With the compliments of the Medical Officer of Health and Director of Social Services Royal Hill Greenwich SE10 01-858 3210 London Borough of Greenwich II GRE 67 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH DIRECTOR OF SOCIAL SERVICES and PRINCIPAL SCHOOL MEDICAL OFFICER 1969 London Borough of GREENWICH REPORT of the MEDICAL OFFICER OF HEALTH DIRECTOR OF SOCIAL SERVICES and PRINCIPAL SCHOOL MEDICAL OFFICER 1969 CONTENTS Page Health Committee 3 Welfare Committee 5 Staff 6 Introductory 9 Section I—General Statistics and Social Conditions 13 ,, II—Vital Statistics 31 ,, III—Prevalence of, and Control Over, Infectious and Other Diseases 57 ,, IV—Personal Health and Related Services 87 ,, v—Community Care 129 ,, VI—Environmental Health 192 ,, VII—Miscellaneous 262 „ VIII—School Health 276 Index 299 Appendix—Statistical Tables 3 HEALTH COMMITTEE (as at 31st December, 1969) The Mayor: (ex-officio) Councillor D. C. Thurley Chairman: Councillor Mrs. W. Mitchell Vice-Chairman: Councillor Dr. A. L. de Silva Aldermen: A. C. Chrisp R. J. Wykes Councillors: Mrs. G. M. Barry H. F. Reilly G. Gibbs Miss K. E. H. Ross Mrs. W. H. M. Hulbert N. R. J. Sims K. J. Johnson L. Squirrell Mrs. M. Mendez G. W. Stow G. E. Offord, J.P. W. F. Strong M. J. Pattenden Mrs. O. I. Wood Terms of Reference: (1) The Committee shall consist of 18 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 and 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. 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, 1969) The Mayor: (ex-officio) Councillor D. C. Thurley Chairman: Councillor F. B. Newland Vice-Chairman: Councillor M. J. Pattenden Aldermen: A. C. Chrisp M. A. Jeffrey Councillors: Mrs. G. M. Barry T. A. J. Malone S. P. Bertram Mrs. M. Mendez N. G. Burbridge. F. E. Mills E. A. Chapman P. G. Mornington P. R. Conie Miss K. E. H. Ross Dr. A. L. de Silva Mrs. E. R. Sharp Mrs. E. M. King K. F. Valpy Terms of Reference: (1) The Committee shall consist of 18 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 (as at 31st December, 1969) Senior Officers: Medical Officer of Health, Director of Dr. J. Kerr Brown Social Services and Principal School Medical Officer: Deputy Medical Officer of Health: Dr. M. E. Watts Principal Medical Officer: Dr. H. Gough-Thomas (from 1.11.69) Medical Officers: Dr. M. B. Edge (from 13.1.69) Dr. B. W. Hordern Dr. J. M. Oldfield Dr. G. G. Sherriff Dr. F. I. Winfield Chief Dental Officer and F. Elston Principal School Dental Officer: Visiting Medical Officers: Dr. J. L. Davidson (from 12.5.69) Dr. G. M. Ferraris (from 1.11.69) Dr. R. S. L. Hood Dr. G. F. Horton Dr. S. L. Price Dr. W. H. D. 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 B. A. Freeman & Chief Mental Health Officer: 7 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 Area "C"—Supervisor: R. C. Baldock Team Leader: Mrs. P. Martin (from 23.9.69) Area "D"—Supervisor: Mrs. J. Y. White Team Leader: J. M. Ashton RESIDENTIAL AND ANCILLARY SERVICES Matrons of Old People's Miss M. Cook Homes: (jrom 1.4.69) Mrs. A. Brown Miss M. Campbell Miss N. M. Hyland Mrs. M. Konsbruck (from 1.12.69) Miss M. Troup Greenwich Hotel Miss W. E. Wilson Superintendent: Homeless Families' Units D. A. Upton Supervisor: Workshop for the Blind R. J. Nottage Manager: Training Centre Supervisors: R. Cansfield (from 21.7.69) Miss B. A. Godfrey P. Rickards Mrs. I. A. Robbins Personal Health Chief Nursing Officer: Miss M. Naunton Deputy Chief Nursing Officer: Miss M. E. Turner Supervisor of Midwives and Miss J. A. Waugh Home Nursing Services: Chief Chiropodists: K. D. Reeve B. L. Berry Home Help Organisers: Miss P. M. Calland Mrs. D. Greeno Mrs. M. O. Black 8 Environmental Health Chief Public Health Inspector: G. B. Allen Deputy Chief Public Health W. F. N. Troughton Inspector: Principal Food Inspectors: F. J. Hoines C. W. Spore Principal Housing Inspector: D. F. Hopgood (from 4.4.69) Senior District Public Health M. E. Poultney Inspector and Hygiene Officer: (from 4.4.69) Principal Public Health W. E. McLelland Inspector (Clean Air): Disinfection and Disinfestation J. G. Lyons Inspector: Rodent Control Inspector: J. W. Dennard Administration Chief Administrative Officer: L. M. Longhurst Deputy Chief Administrative L. A. Westacott Officers: (Departmental) H. J. Morse (from 1.7.69) (Establishment) Section Heads Principal Administrative R. Bruty Assistant: (from 27.7.69) Finance and Supplies: R. E. Sweett Community Care: R. G. Garratt Residential & Ancillary: J. W. Shorter Personal Health: J. Hannen Environmental Health: G. Ryan (from 10.10.69) Staff: R. Augustin Planning and Development: K. G. Allum (from 10.9.69) Health Education, Publicity and A. H. Wilcox Research: J. E. Kay Transport: W. F. Goodall Typing: Mrs. M. Hogan (from 3.1.69) 9 Directorate of Social Services, Municipal Offices, Royal Hill, S.E.10. To the Mayor, Aldermen and Councillors, London Borough of Greenwich. Ladies and Gentlemen, I have much pleasure in presenting this account of the health and social services in Greenwich for 1969. It has been a year when some of the longterm plans made for expansion of the services have come to fruition and it is a matter of satisfaction to see buildings which were at the design stage two or three years ago occupied and in full use. Undoubtedly this year will be remembered as the one when management consultants arrived in the Borough. It would be premature to attempt a definitive assessment of the contribution which management consultants have made, or can make, to the efficient organisation and quality of services to the public but in any judgement they cannot remain exempt from the criteria by which they would deem to judge others. In attempting to arrive even at provisional conclusions, what evidence do we have from the earlier experience of industry and other local authorities? I am bound to say it is not encouraging. What techniques are we being offered in the health and social services which we should not equally have known without them? What are they enabling us to do that we would not have been able to do without them? Notwithstanding the elegantly presented reports, quoted in smooth, persuasive and happy phrases, it is difficult to recognise any profitable truth that would not be obvious to the most thoughtless schoolboy. There is no mystery about management: it consists of a continuing process of logical analysis and prudent housekeeping, allied to a broad appreciation of that which requires to be done. This has to be balanced against the resources which are available. The danger is that in some forms of management, the way local government must work in a democracy has not been clearly understood and the means are often more deeply considered than the ends. The great principle to which I would subscribe—that local authorities exist only for the purposes of increasing the sum of individual happiness, wellbeing or convenience—is not recognised with sufficient clarity or sympathy. Despite the present munificent patronage of these management firms, I would imagine that they are now on an expiring lease; for the time has now come for the soundness of their systems and principles to be related to the real world of practical achievement. 10 During the year, a Green Paper was published on the future structure of the health services. This document is in the process of being overtaken by events and has already been discussed and commented upon at great length. At this stage, therefore, it would appear superfluous to make more than a passing mention. I must now turn to a consideration of the year under review. The vital statistics reflect an over-all satisfactory position and these are analysed in detail in the body of the report. Total notifications of infectious diseases increased slightly but this was due mainly to measles although its incidence was greatly reduced as a result of our immunisation campaign. There is no doubt, however, that protection against measles is lagging behind other protective measures since the demand for this vaccine has proved to be less than anticipated. Tuberculosis, both pulmonary and non-pulmonary, continues to decline but there was a sharp increase in food poisoning due to an isolated outbreak involving 58 persons. There is one disturbing trend, potentially socially disruptive, to be reported: the incidence of venereal disease, in all its forms, is increasing at a rate which, if it continues, must be described as alarming. New cases of residents treated show an over-all increase of 36 per cent and syphilis alone increased by 71 per cent. Since venereal disease is not a notifiable disease, it is almost certain that these figures do not reflect the full picture and there are likely to be many more untreated cases acting as carriers. As with the drug problem, it is difficult not to escape the conclusion that this increase is due to changing standards of ethics and morals and one can only hope that all the experts in the behavioural sciences who influence the pattern of our society will accept the warnings that are becoming so obvious. Domiciliary confinements continue to decline: more mothers are electing to have their babies in hospital and we are fortunate in Greenwich in having an over-all adequacy of maternity beds for our needs. However, early discharges are increasing and we are hoping that local authority midwives can play an increasingly close part in the total midwifery service. The home nursing service has increased both in the numbers of patients receiving care and in total attendances. This trend is to be expected with the emphasis on early hospital discharge and an ageing population requiring more attention. Attachment schemes involving district nurses also increase the work load and at present 33 general practioners and 13 district nurses are working in partnership. 11 The initial enthusiasm shown by the general public for cervical cytology has waned and this year the numbers have declined by 36 per cent. This decline has occurred despite the most strenuous efforts to publicise the value of regular screening of the vulnerable age groups. A similar decline is noted with regard to routine breast examinations. The Directorate has been involved in several important research surveys. Investigations are being undertaken into the incidence of certain chromosome anomalies and congenital malformations; the effect of radiation on the incidence of mongolism; and an enquiry into the special education needs of the physically handicapped. In association with Guy's Hospital, the Chief Dental Officer is using a mobile dental surgery for our physically and mentally handicapped and this is proving a valuable innovation. Staff shortages have meant a cutting back on the chiropody service, and some effort will have to be made at national level to improve the remuneration of chiropodists working for local authorities. Two homes (Tegel and Elmgrove) for the elderly were completed during the year. Both have 60 places, with special care units for 16 very infirm who require a higher degree of nursing and personal care. Day centres and lunch clubs are incorporated, which will facilitate Che close identification of the homes with the life of the local community. The new industrial training centre for mentally handicapped, which is purpose-built, is now in full operation and a new lunch club was opened in Calderwood Street as a joint venture with the Ogilby Housing Association. A section of the report is devoted to the important subject of environmental health and the work of the public health inspectors (although performed in an unobtrusive way) is vital to the wellbeing of the community. During the year, we were glad to welcome the Children's Department, who joined the Directorate and now share the central administration and other common services. The opportunity can be taken eventually to re-organise the integrated social work teams to include child care elements and the free exchange of ideas and professional experience will be valuable, when that can be accomplished. The difficulties, however, should not be minimised. Differences in training and professional attitudes and experiences will require careful blending but at least a start has been made during these last two years in the Directorate towards an eventual generic social work approach. The Directorate is now therefore poised to make significant advances in social care, if a period of stability can be achieved. A planned capital building programme has been accepted, based 12 on realistic measures of future needs. Looking back over the last 5 years, there has been a broad advance on the whole social front; no category of deprived or socially or physically handicapped has not benefited to some extent and, while deficiencies and shortcomings can be demonstrated, these are not due to indifference, to an unawareness of need or to an invincible ignorance but are dictated by the limitation of resources which can be made available. In conclusion, it is always a pleasant task to record my appreciation of the help which I have received from many sources throughout the year. My Chairmen, Councillor Mrs. Mitchell and Councillor Newland, and all the members of the Health and Welfare and Children's Committees have given me unfailing support and my senior colleagues in the Directorate have been ever helpful and have relieved me of much of the burden. I trust that this account of this year of endeavour will give cause for reasonable satisfaction. Your obedient Servant, J. Kerr Brown, Medical Officer of Health and Director of Social Services. 13 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 Foreshore and Tidal Waters 839 acres 12,563 acres Population— *At Census, 1961 230,250 At Census, 1966 (10% sample) 226,980 Estimated, 1969 (mid-year) 228,030 Density of Population (persons per acre) 19.45 Number of Inhabited Dwellings—end 1969 71,346 (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 1969 2,100 Number of Families or Separate Occupiers— *At Census, 1961 75,803 At Census, 1966 (10% sample) 74,050 Rateable Value, 1969 £12,705,449 Sum Represented by a Id. Rate, 1969 £51,000 * Adjusted to accord with Boundary Changes introduced under the London Government Act, 1963. 14 PUBLIC OPEN SPACES Borough Council— Approx. Acreage Altash Gardens 1.90 Batley Park 0.97 Bellott Memorial Gardens 0.19 Bostall Gardens, McLeod Road 2.75 Briset Road Recreation Ground 3.79 Charlton House and Gardens 9.25 Coldharbour Open Space 7.90 Dallin Road Open Space 0.50 East Greenwich Pleasaunce 5.93 Eltham Green 6.00 Horn Park Open Space 8.55 Hughes Fields Recreation Ground 0.74 Middle Park Children's Playing Field 8.00 Pippinhall Farm, Bexley Road 3.40 Plumstead Gardens, Church 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 15 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 Charlkton 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, 1969) Approx. 251.77 16 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 Borougihs, 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 Gallions' Reaches almost to Crossness on the Erith Marshes in Barking Reach. Averaging approximately ¼ mile in width, the River Thames forms the northern boundary of the new Borough which ranges southwards for about 5 miles from this base line in a triangular shape closely resembling that of a map of India. The resultant area is 18.32 square miles. With the exception of the Kidbrooke/Shooters Hill region which is mainly clay, the sub-soil of the greater portion of the Borough consists of gravel and sand and, throughout the whole of the area, the altitude varies from a few feet below high-water mark on the Marshes up to 416 feet above sea level on Shooters Hill. It is a steady climb at every point from the low lying land adjacent to the Thames to the raised plateau of Blackheath where extensive views of London and the river obtainable from this escarpment are incomparable. Few residential districts near the City of London are so full of historical associations as Greenwich, whose streets are among the most interesting of any in the capital and whose wealth of surviving buildings is unrivalled. History has played a large part in determining the types of industries located within its boundary with their consequent effects upon the social conditions of its community. Its particularly favourable siting on the banks of the Thames, its unique place in English history and its close connection with Royalty through the ages 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 17 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 11 had a residence at Greenwich, and Eltham was prominent in royal affairs for some 200 years during the Plantaganet 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 18 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. (Much of this region is now zoned for housing development.) 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 19 destruction of its residential areas. Requisitioning of property became imperative in order to resolve the serious housing problems thereby arising and in this respect over 3,000 units of accommodation were so acquired. Following the war, the respective local authorities immediately proceeded to plan and organise housing programmes to meet residents' needs and, as first priority, arranged for the erection in the Borough of 1,801 Emergency Factory Made Bungalows (later to become known as "pre-fabs"). Meanwhile, traditional building began and continued apace and work on the completion of 2 prewar estates was commenced in December, 1945, in accordance with modernised plans. By the end of 1947, 112 flats and 48 houses had been erected and occupied at Cherry Orchard and the construction of a further 24 houses at Marlborough Lane and 24 old people's flats at East Mascalls was well under way. Other schemes, including the Coldharbour Estate which was begun in the same year, were advancing rapidly and Borough residents were reaping the rewards of the foresight shown by the authorities. Substantial support to these efforts was forthcoming from the London County Council which was developing estates in this area. In April, 1965, at the inauguration of the new Borough, nearly 15,500 dwellings of all types came into the control of the Council. Supplies of building land which, until recently, had been fairly readily available especially in the Woolwich area, became exhausted and, with the exception of the Plumstead Marshes Scheme (a project being actively pursued by the Greater London Council for the accommodation of 60,00 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. An exception to this generalisation is the housing scheme in the Kidbrooke area. Here the Greater London Council has acquired the old Kidbrooke R.A.F. Depot as a development site which, eventually, will provide homes for some 7,000 persons, a large shopping centre, 3 schools and 27 acres of open space. Commenced in 1966, the scheme is expected to be completed by 1977. 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. Furthermore, over 200 units of accommodation for aged persons are furnished by ten groups of almshouses one of which 20 was founded as early as 1558, being the first public charity to be established after the reformation. Although the future housing problem is monumental there is no doubt that it will be tackled by the Council in a manner as firm and resolute as has been demonstrated in previous years. Providing for the needs of Borough residents there are, at the present time, more than 2,000 shops, generally of the smaller kind, many being of the old-fashioned "shop on the corner" type selling a wide range of goods. However, this situation is changing, possibly contrary to the interests of many sections of the public. Town planning is demanding 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 direct from Kent and Surrey. Fruit and vegetables, for the most part, arrive from Kent or from the Covent Garden, Borough, Greenwich, or Spitalfields Markets. The rights of a flourishing daily open-air market in Beresford Square mainly for the sale of meat, fish and poultry, are vested in the Council and date from the reign of James I. A "new market", under cover, in Plumstead Road, is also a popular centre for the daily and week-end shoppers of south-east London. Full-time supervision is afforded by the Borough's Food Inspectors to the private slaughterhouse at Woodlands Farm, Garland Road, one of the most up-to-date and busiest abattoirs in the Metropolitan area. Both the previous local councils, now united in the London Borough of Greenwich, had always been in the forefront of progressive health authorities and, within the new area, this forward looking attitude persists and all aspects of health, welfare and social work, 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 usual municipally-run chiropody clinics to the special maternity, paediatric, geriatric, psychiatric, thoracic and neuro-surgical units based at local hospitals of which there are twelve. Comprehensive Borough Community Care services include 6 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 21 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 "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 3 Industrial Training Centres. A recently opened Hostel caters for the long and short term care of 25 subnormal girls and boys between the ages of 3 and 16 years. Sixty-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 seventeen luncheon clubs, which are responsible for dispensing almost 250,000 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 720 homebound persons and the number of meals provided is at the rate of 165,000 annually. A Day Club for the homebound and 4 Day Rooms have been founded to ameliorate still further the lot of the retired person. More recently, realizing the substantial benefits accruing to the aged from a satisfying holiday, the Council purchased two firstclass 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 22 "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, Well Hall Pleasaunce, Eltham, and a Local History Section at the "Woodlands", Mycenae Road, Blackheath, 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 located at Avery Hill and opened in 1906 was the first to be established by the London County Council. Today, it is a "mixed" training college catering for upwards of 1,165 students and is a constituent college of the University of London Institute of Education with an annexe for 300 mature students at Mile End. Woolwich Polytechnic, now catering for nearly 700 full-time students and over 2,000 parttimers 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 23 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, Shrewsbury House, and West Greenwich House under the auspices of the Greenwich Community Council in conjunction with the I.L.E.A. and, in this connection, it can be stated that there are upwards of 178 clubs and societies affiliated to this Community Council. Besides Associations for rowing and barge sailing, the local sports clubs include the famous Blackheath Football Club (the oldest of all rugby football clubs) and the newer professional Charlton Athletic Football Club. It is hard to believe that the area supports 2 golf clubs, one of which is the Royal Blackheath, the oldest golf club in the world. With royal sanction it was formed nearly 360 years ago as the "Society of Blackheath Goffers" at a time when James I was wont to play with his friends while 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 24 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. Likely to add still further to the already compelling attractions of the Borough is a scheme about to be launched to develop the Cutty Sark Gardens/Greenwich Pier area in a manner worthy of the Borough's historical associations. Greenwich can boast of modern public baths. There are four such establishments within the Borough, each of which has two swimming pools. Moreover, at Eltham, the Council has provided a hydrotherapy pool, and on the Abbey Estate, has introduced a launderette. Warm baths for men and women are to be had at Greenwich, Plumstead and Woolwich and, at the former two premises, in addition to Turkish and Vapour Baths, public laundries still operate. In winter, the large pools at Eltham, Greenwich and Woolwich are covered and utilised for a wide range of recreational pursuits such as 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. 25 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 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 26 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 are the "solid" Eocene formations of Claygate, London, Blackheath and Woolwich and Reading beds followed by that of Thanet Sand. Underlying the whole Eocene strata is the Chalk or Cretaceous formation. Superficial Deposits Made—Made ground, consisting of artificial accumulations of debris and dumped materials from excavations have been spread over a number of areas of the district especially where the material has been used to raise the surface level of alluvial areas to reduce flooding in times of exceptionally high tides and heavy rainfall. Alluvium—Such a term is applied to the deposits up to 30 feet in depth forming the low-lying areas bordering the Thames and its tributaries. Originally marshland, these areas are still liable to flood should the river overflow its banks except where artificial means of protection have been adopted. Consisting of alternations of mud or silt, clay, shell marl, peat, sand and gravel, any or all of which may be present, the deposits may lie directly on "solid formations" or on banks of "river 27 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 Shooters Hill brings a vestige of the Claygate Beds to the surface at the latter locality. London Clay—This is a formation of stiff dark grey or bluishgrey clay which when exposed at the surface or underlying "drift" becomes brown in colour due to weathering. The weathering may penetrate a few inches or reach a depth of 10 feet beyond which the brown-grey mottling indicates incomplete oxidization. When water has stood on the clay for a long period the zone of decomposition may extend to a depth of 40 feet. 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 Shooters 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 28 29 black Hints 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, calcareous matter from shells forms the cement of the conglomerate. In other places the cement is ferruginous or siliceous. Woolwich & Reading Beds—These beds, with a normal thickness of from 25 to 80 feet, have been denuded from a tract which follows the Thames from South Bermondsey to East Woolwich and outcrops only at intervals at Plumstead and Eltham. They comprise a variable group of white, grey or crimson sands, sometimes hardened; red, green, grey or brown clays, frequently mottled; pebbles formed of flint or occasionally quartz, locally cemented into conglomerate; shell beds, concretions of carbonate of lime, selenite, iron pyrites and lignite. Although considered as one division, the Woolwich & Reading beds are distinct, the Reading Beds are characterised by mottled plastic clays, sands and pebbles and the Woolwich Beds consisting of laminated sand and clay with abundant shells. The base of the Woolwich and Reading Beds is relatively constant, being composed of a green or greyish-green sand, somewhat clayey, with flint pebbles and, at intervals, oyster shells. Thanet Sand—Essentially of fine, buff or pale greenish-grey sand, often silt, with a bed of green loam and generally unworn greencoated flints at the base (known as the Bull Head Bed), these beds are exposed around Woolwich, Charlton, Greenwich and north of Lewisham, while at Plumstead Marshes the eroded beds are overlain by superficial deposits. Normally up to 55 feet thick, the beds reach a maximum thickness in the south east of the area. Chalk—This formation, almost entirely composed of soft, white limestone with flints, is present everywhere in the area underlying the Eocene strata except when it comes to the surface at Woolwich and at the Greenwich Fault on both sides of the River Ravensbourne in the vicinity of the Blackheath Hill, Brookmill Road and Loampit Vale areas. Its thickness, which can be from 550 to 740 feet, is subject to considerable variation due to pre-Eocene erosion, but the formation is usually divided into Upper, Middle and Lower chalk beds, and these are often sub-divided in accordance with the types and species of fossils found therein. The accompanying sketch map gives a clearer picture of the various geological formations found within the Borough. 30 METEOROLOGICAL OBSERVATIONS—1969 I am indebted to the Director of the National Maritime Museum and, in particular, to Lieutenant-Commander D. W. Waters, R.N., head of Department of Navigation and Astronomy, for the following meteorological data for the year ended December, 1969— Temperature Highest screen temperature 88° on 16th July Lowest screen temperature 18° on 16th February Maximum in January 56° on 22nd and 23rd „ February 54° on 22nd and 23rd „ November No record (Thermometer damaged) „ December 52° on 21st Sunshine TOTAL FOR YEAR 1,376.0 hours Sunniest day 13.6 hours on 4th July Number of Days, without sun, 96, distributed as follows:— January 15 July 5 February 11 August 2 March 15 September 7 April Nil October 6 May 3 November 8 June 2 December 22 Rainfall TOTAL 20.45 ins. Highest Fall in 24 hours 1.66 ins. on 29th July. Driest Month 1.14 ins. March Wettest Month 3.62 ins. July 31 SECTION II VITAL STATISTICS SUMMARY* Population (mid-year 1969) Total Home Population 228,030 Child Population (under 15 years) 50,200 Elderly Population (over 65 years) 31,190 Density (persons per acre) 19.45 Area Comparability Factors Births—1.04; Deaths—1.08 Marriages Total 2,006 Marriage Rate (persons marrying) (per 1,000 pop) 17.65 Births Live Total: 3,263 M F Total Legitimate 1,498 1,431 2,929 Illegitimate 165 169 334 1,663 1,600 3,263 Crude Rate (per 1,000 pop.) 14.36 Comparable Rate (per 1,000 pop) 14.93 Ratio of Comparable Rate to National Rate 0.91 Illegitimate Live Births—10.2% of all live births Stillbirths Total: 57 M F Total Legitimate 26 19 45 Illegitimate 4 8 12 30 27 57 Rate (per 1,000 total births): 17.17 Total of all Live and Stillbirths 3,320 *These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 32 Deaths Total: 2,551 Males 1,354 Females 1,197 Crude Rate (per 1,000 pop.) 11.23 Comparable Rate (per 1,000 pop.) 12.13 Ratio of Comparable Rate to National Rate 1.02 Natural Increase (excess of births over deaths) 712 Infantile Mortality (deaths of infants under 1 year) Total: 58 Infant Deaths Age Leg. Illeg. Total M F M F Under 1 year 34 17 6 1 58 Under 4 wks. 26 12 4 – 42 Under 1 wk. 23 11 4 – 38 Infant Mortality Rates All Infant Deaths (per 1,000 total live births) 17.77 Legitimate Deaths (per 1,000 legitimate live births) 17.41 Illegitimate Deaths (per 1,000 illegitimate live births) 20.96 Neo-Natal Mortality Rate (per 1,000 total live births 12.87 Early Neo-Natal Mortality Rate (per 1,000 total live births) 11.64 Peri-Natal Mortality Rate (per 1,000 total births) 28.61 Reproductive Wastage (per 1,000 total births) 34.64 Maternal Mortality (incl. Abortion—1) Total: 2 Maternal Mortality Rate (per 1,000 total births) 0.60 33 Death Rates—Special Causes (per 1,000 population) No. Rate Heart Disease (all forms) 849 3.73 Ischaemic Heart Disease 666 2.93 Cerebrovascular Disease 258 1.13 Cancer (all forms incl. Leukaemia) 565 2.49 Lung, Bronchus 158 0.70 Breast 62 0.27 Uterus 10 0.04 Cervix 5 0.02 Leukaemia, Aleukaemia 12 0.05 Tuberculosis (all forms) 7 0.03 Pneumonia 224 0.98 Bronchitis and Emphysema 181 0.80 Congenital Anomalies 14 0.06 Accidents—Motor Vehicle 22 0.10 Home 14 0.06 Suicide 21 0.09 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 34 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. More recently a move was made to initiate 5 year Census periods when, on the night of 24/25th April, 1966, a 10% sample of the population was taken during which, for the first time ever, information regarding cars and garaging facilities was requested. Population General—Determinations of future populations are of vital importance to governments for the framing of social policies, to hospitals for the provision of adequate and suitable facilities, to local authorities who have a duty to plan maternity and child welfare 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. Population levels are dependent on three factors, viz. births, deaths and migration and the extent to which reliance may be placed on projected populations rests upon the accuracy with which these separate factors can be forecast. It is usual, indeed it is the best method available, to base future trends on past experiences (extrapolation) and with death rates this has seldom failed. Birth rates, however, have proved to be rather less reliable and migration, especially since the introduction of the Commonwealth Immigrants Act, 1962, is the most difficult to assess. All signs point to the possibility that, by the end of this century, the world's population will have doubled to 7,000 millions. To the majority of people such a bald statement is virtually meaningless and the inherent implications difficult to visualise. Comprehension is made easier if we say that with the passing of every second of every day 4 births and 2 deaths occur which result in 170,000 extra mouths to feed every 24 hours. Understandably, the bulk of this increase arises in the underdeveloped countries but, as a nation, we are adding our quota, albeit more slowly, to the sum total. Clearly we need to be increasingly concerned with the relationship of population to the "carrying" capacity of the country; failure to achieve balance with our environment will prove disastrous. Estimated mid-year population of England and Wales at 48,826,800 indicates an increase of 233,800 (0.5%) over last year. 35 That of Greater London, viz. 7,703,400 shows a decrease of 56,100 (0.7%) a loss which appears to be more than compensated by a gain of 65,100 (0.4%) over the South East Area as a whole to a total of 17,294,600, a figure which represents 35.5% of the England and Wales population. According to the Registrar-General's mid-year, 1969 estimate, the population of the London Borough of Greenwich has fallen still further. The figure returned is 228,030 thus showing a reduction of 1,670 (0.7%) from that of the previous year and no less than 3,740 (1.6%) since 1965. Greater London Council is anxious about its own loss of almost ¼ million residents since 1965 and is somewhat apprehensive that a continuing decline of this nature would prejudice the area's viability and thereby lose its pride of place as the world's business and commercial centre. Contraction of London's wharfage and docking facilities prior to their final "shut-down" has undoubtedly been a contributory factor in some of the capital's more recent population movements but the closure of a number of large local firms as the result of the rationalisation of industry is the most probable cause for the declining population of Greenwich. Fortunately for this Borough, with the G.L.C.'s development of the Plumstead Marshes, more than restitution will be made when the "Thamesmead" scheme for 60,000 people is completed in the early 1980's. Meanwhile, additions to the Borough's population will now flow from the advancement of the G.L.C.'s Kidbrooke Scheme due to be completed by 1977. Natural Increase—The natural increase for the year, i.e. excess of births over deaths, was 712 compared with the figure of 844 for the previous year. Emigration/Immigration—Migration movements into and out of England and Wales during the year ended 30th June, 1969, as derived from the International Passenger Survey returns, amounted to a net loss of 69,000 (excluding those regarding the Irish Republic). Assessing all sources of migration and making necessary adjustments to the I.P.S. totals concerning intended and actual migration, there was a total net loss of 14,000 in the population of England and Wales. This is only the second year since 1954/5 that a net loss by migration has been recorded. Taking into account a recorded natural increase of 712, there was a presumptive emigration from the Borough of 2.382 persons during the year. 36 Estimates based upon the 1961 Census indicated that at 1st April, 1965, there were 7,947 residents (equivalent to 3.4% of the Borough's total population) who were born outside the British Isles, of whom almost 2/3rds were from the Commonwealth countries, the Colonies or Protectorates. Of the persons enumerated in the Borough of Greenwich during the 1966 Census some 9,350 or 4.5% were born overseas, an increase of 15% since the 1965 estimate; the proportion of these coming from the Commonwealth, Colonies or Protectorates remained roughly the same, i.e. 2/3rds. Numbering 1,812, immigrant children formed 4.84% of the total school roll at the beginning of January 1970. This figure is expected to rise by 300 to 2,100 by the end of 1970 (equivalent to 5.4% of the total school roll). 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 68.7 years for males and 74.9 for females. COMPOSITION OF POPULATION (a) Sex Ratio—Taking the 1966 Census as a basis, it is estimated that the total population of Greenwich is made up of 110,510 males and 117,520 females, giving a sex ratio of 1,063 females per 1,000 males. Ratios for Greater London and England and Wales are 1,081 and 1,056 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, 11% are over the age of 65 years and women in the same age group form 16.2% of the female population; together they account for 13.7% 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 16.6%. 37 ESTIMATED AGE COMPOSITION OF THE POPULATION As estimated by the RegistrarGeneral: Age No. Approx. % of Total Population Under 1 year 3,320 1.5 1 to 4 years (inclusive) 13,980 6.1 5 to 14 years (inclusive) 32,900 14.4 Total Child Population under 15 years 50,200 22.0 Estimated locally: 15 to 64 years (inclusive) 146,640 64.3 65 years and over 31,190 13.7 Total Population 228,030 100.0 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 aproximately 64.3% and that of "dependent" groups collectively, to 35.7%. In effect, this means that for every two persons of "working age" there is one dependent person outside this group. If account also be taken of women over 60 years and of those persons over 15 years still in receipt of fulltime education including those attending special schools, then the "dependent" population rises to almost 41%. Marriages The Marriage Rate is calculated on a "total population" basis and, as such, is not strictly comparable with other areas by reason of discrepencies 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. Mr. G. H. Rodgers, Superintendent Registrar for Greenwich has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the London Borough of Greenwich during 1969. The total of 2,006 gives a marriage rate (i.e. persons marrying) of 17.65 per 1,000 population a decrease of 1.56 from that of the previous year and is 1.45 in advance of the figure of 16.2 for England and Wales. Greater London returned a rate of 18.3. 38 The following table shows particulars given by the various Registrars for the past 5 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 Woolwich 285 604 84 115 60 104 256 484 1,992 231,770 17.24 1966 Greenwich Woolwich 280 570 78 114 23 91 284 487 1,927 231,590 16.69 1967 Greenwich Woolwich 291 597 71 127 69 79 288 544 2,066 231,150 17.94 1968 Greenwich Woolwich 329 612 78 144 80 84 286 586 2,199 229,700 19.21 1969 Greenwich 815 176 174 841 2,006 228,030 17.65 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 1969 the number of wives in this group has risen from 44 to 79 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 194 in 1969 and married females from 267 to 356. 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 1968 (the latest available), the mean age at marriage for bachelor bridegrooms was 24.08 and for spinster brides 21.95, both exemplifying this tendency for earlier marriage. Marriages in which both bride and bridegroom were under 20 numbered 25,432, 41% more than in 1956. Births By relating the number of births to the respective population of a particular group, a birth rate is produced which proves to be a convenient method of indicating the gross rate of increase of the population by births. 39 However, this rate gives no guide to future effects of contemporary variations in fertility on the maintenance or otherwise of the population or its age characteristics and, since the population figure used in its computation not only contains males but also females outside childbearing age, the birth rate should not be used as an accurate calculation of fertility. Live births registered in the Borough during the year totalled 4,109 and of this number 3,589 occurred in hospitals and 520 in private dwellings. In 1,496 cases the parents resided outside the Borough and these births were subsequently transferred to their appropriate districts leaving a figure of 2,613. To this must be added 650 births belonging to this Borough which took place in institutions outside the Borough, thus making a final total for Greenwich of 3,263, a decrease of 141 (4.1%) from that calculated for the previous year. Of the total, 1,663 were males and 1,600 females, a proportion of 1,039 males to 1,000 females compared with 1,058 for England and Wales. 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: — 962 1,651 2,613 Inward Transfers: — 1st Qtr. 44 138 182 2nd Qtr. 95 81 176 3rd Qtr. 41 114 155 4th Qtr. 26 111 137 TOTALS 1,168 2,095 3,263 The Birth Rate for the year, calculated on the figure of 3,263 live births, is 14.36 per 1,000 of the population, 0.50 lower than that computed for 1968. With an area comparability factor of 1.04, an adjusted rate of 14.93 is returned compared with 16.3, the figure for England and Wales and 14.60 for the Greater London area. Inner London returned an unadjusted rate of 15.7 Illegitimate Births The degree of illegitimacy is usually evaluated by calculating illegitimate births as a percentage of total live births. This is satisfactory 40 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. Although medically speaking there is no distinction between a legitimate and an illegitimate birth, nevertheless, statistically it can be demonstrated that illegitimacy reduces the chances of survival in early infancy. Society, as well as the individual, shares the onus of illegitimacy and only widespread education in sexual responsibility can ameliorate the trauma and burden of unplanned pregnancy. Personal counselling, not only on contraception but also on sexual and emotional problems, could be of inestimable value to the young. It would appear generally to be the case that illegitimacy is greatest when social standards, cultural and material, are low and, collectively, factors such as an insecure family life, poor and overcrowded homes, lack of direction and personal drive in life, etc., seem to be implicated. In London, rates tend to be higher than that for the country as a whole possibly by reason of a higher proportion of single females but very probably because of its compelling attraction to pregnant women who find not only anonymity but better facilities in the ante-natal, maternity, social and welfare fields. Illegitimate births in Greenwich during the current year numbered 334, equivalent to 10.2% of all live births registered, an increase of 0.5% over that of 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 15.4%. Figures for the Greater London area and for England and Wales were 11.0% and 8.4% respectively. Effects of the Abortion Act, 1967, (which became operative on 27th April, 1968) are probably not reflected in the past two years' figures but they may well tend to reduce the number of illegitimate live births in the future. 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 13.2. 41 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 57 (30 males—27 females) which is equivalent to a rate of 17.17 per 1,000 total births, an increase of 4.12 over that for 1968. Greater London returned a rate of 12.7 and that for Inner London was 13.4. 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 the 57 stillbirths occurring to Greenwich residents during 1969 (12 of which were illegitimate) reveals that the majority of stillbirths resulted from congenital anomalies, placental insufficiency and haemorrhages. A full analysis of causes of stillbirths is given in the following table:— Abruptio placentae 4 Haemorrhage—accidental 2 Anoxia—premature labour 1 ante partum 4 Asphyxia—intra uterine 2 Hypertension 2 prolapsed cord 1 Macerated foetus 3 Atelectasis—total 1 Placental insufficiency 7 Congenital anomaly— Prematurity 1 anencephaly 8 Rh incompatibility 1 other 5 Toxaemia—pre eclamptic 3 Cord pressure 1 Twin pregnancy 2 Diabetes mellitus 1 Umbilical cord—round neck 1 Difficult labour 2 Unknown 5 Fertility Fertility is a measure of the rate at which a specific community adds to itself by births. It is not to be confused with population growth which is the net result of gains from births, losses by deaths and adjustments in connection with the movements of persons in or out of the area. Nor must too much reliance be placed upon the crude birth rate which, although a convenient way of giving the gross rate of increase of a population by births, serves only as a short-term measurement of the flow of births. 42 True fertility rates must be based not upon the total population but upon the "population at risk" i.e. live births expressed as a rate per 1,000 of women of child-bearing age. This rate is called the "general fertility rate" and for even greater accuracy, this should be sub-divided into legitimate and illegitimate rates. As 90% of all births are legitimate it follows, therefore, that the extent to which people marry influences the flow of births. Moreover, the number of persons marrying is related to the availability of men and women within the marriageable age period which, in turn, is dependent upon antecedent births and the marriages which give rise to them. Thus it can be seen that future fertility is contingent upon past fertility. Fertility varies not only with age, marriage and its duration but also with occupation and social class, with area of residence (whether urban or rural), with race and religion and with several other factors. Some attempt at correction for variation is made by the Registrar-General with his "area comparability factor", but this is unable to take account of human volition and, moreover, the fact that contraception is becoming widespread throughout all classes renders long-range forecasts of population changes unreliable. Between the years 1955 and 1964 births increased, but contrary to expectations, they have subsequently declined. Furthermore, despite the fact that experience has shown that earlier marriage leads to higher fertility, recent statistics have indicated that this trend has been halted, even if only temporarily. Although it would seem logical to attribute this change to the introduction in 1967 of the Family Planning and Abortion Acts, firm evidence, at the moment, is lacking. Opportunity is therefore taken to introduce some comparative statistics to measure and, if warranted, to confirm or deny these influences. Based upon population figures from the 1966 Census, the following table indicates fertility rates calculated for the Borough since 1965 in which (c) is the most and (a) the least accurate of the three methods usually employed to portray fertility:— 43 Fertility 1965 1966 1967 1968 1969 GENERAL (a) Crude Birth Rate (per 1,000 pop.) 16.11 16.10 15.62 14.86 14.36 (b) General Fertility Rate (per 1,000 women 15-44 years) 80.68 80.44 78.37 74.44 71.71* LEGITIMATE (a) Crude Birth Rate (per 1,000 pop.) 14.75 14.71 14.04 13.42 12.89 (b) General Fertility Rate (per 1,000 women 15-44 years) 73.85 73.51 70.41 67.18 64.37 (c) General Fertility Rate (per 1,000 married women 15-44 years) 117.22 120.13 111.76 106.64 98.09† ILLEGITIMATE (a) Crude Birth Rate (per 1,000 pop.) 1.36 1.39 1.59 1.45 1.47 (b) General Fertility Rate (per 1,000 women 15-44 years) 6.82 6.93 7.96 7.26 7.34 (c) General Fertility Rate (per 1,000 unmarried women 15-44 years) 18.54 18.72 21.53 19.62 21.35‡ * England and Wales 86.24 Greater London 78.2 † England and Wales 114.6 Greater London 111.9 ‡ England and Wales 23.34 Greater London 23.21 Fertility of Immigrants Hitherto, very little accurate information has been available concerning immigrants and their fertility although it is generally understood that not only are their completed families larger but that, age for age, they have a higher fertility rate than the native population. As a result of Regulations introduced by the Registrar-General on 1st April, 1969, birth registration must now indicate the birthplace of the parents. Following these changes, an analysis of births registered in the 2nd and 3rd quarters of the current year was undertaken by the R.G.'s department and the accompanying table has been compiled to show the situation as revealed in Greenwich. 44 REGISTERED LIVE BIRTHS BY BIRTHPLACE OF MOTHER RESIDENT FEMALES (1966 Census) Greenwich Births 2nd & 3rd Qtrs. 1969 (as per R.G's Figs.) Fertility Rates (Calculated as a Yearly Rate per 1,000 Females 15-44 years) Place of Birth Age Group 15-44 years Number Per Cent. A B United Kingdom (excl. Ireland) 109,170 (38.6% of total female population of Borough) 1,399 83.6% 66.4 71.8 Ireland 3,170 67 4.0% 109.6 52.8 New Commonwealth Countries India & Pakistan 1,450 150 9.0% 374.0 180.2 West Indies 450 Other 180 Other Commonwealth Countries 330 58 3.4% 117.4 56.6 Cyprus and Malta 280 Others 1,950 WHOLE BOROUGH 116,980 45,150 1,674 100.0% 74.0 74.0 A—Based upon the assumption that each Ethnic Group in the Borough has the same proportion of females between the ages of 15 and 44 years as the Borough as a whole. B —Based upon the assumption that 80% of all resident females born outside the U.K. are between the ages of 15 and 44 years. 45 In interpreting these figures it must be emphasised (a) that country of birth cannot always be equated with race and (b) that although the statistics quoted are for 6 months only, nevertheless, for Greenwich, they do represent a reasonably true pattern for the year. Numbering 2,080, immigrant females from the new Commonwealth countries formed 1.8% of the Borough's total according to the 1966 Census but, during the 6 months covered by the table, 9% of the registered births were to mothers in this group. Unfortunately it is not known what proportion of the total immigrant female population is of childbearing age but if it manifests the same relationship to its total as that of Borough females then the calculated fertility rate for the new Commonwealth countries is some 6 times that of native residents. However, to represent this as a true reflection of the position would be patently misleading for there is little doubt that the proportion of immigrant females in the 15-44 years age group is much higher than our own. Nonetheless, if it is assumed that 80% of all resident females born outside the U.K. fall within this age group (a generous assumption) then the fertility rate of those from the new Commonwealth countries still remains 2½ times that of the indigenous population. 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 1.08, 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 1969 was 2,551, of which 1,354 were males and 1,197 females compared with 46 last year's total of 2,560. This gives a crude Death Rate for the Borough of 11.23 per 1,000 of the population, representing an increase of 0.05 over that calculated for the previous year. When the area comparability factor is taken into account the rate is increased to 12.13 for comparative purposes. The comparable Death Rates for Greater London and for England and Wales are 11.6 and 11.9 respectively. Inner London returned a crude Death Rate of 11.9. In Greenwich, the crude death rate per 1,000 living was 12.25 for males and 10.18 for females compared with 12.44 and 11.27, the respective national rates. 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:— Of the four quarters, the last registered the highest proportion of the year's total deaths and the third the lowest, viz. 28.7% and 21.3% respectively. Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 9 22 15 12 58 Between 1 and 2 years 1 1 1 — 3 Between 2 and 5 years 1 1 1 3 6 Between 5 and 15 years 2 4 3 2 11 Between 15 and 25 years 4 6 3 9 22 Between 25 and 35 years 3 2 4 4 13 Between 35 and 45 years 16 10 17 11 54 Between 45 and 55 years 47 30 41 48 166 Between 55 and 65 years 126 89 97 127 439 Between 65 and 75 years 171 153 126 194 644 75 years and upwards 326 251 236 322 1,135 TOTALS 706 569 544 732 2,551 It will be observed from the following table that during 1969 the deaths in the age group 0-5 years accounted for 2.6% and that of the "over 65's" 69.7% of the year's total. Figures for the previous four years are given for comparative purposes. Two deaths were in respect of centenarians, one a female of 104 and the other a male of 100 years. 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 1354 30 10 3 9 18 8 31 110 288 392 455 F 1197 12 6 6 2 4 5 23 56 151 252 680 4 Enteritis and other Diarrhoeal Diseases M — — — — — — — — — — — — F 1 — — — — — — — — — — 1 5 Tuberculosis of Respiratory System M 2 — — — — — — — 1 1 — — F 2 — — — — — — 1 — — — 1 6 Other Tuberculosis, incl. late effects M 2 — — — — — — — 1 — 1 — F 1 — — — — — — — — — — 1 17 Syphilis and its Sequelae M 1 — — — — — — — — — — 1 F — — — — — — — — — — — — 18 All other Infective and Parasitic Diseases M 2 — 1 — — — — — — 1 — — F 1 — — — — — 1 — — — — — 19 (1) Malignant Neoplasm-Buccal Cavity, etc. M 10 — — — — — — — — 3 3 4 F 2 — — — — — — — — 1 — I (2) Malignant Neoplasm- Oesophagus M 9 — — — — — — — 1 1 3 4 F 6 — — — — — — — — 1 1 4 (3) Malignant Neoplasm-Stomach M 35 — — — — — — 1 3 7 13 11 F 31 — — — — — — — 2 4 9 16 (4) Malignant Neoplasm-Intestine M 30 — — — — — — 2 4 6 11 7 F 33 — — — — — — — 1 10 6 16 (5) Malignant Neoplasm-Larynx M 5 — — — — — — — 1 2 2 — F 2 — — — — — — — — 1 1 — (6) Malignant Neoplasm-Lung, Bronchus M 139 — — — — — — 1 17 47 51 23 F 19 — — — — — — — 3 3 8 5 (7) Malignant Neoplasm-Breast M — — — — — — — — — — — — F 62 — — — — — — 8 12 18 11 13 (8) Malignant Neoplasm-Uterus F 10 — — — — — — 2 1 — 3 4 (9) Malignant Neoplasm-Prostate M 15 — — — — — — — 2 2 4 7 (10) Leukaemia M 7 — — — — — — 2 — 1 3 1 F 5 — — — — — — — — — 1 4 (11) Other Malignant Neoplasms, etc. M 66 — — — 1 2 — 5 6 19 17 16 F 79 — — 1 — — — 3 8 17 23 27 20 Benign and Unspecified Neoplasms M 5 — — — 1 — — — — 3 1 — F 4 — — — — — — — 1 — 1 2 21 Diabetes Mellitus M 10 — — — — — — — — 2 3 5 F 8 — — — — — — — — 2 4 2 22 Avitaminoses, etc M 1 — — — — — — — — — — 1 F 1 — — — — — — — — — 1 23 Anaemias M 2 — — — — — — — — 1 1 — F 2 — — — — — — — — — 1 1 24 Meningitis M — — — — — — — — — — — — F 1 — — — — — — — — — 1 — 25 Active Rheumatic Fever M — — — — — — — — — — — — F 1 — — — — — — — — — 1 — 26 Chronic Rheumatic Heart Disease M 16 — — — — 1 — 1 5 6 2 1 F 16 — — — — — — 1 4 6 1 4 27 Hypertensive Disease M 21 — — — — — — — 1 5 6 9 F 20 — — — — — — — — 1 7 12 28 Ischaemic Heart Disease M 383 — — — — — 1 9 36 98 120 119 F 283 — — — — — — 2 8 23 58 192 29 Other Forms of Heart Disease M 47 — — — — — 1 — — 9 9 28 F 63 — — — — — — — 2 2 10 49 30 Cerebrovascular Disease M 118 — — — — 2 — 1 8 16 30 61 F 140 — — — — — — 1 3 17 27 92 31 Influenza M 5 — — — — — — — — 1 1 3 F 10 — — — — — — — 1 2 2 5 32 Pneumonia M 86 1 1 — 1 — — 2 3 6 19 53 F 138 — 1 — 1 1 — 1 1 12 18 103 33 (1) Bronchitis and Emphysema M 123 — — — — — — 1 4 18 48 52 F 58 — — — — — — 1 1 7 17 32 (2) Asthma M 6 — — — — 1 1 — 2 2 — — F 5 — — 1 — — — — 1 2 — 1 34 Peptic Ulcer M 13 — — — — — — — 1 4 6 2 F 6 — — — — — — — — — 1 5 36 Intestinal Obstruction and Hernia M 12 — — — 1 — — 1 — 2 3 5 F 7 — — — — — — — — — 3 4 37 Cirrhosis of Liver M 2 — — — — — — — — 1 1 — F 5 — — — — — — — 1 — 3 1 38 Nephritis and Nephrosis M 3 — — — — — — — — — 1 2 F 1 — — — — — — — — — 1 — 39 Hyperplasia of Prostate M 4 — — — — — — — — — 1 3 40 Abortion F 1 — — — — — 1 — — — — — 41 Other Complications of Pregnancy, etc. F 1 — — — — 1 — — — — — — 42 Congenital Anomalies M 7 5 1 — — — — — — — 1 — F 7 1 — 7 — — 1 — — 3 — — 43 Birth Injury, Difficult Labour, etc. M 11 11 — — — — — — — — — — F 6 6 — — — — — — — — — — 44 Other Causes of Perinatal Mortality M 13 13 — — — — — — — — — — F 4 4 — — — — — — — — — — 45 Symptoms and ill-defined conditions M 1 — — — — — — — — — — 1 F 3 — — — — — — — — — — 3 46 (1) Other Endocrine Diseases M 1 — — — — — — — — 1 — — F 4 — — — — — — — — — 2 2 (2) Other Diseases of Blood, etc. M — — — — — — — — — — — — F — — — — — — — — — — — — (3) Mental Disorders M 3 — — — — — — 1 — — — 2 F 8 — — — — — — — — — 1 7 (4) Other Diseases of the Nervous System, etc. M 5 — 1 — — — — — — 1 1 2 F 14 — 2 — — — — — 1 1 5 5 (5) Other Diseases of the Circulatory System M 44 — — — — — — — 3 10 16 15 F 49 — — — — — — 1 1 6 11 30 (6) Other Diseases of the Respiratory System M 13 — 3 — — — — — 3 3 2 2 F 10 1 3 — — — — — — 1 2 3 (7) Other Diseases of the Digestive System M 10 — — — — — — 1 1 2 3 3 F 15 — — — — — — — — 5 2 8 (8) Other Diseases of the Genito-urinary System M 6 — — — — — — — — 2 2 2 F 16 — — — — — — — 2 — 3 11 (9) Diseases of Skin, Subcutaneous Tissue M 1 — — — 1 — — — — — — — F 1 — — — — — — — — — — 1 (10) Other Diseases of the Musculo-skeletal System M 2 — — — — — — — — — 1 1 F 4 — — — — — — — — 2 — 2 47 Motor Vehicle Accidents M 14 — 1 1 1 4 1 1 1 — 1 3 F 8 — — — 1 2 — — 1 1 2 1 48 All Other Accidents M 28 — 2 2 3 6 2 1 4 — 4 4 F 13 — — 2 — — 1 — — 1 1 8 49 Suicide and Self-inflicted Injuries M 13 — — — — 1 2 1 2 4 1 2 F 8 — — — — — — 1 1 2 3 1 50 All Other External Causes M 2 — — — — 1 — — — 1 — — F 2 — — — — — 1 1 — — — — 47 Age Group 1965 1966 1967 1968 1969 Under 1 year 80 68 73 59 58 Between 1 & 5 5 10 13 11 9 Between 5 and 15 8 16 8 11 11 Between 15 & 25 24 24 19 17 22 Between 25 & 65 719 676 658 587 672 65 and over 1,708 1,766 1,708 1,875 1,779 Totals 2,544 2,560 2,479 2,560 2,551 Deaths in Institutions The following table gives the number of deaths of Greenwich residents in Public Institutions during the last five 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 1968 2,560 1,888 73.7 1969 2,551 1,902 74.6 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 registered 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, the offspring of such mothers appear more prone to illness and infection subsequently. 48 There were 2 maternal deaths recorded for Greenwich during 1969, one concerned a female of 26 years whose death resulted from "therapeutic abortion and sterilisation", the coroner's verdict being one of "misadventure". Against a maternal death rate of 0.19 for England and Wales, this Borough returned a figure of 0.60 compared with 0.29 for 1968. Excluding abortion, the rate is modified to 0.30 to compare with 0.20 and 0.21, the rates for Greater and Inner London respectively. Infantile Mortality Infant Mortality of any given locality is measured by relating the number of deaths of children under one year of age recorded during the year to the number of live births registered for that particular area during the same period. Bad housing, overcrowding, poor sanitation, low standards of education, illegitimacy, all tend to produce higher infant mortality rates. It follows therefore that the infant mortality rate should provide a reasonably accurate indication of the social circumstances of any particular area. However, it must be borne in mind that as infant mortality has now reached relatively small proportions, any slight deviation in the number of deaths tends to misleading fluctuations in the rate and only a long-term appraisal is likely to reflect the true position. Since the beginning of the century substantial improvements have been achieved. In 1901 the infant mortality rate for 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 1969 are 17.77 and 58 respectively. However, despite the fact that since 1949 actual infant deaths have declined from 96 to 58 (a reduction of 39.6%), neonatal deaths have not shown a pro rata decrease. Indeed, the reverse is true. Twenty years ago neonatal deaths formed 60.4% of all infant deaths whereas today the figure is 72.4%. Over the same period, early neonatal deaths exhibit a similar tendency rising from 50% to 65.5%, thereby emphasising the refractory nature of early childhood hazards despite improved ante-natal services and advances in chemotherapeutics and diagnostic techniques. Moreover, it is becoming clear that methods which previously have been so successful in reducing infant mortality will not suffice to subjugate this seemingly intractable problem of perinatal deaths. 