HC 43374 2nd copy LAM54 LONDON BOROUGH OF LAMBETH HEALTH SERVICES REPORT OF THE MEDICAL OFFICER OF HEALTH 1965 LONDON BOROUGH OF LAMBETH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 2 CONTENTS OF REPORT Page Members of Health Committee 5 Staff of Health Department 7 Introductory remarks of Medical Officer of Health 8 Statistics and Social Conditions of the Area General 10 Births, Birth Rate, Still Births 11 Deaths, Death Rate 11 Maternal Mortality 12 Infantile Mortality 12 Vital Statistics for Years 1956 - 1965 13 Classification of Deaths 14 Notes on Vital Statistics 17 Deaths from Cancer of Lung and Bronchus 18 Prevalence of, and control over, Infectious Disease Notifiable diseases 19 Notifications other than Tuberculosis 20 Age distribution of Infectious Diseases 21 Notes on Infectious Diseases 23 Salmonella Infections 23 Tuberculosis Notifications 25 Personal Health Services Ante-natal and Post-natal Clinics 27 Mothercraft and relaxation classes 27 Dental Treatment 27 Phenylketonuria 27 Welfare Foods 27 Health Visiting 28 Home Nursing 28 Incontinence Pads 29 Domiciliary Midwifery Service 29 Midwives Act 1951 30 Family Planning 30 Day Care of Children 30 Day Nurseries 31 Handicap Register 31 Occasional Creches 31 Prevention of Break-up of Families 32 Vaccination and Immunisation 33 International Certificates of vacination 33 Tuberculosis 33 Recuperative Holidays 34 3 Personal Health Services (continued) Page Chiropody 35 Mental Health Services 35 Home Help Service 40 Statistics - Personal Health Services 40-53 Environmental Health Services Care of the Aged 54 Laundry Service for Aged Incontinent Persons 54 Home Bathing Service 54 Holidays for the Aged 55 Water Supply 56 Sewers 59 Summary of Visits by Public Health Inspectors 59 Complaints 60 Drain Testing 60 Dangerous Structures 61 Summary of Defects and Nuisances found 61 Notices Served 61 Legal Proceedings 62 Dwelling Houses rendered fit 62 Section 95 Public Health (London") Act 1936 62 Drainage Plans 62 Disinfection 63 Disinfestation 63 Prevention of Damage by Pests Act 1949 63 Factories Act 1961 64 Rent Act 1957 66 Rehousing 67 Housing • Work of Public Health Inspectors 68 Slum Clearance Programme 1961-1965 69 Housing Acts 1961-1964 - Houses-in-multiple-occupation 70 Atmospheric Pollution 71 Inspection and Supervision of Food 72 Food Premises 73 Food and Drugs Act 1955 - Section 16 73 Milk and Dairies (General') Regulations 1959 73 Milk (Special Designation) Regulations 1963 74 Sampling of Food and Drugs 75 Bacteriological and other Examinations 78 Labelling of Food 79 Unsound Food 80 Food Complaints 82 Imported Food Regulations 1937-1948 83 Street Markets 84 4 Environmental Health Services (continued) Page Slaughter of Animals Act 84 Public Swimming Baths 84 National Assistance Act 1948 - Burials 85 Land Charges Act 1925 85 Pharmacy and Poisons Act 1933 85 Rag Flock and other Filling Materials Act 1951 86 Hairdressers and Barbers 86 Diseases of Animals Act 1950 86 Pet Animals Act 1951 86 Riding Establishments Act 1964 86 Establishments for Massage or Special Treatment 87 General Health Education 88 Medical Examination of Staff 89 School Health Service Report of the Principal School Medical Officer for the year 1965 90-97 5 LONDON BOROUGH OF LAMBETH HEALTH COMMITTEE (Appointed by the Council 25th March, 1965) The Worshipful the Mayor of Lambeth Councillor Ewan G. Carr, J.P. (Ex-officio) The Deputy Mayor of Lambeth Councillor B. M. Lawrence (Ex-officio) Chairman Councillor S.H. Gurney Vice- Chairman Councillor G.F.S. Light Alderman Mrs. Mary Marock Councillor W.A. Brownett Councillor P.C.H. Cary Councillor T. Cleasby Councillor Mrs. D.R. Colls Councillor G.A. Gold, LL.B. Councillor D.F. How Councillor P.W. Huggett Councillor B.J. Perkins Councillor Mrs. W.E. Privett Councillor T.V. Rowlands, O.B.E. Councillor D.C. Stimpson Co-opted Members Representing Inner London Medical Committee - Dr. K. McFadyean Representing Teaching Hospitals Association - Mr. B.A. McSwiney Representing Lambeth District Nursing Association - Mr. W.J. Hobby 6 ENVIRONMENTAL HEALTH SUB-COMMITTEE Chairman Councillor P.W. Huggett Councillor W.A. Brownett Councillor Mrs. D.R. Colls Councillor S.H. Gurney Councillor D.F. How Councillor G.F.S. Light Councillor B.J. Perkins Councillor D.S. Stimpson 7 STAFF OF HEALTH DEPARTMENT Medical Officer of Health and Principal School Medical Officer A.L. Thrower, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Associate Medical Officer of Health F. Summers, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health N. Christina Walsh, M.B., B.Ch., D.C.H., D.P.H. Principal Administrative Officer D.E. Armstrong Deputy Principal Administrative Officers A.C. Puttock J.M. Roberts Principal Nursing Officer Miss B. Thorn Deputy Principal Nursing Officer Miss S.G. Earl Principal Mental Health Social Worker A.J. Shriever Deputy Principal Mental Health Social Worker Miss C.A. Budd Principal Social Worker (Health Services) Miss M. le S. Kitchin Deputy Principal Social Worker (Health Services) Miss G. Croyden-Smith Chief Dental Officer B.M.S. Spalding Chief Public Health Inspector H. Plinston 8 Public Health Department, Blue Star House, 234/244 Stockwell Road, S.W.9. Tel: 01-274 7722 To the Mayor, Aldermen and Burgesses of the London Borough of Lambeth Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting the first report on the health of the new London Borough of Lambeth, which came into being on 1st April, 1965 as a result of the London Government Act 1963. The new Borough comprises the former metropolitan borough of Lambeth and an eastern portion of the former metropolitan borough of Wandsworth, with a combined population of 339,560 (mid-1965), the largest of any of the new London Boroughs. Despite the difficulties inevitably associated with a major reorganisation of this kind, I am pleased to be able to say that there has been no interruption or deterioration of services to the public, many of whom were unaware of the changes which were taking place. I am grateful to Dr. A.B. Stewart, Medical Officer of Health for the County of London, Dr. F. Summers, Medical Officer of Health for the metropolitan borough of Lambeth, and Dr. J. Tudor Lewis, Medical Officer of Health for the metropolitan borough of Wandsworth, for information in this report relating to the first three months of 1965. It was with pleasure that I learned that Dr. Summers had been appointed Associate Medical Officer of Health in the new London Borough of Lambeth, and I acknowledge the help and advice that he has so willingly given me Since Dr. A.B. Stewart's appointment as Medical Adviser to the Inner London Education Authority, it has been my pleasure as Principal School Medical Officer to work closely with him on matters concerning the school health service. It was the intention from the earliest days that the department should function as one unit, but unfortunately it has had,for the time being,to be divided geographically into two parts; matters mainly concerned with personal health services are dealt with at Blue Star House, and matters concerning environmental health at Offley Road, but frequent meetings of senior staff from the two addresses offset the difficulties to some extent. The responsibilities of the Health Department include the personal health services, formerly administered by the London County Council, the environmental health services, until 31st March, 1965 the concern of the metropolitan boroughs, and the school health service, for which the Council acts as agent of the Inner London Education Authority. 9 The inclusion of a part of the former metropolitan borough of Wandsworth in the new Lambeth resulted in a number of special difficulties in the reorganisation of those services which were previously related to the borough boundary. Not only were maternity and child welfare centres in the transferred part of Wandsworth of a generally poor standard, without satisfactory accommodation for health visitors, but they were badly sited in relation to the new boundary. Some considerable time must elapse before these disadvantages can be overcome, but plans are already being made to this end. The reorganisation of the mental health services presented particular difficulty in that the London County Council's mental health services were organised on a county wide basis, and the premises used for these services adult and junior training centres for the mentally sub-normal, day centres for the mentally ill, and hostels - were unevenly distributed. Lambeth inherited no junior training centre, day centre or hostel from the county and thus has had to rely on facilities provided by other boroughs. While this enabled existing essential needs to be met, damand for these services is growing and will continue to grow. If future demands are to be met, premises must be provided in Lambeth as soon as possible. The Emergency Service which was set up at the outset by the Town Clerk has greatly facilitated the operation of the 24-hour service which must be provided by mental health social workers, domiciliary midwives and 'on-call' medical officers. The service has made possible the joint provision of an out-of-office hours mental health and domiciliary midwifery service, by Lambeth and the adjacent boroughs of Southwark and Wandsworth. My aim over the remaining months of 1965 was to consolidate the services as they existed, to plan for their extension and for the introduction of new services. I am most appreciative of help given me by Committee 'D' prior to April, 1965, and I am particularly grateful to the Chairman and members of the Health Committee and to all members of the Council who have given me so much encouragement and support. It must not be fortgotten that the smooth transfer of services was in large measure due to the guidance of the Joint Working Party on the Personal Health Services and more particularly to the devoted service and loyalty of both the staff transferred from the L.C.C. Divisional Health Office 8, and those already in posts in the metropolitan borough, to whom I pay a special tribute and thanks. I am indebted to the Chief Officers of other departments for the help they have given me. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A.L. THROWER, Medical Officer of Health 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA On 1st April, 1965 the Metropolitan Borough of Lambeth ceased to exist and the new London Borough was formed. The London Borough consists of the former Metropolitan Borough of Lambeth and the following wards of the former Metropolitan Borough of Wandsworth, Larkhall, Clapham North, Clapham Park, Thornton (east of Cavendish Road), Streatham Hill, St. Leonard's (east of the Railway), Streatham Common and Streatham South. The population is the largest of the thirty-two London Boroughs and the Borough covers an area of 6,727 acres. It has common boundaries with Wandsworth, Goydon, Bromley, Southwark and the Cities of London and Westminister. The Borough has approximately 600 acres of parks and open spaces including Brock well, Kennington, Ruskin, Norwood, Archbishop's and Vauxhall Parks, Myatt's Fields, Streatham Common and parts of Clapham and Tooting Bec Commons. Among the world famous buildings within the boundaries are Lambeth Palace, the Oval Cricket Ground, the County Hall, the Royal Festival Hall, the Headquarters of the London Fire Brigade and the Transport Museum at Clapham. Lambeth is divided into five Parliamentary Constituencies, Vauxhall, Brixton, Norwood, Streatham and Gapham, each returning one Member of Parliament. For the purposes of the Borough Council elections the borough is divided into a total of twenty wards each returning three Councillors. Four members are returned to the Greater London Council. STATISTICS GENERAL Area of Borough 6,727 acres No. of Wards 20 No. of Parliamentary Constituencies 5 Population (Mid-year estimate 1965) 339,560 Density of Population i.e. number of Persons per acre 50.4 Number of marriages during year 2,993 Marriage Rate per 1,000 Population 8.8 Rateable Value of District (1st April, 1965) £19,569,636 Sum represented by Penny Rate (1965/1966) £77,600 Number of separately rated houses and flats at 1st April, 1965 91,178 11 VITAL STATISTICS Live Births Legitimate Illegitimate Totals Males 3,175 632 3,807 Females 3,042 590 3,632 Totals 6,217 1,222 7,439 Live Birth Rate per 1,000 Home Population .. 21.91 Birth Rate corrected for comparison with other areas 19.5 Comparability factor (supplied by Registrar-General) 0.89 Birth Rate per 1,000 Home Population England and Wales 18.1 Illegitimate Live Births per cent of total live births 16.4 STILL BIRTHS Legitimate Illegitimate Totals Males 42 15 57 Females 52 9 61 Totals 94 24 118 Still Birth Rate per 1,000 Total Births (i.e. live and still) 15.61 Still Birth Rate per 1,000 Home Population 0.31 Still Birth Rate per 1,000 Total Births England Wales 15.8 DEATHS Males Females Total 1,901 1,808 3,709 Death Rate per 1,000 Home Population 10.92 Death Rate corrected for comparison with other areas 11.36 Comparability factor (supplied by Registrar-General) 1.04 Death Rate per 1,000 Home Population England and Wales 11.5 12 MATERNAL MORTALITY Number of women dying in consequence of childbirth 4 Maternal Mortality Rate per 1,000 Total Births 0.51 INFANTILE MORTALITY Deaths of Infants under 1 year of age Legitimate Illegitimate Totals Males 77 19 96 Females 62 17 79 Totals 139 36 175 Death Rate of infants under 1 year of age per 1,000 live births 23.52 Death Rate of infants under 1 year of age per 1,000 live births, England and Wales 19.0 Legitimate Infantile Mortality Rate 22.5 Illegitimate Infantile Mortality Rate 29.4 Deaths of Infants under 4 weeks of age Legitimate Illegitimate Totals Males 58 14 72 Females 35 8 43 Totals 93 22 115 Neo-natal Mortality Rate (Deaths under four weeks per 1,000 live births) 15.4 Neo-natal Mortality Rate England and Wales 13.0 Deaths of Infants under 1 week of age Legitimate Illegitimate Totals Males 53 13 66 Females 30 6 36 Totals 83 19 102 Early Neo-natal Mortality Rate (Deaths under one week per 1,000 live births) 13.7 Perinatal Mortality Rate (Stillbirths and deaths under one week combined per 1,000 total live and still births) 29.1 Perinatal Mortality Rate England and Wales 26.9 13 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1956 - 1965 METROPOLITAN BOROUGH OF LAMBETH 1956 - 1964 Year Population Deaths * Death Rate Live Births * Live Birth Rate Deaths of Infants under 1 year of age Infantile Mortality Rate Maternal Deaths Maternal Mortality Rate 1956 223,900 2,389 11.10 3,915 15.74 83 21.20 1 .25 1957 224,300 2,359 10.83 4,205 16.82 98 23.90 NIL NIL 1958 223,600 2,529 11.65 4,444 17.12 111 24.98 1 .22 1959 223,300 2,483 11.38 4,685 19.09 116 24.76 1 .21 1960 224,080 2,388 10.86 4,802 19.55 101 21.0 2 .41 1961 221,960 2,585 11.65 4,847 19.87 109 22.41 3 .61 1962 223,370 2,479 11.10 5,329 21.94 102 19.15 5 .92 1963 223,120 2,732 13.71 5,580 22.01 141 25.27 3 .53 1964 223,140 2,417 12.13 5,604 22.10 120 21.41 3 .52 LONDON BOROUGH OF LAMBETH SUMMARY FOR YEAR 1965 1965 339,560 3,709 11.36 7,439 19.5 175 23.52 4 .51 * As adjusted by Comparability factor. 