I LAM-55 london borough of lambeth ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1966 A. L. THROWER, M..B., B.S., M.R.C.S., L.R.C.P., D.P.H. london borough of lambeth ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1966 A. L. THROWER, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. 2 CONTENTS OF REPORT Page Members of Health Committee 5 Staff of Health Department 9 Introductory remarks of Medical Officer of Health 10 Statistics and Social Conditions of the Area General 14 Births, Birth Rate, Still Births 14 Deaths, Death Rate 15 Maternal Mortality 15 Infantile Mortality 16 Vital Statistics for years 1957-1966 17 Classification of causes of death 18 Notes on Vital Statistics 21 Deaths from Cancer of the Lung and Bronchus 23 Road Traffic Accidents 23 Prevalence of, and Control over, Infectious and other Diseases Notifiable Diseases 24 Notifications other than Tuberculosis 25 Age distribution of Infectious Diseases 26 Notes on Infectious Diseases 28 Salmonella Infections 29 Typhoid and Paratyphoid Fever 31 Tuberculosis Notifications 32 Reports of Chest Physicians 33 Personal Health Services Maternity and Child Welfare Centres 37 Mothercraft and Relaxation Classes 37 Dental Treatment 37 Phenylketonuria 37 Welfare Foods 37 Health Visiting 38 Home Nursing 38 Loan of Nursing Equipment 39 Incontinence Pads 39 Domiciliary Midwifery Service 40 Midwives Act 1951 40 Family Planning 41 Day Nurseries 41 Child Minding 41 "Handicap" Registers 41 Occasional Creches 42 Prevention of Break-up of Families 42 3 Peronal Health Services (continued) Page Vaccination and Immunisation 44 International Certificates of Vaccination 44 Cervical Cytology 44 Tuberculosis 45 B.C.G. Vaccination 45 Recuperative Holidays 45 Chiropody 46 Mental Health Service 46 Home Help Service 47 Statistics - Personal Health Services 48-60 Environmental Health Services Care of the Aged 61 Laundry Service for Aged Incontinent 61 Home Bathing Service 62 Water Supply 62 Sewers 65 Summary of work done by District Public Health Inspectors 65 Public Health Act 1936 and 1961 - Works in default 67 Sealing of Disused Drains 67 Drainage Emergency Service 68 Legal Proceedings 68 Rehousing 69 Disinfection 70 Disinfestation 70 Prevention of Damage by Pests Act 1949 70 Atmospheric Pollution - Clean Air Act 1956 71 Factories Act 1961 73 Slum Clearance Programme 1961-1965 75 Housing Acts 1959 and 1964 76 Slum Clearance Programme 1966-1970 76 Individual Unfit Houses and Parts of Houses 78 Houses-in-multiple occupation 79 Housing (Financial Provisions) Act 1958 80 House Improvement Grants 80 Improvement Areas 81 Medical Arrangements for Long-stay Immigrants 81 Noise Abatement Act 1960 82 Unwholesome and Filthy Premises 82 Feral Pigeons 83 Pet Animals Act 1951 83 Animal Boarding Establishments Act 1963 83 Diseases of Animals Act 1950 84 Inspection and Supervision of Food and Food Premises 84 Food and Drugs Act 1955 86 Food Hygiene (General) Regulations 87 4 Environmental Health Services (continued) Page Public Health Imported Food (Regulations) 1937 88 Sampling of Food and Drugs 89 Bacteriological and other Examinations 95 Legal Proceedings 95 Unsound Food 96 Food Complaints 98 Swimming Pools 99 National Assistance Act 1948 - Burials 102 Pharmacy and Poisons Act 1933 102 Establishments for Massage or Special Treatment 102 Riding Establishments Act 1964 102 Hairdressers and Barbers 103 General Health Education 103 Medical Examination of Staff 104 Ambulance Facilities 104 Hospital Facilities 104 Public Health Laboratory Service 104 School Health Service Report of the Principal School Medical Officer for the year 1966 105-112 5 LONDON BOROUGH OF LAMBETH HEALTH COMMITTEE Period from 1st January, 1966 to 26th May, 1966 The Worshipful the Mayor of Lambeth Councillor Ewan G. Carr, B.E.M., J.P. (Ex-officio) The Deputy Mayor of Lambeth Councillor B.M. Lawrence (Ex-officio) Chairman Councillor S.H. Gurney Vice-Chaiiman 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, L.L.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.C. Stimpson 7 HEALTH COMMITTEE Period from 26th May, 1966 to 31st December, 1966 The Worshipful the Mayor of Lambeth Councillor S.H. Gurney, J.P. (Ex-officio) The Deputy Mayor of Lambeth Councillor Ewan G. Carr, B.E.M. (Ex-officio) Chairman Councillor G.F.S. Light Vice-Chairman Councillor P.W. Huggett Alderman Mrs. Mary Marock Alderman A.M. Nelson-Barrett, J.P. Councillor W.A. Brownett Councillor P.C.H. Cary Councillor T. Cleasby Councillor Mrs. D.R. Colls Councillor G.A. Gold, L.L.B. Councillor D.F. How Councillor B.J. Perkins Councillor Mrs. W.E. Privett Councillor T.V. Rowlands, O.B.E. Councillor D.C. Stirnpson 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 8 ENVIRONMENTAL HEALTH SUB-COMMITTEE Chairman Councillor W.A. Brownett Councillor Mrs. D.R. Colls Councillor D.F. How Councillor P.W. Huggett Councillor G.F.S. Light Councillor B.J. Perkins Councillor Mrs. W.E. Privett Councillor D.C. Stimpson 9 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 - Retired 30th September, 1966 J.M. Roberts Principal Nursing Officer Miss B. Thorn Deputy Principal Nursing Officer Miss S.G. Earl - Resigned 14th November, 1966 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 Deputy Chief Public Health Inspector C. Dancer - Appointed 8th August, 1966 Died 18th September, 1966 R.C. Charlton - Appointed 8th December, 1966 10 Public Health Department, Blue Star House, 234/244 Stockwell Road, S.W.9. Tel: 01-274 7722 To the Mayor, Aldermen and Councillors of the London Borough of Lambeth Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my report on the health of the London Borough of Lambeth for the year 1966, the first full year of the Borough's existence. In my report for 1965, I referred to the difficulties which had arisen as a result of the subdivision of services formerly organised on a County-wide basis, and because of the inclusion in Lambeth of a part of the metropolitan borough of Wandsworth, which did not correspond with the areas for which the new services were designed. While the planning of the development and improvement of services over the whole borough has continued, particular attention has been paid to the provision of junior training schools for mentally subnormal children and the provision of a maternity and child welfare centre in the Streatham Hill area. Because of the urgent need for accommodation for mentally subnormal children for whom there was no provision within the Borough, a former primary school was acquired for conversion for temporary use as a junior training school, pending the provision of purpose-built premises. A second temporary school, also to be replaced in due course, was also planned. Until these two schools become available it will be necessary to continue to rely on places made available by other boroughs in their training schools. To relieve the situation to some extent, 10 children are, by arrangement with the hospital authority, sent daily to the training school at Queen Mary's Hospital, Carshalton. With regard to the provision of a maternity and child welfare centre and health visitors' office in the Streatham Hill area, where the services were seriously deficient, arrangement were made for the conversion of a house in Kirkstall Road for temporary use. The Ten Year Plan for the development of the health services which was prepared in 1965 includes proposals for a second temporary junior training school and a day nursery in the Brixton/Stockwell area where demand for this service is greatest, and for replacement of day nurseries and welfare centres occupying unsatisfactory accommodation. 11 Despite a comparatively high level of day nursery provision (581 places) there is a large unsatisfied demand. While it is not possible in the short term to increase the number of day nursery places, some relief has been afforded by a continuing expansion of the occasional creche service, using accommodation in maternity and child welfare centres. The service has increased by some 25% since April, 1965. A cervical cytology service for the detection of early cervical cancer was started on a small scale, limited in the first instance to women over 35 years of age. The development of this service is dependent on the availability of technicians, who are trained and employed by the Regional Hospital Board to examine the specimens collected. After discussion with the consultant venereologist, St. Thomas' Hospital, arrangements were made to expand the work of venereal disease contract tracing; and an additional venereal disease social worker was employed based on the hospital clinic. The Council continued to give financial support to voluntary organisations which contribute to the work of the Health Department and in particular continued to provide a home nursing service through the agency of the Lambeth District Nursing Voluntary Committee. With regard to the Environmental Health Services there have been several significant developments over the year. During the latter part of 1965 it became quite apparent that there was an urgent need for additional experienced Inspectors to deal with the unsatisfactory housing conditions in many parts of the BoroughThree senior Inspectors were appointed in February, and, as a result the existing Slum Clearance Programme was augmented by some 1,400 houses. Surveys were carried out in areas where multiple occupation caused much concern and following an appreciation of the position the Council decided to request the Ministry of Housing and Local Government to approve a scheme for the registration of all houses in the six central wards of the Borough where there were more than two families in occupation. This scheme came into operation on the 8th October and although it is my intention to report fully on the effectiveness of this scheme after it has been in operation for one year, I have chosen to refer in some detail to its development in the body of my report. I consider the registration of houses in multiple occupation to be an essential factor in the strenuous efforts being made to improve living conditions, whether it be by the provision of additional amenities or, alternatively, a suitable reduction in the number of occupants in these houses. In the quest for clean air I report the completion of the existing five year programme in connection with the declaration of Smoke Control areas. A further five year programme was formulated covering 1,274 acres and steady process in this work is being maintained. Nevertheless it will be 1976 before the whole of the Borough is subject to Smoke Control Orders. 12 Regrettably the department cannot yet function as one unit and has to continue, geographically in two parts, the personal health services at Blue Star House and the environmental health services at Offley Road. The difficulties incurred are offset to some extent by frequent meetings of senior staff from the two addresses. Two senior members of the staff of the department left during the year, Miss S.G. Earl, deputy principal nursing officer, to take up an appointment with the Ministry of Health, and Mr. A.C. Puttock, deputy principal administrative officer, who unfortunately had to retire for reasons of ill-health after 46 years' service, most of it in the Lambeth area. I am most fateful to the Chairman and members of the Health Committee for their help and assistance and to all members of the Council who have given me so much encouragement and support. I am most appreciative of the help and co-operation of the family doctors and hospital staffs with whom the department is in almost daily contact throughout the year. The smooth working of the department, in face of the difficulties which inevitably occur in a department of this size, geographically divided, is in large measure due to the willing service, loyalty and co-operation of the staff to whom I pay 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.I,. THROWER Medical officer of Health 13 STATISTICS AND SOCIAL CONDITIONS OF TH F AREA In the North the London Borough of Lambeth has a common boundary - down the middle of the Thames - with the Cities of London and Westminster, and is flanked by the Boroughs of Southwark and Wandsworth and, in the South has common boundaries with the Boroughs of Bromley, Croydon and Merton. The land surface rises from 12 feet above sea level at the river to 50 feet at Brixton, 150 feet at West Norwood, 200 feet at Streatham and about 379 feet at and near the Crystal Palace. The perimeter of the Borough measures 19½ miles and its total area is approximately 1014 square miles. In terms of population, Lambeth is the largest of the London Boroughs. The Borough has approximately 600 acres of park and open spaces including Brockwell, Kennington, Ruskin, Norwood, Archbishop's and Vauxhall Parks, Myatt's Fields, Streatham Common and parts of Clapham and Tooting Bec Commons. Amongst the world famous buildings within its 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. For Parliamentary purposes the Borough is divided into five constituencies, Vauxhall, Brixton, Norwood, Streatham and Clapham, each returning one Member of Parliament. For Borough Council elections the Borough is divided into a total of 20 wards each returning three Councillors. Four members are returned to the Greater London Council. 14 STATISTICS GENERAL Area of the Borough 6727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population Figure supplied by the Registrar General (Mid-year estimate 1966) 339,400 Density of Population - i.e. number of persons per acre (Based on Registrar General's Estimated Population) 50.4 Number of Marriages during the year 2,961 Marriage rate per 1,000 Population 8.7 Rateable Value of District (1st April, 1966) £20,064,764 Sum represented by a penny rate (1966 '67) £80,200 Number of separately rated houses and flats at 1st April 1966 9 2,244 VITAL STATISTICS Legitimate LIVE BIRTHS Illegitimate Totals Males 3,206 623 3,829 Females 2,990 553 3,543 Totals 6,196 1,176 7,372 Live Birth Rate per 1,000 home population 21.74 3irth Rate corrected for comparison with other areas 19.35 Comparability factor supplied by Registrar General 0.89 Birth Rate per 1,000 Home Population area covered by Greater London Council 17.7 Birth Rate per 1,000 Home Population England and Wales 17.7 Corresponding rate for the London Borough of Lambeth for the year 1965 19.5 Illegitimate Live Births per cent of total live births 16% 15 Legitimate STILL BIRTHS Illegitimate Totals Males 52 14 66 Females 45 2 47 97 16 113 Still Birth Rate per 1,000 Total Births (i.e. Live and Still) 15.2 Still Birth Rate per 1,000 total births England and Wales 15.3 Still Birth Rate - Greater London Area 14.2 DEATHS Males Females Total 1,900 1,904 3,804 Death Rate per 1,000 home population 11.2 Death Rate corrected for comparison with other areas 11.87 Comparability Factor supplied by Registrar General 1.06 Death Rate per 1,000 home population England and Wales 11.7 Corresponding rate for the London Borough of Lambeth for the year 1965 11.36 Death Rate per 1,000 home population for the area covered by the Greater London Council 11.1 MATERNAL MORTALITY Number of Women dying in consequence of Childbirth 3 Maternal Mortality Rate per 1,000 total births 0.4 Maternal Mortality Rate per 1,000 total births England and Wales 0.3 16 INFANTILE MORTALITY Deaths of infants under one year of age Legitimate Illegitimate Totals Males 71 14 85 Females 51 17 68 122 31 153 Date rate of infants under one year of age per 1,000 live births 20.8 Death rate of infants under one year of age per 1,000 live births England and Wales 19.0 Legitimate Infantile Mortality rate 19.7 Illegitimate Infantile Mortality rate 26.4 Deaths of infants under four weeks of age Legitimate Illegitimate Totals Males 46 10 56 Females 31 12 43 77 22 99 Neo-natal Mortality Kate (Deaths under four weeks per 1,000 live births) 13.4 Neo-natal Mortality Rate England and Wales 12.9 Deaths of infants under one week of age Legitimate Illegitimate Totals Males 39 10 49 Females 23 12 35 62 22 84 Early Neo-natal mortality rate (Deaths under one week per 1,000 live births) 11.4 Perinatal Mortality rate (Still births and deaths under one week combined per 1,000 total live and still births) 26.3 17 SUMMARY OF VITAL STATISTICS FOR THE T FN YEAR PERIOD 19 57 - 1966 METROPOLITAN BOROUGH OF LAMBETH 1957-1964 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 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 YEARS 1965-1966 1965 339,560 3,709 11.36 7,439 19.5 175 23.52 4 .51 1966 339,400 3,804 11.87 7,372 19.35 153 20.8 3 .40 * As adjusted by comparability factor. 00 LONDON ROIiOI'GII OF LAMBETH CAUSES OF DFATII AT DIFFERENT PERIODS OF LIFE DURING 196fi 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 11 - - - - - - - - 4 4 3 F 7 - - - - - 1 1 3 1 1 - 2. Tuberculosis, Other M 1 - - - - - - - - l - - F 1 - - - - - - - - - - 1 3. Syphilitic Disease M 6 - - - - - - - - 3 2 1 F 6 - - - - - - - - - 3 3 6. Meningococcal Infections M -_ - - - - - - - - - - - F 1 - - - - - - - - 1 - - 9. Other Infective and Parasitic Diseases M 3 - - 1 - - - - - - 2 - F 4 - - - - - - - 1 2 [ 1 10. Malignant Neoplasm, Stomach M 50 - - - - - - 1 9 13 14 13 F 38 - - - - - - 2 3 7 12 14 11. Malignant Neoplasm, Lung, Bronchus M 225 - - - - - 1 7 21 77 80 39 F 57 - - - - - - -- 8 10 23 16 12. Malignant Neoplasm, Breast M - - - - - - - - - - - - F 91 - - - - - 3 5 16 24 23 20 13. Malignant Neoplasm, Uterus F 33 - - - - - - 4 9 7 7 6 14. Other Malignant and Lymphatic Neoplasms M 173 - - - 1 1 2 6 18 38 58 49 F 185 1 - - - 1 2 5 19 31 61 65 15. Leukaemia, Aleukaemia M 6 - - 1 1 1 - - 1 2 - - F 7 - - 1 - - 1 • 1 1 " 3 16. Diabetes M 6 - - - - - - - 1 - 2 3 F 20 - - - - - -•- " 1 4 4 1 1 17. Vascular Lesions of Nervous System M 125 - - - - - - 1 12 28 33 51 F 234 - - - - - 1 4 14 27 59 128 18. Coronary Disease, Angina M 429 - - - - - 1 15 37 127 125 124 F 316 - - - - - - - 10 35 98 173 19. Hypertension with Heart Disease M 26 - - - - - . 