's public library. Arrangements have been made for friends, relatives and Home Helps to borrow books on behalf of homebound persons who cannot visit the libraries themselves. Homebound readers who have no one to help them in this way are encouraged to contact the Hospital Librarian at Greenwich Library who endeavours to arrange a delivery service. Voluntary groups in the area are prepared to collect and deliver library books to homebound elderly persons under a special extended loan scheme. There is available at each branch library a collection of books in specially large type to meet the needs of elderly persons with failing sight. 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.P.s in the calendar year of 1967:— Type of Show N° of Shows During year Venues O.A.P. Club Shows 389 50 *O.P. Homes Film Shows 48 4 *Avery Hill Shows 2 1 *ln conjunction with the Health and Welfare Department 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 variety shows at the Avery Hill Home were presented between August 10th-17th. Carol Services Carol services for the elderly were held at Christ Church, Greenwich, St. Nicholas, Plumstead, and Eltham Congregational churches 180 on 11th, 13th and 14th December, respectively. In all, some 455 persons attended these services after which refreshments were provided by voluntary organisations. Mayor's Fund During the winter emergency, supplies of bagged fuel were issued to necessitous old people who were without heating. The fuel was purchased by the Department with the aid of a generous grant from the Mayor's fund. Christmas Parcels and Gifts Distribution of the Mayor's 1,100 Christmas parcels, the contents of which were determined on department advice, was again effected by a rota of volunteers. Other organisations were concerned in the giving and delivery of a further 340 parcels and gifts of money and there were 12 x 1 cwt. bags of fuel donated for needy elderly persons. A small manufacturing firm in the Eltham area gave a Christmas party for 70 old people in the vicinity of their premises and this department organised the transport. Observers Services provided in this Borough for the elderly are attracting observers from many sources and representatives of interested organisations have been welcomed and given every opportunity to study our services. Advantage is also taken of our services by Health Visitors and Hospital Students in accordance with their various curricula. Voluntary Help & Friendly Visiting, etc. The Department maintains contact with a number of voluntary organisations and individual volunteers who are prepared to carry out services for elderly and handicapped people. These services include visiting, grass cutting, gardening, decorating, driving, escorting, mending, shopping, hairdressing, changing library books, etc. Friendly visits are made by approximately 250 voluntary visitors who report directly to the Department. In addition, church, school and other voluntary groups participate in the visiting scheme. The Department receives much useful information from the visitors, who are able to report should anything be amiss. 181 MISCELLANEOUS SERVICES Receivership The Borough Welfare Officer has continued to act as Receiver, administering the estates of five patients, previously resident in the Borough, who, by reason of mental disorder, are incapable of managing their own affairs. Respective hospital authorities continue to be consulted concerning the patients' well-being and, in accordance with the duties of this office, all proposals within the patients' means which were likely to ameliorate his condition or add to his comfort have been submitted to the Court of Protection. 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. Action was taken to mitigate loss or damage in fifteen instances. In four cases the property was only temporarily safeguarded, in eight other cases it was sold or otherwise disposed of and in the remaining three cases the property was transferred to the Council's store. Burial or Cremation of Deceased Persons The Council's powers under Section 50 of the National Assistance Act to arrange for the burial or cremation of any person where no other suitable arrangements were being made, were exercised in respect of 25 deaths. The Council's expenses totalled £175 9s. 9d., of which approximately £125 was recovered from the estates of the deceased persons. Registration of Disabled and Old Persons' Homes On 27th June, formalities involved in the registration under Section 37 of the National Assistance Act, 1948, of "Fairhaven", 11, Mycenae Road, S.E.3, a hostel for 25 educationally subnormal youths aged between 16 and 21 years, were completed and a certificate was duly issued in accordance with the Regulations. At the 31st December, of the current year, one other establishment was registered (Alveston House) which provides accommodation for 8 elderly women. 182 SECTION VI ENVIRONMENTAL HEALTH Despite the many improvements in the scientific and social fields, man is still exposed to a multiplicity of influences which, unless controlled, could nullify present and all future advances. Many of these factors fall into the category of "environmental" such as air, soil and water pollution; urbanisation with its constant threat of overcrowding, squalor, disease, interminable and unrelenting noise and social maladjustment; food additives, pesticides radioactive residues, population problems, etc. Certainly recent progress in the sphere of medicine has added years to life but this is of little value if we merely add quantity but not quality to living. Health is man's most precious possession and our environmental health services have played and will continue to play a most important part in its promotion and conservation. A measure of the effectiveness of these services will be found in the extent to which they have added "quality" to life. Outlined in this section are the efforts made by the department during 1967 to maintain and improve the high standards already achieved. New Legislation Greater London Council (General Powers) Act, 1967 The promotion of this Act was referred to in the previous Annual Report. The Act provides, inter alia, powers which, apart from some minor amendments, restore legislation previously contained in the London County Council (General Powers) Acts, 1954 and 1955, and enforceable by the former Metropolitan Borough Councils. They concern the registration of hairdressers and barbers, the abatement of urgent nuisances in defective premises and the reinstatement of interrupted water supplies. This Council has fixed 1st June, 1968, as the appointed day as from which, subject to the proviso in Section 21 (1), it will be an offence for any person to carry on the business of a hairdresser or barber on any premises in the Borough unless he is registered in respect of those premises by the Council. 183 Criminal Justice Act, 1967 Briefly this Act provides, inter alia, for increases in fines concerning contraventions of public health legislation. Sanitary Circumstances of the Area The tables on pages 219 to 221 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 40,362 houses and premises have been inspected or reinspected during the year; 1,326 Preliminary and 362 Statutory or Abatement Notices were served. Registered complaints numbered 5,928. Factories Act, 1961 During the year 295 inspections were made by the Council's Inspectors in relation to the 590 registered factories. The latter figure includes 14 premises where mechanical power is not used. Defects were found in 34 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 14 24 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 530 217 16 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 46 54 Total 590 295 16 — 184 Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) — — — — — (a) insufficient — — — — — (b) unsuitable or defective 34 34 — 8 — (c) not separate for sexes Other offences against the Act (not including offences relating to Outwork) — — — — Total 34 34 8 Outwork—(Sections 133 and 134) Nature of work Section 133 Section 134 No. of out-workers in August list required by Sect. 133 (1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing ) Making apparel | etc. 64 — — — — — Linen 2 — — — — — Lampshades 26 — — — — — Colour Cards 1 — .— — — Christmas Crackers 1 — — — — — Leather Goods 3 — — — — — Total 97 — — — — — 185 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 80 (b) Outworkers resident outside the Borough 121 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 50 Total number of Greenwich residents emplqyed as outworkers (as given in August list) 97 Premises where homework is carried on were visited on 80 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 1967, is given in the following tables:— Registration and General Inspections Class of Premises No. of Premises Registered during year Total No. of Premises Registered at end of year No. of Premises receiving General Inspection during the year Offices 11 336 64 Retail Shops 17 1,153 320 Wholesale shops, — — — Warehouses 3 48 12 Catering Estab- — — — lishments, — — — Canteens 6 185 50 Fuel Storage — — — Depots — 5 — TOTALS 37 1,727 446 186 Analysis by Workplace of Persons Employed in Registered Premises Class of Workplace No. of persons employed Offices 5,675 Retail shops 6,808 Wholesale departments, warehouses 1,452 Catering establishments open to the public 1,107 Canteens 142 Fuel storage depots 46 *15,230 *Males 6,494 Females 8,736 A total of 569 visits including 446 general inspections were made to premises during the year. As a result of the service of 87 informal notices, the following contraventions of the Act were remedied :— No. of thermometers provided 40 Abstract of the Act provided 58 First Aid Kits provided 45 Defective floors repaired 22 Washing facilities provided 2 Overcrowding abated 1 Defective stairs or handrails repaired 10 Electric lighting provided or improved 19 Insufficient seating accommodation remedied 1 Inadequate heating remedied 6 Eating facilities provided 2 Additional locker accommodation provided 10 Inadequate ventilation remedied 9 Defective sanitary accommodation remedied 24 Dirty conditions remedied 10 Drinking water provided 1 Floors properly drained 1 Wall surfaces repaired or renewed 10 Hot water supply provided 15 Guards provided on dangerous machines 7 Other contraventions of the Act remedied 29 187 Exemptions No applications were received under the exemption provisions of Section 46 of this Act. 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. Seventy-six notifications were received during the year all but one of which related to non-fatal injuries and of these, the majority were of a minor nature. Each case was investigated by the respective District Public Health Inspector and advice was given where necessary. In 19 cases it was considered necessary to write to the firms concerned and the measures suggested to prevent the recurrence of similar accidents were readily implemented. An inquest was held in respect of the one fatality, that of a young employee run over by a fork-lift truck in his firm's vehicle-loading compound. Apparently the deceased, neither qualified nor entitled to use the machine, asked a young colleague to teach him to drive the truck. Whilst clinging to the side of the truck he had jumped or slipped. A verdict of accidental death was recorded. 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 Fatal NonFatal Prosecution Formal Warning Informal Advice Offices — 4 4 — — — 4 Retail Shops — 52 52 — 6 7 39 Wholesale Shops, Warehouses. I 8 9 — 2 1 6 Catering Establishments open to public, canteens — 11 11 — 1 2 8 RailwayBuildings Totals I 75 76 — 9 10 57 188 Analysis of reported accidents Offices Retail Shops Wholesale Warehouses Catering establishments open to public, canteens Railway Buildings Machinery — 3 2 — — Transport — — — 1 — Falls of persons 3 20 1 3 — Stepping on or striking against object or person 1 9 — 1 — Handling goods — 13 2 4 — Struck by falling object — 1 1 — — Fires and explosions — — — — — Electricity — — — — — Use of hand tools — 2 1 — — Not otherwise specified — 4 2 2 — 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. (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. 189 Pigeon Nuisance A local authority is enabled by Section 74 of the Public Health Act, 1961, to deal with nuisance arising from the congregation of pigeons believed to be ownerless. During the year, 55 complaints were received and, where justified, arrangements were made to reduce the pigeons to a reasonable number by members of the Rodent Control Staff. In one instance narcotic treatment, authorised by licence from the Ministry of Agriculture, Fisheries and Food, was carried out with success at Well Hall Pleasaunce. To ensure that the pigeons would take the narcotic bait, pre-baiting with wheat took place between 4.30 a.m. and 7.00 a.m. for 19 consecutive days. River Pollution No complaints regarding pollution were made to this department during the current year. 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. 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. In continuing their policy of improving the effluent being discharged at their sewage outfalls the G.L.C., during the current year, approved an extension to the Beckton sewage treatment works at a cost estimated to be almost £21 million. Furthermore, the possibility of overland pipeline and sea outfall disposal of digested sludge to a discharge area in the outer Thames estuary is under active consideration. 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. Sampling.—In accordance with the Rivers (Prevention of Pollution) Acts, 1951/61, a sample of water taken by the G.L.C.'s Regional Engineer from the River Ravensbourne at Deptford Bridge 190 on 25th September, 1967, at 11.55 a.m. in fine weather, gave the following results:— pH Value 8.1 Parts Per Million Suspended Solids Negligible Biochemical Oxygen Demand 1.4 Dissolved Oxygen 95.0 Percentage Saturation Dissolved Oxygen 97.3 Classification Very Clean 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 therewith". In London it applies not only to the rivers Ravensbourne, Pool, and Quaggy, the Kid Brook, Kyd Brook and the Lower Kid Brook but also to the parts of all tributaries, brooks and watercourses (whether open or covered) that flow into these rivers or streams. Powers were given to both these County Councils to make by-laws 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 191 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. East Greenwich Relief Sewer To obviate danger of flooding and to take the drainage of the new southern approach to Blackwall Tunnel, the G.L.C. decided to construct a relief sewer from Pelton Road to Deptford pumping station at a cost of £1,088,700. Because of difficult subsoil conditions, the sewer needed to be constructed "in tunnel" with, in some instances, chemical consolidation by injection of the ground ahead with compressed-air working. By the end of the year the work was well advanced. ATMOSPHERIC POLLUTION It would seem that man has learned to add years but relatively little quality to life and that pollution of all descriptions is a concomitant of him and his advancement. As years add wisdom, man at very great expense, seeks to redress the wrongs perpetrated against nature by previous generations, of which air pollution is a typical example. Means are sought to reduce or eliminate the concentrations of oxides of sulphur, nitrogen and carbon and to identify and evaluate the photochemical reactions of partially burnt end-products from automobile exhausts. Greater publicity is now being given to the effects of such chemicals upon sensitive mucous membranes, their likely effects upon water supplies and, indeed, upon all environment generally. Apart from the economic and medical advantages accruing from the introduction of the Clean Air Act in 1956, there have been many other indications that our atmosphere is improving in quality among which is the growing realisation that the cleaning of buildings is now really worthwhile. Furthermore, the ornithologists and botanists report the welcome return to our parks and open spaces of many birds and plants which have been absent for half a century or more. However, legislation covering atmospheric pollution has not been the prerogative of 20th century legislators entirely. Dangers of a contaminated atmosphere were recognised and measures introduced 192 for its control were instituted as early as the 13th century. (In 1306, a Londoner was tried and executed for offending against an Act passed in 1273). Still, it must be conceded that only since the London "smog" of 1952 which precipitated the deaths of some 4,000 persons were strenuous efforts made to control smoke emissions and which resulted finally in the passing of the Clean Air Act, 1956, after the Beaver Committee submitted its report in 1954. For some time it had been recognised that this Act was in need of revision. But, during 1967, attempts by means of a private member's Bill towards securing additional legislation designed to supplement and improve the existing Clean Air Act proved abortive although publication of the Report of the Working Party of Grit and Dust Emission has been followed by the introduction of Regulations under Section 7(2) of the principal Act. In the year up to 31st March, 1968, progress throughout the country in establishing smoke control areas proved more successful than in the previous three years and, to date, 44.95% of the total "black areas" premises were smoke controlled. With a figure of 67.98%, Greater London maintains its substantial lead over other regions. Even so, the percentage for Greenwich at almost 70% compares more than favourably with both these figures. 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 brtng 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 193 processes 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 Charlton In the summer, preliminary arrangements for the formation of the Charlton Smoke Control Area were completed and the Council declared the Area on 2nd August, 1967. Details of the Area are as follow:— This is an Area of predominantly private property comprising some 474 acres and 5,394 dwellings of which it is estimated 3,386 will require some form of conversion or adaptation. Of the total dwellings 2,051 are Borough Council, 47 Greater London Council and 3,296 privately owned and in addition there are 145 nondomestic premises. The Minister of Housing and Local Government confirmed 1st December, 1968, as the operative date of the Area Order. West Greenwich On the same date as the Charlton Smoke Control Area was declared, the Council approved in principle the West Greenwich Smoke Control Area with a view to the making of an Order in the summer of 1968. This Area comprises approximately 530 acres and 6,134 dwellings. At the end of the year there were 7,699 acres and 50,639 dwellings within operative Smoke Control Areas. Details in respect of these Areas and that of Charlton are set out in the table on page 194 and their respective coverage of the Borough shown on the accompanying map. In the past, following confirmation of an Area Order by the Minister, a public meeting has been held. However, at recent meetings the number of residents attending has progressively decreased and as few questions have been asked, this would appear to indicate that the Council's Clean Air Information Service is resolving most difficulties beforehand. In these circumstances and having regard to the ready acceptance of the Clean Air Programme by the public at the present time, the Council decided that public meetings be discontinued. 194 Confirmed Smoke Control Areas 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 1 f. Middle Park (South West) 1.10.60 100 722/ Nil 16 6 Abbey Wood No. 2 1.10.60 78 1,150 Nil 24 4 Clothworkers Wood 1.10.60 260 1,868 Nil 12 4 Greenwich No. 1 1.10.60 76 985 6 40 10 Coldharbour 1.10.61 350 2,806 Nil 33 4 Abbey Wood No. 3 1.10.61 380 1,973 2 59 2 St. Mary's No. 2 1.10.61 26 596 Nil 14 Nil St. Mary's No. 3 1.11.61 12 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 I 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 Charlton 1.12.68 474 5,394 7 110 28 Joint Circular 25/67 and 35/67—Clean Air Act—Supplies of Solid Smokeless Fuels.—This Circular, issued jointly by the Ministry of Health and Local Government and the Welsh Office on 30th May, 1967, refers to paragraphs 13 and 14 of Circular 69/63 in which local authorities were asked to consult representatives of various bodies about supplies of smokeless fuels before making smoke control orders. With effect after 1st June, 1967, paragraph 13 of that Circular is superseded to the extent that solely in respect of supplies of solid smokeless fuels, only the appropriate regional representatives of the Solid Smokeless Fuels Federation (addresses listed in the Appendix to this Circular) need to be consulted. Appendix B to Circular 13/65 is cancelled. Joint Circular 50/67 and 44/67—Clean Air Act, 1956— Chimney Heights.—This Circular issued on 1st November, 1967, refers to the revised edition of the Memorandum on Chimney Heights. The new publication is entitled "Chimney Heights". 195 The most important difference is in the treatment of furnaces emitting only small amounts of sulphur dioxide. In the 1963 Memorandum, the minimum chimney height indicated by Appendix I is 40 feet, and even quite low rates of emission take the height considerably above that level. Experience has shown that these levels are unduly onerous having regard to the smallness of the emission. Appendix I of "Chimney Heights" accordingly allows for uncorrected chimney heights starting at 16 feet and makes no provision for emissions of less than 3 lbs./hr. S02; a new Appendix VI gives final chimney heights for small furnaces starting at 25 feet. Like the earlier Memorandum, "Chimney Heights" is issued without prejudice to the Ministers' consideration of any appeal under section 10 (3) of the Act. Joint Circular 52/67 and 23/67—Grit and Dust.—This Circular issued on 1st August, 1967, refers to the publication "Grit and Dust" on the reduction of air pollution and grit discharged from boiler and furnace chimneys. "Grit and Dust" supplements the Explanatory Memorandum on the industrial provisions of the Clean Air Act, 1956. It is based on the Report of a Working Party which the Clean Air Council agreed should be set up in 1964 to consider ways and means of measuring grit and dust emissions and to advise on appropriate levels of emission in relation to furnaces burning fuel equivalent to 100-50,000 pounds per hour of coal. It contains general guidance on the reduction of grit and dust, explains in detail a method of measuring emissions and gives advice on its use, and recommends levels to which it should normally be possible to reduce emissions. A wider range is covered than the grit and dust provisions of the 1956 Act since sections 6 and 7 do not apply to furnaces burning less than one ton an hour of solid fuel (other than pulverised fuel) or solid waste, and none of the provisions applies to oil fuel furnaces. "Grit and Dust", however, does not cover emissions from furnaces where the material being heated contributes to the emission, as further investigation is necessary. Local authorities, especially those in the black areas (Greater London is one), are called on to review all sources of grit and dust, and to take all practical steps to get the emissions reduced to acceptable limits. As regards the measurement of emissions, attention is drawn to the following points :— (a) Any defects in maintenance and use of the plant should be eliminated beforehand. 196 (b) Co-operation of the firm concerned should be sought and arrangements made for the measurement to be carried out either by the firm or by the local authority with the firm's permission. Authorities have no power under the 1956 Act themselves to carry out measurements without this permission. (c) The Minister will shortly make regulations prescribing the requirements which local authorities may apply to require the measurement of emissions from furnaces covered by Section 7 of the Act, i.e., furnaces burning pulverised fuel and those burning other solid fuel or waste at a rate of one ton an hour or more. The requirements will relate to the making and recording of measurements of emission, the provision of the necessary apparatus and the adaptation of the chimney for the purpose, and the supply to the local authority of the results obtained from the measurements. Failure to comply with the standards recommended in "Grit and Dust" is not an offence under the Act. Evidence of such a failure, however, may well in suitable cases, assist in demonstrating that the means required by Section 5 of the Act for minimising emissions have not been employed. Any grit and dust emissions in the Borough have always been kept under review. From time to time complaints are received but to date none has proved insurmountable and measures introduced, often at the instigation of this Department, have resulted in considerable reduction of such emissions. In the case of premises under the jurisdiction of the District Alkali Inspector, liaison is such that complaints received by this Department are investigated and, if considered necessary, a report of the circumstances is forwarded for the Inspector's attention. There are no pulverised fuel burning plants in the Borough. Grants During the year 1,587 grants amounting to £39,027 4s. Od. 