14 15 LONDON BOROUGH OF LAMBETH CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1965 CAUSE OF DEATH Sex Total All ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over 1. Tuberculosis, respiratory M 18 - - - - - - 1 3 4 7 3 F 2 - 1 - - - - - - 1 - - 2. Tuberculosis, other M - - - - - - - - - - - • F 2 - - - - - - 1 - 1 - - 3. Syphilitic disease M 5 - - - - - - - 1 - 4 - F 5 - - - - - - - - 1 - 4 5. Whooping cough M - - - - - - - - - - - - F 1 - 1 - - - - - - - - - 6. Meningococcal infections M 1 - - - - - 1 - - - - - F - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F 1 - - 1 - - - - - - — - 9. Other infective and parastitic diseases M 3 1 - - - - - - - 1 1 - F 3 - - - - - - - - - 1 2 10. Malignant neoplasm, stomach M 51 - - - - - - 2 6 15 15 13 F 33 - - - - - 1 - - 4 7 21 11. Malignant neoplasm, lung, bronchus M 193 - - - - - 1 4 27 62 66 33 F 54 - - - - - - 1 3 15 18 17 12. Malignant neoplasm, breast M - - - - - - - - - - - - F 65 - - - - - 1 7 18 15 10 14 13. Malignant neoplasm, uterus F 20 - - - - - - 2 4 7 2 5 14. Other maglignant and lymphatic neoplasms M 180 - - - 3 2 3 7 23 41 59 42 F 196 - - 2 - 3 2 4 21 36 61 67 15. Leukaemia, Aleukaemia M 6 - - - 1 - - 1 1 1 1 1 F 11 - - - - 1 1 - 2 2 1 4 16. Diabetes M 3 - - - - - - - - 1 1 1 F 18 - - - - - - - 1 4 8 5 17. Vascular lesions of nervous system M 150 - - - - - - 1 6 22 51 70 F 230 - - - 1 - 2 1 10 20 45 151 18. Coronary disease, angina M 449 - - - - - 2 15 49 121 139 123 F 304 - - - - - 1 3 13 34 83 170 19. Hypertension with heart disease M 11 - - - - - - - - 3 4 4 F 26 - - - - - - - - 4 7 15 20. Other heart disease M 120 - - - - - - 2 10 15 26 67 F 194 - - - - - 2 6 9 10 30 137 21. Other circulatory disease M 79 - - - - - 1 2 3 10 23 40 F 99 - - - - - 1 3 2 11 15 67 22. Influenza M 1 - - - - - - - - - 1 - F 2 - - - - - - - - - 1 1 23. Pneumonia M 117 7 6 - - 1 • 2 1 19 24 57 F. 149 2 11 4 - 1 - 1 1 8 20 101 24. Bronchitis M 151 - 2 - - - 1 1 10 32 55 50 F 59 - 2 - - - - 2 1 6 17 31 25. Other diseases of respiratory system M 21 - - - - - - - 2 7 5 7 F 12 - 1 - - - - - - 2 5 4 26. Ulcer of stomach and duodenum M 17 - - - - - - - 2 2 6 7 F 10 - - - - - - - 1 2 3 4 16 CAUSE OF DEATH Sex Total All ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over 27. Gastritis, enteritis and diarrhoea M 7 - 4 1 - . . - - - 2 - F 13 - 2 1 - - - - - - 4 6 28. Nephritis and nephrosis M 11 - 1 - - - - 2 - 3 2 3 F 8 - - - - 1 - 1 2 1 2 1 29. Hyperplasia of prostate M 18 - - - - - - - - - 3 15 30. Pregnancy, childbirth, abortion F 4 - - - - 1 1 1 1 - - - 31. Congenital malformations M 24 12 4 - 1 1 2 - 2 2 . . F 25 6 11 - 1 1 2 - - 2 1 1 32. Other defined and ill-defined diseases M 149 52 3 7 3 5 6 8 8 22 13 22 F 185 32 5 3 4 1 - 5 11 22 24 78 33. Motor vehicle accidents M 33 - - 1 2 6 5 2 3 5 3 6 F 15 - - - 1 4 1 1 1 2 2 3 34. All other accidents M 53 - 4 3 1 2 3 7 11 8 5 9 F 37 3 2 4 - - - • 1 4 7 16 35. Suicide M 27 - - - - 3 3 7 8 4 1 1 F 23 - - - - - 2 7 3 5 4 2 36. Homicide and operations of war M 3 - - - - 1 1 - - - 1 - F 2 - - 1 1 - - - - - - • TOTAL ALL CAUSES M 1,901 72 24 12 11 21 29 64 176 400 518 574 F 1,808 43 36 16 8 13 17 46 105 219 378 927 GRAND TOTAL 3,709 115 60 28 19 34 46 110 281 619 896 1,501 17 VITAL STATISTICS POPULATION The Registrar-General's estimate for the mid-year 1965 is 339,560. This is 116,620 more than that for the mid-year estimate of the year 1964 in respect of the old Metropolitan Borough of Lambeth. BIRTHS The corrected birth rate for the London Borough of Lambeth is 19.5 per 1,000 home population compared with 22.10 for the Metropolitan Borough of Lambeth for the year 1964. Of the 7,439 births, 1,222 were illegitimate, a percentage of 16.4. STILL BIRTHS The still birth rate of 15.61 per 1,000 total births compares favourably with that for England and Wales which is 15.8 per 1,000 total births. DEATHS The total number of deaths was 3,709, 1,901 males and 1,808 females. Heart and associated diseases accounted for the largest number of deaths, 1,282 people dying from these causes. Malignant neoplasms of all forms ranked second in the causes of death, 809 deaths occurring. Fifty people, 27 men and 23 women took their own lives during the year. Motor vehicle accidents accounted for 46 lives and 50 people died from other accidents. INFANTILE MORTALITY The number of infants who died in the first year of life was 175 giving an infantile mortality rate of 23.52 per 1,000 live births. One hundred and fifteen of the deaths occurred in children under the age of 4 weeks giving a neo-natal mortality rate of 15.4. 18 The causes of death fell into the under.mentioned categories. Cause of death Male Female Total Tuberculosis (Non-respiratory) - 1 1 Meningococcal infections - 1 1 Infective and parasitic diseases 1 - 1 Pneumonia 13 13 26 Bronchitis 2 2 4 Diseases of respiratory system - 1 1 Gastritis, enteritis and diarrhoea 4 2 6 Nephritis and nephrosis 1 - 1 Congenital malformations 16 17 33 Other defined and ill-defined diseases 55 37 92 Accidents 4 5 9 96 79 175 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS Two hundred and forty seven persons, 193 males and 54 females died from cancer of the lung and bronchus compared with 30 from respiratory tuberculosis. The deaths were distributed amongst the various age groups as follows:- Age Male Female Total 25-34 years 1 - 1 35-44 years 4 1 5 45-54 years 27 3 30 55-64 years 62 15 77 65-74 years 66 18 84 75 years and over 33 17 50 193 54 247 19 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The undermentioned diseases are notifiable within the Borough of Lambeth. Anthrax Cholera Diphtheria Dysentery Encephalitis, acute. Enteric fever Erysipelas Food poisoning Malaria Measles Membraneous croup Meningococcal infection Ophthalmia neonatorum Paratyphoid fever Plague Pneumonia, acute influenzal Pneumonia, acute primary Poliomyelitis, acute Puerperal pyrexia Relapsing fever Scabies Scarlet fever Smallpox Tuberculosis, all forms Typhoid fever Typhus fever Whooping cough 20 The following are the total numbers of corrected notifications, other than tuberculosis received in respect of the area covered by the London Borough of Lambeth for the period 1st January to 31st December, 1965. Included in the figures are those relating to the Clapham and Streatham areas transferred from the Metropolitan Borough of Wandsworth on 1st April, 1965. TOTAL NUMBER NOTIFIED Disease Number Scarlet fever 120 Whooping cough 92 Measles 3578 Dysentery 157 Meningococcal infection 2 Acute pneumonia 49 Acute encephalitis (Infective) 1 Typhoid fever 1 Erysipelas 14 Food poisoning 34 Puerperal pyrexia 84 Ophthalmia neonatorum 27 Scabies 40 Total 4199 21 NOTIFICATION OF INFECTIOUS DISEASE-AGE DISTRIBUTION Age Group Scarlet Fever Whooping Cough Measles Dysentery Meningococcal Infection Totals M. F. M. F. M. F. M. F. M. F. Under 1 year 1 - 3 8 81 84 6 6 - - 189 1 - year - 1 7 5 194 195 4 6 - - 412 2 - years 1 2 6 12 217 197 6 8 - - 449 3 - years 8 4 5 7 186 182 7 1 • - 400 4 - years 10 8 4 3 187 172 4 6 - - 394 5-9 years 28 27 12 10 416 388 12 8 1 - 902 10 - 14 years 4 6 1 2 27 16 1 1 - - 58 15 - 24 years 5 1 - 1 9 12 11 8 1 - 48 25 and over - - - 1 3 9 9 22 - - 44 Age unknown 2 1 - 2 5 7 - - - - 17 TOTAL 59 50 38 51 1325 1262 60 66 2 - 2913 Numbers for that part of Wandsworth transferred to Lambeth 11 3 991 31 - 1036 TOTAL 120 92 3578 157 2 3949 22 NOTIFICATION OF INFECTIOUS DISEASE - AGE DISTRIBUTION (Contd.) Age Group Acute Pneumonia Acute Encephalitis Typhoid Fever Erysipelas Food Poisoning Puerperal Pyrexia Ophthalmia Neonatorum Totals Infective Post Infectious M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 years 6 3 - - - - - - - 1 - 2 - - 13 14 39 5-14 years - 1 - - - - - - - - 3 6 - - - - 10 15-44 years 6 7 - 1 - - - - 1 - 9 8 - 80 - - 112 45-64 years 3 6 - - - - 1 - 3 7 2 2 - - - - 24 65 and over 3 2 - - - - - - - 2 • - - • - - 7 Age unknown - 1 - - - - - - - - 1 - - - - - 2 TOTAL 18 20 - 1 - • 1 - 4 10 15 18 - 80 13 14 194 Numbers for that part of Wandsworth transferred to Lambeth 11 - - - - 1 4 - 16 TOTAL 49 1 - 1 14 34 84 27 210 Scabies 40 250 GRAND TOTAL 250 3949 4199 23 NOTIFICATIONS OTHER THAN TUBERCULOSIS A true comparison cannot be made with the year 1964 in that the figures for 1965 refer to the area of the enlarged London Borough of Lambeth and not that of the old Metropolitan Borough. The number of notifications received during the year in respect of the London Borough was 4199. Of this number 3578 notifications were in respect of measles. It is to be expected therefore that the incidence of this disease may be less in 1966. No case of diphtheria or poliomeyelitis occurred during the year. Food Poisoning Thirty four notifications were received. In all instances the cause was unknown. The cases were sporadic and there were no general or family outbreaks. Typhoid Fever At the end of August notification was received from a hospital that a man aged 56 years, a resident of the Borough, had been diagnosed as suffering from typhoid fever. He had been admitted to hospital a few days earlier having been ill for a week. Ten days before the onset of his illness he had returned from a fortnight's holiday in Spain with his wife, daughter, son-in-law and grandchild. They had been a family party and not members of a larger group. All these contacts were investigated but the organism of typhoid was not isolated from any specimens obtained from them. SALMONELLA INFECTIONS NOT FOOD BORNE In addition to the notified cases the following Salmonella infections were brought to the notice of the Health Department. 24 CAUSATIVE GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC TOTAL TOTAL AGENT No. of No. of No. of No. of CASES No. of No. of separate cases separate cases notified or outbreaks and cases outbreaks notified outbreaks notified ascertained sporadic COLS. or ascertained or ascertained Cases COLS. 2 + 4 + 5 1 + 3 + 5 1 2 3 4 5 6 7 1. S. Typhimurium 5 5 5 2. Other 1 Salmonellae 1 4 5 6 9 3. TOTAL 1 4 10 11 14 Type Of Salmonellae Brandenberg 1 4 2 3 6 Heidelberg 1 1 1 Muenchen 1 1 1 Zanzibar 1 1 1 25 TUBERCULOSIS CORRECTED NUMBER OF NOTIFICATIONS RECEIVED DURING THE YEAR AGE RESPIRATORY MENINGES and C.N.S. OTHER TOTAL M. F. M. F. M. F. Under 1 year - - - - - . - 1-year - - - - - - - 2-4 years 1 2 - - 1 1 5 5-9 years - 2 - - - - 2 10-14 years 3 - - - - - 3 15-19 years - 5 - - - 1 6 20-24 years 3 5 - - 2 - 10 25-34 years 18 8 - - 9 4 39 35-44 years 9 7 - - - 4 20 45-54 years 14 4 - - - - 18 55-64 years 15 1 - - - - 16 65-74 years 10 2 - - - - 12 75 and over - 1 - - - - 1 Age unknown 6 4 - - - - 10 TOTAL 79 41 - - 12 10 142 In addition to the above mentioned cases the following new cases were brought to the notice of the Medical Officer of Health other than by formal notification. Males Females Total 3 3 27 PERSONAL HEALTH SERVICES With the passing of the National Health Service Act 1946, the personal health services which had been the responsibility of the Metropolitan Borough Councils, passed to the London County Council in July, 1948. As a result of the London Government Act 1963 they were transferred to the new London Boroughs on 1st April 1965. The arrangements which had been developed by the London County Council continued with little change and without interruption of the service to the public. Certain services, especially, the mental health services, had been developed on a County-wide basis and their distribution was not ideally suited to the individual needs of the Inner London Boroughs. Some inter-borough sharing of services, e.g. training centres, was therefore necessary. The Council intends to maintain and develop the services so that as far as possible the needs of Lambeth residents will ultimately be met within the Borough. ANTE-NATAL AND POST-NATAL CLINICS Clinics are held in maternity and welfare centres by the Council's medical officers and midwives and by general practitioner obstetricians, at which they can examine their patients and make arrangements for their confinements. At the end of the year sessions were held by seven general practitioner obstetricians at four of the Council's Clinics. (See page 40). MOTHERCRAFT AND RELAXATION CLASSES These classes are held by domicilliary midwives and health visitors in maternity and welfare centres for both hospital and domiciliary booked cases. Two hundred and twenty three women made 861 attendances during the year. (See page 41). DENTAL TREATMENT Dental treatment is provided for expectant and nursing mothers and children under the age of five years who are not eligible for the school dental service. The service is provided in conjunction with that for school children, combined use being made of the staff and premises. (See page 41). PHENYLKETONURIA Urine tests for the detection of phenylketonuria are carried out by health visitors on all babies before the age of 8 weeks. WELFARE FOODS National Welfare Foods (Dried Milk, Cod Liver Oil and Orange Juice) are issued at approved prices at all the Council's Maternity and Child Welfare Centres. 