1 2 6 9 8 F 26 - - - - - - - - 2 9 15 20. Other Heart Disease M 105 - - - 1 1 2 1 9 14 30 47 F 195 - - - - 1 2 3 6 12 26 145 21, Other Circulatory Disease M 81 - - - - - 1 3 7 31 19 20 F 102 - 1 - - - 2 2 2 9 19 67 22. Influenza M 6 - - - - - - - 1 3 1 1 F 6 - - 1 - 1 • • " "- 2 3 23. Pneumonia M 148 1 9 - 1 1 - 2 5 11 38 80 F 204 1 8 1 - 1 • 1 3 11 20 158 24. Bronchitis M 156 - 5 - - - 1 - 7 40 51 52 M F 73 - 5 - - - - - 3 7 17 41 25. Other Diseases of Respiratory System M 15 - - - 1 - 1 - 2 2 5 4 F 13 - • 1 - - 1 - ■ 2 2 7 26. Ulcer of Stomach and Duodenum M 13 - - - - - - - 2 1 6 4 F 29 - - - - - • - 1 1 8 19 27. Gastritis, Enteritis and Diarrhoea M 10 - 3 - - - - 2 1 2 1 1 F 8 - 1 - - - --- - * 1 2 4 s CAUSE OK 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 28. Nephritis and Nephrosis M a . . - . . . 1 2 1 2 2 F 6 - • • - - 2 - - 2 - 2 29. Hyperplasia of Prostate M 6 - - - - - • - - 1 1 4 30. Pregnancy, Childbirth, Abortion F 3 - • - • 2 - 1 - * • • 31. Congenital Malformations M 25 8 7 4 - - 1 1 - 3 - 1 F 19 9 5 1 1 - - 1 1 - 1 - 32. Other Defined and Ill-defined Diseases M 141 47 2 . 1 3 1 5 5 18 27 32 F 150 32 2 - - 6 - 4 7 19 24 56 33. Motor Vehicle Accidents M 40 . . 2 - 6 3 4 4 7 11 3 F 11 • - 2 1 • 1 • 1 1 1 4 34. All other Accidents M 42 - 2 4 2 7 2 - 6 4 9 6 F 32 - 2 2 - 3 1 - - 2 4 18 35. Suicide M 41 - - - - 5 3 9 7 9 3 5 F 26 - - - - 2 1 4 8 5 3 3 36. Homicide and Operation of War M 2 - 1 - - - - - - 1 - - F 1 - - - - - 1 • - - - • TOTAL ALL CAUSES M 1,900 56 29 12 8 25 19 59 159 447 533 553 F 1,904 43 25 9 2 16 19 37 117 224 429 983 GRAND TOTAL 3,804 99 54 21 10 41 38 96 276 671 962 1,536 21 VITAI, STATISTICS POPUT ATION The Registrar-General's mid-year estimate for the year 1966 is 339,400. This is a decrease of 160 on the mid-year estimate for 1965. The number of live births exceeded the deaths giving a natural increase of 3,568. This would appear to indicate a movement of residents out of the Borough. BIRTHS The number of live births decreased by 67, giving a corrected birth rate of 19.35 compared with 19.5 in 1965. The birth rate for the Borough is higher than that for England and Wales, and for the Greater London Area, which both stand at 17.7 per 1,000 home population. There was a reduction in the number of illegitimate births - 1,176 occuring compared with 1,222 in 1965. The percentage of illegitimate births, 16 per cent, is still high, in fact more than twice the National average. STILL BIRTHS Fewer still births occurred during the year, giving a still birth rate of 15.2 per 1,000 total births. This rate approximates to that for England and Wales, which is 15.3, but is slightly higher than that for the Greater London Area which is 14.2. DEATHS There were 95 more deaths in 1966 than in 1965, 3,804 deaths occurring compared with 3,709 last year. This, combined with the decrease in population, gives an increased death rate of 11.87. This rate is higher than that for England and Wales which is 11.7 and the Greater London Area which is 11.1. Heart and associated diseases accounted for the largest number of deaths. Malignant neoplasms of all forms ranked second in the causes of death. Fewer people died from Respiratory Tuberculosis. Deaths from Influenza, Pneumonia and Bronchitis increased 593 people dying from these causes compared with 479 in 1965. 22 There were no deaths during the year from diphtheria, whooping cough, poliomyelitis or measles. The number of people taking their own lives increased from 50 in 1965 to 67 during the year under review, and three deaths occurred from homicide. Motor vehicle accidents accounted for 51 deaths, an increase of 3 on the figure for 1965. There were three maternal deaths compared with four in 1965. Forty per cent of all deaths, 553 males and 983 females, were persons aged 75 years or over. INFANTILE MORTALITY Fewer infants died before reaching one year of age, 153 compared with 175 in 1965, giving a reduced infantile mortality rate of 20.8 per 1,000 live births. The mortality rate for the Borough, however, is slightly higher than that for England and Wales which at 19.0 per 1,000 live births is one of the lowest recorded in the country. Ninety nine of the infants died before reaching the age of four weeks, giving a neo-natal mortality rate of 13.4 per 1,000 live births compared with 12.9 for England and Wales. The causes of death fall into the undermentioned categories Cause of Death Male Female Total Malignant and lymphatic Neoplasms . 1 1 Vascular lesions of Nervous System - 1 1 Other circulatory disease - 1 1 Pneumonia 10 9 19 Bronchitis 5 5 10 Gastritis, enteritis, diarrhoea 3 1 4 Congenital malformations 15 14 29 Other defined and ill-defined diseases 49 34 83 Accidents 2 2 4 Homicide 1 - 1 85 68 153 23 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS The number of deaths from cancer of the lung and bronchus increased, 282 occurring compared with 247 in 1965. The deaths among men were nearly four times as great as among women, 225 compared with 57. The deaths were distributed amongst the various age groups as follows Age Male Female Totals 25-34 years 1 - 1 35-44 years 7 - 7 45-54 years 21 8 29 55-64 years 77 10 87 65-74 years 80 23 103 75 years and over 39 16 55 225 57 282 ROAD TRAFFIC ACCIDENTS My thanks are due to the Borough Engineer and Surveyor for the following information regarding road traffic accidents occurring within the Borough of Lambeth during the year 1966. The figures shown refer not only to Lambeth residents but also to persons living in other areas who were involved in accidents in the Borough. The number of fatalities shown may not agree therefore with those in the list of causes of death supplied by the Registrar-General. The Registrar-General's figures refer to Lambeth residents only, and the death may have occurred within the Borough of Lambeth or outside the district. Number of Accidents Adults 2,186 Children 562 Total 2,748 Number of Casualties Killed Adults Children Totals 42 3 45 Seriously injured 393 100 493 Slightly injured 2,394 508 2,902 2,829 611 3,440 24 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 Scarlet Fever Smallpox Tuberculosis, all forms Typhoid Fever Typhus Fever Whooping Cough 25 CORRECTED NUMBER OF NOTIFICATIONS, EXCLUDING TUBERCULOSIS, RECEIVED DURING 1966 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 15 13 9 5 6 11 10 6 40 35 75 Whooping Cough 23 28 29 14 22 25 26 17 100 84 184 Measles 37 37 158 178 136 148 392 365 723 728 1,451 Dysentery 6 22 11 12 6 8 8 6 31 48 79 Meningococcal Infection - - - - - - - 2 - 2 2 Acute Pneumonia 12 10 2 2 3 2 5 6 22 20 42 Acute Encephalitis ( Infective ) - - - - - 1 - 1 - 1 Typhoid Fever - 1 - - - - - - - 1 1 Paratyphoid Fever - - - - - 2 - - - 2 2 Erysipelas 2 2 - 1 2 1 1 - 5 4 9 Food Poisoning - 2 5 4 - - - 2 5 8 13 Puerperal Pyrexia Ophthalmia - 14 - 9 - 23 - 37 - 83 83 Neonatorum 1 - 1 - 3 - - - 5 - 5 TOTALS 96 129 215 225 178 220 443 441 932 1,015 1,947 26 NOTIFICATION OF INFECTIOUS DISFASFS - 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 - 9 7 44 40 2 1 - - 103 1 year - 1 20 9 119 101 2 1 - - 253 2 years 4 2 10 18 114 118 2 2 - 1 271 3 years 7 2 15 18 119 126 2 2 - - 291 4 years 10 7 14 9 94 94 5 - - - 233 5-9 years 12 19 28 19 202 218 8 11 - 1 518 10-14 years 4 2 3 2 9 9 1 1 - - 31 15-25 years 2 - - - 4 5 2 9 - - 22 25 and over - - - - 1 5 7 19 - - 32 Age unknown 1 2 1 2 17 12 - 2 - - 37 TOTALS 40 35 100 84 723 728 31 48 - 2 1,791 27 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION (Contd) Age Group Acute Pneumonia Acute Encephalitis (Infective) Typhoid Fever Paratyphoid Fever Erysipelas Food Poisoning Puerperal Pyrexia Ophthalmia Neonatorum Totals M F M F M F M F M F U F M F M F Under 5 years 5 3 - - - - - - - - 1 - - - 5 - 14 5-14 years 2 1 - - - - - - - - - 1 - - - - 4 15-44 years 7 2 1 - - - - 2 1 - 3 6 - 83 - - 105 45-64 years 7 8 - - - - - - 2 3 1 1 - - - - 22 65 and over 1 6 - - - 1 - - 2 1 - - - - - - 11 Age unknown - - - - - - - - - - - - - - - - - TOTALS 22 20 1 - - 1 - 2 5 4 5 8 - 83 5 - 156 GRAND TOTAL 156 1,791 1,947 28 NOTIFICATIONS OTHER THAN TUBERCULOSIS There was a general reduction in the number of notifications received during the year. In fact, the total number was less than half that for the year 1965. It is pleasing to report that no case of Diphtheria or Poliomyelitis was notified during the year. MEASLES The most prevalent infectious disease was measles, 1,451 cases occurring, thus accounting for 74% of the total notifications. In spite of this, however, there was a considerable reduction on the figure for 1965 when 3,578 cases were notified. No death occurred from the disease. SCARLET FEVER Seventy-five cases were notified compared with 120 in 1965. WHOOPING COUGH One hundred and eighty four cases were notified compared with 92 in 1965. There were no fatal cases. DYSENTERY There was a reduction in the number of cases notified, 79 cases occurring compared with 157 in 1965. MENINGOCOCCAL INFECTION Two cases were notified during the year, the same as for 1965. PNEUMONIA The number of cases notified was reduced by 7. Forty-two notifications were received compared with 49 in 1965. ACUTE ENCEPHALITIS (INFECTIVE) One case was notified, the same as in 1965. 29 ERYSIPELAS Nine cases occurred compared with 14 in 1965, a reduction of 5. PUERPERAL PYREXIA The incidence of this disease was practically the same, 83 cases being notified compared with 84 in 1965. OPHTHALMIA NEONATORUM Five infants were notified as suffering from the disease compared with 27 in 1965, a reduction of 22. FOOD POISONING 13 notifications were received compared with 34 in 1965. This was a reduction of 21. In all instances the causative agent was not identified. The cases were sporadic and there was no general or family outbreak. SALMONELLA INFECTIONS (Not Food Borne) In addition to the notified cases the following Salmonella infections were brought to the notice of the Health Department. 30 CAUSATIVE AGENT GENERAL No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained FAMILY No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases COLS. 1 + 3 + 5 TOTAL No. of cases COLS. 2+4 + 5 , 1 2 3 4 5 6 7 1. S. Typhimurium 2 5 10 12 15 2. Other Salmonellae 1 3 9 10 12 3. TOTAL 3 8 19 22 27 Type of Salmonellae Brandenberg 2 2 2 CholerasuisKunzendorf 3 3 3 Stanley 1 3 - 1 3 Schwarzengrund 1 1 1 Chester 1 1 1 Oranienberg 2 2 2 31 TYPHOID FEVER 1. On 15th February, 1966 information was received from a local hospital that a female patient, Miss M.T., resident in the Borough had been diagnosed las suffering from typhoid fever, and removed to an infectious diseases hospital. A visit was made to the patient's home address and it was ascertained that she had moved there from another address in the borough about a fortnight ago, and had been ill before leaving there. The patient's sister stated that the landlady at the latter address had been ill a few weeks previously. It proved very difficult to get specimens from this latter household, and the first specimens obtained from all the occupants were negative for S. Typhi, as were sewer swabs. All subsequent specimens from the household were negative, with exception of one obtained on 19th March, from the landlady, Mrs. M.B. who, at that time was feeling ill. She was removed to an infectious diseases hospital, and the history of her case is given below. All other contacts both at the home and in hospital proved negative to S. Typhi. She made a slow but good recovery, and was discharged home on 19th April, but was taken ill again on 25th April, and was found to be excreting the typhoid organism. Her condition again improved after treatment, but as it was felt that her gall-bladder was the reservoir of infection this was removed, and she made an uneventful recovery and has remained free from the disease ever since. 2. As stated above, Mrs. M.B. was a contact of the above case, but as she gave a history of previous similar illnesses, it was felt that she in fact was the source of the disease for the previous patient. The course of this case was similar to that of the previous one, as the infection did not clear up until her gallbladder was removed. Both of these cases were infected with the same strain of S. Typhi (phage-type 45) which is prevalent in the West Indies, whence both of these ladies came. 3. This case of typhoid, Miss E.G., was diagnosed, in the same hospital as the first case reported, on 25th February, but must have been from another source as the strain of organism - type E.l. - was different. This lady lived with her sister, but had quite a number of meals out, but generally patronised the same establishments. She had not been abroad in the period prior to the onset of her illness. None of her contacts, or the staff of the restaurants she frequented, were found to carry the organism, and swabs in the sewers also proved negative, so that the source of her infection was not found. 32 PARATYPHOID FEVER On 13th September, a message was received from the infectious diseases unit of a local hospital that a young woman, resident in the Borough, who had been admitted there three days previously had been diagnosed as suffering from Paratyphoid B. fever. She had returned from Turkey with her husband on 2nd September, and took up her duties as a schoolteacher on 5th September. She was only back at school two or three days before falling sick. Her only close contacts were her husband (a medical student) and her brother (a school teacher) who did not go to Turkey. These were supervised by the hospital treating the patient, and did not develop the disease. With the co-operation of the head teachers, of the schools at which the patient and her brother taught, cases of absence from school of staff and pupils in the following three weeks were investigated, but no secondary cases occurred. 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 1 - - - 3 2-4 years 2 - - - - 1 3 5-9 years - 2 - - - 1 3 10-14 years - 1 - - 1 1 3 15-19 years 2 4 - - - 1 7 20-24 years 9 4 - - 3 2 18 25-34 years 17 11 - 1 3 1 33 35-44 years 16 8 1 - - 2 27 45-54 years 15 2 - - 1 - 18 55-64 years 19 3 - - 1 - 23 65-74 years 7 2 - - 1 - 10 75 and over 3 1 - - - 2 6 Age unknown 3 2 - - - - 5 TOTAL 93 42 2 1 10 11 159 33 In addition to the above-mentioned cases, one new case, a female, was brought to the notice of the Medical Officer of Health other than by formal notification. I am indebted to Dr. H.J. Anderson, St. Thomas' Hospital for the following report on the work of the Lambeth North Chest Clinic for the year 1966. NORTH LAMBETH CHEST CLINIC - ST. THOMAS' HOSPITAL Number on Register-Dec. 1966 New Notifications 1966 Number of attendances Men Women Contact Examinations New Old B.C.G. Vaccinations given Newborn Children Staff 13 yr. old Total given Skin Tests given 1822 T.B. 51 Non-Pulmonary T.B. 55 6711 5107 11818 614 2908 86 149 14 2 251 751 North Lambeth Chest Clinic is an integral part of the Outpatient Department of St. Thomas' Hospital with clinics five mornings and four afternoons a week. All types of chest disease are seen, diagnosed and treated if necessary. There has been a noticeable increase in new cases of carcinoma of the bronchus - 49 bronchoscopies were arranged last year, to confirm this diagnosis. In tuberculosis, there were 55 new cases in the actual geographical area - many more were seen and dealt with. Approx. 150 patients are on domicilliary chemotherapy. The special clinics for bronchitis and asthma were well attended, and research on the causes continues. In-patient treatment for all chest diseases is available at the South Western Hospital (40 beds) and chest hospitals in the country, i.e. King George V. Hospital and Eversfield Chest Hospital. 34 The average age of patients is increasing, many are old age pensioners who derive great benefit from various forms of help provided by the Borough, including the recuperative holidays, holidays for the elderly, clubs and homes; many however are very worried by housing conditions and the financial difficulties that a long chronic illness brings. BATTERSEA CHEST CLINIC I am indebted to Dr. J.G.S. McQueen, Chest Physician, Battersea Chest Clinic for the following report on the work of the Clinic for the year 1966. Contracts. 488 contacts of tuberculous cases were examined, of whom 16 were found to be suffering from tuberculosis. Immigrants. It is the general experience in England that in areas where immigrants tend to settle in large numbers, there is an excessive amount of tuberculosis among them, and our area is no exception. Whereas in 1963 immigrants and their children (who may have been born in this country) provided 14% of all notifications in my clinic area, the percentage rose to 24% in 1964, 46% in 1965 and 61% in 1966. This occurred while the notifications among the native populatior of English, Irish, Welsh and Scottish extraction were decreasing, leaving the total number of notifications fairly constant. This excessive amount of tuberculosis mostly occurs in families who have been in this country for several years - few cases are found in immigrants on entry into the country. The total number of cases attending the clinic fa the first time (excluding tuberculosis contacts) was 552, and the total attendances were 4,362. Most of these cases were referred for diagnosis by general practitioners on account of symptoms referable to the chest, but not necessarily on suspicion of tuberculosis. 