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. Forty-one discretionary grants amounting to £911 10s. 7d. were so approved, giving a consolidated figure of 1,628 grants totalling £39,938 14s. 7d. 197 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. One such payment was approved in the year. A further 2 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 also 4/7ths of the grant paid. The Council, in respect of 61 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. Forty notifications were received and six approvals were given in 1967. One approval was given under Section 6 of the Act which, subject to certain conditions, requires that new furnaces shall be fitted with plant to arrest grit and dust. Pollution Recording The Department of Scientific and Industrial Research indicated that as the first stage of the National Survey had now been completed, the number of atmospheric pollution measuring stations could probably be reduced. Following consultation, the Council considered its needs would be met by reducing the nine existing stations to four. This decision was implemented with effect from 31st October, 1967. 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 pollu- 198 tion and with the surveying and inspections of properties in Smoke Control Areas. Such duties involved a total of 12,227 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 6 Number of decisions not to issue certificates 1 Number of decisions to issue certificates : (a) in respect of some but not all defects 4 (b) in respect of all defects 2 6 Number of undertakings given by landlords 4 (under para. 5 of 1j/ Schedule) Number of undertakings refused by Council — (under proviso to para. 5 of Is? Schedule) Number of certificates issued 1 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 2 Objections by tenants to cancellation of certificates upheld — Decisions by Council to cancel notwithstanding tenants' objection — Certificates cancelled 4 In addition to the foregoing, one application (Form "O") received from a landlord for a certificate as to the remedying of defects which he had undertaken to remedy resulted in the issue of a Certificate (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 — — Landlord — 1 199 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 36 complaints were received of which the majority were of a relatively minor nature. Each complaint was investigated and, in most instances, satisfactory improvements were effected. The noise at two large industrial premises were reduced on the completion of works which were in hand at the end of last year. In all a total of 410 visits were carried out during the course of the year by the Public Health Inspectors. Joint Circular 22/67 and 18/67—Noise Nuisance—This Circular, issued on 18th April, 1967, concerns the recommendations contained in the Report of the Committee on the Problem of Noise relating to industrial processes giving rise to specially intractable noise problems. The Circular indicates that as far as industrial noise is concerned the Ministry of Labour have agreed that their Factory Inspectors will make their experiences of the problem available to local authorities and these authorities are requested to consult the Factory Inspector before taking action against noise from industrial premises of any kind. The Factory Inspector may be able to advise on the possibility of suppressing noise at the source or to suggest where specialist advice can be obtained. Factory Inspectors for their part have been asked to consult local authorities before making recommendations for noise reductions in factories in which the local authority is likely to be interested. In addition, the Greater London Council's Scientific Branch, which is equipped with precision measuring equipment, will be prepared to assist London Boroughs. The Minister calls on local authorities to make a determined attack on the problem of industrial noise. In about 2 years' time he proposes to ask authorities to report on progress and on the difficulties encountered so that he can consider whether changes are necessary either in the law or the arrangements for its enforcement. The Circular also refers to nuisances arising from mobile icecream vendors. The Minister urges local authorities to make full use of the powers in the Noise Abatement Act, 1960, to ensure that this source of nuisance is kept within reasonable bounds. It is suggested that information about the size of this problem might be built up by local authorities keeping separate records of complaints about ice-cream chimes and observing regularly whether the vendors are adhering to the Code of Practice drawn up voluntarily by the ice-cream industry. 200 Local authorities are asked to direct some of their publicity activities towards teaching that the creation of unnecessary noise is inconsiderate and ill-mannered and to take such opportunity as they can to promote higher standards of public behaviour in the matter of noise. This Council is aware of the need to keep the problem of noise under constant review and will continue to take all available steps to deal with such nuisance. As far as the problem of industrial noise is concerned, the Council is satisfied, after having recently considered a full report on the subject, that in all cases of nuisance from this source known to the Council everything possible is being done to reduce annoyance and discomfort to the residents affected. In addition, the Council has drawn the attention of local industrialists to the problem and has invited their co-operation in preventing or reducing noise nuisance. Pharmacy and Poisons Act, 1933 During the year the Town Clerk receiyed 6 applications for entry of name in the Council's List of Persons entitled to sell Poisons included in Part II of the Poisons List and 174 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 respository 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. 201 Under the Rag Flock and Other Filling Materials Regulations, 1961 and 1965, four samples, two of Woollen Mixture Felt and one each of Cotton Felt and Rag Flock, were submitted for examination and all proved satisfactory. Licensing Act, 1961 During the year, 17 applications, 4 for registration and 13 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, 117 inspections were made and reports submitted to the Town Clerk. Pet Animals Act, 1951 This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. At the end of the year 11 licences were in operation and 47 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 202 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 1967. 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. During the year 3,992 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, 406 public sewers were tested and maintained, cleansed or emptied. Twelve 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. 203 Relief Sewer By the end of the year, work on a relief sewer from Pelton Road to Deptford pumping station designed to take the drainage of the new southern approach road to Blackwall Tunnel, was well advanced. Flooding, which has often presented itself in the Marsh Ward area at times of heavy rainfall, is expected to be relieved by this sewer which the G.L.C. estimated will cost just over £1 million. 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. No copies of certificates of registration were received from the Minister during the year. Water Supply London's increasing population has repeatedly created problems in the maintenance of an adequate supply of water for domestic purposes. Demands today are already onerous but, with a growing population and greater attention being paid to personal and public hygiene, these are becoming more clamant. As a county London is unique in that it is practically wholly developed. Over the years, building and drainage have disturbed the natural flow of water and such resources as were available have been rendered useless for the supply of pure water. Deficiencies in overground supplies within the county are met by tapping outside sources and water from the higher reaches of the Thames and the Lea together with the exploitation of the underground waterbearing strata form the bulk of London's supplies. Indeed, for some considerable time now, water from springs, streams and wells has been dwindling and greater use has had to be made of the Thames which now contributes more than two thirds of the total of the Metropolitan Water Board's supplies. Regrettably, rivers and their tributaries are themselves becoming polluted and this modern necessity for "re-using" water for domestic purposes is not without its hazards although, to date, these have been successfully dealt with by the Board. 204 Today, synthetic detergents, pesticides and herbicides (the uses of which are on the increase), trade wastes which are greater in quantity and chemically more complex, waste products of nuclear degeneration and even atmospheric pollution are all making their contribution to residues being discharged into river water already deficient in oxygen sufficient fully to degrade the various existing pollutants thereby rendering the future task of providing a pure water supply even more difficult. 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 6£ million people within an area of 540 square miles extending from Ware in the north to Sevenoaks in the south and which has an average daily consumption of about 400 million gallons. One of this Borough's two wells which supply drinking water is a most prolific contributor to the Board's supplies, having a normal output of 5 million gallons per day. The Board is responsible for the purity of its water and the supplies are regularly tested—chemically and physically for an estimation of its clarity, colour and taste, and bacteriologically for assessment of coliform colonies with confirmatory examination for Escherichia coli. There are 72,348 inhabited dwellings in the Borough with direct connections to the Board's mains. On request and following satisfactory reports, 54 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 1/68, 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). (1) (a) The supply was satisfactory both as to quality and quantity throughout 1967. (b) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are 205 flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1967, was 231,150. (ii) No houses were permanently supplied by standpipe. (d) No fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. (2) (a) The supply was derived from the following works and pumping stations:— River Thames from Hampton and Surbiton via Deptford; Deptford, Wilmington, Darenth, Bexley, Wansunt and Crayford Wells. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) The Board's river and well sources have not been considered to have a plumbo-solvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967 206 LEAD CONTENT OF WATER FROM MAIN TAPS IN CONSUMERS' PREMISES (Mg/1. Pb) Number of samples per cent. Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 — 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968". 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 considered 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 was convinced that it was completely safe and he hoped therefore that all local authorities would take steps to make arrangement for the addition of fluoride to public water supplies. 207 METROPOLITAN WATER BOARD—Water Examination Department Average Results of the Chemical Examination of the Water Supply to the London Borough of Greenwich Year 1967 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. Hardness (total) CaC0O3 Hardness (non-carbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate aspo4 Silicate as SiO2 Sulphate as so4 Natural Fluoride as F Surface-active material as Manoxol OT CO2 Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micro-ohms) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) Thames-derived South of River 156 0.021 0.088 4.2 1.12 272 69 5 226 5.1 30 1.9 9 64 0.30 0.01 0.1 12 7.9 580 Bexley 5 0.006 0.030 5.4 0.10 331 89 4 14 0 2.4 20 56 0.20 34 0.0 1 7.2 600 (a) Crayford No. 1 4 0.014 0 .047 7.9 0.42 430 161 5 22 3.2 34 128 0.30 58 0.1 3 7.1 820 (b) Crayford No. 2 4 0.007 0.031 6.5 0.20 319 87 4 21 4.2 27 58 0.20 41 0.1 1 7.2 650 (c) Crayford No. 3 4 0.007 0.035 6.9 0.30 355 107 5 24 4.3 29 84 0.25 42 0.1 2 7.4 730 Darenth 4 0.009 0.033 4.7 0.10 270 46 2 110 1.9 18 24 0.15 24 0.0 0 7.3 510 Deptford 4 0.013 0.053 6.7 0.08 373 131 26 5.5 42 104 0.30 39 0.0 1 7.1 740 Wansunt 7 0.029 0.036 6.5 0.14 333 92 4 19 0 2.7 67 0.20 37 0.1 2 7.1 650 Wilmington 4 0.008 0.037 7.3 0.15 286 54 3 16.0 2.5 26 26 0.20 33 0.2 1 7.3 590 208 Water Supply to the London Borough of Greenwich METROPOLITAN WATER BOARD—Water Examination Department Bacteriological Results Yearly Average 1967 Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent, samples negative 0 ml. Thames-deri vcd, South of River 1,887 8.8 99.52 99.95 Bexley 249 0.1 4 96.39 0.3 97. 59 02 265 0.0 39 100.00 100. 00 (a) Crayford No. 1 128 0.0 3 100.00 — 100.00 — (b) Crayford No. 2 133 0.2 2 100.00 — 100.00 — 255 1.3 62 100.00 100.00 (c) Crayford No. 3 117 0.1 41 100.00 — 100.00 — Darenth 247 0.0 7 99.19 — 99.60 — 253 0.2 1 100.00 100.00 Deptford 250 0.3 32 97.60 0.2 98.80 — 254 1.6 143 99.61 100.00 (a) Wansunt No. 1 (b) Wansunt No. 2 228 136 0.4 0.3 37 38 100.00 99.26 — 100.00 99.26 — 255 0.1 37 100.00 100.00 Wilmington 250 1.5 4 98.80 — 100.00 — 255 0.2 4 99.61 100.00 209 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 minority of 6 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. The possibility of placing the duty of fluoridation of London's water supplies on the Metropolitan Water Board by a General Powers Bill has been explored by the London Boroughs' Association, but the Clerk to the Board has indicated the impracticability of such a suggestion if only for the fact that the respective areas do not coincide. Legislation, to be effective, would need to be made obligatory throughout the country and the Minister is not prepared, at this juncture, to support this solution. Lead Poisoning An indication of the necessity for an inquiring mind and attention to detail was revealed in a case of lead poisoning reported to the department during the current year. Following receipt of information that a 3-year-old Indian boy had been admitted to the Brook Hospital suffering from lead poisoning and that subsequently the mother and another child were found to have a high lead content in the blood which required urgent treatment, the district Public Health Inspector, in company with a hospital doctor, visited the child's home. After detailed and painstaking investigations which elminated paintwork, toys, water supply, cooking utensils, food, etc., the source of the poisoning was narrowed down to a mascara-like substance found to consist of 80% lead sulphide and commonly used by Indian and Pakistani women on themselves mainly as a beauty preparation and on their children for "medicinal purposes" in cases of eye irritation and for improving the vision. Notification of the case to the Ministry was followed by a Press Notice issued by the Home Office warning the public of the potential danger of lead poisoning arising from the use of certain brands of eye cosmetics imported from India and Pakistan. A full report covering the incident was made to the British Medical Journal by the Brook Hospital doctors in the issue dated 13th January, 1968. It is interesting to record that the use of this compound of lead sulphide ore known as "galena" as a cosmetic has an extremely ancient history for pieces of galena have been found in an Egyptian grave dated 4000 B.C. Moreover, it would seem likely that even 210 in those early days it gave rise to lead poisoning for the signs and symptoms of lead poisoning were first described by Nicander of Colophon, a Greek physician, in the 3rd century B.C. Public Baths and Washhouses There are 4 Borough Council Public Baths, 2 Public Washhouses and a Council Launderette. A summary of Bacteriological Samples taken from the various swimming baths during the year with the results of the examinations is given in the following table :— Bath No. of Samples Satisfactory Unsatisfactory Greenwich—1st Class 4 4 — Greenwich—2nd Class 2 2 — Eltham—Small 3 3 — Eltham—Large 1 1 — Eltham—Spas tics 3 3 — Plumstead—Small 2 2 — Plumstead—Large 4 4 — Woolwich—Small 2 2 — Woolwich—Large 4 4 — Totals 25 25 — I am indebted to Mr. D. F. Wallis, Baths Manager, for the following information and statistics in respect of the financial year 1967/68 :— "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 and Badminton. 211 During the year under review 21,542 swimming lessons were 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, 1968 :— Service Eltham Greenwich Plumstead Woolwich Abbey Estate Totals Swimming Public 172,213 78,549 109,238 107,602 — 467,602 Schools 69,581 58,881 89,931 57,385 — 275,778 Clubs 14,433 13,636 18,922 10,290 — 57,281 Tuition 8,834 5,212 5,103 2,393 — 21,542 Spectators Baths 10,532 5,393 6,227 2,823 — 24,975 Private Free (O.A.P. — 41,321 35,210 57,221 — 133,752 etc.) Turkish — 17,091 7,963 — — 25,054 Laundries — 3,540 15,583 — — 19,123 Launderette — — — — 47,415 47,415 Other Recreational Facilities Indoor Cricket (Schools) 155 — — — — 155 Roller Skating — 5,704 — — — 5,704 Table Tennis & Badminton — 1,886 2,178 — — 4,064 Indoor Bowls — — — 14,798 — 14,798 Totals 275,748 231,213 290,355 252,512 47,415 1,097,243 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 3,047 recorded complaints (1,360 of rats and 1,687 of mice), 2,260 were notifications, 432 re-notifications from occupiers or other sources and 355 were found during survey. The monthly average of complaints from all sources was 254. 212 In addition to the investigations of recorded complaints, 7,060 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 10,025. During investigations, infestation was found to exist on 24 occasions in local authority's premises, 1,717 in dwelling houses and 360 in miscellaneous properties and places of business. In all, some 2,753 treatments were effected by the Council and 5 by occupiers or other services. Periodical treatments were carried out at 6 industrial premises, one wharf and two hospitals in the Borough. Following the policy of tracing the source of each infestation, 27 defective drainage systems were discovered. In these instances Notices were served under the Public Health Act, 1936, and the defects remedied. Calls were made as and when necessary on the services of the Borough Engineer and Planning Officer's staff to enter sewers during colour-tests or in the tracing of disused drains and also to the lifting of paving to locate sources of infestation; these services were readily available. Occupiers of business premises and also householders readily report any known or suspected infestation, and the value of routine investigation made in these properties is emphasised by the fact that it is rare to find occupiers tolerating infestation after being made aware of the service available under the Rodent Control scheme. Prevention of Damage by Pests Act, 1949 Rats and mice are notorious not only for the wholesale destruction and fouling of foodstuffs and for the structural damage they cause to buildings, but also for their part in the spread of disease. Leptospirosis (Weil's disease) is primarily a disease of rats and is one which can be fatal to man. The disease is transmitted by means of food, dust, mud, slime and water which has been contaminated by urine or faeces from infected rats. Efficient rodent control is the first and most important defence against this type of disease. The Prevention of Damage by Pests Act, 1949, has placed the onus for the destruction of these pests on Local Authorities and makes obligatory the notification to these authorities by occupiers of any rodent infestation. It has not been found necessary during the year to take legal action to enforce the provisions of the Act. The following report was submitted to the Ministry of Agriculture, Fisheries and Food, for the year ended 31st December, 1967:— 213 Prevention of Damage by Pests Act, 1949 Year ended 31st December, 1967 TYPE OF PROPERTY Properties Other than Sewers Agricultural Agricultural 1. Number of properties in district . 88,554 1 2. (a) Total number of properties (including nearby premises) inspected following notification 3,640 — (b) Number infested by (i) Rats 638 — (ii) Mice 1,193 — 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 6,385 1 (b) Number infested by (i) Rats 126 — (ii) Mice 134 — Sewers 4. Were any sewers infested by rats during the year?—Yes. Surface Properties and Sewers 5. Any other points of interest?—None. 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 1,471 sewer manholes out of a total of 3,920. The pre-baiting and poisoning method was employed and the bait used was sodium fluoracetamide. A repeat treatment of direct poisoning 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 with the following frequencies :— 214 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. Street Gullies There are 15,100 street gullies which were cleansed entirely by mechanical means three times a year. Refuse Collection Some 61,580 tons of refuse were collected from 76,920 dustbins and 3,110 bulk containers. Collection was generally weekly but was more frequent at certain blocks of flats and other premises. The number of requests for special collections of unwanted furniture and other bulky items continued to rise and some 7,400 requests were dealt with in the year. Unwanted Cars Four hundred and thirty unwanted cars were received at the Council's depots and 650 were collected. In addition, 250 abandoned and derelict cars were cleared from the roads. Scrap metal recovered amounted to some 490 tons. Public Conveniences There are 29 conveniences for men and a similar number for women. In all of them water closets are available without charge and, wherever practicable, free washing facilities are provided with paper towels". Flies and Mosquitoes During the year 42 complaints of flies were received, resulting in treatments being carried out to 70 rooms and 21 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. 215 Disinflation of Verminous Premises Dieldrin Concentrate continues to give good results in dealing with verminous premises. During the year the department dealt with 105 cases of dirty and verminous premises, and the disinfestation staff sprayed 318 rooms and contents. In one case 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 67 complaints received concerned either the black garden ant (Lasius niger) or the yellow meadow ant (L. flavis), the workers of which will gain access to houses through cracks in the walls or floors, over sills or through window frames in search of food. Sixty-one treatments involving 136 rooms and 39 external areas were carried out to combat the reported nuisances. Only one complaint was received during the current year concerning one of the commonest of ants, the very small red House or Pharaoh's ant (Monomorium pharaonis), which resulted in the treatment of 2 rooms. This species, being of tropical origin, is incapable of breeding m 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. 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. 216 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. Thirty complaints were received concerning this pest and thorough investigation and treatment with Dieldrin Concentrate resulted in the infestations being considerably reduced. In all, 30 treatments were effected involving 133 rooms. Clover Mite.—Eleven 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. Treatment consisted of spraying 17 rooms and 10 exterior surfaces with Dieldrin Concentrate which 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. Two hundred and eighty-three complaints regarding this pest were received and during the year some 182 nests were destroyed, mainly by means of Gammexane powder or Dieldrin Concentrate. Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith. 217 Complaints Treatments Rooms External Areas Beetles : Black 15 14 98 3 Carpet 11 10 26 — Flour 2 2 4 — Larder 2 2 3 — Leather 3 2 6 — Spider 4 4 10 — Wharf 1 1 4 — Earwigs 7 7 7 6 Fleas 75 64 316 1 Silver Fish 11 11 25 — Slugs 5 4 4 4 Spiders 5 3 6 2 Wild Bees 23 11 — 7 Wood lice 3 2 6 3 Woodworm 5 4 3 — Misc. Insects 34 18 45 5 Forty-five requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by treatments to 135 rooms and 3 external areas. Precautionary Spraying.—During the year, at 42 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 60 rooms and 5 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 39 84 Children under school age 36 23 School children 295 79 Totals 370 186 218 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. Rooms and Articles Disinfected, Year ended 31st December, 1967 Diseases, etc. Premises Entered Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs & Mats Covers Total No. Articles Disinfected Scarlet Fever 7 15 2 10 4 18 18 33 _ _ 9 32 16 2 _ 144 Diphtheria — — — — — —— — — — — — —— —— Tuberculosis 23 60 8 18 12 48 17 40 — — 12 42 29 16 — 242 Cancer 4 2 _ 1 1 1 32 — 2 — 1 _ 2 _ _ — 49 Meningococcal — — — — —— — — — —— — —— —— — Infection 2 5 — 4 2 10 8 14 — — 5 16 10 — — 69 Puerperal — — —— — — — —— — — — — —— — — — —Pyrexia — — — — — — — — — —— — — — — Typhoid Fever — — — — — — — — — — — — — — — — Polio-Myelitis — — — —— —— — — — — — — —— — Erysipelas — — — — — —— — — — — — — — — — Acute — — — — — —— — — —— —— — — — Encephalitis — — — — — — —— — —— — — — — Measles 4 14 — 22 2 35 34 43 — — 14 17 — 2 — 169 Scabies 2 3 _ _ 1 4 2 2 — _ 3 3 1 _ _ 16 Other Diseases 20 21 7 14 7 50 28 45 — 7 13 95 38 14 — 318 Verminous Premises 3 6 — 5 1 30 9 16 — — 11 22 10 — — 104 TOTAL 65 126 17 84 30 227 116 195 — 8 67 229 104 34 1,111 LIBRARY BOOKS DISINFECTED 36 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 1967 totalled 3,126, being 47 more than the previous year. Of this total, 1,157 were from within the Borough compared with 1,107 in 1966. Exhumations Three exhumations were carried out during the current year and a Public Health Inspector was present to see that all the usual precautions were observed. 