49 Prematurity is by far the most common cause of infant mortality and it may well be that, in many instances, the mere occurrence of a premature birth is an indication of the existence of conditions, as yet occult or perhaps not fully understood, which are not conducive to the establishment of a viable infant. Over 29% of all infant deaths resulted from respiratory causes, viz., acute tracheo bronchitis, respiratory distress syndrome and bronchopneumonia. Pathogenesis is still obscure in respect of tracheo bronchitis, often a cause of precipitate death in apparently healthy infants, but cytogenetic evidence is being accumulated which supports the view that these mysterious deaths could be the result of virus infection of the foetus prior to birth. Furthermore, investigations into such tragedies have revealed greater chromosomal abnormalities and a higher proportion than normal of babies with the "simian" line, an hereditary characteristic which can be produced by the rubella virus before birth. Meanwhile the aetiology of the respiratory distress syndrome continues to defy determination. Therapy in such cases tends to be largely supportive and confined to the relief of symptoms. Congenital abnormalities and inherited metabolic disease persistently present substantial problems although recent progress in this field is making the recognition of deviations arising from chromosomal aberrations somewhat easier. So much so that the counselling of prospective parents at "genetic clinics" where investigations can be instigated has become a practicable proposition and could be a logical extension of local health authority services. Unfortunately unmarried mothers still seek ante-natal help considerably later than their married counterparts. Their babies are more likely to be born prematurely and their infant mortality rate is consistently higher than the legitimate rate. Here, surely, is a field in which the concentrated efforts of voluntary and statutory bodies could be relied upon to produce some improvement. Registering an increase of 0.44 over that calculated for 1968, the present infant mortality rate for the Borough, viz., 17.77, compares favourably with the rates of 18.05 and 17.9 returned for England and Wales and Greater London respectively. Inner London recorded a rate of 20.4. Actual infant deaths recorded during the year were 58 (one less than last year) comprising 40 males and 18 females of which 44 occurred in hospitals within the Borough, 11 in hospitals without and 3 at home. The following table shows the causes of and ages at death: 50 INFANTILE MORTALITY DURING THE YEAR 1969 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 Accident - fractured skull — — — — — — — — 1 1 Acute tracheo-bronchitis 1 — — — 1 3 3 — — 7 Anoxia - cerebral (breech delivery) 1 — — — 1 — — — — 1 - cerebral (haemolytic disease of newborn) 1 — — — 1 — — — — 1 - cerebral (prolapsed cord) 2 — — — 2 — — — — 2 - intra uterine 1 — — — 1 — — — — 1 Asphyxia - inhalation of fire fumes — — — — — — — 1 — 1 - inhalation of vomitus — — — — — — — 1 — 1 - born asphyxiated 1 — — — 1 — — — — 1 Cerebral palsy — — — — — 1 — — 1 Chest Infection (mongolism) — — — — — — — — — 1 Congenital anomalies 3 — 2 1 6 — — — 1 7 Haemolytic Disease of Newborn 2 — — — 2 — — — — 2 Otitis media — — — — — 1 — — — 1 Pneumonia - acute lobar — — — 1 1 — — — — 1 - apiration — — — — — 1 — — — 1 - broncho — — — — — — — — 1 1 Prematurity 15 — — — 15 — — — — 15 Prematurity - Rh incompatability 3 — — — 3 — — — — 3 Respiratory distress syndrome 7 — — — 7 — — — — 7 Septic Coma (mental retardation due to birth asphyxia) — — — — — — — — 1 1 Tentorial tear 1 — — — 1 — — — — 1 TOTALS 38 — 2 2 42 5 5 2 4 58 Males 40 Females 18 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 42 deaths, equivalent to 72.4% of all infant deaths and giving a Neonatal Mortality Rate of 12.87 per 1,000 live births. This rate is 0.83 more than that calculated for the previous year and is slightly less favourable than the figure of 11.7 for Greater London and that returned for England and Wales, namely 12.04. Inner London registered a rate of 13.3. Early Neonatal Mortality—Thirty-eight infant deaths occurring during the first week of birth gives an Early Neonatal Mortality Rate of 11.64 per 1,000 live births compared with rates of 10.2 for Greater London and 10.03 for England and Wales. The comparable figure for Inner London was 11.7. 51 Perinatal Mortality—The Perinatal Mortality Rate, calculated from a total of 57 stillbirths and 38 deaths of infants under 1 week, was 28.61 per 1,000 total births, showing an increase of 3.97 over that for 1968. The equivalent rate for England and Wales is 23.4 and that for Greater London 22.8. Inner London recorded a rate of 25.0. Reproductive Wastage—A sum total of 115 stillbirths and infantile deaths gives a Reproductive Wastage Rate of 34.64 per 1,000 total births, an increase of 4.49 over that calculated for the previous year. Figures for England and Wales and Greater London are 31.01 and 30.40 respectively. REMARKS ON OTHER VARIOUS DEATH CAUSES For international statistical comparability certain basic requirements are considered indispensable and these are covered in the articles of the Nomenclature Regulations, 1967, adopted by the Twentieth World Health Assembly on 22nd May, 1967. Following the Nineteenth World Health Assembly in 1966 which, by resolution, adopted the Eighth Revision and Amendment of the International Classification of Diseases to come into effect as from 1st January, 1968, the Registrar-General, from this date, has brought into use a new classification with regard to records and statistics. Although these new catagories are broadly equivalent to the old, inevitably occasional difficulties will be met in reconciling present with previous statistics and exact comparability cannot be assumed. Classification of Deaths—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying practitioner. This enables his department to modify the original classification— hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the RegistrarGeneral. 52 General Total deaths in the country rose by 0.3% during the year but in Greenwich there was a minimal decrease. Increased mortality from heart disease and cancer was offset by falls in deaths from cerebrovascular and respiratory diseases. Reduction in respiratory deaths may well be a reflection of the increase in hours of sunshine by 15% and the decrease of 30% in total rainfall during the current year. Although, statistically, variations in rates may sometimes seem substantial, in many instances actual numbers are small and lead to wide and often only temporary fluctuations. Heart Disease Recognised as the principal "killer" complaint of modern times this classification, covering as it does (a) chronic rheumatic, (b) hypertensive, (c) ischaemic and (d) other forms of heart disease, it was responsible for 849 deaths (467 males and 382 females) during the current year. This total, which was an increase of 37 over that of the previous year, formed 33.3% of the total deaths from all causes and gives a rate of 3.73 per 1,000 of the population. The rate for 1968 was 3.55. Deaths in the Borough from ischaemic heart disease alone accounted for 666 (383 males and 283 females), some 34 more than the 632 who died from this disease in 1968. Of the 383 males who succumbed from this cause, 35% were between the ages of 45 and 65 years compared with less than 11 % of similarly grouped females. Compared with figures for England and Wales and Greater London of 2.86 and 2.65 respectively, the Borough rate was 2.93. Cerebrovascular Disease Of the total of 258 deaths arising from cerebrovascular disease during the year, 140 were females. Apart from ischaemic heart disease, this constituted the main cause of death in females, being responsible for almost 12% of all female deaths during the year. As expected, the greater proportion of these deaths, viz. 119 (85%) occurred in women over the age of 65 years and only 4 (2.8%) in those under 55 years. The present rate of 1.13 shows a slight decrease from that for 1968. Cancer Second only to heart disease as the principal cause of death in the community, this disease, which has so many psychological 53 connotations not met with in other diseases, claimed 565 victims (316 males and 249 females) during the year under review, an increase of 13 over those recorded during 1968. During 1969, deaths from carcinoma of the breast rose by 17 to 62, an increase of almost 38%, and those from cancer of the stomach advanced by 18% to 66. Mortality from cancer of the uterus declined by l/3rd to a total of 10 and the 158 deaths arising from carcinoma of the lung indicated a slightly more favourable trend. Cancer of the bladder accounted for some 18 deaths during the year. The total of 565 cancer deaths was equivalent to 22.1% 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* Malignant Neoplasms: — Buccal Cavity, etc. 10 2 12 0.05 Oesophagus 9 6 15 0.07 Stomach 35 31 66 0.29 Intestine 30 33 63 0.28 Larynx 5 2 7 0.03 Lung, Bronchus 139 19 158 0.70 Breast — 62 62 0.27 Uterus — 10t 10 0.04 Prostate 15 — 15 0.07 Others 66 79 145 0.64 Leukaemia 7 5 12 0.05 Totals 316 249 565 2.49 * Per 1,000 population † Cancer of the Cervix—5 (rale 0.02) Lung Cancer—The persistent rise in total cancer deaths throughout the country is due, almost entirely, to an 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 of 29.768 for England and Wales with a calculated rate of 0.61 indicates an average yearly increase of 3.5% over the last decade. The Borough rate of 0.70, a figure similar to that for 1968, compares favourably with that of 0.75 for Greater London, a conurbation which has consistently returned a high figure while following the national pattern. Although death rates in the country for women who die from lung cancer continue to increase, there are still five times as many 54 men as women who die from this cause. In Greenwich, however, the rate for women fell from 0.42 per 1,000 in 1967 to 0.17 in 1969 but the ratio of male to female deaths from this cause since 1965 remains at slightly more than 4 to 1. The accompanying table giving deaths from lung cancer in the Borough since 1965 is included in order that current trends in this disease 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 1968 — — 1 1 21 2 35 7 65 6 18 5 140 71 161 0.70 1969 — — 1 — 17 3 47 3 51 8 23 5 139 19 158 0.70 Respiratory Deaths Pneumonia—There were three children under one year of age and 193 persons over 65 years in a total of 224 deaths from pneumonia registered during 1969. The total, which consisted of 86 males and 138 females, showed a decrease of 6 from that of the previous year. Compared with rates of 0.84 and 0.91 for England and Wales and Greater London respectively, the Borough returned a rate of 0.98 which was 0.03 less that that for 1968. Bronchitis and Emphysema—During the current year Greenwich had a total of 181 bronchitis deaths, 123 males and 58 females, a decrease of 13 from those recorded for the previous year. The rate computed for the Borough is 0.80 compared with that of 0.67 for England and Wales and for Greater London also. Influenza—Fifteen influenza deaths occurred during the year under review (11 in respect of persons over the age of 65 years) giving a rate of 0.06 for the Borough. The national rate was 0.10 and that for Greater London 0.08. There were 10 deaths recorded in the Borough during 1968. Asthma—Although hitherto not so classified, asthma is now regarded as a respiratory condition and there were 11 deaths in 1969 from this cause. Other Respiratory Deaths—Compared with a figure of 30 deaths for 1968 the current year's total of 23 shows a decrease of 23%. 55 Tuberculosis Recent years have seen lung disease in the form of tuberculosis effectively controlled by chemotherapy and the breeding of tuberculin tested herds of cattle has been eminently successful in almost eliminating the dissemination of other forms of tuberculosis. Total deaths in the Borough from all forms of tuberculosis numbered 7 producing a rate of 0.03. Of the deaths registered, 4 were males and 3 females, with 3 being of non-pulmonary type. The comparable rate for England and Wales was 0.04 and that returned for Greater London was similar. 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 1969 there were 88 deaths from violence in the Borough, giving a rate of 0.39 per 1,000 population compared with a rate of 0.48 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 6,628 deaths in England and Wales during the year, an increase of 4.4% over the previous year when the total was 6,349. Twenty-two persons in the Borough died from motor vehicle accidents during 1969, a similar figure to that recorded for the previous year. The calculated rate of 0.10 compares with 0.14 and 0.11, the rates for England and Wales and Greater London respectively. Home Accidents—This year's total of 14 deaths from home accidents shows an increase of 2 over the 1968 figure giving a rate of 0.06. Of these, 7 resulted from falls, 3 from inhalation of fumes from fires, 1 from burns and 1 from traumatic asphyxia. After swallowing paint from staircase and drainage pipes a child of 3 years died from lead poisoning while another child of one year died from drug absorption subsequent to the ingestion of tablets inadvertently left around the house. Suicide—Contrary to general belief, suicide continues to claim a substantial number of victims. In England and Wales, the number of suicides during 1969 amounted to the formidable figure of 4,326, giving a rate of 0.09 per 1,000 population. Moreover, of this total more than 22%, viz. 951, were recorded in London, giving a rate of 0.12. This compares with 21 deaths and a rate of 0.09 for Greenwich showing decreases of 7 and 0.03 respectively. 56 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 treble those for tuberculosis and 11.5% higher than the total deaths from road accidents. Homicide—Three deaths, one a male of 19 years and two females of 25 and 38 years respectively, were recorded during the year and in each case the defendant was convicted of murder. 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. 57 SECTION III PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Because of the almost complete elimination of former hazards to health of the more serious infectious and communicable diseases, there is a general tendency to under-estimate the importance of the preventive services in the life of the community. It is unfortunate, but true, that a period of years or even generations is usually necessary before the value of any particular form of prevention is established. Contrariwise, curative services need very little time, often only hours or days, to produce results which enable them to claim urgency and a lion's share of available resources, perhaps to the detriment of preventive aspects. However, in these days of major upheavals and precipitate changes, a modification of attitudes can be detected and it is hoped that, in the near future, prevention of illness will have an equal status and claim to support as that afforded the curative services. Naturally it is the Medical Officer of Health and his staff who are concerned primarily with the application of preventive medicine to the community at large but the general practitioner, while continuing to be occupied with the curative services, is more than ever becoming personally involved with preventive aspects. Indeed present conditions require a partnership of hospital, general practitioner and local authority in the preventive field, for the days of the detached doctor providing complete medical care for his patient are gone and those of the research worker attempting to solve, in isolation, complicated biochemical problems are numbered —all emphasis is now on "team" effort. A recent report of the Royal College of General Practitioners gives evidence to support this contention for it shows that the number of G.P.s working alone has fallen from 70% of the total in 1948 to 23% in 1968 although this same report indicates a disturbing decrease in the proportion of young doctors—a poor augury for the future. Whilst most experts would consider the danger of large-scale epidemics today as rather remote, nevertheless several aspects of modern society will for some time to come, demand the undivided attention of health authorities and the active co-operation of a number of other agencies. Today young people are highly mobile and can present a very real problem in the control of certain infectious diseases. 58 tion of unfamiliar complaints, such as intestinal protozoa and helminths, as well as cholera and other gastro-intestinal disorders, is made easier by the speed of modern travel. Again, the introduction into the country of rabies during the current year is not only a timely warning of what could happen if vigilance is relaxed but also brings into the limelight the potential of animals as disseminators of disease. International adoption of the "container" and "dumb lighter" systems of bulk transport will also bring their own peculiar difficulties to the port and riparian authorities. Concurrent with the higher proportion of elderly persons in the community is the serious increase in the chronic and degenerative diseases which are already claiming a greater share of the country's resources. A great deal has already been achieved in the field of preventive medicine, but more effective use of existing epidemiological knowledge could produce even better results. Much of the future success of the preventive services lies in establishing the aetiologies of the non-communicable diseases and the ability of science to eliminate, arrest or ameliorate the effects of those genetically determined. Alcoholism It is estimated that, in one form or another, alcoholism today is afflicting one in every 100 adults and, furthermore, there is reason to believe that this increase has a direct relationship with the rise in crimes of violence. Although heavy drinking and drunkenness have declined during this century, since the last war there appears to have been a resurgence especially in the privacy of the home and, moreover, evidence is accumulating which suggests that the problem is increasingly to be found among young adults. This is rightly causing great concern and demands urgent attention. Psychiatry gives no precise cause for alcoholism but agrees that anxiety in adolescence, depression in middle age and loneliness in old age are important contributory factors. Earliest records show that man's contact with alcohol was mainly of religious origin and that to condemn its use on similar grounds is not only inconsistent but unlikely to command universal support or acclaim. A first step towards getting the problem of alcoholism into proper perspective is to acknowledge the fact that alcohol has always been a part of man's world and that to seek its abolition is futile. Indeed, any attempt at a solution which does not admit to the pleasant and beneficial effects of alcohol is doomed to failure. 59 Clearly few adolescents require instruction about alcohol but, in accordance with the old adage "the child is the father to the man" and in common with other forms of education, we need to broach the subject and its complications well before adulthood. All education is intended to fit the recipient for life in the community and, with this in mind, adolescents must be made aware of the problem arising from the abuse of alcohol and the way it impinges upon many of society's other activities. Success will come not by pressurising the adolescent but by giving accurate and unbiased information and by showing that to drink or not to drink is a decision for him alone. Abnormal drinking in the young often develops in attempts to emulate "adulthood" but, basically, the normal adolescent who drinks does so to be socially acceptable "even if it kills him" and would rather accept alcohol than be considered "odd man out". On the other hand, the young alcoholic is to be found among the emotionally disturbed, insecure, lonely and rejected who has started to drink to reduce anxiety, tension and the feeling of inadequacy. Recent research in Canada into children who had at least one alcoholic parent revealed that all considered they had suffered as a result of the alcoholic situation and that total rather than specific deprivation was a common factor. This had resulted in lack of interest in school, lack of friends in whom they could confide, shame in respect of the alcoholic parent, lack of faith in adults generally and a fatalistic despair of ever making a successful marriage with children of their own. What was even more disturbing was the discovery that 2/3rds of these parents were themselves children of alcoholic families. These findings have been largely corroborated by more recent studies in this country. They confirmed that, when compared with controls, young alcoholics suffered considerably more disturbance, had less satisfactory relationships at every level and complained more frequently of nervous symptoms. However, support for the view that the alcoholic is to be pitied rather than blamed for his weakness has come from recent research undertaken by a London biochemist. He claims to have demonstrated metabolic abnormalities in alcoholics which suggest a genetic or biochemical predisposition to the disease. Coupled with a high lactic acid level in the body he has discovered in the urine of the alcoholic a fermentable carbohydrate which was not dextrose. Furthermore, almost all alcoholics in his investigations had abnormal dermatoglyphics. 60 From his findings it would appear that the heavy drinker drinks because he likes it whereas the alcoholic drinks because he needs it. Whatever the fundamental cause of this distressing and socially stigmatising complaint we ought to recognise that such a problem does exist and make some positive efforts towards its solution. Cancer Since more people are reaching the older age groups, it is perhaps only to be expected that, in existing conditions, death rates from cancer would rise—but slowly. Although generally this seems to be the case, with assistance from modern chemotherapy, radiotherapy and surgery, some rates have been stabilised and others even reduced. Lung cancer is the notable exception. During 1969, over 10% of all male deaths arose from cancer of the lung which has persistently shown an annual increase of 3.5% over the last 15 years. This is all the more discouraging because the greater part of the problem is man-made and preventable. Early in this century the death rate from lung cancer, which tended to be similar in both sexes, was low and remained so until the 1930s at which time a steady advance, especially among males, became discernible. At first, this was attributed to improved diagnosis but an accelerating increase, apparent from 1940 and continuing to the present day, shows this explanation to be largely fallacious. In 1940, the highest incidence of lung cancer was recorded in males 55/65 years of age—those who, as young soldiers in the first World War, adopted the new tobacco habit and became the first group of "all-life" cigarette smokers. As this group ages so the peak incidence moves up correspondingly until eventually, we fervently hope, it will level out. Lung cancer in females is only one fifth of that of males but cigarette smoking in women is increasing rapidly and their mortality from this disease has now reached the proportions attained by men in 1940. If present trends continue it would not be unduly pessimistic to predict a repeat of the male pattern and the emergence in 20 years time of a female lung cancer rate akin to that attending males today. In urban areas atmospheric pollution undoubtedly plays its part in the rising rate of lung cancer but it cannot be of major importance, else why the differential ratio of 5:1 between males and females and furthermore, despite active operation of the Clean Air Act, these rates continue to rise. Indeed, the highest lung cancer rates are to be found in the Channel Islands where the air is pure but cigarette consumption is excessive. 61 As existing treatment for this type of malignancy is far from satisfactory, our hopes for the future must rest in prevention which in this instance clearly demands, as a first step, the reduction of tobacco consumption. Unfortunately, only temporary restraint is occasioned by price rises in cigarettes and the leniency with which smoking in children is viewed today can only result in conditions conducive to a rise in lung cancer deaths at even earlier ages. So far, education has failed to produce a solution but it cannot be wrong to persist in imparting knowledge in the hope that intelligence will finally triumph over fashion, fads and fancies. In previous Reports, outlines have been given of modern researches into the causes of cancer for it is upon the successful outcome of such efforts will prevention be made possible. Recently it has been found that some malignant cells lose the ability to manufacture a body amino-acid called asparagine and have to rely on an external source of supply for their growth and development. Use is made of this fact to attack the malignant cells with the enzyme 1-asparaginase. The attraction of this particular method of treatment is that, unlike cytotoxic drugs which attack all cells, only the target cells are affected and even then only in an indirect way. There are great hopes of success in its use in certain kinds of leukaemia deaths from which have risen by over 13% since 1960 to 3,698 in England and Wales during 1969. Cancer registration which is proceeding methodically throughout all the Regional Hospital Board areas is beginning to provide useful data for epidemiological and clinical research and is adding substantially to the sum total of knowledge necessary for the eventual control of malignancy. Dental Caries—Fluoridation Development of malocclusion, i.e. a situation where teeth are irregular and fail to align properly, can be the result of a number of factors, one of which is heredity. In such cases, remedial treatment which can be quite extensive, is nevertheless limited by the genetically determined framework of the jaw. However, there is one other very important cause of malocclusion, namely, tooth decay, which, if subjected to available preventive measures, could be substantially reduced if not entirely eliminated. As civilization advances, so the incidence of dental decay increases. This inescapable truth emerges from statistics which indicate that dental caries occurs in 98% of the population, the treatment of which costs almost £65 million per year. 62 Dental caries, which is almost entirely preventable, is the name given to the process of decalcification of the mineral elements of teeth and the decomposition of the organic matrix which take place in an acid medium (pH 5.2 or lower) such as is created when soluble carbohydrates are available to acidogenic bacteria. This decalcifying solution is kept in constant contact with tooth surfaces by residual food particles in the mouth. It follows, therefore, that the indictable comestibles are the glutinous or sticky types, such as soft puddings, cakes, buns, biscuits, boiled sweets, chocolate, toffee, etc., the very foods which give rise to obesity. Normally, by the age of 2½ years, all deciduous teeth are in the mouth, thus enabling the eruption of permanent ones to proceed in an orderly fashion between the ages of 6 and 12 years. Unfortunately, by the time five-year-olds receive their first dental examination at school, the situation is usually out of control and the future dental health of the nation already prejudiced. It is estimated that about 50,000 pre-school children every year are affected by rampant dental caries. In effect, this means that the deciduous teeth are casualties almost as soon as they appear, but even more catastrophic, is that the process is likely to be continued into the permanent teeth. Here the enamel is destroyed and the caries spreads through the dentine to the pulp, where a rich blood supply carries the resultant toxins to other parts of the body. Sucrose would appear to be the main cause of dental caries and undoubtedly prevention must include restriction of the present intake of refined carbohydrates, together with a reversion to the more natural and fibrous type of diet. Besides having a gentle cleaning and massaging action, such a regimen will stimulate and excercise the teeth and gums. With the help of the movements of the cheeks, lips and tongue, these factors will mould the newly erupting teeth into their correct positions. But of paramount importance, is the need to ensure that teeth have the best materials for their formation before defective diet has an opportunity to begin its destruction. It is known that a minute quantity of fluorine assists the protection of healthy teeth and reduces the incidence of decay. Fluorides are present in most water supplies and in many foods as a naturally occurring trace element. Because children needing it most might not receive it and because strict dosage control over a long period of time is virtually impossible, the use of fluoride tablets is not advocated. During a period when manpower is insufficient to deal with the enormous amount of untreated dental decay, it is not only logical but extremely economical to ensure that where water supplies are deficient in fluorides, they are brought up to the recommended concentration 1 p.p.m. 63 Fluoridation is sincerely opposed by some on the grounds that "mass medication" is unethical and indiscriminate but much criticism about its introduction and its effects is emotive and uninformed. Available evidence indicates that only beneficial results arise from fluoridation and a recent report in respect of Birmingham reinforces this favourable appraisal. Fluoride at the rate of 1 p.p.m. was introduced into the water supply during December 1964 and, although there was some improvement in the dental condition of 5-year-olds, that in the case of the 3-year-olds was dramatic. Even those whose teeth had not been subjected to fluoride at the formative period derived some benefit from fluoridated water. All this substantial improvement was gained at a cost of 3.3 pence per annum per head of the population. In present circumstances fluoridation is the one measure which, of itself, could save us from becoming a dental prosthetic nation of gastric sufferers. It is this Council's intention to press for legislation requiring the fluoridation of all domestic water supplies. Drug Addiction Drug addiction has been fully covered in previous reports, and there is little of note to add to what has already been written. However, during the present period of indecision when experts are disputing the most effective methods of dealing with this serious situation, several aspects of the problem appear to me to need emphasis. They are:— 1. As with alcohol and tobacco, drug taking is probably here to stay. 2. As a problem, drug addiction has not reached the proportions of alcoholism. 3. A superabundance of publicity seems to have had little, if any, impact upon the spread of drug taking. 4. Transference to hospital of drug addicts has not curtailed their activities. 5. Experience shows that legislation and punitive measures will not produce a solution. By their very nature, young people of whatever class are rebellious of authority, headstrong, impulsive, less cautious, idealistic and curious, and many are fascinated by mind-changing drugs. It may well be that, in the majority of cases, these concommitants of youth provide a more realistic explanation for the spread of drug taking than many of the factors revealed by deep, involved and prolonged sociological and psychological analysis. Indeed, 64 experience shows that the more one denounces a particular favourite form of youthful escapism, the greater becomes its attraction. Fortunately, as the young mature, the majority tend to discard the follies and indiscretions of youth and, in turn, themselves become appalled at the waywardness of their own offspring. It is held by some experienced persons, that a normal individual requires the stimulation of competition to live a full and satisfying life. They hold that increasing the provision of welfare and social services, with their accompanying regulations and conditions, merely adds to the smothering, strangulating and protective care from which the young are trying desparately to escape, with a consequent exacerbation of the problem. To deny that there is substance in these assertions would be foolish, but it is equally true to say that they do not provide the full explanation for the inadequate personalities and those with maturation problems must add their own particular quotas. Because reliable information on drug abuse is scanty and the extent of its spread throughout the country obscure, a recent survey in an Outer London Borough on this particular problem is welcomed. In this survey, it was found, inter alia, that the prevalence of regular drug users was at the rate of 1.68 per one thousand of the population. The age range was from 16-21 years, about one half of whom were in their eighteenth year, and, with only one exception, they had all attended Secondary Modern Schools and most parents were aware of their children's drug taking. Adjusting the rate to agree with the population group 15-20 years, increased it to 22.8, and even more specifically from 7.8 per one thousand at the age of 16 to 48.8 at 18 years. Of the total, 34 per cent. were heroin addicts, the majority of whom became registered after an average interval of one to two years. Delinquency rate of the addicts was significantly higher than that of the controls. Although the investigation covered only regular drug users, it was estimated that a further 4% to 5% of the 15-20 years population were casual users. What is most disquieting is the fact that the survey covered what is considered to be a reasonably typical urban area. At the end of 1969, in-patients in the London area receiving hospital treatment were averaging 70, 40 males and 30 females, whilst those receiving out-patient attention approximated to 900, 750 males and 150 females. At the end of the current year, one Greenwich resident was receiving hospital treatment for heroin addiction. Containing the spread of drug abuse will be difficult but it should begin by making the illicit acquisition of dangerous drugs much 65 more difficult. Local health authorities should undertake their customary epidemiological role and ascertain the extent of the problem and, by concentrating on the "at risk" groups, break the sequence of events leading to addiction. Regrettably, adherence to "confidentiality" proves somewhat of an obstacle in the fight for prevention. Heart Disease My previous reports have extensively covered congenital and acquired heart disease as well as aspects concerning causes and the modern methods adopted to prevent or ameliorate those various conditions. Certainly acquired heart disability is a serious national problem in that it is claiming an ever increasing proportion of our first-class middle-aged men who have so much to contribute to the life of the community. We can ill afford their loss. Our inability to understand completely the aetiology of heart disease is a restricting factor but we are aware that cigarette smoking stimulates the production of adrenalin. This causes the heart to work harder and demand more oxygen but at the same time the lumen of the coronary arteries is narrowed resulting in a reduction of oxygen to the heart muscle. Persistence of such conditions over a number of years can hardly be beneficial. Diet would seem to have some effect on heart disease but its importance and place in prevention and treatment remains obscure. Recent research has found magnesium ions to be essential for the maintenance of normal myocardial structure and function and that acutely infarcted hearts are deficient in magnesium content to the extent of 42% when compared with those from persons dying from sudden traumatic causes. Moreover, it is now thought that magnesium depletion predisposes to arrythmias, infarcts and myocardial necrosis. As magnesium in the body is a trace element, is its absence a matter for the dietitian or physiologist? It is known that men in sedentary occupations are more prone to heart attacks than those actively engaged—clearly an indication that exercise is a preventive measure of major significance. Whilst raising physical tone after an attack there is a great need to sustain morale and mental condition by employing a patient to his full capacity as early as possible and to return him to a normal social environment thus avoiding a relapse into "cardiac neurosis", a most devastating complication. Congenital heart disease falls into a different category. It seems a paradox but we should not be surprised to learn that our successful efforts, nationally, to reduce infant mortality is giving rise to an increase in notified congenital malformations. Those 66 concerning the heart and great vessels have advanced by 15% from 0.80 per 1,000 births in 1965 to 0.92 in 1968. Over the same period the Greenwich rate has never risen above 0.59 for this particular anomaly. Mental Illness In this Borough, all our endeavours are directed towards dealing with mental handicap within the community and home environment. These include the provision of Junior and Industrial Trainin Centres, Day and Combined Centres, a Day Hospital, various Clubs and a recently established Hostel, all of which are under constant surveillance with a view to introducing improvements to meet changing circumstances. A dedicated field and adminstrative organisation provides efficient support. Effective preventive action is based upon profound knowledge and understanding backed by accurate information. Regrettably, in the case of mental illness, much of the data in use at present is empirical although, with recently awakened public interest and the establishment of a number of research study groups, this is being remedied. Prevention of mental illness, if made possible, would bring in its train enormous advantages not the least of which would be the release 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. 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. Causes of mental retardation are often difficult to isolate except in cases resulting from infection such as encephalitis and those resulting from birth injury which, in theory at least, should be preventable. 67 Our 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. Whilst in many areas where services are limited or non existent one can visualise valuable improvements resulting from the transfer of responsibility for the training of the subnormal to the education authorities, it is difficult to see what advantages will accrue to this group in Greenwich. Certainly our training methods are second to none and the envy of many and we provide the most up-to-date facilities available. In this connection it must be said that those suffering from mental defects arising from genetic variations are unlikely to show great advance and their greatest need is for attention from those who really "care"—the source of finance is immaterial. Inherent in this switch of responsibility is the risk that this group will become the least important in the list of educational priorities. Moreover, after the education authorities have had their way, many members of this group will again become charges of the local health authority. Without being unduly pessimistic this is hardly likely to be beneficial to our mentally disabled children. Obesity Obesity does not just arrive over-night. It has a history of insidious development over a number of years and its elimination is certain to prove equally protracted. Statistics show that, for obese individuals, life expectancy is shortened not only by heart disabilities but also by a number of other degenerative conditions such as liver, kidney and gallbladder disease, diabetes, etc., which, in many instances, are accompanied by the painful and crippling effects of arthritis. Furthermore, apart from the rise in incidence rates of hernias, varicose veins, blood pressure and other circulatory disorders, treatment of respiratory diseases such as bronchitis and emphysema is rendered less effective and accidents and operative risks are correspondingly greater. It has been estimated that more than 6% of men and over 11% of women are more than 20% overweight. In infants, rapid weight gain is associated with artificial feeding and the early introduction of cereals for, whereas there is a natural limit to the intake of calories in the breast fed baby, overfeeding is possible (and common) with the artificially fed child. Few determined efforts have been made to ascertain the degree of obesity obtaining throughout the country although two general practices in London were recently investigated with a view to 68 ascertaining whether any relationship existed between social class and obesity. Adults forming the sample were selected so as to correspond to the social class distribution of the city as a whole. It was found that the prevalence of obesity was significantly related to social class, age and sex. In women, obesity was inversely proportional to social class, that of the upper class being only one half of that of the lowest. Men showed a similar but less pronounced trend. Local information is limited to schoolchildren. During 1969, in routine examinations carried out at Greenwich schools, 92 children were noted for treatment and 308 for observation in connection with obesity. This is equivalent to a rate of 10.10 per 1,000 of the school population which is perhaps somewhat less than informed current opinion would have led us to expect. Identification of the population at risk is a prerequisite to any preventive programme. Somewhat unexpectedly the problem turns out to be one mainly concerning the older women in the lowest social class and young children. Prevention of obesity is difficult for, in a relatively affluent society, over-eating is usual and even stimulated by high pressure salesmanship exerted via the well known advertising mediums. Threatened with malnutrition of all kinds from avitaminosis and trace element deficiencies to a lack of energising carbohydrates if certain foods are not ingested, with minimal attention to a balanced diet the cossetted off-spring is quickly weaned on to cereals and encouraged to over-eat by anxious, over-zealous but conditioned parents. Later, the child's diet is further adversely affected when increased pocket money enables the attractions of the tuck shop to wreak their seductive havoc. Replete with a host of bad dietary habits the child advances towards adulthood with all the disadvantages of obesity often to a life of miserable disability or one prematurely shortened by disease. Evidence clearly points to the fact that the "fat" child is extremely likely to become an obese adult. An intrinsic difficulty in the relief from obesity lies in the fact that it demands a modification by the individual of habits from which some satisfaction is derived. Naturally, this change is more easily accomplished at the earlier ages when habits are flexible and the problem is not so great. To be effective, preventive efforts must begin at the ante-natal clinic and continue through school to adulthood. At this particular stage one useful feature of society is that, in preferring the slim and perhaps more aesthetically desirable figure, it subscribes to our aims and encourages the adoption of dietary control, especially among women whose 69 adherence to a balanced regimen, unfortunately, tends to be somewhat intermittent. During life, the average person eats about 30 tons of food at a cost of approximately £6,000 but pays little attention to its nutritional content. Yet nutritional knowledge is not only a matter of health but, particularly in the poorer sections of the community, it should form part of a family's economic policy of getting "value for money". Unhappily palates, those most variable and deceiving of senses, are the usual arbiters in food selection. Maintenance of a balanced diet is essential for successful weight control but, with children, this needs parental understanding, support and encouragement. Young children learn eating habits from their parents who, in general, have little knowledge of and scant regard for the dietetic values of food and to many of whom a balanced diet seems beyond comprehension. Over-indulgent grand-parents and well intentioned neighbours are also factors to be reckoned with in the struggle for a suitable regimen. Any diet, however bizarre, provided it supplies insufficient energy for metabolic needs will lead to weight reduction. But, by and large, fad diets are bad diets because not only are they usually nutritionally unsound but they are so markedly different from the normal eating habits that their use tends to be ephemeral. Adherence to an appropriate intelligent diet is effective even though a favourable result may be long delayed. Success brings its own reward but many become discouraged too easily. The secret is to continue to eat the foods you like, balanced to provide good nutrition, but in only half the quantities you would normally take. This is not a dramatic solution but such a diet will be pleasant and bearable and the chances of its early abandonment will be considerably lessened. Weight reduction will be slow but sure and the spectre of those frightening degenerative diseases in middle and old age will disappear. Respiratory Diseases Over the years man has learned to release nature's stored energy to modify his surroundings but in such a way that he has polluted his environment—a mistake which, very belatedly and at great expense, he hastens to rectify. For some considerable time now Britain has been a country of the ever-burning hearth and smokey city which, together with its damp climate, constitute a constant and serious respiratory hazard to the very young and the very old. Moreover, despite improvements brought about by the Clean Air Acts, much of the atmosphere of the country's urban areas remains polluted. 70 As if this were hardly a sufficient handicap to health many of our inhabitants add cigarette smoking for good measure. It is no wonder that deaths and disabilities from respiratory diseases are mounting. Our death rate from bronchitis is some 3 or 4 times that of most European countries. Over 33 million working days are lost each year from chronic bronchitis (10 times those lost by industrial disputes) and some 5,500 hospital beds are in continuous occupation by bronchitic patients whose average stay is about 4 weeks. Sir George Godber, Chief Medical Officer of the Department of Health has stated that "cigarette smoking is the largest single avoidable cause of disability and death and the number of annual deaths attributable to cigarette smoking must now approach 100,000 in the United Kingdom". There could be no clearer warning and doctors, nurses and teachers in particular need to take a more positive stand against such a destructive habit. Example will prove to be much more effective than precept. Unfortunately, there is a general apathy towards cigarette smoking and its connection with respiratory disease which is particularly evident among school children. Even the government is half-hearted with regard to the introduction of anti-smoking measures. Another concomitant of cigarette smoking, namely lung cancer, with an annual death toll of 30,000 is killing more people than tuberculosis did seventy years ago. It would seem that man's desire for self-immolation is insatiable. Although successfully controlled, tuberculosis, a major cause of prolonged illness and early demise at the turn of the century, has not yet been eliminated and, under certain conditions, a recrudescence is possible. Constant vigilance is essential. Since the publicising of the pollen count in daily newspapers asthma, that most distressing of complaints with psychosomatic as well as physical origins and familial connections, would appear to be more prevalent than previously supposed. Often associated with other illnesses such as rheumatism, chest infections, which are a common source of absenteeism in industry, are subject to intensive investigation as are their relationships with dust inhalation. Virus infections, of which over 100 are known to affect the lung, cannot be treated by antibiotics and are particularly serious and especially deadly in the case of the very young infant. A great deal of research into chest infections is proceeding, successfully and unobtrusively, but much of the country's respiratory disability could be eliminated by intelligent application of the principles of health and hygiene—clearly a field in which the Borough's Health Education Section should excel. 71 Rheumatic Diseases The seriousness with which the department views rheumatic diseases is not new. Even as far back as 1938 a scheme had been drawn up for the establishment in this Borough of a "rheumatism clinic" and it had also been decided to recommend to the Ministry of Health that manifestations of acute rheumatism in children up to 16 years should be made compulsorily notifiable. Unfortunately the 1939/45 war intervened and the subsequent introduction of the National Health Services Act of 1946 rendered void the necessity for local authority schemes. Rheumatism in its broadest sense is one of the oldest diseases known to affect mankind. It attacks people of all ages and is responsible for more prolonged absences from work or school than any other disease. Resultant heart damage or joint deformity are often so tragically disabling that early diagnosis, prompt treatment and well directed after-care are vitally important. Basically, rheumatic diseases are considered to be of two types, namely, those where the disease is essentially the result of inflammatory conditions such as rheumatoid arthritis and ankylosing spondylitis and those in which the essential ingredient is degeneration as exemplified in osteoarthritis and intervertebral disc disease. The pathogenesis of rheumatoid arthritis and related diseases remains obscure. Nevertheless, increasing attention given by research teams to this problem in recent years seems, at long last, likely to yield results. Particles, including bacteria, absorbed by cells are digested by lysosomal enzymes and for some time now it has been suspected that one or more of these enzymes could be the cause of cartilage damage in arthritic joints. Confirmation that seepage of a particular enzyme from cells can have harmful effects not only on the cell itself but also on surrounding tissues has been obtained recently by a research team at Cambridge. This may well herald a more effective approach to the alleviation of the pain and disability of rheumatic diseases with their accompanying social disadvantages. Improvement in the treatment and rehabilitation of the rheumatic groups is of great concern to local authorities for it becomes their responsibility to sustain individuals and their families when they become registered as disabled. It should be the authorities' aim, whenever possible, to ensure that after-care is such as to improve the functional state and so maintain morale which is so essential in such cases. It is pertinent to record that out of a total of 1,412 persons registered as physically handicapped in Greenwich in 1969, 410 or 29% are disabled due to the effects of rheumatism. 72 Venereal Diseases Under the National Health Service Act of 1946, diagnosis and treatment of venereal diseases became a responsibility of the Regional Hospital Boards and the functions of the local health authorities were limited to those of prevention. In practical terms this means the tracing of contacts, a difficult and often unrewarding part of the preventive service, and the establishment of efficient publicity and health education machinery. The term "venereal" is given to a group of diseases acquired during sexual intercourse of which, in England, syphilis and gonorrhoea are the most important. 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. 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. It is more than probable that the oral contraceptive pill is making its contribution to the increased incidence of venereal disease. Its use is promoting greater promiscuity and, in one survey carried out in this country recently, the infectivity rate in women taking the pill was twice that of the general population. Furthermore, there is evidence to the effect that since the pill causes a lowering of the pH value of vaginal mucosa there is an increase in the susceptibility of the female genitalia to certain infections. Homosexuality, possibly aided and abetted by recent liberalising legislation, is also adding its quota to the rising totals. Increased tourism, immigration, drug addiction, social conditions such as broken homes, maladjustment, overcrowding, low intellectual standards have all tended to aggravate the situation. Promiscuous, enlightened, free or permissive are all epithets which could be applied to the 1960s depending upon one's point of view. Unfortunately, in discarding its inhibitions, youth has been mainly responsible for the rapid spread during this decade of venereal disease to the extent that it is double that for 1950 and is fast approximating to the epidemic proportions of 1946 despite modern treatment techniques. Undoubtedly standards of behaviour are personal matters but those of public health are of general concern. It would seem that the time has come for society to weigh the advantages of the new- 73 found "freedom" against changing moral attitudes, the decline in the stability of family life and all the complex emotional relationships upon which it depends and, in this particular instance, the resultant increase in severe illness, anxiety neurosis, sterility and unhappiness. Whether sexual freedom is approved or not, provision must be made for control of its side effects. Perhaps because of our welltried methods and organised clinics infectious syphilis seems largely to have been contained. It is gonorrhoea which is causing the greatest anxiety and, indeed, it is anticipated that its incidence is likely to supplant measles as the most common of our infectious diseases. Although very susceptible to treatment, gonorrhoea has defied all efforts to prevent its spread. The highest rate of infection occurs among those 20 to 24 years of age although girls from 15 to 19 years form the largest single group. One specialist has estimated that not less than 500 women per year become sterile from the effects of gonorrhoea. During the current year, the country recorded a total of 51,148 cases, an increase of 13.7% over that for 1968 and 8% greater than the post-war epidemic year of 1946. With a total of 40,845, non-gonococcal urethritis in males in 1969 was 14.3% higher thus continuing the trend evident since this category was first separately recorded in 1951. At the Greenwich District Hospital Centre in the Miller Wing, new cases of venereal disease treated during 1969 rose overall by 26.5% and specifically by 22.3% in males and 35% in females while at the Dreadnought Seamen's Hospital Centre the total (applicable to males only) increased by 19%. 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 1969 :— 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: 11 6 169 96 484 265 664 367 Dreadnought Seamen's Hospital: 39 — 297 — 1,129 — 1,465 — Cases of venereal disease in Greenwich residents coming to the notice of the department during 1969 are given in the accompanying table. They show disturbing advances over the figures for the 74 previous year. Syphilis rose by 71.4% to 24, gonorrhoea by 52.7% to 168 and other venereal conditions by 32.1% to 753 and the whole group averaged an increase of 36.1% to 945. The total of 945 gives a rate of 4.16 per 1,000 population compared with 3.03 for 1968. New Cases of Residents Treated During 1969 (as given in returns from the undermentioned Centres) Treatment Centre Syphilis Gonorrhoea Other Conditions TOTALS Greenwich District Hospital Miller Wing: 10 55 268 333 Dreadnought Seamen's Hospital: 6 58 272 336 St. John's Hospital: 1 4 51 56 London Hospital: 2 4 18 24 Middlesex Hospital: 2 18 51 71 St. Bartholomew's Hospital: — 1 15 16 King's College Hospital: — 10 12 22 St. Thomas's Hospital: — 18 62 80 Royal Eye Hospital: 1 — 1 2 Moorfields Eye Hospital: 2 — 2 4 Woking Victoria Hospital : — — 1 1 TOTALS 24 168 753 945 Our venereal disease centres have served us well since the Act of 1917 which led to their establishment but with the present recrudescence of these diseases our specialists, whose numbers have remained almost static over the last 10 years, are becoming overwhelmed. The Ministry of Health recognises the situation by allowing hospitals to appoint "supernumary" registrar-ships to junior doctors prepared to undertake work in this field. 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. NOTIFIABLE INFECTIOUS DISEASES AND FOOD POISONING Legislation No further national legislation was enacted during the year under review. The number of Infectious Diseases notified under Sections 47 to 49 of the Health Services and Public Health Act, 1968, and associated Regulations was 1,290. One case, however, was not con- 75 firmed and the corrected figure was therefore 1,289, a total 462 in excess of that for 1968 and almost entirely accounted for by the biennial fluctuation in measles notifications. Details showing age groups, sex and districts are given in the table in the appendix. Exclusion from work From time to time it is necessary that a suspected "carrier" of, or a person in contact with, an infectious disease should be precluded from work in order that the risk of transmission of the disease is minimised. This is especially necessary when the person concerned is a "food handler". National Insurance Act, 1946 Regulation 3(b) of the National Insurance (Unemployment and Sickness Benefit) Regulations, 1948, made under the above Act, enables any person excluded from work under the foregoing provisions 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. Any sickness benefit would of course be taken into account when compensation is made to a person for the loss occasioned by his exclusion from work. On only one occasion was it necessary to take action under Section 41 of the 1961 Public Health Act in respect of a food handler. International Certificates The International Sanitary Regulations prescribe forms of International Certificates of Vaccination against Cholera, Smallpox and Yellow Fever. The form in respect of Smallpox was amended by the Public Health (Aircraft) Regulations, 1966, and the Public Health (Ships) Regulations, 1966, and the new form became compulsory after the 1st January, 1967. To be valid each certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year 4,074 certificates of persons proceeding abroad were so authenticated, of these 3,619 were in respect of Smallpox, 314 Cholera, and 141 for Typhoid. 76 Immunisation and Vaccination Regulation 9 of the Public Health (Infectious Diseases) Regulations, 1968, provides that a medical officer of health may vaccinate or immunise, without charge, any contacts or possible contacts of a case of infectious disease now to be notified (other than tuberculosis) who are willing to receive such treatment. 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 of time. 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 1969 was 2,038, 1,647 under Council arrangements and 391 by general practitioners, the total indicating a fall of 393 from that of the previous year. Figures for re-vaccination were 58 and 197 respectively. Measles The number of cases notified during the year was 1,080 which compared with 2,345 in 1967 and 2,608 in 1965 shows a considerable reduction in the usual biennial return. It may well be that our measles vaccination scheme, commenced in May 1968, is already producing beneficial results. Eight of the notified cases were admitted into hospital, but I am happy to report that no deaths were recorded. During the year, a total of 2,367 children were vaccinated against measles, 2,091 in accordance with Council arrangements and 276 by local general practitioners. Scarlet Fever There were 31 notifications of scarlet fever received compared with 106 in 1968. No deaths were recorded. 77 Whooping Cough The number of cases of whooping cough notifications received was only 25, a decrease of 95 compared with the previous year's total. Two cases were admitted to hospital. No deaths were recorded. With regard to prophylaxis, one child received a combined antigen (whooping cough and diphtheria) and a further 2,900 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 2,901 whooping cough immunisations carried out during the current year. Of these, 353 were effected by local general practitioners who were also responsible for giving 342 reinforcing doses out of a total of 2,214. Diphtheria No case was registered for the year under review, a result similar to that of the previous year. During the year 3,252 primary immunisations were completed in the Borough of which 385 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 6,317 reinforcing doses were given, 570 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 Greenwich District Hospital for use by general practitioners in emergencies. Typhoid One case of typhoid was received. This was the first notification of the disease received since 1966, when, as in this instance, it was the sole notification. The patient recovered from the disease following admittance into hospital for treatment. 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, young children and the very old 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. 