3,613 x-ray examinations were made. The clinic offers miniature (100 mm.) radiography on demand on two sessions per week - Tuesday afternoon and evening; to patients referred by General Practitioners. B.C.G. vaccination is offered to tuberculosis contacts, to immigrants and to children who may have missed the opportunity at school - 135 vaccinations were carried out. 35 MINISTRY OF HEALTH Form T.145 TUBERCULOSIS Return for year ended 31st December, 1966 PART I R.H.B. SOUTHWEST METROLITAN H.M.C B.G. Battersea, Putney & Tooting Names and addresses of Sanatoria, Hospitals and Chest Clinics in the H.M.C. or B.G. covered by this return Battersea Chest Clinic, St. John's Hospital, St. John's Hill, Battersea, S.W.ll. PART II 1. Number of cases of tuberculosis (whether notified or not) under treatment or supervision at 31st December. RESPIRATORY NON-RESPIRATORY Men Women Children Total Men Women Children Total 465 347 55 867 11 12 3 26 2. Number of cases of respiratory tuberculosis (whether notified or not) included in 1. new to the clinic (but excluding transfer from other clinics) during the year ended 31st December. NGN BACTERIOLOGICALLY CONFIRMED BACTERIOLOGICALLY CONFIRMED Men Women Children Total Men Women Children Total Group I 15 7 14 36 2 1 - 3 Group II 9 3 - 12 10 6 - 16 Group HI - - - - 1 - - 1 TOTALS 24 10 14 48 13 7 - 20 36 3. Number of cases of non-respiratory tuberculosis (whether notified or not) included in 1. new to the clinic (but excluding transfers from other clinics) during the year ended 31st December. Men Women Children Total 1 3 - 4 4. Number of cases included in 1. whose broncho-pulmonary secretion was positive during the year. 32 37 PERSONAL HEALTH SERVICES MATERNITY AND CHILD WELFARE CENTRES There are fourteen maternity and child welfare centres in the Borough, two in purpose built accommodation, eight in adapted accommodation and others in premises occupied on a sessional basis. This year it was hoped to improve the facilities in the Streatham Hill area by the adaptation of a house in Kirkstall Road, S.W.2. for use as a maternity and child welfare centre, but, due to the economic situation, the project was deferred until 1967 '68. MOTHERCRAFT AND RELAXATION CLASSES These classes are held by domiciliary midwives and health visitors in maternity and welfare centres for both hospital and domiciliary booked cases. One hundred and eleven women made 625 attendances during the year. DENTAL TREATMENT Dental treatment is provided for expectant and nursing mothers and children under 5 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. PHENYLKETONURIA Tests for the detection of phenylketonuria are carried out by health visitors on all babies before the age of 8 weeks. Phenylketonuria is a metabolic disorder which if left untreated may lead to mental subnormality. 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. 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. 38 HEALTH VISITING The health visiting service is provided by the Council under Section 24 of The National Health Service Act 1946. The work of the health visitor has many facets, embracing directly or indirectly all the social services provided for every member of the family. She maintains close liaison with social workers, general practitioners and hospitals. Other duties include attendance at ante-natal, post-natal and child welfare clinics, running mothercraft and relaxation classes and the important function of health education practised in the home, clinics and schools. There is a growing demand for the services of health visitors, and vacancies continue to exist. (See page 50). HOME NURSING The Lambeth District Nursing Association continued to provide, on behalf of the Council, a home nursing service throughout the Borough for which it receives an appropriate grant. In addition, service is given in a small area in the north of the Borough by the Catholic Nursing Institute (see page 50). 39 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 219 94 Stool Commodes 138 52 Bed Cradles 9 5 Dunlopillo Mattresses 4 - Zimmer Walking Aids 6 2 Back Rests 9 6 Penryn Hoists 5 8 Hospital Beds with lifting pole 6 5 Homecraft Walking Frame 10 5 Fracture Boards (Sets of 4) 24 1 Easicarri Hoists 6 2 Mattresses with covers 4 3 Zimmer Heavy duty Patient Lifter with Sling 1 1 Adult Cot Bed 1 1 Warral Walking Sticks (Tripod) 3 1 Potty Chair 1 - Infant Toilet Seat 3 - Sanitary Chair 1 - Forty-two fire guards were lent to necessitous families with children under 12 years of age, or to necessitous old, handicapped or blind persons. Seven were returned. INCONTINENCE PADS Supplies of incontinence pads have been issued to sixty-one patients 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. 40 DOMICILIARY MIDWIFERY SERVICE The Council discharges its responsibility for the domiciliary midwifery service under the National Health Act 1946, by the direct employment of midwives and through arrangements with the South London Hospital and Lambeth District Nursing Association. The demand for hospital maternity beds continues to be heavy, and the number of mothers entering hospital for their confinements is increasing, in consequence more mothers are being discharged after 48 hours in hospital to the care of the domiciliary midwife to be nursed at home. There have been some changes in the staff of the service during the year. Five midwives left the service for various reasons, and three newly qualified persons were appointed as replacements. During the year 29 pupil midwives from two hospitals in the Borough took their Part II midwifery district training with Lambeth midwives. A teaching hospital in the Borough accepted pupil midwives for training in September 1966. Two of these pupils came to Lambeth for their district training, and two to the Lambeth District Nursing Association to work with the midwives there. Clinics are held in the Centres by the Council's medical officers and midwives, and by general practitioner obstetricians, at which they examine their patients with the midwives. The clinics are attended by patients booked for both domiciliary and hospital confinements. The twenty-four hour supervision of the service shared with the Boroughs of Southwark and Wandsworth through the Emergency Control Service continues to work satisfactorily. Thanks are due to the Lambeth District Nursing Association and the South London Hospital for their co-operation and help during the year. MIDWIVES ACT 1951 The Council is the supervising authority for all midwives practising in the Borough under the Midwives Act 1951. During the year 258 midwives notified the Council of their intention to practise in the Borough. 41 FAMILY PLANNING The Council provides the Family Planning Association with free use of Clinic premises and also makes a per capita payment to the Association in respect of married women referred for family planning advice on medical grounds. The arrangements are similar to those commended to local health authorities by the Minister of Health in Circular 5/66. The issue of this circular and the publicity which accompanied it has led to an increased interest in, and awareness of family planning services generally. Two hundred and five mothers were referred on medical grounds to the family planning association. DAY NURSERIES The Council's Day Nurseries continued to maintain a high rate of attendance. When it became necessary to close Streatham Day Nursery before the new building was completed additional places were made available at the remaining nine nurseries so that the total number of places was not reduced. The new nursery in Upper Tulse Hill is nearing completion. CHILD MINDING The Council is responsible for the registration and supervision of day nurseries and child-minders under the Nurseries and Child-Minders Regulation Act 1948. Because of the lack of nursery school provision in the Borough, there is a continued demand from mothers, particularly in the southern part of the Borough, with children in the three and four years age group, for play group facilities. This demand is being met largely by private individuals and, in fact, often by mothers themselves co-operating to provide facilities either in their own homes or at other premises. This led to an increasing number of applications for registration. At the end of the year there were in the Borough as a whole twenty-three premises or persons registered providing 427 places. The Council operates a scheme for the voluntary registration of child-minders who care for up to two children under five years of age. At the end of the year there were 74 minders so registered, who were caring for 95 children. "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, 42 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 regular intervals. OCCASIONAL CRECHES These are provided at selected Welfare Centres for the minding of small groups of children from two to five years of age, whilst 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 1/9d per child abatable in necessitous cases. No charge is made when the parent is attending a centre activity or a hospital appointment. PREVENTION OF BREAK-UP OF FAMILIES Co-ordination of Services The Standing Committee for Co-ordination continued its work during the year. Quarterly meetings were held, two under the Chairmanship of the Medical Officer of Health and two under the Chairmanship of the Children's Officer. The Committee which co-ordinates the services available in Lambeth to prevent child neglect and the break-up of families, includes the chief officers of the Health, Children's, Housing and Welfare Departments, with the appropriate Senior Officers, the Associate Town Clerk and senior representatives of the Inner London Education Department, the Greater London Council Housing Department and the local offices of the Ministry of Social Security. During the year existing procedures were reviewed and amended. A routine for closer liaison with the Probation Service was agreed, as were the basic principles for the establishment of a residential rehabilitation unit in the Welfare Department, and the provision of a strictly limited amount of long-term sheltered accommodation, at assessed rents, under casework supervision by the Housing Department for families incapable of response to rehabilitation. In July 1966 an index of families was set up by the Children's Officer to facilitate consultation with the police and N.S.P.C.C. 43 One Hundred and fifteen families were involved receiving intensive casework service, from the following workers- Family service unit 39; Health service 35; N.S.P.C.C. 22; Children's Department 19. A meeting was held at Lambeth Town Hall in October 1966 to which the principals of all the main local voluntary agencies were invited and agreements were reached which linked their work still more closely with the statutory authorities. Seventy four case conferences were held to discuss the problems of individual families at the request of the following Children's department 18 Health Department 18 Lambeth Housing Department 9 G.L.C. Housing Department 8 I.L.E.A. 6 Welfare Department 5 Probation Service 3 Family Service Unit 2 N.S.P.C.C. 2 Maudsley Hospital 2 Brixton Child Guidance 1 74 HEALTH SERVICES FAMILY CASEWORKERS Families are referred to these workers from the co-ordinating Committee case conferences, when they present multiple problems which demand more time and care than can be given by normal services. The work is both intensive and prolonged and caseloads must of necessity be kept small, or the aim of providing the service would be defeated. Progress is always slow, with many backsliders; some families indeed may need years of supervision while the children are growing up. The two full time caseworkers employed by the department were concerned during the year with a total of 38 families involving 161 children. 44 VACCINATION AND IMMUNISATION Parents are encouraged to have their babies vaccinated against diphtheria, whooping cough, tetanus, poliomyelitis and smallpox. This may be done, either by the Council's doctors at maternity and child welfare centres and schools or by general practitioners. Re-inforcing doses are also given to older children under similar arrangements. As a result of the controlled trials of measles vaccines undertaken by the Medical Research Council, in which the Health Department co-operated, the Minister of Health issued a circular (6/66) indicating that he was prepared to consider giving approval to any authority who wished to include vaccination against measles a part of its prophylaxis arrangements. This, the Health Committee decided to do, and subsequently the Minister agreed to an amendment to the Council's proposals under the National Health Service Act 1946 to enable measles vaccinations to be undertaken. INTERNATIONAI. CERTIFICATES OF VACCIN ATION 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. C.ARCTNOMA OF THE CERVIX-CYTOLOGICAI. DIAGNOSIS After protracted negotiations a limited service for the collection of cervical smears from well women for cytological diagnostic investigation was commenced in May 1966. Twenty smears per week from two clinics in Lambeth are examined at the South London Hospital Laboratory. Five hundred and eighty one women were examined up to 31st December, 1966 and three positive cases were discovered. It is hoped to expand the service considerably in the near future, but this is dependent on the capacity of hospital laboratories to train the necessary technicians. 45 TUBERCULOSIS The Council is responsible for the services for the prevention of tuberculosis and the care and after-care of Tuberculous patients in the community. These services are carried out in conjunction with the chest clinics provided by the Regional Hospital Boards and the Boards of Governors of teaching hospitals, and are under the general supervision of the chest physician. The Council either employs directly or pays the full cost of T.B. Health Visitors and Welfare Officers who are based at the chest clinic and reimburses the hospital authorities an agreed proportion of the cost of the salary of the chest physician. Extra nourishment (Milk, butter and eggs) are supplied on the recommendation of the Chest Physician and clothing is also provided to a small number of patients. During the year 132 cases received extra nourishment or other benefits. The Council is responsible for Knight's Hill Hostel for homeless infective tuberculous men which provides 32 places. This hostel is one of three serving the Inner London Boroughs. Most of the residents at Knight's Hill are chargeable to other boroughs. B.C.G. Vaccination B.C.G. Vaccination against tuberculosis is undertaken both at the chest clinics, which normally deal with contacts, and by the Council's doctors in schools. This protection is offered to all 13 year old school children each year, and during the period 475 contacts and 3,153 school children were vaccinated. RECUPERATIVE HOLIDAYS Recuperative holidays are provided for expectant and nursing mothers and children under five, psychiatric patients and other adults recovering from illness where a short term holiday involving rest, fresh air and good food only is needed, and regular medical supervision and organised nursing are not required. Patients are placed in private homes and hostels, etc. approved by the Health Department. A total of 146 holidays were provided as follows Expectant and nursing mothers and children under five Psychiatric patients Other adults 37 17 92 46 Similar holidays are arranged (or school children as part of the School Health Service at homes at Deal and Bognor Regis, run by the I.L.E.A. One hundred and fifty four Lambeth children were sent on holiday during the year. 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. Treatment is provided at six centres for certain priority classes including the aged, expectant and nursing mothers, school children and the handicapped. Sessions totalled 1,745 at which 10,807 treatments were given. MENTAL HEALTH SERVICES MENTAL HEALTH SOCIAL WORKERS Mental Health Social Workers deal with the care in the community of the mentally ill and mentally subnormal. They provide support and guidance to | patients and their families and ensure that they receive appropriate community care services and other social and medical services as required. Mental Health Social Workers also have statutory responsibility in connection with compulsory admission to hospital of the mentally disordered when this is necessary, they also assist in arranging informal admissions for their patients when this is more appropriate. A twenty-four hour service is maintained in conjunction with the neighbouring boroughs of Wandsworth and Southwark to deal with emergencies and operates through the Lambeth Emergency Control Service. DAY TRAINING CENTRES 1. Junior Training Centres No Junior Training Centre passed to Lambeth on 1st April, 1965 and to date it has not been possible to open any in the Borough. The Health Committee has, on several occasions, expressed its concern about the situation and has agreed to a number of temporary measures to ease the position until the Council is able to provide an adequate service in the Borough. These have included the admission of severely subnormal children aged 3 to 5 years to day nurseries free of charge, the opening of the special nursery unit at Tulse Hill day nursery and the provision of transport to enable a number of children to attend the training school at Queen Mary's Hospital, Carshalton. In addition, the Committee agreed a scheme for the purchase and adaptation of a 47 school for use as a junior training centre which will go some way to meet the problem although further accommodation will be required before purpose built centres become available. 