219 Mortuary Accommodation Arrangements exist between Greenwich Council and the Council of Lewisham for bodies to the accommodated at the latter's two mortuaries prior to inquests and post mortems or while awaiting burial. During the current year some 935 bodies were so accommodated at a cost to the Council of £1,963 10s. Od. Summary of Work Performed by the Public Health Inspectors during the Year 1967 Inspections— Houses inspected (Complaints, nuisances) 3,681 (Infectious Disease) 1,580 (Overcrowding and other Housing Applicant) 513 Inspections of Factories 295 Licensed Victuallers and Clubs 262 Underground Rooms 69 Pet Shops 47 Stables and Yard 1 Urinals 32 Houses in Multiple Occupation 123 Outworkers' premises 80 Under Clean Air Act 12,227 Miscellaneous 11,842 Inspection of Premises (Clearance Areas) 1,569 (Improvement Grants) 353 (Individual Unfit Houses) 490 (Rent Acts) 32 Inspections of Offices, Shops and Railway premises 569 Investigations (Rats and Mice) 1,599 Investigations (Insect Pests) 769 On Notice from Architects and Builders 323 Re-inspections, calls made, etc 3,906 40,362 Drains— Drains tested—by smoke 35 by water 9 Opened, cleansed and repaired 362 Yards and forecourts drained 8 W.C. Compartments erected or repaired 29 220 W.C. fittings repaired or renewed 68 W.C. pedestals installed or renewed 41 Sanitary conveniences or improvements effected to Factories and Workplaces 34 Urinals cleansed or repaired 10 Dustbins— Provided 23 Pavings— Yards and Forecourts 8 General Water Supply— Water Fittings amended 18 Water supply restored 44 Extra water supply to tenement houses 1 Other Improvements— Rooms cleansed and repaired 9 Rooms and staircases lighted and ventilated 239 Verminous rooms cleansed 318 Roofs, gutters and rainwater pipes repaired 394 Dampness abated 813 Underground Rooms (enforcement of Regulations) — Sinks, baths and lavatory basins provided 14 Sink, lavatory and bath waste pipes trapped or amended 21 Stoves and fireplaces 9 Floors repaired US Miscellaneous repairs 687 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Animals kept in unfit places discontinued or removed 2 Foul Accumulations removed 21 Rat infestation abated 2,101 Smoke Nuisances— Observations 374 Statutory Notices served — Notices, Etc.— Preliminary Notices served 1,326 Statutory or Abatement Notices served 362 Houses rendered fit by informal action 859 221 Legal Proceedings Premises Offence Results of Proceedings 26 Heverham Road Non-compliance with Abatement Notice Summons withdrawn— work completed. 106 Crescent Road „ „ Nuisance Order for work to be completed within 28 days. £5 5s. Od. costs. 256 Burrage Road „ „ Nuisance Order for work to be completed within 14 days. £7 7s. Od. costs. 51a Glenforth Street „ „ Summons withdrawn— work completed. 628 Woolwich Road „ „ Work completed. £10 10s. Od. costs. 60 Glenforth Street „ „ „ „ 11 Kentmere Road „ „ Nuisance Order prohibiting recurrence of nuisance. £6 6s. Od. costs. 17 Ceres Road „ „ Work completed. £3 3s. Od. costs. 2a Alliance Road „ „ Work completed. £5 5s. Od. costs. 9a Alliance Road „ „ „ „ 12a Alliance Road „ „ „ „ 4a Alliance Road „ „ Nuisance Order for work to be completed within 2 months. £2 2s. Od. costs. 35 Piedmont Road „ „ Summons withdrawnwork completed. 67 Ashburnham PI. „ „ „ „ 51a Glenforth Street „ „ Work completed. £7 7s. Od. costs. 52a Glenforth Street „ „ „ „ 10 Winforton Street „ „ Summons withdrawnwork completed. 26 Bos tall Hill „ „ 222 HOUSING It is beyond doubt that unsuitable housing conditions are responsible for many of the smaller and some of the larger tragedies of life and, by reason of its importance in preventive medicine, housing is a public health problem and responsibility. Indeed, the selection and presentation of areas for clearance is a vital duty of the health department. However, when expediency is the order of the day, a medical opinion in housing matters has very little practical weight except perhaps with regard to clearance areas. Such an opinion is rarely sought prior to, or in the early stages of planning and even when given in connection with "re-housing" or "transfer" it has a very limited effect due to the lack of available accommodation. This state of affairs is particularly unfortunate in that many medical and social problems arising in the community more often than not have a connection, directly or indirectly, with housing conditions and much misery and unhappiness could be eliminated or substantially reduced by the use of socio-medical advice in the early planning stages of housing schemes. To be successful, housing authorities need a high degree of prescience with planning ability to match. Much criticism has been levelled by the moderns at the architects and builders of the 19th century when, under severe pressure exerted by the industrial revolution, they became responsible for the urban areas which are now subject to re-planning and rebuilding. In those days the sudden and pressing demand for housing was met by impulsive design and hurried construction—neither actions being conducive to a satisfactory outcome. Similar pressures are making themselves felt today and it is conceivable that similar mistakes are being perpetrated which may warrant similar scathing criticism by future generations. Unfortunately perhaps but inevitably, finance has become the final arbiter in local authority housing schemes and this must lead, in many instances, to a product which is neither aesthetically satisfying nor wholly practical. Many authorities who saw in the Le Corbusier style "skyscraper" flats constructed on the industrial building technique the panacea to their housing problems, have been disillusioned. Far from being cheaper, costs can be anything from 20 to 80 per cent, higher than normal terrace houses of bricks; many such schemes lack nursery schools, creches or lidos; air conditioning is absent and central heating, if present, tends to be expensive; lifts are often slow and readily open to vandalism; double glazing is rare and 223 wind turbulence is a continual source of annoyance, and maintenance costs, already heavy, are rising rapidly. Even the theory that only "point block" schemes with densities up to 150 persons per acre meet the shortage of land problem is proving untenable for Haringey, with 2-storey houses and a few old people's flats has achieved a density of 110 persons per acre while Southwark, with 4-storey flats and maisonettes has managed 173 persons. High-rise dwellings are not new. However, it would seem that previous experiences in this field and the lessons of their inherent disadvantages have not been assimilated or fully understood. The deplorable conditions of many multi-storied dwellings in North London, in the Gorbals district of Glasgow and in many other large conurbations throughout the country bear testimony to the failure of high-rise accommodation medically, economically or socially to provide the ideal setting for family life. Moreover, their clearance as slum properties, although urgent, continues to be a difficult and highly complex operation. Their modern counterparts will be no less intractable when their time comes for replacement. Although we are led to believe that the multi-storied dwelling is now an indispensable part of the modern housing scheme, scant attention is paid to the mental strain occasioned to mothers who, living in accommodation above say the 5th floor, are more than concerned for the safety of their young children. The hazards to the children of lifts, stairs and windows at that height; lack of facilities for play in the immediate vicinity of the dwelling under the eye of the mother; the inadvisability of children to indulge in any hobby that is noisy and likely to be a nuisance to occupants of flats above and below thus tending to lead to bad neighbour relationships; the reluctance of tradesmen to deliver goods to storied dwelling necessitating greater thought on shopping lists; all these militate against the peace of mind of the parent. Furthermore, in urban areas the lack of play space for children is serious yet car parks far exceed the number of playgrounds and, although new housing schemes must include a proportionate space for the parking of cars, there is no such legislation for play. Are we sure that these matters are given their full weight in the preparatory planning of housing schemes? Attention needs to be drawn to one other aspect of multi-storied dwellings and to the serious problems which will accrue to local authorities when people, now in their late 50s and housed in the upper parts of these "skyscrapers", reach the age of retirement in a disabled condition. If not a breakdown then at least a serious dislocation of the practical side of the welfare and social services is presaged. 224 However, anticipating the problem is one thing but moving the "at risk" persons to more suitable ground floor, "purpose-built" or "sheltered" accommodation, however desirable, is likely to be an unattainable objective for present housing, especially for the elderly, is already inadequate and indications are that the position will deteriorate still further. A partial solution to this serious problem could be provided by the correction of under-occupation of property, especially in local authority dwellings. The G.L.C. reports that over 14% of its dwellings (i.e., more than 30,000) are under-occupied by 2 rooms or more and, at their cottage estates such as Becontree, Downham. Roehampton, etc., on an average, nearly one dwelling in every 3 is under-occupied by 2 or more rooms. This had led it to consider schemes to build more small dwellings. Re-housing is now recognised as a social duty but this can so easily be performed without heart or humanity. Perhaps housing estates might be better balanced and therefore more satisfactory if they were planned not merely as so many units of accommodation as they so often are but also with a greater emphasis than hitherto on the potential social, health and welfare effects for, in the long run, it is these matters which will determine the happiness of the coming generation. Housing Act, 1957 Part II—The following procedures were carried out during 1967:— (i) Premises Unfit for Human Habitation—Sections 16 and 17.—The undermentioned premises were considered unfit for human habitation and not capable at reasonable expense of being rendered fit. In five instances Undertakings were 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) Undertakings 79 Raglan Road, S.E.18 48 Red Lion Lane, S.E.18 8 Waverley Road, S.E.18 20 Westdale Road, S.E.18 71 Westdale Road, S.E.18 (b) Closing Orders 56 Abbey Grove, S.E.2 7 Albury Street, S.E.8 51 Ancona Road, S.E.18 225 52 Ancona Road, S.E.18 94 Barth Road, S.E.18 99 Bloomfield Road, S.E.18 14 Burrage Place, S.E.18 29 Burrage Road, S.E.18 108 Crescent Road, S.E.18 7 Dawson Street, S.E.18 48 Dutton Street, S.E.10 9 Gavin Street, S.E.18 31A Greenwich South Street, S.E.10 30 Guildford Grove, S.E.10 28 Gunning Street, S.E.18 27, 27A Hervey Road, S.E.3 1 Howick Mansions, Woolwich Road, S.E.18 49 Jackson Street, S.E.18 131 John Wilson Street, S.E.18 10 King George Street, S.E.10 3, 3A Lamerton Street, S.E.8 21 Marmadon Road, S.E.18 47 Marmadon Road, S.E.18 3 Maryon Road, S.E.7 43 Maryon Road, S.E.7 48 Maxey Road, S.E.18 222 Maxey Road, S.E.18 12 Mineral Street, S.E.18 35 Nightingale Place, S.E.18 8 Ordnance Road, S.E.18 51 Palmerston Crescent, S.E.18 36 Pattison Road, S.E.18 67 Raglan Road, S.E.18 71 Raglan Road, S.E.18 87 Raglan Road, S.E.18 14 Ransom Road, S.E.7 16 Ransom Road, S.E.7 13 Reidhaven Road, S.E.18 136 Royal Hill, S.E.10 21 Tewson Road, S.E.18 36 The Slade, S.E.18 11 Walmer Terrace, S.E.18 6 Warspite Road, S.E.18 65 Waverley Road, S.E.18 430 Woolwich Road, S.E.7 458 Woolwich Road, S.E.7 566 Woolwich Road, S.E.7 568 Woolwich Road, S.E.7 226 (c) Demolition Orders 1 Coleraine Road, S.E.3 43, 43A Marlton Street, S.E.10 (ii) 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:— 71 Ashburnham Grove, S.E.10—Basement front, back and back-addition rooms. 96 Court Road, S.E.9—Basement flat at rear. 75 Eglington Road, S.E.18—Basement front room. 36 Guildford Grove, S.E.10—Basement front and back rooms and kitchen. 13 Maryon Road, S.E.7—Basement front and back rooms and scullery. 38 Plumstead Road, S.E.18—Ground floor back and backaddition rooms and first floor front, back and back-addition rooms. 148 Plumstead Road, S.E.18—Ground floor back and backaddition rooms and scullery, first floor front, back and back-addition rooms and second floor front and back rooms. 68 Tuskar Street, S.E.10—Basement front, back and backaddition rooms. 8 West Grove, S.E.10—Single-storey rear annexe comprising living room, bedroom and kitchen. 746 Woolwich Road, S.E.7—Ground floor front and back rooms and back-addition scullery, first floor front and back rooms and attic front and back rooms and kitchen. (iii) Revocaton of Demolition Order—Section 24—A Demolition Order in respect of the undermentioned premises was revoked: 12 Sandyhill Avenue, S.E.18. 227 (iv) Determination of Closing Orders—Section 27—Closing Orders on premises and parts of premises as follow were determined:— 113 Brewery Road, S.E.18 160 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. 43 The Village, S.E.7— Basement front and back rooms. 1 West Grove Lane. S.E.10—Basement left and right rooms and scullery. Part III—Clearance Areas Joint Circular 69/67 and 61/67—Housing Act, 1957—Slum Clearance—This Circular issued on 25th October, 1967, states that the Minister and the Secretary of State for Wales are engaged upon a general review of the problems of legislation affecting older houses. Their conclusions will be announced in due course but, in the meantime, the Circular gives guidance on several matters relevant to the duty of local authorities to deal with houses unfit for human habitation. Briefly, this guidance has regard to standards of fitness with explanatory notes in the Appendix, the inclusion of buildings in clearance areas as badly arranged, the classification of premises in clearance areas either as a house or as another building and information to tenants of opportunities for well-maintained payments. The following Clearance Areas were reported during the year:— Glyndon Redevelopment Area, Phase II Pattison Road Clearance Areas Nos. 1-10 Area No. 1 33-47 (odd) Richmond Place 36-44 (even) and 58-68 (even) Vicarage Road 16-24 (even), 28, 30, 34, 38, 40, 44, 17, 21-33 (odd) and 39 Hudson Road 91-99 (odd) Raglan Road 23, 24, 27-31 (odd), 35-39 (odd), 43-53 (odd), 59-77 (odd), 83-95 (odd), 99, 101, 30-60 (even), 64 and 66 Pattison Road 14-16 (cons.), 18, 19 and 19£ Dawson Street 24, 26, 30 Swetenham Place 18 Oliver Street Area No. 2 20 and 21 Pattison Road 228 Area No. 3 14, 15, 17 and 17A Pattison Road 32 Richmond Place Area No A 36 and 38 Richmond Place Area No. 5 10 and 11 Pattison Road 28-34 (even) Vicarage Road 13-25 (odd), 6, 10-20 (even), 24 and 26 Richmond Place Area No. 6 22 and 24 Vicarage Road Area No. 7 2 Richmond Place 43-59 (odd) Maxey Road Area No. 8 21, 22 and 25 Oliver Street 71-79 (odd) Maxey Road 6-11 (cons.), 20A and 20-22 (cons.) Dawson Street 12-16 (even) Swetenham Place Area No. 9 2, 4, 5 and 7 Swetenham Place 91, 93 and 97 Maxey Road Area No. 10 109 and 111 Maxey Road Marmadon Road Clearance Areas Nos. 1-4 Area No. 1 39-45 (odd) Glenside Road Area No. 2 1, 3, 9, 25, 27, 33 and 2-12 (even) Glenside Road 7-15 (odd) and 2-8 (even) Marmadon Road 2-18 (even) and 22 Mabyn Road 1-7 (odd), 15 and 17 Hartville Road Area No. 3 21-37 (odd), 18, 20 and 24 Marmadon Road 19 and 26-30 (even) Mabyn Road 21, 27 and 29 Hartville Road 61-67 (odd) and 49 Barth Road Area No. 4 38 and 40 Mabyn Road Plumstead High Street Clearance Areas Nos. 1-5 Area No. 1 7-11 (odd) Reidhaven Road 229 Area No. 2 13-17 (odd) Reidhaven Road Area No. 3 21 and 23 Reidhaven Road Area No. 4 27, 29, 33, 35 and 24 Reidhaven Road 5-11 (odd) Gavin Street 8 Reidhaven Road Area No. 5 1 and 2 Reidhaven Road 1 Gavin Street 17, 17A, 19, 19A, 21, 21A, 23, 31, 37 and 41 Plumstead High Street Ancona Road Clearance Areas Nos. 1-8 Area No. 1 3-7 (odd) Ancona Road Area No. 2 15, 21 and 2-16 (even) Ancona Road Area No. 3 27, 29 and 20 Ancona Road Area No. 4 33, 37 and 24-34 (even) Ancona Road Area No. 5 47 and 38 Ancona Road Area No. 6 55, 57, 61, 63 and 48-52 (even) Ancona Road Area No. 7 64 and 66 Ancona Road Area No. 8 77, 79 and 70 Ancona Road Palmerston Crescent Clearance Areas Nos. 1-3 Area No. 1 1-17 (odd) and 2-8 (even) Palmerston Crescent 144 and 146 Plumstead Common Road Area No. 2 21-25 (odd), 29-47 (odd) and 28-44 (even) Palmerston Crescent Area No. 3 55-65 (odd) Palmerston Crescent Red Lion Lane Clearance Areas Nos. 1-3 Area No. 1 36-44 (even) Red Lion Lane 230 Area No. 2 28-32 (even) Red Lion Lane Area No. 3 22 and 24 Red Lion Lane Westdale Road Clearance Areas Nos. 1-8 Area No. 1 7, 8, 9, 11, 12 Graydon Street 36 and 37 Nightingale Place Area No. 2 1, 2, 3 Graydon Street Area No. 3 10-16 (even) Westdale Road Area No. 4 1-5 (odd), 24-28 (even) and 32 Westdale Road Area No. 5 17 and 19 Westdale Road Area No. 6 27-31 (odd) Westdale Road Area No. 7 35-45 (odd) and 58-62 (even) Westdale Road Area No. 8 53-61 (odd) and 72 Westdale Road 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. 231 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 211 and 31 inspections for discretionary and standard grant applications respectively, and advice was given on 96 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 to apply to Houses in Mu'tiple 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, 123 visits were made by the Housing Inspectors. In 8 instances it was found necessary to serve informal notices requiring the execution of works under this Act. 232 Re-housing (a) Borough Council—The number of families housed and re-housed including transfers, casual voids, etc., amounted to 1,375. Of this number 29 were in respect of families re-housed from outside the Borough. (b) Greater London Council—During the year ended 31st December, 1967, the Greater London Council had provided alternative accommodation for a total of 836 Greenwich families. Of this figure 343 were housed on Greater London Council housing estates outside the Borough. Six families from outside Greenwich were re-housed in the Borough under the Greater London Council scheme. Overcrowding—During 1967 there were 513 visits carried out in respect of complaints of overcrowding and applications for re-housing, as a result of which 15 families were found to be statutorily overcrowded. Council Housing Schemes—(Information supplied by the Borough Engineer and Planning Officer). (a) Schemes in operation at the end of the current year:— Site Total Dwellings Completed by 20.1.68 Glyndon Development Area Phase I—Stage III 204 172 Phase I—Stages IV and V 166 — St. Mary's Redevelopment Area Bowling Green Row—Stage I 125 113 John Wilson Street—Stage II 48 — Gavestone Crescent, S.E.I2 172 — Kidbrooke Park Close 74 39 Herbert Road/Whitworth Road. S.E.I 8 12 (plus 1 shop) — Heathfield Terrace 8 8 Cardwell Cottages 268 — Woolwich Common 140 — Connaught Barracks 330 — Charlton Lane 27 — Mary on Road 188 — Industrialised Building— Various Sites 638 — 233 (b) The following schemes are either those for which the Ministry of Local Government has granted loan sanction or those for which it is envisaged that loan sanction may be granted in 1968:— Site Dwellings Bowling Green Row—Stage 11 24 The Mound 20 Brent Road/Condover Crescent 48 Little Heath (Sheltered Housing) 41 Beasley's Brewery 24 Rectory Place/Leon Street 25 Swingate Lane (Sheltered Housing in part) 44 Coleraine Road—Stage II—Site B 5 Lingfield Crescent 35 Eltham Road 41 Red Lion Lane 90 Haddon Lodge 27 Cleanthus Road 156 INSPECTION OF FOOD AND SUPERVISION OF FOOD PREMISES According to reliable estimates, the present world population of 3,500 million will have doubled by the year 2000. If all these additional people are to be adequately nourished, a great expansion in world food production is essential, for malnutrition has already reached substantial proportions in many parts of the world. Not withstanding the efforts of the U.N.'s Food and Agricultural Organisation to improve world food supplies, in Asia for example, production per capita has fallen by 5% since 1960 and the figure for Latin America is probably worse. Not only must more food be produced but we must consume more of what we grow and to this end we must make the control of pests, which could devour as much as one third of all food production, much more complete. From a purely practical point of view, the responsibility for making good the world's food deficiency falls to the more developed and civilised areas of Europe and America. However, most of the arable land in these regions is already under cultivation and increases in production are achieved mainly by the application of modern scientific and technological methods which include the use of artificial fertilisers, pesticides and herbicides, not to mention the employment of antibiotics, coccidiostatics, tranquillisers, anthelminthics and hormones in dairy farming. If present in sufficient quantities, effects of ingesting many of these compounds could be dangerous and far-reaching. Furthermore, other serious problems 234 are threatening. Long-lived fission products such as strontium 90, iodine 131, caesium 137, etc., residues from nuclear processes, will be held in the soil for many years to come and will eventually find their way into the nation's food. It follows, therefore, that examination of such foodstuffs is, and will get progressively more complicated and, with these more subtle forms of contamination, analysts are confronted with situations requiring new techniques and methods of analysis. In addition to the usual "food-borne" infections, be they bacterial, viral, rickettsial, protozoal, or zooparasitical, the food inspector's difficulties are increasing as a result of this rapid scientific progress which is revealing hazards, new or previously unrecognised, which demand increased attention and more selective sampling. To-day, the intricacies of misleading labelling, the very real dangers of infection and contamination are such that it requires the closest of team work between the Food Inspector, the Analyst, the Bacteriologist and, not least, the Food Trader himself to keep them within reasonable bounds. New Legislation The Slaughterhouses (Meat Inspection Grant) (Revocation) Regulations, 1967. These Regulations with effect from 31st March, 1967, revoked the Slaughterhouses (Meat Inspection Grant) Regulations, 1958, which provided for the payment of Exchequer grants to local authorities in respect of meat inspected in excess of the quantity required for local consumption. They were superseded by the Meat Inspection Regulations, 1963, which empower local authori ties to charge for the inspection of all meat slaughtered for human consumption in their respective districts. The Slaughter of Poultry Act, 1967. Circular 46/67 issued by the Ministry of Agriculture, Fisheries and Food on 7th August, 1967, refers to the above Act which will come into force on a day to be appointed by the Minister. The Act provides that turkeys and domestic poultry intended for sale for human consumption shall be slaughtered instantaneously by decapitation, dislocation of the neck, or other approved method, or stunned and rendered instantaneously insensible until death supervenes. Jewish and Muslim methods of slaughter are exempted from these provisions. When the Act becomes operative, premises where stunning is carried out must be registered with the local authority. This provision will not be brought into effect for some months to allow 235 time for the Minister to approve suitable stunning devices and for owners of poultry slaughterhouses to install them. Local authorities will also be empowered under the Act to carry out inspections to check that any regulations made by the Minister are being observed in premises where poultry are being slaughtered, and to institute proceedings where the provisions of the Act or regulations under it have been contravened. At present there are no premises in the Borough to which this Act applies. The Merchandise Marks (Imported Goods) No. 7 Order, 1934 Amendment Order, 1967. The Merchandise Marks (Imported Goods) No. 7 Order, 1934, as amended (hereinafter referred to as the Principal Order), prohibits the importation into, or the sale or exposure for sale in, the United Kingdom of certain kinds of imported meat and edible offals unless they bear an indication of origin applied in the manner specified in the Order. This Order, which becomes operative on 20th March, 1968, amends the Principal Order to permit a reduction in the size of lettering required when applying the indication of origin to those kinds of meat and edible offals when sold or exposed for sale in pre-packed form, whether wholesale or by retail, in a container or package whose net weight does not exceed 4 lb. The Order also extends to chilled beef, frozen mutton, frozen lamb and frozen pork in pre-packed form a provision in the Principal Order permitting the application of the indication of origin to each container or package of meat. The Importation of Carcases and Animal Products (Amendment) Order, 1967. This Order came into operation on 21st April, 1967. Schedule 3 to the Importation of Carcases and Animal Products Order, 1954, as amended, is further amended by the deletion of Italy from the respective lists of countries of origin from which dry sausage (salami), fully cured bacon and ham. and sausage casings (cleaned and scraped) may be landed in Great Britain without a licence. Other Food Legislation In addition to the foregoing legislation, the undermentioned food Regulations were enacted during the current year:— The Meat Pie and Sausage Roll Regulations, 1967, operative from 31st May, 1968. 