28 In addition certain proprietary baby foods are supplied at special prices on the recommendation of clinic doctors or health visitors to children who attend the centre. HEALTH VISITING Under Section 24 of the National Health Service Act 1946, it is the duty of every local health authority to make provision in their area for the visiting of persons in their homes by health visitors for the purpose of giving advice as to the care of young children, persons suffering from illness and expectant or nursing mothers, and as to the measures necessary to prevent the spread of infection. The health visitors maintain close liaison with social workers, general practitioners and the hospitals. In addition to their visits to mothers, babies and young children under 5 years in the home, they attend at ante-natal, post-natal and child welfare clinics, instruct at mothercraft and relaxation classes, and carry out a vigorous programme of health education in the home, the schools, and clinics. There is a growing demand for the services of health visitors and many vacancies continue to exist. Work with problem families, with handicapped children and on the social problems of a large immigrant population is heavy and increasing. (See page 42). HOME NURSING Section 25 of the National Health Service Act 1946 places duty on every local health authority to make provision for securing the attendance of nurses on persons who require nursing in their own homes. Home nursing in London was provided by a number of grant-aided voluntary bodies, some of which also provided domicilary midwifery services, as agents of the Council. The London County Council did not itself emply district nurses. The various district nursing associations in London made mutual arrangements before 1st April, 1965 to revise the areas which they served to correspond with the boundaries of the new London Boroughs. The Council arranged with the three associations which covered the area of the Borough to combine to form the Lambeth District Nursing Association, and for the Association to provide home nursing (and domiciliary midwifery) services as the Council's agents. (See page 42). 29 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Articles of nursing equipment are loaned free of charge to persons being nursed in their own houses. Smaller articles are loaned by the District Nursing Association, or through the medical loan depots of the Lambeth Division of the British Red Cross Society, to whom the Council makes a grant for this purpose. During the year the following articles of equipment were loaned through the Health Department. Articles Delivered Returned Armchair Commodes 195 83 Stool Commodes 132 45 Zimmer Walking Aids 3 1 Tripod Walking Aids 2 1 Indoor wheel chair 1 - Bed cradles 3 2 Back rest 1 - Rubber Ring (Cushion) 1 - Penryn Hoists 10 4 Easi-Carri Hoists 3 1 Hospital Beds with lifting pole 5 2 Hospital Beds 3 2 Dunlopillo Mattresses 4 3 Mattresses 6 2 Fracture Boards 10 1 Fifty seven fire guards were lent to necessitous families with children under 12 years of age or to necessitous old, handicapped or blind persons. INCONTINENCE PADS Supplies of incontinence pads have been issued to a small number of incontinent persons in their own homes, on the recommendation of the family doctor or district nurse. Recipients must be able to make satisfactory arrangements for the disposal of the used pads. DOMICILIARY MIDWIFERY SERVICE Local Health Authorities are required under Section 23 of the National Health Service Act 1946 to secure that the number of midwives available for attendance on women in their homes as midwives or as maternity nurses is adequate for the needs of the area. The same section also makes local health authorities the local supervising authorities for the purposes of the Midwives Act. 30 Prior to 1st April, 1965 the domiciliary midwifery service of the London County Council was based on both direct employment of midwives and on arrangements with district nursing associations and hospitals. These arrangements continued unchanged. An assistant nursing officer was appointed to act as nonmedical supervisor of midwives, her duties to include such other supervisory nursing duties which may be allocated to her. To ensure that an expectant mother should be able without delay to secure the services of a midwife, joint arrangements with the adjacent boroughs of Southwark and Wandsworth were made. Outside office hours and at other times in case of difficulty, requests from residents in the three boroughs for midwives were centralised through the Information Centre at Lambeth Town Hall, through which midwives could also get in touch with a non-medical supervisor for advice and guidance when necessary. The arrangements worked satisfactorily. (See page 43). MIDWIVES ACT 1951 The Council is the local supervising authority under the Midwives Act 1951, supervising functions under the Act being carried out by the Council's non-medical supervisor of midwives, The number of midwives who notified their intention to practise as midwives within the borough, including those in hospitals, and who were practising at the end of the year was 251. FAMILY PLANNING: MARRIAGE GUIDANCE The Council makes available to the Family Planning Association free of charge accommodation at certain Welfare Centres. Similar facilities are granted to the London Marriage Guidance Council for counselling sessions. Weekly family planning sessions are held under this arrangement and payment is made to the Family Planning Association for advice on family planning on medical grounds to mothers referred by the Council's medical officers, or by general practitioners through the Medical Officer of Health. DAY CARE OF CHILDREN Nurseries and Child-minders Regulation Act 1948 The Act requires that any person who intends to open a day nursery for the daily care of children under 5 years of age, or to receive, for reward, into her own home for daily care, more than two children aged under 5 to whom she is not closely related, shall, before doing so, apply to the local health authority for registration. Seven nurseries (200 places) and 11 persons (child-minders) were registered at the end of the year. 31 Voluntarily registered Child-minders Women who look after during the day one or two children aged under five years are encouraged to register voluntarily with the Council. Those who are registered receive a fee of six shillings a week while minding a child. In return the child-minder agrees to conform to the Council's requirements including regular attendance at the welfare centre with the child, and to accept supervision by the Council's officers who visit the premises regularly and offer advice and assistance as required. Minding charges are a matter for agreement between the parents and the minder. There were 67 minders looking after 85 children registered under these arrangements at the end of the year. DAY NURSERIES There are ten day nurseries, with places for 584 children under 5 years of age. Nurseries are open daily (Monday to Friday). Admission is normally restricted to children with medical or social needs, e.g. those with only one parent who must go to work, those where the home conditions are detrimental to health, or where the mother's health is poor, or where the father's health is poor or his earnings so low that the mother has to go to work to supplement the family income. There is a heavy demand for places and a waiting list for admission is kept. "HANDICAP" REGISTERS Much importance is attached to the development and maintenance of a complete register of all babies and young children who have congenital handicaps or who because of adverse factors occurring during the mother's pregnancy or labour, are "at risk" of developing such handicaps. Information provided by general practitioners, hospitals and midwives is supplemented by the observation of clinic doctors and health visitors. Every child whose name is on the handicap and observation register is brought forward for review by a senior medical officer at appropriate intervals so that the necessary remedial action may be taken. A special review to consider the need for special education is arranged at 2 years 9 months. OCCASIONAL CRECHES Occasional Creche sessions are provided at selected welfare centres for the minding of small groups of children from 2 to 5 years of age while their mothers visit hospital, attend to shopping or other domestic duties, or take part in the activities of the welfare centre where the Creche is held. The charge for the service is ls.9d. a session for each child, abatable in necessitous cases. No charge is made when the parent is a attending a centre activity or a hospital appointment. 32 PREVENTION OF BREAK-UP OF FAMILIES Co-ordination of Services Machinery developed by the London County Council and used in Health Division 8 for inter-departmental co-ordination of efforts to prevent child neglect and family break-up continued in use after 1st April, 1965. Lambeth Standing Committee for Co-ordination was set up in June, 1965, including the Chief Officers of the Health, Children's, Welfare and Housing Departments, the divisional officer and divisional school care organiser of the Inner London Education Authority and the senior manager of the three National Assistance Board Offices concerned. The Principal Social Worker (Health Services) continued as secretary. Representatives of voluntary agencies were invited to attend meetings as appropriate. In October, 1965 a meeting attended by 105 representatives of social agencies, both Statutory and Voluntary, was held to explain the co-ordinating machinery. Seventy six case conferences on individual families were held at the request of the following Housing Departments Health Department Children's Department Education Authority Welfare Department National Assistance Board Probation Service Family Service Unit 28 18 13 6 5 2 2 2 76 All case conferences requested by the Housing Departments concerned families in danger of eviction and therefore liable to become a charge to other services. Casework Much of the preventive work with socially inadequate families and those whose problems they could not solve unaided was done by health visitors. Some families with specially difficult or intractable problems who needed more concentrated and prolonged help than could be given by health visitors were referred through the co-ordinating machinery to two family case workers employed in the Health Department for this purpose The essence of their work is that it shall be both intensive and prolonged, and it follows that they can be concerned with only a small number of families at a time. 33 During the year the caseworkers have worked with 33 families with a total of 154 children. Work with 9 of these families was undertaken at the request of the Children's Department. VACCINATION AND IMMUNISATION Parents are encouraged to have their babies vaccinated against diphtheria, whooping cough, tetanus, poliomyelitis and smallpox. This may be done either at one of the Council's Welfare Centres or by the child's family doctor. Arrangements originated under the London County Council for the systematic following-up of each child in the Borough with the object of securing that all are fully protected against these diseases have been continued. Re-inforcing doses are given to older children under similar arrangements. Vaccination against poliomyelitis for all persons under 40 years of age is also available at the Council's clinics. The Council pays fees to family doctors for records of vaccination of their own patients. Doctors may obtain free of charge from the Council supplies of the antigens used in Welfare Centres, for such of their patients who would be entitled to vaccination by the Council. (See page 45). INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccination/inoculation are required by persons travelling to certain countries abroad. After completion by the vaccinating doctor (normally the person's own doctor) the certificate must be taken or sent for authentication of the doctor's signature by the medical officer of health for the area in which the doctor practises. In Lambeth signatures on certificates are authenticated in the Health Department, Blue Star House, 234/244, Stockwell Road, S.W.9. TUBERCULOSIS Extra Nourishment At the end of the year extra nourishment (milk, butter and eggs) had been supplied on the recommendation of the Chest Physicians to 78 tuberculous persons at home. Clothing was also provided to a small number of such patients. Knight's Hill Hostel Residential accommodation is provided at Knight's Hill Hostel for 32 homeless men who are infective but not confined to bed. This hostel is one of three serving the Inner London Boroughs. Most of the residents at Knight's Hill Hostel are chargeable to other boroughs. 