2. Adult Training Centres Lambeth has one adult training centre. This is an all male centre at Clapham and provides 90 places for subnormal men over 16 years of age. There are 47 Lambeth men attending the centre, the remaining places being occupied by trainees from other boroughs. Thirty-three Lambeth women attend adult training centres in other boroughs. HOME TRAINING The training and occupation for the house bound mentally ill is provided by way of diversional therapy and four patients are receiving regular visits from an occupational therapist. Mentally subnormal children who are unable to attend training centres due to physical handicap receive tuition appropriate to their needs from a home teacher. RESIDENTAL CARE In the absence of residential accommodation administered by the Borough financial responsibility is accepted for 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 both long term and short term care. DAY HOSPITALS FOR MENTALLY ILL 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 in Lambeth 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 treated. HOME HELP SERVICE The demand for the service was maintained during the year. Approximately 88% of the households serviced contained a person over the age of 65. 48 As in 1965 the service was organised in three areas, each staffed by a home help organiser, assistant home help organiser and clerical staff based on offices in Offley Road (Lambeth North) Loughborough Welfare Centre (Lambeth Central) and Riggindale Welfare Centre (Lambeth South). Home Help is provided without charge for families where the mother is suffering from toxaemia erf pregnancy in order that she may undergo the prescribed treatment. Many special needs were met often preventing the break-up of families, reception of children into care and school absence. ANTE-NATAL AND POST NATAL CLINICS Number of Sessions held by: Medical Officers 10 Midwives 50 Sessional General Practitioners 240 Number of women attending for ante-natal examination 1,433 Numer of women attending for post-natal examination 55 Mothercraft and Relaxation Classes Number of women attending:- (a) Hospital booked 93 (b) Domiciliary booked 18 Total 111 Total number of attendances 625 49 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS ATTENDANCES AND TREATMENT A. Number of visits for Treatment during the year Children Expectant and 0-4 (incl) Nursing Mothers First visit 138 30 Subsequent visits 152 58 Total visits 290 88 Number of additional courses of treatment, other than the first course, commenced during the year 7 Treatment provided during the year Number of fillings 206 55 Teeth filled 186 49 Teeth extracted 42 14 General anaesthetics given 16 6 Emergency visits by patients 29 16 Patients x-rayed - - Patients treated by scaling and/or removal of stains from teeth 14 11 Teeth otherwise conserved 215 Number of courses of treatment completed during the year 59 19 B. Patients supplied with a full upper or full lower denture - first time 27 Patients supplied with other dentures 28 2 Number of dentures supplied 29 2 C. General anaesthetics administered by Dental Officers 30 9 D. Inspections during year - First inspections 326 9 Patients in A and D above who required treatment 141 9 Patients in B & C above who were offered treatment 140 9 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period 46.2 50 HEALTH VISITING Cases visited by Health Visitors Children born in 1966 7,334 Children born in 1965 6,989 Children born in 1961-64 14,433 28,756 Persons aged 65 and over 134* Mentally disordered persons 72ø Persons, excluding Maternity cases discharged from hospital (other than Mental Hospitals) 54+ Number of Tuberculous households visited 15 Number of households visited on account of other infectious diseases 35 Total number of effective visits and re-visits 77,285 Total number of unsuccessful visits 15,754 * Included in this figure are 57 persons who were visited at the special request of the general practitioner or hospital. 6 Included in this figure are 16 persons who were visited at the special request of the general practitioner or hospital. + Included in this figure are 39 persons who were visited at the special request of the general practitioner or hospital. HOME NURSING Total number of persons nursed during the year 4,890 Number aged under 5 at first visit during the year 586 Number aged 65 and over at first visit in the year 2,632 Total number of visits during the year 148,853 51 HOME HELP SERVICE Persons for whom service was provided during the year Aged 65 or over 3,566 Chronic sick and tuberculous persons 327 Mentally disordered 4 Maternity cases 145 Others 362 Total 4,404 DOMICILIARY WIDVVIFERY Attendances by midwives Confinements Doctor not booked 4 Doctor booked 956 Number of hospital cases discharged to midwife before tenth day 573 CHILD WELFARE CENTRES Number of children attending during the year Born in 1966 6,001 Born in 1965 5,377 Born in 1961-1964 5,162 Total 16,540 Number of sessions held during the year by Medical Officers 145 Health Visitors 15 Sessional General Practitioners 2,464 Hospital Medical Staff 102 2,726 Number of children referred elsewhere 655 Number of children on "at risk" register at the end of the year 2,640 52 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. Homes registered during the year - - - - 2. Homes whose registrations were withdrawn during the year . . . 3. Homes on the register at the end of the year 10 99 136 235 53 DAY NURSERIES Nurseries mainted by the Authority or by Voluntary organisations under Section 22 of National Health Service Act 1946 Number at end of the year 9 Number of approved places 514 Average daily attendance 479 Number of children on register at the end of the year 595* * This figures includes those on the register at the Streatham Hill Day Nursery dispersed to other nurseries at 5.12.1966 and awaiting placement in new premises. DAILY MINDERS AND REGISTERED NURSERIES Nurseries and Child Minders Regulation Act 1948 Number of Premises registered at the end of the year 12 Number of places 316 Daily minders registered at end of year 11 Number of children minded at end of year 111 National Health Service Act 1946, Section 22 Number of Daily minders receiving fees from the Authority at the end of the year 74 Number of places and children minded at end of the year 95 54 IMMUNISATION AND VACCINATION 1966 Immunisation: Complete Primary Courses-Number of Persons under age 16 Type of Vaccine or dose Year of Birth 1966 1965 1964 1963 1959-62 Others under age 16 Total   1. Quadruple DTPP 4 14 3 - 2 - 23 2. Triple DTP 2,724 2,376 348 141 174 51 5,814 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 4 9 6 9 133 139 300 5. Diphtheria - - - - 1 13 14 6. Pertussis - - - - 1 - 1 7. Tetanus - - - - 4 24 28 8. Salk - - 1 - - - 1 9. Sabin 963 3,298 541 270 590 484 6,146 10. Total-Diphtheria 2,732 2,399 357 150 310 203 6,151 11. Total-Whooping Cough 2,728 2,390 351 141 177 51 5,838 12. Total-Tetanus 2,732 2,399 357 150 313 214 6,165 13. Total-Poliomyelitis 967 3,312 545 270 592 484 6,170 55 IMMUNISATION: REINFORCING DOSES-NUMBER OF PERSONS UNDER AGE 16 Type of Vaccine or dose Year of Birth 1966 1965 1964 1963 1959-62 Others under age 16 Total 1. Quadruple DTPP - 3 4 - 14 2 23 2. Triple DTP - 1,739 1,507 162 635 108 4,151 3. Diphtheria/Pertussis - - - - - - 4. Diphtheria/Tetanus - 19 78 34 1,846 1,211 3,188 5. Diphtheria - - - 1 17 100 118 6. Pertussis - - - - - - - 7. Tetanus - - - - 3 12 15 8. Salk - - - - - - - 9. Sabin - 28 47 21 1,880 947 2,923 10. Total-Diphtheria - 1,761 1,589 197 2,512 1,421 7,480 11. Total-Whooping Cough - 1,742 1,511 162 649 110 4,171 12. Total-Tetanus - 1,761 1,589 196 2,498 1,333 7,377 13. Total-Poliomyelitis - 31 51 21 1,894 949 2,946 56 SMALLPOX VACCINATION Number of Persons Vaccinated Age 0-3 months 4-6 months 7-9 months 10-11 months 1 year 2-4 years 5-15 years Total Primary 9 32 25 34 2,002 872 136 3,110 Re-vaccination - - - - - 7 147 154 57 MENTAL HEALTH Number of persons under Local Health Authority care at 31st December, 1966 Mentally ill Elderly mentally infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1 Total number 3 . 134 164 49 31 92 72 88 69 94 82 878 2 Attending training centre 14 7 23 3 5 5 54 40 38 34 223 3 Awaiting entry to training centre 16 17 23 18 74 4 Receiving home training 1 1 5 2 2 11 5 Awaiting home training 6 Resident in L.A. home/hostel 5 3 8 7 Awaiting residence in L.A. home/hostel 8 Resident at L.A. expense in other homes/hostels 7 11 1 4 3 2 3 6 37 9 Resident at L.A. expense by boarding out in private household 7 1 1 9 10 Attending day hospitals 4 1 5 Receiving home (a) suitable to 11 visits and not attend a included in training lines 2-10 centre 14 20 34 (b) others 3 103 142 10 11 77 65 4 6 40 20 481 58 59 MENTAL HEALTH Number of patients awaiting entry to hospital, admitted for temporary residential care or admitted to guardianship during 1966 Mentslly Ill Elderly mental infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1. Number of persons in L.H.A. area on waiting list for admission to hospital at end of year (a) In urgent need of hospital care 2 1 9 3 15 (b) Not in urgent need of hospital care 1 2 6 9 (c) Total 2 1 1 11 9 24 2. Number of admissions for temporary residential care (e.g. to relieve the family) (a) To N.H.S. hospitals 2 15 13 6 6 42 (b) To L.A. residential accommodation (c) Elsewhere 1 5 2 8 (d) Total 2 1 20 15 6 6 50 Guardian Mentally Ill Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) 3. (s) Admissions to guardianship during the year L.H.A. Other Total (b) Total number under guardianship at end of year L.H.A. 2 1 3 Other Total 2 1 3 60 MENTAL HEALTH Number of persons referred to Local Health Authority during year ended 31st December 1966 Mentally Ill Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (a) General practitioners 2 1 117 172 1 1 3 1 2 300 (b) Hospitals, on discharge from in-patient treatment 80 77 1 1 4 4 1 4 1 1 174 (c) Hospitals, after or during out-patient or day treatme nt 1 65 79 1 1 4 2 1 154 (d) Local education authorities 5 1 5 1 13 17 10 17 5 11 3 88 (e) Police and courts 167 45 1 4 1 1 219 (f) Other sources 1 200 266 32 23 19 18 26 15 4 2 606 (g) Total 9 2 634 640 1 2 46 43 41 45 33 30 8 7 1,541 61 ENVIRONMENTAL HEALTH SERVICES GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA CARE OF THE AGED This work continued to expand, and the number of visits made by the three visitors increased by 771. During the year 1,042 new cases were brought to the notice of the Health Department, an increase of 76 over the number of new cases for 1965. The age groups into which these new cases were divided were as follows:- Male Female Totals 60-69 years 60 141 201 70-74 years 78 141 219 75-79 years 69 146 215 80-89 years 93 255 348 90-94 years 10 41 51 95 years and over 2 6 8 312 730 1,042 The total number of visits made during the year was 8,699. The number of old people persuaded to enter hospitals or institutions voluntarily was 316. One person was removed to an institution by a Court Order under Section 47 of the National Assistance Act 1948. In addition a total of 2,885 persons received help in some form or another. The number of cases on the register, including those from previous years is 4,528. LAUNDRY SERVICE FOR AGED INCONTINENT The arrangements made with Southwark Borough Council for carrying out this service continued during the year. The total number of persons receiving benefit from the scheme during the year was 277 (240). The total visits made were 5,986 (4,574) and the total number of soiled articles collected and taken to Southwark Cleansing Station was 62,938 (52,814). The total weight of the laundry cleansed was 53,105 (45,282) lbs. The figures given in brackets are those for the year 1965. 62 HOME BATHING SERVICE The number of aged persons receiving benefit from this service increased during the year, and 4,100 baths were given. WATER SUPPLY I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board, for the following report on the water supply to the Borough. The supply to the Borough of Lambeth has been satisfactory both as to quality and quantity throughout 1966. The supply was derived from the following works and pumping stations River Thames (Southern Group) and Honor Oak Well. No new sources of supply were instituted. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. No fluoride was added, and where the fluoride content is indicated it represents the naturally occurring fluoride in the water. The supply being hard in character is not liable to be plumbo-solvent. All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. The board has no record of the number of structurally separate dwellings supplied in Lambeth, but the population supplied direct according to the Registrar General's estimates at 30th June, 1966 was 339,396. EXAMINATION OF WATER SUPPLY Bacteriological Results-Yearly Averages 1966 Source of supply BEFORE TREATMENT Number 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 68 0.1 34 99.59 0.1 97.06 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 1,825 10.8 - 99.18 99.95 Honor Oak 70 0.0 15 100.0 100.0 64 Average Results of Chemical Examination Milligrames per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27 C B.O.D. 5 days at 20 Thames-derived South of River 156 0.029 0.090 4.4 1.27 Honor Oak 3 0.055 0.033 0.1 0.39 Description of the Sample Hardness (total) CaCO 3 Hardness (noncarbonate) CaCO 3 Magnesium as Mg Sodium Potassium as Na Sod ium Potassium as K Chloride as C1 Thames-drived South of River 279 77 5 24.2 5.0 32 Honor Oak 316 53 11 14 Description of the Sample Phos phate as PO4 Silicate as SiO 2 Sulphate as SO 4 Natural Fluoride as F Surfaceactive Material as Manoxol OT Turbid ity units Thames-drived South of River 1.8 9 62 0.20 0.01 0.1 Honor Oak 17 72 4.0 Description Colour (Burgess units) pH value Electrical Conductivity (micromhos) Thames-drived South of River 15 7.8 560 Honor Oak 9 7.2 550 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 three 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. The well in Clapham, Rectory Grove, formerly in the old Metropolitan Borough of Wandsworth, is used if and when required to augment the Metropolitan Water Board supply. This well is 400 feet deep supplying 15,000 gallons per hour, and was originally installed in 1927. 65 Sewers I am indebted to the Borough Engineer for supplying me with the following information with regard to sewers within the Borough. During the year a sum of £37,600 was spent on the general maintenance, flushing and cleansing of the sewers for which the Council are the authority. Part of the cleansing works were carried out under contract using a high pressure jetting method. SUM MARY OF WORK DONE BY DISTRICT PUBLIC HEALTH INSPECTORS (1) Inspections Houses/flats inspected under Public Health Act 1936 5,664 Separate lettings 624 Revisits Houses/flats 6,745 Separate lettings 151 (2) Other inspections and visits Miscellaneous 3,879 Prevention of Damage by Pests Act 1949 47 Infectious Diseases 335 National Assistance Acts 1948 and 1951 (aged and Infirm) 11 Factories Act 1961-Outworkers 42 Pet Animals Act 1951 16 Noise Nuisances 185 Food Premises 3,505 Non-effective visits 3,849 (3) Nuisances and Notices Notices served-Public Health Acts 1936 and 1961 (a) Informal 1,292 (b) Statutory 1,640 Notices complied with-Public Health Acts 1936 and 1961 (a) Informal 726 (b) Statutory 718 66 (4) Legal Proceedings Summonses applied for 105 Nuisance Orders made by Magistrates 22 (3) Drainage Plans examined 514 Examinations and Tests 1,448 (6) Complaints Dealt with during year 4,606 (7) Land Charges Act 1925 Enquiries dealt with 3,293 (8) Rent Act 1957 Applications for Certificates of Disrepair 1. Number of applications for certificates during 1966 9 Applications carried forward to 1967 Nil 2. Decisions not to issue Certificates Nil Undertakings on Form K accepted 6 3. Decisions to issue certificates (a) in respect of some, but not all defects 5 (b) in respect of all defects 4 4. Undertakings given by landlords under paragraph 5 of the First Schedule 6 5. Undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil 6. Certificates issued 3 Applications for Cancellations of Certificates 7. Applications by landlords to Local Authority for cancellation of Certificates 4 8. Objections by tenants to cancellation of certificates 1 9. Decisions by Local Authority to cancel in spite of tenants objections Nil 10. Certificates cancelled by Local Authority 3 (9) Improvements effected as a result of service of Notices under the Public Health Act 1936 and 1961 1. Brickwork-walls repaired or rebuilt 12 2. Drains cleared, repaired etc. 165 3. Dampness remedied 282 67 4. Fireplaces and ranges repaired/renewed 18 5. Floors repaired 78 6. Flues repaired 2 7. Internal walls repaired 93 8. Ceilings repaired 127 9. Rainwater pipes/gutters repaired/renewed 88 10. Roofs repaired 163 11. Rooms cleansed 12. Sinks provided/renewed 7 13. Soil pipes repaired and renewed 16 14. Staircases repaired 17 15. Staircases or passages cleansed 2 16. Waste Pipes repaired /renewed 42 17. Water closet apartments cleansed 30 18. Water closet pans and traps renewed 26 19. Water closet-flushing apparatus repaired or renewed 62 20. Water closets-general repairs 29 21. Water supplies provided 24 22. Water services pipes repaired 23 23. Window sash cords renewed 71 24. Windows repaired or renewed 89 25. Miscellaneous improvements 63 Total 1,529 PUBLIC HEALTH ACT 1936 - SECTIONS 39 and 45 PUBLIC HEALTH ACT 1961-SECTIONS 17 and 18 Work required to be done tor Drains, Sanitary Conveniences and premises. Consequent upon Notices served by the Public Health Inspectors, the Council, in pursuance of their powers under the above Acts, carried out works in default in 36 cases. SEALING OF DISUSED DRAINS Many infestations erf rats can be traced to dis-used drains from demolished property not being properly sealed from the sewer. In many cases there are no drainage plans of these old premises and it is a long and tedious job to trace the run of the drains. To assist in this work, a Technical Assistant (Drainage) was appointed in September, and an organisation has been set up to make sure that all disused drains are sealed as near to the sewer as possible when premises are being demolished. 