78 Although 70 notifications of dysentery were received during the year, one case was subsequently rediagnosed as Food Poisoning. The total of 69 shows an increase of 20 over the number received in the preceding year. Eight patients were admitted into hospital but no fatalities were recorded. Ophthalmia Neonatorum There were no cases notified during the year under review compared with 2 for 1968. Poliomyelitis No case was recorded during 1969 compared with one of the non-paralytic type in respect of a non-resident during the previous year. Completed primary poliomyelitis inoculations carried out during the current year numbered 3,073, 502 of which were by general practitioners. Reinforcing doses totalled 3,798, again with 475 being given by general practitioners. Acute Meningitis The 12 notified cases of acute meningitis were all admitted to hospital but no deaths occurred during the year as a result of this disease. Only 4 cases of acute meningitis were notified during the previous year. Acute Encephalitis (Infective or Post-Infectious) There were no cases notified during 1968 but in the current year the two notifications were both "post-infectious". One patient developed the disease after an attack of chicken-pox and the second following mumps. Both patients were admitted to hospital but no deaths were recorded. Tetanus (prophylaxis) During the year, 3,247 persons were protected against tetanus and 6,246 reinforcing doses were given, both being part of combined antigen therapy. Of these treatments, 384 and 569 respectively were effected by general practitioners. Malaria During the year under review two cases of malaria were notified compared with one in 1968. 79 In each case the disease was contracted abroad and the patients were admitted to hospital for treatment. No fatalities were recorded. Infective Jaundice Persons notified as having infective jaundice during the year totalled 20 compared with 28 in 1968. Ten patients were admitted into hospital but there were no recorded deaths. Leprosy No case was recorded during the current year a situation similar to that of the previous year. Tuberculosis There were 47 notifications received during the year and, of these 39 were of the pulmonary type and 8 non-pulmonary, i.e. tuberculosis of parts of the body other than the lungs. From sources other than formal notification there were 5 cases, all of the pulmonary type. One was posthumously notified and the others were derived from the death returns. In 1968 some 46 pulmonary and 17 nonpulmonary cases were notified giving a consolidated figure of 63. Although not always essential, disinfection was offered and carried out in 11 cases including 10 rooms. During 1969, some 2,280 Greenwich school children and students received B.C.G. vaccination under the direction of School Medical Officers. A further 186 contacts were also vaccinated. The number of notified cases of tuberculosis remaining on the Register at 31st December, 1969, was as follows :— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 501 340 9 10 860 35 41 2 5 83 CHEST CLINIC REPORTS Greenwich Chest Clinic I am indebted to Drs. P. Forgacs and D. G. Wraith, Consultant Physicians at the Greenwich Chest Clinic, for the following Report: "Twenty-one new cases of pulmonary tuberculosis were notified during the year. This includes 12 males, of whom 6 were over the 80 age of 45 and 9 females of whom 4 were over the age of 45. There was one non-pulmonary tuberculosis case, a female with tuberculous glands. Twelve patients were transferred in. Of the 7 ante-natal patients X-rayed none was found to have active tuberculosis. Some 120 contacts of persons with tuberculosis or children with positive Mantoux tests and their parents were X-rayed and none had active tuberculosis. Twenty-five children with positive tuberculin tests were referred to us from school but none was found to have active disease and 62 children and young adults were given B.C.G. inoculation because their tuberculin tests were negative. In the course of the year there was a total of 7,025 attendances at the Clinic. These included new tuberculous patients and tuberculous contacts previously mentioned as well as the follow-up supervision of many old-standing tuberculous patients and the 1,992 who were referred for X-ray only. Other chest conditions which were referred to the Clinic for investigation included bronchitis, asthma and carcinoma and many of these patients were kept under supervision. A total of 4,945 X-ray units were taken. On the Welfare side, both supportive and financial help was given to many patients as before." 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: "The major change which occurred during the year was the long awaited transfer of the Woolwich Chest Clinic from Maxey Road to St. Nicholas Hospital. This took place on the 15th September, 1969, and was carried out efficiently and the Clinic is now working smoothly. The total attendance at the Clinics during 1969 was 6,482 of which 1,031 were new patients. The number of tuberculous notifications during the year was 25. Pulmonary Males Females 18 12 6 Over age of 40 7 5 Non-Pulmonary 7 1 6 Over age of 40 1 3 Site: Cervical glands 4 women Nasal septum 1 woman Right kidney 1 woman Spine 1 man Transfers into Borough—16 Pulmonary and 2 Non-Pulmonary. 81 There was also one re-notification and two posthumous notifications, both female. Some 190 contacts were examined and B.C.G. given to 120. Thirty-six Mantoux positive schoolchildren were referred for examination but no case of active disease was found. Forty-three patients were found to have carcinoma of the lung. Many patients with other chest diseases, especially bronchitis and asthma were referred to the Chest Clinic during the year. Our Welfare Officer gives advice and assistance with a wide range of domestic, occupational and personal problems of our patients. Many recuperative holidays have been arranged and special food and clothing provided where necessary. In urgent cases special housing preference is recommended. Our Occupational Therapist now holds a diversional therapy class at Riverdale Centre, 158a Plumstead High Street, S.E.I8 on Thursday 2 4 p.m. and at Sherard Hall, Congregation Church, Court Road, Eltham on Monday 2-4 p.m. by the courtesy of the Greenwich Council. She also visits our housebound patients in their homes and provides them with interesting and profitable hobbies." Mass Radiography 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. Dr. J. M. Morgan, the Director Number of patients on Register—31st December, 1969:— Men Women Boys Girls T otals Pulmonary 363 258 7 6 634 Non-Pulmonary 21 26 0 3 50 Grand Total 684 82 of this Unit to whom 1 am indebted for the following analsyis of the results, points out that "all cases of active tuberculosis occurred among those not X-rayed within the previous 5 years" and, in noting that carcinoma of the bronchus surpassed tuberculosis among those examined, expressed the hope that "as with tuberculosis, satisfactory treatment for the cases diagnosed will be introduced or that a progressive anti-smoking campaign will be successful". Summary of Surveys Carried Out in the Borough from 1st January to 31st December, 1969 PART I.—GENERAL ANALYSIS Men Women Total (a) Total X-rayed 12,696 11,438 24,134 (b) Total previously X-rayed (within 5 years) 6,846 3,479 10,325 (c) Total number reviewed 300 213 513 (d) Number considered abnormal after review 113 123 236 PART II—ANALYSIS OF ABNORMAL FILMS (1) Cases considered tuberculous and referred for further investigation: — (a) No further action required Men 6 Women 5 Total 11 (b) Occasional Supervision 1 4 5 (c) Requiring close supervision or 10 ment 5 5 (d) Still under investigation — — — (e) Refused further investigation — — — (2) Previously known tuberculous cases 1 3 4 (3) Non-tuberculous cases: (a) Investigated (see list below) 65 58 123 (b) Still under investigation 3 1 4 (c) Unfit for investigation 1 — 1 (d) Failed to attend further investigation 1 2 3 (4) Cardio-vascular lesions 18 28 46 (5) Abnormalities requiring no action 12 17 29 Non-Tuberculous Cases Men Women Total Carcinoma of bronchus 13 — 13 Suspect Ca. of bronchus 1 — 1 Secondary deposits in chest 2 2 4 Sarcoidosis* 5 2 7 Spontaneous pneumothorax — 1 1 Thymoma-thymectomy — 1 1 Retrosternal goitre — 2 2 83  Men Women Total Bronchiectasis 3 1 4 Pneumonitis 24 21 45 Paraffin pneumonitis—achalasia of cardia — 1 1 Bronchitis and emphysema group 14 11 25 Diaphragmatic hernia group 1 16 17 Eventration of diaphragm 1 — 1 Azygos vein 1 — 1 Totals 65 58 123 * Includes one case (men) and two cases (women) which were previously known. 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) 5,729 8,708 14,437 2 2 4 3.576 6,384 9,960 2 2 4 Public Surveys-Examination of Special Groups 221 45 266 — — — 30 27 57 — — — Regular Sites 1,916 965 2,881 1 1 2 729 640 1,369 1 1 2 Firms— Routine 1,738 716 2,454 2 1 3 97C 415 1,385 2 1 3 Firms— S.S. Visits 2,772 102 2,874 — — — 388 46 434 — — — Colleges, Schools Hospitals, etc. 270 749 1,019 — — — 110 307 417 — — — Homes, Lodging Houses, etc. 50 153 203 — 1 1 47 140 187 — 1 1 TOTAL 12,696 11,438 24,134 5 5 10 5,850 7,959 13,809 5 5 10 Food Poisoning During the year, 99 cases were notified of which three were not confirmed. In addition, one case of dysentery was subsequently re-diagnosed food poisoning and 28 cases were otherwise ascer— tained, making a total of 125. All cases were investigated with the following results:— 84 No. of Cases Organism (if known) No. of Hospital Cases Remarks 61 Salmonella enteritidis 3 Fifty-eight cases occurred in a general outbreak. Average dura— tion of illness, which was severe, was 7 days. The food suspected was chicken which had been served hot and cold. Two whole chickens removed from the re— mains of the meal and on exam— ination were found to contain Salmonella enteriditis. Of the three remaining cases, two occurred in one family and there was one individual case. No particular food was sus— pected in either instance. 12 5 Salmonella typhimurium Clostridium welchii 2 1 Three cases, all young children, occurred in one family, but no particular food was suspected. Of the nine individual cases, chicken was suspected in one case but verification was not possible. Of the remaining cases, no particular food was suspected. Four cases in one family oc— curred. Sardines consumed at a previous meal was suspected but two samples taken from the remains of this meal (one sample of sardine and one of olive oil) proved negative on examination. One individual case suspected a "take away" meal of sweet and sour pork, and pancake roll purchased from a restaurant. Five samples of similar foods taken from the restaurant, were subsequently examined with negative results. 8 Salmonella panama — Five cases occurred in one family and there were three individual cases. No particular foods were suspected in any of these cases. 2 Salmonella newport — Two individual cases. No particular food suspected. 1 Salmonella Stanley 1 No particular food suspected. 85 No. of Cases Organism (i/ known) No. of Hospital Cases Remarks 1 Salmonella Group B (unknown) — A five-month-old baby. No particular food suspected. 1 Salmonella uphill — No particular food suspected. 1 Salmonella muenster — No particular food suspected. 1 Salmonella bredeney — No particular food suspected. 1 Salmonella give — Patient had recently returned from a holiday abroad. No particular food suspected. 1 Salmonella muenchen — No particular food suspected. 1 Staphylococcus aureus — No particular food suspected. 29 No organisms detected 3 Four cases occurred in a general outbreak. A school meal was suspected but verification was not possible. Five cases occurred in two families and in one household sausage rolls were suspected. Verification, however, was not possible. No particular food was suspected in respect of the other household. Twenty individual cases, although various foods were suspected in no instance was it possible to verify the suspected commodity. 125 TOTALS 10 Local Morbidity 1 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 1969. 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 86 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 longterm sickness. (b) Figures relate only to persons insured for sickness benefit. Sickness, therefore, in children, the aged, the nonemployed 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, 1969 Sickness Benefit Injury Benefit Quarter ended 31.3.69 Deptford Eltham Woolwich 7,342 9,435 8,542 351 422 341 Quarter ended 30.6.69 Deptford Eltham Woolwich 3,911 4,768 4,806 503 566 635 Quarter ended 30.9.69 Deptford Eltham Woolwich 3,616 4,276 4,840 362 378 419 Quarter ended 31.12.69 Deptford Eltham Woolwich 4,822 7,257 7,099 327 379 367 Totals: 70,714 5,050 Compared with 1968, new claims to sickness benefit increased by 3.5% and those for industrial injury by no less than 28%. 87 SECTION IV PERSONAL HEALTH AND RELATED SERVICES General Publication of the Seebohm Report, recommendations from which form the basis of the Local Authority Social Services Bill now before parliament, appears to have increased rather than abated the confusion concerning the various local authority services and their staffs. Adding to the perturbation is the second "green paper" which professes to provide a framework within which illhealth prevention and health promotion will be given fresh and stronger impetus. How these two contemplated legislative measures which seek to divide health and social welfare and remove from the health aspects those very sources which have been important adjuncts in preventing break-down can achieve this objective is difficult to visualise. In many quarters, they are viewed with serious misgivings and some alarm. The position of the health visitor is unique. She has a high standard of medical knowledge backed by more than 100 years of progress and experience in the personal services field which, with her practical understanding of psychology and social science, sets her apart from the purely social worker. However, although she may speak with authority on most aspects of welfare and wellbeing she is primarily an expert in child care and it must not be forgotten that this is where the future has its origins and nothing is more important than to start right. It must be a matter of conjecture as to whether the proposed dichotomy of our services would provide the same intimate relationships and services to the family and individual as hitherto when under the new circumstances much would depend upon the cooperation between departments which could be as good or as bad as local personalities would allow. Time will be the final arbiter. Inevitably such uncertainties have their effect upon recruitment and upon the morale of existing staffs and they tend to be disruptive to the department generally. Staff Our staffing situation improved slightly this year in that recruitment more nearly covered losses, though there were periods of 88 time when recruitment and loss did not match up. In October, 9 new health visitors joined the staff after successfully finishing a "one-year" training course under the sponsorship of the Council while, at the same time, 7 newly sponsored students commenced a similar training. Some of these students are doing their practical placements within the Borough and field-work placements were arranged for students sponsored by other London Boroughs. I regret to have to report that one centre superintendent died after a long illness. In order to comply with the Amendments to the Nurseries and Child Minders Regulation Act, 1948, a centre superintendent was promoted to Senior Nursing Officer on a temporary basis to register all child minders and nurseries in the Borough and a health visitor, who is also a trained and experienced district nurse, obtained promotion into district nursing administration in the Council's service. Five health visitors resigned, one on reaching retiring age, one on marriage, two on becoming pregnant and one to work abroad with the "Save the Children Fund". A sixth health visitor changed from full-time to part-time work on her marriage. The staffing position with the district nurses has remained much the same this year. As most of the nurses are married there is a fairly high turn over of staff and many leave when their husbands' work takes them to another area or because they start their families. Most resignations are for purely domestic reasons which means that as fast as new staff are appointed others leave and, unless extra staff can be appointed, it seems unlikely that this position will change. Numbers of school and clinic nursing staff remained quite static, a refreshing change from previous years and one which we hope will continue for our present staff are exceptionally able people and an asset to the service. 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 1968 which are given in brackets:— 89 No. of Women in Attendance: Ante Natal 1,126 Post Natal 609 1,735 Total No. of Attendances made 5,546 (6,368) No. of Sessions held by: Medical Officers 47 Midwives — G.P.s on Sessional Basis 182 Hospital Medical Staff 263 492 General Practitioner Obstetricians No. of Sessions held 590 No. of Attendances: Ante Natal 6,483 Post Natal 480 6,963 (8,224) Preparation for Childbirth There were 445 psychoprophylaxis and 456 mothercraft sessions during 1969. Attendances at these classes, which were 3,251 and 3,353 respectively, showed an encouraging and increasing interest by mothers in the facilities provided for them. In addition, 577 prospective parents attended the 43 parentcraft evening sessions. Health Visitors also gave talks to 10 organisations outside the Borough services, at which there were 274 attendances. Such work is welcomed as it enables the health visitors' skills to be made available to a wider audience than those of age groups which normally attend clinics and who are visited as part of the daily routine of these officers. 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 1969. They serve also as a reminder of the need for persistent effort to ensure hospital delivery for women in the high risk groups. Of all women having their confinement at home in the Borough having had 4 or more previous children, namely 58, almost one quarter (14) were 35 years of age or more and clearly belonged to a high risk category for whom delivery in a consultant maternity department with full facilities is constantly urged. 90 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 1 (a) 38 15 20 3 — — — — (b) 952 172 480 218 55 18 9 — 2 87 7 48 24 7 1 — — 3 25 3 13 7 2 — — — 4 2 1 1 — — — — 1 1 (a) 44 3 20 15 4 2 — — (b) 570 44 225 177 92 24 8 — 2 98 7 44 35 12 — — 3 189 7 94 64 16 6 2 — 4 5 1 3 1 — — — 2 1 (a) 26 — 9 7 7 3 — — (b) 244 2 50 91 59 35 6 1 2 36 1 12 12 9 2 — — 3 166 2 48 68 39 9 — — 4 3 2 1 — — — — 3 1 (a) 7 — 1 4 1 1 — — (b) 153 — 19 44 54 29 7 — 2 18 — 1 3 8 5 1 — 3 79 — 16 29 19 13 1 1 4 1 — — 1 — — — — 4 1 (a) 8 — 2 — 3 3 — — (b) 69 — 4 20 25 12 7 1 2 6 2 2 — 1 1 — 3 21 — 3 10 6 2 — — 4 — — — — — — — — 5-9 1 (a) 3 — — 2 — 1 — (b) 62 — 1 10 25 20 6 — 2 7 — — 1 4 — 2 — 3 9 _ ] 4 3 1 — 4 — — — — — — — — 10-14 1 (a) — — — — — — — — (b) 1 — — — — 1 — — 2 — — — — — — — — 3 — — — — 4 — — — — — IS & over 1 (a) (b) — — — — — — — 2 — — — — — — — 3 — — — — — — 4 — — — lllegit. 1 (a) 16 4 8 1 3 — — — (b) 265 82 108 39 17 10 8 1 2 23 9 8 2 3 1 — — 3 28 1 6 10 3 8 — — 4 2 1 1 — — TOTAL 1 (a) 142 22 60 32 18 9 1 — (b) 2316 300 887 599 327 149 51 3 2 275 24 115 79 43 10 4 3 517 13 180 189 89 41 4 1 4 13 3 7 3 — — — 1. (a) N.H.S. Hospitals (with G.P. Mat.); (b) N.H.S. Hospitals (without G.P. Mat.) 2. Non N.H.S. Hospitals (mainly Maternity Homes) 3. At Home 4 Other Elderly Primaparae Twenty-eight mothers over the age of 35 years gave birth to their first viable child all of whom were delivered in properly equipped units or hospitals. This total represents 0.8% of all live births to Borough residents during the current year. No elderly primapara was concerned with a multiple pregnancy. 91 Multiple Pregnancies Multiple pregnancies in the Borough during 1969 numbered 38 (some 1.1% of all pregnancies resulting in live births) of which all but one 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 Ka) — — — — — — — — (b) 8 1 4 3 — — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 1(a) — — (b) 10 4 3 3 2 — — — — 3 — — — — — — — — 4 — — — — — — — — 2 1(a) — — — (b) 7 — 1 4 1 1 — — 2 _ _ _ 3 4 — — — — — — — — 3 1(a) — — (b) 3 — 1 1 — 1 — — 2 1 1 3 1 — — — — 1 — — 4 — — — — — — — — 4 1(a) — — — — — — — — (b) 1 1 2 1 — 1 — — — 3 — — — — — — — — 4 — — — — — — — — 5—9 Ka) — — — — — — — — (b) 1 1 2 — — — — — — — — 3 4 — — — — — — — — 10—14 1(a) (b) 2 — — — — — — — — 3 — — — —- — 4 — — — — — — — IS and over Ka) — — — — — — — — (b) _ 2 3 4 — — — — — Illegit. 1(a) — — — — — — — (b) 4 — 3 1 — — — 2 1 1 3 — — — — — — — 4 — — — — — — — — TOTAL 1(a) (b) 34 1 13 11 6 3 — — 2 3 — 1 1 1 — — — 3 1 — — — — 1 — — 4 — — — — — — — — 1. (a) N HS. Hospitals (with OP Mat ): (b) N.H.S. Hospitals (without G.P. Mat.) 2. Non N.H.S. Hospitals (mainly Maternity Homes) 3. At Home 4. Other 92 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 1(a) __ (b) 16 3 7 4 2 2 — — — — — — — — 3 — 4 — — — — — — — — 1(a) (b) 11 3 3 2 3 2 3 — 1 1 1 — — 3 1 — 1 — — — — — 4 — — — — — — — — 2 1(a) — — (b) 5 1 1 2 1 2 — 3 2 1 1 — 4 — — — — — — — 3 1(a) (b) 4 — — 1 2 — 1 2 1 — __ 3 4 — — — — 4 1(a) — — — !— — — — (b) 1 __ l 2 3 — — — — — — — — 4 — — — — — — — — 5—9 1(a) (b) 1 — — l — — — 2 ___ 3 __ 4 — — — — — — 10—14 1(a) — — — — — — — — (b) — — 2 — 3 — — — 4 — — — — 15 and over 1a) — — — — — — — — (b) 2 3 4 — Illegit. 1a) 1 1 (b) 6 — 4 l 1 — — — 2 3 1 2 3 1 — — l — — — — 4 1 — 1 — — — — — TOTAL 1(a) 1 1 — — — — — — (b) 44 3 15 12 9 4 1 — 2 7 1 3 1 2 — — — 3 4 — 1 2 1 — — — 4 1 — 1 — — — — — 1. (a) N.H.S. Hospitals (with G.P. Mat.); (b) N.H.S. Hospitals (without G.P. Mat.) 2. Non N.H.S. Hospitals (mainly Maternity Homes) 3. At Home 4. Other Midwifery Throughout the year the mutually useful liaison between the Borough and the local hospitals continued and, in this respect, the staff particularly appreciated their monthly meeting with colleagues at the British Hospital for Mothers and Babies. 93 Clinic services were maintained for General Practitioner Obstetricians but, with the reduction in the number of home confinements, the use of these facilities by the doctors is gradually declining. Contrary to previous years, the response to the invitation to postnatal examinations was encouraging and the current year's total of 609 attendances showed a rise of some 23% over the 1968 total of 495. Practising Midwives In accordance with the Midwives Act, 1951, notifications of intention to practise as midwives in the London Borough of Greenwich during 1969 were received from 128 persons. Of these, 113 were in respect of hospital midwives and the remainder, i.e. 15, 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, a further 2 areas having a combined midwife/district nurse. There is one relief midwife/district nurse. During 1969 there were 512 home confinements. In addition there were 65 mothers booked for home confinements, but transferred to hospital due to complications, and 386 patients were discharged from hospital after 48 hours or more. Home confinements declined and there was a decrease in patients taking advantage of the "early discharge" scheme (420 during 1968). Domiciliary confinements during the year fell by 16% to a total of 512 and the number of mothers discharged home early after hospital confinement decreased by 8% to 386. Domiciliary Confinements Attended and Hospital Deliveries Nursed at Home Doctor Present Doctor not Present Doctor Not Booked Doctor Booked 2 8 10 492 Totals 10 502 No. of Hospital Deliveries attended by Midwives on discharge before 10th Day 386 94 Domiciliary Confinements by Age and Parity during 1969 Age Total confinements Parity 0 1 2 3 4 5 and over Not known Under 20 No. 19 4 10 5 - - - - % 3.7 0.8 2.0 1.0 — — — - 20-29 No. 365 13 153 127 53 15 2 2 % 71.3 2.5 29.9 24.8 10.3 2.9 0.4 0.4 30-39 No. 124 17 45 40 11 11 % 24.2 — 3.3 8.8 7.8 2.1 2.1 — 40 and over No. 1 1 % 0.2 — — — 0.2 — — — Not known No. 3 1 1 1 % 0.6 0.2 0.2 0.2 — — — — Total No. 512 18 181 178 94 26 13 2 % 100.0 3.5 35.4 34.8 18.3 50 2.5 0.4 95 Domiciliary Births Prematurity and Mortality by Birth Weight Weight Number Proportion per 100 live premature infants Deaths in 24 hours Survivors at 28 days Number per 100 live premature infants Number Per 100 live premature infants 21b 3oz or less — — — — — — 31b 4oz or less 1 5.5 — — 1 5.5 31b 5oz to 4lb6oz 3 16.6 — — 3 16.6 41b 7ozto41b 15oz 5 27.7 — — 5 27.7 51b to 5lb 8oz 9 50.0 — — 9 50.0 All cases 18 100.0 — — 18 100.0 Maternity Outfits In all cases of confinements, other than in hospital, maternity outfits are made available and during the current year some 620 packs were distributed. Conditions for which Midwives summoned Medical Aid during 1969 (Figures for 1968 in brackets) During pregnancy During Labour High Blood Pressure 2 (1) Premature labour 6 (6) Abnormal Presentation 10 (6) Ante-partum haemorrhage — (6) Persistent vomiting — (2) Early rupture of membrane — (2) Pyelitis — (3) Delay in 1st stage 2 (3) Post-maturity 2 (1) Delay in 2nd stage 4 (5) Threatened Abortion 1 (0) Retained placenta 3 (1) Ante-partum Post-partum haemorrhage — (1) Haemorrhage 9 (0) Ruptured perineum 24(52) Foetal distress 8 (2) During puerperium For mother— For infant— Thrombo-phlebitis 1 (6) Foetal distress in labour 8 (2) Pyrexia 5 (21) No movements in 1st stage — (l) Engorged breasts — (1) Asphyxia (severe cyanosis) 1 (7) Abdominal pain 1 (0) Cough and raised temp. — (1) Depression 1 (0) Rectal bleeding 4 (1) Septic finger — (1) Jaundiced — (l) Oral thrush — (2) Rash — (2) Septic Spots — (1) Sticky eyes 5 (5) Mongolism 1 (0) Hypoglycaemia 2 (0) Prematurity 1 (0) Vomiting 2 (0) Paronychia 1 (0) Neck swelling (one side) 1 (0) Severe Coryza 2 (0) 96 Phenylketonuria—Guthrie Test Phenylketonuria is a metabolic disorder which causes mental retardation unless detected and treated from the neo-natal period. Development of a reliable blood test (the Guthrie Test) has enabled an early diagnosis to be made of this condition and during 1969 there were arrangements between the local hospitals and the Department for all infants whether at home or in hospital to have this test on the 6th day of life. In the case of domiciliary births and early discharge cases the Local Authority midwives take the blood specimens and despatch them to the laboratory. No cases of Phenylketonuria were detected during 1969. 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 24 No. of Pupils in Training at 31/12/69 7* *British Hospital for Mothers and Babies 5 Greenwich District Hospital (from Sept. 1969) 2 Refresher Courses In accordance with the rules of the Central Midwives Board, three midwives attended Statutory Refresher Courses during the year, each of one week's duration. In addition, midwives were released for courses as under :— 4 Preparation for Parenthood (6-week day release) 1 Family Planning Seminar (1 day) 11 Study Day—B.H.M.B. Cervical Cytology Attendances at Local Authority cytology clinics again fell despite publicity and encouragement given by health visitors and midwives. However, the picture indicated by Borough statistics does not necessarily reflect the national trend in the use of this screening service, since the impetus of general practitioners to undertake this work on behalf of their own patients has undoubtedly led to many women being investigated in the surgery of their family doctor. The total number of smears taken in these circumstances is not available. The following statistics indicate the volume and type of work undertaken at the various clinics during the year:— 97 Clinics No. of Smears Taken Rustall Lodge 295 Shooters Hill Road 167 Burney Street 81 Plumstead High Street 186 Market Street 294 Local Firms 15 Total at 31/12/69 1 ,038 Age Groups No. of Smears Taken Under 25 years 72 25—35 years 259 35—45 years 334 45—55 years 294 Over 55 years 79 Total 1,038 Parity No. with no Children 152 No. with 1 Child 190 No. with 2 Children 372 No. with 3 Children 222 No. with 4 Children 64 No. with over 4 Children 38 Total 1,038 Breast Examinations No. examined 908 No. requiring further examination 12 With regard to carcinoma of the cervix uteri, there were 5 deaths recorded in the Borough during 1969 which gives a rate of 0.02 per 1,000 population. This is 0.01 less than the rate for 1968 and it again compares favourably with that for England and Wales, viz. 0.05. Breast examinations decreased by 30% to a total of 908 for the current year. Those cases requiring further examination numbered 12, a figure similar to that for 1968. With a total of 62 deaths, cancer of the breast produced a rate of 0.27 per 1,000 population, an increase of 0.07 over that for 1968. The rate for England and Wales at 0.22 also registered a slight increase over the previous year. 98 Family Planning In this country, over 160,000 unwanted children are born each year. Dangers from maternal exhaustion arising from too many pregnancies, neglected toddlers in families with an ever-present new baby, over-worked and tired parents of large and unspaced families with consequent reduction in living standards and, in some instances, the blind perpetuation of hereditary defects must lead most thinking people to the conclusion that the case for family planning is not only overwhelming but that knowledge of contraception is an inalienable human right. In this respect the Family Planning Act of 1967 is a considerable advance, statutorily, over the previous position. Moreover, with the introduction of the "pill", contraception has been made easier and therefore more of a "saleable" health commodity. Despite adverse publicity, thromboembolic complications associated with the use of oral contraceptives are uncommon and, with the introduction of pills with lower hormone levels, these are becoming even rarer—much less than those accompanying normal pregnancy. It is a mistake, however, to imagine that the mere provision of clinics and facilities for birth control is sufficient. There is a clamant need for health education in a field which is riddled with ignorance, prejudice and anti-planning propaganda, not to say acute embarrassment and natural human reticence and inertia. Attitudes can be changed by mass media and group discussion but probably the most effective method is individual counselling by someone with a medical or nursing background. General practitioners, even if interested and willing to allocate the necessary time, are not case-finders and, in any event, can only advise selfreferrals and relatively few women will spontaneously consult the family doctor on such a subject. With her teaching ability, technical knowledge and her long tradition of acceptance by the family as a friend and counsellor, who better than the health visitor to undertake such an important task. However, under the 1967 Act, this Council uses the Family Planning Association on an agency basis which is financially more expedient and, during 1969 grants in respect of this service amounted to £12,173. Cases attending the Greenwich clinics listed below numbered 4,060, a total almost 40% greater than for 1968. Over the same period clinic sessions rose from 521 to 773 and new patients from 956 to 1,275. 99 A clinic for young persons over 16 years of age has been established at Langton Way Welfare Centre where they are able to discuss their emotional, moral and sexual problems. Family Planning Clinics in the area are held at the following premises :— Abbey Welfare Centre Barnfield Residents Association Blackheath Welfare Centre Hall (Langton Way) Greenwich District Hospital Charlton Lane Welfare Centre co ("iller General Wing) Creek Road Welfare Centre 1 H'gh StreCt' Garland Road Welfare Centre St Nicholas Hospital Lionel Road Welfare Centre (Out-patient's Department) I am indebted to Mrs. P. Regester, Administrator of the South East London Branch of the Family Planning Association for the following account of her association's activities in this Borough during the year ended 31st March, 1970. "The Council of the London Borough of Greenwich implements the National Health Service (Family Planning) Act, 1967, and uses the Family Planning Association as its agents for this purpose. It is agreed that no fees will be charged to any patients for medical advice and examination, regardless of their place of residence and that no charges will be made for drugs and appliances supplied to medically or socially necessitous patients. Expenditure in Greenwich for the year ending 31st March, 1970, on medical and lay-staff salaries, supplies and overheads amounted to £21,508; the income from the sale of supplies, etc., was £9,335. The Borough had agreed to make an underwriting grant of £10,000, and this left a deficiency of £2,173, which was also met by the Greenwich Council. This free advice on family planning has been much appreciated by the women attending clinics in the Borough, as is evident from the increase in the number of clinic patients :— 1969 1970 Total number of patients attending 4,060 4,892 Number of new patients 1,275 1,729 Number of medically necessitous patients 109 55 Number of socially necessitous patients 551 469 An interesting point is the fall-off of the number of necessitous patients. This appears to be caused by fewer patients being seen 100 at the special clinic at Plumstead Reception Centre—in 1970, 231 patients were seen, whereas in the previous year 293 were seen. Dr. Michael Clarke, Lecturer in Social Medicine, St. Thomas's Hospital, and FPA doctor, Blackheath FPA Clinic Youth Advisory Session, undertook an interesting survey on the utilisation of FPA services in the London Borough of Greenwich. He undertook this to confirm or refute the suggestion often made that this Association provides services for a disproportionate number of middle class patients. He collected reliable information from clinic cards of all new patients in the Borough; the information on the husband's occupation was translated into Social Class Groupings using the standard tables provided by the Registrar General. These Groupings were then compared with similar data obtained for the whole population of Greenwich. This showed that the patients attending clinics in Greenwich represented a cross-section of the population of the Borough as a whole although the largest group of patients were middle class, which is understandable as this is the largest group of people in Greenwich. There were, however, marked differences in the different clinics, reflecting the wide range of class distribution in the Borough. An interesting new development in Greenwich is the Hospital Visitors' Scheme. F.P.A. trained visitors spend some time each week at the British Hospital for Mothers & Babies, St. Nicholas Hospital, Plumstead, and the Military Hospital, Shooters Hill, seeing maternity patients and giving them information about family planning and addresses of clinics near their homes. For those patients who wish it, an appointment is made at a clinic so that they may attend on leaving hospital. Greenwich is al9o providing a service for sections of the community who could be referred to as "newcomers to family planning"—Asian women, West Indians, Irish girls, Cypriots, Greeks, Turks, Roman Catholics, etc. Most of these people are influenced in their behaviour by heritage, traditions and customs— the Asians and West Indians have little in common except that both these peoples shared the background of the extended family; the deep sense of guilt suffered by the Irish woman (and many others) if she accepted the idea of birth control; and so on. However, the clinics now welcome as patients peoples from many countries and varied beliefs and the numbers are increasing daily. Family planning services in Greenwich are now being fully used and need for extension is evident." 101 Abortion During 1969, 54,158 abortions were notified throughout England and Wales, 33,155 (61.2%) from N.H.S. hospitals and 20,858 (38.3%) from "approved" places. Of the total, 46.7% were in respect of single women of whom almost 5% were under the age of 16 years. Some 3,605, equivalent to 6.6% of the country's total, were notified in the S.E. Metropolitan Regional Hospital area and, of these, 937 or 26% were forwarded from "approved" places. Detailed analyses of legally induced abortions carried out in respect of residents are available only for the period from the introduction of the Abortion Act on 27th April, 1968, to the 31st December of the same year. During that period of approximately 8 months, 180 abortions were effected of which 70 (38.8%) concerned single women, 38 being under 20 years of age of whom 3 were under 16. This gives a calculated annual abortion rate for Greenwich of 5.9 per 1,000 women between the ages of 15 and 44 years. Of the Borough's total of 180, 142 abortions were carried out at N.H.S. hospitals, 138 actually taking place within the S.E. Metropolitan Regional Hospital area. 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. The following tables give information regarding malformations notified to the department during 1969 compared with those returned for England and Wales in 1968. Congenital Malformations (Numbers Notified According to Site) Site No. Notified Rates per 1,000 Total Notified Births Greenwich 1969 England & Wales 1968 ALL SITES 78 23.49 20.00 Central Nervous System 19 5.72 4.47 Eye, ear 2 0.60 0.51 Alimentary system 12 3.61 2.21 Heart and great vessels 1 0.30 0.92 Respiratory system — — 0.19 Uro-genital system 12 3.61 1.54 Limbs 21 6.32 6.95 Other skeletal 1 0.30 0.56 Other systems 4 1.20 1.32 Other malformations 6 1.80 1.32 NOTE:—This table indicates the number of malformations NOT the number of children. 102 Congenital Malformations Notified During 1969 GREENWICH % E & W 1968 Live Still Total % Babies with One malformation 42 8 50 79.4 86.7 Two malformations 7 4 11 17.4 9.7 Three malformations 2 — 2 3.2 2.4 Four malformations — — — 0.7 Five or more formations — — — — 0.5 Total babies 51 12 63 100.0 100.0 These malformations are notified to the Department and summaries are forwarded to the Department of Health and Social Security in accordance with the scheme which has been in operation since January 1st, 1964. We are grateful for the co-operation of all doctors and midwives working in the Borough for their help in providing these statistics. It must be appreciated that the diagnosis of some congenital malformations causes them difficulties during the neo-natal period. Continuing the trend evident since 1965, there was a further decrease of 11.4% in the congenital abnormalities notified during 1969 giving a rate of 23.49 compared with that of 25.51 for the previous year. One exception to this was the increase in deformities of the alimentary system which rose by 50% to a total of 12. However, numbers are small and this is almost certainly a chance fluctuation. Limb Deformities The main limb deformities were congenital dislocation of the hip and talipes, conditions which can usually be completely cured especially when given expert treatment from birth. Such treatment is immediately available to all babies born in this country. Every infant attending the Child Health Clinics is examined by the doctor for congenital dislocation of the hip which, unlike talipes, is not always immediately recognised on neo-natal examination but, when detected and treated at an early age, causes no locomotor problems when the child begins to crawl and walk. 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 1969 rate for 1,000 total notified births was 2.71 compared with a figure of 1.38 for England and Wales and 1.10 for the South East Region for the year 1968. 103 Mongolism—This is another reasonably easily identified defect with a local rate for 1969 of 1.50 per 1,000 total births. Rates for England and Wales and the South East Region for 1968 are 0.77 and 0.83 respectively. Rubella Vaccination Congenital defects arising as a result of an attack of rubella during the first trimester of pregnancy are well known. On an average, one in every six children born in these circumstances is likely to suffer from such defects. In Britain, it has been estimated that major epidemics occur at intervals of 8 to 10 years (the last in 1962) during which about 1,500 women could be expected to contract rubella and, of these, some 500 cases would arise within the first three months of pregnancy. In a non-epidemic year, figures might be as low as 500 and 100 respectively. Small epidemics are likely as often as every 6 years and outbreaks tend to be more prevalent in winter and spring. Recent investigations carried out in the Home Counties reveal that approximately l/3rd of all girls would not have developed immunity to german measles by the age of 15 years. Because so many girls in the 15/20 age group are potential mothers, it is extremely important that protection be given them at an earlier age. Under the control of the G.L.C.'s Research and Intelligence Unit, a trial of rubella vaccine on girls of 11/13 \ years in the I.L.E.A. area has recently been carried out, the results of which could well determine local health authorities' future prophylaxis policy regarding this mild but foetus-damaging infective virus. Between 35,000 and 40,000 children born in Great Britain every year have congential defects requiring medical treatment of which between £ and l/3rd need special educational assistance. A recent investigation based upon a continuing study of 17,500 births occurring during the first week of March, 1958, has shown that these births derived originally from about 21,000 conceptions of which some 10% miscarried as a result of chromosomal or structural abnormalities. Of the 21,000, 10% had severe anomalies arising in early pregnancy but almost 2/3rds did not survive to 7 years. A further 2% died around the time of birth but without detectable malformation. Congenital mental defects were most common—defects in 2 children out of every 1,000 were so severe as to exclude them from any school and they were either attending a training centre or receiving no education at all. Further, one child in every 1,000 104 had a severe degree of neurological abnormality which, together with some retardation rendered impossible any education in the formal sense. Profound intellectual impairment amounted to 2.6 per 1,000. Observation/Handicap Register Plans to incorporate the "At Risk", Handicapped and Deaf lists into one composite Register were put into effect and its compilation continued throughout the current year. At present, for administrative reasons, the "At Risk" register remains separate. This new observation/handicapped register is most complete for children under 5 years but schoolchildren will be fully represented in due course. Co-ordination between all sections interested in the care of handicapped children has always been good but it is probably even better now. Certainly greater use has been made of the new register which demonstrates the ease with which statistics can now be obtained and have already been provided for various research purposes. The accompanying table indicates not only the number of children and the type of handicap from which they suffer but also the trend since 1965. These figures differ from those given in previous Annual Reports in that each child is represented once only and, in the case of multiple handicaps (and many children do have more than one handicap) it is entered under the most severe defect. In cases of doubt, the handicap which most restricts the child is the one listed for the register. Observation and Handicapped Register Analysis of children born during or after J965 on the above Register at 31st December 1969 System Affected MALES born in:- FEMALES born in:- TOTAL CHILDREN 1969 1968 1967 1966 1965 Total 1969 1968 1967 1966 1965 Total Central Nervous System 3 5 6 5 1 20 1 4 6 7 3 21 41 Eye, Ear or Speech 2 3 7 5 17 5 5 1 4 7 22 39 Alimentary System 3 2 4 7 2 18 2 5 4 1 1 13 31 Cardio-Vascular System 6 8 4 12 4 34 4 7 3 6 3 23 57 Respiratory System - - -_ 3 2 5 1 1 1 2 1 6 11 Uro-Genital System 6 3 4 - 3 16 3 4 - 1 — 8 24 Limbs Blood and Metabolic 1 1 7 8 5 4 35 8 7 9 2 7 33 68 Systems - ] ? 1 3 7 2 2 2 2 - 8 15 Mantally Retarded 6 7 2 6 9 30 4 2 4 4 13 27 57 Miscellaneous 2 - - 2 - 4 3 3 - 2 1 9 13 TOTAL 39 36 30 48 33 186 33 40 30 31 36 170 356 105 "At Risk" Register In accordance with regular practice, both the Observation/Handicap and "At Risk" registers were reviewed by a medical officer and most children registered were removed from the "At Risk" list as developing normally by the age of one year or 18 months. The following figures give the number of children on the "At Risk" Register since 1965 with the comparable number of live births in each year:— No. on Register No. of Live Births 1965 933 3,722 1966 1,486 3,715 1967 1,869 3,600 1968 2,280 3,404 1969 2,271 3,263 During 1969 there were three infants on the "At Risk" register who were observed because they were at risk of becoming "battered babies". Deaf Register (Including Partially Hearing) There was a small decrease in the number of deaf and partially hearing children known to the Department at 31st December 1969 but a higher proportion of these were provided with hearing aids and more were attending deaf schools and partially handicapped units while less were on the roll of other special schools. Deaf Register—31st December, 1969 Under Over Total 5 yrs. 5 yrs. No. of Children on register 13 144 157 No. of Children with hearing aids 14 64 78 No. of Children attending Deaf Schools or Partially Hearing Units 48 48 No. of Children attending other Special Schools — 8 8 Deletions from Register during 1969 8 (including 2 discharged as normal, 5 left school and 1 moved away). Selected deaf school leavers are introduced to social workers (Welfare Services) if they are in need of assistance for employment and for other special problems which can arise in the lives of handicapped people at this milestone in their lives. 106 Home Nursing Once again the current year showed an increase in visits made by the District Nurses and a rise in the number of new cases; visits advanced by 14,353 to a total of 217,395 and new cases by 177 to 4,147. Referrals of new cases by general practitioners rose by 392 while those from all other sources fell by 215. Most unexpectedly, referrals from hospitals fell by 45 despite the present policy of encouraging early discharge. Increased visiting resulted mainly from the larger number of new cases but some persons were visited three or four times daily, others were heavy patients requiring the attention of two nurses and there were those who needed greater supervision. Five patients on renal dialysis are visited by the District Nursing staff in a supportive role. Four more general practitioner attachment schemes were started during 1969 and there are now 33 general practitioners and 13 of the District Nursing staff involved. As a result of these schemes the attached nurses discover new interests and are able to work as colleagues and members of the group team, all of whom derive some benefit from this closer association. Of the 2,977 new cases referred by general practitioners, some 1,672 (58%) were from those involved in the "attachment" schemes compared with 1,091 (46%) in 1968. Sources from which New Cases were Referred General Practitioners 2,977 Hospitals 863 Clinics Chest, Ante Natal and Diabetic 23 Geriatric Visitors 91 District Nursing Service 193 4,147 Classification of New Cases No. Cases % Medical 3,445 83.1 Surgical 548 13.2 Maternal Complications 109 2.6 Early Maternity Discharges 8 0.2 Tuberculosis 16 0.4 Mental Ill-health 21 0.5 Total 4,147 100.0 Patients and Visits Total number of Patients 5,392 Total number of Visits 217,395 Average number of Visits to each Patient 40 107 Long-term Cases Patients Nursed for 3 months or more 162 (equivalent to 3% of all cases nursed) Type of Treatment and where effected Treatment At Patients' Homes Elsewhere (e.g. Nurses' Homes) Total % Injections only 43,793 965 44,758 21 Injections plus other treatment 7,566 33 7,599 3 Other Treatment only 164,143 895 165,038 76 TOTALS 215,502 1,893 217,395 100 Age Distribution of Patients Age Group No. of Patients % 0 to 4 years 78 1.5 5 to 64 years 2,557 47.4 65 years and over 2,757 51.1 Total 5,392 100.0 District Nurses—Full-time equivalent 55.5 (including Reliefs and Students) During 1969, the number of areas was increased to 44 and the average case-load for the 13 staff working with general practitioners was 40/48 and 26/36 for the remaining 31 areas. Visits averaged 3.900 per District Nurse which is high. From the home nursing point of view, November and December were very heavy months. However, despite the influenza epidemic and substantial staff sickness our nurses, as always, responded to the emergency and, on occasions, managed 20/24 visits daily. Prolongation of such a situation inevitably leads to maximum visits with a minimum standard of care which even the staff find most unsatisfactory. It is not to be commended other than in exceptional circumstances. Recruitment Anticipated improvement did not materialise and, although assistance was obtained from the School and Clinic Nursing Staff, for several months it was necessary to employ nurses from a private agency. 108 Four auxiliary workers were engaged and, under careful supervision, these were able to help with the bathing of the frail elderly, dressing and undressing patients and other less skilled duties. Marie Curie Day and Night Nursing Service Duties undertaken in the Borough by this organisation involved the services of a night nurse for 35 patients (324 nights), while a further 23 patients received help in other ways, such as the provision of fuel, clothing, bedding and extra nourishment. Woolwich and Plumstead Relief in Sickness Fund In accordance with this scheme 3 patients were provided with the services of a night nurse (22 nights), 36 were assisted with travelling and holidays, and 1,000 received financial help and assistance in the provision of linen, clothing, toilet necessities, special equipment, extra nourishment and fuel, etc. Charles Soames Trust, Greenwich One hundred pounds was spent mainly on help towards holidays for the sick and disabled residents of Greenwich. Training During 1969, ten State Registered Nurses successfully undertook the District Nursing Certificate and a number of State Enrolled Nurses attended an "in-service" training course. Refresher Courses Arrangements were made for 16 District Nursing Sisters to attend refresher courses as under:— 3—2 weeks Practical work Instructors course. 6—1 week refresher course, Q.I.D.N.S. 1—1 week refresher Rehabilitation. 1—1 week course on General Practitioner attachment. 5—1 day Terminal Care Symposium. 3—1 day at Kings College Hospital. Renal Dialysis. Observation Visits These were made by the following students:— 2 Integrated Hospital students 6 weeks with D.N. 5 Integrated Hospital students 8 days with D.N. 2 Medical students 1 day with D.N. 24 Pupil Midwives 1 day with D.N. 37 Hospital students 1 day with D.N. 1 student from Holland 1 day with D.N. 109 Home Help Service At the end of 1969, the equivalent of 312 full-time Home Helps were employed and the table below gives an account of the duties undertaken. Type of Case No. Aged 65 years or over on first Visit in 1969 3,402 Aged under 65 years on first Visit in 1969: Chronic Sick and Tuberculous 175 Mentally Disordered 26 Maternity 87 Others 286 574 Total Cases 3,976 These figures reflect the increasing amount of service given to elderly people. With an advance of over 3% from fewer staff they undoubtedly indicate that the home help is an invaluable member of a team which exists to enable these residents to remain in the community until extreme age or infirmity necessitates admission to one of the Council's Homes for the elderly. Shortages of home helps were apparent in all three areas of the Borough throughout 1969. From experience, the Organisers have learnt that recruitment by advertisement is far from satisfactory and that recommendations from existing staff produce the best recruits to this front-line service. There was the usual staff depletion after Christmas and the school holidays—a number of home helps work to supplement the family income with these objectives in mind. Family Aids "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. Child and Home Help Courses A total of 36 home helps attended two one-week courses of "in-service" training. The programmes included talks and discussions on deprived children, the care of the sick in their own homes, the care of the elderly, the nursing mother and her baby, and first-aid for emergencies in the home. Health Visiting Services were continued on similar lines to those of previous years and the following table summarises the visiting carried out during 1969:— 110 No. of Cases Visited by Health Visitors Children born in 1969 5,633 Children born in 1968 5,107 Children born in 1964/67 7,140 17,880 Persons aged 65 years and over 85 Persons aged 65 years and over (visited at special request of G.P. or Hospital) 45 Mentally Disordered Persons 38 Mentally Disordered Persons (visited at special request of G.P. or Hospital) 9 Persons Discharged from Hospitals other than Mental (excl. maternity cases) 28 Persons Discharged from Hospitals other than Mental (excl. maternity cases) (visited at special request of G.P. or Hospital) 21 Tuberculous Households Visited 19 Households Visited re Other Infectious Diseases 113 Total Effective Visits and Re-visits 48,148 Unsuccessful Visits 10,987 Health Visitors—Full-time equivalent 34.05 T.B. Visitors and T.B. Health Visitors—Full-time equivalent 6.0 Co-operation with Hospital Departments Health visitors attend the diabetic clinics at Greenwich District Hospital and the paediatric clinics at the Memorial Hospital. During this year it has been possible to recommence the practice of a health visitor attending ante-natal clinics and the paediatric clinic at the Greenwhich District Hospital. Problem Family Index Improvement in the staffing position has enabled rather more time to be spent in helping and supporting those families which have specific and sometimes intractable problems. In all areas of the Borough there are families needing a great deal of support in order to cope with the increasing stresses of life. Most of them are families with many children often close together in age. Such families are put on a problem family Index. There were 226 families on the Index in 1969 with a total of 381 children under 5 years of age. With the co-operation of the health visitors the Index is constantly reviewed and checked yearly. These problem families receive frequent visits from health visitors who give them encouraging help and advice and, at times, material assistance and who call in specialist help when necessary. There is con- 1ll siderable co-operation between social workers of the Housing Welfare department, the Directorate of Social Services and the Educational Services in caring for these families and working towards their eventual rehabilitation. However, problem families form only a small proportion of any health visitor's case load. New babies are visited regularly and their mothers given help and advice. The problems of toddlers, school children and teenagers all come under discussion and a great deal of help and encouragement is given to parents. The mother whose family is growing up and who wants more "outside life", those middle-aged whose families have left home and who perhaps are worried and uncertain and the elderly who are approaching retirement, all are given helpful advice and much encouragement and know that, at any time, they can call for sympathetic and practical support. There has been growth and expansion in the service along with modernisation and it is hoped that this will be continued into the 1970s. 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. During the year, 31 health visitor students were receiving field work training in the Borough. During July, August and September, 9 health visitor students who had been sponsored by the London Borough of Greenwich were doing their full-time supervised practical work in Greenwich and this entailed a great deal of preparation and supervision on the part of the centres staff. Field Work Instructor Courses Three health visitors received training as Field Work Instructors, replacing three who had left, and three Field Work Instructors went on follow-up courses. "In Service" Training Two study days were held for clinic nurses and four School nursing sisters were able to attend "in-service" training courses arranged by the London Boroughs Training Committee. Refresher Courses Four health visitors and 10 district nurses went on Refresher courses lasting one week or thirteen days and a number of 1-3 day courses were also attended by the staff. These help considerably in keeping health visitors and nurses up to date and in maintaining their interest. 112 Observation and Other Visits These visits, lasting at least half a day, were paid by 880 student nurses from hospitals in Greenwich. The sessions are an essential part of their hospital training and they entail a considerable amount of preparation by the staff participating. Other visitors (72) included Comprehensive school girls, University students and overseas visitors, all of whom spent at least half a day visiting child welfare centres, school treatment centres, etc., observing the work and the services provided. Surveys Frequently all staff, doctors, health visitors, district nurses and school nurses participate in important and necessary national surveys. The following surveys are receiving the services of Borough staff at present:— Childhood Cancers Health visiting and medical staff remain available to assist the survey undertaken by the Department of Social Medicine at Oxford University but no such deaths reauired follow up during 1969. National Child Development Survey This national survey continues to study the development of children born between 3rd March and 9th March, 1968, inclusive. During 1968, the ten-year follow up examination was carried out requiring the completion of detailed questionnaires by teachers, health visitors and school medical officers and a searching physical and developmental medical examination. A full report on the findings will be available in due course. Spina Bifida The survey by the Greater London Council Research and Intelligence Unit continued into 1969 and, at 31st March, all the 180 children in the study had been visited at least once. Analysis of the data collected is now in progress and, eventually, the results will be published. The community will have a useful prognosis of the medical, social and educational problems in the lives of these children and their families and the opportunity for forward planning must be grasped. Soon after the above investigation began, the Clinical Genetics Unit of the Medical Research Council embarked on a study of mothers who had given birth to children with spina bifida or anencephaly (a malformation of the brain which is incompatible 113 with life). This survey was combined with that of the Greater London Council so that no family was visited more than once. The aim was first to estimate the risks of these malformations occurring more than once in a family and second to study any possible metabolic triggering mechanisms which might act on a foetus already genetically predisposed to these conditions. When this second study is completed, information on these aspects of central nervous system malformations will be invaluable in genetic counselling for parents. South East Regional Survey of Certain Chromosome Anomalies and Congenital Malformations Health visitors continued to notify these cases to the Paediatric Research Unit at Guy's Hospital. The conditions studied were:— Major defects of the central nervous system Hare-lip and cleft palate Infantile pyloric stenosis Down's Syndrome, (mongolism) Intersex States Hirschsprung's Disease Autosomal chromosome anomalies Certain changes in the type of defect to be notified were envisaged for 1970. Radiation History of Parents of Mongols At the end of 1969, the Department was requested to help in another survey by the Paediatric Research Unit of Guy's Hospital. This was an attempt to obtain radiation histories of parents of mongols, matched against similar radiation histories of parents of children handicapped in other ways where there is no likelihood that exposure to radiation could be a factor. The parents studied (with certain necessary exclusions) will be those of mongols (and control children) who have attained the age of six months and have not yet reached their eleventh birthday. In Greenwich, 42 such families of mongol children have been approached for their co-operation. Research Development Project in Compensatory Education This survey, by the Education Department of the University College of Swansea, began during 1968 and continued into 1969. The aim was to discover more about the needs of infant school children and their reponse to schooling. 114 Certain medical statistics were collected relating to a sample of such children, together with other information on their homes, schooling and some background knowledge about the areas in which their schools were situated, e.g. amenities and their accessibility to the school areas. The progress of each child will be followed for three years, mainly through educational and medical records. In some cases children are given occasional short progress checks and parents are interviewed. Survey of Physically Handicapped Children in Ordinary Schools Recognition now given to the special needs of physically handicapped children tends to obscure the fact that in certain circumstances these children do not require education in special schools. In September 1969, in the the course of a national enquiry, the Department of Education and Science requested information on the number of such children, the nature and degree of their handicap, their response to the education provided for them and the extent to which they absorb too much of the teacher's time at the expense of the non-handicapped child and whether they receive sufficient medical and nursing attention. Questionnaires were completed for each child and the results are awaited. It seems likely that the extent to which physically handicapped children attend ordinary schools will depend on the facilities in the area where they live. In the larger conurbations, where provision of special schools is favoured and is sufficiently plentiful, most severely handicapped children will be placed in them. Alternatively, in the case of the less severely handicapped child, a nearby ordinary school of single storey construction with small classes and a sufficient number of interested staff would be able to accommodate the child, at least during his years of primary schooling. 