34 Skin Testing and B.C.G. Vaccination B.C.G. vaccination is available for susceptible (tuberculin negative) contacts, 13 year old school children and students at colleges of further education. Skin testing and vaccination of contacts is carried out at Chest Clinics. School children and students are tested and vaccinated at school or college by the Council's medical staff. The number dealt with during the year was as follows : A. CONTACTS (i) No skin tested 828 (ii) No. found positive 477 (iii) No. found negative 351 (iv) No. vaccinated 316 B. SCHOOL CHILDREN AND STUDENTS (i) No. skin tested 484 (ii) No. found positive 41 (iii) No. found negative 404 (iv) No. vaccinated 433 RECUPERATIVE HOLIDAYS Recuperative holidays are provided on medical recommendation under the National Health Service Act 1946 for mothers and young children (Section 22) and adults (Section 28). Similar holidays are arranged for school children as part of the School Health Service. Such holidays assist in the recuperation of persons who have been suffering from illness but no longer need regular medical and nursing care,by providing rest, fresh air and good food. From 1st April to 31st December, 1965 the following admissions were made to recuperative holiday homes. Expectant and nursing mothers 5 Other adults 90 Children under 5 years (not at school) 9 School children 81 Psychiatric Patients 6 Total 191 35 CHIROPODY Chiropody service is at present provided in part directly by the Council and in part by Lambeth Old People's Welfare Association to which the Council makes a grant for the purpose. Foot clinics, staffed by sessional chiropodists working a total of 41 sessions a week at the end of the year, were provided at six of the Council's Welfare Centres. An average of 230-240 treatments a week were given. Priority is given to elderly or physically handicapped persons and expectant mothers. MENTAL HEALTH SERVICES Mental Health Social Workers In order to cover the wide range of duties in the department, an overall ratio of mental health social workers to population of 1:20,000 has been established. Each social worker appointed is expected to be responsible for his or her own personal case-load of patients under community care and to carry out statutory duties as a mental welfare officer under the Mental Health Act 1959, as and when required. The care of patients in the community by the mental health social workers has been greatly facilitated by the excellent working relationships which have been built up between the social workers and the psychiatric hospitals, out-patient clinics and other establishments, and the statutory and voluntary agencies dealing with their patients. Consultation with the responsible medical officers of the hospitals, and attendance at case conferences and discussions, have proved particularly helpful in this respect. A considerable amount of action and advice is required out of office hours and this was previously covered by a rota of officers working centrally on a countywide basis from County Hall. Since April, 1965, the Boroughs of Lambeth, Southwark and Wandsworth have operated a joint emergency service in which each individual Borough is responsible for the entire out of office hours period for one week in every three, Responsibility for the "duty week" is shared by social workers of the individual Borough being on call on a rota basis, thus interfering as little as possible with the normal work of the department. Training Centres for the Mentally Subnormal The provision of day care, training and rehabilitation for the mentally subnormal was planned on a county-wide basis by the L.C.C., and the available facilities have been continued for the time being on similar terms. The new London Borough boundaries left Lambeth with one mental health establishment only, viz. Clapham Adult Training Centre. 36 This all male centre carries out a wide range of industrial work as part of the overall training programme, and caters for mentally subnormal men and boys over the age of 16 years from this and three adjoining Boroughs. The women and girls in this category have continued their attendance at centres in neighbouring Boroughs, but it is planned to provide facilities for both sexes in a mixed centre in Lambeth as soon as possible. Under a similar agreement, mentally subnormal children attend centres in three neighbouring Boroughs pending the provision of a junior training centre which is planned for Lambeth. Special care unit facilities for children with multiple handicaps will also be provided in the same premises. Other Services for the Mentally Subnormal A home teacher visits a small number of children in their own homes who are unable to attend an ordinary training centre, and she is continuing this work with similar children in other Boroughs who were previously her responsibility under the County Authority. In order to meet the needs of children under the age of 5 years for whom there are insufficient places in existing training centres, a number of mentally subnormal children have been accommodated in ordinary day nurseries. At the same time adaptations have been progressing in one nursery which will provide a special nursery unit for a number of such children, who will later progress to a junior training centre. Special advisory clinics are available for the under 5 age group, where a specially qualified medical officer is available for advice and consultation in connection with the care and training of the mentally handicapped child. Day Centres tor the Me nt ally III Day centres for the mentally ill are available in a neighbouring Borough. A number of Lambeth residents attend these and, in addition, others attend similar centres administered by the Institute of Social Psychiatry. Residential Care In the absence of residential accommodation administered by the Borough, financial responsibility is accepted on behalf of Lambeth patients placed in homes and hostels provided by other local authorities and voluntary bodies, and those boarded out in private households. Placements are made for short-term care to afford temporary relief to the family, for the rehabilitation of those discharged from psychiatric hospitals, or for the long-term care of those needing a supportive residential environment but who are not in need of medical or nursing care. 37 Day Hospitals for Mentally III Persons There is no day hospital within the Borough, but a number of Lambeth patients attend Maudsley, Tooting Bec, West Park and St. George's Day Hospitals. Social workers at the day hospitals are supplied by the boroughs in which they are situated. Home visiting of Lambeth patients is carried out by the Borough's mental health social workers. There is close liaison between Lambeth mental health social workers and hospitals (both day and other) where Lambeth patients are being treated. 38 39 40 HOME HELP SERVICE Prior to 1st April, 1965 the home help service in the Metropolitan Borough of Lambeth was based on two areas. The addition of that part of the Metropolitan Borough of Wandsworth which was included in the London Borough of Lambeth necessitated a re-organisation of the home help service. The service is at present organised in three areas, each staffed by a home help organiser, assistant home help organisers and clerical staff based on offices in Offley Road (Lambeth North), Loughborough Welfare Centre (Lambeth Central) and Riggindale Welfare Centre (Lambeth South). Demands tor the service continue to grow and may be expected to do so, due largely to the increasing number of old people in the community who represent over 80% of those receiving help. Home help is provided without charge for families where the mother is suffering from toxaemia of pregnancy. (See page 43). CO-OPERATION WITH GENERAL PRACTITIONERS Every effort is made to maintain and develop the good relationship which exists between the personal health services and general practitioners. General practitioners are employed for sessional work in Welfare Centres and free use of ante-natal clinics is granted to general practitioner obstetricians who wish to see their own booked patients. One general practitioner who provides a child welfare clinic in his own surgery has requested and been given the services of a health visitor for the session. Any further similar requests would be considered sympathetically within the limits of the available staff. CO-OPERATION WITH HOSPITALS - MATERNITY BEDS The Medical Officer of Health, Principal Nursing Officer and Non-medical Supervisor of Midwives are all members of the two Maternity Liaison Committees which cover the area. ANTE-NATAL AND POST NATAL CLINICS Number of Sessions held by: Medical Officers Midwives Sessional General Practitioners 65 76 174 Number of women attending for ante-natal examination Number of women attending for post-natal examination 1,926 186 41 Mothercraft and Relaxation Classes Number of women attending (a) Hospital booked 179 (b) Domiciliary booked 44 Total number of attendances 861 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN Expectant and Nursing Mothers Number of persons examined during 1965 15 Number of persons who commenced treatment during period 16 Number of courses of treatment completed during the period 5 Treatment provided Scalings and gum treatment 3 Fillings 48 Silver nitrate treatment Crowns and inlays Extractions 14 General anaesthetics 7 Dentures provided Full upper or lower 1 Partial upper or lower 3 Children under 5 years and not eligible for School dental service Number of persons examined during period 186 Number who commenced treatment during period 60 Number of courses of treatment completed during period 42 Treatment provided Scalings and gum treatment 6 Fillings 96 Silver nitrate treatment 37 Crowns and inlays Extractions 11 General anaesthetics 6 Dentures provided 42 Number of premises in use for the provision of the services at the end of the year 3 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period 44.3 HEALTH VISITING Cases visited by Health Visitors:- Children born in 1965 7,919 Children born in 1964 8,850 Children born in 1960/63 15,7% 32,565 Persons aged 65 and over 289* Mentally disordered persons 72ø Persons, excluding Maternity cases discharged from hospital (other than mental hospitals) 49† Number of tuberculous households visited 34 Number of households visited on account of other infectious diseases 30 Total number of effective visits and re-visits 77,055 Total number of unsuccessful visits 17,139 * Included in this figure are 68 persons who were visited at the special request of the general practitioner or hospital. ø Included in this figure are 14 persons who were visited at the special request of the general practitioner or hospital. † Included in this figure are 38 persons who were visited at the special request of the general practitioner or hospital. HOME NURSING Total number of persons nursed during the year 4,572 Number aged under 5 at first visit in 1965 406 Number aged 65 and over at first visit in 1965 2,597 Total number of visits during the year 149,843 43 HOME HELP SERVICE Persons for whom service was provided during the year: Aged 65 or over 3,851 Chronic sick and tuberculous persons 403 Mentally disordered 16 Maternity cases 197 Others 351 Total 4,818 DOMICILIARY MIDWIFERY Attendances by Midwives Confinements Doctor not booked 9 Doctor booked 1,028 Number of hospital cases discharged to 490 midwife before tenth day CHILD WELFARE CENTRES Number of Children attending Born 1965 5,676 Born 1964 5,121 Born 1960/63 5,157 Number of sessions held during the year by Medical Officers 539 Health Visitors 222 Sessional General Practitioners 2,045 Hospital Medical Staff 100 Total sessions 2,906 Number of children referred elsewhere 453 Number of children on "at risk" register at the end of the year 1,878 44 REGISTRATION OF NURSING HOMES UNDER SECTIONS 187 TO 194 OF PUBLIC HEALTH ACT 1936 AS AMENDED BY THE NURSING HOMES ACT 1963 Number of Homes Number of beds provided Maternity Other Total (1) (2) (3) (4) 1. Homes registered during year - - - - 2. Homes whose registrations were withdrawn during year - - - - 3. Homes on the register at end of the year 10 99* 140 239* * Includes 20 beds at home temporarily closed at 31.12.65. 45 IMMUNISATION AND VACCINATION 1965 Immunisation: Completed Primary Courses - Number of Persons under age 16 Type of Vaccine or dose Year of Birth Others under age 16 Total 1965 1964 1963 1962 1958-61 1. Quadruple DTPP 5 19 5 3 1 2 35 2. Triple DTP 2,718 2,528 243 114 113 39 5,755 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 3 15 11 16 85 99 229 5. Diphtheria - - 1 - - 16 17 6. Pertussis - 1 - - - - 1 7. Tetanus - - - 2 6 58 66 8. Poliomyelitis - Salk - 11 10 2 5 10 38 9. Poliomyelitis - Sabin 877 3,520 659 315 620 728 6,719 10. Total - Diphtheria 2,726 2,562 260 133 199 156 6,036 11. Total - Whooping Cough 2,723 2,548 248 117 114 41 5,791 12. Total - Tetanus 2,726 2,562 259 135 205 198 6,085 13. Total - Poliomyelitis 882 3,550 674 320 626 740 6,792 46 IMMUNISATION:- REINFORCING DOSES - NUMBER OF PERSONS UNDER AGE 16 Type of Vaccine or dose Year of Birth Others under age 16 Total 1965 1964 1963 1962 1958-61 1. Quadruple DTPP - 8 19 4 21 4 56 2. Triple DTP - 1.880 1,581 165 643 109 4,378 3. Diphtheria/Pertussis - - 1 - 1 - 2 4. Diphtheria/Tetanus - 47 72 17 1,430 567 2,133 5. Diphtheria - 3 2 2 110 290 407 6. Pertussis - - - - - - - 7. Tetanus - - - - 1 13 14 8. Poliomyelitis - Salk - 2 5 2 15 5 29 9. Poliomyelitis - Sabin - 10 18 11 1,677 863 2,579 10. Total - Diphtheria - 1,938 1,675 188 2,205 970 6,976 11. Total - Whooping Cough - 1,888 1,601 169 665 113 4,436 12. Total - Tetanus - 1,935 1,672 186 2,095 693 6,581 13. Total - Poliomyelitis - 20 42 17 1,713 872 2,664 47 SMALLPOX VACCINATION Number of Persons Vaccinated Age 0-2 months 3-5 months 6-8 months 9-11 months 1 year 2-4 years 5-14 years 15 years and over Total Primary 12 35 41 57 2,146 681 67 27 3,066 Re-vaccination - - - - - 4 38 29 71 48 49 MENTAL HEALTH Patients under Care at 31st December, 1965 Mentally 111 Subnormal Severely Subnormal Total Subnormal and Severely Subnormal Grand Total of Cols 1-12 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 1 F 2 M 3 F 4 M 5 F 6 M 7 F 8 M 9 F 10 M 11 F 12 (a) Attending day training (i) Centre 15 6 4 2 3 4 39 37 46 36 82 89 192 (ii) Awaiting entry thereto 5 1 - 1 9 13 - 2 28 3 31 (b) (i) Resident in residential training care 1 1 1 1 2 (ii) Awaiting residence therein (c) (i) Receiving home training 3 1 1 3 2 1 1 6 2 12 (ii) Awaiting home training (d) (i) Resident in L.A. home/hostel 2 1 3 (ii) Awaiting residence in L.A. home/hostel (iii) Resident at L.A. expense in other residentiel homes/hostels 4 9 1 2 1 3 4 4 7 24 (iv) Resident at L.A. expense by boarding out in private households 4 1 1 6 6 (e) Receiving home visits and not included under (a) to (d):- (i) Suitable to attend a training 15 18 33 33 (ii) Others 1 61 99 22 12 74 51 18 13 30 26 65 181 407 (f) TOTAL NUMBER 1 85 116 32 16 84 58 69 69 93 87 186 322 710 50 51 (1) Number of patients awaiting entry to hospital at 31.12.65 (2) Number of patients admitted for temporary residential care during 1965 Subnormal Severely Subnormal Total Subnormal and Severely Subnormal Grand Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Total M F M F M F M F 1. Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.65 (a) In urgent need of hospital care 1 5 5 11 11 (b) Not in urgent need of hospital care 2 3 1 5 1 6 (c) Total 1 7 8 1 16 1 17 2. Number of admissions for temporary residential care (e.g. to relieve the family) (a) To N.H.S. hospitals 7 13 7 4 20 11 31 (b) To L.A. residential accommodation (c) Elsewhere 1 2 4 4 2 2 9 6 15 (d) Total 1 2 11 17 9 6 29 17 46 52 Number of patients referred to local health authority during the year Referred by Mentally 111 Subnormal Severely Subnormal Total Subnormal and severely subnormal Grand Total of Cols. 1-12 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 1 F 2 M 3 F 4 M 5 F 6 M 7 F 8 M 9 F 10 M 11 F 12 General practitioners 1 95 142 1 1 1 3 241 Hospitals, on discharge from in-patient treatment 71 77 1 5 1 1 3 2 9 159 Hospitals, after or during out-patient or day treatment 18 14 2 1 1 3 6 1 39 Local Education Authorities 5 1 13 9 11 5 7 8 4 37 20 63 Police and Courts 134 39 2 1 3 176 Other sources 1 1 195 218 26 17 7 13 10 8 1 8 61 29 505 TOTAL 7 1 514 490 42 26 25 20 19 19 8 12 106 65 1,183 53 Guardianship There were no admissions to guardianship during the year. The total number under guardianship at the end of the year is as follows:- Guardian Subnormal aged 16 and over Severely Subnormal aged 16 and over Grand Total M F M F L.H.A. 2 - - 1 3 Other - - - - - Total 2 - - 1 3 54 ENVIRONMENTAL HEALTH SERVICES Care of the Aged This work continued to expand. From 1st April, 1965 the area covered included that part of the Metropolitan Borough of Wandsworth amalgamated with the old Metropolitan Borough of Lambeth to form the new London Borough. The number of old peoples visitors was increased from two to three. During the year 966 new cases were brought to the notice of the health department. The age groups into which these new cases were divided were as follows Male Female Total 60-69 years 70 152 222 70-74 years 59 105 164 75-79 years 64 147 211 80-89 years 87 231 318 90-94 years 13 29 42 95 years and over 4 5 9 297 669 966 The total number of visits made during the year was 7,928. The number of old people persuaded to enter hospitals and institutions voluntarily was 325. It was necessary to take action under Section 47 of the National Assistance Act 1948 in one case. A total of 968 persons received help in some form or another. The number of cases on the register, including those from previous years is 3,795. Laundry Service for Aged Incontinent The arrangements made with Southwark Borough Council for carrying out this servioe continued during the year. Number of persons receiving service 240 Total number of visits 4,574 Number of soiled articles collected 52,814 Total weight of laundry cleansed 45,282 lbs. Home Bathing Service An increasing number of aged persons are benfiting from this scheme. During the year 2,816 baths were given. 55 Holidays (or the Aged During May and September 1965, five hundred and fifty five old people were taken by coach to Margate for a week's holiday under the Council's holiday scheme. His Worship the Mayor, the Mayoress and the Chairman of the Health Committee saw all the parties off and visited some of the groups during their stay at Margate. Two re-union parties were held in December. At the invitation of His Worship the Mayor a group of Landladies from Margate with whom the old people stayed attended the second re-union. Administration of die scheme since its inception in 1956 by the Metropolitan Borough of Lambeth has been carried out by the Public Health Department. In future, under the London Borough of Lambeth, this function will be carried on by the Welfare Department LAMBETH OLD PEOPLE'S HOLIDAYS, 1965 SPRING Female Male Totals 60/69 70/75 76 & over 65/69 70/75 76 & over VAUXHALL 9 19 21 3 9 6 67 BRIXTON 15 20 19 4 8 5 71 NORWOOD 16 36 41 8 12 6 119 OLD WANDSWORTH 5 7 12 4 4 11 43 45 82 93 19 33 28 300 Included in the total are 37 married couples. 56 AUTUMN Female Male Totals 60/69 70/75 76 & over 65/69 70/75 76 & over VAUXHALL 6 9 23 Nil 2 4 44 BRIXTON 15 20 16 3 4 5 63 NORWOOD 15 14 13 8 6 8 64 OLD WANDSWORTH 15 20 27 6 8 8 84 51 63 79 17 20 25 255 Included in the total are 28 mairied couples. Water Supply I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board for the following report on the water supplied to the Borough. The supply to the Borough of Lambeth has been satisfactory both for quality and quantity during the year 1965. The main source of supply is River Thames derived water with a small admixture occasionally of water from Honor Oak Well. The population supplied by the Board in the Borough of Lambeth is 339,536, the supply being direct to the houses in every case, none being supplied by means of a standpipe. No new sources of supply were instituted in the area during 1965, nor was there any change in the general scheme of supply, but trunk mains were extended 742 yards. The total distance of new service mains laid in the Borough of Lambeth by the Board during 1965 was 1,191 yards. The number of samples taken during the year was a follows Chemical Examination Bacteriological Examination Thames Derived 156 1,842 Honor Oak Well 1 230 157 2,072 57 The average results are contained in the following tables. Bacteriological Results - Yearly Averages 1965 Source of supply BEFORE TREATMENT dumber of samples Agar plate count per ml. Coliform count Escherichia coli count 20-24 hours at 37 C. 3 days At 22 C. Per cent, samples negative in 100ml. Count per 100ml. Per cent, samples negative in 100ml. Count per 100ml. * Thames-derived South of River Honor Oak 112 0.1 5 99.11 0.3 100.0 - * Hampton, Surbiton and Walton. Source of supply AFTER TREATMENT 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. Per cent. samples negative in 100 ml. * Thames-derived South of River 1,842 7.3 99.89 100.0 Honor Oak 118 0.2 2 100.0 100.0 * Hampton, Surbiton and Walton. 58 Average Results of Chemical Examination Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs. at 27°C B.O.D. 5 days at 20°C Thames-derived South of River* 156 0.035 0.092 4.5 1.20 - Honor Oak 1 0.060 0.018 0.4 0.22 - Description of the Sample Hardness (total) CaC03 Hardness (non carbonate) CaCO^ Magnesium as Mg Chloride as Cl Phosphate as PO4 Silicate as Si02 Thames-derived South of River* 254 66 4 41 2.0 10 Honor Oak 304 39 - 15 - - Description of the Sample Sulphate as SO4 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) pH value Thames-derived South of River* 64 0.20 0.09 0.1 14 7.5 Honor Oak - 0.45 - 2.1 11 7.1 Description of the Sample Electrical Conductivity (micro mhos) Thames-derived South of River* 550 Honor Oak 500 • HAMPTON, SURBITON AND WALTON Water from Wells There are a number of wells in use, the majority of which, however, supply water used only for industrial purposes. The water from two wells is used for drinking purposes, or for the preparation of food. Reports of the analyses of water from these wells are received regularly and have been satisfactory for the year under review. 59 Sewers I am indebted to the Borough Engineer for supplying me with the following information with regard to sewers within the Borough. A sum of £31,000 was provided in the Council's annual programme for the reconstruction of old and defective sewers and for the provision of manholes in Windmill Walk, Darlington Road and Meadow Place. The benefits derived from such schemes include a reduction in rat infestation and possibly flooding although the latter is largely dependent on the capacity of the trunk sewers. The local sewers are under the control of the Borough Council, whilst the trunk sewers, into which the local sewers eventually discharge, are the responsibility of the Greater London Council. The Council's programme of sewer reconstruction is additional to that of repair and maintenance of sewers and of gully maintenance and replacement. During the current year a £5,000 contract has been entered into for the cleansing of sewers. SUMMARY OF VISITS AND INSPECTIONS BY PUBLIC HEALTH INSPECTORS Dwellinghouses Visits Re-visits In respect of nuisances 2,242 4,397 In respect of Certificates under Rent Act 1957 19 6 In respect of re-housing 81 - In respect of Infectious Diseases 332 137 Other reasons 1,879 868 Clean Air Act 1956 Timed observations 101 _ Untimed observations 456 - Other visits, pri vate and industrial premises 16,834 4 Factories Acts Factories with mechanical power 502 19 Factories without mechanical power 182 11 Outworkers 222 - 60 Housing Act 1961 In respect of surveys and complaints 1,410 1,730 In respect of London County Council Mortgage loans 326 74 Drainage New Buildings 155 1,161 Alterations to existing drainage etc. 1,746 2,854 Other Inspections Bakehouses 33 - Butchers Shops 519 - Restaurants 330 10 Fried Fish Shops 25 - Ice Cream Premises 49 - Milkshops 252 6 Public Houses 22 - Greengrocers 32 - Fishmongers 13 - Market Stalls 149 - Grocers 179 - Confectioners 94 - Other Food Premises 734 28 Animals improperly kept 8 4 Personal uncleanliness 5 - Exhumations 2 - Hairdressers and Barbers 34 3 Pet Animals Act 1951 18 - Rodent Control 1,940 2,824 Unclassified 83 23 Caravans 2 - 31,010 13,159 COMPLAINTS The number of complaints received, including rat and mouse infestations was 5,536 DRAIN TESTING Number of drains tested by District Inspectors 2,344 Number of drains tested by Rodent Officer 76 2,420 61 DANGEROUS STRUCTURES Dangerous Structures notified to Greater London Council 20 SUMMARY OF DEFECTS AND NUISANCES FOUND AS A RESULT OF ROUTINE INSPECTION AND INSPECTION FOLLOWING COMPLAINTS Dirty Premises 19 Verminous Premises 26 Defective Roofs 443 Defective rainwater pipes and gutters 270 Damp Premises 595 Defective Drainage and Sanitary Fittings 1,282 Choked Drainage 408 Lighting and Ventilation 58 Defective Water Supplies 134 Dustbins etc. 116 General Defects and dilapidations 750 NOTICES SERVED Number of Intimation Notices served 1,235 Number served under Public Health (London) Act 1936 Section 40 48 Section 82 44 Section 93 17 Section 108/9 29 Number served under Public Health Act 1936 Section 39 183 Section 44 2 Section 45 101 Section 79 23 Section 93 310 Section 83 2 Section 84 2 Section 138 1 Number served under Public Health Act 1961 Section 17 123 Section 18 2 62 LEGAL PROCEEDINGS In respect of 68 summonses returnable to the Lambeth Magistrates Court and Petty Sessional Court, 16 Abatement Orders were made, 29 cases were adjourned sine die and 23 were withdrawn, the nuisances being abated by the respective owners by the date of the hearing. DWELLING HOUSES RENDERED FIT Number of dwelling houses rendered fit in consequence of informal action 890 Number of dwelling houses in which defects were remedied after service of formal notice (a) by Landlords 736 (b) by Council in default of landlords (i) Under Public Health (London) Act 1936 11 (ii) Under Sections 27, 25(1) and 25(2) of London County Council (General Powers) Act 1955 20 (iii) Under Public Health Act 1936, Sections 39, 45 and 93 10 (iv) Under Public Health Act 1961, Section 17 6 47 Outstanding cases from previous year are included. SECTION 95 PUBLIC HEALTH (LONDON) ACT 1936 During 1965 certificates of habitation were issued in respect of 258 new dwellings in regard to the provision of a proper and sufficient water supply. DRAINAGE PLANS All plans are registered with the Borough Engineer but the Public Health Inspectors are responsible for seeing that the work is carried out in accordance with the drainage bye-laws. Thirty plans of new buildings and 25 plans of alterations to existing drains were deposited. 