56 drains were sealed under the supervision of the drainage assistant 75 drainage systems were tested in respect of new premises and 37 tested in existing premises. 68 NUISANCE ARISING FROM STOPPED UP DRAINS - EMERGENCY SERVICE In December 1965 the Council agreed that the Department be given general authority under Section 22 of the Public Health Act 1961, on application from owners or occupiers, to carry out emergency rodding of stopped up drains, and that this service be free of charge. The service has proved highly successful and has been much appreciated by the Ratepayers and there has also been a saving of time of the technical and administrative staff. 74 drains were cleared as a matter of urgency during the year. LEGAI. PROCEEDINGS Statutory action was taken in respect of 105 cases for failure to comply with Notice under Section 93 of the Public Health Act 1936. Abatement Orders were obtained in 22 cases, details of which are set out as follows:- Date Address Magistrate's Decisions 26. 1.66 17 Zennor Road, S.W.12. Ordered Abatement in 14 days defendant to pay £2 costs. 26. 1.66. 104, Hargwyne Street, S.W.9. Ordered Abatement in 21 days defendant to pay £2 costs. 2. 3.66. 25 Gateley Road, S.W.9. Ordered Abatement in 28 days defendant to pay £2 costs. 2. 3.66. 37 Cavendish Gardens, S.W.4. Ordered Abatement in 21 days defendant to pay £2 costs. 2. 3.66. 38 Cavendish Gardens, S.W.4. Ordered Abatement in 21 days defendant to pay £2 costs. 2. 3.66. 44 Pulross Road, S.W.9. Ordered Abatement in 14 days defendant to pay £2 costs. 20. 4.66. 44 Pulross Road, S.W.9. Ordered Abatement in 14 days defendant to pay £2 costs. 24. 5.66. 118 Lyham Road, S.W.2. Ordered Abatement in 21 days defendant to pay £1 costs. 24. 5.66. 61a Hackford Road, S.W.9. Ordered Abatement in 21 days defendant to pay £2 costs. 24. 5.66. 38 Cavendish Gardens, S.W.4. Ordered Abatement in 21 days defendant to pay £1 costs. 1. 6.66. 15 Nealden Street, S.W.9. Ordered Abatement in 14 days defendant to pay £2 costs. 69 27. 7.66. 19 Pendennis Street, S.W.16. Ordered Abatement in 21 days defendant to pay £2 costs. 1.11.66. 152 MayallRoad, S.E.24. Ordered Abatement in 21 days defendant to pay £2 costs. 1.11.66. 34 Heath Road, S.W.8. Ordered Abatement in 14 days defendant to pay £2 costs. 1.11.66. 146 Landor Road, S.W.9. Ordered Abatement in 14 days defendant to pay £2 costs. 29.11.66. 160 Hamilton Road, S.E.27. Ordered Abatement in 21 days defendant to pay £2 costs. 29.11.66. 22 Hay croft Road, S.W.2. Ordered Abatement in 21 days defendant to pay £2 costs. 29.11.66. 30 Med win Street, S.W.4. Ordered Abatement in 14 days defendant to pay £2 costs. 29.11.66. 34 Pearman Street, S.E.1. Ordered Abatement in 21 days defendant to pay £2 costs. 29.11.66. 30 Wincott Street, S.E.11. Order for Council to carry out works within 21 days. 29.11.66. 38 Cavendish Gardens, S.W.4. Ordered Abatement in 28 days defendant to pay £2 costs. 29.11.66. 22 Pearman Street, S.E.1. Ordered Abatement in 28 days defendant to pay £2 costs. 45 cases were adjourned sine die and 38 cases withdrawn following the carrying out of works to abate nuisance. REHOUSING AND OVERCROWDING APPLICATIONS FOR REHOUSING 1,578 cases were dealt with during the year on the following grounds :Lambeth Borough Council Health 1,173 Insanitary conditions 147 Cases previously investigated and checked as being rehoused by Lambeth Borough Council 199 1,519 Greater London Council Health 19 Insanitary conditions 1 Cases previously investigated and checked as being rehoused by Greater London Council 39 59 1,578 70 DISINFECTION The following is a summary of the work carried out by the staff of the Wanless Road Disinfecting Station Number of premises in which cases of Infectious Diseases have occurred 164 Number of rooms included in above 241 Total number of rooms sprayed for all purposes 2,465 Number of articles disinfected by steam 9,429 Number of library books disinfected 1,096 Number of disinfection certificates issued 43 DISINFESTATION Bed Bugs Number of houses visited 212 Number of rooms sprayed 527 Number of houses revisited 37 The rooms were sprayed with a preparation of 5 per cent D.D.T. Lindane with Pybuthrin as a "Knockdown". A large number of complaints of insect infestation were dealt with by the disinfecting staff. The cause of the complaints were wood boring beetles, ants, cockroaches, carpet beetles, spider beetles, clothes moths, silver fish and wasps. The total number of visits made by the staff of the Disinfecting Station for all purposes was 2,342. PREVEN HON OF DAMAGE RY PESTS ACT 1949 During the year the Rodent Officer and his staff were transferred to Wanless Road Depot, because of shortage of accommodation at Offley Road. Although not administratively efficient, there has been no reduction in the service to the public. The staff was strengthened during the year by the appointment of a Senior Rodent Operator who acts as Deputy to the Rodent Officer. There was one meeting of the area Pest Control Committee, organised by the Ministry of Argriculture, Fisheries and Food during the year attended by the Chief Public Health Inspector and the Rodent Officer. 71 The number of complaints of rats and mice was increased by the disruption of the collection of household refuse in the Borough when many complaints were received of rats feeding at overflowing dustbins, or on sites where refuse had been dumped. Not all of these complaints were justified, but it was necessary to investigate each one. The following is a summary of the work carried out during the year:- Complaints received 2,275 Complaints in respect of brown rats 1,489 Complaints in respect of mice 572 Complaints not justified 214 During the course of investigation 3,725 baitings were made. Sewer Treatment In London the sewers are a reservoir for the infestation by rats of houses and other premises. Each year baiting of the sewers is carried out by the Borough Engineer's Department to reduce the number of rats living in the sewers. It is difficult to kill off all the rats in the sewers as access to the sewer can only be obtained at manholes which are provided at infrequent intervals. The work of baiting the sewers is a large undertaking as there are 3,500 sewer manholes in the Borough and it is necessary to visit each one, lift the cover and place the bait near invent level. This work is even more difficult to-day in busy roads xqhere traffic jams can easily occur whilst baiting is in progress. During the year the Borough Engineer's Department laid 4,544 baits in the sewers in the Borough. ATMOSPHERIC POLLUTION - CLEAN AIR ACT 1958 Smoke control Areas The Council's five year programme (1961-1966) has been completed, and a new programme formulated. A large area in the South of the Borough, centering on Royal Circus, West Norwood has been confirmed by the Minister of Housing and Local Government, and the necessary conversion of fireplaces is proceeding. 72 Due to the rapid development in the Gas Industry of the production of town gas from non-solid basic sources, the coke residues previously relied upon for use on open smokeless grates will not be available in the forseeable future. It is unlikely that the production of the premium smokeless fuels, particularly the long awaited products of the National Coal Board "Homefire", "Roomheat" and "Multiheat" will be sufficient to support a continued emphasis on the use of the open fire in future Smoke Control Areas. For this reason, grant assistance under the Clean Air Act 1956 is now being directed to a greater degree of conversion to the use of gas fires, electric thermal storage heaters, closed room heaters and under floor draught fires. In order to conserve such stocks of open fire fuels as are available, grants will in future also be payable in appropriate cases for the conversion of "improved" open fires to these other forms of heating. It should be noted that there is still a prohibition upon the payment of grant in respect of conversion to appliances using direct acting electrical current, this is to assist in the avoidance of "peak load" cuts of supplies of electricity. These general trends in the use of piped and wired non- solid fuels must, of necessity, influence the design of new housing units and the conversion of older Council property. Measurement of Air Pollution The Council continues to maintain five measurement stations in the Borough in collaboration with the Ministry of Technology at Warren Springs Laboratory, Stevenage. The results show that a satisfactory decrease in the concentration of suspended solids - as shown by a "smoke stain" on a filter paper - is being maintained. The same is not true, regrettably in the measurement of the oxides of sulphur, which continue to show a rise in degree of concentration. This rise is undoubtedly due to an increased use in Industry of the heavier residual fractions of crude oil. It is cogent here to state that this does not apply to the lighter distillate fractions of oil used in domestic central heating appliances and particularly to the fuel oils used in motor traction engines. These latter fuels are comparatively free from sulphur contamination. Here again, the increasing use of the heavy grades of fuel oil, requiring, for the control of emission of the oxides of sulphur, much higher chimneys must exercise influence in design of new buildings and in town planning. 73 National Society for Clean Air The Council has renewed its membership of this body and was represented at the International Congress in London on 3rd to 7th October by the Council's delegates who were Councillor Mrs. D.R. Colls and Dr. F. Summers, Associate Medical Officer of Health. Number of inspections 14,348 Number of Notices served under Section 12 of the Clean Air Act 1956 267 Number of prosecutions Nil Number of smoke observations (Timed) 93 Number of smoke observations (Untimed) 315 FACTORIES ACT 1961 Part I 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 134 53 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,032 414 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 62 71 - Total 1,228 538 - 74 2. Cases in which Defects were found:- Number of cases in which defects were found Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.1) 1 1 - 1 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 - - - - (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to Outwork) 4 4 - 4 Total 5 5 - 5 No prosecutions were instituted 75 Part VIII of the Act Outwork (Sections 133 and 134) Nature of Work Number of outworkers in August list required by Section 110 (1) (c) (3) Making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 164 Making of curtains and furniture hangings 18 Making of boxes or other receptacles or parts thereof, made wholly or partially of paper, cardboard, chip or similar material 11 Making of stuffed toys 16 Making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts of articles 3 Manufacture of lampshades other than lampshades made wholly of metal, glass or stone 21 Total 233 No Notices were served or Prosecutions instituted. SLUM CLEARANCE PROGRAMME 1961-1965 At the beginning of the year there remained to be dealt with some properties which were included in the 1961-1965 Slum Clearance Programme. During the year the following properties were represented as unfit Nos. 25-31 (odd) Canterbury Grove Nos. 1-18 (cons) Waylett Place 76 and the area was extended to include:- Nos. 2-10 (even) Canterbury Grove Nos. 7-15 (odd) Lansdowne Hill Nos. 8-20 (even) Lansdowne Hill these latter properties being included in the 1966-1970 Slum Clearance Programme. The Curnick's Lane area was confirmed as a clearance area and a Public Enquiry was held in respect of the Industry Terrace area. HOUSING ACTS 1957 AND 1964 During the latter part of 1965 and early 1966 it became obvious that the amount of work that was necessary to be transacted under the Housing Acts in respect of unfit houses, parts of houses, clearance areas and houses in multiple occupation could not be achieved with the existing staff and three additional Senior Public Health Inspectors (Housing) were appointed in February. SLUM CLEARANCE PROGRAMME 1988-1970 A tenative Five-Year Programme for the years 1966-1970 of approximately 800 houses had been prepared by the staff of the Metropolitan Borough of Lambeth, and for that part of the Metropolitan Borough of Wandsworth which is now included in the London Borough of Lambeth by the Wandsworth Health Department. It was decided, however, that this programme did not represent a true picture of the Borough, and, as a matter of urgency, further surveys were carried out by the newly appointed Housing Inspectors and the Programme for the five years has now been increased to more than 2,000 houses. It will be appreciated that it was necessary to agree this new programme with the Greater London Council and the Minister of Housing and Local Government, and I would like to record my appreciation of the co-operation my staff received from these two bodies. Since that time more detailed surveys are being carried out, and it is anticipated that a further 112 houses will have to be dealt with by clearance area procedure within the five years 1971-1975. During the year a start has been made to deal with the clearance area programme and 581 houses in 3 areas have been represented as unfit for habitation. 77 Areas Number of Houses Canterbury Grove Area Houses unfit for human habitation Waylett Place Nos. 1-18 (cons) 18 Lansdowne Hill Nos. 7-15 (odd) 10-20 (even) 11 Canterbury Grove Nos. 25-31 (odd) 2-10(even) 9 Total 38 Akerman Road Area Houses unfit for human habitation Akerman Road, Nos. 60-74 , 78-94, 100-106, 112-126, 130, 134-170 (even) 94 45-63, 69, 73 , 77-141 (odd) Bramah Road, Nos. 2-24, 42-48, 54-110 (even) 1-21, 37,41-91 (odd) 83 Crawshay Road, Nos. 2-60 (even), 1-37, 57-73 (odd) 58 Elliott Road, Nos. 10-31 (cons) 32-49 (cons) 40 Fairbairn Road. Nos. 2-8, 12-48, 52-92 (even) 3-7, 11-89 (odd) 87 Lothian Road, Nos. 85, 87, 93, 119,127 (odd) 88-98, 106-108 (even) 16 Patmos Road, Nos. 2-60, 64-84 , 88 (even) 43 Treberne Road, Nos. 2-50, 54-60 (even) 3, 11, 15-73 , 77-81 (odd) 67 Total 488 Stonhouse Street Area Houses unfit for human habitation Stonhouse Street, Nos. 43-49, 53-61,69, 83-105, 109-119 (odd) 48-80, 84-102 (even) 55 Total 55 78 INDIVIDUAL UNFIT HOUSES AND PARTS OF HOUSES In addition to areas of unfit houses, there are a number of individual houses and parts of houses, particularly underground rooms, which are unfit for habitation and a start has been made in dealing with these dwellings. Action taken under Part II of the Housing Act 1957 is as follows ! Section 16 (Individual Unfit Houses) 69 Blenheim Gardens 47 Chaucer Road 5 Effra Road 4 Irving Grove 3 Land or Road 27 Lansdowne Gardens 85 Lollard Street 121 Lothian Road 120 Lyham Road 1 Patmos Road 5 Radnor Terrace 14 Romola Road Closing Order made Closing Order made Demolition Order made Closing Order made Closing Order made Closing Order made Closing Order made Closing Order made Closing Order made Closing Order made Compulsory Purchase order Closing Order made Section 18 (Unfit Parts of Houses) Closing Orders were made in respect of the undermentioned properties:- 2 Beadman Street 15 Bloom Grove 96a Bromfelde Road 102 Christchurch Road 128 Christchurch Road 88 Geneva Road 95 Geneva Road 179 Hamilton Road 4 Hamilton Road 160 Lambeth Road 84 Lollard Street 115 Mayall Road 246 Milkwood Road 18 Mawby Street 11 Old Paradise Street 5 Penrith Place 19 Alexandra Drive 7 Penrith Place 9 Penrith Place 10 Penrith Place 16 Perran Road 233 Railton Road 7 St. Johns Crescent 19 Somerleyton Road 43 Somerleyton Road 63 Somerleyton Road 119 Tulse Hill 141 Tulse Hill 195 Tulse Hill 100 Christchurch Road 79 HOUSING ACTS 1961 AND 1964 Houses in Multiple Occupation One of the most serious health problems of the Borough is the number of houses which are in multiple occupation; are overcrowded; the kitchens are shared by two or more families; the water closet is used by too many people to be adequate, and where baths and hot water supplies are absent or defective. These houses are also a potential fire risk as many of the tenants use portable oil heaters in congested and overcrowded rooms and no means of escape in case of fire has been provided. The Council was of the opinion that additional powers were needed to deal with this problem, particularly in the central part of the Borough where a large number of immigrants from the Commonwealth have settled. Discussions were started with the Minister of Housing and Local Government early in the year with a view to making the Registration of Houses in multiple occupation compulsory in the Herne Hill, Tulse Hill, Ferndale, Town Hall, Clapham Park and Clapham Town Wards of the Borough. On 8th September, 1966 the Minister confirmed the London Borough of