236 The Canned Meat Product Regulations, 1967, and The Sausage and Other Meat Product Regulations, 1967, both operative from 31st May, 1969. The Food (Control of Irradiation) Regulations, 1967, which became operative on 1st June, 1967. The Artificial Sweeteners in Food Regulations, 1967, which became wholly operative in December, 1967, and superseded the Food Standards (Saccharin Tablets) Order, 1953, and the Artificial Sweeteners in Food Order, 1953. The Solvents in Food Regulations, 1967, and (Amendment) Regulations, 1967, operative from 3rd November, 1969. The Labelling of Food Regulations, 1967, supersede certain provisions of the Labelling of Food Order, 1953, as amended, relating to the labelling and description of food. To the extent that they apply to any food (other than a soft drink) containing cyclamate, the Regulations come into operation on 1st January, 1968: in all other respects they come into operation on 4th January, 1971. The Coffee and Coffee Products Regulations, 1967, become operative on 4th January, 1971, and supersede the Food Standards (Liquid Coffee Essences) Order, 1945, the Food Standards (Coffee Mixtures) Order, 1952, and article 7 (3) of the Labelling of Food Order, 1953. The Ice-Cream Regulations, 1967, become operative on 4th January, 1971, and supersede with amendments the Food Standards (Ice-Cream) Regulations, 1959, and the provisions of the Labelling of Food Order, 1953, as amended, which relate to ice-cream. The Margarine Regulations, 1967, supersede the Food Standards (Margarine) Order, 1954, the Food Standards (Butter and Margarine) Regulations, 1955, insofar as they relate to margarine, and Part IV A of, and supporting definitions in, the Labelling of Food Order, 1953, as amended. These Regulations come into operation on 4th January, 1971. The revocation of the Part IV A of, and the supporting definitions in, the Order of 1953 as amended is, however, postponed until 5th July, 1971, and until that date Regulations 8 and 10 of these Regulations will not apply to any label, ticket or notice which conforms to the requirements of the said Part IV A. Ministry of Agriculture, Fisheries and Food Circular 75/67 lists in the Appendix chemical products which have been approved 237 between 8th March, 1959, and 30th June, 1967, as alternatives to steam or boiling water in the cleansing of vessels used for storage or conveyance of milk. It is intended in future to issue early in March a cumulative list in this form to the end of each calendar year and early in September a supplementary list to 30th June. For the purpose of the Public Health (Imported Food) Regulations 1937/48, this Ministry issued Circulars officially recognising certificates in respect of the following : Algeria, Argentine Republic, Australia, Belgium, Botswana, Brazil, Canada, China, Cuba. Denmark, Ethiopia, Federal Republic of Germany, Finland, France, Italy, Malta, Netherlands, New Zealand, Norway, Poland, Romania, Singapore, South Africa, Spain, Sweden, Switzerland, Syria, Tanzania, United States of America and Uruguay. 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 202. On 45 occasions the premises of distributors and dairies were visited other than for sampling purposes but in no instance was action required. The Milk (Special Designation) Regulations, 1963 and 1965 There is one milk processing plant in the Borough in respect of which a Dealer's Pasteuriser's Licence was in force on 31st December, 1967, as were the following licences in relation to milk obtained in pre-packed form for sale to the general public:— In Operation 31.12.67 Distribution of Sterilised Milk 180 „ Pasteurised Milk 143 „ Untreated Milk 70 „ Ultra Heat Treated Milk 18 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 twenty-one samples were submitted for the Methylene Blue test, of which 2 failed and 11 were void. "Follow- 238 up" samples taken in respect of the 2 which failed proved satisfactory. Satisfactory reports were received in respect of 221 milk samples submitted for the Phosphatase test. Thirty samples of Sterilised milk were submitted for the Turbidity test and all proved satisfactory. Analytical Examination of Milk—A total of 61 formal samples of designated milks were submitted for chemical analysis and all proved to be genuine. Eleven samples of cream were taken and found to be genuine. Preserved Food and Ice Cream Premises In accordance with the provisions of the Food and Drugs Act, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used:— (a) for the sale, or manufacture for the purpose of sale, of ice cream, or storage of ice cream intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; are required to be registered by the owner or occupier with the Local Authority. Preserved Food Premises (meat, fish, etc.)—The total number of premises on the register at 31st December, 1967, was 226. Five hundred and sixty-seven 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 572. Visits to these premises were made on 85 occasions and 31 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 80 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 the Methylene Blue Reductase Test and a summary of this year's reports is given in the following table:— 239 Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 51 4½ hours or more 1 Satisfactory 12 2½ to 4 hours 2 Sub-standard 8 ½ to 2 hours 3 Unsatisfactory 9 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 80 samples taken during the current year, 14 were of the "soft" variety, 8 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. Blackheath and Woolwich Common Fairs 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 these sources of entertainment. In all, inspectors made 21 visits to the fairs during these holiday periods, but in no instance was action required. Street Traders During the year 29 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 the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, and (Amendment) Regulations, 1966. 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 3,944 visits, as a result of which 416 improvements were effected. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year : 240 Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected No. of Improvements effected Caterers, Restaurants, etc 336 32 102 Grocers, Greengrocers 237 34 98 Butchers' Shops 111 19 75 Dairies and Milk Distributors 45 — — Wharves and Factories 780 3 39 Bakehouses and Bakers' Shops 27 6 15 Ice Cream Premises, Confectioners, etc 85 8 31 Fried Fish Shops 88 7 53 Other Non-Registered Food Premises 142 1 3 Cooked Meats and Preserved Foods 368 * * Visits Re. Infestations 133 — _ „ Markets 314 — — „ „ Food Poisoning 4 — — Sampling Visits 769 — — Fair Visits 14 — — School Visits 159 — — Interviews 249 — — Complaints Investigated 83 — — Totals 3,944 110 416 * Included under Grocers' and Butchers' Shops. 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 wash- hand basins No. with facilities for washing food and equipment Cafes, Restaurants, etc 447 447 447 Grocers 332 332 332 Greengrocers 166 163 Not applicable Butchers 139 139 139 Bakers 70 70 70 Confectioners 289 288 Not applicable Fish Shops 72 72 72 Public Houses 238 238 238 Off Licences 53 53 Not applicable 241 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 27 occasions and, as a result of the inspections, 15 sanitary defects were remedied. Catering Establishments As a result of 336 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 102 occasions. Eighty-nine improvements were carried out at public houses as a result of informal action. Food Rejected The following table is a summary of unsound food voluntarily surrendered during the year:— Shops, Stalls, etc:— Meat— Beef 2,313 lbs. Chicken 46 „ Lamb 610 „ Lambs'Hearts 53 „ Lambs' Kidneys Lambs' Livers 4 „ 200 „ Offal 146 „ Ox Kidneys 120 „ Ox Livers 180 „ Ox Tail 14 „ Pigs' Kidneys 124 „ Pigs' Trotters 45 „ Pork 861 „ Sheep Kidneys 40 „ Turkey 22 „ Canned and Other Foods— 4,778 lbs. Butter 269 lbs. Coconut 100 „ Confectionery 11 Cooked Meats (Canned) 2,512 „ Fish 508 „ Fish (Canned) 100 „ Foods, Various (Canned) 1,146 „ Foods, Various (Frozen) 2,732 ,. Foods, Various (Packets) 1,291 „ Fruit 40 „ Fruit (Canned) 1,217 „ Fruit Juice (Canned) 43 „ Fruit Pulp (Canned) 62 „ Jam and Marmalade 83 „ Meat Pies 10 „ Tomatoes (Canned) 807 „ 242 Tomato Paste (Canned) 82 ,, Vegetables 32 „ Vegetables (Canned) 4,750 „ 15,795 lbs. 20,573 lbs. The Meat Inspection Regulations, 1963, and The Meat Inspection (Amendment) Regulations, 1966. Meat Inspection— There is only one licensed private slaughterhouse in the Borough, namely Woodlands Farm Abattoir at Garland Road, Plumstead. owned and operated by the Royal Arsenal Co-operative Society Limited. The total number of animals presented for slaughter and inspected at this establishment during the year amounted to 50,756. Details are as follows:— Carcases and Offal Inspected and Condemned in Whole or in Part, 1967 Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed and Inspected All Diseases (except Tuberculosis and Cysticerci)— 9,976 126 6 13,382 27,264 Whole carcases condemned — — — 3 47 Carcases of which some part or organ was condemned 3,070 29 1 871 9,750 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 30.9% 23% 16.6% 6.5% 32% Tuberculosis only- Whole carcases condemned — — — — 1 Carcases of which some part or organ was condemned — — — — 300 Percentage of the number inspected affected with Tuberculosis — — — — 1.1% Cysticercosis— Carcases of which some part or organ was condemned and treated by refrigeration 8 — — — — Although the number of cattle presented for slaughter remains fairly constant from year to year, between 9,000 and 10,000, the number of pigs so presented varies very considerably and is the main cause of the fluctuation in the figures recording the annual through-put at the slaughterhouse. 243 Ten thousand fewer pigs were slaughtered this year than in 1966. The most important factor bearing on this reduction was an industrial dispute early in the year, which lasted several weeks, involving the engineers responsible for maintaining the supply of steam and mechanical equipment of the slaughterhouse. This had the effect of seriously restricting the hours available for slaughtering each day and also created difficulties in the matter of keeping the slaughterhouse clean. Large numbers of pigs were diverted to other slaughterhouses during the period of the dispute. The other cause was the outbreak of Foot and Mouth disease in October which was still active in many parts of the country at the end of the year with little immediate prospect of the epidemic coming to an end. Despite the setback caused by the Foot and Mouth disease epidemic which is of serious national importance and concern, the health of livestock generally continues to improve as one disease after another is brought under control. Tuberculosis in cattle and Swine Fever in pigs are diseases which a few years ago not only caused serious losses to livestock producers but were also the reason for large quantities of carcase meat and offal being condemned at slaughterhouses. These diseases have been successfully stamped out by the vigorous policies of eradication initiated and carried out by the Ministry of Agriculture. It is of particular local significance and importance to report that of nearly ten thousand cattle, obtained from almost every producing area in England and Wales, and slaughtered and inspected at the Plumstead slaughterhouse during the year, not one incidence of tuberculosis was observed. Such a result is the highest possible tribute to the success attained by the Ministry's tuberculosis eradication scheme completed in 1960. Another significant success obtained over the last few years is the eradication of the warble-fly which formerly caused serious damage to the hides and skin of cattle, quite apart from the debilitating effect on the animals afflicted by the infestation. It is highly improbable, however, despite these success stories that a stage will be reached when, except perhaps in the smallest slaughterhouse, there will be no condemnation. In this connection, for a variety of reasons and conditions, 35½ tons of offal and carcase meat was declared unfit for human consumption during the year. Pig offal, mainly lungs with respiratory infections, and bovine livers infested with liver flukes or otherwise infected by abscesses, make up the bulk of items condemned because of their unwholesome condition. There were 2,700 bovine livers condemned for the above reasons, weighing more than 12 tons. Nineteen hundred of these livers were 244 infested with liver fluke, or just under 20 per cent. of all cattle admitted to the slaughterhouse during 1967. This constitutes a slight improvement on earlier years but much more needs to be done by way of cleaning up grazing land before this parasite is eliminated. Of the 47 pig carcases condemned during the year, 8 of these were of pigs found to be dead on arrival at the slaughterhouse. Thirty-four others were condemned because of multiple abscesses, the infection in every case thought to have been introduced by tail biting. The other 5 carcases were rejected for a variety of septic conditions. Three sheep carcases were condemned because of multiple abscesses. Looking to the future it is hoped that a much greater effort will be made by all concerned to see that livestock being presented for slaughter arrive in a more cleanly state than at present, particularly cattle and sheep. 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. Eight licences to slaughtermen were renewed and one new slaughterman's licence granted. Butchers' Shops—Frequent visits are made to these shops and in addition to the 111 formal inspections carried out, insanitary defects were remedied in 75 instances. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was this necessary. Public Health (Imported Food) Regulations, 1937 and 1948 The London Borough of Greenwich with a river frontage of some 9 miles with more than 40 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Imported Food Rejected—Unsound or diseased imported meat when surrendered is passed for non-edible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, processed for stock feeding. The following foods were rejected at the wharves:— 245 Meat— Beef 614 lbs. Lamb 4,227 „ Lambs' Liver 76 „ Ox Kidneys 55 „ Ox Tails 59 „ Pork 90 „ Sheep Hearts 122 „ Turkey 26 „ - 5,269 lbs. Canned and Other Foods— Coffee 1,456 lbs. Cooked Meats (Canned) 889 „ Fish (Canned) 1,814 „ Flake Albumen (Canned) 50 Fruit Juice (Canned) 5,388 „ Fruits, Various (Canned) 33,587 „ Jam and Marmalade 60 „ Margarine 28 „ Prunes 16 „ Red Pickle Peppers 29 „ Ravioli 7 „ Tomatoes, Tomato Puree and Paste (Canned) 1,543 „ Vegetables (Canned) 41 „ 44,908 lbs. 50,177 lbs. Caseous Lymphadenitis—This disease, sometimes called "pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcasses 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 22,918 2,290 — — Groundnuts—Presence of A flatoxin—During the year, 8 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:— 246 Country of Origin Quantity Imported Containers Sampled Unsatisfactory Bact. Chem. Dried Egg Albumen America 383 x 50 lb. Ctns. 38 2 — Denmark 20 x 50 lb. Ctns. 2 — — Dried Whole Egg Australia 651 x 160 lb. Drums 89 — — China 4,377x 110 lb. Tins 221 7 — Denmark 420 x 50 lb. Ctns. 30 1 — »» 400 x 56 lb. Ctns. 22 — — Holland 230 x 14 lb. Drums 20 — — II 200 x 55 lb. Drums 20 — — Poland 7,999 x 44 lb. Ctns. 137 — — I* 3.000 x 501b. Ctns. 30 — — Dried Egg Yolk Denmark 200 x 551b. Ctns. 20 — — Frozen Whole Egg Australia 127,829x 281b. Tins 567 — 1 China 33,337 x 44 1b. Tins 221 — 3 » 5,500 x 281b. Tins 51 — — Frozen Egg White China 500 x 44 lb. Tins 25 — — Incidence of Salmonella Organism Found Samples Dried Whole Egg Frozen Whole Egg Dried Egg Albumen Salmonella meleagridis 7 — — „ thornpson 1 — 1 „ tennessee — — 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. Salmonella organisms were found in one consignment during the current year of sampling carried out in the Borough. One heat treatment was effected on the positive albumen and further samples taken all proved satisfactory. English Frozen Whole Egg Plant—In 1967, this plant was in full production. The Liquid Egg (Pasteurisation) Regulations, 1963, were implemented without difficulty and to the complete satisfaction of this Department. Fifty-two samples were submitted to the Amylase Test, all of which proved satisfactory. 247 Egg Processing Plant—Dried Whole Egg—This new plant, which came into operation at the end of 1966, was in full production during the current year. The product was sampled and submitted for bacteriological examination on 26 occasions and in each instance was satisfactory. Desiccated Coconut—During 1967, routine samples of consignments of this product totalled 62, all of which proved 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 27 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 Saudi Arabia 8 21,350 lbs. Australia Curacao Cyprus 4 9 167,297 lbs. New Zealand Ascension Isles 4 90,497 lbs. Bermuda 1 Malta 1 Food and Drugs Act, 1955 Eleven hundred and fourteen samples were submitted for examination to the Public Analyst, of which 109 informal samples were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 79 formal and 926 informal were obtained in the normal course of sampling. Of all the samples obtained, 40 were considered by the Public Analyst to be non-genuine and of this total 13 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 27 non-genuine samples, 10 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 1.69%. Milk was one of the main foods sampled, the total being 61 samples of which 57 were in respect of milk other than Channel 248 Islands. Of this latter figure, the average percentage of milk fat was 3.65% and solids-not-fat 8.82%, 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. Four Channel Islands milks sampled in the Borough during the year proved to have an average content of 4.22% and 9.01% respectively. Dried Milk Regulations, 1965 The two samples of dried milk taken during the year proved satisfactory. The Condensed Milk Regulations, 1959 A satisfactory report was received on the one sample of condensed milk taken during the year. Other Food Examinations Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination Action Taken Bact. or Chem. Result Cream Soda Drink Complaint from member of the public that cream soda had a "catty" smell. Chem. The specimen satisfied the tests applied to it. It was of normal composition for Cream Soda and no unusual taint was observed. Regarding the complaint a "catty" smell, which usually disappears after the bottle has been opened, has in the past been found to have been caused by the persistence of butyric acid producing bacteria under the washer of the cap, which are difficult to remove by washing and which thrive in the medium of Cream Soda. Complainant notified. 249 Article How Obtained Examination Action Taken Bact. or Chem. Result Butter Complaint from member of the public that butter tasted rancid. Chem. The specimen was genuine butter. It appeared to be fresh and of good quality and was tested for rancidity but none was found, the free fatty acids, 0.15%, being lower than usual for butter. Complainant notified. Fish (Cod) Complaint from a Fishmonger that fish was unfit for human consumption. Chem. The specimen satisfied the tests applied to it. The sample was examined immediately upon receipt for freshness. From the smell the pH (7.3) and the total Volatile Bases (19 mg. nitrogen per 100g.), the fish appeared to be quite fresh and fit for consumption. It was, however, unusually wet. Complainant notified. Meat Pies Complaint made on behalf of members of Luncheon Club that meat pie had unpleasant taste. Chem. The pie had an unpleasant, stale smell when rereceived and was unfit for consumption. No explanation found on investigation. Other meat pies supplied by caterers on same day were satisfactory. Complainant notified. No further action. Bread Roll Complaint from member of the public that bread roll contained foreign bodies. Chem. The specimen contained baked in the crumb two small dark grey foreign bodies consisting of dough containing oil and fine particles of iron. Public Analyst's report notified to bakery concerned. Hazard in the bakery trade which occurs occasionally. Complainant informed. No further action. 250 Article How Obtained Examination Action Taken Chem. or Bact. Result Butter Complaint from member of the public that butter was suspected to be margarine. Chem. This specimen was found to consist entirely of genuine butter in good, fresh condition, but appeared to be composed of a blend of butters of noticeably different shades of yellow. Complainant notified. Rissoles Complaint from staff members of a hotel whether rissoles were fit for consumption. Chem. The sample was considered somewhat stale and unpalatable but its pH was 6.5 and no chemical evidence was found to indicate unfitness for consumption. Complainants notified. Mains water supply From bathroom tap following complaint from tenant that mains water supply was discoloured. Bact. Satisfactory. Complainant notified. Dried Skimmed Milk with Non- Milk Fat Complaint from member of the public that dried skimmed milk contained foreign bodies. Chem. The sample satisfied the tests applied to it. It contained a few dark brown specks which were identified as burnt particles of spray dried milk, but the quantity although rather more than usual was not considered excessive and the condition and taste of the product were otherwise quite satisfactory. Complainant notified. 