63 DISINFECTION The following is a summary of the work carried out by the staff of the Wanless Road Disinfecting Station. Number of premises sprayed in which cases of infectious disease occurred 151 Number of rooms included in above 207 Total number of rooms sprayed for all purposes 1,643 Number of articles disinfected 8,963 Number of library books disinfected 1,084 Number of disinfection certificates issued 49 DISINFESTATION Bed Bugs Number of houses visited 215 Number of rooms sprayed 530 Number of houses revisited 28 There were many complaints during the year of insect infestation. The usual offenders were wood boring beetles, ants, cockroaches, drugstore beetles, carpet beetles, dothes moths, wasps and silverfish. The total number of visits made by the staff of the Disinfecting Station for all purposes was 1,877. PREVENTION OF DAMAGE BY PESTS ACT 1949 Rat destruction in dwelling houses and business premises is carried out under the direction of the Rodent Officer. Sewer treatment is carried out by the department of the Borough Engineer in conjunction with the Rodent Officer and his staff. In the case of dwelling houses treatment is undertaken by the Local Authority free of charge, but in the case of business premises a charge is made. During the year 1,906 complaints were received and investigated, 3,695 baitings being carried out. 64 FACTORIES ACT 1961 PART 1 OF THE ACT 1. Inspections for purposes of provisions as to health (including inspections made by the Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 190 193 - (ii) Factories not included in (i) which Section 7 is enforced by the Local Authority 1,055 521 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 59 67 - TOTAL 1,304 781 - 65 2. Cases in which Defects were found - Particulars Number of cases in which defects were found 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 - - - - Ineffective drainage of floors (S.6) - - - - Sanitary Conveniences (S.7) - (a) Insufficient - - - - (b) Unsuitable or defective 5 5 - 5 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to Outwork) - - - - TOTAL 5 5 - 5 NO PROSECUTIONS WERE INSTITUTED 66 PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Nature of Work No. of out-workers in August list required by Section 110(1) (c)(3) Wearing Apparel Making, etc. 176 Cleaning and washing Furniture 1 Handbags 18 Paper Bags 1 Table and bed linen 11 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 3 Stuffed toys 7 Cosaques, Christmas crackers, Christmas stockings, etc. 4 Lampshades 55 TOTAL 276 NO NOTICES WERE SERVED OR PROSECUTIONS INSTITUTED RENT ACT 1957 (a) Applications for Certificates of Disrepair 14 Applications outstanding from 1964 - 14 Decisions not to issue Certificates - Decisions to issue Certificates (a) In respect of some but not all defects 8 (b) In respect of all defects 6 Applications awaiting action at end of year - 14 67 (b) Number of cases where decisions were made to issue Certificates but were waiting action by landlords at end of 1964 - Undertakings given by landlords under paragraph 5 of the First Schedule of the Act 9 Certificates of disrepair issued 4 Work done by owner before Certificate was issued 1 14 (c) Applications for Certificates as to the remedying of defects specified in a landlord's undertaking (a) by landlords 5 (b) by tenants - (c) Applications outstanding from 1964 - 5 Certificates issued (a) Defects remedied 4 (b) Defects not remedied 1 5 (d) Applications by landlords for cancellation of Certificate of disrepair 5 Applications outstanding from 1964 - 5 Certificates cancelled 4 Cancellation refused 1 5 In connection with the applications from landlords for cancellation of Certificates of Disrepair objection to cancellation was lodged in one case. APPLICATIONS FOR REHOUSING The following is a report on the work of the Health Department for the twelve months ending 31st December, 1965. 1,454 cases have been dealt with on the following grounds:- 68 London County Council and Greater London Council Cases Health 62 Insanitary Conditions 1 During the period 18 cases, previously investigated have been checked as being rehoused by the Greater London Council. Lambeth Borough Council Cases Health 1,199 Insanitary Conditions 99 Overcrowding 9 During the period 62 cases, previously investigated have been checked as being rehoused by the Lambeth Borough Council. Enquiries from other sources 4 HOUSING The present year has been marked by the formation of the New London Borough with a population of 339,560. Upon re-organisation no inspectoral staff was transferred from Wandsworth and the inspectorate of the Metropolitan Borough of Lambeth had been depleted by resignations and retirements so that existing staff was fully employed in meeting day to day commitments for the greater part of the year. However as additional inspectors were appointed it was possible towards the end of the year to take the first steps in dealing with the many acute problems facing the Council. During the year the areas remaining to be dealt with under the Slum Clearance Programme 1961/1965 were represented. A further programme for 1966/1970 has been formulated and it is anticipated that with the engagement of more inspectors in the coming year a supplementary programme will be prepared. Under the Housing Acts 1961/1964 a great deal of attention has been paid to houses-in-multiple occupation where applications for mcrtgage loans have been made to the Borough Council and other Authorities. This has been fruitful work in that many improvements in facilities and services in these houses have been effected and potential overcrowding has been prevented. 69 The first application for the improvement of a dwelling outside an Improvement Area was received from a tenant of a house which was amenable to this procedure and a Preliminary Notice under Section 19 of the Housing Act 1964 was issued. This could well be the first of several such applications in the future. The department dealt with applications for both Standard and Discretionary Grants and it is pleasing to record that owners are becoming increasingly aware of the help they can receive financially and technically in converting properties and the provision of the basic standard amenities. HOUSING ACT 1957 Action taken under Part II of the Housing Act. 19 Alexandra Drive Represented 2 Beadman Street Represented 15 Bloom Grove Represented 128 Christchurch Road Represented 317 Clapham Road Closing Order Made 88 Geneva Road Represented 95 Geneva Road Represented 189 Mayall Road Closing Order Made 121 Lothian Road Represented 27 Lansdowne Gardens Represented 2 Shakespeare Road Closing Order determined 19 Somerleyton Road Represented 246 Milkwood Road Represented Slum Clearance programme 1961-1965 Beadman Street Area 3, 4, 5 and 6 Beadman Street (4 houses) Represented 20th January, 1965 Declared 17th February, 1965 Compulsory Purchase Order Made. Padfield Road Area 2, 4, 6, 8, 10, 12, 14, 16 and 18 Padfield Road (9 houses) Represented 17th May, 1965 Declared 16th June, 1965 Compulsory Purchase Order Made 70 Somers Road Area 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26 and 28 Somers Road (14 houses) Represented 13th September, 1965 Declared 13th October, 1965 Compulsory Purchase Order Made. Discretionary Grants Applications Received 10 Applications Approved 10 Standard Grants Applications Received 50 Applications Approved 50 HOUSING ACTS 196 1- 1964 HOUSES - IN - MULTIPLE OCCUPATION During 1965, having regard to the number of individuals or households, or both accommodated on the premises, 23 properties were found to be defective in respect of the following Natural and Artificial lighting Ventilation Water Supply Personal Washing Facilities Drainage and Sanitary conveniences Facilities for the storage, preparation and cooking of foods, and the disposal of waste water, or Installations for space heating or for the use of space heating appliances As a result of this notices under Sections 15 and 19 of the Housing Act 1961 were served on the owners. In addition 1 Order was made applying Management Regulations. 1,211 inspections and 1,730 revisits were made in connection with surveys, complaints and mortgage loans. 71 ATMOSPHERIC POLLUTION CLEAN AIR ACT 1956 Smoke Control Areas Smoke Control Areas now established in the Borough are as follows:- Acreage covered (a) Areas confirmed prior to 31st December, 1965 Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and 15 1421.03 (b) Areas not yet confirmed No. 16 166.85 Total 1587.88 Progress in the establishment of smoke control areas was maintained during the year. At present the target date for completion of Smoke Control in Lambeth is 1976 but with a view to bringing forward this date an extensive programme has been formulated for the next five years. An important Ministerial Circular (No. 51/65) was received in July, 1965. This broadens the basis upon which grants for fireplace conversions are paid, and has resulted in a quickening of public interest, particularly in regard to changeover from the use of coal to the use of gas fires. National Survey of Air Pollution Daily readings of the incidence of Smoke (Suspended particles) and Sulphur Dioxide (Gaseous) have been taken at the undermentioned sites in the Borough. Town Hall, Brixton Hill Norwood Technical College, Knight's Hill South London Hospital, Clapham Common Tate Library, South Lambeth Road United Dairies Ltd., Valley Road. Thanks are due to the laboratory staff at the United Dairies and at Norwood Technical College, Knight's Hill, who service the equipment daily for the Council free of charge. Liaison with the Ministry of Technology at the Warren Springs Laboratory, Stevenage continues to be maintained. 72 The following figures show the number of visits and revisits made by the Smoke Inspector and the Tedinical Assistants during the year:- Visits Revisits Timed Observations 67 - Untimed Observations 454 - Other visits, private and industrial Premises 16,834 1,113 Statutory Notices served under Section 12(2) of the Clean Air Act 1956 237 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Upon the formation of the London Borough of Lambeth it was considered that there should be three inspectors to carry out the Council's functions under the various enactments concerned with food, each being responsible for one third of the Borough. There are four large dairies in the Borough which pasteurise and bottle seven million bottles of milk per week and these are supervised for all purposes by the food inspectors. The large dairy companies have for some time been trying to perfect or purchase an efficient scanning device which will reject bottles in which extraneou matter has remained even after treatment in the bottle washing machines. Over a period of years little real success has been achieved for one reason or another but it appears that at the moment the milk trade is optimistic that such a device will be perfected and put into production in the near future. If successful this should reduce the number of milk bottle complaints. The cold store at Nine Elms continues to require visits by the food inspectors and sampling, especially of imported shrimps and pasteurised whole and egg white, is regularly carried out. The following Regplations and Orders relating to food, the enforcement of which is the responsibility of the Council were made during the year Regulation or Order Operative Date Meat Inspection (Amendment) Regulations 1965 18-10-1965 Milk (Special Designation) (Amendment) Regulations 1965 1-10-1965 Dried Milk Regulations 1965 11- 3-1965 73 FOOD PREMISES During the year under review 1,985 inspections and 64 re-visits were made to food premises in the Borough These inspections and re-visits were made up as follows:- Inspections Re-visits Food Factories 295 17 Bakehouses 10 1 Butchers 460 - Fried Fish Shops 25 - Ice Cream Premises 49 - Milk Shops 209 3 Public Houses 22 - Restaurants 140 10 Dairies 43 - Other 732 33 1985 64 The approximate number of food premises by type of business in the area is as follows:- Grocery and Provisions 362 Greengrocery and Fruit 165 Fish shops, wet, dry and fried 98 Bakers 93 Butchers 142 Restaurants 202 Confectioners 279 FOOD AND DRUGS ACT 1955 - SECTION 16 The number of registered premises is as follows:- Manufacture and/or sale of ice cream 654 Manufacture of sausages and preparation of preserved food etc. 298 MILK AND DAIRIES (GENERAL) REGULATIONS 1959 REGULATION 8 Number of registered distributors 365 Number of registered dairies 4 74 MILK (SPECIAL DESIGNATION) REGULATIONS 1963 The following table shows the number of licences in force:- *Dealers Licences (Pre-packed) Untreated 66 Pasteurised 280 Sterilised 270 Ultra-heat treated 32 Dealers (Pasteurised) Licence 4 Dealer's (Pasteuriser's) Licence 4 * Licences issued are valid for a period of five years. Under the Milk (Special Designation) (Amendment) Regulations 1965 there are four designations of milk "Untreated", "Pasteurised", "Sterilised" and "Ultra Heat Treated". As will be seen from the previous paragraph a new special designation for "Ultra Heat Treated" milk was made during the year and became operative on the 1st October 1965. The requirements of this regulation are that milk is subjected to a temperature of not less than 270°F. for not less than one second. Milk of this type is not produced in Lambeth although it can be obtained in certain shops in the Borough. It is also only available in pint tetrapak cartons for domestic consumers. The majority of this type of milk appears to be exported at the moment and is useful for ships doing round trips of several weeks. Briefly, if the milk is pasteurised for the correct length of time at the right temperature and is filled into a container which is sterile and does not permit ingress of air when filled, it has been claimed that this milk will keep sound and wholesome for six months without the use of a refrigerator. Once the carton is opened the keeping period is no longer than that of other types of milk. It remains to be seen to what extent this "Ultra Heat Treated" milk will be accepted generally, but it is undoubtedly very useful as a standby so that fresh milk is available when consumption has exceeded the amount delivered daily and further fresh milk is required. Persons taking holidays abroad by car might well consider it worth while to take sufficient for the trip especially where young children are concerned. The milk is required to contain the legal minimum of milk fat and solids not fat and should not be mistaken for low fat dried milk which is on the market. 