Lambeth (Registration of Houses in Multiple Occupation) Scheme 1966, making it the duty of owners to supply information to the Council of any house situated in the above Wards, which is occupied by more than two families, to enable the property to be registered. The Scheme was given publicity in the local press, by posters and a booklet was prepared giving information of the Scheme and the Council's requirements for houses in multiple occupation. The Registration Scheme, in itself, will not bring about any quick solution to this immense problem, and it has not been in force long enough yet to enable me to judge its value in controlling the problem. However, from the information which is now being collated from house-tohouse surveys and the information from the registration forms, it would appear that there are two separate problems in multiple occupation in the Borough. First, there are the areas of old houses which although obsolescent are not so bad that they can be included in the Slum Clearance Programme, but which are unfit because of the space available to individual households (persons per room) and the privacy available to the households (sharing accommodation and facilities) and the potential high fire risk of these houses. In these houses it is difficult to obtain any reduction in overcrowding or, in fact, find available rooms spare to install additional water closets, baths and kitchens without some of the tenants being decanted. It is considered that new 80 legislation is required to deal with these houses on an area basis in a similar manner to that adopted when dealing with slum clearance. The second problem in Lambeth is that multiple occupation is spreading to areas which were, until recently, areas of one family houses. It is recognised that many of the houses built before 1914 are now too large for the requirements of to-days families and that smaller units must be provided. It is not always practicable to divide these houses into self-contained units and some multiple occupation is inevitable. This development must be controlled by some form of prior approval by the Local Authority. At present, the owner dividing the house into self-contained units is controlled by the Town Planning Acts, but there is no similar control over houses in multiple occupation. However, it is now becoming apparent that owners of houses included in the area of the Council's Registration Scheme are consulting my department before allowing one family houses to change to multiple occupation and in many cases are willing to provide the necessary facilities before the house is again let. Number of visits and revisits to houses in multiple occupation 874 Number of visits and revisits in registration area 323 Number of dwellings where number of occupants was reduced 106 HOUSING (FINANCIAL PROVISIONS) ACT 1958 The Council and also the Greater London Council requires that applicants for mortgages for the purchase of houses should undertake that all such properties should conform to the provisions of the Housing Act relating to multiple occupation and that any underground rooms should be made to conform with the Regulations. In this connection 1,302 visits and revisits were carried out. In addition, 960 visits and revisits were made to houses where mortgages had previously been granted by the Council, the Greater London Council or Wandsworth Council, to ascertain the present condition and occupation of the houses. HOUSE IMPROVEMENT GRANTS Discretionary Grants There are many houses in the Borough which, under modern conditions of living are too large for one family and owners are persuaded to convert these houses into smaller self-contained units. 81 To encourage owners to carry out this type of conversion the Council may make a grant of up to £500 for each dwelling and during the year 17 discretionary grants were made in respect of 27 dwellings totalling £19,266.18s.6d. Standard Grants Some large houses do readily lend themselves to conversion, and many smaller houses which are suitable for one family occupation lack certain basic amenities, but otherwise will be fit for occupation for some years. Owners are persuaded to provide these basic amenities, i.e. a fixed bath or shower, a wash-hand basin, a hot and cold water supply to bath, basin and sink, an internal water closet and a food store, and the Council makes a grant of up to £155 or up to £350 in certain circumstances towards the cost of the work. During the year 78 standard grants in respect of 102 dwellings were made totalling £9,987.3s 10d. Improvement Areas and Improvement of Houses outside Area Not all owners are willing to take advantage of the Council's grants for improving houses and the Housing Act 1964, gives the Council power, under certain conditions, to require the provision of the basic amenities. The procedure for improvement areas is very protracted and it has not yet been possible with the staff available, to cany out the necessary preliminary surveys to see if there are areas in the Borough suitable for this procedure. It has, however, been possible to deal with individual houses outside of areas and six notices have been served under this Section during the year. These notices require the owner be given at least twelve months to carry out the works, so in no case was the work completed during the year. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS The Minister of Health requested that all Commonwealth Immigrants entering the country should be visited and given information regarding the National Health Service and X-ray service. Port Health Authorities obtain destination addresses from long-stay immigrants and forward them to the appropriate Local Health Authority. These notices are passed to the Public Health Inspectors who, where possible, visit with the aim of ensuring that immigrants learn at an early date how to use the health services and to encourage those from countries with a high incidence of tuberculosis to have a chest X-ray as early as possible. If there are any children under five years of age in the newly arrived family, health visitors are notified. 82 It has been found that numbers of immigrants never reached their destination as notified and it is presumed that accommodation was found at other addresses. During the year 1,104 advice notices were received from the Port Health Authorities and 478 successful visits were made by the Public Health Inspectors from 1st July, 1966 when this scheme was put into operation. NOISE ABATEMENT ACT 1960 With increased mechanisation the level of noise produced has intensified so that more people are conscious of noise nuisance and make complaint. Most of the complaints relate to noise from factory machinery and methods of working, and during the year 89 complaints have been investigated. Of these, in 15 cases a reduction of noise to a tolerable level was obtained by informal action, and in 74 cases it was considered that the best practicable means were being used to minimise the noise, or it was not a nuisance within the meaning of the Act. In one case an ice-cream vendor was warned about the use of a loud speaker from the van after the permitted time. There were no prosecutions under Section 1 or 2 of the Act. 34 BRAILSFORD ROAD, S.W.2. On inspection it was found that the part of these premises occupied by an old lady who kept cats was in a filthy and unwholesome state. A Notice was served on the occupier under Section 83 Public Health Act 1936, as amended by Section 35 of Public Health Act 1961, and in default a warrant was obtained to enter the premises on 16th November, 1966. Five cats were found alive, and apparently in good health, and eight dead cats, in varying stages of decomposition, were removed. Three layers of carpet, stuck together with excreta, were prised from the floor with spades and destroyed. Some furniture was so fouled with excreta and cats' food that it was past cleansing, and also had to be destroyed. The bedroom contained a large collection of newspapers, old clothes, rags and the floor coverings were matted together with excreta. Generally the dwelling was in a filthy state, walls dirty, cobwebs abounding and decoration damaged by cats, and furniture fouled with cats' excreta and cats' food and extremely difficult to cleanse. 83 FERAL PIGEONS It would appear that the number of feral pigeons has been increasing since the end of the last war and that more people are now complaining to the Health Department of the nuisances caused by these flocks. The complaints are mainly of the fouling of buildings and pavements with excreta, although there is always the possibility of infestation of insects (mites and carpet beetles, etc.) from these birds. The Public Health Act 1961 gives the Council power to reduce the number of pigeons, and during the year private contractors have been engaged in this work, and 26 such individual treatments have been carried out. The procedure of reducing the number of feral pigeons following complaint satisfies the persons who have complained, that the Council has taken some action, but it would appear from our observations that dealing with isolated flocks is not the complete answer to this problem, as after the flock has been reduced in numbers, the numbers are again built up by migration from adjacent flocks. This matter is under consideration by the Department and some research is being carried out by my staff as to possible ways of trapping pigeons throughout the whole of the Borough instead of dealing with isolated flocks, to prevent the build up of flocks by migration. 104 investigations were made by the Public Health Inspectors. PET ANIMALS ACT 1951 Arrangements were made in June, 1965 for the veterninary staff of the Corporation of London, to enforce the provision of this Act, as agents for the London Borough of Lambeth. The position was reviewed in September 1966, and whilst retaining the veterinary officer, Corporation of London, in a consultative capacity, it was agreed that the inspection of Pet Animals Establishments should now be carried out by the Public Health Inspectors. During the year 15 visits were made to the 17 pet animal establishments lincensed in the Borough. ANIMAL BOARDING ESTABLISHMENTS ACT 1963 Arrangements were made in June 1965 for the veterinary staff of the Corporation of London, to enforce the provisions of this Act as agents for the London Borough of Lambeth. 84 The position was reviewed in September 1966, and whilst retaining the Veterinary Officer, Corporation of London, in a consultative capacity, it was agreed that the inspection of Animal Boarding Establishments should now be carried out by the Public Health Inspectors. During the year 3 visits were made to the 2 Animal Boarding Establishments licensed in the Borough. DISEASES OF ANIMALS ACT 1950 The administration of the Diseases of Animals Act 1950 was one of the functions transferred to this Council from the former London County Council. Arrangements were made for the Corporation of London, who have the essential veterinary staff to enforce all the necessary provisions of the Act as agents of the London Borough of Lambeth. No formal action under the Act or orders made thereunder was necessary during the year, but the Veterinary Officer, Corporation of London, made 44 visits in Lambeth during the year. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The sampling of imported food at the Nine Elms Cold Store continued throughout the year with an increase in the number of samples taken. The products with which the Food Inspectors were concerned were pasteurised frozen whole egg, shrimps and prawns. On the whole, the position with regard to pasteurised eggs was most satisfactory and relatively few failures of the alphaamylase test were recorded. Arrangements are made in such circumstances for re-pasteurisation to take place. During the year 7,856 packets of shrimps and prawns were exported with an undertaking to re-import them because of unsatisfactory bacteriological results. This was nevertheless a small proportion of the total imports of these products. Although not on the same large scale a number of different types of food were exported from Lambeth, which included:- Ice cream to Hong Kong Sweets of various types to Kuwait, Baghdad Loins and legs of Lamb to Gibraltar and quantities of fish paste, chicken and other paste to many countries. Inspections of the three milk bottling depots in the Borough have been carried out regularly. From these three depots approximately 400 million bottles of milk are distributed per year. 85 The following Regulations and Orders, relating to food, the enforcement of which is the responsibility of the Council, were made during the year:- Slaughterhouses (Hygiene) Regulations (Appointed Day) Order, 1966 Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day) Order, 1966 Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day No. 2) Order, 1966 Slaughterhouses (Hygiene) Regulations (Appointed Day No. 2) Order, 1966 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 Skimmed Milk with Non-fat (Amendment) Regulations, 1966 Meat Inspection (Amendment) Regulations, 1966 Live Poultry (Restrictions) Amendment Order, 1966 Salad Cream Regulations, 1966 Mineral Hydrocarbons in Food Regulations, 1966 Butter Regulations, 1966 Slaughterhouses (Hygiene) Regulations (Appointed Day No. 3) Order, 1966 Colouring Matter in Food Regulations, 1966 Slaughterhouses (Hygiene) (Amendment) Regulations, 1966 Public Health (Aircraft) Regulations, 1966 Public Health (Ships) Regulations, 1966 FOOD PREMISES During the year under review, 3,525 inspections were made to food premises in the Borough. These inspections were made up as follows:- Factories 101 Bakehouses 82 Butchers 387 Fried Fish Shops 87 Ice Cream Premises 123 Milk Shops 37 Public Houses 86 Restaurants and Cafes 361 Dairies 36 Other Food Premises 1,518 Bakers 77 Grovery and Provisions 383 Greengrocers and Fruiterers 247 Total 3,525 86 FOOD AND DRUGS ACT 1955-SECTION 16 The number of registered premises is as follows:- Manufacture and/or sale of ice cream 474 Manufacture of sausages and preparation of preserved etc. food 240 Milk and Dairies (General) Regulations. 1959-Regulation 8 Number of registered distributors 399 Number of registered dairies 3 Milk (Special Designation) Regulations, 1963 The following table shows the number of licences in force:- **Dealer's licences (Pre-packed) Untreated 168 Pasteurised 319 Sterilised 295 Ultra Heat Treated 48 Dealers (Pasteurisers') Licence 3 Dealers (Ultra Heat Treated) Licence 3 **Licences issued are valid for a period of five years. SERVICES UNDER THE FOOD AND DRUGS ACT 1955 (a) Milk Supplies—Brucella Abortus There were no samples of untreated milk taken during the year. The amount of untreated milk sold in the Borough is so small to be almost negligible. (b) The Liquid Egg (Pasteurisation) Regulations, 1963 There are no pasteurisation plants in the Borough. 624 samples of imported liquid egg were submitted to the Alpha-Amylase test, of these, 91 samples failed the test. Between 1% and 2½% of the cartons of liquid egg imported into this Borough were taken by the Food Inspectors during the year. Generally speaking the results from this sampling were most satisfactory, but a few consignments had to be re-exported to the country of origin, which was Shanghai. A certain amount of 87 liquid egg is imported from Australia and during the year there was a case where one particular tin failed the Alpha-Amylase test, and the Australian Egg Board in this country arranged for it to be re-exported back to the original pasteurisation plant for examination. The department was informed that the tin must have become contaminated after the pasteurisation, and the Board has informed us that they are taking steps to ensure that the risk of recurrence of contamination is reduced to an absolute minimum. It may be confusing to talk of frozen liquid egg, but in the Liquid Egg (Pasteurisation) Regulations, 1963 liquid egg means any mixture of yolk and albumen other than reconstituted dry egg and includes any such mixture which is frozen, chilled or otherwise preserved. (c) Food Hygiene (General) Regulations, 1960 The number of food premises by type of business is as follows:- No. of premises No. fitted to comply with Reg.16 No. to which Reg. 19 applies No. fitted to comply with Reg.19 Grocery and Provisions 312 312 134 134 Greengrocery and fruit 193 193 193 193 Fish shops, wet, dry & fried 67 67 67 67 Bakers and bakehouses 98 98 98 98 Butchers 112 112 112 112 Restaurants, cafes, canteens and clubs 238 238 238 238 Confectioners 332 332 129 129 Dairies 31 31 31 31 Delicatessen 8 8 8 8 Food factories and warehouses 17 17 17 17 Public Houses and Off-licences 292 292 292 292 Milk distributors 399 399 Nil Nil Ice cream premises 474 474 53 53 Preserved food premises 240 240 240 240 88 An inspection in March revealed that the underground bakehouse was being used for dough mixing, although it was not suitable for use as regards construction, height, light, ventilation and hygiene, and no certificate of suitability had been issued under the Factories Acts. In addition, several contraventions of the Food Hygiene (General) Regulations were found in the ground level bakehouse. As the owner was unwilling to give up the underground bakehouse, or to bring the ground level bakehouse up to a reasonable standard, summonses were issued against him and proved at the local Petty Sessions, and the owner fined. Since that time the owner has sold the business, the underground bakehouse is no longer used, and the remainder of the premises are now satisfactory. THE PUBLIC HEALTH