251 Article How Obtained Examination Action Taken Bact. or Chem. Result Tea Complaint from member of the public that tea contained foreign bodies. Chem. The specimen contained thirty small lumps of a soft, brown material, measuring from ½ in. to i in. in length, weighing altogether 0.36 gr. and consisting of matted tea leaf hairs. The packers stated the matted tea leaf is known in the trade as tea fluff which intermittently collects around the automatic equipment used in the weighing and packeting of tea. The packers replaced the tea to the customer. In addition to the foregoing complaints, there were 73 others from members of the public. Each case was fully investigated by the Food Inspectors and, where justified, appropriate action was taken. FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1967 (including samples taken under the Public Health (Imported Food) Regulations) Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Almonds, Ground — 3 3 — __ — Arrowroot — 3 3 — — — Aspirin Tablets — 1 1 — — — Baby Foods — 12 12 — — — Baking Powder — 2 2 — — — Barley, Pearl — 2 2 — 1 1 Batter Flour — 1 1 — — — Beverage, Canned — 1 1 — — — Biscuits — 32 32 — 1 1 Blancmange powder — 2 2 — — — Brandy 1 1 2 — — — Bread — 2 2 — — — Bread, Rye 2 2 — — — Bread, Starch reduced — 2 2 — — — Breadcrumbs — 3 3 — — — 252 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Butter — 4 4 — — Cake and Pudding mixture — 7 7 — — — Cake decorations — 1 1 — — — Cake mixture — 3 3 — — — Calf's foot jelly — 1 1 — — — Castor oil — 1 1 — — — Cereal, Breakfast — 1 1 — — — Cheese and cheese spread 9 9 — 1 1 Chloral mixture — 2 2 — — — Chocolate, drinking — 6 6 — 2 2 Coconut, Desiccated — 5 5 — — — Cod liver oil — 1 1 — — — Coffee — 7 7 — 2 2 Coffee beans — 1 1 — — — Coffee extract (dry) — 9 9 — — — Coffee extract (liquid) — 3 3 — — — Colouring matter — 6 6 — — — Confectionery, chocolate — 8 8 — Confectionery, flour — 18 18 — 1 1 Confectionery, sugar — 34 34 — 2 2 Cooking fat — 1 1 — — — Cornflour — 4 4 — — — Cornmeal — 1 1 — — — Cough syrup — 1 11 1 — — — Cream — 11 — — — Cream of tartar — 5 5 — — — Curry, canned — 1 1 — — — Curry powder — 6 6 — — — Custard, canned — 2 2 — — — Custard powder — 4 4 — — — Dandelion coffee essence — 1 1 — — — Dessert mixtures — 1 1 — — — Dessert powder — 22 22 — — — Drinks, soft — 50 50 — — — Drinks, soft, powders — 5 5 — — — Dripping — 2 2 — — — Emuisifier — 1 1 — 1 1 Epsom salts — 1 1 — — — Farina — 1 1 — — — Fish — 2 2 — — — Fish, bottled — 4 4 — — — Fish cakes — 2 2 — 1 1 Fish, canned — 24 24 — 1 1 253 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Fish paste — 11 11 — — — Flavouring compounds — 4 4 — — — Flavouring essence — 3 3 — — — Flour, plain — 2 2 — — — Flour, self-raising — 3 3 — — — Fruit, bottled — 1 1 — — — Fruit, canned — 46 46 — — — Fruit curd — 3 3 — — — Fruit, dried — 17 17 — — — Fruit, glace — 7 7 — — — Fruit juice — 7 7 — 1 1 Fruit pie — 4 4 — — — Fruit puree — 5 5 — 3 3 Fruit syrup — 1 1 — — — Gelatine — 6 6 — — — Gin 2 — 2 — — — Golden raising powder — 1 1 — — Gravy powder — 2 2 — — — Gravy preparation — 6 6 — — — Groundnuts — 8 8 — 1 1 Herbs, dried — 4 4 — — — Honey — 4 4 — — —- Horseradish — 1 1 — — — Ice cream — 4 4 — — — Ice cream powder — 2 2 — — — Ice lollie — 1 1 — — — Ice lollie mixture — 1 1 — — — Jam — 16 16 — 1 1 Jelly, prepared with fruit — 3 3 — — — Jelly tablets and compounds — 22 22 — — — Junket preparation — 2 2 — — — Lentils — 1 1 — — — Macaroni — 3 3 — — — Malt, brewing — 1 1 — — — Margarine — 4 4 — — — Marmalade — 5 5 — — — Marzipan — 3 3 — — — Mayonnaise — 1 1 — — — Meal preparation — 3 3 — 1 1 Meat, minced 7 — 7 — — — Meat paste — 8 8 — — — Meat products 1 21 22 — — — Meat products, bottled — 3 3 — — — Meat products, canned — 65 65 — 2 2 Medicines — 4 4 — 1 1 Meringue mixture — 1 1 — — — 254 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Milk (including Channel Islands) 61 — 61 — — — Milk, condensed — 1 1 — — — Milk, dried — 2 2 — — — Milk, evaporated — 1 1 — — — Milk of Magnesia tablets — 1 1 — — — Milk pudding, canned — 6 6 — — — Mincemeat 4 4 — — — Mushroom cubes — 2 2 — 2 2 Mustard — 1 1 — — — Mustard preparation — 2 2 — 1 1 Mustard, prepared — 4 4 — — — Nuts — 2 2 — — — Oats, breakfast 1 1 — — — Oil, cooking — 3 3 — 1 1 Olive oil — 2 2 — — — Onion cubes — 1 1 — 1 1 Pasta in sauce, canned 2 2 — Pastry mixture — 4 4 — — — Pastry, uncooked — 2 2 — — — Pea flour — 1 1 — — — Peanut butter — 8 8 — 2 2 Peanuts — 1 1 — — — Peanuts, salted — 1 1 — — — Pease pudding, canned — 3 3 — — — Peel, candied — 6 6 — — — Pepper — 5 5 — — — Pickles — 23 23 — — — Poppy seeds — 1 1 — — — Potato crisps — 4 4 — — — Proprietary foods — 12 12 — 1 1 Proprietary medicines — 4 4 — — — Pudding — 4 4 — — — Pudding mixture — 1 1 — — — Pudding, sponge — 4 4 — 1 1 Rennet, essence of — 2 2 — — — Rice — 3 3 — — — Rice, flaked — 1 1 — — — Rice, ground — 2 2 — 1 1 Rum 1 1 2 — — — Rusks — 2 2 — — — Rye crispbread — 2 2 — — — Rye crispbread, starch reduced — 2 2 — — — Saccharin tablets — 2 2 — — — Salt — 6 6 — — — 255 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Sago — 1 1 — Sauce — 32 32 — 1 1 Sauce mix — 2 2 — — — Sauce preparation — 6 6 — 1 1 Sausages 4 — 4 — — — Savouries — 1 1 — — — Seasoning — 2 2 — — — Semolina — 1 1 — — — Soda, bicarbonate of — 1 1 — — — Soup — 1 1 — — — Soup, canned — 11 11 — 1 1 Soup preparation — 15 15 — — — Spaghetti, canned — 1 1 — — — Spice — 12 12 — — — Spreads — 4 4 — — — Stuffing mixtures — 7 7 — — — Suet, shredded — 4 4 — — — Sugar — 7 7 — — — Tapioca — 2 2 — — — Tea — 22 22 — 1 1 Tea (ready for consumption) — 2 2 — 2 2 Throat pastilles — 1 1 — — — Tomatoes, canned — 6 6 — — — Tomato juice, canned — 3 3 — — — Tomato paste — 8 8 — 1 1 Tomato puree — 2 2 — — — Treacle — 2 2 — — — Trifle mixture — 1 1 — — — Trifle preparation — 1 1 — — — Turmeric — 1 1 — — — Vegetables, bottled — 1 1 — — — Vegetables, canned — 21 21 — — — Vegetables, dehydrated — 16 16 — — — Vegetables, dried — 3 3 — — — Vinegar, cider — 2 2 — — — Vinegar, malt — 7 7 — — — Vinegar, tarragon — 1 1 — — — Vinegar, wine — 1 1 — — — Vodka — 1 1 — — — Wine, alcoholic — 6 6 — — — Whisky 2 1 3 — — — Yeast, dried — 3 3 — — — Yoghourt — 3 3 — — — TOTALS 79 1,035 1,114 40 40 256 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 61 Curry Sauce Mix The ingredients of the mixture included cornflour which was not mentioned in the statement of ingredients on the label of the packet. Declaration of ingredients on label to be suitably amended. 74 Fresh Coffee with White Sugar The sample was made from coffee extract, separated milk powder, sugar and water. The sample was obtained from a coin operated vending machine which presents certain difficulties in the use of whole milk. 76 Tea (without Sugar) The sample was made from tea extract, separated milk powder and water. The sample was obtained from a coin operated vending machine which presents certain difficulties in the use of whole milk. 119 Peanut Butter Contained Aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being low. M anuf acturers informed of Public Analyst's Report and that further sample would be obtained. "Follow-up" sample proved genuine. 130 Tea with Sugar The sample was made from tea extract, separated milk powder, sugar and water. Tea with milk is traditionally made with whole milk and a purchaser who expected such tea would in the Public Analyst's opinion be prejudiced by receiving these products unless informed of their constitution by a conspicuous notice at the time of the sale. The sample was obtained from a coin operated vending machine which presents certain difficulties in the use of whole milk. 131 White Coffee with Sugar The sample was made from coffee extract, separated milk powder, sugar and water. White coffee is traditionally made from coffee and whole milk, with or without sugar, and a purchaser who expected such coffee would in the Public Analyst's opinion be prejudiced by receiving these products unless informed of their constitution at the time of the sale. The sample was obtained from a coin operated vending machine which presents certain difficulties in the use of whole milk. 257 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 132 Tea The tea was of very poor quality, the liquor being flat, stale and devoid of aroma, and the character of much of the leaf in the blend differed from that of reputable Indian and Ceylon gardens. The tea was described on the packet as "Choice Blend of Indian and Ceylon Teas. This tea is celebrated for its great strength and delicacy of flavour and is selected from the best gardens of India and Ceylon". This is a cheap grade of tea retailing at 2s. Od. per I lb. or 3s. 6d. per lb. On being informed of the Public Analyst's report the retailer withdrew from sale the remainder of his stock. 141 All Butter Sponge The sample was made with margarine instead of butter. On investigation it was found that the Manufacturers make sponges with butter and also with margarine. It appears that a few sponges made with margarine including the sample were accidentally enclosed in the wrong wrapper. 147 Tuna, canned Contained lead, 10 parts per million by weight. The Lead in Food Regulations, 1961, provide that canned fish should not contain lead in any proportion exceeding 5 parts per million by weight. Remainder of stock in shop was withdrawn immediately on receipt of Public Analyst's report. Investigation by Importers showed that stock withdrawn was free from lead. 168 Prawns in Creole Sauce Comprised a carton containing three inner packets, one of which consisted of rice and was found to contain Talc, 1.5%, an excessive proportion in the Public Analyst's opinion, and Hydrolised starch, 0.4%. The presence of these additives was not disclosed and the labelling of the three inner containers did not comply with the requirements of the Labelling of Food Order. Manufacturers informed of Public Analyst's report in respect of the glazing ingredients and also requested to comply with the requirements of the Labelling of Food Order insofar as the inner containers were concerned. 258 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 242 Grated Parmesan Cheese Consisted of a Medium Fat Hard Cheese, Grated, not labelled in the manner required by the Cheese Regulations, 1965. The sale of this kind of cheese from the shop where the sample was obtained has now ceased. 296 Steak and Kidney, canned Contained meat (including kidney), 83%. In the Public Analyst's opinion canned steak and kidney should contain at least 95% of meat. At present there is no legal standard. Regulations which come into force in 1969 require a minimum content of 95% of meat. 304 Mushroom Cubes The sample did not consist wholly of mushroom, but of a compressed mixture of cornflour, salt, rusk and flavourings with only a small proportion of dehydrated mushroom powder. Please see action taken under sample No. 425. 341 Pure Vegetable Oil The sample consisted of vegetable oil containing small proportions of lemon oil and possibly of colouring matter. The product was labelled in large type "Pure Vegetable Oil", followed by, in small type, "Sunflower oil, lemon oil, colouring". In the Public Analyst's opinion the word "Pure" is inappropriate as a description of a vegetable oil that contains other ingredients. Manufacturer informed of Public Analyst's report and requested to amend the description on the label. 377 Sugared Peanuts (green) Contained two colouring matters, one of which (Blue VRS) is not permitted by the Colouring Matter in Food Regulations. TheColouring Matter in Food Regulations, 1966, only came into operation 2 days before the sample was obtained. The use of this dye has now been discontinued by the Manufacturer concerned. 403 Peanut Butter Contained Aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being low. M anuf acturers informed of Public Analyst's report and that further sample would be obtained. "Followup" sample proved genuine. 259 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 408 Whipped Creamy Chocolate Contained milk fat, less than 0.1%. Since the drink appears to contain no significant quantity of whipped cream, nor of any other form of cream, the description "Whipped Creamy Chocolate" is in the Public Analyst's opinion calculated to be misleading. The supplier of the ingredients to make this drink has now been replaced by another supplier. Further samples to be taken. 424 Onion Cubes The sample did not consist wholly of onion but of a compressed mixture of cornflour, rusk, salt and flavouring with a small proportion of dehydrated onion powder. Manufacturers agreed to re-name the product. 425 Mushroom Cubes The cubes did not consist wholly of mushroom but of a compressed mixture of cornflour, rusk, salt and flavourings with only a small proportion of dehydrated mushroom powder. Manufacturers agreed to re-name the product. 499 Whipped Creamy Chocolate Contained milk fat, less than 0.02%. Since the drink contains no whipped cream, nor any other form of cream, the description was considered misleading. The supplier of the Ingredients to make this drink has now been replaced by another supplier. Further samples to be taken. 602 "Extra" Consisted of Gravy flavouring, not labelled in accordance with the Labelling of Food Order, the common or usual name of the food not being specified on the label. Packers requested to amend the label in accordance with the provisions of the Labelling of Food Order. 718 Pearl Barley The sample had been infested by insects and contained 3 live and 35 dead booklice, Trocles divinitoria. Remainder of stock surrendered by Shopkeeper. Packers stated warehouse and food stocks inspected regularly by a pest control agency. District Inspector for the Authority in which warehouse is situated stated premises free from insect infestation. 260 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 723 Anti- Smoking Tablets The tablet contained Lobeline sulphate, approximately 0.25 mg. per tablet. According to the formula on the label the tablets should have contained Lobeline sulphate 0.5 mg. The technique used by the Public Analyst to determine the amount of Lobeline sulphate content is apparently different from that used by the Manufacturers. Their Chief Chemist and the Public Analyst are collaborating to establish a uniform method of analysis. The manufacturers state that there has been no previous complaint concerning the tablets. 724 Date and Walnut Cake The cake bore small surface growths of mould and was unfit for sale. The mould growth which was very slight was considered to have originated through inattention to stock rotation by the Shopkeeper. 727 Fish Cake The fish cake had a sour, stale smell due to spoilage of the breadcrumbs and was unfit for sale. No account could be made for the spoilage. "Followup" sample proved genuine 882 Rice The rice had been polished and contained talc, 0.4%, the presence of which was not disclosed on the label. Manufacturer requested to include glazing ingredient in the statement of ingredients on the label. 984 Cranberry Sauce The sauce had an unpleasant, musty, smell and taste and was found to contain mould. The Retailer stated he obtained a small stock of Cranberry Sauce for the anticipated Christmas demand and the stock was now exhausted. There had been no other complaint. 261 Sample No. Article Nature of Adulteration and/or irregularity Action Taken (b) In respect of samples taken under Imported Food Regulations TT.15 Cocktail Biscuits Consisted of small empty pastry shells packed in a cardboard box on the top and sides of which were illustrations of attractively coloured cocktail snacks. The description was in French, an English translation only appearing on the bottom of the box, and judged as a whole the label was considered likely to be misleading to an average English purchaser. Letter to Importer. Manufacturer in France agreed to put English translation on face of the box. TT.17 Sugar Confectionery Contained an artificial red colouring matter (consistent with Ponceau CR) not permitted in food by the Colouring Matter in Food Regulations. Letter to Importer. Manufacturer in Western Germany gave assurance that use of this colouring will will be discontinued for exports to this country. TT.24 Fruit Purde, Apricot Consisted of Apricot pulp with sugar and contained 90 and 150 parts per million of sulphur dioxide and sorbic acide respectively. Sorbic acid is a preservative not permitted in this product by the Preservatives in Food Regulations. The product was not labelled in accordance with the requirements of the Labelling of Food Order. Consignment returned to country of origin. Subsequent consignments conforming with both the preservatives in Food Regulations and the Labelling of Food Order. TT.25 Fruit Puree, Prune Consisted of prune pulp with sugar and contained sorbic acid, 200 parts per million. Sorbic acid is a preservative not permitted in this product by the Preservatives in Food Regulation. The product was not labelled in accordance with the requirements of the Labelling of Food Order. C olns ig n m e n t returned to country of origin. Subsequent consignments conforming with both the Preservatives in Food Regulations and the Labelling of Food Order. TT.29 Groundnuts Contained Aflatoxin, the Toxicity Category as defined by the Tropical Products Institute being low. In accordance with Ministry of Health instructions no action possible as toxicity category low. 262 Sample No. Article Nature of Adulteration and/or irregularity Action Taken TT.31 French Mustard with White Wine Contained sulphur dioxide, 370 parts per million, an excessive proportion. The presence of sulphur dioxide was not mentioned in the statement of ingredients on the label. Letter to Importer who requested Manufacturer to comply with requirements of the Preservatives in Food Regulations and Labelling of Food Order. TT.32 Fish Soup, canned The label was in French and did not include a statement of ingredients in English as required by the Labelling of Food Order. Letter to Importer. Assurance given that future consignments will conform with the Order. TT.42 Apricot Purde Consisted of apricot pulp and contained 150 and 140 parts per million of sulphur dioxide and sorbic acid respectively. Sorbic acid is a preservative not permitted in this product by the Preservatives in Food Regulations. The product was not labelled in accordance with the requirements of the Labelling of Food Order. Letter to Importer who replied that the consignment was sent in error and had now been returned to country of origin. TT.43 Tomato Paste, canned The sample contained an excessive amount of fungus, the Howard Mould count being 75% fields positive. The amount of fungus indicated that the product had been made from partly rotten tomatoes. Six further tins taken at random and found to be satisfactory for mould count on examination by the Public Analyst. No further action possible. TT.56 Quince Jelly Contained soluble solids, 62.8%. According to the Food Standards (Preserves) Order, this article should contain not less than 65% of soluble solids. Letter to Manufacturers who agreed that all future consignments would strictly conform with requirements of the Food Standards (Preserves) Order. TT.59 Chicken in Jelly Consisted of Chicken leg, with bone, in liquified jelly and contained meat, 61%. A minimum legal standard of not less than 80% of meat for this article has been proposed by the Ministry of Agriculture, Fisheries and Food. Letter to Importers who requested their suppliers to comply with the suggested minimum standard. 263 Sample No. Article Nature of Adulteration and /or irregularity Action Taken TT.92 Bulk Lemon Juice Contained sulphur dioxide, 1,100 parts per million. Fruit juice should not contain more than 350 parts per million of sulphur dioxide unless the proportion is disclosed. Letter to Importer who requested their Supplier to ensure correct level of preservatives in future consignments. Sulphur dioxide content in respect of this consignment adjusted during refining process carried out at the wharf. TT.103 EmulsifierMono-diGlycerides and Sorbital The constituents included Potassium soap, 2%, the presence of which is not permitted by the Emulsifiers and Stabilisers in Food Regulations. Letter to Importer. Manufacturers agreed to comply with the Regulations in future consignments. 264 SECTION VII MISCELLANEOUS HEALTH EDUCATION SERVICE Seeing that it is the purpose of health education to communicate and that all actions carried out by the Service are with this end in view, the Health Education Officer can perhaps be described, briefly, as a public relations officer for health. Such an officer endeavours to provide communication through the whole range, beginning with person to person contact in the form of leaflets and small groups using teaching apparatus to mass media techniques such as displays, exhibitions, poster publicity and news items. Moreover, in order to take advantage of the latest developments, the communications field must be continually appraised for, to compete in the savage world of modern advertising heavily backed by consumer research and motivation, health education must be equally sophisticated in its approach. Basically, everyone should be interested in maintaining and improving his/her health but that this is not so is evident by the increase in tobacco consumption, the rise in obesity, drug addiction and other forms of self-immolation. Clearly, comparative research is needed to establish the underlying causes for such malpractices. Unfortunately, at present, motivation research is beyond the means of local health authorities but it is hoped that, with the inauguration in 1968 of the new Health Education Council, such projects will be undertaken in order that future priorities may be determined. Meanwhile, local health education resources must be evenly distributed over the entire field including not only the dissemination of information concerning health and its enjoyment but also indicating the types and availability of health and welfare services. In the circumstances, therefore, our Health Education section has had to rely on the tried and tested methods. These included assistance to field staff and others having personal contact with the public, a positive programme of health education to local organisations by way of film shows, talks and displays, and use of mass media and information on latest developments. A substantial progressive step in the work of the Section during 1967 was marked by the innovation of film making (in this instance a coloured production on the training of mentally handicapped children) and, an expansion of health education and provision of general information on health topics to local schools was another significant advance. 265 The following paragraphs give a review of the principal activities undertaken during the current year. Health Education Programme to Local Organisations As in past years, the Health Education Service took positive action in circulating all local organisations with offers of health education facilities which take the form of film shows, talks or combined features, together with displays at local public events. Offers are readily accepted and they provide useful avenues for the dissemination of information and views on a wide variety of subjects. Topics range from services provided by the whole department to sessions by professionals on their own particular specialities, or more specifically, health education themes such as smoking and health, obesity, personal hygiene, etc. Appropriate leaflets are distributed. Groups taking advantage of the facilities offered include all ages and shades of opinion. Intrinsic in such sessions is the opportunity for "feed-back" of views by residents on services provided by the department and indeed by the whole Council. The following tables give an analysis of subject matter and types of organisations visited. TABLE I —Analysis by subject Subject Films Talks Films & Talks Total D O D O D O Home Safety and Resuscitation 10 8 1 5 6 3 33 Food Hygiene 10 1 1 — 1 — 13 Infectious Disease and Pest Control 1 1 1 — 3 — 6 Other Environmental Health . 7 1 2 2 1 4 17 Nutrition 7 2 .— — 1 — 10 Personal Hygiene 6 1 — — — — 7 Smoking 4 6 — — — — 10 Maternal and Child Welfare 9 2 — — 3 — 14 Other Personal Health 10 2 — — 2 — 14 Old People's Welfare 6 — 1 — 1 — 8 Welfare Services 3 — — — 2 — 5 Mental Health 3 2 — 1 2 3 11 Health & Welfare Services — — 5 3 7 6 21 Other Community Care 1 1 — 1 — — 3 77 27 11 12 29 16 172 266 TABLE II —Analysis by organisation Organisation Films Talks Films & Talks Total Attendance D O D O D O Religious 19 8 3 3 4 4 41 1,020 Political 9 4 4 3 5 3 28 635 Old People 17 — — — 2 — 19 1,870 Youth Organisations 11 6 2 1 2 3 25 1,145 Others 21 9 2 5 16 6 59 3,125 77 27 11 12 29 16 172 7,795 D—Duty Hours O—Out of Duty Hours In the circular letter sent to all district organisations, free displays on health education subjects at any local event such as a bazaar, fete, etc., were also offered. Considerable attention was attracted by displays and the distributed leaflets on the three occasions when the offer was accepted. General Publicity Monthly programmes of health education topics receive general publicity by way of displays in shop window premises available to the Department supported by related publicity in the permanent Welfare Centres throughout the Borough. Shop windows are very effective in this aspect, since elaborate displays incorporating animation and lighting can be introduced. In addition, 14 poster sites at railway stations are used and, from time to time, the large number of poster sites under the control of the Entertainments Officer are loaned for use in the more important campaigns through the courtesy of the Amenities Committee. Topics selected for the year were as follows :— Overeating Water Safety Back to School Winter Hazards Mental Health Home Safety Dental Hygiene Holiday Hazards Bronchitis Smoking Food Hygiene Christmas Safety The monthly magazine "Better Health" is distributed regularly to general practitioners and dentists practising in the Borough. Topical matter is frequently included in this distribution. Publicity Material A great deal of publicity material is distributed not only through the outlets already mentioned but also during the special campaigns mounted by the Section. It is an unpalatable fact that 267 much of this material falls on "stony ground"; nevertheless, in conformity with the aims of Health Education, pressure must be sustained in the face of continuous competition. Moreover, having regard to the low cost of this form of publicity compared with its broadcast power, its chances of bearing some fruit can be considered reasonable. In terms of impact and evaluation, however, this must always be an unknown quantity. TABLE III — Distribution of publicity material Subject Leaflets Posters Diabetes 150 — Fireworks 500 135 Drugs 550 26 Sex Education 650 15 Nutrition 1.500 86 Welfare of the Elderly 1,600 — Personal Hygiene 2,620 145 Infectious Disease 3,000 320 Food Hygiene 3,400 265 Mental Health 3,600 450 Dental Health 3,750 360 Vaccination and Immunisation 4,500 10 Maternal & Child Welfare 4,500 350 Water Safety 4,800 110 Smoking 5,600 275 Cancer 6,500 155 Home Safety 7.500 400 Monthly Meeting Since the formation of the Borough in 1965, a monthly meeting has been held to review the latest developments in health education. Membership of the meeting consisted mainly of nursing staff. During 1967, the development of the Health Education Service reached a point at which it was considered that other sectors of the Department, including Public Health Inspectors and Social Workers, should be included. On 9th November, the inaugural session of the enlarged meeting took place and it is hoped that a broader basis of health and welfare teaching will flow from this development. Teaching Techniques A short course in successful instruction and teaching techniques was given to interested staff during the year. 268 Departmental Services In addition to other services, those of Health Education provide numerous facilities such as printing, notices, posters, design, artwork and display panels for different departmental sections. These services also include the provision of audio-visual aid equipment, the previewing of films, etc., for use in "in-service" training and for public showing. On 81 occasions the Service was called upon to show films on behalf of other staff during duty hours and 30 times out of duty hours and, during the year, 40 films were given previews. Films in the possession of the Service are loaned to neighbouring Boroughs on a friendly basis. This facility was made use of on 13 occasions. Mental Health Week—4th to 10th June, 1967. This year a large programme of activities was prepared for the second of a triennial series of weeks devoted to bringing the problems of the mentally disordered to the notice of the general public. It included a small exhibition in the main hall of the Town Hall at Woolwich and a subsidiary display was organised through the courtesy of a local church. Open days were arranged for mental health establishments and, in addition to an expanded circulation and display of posters, hand-bills and car stickers, special news items were sent during the preceding week to the local press advertising the coming campaign. "They Have A Future" Undoubtedly the highlight of the campaign was the production of a film on the work of the Maze Hill Junior Training Centre for the Mentally Handicapped scheduled to have its premier showing at the meeting of the Greenwich Society for the Mentally Handicapped during "campaign" week. Shooting of the film, which is in 16 mm. colour, with magnetic soundtrack and lasting 35 minutes, commenced in February and continued over a period of two months. Editing, soundtracking and copying occupied a further month. With the exception of the copying, the whole of the production was carried out by the Health Education Section. Whilst the film perhaps lacks a professional finish, the fact that the camera team became familiar to the children at the Centre ensured a natural and spontaneous result. The film depicts a day in the life of the Centre, in particular, illustrating the effects of a stimulating educational environment on the development of mentally handicapped children and showing that, by progressive 269 teaching in the four areas of social, intellectual, physical and emotional learning, these children can be said to have a future. The film's premier aroused great interest and it was widely exhibited to various organisations in Greenwich and neighbouring Boroughs. At the latter end of the current year, the film was frequently used by the London Boroughs' Training Committee in courses designed for teachers of the mentally handicapped. Greenwich Show By invitation, for the first time, there was a greater participation by departments this year in the annual Greenwich Show organised by the London Borough of Greenwich. Taking full advantage of the opportunity, the Health Education Section mounted a comprehensive display of the Health and Welfare Services supported by appropriate photographs and leaflets. It was estimated that some 12,000 people visited this very successful function. School Health Education Provision of an effective service to schools in the Borough has long been the aim of the Health Education Section. First steps towards the realisation of this objective were taken by the production of a comprehensive catalogue on visual aids in health education with an eye-catching cover. This catalogue was sent to all educational establishments in the Borough, together with a letter offering the following facilities :— 1. A supply of catalogues embracing health education films, filmstrips, posters and leaflets. 