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 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. 115 In Schools Mothercraft classes continue to be given by Health Visitors and School Sisters in a variety of schools including three Comprehensive schools, a school for educationally subnormal girls and a school for maladjusted children. Informal talks on personal hygiene were given to children of all age groups during regular hygiene surveys. Posters and leaflets were displayed in all Treatment Centres and, where possible, in School medical rooms. Total number of sessions given throughout the year was 413. In 1969, a new venture was started in three primary schools in the Abbey Wood area. This consisted of the showing of films on menstruation to eight year old children, mothers being given the opportunity to be present if they wished. A period for questions and answers followed each showing. Evening sessions were later arranged for parents to see the same film—this was followed by discussions led by a team of teachers, clergy, health visitor and school sister. This proved so successful that it is hoped a wider range of topics will be included in future programmes. Child Health Clinics Sessions at Child Health centres continued satisfactorily during the year although with a continuing change in emphasis. Purposes and aims of the Child Health Service at the end of the 1960s are directed towards seeking out mental and physical disabilities at the earliest moment in order to provide adequate care and treatment for the child and support for its family before the situation gets out of hand and when, possibly, no treatment or support can be of any use. Close liaison with other services and with general practitioners and paediatricians is very necessary and, during 1969, this had increased satisfactorily though there is still much work to be done before complete integration is achieved. Statistics for 1969 relating to Child Health Clinics are given in the following table:— A ttendances No. of Children born in 1969 2,913 No. of Children bom in 1968 3,055 No. of Children born in 1965/67 4,255 10,223 116 Sessions held by:— Medical Officers 285 Health Visitors 239 G.P.s on Sessional basis 1,807 Hospital Medical Staff 2,331 No. of Children referred elsewhere 349 No. of Children on "At Risk" Register 31.12.69 2,271 In addition to advice given to their mothers by health visitors, all children attending the clinics undergo a regular comprehensive medical examination aimed at the early detection of mental, physical and emotional handicaps. Close liaison with paediatricians and general practitioners enables such children to receive prompt treatment and, when necessary, special arrangements for their future education. During the year, the Department of Health and Social Security issued a circular to Local Health Authorities concerning immunisation programmes. Research has indicated that if immunisation is delayed for a month or two immunological response is improved and severe reactions to pertussis immunisation lessened. However, like most boroughs it was considered necessary to modify the scheme to meet local conditions and the amended programme was brought into operation for all new babies from August 1969. The timing of some injections can now be more widely spaced and fewer visits to the clinic or family doctor are necessary to complete a child's protection. Day Nurseries At present there is only one Borough child in the Lewisham Day Nursery which has been used since the allocation of ten places to Greenwich in 1965. Other arrangements are in operation for children who urgently need this type of care. St. Thomas's Private Day Nursery in Woolwich continues to offer places to children sponsored by the Borough as being in need of this service for medical or social reasons. During 1969, four children attended the nursery for social reasons but there was none attending at the end of the year. It is hoped to arrange a second similar scheme with a Nursery in Greenwich during 1970 and a further extension of such arrangements will do much to help certain necessitous children who are less suitable for management by one of the many excellent registered child minders who are known to the Department. Mentally handicapped children under 5 years of age also receive valuable pre-school training at Eltham Creche organised to a large 117 extent by the Greenwich Society for Mentally Handicapped Children, and supported financially by Greenwich Council. A direct interest is taken by the department in the work of the creche and the services of a Medical Officer and one of its Social Workers are made available to the group. The resultant coordination of care and interest between the Society and the Department is invaluable to the development of the child and wellbeing of the whole family. Many young physically handicapped children urgently require a similar service. Only a very small number of the less severely handicapped can be helped in "play groups" and ordinary nursery schools and nursery classes. It is anticipated that, eventually, the Education Services will be able to help with the establishment of nursery classes in schools for the physically handicapped. Such classes could act as assessment centres so that children could be observed and at the age of 5 years, if found to have a minimal handicap, they could be transferred to suitable ordinary primary school. Occasional Creche Service Occasional creches are held at three Child Health centres and these have proved to be very worthwhile. They are held once a week (one centre has two creches, each held weekly) where children under five years are cared for while their mothers attend sessions at the centre, keep hospital appointments, or go shopping on their own. The nominal charge is abated when necessary, and no charge is made to any mother who uses the service when attending hospital. Adoption, Foster Parents and Boarding Out Adoption One of the most serious social problems of the country today (although happily of no great moment in this Borough at present) is the difficulty experienced in the assimilation into society of coloured immigrants in order that hostility and discrimination may be avoided. A corollary to this situation, which is becoming progressively more important, is that of the settlement of children of differing racial origins who, for various reasons, are deprived of a family life. Responsibility, generally, for the placement of these children rests with Adoption Societies and with Children's Departments and, for most adopters, there is an obligation, under Section 3 of the Adoption Act, 1958, to notify the local authority of their intention to adopt. Health Visitors are often in close contact with such children and in some instances their records are of considerable value to the Medical Officer when his observations are sought by the various agencies concerned with adoption. 118 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. 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. The services of this organisation were not made use of during the current year. Mothers' Clubs, etc. These Clubs continue in four of the Council's health clinics. There were 98 sessions during 1969 at which 1,077 mothers met for discussion and talks by experts in a variety of skills which are useful to mothers. There were also 41 meetings of sewing clubs which attracted 668 mothers. Four other such clubs called "Home Advice Groups", two of which were held in Borough welfare clinics, were organised by the Greenwich Council of Social Service. 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 119 of the Greater London Council. When necessary representatives from other statutory and voluntary bodies are invited to attend. During 1969, no meetings were held of this Policy Committee. This again is a reflection of the fact that the Housing Case Conferences for rent arrears and the Intermediate Case Conferences, etc., have so improved team work between the statutory and voluntary services that the need for such meetings becomes correspondingly less. However, arising out of the deliberations of the Co-ordinating Committee in 1968, the Greenwich Community Project was started, with considerable financial help from two grant-making Trusts. By November, 1969, the project had engaged a Community Worker to work on a certain estate in the area. Also, during 1969, an ad hoc meeting was held by the various social service agencies and the electricity and gas boards. This meeting was to discuss the ever increasing problem of debts for electricity and gas and to explore ways of preventing this. The following are the numbers of cases discussed at the various Committees during the year:— Number of Co-ordinating Committees — Number of Intermediate Case Conferences 20 New Cases 18 Old Cases 13 Number of Housing Case Conferences 31 New Cases 132 Old Cases 48 Number of Conferences at Homeless Family Unit 10 New Cases 24 Old Cases 6 Total New Cases discussed 174 Referred by:— Borough Council Children's Department 8 Community Care Branch 30 Housing Department 85 Other Agencies I.L.E.A 5 G.L.C. Housing Department 49 Department of Health and Social Security — Hospital — General Practitioner — Family Service Unit — Other 1 174 120 Family Caseworkers and Family Aid During 1969, plans have been made to increase the establishment of Family Caseworkers to work with families who have been homeless and have had to spend some time in a Homeless Family Unit. Such families are usually more difficult to help settle into the community again and need most support and skilled help. Mrs. Waight, our Family Aid, still continues to be of great assistance to families and helps to relieve the Social Workers by giving necessary, but time consuming, support. Recuperative Holidays These holidays, providing rest, fresh air and good food for those who do not need medical or nursing care, were available under Sections 22 and 28 of the National Health Service Act for those requiring such simple treatment to maintain or regain positive health. Approximately the same use of the scheme was made during 1969 as in the previous year—indicated in the following table:— Type of Case No. Adults: Psychiatric 11 Tuberculous 5 Other Adults 106 Expectant and Nursing Mothers 5 Other Mothers 15 Infants: Accompanied 22 Unaccompanied: Aged 0-1 year — Aged 1-2 years 4 Aged 2-5 years 7 — 33 School Children: Accompanied 23 Unaccompanied 91 — 114 Total Holidays 289 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 121 to find lodgings. Occasionally, mothers requested the Children's Department to arrange for the adoption of their babies. However, where the mother wished to rear her child, every assistance was given by the health visitors with priority admission to a Day Nursery or recommendation to known child minders. During 1969, 138 women contacted the undermentioned Moral Welfare Organisations in Greenwich:— Southwark Catholic Children's Society 7 Southwark Diocesan Association 131 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 Births Ages of Mothers Number Seeking Help 3 Under 15 years — 94 15—19 65 131 20—24 years 54 52 25—29 years 14 26 30—34 years 4 28 35 years and over 1 — Not known — 334 Totals 138 Of 23 women seeking help after their arrival in London, some 18 or 78% were already pregnant. Eleven of the total of 138 given assistance were not of British origin. Welfare Foods Since the closure of the local offices of the Ministry of Food in 1954, responsibility for the distribution of National Welfare Foods has passed, via the London County Council, to the London Borough of Greenwich. Under the Ministry's scheme, food and nutrients to the extent of £5,727 1s. 0d. were sold from the Council's Health Centres and included the following items:— National Dried Milk Cod Liver Oil Vitamin "A" and "D" Tablets Concentrated Orange Juice Sales of additional proprietary foods at special prices and in the manufacturer's "welfare" packs were running at a rate of £18,000 per annum. 122 Child-Minders and Private Day Nurseries Section 60 of the Health Services and Public Health Act, 1968, demanded more stringent control of persons and premises registered in accordance with the Nurseries and Child Minders Regulation Act of 1948, by 1st February, 1969. Such a formidable task required the combined efforts of the Medical and Nursing staff, Public Health Inspectors and administrative personnel for its completion and, in March of the current year, the number of applications awaiting registration was approximately 425. Moreover, new applications were being received at the rate of 60 per month. Registrations effected by 31st December, 1969 are given in the following table and compared with those for 1968:— 1969 1968 Play Groups Registered 36 13 Places Available 829 301 Child Minders Registered 236 35 Places Available 622 198 Unsuccessful applications, as given below, were refused mainly on the grounds of unsuitability of premises:— Applications for Registration of Play Group Refused — Applications for Registration as Child Minder Refused 16 Applications for registration are now running at approximately 6 to 7 each week thus indicating a considerable interest in this work and a willingness by the public to comply with the new regulations. Despite the high proportion of children enjoying pre-school activities, which is very gratifying, there is still a need in certain areas for an extension of this service. In order to add to the value of the useful work already carried out in this field, supervisors and staffs at Day Nurseries and Play Groups are encouraged to participate in one of the courses of training which are becoming increasingly available. Registration of Nursing Homes In accordance with Part VI of the Public Heath 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. As in the previous year and under existing legislation there is only one nursing home registered within the Borough and this provides accommodation for 19 persons as under:— 123 Number of Beds Nursing Home Mental Maternity Others Lady Edith Marsh Nursing Home, 14 St. German's Place, S.E.3 — — 19 Chiropody Services A measure of the importance with which the government views chiropody services is shown by a Bill now before parliament. The Chronically Sick and Disabled Persons Bill seeks a requirement that, local authorities providing chiropody services in accordance with Section 12 of the Health Services and Public Health Act, 1968, shall give to the Secretary of State information as to the extent to which these services are used for the benefit of disabled persons under the age of 65 years. During the year, clinical chiropody in the Borough has seen the attendances fall from the 1968 figure of 41,719 to the current total of 31,321, the number of new cases from 1,546 to 740 and sessions from 5,463 to 4,007. A summary of the 1969 Report of the Council's Chief Chiropodist, Mr. K. Reeve, is given below:— The predicted fall in attendance figures was attributable to the involuntary reduction of staff to three quarters of the level of the preceding year. Staff shortage still gives rise to considerable concern and, in an attempt to alleviate the situation, a scheme of sponsored training is being contemplated for 1970 in the hope that it will ensure a nucleus of personnel for future clinics. Remuneration, which is admittedly too low, and anomalies in rates of pay for permanent and sessional chiropodists form the root cause for the shortage but it is anticipated that the recent agreement on revised scales of salaries reached in December by the Whitley Council will make local government service more rewarding for the profession. Appliance manufacture continued on a limited scale, more provision being made for materials and equipment, although a separate workshop for this part of the service was still not available. The closing months of the current year saw advances made in orthonyx work and, with the introduction of specially designed instruments to facilitate the moulding of materials used in this field, results have been extremely encouraging. It is planned to extend appliance work still further next year by the use of silicone compounds and thermoplastic materials which are light, hygienic and resistant to wear. 124 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. Chiropody Treatment during 1969 No. of Chiropodist Sessions 4,007 Attendances: Children 0- 4 years 9 5-14 years 136 145 Males 15-64 years 2,110 65 years and over 4,225 6,335 Females 15-59 years 7,859 60 years and over 17,017 24,876 Total Attendances 31,356 No. of New Patients 740 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 Pubic Health Officer but also with the Chief Chiropodist. During 1969, some 2,993 domiciliary treatments were effected in respect of 707 persons, an increase of some 12% in both treatment and case load. With such acute staffing difficulties, to ensure the greatest benefit for the genuinely housebound aged, it is essential that all referrals fall within this category—other facilities are available for those of limited mobility. DENTAL TREATMENT (Maternity and Child Welfare) F. ELSTON, L.D.S., R.C.S.Eng., the Chief Dental Officer, reports :— "It has been stated by the Ministry of Health that a satisfactory dental service would be one that provided for the examination of every expectant and nursing mother and the periodical inspection 125 of all pre-school children seeking such facilities outside the general dental scheme of the National Health Service. Furthermore, not less than 9% of a local authority dental officer's time is to be devoted to the care of mothers and pre-school children. As most practices within the National Health Service are necessarily and primarily geared for the treatment of older patients, there is a clamant need for an effective scheme devoted to the introduction of the small child to dental care. However, the Maternity and Child Welfare Dental Service functions within the framework of the School Dental Service and, as previous Annual Reports have shown, available facilities in this latter service are regrettably short of requirements. Moreover, any increase beyond the stipulated 9% of total sessions would naturally depend upon the availability of additional school dental service premises. Children under School Age The service concentrates upon the introduction of these children to dental care and treatment and the dental health education of the mother. Nursing and Expectant Mothers All cases expressing preference for the Service are accepted and their entitlement to free treatment within the general dental services of the National Health Service is explained to them. Unfortunately, our shortage of treatment facilities prompts priority concentration on the children and the postponement of active encouragement of routine treatment of mothers—particularly of dental construction —until the aim of an adequate child service has been achieved. Nevertheless, every effort is made to give guidance in the understanding and prevention of dental disease, to explain the effects of motherhood on oral tissues and to treat acute conditions when they arise. Dependence of the M. & C. W. Dental Service upon the School Dental Service demands the optimum use of time and resources so, in most cases, appointments for mothers and children are booked during school dental sessions and statistical adjustments made accordingly. The limited treatment facilities available, necessitating priority of child over mother, fall seriously short of the effective service which the community requires. Although some form of compromise is achieved under the school dental scheme by the fullest possible service to the young school child, this fails to compensate for the lack of dental supervision from an early age. Over 50% of 126 new school entrants in the Borough require dental treatment and less than 20% show good oral hygiene. Dental clinics cater for all cases whether spontaneous or referred but, in view of the considerable pressure on the treatment facilities of the school dental service, apart from a pilot scheme at one centre, no active recruitment of new patients is undertaken. During 1969, of the 1,731.5 dental treatment sessions, 1,645.3 (95.02%) were in respect of school dentistry and only 86.2 (4.98%) for the M. & C. W. Service, a total which represents little more than one half of the Ministry's recommended figure. Since this percentage consisted mainly of spontaneous requests, it is clear that organised active encouragement would result in an overwhelming of present resources with scant numerical impact on community needs. As an alternative, a more realistic approach would be to raise treatment potential to 9% of the Borough's actual young child and mother populations, currently estimated at 18,000 and 8,000 respectively, giving relative figures of 1,620 and 720 as possible patients. Making due allowance for differing treatment time requirements, this would entail an increase of 1.5 full time dental officers for children and 0.5 for mothers. Present clinic accommodation would be unable to cater for such expansion and, even if one twin surgery were available, its inaccessibility to most residents would reduce its popularity and therefore its effectiveness. This suggested alternative becomes feasible only with the introduction of new school dental service surgeries made available for the requisite amount of use by the M. & C. W. dental services. Dental auxiliaries could be of considerable help with young children but they require supervision and, therefore, the use of twin surgeries. So far, I have referred only to expansion of potential. There is, however, equal need to enlarge the scope of the service. In order to gain experience for universal application when conditions permit, a successful link-up with a toddler's clinic at one centre has been achieved by offering an introductory dental inspection of the child at the time of a physical examination, accompanied by an interview with the mother on prevention. In addition, a twenty minute talk at another centre during each 6 weeks' pre-natal relaxation course has recently been introduced, a task which could well be undertaken by a dental auxiliary. Some more fortunate authorities, with ample facilities, send a dental "third birthday" card, a practice which could be adopted with advantage, perhaps, in this Borough. Another year has passed during which the service endeavoured to cover need whilst having to acknowledge that its contribution 127 was less than adequate. It has been said that dentistry consists of two parts—one is prevention and the other "plumbing". Today, as we learn of the highest achievements in most fields of science and technology, it is difficult to understand why the elimination of a largely preventable complaint such as dental disease is left to depleted teams with insufficient facilities, particularly as the remedy is known and merely awaits application to stem the everincreasing prevalence. Reduction of dental caries and periodontal disease can certainly be effected by a change in dietary regimen but it would seem that, in general, the public is not prepared for such a step—admiration for the plump "bonny baby" and the "affluent figure" still persists. Prevalence of dental decay is greatly influenced by the frequency rather than the size of meals and the habit of "nibbling" is widespread. By definition "habit" is a "settled practice" and, in this case particularly old habits die hard. If the "in-between-meals and sweet beverages" adherents could be weaned from this habit to one of "basic meals only", a great advance would have been made with side benefits concerning the control of obesity and a reduction in heart disease risk. Advocation of such a change should be a major theme of all dental health education as should support for fluoridation. Much adverse publicity has been given to the apparent infringement on personal freedom by the addition of fluoride into water supplies, thereby leaving the consumer no option but to accept. Few people realise that the unnecessarily controversial project of fluoridation only concerns the adjustment of already existing natural fluoride to a level found in areas where its beneficial effects on teeth, namely, their high resistance to dental caries, were noted many years ago. Extensive research has proved the safety of fluoridation and no better example could be quoted of its efficacy than that of Kilmarnock. Here substantial benefits attained after a considerable period of fluoridation were lost when the measure was discontinued. Public Health dental services exist to fight dental disease. With this objective in mind, our service did what it could by way of treatment and dental health education to further this aim but, in the final analysis, it is the public's prerogative to accept or reject professional guidance in respect of personal or public preventive measures. It is to be hoped that all responsible persons concerned directly and indirectly with the promotion of health within the community will bring their influence to bear on public opinion to support the simple and economic truism that prevention is better than cure." 128 Statistical Analysis—1969 ATTENDANCES 1969 1968 First Visits 317 315 Subsequent Visits 528 511 Total Visits 845 826 Emergency Patients 50 36 TREATMENTS No. of Treatment Sessions 86.2 81.5 Total No. of Teeth Treated 609 584 (a) Mothers: No. and percentage— Filled 91 = 87.5% 48 = 90.6% Extracted 13 = 12.5% 5 = 9.4% (b) Children: No. and percentage— Filled 369 = 99.5% 439 = 99.8% Extracted 2 = 0.5% 1 = 0.2% Prophylactic Treatment 176 250 Patients X-rayed 16 14 Dentures — 3 General Anaesthetics — — All Other Operations 140 91 129 SECTION V COMMUNITY CARE There has been little time to appraise the Local Authorities Social Services Act (based upon the Seebohm Report) which is shortly to come into operation, and to estimate its eventual impact on existing services. With the introduction of this Act and the publication of a second "green paper" on the health services, a pattern is emerging which envisages the unification, outside local government, of the three branches of health services and the welding of present welfare and social facilities into a composite "Social Services" department within the ambit of local authorities. Whilst some realignment of local authority services may well be deemed necessary for particular tardy councils or where (local government reorganisation has yet to foe implemented, there would appear to be little advantage, if any, to be gained by such alteration to the health, welfare and social services of this Borough. Creation of uncertainty concerning the ultimate fate of existing services, besides being disruptive to departments generally, gives rise to misgivings and affects recruitment and staff morale—but to what purpose? Certainly before any reorganisation takes place it should be clearly demonstrated that the resultant changes would produce a better and more effective service to the public. Too often it has been found that "compartmentation" detracts from the care and attention a person receives from official sources and extensions of the practice ought not to be encouraged in spheres of public service which, when combined, are likely to have greater beneficial influence than if separately applied. "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." Such is the definition given by W.H.O. which, by implication, recognises that a division between medical and social necessity is largely artificial and illusory. Indeed, even the Seebohm Committee itself stated "the present barriers between departments and specialisms should be broken down" and, furthermore, in more than 50 other paragraphs of its Report, emphasised the inseparable relationship between health and "social" services. Ever since 1965, this department has been unswervingly dedicated towards the object of the provision of "One Door" through 130 which all persons in need of assistance or advice of whatever nature in the health, welfare and social fields could have access to the benefits of a fully integrated service. Within the confines of present financial strictures, it is difficult to visualise how the new legislation, which provides no additional services for the public, could improve on such a concept. Social service, as opposed to health service, is undoubtedly important and it has a vital part to play in the life of the community but it is essentially and of necessity concerned with alleviations of symptoms and attempts to correct existing conditions and circumstances which ought not to have arisen. It is as though one were to treat the devastating effects of smallpox on patients but failed to take precautionary measures to prevent its importation into the country. There is a yawning "no man's land" between those able to sustain themselves in the community and others who are constantly receiving assistance. The area between these extremes, i.e. the preventive field, seems to be nobody's responsibility and it is usually only when damage has been done or breakdown has occurred that help becomes available. Compared with resources allocated for relief, those devoted to prevention, both financial and professional, are relatively insignificant. Adding to this already complicated situation is the fact that improved affluence appears to be bringing in its train a decrease in the threshhold of symptom acceptance and, benefits accruing as a result of technological and medical advances are likely to be offset by increased demands for our services. Undoubtedly, today's rising family affluence is more than ever dependent upon the married woman's excursions into the business and industrial worlds—excursions which are becoming progressively more permanent and often at a time when her children are less mature—hence a mounting insistence for more day nurseries and child minder facilities. For good or ill, it is clear that modern society condones and even encourages these ohanges, but, unfortunately, the acquisition of the car, refrigerator, colour television, etc., far from maintaining happiness and harmony in the home, often precipitates their destruction. Nowadays, for many young people, when beset and bewildered by life's complexities, home is no longer the warm, mellow haven of comfort and solace of yesteryear and, in many instances, consolation or redress is sought elsewhere, sometimes with disastrous results. There is evidence to suggest that sections of our adolescent population need a restoration of the quality of 131 family life but, in these days of new-found "freedoms", such an achievement would be little short of miraculous. Apart from this fundamental alteration in the pattern of life, i.e. from one of close personal family relationships to that predominantly of mercenary acquisition, other disadvantages flow from the modern concept of both parents being "bread winners". Economically, the family with two "wage-earning" parents contributes to the maintenance of high prices, much to the detriment of the "one wage-packet" household. Moreover, a vicious circle is established in that, to perpetuate the rise in standards of personal comfort, the "temporary" married female employee is constrained to become "permanent" and the family with only one bread winner becomes correspondingly and relatively poorer and in greater need of support. Family life disintegrates and enlargement of service departments and their staffs, all of whom rightly seek suitable career structures, is thereby stimulated and professionalism in the social field is increased. Inevitably this leads to a greater proportion of available finances going to those who provide the services rather than to those who need them and, with limited resources, quality begins to conflict with quantity. In the financial climate of recent times, understandably, much has been made of the "business" approach to local government services and, in particular, their "cost effectiveness". Whilst it cannot be denied that there are aspects which could perhaps benefit from such analyses, their value in the health, welfare and social fields is questionable. There has always been an under-estimation of services whose worth to the community has never really been determined, simply because it is indeterminable. How does one cost disability, whether physical or mental, or the human misery bound up with incurable disease and in environmental conditions which we know are not capable of solution for a generation or more? Who is to say that training schemes for the educationally subnormal or bathing and incontinent laundry facilities for infirm elderly people are effective, costwise—and effective for whom? Persistent ill-health, in whatever form, is costly both individually and collectively but results from efforts taken for its prevention or alleviation cannot, with justice, be measured by a financial yardstick. Indeed, once schemes introduced for cogent health or compelling social reasons have been successfully launched, they cannot be expected to function efficiently if, subsequently, they become parsimoniously circumscribed. Profligacy, in whatever guise, must be ruthlessly eliminated but our drive for improvement, 132 ment, expansion, call it what you will, should be motivated not by financial implications but to the end that the community will become healthier and less dependent upon the welfare and social services. However, whether public expenditure should be directed towards these particular aims is a decision outside our control. Today, life is being lived at an ever-increasing rate leaving many people, especially the very old and the young, at times bewildered, irritated and frightened. Is it any surprise that the incidence of mental breakdown is rising or that more adolescents are sorely tempted to become "drop-outs"? Preventive medicine, although perhaps differently directed, far from being effete is as vitally necessary as ever it was. Nationally, we suffer from financial myopia. In the preventive field, where advantages are not immediately apparent, we tend to be cheeseparing whereas with the more spectacular curative procedures we are considerably more avuncular. But the nation will disregard preventive measures at its peril. It would be as well to remember that, due to increased longevity, some children born today are likely to be alive in 2070 or even 2090 along with all the major social problems this entails. Any authority which takes no cognisance of this situation cannot be planning seriously for the future. General Lack of trained personnel in the community care field is universal and the secondment of existing officers to various courses constitutes a handicap to which the department must submit if any advancement in the quality of the staff is to be achieved. Despite the fact that three mental health social workers were seconded for professional training, with the exception of one ward, domiciliary visiting was maintained at a satisfactory level throughout the year and all emergencies were met. Only by the unstinting efforts of the available staff was this made possible. On 2nd October, 1969, our new Industrial Training Centre for 60 mentally handicapped adults at Tunnel Avenue was officially opened. Two occupational therapists recruited during the year undertook domiciliary visits to ascertain need and give advice on aids and adaptations for the use of the handicapped. A further two residential homes for elderly people were completed and put into service during 1969 and the Calderwood Street Lunch Club was established. 133 Again, due to staff shortages, manning of the Reception Room became difficult but the absence of complaints indicates how successfully this was accomplished. Homes for Old People Accommodation available in the Borough for the reception of old people in need of care was augmented by two purpose-built homes which were completed and occupied during the year— "Tegel", at 11 Simnel Road, S.E.12, in May, and "Elmgrove", at 78 Walmer Terrace, S.E.18, in November. Both are 60-bed homes each with a Special Care Unit for 16 persons and facilities for the establishment of a Day Centre for some 40 persons. A further home of similar capacity is expected to be established during the latter part of 1970. With the opening of the two new homes our aim, viz., to have within the Borough boundaries all our own elderly people in Part III accommodation, has now been achieved. Of the Greenwich residents in Southern Grove Lodge, the majority were transferred to our new homes and an arrangement was made with the London Borough of Islington for the remaining 24 residents, who were the responsibility of Greenwich but who had no real connection with the Borough, to be accommodated at Hillside Home for the Retired, at 129 St. John's Way, N.19. Admissions The "admissions panel" led by the Deputy Medical Officer of Health continued to function most effectively in assessing the degree of urgency attaching to the needs of elderly people known or referred to the various branches of the Department. Admissions at 614 showed an increase of 100 over the previous year and fell into the following categories:— (i) New Admissions Greenwich Small Homes (including two short- stay cases) 92 Southern Grove Lodge 51 (ii) Holiday Admissions (scheme to give relief to relatives and others caring for old people and otherwise unable to take a holiday) Greenwich Small Homes 48 Southern Grove Lodge 3 Other Homes 11 (iii) Re-Admissions (mainly from hospitals and holidays) 409 134 Part III Accommodation—Statistics Old People's Homes 1st Jan., 1969 Nos. in Residence 31st Dec., 1969 Nos. in Residence Males Females Total Admitted Died Discharged or Transferred Males Females  Elmgrove _ 55 2 16 37 53 Perrygrove Plumstead Lodge 25 17 32 69 57 86 78 91 3 1 73 84 25 18 34 74 59 92 Sunbury Lodge 14 45 59 77 6 70 15 45 60 Tegel 105 47 31 27 58 Weybourne 19 37 56 101 9 89 20 39 59 'Southern Grove Lodge 83 65 148 107 14 241 — — — Totals 158 248 406 614 33 606 125 256 381 * London Borough of Tower Hamlets One Hundred "Not Out" A resident of Weybourne, Miss Edith Perkins, celebrated her 100th birthday on 8th September of the current year. The Matron and her staff arranged an informal party to mark the occasion which was attended by the Mayor and Mayoress. Miss Perkins received a telegram from the Queen and the gift of a rocking chair purchased from the proceeds of a collection by the landlord of a local public house. Recreation Handicraft instruction, television and radio are provided in all six homes and, in addition, the day-to-day routine of life is varied for the residents, in summer, by outings to the coast and country and, in winter, by colour film shows. "Bingo" sessions are still popular and the occasional party is always a welcomed event. Exchange Holidays Holidays for residents were arranged on an exchange basis with two other local authorities, those of East and West Sussex County Councils. In these exchanges 24 residents were involved with East Sussex and 11 with West Sussex. During the fortnight's holiday, escorted outings were planned for the Out-County residents who were given the opportunity of 135 visiting places of interest in the Borough and in Central London. Reciprocal arrangements were made for the Greenwich residents on holiday in Sussex. These holidays, which were very successful, are to be repeated in future years when it is hoped to include in the scheme other local authorities such as the Council of the County Borough of Brighton. 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. Whenever possible, transfers are arranged to meet the wishes of residents. Staff No difficulty was found in recruiting subordinate staff for our homes but the replacement of senior supervisory staff was not always accomplished expeditiously. Voluntary Homes Visits to Greenwich residents maintained in voluntary homes continue to be made by Officers of the Directorate. In these special establishments the number of persons being maintained on behalf of this Council rose slightly during the current year as the following table indicates:— Voluntary Establishments For 1st Jan., 1969 Admitted Discharged or Died 31st Dec., 1969 No. of Homes No. of Residents No. of Homes No. of Residents Aged 21 29 8 5 22 32 Blind 8 9 1 1 8 9 Epileptics 3 6 3 6 Physically Handicapped 16 21 5 3 18 23 Deaf and Dumb 2 3 — — 2 3 Totals 50 68 14 9 53 73 Other Local Authority Homes With regard to Greenwich residents being maintained in the homes of other local authorities, the position is as shown overleaf. Those in Southern Grove Lodge are not included in the statistics for 1st January, 1969, but former residents of the Lodge transferred to Hillside Home for the Retired have been included in the numbers indicated as being in residence at the end of the year. (vide page 134.) 136 Homeless Families Compared with the previous year, there was a slight decrease in the number of families seeking help on account of homelessness and also of those accepted into residence. Families continued to receive case-worker support, as a result of which there was a further fall in the number in residence at the end of the year, viz. 48, a reduction of 16 (33⅓%) since 1st January, 1969. Some 86 families were rehoused during the year by this Council and 6 by the Greater London Council compared with 96 and Nil respectively for 1968. Homeless Families Accommodation—Statistics Application for Admission (1st January—31st December, 1969) Number of Applications* 206 Number accepted into Residence 131 Excludes numerous preliminary enquiries not amounting to applications. Homes—Admissions and Discharges Resident at 1st Jan., 1969 Admissions Discharges Resident at 31st December, 1969 Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons Families Men Women Children Persons 'Summercourt' 3 2 3 3 8 117 65 120 251 436 117 67 119 251 437 3 — 4 3 7 158a Plumstead High Street 58 45 58 136 239 95 76 94 221 391 112 90 111 250 451 41 31 41 107 179 32 Charlton Road 3 3 3 9 15 6 6 6 15 27 5 5 5 12 22 4 4 4 12 20 1st Jan., 1969 Nos.in Residence 31st Dec., 1969 Nos. in Residence Males Females Total Admitted Died Dischaiged or transferred Males Females Total 7 17 24 28 5 — 22 25 47 137 Families Rehoused Families Men Women Children Persons By Greater London Council 6 1 6 8 15 By London Borough of Greenwich 86 64 85 197 346 By other Local Authorities — — — — — Found own accommodation 37 19 35 86 140 Left for other reasons 18 13 18 34 65 147 97 144 325 566 Family caseworker efforts have been concentrated on the homeless families at 158a Plumstead High Street, and on those who have been rehoused from this Unit. Staff shortages curtailed the assistance and benefits stemming from this arrangement. Unsupported Mothers and Babies During the year, the department gave financial help to 22 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 120.) Again this department made no firm progress towards its own "mother and baby" hostel although plans have been discussed which visualise the acquisition and conversion of a standing property in the Borough for this purpose by 1973. By reason of the continued successful operation in the area of a Greenlow Society hostel the need for a Council establishment is becoming somewhat less urgent than hitherto. Supported by this department, five mothers were admitted to the Greenlow Society's Hostel of whom two were still resident at the end of the current year. 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 impracticable, a solution is sought by the department which endeavours to give the handicapped the greatest of physical and mental freedom compatible with his/her underlying condition. Happily, legislation now before Parliament will give local authorities greater opportunities to assist these particular sections in their communities. About to reach the Statute Book is the 138 Chronically Sick and Disabled Persons' Bill which amounts almost to a "charter" for the disabled. Although unlikely to be opposed, its implementation cannot be expected to begin over-night if for no other reason than the financial implication, a circumstance which local authorities could not have foreseen and made provision for in their current estimates. However, much of what the Bill contains is already common practice in this Borough and, apart from expansion, no drastic alteration in our services is anticipated. From 6th to 11th October the Borough participated in the "Help the Disabled Week" and an exhibition on the theme of "Serve the Disabled" was held at the Victoria Hall, Woolwich. Several statutory and voluntary agencies provided exhibits and the Health Education Section set out displays illustrating the services provided by the Directorate. Attendances at this exhibition, however, were somewhat disappointing. Unfortunately, the Victoria Hall is not accessible to many handicapped persons and it has to be acknowledged that there is no alternative suitable venue within the Borough. Arrangements for holidays, shopping expeditions and Christmas parties continued as before with great success. 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 efforts made to make these registers more comprehensive is shown by the overall total which, at the end of the year, was 115 higher than that for 1968. The following table gives the numbers in the various registers and the rates which these represent per 1,000 population. No. Rate per 1,000 pop. Blind 421 1.85 Partially Sighted 186 0.82 Physically Handicapped 1,412 6.21 2,019 8.88 The rate of registered blindness in Greenwich at 1.85 is slightly more favourable than that for Greater London (2.11) and for England and Wales (2.09). 139 There were 56 deaf persons on the physically handicapped register of whom 15 were also dumb, although this was not necessarily their main disability. Some 880 old persons, not registered as physically handicapped, were reported by the geriatric visitors as being deaf. 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 9,085, compared with a figure of 9,643 for 1968, equivalent to a fall of 5.7%. 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 178 24 280 Routine/Subsequent 1,742 322 5,499 Teaching 107 15 12 Non-effective 388 56 462 Totals 2,415 417 6,253 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. 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 140 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. Registers Registers of blind and partially sighted persons are maintained. New cases which come into notice are referred from many sources including the Department of Health and 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 52 new cases added to the register during the year, 39 (75%) were over the age of 65 years and none under one year. Registered Blind cases at 421 (167 males and 254 females) showed a decrease of 21 from the previous year. With regard to the partially sighted, of the 23 cases newly registered, 18 (78.3%) were over 65 years of age and there were four under the age of 15 years. 141 Blind Persons Register (as at 31st December, 1969) (New cases in brackets) AGE GROUP Number Registered Age at Onset of Blindness M F Total M F Total 0-1 year — — - 17 24 41 1 year — — — 1 1 2 2 years — — — 4 2 6 3 years — 1 1 1 1 2 4 years — 1 1 3 1 4 5-10 years 3 (1) 2 5 (1) 8 10 18 11-15 years 1 1 (1) 2 (1) 2 2 4 16-20 years 5 2 7 4 3 7 21-29 years 6 5 11 8 8 16 30-39 years 9 12 21 22 17 39 40-49 years 16 (1) 9 25 (1) 14 16 30 50-59 years 19 (1) 23 (3) 42 (4) 21 27 48 60-64 years 20 (5) 17 (1) 37 (6) 9 22 31 65-69 years 13 (2) 20 33 (2) 7 25 32 70-79 years 38 (7) 65 (8) 103 (15) 31 55 86 80-84 years 26 (5) 45 (12) 71 (17) 9 27 36 85-89 years 7(1) 35 (3) 42 (4) 3 12 15 90 and over 4 16 (1) 20 (1) — Unknown — - - 3 1 4 Totals 167 (23) 254 (29) 421 (52) 167 254 421 Blind Persons under 16 Years Male Female Aged 2 to 4 years Unsuitable for Education at School: At Home or Elsewhere - - Suitable for Education at School: At Home or Elsewhere 2 Aged 5 to 15 vears Suitable for Education at School: At Special School for Blind (no other defects) 1 - At Other School — 1 Not at School No other defects 1 - With other defects 1 — Unsuitable for Education at School: At Home (no other defects) 1 1 At Home (with other defects) — 1 4 5 142 Blind Persons 16 Years and Over Education, Training and Employment (i) employed and at school AGE GROUPS At School EMPLOYED Under Sheltered Conditions Ordinary Conditions Total Special WorkShops Home Worker Schemes Employ ed M F M F M F M F 16-20 years - - - - - - 1 - 1 21-39 years — - 1 - - - 7 5 13 40-49 years - - 3 - 1 - 5 3 12 50-59 years - - 5 - 2 3 5 6 21 60-64 years - - 4 - 1 - 6 3 14 65 and over - - 1 - - - - - 1 TOTALS - - 14 - 4 3 24 17 62 (ii) TRAINING OR NOT EMPLOYED Male Female Undergoing Training: For Sheltered Employment 2 — For Open Employment 1 — Not Employed: Trained for Sheltered Employment 1 2 Trained for Open Employment — 2 Employable subject to Training: Suitable for Sheltered Employment 1 1 Suitable for Open Employment — 1 Employable without Training: Suitable for Sheltered Employment — — Suitable for Open Employment 5 3 Persons Registered Disabled 29 12 (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 3 14 1 7 _ _ 25 Not capable of Work 16 12 4 6 _ _ 38 Not Working - - - - 87 181 268 TOTALS 19 26 5 13 87 181 331 143 (iv) OCCUPATIONS OF EMPLOYED BLIND PERSONS Occupations Sheltered Conditions Ordinary Conditions Totals Special Work shops Home Worker Schemes Masseurs and Physiotherapists – – 1 1 Lecturers, Teachers and Instructors 1 – – 1 Social & Related Workers – – 1 1 Other Professional Workers – 1 2 3 Typists and Secretaries – – 9 9 Braille Copyists and Proof Readers – 1 – 1 Clerical Workers – – 2 2 Telephone Operators – – 5 5 Shop Managers and Proprietors – 1 1 2 Sales Representatives – – 1 1 Street Vendors – – 1 1 Machine Tool Operators – – 1 1 Fitters and Assemblers – – 3 3 Viewers, Inspectors and Testers – – 1 1 Warehousemen, Storekeepers – – 1 1 Boxers, Fillers and Packers – – 1 1 Knitters and Weavers – 2 – 2 Basket Makers 9 2 – 11 Mat Makers 3 – – 3 Brush Makers 1 – – 1 Labourers – – 4 4 Domestics, Porters, etc. – – 3 3 Launderers, Dry Cleaners – – 3 3 Miscellaneous Service Workers – – 1 1 TOTALS 14 7 41 62 (v) BLIND PERSONS—IN-RESLDENTS (16 years and over) Residential Accommodation (1948 Act, Part 111 (21)) Male Female Homes for Blind 3 5 Others 4 14 Homes (N.H.S.A. 1946—Section 28) – 1 Other Residential Homes – 1 Hospitals for Mentally 111 – 1 Hospitals for Mentally Sub-normal 4 7 Other Hospitals Total 11 29 144 Partially Sighted Persons Register (as at 31st December, 1969) AGE GROUP Number Registered 31.12.69 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 – 1 1 – – – – – – – 5-15 years 2 1 3 – – – – – – – 16-20 years 2 – 2 – – 4 – – – – 21-49 years 19 16 35 3 – 3 – – – – 50-64 years 8 11 19 1 1 2 2 2 – – 65 and over 32 94 126 5 13 18 2 4 – – TOTALS 63 123 186 9 14 23 4 6 – – Training and Employment (16 Years and Over) AGE GROUPS Employed Unemployed and not under Training Training TOTAL Available and capable of 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 5 1 2 – – 4 – 12 50-64 years 2 2 – – 1 – – 5 65 and over 1 – – – 14 54 – 69 TOTALS 8 3 2 – 15 58 1 87 (ii) Persons mainly Industrially Handicapped 16-20 years – – – – – – – – 21-49 years 8 4 3 1 1 6 – 23 50-64 years 1 1 2 1 2 6 – 13 65 and over – – – 1 12 36 – 49 TOTALS 9 5 5 3 15 48 – 85 145 Sheltered Employment Due to retirement, there was a further fall in the total number of registered blind employees in the Greenwich Workshops for the Blind which is administered by the Directorate. To the existing Mattress, Fend-off and Basket Departments the possibility of adding a new department (that of woodworking, making mainly toys) was explored but finally discarded. As previously reported the present workshop buildings are antiquated and unsuited to modern manufacturing requirements. Comprehensive developments must, however, depend upon the Report, which is still awaited, of the Working Party set up to consider the needs not only of the blind but also of other physically handicapped persons in South East London. Blind Homeworkers There is a scheme for the employment of the blind in their own homes for which the Directorate 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. (f) Free loan of a spark guard. 146 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 or Taxes. Welfare of the Physically Handicapped A breakdown of the main conditions registered with the department is given in the following tables. It will be seen that, in accounting for 486 (34.4%) out of a total of 1,412, "organic nervous diseases" form the largest group of which over two-fifths were hemi or paraplegics and one-third spastics or polio victims. With a figure of 410 (28.7%), rheumatic disability constitutes the next largest section and, of these, one-third were classified as rheumatoid arthritis. Much can be done to minimise handicaps arising from neurological lesions; consulations 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. 147 Physically Handicapped Register at 31.12.69 Primary Disabilities DISABILITY GROUPS SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 11-20 21-30 31-40 41-50 51-60 |61-64 65-70 71-80 81-90 90 & over Males Females Amputation M – – 4 2 3 24 9 18 20 7 – 87 28 } 115 F – – 1 – 2 1 4 6 9 5 – Rheumatism M – – – 3 5 5 7 15 12 8 – 55 355 }410 F – 1 2 2 9 39 37 54 139 66 6 Deformities, etc. M – – 3 – – 6 1 2 3 1 – 16 17 } 33 F – 2 3 3 – 5 – 1 2 1 – Systemic Diseases M – – 3 1 8 9 18 13 5 3 – 61 52 } 113 F – 1 4 1 4 13 4 14 8 2 1 Injuries and diseases M 1 6 7 4 4 11 6 6 3 3 1 52 76 } 128 F 1 3 7 7 8 9 5 14 18 4 – Organic Nervous Diseases M 4 15 27 18 43 49 27 28 21 3 – 235 251 } 486 F 1 14 21 16 34 47 26 36 46 10 – Neurosis M – 1 1 – – 1 3 – – – – 6 9 } 15 F – – 2 – 3 2 1 – 1 – – Tuberculosis M – – 1 – 1 3 1 1 1 – – 8 3 } 11 F – – – – 1 1 – 1 – – – Other M – 1 4 3 2 9 5 3 5 2 – 34 67 } 101 F – – 3 1 9 9 7 9 17 12 – Totals M 5 24 50 31 66 117 77 86 70 27 1 554 858 F 2 21 43 30 70 126 84 135 240 100 7 Grand Totals 7 45 93 61 136 243 161 221 310 127 8 1412 (i) Analysis of "Rheumatism" Group DISABILITY SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 11-20 21-30 31-40 41-50 51-60 61-64 65-70 71-80 81-90 90 & over Males Females Arthritis M – – – 2 2 2 5 6 10 5 – 32 176 } 208 F – – – 1 3 16 4 44 62 42 4 Rheumatoid M – – – – 1 3 2 1 2 1 – 10 132 }142 F – 1 2 1 5 22 30 2 54 13 2 Osteo-Arthritis M – – – 1 2 – – 8 – 2 – 13 47 }60 F – – – – 1 1 3 8 23 11 – Totals M – – – 3 5 5 7 15 12 8 – 55 355 F – 1 2 2 9 39 37 54 139 66 6 Grand Totals – 1 2 5 14 44 44 69 151 74 6 410 148 (ii) Analysis of "Disease of Systems" Group DISABILITY SEX AGE GROUPS (in years) TOTALS GRAND TOTALS 0-10 11-20 21-30 31-40 41-50 51-60 61-64 65-70 71-80 81-90 90 & over Males Females Bronchitis M – – 1 – 3 – 3 6 2 2 – 17 10 }27 F – – 1 – 2 2 1 3 – 1 – Heart Diseases M – – 2 – 3 4 6 4 – 1 – 20 25 }45 F – – 3 1 2 6 1 6 4 1 1 Sclerosis M – 1 _ – 1 5 9 3 1 – – 20 16 }36 F – 1 – – – 4 2 5 4 – – Others M – – – 1 1 – – – 2 – – 4 1 } 5 F – – – – – 1 – – – – – Totals M – 1 3 1 8 9 18 13 5 3 – 61 52 F – 1 4 1 4 13 4 14 8 2 1 Grand Totals – 2 7 2 12 22 22 27 13 5 1 113 (iii) Analysis of "Organic Nervous Diseases" Group DISABILITY SEX AGE GROUPS (in years) TOTALS 0-10 11-20 21-30 31-40 41-50 51-60 61-64 65-70 71-80 81-90 90 & over | Males Females GRAND TOTALS Spastics M 1 3 5 9 9 6 3 2 4 – – 42 55 } 97 F 1 8 5 4 7 5 9 8 5 3 – Hemi-and Para-Plegia M 2 2 12 1 13 21 12 21 12 1 – 97 106 }203 F – 1 4 4 9 29 8 15 30 6 – Epilepsy M – 1 5 4 7 7 2 3 3 1 – 33 44 }77 F – 2 7 4 8 6 3 7 6 1 – Poliomyelitis M 1 6 2 2 9 10 7 2 2 1 – 42 25 }67 F – 2 4 3 5 2 3 5 1 – – Encephalitis M – 2 1 – – 1 1 – – – – 5 8 }13 F – – – – 2 3 2 – 1 – – Parkinson's Disease M – – 1 2 5 1 – – – – – 9 8 }17 F – – – – 1 2 1 1 3 – – Friedreich's Ataxia M – – – – – 2 1 – – – – 3 3 }6 F – 1 1 – 1 – – – – – – Other M – 1 1 – – 1 1 – – – – 4 2 }6 F – – – 1 1 – – – – – – Totals M 4 15 27 18 43 49 27 28 21 3 – 235 251 F 1 14 21 16 34 47 26 36 46 10 – Grand Totals 5 29 48 34 77 96 53 64 67 13 486 149 (iv) Additions and Removals—Physically Handicapped Register DISABILITY GROUPS Sex Number at 31.12.68 Additions during yr. Deletions during yr. Number at 31.12.69 Amputation M 72 21 6 87 F 31 4 7 28 Rheumatism M 61 8 14 55 F 326 64 35 355 Deformities M 23 2 9 16 F 25 1 9 17 Systemic Diseases M 52 19 10 61 F 48 13 9 52 Injuries and Diseases M 44 8 – 52 F 66 14 4 76 Organic Nervous Diseases M 197 50 12 235 F 214 45 8 251 Neurosis M 6 – – 6 F 8 1 – 9 Tuberculosis M 11 2 5 8 F 2 1 – 3 Other M 25 13 4 34 F 58 10 1 67 Total M 491 123 60 554 F 778 153 73 858 Grand Totals 1269 276 133 1412 Reference to table (iv) shows that although the number of registrations viz. 1,412, is an increase of 143 over the figure for the previous year, there were actually 276 new registrations during the current year with 133 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, so far as is practicable, the intermingling of persons with differing 150 handicaps. These establishments provide members with facilities not only for training and adjustment but also for pastime activities, handicrafts, etc., and with opportunities for social contact with others of similar disability and with similar interests. In this way, the clubs make an invaluable contribution towards the social rehabilitation of members. Tuition and help in diversionary occupation is provided for those unable to enjoy these benefits. Social Rehabilitation Centre, Ormiston Road Open the whole week, this Centre provides eight half-day sessions for the physically handicapped and one full-day (Tuesday) for the partially sighted, with a midday meal for all attending. Some persons arrive on foot or by public transport but most have to rely upon the Council's special coaches or Invacars for their attendance. Some 120 people are catered for each week. Since the introduction of Combined Centres the tendency for the elderly handicapped to concentrate at this establishment persists and is likely to continue until sufficient special transport can be made available to enable them to take advantage of the Day Centres for the elderly. Although the services of a full-time qualified occupational therapist have been obtained, the demands made on her time by domiciliary visiting limits her activities as Centre Supervisor. A full-time female attendant was appointed during the year and her assistance has proved invaluable. There is a constant waiting list for places at this Centre. 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. Combined Day Centres During 1968, 2 combined Day Centres were brought into operation, one at Federation Hall, Abbey Wood, and the other at Riverdale, 158a Plumstead High Street, catering for 60 and 45 mentally ill and physically handicapped persons respectively. 151 Mixing the physically handicapped and the mentally ill is an experiment which has proved most successful, for the readiness of these persons with differing handicaps to assist each other has resulted in substantial mutual benefit. On her last visit, a Ministry Welfare Officer agreed that these ventures had prospered and that the practicability of such schemes had been proved. Once again there was difficulty in admitting as many physically handicapped persons as we would have liked owing to lack of suitable transport. Vacant places could always have been filled by the mentally ill but this would have disturbed the balance and efficacy of mixed groups and thereby vitiated our agreed policy. Seaside outings, Christmas parties and visits to the theatre have been arranged by both Centres. Federation Centre Progress at the Centre was maintained and interest sustained by the variability of the work which has been mainly contract woodwork such as interwoven fencing, scissor racks, display frames, repairs to department's office furniture, making of aids for the physically disabled and some simple carding and display of stationery supplies. Our aim to introduce two lathes during the current year was circumvented by difficulties with the District Surveyor and owners of property regarding the provision of an external store. This would have freed the internal store for the installation of machinery thus enabling the Centre to become even more progressive. There are hopes that the situation will be resolved during the coming year. Riverdale Centre This Centre, besides having to cope with premises which are somewhat less than ideal, caters for the more chronic type of physically handicapped and, therefore, cannot hope to make substantial advances. However, it does meet the needs of a number of persons and the more severely handicapped young are accommodated in a separate room and provided with special care. A small group of chest cases also uses this Centre one afternoon each week. Persons attending the Centre do so mainly on a one, two or three day basis although a few attend for five days per week. Because the capability of these people is lower than that at the Federation Centre, work is restricted to carding and display of stationery 152 supplies, wiring, soldering, making electrical lamp shades and electric light sockets, and repair and repainting of roadwork signs. A trainee social worker is present daily to assist and a qualified teacher from the I-L.E.A. attends for two sessions per week. 