75 SAMPLING OF FOOD AND DRUGS Chemical Analysis Two hundred and seventy five samples were procured formally, 110 of which were milk, and 1,599 samples were procured informally. Set out below is a table of samples reported by the Public Analyst to be adulterated or otherwise unsatisfactory, showing action in each case. Informal Samples Articles Result of Analysis Action taken Ravioli Buitoni Cream slices (2) Contained only 10 per cent meat Contained fat other than butter fat. Further sample satisfactory Warning letters sent Advocat Contained only 28 per cent proof spirit - 30 per cent claimed Formal sample purchased Legal proceedings Steak and Kidney pie No kidney found Formal sample purchased Minced turkey in jelly Deficient in meat Formal sample purchased Burgers Deficient in meat Formal sample purchased Spirit of Sal Volatile Deficient in Ammonium Carbonate Sale discontinued by vendor Lemon Drink Contained excess saccharin Further samples taken Parrish's Food Poor appearance, much insoluble matter Sale discontinued by vendor Shredded Suet (3) Deficient in fat. Further formal samples satisfactory Buttered Rolls (2) Contained fat other than butter fat Warning letters sent Marzipan High Nitrogen figure Letter sent to manufacturers Calcium Drink Contained prohibited artificial sweetner Letter sent to manufactures 76 Instant low fat milk Deficient in fat, contained excess water Letter sent to manufacturers Stewed steak Deficient in meat Formal sample purchased Hamburgers in gravey Deficient in meat Formal sample purchased Milk tops Deficient in fat Request to legal department for opinion Duncow pourover Deficient in fat Request to legal department for opinion Iodine solution Label claim not justified Matter taken up with pharmacist Sulphur lozenges Chilli powder Deficient in sulphur High ash Matter taken up with pharmacist Formal sample purchased Curry powder High ash Formal sample purchased Parrish's Food (2) Excess iron Formal samples purchased Ammoniated tincture of quinine Deficient in ammonia Formal sample purchased Chilli powder High ash Letter sent to packers Curry powder High ash Letter sent to packers Mi need turkey in jelly Deficient in meat Formal sample purchased Dried Milk Fat less than label claim Referred to Council's legal department Cream Cakes (4) Contained fat other than butter fat Formal samples purchased Curry powder High ash All stocks sold at time of resampling Potato sticks Fat showed rancidity Further sample satisfactory 77 Parrish's Food Iron content in excess of B.P.C. li mit Matter taken up with Pharmacist and Manufacturing Chemist Formamint tablets Low formaldehyde content All stocks sold at time of resampling Minced turkey in jelly Deficient in meat Subsequent sample satisfactory Instant low fat milk 3.5 per cent excess water Formal sample purchased Ferric Ammonium Citrate Dispensed in paper bag and had absorbed water Pharmacist advised. Further sample purchased correctly packed. Soda Mints Excess sodium bicarbonate Stocks withdrawn Cream cakes (2) Contained fat other than butter fat. Attention of Vendor called to offence Formamint tablets Deficient in formalin Pharmacist's attention called to deficiency Sulphur and lime tablets Deficient in sulphur Formal sample purchased Raspberry cough syrup Glycerine content not in accordance with label declaration Letter sent to manufacturers Biskoids (3) Quantities of ingredients not clearly stated Matter taken up with Pharmacist Curry powder High ash Formal sample purchased Milk skimmed Incorrect statutory statement Attention of Vendor called to offence Potato Crisps Fat showed incipient rancidity Letter to Manufacturers Coldrex tablets Quantities not clearly stated Matter taken up with Pharmacist and Manufacturing Chemist Bisurated tablets Incorrect description Matter taken up with Pharmacist and Manufacturing Chemist 78 Parrish's Food Higji iron content Matter taken up with Pharmacist and Manufacturing Chemist Formal samples Whisky Deficient in proof spirit Warning letter sent Gin Deficient in proof spirit Further sample satisfactory Butter Excess moisture Further formal sample satisfactory Cream cake Contained not more than 16 per cent butter fat Warning letter sent Roll and Butter (2) Not butter fat Warning letter sent Instant non-fat milk Excess moisture and mislabelling Letter sent to manufacturers Bread and Butter (2) Fat contained not more than 50 per cent butter fat Warning letters sent Buttered roll Not more than 50 per cent butter fat. Warning letter sent 3uttered roll Not more than 6 per cent butter fat. Warning letter sent Sulphur Lozenges Deficient in sulphur Matter taken up with Manufacturing Chemist Parrish's Food (2) Excess iron Matter taken up with Manufacturing Chemist Sal Vplatile tincture Deficient in ammonium carbonate Warning letter to Pharmacist Instant low-fat milk Excess water, low fat and labelling offence Referred to Council's legal department. BACTERIOLOGICAL AND OTIIER EXAMINATIONS The following samples were submitted to the Public Health Laboratory for examination. 13 Articles marked with an asterisk were suspected of having caused food poisoning, but in none of these cases was the food poisoning organism isolated. Gripe mixture 2 Gripe water 2 Jersey cream 1 Canned ham 2 Bottle only 1 * Bacon 1 * Liver 1 * Breakfast sausage sandwich 2 Compound Magiesia 1 Nurse Harvey's Mixture 1 Ice Cream 19 * Steak pie, peas and potato meal 1 * Turkey 1 Horseflesh 3 Horse liver 1 Of the 19 samples of ice cream examined and submitted to the Methylene Blue Test, 1 fell into grade 3 representing 5.26% of the total. Samples of milk were submitted to the Public Health Laboratory for examination under the Milk (Special Designation) Regulations as follows Methylene Blue Test 387 Twenty were void, the atmospheric shade temperature being over 65° F. Seventeen failed to satisfy the prescribed test. Phosphatase Test 357 All passed the test. Of the 17 samples of milk which failed the Methylene Blue Test, 10 were of raw Tuberculin Tested Channel Islands milk bottled on the farm. The other 7 failures were of milk pasteurised in the Borough. The failures were reported to the Divisional Milk Officer and to the pasteurisers as appropriate. LABELLING OF FOOD As reported in the Annual Report of the Metropolitan Borough of Lambeth for 1964, the revision of the Labelling of Food Order is under consideration. No draft order following the report of the Food Standards Committee set up by the Minister of Agriculture, Fisheries and Food has yet been issued. 80 Inspection at Shops, Stores, Factories and Wharf. Large quantities of food of all varieties were inspected and as a result the following food was surrendered as unfit for human consumption and unsound Certificates were issued. Canned Tons Cwts. Qtrs. Lbs. Meat 3 17 1 26¾ Vegetables 15 - 21¼ Fruit 1 - 2 4 Fish 2 1 15¾ Milk 4 3 14¼ Cream 1 - 26¼ Soup 5 2 14¼ Fruit juice 1 3 17¼ Creamed rice - 3 14 Baby food - 1 26½ Spaghetti - 1 23½ Tomato juice - 1 7 Cheese flaps - - 4¾ Pease pudding - - 24 Ravioli - - 25 Macaroni - - 4 Marmalade - - 2 Jam - - 5 Rice - 1 1 Meat pudding - - ½ Sausages in brine 1 2 15 Frankfurters - - 16 Chocolate pudding - - 1 Prawns - - ¼ Ginger Beer - - 1 Sago pudding - - 5 Apple dumplings - - 6 Tapioca pudding - - 1 Bolognaise - - 1 Mixed grill - - ½ Custard powder - - ¾ 6 14 - 160¾ 81  Tons Cwts Qtrs. Lbs. Untreated Meat 2 7 3 5¾ Fish 2 2 14½ Nuts - - 29 Chickens 2 1 9 Scampi tails 1 1 - 7 Eggs 15 dozen - - - - Potatoes 2 - Winkles 1 - - Silverskin Onions 3 - - Rabbits - 1 5 3 18 3 14¼ Prepared Bacon 2 8 - 23 Frozen food 1 10 - - Jam - 17 Marmalade - 13¾ Sauce - 4¾ Pickle - 11¼ Flour 2 6 Sponge Mix 1 20½ Butter beans - 3 Dried peas - 1 Sandwich spread - -¾ Honey - 1¼ Rice - 13 Biscuits - 16 Salt - 15 Lemon curd - 2 Beetroot - 25 Tomato Ketchup - 5 Margarine 3 12 Tea - 14 Chutney - 1 Butter - 16½ 4 1 1 253/« TOTAL WEIGHT 14 14 2 - y* 82 The method of disposal of food surrendered or condemned as unsound Animal Products where practicable were released to firms specialising in the manufacture of glue and similar commodities and from whom satisfactory guarantees as to disposal have been obtained. As an additional precaution unfit meat is stained. Some food waste which was suitable was diverted to approved sources for utilisation as pig food. The balance was destroyed by incineration in accordance with arrangements entered into with Southwark Borough Council. FOOD COMPLAINTS - 1965 1. Chow Mein Containing insects 2. Corned Beef Bad 3. Chocolate Containing maggot 4. Flaked rice Infested 5« French bread Containing string 6* 2 Butters Rancid 7. Beef meat loaf Caused food poisoning 8. Milk Black in bottom of bottle 9. Cake Containing nail 10. Meat Marked ENGLISH, but imported 11. Current buns Fibre in bun 12* Pilchards Bad smell 13• Bread Foreign body (soot) 14* Cream Cakes Foreign matter (cooked starch) 15» Buns Mouldy 16. Milk Dirty bottle 17. Lemonade Contaminated 18. Milk Dirty bottle 19. Minced Meat Contained piece of wood and metal 20. Sliced loaf Foreign matter (oil) 21. Ice Lolly Fly embedded in side 22. Fried Egg Roll Containing gritty material 23. Apricot Pie Mouldy 24. Bread Mouldy 25. Bread Contained metal object 26. Pork Luncheon Meat Black foreign matter and mould 27. Fish Smelling of ammonia 28. Brown loaf Damp and mushy 29. Maimalade Containing wasp 30. Flour Containing mouse dirts 31. Ice Cream Containing cigarette 32. Fish Smelling of ammonia 33. Milk Glass in bottle 34. Milk Beetle in bottle 35. Com Flakes Containing insects 36. Apple pie Contaminated with ink from paper mache 37. Milk Unple as ant flavour 38. Milk Dirty bottle 39. Milk Bottle chipped 40. Double Cream Containing glass 41. Steak and Kidney Pie Mouldy 42. Bread Containing machine oil 43. Cherry Cake Containing piece of spiky material (weed) 44. Bread Mouldy 83 45. Milk Foreign Matter 46. Milk Foreign matter affixed to interior of bottle 47. Milk Loaf Spider between loaf and wrapper 48. Bread Containing nail 49. Fruit Pie Green mould inside 50. Six one-third pints of milk Foreign matter (Mould and insects) 51. Pearl Barley Containing weevils 52. Milk Containing maggot 53. Corned beef Mouldy 54. Brown Sliced loaf Mouldy 55. 2 Milk Cement substance 56. Milk Dirty 57. Porage Oats Weevils 58. Churn of milk Dirty 59. Pork Pies Mouldy 60. Breast of Lamb Foul smelling, blow fly found in meat 61. Bread Containing wire 62. Sausage Roll Mouldy 63. Marmite Glass in Marmite 64. Milk Cement in bottle 65. Cake (sponge cream filled) Mouldy 66. Milk Glass in bottle 67. Sliced bread Brown matter 68. Meat Pie Containing hairy substance 69. Bread Fly found in bread 70. Loaf Foreign matter 71. Chocolate sweets Larvae infestation 72. Cheese and tomato roll Mouldy 73. 2 Packets of dripping Parts of cigarette in dripping 74. Fried fish Metal in fish 75. Milk Metal cap in bottle 76. Milk Containing straw 77. Wrapped bread Contaminated with hessian 78. Tinned melons Discolouration of interior of cm 79. Meat Pie Containing mouse dirts No. of justified complaints in 1965 - 79 No. of complaints-123 Although, due to the amalgamation of boroughs, no figures are available for comparison, there appears to have been a drop in the number of complaints of dirty milk bottles from one dairy following the replacement of an old washing machine by a much larger, more modern and more efficient machine. Complaints of one third pint milk bottles continue to be a problem but there is now a trend to supply at least some of the school milk in one third pint cartons. Imported Food Regulations 1937 - 1948 Inspections, disposal, and where necessary detention, sampling and chemical analysis or bacteriological examination of food landed in the Borough continue to be the responsibility of the Council and its designated officers, the Medical Officer of Health and the Food Inspectors. 84 The London Cold Storage Company's premises at 32, Wandsworth Road which has a capacity of 16,000 tons began operating as a cold store in August 1964. There are facilities for receiving imported food by barge from the London Docks as well as by road and rail. Two hundred and fifty eight samples of inported food have been taken and submitted to the Public Health Laboratory service for examination for the presence of food poisoning organisms and any indication of undesirable bacterial contaminatio The food samples included frozen cooked meat; frozen beef kidneys; frozen cooked and uncooked prawns; frozen liquid whole egg and pasteurised liquid whole egg. Street Markets Markets are held in The Cut; Lower Marsh, Lambeth Walk and Wilcox Road in the Inner Wards and in Popes Road, Electric Avenue and Brixton Station Road. All are inspected regularly. Slaughter of Animals Act No application was made during the year for the issue of a licence under the provisions of this Act. PUBLIC SWIMMING BATHS 1 am indebted to the Scientific Adviser of the Greater London Council for the following reports on the results of Bacteriological Examinations of water from Kennington Park and Brockwell Park Swimming Baths. 1965 No. of Agar count, 1 ml. 37oC. Presumptive E. coli. samples 48 hrs. coliform without in E. coli. 100 mis. 0-10 11-100 Over 100 in 100 mis. Brockwell Summer 11 10 1 - - 1 Winter 6 6 - - - 1 Kennington Summer 11 7 4 - - - Winter 10 10 - - - - 85 The following comments apply to the incidence of coliform pollution at Brockwell Park - Summer: One sample taken at the deep end of the bath was found to contain coliform bacteria. The free chlorine was zero, due to a heavy bathing load. Winter: One sample was found to contain coliform bacteria and the free chlorine proved to be zero. In both these cases the absence of free chlorine was speedily rectified. NATIONAL ASSISTANCE ACT 1948 Section 50 - Burials Under Section 50 of the National Assistance Act 1948 the Borough Council is required to arrange for the burial or cremation of any person who has died or been found dead in its area if in such cases it appears to the Council that no suitable arrangements for the disposal of the body have been or are being made. During the year 44 funerals were arranged involving 24 males and 20 females. The amount paid to funeral contractors was £659. 18s. 6d. The sum of £419. 3s. 7d. was recovered by the way of grants, insurance policies and money found. The actual cost to the Council was therefore £240. 14s. lid. LAND CHARGES ACT 1925 During the year 4,958 enquiries were received and dealt with in respect of searches under the above mentioned Act. PHARMACY AND POISONS ACT 1933 The sale of certain poisons by persons other the pharmacists is subject to the provisions of this Act and Regulations made thereunder.. A person selling such poisons must have his name entered on a list kept by the Council and must make application annually for re-entry and pay a prescribed fee. Compliance must be made with the requirements relating to storage, transport, labelling and containers. The number of persons entered or retained on the list under Section 21, Part II of the Act was 147. 86 RAG FLOCK AND OTHER FILLING MATERIALS ACT 1951 This Act is designed to secure the use of clean filling materials in articles which are upholstered, Twenty two samples of various filling materials were submitted to a prescribed analyst for examination. All samples complied with the test. HAIRDRESSERS AND BARBERS Prior to 1st April 1965 hairdressers and barbers could not carry on business unless registered with the local authority which also had power to make bye-laws for the conduct of the business. There is now, however, no provision for compulsory registration. At 1st April 1965 the total number of premises on the register was 220. Twenty seven inspections and 3 re-visits were carried out. DISEASES OF ANIMALS ACT 1950 AND ASSOCIATED ACTS PET ANIMALS ACT 1951 RIDING ESTABLISHMENTS ACT 1964 As a result of the re-organisation of the London Boroughs proposals were made by the Corporation of London that it should undertake on behalf of the London Boroughs the enforcement of functions under the Diseases of Animals Act 1950 and Associated Acts. The Council on 16th June 1965 agreed that the Corporation of London should, in accordance with the provisions of Section 5(3) (a) of the London Government Act 1963, undertake on behalf of the Borough of Lambeth the execution and enforcement of the following Acts Diseases of Animals Act 1950 (other than in relation to the importation of animals) and Associated Acts. Pet Animals Act 1951 Riding Establishments Act 1964. The Riding Establishments Act 1964 became operative on 1st April 1965 and under 87 the provisions of the Act no person may keep a riding establishment except under the authority of a licence granted in accordance with the Act. Licences are renewable annually on payment of a fee of ten shillings and are issued subject to a satisfactory report being received from the Veterinary Officer appointed by the Council, in this case the Veterinary Officer of the Corporation of London. During the year the following licences were issued. Riding Establishments 6 Pet animal shops 16 The number of inspections carried out by the Veterinary Officer was as follows:- Riding Establishments 14 Pet Animal shops 59 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT The Council is now the licensing authority for establishments for massage or special treatment under Part IV of the London County Council (General Powers) Act 1920. The licensing of these establishments was dealt with prior to 1st April 1965 by the London County Council. There are in the Borough of Lambeth 48 such establishments. 88 GENERAL Health Education Health education is undertaken by the professional and technical officers of the department in the course of their normal duties. Talks have been given to various organisations on subjects associated with the work of the department, and related subjects. Opportunity is taken at the annual "Key-of-the Door" party organised each year by the Council to place on display some aspect of public health work. Publicity material is displayed on notice boards and leaflets are distributed in Council premises and throughout the Borough. A departmental Health Education Sub-committee, including representative field workers, meets monthly to discuss health propaganda, the mass media to be employed, to initiate displays and exhibitions, to inform the field workers employed in the department of new developments, trends and techniques generally and to appraise new health education material which becomes available. Liaison is maintained with the Public Relations Department of the Council. Use is made of the posters and pamphlets produced and provided free of charge to local authorities by the Ministry of Health material issued by the Central Council of Health Education. Ambulance Services The Greater London Council is responsible under Section 27 of the National Health Service Act 1946 for the provision of the amublance services in the area. Hospital Facilities The undermentioned hospitals are within the Borough. Lambeth Hospital, Brook Drive S.E.ll. South Western Hospital, London Road, S.W.9. Annie McCall Maternity Hospital, Jeffreys Road, S.W.4. King's College Hospital, Denmark Hill, S.E.5. Belgrave Hospital for Children, Clapham Road, S.W.9. St. Thomas's Hospital, Westminster Bridge, S.E.1. St. Thomas's Babies Hospital, Black Prince Road, S.E.11. General Lying-in-Hospital, York Road, S.E.1. Royal Waterloo Hospital, Waterloo Road, S.E.1. South London Hospital, Clapham Common South, S.W.4. Public Health Laboratory Service The Public Health Laboratory Service provides a comprehensive service for the examination of specimens submitted by local authorities and general 89 practitioners. The local laboratory is situated in County Hall and is under the direction of Dr. A.J. Tomlinson. Medical Examination of Staff The Health Department undertakes for the Council medical examination of the staff of the health, children's and welfare departments. This includes new entrants to the service, staff and employees absent through sickness, employees considered for participation in the Council's sick pay scheme and special referrals. Examinations carried out during the year numbered 349. Details are given below Children's Department 73 Health Department 248 Welfare Department 12 Other Boroughs 16 349 90 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE ANNUAL REPORT 1965 The arrangements for the medical inspection and treatment of school children, which operated in the area of the London Borough of Lambeth under the London County Council through the Health Divisions until 31st March, 1965, continued without interruption after the transfer of local responsibility for these services to the Borough on 1st April, 1965. The smooth transition was largely due to the appointment by the Borough Council to senior posts in the Health Department of staff who had long experience of the services under the London County Council. Premises The same premises continued in use as school treatment centres throughout the year, and efforts continued to improve the facilities provided. In its review of the Plan for the Development of the Health Services for 10 years 1966 to 1976, the Borough Council has provided for three combined maternity and child welfare and school treatment centres to replace centres in unsatisfactory accommodation, and has adied the Inner London Education Authority to provide an additional school treatment centre in the northern part of the Borough. Proposals have been initiated for the use of a former maternity and child welfare centre, which is no longer needed for that purpose, for audiology (for which the present provisions in the Borough are seriously inadequate) for speech therapy and for additional dental services. Services Provided in Hospitals In addition to the services provided in the Council's own centres and those of the Inner London Education Authority, treatment sessions for school children are provided at King's College Hospital, The Belgrave Hospital and St. Thomas's Hospital, as follows - School Health Service Social Workers make appointments for and attend all the sessions. King's College Hospital Two refraction sessions a week, linked with orthoptics and surgical treatment when needed. Dental treatment (with ambulance or car transport if required) for children from physically handicapped schools in the Borough. Belgrave Hospital Two refraction, one E.N.T. and one audiology (with auditory training teachers) sessions a week. These sessions are not reserved for children referred by the Borough, and additional facilities for audiology are needed. Proposals for providing these additional facilities are already under consideration. 91 St. Thomas' Hospital One paediatric session a week for enuresis encopresis and psychosomatic conditions, reserved for Inner London Education Authority schoolchildren. Dental Services Premises and equipment Following the appointment, in July 1965, of a chief dnetal officer, a survey of the facilities provided at the five dental clinics in the Borough was carried out The standards of both premises and equipment were found to need improvement in certain respects, and action to secure this is continuing. Dental inspection and treatment In accordance with the policy adopted by the London Education Authority, dental inspections were carried out only for five-year-old school entrants, the parents of older school children being invited by letter to make arrangements for any necessary dental treatment either in the Borough's dental clinics or by their own private dentists. Of those inspected, about 60% were found to be in need of dental treatment. Proposals for the fluoridation of water supplies which have been approved by the Borough Council would, if implemented, make a valuable contribution towards the reduction of dental care in children. Orthodontic service Five sessions a fortnight for orthodontic treatment were provided at Stock well Treatment Centre, at which some children from Southwark and Wandsworth, as well as those from Lambeth attended. Some dental officers also gave orthodontic treatment at their own dental centres. SCHOOL HEALTH SERVICE STATISTICS FOR YEAR 1965 MEDICAL INSPECTIONS (EXCLUDING DENTAL AND HEALTH SURVEYS) School Roll - 20-1-66 44,416 92 Routine Inspections Number inspected 16,897 Number found not to warrant examination (7 plus 'specials scheme') 182 Percentage of Number inspected • Parent present 50.3 Care Committee present 94.2 No. vaccinated against smallpox 71.9 No. immunised against diphtheria 84.2 No. immunised against Whooping Cough 74.2 No. vaccinated against poliomyelitis 79.1 Physical condition unsatisfactory 0.3 Referred for treatment of defects 9.1 Referred for treatment of defects other than vision 4.4 Noo - Routine Inspections (1) Specials 5,116 (2) Re-inspections 4,909 TOTAL (1) and (2) 10,025 No. of routine inspections as percentage of school roll 38.0% No. of non-routine inspections as percentage of scholl roll 22.6% 93 ROUTINE MEDICAL INSPECTIONS 1965 - DEFECTS Number of children noted for treatment or observation expressed as a rate per 1000 inspected Number Inspected 16,897 DEFECTS Skin T 3.43 O 4.14 Eyes • (a) Vision T 49.71 O 63.74 (b) Squint T 4.62 O 3.97 (c) Other T 1.54 O 0.89 Ears - (a) Hearing T 5.15 O 5.92 (b) Otitis Media T 1.30 O 2.60 (c) Other T 0.36 O 0.36 Nose and Throat T 4.79 O 22.49 Speech T 2.43 O 5.92 Lymphatic Glands T 0.18 O 2.01 Heart T 1.24 O 6.15 Lungs T 2.54 O 9.17 Developmental (a) Hernia T 1.30 O 1.83 (b) Other T 0.95 O 2.01 94 Orthopaedic (a) Posture T 0.59 O 2.13 (b) Feet T 1.12 O 5.56 (c) Other T 1.12 O 3.14 Nervous System (a) Epilepsy T 0.77 O 1.78 (b) Other T 0.47 O 0.89 Pyschological (a) Development T 0.95 O 3.31 (b) Stability T 1.12 O 5.39 Abdomen T 0.06 O 0.83 Other T 10.71 O 25.98 T - Treatment O - Observation FINDINGS AT HEALTH SURVEYS - 1965 School Roll - 20-1-66 44,416 1. Comprehensive Surveys (a) Number examined 21,831 (b) Number (occasions) found verminous 193 (c) Percentage found verminous 0.88 95 2. Selective Surveys (a) Number examined 7,316 (b) Number (occasions) found verminous 117 (c) Percentage found verminous 1.60 3. (a) Total times vermin found (1(b) + 2(b)) 310 (b) Total percentage found verminous (3(a) as % of 1(a) + 2(a)) 1.06 (c) Number of individual pupils found verminous 193 (d) Percentage of individual pupils found verminous (of school roll) 0.43 4. Action taken with Verminous cases (a) Advice and/or Lorexane 251* (b) Further action 59 (c) 4(b) expressed as a percentage of 4(a) 23.5 Analysis of 4(b) cases - referrals of hardcore cases to bathing centres Voluntary attendances at bathing Centres No. of pupils 59 No. of statutory notices issued - 5. Communicable Disease Surveys Number examined for:- Athlete's Foot 6,502 Plantar Wart's 6,675 Dysentery Other communicable diseases 4,399 *Includes 39 issues of Tuleo SCHOOL DENTAL STATISTICS - 1965 1. School Roll 44,416 96 2. Number of Sessions Treatment - ordinary 2639.9 Treatment - General Anaesthetic 32. 3 Inspection ?3.0 TOTAL 2745.2 3. First Inspections (a) Number of first inspections in school 6342 (b) Number of first inspections at clinic 5416 (c) TOTAL 11758 (d) Total as percentage of school roll (3(c) as percentage of 1) 26.5 (e) No. inspected found to require treatment 7682 (f) Percentage of no. inspected found to require treatment 65.3 (g) No. offered treatment 7173 (h) Percentage of no. requiring treatment offered treatment 93.4 (i) Percentage of no. requiring treatment elected for private treatment 6.6 4. Reinspections (a) Re-inspections at school - (b) Re-inspections at clinic 1241 (c) TOTAL 1241 (d) No. of re-inspections as percentage of first inspections (4(c) as percentage of 3(c)) 10.6 (e) No. re-inspected found to require treatment 866 (f) Percentage of number re-inspected found to require treatment (4(e) as percentage of 4(c)) 69.8 5. Number of appointments given to: (a) New cases 15317 (b) On treatment cases 17810 Number of attendances made by: (c) New Cases 6940 (d) On Treatment Cases 13883 (e) Emergencies 575 TOTAL ATTENDANCES 21398 97 NON-ROUTINE MEDICAL INSPECTIONS 1965 TYPE OF INSPECTION Bathing Centre Inspections - Scabies 7 Bathing Centre Inspections - other 4 Employment Certificates 585 Theatrical Children 16 School Journeys 2137 Re-cuperative Holidays 75 Outward bound courses 7 Infectious Disease investigation 102 Boarding Schools for the Delicate - pre-departure 77 Boarding Schools for the Delicate - on-return 2 Handicapped pupils - Statutory examination 260 Handicapped pupils - periodic special defect examination 549 Research investigations and enquiries 40 TOTAL 3861 Specials - At request of:Head Teacher - child's name entered in special book 149 Head Teacher - others 509 School Nurse - following health survey 11 School Nurse - others 297 Divisional Education Officer 125 District Care Organiser or Care Committee 22 Parent 85 TOTAL 1198 Others Accident on school premises 3 Referred by School Medical Officer 19 Miscellaneous 35 TOTAL 57 Re-inspections 4909 TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS Special Inspections 5116 Re-inspections 4909 TOTAL 10,025