2. Regular information on health and welfare subjects. 3. An offer of films, filmstrips and visual aid media. 4. An offer of speakers on specialist subjects where these would tend to emphasise subjects dealt with during the school year. 5. An offer of displays and exhibitions on health and welfare subjects. 6. Health and welfare information and assistance on request, including provision of posters and leaflets. By these measures it is hoped to provide not only assistance and a point of contact but also information and incentive to those teachers who wish to develop a positive attitude towards health in the minds of their pupils. In addition school leavers, as future citizens, will thereby be encouraged to make full use of the health and welfare services available to them. 270 Additional Information Service A small publication entitled "TOPIC" serves as a guide to the general public on specific health aspects. Produced at irregular intervals the issues, where possible, will follow a regular format and are intended to give views, offer information and history, provide statistics, weigh up the value of publicity material and visual aids, list relevant bibliography and lighten the effect with appropriate anecdotes. Before the end of the Autumn term, two editions had been circulated, one on "Drug Addiction" and the other on "Foot Health". First reactions from these new ventures indicate that they are likely to be used with considerable enthusiasm by local teachers. Home Safety Part of the special activities of the Health Education Service is the prevention and reduction of home accidents. Continuous emphasis is given to this problem throughout the year and films on home safety are often included in programmes devoted mainly to other aspects of health education. Courses are run, especially for candidates for the Duke of Edinburgh's Award Scheme, and talks on the subject are included in the "in-service" training of Home and Child Helps. A proportion of the programmes to local organisations is devoted exclusively to this serious problem. Visits are made by the Home Safety Officer in cases of complaint and reports are furnished on his findings. Displays, emergency resuscitation sessions and other publicity measures are carried out. An innovation during the year was the institution of a scheme, operated in conjunction with the Boroughs of Southwark and Lewisham, of the reporting, by victims of home accidents, of circumstances leading to the mishap. Report Forms are distributed through the agencies of local hospitals and general practitioners and the three Boroughs concerned have agreed to operate a "transfers in" and "transfers out" system to ensure accurate returns and to increase the size of the catchment area. Comment on the success of the scheme is not yet possible owing to its very recent inception. Safety in the Home Exhibition A Home Safety Exhibition was staged for two weeks during October/November at the Town Hall at Woolwich in support of the "Golden Jubilee Year" of the Royal Society for the Prevention of Accidents. The exhibition covered the areas of the Public Hall and Foyer whilst the stage was used as a film theatre. Many national and local exhibitors participated and a professional presentation, much appreciated by visitors, was achieved. 271 Attendances totalled over 5,000 including 3,000 schoolchildren visiting in organised parties and the success of the exhibition may be judged by the fact that many local schools arranged return visits for additional pupils. Demonstrations demanding personal participation included the "kiss of life" resuscitation method, a telephone kiosk where the dialling of a number elicited a home safety message, a G.P.O. 999 Emergency Call system and a number of other mechanical exhibits requiring "button" pressing for operation. Pre-publicity, together with a school poster competition awarding prizes that were presented during the Exhibition, contributed largely to the success of the venture. MEDICAL EXAMINATIONS A summary is given below of medical examinations carried out by the Department's Medical Officers during 1967, mainly in respect of superannuation and sickness schemes:— Superannuation. Staff No. of Examinees found to be fit 411 No. of Examinees found to be unfit 8 Employees No. of Examinees found to be fit 235 No. of Examinees found to be unfit 9 Sickness. No. Examined after prolonged sickness or at request of a Chief Officer 211 Other Examinations. Carried out by the Council's M.O.s: — On behalf of the London Boroughs Joint Computer Committee 15 On behalf of other Local Authorities 12 Carried out by other Local Authorities:— On behalf of London Borough of Greenwich 10 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. 272 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 four instances it was necessary for the Medical Officer to make a domiciliary visit to enable the appropriate assessment to be made. DEPARTMENTAL TRANSPORT During 1967, the department took delivery of eight new vehicles, five to augment the fleet, and three to replace vehicles proving uneconomical to repair, thus bringing the total vehicle strength to fifty. Allocation of these extra vehicles to sections was as follows: 2 minibuses for the Meals-on-Wheels service, 2x8 cwt. vans for the increased Bathing Centre and Home Bathing services, and one 17 cwt. van for Administration and Supplies. One of the main changes occurring during the year was the decision to make use of the Computer to assist the Transport Organiser to determine more closely the actual usage of each vehicle together with the amount of time spent on vehicle standby and servicing. This resulted in a complete change in the method formerly used to log vehicle usage and the whole fleet was enabled to be hourly rated and an accurate cost charged to any of the department's services requiring transport. The financial tabulations provided proved a great help in the preparation of estimates for the following year. The volume of transport commitments continued to rise during the year, particularly from the sections dealing with the physically handicapped and holidays for the elderly, and use had to be made of the School Bus hiring facilities available from the Inner London Education Authority. The knock for knock agreement between the London Boroughs of Lewisham, Southwark and ourselves whereby help could be solicited from each other when tail lift coaches were able to be spared, continued to be a valuable help. An increase was also shown in the delivery and collection of Home Nursing equipment and aids for the Handicapped, an average of seventy items of equipment being delivered or collected each week during the year from various addresses in the Borough. Meals on Wheels The number of vehicles used for this service was increased by two, bringing the total number of rounds undertaken Monday to Friday each week to seventeen, one of these rounds still being undertaken by the British Red Cross Society as in the previous year. 273 The total number of miles covered by the department's vehicle fleet during the year reached a total of 562,500. POST ENTRY TRAINING Many courses held during 1967 were found to be of great interest and value to members of the Health and Welfare staff. Some courses and conferences have now become firmly established and these are regularly supported each year whilst others are newly organised, when appropriate, to facilitate the consideration and discussion of topical issues. Four Social Workers and two members of staff from Training Centres were seconded on full-time study courses of one or two years' duration, commencing Autumn 1967, and leading to professional qualifications. In addition to the courses listed below, the department was responsible for training 6 student Public Health Inspectors, 7 student Health Visitors and 8 student District Nurses employed by this authority. "In-service" training courses were provided for 11 Child Helpers and 14 Home Helps. training courses, 1967 Administrative Catford College of Com- Local Government Day- merce release Courses Association of Public Health Summer School Lay Administrators Greater London Whitley Course on Management Council Perspectives London Boroughs Manage- Work Study Appreciation ment Services Unit Courses Professional Medical Society of Medical Officers Tutorial Course for School of Health Medical Officers Newcomen Centre, Guy's Study Mornings Hospital University of London Course on the Management of Student Problems Society of Medical Officers Course in Developmental of Health Paediatrics and the Young Handicapped Child London Borough of HamSymposium on Drug Taking, mersmith Recognition, Addiction, Treatment 274 Dental Royal Dental Hospital Course on Endo Dontia British Dental Association Post-Graduate Study Course in Administration Kodak Ltd. One-day X-ray Course for Dental Nurses Nursing Services Health Visitors Association Summer School City and County of Kingston- Refresher Course for Mid- upon-Hull wives Inner London Education Refresher Courses for School Authority Nurses Royal College of Midwives Approved Refresher Courses Queen's Institute of District Study Course in Manage- Nursing ment Queen's Institute of District Refresher Courses Nursing Royal College of Midwives Symposium on Preparation for Parenthood London Boroughs Training Health Visitor Fieldwork Committee Instructors' Course London Boroughs Training Introductory Courses for Committee School Nurses National Childbirth Trust Seminars on Psychoprophy- laxis Royal College of Nursing Study Day National Society for Autistic Course of Lectures Children London Boroughs Training Study Days for District Committee Nurses and Health Visitors Inner London Education Refresher Course in Audio- Authority metry Health Visitors Association Study Day for Health Visitors London Boroughs Training Study Days on Screening for Committee Handicapping Conditions London Boroughs Training Follow-up Study Day for Committee Senior Nursing Staff Social Work London Boroughs Training Seminars in Co-operation Committee with the National Institute of Social Work Training 275 London Boroughs Training Committee London Boroughs Training Committee London Boroughs Training Committee London Boroughs Training Committee London Boroughs Training Committee / British Epilepsy Association Council for Training in Social Work College of Commerce, Bristol Family Service Units London Boroughs Training Committee Welfare National Institute for Social Work Training London Boroughs Training Committee London Council of Social Service Royal College of Nursing Southern Regional Association for the Blind Society of Teachers of the Deaf/National College of Teachers of the Deaf Cambridge University Southern Regional Association for the Blind Health Visitors Association Residential Course for Senior Officers in Health, Welfare and Children's Departments Seminars in Family Casework Seminars in Group Work Seminars in Principles and Practice in Social Work Social Workers Course Social Change and Social Work Full-time Two-year Course leading to the Certificate in Social Work Study Week-end: Taking Stock of Family Casework Study Day for Family Caseworkers Course for Chief and Deputy Chief Welfare Officers Course for Social Workers working with Deaf People Course on Understanding the Elderly The Handicapped Child: Co-ordination of Education, Health and Welfare Services Full-time One-year Training Course for Home Teachers Teach-in towards a Comprehensive Service for Hearing Impaired Persons Seminar Old People—A New Look at the Services Needed Study Work on Problems of Deafness and Blindness Course on Geriatrics 276 London Boroughs Training Committee South East London Technical College London Boroughs Training Committee Mental Health Services Staffordshire County Council London Boroughs Training Committee Chiswick Polytechnic National Association for Mental Health National Association for Mental Health London Boroughs Training Committee London School of Economics University of Manchester London Boroughs Training Committee Environmental Health College for the Distributive Trades College for the Distributive Trades Association of Public Health Inspectors Day-release Course for Matrons and Assistant Matrons of Old People's Homes Course leading to the City and Guilds Certificate in Catering Social Work with the Hard of Hearing Refresher Course for Teachers of the Mentally Handicapped Seminars on the Subnormal Child and the Family Full-time One-year Course leading to the Diploma in the Further Education and Training of Mentally Handicapped Adults Full-time Two-year Diploma Course for Teachers of the Mentally Handicapped Residential Short Course for Staffs of Junior and Adult Training Centres Study Day for Supervisors of Junior Training Centres Full-time One-year Course leading to the Diploma for Social Workers in Mental Health Full-time One-year Course leading to the Certificate in Psychiatric Social Work Day-release Course for Teaching Staff in Junior Training Schools Bacteriology of Food Inspection and Production Refresher Course in Meat Inspection Annual Week-end Seminar 277 Coal Utilisation Council College for the Distributive Trades Ministry of Health South East London Technical College South East London Technical College Health Education London Boroughs Training Committee Central Council for Health Education Central Council for Health Education Public Health and Technical Assistants Course Poultry Hygiene and Inspection Course Civil Defence Course for Public Health Inspectors Course leading to the Ordinary Certificate in Building Construction Course on Noise Prevention Health Education Techniques Summer School Health Education Officers Study Day Other Services Home Help Institute of Home Help Weekend School Organisers conference organisers, 1967 Association of Public Health Inspectors British Dental Association British National Conference on Social Welfare British Paedodontic Society Central Council for Health Education Chest and Heart Association Epidemiological Research Laboratory Federation of Associations of Mental Health Workers Guild of Pastoral Psychology Home Counties Federation of the Queen's Institute of District Nursing King Edward's Hospital Fund for London London Boroughs Association National Association for Maternal and Child Welfare National Association for Mental Health National Bureau for Co-operation in Child Care National Child Development Study 278 Royal College of Nursing Royal College of Surgeons—Faculty of Dental Surgery Royal Institute of Public Health and Hygiene Royal Society of Health Southern Regional Association for the Blind Standing Conference of Societies Registered for Adoption 279 SECTION VIII SCHOOL HEALTH SERVICES REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER The Inner London Education Authority is responsible for the School Health Service but. by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Borough of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and is responsible to that Authority for the day to day running of the Service. Introduction This account of the schoolchildren of Greenwich for 1967 is presented along traditional lines. The report indicates in statistical and tabular form a year of continued progress. Undoubtedly the health and wellbeing of most of our schoolchildren continues to improve. All the measurements and factors accepted as important indices support this contention. The school population was 38,579, of which 15,392 were examined by school medical officers at routine inspections and 11,629 at non-routine inspections. These examinations revealed that only 1% of pupils were in an unsatisfactory state of health. This figure, although lower than last year, is still above the average for the Inner London Boroughs. Last year it was thought that this was due to higher standards being adopted by school medical officers during their medical inspections at Greenwich schools. This view was confirmed by the fact that again during the year under review the number of pupils referred for treatment or kept under observation was over the average for the Inner London Boroughs. The high percentage of defects was most marked in heart, ear, nose and throat, orthopaedic, psychological and abdominal abnormalities and potential abnormalities. Defects of vision were below the average for Inner London, while other defects were no more frequent than the average for the area. With the exception of heart conditions, all the above defects were more frequent than during 280 1966, particularly in the case of disorders of the ear, nose and throat and psychological disturbances. As in previous years, Greenwich has a comparatively high number of children examined for employment purposes. These examinations (788) add a considerable burden to the school medical officers in secondary schools, but they are an essential safeguard when schoolchildren undertake employment such as the delivery of newspapers before and after school hours. In both comprehensive and selective surveys more individuals were found to be verminous (396) than in 1966 (347). The number of examinations for this purpose was 54,885. Slightly fewer children (36) were examined than in 1966 (47) prior to recuperative holidays, whilst 2,633 were examined before joining school journeys to ensure that they were free from infection and fit to participate in all holiday activities. Occasionally it was necessary to inform teaching staff that certain pursuits would be inadvisable, but restrictions are fortunately rare in ordinary school holiday parties. During the year arrangements were made for the usual school medical inspections to be extended to the I.L.E.A.'s school at Goldie Leigh Hospital. The majority of pupils attending this school are long stay hospital cases with chronic skin complaints. The full scheme of medical inspections, including eye testing, audiometry and immunisation were to be conducted at this school starting in the new year. Special Education Special educational facilities for handicapped pupils were increased by the provision of two special schools by the Inner London Education Authority. Charlton Park School for physically handicapped pupils was started at the end of 1966 but it was January 1967 that both the day section and the weekly boarding unit were in operation. The second school was Griffin Manor which is a special unit for autistic children, brain damaged children and children with special educational difficulties. Child Guidance Clinic It is disturbing to note that the negotiations to engage a psychiatrist for the proposed Child Guidance Clinic at Chevening Road Centre were unsuccessful and during the year the Borough had to rely entirely on the Child Guidance facilities at St. Alfege's Hospital. Delays in placement at E.S.N. schools, both day and boarding, continued, but the longest delays were in the placement of children recommended for admission to schools for maladjusted pupils. 281 Speech Therapy This service was administered centrally but Greenwich continued to be more fortunate than most other London Boroughs regarding the number of speech therapists. There still was, however, a waiting list of pupils needing therapy. Verrucae Further trials continued in the treatment of floors with an iodofer. This had a residual activity and treatment of gymnasium floors at various schools in the Borough was carried out in an attempt to reduce the spread of verrucae. Immunisation Greenwich continues to hold the best record for immunisation among the Inner London Boroughs. Figures for diphtheria (91.4%) and polio (90.5%) were the highest and the figures for smallpox and diphtheria the second highest in the Inner London Boroughs. The Principal School Dental Officer in his report deals mainly with the matters raised by one of the Ministry's dental officers in his official inspection of the local authority dental service. The Inspector was impressed by the high standard of equipment, cleanliness and sense of order in the surgeries, but commented on our shortage of staff. This is crucial to the provision of an adequate service, but is unfortunately outside our control. I am glad to record the indebtedness of the Department to the Care Committee and in particular to Miss Comber and her staff. As I write this introduction, Mr. Pattison, the Divisional Education Officer, has retired as has Mr. Curtis, his deputy, and I acknowledge gladly the kindness and consideration which we all received from him, his deputy, and the teaching staff of the local schools. All of us wish Mr. Pattison and Mr. Curtis a long and happy retirement. In conclusion, I wish to express my grateful thanks to the staff in the local School Health Service. I owe a particular debt to Dr. Watts, my deputy, and Dr. Jansz, the Principal Medical Officer, who shouldered the main day to day burden of this service. John Kerr Brown, Principal School Medical Officer. 