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 72 persons benefited from a variety of works, including the provision of hand-rails, grab-rails, ramps, etc. 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 During the year the Council received, on behalf of chronic renal failure patients, 8 hospital requests (2 from the Royal Free, 3 from Guy's and 3 from King's College) for the installation of home dialysis units. Following the precedent set in 1967, 5 adaptations were carried out at a cost to the Council of £200 to £400 each, depending upon the home circumstances and type of property, with the remaining 3 cases under active consideration. In one instance however, after alterations had been made, the patient subsequently decided to remain under constant hospital care. In situations where premises are not adaptable aid is sought from the Housing Department for alternative accommodation. Under powers contained in Section 28 of the National Health Service Act, 1948, it is now the Council's policy to accept full responsibility for such adaptations and that no charge is to be made to the patient. At least once a week special arrangements are made for the collection and disposal of waste arising from the use of dialysis machines in the home. 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 3,383 as compared with 2,821 during the previous year which represents an increase of almost 20%. The following table shows particulars of these loans. 153 Equipment Number Loaned 1969 1968 Bathing Aids Bath Boards 28 16 Bath Mats 144 116 Bath Rails 101 72 Bath Seats 131 105 Bed Aids Air Ripple Bed 40 27 Air Rings 74 103 Back Rests 247 227 Bed Blocks 4 4 Bed Cradles 145 155 Bed Pans 147 129 Fracture Boards 24 29 Mackintosh Sheeting 214 211 Slings 18 — Sorbo Rings 145 141 Urinals 142 109 Beds Adult Cot 5 6 Egerton Bed 2 1 Hospital Bed 27 33 Zed Bed 4 4 Chairs Bambino Toilet Training 3 — Court Self Lift 2 — Powell Ejector 1 — Closets Chemical 1 — Commodes Armchair 571 518 Mobile 3 — Others 12 4 Domestic Aids Brooms 3 — Combs/Holders 1 3 Dustpans 3 — Fireguards 64 39 Pick Up Aids 57 37 Shoe Horns 10 4 Shoe Laces 8 5 Sparkguards 8 7 Spoke Boards 2 — Sponges, Longhandled 2 — Stocking Aids 17 24 Suction Cross 1 — Tap-Turners 1 2 Trolleys 9 2 Wall Can-openers 3 1 154 Equipment Number Loaned 1969 1968 Ealing Aids Cutlery 35 13 Egg Cups 1 — Feeding Cups 4 — Food Guards 6 3 Hoists Easi-Carri 15 13 Zimmer Patient Lifter 2 2 Lifting Poles, Handles and Chains Handy Spring Pole 15 — Lifter-Penryn 18 21 Mattresses Dunlopillo 30 28 Easi-nurse 2 2 Hair 12 11 P.C.P 9 9 Scales Premature Baby 7 5 Tables Cantilever 4 — Overbed 4 — Toilet Aids Raised Toilet Seats 73 41 Toilet Aid (Easi-fit) 19 6 Toilet Aid (Zimmer) 32 23 Toilet Air Rings 6 4 Toilet Seat, Inflatable 2 — Walking Aids Elbow Crutches 15 17 Quadruped Aid 8 2 Tripod Aid 38 32 Walking Frames 193 164 Walking Sticks 117 71 Wheelchairs Indoor 100 52 Outdoor 192 168 Total Issues 3,383 2,821 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 155 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. 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. During the year 394 applications were received of which 111 were subsequently withdrawn or cancelled. Eventually 279 holiday places were allocated thus showing an increase of 18 over the previous year's figure. Of these, 136 together with 20 fit spouses were accommodated at the Little Oyster Holiday Centre, Minster, Isle of Sheppey, where two periods, each of a fortnight, were booked by the Borough. During the holidays at this Centre, attention to the personal care of the handicapped persons was provided by 20 voluntary helpers including "Task Force", the British Red Cross Society, the Directorate's own staff and private individuals. Daily entertainment was arranged by the Holiday Centre staff and this included outings to various parts of Kent including Aylesford Priory, Canterbury, Herne Bay and the hop gardens. One of the Department's tail-lift coaches was available throughout the holiday, and this proved of immense value in ensuring that the more severely handicapped were enabled to participate in most of the activities. Christmas and New Year Parties A total of 387 persons attended at Christmas and New Year Parties arranged by the Directorate. Of the ten parties held, two were at Sherard Hall, Court Road, Eltham, for the blind, partially sighted and deaf, four at Ormiston Road Centre for their physically handicapped members and four at Maze Hill Training Centre for homebound handicapped persons. 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. Therefore, as in previous years, to enable these persons to shop in comparative comfort a Christmas shopping expedition to central 156 Woolwich for about 150 was organised for Wednesday, 19th November. Seven of the larger shops remained open between 5.30 and 8 p.m. and their staffs, who worked voluntarily and without pay, showed extreme kindness and courtesy to the shoppers. Moreover, four of these stores provided refreshments without charge and the R.A.C.S. allowed us free use of their car park. Whilst handicapped persons were encouraged to make their own way to the shops and 20 managed to do so, some with the aid of Invacars, such a venture would have been impossible without the able assistance of members of the police, "Task Force", British Red Cross Society, St. John's Ambulance Brigade and volunteers from the Borough's own staff. On this occasion our own transport was supplemented by vehicles from the London Borough of Lewisham and the Inner London Education Authority. With their own escorts and transport, over 50 handicapped persons from the London Borough of Bexley were also able to participate in the expedition. 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. Indeed, the success of all functions arranged for these groups depends upon its adequacy and the ready co-operation of the drivers. The Council's transport for the disabled comprises a fleet of ' minibuses and six specially designed coaches equipped with a taillift 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. 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. Some impetus to the extension of these services is certain when the Chronically Sick and Disabled Persons Act of 1970 is fully implemented. Substantial future benefits from our policy of appointing trainee social workers are foreseen with the acceptance of 3 of our 157 personnel for professional training during 1969/70 and a fourth during 1970/71. From this it would appear that effective basic training received in this Directorate has some bearing upon acceptance for professional courses. MENTAL HEALTH SERVICES Early legislation in the field of mental health resulted in the introduction of large institutions of up to 2,000 beds capable of catering for all ages with ranging disabilities and erected remote from the areas they served on the assumption that these hospitals would be "self-sufficient" communities. Eventually these establishments became overcrowded, difficulties of staff recruitment arose, co-operation with local health authorities became unnecessarily complicated and prolonged and, on occasions, acceptance by neighbourhood inhabitants a problem. Although some power was vested in local authorities by Section 28 of the 1946 Act, it was not until the Mental Health Act of 1959 that the duty of providing residential services for the mentally handicapped not requiring hospital treatment was really made a local authority responsibility. As a direct result, the provision and expansion of day facilities and training centres has meant less resources for residential accommodation. This, however, is gradually being overcome. Nevertheless, for some years to come, the nation will be dependent upon its inherited "old institutions" not only for its treatment of severe mental handicap requiring hospital facilities but also for the many patients who could conceivably live in the community if sufficient residential accommodation were made available by the local authority. Unfortunately, local authorities are on the horns of a dilemma. With their limited resources should they concentrate on preventive measures with the young and so reduce the number of cases requiring hospitalisation or should they provide more residential accommodation to relieve hospitals of their undoubted heavy burden and thereby fail to stem the tide of mental disability requiring institutional treatment? Certainly experience has shown that success is greatest where a case is accepted into residence directly from the community and that the more prolonged the spell in hospital the less able is a mental patient to return to normal society. Patterns of hospital care are changing but because experiments in the treatment of mental handicap are few and even experts differ as to the ideal "set-up", no definite trend is discernible. However, the modern approach is to seek for the integration of services for the mentally ill into those comprehensive facilities to be provided by the District Hospital and these are to be closely linked with community services at present under the control 158 of local authorities. Such a scheme would ensure better therapeutic liaison between the hospital, the local authority and the family doctor and, whether in-patient, out-patient or day-patient a more stable relationship would emerge, all within an environment familiar to the individual concerned. This latter point will become progressively more important as the proportion of our elderly rises and the psycho-geriatric problems increase correspondingly. General Our policy of dealing with mental handicap within the community and home environment was further promoted by the opening of a new adult industrial training centre in May of the current year. At local hospitals where psychiatric out-patient clinics are held, satisfactory liaisons have been established with consultants which enable individual cases and problems to be discussed with beneficial results. However, with the exception of the Greenwich District Hospital, efforts to attach social workers to these clinics have been unsuccessful although there are distinct possibilities that such arrangements may be in operation at the Woolwich Memorial Hospital by May, 1970, and at St. Nicholas Hospital by 1971. Meanwhile our existing attachments at the Greenwich District and Castlewood Day Hospitals continue to function smoothly. In my 1967 Report I commented on the fact that, throughout the country, parents of some mentally handicapped were concerned that their children were not receiving the best possible education and training commensurate with their abilities and aptitudes and I indicated that, in the best interests of the children, an early decision should be made. This decision has now been taken and our junior training centres are to become the responsibility of the I.L.E.A. from 1st April, 1971, from which date Section 57 of the 1944 Education Act will cease to apply. Although in many cases such a reorganisation may well have been necessary, I am confident that present educational and training facilities available to the mentally handicapped child in Greenwich are such that improvement could only be marginal if at all. Moreover, our experience, locally, has shown that the majority of these mentally handicapped will need supervision and/or social welfare support beyond school age and this will fall to the local authority to supply. Undoubtedly it is the quality of service and its benefits accruing to the handicapped child that should be paramount but the transfer and re-transfer of cases between the responsible authorities which under the new arrangements seems more than likely, can be viewed only with trepidation. 159 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. It is doubtful if any mentally handicapped child fails to be brought to the notice of this Directorate. 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 31 No. of old cases seen 22 Disposal of Cases No. Referred for Statutory Examination 12 No. Referred for Play Group 2 No. Referred for admission to Eltham Creche (Greenwich Society for Mentally Handicapped) 8 No. Referred to Other Services 2 No. of Cases Withdrawn 25 No. of Clinics held in 1969 21 160 Prior to attaining the age of 16 years, mentally handicapped school-leavers are brought to the notice of the mental health service and the question of "after-care" is settled by discussions between the 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 Training Centre Purpose-designed on a difficult site this centre, opened at the end of 1965, 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 educational 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 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. 161 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. Blackwall Industrial Training Centre This building, which is bright and airy with good central heating and a well equipped canteen, originally catered for 36 persons but, with the intervention of the Factory Inspector, this has now been reduced to 25. With a number of the more accomplished trainees transferring to the new adult training centre at Tunnel Avenue and the difficulty experienced by the Supervisor in obtaining less repetitive and more remunerative work, this Centre has not been as successful as one could have wished during the current year. 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 162 to teach them to be emotionally stable and socially acceptable in order that they may live harmoniously within the community. From this Centre several of the trainees, accompanied by members of the staff, joined the North Wales holiday party organised by the Tunnel Avenue Industrial Training Centre. 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. 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. During the year a successfully organised holiday was spent at a large guest house at Cliftonville and several outings to places of interest were undertaken. Some difficulty was experienced in obtaining staff at this Centre which was compelled to operate for the whole year with one post constantly vacant. Tunnel Avenue Industrial Training Centre The year 1969 was notable for the opening on 12th May of this purpose-built Centre designed in accordance with general standards prescribed by the Ministry of Health and catering for the training and daily work of 60 mentally handicapped adults of 16 years and over. Universally acknowledged as an excellent building, this Centre is staffed by a manager and assistants with forward-looking ideas concerning training. Certainly the installation of machinery has made for an extension and variety of work and there is keen competition among the trainees for permission to work the lathes, fly presses and bench drills, etc. In this up-to-date workshop, built to simulate real modern factory conditions, the trainee is confronted with actual "working situations". Furthermore, the provision of a classroom in this Centre enables organised instruction to be given in such social subjects as money values, simple reading and word TUNNEL AVENUE ADULT INDUSTRIAL TRAINING CENTRE Entrance to Centre Training at the Centre is Practical and Varied A section of the Workshop Social Refinement from the Beautician Training in Carding and Packing Workshop Practice "Clocking in " Final Adjustments Dining Room The Delivery Bay 163 recognition, personal cleanliness and neatness and, with the aid of a beautician, girls are taught the discreet use of make-up. In the main and with the closest of co-operation between our Mental Health Services and those of the Education Authority, the trainees are selected from among the "leavers" of E.S.N. schools and it is our aim to assist each individual suffering from a mental disability to make as good an adjustment to life as his/her own particular position and circumstances will allow. During the summer a holiday to a Rainer Foundation Centre in North Wales was organised. Here, among other activities, trainees undertook with great success mountain climbing and canoeing, proving once again that given the opportunity the mentally handicapped can accomplish tasks thought not to be possible a few years ago. By making a donation and loaning a vehicle, the Greenwich Society for Mentally Handicapped Children assisted trainees to have many enjoyable outings. Ministry of Labour There is normal co-operation with the local Disablement Resettlement and Youth Employment Officers who, unfortunately with little success, endeavour to place into employment subnormals who, perforce, must therefore remain in the care of the Mental Health Service. It would appear that more favourable results are obtained by the direct approach to employers for, as problems arise, they can be brought immediately to our notice. Holidays Under a scheme intended to cater for those who would otherwise have no holiday, this year three Centre holidays were organised and, as usual, all children and trainees were subvented at the rate of £2 per head. Twenty-two children from the Maze Hill Training Centre attended, for one week in June, the purpose-built holiday home in Norfolk owned by the National Society for Mentally Handicapped Children. Cost to the parents was £12 6s. 0d. Some 23 trainees from Park Vista Adult Training Centre spent a week's holiday during May at a Cliftonville boarding house at a cost of £8 16s. 0d. and, at a cost of £14, a further 20 trainees from Blackwall Industrial Training Centre spent a week at the Rainer Foundation Outdoor Pursuits Centre, North Wales, in September. Charges for all holidays were subject to abatement under the Council's assessment scale and some recipients paid only a few shillings. 164 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) 25 22 Tunnel Avenue Industrial* (adult Girls and Boys) 60 29 Maze Hill (Junior) 115 115 Guardianship Society, Hove. Not known 5 Other Local Authorities ― 4 * Opened 12th May, 1969 Eltham Creche Under the control of the Greenwich Society for Mentally Handicapped Children, this nursery provides accommodation for some 15 mentally handicapped young children of whom 13 are sponsored by this Council. Boarding Out A few adult subnormals are boarded out with local landladies and where the patient is unable to earn sufficient for his keep or where statutory benefits fall short of needs, facilities exist for the Council to subvent. Long and short term care schemes are successfully introduced and advantage is taken of hospital facilities, approved voluntary homes and of private accommodation supervised by the Guardianship Society, Hove. 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 16s" are provided on Thursday evening at the Park Vista Adult Centre and attendances usually range between 25 and 30. Managed mainly by members of the Blackwall Centre staff, the club is visited on occasions by the Principal Mental Health Officer. At the Albany Institute, Creek Road, a club organised by the Blackfriars Settlement caters for the needs of 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 165 the mixing of normal "teenagers" with the mentally handicapped but this attempt at integration has not been too successful. This venture is entirely volunatry and no financial responsibility devolves on the Council. Under the auspices of the Greenwich Society for Mentally Handicapped Children, a second "Gateway" club for subnormal and E.S.N. Juniors has been established at Eltham on Monday evenings 7 - 9 p.m. 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 16s" by the Greenwich Society for Mentally Handicapped Children. Attendances vary between 18 and 20. Organised by the Elfrida Rathbone Society, two further voluntary clubs were established during the year. One for 60 subnormal children under 16 years of age is held on Tuesday evenings at Griffin Manor School and the other for 50 subnormal adults between the ages of 16 and 21 years which is held on Friday evenings at Abery Street. Hostels or Homes (for Subnormal Patients) During November of 1968, a purpose-built hostel was opened at Ashburnham Grove 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 Junior Training Centre. Since its establishment, staffing difficulties have been encountered which have precluded the use of this hostel to its fullest extent. Nevertheless, it is true to say that, without this accommodation, short term care for children would have been impossible now that Darenth Park is, for all practical purposes, closed to us and, further, the placing of children we have accepted for long term care would have been seriously prejudiced. Subnormal Patients Placed in Homes or Hostels Convents 4 Guardianship Society—Private Homes 9 Ashburnham Hostel 8 Other Local Authority Hostels 2 Spastic Society—Meldreth1 Approved Private Homes 7 Services for the Mentally ill 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 166 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. Future Projects It is the intention of the Directorate to establish a further Combined Centre to accommodate 30 mentally ill and physically handicapped persons at the former Civil Defence premises at Well Hall. Moreover, the property at 6 St. John's Park, when adapted as a hostel, will provide places for 22 mentally ill adults perhaps by the beginning of 1971. Psychiatric Services Clinics, etc. Out-patient clinics for psychiatrics are held as follows :— Greenwich District Hospital Monday p.m. Tuesday a.m. (Children's Diagnostic Clinic) Wednesday p.m. Thursday p.m. St. Nicholas Hospital Monday p.m. Wednesday p.m. Friday p.m. Woolwich Memorial Monday p.m. Hospital Wednesday p.m. Thursday Friday a.m and P.m. 167 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 30s range. Treatment is physically orientated but discussion groups are held and some counselling is undertaken by the psychiatrists. In this unit the majority of patients are neurotics or depressives and supervision of treatment is assumed by the Bexley Hospital consultant psychiatrists who remain the sole sources of referral which is effected almost exclusively through the out-patients clinics. Day Centres (see also page 150) Federation Combined Centre Adapted as a Day Centre in April, 1968, this building, held by the Council on an unexpired lease of 20 years, provides places for 60 persons. This establishment is used as a combined centre to rehabilitate persons who are suffering or have suffered from mental illness and physical handicaps but will also, eventually, 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. 168 Opportunity will be taken to utilize the Centre for evening club and group activities. Riverdale Combined Centre Also established on 1st April, 1968, this Centre is adapted from ground floor premises with easy access at 158a Plumstead High Street, S.E.18. Its purposes are similar to those of Federation Combined Centre but caters for only 45 places, mainly for the more severely handicapped. Fares to and from the Centres are paid or transport is arranged, patients are provided with a subvented midday meal and some form of medical supervision is arranged. There is no doubt but that the readiness of persons with differing handicaps to assist each other has been to their mutual advantage. Both Centres arranged seaside outings, Christmas parties and visits to the theatre but, regretfully, due to a lack of transport, neither Centre was used to its fullest capacity during the year. Mentally III Persons Placed in Homes or Hostels Mental After-Care Association Hostels 11 Private Approved Home 1 S.O.S. Society Hostel 1 National Association for Mental Health Hostel 1 Honor Lea (London Borough of Lewi sham Hostel) 10 Richmond Fellowship Home 1 Other Local Authority Hostel 1 Therapeutic Clubs Club Day Staff Attendances "Tideway Club", Wednesday Mental Health Between 25 and 30 Albany Institute, evening (shared Officers from Creek Road, with neighbouring both Boroughs S.E.8. Borough of Lewisham) "Castlewood", Tuesday evening Bexley Between 20 and 30 Shooter's Hill, (Day patients Hospital S.E.18. only) Appointees "The Links", Friday evening Bexley Between 12 and 18 Castlewood, (For ex Bexley Social Shooter's Hill, Hospital patients) Worker S.E.18. Friday Club, Friday evening Greenwich Between 20 and 30 St. Richard's Borough Social Church Hall, Workers on a Charlton, S.E.7. voluntary basis A therapeutic group for alcoholics supervised by a Bexley Hospital consultant psychiatrist meets at Castlewood on Wednesday evenings. NUMBER OF PERSONS UNDER LOCAL HEALTH AUTHORITY CARE AT 31st DECEMBER 1969 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 5 1 242 394 19 60 — 1 18 23 55 67 79 77 61 74 1,176 2 Attending training centre, etc. — — 28 26 — — — — — — 6 5 11 17 60 48 36 44 281 3 Awaiting entry to training centre, etc. — — 8 12 — — — — — — — — — 1 12 16 1 1 51 4 Receiving home training — — — — — — — — — — — — — — — — — — — 5 Awaiting home training — — — — — — — — — — — — — — — — — — — 6 Resident in L.A. home/hostel — — 5 6 — — — — — — — — — — 2 6 1 — 21 7 Awaiting residence in L.A. home/hostel — — 2 6 — — — — — — — — — — 2 3 — — 13 8 Resident at L.A. expense in other homes/hostels — — 5 4 1 5 — — — — — — — — 2 3 1 6 27 9 Resident at L.A. expense by boarding out in private household — — — — — — — — — — — — — — 1 1 1 6 9 10 Attending day hospitals — — 12 14 1 5 — — — — — — — — — — — — 32 11 Receiving (a) suitable home visits to attend and not a training included in centre lines 2-10 — — — — — — — — — — — — — — — — — — — (b) others 5 1 182 326 17 50 — — 1 — 12 18 44 49 — — 21 16 742 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 1 Female 1 13 Number of persons included in item 6 who reside in accommodation provided under the National Assistance Act, 1948. Male — Female — 169 NUMBER OF PERSONS REFERRED TO LOCAL HEALTH AUTHORITY DURING YEAR ENDED 31st DECEMBER 1969 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 1 — 57 127 — — — — — — 6 5 1 — — — 197 (b) Hospitals, on discharge from in-patient treatment — — 36 48 — — — — — — 4 1 — — 4 4 97 (c) Hospitals, after or during out-patients day treatment — — 19 19 — — — — — — 2 1 — — — — 41 (d) Local education authorities — — 1 4 — — — — 1 3 22 14 5 4 2 1 57 (e) Police and courts — — 11 8 — — — — — — 1 1 — — 1 — 22 (f) Other sources 2 — 46 113 — — — — 6 10 10 16 14 10 1 2 230 (g) Total 3 — 170 319 — — — — 7 13 45 38 20 14 8 7 644 170 NUMBER OF PATIENTS AWAITING ENTRY TO HOSPITAL, ADMITTED FOR TEMPORARY RESIDENTIAL CARE OR ADMITTED TO GUARDIANSHIP DURING 1969 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. 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 — — — — — — — — — — — — — — 6 4 1 1 12 (b) Not in urgent need of hospital care — — — — — — — — — — — — — — — — — — — (c) Total — — — — — — — — — — — — — — 6 4 1 1 12 2. Number of admissions for temporary residential care (e.g. to relieve the family) (a) To N.H.S. hospitals — — — — — — — — — — — — — — 5 1 1 1 8 (b) To L.A. residential accommodation — — — — — — — — — — — — — — 22 19 — — 41 (c) Elsewhere — — — — — — — — — — — — — — 3 5 5 8 21 (d) Total — — — — — — — — — — — — — — 30 25 6 9 70 171 172 GERIATRIC SERVICES In 1870, those persons in England and Wales aged 65 and over numbered slightly more than one million, equivalent to 4½ of the then enumerated inhabitants. If to today's figure of 6½ millions (13%) one adds those women 60 to 64 years, this combined total of approximately 8 millions represents 16% of the existing population of England and Wales. Making due allowance for those persons receiving full time education and for those married women who remain primarily housewives, we are left with a working population of some 23 millions to provide all the resources for the remainder. These amount to 26 millions of whom one-third are of retirement age— not an inconsiderable responsibility. Aggravating the problem is the fact that improvements in medical care and environmental conditions over recent years have enhanced the chances of people reaching retirement age and beyond. Moreover, there has been a decline in the size of the "producing" groups, a trend which is not likely to be reversed until the final decade of this century. Furthermore, even at the present time in this country, there are countless elderly people suffering from loneliness among the 1½ million old persons who live alone, over 300,000 of whom are subject to conditions so appalling that it is estimated that 90,000 die every year from the cold. All of which adds up to a serious "elderly persons" situation which will almost certainly prove to be the biggest and probably the most important of all the social problems to be met by the nation during the next 20 years. Some 25 years ago, a new branch of medicine was established which, by accurate diagnosis and active methods of treatment, was to revolutionise the care of our aged and infirm. It was called "geriatrics". Whilst it cannot be denied that, nationally, some improvements have been seen, the high hopes previously entertained for this specialised service have not been realised. Indeed, today, the term "geriatric" is often used pejoratively to indicate inadequate care and less than satisfactory medical attention. Why should this be so? Perhaps it is the sheer size of the problem and its financial implications in a period when cost effectiveness has become of paramount importance. Or maybe that, as the chances of complete recovery are heavily weighted against the aged, this becomes such a disincentive to the medical and nursing professions as to leave the geriatric branch of medicine seriously understaffed. Again, it may well be that, as a nation, we prefer to allocate a greater proportion of our resources to the more glamorous advances in therapeutics such as transplantations, etc. 173 ever the reasons, which are many and varied, the problem of our elderly not only remains but is literally burgeoning. An analysis of admissions to the acute wards of a large teaching hospital during September of the current year revealed that 70% were over the age of 60 years and 40% over 75. Furthermore, it is well known that approximately 60% of all psychiatric beds in this country's hospitals are occupied by persons over the age of 60. It would be no exaggeration to say that over one half of all hospital beds, which number almost 500,000, are occupied by those of 60 years of age and over. Leaving aside the humane elements of the problem, any reduction in this proportion, however small, would bring enormous financial benefits and a release of vital personnel and equipment. Such an exposition, however, is far from disclosing the full extent of the geriatric problem. In this country it is traditional for medical treatment to be based on the self-reporting of illness, a method known to be largely ineffective in the case of old people. Investigations have shown that more than half of all disabling conditions in elderly persons are unknown to their respective doctors. Since 95% of all old people live and die at home, the total amount of undisclosed disability must be substantial, much of which, however, is preventable. An appraisal of the preceding two paragraphs will establish the inescapable fact that illness, although not the only problem, is by far the most important in old age. Recently, a great deal of attention, perhaps an inordinate amount, has been given to the purely social aspects of the "elderly persons" situation but, no matter how desirable this may be, it cannot solve their present problems arising from ill-health. How, then, is improvement in this field to be achieved? Notwithstanding that, in this instance, there can never be a fully satisfactory solution, nevertheless, apart from the practical effects of relieving pain and suffering there are sound economic advantages to be gained from adopting a more positive approach and greater emphasis on preventive medicine. Unfortunately, preventive medicine has a low rating in medical priorities and, in medical training, only lip service seems to be paid to its importance. Its application to the aged tends to be even more remote. In this respect and vital though their contribution is, hospitals can hardly be expected to improve upon existing efforts for not only are they already working to capacity but the number of geriatric beds is officially being reduced. Moreover, hospitals deal only with those referred to them, namely, patients with overt diseases or persons 174 in whom doctors suspect some disability and these can form only a small proportion of the whole. In the case of the elderly, the elimination of disease and the identification and treatment of precursor states are long term measures to be taken to benefit future generations of old people Rather is it the early detection of established but unreported disease, its arrest and/or treatment of accompanying disabilities which is of immediate value to a substantial majority of the community's older citizens and, for reasons outlined above, neither hospitals nor general practitioners can be counted upon to play a major role in this sector. It falls, therefore, to the local authority's health and welfare departments to cover these preventive aspects. Detection of unreported illness and disability in the aged demands a degree of medical or nursing experience not normally found in social workers. It is, however, a basic discipline of the health visitor and it is the Directorate's policy of relying upon her skills to seek out and ascertain the extent and seriousness of the hidden disabilities of our elderly residents which has proved so successful. Our experience shows, without doubt, that the most acceptable approach to the elderly is by one with a nursing background. Often local government is accused of failing to move with the times and it is true that incipient legislation in this particular field is challenging our present attitudes and existing practices. Yet this is a sphere in which Greenwich has always been recognised as an avant-garde authority. Premature abandonment of principles upon which are based the services, so painstakingly but soundly built up over a number of years, would not only be foolhardy but could well mean settlement for mediocrity, if not worse, during the next vital 20 years. Future Prospects Our present geriatric services are directed towards practical and material support with the declared intention of delaying the as yet, irreversible processes of ageing and maintaining our elderly people more happily in their own homes so that, if or when, hospitalisation becomes necessary, it will be of short duration. In this connection, there is the closest of liaisons between this Directorate and the housing departments of this and the Greater London Councils and with the Department of Health and Social Security and other statutory or voluntary bodies with similar aims. But, without doubt, health is man's most precious possession and nothing is more important to the older citizen than that he should reach retirement physically and mentally fit. However, patterns 175 in old age depend to a large extent upon the qualities inherited at birth and this is where the geriatric problem really begins. In future, by modifying inherited disabilities, by reducing widespread malnutrition, by eliminating infectious and other diseases, by promoting health education both socially and industrially we will achieve a fitter nation and our people will arrive more physically and mentally attuned to a contented retirement. Unfortunately, the attainment of these very objectives will merely serve to augment and intensify the very problems we seek to solve and, moreover, a better educated and informed pensioner will demand even higher standards of amenity. To meet the new situation it is clear that the character of the hospital and local authority home will need to change and this is already presaged by the Government's recent green paper. Expansion of Combined and other Day Centres and the establishment of loosely-knit units or communities where all services can be provided uncomplicated by transport difficulties are obvious lines of improvement. A gradual refining of other supporting services such as home helps, meals-on-wheels, incontinent laundry and bathing facilities, etc., will occur but then, as now, there will be extreme difficulty in recruiting and training people for such practical duties. Indeed, with the extension of full-time education it is conceivable that the need for this type of person will eventually outweigh that for the professional whose own numbers are already below those necessary for maintaining adequate control of the situation. Developed on empirical and preventive lines over a number of years by a farseeing Council, the geriatric services at Greenwich are soundly based on foundations permitting of rapid expansion. However, our previous successes are no guarantee of future success which, in the shadow of coming events, will require all the singleness of purpose and vision of earlier years. In the final analysis, all future prospects will depend upon those resources, both of money and personnel, which we are prepared to allocate to this very serious and increasingly complicated problem. Temporizing cannot prevent or evade the issues engendered by a rapidly expanding elderly population and the greater delay, the more chaotic will be the situation and the more socially costly and personally tragic it will become. Visiting Visits made during 1969 amounted to 19,255, a decrease of some 6% compared with those for the previous year. 176 The number of elderly persons shown in the Register at the end of the year, however, shows a decrease. This results from the abstraction of names of persons who are not subject to regular visiting and have not received a visit during the current year. Elderly People in Receipt of Visits and Other Services Number in Register at 1st January, 1969 8,850 Number in Register at 31st December, 1969 7,831 Elderly Handicapped Persons included in the above Register: (i) Blind 269 (ii) Partially Sighted 126 (iii) Physically Handicapped 666 1,061 Visits by Women Public Health Officers Total Visits by Officers during year 19,255 1st Visits 944 Subsequent Visits 15,599 Unsuccessful Visits 2,712 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, operates at 3 Centres, Tunnel Avenue, Plumstead Baths and Lionel Road. 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. 177 Tunnel Avenue Plumstead Lonel Road Total Number bathed at home 3,184 4,354 3,245 10,783* Number bathed at centre 2,234 1,594 924 4,752† Pedicure 214 135 205 554 Hair-washing 48 87 103 238 * Males 2,750 Females 8,033 † Males 1,094 Females 3,658 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 reveal that the demand remains unabated. Tunnel White Hart Articles Laundered Avenue Road For Incontinence 95,244 89,356 Other Items 18,548 7,148 Totals 113,792 96,504 178 Home Cleansing Service Not infrequently the rooms of elderly people deteriorate into a muddled dirty state and the task of cleaning up becomes too complex for the relations or home helps. In such cases, having first gained the consent of relations or persons concerned, a team consisting of two bath attendants with transport, supervised by a Public Health Officer and equipped with the necessary protective clothing and apparatus, deal with the offending conditions and remove the accumulated rubbish. After such operations, the home help can then carry out her normal duties. Cleansing Services Effected From Plumstead Bathing Centre 7 From Tunnel Avenue Bathing Centre 7 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 for Social Service and full consultation with the department's geriatric branch ensures the treatment of priority cases. Tunnel Avenue—Sessions: 51; Persons Treated: 261. Council of Social Service—Treatments: 2,993. Mobile Meals In planning the development of the Mobile Meals Service 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 and a total of 17 vehicles are now operating. As an economy measure, meals are delivered in metal foil containers and, during the year, these totalled 158,862, an increase of almost 5% over the figure for 1968. Persons receiving Mobile Meals at the end of 1969 numbered 680. The charge for each meal was the same as that made at Lunch Clubs, i.e. 1s. 1d. 179 A restricted service, for cases of special need, was provided during Bank Holidays and over the Christmas and Boxing Day period 192 meals were delivered to elderly people without charge. 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. Provision of Mobile Meals (during 1969) 1969 1968 Mobile Meals served during year 158,862 151,817 Persons on Mobile Meals Register 680 689 (31st December, 1969) Lunch Clubs Lunch Club services continue to expand and 2 more clubs, viz., at Calderwood Street, S.E.I8., and at "Tegel" Old People's Home at Simnel Road, S.E.12., were opened during the year. We are now almost at the stage of being able to state that a Lunch Club is within reasonable travelling distance of every elderly resident in the Borough, a situation which not only ensures that as many as possible enjoy at least one hot meal a day but also provides them with the opportunity of companionship and social contacts which are thereby made available. During 1969 the number of meals served increased by over 21% to a total of 233,027. Again, the cost of the meal was subvented by the Council and the charge to members remained at 1s. 1d. 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. Geriatric Advisory Clinics The clinics which came into operation in June, 1966, continued to operate in 1969 for only six months since the Principal Medical Officer who attended them was promoted to another appointment. The clinics were held at:— Abbey Centre, Eynsham Drive. Anstridge Road Community Centre. Directorate's Medical Room, Royal Hill. Garland Road Centre. Market Street Centre. Plumstead Bathing Centre. 180 During the six months there were 65 attendances of which 20 were new cases and 45 re-visits. Forty-six of these attendances were women and 19 men. Referrals to General Practitioners were 19 „ Dental Practitioners 2 „ Chiropodist 5 „ Optician 3 Referrals to General Practitioners were for the following reasons:— Hypertension 3 Hernia 2 Hearing defects 2 Congestive heart failure 1 Depression 2 Vitamin deficiency 2 Sugar in urine 1 Skin condition 1 Urinary infection 3 Gastric disturbance 2 A general medical examination was carried out on everyone who attended the clinics, provided that they had not recently seen their General Practitioners and were not under active treatment. Examinations included vision and hearing tests, examination of blood pressure and urine testing and advice most frequently sought was in connection with diet, loneliness and decreased mobility. Under the care of Dr. Nicholson, Consultant Geriatrician, the following hospitals have geriatric beds:— The Brook Hospital St. Nicholas Hospital The Memorial Hospital There are also geriatric beds at the Greenwich District Hospital under the supervision of Dr. Boyd, Consultant Geriatrician. Geriatric Adviser to the Council In his Circular 10/65, the Minister of Health pointed out that although the various Health and Welfare Services for the elderly are not under one authority, their purpose is to provide what is essentially a single service for each individual who needs it. There are indications that, despite every effort made to the contrary, much undiagnosed illness and undisclosed disability in the elderly exists. It was clear that early recognition of changes in the physical or mental condition of our old folk in the Council's homes would be most satisfactorily achieved by a doctor responsible both to the hospital and to the local authority. This desire for a closer association between the Health and Welfare department and the hospitals' 181 geriatric services was satisfied by the decision of the Council to appoint the Consultant Geriatrician at the Greenwich District Hospital (St. Alfege's Wing) 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 62 elderly people were admitted to the Old People's Homes under this scheme, generally for a period of two weeks. With the aid of voluntary helpers from many organisations, a number of elderly people were enabled to enjoy a fortnight's holiday at Little Oyster Holiday Camp in the Isle of Sheppey during August or September. This was a substitution for the Council's Avery Hill Holiday Scheme previously organised and operated by the Department's Public Health Officers for selected categories of aged persons. Nutritional Supplements A scheme is in operation throughout the Borough for the sale to bona fide retirement pensioners, at preferential rates, of various nutritional commodities. Distribution is 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. Sales are also made 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 182 Registration Card. Relatives and friends may purchase supplies on behalf of a homebound elderly person on production of this Registration Card. During the year, sales of Nutritional Supplements to retirement pensioners were averaging £10,000 per annum. Housing Recognising the importance off housing circumstances in the lives of our aged residents, regular consultation takes place between the Public Health Officers and representatives of the Housing Departments of this and the Greater London Councils. Furthermore, active participation in the selection of elderly persons for residence in local almshouses and Housing Society properties is also undertaken by the department's officers. Physical Aids A number of conditions arising as a result of old age are assisted by the use of simple aids and arrangements have been made for Women Public Health Officers to authorise issue of such articles in a similar manner as loans of medical equipment. 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 16,000 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. Recreation Facilities for the Elderly Day Clubs for the Homebound Charlton House club still operates successfully and continues to provide opportunities for recreation and social activity for its members. On an average, 10 homebound elderly are transported to the club each day, Monday to Friday, and are served with a meal at midday. Sunbury Lodge and Weybourne, 2 old people's homes, each provide similar facilities for an average of 6 persons each day. Day Clubs for the Elderly Day Clubs where active elderly people may find warmth, comfort and companionship are open from approximately 10 a.m. to 4 p.m.. 183 Monday to Friday, at West Greenwich House, S.E.10., Charlton House, S.E.7., Victorians Club, S.E.9., and at Abery Street, S.E.18. The current year saw the establishment of a further two such clubs at Southwood Road, S.E.9., and at "Tegel" one of our newer old people's homes at Lee., S.E.12. Both operate in conjunction with a Lunch Club held on the same premises. 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 65 established clubs. 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 1,800 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 the 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 June to October, eight of our elderly citizens, who for medical reasons require ground floor 184 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. Holidays began on 14th March and continued until 2nd January, 1970, and during this period, 1,470 guests were accommodated in parties averaging about 80. 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 months May to September some 24 afternoon trips were organised whereby 216 elderly homebound were enabled to enjoy outings to the Kent countryside, local parks and open spaces. Each party was escorted and tea was provided. A further 50 old people were entertained at a summer garden party organised by the Eltham Rotary Club. 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. Demand for the loan of television sets, to even the most deserving cases, far outstrips the supply and there is a waiting list. Library Services The Council's Library Service to Old People's Homes was further extended and collections of books were changed regularly. 185 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. In Greenwich 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:— "I detail below the figures recorded for entertainments provided for Old Age Pensioners in the calendar year 1969. The O.A.P. club shows were provided by the Recreational Services Committee and the films in Old People's Homes were presented in conjunction with the Directorate of Social Services. Total functions Type of show during year Total Venues O.A.P. Club Shows 336 56 Films in Old People's Homes 56 6 Professional variety artistes were engaged for the shows in the Old Age Pensioners clubs and full length colour feature films were screened in the Residential Homes during the months January to March and October to December." Carol Services Between the 9th and 11th December, 1969, approximately 770 old persons attended Carol Services at St. Nicholas' Church, Plumstead; Christchurch, East Greenwich; Eltham Congregational Church and All Saints Church, New Eltham. The Mayor and Mayoress attended two of these functions and the Deputy Mayor attended the remainder. Tea and light refreshments were provided by the Council in halls adjacent to the churches, with the assistance of volunteers from the W.R.V.S. and church organisations. Mention should be made of the co-operation of the Warden of "The 186 Victorians" Club, Eltham, who kindly arranged for 60 members to have their own function, thereby allowing others to attend the Congregational Church Hall, which was filled to capacity. Considerable help was also given by the Head Teachers and staff of the Christchurch and Wyborne Schools who respectively provided a nativity play and a choir as their pupils' contribution to the enjoyment of the congregation at the Greenwich and New Eltham churches. 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, Gifts and Parties Over 350 Christmas parcels for our elderly residents were generously donated mainly by the undermentioned and distributed in accordance with departmental advice:— Woolwich Telephone Exchange Eltham Round Table Young Conservatives Thames Manor School Ealdham School Cub Scouts of Greenwich Several private individuals. Some necessitous old persons received vouchers from the Mayor's Fund and 12 received bags of coal so kindly donated privately for Christmas presentation. On request and in connection with Harvest Festival, 9 local schools were given 200 names of elderly people to whom they dispensed gifts. A small van load of similar gifts from another school was allocated by this department. Staff of the Royal Herbert Hospital gave a highly successful Christmas party for 30 old people in the vicinity of their hospital 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. 187 Advantage is also taken of our services by Health Visitors and Hospital Students in accordance with their various curricula. Voluntary Help and Friendly Visiting, etc. Although voluntary service finds form in various ways it surely is concerned with compassion, a sense of purpose, personal involvement and dedication to a cause. Such service can be said to originate in three different ways. Firstly, it can stem from personal encounter with someone with a self-evident difficulty; secondly, by joining an organisation which has objectives evoking sympathy, it can provide an outlet for unused talents and, thirdly, by donations to world causes, a sense of involvement can be generated in some of the wider issues of life. Of greatest value to local authorities is the individual who is not only able to recognise these divisions but is also possessed of such a personality as to be capable of harnessing, for the benefit of its residents, the abundance of goodwill which undoubtedly exists in the community. Since the establishment of 'Task Force" in the area during 1968, much of the individual voluntary effort in respect of aged persons has declined. Nevertheless, there are several voluntary bodies such as the B.R.C.S., W.R.V.S. and various church organisations working within the Borough with whom the department maintains close and constant contact. For example, among the many duties undertaken by the B.R.C.S. in respect of the elderly is the efficient management of their home for geriatric patients at the "Gables", Blackheath Park, and their convalescent home at St. John's Park. Both are of inestimable value to the Directorate in their services to the elderly. A perusal of the W.R.V.S. Annual Report for 1969 reveals that, in Greenwich, inter alia, they are responsible for 14 old people's clubs, one afternoon and one lunch club; they distribute welfare foods, supply escorts for outings and holidays arranged by the Council, provide a trolley shop at one old people's home and clothing and bedding for the elderly homebound. Veritably a very present help in trouble. Task Force Referrals to "Task Force" by the Community Care Branch (and other sources in the area with similar health and welfare aims) are given in the accompanying tables together with results as known. These statistics do not represent the total work undertaken by "Task Force" but only those in respect of cases falling within the scope of this department. 188 Referrals (Figures in brackets are jobs outstanding—those completed include withdrawn, not needed and died, etc.) Year Friendly visits & general help Gardening Decorating Other Total 8 mths. to March '69 484 (293) 67 (22) 30(10) 68(4) 649 (329) 1969 165 (80) 81 (57) 20(12) 66 (23) 332(172) Reasons for non-completion of referrals: — No suitable visitor 59 27 3 18 107 Waiting suitable weather — 6 — — 6 Waiting to re-contact and referrals — 7 2 4 13 Non-urgent 21 17 7 1 46 Totals 80 57 12 23 172 MISCELLANEOUS SERVICES Receivership During the year, a Greenwich resident in Southern Grove Lodge became incapable, by reason of mental disorder, of managing her own affairs and the Borough Welfare Officer was appointed to act as Receiver thereby increasing to six the number of estates administered by him. 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 the condition or add to his/her comfort have been submitted to the Court of Protection for approval. 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 under Section 48 of the National Assistance Act, 1948, to mitigate loss or damage in eleven instances. In two cases the property was only temporarily safeguarded, in three other cases it was sold or otherwise disposed of and in the remaining six cases the property was transferred to the Council's store. 189 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 20 deaths in the Borough. The Council's expenses totalled £295 7s. 0d., of which approximately £186 was recovered from the estates of the deceased persons. Registration of Disabled and Old Persons' Homes There have been no additions to the number of homes registered by this authority under Section 37 of the National Assistance Act, 1948. At the 31st December 1969, two establishments were currently registered:— "Alveston House"—a private home for 8 elderly ladies; "Fairhaven"—a voluntary hostel for 25 educationally sub-normal youths, between 16-21 years of age. COMMUNITY CARE BRANCH General Statistics—1969 Analysis of Visits Type of Visit O.P.W. M.H. S.W. f.C.W. Total Domiciliary 14,722 7,089 7,054 372 29,237 Hospital 260 782 59 — 1,101 Miscellaneous 1,273 720 391 4 2,388 Office 288 902 675 52 1,917 Non-effective 2,712 1,014 906 2 4,634 Total 19,255 10,507 9,085 430 39,277 New Cases 944 290 482 10 1,726 Purpose of Visit or Interview Case Work— Partially Sighted 327 Blind 1,965 Physically Handicapped 4,993 Mental Health 9,279 Elderly 15,653 Family 2,427 Unmarried Mother — 190 Admission to— Home (L.A. or Vol.) 186 Home (Private) 18 Hospital (in Borough) 137 Hospital (Out of Borough) 238 Hostel 29 Application for Homeless Families' Accommodation 192 Bathing—Domiciliary 124 Cleansing of Home 51 Discharge from Hospital 190 Holiday 403 Loan of Equipment 208 Mobile Meals 115 Outing or Party 148 Teaching 134 Works of Adaptation 104 Services (New Referrals for/to) Borough Services— Bathing—Centre 191 Children's Officer 131 Chiropody—Clinic 150 —Domiciliary 212 Centre—Combined 194 —Mental Health 74 Clothing (Borough) 139 District Nurse 125 Furniture (Borough) 127 Holiday Relief Scheme 186 Holiday 358 Home Help 361 Housing Manager 479 Loan of Equipment 429 Mental Health Hostel 48 Mobile Meals 329 Part III Accommodation 532 Public Health Inspector 89 Radio (Borough) 43 T.V. (Borough) 44 Transport 41 Works of Adaptation 134 191 National Health Service— General Practitioner 398 Hospital or Clinic 225 Ophthalmic (Domiciliary) 48 Dental (Domiciliary) 25 Other Services— British Red Cross Society 60 Church or Club 108 Education 75 Ministry of Labour 96 Ministry of Social Security 123 N.S.P.C.C 20 Probation Officer 51 Radio—Wireless for the Bedridden 28 —Wireless for the Blind 16 Talking Book 14 T.V. (Vol. Schemes) 18 Voluntary Helper 69 Voluntary Society or Agency (Misc.) 209 W.R.V.S 15 192 SECTION VI ENVIRONMENTAL HEALTH SERVICES When Virgil, that famous Roman poet of the 1st century B.C., said "he destroys his health by labouring to preserve it" he was, I feel sure, referring to the hypochondriac and not to those seeking to preserve the quality of their surroundings. Environmental pollution, aspects of which I covered in my Report for 1968, has recently been afforded increased publicity nationally. To a large extent this can be attributed to the growing realisation that greater longevity and an increasing population demands careful re-assessment and a more realistic approach than hitherto to the conservation of our natural resources. Such has been the awakening of the country's conscience that a Royal Commission on Environmental Pollution has been established. Its terms of reference are wide and, ipso facto, its task monumental. Direct chemical pollution of soil, water and air by industry, not excluding our essential services, would seem to be the greatest present and potential hazard but other problems arising indirectly, such as contamination of food, wild-life, etc., are becoming of some moment. Undoubtedly, some causes of pollution are obvious but others are infinitely more difficult to determine for, in certain circumstances, many common substances could be held to be harmful. For our advances in technology and material progress, which cannot be opposed, we must recognise that there is a price to pay other than in cash. We need to see that the cost is neither too high nor that it results in a debasement of the quality of life. In this respect cost yard sticks are useful financial disciplines but, because in times of economic stress they tend to settle for expediency, long-term planning for some aspects of preventive medicine sometimes becomes impossible. Furthermore, cost effectiveness is incapable of taking account of human misery and future services could be adversely affected by too rigid an adherence to a fiscal policy. However, whilst it cannot be denied that environmental pollution is of extreme importance it must be admitted that constant reiteration is likely to lead to monotony which, in turn, may give rise to apathy. For the interested, therefore, I suggest a re-reading of the relevant section of my previous report concerning pollution. 193 New Legislation Public Health (Recurring Nuisances) Act, 1969 The above-mentioned Act, which came into force on the 25th July, 1969, enables a local authority to serve a prohibition notice in respect of any premises where a statutory nuisance has, or is likely to, recur. In the case of a defect of a structural nature the notice shall be served on the owner of the premises and in other cases on the person by whose act, default or sufferance the nuisance arose. If that person cannot be found the notice shall then be served on the occupier or owner of the premises. A prohibition notice may be served whether or not the nuisance is in existence at the time of service and the local authority may, if they think fit, specify the works to be carried out to prevent the nuisance recurring. It is not a requirement of the Act that an Abatement Notice relating to the nuisance should first be served and it provides that a Prohibition Notice and Abatement Notice may be contained in the same document. Where a local authority has served a notice and the nuisance recurs or the requirements of the Notice have not been complied with, the local authority may cause a complaint to be made to a Justice of the Peace. The Court is empowered by the Act to make a nuisance order and also exercise powers contained in similar hearings under the provision of the Public Health Act, 1936. Sanitary Circumstances of the Area The tables on page 225 to 226 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 39,360 houses and premises have been inspected or reinspected during the year; 1,385 Preliminary and 490 Statutory or Abatement Notices were served. Registered complaints numbered 5,435. Factories Act, 1961 During the year 276 inspections were made by the Council's Inspectors in relation to the 571 registered factories. The latter figure includes 10 premises where mechanical power is not used. Defects were found in 45 instances, all of which were remedied. 