IMPORTED FOOD (REGULATIONS), 1937 During the year under review the implementation of the above Regulations, for which the Council is responsible, has gone satisfactorily and well. A considerable amount of whole egg, shrimps, prawns and cooked chicken meat have been imported into this Borough and, generally speaking, have satisfied the required tests. In the relatively few cases where it has not been found possible to release a consignment for distribution in this country, the Importers have either exported the consignment to one of the European Continental countries or returned it to the country of origin, which has usually been China. The following samples were submitted to the Public Health Laboratory for examination:- Number of samples Pasteurised frozen whole egg (China) 538 Pasteurised frozen whole egg (Australia) 86 Frozen hen egg white (China) 68 Headless uncooked prawns (China) 22 Crab meat (China) 8 Shrimps (Japan) 131 Prawns (Japan) 54 Shrimpmeat - 14 Peeled uncooked prawns (Pakistan) 24 Cooked chicken meat (Yugoslavia) 30 Total 975 89 SAMPLING OF FOOD AND DRUGS Chemical Analysis 290 samples were procured formally, 100 of which were milk, and 1,700 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. Formal Samples Articles Result of Analysis Action taken Cream cake Less than 4% butter fat present Contained rodent excrement Legal proceedings instituted. Meat Burgers Deficient in meat Letter to Manufacturers Roll and Butter Fat used contained less than 5% butter fat Warning letter sent Chunky chicken in sauce Deficient in meat Matter taken up with Manufacturers Chopped chicken in jelly Deficient in meat Warning letter to Manufacturers Gin Deficient in proof spirit Further sample obtained-Genuine Fruit salad in syrup Fruit content not in accordance with relevant Code of Practice Repeat sample taken Chopped chicken in jelly Deficient in meat Only minor deficiency-no further action taken Informal Samples Eye lotion (2) Deficient in cocaine Hydrochloride Matter taken up with Manufacturers Wintergreen Oil Deficient in methyl salicytate Further sample taken Sausages, pork Deficient in meat Warning letter sent 90 Melon-canned Can corroded Further import of cans of this code number stopped Mincemeat Slightly deficient in soluble solids Further sample obtained Barley, pearl (2) Grains of barley stuck to adhesive on the closing flap of the carton Investigation carried out regarding packaging Soda-mints Contained a few tablets with excess sodium bicarbonate Old stock—withdrawn from sale Mincemeat Slightly deficient in soluble solids Further sample obtained—found genuine Soft drink (canned) Excess saccharin Letter to Manufacturers Menthol and Wintergreen cream Deficient in methyl salicytate Letter to Manufacturers Dried fruit Dirty. Contained hairs etc. Further sample taken Meat, canned (5) Deficient in meat Further samples taken Meat pie Deficient in meat Further sample taken Tapioca flake Tapioca was not in flake form Letter to Manufacturers Instant non-fat milk Not labelled in accordance with Regulations Letter to Manufacturers Calomine lotion Ambiguous statement of ingredients Warning letter to Manufacturer Chocolate flavoured drink Labelled "drink" but was actually powder Warning letter to Manufacturer Lemonade powder Sold in cellophane bag labelled "assorted jellies" Warning letter to Manufacturer 91 Jelly creams Product consisted of jelly crystals. Word "cream" misleading Letter to Manufacturer Canned mixed veg. (Macedoine) Veg. listed in wrong order M.S.C. used as abbreviation for monosodium glutamate Letter to Manufacturers Canned mixed veg. Carrots comprised more than 40% of total vegetables Letter to Manufacturer Steak and kidney pies (3) Less than 2% kidneys No action, pending expected legislation Borax and honey Labelled B.P.C. although omitted from latest edition Letter to Manufacturers Ground nutmeg Deficient in volatile oil Letter to Manufacturers Sweets Contained a splinter of wood Matter taken up with Manufacturer Concentrated peppermint Misleading description Manufacturers agreed to amend product Bombay Halva No indication in English of nature of material Import of this product now stopped Strawberry syrup Labelled "Fine West Indian Strawberries". No evidence of containing fruit Further sample taken. Relabelled Grape mineral No chemical evidence of presence of grape or grape juice. Analyst's findings sent to Manufacturers Hot pepper sauce Contained undeclared preservative Further sample taken — satisfactory. Flavouring syrup (strawberries) Strawberry juice absent Analyst's findings sent to Manufacturers Khabli chana Several labelling offences Letter to importers 92 Tripes (Flake) canned Signs of incipient corrosion of tin and gas evolved Letter to importers Sauer Kraut canned No list of ingredients displayed Letter to importers Milk chocolate drink Alledged to contain glucose but none found Further sample taken Chop sauce Undeclared preservative Repeat sample taken-genuine Cooking fat Not clearly labelled "Cooking fat" Letter sent. Repeat sample taken Steak and kidney pudding Deficient in kidney Repeat sample taken Chicken noodle snack Deficient in meat Warning letter to Manufacturer Viennese Coffee Labelling offence Label altered Butter fudge Labelling offence Label altered Tomato Kussondi Labelling offence Letters sent Patra Undeclared preservative Repeat sample—genuine Soy sauce Undeclared preservative Repeat sample—genuine Ground nutmeg (2) Deficient in volatile oil Letter sent Steak and kidney pie (2) Deficient in kidney Letter sent, warning to Manufacturer Sparkling Spring drink Labelling-drink was a powder Letter sent Fruit Cocktail in syrup Labelling offence Letter sent Minced beef and onion with gravy (2) Deficient in meat Warning letter to Manufacturer Pate de foie Low meat content Repeat sample-genuine 93 Chopped chicken in jelly Deficient in meat Formal sample purchased Strawberry syrup No strawberry juice present Letter to Manufacturer Chicken capri Deficient in meat Letter to Manufacturer Oysters Fried Labelling offence Letter sent Anchovy Paste High ash and salt content Repeat sample—genuine Steak and kidney pie Deficient in kidney Repeat sample—genuine Contrexeville Spa Water Labelling offence Letter sent Fruit cocktail Content of peaches outside the limit set by Code of Practice Repeat sample taken Canned Paw Paw Can corroded and smelt unpleasant Letter sent. Supply withdrawn Ground Nutmeg Damp and deficient in volatile oil Further samples taken Salt fish cutlets Labelling offence Letter sent Canned mixed veg. Labelling offence Letter sent Turkey and corn Deficient in meat Warning letter to Manufacturers Cooking fat Repeat of previous sample labelling still inadequate Letter sent Dried Fruit Ingredients listed in wrong order Letter sent Vitamin Health Drink Labelled "drink" but consisted of powder Letter to Manufacturers Garden Mint Consisted of mint sauce or mint in vinegar Labelling-matter still in hand Camphorated oil Excess camphor Repeat sample 94 Lemon Curd Deficient in citric acid Repeat sample Ground nutmeg (2) Deficient in volatile oil Repeat samples Almond marzipan Slightly deficient in oil Repeat sample Fruit cocktail (2) in syrup Fruits not present in amounts recommended by Code of Practice Letter sent. Labelling to be amended Fruit salad in syrup (3) Fruits not-present in amounts recommended by Code of Practice Letter sent. Labelling to be amended Ice cream powder Labelling offence Letter sent. Revised label now provided Tonic Vegetable concentration Labelling offence Letter to Manufacturers Steakburgers Deficient in meat Repeat sample taken Cheese preparation Excess water Repeat sample taken Remonlade Labelling offence Letter sent. No further sale Nutmeg-ground Deficient in volatile oil Letter sent. Stocks withdrawn Junior Aspirin Tablets Deficient in aspirin Repeat sample taken To assist the Public Analyst in determining suitable standards, surveys were made in respect of certain foodstuffs, a wide selection of each particular category being sampled. These included:- Pates (12) To ascertain reasonable minimum meat content Steak and kidney pies (13) To ascertain reasonable minimum meat content Canned mixed meat and vegetable To ascertain reasonable minimum meat content Shandies Standard of mix. Fruit Salads/cocktails (10) Labelling offences in respect of order of ingredients Nutmegs (8) In respect of volatile oil content. 95 It has been noticed that there has been a large increase in the number and variety of imported food and delicacies from both Europe and Asia. Many of these have been included in the samples procured. Generally, the foods themselves were found to be quite satisfactory, the faults found, being, understandably perhaps, in connection with the labelling. BACTERIOLOGICAL AND OTHER EXAMINATIONS The following samples were submitted to the Public Health Laboratory for examination. The article marked with an asterisk was suspected of having caused food poisoning, but in this case the food poisoning organism was not isolated. Synthetic Cream Filler 3 Ice Cream Sponge Cake 2 Ice Cream 6 Milk bottles 80 *Corned beef 1 The 6 samples of ice cream were found to be satisfactory. Samples of milk were submitted to the Public Health Laboratory for examination under the Milk (Special Designation) Regulations as follows:- Methylene Blue Test 375 (1 was void, the atmospheric shade temperature being over 65º F). Thirteen failed to satisfy the prescribed test. Phosphatase Test 347 One failed to satisfy the prescribed test. Of the thirteen samples of milk which failed the Methylene Blue Test 6 were of the raw milk bottled on the farm. The other seven failures were of milk pasteurised in the Borough. LEGAL PROCEEDINGS Details of the action taken by the Council under the Food and Drugs Act, 1955, and the food Hygiene Regulations made thereunder are as follows:- 96 Date Offence Magistrate's Decision 20.4.66. Food and Drugs Act 1955 Complaint of fly in loaf of bread Defendant found not guilty and was given a conditional discharge £5.5.0 costs awarded to Council. 3.5.66. Food and Drugs Acts 1955 Complaint, label found in loaf of bread. Defendant found guilty. Fined £5.0.0. Council awarded £5.5.0 costs. 3.6.66. Milk and Dairies (General) Regulations, 1959. Dirty Milk Bottles Defendant pleaded guilty in two cases and in each case the Company was fined £5.0.0 with £7.0.0 costs awarded to the Council. 13.7.66. Food Hygiene (General) Regulations, 1960. Regs.5, 6, 8, 9, 14, 16, 18, 23, 24. Defendants found guilty in all cases except Reg. 14 and fined £4.0.0 in each case. Council awarded £5.5.0 costs. 10.8.66. Food and Drugs Act 1955 Complaint foreign matter in a loaf of bread Defendant found guilty, fined £5.0.0 with £5.0.0 costs awarded to Council. 29.11.66. Food Hygiene (General) Regulations, 1960. Reg.9. Defendant found not guilty. Case dismissed. 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. Qrts. Lbs. Meat 3 7 1 22¼ Vegetables 1 1 - 23½ Fruit 2 15 - 2¼ Fish - 3 3 18 Milk - 4 2 23¼ Cream - - 1 27 Soup - 2 1 13¾ Fruit juice - 1 3 24¾ Tomato juice - - 2 18½ 97  Tons Cwts. Qrts. Lbs. Rice - - - 9 Creamed rice - 1 2 ½ Spaghetti - - 1 22¾ Ravioli - - - 10 Pease pudding - - 1 14½ Cheese flaps - - - 16½ Custard powder - - - ¾ Honey - - - ½ Sweet corn - - - 4½ Salt - • - 2½ Flour - - - 16 Marmite - - - 1 Potato salad - - - ½ Treacle - - - 4 Macaroni - - - 16 Coffee - - - ¼ 8 - 3 12½ Untreated Meat 2 3 1 22½ Fish - 16 1 23 Escallops - 2 - - 3 1 3 17½ Prepared Bacon 2 16 1 1 Frozen foods 5 7 2 16 Pickle - - - 18 Cheese - - - 13 Dried peas - - - 1 Marmalade - - - 27 Jam - - - 5 Crisps - - - ¼ Flour - - - 17 Biscuits - - - 2½ Rice - - - 1 Beetroot - - - 1 Margarine - - - 24 Suet - - - 4 98  Tons Cwts. Qrts. Lbs. Cereals . - . 26½ Sugar - 3 3 6 Butter - - 1 5 Cocoa - - - 1¼ Sultanas - - - 16 Lard - - - 9 Dairy topping - - - ¾ Cake mix - - - 17 Salad cream - - - 21½ Nutmeg 1 11 2 - Fruit and nut roll - - - 4 Iced spongelets - - - 9 Potato mix - 6 1 20 Custard powder - - - 5 Coffee - - - 12 Pepper - - - 14 Jelly crystals - - - 21 10 8 1 10¾ Total 21 11 - 12¾ 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 disposed of by the Food Inspectors at Falcon Wharf, by agreement with the Greater London Council Public Health Engineering Department. FOOD COMPLAINTS - 1966 1. Pint of milk (4) Contained foreign matter 2. Milk bottle (8) Contained foreign matter 3. Can of rhubarb Splashes of grey inside can 4. Milkie loaf Brown discolouration in crumb of loaf 5. Bread Contained foreign matter 6. Sliced loaf of bread Black material 7. Cod Contained worms 8. Carton of Pasteurised Milk Sour 99 9. Can of apricots 10. 31b bag of Self-raising flour 11. Fruit drops 12. Tin of evaporated milk 13. Pies 14. 2/3 pint bottle of milk 15. Cornish pastie 16. Bread 17. Beef and pork sausages 18. Load (sliced) 19. Pork pie 20. Chocolates 21. Loaf of bread 22. 1/3 pint bottle of milk 23: Sliced peaches 24. Empty milk bottle 25. Steak and kidney pie 26. Pickled cucumber 27. Fried skate 28. Whole ham 29. Prawns 30. Cake (2) 31. Sweets 32. Pork pie 33. Sliced loaf 34. Apple pie 35. Strawberry jam 36. Loaf (sliced) 37. Baked beans 38. Tin of corned beef 39 Tin of Pork luncheon meat (2) 40. Bread 41. Loaf of bread 42. Slice of Ryvita 43. Tin of Luncheon meat 44. Bread roll 45. Sardines 46. Block salt 47. Potato crisps 48. Baked beans Number of justified complaints 60 Number of complaints 127 Unpleasant taste Tasted of Chloride, disinfectant smell Wire in fruit drops Metal pellet in tin S tale (out of date) Foreign body (cellophane or wax) Fly in pastry Mouldy Black mould on beef sausages Dust particles Mould in meat Custard flavour Foreign body (moth) Foreign body (bottle cap) Contained flies Foreign body (concrete) Mould Insect in jar Unpleasant taste Colour Musty taste Mouldy Contained maggots Mouldy Mould Unpleasant smell Beetle in jar Mouldy Bee inside tin Mouldy Mouldy Mouldy Foreign body Contained insect Foreign body in centre of meat Currant in roll Fly in tin Dirty - glassy Foreign bodies Contained pieces of glass With regard to the justified complaints listed above the appropriate action was taken in all cases. SWIMMING POOLS There are a number of swimming pools in the Borough, including Clapham Manor Street baths and Streatham baths, which are the responsibility of the Council. All of these baths are subject to regular inspections and sampling of the water. 100 ST. MARTINS HIGH SCHOOL, TULSE HILL Inspections of the pool at this school revealed that the supervision and operation of the plant was most unsatisfactory. Samples, with varying free chlorine readings were observed and over a period, readings were as low as NIL and high as 13.5 p.p.w. (the standard may be taken as 0.5 p.p.m.). The Associate Medical Officer of Health arranged for the bath to be taken out of use until such time as satisfactory arrangements for the day to day running of the pool could be made. A discussion at the school between the Associate Medical Officer of Health the Public Analyst, an officer of the Greater London Council Scientific Advisers Department, the Headmistress of the School and a Senior Public Health Inspector was arranged, and as a result of the Greater London Council accepting responsibility for the adequate training supervision of the employee caring for the pool, the Associate Medical Officer of Health agreed to the resumption of the use of the bath. SWIMMING BATHS - GREATER LONDON COUNCIL I am indebted to the Scientific Adviser of the Greater London Council for the following reports on the results of Bacteriological Examinations of water from swimming baths in Lambeth. No. of Agar count, 1 ml. 37°C. Presumptive E. coli. samples 48 hrs. coliform without in E. coli. 100 mis. 0-10 11-100 Over 100 in 100 mis. Brock well Park Lido Summer 10 8 2 - - 2 Winter 6 5 1 - - - Kennington Park Lido Summer 10 10 - - 1 - Winter 8 8 - - - - 101 No. of Agar count, 1 ml. 37°C. Presumptive E. coli. samples 48 hrs. coliform without in E. coli. 100 mis. 0-10 11-100 Over 100 in 100 mls. Wood vale Residential Home 26 25 1 - - - Shirley Oaks Children's Home 28 23 2 3 3 - Dick Sheppard School 8 6 - 2 - 1 Parkside School 16 16 - - - - St. Martins's in-the-Fields School 28 26 - 2 3 - In all cases where coliform organisms were present, the free chlorine content was found to be zero except in one instance at Dick Sheppard School, where it was found to be very low. This fault was reported and corrected without delay. Re-sampling confirmed that the condition of the bath was satisfactory. St. Martln's-in-the-Fields School At the beginning of the year under review a meeting was called to discuss the results obtaining up to that date. The suggestions put forward were adopted and the equipment was overhauled. Arrangements were also made for the appropriate school staff to be instructed on correct maintenance and on methods for regular testing. During the year, there was one serious lapse due to the absence of free chlorine as the cylinder had run out. It was advised that the bath should be hand dosed until the delivery of a fresh cylinder. Subsequent sampling showed that the fault had been corrected. 102 NATIONAL ASSISTANCE ACT, 1948 SECTION 50 - BURIALS Under Section 50 of the National Assistance Act, 1948 the Lambeth 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 has been, or are being made. During the year 34 funerals were arranged — 21 males and 13 females. The amount paid to funeral contractors was £542.4.0. The sum of £322.9.11. was received by way of grants, insurance policies and money found. The actual cost to the Council was, therefore, £219.14.1. PHARMACY AND POISONS ACT, 1933 The number of persons entered or retained on the list under the Pharmacy and Poisons Act, 1933 (Section 21) Part 11 was 190. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENTS It is a requirement under the London County Council (General Powers) Act, 1920 for establishments giving massage or special treatments to be licensed by Local Authorities. The term "special treatment" covers Chiropody, Manicure, Light, Electric, Vapour or other baths, or other similar treatment. The terms "light, electric, vapour or other baths" include Galvanism, Faradism, Ionisation, Diathermy (long and short wave) Sinusoidal currents. Ultra-violet, Infra-red, X or other rays. Licences are only issued to qualified persons. The number of establishments licensed by the Council is 46. Inspections of the establishments are carried out by the Associate Medical Officer of Health. RIDING ESTABLISHMENTS ACT, 1964 Arrangements were made for the Corporation of London, who have the essential veterinary staff, to enforce the provisions of this Act and the Performing Animals (Regulations) Act, 1925 as Agents of the London Borough of Lambeth. No formal action under these Acts was necessary during the year, but the Veterinary Officer, Corporation of London made 20 visits to the 5 licensed riding establishments in the Borough. 103 HAIRDRESSERS AND BARBERS During the year the Minister of Housing and Local Government agreed to make an order revoking the existing bye-law made by the Lambeth Metropolitan Borough Council and to a new bye-law being made under Section 77 of the Public Health Act, 1961 on the lines of the new model bye-laws. These bye-laws are now inforce, and during the year 52 visits were made to hairdressers and barbers. GENERAL HEALTH EDUCATION Health Education continued throughout the year. Publicity was maintained on all topics in Welfare Centres and other Council Establishments. Special emphasis was placed on smoking, mental health, venereal disease, family planning and the prevention of home accidents. Support was given to campaigns held on a National level, including a Mental Health Campaign held in June sponsored by the National Association of Mental Health, and immunisation and anti-smoking campaigns sponsored by the Ministry of Health. In connection with the Mental Health Campaign an open day was held at the Clapham Adult Training Centre for sub-normal men. A public safety exhibition covering all aspects of safety was staged in November at the Tulse Hill Drill Hall by the department of the Borough Engineer and Surveyor. The Health Department presented a stand dealing with all types of accidents which can occur to under five year olds. The attendance was approximately 5,000. Other health education activities included talks to schools and colleges, mothers in Welfare Centres, relaxation classes and special oourses of in-service training for home helps. Group discussion on the social aspect of common cases took place between medical students from St. Thomas' Hospital and Health Visitors. The Health Education Sub-Committee met at monthly intervals to discuss and chose display materials and to appraise any new health education media which became available. 104 MEDICAL EXAMINATIONS OF STAFF The Health Department undertakes for the Council, medical examinations of staff for 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. In addition, medical examinations are carried out for other local authorities on a reciprocal basis. Examinations carried out during the year numbered 556. Details are given below Health department 286 Children's department 170 Welfare department 89 Other Local Authorities 11 556 AMBULANCE FACILITIES The Greater London Council is responsible, under Section 27 of the National Health Service Act, 1946, for the provision of the Ambulance Service in the area. HOSPITAL FACILITIES The undermentioned hospitals are located in the Borough Lambeth Hospital, Brook Drive, S.E.11. South Western Hospital, Landor Road, S.W.9. Annie McCall Maternity Hospital, Jeffreys Road, S.W.4: Kings College Hospital, Denmark Hill, S.E.5. Belgrave Hospital for Children, Clapham Road, S.W.9. St. Thomas Hospital, Westminster Bridge, S.E.1. St. Thomas' Babies Hospital, Black Prince Road, S.W.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 Practitioners. The local laboratory is situated in County Hall and is under the direction of Dr. A.J. Tomlinson. 105 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for Year 1966. The School Health Service which is the responsibility of the Inner London Education Authority is provided by the Health Department under an agreement between the Council and that authority which includes the joint use of staff. General hygiene unfortunately showed a tendency to decline. Contributory factors were the acute housing shortage in Lambeth, overcrowded multi-occupation and the very high number of mothers who now go out to work. Plans are in hand for a new Inner London Education Authority audiology centre to relieve the overloaded facilities at the existing audiology units. Closer links have been established, through routines carried out by the I.L.E.A. social worker, with the maternity and child welfare service and the Welfare Department. SCHOOL MEDICAL INSPECTIONS All pupils are medically examined as a routine four times duringtheir school life, but numerous other examinations for special purposes are carried out. In addition each child is inspected annually by a school nurse and may also be seen on other occasions by the nurse. Early in their school life all children are given an audiometric test for hearing loss by a specially trained school nurse using the sweep test method. Those who fail this test, or about whose hearing there is some doubt, are given further more accurate pure-tone audiometric tests at a school treatment centre. Where results are still not satisfactory pupils are referred to an audiology unit for further investigation. VISION TESTING IN INFANT SCHOOLS AND NURSERY CLASSES During the year all school nurses in the Borough attended training sessions in Sheridan/Gardiner vision testing technique for under seven year olds. As a routine all children under this age, including new entrants, after the first term, will be given an annual vision screening test. Children failing this test will be referred to vision clinics for special advice. This will ensure that vision defects in school children will in future be detected at an early age so that appropriate treatment can be given. 106 MEDICAL TREATMENT OF SCHOOL CHILDREN During the year the overall amount of treatment found necessary at medical inspections has declined. This is a trend which has continued over the years indicating an improvement in the health of Lambeth school children. Ringworm of the scalp presented a problem to the Lambeth Department and in collaboration with the family doctors and hospital dermatologists measures for control were re-inforced. Both patients and positive contacts were excluded from school and followed up by the school nursing staff. Certain specialists clinics at which only school children are seen are run in conjunction with the Regional Hospital Boards and the Boards of Governors of Teaching Hospitals. Some clinics are provided in hospitals while others are held in school treatment centres when the hospital authorities provide the specialist staff and the local authority the premises and nursing staff. Sessions provided in Teaching Hospitals include two vision sessions at King's College Hospital, two vision and one audiology session at the Belgrave Hospital, and an investigation session for heart diseases, enuresis, dietetics and minor behaviour difficulties. All these sessions are attended by health service social workers, who arrange appointments and act as liaison officers with the hospitals and the I.L.E.A. school care committee and attendance officers. Vision clinics are also provided in local authority premises and at one of these centres an orthoptic clinic is also held. In some instances the local authority provides directly certain treatment facilities and in Lambeth these include special investigation clinics at which children suffering from obesity, enuresis, minor behaviour disorder, and psychosomatic illness are seen by School Medical Officers. Social workers from the health department working with the school medical officers enable parents to take advantage of the specialised help and facilities for treatment which these clinics offer. Minor ailment clinics at which a nurse is in attendance deal with day to day minor accidents and illnesses and are provided at most school treatment centres. Continuing the trend of previous years the number of attendances at minor ailment clinics fell during the year. Most of the cases treated were for athlete's foot and verrucae. GROUP DISCUSSION IN SENIOR SCHOOLS During the summer term, in conjunction with the teaching staff, a series of group discussions was arranged for girls of school leaving age in a secondary modern school. The aim of the project was to enable the girls to discuss freely problems of personal relationships. Five sessions of 45 minutes each were arranged and groups of 15 to 20 girls took part. 107 A wide range of subjects was covered including parent and child relationships, marriage, friendships and choice of careers. One session was devoted to venereal disease and a film "A quarter of a million teenagers" was shown followed by group discussion. The girls took an active part in the discussions, seemed generally interested and thought that the sessions were useful. STUDENT HEALTH SERVICE IN COLLEGES FOR FURTHER EDUCATION A student health service was provided during the year at two colleges for further education. This is a service still in its infancy, but which, with the increasing demand for further education, will undoubtedly expand. The service is primarily preventive and advisory. Prophylaxis and B.C.G. vaccination are offered to all students requiring them. Screening is by medical questionnaire with direct referral to general practitioners for treatment as required. Health education and group discussions on subjects selected by students formed a major part of the activities. Individual counselling at the request of the students was given and if required, referral for psychiatric help was arranged through the general practitioners. SCHOOL HEALTH STATISTICS FOR YEAR 1966 SCHOOL ROLL (May 1966) 44,536 SCHOOL MEDICAL INSPECTION Routine 16,324 Special 4,651 Re-inspections 5,825 Number of Medical Inspections per 1000 pupils 602 Health Surveys - Comprehensive 22,090 Number per 1000 pupils 496 Percentage found verminous 1.5 Health Surveys — Selective 4.241 Number per 1000 pupils 95 Percentage found verminous 4.6 Audiometry:- Number of children given sweep test 7,922 Number of children given pure tone test 541 Number of children referred to otologist at audiology centre 103 108 SCHOOL MEDICAL TREATMENT Hospital and Specialist Clinics Vision Centres:- Vision sessions 327 Number of new cases 922 Total attendances 4,695 Errors of refraction and squint 2,716 Other eye defects 41 Spectacles ordered 1,161 Orthoptic sessions 7 Number of new cases 1 Total attendances 28 Ear, Nose and Throat Centres Sessions Number of new cases Total attendances LOCAL AUTHORITY CLINICS Audiology Centres Sessions 38 Number of new cases 163 Total attendances 217 Special investigation clinics Sessions 154 Number of new cases 185 Total attendances 1,158 Minor ailment centres Sessions Medical Officer 81 Nursing Sister 457 Number of new cases seen by Medical Officer 513 Average per session 6.3 Number of new cases seen by nursing sister only 1,258 Average per session 2.8 Total attendances 10,037 109 Defects treated Athlete's foot 147 Verrucae 680 Ringworm: body 2 Impetigo 28 Other skin diseases 255 Eye diseases 36 Ear diseases 17 Miscellaneous: Bruises, lacerations etc. 481 RECUPERATIVE HOLIDAY HOMES School children (including nursery school children) Number admitted during year 145 SCHOOL DENTAL SERVICES 1966 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER The year has been a period of preparation, planning and re-thinking for the future, within the framework of the Inner London Education Authority. The Dental Adviser together with the Principal School Dental Officers have carried out a complete reappraisal of the I.L.E.A. School Dental Service. The full effect of the agreed policies and plans began to be evident in the latter half of the year. Premises and Equipment The best has been made of the existing premises and a number of minor works have been completed. Attention has been given to improving both surgery and waiting room furniture. The first stage in the modernisation of equipment was achieved by the installation of efficient dental operating lights. All the surgery equipment has been examined and maintained. Plans for New Premises Every effort has been made to ensure that any new projects are modern in layout and design. It is disappointing that one project has not materialised due to not obtaining Ministry loan sanction. Plans are proceeding well for one new dental clinic. It is hoped that the extension of the Brixton clinic to include a second surgery and the adaptation of Barley Mow to provide a new clinic will shortly come to fruition. 110 Resignations Our Orthodontist and one sessional Dental Officer resigned during the year. Appointments Three sessional Dental Officers and one full time Dental Surgery Assistant were appointed during the year. The staff at 31 December 1966 Principal School Dental Officer 3 Full time Dental Officers 6 Sessional Dental Offi cers (Whole time equivalent = 2) Thanks are due to the staff for their loyal service during the year. The ratio of Dental Officers to the 43,000 schoolchildren in the Borough is not a very satisfactory state of affairs, but this can only be rectified by the provision of more premises. Courses and Conferences One full time Dental Officer attended a course on Paedodontics and Orthodontics. The Principal School Dental Officer attended a course on the dental treatment of handicapped children and a conference on dental health education. Dental Health Education The continued high prevalence of dental caries, even of the 5 year old entrants to school, demands a constant need to take every opportunity to impart to children the need for proper attention to oral hygiene and the sensible control of carbohydrate intake. Dental Officers quite rightly spend a good deal of chairside time instructing children in oral hygiene. One school expressed a wish to have their own dental health campaign and assistance was offered to them. Dental Care is one of the Borough's monthly health topics. Orthodontic services After the departure of our Orthodontist new arrangements had to be made for orthodontic treatment. One and a half sessions a week are devoted entirely to orthodontic advice and treatment. An extremely useful link was arranged with King's College Hospital Dental School for the Principal School Dental Officer to attend the Orthodontic Department for one half day a week. 111 Treatment Provision Parents were sent invitations for their children to accept dental treatment under School Health arrangements, except the 5 year old entrants who were inspected at school. These arrangements were in accordance with the I.L.E.A. policy. Over 70% of children attending for a first inspection at a school or clinic were found to require treatment. The treatment pattern shows that over 16 permanent teeth were conserved to each permanent tooth extracted; this is an encouraging sign. Although the situation is similar to the other Inner London Boroughs, it is most unsatisfactory that of the new cases called for an appointment, only about 49% actually attend; this shows a slight improvement from the previous year. Pending Changes Plans were made towards the end of the year for the introduction of a.ten session week for full time staff, provision of further clerical assistance, a phased re-introduction of school dental inspections and the booking of all appointments in clinics rather than centrally. These arrangements coupled with the expected sanction for the purchase of further new equipment and the continuing process of brightening up the premises should set the School Dental Service on the road to a new look in the next year. Co-operation The dental staff cannot work in isolation and I would like to thank all those members of the Borough's Health Department whose willing co-operation and advice have helped in no small measure to achieve some progress in the dental field during the year. SCHOOL DENTAL SERVICES STATISTICS NUMBER OF SESSIONS Ordinary Treatment 2397.6 General Anaesthetic 33.8 School Inspections 48.2 INSPECTIONS First Inspection at School 2040 First Inspection at Clinic 5057 Percentage found to require treatment 71% 112 Re-inspection at school or clinic 1518 Percentage found to require treatment 66.1% TREATMENT New cases: Number of appointments given 13403 Number of attendances by appointment 6601 On treatment cases: Number of appointments given 16142 Number of attendances by appointment 12330 Other attendances (Emergencies) 521 Total attendances 19452 Number of first visits for treatment 5053 Number of additional courses commenced 524 Fillings Permanent teeth 7882 Deciduous teeth 5203 Teeth filled Permanent teeth 7210 Deciduous teeth 4797 Teeth otherwise conserved 2875 Extractions Permanent teeth 420 Deciduous teeth 1544 Prophylaxis 1277 Root fillings 27 Inlays 1 Crowns 7 General anaesthetics administered 594 Number of cases completed 3888 Number of patients X-rayed 191 Orthodontics: New cases 78 Completed cases 42 Appliances fitted: Removable 87 Fixed 7