282 SCHOOL HEALTH SERVICE STATISTICAL REPORT 1967 Number of Pupils (as at May, 1967) Primary 21,678 Secondary 15,487 Nursery School 591 Special, including Hospital schools 823 38,579 Periodic General Medical Inspections Age Groups Number Percentage 4 years and less 924 6.0 5 years 2,881 18.8 6 years 966 6.3 7 years 1,034 6.7 8 years 1,883 12.2 9 years 372 2.4 10 years 214 1.4 11 years 1,196 7.7 12 years 1,689 11.0 13 years 598 3.9 14 years 396 2.6 15 years and over 3,239 21.0 Total 15,392 100.0 Pupils found to require treatment at periodic General Medical Inspections (excluding dental and infection) Age groups inspected For defective vision (excluding squint) For other conditions Total individual pupils 4 years and less 7 85 90 5 years 33 324 349 6 years 18 80 94 7 years 43 108 143 8 years 103 157 251 9 years 17 28 44 10 years 17 15 30 11 years 119 68 179 12 years 180 133 300 13 years 63 41 96 14 years 45 18 61 15 years and over 498 149 618 Totals 1,143 1,206 2,255 283 Percentage of children inspected who were noted for treatment Age and Sex All defects Vision defects Defects other than vision 4 years & less 453 Boys 9.5 0.7 9.0 471 Girls 10.0 0.8 9.3 5 years 1,456 Boys 13.7 1.3 12.8 1,425 Girls 10.5 1.0 9.7 6 years 467 Boys 11.6 2.1 9.8 499 Girls 8.0 1.6 6.8 7 years 493 Boys 16.6 4.7 12.8 541 Girls 11.3 3.7 8.3 8 years 976 Boys 13.2 5.3 8.7 907 Girls 13.5 5.6 7.9 9 years 179 Boys 14.5 6.1 8.9 193 Girls 9.3 3.1 6.2 10 years 123 Boys 8.9 4.9 4.9 91 Girls 20.9 12.1 9.9 11 years 437 Boys 11.2 5.9 5.7 759 Girls 17.1 12.2 5.7 12 years 1,093 Boys 15.6 8.1 8.2 596 Girls 21.6 15.4 7.2 13 years 432 Boys 16.9 10.4 8.3 166 Girls 13.8 10.8 3.0 14 years 266 Boys 14.3 10.5 4.1 130 Girls 17.7 13.1 5.4 15 years 1,564 Boys 17.6 13.8 4.7 & over 1,675 Girls 20.4 16.8 4.5 Total 7,939 Boys *14.5 *6.6 *8.5 7,453 Girls *14.8 *8.3 *7.1 Total both sexes 15,392 14.6 7.4 7.8 * Total average percentage Non-Routine Medical Inspections Re-inspections 6,015 Secondary school reviewals 200 Other non-routine inspections 5,414 (see next table) 11,629 Total Inspections 27,021 284 Analysis of non-routine medical inspections Number Inspected 1967 1966 Bathing Centre inspections—scabies 9 — Bathing Centre inspections—other 6 9 Employment certificates 788 656 Licences for Theatrical employees — — School Journeys 2,633 2,140 Recuperative holidays—prior to holiday 36 47 Recuperative holidays—on return 1 — Secondary School Annual Surveys 200 377 Candidates for higher awards 16 6 Nautical school entrants — — Outward Bound and Adventure Courses — 6 T.B. contacts — — Boarding school for the delicate : Pre-departure inspections 6 — On return 9 — Other handicapped pupils : Statutory examinations 128 6 Periodic special defect examinations 781 531 Research investigations and enquiries 3 18 4,616 3,796 Specials, at request of: Head Teacher—special book 78 58 Head Teacher—other 307 355 School Nurse—after health survey 81 81 School Nurse—other 44 90 Divisional Officer (Education) 80 46 District Care Organiser or Care Committee 27 28 Parent 126 90 School Medical Officer 230 181 973 929 All other non-routine inspections 25 18 Total 5,614 4,743 285 Medical Treatment of Schoolchildren Type of Clinic Sessions New Cases Attendances Minor ailments (nurse) 1,172 15,900 62,688 Minor ailments (doctor) 251 1,956 Special Investigation 165 181 1,198 Dental 1,365 2,657 11,892 Vision 286 1,816 3,915 Ear, nose, throat 41 179 440 Audiology 42 129 327 Defects treated at Minor Ailments Clinics Defect Number Athlete's foot 163 Verrucae 1,344 Ringworm: body 6 Impetigo 68 Other skin diseases 474 Eye diseases 311 Ear diseases 174 Miscellaneous bruises, lacerations, etc. 15,807 Special Clinics—Attendances in 1967 New Cases Total Attendances Audiology 129 327 E.N.T 179 440 Special Investigation Clinics Enuresis 181 1,198 Nutrition Behaviour Problems Rheumatism or Heart Conditions 286 VISION Visual acuity standards of children whose eyes were tested Age Group (years) BOYS Number tested—6,530 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 7 and under 1,269 124 43 43 19 6 10 12 8 855 51 29 34 18 7 11 18 9 154 8 9 6 2 2 3 5 10 108 6 2 4 5 — 1 2 11 364 19 17 14 16 8 13 12 12 919 43 46 35 44 21 18 53 13 342 24 21 18 26 9 9 27 14 217 11 15 15 9 8 6 13 15 and over 1,215 48 68 61 160 43 29 15 Total 5,443 334 250 230 299 104 100 157 GIRLS Number tested—6,025 Age Group (years) 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 7 and under 1,341 105 43 40 18 6 6 6 8 784 54 33 36 16 6 7 15 9 173 11 2 2 5 1 1 4 10 71 6 4 5 2 4 3 6 11 602 50 25 34 41 19 22 59 12 449 39 34 39 45 10 18 53 13 130 15 7 10 6 3 4 8 14 103 3 8 5 13 1 2 12 15 and over 1,225 61 64 74 215 54 55 208 Total 4,878 344 220 245 361 104 118 371 287 Defects treated at Vision Clinics Defect Number Error of refraction and squint 3,438 Other eye defects 24 Spectacles ordered 1,052 Findings at Health Surveys School Roll (May 1967) 38,579 1. Comprehensive surveys (a) Number examined 27,605 (b) Number (occasions) found verminous 165 (c) Percentage found verminous 0.60 2. Selective surveys (a) Number examined 27,280 (b) Number (occasions) found verminous 480 (c) Percentage found verminous 1.76 3. Verminous cases (a) Total times vermin found 645 (b) Total percentage found verminous 1.18 (c) Number of individual pupils found verminous 396 (d) Percentage of individuals found verminous (of School Roll) 1.03 4. Action taken with verminous cases (a) Advice and/or Lorexane 526 (b) Further action 119 (c) Percentage of cases given advice and/or Lorexane requiring further action 22.12 Voluntary attendances at bathing centres: Number of pupils 99 Number of statutory notices issued — 5. Communicable disease surveys Numbers catered for: 1967 1966 Athlete's foot 6,230 11,122 Plantar warts 7,257 10,778 Dysentery 434 71 Other communicable diseases 3,223 1,833 17,144 23,804 288 Prophylaxis School Roll (May 1967) 38.579 Routine Inspections Number inspected 15,392 Number found not to warrant examination 3 (7 plus "special scheme") Percentage of Number inspected of Parent present 55.9 Care Committee present 82.8 Number vaccinated against smallpox 80.7 Number immunised against diphtheria 91.4 Number immunised against whooping cough 82.9 Number vaccinated against poliomyelitis 90.5 Physical condition unsatisfactory 1.0 Referred for treatment of defects 14.6 Referred for treatment of defects other than vision 7.8 Non-Routine Inspections (i) Specials 5,614 (ii) Re-inspections 6,015 Total (i) and (ii) 11,629 Number of routine inspections as percentage of school roll 39.9 Number of non-routine inspections as percentage of school roll 30.1 B.C.G.—1967 SKIN TESTED NEGATIVE B.C.G. GIVEN Schools Further Education & Training Colleges Schools Further Education & Training Colleges Schools Further Education & Training Colleges 1st Quarter 751 33 636 6 636 6 2nd Quarter 501 170 365 33 365 33 3rd Quarter 704 5 619 4 619 4 4th Quarter 880 159 721 24 721 24 Total for 1967 2,836 367 2,341 67 2,341 67 289 Examinations for recuperative holidays Thirty-six such examinations were carried out in 1967 (47 examinations in 1966). 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 Chickenpox 768 Dysentery, diarrhoea or enteritis 91 German Measles 175 Impetigo 38 Influenza 4 Jaundice 8 Measles 714 Mumps 386 Ophthalmia and conjunctivitis 21 Pneumonia 1 Ringworm (scalp) 2 Scabies 4 Scarlet Fever 70 Sore throat and tonsillitis 84 Whooping cough 95 290 Number of Children of all ages noted for Treatment or Observation (Expressed as a rate per 1,000 inspected) Number Inspected — 15,392 Defects Treatment Observations 1967 1966 1967 1966 Skin 8.84 8.51 15.92 11.40 Eyes (a) Vision 74.26 73.47 30.99 31.99 (b) Squint 7.86 6.78 4.81 4.62 (c) Other 1.23 2.22 3.51 3.33 Ears (a) Hearing 7.02 5.05 6.30 5.18 (b) Otitis media 3.77 2.53 6.56 4.50 (c) Other 0.32 0.49 1.62 0.92 Nose and Throat 9.29 9.06 38.14 33.90 Speech 4.81 4.56 10.85 9.37 Lymphatic Glands 0.32 0.68 7.54 6.04 Heart 3.25 3.45 11.89 11.40 Lungs 4.81 6.78 15.66 11.09 Developmental (a) Hernia 1.62 1.42 3.57 4.13 (b) Other 1.69 1.29 8.19 6.84 3.31 2.71 11.76 10.97 Orthopaedic (a) Posture 2.14 1.23 8.90 7.03 (b) Feet 4.68 7.03 32.74 34.88 (c) Other 2.60 2.22 13.58 8.44 9.42 10.48 55.22 50.35 Nervous System (a) Epilepsy 2.08 1.42 1.62 1.23 (b) Other 0.45 0.68 3.31 2.34 2.53 2.10 4.93 3.57 Psychological (a) Development 0.92 1.23 8.32 4.93 (b) Stability 1.17 0.99 15.40 11.03 2.09 2.22 23.72 15.96 Abdomen 0.45 0.37 2.40 1.73 Other 17.09 14.61 40.48 38.64 291 Comparison of Defects noted at 7-plus routine and 7-plus "Special" Medical Examinations in 1967 (Number of children noted for treatment and observation expressed as a rate per 1,000 inspected) Number inspected at 7-plus Routine Inspections 3,286 Number inspected at 7-plus Experimental Scheme Inspections 3 Defects A* B † Skin 27.08 — Eyes (a) Vision 91.60 333.33 (b) Squint 14.91— (c) Other 3.65 — Ears (a) Hearing 16.74 — (b) Otitis media 12.48 — (c) Other 3.04 — Nose and Throat 56.00 — Speech 16.43 — Lymphatic Glands 8.22 — Heart 13.39 — Lungs 19.78 333.33 Developmental (a) Hernia 6.09 — (b) Other 7.61 — Orthopaedic (a) Posture 11.87 — (b) Feet 38.04 — (c) Other 9.43 — Nervous System (a) Epilepsy 4.56 — (b) Other 3.96 — Psychological (a) Development 12.17 — (b) Stability 16.74 — Abdomen 3.04 — Other 49.00 — * Column "A" refers to 7-plus routine medical inspections. † Column "B" refers to 7-plus experimental scheme inspections. 292 Educationally Subnormal Pupils Number examined: 95 Number recommended : 1. Day E.S.N. School 77 2. Boarding E.S.N. School 1 3. Ordinary School with special help 13 4. Junior Training Centre 4 Routine Audiometer Testing Pupils given screening tests 4,764 Pupils failing screening tests 454 Pupils given pure tone tests Pupils failing pure tone tests 200 Pupils referred to Otologists Percentage referred to Otologists 4.20 Visits Made to Schools in the Borough by Public Health Inspectors VISITS—1967 PURPOSE NUMBERS REMARKS Food Hygiene 39 Visits at request of Head Teachers and routine inspections. Food Inspections 35 At request of School Cater- ing Service. Milk Sampling 10 Routine. Infectious Diseases 17 Investigations following medical or school notifications Prophylactic disinfection for Verrucae 4 Nuisances 20 Inspections following complaints of defective sanitary fittings. Surveys 11 For prevention of atmospheric pollution. Lectures on Health Subjects 5 At request of Head Teachers. Rodent Control 12 TOTAL VISITS 159 293 THE SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer In June, 1967, the school dental services in the Borough were reviewed by an officer representing the Department of Education and Science and the Ministry of Health and my report is based mainly on observations concerning points arising from that inspection. The inspector recommended at least one inspection per year, at school, of all children on the school roll with the offer of treatment if this was found to be necessary. Because routine inspections in the Inner London Education Authority's area did not commence until September, 1966, the respective Ministers appreciated that special interim measures were essential before full inspection could be achieved. Although the relatively low number of school dental inspections carried out invited criticism, the policy of giving routine inspections, in the first instance, to children in Infants and Junior schools, combined with a satisfactory output of treatment per session, was commended. At the time of the review, it should be observed that because of the acute shortage of dental surgeons, school dental inspections were deliberately restricted to keep pace with available treatment facilities. Manifestly, we are in full agreement with the necessity of annual inspection and have due regard to the collective dental health of schoolchildren, but any approach other than the one adopted would have led to intractable treatment demands. Nevertheless, during the autumn term an urgent inspection was carried out, although this too had to be geared, pari passu, to the treatment facilities which could be offered. In this context, it would be apposite to recall that in the I.L.E.A. School Health Statistics for 1967 our attendance rate per session was shown to be the second highest whilst our emergency attendances held pride of place, as did our fillings of both permanent and deciduous teeth. Of all the Inner London Boroughs our extraction rate was the lowest. Furthermore, in order to assist dental officers, the School Dental Service is supplied by the School Medical Officer with particulars concerning children suffering from diabetes, epilepsy, haemophilia, rheumatic carditis, congenital heart disease, allergies and other conditions or drug treatments most likely to have a bearing on dentistry. In the review, concern was expressed at staff shortages, the necessity to recruit more dental officers was stressed and it was intimated that future plans should include the engagement of an 294 orthodontist and the employment of dental auxiliaries where practical. The provision of twin dental surgeries was recommended and facilities for the hospital referment of children advocated. Following several staff resignations, favourable trends towards the completion of our dental establishment, evident at the beginof the year, failed to develop and the position regressed. At the latter end of the year some respite was gained and treatment facilities augmented by the employment of temporary dental officers, but the possibility of a full staff complement in the immediate future is remote. Against such a background the present policy of "restricted inspection" seems justified. So far, facilities offered by local hospital orthodontic services have proved satisfactory but inspections will increase and demands for orthodontic consultations and treatment will grow when our establishment of dental officers is complete. Appointment of an orthodontist will then have to be considered. Employment of dental auxiliaries is dependent upon the introduction of twin surgeries with a supervising dental surgeon. These problems continue to have our undivided attention. Dental health education was considered by the inspector to be an important part of the service and to require for its development the co-operation of teachers and other persons in close contact with children. Our efforts in this field, which incidentally received very favourable comments, are well organised. We have our own dental literature for both parents and children and all school dental inspections are preceded by personal talks between the Principal School Dental Officer and the Head Teacher, at which the origins of tooth decay and allied conditions are outlined and appropriate preventive measures indicated. This approach has been highly successful in producing full co-operation and our suggestions regarding the "swish and swallow" routine after meals and snacks, the elimination or conversion of tuck shops and the introduction into the curriculum of simple dental heath education have been readily accepted. Dental health education is coupled with the distribution of literature to parents and children via, and at the discretion of, the school and additional publicity is achieved by the display of suitable material on clinic waiting-room notice boards. Furthermore, throughout treatment, all children are exposed to short bursts of "questionsand answers", individual model demonstrations and assessment of oral hygiene. As the result of a successful, intensive dental health campaign carried out at a secondary school of 2,000 pupils, valuable tion was obtained which will influence our approach to future dental 295 health education. With regard to surgeries, the inspector emphasised the importance of a high standard of accommodation, which should be clean and bright, and stressed the need for modern equipment. The desirability of twin surgery clinics was reiterated and attention was drawn to the need for discussions on future replacement and the provision of facilities in ill-served areas of the Borough. Whilst reprehensive about the lack of suitable premises and commenting adversely about some areas of the Borough which were not well served, the inspector endorsed our efforts to overcome the poor quality of some clinic accommodation, complimented us on the standards of cleanliness and decoration and noted with satisfaction our up-to-date equipment. It has been our earnest endeavour to maintain dental premises to the best of their potential and to ensure that the equipment is not only of the highest standard but that no modern aids are lacking. Works connected with an approach road to the new Blackwall Tunnel involved the demolition of premises previously used for dental purposes and a new dental suite at 103 Shooters Hill was opened in October of this year. Although this clinic conforms in every respect to the standards expected of a modern dental practice, there was insufficient room available to establish a second surgery. In essence, the inspection confirmed, inter alia, that, (a) there was restricted inspection but that this was a deliberate policy resulting from staff shortage; (b) demand, in excess of available treatment facilities, continues; (c) our clinics are pleasant and fully equipped; (d) treatment and dental health education are of the highest order; (e) future progress is necessarily linked with the availability of professional personnel and further expansion. While 1965 could be regarded as a year of assessment and 1966 as that of reorganisation and modernisation, it had been fervently hoped that 1967 would have been the year of achievement. ever, it was not to be. Perhaps the coming year will see the realisation of such aspirations prior to entering upon an expansion phase leading to a realistic dentist/patient ratio. Dental disease is unnecessary and largely preventable and, viewed against this background, the following statistical analysis reveals the alarming state of dental health of the Borough's school child. It forcefully draws attention to the need for expansion of the school dental service and emphasises the urgency of bringing it into line with the high standard and efficiency associated with other branches of preventive public health medicine. 296 SCHOOL DENTAL SERVICE Statistical Analysis 1967 1966 Sessions Treatment Sessions 1,365 1,076 General Anaesthetic Sessions Nil 5 School Inspections 24 10 Attendance New patients— given appointments 4,156 4,446 attended 2,657 2,125 percentage of attendance 63.93% 48% On-treatment patients— given appointments 10,446 7,567 attended 8,891 5,755 percentage of attendance 85.11% 77.4% Emergency patients treated 344 401 Total of attendances 11,892 8,281 Number of treatment cases completed 1,886 2,145 Treatment Total number of teeth treated 8,897 7,674 (1) Permanent Teeth 5,001 3,130 filled 4,917 3,061 extracted (including orthodontics) 84 69 percentage of fillings 98.32% 97.75% percentage of extractions 1.68% 2.25% (2) Deciduous Teeth 3.896 3,225 filled 3,720 2,895 extracted 176 330 percentage of teeth filled 95.48% 81.7% percentage of teeth extracted 4.52% 18.3% Teeth root-filled 391 43 Teeth otherwise conserved 400 1,276 Prophylactic treatment 3,285 1,906 Number of patients X-rayed 733 304 Number of general anaesthetics Nil 49 297 Orthodontics New cases undertaken for treatment or referred 34 35 Inspections Children inspected at schools and clinics 4,039 2,054 Children found to require treatment —number 2,947 1,588 —percentage 73% 77.3% Acceptance—School Dental Service —number 3.090 1,790 —percentage 76.35% 84.7% Acceptance—General Dental Services —number 949 264 —percentage 23.65% 15.3% Clinical analysis of random sample. I. Analysis of dental health: 1. Age group 5 — 13 years 2. Number of children examined 1,000 3. Number of children requiring treatment 611 =61.1% 4. Number of children not requiring treatment 389 = 38.9% 5. Sum total of findings:— carious teeth 1,984 unsavable teeth 40 teeth missing for reasons other than natural shedding 684 teeth with satisfactory fillings 2,037 6. Average findings per child:— carious teeth 1.98 unsavable teeth 0.04 teeth missing for reasons other than natural shedding 0.68 teeth with satisfactory fillings 2.04 7. Average dental health per child:— sum total of diseased + missing 4- filled teeth 4.74 8. Number of children with perfect dentitions and no treatment required 235 = 23.5% 9. Pattern of previous dental treatment:— no previous treatment 375 = 37.5% extractions only 91 = 9.1% fillings only 356 = 35.6% extractions and fillings 178 = 17.8% 298 II. Analysis of oral hygiene: 1. Age group 5-8 years 2. Number of children examined 473 3. Oral hygiene:— good 156 = 32.98% fair 257 = 54.33% poor 60 = 12.68% School Health Service — Social Work Social Workers in the School Health Service are jointly employed by the Inner London Education Authority and the Borough under the direction of the Principal School Medical Officer. They are concerned with socio/medical symptoms and work in school clinics, hospitals and educational units for handicapped children. They work in close contact with all other agencies but particularly with the School Care Committee Service in the Education Service. They are attached to the following clinics:— (a) Local Authority Clinics: Special Investigation Clinics : Health Centre, Market Street, S.E.18. Health Centre, Plumstead High Street, S.E.18. Abbey Wood School, Eynsham Drive, S.E.2. M. &C.W. Centre, Burney Street, S.E.10. M. & C.W. Centre, Rusthall Lodge, Southend Crescent, S.E.9. Audiology : Hearing Centre, Fairfield House, Fairfield Grove, S.E.7. E.N.T.: Health Centre, Market Street, S.E.18. (b) Special Education Units : Beverley School — Deaf. Meridian School — Partially Hearing. Griffin Manor — Autistic Unit. Goldie Leigh Hospital School — Diseases of Skin. Moatbridge School — Maladjusted. (c) Hospital: Memorial Hospital — Child Guidance. INDEX Page A Abattoir 242 Abortion Act, 1967 83 Accidents— Deaths 33,51 Home 33, 52 Motor Vehicles 33, 51 O.S.R.P. Act 187 Accommodation— for Elderly 126 for Homeless 129 for Mortuary 219 for Psychiatrics 159 Acute Encephalitis 73 Acute Influenzal Pneumonia 72 Acute Poliomyelitis 73 Acute Primary Pneumonia 72 Adaptation for Kidney Machine 144 Adoption 114 Adults Cleansed 217 Advisory Clinics, Geriatric 172 Aflatoxin in Ground Nuts 245 Age Composition of Population 36 Age Mortality 41 Alcoholism 54 Aleukaemia 33 Alkali Works Orders 192 Amylase Test—Egg Pasteurisation 246 Analysis of Non Routine Medical Inspections — Schools 284 Analytical Examination of Milk 238 Anencephaly 101 Animal Boarding Establishments Act 201 Ante & Post Natal—Clinics 85 Ante & Post Natal Attendances 86 Antitoxin—Diphtheria 72 Ants, Pharoah's, etc 215 Area—Borough 14 Comparability Factors 32,38,41 Articles and Rooms Disinfected 218 Articles Destroyed 214 Artificial Respiration 271 Asthma 65, 75 Atmospheric Pollution 65, 191 "At Risk" Register 101 Audiology Clinics 298 Audiometer Testing of School Children 292 B Bacteriological Examinations 210, 237, 238, 246, 247, 250 Baiting of Sewers 213 Bakehouses 241 Page Bathing— at Centres 169 at Home 169 Centres 169 Service 169 Baths— Swimming 211 Turkish & Russian 211 Warm 211 Baths & Wash-houses 210 "Battered" Babies 102 B.C.G. Vaccination 74,75,288 Beetles, etc.—Disinfestation 217 Betting, Gaming and Lotteries Act 201 Birth Registrations 39 Births— 32, 38 Age, Parity and Place of Occurrence 87 Illegitimate 32, 39 Legitimate 32, 37 Live 32,39,87 Still 32,40 Blackheath & Woolwich Fairs 239 Blackwall Industrial Training Centre 153 Blind— Clubs 142 Concessions 138 Education, Training and Employment 135 Homeworkers 138 "In" Residents 136 Occupations 136 Registers 133 Sheltered Employment 138 Welfare 132 Blindness 132 Boarding Out— Child Contacts, etc. 114 Subnormal Adults 155 Breast Examinations 94, 95 Bronchitis 33, 50, 64 Bronchogenic Carcinoma 49,50 Brook Chest Clinic 75 Burial or Cremation of Deceased Persons 181 Butchers' Shops 244 C Cancer— Cervix 33 General 33,48,55 Childhood, Survey of 56, 110 Lung 33. 49. 50 INDEX (continued) Page Cancer- Other Special Sites 33,49 Uterus 33, 49 Care and Protection of Property 181 Care Committee 281 Carol Services for Elderly 179 Carcases & Offal Inspected at Slaughterhouse 242 Cars, Disposal of Unwanted 214 Case Conferences 116 Caseous Lymphadenitis 245 Cases of Infectious Diseases 68 Castlewood Day Hospital— Mentally Ill 159 Catering Establishments 241 Census 34 Cerebral— Embolism 48 Haemorrhage 48 Thrombosis 48 Certificates—- Export 247 Disrepair 198 International Vaccination 69 Cervical Cytology 94 Cesspools 202 Chest Clinics 74,75 Chest Physicians' Reports 74,75 Chevening Road Day Centre— Mentally I11 161 Chickenpox — School Children 289 Child- Contacts, Boarding Out 114 Guidance Facilities 280 Helps, Courses 107 Minders, Statutory 119 Minders, Voluntary 119 Population 32, 36 Welfare Clinics 112 Childbirth, Preparation for 86 Children- Cleansed 217 Dual Handicaps 101 Ineducable 102 Chiropody— Domiciliary 121, 171 General 120 Elderly 121, 171 Services 120, 171 Childhood Cancers 110 Christmas Parcels for Elderly 180 Civic Entertainment for Elderly 179 Classification of Deaths 47 Clean Air Act 192 Page Cleansing & Bathing Centres 169, 217 Cleansing of Children 217, 287 Cleansing of Old People 169 Clearance Areas 227 Clinics— Ante Natal 85 Child Welfare 112 Family Planning 99 Genetic 45,63 Geriatric 172 Mental Health 149 Minor Ailments 285 Post Natal 85 Special Investigation 149 Closing Orders— Demolition Orders 226 Determinations 227 Houses 224 Parts of Houses 226 Underground Rooms 226 Undertakings 224 Clover Mite 216 Clubs— Blind 142 Day 176 Deaf 142 Elderly 176 Lunch 172 Mothers' 115 Physically Handicapped 142 Subnormal 156 Therapeutic, Social 163 Clubs & Centres for Handicapped 142 Cockroaches 215 Common Infectious Diseases 52 Communicable Diseases Survey —School Children 287 Community— Care 124 Centres 23 Council 24 Community Services— Geriatric 163 Handicapped 131 Mentally Ill 157 Mentally Subnormal 149 Comparability Factors 32,38,41 Complaints 183,188 Concerts & Outings, etc.— Elderly 178 Concessions for Blind 138 Condensed Milk Regs. 248 Conditional Releases— Imported Egg Products 245 INDEX (continued) Page Conference Organisers 277 Confinement— Arrangements 86, 91 Medical Aid Fees 93 Congenital Malformations— Deaths 33 Notifications 100 Conjunctivitis—School Children 289 Consultant Chest Physicians 74, 75 Conveniences—Public 214 Co-operation with Hospital Depts. 