194 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 10 15 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 523 223 7 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 38 38 — — Total 571 276 7 — 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 45 45 — 16 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 45 45 — 16 — 195 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. 32 — — — — — Linen 1 — — — — — Lampshades 63 — — — — — Braid 11 — — — — — Wig Manufacture 2 — — — — — Dolls' Clothes 1 — — — — — Cardboxes 1 — — — — — Total 111 — — — — — Outworkers—In the last return made by employers of labour, the total number of outworkers in the Borough was shown to be 111, compared with 71 in 1968. Local firms employ 72% of these outworkers, the remainder being employed by firms in various parts of the country Periodical inspections of the outworkers homes are made by the Council's Public Health Inspectors. Altogether 133 such visits were made in 1969 to ensure that the home working conditions were satisfactory. Local industry also employs 73 outworkers who reside outside the Borough. 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 Minstry of Labour in respect of the work carried out during 1969, is given in the following tables:— 196 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 19 361 99 Retail Shops 53 1,148 310 Wholesale shops, Warehouses 2 49 19 Catering Establishments, Canteens 2 182 56 Fuel Storage Depots — 6 — TOTALS 76 1,746 484 Class of Workplace Offices Retail shops Wholesale departments, warehouses Catering establishments open to the public Canteens Fuel storage depots *Males 6,796 Females 8,934 A total of 1,120 visits including 487 general inspections were made to premises during the year. As a result of the service of 99 informal notices, the following contraventions of the Act were remedied:— No. of thermometers provided 44 Abstract of the Act provided 54 First Aid Kits provided 38 Defective floors repaired 2 Washing facilities provided 5 Defective stairs or handrails repaired 3 Electric lighting provided or improved 7 197 Insufficient seating accommodation remedied 1 Inadequate heating remedied 2 Additional locker accommodation provided 1 Inadequate ventilation remedied 4 Defective sanitary accommodation remedied 4 Dirty conditions remedied 26 Wall surfaces repaired or renewed 38 Hot water supply provided 12 Guards provided on dangerous machines 5 Other contraventions of the Act remedied 52 Total 298 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. Of the 54 notifications received during the year, in only three cases was it considered necessary to write to the firms concerned suggesting alternative measures in order to prevent a recurrence of similar accidents. I am happy to report all of the cases notified were non-fatal and mostly of a minor nature. The respective District Public Health Inspector investigated each case and proffered advice where necessary. It is noticeable that, on the whole, accidents are mainly notified by large and established organisations such as multiple stores, supermarkets, etc. Small offices and shops appear either unaware of their responsibility or fail to report any accidents that may occur to their employees. Each quarter a return is made to the Ministry of Labour of notification of accidents. The reported accidents and their analysis for the year under review are summarised in the following tables:— 198 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 — 41 41 — — 3 38 Wholesale Shops, Warehouses — 8 8 — — — 8 Catering Establishments open to public, canteens — 1 1 — — — 1 Fuel Storage Depots — — — — — — — Totals — 54 54 — — 3 51 Analysis of reported accidents Offices Retail Shops Wholesale Warehouses Catering establishments open to public, canteens Railway Buildings Machinery — 1 2 — — Transport — — — — — Falls of persons 1 13 — — — Stepping on or striking against object or person 1 1 — — — Handling goods 1 4 5 — — Struck by falling object — 2 1 — — Fires and explosions — — — 1 — Electricity — — — — — Use of hand tools — 5 — — — Not otherwise specified 1 15 — — — 199 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. 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, 41 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 and with the co-operation of the Ministry of Defence, narcotic treatment, authorised by licence from the Ministry of Agriculture, Fisheries and Food, was carried out in the Royal Arsenal in an attempt to reduce the number of pigeons in Beresford Square. As a further means of controlling the numbers of pigeons, trapping was carried out at five separate sites throughout the Borough. The total number of pigeons caught and destroyed during the year was 1,198. River Pollution In London, sewage and its disposal, amounting to a daily dry flow of approximately 450 million gallons from an area of 500 square miles serving a population of 7 millions, is under the control of the Greater London Council and, after treatment at the northern and southern outfalls at Beckton and Crossness 200 tively, the resultant sewage effluent is discharged into the Thames. It is then considered by various authorities to be a pollutant which, on occasions, gives rise to complaints. During 1969, there was a reduction in rainfall of some 31% from the previous year which led to somewhat unstable operating conditions at Crossness during the dry autumn spell. Pollution loads rose correspondingly and there was a temporary deterioration in the condition of the water in the Greenwich and Woolwich reaches. Improved standards of treatment at Crossness eventually produced a lower pollution load than previously achieved. No complaints regarding pollution were made to this department during the current year. Storm Flooding In contrast with 1968, no storm flooding occurred during the current year and consequently, in this respect, no requests for assistance were received. ATMOSPHERIC POLLUTION An Alkali Act passed in 1863 proclaimed this country to be first in the field with legislation to promote a cleaner atmosphere. Periodically, over the years, other measures have been introduced culminating in the world's first Clean Air Act—that of 1956— which has since been strengthened by the Act of 1968. Our ultimate aim should be to obtain an atmosphere free of toxic compounds as well as carbon particles. Smoke emission throughout the country has been reduced from 2.71 million tons in 1931 to 0.87 million tons in 1967 and, although not so spectacular, the decrease in sulphur dioxide over the same period is substantial. Despite these improvements, however, some 70% of all atmospheric smoke continues to be produced from domestic sources and a growing menace is the pollution arising from the operation of motor and air transport. Dust and grit from industrial processes constitute further hazards. So far, our Clean Air Acts seek only to control the emission of dark smoke, grit and dust and contain no provisions against the discharge of oxides of sulphur. Nevertheless, control of atmospheric pollution in London has proceeded at a relatively more rapid rate than in England and Wales as a whole and, by the end of 1968, over 60% of all premises in Greater London and over 50% of its total acreage were covered by smoke control orders. Figures for Greenwich at the end of 1969 were 72.3% and 74.2% respectively and when the areas recently designated by the Council and outlined in this Section are confirmed by the Minister, the whole of the Borough will then be smoke controlled. 201 New Legislation Smoke Control Areas (Exempted Fireplaces) Order 1969. The above Order was made under Section 11 (4) of the Clean Air Act, 1956, and exempts from that section the "Housewarmer" and Wood Chip Fired Air Heater fireplaces, upon conditions as to proper operations. The Clean Air (Height of Chimneys) (Exemption) Regs. 1969. These Regulations exempt certain chimneys from the general requirement that the proposed height of a new chimney shall be first approved by the local authority. They prescribe the purposes which carry exemption and include temporary heating or power arrangements made during a period of maintenance or replacement of plant, building operations, engineering construction, research and agricultural operations. The Clean A ir (Height of Chimneys) (Prescribed Forms) Regs. 1969. Made under the Clean Air Act, 1968, these Regulations prescribe (i) the form of application for the approval of the local authority to the height of a chimney serving a furnace to which S.6 of that Act applies, and (ii) the particulars to accompany that form. The section applies to furnaces which are being enlarged, or the chimneys serving which are being constructed, after 1st April, 1969. Clean Air Act (Commencement No. 2) Order 1969. This order, made under Section 15 (3) of the Clean Air Act, 1968, brings into force on the 18th October, 1969, those provisions of the Act which are not already in operation. Clean Air (Arrestment Plant) (Exemption) Regs. 1969. Section 3 (1) of the Clean Air Act, 1968, prescribe that certain new furnaces shall be provided with plant approved by the local authority for arresting grit and dust. These Regulations made under Section 4 (1) of the Act prescribe certain classes of furnaces which are exempted from the requirements of the Act while used for certain prescribed purposes. They also prescribe form of application for the exemption of individual furnaces and particulars to accompany the form. The Clean Air (Emission of Dark Smoke) (Exemption) Regs. 1969. These Regulations made under Section 1 (3) of the Clean Air Act, 1968, may exempt, subject to certain conditions, the provisions of Section 1 (1) under which it is an offence to emit dark smoke from industrial or trade premises. The Smoke Control Areas (Authorised Fuels) Regs. 1969. These Regulations declare the fuels specified in Regulation 3 to be authorised fuels for the purposes of the Clean Air Act, 1956. 202 Clean Air Acts, 1956 and 1968 Smoke Control Areas In the autumn, preliminary arrangements for the formation of the Little Heath, St. Nicholas, Woolwich Town Centre and Thamesmead Smoke Control Areas were completed and the Council declared the Areas on 29th October, 1969. Details of each of the Areas are as follow:— Little Heath This is an area of predominantly private property comprising some 150 acres and 1,314 dwellings of which it is estimated 695 will require some form of conversion or adaptation. Of the total dwellings 254 are Borough Council, 76 Greater London Council and 984 privately owned and, in addition, there are 38 nondomestic premises. The Minister of Housing and Local Government confirmed 1st July, 1971, as the operative date of the Area Order. St. Nicholas This area comprises some 80 acres and 1,490 dwellings of which it is estimated that 1,005 will require some form of conversion or adaptation. Of the total dwellings 54 are Borough Council, 8 are Greater London Council and 1,428 privately owned. In addition there are 65 non-domestic premises. The Minister of Housing and Local Government confirmed 1st July, 1971, as the operative date of the Area Order. Woolwich Town Centre This is an area of predominantly business and industrial premises comprising some 130 acres and 295 dwellings of which it is estimated that 56 will require some form of conversion or adaptation. Of the total dwellings 64 are Borough Council, 2 Greater London Council and 229 privately owned. In addition there are 322 non-domestic premises. The Minister of Housing and Local Government confirmed 1st July, 1971, as the operative date of the Area Order. Thamesmead This is an area of some 900 acres and although erection of dwellings has not yet commenced, approximately 11,000 dwellings are likely to be built, commencing towards the end of 1970. Although 65% of these dwellings will be Greater London Council owned, the remaining 35% will be provided by private development. The proposed dwellings should be suitably equipped to comply with the requirements of the Clean Air Acts, 1956 and 1968, therefore, no conversions or adaptations will be necessary. The operative date is 1st July, 1971. 203 Plumstead No. 2, Page Estate, Riverside, Royal Arsenal Western Enclave, Nathan Way and Abbey Wood No. 4 Smoke Control Areas On the same date as the above-mentioned Areas were declared, the Council approved in principle the Plumstead No. 2, Page Estate, Riverside, Royal Arsenal Western Enclave, Nathan Way and Abbey Wood No. 4 Smoke Control Areas with a view to the making of Orders in the autumn of 1970. These areas respectively comprise approximately 235, 310, 921, 85, 35 and 185 acres and 3,180, 2,650, 650 dwellings; the Royal Arsenal Western Enclave, Nathan Way and Abbey Wood No. 4 areas being wholly industrial areas. The majority of the dwellings in the Page Estate are Council owned. At the end of the year there were 8,703 acres and 62,730 dwellings within operative Smoke Control Areas. Details in respect of these Areas and that of Little Heath, St. Nicholas, Woolwich Town Centre and Thamesmead are set out in the table below and their respective coverage of the Borough shown on the accompanying map. 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 16 5 Middle Park (South West) 1.10.60 100 722/ Abbey Wood No. 2 1.10.60 78 1,150 Nil 24 4 Clothworkers Wood 1.10.60 260 1,868 Nil 12 4 Greenwich No. 1 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 12 563 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 8 5,325 6 370 47 St. Mary's No. 4 1.10.63 191 Nil 2 Nil Glyndon No. 2 1.10.63 26 390 Nil 12 1 Rockmount 1.10.63 5 253 Nil 1 1 Greenwich No. 4 1.10.63 262 1,212 Nil Nil 3 Greenwich No. 5 1.10.63 132 1,022 Nil 6 1 Well Hall 1.10.64 540 4,136 Nil 93 11 Glyndon No. 3 1.10.65 6 220 Nil 1 Nil Shooters Hill 1.12.65 480 4,360 1 75 12 Greenwich No. 6 1. 7.66 414 1,586 Nil 29 8 Brook 1.12.66 290 1,885 Nil 34 7 Plumstead 1.12.66 324 3,733 Nil 226 23 Black heath Park 1.12.67 620 3,390 5 61 26 Charlton 1.12.68 474 5,394 7 110 28 West Greenwich 1.12.69 530 6,134 87 450 43 Little Heath 1. 7.71 150 1,314 4 26 8 St. Nicholas 1. 7.71 80 1,490 3 48 14 Woolwich Town Centre 1. 7.71 130 295 6 294 22 Thamesmead 1. 7.71 900 — — — — 204 Grants During the year 772 grants amounting to £22,318 19s. 1d. 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. Twenty-one discretionary grants amounting to £405 7s. 6d. were so approved, giving a consolidated figure of 793 grants totalling £22,724 6s. 7d. 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. Two such payments were approved in the year and two payments were also made in respect of persons in special circumstances. 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 73 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.U.s shall, as far as practicable, be smokeless. Any person installing such a furnace must give prior notice to the Council and may submit detailed plans and specifications for the Council's approval before the works of installation commence. Twenty-seven notifications were received and one approval was given in 1969. Chimney Heights Under Section 6 of the Clean Air Act, 1968, 5 applications were received and chimney heights approved in 3 instances during 1969. Pollution Recording Four atmospheric pollution measuring stations are maintained 205 by the Council and the daily mean concentrations of smoke and sulphur dioxide are calculated on readings taken at these stations. No heavy atmospheric pollution was recorded during the year. Staff Within the Borough a Principal Clean Air Inspector and a team of one Clean Air Inspector and three Technical Assistants are employed full-time on duties in connection with atmospheric pollution and with the surveying and inspections of properties in Smoke Control Areas. Such duties involved a total of 7,237 inspections and visits. Rent Act, 1968 The following table gives details regarding applications received, certificates issued and action taken during the current year in accordance with the Rent Act, 1968. PART I—Applications for Certificates of Disrepair Number of applications for certificates 4 Number of decisions not to issue certificates — Number of decisions to issue certificates: (a) in respect of some but not all defects 2 (b) in respect of all defects 2 Number of undertakings given by landlords 2 (under para. 5 of 1st Schedule) Number of undertakings refused by Council (under proviso to para. 5 of 1st Schedule) Number of certificates issued 2 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 4 Objections by tenants to cancellation of certificates upheld 2 Decisions by Council to cancel notwithstanding tenants' objection — Certificates cancelled 2 In addition to the foregoing ten applications (Form "O") were received, six from landlords and four from tenants, each for a 206 certificate as to the remedying of defects which the landlords had undertaken to remedy. These resulted in the issue of Certificates (Form "P") as follows:— Applications By whom made Form "P" Certificates issued in respect of: — Defects Remedied Defects not/not wholly Remedied In respect of Form "H" undertaking Tenant — — Landlord — — In respect of Form "K" undertaking Tenant 3 1 Landlord 6 — Noise Abatement Act, 1960 Local authorities have been empowered to deal with noise and vibration as statutory nuisances under this Act and during the year 32 complaints of this nature were received and investigated. In most cases the nuisances were of a relatively minor nature and were resolved by informal action on the part of the Public Health Inspectors. In one instance substantial measures were taken at industrial premises in order to reduce noise during the night shift. On completion of these measures a considerable reduction in noise levels was recorded. In all, a total of 223 inspections were carried out during the year by the Public Health Inspectors. Pharmacy and Poisons Act, 1933 During the year the Chief Executive and Town Clerk received 11 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 136 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:— 207 (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. Under the Rag Flock and Other Filling Materials Regulations, 1961 and 1965, two samples were submitted for examination and both proved satisfactory. Licensing Act, 1961 During the year, 10 applications for registration as licensed premises, were made to the Chief Executive and Town Clerk involving inspections by the 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, 104 inspections were made and reports submitted to the Chief Executive and 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 12 licences were in operation and 100 inspections were carried out by the Senior District Public Health Inspector. 208 Hairdressers and Barbers Under Section 21 of the Greater London Council (General Powers) Act, 1967, as from the appointed day it is an offence, subject to the provision in sub-section (1), for any person to carry on the business of a hairdresser or barber on any premises in a Borough unless he is registered in respect of those premises by the Council. This Council fixed 1st June, 1968, as the appointed day and byelaws under Section 77 of the Public Health Act, 1961, were confirmed by the Minister of Housing and Local Government. Premises registered at 31st December, 1969 169 Persons registered at 31st December, 1969 208 Land Charges Act, 1925 Under this Act, enquiries in respect of properties in the Borough are received from time to time by the Chief Executive and 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, 4,211 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, 980 public sewers were tested and maintained, cleansed or emptied. Thirteen cesspools remain in use in the Borough and, under the Borough Engineer and Surveyor'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 Surveyor to the Council for approval. 209 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 Nothing is more commonplace than water. In these islands its cost is almost negligible and yet, as a usable commodity, it is not inexhaustible. It has been estimated that Britain's demands for water will double by the end of this century necessitating the construction, during the next 30 years, of water conservation projects equivalent to the sum total of all those built over the last 100 years. Such will be our requirements that all conventional and some unconventional methods, including desalination, will have to be considered seriously. Indeed, the economics of joint proposals by the Water Resources Board and the Atomic Energy Authority for the siting at Ipswich of an .experimental desalination plant of 1 million gallons per day capacity are already being studied by the Government. Greater London is unique in that it is practically wholly developed. Over the years, buildings 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. Deficiences 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. In fact, 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. Recent nationwide warnings on pollution in general and on water supplies in particular could hardly have been more opportune. 210 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 sufficiently fully to degrade the various existing pollutants thereby rendering the future task of providing a pure water supply even more difficult. It follows that a period of dry conditions accentuates the problem. In this respect it is interesting to record that a successful 3-year pilot scheme by the Thames Conservancy Board has shown the feasibility of a plan to abstract water from underground aquifiers and pump it into the Thames in times of severe drought at the rate of 100 million gallons per day. The whole of the Borough is supplied with water by the Metropolitan Water Board, a Statutory undertaking, which, as a result of the Metropolis Water Act, 1902, was formed in 1903 when it took over the 8 undertakings which were then supplying London's water. As a Board it is committed to supply a population of some 6¼ million people within an area of 540 square miles extending from Ware in the north to Sevenoaks in the south and which has an average daily consumption of about 400 million gallons. One of this Borough's two wells which supply drinking water is a most prolific contributor to the Board's supplies, having a normal output of 5 million gallons per day. The Board is responsible for the purity of its water and the supplies are regularly tested—chemically and physically for an estimation of its clarity, colour and taste, and bacteriologically for assessment of coliform colonies with confirmatory examination for Escherichia coli. There are 71,346 inhabited dwellings in the Borough with direct connections to the Board's mains. On request and following satisfactory reports, 10 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 Department of Health and Social Security Circular 1/70, regarding the water supplies in the Greenwich area:— 211 "You will understand that this information does not relate to private supplies or to supplies derived from or through other Water Undertakings (if any). (1) (a) The supply was satisfactory both as to (i) quality and (ii) quantity throughout 1969. (b) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1969, was 228,030. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. (2) (a) The supply was derived from the following works and pumping stations :- River Thames—derived, also well water from Bexley, Crayford, Darenth, Deptford, Wansunt and Wilmington Pumping Stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement." 212 METROPOLITAN WATER BOARD—Water Examination Department Average Results of the Chemical Examination of the Water Supply to the London Borough of Greenwich - Year 1969 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. B.O.D. 5 days at 20° C Hardness (total) CaCO3 Hardness (non-carbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as po4 Silicate as SiO2 Sulphate as so4 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micro-ohms). (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames-derived 371 0.024 0.083 4.4 1.05 282 79 5 24.0 5.4 32 2. 1 9 58 0.25 0.02 0.1 11 7.9 550 Bexley Well 4 0.008 0.017 5.4 0.30 335 90 20 0.15 0.0 4 7.2 600 (a) Crayford No. 1 4 0. 013 0. 048 9. 3 0.38 416 159 33 0.25 0.1 3 7.1 750 (b) Crayford No. 2 4 0 .004 0.022 6.9 0.08 305 79 28 0.20 0.1 1 7.4 580 (c) Crayford No. 3 4 0. 005 0.033 7.2 0.22 356 118 29 0.20 0.0 2 7.3 660 Darenth Well 4 0. 006 0.016 4.6 0.12 276 54 18 0.15 0.0 2 7.4 490 Deptford Well 4 0. 009 0.025 5.9 0.12 380 150 42 0.25 0.0 4 7.2 730 Wansunt Well 32 0.086 0.037 6.6 0.23 356 107 29 0.20 0.4 3 7.2 650 Wilmington Well 3 0.011 0033 7.6 0. 12 295 70 27 0.15 0.0 0 7.3 560 213 METROPOLITAN WATER BOARD—Water Examination Department Bacteriological Results—Yearly averages, 1969, of Water Supplied to the London Borough of Greenwich Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Thames-derived, 8,196 66.5 - 39.79 19.0 53.97 7.0 3,698 12. 9 - 99.89 100.0 Bexley Well 249 0.2 4 99. 20 - 100.0 - 253 15. 6 97 100.0 100.0 (a) Crayford No. 1 146 0. 1 5 99. 32 - 100.0 - 253 20.9 139 100.0 100.0 (b) Crayford No. 2 145 0. 1 134 99. 31 - 100.0 - (c) Crayford No. 3 113 0.0 15 100.0 - 100.0 - Darenth Well 250 0. 1 13 100.0 - 100. 0 - 251 0.0 3 100. 0 100.0 Deptford Well 248 0.2 6 98. 39 0. 1 99 .19 - 251 0.3 95 100. 0 100.0 (a) Wansunt No. 1 216 2.3 96 99. 07 - 100.0 - 252 0. 1 49 100.0 100.0 (b) Wansunt No. 2 234 0.6 48 100.0 - 100.0 - Wilmington Well 238 0.5 46 98.74 - 99. 58 - 242 0 .1 3 100.0 100.0 214 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 five decayed teeth and in fact, at the age of eleven only on child in very 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. Fluoride is present in most water supplies in small amounts as a naturally occurring chemical and the concentration varies from a trace to 14 parts or more per million in some areas of the world. It is also present in seawater at a concentration of about 1 p.p.m. and it is found in many foods as a trace element. 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 8 authorities have consistently opposed such action and the Metropolitan Water Board is persisting in its policy of not introducing fluoridation until there is unanimity among the authorities supplied. As stated in an earlier Section, it is this Council's intention to press for legislation requiring the fluoridation of all domestic water supplies. 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:— 215 Bath No. of Samples Satisfactory Unsatisfactory Greenwich—1st Class - - - Greenwich—2nd Class - - - Eltham—Small 1 1 - Eltham—Large 1 1 - Eltham—Spastics 1 1 - Plumstead—Small 1 1 - Plumstead—Large 1 1 - Woolwich— Small - - - Woolwich—Large - - - Totals 5 5 - I am indebted to Mr. D. F. Wallis, Baths Manager, for the following information and statistics in respect of the financial year 1969/70. "The Council's Baths Department comprises four Baths Establishments, a Sports Centre 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, a Launderette on the Abbey Estate, and a Sports Centre at Eltham. During the Winter season, the Large Pools at Greenwich and Woolwich are converted into halls, and a wide range of recreational activities are provided, including an indoor bowling green, roller skating, badminton, table tennis, men's "keep fit" and five-a-side football. During the year under review, 15,435 swimming lessons were provided through the various schemes operating in the Department, in addition to instruction given to school children attending in organised classes. Facilities for Cricket and Golf practice and Rhythm and Movement classes for women, are provided at the Eltham Sports Centre." The following table gives attendances at each Establishment for the year ending 31st March, 1970:— 216 Service Eltham Greenwich Plumstead Woolwich Abbey Estate Sports Centre Totals Swimming Public 136,725 65,469 74,041 63,256 - - 339,491 Schools 72,079 56,356 83,145 47,063 - - 258,643 Clubs 12,566 10,498 14,835 6,728 - - 44,627 Tuition 6,501 3,145 4,626 1,163 - - 15,435 Spectators 8,826 4,561 4,959 1,715 - - 20,061 Baths Private - 21,868 24,253 40,605 - - 86,726 Free (O.A.P. etc.) - 3,936 4,666 4,439 - - 13,041 Turkish - 11,366 6,147 - - - 17,513 Laundries - 1,250 12,981 - - - 14,231 Launderette - - - - 49,802 - 49,802 Other Recreational Facilities Roller Skating - 5,291 - - - - 5,291 Badminton & TableTennis - 438 - - - - 438 Indoor Bowls - - - 13,192 - - 13,192 „ Golf - - - - - 1,116 1,116 „ Cricket - - - - - 19,872 19,872 Totals 236,697 184,178 229,653 178,161 49,802 20,988 899,479 Rodent Control General The current year saw a continuance of the Work Study Scheme which was introduced in June, 1968. Under this scheme the staff of the rodent control section was reduced in number from an establishment of nine operators and one investigator to three fulltime and one part-time operators, and one full-time investigator. These men are now paid a bonus of up to 20% of their wages, providing that all complaints and jobs are satisfactorily dealt with. Although all requests for assistance in respect of rodent infestations were dealt with by the reduced staff, it was not found possible to undertake any routine sewer baiting for rats. However, it is proposed that sewer treatments will commence again during 1970. Of a total of 3,298 recorded complaints (1,415 of rats and 1,883 of mice) 2,349 were notifications, 554 re-notifications from occupiers or other sources and 395 found during survey; the monthly average of complaints from all sources was 274. 217 In addition to the investigations of recorded complaints, 5,326 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 8,529. During investigations, infestation was found to exist on 37 occasions in Local Authority premises, 2,081 in dwelling houses and 358 in miscellaneous properties and places of business. In all, some 3,042 treatments were effected by the Council and 3 by occupiers or other services. Periodical treatments were carried out at 17 industrial premises, 4 wharves and 2 hospitals in the Borough. Rodent Control treatments are carried out by the Council free of charge in all private dwellings; for industrial and business premises a charge is made. When it is found that defects of a structural nature are causing or aggravating an infestation of rodents the remedy is taken up with the owner of the premises. Following the policy of tracing the source of each infestation, 37 drains suspected as a cause of rat infestation were tested by the Department's staff and in 23 cases the tests proved positive. In these instances Notices were served under the Public Health Act, 1936, and the defects remedied. 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, requires the Local Authority to take the necessary steps to ensure that, so far as is practicable, their district is kept free from rats and mice, by :- (i) carrying out inspections; (ii) destroying rats and mice on their own property; and (iii) enforcing the duties of owners and occupiers, as set out in the Act. 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, 1969:— 218 Prevention of Damage by Pests Act, 1949 Properties Other than Sewers TYPE OF PROPERTY NonAgricultural Agricultural 1. Number of properties in district 90,000 1 2. (a) Total number of properties (including nearby premises) inspected following notification 5,542 - (b) Number infested by (i) Rats 674 - (ii) Mice 1,538 - 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 6,285 1 (b) Number infested by (i) Rats 170 - (ii) Mice 94 - 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 No routine baiting was undertaken during the current year. Warfarin Resistance Over the past few years it has been established by the Ministry of Agriculture, Fisheries and Food that Warfarin resistance by the house mouse has been increasing and now extends to South East England and includes, in particular, the London area. This genetic change of the mouse has presented a challenge to the rodent control staff, which they have met by using alternative methods of control, such as the narcotic Alphachloralose and various rodenticidal dusts. Acute poisons such as zinc phosphide and arsenic have been used on a limited number of occasions where it was considered there was no risk of danger to the public. The use of these alternative methods of control has however, increased both the time required and the number of visits carried out by the rodent control staff in order successfully to rid the premises of the infestations. Control of Foxes From time to time foxes have been the subject of complaints especially in the Charlton Park/Brook Hospital/Greenwich 219 Cemetery/Shooters Hill areas. By arrangement, control has always been exercised by the Ministry which organised shootings or gassings of the earths as appropriate. During the current year, the Ministry indicated to the Council that it would be withdrawing from such schemes and that after 1st January, 1970, local authorities themselves would have to undertake these duties. Nevertheless, a Ministry advisory service would still be made available to Councils in need. It is this Council's intention to cover our particular situation with a part-time appointment. 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 Surveyor who has kindly supplied me with the following information :- "(a) Street Cleansing and Street Gullies The statistics are substantially the same as previous years, namely, that there are 250 miles of roads in the Borough which were cleansed with the following frequencies :- at least once daily 9% three times weekly 21% twice weekly 70% More than 100 sweepers were employed and, in addition, a mechanical sweeper and sprinkler was used to deal with the main traffic roads and shopping streets. During the current year the Blackwall Tunnel Southern Approach Road was opened and this is swept only by mechanical sweeper. There are 15,100 street gullies which were cleansed entirely by mechanical means three times a year. (b) Refuse Collection Some 62,750 tons of refuse were collected from normal domestic and bulk containers. Again, collection was generally weekly but more frequent from blocks of flats and other premises. 220 Requests for special collections of unwanted furniture, etc., totalled 5,874. (c) Public Conveniences Following on the inception of the new system of manning, the Works Committee decided to experiment with the opening, 24 hours per day throughout the week, of a number of conveniences. Eight were chosen to start with and the result of the experiment was such that a further number was included in the scheme. By the end of the year, with very few exceptions, all conveniences were open continuously. (d) Unwanted Cars During the year, 496 abandoned cars were cleared from the roads; 611 were collected at their owners' request and 487 were delivered by their owners to the Council's Depots." Flies and Mosquitoes During the year 96 complaints of flies were received, resulting in treatments being carried out to 51 rooms and 68 external areas. On request from the Borough and Greater London Council Housing Departments, dust chutes and containers in the multistorey flats are treated with Gammexane. Disinfestation of Verminous Premises Dieldren Concentrate continues to give good results in dealing with verminous premises. During the year the department dealt with 101 cases of dirty and verminous premises, and the disinfestation staff sprayed 259 rooms and contents. In three cases the bedding and effects were removed to the Council's disinfecting station for treatment by steam or formaldehyde. Of other pests which necessitated the treatment of rooms and external areas, the following initiated the greater number of complaints. Ants.—Ants carry no disease but their presence in human foodstuffs is objectionable. Foods of a relatively high sugar content are particularly attractive to ants and the insects are prepared to go to great length in order to obtain a sufficiency for their community. In the main, the 142 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 221 in search of food. One hundred and thirty-two treatments involving 294 rooms and 103 external areas were carried out to combat the reported nuisances. Cockroaches.—The cockroach (Blatta orientalis) and its smaller relative (Blattella germanica) are well known for their destructiveness, especially in relation to stored organic matter, ranging from foodstuffs to book bindings. Food is rendered repulsive from contamination not only with their faeces but also with the secretion from their scent glands, and the cockroach is strongly suspected of transmitting to man a number of pathogenic organisms especially those of an enteric nature. Cockroaches shun the light and are most active during the night. Warmth, moisture, darkness and close proximity to food supplies constitute favourable conditions for breeding. Fifty-seven complaints were received concerning this pest and thorough investigation and treatment with Dieldrin Concentrate resulted in the infestations being considerably reduced. In all, 54 treatments were effected involving 227 rooms. Clover Mite.—Thirty-seven 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 29 rooms and 37 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 or other sites which evoke a certain ingenuity on the part of the disinfestors in order satisfactorily to deal with the nuisance. 222 One hundred and seventy-nine complaints regarding this pest were received and during the year some 117 nests were destroyed, mainly by means of Gammexane powder or Dieldrin Concentrate. Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith. Complaints Treatments Rooms External Areas Beetles: Black 5 5 18 - Carpet 16 14 51 - Larder 7 5 14 - Spider 3 2 7 - Book Lice 2 1 1 - Crickets 1 1 - 1 Earwigs 13 13 38 9 Fleas 167 156 961 6 May Bugs 2 1 3 - Meal Worms 1 - - - Moths 4 4 4 - Psocids 5 5 13 - Silverfish 16 16 39 - Slugs 8 8 5 12 Spiders 4 4 7 1 Wild Bees 18 10 - 10 Wood Lice 13 11 31 5 Woodworm 1 1 1 - Misc. Insects 28 18 41 5 Sixty requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by treatments to 228 rooms and 12 external areas. Precautionary Spraying.—During the year, at 27 premises, unwanted bedding, furniture and miscellaneous household effects were sprayed as a precautionary measure prior to removal by the Borough Engineer and Surveyor's staff. Treatment was effected in 46 rooms and 1 external area. 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, Lionel Road and Plumstead High Street Cleansing Stations and the following Return summarises the work carried out during the year:— 223  Attendances Vermin Scabies Adults 27 205 Children under school age 74 64 School children 369 333 Totals 470 602 During the current year there was a resurgence of verminous conditions and attendances rose by over 34% to a total of 470. Lice are the natural vectors of typhus, trench and relapsing fevers although in temperate climates infection seems generally to be limited to skin organisms giving rise to impetigo, furunculosis and eczema. There is evidence to suggest that, in the London area, the head louse (pediculus humanus capitis) is becoming resistant to the organochlorine insecticides such as DDT and gamma BHC used for present-day treatments. Fortunately, early results from clinical trials initiated by the London School of Hygiene and Tropical Medicine into the use of malathion and carbaryl as alternative methods of treatment are encouraging. Even more startling was the recrudescence of scabies, treatments for which increased by no less than 51% to 602, a total more than 3 times that for 1967. A number of cases of scabies are likely to be complicated by impetigo, a contagious complaint arising from the infection of scratches by staphylococcal and/or streptococcal organisms. Because impetigo is not a notifiable disease our information is limited to the number of children reported by the schools as suffering from this complaint. In 1969, there were 82 children so reported. 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. 224 The accompanying table shows in detail the work carried out during the year. Rooms and Articles Disinfected, Year ended 31st December, 1969 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 4 1 _ 2 1 _ 4 6 _ _ 2 2 _ _ _ 17 Diphtheria 2 3 _ 6 _ 10 14 _ _ _ 3 78 2 _ _ 113 Tuberculosis 11 10 _ 10 _ 17 6 19 _ 4 2 42 13 2 _ 115 Cancer 3 5 2 4 _ 4 _ 4 _ 1 _ 14 7 _ _ 36 Meningococcal Infection _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Puerperal Pyrexia _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Typhoid Fever 2 14 _ 26 _ 43 112 66 _ 2 1 27 154 _ _ 431 Polio-Myelitis _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ Erysipelas Acute _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Encephalitis _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Measles 3 4 _ 2 _ 2 4 7 _ _ _ 11 3 _ _ 29 Scabies 10 17 _ 1 1 2 ?4 8 51 _ 7 7 49 59 2 _ 220 Other Diseases 61 124 4 142 _ 383 90 84 _ 5 28 323 137 2 _ 1,198 Verminous Premises 19 23 3 11 _ 29 36 47 _ 1 19 65 89 _ _ 300 TOTAL 115 201 9 214 3 512 274 284 _ 20 62 611 464 6 2,459 LIBRARY BOOKS DISINFECTED 18 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 1969 totalled 3,432. Of these, 1,200 were from within the Borough compared with 1,189 in 1968. Exhumations No exhumations were carried out during the current year. Mortuary Accommodation Arrangements exist between Greenwich Council and the Council of Lewisham for bodies to be accommodated at the latter's two mortuaries prior to inquests and post mortems or while awaiting burial. During the current year some 1,084 bodies were so accommodated at a cost to the Council of £3,414 12s. 0d. 225 Summary of Work Performed by the Public Health Inspectors during the Year 1969 Inspections— Houses inspected (Complaints, nuisances) 4,730 „ „ (Infectious Disease) 2,956 „ „ (Overcrowding and other Housing Applicants) 396 Inspections of Factories 262 „ „ Licensed Victuallers and Clubs 303 „ „ Underground Rooms 43 „ „ Pet Shops 100 „ „ Stables and Yards _ „ „ Urinals 11 „ „ Houses in Multiple Occupation 99 „ „ Outworkers' premises 133 „ Under Clean Air Act 4,230 „ Miscellaneous 16,573 Inspection of Premises (Clearance Areas) 237 „ „ „ (Improvement Grants) 434 „ „ „ (Individual Unfit Houses) 443 ,, ,, ,, (Rent Acts) 30 Inspections of Offices Shops and Railway premises 1,120 Investigations (Rats and Mice) 735 Investigations (Insect Pests) 791 On Notice from Architects and Builders 357 Re-inspections, calls made, etc 5,377 39,360 Drains— Drains Tested—by smoke 37 ,, ,, —by water _ Opened, cleansed and repaired 943 Yards and forecourts drained 2 W.C. Compartments erected or repaired 50 W.C. fittings repaired or renewed 109 W.C. pedestals installed or renewed 33 Sanitary conveniences or improvements effected to Factories and Workplaces 45 Urinals cleansed or repaired 5 Dustbins— Provided 6 Pavings- Yards and Forecourts 7 226 General Water Supply— Water Fittings amended 30 Water supply restored 15 Extra water supply to tenement houses 2 Other Improvements- Rooms cleansed and repaired 25 Rooms and staircases lighted and ventilated 280 Verminous rooms cleansed 259 Roofs, gutters and rainwater pipes repaired 446 Dampness abated 784 Underground Rooms (enforcement of Regulations) _ Sinks, baths and lavatory basins provided 4 Sink, lavatory and bath waste pipes trapped or amended 53 Stoves and fireplaces 17 Floors repaired 158 Miscellaneous repairs 607 Other Nuisances Abated— Illegal use of Underground rooms discontinued _ Animals kept in unfit places discontinued or removed 9 Foul Accumulations removed 59 Rat infestation abated 3,045 Smoke Nuisances- Observations 288 Statutory Notices served 1 Notices, Etc.- Preliminary Notices served 1,385 Statutory or Abatement Notices served 490 Houses rendered fit by informal action 1,225 Legal Proceedings Premises Offence Results of Proceedings 35 Piedmont Road Non-compliance with Abatement Notice Summons withdrawnwork completed 10 Straightsmouth ,, ,, ,, ,, 32 Hopedale Road ,, ,, ,, ,, 227 HOUSING I stated in my report for 1966 that intrinsically, housing is a constant cycle of regeneration and the idea that its problems can be solved by a once-and-for-all re-building effort is fallacious. Not only is it fallacious but dangerous in that its general acceptance can lead eventually to complacency. A perusal of current literature on this subject seems to suggest that there is some difficulty, if not reluctance, for this truism to be received. Under prevailing conditions, viz, financial stringency, lack of suitable land, shortage of skilled labour, demands for higher standards as a result of improved education, etc., it has clearly been found impossible to keep pace with the need for more and better housing. Every decaying house is not being replaced and it must be remembered that even today's new dwelling will be obsolete in 70 years or less. It is a sobering thought to realise that the useful life span of a house built just after the last war is almost half over. As it has been estimated that approximately 26% of all dwellings in England and Wales are over 80 years old, inevitably one must be drawn to the conclusion that conversion and improvement are essential ingredients of any housing programme if for no other reason than the need to preserve our viable communities and if urban society itself is not to disintegrate. However, house preservation has always been an integral part of the environmental health service and its future importance can certainly be no less although much will depend upon the vigour with which this objective is pursued. It should have strong central and local government support. Sometimes, unfortunately, statutory protection of tenants leads to deterioration of property and conservation of existing housing accommodation is thereby threatened. In the public interest a reappraisal of legislation is indicated. Undoubtedly, it can be said that this is the day of the planner. Everywhere planning has become somewhat of an obsession— so much so that it is now open to the accusation that some planning is perpetrated for "planning's sake". This can hardly be the case but it is true to say that in many aspects of the housing field, previous planning has failed the community, in that, on some occasions, what has been provided has not been what was required. No blame, however, attaches to the planner who is constrained to work within a severely restricted brief. For example, effective planning for special housing needs involving low-maintenance, long-life schemes are sometimes prejudiced by hasty settlements 228 for poor finishes, excess glasswork, inadequate insulation both for noise and heat, etc., on financial grounds, and their possible effects on the development of practical and psychological problems have received scant attention. It would seem that too much emphasis has been placed on providing accommodation and not nearly enough on its long-term influences upon the individual and family life. In many instances, our approach has been somewhat "utopian" rather than practical and, as a result of neglecting to take account of human preferences, natural forces and market influences, planning is failing to reshape society for the better. Housing authorities in urban areas are overwhelmed by density problems and the dominance of high rise accommodation in all their schemes is a logical sequence. Despite the fact that only about 1% of all persons want to live in high flats, over half the total of dwellings under construction in local authorities' schemes is comprised of flats. Under such circumstances, contentment and harmony will be difficult to achieve. Wholesale blighting and denudation of areas with subsequent mass re-housing in high rise flats, is devastating to the family and individual personality. Often there remains little pride in possession nor a sense of belonging and there is complete absence of a community pulse. For most families, flat life is productive of human discomfort if not actual misery. At times it is lonely, noisy and inconvenient for amenities and lacks storage space for all the extraneous things which bring contentment to children. Among other disadvantages, many high rise dwellings have insufficient natural ventilation and suffer in varying degrees from unsightly fungus growth resulting from condensation. Often ineffective, underfloor heating is most expensive especially to those with low incomes and is virtually prohibitive to the retired elderly who, in winter, may well become hypothermic if not subject to lesser ills such as bronchitis, chilblains and other respiratory and circulatory troubles. Perhaps the boom in high rise housing is over but, as a result of dubious planning and doubtful design economics over the past two decades, housing authorities are now left with a heritage of unsuitable housing accommodation for young families and social and welfare problems of ageing persons in multi-storied dwellings, not to mention the intractable nature of future slum clearance. In this Borough we are fortunate that, until recently, sufficient land was available for housing programmes and now, almost in 229 the nick of time, the closure of the Royal Dockyard and a contraction of the Royal Arsenal has produced valuable areas for balanced housing schemes to be entertained with a modicum of disturbance to residents and communities. New Legislation Housing Act, 1969 The above Act, which received the Royal Assent on the 25th July, came generally into effect on the 25th August. The Act is drafted to provide increased compensation for owner-occupiers of unfit premises affected by slum clearance; it raises the improvement grant limits and makes possible the improvement of whole areas instead of just single dwellings and provides, for the first time, financial help towards environmental improvement. It also introduces a new system governing the rent of privately rented dwellings which have been brought up to a satisfactory standard. Legislation on Houses in Multiple Occupation is consolidated, provisions regarding compensation for "well-maintained" premises are extended and the Act places a duty on local authorities to inspect their district from time to time with a view to action under the Housing Acts. In future, determination of fitness for human habitation will include "internal arrangements" and, when repairs are effected, power is given to local authorities to bring a dwelling already fit up to a reasonable standard having due regard to its age, character and locality. Housing Act, 1957 Part II—The following procedures were carried out during 1969 :— (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 two 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 2 Reventlow Road, S.E.9 91 Greenwich South Street, S.E.10 230 (b) Closing Orders 70 Avery Hill Road, S.E.9 18 Brookhill Road, S.E.18 192 Maxey Road, S.E.18 76 Brookmill Road, S.E.8 142 Brewery Road, S.E.18 43 Admaston Road, S.E.18 26 King George Street, S.E.10 118 Crescent Road, S.E.18 161 Reidhaven Road, S.E.18 20 Brookhill Road, S.E.18 21 Brookhill Road, S.E.18 3 Garland Road, S.E.18 95 Greenwich South Street, S.E.10 59 Waverley Road, S.E.18 (c) Demolition Order 3 Merchland Cottages, S.E.9 (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 :— 25 St. John's Park, S.E.3—Basement front left and right rooms, back room, scullery and bathroom. 33/34 Conduit Road, S.E.18—First floor flat over Nos. 33/34 comprising front rooms, back rooms and bathroom; and basement front and back rooms and passage on the east side known as No. 33. 223 Burrage Road, S.E. 18—Basement front and back rooms and scullery. 91 Greenwich South Street, S.E.10—Basement front and back rooms. 10 King George Street, S.E.10—Basement back room. 231 91 King George Street, S.E.10—Basement front and back rooms. 63 Woodhill, S.E.I8—Basement front and back rooms. (iii) Determination of Closing Orders—Section 27—Closing Orders on premises and parts of premises as follow were determined :— 136 Royal Hill, S.E.10 16 Helen Street, S.E.18 28 Gunning Street, S.E.18 10 King George Street, S.E.10 (Closing Order made on basement back room) 63 Woodhill, S.E.18 (Closing Order made on basement front and back rooms) 22 Ransom Road, S.E.7 133 Tewson Road, S.E.18 135 Tewson Road, S.E.18 70 Avery Hill Road, S.E.9 36 Guildford Grove, S.E.10 98 Barth Road, S.E.18 91 King George Street, S.E.10 (Closing Order made on basement back and front rooms) (iv) Revocation of Demolition Order—Section 24.—a Demolition Order in respect of the undermentioned premises was revoked :— 11a Morden Road Mews, S.E.3 Part III—Clearance Areas No Clearance Areas were reported during the current year. House Purchase and Housing Acts, 1958/59 and Housing Act, 1969. Improvement Grants Prior to the enactment of the Housing Act, 1969, authority to pay grants towards the costs of improvements on dwellings was in accordance with Section 30 of the Housing (Financial Provisions) Act, 1958, for Discretionary Grants and with Section 4 of the House Purchase and Housing Act, 1959, for Standard Grants. Applications for grants submitted to the Borough Treasurer are referred to this Directorate for confirmation that the proposed works satisfy the requirements specified by the appropriate Acts. In this connection the Housing Inspectors carried out 276 and 22 inspections for discretionary and standard grant applications 232 respectively and advice was given on 121 occasions in respect of such grants. On completion of standard grant works a further 9 inspections were made. Housing Act, 1969—Part III Qualification Certificates.—The following table is a copy of the return forwarded to the Ministry of Housing and Local Government in respect of the Qualification Certificates issued by the Council at the end of the year under review:— Improvement cases No. of applications for qualification certificates under section 44(2) under consideration at the end of December, 1969 10 No. of certificates of provisional approval issued 4 No. of qualification certificates issued under section 46(3) None Standard amenities already provided No. of applications for qualification certificates under section 44(1) under consideration at end of period 161 No. of qualification certificates issued under section 45(2) in respect of:— (i) dwellings with rateable value of £90 or more in Greater London or of £60 or more elsewhere None (ii) Dwellings with rateable value of £60 to less than £90 in Greater London or of £40 to less than £60 elsewhere None (iii) Dwellings with rateable value of less than £60 in Greater London or less than £40 elsewhere None Exemption for low-income tenants from section 54 No. of certificates issued under section 55 None 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 233 Facilities for storage, preparation and cooking of food and for the disposal of waste water Prevention of overcrowding of sleeping rooms were retained under Sections 36 and 90 of the 1957 Act. However, powers enabling the Council to enforce standards under Section 36 proved to be inadequate and were repealed by Part II of the Housing Act, 1961. Regulations were made subsequently by the Minister under Section 13 of the new Act providing a management code for Councils to apply to Houses in Multiple Occupation. Further, for the purpose of implementing the provisions of Section 15 of the Housing Act, 1961, the Council, on the 14th November, 1962, adopted the standards of provision of amenities, as suggested in the joint report of the Advisory Bodies of Town Clerks and Medical Officers of Health of Metropolitan Borough Councils. This Directorate 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, 177 visits were made by the Housing Inspectors. It was found necessary to serve 14 informal and 4 formal notices requiring the execution of works under this Act. Re-housing (a) Borough Council—The number of families housed and re-housed including transfers, casual voids, etc., amounted to 1,416. Of this number 41 were in respect of families re-housed from outside the Borough. (b) Greater London Council—During the year ended 31st December, 1969, the Greater London Council had provided alternative accommodation for a total of 708 Greenwich families. Of this figure 253 were housed on Greater London Council housing estates outside the Borough. One family from outside Greenwich was re-housed in the Borough under the Greater London Council scheme. Overcrowding During 1969 there were 461 visits carried out in respect of complaints of overcrowding and applications for re-housing, as a result of which 6 families were found to be statutorily overcrowded. 234 Council Housing Schemes—(Information supplied by Mr. J. M. Moore, Borough Architect). (a) Schemes in operation at the end of the current year:- Site Total Dwellings As at 31st Dec. 1969 Completed Under Construction Glyndon Phase 1— Stages 4 and 5 166 4 162 The Mound 20 _ 20 Woolwich Common, Stage I 140 84 56 Connaught Barracks 330 72 258 Bison I B. Contract 638 _ 638 Maryon Road 188 _ 188 Swingate Lane 44 _ 44 (part sheltered housing) Beasley's Brewery Site 24 _ 24 Little Heath (sheltered housing) 41 _ 41 Woolwich Polytechnic Hostel 250 _ 250 Students' Students' Rooms Rooms (b) The following dwellings have been commenced or are planned for commencement before 31st December, 1970:- Site Dwellings Brent Road 48 The Warren 128 The Heights 123 Plumstead High Street 70 Ancona Road (part sheltered housing) 74 Glyndon Phase II, Stage 2 100 Glyndon Stage 2, Linked flats 12 Glyndon Phase II, shops and maisonettes 6 Mabyn Road 98 Palmerston Crescent 56 235 INSPECTION OF FOOD AND SUPERVISION OF FOOD PREMISES New Legislation The Meat (Sterilization) Regulations, 1969. These Regulations, made under Sections 13 and 123 of the Food & Drugs Act, 1955, and which apply to England and Wales only and supersede the Meat (Staining & Sterilization) Regulations, 1960, came into force on the 1st November, 1969. They require all knacker meat and meat (other than the meat of a rabbit or hare) which is imported otherwise than for human consumption, as well as all butcher's meat or imported meat which in either case is unfit for human consumption, to be sterilized before entering the chain of distribution. They also require that imported meat which is unfit for human consumption or imported otherwise than for human consumption and without an official certificate or meat inspection stamp and which is stored in or removed from the port of entry shall be sterilized or shall bear a notice to the effect that the meat is not fit for human consumption. The different categories of meat to which the regulations relate are defined in Reg. 2(1). Provision is made whereby zoos, menageries, mink farms, trout farms and processors may obtain such meat unsterilized if it is transported in locked containers or vehicles. Supplies of meat to hospitals, medical or veterinary schools or similar institutions for instructional or diagnostic purposes and to manufacturing chemists for the manufacture of pharmaceutical products are unaffected by the Regulations. On consignment or delivery of specified meat the Regulations also require that a notice be given or sent therewith giving particulars of the meat and the names and addresses of the persons from and to whom it is being conveyed (Reg. 12). The Regulations are to be enforced by local authorities and port health authorities and prescribe the maximum penalties provided for in Section 106 of the Food and Drugs Act, 1955. The Food (Control of Irradiation) (Amendment) Regulations, 1969. With one exception, the above Regulations, made under Sections 4 and 133 of the Food & Drugs Act, 1955, prohibit the application of ionizing radiation to food intended for sale for human consumption. These Regulations make a further exception to permit the irradiation of food for patients who are certified by a registered medical practitioner to require a sterile diet as an essential factor in their treatment. 236 The Artificial Sweeteners in Food Regulations, 1969. The above Regulations which came into force on the 1st January, 1970, were made under Sections 4, 7 and 123 of the Food and Drugs Act, 1955, and apply to England and Wales only and supersede the Artificial Sweeteners in Food Regulations, 1967. The principal change is that cyclamic acid, calcium cyclamate and sodium cyclamate are no longer permitted sweeteners or permitted ingredients in artificial sweetening tablets. The Soft Drinks (Amendment) Regulations, 1969. These Regulations were made under Sections 4, 7 and 23 of the Food and Drugs Act, 1955, and came into operation on the 1st January, 1970. The Regulations: (a) amend the definition of "permitted artificial sweetener" in the principal regulations so that saccharin, saccharin calcium and saccharin sodium (as defined in the Schedule to these regulations) are the only permitted artificial sweeteners; (b) amend the requirements in Reg. 12 of the principal regulations as to declarations on the sale of soft drinks in or from vending machines; (c) make changes in the forms of expressions, specified in Reg. 13 of the principal regulations, for labels of containers of soft drinks containing any permitted artificial sweetener; (d) amend the specifications for saccharin, saccharin calcium and saccharin sodium in Sch.l to the principal regulations. 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 210. On 67 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, 1969, as were the following licences in relation to milk obtained in pre-packed form for sale to the general public:— 237 In Operation 31.12.69 Distribution of Sterilised Milk 182 „ „ Pasteurised Milk 151 „ Untreated Milk 64 „ Ultra Heat Treated Milk 22 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 seven samples were submitted for the Methylene Blue test, of which 3 failed. "Follow-up" samples taken in respect of the 3 which failed proved satisfactory. Satisfactory reports were received in respect of 235 milk samples submitted for the Phosphatase test. Forty-three samples of Sterilised Milk were submitted for the Turbidity test and all proved satisfactory. Analytical Examination of Milk—A total of 137 formal and 8 informal samples of designated milks were submitted for chemical analysis and all proved to be genuine. Two 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, 1969, was 240. Five hundred and eleven 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 590. Visits to these premises were made on 112 occasions and 19 improvements were effected. 238 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 83 samples were submitted for examination and the ice cream graded according to the Ministry's provisional grading scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given in the following table:— Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 61 4½ hours or more 1 Satisfactory 15 2½ to 4 hours 2 Sub-standard 3 ½ to 2 hours 3 Unsatisfactory 4 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 83 samples taken during the current year, 12 were of the "soft" variety, 5 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. Seventeen samples were submitted for examination and all 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 28 visits to the fairs during these holiday periods, but in no instance was action required. Street Traders During the year 58 applications were received by the Chief Executive and Town Clerk from street traders engaged in the retailing of articles of food. The applications were approved and licences granted. 239 No formal action was necessary in respect of contraventions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, and (Amendent) 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 4,401 visits, as a result of which 478 improvements were effected. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year: Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected No. of Improvements effected Caterers, Restaurants, etc 522 29 165 Grocers, Greengrocers 262 27 166 Butchers' Shops 125 14 49 Dairies and Milk Distributors 67 7 37 Wharves and Factories 780 — — Bakehouses and Bakers' Shops 10 2 12 Ice Cream Premises, Confectioners, etc. 112 4 19 Fried Fish Shops 112 8 30 Other Non-Registered Food Premises 199 — — Cooked Meats and Preserved Foods 437 * * Visits Re. Infestations 167 — — „ „ Markets 316 — — „ „ Food Poisoning 1 — — Sampling Visits 843 — — Fair Visits 28 — — School Visits 40 — — Interviews 285 — — Complaints Investigated 95 — — Totals 4,401 91 478 * 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:— 240 Type of Premises No. of Premises No. provided with washhand basins No. with facilities for washing food and equipment Cafes, Restaurants, etc. 394 394 394 Grocers 346 346 346 Greengrocers 149 149 Not applicable Butchers 141 141 141 Bakers 72 72 72 Confectioners 291 291 Not applicable Fish Shops 73 73 73 Public Houses 217 217 217 Off Licences 54 54 Not applicable Bakehouses At the end of the year, 12 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 10 occasions and, as a result of the inspections, 12 sanitary defects were remedied. Catering Establishments As a result of 469 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 165 occasions. One hundred and two 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— Bacon 2,353 lb. Beef 2,996 „ Chicken 923 „ Lamb 1,242 „ Lambs' Hearts 124 „ Lambs' Livers 157 „ Mincebeef 12 „ Ox Kidneys 10 „ Ox Livers 33 „ Pigs' Kidneys 191 „ Pigs' Livers 14 „ Pigs' Spleens 49 „ Pigs' Trotters 80 „ Pork 1,025 „ 241 Pork Sausages 73 „ Rabbits 55 „ Sheep Kidneys 10 „ Turkey 46 „ 9,393 lb. Canned and Other Foods— Beans (Canned) 117 lb. Beetroot (Jars) 375 „ Butter 48 „ Carrots (Canned) 61 „ Christmas Puddings 36 „ Confectionery 114 „ Cooked Meats 6 „ Cooked Meats (Canned) 4,754 „ Eggs 26 „ Fish 363 „ Fish (Canned) 120 „ Flour 123 „ Foods, Various (Canned) 440 „ Foods, Various (Frozen) 8,323 „ Foods, Various Packets) 629 „ Fruit (Canned) 2,279 „ Fruit Pulp (Canned) 177 „ Jams (Canned and Jars) 108 „ Lard 71 „ Macaroni 26 „ Marmalade (Canned and Jars) 742 „ Nuts 154 „ Peas (Canned) 53 „ Potatoes 112 „ Potatoes (Canned) 20 „ Sausages (Canned) 57 „ Sweetcorn (Canned) 256 „ Tea 93 „ Tomatoes (Canned) 702 „ Tomato Puree, Paste & Juice (Canned) 402 „ Vegetables 35 „ 20,822 lb. 30,2151b. 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, whose licence was renewed for the current year. The total number of animals presented for slaughter and inspected at this establishment during the year amounted to 72,357 compared with 73,068 in 1968. Details are as follow:— 242 Carcases and Offal Inspected and Condemned in Whole or in Part, 1969 Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed and Inspected 9,591 547 25 11,445 50,749 All Diseases (except Tuberculosis and Cysticerci)— Whole carcases condemned – 1 – – 73 Carcases of which some part or organ was condemned 2,455 123 1 663 16,204 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 25.6 23.5 4 5.7 32.2 Tuberculosis only— Whole carcases condemned – – – – – Carcases of which some part or organ was condemned — — — — 594 Percentage of the number inspected affected with Tuberculosis – – – – 1.2 Cysticercosis— Carcases of which some part or organ was condemned and treated by refrigeration 6 – – – – The incidence of disease, parasitic infestations and other conditions rendering carcase meat and offal unsuitable for human consumption followed closely a pattern similar to that of 1968 except with regard to tuberculosis where it is pleasing to report that of the 9,591 cattle inspected not one incident of the disease was observed. There were 43½ tons of carcase meat and offal condemned during the year of which the major portion was offal. A slight decline in the number of ox livers rejected because of infestation by liver fluke was registered and it is hoped that genuine progress will now be made to eradicate completely this parasite which over the years has been responsible for very large quantities of liver being rejected. Some 61 whole pig carcases were condemned because of multiple abscesses a condition thought to be attributable to tail biting to which I referred in my report for 1968. It is always of interest to observe conditions of physiological defect and disease in animals presented for slaughter for human 243 consumption where similar conditions are perhaps more readily diagnosed in human beings. A condition of interest physiologically which appears to effect humans and animals alike is the syndrome generally referred to as "hole in the heart" which is occasionally observed in cattle, sheep and pigs during post mortem inspection of offal. This is a condition where the auricles of the heart, which normally operate independently, remain connected at the prenatal orifice which ordinarily closes at birth. In acute cases the animal so affected would no doubt die shortly after birth or be sent to the knackers yard rather than to the slaughterhouse. When observed in the slaughterhouse, the condition is of a milder form and the heart appears normal apart from its increase in size and weight. One imagines that hypertrophy continues from birth until the heart is powerful enough to compensate for the congenital disability; when this stage is reached the animal appears quite normal. The fact that the animals so affected have apparently lived a normal life if only a relatively short one, appears to be borne out by the perfectly normal condition of the carcase. The bovines so affected were usually between 1½ and 3 years old. The pigs were of butcher quality 4½/5 months old. The generally maintained improvement in animal health continues with the exception of the respiratory infections encountered in pigs which has shown little or no improvement over the years. It must be said however that these infections do not seem to have any detrimental effect on the carcase. Licensing of Slaughterhouses and Slaughtermen—The licence for the one slaughterhouse in the Borough was duly renewed during the year. Ten licences to slaughtermen were also renewed. Butchers' Shops—Frequent visits are made to these shops and in addition to the 125 formal inspections carried out, insanitary defects were remedied in 49 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. 244 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:— Meat— Beef 121 lb. Lamb 2,236 „ Mutton 63 „ Pork 334 „ 2,754 lb. Canned and Other Foods— Asparagus (Canned) 21 lb. Beans (Canned) 47 „ Butter 100 „ Celery Salad (Canned) 9 „ Coconut 100 „ Coffee Beans 112 „ Cooked Meats (Canned) 1,230 „ Cream (Canned) 4 „ Dried Whole Egg (Canned) 220 „ Fish (Canned) 9 „ Fruit (Canned) 24,523 „ Fruit Juice (Canned) 1,749 „ Fruit Pulp (Canned) 253 „ Groundnuts 448 „ Hazlenut Masse 20 „ Jam (Canned) 6 „ Maize Grits 538 „ Meat Preserves 90 „ Potatoes (Canned) 2 „ Ravioli (Canned) 127 „ Rice 1,900 „ Sausages (Canned) 24 „ Steak and Vegetables (Canned) 132 „ Sugar 680 „ Tomatoes (Canned) 28 „ Tomato Puree and Juice (Canned) 539 „ 32,911 lb. 35, 665 lb. Caseous Lymphadenitis—This disease, sometimes called "pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. Results of examinations for caseous lymphadenitis are given below:— Landed Examined Rejected t New Zealand Sheep 22,591 225 1 pr. legs 11 lbs. 245 Groundnuts—Presence of Aflatoxin—During the year, 13 samples were taken, only one of which, on examination, was found to be positive for aflatoxin of medium toxicity. Dried Egg Albumen and Other Imported Egg Products— (Conditional Releases)—Importations of Dried Egg Albumen and other Egg Products continued during the year with the following results:— Country of Origin Quantity Imported Containers Sampled Unsatisfactory Bact. Chem. Dried Egg Albumen America 3,421 x 50 lb. ctns. 194 1 — „ 1,525 x 44 lb. ctns. 75 — — China 475 x 1101b. tins 35 — — Denmark 250 x 44 lb. ctns. 20 — — Germany 265 x 110 1b. tins 15 — — Spain 250 x 44 lb. tins 13 — — Sweden 120 x 44 lb. ctns. 10 — — Dried Whole Egg China 4,730 x 1101b. tins 208 3 — Czechoslovakia 932 x 55 1b. tins 45 — — „ 335 x 44 lb. tins 12 — — „ 200 x 110 lb. tins 20 — — Denmark 840 x 55 lb. ctns. 47 — — England 285 x 44 lb. tins 81 — — Germany 1,067 x 391b. tins 38 — — Holland 800 x 55 lb. drums 40 — — Poland 7,689x 441b. tins 177 1 — Yugoslavia 1,901 x 44 lb. tins 60 — — „ 2,115 x 551b. tins 131 16 — Dried Egg Yolk Denmark 600 x 55 lb. ctns. 30 — — „ 200 x 50 lb. ctns. 10 — — Spain 520 x 55 lb. tins 30 — — Sweden 400 x 110 lb. ctns. 20 — — Frozen Whole Egg Australia 88,874 x 28 lb. tins 246 — 3 China 61,750 x 44 lb. tins 207 — — „ 2,500 x 28 lb. tins 16 — — Holland 3,150 x 38 lb. tins 48 — — „ 300 x 28 lb. tins 6 — — Frozen Egg White Australia 3,334 x 28 lb. tins 64 — — China 500 x 44 lb. tins 10 — — 246 Incidence of Salmonella Organism Found Samples Dried Egg Albumen Dried Whole Egg Frozen Whole Egg Salmonella thornpson 1 2 „ montevideo — 3 — „ typhimurium — 14 — „ livingstone — 1 — With regard to the unsatisfactory consignments, those from China and Yugoslavia were re-exported and the remainder destroyed. English Frozen Whole Egg Plant—During the year, 67 routine samples were submitted to the Public Health Laboratory Service in accordance with the Liquid Egg (Pasteurisation) Regulations, 1963. All passed the Amylase Test. Egg Processing Plant—Dried Whole Egg—One hundred and sixty-one samples were taken and submitted for bacteriological examination, all of which proved satisfactory. Desiccated Coconut—During 1969, routine samples of consignments of this product submitted for bacteriological examination totalled 30, 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 12 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 1 5,190 lb. Australia Bermuda 1 865 lb. „ Cyprus 2 6,138 lb. England Gibraltar 2 3,060 lb. New Zealand Bermuda 2 11,508 lb. „ West Germany 4 680 lb. 247 Food and Drugs Act, 1955 Twelve hundred and forty-eight 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 159 formal and 980 informal were obtained in the normal course of sampling. Of all the samples obtained, 52 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 39 non-genuine samples, 19 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 1.8%. Milk was one of the main foods sampled, the total being 145 samples of which 120 were in respect of milk other than Channel Islands. Of this latter figure, the average percentage of milk fat was 3.54% and solids-not-fat 8.61%, 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. Twenty-five Channel Islands milks sampled in the Borough during the year proved to have an average content of 4.43% and 8.85% respectively. Dried Milk Regulations, 1965 Twelve samples of dried milk were taken during the year, of which 4 proved satisfactory. Of the remaining 8 samples, 6 were from a consignment which was surrendered and the whole stock destroyed. Results of other 2 samples are as follow:— 1. The packet contained the equivalent of 3.9 pints of skimmed milk. It was stated on the label that the packet contained the equivalent of 3 pints of skimmed milk. This declaration would appear to be inappropriate for the weight of dried skimmed milk in the packet. Action taken—Manufacturer advised of Public Analyst's comments and asked for observation. 2. The sample consisted of Dried Skimmed Milk and contained Moisture, 8.0%. According to Regulation 4, this article should not contain more than 5.0% of moisture. 248 When made up the sample was found to have a stale taste and to be of low solubility. Its label made a general claim that minerals were present but gave no quantitative particulars. Action taken—Distributor of product, which is of Australian origin, when informed of Public Analyst's comments, took immediate steps to have withdrawn from retail sale any remaining stocks of this particular brand. The Condensed Milk Regulations, 1959 No samples of condensed milk were taken during the current year. Other Food Examinations Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination n Taken Bact. or Chem. Result Doughnut Complaint from member of the public that doughnut contained mouse droppings. Chem. The specimen consisted of part of a jam doughnut and contained baked inside it four mouse droppings. Reported to Committee. Recommended institution of legal proceedings. Blackcurrant Juice Drink Complaint from member of the public that blackcurrant juice drink tasted watery. Chem. The sample contained not more than 2% blackcurrant juice and according to the Soft Drink Regs. 64 a blackcurrant juice drink intended for consumption without dilution should contain at least 5% of fruit juice. Cafe proprietor warned of infringement of Regulations. No further action. 249 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1969 (including samples taken under the Public Health (Imported Food) Regulations) ANALYSES Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Ale — 2 2 — — — Almonds, ground — 4 4 — — — Baby food — 8 8 — — — Baking Powder — 3 3 — — — Barley, Pearl — 2 2 — — — Beverages — 4 4 — — — Biscuits — 46 46 — — — Blancmange Powder — 4 4 — — — Brandy 1 1 2 — — — Breadcrumbs — 2 2 — — — Bread (rolls) and butter 1 1 Bread (fruit loaf) — 1 1 — — — Bread (starch reduced) — 2 2 — — — Butter — 4 4 — — — Buttermilk — 1 1 — 1 1 Butter powder — 1 1 — 1 1 Cake and pudding mixture — 8 8 — — — Cake decorations — 4 4 — — — Calf's foot jelly — 2 2 — — — Cereal and fruit — 1 1 — — — Cheese and cheese spread — 16 16 — l 1 Chicory, ground — 2 2 — — — Cocoa — 2 2 — — — Coconut, desiccated — 8 8 — — — Coffee — 5 5 — — — Coffee beans — 1 1 — — — Coffee & chicory — 2 2 — — — Coffee extract — 9 9 — 2 2 Colouring matter — 6 6 — — — Confectionery, chocolate — 7 7 — — — Confectionery, diabetic — 1 1 — — — Confectionery, flour — 25 25 — 1 1 Confectionery, sugar — 38 38 — 1 1 Cooking fat — 3 3 — — — 250 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal  Corn flake crumbs — 1 1 — — — Cornflour — 5 5 — — — Cream (sterilised) — 2 2 — — — Cream canned ("Dairy Topping") — 1 1 — — — Cream of Tartar — 1 1 — — — Curry powder — 5 5 — — — Curry preparation — 1 1 — — — Custard, canned — 1 1 — — — Custard powder — 3 3 — — — Dessert powders — 22 22 — — — Dessert preparations — 20 20 — 2 2 Drinks, soft 1 48 49 2 2 4 Drinks, soft powders — 10 10 — 8 8 Dripping — 2 2 — — — Fish, canned — 35 35 — 2 2 Fish (smoked cod) — 1 1 — 1 1 Fish, bottled — 2 2 — — — Fish paste — 5 5 — — — Fish, frozen — 3 3 — — — Fish cakes — 1 1 — — — Flavouring compounds — 5 5 — — — Flavouring essence — 1 1 — — — Flour — 14 14 — 1 1 Food, proprietary — 4 4 — — — Fruit, bottled — 1 1 — 1 1 Fruit, canned — 45 45 — — — Fruit, dried — 10 10 — — — Fruit Juice — 14 14 — 2 2 Fruit pie — 3 3 — — — Fruit curd (lemon) — 3 3 — — — Gelatine — 2 2 — — — Gin 3 — 3 — — — Ginger in syrup — 1 1 — — — Gravy preparation — 8 8 — — — Groundnuts — 13 13 — 1 1 Herbs, dried — 9 9 — — — Honey — 3 3 — — — Ice cream — 17 17 — — — Ice lolly mix — 4 4 — — — Jam — 16 16 — — — Jelly tablets and compounds — 23 23 — 1 1 Jelly prepared with fruit — 1 1 — — — Junket preparation — 4 4 — — — Lard — 3 3 — — — Lentils — 1 1 — — — Macaroni — 1 1 — — — 251 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal  Macaroni cheese, canned — 1 1 — — — Margarine — 4 4 — — — Marmalade — 5 5 — — — Marzipan — 5 5 — — — Mayonnaise — 3 3 — — — Meal preparations — 8 8 — 1 1 Meat 6 2 8 — — — Meat, dehydrated — 1 1 — — — Meat paste — 1 1 — 1 1 Meat, potted — 1 1 — — — Meat products 2 25 27 — 2 2 Meat products, canned — 45 45 — 3 3 Medicines, proprietary — 12 12 — — — Milk (including Channel Islands) 137 8 145 — — — Milk, dried (skimmed) — 12 12 — 8 8 Milk, evaporated — 2 2 — — — Milk pudding, canned — 6 6 — — — Mincemeat — 3 3 — — — Mineral Water — 1 1 — — — Mustard preparation — 5 5 — — — Nuts — 2 2 — — — Oatmeal — 1 1 — — — Oats, breakfast — 2 2 — — — Oil, cooking — 5 5 — — — Olive Oil — 1 1 — — — Paraffin, medicinal — 1 1 — — — Pasta — 1 1 — — — Pastry, uncooked — 1 1 — — — Pastry mixture — 2 2 — — — Pea flour — 2 2 — — — Peas, split — 2 2 — — — Pease pudding, canned — 2 2 — — — Peel, candied — 9 9 — 1 1 Pepper — 5 5 — — — Pickles — 26 26 — 1 1 Puddings — 8 8 — — — Puddings, canned — 1 1 — — — Rice — 10 10 — — — Rum 1 — 1 — — — Rusks — 1 1 — — — Rye flour — 1 1 — — — Sago — 1 1 — — — Salad, Spanish — 1 1 — — — 252 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal  Salad, dressing mix — 1 1 — — — Salt — 6 6 — 1 1 Sauce — 32 32 — 1 1 Sauce preparation — 10 10 — — — Sausages and sausage meat 2 3 5 — — — Savouries — 3 3 — — — Seasoning — 1 1 — — — Semolina — 2 2 — — — Soda, bicarbonate of — 4 4 — — — Soup, canned — 9 9 — — — Soup preparation — 12 12 — 1 1 Spaghetti, canned — 1 1 — — — Spice — 18 18 — — — Spreads — 18 18 — — — Stuffing mixture — 5 5 — — — Suet, shredded — 3 3 — — — Sugar — 11 11 — — — Sulphur tablets — 1 1 — — — Sweeteners, artificial — 9 9 — — — Tapioca — 1 1 — — — Tea — 13 13 — — — Tea extract — 2 2 — — — Tomatoes, canned — 4 4 — — — Tomato juice — 3 3 — — — Tomato paste — 2 2 — — — Tomato puree — 5 5 — — — Trifle, cream — 1 1 — — — Vegetables, pre-packed — 1 1 — — — Vegetables, canned Vegetables, — 27 27 — 1 1 dehydrated — 16 16 — 1 1 Vegetables, frozen — 2 2 — — — Vegetable salad — 1 1 — — — Vegetarian food — 2 2 — — — Vinegar — 13 13 — — — Vinegar, imitation — 2 2 — — — Vodka 1 — 1 — — — Whisky 4 1 5 — — — Wine, alcoholic — 6 6 — — — Yeast, baking — 1 1 — — — Yoghurt — 2 2 — — — TOTALS 159 1,089 1,248 2 50 52 253 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 68 Pork Luncheon Sausage Contained meat 54%. Pork sausages of any kind should contain at least 65% of meat. Manufacturer informed of the result of analysis and also of the coming into force in near future of regulations stipulating the minimum meat content for this type of sausage. 82 Beetroot, Bottled Contained an artificial colouring matter, Red 10B, the presence of which was not disclosed in the statement of ingredients. Manufacturer informed of infringement and requested to amend the label on the product to include the colouring referred to by the Public Analyst. 103 104 105 106 107 108 Instant Low-fat Milk, Skimmed Each sample consisted of Dried Skimmed Milk and respectively contained-moisture 6.2%, 14.2%, 6.1%, 6.4%, 6.3% and 7.5%. By Regulation 4 of the Dried Milk Regulations, 1965, this article should not contain more than 5% of moisture. The solubility of each sample was respectively 99.8%, 75%, 99.9%, 99.6%, 99.7% and 99.8%. In the Public Analyst's opinion the solubility of 75% in respect of sample No. 104 was so low as to render it unsuitable for ordinary use. Manufacturer informed of Public Analyst's findings and has surrendered the remainder of the stock from which samples were taken. 254 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 128 Plain Flour Contained chalk, 190 and iron, 1.2m.gms. per 100 gms. of flour. According to the Bread and Flour Regulations flour should contain not less than 235 m.gms. of chalk and not less than 1.65 m.gms. of iron per 100 gms. of flour. Manufacturer when informed of infringement replied that because of the minute quantities of nutrient and/or creta added to the flour, it is almost impossible to consistently comply with the requirements of the Regulations. A further sample of the same brand of flour proved genuine. 232 Lait GalifW Aromatisd and Crème Fouettèe Consisted of a prepared dessert, inadequately labelled in French. Distributor advised of Public Analyst's comments and of need for manufacturer to comply with Labelling Regulations. 302 Dried Onions Contained sulphur dioxide, 290 parts per million, the presence of which was not disclosed on the label. Manufacturer advised of need to amend present label to include the presence of sulphur dioxide. 304C Doughnut Consisted of part of a jam doughnut and contained baked inside it four mouse droppings. The mouse excrement was found to contain ova of the Whip Worm, Trichocephulus trichiurus. Legal Proceedings instituted. 341 Apple and Raspberry Crumble The sample comprised two packets, and the contents of one contained sulphur dioxide, 800 parts per million. The presence of preservative was not mentioned in the statement of ingredients on the label. Manufacturer advised of Public Analyst's comments and of need to amend the present label on the product to include sulphur dioxide. 255 Sample No. Article Nature of Adulteration and/or irregularity n Taken 373 Sweet and Sour Sauce Contained artificial colouring matter, Orange RN, the presence of which was not disclosed on the statement of ingredients on the label. Manufacturer advised of Public Analysts's comments and of need to amend the present label on the product to include sulphur dioxide. 391 Instant MilkSkimmed Contained the equivalent of 3.9 pints of skimmed milk. The packet was stated on the label to contain the equivalent of 3 pints of skimmed milk. Manufacturer advised of Public Analyst's comments on the sample submitted to him and asked for observations. 413 Instant Coffee Contained caffeine, 2.3%. The small proportion of caffeine found in the sample corresponds to the presence of only 46% of the dried water-soluble solids of ordinary roasted coffee. Instant Coffee should contain at least 95% of dried watersoluble solids of coffee. Manufacturer informed of Public Analyst's comments and asked for observations. 496 Medium Deveined Shrimps, Canned Consisted of large peeled prawns. Distributor of this product, which is imported, has been advised of Public Analyst's comments and requested to communicate same to manufacturing exporter. 507 Aspic Jelly Powder Contained sulphur dioxide, 80 parts per million, the presence of which was not disclosed on the label. Manufacturer advised of Public Analyst's comments and asked to amend label accordingly. 526C Toad-inthe-Hole Consisted of a Toad-in-theHole mixture, uncooked, and contained in the batter part a number of greenish black lumps. These lumps consisted of semi-dry masses of flour, the discolouration being mainly due to traces of partly charred flour. Manufacturer informed of Public Analyst's report and asked for observations. 256 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 552 Stewed Steak in Gravy, Canned Contained meat 73%. Canned Meat with Gravy should contain not less than 75% of meat. Manufacturer advised of Public Analyst's findings when sample was analysed and asked for observations. 597 Fruit Crystals Contained no fruit but consisted of an artificial Lemonade Powder made from sugar and tartaric acid with lemon flavouring and colouring. Manufacturer advised of Public Analyst's findings on his analysis of the product and asked for observations thereon. 608 Table Sea Salt Contained moisture, 10.5%. Table Salt does not normally contain more than 1% of moisture. Manufacturer informed of Public Analyst's comments on the sample. Explanation by manufacturer was that this was an isolated incident possibly due to bulk salt accidently taking up excessive moisture due probably to weather conditions. Subsequent sample proved genuine. 618 Concentrated Apple Juice Consisted of a low calorie apple squash containing approximately 40% of apple juice with added flavouring, artificial sweetening, preserving and colouring matters. This sample was incorrectly labelled "Concentrated Apple Juice" when sent to the Public Analyst. It should have been labelled "Low Calorie Apple Squash", which would then have shown the sample to be genuine. 619 Shandy Contained Proof Spirit, 3.1%, instead of not more than 2% as declared on the label. Manufacturer informed of Public Analyst's comments and asked for observations thereon. 257 Sample No. Article Nature of Adulteration and/or irregularity n Taken 720 Blackcurrant Juice Drink Contained Blackcurrant juice, not more than 2%. The minimum standard for a soft drink containing fruit juice specified in the Soft Drink Regulations is 5% fruit juice. The caterer who served the drink was unaware of the requirements of the Soft Drinks Regulations and has now ceased to dispense the drink referred to. 726 Non-fat Dried Milk The sample had a stale taste, low solubility and 8% of moisture. The maximum limit for moisture specified in the Dried Milk Regulations is 5%. Distributor of this product, which is of Australian origin, when informed of Public Analyst's comments took immediate steps to have withdrawn from retail sale any remaining, stocks of this particular brand. 747 "Lucozade" Contained Liquid Glucose, 19.5%. According to the label on the bottle the ingredients should have included Liquid Glucose, B.P.C. 23.5%. Manufacturer advised of Public Analyst's findings and asked for observations thereon. 780 Blackcurrant Tablets Consisted of Blackcurrant Flavoured Tablets, containing only 5% of blackcurrant juice. Manufacturer acquainted of the Public Analyst's observations and asked for comments. 809 Meatballs in Brown Onion Gravy, Canned Contained meat, 30%. The minimum meat content for Canned Meat Balls specified in the Canned Meat Regulations is 35%. Manufacturer informed of result of analysis and the company's observations invited in respect of the deficiency in meat content. 258 Sample No. Article Nature of Adulteration and/or irregularity Action Taken 835 Instant Coffee Contained caffeine, 2.3%. The small proportion of caffeine found in the sample corresponds to the presence of only 46% of the dried water-soluble solids of ordinary roasted coffee. Instant Coffee should contain at least 95% of dried watersoluble solids of coffee. Manufacturer asked for observations on Public Analyst's comments. 849 Blackcurrant Health Drink Contained sulphur dioxide, 520 parts per million. This article may contain sulphur dioxide in a proportion not exceeding 350 parts per million. Manufacturer informed of result of analysis and asked for observations on the Public Analyst's findings. 893 Cut Mixed Peel Contained sulphur dioxide, 150 parts per million. This article may contain sulphur dioxide in a proportion not exceeding 100 parts per million. Distributor informed of result of analysis and asked for observations thereon. 914 Stewed Steak and Gravy, Canned Contained meat, 70%. Canned meat with gravy should contain not less than 75% of meat. Manufacturer informed of results of analysis and asked for observations thereon. 934 Cocktail Cherries Contained sulphur dioxide, 60 parts per million, the presence of which was not disclosed on the label of the pack. Manufacturer advised of result of analysis and invited to amend the label to include the presence of sulphur dioxide in the declaration of ingredients contained in this product. 259 Sample No. Article Nature of Adulteration and/or irregularity n Taken 938 Concentrated Chicken Stock Tablets Description considered inappropriate since the tablets consisted largely of salt (43%) and contained no chicken stock. The constituents of this product were reformulated some time ago by the Manufacturer in order to conform with the description given to the product. It is probable that the sample obtained for analysis was old stock. The matter is being investigated. 974 Steakette The product was pre-packed for sale but the label did not include a statement of the ingredients nor the name and address of the packer. Manufacturer advised of the Public Analyst's comments and requested to amend the label of the product in order to conform with the requirements of the Labelling of Food Order, 1953. 1020 Skinless Smoked Cod Contained artificial colouring matter the presence of which was not disclosed on the label. Producer advised of infringement and asked to amend the label accordingly. 1061 Buttermilk Contained milk fat, 0.91%. The product was labelled "Cultured Buttermilk Drink Fat Free". Manufacturer advised of Public Analyst's comments on the sample and asked for observations thereon. 1075 "Lift" (Hot Lemon Tea Drink) Contained artificial colouring matter the presence of which was not disclosed on the label. Manufacturer asked to revise label on the product to include the presence of artificial colouring matter in the statement of ingredients. 260 Sample No. Article Nature of Adulteration and/or irregularity Action Taken (b) In respect of samples taken under Imported Food Regulations TT.11 Groundnuts Contained aflatoxin, the Toxicity Category as defined by the Tropical Products Institute (1964) being "medium". Two further samples taken in conjunction with Insurance Surveyors gave negative results for aflatoxin Detention Notice served on original 16 bags sampled. TT.24 Shrimp Cocktail, Canned The pictorial design on the label depicted prawns of approximately four times the size of those contained in the can and was subsequently considered misleading. Letter to Importers requesting them to contact suppliers in country of origin regarding amendment of label. TT.33 Raw Lime Juice Contained sulphur dioxide, 620 parts per million. Fruit juice should not contain more than 350 parts per million of sulphur dioxide unless the proportion is disclosed. Letter to Importers drawing their attention to excess preservative and requesting them to contact their suppliers regarding the infringement of the Preservative in Food Regulations. 1962. TT.37 Winter Bamboo Shoots, Canned Contained salt 0.75%, the presence of which was not disclosed on the label. Letter to Importers drawing their attention to the infringement of the Labelling of Food Order, 1953, and our previous correspondence on a similar matter. 261 Sample No. Article Nature of Adulteration and/or irregularity Action Taken TT.58 Butter Powder Consisted of a Powdered Butter Compound, containing butter, sugar and added non-fatty milk solids. Following correspondence with the Manufacturers, it has been ascertained that this commodity is for use in the food manufacturing field and will never be prepacked for retail sale. In view of this there is no infringement of either the Food and Drugs Act or the Labelling of Food Order, and it has been suggested that a more accurate description of the product in the future would be "Butter Compound Powder". TT.93 Mix for Hot Wine Drink All six products were prepacked each in two containers but the inner container did not bear a statement of ingredients as required by the Labelling of Food Order. TT.97 contained two artificial colouring matters, one of which, Brilliant Blue FCF, is not permitted in food by the Colouring Matter in Food Regulations. Importers informed that all six varieties of Cocktail Mix infringed the Labelling of Food Order, 1953, by reason of the fact that the list of ingredients were not printed on the inner containers. One hundred and fifty cartons of Cocktail Mix Daiquiri were detained because it contained a non-permitted colouring matter namely Brilliant Blue FCF. TT.94 Mix for Hot Toddy TT.95 Mix for Screwdriver Cocktail TT.96 Mix for Whisky Sour Cocktail TT.98 Mix for Collins Cocktail TT.97 Mix for Daiquiri Cocktail TT.105 Processed Cheddar Cheese Contained milk fat in the dry matter 46.4%. Processed Cheddar Cheese should contain not less than 48% milk fat in the dry matter. Letter sent drawing distributors attention to Analyst's report on sample and requesting Manufacturer's observations. TT.108 Mousse de Jambon Contained gelatinised flour 1.5%, the presence of which was not disclosed on the label. Letter sent to Manufacturers requesting label be suitably amended. 262 SECTION VII MISCELLANEOUS HEALTH EDUCATION SERVICE Due to the growing definition of activities into specified areas, the Report of the Health Education Service has been modified for this year. The areas of activity undertaken by the Service may be defined as: 1. The Community. 2. Schools. 3. Health Centres. 4. The Directorate and other Departments of the Council. 5. Home Safety. The Report for 1969, therefore, has been recast to allow for individual consideration of these definitive areas. 1. THE COMMUNITY Film Shows and Talks One of the major and continuing activities of the Service in the community as a whole is the positive offer of free film shows, talks or combined programmes to local organisations in the Borough. Over 400 organisations, comprising youth clubs, political groups, religious gatherings, pensioners organisations, townswomen's guilds, mothers and young wives clubs are circulated each year with details of health education subjects available. The response, as always, is considerable, and in 1969 some 168 organisations were visited. This represents a drop of 7 on the 1968 total and may indicate a tendency towards levelling off from the upsurge of the previous four years. Organisations visited comprised a broad cross-section of those mentioned above. Audience figures varied in each group from as low as 15 to over 100 in the case of pensioners organisations. Health education subjects illustrated covered most of the range indicated in the Appendix at the end of this section of the Report. 263 Displays and Exhibitions Another facet of community health education is the mounting of displays and exhibitions on view to the general public. Every advantage is taken to use opportunities afforded through local shops, display windows and annual functions. Support for national campaigns also enable parts of the work of the Service to be seen in a wider context. Examples of such uses in 1969 are: Churchill House Window—The opportunity for use of this window was available on 4 occasions during the year. Displays, using movement, impact material and vari-coloured lighting were mounted on the themes of environmental health; handicapped welfare; children's services and home safety. The main foyer of the Directorate of Social Services is used from time to time to accentuate current themes highlighted each month. Other Shop Windows—Through the co-operation of local shop owners 3 other occasions arose where shop window displays were utilised on the subjects of mental welfare services and oil heater safety. Public Functions—The Royal Arsenal Co-operative Society were kind enough to offer the use of a complete marquee for the mounting of an exhibition on the Social Services at their annual Sports and Fete Day. Although, for the second year running, heavy rain reduced attendances, the exhibit was well attended and commended. The Greenwich Show, highlight of the Council's publicity year, was an opportunity for the Service to stage an ambitious exhibit, featuring a 16 foot roundabout illustrating the various services of the Directorate. The Service also participated in the Carnival Procession staged on the morning of the opening day. A two-day event, the Greenwich Show attracted over 10,000 visitors and was an effective avenue of publicity. National Campaigns—The Service co-operated in the Council for the Disabled's national "Help the Disabled" Week by mounting a large exhibition in the Town Hall with supporting displays in three large local department stores, together with related publicity. It is difficult to evaluate the impact of displays and exhibitions of this nature, but the favourable press and private comment received would appear to justify the time and effort expended. 264 Posters and Leaflets Aspects of health education are selected from the list (see Appendix) for special emphasis for each month of the year. In addition, material on topical subjects arising during the year are included in the routine distribution. The distribution of posters and leaflets is aimed at maximising the number displayed in places where the general public pass or are congregated. Thus, in addition to the health centres, distribution includes general practitioner and dentist waiting rooms, libraries, public enquiry points and counters in Council premises, public poster sites and railway station poster boards. 2. SCHOOLS A rapidly growing aspect of the Health Education Service Activity is School Health Education. Sterling work is carried out in schools by health visitors, school sisters, medical officers and others employed in the school health service. However, for any large expansion in school health education activity to take place, it is imperative that teachers, intimately concerned in school activities and in the day to day lives of all pupils, should undertake and participate in health education. Mention was made in my 1968 Report of the proposed conferences of head teachers in the Borough of Greenwich under the aegis of the Divisional Education Officer. The conferences took place early in February and were divided into primary and secondary education. The programme for each conference was as follows:— (a) Welcome and Introduction by a District Inspector of the I.L.E.A. (b) "Greenwich Health and Welfare Department" Dr. C. C. A. Jansz, Senior Medical Officer. (c) "Dental Health Education" Mr. F. Elston, Principal School Dental Officer. (d) "What is Health Education?" Mr. J. E. Kay, Health Education Officer. (e) "Greenwich Health Education Service" (including demonstration of visual aids). (f) Discussion. Both conferences were well attended and the immediate response was gratifying, many of the teachers present expressing surprise at the quantity, quality and variety of educational aids available in the field. 265 Following the conferences, letters were sent to all schools reiterating the facilities offered by the Service and suggesting that a discussion with a member of the health education team would prove profitable. The following facilities were offered and supported by a copy of the attractive catalogue of "Visual Aids in Health Education" prepared and published by the Service:— (i) Provision of films, filmstrips and other visual aid teaching material. (ii) Supply of leaflets and posters. (iii) Advice, assistance and reference services in Health Education, topics and communication techniques. (iv) Provision of displays and topic material. (v) Provision of specialist speakers and health education programmes. Although effective response was only moderate, many new links were established with schools in the Borough, and also with the local College of Education. In subsequent months the facilities of the Service, in particular items (i), (ii) and (v) above, were called upon on 87 occasions. Whilst the contribution of schools towards the integration of health education within the school curriculum remains disappointingly low, the start made amongst the 152 schools in the Borough should provide a stable foundation for future development. 3. HEALTH CENTRES The Directorate has 13 permanent and 12 part-time Health Centres. The support services provided by the Health Education Service is aimed at up-dating and sophisticating health education activities in these centres. A monthly health education meeting is held to which representatives from each centre are invited, together with other professionals such as public health inspectors, social workers, etc. New material and educational developments are reviewed and discussion held on effective activities. The Service also provides visual aid, poster, leaflet, display and projectionist facilities for all centres. Routine distribution of material is carried out each month in connection with the monthly topics mentioned earlier. Projectionist and projected aid facilities were used on 132 occasions during 1969. Cytology clinics are held at selected centres, and use is made of the 8mm. film loop projector and cassette "Self Examination of the Breasts" at these clincs. This was used on 52 occasions. 266 4. THE DIRECTORATE AND OTHER DEPARTMENTS OF THE COUNCIL The Service provides many facilities for other Branches of the Directorate and the Council generally due to the reservoir of knowledge and expertise. Previews of specialist films (31), advice and assistance with displays (11), provision of expert help and health education services in "in-service" courses (28). Also advice and assistance in the preparation of posters, leaflets and campaign material is freely given. The expertise of the Service was also sought on a number of occasions by bodies outside the Council, e.g. London Boroughs' Training Committee, London Borough of Hammersmith; Schools Broadcasting Council; London Regional Water Safety Committee; Goldsmiths College. Two "in-service" courses on the use of visual aids were given by the Service and in co-operation with the Health Education Council an "in-service" course on "The Health of the Family" was arranged for all staff early in the year. The film "They Have a Future" made by the Service continued to have wide use. Work was commenced on the production of another film, on Old People's Services in the Borough. 5. HOME SAFETY The Service has special responsibility for the promotion of home safety in the Borough. Whenever possible, aspects of home safety are integrated within the fields of activity of the Service. At least two month's programmes are specially devoted to this subject and every endeavour is made to maximise publicity on the aspect chosen. During 1969 the subjects of Falls and Poisoning were highlighted, with special campaign activity and press coverage. Talks by the Home Safety Officer featured in programmes given to local organisations and, where the subject matter in a film show is mainly concerned wth another aspect of health, a film on home accident prevention is frequently included. Emphasis on home safety is included as part of displays produced by the Service and advice is frequently sought of the Home Safety Officer by those in the Council having responsibility for others, particularly children and the elderly. Many of the badges and awards provided by youth organisations, such as the Girls Life Brigade; Guides; Adventure Corps; incorporate home safety. The Duke of Edinburgh's Award Scheme contains a special section. The Home Safety Officer is frequently called upon to provide training courses in respect of these awards and to act as adjudicator to prospective candidates. 267 APPENDIX ALPHABETICAL LIST OF HEALTH EDUCATION ASPECTS 1. Alcoholism. 2. Artificial Resuscitation. 3. Cancer: (a) Breast (b) Cervix (c) Rectum (d) Lung. 4. Careers: (a) Health Visitor (b) Midwife (c) Social Worker (d) P.H.I. 5. Clean Air. 6. Clean Water. 7. Dental Health and Fluoridation. 8. Drug Addiction. 9. First Aid. 10. Food Hygiene and Food Poisoning. 11. Foot Health. 12. Health Guidance: (a) Sleep (b) Fresh Air (c) Exercise. 13. Home Safety. 14. Housing (Public Health): (a) Maintenance (b) Clearance and Redevelopment (c) Overcrowding. 15. Infectious Diseases: (a) Tuberculosis (b) Measles (c) Whooping Cough (d) Polio (e) Diphtheria (f) Smallpox (g) Tetanus (h) Influenza (i) Coughs and Colds (j) Immunisation and Vaccination. 16. Maternal and Child Welfare. 17. Mental Health: (a) Illness (b) Subnormality (c) Behaviour (d) Social. 18. Noise abatement. 19. Nutrition and Obesity. 20. Old People's Welfare. 21. Personal Hygiene. 22. Pest Control: (a) Rats (b) Mice (c) Insects. 23. Physiology of the Body. 24. Pre-retirement. 25. Sanitation. 26. Sex Education. (a) Puberty (b) Relationships (c) Venereal Disease (d) Family Planning (e) Menopause. 27. Smoking and Health. 268 28. Social Services: (a) Environmental Health (b) Personal Health (c) School Health (d) Mental Health (e) Old People's Welfare (f) Disabled Welfare (g) Children's. 29. Specific Diseases: (a) Asthma (b) Bronchitis (c) Cardiac (d) Chest (e) Diabetes (f) Epilepsy (g) Glandular (h) Rheumatism (i) Stroke (j) Ulcers. 30. Use of Leisure. 31. Water Safety. 32. Welfare of Disabled. 33. Working Conditions (Public Health): (a) Temperature (b) Lighting (c) Ventilation (d) Sanitation. MEDICAL EXAMINATIONS A summary is given below of medical examinations carried out by the Department's Medical Officers during 1969, mainly in respect of superannuation and sickness schemes. Superannuation. Staff No. of Examinees found to be fit 376 No. of Examinees found to be unfit 9 Employees No. of Examinees found to be fit 120 No. of Examinees found to be unfit 20 Sickness No. Examined after prolonged sickness or at request of a Chief Officer 255 Other Examinations Carried out by the Council's M.O.s:— On behalf of the London Boroughs Joint Computer Committee 20 On behalf of other Local Authorities 3 No. examined for entry in Register of Disabled Persons Carried out by other Local Authorities:— On behalf of London Borough of Greenwich 11 269 Medical Assessments—Housing Under the Council's Rehousing Scheme, if an applicant's case is supported on medical or sociological grounds, a certain degree of priority is afforded. During the current year, some 1,312 cases for re-housing or transfer were reviewed and medically assessed. 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. Twenty-two cases were of such medical significance as to warrant special consideration by the Housing Sub-Committee. In one instance it was necessary for a Medical Officer to make a domiciliary visit to enable the appropriate assessment to be made. DEPARTMENTAL TRANSPORT The entire tone of the Directorate's transport for the year 1969 was set by the economic difficulties besetting the country as a whole and although new vehicles had been included in the Capital estimates, their purchase was not proceeded with. With the merger of the Children's Department into the Directorate, however, the total number of vehicles was increased by two, bringing the total vehicle strength up to 54. Nevertheless, during the year it proved possible, by changes of vehicle allocation, to fulfil all extra transport commitments including a 10% increase in the delivery and collection of Medical Loan Equipment. Transport had to be provided to convey approximately 100 physically handicapped people to Little Oyster Holiday Camp, Sheppey, Kent, for two fortnightly periods, and a Christmas shopping expedition in Woolwich was organised for another 80. If the increase of commitments that occurred in 1969 is reflected in 1970 then extra vehicles will have to be provided to enable services to be met. Meals on Wheels As stated above, it was decided not to proceed with the purchase of two extra vehicles to augment the Meals on Wheels service. The number of rounds remained at 17 as in the previous year. Miles covered by the Directorate's vehicle fleet during the year reached a total of 583,456. 270 POST ENTRY TRAINING In 1969, 31 members of staff successfully passed professional or administrative examinations and 51 officers embarked upon examination courses during the year, including 7 Social Workers and 2 Mental Health Training Centre Staff who were granted secondment for full-time study courses of one or two years' duration. The Directorate provided training facilities for 6 student Public Health Inspectors and 6 student District Nurses. Nine students qualified as Health Visitors in 1969 and 7 student Health Visitors commenced training. "In-service" training courses were provided for 30 Child Helps and 33 Attendants at old people's homes. In addition, there were 265 attendances at refresher courses, study days and other short courses. Training Courses, 1969 Administrative Catford College Day release courses leading to the Clerical Division and D.M.A. examinations. London Borough's Management Services Unit Project Network Analysis Appreciation Course. Uxbridge Technical College Decimal Currency—Change for a Pound. Greater London Whitley Council Course in Office Management. London Borough of Hillingdon Course for Local Authority Supervisors of Manual Workers. Royal Institute of Public Administration Appreciation Course in Metrication. South-West London College Office and Clerical Management. N.A.L.G.O. Middle Management Course. South-West London College Work Study Appreciation for Local Government Supervisors. University of London Outlook for Local Government Reform. Professional Medical University of London Management of Student Problems. South-East Metropolitan Regional Hospital Board Post-Graduate Course on Medicine in Old Age. I.L.E.A. Refresher Course in Tuberculin Surveying and B.C.G. Vaccination. Kent and Sussex Hospital Symposium on Geriatrics. 271 Evelina Children's Hospital Developmental and General Paediatrics. Institute for Research into Mental Retardation Biochemical Screening in relation to Mental Retardation. Society of Medical Officers of Health Social Obstetrics. Society of Medical Officers of Health Refresher Course in Developmental Ophthalmology. I.L.E.A. Course for Medical Officers in School Health Service. Children's Hospital, Sydenham Postgraduate Paediatric Course. Nursing London Boroughs' Training Committee Health Visitor Fieldwork Instructors Supplementary Courses. London Boroughs' Training Committee Study days for Child Minder Course Organisers. London Boroughs' Training Committee Introductory Course for School Nurses. London Boroughs' Training Committee Health Education in Schools. London Boroughs' Training Committee Study Day for Nursing Officers. London Boroughs' Training Committee Study Day for Health Visitors and Midwives on Genetic Counselling. London Boroughs' Training Committee Health Surveillance for the Older Age Group. London Boroughs' Training Committee Working with General Practitioners. Royal College of Nursing Refresher Courses for Health Visitors. Royal College of Nursing Follow-up Course for Fieldwork Instructors. Health Visitors Association Refresher Courses for Health Visitors. Health Visitors Association Follow-up Course for Fieldwork Instructors. Chiswick Polytechnic Health Visitor Fieldwork Instructors Course. Queens Institute of District Nursing Refresher Courses and Special Courses. Marie Curie Memorial Foundation Symposium on Domiciliary Care of the Patient with Cancer. Royal College of General Practitioners and Institute of Health Education Health Education and General Practice. The National Childbirth Trust Seminar on Psychoprophylaxis. The National Childbirth Trust Ante-natal Preparation for Childbirth. 272 Chiswick Polytechnic Course for Supervisors of Child Minders and Pre-School Play Group. Institute of Medical Social Workers The Battered Child. London Borough of Hammersmith Health Education in the Community. The Chest and Heart Association New Ideas in Asthma and its Management. Family Planning Association Community Education Project for South London. North-Western Polytechnic Practical Work Instructors Course for Senior District Nurses. British Diabetic Association The Diabetic and Employment: Diet and the Diabetic. Royal College of Midwives Teaching in Preparation for Parenthood. Royal College of Midwives Approved Refresher Courses for Midwives. London Borough of Haringey Detection of Hearing Defects in the Infant and Pre-School Child. National Society of Children's Nurseries What is Subnormality? Kings College Hospital Course on Dialysis. Westminster Technical College Training in Teaching Techniques. Croydon Technical College Fieldwork Instructors Course. Social Work London Boroughs' Training Committee Course for Social Welfare Officers. London Boroughs' Training Committee Working with the Family as a Group. London Boroughs' Training Committee Course for New and Potential Supervisors of Students. London Boroughs' Training Committee Study Day for Principal and Senior Social Welfare Officers. London Boroughs' Training Committee Seminar on Casework Concerning Marital Problems. London Boroughs' Training Committee Seminars on Social Work with Children and their Families. London Boroughs' Training Committee Seminars on Psychological Processes in Social Work with Special Reference to Groups. London Boroughs' Training Committee Course for Mental Health Social Workers. London Boroughs' Training Committee/National Institute for Social Work Training Seminars on Casework Practice. Seminars on Teaching Methods of Student Supervision and the Professional in the Organisation. 273 London Boroughs' Association Practitioners with Services for Disturbed Adolescents. British Epilepsy Association Course for Social Workers. University of Liverpool Community Work and the Caseworker. National Council on Alcoholism Summer School on Alcoholism. Royal Society of Health Loneliness. Institute of Medical Social Workers Full-time 1 year course leading to the Certificate of the Institute of Medical Social Workers. Chiswick Polytechnic Full-time 2 year course leading to the Certificate in Social Work. North-Western Polytechnic Full-time 2 year course leading to the Certificate in Social Work. Croydon Technical College Full-time 2 year course leading to the Certificate in Social Work. Manchester University Certificate in Psychiatric Social Work Course. Full-time 1 year. Welfare Association of Social Workers New Thinking about Welfare. King Edward's Hospital Fund for London Problems of the Long-Stay Patient. London Boroughs' Training Committee Day-release Course for Attendant Staff in Homes for the Elderly. London Boroughs' Training Committee Training for Staff working in Accommodation for Homeless Families. London Boroughs' Training Committee Community Care Course for Experienced Untrained Social Workers. Kent County Council Residential Refresher Course for Matrons and Wardens of Old People's Homes. National Association for Mental Health Care of the Elderly Mentally Infirm Resident. University of Cambridge Old People: A New Look at the Services Needed. Greater London Conference on Old People's Welfare Course on Caring for the Elderly. Thamesmead Christian Community Teach-in. Southern Regional Association for the Blind Residential Refresher Course for Administrators in Blind Welfare. Southern Regional Association for the Blind Refresher Course for Home Teachers/Social Welfare Officers for the Blind. College of Deaf Welfare and Social Studies Modern Aids to Hearing. 274 Mental Health The Spastics Society Physical Education for the Physically Handicapped. The Spastics Society Orff-Schulwerk and the Handicapped Child. London Boroughs' Training Committee Regional Working Conference for Practitioners with Services for Disturbed Adolescents. Barking Regional College Course on Working in a Group. British Epilepsy Association Symposium on the Modern Management of Epilepsy. London Boroughs' Training Committee Study Day for Supervisors of Junior Training Centres. London Boroughs' Training Committee Day-Release Course for Instructors in Adult Training Centres. National Society for Mentally Handicapped Children Subnormality in the Seventies. Churchdown Evening Institute Course in Metalwork. Chiswick Polytechnic Full-time 2 year Diploma Course for Teachers of Mentally Handicapped Children. Bournemouth College of Technology Full-time 1 year Training Course for Instructors of Mentally Handicapped Adults. University of Bristol Full-time 2 year Diploma Course for Teachers of Mentally Handicapped Children. Environmental Health South-East London Technical College Course on Fire Prevention in Buildings. South-East London Technical College Course on Noise Prevention and Control. South-East London Technical College Course on Building Construction. South-East London Technical College Diploma in Atmospheric Pollution Course. College for the Distributive Trades Course on Advances in Food Inspection. Association of Public Health Inspectors Annual Weekend Seminar. Royal Society of Health Layman's Guide to the Food Regulations. Coal Utilisation Council Public Health and Technical Assistant's Course. Association of Public Health Inspectors Symposium on Housing. Association of Public Health Inspectors The Importation of Foodstuffs. 275 Health Education The Health Education Council Summer School in Health Education. London Boroughs' Training Committee Study Day for Health Education Officers. Home Help Service London Boroughs' Training Committee Seminars for Home Help Organisers and Assistant Organisers. Audiology Institute of Laryngology and Otology Refresher Course for Experienced Audiology Technicians. CONFERENCE ORGANISERS, 1969 Association of Public Health Inspectors British Dental Association British Epilepsy Association Federation of Associations of Mental Health Workers Health Visitors Association Local Government Chronicle National Association for Maternal and Child Welfare National Association of Mental Health Royal Institute of Public Health and Hygiene Royal Society of Health Southern Regional Association for the Blind Standing Conference of Societies Registered for Adoption World Health Organisation 276 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 Routine medical inspection of school children in the Borough continued as in previous years. These examinations include all "entrants" to Infant Schools, children after their transfer to either Junior or Secondary Schools and pupils during the penultimate term before they leave school. Older pupils (15+ years) are also examined during the term before they are due to leave school. A total of 39,585 pupils were on the roll of schools in the London Borough of Greenwich during 1969 and of these 15,661 (39.5%) underwent routine medical inspections. A further 11,227 children (28.3%) had non-routine medical inspections. As in previous years parents were invited to attend on these occasions. The general physical condition of pupils in the Borough was slightly below the average of other Inner London Boroughs. In 1.11% of the children examined the physical condition was found to be unsatisfactory compared with the Inner London Education Authority's total of 0.42%. This percentage, however, included 277 some children whose physical condition was regarded as being poor because they were overweight. Non-routine medical examinations were carried out on 2,653 occasions to determine pupils' fitness to undertake school journeys and a further 612 handicapped children were examined to assess their special educational needs. In addition to the above, nonroutine medical examinations were performed on 551 pupils before they were considered fit to take up part-time employment. As a result of the 29,874 comprehensive and 23,688 selective surveys carried out on pupils in the Borough, 357 children (0.9% of the total school roll) were found to be verminous, compared with a figure of 1.20% for the Inner London Education Authority as a whole. There were no new additional schools opened in the Borough during 1969. Child Guidance Clinic For the first half of 1969 the Child Guidance Clinic continued to share the Chevening Road Welfare Centre premises with certain other services but, since August, 1969, the Unit has operated from 63 Rochester Way, London, S.E.3, a move which has given the Unit more space and freedom for its work. As in the previous year, a Psychiatrist and an Educational Psychologist attended the Unit on two days a week and a full-time Psychiatric Social Worker joined this team in January, 1969. During 1969, 82 cases were referred to the Clinic for psychiatric treatment. At the end of the year 34 cases were on the waiting list pending diagnostic interviews and 36 cases were still attending. During the year, 47 cases had been closed and the names of 29 pupils had been withdrawn. Due to overloading, the waiting list was closed in October, 1969, although new clinically urgent cases, however, were still seen. Pressures on the Clinic remain heavy and to meet adequately the rising demand there is a continued need for increased psychiatric and psychiatric social work sessions. The provision of more accommodation would also be advantageous. 278 In view of the waiting list for children to be seen at the Child Guidance Clinic, some were referred to other Child Psychiatrists in the Borough from time to time if their cases warranted earlier attention. Waiting time for the Child Guidance Clinic at Rochester Way is now approximately 10 months. Special Schools At the Charlton Park School for physically handicapped pupils 177 children were on roll. In addition to her weekly attendance the School Medical Officer visited on request and Orthopaedic, Ophthalmic and Cardiological Consultants visited the school at regular intervals during the year. Physiotherapy and Speech Therapy classes continued to be held daily. Other special schools in the Borough include:— School Total on Roll Beverly School for Deaf Children aged 5-11 years 49 Meridian School Unit for Partially Deaf Children aged 5-16 years 33 Hawthorn Cottage School for Delicate Children aged 5-16 years 122 Moatbridge School for Maladjusted Boys and Girls aged 5-16 years 41 Griffin Manor School for Maladjusted Boys and Girls aged 5-16 years 18 Riverway School for E.S.N. Boys 11-16 years 160 Rose Cottage School for E.S.N. Boys and Girls 5-16 years 196 The Slade School for E.S.N. Girls 5-16 years (Mixed 5-11 years) 164 Thomas Doggett School for E.S.N. Boys 11-16 years 97 279 Speech Therapy We are more fortunate than most Inner London Boroughs in having three full-time and three part-time Speech Therapists visiting the Inner London Education Authority schools in the Borough. Despite this, it was necessary to maintain a small waiting list. The number of children awaiting treatment did not exceed a total of 41 at any time. Vaccination and Immunisation Total vaccinations and immunisations for the London Borough of Greenwich were higher than any of the other Inner London Boroughs with the exception of immunisation against Whooping Cough; in this the Borough took the third highest place. The average vaccination against Smallpox was 78.7%. Immunisation against Diphtheria was 92.2%, Poliomyelitis 91.9% and Whooping Cough 85.4%. John Kerr Brown, Principal School Medical Officer. SCHOOL HEALTH SERVICE STATISTICAL REPORT 1969 Number of Pupils (as at May, 1969) Primary 21,559 Secondary 15,632 Nursery School 1,303 Special, including Hospital schools 1,091 39,585 280 Periodic General Medical Inspections Age Groups Number Percentage 4 years and less 971 6.2 5 years 2,744 17.5 6 years 1,155 7.4 7 years 899 5.8 8 years 2,307 14.7 9 years 397 2.5 10 years 218 1.4 11 years 973 6.2 12 years 1,720 11.0 13 years 674 4.3 14 years 568 3.6 15 years and over 3,035 19.4 Total 15,661 100.0 Pupils found to require treatment at periodic General Medical Inspections (excluding dental and infestation) Age groups inspected For defective vision (excluding squint) For other conditions Total individual pupils 4 years and less — 93 93 5 years 32 263 288 6 years 14 129 139 7 years 39 93 124 8 years 136 195 319 9 years 28 36 63 10 years 18 18 35 11 years 103 94 186 12 years 200 161 339 13 years 67 42 101 14 years 69 36 99 15 years and over 484 158 613 Totals 1,190 1,318 2,399 281 Percentage of Children Inspected who were noted for Treatment Age and sex All defects Vision defects Defects other than vision 4 years and less 513 Boys 10.52 — 10.52 458 Girls 8.51 — 8.51 5 years 1,428 Boys 10.22 1.05 9.31 1,316 Girls 10.79 1.29 9.87 6 years 596 Boys 13.42 1.34 12.41 559 Girls 10.55 1.07 9.83 7 years 456 Boys 13.15 3.72 10.30 443 Girls 14.44 4.96 10.38 8 years 1,151 Boys 14.76 5.73 9.90 1,156 Girls 12.88 6.05 7.00 9 years 206 Boys 17.47 7.76 10.19 191 Girls 14.13 6.28 7.85 10 years 122 Boys 15.57 8.19 8.19 96 Girls 16.66 8.33 8.33 11 years 461 Boys 17.78 9.76 9.76 512 Girls 20.31 11.32 9.57 12 years 866 Boys 13.74 8.19 6.00 854 Girls 25.76 15.10 12.76 13 years 362 Boys 12.98 8.01 5.24 312 Girls 17.30 12.17 7.37 14 years 319 Boys 10.34 6.58 3.76 249 Girls 26.50 19.27 9.63 15 years and over 1,633 Boys 16.53 12.85 4.53 1,402 Girls 24.46 19.54 5.99 Total 8,113 Boys *13.75 *6.26 *8.07 7,548 Girls *16.99 *9.03 *8.78 Total both sexes 15,661 15.31 7.59 8.41 * Total average percentage Non-Routine Medical Inspections Re-inspections 6,137 Secondary school reviewals 30 Other non-routine inspections (see next table) 5,060 11,227 Total inspections 26,888 282 Analysis of Non-Routine Medical Inspections Number inspected 1969 1968 Bathing Centre inspections—scabies — 1 Bathing Centre inspections—others — 10 Employment Certificates 551 704 Licences for Theatrical employees — — School Journeys 2,653 2,166 Recuperative holidays—prior to holiday 39 38 Recuperative holidays—on return — — Secondary Schools Annual Surveys 30 26 Candidates for higher awards 20 20 Nautical school entrants — - Outward Bound and Adventure Courses 4 — T.B. contacts — — Boarding school for the delicate: Pre-departure inspections 2 2 On return 66 — Other handicapped pupils: Statutory examinations 208 212 Periodic special defect examinations 612 715 Research investigations and enquiries 28 1 4,213 3,895 Specials, at request of: Head Teacher—special book 115 75 Head Teacher—other 236 272 School Nurse—after health survey 80 128 School Nurse—other 44 45 Divisional Officer (Education) 59 85 District Care Organiser or Care Committee 26 26 Parent 133 127 School Medical Officer 171 182 864 940 All other non-routine inspections 13 3 Total 5,090 4,838 283 Medical Treatment of Schoolchildren Type of Clinic Sessions New Cases Attendances Minor ailments (nurse) 1,172 11,822 40,423 Minor ailments (doctor) 235 1,335 Special Investigation 180 212 1,289 Dental 1,850 3,639 12,904 Vision 278 1,712 3,643 Ear, nose, throat — — — Audiology 45 145 435 Defects treated at Minor Ailments Clinics Defect Number Athlete's foot 203 Verrucae 1,166 Ringworm: body 5 Impetigo 86 Other skin diseases 319 Eye diseases 192 Ear diseases 133 Miscellaneous bruises, lacerations, etc. 11,384 Special Clinics—Attendances in 1969 New Cases Total Attendances Audiology 145 435 E.N.T — — Special Investigation Clinics Enuresis 212 1,289 Nutrition Behaviour Problems Rheumatism or Heart Conditions 284 VISION Routine Medical Inspections TOTAL NUMBER TESTED Boys 6,664 Girls 6,222 Not Wearing Spectacles Percentage of No. Tasted 6/6 84.0 82.9 6/9 4.2 4.0 6/12 or worse 3.3 3.6 Noted for Treatment 3.0 3.5 Wearing Spectacles 6/6 5.3 5.7 6/9 1.6 2.3 6/12 or worse 1.5 1.6 Noted for Treatment 4.6 7.5 With and Without Spectacles (a) Noted for Treatment 9.2 (b) Noted for Observation 4.7 Total of (a) and (b) 13.9 Defects treated at Vision Clinics Defect Number Error of refraction and squint 3,141 Other eye defects 6 Spectacles ordered 973 Findings at Health Surveys School Roll (May 1969) 39,585 1. Comprehensive surveys (a) Number examined 29,874 (b) Number (occasions) found verminous 193 (c) Percentage found verminous 0.65 2. Selective surveys (a) Number examined 23,688 (b) Number (occasions) found verminous 339 (c) Percentage found verminous 1.43 285 3. Verminous cases (a) Total times vermin found 532 (b) Total percentage found verminous 0.99 (c) Number of individual pupils found verminous 357 (d) Percentage of individuals found verminous (of School Roll) 0.90 4. Action taken with verminous cases (a) Advice and/or Lorexane 395 (b) Further action 137 (c) Percentage of cases given advice and/or Lorexane requiring further action 34.68 Voluntary attendances at bathing centres: Number of pupils 85 Number of statutory notices issued - 5. Communicable disease surveys Numbers catered for: 1969 1968 Athlete's foot 6,739 7,383 Plantar warts 7,403 8,178 Dysentery 154 98 Other communicable diseases 2,655 5,743 16,951 21,402 School Medical Inspections (excluding dental and health surveys) School Roll (May 1969) 39,585 Routine Inspections Number inspected 15,661 Number found not to warrant examination (7 plus "special scheme") 37 286 Percentage of Number inspected of Parent present 56.2 Care Committee present 71.8 Number vaccinated against smallpox 78.7 Number immunised against diphtheria 92.2 Number immunised against whooping cough 85.4 Number vaccinated against poliomyelitis 91.9 Physical condition unsatisfactory 1.1 Referred for treatment of defects 15.3 Referred for treatment of defects other than vision 8.4 Non-Routine Inspections (i) Specials 5,090 (ii) Re-inspections 6,137 Total (i) and (ii) 11,227 Number of routine inspections as percentage of school roll 39.5 Number of non-routine inspections as percentage of school roll 28.3 B.C.G.—1969 SKIN TESTED NEGATIVE B.C.G. GIVEN Schools Further Education & Training Colleges Schools Further Education & Training Colleges Schools Further Education & Training Colleges 1st Quarter 921 40 775 22 775 22 2nd Quarter 735 — 652 — 652 — 3rd Quarter 372 — 313 — 313 — 4 th Quarter 616 62 497 21 497 21 Total for 1969 2,644 102 2,237 43 2,237 43 287 Examinations for recuperative holidays Thirty-nine such examinations were carried out in 1969 (38 examinations in 1968). The schoolchildren were examined after recommendations by school medical officers, the Children's Department, the Education Department or various social agencies, as being in need of a holiday which would provide fresh air, nourishing diet and adequate rest. Sometimes these children were accompanied by their siblings, while mother and children under five also enjoyed a holiday elsewhere. Infectious Diseases in Schools Disease Number Cerebro Spinal Meningitis 1 Chickenpox 566 Dysentery, diarrhoea or enteritis 201 German Measles 283 Glandular Fever 4 Impetigo 82 Influenza 7 Jaundice 4 Measles 526 Mumps 779 Ophthalmia and conjunctivitis 11 Pneumonia 2 Ringworm (body) 1 Ringworm (scalp) 1 Scabies 37 Scarlet Fever 42 Sore throat and tonsilitis 61 Whooping cough 26 288 Number of Children of all ages noted for Treatment or Observation Number of children noted for treatment and observation expressed as a rate per 1,000 inspected) Number Inspected 15,661 Defects Treatment Observations 1969 1968 1969 1968 Skin 12.71 9.39 17.24 14.59 Eyes (a) Vision 75.98 73.33 27.97 32.79 (b) Squint 10.66 9.39 5.75 5.39 (c) Other 1.66 1.90 3.26 2.92 Ears (a) Hearing 7.79 6.53 6.51 6.15 (b) Otitis media 2.68 2.92 5.30 5.01 (c) Other 0.77 0.32 0.57 1.14 Nose and Throat 6.26 6.34 35.89 36.60 Speech 4.53 5.84 10.66 9.01 Lymphatic Glands 0.64 0.25 7.09 5.46 Heart 3.38 3.93 11.75 11.29 Lungs 5.49 5.65 14.75 15.22 Developmental (a) Hernia 1.47 1.46 3.26 2.98 (b) Other 1.40 1.90 8.05 9.83 Orthopaedic (a) Posture 1.15 1.52 5.49 5.96 (b) Feet 3.90 3.68 34.42 33.17 (c) Other 2.81 2.60 4.98 10.21 Nervous System (a) Epilepsy 2.62 1.97 1.60 1.40 (b) Other 0.19 0.38 2.04 2.92 Psychological (a) Development 0.96 1.01 11.37 7.74 (b) Stability 1.47 1.21 14.56 12.43 Abdomen 1.53 1.14 3.96 1.84 Other (a) Debility 1.15 16.81 2.36 45.48 (b) Enuresis 7.85 21.71 (c) Obesity 5.87 19.67 (d) Other 2.30 2.94 289 Comparison of Defects noted at 7-plus routine and 7-plus "Special" Medical Examinations in 1969 (Number of children noted for treatment and observation expressed as a rate per 1,000 inspected) Number inspected at 7-plus Routine Inspections 3,566 Number inspected at 7-plus Experimental Scheme Inspections 37 Defects A* B† Skin 26.92 54.06 Eyes (a) Vision 95.35 108.11 (b) Squint 17.11 27.03 (c) Other 4.20 27.03 Ears (a) Hearing 19.91 — (b) Otitis media 7.85 — (c) Other 0.84 — Nose and Throat 53.28 108.11 Speech 14.86 — Lymphatic Glands 7.29 — Heart 16.82 27.03 Lungs 24.12 — Developmental (a) Hernia 6.17 — (b) Other 10.93 27.03 Orthopaedic (a) Posture 6.45 — (b) Feet 33.09 27.03 (c) Other 5.61 27.03 Nervous System (a) Epilepsy 4.20 — (b) Other 2.24 — Psychological (a) Development 17.10 27.03 (b) Stability 21.59 81.08 Abdomen 5.61 — Other (a) Debility 2.80 54.05 (b) Enuresis 28.88 (c) Obesity 11.78 (d) Other 3.92 *Column "A" refers to 7-plus routine medical inspections, † Column "B" refers to 7-plus experimental scheme inspections. 290 Educationally Sub-normal Pupils Number examined: 105 Number recommended: 1. Day E.S.N. School 73 2. Boarding E.S.N. School 7 3. Ordinary School with special help 22 4. Junior Training Centre 2 5. Maladjusted School 1 Routine Audiometer Testing Pupils given screening tests 10,453 Pupils failing screening tests 618 Pupils given pure tone tests Pupils failing pure tone tests 295 Pupils referred to Otologists Percentage referred to Otologists 2.8 Visits made to Schools in the Borough by Public Health Inspectors VISITS—1969 Purpose Numbers Remarks HYGIENE Food—Inspection of Canteen and Kitchens 19 Routine Inspections. Foot—Verrucae Prevention 5 Five discussions at the request of Headmasters. FOOD Inspection—condemnation of unsound food 17 17 items of 116 1b. canned food and 77 lb. Bacon condemned. Sampling 7 Routine. DISEASES Notifiable 0 No visits to schools were considered necessary. Each notification was followed up by home visit. NUISANCES Public Health 3 Inspections on request of Head Teachers. SURVEYS Clean Air Act 1956 6 Little Heath, St. Nicholas and Woolwich Town Centres SCA. Others 10 Alterations. RODENT CONTROL 4 On complaint. DISINFESTATION Insect Pests 4 On request. Talks on Health subjects 1 On request. TOTAL 76 291 School Health Service — Social Work Social workers in the School Health Service are jointly employed by the Inner London Education Authority and the Borough and work under the direction of the Principal School Medical Officer. They are concerned with socio/medical symptoms and work in the School Clinics, Hospitals and in Special Schools for the various types of handicapped children. Because of the nature of their work, they work in close contact with all other agencies but particularly with the School Care Committee Service of the Inner London Education Authority. They are attached to the following Clinics and Schools:— (a) School Health Service Clinics Special Investigation: Health Centre, Market Street, S.E.18. Health Centre, Plumstead Hight 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. (b) Special Schools Beverley School—Deaf. Meridian School—Partially Hearing. Griffin Manor—Maladjusted (Autistic). Goldie Leigh Hospital School—Diseases of the Skin. Moatbridge School—Maladjusted. Charlton Park—Physically Handicapped. Hawthorn Cottage—Delicate. In September, 1970, Nansen Partially Sighted School at present in Lewisham will be moved into Greenwich. Staff During 1969 no member of the staff was released to take further professional courses, but several attended short-term Release Courses and Conferences. The member of the staff released to take a Medical Social Workers' Course at the Institute of Medical Social Workers in 1968 returned to the service in September, 1969. 292 THE SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer Previous reports have chronicled the not inconsiderable progress achieved in the School Dental Services since 1965 despite serious staffing difficulties and, prior to presenting a quinquennial appraisal, it would seem appropriate, at this juncture, to re-state our objectives, namely:— (a) To make dental treatment available to all children attending maintained schools and those otherwise the responsibility of the local education authority with the aim of ensuring that, as far as possible, through dental health education and a high standard of dental care they will leave school free from dental disease and irregularity with not only an understanding of the importance of good natural teeth but also with an inculcated zeal for their preservation. (b) To establish a service for routine school inspection together with routine and emergency treatment clinics and the dissemination of dental health education in both. (c) Annual re-examinations up to the end of school life and arrangements for recall inspections with the opportunity for treatment, if necessary, after each inspection. (d) Where the inspecting dental officer finds it essential, arrangements to be made for treatment within a reasonable time, normally a month. (e) In order to ensure that necessary treatment is in fact received, the responsibility to "follow up" those pupils whose parents elect to make their own arrangements. (f) The need to make the benefits of the service available to all children at some time during their school career. (g) Resources to be made available for orthodontic treatment. (h) Institution of dental health education programmes. (i) Adequate provision for children in special schools. Treatment facilities At present, the service has five surgeries in clinics and a further two functioning in school premises as part of the school. Although not all the surgeries are in premises ideally situated for the purpose, the best use has been made of the potential available. Our first aim was to bring surgeries and waiting rooms into line with the atmosphere expected of and found in good, privately owned practices. 293 In this we have succeeded by such steps as redecoration, replacement of wooden benches and chairs in waiting rooms by modern furniture and by provision of wall boards displaying dental health education material arranged for the various age groups. Equipment is now felt to be up to the standard found in a modern dental practice and includes in all surgeries such aids as X-ray machines, high speed drills, electric aspirators, operating lights, amalgamators, thermostatic control for sterilizers and glass bead sterilizers for root treatment. Improvement costs were kept to a minimum by adding to existing equipment rather than by wasteful replacement. In short, our dental clinics are now pleasant for the patient to come to and for the staff to work in. As mentioned in previous reports, with a school roll of approximately 39,000 the potential of the service is inadequate. Although treatment covers patients of all age groups, excess demand over treatment availability dictates a policy of primary concentration on the younger pupils. These are introduced mainly via school inspections and recommendations whereas the older children are either established patients or attend at parents' spontaneous requests. Numerically, the service is comprehensive for infant schools but, with the exception of two secondary schools with surgeries on the premises, it is inadequate for the older age groups. Geographically, a number of schools are beyond reasonable distance from the clinics and are, therefore, not well served. It is these areas which we are hoping to cover when expansion becomes a reality. In this Borough, ample provision for emergency treatment has been shown to be essential. In theory, a child under regular dental care should rarely be in need of urgent treatment for relief of pain but our relatively high ratio of emergency attendances per session not only points to the need of expansion of the service but also demonstrates that general dental practitioners in the National Health Service are unable fully to cope with the needs of the Borough's child population. Our pursuance of the highest of standards of dental care not only emphasises the axiom that "only the best is good enough for the child" but also provides for the school leaver a yardstick whereby the quality of subsequent dental ministration and products can be accepted or rejected. There remains, however, a problem as to what is entailed in the term "high standard of dental care" and who will be the arbiter. Is it to be the individual dental surgeon in charge of the patient or the head of the service who would acquaint himself with all possible sources of post-graduate training with the affilliation of a teaching hospital to assist him in this direction? With dental surgeons seeking a permanent career within the school 294 dental service, post-graduate training is the obvious answer for he/she will be aware of current practices and few problems of interpretation, if any, should present themselves to an experienced up-to-date dental officer. In the case of the recently qualified dental surgeon or one accepting a temporary post in child dentistry prior to migrating into another possibly more remunerative branch of dental practice, the solution is more complex. Concomitantly, there is the question as to who is to be responsible ultimately for the adoption of higher standards of dental care not only with regard to the individual patient but also for the ensuing clinical reputation and productivity of the service. As is well known, there is a general scarcity of dental surgeons seeking permanent careers in children's dentistry but the geographical position of this Borough renders the situation here even more difficult. Where dental officers remain "in post" for several years the problem tends not to be so acute but where in the course of its school life a child has of necessity, to be treated by successive dental officers, the need for a unified approach to preserve continuity of standards becomes significant. Dental Health Education Our aim of ensuring that children leave school free from dental disease or irregularity requiries no comment other than approval. At the anxious time of becoming a full member of the community, in addition to being dentally fit, the child should be in possession of the simple facts concerning dental disease, its cause and prevention. This applies in all communities but particularly in areas such as ours where the school dental service can consider itself comprehensive only for the younger age groups. Indeed, in such areas it is even more important to establish preventive dentistry at as early an age as possible. Measures taken in this Borough with regard to dental health education are outlined below:— 1. Before School Dental Inspection Initial visit by Principal School Dental Officer to Head Teacher outlining causative factors of dental disease in children and the effective simple preventive measures at our disposal. Practical discussion of preventive steps such as water after meals, the abolition of carbohydrates in tuck-shops and the discouragement of in-between-meal snacks. Presentation of our own dental health education literature and placing a supply for pupils and parents at the Head Teacher's disposal. Suggestion of twice weekly one minute "question-and-answers" as part of the school curriculum to establish constant repetition of the main theme. 295 2. At the School Dental Inspection Professional consultation with attending parents, pointing out examples of cause and effect, with concise instructions and supply of explanatory literature. 3. After School Dental Inspection Informing the Head Teacher of the results and discussing oral hygiene found. Follow-up talk by dental health educator to the children and/or parents at Head Teacher's discretion. 4. At School Dental Clinics (a) Parents of all children are to be instructed in the origin and prevention of dental disorders. (b) Children: (i) To receive preventive and oral hygiene insiractions. (ii) Subsequently to be questioned to ascertain their knowledge. (iii) Constantly to be guided and supervised during their treatment. (c) Display of oral hygiene and preventive material on wall boards in waiting rooms. It is gratifying to note that, on questioning, the majority of children and parents previously exposed to the described programme are now aware of the basic principles. School dental inspections still do not show the theoretically expected standard of good oral hygiene, but the standard of "fair" assessment is becoming noticeably higher in its approach to "good" and cases of gross oral neglect have definitely approached the point of rarity in children of average general hygiene. In February, 1969, a conference was held locally on two consecutive days, attended by the Borough's Head Teachers of primary and secondary schools respectively. In my talk on "Dental Health Education" I outlined the causes of dental disease and its prevention in general and the practical steps to be taken in the two age groups. School Dental Inspections Annual examination of every pupil throughout school life with offer of treatment when required is the least of the objectives of our school dental service for there is no doubt this is the only effective way of supervising the dental health of the school population both individually and collectively. However, as previously stated, such a scheme presupposes adequate clinics and a sufficiency of professional staff if demand is not to exceed available resources. 296 Although present capabilities are barely adequate for one-third of the school population, nevertheless, during 1968 and again in 1969 approximately one pupil in three was examined which, even with full resources, would have been very close to the ideal. This statistical achievement, however, must not conceal the fact that it was impossible to offer treatment within the suggested period of one month and that, after initial care early in school life, we are still leaving two-thirds of the older children without adequate supervision during a most vital period. Furthermore, fewer examinations of children in schools remote from clinics were balanced by the greater response from schools close to treatment facilities. Indeed, a higher acceptance rate from distant schools might well have forced a restriction of our established annual inspection programme for the younger children. An increase in treatment requirements, commensurate with advancing age of the school child, points to the need for an extension of the comprehensive service to secondary school age. This is clearly indicated in the synopsis of my detailed survey of over 10,000 children appended to the 1968 Report. On completion of the survey we returned to the Ministry's primary requirement of segregating children needing treatment from those dentally fit at the time of examination. It is interesting to note that, whilst in the initial survey rampant caries was far from uncommon, with children regularly examined and exposed to dental health education it is now not unusual to encounter difficulties in deciding whether a child needs treatment or not. Despite the depressing tone of this report a definite achievement worthy of note is that our inspections are now mainly revealing early decay and deficient restorations rather than overt dental disease. This trend, which has been observed too often to be coincidence, prompts the conclusion that our progress since 1965 has not been insignificant. My pessimism stems from the belief that half a sixpence is of value only in theory—we must strive to possess the total coin. Orthodontic Treatment While use has had to be made of existing hospital facilities, watch has been kept on the need for establishing an orthodontic service of our own. Cases treated or referred during 1969 total more than 50% above those for 1968 and more than six times those for 1965. It would seem that the time is now opportune for us to undertake this treatment ourselves. Provision jor Children in Special Schools As shown by the above quoted survey the reality of the problem in this field is beyond dispute. Restricted treatment potential. 297 coupled with the considerable time factor associated with treatment of the handicapped child, produces an exquisite dilemma—in a given unit of time is it right to treat one handicapped child or several pupils from general schools? During 1969, following assessment of the problem in 1968, progress was made by giving regular session at two centres to special schools. In this respect we are most grateful for the assistance of the Mobile Dental Unit and its crew seconded from the Dental Department for Children at Guy's Hospital who have made a very effective ingress into this particular problem at two of our special schools. Their efforts are greatly appreciated but they form only part of a three year research project. It would be deplorable and a matter of great concern if such progress were to be followed by a reversion to the pre-existing lack of special facilities. Naturally we are not without plans for the future but their realisation will still be directly proportional to the treatment facilities available when the present project ends. Special schools with established equal need and which have not, as yet, received the benefit of the special services because of our restricted facilities, present no less a problem. This is not intended to indicate that children from other special schools are not being treated but merely that they are unable to receive the additional regular special care which they require. Various solutions, including the use of mobile caravans, are strongly borne in mind both locally and within the framework of the reorganisation of the National Health Service at Government level. In itself, however, transferring of responsibility is not likely to be a solution unless backed by the provision of additional treatment facilities with appropriate specialising staff willing and able to cope with the problem. Summary The gap between our present service and the need as shown by a detailed local survey is to be deplored. We now have a service, well established in atmosphere and equipment, under pressure from maximal demand but organised to assume full responsibility for the school population as soon as its facilities can be adequately expanded. This service operates not only by treating established defects but also by greatly publicising the needs and means of prevention both at home and at school. School dental inspections are now an established routine for the younger age groups and are showing results. We are deeply concerned about the responsibility for the handicapped child, a situation which calls for the speedy provision of additional facilities. 298 SCHOOL DENTAL SERVICE Statistical Analysis 1969 1968 Sessions Treatment 1,645.3 1,610.2 School Inspections 157 134.4 Dental Health Education 48 70 TOTAL SESSIONS 1,850.3 1,814.6 Inspections Children inspected at schools and clinics 13,597 12,677 Percentage found to require treatment 63.8% 70.9% Visits for Treatment First 3,639 3,995 Subsequent 9,265 10,486 TOTAL VISITS 12,904 14,481 Emergency patients 731 551 Broken Appointments Number 4,127 3,291 Percentage 24.23% 18.60% Treatment Given (1) Permanent teeth Fillings 4,808 5,289 Extractions (including orthodontics) 121 153 Ratio of fillings to extractions 36.3 31.6 (2) Deciduous teeth Fillings 4,710 5,749 Extractions (including orthodontics) 321 270 Ratio of fillings to extractions 13.8 18.6 Total number of fillings 9,518 11,038 Ratio of fillings to extractions 21.54 26.09 Teeth root-filled 186 309 Other operations 3,962 6,677 General anaesthetics Nil Nil INDEX Page A Abattoir 241 Abortion Act, 1967 40, 98 Abortions 101 Accidents- Deaths 33, 55 Home 33,55 Motor Vehicles 33,55 O.S.R.P. Act 198 Accommodation—- for Elderly 133 for Homeless 136 for Mortuary 224 for Psychiatrics 167 Acute Encephalitis 78 Acute Meningitis 78 Acute Poliomyelitis 78 Adaptation for Kidney Machine 152 Adoption 117 Adults Cleansed 223 Advisory Clinics, Geriatric 179 Aflatoxin in Ground Nuts 245 Age Composition of Population 36 Age Mortality 46 Alcoholism 58 Aleukaemia 33, 53 Alkali Act 200 Amylase Test—Egg Pasteurisation 246 Analysis of Non Routine Medical Inspections—Schools 282 Analytical Examination of Milk 237 Anencephaly 102 Ante & Post Natal—Clinics 88 Ante & Post Natal Attendances 89 Antitoxin—Diphtheria 77 Ants, Pharoah's, etc. 220 Area—Borough 13 Comparability Factors 31,39,45 Articles and Rooms Disinfected 224 Articles Destroyed 220 Artificial Respiration 267 Asthma 54 Atmospheric Pollution 69, 200 "At Risk" Register 105 Audiology Clinics 283 Audiometer Testing of School Children 290 b Bacteriological Examinations 210, 213, 215, 237, 238, 245, 246 Baiting of Sewers 218 Bakehouses 240 Page Bathing— at Centres 176 at Home 176 Centres 176 Service 176 Baths- Swimming 215 Turkish & Russian 215 Warm 215 Baths & Wash-houses 214 "Battered" Babies 105 B.C.G. Vaccination 79,80,81,286 Beetles, etc.—Disinfestation 222 Betting, Gaming and Lotteries Acts 207 Birth Registrations 38 Births— 31, 38 Age, Parity and Place of Occurrence 90 Domiciliary 90, 93 Illegitimate 31,39,121 Legitimate 31,37, 90 Live 31,38,90 Multiple 91 Premature 95 Still 31,40,92 Blackheath & Woolwich Fairs 238 Blackwall Industrial Training Centre 161 Blind- Clubs 149 Concessions 145 Education, Training and Employment 142 Homeworkers 145 "In" Residents 143 Occupations 143 Registers 140 Sheltered Employment 145 Welfare 139 Blindness 139 Boarding Out— Child Contacts, etc. 118 Subnormal Adults 164 Breast Examinations 97 Bronchitis 33,54,70 Bronchogenic Carcinoma 54 Brook Chest Clinic 80 Burial or Cremation of Deceased Persons 189 Butchers' Shops 243 C Cancer— Cervix 33, 53 Childhood, Survey of 112 INDEX (continued) Page Cancer— General 33,52,60 Lung 33, 53 Other Special Sites 33,53 Registration 61 Uterus 33, 53 Care and Protection of Property 188 Care Committee 118 Carol Services for Elderly 185 Carcases & Offal Inspected at Slaughterhouse 242 Cars, Disposal of Unwanted 220 Case Conferences 119 Caseous Lymphadenitis 244 Cases of Infectious Diseases 74,287 Castlewood Day Hospital— Mentally 111 167 Catering Establishments 240 Census 13, 33 Cerebrovascular Disease 33,52 Certificates— Export 246 Disrepair 205 International Vaccination 75 Cervical Cytology 96 Cesspools 208 Charles Soames Trust 108 Chest Clinics 79,80 Chest Physicians' Reports 79,80 Chevening Road Day Centre— Mentally 111 277 Chickenpox—School Children 287 Child— Contacts, Boarding Out 118 Guidance Facilities 277 Health Centres 115 Helps, Courses 109 Minders, Statutory 122 Minders, Voluntary 122 Population 31,34 Welfare Clinics 115 Childbirth, Preparation for 89 Children— Cleansed 223,285 Dual Handicaps 102 Immigrant 36 Subnormal 159 Chimney Heights, Control of 201,204 Chiropody— Domiciliary 124,178 General 123 Elderly 124,178 Services 123,178 Childhood Cancers 112 Page Christmas Parcels for Elderly 186 Christmas Shopping Expedition 155 Chromosome Anomalies, S.E. Reg. Survey 113 Civic Entertainment for Elderly 185 Classification of Deaths 51 Clean Air Act, 1956 202 Clean Air Act, 1968 202 Cleansing & Bathing Centres 176 Cleansing of Children 223, 285 Cleansing of Old People 176 Clearance Areas 231 Clinics— Ante Natal 88 Child Health 115 Family Planning 98 Genetic 49 Geriatric 179 Mental Health 159, 166 Minor Ailments 283 Post Natal 88 Special Investigation 159,283 Closing Orders— Demolition Orders 230 Determinations 231 Houses 230 Parts of Houses 230 Underground Rooms 230 Undertakings 229 Clover Mite 221 Clubs— Blind 149,150 Day 182 Deaf 150 Elderly 182 Lunch 179 Mothers' 118 Physically Handicapped 149,150 Subnormal 164 Therapeutic, Social 168 Clubs & Centres for Handicapped 149 Cockroaches 221 Coconut, Desiccated 246 Combined Centres 150,167 Common Infectious Diseases 56 Communicable Diseases— School Children 287 Community— Care 129 Care Statistics 189 Centres 23 Council 23 INDEX (continued) Page Community Services— Geriatric 172 Handicapped 137 Mentally 111 165 Mentally Subnormal .159 Comparability Factors 31,39,45 Compensatory Education— Research Dev. Project 113 Complaints 193, 199 Concerts & Outings, etc.— Elderly 184 Concessions for Blind 145 Condensed Milk Regs. 248 Conditional Releases— Imported Egg Products 245 Conference Organisers 275 Confinement— Arrangements 88,93 Medical Aid 95 Congenital Malformations— Deaths 33 Notifications 101 Survey 113 Conjunctivitis—School Children 287 Consultant Chest Physicians 79,80 Control of Foxes 218 Conveniences—Public 220 Co-operation with Hospital Depts. 110 Co-ordinating Committee 118 Council— Dwellings 233 Housing Schemes 234 Rehousing 233 Courses—Training 270 Creches 117 Cremation or Burial of Deceased 189 Cremations 224 Crematorium 224 Cysticercosis 242 Cytology- Cervical 96 d Day— Centres—Mentally 111 167 Clubs—Elderly 182 Clubs—Homebound 182 Combined Centres 150,167 Hospital—Mentally 111 167 Nurseries—Private 116,122 Nursery 116 Rooms 182 Page Day— Training Centres—Sub- normality 160 Deaf Register fincl. Partially Hearing) 105 Death— Causes—Remarks 51 Rates—Special Causes 33 Registrations 45 Deaths— General 32,45 Institutional 47 Table Showing Causes of and Ages at Appendix Table Showing Causes of and Ages under 1 year 50 Violent 55 Defective Dwellings — Repairs 199 Defects of School Children at Routine and Special Medical Examinations 289 Deformities, Limb 102 Demolition Order, Revocation 231 Demolition Orders 230 Density of Population 13,31,34 Dental— Caries 61 Health Education 294 Services—M. & C.W 124 Services—Schools 292 Survey 296 Treatment 128,292,298 Dentistry 124,292 Departmental Transport 269 Desiccated Coconut 246 Determination of Closing Orders 231 Diagnostic Cytology 96 Diphtheria— 77 Antitoxin 77 Immunisation 77,279,286 Disabled & Old Peoples' Homes—Registration 189 Disablement Resettlement Officer 163 Diseased Carcases 242 Diseases— Infectious 57, 74 Respiratory 33,53,54,69 Disinfecting Stations 223 Disinfection 79,223 Disinfestation 222,285 Disinfestation of Verminous Premises 220 Displays—Health Education 263 INDEX (continued) Page Distribution Centres— Nutritional Supplements 181 Welfare Foods 121 District Nursing Service 106 Divisional School Care Organiser 160 Domestic Helps 109 Domiciliary— Births 90,93 Births, Prematurity and Mortality 95 Chiropody 124,178 Confinements 93 Confinements by Age and Parity 94 Midwifery Services 93 Midwives 93 Domiciliary Services— Geriatric 172 Handicapped 137 Midwifery93 Drainage & Sewerage 208 Dried Egg Products—Imported 245 Dried Hen Egg Albumen 245 Dried Milk Regs 247 Drug Addiction 63 Dual Handicaps—Children's 102 Dwellings— Erected by L.A.s 234 Inhabited 13 Separate Occupiers 13 Uninhabited 13 Dysentery 77 E Early Discharges — Maternity Cases 93 Early Neonatal Mortality 32,50 Education Act — Examinations 159 Education and Training Centre —E.S.N 160 Education, Compensatory- Research Dev. Project 113 Education Sessions — Ante Natal 89 Educationally Subnormal Pupils 290 Educationally Subnormal Clubs 164 Egg Albumen—Imported 245 Egg Processing Plant 246 Elderly— Clubs for 182,183 Day Rooms for 182 Lunch Clubs for179 Meals-on-Wheels 178 Population 31,36 Page Elderly— Primaparae 90 Recreational Facilities 182, 184, 185 Visiting 175,187 Elevation of Borough 13 Elfrida Rathbone Soc. Clubs 165 Eltham— Club for Blind 150 Creche 164 Crematorium 224 Nursery for Mentally Handicapped 164 Emergency Obstetric Units 94 Emigration/Immigration 35 Emphysema 54 Employment of Blind Persons 143 Employment of Partially Sighted 145 Encephalitis 78 English Frozen Whole Egg Plant 246 E.N.T. Clinics 283 Entertainment for Elderly 185 Environmental Health Services 192 Examinations— Ante and Post Natal 88 Fitness for Employment 277 Mental Illness 159 Recuperative Holidays 287 Sick Persons 268 Staff Appointments 268 Superannuation 268 Exchange Holidays 134 Exclusion from Work 75 Exhumations 224 Expectation of Life 36 Export Certificates 246 Extracts from Vital Statistics 31 F Factories Act, 1961 193 Factories Inspections 193 Fairs, Blackheath & Woolwich 238 Families, Number of 13 Family— Aids 109, 120 Caseworkers 120 Planning 98 Planning Act 98,99 Planning Association 99 Planning Assoc. Clinics 99 Federation Combined Centre 151,167 Fertility— 41 Clinics 99 Immigrant 43 Rates 43 INDEX (continued) Page Field Work Instructor Courses 111 Film Shows—for Elderly .185 Film Shows and Talks— Health Education 262 Flies and Mosquitoes 220 Flooding, Storm 200 Fluoridation of Water Supplies 61, 127,214 Food and Drugs Act— Genuine Samples 247, 249 Non-Genuine Samples 247,253 Other Food Samples 248 Food— Examination 243 Hygiene Regs 239 Inspection 241,247 Legislation, New 235 Poisoning 83 Premises for Preparation of 239 Rejected 240,244 Foods—Welfare 121, 181 Foot Clinics 123 Foster Parents117 Fouling of Pavements by Dogs 219 Foxes—Control of 218 Friendly Visiting—Elderly 187 Frozen Whole Egg Plant 246 Future Development — Handicapped Services 156 Future Prospects—Geriatric Problems 174 G General Information and Social Conditions 16 General Medical Inspection of School Children 280 General Practitioner Obstetricians' Clinics 89 General Statistics 13 Genetic Clinics66 Geology, Superficial 26 Geriatric Adviser to the Council 180 Geriatric— Clinics 179 Community Services 172 Units 180,181 German Measles 103,287 G.L.C.—Rehousing 233 Gonorrhoea 72 G.P. Obstetricians' Clinics 89 Grants—S.C.A.s 204 Greater London Council (G.P.) Act, 1967 208 Page Greenwich- Chest Clinic 79 Community Council 23 Council of Social Service 124,178 Hotel 183 Show 263 Workshops for the Blind 145 Grit and Dust from Furnaces 201 Ground Nuts—Aflatoxin content 245 Guthrie Test—Phenylketonuria 96 H Hairdressers & Barbers 208 Hairwashing—Elderly 177 Handicapped Adaptation for Kidney Machine 152 Children 101,104 Christmas Shopping Expedition 155 Future Development 156 Holidays 155 Portable Aids 152 Register 104 Services 137 Special Education 278 Transport 156 Works of Access, etc.152 Health- Committee 3 Committee—Terms of Reference 3 Education 114,262 Education Classes 89 Education in Schools 115,264 Education at Welfare Centres 114 Education Subjects 114,267 Surveys 112 Visiting 109 Visitor Training 111 Health and Welfare Dept. Staff 6 Health Services & P.H. Act, 1968 74,122 Heart Disease 33, 52,65 Help The Disabled Week 263 H.M. Inspector of Factories 194 Holiday Hotel for Elderly 183 Holiday Relief for Relatives 133,181 Holidays— Elderly 181, 183 Exchange 134 Handicapped 155 Recuperative 120,287 Subnormal Trainees 163 INDEX (continued) Pane Home— Accidents—Deaths 33,55 Bathing 176 Cleansing Service 178 Help Course 109 Help Service 109 Nursing 106 Nursing Equipment Loans 152 Nursing—Training 108 Safety 266 Visits—Elderly 176 Homeless Families— Accommodation 136 Statistics 136 Homelessness 136 Homes for Mentally 111 168 Homes for Old People— Admissions 133 Council 134 Future Development 133 Provision of 133 Recreation 134 Registration 189 Staff 134 Temporary Admissions 133 Transfer of Residents 135 Voluntary 135 Welfare 134 Homes for Subnormal 165 Homicide 55 Hospital Confinement- Nursed at Home 93 Selection for 89 Hostels for Mentally 111 168 Hostels for Subnormal 165 Hotel, Holiday for Elderly 183 House Improvements 231 House Purchase and Housing Acts 231 House and Trade Refuse 219 Houses— Inhabited 13 Multiple Occupation 232 No. in Borough 13 Unfit 229 Uninhabited 13 Housing— 182,227 Accommodation 233 Clearance Areas 231 Closing Orders 230 Conditions 227 Defects 199 Demolition Orders 230 Determinations 231 Pane Housing— Elderly 182 Financial Provs. Act 231 Homeless Persons 136 Medical Assessments 269 Premises Unfit 229 Repairs and Rents Act 231 Schemes, Council 234 Underground Rooms Act 230 Undertakings 229 Housing Act, 1957—Procedure under 229 Housing Act, 1961 232 Housing Act, 1969 229,232 Hydrotherapy Pool 215 1 Ice Cream— Bacteriological Exams 238 Premises 237 Quantitative Analysis 238 Sampling 238 Illegitimate Births 31,39,90,121 Immigrant— Fertility 43 Schoolchildren 36 Immigration/Emigration 35 Immunisation and Vaccination 76, 77, 78, 79, 80,81, 103,279, 286 Impetigo 223, 283,287 Imported— Egg Products 245 Food Regs. 243,247 Food Rejected 240 Food Samples 247,260 Improvement Grants 231 Incontinent Laundry Service. 177 Industrial— Emissions — Grit & Dust 200 Injury Benefit Claims 86 Rehabilitation 140 Training Centres 161 Infantile Mortality 32,48 Infant Health Clinics 115 Infectious Diseases 57, 74 and Appendix Infectious Diseases— Notifications 74 and Appendix School Children 287 Infective Hepatitis 79 Infertility Clinics 99 Influenza 54 Inhabited Dwellings Innoculations—Poliomyelitis 78 "In Service" Training1ll INDEX (continued) Page Inspections— Food and Food Premises 235 Food 236 Food Premises 237,239 Meat at Slaughterhouse 241 Institution Deaths 47 International Vaccination Certs. 75 Interviews—re Housing (A.M.O.H.) 269 Introductory Review 9 J Jaundice 79 K Kidney Machines, Adaptations for 152 L Laboratory Work 96,210,212,213, 215,237, 238, 245, 246, 247, 248 Land Charges Act 208 Launderette 215 Laundries—Public 215 Laundry Service—Incontinent 177 Lead Content in Water Supply 211 Leaflets—Health Education 264 Legal Proceedings 226 Legislation, New 193,201,229,235 Legitimate Births 31,38 Leprosy 79 Leptospirosis 217 Leukaemia 33, 53 Library Facilities— Blind 146 Elderly 184 Homebound 185 Old People's Homes 184 Lice, Resistance to Chemicals 223 Licences— Milk 236 Radio for Blind 145 Licensing Act, 1961 207 Licensing— Slaughterhouse 243 Slaughtermen 243 Street Traders 238 Limb Deformities 102 Live Births 31,38,90 Loan of Equipment 152 Local Authorities Social Services Bill 87 Local Morbidity 85 London Government Act, 1963 16 Page Lunch Clubs 179 Lung Cancer 33,53, 60 M Main Unit—Homeless 136 Malaria78 Malformations, Congenital— Deaths 33 Notifications 101 Manufacture and Sale of Ice Cream 238 Marie Curie Night Nursing Service 108 Marriages 31,37 Mass Radiography 81 Maternal Mortality 32,47 Maternity Outfits 95 Maternity Services 88 Mayor's Fund—Coal for Elderly 186 Maxey Road Chest Clinic 80 Maze Hill- Chest Clinic 79 Training: Centre 160 Training Centre — Education and Training 160 Nursery Unit 160 Special Unit 161 Meals-on-Wheels 178 Measles76,287 Measles—Vaccination 76 Meat Inspection — Slaughterhouse 241 Meat Regs 241 Meat Surrendered 240 Medical Aid — Confinement Cases 95 Medical Appliances—Loans 152 Medical Assessments—Housing 269 Medical Examinations— Ante Natal 88 Mental Health 159 Post Natal 88 Sick Persons 268 Staff Appointments 268 Superannuation 268 Medical Inspections — School Children 280 Medical Officer of Health's Review 9 Medical Practitioner Obstetrician Clinics 89 Medical Treatment — School Children 283 Meningitis 78 INDEX (continued) Page Mental Health— Act 157 Colour Film 266 Officers 132 Services 157 Special Clinic 159 Statistics 159, 164, 165, 168, 169 Training Centres 160 Week 263 Mental Illness— Community Services 165 Prevention and Treatment 66 Mental Subnormality — Community Services 159 Meteorological Observations 30 Metropolitan Water Board 209 Met. Water Board—Director's Report 210 Mice Destruction 216 Midwifery 92 Midwifery Training — Part II 96 Midwives 93 Mileage of Roads 15 Milk- Analysis 237 Condensed, Regs. 248 Dairies 236 Distributors 23 Dried, Regs.247 Licences 237 Sampling 237 Milk and Dairies Regs 236 Milk (Special Designation) Regs. 236 Ministry of Labour—D.R.O.s and Y.E.O.s 163 Ministry of Social Security- Statistics 85 Minor Ailments Clinics- Defects Treated 283 Minor Hall Club—Blind and Deaf 150 Miscellaneous Services 188,262 Mobile Meals 178 Mongolism 103 Mongols — Radiation History of Parents Survey 113 Moral Welfare 121 Mortuary Accommodation 224 Mothercraft Training 89 Mothers' Clubs 118 Mothers—Rehabilitation 118 Motor Vehicle Accidents— Deaths 33,55 Multiple Pregnancies 91 Mumps—School Children 287 Page N National Assistance Act 189 N.A.A.—Part III Accommodation—Statistics 134 Nat. Child Dev. Survey 112 National Health Service (Family Planning Act), 1967 98 National Insurance Act—Med. Certs 75 National Welfare Foods— Distribution 121 Natural Increase 32, 35 Neonatal Mortality 32, 50 New Housing 234 New Legislation 193, 201,229, 235 Noise Abatement Act 206 Nomenclature Regulations 51 NoniGenuine Samples 247,253 Non-Routine Med. Inspections —Schoolchildren 286 Notices, etc. 193,226 Notifications— Accidents 197 Con. Malformations ' 101 Food Poisoning 83 Infectious Diseases 74 Number of Families 13 Nurseries & Child Minders. 122 Nursing— Equipment—Loans 152 Home 106 Homes—Registration 122 Unit—Mentally Handicapped 160 Nutritional Supplements 181 O Obesity 67 Observation / Handicapped Register 104 Observation of Council's Services 112, 186 Occasional Creche Service 117 Occupational Therapist 81,150 Offices, Shops & Railway Premises— Act 195 Exemptions 197 Inspections 196 Notifications of Accidents 197 Registration 196 Old People—Visiting 175, 187 Old People's— Clubs 183 Homes 133 Homes—Registration 189 INDEX (continued) Page Open Spaces— Borough Council 14 G.L.C 15 H.M. Office of Works 15 Public 14 War Office Dept 15 Ophthalmia — School Children 287 Ophthalmia Neonatorum 78 Ophthalmic Services 140 Organic Nervous Diseases Gp Handicapped 148 Ormiston Road Rehabilitation Centre 150 Orthodontic Treatment 296 Orthopaedic Defect—School Children 288 Other Food Examinations 248 Otology—School Children 290 Outwork 195 Outworkers 195 Overcrowding 233 P Paratyphoid Fever 76 Park Vista Training Centre 162 Part III (N.A.A.) Accommodation Statistics 134 Partially Sighted— Employment and Training 144 Register 144 Parties—Xmas & New Year 155, 186 Parts of Buildings—Unfit 230 Pedicure—Elderly 177 Perinatal Mortality 32,51 Personal Health and Related Services 87 Persons Cleansed 176 Pet Animals Act 207 Pharaoh's Ants 220 Pharmacy and Poisons Act 206 Phenylketonuria 96 P.H. Regs.— Dried Milk 247 Imported Food 243 Meat 241 Milk and Dairies (Gen.) 236 Milk (Spec. Designations) 236 Smallpox Prevention 76 Tuberculosis 79 Physical Aids 153, 182 Physically Handicapped- Additions and Removals 149 Clubs and Centres 149 Combined Day Centres 150, 167 Page Physically Handicapped— Organic Nervous Diseases Gp 148 Primary Disabilities 147 Register 147 Rheumatism Gp 147 Social Rehabilitation Centre 150 Survey 114 Systemic Diseases Gp 148 Welfare 146 Pigeon Nuisance 199 Play Groups 122 Plumbo—solvency 211 Pneumonia 33, 54 Poisoning— Food 83 Lead 55 Poisons Information Service 206 Poliomyelitis 78 Poliomyelitis Inoculations 78 Pollution— Atmospheric 69,200 Recording 204 River 199 Population 13,31,34 Population— Age Composition 36 Child 31,36 Density of 13,31 Elderly 31. 36 England and Wales 34 Greater London 35 Sex Ratio in 36 Working 37 World 34 Portable Aids for Handicapped 153 Post Entry Training 270 Post Natal Clinics 88 Powers and Duties— Health Committee 3 Welfare Committee 5 Practising Midwives 93 Precautionary Spraying 222 Pregnancies, Multiple 91 Premature Baby Units 94 Premises Unfit for Human Habitation 229 Preparation for Childbirth 89 Preserved Food Premises 237 Prevalence and Control over Infectious & Other Diseases 57 Prevention of Damage by Pests Act 217 Primaparae, Elderly 90 INDEX (continued) Page Principal School Dental Officer's Report 292 Principal School Medical Officer's Report 276 Private Day Nurseries 122 Problem Families Index 110 Procedure under Housing Act, 1957 229 Proceedings, Legal 226 Product of Id. Rate 13 Property Protection 188 Prophylaxis 7'6, 77, 78, 79,80, 81, 103 Protection of Property 188 Provision of Accommodation (N.A.A.) 133, 143 Psychiatric Patients — Accommodation 167 Psychiatric Services 166 Psychoprophylaxis in Childbirth 89 Public Baths and Wash-houses 214 Public Conveniences 220 Public Health Laboratory Service 215,237,238 Public Lectures/Demonstrations 265 Publicity— Health Education 262 Services for Elderly 182 Public Open Spaces 14 Public Open Spaces— Council 14 G.L. C 15 H.M. Office of Works 15 War Office Dept 15 Q Quantitative Analysis—Ice Cream 238 R Radio and T.V. for Elderly 184 Radioactive Substances Act 209 Radiography—Mass 81 Rag Flock Act 207 Rag Flock and Other Filling Materials Regs 207 Rainfall—Annual 30 Rateable Value 13 Rates—Births and Deaths, etc. 31 Rats and Mice Destruction 216 Receivership 188 Reception Centre — Homeless 136 Recreational Facilities for Elderly 182 Page Recruitment—District Nursing 107 Recuperative Holidays 120 Recuperative Holidays — Med. Exams. 287 Recurring Nuisances Act 193 Redevelopment—Housing 234 Refresher Courses 96,108,111 Refuse— Collection 219 Disposal 219 Registers— "At Risk" 105 Blind 140 Deaf 105 Elderly People 176 Handicapped 104 Observation/Handicapped 104 Partially Sighted 144 Registration— Births 38 Child Minders 122 Deaths 45 Disabled and Old People's Homes 189 Hairdressers & Barbers 208 Ice Cream Premises 237 Marriages 37 Nursing Homes 122 Play Groups 122 Preserved Food Premises 237 Residential Homes 189 Rehabilitation Centre 150 Rehabilitation of Mothers 118 Rehousing 233 Rehousing— Council 233 G.L.C 233 Interviews by A.M.O.H 269 Medical Grounds 269 Rejected Food 240,244 Relaxation Classes—Ante Natal 89 Remarks on Various Death Causes 51 Rent Act, 1968 205 Report of Dental Officer (M. & C.W.) 124 Report of Principal S.D.O. 292 Report of Principal S.M.O. 276 Reproductive Wastage 32,51 Residential— Homes 133, 143,189 Services 133 Respiratory Infections 69 Respiratory System — Diseases of 54,69 INDEX (continued) Page Review by M.O.H 9 Rheumatic Diseases 71 Rheumatism Gp—Handicapped 147 Ringworm 283,287 Risk Register 105 River Pollution 199 River Smells 199 Riverdale Combined Centre 151,168 Roads, Mileage in Borough 15 Rodent Control 216 Rodent Control—Warfarin Resistance 218 Routine Audiometer Testing 290 Rubella 287 Rubella Vaccination 103 Russian Vapour Baths 215 S Safety in the Home 266 Salmonellae in Egg Imports 246 Samples— None Genuine 237,238, 247,253 Under Food & Drugs Act 247, 249 Sampling- Food and Drugs 247 Ice Cream 238 Milk 237 Sanitary Circumstances of Area 193 Sanitary Work — Summaries, etc. 225 Scabies 223 Scabies and Cleansing Clinics 177, 222 Scarlet Fever 76 Scavenging & Refuse Disposal 219 School Children Cleansed 223, 285 School— Dental Services 292 Dental Services—Statistics 298 Health Education 264 Health Services 276 Health Services—Statistics 279 Health Services—Social Work 291 Treatment Centres 283 Seebohm Report 87,129 Selection of Women for Hospital Confinement .... 89 Separate Occupiers 13 Services— For the Elderly 172 For the Handicapped 137 For the Mentally 111 165 Page Sewerage and Drainage 208 Sewers—Baiting 218 Sex Ratio—Population 36 Sheltered Employment 145 Shop Window Displays— Health Education 263 Shopping Expedition 155 Shops and Offices Inspection 196 Sick Room Equipment—Loans 152 Sickness Claims — Ministry of S.S 86 Sight Testing 180,284 Slaughterhouse—Meat Inspection 241 Slaughterhouse, Slaughtermen— Licensing 243 Smallpox 76 Smallpox Vaccination 76 Smells from River 199 Smoke Control— Appliances 204 Areas 202 Chimney Heights 201,204 Grants 204 Grit & Dust .... 200,201 Installations 204 Pollution Recording 204 Staff 205 Smokeless Fuels—Supplies 201 Smoking and Health—Health Education 267 Soames, Charles—Trust 108 Social— Clubs—Therapeutic 168 Conditions of the Area 16 Rehabilitation Centre 150 Security, Ministry of— Statistics 85 Work—School Health Services 291 Solid Formations—Geology 27 Special— Care Unit—E.S.N. 161 Categories—Placement 278 Clinics—V.D 73 Education Units 278 Investigation Clinics 159,283,289 Investigation—School Children 283,289 Schools 278 Spectacles — Supply to School Children 284 Speech Therapy 279 Spina Bifida Survey 112 Spraying—Precautionary 222 INDEX (continued) Page Staff—Health & Welfare Dept. 6 Statistics— General 13, 31, 33 Tables Appendix Vital 31 Stillbirths 31, 40, 92 Storm Flooding 200 Street Cleansing 219 Street Traders 238 Streets — Mileage in Borough 15 Structurally Separate Dwellings 13 Student— Health Visitors 111 Nurses 108, 112 Sub Fertility Clinics 99 Suicide 33, 55 Summary of Activities—Health Education 262 Summary of Sanitary Work 225 Sunshine, Annual 30 Superficial Deposits 26 Superficial Geology 26 Supervision of Food Premises 239 Supplies of Smokeless Fuels 201 Supplies of Underground Water (Wells) 214 Surveys 112 Swimming— Attendances 216 Baths 215 Instruction 216 Syphilis 72 Systemic Diseases Gp—Handicapped 148 T Task Force 187 Television and Radio Sets— Elderly 184 Temperature, Annual — Max. and Min 30 Tetanus Prophylaxis 78 Therapeutic Clubs—Mentally Ill 168 Therapists 81, 150 Trade and House Refuse 219 Training Centres— Blackwall Lane 161 Maze Hill 160 Park Vista 162 Statistics 164 Tunnel Avenue 162 Training Courses 111, 270 Transfers— Housing 233 Residential Homes 135 Page Transport— Departmental 269 Handicapped 156 Organiser's Report 269 Transported Meals for Old People 178 Tuberculosis— 33, 55, 70, 79 Animals 242 B.C.G. Vaccination 79, 80, 81 Chest Physicians' Reports 79, 80 Tunnel Ave. Trg:. Centre 162 Turkish Baths 215 Typhoid Fever 77 U Unauthorised Fuel, Sale of 201 Underground Rooms—Unfit 230 Underground Water Supplies (Wells) 214 Undertakings—Housing 229 Unfit Premises 229 Uninhabited Dwellings 13 Unsound Food 240, 244 Unsupported Mothers and Babies 120, 137 Unwanted Cars, Disposal 220 V Vaccination 76, 77, 78, 79, 80, 81, 286 Vaccination—International Certs 75 Various Death Causes— Remarks on 51 Venereal Diseases 72 Verminous— Conditions 222, 224 Persons 223 Premises 224 Verrucae 283, 290 Violent Deaths 55 Violet Melchett Mothercraft Unit 118 Vision— Clinics 284 School Children 284 Visiting— Friendly 187 Geriatric 175 Visits by Health Visitors 110 Visits by Women Public Health Officers 175 Visual Acuity of School Children 284 Vital Statistics—Summary 31 INDEX (continued) Page Page Vitamin Supplements 121,181 Vocational Training — Handicapped 150 Voluntary Help—Elderly 187 Voluntary Homes 135 W Warfarin Resistance 218 Wash-houses and Public Baths 214 Wasps 221 Water—Underground Supplies (Wells) 214 Water Supplies, Fluoridation 61, 127, 214 Water Supply 209 Water Supply— Lead Content 211 Letters re Suitability 210 M.W.B. Report 210 Sampling 210, 212, 213 Weil's Disease 217 Welfare— Blind 139 Clinics 115 Committee 5 Committee, Terms of Ref. 5 Foods, Elderly 181 Foods, M. & C.W 121 Moral 121 Physically Handicapped 146 Residential 134 Services 129 Wells 211, 214 Whooping Cough 77 Whooping Cough, Prophylaxis 77 Women Public Health Officers 176 Women Public Health Officers' Visits 176 Woolwich & Blackheath Fairs 238 Woolwich and Brook Chest Clinics 80 Woolwich and Plumstead Relief in Sickness Fund 108 Works of Access and Adaptation for Handicapped 152 Workshops for the Blind 145 X X-Ray— Examinations 80 Mass 81 Y Youth Employment Officers 163 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1969 Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality Age & Sex Group At all Ages 0 to 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-45 45-65 65 & 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 Small-Pox - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - Post-Infectious 2 - - - - - 1 - - - - - 1 - - - - - - - - - - - - 2 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 38 31 1 1 1 2 1 2 2 2 3 5 24 10 3 3 - 1 3 3 - 1 - 1 17 52 Infective Jaundice 11 9 - - - - - - - - - - 2 3 - - 6 2 3 3 - - - 1 4 16 Acute Polio-Myelitis P. - - - - - - - - - - - - - - - - - - - - - - - - - - N.P. - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 13 18 - - - 1 1 1 1 4 2 2 7 8 2 2 - - - - - - - - 12 19 Enteric Fever - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid Fever - 1 - - - - - - - - - - - - - - - 1 - - - - - - - 1 Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection 4 8 - 1 1 - - 2 - - - - 1 1 - 1 1 1 - 1 1 1 - - 5 7 Measles 553 527 23 24 62 61 89 67 84 85 90 88 186 184 16 12 2 6 1 - 1 - - - 427 653 Whooping Cough 13 12 3 2 1 2 2 4 5 1 1 2 1 1 - - - - - - - - - - 10 15 Malaria 2 - - - - - - - - - - - - - - - 1 - - - 1 - - - 1 1 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - Leptispiros - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis, Pulmonary 24 15 - - - - - - - - - - - 1 - - 3 1 10 5 9 4 2 4 17 22 „ Non-Pulmonary 1 7 - - - - - - - - - - - - - - - 1 - 4 1 1 - 1 1 7 Totals 661 628 27 28 65 66 94 76 91 92 96 97 222 208 21 18 13 13 17 16 13 7 2 7 494 795 NOTE:—The above table refers to "Corrected Notifications" only, i.e., all cases in which the diagnosis was not confirmed have been ignored TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December 1969. No. in Short List Causes of Death Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards GREENWICH WOOLWICH St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital 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 3 .. .. .. .. .. .. 1 2 .. .. 1 2 1 .. .. .. .. .. .. .. .. 4 2 Tuberculosis, Other 2 .. .. .. .. .. .. .. 1 .. 1 .. 2 .. .. .. .. .. .. .. .. 2 .. 3 Syphilitic Disease 1 .. .. .. .. .. .. .. .. .. l 1 .. 1 .. .. .. .. .. .. .. .. 2 4 Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Meningococcal Infections .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 7 Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9 Other Infective and Parasitic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Malignant Neoplasm, Stomach 65 .. .. .. .. .. .. 1 15 20 29 25 40 11 .. 7 .. 4 .. 1 1 7 64 11 Malignant Neoplasm, Lung, Bronchus 156 .. .. .. .. .. .. 2 66 60 28 54 102 12 1 4 2 1 .. 1 2 48 129 12 Malignant Neoplasm, Breast 60 .. .. .. .. .. .. 7 30 11 12 11 49 2 .. 3 .. 3 .. 4 2 14 36 13 Malignant Neoplasm, Uterus 11 .. .. .. .. .. .. 2 1 3 5 3 8 .. .. .. .. .. .. .. .. 4 6 14 Other Malignant and Lymphatic Neoplasms 254 .. .. .. .. 1 2 10 88 69 84 86 168 29 8 15 2 9 .. 7 4 57 268 15 Leukaemia, Aleukaemia 13 .. .. .. .. .. .. 1 2 5 5 1 12 .. 1 .. .. .. .. .. 1 2 19 16 Diabetes 17 .. .. .. .. .. .. .. 4 7 6 6 11 .. 2 4 .. .. .. 1 .. 2 17 17 Vascular Lesions of Nervous System 272 .. .. .. .. .. 1 2 50 64 155 79 193 36 5 8 .. 2 .. 2 7 32 399 18 Coronary Disease, Angina 365 .. .. .. .. .. .. 7 105 101 152 120 245 24 8 2 11 .. 3 17 49 286 19 Hypertension with Heart DisDisease 9 .. .. .. .. .. .. .. 2 4 3 4 5 1 1 .. .. .. .. .. .. 2 7 20 Other Heart Disease 457 .. .. .. .. .. 1 7 95 97 257 158 299 83 6 15 2 9 .. 4 12 50 559 21 Other Circulatory Disease 110 .. .. .. .. .. .. .. 22 31 57 32 78 18 4 5 .. .. 4 9 131 22 Influenza 12 .. .. .. .. .. .. .. 2 3 7 4 8 1 1 .. .. .. 1 .. 12 23 Pneumonia 232 .. 3 .. .. .. 1 3 23 36 165 79 153 45 1 10 1 2 .. 2 9 24 278 24 Bronchitis 183 1 6 .. .. .. .. 2 27 71 76 56 127 23 3 6 1 1 .. 2 6 25 163 25 Other Diseases of Respiratory System 19 .. .. .. .. .. .. .. 5 6 8 7 12 1 3 .. .. .. .. .. 2 2 23 26 Ulcer of Stomach and Duodenum 19 .. .. .. .. .. .. .. 5 8 6 8 11 1 .. 1 .. 2 .. .. .. 2 24 27 Gastritis, Enteritis and Diarrhoea 13 .. .. .. .. .. .. .. 4 2 7 2 11 1 .. 1 .. 1 .. .. .. 2 20 28 Nephritis and Nephrosis 7 .. .. .. .. .. .. .. .. 4 3 7 .. .. .. .. .. .. .. .. .. 15 29 Hyperplasia of Prostate 4 .. .. .. .. .. .. .. .. 1 3 2 2 .. 1 1 .. .. .. .. .. .. 6 30 Pregnancy, Childbirth, abortion 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 2 31 Congenital Malformations 18 6 2 .. 2 2 1 1 2 2 .. 2 16 .. .. .. .. .. 2 .. 1 10 22 32 Other defined and ill-defined Diseases 151 34 3 .. 1 2 2 5 31 27 46 52 99 25 4 3 1 5 18 .. 2 29 203 33 Motor Vehicle Accidents 21 .. 1 .. 1 2 7 1 1 3 5 3 18 1 .. ... .. 1 .. .. .. 10 42 34 All other Accidents 37 .. 2 3 2 2 6 3 5 3 11 13 24 3 .. 1 .. .. .. .. .. 6 50 35 Suicide 21 .. .. .. .. .. 1 4 10 4 2 7 14 2 .. 1 .. .. .. .. 1 2 14 36 Homicide and Operations of War 3 .. .. .. .. .. 1 2 .. .. .. .. 3 .. .. .. .. .. .. .. .. 1 .. Totals 2536 41 17 3 6 10 23 62 598 642 1134 816 1720 321 36 93 11 57 20 27 72 392 2802 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. Printed by Bromley Office Supplies & Printing Co., Ltd. 39-41 East Street, Bromley, Kent, BR1 1QT.