109 Co-ordinating Committee 116 Coronary Disease 33,48,60 Council— Dwellings 232 Housing Schemes 232 Rehousing 232 Creches 113,155 Cremation or Burial of Deceased 181 Cremations 218 Crematorium 218 Criminal Justice Act, 1967 183 Cysticercosis 242 Cytology— Bronchial 56 Cervical 56,94,99 D Darenth Park & Goldie Leigh Hospitals 155 Day— Centres—Mentally Ill 161 Clubs—Elderly 176 Clubs—Homebound 176 Hospital—Mentally 111 159 Nurseries—Private 113 Nursery 113 Rooms 176 Training normality 150 Deaf Register (incl. Partially Hearing) 103 Death— Causes—Remarks 47 Rates—Special Causes 33 Registrations 41,47 Deaths— General 32,41 Institutional 42 Table Showing Causes of and Ages at Appendix Page Table Showing Causes of and Ages under 1 year 45 Deaths— Violent 51 Defective Dwellings — Repairs 188 Defects of School Children at Routine and Special Medical Examinations 291 Demolition Orders 226 Density of Population 14, 32 Dental— Caries 57 Health Education 294 Services—M. & C.W 121 Services—Schools 281, 293 Survey 122,297 Treatment 121, 296 Dentistry 121 Departmental Transport 272 Determination of Closing Orders 227 Diagnostic Cytology 56,94,99 Diphtheria— 72 Antitoxin 72 Immunisation 72,288 Disabled & Old People's Homes—Registration 181 Disablement Resettlement Officer 154 Diseased Carcases 242 Diseases— Infectious 53, 68 Respiratory 50,51,56,64,71,72,73 Disinfecting Stations 218 Disinfection 74,218 Disinfestation 215 Disinfestation of Verminous Premises 215 Displays—Health Education 266 Distributon Centres— Nutritional Supplements 175 Welfare Foods 117 District Nursing Service 104 Divisional School Care Organiser 150 Domestic Helps 107 Domiciliary— Births 87, 91 Births, Prematurity and Mortality 92 Chiropody 121, 171 Confinements 91 Confinements by Age and Parity 91 INDEX (continued) Page Domiciliary— Midwifery Services 91 Midwives 90 Domiciliary Services— Geriatric 163 Handicapped 131 Midwifery 91 Drainage & Sewerage 202 Dried Egg Products—Imported 245 Dried Hen Egg Albumen 246 Dried Milk Regs 248 Drug Addiction 58 Dual Handicaps—Children's 101 Dwellings— Erected by L.A.s 232 Inhabited 14 Separate Occupiers 14 Uninhabited 14 Dysentery 72,289 E Early Discharges — Maternity Cases 91 Early Neonatal Mortality 33,46 East Greenwich Relief Sewer 191 Education Act — Examinations 148 Education and Training Centre —E.S.N 150 Education Sessions—Ante Natal84,86 Educationally Subnormal Pupils 292 Educationally Subnormal Clubs 156 Egg Albumen—Imported 245 Egg Processing Plant 247 Elderly— Clubs for 176 Day Rooms for 176 Lunch Clubs for 172 Meals-on-Wheels 171 Population 32, 36 Primaparae 88 Recreational Facilities 176 Visiting 167 Elevation of Borough 14 Eltham— Club for Blind 143 Creche 155 Crematorium 218 Nursery for Mentally Handicapped 155 Emergency Obstetric Units 92 Emigration/Immigration 35 Employment of Blind Persons 135 Employment of Partially Sighted 137 Encephalitis 73 Page English Frozen Whole Egg Plant 246 E.N.T. Clinics 298 Enteric Fever 72 Entertainment for Elderly 179 Environmental Health Services 182 Erysipelas 72 Examinations— Ante and Post Natal 86 Fitness for Employment 271,280 Mental Illness 149 Recuperative Holidays 289 Sick Persons 271 Staff Appointments 271 Superannuation 271 Exhumations 218 Expectation of Life 36 Export Certificates 247 Extracts from Vital Statistics 32 F Factories Act, 1961 183 Factories Inspections 183 Fairs, Blackheath & Woolwich 239 Families. Number of 14 Family— Aids 107,117 Caseworkers 117 Planning 96 Planning Act 82,99 Planning Association 96 Planning Assoc. Clinics 99 Federation Hall Day Centre— Proposed 161 Fertility Clinics 99 Field Work Instructor Courses 111 Film Shows—for Elderly 179 Film Shows and Talks—Health Education 265 Flies and Mosquitoes 214 Flooding of R. Ravensbourne 190 Fluoridation of Water Supplies 57, 205, 206 Food and Drugs Act— Genuine Samples 247,251 Non-Genuine Samples 247,256 Other Food Samples 248 Food— Examination 247,251 Hygiene Regs 240 Inspection 247 Legislation, New 234 Poisoning 78 Premises for Preparation of 239 Rejected 241,244 INDEX (continued) Page Foods—Welfare 117,175 Foot Clinics 120, 171 Foster Parents 114 Fouling of Pavements by Dogs 213 Friendly Visiting—Elderly 180 Frozen Whole Egg Plant 246 Future Development — Hndicapped Services 147 Future Prospects—Geriatric Problems 166 G General Information and Social Conditions 17 General Medical Inspection of School Children 282 General Practitioner Obstetricians' Clinics 86 General Statistics 14 Genetic Clinics 45, 63 Geology, Superficial 26 Geriatric Adviser to the Council 174 Geriatric— Clinics 172 Community Services 163 Units 174 German Measles 289 G.L.C.—Rehousing 232 Gonorrhoea 65 G.P. Obstetricians' Clinics 86 Grants—S.C.A.s 196 Greater London Council (G.P.) Act, 1967 182 Greenwich— Chest Clinic 74 Community Council 24 Council of Social Service 121 Hotel 177 Workshops for the Blind 138 Ground Nuts—Aflatoxin content 245 H Hairwashing—Elderly 170 Handicapped— Adaptation for Kidney Machine 144 Children 102 Christmas Shopping Expedition 147 Future Development 147 Holidays 146 Portable Aids 146 Register 102 Page Handicapped— Services 131 Special Education 280 Transport 147 Works of Access, etc 143 Young People's Centre 143 Health— Committee 3 Committee—Terms of Reference 3 Education 111,264 Education Classes 84, 86 Education in Schools 269 Education at Welfare Centres 111,268 Education Subjects 265 Surveys 56 Visiting 108 Visitor Training 110 Health and Welfare Dept. Staff 6 Heart Disease 33,48,60 H.M. Inspector of Factories 183 Holiday Hotel for Elderly 177 Holiday Relief for Relatives 127, 174 Holidays— Elderly 177 Handicapped 146 Recuperative 118 Subnormal Trainees 155 Home— Accidents—Deaths 33, 52 Bathing 169 Cleansing Service 170 Help Course 107 Help Service 107 Nursing 104 Nursing Equipment— Loans 144 Nursing—Training 106 Safety 270 Visits—Elderly 168 Homeless Families— Accommodation 129 Statistics 130 Homelessness 129 Homes for Mentally Ill 163 Homes for Old People— Admissions 126 Council 126 Future Development 126 Provision of 126 Recreation 127 Registration 181 Staff 128 Temporary Admissions 127 INDEX (continued) Page Homes for Old People— Transfer of Residents 128 Voluntary 128 Welfare 127 Homes for Subnormal 156 Homicide 51 Hospital Confinement— Nursed at Home 91 Selection for 86 Hostels for Mentally Ill 163 Hostels for Subnormal 156 Hotel, Holiday for Elderly 177 House Improvements 230 House Purchase and Housing Acts 230 House and Trade Refuse 213 Houses— Inhabited 14 Multiple Occupation 231 No. in Borough 14 Unfit 224 Uninhabited 14 Housing— 175,222 Accommodation 232 Closing Orders 224 Conditions 222 Defects 188 Demolition Orders 226 Elderly 175 Financial Provs. Act 230 Homeless Persons 129 Medical Assessments 271 Premises Unfit 224 Repairs and Rents Act 230 Schemes, Council 232 Underground Rooms Act 226 Undertakings 224 Housing Act, 1949 230 Housing Act, 1957—Procedure under 224 Housing Act, 1961 231 Hydrotherapy Pool 210 I Ice Cream— Bacteriological Exams. 238 Premises 238 Quantative Analysis 239 Sampling 238 Illegitimate Births 32,39,87,115 Immigration/Emigration .... 35 Immunisation and Vaccination 69, 70,71,72,73,74, 75, 281 Impetigo 289 Page Imported— Egg Products 245 Food Regs. 244 Food Rejected 244 Improvement Grants 230 Incontinent Laundry Service 170 Industrial— Emissions—S.C.A.s 192 Injury Benefit Claims 79 Rehabilitation 143 Training Centres 150 Infantile Mortality 33,43 Infant Welfare Clinics 112 Infectious Diseases 53 and Appendix Infectious Diseases— Notifications 68 and Appendix School Children 289 Infective Hepatitis 61 Infertility Clinics 99 Influenza 289 Inhabited Dwellings 14 Innoculations — Poliomyelitis "In Service" Training 107 Inspections— Food and Food Premises 233 Food 237 Food Premises 238,239 Meat at Slaughterhouse 242 Institution Deaths 42 Integrated Students 106 International Vaccination Certs. 69 Interviews—re Housing (A.M.O.H.) 272 Intra Uterine Contraceptive Device—Sub Clinic 98 Introductory Review J Jaundice 289 Jurisdiction over R. Ravens- bourne 190 K Kidney Machine, Adaptation for 144 Knoyle Street Centre—Mentally Subnormal 154 L Laboratory Work 204, 207, 208, 210, 237 , 238 , 245, 247, 248 Land Charges Act 202 Launderette 210 Laundries—Public 210 Laundry Service — Incontinent 170 INDEX (continued) Page Lead Content in Water Supply 206 Lead Poisoning 209 Leaflets—Health Education 267 Legal Proceedings 221 Legislation, New 82,182,234 Legitimate Births 32, 39 Leprosy 73 Leptospirosis 212 Leukaemia 33 Library Facilities— Blind 139 Elderly 179 Homebound 179 Old People's Homes 179 Licences— Milk 237 Radio for Blind 138 Licensing Act, 1961 201 Licensing— Slaughterhouse 244 Slaughtermen 244 Street Traders 239 Tripe Boiler 244 Live Births 32,39, 87 Loan of Equipment 144 Local Morbidity 79 London Government Act, 1963 17 Lunch Clubs 172 Lung Cancer 33, 50, 64 M Main Unit—Homeless 129 Malaria 73 Malformations, Congenital— Deaths 33 Notifications 100 Manufacture and Sale of Ice Cream 238 Marie Curie Night Nursing Service 106 Marriages 32, 37 Mass Radiography 76 Maternal Mortality 33,43 Maternity Outfits 92 Maternity Services 82 Mayor's Fund—Coal for Elderly 180 Maxey Road Chest Clinic 75 Maze Hill— Chest Clinic 74 Training Centre 150 Training Centre — Education and Training 150 Nursery Unit 150 Special Unit 151 Page Meals-on-Wheels 171 Measles 70,110,289 Measles—Vaccination 70 Meat Inspection — Slaughter- house 242 Meat Regs 242 Meat Surrendered 241 Medical Aid — Confinement Cases 92 Medical Appliances—Loans 144 Medical Assessments—Housing 271 Medical Examinations— Ante Natal 86 Mental Health 149 Post Natal 86 Sick Persons 271 Staff Appointments 271 Superannuation 271 Medical Inspections—School Children 282 Medical Officer of Health's Review 9 Medical Practitioner Obstetrician Clinics 86 Medical Treatment — School Children 285 Meningococcal Infection 73 Mental Health— Act 148 Colour Film 268 Officers 150 Services 148 Statistics 158, 160, 162 Training Centres 150 Week 268 Mental Illness— Community Services 157 Prevention 62 Mental Subnormality — Community Services 149 Meteorological Observations 31 Metropolitan Water Board 58 Met. Water Board—Director's Report 204 Mice Destruction 211 Midwifery 90 Midwifery Training — Part II 93 Midwives 90 Mileage of Roads 16 Milk- Analysis 238,247 Condensed, Regs 248 Dairies 237 Distributors 237 Dried, Regs. 248 INDEX (continued) Page Milk- Licences 237 Sampling 237 Milk and Dairies Regs. 237 Milk (Special Designation) Regs 237 Ministry of Labour—D.R.O.s and Y.E.O.s 154 Ministry of Social Security- Statistics 79 Minor Ailments Clinics— Defects Treated 285 Minor Hall Club—Blind and Deaf 143 Miscellaneous Services 181,264 Mobile Meals 171 Mongolism 101 Moral Welfare 114 Mortuary Accommodation 219 Mothercraft Training 86 Mothers' Clubs 115 Mothers -Rehabilitation 115 Motor Vehicle Accidents— Deaths 33, 51 Multiple Pregnancies 89 Mumps—School Children 289 N National Assistance Act 181 N.A.A.—Part III Accommodation—Statistics 128 National Health Service (Family Planning Act), 1967 82 National Insurance Act—Med. Certs 69 National Welfare Foods— Distribution 117 Natural Increase 32, 35 Neonatal Mortality 33, 46 New Housing 232 New Legislation 82,182,234 Noise Abatement Act 199 Nomenclature Regulations 47 Non-Genuine Samples 247, 256 Non Routine Med. Inspections —Schoolchildren 283 Notices, etc 183.220 Notifications— Accidents 187 Con. Malformations 100 Food Poisoning 78 Infectious Diseases 68 Number of Families 14 Nursing— Equipment—Loans 144 Page Nursing— Homes—Registration 120 Unit—Mentally Handicapped 150 Nutritional Supplements 175 O Observations of Council's Services 106,111,180 Occasional Creche Service 113 Occupational Therapist 143 Offensive Trade — Tripe Boiler 244 Offices, Shops & Railway Premises- Act 185 Exemptions 187 Inspections 185 Notifications of Accidents 187 Registration 185 Old People—Visiting 167 Old People's— Clubs 176 Homes 126 Homes—Registration 181 Open Spaces— Borough Council 15 G.L. C 16 H.M. Office of Works 16 Public 15 War Office Dept 16 Ophthalmia — School Children 289 Ophthalmia Neonatorum 66,73 Ophthalmic Services 133,287 Organic Nervous Diseases Gp Handicapped 141 Ormiston Road Rehabilitation Centre 143 Orthopaedic Defect — School Children 290 Other Food Examinations 248 Otology—Schoolchildren 292 Outwork 184 Outworkers 185 P Paratyphoid Fever 72 Part III (N.A.A.) Accommodation Statistics 128 Partially Sighted— Employment and Training 137 Register 137 Parts of Buildings—Unfit 226 Pedicure—Elderly 170 Perinatal Mortality 33,46 Personal Health and Related Services 80 Persons Cleansed 169,217 INDEX (continued) Page Pet Animals Act 201 Pharaoh's Ants 215 Pharmacy and Poisons Act 200 P.H. Regs.— Dried Milk 248 Imported Food 244 Meat 242 Milk and Dairies (Gen.) 237 Milk (Spec. Designations) 237 Smallpox Prevention 70 Tuberculosis 68 Physical Aids 144, 176 Physically Handicapped— Additions and Removals 142 Clubs and Centres 142 Organic Nervous Diseases Gp 141 Primary Disabilities 140 Register 140 Rheumatism Gp 140 Social Rehabilitation Centre 143 Systemic Diseases Gp 141 Welfare 139 Pigeon Nuisance 189 Pneumonia 33, 50, 64,72, 289 Poisoning— Food 78 Lead 209 Poisons Information Service 200 Poliomyelitis 73 Poliomyelitis Inoculations 73, 288 Pollution— Atmospheric 65,191 Recording 197 River 189 Population 14, 32,34 Population— Age Composition 36 Child 32,36 Density of 14, 32 Elderly 32, 36 England and Wales 34 Greater London 35 Sex Ratio in 36 Working 36 World 34 Portable Aids for Handicapped 146 Post Natal Clinics 85 Powers and Duties— Health Committee 3 Welfare Committee 5 Practising Midwives 90 Precautionary Spraying 217 Pregnancies, Multiple 89 Page Premature Baby Units 92 Premises Unfit for Human Habitation 224 Preparation for Childbirth 86 Preserved Food Premises 238 Prevalence and Control over Infectious & Other Diseases 53 Prevention of Damage by Pests Act 212 Primaparae, Elderly 88 Principal School Dental Officer's Report 293 Principal School Medical Officer's Report 279 Private Day Nurseries 113 Problem Families Index 109 Procedure under Housing Act, 1957 224 Proceedings, Legal 221 Product of Id. Rate 14 Property Protection 181 Prophylaxis 70, 71, 72, 73,74, 75, 288 Protection of Property 181 Provision of Accommodation (N.A.A.) 126 Psychiatric Patients — Accommodation 159 Psychiatric Services 157 Psychoprophylaxis in Childbirth 84, 86 Psychoprophylaxis Course 11 Public Baths and Wash-houses 210 Public Conveniences 214 Public Health Laboratory Service 210,237,238 Public Lectures/Demonstrations 265 Publicity— Health Education 266 Services for Elderly 176 Public Open Spaces 15 Public Open Spaces— Council 15 G.L.C. 16 H.M. Office of Works 16 War Office Dept 16 Puerperal Pyrexia 72 Q Quantitative Analysis—Ice Cream 239 R Radio and T.V. for Elderly 178 Radioactive Substances Act 203 Radiography—Mass 76 Rag Flock Act 200 INDEX (continued) Page Rag Flock and Other Filling Materials Regs 201 Rainfall—Annual 31 Rateable Value 14 Rates—Births and Deaths, etc. 32 Rats and Mice Destruction 211 Ravensboume River—Flooding 190 Receivership 181 Reception Centre — Homeless 129 Recreational Facilities for Elderly 176 Recuperative Holidays 118 Recuperative Holidays — Med. Exams 280,289 Redevelopment—Housing 232 Refresher Courses 93,106,111 Refuse— Collection 213 Disposal 213 Registers— "At Risk" 101 Blind 133 Deaf 103 Elderly People 168 Handicapped 102 Partially Sighted 137 Registration— Births 39 Child Minders 119 Deaths 41 Disabled and Old People's Homes 181 Ice Cream Premises 238 Marriages 37 Nursing Homes 120 Preserved Food Premises 238 Residential Homes 181 Rehabilitation Centre 143 Rehabilitation of Mothers 115 Rehousing 232 Rehousing— Council 232 G.L.C 232 Interviews by A.M.O.H. 272 Medical Grounds 271 Rejected Food 241,244 Relaxation Classes—Ante Natal 86 Relief Sewer, Construction of 191, 203 Remarks on Various Death Causes 47 Rent Act, 1957 198 Report of Dental Officer (M. & C.W.) 121 Report of Principal S.D.O . 293 Report of Principal S.M.O 279 Page Reproductive Wastage 33,46 Residential— Homes 126, 136 Services 126 Respiratory Infections 64 Respiratory System—Diseases of 50,51,64,72,73 Review by M.O.H 9 Rheumatism Gp—Handicapped 140 Riding Establishments Act 202 Ringworm 289 Risk Register 101 River Pollution 189 River Ravensboume— Flooding 190 Jurisdiction 190 River Sampling 189 River Smells 189 Roads, Mileage in Borough 16 Rodent Control 211 Routine Audiometer Testing 292 Rubella 289 Russian Vapour Baths 211 S Safety in the Home 270 Salmonellae in Egg Imports 246 Samples— None Genuine 247, 256 Under Food & Drugs Act 247, 251 Sampling— Food and Drugs 247 Ice Cream 238 Milk 237 River 189 Sanitary Circumstances of Area 183 Sanitary Work — Summaries, etc 219 Scabies 170,289 Scabies and Cleansing Clinics 170 Scarlet Fever 71,289 Scavenging & Refuse Disposal 213 School Children Cleansed 217, 287 School— Dental Services 293 Dental Services — Statistics 296 Health Services 279 Health Services—Statistics 282 Health Services—Social Work 298 Treatment Centres 285 Selection of Women for Hospital Confinement 86 INDEX (continued) Page Separate Occupiers 14 Services— For the Elderly 163 For the Handicapped 131 For the Mentally Ill 157 Sewer, Relief 191,203 Sewerage and Drainage 202 Sewers—Baiting 213 Sex Ratio—Population 36 Sheldon Report (Child Welfare) 80 Shop Window Displays—Health Education 266 Shops and Offices Inspection 185 Sick Room Equipment—Loans 144 Sickness Claims — Ministry of S.S 79 Sight Testing 173,286 Slaughterhouse—Meat Inspection 242 Slaughterhouse, Slaughtermen— Licensing 244 Smallpox 70 Smallpox Vaccination 70, 288 Smells from River 189 Smoke Control— Areas 193 Chimney Heights (Circular) 194 Grants 196 Grit & Dust (Circular) 195 Installations 197 Pollution Recording 197 Staff 197 Smokeless Fuels—Supplies 194 Smoking and Health — Health Education 266 Social— Clubs—Therapeutic 163 Conditions of the Area 17 Rehabilitation Centre 143 Security, Ministry of— Statistics 79 Work—School Health Services 298 Solid Formations—Geology 27 Sonne Dysentery 72 Special— Care Unit—E.S.N 151 Categories—Placement 280 Clinics—V.D 68 Investigation Clinics 149, 285, 298 I nvestigation—School Children 298 Schools 280 Spectacles—Supply to School Children 287 Page Speech Therapy 281 Spina Bifida Survey 110 Spraying—Precautionary 217 St. John's Park Day Centre 161 St. Saviour's Centre for Handicapped Young People 143 Staff—Health & Welfare Dept. 6 Statistics— General 14,34 Tables Appendix Vital 32 Stillbirths 32,40, 88 Storm Flooding 190 Street Cleansing 213 Street Traders 239 Streets—Mileage in Borough 16 Structurally Separate Dwellings 14 Student— Health Visitors 111 Nurses 106,111 Sub Fertility Clinics 99 Suicide 51 Summary of Activities—Health Education 265 Summary of Sanitary Work 219 Sunshine, Annual 31 Superficial Deposits 27 Superficial Geology 26 Supervision of Food Premises 239 Supplies of Smokeless Fuels 194 Supplies of Underground Water (Wells) 206 Surveys 56,109,122,297 Swimming— Attendances 211 Baths 210 Instruction 211 Syphilis 65 Systemic Diseases Gp—Handicapped 141 T Tabes dorsalis 66 Television and Radio Sets— Elderly 178 Temperature, Annual — Max. and Min 31 Tetanus Prophylaxis 73 Therapeutic Clubs—Mentally Ill 163 Therapists 143 Trade and House Refuse 213 Training Centres— Blackwall Lane 153 Knoyle Street 154 Maze Hill 150 INDEX (continued) Page Training Centres— Park Vista 153 Statistics 155 Training Courses 106,273 Transfers— Housing 232 Residential Homes 128 Transport— Departmental 272 Handicapped 147 Organiser 272 Transported Meals for Old People 171 Tripe Boiler—Licensing 244 Tuberculosis— 33, 50, 73 Animals 242 B.C.G. Vaccination 74 Chest Physicians' Reports 74,75 Turkish Baths 211 Typhoid Fever 72 U Underground Rooms—Unfit 226 Underground Water Supplies (Wells) 206 Undertakings—Housing 224 Unfit Premises 224 Uninhabited Dwellings 14 Unsound Food 241, 244 Unsupported Mothers and Babies 114,130 Unwanted Cars, Disposal 214 V Vaccination 70,71,72,74,75 Vaccination—International Certs 69 Various Death Causes— Remarks on 47 Vascular Lesions of Nervous System 33, 48 Venereal Diseases 65 Verminous— Conditions 217 Persons 217 Premises 217 Verrucae 281 Violent Deaths 51 Violet Melchett Mothercraft Unit 115 Vision— Clinics 287 School Children 286 Visiting— Friendly 180 Geriatric 167 Page Visits by Health Visitors 108 Visits by Women Public Health Officers 168 Visual Acuity of School Children 286 Vital Statistics—Summary 32 Vitamin Supplements 117 Vocational Training — Handicapped 135 Voluntary Help—Elderly 180 Voluntary Homes 128 W Wash-houses and Public Baths 210 Wasps 216 Water—Underground Supplies (Wells) 206 Water Supplies, Fluoridation 58,206 Water Supply 203 Water Supply— Lead Content 206 Letters 204 M.W.B. Report 204 Sampling 207,208 Weil's Disease 212 Welfare— Blind 132 Clinics 112 Committee 5 Committee, Terms of Ref. Foods, Elderly 175 Foods, M. & C.W 117 Physically Handicapped 139 Residential 126 Services 124 Wells 206 Whooping Cough 71,289 Whooping Cough, Prophylaxis 71,288 Women Public Health Officers 168 Women Public Health Officers' Visits 168 Woolwich & Blackheath Fairs 239 Woolwich and Brook Chest Clinics 75 Works of Access and Adaptation for Handicapped 143 Workshops for the Blind 138 X X-Ray— Examinations 74,76 Mass 76 Y Youth Employment Officers 154 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1967 Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality Age & Sex Group At all Ages 0 to1 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-Infectious 1 1 1 1 — — — — — — — — — — — — — — — — — — — — — 1 1 — Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery (a) 46 42 1 1 4 1 4 3 2 2 2 5 18 10 — 3 5 3 9 14 l — — — 21 18 22 19 Erysipelas 2 6 — — — — — — — — — — — — — — — — — — — 4 2 2 — 1 2 5 Acute Polio-Myelitis P. — — — — — — — — — — — — — — — — — — — — — — — — — — — — N.P. — — — — — — — — — — — — — — — — — — — — — — — — — — — — Scarlet hever 33 42 1 — 1 — 1 4 4 4 5 6 17 21 1 6 2 — 1 1 — — — — 13 11 20 31 Typhoid Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia (b) — 102 — — — — — — — — — — — — — — — 49 — — — — — — — 17 — 60 Meningococcal Infection 2 1 — — — — 1 — — — — — — — 1 — — 1 — — — — — — — — 2 1 Measles (c) 1148 1197 60 69 167 165 197 184 179 175 181 184 331 38S 73 22 8 10 1 2 1 1 — — 362 399 774 793 Whooping Cough (d) 58 105 3 10 5 3 6 15 6 13 6 14 22 32 9 12 — 2 1 4 — — — — 14 20 42 84 Leprosy — 1 — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 Ophthalmia Neonatorum (e) 5 8 5 8 — — — — — — — — — — — — — — — — — — — — — 4 5 3 Pneumonia, Acute Primary or Acute Influenzal 15 17 — 1 — — — — — — 1 — 3 2 1 — — 1 1 1 5 4 4 8 3 3 12 14 Tuberculosis, Pulmonary 31 15 — — — — — — — — — — — — — — 7 4 4 3 14 5 6 3 8 8 23 7 „ Non-Pulmonary 4 6 — — — — — — — — — — — 1 — — 2 1 — 3 2 1 — — 2 1 2 5 Totals 1345 1543 71 90 177 169 209 206 191 194 195 209 391 451 35 43 24 71 17 82 23 15 12 13 423 483 905 1023 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 8 hospitalised within Greenwich but resident outside the Borough (b) „„ „ 25 „ „ „ „ „ „ „ „ (c) „„ „ 17 „ „ „ „ „ „ „ „ (d) „„ „ 3 „ „ „ „ „ „ „ „ (e) „„ „1 „ „ „ „ „ „ „ „ TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December 1967. No. in Short List Causes of Death Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 2S 2S and under 4S 45 and under 65 65 and under 75 75 and upwards GREENWICH WOOLWICH St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital St. Nicholas Hospital Memorial Hospital B.H.M.B. E. & M. Hospital Other Institutions Outside Institutions Under 4 wks. 4 wks. and under 1 yr. 1 Tuberculosis, Respiratory 12 .. .. .. .. .. .. 1 2 3 6 5 7 2 .. .. .. 1 1 .. .. .. .. 6 6 2 Tuberculosis, Other 1 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 3 Syphilitic Disease 4 .. .. .. .. .. .. .. 2 2 .. 2 2 .. .. 1 .. .. .. l .. .. .. .. 4 4 Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Meningococcal Infections .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 7 Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9 Other Infective and Parasitic Diseases 2 .. .. .. .. .. .. .. 1 1 .. .. 2 .. .. .. .. .. .. l .. .. .. 1 3 10 Malignant Neoplasm, Stomach 65 .. .. .. .. .. .. .. 20 19 26 22 43 11 .. 2 1 2 6 2 .. .. 2 5 52 11 Malignant Neoplasm, Lung, Bronchus 184 .. .. .. .. .. .. 6 74 73 31 60 124 19 2 4 1 25 25 2 .. 4 4 42 140 12 Malignant Neoplasm, Breast 59 .. .. .. .. .. 4 25 17 13 17 42 6 .. 1 .. 4 12 9 .. 2 .. 12 47 13 Malignant Neoplasm, Uterus 14 .. .. .. .. .. .. .. 5 3 6 4 10 3 .. 1 .. 1 .. .. .. .. .. 4 7 14 Other Malignant and Lymphatic Neoplasms 240 .. .. .. .. .. .. 13 78 76 73 70 170 22 6 17 3 26 39 10 .. 8 3 51 264 15 Leukaemia, Aleukaemia 18 .. .. 1 2 .. 2 3 2 4 4 4 14 2 .. 1 1 4 4 .. .. .. .. 4 21 16 Diabetes 16 .. .. .. .. .. .. 1 2 8 5 6 10 5 1 1 .. 3 .. .. .. .. 1 1 16 17 Vascular Lesions of Nervous System 291 .. .. .. .. .. 1 7 47 67 169 90 201 47 3 10 .. 95 44 4 .. 1 9 30 442 18 Coronary Disease, Angina 372 .. .. .. .. .. .. 9 114 108 141 114 258 34 .. 11 2 7 55 27 .. 2 12 43 271 19 Hypertension with Heart DisDisease 8 .. .. .. .. .. 1 .. 1 5 1 2 6 .. .. .. .. 1 .. .. .. .. .. 2 6 20 Other Heart Disease 390 .. 1 .. .. .. 1 9 60 115 204 145 245 84 10 8 1 78 63 8 .. 1 23 38 492 21 Other Circulatory Disease 143 1 .. .. .. .. .. 2 24 35 81 50 93 25 1 8 .. 25 20 5 .. 3 7 18 170 22 Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 23 Pneumonia 173 1 8 .. .. .. .. 3 14 38 109 67 106 53 2 5 .. 26 23 3 .. 2 5 29 231 24 Bronchitis 124 1 3 .. .. .. .. .. 26 46 48 43 81 16 2 3 3 16 13 1 .. 3 6 26 104 25 Other Diseases of Respiratory System 16 .. .. .. .. .. 1 .. 2 7 6 7 9 4 1 .. 1 1 3 .. .. .. .. 2 15 26 Ulcer of Stomach and Duo denum 17 .. .. .. .. .. .. 1 3 9 4 6 11 1 1 1 1 2 3 3 .. .. .. 2 24 27 Gastritis, Enteritis and Diarrhoea 13 .. 1 .. 1 .. .. .. 2 4 5 5 8 1 .. 1 .. 3 1 1 .. .. .. 3 14 28 Nephritis and Nephrosis 21 .. 1 .. .. .. .. .. 8 5 7 5 16 2 1 2 .. 6 3 1 .. .. .. 4 25 29 Hyperplasia of Prostate 12 .. .. .. .. .. .. .. .. 4 8 2 10 2 1 .. .. 2 4 1 .. .. .. 1 17 30 Pregnancy, Childbirth, abortion 2 .. .. .. .. .. 1 1 .. .. .. 1 1 1 .. .. .. 1 .. .. .. .. .. .. 2 31 Congenital Malformations 24 11 5 2 1 1 .. .. 2 2 .. 9 15 1 .. 1 .. 5 .. .. 3 .. .. 10 19 32 Other defined and ill-defined Diseases 170 36 3 1 2 2 1 7 30 26 62 63 107 24 2 10 3 31 20 9 20 1 2 21 232 33 Motor Vehicle Accidents 34 .. .. 1 2 4 4 5 4 5 9 16 18 3 .. 1 .. 6 7 7 .. .. .. 9 62 34 All other Accidents 33 .. 1 .. .. 1 3 6 10 6 6 10 23 1 .. 1 .. 1 6 5 .. .. 4 9 36 35 Suicide 18 .. .. .. .. .. 2 5 10 1 .. 6 12 .. .. 1 .. 1 4 .. .. .. .. 3 13 36 Homicide and Operations of War 2 .. .. .. .. .. 1 1 .. .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. .. 1 Totals 2478 50 23 5 8 8 18 84 568 690 1024 833 1645 369 33 91 17 373 357 100 23 27 78 376 2738 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded.